Socio-economic and locational determinants of accessibility and utilization of primary health-care.

Differences in levels of utilization vary and are a function of socio-economic and geographical factors. This paper presents the results of a questionnaire study involving twelve GP practices in Northamptonshire, UK, of factors which affect access and utilization in asthmatics and diabetics; these groups were selected to control for differences in utilization behaviour, as a result of different aetiologies. The questionnaire sought data on: residential location of patients, utilization characteristics of primary health-care, personal circumstances and mobility and hindrances to access and utilization. Key themes were identified relating to age, gender, social class, employment, ethnicity and proximity to the GP surgery. The young, elderly and females report higher rates of utilization, as do nonmanual workers and those who are unemployed. However, accessibility and utilization vary greatly in response to mobility and locational characteristics; these variations tend to be masked by data on overall rates of usage. Optimal scaling techniques were used to investigate the interactions between the factors affecting accessibility and utilization, and to characterize patients in terms of their levels of utilization. Results confirmed that current service provision afforded a differential level of service to patients, which does not directly reflect their level of need.

Coming of Age: The American Academy of Forensic Sciences and the Forensic Sciences Profession - 1948 to 1998.

In 1998 the American Academy of Forensic Sciences celebrated its first 50 years of operation at its Golden Anniversary Meeting in San Francisco. In anticipation of that event, in 1991 the Academy created a committee to prepare a history of the organization. One of the products of that committee was a book, the principal author of which was one of the authors of this review (KSF). The theme of the opening Plenary Session at the meeting was The History of the Forensic Sciences Profession and of the Academy. This article is based on presentations by the authors at that Plenary Session [2] and on material compiled for the book. Comparisons are made of the early years of the forensic science profession and of the Academy with the status of the current profession and Academy.

Solubility behavior, phase transition, and structure-based nucleation inhibition of etanidazole in aqueous solutions.

PURPOSE: The solubility behavior, phase transition and inhibition of the nucleation process of etanidazole were characterized. METHODS: Solubility measurements as a function of time permitted characterization of the solubility behavior and phase transition. The precipitate from saturated solutions was isolated and characterized by differential scanning calorimetry, polarized light microscopy, x-ray powder diffraction and coulometric analysis. The physical stability of metastable systems was examined in the presence of various structure-based nucleation inhibitors. RESULTS: Etanidazole is soluble in water with an equilibrium solubility of 68.1 mg/mL, pH 6.5 with changes in pH having virtually no effect on the solubility. Etanidazole reaches concentrations in excess of 150 mg/mL within one hour. Etanidazole solutions prepared at 150 mg/ mL contained crystals after rotating for 24 hours. The crystals were isolated and characterized as etanidazole monohydrate. the solubility of etanidazole monohydrate in water increased with time reaching an equilibrium solubility of 68 mg/mL after 24 hours. Therefore, the solubility studies were actually determining the solubility of the more stable monohydrate from of etanidazole. Etanidazole solutions at concentrations of 50, 100 and 150 mg/mL were stabilized to varying degrees with structure-based nucleation inhibitors (imidazole, ethanolamine or diethanolamine). CONCLUSIONS: Anhydrous etanidazole undergoes a transition in aqueous solutions to the more stable monohydrate when the solubility of the monohydrate is exceeded. The physical stability of etanidazole solutions at 4 degrees C is improved following autoclaving. The addition of structure-based nucleation inhibitors effectively stabilized the metastable systems.