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Healthcare resource management: integrating apples and oranges.

Over the past several years this journal has published numerous articles on the merits and benefits of effective resource management. Independently, these articles have supported the value of effective supply and materials management, management engineering and system restructuring, and clinical resource management in being able to save healthcare dollars by designing and injecting efficiencies into the healthcare delivery system. While most of these resource management activities have utilized very similar strategies (see Table 1 "Tools For Improvement"), much of the process revision and progress has remained within the walls of their own individual disciplines. Any widescale attempts to try to fully integrate all of these activities have been hampered by the intricacies of trying to mix apples and oranges. Despite these individual departmental gains, the challenge to conserve healthcare costs continues to permeate throughout all levels of the organization, and institutions are finally beginning to recognize the added value of merging these activities into a more centralized coordinated approach to resource management. Presented is a discussion on the potential value of developing a well-focused, integrated resource management program.

Benchmarking↗

[Proof of soil sickness in growing apple plantations (author's transl)].

1. Soils from five apple orchards of different age and from different sites were tested with respect to the occurrence of soil sickness. 2. Severe or very severe soil sickness could be proved in four of the sites. In one site weak soil sickness could be obtained. 3. These results confirm earlier observations on the occurrence of soil sickness within the regions of growing root systems of older trees. 4. The occurrence of soil sickness in growing plantations can be brought in good correspondence with the ascertainment that microorganisms associated with roots are to be considered as the cause of soil sickness. 5. The significance of the occurrence of soil sickness in growing plantations for development and yield of trees must be investigated in further experiments.

Bacteria↗

Confirmation of patulin and 5-hydroxymethylfurfural in apple juice by gas chromatography/mass spectrometry.

A gas chromatographic/mass spectrometric (GC/MS) method was developed for the confirmation of patulin and 5-hydroxymethylfurfural (HMF) extracted from apple juice. The extraction is based on the official AOAC method for liquid chromatographic analysis. Juice extracts are quickly and easily derivatized with bis(trimethylsilyl)trifluoracetamide under mild conditions, and the trimethylsilyl ethers of the analytes are stable for at least several hours. The analytes are determined by GC/MS using an electron-impact source and selected ion monitoring of characteristic ions. For both analytes, the interassay differences between base-peak ratios for samples and standards were all <7.1% (absolute). The presence of patulin was confirmed at fortification levels of about 30-400 microg/L and naturally occurring levels of about 80-400 microg/L. The presence of HMF was also confirmed at levels < or = 2 mg/L. The proposed mass spectral fragmentation pathways of the analytes are presented.

Beverages↗

An autopsy case of accidental asphyxiation in a storage room for apples.

A 12-year-old boy died in a storage room and his mother was rescued from the same storage room, where many apples were being stored. The atmosphere in the room was strictly controlled and the concentration of oxygen (O2) was recorded. The cause of death was suffocation. According to the records, the concentration of O2 was about 2.7% when the boy died. On the other hand, it was about 3.4% when his mother entered the room and she survived, although she remained unconscious for about four hours. These findings show that the absolute concentration of O2 causing acute death due to O2 deficiency is approximately 2.5-3.0%.

Accidents↗

Successful propagation in vitro of apple rootstock MM106 and influence of phloroglucinol.

Successful in vitro propagation of clonal apple rootstock MM106 was achieved by culturing axillary buds on MS basal medium with BAP (1 mg/L), GA3 (0.5 mg/L) and IBA (0.1 mg/L). Use of liquid medium (LM) in initial cultures reduced phenol exudation to a greater extent and gave maximum sprouting percentage when transferred to solid MS medium. Phloroglucinol (PG) did not enhance sprouting of buds but increased the rate of multiplication when added in the medium. Maximum number of shoots were obtained when MS medium was supplemented with BAP (0.5 mg/L), GA3 (1 mg/L), IBA (0.1 mg/L) and PG (100 mg/L). For rooting, in vitro regenerated shoots were placed in IBA (30 mg/L) for 3 hr and transferred to solidified auxin free medium. Rooting was recorded in about 80% of shoots. Inclusion of PG in rooting medium was not beneficial but shoot cultures grown in its presence gave higher rooting percentage. Rooted plantlets showed about 70% survival rate in potting mixture of sand:soil:perlite (1:1:1).

Culture Media↗

[The cloning of apple ferritin gene (Apfl) from Malus xiaojinensis Cheng et Jiang and its structure analysis].

The special primers were designed based on the sequence information of plant ferritin genes reported in the literature and used for polymerase chain reaction (PCR) with the genomic DNA of Malus xiaojinensis Cheng et Jiang in an attempt to clone apple ferritin gene. A single fragment of 771 bp was successfully obtained from the PCRs and cloned in this study. The sequence and homology analysis results of the fragment showed that the deduced amino acids of the fragment had a ninety-nine percent homology to that of the soybean ferritin gene reported by Lescure et al. (1991). A comparison in details of the nucleotide sequence of the clone and that of the soybean ferritin gene showed that they consisted of the same open reading frame (ORF, 753 bp) and that the cloned fragment had complete initial and stop codes. Within the ORF no introns were found and there were no nucleotide difference in the transit peptide region (TP) of the gene, but five nucleotide mutations were found in the mature peptide region (MP), among which four were synonymous mutations.

Amino Acid Sequence↗

[Relationship between soil water content and water use efficiency of apple leaves].

The relationship between soil water content and water use efficiency (WUE) of apple tree leaf was examined, and the mechanism of WUE variation was also studied by using pot-culture. The results showed that the WUE was upmost when soil water relative content (SWC) reached 52.0%. The increase of WUE when SWC decreased from 77.2% to 52.0% was mainly caused by the change of stomatal conductance. The decline of carboxylation efficiency resulted in the decrease of WUE when SWC decreased from 52.0% to 20.1%. The WUE returned up after being rewatered, but could not reach the control level within a week. The WUE decreased when the soil was waterlogged, but reached the control level in three days after being waterlogged. After the third day, the WUE decreased gradually with the extending of the time being waterlogged. On the sixth day being waterlogged, the carboxylation efficiency decreased.

Malus↗

[Effect of nitrogen on water use efficiency of apple tree].

This paper studied the effect of nitrogen fertilizer on water use efficiency(WUE) and relevant parameters of two years old potted apple trees(Starkrimson/Malus hupenensis) under different soil moisture condition. The results showed that under adequate soil moisture, WUE was decreased with increasing application of nitrogen fertilizer. Nitrogen fertilizer application resulted in an increase of stomatal conductane. Consequently, the transpiration rate was increased more than photosynthetic rate did. Under soil drought, the WUE of plants applied with nitrogen fertilizer was apparently higher than that of control. The WUE value was in the order of high N > medium N > low N. The improvement of WUE was due to the increase of mesophyll capacity, which led to the promotion of photosynthesis.

Malus↗

Cryopreservation of apple dormant buds and shoot tips.

Shoot tips excised from apple (Malus domestica Borkh. cv. Golden Delicious) dormant buds immediately before freezing were successfully cryopreserved using three different methods (vitrification, encapsulation-dehydration and two-step freezing). Two-step freezing produced the highest in vitro growth recovery (83%) of cryopreserved shoot tips, followed by vitrification (60%) and encapsulation-dehydration (33%). By contrast, when dormant buds were cryopreserved using the two-step freezing technique, shoot tips excised from buds after rewarming and cultured in vitro displayed only 16% recovery.

Cryopreservation↗

[Breeding for digenic apple resistance to scab].

The results of the apple breeding for digenic resistance to scab (1979-2000), which is more long-term than the monogenic breeding, have been reviewed. The hybrid seeds obtained from the reciprocal crossing between the Vf and Vm resistance gene donors served as the original material. The seed progeny yielded by backcrosses between these hybrids and the susceptible cultivars were examined (age--first true leaves) using inoculation in a greenhouse. The following criteria were proposed for breeding parental forms and the cultivars of the VfvfVmvm genotype: (1) phenotype segregation in the progeny of three resistant: one susceptible seedling and (2) the presence in the progeny of two types of resistant seedlings: those with the class 1 resistance (points and spots-hypersensitivity) typical of the Vm gene and those with the class 2-3 resistance (chlorotic and necrotic spots) typical of the Vf gene.

Breeding↗

Determination of seventeen polar/thermolabile pesticides in apples and apricots by liquid chromatography/mass spectrometry.

A simple liquid chromatography/mass spectrometry (LC/MS) approach for the determination of widely used representatives of polar/thermolabile pesticides in fruits was developed and validated. The group of pesticides comprised benzimidazoles and azoles (carbendazim, thiabendazole, imazalil, propiconazole, prochloraz, epoxiconazole, flusilazole, tebuconazole, bitertanol); N-methylcarbamates (carbaryl, carbofuran, methiocarb); and phenylureas and benzoylphenylureas (linuron, diflubenzuron, triflumuron, teflubenzuron, flufenoxuron). Matrixes (apple, apricot) were extracted with acetonitrile and crude extracts were cleaned up by solid-phase extraction (SPE) using either mixed cation exchange or hydrophilic lipophilic balance cartridges. LC separation of pesticides was performed on a reversed-phase column, Discovery C18. Electrospray ionization and ion trap MS/MS detection were applied. For most pesticides, overall recoveries ranged from 75 to 122%, and repeatability (as relative standard deviation) from 5 repetitive determinations of recovery ranged from 3 to 21%. Carbofuran was the only compound for which recovery was not satisfactory due to its loss in the SPE cleanup step. Limits of detection were 0.1-3 microg/kg for benzimidazole and azole fungicides and carbamate insecticides. For urea insecticides, detection limits were slightly higher (3-10 microg/kg).

Calibration↗

[Lowering cholesterol with Anticholest--a high fiber guar-apple pectin drink].

In order to determine the efficacy of Anticholest, an apple-pectin-guar soft-drink in reducing elevated cholesterol (c) levels, 33 participants (aged from 8 to 73 years) were divided into three groups of comparable age, body-mass index, total c, LDL-c, HDL-c, and triglycerides. They received this combined fiber product either (group 1) at dosages of 1 cup (17 g) every second day, or (group 2) of 1 cup a day or (group 3) of 2 cups a day. Anticholest significantly reduced total c, LDL-c and the total c/HDL-c ratio. In group 3 HDL-c was increased significantly (p less than 0.01). The average percentage decrease in total c was 10.0% for group 1, 10.7% for group 2, and 15.7% for group 3. LDL-c was lowered 14.4% in group 1, 13.8% in group 2 and 19.1% in group 3. The highest individual reduction amounted to more than 30% for total-c and LDL-c. A significant decrease was also detected in the triglycerides (tg) in group 3 (p less than 0.05). 7 patients were non-responders. Anticholest appears to be an appropriate treatment for patients at risk of coronary heart disease with insufficient or inadequate response to dietary measures, but where long-term pharmacotherapy is not yet indicated. The lack of side effects and its form of administration as a viscous drink are important determinants for long-term compliance, which is essential in the management of a chronic progressive disease such as atherosclerosis.

Adolescent↗

Storage excretion in the Indian apple snail, Pila globosa (Swainson), during aestivation.

Uric acid accumulates in several tissues of the Indian apple snail, P. globosa, during aestivation. This accumulation is particularly high in the foot muscle and reproductive organs. Since the kidney, a tiny organ in the snail, has only a limited capacity to store uric acid, extrarenal tissues are used as storage depots of uric acid during aestivation. It is suggested that the aestivating snail, faced with a cleidoic situation, resorts to storage excretion, a phenomenon well documented in insects.

Adaptation, Physiological↗

A new age ISM: beyond a toxic apple.

Munhall argues for a synthesis and respect for various educational pedagogues, acknowledging the core values and beliefs about education that reflect our infinite variety. The article abandons the myth of the handsome prince and is the second of a trilogy on apples.

Behavioral Sciences↗

Apple juice prevents oxidative stress and impaired cognitive performance caused by genetic and dietary deficiencies in mice.

Increased oxidative stress contributes to the decline in cognitive performance during normal aging and in neurodegenerative conditions such as Alzheimer s disease. Dietary supplementation with fruits and vegetables that are high in antioxidant potential have in some cases compensated for dietary and/or genetic deficiencies that promote increased oxidative stress. Herein, we demonstrate that apple juice concentrate, administered ad libitum in drinking water, can compensate for the increased reactive oxygen species and decline in cognitive performance in maze trials observed when normal and transgenic mice lacking apolipoprotein E are deprived of folate and vitamin E. In addition, we demonstrate that this protective effect is not derived from the sugar content of the concentrate.

Aging↗

Induction of apoptosis by three types of procyanidin isolated from apple (Rosaceae Malus pumila) in human stomach cancer KATO III cells.

We have investigated the effects of three types of procyanidin isolated from apple (Rosaceae Malus pumila) on DNA of human stomach cancer KATO III cells. Induction of apoptosis by these procyanidins was observed in human stomach cancer KATO III cells. Morphological changes showing apoptotic bodies were observed in the KATO III cells treated with procyanidins. The fragmentation of DNA by procyanidins to oligonucleosomal-sized fragments, a characteristic of apoptosis, was observed to be concentration- and time-dependent in the KATO III cells. N-acetyl-L-cysteine, an antioxidant, suppressed the DNA fragmentation induced by these procyanidins. The present study shows that the suppression of KATO III cell-growth by three types of procyanidin results from the induction of apoptosis by these compounds, and that active oxygen is involved in the induction of apoptosis by these compounds in the KATO III cells.

Acetylcysteine↗