Generalizing the effectiveness of pharmaceutical promotional expenditures

We perform a meta-analysis to formulate generalizations on the effectiveness of pharmaceutical promotional instruments. A literature search on this topic yields 58 usable (published and unpublished) sources documenting 781 effects. We investigate different direct-to-physician (DTP) and direct-to-consumer (DTC) instruments and study whether and how moderator variables influence promotional effectiveness. Pharmaceutical promotional elasticities are modest in size and differ among marketing instruments. In general, DTP elasticities are higher than DTC elasticities, but the relative effectiveness of DTP instruments depends on the disease category. Higher elasticities appear in studies that include price as an independent variable in the models. Studies that account for endogeneity find lower elasticities.

Majority and minority influence using the afterimage paradigm:a replication with an unambiguous blue slide

This study re-examines the afterimage paradigm which claims to show that a minority produces a conversion in a task involving afterimage judgements (more private influence than public influence) as opposed to mere compliance produced by a majority. Subsequent failures to replicate this finding have suggested that the changes in the afterimages could be attributed to increased attention due to an ambiguous stimulus coupled with subject suspiciousness. This study attempted to replicate the original experiment but with an unambiguous stimulus in order to remove potential biases. The results showed shifts in afterimages consistent with the increased attention hypothesis for a minority and majority and these were unaffected by the level of suspiciousness reported by the subjects. Additional data shows that no shifts were found in a no-influence control condition showing that shifts were related to exposure to a deviant source and not to response repetition.

Evaluation of Melbourne Edge Test contrast sensitivity measures in the visually impaired

Aim: Contrast sensitivity (CS) provides important information on visual function. This study aimed to assess differences in clinical expediency of the CS increment-matched new back-lit and original paper versions of the Melbourne Edge Test (MET) to determine the CS of the visually impaired. Methods: The back-lit and paper MET were administered to 75 visually impaired subjects (28-97 years). Two versions of the back-lit MET acetates were used to match the CS increments with the paper-based MET. Measures of CS were repeated after 30 min and again in the presence of a focal light source directed onto the MET. Visual acuity was measured with a Bailey-Lovie chart and subjects rated how much difficulty they had with face and vehicle recognition. Results: The back-lit MET gave a significantly higher CS than the paper-based version (14.2 ± 4.1 dB vs 11.3 ± 4.3 dB, p < 0.001). A significantly higher reading resulted with repetition of the paper-based MET (by 1.0 ± 1.7 dB, p < 0.001), but this was not evident with the back-lit MET (by 0.1 ± 1.4 dB, p = 0.53). The MET readings were increased by a focal light source, in both the back-lit (by 0.3 ± 0.81, p < 0.01) and paper-based (1.2 ± 1.7, p < 0.001) versions. CS as measured by the back-lit and paper-based versions of the MET was significantly correlated to patients' perceived ability to recognise faces (r = 0.71, r = 0.85 respectively; p < 0.001) and vehicles (r = 0.67, r = 0.82 respectively; p < 0.001), and with distance visual acuity (both r =-0.64; p < 0.001). Conclusions: The CS increment-matched back-lit MET gives higher CS values than the old paper-based test by approximately 3 dB and is more repeatable and less affected by external light sources. Clinically, the MET score provides information on patient difficulties with visual tasks, such as recognising faces. © 2005 The College of Optometrists.

Neurophysiological evaluation of convergent afferents innervating the human esophagus and area of referred pain on the anterior chest wall

Noxious stimuli in the esophagus cause pain that is referred to the anterior chest wall because of convergence of visceral and somatic afferents within the spinal cord. We sought to characterize the neurophysiological responses of these convergent spinal pain pathways in humans by studying 12 healthy subjects over three visits (V1, V2, and V3). Esophageal pain thresholds (Eso-PT) were assessed by electrical stimulation and anterior chest wall pain thresholds (ACW-PT) by use of a contact heat thermode. Esophageal evoked potentials (EEP) were recorded from the vertex following 200 electrical stimuli, and anterior chest wall evoked potentials (ACWEP) were recorded following 40 heat pulses. The fear of pain questionnaire (FPQ) was administered on V1. Statistical data are shown as point estimates of difference +/- 95% confidence interval. Pain thresholds increased between V1 and V3 [Eso-PT: V1-V3 = -17.9 mA (-27.9, -7.9) P < 0.001; ACW-PT: V1-V3 = -3.38 degrees C (-5.33, -1.42) P = 0.001]. The morphology of cortical responses from both sites was consistent and equivalent [P1, N1, P2, N2 complex, where P1 and P2 are is the first and second positive (downward) components of the CEP waveform, respectively, and N1 and N2 are the first and second negative (upward) components, respectively], indicating activation of similar cortical networks. For EEP, N1 and P2 latencies decreased between V1 and V3 [N1: V1-V3 = 13.7 (1.8, 25.4) P = 0.02; P2: V1-V3 = 32.5 (11.7, 53.2) P = 0.003], whereas amplitudes did not differ. For ACWEP, P2 latency increased between V1 and V3 [-35.9 (-60, -11.8) P = 0.005] and amplitudes decreased [P1-N1: V1-V3 = 5.4 (2.4, 8.4) P = 0.01; P2-N2: 6.8 (3.4, 10.3) P < 0.001]. The mean P1 latency of EEP over three visits was 126.6 ms and that of ACWEP was 101.6 ms, reflecting afferent transmission via Adelta fibers. There was a significant negative correlation between FPQ scores and Eso-PT on V1 (r = -0.57, P = 0.05). These data provide the first neurophysiological evidence of convergent esophageal and somatic pain pathways in humans.

The ‘situated functionality’ of accounting in private equity practices:a social ‘site’ analysis

This paper contributes to the recent ‘practice turn’ in management accounting literature in two ways: (1) by investigating the meshing and consequently the ‘situated functionality’ of accounting in various private equity (PE) practices, and (2) by experimenting with the application of Schatzki’s ‘site’ ontology. By identifying and describing the role and nature of accounting and associated calculative practices in different parts of the PE value chain, we note that the ‘situated functionality’ of accounting is ‘prefigured’ by its ‘dispersed’ nature. A particular contribution of experimenting with Schatzki’s ‘site’ ontology has been to identify theoretical concerns in relation to the meaning and role of the concept ‘general understandings’ and to clarify the definitional issues surrounding this concept. We also identify the close relationship between ‘general understandings’ and ‘teleoaffective structure’ and note their mutually constitutive nature.

Eulerian model for the condensation of pyrolysis vapors in a water condenser

The paper presents the simulation of the pyrolysis vapors condensation process using an Eulerian approach. The condensable volatiles produced by the fast pyrolysis of biomass in a 100 g/h bubbling fluidized bed reactor are condensed in a water cooled condenser. The vapors enter the condenser at 500 °C, and the water temperature is 15 °C. The properties of the vapor phase are calculated according to the mole fraction of its individual compounds. The saturated vapor pressure is calculated for the vapor mixture using a corresponding states correlation and assuming that the mixture of the condensable compounds behave as a pure fluid. Fluent 6.3 has been used as the simulation platform, while the condensation model has been incorporated to the main code using an external user defined function. © 2011 American Chemical Society.

‘Let’s talk about feedback’:an exploration of academic feedback practices in pharmacy education

Feedback is considered one of the most effective mechanisms to aid learning and achievement (Hattie and Timperley, 2007). However, in past UK National Student Surveys, perceptions of academic feedback have been consistently rated lower by final year undergraduate students than other aspects of the student experience (Williams and Kane, 2009). For pharmacy students in particular, Hall and colleagues recently reported that almost a third of students surveyed were dissatisfied with feedback and perceived feedback practice to be inconsistent (Hall et al, 2012). Aims of the Workshop: This workshop has been designed to explore current academic feedback practices in pharmacy education across a variety of settings and cultures as well as to create a toolkit for pharmacy academics to guide their approach to feedback. Learning Objectives: 1. Discuss and characterise academic feedback practices provided by pharmacy academics to pharmacy students in a variety of settings and cultures. 2. Develop academic feedback strategies for a variety of scenarios. 3. Evaluate and categorise feedback strategies with use of a feedback matrix. Description of Workshop Activities: Introduction to workshop and feedback on pre-reading exercise (5 minutes). Activity 1: A short presentation on theoretical models of academic feedback. Evidence of feedback in pharmacy education (10 minutes). Activity 2: Discussion of feedback approaches in participants’ organisations for differing educational modalities. Consideration of the following factors will be undertaken: experiential v. theoretical education, formative v. summative assessment, form of assessment and the effect of culture (20 minutes, large group discussion). Activity 3: Introduction of a feedback matrix (5 minutes). Activity 4: Development of an academic feedback toolkit for pharmacy education. Participants will be divided into 4 groups and will discuss how to provide effective feedback for 2 scenarios. Feedback strategies will be categorised with the feedback matrix. Results will be presented back to the workshop group (20 minutes, small group discussion, 20 minutes, large group presentation). Summary (10 minutes). Additional Information: Pre-reading: Participants will be provided with a list of definitions for academic feedback and will be asked to rank the definitions in order of perceived relevance to pharmacy education. References Archer, J. C. (2010). State of the science in health professional education: effective feedback. Medical education, 44(1), 101-108. Hall, M., Hanna, L. A., & Quinn, S. (2012). Pharmacy Students’ Views of Faculty Feedback on Academic Performance. American journal of pharmaceutical education, 76(1). Hattie, J., & Timperley, H. (2007). The power of feedback. Review of educational research, 77(1), 81-112. Medina, M. S. (2007). Providing feedback to enhance pharmacy students’ performance. American Journal of Health-System Pharmacy, 64(24), 2542-2545.

Accounting and the 'insoluble' problem of health care costs

Health service accounting reforms are frequently promoted, explained or justified with reference to ageing populations, expensive medical technologies and their purported implications for the cost of health care. Drawing on Foucault’s genealogical method, we examine the emergence of concerns regarding health expenditure in the wake of the creation of the British National Health Service in 1948, and their relationship with health service accounting practices. We argue that concerns regarding the cost of health care are historically contingent rather than inescapable consequences of demographic and technological change, and that health service accounting practices are both constitutive and reflective of such concerns. We conclude by relating our analysis to current attempts to control costs and increase efficiency in the health services.

A comparison of job responsibility and activities between registered dietitians with a bachelor's degree and those with a master's degree

Minimal educational requirements for Registered Dietitians (RDs) include a bachelor's degree and practice program. Recently, a master's degree was recommended. Studies have not established whether education affects employment. A secondary analysis of 2005 Dietetics Practice Audit data determined whether job responsibility, individuals supervised, and activities differed between 1,626 bachelor's RDs (B-RDs) and 767 master's (M-RDs) RDs, registered .5 years. Chi-square and ANOVA analyzed differences between B-RDs and M-RDs, at entry-level (0-3 years experience) and beyond-entry-level (3+-5 years experience). Beyond-entry-level B-RDs (31.8%) and entry-level M-RDs (31.9%) reported “supervisor/executive” responsibility more than entry-level B-RDs (26.5%; p=0.01). A higher percentage of M-RDs supervised (29.2%) than B-RDs (24.7%; p=0.02); however, B-RDs supervised more individuals (7.38 ± 4.89) than M-RDs (6.25 ± 4.87; t=2.32; p=0.021). A master's degree has limited benefits; experience may affect responsibility, individuals supervised, and activities more than education.

Seasonal plant water uptake patterns in the saline southeast Everglades ecotone

The purpose of this study was to determine the seasonal water use patterns of dominant macrophytes coexisting in the coastal Everglades ecotone. We measured the stable isotope signatures in plant xylem water of Rhizophora mangle, Cladium jamaicense, and Sesuvium portulacastrum during the dry (DS) and wet (WS) seasons in the estuarine ecotone along Taylor River in Everglades National Park, FL, USA. Shallow soilwater and deeper groundwater salinity was also measured to extrapolate the salinity encountered by plants at their rooting zone. Average soil water oxygen isotope ratios (δ 18O) was enriched (4.8 ± 0.2‰) in the DS relative to the WS (0.0 ± 0.1‰), but groundwater δ 18O remained constant between seasons (DS: 2.2 ± 0.4‰; WS: 2.1 ± 0.1‰). There was an inversion in interstitial salinity patterns across the soil profile between seasons. In the DS, shallow water was euhaline [i.e., 43 practical salinity units (PSU)] while groundwater was less saline (18 PSU). In the WS, however, shallow water was fresh (i.e., 0 PSU) but groundwater remained brackish (14 PSU). All plants utilized 100% (shallow) freshwater during the WS, but in the DS R. mangle switched to a soil–groundwater mix (δ 55% groundwater) while C. jamaicense and S. portulacastrum continued to use euhaline shallow water. In the DS, based on δ 18O data, the roots of R. mangle roots were exposed to salinities of 25.4 ± 1.4 PSU, less saline than either C. jamaicense(39.1 ± 2.2 PSU) or S. portulacastrum (38.6 ± 2.5 PSU). Although the salinity tolerance of C. jamaicense is not known, it is unlikely that long-term exposure to high salinity is conducive to the persistence of this freshwater marsh sedge. This study increases our ecological understanding of how water uptake patterns of individual plants can contribute to ecosystem levels changes, not only in the southeast saline Everglades, but also in estuaries in general in response to global sea level rise and human-induced changes in freshwater flows.

Lifestyle Behaviors and Self-Rated Health: The Living for Health Program

Background. Lack of adherence to dietary and physical activity guidelines has been linked to an increase in chronic diseases in the United States (US). The aim of this study was to assess the association of lifestyle behaviors with self-rated health (SRH). Methods. This cross-sectional study used self-reported data from Living for Health Program ( 1,701) which was conducted from 2008 to 2012 in 190 health fair events in South Florida, US. Results. Significantly higher percent of females as compared to males were classified as obese (35.4% versus 27.0%), reported poor/fair SRH (23.4% versus 15.0%), and were less physically active (33.9% versus 25.4%). Adjusted logistic regression models indicated that both females and males were more likely to report poor/fair SRH if they consumed 2 servings of fruits and vegetables per day (, 95% CI 1.30–3.54; , 95% CI 1.12–7.35, resp.) and consumed mostly high fat foods (, 95% CI 1.03–2.43; , 95% CI 1.67–2.43, resp.). The association of SRH with less physical activity was only significant in females (, 95% CI 1.17–2.35). Conclusion. Gender differences in health behaviors should be considered in designing and monitoring lifestyle interventions to prevent cardiovascular diseases.

Estudo experimental sobre o comportamento do escoamento bifásico água - ar para a medição de vazão em placa de orifício

The measurement of flow through the prediction of differential pressure is widely used in industrial day-to-day, this happens mainly due to the fact that it is used for various types of fluids, such as gas flow and liquid with viscosity distinct even flow of fluids with particles in suspension. The suitability of this equipment for measuring mass flow in two-phase flow is of paramount importance for technological development and reliability of results. When it comes to two-phase flow the relationship between the fluids and their interactions are of paramount importance in predicting the flow. In this paper, we propose the use of concentric orifice plate used in small diameter pipes of 25.4 mm order where a two-phase flow flows between water-air. The measurement of single-phase flow was made with the use of data in NBR 5167-1 which was used to Stolz equation for measuring discharge coefficient. In the two-phase flow was used two correlations widely used in the prognosis of mass flow, the pattern of Zhang (1992) and the model of Chisholm (1967), to the homogeneous flow model. It was observed that the behavior found in Zhang model are consistent more realistic way the mass flow of two-phase flow, since the model Chisholm extrapolate the parameters for the downstream pressure P2, the orifice plate, and the rated discharge coefficient. The use of the change in pressure drop P1-P2 and discharge coefficient, led to a better convergence of the values obtained for the two-phase air-water stream.

(Table 1) Age determination of sediment core KY07-04-PC1

Variations in Mg/Ca-based sea surface temperature and oxygen isotope ratio (d18O) of the surface water in the northern East China Sea (ECS) were reconstructed with high resolution during the last 18 kyr using planktic foraminifera. Millennial-scale variations between warmer, more saline surface water and cooler, less saline surface water were recognized during the early deglacial period and the Holocene, suggesting changes in the mixing ratio between the Kuroshio Water and the Changjiang Diluted Water. Stronger East Asian summer monsoon (EASM) precipitation events in south China are identified at 10.5, 8.8, 7.0, 5.3, 4.7, 2.9, 1.7, and 0.5 ka, based on sea surface salinity (SSS) records of the northern ECS. Weaker EASM precipitation events are also detected at 9.3, 8.3, 7.3, 6.0, 3.3, 2.3, 0.7, and 0.4 ka during the Holocene. These events agree with the maxima in d18O records of stalagmites from various parts of the Changjiang (Yangtze) River drainage. This agreement supports that our SSS record properly captures the millennial-scale dry (less EASM precipitation) events over the drainage basin of the Changjiang River during the Holocene. These dry events are also in good agreement with North Atlantic ice-rafted events, suggesting a teleconnection between North Atlantic climate and the EASM during the Holocene.

Sea-floor images during POLARSTERN cruise ANT-XIII/3 to the Weddell Sea, Antarctica

Transects of a Remotely Operated Vehicle (ROV) providing sea-bed videos and photographs were carried out during POLARSTERN expedition ANT-XIII/3 focussing on the ecology of benthic assemblages on the Antarctic shelf in the South-Eastern Weddell Sea. The ROV-system sprint 103 was equiped with two video- and one still camera, lights, flash-lights, compass, and parallel lasers providing a scale in the images, a tether-management system (TMS), a winch, and the board units. All cameras used the same main lense and could be tilted. Videos were recorded in Betacam-format and (film-)slides were made by decision of the scientific pilot. The latter were mainly made under the aspect to improve the identification of organisms depicted in the videos because the still photographs have a much higher optical resolution than the videos. In the photographs species larger than 3 mm, in the videos larger than 1 cm are recognisable and countable. Under optimum conditions the transects were strait; the speed and direction of the ROV were determined by the drift of the ship in the coastal current, since both, the ship and the ROV were used as a drifting system; the option to operate the vehicle actively was only used to avoide obstacles and to reach at best a distance of only approximately 30 cm to the sea-floor. As a consequence the width of the photographs in the foreground is approximately 50 cm. Deviations from this strategy resulted mainly from difficult ice- and weather conditions but also from high current velocity and local up-welling close to the sea-bed. The sea-bed images provide insights into the general composition of key species, higher systematic groups and ecological guilds. Within interdisciplinary approaches distributions of assemblages can be attributed to environmental conditions such as bathymetry, sediment characteristics, water masses and current regimes. The images also contain valuable information on how benthic species are associated to each other. Along the transects, small- to intermediate-scaled disturbances, e.g. by grounding icebergs were analysed and further impact to the entire benthic system by local succession of recolonisation was studied. This information can be used for models predicting the impact of climate change to benthic life in the Southern Ocean. All these approaches contribute to a better understanding of the fiunctioning of the benthic system and related components of the entire Antarctic marine ecosystem. Despite their scientific value the imaging methods meet concerns about the protection of sensitive Antarctic benthic systems since they are non-invasive and they also provide valuable material for education and outreach purposes.