Informing people about the risks and benefits of medicines: implications for the safe and effective use of medicinal products

Providing effective information about drug risks and benefits has become a major challenge for health professionals, as many people are ill equipped to understand, retain and use the information effectively. This paper reviews the growing evidence that people’s understanding (and health behaviour) is not only affected by the content of medicines information, but also by the particular way in which it is presented. Such presentational factors include whether information is presented verbally or numerically, framed positively or negatively, whether risk reductions are described in relative or absolute terms (and baseline information included), and whether information is personalized or tailored in any way. It also looks at how understanding is affected by the order in which information is presented, and the way in which it is processed. The paper concludes by making a number of recommendations for providers of medicines information, about both the content and presentation of such information, that should enhance safe and effective medicines usage.

MPJ express: Towards thread safe Java HPC

MPJ Express is a thread-safe Java messaging library that provides a full implementation of the mpiJava 1.2 API specification. This specification defines a MPI-like bindings for the Java language. We have implemented two communication devices as part of our library, the first, called niodev is based on the Java New I/O package and the second, called mxdev is based on the Myrinet eXpress library MPJ Express comes with an experimental runtitne, which allows portable bootstrapping of Java Virtual Machines across a cluster or network of computers. In this paper we describe the implementation of MPJ Express. Also, we present a performance comparison against various other C and Java messaging systems. A beta version of MPJ Express was released in September 2005.

The SAFE FOODS framework for improved risk analysis of foods

Three main changes to current risk analysis processes are proposed to improve their transparency, openness, and accountability. First, the addition of a formal framing stage would allow interested parties, experts and officials to work together as needed to gain an initial shared understanding of the issue, the objectives of regulatory action, and alternative risk management measures. Second, the scope of the risk assessment is expanded to include the assessment of health and environmental benefits as well as risks, and the explicit consideration of economic- and social-impacts of risk management action and their distribution. Moreover approaches were developed for deriving improved information from genomic, proteomic and metabolomic profiling methods and for probabilistic modelling of health impacts for risk assessment purposes. Third, in an added evaluation stage, interested parties, experts, and officials may compare and weigh the risks, costs, and benefits and their distribution. As part of a set of recommendations on risk communication, we propose that reports on each stage should be made public.

Characterization of safe nanostructured polymeric materials

The addition of small quantities of nanoparticles to conventional and sustainable thermoplastics leads to property enhancements with considerable potential in many areas of applications including food packaging 1, lightweight composites and high performance materials 2. In the case of sustainable polymers 3, the addition of nanoparticles may well sufficiently enhance properties such that the portfolio of possible applications is greatly increased. Most engineered nanoparticles are highly stable and these exist as nanoparticles prior to compounding with the polymer resin. They remain as nanoparticles during the active use of the packaging material as well as in the subsequent waste and recycling streams. It is also possible to construct the nanoparticles within the polymer films during processing from organic compounds selected to present minimal or no potential health hazards 4. In both cases the characterisation of the resultant nanostructured polymers presents a number of challenges. Foremost amongst these are the coupled challenges of the nanoscale of the particles and the low fraction present in the polymer matrix. Very low fractions of nanoparticles are only effective if the dispersion of the particles is good. This continues to be an issue in the process engineering but of course bad dispersion is much easier to see than good dispersion. In this presentation we show the merits of a combined scattering (neutron and x-ray) and microscopy (SEM, TEM, AFM) approach. We explore this methodology using rod like, plate like and spheroidal particles including metallic particles, plate-like and rod-like clay dispersions and nanoscale particles based on carbon such as nanotubes and graphene flakes. We will draw on a range of material systems, many explored in partnership with other members of Napolynet. The value of adding nanoscale particles is that the scale matches the scale of the structure in the polymer matrix. Although this can lead to difficulties in separating the effects in scattering experiments, the result in morphological studies means that both the nanoparticles and the polymer morphology are revealed.

Rational engineering of recombinant picornavirus capsids to produce safe, protective vaccine antigen

Foot-and-mouth disease remains a major plague of livestock and outbreaks are often economically catastrophic. Current inactivated virus vaccines require expensive high containment facilities for their production and maintenance of a cold-chain for their activity. We have addressed both of these major drawbacks. Firstly we have developed methods to efficiently express recombinant empty capsids. Expression constructs aimed at lowering the levels and activity of the viral protease required for the cleavage of the capsid protein precursor were used; this enabled the synthesis of empty A-serotype capsids in eukaryotic cells at levels potentially attractive to industry using both vaccinia virus and baculovirus driven expression. Secondly we have enhanced capsid stability by incorporating a rationally designed mutation, and shown by X-ray crystallography that stabilised and wild-type empty capsids have essentially the same structure as intact virus. Cattle vaccinated with recombinant capsids showed sustained virus neutralisation titres and protection from challenge 34 weeks after immunization. This approach to vaccine antigen production has several potential advantages over current technologies by reducing production costs, eliminating the risk of infectivity and enhancing the temperature stability of the product. Similar strategies that will optimize host cell viability during expression of a foreign toxic gene and/or improve capsid stability could allow the production of safe vaccines for other pathogenic picornaviruses of humans and animals.

Safe construction through design: perspectives from the site team

How does the work of designers impact on the safety of operatives at the construction site? Safety research and policy emphasize the importance of designing for safe construction, yet the interface between design and construction is poorly understood: accidents have multiple causes making it hard to establish causal links between design choices and safety outcomes. An in-depth case study of a major station project examines how professionals on the construction site perceive and manage the safety challenges of a building design. Analyses reveal understandings that, on the project studied, design has an impact on safety because of: (1) the timing of design work, where the volume of late design changes increased the difficulty of planning safe procedures, e.g. for working at height, lifting heavy items, refurbishing and demolishing old buildings; and (2) inputs from design stakeholders with insufficient practical knowledge of construction and operation required unplanned work-arounds, e.g. to coordinate different sub-systems, provide maintenance access, and manage loads during construction. These findings suggest that safety suffers where projects are under-designed, and that alongside regulation, there is a need for robust management attention to the contractual structures, incentives, processes and tools that enable clients and designers to understand material practices of construction and operation.

Nothing is safe: intolerance of uncertainty is associated with compromised fear extinction learning

Extinction-resistant fear is considered to be a central feature of pathological anxiety. Here we sought to determine if individual differences in Intolerance of Uncertainty (IU), a potential risk factor for anxiety disorders, underlies compromised fear extinction. We tested this hypothesis by recording electrodermal activity in 38 healthy participants during fear acquisition and extinction. We assessed the temporality of fear extinction, by examining early and late extinction learning. During early extinction, low IU was associated with larger skin conductance responses to learned threat vs. safety cues, whereas high IU was associated with skin conductance responding to both threat and safety cues, but no cue discrimination. During late extinction, low IU showed no difference in skin conductance between learned threat and safety cues, whilst high IU predicted continued fear expression to learned threat, indexed by larger skin conductance to threat vs. safety cues. These findings suggest a critical role of uncertainty-based mechanisms in the maintenance of learned fear.

Delivery care in Quang Ninh province, Northern Vietnam : resources and access to safe care.

Every mother and child has the right to survive childbirth which requires skilled birth attendants together with referral and available emergency obstetric care (EmOC). The objective of the study was to describe delivery care routines at different levels in the health care system in Quang Ninh province, Northern Vietnam. The design was cross sectional using a structured questionnaire. Two districts in Quang Ninh province with 40 Community Health Centres (CHC), three district hospitals and one region hospital was included in the study, in total 138 (CHC n=105 and hospitals n=33) health care providers participated. In our study 20% (CHC) of the health care providers assisting deliveries at CHC were midwives and health care provider’s in our study further report to have assisted at less then 10 deliveries/year (81% of respondents at CHC). Findings show that the health care provider’s routines and care for women during labour and delivery vary and that there is a need for re-training and that women in labour should be cared for by health care providers with adequate training like midwifery. In our study CHC had poor resources to provide basic or comprehensive EmOC. Our findings indicate that there is a need for re-training in delivery care among health care providers and since the number of deliveries at CHC is few they should be handled by someone who is a skilled birth attendant. Our findings also show a variation in care routines during labour and delivery among health care providers at CHC and hospital levels and this also show the need for re-training and support from proper authorities in order to improve maternal and newborn health.

To achieve safe and respectful maternity care in tertiary level hospitals in Nepal, relatives are a valued addition to the provision of maternity care

Introduction: The White Ribbon Alliance for safe motherhood believes respectful maternity care is the universal right of every childbearing woman. Methods: NHRC in 2012 approved an inquiry of respectful care at facility-based childbirth. Individual-, focus group interviews and content analysis was used for gathering and analysis of data. Findings: The participating women and the SBAs shared similar views, and this was that together the SBAs and relatives ensured the women remained within the comfort and safety zone when giving birth in a tertiary level maternity unit. Conclusion: The SBAs strategy of having relatives provides basic care alongside the provision of medical care by the SBAs is a strategy that Nepal could use to improve the quality of its maternity care without any additional costs. Clinical implication: Prenatal classes might contribute to preparing relatives. Further Research: Further research could evaluate such a strategy in order to determine its effectiveness in reduction of morbidity and mortality.