Some children learn to read accurately despite language impairments (LI). Nine- to 10-year-olds were categorized as having LI only (n=35), dyslexia (DX) only (n=73), LI + DX (n=54), or as typically developing (TD; n=176). The LI-only group had mild to moderate deficits in reading comprehension. They were similar to the LI + DX group on most language measures, but rapid serial naming was superior to the LI + DX group and comparable to the TD. For a subset of children seen at 4 and 6 years, early phonological skills were equally poor in those later classified as LI or LI + DX. Poor language need not hinder acquisition of decoding, so long as rapid serial naming is intact; reading comprehension, however, is constrained by LI.

Background: Macromolecular crowding and hydrophobic-hydrophilic interfaces promote amyloidogenesis. Results: The outcome of macromolecular crowding on A␤ amyloidogenesis depends on the spatial heterogeneity of the system. Conclusion: Viscosity dominates over the excluded volume effect only when the system contains a hydrophobic-hydrophilic interface. Significance: Studying both interfacial and macromolecular crowding effects together is crucial to understand amyloid systems in a physiological context.

The current literature does not confirm that any methodology reliably improves the outcomes of clinical handover, although information transfer may be increased. Better study designs and consistency of the terminology used to describe handover and its improvement are urgently required.

Recently, we have begun to realize that the billions of microorganisms living in symbiosis with us have an influence on disease. Evidence is mounting that the alimentary tract microbiome, in particular, influences both host metabolic potential and its innate and adaptive immune system. Inflammatory states characterize many bone and joint diseases of aging. This prompts the hypothesis that the gut microbiome could alter the inflammatory state of the individual and directly influence the development of these common and burdensome clinical problems. Because the microbiome is easily modifiable, this could have major therapeutic impact. This perspective discusses evidence to date on the role of the microbiome and the highly prevalent age-related disorders of osteoporosis, osteoarthritis, gout, rheumatoid arthritis, sarcopenia, and frailty. It also reviews data on the effects of probiotics and prebiotic interventions in animal and human models. Despite suggestive findings, research to date is not conclusive, and we identify priorities for research to substantiate and translate findings.

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Trusted evidence. Informed decisions. Better health.

Background Two systems measure surgical site infection rates following colorectal surgeries. Center for Medicare and Medicaid Services pay-for-performance initiatives use National Healthcare Safety Network data for hospital comparisons. Objective Compare database concordance. Design Multi-institution cohort study of system-wide Colorectal Surgery Collaborative. The National Surgical Quality Improvement Program requires rigorous, standardized data capture techniques; National Healthcare Safety Network allows five data capture techniques. Standardized surgical site infection rates were compared between databases. Cohen's Kappa coefficient calculated. Setting Boston-area hospitals. Patients National Healthcare Safety Network or National Surgical Quality Improvement Program patients undergoing colorectal surgery. Main Outcome Measures Standardized surgical-site infection rates Results Thirty-day surgical-site infection rates of 3,547 (National Surgical Quality Improvement Program) vs 5,179 (National Healthcare Safety Network) colorectal procedures (2012-2014). Discrepancies appeared: National Surgical Quality Improvement Program database of Hospital 1 (N=1,480 patients) routinely found surgical-site infection rates around 10%, routinely deemed rate “exemplary” or “as expected” (100%). National Healthcare Safety Network data from the same hospital and time period (N=1,881) revealed similar overall surgical-site infection rate (10%), but standardized rates were deemed “worse than national average” 80% of the time. Overall, hospitals using less rigorous capture methods had improved surgical-site infection rates for National Healthcare Safety Network compared to standardized National Surgical Quality Improvement Program reports. The correlation coefficient between standardized infection rates was 0.03 (p=0.88). During 25 site-time period observations, National Surgical Quality Improvement Program and National Healthcare Safety Network data matched for 52% of observations (13/25). Kappa=0.10 (95% CI: -0.1366-0.3402; p=0.403), indicating poor agreement. Limitations Hospitals located in Northeastern United States only. Conclusions Variation in Center for Medicare and Medicaid Services-mandated National Healthcare Safety Network infection surveillance methodology leads to unreliable results, which is apparent when these results are compared to standardized data. High quality data would improve care quality and compare outcomes amongst institutions.

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