How does the knowledge environment shape procurement practices for orthopaedic medical devices in Mexico?

BACKGROUND: In organisational theory there is an assumption that knowledge is used effectively in healthcare systems that perform well. Actors in healthcare systems focus on managing knowledge of clinical processes like, for example, clinical decision-making to improve patient care. We know little about connecting that knowledge to administrative processes like high-risk medical device procurement. We analysed knowledge-related factors that influence procurement and clinical procedures for orthopaedic medical devices in Mexico. METHODS: We based our qualitative study on 48 semi-structured interviews with various stakeholders in Mexico: orthopaedic specialists, government officials, and social security system managers or administrators. We took a knowledge-management related perspective (i) to analyse factors of managing knowledge of clinical procedures, (ii) to assess the role of this knowledge and in relation to procurement of orthopaedic medical devices, and (iii) to determine how to improve the situation. RESULTS: The results of this study are primarily relevant for Mexico but may also give impulsion to other health systems with highly standardized procurement practices. We found that knowledge of clinical procedures in orthopaedics is generated inconsistently and not always efficiently managed. Its support for procuring orthopaedic medical devices is insufficient. Identified deficiencies: leaders who lack guidance and direction and thus use knowledge poorly; failure to share knowledge; insufficiently defined formal structures and processes for collecting information and making it available to actors of health system; lack of strategies to benefit from synergies created by information and knowledge exchange. Many factors are related directly or indirectly to technological aspects, which are insufficiently developed. CONCLUSIONS: The content of this manuscript is novel as it analyses knowledge-related factors that influence procurement of orthopaedic medical devices in Mexico. Based on our results we recommend that the procurement mechanism should integrate knowledge from clinical procedures adequately in their decision-making. Without strong guidance, organisational changes, and support by technological solutions to improve the generation and management of knowledge, procurement processes for orthopaedic high-risk medical devices will remain sub-optimal

Ultrasound Investigations of Orbital Quadrupolar Ordering in UPd_3

For a high-quality single crystal of UPd_3 we present the relevant elastic constants and ultrasonic attenuation data. In addition to the magnetic phase transition at T_2=4.4 +/- 0.1K and the quadrupolar transition at T_1~6.8K, we find orbital ordering at T_0=7.6 +/- 0.1K concomitant with a symmetry change from hexagonal to orthorhombic. A striking feature is the splitting of the phase transition at T_1 into a second-order transition at T_{+1}=6.9 +/- 0.05K and a first-order transition at T_{-1}=6.7 +/- 0.05K. For the four phase transitions, the quadrupolar order parameters and the respective symmetry changes are specified.Comment: 14 pages (RevTex), 3 eps-figures, accepted by PR

Coherence properties of exciton-polariton OPO condensates in one and two dimensions

We give an overview of the coherence properties of exciton-polariton condensates generated by optical parametric scattering. Different aspects of the first-order coherence (g (1)) have been investigated. The spatial coherence extension of a two-dimensional (2D) polariton system, below and at the parametric threshold, demonstrates the development of a constant phase coherence over the entire condensate, once the condensate phase transition takes place. The effect on coherence of the photonic versus excitonic nature of the condensates is also examined. The coherence of a quasi-1D trap, composed of a line defect, is studied, showing the detrimental effect of reduced dimensionality on the establishment of the long range order. In addition, the temporal coherence decay, g (1)(τ), reveals a fast decay in contrast with the 2D case. The situation of a quasi-1D condensate coexisting with a 2D one is also presentedThe work was supported by the FP7 ITNs Clermont4 (235114) and Spin-optronics (237252), the Spanish MEC (MAT2011-22997), CAM (S-2009/ESP-1503) and Science Foundation Ireland SIRG/I1592 (PRE

Scientific complications and controversies noted in the field of CdS/CdTe thin film solar cells and the way forward for further development

Cadmium telluride-based solar cell is the most successfully commercialised thin film solar cell today. The laboratory-scale small devices have achieved ~ 22%, and commercial solar panels have reached ~ 18% conversion efficiencies. However, there are various technical complications and some notable scientific contradictions that appear in the scientific literature published since the early 1970s. This review paper discusses some of these major complications and controversies in order to focus future research on issues of material growth and characterisation, post-growth processing, device architectures and interpretation of the results. Although CdTe can be grown using more than 14 different growth techniques, successful commercialisation has been taken place using close-space sublimation and electrodeposition techniques only. The experimental results presented in this review are mainly based on electrodeposition. Historical trends of research and commercial successes have also been discussed compared to the timeline of novel breakthroughs in this field. Deeper understanding of these issues may lead to further increase in conversion efficiencies of this solar cell. Some novel ideas for further development of thin film solar cells are also discussed towards the end of this paper

The Future of Rheumatoid Arthritis and Hand Surgery - Combining Evolutionary Pharmacology and Surgical Technique

Rheumatoid arthritis is a systemic autoimmune disease of uncertain aetiology, which is characterized primarily by synovial inflammation with secondary skeletal destructions