The Influence of Electrostatic Controls on MDI Size Distribution Measurements.

Cascade impactor testing is widely used to characterize the aerodynamic particle-size distribution of metered dose inhaler aerosols. Charge is often imparted to MDI aerosols by triboelectrification as formulation rapidly travels through the valve stem and actuator during atomization. The presence of charge on MDI aerosols can impact the accuracy and reproducibility of APSD measurements made using cascade impactors. The aerodynamic particle size distribution of three different experimental MDI formulations were evaluated using the Next Generation Impactor with and without incorporating static controls during testing. The static controls included grounding the analyst and the equipment, using an ionizing air blower and anti-static gun, rinsing and allowing the actuator to air dry prior to testing, and having the analyst not wear gloves or touch the USP throat during testing. For all three formulations, tests that used static controls had lower actuator and throat deposition and correspondingly higher deposition on the impactor stages. While static controls influenced the amount of drug entering into the impactor during testing, the static controls did not otherwise change the aerodynamic particle size distribution of these particles. Static controls had the greatest impact on the ethanol-free HFA-227 formulation. For this formulation, there was a 15% difference in throat deposition for the tests that did or did not incorporate static controls. These results demonstrated that electrostatic effects can lead to meaningful variability in cascade impactor test results. Static controls should be considered when developing cascade impactor test methods for MDI products in order to eliminate variability in test results.

Vaccination invitations sent by warm and competent medical professionals disclosing risks and benefits increase trust and booking intention and reduce inequalities between ethnic groups.

OBJECTIVE: We aim to identify vaccination invitations that foster trust and improve vaccination uptake overall, especially among ethnic minority groups who are more at risk from coronavirus disease (COVID-19) and less likely to be vaccinated. METHOD: In a preregistered 4 × 4 mixed-design experiment, we manipulated how much risk-benefit information the message included within-subjects and the message source between-subjects (N = 4,038 U.K. and U.S. participants, 50% ethnic minority). Participants read four vaccine invitations that varied in vaccination risk-benefit information (randomized order): control (no information), benefits only, risk and benefit, and risk and benefit that mentions vulnerable groups. The messages were sent by one of four sources (random allocation): control (health institution), medical professional (unnamed), warm and competent medical professional (unnamed), and named warm and competent medical professional (Sanjay/Lamar). Participants assessed how much they trusted the message and how likely they would be to book their vaccination appointment. RESULTS: Information about vaccination benefits and risks increased trust, especially among ethnic minority groups-for whom the effect replicated within each group. Trust also increased when the message was sent by a warm and competent medical professional relative to a health institution, but the importance of the source mattered less when more information was shared. CONCLUSIONS: Our research demonstrates the positive impact of outlining the benefits and disclosing the risks of COVID vaccines in vaccination invitation messages. Having a warm and competent medical professional source can also increase trust, especially where the message is limited in scope. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

The Montana model: integrated primary care and behavioral health in a family practice residency program.

To address the local health care needs of both patients and primary care providers in Montana, an integrated primary care and behavioral health family practice clinic was developed. In this paper we describe our experience with integrating mental health and substance abuse services into a primary care setting (a community health center) while simultaneously teaching family practice physicians to take the lead in providing these services. The Deering Community Health Center in Billings, Montana, is a Federally Qualified Health Center serving a largely low-income patient population. The medical care at the clinic is provided primarily by the faculty and residents of the Montana Family Medicine Residency. The teaching model was founded on the belief that improved care will result when physicians have increased comfort with, and are able to enjoy the challenges of, patients with mental illnesses. The enhanced longitudinal curriculum incorporates mental health across the 3 years of the family practice residency. Unique characteristics of this model include staffing and the concurrent delivery of a high volume mental health service while teaching family practice resident physicians and the faculty to integrate this competency into their primary care practices.