Patterns of care and survival for adolescents and young adults with acute leukaemia – a population-based study

We report a population-based study of patterns of care and survival for people with acute leukaemia diagnosed at age 15–29 years during 1984–94 in regions of England and Wales covered by specialist leukaemia registries. There were 879 patients: 417 with acute lymphoblastic leukaemia (ALL) and 462 with acute myeloid leukaemia (AML). For ALL, actuarial survival rates were 43% at 5 years after diagnosis and 37% at 10 years. Survival improved significantly between 1984–88 and 1989–94 for those aged 15–19 at diagnosis. Patients entered in national clinical trials and those not entered had similar survival rates. Survival rates were similar at teaching and non-teaching hospitals and at hospitals treating different numbers of study patients per year. For AML, survival rates were 42% at 5 years after diagnosis and 39% at 10 years. Survival improved significantly between 1984–88 and 1989–94. Patients entered in the Medical Research Council AML10 trial had a higher survival rate than those who were in the earlier AML9 trial. Survival did not vary with category of hospital. We conclude that survival has improved for adolescents and young adults with acute leukaemia but that there is at present no evidence that centralized treatment results in a survival benefit for patients in this age group. © 1999 Cancer Research Campaig

From staff-mix to skill-mix and beyond: towards a systemic approach to health workforce management

Throughout the world, countries are experiencing shortages of health care workers. Policy-makers and system managers have developed a range of methods and initiatives to optimise the available workforce and achieve the right number and mix of personnel needed to provide high-quality care. Our literature review found that such initiatives often focus more on staff types than on staff members' skills and the effective use of those skills. Our review describes evidence about the benefits and pitfalls of current approaches to human resources optimisation in health care. We conclude that in order to use human resources most effectively, health care organisations must consider a more systemic approach - one that accounts for factors beyond narrowly defined human resources management practices and includes organisational and institutional conditions

Experimental Polymer Mechanochemistry and its Interpretational Frameworks

Polymer mechanochemistry is an emerging field at the interface of chemistry, materials science, physics and engineering. It aims at understanding and exploiting unique reactivities of polymer chains confined to highly non-equilibrium stretched geometries by interactions with their surroundings. Macromolecular chains or their segments become stretched in bulk polymers under mechanical loads or when polymer solutions are sonicated or flow rapidly through abrupt contractions. An increasing amount of empirical data suggests that mechanochemical phenomena are widespread wherever polymers are used. In the past decade, empirical mechanochemistry has progressed enormously, from studying fragmentations of commodity polymers by simple backbone homolysis to demonstrations of self-strengthening and stress-reporting materials and mechanochemical cascades using purposefully designed monomers. This progress has not yet been matched by the development of conceptual frameworks within which to rationalize, systematize and generalize empirical mechanochemical observations. As a result, mechanistic and/or quantitative understanding of mechanochemical phenomena remains, with few exceptions, tentative. In this review we aim at systematizing reported macroscopic manifestations of polymer mechanochemistry, and critically assessing the interpretational framework that underlies their molecular rationalizations from a physical chemist's perspective. We propose a hierarchy of mechanochemical phenomena which may guide the development of multiscale models of mechanochemical reactivity to match the breadth and utility of the Eyring equation of chemical kinetics. We discuss the limitations of the approaches to quantifying and validating mechanochemical reactivity, with particular focus on sonicated polymer solutions, in order to identify outstanding questions that need to be solved for polymer mechanochemistry to become a rigorous, quantitative field. We conclude by proposing 7 problems whose solution may have a disproportionate impact on the development of polymer mechanochemistry