Promoters of RbcS genes may contain a GS-box, which is a cis element with a core sequence related to the G-box, but split by a spacer of about 14 bp. Here we describe GSBF1, a DNA-binding protein ...that specifically interacts with a GS-box element located proximal to the G-box in the Brassica napus RbcS IV promoter. Sequence analysis of GSBF1 revealed a basic region/leucine zipper (bZIP) domain that displays structural features distinct from that of G-box binding factors (GBFs). Gel shift experiments showed that recombinant GSBF1 does not efficiently bind to the continuous G-box motif. RNA gel blot analysis indicated that GSBF1 transcripts are cotyledon-specific and accumulate to the highest levels during late seedling development in a ligh-dependent manner. During the same time period, RbcS IV transcript levels decreased simultaneously, suggesting that GSBF1 acts as a developmental, stage-specific, negative regulator of RbcS IV gene expression in rape seedlings.
G-box-binding factors (GBFs) are bZIP proteins that have been implicated in the transcriptional control of a number of plant genes including the family for the small subunit of ...ribulose-1,5-bisphosphate carboxylase/oxygenase. Using rbcS promoter regions as recognition site probes, we have cloned three Brassica GBFs designated as BnGBF1a, 1b and 2a. RNA gel blot analyses showed that all three BnGBF sequences give transcripts of the same size (1.3 kb) but in different amounts at a constant ratio in various tissues and developmental stages (1a > 2a > 1b). Transcript pools were largest in photosynthetically active organs such as leaves and cotyledons. Pool sizes correlated with those of total rbcS transcripts.
IT systems in the healthcare field can have a marked sociotechnical impact: they modify communication habits, alter clinical processes and may have serious ethical implications. The introduction of ...such systems involves very different groups of stakeholders because of the inherent multi-professionalism in medicine and the role of patients and their relatives that are often underrepresented. Each group contributes distinct perspectives and particular needs, which create specific requirements for IT systems and may strongly influence their acceptance and success. In the past, needs analysis, challenges and requirements for medical IT systems have often been addressed using consensus techniques such as the Delphi technique. Facing the heterogeneous spectrum of stakeholders there is a need to develop these techniques further to control the (strong) influence of the composition of the expert panel on the outcome and to deal systematically with potentially incompatible needs of stakeholder groups. This approach uses the strong advantages a Delphi study has, identifies the disadvantages of traditional Delphi techniques and aims to introduce and evaluate a modified approach called 360-Degree Delphi. Key aspects of 360-Degree Delphi are tested by applying the approach to the needs and requirements analysis of a system for managing patients' advance directives and living wills.
360-Degree Delphi (short 360°D), as a modified Delphi process, is specified as a structured workflow with the optional use of stakeholder groups. The approach redefines the composition of the expert panel by setting up groups of different stakeholders. Consensus is created within individual stakeholder groups, but is also communicated between groups, while the iterative structure of the Delphi process remains unchanged. We hypothesize that (1) 360-Degree Delphi yields complementary statements from different stakeholders, which would be lost in classical Delphi; while (2) the variation of statements within individual stakeholder groups is lower than within the total collective. A user study is performed that addresses five stakeholder groups (patients, relatives, medical doctors, nurses and software developers) on the topic of living will communication in an emergency context. Qualitative open questions are used in a Delphi round 0. Answer texts are coded by independent raters who carry out systematic bottom-up qualitative text analysis. Inter-rater reliability is calculated and the resulting codes are used to test the hypotheses. Qualitative results are transferred into quantitative questions and then surveyed in round 1. The study took place in Germany.
About 25% of the invited experts (stakeholders) agreed to take part in the Delphi round 0 (three patients, two relatives, three medical doctors, two qualified nurses and three developers), forming a structured panel of the five stakeholder groups. Two raters created a bottom-up coding, and 238 thematic codes were identified by the qualitative text analysis. The inter-rater reliability showed that 44.95% of the codes were semantically similar and coded for the same parts of the raw textual replies. Based on a consented coding list, a quantitative online-questionnaire was developed and send to different stakeholder groups. With respect to the hypotheses, Delphi round 0 had the following results: (1) doctors had a completely different focus from all the other stakeholder groups on possible channels of communications with the patient; (2) the dispersion of codes within individual stakeholder groups and within the total collective - visualized by box plots - was approximately 28% higher in the total collective than in the sub-collectives, but without a marked effect size. With respect to the hypotheses, Delphi round 1 had the following results: different stakeholder groups had highly diverging opinions with respect to central questions on IT-development. For example, when asked to rate the importance of access control against high availability of data (likert scale, 1 meaning restrictive data access, 6 easy access to all data), patients (mean 4.862, Stdev +/- 1.866) and caregivers (mean 5.667, Stdev: +/- 0.816) highly favored data availability, while relatives would restrict data access (mean 2.778, stdev +/- 1.093). In comparison, the total group would not be representative of either of these individual stakeholder needs (mean 4.344, stdev +/- 1.870).
360-Degree Delphi is feasible and allows different stakeholder groups within an expert panel to reach agreement individually. Thus, it generates a more detailed consensus which pays more tribute to individual stakeholders needs. This has the potential to improve the time to consensus as well as to produce a more representative and precise needs and requirements analysis. However, the method may create new challenges for the IT development process, which will have to deal with complementary or even contradictory statements from different stakeholder groups.
The aims of this investigation were to compare prevalence and severity of lower urinary tract symptoms (LUTS) in both sexes and to analyze their effect on everyday life ('botherness') in a ...cross-sectional study design.
Individuals participating in a health survey in Vienna completed a German version of the Bristol LUTS questionnaire. In this questionnaire, storage (irritative) and voiding (obstructive) symptoms were assessed by six items, each followed by a quality of life ('botherness') question.
A consecutive series of 1,191 women (49.8+/-13.5 years) and 1,211 men (48.5+/-11.9 years) were analyzed. The mean increase in LUTS from the youngest (20-39 years) to the oldest (>70 years) age group was 43.7% (7.3%/decade) for men and 23.6% (3.9%/decade) for women. In all decades, storage symptoms were higher for women. Beyond the age of 60 years this discrepancy declined. Voiding symptoms were almost identical in both sexes until the 5th decade, thereafter they increased significantly in men but not in women. 'Urgency' and 'frequency' were more bothersome to older individuals, 'nocturia' and voiding symptoms were almost equally bothersome to younger and older participants.
These data provide insights into the development of storage and voiding problems with age in both sexes. Sex- and age-stratified analyses of quality of life impairments ('botherness') due to LUTS have demonstrated the importance of age for the impact of LUTS on the bother score.
PDF
