Medication management at home: medication risk factor prevalence and inter-relationships

Background and objective: Patients can have medication-related risk factors associated with poor health outcomes that become evident through visiting them in their homes. These medication-related risk factors may not be apparent in pharmacy and general practitioner (GP) records. The aim was to determine the prevalence and inter-relationships of medication-related risk factors for poor patient health outcomes identifiable through 'in-home' observations. Methods: The design was a cross-sectional study of 204 general practice patients living in their own homes and at risk of medication-related poor health outcomes. Medication-related risk factors were identified in the patients' homes by community pharmacists and GPs. Results and discussion: The prevalence of risk factors varied from 8.3% (multiple medication storage locations) to 55.9% (confused by generic and trade names). There were many relationships observed between the medication-related risk factors, with expired medication having the most relationships with other risk factors followed by therapeutic duplication and poor adherence (9, 6 and 6 relationships respectively). Conclusion: Visiting patients' homes may identify medication-related risk factors not otherwise apparent through patient visits to the health practitioner when medications may be brought for review (i.e. 'brown bag' reviews).

Validation of a novel ELISA for measurement of MDA-LDL in human plasma

The involvement of oxidatively modified low density lipoprotein (LDL) in the development of CHD is widely described. We have produced two antibodies, recognizing the lipid oxidation product malondialdehyde (MDA) on whole LDL or ApoB-100. The antibodies were utilized in the development of an ELISA for quantitation of MDA-LDL in human plasma. Intra- and inter-assay coefficients of variation (% CV) were measured as 4.8 and 7.7%, respectively, and sensitivity of the assay as 0.04 μg/ml MDA-LDL. Recovery of standard MDA-LDL from native LDL was 102%, indicating the ELISA to be specific with no interference from other biomolecules. Further validation of the ELISA was carried out against two established methods for measurement of lipid peroxidation products, MDA by HPLC and F2-isoprostanes by GC-MS. Results indicated that MDA-LDL is formed at a later stage of oxidation than either MDA or F2- isoprostanes. In vivo analysis demonstrated that the ELISA was able to determine steady-state concentrations of plasma MDA-LDL (an end marker of lipid peroxidation). A reference range of 34.3 ± 8.8 μg/ml MDA-LDL was established for healthy individuals. Further, the ELISA was used to show significantly increased plasma MDA-LDL levels in subjects with confirmed ischemic heart disease, and could therefore possibly be of benefit as a diagnostic tool for assessing CHD risk. © 2003 Elsevier Inc.

Inward investment, transaction linkages and productivity spillovers

The article examines the extent to which foreign manufacturing firms in the UK promote productivity growth in the domestically owned manufacturing sector through their buying and supplying relationships. Evidence for intra- and inter-regional externalities from the presence of foreign manufacturing, and intraand inter-industry effects is brought to light. Externalities in the domestic sector are most noticeable where foreign manufacturing sells to domestic manufacturing. These externalities are, however, not wholly robust to different specifications of spatial dependence. The findings are positioned in a debate, which has tended to view backward (as opposed to forward) linkages from multinationals to domestically owned supply bases as a critical driver of indirect economic benefits. © RSAI 2004.

Cohesion in text differentiation : a study of English and Arabic

This thesis sets out to investigate the role of cohesion in the organisation and processing of three text types in English and Arabic. In other words, it attempts to shed some light on the descriptive and explanatory power of cohesion in different text typologies. To this effect, three text types, namely, literary fictional narrative, newspaper editorial and science were analysed to ascertain the intra- and inter-sentential trends in textual cohesion characteristic of each text type in each language. In addition, two small scale experiments which aimed at exploring the facilitatory effect of one cohesive device (i.e. lexical repetition) on the comprehension of three English text types by Arab learners were carried out. The first experiment examined this effect in an English science text; the second covered three English text types, i.e. fictional narrative, culturally-oriented and science. Some interesting and significant results have emerged from the textual analysis and the pilot studies. Most importantly, each text type tends to utilize the cohesive trends that are compatible with its readership, reader knowledge, reading style and pedagogical purpose. Whereas fictional narratives largely cohere through pronominal co-reference, editorials and science texts derive much cohesion from lexical repetition. As for cross-language differences English opts for economy in the use of cohesive devices, while Arabic largely coheres through the redundant effect created by the high frequency of most of those devices. Thus, cohesion is proved to be a variable rather than a homogeneous phenomenon which is dictated by text type among other factors. The results of the experiments suggest that lexical repetition does facilitate the comprehension of English texts by Arab learners. Fictional narratives are found to be easier to process and understand than expository texts. Consequently, cohesion can assist in the processing of text as it can in its creation.

High-performance liquid chromatography and pharmacokinetics of some antibiotics

The principles of High Performance Liquid Chromatography (HPLC) and pharmacokinetics were applied to the use of several clinically-important drugs at the East Birmingham Hospital. Amongst these was gentamicin, which was investigated over a two-year period by a multi-disciplinary team. It was found that there was considerable intra- and inter-patient variation that had not previously been reported and the causes and consequences of such variation were considered. A detailed evaluation of available pharmacokinetic techniques was undertaken and 1- and 2-compartment models were optimised with regard to sampling procedures, analytical error and model-error. The implications for control of therapy are discussed and an improved sampling regime is proposed for routine usage. Similar techniques were applied to trimethoprim, assayed by HPLC, in patients with normal renal function and investigations were also commenced into the penetration of drug into peritoneal dialysate. Novel assay techniques were also developed for a range of drugs including 4-aminopyridine, chloramphenicol, metronidazole and a series of penicillins and cephalosporins. Stability studies on cysteamine, reaction-rate studies on creatinine-picrate and structure-activity relationships in HPLC of aminopyridines are also reported.

Familial and disease specific abnormalities in the neural correlates of the Stroop Task in Bipolar Disorder

Patients with Bipolar Disorder (BD) perform poorly on tasks of selective attention and inhibitory control. Although similar behavioural deficits have been noted in their relatives, it is yet unclear whether they reflect dysfunction in the same neural circuits. We used functional magnetic resonance imaging and the Stroop Colour Word Task to compare task related neural activity between 39 euthymic BD patients, 39 of their first-degree relatives (25 with no Axis I disorders and 14 with Major Depressive Disorder) and 48 healthy controls. Compared to controls, all individuals with familial predisposition to BD, irrespective of diagnosis, showed similar reductions in neural responsiveness in regions involved in selective attention within the posterior and inferior parietal lobules. In contrast, hypoactivation within fronto-striatal regions, implicated in inhibitory control, was observed only in BD patients and MDD relatives. Although striatal deficits were comparable between BD patients and their MDD relatives, right ventrolateral prefrontal dysfunction was uniquely associated with BD. Our findings suggest that while reduced parietal engagement relates to genetic risk, fronto-striatal dysfunction reflects processes underpinning disease expression for mood disorders. © 2011 Elsevier Inc.

The effects of gender and COMT Val158Met polymorphism on fearful facial affect recognition:a fMRI study

The functional catechol-O-methyltransferase (COMT Val108/158Met) polymorphism has been shown to have an impact on tasks of executive function, memory and attention and recently, tasks with an affective component. As oestrogen reduces COMT activity, we focused on the interaction between gender and COMT genotype on brain activations during an affective processing task. We used functional MRI (fMRI) to record brain activations from 74 healthy subjects who engaged in a facial affect recognition task; subjects viewed and identified fearful compared to neutral faces. There was no main effect of the COMT polymorphism, gender or genotypegender interaction on task performance. We found a significant effect of gender on brain activations in the left amygdala and right temporal pole, where females demonstrated increased activations over males. Within these regions, Val/Val carriers showed greater signal magnitude compared to Met/Met carriers, particularly in females. The COMT Val108/158Met polymorphism impacts on gender-related patterns of activation in limbic and paralimbic regions but the functional significance of any oestrogen-related COMT inhibition appears modest. Copyright © 2008 CINP.

Managing supply chain integration:contemporary approaches and scope for further research

The editorial section of the special issue of Production Planning & Control discusses contemporary approaches and scope for further research into the management of supply chain integration. Supply chain integration (SCI) is one of the major challenges in enhancing supply chain performance. Building and sustaining competitive advantage requires strategic collaboration between supply chain partners and synchronized management of intra- and inter-organizational practices and processes. The special issue attempts to address some of the fundamental SCI questions, which include but are not limited to the fields of organizational collaboration, information technology (IT) use, and risk and vulnerability management. The editorial first reviews a few key articles on SCI to provide information about the existing state of knowledge on SCI along with scope for further research.

Formant-Frequency Variation and Informational Masking of Speech by Extraneous Formants : Evidence Against Dynamic and Speech-Specific Acoustical Constraints

How speech is separated perceptually from other speech remains poorly understood. Recent research indicates that the ability of an extraneous formant to impair intelligibility depends on the variation of its frequency contour. This study explored the effects of manipulating the depth and pattern of that variation. Three formants (F1+F2+F3) constituting synthetic analogues of natural sentences were distributed across the 2 ears, together with a competitor for F2 (F2C) that listeners must reject to optimize recognition (left = F1+F2C; right = F2+F3). The frequency contours of F1 − F3 were each scaled to 50% of their natural depth, with little effect on intelligibility. Competitors were created either by inverting the frequency contour of F2 about its geometric mean (a plausibly speech-like pattern) or using a regular and arbitrary frequency contour (triangle wave, not plausibly speech-like) matched to the average rate and depth of variation for the inverted F2C. Adding a competitor typically reduced intelligibility; this reduction depended on the depth of F2C variation, being greatest for 100%-depth, intermediate for 50%-depth, and least for 0%-depth (constant) F2Cs. This suggests that competitor impact depends on overall depth of frequency variation, not depth relative to that for the target formants. The absence of tuning (i.e., no minimum in intelligibility for the 50% case) suggests that the ability to reject an extraneous formant does not depend on similarity in the depth of formant-frequency variation. Furthermore, triangle-wave competitors were as effective as their more speech-like counterparts, suggesting that the selection of formants from the ensemble also does not depend on speech-specific constraints.

Supply chain integration:challenges and solutions

Since its introduction by management consultants in the early 1980s, supply chain management (SCM) has been primarily concerned with the integration of processes and activities both within and between organisations. The concept of supply chain integration (SCI) is based on documented evidence that suggests that much of the waste throughout businesses is a consequence of fragmented supply chain configurations. However, there is also evidence to suggest that the achievement of higher levels of intra- and inter-firm integration presents an array of managerial challenges. The need for innovation in all aspects of SCM is widely recognised. Given the pivotal role of the integration paradigm within SCM, any meaningful innovation in this area must focus heavily on this issue. This chapter outlines some of the challenges by exploring the evolving SCM business context. It goes on to relate SCM theory to the widely cited Porter value chain concept. The core of the chapter provides a detailed description of SCI based on a wide variety of literature. It does so with particular reference to the challenges inherent in implementing an integrated business paradigm with a view to identifying a range of possible innovative solutions. The adoption of more integrated supply chain structures raises questions regarding the nature of both internal and external customer/supplier relationships. The effective management of such relationships is, therefore, given particular focus.