Agrobacterium-mediated transformation of Mycosphaerella fijiensis, the devastating Black Sigatoka pathogen of bananas

Mycosphaerella fijiensis, M. musicola en M. eumusae veroorzaken de Sigatoka-ziekte in banaan. Op dit moment is de toepassing van fungiciden de enige optie om deze ziekte te bestrijden. Het PRPB (Pesticide Reduction Program for Banana) investeert in de ontwikkeling van technieken voor de genotype- en fenotypebepaling van M. fijiensis. Hierbij wordt gebruikt gemaakt van ATMT (Agrobacterium tumefaciens-mediated transformation)

Care and Capability:Understanding Quality of Life in Older Adults Living at Home

The central aim of this thesis is to gain a better understanding about what is important for the quality of life (QoL) of older adults living at home receiving professional care services, and how to assess outcomes of this care in terms of QoL. Specifically, this thesis focuses on how the Adult Social Care Outcomes Toolkit (ASCOT) can be used for determining QoL of older adults in the Netherlands. The ASCOT is an instrument developed in the UK that was designed to evaluate outcomes of social care services by capturing information about an individual’s QoL in eight domains: control over daily life, personal cleanliness and comfort, food and drink, personal safety, social participation and involvement, occupation, accommodation cleanliness and comfort and dignity. The ASCOT is inspired by the Capability Approach (CA). In CA, a distinction is made between capabilities - the things a person has, and functionings - the things a person does. When someone has a capability, they can choose to use it or not. Someone who has access to food can choose to eat but can also consciously refrain from eating, for example in the case of a hunger strike. Central to this are both having access to possibilities, and the freedom to use them or not. . Older adults increasingly live at home and, in this setting, may be confronted with difficulties in their daily life affecting their QoL, for instance a decrease in mobility. The opportunities to engage in various activities and autonomy, i.e. control over one’s life, often decrease because of these difficulties. Care services can support older adults in dealing with challenges and maintaining a preferred level of functioning, contributing to their QoL. The ASCOT is introduced as an instrument to measure outcomes of care for older adults living at home, focusing on the perspective of the care receiver. Four questions are formulated that are the focus of this thesis: 1) How can the ASCOT be understood from the philosophical perspective of the CA? 2) What are important aspects of QoL from the perspective of older adults living at home? 3) How can care services contribute to QoL in older adults living at home? 4) How can important aspects of QoL from the perspective of older adults living at home be addressed in QoL instruments? Within this thesis, different methodologies are combined to answer these questions, in line with and inspired by an empirical ethics approach. In this way, the question how to define QoL in older adults is explored drawing on the strengths of both philosophical and empirical analysis. We conclude that there is a need for a broad QoL tool to evaluate care in older adults living at home. The ASCOT is such a tool. It operationalizes the core assumptions of the capability approach, translating this approach in a practical instrument. From the point of view of older adults, some important domains are missing in the ASCOT. These domains have been included in an extension of the ASCOT, i.e. the EQLT. The domains identified in the EQLT should not be used as tick boxes, but should serve as issues to be discussed in a conversation between clients and care providers. Further implementation of the ASCOT and the EQLT is recommended, not only in professional care, but also in informal care in the community

A Fix for Airway Management Training?:Realism and Suitability of the Fix for Life Cadaver Model

The primary focus of this thesis was the novel Fix for Life (F4L) cadaver model and its possible role in airway management training. The following research questions were addressed: 1. Is the F4L cadaver model a suitable and realistic model for the training and teaching of different airway management techniques? 2. How suitable and realistic is the F4L cadaver model for the training of the identification of the correct anatomical spot to incise for a ‘surgical airway’ (cricothyroidotomy), i.e., the identification of the cricothyroid membrane via palpation and ultrasonography? 3. What is the effectiveness of video-assisted fibreoptic intubation versus videolaryngoscopy in an established difficult airway F4L cadaver model? The F4L cadaver models were compared to formalin-fixed cadaver models and a manikin for suitability and realism for the teaching of 3 basic airway skills: facemask ventilation, tracheal intubation via direct laryngoscopy, and laryngeal mask insertion. The F4L cadaver model was ranked best for facemask ventilation. In other rankings, the F4L cadaver model was not ranked significantly different in regard to the manikin. Both the F4L cadaver model and the manikin were ranked significantly higher than the formalin-fixed cadaver model. With the exception of the score for realism of laryngeal mask insertion, all verbal rating scores between the F4L cadaver model and the manikin were not significantly different. The formalin-fixed cadaver model received the lowest scores. We concluded that there is potential of the F4L cadaver model in airway management training, particularly for facemask ventilation. The F4L cadaver model was also assessed for two advanced airway techniques, namely tracheal intubation with videolaryngoscopy and flexible fibreoptic tracheoscopy. The results in verbal rating scores obtained in this study were very promising, as these were higher compared to the previous study, indicating that the F4L cadaver model could be more suitable for these advanced techniques. These results suggest that the F4L cadaver model could be regarded as a suitable and realistic training model for advanced airway management techniques. A following study describes the suitability and realism of the F4L cadaver model for the training of the identification of the cricothyroid membrane with palpation or ultrasonography. The F4L cadaver model received high verbal rating scores for both techniques, being 8 or higher. The rate of successful identification was significantly higher in the ultrasonography group, although the time needed to do so was longer. We conclude that the F4L cadaver model is realistic and suitable to train the identification of the cricothyroid membrane. The final study primarily compared the success rates of tracheal intubation with videolaryngoscopy versus video-assisted fibreoptic intubation in a difficult airway F4L cadaver model. The success of tracheal intubation was higher with the video-assisted fibreoptic intubation technique, probably due to the higher percentage of glottic opening. In conclusion, the F4L cadaver model was the focus of our different investigations into the possible realism and suitability for airway management training, and the comparison of two intubation techniques for the management of a difficult airway. Based on our studies, the following conclusions can be drawn: 1. The F4L cadaver model could be a suitable and realistic alternative model to the manikin for the training of basic airway maneuvers, in particular for facemask ventilation. 2. The F4L cadaver model is a suitable and realistic model for the teaching of advanced airway procedures, namely videolaryngoscopy and fibreoptic intubation. 3. The F4L cadaver model is a suitable and realistic model for the teaching of cricothyroid membrane identification via palpation and ultrasonography. 4. The higher percentage of glottic opening score obtained with the video-assisted fibreoptic intubation technique versus videolaryngoscopy, probably translates to a higher intubation success in a difficult airway