An evaluation of the promotional factors influencing general practitioners' prescribing behaviour, primarily the pharmaceutical representative.

Thesis (M.B.A.)-University of Natal, Pietermaritzburg, 2003.Generally the pharmaceutical industry operates in a heavily regulated and controlled environment. In South Africa, the regulations governing prescription drugs do not allow the pharmaceutical companies to advertise the prescription drugs directly to the consumers. As a consequence, the greater part of the marketing efforts of the pharmaceutical companies is directed at the medical practitioners, who occupy the crucial decision-making position for the prescription drugs. The study broadly investigates the relative influence of the various promotional factors that may influence the General Practitioner's choice of prescription drug and more specifically, focuses on the characteristics of the pharmaceutical sales representatives that may influence the prescribing behaviour of the General Practitioners. An area sample of 67 general practitioners in Pietermaritzburg, South Africa, was carried out. A total of 58 responses were analysed to determine the perceived influence of various factors on the GPs' choice of new and existing prescription drugs. A specific attempt was made to determine the key influential factors with respect to the promotion by the pharmaceutical representatives and GPs' appreciation of basic statistics used in the presentations by the pharmaceutical representatives

Effectiveness of partial wrapping of stainless-steel wire mesh on compression behavior of concrete cylinders

Partial confinement can provide sufficient reinforcement to enhance the compressive strength and ductility of concrete with lesser confining material. This paper presents the results of an axial compression test conducted on eighteen plain concrete cylinders of 150 mm diameter and 300 mm height partially confined with a Stainless-Steel Wire Mesh (SSWM) strip of different widths. The study included two specimens without wrapping, two fully wrapped specimens, and others wrapped with two SSWM strips of varying widths at both the ends of concrete cylinder. The strain on SSWM up to failure is measured to understand the effectiveness of lateral confining pressure on the behaviour of concrete cylinders. The peak axial compressive strength and corresponding strain of unconfined and SSWM-confined concrete cylinders are compared. The result shows a significant increase in peak confined compressive stress as compared to an unconfined concrete cylinder. However, the confinement efficiency is reduced when the height of the unconfined region exceeds the diameter of the cylinder, and significant strain localisation is detected within the unwrapped region. Based on experimental investigation, a confinement coefficient is suggested for a partial wrapping of SSWM on the concrete cylinder

Case Reports1. A Late Presentation of Loeys-Dietz Syndrome: Beware of TGFβ Receptor Mutations in Benign Joint Hypermobility

Background: Thoracic aortic aneurysms (TAA) and dissections are not uncommon causes of sudden death in young adults. Loeys-Dietz syndrome (LDS) is a rare, recently described, autosomal dominant, connective tissue disease characterized by aggressive arterial aneurysms, resulting from mutations in the transforming growth factor beta (TGFβ) receptor genes TGFBR1 and TGFBR2. Mean age at death is 26.1 years, most often due to aortic dissection. We report an unusually late presentation of LDS, diagnosed following elective surgery in a female with a long history of joint hypermobility. Methods: A 51-year-old Caucasian lady complained of chest pain and headache following a dural leak from spinal anaesthesia for an elective ankle arthroscopy. CT scan and echocardiography demonstrated a dilated aortic root and significant aortic regurgitation. MRA demonstrated aortic tortuosity, an infrarenal aortic aneurysm and aneurysms in the left renal and right internal mammary arteries. She underwent aortic root repair and aortic valve replacement. She had a background of long-standing joint pains secondary to hypermobility, easy bruising, unusual fracture susceptibility and mild bronchiectasis. She had one healthy child age 32, after which she suffered a uterine prolapse. Examination revealed mild Marfanoid features. Uvula, skin and ophthalmological examination was normal. Results: Fibrillin-1 testing for Marfan syndrome (MFS) was negative. Detection of a c.1270G > C (p.Gly424Arg) TGFBR2 mutation confirmed the diagnosis of LDS. Losartan was started for vascular protection. Conclusions: LDS is a severe inherited vasculopathy that usually presents in childhood. It is characterized by aortic root dilatation and ascending aneurysms. There is a higher risk of aortic dissection compared with MFS. Clinical features overlap with MFS and Ehlers Danlos syndrome Type IV, but differentiating dysmorphogenic features include ocular hypertelorism, bifid uvula and cleft palate. Echocardiography and MRA or CT scanning from head to pelvis is recommended to establish the extent of vascular involvement. Management involves early surgical intervention, including early valve-sparing aortic root replacement, genetic counselling and close monitoring in pregnancy. Despite being caused by loss of function mutations in either TGFβ receptor, paradoxical activation of TGFβ signalling is seen, suggesting that TGFβ antagonism may confer disease modifying effects similar to those observed in MFS. TGFβ antagonism can be achieved with angiotensin antagonists, such as Losartan, which is able to delay aortic aneurysm development in preclinical models and in patients with MFS. Our case emphasizes the importance of timely recognition of vasculopathy syndromes in patients with hypermobility and the need for early surgical intervention. It also highlights their heterogeneity and the potential for late presentation. Disclosures: The authors have declared no conflicts of interes

BHPR research: qualitative1. Complex reasoning determines patients' perception of outcome following foot surgery in rheumatoid arhtritis

Background: Foot surgery is common in patients with RA but research into surgical outcomes is limited and conceptually flawed as current outcome measures lack face validity: to date no one has asked patients what is important to them. This study aimed to determine which factors are important to patients when evaluating the success of foot surgery in RA Methods: Semi structured interviews of RA patients who had undergone foot surgery were conducted and transcribed verbatim. Thematic analysis of interviews was conducted to explore issues that were important to patients. Results: 11 RA patients (9 ♂, mean age 59, dis dur = 22yrs, mean of 3 yrs post op) with mixed experiences of foot surgery were interviewed. Patients interpreted outcome in respect to a multitude of factors, frequently positive change in one aspect contrasted with negative opinions about another. Overall, four major themes emerged. Function: Functional ability & participation in valued activities were very important to patients. Walking ability was a key concern but patients interpreted levels of activity in light of other aspects of their disease, reflecting on change in functional ability more than overall level. Positive feelings of improved mobility were often moderated by negative self perception ("I mean, I still walk like a waddling duck”). Appearance: Appearance was important to almost all patients but perhaps the most complex theme of all. Physical appearance, foot shape, and footwear were closely interlinked, yet patients saw these as distinct separate concepts. Patients need to legitimize these feelings was clear and they frequently entered into a defensive repertoire ("it's not cosmetic surgery; it's something that's more important than that, you know?”). Clinician opinion: Surgeons' post operative evaluation of the procedure was very influential. The impact of this appraisal continued to affect patients' lasting impression irrespective of how the outcome compared to their initial goals ("when he'd done it ... he said that hasn't worked as good as he'd wanted to ... but the pain has gone”). Pain: Whilst pain was important to almost all patients, it appeared to be less important than the other themes. Pain was predominately raised when it influenced other themes, such as function; many still felt the need to legitimize their foot pain in order for health professionals to take it seriously ("in the end I went to my GP because it had happened a few times and I went to an orthopaedic surgeon who was quite dismissive of it, it was like what are you complaining about”). Conclusions: Patients interpret the outcome of foot surgery using a multitude of interrelated factors, particularly functional ability, appearance and surgeons' appraisal of the procedure. While pain was often noted, this appeared less important than other factors in the overall outcome of the surgery. Future research into foot surgery should incorporate the complexity of how patients determine their outcome Disclosure statement: All authors have declared no conflicts of interes

The Changing Landscape for Stroke\ua0Prevention in AF: Findings From the GLORIA-AF Registry Phase 2

Background GLORIA-AF (Global Registry on Long-Term Oral Antithrombotic Treatment in Patients with Atrial Fibrillation) is a prospective, global registry program describing antithrombotic treatment patterns in patients with newly diagnosed nonvalvular atrial fibrillation at risk of stroke. Phase 2 began when dabigatran, the first non\u2013vitamin K antagonist oral anticoagulant (NOAC), became available. Objectives This study sought to describe phase 2 baseline data and compare these with the pre-NOAC era collected during phase 1. Methods During phase 2, 15,641 consenting patients were enrolled (November 2011 to December 2014); 15,092 were eligible. This pre-specified cross-sectional analysis describes eligible patients\u2019 baseline characteristics. Atrial fibrillation disease characteristics, medical outcomes, and concomitant diseases and medications were collected. Data were analyzed using descriptive statistics. Results Of the total patients, 45.5% were female; median age was 71 (interquartile range: 64, 78) years. Patients were from Europe (47.1%), North America (22.5%), Asia (20.3%), Latin America (6.0%), and the Middle East/Africa (4.0%). Most had high stroke risk (CHA2DS2-VASc [Congestive heart failure, Hypertension, Age  6575 years, Diabetes mellitus, previous Stroke, Vascular disease, Age 65 to 74 years, Sex category] score  652; 86.1%); 13.9% had moderate risk (CHA2DS2-VASc = 1). Overall, 79.9% received oral anticoagulants, of whom 47.6% received NOAC and 32.3% vitamin K antagonists (VKA); 12.1% received antiplatelet agents; 7.8% received no antithrombotic treatment. For comparison, the proportion of phase 1 patients (of N = 1,063 all eligible) prescribed VKA was 32.8%, acetylsalicylic acid 41.7%, and no therapy 20.2%. In Europe in phase 2, treatment with NOAC was more common than VKA (52.3% and 37.8%, respectively); 6.0% of patients received antiplatelet treatment; and 3.8% received no antithrombotic treatment. In North America, 52.1%, 26.2%, and 14.0% of patients received NOAC, VKA, and antiplatelet drugs, respectively; 7.5% received no antithrombotic treatment. NOAC use was less common in Asia (27.7%), where 27.5% of patients received VKA, 25.0% antiplatelet drugs, and 19.8% no antithrombotic treatment. Conclusions The baseline data from GLORIA-AF phase 2 demonstrate that in newly diagnosed nonvalvular atrial fibrillation patients, NOAC have been highly adopted into practice, becoming more frequently prescribed than VKA in Europe and North America. Worldwide, however, a large proportion of patients remain undertreated, particularly in Asia and North America. (Global Registry on Long-Term Oral Antithrombotic Treatment in Patients With Atrial Fibrillation [GLORIA-AF]; NCT01468701

Nations within a nation: variations in epidemiological transition across the states of India, 1990–2016 in the Global Burden of Disease Study

18% of the world's population lives in India, and many states of India have populations similar to those of large countries. Action to effectively improve population health in India requires availability of reliable and comprehensive state-level estimates of disease burden and risk factors over time. Such comprehensive estimates have not been available so far for all major diseases and risk factors. Thus, we aimed to estimate the disease burden and risk factors in every state of India as part of the Global Burden of Disease (GBD) Study 2016

SurveySignal: A Convenient Solution for Experience Sampling Research Using Participants' Own Smartphones

Experience sampling or ecological momentary assessment offers unique insights into how people think, feel, and behave in their natural environments. Because the method is able to capture situational variation as it happens in real time, experience sampling has become an increasingly popular method in social and personality, psychology, and beyond. With the ubiquity of smartphone ownership and the recent technical advances, conducting experience sampling studies on participants' own devices has become increasingly easy to do. Here, we present one reliable, user-friendly, highly customizable, and cost-effective solution. The web-based application, SurveySignal, integrates the idea of using short message service (SMS) messages as signals and reminders, according to fixed or random schedules and of linking these signals to mobile surveys designed with common online survey software. We describe the method and customizable parameters and then present evaluation results from nine social-psychological studies conducted with SurveySignal (overall N = 1,852). Mean response rates averaged 77% and the median response delay to signals was 8 min. An experimental manipulation of the reminder signal in one study showed that installing a reminder SMS led to a 10% increase in response rates. Next to advantages and limitations of the SMS approach, we discuss how ecologically valid research methods such as smartphone experience sampling can enrich psychological research

Experimental assessment of stainless-steel wire mesh (SSWM) strengthened wet precast beam-column connections

Connections are important elements of precast structures as they introduce discontinuity between the elements affecting strength and stiffness. In the present study, locally available SSWM 40 × 32 is explored as a strengthening material for precast beam column connections. Experiments are conducted on test specimens to evaluate their performance under monotonic vertical loading applied using hydraulic actuator. Various wet precast connections with different location of connections and detailing of beam column reinforcement are considered for this investigation. Two novel SSWM configurations like enclosure of junction with box shape strip and diagonal strips of SSWM are used for strengthening of precast beam column connections. Experimental study is conducted on twelve test specimens to measure their performance in terms of ultimate load capacity, displacement profile, ductility, failure pattern and energy dissipation. SSWM strengthened specimens show 8–43 % improvement in load carrying capacity along with better ductility and energy dissipation. For the precast connections at junction, box shape SSWM strip configuration is recommended while for the connection at the face of column, diagonal strip configuration of SSWM is recommended. Overall, SSWM can be effectively used for strengthening of precast connections

Optimized Esterification of Glycol Glycosides and Argemone Oil for Polyol Synthesis

49-54Transesterification of argemone oil with polyhydirc alcohol is carried out under varied reaction conditions, viz. temperature, time, effect of catalyst, monomer concentration. Extent of reaction is confirmed by end group analysis, i.e., acid value determination of reaction product and a reaction kinetics mechanism is proposed for the different temperature sets