The Thirty Years War(s)

The Thirty Years War, spanning 1618-1648, has been described as the last great war of religion despite pitting Catholics against Catholics and Protestants against Protestants. In addition to religion not playing the role it is supposed to have, a closer look at the motives and goals of the major participants reveals that what we have called a single war is actually much more easily understood as four: The Bohemian Rebellion (1618-1624), Denmark\u27s War with the Emperor (1625-1629), Sweden\u27s War with the Emperor (1630-1648) and France\u27s War with the Habsburgs (1635-1648/59). These four wars are related and sometimes overlap, but they remain nonetheless distinct

High density lipoproteins and reverse cholesterol transport

The e>:periments described in this thesis were performed in order to clarify the mechanism of efflux of cellular cholesterol, a key step in reverse cholesterol transport. It is not known which factors influence the rate of transfer of cholesterol from cells to HDL. Rate limiting steps are important steps in the efflux process and may give more insight into the mechanism of the efflux of cellular cholesterol. Possible rate limiting steps are the cholesteryl ester hydrolysis and subsequent transport of cholesterol to the plasma membrane, the desorption of cholesterol from the membrane, the binding of HDL to the membrane or the composition of the HDL particles. The major pan of the experiments described in this thesis were performed with human endothelial cells (EAhy 926 cell line). These cells are hybrids of human umbilical vein endothelial cells with lung carcinoma cells (A549 line) and show many characteristics of differentiated endothelial cells, e.g., the expression of von Wille brand factor, tissue plasminogen activator, plasminogen activtor inhibitor-type 1, and the production of prostacyclin. In addition, the cells formed confluent monolayers with contact-inhibition of cell growth. For obvious reasons (see section 1.6) we choose to measure only net mass transfer of cholesterol from the cells and first developed a method to enrich the cells with cholesterol using cationized LDL (see chapter 2). Subsequently, we studied the efflux of cholesterol from loaded EAhy 926 cells by different plasma lipoproteins, and the effects of the plasma enzyme lecithin:cholesterol acyltransferase, as described in chapters 3 and 4. In chapter 5 the effect of HDL binding on HDL-mediated cholesterol efflux was studied using modifications of HDL with tetranitromethane and dimethyl suberimidate. The effect of cell membrane phospholipid composition on HDL binding and cholesterol efflux is described in chapter 6. All these experiments were carried out with ultracentrifugally isolated HDL or HDL,. HDL is a heterogeneous population of lipoprotein particles and HDL subfractions with distinct apolipoprotein compositions can be isolated from plasma with immune-affinity columns. The different apolipoprotein composition of these HDL subfractions are expected to be important for the interaction with possible plasma membrane HDL binding proteins and may therefore clarify the role of HDL binding in the efflux of cellular cholesterol. Chapter 7 and 8 contain a description of our investigations of the role of different immunopurified HDL subfractions in the efflux of cellular cholesterol from various cell types as well as in the uptake of HDL hy hepatocytes

Two decades of external peer review of cancer care in general hospitals; the Dutch experience

External peer review was introduced in general hospitals in the Netherlands in 1994 to assess and improve the multidisciplinary team approach in cancer care. This paper aims to explore the value, perceived impact, and (future) role of external peer review in cancer care. Semistructured interviews were held with clinicians, oncology nurses, and managers from fifteen general hospitals that participated in three rounds of peer review over a period of 16 years. Interviewees reflected on the goals and expectations, experiences, perceived impact, and future role of external peer review. Transcriptions of the interviews were coded to discover recurrent themes. Improving clinical care and organization were the main motives for participation. Positive impact was perceived on multiple aspects of care such as shared responsibilities, internal prioritization of cancer care, improved communication, and a clear structure and position of cancer care within general hospitals. Establishing a direct relationship between the external peer review and organizational or clinical impact proved to be difficult. Criticism was raised on the content of the program being too theoretical and organization-focussed after three rounds. According to most stakeholders, external peer review can improve multidisciplinary team work in cancer care; however, the acceptance is threatened by a perceived disbalance between effort and visible clinical impact. Leaner and more clinically focused programs are needed to keep repeated peer reviews challenging and worthwhile

Cost Differences Between Sugammadex and Neostigmine Use in Non-Operating Room Anesthesia Care

rior to the introduction of sugammadex, the only option to reverse rocuronium-induced neuromuscular blockade (NMB) were cholinesterase inhibitors (i.e. neostigmine) and anticholinergics (i.e. glycopyrrolate). Sugammadex administration has been shown to provide a more effective and complete reversal of rocuronium. However, the higher cost of sugammadex has been cited as a limiting factor to its use. The medication costs of sugammadex and neostigmine with glycopyrrolate have been studied in the operating room setting. There is a lack of information regarding the usage and medication costs of sugammadex and neostigmine with glycopyrrolate for non-operating room anesthesia care (NORA). A retrospective chart review was conducted over a 12-month period, from January 1, 2017, to December 31, 2017 aimed at examining the cost associated with the administration of neostigmine with glycopyrrolate versus sugammadex for anesthesia in NORA locations. The following information was collected on patients who met the inclusion criteria: type and dose of NMB reversal agent, age, weight, body mass index (BMI), American Society of Anesthesiologist physical status (ASA PS) classification, NORA locations such as cardiac catheterization laboratory (Cath lab), gastrointestinal laboratory (GI lab), magnetic resonance imaging room (MRI), computed tomography room (CT), interventional radiology (IR), obstetrics (OB) unit, and electrophysiology laboratory (EP lab). This study consisted of 526 patient charts that fulfilled inclusion criteria. Correlational data analysis revealed that there was a weak positive correlation between ASA score and use of sugammadex. There was also a statistically significant difference in the administration between NORA departments, notably in the EP lab. Due to fluctuating costs of sugammadex, neostigmine, and glycopyrrolate, cost analysis did not reveal sugammadex as a cost-effective option for NMB reversal in NORA locations

Des animaux pour humaniser les soins : Éthique des soins et récits de zoothérapie canine auprès de résidents de centres d’hébergement de soins de longue durée

Travail créatif / Creative WorkEn zoothérapie, les gens peuvent à la fois bénéficier d’interactions et de relations avec un humain et un animal. Ce texte présente quelques anecdotes vécues illustrant comment la zoothérapie peut contribuer au bien-être socioaffectif des patients. Ce texte souligne que notre nature sociale rend l’éthique des soins possible pour les soignants et nécessaire pour les patients, tout en faisant un parallèle entre les aptitudes de mes chiens et les miennes. Je plaide aussi pour qu’on ne néglige pas les besoins socioaffectifs des patients.In animal assisted therapy, people can both benefit from interactions and relationships with a human and an animal. This text presents some anecdotal experiences to illustrate how pet therapy can contribute to the social and emotional well-being of patients. This text emphasizes that our social nature makes an ethics of care possible for caregivers and necessary for patients, all while drawing a parallel between the skills of my dogs and my own. I also plead for us not neglect the socio-emotional needs of patients

Les écarts entre les sexes dans les statistiques sociales, le soin aux proches et l’emploi, doit-on toujours s’en préoccuper? L’apport des neurosciences

Travail dirigé présenté à l'École de santé publique en vue de l'obtention du grade de Maîtrise ès arts (M.A.), bioéthiqueAu Québec, certaines politiques sociales visent à éliminer les écarts hommes/femmes dans les statistiques relatives aux catégories d’emploi, salaires, temps de travail et temps consacré aux soins aux enfants. Le féminisme dominant (institutionnalisé et médiatique) encourage des rôles sociaux identiques pour hommes et femmes. Le féminisme de genre, très présent, affirme que ces différences ont pour origine la socialisation différenciée et ne reconnaît aucun apport de la biologie. Les femmes choisissent en plus grand nombre le travail d’aide, de soin et de se consacrer à leur famille. Nombre de différences entre les sexes ont été étudiées dans la structure et la fonction des différentes zones du cerveau. Les prédispositions aux maladies mentales diffèrent, de même que les aptitudes. Les causes en sont multiples : génétiques, endocriniennes, épigénétiques, sociales et environnementales. La somme de ces différences pourraient expliquer certains choix différents des femmes et hommes. Bien loin de remettre en question l’égalitarisme, j’affirme qu’il est paternaliste de ne pas respecter les choix autonomes des femmes et que ces pressions pour des rôles identiques sont inéquitables. Il serait plus bienfaisant de laisser chacune choisir le mode de vie favorable à son bien-être et celui de sa famille, choix effectué en fonction de valeurs morales qui sont les leurs. Dans cette vision, c’est le soin qu’il faut revaloriser (peu importe le sexe du donneur de soins) plutôt que de pousser les femmes à suivre les anciens modèles masculins

The value of external peer review in oncology: evaluating the impact on cancer services in Dutch hospitals

During the 1980’s and 90’s, cancer treatment became increasingly multidisciplinary. Adjuvant chemotherapy and radiotherapy transferred cancer treatment from a monodisciplinary responsibility to that of multiple medical disciplines. To improve the quality of multidisciplinary care, eight regional Comprehensive Cancer Organizations were established. They formed networks of healthcare professionals and cancer institutes aiming to improve cancer care through registry, research, guideline development, knowledge exchange and organizational improvement without having a treatment function themselves. In 2011, they fused into the Netherlands Comprehensive Cancer Organization (IKNL). Anticipating the increasing multidisciplinary character of cancer treatment, the Comprehensive Cancer Organization in the North of the Netherlands introduced an external peer review programme in 1994 to review the multidisciplinary organization of cancer care in hospitals. It gradually spread over the country and was eventually used nationwide. The majority of Dutch hospitals has gone through the procedure at least once and in some regions already thrice. The programme initially focussed on organizational requirements for multidisciplinary care. Over time, it evolved and also paid attention to important (inter)national trends such as centralization, but the primary focus remained on the organization of cancer care as a whole (not specific tumour types). \ud Even though there is almost 20 years of experience with the external peer review programme for multidisciplinary cancer care there is no structured evidence of its effectiveness on quality improvement. This is a more general problem for external peer review and accreditation programmes worldwide and the lack of conclusive evidence has led to many calls for research in this field. The aim of this dissertation was to investigate the impact of the external peer review programme for multidisciplinary cancer care on clinical outcomes and organization. Four main research questions structured the research in this dissertation: (1) How can the impact of external peer review on quality of care be studied methodologically? (2) What is the impact of the programme on clinical quality of cancer care? (3) What are the experiences of stakeholders and what is the perceived value of the programme? (4) What drives quality related organizational change in cancer care

Commensal observing with the Allen Telescope array: software command and control

The Allen Telescope Array (ATA) is a Large-Number-Small-Diameter radio telescope array currently with 42 individual antennas and 5 independent back-end science systems (2 imaging FX correlators and 3 time domain beam formers) located at the Hat Creek Radio Observatory (HCRO). The goal of the ATA is to run multiple back-ends simultaneously, supporting multiple science projects commensally. The primary software control systems are based on a combination of Java, JRuby and Ruby on Rails. The primary control API is simplified to provide easy integration with new back-end systems while the lower layers of the software stack are handled by a master observing system. Scheduling observations for the ATA is based on finding a union between the science needs of multiple projects and automatically determining an efficient path to operating the various sub-components to meet those needs. When completed, the ATA is expected to be a world-class radio telescope, combining dedicated SETI projects with numerous radio astronomy science projects.Comment: SPIE Conference Proceedings, Software and Cyberinfrastructure for Astronomy, Nicole M. Radziwill; Alan Bridger, Editors, 77400Z, Vol 774