Managed care: quality management differentiates the product

Comprehensive quality management is a goal that requires major corporate commitment to implement and maintain. The best results in a quality management program will be achieved when all components are tied together in a comprehensive program. To do that, a significant investment in personnel and equipment is required. As the benefits of having a program such as the one as described above become more widely known and accepted, more and more managed care insurers and providers will adopt these or similar standards. The question, "How do you know that patients are getting high-quality and sufficient care?" cannot be answered today by insurers who do not have such a program.     

Prenatal exposure to ionizing radiation and subsequent development of seizures

Seizures are a frequent sequela of impaired brain development and can be expected to affect more children with radiation-related brain damage than children without such damage. This report deals with the incidence and type of seizures among survivors prenatally exposed to the atomic bombing of Hiroshima and Nagasaki, and their association with specific stages of prenatal development at the time of irradiation. Fetal radiation dose was assumed to be equal to the dose to the maternal uterus. Seizures here include all references in the clinical record to "seizure," "epilepsy," or "convulsion." Histories of seizures were obtained at biennial routine clinical examinations starting at about the age of 2 years. These clinical records were used to classify seizures as febrile or unprovoked (without precipitating cause). No seizures were ascertained among subjects exposed 0-7 weeks after fertilization at doses higher than 0.10 Gy. The incidence of seizures was highest with irradiation at the eighth through the 15th week after fertilization among subjects with doses exceeding 0.10 Gy and was linearly related to the level of fetal exposure. This obtains for all seizures without regard to the presence of fever or precipitating causes, and for unprovoked seizures. When the 22 cases of severe mental retardation were excluded, the increase in seizures was only suggestively significant and only for unprovoked seizures. After exposure at later stages of development, there was no increase in recorded seizures.     

Design of Copolymer-Based Blend Compatibilizers for Mixed Plastic Recycling

Mixed plastic waste recycling represents a significant challenge as the phase separation of different components dictates downgraded performance. Polymer-based compatibilizers can offer a promising solution to address this issue, through effectively reducing surface tension and increasing interfacial strength between distinct components to result in improved mechanical and thermal properties of recycled products. This perspective provides an overview of the fundamental concepts for the rational design of copolymer blend compatibilizers and discusses their recent advances, including both preformed and in situ generated systems. Impacts of key material parameters of compatibilizers, such as chain topology, chemical composition, and block sequence on their performance of remediating mixed plastics are discussed. Additionally, reactive compatibilization strategies are also introduced, including in situ formation of polymers, installing functional groups on mixed plastics, and employing dual compatibilization strategies. Looking forward, there are many research and technology opportunities in this area, especially for enabling the use of blend compatibilizers to practically address mixed plastic wastes at scale. Specifically, future compatibilizer design and application should provide strong competitiveness in both cost and energy savings, and carbon emission reduction. Together, the development of blend compatibilizers is an important step in establishing plastic circular economy and creating a more sustainable future.     

Surface Modification of Poly(lactide-co-glycolide) Nanospheres by Biodegradable Poly(lactide)-Poly(ethylene glycol) Copolymers

The modification of surface properties of biodegradable poly(lactide-co-glycolide) (PLGA) and model polystyrene nanospheres by poly(lactide)-poly(ethlene glycol) (PLA:PEG) copolymers has been assessed using a range of in vitro characterization methods followed by in vivo studies of the nanospheres biodistribution after intravenous injection into rats. Coating polymers with PLA:PEG ratio of 2:5 and 3:4 (PEG chains of 5000 and 2000 Da, respectively) were studied. The results reveal the formation of a PLA: PEG coating layer on the particle surface resulting in an increase in the surface hydrophilicity and decrease in the surface charge of the nanospheres. The effects of addition of electrolyte and changes in pH on stability of the nanosphere dispersions confirm that uncoated particles are electrostatically stabilized, while in the presence of the copolymers, steric repulsions are responsible for the stability. The PLA:PEG coating also prevented albumin adsorption onto the colloid surface. The evidence that this effect was observed for the PLA:PEG 3:4 coated nanospheres may indicate that a poly(ethylene glycol) chain of 2000 Da can provide an effective repulsive barrier to albumin adsorption. The in vivo results reveal that coating of PLGA nanospheres with PLA:PEG copolymers can alter the biodistribution in comparison to uncoated PLGA nanospheres. Coating of the model polystyrene nanospheres with PLA:PEG copolymers resulted in an initial high circulation level, but after 3 hours the organ deposition data showed values similar to uncoated polystyrene spheres. The difference in the biological behaviour of coated PLGA and polystyrene nanospheres may suggest a different stability of the adsorbed layers on these two systems. A similar biodistribution pattern of PLA:PEG 3:4 to PEG 2:5 coated particles may indicate that poly(ethylene glycol) chains in the range of 2000 to 5000 can produce a comparable effect on in vivo behaviour.     

Can a house call by a public health nurse improve the quality of the discharge process for geriatric patients?

OBJECTIVE: To determine whether there was any benefit from a single house call by a health visitor (a public health nurse) to an elderly person after discharge home from a geriatric hospital. METHODS: A randomized controlled trial with blind assessments at 28 days was conducted. Subjects included residents of Bath, England, with an average age of 83 years, who were discharged consecutively from a geriatric hospital to their homes. Intervention was a single visit by a health visitor 72 hours after discharge, to ensure the patient was settled at home, or normal post-discharge care. Outcome measures taken at 28 days by a research nurse included survival, hospital readmissions, nursing home admissions, cognitive and physical function, services requested and supplied, and drug therapy. RESULTS: There were no important differences between the intervention and control groups at 28 days on any of the outcome measurements. The control subjects did better than the study subjects on many of the outcome measures. CONCLUSION: A house call by a health visitor to elderly patients after discharge from geriatric wards does not measurably improve the quality of the discharge.     

Modeling breathing-zone concentrations of airborne contaminants generated during compressed air spray painting

This paper presents a mathematical model to predict breathing-zone concentrations of airborne contaminants generated during compressed air spray painting in cross-flow ventilated booths. The model focuses on characterizing the generation and transport of overspray mist. It extends previous work on conventional spray guns to include exposures generated by HVLP guns. Dimensional analysis and scale model wind-tunnel studies are employed using non-volatile oils, instead of paint, to produce empirical equations for estimating exposure to total mass. Results indicate that a dimensionless breathing zone concentration is a nonlinear function of the ratio of momentum flux of air from the spray gun to the momentum flux of air passing through the projected area of the worker's body. The orientation of the spraying operation within the booth is also very significant. The exposure model requires an estimate of the contaminant generation rate, which is approximated by a simple impactor model. The results represent an initial step in the construction of more realistic models capable of predicting exposure as a mathematical function of the governing parameters.