The impact of ageing on the barriers to drug delivery

Generally, we like to see ageing as a process that is happening to people older than ourselves. However the process of ageing impacts on a wide range of functions within the human body. Whilst many of the outcomes of ageing can now be delayed or reduced, age-related changes in cellular, molecular and physiological functionality of tissues and organs can also influence how drugs enter, distribute and are eliminated from the body. Therefore, the changing profile of barriers to drug delivery should be considered if we are to develop more age-appropriate medicines. Changes in the drug dissolution and absorption in older patients may require the formulation of oral delivery systems that offer enhanced retention at absorption sites to improve drug delivery. Alternatively, liquid and fast-melt dosage systems may address the need of patients who have difficulties in swallowing medication. Ageing-induced changes in the lung can also result in slower drug absorption, which is further compounded by disease factors, common in an ageing population, that reduce lung capacity. In terms of barriers to drug delivery to the eye, the main consideration is the tear film, which like other barriers to drug delivery, changes with normal ageing and can impact on the bioavailability of drugs delivery using eye drops and suspensions. In contrast, whilst the skin as a barrier changes with age, no significant difference in absorption of drugs from transdermal drug delivery is observed in different age groups. However, due to the age-related pharmacokinetic and pharmacodynamic changes, dose adaptation should still be considered for drug delivery across the skin. Overall it is clear that the increasing age demographic of most populations, presents new (or should that be older) barriers to effective drug delivery. © 2012 Elsevier B.V. All rights reserved.

Paediatric 'care closer to home':stake-holder views and barriers to implementation

In this study we explore the views of NHS stakeholders on providing paediatric ‘care closer to home’ (CCTH), in community-based outpatient clinics delivered by consultants. Design: Semi-structured interviews and thematic framework analysis. Setting: UK specialist children's hospital and surrounding primary care trusts. Participants: 37 NHS stakeholders including healthcare professionals, managers, commissioners and executive team members. Results: Participants acknowledged that outreach clinics would involve a change in traditional ways of working and that the physical setting of the clinic would influence aspects of professional practice. Different models of CCTH were discussed, as were alternatives for improving access to specialist care. Participants supported CCTH as a good principle for paediatric outpatient services; however the challenges of setting up and maintaining community clinics meant they questioned how far it could be achieved in practice. Conclusions: The place of service delivery is both an issue of physical location and professional identity. Policy initiatives which ignore assumptions about place, power and identity are likely to meet with limited success.

How habits, social ties, and economic switching barriers affect customer loyalty in contractual service settings

While existing literature acknowledges positive effects of satisfaction and economic switching barriers for building customer loyalty, studies analyzing interactions of these antecedents reveal mixed findings. Prior research does not consider, as antecedents of switching barriers, either habits or social ties that result from shared service-usage within a family or community. This paper contributes to the literature, first, by replicating the effects of satisfaction, economic switching barriers, and their interaction with customer loyalty and word-of-mouth of subscribers to a contractual service. Second, the study empirically tests the role of social ties as a social switching barrier. Third, the study introduces and tests the effects of habits as a precursor of economic and social switching barriers. Results reveal significant positive effects of satisfaction, economic switching barriers, and social ties on customer loyalty and word-of-mouth. Additionally, economic switching barriers and social ties interact significantly with satisfaction and habits act as a precursor of economic switching barriers and social ties.

Switching barriers in the four-stage loyalty model

Oliver (1997) suggests a four-stage loyalty model proposing that loyalty consists of belief, affect, intentions, and action. Although this model has recently been subject to empirical examination, the issue of moderator variables has been largely neglected. This article fills that void by analyzing the moderating effects of switching barriers, using a sample of 589 customers of a large do-it-yourself (DIY) retailer. The results suggest that these moderators exert an influence on the development of the different stages of the loyalty sequence. Specifically, switching costs, social benefits, and attractiveness of alternatives are found to be important moderators of the links in the four-stage loyalty model.

Advancing age and bleeding risk are the strongest barriers to anticoagulant prescription in atrial fibrillation

In clinical practice many patients with atrial fibrillation (AF) at high thromboembolic risk fail to receive adequate oral anticoagulation (OAC) [1]. The complex management of anticoagulant therapy [frequent international normalised ratio (INR) monitoring because of narrow therapeutic window, interaction with food and alcohol, concomitant medications and comorbities], the overestimation of bleeding risk and the underestimation of stroke risk, may partially explain physicians' reluctance to prescribe anticoagulation. In the current issue of Age and Ageing, Pugh and Mead [2] report a systematic review on physicians' attitudes concerning anticoagulant treatment among AF patients. Through surveys (questionnaire, clinical vignette and interview) on hypothetical case scenarios, they have identified the barriers to effective anticoagulant prescription, as follows: increasing age, bleeding risk or previous bleeding, fall risk, co-morbidities (e.g. chronic alcoholism or cognitive impairment) and lack of compliance. In particular, advanced age has been reported as the most striking reason for with-holding anticoagulation, while risk of falls and previous bleeding are also disproportionate barriers to warfarin prescription.

Breaking down barriers:teenage girls’ perceptions of engineering as a study and career choice

Background: Stereotypically perceived to be an ‘all male’ occupation, engineering has for many years failed to attract high numbers of young women [1,2]. The reasons for this are varied, but tend to focus on misconceptions of the profession as being more suitable for men. In seeking to investigate this issue a participatory research approach was adopted [3] in which two 17 year-old female high school students interviewed twenty high school girls. Questions focused on the girls’ perceptions of engineering as a study and career choice. The findings were recorded and analysed using qualitative techniques. The study identified three distinctive ‘influences’ as being pivotal to girls’ perceptions of engineering; pedagogical; social; and, familial. Pedagogical Influences: Pedagogical influences tended to focus on science and maths. In discussing science, the majority of the girls identified biology and chemistry as more ‘realistic’ whilst physics was perceived to more suitable for boys. The personality of the teacher, and how a particular subject is taught, proved to be important influences shaping opinions. Social Influences: Societal influences were reflected in the girls’ career choice with the majority considering medical or social science related careers. Although all of the girls believed engineering to be ‘male dominated’, none believed that a woman should not be engineer. Familial Influences: Parental influence was identified as key to career and study choice; only two of the girls had discussed engineering with their parents of which only one was being actively encouraged to pursue a career in engineering. Discussion: The study found that one of the most significant barriers to engineering is a lack of awareness. Engineering did not register in the girls’ lives, it was not taught in school, and only one had met a female engineer. Building on the study findings, the discussion considers how engineering could be made more attractive to young women. Whilst misconceptions about what an engineer is need to be addressed, other more fundamental pedagogical barriers, such as the need to make physics more attractive to girls and the need to develop the curriculum so as to meet the learning needs of 21st Century students are discussed. By drawing attention to the issues around gender and the barriers to engineering, this paper contributes to current debates in this area – in doing so it provides food for thought about policy and practice in engineering and engineering education.

Firm growth and barriers to growth among small firms in India

Empirical work on micro and small firms focuses on developed countries, while existing work on developing countries is all too often based on small samples taken from ad hoc questionnaires. The census data we analyze here are fairly representative of small business structure in India. Consistent with findings from prior research on developed countries, size and age have a negative impact on firm growth in the majority of specifications. Enterprises managed by women have lower expected growth rates. Proprietary firms face lower growth on the whole, especially if they are young firms. Exporting has a positive effect on firm growth, especially for young firms and for female-owned firms. Although some small firms are able to convert know-how into commercial success, we find that many others are unable to translate it into superior growth.

Overcoming barriers to membrane protein structure determination

After decades of slow progress, the pace of research on membrane protein structures is beginning to quicken thanks to various improvements in technology, including protein engineering and microfocus X-ray diffraction. Here we review these developments and, where possible, highlight generic new approaches to solving membrane protein structures based on recent technological advances. Rational approaches to overcoming the bottlenecks in the field are urgently required as membrane proteins, which typically comprise ~30% of the proteomes of organisms, are dramatically under-represented in the structural database of the Protein Data Bank.

Characterization of engineered biochar for soil management

Pyrolysis is an energy conversion technology which by heating organic materials in the absence of oxygen, produces liquid, gaseous, and solid fuel products. Biochar, the solid product, can also be used as a soil amendment and, simultaneously, enables us to sequester carbon in the soil. By controlling the pyrolysis process, it is possible to engineer biochar suitable for the remediation of specific soil management problems. This research uses a characterization method more suited to producing biochar for soil amendment purposes than the existing biochar fuel characterization standards. This is the first research to use wastewater irrigated willow as a pyrolysis feedstock. The extensive characterization of biochar produced over a range of temperatures (410-810°C) yielded data on key properties relevant to soil under management: low surface area (1.4 to 5.4 m2/g), low bulk density (0.15-0.18 g/cm3), high pH values (7.8-9.4) and high water-holding capacity (1.8 to 4.3 cm3/g). Extraction experiments demonstrated low bioavailability of char nutrients (N, P, K, Ca, and Mg). This research also studied this artificial nitrogen cycle of pyrolysis: nitrogen accumulated in the wood from the wastewater and high levels of nitrogen remained in the biochar in a stable form not directly available to plants. Copyright © 2013 American Institute of Chemical Engineers Environ Prog.