Evaluation of a General Practitioner with Special Interest model: lessons learned from staff experiences.

BACKGROUND: The integration of general practitioners into specialist outpatient clinics is associated with improved access to care; however, little is understood about the organisation-level factors that affect successful implementation. We aimed to identify factors that were facilitators or barriers to the implementation of a General Practitioner with Special Interest (GPwSI) model of care across a range of specialties. METHODS: Semi-structured, in-depth interviews were conducted with 25 stakeholders at 13 GPwSI clinics in operation within a Queensland public health service. A deductive content analysis was conducted using the Consolidated Framework for Implementation Research (CFIR). RESULTS: Stakeholders generally supported the GPwSI model and saw advantages to patients and specialist medical practitioners in terms of waiting lists, workload, and improving clinician self-efficacy and knowledge. A number of factors were identified as being crucial to the success of the program, such as adequate support and planning for the implementation, appropriate funding and advocacy. CONCLUSIONS: Our evaluation indicates that a GPwSI model can be a beneficial resource for improving care to patients and reducing wait lists, dependent upon adequate planning, training, and support.

A brucellosis disease control strategy for the Kakheti region of the country of Georgia: an agent-based model.

Brucellosis has been reported in livestock and humans in the country of Georgia with Brucella melitensis as the most common species causing disease. Georgia lacked sufficient data to assess effectiveness of the various potential control measures utilizing a reliable population-based simulation model of animal-to-human transmission of this infection. Therefore, an agent-based model was built using data from previous studies to evaluate the effect of an animal-level infection control programme on human incidence and sheep flock and cattle herd prevalence of brucellosis in the Kakheti region of Georgia. This model simulated the patterns of interaction of human-animal workers, sheep flocks and cattle herds with various infection control measures and returned population-based data. The model simulates the use of control measures needed for herd and flock prevalence to fall below 2%. As per the model output, shepherds had the greatest disease reduction as a result of the infection control programme. Cattle had the greatest influence on the incidence of human disease. Control strategies should include all susceptible animal species, sheep and cattle, identify the species of brucellosis present in the cattle population and should be conducted at the municipality level. This approach can be considered as a model to other countries and regions when assessment of control strategies is needed but data are scattered.

Crystal structures of manganese and cobalt dichloride monohydrate and deuteration effects on magnetic behavior.

This work reports the long sought crystal structures of the title members of the intriguing series of 3d transition metal dichloride monohydrates. The double chain structure which results from rearrangement of the well-known pseudo-octahedral coordination geometry and single chains in the corresponding metal chloride dihydrate is extremely unusual. MnCl2·H2O and CoCl2·H2O each crystallize in orthorhombic space group Pnma with Z = 4 and lattice parameters a = 9.0339(1), 8.8207(3); b = 3.68751(5), 3.5435(1); c = 11.5385(2), 11.2944(4) all in Å and for Mn, Co, respectively. Results are reported also for both fully deuterated systems; the structures remain the same with lattice parameter changes typically much less than 0.1%. Various magnetic properties of MnCl2·D2O and CoCl2·D2O are reported. For the latter, there are no apparent differences, qualitatively or quantitatively, from the previously measured properties of CoCl2·H2O. Interestingly, for the former some differences with respect to MnCl2·H2O are apparent, principally a lower Tmax = 3.10(10) K about which a broad antiferromagnetic maximum is centered, and a larger value χmax = 0.336(3) emu/mol. However, antiferromagnetic ordering appears to occur at essentially the same 2.18(2) K. Results of fits to susceptibilities of MnCl2·D2O and CoCl2·D2O are compared with those obtained before for MnCl2·H2O and CoCl2·H2O. Structural considerations serve to rationalize the physical properties, especially the lower dimensional magnetism of monohydrates.

Risk factors associated with human brucellosis in the country of Georgia: a case-control study.

Human brucellosis occurs when humans ingest or contact Brucella spp. from shedding animals or contaminated environments and food. In Georgia animal and human brucellosis is endemic, but the epidemiology has not been fully characterized. A case-control study was conducted in 2010 to identify risk factors for human brucellosis. Using multivariable logistic regression, the following risk factors were identified: animal-related work [odds ratio (OR) 77·8, 90% confidence interval (CI) 4·7-1278], non-animal-related work (OR 12·7, 90% CI 1·1-149), being unemployed or a pensioner (OR 13·1, 90% CI 1·7, 101), sheep ownership (OR 19·3, 90% CI 5·1-72·6), making dairy products (OR 12·4, 90% CI 1·4-113), living in eastern Georgia (Kakheti) (OR 278·1, 90% CI 9·5-8100), and being aged >44 years (OR 9·3, 90% CI 1·02-84·4). Education of at-risk groups about risk factors and control of disease in sheep may reduce the human disease risk. This is the first study of its kind in Georgia since the collapse of the Soviet Union.

Co-expression of Flt-3 ligand gene ablates tumor immunity elicited by HER-2/neu DNA vaccine in transgenic mice.

Fms-like tyrosine-kinase 3 ligand (Flt-3L), is a powerful hematopoyetic growth factor, known to modulate the immune response against delivered antigens by acting either as an adjuvant or tolerogenic stimulus. In this study we evaluated the use of murine Flt-3 ligand plasmid (pFl) in combination with a DNA vaccine encoding rat-p185 oncoprotein extra cellular domain (pECD) in the prevention of mammary carcinogenesis in rat-neu HER-2 mutated (neuT) transgenic mice. We demonstrate that intramuscular (i.m.) co-immunization of pFl inhibits the production of anti-HER-2 antibody elicited by pECD vaccine, resulting in the development of spontaneous carcinomas in all co-immunized mice. The inhibitory effect on antibody production by mFlt3 gene appeared to be: dose-dependent, linked to the injection site and timing, and transient in nature. Additionally, we show that co-administration of pFI and pECD plasmids was unable to trigger cytotoxic T-cell immune response in neuT mice. On the other hand, we found that the combination of pFl with pECD had no impact on the ability of pECD to reject HER-2+ transplantable tumors in parental mice. In summary our results demonstrate that, depending on tumor model, co-administration of pFl gene can produce untoward effects to immune response, and thus its application as a vaccine adjuvant should be carefully evaluated.

ATP-dependent chromatin remodeling activities.

Genetic and biochemical approaches have indicated that the packaging of DNA into chromatin can be repressive to transcription. ATP-dependent chromatin remodelling activities can facilitate transcription from chromatin templates. Consistent with this, biochemical assays have shown that the action of ATP-dependent chromatin remodelling activities increase the accessibility of DNA within chromatin templates. However more recent functional studies suggest that many ATP-dependent chromatin remodelling activities can also function as repressors of transcription. Here we review recent advances to our understanding of the biological function of these complexes. We then consider some of the mechanisms by which ATP-dependent chromatin remodelling activities together with other forms of chromatin remodelling or modifying enzymes may act to regulate genomic accessibility either positively or negatively.

Mechanisms for ATP-dependent chromatin remodelling.

Gene regulation involves the generation of a local chromatin topology that is conducive to transcription. Several classes of chromatin remodelling activity have been shown to play a role in this process. ATP-dependent chromatin-remodelling activities use energy derived from the hydrolysis of ATP to alter the structure of chromatin, making it more accessible for transcription factor binding. The yeast SWI-SWF complex is the founding member of this family of ATP-dependent chromatin-remodelling activities. We have developed a model system to study the ability of the SWI-SWF complex to alter chromatin structure. Using this system, we find that SWI-SWF is able to alter the position of nucleosomes along the DNA. This is consistent with recent reports that other ATP-dependent chromatin-remodelling activities can alter the positions of nucleosomes along DNA. This suggests that nucleosome mobilization may be a general feature of the activity of ATP-dependent chromatin-remodelling activities. Some of the mechanisms by which nucleosomes may be moved along DNA are discussed.

Generation of superhelical torsion by ATP-dependent chromatin remodeling activities.

ATP-dependent chromatin remodeling activities participate in the alteration of chromatin structure during gene regulation. All have DNA- or chromatin-stimulated ATPase activity and many can alter the structure of chromatin; however, the means by which they do this have remained unclear. Here we describe a novel activity for ATP-dependent chromatin remodeling activities, the ability to generate unconstrained negative superhelical torsion in DNA and chromatin. We find that the ability to distort DNA is shared by the yeast SWI/SNF complex, Xenopus Mi-2 complex, recombinant ISWI, and recombinant BRG1, suggesting that the generation of superhelical torsion represents a primary biomechanical activity shared by all Snf2p-related ATPase motors. The generation of superhelical torque provides a potent means by which ATP-dependent chromatin remodeling activities can manipulate chromatin structure.