Background: It has been reported that appraisal by peers can be effective.
Aim: To investigate whether feedback from a peer group (PG) compared to that by a staff member during a practice visit (PV) ...is as effective in improving the quality of action plans.
Methods: Seventy-three general practitioner (GP) trainers randomized into either a PG or PV were instructed to draw up action plans using the SMART criteria to realize the goals set in their personal development plans (PDPs). To improve action plans, feedback was given in either PG or PV. Quality of baseline and follow-up action plans, operationalized as the SMARTness with which plans were formulated, was assessed using a study-specific instrument.
Results: Response rate for submitting both baseline and follow-up action plans was 89% in the PG versus 79% in the PV. It was feasible to determine scores on all SMART criteria, except for the criterion 'Acceptability'. Significant improvement was made on the remaining four criteria irrespective of the feedback setting.
Conclusions: PGs cost less and seem equally effective in improving the SMARTness of the action plans. Moreover, they also seem to stimulate GP trainers more to write a PDP. Therefore, they may be favoured over PVs.
Aims/hypothesis In a previous study, we demonstrated that a creatine kinase (CK) modulates KATP channel activity in pancreatic beta cells. To explore phosphotransfer signalling pathways in more ...detail, we examined whether KATP channel regulation in beta cells is determined by a metabolic interaction between adenylate kinase (AK) and CK. Methods Single channel activity was measured with the patch-clamp technique in the inside-out (i/o) and open-cell attached (oca) configuration. Results The ATP sensitivity of KATP channels was higher in i/o patches than in permeabilised beta cells (oca). One reason for this observation could be that the local ATP:ADP ratio in the proximity of the channels is determined by factors not active in i/o patches. AMP (0.1 mmol/l) clearly increased open channel probability in the presence of ATP (0.125 mmol/l) in permeabilised cells but not in excised patches. This suggests that AK-catalysed ADP production in the vicinity of the channels is involved in KATP channel regulation. The observation that the stimulatory effect of AMP on KATP channels was prevented by the AK inhibitor P ¹,P ⁵-di(adenosine-5')pentaphosphate (Ap₅A; 20 μmol/l) and abolished in the presence of the non-metabolisable ATP analogue adenosine 5'-(β,γ-imido)triphosphate tetralithium salt (AMP-PNP; 0.12 mmol/l) strengthens this idea. In beta cells from AK1 knockout mice, the effect of AMP was less pronounced, though not completely suppressed. The increase in KATP channel activity induced by AMP in the presence of ATP was outweighed by phosphocreatine (1 mmol/l). We suggest that this is due to an elevation of the ATP concentration by CK. Conclusions/interpretation We propose that phosphotransfer events mediated by AK and CK play an important role in determining the effective concentrations of ATP and ADP in the microenvironment of pancreatic beta cell KATP channels. Thus, these enzymes determine the open probability of KATP channels and eventually the actual rate of insulin secretion.
Markets are dynamic by nature, and marketing efforts can be directed to stimulate, reduce, or to utilize these dynamics. The field of marketing dynamics aims at modeling the effects of marketing ...actions and policies on short-term performance (“lift”) and on long-term performance (“base”). One of the core questions within this field is: “How do marketing efforts affect outcome metrics such as revenues, profits, or shareholder value over time?” Developments in statistical modeling and new data sources allow marketing scientists to provide increasingly comprehensive answers to this question. We present an outlook on developments in modeling marketing dynamics and specify research directions.
Due to possible presence and spread of contagious animal viruses via natural sausage casings the international trade in these food products is subject to veterinary and public health requirements. In ...order to manage these restrictions we determined the effect of casing preservation on four highly contagious viruses for livestock: foot-and-mouth-disease virus (FMDV), classical swine fever virus (CSFV), swine vesicular disease virus (SVDV) and African swine fever virus (ASFV). We used an
in vitro 3D collagen matrix model in which cells, infected with the four different viruses were embedded in a bovine collagen type I gel matrix and treated with either saturated salt (NaCl) or phosphate supplemented saturated salt at four different temperatures (4, 12, 20 and 25
°C) during a period of 30
days. The results showed that all viruses were faster inactivated at higher temperatures, but that stability of the various viruses at 4
°C differed. Inactivation of FMDV in the 3D collagen matrix model showed a clear temperature and treatment effect on the reduction of FMDV titres. At 4 and 12
°C phosphate supplemented salt showed a very strong FMDV inactivation during the first hour of incubation. Salt (NaCl) only had a minor effect on FMDV inactivation. Phosphate supplemented salt treatment increased the effect temperature had on inactivation of CSFV. In contrast, the salt (NaCl) treatment only increased CSFV inactivation at the higher temperatures (20
°C and 25
°C). Also SVDV inactivation was increased by phosphate supplemented salt, but salt (NaCl) treatment only resulted in a significant decrease of SVDV titre at a few time points. The ASFV results showed that both salt (NaCl) and phosphate supplemented salt were capable to inactivate ASFV within 48
h. In contrast to the other viruses (FMDV, CSFV and SVDV), ASFV was the most stable virus even at higher temperatures. The results obtained in this
in vitro model underline the efficacy of a combined treatment using phosphate supplemented salt and storage at 20
°C or higher for a period of 30
days. This treatment may therefore be useful in reducing the animal health risks posed by spread of contagious animal viruses by international trade of natural sausage casings.
► To study virus inactivation in natural casings a 3D collagen matrix model was used. ► Inactivation of FMDV, CSFV, SVDV and ASFV was studied at 4, 12, 20, 25
°C for 30
days. ► Treatment with phosphate salt mixture was superior over salt to inactivate viruses. ► Phosphate salt and storage at 20
°C for 30
days is sufficient for virus inactivation. ► This treatment reduces risks of spread of viruses by international trade in casings.
In patients with ST-segment elevation myocardial infarction (STEMI), the time of onset of ischemia has been associated with myocardial infarction (MI) size. Myocardial blush grade (MBG) reflects ...myocardial response to ischemia/reperfusion injury, which may differ according to time of the day. The aim of our study was to explore the 24-hour variation in MBG and MI size in relation to outcomes in STEMI patients. A retrospective multicenter analysis of 6970 STEMI patients was performed. Time of onset of STEMI was divided into four 6-hour periods. STEMI patients have a significant 24-hour pattern in onset of symptoms, with peak onset around 09:00 hour. Ischemic time was longest and MI size, estimated by peak creatine kinase concentration, was largest in patients with STEMI onset between 00:00 and 06:00 hours. Both MBG and MI size were independently associated with mortality. Time of onset of STEMI was not independently associated with mortality when corrected for baseline and procedural factors. Interestingly, patients presenting with low MBG between 00:00 and 06:00 hours had a better prognosis compared to other groups. In conclusion, patients with symptom onset between 00:00 and 06:00 hours have longer ischemic time and consequently larger MI size. However, this does not translate into a higher mortality in this group. In addition, patients with failed reperfusion presenting in the early morning hours have better prognosis, suggesting a 24-hour pattern in myocardial protection.
Muscle function depends on an adequate ATP supply to sustain the energy consumption associated with Ca 2+ cycling and actomyosin sliding during contraction. In this regulation of energy homeostasis, ...the creatine kinase (CK) circuit
for high energy phosphoryl transfer between ATP and phosphocreatine plays an important role. We earlier established a functional
connection between the activity of the CK system and Ca 2+ homeostasis during depolarization and contractile activity of muscle. Here, we show how CK activity is coupled to the kinetics
of spontaneous and electrically induced Ca 2+ transients in the sarcoplasm of myotubes. Using the UV ratiometric Ca 2+ probe Indo-1 and video-rate confocal microscopy in CK-proficient and -deficient cultured cells, we found that spontaneous
and electrically induced transients were dependent on ryanodine-sensitive Ca 2+ release channels, sarcoplasmic/endoplasmic reticulum Ca 2+ -ATPase pumps, extracellular calcium, and functional mitochondria in both cell types. However, at increasing sarcoplasmic
Ca 2+ load (induced by electrical stimulation at 0.1, 1, and 10 Hz), the Ca 2+ removal rate and the amount of Ca 2+ released per transient were gradually reduced in CK-deficient (but not wild-type) myotubes. We conclude that the CK/phosphocreatine
circuit is essential for efficient delivery of ATP to the sarcoplasmic/endoplasmic reticulum Ca 2+ -ATPase pumps and thereby directly influences sarcoplasmic reticulum refilling and the kinetics of the sarcoplasmic Ca 2+ signals.
Abstract Background In vitro studies have shown the feasibility of coronary lesion grading with computed tomography angiography (CTA), intravascular ultrasound (IVUS) and optical coherence tomography ...(OCT) as compared to histology, whereas OCT had the highest discriminatory capacity. Objective We investigated the ability of CTA and IVUS to differentiate between early and advanced coronary lesions in vivo, OCT serving as standard of reference. Methods Multimodality imaging was prospectively performed in 30 NSTEMI patients. Plaque characteristics were assessed in 1083 cross-sections of 30 culprit lesions, co-registered among modalities. Absence of plaque, fibrous and fibrocalcific plaque on OCT were defined as early plaque, whereas lipid rich-plaque on OCT was defined as advanced plaque. Odds ratios adjusted for clustering were calculated to assess associations between plaque types on CTA and IVUS with early or advanced plaque. Results Normal findings on CTA as well as on IVUS were associated with early plaque. Non-calcified, calcified plaques and the napkin ring sign on CTA were associated with advanced plaque. On IVUS, fatty and calcified plaques were associated with advanced plaque. Conclusions In vivo coronary plaque characteristics on CTA and IVUS are associated with plaque characteristics on OCT. Of note, normal findings on CTA and IVUS relate to early lesions on OCT. Nevertheless, multiple plaque features on CTA and IVUS are related to advanced plaques on OCT, which may make it difficult to use qualitative plaque assessment in clinical practice.
Aims - It is important to know the contribution of a protected area to global conservation. A new method called 'Relative Floristic Resemblance' that uses databased and georeferenced herbarium ...specimens, is introduced. Its usefulness and applicability to assess the conservation
value of protected areas is addressed. Method - This is tested using the collection database of the National Herbarium of The Netherlands (NHN) and species checklists of Gabon and of five national parks in Gabon and the Central African Republic. Results -
The method proved to be a valuable instrument for revealing this conservation value, and can even, though with caution, be used for areas where a species list is still incomplete. We conclude that the four Gabonese parks are well chosen and each clearly conserve a different and comparatively
unique flora. The Dzanga-Sangha Reserve captures a flora that ranges across a considerable part of the Congo Basin.
We evaluated the implementation and effectiveness of adjunctive dexamethasone in adults with meningococcal meningitis.
We compared 2 Dutch prospective nationwide cohort studies on community-acquired ...meningococcal meningitis. A total of 258 patients with CSF culture-proven meningitis were enrolled between 1998 and 2002, before routine dexamethasone therapy was introduced, and 100 patients from March 2006 to January 2011, after guidelines recommended dexamethasone.
Dexamethasone was administered in 43 of 258 (17%) patients in the 1998-2002 cohort and in 86 of 96 (90%) patients in the 2006-2011 cohort (p < 0.001), and was started with or before the first dose of antibiotics in 12 of 258 (5%) and 85 of 96 (89%) patients (p < 0.001). Rates of unfavorable outcome were similar between cohorts (12 of 100 12% vs 30 of 258 12%; p = 0.67), also after correction for meningococcal serogroup. The rates of hearing loss (3 of 96 3% vs 19 of 237 8%; p = 0.10) and death (4 of 100 4% vs 19 of 258 7%; p = 0.24) were lower in the 2006-2011 cohort, but this did not reach significance. The rate of arthritis was lower in patients treated with dexamethasone (32 of 258 12% vs 5 of 96 5%, p = 0.046). Dexamethasone was not associated with adverse events.
Adjunctive dexamethasone is widely prescribed for patients with meningococcal meningitis and is not associated with harm. The rate of arthritis has decreased after the implementation of dexamethasone.
This study provides Class III evidence that adjuvant dexamethasone in adults with meningococcal meningitis does not increase negative outcomes such as deafness, death, or negative Glasgow Outcome Scale measures.
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