Measures of Quality of Care for People with HIV: A Scoping Review of Performance Indicators for Primary Care

The healthcare of people with HIV is transitioning from specialty care to the primary healthcare (PHC) system. However, many of the performance indicators used to measure the quality of HIV care pre-date this transition. The goal of this work was to examine how existing HIV care performance indicators measure the comprehensive and longitudinal care offered in a PHC setting. A scoping review consisting of peer-reviewed and grey literature searches was performed. Two reviewers evaluated study eligibility and indicators in documents meeting inclusion criteria were extracted into a database. Indicators were matched to a PHC performance measurement framework to determine their applicability for evaluating quality of care in the PHC setting. The literature search identified 221 publications, of which 47 met inclusion criteria. 1184 indicators were extracted and removal of duplicates left 558 unique indicators. A majority of the 558 indicators fell under the ‘secondary prevention’ (12%) and ‘care of chronic conditions’ (33%) domains when indicators were matched to the PHC performance framework. Despite the imbalance, nearly all performance domains in the PHC framework were populated by at least one indicator with significant concentrations in domains such as patient-provider relationship, patient satisfaction, population and community characteristics, and access to care. Existing performance frameworks for the care of people with HIV provide a comprehensive set of indicators that align well with a PHC performance framework. Nonetheless, some important elements of care, such as patient-reported outcomes, are poorly covered by existing indicators. Advancing our understanding of how the experience of care for people with HIV is impacted by changes in health services delivery, specifically more care within the PHC system, will require performance indicators to capture this aspect of HIV care.     

Does Weeding Promote Regeneration of an Indigenous Tree Community in Felled Pine Plantations in Uganda?

The use of plantations to manage extensive tracks of deforested lands in the tropics is a conservation strategy that has recently received considerable attention. Plantation trees can promote seed dispersal by attracting dispersers and creating favorable site conditions, leading to increased germination and establishment of indigenous trees. Subsequently, plantation trees can be harvested for profit or left to senesce, leaving a native tree community. We evaluated the effect of vine, grass, and shrub cutting (weeding) over a 3‐year period on regeneration of indigenous trees subsequent to the removal of plantation softwoods in Kibale National Park, Uganda. Counter to what would be expected if weeding released trees from competition, we found no difference in the total number of stems or in the stems greater than 10 cm diameter at breast height between control and weeded plots; there were more stems greater than 1 cm diameter at breast height in the control plots. For species found in both control and weeded plots, the maximum size of individuals did not differ. At the end of the study, 61 species were found in the control plots and 43 species were found in the weeded plots, and in both types of plots the three most abundant species were the same. The number of species and stems classified as early or middle successional species did not differ between weeded and control plots. The fact that weeding did not promote regeneration of indigenous trees after the removal of plantation trees illustrates the importance of evaluating and field‐testing potential management options.     

Embryonal carcinoma-derived growth factor activates protein kinase C in vivo and in vitro.

We have recently reported that a polypeptide mitogen, the embryonal carcinoma-derived growth factor (ECDGF), induces phosphorylation of the epidermal growth factor (EGF) receptor in intact C3H 10T 1/2 mouse fibroblasts with concomittant loss of high affinity EGF binding sites. This phenomenon appears to be mediated through an activation of protein kinase C. Several groups have described an acidic 80,000 dalton protein substrate of protein kinase C. In this paper, we demonstrate that the addition of ECDGF or the phorbol ester TPA to intact C3H 10T 1/2 cells results in the enhanced phosphorylation of this 80 kd protein in vivo. Furthermore, this response is demonstrable in vitro. Thus the addition of ECDGF, the phorbol ester TPA, protein kinase C or phosphoinositidase C to crude membranes prepared from C3H 10T 1/2 cells resulted in the enhanced phosphorylation of this protein. Data obtained by phosphopeptide mapping of the 80 kd protein show that the ECDGF-induced activation of protein kinase C in our membrane preparations is comparable with that obtained in vivo. The availability of an in vitro system in which this response is preserved should now allow a detailed biochemical analysis of the steps between binding of a mitogen to its receptor and the activation of protein kinase C.     

Mitochondrial DNA of the extinct quagga: Relatedness and extent of postmortem change

Sequences are reported for portions of two mitochondrial genes from a domestic horse and a plains zebra and compared to those published for a quagga and a mountain zebra. The extinct quagga and plains zebra sequences are identical at all silent sites, whereas the horse sequence differs from both of them by 11 silent substitutions. Postmortem changes in quagga DNA may account for the two coding substitutions between the quagga and plains zebra sequences. The hypothesis that the closest relative of the quagga is the domestic horse receives no support from these data. From the extent of sequence divergence between horse and zebra mitochondrial DNAs (mtDNAs), as well as from information about the fossil record, we estimate that the mean rate of mtDNA divergence in Equus is similar to that in other mammals, i.e., roughly 2% per million years.     

Twenty-four-hour variations in activity,core temperature,metabolic rate,and respiratory quotient in captive chinese pangolins

The circadian rhythms in activity, core temperature (T_c), O₂ consumption, CO₂ production, and respiratory quotient (RQ) were monitored in four captive Chinese pangolins (Manis pentadactyla). The pangolins were strictly nocturnal, never emerging from their nest before 1600 h, and their intermittent activity continued no later than 0230. As is usual in nocturnal mammals, the highest values observed in T_c, O₂ consumption, and CO₂ production occurred during the night; the lowest values occurred during the day. The magnitude of the variation in T_c, O₂ consumption, CO₂ production, and RQ averaged 1.2°C, 1.3 ml O₂ kg^?1 min^?1, 1.2 ml CO₂ kg^?1 min^?1, and 0.24, respectively. The circadian pattern in RQ was independent of activity, T_c, and the metabolic parameters and was of a different character than the patterns exhibited in the other variables. RQ remained constant at either a high or low level for long periods (8–10 h) and then increased or decreased relatively rapidly (1–2h) to the other level as in a square wave, whereas the rhythms in the other variables are similar to sine waves. The sharp increase in RQ was followed by a slow decline in T_c, and the sharp decline in RQ was followed by a slow increase in T_c.