Construction of plasmid vectors bearing a NotI- expression cassette based on the lac promoter

We have constructed two plasmid vectors for cloning and expression of DNA fragments controlled by the lac promoter as a NotI-expression cassette. Whereas plasmid pSJ33 allows mobilization of the expression cassette into a wide variety of Gram-negative bacteria by RP4-mediated conjugation, the low-copy-number plasmid pSJP18Not facilitates cloning and expression in Escherichia coli when high gene dosage may be detrimental. In addition to their suitable cloning features (e.g. multiple cloning site, lacZa fragment, compatible with ColE1-derived vectors), these plasmids are particularly useful as auxiliary vectors for cloning of the expression cassettes at the NotI site of mini-transposon elements and their eventual stable insertion into the host chromosome

Implementing a Health Maintenance Organisation in West Africa

The purpose of this report is to determine whether health maintenance organisations (HMOs) can provide a suitable and viable form of financial health protection and service provision in selected West African countries, supplementary to existing healthcare provision and coverage. Burkina Faso, Côte d’Ivoire, The Gambia, Guinea-Bissau, Liberia and Sierra Leone were chosen as country examples. Chapter 1 provides the context for the health and healthcare situation in West Africa as well as specific country profiles, whilst Chapter 2 describes factors to be considered when establishing an HMO. The range of technical di-mensions of an HMO introduced in this report includes: administration, human resources, financing, accreditation, service availability and readiness, the benefits catalogue, paying providers, drugs and quality management. Each of these dimensions is further discussed in Chapters 3 – 10. The administration of an HMO consists of nine interconnected fields: management dash-board, quality management, IT department, purchasing and coordination, finance and ac-counting, health plan and benefit package, member management, human resources, and marketing. In Chapter 3, the authors give a more in-depth analysis of the fields of marketing and member management. Recommendations provided in this chapter include the use of different marketing approaches to bridge the gap between communities and the HMO by establishing informative advertising (e.g., via a mobile responsive website, social media, posters, flyers, radio, and recorded information). Chapter 4 focuses on an HMO’s human resources, particularly in regard to staff recruiting, development and retention. Staff development expands staff competence by increasing employees’ motivation and job satisfaction, which leads to an increase in their performance and productivity, thereby improving staff retention. Furthermore, staff retention is important for ensuring a long-term commitment to the HMO. In conclusion, the success of an HMO is crucially dependent on motivating staff and enabling them to exercise, develop and share their skills. Chapter 5 covers the financial aspects of an HMO, including dimensions related to its target population, financial barriers, funding resources, management of funds, and specific coun-try challenges. In order to calculate the necessary resources, this chapter make clear that an HMO must consider cost projections for the benefit package, infrastructure development, administration, expansion and a reserve. To establish an accreditation system, HMOs can interact with stakeholders from different fields and levels of service delivery and administration, as examined in Chapter 6. The polit-ical and social conditions of a country must be considered by the HMO in order to effective-ly implement an accreditation system. Besides this, an HMO can seek to improve the per-formance quality of healthcare by supporting the establishment of an accreditation scheme. Reliable information on service availability and readiness is necessary for successful health systems management as it allows health services to be tracked in terms of how they have responded to changed inputs and processes. In Chapter 7, the authors analyse the Service Availability and Readiness Assessment (SARA) tool, and recommend its application within the HMO, as it offers a standardised approach to monitoring the supply of services by providing a standard set of tracer indicators. To implement a health benefit package (HBP), the authors assess existing models, such as the one introduced by Glassman et al. (2017) which specifies ten core elements of an HBP design and helps to enable discussions on the most relevant aspects in designing an HBP for an HMO. Chapter 8 presents a coinsurance scheme within the HBP design which will affect the service utilisation of members as well as utilisation management as one method for cost control. In addition, actuarial calculations are proposed using Sierra Leone as a case example. Chapter 9 describes the pharmaceutical supply chain required by an HMO. Important steps of the HMO’s medicine supply chain include: selection, quantification and forecasting, pro-curement, storage, and distribution of medical products. Medicines provided by the HMO must be safe, available, accessible, and affordable at all times and for all members. Stock-outs must be avoided, and therefore this chapter recommends employing community-based health workers in order to ensure distribution to patients in rural areas. Quality management is an important field in an HMO analysed in Chapter 10 of this report. It includes patient safety, efficiency, and patient satisfaction; all factors that must be con-sidered during the implementation of an HMO. The chapter concludes by noting that quality is highly subjective and must therefore be applied to the specific context of an HMO within a specific country. Finally, Chapters 11 and 12 of the report include implementation challenges of an HMO in West Africa, as well next steps that should be followed. Although similar challenges con-cerning the social, political, or structural environment can be found in most West African countries, direct transfer of elaborated information to other countries and healthcare situa-tions is not always possible. As well as these situational challenges, HMOs encounter dif-ferent questions such as how to balance the scope of available services against the cover-age of diverse geographical areas, engagement of various stakeholders and reflection of respective values, interests and perspectives of local populations. Limitations of the report include a lack of specificity in general, and the use of many specific country settings, as observations and examples for one HMO dimension may not always be transferable to other regions and healthcare situations. Therefore, this report is not meant to provide concrete conclusions or solutions in regard to the implementation of an HMO in a specific country setting. In conclusion, this report states that HMOs have the potential to play a substantial role in healthcare system strengthening, provision of quality healthcare services and the preven-tion of financial burden due to ill-health. As a result, an HMO can support West African countries in their role to fulfil their obligation of protecting the health of their citizens. Addi-tionally, the authors strongly believe that an HMO must reflect the cultural, societal and political environment in which it is implemented. Therefore, it is essential that research be conducted prior to its implementation in addition to including the relevant local stakeholders as early as possible in the process

Superallowed 0+ to 0+ nuclear beta decays: A new survey with precision tests of the conserved vector current hypothesis and the standard model

A new critical survey is presented of all half-life, decay-energy and branching-ratio measurements related to 20 0+ to 0+ beta decays. Compared with our last review, there are numerous improvements: First, we have added 27 recently published measurements and eliminated 9 references; of particular importance, the new data include a number of high-precision Penning-trap measurements of decay energies. Second, we have used the recently improved isospin symmetry-breaking corrections. Third, our calculation of the statistical rate function now accounts for possible excitation in the daughter atom. Finally, we have re-examined the systematic uncertainty associated with the isospin symmetry-breaking corrections by evaluating the radial-overlap correction using Hartree-Fock radial wave functions and comparing the results with our earlier calculations, which used Saxon-Woods wave functions; the provision for systematic uncertainty has been changed as a consequence. The new corrected Ft values are impressively constant and their average, when combined with the muon liftime, yields the up-down quark-mixing element of the Cabibbo-Kobayashi-Maskawa (CKM) matrix, V_{ud} = 0.97425(22). The unitarity test on the top row of the matrix becomes |V_{ud}|^2 + |V_{us}|^2 + |V_{ub}|^2 = 0.99995(61). Both V_{ud} and the unitarity sum have significantly reduced uncertainties compared with our previous survey, although the new value of V_{ud} is statistically consistent with the old one. From these data we also set limits on the possible existence of scalar interactions, right-hand currents and extra Z bosons. Finally, we discuss the priorities for future theoretical and experimental work with the goal of making the CKM unitarity test even more definitive.Comment: 36 pages, 11 tables, 9 figure

Superallowed nuclear beta decays: A critical survey with tests of CVC and the standard model

A complete and critical survey is presented of all half-life, decay-energy and branching-ratio measurements related to 20 superallowed decays; no measurements are ignored, though some are rejected for cause and others updated. A new calculation of the statistical rate function is described and experimental ft values determined. The associated theoretical corrections needed to convert these results into Ft values are discussed, and careful attention is paid to the origin and magnitude of their uncertainties. As an exacting confirmation of the conserved vector current hypothesis, the Ft values are seen to be constant to 3 parts in 10^4. These data are also used to set new limits on any possible scalar interactions or right-hand currents. The average Ft value obtained from the survey, when combined with the muon lifetime, yields the CKM matrix element Vud = 0.9738(4); and the unitarity test on the top row of the matrix becomes |Vud|^2 + |Vus|^2 + |Vub|^2 = 0.9966(14) using the PDG's currently recommended values for Vus and Vub. We discuss the priorities for future theoretical and experimental work with the goal of making the CKM unitarity test more definitive.Comment: 64 pages, 4 postscript figure

Construction of plasmid vectors bearing a NotI-expression cassette based on the lac promoter

3 p.-1 fig.We have constructed two plasmid vectors for cloning and expression of DNA fragments controlled by the lac promoter as a NotI-expression cassette. Whereas plasmid pSJ33 allows mobilization of the expression cassette into a wide variety of Gram-negative bacteria by RP4-mediated conjugation, the low-copy-number plasmid pSJP18Not facilitates cloning and expression in Escherichia coli when high gene dosage may be detrimental. In addition to their suitable cloning features (e.g. multiple cloning site, lacZa fragment, compatible with ColE1-derived vectors), these plasmids are particularly useful as auxiliary vectors for cloning of the expression cassettes at the NotI site of mini-transposon elements [1, 2] and their eventual stable insertion into the host chromosome.This work was funded by Contract BIO2-CT92-0084 of the BIOTECH program of the EU.Peer reviewe