Who cares wins? A comparative analysis of household waste medicines and batteries reverse logistics systems – the case of the NHS (UK).

Purpose The purpose of this paper is to determine how best to reduce, reuse and dispose of household waste medicines in the National Health Service (NHS) (UK). Design/Methodology/Approach Through a combination of literature review and empirical work, this research investigates the existing household waste medicines Reverse Logistics (RL) system, and makes recommendations for improvement by benchmarking it against household waste batteries RL system. The viability and feasibility of these recommendations are evaluated through in-depth interviews with healthcare professionals and end user surveys. Findings The batteries RL system appears to be a more structured and effective system with more active engagement from actors/stakeholders in instigating RL practices and for this very reason is an excellent comparator for waste medicines RL practices. Appropriate best practices are recommended to be incorporated into the waste medicines RL system, including recapturing product value, revised processing approaches, system co-operation and enforcement, drivers and motivations, and system design and facilitation. Research implications/limitations This study offers academics and professionals an improved insight into the current household waste medicines RL system, and provides a step towards reducing an existing gap in this under-researched area. A limitation is that only a small sample of healthcare professionals were involved in subjectively evaluating the feasibility of the recommendations, so the applicability of the recommendations needs to be tested in a wider context and the cost effectiveness of implementing the recommendations needs to be analysed. Practical implications Reducing, reusing and properly disposing of waste medicines contribute to economic sustainability, environmental protection and personal and community safety. The information retrieved from analysing returned medicines can be used to inform prescribing practice so as to reduce unnecessary medicine waste and meet the medicine optimisation agenda. Originality/value This paper advocates learning from best practices in batteries RL to improve the waste medicines RL design and execution, and it supports the current NHS agenda on medicine waste reduction (DoH, 2012). The recommendations made in the paper not only aim to reduce medicine waste, but also to use medicines effectively, placing the emphasis on improving health outcomes

Immunohistochemistry(IHC) staining for Wnt5a, JNK1, NF-κB p65, and COX-2.

<p>IHC staining for Wnt5a (A–D; ×400); IHC staining for JNK1 (E–H; ×400); IHC staining for NF-κB p65 (I–L; ×400); IHC staining for COX-2 (M–P; ×400). The Integral Optical Density(IOD) of Wnt5a (Q), JNK1 (R), NF-κB p65 (S); COX-2 (T). ^*<i>P</i><0.01 <i>vs.</i> the control group and the control-cele group; ^**<i>P</i><0.01 <i>vs.</i> the T2DM-NASH group. White = control; Gray = control-cele; Black = T2DM-NASH; Striped = T2DM-NASH-Cele.</p

Serum metabolic parameters in four groups.

<p>Serum metabolic parameters in four groups.</p

Basic parameters in four groups.

<p>Basic parameters in four groups.</p

T₂DM rats fed with a HF-HS diet developed severe steatohepatitis.

<p>H&E-stained livers ((A–D; ×200) and (E–H; ×400)). Oil Red-O staining of livers lipid accumulation (I–L; ×200). The results of NAFLD activity score (NAS) (M–P). Quantification results of steatosis (M), lobular inflammation (N), ballooning (O), NAS total scores (P). ^*<i>P</i><0.01 <i>vs.</i> the control group and the control-cele group;^**<i>P</i><0.01 <i>vs.</i> the T2DM-NASH group. White = control; Gray = control-cele; Black = T2DM-NASH; Striped = T2DM-NASH-Cele.</p

Western blot analysis of Wnt5a, JNK1, NF-κB p65, and COX-2 protein expression.

<p>Representative western blot images and quantitative analysis of Wnt5a (A), JNK1 p54 and p46 (B), NF-κB p65 (C), and COX-2 (D). GAPDH was used as a loading control. ^*<i>P</i><0.01 <i>vs.</i> the control group and the control-cele group; ^**<i>P</i><0.01 <i>vs.</i> the T2DM-NASH group. White = control; Gray = control-cele; Black = T2DM-NASH; Striped = T2DM-NASH-Cele.</p

Mutations in hepatitis B virus polymerase are associated with the postoperative survival of hepatocellular carcinoma patients

<div><p>Proofreading deficiencies of hepatitis B virus polymerase result in frequent DNA mutations in the hepatitis B virus genome. Here, we performed sequencing analysis of the hepatitis B virus polymerase gene to assess its association with the postoperative survival in 92 patients with HBV-related hepatocellular carcinoma by using the Kaplan–Meier method. The 2525, 2733, 2738, 2768, 2946, 3063, 3066, 3109, 31, 529, 735, 939, 1078, 1137, 1383, 1461, 1485, 1544, and 1613 mutation sites were identified as being associated with HCC outcomes by the log-rank test. After adjusting for clinical characteristics by using the Cox hazard model, site 31 (relative risk, 8.929; 95% confidence interval, 3.433–23.22; <i>P</i> = 0.000) in the spacer domain and sites 529 (relative risk, 5.656; 95% confidence interval, 1.599–19.999; <i>P</i> = 0.007) and 1078 (relative risk, 3.442; 95% confidence interval, 1.070–11.068; <i>P</i> = 0.038) in the reverse transcriptase domain of hepatitis B virus polymerase were identified as independent predictors of postoperative survival in hepatitis B virus related hepatocellular carcinoma. The mutations at the 31 (Ser314Pro), 529 (Asp480Asn), and 1078 (Ser663Ala) sites all resulted in amino acid changes in hepatitis B virus polymerase and were associated with shortened life-span. The 31 and 529 sites were located in the overlapping region for the PreS and S genes but did not induce amino acid substitution in these two regions. Our finding of the correlation between hepatitis B virus DNA polymerase mutations and hepatocellular carcinoma survival will help identify the patients subgroup with poor prognosis, and help the clinicians to refine the therapeutic decision individualized.</p></div

Multivariate analysis of the clinical factors associated with postoperative survival in HBV-HCC patients.

<p>Multivariate analysis of the clinical factors associated with postoperative survival in HBV-HCC patients.</p

Engineering the Work Function of Buckled Boron α‑Sheet by Lithium Adsorption: A First-Principles Investigation

First-principles density functional theory calculations were performed to study the effect of Li adsorption on the structural and electronic properties, particularly the work function, of boron α-sheet. The calculated binding energies indicated that boron α-sheet could be well stabilized by the adsorption of Li atoms. Furthermore, the work functions of Li-adsorbed boron α-sheets were observed to decrease drastically with increasing Li coverage. The work functions are lower than that of Mg and even, for some of them, lower than that of Ca, indicating a considerable potential application of Li-adsorbed boron α-sheets as field-emission and electrode materials. Based on the calculated geometric and electronic structures, we discuss in details some possible aspects affecting the work function. The Li coverage dependence of the work functions of Li-adsorbed boron α-sheets was further confirmed by electrostatic potential analyses. The relationship between the work function variation and the Fermi and vacuum energy level shifts was also discussed, and we observed that the variation of the work function is primarily associated with the shift of the Fermi energy level. It is the surface dipole formed by the interaction between adatoms and substrate that should be responsible for the observed variation of the work function, whereas the increasing negative charge and rumpling for boron α-sheet only play minor roles. Additionally, the effect of Li adatoms on the work function of boron α-sheet was confirmed to be much stronger than that of graphene or a graphene double layer

First-Principles Investigation of the Electronic Properties and Stabilities of the LaAlO₃ (001) and (110) (1 × 1) Polar Terminations

The first-principles thermodynamics characterization of the stabilities and electronic properties of the LaAlO₃ (001) and (110) polar surfaces was systematically performed using density functional theory methods. Two types of polar surfaces, including the terminations along the (001) orientation (the LaO- and AlO₂-terminated surfaces) and the (110) orientation (the LaAlO-, O₂-, La-, AlO-, and O-terminated surfaces), were considered in this study. The computational results of the charge redistributions and geometries confirm that the electronic structure change and surface reconstruction should be responsible for the cancellation of the macroscopic dipole moments of these polar terminations, which stabilizes them. The charge neutralization can also be achieved by the charge redistribution of surface atoms. Furthermore, using the surface grand potential method in which the effect of the chemical environment on surface stability is considered, we constructed the stability phase diagram of the LaAlO₃ (001) and (110) polar surfaces. The results indicate that only the O (110), LaO (001), and AlO₂ (001) terminations have corresponding stability domains and can be considered targets in further experimental investigations