Interaction among species, time-of-day, and soil water potential on biochemical and physiological characteristics of cladodes of Opuntia.

The physiology and biochemistry of young Opuntia spp. cladodes relate with their Crassulacean acid metabolism, which extends over the day-night cycle in four phases, is species-dependent and is affected by water availability. This study aimed to assess the interaction among species, time-of-day, and the soil water potential (ΨW) on biochemical and physiological characteristics of cladodes of Opuntia species. Three-week-old cladodes were harvested at 7:00 a.m. and 3:00 p.m. from plants with or without irrigation for 30 d (-0.17 and -5.72 MPa soil ΨW), from O. albicarpa, O. ficus-indica, O. hyptiacantha, O. megacantha, and O. streptacantha. The experimental design was a factorial 5 x 2 x 2 (species, sampling time and soil ΨW). The experimental unit was one cladode per plant, and six repetitions were evaluated. Total acids, glucose, fructose, sucrose, starch, total phenolics, free amino acids, and soluble proteins concentrations were evaluated, as well as acid invertase and neutral invertase activities. The interaction among species x soil ΨW and species x time of the day was significant (P ≤ 0.05) in all variables evaluated. An exception was the species x soil ΨW on starch concentration (P = 0.1827). The biochemical and physiological characteristics of Opuntia cladodes were modified by the time of the day and soil ΨW interaction, but most of the characteristics were positively or inversely affected depending on the species, frequently displaying a descending trend following O. streptacantha, O. hyptiacantha, O. megacantha, O. albicarpa and O. ficus-indica. The total acids, glucose, fructose, starch, soluble proteins, and free amino acids concentrations revealed that domestication significantly modifies C and N metabolism in Opuntia.

[Factors influencing the use of mechanisms for coordinating healthcare levels in Colombia]. / Factores que influyen en el uso de mecanismos de coordinación entre niveles asistenciales en Colombia.

OBJECTIVE: To analyse the factors influencing the use of mechanisms for the clinical coordination of two Colombian public healthcare networks' healthcare levels in Bogotá from the main social actors' perspective. METHOD: This was a descriptive-interpretative, qualitative study of two public healthcare networks. Discussion groups and semi-structured interviews were used for collecting information. The approach involved two-stage theoretical sampling of a selection of centres operating at different healthcare levels and a selection of informants, including managers (n=19), healthcare employees (n=23) and administrative staff (n=20). Content analysis involved adopting a mixed method approach for generating categories, segmented by network, informant group and topic. RESULTS: Both networks had few mechanisms for enabling the clinical coordination of healthcare levels; information transfer mechanisms predominated and clinical management coordination mechanisms only dealt with maternal-perinatal care. Organisational factor-related complications were found regarding their use: lack of time, staff turnover, administrative use and technological deficiency. Employee/staff-related difficulties were due to lack of interest. These factors directly affected coordination with limited information transfer, patient follow-up and healthcare quality (diagnosis and treatment delays). CONCLUSIONS: The results highlighted the limited use of clinical coordination mechanisms in both public healthcare networks studied here, with problems in their use. Changes are required that affect directly organisational factors (time for coordination and working conditions) and professional factors (attitudes towards collaborative work).

Histochemical Staining and Quantification of Arbuscular Mycorrhizal Fungal Colonization.

Histochemical staining and light microscopy-based techniques have been widely used to detect and quantify arbuscular mycorrhizal fungi (AMF) in roots. Here we describe a standardized method for staining of AMF in colonized roots, and we provide possible modifications to adjust the protocol according to particular requirements, such as the type of root material or the reduction of toxic products. In addition, we also summarize some of the most common ways to quantify arbuscular mycorrhizal colonization.

[Knowledge and use of clinical coordination mechanisms in healthcare networks in Latin America]. / Conocimiento y uso de mecanismos de coordinación clínica de servicios de salud de Latinoamérica.

OBJECTIVE: To analyze the level of knowledge and use, and the characteristics of use, of care coordination mechanisms in public healthcare networks of six Latin America countries. METHOD: Cross-sectional study based on a survey using the COORDENA® questionnaire with primary and secondary care doctors (348 doctors/country) of public healthcare networks in Argentina, Brazil, Chile, Colombia, Mexico and Uruguay (May-October 2015). Analyzed variables: degree of knowledge and use of information coordination (referral/reply letter, discharge report, phone, e-mail) and of clinical management coordination (shared clinical guidelines, joint meetings) mechanisms. Descriptive analyses were conducted. RESULTS: Knowledge of clinical information coordination mechanisms was high in both care levels and analyzed networks as was the use of referral/reply letter. There was greater variability in the use of discharge reports (from 40.0% in Brazil to 79.4% in Mexico) and, except for Argentina, a low reception reported by primary care doctors stands out (12.3% in Colombia and 55.1% in Uruguay). In contrast, knowledge of clinical management coordination mechanisms was limited, especially among secondary care doctors. It is noteworthy, however, that adherence to clinical guidelines was high (from 83.1% in Mexico to 96.8% in Brazil), while participation in joint meetings varied widely (from 23.7% in Chile to 76.2% in Brazil). The difficulties reported in the use of the mechanisms are related to structural and organizational factors. CONCLUSIONS: The limited knowledge and use of coordination mechanisms shows insufficient diffusion and implementation. Strategies to increase its use are needed, including the related factors.

Doctors' opinions on clinical coordination between primary and secondary care in the Catalan healthcare system.

OBJECTIVE: To analyse doctors' opinions on clinical coordination between primary and secondary care in different healthcare networks and on the factors influencing it. METHODS: A qualitative descriptive-interpretative study was conducted, based on semi-structured interviews. A two-stage theoretical sample was designed: 1) healthcare networks with different management models; 2) primary care and secondary care doctors in each network. Final sample size (n = 50) was reached by saturation. A thematic content analysis was conducted. RESULTS: In all networks doctors perceived that primary and secondary care given to patients was coordinated in terms of information transfer, consistency and accessibility to SC following a referral. However, some problems emerged, related to difficulties in acceding non-urgent secondary care changes in prescriptions and the inadequacy of some referrals across care levels. Doctors identified the following factors: 1) organizational influencing factors: coordination is facilitated by mechanisms that facilitate information transfer, communication, rapid access and physical proximity that fosters positive attitudes towards collaboration; coordination is hindered by the insufficient time to use mechanisms, unshared incentives in prescription and, in two networks, the change in the organizational model; 2) professional factors: clinical skills and attitudes towards coordination. CONCLUSIONS: Although doctors perceive that primary and secondary care is coordinated, they also highlighted problems. Identified factors offer valuable insights on where to direct organizational efforts to improve coordination.

Suppression of allene oxide synthase 3 in potato increases degree of arbuscular mycorrhizal fungal colonization.

Arbuscular mycorrhizal (AM) is a mutually beneficial interaction among higher plants and soil fungi of the phylum Glomeromycota. Numerous studies have pointed that jasmonic acid plays an important role in the development of the intraradical fungus. This compound belongs to a group of biologically active compounds known as oxylipins which are derived from the oxidative metabolism of polyunsaturated fatty acids. Studies of the regulatory role played by oxylipins in AM colonization have generally focused on jasmonates, while few studies exist on the 9-LOX pathway of oxylipins during AM formation. Here, the cDNA of Allene oxide synthase 3 (AOS3), a key enzyme in the 9-LOX pathway, was used in the RNA interference (RNAi) system to transform potato plants in order to suppress its expression. Results show increases in AOS3 gene expression and 9-LOX products in roots of wild type potato mycorrhizal plants. The suppression of AOS3 gene expression increases the percentage of root with mycorrhizal colonization at early stages of AM formation. AOS3 RNA interference lead to an induction of LOXA and 13-LOX genes, a reduction in AOS3 derived 9-LOX oxylipin compounds and an increase in jasmonic acid content, suggesting compensation between 9 and 13-LOX pathways. The results in a whole support the hypothesis of a regulatory role for the 9-LOX oxylipin pathway during mycorrhization.

The effect of pollen source vs. flower type on progeny performance and seed predation under contrasting light environments in a cleistogamous herb.

Dimorphic cleistogamy is a specialized form of mixed mating system where a single plant produces both open, potentially outcrossed chasmogamous (CH) and closed, obligately self-pollinated cleistogamous (CL) flowers. Typically, CH flowers and seeds are bigger and energetically more costly than those of CL. Although the effects of inbreeding and floral dimorphism are critical to understanding the evolution and maintenance of cleistogamy, these effects have been repeatedly confounded. In an attempt to separate these effects, we compared the performance of progeny derived from the two floral morphs while controlling for the source of pollen. That is, flower type and pollen source effects were assessed by comparing the performance of progeny derived from selfed CH vs. CL and outcrossed CH vs. selfed CH flowers, respectively. The experiment was carried out with the herb Ruellia nudiflora under two contrasting light environments. Outcrossed progeny generally performed better than selfed progeny. However, inbreeding depression ranges from low (1%) to moderate (36%), with the greatest value detected under shaded conditions when cumulative fitness was used. Although flower type generally had less of an effect on progeny performance than pollen source did, the progeny derived from selfed CH flowers largely outperformed the progeny from CL flowers, but only under shaded conditions and when cumulative fitness was taken into account. On the other hand, the source of pollen and flower type influenced seed predation, with selfed CH progeny the most heavily attacked by predators. Therefore, the effects of pollen source and flower type are environment-dependant and seed predators may increase the genetic differences between progeny derived from CH and CL flowers. Inbreeding depression alone cannot account for the maintenance of a mixed mating system in R. nudiflora and other unidentified mechanisms must thus be involved.

Factors associated to experienced continuity of care between primary and outpatient secondary care in the Catalan public healthcare system.

OBJECTIVE: To analyze patient's reported elements of relational, informational and managerial (dis)continuity between primary and outpatient secondary care and to identify associated factors. METHODS: Cross-sectional study by means of a survey of a random sample of 1500 patients attended in primary and secondary care for the same condition. The study settings consisted of three health areas of the Catalan health system. Data were collected in 2010 using the CCAENA questionnaire, which identifies patients' experiences of continuity of care. Descriptive analyses and multivariable logistic regression models were carried out. RESULTS: Elements of continuity of care were experienced by most patients. However, elements of discontinuity were also identified: 20% and 15% were seen by more than one primary or secondary care physician, respectively. Their secondary care physician or both professionals were identified as responsible for their care by 40% and 45% of users, respectively. Approximately 20% reported a lack of information transfer. Finally, 72% of secondary care consultations were due to primary care referral, whilst only 36% reported a referral back to primary care. Associated factors were healthcare setting, age, sex, perceived health status and disease duration. CONCLUSION: Users generally reported continuity of care, although elements of discontinuity were also identified, which can be partially explained by the healthcare setting and some individual factors. Elements of discontinuity should be addressed to better adapt care to patients' needs.

[Integral health provision by two Catalonian health providing entities (Spain)]. / Integración Asistencial de Dos Organizaciones en Cataluña, España.

OBJECTIVE: Health policies aimed at promoting collaboration amongst providers have led to different initiatives, amongst them integrated healthcare delivery systems (IDS); these have been analysed mainly in the USA but hardly so in Colombia or Spain . This article thus analyses the experience of two IDS in Catalonia for identifying elements for improvement. METHODS: This was a case-study carried out via individual semi-structured interviews and analysing documents. Two IDS were selected; a sample of documents and reports providing information on analysis variables were selected for each case. Content was analysed via mixed categories and segmentation by cases and topics. RESULTS: Both IDS are health-care providing organisations presenting backward vertical integration, having total internal service production and virtual integration of ownership. BSA is funded by providing services whilst SSIBE relies on shareholding via capitation pilot test. Both have closely coordinated multiple managing bodies and have defined overall strategies orientated towards coordination and efficiency; they differ regarding implementation time. BSA has a divisional structure and SSIBE a functional one, organised by transversal areas. Clinical coordination is based on standardising processes and abilities, having few mechanisms for mutual adaptation and disparity in the number of instruments implemented. CONCLUSIONS: Both organisations presented enabling and hindering factors for clinical coordination which would need changes in internal and external components in order to improve overall efficiency and health care continuity.

Integración asistencial de dos organizaciones en Cataluña, España / Integral health provision by two Catalonian health providing entities ( Spain )

Objetivo: El objetivo es analizar la experiencia de dos redes integradas de servicios de salud (RISS ) en Cataluña para identificar elementos de mejora. Métodos: Estudio de casos, mediante análisis de documentos y entrevistas individuales semi-estructuradas. Se seleccionaron dos casos -RISS- y para cada caso, documentos e informantes que proporcionaran información sobre las dimensiones de análisis. Se realizó análisis de contenido con generación mixta de categorías y segmentación por casos y temas. Trabajo de campo en 2004. Resultados: Ambas son organizaciones sanitarias integradas verticalmente hacia atrás, con producción interna total de servicios e integración virtual en la propiedad. Mientras la financiación de BSA es por línea de servicio, SSIBE participa en la prueba piloto de financiación capitativa. Ambas disponen de un gobierno múltiple estrechamente coordinado y han definido estrategias globales orientadas a la coordinación y la eficiencia, con diferencias en cuanto a tiempo de desarrollo. Mientras BSA poseía una estructura divisional, la de SSIBE es funcional por ámbitos transversales. La coordinación asistencial se basa en la normalización de procesos y de habilidades, con escasos mecanismos de adaptación mutua y disparidad en el número de instrumentos implementados. Conclusiones: Ambas organizaciones presentan elementos favorables y desfavorables a la coordinación asistencial, que requerirían cambios en los ámbitos interno y externo, que conduzcan hacia la eficiencia y la continuidad asistencial.

Objective: Health policies aimed at promoting collaboration amongst providers have led to different initiatives, amongst them integrated healthcare delivery systems (IDS); these have been analysed mainly in the USA but hardly so in Colombia or Spain . This article thus analyses the experience of two IDS in Catalonia for identifying elements for improvement. Methods: This was a case-study carried out via individual semi-structured interviews and analysing documents. Two IDS were selected; a sample of documents and reports providing information on analysis variables were selected for each case. Content was analysed via mixed categories and segmentation by cases and topics. Results: Both IDS are health-care providing organisations presenting backward vertical integration, having total internal service production and virtual integration of ownership. BSA is funded by providing services whilst SSIBE relies on shareholding via capitation pilot test. Both have closely coordinated multiple managing bodies and have defined overall strategies orientated towards coordination and efficiency; they differ regarding implementation time. BSA has a divisional structure and SSIBE a functional one, organised by transversal areas. Clinical coordination is based on standardising processes and abilities, having few mechanisms for mutual adaptation and disparity in the number of instruments implemented. Conclusions: Both organisations presented enabling and hindering factors for clinical coordination which would need changes in internal and external components in order to improve overall efficiency and health care continuity.

[Adult vaccination update]. / Actualización en la vacunación del adulto.

Vaccination, as a global concept, is the most cost-effective strategy in primary prevention of communicable diseases. One of the bigger difficulties in adult population is to reach the same vaccine coverage as in childhood vaccine programs. In order to solve this deficit, strategies established in the primary level are basic, due the fact that it's the first contact of adult population with health programs. Tertiary level could help to optimize vaccine coverage in specific groups. Active immunization in adults is established evaluating factors as age and gender, but specific circumstances associated with medical conditions, treatments or occupation could extend vaccine administration in adults.