SIMPLE: implementation of recommendations from international evidence-based guidelines on caesarean sections in the Netherlands. Protocol for a controlled before and after study

Background

Caesarean section (CS) rates are rising worldwide. In the Netherlands, the most significant rise is observed in healthy women with a singleton in vertex position between 37 and 42 weeks gestation, whereas it is doubtful whether an improved outcome for the mother or her child was obtained. It can be hypothesized that evidence-based guidelines on CS are not implemented sufficiently. Therefore, the present study has the following objectives: to develop quality indicators on the decision to perform a CS based on key recommendations from national and international guidelines; to use the quality indicators in order to gain insight into actual adherence of Dutch gynaecologists to guideline recommendations on the performance of a CS; to explore barriers and facilitators that have a direct effect on guideline application regarding CS; and to develop, execute, and evaluate a strategy in order to reduce the CS incidence for a similar neonatal outcome (based on the information gathered in the second and third objectives).

Methods

An independent expert panel of Dutch gynaecologists and midwives will develop a set of quality indicators on the decision to perform a CS. These indicators will be used to measure current care in 20 hospitals with a population of 1,000 women who delivered by CS, and a random selection of 1,000 women who delivered vaginally in the same period. Furthermore, by interviewing healthcare professionals and patients, the barriers and facilitators that may influence the decision to perform a CS will be measured. Based on the results, a tailor-made implementation strategy will be developed and tested in a controlled before-and-after study in 12 hospitals (six intervention, six control hospitals) with regard to effectiveness, experiences, and costs.

Discussion

This study will offer insight into the current CS care and into the hindering and facilitating factors influencing obstetrical policy on CS. Furthermore, it will allow definition of patient categories or situations in which a tailor-made implementation strategy will most likely be meaningful and cost effective, without negatively affecting the outcome for mother and child.

Trial registration

http://www.clinicaltrials.gov: NCT01261676     

Localization of acetylcholine receptors and synaptic ultrastructure at nerve-muscle contacts in culture: dependence on nerve type

In cultures of xenopus myotomal muscle cells and spinal cord (SC) some of the nerve-muscle contacts exhibit a high density of acetylcholine receptors (AchRs [Anderson et al., 1977, J. Physiol. (Lond.). 268:731- 756,757-773]) and synaptic ultrastructure (Weldon and Cohen, 1979, J. Neurocytol. 8:239-259). We have examined whether similarly specialized contacts are established when the muscle cells are cultured with explants of xenopus dorsal root ganglia (DRG) or sympathetic ganglia (SG). The outgrowth from the ganglionic explants contained neuronal and non- neuronal cell processes. Although both types of processes approached within 100 A of muscle cells, synaptic ultrastructure was rarely observed at these contacts. Because patches of postsynaptic ultrastructure also develop on noncontacted muscle cells, the very few examples of contacts with such specializations probably occurred by chance. AChRs were stained with fluroscent α-bungarotoxin. More than 70 percent of the SC-contacted muscle cells exhibited a high receptor density along the path of contact. The corresponding values for DRG- and SG- contacted muscle cells were 10 and 6 percent. Similar values were obtained when the ganlionic and SC explants were cultured together in the same chamber. The few examples of high receptor density at ganglionic-muscle contacts resembled the characteristic receptor patches of noncontacted muscle cells rather than the narrow bands of high receptor density seen at SC-muscle contacts. In addition, more than 90 percent of these ganglionic- contacted muscle cells had receptor patches elsewhere, compared to less than 40 percent for the SC-contacted muscle cells. These findings indicate that the SC neurites possess a specific property which is important for the establishment of synaptically specialized contacts with muscle and that this property is lacking in the DRG and SG neurites.     

Plasmonic Enhancement of Dye Sensitized Solar Cells via a Tailored Size-Distribution of Chemically Functionalized Gold Nanoparticles

A substantial and stable increase of the current density J_sc of ruthenium (Ru) dye sensitized solar cells (DSC) of up to 16.18% and of the power efficiency of up to 25.5% is demonstrated in this article via plasmonic enhancement. The key aspect of this work is the use of a tailored bimodal size distribution of functionalized gold nanoparticles (AuNPs) that have been chemically immobilized onto the mesoporous titanium dioxide (TiO₂) layer via short, stable dithiodibutyric acid linkers. The size distribution of the AuNPs is a result of theoretical calculations that aimed at the perfection of the absorption characteristics of the complete solar cell system over a wide range of wavelengths. The functionalization of the AuNPs serves to bind them at a close but defined distance to TiO₂-particles and additionally to chemically protect them against potential corrosion by the electrolyte. Simulations of near field (enhanced absorption) and far field (scattering) contributions have been used to tailor a complex AuNPs bimodal size distribution that had subsequently demonstrated experimentally a close to optimum improvement of the absorbance over a wide wavelength range (500–675 nm) and therefore an impressive DSC efficiency enhancement. Finally, the modified DSCs are exhibiting pronounced longevity and stable performance as confirmed via long time measurements. In summary, the presented systems show increased performance compared to non plasmonic enhanced cells with otherwise identical composition, and are demonstrating a previously unpublished longevity for iodide electrolyte/AuNPs combinations.     

Interaction of caldesmon and myosin subfragment 1 with the C-terminus of actin.

The interactions of caldesmon and S1 with the C-terminus of actin were examined in co-sedimentation experiments using proteolytically truncated actin. It is shown that removal of 6 residues from the C-terminus of actin reduces the binding of caldesmon by about 50% while improving the binding of S1 to actin. We also show that S1 protects actin's C-terminus from enzymatic cleavage. Both S1 and caldesmon binding to actin are decreased in the presence of an actin C-terminal peptide. These results emphasize the importance of the C-terminus of actin in binding to S1 and caldesmon.     

Biofilter efficiency of <i>Eichhornia crassipes</i> in wastewater treatment of fish farming in Amazonia

Fish is a very important part of the human diet in Amazonia. Near the growing cities, fish populations and individual size have decreased over the past decades. Alternatives to traditional and industrial fishing arise, including fish farming. Strategies to minimize the impact of fish farms on the environment are needed to have a regular and healthy fish supply. This is to avoid a reduction of biodiversity, a depletion of natural resources, and/or the induction of significant changes in the structure and functioning of adjacent ecosystems. Very little research has been performed on management of effluents as to maintain the quality of water resources. The present study aimed at testing the efficiency of the Amazonian aquatic macrophyte Eichhornia crassipes as a biofilter for the treatment of effluents from fish farming. In three filtering treatments (50%, 75% and 100% plant cover) and a control (0%), physical and chemical properties of the water were measured and analyzed in a nursery with fish after passing the biofilter system, with a hydraulic retention time of 24 hours. The analyzed variables showed no significant differences (p>0.05) among the treatments with 50-100% cover, indicating that 50% cover would be enough for a good efficiency of the biofilter. All parameters were reduced after passage of the biofilter under the presence of E. crassipes: 73.7% for electrical conductivity, 15% for pH, 84.5% for turbidity, 86.8% for nitrite, 69% for total phosphorus, and 77.8% for orthophosphate. The concentrations of total nitrogen, nitrate and ammonium ions were not significantly changed (p>0.05). We conclude that E. crassipes is effective in improving the quality of effluents from fish farming, with less efficiency for nitrogen compounds. Our treatment system can be adopted by small and medium-sized farmers, aiming at a sustainable employment of the activity.     

Association study of the nicotinic acetylcholine receptor alpha4 subunit gene, CHRNA4, in attention-deficit hyperactivity disorder

Attention-deficit hyperactivity disorder (ADHD) is a common childhood-onset psychiatric condition with a strong genetic component. Evidence from pharmacological, clinical and animal studies has suggested that the nicotinic system could be involved in the disorder. Previous studies have implicated the nicotinic acetylcholine receptor α4 subunit gene, CHRNA4 , in ADHD. Particularly, a polymorphism in the exon 2–intron 2 junction of CHRNA4 has been associated with severe inattention defined by latent class analysis. In the current study, we used the transmission disequilibrium test (TDT) to investigate four polymorphisms encompassing this region of CHRNA4 for association with ADHD in a sample of 264 nuclear families from Toronto. No significant evidence of biased transmission was observed for any of the marker alleles for ADHD defined as a categorical trait (all subtypes included), although one haplotype showed marginal evidence of under-transmission. No association was found with the ADHD predominantly inattentive subtype or with symptom dimension scores of inattention. On the contrary, nominally significant evidence of association of individual markers was obtained for the ADHD combined subtype and with teacher-rated hyperactivity–impulsivity scores, with the same haplotype being under-transmitted. Based on our results and others, CHRNA4 may be involved in ADHD; however, its role in ADHD symptomatology remains to be clarified.     

Membrane targeting and stabilization of sarcospan is mediated by the sarcoglycan subcomplex

The dystrophin-glycoprotein complex (DGC) is a multisubunit complex that spans the muscle plasma membrane and forms a link between the F-actin cytoskeleton and the extracellular matrix. The proteins of the DGC are structurally organized into distinct subcomplexes, and genetic mutations in many individual components are manifested as muscular dystrophy. We recently identified a unique tetraspan-like dystrophin-associated protein, which we have named sarcospan (SPN) for its multiple sarcolemma spanning domains (Crosbie, R.H., J. Heighway, D.P. Venzke, J.C. Lee, and K.P. Campbell. 1997. J. Biol. Chem. 272:31221-31224). To probe molecular associations of SPN within the DGC, we investigated SPN expression in normal muscle as a baseline for comparison to SPN's expression in animal models of muscular dystrophy. We show that, in addition to its sarcolemma localization, SPN is enriched at the myotendinous junction (MTJ) and neuromuscular junction (NMJ), where it is a component of both the dystrophin- and utrophin-glycoprotein complexes. We demonstrate that SPN is preferentially associated with the sarcoglycan (SG) subcomplex, and this interaction is critical for stable localization of SPN to the sarcolemma, NMJ, and MTJ. Our experiments indicate that assembly of the SG subcomplex is a prerequisite for targeting SPN to the sarcolemma. In addition, the SG- SPN subcomplex functions to stabilize alpha-dystroglycan to the muscle plasma membrane. Taken together, our data provide important information about assembly and function of the SG-SPN subcomplex.     

Assembly of the dystrophin-associated protein complex does not require the dystrophin COOH-terminal domain

Dystrophin is a multidomain protein that links the actin cytoskeleton to laminin in the extracellular matrix through the dystrophin associated protein (DAP) complex. The COOH-terminal domain of dystrophin binds to two components of the DAP complex, syntrophin and dystrobrevin. To understand the role of syntrophin and dystrobrevin, we previously generated a series of transgenic mouse lines expressing dystrophins with deletions throughout the COOH-terminal domain. Each of these mice had normal muscle function and displayed normal localization of syntrophin and dystrobrevin. Since syntrophin and dystrobrevin bind to each other as well as to dystrophin, we have now generated a transgenic mouse deleted for the entire dystrophin COOH-terminal domain. Unexpectedly, this truncated dystrophin supported normal muscle function and assembly of the DAP complex. These results demonstrate that syntrophin and dystrobrevin functionally associate with the DAP complex in the absence of a direct link to dystrophin. We also observed that the DAP complexes in these different transgenic mouse strains were not identical. Instead, the DAP complexes contained varying ratios of syntrophin and dystrobrevin isoforms. These results suggest that alternative splicing of the dystrophin gene, which naturally generates COOH-terminal deletions in dystrophin, may function to regulate the isoform composition of the DAP complex.