AFLP analysis reveals a lack of phylogenetic structure within Solanum section Petota

<p>Abstract</p> <p>Background</p> <p>The secondary genepool of our modern cultivated potato (<it>Solanum tuberosum </it>L.) consists of a large number of tuber-bearing wild <it>Solanum </it>species under <it>Solanum </it>section <it>Petota</it>. One of the major taxonomic problems in section <it>Petota </it>is that the series classification (as put forward by Hawkes) is problematic and the boundaries of some series are unclear. In addition, the classification has received only partial cladistic support in all molecular studies carried out to date.</p> <p>The aim of the present study is to describe the structure present in section <it>Petota</it>. When possible, at least 5 accessions from each available species and 5 individual plants per accession (totally approx. 5000 plants) were genotyped using over 200 AFLP markers. This resulted in the largest dataset ever constructed for <it>Solanum </it>section <it>Petota</it>. The data obtained are used to evaluate the 21 series hypothesis put forward by Hawkes and the 4 clade hypothesis of Spooner and co-workers.</p> <p>Results</p> <p>We constructed a NJ tree for 4929 genotypes. For the other analyses, due to practical reasons, a condensed dataset was created consisting of one representative genotype from each available accession. We show a NJ jackknife and a MP jackknife tree. A large part of both trees consists of a polytomy. Some structure is still visible in both trees, supported by jackknife values above 69. We use these branches with >69 jackknife support in the NJ jackknife tree as a basis for informal species groups. The informal species groups recognized are: Mexican diploids, Acaulia, Iopetala, Longipedicellata, polyploid Conicibaccata, diploid Conicibaccata, Circaeifolia, diploid Piurana and tetraploid Piurana.</p> <p>Conclusion</p> <p>Most of the series that Hawkes and his predecessors designated can not be accepted as natural groups, based on our study. Neither do we find proof for the 4 clades proposed by Spooner and co-workers. A few species groups have high support and their inner structure displays also supported subdivisions, while a large part of the species cannot be structured at all. We believe that the lack of structure is not due to any methodological problem but represents the real biological situation within section <it>Petota</it>.</p

Design of a randomised controlled trial on immune effects of acidic and neutral oligosaccharides in the nutrition of preterm infants: carrot study

<p>Abstract</p> <p>Background</p> <p>Prevention of serious infections in preterm infants is a challenge, since prematurity and low birth weight often requires many interventions and high utility of devices. Furthermore, the possibility to administer enteral nutrition is limited due to immaturity of the gastrointestinal tract in the presence of a developing immune system. In combination with delayed intestinal bacterial colonisation compared with term infants, this may increase the risk for serious infections. Acidic and neutral oligosaccharides play an important role in the development of the immune system, intestinal bacterial colonisation and functional integrity of the gut. This trial aims to determine the effect of enteral supplementation of acidic and neutral oligosaccharides on infectious morbidity (primary outcome), immune response to immunizations, feeding tolerance and short-term and long-term outcome in preterm infants. In addition, an attempt is made to elucidate the role of acidic and neutral oligosaccharides in postnatal modulation of the immune response and postnatal adaptation of the gut.</p> <p>Methods/Design</p> <p>In a double-blind placebo controlled randomised trial, 120 preterm infants (gestational age <32 weeks and/or birth weight <1500 gram) are randomly allocated to receive enteral acidic and neutral oligosaccharides supplementation (20%/80%) or placebo supplementation (maltodextrin) between day 3 and 30 of life. Primary outcome is infectious morbidity (defined as the incidence of serious infections). The role of acidic and neutral oligosaccharides in modulation of the immune response is investigated by determining the immune response to DTaP-IPV-Hib(-HBV)+PCV7 immunizations, plasma cytokine concentrations, faecal Calprotectin and IL-8. The effect of enteral acidic and neutral oligosaccharides supplementation on postnatal adaptation of the gut is investigated by measuring feeding tolerance, intestinal permeability, intestinal viscosity, and determining intestinal microflora. Furthermore, short-term and long-term outcome are evaluated.</p> <p>Discussion</p> <p>Especially preterm infants, who are at increased risk for serious infections, may benefit from supplementation of prebiotics. Most studies with prebiotics only focus on the colonisation of the intestinal microflora. However, the pathways how prebiotics may influence the immune system are not yet fully understood. Studying the immune modulatory effects is complex because of the multicausal risk of infections in preterm infants. The combination of neutral oligosaccharides with acidic oligosaccharides may have an increased beneficial effect on the immune system. Increased insight in the effects of prebiotics on the developing immune system may help to decrease the (infectious) morbidity and mortality in preterm infants.</p> <p>Trial registration</p> <p>Current Controlled Trials ISRCTN16211826.</p

Zorgbalans 2014 : De prestaties van de Nederlandse gezondheidszorg

Dit rapport is in het Engels verschenen met nummer: 2015-0050 : Dutch Healthcare Performance Report De Zorgbalans geeft een beeld van de kwaliteit, de toegankelijkheid en de betaalbaarheid van de Nederlandse gezondheidszorg. Hieruit blijkt onder andere dat de toegankelijkheid van de gezondheidszorg een van de sterkste eigenschappen van de gezondheidszorg in Nederland is. De meeste eerstelijnszorgverleners zoals huisartsen, fysiotherapeuten of verloskundigen kunnen binnen een paar minuten worden bereikt. Een autorit naar een ziekenhuis duurt bijna nooit langer dan een half uur. Verder zijn wachttijden sinds 2008 voor de meeste behandelingen afgenomen. Er wacht nog wel een aanzienlijk aantal mensen op een plek in een verzorgingshuis of verpleeghuis, maar daardoor ontstaan zelden ernstige problemen. Het aantal mensen dat vanwege de kosten wel eens afziet van zorg is sinds 2010 toegenomen. Zo had 12 procent van de volwassen bevolking in 2013 wel eens afgezien van een bezoek aan een arts vanwege de kosten, tegenover 2 procent drie jaar daarvoor. Hiermee lijkt de financiële toegankelijkheid minder vanzelfsprekend dan voorheen; andere voorbeelden zijn medicijnen afhalen of een labonderzoek laten doen. Wat de kwaliteit van zorg betreft zijn er enkele gunstige ontwikkelingen te zien: het aantal mensen dat 30 dagen na een beroerte of hartinfarct stierf, nam af, evenals de (vermijdbare) sterfte in ziekenhuizen en het aantal ziekenhuisinfecties. Mensen met een gebroken heup worden sneller geopereerd, de vijfjaarsoverleving bij verschillende vormen van kanker steeg, en er zijn minder mensen in de langdurige zorg ondervoed. Ook internationaal scoort Nederland op veel punten bovengemiddeld. Zo worden veel minder antibiotica voorgeschreven in de eerste lijn dan in de meeste andere landen. Minder gunstig zijn het aantal sterfgevallen na een beroerte en de babysterfte. In de ouderenzorg is het tekort aan tijd en aandacht die worden besteed aan cliënten een veel voorkomend probleem. Meer dan de helft van de werknemers in verpleeghuizen gaf in 2013 aan dat er onvoldoende personeel is om goede kwaliteit van zorg te kunnen leveren. Verder blijkt de behandeling per zorgaanbieder sterk te kunnen verschillen. Een voorbeeld daarvan is de behandeling bij vrouwen die in een ziekenhuis bevallen van hun eerste kind zonder dat er sprake is van bijzonderheden (zoals een meerling of een stuitligging). In sommige ziekenhuizen wordt 40 procent van zulke bevallingen ingeleid, terwijl dit bij de meest ziekenhuizen in slechts 10 procent gedaan wordt. Vergelijkbare verschillen zijn waargenomen bij het uitvoeren van kunstverlossingen en keizersneden. De zorguitgaven vertonen na 2011 een opvallende trendbreuk. De uitgaven stegen tussen 2000 en 2013 gemiddeld met 5,5 procent per jaar, maar deze stijging vlakte de laatste drie jaar af. Binnen Europa hoort Nederland nog altijd tot de landen met de hoogste zorguitgaven als percentage van het Bruto Binnenlands Product, wat voornamelijk is toe te schrijven aan uitgaven aan de langdurige zorg. De Zorgbalans is nuttig voor iedereen die meer wil weten over de stand van zaken en ontwikkelingen binnen de Nederlandse gezondheidszorg. Aan de basis van de Zorgbalans ligt een schat aan informatie uit ruim 65 verschillende databronnen.The Dutch Health Care Performance Report reports on the quality, accessibility and affordability of Dutch health care. It shows, amongst others, that accessibility is one of the strong points of health care in the Netherlands. The majority of primary care professionals, such as general practitioners, physiotherapists and midwives, can be reached by car within a few minutes. A car journey to a hospital rarely takes more than half an hour. Waiting times have been reduced since 2008 for the vast majority of treatment modalities. Still, a considerable number of people are on a waiting list for a residential home or nursing home The number of people who occasionally forego care for financial reasons has been on the rise since 2010. Thus, 12 per cent of the adult population reported having decided against seeing a doctor in 2013 because of the anticipated costs against 2 per cent three years earlier. Financial access seems less a matter of course than it used to be; other examples are failure to undergo laboratory testing or to fill drug prescriptions. There are some favourable trends regarding the quality of care: the number of people that died within 30 days following stroke or acute myocardial infarction declined, and so did the rates of (avoidable) hospital mortality and hospital-acquired infections. People with a hip fracture were more promptly operated on, the five-year survival rates for several types of cancer increased, and less people in long-term care were undernourished. Internationally, the Netherlands scores also above average at various points. For example, far less antibiotics are prescribed in primary care in comparison with many other countries. Less positive are the rates for mortality following stroke and for neonatal mortality. In elderly care the lack of sufficient time and attention for clients, is a common problem. Over half of all care providers in nursing homes reported in 2013 that insufficient staff was available to enable good-quality care. Another finding pertains to the variation in practice between health care providers. An example is the treatment of women who give birth in a hospital to their first child who are not at a special risk (like multiple births or fetus in breech presentation). Some hospitals induce labour in 40 per cent of these women, as compared to only 10 per cent in most hospitals. Comparable disparities were found with regard to assisted and Caesarean deliveries. Dutch health care expenditures show a striking trend deviation after 2011. In the 2000-2013 period expenditures were mounting on average by 5.5% a year, but the increase slackened over the past three years. Within Europe, the Netherlands is still one of the countries with the highest health care spending as a percentage of the gross domestic product; this is attributable mainly to the costs of long-term care. The Dutch Health Care Performance Report is useful to everyone who wants to know more about the state of affairs and trends in Dutch health care. The report draws on a wealth of information from more than 65 data sources.Ministerie van VW

A new test of the construct validity of the CarerQol instrument: measuring the impact of informal care giving

Purpose: Most economic evaluations of health care programmes do not consider the effects of informal care, while this could lead to suboptimal policy decisions. This study investigates the construct validity of the CarerQol instrument, which measures and values carer effects, in a new population of informal caregivers. Methods: A questionnaire was distributed by mail (n = 1,100, net response rate = 21%) to regional informal care support centers throughout the Netherlands. Two types of construct validity, i.e., convergent and clinical validity, have been analyzed. Convergent validity was assessed with Spearman's correlation coefficients and multivariate correlation between the burden dimensions (CarerQol-7D) and the valuation component (CarerQol-VAS) of the CarerQol. Additionally, convergent validity was analyzed with Spearman's correlation coefficients between the CarerQol and other measures of subjective caregiver burden (SRB, PU). Clinical validity was evaluated with multivariate correlation between CarerQol-VAS and CarerQol-7D, characteristics of caregivers, care recipients and care situation among the whole sample of caregivers and subgroups. Results: The positive (negative) dimensions of CarerQol-7D were positively (negatively) related to CarerQol-VAS, and almost all had moderate strength of convergent validity. CarerQol-VAS was positively associated with PU and negatively with SRB. The CarerQol-VAS reflects differences in important background characteristics of informal care: type of relationship, age of the care recipient and duration of care giving were associated with higher CarerQol-VAS scores. These results confirmed earlier tests of the construct validity of the CarerQol. Furthermore, the dimensions of CarerQol-7D significantly explained differences in CarerQol-VAS scores among subgroups of carers. Conclusion: Notwithstanding the limitations of our study, such as the low response rate, this study shows that the CarerQol provides a valid means to measure carer effects for use in economic evaluations. Future research should derive a valuation set for the CarerQol and further address the instrument's content validity, sensitivity and reliability