The financial imperative of physicians to control demand of laboratory testing

It is an integral component of doctor's duty of care to understand the significant impact laboratory testing has on the expense an ultimate quality of healthcare patients receive, yet the costs of these tests are poorly perceived. Utilising semi-structured interviews and questionnaires, we assessed surgeon's perceived costs of two commonly encountered clinical scenarios requiring out of hours laboratory testing. Of the 35 participants only 23.3% (n = 7) accurately estimated the overall cost. The most expensive test was "Type and Screen" at Euro 83, with 77.3% (n = 17) underestimating the cost. Non-consultant hospital doctors qualified for 3 years were more likely to underestimate on-call costs (p = 0.042). It is of utmost importance to improve the knowledge of all surgeons of the financial implications of investigations. Through education we can potentially reduce un-warranted costs and fulfill our duty of care in the most cost efficient manner.     

Solutions to discrimination in work and housing identified by people with mental illness

Several studies have examined the breadth and depth of the impact of the stigma and discrimination associated with mental illness. This study examines perceived solutions to discrimination in housing and employment situations. We expected identification of solutions to be positively associated with disease insight and personal empowerment. One hundred people with serious mental illness completed measures of perceived solutions to discrimination exhibited by an employer or a landlord. They also completed measures of empowerment and insight. Results showed high frequency solutions included looking for a job or apartment elsewhere, or seeking help from family and friends. Insight was significantly associated with number of endorsed solutions, while the interaction between insight and empowerment described a nonsignificant trend. Implications of these findings for stigma change are discussed.     

Psychosocial treatment compliance scale for people with psychotic disorders

OBJECTIVE: Psychosocial treatment compliance is essential for effective treatment outcomes. A psychometrically valid compliance scale is required for identifying possible obstacles causing treatment non-compliance and testing the effectiveness of compliance therapy. This study developed a scale to measure psychosocial treatment compliance of people with psychotic disorders and established its psychometric properties. METHOD: An initial item pool was generated by literature review and contacts with psychiatric professionals. The content validity and cultural relevancy of this scale were examined by experienced researchers, mental health professionals and mental health consumers which resulted in the 17-item Psychosocial Treatment Compliance Scale (PTCS). Some 108 adults with a DSM-IV diagnosis of psychosis verified by certified psychiatrists were recruited from mental hospitals and social service settings in Hong Kong. Self-stigma, self-esteem, self-efficacy, insight and attitudes to medication of the participants were measured by relevant assessment instruments through interviews. Case therapists then filled in the PTCS and recorded their demographic data. SPSS version 11.0 was used for data analysis. RESULTS: Exploratory factor analysis revealed a two-factor solution (participation and attendance) accounting for 70.74% of the variance. Test-retest reliability and internal consistency were 0.90 and 0.96, respectively, for 'participation'; and 0.86 and 0.87, respectively, for 'attendance'. Its convergent validity was supported by the correlational relationships with measures on self-stigma, self-esteem, self-efficacy, insight and attitudes to medication. CONCLUSION: PTCS is a reliable and valid scale which may be used to measure the compliance to psychosocial treatment of people with psychotic disorders.     

Concentrated insulins: History and critical reappraisal

The earliest marketed insulins were crude acidic formulations with concentrations of ≤10 units/mL. Since the early 1920s, insulins have improved continually, via bioengineering, process, and chemical modifications. Today, most insulin formulations have a concentration of 100 units/mL (U100). However, more concentrated insulin formulations (200, 300, and 500 units/mL; U200, U300, and U500, respectively) are also available. There is a tendency to assume that concentrated insulins are similar, both to each other and to their U100 counterparts, but this is not always the case: two concentrated insulins, namely insulin degludec U200 and insulin lispro U200, are bioequivalent to their U100 counterparts, whereas regular human insulin U500 and insulin glargine U300 are not. The advent of these concentrated insulins offers greater opportunities to provide tailored therapy for patients; it also introduces potential confusion, and highlights the need for prescriber and patient education. Precise and accurate dedicated insulin delivery devices are also necessary for the safe use of these concentrated insulins. Although some clinicians only use concentrated insulin with obese and severely insulin‐resistant patients, other patients would also benefit from the reduced injection volume associated with concentrated insulins, or the modified time‐action profile of some concentrated insulins. The aim of this review is to enhance understanding of the historic development and the safe and effective use of concentrated insulins in clinical practice.     

鹰视眼前段分析仪对前房的测量分析

目的应用鹰视眼前段分析仪（Oculyser）对前房角宽度（ACAW）和前房深度（ACD）进行定量测量,探讨Oculyser在前房测量的应用价值以及多种仪器眼前房生物学参数的关系。方法应用Oculyser对闭角型青光眼和老年性白内障ACAW和ACD进行定量测量,并对各组参数进行统计分析。结果与老年性白内障组相比,闭角青光眼急性发作组和临床前期组ACAW、ACD差异均具有统计学意义。而闭角青光眼急性发作组和临床前期组间比较,ACAW、ACD差异无统计学意义。男女性别间ACAW、ACD差异无统计学意义。结论Oculyser具有客观、准确、非接触和避免人为干扰等优点,可应用于前房角的测量。     

Combining meteorites and missions to explore Mars

Laboratory studies of meteorites and robotic exploration of Mars reveal scant atmosphere, no evidence of plate tectonics, past evidence for abundant water, and a protracted igneous evolution. Despite indirect hints, direct evidence of a martian origin came with the discovery of trapped atmospheric gases in one meteorite. Since then, the study of martian meteorites and findings from missions have been linked. Although the meteorite source locations are unknown, impact ejection modeling and spectral mapping of Mars suggest derivation from small craters in terrains of Amazonian to Hesperian age. Whereas most martian meteorites are young (< 1.3 Ga), the spread of whole rock isotopic compositions results from crystallization of a magma ocean > 4.5 Ga and formation of enriched and depleted reservoirs. However, the history inferred from martian meteorites conflicts with results from recent Mars missions, calling into doubt whether the igneous histor y inferred from the meteorites is applicable to Mars as a whole. Allan Hills 84001 dates to 4.09 Ga and contains fluid-deposited carbonates. Accompanying debate about the mechanism and temperature of origin of the carbonates came several features suggestive of past microbial life in the carbonates. Although highly disputed, the suggestion spurred interest in habitable extreme environments on Earth and throughout the Solar System. A flotilla of subsequent spacecraft has redefined Mars from a volcanic planet to a hydrologically active planet that may have harbored life. Understanding the history and habitability of Mars depends on understanding the coupling of the atmosphere, surface, and subsurface. Sample return that brings back direct evidence from these diverse reservoirs is essential.     

Molecular evolutionary studies of Lassa virus nucleoprotein 2

ObjectiveTo study the virulence diversity through molecular evolution, and to provide insight on circulating antibodies.MethodsThe nucleotide sequences of 18 Lassa virus genomic RNA encoding Lassa virus nucleoprotein isolates collected from different parts of the world since the identification of the Josiah strain were obtained from the GenBank and nucleotide substitution among them studied using the computer program MEGA 4. The genetic distances among strains were predicted by pairwise nucleotide differences.ResultsThe rate of synonymous substitution was high 5.889 per nucleotide per year and nonsynonymous was higher at 49.664. The average predicted rate of synonymous and nonsynonymous using modified Nei-Gojobori (assuming transition/transversion bias=2) was 27.9 which was taken as the genetic distance between strains. The average number of synonymous sites is 150.741 while the average number of nonsynonymous sites is 392.259. The phylogenetic tree was inferred by unweighted pairwise grouping in MEGA4 and using neighbour-joining method. The time of emergence of Lassa virus was predicted to be around January 1920. However, the first human appearance of the virus was predicted to be around May (1 959±24) months. In synonymous substitution the rate of (G-T) rare was high. The nucleotide frequencies were 0.314 (A), 0.246 (T/U), 0.204 (C) and 0.235 (G). The transition/transversion ratio k₁=14.991 (purines) and k₂=69.916 (pyrimidines). The overall transition/transversion bias R=16.662 with a total of 620 position in the final data set. These figures are far higher than an earlier study using Lassa virus glycoprotein. The nucleotide diversity were also very high using the Taijima's model in MEGA 4.ConclusionsThe divergence within strains always coincides with the period of epidemic which goes to confirm that the cause of epidemic outbreak should be the emergence of new strain and also why the infection remains endemic despite circulating antibodies. A comparison with a similar study with the viral glycoprotein concludes that the glycoprotein is more suited for vaccine development.