Distant Centers Research Articles

The Influence of Insurance Status on Access to and Utilization of a Tertiary Hand Surgery Referral Center

The purpose of this study was to systematically examine the impact of insurance status on access to and utilization of elective specialty hand surgical care. We hypothesized that patients with Medicaid insurance or those without insurance would have greater difficulty accessing care both in obtaining local surgical care and in reaching a tertiary center for appointments. This retrospective cohort study included all new patients with orthopaedic hand problems (n = 3988) at a tertiary center in a twelve-month period. Patient insurance status was categorized and clinical complexity was quantified on an ordinal scale. The relationships of insurance status, clinical complexity, and distance traveled to appointments were quantified by means of statistical analysis. An assessment of barriers to accessing care stratified with regard to insurance status was completed through a survey of primary care physicians and an analysis of both patient arrival rates and operative rates at our tertiary center. Increasing clinical complexity significantly correlated (p < 0.001) with increasing driving distance to the appointment. Patients with Medicaid insurance were significantly less likely (p < 0.001) to present with problems of simple clinical complexity than patients with Medicare and those with private insurance. Primary care physicians reported that 62% of local surgeons accepted patients with Medicaid insurance and 100% of local surgeons accepted patients with private insurance. Forty-four percent of these primary care physicians reported that, if patients who were underinsured (i.e., patients with Medicaid insurance or no insurance) had been refused by community surgeons, they were unable to drive to our tertiary center because of limited personal resources. Patients with Medicaid insurance (26%) were significantly more likely (p < 0.001) to fail to arrive for appointments than patients with private insurance (11%), with no-show rates increasing with the greater distance required to reach the tertiary center. Economically disadvantaged patients face barriers to accessing specialty surgical care. Among patients with Medicaid coverage or no insurance, local surgical care is less likely to be offered and yet personal resources may limit a patient's ability to reach distant centers for non-emergency care.

P97 Transition from a District General Hospital (DGH) Clinic to a Distant Adult Centre

Background Transition between CF centres in the same town is well reported but there is less work on transition from large DGH clinics to distant adult centres. Our local paediatric unit provides total care for 60 patients. The majority will move on to the adult centre in a city 45 miles away. Until the last 2 years transition had been taking place very late because low staffing at the adult unit limited outreach support for the local patients who were thus reluctant to move on. The paediatric team felt that although transition was hampered by the lack of a local adult centre an increase in adult staffing was an opportunity to review current practiscs and identify areas for improvement. Aims To identify ways in which the transition process could be improved and to explore the need for the introduction of formal transition clinics. Methods Adolescents (13–18 years) within the paediatric clinic and young adults (18–26 years) who had completed transition to the adult centre in the last two years were surveyed using a proforma merging the standards of the CF trust and Department of Health. The CF nurses also completed questionnaires about these patients. Results 16/19 identified patients took part. CF nurse results showed that only 37% of patients started transition between ages 13 and 16 and only 50% had a key worker. Whilst the nurses felt that they offered most teenagers the opportunity to be seen alone only 14% of patients stated they were seen on their own and most said they would strongly prefer it. Discussions of careers, finance, higher education and fertility took place in up to 43%, but commonly after age 16. Patients reported wanting more information on these topics. Although 60% of patients marked the adult clinic was easy to reach and had appropriate facilities, the ‘free comments’ section revealed difficulties. Conclusions There are areas of practise that can be improved in the paediatric clinic independently of the setting up of transition clinics. More teenagers need to be seen on their own and cheque lists are needed to ensure all relevant areas are discussed.

An Adaptive Approach to High-Throughput Inter-Cloud Data Transmission Based on Fast TCP

Cloud service is a trend of promising services on Internet. Data centers with high performance are the key to realize real-time services for worldwide users. For the users travelling in global, data mobility between cloud data centers is essential to offer quality-ensured cloud services. However, existing transmission protocols such as TCP, do not support high speed and high throughput transmission on long-distance networks. Legacy TCP lacks of the ability to efficiently transport data between distant data centers. In this paper, an adaptive Fast TCP is proposed to move data faster between data centers of cloud services. The proposed approach adapts the operational parameter of Fast TCP connections to improve the throughput and the rapidness of TCP connections. Numeric results show that the throughput is improved by 2.5 times and the rapid response of flow control eliminates packet loss. The better data mobility contributes the service quality of travelling users in clouds.

‘In the heart, there’s nothing’: unruly youth, generational vertigo and territory

Young Ladakhis have grown up along disputed borders between Pakistan and China in India’s Jammu and Kashmir State. During their lifetimes, conflict in Kashmir and in their hometowns (between the Buddhist majority and Muslim minority) has highlighted the region’s geopolitical vulnerability; in words overheard in the schoolyard and kitchen, religion is always already political and territorial. This article traces how young Muslim and Buddhist Ladakhis in Ladakh’s Leh District are constituted as a category and site of territorial potential, and how the young people I spoke with navigate and elude this positioning. Their grandparents married across religious lines and their parents used family planning enthusiastically, but these practices are now political problems. Youth alternate between cynicism and hopeful visions of the future. Meanwhile, parents see education in distant urban centres as a path to a desired ‘modernity’, but also as a dangerous site where unruly love, lack of supervision and immorality might compromise religious identity. Building on geographies of young people and religion, and on anthropologies of the future, this research draws on two youth projects, a survey and interviews. I suggest that parents, political actors and religious leaders conceive of the young as crucial to the constitution of future territories. This makes their bodies a site of intense anxiety and regulation, as well as hope and potential. Beyond this case study, I offer the concept of generational vertigo, a mixture of apprehension and anticipation regarding the future, and suggest that attending to how and why this vertigo is manifest provides a way to think through relationships between young people, time and territory. The future is located in the volatile bodies of young people; hence the desire to defend territory and shape the future is manifest in attempts to manage the potential of these bodies.

Changing trends on the place of delivery: why do Nepali women give birth at home?

BackgroundHome delivery in unhygienic environment is common in Nepal. This study aimed to identify whether practice of delivery is changing over time and to explore the factors contributing to women’s decision for choice of place of delivery.MethodsA community based cross sectional study was conducted among 732 married women of reproductive age (MWRA) in Kavrepalanchok district of Nepal in 2011. Study wards were selected randomly and all MWRA residing in the selected wards were interviewed. Data were collected through pre-tested interviewer administered questionnaire. Chi-square and multivariate analysis was used to examine the association between socio-demographic factors and place of delivery.ResultsThe study shows that there was almost 50% increasement in institutional delivery over the past ten years. The percentage of last birth delivered in health institution has increased from 33.7% before 10 years to 63.8% in the past 5 years. However, the place of delivery varied according to residence. In urban area, most women 72.3% delivered in health institutions while only 35% women in rural and 17.5% in remote parts delivered in health institutions. The key socio-demographic factors influencing choice of place of delivery included multi parity, teen-age pregnancy, less or no antenatal visits. Having a distant health center, difficult geographical terrain, lack of transportation, financial constraints and dominance of the mothers- in-law were the other main reasons for choosing a home delivery. Psychological vulnerability and insecurity of rural women also led to home delivery, as women were shy and embarrassed in visiting the health center.ConclusionThe trend of delivery at health institution was remarkably increased but there were strong differentials in urban–rural residency and low social status of women. Shyness, dominance of mothers in law and ignorance was one of the main reasons contributing to home delivery.

Liver Grafts Procured by Other Transplant Teams Do Not Affect Posttransplantation Outcomes

BackgroundTransplant surgeons have one the riskiest jobs in medicine. Multiple reports have described fatalities involving transplant team members who were traveling to recover organs for transplantation. There are few initiatives to use allografts recovered by local teams. We tested the impact of local organ procurement on posttransplantation survival. MethodsThis single-center retrospective study included primary deceased-donor liver grafts transplanted under the Model for End-stage Liver Disease system. Multivariate analysis was performed to evaluate whether liver allografts procured outside of the organ procurement organization (OPO) region were related to allograft loss. We also studied posttransplantation survival according to local procurement. ResultsThere were 271 transplantations performed with local donors, 19 from other states, and 54 from within our state but outside of our OPO. Recipient demographic data were similar among the groups. There were more male (P = .007), slim (P = .01), and younger (P = .008) donors among allografts from other states (national group). Local or regional donors had brain death more often related to cerebrovascular accidents. National donors had brain death related to trauma (P = .01). Multivariate analysis confirmed that local organ retrieval was not related to posttransplantation survival. Kaplan-Meier curves showed no difference in patient and graft survivals among the groups. ConclusionsLocal procurement did not affect posttransplantation survival. Liver allografts procured by other teams showed equivalent posttransplantation outcomes. Policies that stimulate the training of local teams to procure liver allografts for distant transplant centers should be launched to increase job safety for transplant surgeons.

Pan‐endothelial viability assessment with the triple HEC staining of organ cultured precut DSAEK vs full thickness corneas

AbstractPurpose To assess the viable endothelial cell density (vECD) of posterior lamellar grafts, stored in organ culture, precut by eye bank technicians, and sent to a distant center.Methods Paired corneas with an ECD &gt;2200 cells/mm2 at the standard assessment with the SambaCornea analyser (TribVn, France), were stored in CorneaMax (Eurobio, France) and deswelled in CorneaJet (5% Dextran T500) for 6 to 24 hours prior to pre‐cutting. They were randomly assigned as full‐thickness grafts or as precut posterior transplants for DSAEK using a microkeratome with a 350μm head (Moria, France). Corneas were sent to a distant center where the vECD was assessed by using the triple Hoechst/Ethidium/Calcein (HEC) staining and fluorescent image analysis of the entire posterior surface: calculation of the area covered by living cells (H+/C+/E‐) coupled with counting of nuclei in large areas allowed to determine the vECD, i.e. the useful cell pool (Pipparelli. IOVS 2011.52:6018). DSAEK and controls data were compared with non‐parametric tests.Results In both groups, the vECD was lower than the standard ECD determined by the eye bank (for 20±7% for full thickness grafts, 34±16% for DSAEK), because living cells never completely covered the entire posterior surface. vECD were respectively of 2006+/‐349 vs 1661+/‐464 (P=0.075).Conclusion The HEC triple staining combined with image analysis provides a unique accurate assessment of the endothelial quality by giving the vECD. This laboratory technique allows a reliable assessment of the endothelial quality of tissues supplied to surgeons, precut or not. It can also be used to assess any methods liable to modify EC.

Complications and safety of jugular and azygous angioplasty in CCSVI patients with multiple sclerosis

Endovascular procedures for chronic cerebrospinal venous insufficiency are now practiced in several international centers, despite polarization of opinions among clinicians. Complications from these procedures are now presenting to distant centers. This article reviews the reported complications from several of these institutions. The results of this study demonstrate that the reporting of complication data is sparse, prone to bias and lacks long-term follow-up. There is a need for robust interventional registries of chronic cerebrospinal venous insufficiency to operate in conjunction with high-quality randomized controlled trials in order to accurately report the safety and efficacy of endovenous procedures.

Diversity and Relationships of Eggplants from Three Geographically Distant Secondary Centers of Diversity

Eggplant (Solanum melongena L.) was domesticated in the Indo-Birmanian region, which is also the primary center of diversity for this crop. From there eggplant spread to other regions, and diversity accumulated in several secondary centers of diversity. We have assessed the diversity and relationships of 52 accessions of eggplant from three geographically distant secondary centers of diversity (China, Spain, and Sri Lanka) using 28 morphological descriptors and 12 highly polymorphic genomic SSRs. A wide variation was found for most morphological traits, and significant differences among the three centers of diversity were detected for 22 of these traits. The PCA analysis showed that eggplants from the three origins were morphologically differentiated, and accessions from each of the three secondary centers of diversity presented a typical combination of morphological characteristics. In this respect, discriminant analysis showed that accessions could be correctly classified to their origin using only six traits. The SSR characterization identified 110 alleles and allowed obtaining a unique genetic fingerprint for each accession. Many alleles were found to be private to each origin, but no universal alleles were found for any of the origins. The PCA analysis showed that the genetic differentiation among origins was less clear than for morphological traits, although the analysis of the population structure shows that accessions mostly group according to the origin, but also provides evidence of migration among the three secondary centers of diversity. The genetic diversity (HT) within each origin was high, ranging between HT = 0.5400 (Sri Lanka) and HT = 0.4943 (China), while the standardized genetic differentiation (G’ST) among origins was moderate (G’ST = 0.2657). The correlation between morphological and SSR distances was non-significant (r = 0.044), indicating that both data are complementary for the conservation of germplasm and breeding of eggplant. These results are relevant for the management of genetic resources, breeding programmes, and evolutionary studies of eggplant.

Dinuclear Copper Complexes with Imidazole Derivative Ligands: A Theoretical Study Related to Catechol Oxidase Activity

Catechol oxidase is a very important and interesting metalloprotein. In spite of the efforts to understand the reaction mechanism of this protein, there are important questions that remain unanswered concerning the catalytic mechanism of this enzyme. In this article, dinuclear copper compounds are used as biomimetic models of catechol oxidase to study plausible reaction paths. These dinuclear copper(II) complexes have distant metal centers (of 7.5 Å approximately) and superior catalytic activity to that of many dicopper complexes with shorter Cu-Cu distances. One mononuclear copper(II) complex is also analyzed in this investigation in order to see the influence of the two metal centers in the catalytic activity. Density functional theory calculations were performed to obtain optimized structures, vertical ionization energies, vertical electron affinities, the electrodonating power (ω(-)), the electroaccepting power (ω(+)) and the energy difference of several reaction paths. The K(M) experimental results that were previously reported compare well with the electroaccepting power (ω(+)) of the copper compounds that are included in this article, indicating that this index is useful for the interpretation of the electron transfer capacity and therefore the catalytic activity. The catechol moiety coordinates to only one Cu ion, but two metal atoms are needed in order to have a good electron acceptor capacity of the biomimetic models.

Remote hearing aid fitting: Tele-audiology in the context of Brazilian Public Policy.

Summary Introduction: Currently, the Brazilian government has certificated nearly 140 specialized centers in hearing aid fittings through the Brazilian National Health System (SUS). Remote fitting through the Internet can allow a broader and more efficient coverage with a higher likelihood of success for patients covered by the SUS, as they can receive fittings from their own homes instead of going to the few and distant specialized centers. Aim: To describe a case of remote fitting between 2 cities, with revision of the literature. Method: Computer gears, a universal interface, and hearing aids were used. Case study: An audiologist located in a specialized center introduced a new hearing aid and its fitting procedure to a remote center (200 km away). The specialized center helped the remote center in fitting a hearing aid in 2 patients, and performed fitting in one of its own patients. The whole process was done through the Internet with audio and video in real time. Results: Three patients were fitted remotely. Three audiologists were remotely trained on how to fit the hearing aids. Conclusions: Remote fitting of hearing aids is possible through the Internet, as well as further supplying technical training to a remote center about the fitting procedures. Such a technological approach can help the government advance public policies on hearing rehabilitation, as patients can be motivated about maintaining their use of hearing aids with the option to ask for help in the comfort of their own homes.

The Italian Rare Cancer Network.

10053 Background: Rare cancers (RC) are a challenge in terms of quality of care, access to health resources and clinical research. The Italian Rare Cancer Network (RTR: “Rete Tumori Rari”) is a clinical collaborative effort to improve quality of care in adult rare solid cancers in Italy. RTR enables institutions to share clinical cases and to rationalize access to distant reference centers minimizing patient migration. It indirectly promotes collaborative clinical research by encouraging accrual into clinical trials and supporting observational studies. Methods: RTR includes 150 oncology institutions across Italy. Clinical cases are shared asynchronously over a secure Web resource. Data, images and transactions are stored in an online clinical record. Patients are shared: 1. "logically”, when they are dealt with following common clinical practice guidelines; 2. "virtually”, when they are discussed over the network between two or more centers; 3: "physically", when they are referred to an excellence center for a specific treatment modality. Pathology review is arranged through transferal of paraffin-embedded specimens and upload of consultations. While it was chosen not to implement telepathology facilities, a teleradiology resource is now available. Results: From 2003 to 2011, more than 5,000 rare cancers cases (mostly sarcomas) have been uploaded. More than 1,300 teleconsultations have been delivered, while more than 1,000 patients moved across the network during their experience of disease. 700 cases were reviewed pathologically: amongst 365 cases originally diagnosed as soft tissues sarcomas up to 2010, treatment-relevant discordances were recorded in more than one third. An observational prospective study on gastrointestinal stromal tumors was done, enrolling 800 patients. An original paper documenting the activity of a drug in a highly specific sarcoma subgroup was published. Conclusions: Clinical asynchronous online collaboration on RC is feasible through a Web-based secure environment and proved the most practical way of clinical distant sharing. Pathologic review was a crucial network service, with a special added value in RC. Retrospective and prospective observational studies, and unplanned observations in very rare cases, were an interesting by-product.

The VA Maryland Health Care System's telemental health program.

The VA Maryland Health Care System introduced videoconferencing technology to provide psychiatry, evidenced-based psychotherapy, case management, and patient education at rural clinics where it was difficult to recruit providers. Telemental health services enable rural clinics to offer additional services, such as case management and patient education. Services have been expanded to urban outpatient clinics where a limited number of mental health clinic hours are available. This technology expands the availability of mental health providers and services, allowing patients to receive services from providers located at distant medical centers.

Factors affecting the turnaround time for manufacturing, testing, and release of cellular therapy products prepared at multiple sites in support of multicenter cardiovascular regenerative medicine protocols: a Cardiovascular Cell Therapy Research Network (CCTRN) study.

Cellular therapy studies are often conducted at multiple clinical sites to accrue larger patient numbers. In many cases this necessitates use of localized good manufacturing practices facilities to supply the cells. To assure consistent quality, oversight by a quality assurance group is advisable. In this study we report the findings of such a group established as part of the Cardiovascular Cell Therapy Research Network (CCTRN) studies involving use of autologous bone marrow mononuclear cells (ABMMCs) to treat myocardial infarction and heart failure. Factors affecting cell manufacturing time were studied in 269 patients enrolled on three CCTRN protocols using automated cell processing system (Sepax, Biosafe SA)-separated ABMMCs. The cells were prepared at five good manufacturing practices cell processing facilities and delivered to local treatment sites or more distant satellite centers. Although the Sepax procedure takes only 90 minutes, the total time for processing was approximately 7 hours. Contributing to this were incoming testing and device preparation, release testing, patient randomization, and product delivery. The mean out-of-body time (OBT), which was to be less than 12 hours, averaged 9 hours. A detailed analysis of practices at each center revealed a variety of factors that contributed to this OBT. We conclude that rapid cell enrichment procedures may give a false impression of the time actually required to prepare a cellular therapy product for release and administration. Institutional procedures also differ and can contribute to delays; however, in aggregate it is possible to achieve an overall manufacturing and testing time that is similar at multiple facilities.

Mechanistic insight on the catecholase activity of dinuclear copper complexes with distant metal centers

The catecholase activity of two dinuclear Cu(II) complexes with distant metal centers is discussed together with solid state and solution studies. The crystal structure for one of them, [Cu(2)(diep)(H(2)O)(4)](ClO(4))(4)·2H(2)O, is described, showing the two copper ions are 7.457 Å apart and in a square pyramidal coordination. Both complexes display a weak antiferromagnetic coupling in the solid state that is manifest in the dimer EPR spectra obtained in frozen solution. The pH-potentiometric speciation performed in 1:1 MeOH-H(2)O allowed the assignment of hydrolyzed copper species as those catalytically active in the oxidation of 3,5-di-tert-butylcatechol (DTBC). The kinetic measurements led us to propose behavior consistent with Michaelis-Menten plus a linear dependence of the initial rate on [DTBC]. This can be associated with the presence of more than one catalytically active species, which is consistent with the evidence of several differently hydrolyzed species shown in the predominance diagrams. Product characterization studies led to establishing the formation of hydrogen peroxide during the catalytic cycle, while semiquinone and superoxide radicals were detected by EPR spectroscopy, supporting one-electron transference at each of the copper centers.

The Contradictory Logic of Global Ecosystem Services Markets

Commodification and transnational trading of ecosystem services is the most ambitious iteration yet of the strategy of ‘selling nature to save it’. The World Bank and UN agencies contend that global carbon markets can slow climate change while generating resources for development. Consonant with ‘inclusionary’ versions of neoliberal development policy, advocates assert that international payment for ecosystem services (PES) projects, financed by carbon-offset sales and biodiversity banking, can benefit the poor. However, the World Bank also warns that a focus on poverty reduction can undermine efficiency in conservation spending. The experience of ten years of PES illustrates how, in practice, market-efficiency criteria clash directly with poverty-reduction priorities. Nevertheless, the premises of market-based PES are being extrapolated as a model for global REDD programmes financed by carbon-offset trading. This article argues that the contradiction between development and conservation observed in PES is inevitable in projects framed by the asocial logic of neoclassical economics. Application in international conservation policy of the market model, in which profit incentives depend upon differential opportunity costs, will entail a net upward redistribution of wealth from poorer to wealthier classes and from rural regions to distant centres of capital accumulation, mainly in the global North.

ES5-3: Novel Approaches to Breast Cancer Management in Low-Income Countries.

Abstract There is clear evidence that the global burden of cancer is increasingly affecting low and middle - income countries, effectively those nations who have least health infrastructure to deal with complex diseases like cancer. A new approach to cancer therapy is required that combines efficacy, reduced side effects, cost-effectiveness with a delivery mechanism that does not rely on access to distant and expensive regional cancer centres. To this end we propose to develop a combination oral chemotherapy formulation which is likely to offer a clinically useful advantage to patients suffering from breast cancer For almost half a century, systemic therapy of cancer has been dominated by the use of cytotoxic chemotherapeutics. Most of these drugs are DNA damaging agents or microtubule inhibitors that are designed to inhibit or kill rapidly dividing cells, often administered in single doses or short courses of therapy at the highest doses possible, with prolonged breaks (generally of 2–3 weeks in duration) between successive cycles of therapy. A reappraisal of the optimal way of administering chemotherapy is underway. Instead of using short bursts of toxic chemotherapy interspersed with long breaks to allow recovery from the harmful side effects, there is now a shift in thinking towards the view that more chronic or decelerated schedules of drug administration using much smaller individual doses than the MTD may be more effective — not only in terms of reducing certain toxicities, but perhaps also improving anti-tumour efficacy with an additional anti-endothelial cell effect, so-called ‘metronomic’ chemotherapy. We propose development of a flat dose, combination, oral chemotherapy formulation which will contain the following classes of antineoplastic agents, which have been shown to have activity in breast cancer. Fluoropyrimidines eg Capecitabine; Alkylating Agents eg Cyclophosphamide; Antiemetics eg Metoclopramide; administered continuously at doses inducing Grade 1 toxicity. The drug doses will be carefully selected to provide moderately effective cancer control with reduced toxicity profiles. The clinical development pathway will be conducted in India and SubSaharan Africa with a view to providing a managed package of care which will allow delivery of the MetroPill to women with breast cancer in rural and minor urban settings rather than the regional cancer centres. We will train a cohort of district general hospital doctors/nurses to monitor and deliver the MetroPill, supported by a teaching package app and mobile phone technology to provide symptom support for patients. A phase 1 feasibility and pharmacokinetic study will be performed in 20–30 patients followed by single arm Phase 2 studies(n=40 patients) in breast cancer patients, which will report response rates, progression free survival and quality of life as a prelude to phase 3 trials. We believe that this is the sort of lateral approach we must consider if we are to take elements of cancer therapy to those regions which lie beyond the shadow of conventional cancer centres. Citation Information: Cancer Res 2011;71(24 Suppl):Abstract nr ES5-3.

Research, Development and Application of Surface Displacement Automatic Monitoring System of Tailings Dam

An effective monitoring system is conducive to grasp the dynamic evolution process of disaster occurring, to study the disaster-mechanism, to forecast the future development trend and ultimately to predict the disaster occurring. In this paper, focused on the surface displacement, an automatic on-line monitoring system of tailings dam which based on GSM/GPRS communication platform has been researched and developed. As a part of tailing pond disaster monitoring system, the researched and developed monitoring system could monitor the surface displacement of tailings dam automatically and remotely, and also can collect deformation data regularly and transfer to distant control center real-time. According to its application in an iron tailings dam in Diaxian, Shanxi Province of China, the researched and developed monitoring system could achieve the same monitoring effect with the electronic total station. This automatic monitoring system provided another method to grasp the dynamic evolution process of tailings dam from stability to failing down.

Intramolecular electron transfer in sulfite-oxidizing enzymes: probing the role of aromatic amino acids

Sulfite oxidase (SO) is a molybdoheme enzyme that is important in sulfur catabolism, and mutations in the active site region are known to cause SO deficiency disorder in humans. This investigation probes the effects that mutating aromatic residues (Y273, W338, and H337) in the molybdenum-containing domain of human SO have on both the intramolecular electron transfer (IET) rate between the molybdenum and iron centers using laser flash photolysis and on catalytic turnover via steady-state kinetic analysis. The W338 and H337 mutants show large decreases in their IET rate constants (k (ET)) relative to the wild-type values, suggesting the importance of these residues for rapid IET. In contrast, these mutants are catalytically competent and exhibit higher k (cat) values than their corresponding k (ET), implying that these two processes involve different conformational states of the protein. Redox potential investigations using spectroelectrochemistry revealed that these aromatic residues close to the molybdenum center affect the potential of the presumably distant heme center in the resting state (as shown by the crystal structure of chicken SO), suggesting that the heme may be interacting with these residues during IET and/or catalytic turnover. These combined results suggest that in solution human SO may adopt different conformations for IET and for catalysis in the presence of the substrate. For IET the H337/W338 surface residues may serve as an alternative-docking site for the heme domain. The similarities between the mutant and wild-type EPR spectra indicate that the active site geometry around the Mo(V) center is not changed by the mutations studied here.

M-learning: mobile phones’ appropriateness and potential for the training of laboratory technicians in limited-resource settings

As previously demonstrated, m-phones can be easily used, without any adapter, to photograph and send images from a microscope. The objective of the current study was to test the appropriateness and educational potential of this mobile diagnosis approach with health workers in limited-resource settings, such as health units in Uganda, Bangladesh and Afghanistan. A total of 61 lab technicians were trained in basic lab skills and in using the m-phone to capture microscopic images and send them to distant Reference Centers for a second opinion. Structured pre-test interviews were used to define parameters such as health workers’ sex and age, duty station, schooling, experience in the laboratory, access to internet and availability to and use of m-phones. Images from the microscope were also uploaded on the available computers and shared on the screen to facilitate group discussions and comparisons with reference images. Standard instructions were then elaborated and tested with totally inexperienced people. Results showed that use of integrated camera m-phones was widespread. Mobile Messaging Service (MMS) was commonly accessible, however, not used. Neither m-microscopy, nor clinical use of m-phones was previously known among local health workers. A standard written procedure, without any additional verbal instruction, was enough to easily learn to take pictures of the microscope samples, even for the most inexperienced person. The possibility to share images on the m-phone and/or a computer screen, and the group discussions proved to be phenomenal educational tools.