Healthcare choice: Discourses, perceptions, experiences and practices

Policy discourse shaped by neoliberal ideology, with its emphasis on marketisation and competition, has highlighted the importance of choice in the context of healthcare and health systems globally. Yet, evidence about how so-called consumers perceive and experience healthcare choice is in short supply and limited to specific healthcare systems, primarily in the Global North. This special issue aims to explore how choice is perceived and utilised in the context of different systems of healthcare throughout the world, where choice, at least in policy and organisational terms, has been embedded for some time. The articles are divided into those emphasising: embodiment and the meaning of choice; social processes associated with choice; the uncertainties, risks and trust involved in making choices; and issues of access and inequality associated with enacting choice. These sociological studies reveal complexities not always captured in policy discourse and suggest that the commodification of healthcare is particularly problematic

Trust, regulatory processes and NICE decision-making: Appraising cost-effectiveness models through appraising people and systems.

This article presents an ethnographic study of regulatory decision-making regarding the cost-effectiveness of expensive medicines at the National Institute for Health and Care Excellence (NICE) in England. We explored trust as one important mechanism by which problems of complexity and uncertainty were resolved. Existing studies note the salience of trust for regulatory decisions, by which the appraisal of people becomes a proxy for appraising technologies themselves. Although such (dis)trust in manufacturers was one important influence, we describe a more intricate web of (dis)trust relations also involving various expert advisors, fellow committee members and committee Chairs. Within these complex chains of relations, we found examples of both more blind-acquiescent and more critical-investigative forms of trust as well as, at times, pronounced distrust. Difficulties in overcoming uncertainty through other means obliged trust in some contexts, although not in others. (Dis)trust was constructed through inferences involving abstract systems alongside actors’ oral and written presentations-of-self. Systemic features and ‘forced options’ to trust indicate potential insidious processes of regulatory capture

Optimization of PECVD process for ultra thin tunnel SiOx film as passivation layer for silicon heterojunction solar cells

Ultra thin silicon oxide a SiOx H films have been grown by means of plasma enhanced chemical vapor deposition PECVD to replace the standard hydrogenated amorphous silicon a Si H passivation layer for silicon heterojunction solar cells to reduce parasitic absorption. Additionally, silicon oxide surfaces are well known as superior substrates for the nucleation enhancement for nanocrystalline silicon doped films. Symmetrical passivation samples were fabricated with variable a SiOx H layers with a thickness of 10 1.5 nm and characterized after several annealing steps 25 650 C . The best value reached so far on lt;100 gt; oriented Si wafers is implied open circuit voltage of 686 mV and minority carrier lifetime of 1.6 ms after annealing at 300 C. Such values were found to be reproducible even for ultra thin a SiOx H layers 1.5 n

Zinc oxide films grown by galvanic deposition from 99% metals basis zinc nitrate electrolyte

The use of relatively low purity zinc nitrate for electrochemical deposition of compact ZnO films is attractive for large scale production because of the cost saving potential. ZnO films were grown on SnO2:F and magnetron sputtered ZnO:Al templates using a three electrode potentiostatic system in galvanic mode. The electrolyte consisted of a 0.1 M zinc nitrate solution (either 99.998% or 99% purity) and 1 mM aluminium nitrate for extrinsic doping, when required. Moderate deposition rates of up to 0.9 nm s−1 were achieved on ZnO:Al templates with lower rates of up to 0.5 nm s−1 on SnO2:F templates. Observation of SEM images of the films revealed a wall-like morphology whose lateral thickness (parallel to the substrate) reduced as aluminium was added to the system either in the electrolyte or from the substrate. However, pre- deposition activation of the template by applying a negative voltage (approximately −2 V) allowed the growth of compact films even for the low purity electrolyte. The optical band gap energy of intrinsically doped films was lower than that of the Al doped films. The composite electrical conductivity of all the films studied, as inferred from sheet resistance and Hall effect measurements of the ZnO/template stacks was much less than that of the uncoated templates. A strong E2 (high) mode at around 437 cm−1 was visible in the Raman spectra for most films confirming the formation of ZnO. However, both the Raman modes and XRD reflections associated with wurtzite ZnO diminished for the Al doped films indicating a high level of mainly oxygen related defects. Based on these data, further studies are underway to improve the doping efficiency of aluminium, the crystalline structure and thus the conductivity of such films

Managing the symptoms of neuropathic pain: An exploration of patients' experiences

The debilitating effects of chronic neuropathic pain on everyday life are considerable but little is known about how individual sufferers manage these effects. Virtually nothing is known about what patients prefer, what measures they take themselves, when, or in what combinations. The aim of this study was to explore patients’ reports of how they managed their neuropathic pain symptoms. Three focus groups including 10 participants were used to generate qualitative data on both individual and shared experiences of managing their symptoms of neuropathic pain. Discussions were recorded and transcribed verbatim. Data were analysed using thematic analysis, identifying categories and broader themes of importance to patients. The most common management strategy was the use of conventional medications, often associated with poor effectiveness and unpleasant side-effects. Complementary and alternative medicine was ineffective but many found resting or retreating helpful. They exhibited a repeated cycle of seeking help to manage the pain, with each unsuccessful attempt followed by new attempts. Some had tried to accept their pain, but there was insufficient psychological, social, emotional and practical support to allow them to do this successfully. This exploratory study provides a basis from which to develop a larger study to validate and extend the findings. Other issues meriting research are the effectiveness of cognitive behavioural therapies for those with neuropathic pain; and an exploration and subsequent evaluation of different types of social, practical and emotional support needed to help live with neuropathic pain

Lung cancer diagnosed following an emergency admission: exploring patient and carer perspectives on delay in seeking help

Purpose Compared to others, patients diagnosed with lung cancer following an emergency, unplanned admission to hospital (DFEA) have more advanced disease and poorer prognosis. Little is known about DFEA patients’ beliefs about cancer and its symptoms or about their help-seeking behaviours prior to admission. Methods As part of a larger single-centre, prospective mixed-methods study conducted in one University hospital, we undertook qualitative interviews with patients DFEA and their carers to obtain their understanding of symptoms and experiences of trying to access healthcare services before admission to hospital. Interviews were recorded and transcribed. Framework analysis was employed. Results Thirteen patients and 10 carers plus 3 bereaved carers took part in interviews. Three patient/carer dyads were interviewed together. Participants spoke about their symptoms and why they did not seek help sooner. They described complex and nuanced experiences. Some (n = 12) had what they recalled as the wrong symptoms for lung cancer and attributed them either to a pre-existing condition or to ageing. In other cases (n = 9), patients or carers realised with hindsight that their symptoms were signs of lung cancer, but at the time had made other attributions to account for them. In some cases (n = 3), a sudden onset of symptoms was reported. Some GPs (n = 6) were also reported to have made incorrect attributions about cause. Conclusion Late diagnosis meant that patients DFEA needed palliative support sooner after diagnosis than patients not DFEA. Professionals and lay people interpret health and illness experiences differently

Status and Trends of Inland Wetland and Aquatic Habitats in the Corpus Christi Area

Wetland and aquatic habitats are essential components of estuarine systems along the Texas coast. These valuable resources are highly productive biologically and chemically and are part of an ecosystem on which a variety of flora and fauna depend. Scientific investigations of wetland distribution and abundance through time are prerequisites to effective habitat management, thereby ensuring their protection and preservation and directly promoting long-term biological productivity and public use. This report presents results of an investigation to determine the current status and historical trends of wetlands and associated aquatic habitats in the Corpus Christi area from Lamar Peninsula to Encinal Peninsula. The study area encompasses most of the mainland between the Gulf Intracoastal Waterway (GIWW) and the Texas General Land Office Coastal Management Program boundary, an area located within Refugio, Aransas, San Patricio, and Nueces Counties (Fig. 1). Natural environments include wetlands, wind-tidal flats, riparian woodlands, and bay shorelines. The methods and classification system used in this report follow those found in the Texas coastal barrier-island report for the Coastal Bend (White et al., 2002).Bureau of Economic Geolog

Distribution of Benthic Macroinvertebrates Beaumont Port Arthur Area

On March 1, 1976, the Bureau of Economic Geology initiated an extensive program of benthic sampling in the State submerged lands (McGowen and Morton, 1979). The state-owned submerged lands of Texas cover nearly 6,000 square miles (15,540 km2) and extend from Mexico to Louisiana. This area includes bays, estuaries, lagoons, and the inner continental shelf located 10.3 miles (16.6 km) seaward of the Gulf shoreline (see fig. 1). Benthic samples were collected at 1-mile (1.6-km) intervals. By January 1978, a total of 6,697 samples had been collected. Sample analysis encompassed textural studies (grain size properties), geochemistry (trace elements and total organic carbon), and biological studies. This report focuses on the biology of the submerged lands in the Beaumont-Port Arthur area and provides preliminary information on benthic macroinvertebrate assemblages and diversity. It serves as a baseline inventory of biological data necessary to predict and assess potential problems and environmental impacts related to energy production, food production, recreation, and transportation.Bureau of Economic Geolog