Abstract Objective There is much discussion at present on the need for a more patient-centered health service. However, it is not always clear what exactly this means for patients or healthcare ...providers. Furthermore many current trends in healthcare and society may in fact move the consultation further from the patient-centered model. In this article I shall critically review the current state of the consultation. Methods This article is based on a critical review of the literature. I shall firstly outline what is meant by the terms ‘patient centeredness’ and ‘participation’. I shall then examine what wider factors may facilitate or impede effective communication within the consultation. Results Patient centeredness and participation is challenged by several factors including the ‘co-modification’ of healthcare, the information revolution, the tension between choice and continuity, the process of medicalisation, population health strategies and the availability of resources. Conclusion I will argue that precisely because of these wider trends in society the consultation is now more important than ever as a point of access, communication, understanding and delivery of healthcare. Practice implications The structure and aims of the consultation must be re-visited in the light of the rapid pace of change in service delivery. As such, healthcare professionals may need to advocate for the continuing role of the patient-centered consultation.
For any natural number
n
, the group
G
n
of all invertible affine transformations of
n
-dimensional Euclidean space has, up to equivalence, just one square-integrable representation and the left ...regular representation of
G
n
is a multiple of this square-integrable representation. We provide a concrete realization
σ
of this distinguished representation in the two-dimensional case. We explicitly decompose the Hilbert space
L
2
(
G
2
)
as a direct sum of left-invariant closed subspaces on each of which the left regular representation acts as a representation equivalent to
σ
.
The group
G
2
of invertible affine transformations of
R
2
has, up to equivalence, one irreducible representation that is square–integrable. Two new realizations of this representation are presented ...and the associated Duflo–Moore operator is calculated. Two novel, but equivalent, continuous wavelet transforms, acting on functions of two plus one variables, are then derived.
Third sector organizations are oftentimes seen as contributing to a robust civil society. Yet the dominant modes of third sector organizational governance often adhere to a unitary orientation. The ...over-reliance on unitary modes of governance introduces two challenges: first, organizational stakeholders are kept from utilizing participatory mechanisms that would enable them to act as societal intermediaries, and; second, these organizations may underperform due to the artificial separation of stakeholders from participating in governance. This paper addresses calls to widen our knowledge by translating theory into practice through a discussion about the efficacy of pluralistic governance. The co-operative enterprise in introduced to focus analyses on pluralist modes of stakeholder governance. A specific co-operative's governance structure and practice is introduced-Choctaw Electric Co-operative-through an archival analyses of secondary media accounts of a stakeholder-led reform initiative in rural Oklahoma. The Ostrom Design Principles-a diagnostic used to assess institutional robustness-are applied to demonstrate the shortsightedness of unitary governance, and highlight the potential benefits of pluralistic stakeholder engagement. Knowledge is widened in two ways: first, empirical analyses of co-operative enterprise may provide for significant insights and innovations in third sector governance, and; second proper systems of pluralistic governance exhibit enormous capacity to better orient the firm toward better serving the stakeholder base, improving performance and institutional robustness, while empowering stakeholders as societal intermediaries.
The search for an effective and sustainable treatment method to remove the recalcitrant atom-bridged bis-anilino compounds, 4,4′-methylenedianiline (MDA) and 4,4′-thiodianiline (TDA) from water is a ...major challenge and focus of this study. The escalating discharge of these two toxic and carcinogenic pollutants from industrial sources may pose a serious threat to the environment. Crude soybean peroxidase (SBP), isolated from soybean seed hulls (coats), catalyzes the oxidative polymerization of these aqueous pollutants in the presence of hydrogen peroxide. The effects of several process parameters, i.e., pH, hydrogen peroxide-to-substrate concentration ratio and SBP concentration, were investigated to optimize the performance of enzymatic treatment. The minimum effective SBP concentration required for removal of MDA was 0.70 U/mL, which was higher than that of TDA (0.15 U/mL). The reaction time course to achieve ≥95% removal of these compounds from water was determined under those optimum conditions. Identification of the transformed products was performed by means of high-resolution electrospray ionization mass spectrometry. The products generally observed were protonated oxidized oxidative dimers and higher oligomers (most commonly azo-coupled products). Michaelis constant, KM, and maximum reaction velocity, Vmax, obtained from the Michaelis-Menten (M-M) model revealed that TDA had a 65-fold lower KM than MDA (indicating TDA's higher affinity for SBP), and almost 5-fold higher Vmax than MDA. A pro-forma cost analysis is presented to assess the possibility of commercialization of enzymatic treatment as an alternative to conventional/traditional treatment methods.
•SBP-induced removal of harmful arylamine substrates in water was accomplished.•Optimization of parameters: pH, H2O2 and SBP concentrations, was achieved.•Substrate kinetic parameters, KM and Vmax, determined by Michaelis-Menten model.•Mass spectrometry found oxidized oxidative dimers and higher oligomers in products.•Enzymatic removal of substrates was cheaper than conventional treatment methods.
Lignocellulosic biomass conversion using cellulases/polygalacturonases is a process that can be progressively influenced by several determinants involved in cellulose microfibril degradation. This ...article focuses on the kinetics and thermodynamics of thermal inactivation of recombinant Escherichia coli cellulases, cel12B, cel8C and a polygalacturonase, peh 28, derived from Pectobacterium carotovorum sub sp. carotovorum. Several consensus motifs conferring the enzymes' thermal stability in both cel12B and peh28 model structures have been detailed earlier, which were confirmed for the three enzymes through the current study of their thermal inactivation profiles over the 20-80°C range using the respective activities on carboxymethylcellulose and polygalacturonic acid. Kinetic constants and half-lives of thermal inactivation, inactivation energy, plus inactivation entropies, enthalpies and Gibbs free energies, revealed high stability, less conformational change and protein unfolding for cel12B and peh28 due to thermal denaturation compared to cel8C. The apparent thermal stability of peh28 and cel12B, along with their hydrolytic efficiency on a lignocellulosic biomass conversion as reported previously, makes these enzymes candidates for various industrial applications. Analysis of the Gibbs free energy values suggests that the thermal stabilities of cel12B and peh28 are entropy-controlled over the tested temperature range.
•Novel enzymatic polymerization of selected quinolines achieved.•3-Amino or hydroxyl substitution made them substrates of soybean peroxidase.•Optimization of parameters resulted in ≥94% substrate ...transformation efficiency.•Mass spectrometry suggested oxidative dimers and trimers are the products.•Free radical spin density maps predict possible radical coupling sites.
Although heterocyclic aromatics make up a vast group of water contaminants, the effect of enzyme on this class of recalcitrant compounds is largely unknown. Here, the feasibility of treatment of selected quinolines with soybean peroxidase is demonstrated and the effects of the most important parameters; pH, enzyme concentration, and peroxide concentration are optimized for each compound. 3-hydroxy and 3-aminoquinoline were found to be substrates amenable to ≥ 94% removal with pH optima of 8.6 and 5.6, respectively. In order to identify the transformation products of such treatment, the solution and precipitate after enzymatic treatment were analyzed by mass spectrometry to find that the dominant products were dimers and trimers from oxidative radical coupling. In addition, for 3-aminoquinoline azo-linked dimers and trimers were found. Computational techniques used to investigate the influence of redox potential and ionization energy of pollutants on their treatability by SBP showed a possible threshold between substrates and non-substrates. Computed spin densities were used to predict the regiochemistry of the radical coupling reaction.
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