Delayed response to cold stress is characterized by successive metabolic shifts culminating in apple fruit peel necrosis.

BACKGROUND: Superficial scald is a physiological disorder of apple fruit characterized by sunken, necrotic lesions appearing after prolonged cold storage, although initial injury occurs much earlier in the storage period. To determine the degree to which the transition to cell death is an active process and specific metabolism involved, untargeted metabolic and transcriptomic profiling was used to follow metabolism of peel tissue over 180 d of cold storage. RESULTS: The metabolome and transcriptome of peel destined to develop scald began to diverge from peel where scald was controlled using antioxidant (diphenylamine; DPA) or rendered insensitive to ethylene using 1-methylcyclopropene (1-MCP) beginning between 30 and 60 days of storage. Overall metabolic and transcriptomic shifts, representing multiple pathways and processes, occurred alongside α-farnesene oxidation and, later, methanol production alongside symptom development. CONCLUSIONS: Results indicate this form of peel necrosis is a product of an active metabolic transition involving multiple pathways triggered by chilling temperatures at cold storage inception rather than physical injury. Among multiple other pathways, enhanced methanol and methyl ester levels alongside upregulated pectin methylesterases are unique to peel that is developing scald symptoms similar to injury resulting from mechanical stress and herbivory in other plants.

Chilling-related cell damage of apple (Malus × domestica Borkh.) fruit cortical tissue impacts antioxidant, lipid and phenolic metabolism.

'Soggy breakdown' (SB) is an internal flesh disorder of 'Honeycrisp' apple (Malus × domestica Borkh.) fruit that occurs during low temperature storage. The disorder is a chilling injury (CI) in which visible symptoms typically appear after several weeks of storage, but information about the underlying metabolism associated with its induction and development is lacking. The metabolic profile of flesh tissue from wholly healthy fruit and brown and healthy tissues from fruit with SB was characterized using gas chromatography-mass spectrometry (GC-MS) and liquid chromatograph-mass spectrometry (LC-MS). Partial least squares discriminant analysis (PLS-DA) and correlation networks revealed correlation among ester volatile compounds by composition and differences in phytosterol, phenolic and putative triacylglycerides (TAGs) metabolism among the tissues. anova-simultaneous component analysis (ASCA) was used to test the significance of metabolic changes linked with tissue health status. ASCA-significant components included antioxidant compounds, TAGs, and phytosterol conjugates. Relative to entirely healthy tissues, elevated metabolite levels in symptomatic tissue included γ-amino butyric acid, glycerol, sitosteryl (6'-O-palmitoyl) ß-d-glucoside and sitosteryl (6'-O-stearate) ß-d-glucoside, and TAGs containing combinations of 16:0, 18:3, 18:2 and 18:1 fatty acids. Reduced metabolite levels in SB tissue included 5-caffeoyl quinate, ß-carotene, catechin, epicatechin, α-tocopherol, violaxanthin and sitosteryl ß-d glucoside. Pathway analysis indicated aspects of primary metabolism differed according to tissue condition, although differences in metabolites involved were more subtle than those of some secondary metabolites. The results implicate oxidative stress and membrane disruption processes in SB development and constitute a diagnostic metabolic profile for the disorder.

The austerity bargain and the social self: conceptual clarity surrounding health cutbacks.

As necessary austerity measures make major inroads into western health services, this paper investigates the philology of austerity and finds that there are two subtly similar yet importantly different derivations from the Latin and the Greek. The Latin austerus is an abstract term meaning dry, harsh, sour; whereas the Greek austeros has a more embodied and literal meaning of making the tongue dry. What seems an initially subtle difference between the metaphorical and the metonymic plays out as involving seriously different outcomes between harsh economic measures and the literal effects on the people suffering under measures that actually make the tongue dry. The paper argues that between the trope and the literal that which Wittgenstein described as 'a language game' ensues wherein the metaphorical through a sleight of grammar is passed off as being real while, the literal effects on real people is downplayed as metaphorical 'collateral damage'. The paper further argues that within this grammar that forces itself upon us, the game of capital is played out through what the author terms an austerity bargain that is levelled by the financial elites: healthy capitalism equals a healthy society. The paper then examines the six elements of the social determinants of health and what actually contributes to a healthy society. Rather than being under an individual threat of exclusion from what Marx termed a superabundance, the paper considers the irreducible differences between the game of capital's individualism, and, the social determinants of health's social inclusion, legitimization and that which Habermas termed public authentication. The paper concludes that not only do necessary austerity measures need to be critiqued but that they radically undermine what determines a healthy society. It follows also that the social determinants of health, radically undermine the bargain inherent for the privileged few within the game of capital.

Are healthcare middle management jobs extreme jobs?

PURPOSE: The purpose of this paper is to explore the incidence of "extreme jobs" among middle managers in acute hospitals, and to identify individual and organizational implications. DESIGN/METHODOLOGY/APPROACH: The paper is based on interviews and focus groups with managers at six hospitals, a "proof of concept" pilot with an operations management team, and a survey administered at five hospitals. FINDINGS: Six of the original dimensions of extreme jobs, identified in commercial settings, apply to hospital management: long hours, unpredictable work patterns, tight deadlines with fast pace, broad responsibility, "24/7 availability", mentoring and coaching. Six healthcare-specific dimensions were identified: making life or death decisions, conflicting priorities, being required to do more with fewer resources, responding to regulatory bodies, the need to involve many people before introducing improvements, fighting a negative climate. Around 75 per cent of hospital middle managers have extreme jobs. RESEARCH LIMITATIONS/IMPLICATIONS: This extreme healthcare management job model was derived inductively from a qualitative study involving a small number of respondents. While the evidence suggests that extreme jobs are common, further research is required to assess the antecedents, incidence, and implications of these working practices. PRACTICAL IMPLICATIONS: A varied, intense, fast-paced role with responsibility and long hours can be rewarding, for some. However, multi-tasking across complex roles can lead to fatigue, burnout, and mistakes, patient care may be compromised, and family life may be adversely affected. ORIGINALITY/VALUE: As far as the authors can ascertain, there are no other studies exploring acute sector management roles through an extreme jobs lens.

Don't stop the clock: manipulating hospital waiting lists.

PURPOSE: This paper aims to explore the theoretical and practical management implications of a case involving the falsification of hospital patient waiting lists for elective orthopaedic surgery. DESIGN/METHODOLOGY/APPROACH: This case study is based on qualitative schedule-structured interviews with 20 senior hospital staff (managerial and clinical), including the head of the investigation team, downloads from the hospital website, and internal hospital documentation. Those data were used to construct an event narrative exploring the underlying causes and implications of the incident. FINDINGS: The blame for misconduct pointed at three surgeons, a senior manager, a general manager, an assistant general manager, one administrative staff member, and several organizational factors. In addition to censuring some of those involved, an investigation recommended changes to training and working practices, policies and procedures, governance arrangements, and organization culture, and led to an external evaluation of the hospital board. However, one year later, another similar incident occurred. RESEARCH LIMITATIONS/IMPLICATIONS: This is a single case, and events are viewed through a management lens, the individuals concerned being protected by research ethics considerations. PRACTICAL IMPLICATIONS: By detailing the sequence of events, surrounding conditions, and the reactions of multiple players, this analysis reveals typified responses to incidents of this kind, and the limitations inherent in post-event investigations. If the benefits derived from national targets are to be realized in a manner which commands support from staff at all levels, then greater attention should be paid by managers and regulators to issues of transparency, responsiveness, and honesty. As core dimensions of good governance, managers must be accountable for helping to meet targets, and also for tracking how targets are met, ensuring that resources are made available, and that problematic issues raised are promptly and effectively addressed. ORIGINALITY/VALUE: Studies of organizational misbehaviour are rare in healthcare where the focus often lies with patient deaths and injuries arising from system failures and gross individual misconduct. The analysis in this case explores the organizational conditions that contribute to such incidents.

Differential Partitioning of Triterpenes and Triterpene Esters in Apple Peel.

Apple peel is a rich source of secondary metabolites, and several studies have outlined the dietary health benefits of ursane-type triterpenes in apple. Changes in triterpene metabolism have also been associated with the development of superficial scald, a postharvest apple peel browning disorder, and postharvest applications of diphenylamine and 1-methylcyclopropene. Previously, studies have generated metabolite profiles for whole apple peel or apple wax. In this study, we report separate metabolic analyses of isolated wax fractions and peel epidermis to investigate the spatial distribution of secondary metabolites in peel. In addition to examining previously reported triterpenes, we identified several unreported fatty acid esters of ursane-type triterpenes (C14-C22). All free pentacyclic triterpenes and triterpenic acids, with the exception of ß-amyrin, were localized in the wax layer, along with esters of ursolic acid and uvaol. All sterols, sterol derivatives and α-amyrin esters were localized in the dewaxed peel epidermis.

Sweat the small stuff: a case study of small-scale change processes and consequences in acute care.

Solving small, annoying problems may appear to be unimportant in a political, demographic, and economic climate that focuses attention on radical long-term changes to the organization, delivery, funding, and regulation of the healthcare system. Most contemporary commentary emphasizes the need for large-scale, major, strategic, transformational change. Deliberately designed to focus on minor issues, however, the intervention reported here, in a hospital gastroenterology department, demonstrates how small changes generate major benefits for patients, staff, and hospital performance. This approach can also strengthen clinical-managerial relationships, which are key to larger scale changes and which suffer when 'the small stuff' is not fixed. The success of this intervention is explained with reference to a model of change combining context, content, process, and individual dispositions. The intervention, however, is easily modified to suit different contexts and was subsequently used successfully in other service areas in the same hospital. These outcomes present a challenge to the contemporary preoccupation with transformational change. Healthcare managers are thus advised, on the basis of this experience, to be alert to what appear to be minor unresolved issues, and to address these rapidly, in addition to larger scale, longer term projects.

Ripening, storage temperature, ethylene action, and oxidative stress alter apple peel phytosterol metabolism.

The chilling conditions of apple cold storage can provoke an economically significant necrotic peel disorder called superficial scald (scald) in susceptible cultivars. Disorder development can be reduced by inhibiting ethylene action or oxidative stress as well as intermittent warming. It was previously demonstrated that scald is preceded by a metabolomic shift that results in altered levels of various classes of triterpenoids, including metabolites with mass spectral features similar to ß-sitosterol. In this study, a key class of phytosterol metabolites was identified. Changes in peel tissue levels of conjugates of ß-sitosterol and campesterol, including acylated steryl glycosides (ASG), steryl glycosides (SG) and steryl esters (SE), as well as free sterols (FS), were determined during the period of scald development. Responses to pre-storage treatment with the ethylene action inhibitor, 1-methylcyclopropene, or an antioxidant (diphenylamine), rapid temperature elevation, and cold acclimation using intermittent warming treatments were evaluated. Diphenylamine, 1-MCP, and intermittent warming all reduced or prevented scald development. ASG levels increased and SE levels decreased in untreated control fruit during storage. Removing fruit from cold storage to ambient temperature induced rapid shifts in ASG and SE fatty acyl moieties from unsaturated to saturated. FS and SG levels remained relatively stable during storage but SG levels increased following a temperature increase after storage. ASG, SE, and SG levels did not increase during 6 months cold storage in fruit subjected to intermittent warming treatment. Overall, the results show that apple peel phytosteryl conjugate metabolism is influenced by storage duration, oxidative stress, ethylene action/ripening, and storage temperature.