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Sample records for adherence odds ratio

  1. A comparison of marginal odds ratio estimators.

    PubMed

    Loux, Travis M; Drake, Christiana; Smith-Gagen, Julie

    2017-02-01

    Uses of the propensity score to obtain estimates of causal effect have been investigated thoroughly under assumptions of linearity and additivity of exposure effect. When the outcome variable is binary relationships such as collapsibility, valid for the linear model, do not always hold. This article examines uses of the propensity score when both exposure and outcome are binary variables and the parameter of interest is the marginal odds ratio. We review stratification and matching by the propensity score when calculating the Mantel-Haenszel estimator and show that it is consistent for neither the marginal nor conditional odds ratio. We also investigate a marginal odds ratio estimator based on doubly robust estimators and summarize its performance relative to other recently proposed estimators under various conditions, including low exposure prevalence and model misspecification. Finally, we apply all estimators to a case study estimating the effect of Medicare plan type on the quality of care received by African-American breast cancer patients.

  2. Prevalence odds ratio versus prevalence ratio: choice comes with consequences.

    PubMed

    Tamhane, Ashutosh R; Westfall, Andrew O; Burkholder, Greer A; Cutter, Gary R

    2016-12-30

    Odds ratio, risk ratio, and prevalence ratio are some of the measures of association which are often reported in research studies quantifying the relationship between an independent variable and the outcome of interest. There has been much debate on the issue of which measure is appropriate to report depending on the study design. However, the literature on selecting a particular category of the outcome to be modeled and/or change in reference group for categorical independent variables and the effect on statistical significance, although known, is scantly discussed nor published with examples. In this article, we provide an example of a cross-sectional study wherein prevalence ratio was chosen over (Prevalence) odds ratio and demonstrate the analytic implications of the choice of category to be modeled and choice of reference level for independent variables. Copyright © 2016 John Wiley & Sons, Ltd.

  3. [Odds Ratio: review about the meaning of an epidemiological measure].

    PubMed

    Aguiar, Pedro; Nunes, Baltazar

    2013-01-01

    Introdução: É importante rever a validade do Odds Ratio como medida de associação e efeito, assim como, qual o viés introduzido pelo Odds Ratio quando este representa uma razão de riscos ou uma razão de prevalências em situação de doença mais frequente.Material e Métodos: Simulámos numa coorte de 200 indivíduos com 100 expostos e 100 não expostos a um fator de risco, um cenário de doença rara e outro de doença mais frequente, com razão de riscos igual em ambos os cenários. Determinaram-se o Odds Ratio e o Risco Relativo pelo método clássico (padrão) e respectivamente por regressão logística e regressão de Poisson. Introduziu-se de seguida uma variável de confundimento e determinaram-se o Odds Ratio e o Risco Relativo pelo método de Mantel-Hanszel (análise estratificada padrão) e respectivamente por regressão logística e regressão de Poisson. As análises estatísticas foram efectuadas em SPSS V20.Resultados: Para a doença rara, o Odds Ratio aproximou-se do Risco Relativo. Quando a doença foi mais frequente, o Odds Ratio sobrestimou o Risco Relativo. Nesta situação, e com a presença de uma variável de confundimento, o Risco Relativo ajustado por regressão de Poisson permitiu obter estimativas mais válidas da razão de riscos que o Odds Ratio ajustado por regressão logística. Os intervalos de confiança do Risco Relativo estimado por regressão de Poisson foram sempre mais largos que os determinados por análise de Mantel-Hanszel.Conclusões: O Odds Ratio e a regressão logística múltipla são procedimentos válidos em estudos caso-controlo e em estudosprospetivos e transversais de natureza exploratória. O Odds Ratio não deve ser interpretado como uma razão de riscos ou razão de prevalências se o resultado de saúde não é raro. A análise de regressão múltipla de Poisson deve ser considerada como alternativa válida à regressão logística múltipla, especialmente em estudos de uma exposição específica.

  4. Odds ratios for mediation analysis for a dichotomous outcome.

    PubMed

    Vanderweele, Tyler J; Vansteelandt, Stijn

    2010-12-15

    For dichotomous outcomes, the authors discuss when the standard approaches to mediation analysis used in epidemiology and the social sciences are valid, and they provide alternative mediation analysis techniques when the standard approaches will not work. They extend definitions of controlled direct effects and natural direct and indirect effects from the risk difference scale to the odds ratio scale. A simple technique to estimate direct and indirect effect odds ratios by combining logistic and linear regressions is described that applies when the outcome is rare and the mediator continuous. Further discussion is given as to how this mediation analysis technique can be extended to settings in which data come from a case-control study design. For the standard mediation analysis techniques used in the epidemiologic and social science literatures to be valid, an assumption of no interaction between the effects of the exposure and the mediator on the outcome is needed. The approach presented here, however, will apply even when there are interactions between the effect of the exposure and the mediator on the outcome.

  5. Odds ratio analysis in women with endometrial cancer

    PubMed Central

    Żak, Ewa; Pięta, Beata

    2016-01-01

    Introduction Despite the progress in diagnosis and treatment of malignant tumours, the effects of treatment are insufficient. Reduction of the risk of cervical, ovarian, and endometrial cancer is possible by introducing preventative actions. Aim of the study The aim of the thesis is the analysis of selected risk factors that may affect the increase or decrease in the odds ratio of developing endometrial cancer. Material and methods The study was conducted among patients of the Gynaecology and Obstetrics Hospital of Poznań University of Medical Sciences in the years 2011-2013. The research included a total of 548 female respondents aged between 40 and 84 years. Women responded to questions assessing elements of lifestyle such as consumption of alcohol, smoking, and eating certain groups of foods. Results The respondents consuming fruits and vegetables several times a week have a reduced risk of odds ratio and the OR is 0.85; 95% CI: 0.18-4.09, compared to the women who rarely consume vegetables and fruits. Consumption of whole-wheat bread several times a week reduces the risk of developing the cancer, OR = 0.59; 95% CI: 0.14-2.47, compared to women not consuming wholegrain bread at all. Respondents who consumed red meat, such as veal, pork, and lamb in the amount of 101-200 g per day have an increased risk of developing the disease: OR = 2.16; 95% CI: 1.09-4.28, compared to women not consuming red meat at all. Conclusions A diet rich in fruit and vegetables, onions, garlic, whole grains, and beans should be introduced in order to reduce the risk of endometrial cancer. The consumption of red meat and white pasta should be reduced or even eliminated. PMID:27095953

  6. [Razón de posibilidades: a proposed translation of the term odds ratio].

    PubMed

    Tapia, J A; Nieto, F J

    1993-01-01

    In English, odds ratio is a basic epidemiological measure approximating the relative risk. Odds ratio has been translated into Spanish in several ways, which has produced great terminological confusion. On the other hand, the English word odds is often used in epidemiology or statistics English textbooks, alone or as part of other expressions, but always keeping a definite mathematical meaning, which calls for a similarly definite term in Spanish. We discuss several translations of odds ratio found in the literature and propose the Spanish word "posibilidades" as a translation of odds and "razón de posibilidades" as a translation of odds ratio.

  7. Isomer residual ratio of odd-odd isotope {sup 180}Ta in supernova nucleosynthsis

    SciTech Connect

    Hayakawa, Takehito; Kajino, Toshitaka; Chiba, Satoshi; Mathews, Grant

    2010-06-01

    The nucleosynthesis of {sup 180}Ta has remained an unsolved problem and as its origin many nucleosynthesis mechanisms have been proposed. This isotope has the unique feature that the naturally occurring abundance of {sup 180}Ta is actually a meta-stable isomer (half-life of >=10{sup 15} yr), while the ground state is a 1{sup +} unstable state which beta-decays with a half-life of only 8.15 hr. We have made a new time-dependent calculation of {sup 180}Ta meta-stable isomer residual ratio after supernova neutrino-induced reactions. This residual isomer ratio is crucial for understanding the production and survival of this naturally occurring rare isotope. We have constructed a new model under temperature evolution after type II supernova explosion. We include the explicit linking between the isomer and all known excited states and found that the residual ratio is insensitive to astrophysical parameters such as neutrino energy spectrum, explosion energy, decay time constant. We find that the explicit time evolution of the synthesis of {sup 180}Ta avoids the overproduction relative to {sup 138}La for a neutrino process neutrino temperature of 4 MeV.

  8. At Odds: Concerns Raised by Using Odds Ratios for Continuous or Common Dichotomous Outcomes in Research on Physical Activity and Obesity.

    PubMed

    Lovasi, Gina S; Underhill, Lindsay J; Jack, Darby; Richards, Catherine; Weiss, Christopher; Rundle, Andrew

    2012-01-01

    PURPOSE: Research on obesity and the built environment has often featured logistic regression and the corresponding parameter, the odds ratio. Use of odds ratios for common outcomes such obesity may unnecessarily hinder the validity, interpretation, and communication of research findings. METHODS: We identified three key issues raised by the use of odds ratios, illustrating them with data on walkability and body mass index from a study of 13,102 New York City residents. RESULTS: First, dichotomization of continuous measures such as body mass index discards theoretically relevant information, reduces statistical power, and amplifies measurement error. Second, odds ratios are systematically higher (further from the null) than prevalence ratios; this inflation is trivial for rare outcomes, but substantial for common outcomes like obesity. Third, odds ratios can lead to incorrect conclusions during tests of interactions. The odds ratio in a particular subgroup might higher simply because the outcome is more common (and the odds ratio inflated) compared with other subgroups. CONCLUSION: Our recommendations are to take full advantage of continuous outcome data when feasible and to use prevalence ratios in place of odds ratios for common dichotomous outcomes. When odds ratios must be used, authors should document outcome prevalence across exposure groups.

  9. Understanding relative risk, odds ratio, and related terms: as simple as it can get.

    PubMed

    Andrade, Chittaranjan

    2015-07-01

    Risk, and related measures of effect size (for categorical outcomes) such as relative risks and odds ratios, are frequently presented in research articles. Not all readers know how these statistics are derived and interpreted, nor are all readers aware of their strengths and limitations. This article examines several measures, including absolute risk, attributable risk, attributable risk percent, population attributable risk percent, relative risk, odds, odds ratio, and others. The concept and method of calculation are explained for each of these in simple terms and with the help of examples. The interpretation of each is presented in plain English rather than in technical language. Clinically useful notes are provided, wherever necessary.

  10. How Much More Likely? The Implications of Odds Ratios for Probabilities

    ERIC Educational Resources Information Center

    Liberman, Akiva M.

    2005-01-01

    Binary outcome data are common in research and evaluation. They are often analyzed using logistic regression, and results of these analyses are often reported in the form of odds ratios (ORs). However, ORs are not directly interpretable in the metric commonly used in policy-relevant discussions, which concerns probabilities. ORs are unfamiliar to…

  11. An Odds Ratio Approach for Detecting DDF under the Nested Logit Modeling Framework

    ERIC Educational Resources Information Center

    Terzi, Ragip; Suh, Youngsuk

    2015-01-01

    An odds ratio approach (ORA) under the framework of a nested logit model was proposed for evaluating differential distractor functioning (DDF) in multiple-choice items and was compared with an existing ORA developed under the nominal response model. The performances of the two ORAs for detecting DDF were investigated through an extensive…

  12. Exact Confidence Intervals for the Relative Risk and the Odds Ratio

    PubMed Central

    Wang, Weizhen; Shan, Guogen

    2015-01-01

    Summary For comparison of proportions there are three commonly used measurements: the difference, the relative risk and the odds ratio. Significant effort has been spent on exact confidence intervals for the difference. In this paper, we focus on the relative risk and the odds ratio when data are collected from a matched-pairs design or a two-arm independent binomial experiment. Exact one-sided and two-sided confidence intervals are proposed for each configuration of two measurements and two types of data. The one-sided intervals are constructed using an inductive order, they are the smallest under the order, and are admissible under the set inclusion criterion. The two-sided intervals are the intersection of two one-sided intervals. R codes are developed to implement the intervals. Supplementary materials for this article are available online. PMID:26228945

  13. Odds ratios and confidence intervals: a review for the pediatric oncology clinician.

    PubMed

    Laing, Catherine M; Rankin, James A

    2011-01-01

    Professional registered nurses (RNs) are active participants in seeking and interpreting research evidence. To facilitate knowledge transfer for RNs at the bedside, it behooves researchers to present their findings in a format that facilitates understanding. There is also an expectation that clinicians are capable of interpreting results in a meaningful way. It is important to be able to understand and interpret research reports where statistical methods are used as part of providing the safest and best care for patients. The purpose of this article is to describe the basic concepts of odds ratios and confidence intervals used in research. These statistical measures are used frequently in quantitative research and are often the principle measure of association that is reported. The more comfortable pediatric oncology clinicians are with the interpretation of odds ratios and confidence intervals, the better equipped they will be to bring relevant research results from the "bench" to the bedside.

  14. Odds Ratio Product of Sleep EEG as a Continuous Measure of Sleep State

    PubMed Central

    Younes, Magdy; Ostrowski, Michele; Soiferman, Marc; Younes, Henry; Younes, Mark; Raneri, Jill; Hanly, Patrick

    2015-01-01

    Study Objectives: To develop and validate an algorithm that provides a continuous estimate of sleep depth from the electroencephalogram (EEG). Design: Retrospective analysis of polysomnograms. Setting: Research laboratory. Participants: 114 patients who underwent clinical polysomnography in sleep centers at the University of Manitoba (n = 58) and the University of Calgary (n = 56). Interventions: None. Measurements and Results: Power spectrum of EEG was determined in 3-second epochs and divided into delta, theta, alpha-sigma, and beta frequency bands. The range of powers in each band was divided into 10 aliquots. EEG patterns were assigned a 4-digit number that reflects the relative power in the 4 frequency ranges (10,000 possible patterns). Probability of each pattern occurring in 30-s epochs staged awake was determined, resulting in a continuous probability value from 0% to 100%. This was divided by 40 (% of epochs staged awake) producing the odds ratio product (ORP), with a range of 0–2.5. In validation testing, average ORP decreased progressively as EEG progressed from wakefulness (2.19 ± 0.29) to stage N3 (0.13 ± 0.05). ORP < 1.0 predicted sleep and ORP > 2.0 predicted wakefulness in > 95% of 30-s epochs. Epochs with intermediate ORP occurred in unstable sleep with a high arousal index (> 70/h) and were subject to much interrater scoring variability. There was an excellent correlation (r2 = 0.98) between ORP in current 30-s epochs and the likelihood of arousal or awakening occurring in the next 30-s epoch. Conclusions: Our results support the use of the odds ratio product (ORP) as a continuous measure of sleep depth. Citation: Younes M, Ostrowski M, Soiferman M, Younes H, Younes M, Raneri J, Hanly P. Odds ratio product of sleep EEG as a continuous measure of sleep state. SLEEP 2015;38(4):641–654. PMID:25348125

  15. A method to compute multiplicity corrected confidence intervals for odds ratios and other relative effect estimates.

    PubMed

    Efird, Jimmy Thomas; Nielsen, Susan Searles

    2008-12-01

    Epidemiological studies commonly test multiple null hypotheses. In some situations it may be appropriate to account for multiplicity using statistical methodology rather than simply interpreting results with greater caution as the number of comparisons increases. Given the one-to-one relationship that exists between confidence intervals and hypothesis tests, we derive a method based upon the Hochberg step-up procedure to obtain multiplicity corrected confidence intervals (CI) for odds ratios (OR) and by analogy for other relative effect estimates. In contrast to previously published methods that explicitly assume knowledge of P values, this method only requires that relative effect estimates and corresponding CI be known for each comparison to obtain multiplicity corrected CI.

  16. Likelihood ratio and posterior odds in forensic genetics: Two sides of the same coin.

    PubMed

    Caliebe, Amke; Walsh, Susan; Liu, Fan; Kayser, Manfred; Krawczak, Michael

    2017-05-01

    It has become widely accepted in forensics that, owing to a lack of sensible priors, the evidential value of matching DNA profiles in trace donor identification or kinship analysis is most sensibly communicated in the form of a likelihood ratio (LR). This restraint does not abate the fact that the posterior odds (PO) would be the preferred basis for returning a verdict. A completely different situation holds for Forensic DNA Phenotyping (FDP), which is aimed at predicting externally visible characteristics (EVCs) of a trace donor from DNA left behind at the crime scene. FDP is intended to provide leads to the police investigation helping them to find unknown trace donors that are unidentifiable by DNA profiling. The statistical models underlying FDP typically yield posterior odds (PO) for an individual possessing a certain EVC. This apparent discrepancy has led to confusion as to when LR or PO is the appropriate outcome of forensic DNA analysis to be communicated to the investigating authorities. We thus set out to clarify the distinction between LR and PO in the context of forensic DNA profiling and FDP from a statistical point of view. In so doing, we also addressed the influence of population affiliation on LR and PO. In contrast to the well-known population dependency of the LR in DNA profiling, the PO as obtained in FDP may be widely population-independent. The actual degree of independence, however, is a matter of (i) how much of the causality of the respective EVC is captured by the genetic markers used for FDP and (ii) by the extent to which non-genetic such as environmental causal factors of the same EVC are distributed equally throughout populations. The fact that an LR should be communicated in cases of DNA profiling whereas the PO are suitable for FDP does not conflict with theory, but rather reflects the immanent differences between these two forensic applications of DNA information.

  17. Beta-binomial model for meta-analysis of odds ratios.

    PubMed

    Bakbergenuly, Ilyas; Kulinskaya, Elena

    2017-01-25

    In meta-analysis of odds ratios (ORs), heterogeneity between the studies is usually modelled via the additive random effects model (REM). An alternative, multiplicative REM for ORs uses overdispersion. The multiplicative factor in this overdispersion model (ODM) can be interpreted as an intra-class correlation (ICC) parameter. This model naturally arises when the probabilities of an event in one or both arms of a comparative study are themselves beta-distributed, resulting in beta-binomial distributions. We propose two new estimators of the ICC for meta-analysis in this setting. One is based on the inverted Breslow-Day test, and the other on the improved gamma approximation by Kulinskaya and Dollinger (2015, p. 26) to the distribution of Cochran's Q. The performance of these and several other estimators of ICC on bias and coverage is studied by simulation. Additionally, the Mantel-Haenszel approach to estimation of ORs is extended to the beta-binomial model, and we study performance of various ICC estimators when used in the Mantel-Haenszel or the inverse-variance method to combine ORs in meta-analysis. The results of the simulations show that the improved gamma-based estimator of ICC is superior for small sample sizes, and the Breslow-Day-based estimator is the best for n⩾100. The Mantel-Haenszel-based estimator of OR is very biased and is not recommended. The inverse-variance approach is also somewhat biased for ORs≠1, but this bias is not very large in practical settings. Developed methods and R programs, provided in the Web Appendix, make the beta-binomial model a feasible alternative to the standard REM for meta-analysis of ORs. © 2017 The Authors. Statistics in Medicine Published by John Wiley & Sons Ltd.

  18. Estimation of conditional and marginal odds ratios using the prognostic score.

    PubMed

    Hajage, David; De Rycke, Yann; Chauvet, Guillaume; Tubach, Florence

    2017-02-20

    Introduced by Hansen in 2008, the prognostic score (PGS) has been presented as 'the prognostic analogue of the propensity score' (PPS). PPS-based methods are intended to estimate marginal effects. Most previous studies evaluated the performance of existing PGS-based methods (adjustment, stratification and matching using the PGS) in situations in which the theoretical conditional and marginal effects are equal (i.e., collapsible situations). To support the use of PGS framework as an alternative to the PPS framework, applied researchers must have reliable information about the type of treatment effect estimated by each method. We propose four new PGS-based methods, each developed to estimate a specific type of treatment effect. We evaluated the ability of existing and new PGS-based methods to estimate the conditional treatment effect (CTE), the (marginal) average treatment effect on the whole population (ATE), and the (marginal) average treatment effect on the treated population (ATT), when the odds ratio (a non-collapsible estimator) is the measure of interest. The performance of PGS-based methods was assessed by Monte Carlo simulations and compared with PPS-based methods and multivariate regression analysis. Existing PGS-based methods did not allow for estimating the ATE and showed unacceptable performance when the proportion of exposed subjects was large. When estimating marginal effects, PPS-based methods were too conservative, whereas the new PGS-based methods performed better with low prevalence of exposure, and had coverages closer to the nominal value. When estimating CTE, the new PGS-based methods performed as well as traditional multivariate regression. Copyright © 2016 John Wiley & Sons, Ltd.

  19. The Overall Odds Ratio as an Intuitive Effect Size Index for Multiple Logistic Regression: Examination of Further Refinements

    ERIC Educational Resources Information Center

    Le, Huy; Marcus, Justin

    2012-01-01

    This study used Monte Carlo simulation to examine the properties of the overall odds ratio (OOR), which was recently introduced as an index for overall effect size in multiple logistic regression. It was found that the OOR was relatively independent of study base rate and performed better than most commonly used R-square analogs in indexing model…

  20. Body mass index, cigarette smoking, and alcohol consumption and cancers of the oral cavity, pharynx, and larynx: modeling odds ratios in pooled case-control data.

    PubMed

    Lubin, Jay H; Gaudet, Mia M; Olshan, Andrew F; Kelsey, Karl; Boffetta, Paolo; Brennan, Paul; Castellsague, Xavier; Chen, Chu; Curado, Maria Paula; Dal Maso, Luigino; Daudt, Alexander W; Fabianova, Eleonora; Fernandez, Leticia; Wünsch-Filho, Victor; Franceschi, Silvia; Herrero, Rolando; Koifman, Sergio; La Vecchia, Carlo; Lazarus, Philip; Levi, Fabio; Lissowska, Jolanta; Mates, Ioan Nicolae; Matos, Elena; McClean, Michael; Menezes, Ana; Morgenstern, Hal; Muscat, Joshua; Eluf Neto, Jose; Purdue, Mark P; Rudnai, Peter; Schwartz, Stephen M; Shangina, Oxana; Sturgis, Erich M; Szeszenia-Dabrowska, Neonilia; Talamini, Renato; Wei, Qingyi; Winn, Deborah; Zhang, Zuo-Feng; Hashibe, Mia; Hayes, Richard B

    2010-06-15

    Odds ratios for head and neck cancer increase with greater cigarette and alcohol use and lower body mass index (BMI; weight (kg)/height(2) (m(2))). Using data from the International Head and Neck Cancer Epidemiology Consortium, the authors conducted a formal analysis of BMI as a modifier of smoking- and alcohol-related effects. Analysis of never and current smokers included 6,333 cases, while analysis of never drinkers and consumers of < or =10 drinks/day included 8,452 cases. There were 8,000 or more controls, depending on the analysis. Odds ratios for all sites increased with lower BMI, greater smoking, and greater drinking. In polytomous regression, odds ratios for BMI (P = 0.65), smoking (P = 0.52), and drinking (P = 0.73) were homogeneous for oral cavity and pharyngeal cancers. Odds ratios for BMI and drinking were greater for oral cavity/pharyngeal cancer (P < 0.01), while smoking odds ratios were greater for laryngeal cancer (P < 0.01). Lower BMI enhanced smoking- and drinking-related odds ratios for oral cavity/pharyngeal cancer (P < 0.01), while BMI did not modify smoking and drinking odds ratios for laryngeal cancer. The increased odds ratios for all sites with low BMI may suggest related carcinogenic mechanisms; however, BMI modification of smoking and drinking odds ratios for cancer of the oral cavity/pharynx but not larynx cancer suggests additional factors specific to oral cavity/pharynx cancer.

  1. Np.OR: an S-Plus function for pointwise nonparametric estimation of odds-ratios of continuous predictors.

    PubMed

    Saez, Marc; Cadarso-Suárez, Carmen; Figueiras, Adolfo

    2003-06-01

    Calculating odds ratios (OR) and corresponding confidence intervals (CI) for exposures that have been measured using a continuous scale, presents important limitations in the traditional practice of epidemiology. Our objective is to describe an S-Plus function, that we called np.OR, that allows the computation of the pointwise estimates of the ORs as well as their corresponding CIs of continuous predictors introduced nonlinearly in a generalised model. The function can also be generalised to compute the pointwise estimates of categorical predictors that were introduced nonlinearly. To illustrate usage of the program we analyse the relationship between ambient temperature and total mortality in Barcelona for the period 1991-1995, while controlling for observed and unobserved confounders.

  2. The association in a two-way contingency table through log odds ratio analysis: the case of Sarno river pollution.

    PubMed

    Camminatiello, Ida; D'Ambra, Antonello; Sarnacchiaro, Pasquale

    2014-01-01

    In this paper we are proposing a general framework for the analysis of the complete set of log Odds Ratios (ORs) generated by a two-way contingency table. Starting from the RC (M) association model and hypothesizing a Poisson distribution for the counts of the two-way contingency table we are obtaining the weighted Log Ratio Analysis that we are extending to the study of log ORs. Particularly we are obtaining an indirect representation of the log ORs and some synthesis measures. Then for studying the matrix of log ORs we are performing a generalized Singular Value Decomposition that allows us to obtain a direct representation of log ORs. We also expect to get summary measures of association too. We have considered the matrix of complete set of ORs, because, it is linked to the two-way contingency table in terms of variance and it allows us to represent all the ORs on a factorial plan. Finally, a two-way contingency table, which crosses pollution of the Sarno river and sampling points, is to be analyzed to illustrate the proposed framework.

  3. Correlating observed odds ratios from lung cancer case-control studies to SNP functional scores predicted by bioinformatic tools

    PubMed Central

    Zhu, Yong; Hoffman, Aaron; Wu, Xifeng; Zhang, Heping; Zhang, Yawei; Leaderer, Derek; Zheng, Tongzhang

    2008-01-01

    Bioinformatic tools are widely utilized to predict functional single nucleotide polymorphisms (SNPs) for genotyping in molecular epidemiological studies. However, the extent to which these approaches are mirrored by epidemiological findings has not been fully explored. In this study, we first surveyed SNPs examined in case-control studies of lung cancer, the most extensively-studied cancer type. We then computed SNP functional scores using four popular bioinformatics tools: SIFT, PolyPhen, SNPs3D, and PMut, and determined their predictive potential using the odds ratios (ORs) reported. Spearman’s correlation coefficient (r) for the association with SNP score from SIFT, PolyPhen, SNPs3D, and PMut, and the summary ORs were r = −0.36 (p = 0.007), r = 0.25 (p = 0.068), r = −0.20 (p = 0.205), and r = −0.12 (p = 0.370) respectively. By creating a combined score using information from all four tools we were able to achieve a correlation coefficient of r = 0.51 (p < 0.001). These results indicate that scores of predicted functionality could explain a certain fraction of the lung cancer risk detected in genetic association studies and more accurate predictions may be obtained by combining information from a variety of tools. Our findings suggest that bioinformatic tools are useful in predicting SNP functionality and may facilitate future genetic epidemiological studies. PMID:18191955

  4. [Odds ratio between sociocultural factors, body dissatisfaction, and body mass index in university students of Hidalgo, Mexico].

    PubMed

    Zaragoza Cortes, Jessica; Saucedo-Molina, Teresita de Jesús; Fernández Cortés, Trinidad Lorena

    2011-03-01

    After to identify risky factors involved in the prediction and prevention of eating disorders (ED), in a sample of university males and females students from an urban setting in Hidalgo. Mexico; the main purpose of this paper was to reaffirm the following assumptions: 1) Dissatisfaction with body shape is closely related to both, the influence of sociocultural factors as Body Mass Index (BMI); 2) The participating women reported more dissatisfaction with body shape, indicating greater influence of sociocultural factors than men.Transversal, descriptive and association field research was carried out in a sample of 490 students (57% females. 43% males), from 16 to 30 years old (X(-) = 19.63, SD = +/- 2.11). Multidimensional self-reported questionnaire were applied. BMI was obtained by measuring each subject's weight and height. Regarding the impact association measures obtained by Odds Ratio, there were significant association (p < 0.05) between high BMI and body image dissatisfaction. Also, statistically significant associations (p < 0.05) were found between body dissatisfaction and sociocultural factors (distress because of body image, influence of advertising, and influence of verbal messages), and between BMI and these latter, where men showed a higher risk. Findings suggest that body dissatisfaction in women, and BMI, specifically overweight in men, act like key agents of the impact of sociocultural factors in the researched sample.

  5. Non-parametric estimation of the odds ratios for continuous exposures using generalized additive models with an unknown link function.

    PubMed

    Cadarso-Suárez, Carmen; Roca-Pardiñas, Javier; Figueiras, Adolfo; González-Manteiga, Wenceslao

    2005-04-30

    The generalized additive, model (GAM) is a powerful and widely used tool that allows researchers to fit, non-parametrically, the effect of continuous predictors on a transformation of the mean response variable. Such a transformation is given by a so-called link function, and in GAMs this link function is assumed to be known. Nevertheless, if an incorrect choice is made for the link, the resulting GAM is misspecified and the results obtained may be misleading. In this paper, we propose a modified version of the local scoring algorithm that allows for the non-parametric estimation of the link function, by using local linear kernel smoothers. To better understand the effect that each covariate produces on the outcome, results are expressed in terms of the non-parametric odds ratio (OR) curves. Bootstrap techniques were used to correct the bias in the OR estimation and to construct point-wise confidence intervals. A simulation study was carried out to assess the behaviour of the resulting estimates. The proposed methodology was illustrated using data from the AIDS Register of Galicia (NW Spain), with a view to assessing the effect of the CD4 lymphocyte count on the probability of being AIDS-diagnosed via Tuberculosis (TB). This application shows how the link's flexibility makes it possible to obtain OR curve estimates that are less sensitive to the presence of outliers and unusual values that are often present in the extremes of the covariate distributions.

  6. Binary Logistic Regression Analysis for Detecting Differential Item Functioning: Effectiveness of R[superscript 2] and Delta Log Odds Ratio Effect Size Measures

    ERIC Educational Resources Information Center

    Hidalgo, Mª Dolores; Gómez-Benito, Juana; Zumbo, Bruno D.

    2014-01-01

    The authors analyze the effectiveness of the R[superscript 2] and delta log odds ratio effect size measures when using logistic regression analysis to detect differential item functioning (DIF) in dichotomous items. A simulation study was carried out, and the Type I error rate and power estimates under conditions in which only statistical testing…

  7. The Effects of Small Sample Size on Identifying Polytomous DIF Using the Liu-Agresti Estimator of the Cumulative Common Odds Ratio

    ERIC Educational Resources Information Center

    Carvajal, Jorge; Skorupski, William P.

    2010-01-01

    This study is an evaluation of the behavior of the Liu-Agresti estimator of the cumulative common odds ratio when identifying differential item functioning (DIF) with polytomously scored test items using small samples. The Liu-Agresti estimator has been proposed by Penfield and Algina as a promising approach for the study of polytomous DIF but no…

  8. Odd + Odd = Odd: Is It Possible?

    ERIC Educational Resources Information Center

    Sinitsky, Ilya; Zazkis, Rina; Leikin, Roza

    2011-01-01

    In this article, the authors explore the reasons why some mathematical functions are referred to as odd, and others as even. They start by recalling the definitions of both functions. Simply stated, the value of an even function is the same for a number and its opposite, whereas the value of an odd function changes for the opposite number when the…

  9. Pooling dietary data using questionnaires with open-ended and predefined responses: implications for comparing mean intake or estimating odds ratios.

    PubMed

    Swartz, Michael D; Forman, Michele R; Mahabir, Somdat; Etzel, Carol J

    2010-03-15

    In the current era of diet-gene analyses, large sample sizes are required to uncover the etiology of complex diseases. As such, consortia form and often combine available data. Food frequency questionnaires, which commonly use 2 different types of responses about the frequency of intake (predefined responses and open-ended responses), may be pooled to achieve the desired sample size. The common practice is to categorize open-ended responses into the predefined response categories. A problem arises when the predefined categories are noncontiguous: possible open-ended responses may fall in gaps between the predefined categories. Using simulated data modeled from frequency of intake among 1,664 controls in a lung cancer case-control study at The University of Texas M. D. Anderson Cancer Center (Houston, Texas, 2000-2005), the authors describe the effect of different categories of open-ended responses that fall in between noncontiguous, predefined response sets on estimates of the mean difference in intake and the odds ratios. A significant inflation of false positives appears when comparing mean differences of intake, while the bias in estimating odds ratios may be acceptably small. Therefore, if pooling data cannot be restricted to the same type of response, inferences should focus on odds ratio estimation to minimize bias.

  10. A case-control study of cholecystectomy and right-side colon cancer: the influence of alternative data sources and differential interview participation proportions on odds ratio estimates.

    PubMed

    Vernick, L J; Kuller, L H

    1982-07-01

    One hundred fifty patients with right-side colon cancer (i.e., patients with adenocarcinoma of the cecum or ascending colon) were compared to 150 matched left-side colon cancer controls (i.e., patients with adenocarcinoma of the descending or sigmoid colon) and to 123 neighborhood controls, Pittsburgh, Pennsylvania, Standard Metropolitan Statistical Area, 1975-1978. The gastrointestinal surgical history was ascertained for all study subjects so that the presence or absence of a history of cholecystectomy could be noted. Cholecystectomy history was obtained through telephone interviews and whenever possible subsequently validated from operative and pathology reports at time of cholecystectomy. Cholecystectomy history for the colon cancer patients was also abstracted from hospital records at time of colon cancer diagnosis with an attempt to confirm the gallbladder's status through operative reports, cholecystograms, and physical examinations. Hospital records and interviews for the colon cancer patients appeared to provide accurate exposure history. Point estimates of the odds ratios and confidence intervals for intra- and inter-data source comparisons (i.e., hospital records, interviews, and hospital records and interviews combined) were comparable with similar measures of effect. Consistent odds ratio estimates appeared in both left-side colon cancer controls (1.9) and neighborhood controls (1.89). The authors suggest that changes in bile acid metabolism following cholecystectomy may be associated an increased risk of right-side colon cancer.

  11. Correlates of Pediatric CPAP Adherence

    PubMed Central

    Hawkins, Stephen M.M.; Jensen, Emily L.; Simon, Stacey L.; Friedman, Norman R.

    2016-01-01

    Study Objectives: Obstructive sleep apnea (OSA) is a common pediatric condition characterized by recurrent partial or complete cessation of airflow during sleep, typically due to inadequate upper airway patency. Continuous positive airway pressure (CPAP) is a therapeutic option that reduces morbidity. Despite efforts to promote use, CPAP adherence is poor in both pediatric and adult populations. We sought to determine whether demographics, insurance status, OSA severity, therapeutic pressure, or comorbid conditions were associated with pediatric CPAP adherence. Methods: A retrospective review of adherence download data was performed on all pediatric patients with initiation or adjustment of CPAP treatment over a one-year period with documented in-laboratory CPAP titration. Patients were grouped as CPAP adherent or non-adherent, where adherence was defined as > 70% nightly use and average usage ≥ 4 hours per night. Differences between the groups were analyzed by χ2 test. Results: Overall, nearly half of participants were CPAP adherent (49%, 69/140). Of the demographic data collected (age, ethnicity, sex, insurance status), only female sex was associated with better adherence (60.9% vs 39.5% of males adherent; odds ratio [OR] = 2.41, 95%CI = 1.20–4.85; p = 0.01). Severity of OSA (diagnostic apnea-hypopnea index [AHI] and degree of hypoxemia), therapeutic pressure, and residual AHI did not impact CPAP adherence (p > 0.05). Patients with developmental delay (DD) were more likely to be adherent with CPAP than those without a DD diagnosis (OR = 2.55, 95%CI = 1.27–5.13; p = 0.007). Female patients with trisomy 21 tended to be more adherent, but this did not reach significance or account for the overall increased adherence associated with female sex. Conclusions: Our study demonstrates that adherence to CPAP therapy is poor but suggests that female sex and developmental delay are associated with better adherence. These findings support efforts to understand the

  12. An efficient test based on the inferential model for the non-inferiority of odds ratio in matched-pairs design.

    PubMed

    Wang, Zhining; Jin, Hua; Lu, Hezhi; Jin, Yaolan

    2017-01-01

    Non-inferiority of one treatment to another based on odds ratio for the matched-pair design is a common issue in the medical research. Liu et al. derived two asymptotic tests, delta method and score test, which can be applicable for large samples but may tend to be liberal for small sample sizes. Jin et al. proposed an IM-based method that can control the type I risk well but may be somewhat conservative. In this paper, we extend the IM-based method to RIM-based test using the randomized plausibility function. We prove that our new proposed method is not only valid but also efficient. Simulation studies confirm that the RIM-based test is better than other methods. A numerical example illustrates the proposed method.

  13. A note on the use of the generalized odds ratio in meta-analysis of association studies involving bi- and tri-allelic polymorphisms

    PubMed Central

    2011-01-01

    Background The generalized odds ratio (GOR) was recently suggested as a genetic model-free measure for association studies. However, its properties were not extensively investigated. We used Monte Carlo simulations to investigate type-I error rates, power and bias in both effect size and between-study variance estimates of meta-analyses using the GOR as a summary effect, and compared these results to those obtained by usual approaches of model specification. We further applied the GOR in a real meta-analysis of three genome-wide association studies in Alzheimer's disease. Findings For bi-allelic polymorphisms, the GOR performs virtually identical to a standard multiplicative model of analysis (e.g. per-allele odds ratio) for variants acting multiplicatively, but augments slightly the power to detect variants with a dominant mode of action, while reducing the probability to detect recessive variants. Although there were differences among the GOR and usual approaches in terms of bias and type-I error rates, both simulation- and real data-based results provided little indication that these differences will be substantial in practice for meta-analyses involving bi-allelic polymorphisms. However, the use of the GOR may be slightly more powerful for the synthesis of data from tri-allelic variants, particularly when susceptibility alleles are less common in the populations (≤10%). This gain in power may depend on knowledge of the direction of the effects. Conclusions For the synthesis of data from bi-allelic variants, the GOR may be regarded as a multiplicative-like model of analysis. The use of the GOR may be slightly more powerful in the tri-allelic case, particularly when susceptibility alleles are less common in the populations. PMID:21645382

  14. Observed-to-expected ratio for adherence to treatment guidelines as a quality of care indicator for ovarian cancer☆

    PubMed Central

    Galvan-Turner, Valerie B.; Chang, Jenny; Ziogas, Argyrios; Bristow, Robert E.

    2016-01-01

    Objective To develop an observed-to-expected ratio (O/E) for adherence to National Comprehensive Cancer Network (NCCN) ovarian cancer treatment guidelines as a risk-adjusted hospital measure of quality care correlated with disease-specific survival. Methods Consecutive patients with stages I–IV epithelial ovarian cancer were identified from the California Cancer Registry (1/1/96–12/31/06). Using a fit logistic regression model, O/E for guideline adherence was calculated for each hospital and distributed into quartiles stratified by hospital annual case volume: lowest O/E quartile or annual hospital case volume <5, middle two O/E quartiles and volume ≥5, and highest O/E quartile and volume ≥5. A multivariable logistic regression model was used to characterize the independent effect of hospital O/E on ovarian cancer-specific survival. Results Overall, 18,491 patients were treated at 405 hospitals; 37.3% received guideline adherent care. Lowest O/E hospitals (n = 285) treated 4661 patients (25.2%), mean O/E = 0.77 ± 0.55 and median survival 38.9 months (95%CI = 36.2–42.0 months). Intermediate O/E hospitals (n = 85) treated 8715 patients (47.1%), mean O/E = 0.87 ± 0.17 and median survival of 50.5 months (95% CI = 48.4–52.8 months). Highest O/E hospitals (n = 35) treated 5115 patients (27.7%), mean O/E = 1.34 ± 0.14 and median survival of 53.8 months (95% CI = 50.2–58.2 months). After controlling for other variables, treatment at highest O/E hospitals was associated with independent and statistically significant improvement in ovarian cancer-specific survival compared to intermediate O/E (HR = 1.06, 95% CI = 1.01–1.11) and lowest O/E (1.16, 95% CI = 1.10–1.23) hospitals. Conclusions Calculation of hospital-specific O/E for NCCN treatment guideline adherence, combined with minimum case volume criterion, as a measure of ovarian cancer quality of care is feasible and is an independent predictor of survival. PMID:26387962

  15. Antiretroviral adherence during pregnancy and postpartum in Latin America.

    PubMed

    Kreitchmann, Regis; Harris, D Robert; Kakehasi, Fabiana; Haberer, Jessica E; Cahn, Pedro; Losso, Marcelo; Teles, Elizabete; Pilotto, Jose H; Hofer, Cristina B; Read, Jennifer S

    2012-08-01

    Adherence to antiretrovirals by pregnant women (and postpartum women if breastfeeding) is crucial to effectively decrease maternal viral load and decrease the risk of mother-to-child transmission of HIV. Our objectives were to describe self-reported adherence to antiretrovirals during the antepartum (after 22 weeks of pregnancy) and postpartum periods (6-12 weeks and 6 months), and identify predictors of adherence among HIV-infected women enrolled and followed in a prospective cohort study from June 2008 to June 2010 at multiple sites in Latin America. Adherence was evaluated using the number of missed and expected doses during the 3 days before the study visit. At the pre-delivery visit, 340 of 376 women (90%) reported perfect adherence. This rate significantly decreased by 6-12 weeks (171/214 [80%]) and 6 months postpartum (163/199 [82%], p<0.01). The odds for less than perfect adherence at the pre-delivery visit was significantly higher for pregnant women with current tobacco use (odds ratio [OR]=2.9, 95% confidence interval [CI]: 1.46-6.14; p=0.0029). At 6-12 weeks postpartum, the probability of non-perfect adherence increased by 6% for each 1 year increase in age (OR=1.06, 95% CI: 1.00-1.12, p=0.0497). At 6 months postpartum, the odds of nonperfect adherence was higher for those who were currently using alcohol (OR=3.04, 95% CI: 1.34-6.90; p=0.0079). Although a self-report measure of adherence based on only 3 days may lead to overestimation of actual adherence over time, women with perfect adherence had lower viral loads and higher CD4 counts. Adherence to antiretrovirals decreased significantly postpartum. Interventions should target women at high risk for lower adherence during pregnancy and postpartum, including tobacco and alcohol users.

  16. Antiretroviral Adherence During Pregnancy and Postpartum in Latin America

    PubMed Central

    Harris, D. Robert; Kakehasi, Fabiana; Haberer, Jessica E.; Cahn, Pedro; Losso, Marcelo; Teles, Elizabete; Pilotto, Jose H.; Hofer, Cristina B.; Read, Jennifer S.

    2012-01-01

    Abstract Adherence to antiretrovirals by pregnant women (and postpartum women if breastfeeding) is crucial to effectively decrease maternal viral load and decrease the risk of mother-to-child transmission of HIV. Our objectives were to describe self-reported adherence to antiretrovirals during the antepartum (after 22 weeks of pregnancy) and postpartum periods (6–12 weeks and 6 months), and identify predictors of adherence among HIV-infected women enrolled and followed in a prospective cohort study from June 2008 to June 2010 at multiple sites in Latin America. Adherence was evaluated using the number of missed and expected doses during the 3 days before the study visit. At the pre-delivery visit, 340 of 376 women (90%) reported perfect adherence. This rate significantly decreased by 6–12 weeks (171/214 [80%]) and 6 months postpartum (163/199 [82%], p<0.01). The odds for less than perfect adherence at the pre-delivery visit was significantly higher for pregnant women with current tobacco use (odds ratio [OR]=2.9, 95% confidence interval [CI]: 1.46–6.14; p=0.0029). At 6–12 weeks postpartum, the probability of non-perfect adherence increased by 6% for each 1 year increase in age (OR=1.06, 95% CI: 1.00–1.12, p=0.0497). At 6 months postpartum, the odds of nonperfect adherence was higher for those who were currently using alcohol (OR=3.04, 95% CI: 1.34–6.90; p=0.0079). Although a self-report measure of adherence based on only 3 days may lead to overestimation of actual adherence over time, women with perfect adherence had lower viral loads and higher CD4 counts. Adherence to antiretrovirals decreased significantly postpartum. Interventions should target women at high risk for lower adherence during pregnancy and postpartum, including tobacco and alcohol users. PMID:22663185

  17. Predictors of adherence in a prevention program for patients with metabolic syndrome.

    PubMed

    Susin, Nathália; de Melo Boff, Raquel; Ludwig, Martha Walig Brusius; Feoli, Ana Maria Pandolfo; da Silva, Andreia Gustavo; Macagnan, Fabricio Elder; da Silva Oliveira, Margareth

    2016-10-01

    The study objectives were (1) comparison of baseline characteristics between individuals with metabolic syndrome, adhering/not adhering to a primary prevention program modificação do estilo de vida e risco cardiovascular; and (2) determination of risk factors for program adherence. The sample included 127 participants with mean age (±standard deviation) of 49.58 (±7.77) years, participating in the modificação do estilo de vida e risco cardiovascular between 2010 and 2012. Results show that program adherence predictors were age (odds ratio: 1.134, 95% confidence interval: 1.106-1.833); practicing physical exercise (odds ratio: 1.322, 95% confidence interval: 1.115-7.589); self-efficacy for regular eating habits (odds ratio: 2.044, 95% confidence interval: 1.184-3.377); low binge eating scores (odds ratio: 1.922, 95% confidence interval: 1.118-3.974); and low isolation and depression scores (odds ratio: 0.721, 95% confidence interval: 0.322-0.917).

  18. Oppositional Defiant Disorder (ODD)

    MedlinePlus

    ... manage a child with ODD. Doctors, counselors and child development experts can help. Treatment of ODD involves therapy, ... exhibit oppositional behavior at certain stages of a child's development. Signs of ODD generally begin during preschool years. ...

  19. Evaluating Adherence to Antiretroviral Therapy Using Pharmacy Refill Records in a Rural Treatment Site in South Africa

    PubMed Central

    Gachara, George; Mavhandu, Lufuno G.; Rogawski, Elizabeth T.; Manhaeve, Cecile

    2017-01-01

    Optimal adherence to combination antiretroviral therapy (cART) is critical to maintain virologic suppression, thereby ensuring the global success of HIV treatment. We evaluated adherence to cART using pharmacy refill records and determined the adherence threshold resulting in >90% virologic suppression in a community run treatment site in South Africa. Additionally, we analysed factors associated with adherence using univariable and multivariable logistic regression models. Logistic regression was also performed to determine the relationship between adherence and virologic suppression and the adherence threshold resulting in <10% virologic failure. The overall median (interquartile range) adherence was 95% (88.6–98.4%). Out of the study participants, 210/401 (52.4%) had optimal (≥95%) adherence while only 37/401 (9.2%) had poor (≤80%) adherence. The majority (90.5%) of patients with optimal adherence had virologic suppression. Having TB at registration into care was found to be negatively associated with adherence (adjusted odds ratio [AOR], 0.382; p ≤ .05). Compared to nonadherent individuals, optimally adherent participants were more likely to achieve virologic suppression (OR 2.92; 95% CI: 1.63–5.22). Only adherence rates above 95% were observed to lead to <10% virologic failure. cART adherence measured by pharmacy refill records could serve as a useful predictor of virologic failure; adherence rates >95% are needed to maintain optimal virologic suppression. PMID:28255456

  20. Dosing frequency and adherence in chronic psychiatric disease: systematic review and meta-analysis

    PubMed Central

    Medic, Goran; Higashi, Kyoko; Littlewood, Kavi J; Diez, Teresa; Granström, Ola; Kahn, René S

    2013-01-01

    Background The purpose of this study was to investigate the impact of dosing frequency on adherence in severe chronic psychiatric and neurological diseases. Methods: A systematic literature review was conducted for articles in English from medical databases. Diseases were schizophrenia, psychosis, epilepsy, bipolar disorder, and major depressive disorder. Results: Of 1420 abstracts screened, 12 studies were included. Adherence measures included Medication Event Monitoring System (MEMS®), medication possession ratio, medication persistence, and refill adherence. Three schizophrenia and one epilepsy study used MEMS, and all showed a trend towards higher adherence rates with less frequent dosing regimens. Three depression and one schizophrenia study used the medication possession ratio; the pooled odds ratio of being adherent was 89% higher (ie, 1.89, 95% credibility limits 1.71–2.09) on once-daily versus twice-daily dosing. Two studies in depression and one in all bupropion patients assessed medication persistence and refill adherence. The pooled odds ratio for the two depression studies using medication persistence was 2.10 (95% credibility limits 1.86–2.37) for once-daily versus twice-daily dosing. For refill adherence after 9 months, 65%–75% of patients on once-daily versus 56% on twice-daily dosing had at least one refill. In all but one of the studies using other measures of adherence, adherence rates were higher with once-daily dosing compared with more frequent dosing regimens. No relevant studies were identified for bipolar disorder or psychosis. Conclusion: Differences in study design and adherence measures used across the studies were too large to allow pooling of all results. Despite these differences, there was a consistent trend of better adherence with less frequent dosing. PMID:23355782

  1. Suboptimal treatment adherence in bipolar disorder: impact on clinical outcomes and functioning

    PubMed Central

    Montes, Jose Manuel; Maurino, Jorge; de Dios, Consuelo; Medina, Esteban

    2013-01-01

    Background The primary aim of this study was to assess drug treatment adherence in patients with bipolar disorder and to identify factors associated with adherence. The secondary aim was to analyze the impact of suboptimal adherence on clinical and functional outcomes. Methods A cross-sectional study was conducted in a sample of outpatients receiving an oral antipsychotic drug. Medication adherence was assessed combining the 10-item Drug Attitude Inventory, the Morisky Green Adherence Questionnaire, and the Compliance Rating Scale. Logistic regression was used to determine significant variables associated with suboptimal adherence to medication. Results Three hundred and three patients were enrolled into the study. The mean age was 45.9 ± 12.8 years, and 59.7% were females. Sixty-nine percent of patients showed suboptimal adherence. Disease severity and functioning were significantly worse in the suboptimal group than in the adherent group. Multivariate analysis showed depressive polarity of the last acute episode, presence of subsyndromal symptoms, and substance abuse/dependence to be significantly associated with suboptimal treatment adherence (odds ratios 3.41, 2.13, and 1.95, respectively). Conclusion A high prevalence of nonadherence was found in an outpatient sample with bipolar disorder. Identification of factors related to treatment adherence would give clinicians the opportunity to select more adequately patients who are eligible for potential adherence-focused interventions. PMID:23378745

  2. Non-adherence to topical treatments for actinic keratosis

    PubMed Central

    Shergill, Bav; Zokaie, Simon; Carr, Alison J

    2014-01-01

    Background There is limited information on the patterns of use, adherence rates, and factors that impact adherence with topical treatments for actinic keratosis (AK). Objectives To establish patterns of use and adherence with topical treatments for AK and to identify treatment-related factors that impact on adherence. Methods A community-based, cross-sectional study was performed using a standardized questionnaire completed online or via telephone interview. Patients were stratified according to the presence of AK lesions on the scalp and/or other extremities; and presence of scarring resulting from treatment. Results This study included 305 patients with AK who were currently using a patient-applied topical therapy for AK or had used one within the previous 12 months. In total, 88% (n = 268/305) of patients were either non-adherent, non-persistent or both non-adherent and non-persistent to topical therapy. Duration of treatment was associated with increasing rates of non-adherence (adjusted odds ratio [OR]; for treatment durations greater than 4 weeks, 2.2, P < 0.01): 52% of patients were non-adherent with 3–4 week treatment duration; 69% of patients with 4–8 week treatment duration; and 71% of patients with 6–12 week treatment duration. There were similar increases in non-persistence with increasing treatment duration (adjusted OR; for treatment durations greater than 4 weeks, 2.1, P < 0.05). Conclusion This study found high rates of non-adherence and non-persistence in patients with AK. Duration of treatment was a significant factor contributing to non-adherence and non-persistence to topical treatments. Patient-applied topical therapies that require less frequent application and have shorter treatment duration may be associated with improved adherence rates. PMID:24379656

  3. Odd-odd deformed proton emitters.

    PubMed

    Ferreira, L S; Maglione, E

    2001-02-26

    Proton decay from odd-odd deformed nuclei is a long-standing unsolved problem. We present for the first time an exact solution using single particle Nilsson resonances. The lifetime is found to depend strongly on the single particle level occupied by the unpaired neutron, allowing a clear assignment of its Nilsson level. The emitters 112Cs, 140Ho, 150Lu, and 150Lu(m) are considered. The agreement with the experimental data is very good with deformations 0.1

  4. Self-Assessment of Adherence to Medication: A Case Study in Campania Region Community-Dwelling Population

    PubMed Central

    Menditto, Enrica; Guerriero, Francesca; Orlando, Valentina; Crola, Catherine; Di Somma, Carolina; Illario, Maddalena; Morisky, Donald E.; Colao, Annamaria

    2015-01-01

    Objectives. The aim of the study was to assess self-reported medication adherence measure in patients selected during a health education and health promotion focused event held in the Campania region. The study also assessed sociodemographic determinants of adherence. Methods. An interviewer assisted survey was conducted to assess adherence using the Italian version of the 8-item Morisky Medication Adherence Scale (MMAS-8). Participants older than 18 years were interviewed by pharmacists while waiting for free-medical checkup. Results. A total of 312 participants were interviewed during the Health Campus event. A total of 187 (59.9%) had low adherence to medications. Pearson's bivariate correlation showed positive association between the MMAS-8 score and gender, educational level and smoking (P < 0.05). A multivariable analysis showed that the level of education and smoking were independent predictors of adherence. Individuals with an average level of education (odds ratio (OR), 2.21, 95% confidence interval (CI), 1.08–4.52) and nonsmoker (odds ratio (OR) 1.87, 95% confidence interval (CI), 1.04–3.35) were found to be more adherent to medication than those with a lower level of education and smoking. Conclusion. The analysis showed very low prescription adherence levels in the interviewed population. The level of education was a relevant predictor associated with that result. PMID:26346487

  5. Ratio

    NASA Astrophysics Data System (ADS)

    Webster, Nathan A. S.; Pownceby, Mark I.; Madsen, Ian C.; Studer, Andrew J.; Manuel, James R.; Kimpton, Justin A.

    2014-12-01

    Effects of basicity, B (CaO:SiO2 ratio) on the thermal range, concentration, and formation mechanisms of silico-ferrite of calcium and aluminum (SFCA) and SFCA-I iron ore sinter bonding phases have been investigated using an in situ synchrotron X-ray diffraction-based methodology with subsequent Rietveld refinement-based quantitative phase analysis. SFCA and SFCA-I phases are the key bonding materials in iron ore sinter, and improved understanding of the effects of processing parameters such as basicity on their formation and decomposition may assist in improving efficiency of industrial iron ore sintering operations. Increasing basicity significantly increased the thermal range of SFCA-I, from 1363 K to 1533 K (1090 °C to 1260 °C) for a mixture with B = 2.48, to ~1339 K to 1535 K (1066 °C to 1262 °C) for a mixture with B = 3.96, and to ~1323 K to 1593 K (1050 °C to 1320 °C) at B = 4.94. Increasing basicity also increased the amount of SFCA-I formed, from 18 wt pct for the mixture with B = 2.48 to 25 wt pct for the B = 4.94 mixture. Higher basicity of the starting sinter mixture will, therefore, increase the amount of SFCA-I, considered to be more desirable of the two phases. Basicity did not appear to significantly influence the formation mechanism of SFCA-I. It did, however, affect the formation mechanism of SFCA, with the decomposition of SFCA-I coinciding with the formation of a significant amount of additional SFCA in the B = 2.48 and 3.96 mixtures but only a minor amount in the highest basicity mixture. In situ neutron diffraction enabled characterization of the behavior of magnetite after melting of SFCA produced a magnetite plus melt phase assemblage.

  6. Comprehensive medication management services influence medication adherence among Japanese older people

    PubMed Central

    Hirakawa, Yoshihisa; Hilawe, Esayas Haregot; Chiang, Chifa; Kawazoe, Nobuo; Aoyama, Atsuko

    2015-01-01

    Objective: Assistance from health professionals is very important to ensure medication adherence among older people. The present study aimed to assess the relationship between receipt of comprehensive medication management services by primary care physicians and medication adherence among community-dwelling older people in rural Japan. Methods: Data including medication adherence and whether or not a doctor knew all the kinds of medicines being taken were obtained from individuals aged 65 years or older who underwent an annual health checkup between February 2013 and March 2014 at a public clinic in Asakura. The subjects were divided into 2 groups: adherent (always) and non-adherent (not always). A logistic regression analysis was performed to assess the association between the presence of a doctor who was fully responsible for medication adherence and self-reported adherence. Predictors that exhibited significant association (p-value < 0.05) with medication adherence in a univariate analysis were entered in the model as possible confounding factors. The results were presented as odds ratios (OR) and 95% confidence intervals (CI). Results: Among four-hundred ninety-seven subjects in total, the adherent group included 430 subjects (86.5%), and its members were older than those of the non-adherent group. Significant predictors of good medication adherence included older age, no discomforting symptoms, eating regularly, diabetes mellitus and having a doctor who knew all the kinds of medicines being taken. After being adjusted for confounding variables, the subjects with a doctor who knew all the kinds of medicines they were taking were three times more likely to be adherent to medication (OR 3.01, 95% CI 1.44-6.99). Conclusion: Receipt of comprehensive medication management services for older people was associated with medication adherence. PMID:26705432

  7. Structure of odd-odd 136La at high spin

    NASA Astrophysics Data System (ADS)

    Bhattacharjee, Tumpa; Chanda, Somen; Bhattacharyya, Sarmishtha; Basu, Swapan Kumar; Bhowmik, R. K.; Muralithar, S.; Singh, R. P.; Pattabiraman, N. S.; Ghugre, S. S.; Datta Pramanik, U.; Bhattacharya, S.

    2005-04-01

    The high spin states in the N=79 odd-odd 136La nucleus have been investigated by in-beam γ-spectroscopic techniques following the 130Te( 11B, 5 n) 136La reaction at E=52 MeV using an array, consisting of eight Compton-suppressed clover germanium detectors. Thirty nine new γ rays have been assigned to 136La on the basis of γ ray singles and γγ-coincidence data. The level scheme of 136La has been extended above the known 115 ms isomer upto an excitation energy of 4.6 MeV and spin 18 ℏ. Thirty one new levels have been proposed and spin-parity assignments for most of the newly proposed levels have been made on the basis of the deduced asymmetry ratios and polarisation information for the de-exciting transitions. The observed positive parity yrast band has been compared with the theoretical calculation, done within the framework of particle rotor coupling model (PRM) where the two odd quasi-particles are coupled to an axially symmetric core. The level structure has been discussed in the light of the known systematics of the neighbouring N=79 isotonic nuclei.

  8. Rethinking adherence.

    PubMed

    Steiner, John F

    2012-10-16

    In 2012, the Centers for Medicare & Medicaid Services (CMS) will introduce measures of adherence to oral hypoglycemic, antihypertensive, and cholesterol-lowering drugs into its Medicare Advantage quality program. To meet these quality goals, delivery systems will need to develop and disseminate strategies to improve adherence. The design of adherence interventions has too often been guided by the mistaken assumptions that adherence is a single behavior that can be predicted from readily available patient characteristics and that individual clinicians alone can improve adherence at the population level.Effective interventions require recognition that adherence is a set of interacting behaviors influenced by individual, social, and environmental forces; adherence interventions must be broadly based, rather than targeted to specific population subgroups; and counseling with a trusted clinician needs to be complemented by outreach interventions and removal of structural and organizational barriers. To achieve the adherence goals set by CMS, front-line clinicians, interdisciplinary teams, organizational leaders, and policymakers will need to coordinate efforts in ways that exemplify the underlying principles of health care reform.

  9. Against All Odds

    ERIC Educational Resources Information Center

    Manzo, Kathleen Kennedy

    2005-01-01

    More than a decade ago, no one held out much hope for the poor, immigrant children at Kennedy Middle School. Nobody thinks that now. This article presents how Kennedy Middle School transformed and beat all the odds to be a "school to watch." In many ways, Kennedy Middle School has become a model of middle-grades improvement. Test scores,…

  10. Odd Shape Out

    ERIC Educational Resources Information Center

    Cady, Jo Ann; Wells, Pamela

    2016-01-01

    The Odd Shape Out task was an open-ended problem that engaged students in comparing shapes based on their properties. Four teachers submitted the work of 116 students from across the country. This article compares various student's responses to the task. The problem allowed for differentiation, as shown by the many different ways that students…

  11. Chronic Obstructive Pulmonary Disease Illness and Medication Beliefs are Associated with Medication Adherence.

    PubMed

    Krauskopf, Katherine; Federman, Alex D; Kale, Minal S; Sigel, Keith M; Martynenko, Melissa; O'Conor, Rachel; Wolf, Michael S; Leventhal, Howard; Wisnivesky, Juan P

    2015-04-01

    Almost half of patients with COPD do not adhere to their medications. Illness and medication beliefs are important determinants of adherence in other chronic diseases. Using the framework of the Common Sense Model of Self-Regulation (CSM), we determined associations between potentially modifiable beliefs and adherence to COPD medications in a cohort of English- and Spanish-speaking adults with COPD from New York and Chicago. Medication adherence was assessed using the Medication Adherence Report Scale. Illness and medication beliefs along CSM domains were evaluated using the Brief Illness Perception Questionnaire (B-IPQ) and the Beliefs about Medications Questionnaire (BMQ). Unadjusted analysis (with Cohen's d effect sizes) and multiple logistic regression were used to assess the relationship between illness and medication beliefs with adherence. The study included 188 participants (47% Black, 13% Hispanics); 109 (58%) were non-adherent. Non-adherent participants were younger (p < 0.001), more likely to be Black or Hispanic (p = 0.001), to have reported low income (p = 0.02), and had fewer years of formal education (p = 0.002). In unadjusted comparisons, non-adherent participants reported being more concerned about their COPD (p = 0.011; Cohen's d = 0.43), more emotionally affected by the disease (p = 0.001; Cohen's d = 0.54), and had greater concerns about COPD medications (p < 0.001, Cohen's d = 0.81). In adjusted analyses, concerns about COPD medications independently predicted non-adherence (odds ratio: 0.52, 95% confidence interval: 0.36-0.75). In this cohort of urban minority adults, concerns about medications were associated with non-adherence. Future work should explore interventions to influence patient adherence by addressing concerns about the safety profile and long-term effects of COPD medications.

  12. Adherence to hypertension medication: Quantitative and qualitative investigations in a rural Northern Vietnamese community

    PubMed Central

    Nguyen, Thi-Phuong-Lan; Schuiling-Veninga, Catharina C. M.; Nguyen, Thi Bach Yen; Vu, Thu-Hang; Wright, E. Pamela; Postma, Maarten J.

    2017-01-01

    Objectives The purposes of this study were to assess the adherence to medication of hypertensive patients visiting community health stations in a rural area in Vietnam, to examine the relationship between levels of adherence and cardiovascular risk among hypertensive patients and to further understand factors influencing adherence. Methods This study is part of a prospective one-year study conducted on hypertension management in a population aged 35 to 64 years. Data on age, sex, blood pressure and blood test results were collected at baseline. Cardiovascular risk was based on the Cardiovascular Risk Prediction Model for populations in Asia. To calculate medication adherence, the number of days the drug was taken was divided by the number of days since the first day of the prescription. A threshold of 80% was applied to differentiate between adherence and non-adherence. In-depth interviews were conducted among 18 subjects, including subjects classified as adherent and as non-adherent. Results Among 315 patients analyzed, 49.8% of the patients were adherent. Qualitative investigation revealed discrepancies in classification of adherence and non-adherence based on quantitative analysis and interviews. No significant difference in medication compliance between two cardiovascular disease risk groups (<10% vs. >10% risk) was found, also not after controlling for age, sex, and ethnicity (adjusted odds ratio at 1.068; 95% CI: 0.614 to 1.857). The odds of medication adherence in females was 1.531 times higher than in males but the difference was not statistically significant (95% CI: 0.957 to 2.448). Each one-year increase in age resulted in patients being 1.036 times more likely to be compliant (95% CI: 1.002 to 1.072). Awareness of complications related to hypertension was given as the main reason for adherence to therapy. Conclusions Medication adherence rate was relatively low among hypertensive subjects. The data suggest that rather than risk profile, the factor of

  13. Adherence to the Mediterranean diet is associated with lower platelet and leukocyte counts: results from the Moli-sani study.

    PubMed

    Bonaccio, Marialaura; Di Castelnuovo, Augusto; De Curtis, Amalia; Costanzo, Simona; Persichillo, Mariarosaria; Donati, Maria Benedetta; Cerletti, Chiara; Iacoviello, Licia; de Gaetano, Giovanni

    2014-05-08

    Platelet (PLT) and white blood cell (WBC) counts are 2 markers of inflammation and have been linked to the risk for cerebrovascular and coronary heart disease. A Mediterranean diet (MD) has been associated with reduced inflammation and mortality for major chronic diseases. We aimed at evaluating the association between the MD and both PLT and WBC counts. This cross-sectional analysis in a population-based cohort study included 14,586 healthy Italian citizens enrolled within the Moli-sani study. Adherence to MD was appraised by either the MD Score (MDS) or the Italian Mediterranean Index (IMI). PLT and WBC counts were both inversely related to MD adherence (MDS: P < .0001 and P = .008, respectively). As compared with those with poorer MD adherence, subjects with greater adherence had both reduced odds of being in the highest PLT-count group (MDS: odds ratio = 0.50; 95% confidence interval, 0.31-0.80) and increased odds of being in the lowest WBC-count group (IMI: odds ratio = 1.41; 95% confidence interval, 1.07-1.86). The association between WBC count and MDS disappeared when further adjusted for PLT count, whereas the association between PLT count and the MD was not affected by adjustment for WBCs. Food antioxidant and dietary fiber content modified the inverse association between MDS and WBC count and partially accounted for the association with PLTs.

  14. The Association Between Treatment Adherence to Nicotine Patches and Smoking Cessation in Pregnancy: A Secondary Analysis of a Randomized Controlled Trial

    PubMed Central

    Aveyard, Paul; Cooper, Sue; Leonardi-Bee, Jo; Coleman, Tim

    2016-01-01

    Introduction: In nonpregnant “quitters,” adherence to nicotine replacement therapy (NRT) increases smoking cessation. We investigated relationships between adherence to placebo or NRT patches and cessation in pregnancy, including an assessment of reverse causation and whether any adherence: cessation relationship is moderated when using nicotine or placebo patches. Methods: Using data from 1050 pregnant trial participants, regression models investigated associations between maternal characteristics, adherence and smoking cessation. Results: Adherence during the first month was associated with lower baseline cotinine concentrations (β −0.08, 95% confidence interval [CI] −0.15 to −0.01) and randomization to NRT (β 2.59, 95% CI 1.50 to 3.68). Adherence during both treatment months was associated with being randomized to NRT (β 0.51, 95% CI 0.29 to 0.72) and inversely associated with higher nicotine dependence. Adherence with either NRT or placebo was associated with cessation at 1 month (odds ratio [OR] 1.11, 95% CI 1.08 to 1.13) and delivery (OR 1.06, 95% CI 1.03 to 1.09), but no such association was observed in the subgroup where reverse causation was not possible. Amongst all women, greater adherence to nicotine patches was associated with increased cessation (OR 2.47, 95% CI 1.32 to 4.63) but greater adherence to placebo was not (OR 0.98, 95% CI: 0.44 to 2.18). Conclusion: Women who were more adherent to NRT were more likely to achieve abstinence; more nicotine dependent women probably showed lower adherence to NRT because they relapsed to smoking more quickly. The interaction between nicotine-containing patches and adherence for cessation suggests that the association between adherence with nicotine patches and cessation may be partly causal. Implications: This study used placebo randomized controlled trial data to investigate both associations between women’s characteristics and adherence to NRT patch treatment, and the relationship between

  15. Binge drinking, poor mental health, and adherence to treatment among California adults with asthma.

    PubMed

    Haskard, Kelly B; Banta, Jim E; Williams, Summer L; Haviland, Mark G; DiMatteo, M Robin; Przekop, Peter; Werner, Leonard S; Anderson, Donald L

    2008-06-01

    Binge drinking and poor mental health may affect adherence to treatment for individuals with asthma. The purposes were to (a) examine the relationship of self-reported binge drinking and mental health to adherence to daily asthma control medications and (b) identify other demographic and health-related factors associated with asthma control medication adherence. Secondary analyses of 2003 adult California Health Interview Survey data were undertaken, and these analyses identified 3.2 million California adults who had been told by a physician they had asthma. Of these, approximately 1.7 million were symptomatic. Binge drinking significantly predicted medication nonadherence among California adults with symptomatic asthma (OR = .63, 95% CI = .45-.89), whereas poor mental health did not. Other predictors of nonadherence (odds ratios < 1, p < .05) included being overweight, younger age, having some college education, being a current smoker, and having no usual source of medical care. Predictors of adherence (odds ratios > 1, p < .05) were older age, more frequent asthma symptoms, more ER visits, more missed work days, being African American, and being a non-citizen. Intervention efforts could be directed toward improving medication adherence among adult asthma patients who engage in risky health behaviors such as binge drinking. Also at risk for medication nonadherence and therefore good targets for asthma control medication management interventions are adults who are overweight, younger (18-44 age range), have some college education, and no usual source of medical care.

  16. Young Age Predicts Poor Antiretroviral Adherence and Viral Load Suppression Among Injection Drug Users

    PubMed Central

    Hadland, Scott E.; Milloy, M.-J.; Kerr, Thomas; Zhang, Ruth; Guillemi, Silvia; Hogg, Robert S.; Montaner, Julio S.

    2012-01-01

    Abstract Previous studies of adherence to antiretroviral therapy (ART) for HIV among young injection drug users (IDU) have been limited because financial barriers to care disproportionately affect youth, thus confounding results. This study examines adherence among IDU in a unique setting where all medical care is provided free-of-charge. From May 1996 to April 2008, we followed a prospective cohort of 545 HIV-positive IDU of 18 years of age or older in Vancouver, Canada. Using generalized estimating equations (GEE), we studied the association between age and adherence (obtaining ART≥95% of the prescribed time), controlling for potential confounders. Using Cox proportional hazards regression, we also studied the effect of age on time to viral load suppression (<500 copies per milliliter), and examined adherence as a mediating variable. Five hundred forty-five participants were followed for a median of 23.8 months (interquartile range [IQR]=8.5–91.6 months). Odds of adherence were significantly lower among younger IDU (adjusted odds ratio [AOR]=0.76 per 10 years younger; 95% confidence interval [CI], 0.65–0.89). Younger IDU were also less likely to achieve viral load suppression (adjusted hazard ratio [AHR]=0.75 per 10 years younger; 95% CI, 0.64–0.88). Adding adherence to the model eliminated this association with age, supporting the role of adherence as a mediating variable. Despite absence of financial barriers, younger IDU remain less likely to adhere to ART, resulting in inferior viral load suppression. Interventions should carefully address the unique needs of young HIV-positive IDU. PMID:22429003

  17. Adherence and Viral Suppression among Infants and Young Children Initiating Protease Inhibitor-Based Antiretroviral Therapy

    PubMed Central

    Teasdale, Chloe A; Abrams, Elaine J; Coovadia, Ashraf; Strehlau, Renate; Martens, Leigh; Kuhn, Louise

    2012-01-01

    Background High levels of adherence to antiretroviral therapy (ART) are considered necessary to achieve viral suppression. We analyzed data from a cohort of HIV-infected children who were less than 2 years of age receiving protease inhibitor (PI)-based ART to investigate associations between viral suppression and adherence ascertained using different methods. Methods Data were from the pre-randomization phase of a clinical trial in South Africa of HIV-infected children initiating either ritonavir-boosted lopinavir (LPV/r)- or ritonavir-based ART. At scheduled visits during the first 24 weeks of enrollment, study pharmacists measured quantities of medications returned (MR) to the clinic. Caregivers answered questionnaires on missed doses and adherence barriers. Associations between adherence and viral suppression (HIV-1 RNA <400 copies/mL) were investigated by regimen. Results By 24 weeks, 197/269 (73%) children achieved viral suppression. There was no association between viral suppression and caregiver reported missed doses or adherence barriers. For children receiving the LPV/r-based regimen, MR adherence to each of the three drugs in the regimen (LPV/r, lamivudine or stavudine) individually or together was associated with viral suppression at different adherence thresholds. For example, <85% adherence to any of the three medications significantly increased odds of lack of viral suppression (Odds Ratio [OR] 2.30 [95% CI: 1.30–4.07], p=.004). In contrast, for children receiving the ritonavir-based regimen, there was no consistent pattern of association between MR and viral suppression. Conclusions Caregiver reports of missed doses did not predict virologic response to treatment. Pharmacist medication reconciliation correlated strongly with virologic response for children taking a LPV/r-based regimen and appears to be a valid method for measuring pediatric adherence. PMID:23249913

  18. Medication Adherence and Readmission In Medicare Myocardial Infarction

    PubMed Central

    Zhang, Yuting; Kaplan, Cameron M.; Baik, Seo Hyon; Chang, Chung-Chou H.; Lave, Judith R.

    2014-01-01

    Objectives To examine the relationship between 6-month medication adherence and 1-year down-stream heart-disease related readmission among patients who survived a myocardial infarction (MI). Study Design Retrospective, nested case-control analysis of Medicare fee-for-service beneficiaries who were discharged alive post-MI in 2008 (n = 168,882). Methods Patients in the case group had their first heart-disease related readmission post-MI discharge during 6-9 months and/or 9-12 months. We then used propensity score matching mechanism to identify patients in the control group who had similar characteristics, but did not have a readmission in the same time window. Adherence was defined as the average 6-month medication possession ratio (MPR) prior to the first date of the time-window of defining readmission. Results After controlling for demographic, insurance coverage and clinical characteristics, patients who had a heart-disease related readmission had worse adherence, with MPR of 0.70 and 0.74 in the case and control groups. Odds ratio of MPR ≥0.75 was 0.79 (95% CI 0.75-0.83) among those with a readmission relative to those without. Conclusion Our study shows that better 6-month medication adherence may reduce heart-disease related readmissions within a year after an MI. PMID:25651604

  19. The association between Self-Reported Medication Adherence scores and systolic blood pressure control: a SPRINT baseline data study.

    PubMed

    Haley, William E; Gilbert, Olivia N; Riley, Robert F; Newman, Jill C; Roumie, Christianne L; Whittle, Jeffrey; Kronish, Ian M; Tamariz, Leonardo; Wiggers, Alan; Morisky, Donald E; Conroy, Molly B; Kovalik, Eugene; Kressin, Nancy R; Muntner, Paul; Goff, David C

    2016-11-01

    We examined baseline data from the Systolic Blood Pressure Intervention Trial (SPRINT) to investigate whether medication adherence, measured by the 8-item Morisky Medication Adherence Scale (MMAS-8), was associated with systolic blood pressure (SBP) and whether MMAS-8 score and number of antihypertensive medications interacted in influencing SBP. A total of 8435 SPRINT participants were included: 21.2% had low adherence (MMAS-8: <6); 40.0% had medium adherence (6 to <8); and 38.8% had high adherence (8). SBP was <140 mm Hg in 54.6%; 140-160 mm Hg in 36.6%; and >160 mm Hg in 8.8%. In multivariable regression, medium vs. low adherence weakly associated with lower SBP (odds ratio: 1.17; confidence interval: 1.04, 1.31). SPRINT eligibility criteria should be considered when interpreting results. Efforts to understand and enhance adherence are crucial to improve population health, and using self-report instruments might be considered for predicting treatment adherence and response in future efficacy trials and for identifying patients for adherence support in clinical practice.

  20. Adherence to antiepilepsy drug therapy.

    PubMed

    Faught, Edward

    2012-11-01

    Adherence to antiepilepsy drug (AED) therapy is critical for effective disease management, yet adherence and persistence rates are low due to several barriers. The definitions of adherence (80% rate of total pills taken, medication possession ratio, and days covered by prescriptions filled) and methods of measurement (patient self-reports, serum drug levels, pill counts, electronic bottle tops, and reviews of pharmacy records) are not without limitations, and their applicability to epilepsy is not clear. The use of simple adherence scales during office visits can provide an overall impression of a patient's adherence and can serve as a basis for practitioner-patient dialog. Efforts to improve adherence should focus on provider and healthcare system determinants versus those focused only on the patient. These interventions include non-judgmental communication, patient education, simplification of the dosage regimen with once-daily therapies, and the use of patient reminders.

  1. Understanding Statin Non-Adherence: Knowing Which Perceptions and Experiences Matter to Different Patients

    PubMed Central

    Wouters, Hans; Van Dijk, Liset; Geers, Harm C. J.; Winters, Nina A.; Van Geffen, Erica C. G.; Stiggelbout, Anne M.; Bouvy, Marcel L.

    2016-01-01

    Background Non-adherence to statins is substantial and is associated with numerous perceptions and experiences. However, time limits in clinical practice constrain in depth explorations of these perceptions and experiences. Objectives To propose and examine a strategy aimed at an efficient assessment of a wide array of perceptions and experiences regarding the efficacy, side effects, and practical problems of statins. Furthermore, to assess associations between this wide array of experiences and perceptions and non-adherence and to examine whether patients' 'perceived self-efficacy' moderated these associations. Methods Patients were recruited through community pharmacies. A wide array of specific patient perceptions and experiences was efficiently assessed using the electronic Tailored Medicine Inventory that allows people to skip irrelevant questions. Adherence was measured through self-report and pharmacy refill data. Results Of the two-hundred twenty-nine patients who participated (mean age 63.9, standard deviation 10.2), 40%-70% doubted the necessity of or lacked knowledge about the efficacy of statins, 20%-35% of the patients were worried about joint and muscle side effects or had experienced these, and 23% had encountered practical problems regarding information about statins, intake of tablets, the package, or the blister. Experiencing more practical problems was associated with increased unintentional non-adherence (Odds ratio 1.54, 95%CI:1.13–2.10, P < 0.01), whereas worrying about side effects was associated with increased intentional non-adherence (Odds ratio 1.90, 95%CI:1.17–3.08, P < 0.01). Higher 'perceived self-efficacy' did not moderate these associations. Conclusions Insight into patients' specific barriers with regard to appropriate statin use may reveal personal reasons for being non-adherent. The Tailored Medicine Inventory is a promising tool to devise individualized intervention strategies aimed at improving adherence by the clinician

  2. Patient education improves adherence to peg-interferon and ribavirin in chronic genotype 2 or 3 hepatitis C virus infection: A prospective, real-life, observational study

    PubMed Central

    Cacoub, Patrice; Ouzan, Denis; Melin, Pascal; Lang, Jean-Philippe; Rotily, Michel; Fontanges, Thierry; Varastet, Marina; Chousterman, Michel; Marcellin, Patrick

    2008-01-01

    AIM: To evaluate the impact of therapeutic education on adherence to antiviral treatment and sustained virological response (SVR) in a real-life setting in genotype 2/3 hepatitis C, as there are few adherence data in genotype 2/3 infection, even from randomized trials. METHODS: This prospective survey included genotype 2/3 patients who received peg-interferon alfa-2b and ribavirin. There was no intervention. Adherence was self-reported over the past 4 wk (peg-interferon) or 7 d (ribavirin). Adherence to bitherapy was defined as adherence to the two drugs for ≥ 20 wk. SVR was defined as undetectable RNA ≥ 12wk after the end of treatment. RESULTS: 370/674 patients received education during the first 3 mo of treatment. After 6 mo, adherence to bitherapy was higher in educated patients (61% vs 47%, P = 0.01). Adherence to peg-interferon was 78% vs 69% (P = 0.06). Adherence to ribavirin was 70% vs 56% (P = 0.006). The SVR (77% vs 70%, P = 0.05) and relapse (10% vs 16%, P = 0.09) rates tended to be improved. After adjustment for baseline differences, education improved adherence [Odds ratio (OR) 1.58, P = 0.04] but not the SVR (OR 1.54, P = 0.06). CONCLUSION: In genotype 2/3 patients, therapeutic education helped maintain real-life adherence to bitherapy. PMID:18985810

  3. Use of peers to improve adherence to antiretroviral therapy: a global network meta-analysis

    PubMed Central

    Kanters, Steve; Park, Jay JH; Chan, Keith; Ford, Nathan; Forrest, Jamie; Thorlund, Kristian; Nachega, Jean B; Mills, Edward J

    2016-01-01

    Introduction It is unclear whether using peers can improve adherence to antiretroviral therapy (ART). To construct the World Health Organization's global guidance on adherence interventions, we conducted a systematic review and network meta-analysis to determine the effectiveness of using peers for achieving adequate adherence and viral suppression. Methods We searched for randomized clinical trials of peer-based interventions to promote adherence to ART in HIV populations. We searched six electronic databases from inception to July 2015 and major conference abstracts within the last three years. We examined the outcomes of adherence and viral suppression among trials done worldwide and those specific to low- and middle-income countries (LMIC) using pairwise and network meta-analyses. Results and discussion Twenty-two trials met the inclusion criteria. We found similar results between pairwise and network meta-analyses, and between the global and LMIC settings. Peer supporter+Telephone was superior in improving adherence than standard-of-care in both the global network (odds-ratio [OR]=4.79, 95% credible intervals [CrI]: 1.02, 23.57) and the LMIC settings (OR=4.83, 95% CrI: 1.88, 13.55). Peer support alone, however, did not lead to improvement in ART adherence in both settings. For viral suppression, we found no difference of effects among interventions due to limited trials. Conclusions Our analysis showed that peer support leads to modest improvement in adherence. These modest effects may be due to the fact that in many settings, particularly in LMICs, programmes already include peer supporters, adherence clubs and family disclosures for treatment support. Rather than introducing new interventions, a focus on improving the quality in the delivery of existing services may be a more practical and effective way to improve adherence to ART. PMID:27914185

  4. Association between adherence to medications for COPD and medications for other chronic conditions in COPD patients

    PubMed Central

    Dhamane, Amol D; Schwab, Phil; Hopson, Sari; Moretz, Chad; Annavarapu, Srinivas; Burslem, Kate; Renda, Andrew; Kaila, Shuchita

    2017-01-01

    Background Patients with COPD often have multiple comorbidities requiring use of multiple medications, and adherence rates for maintenance COPD (mCOPD) medications are already known to be suboptimal. Presence of comorbidities in COPD patients, and use of medications used to treat those comorbidities (non-COPD medications), may have an adverse impact on adherence to mCOPD medications. Objective The objective of the study was to evaluate the association between non-adherence to mCOPD medications and non-COPD medications in COPD patients. Methods COPD patients were identified using a large administrative claims database. Selected patients were 40–89 years old and continuously enrolled for 12 months prior to and 24 months after the first identified COPD diagnosis (index date) during January 1, 2009 to December 31, 2010. Patients were required to have ≥1 prescription for a mCOPD medication within 365 days of the index date and ≥1 prescription for one of 12 non-COPD medication classes within ±30 days of the first COPD prescription. Adherence (proportion of days covered [PDC]) was measured during 365 days following the first COPD prescription. The association between non-adherence (PDC <0.8) to mCOPD and non-adherence to non-COPD medications was determined using logistic regression, controlling for baseline patient characteristics. Results A total of 14,117 patients, with a mean age of 69.9 years, met study criteria. Of these, 40.9% were males and 79.2% were non-adherent to mCOPD medications with a mean PDC of 0.47. Non-adherence to mCOPD medications was associated with non-adherence to 10 of 12 non-COPD medication classes (odds ratio 1.38–1.78, all P<0.01). Conclusion Adherence to mCOPD medications is low. Non-adherence (or adherence) to mCOPD medications is positively related to non-adherence (or adherence) to non-COPD medications, implying that the need to take medications prescribed for comorbid conditions does not adversely impact adherence to m

  5. Investigating factors associated with adherence behaviour in patients with chronic myeloid leukemia: an observational patient-centered outcome study

    PubMed Central

    Efficace, F; Baccarani, M; Rosti, G; Cottone, F; Castagnetti, F; Breccia, M; Alimena, G; Iurlo, A; Rossi, A R; Pardini, S; Gherlinzoni, F; Salvucci, M; Tiribelli, M; Vignetti, M; Mandelli, F

    2012-01-01

    Background: Optimal adherence to imatinib therapy is of paramount importance to maximise treatment effectiveness in patients with chronic myeloid leukaemia (CML). The main objective of this study was to investigate patient-reported personal factors associated with adherence behaviour. Methods: Analysis was conducted on 413 CML patients receiving long-term therapy with imatinib. Adherence behaviour was measured with the Morisky Medication Adherence Scale and personal factors investigated included: quality of life, perceived social support, fatigue, symptom burden, psychological wellbeing and desire for additional information. Key socio-demographic and treatment-related factors were also taken into account. Univariate and multivariate logistic regression analyses were used to investigate factors associated with optimal adherence to therapy. Results: In all, 53% of patients reported an optimal adherence behaviour. The final multivariate model retained the following variables as independent predictors of optimal adherence to therapy: desire for more information (ref. no), odds ratio (OR)=0.43 (95% confidence interval (CI), 0.29–0.66; P<0.001), social support (higher score representing greater support), OR=1.29 (95% CI, 1.11–1.49; P<0.001) and concomitant drug burden (ref. no), OR=1.82 (95% CI, 1.18–2.80; P=0.006). Conclusion: This study suggests that a higher level of social support, satisfaction with information received and concomitant drug burden are the main factors associated with greater adherence to long-term imatinib therapy. PMID:22871884

  6. Tilted axis rotation in odd-odd {sup 164}Tm

    SciTech Connect

    Reviol, W.; Riedinger, L.L.; Wang, X.Z.; Zhang, J.Y.

    1996-12-31

    Ten band structures are observed in {sup 164}Tm, among them sets of parallel and anti-parallel couplings of the proton and neutron spins. The Tilted Axis Cranking scheme is applied for the first time to an odd-odd nucleus in a prominent region of nuclear deformation.

  7. Antidepressant adherence after psychiatric hospitalization

    PubMed Central

    Zivin, Kara; Ganoczy, Dara; Pfeiffer, Paul N.; Miller, Erin M.; Valenstein, Marcia

    2010-01-01

    Objective Depressed patients discharged from psychiatric hospitalizations face increased risks for adverse outcomes including suicide, yet antidepressant adherence rates during this high-risk period are unknown. Using Veterans Affairs (VA) data, we assessed antidepressant adherence and predictors of poor adherence among depressed veterans following psychiatric hospitalization. Method We identified VA patients nationwide with depressive disorders who had a psychiatric hospitalization between April 1, 1999 and September 30, 2003, received antidepressant medication, and had an outpatient appointment following discharge. We calculated medication possession ratios (MPRs), a measure of medication adherence, within three and six months following discharge. We assessed patient factors associated with having lower levels of adherence (MPRs <0.8) after discharge. Results 20,931 and 23,182 patients met criteria for three and six month MPRs. The mean three month MPR was 0.79 (s.d.=0.37). The mean six month MPR was 0.66 (s.d.=0.40). Patients with poorer adherence were male, younger, non-white, and had a substance abuse disorder, but were less likely to have PTSD or other anxiety disorders. Conclusion Poor antidepressant adherence is common among depressed patients after psychiatric hospitalization. Efforts to improve adherence at this time may be critical in improving the outcomes of these high-risk patients. PMID:19609666

  8. Insulin adherence and persistence among Chinese patients with type 2 diabetes: a retrospective database analysis

    PubMed Central

    He, Xiaoning; Chen, Liming; Wang, Ke; Wu, Haiya; Wu, Jing

    2017-01-01

    Objective To assess adherence and persistence to insulin therapy and identify its associated factors among Chinese insulin-naïve patients with type 2 diabetes (T2D). Methods Tianjin Urban Employee Basic Medical Insurance claims database was used (2008–2011). Adult patients with T2D who initiated insulin therapy during January 2009 through December 2010 and were continuously enrolled for 12 months pre-(baseline) and 12 months post-initiation (follow-up) were included. Patients who had a ≥80% medication possession ratio were deemed adherent, while patients who had no gaps of ≥90 days in insulin therapy were deemed persistent. Associated factors of insulin adherence and persistence were detected by univariate and multivariate analyses. Results A total of 24,192 patients were included; the patients had a mean age of 58.9 years, with 49.5% being female. About 51.9% of the patients had human insulin as initiation therapy, while 39.1% were initiated with insulin analog and 9.0% with animal-derived insulin. Premixed insulin (77.3%) was prescribed most often in comparison with basal (11.8%) and prandial (10.9%) insulin. Only 30.9% of patients were adherent, and the mean (standard deviation) medication possession ratio was 0.499 (0.361). About 53.0% of patients persisted insulin therapy during follow-up, and the mean time to nonpersistence was 230.3 (145.5) days. Patients initiated with analog were more likely to be adherent (adjusted odds ratio: 1.07, P=0.036) and persistent (adjusted hazard ratio: 0.88, P<0.001) compared with those initiated with human insulin. Patients initiation with basal insulin had lower adherence relative to premixed (adjusted odds ratio: 0.79, P<0.001). Patients comorbid with hypertension or dyslipidemia, initiated with prandial insulin, and with baseline severe hypoglycemic events were more likely to be nonadherent/nonpersistent. Conclusion The insulin adherence and persistence among Chinese patients with T2D are generally poor. Initiation

  9. Impossibility to eliminate observer effect in the assessment of adherence in clinical trials

    PubMed Central

    Myers, Jonathan S; Fudemberg, Scott J; Fintelmann, Robert E; Hark, Lisa A; Khanna, Nitasha; Leiby, Benjamin E; Waisbourd, Michael

    2016-01-01

    Purpose To utilize the Travoprost Dosing Aid (DA) in the assessment of patient medication adherence, while also determining whether or not altering the functionality of the DA in three randomized subject groups can reduce observer effect. Methods Forty-five subjects were randomized into three groups: two with monitored DAs and one without monitoring. One group of subjects was given a DA that both monitored drop usage and had visual and audible alarms, while the other monitored group included subjects given a DA that had no alarms but continued to monitor drop usage. The third group was given a DA that had no alarm reminders or dose usage monitoring. Subjects were informed that some monitors would not be functional, in an attempt to reduce observer effect, or the effect of being monitored on subject behavior and adherence. A six-item questionnaire was also utilized to assess how the subjects felt about their adherence and DA use. Results The overall adherence rates were found to be 78% in the fully functional group (95% confidence interval: 70–88) and 76% in the no alarms group (95% confidence interval: 65–89). No association was seen between questionnaire response and medication adherence. The patients in the DA group without alarms had a significantly higher odds ratio of medication adherence if they reported on the questionnaire that using the DA did affect how much they used their drops. Conclusion Though the use of DA was expected to reveal different rates of adherence depending on the functionality of the DA between groups, patients with a nonfunctioning DA did not have a significant difference in medication adherence compared to those given a fully functional DA. This supports that an observer effect was not reduced despite these interventions, and that the subjects adhered to taking their medications as if they had a functioning DA and were being monitored. PMID:27822015

  10. Factors influencing medication knowledge and beliefs on warfarin adherence among patients with atrial fibrillation in China

    PubMed Central

    Zhao, Shujuan; Zhao, Hongwei; Wang, Xianpei; Gao, Chuanyu; Qin, Yuhua; Cai, Haixia; Chen, Boya; Cao, Jingjing

    2017-01-01

    Objectives Warfarin is often used for ischemic stroke prevention in patients with atrial fibrillation (AF), but the factors affecting patient adherence to warfarin therapy have not been fully understood. Methods A cross-sectional survey was conducted in AF patients undergoing warfarin therapy at least 6 months prior to the study. The clinical data collected using questionnaires by phone interviews included the following: 1) self-reported adherence measured by the Morisky Medication Adherence Scale-8©; 2) beliefs about medicines surveyed by Beliefs about Medicines Questionnaire (BMQ); and 3) drug knowledge as measured by the Warfarin Related Knowledge Test (WRKT). Demographic and clinical factors associated with warfarin adherence were identified using a logistic regression model. Results Two hundred eighty-eight patients completed the survey and 93 (32.3%) of them were classified as nonadherent (Morisky Medication Adherence Scale-8 score <6). Major factors predicting warfarin adherence included age, cardiovascular disorders, WRKT, and BMQ; WRKT and BMQ were independently correlated with adherence to warfarin therapy by multivariate logistic regression analysis. Adherents were more likely to have greater knowledge scores and stronger beliefs in the necessity of their specific medications ([odds ratio {OR} =1.81, 95% confidence interval {CI} =1.51–2.15] and [OR =1.17, 95% CI =1.06–1.29], respectively). Patients with greater concerns about adverse reactions and more negative views of general harm were more likely to be nonadherent ([OR =0.76, 95% CI =0.69–0.84] and [OR =0.82, 95% CI =0.73–0.92], respectively). Conclusion BMK and WRKT are related with patient behavior toward warfarin adherence. BMQ can be applied to identify patients at increased risk of nonadherence. PMID:28223782

  11. Selected factors affecting adherence in the pharmacological treatment of arterial hypertension

    PubMed Central

    Jankowska-Polańska, Beata; Chudiak, Anna; Uchmanowicz, Izabella; Dudek, Krzysztof; Mazur, Grzegorz

    2017-01-01

    Background Low adherence to hypertension (HT) management is one of the major contributors to poor blood pressure (BP) control. Approximately 40%–60% of patients with HT do not follow the prescribed treatment. The aim of the study was to analyze the relationship between selected variables and adherence to hypotensive pharmacological treatment. Besides socioclinical variables, the study focused on the role of illness acceptance. Participants and methods The study included 602 patients with HT. Adherence and acceptance of illness were assessed using the following validated instruments: the Acceptance of Illness Scale (AIS) and the Morisky Medication Adherence Scale (MMAS). Results The high-adherence group comprised a significantly higher percentage of patients with high illness acceptance scale scores than that of patients with low-to-moderate scores (42.4 vs 31.8%; P=0.008<0.01). The odds ratio (OR) showed that high adherence to pharmacological treatment was >1.5 times as likely to occur in the high acceptance group as in the low-to-moderate acceptance group (OR =1.58, 95% CI 1.14–2.19). Spearman’s rank correlation coefficients showed statistically significant correlations between adherence and sex (men ρ=−0.101; P=0.012), age >45–66 years (ρ=0.098; P=0.015), higher education level (ρ=0.132; P=0.001), grade ESC of HT (ρ=−0.037; P=0.057), receiving one-tablet polytherapy (ρ=0.131; P=0.015), and illness acceptance (ρ=0.090; P=0.024). Conclusion Acceptance of illness is correlated with adherence to pharmacological treatment, and consideration should be given to more widespread assessment of illness acceptance in daily practice. Male sex, age >45–66 years, duration of illness grade ESC of HT, and receiving one-tablet polytherapy are significant determinants of adherence to pharmacological treatment in HT. PMID:28280309

  12. Early Detection of Poor Adherers to Statins: Applying Individualized Surveillance to Pay for Performance

    PubMed Central

    Zimolzak, Andrew J.; Spettell, Claire M.; Fernandes, Joaquim; Fusaro, Vincent A.; Palmer, Nathan P.; Saria, Suchi; Kohane, Isaac S.; Jonikas, Magdalena A.; Mandl, Kenneth D.

    2013-01-01

    Background Medication nonadherence costs $300 billion annually in the US. Medicare Advantage plans have a financial incentive to increase medication adherence among members because the Centers for Medicare and Medicaid Services (CMS) now awards substantive bonus payments to such plans, based in part on population adherence to chronic medications. We sought to build an individualized surveillance model that detects early which beneficiaries will fall below the CMS adherence threshold. Methods This was a retrospective study of over 210,000 beneficiaries initiating statins, in a database of private insurance claims, from 2008-2011. A logistic regression model was constructed to use statin adherence from initiation to day 90 to predict beneficiaries who would not meet the CMS measure of proportion of days covered 0.8 or above, from day 91 to 365. The model controlled for 15 additional characteristics. In a sensitivity analysis, we varied the number of days of adherence data used for prediction. Results Lower adherence in the first 90 days was the strongest predictor of one-year nonadherence, with an odds ratio of 25.0 (95% confidence interval 23.7-26.5) for poor adherence at one year. The model had an area under the receiver operating characteristic curve of 0.80. Sensitivity analysis revealed that predictions of comparable accuracy could be made only 40 days after statin initiation. When members with 30-day supplies for their first statin fill had predictions made at 40 days, and members with 90-day supplies for their first fill had predictions made at 100 days, poor adherence could be predicted with 86% positive predictive value. Conclusions To preserve their Medicare Star ratings, plan managers should identify or develop effective programs to improve adherence. An individualized surveillance approach can be used to target members who would most benefit, recognizing the tradeoff between improved model performance over time and the advantage of earlier detection. PMID

  13. Reasons for non-adherence to antiretroviral therapy: patients' perspectives provide evidence of multiple causes.

    PubMed

    Walsh, J C; Horne, R; Dalton, M; Burgess, A P; Gazzard, B G

    2001-12-01

    The objective of the study was to define common reasons for non-adherence (NA) to highly active antiretroviral therapy (HAART) and the number of reasons reported by non-adherent individuals. A confidential questionnaire was administered to HIV-seropositive patients taking proteinase inhibitor based HAART. Median self-reported adherence was 95% (n = 178, range = 60-100%). The most frequent reasons for at least 'sometimes' missing a dose were eating a meal at the wrong time (38.2%), oversleeping (36.3%), forgetting (35.0%) and being in a social situation (30.5%). The mean number of reasons occurring at least 'sometimes' was 3.2; 20% of patients gave six or more reasons; those reporting the lowest adherence reported a significantly greater numbers of reasons (rho = - 0.59; p < 0.001). Three factors were derived from the data by principal component analysis reflecting 'negative experiences of HAART', 'having a low priority for taking medication' and 'unintentionally missing doses', accounting for 53.8% of the variance. On multivariate analysis only the latter two factors were significantly related to NA (odds ratios 0.845 and 0.849, respectively). There was a wide spectrum of reasons for NA in our population. The number of reasons in an individual increased as adherence became less. A variety of modalities individualized for each patient are required to support patients with the lowest adherence.

  14. Potentially modifiable factors associated with non-adherence to phosphate binder use in patients on hemodialysis

    PubMed Central

    2013-01-01

    Background Despite the evidence that phosphate binder (PB) is associated with improved outcomes many hemodialysis patients do not adhere to prescribed PB regimen. Therefore, barriers to PB adherence should be identified and eliminated. The purpose of this study was to evaluate PB adherence among hemodialysis patients and to explore potentially modifiable factors associated with low PB adherence. Methods A cross-sectional study (502 patients) was performed in four dialysis units in Salvador, Brazil, using data from the second phase of the Prospective Study of the Prognosis of Chronic Hemodialysis Patients (PROHEMO). Patients were categorized as adherent or non-adherent to PB based on their responses to a semi-structured questionnaire. Results Non-adherence to PB was observed for 65.7% of the patients. After adjustments for numerous covariates, cerebrovascular disease (odds ratio (OR), 3.30; 95% confidence interval (CI), 1.03-10.61), higher PTH (OR per each 300 pg/mL, 1.14; 95% CI, 1.01-1.28), lack of comprehension of the appropriate time to use PB (OR, 7.09; 95% CI, 2.10-23.95) and stopping PB use after feeling better (OR, 4.54; 95% CI, 1.45-14.25) or feeling worse (OR, 11.04; 95% CI, 1.79- 68.03) were significantly associated with PB non-adherence. By contrast, the adjusted odds of PB non-adherence were lower for patients with more years on dialysis (OR by each 2 years, 0.87; 95% CI, 0.80-0.95), with serum phosphorus above 5.5 mg/dL (OR, 0.53; 95% CI 0.34-0.82), who referred that were encouraged by the dialysis staff to be independent (OR, 0.52; 95% CI 0.30-0.90), and reported that the nephrologist explained how PB should be used (OR, 0.20; 95% CI 0.05-0.73). Conclusion The results of the present study are encouraging by showing evidence that improvement in the care provided by the dialysis staff and the attending nephrologist may play an important role in reducing the high prevalence of non-adherence to PB in maintenance hemodialysis patients. A new

  15. Can Rapid Diagnostic Testing for Malaria Increase Adherence to Artemether-Lumefantrine?: A Randomized Controlled Trial in Uganda.

    PubMed

    Saran, Indrani; Yavuz, Elif; Kasozi, Howard; Cohen, Jessica

    2016-04-01

    Most patients with suspected malaria do not receive diagnostic confirmation before beginning antimalarial treatment. We investigated the extent to which uncertainty about malaria diagnosis contributes to patient nonadherence to artemether-lumefantrine (AL) treatment through a randomized controlled trial in central Uganda. Among 1,525 patients purchasing a course of AL at private drug shops, we randomly offered 37.6% a free malaria rapid diagnostic test (RDT) and then assessed adherence through home visits 3 days later. Of these subjects, 68.4% tested positive for malaria and 65.8% adhered overall. Patients who tested positive did not have significantly higher odds of adherence than those who were not offered the test (adjusted odds ratio [OR]: 1.07, 95% confidence interval [CI]: 0.734-1.57,P= 0.719). Patients who received a positive malaria test had 0.488 fewer pills remaining than those not offered the test (95% CI: -1.02 to 0.043,P= 0.072). We found that patients who felt relatively healthy by the second day of treatment had lower odds of completing treatment (adjusted OR: 0.532, 95% CI: 0.394-0.719,P< 0.001). Our results suggest that diagnostic testing may not improve artemisinin-based combination therapy adherence unless efforts are made to persuade patients to continue taking the full course of drugs even if symptoms have resolved.

  16. ODD Symptom Network during Preschool.

    PubMed

    Smith, Tess E; Lee, Christine A; Martel, Michelle M; Axelrad, Marni E

    2016-08-15

    Several different conceptualizations of Oppositional Defiant Disorder (ODD) symptoms have been proposed, including one undivided set of symptoms (DSM-IV-TR; APA 2000); two domains of symptoms subdivided into affective and behavioral; and three domains of symptoms subdivided as angry/irritable, argumentative/defiant, and spiteful. The current study utilizes a novel approach to examining the division of ODD symptoms through use of network analysis. Participants were 109 preschoolers (64 male) between the ages of three and six (M = 4.34 years, SD = 1.08) and their parents and teachers/caregivers, who provided ratings of ODD symptoms. Results are consistent with one-, two-, and three- cluster solutions of ODD, but perhaps provide most support for the three-cluster solution. In addition, results support the idea that negative affect, particularly anger, forms the core of the ODD symptom network during preschool. These results suggest the importance of targeting anger in preschool interventions for ODD.

  17. Socioeconomic and familial characteristics influence caretakers' adherence to the periodic vitamin A capsule supplementation program in Central Java, Indonesia.

    PubMed

    Pangaribuan, Rosnani; Scherbaum, Veronika; Erhardt, Jürgen G; Sastroamidjojo, Soemilah; Biesalski, Hans K

    2004-06-01

    The adherence of program participants to periodic vitamin A capsule (VAC) supplementation among children aged 1-5 years (n = 677) in Central Java, Indonesia was assessed. Fourteen villages from five sub-districts and one ward from one sub-district in Central Java were included in the study to represent rural and suburban areas. All questions about demographic factors, socioeconomic conditions, current dietary practice and healthcare-seeking attitudes for common childhood illnesses, previous breastfeeding experience, their knowledge about vitamin A and adherence to the VAC program after capsule distribution (two periods in 2000) were asked. Caretakers with limited knowledge about the health benefits of vitamin A, households with more than one preschool child, and households with older children (> 36 months) were associated with a decreased likelihood of regular participation in the program with odds ratios of 0.38, 0.55, and 0.26, respectively (p < 0.01). The percentage of caretakers who utilized community health centers, village health posts or midwives' practices in rural areas, was significantly higher (86.6 per cent, p < 0.001) than in suburban areas (62.8 per cent). Living in a rural location was associated with an increased adherence to participate in the program regularly with an odds ratio of 2.02 (p < 0.01). In conclusion, nutritional education and periodic social marketing should be re-emphasized and other potential delivery channels, such as private healthcare practices, could also contribute to an increase adherence of supplementation program.

  18. Mental Health and Antiretroviral Adherence Among Youth Living With HIV in Rwanda

    PubMed Central

    Smith Fawzi, Mary C.; Ng, Lauren; Kanyanganzi, Fredrick; Kirk, Catherine; Bizimana, Justin; Cyamatare, Felix; Mushashi, Christina; Kim, Taehoon; Kayiteshonga, Yvonne; Binagwaho, Agnes; Betancourt, Theresa S.

    2016-01-01

    BACKGROUND AND OBJECTIVES In Rwanda, significant progress has been made in advancing access to antiretroviral therapy (ART) among youth. As availability of ART increases, adherence is critical for preventing poor clinical outcomes and transmission of HIV. The goals of the study are to (1) describe ART adherence and mental health problems among youth living with HIV aged 10 to 17; and (2) examine the association between these factors among this population in rural Rwanda. METHODS A cross-sectional analysis was conducted that examined the association of mental health status and ART adherence among youth (n = 193). ART adherence, mental health status, and related variables were examined based on caregiver and youth report. Nonadherence was defined as ever missing or refusing a dose of ART within the past month. Multivariate modeling was performed to examine the association between mental health status and ART adherence. RESULTS Approximately 37% of youth missed or refused ART in the past month. In addition, a high level of depressive symptoms (26%) and attempt to hurt or kill oneself (12%) was observed in this population of youth living with HIV in Rwanda. In multivariate analysis, nonadherence was significantly associated with some mental health outcomes, including conduct problems (odds ratio 2.90, 95% confidence interval 1.55–5.43) and depression (odds ratio 1.02, 95% confidence interval 1.01–1.04), according to caregiver report. A marginally significant association was observed for youth report of depressive symptoms. CONCLUSIONS The findings suggest that mental health should be considered among the factors related to ART nonadherence in HIV services for youth, particularly for mental health outcomes, such as conduct problems and depression. PMID:27677570

  19. Modeling level structures of odd-odd deformed nuclei

    SciTech Connect

    Hoff, R.W.; Kern, J.; Piepenbring, R.; Boisson, J.P.

    1985-01-15

    A technique for modeling quasiparticle excitation energies and rotational parameters in odd-odd deformed nuclei has been applied to actinide species where new experimental data have been obtained by use of neutron-capture gamma-ray spectroscopy. The input parameters required for the calculation were derived from empirical data on single-particle excitations in neighboring odd-mass nuclei. Calculated configuration-specific values for the Gallagher-Moszkowski splittings were used. Calculated and experimental level structures for /sup 238/Np, /sup 244/Am, and /sup 250/Bk are compared, as well as those for several nuclei in the rare-earch region. The agreement for the actinide species is excellent, with bandhead energies deviating 22 keV and rotational parameters 5%, on the average. Corresponding average deviations for five rare-earth nuclei are 47 keV and 7%. Several applications of this modeling technique are discussed.

  20. Modeling level structures of odd-odd deformed nuclei

    SciTech Connect

    Hoff, R.W.; Kern, J.; Piepenbring, R.; Boisson, J.P.

    1984-09-07

    A technique for modeling quasiparticle excitation energies and rotational parameters in odd-odd deformed nuclei has been applied to actinide species where new experimental data have been obtained by use of neutron-capture gamma-ray spectroscopy. The input parameters required for the calculation were derived from empirical data on single-particle excitations in neighboring odd-mass nuclei. Calculated configuration-specific values for the Gallagher-Moszkowski splittings were used. Calculated and experimental level structures for /sup 238/Np, /sup 244/Am, and /sup 250/Bk are compared, as well as those for several nuclei in the rare-earth region. The agreement for the actinide species is excellent, with bandhead energies deviating 22 keV and rotational parameters 5%, on the average. Corresponding average deviations for five rare-earth nuclei are 47 keV and 7%. Several applications of this modeling technique are discussed. 18 refs., 5 figs., 4 tabs.

  1. The Effect on Treatment Adherence of Administering Drugs as Fixed-Dose Combinations versus as Separate Pills: Systematic Review and Meta-Analysis

    PubMed Central

    van Galen, Katy A.; Nellen, Jeannine F.; Nieuwkerk, Pythia T.

    2014-01-01

    Administering drugs as fixed-dose combinations (FDCs) versus the same active drugs administered as separate pills is assumed to enhance treatment adherence. We synthesized evidence from randomized controlled trials (RCTs) about the effect of FDCs versus separate pills on adherence. We searched PubMed for RCTs comparing a FDC with the same active drugs administered as separate pills, including a quantitative estimate of treatment adherence, without restriction to medical condition. The odds ratio (OR) of optimal adherence with FDCs versus separate pills was used as common effect size and aggregated into a pooled effect estimate using a random effect model with inverse variance weights. Out of 1258 articles screened, only six studies fulfilled inclusion criteria. Across medical conditions, administering drugs as FDC significantly increased the likelihood of optimal adherence (OR 1.33 (95% CI, 1.03–1.71)). Within subgroups of specific medical conditions, the favourable effect of FDCs on adherence was of borderline statistical significance for HIV infection only (OR 1.46 (95% CI, 1.00–2.13)). We observed a remarkable paucity of RCTs comparing the effect on adherence of administering drugs as FDC versus as separate pills. Administering drugs as FDC improved medication adherence. However, this conclusion is based on a limited number of RCTs only. PMID:25276422

  2. The Effect on Treatment Adherence of Administering Drugs as Fixed-Dose Combinations versus as Separate Pills: Systematic Review and Meta-Analysis.

    PubMed

    van Galen, Katy A; Nellen, Jeannine F; Nieuwkerk, Pythia T

    2014-01-01

    Administering drugs as fixed-dose combinations (FDCs) versus the same active drugs administered as separate pills is assumed to enhance treatment adherence. We synthesized evidence from randomized controlled trials (RCTs) about the effect of FDCs versus separate pills on adherence. We searched PubMed for RCTs comparing a FDC with the same active drugs administered as separate pills, including a quantitative estimate of treatment adherence, without restriction to medical condition. The odds ratio (OR) of optimal adherence with FDCs versus separate pills was used as common effect size and aggregated into a pooled effect estimate using a random effect model with inverse variance weights. Out of 1258 articles screened, only six studies fulfilled inclusion criteria. Across medical conditions, administering drugs as FDC significantly increased the likelihood of optimal adherence (OR 1.33 (95% CI, 1.03-1.71)). Within subgroups of specific medical conditions, the favourable effect of FDCs on adherence was of borderline statistical significance for HIV infection only (OR 1.46 (95% CI, 1.00-2.13)). We observed a remarkable paucity of RCTs comparing the effect on adherence of administering drugs as FDC versus as separate pills. Administering drugs as FDC improved medication adherence. However, this conclusion is based on a limited number of RCTs only.

  3. Nonadiabatic effects in odd-odd deformed proton emitters

    SciTech Connect

    Patial, M.; Jain, A. K.; Arumugam, P.; Maglione, E.; Ferreira, L. S.

    2011-11-30

    We present for the first time, the nonadiabatic quasiparticle approach to study proton emission from odd-odd deformed nuclei. Coriolis effects are incorporated in both the parent and daughter wavefunctions and hence our formalism allows us to study their complete role on the decay widths. First results obtained for the nucleus {sup 112}Cs suggest a weak dependance on Coriolis effect. However, we are able to reproduce the experimental half-lives without assuming the exact Nilsson orbital from which the decay proceeds.

  4. Comparison of adherence and persistence among adults with type 2 diabetes mellitus initiating saxagliptin or linagliptin

    PubMed Central

    Farr, Amanda M; Sheehan, John J; Davis, Brian M; Smith, David M

    2016-01-01

    Background Adherence and persistence to antidiabetes medications are important to control blood glucose levels among individuals with type 2 diabetes mellitus (T2D). Objectives The objective of this study was to compare adherence and persistence over a 12-month period between patients initiating saxagliptin and patients initiating linagliptin, two dipeptidyl peptidase-4 inhibitors. Methods This retrospective cohort study was conducted in MarketScan® Commercial and Medicare Supplemental claims databases. Patients with T2D initiating saxagliptin or linagliptin between January 1, 2009, and June 30, 2013, were selected. Patients were required to be at least 18 years old and have 12 months of continuous enrollment prior to and following initiation. Adherence and persistence to initiated medication were measured over the 12 months after initiation using outpatient pharmacy claims. Patients were considered adherent if the proportion of days covered was ≥0.80. Patients were considered nonpersistent (or to have discontinued) if there was a gap of >60 days without initiated medication on hand. Multivariable logistic regression and multivariable Cox proportional hazard models were fit to compare adherence and persistence, respectively, between the two cohorts. Results There were 21,599 saxagliptin initiators (mean age 55 years; 53% male) and 5,786 linagliptin initiators (mean age 57 years; 54% male) included in the study sample. Over the 12-month follow-up, 46% of saxagliptin initiators and 42% of linagliptin initiators were considered adherent and 47% of saxagliptin initiators and 51% of linagliptin initiators discontinued their initiated medication. After controlling for patient characteristics, saxagliptin initiation was associated with significantly greater odds of being adherent (adjusted odds ratio =1.212, 95% CI 1.140–1.289) and significantly lower hazards of discontinuation (adjusted hazard ratio =0.887, 95% CI 0.850–0.926) compared with linagliptin initiation

  5. HIV Medication Adherence

    MedlinePlus

    HIV Treatment HIV Medication Adherence (Last updated 3/2/2017; last reviewed 3/2/2017) Key Points Medication adherence means sticking firmly to ... Before and After Starting HIV Medicines . What is medication adherence? Adherence means “to stick firmly.” So for ...

  6. Colon Cancer Staging in Vulnerable Older Adults: Adherence to National Guidelines and Impact on Survival

    PubMed Central

    Leal, TB; Holden, T; Cavalcante, L; Allen, GO; Schumacher, JR; Smith, MA; Weiss, JM; Neuman, HB; LoConte, NK

    2015-01-01

    Background There is concern that elders are not adequately evaluated prior to colon cancer surgery. We sought to determine adherence with ACOVE-3 (Assessing Care of Vulnerable Elders) quality indicators for pre-operative staging prior to colectomy for colon cancer utilizing the Surveillance, Epidemiology and End Results (SEER)-Medicare linked database (1992–2005). Methods We determined the proportion of patients aged 75 and older who had preoperative staging prior to colectomy for colon adenocarcinoma. Preoperative staging was defined as abdominopelvic computed tomography or magnetic resonance imaging scan (SCAN) and colonoscopy or flexible sigmoidoscopy (SCOPE). Multivariate logistic regression identified predictors of adherence. Odds ratios were adjusted for comorbidity, socioeconomic status, and disease severity. The association of adherence to ACOVE-3 and survival was quantified. Results Of the 37,862 patients, the majority were 75–84 years, 28% of the patients were ≥85 years. Regarding preoperative staging in the 6-month interval prior to surgical resection, 8% had neither SCAN nor SCOPE, 6% had only SCAN, 43% had only SCOPE, and 43% had both SCAN and SCOPE. Compared to patients who were not staged, those evaluated with either SCOPE alone or SCAN plus SCOPE had lower odds of 3-year mortality. Patients who were staged with SCAN alone had an increased odds of death compared to those who had neither SCAN or SCOPE. Conclusions These data demonstrate that the majority of vulnerable elders with colon cancer did not receive appropriate preoperative staging prior to resection. The findings also confirm that adherence to ACOVE-3 guidelines is associated with improved long-term survival. PMID:25914900

  7. On Quantizable Odd Lie Bialgebras

    NASA Astrophysics Data System (ADS)

    Khoroshkin, Anton; Merkulov, Sergei; Willwacher, Thomas

    2016-09-01

    Motivated by the obstruction to the deformation quantization of Poisson structures in infinite dimensions, we introduce the notion of a quantizable odd Lie bialgebra. The main result of the paper is a construction of the highly non-trivial minimal resolution of the properad governing such Lie bialgebras, and its link with the theory of so-called quantizable Poisson structures.

  8. Reflection asymmetry in odd-A and odd-odd actinium nuclei

    SciTech Connect

    Ahmad, I.

    1993-09-01

    Theoretical calculations and measurements indicate that octupole correlations are at a maximum in the ground states of the odd-proton nuclei Ac and Pa. It has been expected that odd-odd nuclei should have even larger amount of octupole-octupole correlations. We have recently made measurements on the structure of {sup 224}Ac. Although spin and parity assignments could not be made, two bands starting at 354.1 and 360.0 keV have properties characteristic of reflection asymmetric shape. These two bands have very similar rotational constants and also similar alpha decay rates, which suggest similarity between the wavefunctions of these bands. These signatures provide evidence for octupole correlations in these nuclides.

  9. Comparative analysis of non-adherence to medication treatment for systemic arterial hypertension in urban and rural populations 1

    PubMed Central

    Magnabosco, Patricia; Teraoka, Eliana Cavalari; de Oliveira, Edward Meirelles; Felipe, Elisangela Aparecida; Freitas, Dayana; Marchi-Alves, Leila Maria

    2015-01-01

    OBJECTIVE: to evaluate the indexes and the main factors associated with non-adherence to medication treatment for systemic arterial hypertension between urban and rural areas. METHOD: analytical study based on an epidemiological survey with a sample of 247 hypertensive residents of rural and urban areas, with application of a socio-demographic and economic questionnaire, and treatment adherence assessment. The Pearson's Chi-square test was used and the odds ratio (OD) was calculated to analyze the factors related to non-adherence. RESULTS: the prevalence of non-adherence was 61.9% and it was higher in urban areas (63.4%). Factors significantly associated with non-adherence were: male gender (OR=1.95; 95% CI 1.08-3.50), age 20-59 years old (OR=2.51; 95% CI 1.44-4.39), low economic status (OR=1.95; 95% CI 1.09-3.47), alcohol consumption (OR=5.92, 95% CI 1.73-20.21), short time of hypertension diagnosis (OR=3.07; 95% CI 1.35-6.96) and not attending the health service for routine consultations (OR=2.45; 1.35-4.42). CONCLUSION: the socio-demographic/economic characteristics, lifestyle habits and how to relate to health services were the factors that presented association with non-adherence regardless of the place of residence. PMID:25806627

  10. Theoretical description of fine structure in the α decay of heavy odd-odd nuclei

    NASA Astrophysics Data System (ADS)

    Ni, Dongdong; Ren, Zhongzhou

    2013-02-01

    The newly developed multichannel cluster model (MCCM), based on the coupled-channel Schrödinger equation with outgoing wave boundary conditions, is extended to study the α-decay fine structure in heavy odd-odd nuclei. Calculations are performed for the α transitions to favored rotational bands where the unpaired nucleons remain unchanged. The simple WKB barrier penetration formula is also used to evaluate the branching ratios for various daughter states. It is found that the WKB formula seems to overestimate the branching ratios for the second and third members of the favored rotational band, while the MCCM gives a precise description of them without any adjustable parameters. Moreover, the experimental total α-decay half-lives are well reproduced within the MCCM.

  11. Excited states of the 150Pm odd-odd nucleus

    NASA Astrophysics Data System (ADS)

    Bucurescu, D.; Drăgulescu, E.; Pascu, S.; Wirth, H.-F.; Filipescu, D.; Căta-Danil, G.; Căta-Danil, I.; Deleanu, D.; Eppinger, K.; Faestermann, T.; Ghiţă, D. G.; Glodariu, T.; Hertenberger, R.; Ivaşcu, M.; Krücken, R.; Mărginean, N.; Mărginean, R.; Mihai, C.; Negret, A.; Sava, T.; Stroe, L.; Wimmer, K.; Zamfir, N. V.

    2012-01-01

    The knowledge of excited states in the odd-odd 150Pm, completely unknown until recently, is important both for understanding double β decay of 150Nd and for nuclear structure studies in mass regions with a quantum phase transition. A large number of excited states have been determined for the first time in this nucleus by measuring spectra of the 152Sm(d,α) direct reaction at 25 MeV with the Munich Q3D spectrograph and by γ-ray spectroscopy with the (p,nγ) reaction at 7.1 MeV at the Bucharest tandem accelerator. Some of these levels correspond to peaks recently observed with the (3He,t) reaction at 140 MeV/u.

  12. Factors Associated with Adherence to the HEDIS Quality Measure in Medicaid Patients with Schizophrenia

    PubMed Central

    Lafeuille, Marie-Hélène; Frois, Christian; Cloutier, Michel; Duh, Mei Sheng; Lefebvre, Patrick; Pesa, Jacqueline; Clancy, Zoe; Fastenau, John; Durkin, Mike

    2016-01-01

    Background Treatment continuity is a major challenge in the long-term management of patients with schizophrenia; poor patient adherence to antipsychotic drugs has been associated with negative clinical outcomes. Long-acting injectable therapies may improve adherence and lessen the risk for psychiatric-related relapse, often leading to rehospitalization and higher healthcare costs. Therefore, understanding the determinants of adherence to antipsychotics is critical in the management of patients with schizophrenia. Objective To assess the impact of baseline patient characteristics on adherence as measured by the Healthcare Effectiveness Data and Information Set (HEDIS) measure of continuity of antipsychotic medications among patients with Medicaid coverage. Methods Medicaid healthcare claims data between 2008 and 2011 from 5 states were used to identify patients who were diagnosed with schizophrenia (aged 25–64 years) and received ≥1 antipsychotic prescriptions in baseline year 2010 and in measurement year 2011. The HEDIS continuity of antipsychotic medications (ie, adherence) measure was defined as the proportion of days covered with any antipsychotic medication ≥80% during the measurement year. The 2 cohorts compared paliperidone palmitate with any other antipsychotics, including quetiapine, risperidone, and haloperidol. The baseline-year characteristics were evaluated as potential predictive factors of adherence in the measurement year using multivariate logistic regressions. The regression models incorporated the inverse probability of treatment weights to control for differences in baseline characteristics between the paliperidone palmitate and the other antipsychotics cohort. Results Among the 12,990 patients who received an antipsychotic during the study period, 48.6% successfully achieved the continuity criteria in the measurement year. After controlling for other covariates, the odds of adherence were improved by adherence at baseline (odds ratio [OR

  13. Hypertension: adherence to treatment in rural Bangladesh – findings from a population-based study

    PubMed Central

    Khanam, Masuma Akter; Lindeboom, Wietze; Koehlmoos, Tracey Lynn Perez; Alam, Dewan Shamsul; Niessen, Louis; Milton, Abul Hasnat

    2014-01-01

    Background Poor adherence has been identified as the main cause of failure to control hypertension. Poor adherence to antihypertensive treatment is a significant cardiovascular risk factor, which often remains unrecognized. There are no previous studies that examined adherence with antihypertensive medication or the characteristics of the non-adherent patients in Bangladesh. Objective This paper aims to describe hypertension and factors affecting adherence to treatment among hypertensive persons in rural Bangladesh. Design The study population included 29,960 men and women aged 25 years and older from three rural demographic surveillance sites of the International Center for Diarrheal Disease Research, Bangladesh (icddr,b): Matlab, Abhoynagar, and Mirsarai. Data was collected by a cross-sectional design on diagnostic provider, initial, and current treatment. Discontinuation of medication at the time of interview was defined as non-adherence to treatment. Results The prevalence of hypertension was 13.67%. Qualified providers diagnosed only 53.5% of the hypertension (MBBS doctors 46.1 and specialized doctors 7.4%). Among the unqualified providers, village doctors diagnosed 40.7%, and others (nurse, health worker, paramedic, homeopath, spiritual healer, and pharmacy man) each diagnosed less than 5%. Of those who started treatment upon being diagnosed with hypertension, 26% discontinued the use of medication. Age, sex, education, wealth, and type of provider were independently associated with non-adherence to medication. More men discontinued the treatment than women (odds ratio [OR] 1.74, confidence interval [CI] 1.48–2.04). Non-adherence was greater when hypertension was diagnosed by unqualified providers (OR 1.52, CI 1.31–1.77). Hypertensive patients of older age, least poor quintile, and higher education were less likely to be non-adherent. Patients with cardiovascular comorbidity were also less likely to be non-adherent to antihypertensive medication (OR 0

  14. A Metaanalysis of Interventions to Improve Adherence to Lipid-Lowering Medication

    PubMed Central

    Deichmann, Richard E.; Morledge, Michael D.; Ulep, Robin; Shaffer, Johnathon P.; Davies, Philippa; van Driel, Mieke L.

    2016-01-01

    Background: Inadequate patient adherence to a medication regimen is a major factor in the lack of success in treating hyperlipidemia. Improved adherence rates may result in significantly improved cardiovascular outcomes in populations treated with lipid-lowering therapy. The purpose of this metaanalysis was to evaluate the effectiveness of interventions aimed at improving adherence to lipid-lowering drugs, focusing on measures of adherence and clinical outcomes. Methods: We searched the Cochrane Central Register of Controlled Trials, MEDLINE, EMBASE, PsycINFO, and the Cumulative Index to Nursing and Allied Health Literature databases through January 14, 2015, and also used the results from previous Cochrane reviews of this title. Randomized controlled trials of adherence-enhancing interventions for lipid-lowering medication in adults in an ambulatory setting with measurable outcomes were evaluated with criteria outlined by the Cochrane Handbook for Systematic Reviews of Interventions. Results: Twenty-seven studies randomly assigning 899,068 participants to a variety of interventions were analyzed. One group of interventions categorized as intensified patient care showed significant improvement in adherence rates when compared to usual care (odds ratio 1.93; 95% confidence interval [CI] 1.29-2.88). Additionally, after <6 months of follow-up, total cholesterol decreased by a mean of 17.15 mg/dL (95% CI 1.17-33.14), while after >6 months total cholesterol decreased by a mean of 17.57 mg/dL (95% CI 14.95-20.19). Conclusion: Healthcare systems that can implement team-based intensified patient care interventions, such as electronic reminders, pharmacist-led interventions, and healthcare professional education of patients, may be successful in improving adherence rates to lipid-lowering medicines. PMID:27660570

  15. Adherence to artemether/lumefantrine treatment in children under real-life situations in rural Tanzania.

    PubMed

    Simba, Daudi O; Kakoko, Deodatus; Tomson, Goran; Premji, Zul; Petzold, Max; Mahindi, Margarita; Gustafsson, Lars L

    2012-01-01

    A follow-up study was conducted to determine the magnitude of and factors related to adherence to artemether/lumefantrine (ALu) treatment in rural settings in Tanzania. Children in five villages of Kilosa District treated at health facilities were followed-up at their homes on Day 7 after the first dose of ALu. For those found to be positive using a rapid diagnostic test for malaria and treated with ALu, their caretakers were interviewed on drug administration habits. In addition, capillary blood samples were collected on Day 7 to determine lumefantrine concentrations. The majority of children (392/444; 88.3%) were reported to have received all doses, in time. Non-adherence was due to untimeliness rather than missing doses and was highest for the last two doses. No significant difference was found between blood lumefantrine concentrations among adherent (median 286 nmol/l) and non-adherent [median 261 nmol/l; range 25 nmol/l (limit of quantification) to 9318 nmol/l]. Children from less poor households were more likely to adhere to therapy than the poor [odds ratio (OR)=2.45, 95% CI 1.35-4.45; adjusted OR=2.23, 95% CI 1.20-4.13]. The high reported rate of adherence to ALu in rural areas is encouraging and needs to be preserved to reduce the risk of emergence of resistant strains. The age-based dosage schedule and lack of adherence to ALu treatment guidelines by health facility staff may explain both the huge variability in observed lumefantrine concentrations and the lack of difference in concentrations between the two groups.

  16. The Madison Avenue Effect: How drug presentation style influences adherence and outcome in patients with asthma

    PubMed Central

    Clerisme-Beaty, Emmanuelle M; Bartlett, Susan J; Teague, W. Gerald; Lima, John; Irvin, Charles G; Cohen, Rubin; Castro, Mario; Wise, Robert A; Rand, Cynthia S

    2010-01-01

    Background Little is known about how drug presentation influences medication adherence. Objective Examine the effect of an educational program aimed at increasing expectations of treatment benefit on medication adherence. Methods Data are analyzed from 99 participants who underwent electronic drug monitoring during TAPE (Trial of Asthma Patient Education), a randomized placebo-controlled multi-center trial. Participants with suboptimally-controlled asthma were randomized to placebo or montelukast in conjunction with a presentation mode that was either neutral or designed to increase outcome expectancy. Adherence was monitored electronically over 4 weeks, and was defined as ≥ 80% use of prescribed doses. Outcome expectancy, peak expiratory flow, pre-bronchodilator forced expiratory volume, asthma control (ACQ), and asthma-related quality of life were assessed at baseline and at the 4-week follow-up. Results Average electronic medication adherence was 69.9%. There was a significant interaction between presentation mode and drug assignment, with participants in the enhanced/montelukast group having a higher change in outcome expectancy (Δ 2.1 points, p < 0.001) and better medication adherence (odds ratio 4.0, CI 1.1, 14.3) compared to those in the neutral/placebo group. There was no difference in asthma symptoms, quality of life, or clinical outcomes based on presentation mode. Rather, increased outcome expectancy was associated with modest improvements in asthma symptoms after adjusting for presentation mode, drug assignment, and medication adherence. Conclusion The use of an enhanced presentation aimed at increasing outcome expectancy may lead to improved medication adherence. PMID:21281871

  17. Efficacy of interventions in improving highly active antiretroviral therapy adherence and HIV-1 RNA viral load. A meta-analytic review of randomized controlled trials.

    PubMed

    Simoni, Jane M; Pearson, Cynthia R; Pantalone, David W; Marks, Gary; Crepaz, Nicole

    2006-12-01

    Adherence to highly active antiretroviral therapy (HAART) is generally suboptimal, limiting the effectiveness of HAART. This meta-analytic review examined whether behavioral interventions addressing HAART adherence are successful in increasing the likelihood of a patient attaining 95% adherence or an undetectable HIV-1 RNA viral load (VL). We searched electronic databases from January 1996 to September 2005, consulted with experts in the field, and hand searched reference sections from relevant articles. Nineteen studies (with a total of 1839 participants) met the selection criteria of describing a randomized controlled trial among adults evaluating a behavioral intervention with HAART adherence or VL as an outcome. Random-effects models indicated that across studies, participants in the intervention arm were more likely than those in the control arm to achieve 95% adherence (odds ratio [OR] = 1.50, 95% confidence interval [CI]: 1.16 to 1.94); the effect was nearly significant for undetectable VL (OR = 1.25; 95% CI: 0.99 to 1.59). The intervention effect for 95% adherence was significantly stronger in studies that used recall periods of 2 weeks or 1 month (vs. adherence intervention strategies were shown to be successful, but more research is needed to identify the most efficacious intervention components and the best methods for implementing them in real-world settings with limited resources.

  18. Factors influencing adherence among older people with osteoarthritis.

    PubMed

    Loew, Laurianne; Brosseau, Lucie; Kenny, Glen P; Durand-Bush, Natalie; Poitras, Stéphane; De Angelis, Gino; Wells, George A

    2016-09-01

    This study aims to identify potential factors that could affect adherence and influence the implementation of an evidence-based structured walking program, among older adults diagnosed with knee osteoarthritis. A total of 69 participants with mild to moderate osteoarthritis of the knee fulfilled an online survey on potential factors that could affect their adherence to an evidence-based structured walking program. Adherence with regard to the influencing factors was explored using a logistic regression model. Results tend to show higher odds of adhering to the evidence-based walking program if the participants were supervised (more than 2.9 times as high), supported by family/friends (more than 3.7 times as high), and not influenced by emotional involvement (more than 11 times as high). The odds of adhering were 3.6 times lower for participants who indicated a change in their medication intake and 3.1 times lower for individuals who considered themselves as less physically active (95 % confidence interval (CI)). Our exploratory findings identified and defined potential adherence factors that could guide health professionals in their practice to better identify positive influences and obstacles to treatment adherence, which would lead to the adoption of a more patient-centered approach. A large-scale study is required to clearly delineate the key factors that would influence adherence. We addressed a new knowledge gap by identifying the main strategies to promote the long-term adherence of community-based walking program.

  19. Tuberculosis treatment adherence and fatality in Spain

    PubMed Central

    2009-01-01

    Background The adherence to long tuberculosis (TB) treatment is a key factor in TB control programs. Always some patients abandon the treatment or die. The objective of this study is to identify factors associated with defaulting from or dying during antituberculosis treatment. Methods Prospective study of a large cohort of TB cases diagnosed during 2006-2007 by 61 members of the Spanish Society of Pneumology and Thoracic Surgery (SEPAR). Predictive factors of completion outcome (cured plus completed treatment vs. defaulters plus lost to follow-up) and fatality (died vs. the rest of patients) were based on logistic regression, calculating odds ratios (OR) and 95% confidence intervals (CI). Results Of the 1490 patients included, 29.7% were foreign-born. The treatment outcomes were: cured 792 (53.2%), completed treatment 540 (36.2%), failure 2 (0.1%), transfer-out 33 (2.2%), default 27 (1.8%), death 27 (1.8%), lost to follow-up 65 (4.4%), other 4 (0.3%). Completion outcome reached 93.5% and poor adherence was associated with: being an immigrant (OR = 2.03; CI:1.06-3.88), living alone (OR = 2.35; CI:1.05-5.26), residents of confined institutions (OR = 4.79; CI:1.74-13.14), previous treatment (OR = 2.93; CI:1.44-5.98), being an injecting drug user (IDU) (OR = 9.51; CI:2.70-33.47) and treatment comprehension difficulties (OR = 2.93; CI:1.44-5.98). Case fatality was 1.8% and it was associated with the following variables: age 50 or over (OR = 10.88; CI:1.12-105.01), retired (OR = 12.26;CI:1.74-86.04), HIV-infected (OR = 9.93; CI:1.48-66.34), comprehension difficulties (OR = 4.07; CI:1.24-13.29), IDU (OR = 23.59; CI:2.46-225.99) and Directly Observed Therapy (DOT) (OR = 3.54; CI:1.07-11.77). Conclusion Immigrants, those living alone, residents of confined institutions, patients treated previously, those with treatment comprehension difficulties, and IDU patients have poor adherence and should be targeted for DOT. To reduce fatality rates, stricter monitoring is required

  20. Treatment adherence and other patient-reported outcomes as cost determinants in multiple sclerosis: a review of the literature

    PubMed Central

    Lizán, Luis; Comellas, Marta; Paz, Silvia; Poveda, José Luis; Meletiche, Dennis M; Polanco, Carlos

    2014-01-01

    Background Treatment adherence is one of the key factors for achieving optimal clinical outcomes. In order to assess costs related to adherence to, and persistence and compliance with, disease-modifying therapies (DMTs) in patients with multiple sclerosis (MS), a narrative review of the literature was performed. Satisfaction with and preference for DMTs and their delivery devices were also assessed, as both can have an influence on patients’ adherence and persistence. Methods Electronic databases (MEDLINE, PubMed, Google Scholar, congress proceedings) were searched to identify publications analyzing MS costs related to adherence, persistence, satisfaction, and preferences for MS treatments. Bibliographic references were hand searched. English or Spanish studies published between January 2007 and January 2013 were selected. Results A total of 398 titles were identified, of which 12 met the inclusion criteria. Six studies evaluated the impact of adherence, persistence, and compliance on treatment costs; four publications analyzed satisfaction with DMTs; and two assessed treatment preferences based on attributes of the delivery device. Increased adherence and persistence were associated with better clinical outcomes, leading to lower relapse risk (odds ratio [OR]: 0.71; 95% confidence interval [CI]: 0.59–0.85) and a decrease in health care resource use, such as MS-related hospitalizations (OR: 0.63; 95% CI: 0.47–0.83) and emergency department visits (OR: 0.80; 95% CI: 0.60–1.07). This reduction in resource use led to a patient/year total cost reduction (excluding DMT costs) of up to 22%. Conclusion This review highlights the importance of ensuring adequate adherence in MS patients through treatments and devices better tailored to patients’ needs that could enhance clinical outcomes and reduce MS costs. Understanding the factors underlying satisfaction and compliance with treatment and patients’ preference for certain therapies could help in the development

  1. Medication Adherence in Children and Adolescents with HIV Infection: Associations with Behavioral Impairment

    PubMed Central

    Williams, Paige; Montepiedra, Grace; McCabe, Marie; Nichols, Sharon; Sirois, Patricia A.; Storm, Deborah; Farley, John; Kammerer, Betsy

    2011-01-01

    Abstract The impact of behavioral functioning on medication adherence in children with perinatally acquired HIV infection is not well-explored, but has important implications for intervention. This report addresses the relationship between behavioral functioning and child self-report or caregiver report of medication adherence among children and adolescents enrolled in Pediatric AIDS Clinical Trials Group Protocol 219C (conducted 2000–2007). A total of 1134 participants, aged 3–17 years, received a behavioral evaluation and adherence assessment. Complete adherence was defined as taking 100% of prescribed antiretroviral medications during three days preceding the study visit. Multivariable logistic regression models were used to evaluate associations between adherence and behavioral functioning, adjusting for potential confounders, including demographic, psychosocial, and health factors. Children demonstrated higher than expected rates of behavioral impairment (≈7% expected with T > 65) in the areas of conduct problems (14%, z = 7.0, p < 0.001), learning problems (22%, z = 12.2, p < 0.001), somatic complaints (22%, z = 12.6, p < 0.001), impulsivity-hyperactivity (20%, z = 11.1, p < 0.001), and hyperactivity (19%, z = 10.6, p < 0.001). Children with behavioral impairment in one or more areas had significantly increased odds of nonadherence [adjusted odds ratio (aOR) = 1.49, p = 0.04]. The odds of nonadherence were significantly higher for those with conduct problems and general hyperactivity (aOR = 2.03, p = 0.005 and aOR = 1.68, p = 0.02, respectively). Psychosocial and health factors, such as recent stressful life events and higher HIV RNA levels, were also associated with nonadherence. Knowledge of behavioral, health, and social influences affecting the child and family should guide the development of appropriate, evidence-based interventions for medication adherence. PMID:21323533

  2. Medication adherence in children and adolescents with HIV infection: associations with behavioral impairment.

    PubMed

    Malee, Kathleen; Williams, Paige; Montepiedra, Grace; McCabe, Marie; Nichols, Sharon; Sirois, Patricia A; Storm, Deborah; Farley, John; Kammerer, Betsy

    2011-03-01

    The impact of behavioral functioning on medication adherence in children with perinatally acquired HIV infection is not well-explored, but has important implications for intervention. This report addresses the relationship between behavioral functioning and child self-report or caregiver report of medication adherence among children and adolescents enrolled in Pediatric AIDS Clinical Trials Group Protocol 219C (conducted 2000-2007). A total of 1134 participants, aged 3-17 years, received a behavioral evaluation and adherence assessment. Complete adherence was defined as taking 100% of prescribed antiretroviral medications during three days preceding the study visit. Multivariable logistic regression models were used to evaluate associations between adherence and behavioral functioning, adjusting for potential confounders, including demographic, psychosocial, and health factors. Children demonstrated higher than expected rates of behavioral impairment (≈7% expected with T > 65) in the areas of conduct problems (14%, z = 7.0, p < 0.001), learning problems (22%, z = 12.2, p < 0.001), somatic complaints (22%, z = 12.6, p < 0.001), impulsivity-hyperactivity (20%, z = 11.1, p < 0.001), and hyperactivity (19%, z = 10.6, p < 0.001). Children with behavioral impairment in one or more areas had significantly increased odds of nonadherence [adjusted odds ratio (aOR) = 1.49, p = 0.04]. The odds of nonadherence were significantly higher for those with conduct problems and general hyperactivity (aOR = 2.03, p = 0.005 and aOR = 1.68, p = 0.02, respectively). Psychosocial and health factors, such as recent stressful life events and higher HIV RNA levels, were also associated with nonadherence. Knowledge of behavioral, health, and social influences affecting the child and family should guide the development of appropriate, evidence-based interventions for medication adherence.

  3. Financial incentives to improve adherence to antipsychotic maintenance medication in non-adherent patients: a cluster randomised controlled trial.

    PubMed Central

    Priebe, Stefan; Bremner, Stephen A; Lauber, Christoph; Henderson, Catherine; Burns, Tom

    2016-01-01

    : patients in the intervention group showed statistically significant improvement in adherence of at least 95% (adjusted odds ratio 8.21, 95% CI 2.00 to 33.67; p = 0.003) and subjective quality of life (difference in means 0.71, 95% CI 0.26 to 1.15; p = 0.002). Follow-ups: after incentives stopped, adherence did not differ significantly between groups, neither during the first 6 months (adjusted difference in means -7.4%, 95% CI -17.0% to 2.1%; p = 0.175) nor during the period from month 7 to month 24 (difference in means -5.7%, 95% CI -13.1% to 1.7%; p = 0.130). Cost-effectiveness: the average costs of the financial incentives was £303. Overall costs per patient were somewhat higher in the intervention group, but the difference was not significant. Semistructured interviews: the majority of patients and clinicians reported positive experiences with the incentives beyond their monetary value. These included improvement in the therapeutic relationship. The majority of both patients and clinicians perceived no negative impact after the intervention was stopped after 1 year. CONCLUSIONS: Financial incentives are effective in improving adherence to LAI medication. Health-care costs (including costs of the financial incentive) are unlikely to be increased substantially by this intervention. Once the incentives stop, the advantage is not maintained. The experiences of both patients and clinicians are largely, but not exclusively, positive. Whether or not financial incentives are effective for patients with more favourable background, those on oral mediation or for shorter or longer time periods remains unknown. TRIAL REGISTRATION: Current Controlled Trials ISRCTN77769281. FUNDING: This project was funded by the National Institute for Health Research (NIHR) Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 20, No. 70. See the NIHR Journals Library website for further project information. PMID:27682868

  4. Levels in doubly odd 138Pr

    NASA Astrophysics Data System (ADS)

    Gangopadhyay, G.; Bhowal, Samit; Bhowmik, R. K.; Datta Pramanik, U.; Ghosh, P.; Goswami, A.; Petrache, C.; Mukherjee, A.; Muralithar, S.; Raut, Rajarshi; Saha Sarkar, M.; Singh, A. K.; Singh, R. P.; Bhattacharya, S.

    2005-05-01

    The band structures of the doubly odd 138Pr nucleus have been investigated using the 128Te(14N, 4n)138Pr reaction at a beam energy of 55-65 MeV. Altogether six distinct structures have been established, of which the lower part of the yrast band and two side bands were known from earlier works. The observed level properties of the members of the yrast band have been compared with theoretical calculations performed within the Particle Rotor Model (PRM) with axially symmetric core. The experimental branching ratios and B(M1)/B(E2) values when compared with the theoretical results of the PRM, suggest an oblate core.

  5. Development of a new diabetes medication self-efficacy scale and its association with both reported problems in using diabetes medications and self-reported adherence

    PubMed Central

    Sleath, Betsy; Carpenter, Delesha M; Blalock, Susan J; Davis, Scott A; Hickson, Ryan P; Lee, Charles; Ferreri, Stefanie P; Scott, Jennifer E; Rodebaugh, Lisa B; Cummings, Doyle M

    2016-01-01

    Background Although there are several different general diabetes self-efficacy scales, there is a need to develop a self-efficacy scale that providers can use to assess patient’s self-efficacy regarding medication use. The purpose of this study was to: 1) develop a new diabetes medication self-efficacy scale and 2) examine how diabetes medication self-efficacy is associated with patient-reported problems in using diabetes medications and self-reported adherence. Patients and methods Adult English-speaking patients with type 2 diabetes were recruited from a family medicine clinic and a pharmacy in Eastern North Carolina, USA. The patients were eligible if they reported being nonadherent to their diabetes medicines on a visual analog scale. Multivariable regression was used to examine the relationship between self-efficacy and the number of reported diabetes medication problems and adherence. Results The diabetes medication self-efficacy scale had strong reliability (Cronbach’s alpha =0.86). Among a sample (N=51) of mostly African-American female patients, diabetes medication problems were common (6.1±3.1) and a greater number of diabetes medications were associated with lower medication adherence (odds ratio: 0.35; 95% confidence interval: 0.13, 0.89). Higher medication self-efficacy was significantly related to medication adherence (odds ratio: 1.17; 95% confidence interval: 1.05, 1.30) and inversely related to the number of self-reported medication problems (β=−0.13; P=0.006). Conclusion Higher diabetes medication self-efficacy was associated with fewer patient-reported medication problems and better medication adherence. Assessing medication-specific self-efficacy may help to identify medication-related problems that providers can help the patients address, potentially improving adherence and patient outcomes. PMID:27354769

  6. Depression and adherence to antiretroviral therapy in low-, middle- and high-income countries: a systematic review and meta-analysis

    PubMed Central

    Uthman, Olalekan A.; Magidson, Jessica F.; Safren, Steven A.; Nachega, Jean B.

    2015-01-01

    We investigated the associations between depressive symptoms and adherence to antiretroviral therapy (ART) among people living with HIV (PLHIV). We searched the PubMed, EMBASE and Cochrane CENTRAL databases for studies that studies that reported an association between depression and adherence to ART as a primary or secondary outcome. We used a random-effect model to pool the risk estimates from the individual studies. The odds ratio (OR) with their 95% CIs were used as summary estimates. Of 2,861 citations, 111 studies that recruited 42,366 PLHIV met our inclusion criteria. When reported, the rate of PLHIV with depressive symptoms ranged from 12.8% to 78% and the proportion of PLHIV who achieved good adherence (≥ 80%) ranged from 20% to 98%. There were no significant differences in rate of depressive symptoms in PLHIV by country income group; however, the proportion of PLHIV who achieved good adherence was significantly higher in lower-income countries (as defined in the 2012 World Bank Country Income Groups) (pooled rate = 86%) compared to higher-income countries (pooled rate = 67.5%; p<.05). We found that the likelihood of achieving good ART adherence was 42% lower among those with depressive symptoms compared to those without (pooled OR = 0.58, 95% CI 0.55 to 0.62). The relationship between depressive symptoms and adherence to ART was consistent across the country’s income group, study design, and adherence rates. We found that the magnitude of the association significantly decreases with more recent publications and increasing study sample size. The higher the prevalence of depressive symptoms of PLHIV recruited in the studies, the lower the likelihood of achieving good adherence to ART. In conclusion, the likelihood of achieving good adherence was lower among those with depressive symptoms compared to those without. PMID:25038748

  7. Medication adherence in schizophrenia.

    PubMed

    Acosta, Francisco Javier; Hernández, José Luis; Pereira, José; Herrera, Judit; Rodríguez, Carlos J

    2012-10-22

    Non-adherence is a major problem in the treatment of schizophrenia. Its high prevalence, potentially severe consequences and associated costs make the study of this phenomenon a priority issue. In this article, basic non-adherence concepts of prevalence, consequences, evaluation methods, methodological restrictions of available studies, risk factors and intervention strategies, are reviewed. Studying non-adherence risk factors is a necessary step toward designing adequately oriented intervention strategies. An operative definition of adherence and good knowledge of its evaluation methods are essential to study this phenomenon. Unfortunately, most available studies contain methodological restrictions, especially concerning the evaluation methods, and an agreed operative definition of adherence has only very recently been reached. Knowing non-adherence risk factors, intervention strategies and available evidence on their effectiveness is essential in making treatment decisions in daily clinical practice.

  8. Use of prior odds for missing persons identifications

    PubMed Central

    2011-01-01

    Identification of missing persons from mass disasters is based on evaluation of a number of variables and observations regarding the combination of features derived from these variables. DNA typing now is playing a more prominent role in the identification of human remains, and particularly so for highly decomposed and fragmented remains. The strength of genetic associations, by either direct or kinship analyses, is often quantified by calculating a likelihood ratio. The likelihood ratio can be multiplied by prior odds based on nongenetic evidence to calculate the posterior odds, that is, by applying Bayes' Theorem, to arrive at a probability of identity. For the identification of human remains, the path creating the set and intersection of variables that contribute to the prior odds needs to be appreciated and well defined. Other than considering the total number of missing persons, the forensic DNA community has been silent on specifying the elements of prior odds computations. The variables include the number of missing individuals, eyewitness accounts, anthropological features, demographics and other identifying characteristics. The assumptions, supporting data and reasoning that are used to establish a prior probability that will be combined with the genetic data need to be considered and justified. Otherwise, data may be unintentionally or intentionally manipulated to achieve a probability of identity that cannot be supported and can thus misrepresent the uncertainty with associations. The forensic DNA community needs to develop guidelines for objectively computing prior odds. PMID:21707977

  9. Social Support and the Mediating Roles of Alcohol Use and Adherence Self-Efficacy on Antiretroviral Therapy (ART) Adherence Among ART Recipients in Gauteng, South Africa.

    PubMed

    Kekwaletswe, Connie T; Jordaan, Esmé; Nkosi, Sebenzile; Morojele, Neo K

    2016-11-11

    We sought to (a) replicate and (b) extend (via the addition of alcohol use) Cha et al.'s cross-sectional multi-component model of ART adherence on the relationship between social support, depression, self-efficacy beliefs, and antiretroviral therapy (ART) adherence, among HIV patients in Tshwane, South Africa. Using purposive sampling, 304 male and female ART recipients were recruited. ART adherence was assessed using three manifest indicators: total adherence ratio, the CASE adherence index and 1-month adherence measure. Data were analysed using structural equation modeling. In our replicated model, social support had both direct and indirect relationships with ART adherence, and inclusion of alcohol use improved prediction of ART adherence. Direct and indirect effects of alcohol use on ART adherence emerged: adherence self-efficacy beliefs partially mediated the latter path. Findings highlight the importance of integrating into ART promotion interventions, the reduction of alcohol use, provision of social support, and enhancement of adherence self-efficacy beliefs.

  10. Relationship between viral load and behavioral measures of adherence to antiretroviral therapy in children living with HIV in Latin America

    PubMed Central

    Duarte, Horacio A.; Harris, D. Robert; Tassiopoulos, Katherine; Leister, Erin; Negrini, Silvia Fabiana Biason de Moura; Ferreira, Flavia Faleiro; Cruz, Maria Leticia Santos; Pinto, Jorge; Allison, Susannah; Hazra, Rohan

    2016-01-01

    Few studies have examined antiretroviral therapy adherence in Latin American children. Standardized behavioral measures were applied to a large cohort of HIV-infected children in Brazil, Mexico, and Peru to assess adherence to prescribed antiretroviral therapy doses during the three days prior to study visits, assess timing of last missed dose, and evaluate the ability of the adherence measures to predict viral suppression. Time trends in adherence were modeled using a generalized estimating equations approach to account for possible correlations in outcomes measured repeatedly in the same participants. Associations of adherence with HIV viral load were examined using linear regression. Mean enrollment age of the 380 participants was 5 years; 57.6% had undetectable' viral load (<400 copies/mL). At enrollment, 90.8% of participants were perfectly (100%) adherent, compared to 87.6% at the 6-month and 92.0% at the 12-month visit; the proportion with perfect adherence did not differ over time (p=0.1). Perfect adherence was associated with a higher probability of undetectable viral load at the 12-month visit (odds ratio=4.1, 95% confidence interval: 1.8–9.1; p<0.001), but not at enrollment or the 6-month visit (p>0.3). Last time missed any antiretroviral therapy dose was reported as "never" for 52.0% at enrollment, increasing to 60.7% and 65.9% at the 6- and 12-month visits, respectively (p<0.001 for test of trend). The proportion with undetectable viral load was higher among those who never missed a dose at enrollment and the 12-month visit (p≤0.005), but not at the 6-month visit (p=0.2). While antiretroviral therapy adherence measures utilized in this study showed some association with viral load for these Latin American children, they may not be adequate for reliably identifying non-adherence and consequently children at risk for viral resistance. Other strategies are needed to improve the evaluation of adherence in this population. PMID:25743569

  11. Odds of observing the multiverse

    SciTech Connect

    Dahlen, A.

    2010-03-15

    Eternal inflation predicts that our observable universe lies within a bubble (or pocket universe) embedded in a volume of inflating space. The interior of the bubble undergoes inflation and standard cosmology, while the bubble walls expand outward and collide with other neighboring bubbles. The collisions provide either an opportunity to make a direct observation of the multiverse or, if they produce unacceptable anisotropy, a threat to inflationary theory. The probability of an observer in our bubble detecting the effects of collisions has an absolute upper bound set by the odds of being in the part of our bubble that lies in the forward light cone of a collision; in the case of collisions with bubbles of identical vacua, this bound is given by the bubble nucleation rate times (H{sub O}/H{sub I}){sup 2}, where H{sub O} is the Hubble scale outside the bubbles and H{sub I} is the scale of the second round of inflation that occurs inside our bubble. Similar results were obtained by Freigovel et al. using a different method for the case of collisions with bubbles of much larger cosmological constant; here, it is shown to hold in the case of collisions with identical bubbles as well.

  12. General parity-odd CMB bispectrum estimation

    SciTech Connect

    Shiraishi, Maresuke; Liguori, Michele; Fergusson, James R. E-mail: michele.liguori@pd.infn.it

    2014-05-01

    We develop a methodology for estimating parity-odd bispectra in the cosmic microwave background (CMB). This is achieved through the extension of the original separable modal methodology to parity-odd bispectrum domains (ℓ{sub 1}+ℓ{sub 2}+ℓ{sub 3} = odd). Through numerical tests of the parity-odd modal decomposition with some theoretical bispectrum templates, we verify that the parity-odd modal methodology can successfully reproduce the CMB bispectrum, without numerical instabilities. We also present simulated non-Gaussian maps produced by modal-decomposed parity-odd bispectra, and show the consistency with the exact results. Our new methodology is applicable to all types of parity-odd temperature and polarization bispectra.

  13. Etanercept‐Methotrexate Combination Therapy Initiators Have Greater Adherence and Persistence Than Triple Therapy Initiators With Rheumatoid Arthritis

    PubMed Central

    Johnson, Barbara H.; Tang, Derek H.; Shah, Neel; Harrison, David J.; Collier, David H.

    2015-01-01

    Objective To estimate adherence and persistence with etanercept plus methotrexate (ETN‐MTX) combination therapy and MTX, hydroxychloroquine, and sulfasalazine triple therapy at 1 year following treatment initiation in adults with rheumatoid arthritis (RA). Methods This retrospective analysis used data from the Truven Health MarketScan Commercial and Medicare Supplemental databases from January 2009 to July 2013. Adherence was defined as having percentage of days covered >80% for all drugs within each regimen. Persistence was defined as no treatment gap >45 days for any drug and no addition or switching to other disease‐modifying antirheumatic drugs. Multiple logistic regression models were employed in the analyses to control for potential confounders. Results A total of 3,724 ETN‐MTX patients and 818 triple therapy patients were eligible. At 1 year, 27.9% who were taking ETN‐MTX and 18.2% using triple therapy were adherent to all agents in their regimen (P < 0.0001), and 29.4% who were taking ETN‐MTX and 23.2% using triple therapy were persistent (P < 0.001). After adjusting for confounders, ETN‐MTX patients had significantly greater odds of being adherent (odds ratio [OR] 1.79, 95% confidence interval [95% CI] 1.47–2.17) and persistent (OR 1.45, 95% CI 1.20–1.72) compared with patients using triple therapy. Conclusion Patients with RA initiating treatment with ETN‐MTX combination therapy demonstrated greater adherence and persistence at 1 year than patients initiating triple therapy. PMID:26097194

  14. Trauma, Dissociation, and Antiretroviral Adherence among Persons Living with HIV/AIDS

    PubMed Central

    Keuroghlian, Alex S.; Kamen, Charles S.; Neri, Eric; Lee, Susanne; Liu, Rhianon; Gore-Felton, Cheryl

    2011-01-01

    Background There are approximately 1,000,000 persons living with HIV/AIDS (PLH) in the United States; to reduce rates of new infection and curb disease progression, adherence to HIV medication among PLH is critical. Despite elevated trauma rates in PLH, no studies to date have investigated the relationship between dissociation, a specific symptom of trauma, and HIV medication adherence. We hypothesized that Post-Traumatic Stress Disorder (PTSD) symptoms would be associated with lower adherence, and that dissociation would moderate this relationship. Methods Forty-three individuals with HIV were recruited from community-based clinics to participate in a cross-sectional study. The relationship of trauma, dissociation, and their interaction to the probability of antiretroviral adherence was assessed using a hierarchical binary logistic regression analysis. Results Among 38 eligible participants, greater PTSD was associated with lower odds of adherence (OR = .92, p < .05). Dissociation moderated the effect of PTSD on adherence, resulting in lower odds of adherence (OR = .95, p < .05). PTSD symptoms were significantly associated with lower odds of adherence in individuals reporting high levels of dissociation (OR = .86, p < .05) but not in those reporting low levels of dissociation (OR = 1.02, p > .05). Conclusions This is the first study to demonstrate a relationship between dissociation and medication adherence. Findings are discussed in the context of clinical management of PLH with trauma histories and the need for interventions targeting dissociative symptomatology to optimize adherence. PMID:21636097

  15. Nutrition knowledge is associated with higher adherence to Mediterranean diet and lower prevalence of obesity. Results from the Moli-sani study.

    PubMed

    Bonaccio, Marialaura; Di Castelnuovo, Augusto; Costanzo, Simona; De Lucia, Francesca; Olivieri, Marco; Donati, Maria Benedetta; de Gaetano, Giovanni; Iacoviello, Licia; Bonanni, Americo

    2013-09-01

    A Mediterranean dietary pattern has been associated with reducing the risk of cardiovascular and chronic disease. The aim of this study was to evaluate the role of nutrition knowledge in determining possible differences among dietary patterns in a general population from a Mediterranean region. We conducted a cross-sectional study on a subsample of 744 subjects enrolled in the population-based cohort of the Moli-sani Project. A 92-item questionnaire on nutrition knowledge was elaborated, validated and administered. Dietary information were obtained from the EPIC food frequency questionnaire and adherence to a Mediterranean dietary pattern was evaluated both by the a priori Greek Mediterranean diet score and the a posteriori approach obtained by principal component analysis. Nutrition knowledge was significantly associated with higher adherence to a Mediterranean dietary pattern. The odds of having higher adherence to a Mediterranean dietary pattern increased with greater nutrition knowledge. The odds ratio of being obese significantly decreased with increasing nutrition knowledge levels. The results showed that nutrition knowledge was significantly associated with higher adherence to a Mediterranean dietary pattern and with lower prevalence of obesity in a Southern Italian region with Mediterranean diet tradition independently from education and other socioeconomic factors.

  16. Use of medicines and adherence to standard treatment guidelines in rural community health centers, Timor-Leste.

    PubMed

    Higuchi, Michiyo; Okumura, Junko; Aoyama, Atsuko; Suryawati, Sri; Porter, John

    2015-03-01

    The use of medicines and nurses'/midwives' adherence to standard treatment guidelines (STGs) were examined in Timor-Leste during the early stage of the nation's new health system development. A cross-sectional study was conducted as the quantitative element of mixed methods research. Retrospective samples from patient registration books and prospective observations were obtained in 20 randomly selected rural community health centers. The medicines use indicators, in particular the level of injection use, in Timor-Leste did not suggest overprescription. Prescribers with clinical nurse training prescribed significantly fewer antibiotics than those without such training (P < .01). The adjusted odds ratio of prescribing adherence for clinical nurse training, after accounting for confounders and prescriber clustering, was 6.6 (P < .01). STGs for nonphysician health professionals at the primary health care level have potential value in basic health care delivery, including appropriate use of medicines, in resource-limited communities when strategically developed and introduced.

  17. An evaluation of adherence in patients with multiple sclerosis newly initiating treatment with a self-injectable or an oral disease-modifying drug

    PubMed Central

    Munsell, Michael; Frean, Molly; Menzin, Joseph; Phillips, Amy L

    2017-01-01

    Objective As the multiple sclerosis (MS) disease-modifying drug (DMD) treatment options have expanded to include oral therapies, it is important to understand whether route of administration is associated with DMD adherence. The objective of this study was to compare adherence to DMDs in patients with MS newly initiating treatment with a self-injectable versus an oral DMD. Methods This retrospective database study used IMS Health Real World Data Adjudicated Claims – US data between July 1, 2010 and June 30, 2014. Adherence was measured by medication possession ratio (MPR), calculated as the total number of treated days divided by the total number of days from the first treated day until the end of 12-month follow-up. A binary measure representing adherence (MPR ≥0.8) versus nonadherence (MPR <0.8) to therapy was used. Logistic regression evaluated the likelihood of adherence to index DMD type (self-injectable vs oral). Covariates included patient baseline characteristics (ie, age, sex, comorbidities) and index DMD type. Results The analysis included 7,207 self-injectable and 1,175 oral DMD-treated patients with MS. In unadjusted analyses, the proportion of patients adherent to therapy (MPR ≥0.8) did not differ significantly between the self-injectable (54.1%) and the oral DMD cohorts (53.0%; P=0.5075). After controlling for covariates, index DMD type was not a significant predictor of adherence (odds ratio [OR] 1.062; 95% confidence interval [CI]: 0.937–1.202; P=0.3473). Higher likelihood of adherence was associated with male sex (OR 1.20; 95% CI: 1.085–1.335; P=0.0005) and age groups older than 18–34 years (ORs 1.220–1.331; P<0.01). Depression was associated with a lower likelihood of adherence (OR 0.618; 95% CI: 0.511–0.747; P<0.0001). Conclusion Male sex and age older than 18–34 years were significantly associated with a higher likelihood of adherence, while depression was associated with a lower likelihood of adherence. Index DMD type

  18. Clinicians’ Adherence to Guidelines on Evaluation of Hypertension in Children and Adolescents

    PubMed Central

    Hartz, Jacob; Li, Jennifer S.; Akintoye, Ololade O.; Hornik, Christoph P.

    2016-01-01

    Background Hypertension is increasingly prevalent among children. We sought to review provider adherence to the National High Blood Pressure Education Program (NHBPEP) recommendations at a single academic medical center. Methods We identified children 3–18 years of age with hypertension based on outpatient-visit International Classification of Diseases, Ninth Edition, Clinical Modification codes from 2006–2012. We calculated the odds of individual tests administration for 10 recommended tests, adjusting for demographic characteristics. Results We identified 3588/216,855 (1.7%) children diagnosed with hypertension at a median age of 14 years (25th, 75th percentile 10, 16). No child received all 10 recommended tests. The median number of tests administered was 2 (1, 4), but varied significantly by race and age. Urine drug screen (<1%) and renin levels (1%) were the least common, while serum creatinine (49%) and echocardiogram (40%) were the most common tests. Male children were more likely to receive an echocardiogram (odds ratio 1.43; 95% confidence interval 1.24–1.64), and black children and those ≥11 years old were less likely to have their serum creatinine checked. Adherence to the guidelines did not improve over time (p=0.24). Conclusions Children evaluated for hypertension in the outpatient setting infrequently receive the diagnostic tests recommended in the NHBPEP’s report. Test administration frequency varies by patient demographics, but has not improved significantly over time. PMID:27358298

  19. The association between optimal lifestyle adherence and short-term incidence of chronic conditions among employees.

    PubMed

    Pronk, Nicolaas P; Lowry, Marcia; Kottke, Thomas E; Austin, Erin; Gallagher, Jason; Katz, Abigail

    2010-12-01

    "Optimal lifestyle," comprising abstinence from smoking, adequate physical activity, eating 5 servings of fruits and vegetables each day, and consuming limited or no alcohol, is associated with low risk of chronic disease when unselected populations are observed for long periods of time. It is unclear whether these same associations are present when observation is limited to employed individuals followed for a brief period of time. The purpose of this investigation was to study the association between adherence to optimal lifestyle and the incidence of chronic conditions among employees over a 2-year period. Logistic regression was used to assess the association between employees' (N  = 6848) adherence to optimal lifestyle and the incidence of diabetes, heart disease, cancer, hypertension, high cholesterol, and back pain during a 2-year period. All data were self-reported. Adherence to any 3 components of the optimal lifestyle was associated with a significantly lower near-term incidence of diabetes (odds ratio [OR] =  0.56; 95% confidence interval [CI] = 0.31-0.97) and back pain (OR = 0.69; 95% CI = 0.53-0.92). Adherence to all 4 optimal lifestyle components was significantly associated with lower near-term incidence of back pain (OR = 0.44; 95% CI = 0.26-0.76). Physical activity was associated with significantly lower near-term incidence risk of heart disease (OR = 0.60; 95% CI = 0.38-0.95), high cholesterol (OR = 0.80; 95% CI = 0.66-0.99), and diabetes (OR = 0.51; 95% CI = 0.30-0.86). Adherence to optimal lifestyle, in particular adequate physical activity, is associated with lower near-term risk of developing several chronic conditions. Employers and payers should consider this fact when formulating policy or allocating resources for health care and health promotion.

  20. Quality of life and adherence to inhaled corticosteroids and tiotropium in COPD are related

    PubMed Central

    Koehorst-ter Huurne, Kirsten; Kort, Sharina; van der Palen, Job; van Beurden, Wendy JC; Movig, Kris LL; van der Valk, Paul; Brusse-Keizer, Marjolein

    2016-01-01

    Background Poor adherence to inhaled medications in COPD patients seems to be associated with an increased risk of death and hospitalization. Knowing the determinants of nonadherence to inhaled medications is important for creating interventions to improve adherence. Objectives To identify disease-specific and health-related quality of life (HRQoL) factors, associated with adherence to inhaled corticosteroids (ICS) and tiotropium in COPD patients. Methods Adherence of 795 patients was recorded over 3 years and was deemed optimal at >75%–≤125%, suboptimal at ≥50%–<75%, and poor at <50% (underuse) or >125% (overuse). Health-related quality of life was measured with the Clinical COPD Questionnaire and the EuroQol-5D questionnaire. Results Patients with a higher forced expiratory volume in 1 second (FEV1)/vital capacity (VC) (odds ratio [OR] =1.03) and ≥1 hospitalizations in the year prior to inclusion in this study (OR =2.67) had an increased risk of suboptimal adherence to ICS instead of optimal adherence. An increased risk of underuse was predicted by a higher FEV1/VC (OR =1.05). Predictors for the risk of overuse were a lower FEV1 (OR =0.49), higher scores on Clinical COPD Questionnaire-question 3 (anxiety for dyspnea) (OR =1.26), and current smoking (OR =1.73). Regarding tiotropium, predictors for suboptimal use were a higher FEV1/VC (OR =1.03) and the inability to perform usual activities as asked by the EuroQol-5D questionnaire (OR =3.09). A higher FEV1/VC also was a predictor for the risk of underuse compared to optimal adherence (OR =1.03). The risk of overuse increased again with higher scores on Clinical COPD Questionnaire-question 3 (OR =1.46). Conclusion Several disease-specific and quality of life factors are related to ICS and tiotropium adherence, but a clear profile of a nonadherent patient cannot yet be outlined. Overusers of ICS and tiotropium experience more anxiety. PMID:27555758

  1. Observed parity-odd CMB temperature bispectrum

    SciTech Connect

    Shiraishi, Maresuke; Liguori, Michele; Fergusson, James R. E-mail: michele.liguori@pd.infn.it

    2015-01-01

    Parity-odd non-Gaussianities create a variety of temperature bispectra in the cosmic microwave background (CMB), defined in the domain: ℓ{sub 1} + ℓ{sub 2} + ℓ{sub 3} = odd. These models are yet unconstrained in the literature, that so far focused exclusively on the more common parity-even scenarios. In this work, we provide the first experimental constraints on parity-odd bispectrum signals in WMAP 9-year temperature data, using a separable modal parity-odd estimator. Comparing theoretical bispectrum templates to the observed bispectrum, we place constraints on the so-called nonlineality parameters of parity-odd tensor non-Gaussianities predicted by several Early Universe models. Our technique also generates a model-independent, smoothed reconstruction of the bispectrum of the data for parity-odd configurations.

  2. Adherence of bacteria to heart valves in vitro.

    PubMed

    Gould, K; Ramirez-Ronda, C H; Holmes, R K; Sanford, J P

    1975-12-01

    The abilities of 14 strains of aerobic gram-positive cocci and gram-negative bacilli to adhere in vitro to human or canine aortic valve leaflets were compared. 2-mm sections of excised valve leaflets were obtained by punch biopsy and were incubated under standardized conditions in suspensions of bacteria. Valve sections were subsequently washed and homogenized, and quantitative techniques were used to determine the proportions of bacteria from the initial suspensions that had adhered to the valve sections. Comparable results were obtained when these adherence ratios were determined by two independent methods based either on measurements of bacterial viability or of radioactivity in 51Cr-labeled bacteria. For each bacterial strain, the adherence ratio was constant over a wide range of concentrations of bacteria in the incubation medium. Strains of enterococci, viridans streptococci, coagulase-positive and coagulase-negative staphylococci and Pseudomonas aeruginosa (adherence ratios 0.003-0.017) were found to adhere more readily to valve sections than strains of Escherichia coli and Klebsiella pneumoniae (adherence ratios 0.00002-0.00004). The organisms that most frequently cause bacterial endocarditis were found to adhere best to heart valves in vitro, suggesting that the ability to adhere to valvular endothelium may be an important or essential charcteristic of bacteria that cause endocarditis in man.

  3. Understanding Patients’ Adherence-Related Beliefs about Medicines Prescribed for Long-Term Conditions: A Meta-Analytic Review of the Necessity-Concerns Framework

    PubMed Central

    Horne, Rob; Chapman, Sarah C. E.; Parham, Rhian; Freemantle, Nick; Forbes, Alastair; Cooper, Vanessa

    2013-01-01

    Background Patients’ beliefs about treatment influence treatment engagement and adherence. The Necessity-Concerns Framework postulates that adherence is influenced by implicit judgements of personal need for the treatment (necessity beliefs) and concerns about the potential adverse consequences of taking it. Objective To assess the utility of the NCF in explaining nonadherence to prescribed medicines. Data sources We searched EMBASE, Medline, PsycInfo, CDSR/DARE/CCT and CINAHL from January 1999 to April 2013 and handsearched reference sections from relevant articles. Study eligibility criteria Studies using the Beliefs about Medicines Questionnaire (BMQ) to examine perceptions of personal necessity for medication and concerns about potential adverse effects, in relation to a measure of adherence to medication. Participants Patients with long-term conditions. Study appraisal and synthesis methods Systematic review and meta-analysis of methodological quality was assessed by two independent reviewers. We pooled odds ratios for adherence using random effects models. Results We identified 3777 studies, of which 94 (N = 25,072) fulfilled the inclusion criteria. Across studies, higher adherence was associated with stronger perceptions of necessity of treatment, OR = 1.742, 95% CI [1.569, 1.934], p<0.0001, and fewer Concerns about treatment, OR = 0.504, 95% CI: [0.450, 0.564], p<0.0001. These relationships remained significant when data were stratified by study size, the country in which the research was conducted and the type of adherence measure used. Limitations Few prospective longitudinal studies using objective adherence measures were identified. Conclusions The Necessity-Concerns Framework is a useful conceptual model for understanding patients’ perspectives on prescribed medicines. Taking account of patients’ necessity beliefs and concerns could enhance the quality of prescribing by helping clinicians to engage patients in treatment decisions and

  4. Weight loss intervention adherence and factors promoting adherence: a meta-analysis

    PubMed Central

    Lemstra, Mark; Bird, Yelena; Nwankwo, Chijioke; Rogers, Marla; Moraros, John

    2016-01-01

    Background Adhering to weight loss interventions is difficult for many people. The majority of those who are overweight or obese and attempt to lose weight are simply not successful. The objectives of this study were 1) to quantify overall adherence rates for various weight loss interventions and 2) to provide pooled estimates for factors associated with improved adherence to weight loss interventions. Methods We performed a systematic literature review and meta-analysis of all studies published between January 2004 and August 2015 that reviewed weight loss intervention adherence. Results After applying inclusion and exclusion criteria and checking the methodological quality, 27 studies were included in the meta-analysis. The overall adherence rate was 60.5% (95% confidence interval [CI] 53.6–67.2). The following three main variables were found to impact adherence: 1) supervised attendance programs had higher adherence rates than those with no supervision (rate ratio [RR] 1.65; 95% CI 1.54–1.77); 2) interventions that offered social support had higher adherence than those without social support (RR 1.29; 95% CI 1.24–1.34); and 3) dietary intervention alone had higher adherence than exercise programs alone (RR 1.27; 95% CI 1.19–1.35). Conclusion A substantial proportion of people do not adhere to weight loss interventions. Programs supervising attendance, offering social support, and focusing on dietary modification have better adherence than interventions not supervising attendance, not offering social support, and focusing exclusively on exercise. PMID:27574404

  5. Pharmacy adherence measures to assess adherence to antiretroviral therapy: review of the literature and implications for treatment monitoring.

    PubMed

    McMahon, James H; Jordan, Michael R; Kelley, Karen; Bertagnolio, Silvia; Hong, Steven Y; Wanke, Christine A; Lewin, Sharon R; Elliott, Julian H

    2011-02-15

    Prescription or pill-based methods for estimating adherence to antiretroviral therapy (ART), pharmacy adherence measures (PAMs), are objective estimates calculated from routinely collected pharmacy data. We conducted a literature review to evaluate PAMs, including their association with virological and other clinical outcomes, their efficacy compared with other adherence measures, and factors to consider when selecting a PAM to monitor adherence. PAMs were classified into 3 categories: medication possession ratio (MPR), pill count (PC), and pill pick-up (PPU). Data exist to recommend PAMs over self-reported adherence. PAMs consistently predicted patient outcomes, but additional studies are needed to determine the most predictive PAM parameters. Current evidence suggests that shorter duration of adherence assessment (≤ 6 months) and use of PAMs to predict future outcomes may be less accurate. PAMs which incorporate the number of days for which ART was prescribed without the counting of remnant pills, are reasonable minimum-resource methods to assess adherence to ART.

  6. Maternal perceptions of social context and adherence to maternal and child health (MCH) clinic recommendations among marginalized Bedouin mothers.

    PubMed

    Daoud, Nihaya; Shoham-Vardi, Ilana

    2015-03-01

    National maternal and child health (MCH) care systems often deliver universal health care recommendations that do not take into consideration the social context of infant care (IC) for marginalized groups. We examined associations between maternal perceptions of social context (MPSC) and adherence by minority Bedouin mothers in Israel to three commonly recommended IC practices. We conducted personal interviews with 464 mothers visiting 14 MCH clinics using a structured questionnaire based on findings from a previous focus-group study, and guided by constructs of the Health Beliefs Model. Items were tested for validity and reliability. We used multivariate analysis to identify MPSC constructs associated with adherence to MCH clinic recommendations (timely postnatal first visit, sustaining breastfeeding, and use of infant car seat). Social context, when perceived as a barrier to IC, was negatively associated with adherence to timely first postnatal MCH clinic visit (odds ratio, 95 %, confidence intervals (OR 1.45, 95 % CI 1.24, 1.70) and use of infant car seat (OR 1.43, 95 % CI 1.21, 1.69). However, social context was positively associated with sustained breastfeeding (OR 0.54, 95 % CI 0.37, 0.79). Perceptions of the severity of infant health problems, and family financial and relationship problems had less significant associations with adherence to MCH clinic recommendations. Adherence by marginalized mothers to MCH clinic recommendations is related to their perceptions of social context. When there are higher financial and other living conditions barriers mothers tend toward lower adherence to these recommendations. MCH policy makers and service providers must consider MPSC in planning and delivery of MCH recommendations.

  7. High-intensity cannabis use and adherence to antiretroviral therapy among people who use illicit drugs in a Canadian setting.

    PubMed

    Slawson, Gregory; Milloy, M-J; Balneaves, Lynda; Simo, Annick; Guillemi, Silvia; Hogg, Robert; Montaner, Julio; Wood, Evan; Kerr, Thomas

    2015-01-01

    Cannabis is increasingly prescribed clinically and utilized by people living with HIV/AIDS (PLWHA) to address symptoms of HIV disease and to manage side effects of antiretroviral therapy (ART). In light of concerns about the possibly deleterious effect of psychoactive drug use on adherence to ART, we sought to determine the relationship between high-intensity cannabis use and adherence to ART among a community-recruited cohort of HIV-positive illicit drug users. We used data from the ACCESS study, an ongoing prospective cohort study of HIV-seropositive illicit drug users linked to comprehensive ART dispensation records in a setting of universal no-cost HIV care. We estimated the relationship between at least daily cannabis use in the last 6 months, measured longitudinally, and the likelihood of optimal adherence to ART during the same period, using a multivariate linear mixed-effects model accounting for relevant socio-demographic, behavioral, clinical and structural factors. From May 2005 to May 2012, 523 HIV-positive illicit drug users were recruited and contributed 2,430 interviews. At baseline, 121 (23.1 %) participants reported at least daily cannabis use. In bivariate and multivariate analyses we did not observe an association between using cannabis at least daily and optimal adherence to prescribed HAART (Adjusted Odds Ratio = 1.12, 95 % Confidence Interval [95 % CI]: 0.76-1.64, p value = 0.555.) High-intensity cannabis use was not associated with adherence to ART. These findings suggest cannabis may be utilized by PLWHA for medicinal and recreational purposes without compromising effective adherence to ART.

  8. Food Labels Use Is Associated with Higher Adherence to Mediterranean Diet: Results from the Moli-Sani Study

    PubMed Central

    Bonanni, Americo E.; Bonaccio, Marialaura; di Castelnuovo, Augusto; de Lucia, Francesca; Costanzo, Simona; Persichillo, Mariarosaria; Zito, Francesco; Donati, Maria Benedetta; de Gaetano, Giovanni; Iacoviello, Licia

    2013-01-01

    Mediterranean diet (MD) has been associated with lower risk of ischemic cerebro- and cardio-vascular disease, neurological degenerative disease, and breast and colonrectal cancers. Nevertheless, adherence to this pattern has decreased. Food labels are a potentially valid means to encourage towards healthier dietary behavior. This study, conducted on a subsample of 883 subjects enrolled in the Moli-sani Project, evaluated whether food labels reading (LR) is associated with MD adherence. Participants completed a questionnaire on nutrition knowledge, information, and attitudes, with a specific question on food labels reading. Biometric measurements, socio-economic status, education, physical activity, and smoking habits were collected. The European Prospective Investigation into Cancer and Nutrition (EPIC) food frequency questionnaire was used to collect dietary habits, and subsequently evaluated by both the Mediterranean diet score (MDS) and Italian Mediterranean index (IMI), a priori dietary patterns. Food consumption patterns were generated by Principal Components Analysis (PCA), an a posteriori approach. Multivariable odds ratios were calculated to quantify the association of LR categories with dietary habits. LR was significantly associated with greater adherence to both MDS (p = 0.0004) and IMI (p = 0.0019) in a multivariable model. LR participants had 74% (MDS) or 68% (IMI) higher probability to be in the highest level of adherence to Mediterranean diet-like patterns. Moreover, they showed greater adherence to Mediterranean-like food consumption patterns (0.1 vs. −0.2, p < 0.0001) and lower adherence to two Western-like patterns (0.01 vs. 0.2, p = 0.009 and 0.1 vs. 0.2, p = 0.02). These findings support an association between food label use and consuming a Mediterranean-type diet. PMID:24192994

  9. Impact of adherence on subcutaneous interferon beta-1a effectiveness administered by Rebismart® in patients with multiple sclerosis

    PubMed Central

    Edo Solsona, María Dolores; Monte Boquet, Emilio; Casanova Estruch, Bonaventura; Poveda Andrés, José Luis

    2017-01-01

    Background Adherence to disease-modifying drugs (DMDs) is one of the key factors for achieving optimal clinical outcomes. Rebismart® is an injection device for subcutaneous administration of interferon beta-1a (INF β-1a) that is also able to monitor adherence objectively. The aim of this study was to describe adherence to INF β-1a using the said electronic autoinjection device and to explore the relationship between adherence and relapses in a Spanish cohort. Methods This is a retrospective observational study in which 110 Spanish patients self-administered INF β-1a subcutaneously using an electronic autoinjection device between June 2010 and June 2015. The primary end point was the percentage of adherence measured by Rebismart® to subcutaneous INF β-1a injections calculated as number of injections received in time period versus number of injections scheduled in time period. Other variables recorded were demographic and clinical data. Statistical analysis was performed using SPSS 19.0 software. Results Median adherence for the total study period was 96.5% (interquartile range [IQR]: 91.1–99.1). Similar values were observed during the first 6 months: 98.7% (IQR: 91.3–100), and the last 6 months: 97.6% (IQR: 91.1–99.8). Median duration of treatment was 979 days (IQR: 613.8–1,266.8). During the entire treatment period, 77.3% of patients were relapse free and mean annualized relapse rate was 0.14 (standard deviation: 0.33). Increased adherence was associated with better clinical outcomes, leading to lower relapse risk (odds ratio: 0.953; 95% confidence interval: 0.912–0.995). Specifically, every percentage unit increase in adherence resulted in a 4.7% decrease in relapse. Conclusion Patients with multiple sclerosis who self-injected INF β-1a with Rebismart® had excellent adherence, correlating with a high proportion of relapse-free patients and very low annualized relapse rate. PMID:28280313

  10. Structure evolution and phase transition in odd-mass nuclei

    NASA Astrophysics Data System (ADS)

    Bucurescu, D.; Zamfir, N. V.

    2017-01-01

    The evolution of level structures due to the unique parity orbitals g9 /2, h11 /2, and i13 /2 in odd-mass nuclei from Zn to Am is studied within a unified framework, by correlations between ratios of excitation energies in both odd-mass nuclei and their even-even core nuclei. These plots reveal regularities that can be understood in terms of the particle-plus-rotor model, as evolutions along its three limiting coupling schemes: weak coupling, decoupling, and strong coupling, and transitions between them. Peculiar transitions between the decoupling and strong coupling schemes are found in both i13 /2 structures of neutron-odd nuclei and h11 /2 structures of proton-odd nuclei, at neutron numbers around 90 and 70, respectively. These are correlated with the critical shape phase transitions from vibrator to rotor from the even-even nuclei in the same regions and are characterized as critical phase transitions too. This behavior is corroborated with a nonmonotonic behavior of the differential variation of the two-neutron separation energies in the same nuclear regions.

  11. Correlation between Use of Antiretroviral Adherence Devices by HIV-infected Youth and Plasma HIV RNA and Self-reported Adherence

    PubMed Central

    Saberi, Parya; Mayer, Kenneth; Vittinghoff, Eric; Naar-King, Sylvie

    2014-01-01

    Our objective was to investigate antiretroviral adherence device use by HIV-infected youth and assess associations of device use with viral suppression and self-reported adherence. This cross-sectional, multisite, clinic-based study included data from 1,317 HIV-infected individuals 12-24 years of age that were prescribed antiretroviral therapy. Mean adherence in the past seven days was 86.1% and 50.5% had an undetectable HIV RNA. Pillbox was the most commonly endorsed device. No specific device was independently associated with higher odds of 100% adherence. Paradoxically, having an undetectable HIV RNA was inversely associated with use of adherence devices (OR=0.80; p=0.04); however, among those with <100% adherence, higher adherence was associated with use of one or more adherence devices (coefficient=7.32; p=0.003). Our data suggest that adolescents who experienced virologic failure often used adherence devices which may not have been sufficiently effective in optimizing adherence. Therefore, other tailored adherence-enhancing methods need to be considered to maximize virologic suppression and decrease drug resistance and HIV transmission. PMID:24879628

  12. Topology Explains Why Automobile Sunshades Fold Oddly

    ERIC Educational Resources Information Center

    Feist, Curtis; Naimi, Ramin

    2009-01-01

    Automobile sunshades always fold into an "odd" number of loops. The explanation why involves elementary topology (braid theory and linking number, both explained in detail here with definitions and examples), and an elementary fact from algebra about symmetric group.

  13. Intrinsic excitations in doubly odd nuclei

    SciTech Connect

    Sood, P.C.

    1985-01-15

    A procedure is outlined for predicting the bandhead energies of the two-particle (intrinsic) states of odd-odd deformed nuclei based on a quantitative evaluation of the zero range n-p residual interaction energy. We present our results for 250Bk, where many such levels are experimentally known, and for 236Np and 246Am, where the information is very scarce and that too uncertain, to illustrate the effectiveness of this approach.

  14. Relationship between viral load and behavioral measures of adherence to antiretroviral therapy in children living with human immunodeficiency virus in Latin America.

    PubMed

    Duarte, Horacio A; Harris, Donald Robert; Tassiopoulos, Katherine; Leister, Erin; Negrini, Silvia Fabiana Biason de Moura; Ferreira, Flávia Faleiro; Cruz, Maria Letícia Santos; Pinto, Jorge; Allison, Susannah; Hazra, Rohan

    2015-01-01

    Few studies have examined antiretroviral therapy adherence in Latin American children. Standardized behavioral measures were applied to a large cohort of human immunodeficiency virus-infected children in Brazil, Mexico, and Peru to assess adherence to prescribed antiretroviral therapy doses during the three days prior to study visits, assess timing of last missed dose, and evaluate the ability of the adherence measures to predict viral suppression. Time trends in adherence were modeled using a generalized estimating equations approach to account for possible correlations in outcomes measured repeatedly in the same participants. Associations of adherence with human immunodeficiency virus viral load were examined using linear regression. Mean enrollment age of the 380 participants was 5 years; 57.6% had undetectable' viral load (<400 copies/mL). At enrollment, 90.8% of participants were perfectly (100%) adherent, compared to 87.6% at the 6-month and 92.0% at the 12-month visit; the proportion with perfect adherence did not differ over time (p=0.1). Perfect adherence was associated with a higher probability of undetectable viral load at the 12-month visit (odds ratio=4.1, 95% confidence interval: 1.8-9.1; p<0.001), but not at enrollment or the 6-month visit (p>0.3). Last time missed any antiretroviral therapy dose was reported as "never" for 52.0% at enrollment, increasing to 60.7% and 65.9% at the 6- and 12-month visits, respectively (p<0.001 for test of trend). The proportion with undetectable viral load was higher among those who never missed a dose at enrollment and the 12-month visit (p≤0.005), but not at the 6-month visit (p=0.2). While antiretroviral therapy adherence measures utilized in this study showed some association with viral load for these Latin American children, they may not be adequate for reliably identifying non-adherence and consequently children at risk for viral resistance. Other strategies are needed to improve the evaluation of adherence in

  15. DOSE-RESPONSE RELATIONSHIP BETWEEN METHADONE DOSE AND ADHERENCE TO ANTIRETROVIRAL THERAPY AMONG HIV-POSITIVE PERSONS WHO USE ILLICIT OPIOIDS

    PubMed Central

    Lappalainen, Leslie; Nolan, Seonaid; Dobrer, Sabina; Puscas, Cathy; Montaner, Julio; Ahamad, Keith; Dong, Huiru; Kerr, Thomas; Wood, Evan; Milloy, M-J

    2015-01-01

    Background and Aims For HIV-positive individuals who use illicit opioids, engagement in methadone maintenance therapy (MMT) can contribute to improved HIV treatment outcomes. However, to our knowledge, the role of methadone dosing in adherence to antiretroviral therapy (ART) has not yet been investigated. We sought to examine the relationship between methadone dose and ART adherence among a cohort of persons who use illicit opioids. Design and Setting We used data from the ACCESS study, an ongoing prospective observational cohort of HIV-positive persons who use illicit drugs in Vancouver, Canada, confidentially linked to comprehensive HIV treatment data in a setting of universal no-cost medical care including medications. We evaluated the longitudinal relationship between methadone dose and the likelihood of ≥ 95% adherence to ART among ART-exposed participants during periods of engagement in MMT. Participants 297 ART-exposed individuals on MMT were recruited between December 2005 and May 2013 and followed for a median of 42.1 months. Measurements We measured methadone dose at ≥ 100 vs < 100 mg/day and the likelihood of ≥ 95% adherence to ART. Findings In adjusted generalized estimating equation (GEE) analyses, MMT dose ≥ 100 mg/day was independently associated with optimal adherence to ART (adjusted odds ratio [AOR] = 1.38; 95% confidence interval [CI]: 1.08 – 1.77, p = 0.010). In a sub-analysis, we observed a dose-response relationship between increasing MMT dose and ART adherence (AOR = 1.06 per 20 mg/day increase, 95% CI: 1.00 – 1.12, p = 0.041). Conclusion Among HIV-positive individuals in methadone maintenance therapy, those receiving higher doses of methadone (≥ 100 mg/day) are more likely to achieve ≥ 95% adherence to antiretroviral therapy than those receiving lower doses. PMID:25940906

  16. Associations of adherence to the New Nordic Diet with risk of preeclampsia and preterm delivery in the Norwegian Mother and Child Cohort Study (MoBa).

    PubMed

    Hillesund, Elisabet Rudjord; Øverby, Nina C; Engel, Stephanie M; Klungsøyr, Kari; Harmon, Quaker E; Haugen, Margaretha; Bere, Elling

    2014-10-01

    Preeclampsia and preterm delivery are serious complications of pregnancy and leading causes of perinatal mortality and morbidity worldwide. Dietary factors might be associated with these adverse outcomes. We investigated whether adherence to the New Nordic Diet (NND) was associated with preeclampsia and preterm delivery risks in the Norwegian Mother and Child Cohort Study (MoBa). Participants were recruited from all over Norway during the period 1999-2008. A previously constructed diet score assessing meal frequency, and the consumption of Nordic fruits, root vegetables, cabbages, potatoes, oatmeal porridge, whole grains, wild fish, game, berries, milk and water, was used to assess NND adherence. Associations between NND adherence and the outcomes were estimated in adjusted multivariate logistic regression models. Odds ratios (ORs) and 95 % confidence intervals (CIs) were calculated. A total of 72,072 women was included in the study. High versus low NND adherence was associated with lower risk of total preeclampsia (OR 0.86; 95 % CI 0.78-0.95) and early preeclampsia (OR 0.71; 95 % CI 0.52-0.96). High compared with low NND adherence was associated with a lower risk of spontaneous preterm delivery among nulliparous women (OR 0.77; 95 % CI 0.66-0.89), whereas multiparous women with high NND adherence had a marginally significant higher risk of preterm delivery (OR 1.24; 95 % CI 1.00-1.53). High NND adherence was associated with a lower relative risk of preeclampsia and of spontaneous preterm delivery among nulliparous women; however, among multiparous women there was a higher relative risk of preterm delivery.

  17. The effects of empowered motivation on exercise adherence and physical fitness in college women

    PubMed Central

    Kim, Sook-Jung; Cho, Bok-Hee

    2013-01-01

    The purpose of this study is to identify the effects of exercise adherence when exercise motivation was empowered. It was planned as a pretest-posttest nonequivalent quasi-experimental design. The study subjects were female college students who wanted exercise and agreed to participate in the Jane Fonda Workout Program (1982) for a period of six months. The subject sample was divided into an experimental group and a control group by college department to prevent contamination of the intervention, which promotes long-term exercise-program adherence through the EMPOWER Step Program. All subjects’ body composition and physical fitness were measured using the Inbody (520) Body Composition Analyzer and Helmas (Korea) measuring equipment. Cronbach’s α, t-test, odds ratio and analysis of covariance were used to analyze the data using the Statistical Package for the Social Sciences program. According to the results the experimental group showed a 66.66% exercise adherence success rate and the control group showed only a 26.31% success rate (OR= 5.60, P= 0.01; t= 2.932, P= 0.006). Skeletal muscle mass was significantly higher in the experimental group than in the control group (F= 8.45, P= 0.006). Body fat mass decreased significantly more in the experimental group than in the control group (F= 6.08 P= 0.01). Empowered motivation has positive effects on adherence to exercise regimes and physical fitness in female college students. Therefore it is suggested to actively utilize the EMPOWER Step Program to foster long-term exercise. PMID:24278872

  18. Association of First-Line and Second-Line Antiretroviral Therapy Adherence

    PubMed Central

    Ramadhani, Habib O.; Bartlett, John A.; Thielman, Nathan M.; Pence, Brian W.; Kimani, Stephen M.; Maro, Venance P.; Mwako, Mtumwa S.; Masaki, Lazaro J.; Mmbando, Calvin E.; Minja, Mary G.; Lirhunde, Eileen S.; Miller, William C.

    2014-01-01

    Background  Adherence to first-line antiretroviral therapy (ART) may be an important indicator of adherence to second-line ART. Evaluating this relationship may be critical to identify patients at high risk for second-line failure, thereby exhausting their treatment options, and to intervene and improve patient outcomes. Methods  Adolescents and adults (n = 436) receiving second-line ART were administered standardized questionnaires that captured demographic characteristics and assessed adherence. Optimal and suboptimal cumulative adherence were defined as percentage adherence of ≥90% and <90%, respectively. Bivariable and multivariable binomial regression models were used to assess the prevalence of suboptimal adherence percentage by preswitch adherence status. Results  A total of 134 of 436 (30.7%) participants reported suboptimal adherence to second-line ART. Among 322 participants who had suboptimal adherence to first-line ART, 117 (36.3%) had suboptimal adherence to second-line ART compared with 17 of 114 (14.9%) who had optimal adherence to first-line ART. Participants who had suboptimal adherence to first-line ART were more likely to have suboptimal adherence to second-line ART (adjusted prevalence ratio, 2.4; 95% confidence interval, 1.5–3.9). Conclusions  Adherence to first-line ART is an important predictor of adherence to second-line ART. Targeted interventions should be evaluated in patients with suboptimal adherence before switching into second-line therapy to improve their outcomes. PMID:25734147

  19. Relationship between hunger, adherence to antiretroviral therapy and plasma HIV RNA suppression among HIV-positive illicit drug users in a Canadian setting.

    PubMed

    Anema, Aranka; Kerr, Thomas; Milloy, M-J; Feng, Cindy; Montaner, Julio S G; Wood, Evan

    2014-04-01

    Food insecurity may be a barrier to achieving optimal HIV treatment-related outcomes among illicit drug users. This study therefore, aimed to assess the impact of severe food insecurity, or hunger, on plasma HIV RNA suppression among illicit drug users receiving antiretroviral therapy (ART). A cross-sectional Multivariate logistic regression model was used to assess the potential relationship between hunger and plasma HIV RNA suppression. A sample of n = 406 adults was derived from a community-recruited open prospective cohort of HIV-positive illicit drug users, in Vancouver, British Columbia (BC), Canada. A total of 235 (63.7%) reported "being hungry and unable to afford enough food," and 241 (59.4%) had plasma HIV RNA < 50 copies/ml. In unadjusted analyses, self-reported hunger was associated with lower odds of plasma HIV RNA suppression (Odds Ratio = 0.59, 95% confidence interval [CI]: 0.39-0.90, p = 0.015). In multivariate analyses, this association was no longer significant after controlling for socio-demographic, behavioral, and clinical characteristics, including 95% adherence (Adjusted Odds Ratio [AOR] = 0.65, 95% CI: 0.37-1.10, p = 0.105). Multivariate models stratified by 95% adherence found that the direction and magnitude of this association was not significantly altered by the adherence level. Hunger was common among illicit drug users in this setting. Although, there was an association between hunger and lower likelihood of plasma HIV RNA suppression, this did not persist in adjusted analyses. Further research is warranted to understand the social-structural, policy, and physical factors shaping the HIV outcomes of illicit drug users.

  20. Extremal charged rotating black holes in odd dimensions

    SciTech Connect

    Allahverdizadeh, Masoud; Kunz, Jutta; Navarro-Lerida, Francisco

    2010-07-15

    Employing higher order perturbation theory, we obtain charged rotating black holes in odd dimensions, where the Einstein-Maxwell Lagrangian may be supplemented with a Chern-Simons term. Starting from the Myers-Perry solutions, we use the electric charge as the perturbative parameter and focus on extremal black holes with equal-magnitude angular momenta. For Einstein-Maxwell-Chern-Simons theory with arbitrary Chern-Simons coupling constant, we perform the perturbations up to 3rd order for any odd dimension. We discuss the physical properties of these black holes and study their dependence on the charge. In particular, we show that the gyromagnetic ratio g of Einstein-Maxwell black holes differs from the lowest order perturbative value D-2, and that the first correction term to g/(D-2) is universal.

  1. Levels of adherence and factors associated with adherence to option B+ prevention of mother-to-child transmission among pregnant and lactating mothers in selected government health facilities of South Wollo Zone, Amhara Region, northeast Ethiopia, 2016

    PubMed Central

    2016-01-01

    OBJECTIVES The aim of this study was to measure the levels of adherence and to identify factors associated with adherence to option B+ prevention of mother-to-child transmission (PMTCT) among pregnant and lactating mothers in selected government health facilities of South Wollo Zone, Amhara Region, northeast Ethiopia. METHODS An institution-based cross-sectional quantitative study design was employed from March 1, 2016 to April 14, 2016, using a standard structured data collection instrument. A sample of 191 human immunodeficiency virus (HIV)-positive pregnant and lactating mothers who were receiving PMTCT follow-up in the selected health facilities participated in the study. The data were entered using EpiData 3.1 and analyzed using SPSS version 21. Bivariate and multivariate logistic regression analyses were employed to identify factors associated with adherence. The p-values <0.05 and 95% confidence intervals (CIs) were used to identify associations between independent predictors and the outcome variable. RESULTS The level of adherence to option B+ PMTCT drugs was 87.9%. Women who received in-hospital treatment, who lived in rural areas, and faced challenges in initiating lifelong option B+ treatment on the same-day that they were diagnosed with HIV were less likely to adhere to the treatment (adjusted odds ratios [95% CI] of 0.3 [0.11 to 0.82], 0.26 [0.1 to 0.73], and 0.08 [0.02 to 0.37], respectively). CONCLUSIONS Collaborative efforts of zonal health departments with health facility administrators and counselors are recommended for effective and efficient interventions focusing on hospitals, rural areas, and patients who face challenges on the day of their diagnosis. PMID:27733034

  2. Odd-frequency Superconductivity in Driven Systems

    NASA Astrophysics Data System (ADS)

    Triola, Christopher; Balatsky, Alexander

    We show that Berezinskii's classification of the symmetries of Cooper pair amplitudes in terms of parity under transformations that invert spin, space, time, and orbital degrees of freedom holds for driven systems even in the absence of translation invariance. We then discuss the conditions under which pair amplitudes which are odd in frequency can emerge in driven systems. Considering a model Hamiltonian for a superconductor coupled to an external driving potential, we investigate the influence of the drive on the anomalous Green's function, density of states, and spectral function. We find that the anomalous Green's function develops odd in frequency component in the presence of an external drive. Furthermore we investigate how these odd-frequency terms are related to satellite features in the density of states and spectral function. Supported by US DOE BES E 304.

  3. Odd-frequency superconductivity in driven systems

    NASA Astrophysics Data System (ADS)

    Triola, Christopher; Balatsky, Alexander V.

    2016-09-01

    We show that Berezinskii's classification of the symmetries of Cooper pair amplitudes holds for driven systems even in the absence of translation invariance. We then consider a model Hamiltonian for a superconductor coupled to an external driving potential and, treating the drive as a perturbation, we investigate the corrections to the anomalous Green's function, density of states, and spectral function. We find that in the presence of an external drive the anomalous Green's function develops terms that are odd in frequency and that the same mechanism responsible for these odd-frequency terms generates additional features in the density of states and spectral function.

  4. Ethical considerations in adherence research

    PubMed Central

    Patel, Nupur U; Moore, Blake A; Craver, Rebekah F; Feldman, Steven R

    2016-01-01

    Poor adherence to treatment is a common cause of medical treatment failure. Studying adherence is complicated by the potential for the study environment to impact adherence behavior. Studies performed without informing patients about adherence monitoring must balance the risks of deception against the potential benefits of the knowledge to be gained. Ethically monitoring a patient’s adherence to a treatment plan without full disclosure of the monitoring plan requires protecting the patient’s rights and upholding the fiduciary obligations of the investigator. Adherence monitoring can utilize different levels of deception varying from stealth monitoring, debriefing after the study while informing the subject that some information had been withheld in regard to the use of adherence monitoring (withholding), informed consent that discloses some form of adherence monitoring is being used and will be disclosed at the end of the study (authorized deception), and full disclosure. Different approaches offer different benefits and potential pitfalls. The approach used must balance the risk of nondisclosure against the potential for confounding the adherence monitoring data and the potential benefits that adherence monitoring data will have for the research subjects and/or other populations. This commentary aims to define various methods of adherence monitoring and to provide a discussion of the ethical considerations that accompany the use of each method and adherence monitoring in general as it is used in clinical research. PMID:27980394

  5. Ethical considerations in adherence research.

    PubMed

    Patel, Nupur U; Moore, Blake A; Craver, Rebekah F; Feldman, Steven R

    2016-01-01

    Poor adherence to treatment is a common cause of medical treatment failure. Studying adherence is complicated by the potential for the study environment to impact adherence behavior. Studies performed without informing patients about adherence monitoring must balance the risks of deception against the potential benefits of the knowledge to be gained. Ethically monitoring a patient's adherence to a treatment plan without full disclosure of the monitoring plan requires protecting the patient's rights and upholding the fiduciary obligations of the investigator. Adherence monitoring can utilize different levels of deception varying from stealth monitoring, debriefing after the study while informing the subject that some information had been withheld in regard to the use of adherence monitoring (withholding), informed consent that discloses some form of adherence monitoring is being used and will be disclosed at the end of the study (authorized deception), and full disclosure. Different approaches offer different benefits and potential pitfalls. The approach used must balance the risk of nondisclosure against the potential for confounding the adherence monitoring data and the potential benefits that adherence monitoring data will have for the research subjects and/or other populations. This commentary aims to define various methods of adherence monitoring and to provide a discussion of the ethical considerations that accompany the use of each method and adherence monitoring in general as it is used in clinical research.

  6. A MULTI-CENTER CLUSTER-RANDOMIZED TRIAL OF A MULTI-FACTORIAL INTERVENTION TO IMPROVE ANTIHYPERTENSIVE MEDICATION ADHERENCE AND BLOOD PRESSURE CONTROL AMONG PATIENTS AT HIGH CARDIOVASCULAR RISK (The COM99 study)*

    PubMed Central

    Pladevall, Manel; Brotons, Carlos; Gabriel, Rafael; Arnau, Anna; Suarez, Carmen; de la Figuera, Mariano; Marquez, Emilio; Coca, Antonio; Sobrino, Javier; Divine, George; Heisler, Michele; Williams, L Keoki

    2010-01-01

    Background Medication non-adherence is common and results in preventable disease complications. This study assesses the effectiveness of a multifactorial intervention to improve both medication adherence and blood pressure control and to reduce cardiovascular events. Methods and Results In this multi-center, cluster-randomized trial, physicians from hospital-based hypertension clinics and primary care centers across Spain were randomized to receive and provide the intervention to their high-risk patients. Eligible patients were ≥50 years of age, had uncontrolled hypertension, and had an estimated 10-year cardiovascular risk greater than 30%. Physicians randomized to the intervention group counted patients’ pills, designated a family member to support adherence behavior, and provided educational information to patients. The primary outcome was blood pressure control at 6 months. Secondary outcomes included both medication adherence and a composite end-point of all cause mortality and cardiovascular-related hospitalizations. Seventy-nine physicians and 877 patients participated in the trial. The mean duration of follow-up was 39 months. Intervention patients were less likely to have an uncontrolled systolic blood pressure (odds ratio 0.62; 95% confidence interval [CI] 0.50–0.78) and were more likely to be adherent (OR 1.91; 95% CI 1.19–3.05) when compared with control group patients at 6 months. After five years 16% of the patients in the intervention group and 19% in the control group met the composite end-point (hazard ratio 0.97; 95% CI 0.67–1.39). Conclusions A multifactorial intervention to improve adherence to antihypertensive medication was effective in improving both adherence and blood pressure control, but it did not appear to improve long-term cardiovascular events. PMID:20823391

  7. Lifestyles and Risk Factors Associated with Adherence to the Mediterranean Diet: A Baseline Assessment of the PREDIMED Trial

    PubMed Central

    Hu, Emily A.; Toledo, Estefania; Diez-Espino, Javier; Estruch, Ramon; Corella, Dolores; Salas-Salvado, Jordi; Vinyoles, Ernest; Gomez-Gracia, Enrique; Aros, Fernando; Fiol, Miquel; Lapetra, Jose; Serra-Majem, Lluis; Pintó, Xavier; Portillo, Maria Puy; Lamuela-Raventos, Rosa M.; Ros, Emilio; Sorli, Jose V.; Martinez-Gonzalez, Miguel A.

    2013-01-01

    Background The traditional Mediterranean dietary pattern (MedDiet) is associated with longevity and low rates of cardiovascular disease (CVD). However, there is little information on who is more likely to follow this food pattern. Aim To evaluate how different factors are associated with lower MedDiet adherence in older Spanish subjects. Methods We included 7305 participants (men aged 55–80 y, women 60–80 y) at high-risk of CVD recruited into the PREDIMED trial (ISRCTN35739639). Socioeconomic, anthropometric, lifestyle characteristics and CVD risk factors were recorded. A validated 14-item questionnaire was used to evaluate MedDiet adherence at baseline. Multivariate models were used to estimate odds ratios (OR) and 95% confidence intervals for lower adherence to the MedDiet (<9 points out of 14) and ascertain factors independently associated with it. Results Former smoking (OR = 0.87; 95% CI, 0.78–0.98), physical activity (OR for the 3rd vs. the 1sttertile: 0.69; 0.62–0.78), and higher educational level (OR for university vs. less than primary school: 0.54; 0.38–0.77) were associated with higher MedDiet adherence. Conversely, having a larger waist-to-height ratio (OR for 0.1 units, 1.35; 1.22–1.49), being diabetic (OR = 1.13; 1.03–1.24), being single (OR = 1.27; 1.01–1.61) or divorced or separated (OR = 1.44; 1.09–1.89), and current smoking (OR = 1.28; 1.11–1.47) were associated with lower adherence. Conclusions Participants with little education, a larger waist-to-height ratio, or diabetes and those who were less physically active, single, divorced or separated, or smokers were less likely to adhere to the MedDiet, an ideal model for food choices. Stronger efforts of health promotion are needed in these groups to foster adoption of the MedDiet. PMID:23637743

  8. Perceived Family Support and Antiretroviral Adherence in HIV-Positive Individuals: Results from a Community-Based Positive Living With HIV Study.

    PubMed

    Poudel, Krishna C; Buchanan, David R; Amiya, Rachel M; Poudel-Tandukar, Kalpana

    2015-01-01

    The purpose of this study was to examine the association between perceived family support, either positive or negative, and adherence to antiretroviral medication regimens among HIV-positive individuals in the Kathmandu Valley, Nepal. We measured past 3-month antiretroviral adherence among 233 HIV-positive individuals, in relation to perceived family support, both positive (in terms of emotional and instrumental support) and negative (in the form of negative interactions), using the 10-item Nepali Family Support and Difficulty Scale. Medium and high levels of perceived emotional support from family were associated with reduced risk of antiretroviral nonadherence, compared with low levels of perceived emotional support (adjusted odds ratio [AOR]  = 0.37, 95% confidence interval [CI] [0.16, 0.88], and AOR  = 0.23, 95% CI [0.08, 0.64], respectively). Conversely, higher levels of felt emotional distance (AOR  = 1.46, 95% CI [1.00, 2.14]) and experienced physical harm (AOR  = 2.04, 95% CI [1.07, 3.91]) were associated with increased risk of nonadherence. The results support the recommendation that service providers need to be aware of the significant role of family support in shaping antiretroviral adherence and to consider ways to strengthen positive family support while minimizing negative family interactions to increase adherence rates.

  9. Confusion between Odds and Probability, a Pandemic?

    ERIC Educational Resources Information Center

    Fulton, Lawrence V.; Mendez, Francis A.; Bastian, Nathaniel D.; Musal, R. Muzaffer

    2012-01-01

    This manuscript discusses the common confusion between the terms probability and odds. To emphasize the importance and responsibility of being meticulous in the dissemination of information and knowledge, this manuscript reveals five cases of sources of inaccurate statistical language imbedded in the dissemination of information to the general…

  10. PARITY ODD BUBBLES IN HOT QCD.

    SciTech Connect

    KHARZEEV,D.; PISARSKI,R.D.; TYTGAT,M.H.G.

    1998-04-16

    We consider the topological susceptibility for an SU(N) gauge theory in the limit of a large number of colors, N {r_arrow} {infinity}. At nonzero temperature, the behavior of the topological susceptibility depends upon the order of the deconfining phase transition. The most interesting possibility is if the deconfining transition, at T = T{sub d}, is of second order. Then we argue that Witten's relation implies that the topological susceptibility vanishes in a calculable fashion at Td. As noted by Witten, this implies that for sufficiently light quark masses, metastable states which act like regions of nonzero {theta}--parity odd bubbles--can arise at temperatures just below T{sub d}. Experimentally, parity odd bubbles have dramatic signatures: the {eta}{prime} meson, and especially the {eta} meson, become light, and are copiously produced. Further, in parity odd bubbles, processes which are normally forbidden, such as {eta} {r_arrow} {pi}{sup 0}{pi}{sup 0}, are allowed. The most direct way to detect parity violation is by measuring a parity odd global asymmetry for charged pions, which we define.

  11. Odd numbers of photons and teleportation

    NASA Astrophysics Data System (ADS)

    Enk, S. J.

    2003-02-01

    Several teleportation protocols, namely those using entangled coherent states, entangled squeezed states, and the single-photon Einstein-Podolsky-Rosen state, are all shown to be particular instances of a more general scheme that relies on the detection of an odd number of photons.

  12. Experimental level-structure determination in odd-odd actinide nuclei

    SciTech Connect

    Hoff, R.W.

    1985-04-04

    The status of experimental determination of level structure in odd-odd actinide nuclei is reviewed. A technique for modeling quasiparticle excitation energies and rotational parameters in odd-odd deformed nuclei is applied to actinide species where new experimental data have been obtained by use of neutron-capture gamma-ray spectroscopy. The input parameters required for the calculation are derived from empirical data on single-particle excitations in neighboring odd-mass nuclei. Calculated configuration-specific values for the Gallagher-Moszkowski splittings are used. Calculated and experimental level structures for /sup 238/Np, /sup 244/Am, and /sup 250/Bk are compared, as well as those for several nuclei in the rare-earth region. The agreement for the actinide species is excellent, with bandhead energies deviating 22 keV and rotational parameters 5%, on the average. Applications of this modeling technique are discussed.

  13. Medication adherence: process for implementation

    PubMed Central

    Mendys, Phil; Zullig, Leah L; Burkholder, Rebecca; Granger, Bradi B; Bosworth, Hayden B

    2014-01-01

    Improving medication adherence is a critically important, but often enigmatic objective of patients, providers, and the overall health care system. Increasing medication adherence has the potential to reduce health care costs while improving care quality, patient satisfaction and health outcomes. While there are a number of papers that describe the benefits of medication adherence in terms of cost, safety, outcomes, or quality of life, there are limited reviews that consider how best to seamlessly integrate tools and processes directed at improving medication adherence. We will address processes for implementing medication adherence interventions with the goal of better informing providers and health care systems regarding the safe and effective use of medications. PMID:25114513

  14. (abstract) Odd Hydrogen in the Atmospheres of Earth and Mars

    NASA Technical Reports Server (NTRS)

    Nair, Hari; Allen, Mark; Yung, Yuk L.

    1994-01-01

    The Martian atmosphere has many features in common with the terrestrial mesosphere. Both share similar pressure and temperature ranges, and much of the same chemistry operates in each. For example, the radical species H, OH, and H(sub 2)O, which comprise the odd hydrogen family, are of central importance in the catalytic destruction of CO and O(sub 3) in both atmospheres. The inclusion of recent chemical kinetics data, specifically temperature dependent CO(sub 2) absorption cross-sections, into our one dimensional photochemical model of the Martial atmosphere shows that oxidation of CO by odd hydrogen is too efficient. The incorporation of smaller cross sections for CO(sub 2) leads to an enhanced photolysis rate of water vapor, increasing odd hydrogen to the point where the predicted mixing ratio of CO in our model is substantially less than the observed value of 6.5 x 10(sup -4). Interestingly, most photochemical models of the terrestrial mesosphere underestimate the CO and O(sub 3) densities using currently accepted photodissociation and kinetic rate coefficients. This has also been attributed to an overabundance of odd hydrogen in the models. We shall show that agreement between models and observations of CO in the Martian atmosphere as well as of CO and O(sub 3) in the terrestrial mesosphere can be achieved by revising the rate constants for the reactions OH + HO(sub 2) and CO + OH within their published uncertainties. The fact that similar revisions alleviate discrepancies in both the terrestrial and Martian atmospheres warrants a re-evaluation of these key rate constants at the appropriate temperatures and pressures.

  15. Brief Report: PrEP Uptake, Adherence, and Discontinuation Among California YMSM Using Geosocial Networking Applications.

    PubMed

    Holloway, Ian W; Dougherty, Ryan; Gildner, Jennifer; Beougher, Sean C; Pulsipher, Craig; Montoya, Jorge A; Plant, Aaron; Leibowitz, Arleen

    2017-01-01

    We investigated pre-exposure prophylaxis (PrEP) uptake, adherence, and discontinuation among young app-using men who have sex with men in California (N = 761). Approximately, 9.7% of participants had ever used PrEP; 87% of those deemed good candidates for screening (indicated by a Centers for Disease Control and Prevention risk index score ≥10) were not current or past users. PrEP use was associated with higher income [adjusted odds ratio (aOR): 4.13; confidence interval (CI): 1.87 to 9.12], receptive condomless anal sex (aOR: 3.41; CI: 1.71 to 6.78), HIV-positive sex partners (aOR: 2.87; CI: 1.53 to 5.38), popper use (aOR: 3.47; CI: 1.96 to 6.13), and recent sexually transmitted infection diagnosis (aOR: 2.90; CI: 1.64 to 5.13). Some users (41.5%) wanted help remembering to take PrEP. The top reason for discontinuation was concern about long-term side effects (33.0%). Young men who have sex with men app users are prime candidates for PrEP, despite low uptake. Apps may be useful tools for PrEP information dissemination, adherence monitoring, and support.

  16. An easy intervention to improve short-term adherence to medications in community-dwelling older outpatients. A pilot non-randomised controlled trial

    PubMed Central

    2011-01-01

    Background Complex interventions to improve compliance to pharmacological treatment in older people have given mixed results and are not easily applicable in clinical practice. The aim of this study was to test the short-term efficacy on self-reported medication adherence of an easy intervention in which the patient or caregiver was asked to transcribe the pharmacological treatment while it was dictated to him/her by the doctor. Methods Pilot non-randomised controlled trial involving 108 community-dwelling outpatients aged 65+ (54 in the intervention arm, 54 controls) referred to a geriatric service from May to July 2009 and prescribed by the geriatrician a change in therapy. The intervention was applied at the end of the visit to the person managing the medications, be it the elder or his/her caregiver. Outcome of the study was the occurrence of any adherence error, assessed at a one-month follow-up by means of a semi-structured interview. Results The socio-demographic, functional and clinical characteristics of the two compared groups were similar at baseline. At a one-month follow-up 43 subjects (40%) had made at least one adherence error, whether unintentional or intentional. In the intervention group the prevalence of adherence errors was lower than in controls (20% vs 59%; adjusted odds ratio 0.16, 95% confidence interval 0.07 - 0.39; p < 0.001) after adjusting for the person managing the medications, the adherence errors at baseline and for the number of prescribed drugs. Conclusions In an older outpatient population the intervention considered was effective in reducing the prevalence of adherence errors in the month following the visit. Trial registration Australian and New Zealand Clinical Trials Register (ANZCTR): ACTRN12611000347965 PMID:21729274

  17. Increased adherence to prenatal group B streptococcal screening guidelines through a paired electronic reminder and education intervention.

    PubMed

    Maclaughlin, Kathy L; Garrison, Gregory M; Matthews, Marc R; O'Brien, Marcia L; Westby, Elizabeth; Targonski, Paul V

    2014-01-01

    The 2010 Centers for Disease Control and Prevention (CDC) update on perinatal group B streptococcal (GBS) prevention advises universal vaginal-rectal GBS screening of pregnant women in the 35th through 37th week of gestation. Because GBS colonization is transient, a test performed more than 5 weeks before delivery may not have sufficient negative predictive value to be clinically useful. Our objective was to increase rates of quality-improved, CDC-adherent GBS screening and decrease repeat screening. A reminder for maternal vaginal-rectal GBS testing was added to the physicians' electronic ordering screen, and family medicine physicians and residents were educated about screening guidelines through standardized, in-person presentations. Retrospective chart review was performed before and after these interventions. Univariate or bivariate analysis was performed for demographic factors, timing of first screen, rates of CDC-adherent screening (the newly defined quality-improved screen and the usual screen), and rates of repeat and unnecessary screens. Multivariate analysis was performed with quality-improved and usual screening as dependent variables. Bivariate analysis showed that post-intervention rates of quality-improved screening increased from 30 to 62 % (P < .001), usual screening increased from 69 to 84 % (P = .005), and repeat GBS screening decreased from 20 to 8 % (P = .007). Multivariate analysis showed increased post-intervention odds of quality-improved screening [odds ratio (OR) 3.59; 95 % CI 2.07-6.34] and usual screening (OR 2.67; 95 % CI 1.40-5.25). Low-cost, reproducible quality improvement interventions (electronic order reminder, educational sessions) have the potential to increase guideline adherence for GBS screening in pregnant women and decrease repeat screening.

  18. Spectroscopic evidence of odd frequency superconducting order

    PubMed Central

    Pal, Avradeep; Ouassou, J. A.; Eschrig, M.; Linder, J.; Blamire, M. G.

    2017-01-01

    Spin filter superconducting S/I/N tunnel junctions (NbN/GdN/TiN) show a robust and pronounced Zero Bias Conductance Peak (ZBCP) at low temperatures, the magnitude of which is several times the normal state conductance of the junction. Such a conductance anomaly is representative of unconventional superconductivity and is interpreted as a direct signature of an odd frequency superconducting order. PMID:28106102

  19. Adherence to antiretroviral therapy and its associated factors among children at South Wollo Zone Hospitals, Northeast Ethiopia: a cross-sectional study

    PubMed Central

    2014-01-01

    Background Poor adherence to antiretroviral therapy negatively affects the suppression of viral replication. It increases risks of drug resistance, treatment failure, Acquired Immuno Deficiency Syndrome (AIDS)-related morbidity and mortality among children. This study assessed the level of adherence to antiretroviral therapy and its associated factors among children at hospitals in South Wollo Zone, Northeast Ethiopia. Methods An institution-based cross-sectional study was conducted among Human Immunodeficiency Virus (HIV)-infected children in April 2013. A total of 464 children who were taking Antiretroviral Therapy (ART) in the hospitals were included. Data were collected using pretested and structured questionnaires using a face-to-face interview method. Descriptive and summary statistics were employed. Bivariate and multiple logistic regressions were computed. Odds ratios and their 95% confidence intervals were computed to determine the level of significance. Results Of the 464 study samples, 440 children with their caregivers were included in the final analysis. A total of 78.6% of the caregivers reported that their children were adherent to antiretroviral therapy in the month prior to the interview. Caregivers' knowledge about antiretroviral treatment [AOR = 2.72(95% CI: 1.82, 5.39)], no current substance use of the caregivers [Adjusted Odds Ratio (AOR) = 2.21(95% Confidence Interval (CI): 1.34, 7.13)], proximity to the health care facility [AOR = 2.31(95% CI: 1.94, 4.63)], if the child knows HIV-positive status [AOR = 3.47(95% CI: 2.10, 6.81)] and caregiver’s educational status [AOR = 0.59(95% CI: 0.21, 0.82)] were significantly and independently associated with adherence of children to antiretroviral therapy. Conclusion Adherence of antiretroviral therapy in this study was comparable to other studies conducted in developing countries. Caregiver’s knowledge about antiretroviral therapy, no current use of substances, close proximity to

  20. Adherence to antiretroviral therapy (ART) during the early months of treatment in rural Zambia: influence of demographic characteristics and social surroundings of patients

    PubMed Central

    2012-01-01

    Background Around 70% of those living with HIV in need of treatment accessed antiretroviral therapy (ART) in Zambia by 2009. However, sustaining high levels of adherence to ART is a challenge. This study aimed to identify the predictive factors associated with ART adherence during the early months of treatment in rural Zambia. Methods This is a field based observational longitudinal study in Mumbwa district, which is located 150 km west of Lusaka, the capital of Zambia. Treatment naive patients aged over 15 years, who initiated treatment during September-November 2010, were enrolled. Patients were interviewed at the initiation and six weeks later. The treatment adherence was measured according to self-reporting by the patients. Multiple logistic regression analysis was performed to identify the predictive factors associated with the adherence. Results Of 157 patients, 59.9% were fully adherent to the treatment six weeks after starting ART. According to the multivariable analysis, full adherence was associated with being female [Adjusted Odds Ratio (AOR), 3.3; 95% Confidence interval (CI), 1.2-8.9], having a spouse who were also on ART (AOR, 4.4; 95% CI, 1.5-13.1), and experience of food insufficiency in the previous 30 days (AOR, 5.0; 95% CI, 1.8-13.8). Some of the most common reasons for missed doses were long distance to health facilities (n = 21, 53.8%), food insufficiency (n = 20, 51.3%), and being busy with other activities such as work (n = 15, 38.5%). Conclusions The treatment adherence continues to be a significant challenge in rural Zambia. Social supports from spouses and people on ART could facilitate their treatment adherence. This is likely to require attention by ART services in the future, focusing on different social influences on male and female in rural Zambia. In addition, poverty reduction strategies may help to reinforce adherence to ART and could mitigate the influence of HIV infection for poor patients and those who fall into poverty after

  1. Stratospheric distributions of odd nitrogen and odd hydrogen in a two-dimensional model

    NASA Technical Reports Server (NTRS)

    Prinn, R. G.; Alyea, F. N.; Cunnold, D. M.

    1975-01-01

    A two-dimensional pole-to-pole chemical model of the stratosphere is developed which extends from 8 to 38 km in altitude. Atmospheric motions are simulated by mean vertical and meridional winds and eddy diffusion coefficients. Seasonally averaged distributions of important odd nitrogen (NO, NO2, and HNO3) and odd hydrogen (H, OH, HO2, H2O2) compounds are computed. Photodissociation of N2O leads to production of odd nitrogen in the stratosphere, and the odd nitrogen is ultimately removed by downward transport into the troposphere and by rain-out (modeled by a rain-out lifetime of 30 days below 8-km altitude). Results are presented for a quasi-steady state in which seasonal cycles repeat themselves. These results show significant latitudinal as well as vertical variations in the predicted species which emphasize the need for at least two dimensions in accurate stratospheric modeling. Computed concentrations are compared with observations when they exist.

  2. Effects of Telephone Counseling Intervention by Pharmacists (TelCIP) on Medication Adherence; Results of a Cluster Randomized Trial

    PubMed Central

    Kooij, Marcel J.; Heerdink, Eibert R.; van Dijk, Liset; van Geffen, Erica C. G.; Belitser, Svetlana V.; Bouvy, Marcel L.

    2016-01-01

    Objectives: To assess the effect of a pharmacist telephone counseling intervention on patients' medication adherence. Design: Pragmatic cluster randomized controlled trial. Setting: 53 Community pharmacies in The Netherlands. Participants: Patients ≥18 years initiating treatment with antidepressants, bisphosphonates, Renin-Angiotensin System (RAS)-inhibitors, or statins (lipid lowering drugs). Pharmacies in arm A provided the intervention for antidepressants and bisphosphonates and usual care for RAS-inhibitors and statins. Pharmacies in arm B provided the intervention for RAS-inhibitors and statins and usual care for antidepressants and bisphosphonates. Intervention: Intervention consisted of a telephone counseling intervention 7–21 days after the start of therapy. Counseling included assessment of practical and perceptual barriers and provision of information and motivation. Main outcome measure: Primary outcome was refill adherence measured over 1 year expressed as continuous outcome and dichotomous (refill rate≥80%). Secondary outcome was discontinuation within 1 year. Results: In the control arms 3627 patients were eligible and in the intervention arms 3094 patients. Of the latter, 1054 patients (34%) received the intervention. Intention to treat analysis showed no difference in adherence rates between the intervention and the usual care arm (74.7%, SD 37.5 respectively 74.5%, 37.9). More patients starting with RAS-inhibitors had a refill ratio ≥80% in the intervention arm compared to usual care (81.4 vs. 74.9% with odds ratio (OR) 1.43, 95%CI 1.11–1.99). Comparing patients with counseling to patients with usual care (per protocol analysis), adherence was statistically significant higher for patients starting with RAS-inhibitors, statins and bisphosphonates. Patients initiating antidepressants did not benefit from the intervention. Conclusions: Telephone counseling at start of therapy improved adherence in patients initiating RAS-inhibitors. The per

  3. Factors associated with poor adherence to antiviral treatment for hepatitis B.

    PubMed

    Allard, N; Dev, A; Dwyer, J; Srivatsa, G; Thompson, A; Cowie, B

    2017-01-01

    Antiviral therapy for hepatitis B is effective and reduces the risk of progression to cirrhosis and liver cancer but is often required for an indefinite duration. Treatment adherence is important to prevent the development of resistance and optimize outcomes. Pharmacy adherence measures can be used to assess treatment adherence, with the medication possession ratio being less susceptible to bias than physician- or self-reported adherence. The aim of this study was to measure adherence in public hospital outpatients over a 3-year period and to examine factors associated with nonadherence. A retrospective study of pharmacy records of patients dispensed antiviral therapy for hepatitis B from four major hospitals in Melbourne between 2010 and 2013. Hospital record numbers were linked with and de-identified demographic information including age, sex, Indigenous status, country of birth, interpreter requirement, spoken language and postcode of residence. The medication possession ratio was the outcome measure with poor adherence defined <.90. Univariate logistic regression and multivariate logistic regression were performed to examine associations with nonadherence. Records of 1026 patients were included in the analysis. Twenty per cent of all participants met the definition of poor adherence. Significant factors affecting adherence included age <35 years (P=.002), hospital site and treatment by multiple doctors within shorter time periods. This is the largest study examining detailed factors associated with adherence to hepatitis B treatment. Understanding poor adherence in clinical settings, and the factors associated with lower adherence, is important to inform efforts towards promoting treatment adherence for hepatitis B.

  4. Effectiveness of financial incentives to improve adherence to maintenance treatment with antipsychotics: cluster randomised controlled trial

    PubMed Central

    Yeeles, Ksenija; Bremner, Stephen; Lauber, Christoph; Eldridge, Sandra; Ashby, Deborah; David, Anthony S; O’Connell, Nicola; Forrest, Alexandra; Burns, Tom

    2013-01-01

    Objective To test whether offering financial incentives to patients with psychotic disorders is effective in improving adherence to maintenance treatment with antipsychotics. Design Cluster randomised controlled trial. Setting Community mental health teams in secondary psychiatric care in the United Kingdom. Participants Patients with a diagnosis of schizophrenia, schizoaffective disorder, or bipolar disorder, who were prescribed long acting antipsychotic (depot) injections but had received 75% or less of the prescribed injections. We randomly allocated 73 teams with a total of 141 patients. Primary outcome data were available for 35 intervention teams with 75 patients (96% of randomised) and for 31 control teams with 56 patients (89% of randomised). Interventions Participants in the intervention group were offered £15 (€17; $22) for each depot injection over a 12 month period. Participants in the control condition received treatment as usual. Main outcome measure The primary outcome was the percentage of prescribed depot injections given during the 12 month intervention period. Results 73 teams with 141 consenting patients were randomised, and outcomes were assessed for 131 patients (93%). Average baseline adherence was 69% in the intervention group and 67% in the control group. During the 12 month trial period adherence was 85% in the intervention group and 71% in the control group. The adjusted effect estimate was 11.5% (95% confidence interval 3.9% to 19.0%, P=0.003). A secondary outcome was an adherence of ≥95%, which was achieved in 28% of the intervention group and 5% of the control group (adjusted odds ratio 8.21, 95% confidence interval 2.00 to 33.67, P=0.003). Although differences in clinician rated clinical improvement between the groups failed to reach statistical significance, patients in the intervention group had more favourable subjective quality of life ratings (β=0.71, 95% confidence interval 0.26 to 1.15, P=0.002). The number of admissions

  5. Adherence as a language game.

    PubMed

    Kolberg, Espen Skarstein

    2017-03-02

    Non-adherence, i.e. medication intake behavior not corresponding with agreed recommendations, is associated with increased morbidity and death, and it has been estimated that as many as 50% of patients in developed countries are not taking their medications as prescribed. But even as efforts in improving medication adherence over the years have increased, results are inconsistent, with only a minority of clinical trials showing any improvement in both adherence and clinical outcome. Since patient education is central to promoting good medication adherence, and language is integral to education, perhaps an exploration of the meaning and use of language, using the philosophy of Ludwig Wittgenstein, is in order.

  6. A Longitudinal Study of Adherence to the Mediterranean Dietary Pattern and Metabolic Syndrome in a Non-Mediterranean Population

    PubMed Central

    Mirmiran, Parvin; Moslehi, Nazanin; Mahmoudof, Hessameddin; Sadeghi, Mahbubeh; Azizi, Fereidoun

    2015-01-01

    Background: Adherence to the Mediterranean diet (MedDiet) has been proposed to reduce the risk of metabolic syndrome (MetS), but the association of the diet on MetS in non-Mediterranean populations remains unclear. Objectives: The aim of this study was to investigate whether adherence to the MedDiet is related to the incident MetS and its components during a 3-year follow-up among Iranian adults. Patients and Methods: Longitudinal associations between the MedDiet and MetS components were investigated on 2241 adults, aged 18 - 74 years, without type 2 diabetes selected from participants of the Tehran lipid and glucose study (TLGS). The association between the MedDiet and MetS incidence was also examined in 1661 participants, free of Mets at baseline. Adherence to the MedDiet was assessed using the traditional Mediterranean diet score (MDS) and a recently posteriori adaptation of the MDS of Sofi et al. (Sofi-MDS). MetS was defined according to the recent interim consensus. Results: After adjusting for potential confounders, neither higher MDS nor higher Sofi-MDS were significantly associated with the mean values of MetS components and the risk of metabolic abnormalities incidence after 3 years follow-up. During the 3 years of follow-up, 246 developed MetS were identified. In multivariable model, the adjusted odds ratio (OR) of developing MetS did not differ significantly in participants with the highest tertile of the MDS (OR (95% CI): 0.88 (0.62 - 1.23)) or sofi-MDS (OR (95% CI):1.12 (0.77 - 1.62)) compared to those in the lowest tertiles. Conclusions: Adherence to the MedDiet, according to MDS and Sofi-MDS, may not predict MetS components and MetS incidence after 3 years of follow-up in Iranian adult populations. PMID:26425127

  7. Association between adherence, treatment satisfaction and illness perception in hypertensive patients.

    PubMed

    Saarti, S; Hajj, A; Karam, L; Jabbour, H; Sarkis, A; El Osta, N; Rabbaa Khabbaz, L

    2016-05-01

    The relationship between adherence to antihypertension medications, treatment satisfaction and illness perception has not been studied so far. The primary objective of this study was to examine the association between adherence to medication, treatment satisfaction and illness perception in Lebanese hypertensive patients. The relation between medication adherence and blood pressure (BP) control was also assessed. In this cross-sectional study, patients were recruited from the physician's practice offices and community pharmacies in Beirut. Patients who had been treated for hypertension for at least 3 months were invited to participate in the study; they completed three questionnaires: the 8-item Morisky Medication Adherence Scale (MMAS-8), the Treatment Satisfaction Questionnaire for Medication (TSQM-4) and the Brief Illness Perception Questionnaire (BIPQ). BP was also measured and recorded. A total of 117 subjects were included, of whom 29.1% had poor adherence to their antihypertension treatment (MMAS-8 scores<6). The odds of having well-controlled hypertension was 3.5 times higher in patients with high adherence compared with patients with poor adherence (P=0.010). Treatment satisfaction was significantly greater in patients with good adherence (P<0.001). Neither socio-demographic, disease- nor drug-related characteristics of the participants were significantly associated with medication adherence. As for illness perception, even though the mean BIPQ score of adherent participants was lower than the mean score of non-adherent participants, this difference did not reach statistical significance. In conclusion, treatment satisfaction was found to be a predictor of adherence. Studies are needed to determine whether interventions to increase satisfaction can improve adherence and BP control.

  8. Odd-parity D states in He.

    NASA Technical Reports Server (NTRS)

    Bhatia, A. K.

    1972-01-01

    The states considered lie below the n = 2 threshold of He(+) and decay radiatively to the lower states. The most general D-state wave function of odd parity of two electrons is examined. The results presented are optimized with respect to four nonlinear parameters for 112 terms. A mass-polarization correction is given for all the states listed. The positions of the D states, including the reduced mass and the mass-polarization corrections, with respect to the ground state of He are reported.

  9. Determinants of medication adherence among adults with type 2 diabetes mellitus in three Malaysian public health clinics: a cross-sectional study

    PubMed Central

    Chew, Boon-How; Hassan, Noor-Hasliza; Sherina, Mohd-Sidik

    2015-01-01

    Medication adherence (MA) in adults with type 2 diabetes mellitus (T2D) is associated with improved disease control (glycated hemoglobin, blood pressure, and lipid profile), lower rates of death and diabetes-related complications, increased quality of life, and decreased health care resource utilization. However, there is a paucity of data on the effect of diabetes-related distress, depression, and health-related quality of life on MA. This study examined factors associated with MA in adults with T2D at the primary care level. This was a cross-sectional study conducted in three Malaysian public health clinics, where adults with T2D were recruited consecutively in 2013. We used the 8-item Morisky Medication Adherence Scale (MMAS-8) to assess MA as the main dependent variable. In addition to sociodemographic data, we included diabetes-related distress, depressive symptoms, and health-related quality of life as independent variables. Independent association between the MMAS-8 score and its determinants was done using generalized linear models with a gamma distribution and log link function. The participant response rate was 93.1% (700/752). The majority were female (52.8%), Malay (52.9%), and married (79.1%). About 43% of patients were classified as showing low MA (MMAS-8 score <6). Higher income (adjusted odds ratio 0.90) and depressive symptoms (adjusted odds ratio 0.99) were significant independent determinants of medication non-adherence in young adults with T2D. Low MA in adults with T2D is a prevalent problem. Thus, primary health care providers in public health clinics should focus on MA counselling for adult T2D patients who are younger, have a higher income, and symptoms of depression. PMID:25999699

  10. Clonogenic Assay: Adherent Cells

    PubMed Central

    Rafehi, Haloom; Orlowski, Christian; Georgiadis, George T.; Ververis, Katherine; El-Osta, Assam; Karagiannis, Tom C.

    2011-01-01

    The clonogenic (or colony forming) assay has been established for more than 50 years; the original paper describing the technique was published in 19561. Apart from documenting the method, the initial landmark study generated the first radiation-dose response curve for X-ray irradiated mammalian (HeLa) cells in culture1. Basically, the clonogenic assay enables an assessment of the differences in reproductive viability (capacity of cells to produce progeny; i.e. a single cell to form a colony of 50 or more cells) between control untreated cells and cells that have undergone various treatments such as exposure to ionising radiation, various chemical compounds (e.g. cytotoxic agents) or in other cases genetic manipulation. The assay has become the most widely accepted technique in radiation biology and has been widely used for evaluating the radiation sensitivity of different cell lines. Further, the clonogenic assay is commonly used for monitoring the efficacy of radiation modifying compounds and for determining the effects of cytotoxic agents and other anti-cancer therapeutics on colony forming ability, in different cell lines. A typical clonogenic survival experiment using adherent cells lines involves three distinct components, 1) treatment of the cell monolayer in tissue culture flasks, 2) preparation of single cell suspensions and plating an appropriate number of cells in petri dishes and 3) fixing and staining colonies following a relevant incubation period, which could range from 1-3 weeks, depending on the cell line. Here we demonstrate the general procedure for performing the clonogenic assay with adherent cell lines with the use of an immortalized human keratinocyte cell line (FEP-1811)2. Also, our aims are to describe common features of clonogenic assays including calculation of the plating efficiency and survival fractions after exposure of cells to radiation, and to exemplify modification of radiation-response with the use of a natural antioxidant

  11. Measurement of Psychiatric Treatment Adherence

    PubMed Central

    Sajatovic, Martha; Velligan, Dawn; Weiden, Peter J.; Valenstein, Marcia; Ogedegbe, Gbenga

    2014-01-01

    Objective Nonadherence to medications for mental disorders substantially limits treatment effectiveness and results in higher rates of relapse, hospitalization, and disability. Accurate measurement of medication adherence is important not only in adherence research, but also in clinical trials in which medications are being evaluated, and in clinical practice where failure to detect nonadherence results in premature medication changes, unnecessary polypharmacy, and greater likelihoods of functional deteriorations and hospitalizations. This is a review of psychiatric treatment adherence methods and measures arising from a meeting on “Methodological Challenges in Psychiatric Treatment Adherence Research” held on September 27-28, 2007 in Bethesda, MD and organized by the National Institute of Mental Health (NIMH). Methods This paper reviews the range of modalities currently available for assessing adherence behavior including pill counts, pharmacy records, technology-assisted monitoring, biological assays, and a range of self-report and interviewer-rated scales. Measures of adherence attitudes are also reviewed. Results Each of the adherence measures described are imperfect estimates of actual medication ingestion but each provides informative estimates of adherence or the attitudinal factors associated with adherence. Measure selection depends on a range of factors including the patient sample, the context in which the measure is being used, and the clinical outcomes expected from various levels of nonadherence. The use of multiple measures of adherence is encouraged to balance the limitations of individual measures. Conclusion While adherence assessment has become increasingly sophisticated in recent years there remains a need for refinement and expansion on currently available methods and measures. PMID:21109048

  12. Enhanced T-odd, P-odd electromagnetic moments in reflection asymmetric nuclei

    SciTech Connect

    Spevak, V.; Auerbach, N.; Flambaum, V.V.

    1997-09-01

    Collective P- and T-odd moments produced by parity and time invariance violating forces in reflection asymmetric nuclei are considered. The enhanced collective Schiff, electric dipole, and octupole moments appear due to the mixing of rotational levels of opposite parity. These moments can exceed single-particle moments by more than 2 orders of magnitude. The enhancement is due to the collective nature of the intrinsic moments and the small energy separation between members of parity doublets. In turn these nuclear moments induce enhanced T- and P-odd effects in atoms and molecules. A simple estimate is given and a detailed theoretical treatment of the collective T-, P-odd electric moments in reflection asymmetric, odd-mass nuclei is presented. In the present work we improve on the simple liquid drop model by evaluating the Strutinsky shell correction and include corrections due to pairing. Calculations are performed for octupole deformed long-lived odd-mass isotopes of Rn, Fr, Ra, Ac, and Pa and the corresponding atoms. Experiments with such atoms may improve substantially the limits on time reversal violation. {copyright} {ital 1997} {ital The American Physical Society}

  13. Quantum Hall effect on odd spheres

    NASA Astrophysics Data System (ADS)

    Coşkun, Ü. H.; Kürkçüoǧlu, S.; Toga, G. C.

    2017-03-01

    We solve the Landau problem for charged particles on odd dimensional spheres S2 k -1 in the background of constant SO (2 k -1 ) gauge fields carrying the irreducible representation (I/2 ,I/2 ,…,I/2 ). We determine the spectrum of the Hamiltonian, the degeneracy of the Landau levels and give the eigenstates in terms of the Wigner D -functions, and for odd values of I , the explicit local form of the wave functions in the lowest Landau level (LLL). The spectrum of the Dirac operator on S2 k -1 in the same gauge field background together with its degeneracies is also determined, and in particular, its number of zero modes is found. We show how the essential differential geometric structure of the Landau problem on the equatorial S2 k -2 is captured by constructing the relevant projective modules. For the Landau problem on S5, we demonstrate an exact correspondence between the union of Hilbert spaces of LLLs, with I ranging from 0 to Imax=2 K or Imax=2 K +1 to the Hilbert spaces of the fuzzy CP 3 or that of winding number ±1 line bundles over CP 3 at level K , respectively.

  14. Sigma decomposition: the CP-odd Lagrangian

    NASA Astrophysics Data System (ADS)

    Hierro, I. M.; Merlo, L.; Rigolin, S.

    2016-04-01

    In Alonso et al., JHEP 12 (2014) 034, the CP-even sector of the effective chiral Lagrangian for a generic composite Higgs model with a symmetric coset has been constructed, up to four momenta. In this paper, the CP-odd couplings are studied within the same context. If only the Standard Model bosonic sources of custodial symmetry breaking are considered, then at most six independent operators form a basis. One of them is the weak- θ term linked to non-perturbative sources of CP violation, while the others describe CP-odd perturbative couplings between the Standard Model gauge bosons and an Higgs-like scalar belonging to the Goldstone boson sector. The procedure is then applied to three distinct exemplifying frameworks: the original SU(5)/SO(5) Georgi-Kaplan model, the minimal custodial-preserving SO(5)/SO(4) model and the minimal SU(3)/(SU(2) × U(1)) model, which intrinsically breaks custodial symmetry. Moreover, the projection of the high-energy electroweak effective theory to the low-energy chiral effective Lagrangian for a dynamical Higgs is performed, uncovering strong relations between the operator coefficients and pinpointing the differences with the elementary Higgs scenario.

  15. Soil clay content underlies prion infection odds

    USGS Publications Warehouse

    David, Walter W.; Walsh, D.P.; Farnsworth, Matthew L.; Winkelman, D.L.; Miller, M.W.

    2011-01-01

    Environmental factors-especially soil properties-have been suggested as potentially important in the transmission of infectious prion diseases. Because binding to montmorillonite (an aluminosilicate clay mineral) or clay-enriched soils had been shown to enhance experimental prion transmissibility, we hypothesized that prion transmission among mule deer might also be enhanced in ranges with relatively high soil clay content. In this study, we report apparent influences of soil clay content on the odds of prion infection in free-ranging deer. Analysis of data from prion-infected deer herds in northern Colorado, USA, revealed that a 1% increase in the clay-sized particle content in soils within the approximate home range of an individual deer increased its odds of infection by up to 8.9%. Our findings suggest that soil clay content and related environmental properties deserve greater attention in assessing risks of prion disease outbreaks and prospects for their control in both natural and production settings. ?? 2011 Macmillan Publishers Limited. All rights reserved.

  16. Meeting report for Odd Pols 2012.

    PubMed

    Roy-Engel, Astrid M; Moss, Thomas; Maraia, Richard J

    2013-08-15

    The Eighth International Biennial Conference on RNA polymerases I and III (the 'Odd Pols') was held June 7-11, 2012 at The Airlie Center in Warrenton Virginia, USA. It was sponsored by the Universite Laval and the Eunice Kennedy Shriver National Institute of Child Health and Human Development, NIH, and organized by Rich Maraia and Tom Moss. The meeting honored the memory of Pierre Thuriaux (Jan 1, 1950-March 18, 2012) and David Schneider reminisced on the important accomplishments his mentor Masayasu Nomura (1927-2011). The goal of the conference was to bring together the world's experts on RNA polymerase I and RNA polymerase III to highlight and share their latest results and varied experimental approaches. The meeting drew attendees from twelve countries and most contributed through oral and poster presentations. The talks were organized into several sessions subdivided into 10 distinct topics. The keynote speaker, Ian Willis, opened the meeting with his presentation entitled "New Regulators of Signaling to Odd Pols" and the closing presentation was given by Patrick Cramer with his presentation "Conservation of the RNA polymerase I, II and III transcription initiation machineries". Here we present some of the highlights from the meeting using summaries provided by the participants.

  17. [Treatment adherence: a key element].

    PubMed

    Bastida, Guillermo; Sánchez Montes, Cristina; Aguas, Mariam

    2011-12-01

    A substantial percentage of patients fail to follow health professionals' recommendations, which affects the management of chronic diseases, reducing the effectiveness of therapeutic interventions and increasing the costs of the disease. Lack of adherence is a multidimensional phenomenon and is influenced by numerous factors that should be identified. A multiplicity of measures is available to improve adherence, such as simplifying treatment administration, but none of these measures is effective when used alone. One way of tackling lack of adherence is by identifying patients' barriers to medication and involving them in decision making. Ulcerative colitis (UC) poses a risk for lack of treatment adherence. In this disease, poor adherence correlates with poor disease control (drug effectiveness) and with higher costs. As in other chronic diseases, the causes associated with poor adherence are multiple, including psychosocial factors, the physician-patient relationship and patients' prejudices toward medication. A single dose of aminosalycylates (5-ASA) should be recommended, as this dose is as safe and effective as other regimens. However, by itself, this recommendation does not seem to improve adherence. Identifying the scale of the problem and developing strategies to involve the patient in decision making is crucial to improve treatment adherence.

  18. Biologic Influences on Exercise Adherence.

    ERIC Educational Resources Information Center

    Dishman, Rod K.

    1981-01-01

    Diagnostic profiles of 362 male participants in an exercise program were analyzed to determine the biological variables between exercise adherence and symptoms of coronary disease. Findings indicated that individuals with lower metabolic capacity tended to adhere longer, to be less fit, were leaner, and began with more symptoms related to coronary…

  19. Optimizing adherence to antiretroviral therapy

    PubMed Central

    Sahay, Seema; Reddy, K. Srikanth; Dhayarkar, Sampada

    2011-01-01

    HIV has now become a manageable chronic disease. However, the treatment outcomes may get hampered by suboptimal adherence to ART. Adherence optimization is a concrete reality in the wake of ‘universal access’ and it is imperative to learn lessons from various studies and programmes. This review examines current literature on ART scale up, treatment outcomes of the large scale programmes and the role of adherence therein. Social, behavioural, biological and programme related factors arise in the context of ART adherence optimization. While emphasis is laid on adherence, retention of patients under the care umbrella emerges as a major challenge. An in-depth understanding of patients’ health seeking behaviour and health care delivery system may be useful in improving adherence and retention of patients in care continuum and programme. A theoretical framework to address the barriers and facilitators has been articulated to identify problematic areas in order to intervene with specific strategies. Empirically tested objective adherence measurement tools and approaches to assess adherence in clinical/ programme settings are required. Strengthening of ART programmes would include appropriate policies for manpower and task sharing, integrating traditional health sector, innovations in counselling and community support. Implications for the use of theoretical model to guide research, clinical practice, community involvement and policy as part of a human rights approach to HIV disease is suggested. PMID:22310817

  20. [Strategies to improve medication adherence].

    PubMed

    Laufs, U; Böhm, M; Kroemer, H K; Schüssel, K; Griese, N; Schulz, M

    2011-08-01

    Up to 50 % of patients with chronic diseases do not take their medication regularly. Poor adherence to drug therapy is associated with higher morbidity and mortality. A selective literature search using the terms adherence, compliance, concordance, persistence, medication management, and pharmaceutical care was performed. Evidence for improving adherence has been provided for the following principles: individual counselling of patients and care givers, medication management including simplifying dosing and use of combination tablets as well as the use of individual unit doses, e. g. blister cards. The effectiveness has only been shown for the duration of the interventions. The improvement of medication adherence represents an area of research with high impact on outcomes and cost. Measures to improve adherence may be as important as the development of novel therapies. However, prospective clinical evaluations with clinical endpoints are missing especially for the German health care system in order to develop recommendations for clinical practice. Joint efforts of physicians and pharmacists are needed.

  1. Odd-even staggering of heavy cluster spontaneous emission rates

    NASA Astrophysics Data System (ADS)

    Poenaru, D. N.; Greiner, W.; Ivaşcu, M.; Mazilu, D.; Plonski, I. H.

    1986-12-01

    Experimentally observed enhanced14C and24Ne emission rates from even-even parents in comparison with that from even-odd or odd-even nuclei are explained in the framework of the analytical superasymmetric fission model, by taking various prescriptions for the zero point vibration energy of even-even, even-odd, odd-even and odd-odd emitters. Longer half-lives than previously computed are obtained by extrapolating the present prescriptions to emitted clusters heavier than24Ne.

  2. Shell Model Description of the Odd-Odd Co and Cu Nuclei

    SciTech Connect

    Medina, N. H.; Allegro, P. R. P.; Oliveira, J. R. B. de; Ribas, R. V.; Seale, W. A.; Toufen, D. L.; Silveira, M. A. G.

    2007-10-26

    The known excited states of the odd-odd nuclei {sup 54,56,58,60}Co and 60,62,64,66Cu were interpreted in the framework of the large scale shell model (LSSM), using several effective interactions and configuration spaces. For the description of the negative parity states, we have allowed one particle excitation to the g{sub 9/2} orbital. The LSSM using the GXPF1 effective interaction reproduces well the first excited states in all of these nuclei.

  3. Proton emission from the deformed odd-odd nuclei near drip line

    NASA Astrophysics Data System (ADS)

    Patial, M.; Arumugam, P.; Jain, A. K.; Maglione, E.; Ferreira, L. S.

    2016-01-01

    Proton emission from odd-odd nuclei is studied within the two quasiparticle plus rotor model which includes the non-adiabatic effects and the residual interaction between valence proton and neutron. Justification of the formalism is discussed through corroboration of our results with the experimental spectrum of 180Ta. Exact calculations are performed to get the proton emission halflives. Our results for the proton emitter 130Eu leads to the assignment of spin and parity Jπ = 1+ for the ground state. The role of Coriolis and residual neutron-proton interactions on the proton emission halflives and their interplay are also discussed.

  4. Predictors of adherence to screening guidelines for chronic diseases of lifestyle, cancers, and HIV in a health-insured population in South Africa

    PubMed Central

    Adonis, Leegale; Basu, Debashis; Luiz, John

    2014-01-01

    Background Adherence to screening guidelines has been widely accepted to reduce morbidity, mortality, and cost outcomes. The aim of this study was to identify predictors of adherence to screening guidelines for chronic diseases of lifestyle (CDL), cancers, and HIV in a health-insured population in South Africa, some of whom voluntarily opt into a wellness program that incentivizes screening. Method A cross-sectional study for the period 2007–2011 was conducted using a random sample of 170,471 health insurance members from a single insurer. Adherence to screening guidelines was calculated from medical claims data. Results Adherence to screening guidelines ranged from 1.1% for colorectal cancer to 40.9% for cholesterol screening. Members of the wellness program were up to three times more likely to screen for diseases (odds ratio [OR]=3.2 for HIV screening, confidence interval [CI]=2.75–3.73). Plan type (full comprehensive plan) was most strongly associated with cholesterol screening (OR=3.53, CI=3.27–3.80), and most negatively associated (hospital-only core plan) with cervical cancer screening (OR= 0.44, CI=0.28–0.70). Gender was a negative predictor for glucose screening (OR=0.88, CI=0.82–0.96). Provincial residence was most strongly associated with cervical cancer screening (OR=1.89, CI=0.65–5.54). Conclusion Adherence to screening recommendations was <50%. Plan type, gender, provincial residence, and belonging to an incentivized wellness program were associated with disproportionate utilization of screening services, even with equal payment access. PMID:24647130

  5. Comparative study of Gamow-Teller strength distributions in the odd-odd nucleus V50 and its impact on electron capture rates in astrophysical environments

    NASA Astrophysics Data System (ADS)

    Nabi, Jameel-Un; Sajjad, Muhammad

    2007-11-01

    Gamow-Teller (GT) strength transitions are an ideal probe for testing nuclear structure models. In addition to nuclear structure, GT transitions in nuclei directly affect the early phases of Type Ia and Type-II supernovae core collapse since the electron capture rates are partly determined by these GT transitions. In astrophysics, GT transitions provide an important input for model calculations and element formation during the explosive phase of a massive star at the end of its life-time. Recent nucleosynthesis calculations show that odd-odd and odd-A nuclei cause the largest contribution in the rate of change of lepton-to-baryon ratio. In the present manuscript, we have calculated the GT strength distributions and electron capture rates for odd-odd nucleus V50 by using the pn-QRPA theory. At present V50 is the first experimentally available odd-odd nucleus in fp-shell nuclei. We also compare our GT strength distribution with the recently measured results of a V50(d, He2)Ti50 experiment, with the earlier work of Fuller, Fowler, and Newman (referred to as FFN) and subsequently with the large-scale shell model calculations. One curious finding of the paper is that the Brink's hypothesis, usually employed in large-scale shell model calculations, is not a good approximation to use at least in the case of V50. SNe Ia model calculations performed using FFN rates result in overproduction of Ti50, and were brought to a much acceptable value by employing shell model results. It might be interesting to study how the composition of the ejecta using presently reported QRPA rates compare with the observed abundances.

  6. Medication Adherence and Blood Pressure Control Among Hypertensive Patients With Coexisting Long-Term Conditions in Primary Care Settings

    PubMed Central

    Li, Yu Ting; Wang, Harry H.X.; Liu, Kirin Q.L.; Lee, Gabrielle K.Y.; Chan, Wai Man; Griffiths, Sian M.; Chen, Ruo Ling

    2016-01-01

    (adjusted odds ratio 2.07, 95% CI 1.70–2.53, P < 0.001). Diabetes was the most prevalent concomitant long-term condition among hypertensive patients with poor BP control (38.6%, 95% CI 35.8–41.4 vs 19.7%, 95% CI 17.5–21.9 for patients with good BP control, P < 0.001). Multimorbidity was common among hypertensive patients, and was associated with poor BP control. Subjects with coexisting diabetes, heart disease, or chronic kidney disorder should receive more clinical attention to achieve better clinical outcomes. PMID:27196458

  7. W${'}$ signatures with odd Higgs particles

    SciTech Connect

    Dobrescu, Bogdan A.; Peterson, Andrea D.

    2014-08-13

    We point out that W' bosons may decay predominantly into Higgs particles associated with their broken gauge symmetry. We demonstrate this in a renormalizable model where the W' and W couplings to fermions differ only by an overall normalization. This "meta-sequential" W' boson decays into a scalar pair, with the charged one subsequently decaying into a W boson and a neutral scalar. These scalars are odd under a parity of the Higgs sector, which consists of a complex bidoublet and a doublet. Finally, the W' and Z' bosons have the same mass and branching fractions into scalars, and may show up at the LHC in final states involving one or two electroweak bosons and missing transverse energy.

  8. W$${'}$$ signatures with odd Higgs particles

    DOE PAGES

    Dobrescu, Bogdan A.; Peterson, Andrea D.

    2014-08-13

    We point out that W' bosons may decay predominantly into Higgs particles associated with their broken gauge symmetry. We demonstrate this in a renormalizable model where the W' and W couplings to fermions differ only by an overall normalization. This "meta-sequential" W' boson decays into a scalar pair, with the charged one subsequently decaying into a W boson and a neutral scalar. These scalars are odd under a parity of the Higgs sector, which consists of a complex bidoublet and a doublet. Finally, the W' and Z' bosons have the same mass and branching fractions into scalars, and may showmore » up at the LHC in final states involving one or two electroweak bosons and missing transverse energy.« less

  9. Morbidly adherent placenta.

    PubMed

    Abuhamad, Alfred

    2013-10-01

    Morbidly adherent placenta, which describes placenta accreta, increta, and percreta, implies an abnormal implantation of the placenta into the uterine wall. The incidence of placenta accreta has increased significantly over the past several decades, with the main risk factors include prior cesarean section and placental previa. Sonographic markers of placenta accreta can be present as early as the first trimester and include a low uterine implantation of a gestational sac, multiple vascular lacunae within the placenta, loss of the normal hypoechoic retroplacental zone, and abnormality of the uterine serosa-bladder interface, among others. Ultrasound has high sensitivity and specificity for the diagnosis of placenta accreta and MRI should be reserved for rare cases in which the ultrasound is non-diagnostic. The optimum time for planned delivery for a patient with placenta accreta is around 34-35 weeks following a course of corticosteroid injection. The successful management of placenta accreta includes a multidisciplinary care team approach with the successful management relying heavily on the prenatal diagnosis of this entity and preparing for the surgical management in a multidisciplinary approach by assuring the most skilled team is available for those patients.

  10. Reinforcing adherence to antihypertensive medications.

    PubMed

    Petry, Nancy M; Alessi, Sheila M; Byrne, Shannon; White, William B

    2015-01-01

    This pilot study evaluated a reinforcement intervention to improve adherence to antihypertensive therapy. Twenty-nine participants were randomized to standard care or standard care plus financial reinforcement for 12 weeks. Participants in the reinforcement group received a cell phone to self-record videos of adherence, for which they earned rewards. These participants sent videos demonstrating on-time adherence 97.8% of the time. Pill count adherence differed significantly between the groups during treatment, with 98.8%±1.5% of pills taken during treatment in the reinforcement condition vs 92.6%±9.2% in standard care (P<.002). Benefits persisted throughout a 3-month follow-up, with 93.8%±9.3% vs 78.0%±18.5% of pills taken (P<.001). Pill counts correlated significantly (P<.001) with self-reports of adherence, which also differed between groups over time (P<.01). Systolic blood pressure decreased modestly over time in participants overall (P<.01) but without significant time-by-group effects. These results suggest that reinforcing medication adherence via cellular phone technology and financial reinforcement holds potential to improve adherence.

  11. The relationship between clinical outcomes and medication adherence in difficult-to-control asthma.

    PubMed

    Murphy, Anna C; Proeschal, Amandine; Brightling, Christopher E; Wardlaw, Andrew J; Pavord, Ian; Bradding, Peter; Green, Ruth H

    2012-08-01

    Medication non-adherence and the clinical implications in difficult-to-control asthma were audited. Prescription issue data from 115 patients identified sub-optimal adherence (<80%) in 65% of patients on inhaled corticosteroids (ICS) or combined ICS/long-acting β2 agonist (LABA). In those using separate ICS and LABA, adherence to LABA (50%) was significantly better than to ICS (14.3%). Patients with sub-optimal ICS adherence had reduced FEV(1) and higher sputum eosinophil counts. Adherence ratio was an independent predictor of previous ventilation for acute severe asthma (p=0.008). The majority of patients with difficult-to-control asthma are non-adherent with their asthma medication. Non-adherence is correlated with poor clinical outcomes.

  12. Adherence and rehospitalizations in patients with schizophrenia: evidence from Japanese claims data

    PubMed Central

    Kuwabara, Hiroyo; Saito, Yoshimichi; Mahlich, Jörg

    2015-01-01

    Background The aim of this study is to analyze if there is a relationship between adherence to antipsychotic medication and rehospitalization for patients diagnosed with schizophrenia in Japan. Methods Based on Japanese claims data, we constructed three patient groups based on their medication possession ratio (MPR). Controlling for potential confounders, a Cox proportional hazard model was employed to assess if medication adherence affects the risk of rehospitalization. Results Patients with good adherence (MPRs from 0.8–1.1) had the lowest rates of admission. Both poor adherence (MPRs <0.8) and overadherence (MPRs >1.1) were associated with a significant higher risk of rehospitalization with hazard ratios of 4.7 and 2.0, respectively. Conclusion The results of this study support the notion that good adherence to antipsychotic medication reduces the risk of rehospitalization of schizophrenia patients. Appropriate measures should be taken to improve adherence of schizophrenia patients. PMID:25897229

  13. Antiretroviral Non-Adherence is Associated With a Retrieval Profile of Deficits in Verbal Episodic Memory.

    PubMed

    Obermeit, Lisa C; Morgan, Erin E; Casaletto, Kaitlin B; Grant, Igor; Woods, Steven Paul

    2015-01-01

    HIV-associated deficits in verbal episodic memory are commonly associated with antiretroviral non-adherence; however, the specific aspects of memory functioning (e.g., encoding, consolidation, or retrieval) that underlie this established relationship are not well understood. This study evaluated verbal memory profiles of 202 HIV+ participants who underwent a 30-day electronic monitoring of antiretroviral adherence. At the group level, non-adherence was significantly associated with lower scores on immediate and delayed passage recall and word list learning. Retention and recognition of passages and word lists were not related to adherence. Participants were then classified as having either a normal verbal memory profile, a "subcortical" retrieval profile (i.e., impaired free recall with relatively spared recognition), or a "cortical" encoding profile (e.g., cued recall intrusions) based on the Massman et al. ( 1990 ) algorithm for the California Verbal Learning Test. HIV+ participants with a classic retrieval deficit had significantly greater odds of being non-adherent than participants with a normal or encoding profile. These findings suggest that adherence to prescribed antiretroviral regimens may be particularly vulnerable to disruption in HIV+ individuals due to deficits in the complex process of efficiently accessing verbal episodic information with minimal cues. A stronger relationship between non-adherence and passage (vs. word list) recall was also found and may reflect the importance of contextual features in remembering to take medications. Targeted interventions for enhancing and supporting episodic memory retrieval processes may improve antiretroviral adherence and overall health outcomes among persons living with HIV.

  14. Substance Use and Adherence Among People Living with HIV/AIDS Receiving cART in Latin America.

    PubMed

    De Boni, Raquel B; Shepherd, Bryan E; Grinsztejn, Beatriz; Cesar, Carina; Cortés, Claudia; Padgett, Denis; Gotuzzo, Eduardo; Belaunzarán-Zamudio, Pablo F; Rebeiro, Peter F; Duda, Stephany N; McGowan, Catherine C

    2016-11-01

    This cross-sectional study describes substance use prevalence and its association with combination antiretroviral therapy (cART) adherence among 3343 individuals receiving care at HIV clinics in Argentina, Brazil, Chile, Honduras, Mexico, and Peru. A rapid screening tool evaluated self-reported 7-day recall of alcohol, marijuana, cocaine, heroin, and methamphetamine use, and missed cART doses. Overall, 29.3 % individuals reported having ≥1 alcoholic drinks, 5.0 % reported any illicit drug use and 17.0 % reported missed cART doses. In the logistic regression model, compared to no substance use, alcohol use [adjusted odds ratio (AOR) = 2.46, 95 % confidence interval (CI): 1.99-3.05], illicit drug use (AOR = 3.57, 95 % CI: 2.02-6.30), and using both alcohol and illicit drugs (AOR = 4.98, 95 % CI: 3.19-7.79) were associated with missed cART doses. The associations between substance use and likelihood of missing cART doses point to the need of targeting alcohol and illicit drug use to improve adherence among people living with HIV in Latin America.

  15. Polysomnographic predictors of persistent continuous positive airway pressure adherence in patients with moderate and severe obstructive sleep apnea.

    PubMed

    Chen, Yung-Fu; Hang, Liang-Wen; Huang, Chun-Sen; Liang, Shinn-Jye; Chung, Wei-Sheng

    2015-02-01

    Extensive use of continuous positive airway pressure (CPAP) has positive clinical benefits for most patients with obstructive sleep apnea (OSA). However, patient adherence is a major limiting factor to the effectiveness of CPAP treatment. This study determined the potential and quantifiable factors affecting the willingness of patients with OSA to undertake CPAP treatment by comparing the polysomnographic parameters recorded during diagnosis and titration. Patients with moderate and severe OSA who attended diagnostic polysomnography (PSG) and CPAP titration at the sleep center of China Medical University Hospital (CMUH) were included in the study. A total of 312 patients were divided into persistent users and nonusers of CPAP according to their use of in-home CPAP following titration and a 7-day CPAP trial. Multivariate logistic regression analyses were used to define the potential polysomnographic predictors of persistent CPAP adherence, and odds ratios (ORs) and 95% confidence intervals (CIs) were calculated. Most patients were men older than 50 years who were overweight or obese. Among the patients, 146 (46.8%) became persistent CPAP users. A 10% improvement of oxygen desaturation index (ODI) and a 10% increment in deep sleep percentage increased the chance of persistent CPAP use 1.18-fold and 1.07-fold, respectively. In addition, the improved ODI and deep sleep during CPAP titration increased the chance of persistent CPAP user. The polysomnographic parameters obtained from diagnosis and during titration can facilitate the prediction of persistent CPAP use.

  16. Medication Adherence Measures: An Overview.

    PubMed

    Lam, Wai Yin; Fresco, Paula

    2015-01-01

    WHO reported that adherence among patients with chronic diseases averages only 50% in developed countries. This is recognized as a significant public health issue, since medication nonadherence leads to poor health outcomes and increased healthcare costs. Improving medication adherence is, therefore, crucial and revealed on many studies, suggesting interventions can improve medication adherence. One significant aspect of the strategies to improve medication adherence is to understand its magnitude. However, there is a lack of general guidance for researchers and healthcare professionals to choose the appropriate tools that can explore the extent of medication adherence and the reasons behind this problem in order to orchestrate subsequent interventions. This paper reviews both subjective and objective medication adherence measures, including direct measures, those involving secondary database analysis, electronic medication packaging (EMP) devices, pill count, and clinician assessments and self-report. Subjective measures generally provide explanations for patient's nonadherence whereas objective measures contribute to a more precise record of patient's medication-taking behavior. While choosing a suitable approach, researchers and healthcare professionals should balance the reliability and practicality, especially cost effectiveness, for their purpose. Meanwhile, because a perfect measure does not exist, a multimeasure approach seems to be the best solution currently.

  17. Medication Adherence Measures: An Overview

    PubMed Central

    Lam, Wai Yin; Fresco, Paula

    2015-01-01

    WHO reported that adherence among patients with chronic diseases averages only 50% in developed countries. This is recognized as a significant public health issue, since medication nonadherence leads to poor health outcomes and increased healthcare costs. Improving medication adherence is, therefore, crucial and revealed on many studies, suggesting interventions can improve medication adherence. One significant aspect of the strategies to improve medication adherence is to understand its magnitude. However, there is a lack of general guidance for researchers and healthcare professionals to choose the appropriate tools that can explore the extent of medication adherence and the reasons behind this problem in order to orchestrate subsequent interventions. This paper reviews both subjective and objective medication adherence measures, including direct measures, those involving secondary database analysis, electronic medication packaging (EMP) devices, pill count, and clinician assessments and self-report. Subjective measures generally provide explanations for patient's nonadherence whereas objective measures contribute to a more precise record of patient's medication-taking behavior. While choosing a suitable approach, researchers and healthcare professionals should balance the reliability and practicality, especially cost effectiveness, for their purpose. Meanwhile, because a perfect measure does not exist, a multimeasure approach seems to be the best solution currently. PMID:26539470

  18. How Salmonella survive against the odds.

    PubMed

    Foster, J W; Spector, M P

    1995-01-01

    The enteric pathogen Salmonella typhimurium faces daunting odds during its voyages in the natural environment and through an infected host. It must manage stresses ranging from feast to famine, acid to base, and high to low osmolarity, among others, as well as counter various types of oxidative stress and a variety of antimicrobial peptides. The defenses used to survive these encounters can be specific or can provide cross protection to a variety of hostile conditions. Once inside a host, Salmonella spp. escape the extracellular environment and thus humoral immunity by invading professional and nonprofessional phagocytes in which a new set of challenges await. Some of these stresses are similar to those encountered in the natural environment (e.g. acid, starvation) but the bacterial response is complicated by the simultaneous occurrence of multiple stresses. S. typhimurium appears to sense various in vivo cues and responds by seducing the host signal-transduction pathways that are required to phagocytize the bacterial cell. The pathogen then calls upon components of its stress-response arsenal to survive the intracellular environment. These survival strategies enable the organism to persist in nature, where conditions are usually suboptimal, and equip the bacterium with pathogenic properties that, if successful, will provide it with a very rich and stress-free growth environment, a dead host.

  19. Beating the odds--surviving extreme hyperkalemia.

    PubMed

    Muck, Philip M; Letterer, Sebastian; Lindner, Ulrich; Lehnert, Hendrik; Haas, Christian Stefan

    2012-01-01

    Severe hyperkalemia (>7 mmol/L) is a medical emergency because of possible fatal arrhythmias. We here report the case of a 58-year-old woman surviving extreme hyperkalemia (>10 mmol/L). The patient with a history of congestive heart failure, a DDD pacemaker and mild chronic renal insufficiency was admitted with progressive weakness and sudden onset of hypotension and bradycardia in the absence of any pacemaker action. Laboratory tests revealed an extreme serum potassium level of 10.1 mmol/L, with a slightly elevated serum creatinine of 149 μmol/L. Treatment with norepinephrine, sodium bicarbonate, and insulin improved both the hemodynamic situation and the serum potassium with subsequent regaining pacemaker actions even before additional hemodialysis normalized the potassium level. A thorough investigation demonstrated that several mechanisms contributed to the extreme potassium level: urinalysis and a low transtubular potassium gradient in the presence of metabolic acidosis with normal anion gap pointed to preexisting interstitial nephritis, with renal tubular acidosis type IV as the predisposing factor, whereas several drugs and acute impairment of renal function contributed to the dangerous situation. Despite the odds for fatal outcome, the patient recovered completely, and long-term management was initiated to prevent recurrent hyperkalemia.

  20. Hybrid configuration mixing model for odd nuclei

    NASA Astrophysics Data System (ADS)

    Colò, G.; Bortignon, P. F.; Bocchi, G.

    2017-03-01

    In this work, we introduce a new approach which is meant to be a first step towards complete self-consistent low-lying spectroscopy of odd nuclei. So far, we essentially limit ourselves to the description of a double-magic core plus an extra nucleon. The model does not contain any free adjustable parameter and is instead based on a Hartree-Fock (HF) description of the particle states in the core, together with self-consistent random-phase approximation (RPA) calculations for the core excitations. We include both collective and noncollective excitations, with proper care of the corrections due to the overlap between them (i.e., due to the nonorthonormality of the basis). As a consequence, with respect to traditional particle-vibration coupling calculations in which one can only address single-nucleon states and particle-vibration multiplets, we can also describe states of shell-model types like 2 particle-1 hole. We will report results for 49Ca and 133Sb and discuss future perspectives.

  1. Odd frequency pairing of interacting Majorana fermions

    NASA Astrophysics Data System (ADS)

    Huang, Zhoushen; Woelfle, Peter; Balatsky, Alexandar

    Majorana fermions are rising as a promising key component in quantum computation. While the prevalent approach is to use a quadratic (i.e. non-interacting) Majorana Hamiltonian, when expressed in terms of Dirac fermions, generically the Hamiltonian involves interaction terms. Here we focus on the possible pair correlations in a simple model system. We study a model of Majorana fermions coupled to a boson mode and show that the anomalous correlator between different Majorana fermions, located at opposite ends of a topological wire, exhibits odd frequency behavior. It is stabilized when the coupling strength g is above a critical value gc. We use both, conventional diagrammatic theory and a functional integral approach, to derive the gap equation, the critical temperature, the gap function, the critical coupling, and a Ginzburg-Landau theory allowing to discuss a possible subleading admixture of even-frequency pairing. Work supported by USDOE DE-AC52-06NA25396 E304, Knut and Alice Wallenberg Foundation, and ERC DM-321031.

  2. Adherence to highly active antiretroviral therapy in Hyderabad, India: barriers, facilitators and identification of target groups.

    PubMed

    Dworkin, Mark S; Douglas, G W; Sabitha Rani, G P; Chakraborty, Apurba

    2016-03-01

    We assessed the barriers and facilitators to highly active antiretroviral therapy adherence and determined their prevalence among HIV/AIDS patients in Hyderabad, India. We conducted a cross-sectional study among HIV-infected adults prescribed highly active antiretroviral therapy and receiving care from nine clinics. Depression was screened using Patient Health Questionnaire 9 and facilitators of HIV medication adherence were assessed using an 11-item scale which yielded a total positive attitude to disease score. Prevalence ratios of non-adherence between different categories of potential risk factors were calculated. We compared mean 'facilitators to adherence' scores between the adherent and non-adherent population. Multivariable Poisson regression with robust variance was used to identify independent risk factors. Among the 211 respondents, nearly 20% were non-adherent, approximately 8% had either moderately severe or severe depression and mean score for combined facilitators to medication adherence was 33.35 (±7.88) out of a possible 44 points. Factors significantly associated with non-adherence included older age, female sex worker, moderate-to-severe depression and the combined facilitators to medication adherence score. These data from a broad range of clinical settings in Hyderabad reveal that key groups to focus on for adherence intervention are female sex workers, older persons and those with depression.

  3. The ODD protocol: A review and first update

    USGS Publications Warehouse

    Grimm, Volker; Berger, Uta; DeAngelis, Donald L.; Polhill, J. Gary; Giske, Jarl; Railsback, Steve F.

    2010-01-01

    The 'ODD' (Overview, Design concepts, and Details) protocol was published in 2006 to standardize the published descriptions of individual-based and agent-based models (ABMs). The primary objectives of ODD are to make model descriptions more understandable and complete, thereby making ABMs less subject to criticism for being irreproducible. We have systematically evaluated existing uses of the ODD protocol and identified, as expected, parts of ODD needing improvement and clarification. Accordingly, we revise the definition of ODD to clarify aspects of the original version and thereby facilitate future standardization of ABM descriptions. We discuss frequently raised critiques in ODD but also two emerging, and unanticipated, benefits: ODD improves the rigorous formulation of models and helps make the theoretical foundations of large models more visible. Although the protocol was designed for ABMs, it can help with documenting any large, complex model, alleviating some general objections against such models.

  4. The distributions of odd nitrogen and odd hydrogen in the natural and perturbed stratosphere

    NASA Technical Reports Server (NTRS)

    Prinn, R. G.; Alyea, F. N.; Cunnold, D. M.; Katz, A.

    1974-01-01

    In order to quantitatively illustrate the effects of quasi-horizontal transport of certain gases and of the reactions influencing their concentrations, a vertical-meridional pole-to-pole stratospheric model is presented which explicitly predicts concentrations of odd nitrogen and odd hydrogen compounds in the natural stratosphere and also in a perturbed stratosphere incorporating artificial injection of nitrogen oxides by an SST fleet. The northern hemisphere SST operations clearly have a very large local effect on the nitrogen oxide distribution and also have a significant effect on the southern hemisphere. The largest changes are seen at the point of injection of the nitrogen oxides. Results are in agreement with previous one-dimensional models.

  5. Structure of the yrast band in the odd-odd deformed nucleus {sup 156}Pm

    SciTech Connect

    Sood, P. C.; Sai, K. Vijay; Gowrishankar, R.; Sainath, M.

    2011-05-15

    The six-level sequence deduced for the odd-odd nucleus {sup 156}Pm in the high-spin studies following spontaneous fission of {sup 252}Cf is shown to constitute the K{sup {pi}=}4{sup +} yrast band having the two-quasiparticle configuration {l_brace}p:5/2[532]+ n:3/2[521]{r_brace}. Spin parities I{sup {pi}=}4{sup +} through 9{sup +} are assigned to the earlier suggested six levels. The location and the decay {gamma}'s of the 10{sup +} level of this band are indicated. It is also pointed out that there are no {gamma} rays common to these postfission high-spin spectra and those seen in the {sup 156}Nd {beta}-decay studies.

  6. The effect of prebiotics on adherence of probiotics.

    PubMed

    Kadlec, Robert; Jakubec, Martin

    2014-01-01

    Prebiotics are generally considered to promote the function or viability of probiotics via their fermentation, but their effect on the adherence of probiotics is still unclear. In this study, we examined the effect of 4 commercially available prebiotics [Orafti GR, Orafti P95, and Orafti Synergy (Beneo GmbH, Mannheim, Germany), and Vivinal (Friesland Foods Domo, Amersfoort, the Netherlands)] and 3 simple saccharides (glucose, galactose, and lactose) on the adherence of 5 probiotic type strains, 2 lactococci starter cultures, and 5 potential dairy probiotic strains from the Culture Collection of Dairy Microorganisms (Tábor, Czech Republic). Adherence was tested in microtiter plates on the following types of substrate: polystyrene alone and polystyrene coated with either porcine mucus or cocultures of the human colon cell lines Caco2 and HT29-MXT (1:9 ratio of HT29-MXT:Caco2). Adherence was evaluated as a change in fluorescence in the well of a microtiter plate. The most commonly observed effect (with a few exceptions) of prebiotics was decreased adherence of the tested strains observed on all types of substrate. The tested saccharides, which are part of the residual compounds of the used prebiotics, had a very similar effect-eliciting a decrease in adherence ability in the majority of the probiotic strains.

  7. Improving outpatient primary medication adherence with physician guided, automated dispensing

    PubMed Central

    Moroshek, Jacob G

    2017-01-01

    Background Physician dispensing, different from pharmacist dispensing, is a way for practitioners to supply their patients with medications, at the point of care. The InstyMeds dispenser and logistics system can automate much of the dispensing, insurance adjudication, inventory management, and regulatory reporting that is required of physician dispensing. Objective To understand the percentage of patients that exhibit primary adherence to medication in the outpatient setting when choosing InstyMeds. Method The InstyMeds dispensing database was de-identified and analyzed for primary adherence. This is the ratio of patients who dispensed their medication to those who received an eligible prescription. Results The average InstyMeds emergency department installation has a primary adherence rate of 91.7%. The maximum rate for an installed device was 98.5%. Conclusion Although national rates of primary adherence have been found to be in the range of 70%, automated physician dispensing vastly improves the rate of adherence. Improved adherence should lead to better patient outcomes, fewer return visits, and lower healthcare costs. PMID:28115860

  8. Adherence to Long-Acting Bronchodilators After Discharge for COPD: How Much of the Geographic Variation is Attributable to the Hospital of Discharge and How Much to the Primary Care Providers?

    PubMed

    Di Martino, Mirko; Ventura, Martina; Cappai, Giovanna; Lallo, Adele; Davoli, Marina; Agabiti, Nera; Fusco, Danilo

    2017-02-01

    In moderate-severe chronic obstructive pulmonary disease (COPD), long-acting bronchodilators (LBs) are recommended to improve the quality of life. The aims of this study were to measure adherence to LBs after discharge for COPD, identify determinants of adherence, and compare amounts of variation attributable to hospitals of discharge and primary care providers, i.e. local health districts (LHDs) and general practitioners (GPs). This cohort study was based on the Lazio region population, Italy. Patients discharged in 2007-2011 for COPD were followed up for 2 years. Adherence was defined as a medication possession ratio >80%. Cross-classified models were performed to analyse variation. Variances were expressed as median odds ratios (MORs). An MOR of 1.00 stands for no variation, a large MOR indicates considerable variation. We enrolled 13,178 patients. About 29% of patients were adherent to LBs. Adherence was higher for patients discharged from pneumology wards and for patients with GPs working in group practice. A relevant variation between LHDs (MOR = 1.21, p = 0.001) and GPs (MOR = 1.28, p = 0.035) was detected. When introducing the hospital of discharge in the model, the MOR related to LHDs decreased to 1.05 (p = 0.345), MOR related to GPs dropped to 1.22 (p = 0.086), whereas MOR associated with hospitals of discharge was 1.38 (p < 0.001). Treatments with proven benefit for COPD were underused. Moreover, a relevant geographic variation was observed. This heterogeneity raises equity concerns in access to optimal care. The reduction of variability among LHDs and GPs after entering the hospital level proved that differences we observe in primary care partially 'reflect' the clinical approach of hospitals of discharge.

  9. Even-odd effects in Z and N distributions of fragments emitted at intermediate energies

    SciTech Connect

    Lombardo, I.; Lanzalone, G.; Agodi, C.; Amorini, F.; Anzalone, A.; Han, J.; Maiolino, C.; Auditore, L.; Loria, D.; Trifiro, A.; Trimarchi, M.; Berceanu, I.; Cardella, G.; De Filippo, E.; Pagano, A.; Papa, M.; Pirrone, S.; Cavallaro, S.; Porto, F.; Rizzo, F.

    2011-08-15

    Even-odd effects in Z and N distributions of light fragments emitted at forward angles in nuclear collisions {sup 40}Ca + {sup 40}Ca, {sup 40}Ca + {sup 48}Ca, and {sup 48}Ca + {sup 48}Ca at 25 MeV/nucleon and identified in charge and mass with the Chimera multidetector have been analyzed. The amplitude of even-odd staggering effects seems to be related to the neutron to proton ratio N/Z of the entrance channels. A qualitative explanation of this effect, taking into account the deexcitation phase of primary excited fragments, is discussed.

  10. Allopurinol use in a New Zealand population: prevalence and adherence.

    PubMed

    Horsburgh, Simon; Norris, Pauline; Becket, Gordon; Arroll, Bruce; Crampton, Peter; Cumming, Jacqueline; Keown, Shirley; Herbison, Peter

    2014-07-01

    Allopurinol is effective for the control of gout and its long-term complications when taken consistently. There is evidence that adherence to allopurinol therapy varies across population groups. This may exacerbate differences in the burden of gout on population groups and needs to be accurately assessed. The aim of this study was to describe the prevalence of allopurinol use in a region of New Zealand using community pharmacy dispensing data and to examine the levels of suboptimal adherence in various population groups. Data from all community pharmacy dispensing databases in a New Zealand region were collected for a year covering 2005/2006 giving a near complete picture of dispensings to area residents. Prevalence of allopurinol use in the region by age, sex, ethnicity and socioeconomic position was calculated. Adherence was assessed using the medication possession ratio (MPR), with a MPR of 0.80 indicative of suboptimal adherence. Multiple logistic regression was used to explore variations in suboptimal adherence across population groups. A total of 953 people received allopurinol in the study year (prevalence 3%). Prevalence was higher in males (6%) than in females (1%) and Māori (5%) than non-Māori (3%). The overall MPR during the study was 0.88, with 161 (22%) of patients using allopurinol having suboptimal adherence. Non-Māori were 54% less likely to have suboptimal allopurinol adherence compared to Māori (95% CI 0.30-0.72, p = 0.001). These findings are consistent with those from other studies nationally and internationally and point to the important role for health professionals in improving patient adherence to an effective gout treatment.

  11. GT Strength in Odd-A Nuclei^*

    NASA Astrophysics Data System (ADS)

    Watson, J. W.; Du, Q. Q.

    1998-04-01

    We measured the complete set of polarization-transfer observables (D_ij) for the ^13C(p,n)^13N and ^15N(p,n)^15O reactions at 135 MeV. From the D_ijs we constructed the spin-independent, spin-longitudinal, and spin-transverse responses [1] D_0, D_q, Dn and D_p. From these responses we extracted, in a model-independent way, the Δ J=0 and Δ J=1 (``F'' and ``GT'') fractions of the J^π=1/2^-arrow1/2^- g.s. to g.s. transitions for these reactions. The ``F'' fraction, f_F=D_0(0^circ); the ``GT'' fraction, f_GT=D_q(0^circ)+D_n(0^circ)+D_p(0^circ)= 1- D_0(0^circ). The extracted GT fractions, f_GT, are substantially larger than one would predict from β-decay matrix elements and the systematics of the (p,n) reaction on even-A nuclei. These results confirm earlier, model-dependent determinations of f_GT obtained from the (p,n) reaction on ^13C, ^15N and ^39K at other energies [2], [3], [4], indicating that considerable caution must be used when extracting B(GT) matrix elements from odd-A (p,n) data. * Research supported in part by the U.S. NSF. [1] M. Ichimura, K. Kawahigashi, Phys. Rev. C 45 1822 (1992). [2] T. N. Taddeucci, C. A. Goulding, T. A. Carey, R. C. Byrd, C. D. Goodman, C. Gaarde, J. Larsen, D. Horen, J. Rapaport, and E. Sugarbaker, Nucl. Phys. A469 125 (1987). [3] H. Sakai, H. Okamura, N. Matsuoka, A. Shimizu, T. Suda, M. Ieiri and H. M. Shimizu, Nuclear Physics A579 45-61 (1994). [4] W. Huang, Ph.D. dissertation, Indiana U., 1991, (unpublished).

  12. Urban environment adherence to the Mediterranean diet and prevalence of asthma symptoms among 10- to 12-year-old children: The Physical Activity, Nutrition, and Allergies in Children Examined in Athens study.

    PubMed

    Grigoropoulou, Dimitra; Priftis, Kostas N; Yannakoulia, Mary; Papadimitriou, Anastasios; Anthracopoulos, Michael B; Yfanti, Konstantina; Panagiotakos, Demosthenes B

    2011-01-01

    Epidemiological studies have revealed several associations between asthma symptoms and environmental and dietary factors, but the potential environment- diet interactions on asthma incidence have rarely been investigated. The aim of this work was to evaluate the interrelationships between urban/rural environment, adherence to a healthy dietary pattern, the Mediterranean diet, and childhood asthma. A cross-sectional survey was performed and 1125 (529 boys), 10- to 12-year-old children were selected from 18 schools located in urban Athens area (n = 700) and from 10 schools located in rural areas of Ilia and Viotia (n = 425), Greece. Children and their parents completed standardized questionnaires, which evaluated, among others, environmental factors and dietary habits. Asthma was defined according to Phase II of the International Study on Allergies and Asthma in Childhood criteria. Adherence to the Mediterranean diet was assessed using the Mediterranean and Diet Quality Index for children and adolescents (KIDMED) score. Living in urban areas was associated with higher odds of ever had asthma symptoms by 1.78 times (95% confidence interval [CI], 1.25-2.54) when compared with rural areas. In contrast, 1-unit increase in the KIDMED score was associated with 16% lower likelihood of having asthma symptoms (95% CI, 0.77-0.91), after adjusting for various confounders. When stratifying the analysis by area of living it was observed that adherence to the Mediterranean diet was associated with lower likelihood of asthma in both urban and rural areas (urban, odds ratio [OR] = 0.81, 95% CI, 0.73-0.91; rural, OR = 0.87, 95% CI, 0.75-1.00). Urban environment seems to increase the likelihood of childhood asthma, whereas adherence to the healthy Mediterranean dietary pattern could mediate the aforementioned association and confers significant protection.

  13. Fever and Pain Management in Childhood: Healthcare Providers’ and Parents’ Adherence to Current Recommendations

    PubMed Central

    Raffaeli, Genny; Orenti, Annalisa; Gambino, Monia; Peves Rios, Walter; Bosis, Samantha; Bianchini, Sonia; Tagliabue, Claudia; Esposito, Susanna

    2016-01-01

    In order to evaluate the adherence of healthcare providers and parents to the current recommendations concerning fever and pain management, randomized samples of 500 healthcare providers caring for children and 500 families were asked to complete an anonymous questionnaire. The 378 health care providers (HCPs) responding to the survey (75.6%) included 144 primary care pediatricians (38.1%), 98 hospital pediatricians (25.9%), 62 pediatric residents (16.4%), and 71 pediatric nurses (19.6%); the 464 responding parents (92.8%) included 175 whose youngest (or only) child was ≤5 years old (37.7%), 175 whose youngest (or only) child was aged 6–10 years (37.7%), and 114 whose youngest (or only) child was aged 11–14 years (24.6%). There were gaps in the knowledge of both healthcare providers and parents. Global adherence to the guidelines was lower among the pediatric nurses than the other healthcare providers (odds ratio 0.875; 95% confidence interval 0.795–0.964). Among the parents, those of children aged 6–10 and 11–14 years old, those who were older, and those without a degree answered the questions correctly significantly less frequently than the others. These findings suggest that there is an urgent need to improve the dissemination of the current recommendations concerning fever and pain management among healthcare providers and parents in order to avoid mistaken and sometimes risky attitudes, common therapeutic errors, and the unnecessary overloading of emergency department resources. Pediatric nurses and parents with older children, those who are older, and those with a lower educational level should be the priority targets of educational programmes. PMID:27187436

  14. Equity in adherence to antiretroviral therapy among economically vulnerable adolescents living with HIV in Uganda

    PubMed Central

    Bermudez, Laura Gauer; Jennings, Larissa; Ssewamala, Fred M.; Nabunya, Proscovia; Mellins, Claude; McKay, Mary

    2016-01-01

    ABSTRACT Studies from sub-Saharan Africa indicate that children made vulnerable by poverty have been disproportionately affected by HIV with many exposed via mother-to-child transmission. For youth living with HIV, adherence to life-saving treatment regimens are likely to be affected by the complex set of economic and social circumstances that challenge their families and also exacerbate health problems. Using baseline data from the National Institute of Child and Human Development (NICHD) funded Suubi+Adherence study, we examined the extent to which individual and composite measures of equity predict self-reported adherence among Ugandan adolescents aged 10–16 (n = 702) living with HIV. Results showed that greater asset ownership, specifically familial possession of seven or more tangible assets, was associated with greater odds of self-reported adherence (OR 1.69, 95% CI: 1.00–2.85). Our analyses also indicated that distance to the nearest health clinic impacts youth’s adherence to an ARV regimen. Youth who reported living nearest to a clinic were significantly more likely to report optimal adherence (OR 1.49, 95% CI: 0.92–2.40). Moreover, applying the composite equity scores, we found that adolescents with greater economic advantage in ownership of household assets, financial savings, and caregiver employment had higher odds of adherence by a factor of 1.70 (95% CI: 1.07–2.70). These findings suggest that interventions addressing economic and social inequities may be beneficial to increase antiretroviral therapy (ART) uptake among economically vulnerable youth, especially in sub-Saharan Africa. This is one of the first studies to address the question of equity in adherence to ART among economically vulnerable youth with HIV. PMID:27392003

  15. Evaluation of SMS reminder messages for altering treatment adherence and health seeking perceptions among malaria care-seekers in Nigeria

    PubMed Central

    Liu, Jenny X.; Modrek, Sepideh

    2016-01-01

    In Nigeria, access to malaria diagnostics may be expanded if drug retailers were allowed to administer malaria rapid diagnostic tests (RDTs). A 2012 pilot intervention showed that short message service (SMS) reminder messages could boost treatment adherence to RDT results by 10–14% points. This study aimed to replicate the SMS intervention in a different population, and additionally test the effect of an expanded message about anticipated RDT access policy change on customers’ acceptability for drug retailers’ administration of RDTs. One day after being tested with an RDT, participants who purchased malaria treatment from drug shops were randomized to receive (1) a basic SMS reminder repeating the RDT result and appropriate treatment actions, (2) an expanded SMS reminder additionally saying that the ‘government might allow pharmacists/chemists to do RDTs’ or (3) no SMS reminders (i.e. control). Using regression analysis, we estimate intent-to-treat (ITT) and treatment effects on the treated for 686 study participants. Results corroborate previous findings that a basic SMS reminder increased treatment adherence [odds ratio (OR) = 1.53, 95% CI 0.96–2.44] and decreased use of unnecessary anti-malarials for RDT-negative adults [OR = 0.63, 95% CI 0.39–1.00]. The expanded SMS also increased adherence for adults [OR = 1.42, 95% CI 0.97–2.07], but the effects for sick children differed—the basic SMS did not have any measurable impact on treatment adherence [OR = 0.87, 95% CI 0.24–3.09] or use of unnecessary anti-malarials [OR = 1.27, 95% CI 0.32–1.93], and the expanded SMS actually led to poorer treatment adherence [OR = 0.26, 95% CI 0.10–0.66] and increased use of unnecessary anti-malarials [OR = 4.67, 95% CI 1.76–12.43]. Further, the targeted but neutral message in the expanded SMS lowered acceptance for drug retailers' administration of RDTs [OR = 0.55, 95% CI 0.10–2.93], counter to what we hypothesized. Future

  16. The challenge of patient adherence

    PubMed Central

    Martin, Leslie R; Williams, Summer L; Haskard, Kelly B; DiMatteo, M Robin

    2005-01-01

    Quality healthcare outcomes depend upon patients' adherence to recommended treatment regimens. Patient nonadherence can be a pervasive threat to health and wellbeing and carry an appreciable economic burden as well. In some disease conditions, more than 40% of patients sustain significant risks by misunderstanding, forgetting, or ignoring healthcare advice. While no single intervention strategy can improve the adherence of all patients, decades of research studies agree that successful attempts to improve patient adherence depend upon a set of key factors. These include realistic assessment of patients' knowledge and understanding of the regimen, clear and effective communication between health professionals and their patients, and the nurturance of trust in the therapeutic relationship. Patients must be given the opportunity to tell the story of their unique illness experiences. Knowing the patient as a person allows the health professional to understand elements that are crucial to the patient's adherence: beliefs, attitudes, subjective norms, cultural context, social supports, and emotional health challenges, particularly depression. Physician–patient partnerships are essential when choosing amongst various therapeutic options to maximize adherence. Mutual collaboration fosters greater patient satisfaction, reduces the risks of nonadherence, and improves patients' healthcare outcomes. PMID:18360559

  17. Cosmic impact: What are the odds?

    NASA Astrophysics Data System (ADS)

    Harris, A. W.

    2009-12-01

    Firestone et al. (PNAS 104, 16016-16021, 2007) propose that the impact of a ~4 km diameter comet (or multiple bodies making up a similar mass) led to the Younger Dryas cooling and extinction of megafauna in North America, 12,900 years ago. Even more provocatively, Firestone et al. (Cycle of Cosmic Catastrophes, Bear & Co. Books, 2006, 392pp), suggest that a nearby supernova may have produced a comet shower leading to the impact event, either by disturbing the Oort Cloud or by direct injection of 4-km comet-like bodies to the solar neighborhood. Here we show: (a) A supernova shockwave or mass ejection is not capable of triggering a shower of comets from the Oort Cloud. (b) An Oort Cloud shower from whatever cause would take 100,000 years or more for the perturbed comets to arrive in the inner solar system, and the peak flux would persist for some hundreds of thousands more years. (c) Even if all 20 solar masses or so of ejected matter from a SN were in the form of 4-km diameter balls, the probability of even one such ball hitting the Earth from an event 100 light years away would be about 3e-5. (d) A 4-km diameter ball traveling fast enough to get here from 100 LY away in some tens of thousands of years would deliver the energy of a 50 km diameter impactor traveling at typical Earth-impact velocity (~20 km/sec). We review the current impact flux on the Earth from asteroids and comets, and show that the probability of an impact of a 4-km diameter asteroid in an interval of 13,000 years is about one in a thousand, and the probability of a comet impact of that size is a few in a million. An "impact shower" caused by the injection or breakup of comets or asteroids in the inner solar system by whatever means would take tens to hundreds of thousands of years to clear out, thus the population of NEOs we see now with our telescopic surveys is what we’ve had for the last few tens of thousands of years, at least. Faced with such low odds, the evidence that such a large

  18. Psychosocial Syndemics are Additively Associated with Worse ART Adherence in HIV-infected Individuals

    PubMed Central

    Blashill, Aaron J.; Bedoya, C. Andres; Mayer, Kenneth H.; O’Cleirigh, Conall; Pinkston, Megan; Remmert, Jocelyn E.; Mimiaga, Matthew J.; Safren, Steven A.

    2014-01-01

    Adherence to antiretroviral therapy (ART) among HIV-infected individuals is necessary to both individual and public health, and psychosocial problems have independently been associated with poor adherence. To date, studies have not systematically examined the effect of multiple, co-occurring psychosocial problems (i.e., “syndemics”) on ART adherence. Participants included 333 HIV-infected individuals who completed a comprehensive baseline evaluation, as part of a clinical trial to evaluate an intervention to treat depression and optimize medication adherence. Participants completed self-report questionnaires, and trained clinicians completed semi-structured diagnostic interviews. ART non-adherence was objectively measured via an electronic pill cap (i.e., MEMS). As individuals reported a greater number of syndemic indicators, their odds of non-adherence increased. Co-occurring psychosocial problems have an additive effect on the risk for poor ART adherence. Future behavioral medicine interventions are needed that address these problems comprehensively, and/or the core mechanisms that they share. PMID:25331267

  19. Psychosocial Syndemics are Additively Associated with Worse ART Adherence in HIV-Infected Individuals.

    PubMed

    Blashill, Aaron J; Bedoya, C Andres; Mayer, Kenneth H; O'Cleirigh, Conall; Pinkston, Megan M; Remmert, Jocelyn E; Mimiaga, Matthew J; Safren, Steven A

    2015-06-01

    Adherence to antiretroviral therapy (ART) among HIV-infected individuals is necessary to both individual and public health, and psychosocial problems have independently been associated with poor adherence. To date, studies have not systematically examined the effect of multiple, co-occurring psychosocial problems (i.e., "syndemics") on ART adherence. Participants included 333 HIV-infected individuals who completed a comprehensive baseline evaluation, as part of a clinical trial to evaluate an intervention to treat depression and optimize medication adherence. Participants completed self-report questionnaires, and trained clinicians completed semi-structured diagnostic interviews. ART non-adherence was objectively measured via an electronic pill cap (i.e., MEMS). As individuals reported a greater number of syndemic indicators, their odds of non-adherence increased. Co-occurring psychosocial problems have an additive effect on the risk for poor ART adherence. Future behavioral medicine interventions are needed that address these problems comprehensively, and/or the core mechanisms that they share.

  20. Parental education level is associated with clustering of metabolic risk factors in adolescents independently of cardiorespiratory fitness, adherence to the Mediterranean diet, or pubertal stage.

    PubMed

    Santos, Rute; Moreira, Carla; Abreu, Sandra; Lopes, Luís; Ruiz, Jonatan R; Moreira, Pedro; Silva, Pedro; Mota, Jorge

    2014-08-01

    Few studies have reported associations between clustering metabolic risk factors and socioeconomic status (SES) in youth. This study aimed to analyze the association between clustering metabolic risk factors and SES in adolescents. It was hypothesized that SES is inversely related to clustering metabolic risk factors. This 2009 cross-sectional school-based study investigated 517 Portuguese adolescents ages 15-18 years. The study considered the age- and sex-adjusted z-scores for the ratio of total cholesterol/high-density lipoprotein, homeostasis model, triglycerides, and systolic blood pressure, and a metabolic risk score was constructed by summing all the z-scores (≥1 standard deviation was considered high risk). Cardiorespiratory fitness was estimated by the 20 m shuttle-run test and dietary intake by a food frequency questionnaire. The best of parental education was used as a proxy measure of SES. The results showed that adolescents with low SES were more likely to have a high metabolic risk score (odds ratio [OR], 1.96; p < 0.020) regardless of cardiorespiratory fitness, adherence to the Mediterranean diet, or pubertal stage. In conclusion, a lower SES was associated with increased risk for a high metabolic risk score among Azorean adolescents after adjustment for pubertal stage, adherence to the Mediterranean diet, and cardiorespiratory fitness. Future health-promotion strategies among Azorean adolescents should consider the impact of SES on their health.

  1. Adherence to Antiretroviral Therapy (ART) in Yaoundé-Cameroon: Association with Opportunistic Infections, Depression, ART Regimen and Side Effects

    PubMed Central

    Fonsah, Julius Y.; Njamnshi, Alfred K.; Kouanfack, Charles; Qiu, Fang; Njamnshi, Dora M.; Tagny, Claude T.; Nchindap, Emilienne; Kenmogne, Léopoldine; Mbanya, Dora; Heaton, Robert; Kanmogne, Georgette D.

    2017-01-01

    Following global efforts to increase antiretroviral therapy (ART) access in Sub-Saharan Africa, ART coverage among HIV-infected Cameroonians increased from 0% in 2003 to 22% in 2014. However, the success of current HIV treatment programs depends not only on access to ART, but also on retention in care and good treatment adherence. This is necessary to achieve viral suppression, prevent virologic failure, and reduce viral transmission and HIV/AIDS-related deaths. Previous studies in Cameroon showed poor adherence, treatment interruption, and loss to follow-up among HIV+ subjects on ART, but the factors that influence ART adherence are not well known. In the current cross-sectional study, patient/self-reported questionnaires and pharmacy medication refill data were used to quantify ART adherence and determine the factors associated with increased risk of non-adherence among HIV-infected Cameroonians. We demonstrated that drug side-effects, low CD4 cell counts and higher viral loads are associated with increased risk of non-adherence, and compared to females, males were more likely to forego ART because of side effects (p<0.05). Univariate logistic regression analysis demonstrated that subjects with opportunistic infections (on antibiotics) had 2.42-times higher odds of having been non-adherent (p<0.001). Multivariable analysis controlling for ART regimen, age, gender, and education showed that subjects with opportunistic infections had 3.1-times higher odds of having been non-adherent (p<0.0003), with significantly longer periods of non-adherence, compared to subjects without opportunistic infections (p = 0.02). We further showed that compared to younger subjects (≤40 years), older subjects (>40 years) were less likely to be non-adherent (p<0.01) and had shorter non-adherent periods (p<0.0001). The presence of depression symptoms correlated with non-adherence to ART during antibiotic treatment (r = 0.53, p = 0.04), and was associated with lower CD4 cell counts (p

  2. Adherence to Antiretroviral Therapy (ART) in Yaoundé-Cameroon: Association with Opportunistic Infections, Depression, ART Regimen and Side Effects.

    PubMed

    Fonsah, Julius Y; Njamnshi, Alfred K; Kouanfack, Charles; Qiu, Fang; Njamnshi, Dora M; Tagny, Claude T; Nchindap, Emilienne; Kenmogne, Léopoldine; Mbanya, Dora; Heaton, Robert; Kanmogne, Georgette D

    2017-01-01

    Following global efforts to increase antiretroviral therapy (ART) access in Sub-Saharan Africa, ART coverage among HIV-infected Cameroonians increased from 0% in 2003 to 22% in 2014. However, the success of current HIV treatment programs depends not only on access to ART, but also on retention in care and good treatment adherence. This is necessary to achieve viral suppression, prevent virologic failure, and reduce viral transmission and HIV/AIDS-related deaths. Previous studies in Cameroon showed poor adherence, treatment interruption, and loss to follow-up among HIV+ subjects on ART, but the factors that influence ART adherence are not well known. In the current cross-sectional study, patient/self-reported questionnaires and pharmacy medication refill data were used to quantify ART adherence and determine the factors associated with increased risk of non-adherence among HIV-infected Cameroonians. We demonstrated that drug side-effects, low CD4 cell counts and higher viral loads are associated with increased risk of non-adherence, and compared to females, males were more likely to forego ART because of side effects (p<0.05). Univariate logistic regression analysis demonstrated that subjects with opportunistic infections (on antibiotics) had 2.42-times higher odds of having been non-adherent (p<0.001). Multivariable analysis controlling for ART regimen, age, gender, and education showed that subjects with opportunistic infections had 3.1-times higher odds of having been non-adherent (p<0.0003), with significantly longer periods of non-adherence, compared to subjects without opportunistic infections (p = 0.02). We further showed that compared to younger subjects (≤40 years), older subjects (>40 years) were less likely to be non-adherent (p<0.01) and had shorter non-adherent periods (p<0.0001). The presence of depression symptoms correlated with non-adherence to ART during antibiotic treatment (r = 0.53, p = 0.04), and was associated with lower CD4 cell counts (p

  3. A validated measure of adherence to antibiotic prophylaxis in children with sickle cell disease

    PubMed Central

    Duncan, Natalie A; Kronenberger, William G; Hampton, Kisha C; Bloom, Ellen M; Rampersad, Angeli G; Roberson, Christopher P; Shapiro, Amy D

    2016-01-01

    Background Antibiotic prophylaxis is a mainstay in sickle cell disease management. However, adherence is estimated at only 66%. This study aimed to develop and validate a Sickle Cell Antibiotic Adherence Level Evaluation (SCAALE) to promote systematic and detailed adherence evaluation. Methods A 28-item questionnaire was created, covering seven adherence areas. General Adherence Ratings from the parent and one health care provider and medication possession ratios were obtained as validation measures. Results Internal consistency was very good to excellent for the total SCAALE (α=0.89) and four of the seven subscales. Correlations between SCAALE scores and validation measures were strong for the total SCAALE and five of the seven subscales. Conclusion The SCAALE provides a detailed, quantitative, multidimensional, and global measurement of adherence and can promote clinical care and research. PMID:27354768

  4. Intervention Strategies for Improving Patient Adherence to Follow-Up in the Era of Mobile Information Technology: A Systematic Review and Meta-Analysis

    PubMed Central

    2014-01-01

    Background Patient adherence to follow-up plays a key role in the medical surveillance of chronic diseases and affects the implementation of clinical research by influencing cost and validity. We previously reported a randomized controlled trial (RCT) on short message service (SMS) reminders, which significantly improved follow-up adherence in pediatric cataract treatment. Methods RCTs published in English that reported the impact of SMS or telephone reminders on increasing or decreasing the follow-up rate (FUR) were selected from Medline, EMBASE, PubMed, and the Cochrane Library through February 2014. The impacts of SMS and telephone reminders on the FUR of patients were systematically evaluated by meta-analysis and bias was assessed. Results We identified 13 RCTs reporting on 3276 patients with and 3402 patients without SMS reminders and 8 RCTs reporting on 2666 patients with and 3439 patients without telephone reminders. For the SMS reminders, the majority of the studies (>50%) were at low risk of bias, considering adequate sequence generation, allocation concealment, blinding, evaluation of incomplete outcome data, and lack of selective reporting. For the studies on the telephone reminders, only the evaluation of incomplete outcome data accounted for more than 50% of studies being at low risk of bias. The pooled odds ratio (OR) for the improvement of follow-up adherence in the SMS group compared with the control group was 1.76 (95% CI [1.37, 2.26]; P<0.01), and the pooled OR for the improvement of follow-up adherence in the telephone group compared with the control group was 2.09 (95% CI [1.85, 2.36]; P<0.01); both sets showed no evidence of publication bias. Conclusions SMS and telephone reminders could both significantly improve the FUR. Telephone reminders were more effective but had a higher risk of bias than SMS reminders. PMID:25100267

  5. Race and medication adherence in Medicaid enrollees with type-2 diabetes.

    PubMed Central

    Shenolikar, Rahul A.; Balkrishnan, Rajesh; Camacho, Fabian T.; Whitmire, J. Timothy; Anderson, Roger T.

    2006-01-01

    OBJECTIVE: The association of medication adherence with race has been inadequately studied previously in type-2 diabetes patients. The study objective was to determine the association between race and medication adherence among type-2 diabetes patients. METHODS: This was a retrospective cohort study, which compared medication adherence among different races of Medicaid insured patients with type-2 diabetes newly starting oral antidiabetic medication. A total of 1,527 African-American patients newly starting antidiabetic medication between July 2001 and June 2002 were compared with 1,128 white patients and 514 patients of other race. Medication adherence was measured as medication possession ratio using prescription refill patterns. Multivariate regression analyses were used to determine the difference in adherence rates adjusting for other covariates. RESULTS: Medication adherence rate was significantly higher for whites [0.59 (0.31)] as compared to African Americans [0.54 (0.31), (p<0.05)]. In multivariate analyses, the adherence rate of African-American patients was found to be significantly lower by 12% as compared to whites after adjusting for other covariates. Metformin users were associated with a 62% decrease in adherence rate as compared with the sulfonylureas group (p<0.05). CONCLUSION: The antidiabetic medication adherence was associated with race. Future research should investigate patient-related factors affecting medication adherence in type-2 diabetes patients. PMID:16895275

  6. High-spin states and shell structure of the odd-odd nucleus {sup 90}Nb

    SciTech Connect

    Cui, X.Z.; Zhang, Z.L.; Meng, R.; Yang, C.X.; Zhu, L.H.; Wu, X.G.; Wang, Z.M.; He, C.Y.; Li, G.S.; Wen, S.X.; Ma, R.G.; Liu, Y.; Luo, P.; Zheng, Y.; Ndontchueng, M.M.; Huo, J.D.

    2005-10-01

    The high-spin states of the odd-odd nucleus {sup 90}Nb have been investigated with in-beam {gamma}-spectroscopic techniques via the {sup 76}Ge({sup 19}F,5n){sup 90}Nb reaction at a beam energy of 80 MeV. {gamma}-{gamma} coincidences were measured using a {gamma}-ray detector array. Twenty new {gamma} rays have been assigned to {sup 90}Nb and the level scheme has been extended up to an excitation energy of 8.095 MeV at spin 18({Dirac_h}/2{pi}). The level structure of {sup 90}Nb at high spin states has been well reproduced using semiempirical shell-model calculations in the model space {pi}(1p{sub 1/2},0f{sub 5/2},0g{sub 9/2}){nu}(0g{sub 9/2}). The results show that the excitation of protons plays an important role in generating the high-spin states of {sup 90}Nb.

  7. Diabatic crossing of chiral "twins" in the odd-odd 106Ag nucleus: A theoretical perspective

    NASA Astrophysics Data System (ADS)

    Malik, Sham S.

    2016-07-01

    A systematic study of both the observed positive-parity magnetic rotation band and the negative-parity Δ I =1 doublet bands in an odd-odd 106Ag nucleus is carried out. The negative-parity doublet bands depict some unusual features that have not been observed in any isotope in the mass A =100 region. For instance, (i) the moment of inertia of the partner band is quite different from that of the yrast band, and (ii) these bands cross each other at an angular momentum of I =14 ℏ . Also, the observed significantly large but constant B (M 1 ) transitions confirm that the strong M 1 transitions are being reinforced by the contributions from collective rotation. To explain these features, a collective model has been developed whose kinetic and potential energies are extracted from the tilted-axis cranking model. Instead of the triaxial parameter γ , a second-order phase transition is found to be responsible for the spontaneous breakdown of chiral symmetry. Analytical solution of the Schrödinger equation has generated a doublet nondegenerate eigenvalue spectrum. The ensuing model results based on the two-quasiparticle configuration π g9/2⊗ν h11/2 exhibit similarities with many observed features of the negative-parity doublet bands and hence confirm their chiral character. The cranking mass parameter in kinetic energy plays an important role in diabatic crossing between these emerged chiral twin bands.

  8. Neutron-proton multiplets in the odd-odd nucleus 53 37 90Rb

    NASA Astrophysics Data System (ADS)

    Czerwiński, M.; RzÄ ca-Urban, T.; Urban, W.; BÄ czyk, P.; Sieja, K.; Timár, J.; Nyakó, B. M.; Kuti, I.; Tornyi, T. G.; Atanasova, L.; Blanc, A.; Jentschel, M.; Mutti, P.; Köster, U.; Soldner, T.; de France, G.; Simpson, G. S.; Ur, C. A.

    2016-03-01

    Medium-spin excited levels in 90Rb, populated in the fission of 235U induced by neutrons, have been observed for the first time. γ radiation from fission has been measured by using the EXILL array of Ge detectors at the cold-neutron-beam facility PF1B of the Institut Laue-Langevin, Grenoble. Low-energy levels are interpreted as members of the π p3/2 -1ν (d5/2) 3 , π f5/2 -1ν (d5/2) 3 , and π g9 /2ν (d5/2) 3 multiplets with the 0- ground state due to the seniority-3 coupling in the ν d5 /2 shell. Analogous anomalous coupling within the π g9 /2ν (d5/2) 3 configuration explains the 5+, 6+, and 7+ triplet of states, observed at medium spins, similar to the triplet seen in the N =53 isotone, 88Br. Shell-model calculations reproduce well the proposed structures in Rb,9088 and support the seniority-3 coupling in N =53 isotones and its absence in N =51 isotones. The structure of the odd-odd 88Rb and 90Rb nuclei provides an argument in favor of the collectivity building up at the neutron number N =53 .

  9. Adherence to the dietary guidelines for Americans and endometrial cancer risk

    PubMed Central

    Chandran, Urmila; Bandera, Elisa V.; Williams-King, Melony G.; Sima, Camelia; Bayuga, Sharon; Pulick, Katherine; Zauber, Ann G.; Olson, Sara H.; Wilcox, Homer

    2011-01-01

    The Healthy Eating Index (HEI) was developed by the US Department of Agriculture with the goal of quantifying adherence to the Dietary Guidelines for Americans. The purpose of this study was to evaluate the impact of the HEI-2005 score and each of its components on endometrial cancer risk in a population-based case–control study in New Jersey. A total of 424 cases and 398 controls completed a Food Frequency Questionnaire, which was used to derive the HEI-2005 score. Odds ratios (OR) and 95% confidence intervals (CI) were calculated using unconditional logistic regression while adjusting for potential covariates, which included all major endometrial cancer risk factors. The adjusted OR for women in the highest quartile when compared to the lowest quartile was 0.83 (95% CI: 0.52–1.34). For the meat and beans component comprising meat, eggs, poultry, fish, and beans, the OR was 0.70 (95% CI: 0.45–1.11; p for trend: 0.07), with little evidence of an association with any of the individual foods. There was no indication of an association for any of the other components of the HEI or of effect modification by body mass index. This study suggested limited value for the HEI-2005 in predicting endometrial cancer risk. PMID:20652737

  10. Engineering Escherichia coli for odd straight medium chain free fatty acid production.

    PubMed

    Wu, Hui; San, Ka-Yiu

    2014-10-01

    Microbial biosynthesis of free fatty acids (FFAs) can be achieved by introducing an acyl-acyl carrier protein thioesterase gene into Escherichia coli. The engineered E. coli usually produced even chain FFAs. In this study, propionyl-CoA synthetase (prpE) from Salmonella enterica was overexpressed in two efficient even chain FFAs producers, ML103 (pXZM12) carrying the acyl-ACP thioesterase gene from Umbellularia californica and ML103 (pXZ18) carrying the acyl-ACP thioesterase gene from Ricinus communis combined with supplement of extracellular propionate. With these metabolically engineered E. coli, the odd straight chain FFAs, undecanoic acid (C11:0), tridecanoic acid (C13:0), and pentadecanoic acid (C15:0) were produced from glucose and propionate. The highest total odd straight chain FFAs produced by ML103 (pXZM12, pBAD-prpE) reached 276 mg/l with a ratio of 23.43 % of the total FFAs. In ML103 (pXZ18, pBAD-prpE), the highest total odd straight chain FFAs accumulated to 297 mg/l, and the ratio reached 17.68 % of the total FFAs. Due to the different substrate specificity of the acyl-ACP thioesterases, the major odd straight chain FFA components of ML103 (pXZM12, pBAD-prpE) were undecanoic acid and tridecanoic acid, while the ML103 (pXZ18, pBAD-prpE) preferred pentadecanoic acid.

  11. Odds of Getting Adequate Physical Activity by Dog Walking

    PubMed Central

    Soares, Jesus; Epping, Jacqueline N.; Owens, Chantelle J.; Brown, David R.; Lankford, Tina J.; Simoes, Eduardo J.; Caspersen, Carl J.

    2015-01-01

    Background We aimed to determine the likelihood that adult dog owners who walk their dogs will achieve a healthy level of moderate-intensity (MI) physical activity (PA), defined as at least 150 mins/wk. Methods We conducted a systematic search of 6 databases with data from 1990–2012 on dog owners’ PA, to identify those who achieved MIPA. To compare dog-walkers’ performance with non–dog walkers, we used a random effects model to estimate the unadjusted odds ratio (OR) and corresponding 95% confidence interval (CI). Results We retrieved 9 studies that met our inclusion criterion and allowed OR calculations. These yielded data on 6980 dog owners aged 18 to 81 years (41% men). Among them, 4463 (63.9%) walked their dogs. Based on total weekly PA, 2710 (60.7%) dog walkers, and 950 (37.7%) non–dog walkers achieved at least MIPA. The estimated OR was 2.74 (95% CI 2.09–3.60). Conclusion Across 9 published studies, almost 2 in 3 dog owners reported walking their dogs, and the walkers are more than 2.5 times more likely to achieve at least MIPA. These findings suggest that dog walking may be a viable strategy for dog owners to help achieve levels of PA that may enhance their health. PMID:24733365

  12. Impact of an exercise program on adherence and fitness indicators.

    PubMed

    Carpenter, Roger; Gilleland, Diana

    2016-05-01

    Adherence to exercise is one of the most problematic health behaviors. This pilot study describes the impact of an exercise program on adherence to exercise and fitness indicators for overweight and obese adults enrolled in an insurance reimbursed exercise plan. Chart reviews were conducted retrospectively in a convenience sample of 77 subjects from a human performance lab (HPL) at a large southern university. Charts from 2004 to 2009 were reviewed for health history, fitness indicators (fitness level, weight, BMI, hip/waist ratio, % body fat, BP, HR, cholesterol), and adherence (number of exercise sessions/month). Exercise supervision was operationalized in two phases over 12 months: Phase I (3 months supervised exercise) and Phase II (9 months unsupervised exercise). Fifty-eight participants completed Phase I, and 8 completed Phase II. Six-nine percent of those completing Phase I visited the gym at least 8 times/month with significant (α=.05) improvement in all fitness indicators. Those visiting <8 times/month had improvement in fitness level, weight, BMI, and % body fat. Twenty-four subjects continued into Phase II, with only eight completing Phase II. Of those eight, only one subject visited the HPL at least 8 times/month. Health history data including co-morbidities, symptoms, habits, perceived tension, job stress, and fitness level were not associated with adherence. Symptoms of swollen, stiff, painful joints, and swollen ankles and legs were associated with decreased adherence to exercise. Supervised exercise was positively related to adherence and improved fitness indicators. Adults with joint symptoms may require more support. Based on these pilot data, designing a study with a larger sample and the inclusion of barriers and facilitators for adherence to self-directed exercise would allow additional analysis. Innovative interventions are needed that mimic the supervised environment, shifting responsibility for the exercise plan from the supervisor to

  13. Current Concepts for PrEP Adherence

    PubMed Central

    Haberer, Jessica E.

    2016-01-01

    Purpose of review This review describes 1) the current understanding of adherence to oral PrEP, 2) methods for adherence measurement, 3) approaches to supporting PrEP adherence, and 4) guidance for defining PrEP adherence goals within the larger context of HIV prevention. Recent findings PrEP adherence has generally been higher in recent trials, open-label extensions, and demonstration projects compared to the initial clinical trials; potential explanations include known PrEP efficacy and different motivations to take PrEP. Recent studies have explored adherence monitoring through electronic pill containers, short message service (SMS), and drug concentrations in hair and dried blood spots. The few PrEP adherence interventions developed to date include combinations of enhanced counseling, feedback of objective adherence measurement, and SMS. Conceptualization of PrEP adherence is evolving. The goal is not 100% adherence indefinitely, as it was in clinical trials. PrEP adherence should be defined with respect to HIV exposure, which varies over time by sexual behavior and use of other prevention strategies. Summary PrEP adherence beyond clinical trials has generally been high enough to achieve reliable HIV prevention. Future efforts to measure and support PrEP adherence should focus on the context of risk for HIV acquisition, accounting for dynamic behaviors and choices among HIV prevention options. PMID:26633638

  14. Medication Adherence and the Risk of Cardiovascular Mortality and Hospitalization Among Patients With Newly Prescribed Antihypertensive Medications.

    PubMed

    Kim, Soyeun; Shin, Dong Wook; Yun, Jae Moon; Hwang, Yunji; Park, Sue K; Ko, Young-Jin; Cho, BeLong

    2016-03-01

    The importance of adherence to antihypertensive treatments for the prevention of cardiovascular disease has not been well elucidated. This study evaluated the effect of antihypertensive medication adherence on specific cardiovascular disease mortality (ischemic heart disease [IHD], cerebral hemorrhage, and cerebral infarction). Our study used data from a 3% sample cohort that was randomly extracted from enrollees of Korean National Health Insurance. Study subjects were aged ≥20 years, were diagnosed with hypertension, and started newly prescribed antihypertensive medication in 2003 to 2004. Adherence to antihypertensive medication was estimated as the cumulative medication adherence. Subjects were divided into good (cumulative medication adherence, ≥80%), intermediate (cumulative medication adherence, 50%-80%), and poor (cumulative medication adherence, <50%) adherence groups. We used time-dependent Cox proportional hazards models to evaluate the association between medication adherence and health outcomes. Among 33 728 eligible subjects, 670 (1.99%) died of coronary heart disease or stroke during follow-up. Patients with poor medication adherence had worse mortality from IHD (hazard ratio, 1.64; 95% confidence interval, 1.16-2.31; P for trend=0.005), cerebral hemorrhage (hazard ratio, 2.19; 95% confidence interval, 1.28-3.77; P for trend=0.004), and cerebral infarction (hazard ratio, 1.92; 95% confidence interval, 1.25-2.96; P for trend=0.003) than those with good adherence. The estimated hazard ratios of hospitalization for cardiovascular disease were consistent with the mortality end point. Poor medication adherence was associated with higher mortality and a greater risk of hospitalization for specific cardiovascular diseases, emphasizing the importance of a monitoring system and strategies to improve medication adherence in clinical practice.

  15. Level Density In Interacting Boson-Fermion-Fermion Model (IBFFM) Of The Odd-Odd Nucleus 196Au

    SciTech Connect

    Kabashi, Skender; Bekteshi, Sadik

    2007-04-23

    The level density of the odd-odd nucleus 196Au is investigated in the interacting boson-fermion-fermion model (IBFFM) which accounts for collectivity and complex interaction between quasiparticle and collective modes.The IBFFM total level density is fitted by Gaussian and its tail is also fitted by Bethe formula and constant temperature Fermi gas model.

  16. Reasons Low-Income Parents Offer Snacks to Children: How Feeding Rationale Influences Snack Frequency and Adherence to Dietary Recommendations.

    PubMed

    Blaine, Rachel E; Fisher, Jennifer Orlet; Taveras, Elsie M; Geller, Alan C; Rimm, Eric B; Land, Thomas; Perkins, Meghan; Davison, Kirsten K

    2015-07-21

    Although American children snack more than ever before, the parental role in promoting snacking is not well understood. In 2012-2013 at baseline in an intervention study to prevent childhood obesity in low-income Massachusetts communities, n = 271 parents of children aged 2-12 years completed surveys regarding nutritive and non-nutritive reasons they offered children snacks, demographics, and dietary factors. An analysis of variance demonstrated that parents reported offering snacks (mean/week; standard deviation (SD)) for nutritive reasons like promoting growth (x̄ = 2.5; SD 2.2) or satisfying hunger (x̄ = 2.4; SD 2.1) almost twice as often as non-nutritive reasons like keeping a child quiet (x̄ = 0.7; SD 1.5) or celebrating events/holidays (x̄ = 0.8; SD 1.1). Parents reported giving young children (2-5 years) more snacks to reward behavior (1.9 vs. 1.1, p < 0.001), keep quiet (1.0 vs. 0.5, p < 0.001), and celebrate achievements (1.7 vs. 1.0, p < 0.001) than parents of older children (6-12 years). Multivariable logistic regression models were used to obtain adjusted odds ratios, which indicated reduced child adherence to dietary recommendations when parents offered snacks to reward behavior (Odds Ratio (OR) = 0.83; 95% Confidence Interval (CI) 0.70-0.99), celebrate events/holidays (OR = 0.72; 95% CI 0.52-0.99), or achievements (OR = 0.82; 95% CI 0.68-0.98). Parental intentions around child snacking are likely important targets for obesity prevention efforts.

  17. Enhancing Adherence in Clinical Exercise Trials.

    ERIC Educational Resources Information Center

    O'Neal, Heather A.; Blair, Steven N.

    2001-01-01

    Discusses exercise adherence from the perspective of adhering to an exercise treatment in a controlled trial, focusing on: adherence (to intervention and measurement); the development of randomized clinical trials; exemplary randomized clinical trials in exercise science (exercise training studies and physical activity interventions); and study…

  18. Comparison of prospective daily diaries and retrospective recall to measure oral contraceptive adherence

    PubMed Central

    Huber, Larissa R. Brunner; Broel, Elizabeth C.; Mitchelides, Ashley N.; Dmochowski, Jacek; Dulin, Michael; Scholes, Delia

    2013-01-01

    BACKGROUND The purpose of this study was to determine if retrospective recall of oral contraceptive (OC) adherence provides data that are similar to data collected via daily diaries over the same time period. Factors associated with inconsistent agreement between prospective and retrospective measurements of adherence also were explored. STUDY DESIGN A total of 185 women participated in a longitudinal, prospective cohort of OC users and 113 of these women provided complete information on OC adherence during follow-ups. Concordance beyond chance was assessed using weighted kappa statistics and logistic regression was used to identify factors associated with inconsistent reporting of adherence. RESULTS There was substantial agreement between prospective and retrospective adherence information (weighted kappa=0.64; 95% CI: 0.52, 0.77). Participants with a high school education or less and those who had problems with feeling sad while using OCs had increased odds of inconsistent reporting of adherence (OR=4.38, 95% CI: 1.41, 13.61 and OR=3.52, 95% CI: 1.25, 9.94; respectively). CONCLUSION While prospective data collection via diaries may improve accuracy, the added expense and burden on study participants may not be necessary. However, the use of retrospective recall may not be appropriate for all study populations. PMID:23582236

  19. The Role of Cognitive Functioning in Medication Adherence of Children and Adolescents with HIV Infection

    PubMed Central

    Williams, Paige L.; Montepiedra, Grace; Nichols, Sharon; Sirois, Patricia A.; Storm, Deborah; Farley, John; Kammerer, Betsy

    2009-01-01

    Objective To evaluate the relationship between cognitive functioning and medication adherence in children and adolescents with perinatally acquired HIV infection. Methods Children and adolescents, ages 3–18 (N = 1,429), received a cognitive evaluation and adherence assessment. Multiple logistic regression models were used to identify associations between adherence and cognitive status, adjusting for potential confounding factors. Results Children's average cognitive performance was within the low-average range; 16% of children were cognitively impaired (MDI/FSIQ <70). Cognitive status was not associated with adherence to full medication regimens; however, children with borderline/low average cognitive functioning (IQ 70–84) had increased odds of nonadherence to the protease inhibitor class of antiretroviral therapy. Recent stressful life events and child health characteristics, such as HIV RNA detectability, were significantly associated with nonadherence. Conclusion Cognitive status plays a limited role in medication adherence. Child and caregiver psychosocial and health characteristics should inform interventions to support adherence. PMID:18647794

  20. The competition between alpha decay and spontaneous fission in odd-even and odd-odd nuclei in the range 99 ≤ Z ≤ 129

    NASA Astrophysics Data System (ADS)

    Santhosh, K. P.; Priyanka, B.

    2015-08-01

    The predictions on the mode of decay of the odd-even and odd-odd isotopes of heavy and superheavy nuclei with Z = 99- 129, in the range 228 ≤ A ≤ 336, have been done within the Coulomb and proximity potential model for deformed nuclei (CPPMDN). A comparison of our calculated alpha half lives with the values computed using other theoretical models shows good agreement with each other. An extensive study on the spontaneous fission half lives of all the isotopes under study has been performed to identify the long-lived isotopes in the mass region. The study reveals that the alpha decay half lives and the mode of decay of the isotopes with Z = 109, 111, 113, 115 and 117, evaluated using our formalisms, agree well with the experimental observations. As our study on the odd-even and odd-odd isotopes of Z = 99- 129 predicts that, the isotopes 238,240-25499, 244,246-258101, 248,250,252-260,262103, 254,256,258-262,264105, 258,260,262-264,266107, 262,264,266-274109, 266,268-279111, 270-284,286113, 272-289,291115, 274-299117, 276-307119, 281-314121, 287-320,322123, 295-325125, 302-327127 and 309-329129 survive fission and have alpha decay channel as the prominent mode of decay, these nuclei could possibly be synthesized in the laboratory and this could be of great interest to the experimentalists. The behavior of these nuclei against the proton decay has also been studied to identify the probable proton emitters in this region of nuclei.

  1. Colorings of odd or even chirality on hexagonal lattices

    NASA Astrophysics Data System (ADS)

    Cépas, O.

    2017-02-01

    We define two classes of colorings that have odd or even chirality on hexagonal lattices. This parity is an invariant in the dynamics of all loops, and explains why standard Monte Carlo algorithms are nonergodic. We argue that adding the motion of "stranded" loops allows for parity changes. By implementing this algorithm, we show that the even and odd classes have the same entropy. In general, they do not have the same number of states, except for the special geometry of long strips, where a Z2 symmetry between even and odd states occurs in the thermodynamic limit.

  2. Superdeformation studies in the odd-odd nucleus {sup 192}Tl

    SciTech Connect

    Fischer, S.; Carpenter, M.P.; Janssens, R.V.F.

    1995-08-01

    The study of yrast and near-yrast structures of odd-odd nuclei to high spins is somewhat limited due to the complexity of the spectra resulting from the many proton-neutron couplings near the Fermi surface. In superdeformed nuclei, the number of available protons and neutrons near the Fermi surface is somewhat limited due to the presence of large-shell gaps which stabilize the nuclear shape. A relatively small number of available neutron and proton configurations can lead to fragmentation of the SD intensity into a number of different bands. Two good examples of this phenomenon were found in {sup 192}Tl and {sup 194}Tl where the presence of six superdeformed bands were reported in both nuclei. We reexamined {sup 192}Tl at Gammasphere using the {sup 160}Gd({sup 37}Cl,5n) reaction at 178 MeV to populate states in the superdeformed well of this nucleus. While our previous study on {sup 192}Tl at ATLAS was very successful, a number of questions remained which formed the basis of our objectives in this experiment: obtain better {gamma}-ray energies for the known transitions and identify higher spin members in each band; determine how the bands feed the known yrast states in {sup 192}Tl as well as determine the complete spectrum in coincidence with the SD bands; look for M1 transitions connecting proposed signature partners; and attempt to identify other excitations in the superdeformed well. Analysis is underway and four of the six bands were confirmed. The reasons that two of the reported bands were not observed in this latest work is still under investigation. As of this time, no other superdeformed bands were identified in the data. Two of the confirmed SD bands have a constant moment of inertia and show indications of cross-talk between each other. This observation is not unexpected since the calculated M1 rates for the proposed configuration of the band, {pi}{sub 13/2} x {upsilon}j{sub 15/2}, indicate that M1 transitions linking the two SD bands should be observed.

  3. Cryopreservation of adherent neuronal networks.

    PubMed

    Ma, Wu; O'Shaughnessy, Thomas; Chang, Eddie

    2006-07-31

    Neuronal networks have been widely used for neurophysiology, drug discovery and toxicity testing. An essential prerequisite for future widespread application of neuronal networks is the development of efficient cryopreservation protocols to facilitate their storage and transportation. Here is the first report on cryopreservation of mammalian adherent neuronal networks. Dissociated spinal cord cells were attached to a poly-d-lysine/laminin surface and allowed to form neuronal networks. Adherent neuronal networks were embedded in a thin film of collagen gel and loaded with trehalose prior to transfer to a freezing medium containing DMSO, FBS and culture medium. This was followed by a slow rate of cooling to -80 degrees C for 24 h and then storage for up to 2 months in liquid nitrogen at -196 degrees C. The three components: DMSO, collagen gel entrapment and trehalose loading combined provided the highest post-thaw viability, relative to individual or two component protocols. The post-thaw cells with this protocol demonstrated similar neuronal and astrocytic markers and morphological structure as those detected in unfrozen cells. Fluorescent dye FM1-43 staining revealed active recycling of synaptic vesicles upon depolarizing stimulation in the post-thaw neuronal networks. These results suggest that a combination of DMSO, collagen gel entrapment and trehalose loading can significantly improve conventional slow-cooling methods in cryopreservation of adherent neuronal networks.

  4. Dosing patterns and medication adherence in bipolar disorder patients treated with lurasidone: a US retrospective claims database analysis

    PubMed Central

    Sajatovic, Martha; Ng-Mak, Daisy; Solem, Caitlyn T.; Lin, Fang-Ju; Rajagopalan, Krithika; Loebel, Antony

    2016-01-01

    Background: The aim of this study was to describe dosing patterns and medication adherence among bipolar patients who initiated lurasidone in a real-world setting. Methods: Adult bipolar patients who initiated lurasidone between 1 November 2010 and 31 December 2012 (index period) with 6-month pre- and post-index continuous enrollment were identified from the IMS RWD Adjudicated Claims US database. Patients were grouped by starting lurasidone daily dose: 20 mg (7.1%), 40 mg (62.2%), 60–80 mg (28.7%), and 120–160 mg (2.1%). Patient characteristics were compared across doses using Cochran–Armitage trend tests. Multivariable ordinal logistic regression assessed the association between initial lurasidone dose and patient characteristics. Medication adherence was measured using medication possession ratio (MPR). Results: Of 1114 adult bipolar patients (mean age 40.6 years, 70.6% female), 90% initiated lurasidone at 40 mg or 80 mg/day (mean 51.9 mg/day). Of these, 16.2% initiated lurasidone as monotherapy. Mean lurasidone maintenance dose was 55.2 mg/day and mean MPR was 0.53 [standard deviation (SD) = 0.34] over the 6-month follow up. Substance use, hyperglycemia, obesity, and prior antipsychotic use were associated with higher initial lurasidone doses (p < 0.05). Odds of a 20 mg/day increase in initial lurasidone dose was 1.6-times higher for patients with substance use [95% confidence interval (CI): 1.16−2.24], 2.6-times higher with hyperglycemia problems (95% CI: 1.15−5.83), 1.7-times higher with obesity (95% CI: 1.05−2.60), and 1.3 (95% CI: 1.01−1.78) and 1.8-times higher (95% CI: 1.17−2.86) with prior use of second- and first-generation antipsychotics, respectively. Conclusions: This real-world analysis of bipolar patients indicated that 40 mg or 80 mg/day were the most common starting doses of lurasidone. A majority of patients used concomitant psychiatric medications (polypharmacy). Higher doses of lurasidone were prescribed to patients with

  5. Socioeconomic factors explain suboptimal adherence to antiretroviral therapy among HIV-infected Australian adults with viral suppression

    PubMed Central

    Siefried, Krista J.; Mao, Limin; Kerr, Stephen; Cysique, Lucette A.; Gates, Thomas M.; McAllister, John; Maynard, Anthony; de Wit, John; Carr, Andrew

    2017-01-01

    Background Missing more than one tablet of contemporary antiretroviral therapy (ART) per month increases the risk of virological failure. Recent studies evaluating a comprehensive range of potential risk factors for suboptimal adherence are not available for high-income settings. Methods Adults on ART with undetectable viral load (UDVL) were recruited into a national, multi-centre cohort, completing a comprehensive survey assessing demographics, socio-economic indicators, physical health, well-being, life stressors, social supports, HIV disclosure, HIV-related stigma and discrimination, healthcare access, ART regimen, adherence, side effects, costs and treatment beliefs. Baseline data were assessed, and suboptimal adherence was defined as self-reported missing ≥1 ART dose/month over the previous 3-months; associated factors were identified using bivariate and multivariate binary logistic regression. Results We assessed 522 participants (494 [94.5%] men, mean age = 50.8 years, median duration UDVL = 3.3 years [IQR = 1.2–6.8]) at 17 sexual health, hospital, and general practice clinics across Australia. Seventy-eight participants (14.9%) reported missing ≥1 dose/month over the previous three months, which was independently associated with: being Australian-born (AOR [adjusted odds ratio] = 2.4 [95%CI = 1.2–4.9], p = 0.014), not being in a relationship (AOR = 3.3 [95%CI = 1.5–7.3], p = 0.004), reaching the “Medicare safety net” (capping annual medical/pharmaceutical costs) (AOR = 2.2 [95%CI = 1.1–4.5], p = 0.024), living in subsidised housing (AOR = 2.5 [95%CI = 1.0–6.2], p = 0.045), receiving home-care services (AOR = 4.4 [95%CI = 1.0–18.8], p = 0.046), HIV community/outreach services linkage (AOR = 2.4 [95%CI = 1.1–5.4], p = 0.033), and starting ART following self-request (AOR = 3.0 [95%CI = 1.3–7.0], p = 0.012). Conclusions In this population, 15% reported recent suboptimal ART adherence at levels associated in prospective studies with

  6. Characterization of isomers in the neutron-rich odd-odd nucleus {sup 156}Pm

    SciTech Connect

    Sood, P. C.; Gowrishankar, R; Sai, K. Vijay; Sainath, M.

    2011-02-15

    Critical examination of the experimental data from {sup 156}Nd and {sup 156}Pm {beta} decays and the observed location of relevant neutron and proton orbitals in the neighboring odd-A isotones and isotopes, taken together with the low-lying two-quasiparticle (2qp) structures expected in {sup 156}Pm from the rotor-particle model, lead to the conclusion that a consistent description of all the available data is achieved with the I{sup {pi}}=4{sup +} spin-parity assignment to the 26.7s {sup 156}Pm ground state (g.s.) and assignment of I{sup {pi}}=1{sup +} to its 150.3-keV isomer with the 2qp configuration 4{sub g.s.}{sup +}{l_brace}p{sub o}:5/2[532{up_arrow}]{+-}n{sub o}:3/2[521{up_arrow}]{r_brace}1{sub 150}{sup +}. In the process, a two-neutron configuration is also suggested for the 1509-keV 4{sup +} level in the daughter nucleus {sup 156}Sm. The present analysis reiterates the important question of whether the {beta}-decay log ft value, by itself, can be employed to deduce the relative parity of the {beta}-connected states.

  7. Genes Plus Erratic Sleep May Raise Odds for Obesity

    MedlinePlus

    ... Search Search MedlinePlus GO GO About MedlinePlus Site Map FAQs Customer ... of this page: https://medlineplus.gov/news/fullstory_164039.html Genes Plus Erratic Sleep May Raise Odds for Obesity ...

  8. Can Depression Up Odds for Arthritis Linked to Psoriasis?

    MedlinePlus

    ... https://medlineplus.gov/news/fullstory_163780.html Can Depression Up Odds for Arthritis Linked to Psoriasis? Mood ... 24, 2017 FRIDAY, Feb. 24, 2017 (HealthDay News) -- Depression in people with the chronic inflammatory skin disease ...

  9. Cavity tests of parity-odd Lorentz violations in electrodynamics

    NASA Astrophysics Data System (ADS)

    Mewes, Matthew; Petroff, Alexander

    2007-03-01

    Electromagnetic resonant cavities form the basis for a number modern tests of Lorentz invariance. The geometry of most of these experiments implies unsuppressed sensitivities to parity-even Lorentz violations only. Parity-odd violations typically enter through suppressed boost effects, causing a reduction in sensitivity by roughly 4 orders of magnitude. Here we discuss possible techniques for achieving unsuppressed sensitivities to parity-odd violations using asymmetric resonators.

  10. The odd-number sequence: squares and sums

    NASA Astrophysics Data System (ADS)

    Leyendekkers, J. V.; Shannon, A. G.

    2015-11-01

    Direct study of various characteristics of integers and their interactions is readily accessible to undergraduate students. Integers obviously fall in different classes of modular rings and thus have features unique to that class which can result in a variety of formations, particularly with sums of squares. The sum of the first n odd numbers is itself the square of n within the odd number sequence, from which testing for primality within the Fibonacci sequence is investigated in this note.

  11. Antiretroviral Non-Adherence is Associated with a Retrieval Profile of Deficits in Verbal Episodic Memory

    PubMed Central

    Obermeit, Lisa C.; Morgan, Erin E.; Casaletto, Kaitlin B.; Grant, Igor; Woods, Steven Paul

    2015-01-01

    Objective HIV-associated deficits in verbal episodic memory are commonly associated with antiretroviral non-adherence; however, the specific aspects of memory functioning (e.g., encoding, consolidation, or retrieval) that underlie this established relationship are not well understood. Method This study evaluated verbal memory profiles of 202 HIV+ participants who underwent a 30-day electronic monitoring of antiretroviral adherence. Results At the group level, non-adherence was significantly associated with lower scores on immediate and delayed passage recall and word list learning. Retention and recognition of passages and word lists were not related to adherence. Participants were then classified as having either a normal verbal memory profile, a “subcortical” retrieval profile (i.e., impaired free recall with relatively spared recognition), or a “cortical” encoding profile (e.g., cued recall intrusions) based on the Massman et al. (1990) algorithm for the California Verbal Learning Test. HIV+ participants with a classic retrieval deficit had significantly greater odds of being non-adherent than participants with a normal or encoding profile. Conclusions These findings suggest that adherence to prescribed antiretroviral regimens may be particularly vulnerable to disruption in HIV+ individuals due to deficits in the complex process of efficiently accessing verbal episodic information with minimal cues. A stronger relationship between non-adherence and passage (vs. word list) recall was also found and may reflect the importance of contextual features in remembering to take medications. Targeted interventions for enhancing and supporting episodic memory retrieval processes may improve antiretroviral adherence and overall health outcomes among persons living with HIV. PMID:25781903

  12. Projected shell model study of odd-odd f-p-g shell proton-rich nuclei

    NASA Astrophysics Data System (ADS)

    Palit, R.; Sheikh, J. A.; Sun, Y.; Jain, H. C.

    2003-01-01

    A systematic study of two-quasiparticle bands of the proton-rich odd-odd nuclei in the mass A˜70 80 region is performed using the projected shell model approach. The study includes Br, Rb, and Y isotopes with N=Z+2 and Z+4. We describe the energy spectra and electromagnetic transition strengths in terms of the configuration mixing of the angular-momentum projected multi-quasiparticle states. Signature splitting and signature inversion in the rotational bands are discussed and are shown to be well described. A preliminary study of the odd-odd N=Z nucleus 74Rb, using the concept of spontaneous symmetry breaking is also presented.

  13. The Scale of Self-Efficacy Expectations of Adherence to Antiretroviral Treatment: A Tool for Identifying Risk for Non-Adherence to Treatment for HIV

    PubMed Central

    Drachler, Maria de Lourdes; Drachler, Carlos Wietzke; Teixeira, Luciana Barcellos; de Carvalho Leite, José Carlos

    2016-01-01

    Background Identification of risk for non-adherence to treatment is a challenge for personalized care for people living with HIV. Standardized questionnaires of patients’ expectations of their capability to overcome obstacles for treatment adherence may be used as a pre-screening for risk identification. A scale of self-efficacy expectations of adherence to antiretroviral treatment (SEA-ART scale) was previously developed. This study assesses the scale validity in predicting non-adherence to ART in adults living with HIV. Methods and Findings A prospective cohort study applied a 21-item SEA-ART scale to 275 adults in ART treatment at an outpatient public service for HIV in Southern Brazil. ART medications taken were assessed at one-month follow-up; ART adherence was devised as an intake of 95% and more of the prescribed medication. A SEA-ART score was calculated by adding up the scores of all items. Multivariable logistic regression and the Area Under the Receiver-Operating-Characteristic Curve (AUROC) were applied to examine the ability of the SEA-ART score to predict non-adherence at follow-up. The SEA-ART score varied from 21 to 105; mean 93.9; median 103.0. Non-adherence was 30.3% (n = 81/267). The odds of non-adherence was 8% lower for each unit increase of the SEA-ART score; after adjustment for age, sex, formal education and time in treatment (OR = 0.92; 95%CI 0.90–0.95; LRT for linear trend, p = 0.002). The AUROC was 0.80 (95%CI 0.73–0.87; p<0.001). The SEA-ART optimal cut-off value was 101, providing a sensitivity of 76.5%, a specificity of 73.1%, a positive predictive value of 55.4% and a negative predictive value of 87.7%. There was no evidence of difference in sensitivity, and specificity among groups organized by age, gender, formal education and time in treatment. Conclusions The SEA-ART scale appears to have a good capacity to discriminate between adherents and non-adherents at one-month follow-up. Further studies should confirm these results

  14. Redundant prepuce increases the odds of chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS)

    PubMed Central

    Zhao, Yu-Yang; Xu, Dong-Liang; Zhao, Fu-Jun; Han, Bang-Min; Shao, Yi; Zhao, Wei; Xia, Shu-Jie

    2014-01-01

    Some published evidence has revealed that the dendritic cells can interact with pathogens that exist in the inner foreskin. This information provides a new vision that pathogens could play a role through the redundant prepuce; numerous studies have failed to find pathogens in prostates of patients who had chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS). However, no studies have reported an association between foreskin length and CP/CPPS. Hence, we conducted a retrospective case-control study of clinical data from 322 CP/CPPS patients (case group) and 341 nonCP/CPPS patients (control group). Demographic characteristics, lifestyle factors, and foreskin lengths were collected and analyzed. Multivariate logistic regression was adopted to calculate the odds of foreskin length for CP/CPPS. According to the multivariate logistic regression results, when the foreskin length covered up more than half of the glans penis, the odds for CP/CPPS were higher with an increased foreskin (odds ratio (OR): 1.66, 95% confidence interval (CI): 1.04–2.66). In comparison, when the glans penis was completely covered by the foreskin, the OR value increased to 1.86 (95% CI, 1.2–2.88). The study results showed an association between foreskin length and the odds of CP/CPPS. When the foreskin length covered up more than half of the glans penis, there were greater odds for CP/CPPS. This possible mechanism might result from interaction between pathogens and DCs in the inner foreskin, consequently activating T-cells to mediate allergic inflammation in the prostate and producing the autoimmunizations causing CP/CPPS. PMID:24875824

  15. Redundant prepuce increases the odds of chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS).

    PubMed

    Zhao, Yu-Yang; Xu, Dong-Liang; Zhao, Fu-Jun; Han, Bang-Min; Shao, Yi; Zhao, Wei; Xia, Shu-Jie

    2014-01-01

    Some published evidence has revealed that the dendritic cells can interact with pathogens that exist in the inner foreskin. This information provides a new vision that pathogens could play a role through the redundant prepuce; numerous studies have failed to find pathogens in prostates of patients who had chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS). However, no studies have reported an association between foreskin length and CP/CPPS. Hence, we conducted a retrospective case-control study of clinical data from 322 CP/CPPS patients (case group) and 341 nonCP/CPPS patients (control group). Demographic characteristics, lifestyle factors, and foreskin lengths were collected and analyzed. Multivariate logistic regression was adopted to calculate the odds of foreskin length for CP/CPPS. According to the multivariate logistic regression results, when the foreskin length covered up more than half of the glans penis, the odds for CP/CPPS were higher with an increased foreskin (odds ratio (OR): 1.66, 95% confidence interval (CI): 1.04-2.66). In comparison, when the glans penis was completely covered by the foreskin, the OR value increased to 1.86 (95% CI, 1.2-2.88). The study results showed an association between foreskin length and the odds of CP/CPPS. When the foreskin length covered up more than half of the glans penis, there were greater odds for CP/CPPS. This possible mechanism might result from interaction between pathogens and DCs in the inner foreskin, consequently activating T-cells to mediate allergic inflammation in the prostate and producing the autoimmunizations causing CP/CPPS.

  16. Executive functions in preschoolers with ADHD, ODD, and comorbid ADHD-ODD: Evidence from ecological and performance-based measures.

    PubMed

    Ezpeleta, Lourdes; Granero, Roser

    2015-09-01

    Executive functioning in 3-year-old preschoolers with attention-deficit hyperactivity disorder (ADHD), oppositional-defiant disorder (ODD), comorbid ADHD+ODD, and children without any of these conditions (control group) was examined. A community sample including 622 children was diagnosed using a diagnostic interview following DSM-IV criteria, and assessed using the Behavior Rating Inventory of Executive Function Preschool version (BRIEF-P) and the Kiddie-Conners' Continuous Performance Test. The children diagnosed with ADHD showed the poorest executive function (EF) profile in comparison with controls, and were closely followed up in this respect by the comorbid ADHD+ODD children. The ADHD and comorbid groups presented similar executive difficulties. The ODD group obtained mean scores statistically equal to those of controls in EF. These findings suggest that, in preschoolers, executive functioning deficits assessed with a performance-based measure or with behavioural descriptions are specific to children with ADHD, in comparison with those with ODD. This study contributes knowledge about EFs in two prevalent and comorbid disorders in preschool children, ADHD and ODD, knowledge that can help our understanding of specific deficits and the design of specific early intervention initiatives.

  17. Adherence of Pseudomonas aeruginosa to contact lenses

    SciTech Connect

    Miller, M.J.

    1988-01-01

    The purpose of this research was to examined the interactions of P. aeruginosa with hydrogel contact lenses and other substrata, and characterize adherence to lenses under various physiological and physicochemical conditions. Isolates adhered to polystyrene, glass, and hydrogel lenses. With certain lens types, radiolabeled cells showed decreased adherence with increasing water content of the lenses, however, this correlation with not found for all lenses. Adherence to rigid gas permeable lenses was markedly greater than adherence to hydrogels. Best adherence occurred near pH 7 and at a sodium chloride concentration of 50 mM. Passive adhesion of heat-killed cells to hydrogels was lower than the adherence obtained of viable cells. Adherence to hydrogels was enhanced by mucin, lactoferrin, lysozyme, IgA, bovine serum albumin, and a mixture of these macromolecules. Adherence to coated and uncoated lenses was greater with a daily-wear hydrogel when compared with an extended-wear hydrogel of similar polymer composition. Greater adherence was attributed to a higher concentration of adsorbed macromolecules on the 45% water-content lens in comparison to the 55% water-content lens.

  18. Comparison of Trial Participants and Open Access Users of a Web-Based Physical Activity Intervention Regarding Adherence, Attrition, and Repeated Participation

    PubMed Central

    Martin-Diener, Eva; Bauer, Georg; Braun-Fahrländer, Charlotte; Martin, Brian W

    2010-01-01

    was similar during the first and the longest visits; for trial participants, adherence was lower during the first visits and higher during the longest visits. Of registered open access users and trial participants, 25.8% and 67.3% respectively visited Active-online repeatedly (P< .001). Predictors of repeated use were male sex (odds ratio [OR] = 1.2, 95% confidence interval [CI] = 1.04-1.38) and increasing age category in registered open access users, and age 46-60 versus < 30 years (OR = 3.04, 95% CI = 1.25-7.38) and Swiss nationality (ORnonSwiss= 0.64, 95% CI = 0.41-1.00) in trial participants. Despite reminder emails, attrition was much higher in registered open access users compared with trial participants, with a median lifetime website usage of 0 days in open access users and 290 days in trial participants. Conclusions Adherence, patterns of use, attrition, and repeated participation differed between trial participants and open access users. Reminder emails to encourage repeated participation were effective for trial participants but not for registered open access users. These issues are important when interpreting results of randomized controlled effectiveness trials. PMID:20147006

  19. Interventions to improve adherence to treatment for paediatric tuberculosis in low- and middle-income countries: a systematic review and meta-analysis

    PubMed Central

    Weaver, Meaghann S; Lönnroth, Knut; Howard, Scott C; Roter, Debra L

    2015-01-01

    Abstract Objective To assess the design, delivery and outcomes of interventions to improve adherence to treatment for paediatric tuberculosis in low- and middle-income countries and develop a contextual framework for such interventions. Methods We searched PubMed and Cochrane databases for reports published between 1 January 2003 and 1 December 2013 on interventions to improve adherence to treatment for tuberculosis that included patients younger than 20 years who lived in a low- or middle-income country. For potentially relevant articles that lacked paediatric outcomes, we contacted the authors of the studies. We assessed heterogeneity and risk of bias. To evaluate treatment success – i.e. the combination of treatment completion and cure – we performed random-effects meta-analysis. We identified areas of need for improved intervention practices. Findings We included 15 studies in 11 countries for the qualitative analysis and of these studies, 11 qualified for the meta-analysis – representing 1279 children. Of the interventions described in the 15 studies, two focused on education, one on psychosocial support, seven on care delivery, four on health systems and one on financial provisions. The children in intervention arms had higher rates of treatment success, compared with those in control groups (odds ratio: 3.02; 95% confidence interval: 2.19–4.15). Using the results of our analyses, we developed a framework around factors that promoted or threatened treatment completion. Conclusion Various interventions to improve adherence to treatment for paediatric tuberculosis appear both feasible and effective in low- and middle-income countries. PMID:26600612

  20. Odds of fault and factors for out-of-state drivers in crashes in four states of the USA.

    PubMed

    Harootunian, Kristine; Lee, Brian H Y; Aultman-Hall, Lisa

    2014-11-01

    Drivers outside their country of residence are at a safety disadvantage when compared to native counterparts. This research aimed to (1) investigate if out-of-state drivers in the United States experienced the same vulnerabilities as foreign drivers, and (2) examine the relations of out-of-state crashes to various human and environmental factors. Crash data from Florida, Maine, Minnesota, and Nevada was analyzed to model fault using logistic regressions. Univariate regressions showed that out-of-state drivers had increased odds of fault, ranging from 17% to 92%, for a single-vehicle crash compared to in-state drivers in all states except Florida, where there was no difference between groups. Odds were elevated for out-of-state drivers in two-vehicle crashes by 3% to 19% in all states except Florida and Minnesota, where, again, there was no difference between groups. Human and environmental factors such as age, sex, driving conditions, and seasons were examined with multivariate regressions for in- and out-of-state groups separately, and their odds ratios were compared. For single-vehicle crashes age, sex, road grade, surface condition, light conditions, and day of week were factors that increased at least one of the two groups' odds of fault in all states. Sex, surface condition, and light conditions increased the odds of fault for at least one of the groups in two-vehicle crashes in all four states. Factors that consistently increased odds of fault for both single- and two-vehicle crashes were males, non-vehicle owners, curves, and inclement weather. Although there were several factors in each state that increased odds of fault for out-of-state drivers, no factors consistently increased odds of fault for out-of-state drivers across all four states.

  1. Soil adherence to human skin

    SciTech Connect

    Driver, J.H.; Konz, J.J.; Whitmyre, G.K. )

    1989-12-01

    Dermal exposure to soils contaminated with toxic chemicals represents a potential public health hazard. These soils, contaminated with chemicals such as PCBs and dioxins, may be found at various locations throughout the US. Furthermore, dermal contact with pesticide-containing particles and contaminated soil particles is of importance for exposures to agricultural workers who reenter fields after pesticide application. With respect to dermal exposure to pesticide-contaminated particulate matter, several occurrences of human toxicity to ethyl parathion in citrus groves have been reported. These exposures resulted from dermal contact with high concentrations of the toxic transformation product paraoxon in soil dust contaminated as a result of application of pesticide to the overhead foliage of trees. To assess dermal exposure to chemically-contaminated soil at sites of concern, dermal adherence of soil must be determined prior to the assessment of dermal absorption. The purpose of the experiment reported herein was to determine the amount of soil (mg/cm{sup 2}) that adheres to adult hands under various soil conditions. These conditions include the type of soil, the organic content of the soil, and the particle size of the soil.

  2. Adherence to antipsychotic medication among homeless adults in Vancouver, Canada: a 15-year retrospective cohort study

    PubMed Central

    Moniruzzaman, A.; Fazel, S.; Procyshyn, R.; Somers, J. M.

    2016-01-01

    Purpose The purpose of this study was to investigate the level of adherence to antipsychotic prescription medication in a well-defined homeless cohort over a 15-year period. We hypothesized that adherence would be well below the recommended threshold for clinical effectiveness (80 %), and that it would be strongly associated with modifiable risk factors in the social environment in which homeless people live. Method Linked baseline data (including comprehensive population-level administrative prescription records) were examined in a subpopulation of participants from two pragmatic-randomized trials that investigated Housing First for homeless and mentally ill adults. Adherence to antipsychotic medication was operationalized using the medication possession ratio. Multivariable logistic regression was used to estimate effect sizes between socio-demographic, homelessness-related and illness factors, and medication possession ratio. Results Among the 290 participants who met inclusion criteria for the current analysis, adherence to antipsychotic prescription was significantly associated with: history of psychiatric hospitalization; receipt of primary medical services; long-acting injectable antipsychotic formulations; and duration of homelessness. Mean medication possession ratio in the pre-randomization period was 0.41. Socio-demographic characteristics previously correlated with antipsychotic non-adherence were not significantly related to medication possession ratio. Conclusions This is the first study to quantify the very low level of adherence to antipsychotic medication among homeless people over an extended observation period of 15 years. Each of the four factors found to be significantly associated with adherence presents opportunities for intervention. Strategies to end homelessness for this population may represent the greatest opportunity to improve adherence to antipsychotic medication. PMID:27338740

  3. Patient perceptions of voice therapy adherence.

    PubMed

    van Leer, Eva; Connor, Nadine P

    2010-07-01

    Patient perspectives of behavioral voice therapy, including perspectives of treatment adherence, have not been formally documented. Because treatment adherence is, to a large extent, determined by patient beliefs, assessment of patient perspectives is integral to the study of adherence. Fifteen patients who had undergone at least two sessions of direct voice therapy for a variety of voice disorders/complaints were interviewed about their perspectives on voice therapy, with a particular focus on adherence. Interviews were transcribed and analyzed for content according to qualitative methods. Three common content themes emerged from the transcripts: Voice Therapy is Hard, Make it Happen, and The Match Matters. Findings were compared with reports of patient experiences in other behavioral interventions, such as diet and exercise, and related to existing theoretical models of behavior change and therapeutic process. This study yields information toward the development of scales to measure adherence-related constructs and strategies to improve treatment adherence in voice therapy.

  4. Factors influencing bacterial adherence to biomaterials.

    PubMed

    Merritt, K; Chang, C C

    1991-01-01

    The adherence of bacteria to implanted medical devices is believed to be important in the development of implant associated infections. Measures which reduce bacterial adherence should reduce the incidence of these infections. However, in order to assess the importance of adherence, the effectiveness of methods to reduce adherence, and compare data from different laboratories, the conditions of the in vitro studies on adherence need to be specified. There are currently no correct and incorrect methods, however, methods used need to be carefully described. The studies reported here indicate that the definition of adherence needs to be established, with the use of polystyrene as the reference material recommended. Since the adherent organisms lose adherence traits with culture, cultures must be selected for adherence regularly. It is important to control the number of organisms/ml but the volume used is not important. The medium used to grow the organisms and the use of stationary, rocking or flow conditions will alter adherence and need to be specified and be consistent within a set of experiments. Culture conditions, methods of rinsing the material, methods of elution and counting, or direct counting of organisms on the material need to be specified. Finally, as much information as possible on the bulk and surface properties of the material should be provided. The handling of the material for the experiments should be careful and defined. Fingerprints, contact with protein, wet surfaces vs dry surfaces, etc., will all affect the subsequent adherence. The materials should not be re-used since the removal of the adherent proteins or the biofilm is very difficult. Progress can be made in this important area if the details of procedures are specified.

  5. Estimating Regression Parameters in an Extended Proportional Odds Model

    PubMed Central

    Chen, Ying Qing; Hu, Nan; Cheng, Su-Chun; Musoke, Philippa; Zhao, Lue Ping

    2012-01-01

    The proportional odds model may serve as a useful alternative to the Cox proportional hazards model to study association between covariates and their survival functions in medical studies. In this article, we study an extended proportional odds model that incorporates the so-called “external” time-varying covariates. In the extended model, regression parameters have a direct interpretation of comparing survival functions, without specifying the baseline survival odds function. Semiparametric and maximum likelihood estimation procedures are proposed to estimate the extended model. Our methods are demonstrated by Monte-Carlo simulations, and applied to a landmark randomized clinical trial of a short course Nevirapine (NVP) for mother-to-child transmission (MTCT) of human immunodeficiency virus type-1 (HIV-1). Additional application includes analysis of the well-known Veterans Administration (VA) Lung Cancer Trial. PMID:22904583

  6. Effective field theory for vibrations in odd-mass nuclei

    NASA Astrophysics Data System (ADS)

    Coello Pérez, E. A.; Papenbrock, T.

    2016-11-01

    Heavy even-even nuclei exhibit low-energy collective excitations that are separated in scale from the microscopic (fermion) degrees of freedom. This separation of scale allows us to approach nuclear vibrations within an effective field theory (EFT). In odd-mass nuclei collective and single-particle properties compete at low energies, and this makes their description more challenging. In this article we describe spherical odd-mass nuclei with ground-state spin I =1/2 by means of an EFT that couples a fermion to the collective degrees of freedom of an even-even core. The EFT relates observables such as energy levels, electric quadrupole transition strengths, and magnetic dipole moments of the odd-mass nucleus to those of its even-even neighbor and allows us to quantify theoretical uncertainties. For isotopes of rhodium and silver the theoretical description is consistent with data within experimental and theoretical uncertainties. Several testable predictions are made.

  7. Even and odd Wigner negative binomial states: Nonclassical properties

    NASA Astrophysics Data System (ADS)

    Mojaveri, B.; Dehghani, A.

    2015-10-01

    By using Wigner-Heisenberg algebra (WHA) and its Fock representation, even and odd Wigner negative binomial states (WNBSs) |M,ξ,ν>±W (ν = 0 corresponds to the ordinary even and odd negative binomial states (NBSs)) are introduced. These states can be reduced to the Wigner cat states in special limit. We establish the resolution of identity property for them through a positive definite measure on the unit disc. Some of their nonclassical properties, such as Mandel’s parameter and quadrature squeezing have been investigated numerically. We show that in contrast with the even NBSs, even WNBSs may exhibit sub-Poissonian statistics. Also squeezing in the field quadratures appears for both even and odd WNBSs. It is found that the deformation parameter ν plays an essential role in displaying highly nonclassical behaviors.

  8. Medication Adherence: A Call for Action

    PubMed Central

    Bosworth, Hayden B.; Granger, Bradi B.; Mendys, Phil; Brindis, Ralph; Burkholder, Rebecca; Czajkowski, Susan M.; Daniel, Jodi G.; Ekman, Inger; Ho, Michael; Johnson, Mimi; Kimmel, Stephen E.; Liu, Larry Z; Musaus, John; Shrank, William H.; Buono, Elizabeth Whalley; Weiss, Karen; Granger, Christopher B.

    2013-01-01

    Poor adherence to efficacious cardiovascular related medications has led to considerable morbidity, mortality, and avoidable health care costs. This paper provides results of a recent think tank meeting in which various stakeholder groups representing key experts from consumers, community health providers, the academic community, decision-making government officials (FDA, NIH, etc), and industry scientists met to evaluate the current status of medication adherence and provide recommendations for improving outcomes. Below, we review the magnitude of the problem of medication adherence, prevalence, impact, and cost. We then summarize proven effective approaches and conclude with a discussion of recommendations to address this growing and significant public health issue of medication non adherence. PMID:21884856

  9. Extremal charged rotating dilaton black holes in odd dimensions

    SciTech Connect

    Allahverdizadeh, Masoud; Kunz, Jutta; Navarro-Lerida, Francisco

    2010-09-15

    Employing higher-order perturbation theory, we find a new class of charged rotating black hole solutions of Einstein-Maxwell-dilaton theory with general dilaton coupling constant. Starting from the Myers-Perry solutions, we use the electric charge as the perturbative parameter, and focus on extremal black holes with equal-magnitude angular momenta in odd dimensions. We perform the perturbations up to 4th order for black holes in 5 dimensions and up to 3rd order in higher odd dimensions. We calculate the physical properties of these black holes and study their dependence on the charge and the dilaton coupling constant.

  10. Hot Topics in Primary Care: Medication Adherence in Type 2 Diabetes Mellitus: Real-World Strategies for Addressing a Common Problem.

    PubMed

    Brunton, Stephen A; Polonsky, William H

    2017-04-01

    The importance of treatment adherence is well established, as poor adherence contributes to disease progression and increased morbidity and mortality. Analysis of 11,272 veterans with T2DM with a mean follow-up of 5 years showed that for each 10% increase in the medication possession ratio, the mean glycated hemoglobin (HbA1c) decreased by 0.24%. Poor adherence also leads to increased health care resource utilization and costs, including more frequent hospitalizations. Conversely, while improved adherence increases medication costs, it can decrease overall health care resource utilization and costs. Improved medication adherence also contributes to improvement in diabetes-related quality of life.

  11. Adherence of sputtered titanium carbides

    NASA Technical Reports Server (NTRS)

    Brainard, W. A.; Wheeler, D. R.

    1979-01-01

    The study searches for interface treatment that would increase the adhesion of TiC coating to nickel- and titanium-base alloys. Rene 41 (19 wt percent Cr, 11 wt percent Mo, 3 wt percent Ti, balance Ni) and Ti-6Al-4V (6 wt percent Al, 4 wt percent V, balance Ti) are considered. Adhesion of the coatings is evaluated in pin-and disk friction tests. The coatings and interface regions are examined by X-ray photoelectron spectroscopy. Results suggest that sputtered refractory compound coatings adhere best when a mixed compound of coating and substrate metals is formed in the interfacial region. The most effective type of refractory compound interface appears to depend on both substrate and coating material. A combination of metallic interlayer deposition and mixed compound interface formation may be more effective for some substrate coating combinations than either alone.

  12. Adherence to Pharmacotherapy and Medication-Related Beliefs in Patients with Hypertension in Lima, Peru

    PubMed Central

    Miranda, J. Jaime; Diez-Canseco, Francisco; Malaga, German

    2014-01-01

    Objective To characterize adherence to pharmacological medication and beliefs towards medication in a group of patients with hypertension in a large national hospital. Materials and Methods Cross-sectional survey among patients with hypertension attending the outpatient clinic of a large national hospital. Exposure of interest was the patient's beliefs towards general medication and antihypertensive drugs, i.e. beliefs of harm, overuse, necessity and concern, measured using the Beliefs about Medication questionnaire. Main outcome was adherence measured using the Morisky Medication Adherence Scale-8. Multivariate analysis was conducted using Poisson distribution logistic regression, prevalence ratios and 95% confidence intervals were calculated. Results Data from 115 participants, 67% females and mean age 62.7 years were analyzed. Low adherence was found in 57.4%. Highest scores were on the ideas of necessity and one of the most rated statements was “physicians would prescribe less medication if they spent more time with patients”. Beliefs of harm about medications and concerns about antihypertensive drugs were higher in the low adherence group (p<0.01). Those who scored higher on ideas of harm were 52% less likely of being high adherents (PR 0.48; 95% CI 0.25–0.93) and those with higher scores on concerns were 41% less likely of being high adherents (PR 0.59; 95% CI 0.39–0.91). Patients whose ideas of necessity outweighed their concerns were more likely to be adherent (PR 2.65; 95% CI 1.21–5.81). Conclusions Low adherence to antihypertensive medication is common. High scores on ideas of harm, concern and a high necessity-concern differential were predictors of medication adherence. PMID:25470372

  13. Adherence to the DASH Diet is inversely associated with incidence of type 2 diabetes: the insulin resistance atherosclerosis study.

    PubMed

    Liese, Angela D; Nichols, Michele; Sun, Xuezheng; D'Agostino, Ralph B; Haffner, Steven M

    2009-08-01

    OBJECTIVE The Dietary Approaches to Stop Hypertension (DASH) diet has been widely promoted; however, little is known about its impact on type 2 diabetes. RESEARCH DESIGN AND METHODS We evaluated the association of the DASH diet with incidence of type 2 diabetes among 862 participants of the Insulin Resistance Atherosclerosis Study (IRAS) who completed a 1-year food frequency questionnaire at baseline. Type 2 diabetes odds ratios (ORs) were estimated at tertiles of the DASH score. RESULTS An inverse association was observed in whites (tertile 2 vs. tertile 1, OR 0.66 [95% CI 0.29-1.48]) that became significant for the most extreme contrast (tertile 3 vs. tertile 1, 0.31 [0.13-0.75]), with adjustment for covariates. No association was observed in blacks or Hispanics (tertile 2 vs. tertile 1, 1.16 [0.61-2.18 ]; tertile 3 vs. tertile 1, 1.34 [0.70-2.58 ]). CONCLUSIONS Adherence to the DASH dietary pattern, which is rich in vegetables, fruit, and low-fat dairy products, may have the potential to prevent type 2 diabetes.

  14. Impact of a care pathway for COPD on adherence to guidelines and hospital readmission: a cluster randomized trial

    PubMed Central

    Vanhaecht, Kris; Lodewijckx, Cathy; Sermeus, Walter; Decramer, Marc; Deneckere, Svin; Leigheb, Fabrizio; Boto, Paulo; Kul, Seval; Seys, Deborah; Panella, Massimiliano

    2016-01-01

    Purpose Current in-hospital management of exacerbations of COPD is suboptimal, and patient outcomes are poor. The primary aim of this study was to evaluate whether implementation of a care pathway (CP) for COPD improves the 6 months readmission rate. Secondary outcomes were the 30 days readmission rate, mortality, length of stay and adherence to guidelines. Patients and methods An international cluster randomized controlled trial was performed in Belgium, Italy and Portugal. General hospitals were randomly assigned to an intervention group where a CP was implemented or a control group where usual care was provided. The targeted population included patients with COPD exacerbation. Results Twenty-two hospitals were included, whereof 11 hospitals (n=174 patients) were randomized to the intervention group and 11 hospitals (n=168 patients) to the control group. The CP had no impact on the 6 months readmission rate. However, the 30 days readmission rate was significantly lower in the intervention group (9.7%; 15/155) compared to the control group (15.3%; 22/144) (odds ratio =0.427; 95% confidence interval 0.222–0.822; P=0.040). Performance on process indicators was significantly higher in the intervention group for 2 of 24 main indicators (8.3%). Conclusion The implementation of this in-hospital CP for COPD exacerbation has no impact on the 6 months readmission rate, but it significantly reduces the 30 days readmission rate. PMID:27920516

  15. Predictors of adherence to safe handling practices for antineoplastic drugs: A survey of hospital nurses.

    PubMed

    Silver, Sharon R; Steege, Andrea L; Boiano, James M

    2016-01-01

    Despite growing awareness of the hazards of exposure to antineoplastic drugs (ADs), surveys continue to find incomplete adherence to recommended safe handling guidelines. A 2011 survey of healthcare workers presents an opportunity to examine factors associated with adherence among 1094 hospital nurses who administered ADs. Data for these hypothesis-generating analyses were taken from an anonymous, web-based survey of healthcare workers. Regression modeling was used to examine associations between a number of predictors (engineering controls, work practices, nurse perceptions, and nurse and hospital characteristics) and three outcomes reported by nurses: use of personal protective equipment (PPE); activities performed with gloves previously worn to administer ADs; and spills of ADs. Adherence to safe handling guidelines was not universal, and AD spills were reported by 9.5% of nurses during the week prior to the survey. Familiarity with safe handling guidelines and training in safe handling were associated with more reported PPE use. Nurse-perceived availability of PPE was associated with more reported PPE use and lower odds of reported spills. Use of closed system drug-transfer devices and luer-lock fittings also decreased the odds of self-reported AD spills, while more frequent AD administration increased the risk. AD administration frequency was also associated with performing more activities with gloves previously worn to administer ADs, and nurse perception of having adequate time for taking safety precautions with fewer such activities. The results suggest that training and familiarity with guidelines for safe handling of ADs, adequate time to adhere to guidelines, and availability of PPE and certain engineering controls are key to ensuring adherence to safe handling practices. Further assessment of training components and engineering controls would be useful for tailoring interventions targeting these areas.

  16. Adherence to guidelines on cervical cancer screening in general practice: programme elements of successful implementation.

    PubMed Central

    Hermens, R P; Hak, E; Hulscher, M E; Braspenning, J C; Grol, R P

    2001-01-01

    BACKGROUND: There is still only limited understanding of whether and why interventions to facilitate the implementation of guidelines for improving primary care are successful. It is therefore important to look inside the 'black box' of the intervention, to ascertain which elements work well or less well. AIM: To assess the associations of key elements of a nationwide multifaceted prevention programme with the successful implementation of cervical screening guidelines in general practice. DESIGN OF STUDY: A nationwide prospective cohort study. SETTING: A random sample of one-third of all 4,758 general practices in The Netherlands (n = 1,586). METHOD: General practitioners (GPs) in The Netherlands were exposed to a two-and-a-half-year nationwide multifaceted prevention programme to improve the adherence to national guidelines for cervical cancer screening. Adherence to guidelines at baseline and after the intervention and actual exposure to programme elements were assessed in the sample using self-administered questionnaires. RESULTS: Both baseline and post-measurement questionnaires were returned by 988 practices (response rate = 62%). No major differences in baseline practice characteristics between study population, non-responders, and all Netherlands practices were observed. After the intervention all practices improved markedly (P<0.001) in their incorporation of nine out of 10 guideline indicators for effective cervical screening into practice. The most important elements for successful implementation were: specific software modules (odds ratios and 95% confidence intervalsfor all nine indicators ranged from OR = 1.85 [95% CI = 1.24-2.77] to OR = 10.2 [95% CI = 7.58-14.1]); two or more 'practice visits' by outreach visitors (ORs and 95% CIs for six indicators ranged from OR = 1.46 [95% CI= 1.01-2.12] to OR = 2.35 [95% CI = 1.63-3.38]); and an educational programme for practice assistants (ORs and 95% CIs for four indicators ranged from OR = 1.57 [95% CI = 1

  17. Adherence in ulcerative colitis: an overview

    PubMed Central

    Testa, Anna; Castiglione, Fabiana; Nardone, Olga Maria; Colombo, Giorgio L

    2017-01-01

    Medication adherence is an important challenge while treating chronic illnesses, such as ulcerative colitis (UC), that require a long-term management to induce and maintain clinical remission. This review provides an overview of the role that medication adherence plays in the routine management of UC, with a focus on the results of a recent Italian study reporting the perception of patients with UC regarding adherence to treatment. A literature analysis was conducted on topics, such as measurement of adherence in real practice, causes, risk factors and consequences of non-adherence and strategies, to raise patients’ adherence. Most of the data refer to adherence to 5-aminosalicylic acid, and standard of care for the induction and maintenance of remission in UC. The adherence rate to 5-aminosalicylic acid is low in clinical practice, thus resulting in fivefold higher risk of relapse, likely increased risk of colorectal cancer, reduced quality of life and higher health care costs for in- and outpatient settings. There are various causes affecting non-adherence to therapy: forgetfulness, high cost of drugs, lack of understanding of the drug regimen – which are sometimes due to insufficient explanation by the specialist – anxiety created by possible adverse events, lack of confidence in physicians’ judgment and complex dosing regimen. The last aspect negatively influences adherence to medication both in clinical trial settings and in real-world practice. Regarding this feature, mesalamine in once-daily dosage may be preferable to medications with multiple doses per day because the simplification of treatment regimens improves adherence. PMID:28260866

  18. The Antarctic ozone minimum - Relationship to odd nitrogen, odd chlorine, the final warming, and the 11-year solar cycle

    NASA Technical Reports Server (NTRS)

    Callis, L. B.; Natarajan, M.

    1986-01-01

    Photochemical calculations along 'diabatic trajectories' in the meridional phase are used to search for the cause of the dramatic springtime minimum in Antarctic column ozone. The results indicate that the minimum is principally due to catalytic destruction of ozone by high levels of total odd nitrogen. Calculations suggest that these levels of odd nitrogen are transported within the polar vortex and during the polar night from the middle to upper stratosphere and lower mesosphere to the lower stratosphere. The possibility that these levels are related to the 11-year solar cycle and are increased by enhanced formation in the thermosphere and mesosphere during solar maximum conditions is discussed.

  19. High-spin level scheme of doubly odd 128I

    NASA Astrophysics Data System (ADS)

    Ding, B.; Wang, H. X.; Jiang, H.; Zhang, Y. H.; Zhou, X. H.; Zhao, Y. M.; Wang, S. T.; Liu, M. L.; Li, G. S.; Zheng, Y.; Zhang, N. T.; Zhou, H. B.; Ma, Y. J.; Sasakiz, Y.; Yamada, K.; Ohshima, H.; Yokose, S.; Ishizuka, M.; Komatsubara, T.; Furuno, K.

    2012-09-01

    High-spin states in the odd-odd 128I have been studied experimentally using the 124Sn(7Li, 3nγ)128I reaction at beam energies of 28 and 32 MeV. A level scheme built on the known T1/2=175 ns, (6-) isomer has been established. The low-lying states in the level scheme have been proposed to be associated with the πd5/2⊗νh11/2 and πg7/2⊗νh11/2 two-quasiparticle excitations. The strongly populated negative-parity states, forming a bandlike structure, have been assigned to be based on the πg7/2⊗νh11/2 configuration. The πh11/2⊗νh11/2 multiplet 9+, 10+, and 11+ members have been identified according to the systematics of the corresponding level structures observed in the lighter odd-odd iodine isotopes. The two-quasiparticle configuration assignments are supported by the nucleon pair approximation and empirical shell-model calculations.

  20. Band structure of doubly-odd nuclei around mass 130

    SciTech Connect

    Higashiyama, Koji; Yoshinaga, Naotaka

    2011-05-06

    Nuclear structure of the doublet bands in the doubly-odd nuclei with mass A{approx}130 is studied in terms of a pair-truncated shell model. The model reproduces quite well the energy levels of the doublet bands and the electromagnetic transitions. The analysis of the electromagnetic transitions reveals new band structure of the doublet bands.

  1. Are the Odds Against the Origin of Life Too Great?

    ERIC Educational Resources Information Center

    Carrier, Richard

    2000-01-01

    Statistics are offered to "prove" odds against the origin of life. Presents a summary analysis of all known examples to be used to check these claims whenever they are brought up in conversations, debates, books, or articles. Addresses scientific work misused by anti-evolutionists and the pseudoscientific assertions of the…

  2. Stacking the Odds: A National Directory of Exemplary Programs.

    ERIC Educational Resources Information Center

    Snyder, Jon D.; Spindel, Ann

    A recent study found that many students have dreams for the future, but many of them are on paths that do not lead to that future. Many institutions are already taking steps to close the gap between aspirations and reality, and some of the programs that are working to stack the odds in children's favor are profiled in this directory. Educational…

  3. Odd Laplacians: geometrical meaning of potential and modular class

    NASA Astrophysics Data System (ADS)

    Khudaverdian, Hovhannes M.; Peddie, Matthew T.

    2017-01-01

    A second-order self-adjoint operator Δ =Spartial ^2+U is uniquely defined by its principal symbol S and potential U if it acts on half-densities. We analyse the potential U as a compensating field (gauge field) in the sense that it compensates the action of coordinate transformations on the second derivatives in the same way as an affine connection compensates the action of coordinate transformations on first derivatives in the first-order operator, a covariant derivative, nabla =partial +Γ . Usually a potential U is derived from other geometrical constructions such as a volume form, an affine connection, or a Riemannian structure, etc. The story is different if Δ is an odd operator on a supermanifold. In this case, the second-order potential becomes a primary object. For example, in the case of an odd symplectic supermanifold, the compensating field of the canonical odd Laplacian depends only on this symplectic structure and can be expressed by the formula obtained by K. Bering. We also study modular classes of odd Poisson manifolds via Δ -operators, and consider an example of a non-trivial modular class which is related with the Nijenhuis bracket.

  4. A Study of Odd- and Even-Number Cultures

    ERIC Educational Resources Information Center

    Nishiyama, Yutaka

    2006-01-01

    Japanese prefer odd numbers, whereas Westerners emphasize even numbers, an observation that is clear from the distribution of number-related words in Japanese and English dictionaries. In this article, the author explains why these two cultures differ by surveying the history of numbers, including yin-yang thought from ancient China, ancient Greek…

  5. Search for very light CP-odd Higgs Boson in radiative decays of Upsilon(1S).

    PubMed

    Love, W; Savinov, V; Mendez, H; Ge, J Y; Miller, D H; Shipsey, I P J; Xin, B; Adams, G S; Anderson, M; Cummings, J P; Danko, I; Hu, D; Moziak, B; Napolitano, J; He, Q; Insler, J; Muramatsu, H; Park, C S; Thorndike, E H; Yang, F; Artuso, M; Blusk, S; Khalil, S; Li, J; Mountain, R; Nisar, S; Randrianarivony, K; Sultana, N; Skwarnicki, T; Stone, S; Wang, J C; Zhang, L M; Bonvicini, G; Cinabro, D; Dubrovin, M; Lincoln, A; Naik, P; Rademacker, J; Asner, D M; Edwards, K W; Reed, J; Briere, R A; Ferguson, T; Tatishvili, G; Vogel, H; Watkins, M E; Rosner, J L; Alexander, J P; Cassel, D G; Duboscq, J E; Ehrlich, R; Fields, L; Galik, R S; Gibbons, L; Gray, R; Gray, S W; Hartill, D L; Heltsley, B K; Hertz, D; Hunt, J M; Kandaswamy, J; Kreinick, D L; Kuznetsov, V E; Ledoux, J; Mahlke-Krüger, H; Mohapatra, D; Onyisi, P U E; Patterson, J R; Peterson, D; Riley, D; Ryd, A; Sadoff, A J; Shi, X; Stroiney, S; Sun, W M; Wilksen, T; Athar, S B; Patel, R; Yelton, J; Rubin, P; Eisenstein, B I; Karliner, I; Mehrabyan, S; Lowrey, N; Selen, M; White, E J; Wiss, J; Mitchell, R E; Shepherd, M R; Besson, D; Pedlar, T K; Cronin-Hennessy, D; Gao, K Y; Hietala, J; Kubota, Y; Klein, T; Lang, B W; Poling, R; Scott, A W; Zweber, P; Dobbs, S; Metreveli, Z; Seth, K K; Tomaradze, A; Libby, J; Martin, L; Powell, A; Wilkinson, G; Ecklund, K M

    2008-10-10

    We search for a non-SM-like CP-odd Higgs boson (a(1)(0)) decaying to tau(+)tau(-) or mu(+)mu(-) in radiative decays of the Upsilon(1S). No significant signal is found, and upper limits on the product branching ratios are set. Our tau(+)tau(-) results are almost 2 orders of magnitude more stringent than previous upper limits. Our data provide no evidence for a Higgs state with a mass of 214 MeV decaying to mu(+)mu(-), previously proposed as an explanation for 3 Sigma(+)-->pmu(+)mu(-) events observed by the HyperCP experiment. Our results constrain NMSSM models.

  6. The importance of inhaler devices: the choice of inhaler device may lead to suboptimal adherence in COPD patients

    PubMed Central

    Darbà, Josep; Ramírez, Gabriela; Sicras, Antoni; Francoli, Pablo; Torvinen, Saku; Sánchez-de la Rosa, Rainel

    2015-01-01

    Objective This study aims to identify factors associated with poor adherence to COPD treatment in patients receiving a fixed-dose combination (FDC) of inhaled corticosteroids and long-acting β2-agonist (ICS/LABA), focusing on the importance of inhaler devices. Methods We conducted a retrospective and multicenter study based on a review of medical registries between 2007 and 2012 of COPD patients (n=1,263) treated with ICS/LABA FDC, whose medical devices were either dry powder inhalers (DPIs) or pressurized metered-dose inhalers (pMDI). Medication adherence included persistence outcomes through 18 months and medication possession ratios. Data on exacerbations, comorbidities, demographic characteristics, and health care resource utilization were also included as confounders of adherence. Results The analyses revealed that COPD patients whose medication was delivered through a DPI were less likely to have medication adherence compared to patients with pMDI, after adjusting for confounding factors, especially active ingredients. Younger groups of patients were less likely to be adherent compared to the oldest group. Smoker men were less likely to be adherent compared to women and non-smokers. Comorbidities decreased the probability of treatment adherence. Those patients that visited their doctor once a month were more likely to adhere to their medication regimen; however, suboptimal adherence was more likely to occur among those patients who visited more than three times per month their doctor. We also found that worsening of COPD is negatively associated with adherence. Conclusion According to this study, inhaler devices influence patients’ adherence to long-term COPD medication. We also found that DPIs delivering ICS/LABA FDC had a negative impact on adherence. Patients’ clinic and socioeconomic characteristics were associated with adherence. PMID:26604733

  7. A Review of Treatment Adherence Measurement Methods

    ERIC Educational Resources Information Center

    Schoenwald, Sonja K.; Garland, Ann F.

    2013-01-01

    Fidelity measurement is critical for testing the effectiveness and implementation in practice of psychosocial interventions. Adherence is a critical component of fidelity. The purposes of this review were to catalogue adherence measurement methods and assess existing evidence for the valid and reliable use of the scores that they generate and the…

  8. Current Situation of Medication Adherence in Hypertension

    PubMed Central

    Vrijens, Bernard; Antoniou, Sotiris; Burnier, Michel; de la Sierra, Alejandro; Volpe, Massimo

    2017-01-01

    Despite increased awareness, poor adherence to treatments for chronic diseases remains a global problem. Adherence issues are common in patients taking antihypertensive therapy and associated with increased risks of coronary and cerebrovascular events. Whilst there has been a gradual trend toward improved control of hypertension, the number of patients with blood pressure values above goal has remained constant. This has both personal and economic consequences. Medication adherence is a multifaceted issue and consists of three components: initiation, implementation, and persistence. A combination of methods is recommended to measure adherence, with electronic monitoring and drug measurement being the most accurate. Pill burden, resulting from free combinations of blood pressure lowering treatments, makes the daily routine of medication taking complex, which can be a barrier to optimal adherence. Single-pill fixed-dose combinations simplify the habit of medication taking and improve medication adherence. Re-packing of medication is also being utilized as a method of improving adherence. This paper presents the outcomes of discussions by a European group of experts on the current situation of medication adherence in hypertension. PMID:28298894

  9. Biosynthesis of odd-chain fatty alcohols in Escherichia coli.

    PubMed

    Cao, Ying-Xiu; Xiao, Wen-Hai; Liu, Duo; Zhang, Jin-Lai; Ding, Ming-Zhu; Yuan, Ying-Jin

    2015-05-01

    Engineered microbes offer the opportunity to design and implement artificial molecular pathways for renewable production of tailored chemical commodities. Targeted biosynthesis of odd-chain fatty alcohols is very challenging in microbe, due to the specificity of fatty acids synthase for two-carbon unit elongation. Here, we developed a novel strategy to directly tailor carbon number in fatty aldehydes formation step by incorporating α-dioxygenase (αDOX) from Oryza sativa (rice) into Escherichia coli αDOX oxidizes Cn fatty acids (even-chain) to form Cn-1 fatty aldehydes (odd-chain). Through combining αDOX with fatty acyl-acyl carrier protein (-ACP) thioesterase (TE) and aldehyde reductase (AHR), the medium odd-chain fatty alcohols profile (C11, C13, C15) was firstly established in E. coli. Also, medium even-chain alkanes (C12, C14) were obtained by substitution of AHR to aldehyde decarbonylase (AD). The titer of odd-chain fatty alcohols was improved from 7.4mg/L to 101.5mg/L in tube cultivation by means of fine-tuning endogenous fatty acyl-ACP TE (TesA'), αDOX, AHRs and the genes involved in fatty acids metabolism pathway. Through high cell density fed-batch fermentation, a titer of 1.95g/L odd-chain fatty alcohols was achieved, which was the highest reported titer in E. coli. Our system has greatly expanded the current microbial fatty alcohols profile that provides a new brand solution for producing complex and desired molecules in microbes.

  10. Antiferromagnetic molecular nanomagnets with odd-numbered coupled spins

    NASA Astrophysics Data System (ADS)

    Owerre, S. A.; Nsofini, J.

    2015-05-01

    In recent years, studies on cyclic molecular nanomagnets have captivated the attention of researchers. These magnets are finite in size and contain very large spins. They are interesting because they possess macroscopic quantum tunneling of Néel vectors. For antiferromagnetic molecular nanomagnets with finite number of even-numbered coupled spins, tunneling involves two classical localized Néel ground states separated by a magnetic energy barrier. The question is: can such phenomena be observed in nanomagnets with odd number of magnetic ions? The answer is not directly obvious because cyclic chains with odd-numbered coupled spins are frustrated as one cannot obtain a perfect Néel order. These frustrated spins can indeed be observed experimentally, so they are of interest. In this letter, we theoretically investigate macroscopic quantum tunneling in this odd spin system with arbitrary spins s, in the presence of a magnetic field applied along the plane of the magnet. In contrast to systems with an even-numbered coupled spins, the ground state of the cyclic odd-spin system contains a topological soliton due to spin frustration. Thus, the classical ground state is 2N-fold degenerate as the soliton can be placed anywhere along the ring with total S_z=+/- s . Small quantum fluctuations delocalize the soliton with a formation of an energy band. We obtain this energy band using degenerate perturbation theory at order 2s. We show that the soliton ground state is chiral for half-odd integer spins and non-chiral for integer spins. From the structure of the energy band we infer that as the value of the spin increases the inelastic polarized neutron-scattering intensity may increase or decrease depending on the strengths of the parameters of the Hamiltonian.

  11. Entrance-channel effects in odd-Z tranactinide compound nucleus reactions

    SciTech Connect

    Nelson, S.L.; Gregorich, K.E.; Dragojevic, I.; Dullmann, Ch.E.; Eichler, R.; Folden III, C.M.; Garcia, M.A.; Gates, J.M.; Stavsetra, L.; Sudowe, R.; Nitsche, H.

    2007-09-01

    Swiatecki, Siwek-Wilczynska, and Wilczynski's 'Fusion By Diffusion' description [1] of transactinide (TAN) compound nucleus (CN) formation utilizes a three-step model. The first step is the 'sticking', or capture, which can be calculated relatively accurately. The second step is the probability for the formation of a CN by 'diffusion' analogous to that of Brownian motion. Lastly, there exists the probability of the CN 'surviving' deexcitation by neutron emission, which competes with fission and other de-excitation modes. This model predicts and reproduces cross sections typically within a factor of two. Producing the same CN with different projectile-target pairs is a very sensitive way to test entrance channel effects on heavy element production cross sections. If the same CN is produced at or near the same excitation energy the survival portion of the theory is nearly identical for the two reactions. This method can be used as a critical test of the novel 'diffusion' portion of the model. The reactions producing odd-Z TAN CN such as Db, Bh, Mt, and Rg (Z = 105, 107, 109, and 111, respectively) were first studied using even-Z projectiles on {sup 209}Bi targets (as opposed to odd-Z projectiles on {sup 208}Pb targets) because lower effective fissility [2] was expected to lead to larger cross sections. Many odd-Z projectile reactions producing odd-Z CN had not been studied in-depth until very recently. We have completed studies of these reaction pairs with the 88-Inch Cyclotron and the Berkeley Gas-Filled Separator (BGS) at the Lawrence Berkeley National Laboratory (LBNL), see Figure 1. Cross section ratios for several pairs of reactions will be presented and compared with theory.

  12. Odds, prevalence and predictors of sleep problems in school-age normal children.

    PubMed

    Spruyt, Karen; O'Brien, Louise M; Cluydts, Raymond; Verleye, Gino Benjamin; Ferri, Raffaele

    2005-06-01

    The objectives of the study were to describe the prevalence, odds, and predictors of 36 paediatric sleep behaviours and describe their coexistence in a school-age normal population. The design was community-based questionnaire survey of sleep-wake patterns, sleep environment, and 36 sleep behaviours indicative of six sleep disorder-subscales using the Health-Behaviour Questionnaire. A caregivers' report of 3045 children aged 6-13 years in Belgium constituted the participants. Prevalence of each sleep behaviour was calculated. Log-linear modelling within and between the sleep disorder-subscales was used to screen for coexistence. The effect size of selected night-time parameters to the likelihood of sleep behaviours and disorder-subscale was expressed as odds ratios via logit regression analysis. Significant differences in sleep-wake patterns were found between weekday and weekend. Ranking by odds showed that: (1) sleep problems such as 'tired when waking up', 'repetitive limb movements', 'going to bed reluctantly', and 'sleep paralysis' and; (2) the disorder-subscale 'excessive somnolence' are common in children. Coexistences within and between disorder-subscales of sleep problems are evident in a school-age, normal population. These results suggest that disorders of excessive somnolence (DES) are highly prevalent in a non-clinical sample of school-age children. Furthermore, sleep-onset latency and a noisy, not well-darkened room are predictive towards the odds for exhibiting sleep problems and disorders. It is advocated that more information on the importance of good sleep-wake hygiene should reach parents and children.

  13. Motivating patient adherence to allergic rhinitis treatments.

    PubMed

    Bender, Bruce G

    2015-03-01

    Patient nonadherence significantly burdens the treatment of allergic rhinitis (AR). Fewer than half of prescribed doses of intranasal corticosteroid medication are taken. The challenges for immunotherapies are even greater. While sustained treatment for 3 to 5 years is required for full benefit, most patients receiving immunotherapy, either subcutaneous or sublingual, stop treatment within the first year. Although research into interventions to improve AR adherence is lacking, lessons learned from adherence interventions in other chronic health conditions can be applied to AR. Two well-established, overriding models of care-the chronic care model and patient-centered care-can improve adherence. The patient-centered care model includes important lessons for allergy providers in their daily practice, including understanding and targeting modifiable barriers to adherence. Additionally, recent studies have begun to leverage health information and communication technologies to reach out to patients and promote adherence, extending patient-centered interventions initiated by providers during office visits.

  14. Adherence to Glaucoma Medications Over 12 Months in Two US Community Pharmacy Chains

    PubMed Central

    Feehan, Michael; Munger, Mark A.; Cooper, Daniel K.; Hess, Kyle T.; Durante, Richard; Jones, Gregory J.; Montuoro, Jaime; Morrison, Margaux A.; Clegg, Daniel; Crandall, Alan S.; DeAngelis, Margaret M.

    2016-01-01

    This study determined the degree of adherence to medications for glaucoma among patients refilling prescriptions in community pharmacies. Methods: Data abstracted from the dispensing records for 3615 adult patients (18 years or older, predominantly over 45) receiving glaucoma medications from two retail pharmacy chains (64 stores in total) were analyzed. From a 24-month historic data capture period, the 12-month levels of adherence were determined using standard metrics, the proportion of days covered (PDC) and the medication possession ratio (MPR). The overall 12-month mean PDC was only 57%, and the mean MPR was 71%. Using a criterion by which 80% coverage was considered satisfactory adherence, only 30% had satisfactory overall 12-month PDC coverage, and only 37% had satisfactory overall 12-month MPR coverage. Refill adherence increased with age and was highest in the 65-and-older age group (p < 0.001). Differential adherence was found across medication classes, with the highest satisfactory coverage seen for those taking alpha2-adrenergic agonists (PDC = 36.0%; MPR = 47.6%) down to those taking direct cholinergic agonists (PDC = 25.0%; MPR = 31.2%) and combination products (PDC = 22.7%; MPR = 31.0%). Adherence to glaucoma medications in the community setting, as measured by pharmacy refill data, is very poor and represents a critical target for intervention. Community pharmacists are well positioned to monitor and reinforce adherence in this population. PMID:27618115

  15. Transient improvement of urticaria induces poor adherence as assessed by Morisky Medication Adherence Scale-8.

    PubMed

    Kaneko, Sakae; Masuda, Koji; Hiragun, Takaaki; Inomata, Naoko; Furue, Masutaka; Onozuka, Daisuke; Takeuchi, Satoshi; Murota, Hiroyuki; Sugaya, Makoto; Saeki, Hidehisa; Shintani, Yoichi; Tsunemi, Yuichiro; Abe, Shinya; Kobayashi, Miwa; Kitami, Yuki; Tanioka, Miki; Imafuku, Shinichi; Abe, Masatoshi; Hagihara, Akihito; Morisky, Donald E; Katoh, Norito

    2015-11-01

    Poor adherence to medication is a major public health challenge. Here, we aimed to determine the adherence to oral and topical medications and to analyze underlying associated factors using the translated Japanese version of Morisky Medication Adherence Scale-8 regarding urticaria treatment. Web-based questionnaires were performed for 3096 registered dermatological patients, along with a subanalysis of 751 registered urticaria patients in this study. The adherence to oral medication was significantly associated with the frequency of hospital visits. Variables that affected the adherence to topical medication included age and experience of drug effectiveness. The rate of responses that "It felt like the symptoms had improved" varied significantly among the dermatological diseases treated with oral medications. Dermatologists should be aware that adherence to the treatment of urticaria is quite low. Regular visits and active education for patients with urticaria are mandatory in order to achieve a good therapeutic outcome by increasing the adherence.

  16. Mesospheric Odd Nitrogen Enhancements During Relativistic Electron Precipitation Events

    NASA Technical Reports Server (NTRS)

    Aikin, A. C.; Smith, H. J. P.

    1999-01-01

    The behavior of mesospheric odd nitrogen species during and following relativistic and diffuse auroral precipitation events is simulated, Below 75 km nitric oxide is enhanced in proportion to the ion pair production function associated with the electron precipitation and the length of the event. Nitrogen dioxide and nitric acid are also enhanced. At 65 km the percentage of odd nitrogen for N is 0.1%, HNO3 is 1.6%, NO2 is 15%, and NO is 83.3%. Between 75 and 85 km NO is depleted during particle events due to the faster destruction of NO by N relative to the production of NO by N reacting with O2. Recovery of NO depends on transport from the lower thermosphere, where NO is produced in abundant amounts during particle events.

  17. Flexible Viologen Cyclophanes: Odd/Even Effects on Intramolecular Interactions.

    PubMed

    Berville, Mathilde; Choua, Sylvie; Gourlaouen, Christophe; Boudon, Corinne; Ruhlmann, Laurent; Bailly, Corinne; Cobo, Saioa; Saint-Aman, Eric; Wytko, Jennifer; Weiss, Jean

    2017-01-04

    The ability of three bis-viologen cyclophanes to act as redox-triggered contractile switches is investigated. Odd/even effects in the formation of cyclic bis-viologens are circumvented by the use of a Zincke salt intermediate and a tetrathiafulvalene template to prepare a flexible cyclophane with hexyl linkers. Comparative spectro-electrochemical studies of this macrocycle with two other pentyl- or heptyl-linked cyclic bis-viologens show that the development of intramolecular interactions in aqueous solution depends on the length of the bridges. This dependence is confirmed by EPR and DFT studies of the magnetic coupling in the diradical dication species. The anti-ferromagnetic or ferromagnetic nature of the coupling depend, respectively, on the odd or even number of methylene groups in the spacer.

  18. Investigation of odd-order nonlinear susceptibilities in atomic vapors

    SciTech Connect

    Yan, Yaqi; Wu, Zhenkun; Si, Jinhai; Yan, Lihe; Zhang, Yiqi; Yuan, Chenzhi; Sun, Jia; Zhang, Yanpeng

    2013-06-15

    We theoretically deduce the macroscopic symmetry constraints for arbitrary odd-order nonlinear susceptibilities in homogeneous media including atomic vapors for the first time. After theoretically calculating the expressions using a semiclassical method, we demonstrate that the expressions for third- and fifth-order nonlinear susceptibilities for undressed and dressed four- and six-wave mixing (FWM and SWM) in atomic vapors satisfy the macroscopic symmetry constraints. We experimentally demonstrate consistence between the macroscopic symmetry constraints and the semiclassical expressions for atomic vapors by observing polarization control of FWM and SWM processes. The experimental results are in reasonable agreement with our theoretical calculations. -- Highlights: •The macroscopic symmetry constraints are deduced for homogeneous media including atomic vapors. •We demonstrate that odd-order nonlinear susceptibilities satisfy the constraints. •We experimentally demonstrate the deduction in part.

  19. Odd-frequency triplet pairing in mixed-parity superconductors

    NASA Astrophysics Data System (ADS)

    Cuoco, Mario; Gentile, Paola; Noce, Canio; Romano, Alfonso; Annunziata, Gaetano; Linder, Jacob

    2012-02-01

    We show that mixed-parity superconductors may exhibit equal-spin pair correlations that are odd-in-time and can be tuned by means of an applied field. The direction and the amplitude of the pair correlator in the spin space turn out to be strongly dependent on the symmetry of the order parameter, and thus provide a tool to identify different types of singlet-triplet mixed configurations. We suggest that odd-in-time spin-polarized pair correlations can be generated without magnetic inhomogeneities in superconducting/ferromagnetic hybrids with non-centrosymmetric superconductor or when parity mixing is induced at the interface. Paola Gentile, Canio Noce, Alfonso Romano, Gaetano Annunziata, Jacob Linder, Mario Cuoco, arXiv:1109.4885

  20. Shape phase transitions in odd-A nuclei

    SciTech Connect

    Alonso, C. E.; Arias, J. M.; Fortunato, L.; Vitturi, A.

    2008-11-11

    We investigate shape phase transitions in odd nuclei within the Interacting Boson Fermion Model. Special attention is given to the case of the transition from the vibrational behaviour to the stable axial deformation. The odd particle is assumed to be moving in the three single particle orbitals j = 1/2,3/2,5/2 with a boson-fermion Hamiltonian that leads to the occurrence of the SU{sup BF}(3) boson-fermion symmetry when the boson part approaches the SU(3) condition. Both energy spectra and electromagnetic transitions show characteristic patterns similar to those displayed by the even nuclei at the corresponding critical point. The role of the additional particle in characterizing the properties of the critical points in finite quantal systems is investigated by resorting to the formalism based on the intrinsic frame.

  1. Adherence to Antihypertensive Medications in Iranian Patients.

    PubMed

    Behnood-Rod, Azin; Rabbanifar, Omid; Pourzargar, Pirouz; Rai, Alireza; Saadat, Zahra; Saadat, Habibollah; Moharamzad, Yashar; Morisky, Donald E

    2016-01-01

    Introduction. Appropriate adherence to medication is still a challenging issue for hypertensive patients. We determined adherence to antihypertensive(s) and its associated factors among 280 Iranian patients. Methods. They were recruited consecutively from private and university health centers and pharmacies in four cities. The validated Persian version of the 8-item Morisky Medication Adherence Scale (MMAS-8) was administered to measure adherence. Results. Mean (±SD) overall MMAS-8 score was 5.75 (±1.88). About half of the sample (139 cases, 49.6%) showed low adherence (MMAS-8 score < 6). There was a negative linear association between the MMAS-8 score and systolic BP (r = -0.231, P < 0.001) as well as diastolic BP (r = -0.280, P < 0.001). In linear regression model, overweight/obesity (B = -0.52, P = 0.02), previous history of admission to emergency services due to hypertensive crisis (B = -0.79, P = 0.001), and getting medication directly from drugstore without refill prescription in hand (B = -0.51, P = 0.04) were factors recognized to have statistically significant association with the MMAS-8 score. Conclusion. Antihypertensive adherence was unsatisfactory. We suggest that health care providers pay special attention and make use of the aforementioned findings in their routine visits of hypertensive patients to recognize those who are vulnerable to poor adherence.

  2. Adherence to Antihypertensive Medications in Iranian Patients

    PubMed Central

    Behnood-Rod, Azin; Rabbanifar, Omid; Pourzargar, Pirouz; Rai, Alireza; Saadat, Zahra; Saadat, Habibollah; Moharamzad, Yashar; Morisky, Donald E.

    2016-01-01

    Introduction. Appropriate adherence to medication is still a challenging issue for hypertensive patients. We determined adherence to antihypertensive(s) and its associated factors among 280 Iranian patients. Methods. They were recruited consecutively from private and university health centers and pharmacies in four cities. The validated Persian version of the 8-item Morisky Medication Adherence Scale (MMAS-8) was administered to measure adherence. Results. Mean (±SD) overall MMAS-8 score was 5.75 (±1.88). About half of the sample (139 cases, 49.6%) showed low adherence (MMAS-8 score < 6). There was a negative linear association between the MMAS-8 score and systolic BP (r = −0.231, P < 0.001) as well as diastolic BP (r = −0.280, P < 0.001). In linear regression model, overweight/obesity (B = −0.52, P = 0.02), previous history of admission to emergency services due to hypertensive crisis (B = −0.79, P = 0.001), and getting medication directly from drugstore without refill prescription in hand (B = −0.51, P = 0.04) were factors recognized to have statistically significant association with the MMAS-8 score. Conclusion. Antihypertensive adherence was unsatisfactory. We suggest that health care providers pay special attention and make use of the aforementioned findings in their routine visits of hypertensive patients to recognize those who are vulnerable to poor adherence. PMID:27069676

  3. Odd Harmonics in Exoplanet Photometry: Weather or Artifact?

    NASA Astrophysics Data System (ADS)

    Cowan, Nicolas B.; Chayes, Victoria; Bouffard, Élie; Meynig, Max; Haggard, Hal M.

    2017-01-01

    In addition to the transits of a planet in front of its star and the eclipses of the planet by its star, researchers have reported flux variations at the orbital frequency and its harmonics: planetary reflection and/or emission and Doppler beaming of starlight produce one peak per orbit, while ellipsoidal variations of a tidally distorted star and/or planet produce two maxima per orbit. Researchers have also reported significant photometric variability at three times the orbital frequency, as yet unexplained. Reflected phase variations of homogeneous planets only contain power at the orbital frequency and its even harmonics. We show that odd harmonics can, however, be produced by an edge-on planet with a time-variable map, or an inclined planet with a North-South (N-S) asymmetric map. For tidally-locked planets with thick atmospheres, either of these scenarios entail weather: planets with zero obliquity experience N-S symmetric stellar forcing. North-South asymmetry would therefore suggest stochastic localized features, i.e., weather. However, we find that previous claims of large-amplitude odd modes in Kepler photometry are artifacts of removing planetary transits rather than modeling them. The only reliable claims of odd harmonics remain HAT-P-7b and Kepler-13Ab, for which the third mode amplitude is 6-8% of the planetary flux. Although time-variable albedo maps could in principle explain these odd harmonics, upper-limits on the infrared variability of other hot Jupiters make this scenario unlikely. We recommend further studying the tidal effects of close-in planets on their host stars, as this remains the only plausible hypothesis.

  4. OPE of Green functions in the odd sector of QCD

    NASA Astrophysics Data System (ADS)

    Kadavý, T.; Kampf, K.; Novotný, J.

    2017-03-01

    A review of familiar results of the three-point Green functions of currents in the odd-intrinsic parity sector of QCD is presented. Such Green functions include very well-known examples of VVP, VAS or AAP correlators. We also present new results for VVA and AAA Green functions that have not yet been studied extensively in the literature before, more importantly with a phenomenological study and a discussion of the highenergy behaviour and its relation to the QCD condensates.

  5. Decoupling and anomalous bandcrossings in odd-proton nuclei

    SciTech Connect

    Wu, C.S. , Center of Theoretical Physics, P.O. Box 8730, Beijing 100080 Department of Physics, Peking University, Beijing 100871 Institute of Theoretical Physics, Academia Sinica, Beijing 100080 )

    1995-04-01

    The anomalous bandcrossing observed in the [541] [down arrow] bands of odd-[ital Z] nuclei from the rare-earth region was investigated in the framework of the particle-rotor model. The participation of the decoupling term in the [ital K]=1/2 band will give rise to a significant shift of the bandcrossing frequency, with an amplitude comparable to the observed values.

  6. Alternating parity structure in doubly odd /sup 218/Ac

    SciTech Connect

    Debray, M.E.; Davidson, M.; Kreiner, A.J.; Davidson, J.; Falcone, G.; Hojman, D.; Santos, D.

    1989-03-01

    States in doubly odd /sup 218/Ac have been studied using in-beam ..cap alpha..-, ..gamma..-, and e/sup -/-spectroscopy techniques mainly through the /sup 209/Bi(/sup 12/C,3n)= fusion-evaporation reaction. /sup 218/Ac shows a band structure, with interleaved states of alternating parities connected by enhanced B(E1) transitions, which is strikingly similar to the one in its isotone /sup 217/Ra.

  7. Observations of Chiral Odd GPDs and Their Implications

    NASA Astrophysics Data System (ADS)

    Goldstein, Gary R.; Liuti, Simonetta; Gonzalez-Hernandez, J. Osvaldo

    2014-01-01

    Our original suggestion to investigate exclusive π0 electroproduction as a method for extracting the tensor charge, transversity, and other quantities related to chiral odd generalized parton distributions from cross section and asymmetry data is reviewed. We explain some of the details of the process: i) the connection between the helicity description and the cartesian basis; ii) the dependence on the momentum transfer squared, Q2, and iii) the angular momentum, parity, and charge conjugation constraints (JPC quantum numbers).

  8. Medication Adherence in the General Population

    PubMed Central

    Glombiewski, Julia A.; Nestoriuc, Yvonne; Rief, Winfried; Glaesmer, Heide; Braehler, Elmar

    2012-01-01

    Background Adherence to medication is low in specific populations who need chronic medication. However, adherence to medication is also of interest in a more general fashion, independent of specific populations or side effects of particular drugs. If clinicians and researchers expect patients to show close to full adherence, it is relevant to know how likely the achievement of this goal is. Population based rates can provide an estimate of efforts needed to achieve near complete adherence in patient populations. The objective of the study was to collect normative data for medication nonadherence in the general population. Methods and Findings We assessed 2,512 persons (a representative sample of German population). Adherence was measured by Rief Adherence Index. We also assessed current medication intake and side effects. We found that at least 33% of Germans repeatedly fail to follow their doctor's recommendations regarding pharmacological treatments and only 25% of Germans describe themselves as fully adherent. Nonadherence to medication occurs more often in younger patients with higher socioeconomic status taking short-term medications than in older patients with chronic conditions. Experience with medication side effects was the most prominent predictor of nonadherence. Conclusions The major strengths of our study are a representative sample and a novel approach to assess adherence. Nonadherece seems to be commonplace in the general population. Therefore adherence cannot be expected per se but needs special efforts on behalf of prescribers and public health initiatives. Nonadherence to medication should not only be considered as a drug-specific behaviour problem, but as a behaviour pattern that is independent of the prescribed medication. PMID:23272064

  9. Fluctuation theorems and entropy production with odd-parity variables

    NASA Astrophysics Data System (ADS)

    Park, Hyunggyu; Lee, Hyun Keun; Kwon, Chulan

    2013-03-01

    We show that the total entropy production in stochastic processes with odd-parity variables (under time reversal) is separated into three parts, only two of which satisfy the integral fluctuation theorems in general. One is the usual excess contribution, which can appear only transiently and is called non-adiabatic. Another one is attributed solely to the breakage of detailed balance. The last part not satisfying the fluctuation theorem comes from the steady-state distribution asymmetry for odd-parity variables, which is activated in a non-transient manner. The latter two parts combine together as the house-keeping (adiabatic) contribution, whose positivity is not guaranteed except when the excess contribution completely vanishes. Our finding reveals that the equilibrium requires the steady-state distribution symmetry for odd-parity variables independently, in addition to the usual detailed balance. This work was supported by Mid-career Researcher Program through NRF grant (No. 2010-0026627) funded by the MEST.

  10. Decline in Cardiorespiratory Fitness and Odds of Incident Sleep Complaints

    PubMed Central

    Dishman, Rodney K.; Sui, Xuemei; Church, Timothy S.; Kline, Christopher E.; Youngstedt, Shawn D.; Blair, Steven N.

    2014-01-01

    Purpose To examine longitudinal change in cardiorespiratory fitness and odds of incident sleep problems. Methods A cohort of 7368 men and 1155 women, aged 20–85 years, from the Aerobics Center Longitudinal Study. The cohort did not complain of sleep problems, depression, or anxiety at their first clinic visit. Cardiorespiratory fitness assessed at 4 clinic visits between 1971–2006, each separated by an average of 2–3 years, was used as a proxy measure of cumulative physical activity exposure. Sleep complaints were made to a physician during follow-up. Results Across visits, there were 784 incident cases of sleep complaints in men and 207 cases in women. After adjustment for age, time between visits, body mass index, smoking, alcohol use, chronic medical conditions, complaints of depression or anxiety at each visit, and fitness at Visit 1, each minute decline in treadmill endurance (i.e., a decline in cardiorespiratory fitness of approximately one-half MET) between ages 51 to 56 increased the odds of incident sleep complaints by 1.7% (1.0–2.4%) in men and 1.3% (0.0–2.8%) in women. Odds were ~8% higher per minute decline in people with sleep complaints at 2 or 3 visits. Conclusion The results indicate that maintenance of cardiorespiratory fitness during middle-age, when decline in fitness typically accelerates and risk of sleep problems is elevated, helps protect against the onset of sleep complaints made to a physician. PMID:25207930

  11. Signatures of shape phase transitions in odd-mass nuclei

    NASA Astrophysics Data System (ADS)

    Nomura, K.; Nikšić, T.; Vretenar, D.

    2016-12-01

    Quantum phase transitions between competing ground-state shapes of atomic nuclei with an odd number of protons or neutrons are investigated in a microscopic framework based on nuclear energy density functional theory and the particle-plus-boson-core coupling scheme. The boson-core Hamiltonian, as well as the single-particle energies and occupation probabilities of the unpaired nucleon, are completely determined by constrained self-consistent mean-field calculations for a specific choice of the energy density functional and paring interaction, and only the strength parameters of the particle-core coupling are adjusted to reproduce selected spectroscopic properties of the odd-mass system. We apply this method to odd-A Eu and Sm isotopes with neutron number N ≈90 , and explore the influence of the single unpaired fermion on the occurrence of a shape phase transition. Collective wave functions of low-energy states are used to compute quantities that can be related to quantum order parameters: deformations, excitation energies, E 2 transition rates, and separation energies, and their evolution with the control parameter (neutron number) is analyzed.

  12. Medication Adherence Interventions That Target Subjects with Adherence Problems: Systematic Review and Meta-analysis

    PubMed Central

    Conn, Vicki S.; Ruppar, Todd M.; Enriquez, Maithe; Cooper, Pam

    2015-01-01

    Background Inadequate medication adherence is a pervasive, under-recognized cause of poor health outcomes. Many intervention trials designed to improve medication adherence have targeted adults with adherence problems. No previous reviews have synthesized the effectiveness of medication adherence interventions focused on subjects with medication adherence difficulties. Objective This systematic review and meta-analysis synthesized findings from medication adherence intervention studies conducted among adults with medication adherence difficulties. Methods Primary research studies were eligible for inclusion if they tested an intervention designed to increase medication adherence among adults with documented adherence difficulties and reported medication adherence behavior outcomes. Comprehensive search strategies of 13 computerized databases, author and ancestry searches, and hand searches of 57 journals were used to locate eligible primary research. Participant demographics, intervention characteristics, and methodological features were reliably coded from reports along with medication adherence outcomes. Effect sizes for outcomes were calculated as standardized mean differences, and random effects models were used to estimate overall mean effects. Exploratory dichotomous and continuous variable moderator analyses were employed to examine potential associations between medication adherence effect size and sample, intervention, and methodological characteristics. Results Data were extracted from 53 reports of studies involving 8,243 individual primary study participants. The overall standardized mean difference effect size for treatment vs. control subjects was 0.301. For treatment pre- vs. post-intervention comparisons, the overall effect size was 0.533. Significantly larger effect sizes were associated with interventions incorporating prompts to take medications than interventions lacking medication prompts (0.497 vs. 0.234). Larger effect sizes were also found

  13. Acoustic response from adherent targeted contrast agents

    PubMed Central

    Zhao, Shukui; Kruse, Dustin E.; Ferrara, Katherine W.; Dayton, Paul A.

    2006-01-01

    In ultrasonic molecular imaging, encapsulated micron-sized gas bubbles are tethered to a blood vessel wall by targeting ligands. A challenging problem is to detect the echoes from adherent microbubbles and distinguish them from echoes from non-adherent agents and tissue. Echoes from adherent contrast agents are observed to include a high amplitude at the fundamental frequency, and significantly different spectral shape compared with free agents (p < 0.0003). Mechanisms for the observed acoustical difference and potential techniques to utilize these differences for molecular imaging are proposed. PMID:17225437

  14. Detection of Low Adherence in Rural Tuberculosis Patients in China: Application of Morisky Medication Adherence Scale

    PubMed Central

    Xu, Minlan; Markström, Urban; Lyu, Juncheng; Xu, Lingzhong

    2017-01-01

    The detection and analysis of cases of low medication adherence is important for helping to control tuberculosis (TB). The purpose of this study was to detect low adherence in rural TB patients by using the eight-item Morisky Medication Adherence Scale of Chinese version (C-MMAS-8) and to further analyze the adherence-related variables. A total of 358 rural TB patients recruited through multi-stage randomized sampling participated in the survey. Data were collected by the use of interviewer-led questionnaires. First, the reliability and validity of the C-MMAS-8 were determined. Second, the adherence level was assessed, and factors related to low adherence were analyzed by using Pearson’s chi-square test and then in multiple logistic regression model. Finally, the prediction of the logistic model was assessed with Receiver Operating Characteristic (ROC) curves. The C-MMAS-8 could be used to detect low adherence in TB patients with good reliability and validity. By using the referred cutoff points of MMAS-8, it was found that more than one-third of the participants had low medication adherence. Further analysis revealed the variables of being older, a longer treatment time, and being depressive were significantly related to low adherence. The ROC of the model was assessed as good using the cutoff point. We conclude that appropriately tailored strategies are needed for health-care providers to help rural TB patients cope with low medication adherence. PMID:28257075

  15. Adherence to Buprenorphine Maintenance Treatment in Opioid Dependence Syndrome: A Case Control Study

    PubMed Central

    Bandawar, Mrunal; Kandasamy, Arun; Chand, Prabhat; Murthy, Pratima; Benegal, Vivek

    2015-01-01

    Background: Opioid Use disorders are emerging as a serious public health concern in India. Opioid substitution treatment is one of the emerging forms of treatment in this population which needs more evidence to increase its availability and address prejudices towards the same. Materials and Methods: This is a case control study with retrospective design reviewing the charts of patients with opioid dependence syndrome registered between January 2005 to December 2012. Adherence to treatment was the outcome variable assessed in this study. Results: The odds of the Buprenorphine Maintenance Treatment (BMT) group remaining in treatment is 4.5 (P < 0.005) times more than Naltrexone Maintenance Treatment (NMT) group and 7 times (P < 0.001) more than Psychosocial intervention (PST) alone group. Discussion: We believe that these study findings will help in reducing the prejudice towards BMT and encourage further research in this field. Conclusion: BMT has a better adherence rate than other treatments in opioid use disorders. PMID:26664083

  16. [Using log-binomial model for estimating the prevalence ratio].

    PubMed

    Ye, Rong; Gao, Yan-hui; Yang, Yi; Chen, Yue

    2010-05-01

    To estimate the prevalence ratios, using a log-binomial model with or without continuous covariates. Prevalence ratios for individuals' attitude towards smoking-ban legislation associated with smoking status, estimated by using a log-binomial model were compared with odds ratios estimated by logistic regression model. In the log-binomial modeling, maximum likelihood method was used when there were no continuous covariates and COPY approach was used if the model did not converge, for example due to the existence of continuous covariates. We examined the association between individuals' attitude towards smoking-ban legislation and smoking status in men and women. Prevalence ratio and odds ratio estimation provided similar results for the association in women since smoking was not common. In men however, the odds ratio estimates were markedly larger than the prevalence ratios due to a higher prevalence of outcome. The log-binomial model did not converge when age was included as a continuous covariate and COPY method was used to deal with the situation. All analysis was performed by SAS. Prevalence ratio seemed to better measure the association than odds ratio when prevalence is high. SAS programs were provided to calculate the prevalence ratios with or without continuous covariates in the log-binomial regression analysis.

  17. Adherence to Mammography Screening Guidelines Among Transgender Persons and Sexual Minority Women.

    PubMed

    Bazzi, Angela Robertson; Whorms, Debra S; King, Dana S; Potter, Jennifer

    2015-11-01

    We used retrospective (2012-2013) chart review to examine breast cancer screening among transgender persons and sexual minority women (n = 1263) attending an urban community health center in Massachusetts. Transgender were less likely than cisgender patients and bisexuals were less likely than heterosexuals and lesbians to adhere to mammography screening guidelines (respectively, adjusted odds ratios = 0.53 and 0.56; 95% confidence intervals = 0.31, 0.91 and 0.34, 0.92) after adjustment for sociodemographics. Enhanced cancer prevention outreach is needed among gender and sexual minorities.

  18. Medication adherence behaviors of Medicare beneficiaries

    PubMed Central

    Carr-Lopez, Sian M; Shek, Allen; Lastimosa, Janine; Patel, Rajul A; Woelfel, Joseph A; Galal, Suzanne M; Gundersen, Berit

    2014-01-01

    Background Medication adherence is crucial for positive outcomes in the management of chronic conditions. Comprehensive medication consultation can improve medication adherence by addressing intentional and unintentional nonadherence. The Medicare Part D prescription drug benefit has eliminated some cost barriers. We sought to examine variables that impact self-reported medication adherence behaviors in an ambulatory Medicare-beneficiary population and to identify the factors that influence what information is provided during a pharmacist consultation. Methods Medicare beneficiaries who attended health fairs in northern California were offered medication therapy management (MTM) services during which demographic, social, and health information, and responses to survey questions regarding adherence were collected. Beneficiaries were also asked which critical elements of a consultation were typically provided by their community pharmacist. Survey responses were examined as a function of demographic, socioeconomic, and health-related factors. Results Of the 586 beneficiaries who were provided MTM services, 575 (98%) completed the adherence questions. Of responders, 406 (70%) reported taking medications “all of the time”. Of the remaining 169 (30%), the following reasons for nonadherence were provided: 123 (73%) forgetfulness; 18 (11%) side effects; and 17 (10%) the medication was not needed. Lower adherence rates were associated with difficulty paying for medication, presence of a medication-related problem, and certain symptomatic chronic conditions. Of the 532 who completed survey questions regarding the content of a typical pharmacist consultation, the topics included: 378 (71%) medication name and indication; 361 (68%) administration instructions; 307 (58%) side effects; 257 (48%) missed-dose instructions; and 245 (46%) interactions. Subsidy recipients and non-English speakers were significantly less likely to be counseled on drug name, indication, and side

  19. Antiplatelet resistance in outpatients with monitored adherence.

    PubMed

    Walter, Philipp N; Tsakiris, Dimitrios A; Romanens, Michel; Arnet, Isabelle; Hersberger, Kurt E

    2014-01-01

    Antiplatelet resistance with aspirin and clopidogrel has been associated with clinical, cellular and pharmacogenetic factors; and non-adherence has been considered as a major contributor to resistance in outpatients. We aimed at assessing factors to resistance when adherence to the antiplatelet drugs and all other oral solid drugs was controlled for. In a pilot study, we tested arachidonic acid and/or ADP-induced in vitro platelet aggregation of 82 outpatients with chronic aspirin and/or clopidogrel treatment before and after a one-week period of measuring the patient's adherence with the polymedication electronic monitoring system (POEMS). Resistance was found in 20% (aspirin; n = 69) and 25% (clopidogrel; n = 32) of the patients after monitored adherence. Mean platelet aggregation was not (aspirin) or non-significantly (clopidogrel) lowered when compared to baseline. Diabetes mellitus and inflammation were consistently associated with resistance to both drugs, but CYP2C19 polymorphisms could not be confirmed as predictors of clopidogrel response. Electronically compiled multidrug dosing histories allowed the concomitant intake of high-dose lipophilic statins to be identified as a risk factor of impaired response to clopidogrel and revealed that exposure to further potential drug-drug interactions (DDIs) was too low for analysis. Multidrug adherence monitoring allowed thus dismissing non-adherence as a major contributor to resistance and inter-individual response variability in an outpatient setting. Additionally, it allowed analysing the impact of DDIs according to the actual exposure to the potentially interfering drugs. Further studies based on this methodology are essential to prevent misleading results due to incomplete adherence and gain additional insight into the impact of timing adherence on antiplatelet drug response.

  20. Microbicide clinical trial adherence: insights for introduction

    PubMed Central

    Woodsong, Cynthia; MacQueen, Kathleen; Amico, K Rivet; Friedland, Barbara; Gafos, Mitzy; Mansoor, Leila; Tolley, Elizabeth; McCormack, Sheena

    2013-01-01

    After two decades of microbicide clinical trials it remains uncertain if vaginally- delivered products will be clearly shown to reduce the risk of HIV infection in women and girls. Furthermore, a microbicide product with demonstrated clinical efficacy must be used correctly and consistently if it is to prevent infection. Information on adherence that can be gleaned from microbicide trials is relevant for future microbicide safety and efficacy trials, pre-licensure implementation trials, Phase IV post-marketing research, and microbicide introduction and delivery. Drawing primarily from data and experience that has emerged from the large-scale microbicide efficacy trials completed to-date, the paper identifies six broad areas of adherence lessons learned: (1) Adherence measurement in clinical trials, (2) Comprehension of use instructions/Instructions for use, (3) Unknown efficacy and its effect on adherence/Messages regarding effectiveness, (4) Partner influence on use, (5) Retention and continuation and (6) Generalizability of trial participants' adherence behavior. Each is discussed, with examples provided from microbicide trials. For each of these adherence topics, recommendations are provided for using trial findings to prepare for future microbicide safety and efficacy trials, Phase IV post-marketing research, and microbicide introduction and delivery programs. PMID:23561044

  1. Interventions to increase adherence to acne treatment

    PubMed Central

    Moradi Tuchayi, Sara; Alexander, Tiffany M; Nadkarni, Anish; Feldman, Steven R

    2016-01-01

    Background Adherence to acne medication is poor and is a major reason why treatment plans are ineffective. Recognizing solutions to nonadherence is critical. Objective The purpose of this study is to describe the hurdles associated with acne nonadherence and to provide mechanisms on how to ameliorate them. Methods PubMed database was searched. Of the 419 search results, 29 articles were reviewed to identify hurdles to adherence and corresponding solutions. Results Hurdles to primary nonadherence where the medication is not even started, include lack of knowledge, confusion about usage, weak physician–patient relationship, fear of adverse reactions, and cost. Secondary nonadherence hurdles where the medication is started but is not taken as directed include lack of results, complex regimens, side effects, busy lifestyle, forgetfulness, inconvenience, and psychiatric comorbidity. Solutions to these hurdles include treatment simplification, technology, and dynamic education. Limitations Adherence is affected by numerous factors, but available literature analyzing acne adherence and interventions to improve adherence to treatment is limited. Conclusion There are several hurdles in adhering to acne treatment. Recognition of these hurdles and finding appropriate solutions may be as important to treatment outcomes as choosing the right medication to prescribe. PMID:27784999

  2. Impact of Mental Disorders on the Association Between Adherence to Antihypertensive Agents and All-Cause Healthcare Costs.

    PubMed

    Gentil, Lia; Vasiliadis, Helen Maria; Préville, Michel; Berbiche, Djamal

    2017-01-01

    Depression and anxiety are factors associated with poor adherence to medications that lead to increased healthcare costs. The authors hypothesize that these conditions will moderate the association between adherence and healthcare costs. The aim was to examine the healthcare costs associated with adherence to antihypertensive agents in the elderly with and without depression and anxiety. The sample included participants with hypertension and used hypertensive agents (N=926). Medication possession ratio was used to calculate medication adherence. Mean total healthcare costs included costs for inpatient stays, emergency department visits, outpatient visits, physician fees, and outpatient medications. Mental disorders were assessed using a questionnaire based on Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition criteria. The total healthcare costs were significantly greater for nonadherent participants with depression/anxiety than for adherent participants without depression/anxiety (Δ$1841, P<.0001). This study suggests that treating mental disorders in elderly patients with hypertension will decrease total healthcare costs.

  3. Effective extraction of Arabidopsis adherent seed mucilage by ultrasonic treatment

    PubMed Central

    Zhao, Xianhai; Qiao, Lijun; Wu, Ai-Min

    2017-01-01

    The Arabidopsis seed coat is composed of two layers of mucilage, a water-soluble non-adherent outer layer and an adherent inner layer. The non-adherent mucilage can easily be extracted by gentle shaking. However, adherent mucilage is extremely difficult to dissociate from the seed coat. Despite various treatments to extract the adherent mucilage, including EDTA, ammonium oxalate, dilute alkali or acid washes, most of it remains on the seed coat. Here, we show for the first time the extraction of almost all of the adherent mucilage from the Arabidopsis seed coat. Our results demonstrate that ultrasonic treatment was able to extract the adherent mucilage effectively within 20 seconds. Adherent mucilage, like non-adherent mucilage, is mainly composed of rhamnogalacturonan I (RG I). The crystalline cellulose content in adherent mucilage was measured as 3.7 mg g−1 of dry seed. Compared with non-adherent mucilage, the adherent mucilage exhibits relatively stable levels of sugar under various environmental conditions. In all cases, adherent mucilage showed higher levels of sugar than non-adherent mucilage. The cell wall remnant could associate with the adherent mucilage, which could prevent the extraction of the adherent mucilage. Our results show that ultrasonic treatment is an effective method for the quick extraction of Arabidopsis adherent mucilage with little effort. PMID:28091592

  4. Isospin odd @pK scattering length [rapid communication

    NASA Astrophysics Data System (ADS)

    Schweizer, J.

    2005-10-01

    We make use of the chiral two-loop representation of the πK scattering amplitude [J. Bijnens, P. Dhonte, P. Talavera, JHEP 0405 (2004) 036] to investigate the isospin odd scattering length at next-to-next-to-leading order in the SU (3) expansion. This scattering length is protected against contributions of ms in the chiral expansion, in the sense that the corrections to the current algebra result are of order Mπ2. In view of the planned lifetime measurement on πK atoms at CERN it is important to understand the size of these corrections.

  5. Neutron-proton pairing correlations in odd mass systems

    SciTech Connect

    Fellah, M. Allal, N. H.; Oudih, M. R.

    2015-03-30

    An expression of the ground-state which describes odd mass systems within the BCS approach in the isovector neutron-proton pairing case is proposed using the blocked level technique. The gap equations as well as the energy expression are then derived. It is shown that they exactly generalize the expressions obtained in the pairing between like-particles case. The various gap parameters and the energy are then numerically studied as a function of the pairing-strength within the schematic one-level model.

  6. Role of relative size of asperities and adhering particles on the adhesion force.

    PubMed

    Kumar, Aditya; Staedler, Thorsten; Jiang, Xin

    2013-11-01

    Adhesion force between silica microspheres of different sizes and different rough surfaces (silicon and diamond like carbon) has been measured with an atomic force microscope (AFM). Surface roughness, asperity geometry, and size of adhering particles play an important role in determining the adhesion force. Adhesion force linearly increases with size of adhering particle for smooth surfaces and can be described by the JRK model. Adhesion force of adhering particle bigger than in size to the asperities decreases with surface roughness and can be described by the Rabinovich model. For the particles smaller than or similar in size to the asperities, the adhesion force increases with surface roughness. In later case, the interaction of adhering particles with valley portion of asperities is dominated and the contact area increases. On the basis of Rabinovich model, a new equation, which takes the relative size of adhering particles and asperities into account, is derived and compared with experimental results. The normalized adhesion force decreases with ratio of root-mean-square (rms) roughness to radius of adhering particle up to 0.0025, followed by increasing normalized adhesion forces.

  7. Adherence and Persistence with Once-Daily Teriparatide in Japan: A Retrospective, Prescription Database, Cohort Study

    PubMed Central

    Tanaka, Ikuko; Sato, Masayo; Sugihara, Tomoko; Faries, Douglas E.; Nojiri, Shuko; Graham-Clarke, Peita; Flynn, Jennifer A.; Burge, Russel T.

    2013-01-01

    Adherence and persistence with osteoporosis treatments are essential for reducing fracture risk. Once-daily teriparatide is available in Japan for treating osteoporosis in patients with a high risk of fracture. The study objective was to describe real-world adherence and persistence with once-daily teriparatide 20 μg during the first year of treatment for patients who started treatment during the first eight months of availability in Japan. This prescription database study involved patients with an index date (first claim) between October 2010 and May 2011, a preindex period ≥6 months, and a postindex period ≥12 months and who were aged >45 years. Adherence (medication possession ratio (MPR)) and persistence (time from the start of treatment to discontinuation; a 60-day gap in supply) were calculated. A total of 287 patients started treatment during the specified time period; 123 (42.9%) were eligible for inclusion. Overall mean (standard deviation) adherence was 0.702 (0.366), with 61.0% of patients having high adherence (MPR > 0.8). The percentage of patients remaining on treatment was 65.9% at 180 days and 61.0% at 365 days. Our findings suggest that real-world adherence and persistence with once-daily teriparatide in Japan are similar to that with once-daily teriparatide in other countries and with other osteoporosis medications. PMID:24455412

  8. Adherence to abiraterone among the first 86 recipients after release in Saskatchewan.

    PubMed

    Smith, A D; Olson, C; Lyons, B; Tran, D; Blackburn, D F

    2015-02-01

    Metastatic castration-resistant prostate cancer is now commonly treated with abiraterone, an orally administered chronic medication. Although abiraterone has certain advantages over docetaxel-based therapy, patients are now responsible for ensuring optimal adherence to their medication. To our knowledge, adherence to abiraterone in a real-world setting has never been described. The objective of the present study was to measure adherence to abiraterone among the first patients to receive the drug in Saskatchewan. Electronic pharmacy claims were obtained from the Saskatchewan Cancer Agency after removal of patient names and identifiers. All patients with at least 1 dispensation for abiraterone between August 2011 and October 2013 were eligible. The primary endpoint was the percentage of patients achieving optimal adherence at 6 months, defined as a medication possession ratio (mpr) of 80% or better. During the study period, 141 patients received abiraterone, among whom 86 could be followed for at least 6 months. Optimal adherence was achieved in 82.6% of patients (71 of 86) at 6 months, with 79.1% achieving a mpr of at least 90%. Of patients with available follow-up to 1 year, 81.6% (31 of 38) maintained optimal adherence during the entire period.

  9. Closely Spaced Pregnancies Are Associated With Increased Odds of Autism in California Sibling Births

    PubMed Central

    Liu, Kayuet; Bearman, Peter S.

    2011-01-01

    OBJECTIVE: To determine whether the interpregnancy interval (IPI) is associated with the risk of autism in subsequent births. METHODS: Pairs of first- and second-born singleton full siblings were identified from all California births that occurred from 1992 to 2002 using birth records, and autism diagnoses were identified by using linked records of the California Department of Developmental Services. IPI was calculated as the time interval between birth dates minus the gestational age of the second sibling. In the primary analysis, logistic regression models were used to determine whether odds of autism in second-born children varied according to IPI. To address potential confounding by unmeasured family-level factors, a case-sibling control analysis determined whether affected sibling (first versus second) varied with IPI. RESULTS: An inverse association between IPI and odds of autism among 662 730 second-born children was observed. In particular, IPIs of <12, 12 to 23, and 24 to 35 months were associated with odds ratios (95% confidence intervals) for autism of 3.39 (3.00–3.82), 1.86 (1.65–2.10), and 1.26 (1.10–1.45) relative to IPIs of ≥36 months. The association was not mediated by preterm birth or low birth weight and persisted across categories of sociodemographic characteristics, with some attenuation in the oldest and youngest parents. Second-born children were at increased risk of autism relative to their firstborn siblings only in pairs with short IPIs. CONCLUSIONS: These results suggest that children born after shorter intervals between pregnancies are at increased risk of developing autism; the highest risk was associated with pregnancies spaced <1 year apart. PMID:21220394

  10. Type of Diabetes Mellitus and the Odds of Gleason Score 8 to 10 Prostate Cancer

    SciTech Connect

    Kang, Josephine; Chen Minghui; Zhang Yuanye; Moran, Brian J.; Dosoretz, Daniel E.; Katin, Michael J.; Braccioforte, Michelle H.; Salenius, Sharon A.; D'Amico, Anthony V.

    2012-03-01

    Purpose: It has been recently shown that diabetes mellitus (DM) is significantly associated with the likelihood of presenting with high-grade prostate cancer (PCa) or Gleason score (GS) 8 to 10; however, whether this association holds for both Type 1 and 2 DM is unknown. In this study we evaluated whether DM Type 1, 2, or both are associated with high-grade PCa after adjusting for known predictors of high-grade disease. Methods and Materials: Between 1991 and 2010, a total of 15,330 men diagnosed with PCa and treated with radiation therapy were analyzed. A polychotomous logistic regression analysis was performed to evaluate whether Type 1 or 2 DM was associated with odds of GS 7 or GS 8 to 10 compared with 6 or lower PCa, adjusting for African American race, age, prostate-specific antigen (PSA) level, and digital rectal examination findings. Results: Men with Type 1 DM (adjusted odds ratio [AOR], 2.05; 95% confidence interval [CI], 1.28-3.27; p = 0.003) or Type 2 DM (AOR, 1.58; 95% CI, 1.26-1.99; p < 0.001) were significantly more likely to be diagnosed with GS 8 to 10 PCa compared with nondiabetic men. However this was not true for GS 7, for which these respective results were AOR, 1.30; 95% CI, 0.93-1.82; p = 0.12 and AOR, 1.13; 95% CI, 0.98-1.32; p = 0.10. Conclusion: Type 1 and 2 DM were associated with a higher odds of being diagnosed with Gleason score 8 to 10 but not 7 PCa. Pending validation, men who are diagnosed with Type I DM with GS 7 or lower should be considered for additional workup to rule out occult high-grade disease.

  11. Dynamic mechanical measurement of the viscoelasticity of single adherent cells

    NASA Astrophysics Data System (ADS)

    Corbin, Elise A.; Adeniba, Olaoluwa O.; Ewoldt, Randy H.; Bashir, Rashid

    2016-02-01

    Many recent studies on the viscoelasticity of individual cells link mechanics with cellular function and health. Here, we introduce a measurement of the viscoelastic properties of individual human colon cancer cells (HT-29) using silicon pedestal microelectromechanical systems (MEMS) resonant sensors. We demonstrate that the viscoelastic properties of single adherent cells can be extracted by measuring a difference in vibrational amplitude of our resonant sensor platform. The magnitude of vibration of the pedestal sensor is measured using a laser Doppler vibrometer (LDV). A change in amplitude of the sensor, compared with the driving amplitude (amplitude ratio), is influenced by the mechanical properties of the adhered cells. The amplitude ratio of the fixed cells was greater than the live cells, with a p-value <0.0001. By combining the amplitude shift with the resonant frequency shift measure, we determined the elastic modulus and viscosity values of 100 Pa and 0.0031 Pa s, respectively. Our method using the change in amplitude of resonant MEMS devices can enable the determination of a refined solution space and could improve measuring the stiffness of cells.

  12. Structure of dipole bands in doubly odd 102Ag

    NASA Astrophysics Data System (ADS)

    Singh, V.; Sihotra, S.; Malik, S. S.; Bhat, G. H.; Palit, R.; Sheikh, J. A.; Kumar, S.; Singh, N.; Singh, K.; Goswamy, J.; Sethi, J.; Saha, S.; Trivedi, T.; Mehta, D.

    2016-10-01

    Excited states in the transitional doubly odd 102Ag nucleus were populated in the 75As(31P,p 3 n ) fusion-evaporation reaction using the 125 MeV incident 31P beam. The subsequent deexcitations were investigated through in-beam γ -ray spectroscopic techniques using the Indian National Gamma Array spectrometer equipped with 21 clover Ge detectors. The level scheme in 102Ag has been established up to excitation energy ˜6.5 MeV and angular momentum 19 ℏ . The earlier reported level scheme is considerably extended and modified to result in a pair of nearly degenerate negative-parity dipole bands. Lifetime measurements for the states of these two dipole bands have been performed by using the Doppler-shift attenuation method. The two nearly degenerate bands exhibit different features with regard to kinetic moment of inertia, and the reduced transition probabilities B (M 1 ) and B (E 2 ) , which do not favor these to be chiral partners. These bands are discussed in the framework of the hybrid version of tilted-axis cranking (tac) model calculations and assigned the π g9 /2⊗ν h11 /2 and π g9 /2⊗ν h11 /2(d5/2/g7 /2) 2 configurations. The tac model calculations are extended to the nearly degenerate bands observed in the heavier doubly odd Ag-108104 isotopes.

  13. Treatment adherence, clinical outcomes, and economics of triple-drug therapy in hypertensive patients.

    PubMed

    Panjabi, Sumeet; Lacey, Michael; Bancroft, Timothy; Cao, Felix

    2013-01-01

    Poor antihypertensive treatment adherence adversely affects blood pressure control. We analyzed US health plan data to assess the impact of fixed- versus loose-dose triple-combination therapy on adherence, clinical, and economic outcomes. Patients initiating triple therapy with an angiotensin receptor blocker, angiotensin-converting enzyme inhibitor, or beta blocker plus amlodipine and hydrochlorothiazide comprised three cohorts. Within-cohort comparisons were made between fixed-dose combinations of two antihypertensives plus a second pill (two pills) or three separate pills. Outcomes included adherence, cardiovascular events, health care resource use, and costs for patients with ≥ 12 months follow-up. A total of 16,290 patients were matched. Patients receiving two pills were more likely to be adherent (P < .001) and less likely to discontinue treatment (P < .001) across all cohorts. Therapy with two versus three pills resulted in significantly lower adjusted risk of cardiovascular events (hazard ratio = 0.76, P = .005) in the beta blocker cohort only. Total adjusted health care costs were significantly lower for two- versus three-pill therapy in the beta blocker cohort only (cost ratio = 0.74 overall, P < .01; 0.71 hypertension-attributable, P < .01). In patients with hypertension requiring triple therapy, fixed-dose combinations that lower pill burden may improve adherence (seen across all cohorts) and clinical outcomes (seen in the beta blocker cohort) without increasing health care costs.

  14. The distribution of odd nitrogen in the lower stratosphere and possible perturbations caused by stratospheric air transport

    NASA Technical Reports Server (NTRS)

    Isaksen, I. S. A.; Hesstvedt, E.

    1973-01-01

    In the lower stratosphere a significant production of odd nitrogen results from the reaction N2O + O(D-1) yields 2NO. Since the transport is relatively slow, odd nitrogen builds up with a maximum mixing ratio of 2 x 10 to the minus 8th power at 30 Km. Profiles of odd nitrogen, for different latitudes, winter and summer, are computed from one-dimensional transport models. Variations with latitude are small. Horizontal transport is therefore not believed to alter our results significantly. In order to evaluate the effect of odd nitrogen upon the ozone layer, NO(x) profiles are calculated. OH is here a key component, since it converts NO2 to HNO3. In the region where ozone is determined by chemistry rather than by transport (above 25 km), NO2 is found to be relatively abundant. The effect of stratospheric transport on the NO(x) distribution is shown to depend critically upon the height of emission. The effect increases by a factor of 5 or more for a change of flight level from 18 km to 23 km. This strong dependence should be duely considered when future stratospheric transport is discussed.

  15. Correlations of Energy Ratios for Collective Nuclear Bands

    NASA Astrophysics Data System (ADS)

    Zamfir, N. V.; Bucurescu, D.; Căta-Danil, G.; Ivaşcu, M.; Mărginean, N.

    2009-01-01

    It is shown that the Mallmann's energy correlations, introduced a long time ago for the ground state bands of the even-even nuclei are, in fact, universal. Various bands in all collective nuclei (even-even, odd-even, and odd-odd) obey the same systematics. This unique, universal behaviour indicates the same spin dependence of the energy of the levels and, consequently, a common structure of all collective bands. Based on the second-order anharmonic vibrator description, parameter-free recurrence relations between energy ratios are deduced. These relations can be used to predict levels of higher spins in various bands.

  16. Correlations of Energy Ratios for Collective Nuclear Bands

    NASA Astrophysics Data System (ADS)

    Zamfir, N. V.; Bucurescu, D.; Căta-Danil, G.; Ivaşcu, M.; Mărginean, N.

    2009-03-01

    It is shown that the Mallmann's energy correlations, introduced a long time ago for the ground state bands of the even-even nuclei are, in fact, universal. Various bands in all collective nuclei (even-even, odd-even, and odd-odd) obey the same systematics. This unique, universal behaviour indicates the same spin dependence of the energy of the levels in all bands in all collective nuclei. Based on a second-order anharmonic vibrator description, parameter-free recurrence relations between energy ratios are deduced. These relations can be used to predict levels of higher spins in various bands.

  17. The Relative Odds of Progressing by Structural and Functional Tests in Glaucoma

    PubMed Central

    Abe, Ricardo Y.; Diniz-Filho, Alberto; Zangwill, Linda M.; Gracitelli, Carolina P. B.; Marvasti, Amir H.; Weinreb, Robert N.; Baig, Saif; Medeiros, Felipe A.

    2016-01-01

    Purpose The purpose of this study was to evaluate the effect of disease severity and number of tests acquired during follow-up on the relative odds of identifying progression by structural or functional tests in glaucoma. Methods This was an observational cohort study involving 462 eyes of 305 patients with glaucoma and 62 eyes of 49 healthy subjects. Glaucoma patients and healthy subjects were followed for an average of 3.6 ± 0.9 and 3.8 ± 0.9 years, with a median (interquantile range) of 8 (6–9) and 7 (6–8) visits, respectively. At each visit, subjects underwent visual field assessment with standard automated perimetry (SAP) and retinal nerve fiber layer (RNFL) evaluation by spectral-domain optical coherence tomography (SD-OCT). Slopes of change in SAP mean sensitivity and OCT RNFL thickness over time were estimated by linear regression using progressively cumulative visits over time. Cutoff values for age-related expected rates of change for each test were obtained from the healthy group. Progression by SD-OCT and/or SAP was determined if the slope of change was statistically significant and also lower (faster) than the fifth percentile cutoff calculated from the healthy group. A generalized estimating equation logistic regression model was used to evaluate the relative odds of progressing by OCT versus SAP in glaucoma eyes. Results Eyes with less severe disease at baseline had a higher chance of being detected as progressing by SD-OCT but not by SAP, whereas an increase in disease severity at baseline increased the chance that the eye would be detected as progressing by SAP but not SD-OCT. Each 1 dB higher MD was associated with a 5% increase in the odds of detecting progression by SD-OCT versus SAP (odds ratio = 1.05 per 1 dB; 95% confidence interval: 1.01–1.09; P = 0.005). Conclusions The ability to detect glaucoma progression by SAP versus SD-OCT is significantly influenced by the stage of disease. Our results may provide useful information for

  18. Psychological perspective of medication adherence in transplantation

    PubMed Central

    De Pasquale, Concetta; Veroux, Massimiliano; Fornaro, Michele; Sinagra, Nunzia; Basile, Giusi; Gozzo, Cecilia; Santini, Roberta; Costa, Alessandra; Pistorio, Maria Luisa

    2016-01-01

    AIM To identify the risk factors and the post-transplant psychological symptoms that affect adherence to therapy in a population of kidney transplant recipients. METHODS The study examined the psychological variables likely responsible for the non-adherent behavior using a psychological-psychiatric assessment, evaluation of the perception of patients’ health status, and an interview regarding the anti-rejection drug therapy assumption. The study included 74 kidney transplant recipients. RESULTS Individuals with a higher level of education and more years since transplantation showed better mental balance. Regarding gender, women appeared to be less adherent to therapy. Further, the years since transplantation adversely affected the proper pharmacological assumption. Adherence to therapy did not significantly change with the mental health index. CONCLUSION The biopsychosocial illness model provides a conceptual frame of reference in which biological, psychological, and social aspects take on the same importance in the adherence to treatment protocols. For effective management, it is necessary to understand the patients’ personal experiences, their assumptions about the disease, health status perception, and mood, and to identify any “barriers” that could cause them to become noncompliant. PMID:28058225

  19. Adherence to Glycemic Monitoring in Diabetes

    PubMed Central

    Patton, Susana R.

    2015-01-01

    Glucose monitoring either by self-monitoring of blood glucose (SMBG) or continuous glucose monitoring (CGM) plays an important role in diabetes management and in reducing risk for diabetes-related complications. However, despite evidence supporting the role of glucose monitoring in better patient health outcomes, studies also reveal relatively poor adherence rates to SMBG and CGM use and numerous patient-reported barriers. Fortunately, some promising intervention strategies have been identified that promote at least short-term improvements in patients’ adherence to SMBG. These include education, problem solving, contingency management, goal setting, cognitive behavioral therapy, and motivational interviewing. Specific to CGM, interventions to promote greater use among patients are currently under way, yet one pilot study provides data suggesting better maintenance of CGM use in patients showing greater readiness for behavior change. The purpose of this review is to summarize the literature specific to glucose monitoring in patients with diabetes focusing specifically on current adherence rates, barriers to monitoring, and promising intervention strategies that may be ready to deploy now in the clinic setting to promote greater patient adherence to glucose monitoring. Yet, to continue to help patients with diabetes adhere to glucose monitoring, future research is needed to identify the treatment strategies and the intervention schedules that most likely lead to long-term maintenance of optimal glycemic monitoring levels. PMID:25591853

  20. A fast degrading odd-odd aliphatic polyester-5,7 made by condensation polymerization for biomedical applications.

    PubMed

    Chen, Fei; Nölle, Jan Martin; Wietzke, Steffen; Reuter, Marco; Chatterjee, Sangam; Koch, Martin; Agarwal, Seema

    2012-01-01

    A fast enzymatic degradable aliphatic all-odd-polyester-5,7, based on 1,7-heptanedioic acid (pimelic acid) and 1,5-pentanediol, was synthesized by polycondensation. The structural characterization of the polyester was done using 1D- and 2D-NMR spectroscopic techniques. The properties of the resulting polyester-like crystallization behavior, enzymatic degradation, thermal stability, etc., were investigated using differential scanning calorimetry, wide-angle X-ray diffraction, scanning electron microscopy and gel-permeation chromatography. Terahertz time-domain spectroscopy was employed to determine the glass transition temperature, which could not be revealed reliably by conventional thermal analysis. The properties of all-odd-polyester-5,7 were compared with a well-known enzymatic degradable polyester (polycaprolactone). The results indicated that polyester-5,7 has a crystal structure similar to PCL, but a much faster degradation rate. The morphology of polyester-5,7 film during enzymatic degradation showed a fibrillar structure and degradation began by surface erosion.

  1. Evidence of antimagnetic rotation in odd-A {sup 105}Cd

    SciTech Connect

    Choudhury, Deepika; Jain, A. K.; Patial, M.; Gupta, N.; Arumugam, P.; Dhal, A.; Sinha, R. K.; Chaturvedi, L.; Joshi, P. K.; Trivedi, T.; Palit, R.; Kumar, S.; Garg, R.; Mandal, S.; Negi, D.; Mohanto, G.; Muralithar, S.; Singh, R. P.; Madhavan, N.; Bhowmik, R. K.

    2010-12-15

    The lifetimes of the levels above spin 23/2{sup -} in the negative-parity yrast band of {sup 105}Cd have been measured using the Doppler shift attenuation method. The obtained B(E2) values are small and show a decrease with an increase in spin. This establishes, for the first time, antimagnetic rotation (AMR) in an odd-A nucleus. An excellent agreement between the theoretical (semiclassical model) and experimental results along with a large I{sup (2)}/B(E2) ratio for the states strongly suggests that the structure of the levels beyond spin 23/2{sup -} has the character of a twin-shears type AMR band resulting from the coupling of a pair of g{sub 9/2} proton holes with aligned h{sub 11/2} and (g{sub 7/2}){sup 2} neutron particles, along with a small contribution from the core rotation.

  2. Optimal odd-periodic complementary sequences for diffuse wireless optical communications

    NASA Astrophysics Data System (ADS)

    Wang, Jun-Bo; Xie, Xiu-Xiu; Jiao, Yuan; Song, Xiaoyu; Zhao, Xibin; Gu, Ming; Sheng, Ming

    2012-09-01

    Indoor wireless optical communication (WOC) systems become promising because of their distinct advantages over their radio frequency counterparts. We address the optimal odd-periodic complementary sequences (OPCSs) for estimating a channel impulse response in WOC systems. Based on the Cramer-Rao bound, a criterion for design the optimal OPCSs is introduced. Optimum OPCSs are obtained and tabulated by computer search for different channel responses and OPCS length. Moreover, the sequence detection performance measured by bit error ratio (BER) for OPCSs-based channel estimation is also investigated. Simulation results show that the sequence detection performance can be significantly improved by using the optimal OPCS pairs. Moreover, the longer OPCS is, the better a BER performance can be obtained when the channel order is held fixed.

  3. On strontium isotopic anomalies and odd-A p-process abundances. [in solar system

    NASA Technical Reports Server (NTRS)

    Clayton, D. D.

    1978-01-01

    Several aspects of the nucleosynthesis of Sr isotopes are considered in an attempt to shed light on the problem of the Sr isotopic anomalies discovered in an inclusion of the Allende meteorite. Decomposition of the Sr isotopes into average r-, s-, and p-process nucleosynthetic classes is performed. It is suggested that the Allende inclusion most likely has an excess of s-process Sr and that the initial Sr-87/Sr-86 isotopic ratio is probably slightly more primitive than basaltic achondrites. The results also show that Sn-115 is mostly due to the r-process and that odd-A yields are very small. It is concluded that if the Sr anomaly in the inclusion is an average s enhancement, it argues somewhat in favor of a model of gas/dust fractionation of s and r isotopes during accumulation of the inclusion parent in the protosolar cloud.

  4. Systematics of fine structure in the α decay of deformed odd-mass nuclei

    NASA Astrophysics Data System (ADS)

    Ren, Zhongzhou; Ni, Dongdong

    2014-12-01

    We present a detailed analysis of the a-decay fine structure in 32 deformed odd-mass nuclei from Z = 93 to Z = 102. The α-decay half-lives are systematically calculated within the multichannel cluster model (MCCM), which turns out to well reproduce the experimental data and show the neutron deformed shell structure. The branching ratios for various daughter states are investigated in the MCCM and in the WKB barrier penetration approach, respectively. It is found that the MCCM results agree well with the experimental data, while the WKB results have relatively large deviations from the experimental data for the α transitions to the high-lying members of the rotational band.

  5. Bipolar disorder: medication adherence and life contentment.

    PubMed

    Darling, Carol Anderson; Olmstead, Spencer B; Lund, Victoria E; Fairclough, Jaime F

    2008-06-01

    Using family stress theory, we examined the influence of family and health stress, level of coping, and internal health locus of control upon the life contentment of individuals diagnosed with bipolar disorder (BPD) who were either adherent or nonadherent to their medication regimens. A survey-interview design was used with a sample of 100 individuals diagnosed with BPD; 50 participants were adherent to their medication and 50 were considered nonadherent. The results indicated that the adherent group had fewer health problems and more resources for coping with stress, possessed a stronger belief that their own behaviors controlled their health status, and had higher life contentment compared to nonadherent participants. For the participants in this study, internal health locus of control had the greatest total effect on life contentment followed by family coping. Implications included the need to comprehensively assess each individual regarding the multiple factors in one's life that influence an effective treatment regimen.

  6. Phase transition in odd-N Pd-isotopes

    NASA Astrophysics Data System (ADS)

    Zhou, Hou-Bing; Dong, Guo-Xiang; Sun, Xiao-Jun; Xu, Fu-Rong

    2015-11-01

    Phase transition in odd-N isotopes 99,101,103Pd are investigated via the E-GOS (E-Gamma Over Spin) curves, which strongly suggest a structure evolution from vibration to rotation along the yrast lines with increasing spin. Theoretical calculations have been performed for the ground state bands of 99,101,103Pd in the framework of the cranked shell model (CSM) and the alignment properties observed experimentally are analyzed employing this model. The results show that the phase transition in the ground state bands of 99,101,103Pd can be interpreted as the valence nucleons start to occupy the g9/2 proton orbitals with increasing spin which would polarize the core to a small, but rigid quadrupole deformation. Supported by Natural Science Foundation of Guangxi (2014jjBA10016, 2014jjDA10012) and National Natural Science Foundation of China (11465005)

  7. Near yrast states in doubly odd [sup 214]Fr

    SciTech Connect

    Debray, M.E.; Kreiner, A.J.; Kesque, J.M.; Ozafran, M.; Romo, A.; Somacal, H.; Vazquez, M.E. ); Davidson, J.; Davidson, M. ); Ahn, K.; Fossan, D.B.; Liang, Y.; Ma, R.; Paul, E.S.; Piel, W.F. Jr.; Xu, N. )

    1993-11-01

    High spin states of doubly odd [sup 214]Fr[sub 127] have been investigated using in-beam [gamma]-ray and conversion electron spectroscopy techniques through the [sup 206]Pb([sup 11]B, 3[ital n]) and [sup 208]Pb([sup 11]B, 5[ital n]) fusion-evaporation reactions. Completely new spectrocopic information has been obtained. The yrast level structure is established up to spin (19[sup +]) and some information on [gamma] transitions from higher-lying levels is also obtained. Two new isomers [ital T][sub 1/2]=174(20) ns and [ital T][sub 1/2]=11(2) ns were found. Configuration assignments for the low-lying levels are discussed. Information on residual proton-neutron interactions is extracted.

  8. Odd-frequency pairing of interacting Majorana fermions

    DOE PAGES

    Huang, Zhoushen; Wolfle, P.; Balatsky, Alexander V.

    2015-09-14

    In this study, Majorana fermions are rising as a promising key component in quantum computation. Although the prevalent approach is to use a quadratic (i.e., noninteracting) Majorana Hamiltonian, when expressed in terms of Dirac fermions, generically the Hamiltonian involves interaction terms. Here we focus on the possible pair correlations in a simple model system. We study a model of Majorana fermions coupled to a boson mode and show that the anomalous correlator between different Majorana fermions, located at opposite ends of a topological wire, exhibits odd-frequency behavior. It is stabilized when the coupling strength g is above a critical valuemore » gc. We use both, conventional diagrammatic theory and a functional integral approach, to derive the gap equation, the critical temperature, the gap function, the critical coupling, and a Ginzburg-Landau theory that allows discussing a possible subleading admixture of even-frequency pairing.« less

  9. Odd-frequency pairing of interacting Majorana fermions

    NASA Astrophysics Data System (ADS)

    Huang, Zhoushen; Wölfle, P.; Balatsky, A. V.

    2015-09-01

    Majorana fermions are rising as a promising key component in quantum computation. Although the prevalent approach is to use a quadratic (i.e., noninteracting) Majorana Hamiltonian, when expressed in terms of Dirac fermions, generically the Hamiltonian involves interaction terms. Here we focus on the possible pair correlations in a simple model system. We study a model of Majorana fermions coupled to a boson mode and show that the anomalous correlator between different Majorana fermions, located at opposite ends of a topological wire, exhibits odd-frequency behavior. It is stabilized when the coupling strength g is above a critical value gc. We use both, conventional diagrammatic theory and a functional integral approach, to derive the gap equation, the critical temperature, the gap function, the critical coupling, and a Ginzburg-Landau theory that allows discussing a possible subleading admixture of even-frequency pairing.

  10. Odd-frequency pairing of interacting Majorana fermions

    SciTech Connect

    Huang, Zhoushen; Wolfle, P.; Balatsky, Alexander V.

    2015-09-14

    In this study, Majorana fermions are rising as a promising key component in quantum computation. Although the prevalent approach is to use a quadratic (i.e., noninteracting) Majorana Hamiltonian, when expressed in terms of Dirac fermions, generically the Hamiltonian involves interaction terms. Here we focus on the possible pair correlations in a simple model system. We study a model of Majorana fermions coupled to a boson mode and show that the anomalous correlator between different Majorana fermions, located at opposite ends of a topological wire, exhibits odd-frequency behavior. It is stabilized when the coupling strength g is above a critical value gc. We use both, conventional diagrammatic theory and a functional integral approach, to derive the gap equation, the critical temperature, the gap function, the critical coupling, and a Ginzburg-Landau theory that allows discussing a possible subleading admixture of even-frequency pairing.

  11. Torsion, parity-odd response, and anomalies in topological states

    NASA Astrophysics Data System (ADS)

    Parrikar, Onkar; Hughes, Taylor L.; Leigh, Robert G.

    2014-11-01

    We study the response of a class of topological systems to electromagnetic and gravitational sources, including torsion and curvature. By using the technology of anomaly polynomials, we derive the parity-odd response of a massive Dirac fermion in d =2 +1 and d =4 +1 , which provides a simple model for a topological insulator. We discuss the covariant anomalies of the corresponding edge states, from a Callan-Harvey anomaly inflow, as well as a Hamiltonian spectral flow point of view. We also discuss the applicability of our results to other systems such as Weyl semimetals. Finally, using dimensional reduction from d =4 +1 , we derive the effective action for a d =3 +1 time-reversal invariant topological insulator in the presence of torsion and curvature, and discuss its various physical consequences.

  12. Dimension-5 CP -odd operators: QCD mixing and renormalization

    DOE PAGES

    Bhattacharya, Tanmoy; Cirigliano, Vincenzo; Gupta, Rajan; ...

    2015-12-23

    Here, we study the off-shell mixing and renormalization of flavor-diagonal dimension-five T- and P-odd operators involving quarks, gluons, and photons, including quark electric dipole and chromoelectric dipole operators. Furthermore, we present the renormalization matrix to one loop in themore » $$\\bar{MS}$$ scheme. We also provide a definition of the quark chromoelectric dipole operator in a regularization-independent momentum-subtraction scheme suitable for nonperturbative lattice calculations and present the matching coefficients with the $$\\bar{MS}$$ scheme to one loop in perturbation theory, using both the naïve dimensional regularization and ’t Hooft–Veltman prescriptions for γ5.« less

  13. Exposure to Childhood Traumas Ups the Odds of Giving Birth to Daughters

    PubMed Central

    Kaitz, Marsha; Rokem, Ann Marie; Mankuta, David; Davidov, Maayan; Faraone, Stephen V.

    2014-01-01

    Purpose This study examined the likelihood of giving birth to a daughter as a function of women’s exposure to four categories of stressors: Childhood Trauma, Adult Trauma, Chronic Stressors, and Recent (adverse) Life Events. Hypothesis 1 stated that that exposure to Recent Life Events (near conception) and to childhood traumas would increase women’s chances of having a girl baby. Hypothesis 2 stated that the relation between stress and gender outcome is mediated by persistent PTSD symptoms. Method The final sample was comprised of 225 women. The design was Prospective Observational. At first contact, women were retained if they were < 27 weeks pregnant and met initial inclusion criteria. In interview 2, at 27–30 weeks, women were excluded for positive diagnoses of anxiety disorders besides PTSD with or without depression (Structured Clinical Interview for DSM disorders). In interview 3 (30–34 weeks), reports on stress categories (Social Stress Indicator Questionnaire, SSI) and PTSD symptoms (Post Traumatic Checklist) were obtained. Infant Gender was obtained from medical records. The relation between stress categories and the distribution of girl/boy infants was examined with Chi Squares and Logistic Regression analyses. Mediation was tested with the macro PROCESS (Hayes 2012). Results Childhood Trauma was the only stress category that increased the odds of having a girl; with an odds ratio of > 3.0 for women who had been exposed to more than two such events. PTSD symptoms (partially) mediated the relation between Childhood Trauma and infant gender. Conclusions Findings suggest that women’s exposure to childhood trauma contributes to the determination of the sex ratio at birth and that PTSD symptoms are part of the cause. PMID:24221408

  14. Exposure to childhood traumas ups the odds of giving birth to daughters.

    PubMed

    Kaitz, Marsha; Rokem, Ann Marie; Mankuta, David; Davidov, Maayan; Faraone, Stephen V

    2014-04-01

    This study examined the likelihood of giving birth to a daughter as a function of women's exposure to four categories of stressors: childhood trauma, adult trauma, chronic stressors, and recent (adverse) life events. Hypothesis 1 stated that exposure to recent life events (near conception) and to childhood traumas would increase women's chances of having a girl baby. Hypothesis 2 stated that the relationship between stress and gender outcome is mediated by persistent posttraumatic stress disorder (PTSD) symptoms. The final sample was comprised of 225 women. The design was prospective observational. At first contact, women were retained if they were <27 weeks pregnant and met initial inclusion criteria. In interview 2, at 27-30 weeks, women were excluded for positive diagnoses of anxiety disorders besides PTSD with or without depression (Structured Clinical Interview for DSM-IV Disorders). In interview 3 (30-34 weeks), reports on stress categories (Social Stress Indicator Questionnaire) and PTSD symptoms (Post-Traumatic Checklist) were obtained. Infant gender was obtained from medical records. The relationship between stress categories and the distribution of girl/boy infants was examined with Chi Squares and logistic regression analyses. Mediation was tested with the macro PROCESS (Hayes 2012). Childhood trauma was the only stress category that increased the odds of having a girl, with an odds ratio of >3.0 for women who had been exposed to more than two such events. PTSD symptoms (partially) mediated the relationship between childhood trauma and infant gender. Findings suggest that women's exposure to childhood trauma contributes to the determination of the sex ratio at birth and that PTSD symptoms are part of the cause.

  15. Decline in Cardiorespiratory Fitness and Odds of Incident Depression

    PubMed Central

    Dishman, Rodney K.; Sui, Xuemei; Church, Timothy S.; Hand, Gregory A.; Trivedi, Madhukar H.; Blair, Steven N.

    2012-01-01

    Background Studies of physical activity and incidence of physician-diagnosed depression have been limited to a single estimate of self-reported physical activity exposure, despite follow-up periods lasting many years. Purpose To examine longitudinal change in cardiorespiratory fitness, an objective marker of habitual physical activity, and incident depression complaints made to a physician. Methods Cardiorespiratory fitness assessed at four clinic visits between 1971 and 2006, each separated by an average of 2–3 years, was used to objectively measure cumulative physical activity exposure in cohorts of 7936 men and 1261 women, aged 20–85 years, from the Aerobics Center Longitudinal Study who did not complain of depression at their first clinic visit in 1971–2003. Data were analyzed in August 2010. Results Across subsequent visits, there were 446 incident cases in men and 153 cases in women. After adjustment for age, time between visits, BMI at each visit, and fitness at Visit 1, each 1-minute decline in treadmill endurance (i.e., a decline in cardiorespiratory fitness of approximately 1 half-MET) between ages 51 and 55 years in men and ages 53 and 56 years in women, increased the odds of incident depression complaints by approximately 2% and 9.5%, respectively. The increased odds remained significant but were attenuated to 1.3% and 5.4% after further adjustment at each visit for smoking, alcohol use, chronic medical conditions, anxiety, and sleep problems. Conclusions Maintenance of cardiorespiratory fitness during late middle-age, when decline in fitness typically accelerates, helps protect against the onset of depression complaints made to a physician. PMID:22992353

  16. An Overview of Modeling Middle Atmospheric Odd Nitrogen

    NASA Technical Reports Server (NTRS)

    Jackman, Charles H.; Kawa, S. Randolph; Einaudi, Franco (Technical Monitor)

    2001-01-01

    Odd nitrogen (N, NO, NO2, NO3, N2O5, HNO3, HO2NO2, ClONO2, and BrONO2) constituents are important components in the control of middle atmospheric ozone. Several processes lead to the production of odd nitrogen (NO(sub y)) in the middle atmosphere (stratosphere and mesosphere) including the oxidation of nitrous oxide (N2O), lightning, downflux from the thermosphere, and energetic charged particles (e.g., galactic cosmic rays, solar proton events, and energetic electron precipitation). The dominant production mechanism of NO(sub y) in the stratosphere is N2O oxidation, although other processes contribute. Mesospheric NO(sub y) is influenced by N2O oxidation, downflux from the thermosphere, and energetic charged particles. NO(sub y) is destroyed in the middle atmosphere primarily via two processes: 1) dissociation of NO to form N and O followed by N + NO yielding N2 + O to reform even nitrogen; and 2) transport to the troposphere where HNO3 can be rapidly scavenged in water droplets and rained out of the atmosphere. There are fairly significant differences among global models that predict NO(sub y). NO(sub y) has a fairly long lifetime in the stratosphere (months to years), thus disparate transport in the models probably contributes to many of these differences. Satellite and aircraft measurement provide modeling tests of the various components of NO(sub y). Although some recent reaction rate measurements have led to improvements in model/measurement agreement, significant differences do remain. This presentation will provide an overview of several proposed sources and sinks of NO(sub y) and their regions of importance. Multi-dimensional modeling results for NO(sub y) and its components with comparisons to observations will also be presented.

  17. Cell Phone Intervention to Improve Adherence

    PubMed Central

    Marciel, Kristen K.; Saiman, Lisa; Quittell, Lynne M.; Dawkins, Kevin; Quittner, Alexandra L.

    2010-01-01

    Summary Background Treatment regimens for patients with cystic fibrosis (CF) are time-consuming and complex, resulting in consistently low adherence rates. To date, few studies have evaluated innovative technologies to improve adherence in this population. Current infection control guidelines for patients with CF seek to minimize patient-to-patient transmission of potential pathogens. Thus, interventions must avoid face-to-face contact and be delivered individually, limiting opportunities for peer support. This study aimed to develop and assess a web-enabled cell phone, CFFONE™, designed to provide CF information and social support to improve adherence in adolescents with CF. Methods The acceptability, feasibility, and utility of CFFONE™ were evaluated with health care professionals (n = 17) adolescents with CF aged 11–18 years old (n = 12), adults with CF aged 21–36 years old (n = 6), parents of adolescents with CF (n = 12), and technology experts (n = 8). Adolescents also tested a prototype of CFFONE™ (n = 9). Qualitative and quantitative data were collected. Results Focus group data with health care = professionals indicated a need for this intervention, and indicated that CFFONE™ would be likely to improve knowledge and social support, and somewhat likely to improve adherence. Adolescent, adults, and parents all rated CFFONE™ as likely to improve adherence. Technology experts rated the prototype design and format as appropriate. Conclusions The current study provided some support from key stakeholders for this intervention to improve adherence in adolescents with CF. Next steps include a multi-center trial of the efficacy and safety of CFFONE™. PMID:20054860

  18. A Review of Treatment Adherence Measurement Methods

    PubMed Central

    Schoenwald, Sonja K.; Garland, Ann F.

    2013-01-01

    Fidelity measurement is critical for testing the effectiveness and implementation in practice of psychosocial interventions. Adherence is a critical component of fidelity. The purposes of this review were to catalogue adherence measurement methods and assess existing evidence for the valid and reliable use of scores they generate and feasibility of use in routine care settings. Method A systematic literature search identified articles published between 1980–2008 reporting studies of evidence-based psychosocial treatments for child or adult mental health problems, and including mention of adherence or fidelity assessment. Coders abstracted data on the measurement methods and clinical contexts of their use. Results 341 articles were reviewed in which 249 unique adherence measurement methods were identified. These methods assessed many treatment models, although more than half (59%) assessed Cognitive Behavioral Treatments. The measurement methods were used in studies with diverse clientele and clinicians. The majority (71.5%) of methods were observational. Information about psychometric properties was reported for 35% of the measurement methods, but adherence-outcomes relationships were reported for only ten percent. Approximately one third of the measures were used in community- based settings. Conclusions Many adherence measurement methods have been used in treatment research; however, little reliability and validity evidence exists for the use of these methods. That some methods were used in routine care settings suggests the feasibility of their use in practice; however, information about the operational details of measurement, scoring, and reporting is sorely needed to inform and evaluate strategies to embed fidelity measurement in implementation support and monitoring systems. PMID:22888981

  19. Abuse and resilience in relation to HAART medication adherence and HIV viral load among women with HIV in the United States.

    PubMed

    Dale, Sannisha; Cohen, Mardge; Weber, Kathleen; Cruise, Ruth; Kelso, Gwendolyn; Brody, Leslie

    2014-03-01

    Abuse is highly prevalent among HIV+ women, leading to behaviors, including lower adherence to highly active antiretroviral therapy (HAART) that result in poor health outcomes. Resilience (functioning competently despite adversity) may buffer the negative effects of abuse. This study investigated how resilience interacted with abuse history in relation to HAART adherence, HIV viral load (VL), and CD4+ cell count among a convenience sample of 138 HIV+ women from the Ruth M. Rothstein CORE Center/Cook County Health and Hospital Systems site of the Women's Interagency HIV Study (WIHS). Resilience was measured by the 10-item Connor-Davidson Resilience Scale (CD-RISC). HAART adherence (≥95% vs. <95% self reported usage of prescribed medication) and current or prior sexual, physical, or emotional/domestic abuse, were reported during structured interviews. HIV viral load (≥20 vs. <20 copies/mL) and CD4+ count (200 vs. <200 cells/mm) were measured with blood specimens. Multiple logistic regressions, controlling for age, race, income, enrollment wave, substance use, and depressive symptoms, indicated that each unit increase in resilience was significantly associated with an increase in the odds of having ≥95% HAART adherence and a decrease in the odds of having a detectable viral load. Resilience-Abuse interactions showed that only among HIV+ women with sexual abuse or multiple abuses did resilience significantly relate to an increase in the odds of ≥95% HAART adherence. Interventions to improve coping strategies that promote resilience among HIV+ women may be beneficial for achieving higher HAART adherence and viral suppression.

  20. Abuse and Resilience in Relation to HAART Medication Adherence and HIV Viral Load Among Women with HIV in the United States

    PubMed Central

    Cohen, Mardge; Weber, Kathleen; Cruise, Ruth; Kelso, Gwendolyn

    2014-01-01

    Abstract Abuse is highly prevalent among HIV+ women, leading to behaviors, including lower adherence to highly active antiretroviral therapy (HAART) that result in poor health outcomes. Resilience (functioning competently despite adversity) may buffer the negative effects of abuse. This study investigated how resilience interacted with abuse history in relation to HAART adherence, HIV viral load (VL), and CD4+ cell count among a convenience sample of 138 HIV+ women from the Ruth M. Rothstein CORE Center/Cook County Health and Hospital Systems site of the Women's Interagency HIV Study (WIHS). Resilience was measured by the 10-item Connor-Davidson Resilience Scale (CD-RISC). HAART adherence (≥95% vs. <95% self reported usage of prescribed medication) and current or prior sexual, physical, or emotional/domestic abuse, were reported during structured interviews. HIV viral load (≥20 vs. <20 copies/mL) and CD4+ count (200 vs. <200 cells/mm) were measured with blood specimens. Multiple logistic regressions, controlling for age, race, income, enrollment wave, substance use, and depressive symptoms, indicated that each unit increase in resilience was significantly associated with an increase in the odds of having ≥95% HAART adherence and a decrease in the odds of having a detectable viral load. Resilience-Abuse interactions showed that only among HIV+ women with sexual abuse or multiple abuses did resilience significantly relate to an increase in the odds of ≥95% HAART adherence. Interventions to improve coping strategies that promote resilience among HIV+ women may be beneficial for achieving higher HAART adherence and viral suppression. PMID:24568654

  1. The Impact of Text Message Reminders on Adherence to Antimalarial Treatment in Northern Ghana: A Randomized Trial

    PubMed Central

    Raifman, Julia R. G.; Lanthorn, Heather E.; Rokicki, Slawa; Fink, Günther

    2014-01-01

    Background Low rates of adherence to artemisinin-based combination therapy (ACT) regimens increase the risk of treatment failure and may lead to drug resistance, threatening the sustainability of current anti-malarial efforts. We assessed the impact of text message reminders on adherence to ACT regimens. Methods Health workers at hospitals, clinics, pharmacies, and other stationary ACT distributors in Tamale, Ghana provided flyers advertising free mobile health information to individuals receiving malaria treatment. The messaging system automatically randomized self-enrolled individuals to the control group or the treatment group with equal probability; those in the treatment group were further randomly assigned to receive a simple text message reminder or the simple reminder plus an additional statement about adherence in 12-hour intervals. The main outcome was self-reported adherence based on follow-up interviews occurring three days after treatment initiation. We estimated the impact of the messages on treatment completion using logistic regression. Results 1140 individuals enrolled in both the study and the text reminder system. Among individuals in the control group, 61.5% took the full course of treatment. The simple text message reminders increased the odds of adherence (adjusted OR 1.45, 95% CI [1.03 to 2.04], p-value 0.028). Receiving an additional message did not result in a significant change in adherence (adjusted OR 0.77, 95% CI [0.50 to 1.20], p-value 0.252). Conclusion The results of this study suggest that a simple text message reminder can increase adherence to antimalarial treatment and that additional information included in messages does not have a significant impact on completion of ACT treatment. Further research is needed to develop the most effective text message content and frequency. Trial Registration ClinicalTrials.gov NCT01722734 PMID:25350546

  2. Adherence to Cardiovascular Medications: Lessons Learned and Future Directions

    PubMed Central

    Kronish, Ian M; Ye, Siqin

    2013-01-01

    Approximately 50% of patients with cardiovascular disease and/or its major risk factors have poor adherence to their prescribed medications. Finding novel methods to help patients improve their adherence to existing evidence-based cardiovascular drug therapies has enormous potential to improve health outcomes while potentially reducing health care costs. The goal of this report is to provide a review of the current understanding of adherence to cardiovascular medications from the point of view of prescribing clinicians and cardiovascular researchers. Key topics addressed include: 1) definitions of medication adherence; 2) prevalence and impact of non-adherence; 3) methods for assessing medication adherence; 4) reasons for poor adherence; and 5) approaches to improving adherence to cardiovascular medications. For each of these topics, the report seeks to identify important gaps in knowledge and opportunities for advancing the field of cardiovascular adherence research. PMID:23621969

  3. Adherence discourse among African-American women taking HAART

    PubMed Central

    Sankar, A.; Luborsky, M.; Schuman, P.; Roberts, G.

    2014-01-01

    Low adherence is the single most important challenge to controlling HIV through the use of high acting anti-retrovirals (HAART). Non-adherence poses an immediate threat to individuals who develop resistant forms of the virus as well as a public health threat if those individuals pass on treatment-resistant forms of the virus. To understand the concerns and perceptions that promote or deter adherence to antiretroviral medication by HIV-positive African-American women, we conducted in-depth interviews with 15 African-American women taking HAART. We focused on the discourse and narratives women use in talking about their adherence practice. Discourse analysis was utilized to identify and explore the sources of influence used by these women in describing their adherence practice. Roughly a third of the sample fell into each of the three self-assessed adherence categories: always adherent, mostly adherent and somewhat adherent. Among the ‘always adherent’, 80% of the sources of influence cited supported adherence, while only 48% and 47% of the authoritative sources cited by women in the ‘mostly’ and ‘somewhat’ categories supported adherence. Each self-assessed adherence group was characterized by its own distinctive discourse style. Findings suggest that adherence to HAART among African-American HIV-positive women would be improved by identifying those influences undermining adherence. Focused study of the ‘always adherent’ types is recommended. PMID:11940279

  4. Medication Adherence Pattern and Factors affecting Adherence in Helicobacter Pylori Eradication Therapy.

    PubMed

    Shakya Shrestha, S; Bhandari, M; Thapa, S R; Shrestha, R; Poudyal, R; Purbey, B; Gurung, R B

    2016-01-01

    Background Helicobacter pylori (H. pylori) infection is the most common chronic bacterial infection worldwide affecting approximately half of the world's population. A number of screening tests as well as complex multi-drug therapies are available for the detection and treatment of H. pylori infection. However, the optimum eradication rates of H. pylori infection can only be achieved if adherence to drug therapy is higher. Therefore, it is of utmost importance to determine the factors leading to poor adherence to obtain successful treatment outcomes. Objective To determine the medication adherence pattern in patients with H. pylori infection and assess the factors associated with non-adherence to the prescribed drug therapy. Method Patients meeting the inclusion criteria who were confirmed as H. pylori positive by rapid urease test (histopathology) and/ or stool antigen test and those under H. pylori eradication therapy were considered. Informed consent was taken from the patients or from the patient party in incapacitated patients. They were then interviewed using structured questionnaire. Statistical analysis was done using SPSS version 20 and a p-value < 0.05 was considered as statistically significant. Result Among the 70 participants included in this study, 57.10% (n=40) of them were males. The mean (±SD) age of the patients was 42.36 years (±17.93). Higher number (85.70% (n=60)) of the patients were adherent to the recommended medication. Forgetfulness was the reason for missing dose in a majority (80% (n=8)) of the nonadherent patients. A highly significant association (p<0.05) was observed between adherence and absence of symptomatic relief. However, there was no statistically significant association (p>0.05) between patients' adherence to gender, age, literacy, and the prescribed treatment regimen. Conclusion Majority of the patients with H. pylori infection were adherent to medication. Forgetfulness was the major reason for missing dose in the non-adherent

  5. Unique first-forbidden β-decay transitions in odd-odd and even-even heavy nuclei

    NASA Astrophysics Data System (ADS)

    Nabi, Jameel-Un; Çakmak, Necla; Majid, Muhammad; Selam, Cevad

    2017-01-01

    The allowed Gamow-Teller (GT) transitions are the most common weak nuclear processes of spin-isospin (στ) type. These transitions play a key role in numerous processes in the domain of nuclear physics. Equally important is their contribution in astrophysics, particularly in nuclear synthesis and supernova-explosions. In situations where allowed GT transitions are not favored, first-forbidden transitions become significant, specifically in medium heavy and heavy nuclei. For neutron-rich nuclei, first-forbidden transitions are favored mainly due to the phase-space amplification for these transitions. In this work we calculate the allowed GT as well as unique first-forbidden (U1F) | ΔJ | = 2 transitions strength in odd-odd and even-even nuclei in mass range 70 ≤ A ≤ 214. Two different pn-QRPA models were used with a schematic separable interaction to calculate GT and U1F transitions. The inclusion of U1F strength improved the overall comparison of calculated terrestrial β-decay half-lives in both models. The ft values and reduced transition probabilities for the 2- ⟷0+ transitions were also calculated. We compared our calculations with the previously reported correlated RPA calculation and experimental results. Our calculations are in better agreement with measured data. For stellar applications we further calculated the allowed GT and U1F weak rates. These include β±-decay rates and electron/positron capture rates of heavy nuclei in stellar matter. Our study shows that positron and electron capture rates command the total weak rates of these heavy nuclei at high stellar temperatures.

  6. Adherence to Dietary Recommendations Is Associated with Acculturation among Latino Farm Workers12

    PubMed Central

    Matias, Susana L.; Stoecklin-Marois, Maria T.; Tancredi, Daniel J.; Schenker, Marc B.

    2013-01-01

    We examined adherence to dietary recommendations on fruit/vegetable and fat intake and identified correlates with acculturation indicators as well as with family, lifestyle, and occupational factors in a farm worker cohort in central California. Interviewer-administered questionnaires for this cross-sectional study were completed from January 2006 to April 2007. Participants were 18- to 55-y-old Latinos living in Mendota in a farm worker household. We assessed fruit/vegetable consumption and fat intake using the Block Fruit/Vegetable/Fiber Screener and the Block Dietary Fat Screener, respectively. Survey data analysis methods for contingency tables and logistic regression were used for assessing associations. The sample included 802 participants, reporting mean fruit and vegetable intake ( ± SD) of 5.0 ± 1.5 daily servings, and 47% reporting < 5 daily servings. Being born in Mexico or Central America and longer United States residency were associated with higher odds of consuming ≥ 5 daily fruit/vegetable servings and more frequent consumption of field products while working was associated with lower adherence to this recommendation. The average daily percent of calories from fat was 35.0 ± 4.1% and 53% of participants consumed > 35% of daily calories from fat. Men born in Mexico, women born in Central America, and participants who worked in fruit or vegetable crops had higher odds of consuming ≤ 35% of calories from fat. Higher acculturation level, United States school attendance, and having a child at home were associated with lower adherence to this recommendation. Acculturation, family, and occupational correlates of diet quality were identified in this underserved, immigrant population. Our findings may assist program targeting and intervention efforts. PMID:23864507

  7. Childhood Adversity as a Predictor of Non-Adherence to Statin Therapy in Adulthood

    PubMed Central

    Korhonen, Maarit Jaana; Halonen, Jaana I.; Brookhart, M. Alan; Kawachi, Ichiro; Pentti, Jaana; Karlsson, Hasse; Kivimäki, Mika; Vahtera, Jussi

    2015-01-01

    Purpose To investigate whether adverse experiences in childhood predict non-adherence to statin therapy in adulthood. Methods A cohort of 1378 women and 538 men who initiated statin therapy during 2008–2010 after responding to a survey on childhood adversities, was followed for non-adherence during the first treatment year. Log-binomial regression was used to estimate predictors of non-adherence, defined as the proportion of days covered by dispensed statin tablets <80%. In fully adjusted models including age, education, marital status, current smoking, heavy alcohol use, physical inactivity, obesity, presence of depression and cardiovascular comorbidity, the number of women ranged from 1172 to 1299 and that of men from 473 to 516, because of missing data on specific adversities and covariates. Results Two in three respondents reported at least one of the following six adversities in the family: divorce/separation of the parents, long-term financial difficulties, severe conflicts, frequent fear, severe illness, or alcohol problem of a family member. 51% of women and 44% of men were non-adherent. In men, the number of childhood adversities predicted an increased risk of non-adherence (risk ratio [RR] per adversity 1.11, 95% confidence interval [CI] 1.01–1.21], P for linear trend 0.013). Compared with those reporting no adversities, men reporting 3–6 adversities had a 1.44-fold risk of non-adherence (95% CI 1.12–1.85). Experiencing severe conflicts in the family (RR 1.27, 95% CI 1.03–1.57]) and frequent fear of a family member (RR 1.27, 95% CI 1.00–1.62]) in particular, predicted an increased risk of non-adherence. In women, neither the number of adversities nor any specific type of adversity predicted non-adherence. Conclusions Exposure to childhood adversity may predict non-adherence to preventive cardiovascular medication in men. Usefulness of information on childhood adversities in identification of adults at high risk of non-adherence deserves

  8. Adherence to Exercise and Physical Activity: Preface.

    ERIC Educational Resources Information Center

    Morgan, William P.; Dishman, Rod K.

    2001-01-01

    Introduces a collection of papers on adherence to exercise programs and physical activity from the 2000 American Academy of Kinesiology and Physical Education conference, which included research on middle school boys and girls, college men and women, and men and women in the later years, as well as on the more traditional subject of middle aged…

  9. Adherence to Sports-Injury Rehabilitation Programs.

    ERIC Educational Resources Information Center

    Fisher, A. Craig; And Others

    1988-01-01

    Analysis of 41 injured college athletes' responses to a questionnaire revealed that those athletes who adhered to their rehabilitation program were more self-motivated, tolerated pain better, perceived that they worked harder at their rehabilitation, and were less bothered by scheduling of sessions and athletic training environmental conditions.…

  10. E-health strategies to support adherence

    Technology Transfer Automated Retrieval System (TEKTRAN)

    Adherence to healthy behaviors and self-care strategies is a concern among clinicians. E-health applications, such as the internet, personal communication devices, electronic health records and web portals, and electronic games, may be a way to provide health information in a way that is reliable, c...

  11. Funhaler spacer: improving adherence without compromising delivery

    PubMed Central

    Watt, P; Clements, B; Devadason, S; Chaney, G

    2003-01-01

    A novel asthma spacer device, the "Funhaler", incorporates incentive toys which are isolated from the main inspiratory circuit by a valve. Here we show that its use does not compromise drug delivery. Improved adherence combined with satisfactory delivery characteristics suggest that the Funhaler may be useful for management of young asthmatics. PMID:12818901

  12. Non-adherence in difficult asthma and advances in detection.

    PubMed

    Lindsay, John T; Heaney, Liam G

    2013-12-01

    Non-adherence to anti-inflammatory therapies is common in patients referred for specialist assessment at difficult-to-treat asthma services. In the difficult asthma setting, non-adherence to treatment is associated with poor baseline asthma control, increased frequency of exacerbations and asthma-related hospitalizations, as well as increased risk of death. Here, we present a review of the current literature surrounding the prevalence and risks of non-adherence in difficult asthma and we report on current methods of measuring treatment adherence and advances in the detection of non-adherence. We will also explore methods by which non-adherence in difficult asthma can be addressed.

  13. Impact of organizational factors on adherence to laboratory testing protocols in adult HIV care in Lusaka, Zambia

    PubMed Central

    2012-01-01

    Background Previous operational research studies have demonstrated the feasibility of large-scale public sector ART programs in resource-limited settings. However, organizational and structural determinants of quality of care have not been studied. Methods We estimate multivariate regression models using data from 13 urban HIV treatment facilities in Zambia to assess the impact of structural determinants on health workers’ adherence to national guidelines for conducting laboratory tests such as CD4, hemoglobin and liver function and WHO staging during initial and follow-up visits as part of Zambian HIV care and treatment program. Results CD4 tests were more routinely ordered during initial history and physical (IHP) than follow-up (FUP) visits (93.0 % vs. 85.5 %; p < 0.01). More physical space, higher staff turnover and greater facility experience with ART was associated with greater odds of conducting tests. Higher staff experience decreased the odds of conducting CD4 tests in FUP (OR 0.93; p < 0.05) and WHO staging in IHP visit (OR 0.90; p < 0.05) but increased the odds of conducting hemoglobin test in IHP visit (OR 1.05; p < 0.05). Higher staff burnout increased the odds of conducting CD4 test during FUP (OR 1.14; p < 0.05) but decreased the odds of conducting hemoglobin test in IHP visit (0.77; p < 0.05) and CD4 test in IHP visit (OR 0.78; p < 0.05). Conclusion Physical space plays an important role in ensuring high quality care in resource-limited setting. In the context of protocolized care, new staff members are likely to be more diligent in following the protocol verbatim rather than relying on memory and experience thereby improving adherence. Future studies should use prospective data to confirm the findings reported here. PMID:22551413

  14. Factors affecting medication adherence in elderly people

    PubMed Central

    Jin, Hyekyung; Kim, Yeonhee; Rhie, Sandy Jeong

    2016-01-01

    Background Little is known about the functional health literacy (FHL) associated with medication adherence in elderly patients. The aim of this study was to examine the FHL among older adults and identify influencing factors that can predict medication adherence. Methods This was a cross-sectional survey. Participants (n=160) aged 65 years and older were selected from outpatient clinics of 3 tertiary care hospitals, 6 community pharmacies, and 2 senior centers between November 1 and 30, 2014. The participants’ FHL was measured using the Korean Functional Health Literacy Test, which consists of 15 items including 8 numeracy and 7 reading comprehension items. Medication adherence was measured by the Adherence to Refills and Medication Scale. Descriptive statistics, chi-square or Fisher’s exact test, and multiple regression analyses were used to analyze the data. Results The mean score of the total FHL was 7.72±3.51 (range 0–15). The percentage of the total number of correct answers for the reading comprehension subtest and numeracy subtest were 48.1% and 54.4%, respectively. Among 160 participants, 52.5% showed low adherence to medication. The factors affecting medication adherence included the patient’s degree of satisfaction with the service (β=−0.215, P=0.022), sufficient explanation of medication counseling (β=−0.335, P=0.000), education level (β=−0.153, P=0.045), health-related problems (β=−0.239, P=0.004), and dosing frequency (β=0.189, P=0.018). Conclusion In this study, we found medication adherence of elderly patients was associated with education level, health-related problems, dosing frequency, satisfaction with patient counseling, and explanation of medication, but no association was found with FHL. Pharmacists should consider elderly patients’ individual characteristics such as educational background and specific patient-related health problems, provide sufficient information and explanation of medication, and ensure patient

  15. Odds ratio for 2 × 2 tables: Mantel-Haenszel estimator, profile likelihood, and presence of surrogate responses.

    PubMed

    Banerjee, Buddhananda; Biswas, Atanu

    2014-01-01

    Use of surrogate outcome to improve the inference in biomedical problems is an area of growing interest. Here, we consider a setup where both the true and surrogate endpoints are binary and we observe all the surrogate endpoints along with a few true endpoints. In a two-treatment setup we study the surrogate-augmented Mantel-Haenszel estimator based on observations from different groups when the group effect is present. We compare the Mantel-Haenszel estimator with the one obtained by maximizing profile likelihood in a surrogate augmented setup. We observe that the performances of these estimators are very close.

  16. The effects of low-shear stress on Adherent-invasive Escherichia coli.

    PubMed

    Allen, Christopher A; Niesel, David W; Torres, Alfredo G

    2008-06-01

    The impact of low-shear stress (LSS) was evaluated on an Adherent-invasive Escherichia coli clinical isolate (AIEC strain O83:H1) from a Crohn's disease patient. High-aspect ratio vessels (HARVs) were used to model LSS conditions to characterize changes in environmental stress resistance and adhesion/invasive properties. Low-shear stress-grown cultures exhibited enhanced thermal and oxidative stress resistance as well as increased adherence to Caco-2 cells, but no changes in invasion were observed. An AIEC rpoS mutant was constructed to examine the impact of this global stress regulator. The absence of RpoS under LSS conditions resulted in increased sensitivity to oxidative stress while adherence levels were elevated in comparison with the wild-type strain. TnphoA mutagenesis and rpoS complementation were carried out on the rpoS mutant to identify those factors involved in the LSS-induced adherence phenotype. Mutagenesis results revealed that one insertion disrupted the tnaB gene (encoding tryptophan permease) and the rpoS tnaB double mutant exhibited decreased adherence under LSS. Complementation of the tnaB gene, or medium supplemented with exogenous indole, restored adhesion of the rpoS tnaB mutant under LSS conditions. Overall, our study demonstrated how mechanical stresses such as LSS altered AIEC phenotypic characteristics and identified novel functions for some RpoS-regulated proteins.

  17. Immunoregulatory adherent cells in human tuberculosis: radiation-sensitive antigen-specific suppression by monocytes

    SciTech Connect

    Kleinhenz, M.E.; Ellner, J.J.

    1985-07-01

    In human tuberculosis, adherent mononuclear cells (AMC) selectively depress in vitro responses to the mycobacterial antigen tuberculin purified protein derivative (PPD). The phenotype of this antigen-specific adherent suppressor cell was characterized by examining the functional activity of adherent cells after selective depletion of sheep erythrocyte-rosetting T cells or OKM1-reactive monocytes. Adherent cell suppression was studied in the (/sup 3/H)thymidine-incorporation microculture assay by using T cells rigorously depleted of T cells with surface receptors for the Fc portion of IgG (T gamma cells) as antigen-responsive cells. PPD-induced (/sup 3/H)thymidine incorporation by these non gamma T cells was uniformly reduced (mean, 42% +/- 10% (SD)) when autologous AMC were added to non gamma T cells at a ratio of 1:2. Antigen-specific suppression by AMC was not altered by depletion of sheep erythrocyte-rosetting T cells or treatment with indomethacin. However, AMC treated with OKM1 and complement or gamma irradiation (1,500 rads) no longer suppressed tuberculin responses in vitro. These studies identify the antigen-specific adherent suppressor cell in tuberculosis as an OKM1-reactive, non-erythrocyte-rosetting monocyte. The radiosensitivity of this monocyte immunoregulatory function may facilitate its further definition.

  18. Factors associated with low adherence to medicine treatment for chronic diseases in Brazil

    PubMed Central

    Tavares, Noemia Urruth Leão; Bertoldi, Andréa Dâmaso; Mengue, Sotero Serrate; Arrais, Paulo Sergio Dourado; Luiza, Vera Lucia; Oliveira, Maria Auxiliadora; Ramos, Luiz Roberto; Farias, Mareni Rocha; Pizzol, Tatiane da Silva Dal

    2016-01-01

    ABSTRACT OBJECTIVE To analyze factors associated with low adherence to drug treatment for chronic diseases in Brazil. METHODS Analysis of data from Pesquisa Nacional sobre Acesso, Utilização e Promoção do Uso Racional de Medicamentos (PNAUM - Brazilian Survey on Access, Use and Promotion of Rational Use of Medicines), a population-based cross-sectional household survey, based on a probabilistic sample of the Brazilian population. We analyzed the association between low adherence to drug treatment measured by the Brief Medication Questionnaire and demographic, socioeconomic, health, care and prescription factors. We used Poisson regression model to estimate crude and adjusted prevalence ratios, their respective 95% confidence interval (95%CI) and p-value (Wald test). RESULTS The prevalence of low adherence to drug treatment for chronic diseases was 30.8% (95%CI 28.8-33.0). The highest prevalence of low adherence was associated with individuals: young adults; no education; resident in the Northeast and Midwest Regions of Brazil; paying part of the treatment; poor self-perceived health; three or more diseases; reported limitations caused by a chronic disease; using five drugs or more. CONCLUSIONS Low adherence to drug treatment for chronic diseases in Brazil is relevant, and regional and demographic differences and those related to patients’ health care and therapy regime require coordinated action between health professionals, researchers, managers and policy makers. PMID:27982378

  19. Bacterial adherence to anodized titanium alloy

    NASA Astrophysics Data System (ADS)

    Pérez-Jorge Peremarch, C.; Pérez Tanoira, R.; Arenas, M. A.; Matykina, E.; Conde, A.; De Damborenea, J. J.; Gómez Barrena, E.; Esteban, J.

    2010-11-01

    The aim of this study was to evaluate Staphylococcus sp adhesion to modified surfaces of anodized titanium alloy (Ti-6Al-4V). Surface modification involved generation of fluoride-containing titanium oxide nanotube films. Specimens of Ti-6Al-4V alloy 6-4 ELI-grade 23- meets the requirements of ASTM F136 2002A (AMS 2631B class A1) were anodized in a mixture of sulphuric/hydrofluoric acid at 20 V for 5 and 60 min to form a 100 nm-thick porous film of 20 nm pore diameter and 230 nm-thick nanotube films of 100 nm in diameter. The amount of fluorine in the oxide films was of 6% and of 4%, respectively. Collection strains and six clinical strains each of Staphylococcus aureus and Staphylococcus epidermidis were studied. The adherence study was performed using a previously published protocol by Kinnari et al. The experiments were performed in triplicates. As a result, lower adherence was detected for collection strains in modified materials than in unmodified controls. Differences between clinical strains were detected for both species (p<0.0001, Kruskal-Wallis test), although global data showed similar results to that of collection strains (p<0.0001, Kruskal-Wallis test). Adherence of bacteria to modified surfaces was decreased for both species. The results also reflect a difference in the adherence between S. aureus and S. epidermidis to the modified material. As a conclusion, not only we were able to confirm the decrease of adherence in the modified surface, but also the need to test multiple clinical strains to obtain more realistic microbiological results due to intraspecies differences.

  20. High relapse rate and poor medication adherence in the Chinese population with schizophrenia: results from an observational survey in the People’s Republic of China

    PubMed Central

    Xiao, Jingbo; Mi, Weifeng; Li, Lingzhi; Shi, Ying; Zhang, Hongyan

    2015-01-01

    Background Relapse is common in schizophrenia, and seriously impacts patients’ quality of life and social functioning. Many factors have been identified that may potentially increase the risk of relapse. This study was designed to investigate the relapse rate in the year following hospital discharge among Chinese patients with schizophrenia in the naturalistic condition, and to explore possible risk factors related to relapse. Methods We conducted a large, multicenter, retrospective, observational study in ten psychiatric hospitals throughout the People’s Republic of China. Nine hundred and ninety-two schizophrenic outpatients aged 18–65 years discharged from these hospitals between September 2011 and February 2012 with recovery/improvement of their condition were included in the study. Information about relapse and correlative factors during the year after discharge was collected by telephone interview using a questionnaire. Results Eight hundred and seventy-six of 992 eligible patients completed the telephone survey. Of these patients, 293 (33.4%) had at least one relapse within 1 year after discharge, and 165 (18.8%) were rehospitalized. In respondents’ view, the most important factor contributing to relapse was poor medication adherence (50.7%). Approximately 30% of the respondents had a negative attitude toward medication, with the impression that there was no need to take drugs at all or for a long time. Nonadherent patients (37.9%) had a relapse rate that was 2.5-fold higher than adherent patients (54.5% versus 20.7%, P<0.001). The top five risk factors associated with relapse were nonadherence to medication (odds ratio [OR] 4.602, 95% confidence interval [CI] 3.410–6.211), being without work (OR 3.275, 95% CI 2.291–4.681), poor self-care ability (OR 2.996, 95% CI 2.129–4.214), poor interpersonal skills (OR 2.635, 95% CI 1.951–3.558), and hospitalization on more than three occasions (OR 2.299, 95% CI 1.691–3.126). Conclusion The 1-year

  1. Massive and massless higher spinning particles in odd dimensions

    NASA Astrophysics Data System (ADS)

    Bastianelli, Fiorenzo; Bonezzi, Roberto; Corradini, Olindo; Latini, Emanuele

    2014-09-01

    We study actions for massive bosonic particles of higher spins by dimensionally reducing an action for massless particles. For the latter we take a model with a SO( N) extended local supersymmetry on the worldline, that is known to describe massless (conformal) particles of higher spins in flat spacetimes of even dimensions. Dimensional reduction produces an action for massive spinning particles in odd dimensions. The field equations that emerge in a quantization à la Dirac are shown to be equivalent to the Fierz-Pauli ones. The massless limit generates a multiplet of massless states with higher spins, whose first quantized field equations have a geometric form with fields belonging to various types of Young tableaux. These geometric equations can be partially integrated to show their equivalence with the standard Fronsdal-Labastida equations. We covariantize our model to check whether an extension to curved spacetimes can be achieved. Restricting to (A)dS spaces, we find that the worldline gauge algebra becomes nonlinear, but remains first class. This guarantees consistency on such backgrounds. A light cone analysis confirms the presence of the expected propagating degrees of freedom. A covariant analysis is worked out explicitly for the massive case, which is seen to give rise to the Fierz-Pauli equations extended to (A)dS spaces. It is worth noting that in D = 3 the massless limit of our model with N → ∞ has the same field content of the Vasiliev's theory that accommodates each spin exactly once.

  2. Ferroelectric behavior of the odd-numbered nylons

    SciTech Connect

    Scheinbeim, J.I.; Newman, B.A.

    1993-12-31

    Recent work in the Polymer Electroprocessing Laboratory. Rutgers University, has shown that the odd-numbered nylons (11, 9, 7, 5) constitute the second known family of ferroelectric polymers: poly(vinylidene fluoride) and its co-polymers are the only other known family of ferroelectric polymers. Using mel-quenched and cold-drawn samples of nylon 11 which exhibit double orientation (chain axes in the draw direction and hydrogen bonds in the plane of the films) the authors examined changes in orientation of the polar (hydrogen bonds) and non-polar (hydrocarbon) sections as a function of annealing temperature and applied electric field. Using FTIR and WAXD studies, the authors have found that the samples polarized by application of electric fields before high temperature annealing exhibit diffraction patterns rotated by 90{degrees} from those of samples exposed to only high temperature annealing. These studies also show that the polarized, annealed samples are triply oriented and that they hydrocarbon sections exhibit little crystal order unless samples are annealed at high temperature.

  3. Increasing the Odds: Applying Emergentist Theory in Language Intervention

    PubMed Central

    Poll, Gerard H.

    2011-01-01

    Purpose This review introduces a leading theory of language development, emergentism, the view that language ability is the product of interactions between the language environment and the learning capabilities of the child. It suggests ways in which emergentism provides a theoretical rationale for interventions designed to address developmental language delays in young children. Method A review of selected literature on emergentist theory and research is presented, with a focus on the acquisition of early morphology and syntax. A significant method for developing and testing emergentist theory, connectionist modeling, is described. Key themes from both connectionist and behavioral studies are summarized and applied with specific examples to language intervention techniques. A case study is presented to integrate elements of emergentism with language intervention. Conclusions Evaluating the theoretical foundation for language interventions is an important step in evidence-based practice. This article introduces three themes in the emergentist literature that have implications for language intervention: sufficiency of language input, active engagement of the child with the input, and the introduction of factors that increase the odds for correctly mapping language form to meaning. Evidence supporting the importance of these factors in effective language intervention is presented, along with limitations in that evidence. PMID:21616988

  4. Even-odd entanglement in boson and spin systems

    NASA Astrophysics Data System (ADS)

    Rossignoli, R.; Canosa, N.; Matera, J. M.

    2011-04-01

    We examine the entanglement entropy of the even half of a translationally invariant finite chain or lattice in its ground state. This entropy measures the entanglement between the even and odd halves (each forming a “comb” of n/2 sites) and can be expected to be extensive for short-range couplings away from criticality. We first consider bosonic systems with quadratic couplings, where analytic expressions for arbitrary dimensions can be provided. The bosonic treatment is then applied to finite spin chains and arrays by means of the random-phase approximation. Results for first-neighbor anisotropic XY couplings indicate that, while at strong magnetic fields this entropy is strictly extensive, at weak fields important deviations arise, stemming from parity-breaking effects and the presence of a factorizing field (in the vicinity of which it becomes size-independent and identical to the entropy of a contiguous half). Exact numerical results for small spin s chains are shown to be in agreement with the bosonic random-phase approximation prediction.

  5. Odd-even staggering in the neutron-proton interaction and nuclear mass models

    NASA Astrophysics Data System (ADS)

    Cheng, Y. Y.; Zhao, Y. M.; Arima, A.

    2015-02-01

    In this paper we study odd-even staggering of the empirical neutron-proton interaction between the last neutron and the last proton, denoted as δ V1 n -1 p , and its consequence in the Garvey-Kelson mass relations (GKs) and nuclear mass models. The root-mean-squared deviations of predicted masses respectively for even-A and odd-A nuclei by using two combinatorial GKs suggest a large odd-even staggering of δ V1 n -1 p between even-odd and odd-even nuclei, while the odd-even difference of δ V1 n -1 p between even-even and odd-odd nuclei is much smaller. The contribution of the odd-even staggering of δ V1 n -1 p between even-A and odd-A nuclei in deviations of theoretical δ V1 n -1 p values of the Duflo-Zuker model and the improved Weizs a ̈cker -Skyrme model are well represented by an isospin-dependent term. The consideration of this odd-even staggering improves our description of binding energies and one-neutron separation energies in both the Duflo-Zuker model and the improved Weizs a ̈cker -Skyrme model.

  6. Using communication skills to improve adherence in children with chronic disease: the adherence equation.

    PubMed

    Brand, Paul L P; Klok, Ted; Kaptein, Adrian A

    2013-12-01

    Nonadherence to maintenance medication is common in paediatric chronic conditions. Despite the common belief that nonadherence is therapy-resistant, and the apparent lack of evidence for successful interventions to improve adherence, there is, in fact, a considerable body of evidence suggesting that adherence can be improved by applying specific communicative consultation skills. These can be summarized as the adherence equation: adherence=follow-up+dialogue+barriers and beliefs+empathy and education => concordance. Close follow-up of children with a chronic condition is needed to establish a therapeutic partnership with the family. Teaching self management skills is not a unidirectional process of providing information, but requires a constructive and collaborative dialogue between the medical team and the family. Identifying barriers to adherence can be achieved in a non-confrontational manner, by showing a genuine interest what the patient's views and preferences are. In particular, parental illness perceptions and medication beliefs should be identified, because they are strong drivers of nonadherence. Through empathic evidence-based education, such perceptions and beliefs can be modified. By applying these strategies, concordance between the child's family and the medical team can be achieved, resulting in optimal adherence to the jointly created treatment plan.

  7. Treatment Adherence in Adolescents With Inflammatory Bowel Disease: The Collective Impact of Barriers to Adherence and Anxiety/Depressive Symptoms

    PubMed Central

    Gray, Wendy N.; Denson, Lee A.; Baldassano, Robert N.

    2012-01-01

    Objective Knowledge of factors impacting adolescents’ ability to adhere to their inflammatory bowel disease (IBD) regimen is limited. The current study examines the collective impact of barriers to adherence and anxiety/depressive symptoms on adolescent adherence to the IBD regimen. Methods Adolescents (n = 79) completed measures of barriers to adherence, adherence, and anxiety/depressive symptoms at one of two specialty pediatric IBD clinics. Results Most adolescents reported barriers to adherence and 1 in 8 reported borderline or clinically elevated levels of anxiety/depressive symptoms. Anxiety/depressive symptoms moderated the relationship between barriers to adherence and adherence. Post hoc probing revealed a significant, additive effect of higher anxiety/depressive symptoms in the barriers–adherence relationship, with adherence significantly lower among adolescents with higher barriers and higher anxiety/depressive symptoms. Conclusions In order to optimize adherence in adolescents, interventions should target not only barriers to adherence but also any anxiety/depressive symptoms that may negatively impact efforts to adhere to recommended treatment. PMID:22080456

  8. Measuring Adherence to Practice Guidelines for the Management of Hypertension

    PubMed Central

    Milchak, Jessica L.; Carter, Barry L.; Ardery, Gail; James, Paul A.

    2006-01-01

    Adherence to practice guidelines is frequently used as a measure of quality of care. Numerous studies have evaluated physician adherence to hypertension guidelines by prescription data, physician survey data, or medical record review. However, most have methodological limitations that might underestimate physician adherence. Accurate and meaningful characterization of adherence rests on evaluation of varied components of hypertension care, use of explicit validated performance measures, incorporation of implicit and explicit review, and linkage of process measures to blood pressure outcomes. PMID:15381676

  9. Improved assay for quantitating adherence of ruminal bacteria to cellulose.

    PubMed Central

    Rasmussen, M A; White, B A; Hespell, R B

    1989-01-01

    A quantitative technique suitable for the determination of adherence of ruminal bacteria to cellulose was developed. This technique employs adherence of cells to cellulose disks and alleviates the problem of nonspecific cell entrapment within cellulose particles. By using this technique, it was demonstrated that the adherence of Ruminococcus flavefaciens FD1 to cellulose was inhibited by formaldehyde, methylcellulose, and carboxymethyl cellulose. Adherence was unaffected by acid hydrolysates of methylcellulose, glucose, and cellobiose. PMID:2782879

  10. Micronutrient supplementation adherence and influence on the prevalences of anemia and iron, zinc and vitamin A deficiencies in preemies with a corrected age of six months

    PubMed Central

    de Freitas, Brunnella Alcantara Chagas; Lima, Luciana Moreira; Moreira, Maria Elisabeth Lopes; Priore, Silvia Eloiza; Henriques, Bruno David; Carlos, Carla Fernanda Lisboa Valente; Sabino, Jusceli Souza Nogueira; do Carmo Castro Franceschini, Sylvia

    2016-01-01

    OBJECTIVE: To analyze adherence to the recommended iron, zinc and multivitamin supplementation guidelines for preemies, the factors associated with this adherence, and the influence of adherence on the occurrence of anemia and iron, zinc and vitamin A deficiencies. METHODS: This prospective cohort study followed 58 preemies born in 2014 until they reached six months corrected age. The preemies were followed at a referral secondary health service and represented 63.7% of the preterm infants born that year. Outcomes of interest included high or low adherence to iron, zinc and multivitamin supplementation guidelines; prevalence of anemia; and prevalences of iron, zinc, and vitamin A deficiencies. The prevalence ratios were calculated by Poisson regression. RESULTS: Thirty-eight (65.5%) preemies presented high adherence to micronutrient supplementation guidelines. At six months of corrected age, no preemie had vitamin A deficiency. The prevalences of anemia, iron deficiency and zinc deficiency were higher in the low-adherence group but also concerning in the high-adherence group. Preemies with low adherence to micronutrient supplementation guidelines were 2.5 times more likely to develop anemia and 3.1 times more likely to develop zinc deficiency. Low maternal education level increased the likelihood of nonadherence to all three supplements by 2.2 times. CONCLUSIONS: Low maternal education level was independently associated with low adherence to iron, zinc and vitamin A supplementation guidelines in preemies, which impacted the prevalences of anemia and iron and zinc deficiencies at six months of corrected age. PMID:27626474

  11. Characterization of long-lived isomers in the odd-odd heavy actinide 254Md

    NASA Astrophysics Data System (ADS)

    Sood, P. C.; Gowrishankar, R.

    2017-02-01

    Bandhead energies of all the physically admissible low-lying two-quasiparticle configuration states in the doubly-odd heavy actinide Md 153 101 254 are evaluated using the well-tested two-quasiparticle rotor model with explicit inclusion of the residual proton-neutron interaction. A critical examination of these results, aimed at characterization of the long-lived (t1 /2=10 min and 28 min; %ɛ ≤100 ) isomer pair, conclusively rules out a high-spin (J ≥5 ) assignment for either of the isomers. Our analysis leads to JπK =1-0 {p :1 /2-[521 ] ⊗n :1 /2+) [620 ] } and 3-3 {p :7 /2-[514 ] ⊗n :1 /2+[620 ] } assignments, respectively, to these isomers and designates the 10-min isomer as its ground state. Our study reveals a "landmark" position for 254Md in the decay path of super heavy elements. The as-yet unobserved electron capture decay branches from each of the two 254Md isomers to 254Fm levels are specified.

  12. Comparison in Adherence to Osteoporosis Guidelines according to Bone Health Status in Korean Adult

    PubMed Central

    Lim, Hee-Sook; Kim, Soon-Kyung; Lee, Hae-Hyeog; Byun, Dong Won; Kim, Tae-Hee

    2016-01-01

    Background Osteoporosis one of the most serious disease to decrease the quality of life and cause economic loss. Thus, prevention of osteoporosis has become an important health concern. The study examined in adherence to osteoporosis guidelines and compared the levels of adherence to osteoporosis guidelines between bone health status in Korean adult. Methods This study used data from a nationally represented sample of Koreans (n=3,419) from 2008 to 2011 Korea National Health and Nutrition Examination Survey. We were divided into three groups by T-score: normal, osteopenia and osteoporosis. Assessment of adherence level was based on 5 components of osteoporosis guidelines, considering intake of sodium, calcium and protein, smoking and regular exercise. Results The sex, body mass index, income and educational level did not significantly differ between three groups. Deficient intake of calcium was significantly associated with a threefold greater odds in osteoporosis group (OR 3.6; 95% confidence interval [CI] 2.52-5.22). Excessive protein intake was significantly increased the risk only in osteoporosis group compared to the normal group (OR 1.71; 95% CI 1.15-2.62). Smoking increased the risk in osteoporosis group compared to the normal group (OR 2.88; 95% CI 1.75-4.76), osteoporosis group compared to the osteopenia group (OR 2.69; 95% CI 1.61-4.55). Conclusions Nutritional factor (intake of calcium and protein) and lifestyle-related factor (smoking and exercise) must be accompanied the management for bone health. An adherence of guidelines is considered very important for the prevention of osteoporosis. PMID:27622178

  13. Understanding how adherence goals promote adherence behaviours: a repeated measure observational study with HIV seropositive patients

    PubMed Central

    2012-01-01

    Background The extent to which patients follow treatments as prescribed is pivotal to treatment success. An exceptionally high level (> 95%) of HIV medication adherence is required to suppress viral replication and protect the immune system and a similarly high level (> 80%) of adherence has also been suggested in order to benefit from prescribed exercise programmes. However, in clinical practice, adherence to both often falls below the desirable level. This project aims to investigate a wide range of psychological and personality factors that may lead to adherence/non-adherence to medical treatment and exercise programmes. Methods HIV positive patients who are referred to the physiotherapist-led 10-week exercise programme as part of the standard care are continuously recruited. Data on social cognitive variables (attitude, intention, subjective norms, self-efficacy, and outcome beliefs) about the goal and specific behaviours, selected personality factors, perceived quality of life, physical activity, self-reported adherence and physical assessment are collected at baseline, at the end of the exercise programme and again 3 months later. The project incorporates objective measures of both exercise (attendance log and improvement in physical measures such as improved fitness level, weight loss, improved circumferential anthropometric measures) and medication adherence (verified by non-invasive hair analysis). Discussion The novelty of this project comes from two key aspects, complemented with objective information on exercise and medication adherence. The project assesses beliefs about both the underlying goal such as following prescribed treatment; and about the specific behaviours such as undertaking the exercise or taking the medication, using both implicit and explicit assessments of patients’ beliefs and attitudes. We predict that i) the way people think about the underlying goal of their treatments explains medication and exercise behaviours over and above

  14. The influence of wearing schemes and supportive telephone calls on adherence in accelerometry measurement: results of a randomized controlled trial

    PubMed Central

    van den Berg, Neeltje; Ulbricht, Sabina; Schwaneberg, Thea; Weitmann, Kerstin; Weymar, Franziska; Groß, Stefan; Dörr, Marcus; Hoffmann, Wolfgang

    2017-01-01

    Background Physical activity (PA) can be assessed by accelerometer monitors. However, a high adherence to wearing this device is essential to obtain valid data. In this study, the influence of different wearing schemes and additional supportive phone calls (SPCs) on adherence was examined. Methods A randomized study with four groups was conducted in the context of a health examination program among participants aged 40–75 years without a history of cardiovascular diseases. Participants were recruited in different settings (general medical practices, job center, and health insurance). The participants were asked to wear an accelerometer for 7 consecutive days according to the wearing scheme “day and night” or “day only” and received or did not receive SPCs. Full adherence was defined as a total wearing time of 98 hours (between 8 am and 10 pm during 7 days). A generalized linear model was used to calculate the difference between the maximum possible and the observed adherence. Results Adherence could be assessed for 249 participants (mean age: 56.40 years; standard deviation [SD] 9.83, 40% males). The mean wearing time was 84.04 hours (SD 20.75). Participants with the wearing scheme day and night were significantly more adherent than participants with the wearing scheme day only (incidence rate ratio [IRR] 0.63; P=0.005). SPCs had no additional effect on adherence (IRR 0.80; P=0.168). Conclusion To assess PA, the wearing scheme day and night provides the best possible adherence in this group of participants. Further studies are necessary to examine adherence and the effects of additional SPCs in other samples or settings. PMID:28356721

  15. Adherence to Concurrent Tuberculosis Treatment and Antiretroviral Treatment among Co-Infected Persons in South Africa, 2008–2010

    PubMed Central

    Webb Mazinyo, Ernesha; Kim, Lindsay; Masuku, Sikhethiwe; Lancaster, Joey L.; Odendaal, Ronel; Uys, Margot; Podewils, Laura Jean; Van der Walt, Martie L.

    2016-01-01

    Background Adherence to tuberculosis (TB) treatment and antiretroviral therapy (ART) reduces morbidity and mortality among persons co-infected with TB/HIV. We measured adherence and determined factors associated with non-adherence to concurrent TB treatment and ART among co-infected persons in two provinces in South Africa. Methods A convenience sample of 35 clinics providing integrated TB/HIV care was included due to financial and logistic considerations. Retrospective chart reviews were conducted among persons who received concurrent TB treatment and ART and who had a TB treatment outcome recorded during 1 January 2008–31 December 2010. Adherence to concurrent TB and HIV treatment was defined as: (1) taking ≥80% of TB prescribed doses by directly observed therapy (DOT) as noted in the patient card; and (2) taking >90% ART doses as documented in the ART medical record during the concurrent treatment period (period of time when the patient was prescribed both TB treatment and ART). Risk ratios (RRs) and 95% confidence intervals (CIs) were used to identify factors associated with non-adherence. Results Of the 1,252 persons receiving concurrent treatment, 138 (11.0%) were not adherent. Non-adherent persons were more likely to have extrapulmonary TB (RR: 1.71, 95% CI: 1.12 to 2.60) and had not disclosed their HIV status (RR: 1.96, 95% CI: 1.96 to 3.76). Conclusions The majority of persons with TB/HIV were adherent to concurrent treatment. Close monitoring and support of persons with extrapulmonary TB and for persons who have not disclosed their HIV status may further improve adherence to concurrent TB and antiretroviral treatment. PMID:27442440

  16. 6MP adherence in a multiracial cohort of children with acute lymphoblastic leukemia: a Children's Oncology Group study.

    PubMed

    Bhatia, Smita; Landier, Wendy; Hageman, Lindsey; Kim, Heeyoung; Chen, Yanjun; Crews, Kristine R; Evans, William E; Bostrom, Bruce; Casillas, Jacqueline; Dickens, David S; Maloney, Kelly W; Neglia, Joseph P; Ravindranath, Yaddanapudi; Ritchey, A Kim; Wong, F Lennie; Relling, Mary V

    2014-10-09

    Durable remissions in children with acute lymphoblastic leukemia (ALL) require a 2-year maintenance phase that includes daily oral 6-mercaptopurine (6MP). Adherence to oral 6MP among Asian-American and African-American children with ALL is unknown. We enrolled 298 children with ALL (71 Asian Americans, 68 African Americans, and 159 non-Hispanic whites) receiving oral 6MP for the maintenance phase. Adherence was measured electronically for 39 803 person-days. Adherence declined from 95.0% (month 1) to 91.8% (month 5, P < .0001). Adherence rates were significantly (P < .0001) lower in Asian Americans (90.0% ± 4.9%) and African Americans (87.1% ± 4.4%), as compared with non-Hispanic whites (95.2% ± 1.3%). Race-specific sociodemographic characteristics helped explain poor adherence (African Americans: low maternal education [less than a college degree: 78.9%, vs at least college degree: 94.6%; P < .0001]; Asian Americans: low-income households [<$50 000: 84.5%, vs ≥$50 000: 96.7%; P = .04]; households without mothers as full-time caregivers [85.6%] vs households with mothers as full-time caregivers [97.2%; P = .05]). Adherence rate below 90% was associated with increased relapse risk (hazard ratio, 3.9; P = .01). Using an adherence rate <90% to define nonadherence, 20.5% of the participants were nonadherers. We identify race-specific determinants of adherence, and define a clinically relevant level of adherence needed to minimize relapse risk in a multiracial cohort of children with ALL. This trial was registered at www.clinicaltrials.gov as #NCT00268528.

  17. WCRF/AICR recommendation adherence and breast cancer incidence among postmenopausal women with and without non-modifiable risk factors.

    PubMed

    Nomura, Sarah J O; Inoue-Choi, Maki; Lazovich, DeAnn; Robien, Kim

    2016-06-01

    Taller height, family history of breast cancer, greater number of years of potential fertility and nulliparity are established non-modifiable risk factors for postmenopausal breast cancer. Greater adherence to the World Cancer Research Fund/American Institute for Cancer Research (WCRF/AICR) diet, physical activity and body weight recommendations has previously been shown to be associated with lower breast cancer risk. However, no prior studies have evaluated whether women with non-modifiable risk factors receive similar benefits from recommendation adherence compared to women without these risk factors. In the Iowa Women's Health Study prospective cohort, we investigated whether associations of WCRF/AICR recommendation adherence differed by the presence/absence of non-modifiable breast cancer risk factors. Baseline (1986) questionnaire data from 36,626 postmenopausal women were used to create adherence scores for the WCRF/AICR recommendations (maximum score = 8.0). Overall and single recommendation adherence in relation to breast cancer risk (n = 3,189 cases) across levels of non-modifiable risk factors were evaluated using proportional hazards regression. Mean adherence score was 5.0 points (range: 0.5-8.0). Higher adherence scores (score ≥ 6.0 vs. ≤ 3.5, HR = 0.76, 95% CI = 0.67-0.87), and adherence to the individual recommendations for body weight and alcohol intake were associated with a lower breast cancer incidence. While not statistically significant among women with more non-modifiable risk factors (score ≥ 6.0 vs. ≤ 3.5, HR = 0.76, 95% CI = 0.36-1.63), hazard ratios were comparable to women with the no non-modifiable risk factors (score ≥ 6.0 vs. ≤ 3.5, HR = 0.74, 95% CI = 0.49-0.93) (p-interaction = 0.57). WCRF/AICR recommendation adherence is associated with lower breast cancer risk, regardless of non-modifiable risk factor status.

  18. Medication Adherence in Psychopharmacologically Treated Adults with ADHD

    ERIC Educational Resources Information Center

    Safren, Steven A.; Duran, Petra; Yovel, Iftah; Perlman, Carol A.; Sprich, Susan

    2007-01-01

    Objective: One of the potential causes of residual symptoms of ADHD in adults can be difficulties with consistent adherence to medications. Method: This formative study examined self-reported medication adherence in adults with ADHD with clinically significant symptoms despite medication treatment. Results: Mean adherence for the two-week period…

  19. A Matter of Trust: Patient Barriers to Primary Medication Adherence

    ERIC Educational Resources Information Center

    Polinski, J. M.; Kesselheim, A. S.; Frolkis, J. P.; Wescott, P.; Allen-Coleman, C.; Fischer, M. A.

    2014-01-01

    Primary medication adherence occurs when a patient properly fills the first prescription for a new medication. Primary adherence only occurs about three-quarters of the time for antihypertensive medications. We assessed patients' barriers to primary adherence and attributes of patient-provider discussions that might improve primary adherence…

  20. Medication Adherence among Older Adults with Schizophrenia

    PubMed Central

    Leutwyler, Heather C.; Fox, Patrick J.; Wallhagen, Margaret

    2014-01-01

    Older adults with schizophrenia are a growing segment of the population yet their physical and mental health status is extremely poor. The paper presents findings from a qualitative study that explored the understanding older adults with schizophrenia have of their physical health status. The study was conducted among 28 older adults with schizophrenia from a variety of settings using semi-structured interviews and participant observation. Self-management of psychiatric and non-psychiatric medications and its affect on their health status was one of the central themes that emerged from the study. Different styles of medication adherence were identified and factors associated with each style are presented. The findings provide insights into the design of clinical interventions aimed at promoting medication adherence among older adults with schizophrenia. PMID:23327119

  1. An ingestible sensor for measuring medication adherence.

    PubMed

    Hafezi, Hooman; Robertson, Timothy L; Moon, Greg D; Au-Yeung, Kit-Yee; Zdeblick, Mark J; Savage, George M

    2015-01-01

    In this paper, we describe the design and performance of the first integrated-circuit microsensor developed for daily ingestion by patients. The ingestible sensor is a device that allows patients, families, and physicians to measure medication ingestion and adherence patterns in real time, relate pharmaceutical compliance to important physiologic metrics, and take appropriate action in response to a patient's adherence pattern and specific health metrics. The design and theory of operation of the device are presented, along with key in-vitro and in-vivo performance results. The chemical, toxicological, mechanical, and electrical safety tests performed to establish the device's safety profile are described in detail. Finally, aggregate results from multiple clinical trials involving 412 patients and 5656 days of system usage are presented to demonstrate the device's reliability and performance as part of an overall digital health feedback system.

  2. Preconception maternal polychlorinated biphenyl concentrations and the secondary sex ratio

    SciTech Connect

    Taylor, Kira C.; Jackson, Leila W.; Lynch, Courtney D.; Kostyniak, Paul J.; Buck Louis, Germaine M. . E-mail: louisg@mail.nih.gov

    2007-01-15

    The secondary sex ratio is the ratio of male to female live births and historically has ranged from 102 to 106 males to 100 females. Temporal declines have been reported in many countries prompting authors to hypothesize an environmental etiology. Blood specimens were obtained from 99 women aged 24-34 prior to attempting pregnancy and quantified for 76 polychlorinated biphenyl (PCB) congeners using dual column gas chromatography with electron capture detection. Women were prospectively followed until pregnancy or 12 cycles of trying. The odds of a male birth for three PCB groupings (total, estrogenic, anti-estrogenic) controlling for maternal characteristics were estimated using logistic regression. Among the 50 women with live births and PCB data, 26 female and 24 male infants were born (ratio 0.92). After adjusting for age and body mass index, odds of a male birth were elevated among women in the second (OR=1.29) and third (OR=1.48) tertiles of estrogenic PCBs; odds (OR=0.70) were reduced among women in the highest tertile of anti-estrogenic PCBs. All confidence intervals included one. The direction of the odds ratios in this preliminary study varied by PCB groupings, supporting the need to study specific PCB patterns when assessing environmental influences on the secondary sex ratio.

  3. Adherence to the Dietary Approaches to Stop Hypertension-style diet in relation to glioma: a case-control study.

    PubMed

    Benisi-Kohansal, Sanaz; Shayanfar, Mehdi; Mohammad-Shirazi, Minoo; Tabibi, Hadi; Sharifi, Giuve; Saneei, Parvane; Esmaillzadeh, Ahmad

    2016-03-28

    Data on the association of adherence to the Dietary Approaches to Stop Hypertension (DASH)-style and glioma are scarce. We aimed to examine the association between adherence to the DASH-style diet and glioma in Iranian adults. In this study, 128 pathologically confirmed cases of glioma were recruited from hospitals and 256 age- and sex-matched controls were enrolled from other wards of the hospital. Dietary intakes were assessed using a 126-item validated FFQ. Adherence to the DASH-style diet was followed considering the healthy and non-healthy foods emphasised in the DASH dietary pattern. After controlling for potential confounders, individuals with the greatest adherence to the DASH diet were 72 % less likely to have glioma compared with those with the lowest adherence (OR 0·28; 95 % CI 0·13, 0·57). Individuals with the highest consumption of fruits had lower odds for having glioma compared with those with the lowest intake (OR 0·31; 95 % CI 0·14, 0·68). A protective association was also observed between consumption of legumes and nuts and risk of glioma (OR 0·23; 95 % CI 0·10, 0·53). We found a significant positive association between red and processed meat (OR 2·60; 95 % CI 1·16, 5·81) and salt intakes (OR 2·87; 95 % CI 1·30, 6·34) and risk of glioma, after taking all potential confounders into account. Adherence to the DASH-style dietary pattern was inversely associated with glioma. In addition, some components of the DASH diet, including red meats and salt intakes, were positively associated with glioma. Consumption of nuts and legumes as well as fruits was inversely associated with glioma. Prospective cohort studies are required to confirm our findings.

  4. Concordance of adherence measurement using self-reported adherence questionnaires and medication monitoring devices.

    PubMed

    Shi, Lizheng; Liu, Jinan; Koleva, Yordanka; Fonseca, Vivian; Kalsekar, Anupama; Pawaskar, Manjiri

    2010-01-01

    The primary objective of this review was to identify and examine the literature on the association between medication adherence self-reported questionnaires (SRQs) and medication monitoring devices. The primary literature search was performed for 1980-2009 using PubMed, PubMed In Process and Non-Indexed, Ovid MEDLINE, Ovid MEDLINE In-Process, PsycINFO (EBSCO), CINAHL (EBSCO), Ovid HealthStar, EMBASE (Elsevier) and Cochrane Databases and using the following search terms: 'patient compliance', 'medication adherence', 'treatment compliance', 'drug monitoring', 'drug therapy', 'electronic', 'digital', 'computer', 'monitor', 'monitoring', 'drug', 'drugs', 'pharmaceutical preparations', 'compliance' and 'medications'. We identified studies that included SRQs and electronic monitoring devices to measure adherence and focused on the SRQs that were found to be moderately to highly correlated with the monitoring devices. Of the 1679 citations found via the primary search, 41 full-text articles were reviewed for correlation between monitoring devices and SRQs. A majority (68%) of articles reported high (27%), moderate (29%) or significant (12%) correlation between monitoring devices (37 using Medication Event Monitoring System [MEMS®] and four using other devices) and SRQs (11 identified and numerous other unnamed SRQs). The most commonly used SRQs were the Adult/Pediatric AIDS Clinical Trial Group (AACTG/PACTG; 24.4%, 10/41) followed by the 4-item Morisky (9.8%, 4/41), Brief Medication Questionnaire (9.8%, 4/41) and visual analogue scale (VAS; 7.3%, 3/41). Although study designs differed across the articles, SRQs appeared to report a higher rate of medication adherence (+14.9%) than monitoring devices. In conclusion, several medication adherence SRQs were validated using electronic monitoring devices. A majority of them showed high or moderate correlation with medication adherence measured using monitoring devices, and could be considered for measuring patient

  5. Adherence and non-adherence to treatments: focus on pharmacy practice in Nepal.

    PubMed

    Bastakoti, Suresh; Khanal, Saval; Dahal, Bibek; Pun, Nirmala Tilija

    2013-04-01

    Nepal is one of the developing countries having many limitations in providing the quality health services to its population. In many countries, improvement in patients' adherence to the pharmacotherapy had been one of major outcome of quality pharmaceutical services. Till date, very less thing has been done in this area in Nepal; so it seems mandatory to improve the patient adherence to the treatment plans. Adherence to the medical therapy can be explained by the extent of the behavioral coincidence to the medication and non-medication regimen by a patient whereas compliance and concordance are two different models of patient adherence to the therapy. Compliance model suggests that patients have been brought responsible for being unable to follow 'doctor's order and concordance tempts to measure the degree of agreement between patient and his or her clinician about the nature of illness and the best possible therapy for the welfare of the patient. Non-adherence to the therapy may lead to different problems as consequences of non-adherence in four different level- individual, institutional, societal and national levels. Although some programs like, "Direct Observation Treatment, Short-course (DOTS) for tuberculosis, implementation of antiretroviral treatment schedules for HIV patients and pediatric vaccination models," are the examples of attention towards the cases of noncompliance in Nepal. It has long been faced its limitations in the forms of either untrained manpower or lack of good documentation of patients' adherence to therapy or high illiteracy rate or unaffordibility of patients to their treatment or lack of pharmaceutical care services.

  6. Marital satisfaction and adherence to religion

    PubMed Central

    Jafari, F; Neisani Samani, L; Fatemi, N; Ta’avoni, S; Abolghasemi, J

    2015-01-01

    Background: One of the most important determinants of health and marital satisfaction, the family and religious adherence can be effective because religion includes guidelines for life and providing a system of beliefs and values make these features can affect family life. Approach: This descriptive research - an analysis performed to assess the level of satisfaction of 47 questionnaires marital satisfaction questionnaire whose validity and reliability were evaluated and a couple of them asked to assess adherence to religion. The study population included 382 couples in Tehran that a cluster of 22 districts of Tehran were the selected. To analyze the data, ANOVA, Chi-square, and Pearson correlation coefficient using the software SPSS (version 22) became all tests were performed at the 5% level. Results: The data showed that the average age is 34 for women and 38 years for men and the majority of couples are in appropriate level in religiosity (40.5 percent). The results showed a main direct relation among religiosity and marital satisfaction of men and women (p ≤ 0.001). The correlation among religiosity and marital satisfaction of women r = 0.271 and this factor in men r = 0.200 was obtained indicating a direct relationship was significant. Conclusion: couples who were both committed to religion, their marital satisfaction score was more than couples without adherence to religion, and thus promoting religious beliefs and commitment can increase their marital satisfaction in couples. PMID:28316734

  7. [Drug prescriptions: Adherence and understanding in Madagascar].

    PubMed

    Raharinjatovo, L; Ralandison, S

    2015-01-01

    Frequently ignored or neglected, poor adherence is an important cause of treatment failure and a major public health problem. We assessed the factors involved in adherence in a hospital in Madagascar. This long-term study evaluated two groups of variables: patients' level of understanding of their disease and drug prescriptions, and the information on the prescription written by the doctor. We interviewed 93 in-patients (mean age: 50 years) and found that 16% were illiterate. Overall, 27% did not know the name of their illness, 34% were unaware of the treatment objectives, and 14% did not understand the drug prescription. On 20% of the prescriptions, the patients' name was not included, and the daily dose information and schedule was omitted from 16%. A day after receiving the prescription, only 64% had purchased the medication and only 53% of all patients had taken any. A correlation was observed between illiteracy, knowledge of the disease/treatment goals, and non-purchase of drugs. The poor quality of information contained in the prescriptions and patients' poor understanding of what they were supposed to do are obvious. Using pre-completed health forms and text messages might improve adherence.

  8. Investigation of the correlation between odd oxygen and secondary organic aerosol in Mexico City and Houston

    NASA Astrophysics Data System (ADS)

    Wood, E. C.; Canagaratna, M. R.; Herndon, S. C.; Kroll, J. H.; Onasch, T. B.; Kolb, C. E.; Worsnop, D. R.; Knighton, W. B.; Seila, R.; Zavala, M.; Molina, L. T.; Decarlo, P. F.; Jimenez, J. L.; Weinheimer, A. J.; Knapp, D. J.; Jobson, B. T.; Stutz, J.; Kuster, W. C.; Williams, E. J.

    2010-02-01

    Many recent models underpredict secondary organic aerosol (SOA) particulate matter (PM) concentrations in polluted regions, indicating serious deficiencies in the models' chemical mechanisms and/or missing SOA precursors. Since tropospheric photochemical ozone production is much better understood, we investigate the correlation of odd-oxygen ([Ox]≡[O3]+[NO2]) and the oxygenated component of organic aerosol (OOA), which is interpreted as a surrogate for SOA. OOA and Ox measured in Mexico City in 2006 and Houston in 2000 were well correlated in air masses where both species were formed on similar timescales (less than 8 h) and not well correlated when their formation timescales or location differed greatly. When correlated, the ratio of these two species ranged from 30 μg m-3 ppm-1 (STP) in Houston during time periods affected by large petrochemical plant emissions to as high as 160 μg m-3 ppm-1 in Mexico City, where typical values were near 120 μg m-3 ppm-1. On several days in Mexico City, the [OOA]/[Ox] ratio decreased by a factor of ~2 between 08:00 and 13:00 LT. This decrease is only partially attributable to evaporation of the least oxidized and most volatile components of OOA; differences in the diurnal emission trends and timescales for photochemical processing of SOA precursors compared to ozone precursors also likely contribute to the observed decrease. The extent of OOA oxidation increased with photochemical aging. Calculations of the ratio of the SOA formation rate to the Ox production rate using ambient VOC measurements and traditional laboratory SOA yields are lower than the observed [OOA]/[Ox] ratios by factors of 5 to 15, consistent with several other models' underestimates of SOA. Calculations of this ratio using emission factors for organic compounds from gasoline and diesel exhaust do not reproduce the observed ratio. Although not succesful in reproducing the atmospheric observations presented, modeling P(SOA)/P(Ox) can serve as a useful test

  9. Investigation of the correlation between odd oxygen and secondary organic aerosol in Mexico City and Houston

    NASA Astrophysics Data System (ADS)

    Wood, E. C.; Canagaratna, M. R.; Herndon, S. C.; Onasch, T. B.; Kolb, C. E.; Worsnop, D. R.; Kroll, J. H.; Knighton, W. B.; Seila, R.; Zavala, M.; Molina, L. T.; Decarlo, P. F.; Jimenez, J. L.; Weinheimer, A. J.; Knapp, D. J.; Jobson, B. T.; Stutz, J.; Kuster, W. C.; Williams, E. J.

    2010-09-01

    Many recent models underpredict secondary organic aerosol (SOA) particulate matter (PM) concentrations in polluted regions, indicating serious deficiencies in the models' chemical mechanisms and/or missing SOA precursors. Since tropospheric photochemical ozone production is much better understood, we investigate the correlation of odd-oxygen ([Ox]≡[O3]+[NO2]) and the oxygenated component of organic aerosol (OOA), which is interpreted as a surrogate for SOA. OOA and Ox measured in Mexico City in 2006 and Houston in 2000 were well correlated in air masses where both species were formed on similar timescales (less than 8 h) and not well correlated when their formation timescales or location differed greatly. When correlated, the ratio of these two species ranged from 30 μg m-3/ppm (STP) in Houston during time periods affected by large petrochemical plant emissions to as high as 160 μg m-3/ppm in Mexico City, where typical values were near 120 μg m-3/ppm. On several days in Mexico City, the [OOA]/[Ox] ratio decreased by a factor of ~2 between 08:00 and 13:00 local time. This decrease is only partially attributable to evaporation of the least oxidized and most volatile components of OOA; differences in the diurnal emission trends and timescales for photochemical processing of SOA precursors compared to ozone precursors also likely contribute to the observed decrease. The extent of OOA oxidation increased with photochemical aging. Calculations of the ratio of the SOA formation rate to the Ox production rate using ambient VOC measurements and traditional laboratory SOA yields are lower than the observed [OOA]/[Ox] ratios by factors of 5 to 15, consistent with several other models' underestimates of SOA. Calculations of this ratio using emission factors for organic compounds from gasoline and diesel exhaust do not reproduce the observed ratio. Although not succesful in reproducing the atmospheric observations presented, modeling P(SOA)/P(Ox) can serve as a useful test

  10. Pure odd-order oscillators with constant excitation

    NASA Astrophysics Data System (ADS)

    Cveticanin, L.

    2011-02-01

    In this paper the excited vibrations of a truly nonlinear oscillator are analyzed. The excitation is assumed to be constant and the nonlinearity is pure (without a linear term). The mathematical model is a second-order nonhomogeneous differential equation with strong nonlinear term. Using the first integral, the exact value of period of vibration i.e., angular frequency of oscillator described with a pure nonlinear differential equation with constant excitation is analytically obtained. The closed form solution has the form of gamma function. The period of vibration depends on the value of excitation and of the order and coefficient of the nonlinear term. For the case of pure odd-order-oscillators the approximate solution of differential equation is obtained in the form of trigonometric function. The solution is based on the exact value of period of vibration. For the case when additional small perturbation of the pure oscillator acts, the so called 'Cveticanin's averaging method' for a truly nonlinear oscillator is applied. Two special cases are considered: one, when the additional term is a function of distance, and the second, when damping acts. To prove the correctness of the method the obtained results are compared with those for the linear oscillator. Example of pure cubic oscillator with constant excitation and linear damping is widely discussed. Comparing the analytically obtained results with exact numerical ones it is concluded that they are in a good agreement. The investigations reported in the paper are of special interest for those who are dealing with the problem of vibration reduction in the oscillator with constant excitation and pure nonlinear restoring force the examples of which can be found in various scientific and engineering systems. For example, such mechanical systems are seats in vehicles, supports for machines, cutting machines with periodical motion of the cutting tools, presses, etc. The examples can be find in electronics

  11. Systematic Review of Educational Interventions to Improve Glaucoma Medication Adherence

    PubMed Central

    Newman-Casey, Paula Anne; Weizer, Jennifer S.; Heisler, Michele; Lee, Paul P.; Stein, Joshua D.

    2014-01-01

    Adherence to prescribed glaucoma medications is often poor, and proper adherence can be challenging for patients. We systematically reviewed the literature and identified eight studies using educational interventions to improve glaucoma medication adherence. Overall, five of the eight studies found that educational interventions lead to a significant improvement in medication adherence, and the remaining studies found a trend towards improvement. Using information from this systematic review and Health Behavior Theory, we constructed a conceptual framework to illustrate how counseling and education can improve glaucoma medication adherence. More rigorous studies grounded in Health Behavior Theory with adequately powered samples and longer follow-up are needed. PMID:23697623

  12. Nuclear Shell Structure and Beta Decay I. Odd A Nuclei II. Even A Nuclei

    DOE R&D Accomplishments Database

    Mayer, M.G.; Moszkowski, S.A.; Nordheim, L.W.

    1951-05-01

    In Part I a systematics is given of all transitions for odd A nuclei for which sufficiently reliable data are available. The allowed or forbidden characters of the transitions are correlated with the positions of the initial and final odd nucleon groups in the nuclear shell scheme. The nuclear shells show definite characteristics with respect to parity of the ground states. The latter is the same as the one obtained from known spins and magnetic moments in a one-particle interpretation. In Part II a systematics of the beta transitions of even-A nuclei is given. An interpretation of the character of the transitions in terms of nuclear shell structure is achieved on the hypothesis that the odd nucleon groups have the same structure as in odd-A nuclei, together with a simple coupling rule between the neutron and proton groups in odd-odd nuclei.

  13. Promoting adherence to nebulized therapy in cystic fibrosis: poster development and a qualitative exploration of adherence

    PubMed Central

    Jones, Stephen; Babiker, Nathan; Gardner, Emma; Royle, Jane; Curley, Rachael; Hoo, Zhe Hui; Wildman, Martin J

    2015-01-01

    Background Cystic fibrosis (CF) health care professionals recognize the need to motivate people with CF to adhere to nebulizer treatments, yet little is known about how best to achieve this. We aimed to produce motivational posters to support nebulizer adherence by using social marketing involving people with CF in the development of those posters. Methods The Sheffield CF multidisciplinary team produced preliminary ideas that were elaborated upon with semi-structured interviews among people with CF to explore barriers and facilitators to the use of nebulized therapy. Initial themes and poster designs were refined using an online focus group to finalize the poster designs. Results People with CF preferred aspirational posters describing what could be achieved through adherence in contrast to posters that highlighted the adverse consequences of nonadherence. A total of 14 posters were produced through this process. Conclusion People with CF can be engaged to develop promotional material to support adherence, providing a unique perspective differing from that of the CF multidisciplinary team. Further research is needed to evaluate the effectiveness of these posters to support nebulizer adherence. PMID:26346635

  14. Experimental identification of intruder bandheads in odd-mass {sup 187-193}Pb

    SciTech Connect

    Andreyev, A. N.; Huyse, M.; Van de Vel, K.; Van Duppen, P.; Cocks, J. F. C.; Dorvaux, O.; Greenlees, P.; Jones, P.; Julin, R.; Juutinen, S.; Helariutta, K.; Kettunen, H.; Kuusiniemi, P.; Leino, M.; Muikku, M.; Trzaska, W. H.; Eskola, K.; Wyss, R.

    1999-11-16

    Fine-structure {alpha}-decays of the odd mass {sup 191-197}Po identifying proton based intruder states in the daughter lead nuclei have been observed, leading to a systematics of intruder states in odd mass lead isotopes from {sup 197}Pb down to {sup 187}Pb. The interpretation of these states involves the coupling of the i{sub 13/2} or p{sub 3/2} odd neutron to the oblate deformed even lead core.

  15. Experimental Identification of Intruder Bandheads in Odd-Mass {sup 187-193}Pb

    SciTech Connect

    A.N. Andreyev; J.F.C. Cocks; O. Dorvaux; K. Eskola; P. Greenlees; P. Jones; R. Julin; S. Juutinen; K. Helariutta; M. Huyse; H. Kettunen; P. Kuusiniemi; M. Leino; M. Muikku; W.H. Trzaska; K. Van de Vel; P. Van Duppen; R. Wyss

    1999-12-31

    Fine-structure {alpha}-decays of the odd mass {sup 191-197}Po identifying proton based intruder states in the daughter lead nuclei have been observed, leading to a systematics of intruder states in odd mass lead isotopes from {sup 197}Pb down to {sup 187}Pb. The interpretation of these states involves the coupling of the i{sub 13/2} or p{sub 3/2} odd neutron to the oblate deformed even lead core.

  16. The odds of delivering one, two or three extremely low birth weight (< 1000 g) triplet infants: a study of 3288 sets.

    PubMed

    Blickstein, Isaac; Jacques, Debbie L; Keith, Louis G

    2002-01-01

    The odds of an individual triplet pregnancy to end with neonates weighing < 1000 g (extremely low birth weight [ELBW]) are unknown. We analyzed a nationwide perinatal database collected by Matria Healthcare, Inc. (Marietta, GA) to select from 3288 triplets those weighing 500-1000 g, delivered during the period 1988-2000 in the United States. We counted the number of sets with one, two, and three ELBW neonates and compared the incidence of ELBW infants between the subsets of nulliparas and multiparas. The odds of delivering at least one ELBW infant was significantly higher among nulliparas (1:8) than among multiparas (1:14), Odds Ratio (OR) 1.9, 95% Confidence Interval (CI) 1.9, 2.5. The odds of having at least two ELBW sibs in nulliparas (1:16) is twice higher than in multiparas (1:31), OR 2.0, 95% CI 1.3, 2.9. Nulliparas and multiparas had similar odds of delivering three ELBW infants (1:29 versus 1:40, OR 1.3, 95% CI 0.9, 2.1). Nulliparas are at significantly increased risk of delivering one or two ELBW triplets. This observation is no less than alarming and highlighted by the exceptionally high risk of major neurological deficits reported among ELBW infants.

  17. Adherence to Insulin Pen Therapy Is Associated with Reduction in Healthcare Costs Among Patients with Type 2 Diabetes Mellitus

    PubMed Central

    Chandran, Arthi; Bonafede, Machaon K.; Nigam, Sonali; Saltiel-Berzin, Rita; Hirsch, Laurence J.; Lahue, Betsy J.

    2015-01-01

    Background Type 2 diabetes mellitus is a chronic metabolic disorder that poses a significant economic burden on the US healthcare system associated with direct and indirect medical costs, loss of productivity, and premature mortality. Objectives To determine whether increased adherence to therapy among patients with type 2 diabetes who use an insulin pen is associated with reduced healthcare costs, and to describe the overall healthcare costs of patients with type 2 diabetes. Methods This retrospective claims database analysis used the Truven Health MarketScan Commercial and Medicare Supplemental databases to identify patients diagnosed with type 2 diabetes with at least 1 insulin pen prescription claim between January 2006 and September 2010. Insulin pen adherence was measured using the medication possession ratio (MPR). The cost outcomes included all-cause and type 2 diabetes–related costs by type of service (ie, inpatient, outpatient medical, outpatient pharmacy), which were calculated in 2011 US dollars. Insulin adherence and overall healthcare costs were evaluated over the 12-month postindex period. Results A total of 32,361 patients met the study inclusion criteria, with an average MPR of 0.63 (standard deviation [SD], 0.29). Overall, patients with type 2 diabetes who used an insulin pen had an average annual healthcare cost of $19,612, which was driven by inpatient costs (37.2%) and outpatient pharmacy costs (24.4%). There is a significant difference in the average annual per-patient healthcare expenditures between the least adherent group (MPR <0.20; 11.0% of patients) and the most adherent group (MPR >0.80; 34.6% of patients) $26,310 versus $23,839, respectively (P = .007). Patients with the greatest insulin adherence had higher overall pharmacy costs than patients with the lowest insulin adherence ($10,174 vs $5395, respectively; P <.001). Conclusions The total healthcare expenditures of patients with type 2 diabetes who utilized insulin pens decreased

  18. Kitchen table wisdom: a Freirian approach to medication adherence.

    PubMed

    Williams, Ann B; Burgess, Jane D; Danvers, Karina; Malone, Janice; Winfield, Subrena D; Saunders, Lois

    2005-01-01

    Most interventions to promote medication adherence are based on psychological theories of individual behavior. In contrast, this article describes the theory and practice of a socially based adherence intervention that is guided by the educational principles of Paolo Freire. This approach asserts that adherence is influenced by the patient's social context and attempts to improve adherence through identifying social constraints on adherence behavior. The program builds on the traditions of patient education through home nursing visits. Using a dialectic process of dialogue and problem solving and working with a team that includes a nurse and a peer-educator, patients are encouraged to act to change their social environment to support their desire to achieve high levels of medication adherence. This strategy does not replace, but rather supplements, traditional methods of understanding individual patient behavior and allows the patient and the nurse to consider potential solutions to adherence challenges in the larger social context.

  19. Pediatric Psychologist Use of Adherence Assessments and Interventions

    PubMed Central

    Rohan, Jennifer M.; Martin, Staci; Hommel, Kevin; Greenley, Rachel Neff; Loiselle, Kristin; Ambrosino, Jodie; Fredericks, Emily M.

    2013-01-01

    Objective To document current clinical practices for medical regimen adherence assessment and intervention in the field of pediatric psychology. Methods 113 members of the Society of Pediatric Psychology completed an anonymous online survey that assessed use of adherence assessments and interventions in clinical practice, barriers and facilitators to their use, and preferred resources for obtaining information on adherence assessments and interventions. Results Respondents reported using a range of adherence assessment and intervention strategies, some of which are evidence-based. Barriers to implementing these clinical strategies included time constraints and lack of familiarity with available clinical tools. Respondents reported that education about effective clinical tools would facilitate their use of adherence assessments and interventions. Conclusions Future research and clinical efforts in adherence should consider developing practical tools for clinical practice, making accessible resources to promote dissemination of these tools, and increase understanding of clinician implementation of adherence assessments and interventions. PMID:23658375

  20. Evaluating an Adaptive and Interactive mHealth Smoking Cessation and Medication Adherence Program: A Randomized Pilot Feasibility Study

    PubMed Central

    Anderson, Melissa L; Bradley, Katharine; An, Lawrence C; Catz, Sheryl L

    2016-01-01

    /22, 97%) and would recommend the program to others (20/23, 87%). They also rated the program as convenient, responsive to their needs, and easy to use. Abstinence rates at 5-month follow-up were 36% in the experimental arm versus 24% among controls (odds ratio 1.79 [0.61-5.19], P=.42). Experimental participants used their varenicline an average of 46 days versus 39 among controls (P=.49). More than two-thirds (22/33, 67%) of experimental participants and three-quarters (25/33, 76%) of controls prematurely discontinued their varenicline use (P=.29). Conclusions The MyMAP intervention was found to be feasible and acceptable. Since the study was not powered for statistical significance, no conclusions can be drawn about the program’s effects on smoking abstinence or medication adherence, but the overall study results suggest further evaluation in a larger randomized trial is warranted. ClinicalTrial ClinicalTrials.gov NCT02136498; https://clinicaltrials.gov/ct2/show/NCT02136498 (Archived by WebCite at http://www.webcitation.org/6jT3UMFLj) PMID:27489247

  1. Mobile Phone Text Messages to Support Treatment Adherence in Adults With High Blood Pressure (StAR): A Single-Blind, Randomized Trial

    PubMed Central

    Bobrow, Kirsten; Farmer, Andrew J; Springer, David; Shanyinde, Milensu; Yu, Ly-Mee; Brennan, Thomas; Rayner, Brian; Namane, Mosedi; Steyn, Krisela; Tarassenko, Lionel; Levitt, Naomi

    2016-01-01

    Background We assessed the effect of automated treatment adherence support delivered via mobile-phone short message system (SMS) text-messages on blood pressure. Methods and Results In this pragmatic single-blind, three-arm randomized trial (StAR), undertaken in South Africa, patients treated for high blood pressure were randomly allocated in a 1:1:1 ratio to information-only or interactive SMS text-messaging, or usual care. The primary outcome was change in systolic blood pressure at 12-months from baseline measured with a validated oscillometric device. All trial staff were masked to treatment allocation. Analyses were intention to treat. Between June 26, 2012 and November 23, 2012, 1372 participants were randomized to receive information-only SMS text-messages (n=457), interactive SMS text-messages (n=458), or usual care (n=457). Primary outcome data were available for 1256 (92%) participants. At 12-months, the mean adjusted change (95% CI) in systolic blood pressure compared to usual care was −2.2 mm Hg (−4.4 to −0.04) with information-only SMS and −1.6 mm Hg (−3.7 to 0.6) with interactive SMS. Odds ratios (95% CI) for the proportion of participants with a blood pressure <140/90mm Hg were for information-only messaging 1.42 (1.03 to 1.95) and for interactive messaging 1.41 (1.02 to 1.95) compared to usual care. Conclusions In this randomized trial of an automated adherence support program delivered by SMS text-message in a general outpatient population of adults with high blood pressure, we found a small, reduction in systolic blood pressure control compared to usual care at 12-months. There was no evidence that an interactive intervention increased this effect. Clinical Trial Registration Information ClinicalTrials.gov. Identifier: South African National Clinical Trials Register number (SANCTR DOH-27-1212-386); Pan Africa Trial Register (PACTR201411000724141). PMID:26769742

  2. Even the Odd Numbers Help: Failure Modes of SAM-Based Tunnel Junctions Probed via Odd-Even Effects Revealed in Synchrotrons and Supercomputers.

    PubMed

    Thompson, Damien; Nijhuis, Christian A

    2016-10-18

    This Account describes a body of research in atomic level design, synthesis, physicochemical characterization, and macroscopic electrical testing of molecular devices made from ferrocene-functionalized alkanethiol molecules, which are molecular diodes, with the aim to identify, and resolve, the failure modes that cause leakage currents. The mismatch in size between the ferrocene headgroup and alkane rod makes waxlike highly dynamic self-assembled monolayers (SAMs) on coinage metals that show remarkable atomic-scale sensitivity in their electrical properties. Our results make clear that molecular tunnel junction devices provide an excellent testbed to probe the electronic and supramolecular structures of SAMs on inorganic substrates. Contacting these SAMs to a eutectic "EGaIn" alloy top-electrode, we designed highly stable long-lived molecular switches of the form electrode-SAM-electrode with robust rectification ratios of up to 3 orders of magnitude. The graphic that accompanies this conspectus displays a computed SAM packing structure, illustrating the lollipop shape of the molecules that gives dynamic SAM supramolecular structures and also the molecule-electrode van der Waals (vdW) contacts that must be controlled to form good SAM-based devices. In this Account, we first trace the evolution of SAM-based electronic devices and rationalize their operation using energy level diagrams. We describe the measurement of device properties using near edge X-ray absorption fine structure spectroscopy, cyclic voltammetry, and X-ray photoelectron spectroscopy complemented by molecular dynamics and electronic structure calculations together with large numbers of electrical measurements. We discuss how data obtained from these combined experimental/simulation codesign studies demonstrate control over the supramolecular and electronic structure of the devices, tuning odd-even effects to optimize inherent packing tendencies of the molecules in order to minimize leakage currents

  3. Universal one-dimensional atomic gases near odd-wave resonance

    NASA Astrophysics Data System (ADS)

    Cui, Xiaoling

    2016-10-01

    We show the renormalization of the contact interaction for odd-wave scattering in one-dimension (1D). Based on the renormalized interaction, we exactly solve the two-body problem in a harmonic trap and further explore the universal properties of spin-polarized fermions near odd-wave resonance by using the operator-product-expansion method. It is found that the high-momentum distribution behaves as C /k2 , with C being the odd-wave contact. Various universal relations are derived. Our work suggests a universal system emergent in 1D with large odd-wave scattering length.

  4. Association of Ongoing Drug and Alcohol Use with Non-Adherence to Antiretroviral Therapy and Higher Risk of AIDS and Death: Results from ACTG 362

    PubMed Central

    COHN, Susan E.; JIANG, Hongyu; MCCUTCHAN, J. Allen; KOLETAR, Susan L.; MURPHY, Robert L.; ROBERTSON, Kevin R.; DESTMAURICE, Annabelle; CURRIER, Judith S.; WILLIAMS, Paige L.

    2011-01-01

    Drug and alcohol use have been associated with a worse prognosis in short-term and cross-sectional analyses of HIV-infected populations, but longitudinal effects on adherence to antiretroviral therapy (ART) and clinical outcomes in advanced AIDS are less well characterized. We assessed self-reported drug and alcohol use in AIDS patients, and examined their association with non-adherence and death or disease progression in a multicenter observational study. We defined non-adherence as reporting missed ART doses in the 48 hours before study visits. The association between drug use and ART non-adherence was evaluated using repeated measures generalized estimating equation (GEE) models. The association between drug and alcohol use and time to new AIDS diagnosis or death was evaluated via Cox regression models, controlling for covariates including ART adherence. Of 643 participants enrolled between 1997–1999 and followed through 2007, at entry 39% reported ever using cocaine, 24% amphetamines, and 10% heroin. Ongoing drug use during study follow-up was reported by 9% using cocaine, 4% amphetamines, and 1% heroin. Hard drug (cocaine, amphetamines, or heroin) users had 2.1 times higher odds (p=0.001) of ART non-adherence in GEE models and 2.5 times higher risk (p=0.04) of AIDS progression or death in Cox models. Use of hard drugs was attenuated as a risk factor for AIDS progression or death after controlling for non-adherence during follow-up (HR=2.11, p=0.08), but was still suggestive of a possible adherence-independent mechanism of harm. This study highlights the need to continuously screen and treat patients for drug use as a part of ongoing HIV care. PMID:21293986

  5. Computational Tension Mapping of Adherent Cells Based on Actin Imaging.

    PubMed

    Manifacier, Ian; Milan, Jean-Louis; Jeanneau, Charlotte; Chmilewsky, Fanny; Chabrand, Patrick; About, Imad

    2016-01-01

    Forces transiting through the cytoskeleton are known to play a role in adherent cell activity. Up to now few approaches haves been able to determine theses intracellular forces. We thus developed a computational mechanical model based on a reconstruction of the cytoskeleton of an adherent cell from fluorescence staining of the actin network and focal adhesions (FA). Our custom made algorithm converted the 2D image of an actin network into a map of contractile interactions inside a 2D node grid, each node representing a group of pixels. We assumed that actin filaments observed under fluorescence microscopy, appear brighter when thicker, we thus presumed that nodes corresponding to pixels with higher actin density were linked by stiffer interactions. This enabled us to create a system of heterogeneous interactions which represent the spatial organization of the contractile actin network. The contractility of this interaction system was then adapted to match the level of force the cell truly exerted on focal adhesions; forces on focal adhesions were estimated from their vinculin expressed size. This enabled the model to compute consistent mechanical forces transiting throughout the cell. After computation, we applied a graphical approach on the original actin image, which enabled us to calculate tension forces throughout the cell, or in a particular region or even in single stress fibers. It also enabled us to study different scenarios which may indicate the mechanical role of other cytoskeletal components such as microtubules. For instance, our results stated that the ratio between intra and extra cellular compression is inversely proportional to intracellular tension.

  6. Computational Tension Mapping of Adherent Cells Based on Actin Imaging

    PubMed Central

    Manifacier, Ian; Milan, Jean-Louis; Jeanneau, Charlotte; Chmilewsky, Fanny; Chabrand, Patrick; About, Imad

    2016-01-01

    Forces transiting through the cytoskeleton are known to play a role in adherent cell activity. Up to now few approaches haves been able to determine theses intracellular forces. We thus developed a computational mechanical model based on a reconstruction of the cytoskeleton of an adherent cell from fluorescence staining of the actin network and focal adhesions (FA). Our custom made algorithm converted the 2D image of an actin network into a map of contractile interactions inside a 2D node grid, each node representing a group of pixels. We assumed that actin filaments observed under fluorescence microscopy, appear brighter when thicker, we thus presumed that nodes corresponding to pixels with higher actin density were linked by stiffer interactions. This enabled us to create a system of heterogeneous interactions which represent the spatial organization of the contractile actin network. The contractility of this interaction system was then adapted to match the level of force the cell truly exerted on focal adhesions; forces on focal adhesions were estimated from their vinculin expressed size. This enabled the model to compute consistent mechanical forces transiting throughout the cell. After computation, we applied a graphical approach on the original actin image, which enabled us to calculate tension forces throughout the cell, or in a particular region or even in single stress fibers. It also enabled us to study different scenarios which may indicate the mechanical role of other cytoskeletal components such as microtubules. For instance, our results stated that the ratio between intra and extra cellular compression is inversely proportional to intracellular tension. PMID:26812601

  7. Topography Influences Adherent Cell Regulation of Osteoclastogenesis.

    PubMed

    Nagasawa, M; Cooper, L F; Ogino, Y; Mendonca, D; Liang, R; Yang, S; Mendonca, G; Uoshima, K

    2016-03-01

    The importance of osteoclast-mediated bone resorption in the process of osseointegration has not been widely considered. In this study, cell culture was used to investigate the hypothesis that the function of implant-adherent bone marrow stromal cells (BMSCs) in osteoclastogenesis is influenced by surface topography. BMSCs isolated from femur and tibia of Sprague-Dawley rats were seeded onto 3 types of titanium surfaces (smooth, micro, and nano) and a control surface (tissue culture plastic) with or without osteogenic supplements. After 3 to 14 d, conditioned medium (CM) was collected. Subsequently, rat bone marrow-derived macrophages (BMMs) were cultured in media supplemented with soluble receptor activator of NF-κB ligand (RANKL) and macrophage colony-stimulating factor (M-CSF) as well as BMSC CM from each of the 4 surfaces. Gene expression levels of soluble RANKL, osteoprotegerin, tumor necrosis factor α, and M-CSF in cultured BMSCs at different time points were measured by real-time polymerase chain reaction. The number of differentiated osteoclastic cells was determined after tartrate-resistant acid phosphatase staining. Analysis of variance and t test were used for statistical analysis. The expression of prominent osteoclast-promoting factors tumor necrosis factor α and M-CSF was increased by BMSCs cultured on both micro- and nanoscale titanium topographies (P < 0.01). BMSC CM contained a heat-labile factor that increased BMMs osteoclastogenesis. CM from both micro- and nanoscale surface-adherent BMSCs increased the osteoclast number (P < 0.01). Difference in surface topography altered BMSC phenotype and influenced BMM osteoclastogenesis. Local signaling by implant-adherent cells at the implant-bone interface may indirectly control osteoclastogenesis and bone accrual around endosseous implants.

  8. Improving adherence and outcomes in diabetic patients

    PubMed Central

    Joshi, Renu; Joshi, Disha; Cheriyath, Pramil

    2017-01-01

    Objective Nonadherence in diabetes is a problem leading to wasted resources and preventable deaths each year. Remedies for diminishing nonadherence are many but marginally effective, and outcomes remain suboptimal. Aim The aim of this study was to test a new iOS “app”, PatientPartner. Derived from complexity theory, this novel technology has been extensively used in other fields; this is the first trial in a patient population. Methods Physicians referred patients who were “severely non-adherent” with HbA1c levels >8. After consent and random assignment (n=107), subjects in the intervention group were immersed in the 12-min PatientPartner game, which assesses and trains subjects on parameters of thinking that are critical for good decision making in health care: information management, stress coping, and health strategies. The control group did not play PatientPartner. All subjects were called each week for 3 weeks and self-reported on their medication adherence, diet, and exercise. Baseline and 3-month post-intervention HbA1c levels were recorded for the intervention group. Results Although the control group showed no difference on any measures at 3 weeks, the intervention group reported significant mean percentage improvements on all measures: medication adherence (57%, standard deviation [SD] 18%–96%, SD 9), diet (50%, SD 33%–75%, SD 28), and exercise (29%, SD 31%–43%, SD 33). At 3 months, the mean HbA1c levels in the intervention group were significantly lower (9.6) than baseline (10.7). Conclusion Many programs to improve adherence have been proved to be expensive and marginally effective. Therefore, improvements from the single use of a 12-min-long “app” are noteworthy. This is the first ever randomized, controlled trial to demonstrate that an “app” can impact the gold standard biological marker, HbA1c, in diabetes. PMID:28243070

  9. Assignment of single particle configurations in odd-A nuclei near A~100 with angular correlation measurements

    NASA Astrophysics Data System (ADS)

    Ramayya, A. V.; Hamilton, J. H.; Hwang, J. K.; Liu, S. H.; Daniel, A. V.; Goodin, C.; Luo, Y. X.; Rasmussen, J. O.; Stone, N. J.; Zhu, S. J.; Li, K.

    2011-01-01

    The multipole mixing ratios of ΔI = 1 transitions between levels in rotational bands built on single-particle states in odd neutron nuclei are dependent on the configurations of the states. In particular, the mixing ratio can be used to distinguish between several possible single-particle configurations if interpreted with the particle plus axial-rotor model (PRM). This work features the first determination of the ground-state configurations of 109,111Ru. The single-particle structures of the ground states of 101Zr and 103,105,107Mo as well as excited states in 103,107Mo are also investigated, with a new result found in 107Mo.

  10. Nuclear Data Evaluation for Mass Chain A=217:Odd-Proton Nuclei.

    PubMed

    Nafee, Sherif S; Shaheen, Salem A; Al-Ramady, Amir M

    2016-01-01

    Thallium (81(217)Tl, Bismuth (83(217)Bi), Astatine (85(217)At), Francium (87(217)Fr), Actinium (89(217)Ac) and Protactinium (91(217)Pa) are of odd-proton numbers among the mass chain A = 217. In the present work, the half-lives and gamma transitions for the six nuclei have been studied and adopted based on the recently published interactions or unevaluated nuclear data sets XUNDL. The Q (α) has been updated based on the recent published work of the Atomic Mass Evaluation AME2012 as well. Moreover, the total conversion electrons as well as the K-Shell to L-Shell, L-Shell to M-Shell and L-Shell to N-Shell Conversion Electron Ratios have been calculated using BrIcc code v2.3. An updated skeleton decay scheme for each of the above nuclei has been presented here. The decay hindrance factors (HF) calculated using the ALPHAD program, which is available from Brookhaven National Laboratory's website, have been calculated for the α- decay data sets for (221)Fr-, (221)Ac- and (221)Pa-α-decays.

  11. Nuclear Data Evaluation for Mass Chain A=217:Odd-Proton Nuclei

    PubMed Central

    Nafee, Sherif S.; Shaheen, Salem A.; Al-Ramady, Amir M.

    2016-01-01

    Thallium (Tl81217), Bismuth (Bi83217), Astatine (At85217), Francium (Fr87217), Actinium (Ac89217) and Protactinium (Pa91217) are of odd-proton numbers among the mass chain A = 217. In the present work, the half-lives and gamma transitions for the six nuclei have been studied and adopted based on the recently published interactions or unevaluated nuclear data sets XUNDL. The Q (α) has been updated based on the recent published work of the Atomic Mass Evaluation AME2012 as well. Moreover, the total conversion electrons as well as the K-Shell to L-Shell, L-Shell to M-Shell and L-Shell to N-Shell Conversion Electron Ratios have been calculated using BrIcc code v2.3. An updated skeleton decay scheme for each of the above nuclei has been presented here. The decay hindrance factors (HF) calculated using the ALPHAD program, which is available from Brookhaven National Laboratory’s website, have been calculated for the α- decay data sets for 221Fr-, 221Ac- and 221Pa- α-decays. PMID:26761207

  12. Adherence and receptor relationships of Candida albicans.

    PubMed Central

    Calderone, R A; Braun, P C

    1991-01-01

    The cell surface of Candida albicans is composed of a variety of polysaccharides such as glucan, chitin, and mannan. The first two components primarily provide structure, while the mannan, often covalently linked to protein, constitutes the major antigen of the organism. Mannoproteins also have enzymatic activity (acid protease) and ligand-receptor functions. The complement receptors of C. albicans appear to be mannoproteins that are required for the adherence of the organism to endothelial cells. This is certainly true of the CR3-like protein of C. albicans. Proof that the CR3 is the Candida receptor for endothelial cells is derived from two observations. First, mutants lacking CR3 activity are less adherent in vitro and, in fact, less virulent. Second, the ligand recognized by the CR3 receptor (C3bi) as well as anti-CR3 antibodies blocks adherence of the organism to endothelial cells. The CR2 of C. albicans appears to promote the adherence of the organism to plastic substrates. Unlike the CR2 of mammalian cells, the Candida CR2 recognizes ligands containing the RGD sequence of amino acids in addition to the C3d ligand, which does not contain the RGD sequence. There is uncertainty as to whether the Candida CR2 and CR3 are, in fact, different proteins. A mannoprotein has also been described as the adhesin for epithelial cells. In this case, the receptor has a lectinlike activity and recognizes fucose- or glucosamine-containing glycoproteins of epithelial cells, depending on the strain of C. albicans. The oligosaccharide component of the receptor is probably not involved in ligand recognition and may serve to stabilize the receptor. However, the oligosaccharide factor 6 epitope of mannan may also provide adhesin activity in the recognition of epithelial cells. Mannoproteins can be extracted from cells by a number of reagents. Zymolyase, for instance, tends to remove structural mannoproteins, which contain relatively little protein and are linked to glucan. Reagents

  13. Adherence and Dosage Contributions to Parenting Program Quality

    PubMed Central

    Gross, Thomas J.; Mason, W. Alex; Parra, Gilbert; Oats, Robert; Ringle, Jay; Haggerty, Kevin P.

    2015-01-01

    Objective The 3 most frequently examined elements of treatment fidelity are adherence, dosage, and quality. The relationships between these fidelity elements are complex, and additional research is needed to provide clarity. Improving clarity may be especially relevant to parenting programs, which tend to include direct explicit instruction (DEI) elements (i.e., instruction, modeling, and practice). The adherence to and dosage of these DEI elements are frequently assumed to improve program quality; however, little information is available to determine if such adherence and dosage affect program quality. This study examines whether adherence to and dosage of DEI elements predict quality ratings for a widely disseminated, manualized parenting program. Method Adherence is defined as the percentage of intervention tasks completed for each DEI element. Dosage is defined as the number of minutes and seconds spent in each intervention DEI element. Treatment fidelity is assessed for 36 of 144 sessions across 10 program facilitators. A hierarchical linear regression analysis examines the contributions of adherence and dosage in the prediction of session quality ratings. Results The analysis indicates that adherence accounts for a significant proportion of the variance (26%), whereas dosage contributes a nonsignificant proportion of variance (11%). Adherence to skill practice was the strongest individual predictor (β = .445, p < .01). Conclusions Findings suggest that ensuring a high degree of adherence can contribute to quality program delivery. However, more exploration is needed to better understand the ways in which adherence and dosage of DEI elements affect program quality. PMID:26726301

  14. The use of incentives to reinforce medication adherence

    PubMed Central

    DeFulio, Anthony; Silverman, Kenneth

    2012-01-01

    Objective Poor medication adherence is a longstanding problem, and is especially pertinent for individuals with chronic conditions or diseases. Adherence to medications can improve patient outcomes and greatly reduce the cost of care. The purpose of the present review is to describe the literature on the use of incentives as applied to the problem of medication adherence. Methods We conducted a systematic review of peer-reviewed empirical evaluations of incentives provided to patients contingent upon medication adherence. Results This review suggests that incentive-based medication adherence interventions can be very effective, but there are few controlled studies. The studies on incentive-based medication adherence interventions most commonly feature patients taking medication for drug or alcohol dependence, HIV, or latent tuberculosis. Across studies that reported percent adherence comparisons, incentives increased adherence by a mean of 20 percentage points, but effects varied widely. Cross-study comparisons indicate a positive relationship between the value of the incentive and the impact of the intervention. Post-intervention evaluations were rare, but tended to find that adherence effects diminish after the interventions are discontinued. Conclusions Incentive-based medication adherence interventions are promising but understudied. A significant challenge for research in this area is the development of sustainable and cost-effective long-term interventions. PMID:22580095

  15. LONGITUDINAL ASSOCIATION BETWEEN MEDICATION ADHERENCE AND LUNG HEALTH IN PEOPLE WITH CYSTIC FIBROSIS

    PubMed Central

    Eakin, Michelle N.; Bilderback, Andrew; Boyle, Michael P.; Mogayzel, Peter J.; Riekert, Kristin A.

    2011-01-01

    Background This study examined the relationship of medication adherence to frequency of pulmonary exacerbation and rate of decline in FEV1% predicted (FEV1). Methods 95 CF patients ages 6 years or older and prescribed a pulmonary medication, enrolled in a longitudinal retrospective review of medication adherence and health outcomes (the occurrence and frequency of intravenous (IV) antibiotic treatments and FEV1) over 12-months. Pharmacy refill records were used to calculate a medication possession ratio (MPR). Results Composite MPR predicted the occurrence of at least one pulmonary exacerbation requiring a course of IV antibiotics (IRR=2.34, p=0.05), but not the frequency of exacerbations, after controlling for gender, baseline FEV1, and regimen complexity. Composite MPR predicted baseline FEV1 (estimate=29.81, p=.007), but not decline in FEV1. Conclusions These results demonstrate a significant relation between medication adherence and IV antibiotics in CF patients, highlighting the importance of addressing adherence during clinic visits to improve health outcomes. PMID:21458391

  16. Into the Cuckoo's Nest: "Silver Linings Playbook" and Movies about Odd People

    ERIC Educational Resources Information Center

    Beck, Bernard

    2013-01-01

    Odd people have always been identified and often treated differently in human societies. In modern times, they have been described as being afflicted with a psychological condition to be treated by specialists and assigned to a "crazy" category by general society. Movies about such odd people have a long history. A recent movie,…

  17. Investigation of Cool and Hot Executive Function in ODD/CD Independently of ADHD

    ERIC Educational Resources Information Center

    Hobson, Christopher W.; Scott, Stephen; Rubia, Katya

    2011-01-01

    Background: Children with oppositional defiant disorder/conduct disorder (ODD/CD) have shown deficits in "cool" abstract-cognitive, and "hot" reward-related executive function (EF) tasks. However, it is currently unclear to what extent ODD/CD is associated with neuropsychological deficits, independently of attention deficit hyperactivity disorder…

  18. ODD and ADHD Symptoms in Ukrainian Children: External Validators and Comorbidity

    ERIC Educational Resources Information Center

    Drabick, Deborah A. G.; Gadow, Kenneth D.; Carlson, Gabrielle A.; Bromet, Evelyn J.

    2004-01-01

    Objective: To examine potential external validators for oppositional defiant disorder (ODD) and attention-deficient/hyperactive disorder (ADHD) symptoms in a Ukrainian community-based sample of 600 children age 10 to 12 years old and evaluate the nature of co-occurring ODD and ADHD symptoms using mother- and teacher-defined groups. Method: In…

  19. Fitting Proportional Odds Models to Educational Data in Ordinal Logistic Regression Using Stata, SAS and SPSS

    ERIC Educational Resources Information Center

    Liu, Xing

    2008-01-01

    The proportional odds (PO) model, which is also called cumulative odds model (Agresti, 1996, 2002 ; Armstrong & Sloan, 1989; Long, 1997, Long & Freese, 2006; McCullagh, 1980; McCullagh & Nelder, 1989; Powers & Xie, 2000; O'Connell, 2006), is one of the most commonly used models for the analysis of ordinal categorical data and comes from the class…

  20. The Correlation of Secondary Organic Aerosol with Odd Oxygen in Mexico City

    EPA Science Inventory

    Data from a mountain location intercepting the Mexico City emission plume demonstrate a strong correlation between secondary organic aerosol and odd-oxygen (O3 + NO2). The measured oxygenated-organic aerosol correlates with odd-oxygen measurements with an a...

  1. Association of Anxiety and ODD/CD in Children with and without ADHD

    ERIC Educational Resources Information Center

    Humphreys, Kathryn L.; Aguirre, Vincent P.; Lee, Steve S.

    2012-01-01

    The goal of this study is to examine levels of oppositional defiant disorder (ODD) and conduct disorder (CD) in four groups of children: attention-deficit/hyperactivity disorder (ADHD) only, anxiety only, ADHD and anxiety, and controls (i.e., non-ADHD youth). Although children with ADHD exhibit more ODD and CD than non-ADHD youth, it is unknown if…

  2. Why Some Schools with Latino Children Beat the Odds...and Others Don't

    ERIC Educational Resources Information Center

    Waits, Mary Jo; Campbell, Heather E.; Gau, Rebecca; Jacobs, Ellen; Rex, Tom; Hess, Robert K.

    2006-01-01

    Throughout Arizona and the Southwest, the odds are against high achievement in schools with a mostly Latino, mostly poor student enrollment. Some schools, however, "beat the odds" and achieve consistently high results or show steady gains. Why do these schools succeed where others fail? Using the methodology of business guru Jim Collins…

  3. The Interplay among Preschool Child and Family Factors and the Development of ODD Symptoms

    ERIC Educational Resources Information Center

    Harvey, Elizabeth A.; Metcalfe, Lindsay A.

    2012-01-01

    The present study examined (a) the interactions between early behavior, early parenting, and early family adversity in predicting later oppositional defiant disorder (ODD) symptoms, and (b) the reciprocal relations between parent functioning and ODD symptoms across the preschool years. Participants were 258 three-year-old children (138 boys, 120…

  4. Clinically Referred ODD Children with or without CD and Healthy Controls: Comparisons across Contextual Domains

    ERIC Educational Resources Information Center

    Kolko, David J.; Dorn, Lorah D.; Bukstein, Oscar; Burke, Jeffrey D.

    2008-01-01

    This study compares 6-11-year-old, clinically referred boys and girls diagnosed with Oppositional Defiant Disorder, either with (ODD + CD, n = 40) or without Conduct Disorder (ODD only; n = 136), to a matched sample of healthy control children (HC; n = 69). Multiple informants completed intake diagnostic interviews and self-reports to evaluate…

  5. Adherence to medication in the community: audit cycle of interventions to improve the assessment of adherence

    PubMed Central

    Farooq, Saeed; Choudry, Abid

    2017-01-01

    Aims and method To investigate whether medication adherence is monitored during follow-up in out-patient reviews. A retrospective audit was carried out with a sample of 50 follow-up patients with a diagnosis of schizophrenia or schizoaffective disorder. Following this, interventions were made prior to the re-audit (including text messaging clinicians and prompt sheets in the out-patient department to encourage adherence discussions). Results There was an improvement on all the standards set for this audit following the interventions. More doctors had discussed medication adherence (62% second cycle v. 50% first cycle) with their patient and there was increased discussion and documentation regarding medication side-effects (60% second cycle v. 30% first cycle). More clinicians discussed the response to medication (60% second cycle v. 46% first cycle). Clinical implications Treatment adherence is not regularly monitored or recorded in clinical notes in routine psychiatric out-patient appointments. This highlights the need for regular training to improve practice. PMID:28184317

  6. Hospital Fall Prevention: A Systematic Review of Implementation, Components, Adherence, and Effectiveness

    PubMed Central

    Hempel, Susanne; Newberry, Sydne; Wang, Zhen; Booth, Marika; Shanman, Roberta; Johnsen, Breanne; Shier, Victoria; Saliba, Debra; Spector, William D; Ganz, David A

    2013-01-01

    Objectives To systematically document the implementation, components, comparators, adherence, and effectiveness of published fall prevention approaches in U.S. acute care hospitals. Design Systematic review. Studies were identified through existing reviews, searching five electronic databases, screening reference lists, and contacting topic experts for studies published through August 2011. Setting U.S. acute care hospitals. Participants Studies reporting in-hospital falls for intervention groups and concurrent (e.g., controlled trials) or historic comparators (e.g., before–after studies). Intervention Fall prevention interventions. Measurements Incidence rate ratios (IRR, ratio of fall rate postintervention or treatment group to the fall rate preintervention or control group) and ratings of study details. Results Fifty-nine studies met inclusion criteria. Implementation strategies were sparsely documented (17% not at all) and included staff education, establishing committees, seeking leadership support, and occasionally continuous quality improvement techniques. Most interventions (81%) included multiple components (e.g., risk assessments (often not validated), visual risk alerts, patient education, care rounds, bed-exit alarms, and postfall evaluations). Fifty-four percent did not report on fall prevention measures applied in the comparison group, and 39% neither reported fidelity data nor described adherence strategies such as regular audits and feedback to ensure completion of care processes. Only 45% of concurrent and 15% of historic control studies reported sufficient data to compare fall rates. The pooled postintervention incidence rate ratio (IRR) was 0.77 (95% confidence interval = 0.52–1.12, P = .17; eight studies; I2: 94%). Meta-regressions showed no systematic association between implementation intensity, intervention complexity, comparator information, or adherence levels and IRR. Conclusion Promising approaches exist, but better reporting of

  7. Odd-even effect in heavy-ion collisions at intermediate energies

    SciTech Connect

    Su Jun; Zhang Fengshou; Bian Baoan

    2011-01-15

    Heavy-ion collisions at intermediate energies are studied by the isospin-dependent quantum molecular dynamics model in the company of the GEMINI model. The isospin-dependent quantum molecular dynamics model is applied to describe the violent stage of the collisions, while the GEMINI model is applied to simulate the decays of the prefragments. The present study mainly focuses on the odd-even effect in the yields of the final fragments. We find that the odd-even effect appears in the deexcitation process of the excited prefragments, and is affected by the excitation energies and the isotope distributions of the prefragments. Both the projectile-isospin-dependent odd-even effect in the region of -4{<=}T{sub Z}{<=}1 and the role of the symmetry energy on the odd-even effect are studied. We find that the odd-even effect depends sensitively on the symmetry energy.

  8. Odd-skipped maintains prohemocyte potency and blocks blood cell development in Drosophila.

    PubMed

    Gao, Hongjuan; Wu, Xiaorong; Fossett, Nancy

    2011-03-01

    Studies using Drosophila have contributed significantly to our understanding of regulatory mechanisms that control stem cell fate choice. The Drosophila blood cell progenitor or prohemocyte shares important characteristics with mammalian hematopoietic stem cells, including quiescence, niche dependence, and the capacity to form all three fly blood cell types. This report extends our understanding of prohemocyte fate choice by showing that the zinc-finger protein Odd-skipped promotes multipotency and blocks differentiation. Odd-skipped was expressed in prohemocytes and downregulated in terminally differentiated plasmatocytes. Furthermore, Odd-skipped maintained the prohemocyte population and blocked differentiation of plasmatocytes and lamellocytes but not crystal cells. A previous study showed that Odd-skipped expression is downregulated by Decapentaplegic signaling. This report provides a functional basis for this regulator/target pair by suggesting that Decapentaplegic signaling limits Odd-skipped expression to promote prohemocyte differentiation. Overall, these studies are the basis for a gene regulatory model of prohemocyte cell fate choice.

  9. Odd-Mode Surface Plasmon Polaritons Supported by Complementary Plasmonic Metamaterial

    PubMed Central

    Gao, Xi; Zhou, Liang; Cui, Tie Jun

    2015-01-01

    Surface plasmon polaritons (SPPs), either on metal-dielectric interfaces in optical frequencies or on structured metal surfaces in the lower frequencies, are dominantly even modes. Here we discover dominant odd-mode SPPs on a complementary plasmonic metamaterial, which is constructed by complementary symmetric grooves. We show that the fundamental SPP mode on such a plasmonic metamaterial is a tightly confined odd mode, whose dispersion curve can be tuned by the shape of groove. According to the electric field distributions of odd-mode SPPs, we propose a high-efficiency transducer using asymmetric coplanar waveguide and slot line to excite the odd-mode SPPs. Numerical simulations and experimental results validate the high-efficiency excitation and excellent propagation performance of odd-mode SPPs on the complementary plasmonic waveguides in the microwave frequencies. PMID:25783166

  10. Adherence to immunosuppression: a prospective diary study.

    PubMed

    Gordon, E J; Prohaska, T R; Gallant, M P; Siminoff, L A

    2007-12-01

    Immunosuppression adherence among kidney transplant recipients is essential for graft survival. However, nonadherence is common, jeopardizing graft survival. Besides skipping dosages, little is known about other forms of medication nonadherence and their underlying reasons. This study sought to examine patients' extent of medication adherence over time and reasons for nonadherence. Thirty-nine new kidney transplant recipients were asked to complete a month-long medication-taking diary that included reporting medication nonadherence such as skipped medications, medications taken early or late, taking dosages greater or less than prescribed, and the reason for each occurrence of nonadherence. Of the 20 (51%) patients who completed the diary, 11 (55%) reported at least 1 form of nonadherence. Eleven patients reported taking their immunosuppression at least 1 hour later than the prescribed time, 1 patient reported skipping medication, but no patients reported changing the dosage on their own. Immunosuppression was taken on average 1.5 hours after the prescribed time. Of those patients who took their medications late, there were on average 3.1 occasions of taking it late. The most common reasons for this behavior included health care-related issues, followed by oversleeping, being away from home, work-related barriers, and forgetting. The majority of kidney transplant recipients took medications later than prescribed during 1 month. Future research should determine the clinical impact on graft function of late administration of immunosuppression. Interventions should be designed to better assist kidney recipients with taking medications on time, especially when they are away from home.

  11. Statistical dynamics of religions and adherents

    NASA Astrophysics Data System (ADS)

    Ausloos, M.; Petroni, F.

    2007-02-01

    Religiosity is one of the most important sociological aspects of populations. All religions may evolve in their beliefs and adapt to the society developments. A religion is a social variable, like a language or wealth, to be studied like any other organizational parameter. Several questions can be raised, as considered in this study; e.g.: i) From a "macroscopic" point of view: How many religions exist at a given time? ii) From a "microscopic" viewpoint: How many adherents belong to one religion? Does the number of adherents increase or not, and how? No need to say that if quantitative answers and mathematical laws are found, agent-based models can be imagined to describe such non-equilibrium processes. It is found that empirical laws can be deduced and related to preferential attachment processes, like on an evolving network; we propose two different algorithmic models reproducing as well the data. Moreover, a population growth-death equation is shown to be a plausible modeling of evolution dynamics in a continuous-time framework. Differences with language dynamic competition are emphasized.

  12. Obesity increases the odds of acquiring and incarcerating noninguinal abdominal wall hernias.

    PubMed

    Lau, Briana; Kim, Hanjoo; Haigh, Philip I; Tejirian, Talar

    2012-10-01

    The current data available describing the relationship of obesity and abdominal wall hernias is sparse. The objective of this study was to investigate the current prevalence of noninguinal abdominal wall hernias and their correlation with body mass index (BMI) and other demographic risk factors. Patients with umbilical, incisional, ventral, epigastric, or Spigelian hernias with or without incarceration were identified using the regional database for 14 hospitals over a 3-year period. Patients were stratified based on their BMI. Univariate and multivariate analyses were performed to distinguish other significant risk factors associated with the hernias. Of 2,807,414 patients, 26,268 (0.9%) had one of the specified diagnoses. Average age of the patients was 52 years and 61 per cent were male. The majority of patients had nonincarcerated umbilical hernias (74%). Average BMI was 32 kg/m2. Compared with patients with a normal BMI, the odds of having a hernia increased with BMI: BMI of 25 to 29.9 kg/m2 odds ratio (OR) 1.63, BMI of 30 to 39.9 kg/m2 OR 2.62, BMI 40 to 49.9 kg/m2 OR 3.91, BMI 50 to 59.9 kg/m2 OR 4.85, and BMI greater than 60 kg/m2 OR 5.17 (P<0.0001). Age older than 50 years was associated with a higher risk for having a hernia (OR, 2.12; 95% [CI], 2.07 to 2.17), whereas female gender was associated with a lower risk (OR, 0.53; 95% CI, 0.52 to 0.55). Those with incarcerated hernias had a higher average BMI (32 kg/m2 vs 35 kg/m2; P<0.0001). Overall, BMI greater than 40 kg/m2 showed an increased chance of incarceration, and a BMI greater than 60 kg/m2 had the highest chance of incarceration, OR 12.7 (P<0.0001). Age older than 50 years and female gender were also associated with a higher risk of incarceration (OR, 1.28; 95% CI, 1.02 to 1.59 and OR, 1.80; CI, 1.45 to 2.24). Increasing BMI and increasing age are associated with a higher prevalence and an increased risk of incarceration of noninguinal abdominal wall hernias.

  13. Neutral red uptake inhibition in adhered and adhering rat hepatoma-derived Fa32 cells to predict human toxicity.

    PubMed

    Dierickx, Paul J; Scheers, Ellen M

    2002-01-01

    The cytotoxicity of the MEIC (Multicentre Evaluation of In vitro Cytotoxicity) reference chemicals was investigated by measuring the neutral red uptake inhibition in adhered and adhering rat hepatoma-derived Fa32 cells. The adhered cells were seeded and then treated and the adhering cells were treated simultaneously upon seeding. Five of the 44 test chemicals were twofold more toxic in adhering cells; ethylene glycol was 28-fold more toxic and mercuric chloride was 5.2-fold more toxic than in adhered cells. The cytotoxicity of dithiothreitol was altered in the same way as that of ethylene glycol, probably by interacting with calcium. When the neutral red uptake inhibition was compared with human toxicity, the correlation coefficient for adhering cells was almost identical to that obtained previously in human hepatoma-derived Hep G2 cells and slightly higher for adhered cells. The Hep G2 assay was the best acute in vitro assay for the prediction of human toxicity within the MEIC study. An obviously better correlation was obtained when the strong intoxicant mercuric chloride was withdrawn from the comparison, both for the adhered and the adhering cells. Altogether, the results can be integrated very well with the basal cytotoxicity concept.

  14. Adherence to Antihypertensives in Patients With Comorbid Condition

    PubMed Central

    Saadat, Zahra; Nikdoust, Farahnaz; Aerab-Sheibani, Hossein; Bahremand, Mostafa; Shobeiri, Elham; Saadat, Habibollah; Moharramzad, Yashar; Morisky, Donald E.

    2015-01-01

    Background: Comorbidity has been noted as a potential barrier to proper adherence to antihypertensive medications. Objectives: We decided to investigate whether comorbidity could significantly affect adherence of Iranian patients with hypertension to their medication regimen. Patients and Methods: Two hundred and eighty consecutive hypertensive patients were interviewed in 4 cities of Iran. The 8-item Morisky medication adherence scale (MMAS-8) (validated in Persian) was used to assess medication adherence. This scale determines adherence by scores as lower than 6 (low adherence), 6 or 7 (moderate adherence), and 8 (high adherence). Comorbidity was considered as any concomitant medical condition, which necessitates the patient to take medicine for a minimum of 6 months prior to the interviews. Results: The most common comorbid conditions were ischemic heart disease (65 patients, 23.2%), diabetes mellitus (55 patients, 19.6%), and dyslipidemia (51 patients, 18.2%). Mean (± SD) MMAS-8 score in comorbid group was 5.68 (± 1.85) and in non-comorbid hypertensive patients, it was 5.83 (± 1.91) (P = 0.631). Mean (± SD) number of comorbidities was 1.53 (± 0.75) in low adherence group compared to 1.54 (± 0.77) in moderate/high adherers (P = 0.98). With increasing the number of comorbid diseases, the proportion of patients with high adherence decreased successively from 20% in those with no comorbid disease to 14.1% in those with one or two comorbid conditions, and finally 11.1% in those with 3 to 5 comorbid conditions. Conclusions: With increasing the number of comorbid conditions, the proportion of patients with high adherence decreases. In our opinion, this finding is a useful clinical note for healthcare providers when managing patients with hypertension who have other medical problems at the same time. PMID:26539419

  15. What strategies do ulcerative colitis patients employ to facilitate adherence?

    PubMed Central

    Kawakami, Aki; Tanaka, Makoto; Naganuma, Makoto; Maeda, Shin; Kunisaki, Reiko; Yamamoto-Mitani, Noriko

    2017-01-01

    Background Overall, 30%–45% of patients with ulcerative colitis (UC) are non-adherent and have difficulties taking their medications; this non-adherence increases the risk of clinical relapse 1.4- to 5.5-fold. This study aimed to clarify the strategies patients employ to facilitate adherence and determine whether the strategies had an impact on good adherence. Methods This was a cross-sectional survey using a self-administered questionnaire and review of medical records. Patients diagnosed as having UC and attending one of the outpatient clinics of four urban hospitals from June 2009 to December 2012 were enrolled. A questionnaire was developed to identify the strategies patients employ to facilitate adherence and then administered to patients with UC. Adherence to 5-aminosalicylic acid was calculated, and univariate and multiple logistic regression analyses were performed to determine the strategies that were associated with good adherence. Results The final analyses included 671 participants (mean age 40.2 years; 54.3% males). The valid response rate was 96.9%; 186 (27.7%) participants were classified as non-adherent, the mean adherence rate being 86.1% (standard deviation [SD] 17.9). Seven strategies that patients employ to facilitate adherence were identified, the following two being significantly associated with good adherence: “I keep my medicines where I eat meals” and “I keep each day’s medicine in a pill case or something similar to make sure I have taken them”. Conclusion The identified strategies might be used to develop a program to improve medication adherence in patients with UC. PMID:28203059

  16. Social work and medical care: electronic reminders to address adherence.

    PubMed

    Whisenhunt, Allison

    2014-01-01

    Social workers are often involved with patients and families around adherence, both to clinic appointments as well as to the medication regimen. An evidence-based practice project was created and implemented to determine the efficacy of electronic reminders such as text messaging on adherence. The implications of improving adherence can positively impact the patient on an individual level as well as reduce costs and increase revenue at a systems level.

  17. Analysis of the triaxial, strongly deformed bands in odd-odd nucleus 164Lu with the tops-on-top model

    NASA Astrophysics Data System (ADS)

    Sugawara-Tanabe, Kazuko; Tanabe, Kosai; Yoshinaga, Naotaka

    2014-06-01

    The top-on-top model with angular-momentum-dependent moments of inertia is extended to the tops-on-top model for an odd-odd nucleus, where one proton and one neutron in each single-j orbital are coupled to the triaxial rotor. For a pure rotor case, an explicit algebraic formula for the triaxial, strongly deformed (TSD) band levels is given, and its stability problem is discussed. Both positive and negative parity TSD bands are well reproduced by taking account of attenuation factors in the Coriolis interaction and the proton-neutron interaction in the recoil term. Difference in quantum numbers between the yrast and yrare TSD bands is confirmed by direct estimation of spin alignments. The electromagnetic transition rates of B(M1) are much reduced because of the different sign of g-factors in comparison with the odd-A case, while B(E2) are in the same order.

  18. 14 CFR 1260.72 - Adherence to original budget estimates.

    Code of Federal Regulations, 2010 CFR

    2010-01-01

    ...) Although NASA assumes no responsibility for budget overruns, the recipient may spend grant funds without strict adherence to individual allocations within the proposed budgets, except that recipients...

  19. The role of family caregivers in HIV medication adherence.

    PubMed

    Beals, K P; Wight, R G; Aneshensel, C S; Murphy, D A; Miller-Martinez, D

    2006-08-01

    This study examines the role that mid-life and older wives and mothers play in promoting medication adherence among their HIV-infected husbands or adult sons who require daily living assistance. Interviews were conducted with 112 caregiving dyads, with caregivers reporting on their own behaviours and attitudes towards medications, and care-recipients (persons living with HIV [PLH]) providing information about their own adherence practices. By examining how caregiver characteristics, behaviours, and attitudes may influence PLH adherence it is explicitly recognized that caregivers and PLH are linked within a caregiving dyad. Findings indicate that caregivers often remind PLH to take medications, but these reminders are not significantly associated with adherence. Caregivers also report strong attitudes about medication hassles, concerns over treatment failure and general concerns about adherence. Controlling for background characteristics, high perceived adherence hassles on the part of the caregiver were associated with low PLH adherence, providing evidence of shared influence within the caregiving dyad. Adherence interventions may maximize their effectiveness if they consider the role of the family caregiver because these data suggest that caregiver attitudes are linked with PLH adherence behaviours.

  20. Adherence of skin bacteria to human epithelial cells.

    PubMed Central

    Romero-Steiner, S; Witek, T; Balish, E

    1990-01-01

    Aerobic and anaerobic bacteria isolated from human axillae were tested for their capacity to adhere to buccal epithelial cells, immortalized human epithelial (HEp-2) cells, and undifferentiated and differentiated human epithelial cells. In general, both aerobic and anaerobic diphtheroids adhered better to differentiated human epithelial cells than to HEp-2 and undifferentiated human epithelial cells (P less than 0.05). Mannose, galactose, fucose, N-acetyl-D-glucosamine, and fibronectin were also assayed for their capacity to inhibit the adherence of diphtheroids to human epithelial cells. A great deal of variability was observed in the capacity of the latter compounds to inhibit the attachment of aerobic diphtheroids to undifferentiated and differentiated epithelial cells. Overall, mannose appeared to be best at inhibiting the adherence of the aerobic diphtheroids to undifferentiated human epithelial cells. Galactose, fucose, N-acetyl-D-glucosamine, and fibronectin showed a greater capacity to inhibit attachment of aerobic diphtheroids to differentiated than to undifferentiated human epithelial cells. The inhibition of adherence to differentiated human epithelial cells varied with the microorganism and the compound tested; however, the highest and most consistent inhibition of adherence (76.1 to 88.6%) was observed with a 5% solution of N-acetyl-D-glucosamine. The in vitro adherence and adherence inhibition assays presented here demonstrate that a number of adhesins and receptors are involved in the adherence of skin bacteria to human epithelial cells and receptors on human epithelial cells are apparently altered during differentiation. PMID:2298877

  1. Adherence in the CAPRISA 004 tenofovir gel microbicide trial.

    PubMed

    Mansoor, Leila Essop; Abdool Karim, Quarraisha; Yende-Zuma, Nonhlanhla; MacQueen, Kathleen M; Baxter, Cheryl; Madlala, Bernadette T; Grobler, Anneke; Abdool Karim, Salim S

    2014-05-01

    High adherence is key to microbicide effectiveness. Here we provide a description of adherence interventions and the adherence rates achieved in the CAPRISA 004 Tenofovir gel trial. Adherence support for the before-and-after dosing strategy (BAT 24) was provided at enrolment and at each monthly study visit. This initially comprised individual counselling and was replaced midway by a structured theory-based adherence support program (ASP) based on motivational interviewing. The 889 women were followed for an average of 18 months and attended a total of 17,031 monthly visits. On average women reported five sex acts and returned 5.9 empty applicators per month. The adherence rate based on applicator count in relation to all reported sex acts was 72.2 % compared to the 82.0 % self-reported adherence during the last sex act. Adherence support activities, which achieve levels of adherence similar to or better than those achieved by the CAPRISA 004 ASP, will be critical to the success of future microbicide trials.

  2. [Medication adherence of elderly in Porto Alegre, RS].

    PubMed

    Rocha, Cristiane Hoffmeister; de Oliveira, Ana Paula Sueiro; Ferreira, Caroline; Faggiani, Fabiana Tôrres; Schroeter, Guilherme; de Souza, Antônio Carlos Araújo; DeCarli, Geraldo Attilio; Morrone, Fernanda Bueno; Werlang, Maria Cristina

    2008-04-01

    Polipharmacy and medication non-adherence are problems faced frequently in the treatment of elderly patients. An exploratory cross-sectional study and quantitative approach were conducted to assess the frequency of treatment-adherence in elderly and how polipharmacy can affect adherence. Four hundred and sixty six elderly answered a questionnaire in Porto Alegre, RS in individual interviews. The adherence frequency found was 173 (37.1%) and was higher among those, who use less medication. These results indicate the need for implementing educational programs for the elderly in order to help them to follow their drug therapy.

  3. Medication Adherence: Tailoring the Analysis to the Data

    PubMed Central

    Saberi, Parya; Johnson, Mallory O.; McCulloch, Charles E.; Vittinghoff, Eric; Neilands, Torsten B.

    2011-01-01

    The purpose of this paper is to explore more comprehensive methods to analyze antiretroviral non-adherence data. Using illustrative data and simulations, we investigated the value of using binary logistic regression (LR; dichotomized at 0% non-adherence) versus a hurdle model (combination of LR plus generalized linear model for >0% non-adherence) versus a zero-inflated negative binomial (ZINB) model (simultaneously modeling 0% non-adherence and >0% non-adherence). In simulation studies, the hurdle and ZINB models had similar power but both had higher power in comparison to LR alone. The hurdle model had higher power than ZINB in settings where covariate effects were restricted to one or the other part of the model (0% non-adherence or degree of non-adherence). Use of the hurdle and ZINB models are powerful and valuable approaches in analyzing adherence data which yield a more complete picture than LR alone. We recommend adoption of this methodology for future antiretroviral adherence research. PMID:21833689

  4. The association of smoking with medical treatment adherence in the workforce of a large employer

    PubMed Central

    Sherman, Bruce W; Lynch, Wendy D

    2014-01-01

    Purpose Prior descriptive epidemiology studies have shown that smokers have lower compliance rates with preventive care services and lower chronic medication adherence rates for preventive care services in separate studies. The goal of this study was to perform a more detailed analysis to validate both of these findings for current smokers versus nonsmokers within the benefit-covered population of a large US employer. Patients and methods This study involved the analysis of incurred medical and pharmacy claims for employee and spouse health plan enrollees of a single US-based employer during 2010. Multivariate regression models were used to compare data by active or never-smoker status for preventive care services and medication adherence for chronic conditions. Analysis controlled for demographic variables, chronic condition prevalence, and depression. Results Controlling for demographic variables and comorbid conditions, smokers had significantly lower cancer screening rates, with absolute reductions of 6%–13%. Adherence to chronic medication use for hypertension was also significantly lower among smokers, with nearly 7% fewer smokers having a medication possession ratio of ≥80%. Smokers were less adherent to depression medications (relative risk =0.79) than nonsmokers (P=0.10). While not statistically significant, smokers were consistently less adherent to all other medications than nonsmokers. Conclusion Current smokers are less compliant with recommended preventive care and medication use than nonsmokers, likely contributing to smoking-related employer costs. Awareness of these care gaps among smokers and direct management should be considered as part of a comprehensive population health-management strategy. PMID:24790415

  5. Provider-Focused Intervention Increases Adherence-Related Dialogue, But Does Not Improve Antiretroviral Therapy Adherence in Persons with HIV

    PubMed Central

    Wilson, Ira B.; Laws, M. Barton; Safren, Steven A.; Lee, Yoojin; Lu, Minyi; Coady, William; Skolnik, Paul R.; Rogers, William H.

    2010-01-01

    Background Physicians' limited knowledge of patients' antiretroviral adherence may reduce their ability to perform effective adherence counseling. Methods We conducted a randomized, cross-over study of an intervention to improve physicians' knowledge of patients' antiretroviral adherence. The intervention was a report given to the physician prior to a routine office visit that included data on: MEMS and self-reported data on antiretroviral adherence, patients' beliefs about antiretroviral therapy, reasons for missed doses, alcohol and drug use, and depression. We audio-recorded one intervention and one control visit for each patient to analyze differences in adherence related dialogue. Results 156 patients were randomized, and 106 completed all 5 study visits. Paired audio-recorded visits were available for 58 patients. Using a linear regression model that adjusted for site and baseline MEMS adherence, adherence following intervention visits did not differ significantly from control visits (2.0% higher, p=0.31, 95% CI -1.95% – 5.9%). There was a trend toward more total adherence-related utterances (median of 76 vs. 49.5, p=0.07) and a significant increase in utterances about the current regimen (median of 51.5 vs. 32.5, p=0.0002) in intervention compared with control visits. However less than 10% of adherence-related utterances were classified as “problem solving” in content, and one third of physicians' problem solving utterances were directive in nature. Conclusions Receipt of a detailed report prior to clinic visits containing data about adherence and other factors did not improve patients' antiretroviral adherence. Analyses of patient-provide dialogue suggests that providers who care for persons with HIV may benefit from training in adherence counseling techniques. PMID:20048680

  6. Prognostic Significance of Neutrophil-to-Lymphocyte