Optimising Multi-stakeholder Practices in Patient Engagement: A Gap Analysis to Enable Focused Evolution of Patient Engagement in the Development and Lifecycle Management of Medicines.

BACKGROUND: The PARADIGM consortium aimed to make patient engagement in the development and lifecycle management of medicines easier and more effective for all, with the development of new tools that fulfil robustly defined gaps where engagement is suboptimal. AIMS: To generate an inventory of gaps in patient engagement practices and process from existing global examples. METHODS: A large set of criteria for effective patient engagement previously defined via a multi-stakeholder Delphi method, were mapped under fourteen overarching themes. A gap analysis was then performed by twenty-seven reviewers against the resulting forty-six mapped criteria, on a sample of seventy initiatives from global databases. RESULTS: An inventory of gaps was identified including contextual information as to why the gaps exist. Our work identified general patterns where patient engagement was suboptimal-defined as; fragmented reporting and dissemination of patient engagement activities, and the fundamental principles defined in frameworks or guidance being poorly adhered to in actual practice. Specific gaps were identified for sixteen criteria. Additionally, it was also common to observe primary aspects of a process were addressed for a given criteria (i.e. training for roles and responsibilities) but a secondary context element was lacking (i.e. making training material accessible/understandable/meaningful to all participants). CONCLUSION: The results show that the evolution towards meaningful and systematic patient engagement is occurring, yet more importantly they provide clear directional insights to help enhance collaborative practices and co-design solutions. This targeted impact to catalyse a needs-oriented health system that integrates patient engagement at its core is essential.

Microwave assisted digestion of atmospheric aerosol samples followed by inductively coupled plasma mass spectrometry determination of trace elements.

A microwave digestion method in a closed vessel was developed for the determination of trace metals in atmospheric aerosols using inductively coupled plasma mass spectrometry (ICP-MS). A recovery study for the elements V, Cr, Mn, Fe, Co, Ni, Cu, Zn, As, Se, Cd, Sb, and Pb was conducted using multi-elemental standard solutions, NIST 1633b Trace Elements in Coal Fly Ash, and NIST 1648 Urban Particulate Matter. A simple digestion method using only HNO3/H2O2 gave good recoveries (90%-108%) for all elements except Cr in SRM 1648, but yielded low recoveries for SRM 1633b. A more robust method using HNO3/H2O2/HF/H3BO3 yielded higher recoveries (82%-103%) for the lighter elements (V-Zn) in SRM 1633b, and improved the Cr recovery in SRM 1648, but decreased the Se recovery in both SRMs. A comparative analysis of aerosol samples obtained at a remote mountain location Nathiagali, Pakistan (2.5 km above mean sea level), and Mayville, New York, downwind from the highly industrialized Midwestern United States, was carried out using Instrumental Neutron Activation Analysis (INAA) for the elements Cr, Mn, Fe, Co, Zn, As, Se, and Sb. The simple digestion method yielded excellent agreement for Cr, Fe, Zn, As, Se, and Sb, with slopes of the ICP-MS vs. INAA regressions of 0.90-1.00 and R2 values of 0.96-1.00. The regressions for Mn and Co had slopes of 0.82 and 0.84 with R2 values of 0.83 and 0.82, respectively. Addition of HF/H3BO3 did not improve the correlation for any of the elements and degraded the precision somewhat. The technique provides sensitivity and accuracy for trace elements in relatively small aerosol samples used in atmospheric chemistry studies related to SO2 oxidation in cloud droplets. The ability to determine concentrations of a very large number of elements from a single analysis will permit source apportionment of various trace pollutants and hence strategies to control the sources of air pollution. This is particularly important as the health effects of particulate matter are increasingly recognized.

Lunar volcanism: age of the glass in the apollo 17 orange soil.

The formation age of the glass in the orange soil brought back by the Apollo 17 astronauts from the Taurus-Littrow valley has been measured by the (40)Ar-(39)Ar stepwise heating technique to be 3710 +/- 60 x 10(6) years. The orange glass is thus much older than expected. Four fragments, presumably from the subfloor basalt, were also analyzed and have crystallization ages of 3710 +/- 70, 3720 +/- 50, 3770 +/- 50, and 3790 +/- 70 x 10(6) years. These ages do not provide evidence for recent extensive lunar volcanism. The magmatic activity in the Sea of Serenity and the Sea of Tranquillity occurred very close in time, if not contemporaneously. The volcanic activity in the Sea of Tranquillity and the Sea of Serenity may have been triggered by the impact event forming the Sea of Rains basin.

Age of a lunar anorthosite.

The crystallization age of an Apollo 15 anorthosite rock, 15415,9, returned from the lunar highlands has been measured to be (4.09 +/- 0.19) x 10(9) years. The primitive lunar crust must have been formed in the first 300 to 400 x 10(6) years. The results give some credence to the hypothesis that the primitive lunar surface was molten and large-scale fractional crystallization occurred in the early history of the moon.

Ages of crystalline rocks from fra mauro.

Crystallization ages for six rocks from Fra Mauro have been measured by the argon-40-argon-39 method. All six rocks give an age of 3.77 +/- 0.15 x 10(9) years, which is the same as for fragmental rocks from this site. It is concluded that the Imbrium event and the crystallization of a significant portion of the pre-Imbrian basalts were essentially contemporaneous.

Magnesium-28 in rain: produced by cosmic rays.

Existence of magnesium-28 (half-life, 21.3 hours) produced by cosmic rays in rain at concentrations of 1.7 and 6.1 x 10(-1) atoms per milliliter was established radiochemically by isolating this nuclide from several hundred liters of rain samples collected at Fayetteville, Arkansas.