How value co-creation and co-destruction unfolds: a longitudinal perspective on dialogic engagement in health services interactions

Complex services, such as healthcare, struggle to realize the benefits of value co-creation due to the substantial challenges of managing such services over the long-term. Key to overcoming these challenges to value co-creation is a profound understanding of dialogue (i.e., ‘quality of discourse’ facilitating shared meaning) during service interactions. Contributing to an emerging literature, we undertake a longitudinal, ethnographic study to assess dialogue between professionals and patients through the lens of dialogic engagement (i.e., iterative mutual learning processes that bring about action through dialogue). We develop and empirically support six dialogic co-creation and co-destruction mechanisms that impact on the resolution of tensions and integration of knowledge resources between service providers and consumers. We reveal the multidimensional and dynamic nature of value created or destroyed through these mechanisms in dialogue over time. Taking healthcare as an exemplar, we offer a research agenda for developing our understanding of DE in complex services

Racial differences in human platelet PAR4 reactivity reflect expression of PCTP and miR-376c.

Racial differences in the pathophysiology of atherothrombosis are poorly understood. We explored the function and transcriptome of platelets in healthy black (n = 70) and white (n = 84) subjects. Platelet aggregation and calcium mobilization induced by the PAR4 thrombin receptor were significantly greater in black subjects. Numerous differentially expressed RNAs were associated with both race and PAR4 reactivity, including PCTP (encoding phosphatidylcholine transfer protein), and platelets from black subjects expressed higher levels of PC-TP protein. PC-TP inhibition or depletion blocked PAR4- but not PAR1-mediated activation of platelets and megakaryocytic cell lines. miR-376c levels were differentially expressed by race and PAR4 reactivity and were inversely correlated with PCTP mRNA levels, PC-TP protein levels and PAR4 reactivity. miR-376c regulated the expression of PC-TP in human megakaryocytes. A disproportionately high number of microRNAs that were differentially expressed by race and PAR4 reactivity, including miR-376c, are encoded in the DLK1-DIO3 locus and were expressed at lower levels in platelets from black subjects. These results suggest that PC-TP contributes to the racial difference in PAR4-mediated platelet activation, indicate a genomic contribution to platelet function that differs by race and emphasize a need to consider the effects of race when developing anti-thrombotic drugs

Synthesis of aryltrifluoromethylpyridazines. Applications to the synthesis of rod-like molecules as liquid crystals

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Décès secondaire à une injection intraveineuse lente de Tramadol lors d’une prise en charge médicale : à propos d’un cas

International audienceIntroductionTramadol is a synthetic opioid analgesic with two major metabolites O-desmethyltramadol (M1) and N-desmethyltramadol (M2), both metabolized by P450 CYP2D6 cytochrome. This molecule is generally considered to be devoid of serious side effects; however, it presents significant toxicity, particularly cardiac toxicity. Three cases of cardiac arrest due to the use of tramadol have been described in the literature but none led to death.Case reportWe, here, report the case of a 27-year-old Caucasian woman, admit in an emergency unit for a fall on roller skates, who died from sudden cardiopulmonary arrest, refractory to resuscitation, shortly after a slow intravenous injection of tramadol. Any cause of death was found at the autopsy except the presence of tramadol at a therapeutic concentration.DiscussionIn general, when tramadol is involved in a death, it is associated with the intake of other toxic substances and it is found in high concentration in blood. Here, tramadol and its metabolite M1 were found at concentrations expected for the clinical situation and mode of administration. At these concentrations, any serious or lethal adverse effects are usually observed. A higher than normal blood catecholamine level due to a state of severe stress may have potentiated the cardiac side effects of the molecule and thus lead to death through the cardio-toxic action of tramadol.ConclusionTo our knowledge, this is the first fatal case of cardiorespiratory arrest after slow injection of tramadol in a young subject, without comorbidity, in the context of an adapted use of this analgesic. The resuscitation carried out, although maximal and early, did not result in survival.IntroductionLe tramadol est un antalgique opiacé synthétique de palier II, dont les principaux métabolites sont le O-desméthyltramadol (M1) et le N-desméthyltramadol (M2), métabolisés par le cytochrome P450 CYP2D6. Cette molécule est généralement considérée comme dépourvue d’effets secondaires graves ; néanmoins, elle présente une toxicité non négligeable, notamment cardiaque. Trois cas d’arrêts cardiaques imputables à l’usage du tramadol ont été décrits dans la littérature, mais aucun n’a conduit au décès du sujet.À propos du casCet article présente le cas d’une jeune femme caucasienne, de 27 ans, prise en charge pour une chute en rollers, décédée des suites d’un arrêt cardiorespiratoire brutal, réfractaire à toute réanimation, survenu peu après une injection intraveineuse lente de tramadol. Aucune cause de décès n’avait été mise en évidence à l’autopsie, hormis la présence sanguine de tramadol à une concentration thérapeutique.DiscussionEn général, lorsque le tramadol est impliqué dans un décès, il est associé à la prise d’autres substances toxiques et il est présent en grande quantité. Ici, le tramadol et son métabolite M1 étaient retrouvés à des concentrations attendues pour la situation clinique et le mode d’administration. À ces concentrations, aucun effet indésirable grave ou létal n’est habituellement observé. Un taux sanguin de catécholamines plus élevé que la normale, dû à un état de stress important, a pu potentialiser les effets secondaires cardiaques de la molécule et ainsi entraîner le décès par l’action cardiotoxique du tramadol.ConclusionC’est, à notre connaissance, le premier cas mortel d’arrêt cardiorespiratoire au décours immédiat d’une injection lente de tramadol, chez un sujet jeune, sans antécédents, dans le cadre d’une utilisation adaptée de cet antalgique. La réanimation menée, bien que maximale et précoce, n’a pu permettre la survie de la jeune femme

Synthèse de cristaux liquides calamitiques à motif pyridazinique

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Synthèse de cristaux liquides à motif trifluorométhylpyridazinique

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A Numerical study of compacted clay tensile strength by discrete element modelling: A bending test application

International audienceThe study of the clay tensile behaviour is one of the topics which requires a specific lighting especially when we give a closely attention to the pathology of the constructions built with or on the clays submitted to significant tensilestrenght. Therefore, failure or damage of clay can be related especially to tensile limit and not to shear limit overtaking. It is the case of compacted clay liners in wastes landfill cover or for embankments built on high compressible soils. In order to study the tensile compacted clay behaviour, a series of laboratory bending tests were carried out. On the basis of the test results, different numerical simulations using Discrete Element Method were engaged. Two numerical bending tests were carried out: a three points bending and a four points bending. A comparison between the two numerical protocols is given. Four analytical models (classical elasticity, bimodular elasticity, differential model and struts-tie method) are used in order to interpret bending tests results and are compared with the numerical simulations. At the same time, the validity of the assumptions relative to the four models was discussed. To outcome to these results, a study and an adjustment of numerical and micromechanical parameters were carried out. It was demonstrated that the Discrete Element Method has a strong correlation with laboratory tests and can contribute somewhat to the understanding and discussion on the validity degree of the kind of indirect tests and of their interpretation