Evaluation of Functional Characteristics of Lactose by Inverse Gas Chromatography

AbstractThe work was focused on the analysis of different batches of the common pharmaceutical excipient lactose using inverse gas chromatography (IGC). Several batches of amorphous (spray dried) and crystalline form of lactose were studied. Surface properties represented by the surface energy and specific (acid-base) interactions between probes and analyzed samples shows batch variations and significant differences between manufacturers and technological processes. The second part of this work was focused on effect of relative humidity and temperature on stability of lactose. The variations of surface energy and specific interactions over time were studied. The changes in surface properties of two batches of lactose-amorphous and crystalline caused by higher relative humidity were measured by IGC. From measured values are obvious different chemical and physical properties of both lactose forms. Negative effect of higher temperature and air humidity lead to changes in surface energy and mainly rapid changes of electron–acceptor and electron-donor surface sites. Lactose monohydrate shows dramatic decrease in the surface energy and in the strength of electron-accepting sites on the contrary of spray dried where the acidity of surface increased

Improving medical students' attitudes towards the chronic sick: a role for social science research

<b>Background</b> Many medical students are negatively disposed toward the elderly and chronic sick. The present study assessed the impact of a community-based teaching initiative, the Life History Project, on students' attitudes to these groups. <p></p> <b>Methods</b> A questionnaire including Likert based responses and free text comments was distributed to all first-year MBChB students after completion of their Life History coursework. Data was analysed using SPSS and content analysis. <p></p> <b>Results</b> A high proportion of students believed the Life History Project had increased their understanding of both psychological and social aspects of health and illness and the role of the humanistic social sciences within this. We discovered that the Life History Project not only gave students first-hand experience of the elderly and chronic sick but also had a positive effect on their attitudes towards these groups. The qualitative free text comments corroborated these views. <p></p> <b>Conclusions</b> It is possible to positively influence medical students' attitudes towards these stigmatised groups; it is therefore important that we continue to enhance opportunities for learning about the impact of chronic illness on individuals and society throughout the curriculum

Bedside rationing by general practitioners: A postal survey in the Danish public healthcare system

<p>Abstract</p> <p>Background</p> <p>It is ethically controversial whether medical doctors are morally permitted to ration the care of their patients at the bedside. To explore whether general practitioners in fact do ration in this manner we conducted a study within primary care in the Danish public healthcare system. The purpose of the study was to measure the extent to which general practitioners (GPs) would be willing to factor in cost-quality trade-offs when prescribing medicine, and to discover whether, and if so to what extent, they believe that patients should be informed about this.</p> <p>Methods</p> <p>Postal survey of 600 randomly selected Danish GPs, of which 330 responded to the questionnaire. The Statistical Package for the Social Sciences (SPSS, version 14.0) was used to produce general descriptive statistics. Significance was calculated with the McNemar and the chi-square test. The main outcome measures of the study were twofold: an assessment of the proportion of GPs who, in a mainly hypothetical setting, would consider cost-quality trade-offs relevant to their clinical decision-making given their economic impact on the healthcare system; and a measure of the extent to which they would disclose this information to patients.</p> <p>Results</p> <p>In the hypothetical setting 95% of GPs considered cost-quality trade-offs relevant to their clinical decision-making given the economic impact of such trade-offs on the healthcare system. In all 90% stated that this consideration had been relevant in clinical decision-making within the last month. In the hypothetical setting 55% would inform their patients that they considered a cost-quality trade-off relevant to their clinical decisions given the economic impact of such trade-offs on the healthcare system. The most common reason (68%) given for not wanting to inform patients about this matter was the belief that the information would not prove useful to patients. In the hypothetical setting cost-quality trade-offs were considered relevant significantly more often in connection with concerns about costs to the patient (86%) than they were in connection with concerns about costs to the healthcare system (55%; p < 0.001).</p> <p>Conclusion</p> <p>Although readiness to consider cost-quality trade-offs relevant to clinical decisions is prevalent among GPs in Denmark, only half of GPs would disclose to patients that they consider this relevant to their clinical decision-making. The results of this study raise two important ethical problems. First, under Danish law physicians are required to inform patients about all equal treatments. The fact that only a few GPs would inform their patients about all of the relevant treatments therefore seems to contravene Danish law. Second, it is ethically controversial that physicians act as economic gatekeepers.</p

Recursive least squares semi-blind beamforming for MIMO using decision directed adaptation and constant modulus criterion

A new semi-blind adaptive beamforming scheme is proposed for multi-input multi-output (MIMO) induced and space- division multiple-access based wireless systems that employ high order phase shift keying signaling. A minimum number of training symbols, very close to the number of receiver antenna elements, are used to provide a rough initial least squares estimate of the beamformer0s weight vector. A novel cost function combining the constant modulus criterion with decision-directed adaptation is adopted to adapt the beamformer weight vector. This cost function can be approximated as a quadratic form with a closed-form solution, based on which we then derive the recursive least squares (RLS) semi-blind adaptive beamforming algorithm. This semi-blind adaptive beamforming scheme is capable of converging fast to the minimum mean-square-error beamforming solution, as demonstrated in our simulation study. Our proposed semi-blind RLS beamforming algorithm therefore provides an e±cient detection scheme for the future generation of MIMO aided mobile communication systems

Who wants to be involved in health care decisions? Comparing preferences for individual and collective involvement in England and Sweden

Background: Patient and public involvement (PPI) is framed as positive for individuals, the health system, public health, as well as for communities and society as a whole. We investigated whether preferences for PPI differed between two countries with Beveridge type health systems-Sweden and England. We measured willingness to be involved in individual treatment decisions and in decisions about the organization and provision of local health and social care services. Methods: This was a comparative cross-sectional study of the general population's preferences. Together, the two samples included 3125 respondents; 1625 in England and 1500 in Sweden. Country differences were analysed in a multinomial regression model controlling for gender, age and educational attainment. Results: Overall, 68% of respondents wanted a passive patient role and 44% wanted to be involved in local decisions about organization and provision of services. In comparison with in Sweden, they were in England less likely to want a health professional such as a GP or consultant to make decisions about their treatment and also more likely to want to make their own decisions. They were also less likely to want to be involved in local service development decisions. An increased likelihood of wanting to be involved in organizational decision-making was associated with individuals wanting to make their own treatment decisions. Women were less likely to want health professionals to make decisions and more likely to want to be involved in organizational decisions. Conclusions: An effective health system that ensures public health must integrate an effective approach to PPI both in individual treatment decisions and shaping local health and social care priorities. To be effective, involvement activities must take in to account the variation in the desire for involvement and the implications that this has for equity. More work is needed to understand the relationship between the desire to be involved and actually being involved, but both appear related to judgements of the impact of involvement on health care decisions

A Lamb-wave-based technique for damage detection in composite laminates

This paper presents the application of Lamb waves to inspect damage in composite laminates. The proposed methodology employs a network of transducers that are used to sequentially scan the structure before and after the presence of damage by transmitting and receiving Lamb wave pulses. A damage localization image is reconstructed by analyzing the cross-correlation of the scatter signal envelope with the excitation pulse envelope for each transducer pair. A potential damage area is then reconstructed by superimposing the image observed from each actuator and sensor signal path. Both numerical and experimental case studies are used to verify the proposed methodology for composite laminates. Three-dimensional finite element models with a transducer network consisting of four transducer elements are used in the numerical case studies. The experimental case studies employ a transducer network using four piezoelectric transducers as transmitter elements and a laser vibrometer to measure the response signals at four locations close to the transducers. The results show that the method enables the reliable detection of structural damage with locating inaccuracies of the order of a few millimeters inside as well as outside of an inspection area of 100 x 100 mm².C T Ng and M Veid

Experience-based utility and own health state valuation for a health state classification system: why do it and how to do it

In the estimation of population value sets for health state classification systems such as the EQ-5D, there is increasing interest in asking respondents to value their own health state, sometimes referred to as "experienced-based utility values" or more correctly ownrather than hypothetical health states. Own health state values differ to hypothetical health state values, and this may be attributed to many reasons. This paper critically examines: whose values matter; why there is a difference between own and hypothetical values; how to measure own health state values; and why to use own health state values. Finally, the paper also examines other ways that own health state values can be taken into account, such as including the use of informed general population preferences that may better take into account experience-based values

Extent and patterns of community collaboration in local health departments: An exploratory survey

<p>Abstract</p> <p>Background</p> <p>Local public health departments (LHDs) in the United States have been encouraged to collaborate with various other community organizations and individuals. Current research suggests that many forms of active partnering are ongoing, and there are numerous examples of LHD collaboration with a specific organization for a specific purpose or program. However, no existing research has attempted to characterize collaboration, for the defined purpose of setting community health status priorities, between a defined population of local officials and a defined group of alternative partnering organizations. The specific aims of this study were to 1) determine the range of collaborative involvement exhibited by a study population of local public health officials, and, 2) characterize the patterns of the selection of organizations/individuals involved with LHDs in the process of setting community health status priorities.</p> <p>Methods</p> <p>Local health department officials in North Carolina (n = 53) responded to an exploratory survey about their levels of involvement with eight types of possible collaborator organizations and individuals. Descriptive statistics and the stochastic clustering technique of Self-Organizing Maps (SOM) were used to characterize their collaboration.</p> <p>Results</p> <p>Local health officials vary extensively in their level of collaboration with external collaborators. While the range of total involvement varies, the patterns of involvement for this specific function are relatively uniform. That is, regardless of the total level of involvement (low, medium or high), officials maintain similar hierarchical preference rankings with Community Advisory Boards and Local Boards of Health most involved and Experts and Elected Officials least involved.</p> <p>Conclusion</p> <p>The extent and patterns of collaboration among LHDs with other community stakeholders for a specific function can be described and ultimately related to outcome measures of LHD performance.</p

Health Systems and Sustainability: Doctors and Consumers Differ on Threats and Solutions

Background: Healthcare systems face the problem of insufficient resources to meet the needs of ageing populations and increasing demands for access to new treatments. It is unclear whether doctors and consumers agree on the main challenges to health system sustainability. Methodology: We conducted a mail survey of Australian doctors (specialists and general practitioners) and a computer assisted telephone interview (CATI) of consumers to determine their views on contributors to increasing health care costs, rationing of services and involvement in health resource allocation decisions. Differences in responses are reported as odds ratios (OR) and 99% confidence intervals (CI). Results: Of 2948 doctors, 1139 (38.6%) responded; 533 of 826 consumers responded (64.5% response). Doctors were more concerned than consumers with the effects of an ageing population (OR 3.0; 99% CI 1.7, 5.4), and costs of new drugs and technologies (OR 5.1; CI 3.3, 8.0), but less likely to consider pharmaceutical promotional activities as a cost driver (OR 0.29, CI 0.22, 0.39). Doctors were more likely than consumers to view ‘community demand’ for new technologies as a major cost driver, (OR 1.6; 1.2, 2.2), but less likely to attribute increased costs to patients failing to take responsibility for their own health (OR 0.35; 0.24, 0.49). Like doctors, the majority of consumers saw a need for public consultation in decisions about funding for new treatments. Conclusions: Australian doctors and consumers hold different views on the sustainability of the healthcare system, and a number of key issues relating to costs, cost drivers, roles and responsibilities. Doctors recognise their dual responsibility to patients and society, see an important role for physicians in influencing resource allocation, and acknowledge their lack of skills in assessing treatments of marginal value. Consumers recognise cost pressures on the health system, but express willingness to be involved in health care decision making