Do governance choices matter in health care networks? : an exploratory configuration study of health care networks

Background: Health care networks are widely used and accepted as an organizational form that enables integrated care as well as dealing with complex matters in health care. However, research on the governance of health care networks lags behind. The research aim of our study is to explore the type and importance of governance structure and governance mechanisms for network effectiveness. Methods: The study has a multiple case study design and covers 22 health care networks. Using a configuration view, combinations of network governance and other network characteristics were studied on the level of the network. Based on interview and questionnaire data, network characteristics were identified and patterns in the data looked for. Results: Neither a dominant (or optimal) governance structure or mechanism nor a perfect fit among governance and other characteristics were revealed, but a number of characteristics that need further study might be related to effective networks such as the role of governmental agencies, legitimacy, and relational, hierarchical, and contractual governance mechanisms as complementary factors. Conclusions: Although the results emphasize the situational character of network governance and effectiveness, they give practitioners in the health care sector indications of which factors might be more or less crucial for network effectiveness

Mutational analysis of the carbohydrate binding activity of the tobacco lectin

At present the three-dimensional structure of the tobacco lectin, further referred to as Nictaba, and its carbohydrate-binding site are unresolved. In this paper, we propose a three-dimensional model for the Nictaba domain based on the homology between Nictaba and the carbohydrate-binding module 22 of Clostridium thermocellum Xyn10B. The suggested model nicely fits with results from circular dichroism experiments, indicating that Nictaba consists mainly of beta-sheet. In addition, the previously identified nuclear localization signal is located at the top of the protein as a part of a protruding loop. Judging from this model and sequence alignments with closely related proteins, conserved glutamic acid and tryptophan residues in the Nictaba sequence were selected for mutational analysis. The mutant DNA sequences as well as the original Nictaba sequence have been expressed in Pichia pastoris and the recombinant proteins were purified from the culture medium. Subsequently, the recombinant proteins were characterized and their carbohydrate binding properties analyzed with glycan array technology. It was shown that mutation of glutamic acid residues in the C-terminal half of the protein did not alter the carbohydrate-binding activity of the lectin. In contrast, mutation of tryptophan residues in the N-terminal half of the Nictaba domain resulted in a complete loss of carbohydrate binding activity. These results suggest that tryptophan residues play an important role in the carbohydrate binding site of Nictaba

Polysaccharide utilization loci and nutritional specialization in a dominant group of butyrate-producing human colonic Firmicutes

Acknowledgements The Rowett Institute of Nutrition and Health (University of Aberdeen) receives financial support from the Scottish Government Rural and Environmental Sciences and Analytical Services (RESAS). POS is a PhD student supported by the Scottish Government (RESAS) and the Science Foundation Ireland, through a centre award to the APC Microbiome Institute, Cork, Ireland. Data Summary The high-quality draft genomes generated in this work were deposited at the European Nucleotide Archive under the following accession numbers: 1. Eubacterium rectale T1-815; CVRQ01000001–CVRQ0100 0090: http://www.ebi.ac.uk/ena/data/view/PRJEB9320 2. Roseburia faecis M72/1; CVRR01000001–CVRR010001 01: http://www.ebi.ac.uk/ena/data/view/PRJEB9321 3. Roseburia inulinivorans L1-83; CVRS01000001–CVRS0 100 0151: http://www.ebi.ac.uk/ena/data/view/PRJEB9322Peer reviewedPublisher PD

Initial Reports of the Deep Sea Drilling Project, vol. 85

Covering Leg 85 of the cruises of the Drilling Vessel Glomar Challenger Los Angeles, California, to Honolulu, Hawaii March-April 1982. Includes six chapters: 1. INTRODUCTION: BACKGROUND AND EXPLANATORY NOTES, DEEP SEA DRILLING PROJECT LEG 85, CENTRAL EQUATORIAL PACIFIC 2. SITE 571 3. SITE 572 4. SITE 573 5. SITE 574 6. SITE 57

Synthesis of Nanofiltration Membrane Developed from Triethanolamine (TEOA) and Trimesoyl Chloride (TMC) for Separation of Xylose from Glucose

Synthesis of thin film composite (TFC) nanofilt ration (NF) membrane has experienced tremendous development since the concept of interfacial polymerisation (IP) was first introduced. One of its new application is on the separation of xylose from glucos e in biomass hydrolysate. In this present study, NF TFC membrane has been produced through interfacial poly merisation by manipulation the concentration of triethanolamine (TEOA) at 35 min reaction time with 0. 15 % w/v of trimesoyl chloride (TMC). The membrane was then characterised in term of their chemical and physical properties, and separation performance between xylose and glucose. The growth of thin layer f ilm depends on concentration of TEOA as the monomer and reaction time. As concentration of TEOA and re action time increased, the layer of the TFC becomes thicker thus decreases the permeability of the membrane. Contradicted to this study, the lowest and the highest permeability were recorded at 4 % w/v of TEOA and 8 % w/v of TEOA at reaction time of 35-min in TMC. The TFC membrane prepared with 4 % w/v TEOA has high in permeate flux, resultant in high xylose separation of 1.3. Low permeate flux but moderate xylose separation factor of 0.93 was obtained for the TFC membrane prepared with 8 % w/v TEOA

The physiological burden of the 6-minute walk test compared with cardiopulmonary exercise stress test in patients with severe aortic atenosis

Background Management of aortic stenosis (AS) relies on symptoms. Exercise testing is recommended for asymptomatic patients with significant AS but is often experienced as forbidding and/or technically unrealistic for patients who are often frail, deconditioned, and intimidated by the exercise test. We compared the physiological burden assessed with gas exchange assessments to gauge and respiratory exchange ratio (RER) of a 6-minute walk test (6MWT) to a cardiopulmonary exercise stress test (CPET) in patients with severe AS. peak oxygen utilization Methods Adults with equivocal symptoms and severe AS (1-aortic valve area [AVA] ≤ 1.0 cm2 or AVA index ≤ 0.6 cm2/m2, 2-peak aortic jet velocity ≥ 4.0 m/sec, 3-mean transvalvular pressure gradient ≥ 40 mm Hg by rest or dobutamine stress echocardiography, or 4-aortic valve calcification ≥ 1200 in women or ≥ 2000 AU in men) were studied. All participants completed both a 6MWT and symptom-limited progressive bicycle exercise testing. Breath-by-breath gas analysis and 12-lead electrocardiography were completed during 6MWT and CPET. Results: Eleven patients were studied. Patients walked on average 330 ± 75 m during the 6MWT and achieved a maximal workload of 48 ± 14 watts during the CPET. During the 6MWT, peak maximal oxygen uptake (O2peak) was 12.8 ± 2.5 vs 10.8 ± 4.2 mL/kg/min during the CPET. Respiratory exchange ratio exceeded 1.1 in both the 6MWT and CPET indicating similarly high exertion. Compared with the CPET, a larger proportion of the 6MWT was performed at a high intensity level (78% ± 28% vs 33% ± 24% at > 85% V̇O2peak; P = 0.004). Conclusions The 6MWT with breath-by-breath gas analysis was well tolerated and able to achieve a physiological intense RER and O2peak that are similar to symptom-limited CPET in patients with severe AS.Introduction La prise en charge de la sténose aortique (SA) dépend des symptômes. L’épreuve d’effort est recommandée aux patients asymptomatiques qui ont une SA significative, mais elle est souvent perçue comme dangereuse et/ou théoriquement irréaliste chez ces patients qui sont souvent fragiles, en mauvaise forme et craintifs par l’épreuve d’effort. Nous avons comparé le fardeau physiologique calculé par la consommation maximale de l’oxygène (O2max) et le quotient respiratoire (QR) d’un test de marche de 6 minutes (TM6) et d'une épreuve d’effort maximal chez des patients avec une SA sévère. Méthodes Tous les patients présentaient une SA symptomatique et sévère (1-aire valvulaire aortique [AVA] ≤ 1,0 cm2 ouAVA ≤ 0,6 cm2/m2, 2-une vélocité maximale du flux aortique ≥ 4,0 m/sec, 3-un gradient de pression transvalvulaire moyen ≥ 40 mmHg au repos ou à l’échocardiographie à l’effort sous dobutamine ou 4-une calcification valvulaire aortique (AU) ≥ 1200 chez les femmes ou ≥ 2000 AU chez les hommes). Les participants ont effectué un TM6 et une ’épreuve d’effort maximal de type rampe sur vélo. L’analyse des échanges gazeux respiration par respiration et un électrocardiogramme à 12 dérivations ont été effectués durant le TM6 et l'épreuve d'effort maximal. Résultats Un total de 11 patients ont participé à l'étude. Les patients ont marché en moyenne 330 ± 75 m durant le TM6 et ont atteint une charge de travail maximale de 48 ± 14 watts durant l’épreuve d'effort maximal. Durant le TM6, le O2max était de 12,8 ± 2,5 vs 10,8 ± 4,2 ml/kg/min durant l’épreuve d'effort maximal. Le QR était supérieur à 1,1 au TM6 ainsi qu'à l’épreuve d'effort maximal. Comparativement à l’épreuve d'effort maximal, un pourcentage plus important au TM6 a été réalisée à une intensité élevée (78 % ± 28 % vs 33 % ± 24 % à > 85 % V̇O2max; P = 0,004). Conclusions Le TM6 avec mesure directe des échanges gazeux était bien toléré et susceptible d’atteindre des valeurs physiologiques d'intensité élevée pour le QR et le O2max. Les valeurs atteintes au TM6 étaient semblables à celles de l'épreuve d'effort maximal chez les patients avec une SA sévère

Therapeutic follow-up of postoperative patients on tramadol in the intensive care unit a tertiary African hospital: a cohort study

Background: Tramadol, an analgesic, is a prodrug requiring bioactivation through cytochrome P450 enzymes (CYP450) to obtain O-desmethyltramadol (M1), its active metabolite. However, little is known on the African pharmacogenetic profile of tramadol metabolism. Hence, we aimed to study the biological efficacy of tramadol in an African population.Methods: This was a prospective cohort study over a 3-month period carried out at intensive care unit of a Cameroonian tertiary hospital. We enrolled patients with moderate-to-severe pain surgery, who had not been administered drugs metabolized by CYP450. Immediately after surgery, 2 mg/kg of tramadol was administered intravenously every 6 hours. Pain was assessed using the visual analog scale (VAS) within the first 24 hours. Vital signs and side effects were recorded. Plasma samples were collected at 3rd and 6th hours to assay tramadol and M1 using HPLC-UV.Results: We enrolled 30 patients with a mean age of 32 years operated for caesarean section, laparotomy and cancer surgery, under spinal and general anesthesia. Before administration of tramadol, the VAS was 6/10. The VAS decreased 4/10 to 1/10 between the 3rdand the 6th hour. There was a reduction of the respiratory rate of 3 breath cycles per minute as early as the 6th hour. Samples from 13 patients were analyzed. M1 was found in all patients; of which 4 had a slow metabolism and 3 had a faster metabolism.Conclusions: Overall there was good correlation between the clinical and biological analgesic efficacy of tramadol