Strain relaxation dynamics of multiferroic orthorhombic manganites.

Resonant Ultrasound Spectroscopy has been used to characterise strain coupling and relaxation behaviour associated with magnetic/magnetoelectric phase transitions in GdMnO3, TbMnO3 and TbMn0.98Fe0.02O3 through their influence on elastic/anelastic properties. Acoustic attenuation ahead of the paramagnetic colinear-sinusoidal/incommensurate/antiferromagnetic transition at ~41 K correlates with anomalies in dielectric properties and is interpreted in terms of Debye-like freezing processes. A loss peak at ~150 K is related to a steep increase in electrical conductivity with a polaron mechanism. The activation energy, Ea, of ≥ ~0.04 eV from a loss peak at ~80 K is consistent with the existence of a well-defined temperature interval in which the paramagnetic structure is stabilised by local, dynamic correlations of electric and magnetic polarisation that couple with strain and have relaxation times in the vicinity of ~10-6 s. Comparison with previously published data for Sm0.6Y0.4MnO3 confirms that this pattern may be typical for multiferroic orthorhombic RMnO3 perovskites (R = Gd, Tb, Dy). A frequency-dependent loss peak near 10 K observed for TbMnO3 and TbMn0.98Fe0.02O3, but not for GdMnO3, yielded Ea ≥ ~0.002 eV and is interpreted as freezing of some magnetoelastic component of the cycloid structure. Small anomalies in elastic properties associated with the incommensurate and cycloidal magnetic transitions confirm results from thermal expansion data that the magnetic order parameters have weak but significant coupling with strain. Even at strain magnitudes of ~0.1-1 ‰, polaron-like strain effects are clearly important in defining the development and evolution of magnetoelectric properties in these materials. Strains associated with the cubic - orthorhombic transition due to the combined Jahn-Teller/octahedral tilting transition in the vicinity of 1500 K are 2-3 orders of magnitude greater. It is inevitable that ferroelastic twin walls due to this transition would have significantly different magnetoelectric properties from homogeneous domains due to magnetoelastic coupling with steep strain gradients.This work was funded by EPSRC Grant No. EP/ P024904/1 (UK). RUS facilities were established through grants from the Natural Environment Research Council (Grants No. NE/B505738/1 and No. NE/F017081/1) and the Engineering and Physical Sciences Research Council (Grant No. EP/I036079/1) to MAC. The work at the University of Warwick was supported by EPSRC,UK through Grant EP/T005963/1

Practical recommendations on the use of lenalidomide in the management of myelodysplastic syndromes

Lenalidomide, an oral immunomodulatory agent, has received approval in the USA from the Food and Drug Administration (FDA) for the management of myelodysplastic syndromes (MDS) classified by the International Prognostic Scoring System (IPSS) as low risk or intermediate-1 risk and with a deletion 5q (del(5q)) cytogenetic abnormality. Although some patients with del(5q) have a relatively good prognosis, all del(5q) patients will become transfusion-dependent at some point during the course of their disease. The results of two clinical trials in more than 160 patients with MDS have demonstrated clear therapeutic benefits of lenalidomide, with >60% of patients achieving independence from transfusion during therapy, irrespective of age, prior therapy, sex, or disease-risk assessment. The recommendations presented in this review will aid the safe administration of lenalidomide for the treatment of patients with low-risk or intermediate-1-risk MDS and a del(5q) cytogenetic abnormality, and they will help physicians avoid unnecessary dose reduction or interruption, thus assuring the best efficacy for patients

Investigating the Willingness to Pay for a Contributory National Health Insurance Scheme in Saudi Arabia:A Cross-sectional Stated Preference Approach

Background: The Saudi Healthcare System is universal, financed entirely from government revenue principally derived from oil, and is ‘free at the point of delivery’ (non-contributory). However, this system is unlikely to be sustainable in the medium to long term. This study investigates the feasibility and acceptability of healthcare financing reform by examining households’ willingness to pay (WTP) for a contributory national health insurance scheme. Methods: Using the contingent valuation method, a pre-tested interviewer-administered questionnaire was used to collect data from 1187 heads of household in Jeddah province over a 5-month period. Multi-stage sampling was employed to select the study sample. Using a double-bounded dichotomous choice with the follow-up elicitation method, respondents were asked to state their WTP for a hypothetical contributory national health insurance scheme. Tobit regression analysis was used to examine the factors associated with WTP and assess the construct validity of elicited WTP. Results: Over two-thirds (69.6%) indicated that they were willing to participate in and pay for a contributory national health insurance scheme. The mean WTP was 50 Saudi Riyal (US$13.33) per household member per month. Tobit regression analysis showed that household size, satisfaction with the quality of public healthcare services, perceptions about financing healthcare, education and income were the main determinants of WTP. Conclusions: This study demonstrates a theoretically valid WTP for a contributory national health insurance scheme by Saudi people. The research shows that willingness to participate in and pay for a contributory national health insurance scheme depends on participant characteristics. Identifying and understanding the main influencing factors associated with WTP are important to help facilitate establishing and implementing the national health insurance scheme. The results could assist policy-makers to develop and set insurance premiums, thus providing an additional source of healthcare financing

Women’s, partners’ and healthcare providers’ views and experiences of assisted vaginal birth: a systematic mixed methods review

Background When certain complications arise during the second stage of labour, assisted vaginal delivery (AVD), a vaginal birth with forceps or vacuum extractor, can effectively improve outcomes by ending prolonged labour or by ensuring rapid birth in response to maternal or fetal compromise. In recent decades, the use of AVD has decreased in many settings in favour of caesarean section (CS). This review aimed to improve understanding of experiences, barriers and facilitators for AVD use. Methods Systematic searches of eight databases using predefined search terms to identify studies reporting views and experiences of maternity service users, their partners, health care providers, policymakers, and funders in relation to AVD. Relevant studies were assessed for methodological quality. Qualitative findings were synthesised using a meta-ethnographic approach. Confidence in review findings was assessed using GRADE CERQual. Findings from quantitative studies were synthesised narratively and assessed using an adaptation of CERQual. Qualitative and quantitative review findings were triangulated using a convergence coding matrix. Results Forty-two studies (published 1985–2019) were included: six qualitative, one mixed-method and 35 quantitative. Thirty-five were from high-income countries, and seven from LMIC settings. Confidence in the findings was moderate or low. Spontaneous vaginal birth was most likely to be associated with positive short and long-term outcomes, and emergency CS least likely. Views and experiences of AVD tended to fall somewhere between these two extremes. Where indicated, AVD can be an effective, acceptable alternative to caesarean section. There was agreement or partial agreement across qualitative studies and surveys that the experience of AVD is impacted by the unexpected nature of events and, particularly in high-income settings, unmet expectations. Positive relationships, good communication, involvement in decision-making, and (believing in) the reason for intervention were important mediators of birth experience. Professional attitudes and skills (development) were simultaneously barriers and facilitators of AVD in quantitative studies. Conclusions Information, positive interaction and communication with providers and respectful care are facilitators for acceptance of AVD. Barriers include lack of training and skills for decision-making and use of instruments

Stability of sandwich plates by mixed, higher-order analytical formulation

A unified mixed, higher-order analytical formulation has been presented in this paper to predict general buckling as well as wrinkling of a general multi-layer, multi-core sandwich plate having any arbitrary sequence of stiff layers and cores. Assumptions of thin stiff layers and anti-plane core, which are usually made in the analysis of sandwiches, have been eliminated in the present formulation. Displacements as well as the transverse stress continuities have been enforced in the formulation by incorporating them as the degrees-of-freedom. The modal transverse stresses have been obtained directly as eigen vectors and thus their separate calculations have been advantageously avoided. Two sets of mixed models have been proposed on the basis of individual layer as well as equivalent single layer (ESL) theories by selectively incorporating non-linear components of Green's strain tensor. Solutions from the models have been shown to be in excellent agreement with the available three-dimensional elasticity solutions as well as with the available experimental results. It has been demonstrated that the ESL theories cannot accurately evaluate the overall buckling as well as the wrinkling loads of sandwiches. Limitations of the typical simplifying assumptions have also been highlighted. (C) 2003 Elsevier Ltd