Returned medicines:Waste or a wasted opportunity?

Background: Re-use of unused medicines returned from patients is currently considered unethical in the UK and these are usually destroyed by incineration. Previous studies suggest that many of these medicines may be in a condition suitable for re-use. Methods: All medicines returned over two months to participating community pharmacies and GP surgeries in Eastern Birmingham PCT were assessed for type, quantity and value. A registered pharmacist assessed packs against set criteria to determine the suitability for possible re-use. Results: Nine hundred and thirty-four return events were made from 910 patients, comprising 3765 items worth £33 608. Cardiovascular drugs (1003, 27%) and those acting on the CNS (884, 24%) were most prevalent. Returned packs had a median of 17 months remaining before expiry and one-quarter of packs (1248 out of 4291) were suitable for possible re-use. One-third of those suitable for re-use (476 out of 1248) contained drugs in the latest WHO Essential Drugs List. Conclusion: Unused medicines are returned in substantial quantities and have considerable financial value, with many in a condition suitable for re-use. We consider it appropriate to reopen the debate on the potential for re-using these medicines in developing countries where medicines are not widely available and also within the UK. © The Author 2007, Published by Oxford University Press on behalf of Faculty of Public Health. All rights reserved.

An analysis of returned medicines in primary care

Objective: The number of pharmaceutical items issued on prescription is continually rising and contributing to spiralling healthcare costs. Although there is some data highlighting the quantity, in terms of weight of medicines returned specifically to community pharmacies, little is known about the specific details of such returns or other destinations for wasted medications. This pilot study has been designed to investigate the types and amounts of medicines returned to both general practices (GPs) and associated local community pharmacies determining the reasons why these medicines have been returned. Method: The study was conducted in eight community pharmacies and five GP surgeries within East Birmingham over a 4-week period. Main outcome Measure: Reason for return and details of returned medication. Results: A total of 114 returns were made during the study: 24 (21.1) to GP surgeries and 90 (78.9) to community pharmacies. The total returns comprised 340 items, of which 42 (12.4) were returned to GPs and 298 (87.6) to pharmacies, with the mean number of items per return being 1.8 and 3.3, respectively. Half of the returns in the study were attributed to the doctor changing or stopping the medicine; 23.7 of returns were recorded as excess supplies or clearout often associated with patients' death and 3.5 of returns were related to adverse drug reactions. Cardiovascular drugs were most commonly returned, amounting to 28.5 of the total drugs returned during the study. Conclusions: The results from this pilot study indicate that unused medicines impose a significant financial burden on the National Health Service as well as a social burden on the United Kingdom population. Further studies are examining the precise nature of returned medicines and possible solutions to these issues. © Springer 2005.

Critical pedagogy/popular education group

Few today doubt that English Higher Education (HE), like the wider world in which it is located, is in crisis. This is, in part, an economic crisis, as the government response to the current recession seems to be that of introducing the kind of neoliberal ‘shock doctrine’ (Klein 2007) or ‘shock therapy’ (Harvey 2005) that previously resulted in swingeing cuts in public services in Southern nations. Our aim in producing this volume is that these contributions help develop a collective response to the seeming limits of these conditions. We view the strength of these contributions in part as providing palpable evidence of how we and our colleagues are acting with critical hope under current conditions so that we might encourage others to work with us to build, together, more progressive formal and informal education systems that address and seek to redress multiple injustices of the world today.

Structural studies in tellurium chemistry

The primary theme of this research was the characterisation of new and novel organo-tellurium complexes, using the technique of single crystal X-ray analysis to establish more firmly the various coordination modes of tellurium. In each study the unit cell dimensions and intensity data were collected using an Enraf-Nonius CAD-4, four circle diffractometer. The raw data collected in turn was transferred to the Birmingham University Honeywell Multics System and processed using the appropriate computer packages for the determination of crystal structures. The molecular and crystal structures of: bis[2-(2-pyridyl)phenyl]tritelluride, bis[2-(N-hydroxy)iminophenyl] ditelluride, 2-(2-pyridyl)phenyltellurium(IV) tribromide, (2-N,N-dimethylbenzylamine-C,N')tellurium(IV)tribromide, 2-dichloro(butyl)tellurobenzaldehyde, 2-dichlorobutotelluro-N-dimethylbenzyl ammonium chloride, dimethyldithiocarbamato[2-(2-pyridyl)phenyl]tellurium(II), dimethyldithiocarbamato[2-(2-quinolinyl)phenyl]tellurium(II) and para-ethoxypheny[2-(2-pyridyl)phenyl]telluride are described. In each structure, the Lewis acidity of tellurium appears to be satisfied by autocomplex formation, through short-range intramolecular secondary bonds between tellurium and an electron denoting species, (generally nitrogen in these structures) with long range weak inter molecular contacts forming in the majority of the tellurium(IV) structures. The order of Lewis acidity in each structure can be considered to be reflected by the length of the short range intramolecular secondary bond, identified, that is, when tellurium has a low Lewis acidity this interaction is long. Interestingly, no primary bonds are found trans to a Te-C covalent bond in any of the above structures, highlighting the strong trans effect of aromatic and aryl groups in tellurium complexes.

Sociolinguistic variability in oral narrative.

This thesis begins with a sociolinguistic correlational study of three phonetic variables - (h), (t) and (ing) - as used by four occupational groups - nurses, chefs, hairdressers and taxi-drivers. The groups were selected to incorporate three independent variables: sex (male-dominated versus female-dominated occupations); training (length and specialisation - nurses and chefs being more specialised than hairdressers and taxi-drivers) and location (the populations were selected from two cities - Liverpool and Birmingham). Although the correlational work demonstrates intra-sex and occupation consistency in speakers' choice of linguistic variants (females (particularly nurses) being significantly closer to the prestige norm), it is essentially non-explanatory and cannot accout for narrative dynamics and style shift. Therefore, an in-depth qualitative examination of the data (which draws mainly on Narrative and Discourse Analysis) forms the major part of the analysis. The study first analyses features common to all the narratives, direct speech, expressive phonology and linguistic ambiguity emerging as characteristic of all humorous storytelling. Secondly, three major sources of inter-personal variation are invetigated: narrator perspective, sex and occuptational role. Perspective is found to vary with topic and personality, greater narrator involvement coinciding with a higher proportion of internal evaluation devices. Sex differences include topic choice and bonding in the storytelling sessions. Sex differences are also evident in style shifting, where the narrator mimics the voice of a character in the narrative (aodpting segmental and/or prosodic tokens to signal a change of persona). The research finds that female narrators rarely employ segmental accommodation downwards on the social scale (whereas men do), but are on the other hand adept at using prosodic effects for mimicry. Taxi-drivers emerge as the group with the most distinctive narrative flair, a fact which is related to their occupation. The conclusion stresses a need for both quantitative and qualitative approaches to data; the importance of occupational role, as opposed to sex role per se in determining narrative conventions; the view of narrative as a negotiable entity, which is the product of relationships among participants; and the importance of considering the totality of the communicative act.

Radioimmunoassay of insulin and glucagon with studies on the obese hyperglycaemic syndrome in mice

Sensitive and precise radioimmunoassays for insulin and glucagon have been established. Although it was possible to employ similar precepts to the development of both hormone assays, the establishment of a reliable glucagon radioimmunoassay was complicated by the poor immunogenicity and instability of the peptide. Thus, unlike insulin antisera which were prepared by monthly injection of guinea pigs with crystalline insulin emulsified in adjuvant, the successful production of glucagon antisera was accomplished by immunisation of rabbits and guinea pigs with glucagon covalently linked to bovine plasma albumin. The conventional chloramine-T iodination with purification by gel chromatography was only suitable for the production of labelled insulin. Quality tracer for use in the glucagon radioimmunoassay was prepared by trace iodination, with subsequent purification of monoiodinated glucagon by anion exchange chromatography. Separation of free and antibody bound moieties by coated charcoal was applicable to both hormone assays, and a computerised data processing system, relying on logit-log transformation, was used to analyse all assay results. The assays were employed to evaluate the regulation of endocrine pancreatic function and the role of insulin and glucagon in the pathogenesis of the obese hyperglycaemic syndrome in mice. In the homozygous (ob/ob) condition, mice of the Birmingham strain were characterised by numerous abnormalities of glucose homeostasis, several of which were detected in heterozygous (ob/+) mice. Obese mice exhibited pancreatic alpha cell dysfunction and hyperglucagonaemia. Investigation of this defect revealed a marked insensitivity of an insulin dependent glucose sensing mechanism that inhibited glucagon secretion. Although circulating glucagon was of minor importance in the maintenance of hyperinsulinaemia, lack of suppression of alpha cell function by glucose and insulin contributed significantly to both the insulin insensitivity and the hyperglycaemia of obese mice.

Elastic and inelastic scattering of fast neutrons in fusion reactor materials

In this work, the angular distributions for elastic and. inelastic scattering of fast neutrons in fusion .reactor materials have been studied. Lithium and lead material are likely to be common components of fusion reactor wall configuration design. The measurements were performed using an associated particle time-of- flight technique. The 14 and 14.44 Mev neutrons were produced by the T(d,n} 4He reaction with deuterons being accelerated in a 150kev SAMES type J accelerator at ASTON and in.the 3. Mev DYNAMITRON at the Joint Radiation Centre, Birmingham respectively. The associated alpha-particles and fast. neutrons were detected.by means of a plastic scintillator mounted on a fast focused photomultiplier tube. The samples used were extended flat plates of thicknesses up to 0.9 mean-free-path for Lithium and 1.562 mean-free-path for Lead. The differential elastic scattering cross-sections were measured for 14 Mev neutrons for various thicknesses of Lithium and Lead in the angular range from zero to; 90º. In addition, the angular distributions of elastically scattered 14,.44 Mev .neutrons from Lithium samples were studied in the same angular range. Inelastic scattering to the 4.63 Mev state in 7Li and the 2.6 Mev state, and 4.1 Mev state in 208Pb have:been :measured.The results are compared to ENDF/B-IV data files and to previous measurements. For the Lead samples the differential neutron scattering:cross-sections for discrete 3 Mev ranges and the angular distributions were measured. The increase in effective cross-section due to multiple scattering effects,as the sample thickness increased:was found to be predicted by the empirical .relation ....... A good fit to the exoerimental data was obtained using the universal constant............ The differential elastic scattering cross-section data for thin samples of Lithium and Lead were analyzed in terms of optical model calculations using the. computer code. RAROMP. Parameter search procedures produced good fits to the·cross-sections. For the case of thick samples of Lithium and Lead, the measured angular distributions of :the scattered neutrons were compared to the predictions of the continuous slowing down model.

Pupil resistance to their schooling experience

The thesis explores the nature of pupil resistance; it investigates what constitutes it and how it can be explained. Various ethnic and national group, male and female working-class resistance if analysed in two secondary schools in Birmingham (England) and one school in Sydney (Australia). It focuses on the pupils’ experience of school. ‘Compressed ethnographies’ (Walford and Miller, 1991) were conducted in each school to examine pupil resistance. The research found that structural societal state factors, regional, community and formal, informal and physical characteristics of each school, together with the teachers and pupils characteristics and background all influence resistance. The class, gender, ethnic and national identity of each pupil shapes resistance. In all three schools that were involved with the research, girls were more likely to exhibit overt, collective forms of resistance, whereas lads were more likely to operate alone. Islander pupils in Sydney and African-Caribbean kids in Birmingham were more likely to display engaged forms of resistance. Girls tended to show more engaged forms compared to their male counterparts across all ethnic and national cultures. Resistance is complex and dynamic, the definition alters depending upon context. Dimensions of resistance are developed; including overt, covert; individual, collective; intentional, unintentional; engaged and detached forms. Resistance operates within a structure and agency framework, the pupils can shape their own schooling experience mediated within the structures of their school, community and society. Some pupils manage their resources and the structures better than others; how the pupil manages and operates within the structures influences their resistance response. Resistance is contradictory and can reinforce the status quo. To fully understand resistance, it must be contextualised.

How SME owners’ characteristics influences external advice and access to finance

This paper aims to investigate the linkage between the use of external advice and access to finance for small and medium-sized enterprises (SMEs) in the UK, with particular consideration of differences in personal characteristics: gender, ethnicity and education. The approach adopted for the research is a telephone survey conducted by the Barclays small business research team in late 2005 on behalf of the authors. These data are quantitative in nature and involve a large sample of 400 SMEs with specific questions analysed by gender, ethnicity and education level. The approach adopted is robust and empirically sound and is a long established research methodology. We find that there appears to be a correlation between the provision of external advice and the ability to raise bank finance. Furthermore, there are clear gender, ethnic and educational differentials in the use of particular sources of advice, for example: Gender • men and women are equally likely to use accountants as sources of advice. • men are more likely to use family and friends and solicitors. • women, however, are around twice as likely to access external advice from Business Link and Enterprise Agencies. Ethnicity • family and friends is predominant amongst Asians or black respondents and the other ethnic group, which is also slightly true of accountants and solicitors. • ethnic minority respondents were considerably less likely to use Business Link/ Enterprise Agencies. Education • graduates are most likely to use solicitors and accountants, whilst they are very low users of advice from family and friends and Business Links/Enterprise Agencies. • O level and A level educated respondents predominate in family and friends and Business Link/ Enterprise Agencies.

A study of potential serum markers for a diagnosis of gram-positive and gram-negative bacterial sepsis

Sepsis continues to be a major cause of morbidity and mortality as it can readily lead tosevere sepsis, septic shock, multiple organ failure and death. The onset can be rapid and difficult to define clinically. Despite the numerous candidate markers proposed in the literature, to date a serum marker for sepsis has not been found. The aim of this study was to assay the serum of clinically diagnosed patients with eithera Gram-negative or Gram- positive bacterial sepsis for elevated levels of nine potentialmarkers of sepsis, using commercially produced enzyme linked immunosorbent assays(ELISA). The purpose was to find a test marker for sepsis that would be helpful toclinicians in cases of uncertain sepsis and consequently expose false positive BC'scaused by skin or environmental contaminants. Nine test markers were assayed including IL-6, IL-I 0, ILI2, TNF-α, lipopolysaccharide binding protein, procalcitonin, sE-selectin, sICAM -1 and a potential differential marker for Gram-positive sepsis- anti-lipid S antibody. A total of 445 patients were enrolled into this study from the Queen Elizabeth Hospital and Selly Oak Hospital (Birmingham). The results showed that all the markers were elevated in patients with sepsis and that patients with a Gram-negative sepsis consistently produced higher median/range serum levels than those with a Gram-positive sepsis. No single marker was able to identify all the septic patients. Combining two markers caused the sensitivities and specificities for a diagnosis of sepsis to increase to within a 90% to 100% range. By a process of elimination the markers that survived into the last phase were IL-6 with sICAM -1, and anti-lipid S IgG assays Defining cut-off levels for a diagnosis of sepsis became problematic and a semi-blind trial was devised to test the markers in the absence of both clinical details and positive blood cultures. Patients with pyrexia of unknown origin and negative BC were included in this phase (4). The results showed that IL-6 with sICAM-l are authentic markers of sepsis. There was 82% agreement between the test marker diagnosis and the clinical diagnosis for sepsis in patients with a Gram-positive BC and 78% agreement in cases of Gram-negative Be. In the PUO group the test markers identified 12 cases of sepsis and the clinical diagnosis 15. The markers were shown to differentiate between early sepsis and sepsis, inflammatory responses and infection. Anti-lipid S with IL-6 proved be a sensitive marker for Gram-positive infections/sepsis.

Variable impedance bearings for large rotating machinery

This thesis describes an investigation which was carried out under the Interdisciplinary Higher Degres (IHD) Scheme of The University of Aston in Birmingham. The investigation, which involved joint collaboration between the IHD scheme, the Department of Mechanical Engineering, and G.E.C. Turbine Generators Limited, was concerned with hydrostatic bearing characteristics and of how hydrostatic bearings could be used to enable turbine generator rotor support impedances to be controlled to give an improved rotor dynamic response. Turbine generator rotor critical speeds are determined not only by the mass and flexibility of the rotor itself, which are relatively easily predicted, but also by the dynamic characteristics of the bearing oil film, pedestal, and foundations. It is because of the difficulty in accurately predicting the rotor support characteristics that the designer has a problem in ensuring that a rotor's normal running speed is not close to one of its critical speeds. The consequence of this situation is that some rotors do have critical speeds close to their normal running speed and the resulting high levels of vibration cause noise, high rotor stresses, and a shortening of bearing life. A combined theoretical and experimental investigation of the effects of mounting the normal rotor journal bearing in a hydrostatic bearing was carried out. The purpose of the work was to show that by changing the oil flow resistance offered by capillaries connecting accumulators to the hydrostatic bearing, the overall rotor support characteristics could be tuned to enable rotor critical speeds to be moved at will. Testing of a combined journal and hydrostatic bearing has confirmed the theory of its operation and a theoretical study of a full size machine showed that its critical speed could be moved by over 350 rpm and that its rotor vibration at running speed could be reduced by 80%.

Heat transfer from molten materials to liquids

An apparatus was designed and constructed which enabled material to be melted and heated to a maximum temperature of 1000C and then flooded with a pre-heated liquid. A series of experiments to investigate the thermal interaction between molten metals (aluminium, lead and tin) and sub-cooled water were conducted. The cooling rates of the molten materials under conditions of flooding were measured with a high speed-thermocouple and recorded with a transient recorder. A simplified model for calculating heat fluxes and metal surface temperatures was developed and used. Experimental results yielded boiling heat transfer in the transition film and stable film regions of the classic boiling curve. Maximum and minimum heat fluxes were observed at nucleate boiling crisis and the Leidenfrost point respectively. Results indicate that heat transfer from molten metals to sub-cooled water is a function of temperature and coolant depth and not a direct function of the physical properties of the metals. Heat transfer in the unstable transition film boiling region suggests that boiling dynamics in this region where a stationary molten metal is under pool boiling conditions at atmospheric pressure would not initiate a fuel-coolant interaction. Low heat fluxes around the Leidenfrost point would provide efficient fuel-coolant decoupling by a stable vapour blanket to enable coarse mixing of the fuel and coolant to occur without appreciable loss of thermal energy from the fuel. The research was conducted by Gareph Boxley and was submitted for the degree of PhD at the University of Aston in Birmingham in 1980.

Studies of solar radiation and its measurement

A mathematical model has been developed for predicting the spectral distribution of solar radiation incident on a horizontal surface. The solar spectrum in the wavelength range 0.29 to 4.0 micrometers has been divided in 144 intervals. Two variables in the model are the atmospheric water vapour content and atmospheric turbidity. After allowing for absorption and scattering in the atmosphere, the spectral intensity of direct and diffuse components of radiation are computed. When the predicted radiation levels are compared with the measured values for the total radiation and the values with glass filters RG715, RG630 and OG530, a close agreement (± 5%) has been achieved under clear sky conditions. A solar radiation measuring facility, close to the centre of Birmingham, has been set up utilising a microcomputer based data logging system. A suite of computer programs in the BASIC programming language has been developed and extensively tested for solar radiation data, logging, analysis and plotting. Two commonly used instruments, the Eppley PSP pyranometer and the Kipp and Zonen CM5 pyranometer, have been compared under different experimental conditions. Three models for computing the inclined plane irradiation, using total and diffuse radiation on a horizontal surface, have been tested for Birmingham. The anisotropic-alI-sky model, proposed by Klucher, provides a good agreement between the measured and the predicted radiation levels. Measurements of solar spectral distribution, using glass filters, are also reported for a number of inclines facing South.

Gamma rays associated with neutron scattering in fusion reactor materials

The gamma-rays produced by the inelastic scattering of 14 MeV neutrons. in fusion reactor materials have been studied using a gamma-ray spectrometer employing a sodium iodide scintillation detector. The source neutrons are produced by the T(d,n)4He reaction using the SAMES accelerator at the University of Aston in Birmingham. In order to eliminate the large gamma-ray background and neutron signal due to the sensitivity of the sodium iodide detector to neutrons, the gamma-ray detector is heavily shielded and is used together with a particle time of flight discrimination system based on the associated particle time of flight method. The instant of production of a source neutron is determined by detecting the associated alpha-particle enabling discrimination between the neutrons and gamma-rays by their different time of flight times. The electronic system used for measuring the time of flight of the neutrons and gamrna-rays over the fixed flight path is described. The materials studied in this work were Lithium and Lead because of their importance as fuel breeding and shielding materials in conceptual fusion reactor designs. Several sample thicknesses were studied to determine the multiple scattering effects. The observed gamma-ray spectra from each sample at several scattering angles in the angular range Oº - 90° enabled absolute differential gamma-ray production cross-sections and angular distributions of the resolved gamma-rays from Lithium to be measured and compared with published data. For the Lead sample, the absolute differential gamma-ray production cross-sections for discrete 1 MeV ranges and the angular distributions were measured. The measured angular distributions of the present work and those on Iron from previous work are compared to the predictions of the Monte Carlo programme M.O.R.S.E. Good agreement was obtained between the experimental results and the theoretical predictions. In addition an empirical relation has been constructed which describes the multiple scattering effects by a single parameter and is capable of predicting the gamma-ray production cross-sections for the materials to an accuracy of ± 25%.