Individual Budgets : Lessons from Early Users' Experiences

Within the context of modernization, there has been a trend towards 'cash-for-care' schemes designed to bring choice and control closer to the service user. In England, Individual Budgets (IBs) are being piloted, with the aim of promoting personalized support for disabled people and other users of social care services. This paper reports on the experiences and outcomes of early IB users two to three months after first being offered an IB. The users included adults with physical/sensory impairments, learning difficulties, mental health problems and older people. Semi-structured interviews were carried out with nine service users and five proxies. The findings suggest that IBs have the potential to be innovative and life-enhancing. However, achieving this potential in practice depends on a range of other factors, including changes in the routine practices and organizational culture of adult social care services and ensuring users have access to appropriate documentation and support. Any conclusions drawn from the experiences of these early IB users must be treated with caution. The findings nevertheless indicate some of the issues that will need to be addressed as IBs are implemented more widely to replace conventional forms of adult social care provision

Serum lactate as a prognostic factor in coronary artery bypass graft operation by on pump method

Background: Lactic acidosis in cardiac surgical patients is a manifestation of systemic inflammation and excess pro-inflammatory cytokine production. This investigation was designed to integrate basic concepts about lactate acidosis with a clinically used of serum lactate in patients under coronary artery bypass surgery (CABG) by on pump method. Methods: From August to September 2012, 15 patients scheduled for routine cardiac surgery entered to our sample and followed up two weeks. Lactate concentration in arterial blood sample was studied. Method of surgery duration of cardiopulmonary bypass, aorta cross clamp timing, hemodynamic parameters, inotrope dosage and patient outcome were documented. The data were collected and analyzed. Results: The mean age of the patients was 62±14 years. The patients with a poor outcome had significantly higher lactate levels in ABG samples (p0.05). The PH of ABG samples did not generally correlate with the ABG lactate concentration (r=0.116, p=0.68). Increased lactate concentration was reliably associated with patient hemodynamic parameters, inotrope dosage, duration of on pump time and aorta cross clamp time. Conclusion: This study demonstrates a correlation between serum lactate levels and patient prognosis after CABG surgery by on pump method

Interleukin 6, interleukin 1&#946, estradiol and testosterone concentrations in serum and follicular fluid of females with stimulated and non-stimulated ovaries

The ovarian physiology is regulated by some complex factors such as hormones and growth factors. The hormones and growth factors are synthesized by follicular and ovarian cells during follicular maturation stage and cytokines are synthesized by the immune system. Interaction between immune and endocrine systems modulates ovarian function through the secretion of regulatory soluble factors, especially cytokines. There is a close contact between corona-cumulus-oocyte complex with follicular fluid which affects the quality and degree of oocyte maturation. The objectives of this study were to determine the levels of interleukin-6 (IL-6), interleukin 1β, estradiol and testosterone concentration in serum and follicular fluid of women with stimulated and non-stimulated ovaries. A total of 41 women, 27 in stimulated and 14 non-stimulated cycles, undergoing intra cytoplasmic sperm injection (ICSI) treatment were included in this study. Follicular fluid and serum samples from all cases were collected at the time of oocyte retrieval and concentration of testosterone, estradiol, interleukin 6 and interleukin 1β were measured. The results show that serum concentration of testosterone was significantly higher in non stimulated cases. Also, the serum and follicular fluid concentrations of interleukin 6 and interleukin 1β in stimulated cases were significantly higher than non stimulated group. There was an important negative correlation between the level of testosterone in patient's serum and IL-6 and IL-1β levels of follicular fluid. In conclusion, according to these results, it seems that the levels of testosterone and IL-6 and IL-1β in patient's serum and follicular fluid are a good factor for prediction of maturity of oocytes.Key words: Oocyte maturation, follicular fluid, interleukin 6, interleukin 1β, testosterone, estradiol

Molecular Competition in G1 Controls When Cells Simultaneously Commit to Terminally Differentiate and Exit the Cell Cycle

Terminal differentiation is essential for the development and maintenance of tissues in all multi-cellular organisms and is associated with permanent exit from the cell cycle. Failure to permanently exit the cell cycle can result in cancer and disease. However, the molecular mechanisms and timing that coordinate differentiation commitment and cell cycle exit are not yet understood. Using live, single-cell imaging of cell cycle progression and differentiation commitment during adipogenesis, we show that a rapid switch mechanism engages exclusively in G1 to trigger differentiation commitment simultaneously with permanent exit from the cell cycle. We identify a molecular competition in G1 between when the differentiation switch is triggered and when the proliferative window closes that allows mitogen and differentiation stimuli to control the balance between terminally differentiating cells produced and progenitor cells kept in reserve, a parameter of critical importance for enabling proper development of tissue domains and organs. Zhao et al. show that in terminally differentiating cells, a rapid switch mechanism engages exclusively during a G1 period to trigger simultaneous differentiation commitment and permanent cell cycle exit. A molecular competition in each G1 period allows cells to control the balance the terminally differentiating cells produced and progenitor cells kept in reserve

Aluminum Complexes of N2O23‒ Formazanate Ligands Supported by Phosphine Oxide Donors

The synthesis and characterization of a new family of phosphine-oxide-supported aluminum formazanate complexes (7a, 7b, 8a, 9a) are reported. X-ray diffraction studies revealed that the aluminum atoms in the complexes adopt an octahedral geometry in the solid state. The equatorial positions are occupied by an N2O23‒ formazanate ligand, and the axial positions are occupied by L-type phosphine oxide donors. UV-vis absorption spectroscopy revealed that the complexes were strongly absorbing (ε ~ 30,000 M‒1 cm‒1) between 500 and 700 nm. The absorption maxima in this region were simulated using time-dependent density-functional theory. With the exception of 3-cyano substituted complex 7b, which showed maximum luminescence intensity in the presence of excess phosphine oxide, the title complexes are non-emissive in solution and the solid state. The electrochemical properties of the complexes were probed using cyclic voltammetry. Each complex underwent sequential one-electron oxidations in potential ranges of ‒0.12 to 0.29 V and 0.62 to 0.97 V, relative to the ferrocene/ferrocenium redox couple. Electrochemical reduction events were observed at potentials between ‒1.34 and ‒1.75 V. When combined with tri-n-propylamine as a coreactant, complex 7b acted as an electrochemiluminescence emitter with a maximum electrochemiluminescence intensity at a wavelength of 735 nm, red-shifted relative to the photoluminescence maximum of the same compound

Numerical model development to predict the behaviour of infant/neonate crash dummy restrained inside of an incubator under deceleration

In this paper, advanced finite element (FE) methods are developed to investigate the effect of deceleration on the crash dummy test complied with British Standard Engineering (BS EN 1789). These techniques, which are related to material modelling, joints and contacts, offer an advanced numerical model representing an infant incubator with all complex boundary conditions and design contents. It is shown that the response of an infant incubator is a function of the ratchet straps, the tension on the belts, the belt type and the distance of the belts from the edges of the incubator, which can significantly affect the experienced acceleration, by the infant. The validation process is performed against experimental studies and various case parameters such as crash dummy mass and negative acceleration impulse are discussed in detail. The developed numerical model is capable to predict the behaviour of the crash dummy and the incubator in terms of acceleration, trajectory and kinematics by less than 8% error

Molecular architecture of transcription factor hotspots in early adipogenesis

SummaryTranscription factors have recently been shown to colocalize in hotspot regions of the genome, which are further clustered into super-enhancers. However, the detailed molecular organization of transcription factors at hotspot regions is poorly defined. Here, we have used digital genomic footprinting to precisely define factor localization at a genome-wide level during the early phase of 3T3-L1 adipocyte differentiation, which allows us to obtain detailed molecular insight into how transcription factors target hotspots. We demonstrate the formation of ATF-C/EBP heterodimers at a composite motif on chromatin, and we suggest that this may be a general mechanism for integrating external signals on chromatin. Furthermore, we find evidence of extensive recruitment of transcription factors to hotspots through alternative mechanisms not involving their known motifs and demonstrate that these alternative binding events are functionally important for hotspot formation and activity. Taken together, these findings provide a framework for understanding transcription factor cooperativity in hotspots