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1.
Methods Mol Biol ; 2546: 459-472, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-36127613

RESUMO

We describe an LC-MS/MS method for serum testosterone using a novel extraction media, AC Extraction Plate™ (AC Plate,Tecan Schweiz). The AC Plate principle is essentially that of a liquid-liquid extraction (LLE) but employs a stationary nonpolar phase coated on the wells of 96-well plates instead of a nonmiscible organic solvent for partitioning testosterone out of serum, leaving interfering substances behind. This low complexity sample preparation protocol has been validated for and used in production in our laboratory with both manual and automated liquid handling. The primary advantage of this method is the highly reproducible nature of an extraction method that does not require LC-MS/MS expertise or specialized extraction equipment. We modified the existing vendor application and validated the method for matrix effect, recovery, precision, trueness [accuracy relative to certified reference material (CRM)], specificity, reportable range, sample stability, various sample containers, and correlation with other methods.Method performance is excellent, with a reportable range of 4-750 ng/dL, between-day quality control coefficient of variation (CV) over 12 months of <8%, mean accuracy of <4.0% bias against CRM, no interference from hemolysis, icterus, lipemia, serum separator tube gel, or common steroids/metabolites, and mean bias of 1.3% versus 4 other LC-MS/MS testosterone methods. An investigation of calibration stability and robustness supports sparse (3 versus 6 calibrators) and/or historical calibration for routine use.


Assuntos
Espectrometria de Massas em Tandem , Testosterona , Cromatografia Líquida/métodos , Extração Líquido-Líquido , Solventes , Espectrometria de Massas em Tandem/métodos
2.
Clin Chim Acta ; 491: 30-38, 2019 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-30615854

RESUMO

A liquid chromatography tandem mass spectrometry method was developed for quantifying ten cannabinoids in oral fluid (OF). This method utilizes OF collected by the Quantisal™ device and concurrently quantifies cannabinol (CBN), cannabidiol (CBD), Δ9-tetrahydrocannabinol (THC), 11-hydroxy-Δ9-THC (11-OH-THC), 11-nor-9-carboxy-Δ9-THC (THC-COOH), 11-nor-9-carboxy-Δ9-THC glucuronide (THC-COOH-gluc), Δ9-THC glucuronide (THC-gluc), cannabigerol (CBG), tetrahydrocannabiverin (THCV), and Δ9-tetrahydrocannabinolic acid A (THCA-A). Solid phase extraction was optimized using Oasis Prime HLB 30 mg 96-well plates. Cannabinoids were separated by liquid chromatography over a BEH C18 column and detected by a Waters TQ-S micro tandem mass spectrometer. The lower limits of quantification (LLOQ) were 0.4 ng/mL for CBN, CBD, THC, 11-OH-THC, THC-gluc, and THCV; and 1.0 ng/mL for THC-COOH, THC-COOH-gluc, CBG and THCA-A. Linear ranges extended to 2000 ng/mL for THC and 200 ng/mL for all other analytes. Inter-day analytical bias and imprecision at three levels of quality control (QC) was within ±15%. Mean extraction efficiencies ranged from 26.0-98.8%. Applicability of this method was tested using samples collected from individuals randomly assigned to smoke either a joint containing <0.1%, 5.9%, or 13.4% THC content. This method was able to identify and calculate the concentration of 6 of 10 cannabinoids validated in this method.


Assuntos
Líquidos Corporais/química , Canabinoides/análise , Cromatografia Líquida/métodos , Testes de Química Clínica/métodos , Espectrometria de Massas em Tandem/métodos , Calibragem , Canabinoides/isolamento & purificação , Humanos , Modelos Lineares
3.
Methods Mol Biol ; 1378: 301-20, 2016.
Artigo em Inglês | MEDLINE | ID: mdl-26602142

RESUMO

Serum from bar-coded tubes, and then internal standard, are pipetted to 96-well plates with an 8-channel automated liquid handler (ALH). The first precipitation reagent (methanol:ZnSO4) is added and mixed with the 8-channel ALH. A second protein precipitating agent, 1 % formic acid in acetonitrile, is added and mixed with a 96-channel ALH. After a 4-min delay for larger precipitates to settle to the bottom of the plate, the upper 36 % of the precipitate/supernatant mix is transferred with the 96-channel ALH to a Sigma Hybrid SPE(®) plate and vacuumed through for removal of phospholipids and precipitated proteins. The filtrate is collected in a second 96-well plate (collection plate) which is foil-sealed, placed in the autosampler (ALS), and injected into a multiplexed LC-MS/MS system running AB Sciex Cliquid(®) and MPX(®) software. Two Shimadzu LC stacks, with multiplex timing controlled by MPX(®) software, inject alternately to one AB Sciex API-5000 MS/MS using positive atmospheric pressure chemical ionization (APCI) and a 1.87 min water/acetonitrile LC gradient with a 2.1 × 20 mm, 2.7 µm, C18 fused core particle column (Sigma Ascentis Express). LC-MS/MS through put is ~44 samples/h/LC-MS/MS system with dual-LC channel multiplexing. Plate maps are transferred electronically from the ALH and reformatted into LC-MS/MS sample table format using the Data Innovations LLC (DI) Instrument Manager middleware application. Before collection plates are loaded into the ALS, the plate bar code is manually scanned to download the sample table from the DI middleware to the LC-MS/MS. After acquisition-LC-MS/MS data is analyzed with AB Sciex Multiquant(®) software using customized queries, and then results are transferred electronically via a DI interface to the LIS. 2500 samples/day can be extracted by two analysts using four ALHs in 4-6 h. LC-MS/MS analysis of those samples on three dual-channel LC multiplexed LC-MS/MS systems requires 19-21 h and data analysis can be done by two analysts in 4-6 h.


Assuntos
Métodos Analíticos de Preparação de Amostras/métodos , Análise Química do Sangue/métodos , Vitamina D/análogos & derivados , Métodos Analíticos de Preparação de Amostras/instrumentação , Automação , Análise Química do Sangue/instrumentação , Proteínas Sanguíneas/isolamento & purificação , Cromatografia Líquida , Humanos , Fosfolipídeos/isolamento & purificação , Controle de Qualidade , Espectrometria de Massas em Tandem , Vitamina D/sangue , Vitamina D/isolamento & purificação
4.
Methods Mol Biol ; 1383: 133-51, 2016.
Artigo em Inglês | MEDLINE | ID: mdl-26660183

RESUMO

Urine is processed with a simple C18 solid-phase extraction (SPE) and reconstituted in mobile phase. The liquid chromatography system (LC) injects 10 µL of extracted sample onto a reverse-phase LC column for gradient analysis with ammonium formate/acetonitrile mobile phases. Drugs in the column eluent become charged in the ion source using positive electrospray ionization (ESI). Pseudomolecular ions (M + H) are analyzed by a hybrid triple-quadrupole linear ion trap (QqQ and QqLIT) mass spectrometer using an SRM-IDA-EPI acquisition. An initial 125 compound selected ion monitoring (SRM) survey scan (triple quadrupole or QqQ mode) is processed by the information-dependent acquisition (IDA) algorithm. The IDA algorithm selects SRM signals from the survey scan with a peak height above the threshold (the three most abundant SRM signals above 1000 cps) to define precursor ions for subsequent dependent scanning. In the dependent QqLIT scan(s), selected precursor ion(s) are passed through the first quadrupole (Q1), fragmented with three different collision energies in the collision cell (Q2 or q), and product ions are collected in the third quadrupole (Q3), now operating as a linear ion trap (LIT). The ions are scanned out of the LIT in a mass dependent manner to produce a full-scan product ion spectrum (m/z 50-700) defined as an Enhanced (meaning acquired in LIT mode) Product Ion (EPI) spectrum (Mueller et al., Rapid Commun Mass Spectrom 19:1332-1338, 2005). Each EPI spectrum is linked to its precursor ion and to the associated SRM peak from the survey scan. EPI spectra are automatically searched against a 125 drug library of reference EPI spectra for identification. When the duty cycle is complete (one survey scan of 125 SRMs plus 0-3 dependent IDA-EPI scans) the mass spectrometer begins another survey scan of the 125 SRMs.


Assuntos
Cromatografia Líquida/métodos , Espectrometria de Massas/métodos , Preparações Farmacêuticas/urina , Extração em Fase Sólida/métodos , Urinálise/métodos , Humanos
5.
Evolution ; 68(7): 1845-55, 2014 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-24713065

RESUMO

The evolution of self-fertilization is one of the most commonly traversed transitions in flowering plants, with profound implications for population genetic structure and evolutionary potential. We investigated factors influencing this transition using Witheringia solanacea, a predominantly self-incompatible (SI) species within which self-compatible (SC) genotypes have been identified. We showed that self-compatibility in this species segregates with variation at the S-locus as inherited by plants in F1 and F2 generations. To examine reproductive assurance and the transmission advantage of selfing, we placed SC and SI genotypes in genetically replicated gardens and monitored male and female reproductive success, as well as selfing rates of SC plants. Self-compatibility did not lead to increased fruit or seed set, even under conditions of pollinator scarcity, and the realized selfing rate of SC plants was less than 10%. SC plants had higher fruit abortion rates, consistent with previous evidence showing strong inbreeding depression at the embryonic stage. Although the selfing allele did not provide reproductive assurance under observed conditions, it also did not cause pollen discounting, so the transmission advantage of selfing should promote its spread. Given observed numbers of S-alleles and selfing rates, self-compatibility should spread even under conditions of exceedingly high initial inbreeding depression.


Assuntos
Alelos , Polinização , Autoincompatibilidade em Angiospermas/genética , Solanaceae/genética , Evolução Molecular , Aptidão Genética , Autofertilização/genética , Solanaceae/fisiologia
6.
J Contin Educ Health Prof ; 34(1): 56-67, 2014.
Artigo em Inglês | MEDLINE | ID: mdl-24648364

RESUMO

INTRODUCTION: Evidence suggests that Crew Resource Management (CRM), a form of team training, is beneficial. In CRM training, participants learn individual portable team skills such as communication and decision making through group discussion and activities. However, the usual 1-day course format is not always compatible with health care organizational routines. A modular training format, while theoretically sound, is untested for interprofessional team training. The aim of this study was to explore the potential for modularized CRM training to be delivered to a group of interprofessional learners. METHOD: Modularized CRM training, consisting of two 2-hour workshops, was delivered to health care workers in an Australian tertiary hospital. Kirkpatrick's evaluation model provided a framework for the study. Baseline attitude surveys were conducted prior to each workshop. Participants completed a written questionnaire at the end of each workshop that examined their motivations, reactions to the training, and learner demographics. An additional survey, administered 6 weeks post training, captured self-assessed behavior data. RESULTS: Twenty-three individuals from a range of professions and clinical streams participated. One in 5 participants (22%) reported that they translated teamwork skills to the workplace. While positive about the workshop format and content, many respondents identified personal, team, and organizational barriers to the application of the workshop techniques. DISCUSSION: CRM training when delivered in a modular format has positive outcomes. Following the training, some respondents overcame workplace barriers to attempt to change negative workplace behavior. This progress provides cautious optimism for the potential for modular CRM training to benefit groups of interprofessional health staff.


Assuntos
Pessoal de Saúde/educação , Capacitação em Serviço/métodos , Modelos Educacionais , Equipe de Assistência ao Paciente/organização & administração , Adulto , Austrália , Aviação , Conscientização , Comunicação , Feminino , Humanos , Avaliação de Programas e Projetos de Saúde , Inquéritos e Questionários
7.
Med Educ ; 44(4): 396-403, 2010 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-20444075

RESUMO

CONTEXT: There is increasing agreement that graduates who finish tertiary education with the full complement of skills and knowledge required for their designated profession are not 'work-ready' unless they also acquire interpersonal, collaborative practice and team-working capabilities. Health workers are unable to contribute to organisational culture in a positive way unless they too attain these capabilities. These capabilities have been shown to improve health care in terms of patient safety, worker satisfaction and health service efficiency. Given the importance of interprofessional learning (IPL) which seeks to address these capabilities, why is IPL not consistently embedded into the education of undergraduates, postgraduates and vocationally qualified personnel through formal assessment? METHODS: This paper offers an argument for the formal assessment of IPL. It illustrates how the interests of the many stakeholders in IPL can benefit from, and contribute to, the integration of IPL into mainstream professional development and tertiary education. It offers practical examples of assessment in IPL which could drive learning and offer authentic, contextual teaching and learning experiences to undergraduates and health workers alike. CONCLUSIONS: Assessment drives learning and without formal assessment IPL will continue to be viewed as an optional topic of little relative importance for learners. In order to make the next step forward, IPL needs to be recognised and endorsed through formal assessment, both at the tertiary education level and within the workplace environment. This is supported by workforce initiatives and tertiary education policy which can be used to specify the capabilities or generic skills necessary for effective teamwork and collaborative practice.


Assuntos
Educação Médica/métodos , Avaliação Educacional/métodos , Relações Interprofissionais , Modelos Educacionais , Competência Profissional/normas , Austrália , Currículo , Educação Médica/normas , Avaliação Educacional/normas , Humanos
8.
J Interprof Care ; 24(4): 386-400, 2010 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-20377379

RESUMO

UNLABELLED: Work-integrated learning is essential to health professional education, but faces increasing academic and industry resource pressures. The aim of this pilot "Professional Practice Project" was to develop and implement an innovative education intervention for clinical educators across several health disciplines. The project used interprofessional collaboration as its underlying philosophy, and a participatory action research methodology in four cycles: Cycle 1: Formation of an interprofessional project executive and working party from academic staff. Data collection of student insights into work integrated learning. Cycle 2: Formation of an interprofessional reference group to inform curriculum development for a series of clinical education workshops. Cycle 3: Delivery of workshops; 174 clinical educators, supervisors and preceptors attended two workshops: "Introduction to experiential learning" and " CONTEXT: utilizing available resources for learning". Cycle 4: Seminar discussion of the Professional Practice Project at a national health-education conference. This pilot project demonstrated the advantages of using collaborative synergies to allow innovation around clinical education, free from the constraints of traditional discipline-specific education models. The planning, delivery and evaluation of clinical education workshops describe the benefits of interprofessional collaboration through enhanced creative thinking, sharing of clinical education models and a broadening of experience for both learners and facilitators.


Assuntos
Comportamento Cooperativo , Docentes , Pessoal de Saúde/educação , Relações Interprofissionais , Comunicação , Currículo , Humanos
9.
Methods Mol Biol ; 603: 187-202, 2010.
Artigo em Inglês | MEDLINE | ID: mdl-20077071

RESUMO

A liquid-liquid extraction (LLE) of drugs and internal standard (promazine) is performed by mixing urine at basic pH with 1-chlorobutane. There are no hydrolysis or derivatization steps. After centrifugation the organic (upper) layer is transferred to another tube and evaporated. The dried extract is reconstituted with ethyl acetate and 1 microL is injected onto the GCMS. Drugs are volatilized in the GC inlet and separated on a capillary column. In the EI source drugs become positively charged and fragment. Mass analysis of ionized fragments occurs with a single quadrupole. The resulting full scan mass spectra are automatically searched against three libraries.


Assuntos
Cromatografia Gasosa-Espectrometria de Massas/métodos , Preparações Farmacêuticas/urina , Espectrometria de Massas por Ionização por Electrospray/métodos , Acetatos/química , Algoritmos , Butanos/química , Humanos , Promazina/química , Padrões de Referência
10.
Methods Mol Biol ; 603: 203-18, 2010.
Artigo em Inglês | MEDLINE | ID: mdl-20077072

RESUMO

Centrifuged urine, internal standard (promazine), and ammonium formate buffer are mixed in an autosampler vial to achieve a 10-fold dilution of the specimen. Without additional pretreatment, 10 microL of the sample is injected onto a C18 reverse phase column for gradient analysis with ammonium formate/acetonitrile mobile phases. Drugs in the column eluent become charged in the ion source using positive electrospray atmospheric pressure ionization. Pseudomolecular drug ions are analyzed by a hybrid triple quadrupole linear ion trap mass spectrometer operated with a 264-drug selected ion monitoring (SRM) acquisition method that includes an information-dependant acquisition (IDA) algorithm.


Assuntos
Cromatografia Líquida/métodos , Preparações Farmacêuticas/urina , Espectrometria de Massas em Tandem/métodos , Acetonitrilas/química , Algoritmos , Formiatos/química , Humanos , Promazina/química , Padrões de Referência , Reprodutibilidade dos Testes
11.
Am J Bot ; 97(8): 1328-33, 2010 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-21616885

RESUMO

PREMISE OF THE STUDY: Embryonic inbreeding depression is a key influence on mating system evolution and can be difficult to estimate in self-incompatible species. A pollen chase experiment was used to estimate the magnitude of embryonic inbreeding depression in Costa Rican Witheringia solanacea, a species polymorphic for self-incompatibility (SI). In a pollen chase experiment, bud self-pollinations are followed after anthesis by outcross pollinations, with a comparable pair of outcross pollinations used as a control. Lowered seed set for the self-precedence treatment indicates embryonic inbreeding depression. • METHODS: Embryonic inbreeding depression was assayed for self-compatible (SC) individuals and for SI plants from two populations that differ quantitatively in the onset and enzymatic activity of their SI response. Microsatellite markers were used to assay the selfing rate of a sample of surviving progeny from the prior self-pollination treatment. • KEY RESULTS: SC individuals showed no evidence of embryonic inbreeding depression. In SI plants, prior self-pollination reduced seed number by 28-70%, depending on population. Microsatellite genotyping revealed that embryonic inbreeding depression was even more severe than estimated by the phenotypic data: for mature fruits resulting from self-pollination precedence, the majority of the progeny were the result of outcross fertilization. • CONCLUSIONS: Lineage-specific purging of recessive lethals has accompanied the evolution of SC in this species. SI populations show contrasting levels of embryonic inbreeding depression, with nearly complete embryonic lethality upon selfing in the Monteverde population. In the face of high embryonic inbreeding depression, an increase in selfing rate can evidently occur only under severe pollen limitation.

12.
J Forensic Sci ; 54(6): 1485-7, 2009 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-19878416

RESUMO

A case is presented of a 39-year-old woman who suffered severe debilitation because of a hemorrhagic stroke in the context of substance abuse. The patient presented to the emergency room with rapidly diminishing mental status, hypertension, and vasoconstriction; her friends provided a history of ingestion of cocaine, 3,4-methylenedioxymethamphetamine (MDMA), and 2C-I, a novel designer amine. A multi-targeted LC-MS/MS method for sympathomimetic amines and related drugs in urine detected and quantified 2C-I and MDA, while ruling out MDMA. The cause of the stroke was determined to be an underlying cerebrovascular abnormality called Moyamoya, secondary to substance abuse. In clinical laboratories, gas chromatography-mass spectrometry or liquid chromatography-tandem mass spectrometry (LC-MS/MS) confirmation of a positive amphetamine immunoassay is usually directed only towards amphetamine, methamphetamine, MDMA and MDA. This report demonstrates the utility of testing for a wider menu of compounds using LC-MS/MS in order to better characterize the prevalence and toxicities of novel amines such as 2C-I.


Assuntos
3,4-Metilenodioxianfetamina/efeitos adversos , Drogas Desenhadas/efeitos adversos , Dimetoxifeniletilamina/análogos & derivados , Alucinógenos/efeitos adversos , Hemorragias Intracranianas/etiologia , Acidente Vascular Cerebral/etiologia , 3,4-Metilenodioxianfetamina/análise , Adulto , Cromatografia Gasosa , Drogas Desenhadas/análise , Dimetoxifeniletilamina/efeitos adversos , Dimetoxifeniletilamina/análise , Feminino , Toxicologia Forense , Cromatografia Gasosa-Espectrometria de Massas , Alucinógenos/análise , Humanos , Doença de Moyamoya/complicações , Doença de Moyamoya/diagnóstico , Quadriplegia/etiologia , Detecção do Abuso de Substâncias/métodos , Transtornos Relacionados ao Uso de Substâncias/complicações
13.
Clin Chem ; 55(1): 126-33, 2009 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-19028813

RESUMO

BACKGROUND: Approximately 6% of new-onset seizures are drug-related, but there is currently no reliable way to determine if a seizure is drug-induced. Liquid chromatography-tandem mass spectrometry (LC-MS/MS) is a powerful tool that allows simultaneous detection of numerous analytes of diverse chemical nature in patient samples. This allows a single analysis to incorporate many compounds relevant to a particular clinical presentation, such as suspected drug-induced seizures. We investigated whether results from a seizure panel using LC-MS/MS could affect patient care. METHODS: We developed a semiquantitative LC-MS/MS assay to detect 12 chemically diverse drugs implicated in drug-related seizures. We collected leftover serum and plasma samples from patients who had seized, performed solid-phase extraction, and analyzed the samples using a hybrid triple quadrupole/linear ion trap mass spectrometer. After assembling a team of medical and toxicology experts, we developed and used a scoring system to determine whether the results of the seizure panel would have affected patient treatment in each case where a drug was detected. RESULTS: In an analysis of 157 samples from patients who seized, 17 (11%) were found to be positive for a drug on the seizure panel. The team of experts determined that the test results probably or definitely would have affected treatment in 7 (41%) of these cases. CONCLUSIONS: A test that detects the presence of drugs implicated in drug-induced seizures can help physicians determine if an unexplained seizure is drug-related and thus potentially better direct patient care. Additionally, LC-MS/MS is an effective tool for answering clinically driven questions.


Assuntos
Monitoramento de Medicamentos , Efeitos Colaterais e Reações Adversas Relacionados a Medicamentos , Preparações Farmacêuticas/sangue , Convulsões/sangue , Convulsões/induzido quimicamente , Adulto , Idoso , Cromatografia Líquida , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Sensibilidade e Especificidade , Extração em Fase Sólida , Espectrometria de Massas em Tandem
14.
Clin Chim Acta ; 396(1-2): 86-8, 2008 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-18619430

RESUMO

BACKGROUND: s-Adenosylmethionine (SAM)1 has been suggested as a diagnostic test and surrogate marker for Pneumocystis jirovecii pneumonia (PCP) in HIV-positive patients. In this study, we report a robust hydrophilic-interaction liquid chromatography tandem mass spectrometry (LC-MS/MS) assay that can be used to quantitate serum SAM in clinical laboratories. METHODS: Proteins in serum samples were precipitated using trichloroacetic acid. The supernatant was separated after centrifugation. D3d3-SAM was added as the internal standard. SAM and d3-SAM were extracted using a mixed-mode cation exchange column. Extracts were dried under nitrogen and reconstituted in H2O and acetonitrile (1:9, vol:vol). HPLC-tandem mass spectrometry analysis was performed with a silica column and multiple reaction monitoring for SAM and d3-SAM. RESULTS: The limit of quantitation (LOQ) for SAM was 10 ng/mL. The assay was linear between 10 and 500 ng/mL. Intra-assay coefficient of variation (CV) was 8% and inter-assay CV was 17% at the LOQ. Turnaround time for each specimen was approximately 1 h. Using this method, we found that serum SAM concentration was correlated with fasting status, especially methionine intake. We also measured acute and convalescent serum SAM levels of 8 HIV-positive patients with PCP and non-PCP pneumonia. SAM concentrations in convalescent samples were significantly increased compared to acute levels only in patients with PCP. CONCLUSIONS: The LC-MS/MS method had sufficient analytical sensitivity for detecting low levels of SAM found in HIV-infected patients and can be used for quantitative measurements in a clinical laboratory. This method facilitates research and possible clinical application of SAM as a marker for PCP.


Assuntos
Infecções por HIV/sangue , S-Adenosilmetionina/sangue , S-Adenosilmetionina/química , Espectrometria de Massas em Tandem/métodos , Água/química , Biomarcadores/sangue , Jejum , Humanos
16.
BMC Health Serv Res ; 7: 144, 2007 Sep 13.
Artigo em Inglês | MEDLINE | ID: mdl-17854507

RESUMO

BACKGROUND: Inter-professional learning (IPL) and inter-professional practice (IPP) are thought to be critical determinants of effective care, improved quality and safety and enhanced provider morale, yet few empirical studies have demonstrated this. Whole-of-system research is even less prevalent. We aim to provide a four year, multi-method, multi-collaborator action research program of IPL and IPP in defined, bounded health and education systems located in the Australian Capital Territory (ACT). The project is funded by the Australian Research Council under its industry Linkage Program. METHODS/DESIGN: The program of research will examine in four inter-related, prospective studies, progress with IPL and IPP across tertiary education providers, professional education, regulatory and registration bodies, the ACT health system's streams of care activities and teams, units and wards of the provider facilities of the ACT health system. One key focus will be on push-pull mechanisms, ie, how the education sector creates student-enabled IPP and the health sector demands IPL-oriented practitioners. The studies will examine four research aims and meet 20 research project objectives in a comprehensive evaluation of ongoing progress with IPL and IPP. DISCUSSION: IPP and IPL are said to be cornerstones of health system reforms. We will measure progress across an entire health system and the clinical and professional education systems that feed into it. The value of multi-methods, partnership research and a bi-directional push-pull model of IPL and IPP will be tested. Widespread dissemination of results to practitioners, policymakers, managers and researchers will be a key project goal.


Assuntos
Educação Profissional em Saúde Pública/métodos , Pesquisa sobre Serviços de Saúde/métodos , Relações Interprofissionais , Aprendizagem , Modelos Educacionais , Administração em Saúde Pública/educação , Centros Médicos Acadêmicos , Território da Capital Australiana , Comportamento Cooperativo , Reforma dos Serviços de Saúde , Humanos , Projetos Piloto , Desenvolvimento de Programas , Avaliação de Programas e Projetos de Saúde , Integração de Sistemas
17.
Am J Bot ; 93(4): 592-8, 2006 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-21646220

RESUMO

Breakdown of genetically enforced self-incompatibility (SI), an extremely common and important evolutionary transition in plants, has conventionally been conceived as a qualitative rather than a quantitative change. We evaluated qualitative and quantitative variation in SI for four populations of Witheringia solanacea in Costa Rica, examining growth of self-pollen tubes in pollinations of buds and mature flowers. We also measured levels of RNase production in styles to determine whether enzyme production was correlated with differences in self-rejection. The two small populations contained both self-compatible (SC) individuals and obligate outcrossers (female or SI). Plants in the two large populations were uniformly SI as revealed by pollen tube growth, although several of these individuals sporadically set seed autogamously. Stylar RNase activity did not differ significantly between bud and mature flowers, but self-pollen tube growth did differ, suggesting that a gene product in addition to S-RNase is responsible for developmental onset of SI. Population-level differences in RNase activity were consistent with differences in the strength of the rejection response in bud pollinations, suggesting that a threshold level of S-RNase, in combination with other factors, is necessary for SI. Our results support a growing body of evidence that not only qualitative variation in SI, but also quantitative variation may be functionally significant.

18.
JAMA ; 290(2): 238-47, 2003 Jul 09.
Artigo em Inglês | MEDLINE | ID: mdl-12851279

RESUMO

CONTEXT: The expression and release of tissue factor is a major trigger for the activation of coagulation in patients with sepsis. Tissue factor pathway inhibitor (TFPI) forms a complex with tissue factor and blood protease factors leading to inhibition of thrombin generation and fibrin formation. OBJECTIVES: To determine if administration of tifacogin (recombinant TFPI) provides mortality benefit in patients with severe sepsis and elevated international normalized ratio (INR) and to assess tifacogin safety in severe sepsis, including patients with low INR. DESIGN AND SETTING: A randomized, double-blind, placebo-controlled, multicenter, phase 3 clinical trial conducted from March 21, 2000, through September 27, 2001, in 245 hospitals in 17 countries in North America, Europe, and Israel. PATIENTS: The primary efficacy population consisted of 1754 patients (> or =18 years) with severe sepsis and a high INR (> or =1.2) randomly assigned to intravenous infusion of either tifacogin (0.025 mg/kg per hour for 96 hours, n = 880) or placebo (arginine citrate buffer, n = 874), and 201 patients with a low INR (<1.2) randomly assigned to receive the same dose of either tifacogin or placebo. MAIN OUTCOME MEASURE: All-cause 28-day mortality. RESULTS: Overall mortality at 28 days in the tifacogin-treated group (n = 880) vs the placebo group (n = 874) for high INR was 34.2% vs 33.9%, respectively (P =.88, Pearson chi2 test; P =.75, logistic regression model). None of the protocol-specified secondary end points differed between the tifacogin vs placebo groups. An analysis on the first 722 patients demonstrated a mortality rate of 38.9% for placebo vs 29.1% for tifacogin (P =.006, Pearson chi2 test). Tifacogin significantly attenuated prothrombin fragment 1.2 and thrombin:antithrombin complex levels (P<.001, 2-sample t test) in patients with high and low INR. Overall mortality was lower in the tifacogin response in patients with low INR (12%; n = 83) vs placebo (22.9%; n = 118) (P =.051, Pearson chi2 test; P =.03, logistic regression model). There was an increase in serious adverse events with bleeding in the tifacogin group in both cohorts (6.5% tifacogin and 4.8% placebo for high INR; 6.0% tifacogin and 3.3% placebo for low INR). CONCLUSIONS: Treatment with tifacogin had no effect on all-cause mortality in patients with severe sepsis and high INR. Tifacogin administration was associated with an increase in risk of bleeding, irrespective of baseline INR.


Assuntos
Anticoagulantes/uso terapêutico , Lipoproteínas/uso terapêutico , Proteínas/uso terapêutico , Síndrome de Resposta Inflamatória Sistêmica/tratamento farmacológico , Método Duplo-Cego , Interações Medicamentosas , Feminino , Heparina/uso terapêutico , Humanos , Coeficiente Internacional Normatizado , Lipoproteínas/efeitos adversos , Lipoproteínas/sangue , Masculino , Pessoa de Meia-Idade , Proteínas/efeitos adversos , Proteínas Recombinantes/uso terapêutico , Análise de Sobrevida , Síndrome de Resposta Inflamatória Sistêmica/sangue
19.
Evolution ; 56(11): 2187-95, 2002 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-12487349

RESUMO

Genetically based variation in outcrossing rate generates lineages within populations that differ in their history of inbreeding. According to some models, mating-system modifiers in such populations will demonstrate both linkage and identity disequilibrium with fitness loci, resulting in lineage-specific inbreeding depression. Other models assert that differences among families in levels of inbreeding depression are mainly attributable to random accumulation of genetic load, unrelated to variation at mating-system loci. We measured female reproductive success of selfed and outcrossed progeny from naturally occurring lineages of Datura stramonium, a predominantly self-fertilizing annual weed that has heritable variation in stigma-anther separation, a trait that influences selfing rates. Progeny from inbred lineages (as identified by high degree of anther-stigma overlap) showed equal levels of seed production, regardless of cross type. Progeny from mixed lineages (as identified by relatively high separation between anthers and stigma) showed moderate levels of inbreeding depression. We found a significant correlation between anther-stigma separation and relative fitness of selfed and outcrossed progeny, suggesting that family-level inbreeding depression may be related to differences among lineages in inbreeding history in this population. Negative inbreeding depression in putatively inbred lineages may be due in part to additive effects or to epistatic interactions among loci.


Assuntos
Datura stramonium/genética , Flores , Variação Genética , Datura stramonium/anatomia & histologia , Datura stramonium/fisiologia , Endogamia , Reprodução
20.
Oecologia ; 107(4): 504-512, 1996 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-28307394

RESUMO

In this paper I report components of effectiveness for pollinators of a tropical distylous shrub, Psychotria suerrensis (Rubiaceae), which is visited by a variety of bees, wasps, and butterflies, and by two species of hummingbirds. In the field, I measured the following components of effectiveness: frequency of visits, evenness of visits across plants, and diurnal pattern of visits. I also used flight-cage experiments to compare pollentransfer abilities of euglossine bees and heliconiid butterflies. Euglossine bees visited more frequently, visited earlier in the day, and visited a higher proportion of plants in the population than did other taxa. In flight cage experiments, bees and butterflies transferred similar amounts of pollen overall, but bees transferred significantly more inter-morph (compatible) pollen. For each component measured, euglossine bees appeared to be the most effective pollinators.

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