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Gayathri Embuldeniya Jennifer Gutberg Walter P. Wodchis 《Health policy (Amsterdam, Netherlands)》2021,125(1):83-89
Purpose/settingTo encourage clinical and financial efficiency, the Canadian province of Ontario initiated an integrated care program – Integrated Funding Models (IFMs) that required collaboration and coordination across acute and post-acute care sectors. This research shows how program implementers went beyond policy-makers’ original designs, to make integrated care sustainable for chronic diseases.MethodsForty-five interviews were conducted with program participants at three chronic disease programs, as well as with policymakers. Interviews were conducted over two phases; during early implementation in 2016, and as programs matured in 2018. Data were analyzed through a cultural constructivist lens to understand how participants shaped programs.FindingsParticipants desired greater accountability and control. Participants in the first program wanted localized control over decision-making. In the second, participants initiated greater control over financial uncertainty. In the third program, hospital participants sought greater control over community care. Participants across programs simultaneously wanted integrated care to be expanded holistically, spatially, and temporally for patients, extending the length of care, and expanding the spaces in which care was provided. Findings also suggest a gap between program implementers’ and policymakers’ conceptualizations of integrated care.ConclusionThis work shows how IFMs were reimagined in ways that transcended their original conceptualization as spatially and temporally delimited initiatives aimed at improving coordination and efficiency. It has practical implications for those facing sustainability challenges in other contexts. 相似文献
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Saravana Kumar Jaganathan Muthu Vignesh Vellayappan Gayathri Narasimhan Eko Supriyanto 《World journal of gastroenterology : WJG》2014,20(16):4618-4625
Colorectal cancer is the second leading cause of cancer-related deaths in the United States.Recent studies prove that though chemotherapeutic agents are being used for the treatment of colon cancer,they become non-effective when the cancer progresses to an invasive stage.Since consumption of certain dietary agents has been linked with various cancers,fruit juices have been investigated for their consistently protective effect against colon cancer.The unique biochemical composition of fruit juices is responsible for their anticancer properties.In this review,the chemo-preventive effect of fruit juices such as pomegranate and citrus juices against colon cancer are discussed.For this purpose,the bioavailability,in vitro and in vivo effects of these fruit juices on colorectal cancer are highlighted.Moreover,there is a scarcity of studies involving human trials to estimate the preventive nature of these juices against colon cancer.This review will support the need for more preclinical tests with these crude juices and their constituents in different colorectal cancer cell lines and also some epidemiological studies in order to have a better understanding and promote pomegranate and citrus juices as crusaders against colon cancer. 相似文献
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Participation of the S4 voltage sensor in the Mg2+-dependent activation of large conductance (BK) K+ channels 下载免费PDF全文
Hu L Shi J Ma Z Krishnamoorthy G Sieling F Zhang G Horrigan FT Cui J 《Proceedings of the National Academy of Sciences of the United States of America》2003,100(18):10488-10493
The S4 transmembrane segment is the primary voltage sensor in voltage-dependent ion channels. Its movement in response to changes in membrane potential leads to the opening of the activation gate, which is formed by a separate structural component, the S6 segment. Here we show in voltage-, Ca2+-, and Mg2+-dependent, large conductance K+ channels that the S4 segment participates not only in voltage- but also Mg2+-dependent activation. Mutations in S4 and the S4-S5 linker alter voltage-dependent activation and have little or no effect on activation by micromolar Ca2+. However, a subset of these mutations in the C-terminal half of S4 and in the S4-S5 linker either reduce or abolish the Mg2+ sensitivity of channel gating. Cysteine residues substituted into positions R210 and R213, marking the boundary between S4 mutations that alter Mg2+ sensitivity and those that do not, are accessible to a modifying reagent [sodium (2-sulfonatoethyl)methane-thiosulfonate] (MTSES) from the extracellular and intracellular side of the membrane, respectively, at -80 mV. This implies that interactions between S4 and a cytoplasmic domain may be involved in Mg2+-dependent activation. These results indicate that the voltage sensor is critical for Mg2+-dependent activation and the coupling between the voltage sensor and channel gate is a converging point for voltage- and Mg2+-dependent activation pathways. 相似文献
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Cohen BE Pralle A Yao X Swaminath G Gandhi CS Jan YN Kobilka BK Isacoff EY Jan LY 《Proceedings of the National Academy of Sciences of the United States of America》2005,102(4):965-970
The usefulness of fluorescence in studying protein motions derives from its sensitivity, kinetic resolution, and compatibility with both live cells and physiological assays. Recent advances in microscopy and membrane protein purification have permitted the observation of fluorescence changes that accompany the functional transitions of complex eukaryotic membrane proteins. These techniques rely on probes that can clearly report the environmental changes of specific residues, but most commonly available side-chain-reactive probes are not well suited for this purpose. Here, we introduce a red Cys-reactive probe, aminophenoxazone maleimide (APM), designed with improved chemical and spectral properties for reporting protein conformational change. APM is compact, uncharged, and has a short linker between probe and protein, all of which ensure that it can closely track the motions of the side chain to which it is attached. It undergoes large polarity-dependent changes in Stokes shift, as well as large bathochromic shifts in both excitation maximum (from 521 nm in toluene to 598 nm in water) and emission maximum (580 nm to 633 nm). These polarity-dependent spectral changes offer a potentially simple means of relating fluorescence to local structure and motion, although they are partially offset by some complicating factors in APM fluorescence. We find that, like a rhodamine maleimide, APM senses the conformational changes underlying voltage sensing in the Shaker potassium channel, and it is superior at a site that shows limited reactivity to the rhodamine. The spectral characteristics of APM can also report subtle differences between aqueous positions in purified preparations of the beta2 adrenergic receptor. 相似文献
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Jasmine Aliya G.V. Akila Durai Vanitha M. Anitha Rani Shriraam Vanishree V. Samya T. Gayathri Mahadevan Shriraam 《International journal of diabetes in developing countries.》2021,41(2):293-300
International Journal of Diabetes in Developing Countries - There is a huge burden of diabetes-related complications, both microvascular and macrovascular, in India. With the rising prevalence of... 相似文献
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Jitendra Jethwani Gayathri S. Jethwani A. K. Verma 《Journal of Indian Prosthodontic Society》2012,12(1):55-58
The loss of an eye is the most devastating, psychologically damaging experience for a patient. All hope to bring such patients back to their accustomed and comfortable life-style rests on a cosmetically acceptable prosthesis. An intra-orbital ocular prosthesis serves the purpose in those defects where the orbital margins are intact. Though the stock eye may match the natural eye’s iris and sclera in color, the fit of the prosthesis to the tissue bed may not be as good as desired. Herein, a functional ocular impression technique is presented to achieve a better fit of the prosthesis to the defect area. This technique aims to combine cosmetic excellence with comfort for greater benefit to the patient. 相似文献
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We here investigate the occurrence of fluoride intake-associated alterations in patients with hematologic disease on triazol antifungal medication. Clinical, laboratory, and radiology data of overall 43 patients with hematologic malignancies taking voriconazole (n = 20), posaconazole (n = 8), and itraconazole (n = 4), and a hematologic patient control group (n = 11) are described. Bone pain and radiologic evidence of periostitis were exclusively observed in patients receiving long-term voriconazole. Cessation of treatment led to clinical improvement in all cases. In line with clinical evidence, fluoride serum concentration was elevated in patients receiving voriconazole (median, 156.5 μg/L; interquartile range, 96.8 μg/L; normal < 30 μg/L) but not in the other treatment groups (P < .001 for all comparisons vs voriconazole). We conclude that serum fluoride levels were elevated on average 5-fold above normal levels in hematologic patients receiving voriconazole. Clinically relevant skeletal disease was associated with renal insufficiency and above 10-fold elevated fluoride levels, and was reversible on termination of voriconazole treatment. 相似文献