Dry and wet interfaces: Influence of solvent particles on molecular recognition

We present a coarse-grained lattice model to study the influence of water on the recognition process of two rigid proteins. The basic model is formulated in terms of the hydrophobic effect. We then investigate several modifications of our basic model showing that the selectivity of the recognition process can be enhanced by considering the explicit influence of single solvent particles. When the number of cavities at the interface of a protein-protein complex is fixed as an intrinsic geometric constraint, there typically exists a characteristic fraction that should be filled with water molecules such that the selectivity exhibits a maximum. In addition the optimum fraction depends on the hydrophobicity of the interface so that one has to distinguish between dry and wet interfaces.Comment: 11 pages, 7 figure

Healthcare seeking behaviour, barriers in accessing medicines, and coping strategies in Africa : evidence from Koboko District, Uganda

Despite free healthcare in public facilities, access to medicines is a serious problem in Uganda. Unavailability of drugs in the public sector, high prices in the private sector, and the absence of a national insurance system result in high out-of-pocket expenditures for households. Drug shops run by the communities present an opportunity to improve access to medicines for people in the poor rural northern west district Koboko. Managed by community members and provided with medicines by a non-governmental organization, such shops could offer lower prices than the private sector. To initiate such a project insights into the local health sector are required. In this context this thesis offers a starting point for the implementation of community run drug shops. Using a household questionnaire, 105 households were surveyed in Koboko District. On average almost 3 sicknesses per household were documented resulting in a dataset of 292 sicknesses. To gain a better understanding of the current situation, household’s healthcare seeking behaviour, barriers in accessing medicines, and coping strategies with acute illness costs were investigated. Principal Component Analysis was used to estimate the socioeconomic status of each household and in addition to descriptive analysis, logistic regressions were run to identify relevant explanatory variables concerning seeking behaviours and coping strategies. Results show that most households consult mainly public health centres in case of sicknesses; this includes households with a higher socioeconomic status (contrary to what was hypothesized). Informal treatments do not play an important role. At the same time medicines are usually obtained from private facilities. Urban and wealthier households were found to have significantly better access to medicines emphasizing the problem of health equity. Unavailability of medicines and high prices in the private sector are identified as major barriers in accessing healthcare while geographical and quality issues are less serious obstacles. To finance acute sickness costs, many households have to sell food, even though it is usually used for their own consumption. In particular rural households can seldom rely on savings. These results demonstrate that community run drug shops have the potential to improve access to medicines. Nevertheless, several challenges remain, such as promoting community awareness and the organization of a well functioning management

Trainee-supervisor collaboration, progress-visualisation, and coaching: a survey on challenges in assessment of ICU trainees

Abstract Background Assessing trainees is crucial for development of their competence, yet it remains a challenging endeavour. Identifying contributing and influencing factors affecting this process is imperative for improvement. Methods We surveyed residents, fellows, and intensivists working in an intensive care unit (ICU) at a large non-university hospital in Switzerland to investigate the challenges in assessing ICU trainees. Thematic analysis revealed three major themes. Results Among 45 physicians, 37(82%) responded. The first theme identified is trainee-intensivist collaboration discontinuity. The limited duration of trainees’ ICU rotations, large team size operating in a discordant three-shift system, and busy and unpredictable day-planning hinder sustained collaboration. Potential solutions include a concise pre-collaboration briefing, shared bedside care, and post-collaboration debriefing involving formative assessment and reflection on collaboration. The second theme is the lack of trainees’ progress visualisation, which is caused by unsatisfactory familiarisation with the trainees’ development. The lack of an overview of a trainee’s previous achievements, activities, strengths, weaknesses, and goals may result in inappropriate assessments. Participants suggested implementing digital assessment tools, a competence committee, and dashboards to facilitate progress visualisation. The third theme we identified is insufficient coaching and feedback. Factors like personality traits, hierarchy, and competing interests can impede coaching, while high-quality feedback is essential for correct assessment. Skilled coaches can define short-term goals and may optimise trainee assessment by seeking feedback from multiple supervisors and assisting in both formative and summative assessment. Based on these three themes and the suggested solutions, we developed the acronym “ICU-STAR” representing a potentially powerful framework to enhance short-term trainee-supervisor collaboration in the workplace and to co-scaffold the principles of adequate assessment. Conclusions According to ICU physicians, trainee-supervisor collaboration discontinuity, the lack of visualisation of trainee’s development, and insufficient coaching and feedback skills of supervisors are the major factors hampering trainees’ assessment in the workplace. Based on suggestions by the survey participants, we propose the acronym “ICU-STAR” as a framework including briefing, shared bedside care, and debriefing of the trainee-supervisor collaboration at the workplace as its core components. With the attending intensivists acting as coaches, progress visualisation can be enhanced by actively collecting more data points. Trial registration N/A