Generic drugs: international trends and policy developments in Australia

Public and private third-party payers in many countries encourage or mandate the use of generic drugs. This article examines the development of generics policy in Australia, against the background of a description of international trends in this area, and related experiences of reference pricing programs. The Australian generics market remains underdeveloped due to a historical legacy of small Pharmaceutical Benefits Scheme price differentials between originator brands and generics. It is argued that policy measures open to the Australian government can be conceived as clustering around two different approaches: incremental changes within the existing regulatory framework, or a shift towards a high volume/low price role of generics which would speed up the delivery of substantial cost savings, and could provide enhanced scope for the financing of new, patented drugs.

Enabling industrial scale simulation / emulation models

OLE Process Control (OPC) is an industry standard that facilitates the communication between PCs and Programmable Logic Controllers (PLC). This communication allows for the testing of control systems with an emulation model. When models require faster and higher volume communications, limitations within OPC prevent this. In this paper an interface is developed to allow high speed and high volume communications between a PC and PLC enabling the emulation of larger and more complex control systems and their models. By switching control of elements within the model between the model engine and the control system it is possible to use the model to validate the system design, test the real world control systems and visualise real world operation.

A novel method of tube manufacture for vehicle crashworthiness utilising the QUICKSTEP™ Process.

A novel method of composite tube manufacture was developed for potential use in automotive crash structures. Tubes were crushed axially under quasi-static conditions and highly repeatable behaviour was observed with an average specific energy absorption of -85kJ/kg. DMTA results indicated that the tubes were fully cured, even when the cycle was reduced to 7 minutes, giving this process huge potential for high-volume production.

Immobilized enzyme technology for debittering citrus fruit juices

There has been increased interest in the use of immobilized enzymes in fruit juice industry for debittering of citrus fruit juices due to their high efficiency to remove bitter flavonoids. The structure of naringin, responsible for immediate bitterness, and of limonin, responsible for "delayed bitterness" has been discussed. This chapter also discusses various attempts that have been made to immobilize enzymes on an appropriate support so as to enable their use in debittering of citrus fruit juices. These include physicochemical and enzyme biotechnological approaches which makes the fruit juice more acceptable and cost effective to the consumer. Despite of high volume of production of citrus fruits and fruit juices, suitable processes to produce non-bitter citrus juice by immobilized enzymes technology has not yet commercialized globally.

The Renal Treatment Satisfaction Questionnaire (RTSQ): a measure of satisfaction with treatment for chronic kidney failure.

BACKGROUND: Quality and effectiveness of care can be enhanced through the use of condition-specific measures of satisfaction with treatment. The aim of the present study was to design and develop a measure of satisfaction with treatment for patients with chronic kidney failure (CKF) for use in routine clinical care and clinical trials. The Renal Treatment Satisfaction Questionnaire (RTSQ) was designed to be suitable for people using any of the various treatment modalities for CKF. Items measure satisfaction with aspects of treatment, including convenience, flexibility, freedom, and satisfaction to continue with present form of treatment.

METHODS: A 12-item RTSQ was investigated at a UK hospital-based renal unit, using data from 140 outpatients undergoing renal replacement therapy (hemodialysis, n = 35; continuous ambulatory peritoneal dialysis, n = 57; transplantation, n = 46).

RESULTS: An 11-item scale was developed from the original 12-item version, with a single factor accounting for 59% of the variance and item loadings greater than 0.58. Scale reliability was excellent (alpha = 0.93) in the full sample and proved robust to analysis in separate treatment subgroups. As expected, RTSQ scores differed significantly ( P < 0.0001) between the transplantation and other treatment groups. Those who had received a transplant expressed greater overall satisfaction, with specific advantages of transplantation shown by all individual items, including convenience, time, lifestyle, freedom, and satisfaction to continue current treatment.

CONCLUSION: The RTSQ provides a brief reliable measure of satisfaction with treatment for patients with CKF that is suitable for use in routine clinical care and clinical trials.

Concentrations of major grass group 5 allergens in pollen grains and atmospheric particles : implications for hay fever and allergic asthma sufferers sensitized to grass pollen allergens

Background

Grass pollen allergens are the most important cause of hay fever and allergic asthma during summer in cool temperate climates. Pollen counts provide a guide to hay fever sufferers. However, grass pollen, because of its size, has a low probability of entering the lower airways to trigger asthma. Yet, grass pollen allergens are known to be associated with atmospheric respirable particles.
Objective

We aimed (1) to determine the concentration of group 5 major allergens in (a) pollen grains of clinically important grass species and (b) atmospheric particles (respirable and nonrespirable) and (2) to compare the atmospheric allergen load with clinical data to assess different risk factors for asthma and hay fever.
Methods

We have performed a continuous 24 h sampling of atmospheric particles greater and lower than 7.2 μm in diameter during the grass pollen season of 1996 and 1997 (17 October 1996–16 January 1997) by means of a high volume cascade impactor at a height of about 15 m above ground in Melbourne. Using Western analysis, we assessed the reactivity of major timothy grass allergen Phl p 5 specific monoclonal antibody (MoAb) against selected pollen extracts. A MoAb-based ELISA was then employed to quantify Phl p 5 and cross-reactive allergens in pollen extracts and atmospheric particles larger and smaller than 7.2 μm.
Results

Phl p 5-specific MoAb detected group 5 allergens in tested grass pollen extracts, indicating that the ELISA employed here determines total group 5 allergen concentrations. On average, 0.05 ng of group 5 allergens were detectable per grass pollen grain. Atmospheric group 5 allergen concentrations in particles > 7.2 μm were significantly correlated with grass pollen counts (rs = 0.842, P < 0.001). On dry days, 37% of the total group 5 allergen load, whereas upon rainfall, 57% of the total load was detected in respirable particles. After rainfall, the number of starch granule equivalents increased up to 10-fold; starch granule equivalent is defined as a hypothetical potential number of airborne starch granules based on known pollen count data. This indicates that rainfall tended to wash out large particles and contributed to an increase in respirable particles containing group 5 allergens by bursting of pollen grains. Four day running means of group 5 allergens in respirable particles and of asthma attendances (delayed by 2 days) were shown to be significantly correlated (P < 0.001).
Conclusion

Here we present, for the first time, an estimation of the total group 5 allergen content in respirable and nonrespirable particles in the atmosphere of Melbourne. These results highlight the different environmental risk factors for hay fever and allergic asthma in patients, as on days of rainfall following high grass pollen count, the risk for asthma sufferers is far greater than on days of high pollen count with no associated rainfall. Moreover, rainfall may also contribute to the release of allergens from fungal spores and, along with the release of free allergen molecules from pollen grains, may be able to interact with other particles such as pollutants (i.e. diesel exhaust carbon particles) to trigger allergic asthma.

Immunologic significance of respirable atmospheric starch granules containing major birch allergen Bet v 1

Background: Birch-pollen allergens are an important cause of early spring hay fever and allergic asthma. Recently, we reported a mechanism for the release of respirable allergenic particles from birch pollen containing the major allergen Bet v 1. In this study, we aimed to assess the immunologic significance of the released Bet v 1-containing starch granules in the environment.

Methods: A two-site monoclonal antibody-based assay (ELISA) was employed to quantitate Bet v 1 in high-volume air sampler filter extracts, and immunogold-labelling was used on sections of these extracts to localize Bet v 1. Immunoblot analyses were performed with pooled sera from patients sensitive to birch pollen.

Results: Atmospheric starch granules contained Bet v 1, and the concentration increased upon light rainfall. Sera from patients allergic to birch allergens recognized extracts from isolated starch granules.

Conclusions: The clinical implications of these findings are that starch granules released from birch pollen are potentially able to trigger allergic asthmatic reactions to Bet v 1, since the allergen occurs in respirable particles. Thus, clinicians can advise asthma patients to remain indoors on days of light rainfall during the birch-pollen season to avoid high levels of allergen exposure.

Source of Bet v 1 loaded inhalable particles from birch revealed

Allergenic proteins present in pollen grains, when inhaled, interact with the airways to cause an attack of asthma in susceptible humans. In one system, grass pollen grains rupture osmotically in rainfall, releasing allergen-containing inhalable particles into the atmosphere. In contrast, birch tree pollen grains do not rupture under these conditions, yet the major allergen, Bet v 1, has been detected in the atmosphere in inhalable particles of unknown origin. It is possible that Bet v 1 may diffuse from intact settled pollen grains and the allergenic material may again become airborne, interacting with settled fine particles from other sources prior to resuspension. This study investigates the mechanism for the release of birch pollen allergen-containing inhalable particles from pollen grains. We propose the hypothesis that (1) airborne birch pollen grains settle on nearby leaf surfaces; (2) then, following light rainfall, the grains germinate and, (3) later, pollen tubes burst, releasing inhalable particles carrying Bet v 1 into the atmospheric aerosol.   We used microscopic analyses of pollen behaviour following anther opening, a Burkard volumetric trap for pollen counts and a high volume air sampler with a two-stage cascade impactor for quantitative immunochemical analyses of Bet v 1. On dry days of high birch pollen count (48 grains/m3, 1.5 ng/m3 of Bet v 1), we found that the surfaces of birch leaves became coated with pollen. This ”pollen rain” is a source of secondary emission of allergens into the atmosphere. We observed that following light rainfall (<1 mm per day), about 80% of the birch pollen grains germinated, producing pollen tubes, especially in the sticky surface secretions of leaf glands. These pollen tubes may grow up to 300 μm in length prior to rupturing, each releasing about 400 starch granules coated with allergen molecules that may, after drying, be dispersed into the aerosol. On these days following light rainfall, the highest atmospheric levels of Bet v 1 (1.18 ng/m3) are associated with inhalable particles. Following heavy rainfall, both pollen and inhalable particles are washed from the atmosphere. Immunoprinting studies show that Bet v 1 is associated with starch granules rather than the smaller orbicules. Bet v 1 is present in the atmosphere in large particles, i.e. in particular pollen grains and in inhalable particles, i.e. in particular starch granules.

Organic compounds present in the natural Amazonian aerosol : characterization by gas chromatography–mass spectrometry

[1] As part of the Large-Scale Biosphere-Atmosphere Experiment in Amazonia (LBA)-Cooperative LBA Airborne Regional Experiment (CLAIRE) 2001 campaign in July 2001, separate day and nighttime aerosol samples were collected at a ground-based site in Amazonia, Brazil, in order to examine the composition and temporal variability of the natural “background” aerosol. We used a high-volume sampler to separate the aerosol into fine (aerodynamic diameter, AD < 2.5 μm) and coarse (AD > 2.5 μm) size fractions and quantified a range of organic compounds in methanolic extracts of the samples by a gas chromatographic-mass spectrometric technique. The carbon fraction of the compounds could account for an average of 7% of the organic carbon (OC) in both the fine and coarse aerosol fractions. We observed the highest concentrations of sugars, sugar alcohols, and fatty acids in the coarse aerosol samples, which suggests that these compounds are associated with primary biological aerosol particles (PBAP) observed in the forest atmosphere. Of these, trehalose, mannitol, arabitol, and the fatty acids were found to be more prevalent at night, coinciding with a nocturnal increase in PBAP in the 2–10 μm size range (predominantly yeasts and other small fungal spores). In contrast, glucose, fructose, and sucrose showed persistently higher daytime concentrations, coinciding with a daytime increase in large fungal spores, fern spores, pollen grains, and, to a lesser extent, plant fragments (generally >20 μm in diameter), probably driven by lowered relative humidity and enhanced wind speeds/convective activity during the day. For the fine aerosol samples a series of dicarboxylic and hydroxyacids were detected with persistently higher daytime concentrations, suggesting that photochemical production of a secondary organic aerosol from biogenic volatile organic compounds may have made a significant contribution to the fine aerosol. Anhydrosugars (levoglucosan, mannosan, galactosan), which are specific tracers for biomass burning, were detected only at low levels in the fine aerosol samples. On the basis of the levoglucosan-to-OC emission ratio measured for biomass burning aerosol, we estimate that an average of ∼16% of the OC in the fine aerosol was due to biomass burning during CLAIRE 2001, indicating that the major fraction was associated with biogenic particles.

Improving renal patient care without compromising safety: interactive simulated e-learning

The nephrology educators network [NEN] recognised in 2007 that inequities existed in the access and delivery of evidence based renal education programs particularly to nurses in regional and remote areas. To address this, a web-based approach to learning, through the development of peer reviewed, interactive nephrology e-learning programs was adopted. These programs aligned with the tenets of e-learning instructional design and afforded more effective and consistent clinical support and induction for nurses in the renal specialty. The e-learning programs promote a standardised evidence-based approach to nephrology education and were developed by content experts from across Australia and New Zealand. The design methodology avoided the duplication of resources while also encouraging knowledge transfer between participating health organisations.

This paper will discuss the development and successful implementation of these e-learning programs across renal healthcare units in Australasia. Implemented packages include: Introduction to Buttonhole Cannulation – featuring an interactive ultrasound and cannulation application; Introduction to Haemodialysis; Introduction to Peritoneal Dialysis [PD], featuring simulated PD machines, allowing for the teaching of troubleshooting without compromising patient safety. E-learning programs are further supported through interactive case scenarios that present unfolding real world simulations and enable learners to meet different patients and manage their care while learning about key messages relating to renal health. Modules currently in development include; Acute Kidney Injury; Fluid Assessment, Water Quality and Vascular Access. The implementation of these programs assist the facilitation of positive change in teaching and learning practices in nephrology nursing aimed at improving patient outcomes.

Typical and atypical haemolytic uraemic syndrome: A brief case comparison report for nurses

Background: Haemolytic uraemic syndrome (HUS) is one of the main causes of acute kidney injury in children. It is a multifaceted disease, characterised by microangiopathic haemolytic anaemia and thrombocytopaenia. It can often affect multiple organ systems, including the central nervous and renal systems.

Effects of zirconium and strontium on the biocorrosion of Mg-Zr-Sr alloys for biodegradable implant applications

The successful applications of magnesium (Mg) alloys as biodegradable orthopedic implants are mainly restricted due to their rapid degradation rate in the physiological environment, leading to a loss of mechanical integrity. This study systematically investigated the degradation behaviors of novel Mg-Zr-Sr alloys using electrochemical techniques, hydrogen evolution, and weight loss in simulated body fluid (SBF). The microstructure and degradation behaviors of the alloys were characterized using optical microscopy, XRD, SEM, and EDX. The results indicate that Zr and Sr concentrations in Mg alloys strongly affected the degradation rate of the alloys in SBF. A high concentration of 5 wt% Zr led to acceleration of anodic dissolution, which significantly decreased the biocorrosion resistance of the alloys and their biocompatibility. A high volume fraction of Mg17Sr2 phases due to the addition of excessive Sr (over 5 wt%) resulted in enhanced galvanic effects between the Mg matrix and Mg17Sr2 phases, which reduced the biocorrosion resistance. The average Sr release rate is approximately 0.15 mg L^-1 day^-1, which is much lower than the body burden and proves its good biocompatibility. A new biocorrosion model has been established to illustrate the degradation of alloys and the formation of degradation products on the surface of the alloys. It can be concluded that the optimal concentration of Zr and Sr is less than 2 wt% for as-cast Mg-Zr-Sr alloys used as biodegradable orthopedic implants.

Effect of an acute bout of plyometric exercise on neuromuscular fatigue and recovery in recreational athletes

Although plyometric training is widely used by sports coaches as a method of improving explosive power in athletes, many prescribe volumes in excess of the National Strength and Conditioning Association recommendations. The purpose of this study was to assess voluntary and evoked muscle characteristics to assess the neuromuscular impact of a high-volume bout of plyometric exercise that was non-exhaustive. Ten athletes who did not have plyometric training experience and were in their competitive season for club-level sport volunteered for the study. After at least 2 days without high-intensity activity, subjects were assessed on maximal twitch torque, time to peak torque, rate of twitch torque development, twitch half-relaxation time, rate of twitch relaxation, and voluntary activation by the interpolated twitch technique before, immediately after, and 2 hours after a high-volume plyometric training program (212 ground contacts). Data were analyzed by repeated-measures analysis of variance and described as mean +/- SD and Cohen d. Statistically significant decrements appeared immediately after the training protocol in the total torque generated by maximal voluntary contractions (p < 0.05, d = -0.51) and twitch (p < 0.01, d = -0.92), rate of twitch torque development (p < 0.01, d = -0.77), and rate of relaxation (p < 0.01, d = -0.73). However, we did not observe any differences that remained statistically different after 2 hours. There were no significant differences observed at any time point in time to peak twitch, half-relaxation time, or voluntary activation. We conclude that high-volume plyometric training results primarily in peripheral fatigue that substantially impairs force and rate of force development. We recommend that coaches carefully monitor the volume of plyometric training sessions to avoid neuromuscular impairments that can result in suboptimal training.

Effects of Mg17Sr2 Phase on the bio-corrosion behavior of Mg-Zr-Sr alloys

The effect of the second phase Mg17Sr2 on the biocorrosion behavior of Mg5ZrxSr (x = 0, 2, 5 wt%) alloys before and after solution treatment was investigated. Electrochemical impedance spectroscopy, cathodic polarization and hydrogen evolution were used to evaluate the biocorrosion of Mg5ZrxSr. We found that Mg17Sr2 precipitated on boundary zones and enhanced the galvanic effect, leading to a severer corrosion of the Mg matrix adjacent to Mg17Sr2. The corrosion subsequently spread gradually from the regions adjacent to the Mg17Sr2 to the central Mg matrix. However, a high volume fraction of Mg17Sr2 could also form a continuous network, isolate the Mg matrix and act as a barrier of corrosion.

Hot deformation and recrystallization of a metastable beta titanium ingot

Hot deformation behavior and microstructure evolution of a coarse grain metastable beta titanium alloy (Ti-5Al-5Mo-5V-3Cr) was investigated using uniaxial compression testing followed by a subsequent beta annealing treatment. Compression testing was carried out at 720 °C and strain rates between 0.001-10 s-1 on samples with beta annealed condition and aged microstructure containing high volume fraction of relatively large alpha precipitates. The peak load of the aged samples are higher than the non-aged specimens but they show rather similar steady state flow stress. The subsequent beta annealing treatment on the compressed aged samples leads to breaking down the ingot microstructure and formation of a fully recrystallized beta phase with massive grain refinement (order of millimeter to ∼100 μm). However, after annealing such grain refinement is not seen for the non-aged samples except at high strain rates that showed partial and local recrystallization.