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Biomedical subjects

A L Greer

Publications and source records attributed to A L Greer.

At least 19 recordsLinked to original sources

Making metallic glasses plastic by control of residual stress.

Metallic glasses, now that many compositions can be made in bulk, are of interest for structural applications exploiting their yield stress and yield strain, which are exceptionally high for metallic materials. Their applicability is limited by their near-zero tensile ductility resulting from work-softening and shear localization. Even though metallic glasses can show extensive local plasticity, macroscopically they can effectively be brittle, and much current research is directed at improving their general plasticity. In conventional engineering materials as diverse as silicate glasses and metallic alloys, we can improve mechanical properties by the controlled introduction of compressive surface stresses. Here we demonstrate that we can controllably induce such residual stresses in a bulk metallic glass, and that they improve the mechanical performance, in particular the plasticity, but that the mechanisms underlying the improvements are distinct from those operating in conventional materials.

Journal Article↗

Amorphous metallic plastic.

We report cerium-based bulk metallic glasses with an exceptionally low glass transition temperature Tg, similar to or lower than that of many polymers. We demonstrate that, in near-boiling water, these materials can be repeatedly shaped, and can thus be regarded as metallic plastics. Their resistance to crystallization permits extended forming times above Tg and ensures an adequate lifetime at room temperature. Such materials, combining polymerlike thermoplastic behavior with the distinctive properties of metallic glasses, are highly unusual for metallic alloys and have great potential in applications and can also facilitate studies of the supercooled liquid state.

Journal Article↗

The influence of patients' concerns on surgeons' recommendations for early breast cancer.

This paper examines whether an older patient's concerns about surgical treatment of breast cancer--such as fear of dying or about losing a breast--affect the treatment recommendations by their surgeons. A sample of 137 older women diagnosed with early stage breast cancer between 1994 and 1996 were interviewed within 2 months of diagnosis to determine demographic characteristics, their attitudes about breast cancer treatments, and which surgical treatment their surgeon initially recommended. The treatment preferences of the 35 surgeons treating these women were ascertained by asking them what treatment they would usually recommend to a hypothetical 75-year-old woman with early stage breast cancer. Patients who reported their feelings about losing a breast as 'very important' were less likely to be recommended mastectomy (Odds Ratio (OR) = 0.39; 95% (Confidence Interval) CI 0.16, 0.94), while patients who reported fear of dying from breast cancer as 'very important' were more likely to be recommended mastectomy (OR = 4.60; 95% CI 1.94, 11.59), after adjusting for surgeons' age and the surgeons' treatment preference when presented with a hypothetical patient. It is concluded that surgeons integrate patients' attitudes and concerns into their treatment recommendations.

Aged↗

Structural and dynamic properties of crystalline and amorphous phases in raffinose-water mixtures.

PURPOSE: To obtain an improved characterisation of the raffinose-water solid-solid and solid-liquid state diagram, and to study the thermophysical behaviour of the solid amorphous phase. This information is expected to shed light on the potential of raffinose as a pharmaceutical excipient, for stabilising labile preparations at high temperatures. METHODS: X-ray diffraction, scanning electron microscopy, polarised-light microscopy, differential scanning calorimetry (DSC) and thermogravimetric analysis (TGA) were applied to study raffinose pentahydrate and its behaviour during progressive dehydration. RESULTS: Isothermal dehydration of raffinose pentahydrate led to its gradual amorphisation, but also to minor changes in the diffractograms, suggesting the probability of lower stable hydrates. Their existence was confirmed by DSC. Anhydrous raffinose was found to be completely amorphous, and this was supported by the gradual disappearance of birefringence during dehydration. In contrast, electron micrographs, taken during the dehydration process, exhibited no changes in the original ultrastructural crystal morphology. The widths of the glass-to-fluid transitions and the absolute specific heats of crystalline and amorphous phases in the vitreous and fluid states were used to estimate some structural and relaxation characteristics of amorphous raffinose-water mixtures. CONCLUSIONS: Raffinose forms the most "fragile" glass of those pharmaceutical excipients for which data are available. In its thermomechanical properties, it is superior to trehalose and should therefore be effective as a long-term stabiliser for dried biopharmaceutical preparations at temperatures up to 65 degrees C.

Calorimetry, Differential Scanning↗

Some consequences of market forces in US hospitals: lessons for the new look NHS.

"We write", say Ann Greer and Scott Greer, "with the thought that an idea should not travel unencumbered by the experience of its implementation". They survey the arguments for a market in health care, describe the impact of competitive health policies in the USA and conclude that none of the expected benefits of the market have materialised.

Economic Competition↗

The state of the art versus the state of the science. The diffusion of new medical technologies into practice.

This paper offers a theory to explain the diffusion of new medical technologies into local practice. Based on several hundred interviews with community hospital physicians, it anchors technology decisions in the norms and relationships of local practice. Physician descriptions of their use of different types of assessment information provide insight into the way in which local consenses on appropriate practice are formed, guide behavior, and change. To understand new technology adoption, it is necessary to (a) differentiate "formed" (complete) and "dynamic" (still developing) technologies, and (b) appreciate the extent to which medical practice is locally organized. Concepts from organizational literature, then, become useful in explaining the penetration of these medical communities and the circumstances under which a new modality takes hold in them. Within the framework presented, previously puzzling findings regarding variations in local practice and the poor relationship between practice behavior and the published literature become understandable.

Attitude of Health Personnel↗

Rationing medical technology. Hospital decision making in the United States and England.

This paper analyzes medical technology decision making in the United States and England in terms of the appropriateness of different decision-making models to the organization and delivery of medical care, and to the rationing of technology among and within hospitals. It examines the effect on the American hospital of prospective payment programs from the perspective of organizational structure and decision making. The strategies of central control and specification which characterize these programs are contrasted with decision-making procedures in the English National Health Service, which have emphasized decentralization, delegation, and consensus. The analysis suggests that decentralized models of decision making are more supportive of essential elements of medical care including doctor-patient trust and professional responsibility and are more able to achieve rationing decisions which are compatible with professional and consumer preferences.

Data Collection↗

Medical technology and professional dominance theory.

The expansion of medical technology in hospitals is commonly asserted to be a result of the preferences of medical doctors translated into organizational policies as a result of professional dominance in health care organizations. This paper examines the theoretical and empirical bases for hypotheses of professional dominance and the utility of these hypotheses in explaining hospital decisions to adopt new medical technologies. The analysis, which is based on 5 years of data collection including 378 personal interviews at 25 U.S. hospitals, indicates that appropriate application of the concept requires specification of the type of physician exercising influence and of the hospital decision systems within which it is exercised. Specification is needed because neither physicians nor hospitals are unitary categories when considered in relation to technology adoptions . In this paper, four categories of physicians are identified: community generalists, community specialists, referral specialists and hospital-based specialists. Members of these categories exhibit different skills and interests, different relationships to hospitals and hospital technologies, and differential access to the resources of organization influence including two unrelated to professional dominance. To understand the exercise of physician influence, it is further useful to differentiate three decision systems which review and pass judgement on different types of hospital technologies. They are: the medical-individualistic, the fiscal-managerial and the strategic-institutional. The three decision systems make decisions in accord with different values and goals and display different decision structures and dynamics. Ironically , the physicians who most clearly possess the resources of influence associated with professional dominance are centrally involved in only one of the three systems.(ABSTRACT TRUNCATED AT 250 WORDS)

Data Collection↗

The continuity of moral reform: community mental health centers.

Contemporary involvement of citizens in the formation of mental health policies continues a long history of influential lay advocates achieving desired reforms. The Community Mental Health Centers Program arose from, and also recognized, the citizens' movement for community care. This legislation mandated and encouraged citizen membership on the governing boards of local centers. The influence of these citizen bodies is seen in the diversity and continuing evolution of the local centers structurally, in orientation and in services provided. Three examples from original field research are provided to illustrate.

Community Mental Health Centers↗

Patient leverage theory proves to be false.

The assumption that hospitals must procure new technologies to recruit and retain physicians appears to be false, according to the study done by these authors.

Attitude of Health Personnel↗

Advances in the study of diffusion of innovation in health care organizations.

Federal government programs of the 1960s to rapidly diffuse technologies have been displaced on the '70s by efforts to constrain costly technological growth. As a guide to action, the understanding of reasons for adoption of innovation is essential; but the utility of available diffusion theory is limited by its focus on the speed of diffusion rather than any reasons for its adoption by organizations. In a practical sense, more is known about the administrator as decision maker than about those increasing situatiions in which physicians play a more central part. Until coherent, empirically grounded theories of organizational innovation are available, large-scale "tests" are premature and wasteful.

Creativity↗

Computerized medical records and clinic function.

Formal studies of computerized information systems for ambulatory patients are rare. As part of an evaluation of the effects of such a system on clinic function, we divided the residents in our teaching clinic into a study group with access to COSTAR and a control group with access to conventional medical records alone. Nurses and clerical personnel in the clinic were allowed to use the computerized records only for patients of residents in the study group. We sampled the attitudes of nurses and clerical personnel toward use of the computer and performed detailed time studies of patient flow in the clinic. Responses to questionnaires reflected acceptance of computerization by the personnel sampled, who favored COSTAR records over conventional records, primarily because of the increased availability of information for telephone management and demand care. The residents never became facile users of COSTAR--a problem that we attribute to the infrequency of their clinic sessions. As a result, and because the workloads of residents using COSTAR were larger, waiting times were longer in clinics attended by these residents. Overall, the most intensive users of the computerized medical records were not the physicians. Improved productivity and better use of time among the nurses and clerical personnel were thought to outweigh the residents' perceptions.

Attitude to Computers↗