Home, training and work: mobility of British doctors

This study examines the locations of family homes, medical schools and places of specialist training, and work of doctors qualifying from UK medical schools in 5 calendar years between 1974 and 1993. The contribution of each UK region to the medical workforce relative to its population is assessed and trends over time are examined. The relationship between place of family home and medical school attended is examined for 14,108 doctors. Career appointment location and its relationship to medical school and family home loc‐ation are examined for over 4000 doctors. For the qualifiers of 1983, an additional analysis incorporating place of training is included. Large differences were found in the percentage of medical students from local family homes attending each regional medical school. In some cases differences reflected local populations but other cases had no obvious cause. Over all cohorts studied, 38% of respondents attended a medical school in the region of their family home (32% of 1993 qualifiers), 42% held a career post in the same region as their medical school, and 38% held a career post in the same region as their family home. Among the qualifiers of 1983, 65% had a career post in the same region as their postgraduate training, 34% also attended medical school in the same region, and 19% also came from family homes in the same region. More women than men took up a career post in the same region as their postgraduate training. The relationships to family home and medical school did not differ by gender. Consultants appeared slightly less likely than GPs to have stayed within a region, but this difference was not statistically significant.     

Application of Moment Analysis to Nonlinear Drug Disposition Described by the Michaelis–Menten Equation

An equation for the mean residence time (MRT) of drug in the body is derived for the system where drug is injected intravenously into a one-compartment model and eliminated by a single, capacity-limited process. This MRT is a complex function of dose, volume, V _m, and K _m but degenerates into the classical volume/clearance expression under limiting low-dose conditions (K _m C ₀). The equation was validated by comparison of the MRT obtained by direct calculation versus numerical area estimation for simulated data. The equation may be useful analytically in the estimation of the fundamental Michaelis–Menten parameters, V _m and K _m, from experimental data.     

Model-independent assessment of accumulation kinetics based on moments of drug disposition curves

Summary The bounds of the accumulation profile can be predicted on the basis of the mean disposition residence time (MDRT) of a drug. The time to reach 90% of the plateau level (t _0.9) is less than 3.7 MDRT. This prediction can be improved if, in addition, the variance of disposition residence time (VDRT, CV _D ² =VDRT/MDRT²), or the terminal exponential coefficient (), is known. For CV _D ² 1 or MDRT1, the time to reach steady state (t_0.9) approaches 2.3 MDRT (limiting case of monoexponential drug disposition curve). Conditions are stated under which can be regarded as the principal determinant of the accumulation rate.     

城市住宅新区医疗卫生服务需求的现状与对策

目的:了解城市住宅新区医疗卫生服务供给与需求的现状,为决策部门合理分配卫生资源提供参考依据。方法:根据浙江省城市地理位置和经济文化、发展程度,在全省范围内选择有代表性的城市,采用城、区街(居委会)住户4个层次随机抽样方法调查4810户家庭。结果:住宅新区个人和家庭医疗卫生服务需求大于供给,希望社区提供全天候卫生服务。医疗费用支出占家庭收入的6.20％,绝大多数家庭能承担各项医疗费用,家庭每年最多能支出医疗保健服务费用平均为2565.15元。     

Potato processing in the central highlands of Peru

The processing of food products is an important economic activity of rural households in the Andean Highlands of Perú. Potatoes are processed into several dehydrated products the most common of which are chuño and papa seca. Chuño is a freezedried product made principally from bitter types of potatoes (Solarium juzepczukii and S. curtilobum) while papa seca is made from common varieties. This article describes how these and other products are made and their role within the Peruvian diet.     

Non-clinical pharmacokinetics and pharmacodynamics of rVIII-SingleChain,a novel recombinant single-chain factor VIII

Introduction

rVIII-SingleChain (CSL627), a novel recombinant coagulation factor VIII (FVIII), is under investigation in a phase I/III clinical programme (AFFINITY) for the treatment of haemophilia A. Non-clinical studies were conducted to investigate the pharmacokinetic/pharmacodynamic profile of rVIII-SingleChain in comparison with full-length recombinant FVIII.

Materials and Methods

Binding affinity of rVIII-SingleChain for von Willebrand factor was investigated by surface plasmon resonance analysis. The pharmacokinetic profile of rVIII-SingleChain was compared with a marketed full-length recombinant FVIII concentrate (Advate^®) in haemophilia A mice, von Willebrand factor knock-out mice, Crl:CD (SD) rats, rabbits and cynomolgus monkeys. Systemic FVIII activity or antigen levels were recorded. Procoagulant activity was measured in an FeCl₃-induced arterial occlusion model and by recording thrombin generation activity (ex vivo) after administration of 200–250 IU/kg rVIII-SingleChain or full-length FVIII to haemophilia A mice.

Results

rVIII-SingleChain displayed a high affinity for von Willebrand factor (K_D = 44 pM vs. 139 pM for full-length recombinant FVIII). In all animal species tested, rVIII-SingleChain had more favourable pharmacokinetic properties than full-length recombinant FVIII: clearance was decreased and area under the curve and terminal half-life were enhanced vs. full-length recombinant FVIII, while in vivo recovery and volume of distribution were equivalent. rVIII-SingleChain showed a prolonged thrombin generation potential and prolonged procoagulant activity vs. full-length recombinant FVIII in an FeCl₃-induced arterial occlusion model.

Conclusions

rVIII-SingleChain had a higher affinity for von Willebrand factor than full-length recombinant FVIII and displayed favourable pharmacokinetic/pharmacodynamic properties in non-clinical models.     

Place of residence before hospital admission and mortality at 12‐months in Spanish patients aged 70 years or older

Aim: Hospitalization of elderly people is often followed by high mortality rates. The aim of this study was to analyze the influence of prior residence on 1‐year mortality after hospital discharge in patients aged 70 years and over. Methods: This was a prospective observational cohort study. Participants were 426 patients discharged from the Internal Medicine Department at a Spanish Hospital who were followed for a 12‐month period. Data collection was carried out during hospitalization and included sociodemographic characteristics, comorbidity (Charlson index), functional (Barthel index and Lawton scale) and cognitive conditions (Short Portable Mental Status Questionnaire), together with parameters related to the disease causing admission (diagnosis related group, laboratory tests, length of hospital stay). Mortality was carried out using telephone interviews. Results: A total of 420 (98.6%) patients were located at the end of follow up. Of these, 95 patients had died, giving an overall 1‐year mortality of 22.6%. The mortality rate for patients living in their private homes was 15.6% versus 24.7% for those living with relatives and 60% for those living in institutions. After adjustment for potential confounders, prior residence was associated with mortality with a hazard ratio of 3.98 (95% CI 1.94–8.17) for those institutionalized and a hazard ration of 1.68 (95% CI 0.99–2.16) for those living with relatives, as compared with patients living in their private homes. Conclusions: Prior residence is associated with 1‐year‐mortality following discharge after controlling for several multidimensional factors. Geriatr Gerontol Int 2012; ??: ??–??.     

Ethnicity,length of residence,and prospective trends in body mass index in a national sample of Australian adults (2006–2014)

Purpose

Increasing global migration, high obesity in developed countries, and ethnic health inequalities are compelling reasons to monitor immigrant obesity trends. Longitudinal studies of ethnicity, length of residence, and adiposity in contexts outside of the United States are lacking.