Background
In national health systems based on primary care, cross-level clinical coordination (CC) is a priority, as it may improve quality of care. Evidence on the impact of information and ...communication technology (ICT)-based coordination mechanisms on CC is inconclusive. The implementation of those mechanisms increased during the pandemic. The aim is to adapt the validated COORDENA-CAT questionnaire, for measuring CC, to analyse the implementation of ICT-based coordination mechanisms and its impact on CC in three regions of Spain.
Methods
The COORDENA-CAT questionnaire underwent a two-stage adaptation process:1) contents revision based on literature review, expert discussions, and pretest to adapt the contents and language and produce a version for each region; and 2) piloting the adapted version by self-administration of the questionnaire to primary and secondary care doctors in the health systems of two of the participating regions.
Results
The adapted version (COORDENA-TICs) kept most of the original contents. Main changes were on coordination mechanisms section. Pretest showed an adequate level of comprehensiveness, comprehension, sequence of themes and questions, and length. A low non-response rate was observed, with little variability or unexpected responses. The question on any difficulties encountered in answering the questionnaire revealed no relevant difficulties. The Shared Electronic Medical Record of each region was the most frequently used ICT-based coordination mechanism. Limited access to information and technical issues related to its use were the most common difficulties encountered. Suggestions for improving its use were receiving specific training on its use.
Conclusions
COORDENA-TICs questionnaire is a useful tool to assess utilization of ICT-based coordination mechanisms and its impact on CC from the perspective of primary and secondary care doctors. It will allow comparisons across areas, regions and to evaluate changes over time
Key messages
Evidence on the impact of ICT-based coordination mechanisms on clinical coordination is inconclusive.
COORDENA-TICs questionnaire could be useful to measure the impact of ICT-based coordination mechanisms on clinical coordination.
The alkali activation of waste materials (especially those coming from industrial and mining activities) has become an important area of research in many laboratories because it is possible to use ...these materials to synthesize inexpensive and ecologically sound cementlike construction materials. In the present paper, the mechanism of activation of a fly ash (no other solid material was used) with highly alkaline solutions is described. These solutions, made with NaOH, KOH, water glass, etc., have the common characteristic of having a very high OH
− concentration. The product of the reaction is an amorphous aluminosilicate gel having a structure similar to that of zeolitic precursors. Temperature and time of curing of specimens together with the solution/fly ash ratio are some of the variables that were studied. These variables have been shown to notably influence the development of the mechanical strength of the final product. Mechanical strengths with values in the 60 MPa range were obtained after curing the fly ash at 85°C for only 5 h.
Both in Drosophila and vertebrate epithelial cells, the establishment of apicobasal polarity requires the apically localized, membrane-associated Par-3-Par-6-aPKC protein complex. In Drosophila, this ...complex colocalizes with the Crumbs-Stardust (Sdt)-Pals1-associated TJ protein (Patj) complex. Genetic and molecular analyses suggest a functional relationship between them. We show, by overexpression of a kinase-dead Drosophila atypical PKC (DaPKC), the requirement for the kinase activity of DaPKC to maintain the position of apical determinants and to restrict the localization of basolateral ones. We demonstrate a novel physical interaction between the apical complexes, via direct binding of DaPKC to both Crb and Patj, and identify Crumbs as a phosphorylation target of DaPKC. This phosphorylation of Crumbs is functionally significant. Thus, a nonphosphorylatable Crumbs protein behaves in vivo as a dominant negative. Moreover, the phenotypic effect of overexpressing wild-type Crumbs is suppressed by reducing DaPKC activity. These results provide a mechanistic framework for the functional interaction between the Par-3-Par-6-aPKC and Crumbs-Sdt-Patj complexes based in the posttranslational modification of Crb by DaPKC.
Background and importanceUstekinumab is a real option for treating Crohn’s disease (CD) refractory to anti-tumour necrosis factor (anti-TNF) drugs. After a first intravenous dose, it is administered ...as a subcutaneous maintainance dose every 8–12 weeks.Some observational studies display that a dosage interval shortening (DIS) may improve clinical results in patients with partial response or early exhaustion of response between different doses.Aim and objectivesQuantifying proportion of patients treated with ustekinumab who require DIS.Assessing effectiveness and safety of DIS with ustekinumab in refractory CD.Material and methodsWe conducted an observational and retrospective research study in adult patients with CD refractory to anti-TNF drugs. Patients started treatment with ustekinumab, firstly intravenous 6 mg/kg, and then subcutaneous 90 mg every 8 weeks. Included in the study were patients with DIS in June 2019–February 2021, with later follow-up of at least 6 months.Effectiveness: assesed with clinical remission (CRem), defined as obtaining a Harvey–Bradshaw Index (HBI) <4, and clinical response (CResp), defined as a reduction of >3 points in HBI with respect to baseline. Both endpoints were evaluated at 3 and 6 months.Tolerance/safety: determined at 3 and 6 months. Every discontinuation or adverse event will be notified.ResultsData of 41 patients (21 men) treated with ustekinumab for at least 1 year were obtained. Population had a median of 1.6 previous biological treatments. 15 patients have maintained the initial regimen with ustekinumab. However, 26 patients (63.4%) needed DIS, for partial response (17/26; 65.4%) or early exhaustion of response (9/26; 34.6%). 16 of these had data after DIS of at least 6 months: 7 patients had a dose every 6 weeks, and 7 had a dose every 4 weeks.CRem was obtained in 10 patients (62.5%) at 3 and 6 months. CResp was reached in 5 patients (31.2%) at 3 months and in 7 patients (43.7%) at 6 months. 2 patients stopped the treatment for ineffectiveness. There were no adverse events or discontinuations for safety reasons associated with DIS.Conclusion and relevanceA high number of patients have required DIS with ustekinumab. DIS of ustekinumab has shown high safety and ability for rescuing a substantial percentage of patients with partial response or early exhaustion of response. Effectiveness results are similar at 3 and 6 months after intensification, which might be important for making decisions about treatment earlier.References and/or acknowledgementsConflict of interestNo conflict of interest
Zucchini squash showed chilling injury (CI) damage as pitting on 93% of their surface after 12 days at 2 °C, and a 2−2.5-fold increase in putrescine levels in both skin and pulp was detected during ...storage (from 162 and 38 to 320 and 98 nmol g-1 of fresh weight, respectively). Abscisic acid concentration increased mainly in the skin. Treatments with CO2 prior to storage at 2 °C were found to be effective in reducing CI. With 5% CO2, increases in putrescine and abscisic acid levels were lower than in control fruits, while exposure to 40% CO2 resulted in a decrease of these values. Spermidine and spermine levels decreased during storage, regardless of treatment. Thus, the 40% CO2 treatment was more effective than the 5% CO2 one in reducing both CI and the putrescine and abscisic acid changes found in control chilling-injured squash. Keywords: Zucchini; chilling injury; polyamines; abscisic acid
We investigated the effect of a preservative solution containing boric acid on the senescence of cut carnation flowers (
Dianthus caryophyllus L. cv. Master). A 24-h pulse treatment with the ...preservative solution containing 50, 75 or 100 mM boric acid or continuous treatment with 1 mM boric acid resulted in strong inhibition of the climacteric ethylene production. Both the pulse and continuous treatments significantly increased flower longevity. Free and conjugated 1-aminocyclopropane-1-carboxylic acid (ACC) and ACC oxidase activity increased in carnation petals during senescence, although significantly less in boric acid-treated carnations than in control flowers. The levels of putrescine increased as senescence progressed in both control and boric acid-treated carnations and an increase in spermidine levels was higher in treated carnations. Abscisic acid levels in petals also increased during senescence, but much less in boric acid-treated carnations. It is concluded that boric acid prevents the early rise in ethylene production and considerably improves carnation vase life.
The effects of calcium deficiency on the appearance of ``glassiness'' or ``watercore'' and texture evolution in cantaloupe muskmelon (Cucumis mélo L.) and on polygalacturonase (PG) and ...b-galactosidase activities and their relation to ethylene production were studied. Watercore increased in melons cultivated with calcium-deficient nutrient solutions, as did ripening, which could be related to their lower calcium content. Whole fruit firmness and flesh firmness decreased from 34 days after set (DAS) in control melons, while in calcium-deficient fruits, the softening process had begun before day 33 after fruit set, both parameters being significantly lower in these. The activity of b-galactosidase increased during melon ripening, reaching maximum values two days earlier in melons grown with calcium-deficient solutions than in control ones. However, no PG activity was detected in control melons, but this activity increased during ripening in melons grown with low and removed calcium solutions, a fact that positively correlated with decreased fruit firmness. Ethylene production rate increased sharply as fruit ripened, which could be responsible for the increase in b-galactosidase activity and so for fruit softening. However, the higher softening and glassiness incidence observed in melons irrigated with calcium-deficient solutions could be due to PG activity.
Se ha estudiado el efecto de la deficiencia de calcio en la aparición de vitrescencia y en la evolución de la firmeza en melon Cantalupe (Cucumis melo L.), así como en la actividad de los enzimas poligalacturonasa (PG) y β-galactosidasa y su relación con la producción de etileno. La aparición de vitrescencia aumentó durante la maduración en todos los melones cultivados con disoluciones nutritivas deficientes en calcio, lo que podría relacionarse con su menor contenido en calcio. La firmeza del fruto entero y de la pulpa disminuyó a partir de los 34 días desde el cuaje (DAS) en los melones control, mientras que en los frutos deficientes en calcio, el proceso de ablandamiento había comenzado antes de los 33 DAS, siendo ambos parámetros significativamente más bajos en estos frutos. La actividad β-galactosidasa aumentó durante la maduración del melón, alcanzando valores máximos dos días antes en los melones cultivados con disoluciones deficientes en calcio que en los controles. No se detectó actividad PG en los melones control, sin embargo esta actividad aumentó durante la maduración en los melones cultivados con disoluciones deficientes en calcio, lo que se correlacionó positivamente con el ablandamiento de los frutos. La tasa de producción de etileno aumentó rapidamente con la maduración, lo que pudo ser responsable del aumento en la actividad b-galactosidasa y del ablandamiento del fruto. Sin embargo, la incidencia de vitrescencia y el mayor ablandamiento de los melones cultivados con disoluciones deficientes en calcio podría deberse a la actividad poligalacturonasa.
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