Sample records for adoptively transferred adherent

  1. Tissue distribution of adoptively transferred adherent lymphokine-activated killer cells assessed by different cell labels

    DEFF Research Database (Denmark)

    Basse, P; Herberman, R B; Hokland, M;


    Assessment of the tissue distribution of adoptively transferred adherent lymphokine-activated killer A-LAK) cells by use of 51Cr indicated that these effector cells, after an initial phase in the lungs, distributed in high numbers to liver and spleen (30% and 10% of injected dose, respectively......). However, when this experiment was repeated with 125IdUrd as cell label, fewer than 2% and 0.5% of the injected cells distributed into liver and spleen respectively. To analyse this discrepancy, we compared the tissue distribution of 51Cr- and 125IdUrd-labelled A-LAK cells with that indicated...

  2. Genetic factors in exercise adoption, adherence and obesity. (United States)

    Herring, M P; Sailors, M H; Bray, M S


    Physical activity and exercise play critical roles in energy balance. While many interventions targeted at increasing physical activity have demonstrated efficacy in promoting weight loss or maintenance in the short term, long term adherence to such programmes is not frequently observed. Numerous factors have been examined for their ability to predict and/or influence physical activity and exercise adherence. Although physical activity has been demonstrated to have a strong genetic component in both animals and humans, few studies have examined the association between genetic variation and exercise adherence. In this review, we provide a detailed overview of the non-genetic and genetic predictors of physical activity and adherence to exercise. In addition, we report the results of analysis of 26 single nucleotide polymorphisms in six candidate genes examined for association to exercise adherence, duration, intensity and total exercise dose in young adults from the Training Interventions and Genetics of Exercise Response (TIGER) Study. Based on both animal and human research, neural signalling and pleasure/reward systems in the brain may drive in large part the propensity to be physically active and to adhere to an exercise programme. Adherence/compliance research in other fields may inform future investigation of the genetics of exercise adherence.

  3. Physical activity adoption to adherence, lapse, and dropout: a self-determination theory perspective. (United States)

    Kinnafick, Florence-Emilie; Thøgersen-Ntoumani, Cecilie; Duda, Joan L


    Grounded in Self-Determination Theory, we aimed to explore and identify key motivational processes involved in the transition from a physically inactive to an active lifestyle, and the processes involved in lapse and dropout behavior within a walking program. We implemented a qualitative, longitudinal case study method, using semistructured interviews and theoretical thematic analyses. Fifteen women were interviewed over 10 months and three profiles were generated: (a) nonadherence, (b) lapse/readoption of physical activity, and (c) adherence. Internalization of walking behavior was key to adherence. Satisfaction of the needs for competence and relatedness were central for participation during exercise at the adoption stages, and autonomy was particularly pertinent in facilitating adherence. Those who lapsed and restarted physical activity experienced feelings of autonomy at the point of readoption. Sources of support were driving forces in the adoption and adherence phases.

  4. Adoptive transfer of macrophages ameliorates renal fibrosis in mice. (United States)

    Nishida, Masashi; Okumura, Yasuko; Fujimoto, Shin-Ichiro; Shiraishi, Isao; Itoi, Toshiyuki; Hamaoka, Kenji


    We performed adoptive transfer of bone marrow-derived (BM) macrophages following pharmacological depletion of leukocytes in a mouse model of unilateral ureteral obstruction (UUO). Treatment with cyclophosphamide (CPM) caused marked decrease in the numbers of F4/80-positive interstitial macrophages as well as in peripheral blood leukocyte counts, and adoptive transfer of BM macrophages to CPM-treated mice resulted in significant increase in the numbers of interstitial macrophages both at day 5 and at day 14 after UUO. At day 5 after UUO, no significant change was observed in the degree of renal interstitial fibrosis either by treatment with CPM or with CPM+macrophage. However, at day 14 after UUO, treatment with CPM caused significant increase in the degree of interstitial fibrosis, and adoptive macrophage transfer to these mice attenuated this enhancement in renal fibrosis. Our result suggests the role of infiltrating macrophages on facilitating tissue repair at late stage of UUO.

  5. Immunotherapy of cancer employing adoptive T cell transfer

    Institute of Scientific and Technical Information of China (English)



    The current concept of“Adoptive T Cell Immunotherapy of Cancer”is quite different from how it was originally conceived.With the development of modern technology in molecular biology,cell biology,immunology and biochemistry during the last twenty years or so,adoptive immunotherapy has grown from its initial form of a simple“blood cell transfer”into its present process which involves host vauccination,effector cell activation/polarization and genetic modification.With the use of immune adjuvants and the identification/characterization of tumor-reactive T cell subsets,or in combination with other therapeutic strategies,adoptively transferred T cells have become much more potent inmediating tumor regression.In addition,studies on the trafficking of infused T cells,cell transfer performed in lymphopenic models,as well as the discovery of novel techniques in immune monitoring for the generation of effector cells in vitro and after cell transfer in vivo have provided useful tools to further improve the therapeutic efficacy of this approach.This article will review these related aspects of adoptive T cell immunotherapy of cancer with specific comments on certain critical areas in the application of this approach.With the rapidly evolving advances in this area,it is hoped that this cellular immunologic therapy as it was conceptualized in the past,can become more useful in the treatment of human cancer in the near future.

  6. Adoptive cell transfer in the treatment of metastatic melanoma

    DEFF Research Database (Denmark)

    Straten, Per thor; Becker, Jürgen C


    Adoptive cell therapy (ACT) for metastatic cancer is the focus of considerable research effort. Rosenberg's laboratory demonstrated a 50% response rate in stage IV melanoma patients treated with in vitro expanded tumor-infiltrating lymphocytes (TILs) and high-dose IL-2 administered after nonmyelo......Adoptive cell therapy (ACT) for metastatic cancer is the focus of considerable research effort. Rosenberg's laboratory demonstrated a 50% response rate in stage IV melanoma patients treated with in vitro expanded tumor-infiltrating lymphocytes (TILs) and high-dose IL-2 administered after...... nonmyeloablative conditioning (Dudley et al., 2002a). Because early attempts to use expanded TILs in melanoma therapy failed to demonstrate better efficacy than high-dose IL-2 (Rosenberg et al., 1994), the efficacy of TILs and nonmyeloablative conditioning in combination implies that patient conditioning...

  7. Accumulation in tumor tissue of adoptively transferred T cells: A comparison between intravenous and intraperitoneal injection

    DEFF Research Database (Denmark)

    Petersen, Charlotte Christie; Petersen, Mikkel Steen; Agger, Ralf;


    Accumulation of T cells at the tumor is essential in cancer immunotherapy based on adoptive transfer of tumor-specific T cells. To gain further insight into the accumulation process and to evaluate the effect of using different routes of cell transfer, we investigated the accumulation of ovalbumin...

  8. Proliferation-linked apoptosis of adoptively transferred T cells after IL-15 administration in macaques.

    Directory of Open Access Journals (Sweden)

    Carolina Berger

    Full Text Available The adoptive transfer of antigen-specific effector T cells is being used to treat human infections and malignancy. T cell persistence is a prerequisite for therapeutic efficacy, but reliably establishing a high-level and durable T cell response by transferring cultured CD8(+ T cells remains challenging. Thus, strategies that promote a transferred high-level T cell response may improve the efficacy of T cell therapy. Lymphodepletion enhances persistence of transferred T cells in mice in part by reducing competition for IL-15, a common γ-chain cytokine that promotes T cell memory, but lymphodepleting regimens have toxicity. IL-15 can be safely administered and has minimal effects on CD4(+ regulatory T cells at low doses, making it an attractive adjunct in adoptive T cell therapy. Here, we show in lymphoreplete macaca nemestrina, that proliferation of adoptively transferred central memory-derived CD8(+ effector T (T(CM/E cells is enhanced in vivo by administering IL-15. T(CM/E cells migrated to memory niches, persisted, and acquired both central memory and effector memory phenotypes regardless of the cytokine treatment. Unexpectedly, despite maintaining T cell proliferation, IL-15 did not augment the magnitude of the transferred T cell response in blood, bone marrow, or lymph nodes. T cells induced to proliferate by IL-15 displayed increased apoptosis demonstrating that enhanced cycling was balanced by cell death. These results suggest that homeostatic mechanisms that regulate T cell numbers may interfere with strategies to augment a high-level T cell response by adoptive transfer of CD8(+ T(CM/E cells in lymphoreplete hosts.

  9. Improving the outcome of adoptive cell transfer by targeting tumor escape. (United States)

    Kaluza, Karen M; Vile, Richard


    Adoptive T-cell transfer is among the most promising immunotherapies against cancer. To continue increasing the potential of this therapy, our studies focus on the inhibition of tumor recurrence. Recently, we have demonstrated several ways in which combination therapies involving multiple T-cell populations and immunostimulatory chemotherapy can enhance long-term survival.

  10. Effect of adoptive transfer or depletion of regulatory T cells on triptolide-induced liver injury

    Directory of Open Access Journals (Sweden)

    Xinzhi eWang


    Full Text Available ObjectiveThe aim of this study is to clarify the role of regulatory T cell (Treg in triptolide (TP-induced hepatotoxicity. MethodsFemale C57BL/6 mice received either adoptive transfer of Tregs or depletion of Tregs, then underwent TP administration and were sacrificed 24 hours after TP administration. Liver injury was determined according to ALT and AST levels in serum and histopathological change in liver tissue. Hepatic frequencies of Treg cells and the mRNA expression levles of transcription factor FoxP3 and RORγt, IL-10, SOCS and Notch/Notch ligand were investigated.ResultsDuring TP-induced liver injury, hepatic Treg and IL-10 decreased, while Th17 cell transcription factor RORγt, SOCS signaling and Notch signaling increased, accompanied with liver inflammation. Adoptive transfer of Tregs ameliorated the severity of TP-induced liver injury, accompanied with increased levels of hepatic Treg and IL-10. Adoptive transfer of Tregs remarkably inhibited the expression of RORγt, SOCS3, Notch1 and Notch3. On the contrary, depletion of Treg cells in TP-administered mice resulted in a notable increase of RORγt, SOCS1, SOCS3 and Notch3, while the Treg and IL-10 of liver decreased. Consistent with the exacerbation of liver injury, higher serum levels of ALT and AST were detected in Treg-depleted mice. ConclusionsThese results showed that adoptive transfer or depletion of Tregs attenuated or aggravated TP-induced liver injury, suggesting that Tregs could play important roles in the progression of liver injury. SOCS proteins and Notch signaling affected Tregs, which may contribute to the pathogenesis of TP-induced hepatotoxicity.

  11. Effective adoptive transfer of haploidentical tumor-specific T cells in B 16-melanoma bearing mice

    Institute of Scientific and Technical Information of China (English)

    CUI Nai-peng; XIE Shao-jian; HAN Jin-sheng; MA Zhen-feng; CHEN Bao-ping; CAI Jian-hui


    Background Adoptive transfer of allogeneic tumor-specific T cells often results in severe graft-versus-host disease (GVHD).Here,we sought to maximize graft-versus-tumor and minimize GVHD by using haploidentical T cells in pre-irradiated B16-melanoma bearing mice.Methods C57BL/6 mice bearing B16-melanoma tumors were irradiated with 0,5,or 7 Gy total body irradiation (TBI),or 7 Gy TBI plus bone marrow transplantation.Tumor areas were measured every 3 days to assess the influence of irradiation treatment on tumor regression.B16-melanoma bearing mice were irradiated with 7 Gy TBI; sera and spleens were harvested at days 1,3,5,7,9,11,and 13 after irradiation.White blood cell levels were measured and transforming growth factor β1 (TGF-β1) and interleukin 10 (IL-10) levels in serum were detected using enzyme-linked immunosorbent assay (ELISA) kits.Real-time reverse transcription-polymerase chain reaction (RT-PCR) and flow cytometry were performed to test TGF-β1,IL-10 and Foxp3 mRNA levels and the proportion of CD4+CD25+Foxp3+ T-regulatory cells (Tregs) in spleens.B16-melanoma bearing C57BL/6 mice were irradiated with 7 Gy TBI followed by syngeneic (Syn1/Syn2) or haploidentical (Hap1/Hap2),dendritic cell-induced cytotoxic T lymphocytes (DC-CTLs) treatment,tumor areas and system GVHD were observed every 3 days.Mice were killed 21 days after the DC-CTLs adoptive transfer;histologic analyses of eyes,skin,liver,lungs,and intestine were then performed.Results Irradiation with 7 Gy TBI on the B16-melanoma-bearing mice did not influence tumor regression compared to the control group; however,it down-regulated the proportion of Tregs in spleens and the TGF-β1 and IL-10 levels in sera and spleens,suggesting inhibition of autoimmunity and intervention of tumor microenvironment.Adoptive transfer of haploidentical DC-CTLs significantly inhibited B16-melanoma growth.GVHD assessment and histology analysis showed no significant difference among the groups.Conclusion Adoptive transfer

  12. Characterization of the natural killer T-cell response in an adoptive transfer model of atherosclerosis. (United States)

    VanderLaan, Paul A; Reardon, Catherine A; Sagiv, Yuval; Blachowicz, Lydia; Lukens, John; Nissenbaum, Michael; Wang, Chyung-Ru; Getz, Godfrey S


    Natural killer T (NKT) cells have recently been implicated in atherogenesis, primarily for their ability to recognize and respond to lipid antigens. Because the atherosclerotic lesion is characterized by the retention and modification of lipids in the vascular wall, NKT cells may be involved in promoting the local vascular inflammatory response. Here, we investigate the proatherogenic role of NKT cells in an adoptive transfer model of atherosclerosis, using as recipients immune-deficient, atherosclerosis-susceptible RAG1(-/-)LDLR(-/-) mice. The adoptive transfer of an NKT cell-enriched splenocyte population from Valpha14Jalpha18 T-cell receptor transgenic mice resulted in a 73% increase in aortic root lesion area compared with recipients of NKT cell-deficient splenocytes derived from CD1d(-/-) mice after 12 weeks of Western-type diet feeding. The total serum from hypercholesterolemic mice leads to a small but significant activation of Valpha14Jalpha18 T-cell receptor-expressing hybridoma line by dendritic cells that is CD1d-dependent. Therefore, these studies demonstrate that NKT cells are proatherogenic in the absence of exogenous stimulation, and this activity is likely associated with endogenous lipid antigens carried by lipoproteins in the circulation and perhaps also in the atherosclerotic plaque.

  13. Elimination of metastatic melanoma using gold nanoshell-enabled photothermal therapy and adoptive T cell transfer.

    Directory of Open Access Journals (Sweden)

    Adham S Bear

    Full Text Available Ablative treatments such as photothermal therapy (PTT are attractive anticancer strategies because they debulk accessible tumor sites while simultaneously priming antitumor immune responses. However, the immune response following thermal ablation is often insufficient to treat metastatic disease. Here we demonstrate that PTT induces the expression of proinflammatory cytokines and chemokines and promotes the maturation of dendritic cells within tumor-draining lymph nodes, thereby priming antitumor T cell responses. Unexpectedly, however, these immunomodulatory effects were not beneficial to overall antitumor immunity. We found that PTT promoted the infiltration of secondary tumor sites by CD11b(+Ly-6G/C(+ myeloid-derived suppressor cells, consequently failing to slow the growth of poorly immunogenic B16-F10 tumors and enhancing the growth of distant lung metastases. To exploit the beneficial effects of PTT activity against local tumors and on antitumor immunity whilst avoiding the adverse consequences, we adoptively transferred gp100-specific pmel T cells following PTT. The combination of local control by PTT and systemic antitumor immune reactivity provided by adoptively transferred T cells prevented primary tumor recurrence post-ablation, inhibited tumor growth at distant sites, and abrogated the outgrowth of lung metastases. Hence, the combination of PTT and systemic immunotherapy prevented the adverse effects of PTT on metastatic tumor growth and optimized overall tumor control.

  14. Elimination of metastatic melanoma using gold nanoshell-enabled photothermal therapy and adoptive T cell transfer. (United States)

    Bear, Adham S; Kennedy, Laura C; Young, Joseph K; Perna, Serena K; Mattos Almeida, Joao Paulo; Lin, Adam Y; Eckels, Phillip C; Drezek, Rebekah A; Foster, Aaron E


    Ablative treatments such as photothermal therapy (PTT) are attractive anticancer strategies because they debulk accessible tumor sites while simultaneously priming antitumor immune responses. However, the immune response following thermal ablation is often insufficient to treat metastatic disease. Here we demonstrate that PTT induces the expression of proinflammatory cytokines and chemokines and promotes the maturation of dendritic cells within tumor-draining lymph nodes, thereby priming antitumor T cell responses. Unexpectedly, however, these immunomodulatory effects were not beneficial to overall antitumor immunity. We found that PTT promoted the infiltration of secondary tumor sites by CD11b(+)Ly-6G/C(+) myeloid-derived suppressor cells, consequently failing to slow the growth of poorly immunogenic B16-F10 tumors and enhancing the growth of distant lung metastases. To exploit the beneficial effects of PTT activity against local tumors and on antitumor immunity whilst avoiding the adverse consequences, we adoptively transferred gp100-specific pmel T cells following PTT. The combination of local control by PTT and systemic antitumor immune reactivity provided by adoptively transferred T cells prevented primary tumor recurrence post-ablation, inhibited tumor growth at distant sites, and abrogated the outgrowth of lung metastases. Hence, the combination of PTT and systemic immunotherapy prevented the adverse effects of PTT on metastatic tumor growth and optimized overall tumor control.

  15. Technical Considerations for the Generation of Adoptively Transferred T Cells in Cancer Immunotherapy

    Directory of Open Access Journals (Sweden)

    Anthony Visioni


    Full Text Available A significant function of the immune system is the surveillance and elimination of aberrant cells that give rise to cancer. Even when tumors are well established and metastatic, immune-mediated spontaneous regressions have been documented. While there are have been various forms of immunotherapy, one of the most widely studied for almost 40 years is adoptive cellular immunotherapy, but its success has yet to be fully realized. Adoptive cell transfer (ACT is a therapeutic modality that has intrigued physicians and researchers for its many theoretical benefits. Preclinical investigations and human trials have utilized natural killer (NK cells, dendritic cells (DC, macrophages, T-cells or B-cells for ACT with the most intense research focused on T-cell ACT. T-cells are exquisitely specific to the target of its T-cell receptor (TCR, thus potentially reducing the amount of collateral damage and off-target effects from treatment. T-cells also possess a memory subset that may reduce the risk of recurrence of a cancer after the successful treatment of the primary disease. There are several options for the source of T-cells used in the generation of cells for ACT. Perhaps the most widely known source is T-cells generated from tumor-infiltrating lymphocytes (TILs. However, studies have also employed peripheral blood mononuclear cells (PBMCs, lymph nodes, and even induced pluripotent stem cells (IPSCs as a source of T-cells. Several important technical considerations exist regarding benefits and limitations of each source of T-cells. Unique aspects of T-cells factor into their ability to be efficacious in ACT including the total number of cells available for ACT, the anti-tumor efficacy on a per cell basis, the repertoire of TCRs specific to tumor cells, and their ability to traffic to various organs that harbor tumor. Current research is attempting to unlock the full potential of these cells to effectively and safely treat cancer.

  16. Physicians’ experience adopting the electronic transfer of care communication tool: barriers and opportunities

    Directory of Open Access Journals (Sweden)

    de Grood C


    Full Text Available Chloe de Grood, Katherine Eso, Maria Jose Santana Department of Community Health Sciences, W21C Research and Innovation Centre, Institute of Public Health, University of Calgary, Calgary, AB, Canada Purpose: The purpose of this study was to assess physicians' perceptions on a newly developed electronic transfer of care (e-TOC communication tool and identify barriers and opportunities toward its adoption. Participants and methods: The study was conducted in a tertiary care teaching center as part of a randomized controlled trial assessing the efficacy of an e-TOC communication tool. The e-TOC technology was developed through iterative consultation with stakeholders. This e-TOC summary was populated by acute care physicians (AcPs and communicated electronically to community care physicians (CcPs. The AcPs consisted of attending physicians, resident trainees, and medical students rotating through the Medical Teaching Unit. The CcPs were health care providers caring for patients discharged from hospital to the community. AcPs and CcPs completed validated surveys assessing their experience with the newly developed e-TOC tool. Free text questions were added to gather general comments from both groups of physicians. Units of analysis were individual physicians. Data from the surveys were analyzed using mixed methods. Results: AcPs completed 138 linked pre- and post-rotation surveys. At post-rotation, each AcP completed an average of six e-TOC summaries, taking an average of 37 minutes per e-TOC summary. Over 100 CcPs assessed the quality of the TOC summaries, with an overall rating of 8.3 (standard deviation: 1.48; on a scale of 1–10. Thematic analyses revealed barriers and opportunities encountered by physicians toward the adoption of the e-TOC tool. While the AcPs highlighted issues with timeliness, usability, and presentation, the CcPs identified barriers accessing the web-based TOC summaries, emphasizing that the summaries were timely and the

  17. Ctla-4 blockade plus adoptive T-cell transfer promotes optimal melanoma immunity in mice. (United States)

    Mahvi, David A; Meyers, Justin V; Tatar, Andrew J; Contreras, Amanda; Suresh, Marulasiddappa; Leverson, Glen E; Sen, Siddhartha; Cho, Clifford S


    Immunotherapeutic approaches to the treatment of advanced melanoma have relied on strategies that augment the responsiveness of endogenous tumor-specific T-cell populations [eg, cytotoxic T lymphocyte-associated antigen 4 (CTLA-4) blockade-mediated checkpoint inhibition] or introduce exogenously prepared tumor-specific T-cell populations [eg, adoptive cell transfer (ACT)]. Although both approaches have shown considerable promise, response rates to these therapies remain suboptimal. We hypothesized that a combinatorial approach to immunotherapy using both CTLA-4 blockade and nonlymphodepletional ACT could offer additive therapeutic benefit. C57BL/6 mice were inoculated with syngeneic B16F10 melanoma tumors transfected to express low levels of the lymphocytic choriomeningitis virus peptide GP33 (B16GP33), and treated with no immunotherapy, CTLA-4 blockade, ACT, or combination immunotherapy of CTLA-4 blockade with ACT. Combination immunotherapy resulted in optimal control of B16GP33 melanoma tumors. Combination immunotherapy promoted a stronger local immune response reflected by enhanced tumor-infiltrating lymphocyte populations, and a stronger systemic immune responses reflected by more potent tumor antigen-specific T-cell activity in splenocytes. In addition, whereas both CTLA-4 blockade and combination immunotherapy were able to promote long-term immunity against B16GP33 tumors, only combination immunotherapy was capable of promoting immunity against parental B16F10 tumors as well. Our findings suggest that a combinatorial approach using CTLA-4 blockade with nonlymphodepletional ACT may promote additive endogenous and exogenous T-cell activities that enable greater therapeutic efficacy in the treatment of melanoma.

  18. Transfer and adoption of advanced information technology solutions in resource-poor environments: the case of telemedicine systems adoption in Ethiopia. (United States)

    Kifle, Mengistu; Payton, Fay Cobb; Mbarika, Victor; Meso, Peter


    The study of the adoption of information technology (IT) by individuals has taken two approaches, one emphasizing rationalistic goal-oriented behavior and the other focusing on poignant forces that influence an individual's reaction to a new IT. These approaches are not necessarily mutually exclusive. Individuals' acceptance and subsequent usage of a new IT is predicated on both. Additionally, the tendency in past studies has been to examine either the rational or the poignant factors in the context of a "resource-rich" environment-one in which there is an abundance of IT, adequate infrastructure, and a high level of acculturation to technology solutions. Consequently, there is a clear need for the examination of these factors in resource-poor environments, where assumptions on technology abundance and technology culturation do not hold. We empirically test a model that explains the intention of physicians in a resource-poor environment (epitomized by rural Ethiopia) to adopt telemedicine systems. This model integrates the rational factors driving goal-oriented behavior with the poignant/emotive factors that are an innate part of each adopter's reaction to the new technology. We use the model to expose salient contextual factors that explain the acceptance behavior of individuals toward complex information and communications technology (ICT) solutions and implications of these on the management of technology transfer initiatives in a resource-poor environment. The model is parsimonious, yet explains 28% of the variance in the intention to adopt telemedicine systems and 58% in perceived ease of use. The theoretical and practical implications of this model are discussed. Namely, Sub-Saharan African, in general, and Ethiopian culture, in particular, plays an integral role in the adoption of ICT solutions. Organizational positions and roles among physicians, clinical professionals, and superiors stand to impact the adoption of telemedicine and other healthcare

  19. Stable activity of diabetogenic cells with age in NOD mice: dynamics of reconstitution and adoptive diabetes transfer in immunocompromised mice. (United States)

    Kaminitz, Ayelet; Mizrahi, Keren; Ash, Shifra; Ben-Nun, Avi; Askenasy, Nadir


    The non-obese diabetic (NOD) mouse is a prevalent disease model of type 1 diabetes. Immune aberrations that cause and propagate autoimmune insulitis in these mice are being continually debated, with evidence supporting both dominance of effector cells and insufficiency of suppressor mechanisms. In this study we assessed the behaviour of NOD lymphocytes under extreme expansion conditions using adoptive transfer into immunocompromised NOD.SCID (severe combined immunodeficiency) mice. CD4(+)  CD25(+) T cells do not cause islet inflammation, whereas splenocytes and CD4(+)  CD25(-) T cells induce pancreatic inflammation and hyperglycaemia in 80-100% of the NOD.SCID recipients. Adoptively transferred effector T cells migrate to the lymphoid organs and pancreas, proliferate, are activated in the target organ in situ and initiate inflammatory insulitis. Reconstitution of all components of the CD4(+) subset emphasizes the plastic capacity of different cell types to adopt effector and suppressor phenotypes. Furthermore, similar immune profiles of diabetic and euglycaemic NOD.SCID recipients demonstrate dissociation between fractional expression of CD25 and FoxP3 and the severity of insulitis. There were no evident and consistent differences in diabetogenic activity and immune reconstituting activity of T cells from pre-diabetic (11 weeks) and new onset diabetic NOD females. Similarities in immune phenotypes and variable distribution of effector and suppressor subsets in various stages of inflammation commend caution in interpretation of quantitative and qualitative aberrations as markers of disease severity in adoptive transfer experiments.

  20. [Adoptive transfer of immunity against Nippostrongylus brasiliensis in mice. In vitro restimulation of immune cells before their transfer]. (United States)

    Rhalem, A; Bourdieu, C; Luffau, G; Péry, P


    When mesenteric lymph node cells from infected mice were stimulated during an in vitro culture with exoantigens or with a purified protective antigen of Nippostrongylus brasiliensis, a drop was noted in the number of cells required to transfer protection to new mice. A maximal effect was already obtained after 4 hrs. of culture, but irradiated cells or cells from another mouse strain were unable to mediate this transfer. T cells were more effective than B cells in transferring the protection.

  1. Activation of "eclipsed" lymphoid cells from advanced tumor-bearing mice through adoptive transfer to sublethally irradiated syngeneic hosts. (United States)

    Youn, J K; Le Francois, D; Hue, G; Santillana, M; Barski, G


    Immunologically inactive or "eclipsed" lymphoid cells from advanced tumor-bearing mice were investigated following their adoptive transfer to irradiated syngeneic hosts. Experiments were performed with two syngeneic tumor-host system: the T5-BALB/c tumor line chronically infected with a low-leukemogenic Rauscher virus variant and the TM1-C3H tumor line developed from a spontaneous C3H/He mouse mammary tumor. In confirmation of our previous data, peritoneal cells (PC) from advanced tumor-bearing mice (EPC) appeared to have lost any capacity to inhibit specifically the growth of corresponding tumor target cells in vitro colony inhibition (CI) tests, whereas PC from immunized mice (IPC) were perfectly active. When these EPC were adoptively transferred by intraperitoneal inoculation into sublethally irradiated (450 R) syngeneic mice in association with respective tumor extracts (TE), the PC from such recipient mice, taken 5 to 13 days later, were nearly as active in in vitro CI tests as were PC from parallel IPC-recipient mice. For this recovery of specific immunological activity following the adoptive transfer of EPC the adjunction of the TE and irradiation of the recipient animals seem important and may be necessary. On the other hand, no specific immunological activity was seen in PC from irradiated mice to which PC from normal mice had been transferred with TE. In addition to the in vitro results, an effect of adoptive transfer of EPC (retardation of tumor growth) was also observed in vivo. It is concluded that the "eclipsed" immunologically inactive state of the EPC in mice bearing advanced tumor is not irreversible and that activation of these cells can occur in vivo under certain conditions helped by the presence of tumor-specific antigenic stimulus.

  2. Desiccation of adhering and biofilm Listeria monocytogenes on stainless steel: Survival and transfer to salmon products

    DEFF Research Database (Denmark)

    Hansen, Lisbeth Truelstrup; Vogel, Birte Fonnesbech


    The foodborne bacterial pathogen, Listeria monocytogenes, commonly contaminates foods during processing, where the microorganisms are potentially subjected to low relative humidity (RH) conditions for extended periods of time. The objective of this study was to examine survival during desiccation...... (43% RH and 15°C) of biofilm L. monocytogenes N53-1 cells on stainless steel coupons and to assess subsequent transfer to salmon products. Formation of static biofilm (2days at 100% RH and 15°C) prior to desiccation for 23days significantly (P...

  3. Development of an Autologous Macrophage-based Adoptive Gene Transfer Strategy to Treat Posttraumatic Osteoarthritis (PTOA) and Osteoarithritis (OA) (United States)


    of the diseases. The proposed study will test two hypotheses: 1) the autologous macrophage-based adoptive gene transfer strategy can effectively...12% of all OA are resulted from an acute trauma to the joint and are referred to as PTOA [1]. It is estimated that the total cost of OA cases is...and medications. Joint replacement surgery may also be required in eroding forms of arthritis . Medications can help reduce inflammation in the joint

  4. Development of allogeneic NK cell adoptive transfer therapy in metastatic melanoma patients: in vitro preclinical optimization studies.

    Directory of Open Access Journals (Sweden)

    Michal J Besser

    Full Text Available Natural killer (NK cells have long been considered as potential agents for adoptive cell therapy for solid cancer patients. Until today most studies utilized autologous NK cells and yielded disappointing results. Here we analyze various modular strategies to employ allogeneic NK cells for adoptive cell transfer, including donor-recipient HLA-C mismatching, selective activation and induction of melanoma-recognizing lysis receptors, and co-administration of antibodies to elicit antibody-dependent cell cytotoxicity (ADCC. We show that NK cell activation and induction of the relevant lysis receptors, as well as co-administration of antibodies yield substantial anti-cancer effects, which are functionally superior to HLA-C mismatching. Combination of the various strategies yielded improved effects. In addition, we developed various clinically-compatible ex vivo expansion protocols that were optimized according to fold expansion, purity and expression of lysis receptors. The main advantages of employing allogeneic NK cells are accessibility, the ability to use a single donor for many patients, combination with various strategies associated with the mechanism of action, e.g. antibodies and specific activation, as well as donor selection according to HLA or CD16 genotypes. This study rationalizes a clinical trial that combines adoptive transfer of highly potent allogeneic NK cells and antibody therapy.

  5. Interorganizational transfer of technology - A study of adoption of NASA innovations (United States)

    Chakrabarti, A. K.; Rubenstein, A. H.


    The paper describes a study on the effects of top management support, various techno-economic factors, organizational climate, and decision-making modes on the adoption of NASA innovations. Field research consisted of interviews and questionnaires directed to sixty-five organizations. Forty-five test cases where different decisions for adoption of ideas for new products or processes were made on NASA Tech Briefs were studied in relation to the effects of various factors on the degree of success of adoption, including: (1) the degree of general connection of the technology to the firm's existing operation, (2) the specificity of the relationship between the technology and some existing and recognized problem, (3) the degree of urgency of the problem to which the technology was related, (4) maturity of technology available to implement the technology, (5) availability of personnel and financial resources to implement the technology, (6) degree of top management interest, (7) the use of confrontation in joint-decision, (8) the use of smoothing in decision-making, and (9) the use of forcing in decision-making. It was found that top managements interest was important in the product cases only, and that the success of process innovations was dependent on the quality of information and the specificity of the relationship between the technology and some recognized existing problem.

  6. Myosin Specific-T Lymphocytes Mediated Myocardial Inflammation in Adoptive Transferred Rats

    Institute of Scientific and Technical Information of China (English)

    Jin Zhang; Yuhua Liao; Xiang Cheng; Jing Chen; Peng Chen; Xiang Gao; Zhengjenny Zhang


    Myosin specific-T lymphocytes might mediate myocardial inflammation and remodeling after AMI. Myosinactivated or unactivated T lymphocytes in vitro were transferred into naǐve syngeneic rats, respectively. T lymphocyte infiltration and myocyte apoptosis were explored by the H&E and TUNNEL. Proteins and mRNA levels of cytokines (IL-1β, IL-6 and TNF-α) in myocardium were determined by RT-PCR and immunohistochemistry. T lymphocyte infiltration was evidently observed after one week of activated T cell transfer. The expressions of cytokines were elevated markedly one week later. The myocyte apoptosis occurred after T lymphocyte infiltration in myocardium. Our findings suggest that cardiac myosin activated-T lymphocytes may mediate myocardial inflammation and remodeling.

  7. The immunologic profile of adoptively transferred lymphocytes influences stroke outcome of recipients☆ (United States)

    Zierath, Dannielle; Schulze, Juliane; Kunze, Allison; Drogomiretskiy, Olga; Nhan, Derek; Jaspers, Brett; Dressel, Alexander; Becker, Kyra


    Animals that have myelin basic protein (MBP) specific lymphocytes with a Th1(+) phenotype have worse stroke outcome than those that do not. Whether these MBP specific cells contribute to worsened outcome or are merely a consequence of worse outcome is unclear. In these experiments, lymphocytes were obtained from donor animals one month after stroke and transferred to naïve recipient animals at the time of cerebral ischemia. The MBP specific phenotype of donor cells was determined prior to transfer. Animals that received either MBP specific Th1(+) or Th17(+) cells experienced worse neurological outcome, and the degree of impairment correlated with the robustness of MBP specific Th1(+) and Th17(+) responses. These data demonstrate that the immunologic phenotype of antigen specific lymphocytes influences stroke outcome. PMID:23948692

  8. Hymenolepis nana: adoptive transfer of protective immunity and delayed type hypersensitivity response with mesenteric lymph node cells in mice. (United States)

    Asano, K; Muramatsu, K; Okamoto, K


    A marked degree of footpad swelling was observed in BALB/c mice infected with Hymenolepis nana eggs, when soluble egg antigen was injected into their footpads 4 to 21 days after the egg infection, indicating delayed type hypersensitivity responses in infected mice. Adoptive transfer with mesenteric lymph node cells from donor mice (BALB/c strain; +/+) infected with eggs 4 days before cell collection could confer this hypersensitivity to recipient nude mice (BALB/c strain; nu/nu). These mesenteric lymph node cells were then divided into two fractions, blast-enriched and blast-depleted cells, by density gradient centrifugation with Percoll. The recipients intravenously injected with the blast-depleted cell fraction showed a marked increase in footpad thickness, whereas the intravenous transfer of the blast-enriched cell fraction resulted in an insignificant increase in footpad thickness. The transfer of the blast-enriched cell fraction, but not of the blast-depleted cell fraction, conferred a strong adoptive immunity on syngeneic recipient nude mice, when the immunity transferred was assessed by examining cysticercoids developed in the intestinal villi on Day 4 of challenge infection. The lack of delayed type hypersensitivity response in mice that received the blast-enriched cell population was not due to a lack of the capacity of the cells to induce the response, because the cells were capable of inducing a significant increase in thickness of footpads of normal mice when these cells were locally injected into the footpad together with soluble egg antigen.(ABSTRACT TRUNCATED AT 250 WORDS)

  9. Safety and therapeutic efficacy of adoptive p53-specific T cell antigen receptor (TCR) gene transfer



    Immunotherapy with T cells genetically modified by retroviral transfer of tumor-associated antigen (TAA)-specific T cell receptors (TCR) is a promising approach in targeting cancer. Therefore, using a universal TAA to target different tumor entities by only one therapeutic approach was the main criteria for our TAA-specific TCR. Here, an optimized (opt) αβ-chain p53(264-272)-specific and an opt single chain (sc) p53(264-272)-specific TCR were designed, to reduce mispairing reactions of endoge...

  10. Adoptive transfer of MART-1 T cell receptor transgenic lymphocytes and dendritic cell vaccination in patients with metastatic melanoma (United States)

    Chodon, Thinle; Comin-Anduix, Begonya; Chmielowski, Bartosz; Koya, Richard C; Wu, Zhongqi; Auerbach, Martin; Ng, Charles; Avramis, Earl; Seja, Elizabeth; Villanueva, Arturo; McCannel, Tara A.; Ishiyama, Akira; Czernin, Johannes; Radu, Caius G.; Wang, Xiaoyan; Gjertson, David W.; Cochran, Alistair J.; Cornetta, Kenneth; Wong, Deborah J.L.; Kaplan-lefko, Paula; Hamid, Omid; Samlowski, Wolfram; Cohen, Peter A.; Daniels, Gregory A.; Mukherji, Bijay; Yang, Lili; Zack, Jerome A.; Kohn, Donald B.; Heath, James R.; Glaspy, John A.; Witte, Owen N.; Baltimore, David; Economou, James S.; Ribas, Antoni


    Purpose It has been demonstrated that large numbers of tumor-specific T cells for adoptive cell transfer (ACT) can be manufactured by retroviral genetic engineering of autologous peripheral blood lymphocytes and expanding them over several weeks. In mouse models, this therapy is optimized when administered with dendritic cell (DC) vaccination. We developed a short one-week manufacture protocol to determine the feasibility, safety and antitumor efficacy of this double cell therapy. Experimnetal Design A clinical trial (NCT00910650) adoptively transferring MART-1 T cell receptor (TCR) transgenic lymphocytes together with MART-1 peptide pulsed DC vaccination in HLA-A2.1 patients with metastatic melanoma. Autologous TCR transgenic cells were manufactured in 6 to 7 days using retroviral vector gene transfer, and re-infused with (n = 10) or without (n = 3) prior cryopreservation. Results 14 patients with metastatic melanoma were enrolled and nine out of 13 treated patients (69%) showed evidence of tumor regression. Peripheral blood reconstitution with MART-1-specific T cells peaked within two weeks of ACT indicating rapid in vivo expansion. Administration of freshly manufactured TCR transgenic T cells resulted in a higher persistence of MART-1-specific T cells in the blood as compared to cryopreserved. Evidence that DC vaccination could cause further in vivo expansion was only observed with ACT using non-cryopreserved T cells. Conclusion Double cell therapy with ACT of TCR engineered T cells with a very short ex vivo manipulation and DC vaccines is feasible and results in antitumor activity, but improvements are needed to maintain tumor responses. PMID:24634374

  11. Adoptive transfer of helminth antigen-pulsed dendritic cells protects against the development of experimental colitis in mice. (United States)

    Matisz, Chelsea E; Leung, Gabriella; Reyes, Jose Luis; Wang, Arthur; Sharkey, Keith A; McKay, Derek M


    Infection with helminth parasites and treatment with worm extracts can suppress inflammatory disease, including colitis. Postulating that dendritic cells (DCs) participated in the suppression of inflammation and seeking to move beyond the use of helminths per se, we tested the ability of Hymenolepis diminuta antigen-pulsed DCs to suppress colitis as a novel cell-based immunotherapy. Bone marrow derived DCs pulsed with H. diminuta antigen (HD-DCs), or PBS-, BSA-, or LPS-DCs as controls, were transferred into wild-type (WT), interleukin-10 (IL-10) knock-out (KO), and RAG-1 KO mice, and the impact on dinitrobenzene sulphonic acid (DNBS)-induced colitis and splenic cytokine production assessed 72 h later. Mice receiving HD-DCs were significantly protected from DNBS-induced colitis and of the experimental groups only these mice displayed increased Th2 cytokines and IL-10 production. Adoptive transfer of HD-DCs protected neither RAG-1 nor IL-10 KO mice from DNBS-colitis. Furthermore, the transfer of CD4(+) splenocytes from recipients of HD-DCs protected naïve mice against DNBS-colitis, in an IL-10 dependent manner. Thus, HD-DCs are a novel anti-colitic immunotherapy that can educate anti-colitic CD4(+) T cells: mechanistically, the anti-colitic effect of HD-DCs requires that the host has an adaptive immune response and the ability to mobilize IL-10.

  12. Immune tolerance induced by adoptive transfer of dendritic cells in an insulin-dependent diabetes mellitus routine model

    Institute of Scientific and Technical Information of China (English)

    Cheng-liang ZHANG; Xiao-lei ZOU; Jia-bei PENG; Ming XIANG


    Aim: To investigate the effect and underlying mechanisms of inunune-tolerance induced by the adoptive transfer of bone marrow (BM)-derived dendritic cells (DC) in insulin-dependent diabetes mellitus (IDDM) mice. Methods: The IDDM model was established by a low dose of streptozotocin (STZ) in Balb/c mice. Two DC subpopulations were generated from the BM cells with granulocyte-macroph-age colony-stimulating factor with or without interleukin-4. The purity and the T cell stimulatory capability of DC were identified. These cells were used to modu-late autoimmune response in pre-diabetic mice. Blood glucose was examined weekly; pancreas tissues were taken for histopathological analysis, and CD4+ T cells were isolated to detect lymphocyte proliferation by MTT assay and the ratio of CD4+CD25+ T cells by fluorescence-activated cell sorting (FACS). The cytokine secretion was determined by ELISA analysis. Results: Two DC subsets were generated from BM, which have phenotypes of mature DC (mDC) and immature DC (iDC), respectively. The level of blood glucose decreased significantly by transferring iDC (P<0.01) rather than mDC. Less lymphocyte infiltration was ob-served in the islets, and pancreatic structure was intact. In vitro, proliferation of lymphocytes decreased and the proportion of CD4+CD25+ T cells increased remarkably, compared with the mDC-treated groups (P<0.05), which were associ-ated with increased level of the Th2 cytokine and reduced level of the Th1 cytokine after iDC transfer. Conclusion: Our data showed that iDC transfer was able to confer protection to mice from STZ-induced IDDM. The immune-tolerance to IDDM may be associated with promoting the production of CD4+CD25+ T cells and inducing regulatory Th2 responses in vivo.

  13. Passive adoptive transfer of antitumor immunity induced by laser-dye-immunoadjuvant treatment in a rat metastatic breast cancer model (United States)

    Chen, Wei R.; Liu, Hong; Singhal, Anil K.; Nordquist, Robert E.


    The ideal cancer treatment modalities should not only cause tumor regression and eradication but also induce a systemic anti-tumor immunity. This is essential for control of metastatic tumors and for long-term tumor resistance. Laser immunotherapy using a laser, a laser-absorbing dye and an immunoadjuvant has induced such a long-term immunity in treatment of a mammary metastatic tumor. The successfully treated rats established total resistance to multiple subsequent tumor challenges. For further mechanistic studies of the antitumor immunity induced by this novel treatment modality, passive adoptive transfer was performed using splenocytes as immune cells. The spleen cells harvested from successfully treated tumor-bearing rats provided 100% immunity in the naive recipients. The passively protected first cohort rats were immune to tumor challenge with an increased tumor dose; their splenocytes also prevented the establishment of tumor in the second cohort of naive recipient rats. This immunity transfer was accomplished without the usually required T-cell suppression in recipients.

  14. Modulation of tumor response to photodynamic therapy in severe combined immunodeficient (SCID) mice by adoptively transferred lymphoid cells (United States)

    Korbelik, Mladen; Krosl, Gorazd; Krosl, Jana; Dougherty, Graeme J.


    Photodynamic treatment, consisting of intravenous injection of PhotofrinR (10 mg/kg) followed by exposure to 110 J/cm2 of 630 plus or minus 10 nm light 24 hours later, cured 100% of EMT6 tumors (murine mammary sarcoma) growing in syngeneic immunocompetent BALB/C mice. In contrast, the same treatment produced no cures of EMT6 tumors growing in either nude or SCID mice (immunodeficient strains). EMT6 tumors growing in BALB/C and SCID mice showed no difference in either the level of PhotofrinR accumulated per gram of tumor tissue, or the extent of tumor cell killing during the first 24 hours post photodynamic therapy (PDT). In an attempt to improve the sensitivity to PDT of EMT6 tumors growing in SCID mice, these hosts were given either splenic T lymphocytes or whole bone marrow from BALB/C mice. The adoptive transfer of lymphocytes 9 days before PDT was successful in delaying tumor recurrence but produced no cures. A better improvement in PDT response was obtained with tumors growing in SCID mice reconstituted with BALB/C bone marrow (tumor cure rate of 63%). The results of this study demonstrate that, at least with the EMT6 tumor model, antitumor immune activity mediated by lymphoid cell populations makes an important contribution to the curative effect of PDT.

  15. Generation of autologous tumor-specific T cells for adoptive transfer based on vaccination, in vitro restimulation and CD3/CD28 dynabead-induced T cell expansion

    DEFF Research Database (Denmark)

    Brimnes, Marie Klinge; Gang, Anne Ortved; Donia, Marco


    Adoptive cell transfer (ACT) of in vitro expanded autologous tumor-infiltrating lymphocytes (TIL) has been shown to exert therapeutic efficacy in melanoma patients. We aimed to develop an ACT protocol based on tumor-specific T cells isolated from peripheral blood and in vitro expanded by Dynabead...

  16. Combined IL-15 and IL-12 drives the generation of CD34-derived natural killer cells with superior maturation and alloreactivity potential following adoptive transfer

    NARCIS (Netherlands)

    Cany, J.S.; Waart, A.B. van der; Spanholtz, J.; Tordoir, M.; Jansen, J.H.; Voort, R. van der; Schaap, N.P.; Dolstra, H.


    Adoptive transfer of allogeneic natural killer (NK) cells represents a promising treatment approach against cancer, including acute myeloid leukemia (AML). Previously, we reported a cytokine-based culture method for the generation of NK cell products with high cell number and purity. In this system,

  17. High vitamin D3 diet administered during active colitis negatively affects bone metabolism in an adoptive T cell transfer model. (United States)

    Larmonier, C B; McFadden, R-M T; Hill, F M; Schreiner, R; Ramalingam, R; Besselsen, D G; Ghishan, F K; Kiela, P R


    Decreased bone mineral density (BMD) represents an extraintestinal complication of inflammatory bowel disease (IBD). Vitamin D₃ has been considered a viable adjunctive therapy in IBD. However, vitamin D₃ plays a pleiotropic role in bone modeling and regulates the bone formation-resorption balance, depending on the physiological environment, and supplementation during active IBD may have unintended consequences. We evaluated the effects of vitamin D₃ supplementation during the active phase of disease on colonic inflammation, BMD, and bone metabolism in an adoptive IL-10-/- CD4⁺ T cell transfer model of chronic colitis. High-dose vitamin D₃ supplementation for 12 days during established disease had negligible effects on mucosal inflammation. Plasma vitamin D₃ metabolites correlated with diet, but not disease, status. Colitis significantly reduced BMD. High-dose vitamin D₃ supplementation did not affect cortical bone but led to a further deterioration of trabecular bone morphology. In mice fed a high vitamin D₃ diet, colitis more severely impacted bone formation markers (osteocalcin and bone alkaline phosphatase) and increased bone resorption markers, ratio of receptor activator of NF-κB ligand to osteoprotegrin transcript, plasma osteoprotegrin level, and the osteoclast activation marker tartrate-resistant acid phosphatase (ACp5). Bone vitamin D receptor expression was increased in mice with chronic colitis, especially in the high vitamin D₃ group. Our data suggest that vitamin D₃, at a dose that does not improve inflammation, has no beneficial effects on bone metabolism and density during active colitis or may adversely affect BMD and bone turnover. These observations should be taken into consideration in the planning of further clinical studies with high-dose vitamin D₃ supplementation in patients with active IBD.

  18. Adoptive transfer of Mammaglobin-A epitope specific CD8 T cells combined with a single low dose of total body irradiation eradicates breast tumors. (United States)

    Lerret, Nadine M; Rogozinska, Magdalena; Jaramillo, Andrés; Marzo, Amanda L


    Adoptive T cell therapy has proven to be beneficial in a number of tumor systems by targeting the relevant tumor antigen. The tumor antigen targeted in our model is Mammaglobin-A, expressed by approximately 80% of human breast tumors. Here we evaluated the use of adoptively transferred Mammaglobin-A specific CD8 T cells in combination with low dose irradiation to induce breast tumor rejection and prevent relapse. We show Mammaglobin-A specific CD8 T cells generated by DNA vaccination with all epitopes (Mammaglobin-A2.1, A2.2, A2.4 and A2.6) and full-length DNA in vivo resulted in heterogeneous T cell populations consisting of both effector and central memory CD8 T cell subsets. Adoptive transfer of spleen cells from all Mammaglobin-A2 immunized mice into tumor-bearing SCID/beige mice induced tumor regression but this anti-tumor response was not sustained long-term. Additionally, we demonstrate that only the adoptive transfer of Mammaglobin-A2 specific CD8 T cells in combination with a single low dose of irradiation prevents tumors from recurring. More importantly we show that this single dose of irradiation results in the down regulation of the macrophage scavenger receptor 1 on dendritic cells within the tumor and reduces lipid uptake by tumor resident dendritic cells potentially enabling the dendritic cells to present tumor antigen more efficiently and aid in tumor clearance. These data reveal the potential for adoptive transfer combined with a single low dose of total body irradiation as a suitable therapy for the treatment of established breast tumors and the prevention of tumor recurrence.

  19. Immunoenhancing properties of the anti-tumor effects of adoptively transferred T cells with chemotherapeutic cyclophosphamide by co-administration of bone marrow cells

    Directory of Open Access Journals (Sweden)

    Mohamed L. Salem


    Full Text Available In this study we aimed to determine the anti-tumor efficacy of co-treatment of adoptively transferred T cells with bone marrow either harvested from naïve mice or G-CSF activated after treatment with the anti-cancer drug cyclophosphamide (CTX as a source enriched in stem cells. CTX-treated Swiss Albino (CD-1 mice were injected with 2 × 105 Ehrlich ascetic carcinoma (EAC cell line and then adoptively transferred with in vitro co-activated T cells with or without bone marrow one day post CTX treatment. All mice were vaccinated with tumor lysate and Hiltonol®. The results showed that co-transfer of activated T cells with bone marrow provided the highest antitumor effect and induced marked increase in numbers of splenocytes, leucocytes and bone marrow cells. Interestingly, T cells derived from EAC tumor-bearing host induced higher effects than those from normal mice. In sum, our data suggest that combination of CTX and activated transferred T cells with bone marrow induces proliferation and expansion of immune cells, which are functional and can be exploited in vivo to foster more effective antitumor adoptive immunotherapy strategies.

  20. The stoichiometric production of IL-2 and IFN-γ mRNA defines memory T cells that can self-renew after adoptive transfer in humans. (United States)

    Wang, Anran; Chandran, Smita; Shah, Syed A; Chiu, Yu; Paria, Biman C; Aghamolla, Tamara; Alvarez-Downing, Melissa M; Lee, Chyi-Chia Richard; Singh, Sanmeet; Li, Thomas; Dudley, Mark E; Restifo, Nicholas P; Rosenberg, Steven A; Kammula, Udai S


    Adoptive immunotherapy using ex vivo-expanded tumor-reactive lymphocytes can mediate durable cancer regression in selected melanoma patients. Analyses of these trials have associated the in vivo engraftment ability of the transferred cells with their antitumor efficacy. Thus, there is intensive clinical interest in the prospective isolation of tumor-specific T cells that can reliably persist after transfer. Animal studies have suggested that central memory CD8(+) T cells (T(CM)) have divergent capabilities including effector differentiation to target antigen and stem cell-like self-renewal that enable long-term survival after adoptive transfer. We sought to isolate human melanoma-specific T(CM) to define their in vivo fate and function after autologous therapeutic transfer to metastatic patients. To facilitate the high-throughput identification of these rare cells from patients, we report that T(CM) have a defined stoichiometric production of interleukin-2 (IL-2) and interferon-γ (IFN-γ) mRNA after antigen stimulation. Melanoma-specific T cells screened for high relative IL-2 production had a T(CM) phenotype and superior in vitro proliferative capacity compared to cells with low IL-2 production. To investigate in vivo effector function and self-renewal capability, we allowed melanoma-specific T(CM) to undergo in vitro expansion and differentiation into lytic effector clones and then adoptively transferred them back into their hosts. These clones targeted skin melanocytes in all five patients and persisted long term and reacquired parental T(CM) attributes in four patients after transfer. These findings demonstrate the favorable engraftment fitness for human T(CM)-derived clones, but further efforts to improve their antitumor efficacy are still necessary.

  1. Transfer of contaminants from surface to hands : experimental assessment of linearity of the exposure process, adherence to the skin, and area exposed during fixed pressure and repeated contact with surfaces contaminated with a powder

    NARCIS (Netherlands)

    Brouwer, D.H.; Kroese, R.; Hemmen, J.J. van


    Estimation of dermal exposure in the workplace resulting from contact with contaminated surfaces is important in risk assessment. Models have been developed to describe the process of exposure due to transfer, but for major input parameters - that is, contact area surface and adherence - defaults ar

  2. Identification of a Novel Immunodominant HLA-B*07: 02-restricted Adenoviral Peptide Epitope and Its Potential in Adoptive Transfer Immunotherapy. (United States)

    Günther, Patrick S; Peper, Janet K; Faist, Benjamin; Kayser, Simone; Hartl, Lena; Feuchtinger, Tobias; Jahn, Gerhard; Neuenhahn, Michael; Busch, Dirk H; Stevanović, Stefan; Dennehy, Kevin M


    Adenovirus infections of immunocompromised patients, particularly following allogeneic hematopoietic stem cell transplantation, are associated with morbidity and mortality. Immunotherapy by adoptive transfer of hexon-specific and penton-specific T cells has been successfully applied, but many approaches are impeded by the low number of HLA class I-restricted adenoviral peptide epitopes described to date. We use a novel method to identify naturally presented adenoviral peptide epitopes from infected human cells, ectopically expressing defined HLA, using peptide elution and liquid chromatography-mass spectrometry analysis. We show that the previously described HLA-A*01:01-restricted peptide epitope LTDLGQNLLY from hexon protein is naturally presented, and demonstrate the functionality of LTDLGQNLLY-specific T cells. We further identify a novel immunodominant HLA-B*07:02-restricted peptide epitope VPATGRTLVL from protein 13.6 K, and demonstrate the high proliferative, cytotoxic, and IFN-γ-producing capacity of peptide-specific T cells. Lastly, LTDLGQNLLY-specific T cells can be detected ex vivo following adoptive transfer therapy, and LTDLGQNLLY-specific and VPATGRTLVL-specific T cells have memory phenotypes ex vivo. Given their proliferative and cytotoxic capacity, such epitope-specific T cells are promising candidates for adoptive T-cell transfer therapy of adenovirus infection.

  3. Immunomodulatory Effects of Hemagglutinin- (HA- Modified A20 B-Cell Lymphoma Expanded as a Brain Tumor on Adoptively Transferred HA-Specific CD4+ T Cells

    Directory of Open Access Journals (Sweden)

    Valentin P. Shichkin


    Full Text Available Previously, the mouse A20 B-cell lymphoma engineered to express hemagglutinin (HA antigen (A20HA was used as a systemic tumor model. In this work, we used the A20HA cells as a brain tumor. HA-specific CD4+ T cells were transferred intravenously in a tail vein 5 days after A20HA intracranial inoculation and analyzed on days 2, 9, and 16 after the adoptive transfer by different methods. The transferred cells demonstrated state of activation as early as day 2 after the adoptive transfer and most the of viable HA-specific cells became anergic on day 16. Additionally, symptoms of systemic immunosuppression were observed in mice with massive brain tumors at a late stage of the brain tumor progression (days 20–24 after the A20HA inoculation. Despite that, a deal of HA-specific CD4+ T cells kept the functional activity even at the late stage of A20HA tumor growth. The activated HA-specific CD4+ T cells were found also in the brain of brain-tumor-bearing mice. These cells were still responding to reactivation with HA-peptide in vitro. Our data support an idea about sufficient role of both the tumor-specific and -nonspecific mechanisms inducing immunosuppression in cancer patients.

  4. Morphological appearance, content of extracellular matrix and vascular density of lung metastases predicts permissiveness to infiltration by adoptively transferred natural killer and T cells

    DEFF Research Database (Denmark)

    Yang, Q.; Goding, S.; Hagenaars, M.;


    We have recently shown that adoptively transferred, IL-2-activated natural killer (A-NK) cells are able to eliminate well-established B16-F10.P1 melanoma lung metastases. However, some B16-F10.P1 lung metastases were resistant to infiltration by the A-NK cells and also resistant to the A-NK cell....... Analyses of tumors for extracellular matrix (ECM) components and PECAM-1(+) vasculature, revealed that the I-R lesions are hypovascularized and contain very little laminin, collagen and fibronectin. In contrast, the I-P loose tumors are well-vascularized and they contain high amounts of ECM components...

  5. Antibody responses to allergen Lol pIV are suppressed following adoptive transfer of B lymphocytes from the internal image anti-idiotypic antibody-treated mice. (United States)

    Zhou, E M; Kisil, F T


    An internal image anti-idiotypic antibody, designated B1/1, was generated against an idiotope (Id91) of the monoclonal antibody (mAb91) specific for Lol pIV. The administration of B1/1 in PBS, at doses ranging from 100 ng to 100 micrograms/mouse, to syngeneic Balb/c mice resulted in the suppression of the formation of anti-Lol pIV antibodies that possessed the Id91. Spleen cells obtained from the mice 2 weeks after the treatment with B1/1 (25 micrograms/mouse) were adoptively transferred intravenously into the syngeneic recipients which were challenged intraperitoneally with Lol pIV in alum 2 hr after the transfer. The recipients were boosted with Lol pIV 14 days later. It was demonstrated that the transfer of splenic B cells (but not of T cells) from B1/1-treated donors induced a significant suppression of not only the level of IgE and IgG antibodies to Lol pIV, but also the level of antibodies possessing the Id91. Treatment of the B cells with mAb91 plus complement abrogated their ability to transfer the suppression. This study indicates that the treatment with the anti-Id B1/1 generated B cells that were characterized, serologically, as possessing the anti-Id-like antibodies on their surface and were responsible for transferring the suppression of the formation of antibodies to allergen Lol pIV and the expression of Id91.

  6. Application of Adoptive T-Cell Therapy Using Tumor Antigen-Specific T-Cell Receptor Gene Transfer for the Treatment of Human Leukemia

    Directory of Open Access Journals (Sweden)

    Toshiki Ochi


    Full Text Available The last decade has seen great strides in the field of cancer immunotherapy, especially the treatment of melanoma. Beginning with the identification of cancer antigens, followed by the clinical application of anti-cancer peptide vaccination, it has now been proven that adoptive T-cell therapy (ACT using cancer antigen-specific T cells is the most effective option. Despite the apparent clinical efficacy of ACT, the timely preparation of a sufficient number of cancer antigen-specific T cells for each patient has been recognized as its biggest limitation. Currently, therefore, attention is being focused on ACT with engineered T cells produced using cancer antigen-specific T-cell receptor (TCR gene transfer. With regard to human leukemia, ACT using engineered T cells bearing the leukemia antigen-specific TCR gene still remains in its infancy. However, several reports have provided preclinical data on TCR gene transfer using Wilms' tumor gene product 1 (WT1, and also preclinical and clinical data on TCR gene transfer involving minor histocompatibility antigen, both of which have been suggested to provide additional clinical benefit. In this review, we examine the current status of anti-leukemia ACT with engineered T cells carrying the leukemia antigen-specific TCR gene, and discuss the existing barriers to progress in this area.

  7. Policy Borrowing and Transfer, and Policy Convergence: Justifications for the Adoption of the Bologna Process in the CEMAC Region and the Cameroonian Higher Education System through the LMD Reform (United States)

    Eta, Elizabeth Agbor


    The borrowing and transfer of policies, ideas and practices from one system to another may in part explain the convergence of educational systems. Using text documents as research material, this paper examines the adoption and transfer of Bologna Process (BP) ideas in the Economic and Monetary Community of Central Africa (CEMAC) and in the…

  8. Bimodal ex vivo expansion of T cells from patients with head and neck squamous cell carcinoma: a prerequisite for adoptive cell transfer

    DEFF Research Database (Denmark)

    Junker, Niels; Wenandy, Lynn; Dombernowsky, Sarah Louise;


    Abstract Background aims. Adoptive transfer of tumor-infiltrating lymphocytes (TIL) has proven effective in metastatic melanoma and should therefore be explored in other types of cancer. The aim of this study was to examine the feasibility of potentially expanding clinically relevant quantities...... tumors in high-dose interleukin (IL)-2. Secondly, selected bulk cultures were rapidly expanded using anti-CD3 antibody, feeder cells and high-dose IL-2. T-cell subsets were phenotypically characterized using flow cytometry. T-cell receptor (TCR) clonotype mapping was applied to examine clonotype dynamics....... Rapid expansions generated up to 3500-fold expansion of selected TIL cultures within 17 days. The cultures mainly consisted of T-effector memory cells, with varying distributions of CD8(+) and CD4(+) subtypes both among cultures and patients. TCR clonotype mapping demonstrated oligoclonal expanded...

  9. Intestinal barrier dysfunction develops at the onset of experimental autoimmune encephalomyelitis, and can be induced by adoptive transfer of auto-reactive T cells.

    Directory of Open Access Journals (Sweden)

    Mehrnaz Nouri

    Full Text Available Multiple sclerosis (MS is a chronic inflammatory demyelinating disease of the central nervous system with a pathogenesis involving a dysfunctional blood-brain barrier and myelin-specific, autoreactive T cells. Although the commensal microbiota seems to affect its pathogenesis, regulation of the interactions between luminal antigens and mucosal immune elements remains unclear. Herein, we investigated whether the intestinal mucosal barrier is also targeted in this disease. Experimental autoimmune encephalomyelitis (EAE, the prototypic animal model of MS, was induced either by active immunization or by adoptive transfer of autoreactive T cells isolated from these mice. We show increased intestinal permeability, overexpression of the tight junction protein zonulin and alterations in intestinal morphology (increased crypt depth and thickness of the submucosa and muscularis layers. These intestinal manifestations were seen at 7 days (i.e., preceding the onset of neurological symptoms and at 14 days (i.e., at the stage of paralysis after immunization. We also demonstrate an increased infiltration of proinflammatory Th1/Th17 cells and a reduced regulatory T cell number in the gut lamina propria, Peyer's patches and mesenteric lymph nodes. Adoptive transfer to healthy mice of encephalitogenic T cells, isolated from EAE-diseased animals, led to intestinal changes similar to those resulting from the immunization procedure. Our findings show that disruption of intestinal homeostasis is an early and immune-mediated event in EAE. We propose that this intestinal dysfunction may act to support disease progression, and thus represent a potential therapeutic target in MS. In particular, an increased understanding of the regulation of tight junctions at the blood-brain barrier and in the intestinal wall may be crucial for design of future innovative therapies.

  10. Distribution of adoptively transferred porcine T-lymphoblasts tracked by {sup 18}F-2-fluoro-2-deoxy-D-glucose and position emission tomography

    Energy Technology Data Exchange (ETDEWEB)

    Eriksson, Olof, E-mail: [Division of Radiology, Department of Oncology, Radiology, Oncology and Radiation Science, Uppsala University, Uppsala 751 87 (Sweden); Uppsala Imanet AB, GE Healthcare, Uppsala 751 85 (Sweden); Sadeghi, Arian; Carlsson, Bjoern; Eich, Torsten [Division of Immunology, Department of Immunology, Genetics and Pathology, Uppsala University, Uppsala 751 87 (Sweden); Lundgren, Torbjoern [Division of Transplantation Surgery, CLINTEC, Karolinska Institute, Stockholm 171 77 (Sweden); Nilsson, Bo; Toetterman, Thomas; Korsgren, Olle [Division of Immunology, Department of Immunology, Genetics and Pathology, Uppsala University, Uppsala 751 87 (Sweden); Sundin, Anders [Division of Radiology, Department of Oncology, Radiology, Oncology and Radiation Science, Uppsala University, Uppsala 751 87 (Sweden); Department of Radiology, Karolinska University Hospital and Molecular Medicine and Surgery, Karolinska Institute, Stockholm 171 77 (Sweden)


    Introduction: Autologous or allogeneic transfer of tumor-infiltrating T-lymphocytes is a promising treatment for metastatic cancers, but a major concern is the difficulty in evaluating cell trafficking and distribution in adoptive cell therapy. This study presents a method of tracking transfusion of T-lymphoblasts in a porcine model by {sup 18}F-2-fluoro-2-deoxy-D-glucose ([{sup 18}F]FDG) and positron emission tomography. Methods: T-lymphoblasts were labeled with the positron-emitting tracer [{sup 18}F]FDG through incubation. The T-lymphoblasts were administered into the bloodstream, and the distribution was followed by positron emission tomography for 120 min. The cells were administered either intravenously into the internal jugular vein (n=5) or intraarterially into the ascending aorta (n=1). Two of the pigs given intravenous administration were pretreated with low-molecular-weight dextran sulphate. Results: The cellular kinetics and distribution were readily quantifiable for up to 120 min. High (78.6% of the administered cells) heterogeneous pulmonary uptake was found after completed intravenous transfusion. The pulmonary uptake was decreased either by preincubating and coadministrating the T-lymphoblasts with low-molecular-weight dextran sulphate or by administrating them intraarterially. Conclusions: The present work shows the feasibility of quantitatively monitoring and evaluating cell trafficking and distribution following administration of [{sup 18}F]FDG-labeled T-lymphoblasts. The protocol can potentially be transferred to the clinical setting with few modifications.

  11. Adoptive Transfer of Treg Cells Combined with Mesenchymal Stem Cells Facilitates Repopulation of Endogenous Treg Cells in a Murine Acute GVHD Model. (United States)

    Lee, Eun-Sol; Lim, Jung-Yeon; Im, Keon-Il; Kim, Nayoun; Nam, Young-Sun; Jeon, Young-Woo; Cho, Seok-Goo


    Therapeutic effects of combined cell therapy with mesenchymal stem cells (MSCs) and regulatory T cells (Treg cells) have recently been studied in acute graft-versus-host-disease (aGVHD) models. However, the underlying, seemingly synergistic mechanism behind combined cell therapy has not been determined. We investigated the origin of Foxp3+ Treg cells and interleukin 17 (IL-17+) cells in recipients following allogeneic bone marrow transplantation (allo-BMT) to identify the immunological effects of combined cell therapy. Treg cells were generated from eGFP-expressing C57BL/6 mice (Tregegfp cells) to distinguish the transferred Treg cells; recipients were then examined at different time points after BMT. Systemic infusion of MSCs and Treg cells improved survival and GVHD scores, effectively downregulating pro-inflammatory Th×and Th17 cells. These therapeutic effects of combined cell therapy resulted in an increased Foxp3+ Treg cell population. Compared to single cell therapy, adoptively transferred Tregegfp cells only showed prolonged survival in the combined cell therapy group on day 21 after allogeneic BMT. In addition, Foxp3+ Treg cells, generated endogenously from recipients, significantly increased. Significantly higher levels of Tregegfp cells were also detected in aGVHD target organs in the combined cell therapy group compared to the Treg cells group. Thus, our data indicate that MSCs may induce the long-term survival of transferred Treg cells, particularly in aGVHD target organs, and may increase the repopulation of endogenous Treg cells in recipients after BMT. Together, these results support the potential of combined cell therapy using MSCs and Treg cells for preventing aGVHD.

  12. HIV Medication Adherence (United States)

    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 ...

  13. The immunosuppressive effects of phthalocyanine photodynamic therapy in mice are mediated by CD4+ and CD8+ T cells and can be adoptively transferred to naive recipients. (United States)

    Yusuf, Nabiha; Katiyar, Santosh K; Elmets, Craig A


    Photodynamic therapy (PDT) is a promising treatment modality for malignant tumors but it is also immunosuppressive which may reduce its therapeutic efficacy. The purpose of our study was to elucidate the role of CD4+ and CD8+ T cells in PDT immunosuppression. Using silicon phthalocyanine 4 (Pc4) as photosensitizer, nontumor-bearing CD4 knockout (CD4-/-) mice and their wild type (WT) counterparts were subjected to Pc4-PDT in a manner identical to that used for tumor regression (1 cm spot size, 0.5 mg kg(-1) Pc4, 110 J cm(-2) light) to assess the effect of Pc4-PDT on cell-mediated immunity. There was a decrease in immunosuppression in CD4-/- mice compared with WT mice. We next examined the role of CD8+ T cells in Pc4-PDT-induced immunosuppression using CD8-/- mice following the same treatment regimen used for CD4-/- mice. Similar to CD4-/- mice, CD8-/- mice exhibited less immunosuppression than WT mice. Pc4-PDT-induced immunosuppression could be adoptively transferred with spleen cells from Pc4-PDT treated donor mice to syngenic naive recipients (P PDT-induced immunosuppression but do not affect PDT-induced regression of tumors may prove superior to PDT alone in promoting long-term antitumor responses.

  14. Generation of autologous tumor-specific T cells for adoptive transfer based on vaccination, in vitro restimulation and CD3/CD28 dynabead-induced T cell expansion. (United States)

    Brimnes, Marie Klinge; Gang, Anne Ortved; Donia, Marco; Thor Straten, Per; Svane, Inge Marie; Hadrup, Sine Reker


    Adoptive cell transfer (ACT) of in vitro expanded autologous tumor-infiltrating lymphocytes (TIL) has been shown to exert therapeutic efficacy in melanoma patients. We aimed to develop an ACT protocol based on tumor-specific T cells isolated from peripheral blood and in vitro expanded by Dynabeads® ClinExVivo™CD3/CD28. We show here that the addition of an in vitro restimulation step with relevant peptides prior to bead expansion dramatically increased the proportion of tumor-specific T cells in PBMC-cultures. Importantly, peptide-pulsed dendritic cells (DCs) as well as allogeneic tumor lysate-pulsed DCs from the DC vaccine preparation could be used with comparable efficiency to peptides for in vitro restimulation, to increase the tumor-specific T-cell response. Furthermore, we tested the use of different ratios and different types of Dynabeads® CD3/CD28 and CD3/CD28/CD137 T-cell expander, for optimized expansion of tumor-specific T cells. A ratio of 1:3 of Dynabeads® CD3/CD28 T-cell expander to T cells resulted in the maximum number of tumor-specific T cells. The addition of CD137 did not improve functionality or fold expansion. Both T-cell expansion systems could generate tumor-specific T cells that were both cytotoxic and effective cytokine producers upon antigen recognition. Dynabeads®-expanded T-cell cultures shows phenotypical characteristics of memory T cells with potential to migrate and expand in vivo. In addition, they possess longer telomeres compared to TIL cultures. Taken together, we demonstrate that in vitro restimulation of tumor-specific T cells prior to bead expansion is necessary to achieve high numbers of tumor-specific T cells. This is effective and easily applicable in combination with DC vaccination, by use of vaccine-generated DCs, either pulsed with peptide or tumor-lysate.

  15. Adoptive Transfer of Engineered Rhesus Simian Immunodeficiency Virus-Specific CD8+ T Cells Reduces the Number of Transmitted/Founder Viruses Established in Rhesus Macaques. (United States)

    Ayala, Victor I; Trivett, Matthew T; Barsov, Eugene V; Jain, Sumiti; Piatak, Michael; Trubey, Charles M; Alvord, W Gregory; Chertova, Elena; Roser, James D; Smedley, Jeremy; Komin, Alexander; Keele, Brandon F; Ohlen, Claes; Ott, David E


    AIDS virus infections are rarely controlled by cell-mediated immunity, in part due to viral immune evasion and immunodeficiency resulting from CD4(+) T-cell infection. One likely aspect of this failure is that antiviral cellular immune responses are either absent or present at low levels during the initial establishment of infection. To test whether an extensive, timely, and effective response could reduce the establishment of infection from a high-dose inoculum, we adoptively transferred large numbers of T cells that were molecularly engineered with anti-simian immunodeficiency virus (anti-SIV) activity into rhesus macaques 3 days following an intrarectal SIV inoculation. To measure in vivo antiviral activity, we assessed the number of viruses transmitted using SIVmac239X, a molecularly tagged viral stock containing 10 genotypic variants, at a dose calculated to transmit 12 founder viruses. Single-genome sequencing of plasma virus revealed that the two animals receiving T cells expressing SIV-specific T-cell receptors (TCRs) had significantly fewer viral genotypes than the two control animals receiving non-SIV-specific T cells (means of 4.0 versus 7.5 transmitted viral genotypes; P = 0.044). Accounting for the likelihood of transmission of multiple viruses of a particular genotype, the calculated means of the total number of founder viruses transmitted were 4.5 and 14.5 in the experimental and control groups, respectively (P = 0.021). Thus, a large antiviral T-cell response timed with virus exposure can limit viral transmission. The presence of strong, preexisting T-cell responses, including those induced by vaccines, might help prevent the establishment of infection at the lower-exposure doses in humans that typically transmit only a single virus.

  16. Adherence to antidepressants

    Directory of Open Access Journals (Sweden)

    Abimbola Farinde


    Full Text Available While major depression is considered a frequent mental illness there are ongoing reports of high non-adherence to antidepressant medications which places suffers at high risk for relapse, recurrence, or greater impairment,. The World Health Organization (WHO defines adherence as the extent to which a person′s behavior (e.g. taking medications can align with the agreed recommendations of a health care provider. Unfortunately while patient may recognize the importance of adherence to antidepressant medications the majority of patients do not adhere to their prescribed antidepressants. Some of the factors that may contribute to or lead to non-adherence include knowingly or unknowingly missing doses, taking extra doses, delaying administration times, or taking drug holidays. Pharmacists have the unique ability to deter non-adherence through the performance of continuous assessment and monitoring of adherence in this population given these accessibility. Additionally, pharmacists are able to develop therapeutic alliances with patients that can help to increase the likelihood of achieving positive patient outcomes. Antidepressant non-adherence can be viewed as a significant public health concern so it is important for patients to be educated about the importance of adherence, and health care professionals should be aware of factors or patient characteristics that can serve as barriers to non-adherence.

  17. An Adherence Semigroup

    Institute of Scientific and Technical Information of China (English)


    By a dynamical system we mean a pair of (X,T), where X is compact Hausdorff space. In this paper we define an adherence semigroup A(X,T)∈XX, which is the set of all pointwise limit of subnets of (Tn)n∈N. We will prove some commonness between adherence semigroup and Ellis semigroup.

  18. Cryopreservation of adherent neuronal networks. (United States)

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


    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.

  19. HIV Treatment Adherence (United States)

    ... Viral Suppression Doctor, Clinical & Dental Visits Treatment Adherence Mental Health Substance Abuse Issues Sexual Health Nutrition & Food Safety Exercise Immunizations Aging with HIV/AIDS Women’s Health Housing ...

  20. Questions about Adoption (United States)

    ... more about their How-to-Adopt and Adoption Parenting Network . Q: What are the different types of adoption? A: Children can be adopted through the national public child welfare system, private ...

  1. Factors influencing adherence among older people with osteoarthritis. (United States)

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


    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.

  2. The Use of Video in Knowledge Transfer of Teacher-Led Psychosocial Interventions: Feeling Competent to Adopt a Different Role in the Classroom (L'utilisation de la vidéo dans le transfert de connaissances dans les interventions psychosociales menées par les enseignants : sentir que l'on a la compétence d'adopter un rôle différent dans la salle de classe) (United States)

    Beauregard, Caroline; Rousseau, Cécile; Mustafa, Sally


    Because they propose a form of modeling, videos have been recognised to be useful to transfer knowledge about practices requiring teachers to adopt a different role. This paper describes the results of a satisfaction survey with 98 teachers, school administrators and professionals regarding their appreciation of training videos showing teacher-led…


    Directory of Open Access Journals (Sweden)

    Ramona DUMITRIU


    Full Text Available This paper explores the monetary expectations induced to the managers of Romanian firms by adheration. It is based on an investigation among twenty Romanian executives regarding the impact on adheration over monetary aspects: inflation, exchange rates and adoption of euro. We conclude that the results of the monetary policy in the last years made the executives confident that the Romanian authorities could maintain the monetary stability after theadheration.

  4. Adoptive transfer of bone marrow-derived dendritic cells decreases inhibitory and regulatory T-cell differentiation and improves survival in murine polymicrobial sepsis. (United States)

    Wang, Hong-Wei; Yang, Wen; Gao, Lei; Kang, Jia-Rui; Qin, Jia-Jian; Liu, Yue-Ping; Lu, Jiang-Yang


    A decrease in the number of dendritic cells (DCs) is a major cause of post-sepsis immunosuppression and opportunistic infection and is closely associated with poor prognosis. Increasing the number of DCs to replenish their numbers post sepsis can improve the condition. This therapeutic approach could improve recovery after sepsis. Eighty C57BL/6 mice were subjected to sham or caecal ligation and puncture (CLP) surgery. Mice were divided into four groups: (i) Sham + vehicle, (ii) Sham + DC, (iii) CLP + vehicle, and (iv) CLP + DC. Bone-marrow-derived DCs (BMDCs) were administered at 6, 12 and 24 hr after surgery. After 3 days, we assessed serum indices of organ function (alanine aminotransferase, aspartate aminotransferase, creatinine, amylase and lipase), organ tissue histopathology (haematoxylin and eosin staining), cytokine [interferon-γ (IFN-γ), tumour necrosis factor-α, interleukin-12p70 (IL-12p70), IL-6 and IL-10] levels in the serum, programmed death-1 (PD-1) expression on T cells, regulatory T-cell differentiation in the spleen, and the survival rate (monitored for 7 days). BMDC transfer resulted in the following changes: a significant reduction in damage to the liver, kidney and pancreas in the CLP-septic mice as well as in the pathological changes seen in the liver, lung, small intestine and pancreas; significantly elevated levels of the T helper type 1 (Th1) cytokines IFN-γ and IL-12p70 in the serum; decreased levels of the Th2 cytokines IL-6 and IL-10 in the serum; reduced expression of PD-1 molecules on CD4(+) T cells; reduced the proliferation and differentiation of splenic suppressor T cells and CD4(+)  CD25(+)  Foxp3(+) regulatory T cells, and a significant increase in the survival rate of the septic animals. These results show that administration of BMDCs may have modulated the differentiation and immune function of T cells and contributed to alleviate immunosuppression, hence reducing organ damage and mortality post sepsis. Hence

  5. Technology transfer trends in Indian space programme (United States)

    Sridhara Murthi, K. R.; Shoba, T. S.


    Indian space programme, whose objectives involve acceleration of economic and social development through applications of space technology, has been engaged in the development of state-of-the-art satellite systems, launch vehicles and equipment necessary for applications. Even during the early phase of evolution of this Programme, deliberate policies have been adopted by the national space agency, namely, Indian Space Research Organisation (ISRO), to promote spin-off benefit from the technologies developed for the use of space projects. Consistently adhering to this policy, ISRO has transferred over 280 technologies till date, spanning a wide spectrum of disciplines. This has resulted in a fruitful two-way cooperation between a number of SMEs and the ISRO. In order to make the technology transfer process effective, ISRO has adopted a variety of functional and organizational policies that included awareness building measures, licensee selection methods, innovative contract systems, diverse transfer processes, post licencing services and feedback mechanisms. Besides analyzing these policies and their evolution, the paper discusses various models adopted for technology transfer and their impact on assessment. It also touches upon relevant issues relating to creating interface between public funded R&D and the private commercial enterprises. It suggests few models in which international cooperation could be pursued in this field.

  6. The Problem of Exercise Adherence: Fighting Sloth in Nations with Market Economies. (United States)

    Dishman, Rod K.


    Discusses physical activity and exercise adherence, describing five conundrums that retard advances in knowledge about causal determinants of physical activity and successful interventions that increase physical activity and exercise adherence: adoption versus maintenance; social marketing versus product marketing; mediators of physical activity;…

  7. Adopted Children and Discipline (United States)

    ... Life Listen Español Text Size Email Print Share Adopted Children & Discipline Page Content Article Body Some parents are hesitant to discipline the child they have adopted. They may set fewer limits than they would ...

  8. Abnormal T-cell reactivity against paternal antigens in spontaneous abortion: adoptive transfer of pregnancy-induced CD4+CD25+ T regulatory cells prevents fetal rejection in a murine abortion model. (United States)

    Zenclussen, Ana Claudia; Gerlof, Katrin; Zenclussen, Maria Laura; Sollwedel, André; Bertoja, Annarosa Zambon; Ritter, Thomas; Kotsch, Katja; Leber, Joachim; Volk, Hans-Dieter


    Mammalian pregnancy is thought to be a state of immunological tolerance. The mechanisms underlying this phenomenon are still poorly understood. Here, we determined whether an inappropriate function of T regulatory (Treg) cells is involved in the pathogenesis of spontaneous abortion. We evaluated spleen and decidual lymphocytes from CBA/J mice undergoing immunological abortion (DBA/2J-mated) or having normal pregnancy (BALB/c-mated) on day 14 of gestation for ex vivo cytokine production after PMA or paternal antigen (alloantigen) stimulation. Treg activity was characterized by quantifying CD4(+)CD25(+) cells, foxp3 expression, and interleukin-10 secretion. Decidual lymphocytes from abortion CBA/J mice contained a significantly higher frequency of interferon-gamma-producing T cells specific for paternal antigens compared to those from normal pregnancy (7.8% versus 2.7%, P abortion mice. Very interestingly, CD4(+)CD25(+) Treg cells from normal pregnant and nonpregnant CBA/J mice could inhibit both proliferation and interferon-gamma secretion of lymphocytes from abortion mice in vitro whereas in vivo prevention of fetal rejection could only be achieved after adoptive transfer of Treg cells from normal pregnant mice. Our data suggest that pregnancy-induced Treg cells play a vital role in maternal tolerance to the allogeneic fetus.

  9. Adherence as a language game. (United States)

    Kolberg, Espen Skarstein


    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.

  10. [Adherence to psychopharmacological treatment: Psychotherapeutic strategies to enhance adherence]. (United States)

    Lencer, R; Korn, D


    Effective psychopharmacological medication with good tolerability represents the cornerstone of treatment for severe mental illness; however, the 1-year adherence rates are only approximately 50%. The term adherence emphasizes the collaborative responsibility of the clinician and the patient for a positive treatment outcome. Reasons for non-adherence are manifold and include patient-specific factors, such as self-stigmatization, lack of social and familial support, cognitive impairment and substance use besides insufficient effectiveness and the occurrence of side effects of the psychotropic drugs. To enhance adherence, both clinician and patient have to fully understand all the reasons for and against adherence to medication before a collaborative decision is made on future long-term treatment. A positive attitude towards medication critically depends on whether patients feel that the medication supports the attainment of the individual goals.

  11. Biologic Influences on Exercise Adherence. (United States)

    Dishman, Rod K.


    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…

  12. The claim from adoption. (United States)

    Petersen, Thomas Sobirk


    In this article several justifications of what I call 'the claim from adoption' are examined. The claim from adoption is that, instead of expending resources on bringing new children into the world using reproductive technology and then caring for these children, we ought to devote these resources to the adoption and care of existing destitute children. Arguments trading on the idea that resources should be directed to adoption instead of assisted reproduction because already existing people can benefit from such a use of resources whereas we cannot benefit individuals by bringing them into existence are rejected. It is then argued that a utilitarian argument proposed by Christian Munthe that supports the claim from adoption in some situations should be rejected because the support it offers does not extend to certain situations in which it seems morally obvious that resources should be expended on adoption rather than assisted reproduction. A version of the Priority View improves upon Munthe's utilitarianism by supporting the claim from adoption in the cases in which Munthe's argument failed. Some allegedly counterintuitive implications of the Priority View are then discussed, and it is concluded that the Priority View is more plausible than utilitarianism. In a concluding section on policy issues it is argued that, even though the claim from adoption can be justified in a variety of situations, it does not follow that, in these situations, governments should direct resources away from assisted reproduction and towards adoption.

  13. The Danish Adoption Register

    DEFF Research Database (Denmark)

    Petersen, Liselotte; Sørensen, Thorkild I A


    The Danish Adoption Register was established in 1963-1964 to explore the genetic and environmental contribution to familial aggregation of schizophrenia.......The Danish Adoption Register was established in 1963-1964 to explore the genetic and environmental contribution to familial aggregation of schizophrenia....

  14. Evaluation of adherence to therapy in patients of chronic kidney disease

    Directory of Open Access Journals (Sweden)

    Smita Sontakke


    Full Text Available Objective: To evaluate adherence to medication and study factors associated with non-adherence in chronic kidney disease (CKD patients. Methods: A prospective, cross-sectional, questionnaire based study was conducted in Nephrology department of a super specialty hospital. Patients above 18 years of age, suffering from CKD from six months or more were interviewed using self-designed, semi-structured questionnaire to get information about adherence to medication, diet restriction and lifestyle modification (n = 150. Morisky medication adherence questionnaire was used to calculate overall adherence. In this higher score indicates poor adherence. Main outcome measures included prevalence of non-adherence and factors associated with the same. Results: Average number of medicines taken by each patient was 8.0+1.612 (mean+SD per day. Non-adherence to medication schedule was reported in 34% patients. Common causes of non-adherence were high cost (21.3%, complex dosing schedule (20%, fear of adverse effects (16%. Sixty-eight% patients were not aware about importance of taking each medicine. Sixteen% stopped taking medicines due to high cost. Forty-two% suggested that government should adopt measures to provide free medicines to poor patients. In Morisky medication adherence questionnaire high, medium and low adherence was reported in 7.3%, 55.3% and 37.3% of patients, respectively. Moderately positive correlation was observed between poor adherence and number of concurrent illnesses and number of medicines taken. Conclusion: Since majority of patients were not aware about importance of taking each medicine, creating awareness about the same is essential for improving adherence to therapy. Measures to provide free medicines to non-affording patients need to be implemented since high cost was other major cause of non-adherence.

  15. The Colorado Adoption Project. (United States)

    Plomin, R; DeFries, J C


    This report provides an overview of the Colorado Adoption Project (CAP), a longitudinal, prospective, multivariate adoption study of behavioral development. Examples of the types of analyses that can be conducted using this design are presented. The examples are based on general cognitive-ability data for adoptive, biological, and control parents; assessments of their home environment; and Bayley Mental Development Index scores for 152 adopted children and 120 matched control children tested at both 1 and 2 years of age. The illustrative analyses include matched control children tested at both 1 and 2 years of age. The illustrative analyses include examination of genetic and environmental sources of variance, identification of environmental influence devoid of genetic bias, assessment of genotype-environment interaction and correlation, and analyses of the etiology of change and continuity in development.

  16. Adopt Your Watershed (United States)

    U.S. Environmental Protection Agency — Adopt Your Watershed is a Website that encourages stewardship of the nation's water resources and serves as a national inventory of local watershed groups and...

  17. Becoming an Adoptive Parent

    DEFF Research Database (Denmark)

    McIlvenny, Paul; Raudaskoski, Pirkko Liisa

    , we trace how adopters publicly narrate their own experiences and problems with fertility and with adoption, as well as how they construct their personal websites, network with others locally and internationally, orient to other ‘sites’ or sources of information, share advice and create 'public goods...... those practices which may precipitate a 'call for help' to distant actors, such as social welfare provision or counselling services....

  18. Adherence to Treatment of Phenylketonuria

    Directory of Open Access Journals (Sweden)

    Tatiane Alves Vieira


    Full Text Available Introduction: Phenylketonuria (PKU is caused by the deficient activity of phenylalanine hydroxylase. Aim: To identify the factors associated with treatment adherence among patients with PKU seen at a southern Brazil reference center. Methodology: A cross-sectional, outpatient-based study including 56 patients with PKU (median age, 12 years for whom a Phe-restrict diet plus specific metabolic formula have been prescribed. Patients were considered adherent or nonadherent depending on the median phenylalanine concentration for the 12 months prior to study and target levels of phenylalanine for each age range (<13 years = ≤360 µmol/L; ≥13 years = ≤900 µmol/L. Data were collected through a review of patient’s medical records and a set of interviews with patients and their relatives. Results: Eighteen patients (32.1%; ≥13 years, 11 were classified as treatment adherent. Among all factors analyzed, only mental retardation, living with parents, and level of maternal education were associated with adherence to treatment. Conclusion: Our findings reinforce the importance of the family as promoting factor for treatment adherence.

  19. Study of Adherent Oxide Scales (United States)


    The bond between alumina and NiCrAl substrate is intrinsically strong. The segregation of sulfur to the interface reduces bond strength, sulfur is...which laser-processing and minor element additions improve oxide scale adherence of a NiCrAl turbine coating composition. However, it was shown at the...adherence. However, significant observations were made with respect to the morphology of the oxide scale that forms on NiCrAl and NiCrAlY and these are

  20. Beyond the adoption/ non-adoption dichotomy: the impact of innovation characteristics on potential adopters' transition through adoption process stages

    NARCIS (Netherlands)

    Agarwal, M.K.; Frambach, R.T.


    Research on innovation adoption has suffered from a bias towards understanding the factors that affect the dichotomous adoption/non-adoption decision.Much less attention is devoted to the question why potential adopters fail to progress to the adoption stage from earlier stages in the decision makin

  1. Adherence with Preventive Medication in Childhood Asthma

    Directory of Open Access Journals (Sweden)

    Scott Burgess


    Full Text Available Suboptimal adherence with preventive medication is common and often unrecognised as a cause of poor asthma control. A number of risk factors for nonadherence have emerged from well-conducted studies. Unfortunately, patient report a physician's estimation of adherence and knowledge of these risk factors may not assist in determining whether non-adherence is a significant factor. Electronic monitoring devices are likely to be more frequently used to remind patients to take medication, as a strategy to motivate patients to maintain adherence, and a tool to evaluate adherence in subjects with poor disease control. The aim of this paper is to review non-adherence with preventive medication in childhood asthma, its impact on asthma control, methods of evaluating non-adherence, risk factors for suboptimal adherence, and strategies to enhance adherence.

  2. Adoption, nation, migration

    DEFF Research Database (Denmark)

    Müller, Anders Riel


    Som transnationalt adopteret vokser man ofte op med en fortælling om, at man er født i et fattigt land. Og at ens første forældre var fattige eller oplevede så store problemer, at de ikke så andre muligheder end at afgive en til adoption. Det er en historie, man bliver fortalt igen og igen. Og so...

  3. Adherence of Model Molecules to Silica Surfaces: First Principle Calculations (United States)

    Nuñez, Matías; Prado, Miguel Oscar

    The adherence of "model molecules" methylene blue and eosine Y ("positive" and "negatively" charged respectively) to crystal SiO2 surfaces is studied from first principle calculations at the DFT level. Adsorption energies are calculated which follow the experimental threads obtained elsewhere (Rivera et al., 2013). We study the quantum nature of the electronic charge transfer between the surface and the molecules, showing the localized and delocalized patterns associated to the repulsive and attractive case respectively.

  4. Adoption of Broadband Services

    DEFF Research Database (Denmark)

    Falch, Morten


    successful markets for broadband. This is done through analysis of national policies in three European countries-Denmark, Sweden, and Germany-and the U.S., Japan, and South Korea. We concluded that successful implementation of broadband depends on the kind of policy measures to be taken at the national level....... Many countries have provided active support for stimulating diffusion of broadband and national variants of this type of policies in different countries are important for an explanation of national differences in adoption of broadband....

  5. Åben Adoption

    DEFF Research Database (Denmark)

    Jeldtoft, Nadia


    barn adopteres, jo mere stabil og uproblematisk bliver relationen mellem barn og adoptivforældre. Samtidig peger undersøgelserne på, at adoptioner med høj grad af åbenhed og kontakt mellem barn, adoptivforældrene og de biologiske forældre fungerer bedst. Hermed rokkes ved en udbredt forestilling om......Denne rapport er en systematisk forskningsoversigt over udenlandske erfaringer med adoption i forhold til anbringelse uden for hjemmet, fx familiepleje, institutionsanbringelse og hjemgivelse til de biologiske forældre. Konklusionerne i rapporten er overraskende entydige: Adopterede børn klarer sig...

  6. Adherence to the Treatment in Psychiatric Patients

    Directory of Open Access Journals (Sweden)

    Mehmet Emin Demirkol


    Conclusion: Although medical treatments and drug industry develop day by day, there have been no changes in the treatment adherence ratios in the past years. To generate possible solutions, treatment adherence should be assessed in all clinical interviews and if patient is non-adherent this issue should be handled seriously. [Cukurova Med J 2015; 40(3.000: 555-568

  7. After adoption: dissolution or permanence? (United States)

    Festinger, Trudy


    Results are presented on the whereabouts of 516 adopted children, based on a random sample of children adopted from placement in New York City in 1996. Data from interviews with adoptive parents were augmented by information from adoption subsidy records and state child tracking files, as well as interviews with caregivers of children whose adoptive parents were deceased. There were few dissolutions, but postadoption service needs were many.

  8. ATM Technology Adoption in U.S. Campus Networking. (United States)

    Yao, Engui; Perry, John F.; Anderson, Larry S.; Brook, R. Dan; Hare, R. Dwight; Moore, Arnold J.; Xu, Xiaohe

    This study examined the relationships between ATM (asynchronous transfer mode) adoption in universities and four organizational variables: university size, type, finances, and information processing maturity. Another purpose of the study was to identify the current status of ATM adoption in campus networking. Subjects were university domain LAN…

  9. Adherence and health care costs

    Directory of Open Access Journals (Sweden)

    Iuga AO


    Full Text Available Aurel O Iuga,1,2 Maura J McGuire3,4 1Johns Hopkins Bloomberg School of Public Health, 2Johns Hopkins University, 3Johns Hopkins Community Physicians, 4Johns Hopkins University School of Medicine, Baltimore, MD, USA Abstract: Medication nonadherence is an important public health consideration, affecting health outcomes and overall health care costs. This review considers the most recent developments in adherence research with a focus on the impact of medication adherence on health care costs in the US health system. We describe the magnitude of the nonadherence problem and related costs, with an extensive discussion of the mechanisms underlying the impact of nonadherence on costs. Specifically, we summarize the impact of nonadherence on health care costs in several chronic diseases, such as diabetes and asthma. A brief analysis of existing research study designs, along with suggestions for future research focus, is provided. Finally, given the ongoing changes in the US health care system, we also address some of the most relevant and current trends in health care, including pharmacist-led medication therapy management and electronic (e-prescribing. Keywords: patient, medication, adherence, compliance, nonadherence, noncompliance, cost

  10. Tuberculosis treatment adherence and fatality in Spain

    Directory of Open Access Journals (Sweden)

    Vidal Rafael


    Full Text Available Abstract 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

  11. Process of adoption communication openness in adoptive families: adopters’ perspective

    Directory of Open Access Journals (Sweden)

    Maria Acciaiuoli Barbosa-Ducharne


    Full Text Available Abstract Communication about adoption is a family interaction process which is more than the simple exchange of information. Adoption communication can be characterized in terms of the level of openness of family conversations regarding the child’s past and the degree of the family’s adoption social disclosure. The objective of this study is to explore the process of adoption communication openness in Portuguese adoptive families by identifying the impact of variables related to the adoption process, the adoptive parenting and the adoptee. One hundred twenty five parents of children aged 3 to 15, who were adopted on average 4 years ago, participated in this study. Data was collected during home visits using the Parents Adoption Process Interview. A cluster analysis identified three different groups of families according to the level of adoption communication openness within the family and outside. The findings also showed that the process of the adoption communication openness started when parents decided to adopt, developed in parent-child interaction and was susceptible to change under professional intervention. The relevance of training given to prospective adopters and of professional practice based on scientific evidence is highlighted.

  12. Adopting EIL in China

    Institute of Scientific and Technical Information of China (English)



    In this paper, I state my views of the global spread of English. Through analysis of the reasons of the wide spread of EIL, I emphasize that adopting varieties of models is vitally important in relation to English teaching and learning in China, despite a number of obstacles still existing. British, American, Australian, Canada, or any other English should be taught compatibly. No matter what varieties we use, intelligibility is most important among people from other cultures with different linguistic background. Pedagogy should also be adjusted to follow the features of EIL aiming to facilitate learners' communication with people from a wide range of countries and to access the vast amount of information currently available in English. Therefore, supportive policy should be made to both raise all people's awareness of English used internationally and guarantee the need from education practice. Curriculum, without doubt, should include varieties of English in addition to British and American English.

  13. Adherence in paediatric renal failure and dialysis: an ethical analysis of nurses' attitudes and reported practice. (United States)

    Mellor, Joe Scott; Hulton, Sally-Anne; Draper, Heather


    Minors have difficulty adhering to the strict management regimen required whilst on renal dialysis for chronic renal failure. This leads to ethical tensions as healthcare professionals (HCPs) and parents try, in the minor's best interests, to ensure s/he adheres. All 11 dialysis nurses working in a large, regional paediatric dialysis unit were interviewed about their perceptions and management of non-adherence and the ethical issues this raised for them. Participants reported negative attitudes to non-adherence alongside sympathy and feelings of frustration. They discussed the competing responsibilities between nurses, parents and minors, and how responsibility ought to be transferred to the minor as s/he matures; the need for minors to take responsibility ahead of transferring to adult services; and, the process of transferring this responsibility. Our discussion concentrates on the ethical issues raised by the participants' reports of how they respond to non-adherence using persuasion and coercion. We consider how understandings of capacity, traditional individual autonomy, and willpower can be used to comprehend the issue of non-adherence. We consider the relational context in which the minor receives, and participates in, healthcare. This exposes the interdependent triad of relationships between HCP, parent and minor and aids understanding of how to provide care in an ethical way. Relational ethics is a useful alternative understanding for professionals reflecting upon how they define their obligations in this context.

  14. The Texas Adoption Project: adopted children and their intellectual resemblance to biological and adoptive parents. (United States)

    Horn, J M


    Intelligence test scores were obtained from parents and children in 300 adoptive families and compared with similar measures available for the biological mothers of the same adopted children. Results supported the hypothesis that genetic variability is an important influence in the development of individual differences for intelligence. The most salient finding was that adopted children resemble their biological mothers more than they resemble the adoptive parents who reared them from birth. A small subset of the oldest adopted children did not resemble their biological mothers. The suggestion that the influence of genes declines with age is treated with caution since other adoption studies report a trend in the opposite direction.

  15. Adoption Resources for Black Children (United States)

    Gallagher, Ursula M.


    The growing number of adoptions in this country, including racially mixed adoptions, attest to the general acceptance of adoption as a way of bringing love to children in need of families of their own and the satisfactions of parenthood to childless couples, single men and women, and families who have room for one more. (Author/AJ)

  16. Adoption Resource Directory: Region X. (United States)


    State, regional, and national adoption resources are described in this directory for residents of Region X states (Alaska, Idaho, Oregon, and Washington). Emphasizing the adoption of children with special needs, the directory gives organizational contacts for parents in various stages of the adoption process and mentions resources for social…

  17. Intellectual resemblance among adoptive adoptive and biological relatives: the Texas adoption project. (United States)

    Horn, J M; Loehlin, J C; Willerman, L


    Intellectual and personality measures were available from unwed mothers who gave their children up for adoption at birth. The same or similar measures have been obtained from 300 sets of adoptive parents and all of their adopted and natural children in the Texas Adoption Project. The sample characteristics are discussed in detail, and the basic findings for IQ are presented. Initial analyses of the data on IQ suggest moderate heritabilities. Emphasis is placed on the preliminary nature of these findings.

  18. Technology Adoption: an Interaction Perspective (United States)

    Sitorus, Hotna M.; Govindaraju, Rajesri; Wiratmadja, I. I.; Sudirman, Iman


    The success of a new technology depends on how well it is accepted by its intended users. Many technologies face the problem of low adoption rate, despite the benefits. An understanding of what makes people accept or reject a new technology can help speed up the adoption rate. This paper presents a framework for technology adoption based on an interactive perspective, resulting from a literature study on technology adoption. In studying technology adoption, it is necessary to consider the interactions among elements involved in the system, for these interactions may generate new characteristics or new relationships. The interactions among elements in a system adoption have not received sufficient consideration in previous studies of technology adoption. Based on the proposed interaction perspective, technology adoption is elaborated by examining interactions among the individual (i.e. the user or prospective user), the technology, the task and the environment. The framework is formulated by adopting several theories, including Perceived Characteristics of Innovating, Diffusion of Innovation Theory, Technology Acceptance Model, Task-Technology Fit and usability theory. The proposed framework is illustrated in the context of mobile banking adoption. It is aimed to offer a better understanding of determinants of technology adoption in various contexts, including technology in manufacturing systems.

  19. Adopted youth and sleep difficulties

    Directory of Open Access Journals (Sweden)

    Radcliff Z


    Full Text Available Zach Radcliff, Allison Baylor, Bruce Rybarczyk Department of Psychology, Virginia Commonwealth University, Richmond, VA, USA Abstract: Sleep is a critical component of healthy development for youth, with cascading effects on youth’s biological growth, psychological well-being, and overall functioning. Increased sleep difficulties are one of many disruptions that adopted youth may face throughout the adoption process. Sleep difficulties have been frequently cited as a major concern by adoptive parents and hypothesized in the literature as a problem that may affect multiple areas of development and functioning in adopted youth. However, there is limited research exploring this relationship. Using a biopsychosocial framework, this paper reviews the extant literature to explore the development, maintenance, and impact of sleep difficulties in adopted youth. Finally, implications for future research and clinical interventions are outlined. Keywords: adoption, sleep, youth

  20. Intent-to-adhere and adherence to malaria prevention recommendations in two travel clinics. (United States)

    Goldstein, Irit; Grefat, Rami; Ephros, Moshe; Rishpon, Shmuel


    Malaria infects 30,000 travelers annually worldwide. At greatest risk are those who travel for long duration. Prevention of malaria includes chemoprophylaxis. This prospective study on 121 travelers who visited two travel clinics shows that adherence to prophylactic treatment was low, especially in long duration trips, and that adherence rate could be predicted by the much more available intent-to-adhere rate.

  1. Adoption and Assisted Reproduction. Adoption and Ethics, Volume 4. (United States)

    Freundlich, Madelyn

    The controversies in adoption have extended across a spectrum of policy and practice issues, and although the issues have become clear, resolution has not been achieved nor has consensus developed regarding a framework on which to improve the quality of adoption policy and practice. This book is the fourth in a series to use an ethics-based…

  2. Homosexuality and adoption in Brazil. (United States)

    Uziel, A P


    Western societies are undergoing legal and policy changes in relation to laws governing the family, marital status, sexual orientation and the welfare of children, including in Brazil where, in the 1990s, the rights of homosexuals were incorporated into ongoing debates about what constitutes a family. This paper discusses the issue of adoption of children by homosexual men in Brazil, using information from court records from 1995-2000 in Rio de Janeiro, and from interviews with two judges, five psychologists and four social workers who evaluate those wishing to adopt. It uses the case records of one man's application to adopt, in which homosexuality became a central issue. Both the construction of masculinity in relation to parenting and concepts of the family were the parameters upon which the decision to allow him to adopt or not depended. Because the legislation does not specify what the sexual orientation of would-be adoptive parents should be, it is possible for single persons to adopt if they show they can be good parents. As more single people, alone or in couples, seek to adopt, it is important to clarify the criteria for judicial decisions on adoption applications. A dialogue is therefore needed on the meaning of family and whether and how it relates to sexual orientation. It is only on this basis that the courts can take a clear decision as to whether being homosexual is a relevant issue in regard to applications to adopt or not.

  3. Measurement of oxide adherence to PFM alloys. (United States)

    Mackert, J R; Parry, E E; Hashinger, D T; Fairhurst, C W


    A method has been reported for evaluating adherence of an oxide to its substrate metal to a maximum value of about 40 MPa. Oxidized alloy plates were cemented between two aluminum cylinders with a high-strength cyanoacrylate cement and loaded in tension until failure occurred either at the oxide/metal interface, within the oxide layer, or in the cement itself. Significant differences were found among the oxide adherence values obtained from different PFM alloys. The oxides formed on five of the alloys exhibited adherence strengths in excess of the published value for cohesive strength of dental opaque porcelain, indicating that they possess sufficient adherence to act as the transition zone between the porcelain and the alloy. In addition, a correspondence was found between the quality of porcelain bond for a given alloy and its oxide adherence strength. These results remove the principal objection to the oxide-layer theory of porcelain bonding in dental alloy systems and emphasize the importance of oxide adherence in the establishment of a bond. It is therefore suggested that future work devoted to porcelain-metal bonding should seek to elucidate the mechanism of oxide adherence to PFM alloys and explore the development of new alloys which form adherent oxides.

  4. Asthma and Adherence to Inhaled Corticosteroids

    DEFF Research Database (Denmark)

    Bårnes, Camilla Boslev; Ulrik, Charlotte Suppli


    Inhaled corticosteroids (ICS) are the cornerstone of maintenance asthma therapy. However, in spite of this, adherence to ICS remains low. The aim of this systematic literature review was to provide an overview of the current knowledge of adherence to ICS, effects of poor adherence, and means...... was found to be between 22 and 63%, with improvement up to and after an exacerbation. Poor adherence was associated with youth, being African-American, having mild asthma, ... prescribed fixed-combination therapy (ICS and long-acting β2 agonists). Good adherence was associated with higher FEV1, a lower percentage of eosinophils in sputum, reduction in hospitalizations, less use of oral corticosteroids, and lower mortality rate. Overall, 24% of exacerbations and 60% of asthma...

  5. Faculty Adoption of Educational Technology (United States)

    Moser, Franziska Zellweger


    Although faculty support has been identified as a critical factor in the success of educational-technology programs, many people involved in such efforts underestimate the complexities of integrating technology into teaching. In this article, the author proposes an adoption cycle to help tackle the complex issue of technology adoption for…

  6. Healthy Travel for International Adoptions

    Centers for Disease Control (CDC) Podcasts


    The number of international adoptions, many from developing countries, has doubled in the last 10 years. This podcast discusses ways adoptive families can protect their own health and the health of their new children.  Created: 10/22/2007 by National Center for the Prevention, Detection and Control of Infectious Diseases (NCPDCID).   Date Released: 10/24/2007.

  7. Adopting Children with Attachment Problems. (United States)

    Hughes, Daniel A.


    Notes that attachment behavior in infants is a facet of normal child development, and that children with attachment problems require special attention during and after the adoption process. Presents actions needed to increase the probability that such children can be successfully adopted, detailed attachment patterns, and parenting strategies and…

  8. Intra-Firm Adoption Decisions

    NARCIS (Netherlands)

    Y.M. van Everdingen (Yvonne); B. Wierenga (Berend)


    textabstractThe subject of this paper is intra-firm adoption decisions, a relatively unexplored research area in the marketing literature. In particular, we investigate which factors influence the intra-firm adoption decisions regarding the common European currency of the treasury, purchasing and sa

  9. Parents’ Feelings Towards Their Adoptive and Non-Adoptive Children (United States)

    Glover, Marshaun B.; Mullineaux, Paula Y.; Deater-Deckard, Kirby; Petrill, Stephen A.


    In the current study, we examined parent gender differences in feelings (negativity and positivity) and perceptions of child behavioural and emotional problems in adoptive and biological parent–child dyads. In a sample of 85 families, we used a novel within-family adoption design in which one child was adopted and one child was a biological child of the couple, and tested whether the links between parent feelings and child maladjustment included effects of passive gene–environment correlation. Parents reported more negativity and less positivity as well as higher levels of externalizing behaviour for the adopted child compared to the non-adopted child, although effect sizes were small and no longer statistically significant after correcting for multiple comparisons. Fathers and mothers did not differ significantly in their reports of positive and negative feelings towards their children or in regard to child externalizing and internalizing behaviours. The correlations between parental negativity and positivity and child externalizing and internalizing were similar for fathers and mothers, and for adopted and non-adopted children. The findings suggest similar parent–child relationship processes for fathers and mothers, and that genetic transmission of behaviour from parent to child does not account for the association between parental warmth and hostility and child-adjustment problems. PMID:21088705

  10. Transient improvement of urticaria induces poor adherence as assessed by Morisky Medication Adherence Scale-8. (United States)

    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


    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.

  11. Improving adherence with inhaler therapy in COPD

    Directory of Open Access Journals (Sweden)

    Suzanne C Lareau


    Full Text Available Suzanne C Lareau1, Barbara P Yawn21College of Nursing, University of Colorado Denver, Aurora, Colorado; 2Department of Research, Olmsted Medical Center, Rochester, Minnesota, USAAbstract: Chronic obstructive pulmonary disease (COPD is a major public health problem, associated with considerable morbidity and health care costs. The global burden of COPD morbidity is predicted to rise substantially in the coming decade, but could be moderated by better use of existing management strategies. Smoking cessation, medication therapy, and pulmonary rehabilitation have all been shown to diminish morbidity and improve patient outcomes. But each of these strategies requires adherence. Adherence is crucial for optimizing clinical outcomes in COPD, with nonadherence resulting in a significant health and economic burden. Suboptimal medication adherence is common among COPD patients, due to a number of factors that involve the medication, the delivery device, the patient, and the health professionals caring for the patient. Lack of medication adherence needs to be identified and addressed by using simplified treatment regimens, increasing patient knowledge about self-management, and enhancing provider skills in patient education, communication, and adherence counseling. This article reports some of the challenges of medication nonadherence faced by the clinician in the management of COPD, and suggests ways to evaluate and improve adherence effectively in primary care.Keywords: chronic obstructive pulmonary disease, adherence, clinician

  12. Adherence to Antihypertensive Medications in Iranian Patients

    Directory of Open Access Journals (Sweden)

    Azin Behnood-Rod


    Full Text Available 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.

  13. Who takes the medicine? Adherence to antiretroviral therapy in Southern Ethiopia

    Directory of Open Access Journals (Sweden)

    Teshome W


    Full Text Available Wondu Teshome,1 Mihretu Belayneh,1 Mathewos Moges,1 Misganu Endriyas,2 Emebet Mekonnen,2 Sinafiksh Ayele,2 Tebeje Misganaw,2 Mekonnen Shiferaw,2 Palanivel Chinnakali,3 Sven Gudmund Hinderaker,4 Ajay MV Kumar5 1School of Public and Environmental Health, College of Medicine and Health Sciences, Hawassa University, Hawassa, Ethiopia; 2Research Technology Transfer Process Unit, SNNP Regional Health Bureau, Hawassa, Ethiopia; 3Department of Preventive and Social Medicine, Jawaharlal Institute of Post-graduate Medical Education and Research, Puducherry, India; 4Centre for International Health, University of Bergen, Bergen, Norway; 5The International Union Against Tuberculosis and Lung Disease, South-East Asia Regional Office, New Delhi, India Background: Treatment adherence is critical for the success of antiretroviral therapy (ART for people living with HIV. There is limited representative information on ART drug adherence and its associated factors from Southern Ethiopia. We aimed at estimating the level of adherence to ART among people living with HIV and factors associated with it in 20 randomly selected ART clinics of Southern Ethiopia.Methods: In this cross-sectional study, we interviewed consecutive HIV patients on first-line antiretroviral regimen attending the clinics in June 2014 using a pretested and structured questionnaire. For measuring adherence, we used 4-day recall method based on “The AIDS Clinical Trial Group adherence assessment tool”. Patients were classified as “Incomplete adherence” if they missed any of the doses in the last 4 days. Data were singly entered using EpiData and descriptive analysis, and unadjusted odds ratios were calculated using EpiDataStat software. Multivariate logistic regression analysis was performed using Stata v12.0.Results: Of 974 patients interviewed, 539 (56% were females, and mean age was 35 years. The proportion of patients with incomplete adherence was 13% (95% confidence interval: 11%–15

  14. Factors Affecting Adoption of Recommended Cauliflower Production Technology in Nepal

    Directory of Open Access Journals (Sweden)

    Pankaj Raj Dhital


    Full Text Available Binary logit regression model of econometrics was used to identify the factors affecting adoption of recommended agricultural technology by the commercial farmers of Nepal. A survey was carried out in 2012 in 120 households from Kavre district, Nepal. The objective was to appraise factors affecting adoption of recommended technology of cauliflower, finding out the level of adoption, identifying the constraints of cauliflower cultivation, assessing the perceived level of satisfaction and studying the relationship of certain selected variables on the adoption. Education, Occupation, contact with Personal Localite sources of information, Group membership and Experience were the most influencing factors for adoption of recommended technology. Though, other factors were not strong enough to contribute significantly but indirectly influence the adoption decision of farmers as combined effects. Occupation was found as negatively associated. Landholding size was strongly and positively influencing among the non significant factors. The level of satisfaction and the constraints of cauliflower production were also identified. Transfer of technology will be effective if and only if the client adopts the technology. For an effective transfer of technology, it is better to go for activities for the welfare of the socioeconomic factors of the farmers.

  15. Improving Patients' Adherence to Physical Activity in Diabetes Mellitus: A Review

    Directory of Open Access Journals (Sweden)

    Shan-hu Qiu


    Full Text Available Regular physical activity (PA is a key element in the prevention and management of type 2 diabetes mellitus (T2DM. Participation in regular PA improves blood glucose control and can prevent or delay T2DM and its complications, along with positively affecting lipids, blood pressure, cardiovascular events, mortality, and quality of life. However, most people with T2DM are not active and show poor adherence. This paper reviews the possible barriers to PA and strategies to improve the adherence to PA. Based on the currently available literature, it is concluded that self-efficacy and social support from family, friends, and health care providers play the important role in adoption and maintenance of regular PA. Here we also highlight some new modern and innovative interventions that facilitate exercise participation and improve the adherence.

  16. Multimodal Resources in Transnational Adoption

    DEFF Research Database (Denmark)

    Raudaskoski, Pirkko Liisa

    The paper discusses an empirical analysis which highlights the multimodal nature of identity construction. A documentary on transnational adoption provides real life incidents as research material. The incidents involve (or from them emerge) various kinds of multimodal resources and participants...

  17. Patient Adherence to Biologic Agents in Psoriasis

    DEFF Research Database (Denmark)

    Hsu, Der Yi; Gniadecki, Robert


    BACKGROUND: Low adherence to therapies in psoriasis decreases treatment outcomes and increases the total health care costs. In spite of the wide use of biologic agents, patients' adherence to these drugs has not been extensively investigated. OBJECTIVE: The aim of this study is to measure adherence...... adverse effects, and positive attitudes to the treatment. CONCLUSION: Adherence to biologic therapies is very high in patients with psoriasis, which is consistent with a positive attitude to the treatment....... to the biologic drugs in a population of patients treated for psoriasis vulgaris using the medication possession ratio (MPR) index and to survey patients' attitudes to the treatment. METHODS: This is a single-center study on 247 patients with psoriasis vulgaris treated with adalimumab (n = 113), etanercept (n...

  18. Adherence to anti-depressant medication

    DEFF Research Database (Denmark)

    Buus, Niels


    The study of medicine taking is controversial as it often reveals a discrepancy between healthcare professionals' advice and patients' actual behaviour. Qualitative researchers have examined depressed people's adherence to prescriptions of antidepressants by exploring the meaning they impute to t...

  19. Open adoption and adoptive mothers: attitudes toward birthmothers, adopted children, and parenting. (United States)

    Lee, J S; Twaite, J A


    The nature and extent of contact between 238 adoptive mothers and their child's biological mother was assessed for the period prior to the birth of the child and during the first two years of the child's life. Adoptive mothers who reported such contact prior to the child's birth had significantly more favorable attitudes toward both the biological mother and the adopted child. Those with contact either before or after the birth also demonstrated significantly more favorable parenting attitudes. Policy implications and the need for further research are noted.

  20. Determinants of Effective Information Transfer in International Regulatory Standards Adoption (United States)

    Popescu, Denisa


    The role of international regulatory standards within the current global environment has become of the most importance. The age of the global system and free market capitalism carried us into the unprecedented age of regulations, and standard setting. Regulations are now becoming the emerging mode of global governance. This study focuses on…

  1. Mobile Applications to Improve Medication Adherence. (United States)

    Haase, Jamie; Farris, Karen B; Dorsch, Michael P


    Background and Introduction: Mobile applications are useful tools to improve medication adherence. As developers continue to improve the features of existing mobile applications, pharmacists should be aware of the current features that are available to patients. There are limited studies available that discuss which applications have the most desirable features. The aim of this study was to compare available mobile applications and identify ideal application features used to improve medication adherence.

  2. Microbicide clinical trial adherence: insights for introduction

    Directory of Open Access Journals (Sweden)

    Cynthia Woodsong


    Full Text Available 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.

  3. Personality disorders in adopted versus non-adopted adults. (United States)

    Westermeyer, Joseph; Yoon, Gihyun; Amundson, Carla; Warwick, Marion; Kuskowski, Michael A


    The goal of this epidemiological study was to investigate lifetime history and odds ratios of personality disorders in adopted and non-adopted adults using a nationally representative sample. Data, drawn from the National Epidemiological Survey on Alcohol and Related Conditions (NESARC), were compared in adopted (n=378) versus non-adopted (n=42,503) adults to estimate the odds of seven personality disorders using logistic regression analyses. The seven personality disorders were histrionic, antisocial, avoidant, paranoid, schizoid, obsessive-compulsive, and dependent personality disorder. Adoptees had a 1.81-fold increase in the odds of any personality disorder compared with non-adoptees. Adoptees had increased odds of histrionic, antisocial, avoidant, paranoid, schizoid, and obsessive-compulsive personality disorder compared with non-adoptees. Two risk factors associated with lifetime history of a personality disorder in adoptees compared to non-adoptees were (1) being in the age cohort 18-29 years (but no difference in the age 30-44 cohort), using the age 45 or older cohort as the reference and (2) having 12 years of education (but no difference in higher education groups), using the 0-11 years of education as the reference. These findings support the higher rates of personality disorders among adoptees compared to non-adoptees.

  4. SMEs' E-commerce Adoption

    DEFF Research Database (Denmark)

    Scupola, Ada


    Purpose - Proposes providing an insight about factors affecting business-to-business e-commerce adoption and implementation in small to medium-sized enterprises (SMEs), highlighting similarities and differences between Danish and Australian SMEs.    Design/methodology/approach - The research...... is based on a wide literature review, focused on proposing a theoretical model of technological, environmental and organizational factors influencing e-commerce adoption and implementation. Subsequently, a questionnaire based on the research model has been developed and face-to-face interviews were...... conducted in Danish and Australian companies. Findings - The findings both corroborate previous results about significant factors affecting SMEs' b-to-b e-commerce adoption and implementation and provide new, interesting insights. The study also finds many similarities and differences between Denmark...

  5. Adopting to Agile Software Development

    Directory of Open Access Journals (Sweden)

    Linkevics Gusts


    Full Text Available Agile software development can be made successful, but there is no well-defined way how to achieve this. The problem is that the successful adoption of agile methods and practices is a complex process and this process should be customizable for a particular organization or a team. This research focuses on identification of agile methods and practices. Result of the research is the ranking of agile methods, practices and their usage trends. As some terms of agile software development are interpreted differently in different organizations and teams, terminology used is analyzed. Results of the research can be used as a reference material for those who are planning to adopt agile methods or are looking for the next agile practice to implement. Results will be used for the development of an expert system to support agile adoption.

  6. Achieving Adherence to Evidence-Based Practices: Are Health IT and Hospital-Physician Integration Complementary or Substitutive Strategies? (United States)

    Everson, Jordan; Lee, Shoou-Yih Daniel; Adler-Milstein, Julia


    In response to evolving policies and conditions, hospitals have increased health information technology (HIT) adoption and strived to improve hospital-physician integration. While evidence suggests that both HIT and integration confer independent benefits, when combined, they may provide complementary means to achieve high performance or overlap to offset each other's contribution. We explore this relationship in the context of hospital adherence to evidence-based practices (EBPs). Using the American Hospital Association's Annual and IT Supplement surveys, and Centers for Medicare and Medicaid Services's Hospital Compare, we estimate the independent relationships and interactions between HIT and hospital-physician integration with respect to EBP adherence. HIT adoption and tight (but not loose) integration are independently associated with greater adherence to EBPs. The interaction between HIT adoption and tight integration is negative, consistent with an offsetting association between HIT adoption and integration in their relationship to EBP adherence. This finding reveals the need to be aware of potential substitutive effects from simultaneous pursuit of multiple approaches to performance improvement.

  7. Adherence in patients with chronic treatment: data of “adherence day 2013”

    Directory of Open Access Journals (Sweden)

    Olatz Ibarra Barrueta


    Full Text Available Objetive: The primary objective of this study was to evaluate the adherence level in chronic conditions patients during “The Adherence Day” celebrated on November 15, 2013. Methods: We performed a transversal, observational and multicenter study at 43 Spanish hospitals, in order to estimate adherence in chronic treatments. We used the validated questionnaires Haynes- Sackett and Morisky- Green to measure medication adherence; but also a visual analogue scale and questions related with treatment complexity and selective adherence were applied. We performed a descriptive analysis and the closeness of agreement between questionnaires results. Results: A total of 723 surveys were collected especially among outpatients. 43% of the participants were women, with a median age of 51 and taking 3 drugs per day. 10.8% of the patients reported to have difficulty taking their pills according to Haynes- Sackett test. However, depending on Morisky- Green questionnaire, 56.4% of the participants were totally compliant; but considering only the question about forgetfulness, more were adherents (77%. 71% of the patients considered their compliance level as good (more than 8 according to visual analogue scale. And 11% presented a selective adherence, no taking equally well all the medications. The closeness of agreement between questionnaires and Morisky- Green test, as gold standard, was poor for Haynes- Sackett and weak for visual analogue scale. Conclusions: In our study only 56% of the patients with chronic treatment had a perfect adherence

  8. Assessing adherence factors in patients under topical treatment: development of the Topical Therapy Adherence Questionnaire (TTAQ). (United States)

    Zschocke, Ina; Mrowietz, Ulrich; Lotzin, Annett; Karakasili, Eleni; Reich, Kristian


    Medication adherence rates strongly depend on favorable disease outcomes. It is known that medication adherence rates are lower for topical treatment than for systemic treatment. However, to date no validated instrument for the assessment of adherence factors in topical treatment is available. The aim of this study was to develop a new questionnaire to assess adherence risk factors in topical treatment. The development of the Topical Therapy Adherence Questionnaire (TTAQ) and Patient Preference Questionnaire (PPQ) was based on a systematic literature review, and qualitative patient focus interviews and expert focus groups' input. The psychometric properties and comprehensibility of the TTAQ and PPQ were assessed in a feasibility study with 59 psoriasis patients. Our first preliminary results indicate that the TTAQ and PPQ are psychometrically sound and reliable measures for the assessment of factors influencing topical treatment adherence. The questionnaires are currently being further developed and various parameters (e.g., time point of assessment) are currently being tested in an exploratory pilot study with ca. 2,000 psoriasis patients receiving topical treatment in a European clinical trial. The use of the final versions of TTAQ and PPQ in clinical practice may facilitate the early identification of specific non-adherence factors in patients under topical treatment, which could enable designing and applying adherence-enhancing interventions according to the patient's individual needs.

  9. Has the Academy Adopted TQM? (United States)

    Birnbaum, Robert; Deshotels, Judy


    A survey of 469 colleges and universities assessed the degree to which colleges and universities have adopted total quality management (TQM) or continuous quality improvement (CQI) techniques. Results suggest use of TQM/CQI is lower than predicted, at about 13% of institutions. Variations in extent of use of the approach are discussed. (MSE)

  10. Why Adoption of Standards Matters (United States)

    Journal of Staff Development, 2016


    A total of 39 states have adopted, adapted, or endorsed the Standards for Professional Learning, including the standards issued in 2011 (labeled in red) and those published earlier (labeled in blue). Making a commitment to the standards is a commitment to continuous learning for all educators in a school.


    Institute of Scientific and Technical Information of China (English)



    How to make CET tailored to the requirements of thesociety is a topic of great significance. This paper is meant toexplore the advantages of adopting communicative approaches inCET( College English Teaching ) by comparing communicativeapproaches with traditional ones and presenting our practice ofemploying communicative approaches as well as the result.

  12. Chinese adoption: practices and challenges. (United States)

    Lihua, H


    The majority of children in China who are the subject of protective services are either abandoned or disabled. Recent reform efforts in China's child welfare practices have focused on the importance of providing safe, permanent families for children in lieu of long-term institutional care. Although challenges still exist, adoption and foster care are increasingly being seen as viable alternatives for these children.

  13. Predicting Virtual Learning Environment Adoption

    DEFF Research Database (Denmark)

    Penjor, Sonam; Zander, Pär-Ola Mikael


    This study investigates the significance of Rogers’ Diffusion of Innovations (DOI) theory with regard to the use of a Virtual Learning Environment (VLE) at the Royal University of Bhutan (RUB). The focus is on different adoption types and characteristics of users. Rogers’ DOI theory is applied...

  14. Adherence and retention on antiretroviral therapy in a public-private partnership program in Nigeria

    Directory of Open Access Journals (Sweden)

    K Torpey


    Full Text Available Initiation of HIV-positive patients on antiretroviral therapy (ART in Nigeria was restricted to secondary and tertiary level hospitals due to weak health systems in primary health centres (PHCs. Shell Petroleum Development Company (SDPC Nigeria and FHI 360 using a systems strengthening approach, piloted ART enrolment in a PHC in south-eastern Nigeria. This study sought to evaluate patients’ adherence and mortality on ART, and associated risk factors. We reviewed clinic records of adult patients initiating ART between January 2007 and December 2009. Adherence was calculated as the number of days of medication dispensed as a percentage of total number of days evaluated. Outcome measures were probability of being alive and retained in care at 12 and 24 months on ART. Competing risks regression models were used to assess potential predictors associated with mortality. Total of 196 patients (64.8% males were initiated on ART. Patients’ median age was 35 years (IQR 30–44; median CD4 at initiation was 132 cells/mm3 (IQR 82–212, Patients in WHO stage III and IV constituted 73 (37.6% and 83 (42.8% respectively. Majority (108 [55.1%] of patients had adherence rates >95%. Adherence levels ranged: 70–85%, 50–65% and <50% in 29 (14.8%, 30 (15.3% and 29 (14.8% of patients respectively. Nucleoside backbone use were AZT/3TC (69.4% d4T/3TC (28.6% and TDF/FTC (2%. At 12 months of follow up, 80.6% (158 were alive and on ART, mortality accounted for 12.8% (25, 11 (5.6% were LTFU and 2 (1.1% transferred out. At 24 months on ART survival decreased to 64.3% (126, 20.4% (40 died, 9.2% (18 were LTFU and 12 (6.1% transferred out. Competing risks regression models revealed that patients’ factors significantly associated with mortality include: bedridden patients (HR=3.6 [95% CI: 1.11–11.45], p=0.03, referent: working, <50% adherence levels (HR=27.7 [95% CI: 8.55–89.47], p<0.0001, referent: >95% adherence level. In conclusion, majority of attrition was

  15. Computer controlled chamber measurements for clay adherence relevant for potential dioxin exposure through skin. (United States)

    Ferguson, Alesia; Bursac, Zoran; Johnson, Wayne; Davis, Jasmine


    A computer-controlled mechanical chamber was used to control the contact between aluminum sheet samples laden with clay, and cotton sheet samples for the measurement of mass transfer. The contact parameters of pressure (20 to 60 kPa) and time (10 to 70 sec) were varied for 160 multiple experiments of mass soil transfer. Before log transformation the average transfer for 'First Transfer' of clay particles was 34.4 ± 6.3 mg/8.97 cm(2) while that for 'Total Transfer' was 36.1 ± 6.8 mg/8.97 cm(2). Second contact, therefore, resulted in an average transfer of 1.70 ± 0.76 mg/8.97 cm(2). These values are well above adherence values measured for potting soil and sand as reported for previous experiments using the same methodologies. Based on the univariate analysis and the multiple regression analysis we were able to see some effect of parameters on the clay adherence values. The effect of pressure increases was significant for the higher levels of 50 and 60 kPa. In addition, we observed that increases in temperature were significant for 'First Transfer,' and less so for 'Total Transfer'. Past experiments using potting soil and play sand show high adherence values to human cadaver skin over cotton sample; the same scenario would be expected for clay. This data set can be used to improve estimates of dermal exposure to dioxins found in ball clays often used by artisans in the making of pottery.

  16. Improving medication adherence in patients with hypertension

    DEFF Research Database (Denmark)

    Hedegaard, Ulla; Kjeldsen, Lene Juel; Pottegård, Anton


    BACKGROUND: and Purpose: In patients with hypertension, medication adherence is often suboptimal, thereby increasing the risk of ischemic heart disease and stroke. In a randomized trial, we investigated the effectiveness of a multifaceted pharmacist intervention in a hospital setting to improve...... medication adherence in hypertensive patients. Motivational interviewing was a key element of the intervention. METHODS: Patients (N=532) were recruited from 3 hospital outpatient clinics and randomized to usual care or a 6-month pharmacist intervention comprising collaborative care, medication review......, tailored adherence counselling including motivational interviewing and telephone follow-ups. The primary outcome was composite medication possession ratio (MPR) to antihypertensive and lipid-lowering agents, at one-year follow-up, assessed by analyzing pharmacy records. Secondary outcomes at 12 months...

  17. Adherence to diabetes medication in individuals with schizophrenia:a systematic review of rates and determinants of adherence


    Gorczynski, Paul; Patel, Hiren; Ganguli, Rohan


    Introduction: Despite the importance of medication adherence for the effective treatment of type II diabetes mellitus (T2DM), little research has examined adherence with diabetes medication treatment in schizophrenia. The purpose of this systematic review was to 1) evaluate rates of adherence and determinants of adherence with medication for T2DM in individuals with schizophrenia, and, where possible, 2) examine the relationship between medication adherence and glycemic control. Methods: Stud...

  18. Comparisons of computer-controlled chamber measurements for soil-skin adherence from aluminum and carpet surfaces. (United States)

    Ferguson, Alesia; Bursac, Zoran; Coleman, Sheire; Johnson, Wayne


    A computer-controlled mechanical chamber was used to control the contact between carpet and aluminum sheet samples laden with soil, and human cadaver skin and cotton sheet samples for the measurement of mass soil transfer. The contact parameters of pressure (10-50 kPa) and time (10-50s) were varied for 768 experiments of mass soil transfer, where two soil types (play sand and lawn soil) and two soil particle sizes (soil mass transfer to cadaver skin was higher than mean transfer to cotton sheets for both carpet and aluminum transfers, and also generally higher pressure was associated with larger amounts of soil transfer for all contact scenarios. The mean soil adherence from carpet was 0.37+/-0.4 mg/cm(2), while the mean soil adherence from aluminum was 0.42+/-0.6 mg/cm(2). For aluminum, smaller soil particle size was associated with more transfer (p=0.0349), while for carpet, larger soil size was associated with more transfer (pSoil type was significant but only for aluminum surface, where sand was associated with higher adherence (psoils and dust present in indoor environments.

  19. Factors affecting medication adherence in elderly people

    Directory of Open Access Journals (Sweden)

    Jin HK


    Full Text Available Hyekyung Jin,1 Yeonhee Kim,2 Sandy Jeong Rhie1,3 1College of Pharmacy, 2Center for Excellence in Teaching & Learning, 3Division of Life and Pharmaceutical Sciences, Ewha Womans University, Seoul, Republic of Korea 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

  20. Adherence to methotrexate in rheumatoid arthritis

    DEFF Research Database (Denmark)

    Bliddal, Henning; Eriksen, Stine A; Christensen, Robin;


    Objectives. To study adherence to methotrexate (MTX) and factors of importance thereof in patients with rheumatoid arthritis (RA). Methods. Patients with a hospital diagnosis of RA (ICD10 codes M05.X or M06.X) after January 1, 1997, and aged ≥18 years at the date of first diagnosis/contact, with ......Objectives. To study adherence to methotrexate (MTX) and factors of importance thereof in patients with rheumatoid arthritis (RA). Methods. Patients with a hospital diagnosis of RA (ICD10 codes M05.X or M06.X) after January 1, 1997, and aged ≥18 years at the date of first diagnosis...

  1. Biomarkers and biometric measures of adherence to use of ARV-based vaginal rings

    Directory of Open Access Journals (Sweden)

    Randy M Stalter


    for further development based on the following measurements: intracellular drug levels, drug levels in hair, the accumulation of a vaginal analyte that diffuses into the ring, and the depletion of an intrinsic ring constituent. Conclusions: While some approaches show significant promise over others, it is recommended that a strategy of using complementary biometric and behavioural approaches be adopted to best understand participants’ adherence to ARV-based ring products in clinical trials.

  2. Adoção da estratégia modular por empresas do setor automotivo e as implicações relativas à transferência de atividades no desenvolvimento de produto: um estudo de casos múltiplos Adoption of the modular strategy for companies in the automotive sector and the implications regarding the transfer of new product development activities: a multiple case study

    Directory of Open Access Journals (Sweden)

    Evandro Prieto


    Full Text Available A modularidade aplicada ao desenvolvimento de novos produtos, acompanhada da terceirização das atividades de produção, tem sido uma estratégia adotada pelas montadoras automotivas. O desenvolvimento de produto no contexto da estratégia modular implica em uma redistribuição das atividades inerentes a este processo, baseando-se na decomposição e na divisão das tarefas entre as montadoras e seus fornecedores. Nesse contexto, este estudo investiga as implicações da estratégia modular no processo de capacitação e na transferência de atividades de desenvolvimento de produto entre os fornecedores de primeiro e segundo nível da cadeia de suprimentos automotiva. O trabalho é desenvolvido por meio de uma abordagem metodológica de múltiplos casos. As empresas investigadas foram posicionadas em níveis distintos de competências modulares - "embrionária", "em desenvolvimento" e "madura"-, de acordo com as evidências empíricas levantadas. Evidenciou-se uma relação entre o estágio de maturidade de competências e as principais atividades de desenvolvimento de produto.Modularity applied to new product development together with the externalisation of production has been a strategy adopted by automotive companies. New product development in the context of modular strategy implies a redistribution of inherent activities of production. This is based on a work division among assemblers and their suppliers. In this context, this study investigates the implications of modular strategies in the process of transferring value-added activities in new product development between first and second tier suppliers. The study is developed based on a multiple case study approach. The investigated companies were positioned in distinct levels of modular competencies ('embrionary', 'in development', and 'mature', according to empirical evidence. A relationship between the stage of maturity and major new product development practices was identified.

  3. La gestion des adoptions internationales


    Boéchat, Hervé


    Après les rumeurs nées lors du tsunami et le désastre avéré de L’Arche de Zoé, l’adoption – et plus généralement le sort des enfants – est devenue une préoccupation majeure en cas de catastrophe naturelle ou de conflit. Haïti, pays depuis longtemps ouvert à l’adoption internationale, n’a pas échappé à la polémique. Hervé Boéchat nous livre l’appréciation de son institution sur cet épisode qui n’a sans doute pas contribué à apaiser le ressentiment des Haïtiens contre la « communauté internati...

  4. Sharing Experiences of Intercountry Adoption

    DEFF Research Database (Denmark)

    Raudaskoski, Pirkko; McIlvenny, Paul

    are interactionally occasioned. Our special concern is with how the past is built into the present through memory work that is actualised and performed not just through language but also through embodied attention such as body posture, gaze and gestures. In other words, we study how the past is folded into the now...... the perspective of the kinds of work that talking about the past does in a specific interaction. Middleton & Brown (2005) extend this interactional perspective to include, on the one hand, the experience of being in the world (ie. duration), and, on the other hand, the use of mediational means (eg. language...... of this research is to better understand the relationships between multimodality, embodiment, interaction and affect. We present the results of our analysis of how the experiences of adoptive parents are (re)mediated in a Danish television documentary series following five prospective adoptive couples, not all...

  5. Revision of the Adoption Law

    Institute of Scientific and Technical Information of China (English)


    DECEMBER 29, 1991, saw thePresident of the People’sRepublic of China promulgatea new adoption law by Order 54, a lawwhich was introduced to the seventhNational People’s Congress at thetwenty-third meeting of its StandingCommittee and which took effect fromApril 1, 1992. This was the first suchadoption law in China and, althoughadoption did occur prior to itsimplementation, it was not then boundby legal measures or guarantee.

  6. Introducing the Adherence Strategy Engineering Framework (ASEF)

    DEFF Research Database (Denmark)

    Wagner, Stefan Rahr; Toftegaard, Thomas Skjødeberg; Bertelsen, Olav W.


    Background: Patients performing self-care in the unsupervised setting do not always adhere to the instructions they were initially provided with. As a consequence, a patient’s ability to successfully comply with the treatment plan cannot be verified by the treating healthcare professional, possib...

  7. Community health workers adherence to referral guidelines

    DEFF Research Database (Denmark)

    Lal, Sham; Ndyomugenyi, Richard; Paintain, Lucy


    Background Many malaria-endemic countries have implemented national community health worker (CHW) programmes to serve remote populations that have poor access to malaria diagnosis and treatment. Despite mounting evidence of CHWs’ ability to adhere to malaria rapid diagnostic tests (RDTs) and trea......Background Many malaria-endemic countries have implemented national community health worker (CHW) programmes to serve remote populations that have poor access to malaria diagnosis and treatment. Despite mounting evidence of CHWs’ ability to adhere to malaria rapid diagnostic tests (RDTs......) and treatment guidelines, there is limited evidence whether CHWs adhere to the referral guidelines and refer severely ill children for further management. In southwest Uganda, this study examined whether CHWs referred children according to training guidelines and described factors associated with adherence...... to the referral guideline. Methods A secondary analysis was undertaken of data collected during two cluster-randomized trials conducted between January 2010 and July 2011, one in a moderate-to-high malaria transmission setting and the other in a low malaria transmission setting. All CHWs were trained to prescribe...

  8. Barriers to adherence in cystic fibrosis

    DEFF Research Database (Denmark)

    Bregnballe, Vibeke; Schiøtz, Peter Oluf


    Danish patients with cystic fibrosis aged 14 to 25 years and their parents. Conclusions: The present study showed that the majority of adolescents with CF and their parents experienced barriers to treatment adherence. Patients and parents agreed that the three most common barriers encountered lack...


    Directory of Open Access Journals (Sweden)



    Full Text Available ABSTRACT: BACKGROUND: In spite of any number of medicines will not be of use unless patient takes’ them. After diagnosing the disease, the next most i mportant step is to follow the instructions of physician in terms of treatment. The doctor’s respons ibility does not end with writing prescription, assuming patient will adhere to it. He/ she should cross check the behavior of patient for drug compliance and see that patient follo ws it and get the benefit. Non compliance is the main barrier for the effective delivery of the medical care. This will have greater implications on the economic burde n on the country in terms of frequent hospitalization, use of expensive medicines in case o f relapse due to non adherence.Though the terms compliance and adherence are used synonymously , they differ in the delivery of quality of the medicare as the former implicates the passive fol lowing of the physician instruction, while in the later, patient actively participates in the dev elopment of the treatment plan, which will improves outcome of the treatment. Adherence is the preferred term over compliance by WHO.

  10. Psoriasis: improving adherence to topical therapy.

    NARCIS (Netherlands)

    Feldman, S.R.; Horn, E.J.; Balkrishnan, R.; Basra, M.K.; Finlay, A.Y.; McCoy, D.; Menter, A.; Kerkhof, P.C.M. van de


    Topical therapy has an important role in psoriasis treatment. It is efficacious and has a favorable safety profile as demonstrated in clinical trials. However, poor treatment outcomes from topical therapy regimens likely result from poor adherence and ineffective use of the medication. The Internati

  11. Adherence to Exercise and Physical Activity: Preface. (United States)

    Morgan, William P.; Dishman, Rod K.


    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…

  12. Non-adherence in difficult asthma and advances in detection. (United States)

    Lindsay, John T; Heaney, Liam G


    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. Bacterial adherence to anodized titanium alloy

    Energy Technology Data Exchange (ETDEWEB)

    Peremarch, C Perez-Jorge; Tanoira, R Perez; Arenas, M A; Matykina, E; Conde, A; De Damborenea, J J; Gomez Barrena, E; Esteban, J, E-mail:


    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.

  14. Adopted: A practical salinity scale (United States)

    The Unesco/ICES/SCOR/IAPSO Joint Panel on Oceanographic Tables and Standards has recommended the adoption of a Practical Salinity Scale, 1978, and a corresponding new International Equation of State of Seawater, 1980. A full account of the research leading to their recommendation is available in the series Unesco Technical Papers in Marine Science.The parent organizations have accepted the panel's recommendations and have set January 1, 1982, as the date when the new procedures, formulae, and tables should replace those now in use.

  15. Policy Issues in Gay and Lesbian Adoption. (United States)

    Sullivan, Ann


    Notes that adoption agencies have developed few specific policies on the issue of lesbian and gay adoption. Provides an overview of key considerations about homosexual adopters, including beliefs and values of agency professionals, the legal and social ramifications of adoption into a relationship not based on marriage, and possible consequences…

  16. Experiencing antiretroviral adherence: helping healthcare staff better understand adherence to paediatric antiretrovirals

    Directory of Open Access Journals (Sweden)

    Phelps Benjamin R


    Full Text Available Abstract Background Lack of adherence to antiretroviral medications is one of the key challenges for paediatric HIV care and treatment programmes. There are few hands-on opportunities for healthcare workers to gain awareness of the psychosocial and logistic challenges that caregivers face when administering daily antiretroviral therapy to children. This article describes an educational activity that allows healthcare workers to simulate this caregiver role. Methods Paediatric formulations of several antiretroviral medications were dispensed to a convenience sample of staff at the Baylor College of Medicine-Bristol-Myers Squibb Children's Clinical Center of Excellence in Mbabane, Swaziland. The amounts of the medications remaining were collected and measured one week later. Adherence rates were calculated. Following the exercise, a brief questionnaire was administered to all staff participants. Results The 27 clinic staff involved in the exercise had varying and low adherence rates over the week during which the exercise was conducted. Leading perceived barriers to adherence included: "family friends don't help me remember/tell me I shouldn't take it" and "forgot". Participants reported that the exercise was useful as it allowed them to better address the challenges faced by paediatric patients and caregivers. Conclusions Promoting good adherence practices among caregivers of children on antiretrovirals is challenging but essential in the treatment of paediatric HIV. Participants in this exercise achieved poor adherence rates, but identified with many of the barriers commonly reported by caregivers. Simulations such as this have the potential to promote awareness of paediatric ARV adherence issues among healthcare staff and ultimately improve adherence support and patient outcomes.

  17. Ensuring medication adherence with direct oral anticoagulant drugs: lessons from adherence with vitamin K antagonists (VKAs). (United States)

    Di Minno, Alessandro; Spadarella, Gaia; Tufano, Antonella; Prisco, Domenico; Di Minno, Giovanni


    Medication adherence (taking drugs properly) is uncommon among patients on warfarin. Poor adherence to warfarin leads to an increase in adverse medical events, including stroke in atrial fibrillation (AF). Factors related to patients, physicians and the health system account for poor adherence. Direct oral anticoagulants (DOACs) are easier to use than warfarin, with fewer drug and food interactions and no need for routine blood monitoring. A proper use of DOACs may reduce the risk of stroke in AF. However, in clinical settings where no laboratory monitoring is needed, a poor medication adherence is common and may impact clinical outcomes. In the management of chronic disorders, careful knowledge of the individual patient's attitudes and behaviors is a pre-requisite for a successful doctor-patient communication. To increase patient's awareness of the risks and benefits of DOACs and, in turn, increase medication adherence, at each follow-up visit physicians should screen for priorities and motivational problems; check for the lack of understanding and/or knowledge; assess any health system or personal barriers to medication adherence; identify appropriate interventions and provide tailored support to patient needs. Dissemination of guidelines to the health care chain (prescribing physician, general practitioners, caregivers, nurses, pharmacists) further encourages medication adherence. However, the long-term effect of some of these strategies is unknown; one tool may not fit all patients, and the prescribing physician should consider individualization of these aids to ensure medication adherence and persistence (continuing to take drugs properly in long-term treatments) for DOACs in every day practice.

  18. Adherence of Moraxella bovis to cell cultures of bovine origin. (United States)

    Annuar, B O; Wilcox, G E


    The adherence of five strains of Moraxella bovis to cell cultures was investigated. M bovis adhered to cultures of bovine corneal epithelial and Madin-Darby bovine kidney cells but not to cell types of non-bovine origin. Both piliated and unpiliated strains adhered but piliated strains adhered to a greater extent than unpiliated strains. Antiserum against pili of one strain inhibited adherence of piliated strains but caused only slight inhibition of adherence to the unpiliated strains. Treatment of bacteria with magnesium chloride caused detachment of pili from the bacterial cell and markedly inhibited adherence of piliated strains but caused only slight inhibition of adherence by the unpiliated strains. The results suggested that adhesion of piliated strains to cell cultures was mediated via pili but that adhesins other than pili may be involved in the attachment of unpiliated strains of M bovis to cells.

  19. [Adoptive parents' satisfaction with the adoption experience and with its impact on family life]. (United States)

    Sánchez-Sandoval, Yolanda


    In this study, we discuss the relevance of adoptive families' satisfaction in the assessment of adoption processes. The effects of adoption on a sample group of 272 adoptive families are analyzed. Most families show high levels of satisfaction as to: their decision to adopt, the features of their adopted children and how adoption has affected them as individuals and as a family. Statistical analyses show that these families can have different satisfaction levels depending on certain features of the adoptees, of the adoptive families or of their educational style. Life satisfaction of the adoptees is also related to how their adoptive parents evaluate the adoption.

  20. Improving adherence to medical regimens for juvenile rheumatoid arthritis

    Directory of Open Access Journals (Sweden)

    Lindsley Carol B


    Full Text Available Abstract Poor adherence to medical regimens can compromise the efficacy of treatments for children and adolescents with juvenile rheumatoid arthritis (JRA. The purpose of this review is to describe medical regimens for the treatment of JRA and the rates of adherence to these regimens. We also summarize and critically the few research studies aimed at improving adherence to regimens for JRA. Finally, we summarize strategies for enhancing adherence in clinical practice.

  1. Iron Chelation Adherence to Deferoxamine and Deferasirox in Thalassemia


    Trachtenberg, Felicia; Vichinsky, Elliott; Haines, Dru; Pakbaz, Zahra; Mednick, Lauren; Sobota, Amy; Kwiatkowski, Janet; Thompson, Alexis A.; Porter, John; Coates, Thomas; Giardina, Patricia J.; Olivieri, Nancy; Yamashita, Robert; Neufeld, Ellis J.


    The Thalassemia Clinical Research Network collected adherence information from 79 patients on deferoxamine and 186 on deferasirox from 2007 to 2009. Chelation adherence was defined as percent of doses administered in the last 4 weeks (patient report) out of those prescribed (chart review). Chelation history since 2002 was available for 97 patients currently on deferoxamine and 217 on deferasirox, with crude estimates of adherence from chart review. Self-reported adherence to both deferoxamine...

  2. Medication adherence among transgender women living with HIV



    Medication adherence is linked to health outcomes among adults with HIV infection. Transgender women living with HIV (TWLWH) in the U.S. report suboptimal adherence to medications and are found to have difficulty integrating HIV medication into their daily routine, but few studies explore factors associated with medication adherence among transgender women. Thus, the purpose of this paper is to examine demographic and clinical factors related to self-reported medication adherence among transg...

  3. Radiative heat transfer

    CERN Document Server

    Modest, Michael F


    The third edition of Radiative Heat Transfer describes the basic physics of radiation heat transfer. The book provides models, methodologies, and calculations essential in solving research problems in a variety of industries, including solar and nuclear energy, nanotechnology, biomedical, and environmental. Every chapter of Radiative Heat Transfer offers uncluttered nomenclature, numerous worked examples, and a large number of problems-many based on real world situations-making it ideal for classroom use as well as for self-study. The book's 24 chapters cover the four major areas in the field: surface properties; surface transport; properties of participating media; and transfer through participating media. Within each chapter, all analytical methods are developed in substantial detail, and a number of examples show how the developed relations may be applied to practical problems. It is an extensive solution manual for adopting instructors. Features: most complete text in the field of radiative heat transfer;...

  4. Understanding how adherence goals promote adherence behaviours: a repeated measure observational study with HIV seropositive patients

    Directory of Open Access Journals (Sweden)

    Jones Gareth


    Full Text Available Abstract 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

  5. Medication Adherence in Psychopharmacologically Treated Adults with ADHD (United States)

    Safren, Steven A.; Duran, Petra; Yovel, Iftah; Perlman, Carol A.; Sprich, Susan


    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…

  6. Adhesion Forces and Composition of Planktonic and Adhering Oral Microbiomes

    NARCIS (Netherlands)

    Wessel, S. W.; Chen, Y.; Maitra, A.; van den Heuvel, E. R.; Slomp, A. M.; Busscher, H. J.; van der Mei, H. C.


    The oral microbiome consists of a planktonic microbiome residing in saliva and an adhering microbiome (the biofilm adhering to oral hard and soft tissues). Here we hypothesized that possible differences in microbial composition of the planktonic and adhering oral microbiome on teeth can be related t

  7. Measuring adherence to treatment of paediatric HIV/AIDS. (United States)

    Naar-King, S; Frey, M; Harris, M; Arfken, C


    Parent, child, physician report and pill counts were used to measure adherence in paediatric HIV. Relationships to viral load were assessed. Pill counts were considered invalid. Adherence measures did not correlate with one another. Physicians reported lower adherence than parents, but parent and physician report correlated with viral load. The clinical and research utility of the various measures are discussed.

  8. 78 FR 34109 - ``Script Your Future'' Medication Adherence Campaign (United States)


    ... HUMAN SERVICES Food and Drug Administration ``Script Your Future'' Medication Adherence Campaign AGENCY... importance of medication adherence to enhance the health of Americans. Medication adherence is taking... each patient. Nearly three out of four Americans report that they do not take their medication...

  9. A Matter of Trust: Patient Barriers to Primary Medication Adherence (United States)

    Polinski, J. M.; Kesselheim, A. S.; Frolkis, J. P.; Wescott, P.; Allen-Coleman, C.; Fischer, M. A.


    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…

  10. Medication adherence among older adults with schizophrenia. (United States)

    Leutwyler, Heather C; Fox, Patrick J; Wallhagen, Margaret


    Older adults with schizophrenia are a growing segment of the population, yet their physical and mental health status is extremely poor. This article 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 effect on participants' 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.

  11. Electronic Dental Records System Adoption. (United States)

    Abramovicz-Finkelsztain, Renata; Barsottini, Claudia G N; Marin, Heimar Fatima


    The use of Electronic Dental Records (EDRs) and management software has become more frequent, following the increase in prevelance of new technologies and computers in dental offices. The purpose of this study is to identify and evaluate the use of EDRs by the dental community in the São Paulo city area. A quantitative case study was performed using a survey on the phone. A total of 54 offices were contacted and only one declinedparticipation in this study. Only one office did not have a computer. EDRs were used in 28 offices and only four were paperless. The lack of studies in this area suggests the need for more usability and implementation studies on EDRs so that we can improve EDR adoption by the dental community.

  12. Use of new technology to improve utilization and adherence to immunotherapy. (United States)

    Joshi, Smita; Dimov, Ves


    Technology and social media have dramatically altered the landscape in which we practice medicine. Clinicians have increasingly turned to technology and the internet to enhance patient care. Allergists have used these modalities to improve utilization and adherence to immunotherapy. Electronic medical records (EMRs) are being widely adopted by allergy practices and some offer allergy/immunology specific modules that aid in daily workflow. The development of specialized devices that reduce pain associated with immunotherapy administration may improve compliance with immunotherapy. Social media and other forms of electronic communication such as e-mail, Facebook, Twitter, short message service (SMS), and YouTube give clinicians multiple avenues to disseminate information and reach their patients, possibly improving patient adherence to therapy. Finally, tablet computers, online networks, and electronic surveys provide additional ways to connect patients and physicians.

  13. Improving diabetes medication adherence: successful, scalable interventions

    Directory of Open Access Journals (Sweden)

    Zullig LL


    Full Text Available Leah L Zullig,1,2 Walid F Gellad,3,4 Jivan Moaddeb,2,5 Matthew J Crowley,1,2 William Shrank,6 Bradi B Granger,7 Christopher B Granger,8 Troy Trygstad,9 Larry Z Liu,10 Hayden B Bosworth1,2,7,11 1Center for Health Services Research in Primary Care, Durham Veterans Affairs Medical Center, Durham, NC, USA; 2Department of Medicine, Duke University, Durham, NC, USA; 3Center for Health Equity Research and Promotion, Pittsburgh Veterans Affairs Medical Center, Pittsburgh, PA, USA; 4Division of General Internal Medicine, University of Pittsburgh, Pittsburgh, PA, USA; 5Institute for Genome Sciences and Policy, Duke University, Durham, NC, USA; 6CVS Caremark Corporation; 7School of Nursing, Duke University, Durham, NC, USA; 8Department of Medicine, Division of Cardiology, Duke University School of Medicine, Durham, NC, USA; 9North Carolina Community Care Networks, Raleigh, NC, USA; 10Pfizer, Inc., and Weill Medical College of Cornell University, New York, NY, USA; 11Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, NC, USA Abstract: Effective medications are a cornerstone of prevention and disease treatment, yet only about half of patients take their medications as prescribed, resulting in a common and costly public health challenge for the US healthcare system. Since poor medication adherence is a complex problem with many contributing causes, there is no one universal solution. This paper describes interventions that were not only effective in improving medication adherence among patients with diabetes, but were also potentially scalable (ie, easy to implement to a large population. We identify key characteristics that make these interventions effective and scalable. This information is intended to inform healthcare systems seeking proven, low resource, cost-effective solutions to improve medication adherence. Keywords: medication adherence, diabetes mellitus, chronic disease, dissemination research

  14. A Study of Adherent Oxide Formation (United States)


    improve oxide scale adherence to NiCrAl were investigated. Laser-processed materials were isothermally and cyclically oxidized and oxide scale...modified NiCrAl altered the morphology of the alumina scale and promoted the formation of a thinner, dense protective layer. • Thin aluminum oxide films...6 A. Materials. ........................... 6 B. Oxidation Studies. ....................... 7 1. NiCrAl .. .......................... 7a2

  15. Pharmacy Adherence Measures to Assess Adherence to Antiretroviral Therapy: Review of the Literature and Implications for Treatment Monitoring


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


    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: medica...

  16. Concordance of adherence measurement using self-reported adherence questionnaires and medication monitoring devices. (United States)

    Shi, Lizheng; Liu, Jinan; Koleva, Yordanka; Fonseca, Vivian; Kalsekar, Anupama; Pawaskar, Manjiri


    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

  17. Can adherence to antihypertensive therapy be used to promote adherence to statin therapy?

    Directory of Open Access Journals (Sweden)

    Richard H Chapman


    Full Text Available Richard H Chapman1, Elise M Pelletier1, Paula J Smith1, Craig S Roberts21US Health Economics and Outcomes Research, IMS Health, Falls Church, VA, USA; 2Global Outcomes Research, Pfizer Inc, New York, NY, USAObjective: To compare adherence with statin therapy in patients switching to single-pill amlodipine besylate/atorvastatin calcium with patients adding a separate statin to their amlodipine regimen.Methods: We identified hypertensive patients prescribed amlodipine who switched to amlodipine/atorvastatin (switch or added a statin to their amlodipine regimen (add-on from July 2004 to June 2007. Propensity score matching (1 switch:3 add-on was applied based on ‘nearest neighbor’ approach. The primary adherence measure was patients with proportion of days covered (PDC ≥0.80 at 180 days; secondary measures included mean PDC and persistence. A sensitivity analysis was performed, accounting for total statin/amlodipine exposure.Results: Among 4556 matched patients (n = 1139 switch; n = 3417 add-on, mean age was 53.9 years and 52.1% were male. After 180 days, adherence with statin therapy was higher for the switch vs add-on cohort (50.8% vs 44.3%; P < 0.001. After adjusting for pre-index amlodipine adherence, the switch cohort was more likely to be adherent than the add-on cohort (odds ratio: 1.64 [95% confidence interval: 1.42 to 1.89]. Persistence was higher in the switch than the add-on cohort (127.6 vs 117 days; P < 0.001.Conclusion: Hypertensive patients taking amlodipine who initiated statin therapy via single-pill amlodipine/atorvastatin were more likely to remain adherent to their statin than patients adding a separate statin to their antihypertensive regimen.Keywords: adherence, amlodipine, atorvastatin, cardiovascular disease, persistence, single-pill

  18. Adherence to asthma guidelines in general practices. (United States)

    Roghmann, M C; Sexton, M


    Adherence to asthma practice guidelines is low. Improved compliance could potentially improve care of patients with asthma. The purpose of this study was to determine if patients managed in a general practice with an associated asthma clinic are more likely to use asthma medications according to clinical practice guidelines than patients managed in the general surgery of the practice. A cross-sectional study of adult asthmatics, aged 18-55 years, was conducted in six British general practices. Prescription data on all asthma medication was collected for a 6-month period. Information on asthma clinic attendance, age, sex, employment status, other medical illness, and how patients used their inhaled beta2-agonist was collected through questionnaire. The prescription data for asthma medication and patient use of inhaled beta2-agonist were compared to the British Thoracic Society's (BTS) Guidelines for Management of Asthma in Adults to determine if the patient's asthma medication regimen was appropriate. There was no significant association found between appropriate asthma medication and asthma clinic attendance or other patient characteristics. Adherence to the BTS guidelines was low. Fifty-eight percent of the asthma patients used asthma medication regimens that were not consistent with the BTS guidelines published 1 year earlier. Adherence to the BTS guidelines was low regardless of patient characteristics, including asthma clinic attendance, age, sex, employment status, other medical illness, or individual practice. These findings underscore the need to document the utility of clinical practice guidelines which may improve physician compliance.

  19. Adherence to physical and mental activity interventions: Coping plans as a mediator and prior adherence as a moderator.

    NARCIS (Netherlands)

    Evers, A.W.M.; Klusmann, V.; Schwarzer, R.; Heuser, I.


    Objective. Adherence to behavioural intervention programmes is a necessary condition for beneficial outcomes to be achieved. This study tested whether social cognitive variables and coping plans predict adherence. Design and methods. Adherence was examined in a randomized controlled trial with healt

  20. Adherence of Helicobacter pylori to the Gastric Mucosa

    Directory of Open Access Journals (Sweden)

    Marguerite Clyne


    Full Text Available Bacterial adhesion to the intestinal epithelium is a critical initial step in the pathogenesis of many enteric diseases. Helicobacter pylori is a duodenal pathogen that adheres to the gastric epithelium and causes gastritis and peptic ulceration. The mechanism by which H pylori causes disease has not yet been elucidated but adherence to the gastric mucosa is thought to be an important virulence determinant of the organism. What is known about adherence of H pylori to the gastric mucosa is summarized. Topics discussed are the mechanism of H pylori adherence; in vitro and in vivo models of H pylori infection; and adherence and potential adhesins and receptors for H pylori.

  1. Adherence Characteristics of Cement Clinker on Basic Bricks

    Institute of Scientific and Technical Information of China (English)

    GUO Zongqi; Michel Rigaud


    Based on the sandwich test, adherence mechanisms of cement clinker on various basic bricks were tackled by microstructural observations with help of cathodoluminescence technique. Doloma based bricks offer sufficient lime to react with clinker, forming C3 S rich layer and initializing superior adherence. However, clinker with low silica ratio leads to MgO agglomeration at the interface of doloma bricks, which reduces adherence strength. On magnesia spinel bricks, fine, crystalline spinel easily reacts with lime containing phases from clinker to form lowmelting phases and belite zone, which shows high adherence performance. Lack of fine spinel in magnesia spinel bricks results in poor adherence.

  2. Problems of adhering organisms in power stations. Hatsudensho ni okeru fuchaku seibutsu no mondai

    Energy Technology Data Exchange (ETDEWEB)

    Sakaguchi, Isamu (Central Research Inst. of Electric Power Industry, Tokyo (Japan))


    Much seawater is used in thermal power station in Japan to cool condensers but organisms adhered on the water channel system result many troubles such as increase of flowing resistance, reduction of thermal transfer efficiendy, corrosion or erosion-corrosion of condenser pipes, and cleaning difficulty for periodic inspection. Living organisms range from micro bacteria of 2 mum to oysters and others of about 10cm size. For these reasons, the intake open channel is previously designed to larger size and this margin is called the shellfish allowance. Mussels which adhere most on circulating water channels, are one of Bivalvia, grow to 3-6cm and in maximum case to 9cm in a year. These adhere on the surface base by secreting adhesive disc consisting of byssus. Barnacles are one of Crustacea and their larvas search preferable places as to light, roughness and water flow and can adhere on a place in considerably rapid water flow. Other organisms are bacteria and Hydrozoa. Many problems are caused by these organisms even now. 8 refs., 3 figs., 2 tabs.

  3. Multiple interacting factors influence adherence, and outcomes associated with surgical safety checklists: a qualitative study.

    Directory of Open Access Journals (Sweden)

    Anna R Gagliardi

    Full Text Available The surgical safety checklist (SSC is meant to enhance patient safety but studies of its impact conflict. This study explored factors that influenced SSC adherence to suggest how its impact could be optimized.Participants were recruited purposively by profession, region, hospital type and time using the SSC. They were asked to describe how the SSC was adopted, associated challenges, perceived impact, and suggestions for improving its use. Grounded theory and thematic analysis were used to collect and analyse data. Findings were interpreted using an implementation fidelity conceptual framework.Fifty-one participants were interviewed (29 nurses, 13 surgeons, 9 anaesthetists; 18 small, 14 large and 19 teaching hospitals; 8 regions; 31 had used the SC for ≤12 months, 20 for 13+ months. The SSC was inconsistently reviewed, and often inaccurately documented as complete. Adherence was influenced by multiple issues. Extensive modification to accommodate existing practice patterns eliminated essential interaction at key time points to discuss patient management. Staff were often absent or not paying attention. They did not feel it was relevant to their work given limited evidence of its effectiveness, and because they were not engaged in its implementation. Organizations provided little support for implementation, training, monitoring and feedback, which are needed to overcome these, and other individual and team factors that challenged SSC adherence. Responses were similar across participants with different characteristics.Multiple processes and factors influenced SSC adherence. This may explain why, in studies evaluating SSC impact, outcomes were variable. Recommendations included continuing education, time for pilot-testing, and engaging all staff in SSC review. Others may use the implementation fidelity framework to plan SSC implementation or evaluate SSC adherence. Further research is needed to establish which SSC components can be modified

  4. Sharia Adherence Mosque Survey: Correlations between Sharia Adherence and Violent Dogma in U.S. Mosques

    Directory of Open Access Journals (Sweden)

    Mordechai Kedar


    Full Text Available A random survey of 100 representative mosques in the U.S. was conducted to measure the correlation between Sharia adherence and dogma calling for violence against non-believers.  Of the 100 mosques surveyed, 51% had texts on site rated as severely advocating violence; 30% had texts rated as moderately advocating violence; and 19% had no violent texts at all.  Mosques that presented as Sharia adherent were more likely to feature violence-positive texts on site than were their non-Sharia-adherent counterparts.  In 84.5% of the mosques, the imam recommended studying violence-positive texts.  The leadership at Sharia-adherent mosques was more likely to recommend that a worshipper study violence-positive texts than leadership at non-Sharia-adherent mosques.  Fifty-eight percent of the mosques invited guest imams known to promote violent jihad.  The leadership of mosques that featured violence-positive literature was more likely to invite guest imams who were known to promote violent jihad than was the leadership of mosques that did not feature violence-positive literature on mosque premises.  

  5. Iron Chelation Adherence to Deferoxamine and Deferasirox in Thalassemia (United States)

    Trachtenberg, Felicia; Vichinsky, Elliott; Haines, Dru; Pakbaz, Zahra; Mednick, Lauren; Sobota, Amy; Kwiatkowski, Janet; Thompson, Alexis A.; Porter, John; Coates, Thomas; Giardina, Patricia J.; Olivieri, Nancy; Yamashita, Robert; Neufeld, Ellis J.


    The Thalassemia Clinical Research Network collected adherence information from 79 patients on deferoxamine and 186 on deferasirox from 2007 to 2009. Chelation adherence was defined as percent of doses administered in the last 4 weeks (patient report) out of those prescribed (chart review). Chelation history since 2002 was available for 97 patients currently on deferoxamine and 217 on deferasirox, with crude estimates of adherence from chart review. Self-reported adherence to both deferoxamine and deferasirox were quite high, with slightly higher adherence to the oral chelator (97 vs. 92%). Ninety percent of patients on deferasirox reported at least 90% adherence, compared with 75% of patients on deferoxamine. Adherence to both chelators was highest in children, followed by adolescents and older adults. Predictors of lower deferoxamine adherence were smoking in the past year, problems sticking themselves (adults only), problems wearing their pump, and fewer transfusions in the past year. Predictors of lower deferasirox adherence were bodily pain and depression. Switching chelators resulted in increased adherence, regardless of the direction of the switch, although switching from deferoxamine to deferasirox was far more common. As adherence to deferoxamine is higher than previously reported, it appears beneficial for patients to have a choice in chelators. PMID:21523808

  6. Iron chelation adherence to deferoxamine and deferasirox in thalassemia. (United States)

    Trachtenberg, Felicia; Vichinsky, Elliott; Haines, Dru; Pakbaz, Zahra; Mednick, Lauren; Sobota, Amy; Kwiatkowski, Janet; Thompson, Alexis A; Porter, John; Coates, Thomas; Giardina, Patricia J; Olivieri, Nancy; Yamashita, Robert; Neufeld, Ellis J


    The Thalassemia Clinical Research Network collected adherence information from 79 patients on deferoxamine and 186 on deferasirox from 2007 to 2009. Chelation adherence was defined as percent of doses administered in the last 4 weeks (patient report) out of those prescribed(chart review). Chelation history since 2002 was available for 97 patients currently on deferoxamine and 217 on deferasirox, with crude estimates of adherence from chart review. Self-reported adherence to both deferoxamine and deferasirox were quite high, with slightly higher adherence to the oral chelator (97 vs. 92%). Ninety percent of patients on deferasirox reported at least 90% adherence, compared with 75% of patients on deferoxamine. Adherence to both chelators was highest in children, followed by adolescents and older adults.Predictors of lower deferoxamine adherence were smoking in the past year, problems sticking themselves (adults only), problems wearing their pump, and fewer transfusions in the past year. Predictors of lower deferasirox adherence were bodily pain and depression. Switching chelators resulted in increased adherence, regardless of the direction of the switch, although switching from deferoxamine to deferasirox was far more common. As adherence to deferoxamine is higher than previously reported, it appears beneficial for patients to have a choice in chelators.

  7. Macro influencers of electronic health records adoption. (United States)

    Raghavan, Vijay V; Chinta, Ravi; Zhirkin, Nikita


    While adoption rates for electronic health records (EHRs) have improved, the reasons for significant geographical differences in EHR adoption within the USA have remained unclear. To understand the reasons for these variations across states, we have compiled from secondary sources a profile of different states within the USA, based on macroeconomic and macro health-environment factors. Regression analyses were performed using these indicator factors on EHR adoption. The results showed that internet usage and literacy are significantly associated with certain measures of EHR adoption. Income level was not significantly associated with EHR adoption. Per capita patient days (a proxy for healthcare need intensity within a state) is negatively correlated with EHR adoption rate. Health insurance coverage is positively correlated with EHR adoption rate. Older physicians (>60 years) tend to adopt EHR systems less than their younger counterparts. These findings have policy implications on formulating regionally focused incentive programs.

  8. Are You Pregnant and Thinking about Adoption? (United States)

    ... reactions for birth parents after they place their child for adoption. Some birth parents also go through phases of feeling guilty and ... org/ Open Adoption Bloggers http: / / openadoptionbloggers. com Publications Child ... from: https: / / www. childwelfare. gov/ pubs/ f_ ...

  9. Impact of Adoption on Birth Parents (United States)

    ... best interests ahead of their own when they make the decision to place the child for adoption (Child Welfare Information Gateway, 2007). Other reasons birth parents place their children for adoption include societal and ...




  11. Association between diabetes treatment adherence and parent-child agreement regarding treatment responsibilities. (United States)

    Lancaster, Blake Mark; Gadaire, Dana M; Holman, Kathryn; LeBlanc, Linda A


    When primary responsibility for Type 1 diabetes (DM1) treatment adherence transfers from parents to adolescents, glycemic control often suffers. Low rates of treatment adherence during this transition are possibly attributable to decreased parental involvement, disagreements between parents and children regarding treatment responsibilities, and increased family conflict. The current investigation assessed the relationships between each of these variables and glycemic control among youth diagnosed with DM1. Parent and child report questionnaires were completed by 64 parent-child dyads (ages 8-18) with a child diagnosed with DM1. HbA1c readings served as measures of glycemic control. Parental involvement in their children's treatment was reported to decline with age, however absolute levels of parent involvement were not significantly correlated with youth HbA1c levels. Parent-child agreement regarding treatment responsibility and reports of diabetes-related conflict were significant predictors of glycemic control. Results support previous findings implicating parent-child agreement regarding treatment responsibilities and family conflict as predictors of treatment adherence among youth with DM1. The current study found this relationship to be significant for a larger population of children for which past research has failed to find such an effect. Taken together, these findings suggest further research is warranted to identify effective methods for transferring treatment responsibilities from parents to children.

  12. Pharmacy adherence measures to assess adherence to antiretroviral therapy: review of the literature and implications for treatment monitoring. (United States)

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


    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.

  13. Interventions to enhance adherence to dietary advice for preventing and managing chronic diseases in adults: a study protocol

    Directory of Open Access Journals (Sweden)

    Gravel Karine


    Full Text Available Abstract Background Adoption of a healthy diet has been identified as the cornerstone in the prevention and management of chronic diseases. However, non-adherence to lifestyle changes raises an important issue since adherence level to dietary advice is a key determinant of the effectiveness of dietary treatment. Therefore, based on the results of a Cochrane systematic review on interventions for enhancing adherence to dietary advice for preventing and managing chronic diseases in adults, the aim of this study is to assess the importance and applicability of interventions enhancing adherence to dietary advice in the Canadian context. Methods/Design In phase 1, dietitians' opinion will be assessed through a Delphi study regarding the importance and the applicability in the Canadian context of the interventions found the most effective to enhance adherence to dietary advice through a Cochrane systematic review. In phase 2, findings of the Cochrane systematic review assessing the effects of interventions for enhancing adherence to dietary advice will be reported in a practical format on an online knowledge translation tool for dietitians and other health professionals. Discussion In recent years, there has been an increasing recognition of the failure to translate research findings into clinical practice. Therefore, knowledge translation efforts need to prioritize effective interventions that will be the most relevant for practice and end-users by adapting them to the local context. Our study will provide decision makers in the field of dietetic practice with essential knowledge on adherence for elaborating educational activities for academic or professional settings that will respond to dietitians' priorities in terms of importance and applicability to day-to-day practice.

  14. Medication adherence, work performance and self-esteem among psychiatric patients attending psychosocial rehabilitation services at Bangalore, India

    Directory of Open Access Journals (Sweden)

    Sailaxmi Gandhi


    Full Text Available Context: Work benefits mental health in innumerable ways. Vocational rehabilitation can enhance self-esteem. Medication adherence can improve work performance and thereby the individuals′ self-esteem. Aim: To test the hypothesis that there would be a significant correlation between medication adherence, work performance and self-esteem. Setting and Design: A quantitative, descriptive correlational research design was adopted to invite patients attending psychiatric rehabilitation services to participate in the research. Material and Methods: Data was collected from a convenience sample of 60 subjects using the ′Medication Adherence Rating scale′, ′Griffiths work behaviour scale′ and the ′Rosenberg′s Self-esteem scale′. Statistical analysis used: Analysis was done using spss18 with descriptive statistics, Pearsons correlation coefficient and multiple regression analysis. Results: There were 36 males and 24 females who participated in this study. The subjects had good mean medication adherence of 8.4 ± 1.5 with median of 9.00, high mean self-esteem of 17.65 ± 2.97 with median of 18.0 and good mean work performance of 88.62 ± 22.56 with median of 93.0. Although weak and not significant, there was a positive correlation (r = 0.22, P = 0.103 between medication adherence and work performance; positive correlation between (r = 0.25, P = 0.067 medication adherence and self-esteem; positive correlation between (r = 0.136, P = 0.299 work performance and self-esteem. Multiple regression analysis showed no significant predictors for medication adherence, work performance and self-esteem among patients with psychiatric illness. Conclusions: Medication monitoring and strengthening of work habit can improve self-esteem thereby, strengthening hope of recovery from illness.

  15. Adoptive immunotherapy of advanced melanoma. (United States)

    Shapira-Frommer, Ronnie; Schachter, Jacob


    Adoptive cell therapy (ACT) has emerged as an effective therapy for patients with metastatic melanoma. Since the first introduction of the protocol in 1988 [1], major improvements have been achieved with response rates of 40%-72% among patients who were resistant to previous treatment lines. Both cell product and conditioning regimen are major determinants of treatment efficacy; therefore, developing ACT protocols explore diverse ways to establish autologous intra-tumoral lymphocyte cultures or peripheral effector cells as well as different lymphodepleting regimens. While a proof of feasibility and a proof of concept had been established with previous published results, ACT will need to move beyond single-center experiences, to confirmatory, multi-center studies. If ACT is to move into widespread practice, it will be necessary to develop reproducible high quality cell production methods and accepted lymphodepleting regimen. Two new drugs, ipilimumab (Yervoy, Bristol-Myers Squibb) and vemurafenib (Zelboraf, Roche), were approved in 2011 for the treatment of metastatic melanoma based on positive phase III trials. Both drugs show a clear overall survival benefit, so the timing of when to use ACT will need to be carefully thought out. In contrast to these 2 new, commercially available outpatient treatments, ACT is a personally-specified product and labor-intensive therapy that demands both acquisition of high standard laboratory procedures and close clinical inpatient monitoring during treatment. It is unique among other anti-melanoma treatments, providing the potential for a durable response following a single, self-limited treatment. This perspective drives the efforts to make this protocol accessible for more patients and to explore modifications that may optimize treatment results.

  16. Adherence to Mediterranean diet and bone health

    Directory of Open Access Journals (Sweden)

    Antonio Romero Pérez


    Full Text Available Introduction: Several studies have concluded that incidences of osteoporosis and osteoporosis-related fractures vary across the European Union, the lowest incidence being reported in the Mediterranean area. The beneficial effect is mainly attributed to a specific eating pattern. The Mediterranean diet contain a complex array of naturally occurring bioactive molecules with antioxidant, anti-inflammatory and alkalinising properties that may contribute to the bone-sparing effect of the Mediterranean diet. Objective: The purpose of this review is to examine the evidence to date on the effects of Mediterranean diet on bone health. Methods: The search for articles came from extensive research in the following databases: PubMed, Scopus and Web of Science. We used the search terms "Mediterranean diet", "adherence", "fruit and vegetable", "olive oil", "fish" "legume", "cereal" "alcohol", "bone", "osteoporosis", "fracture", and combinations, such as "Mediterranean diet and bone" or "Mediterranean diet and fracture". Results: A limited number of studies have examined the relationship between Mediterranean Diet and bone health, and they have reported conflicting results. On the one hand, adherence to a traditional MeDi has been associated with higher bone mineral density and lower fracture risk. The results of these studies could be attributed to the combined beneficial effects of individual components of the Mediterranean diet. On the contrary, several studies failed to show any association between adherence to the MeDi and indices of bone mass. Conclusions: Further large-scale studies are required to clarify the effect of Mediterranean diet on bone health, in order to establish the role of this diet in the prevention of osteoporosis.

  17. On World Religion Adherence Distribution Evolution (United States)

    Ausloos, Marcel; Petroni, Filippo

    Religious adherence can be considered as a degree of freedom, in a statistical physics sense, for a human agent belonging to a population. The distribution, performance and life time of religions can thus be studied having in mind heterogeneous interacting agent modeling. We present a comprehensive analysis of 58 so-called religions (to be better defined in the main text) as measured through their number of adherents evolutions, between 1900 and 2000, - data taken from the World Christian Trends (Barrett and Johnson, "World Christian Trends AD 30 - AD 2200: Interpreting the Annual Christian Megacensus", William Carey Library, 2001): 40 are considered to be "presently growing" cases, including 11 turn overs in the twentieth century; 18 are "presently decaying", among which 12 are found to have had a recent maximum, in the nineteenth or the twentieth century. The Avrami-Kolmogorov differential equation which usually describes solid state transformations, like crystal growth, is used in each case in order to obtain the preferential attachment parameter introduced previously (Europhys Lett 77:38002, 2007). It is not often found close to unity, though often corresponding to a smooth evolution. However large values suggest the occurrence of extreme cases which we conjecture are controlled by so-called external fields. A few cases indicate the likeliness of a detachment process. We discuss a few growing and decaying religions, and illustrate various fits. Some cases seem to indicate the lack of reliability of the data, but others some marked departure from Avrami law. Whence the Avrami evolution equation might be surely improved, in particular, and somewhat obviously, for the decaying religion cases. We point out two major difficulties in such an analysis: (1) the "precise" original time of apparition of a religion, (2) the time at which there is a maximum number of adherents, both information being necessary for integrating reliably any evolution equation.

  18. Community health workers adherence to referral guidelines

    DEFF Research Database (Denmark)

    Lal, Sham; Ndyomugenyi, Richard; Paintain, Lucy;


    Background Many malaria-endemic countries have implemented national community health worker (CHW) programmes to serve remote populations that have poor access to malaria diagnosis and treatment. Despite mounting evidence of CHWs’ ability to adhere to malaria rapid diagnostic tests (RDTs...... artemisinin-based combination therapy (ACT) and recognize symptoms in children that required immediate referral to the nearest health centre. Intervention arm CHWs had additional training on how to conduct an RDT; CHWs in the control arm used a presumptive diagnosis for malaria using clinical signs...

  19. Adherence to antiretroviral therapy among people living with HIV

    Directory of Open Access Journals (Sweden)

    Basavaprabhu Achappa


    Full Text Available Background: Acquired immune deficiency syndrome (AIDS is now considered as a manageable chronic illness. There has been a dramatic reduction in human immunodeficiency virus (HIV related morbidity and mortality due to antiretroviral therapy. A high level of adherence (>95% is required for antiretroviral therapy to be effective. There are many barriers to adherence in both developed and developing countries. Aim: The aim of our study was to determine adherence levels and factors influencing adherence to antiretroviral therapy among people living with HIV. Materials and Methods: Using a cross-sectional study design, 116 HIV positive patients receiving antiretroviral therapy for at least 1 year were interviewed using a semi structured questionnaire. The collected data was analyzed using Statistical Product and Service Solutions (SPSS version 11.5. Chi-square test was done. A P value of < 0.05 was considered statistically significant. Results: Of 116 participants, 63.7% reported adherence ≥ 95%. Mean adherence index was 91.25%. Financial constraints, forgetting to take medication, lack of family care, depression, alcohol use, social stigma and side effects to antiretroviral therapy were barriers for adherence in our study. Conclusion: Adherence to antiretroviral therapy in south India is suboptimal. Intensive adherence counseling should be provided to all patients before initiation ofantiretroviral therapy. Health care providers must identify possible barriers to adherence at the earliest and provide appropriate solutions.

  20. [Attachment and Adoption: Diagnostics, Psychopathology, and Therapy]. (United States)

    Brisch, Karl-Heinz


    This presentation describes the development of attachment between adopted children and their adoptive parents with a focus on the particular issues seen in international adoptions. The questions of settling in, trauma in the country of origin, and the motivations of the adoptive parents will be discussed. Diagnosis and various psychopathological manifestations will be examined, as will outpatient and inpatient modes of therapy. The treatment of children of various ages will be covered along with the necessity for intensive counseling and psychotherapy for the adoptive parents. This will enable the parents to work through early trauma, which will give them and their adopted child the basis for developing healthy attachment patterns. This in turn will enable the child to mature and integrate into society. Possibilities of prevention are discussed. Many of the approaches discussed here regarding attachment and adoption may be applied to foster children and their foster parents.

  1. Patient adherence to medical treatment: a review of reviews

    Directory of Open Access Journals (Sweden)

    Heerdink Rob


    Full Text Available Abstract Background Patients' non-adherence to medical treatment remains a persistent problem. Many interventions to improve patient adherence are unsuccessful and sound theoretical foundations are lacking. Innovations in theory and practice are badly needed. A new and promising way could be to review the existing reviews of adherence to interventions and identify the underlying theories for effective interventions. That is the aim of our study. Methods The study is a review of 38 systematic reviews of the effectiveness of adherence interventions published between 1990 and 2005. Electronic literature searches were conducted in Medline, Psychinfo, Embase and the Cochrane Library. Explicit inclusion and exclusion criteria were applied. The scope of the study is patient adherence to medical treatment in the cure and care sector. Results Significant differences in the effectiveness of adherence interventions were found in 23 of the 38 systematic reviews. Effective interventions were found in each of four theoretical approaches to adherence interventions: technical, behavioural, educational and multi-faceted or complex interventions. Technical solutions, such as a simplification of the regimen, were often found to be effective, although that does not count for every therapeutic regimen. Overall, our results show that, firstly, there are effective adherence interventions without an explicit theoretical explanation of the operating mechanisms, for example technical solutions. Secondly, there are effective adherence interventions, which clearly stem from the behavioural theories, for example incentives and reminders. Thirdly, there are other theoretical models that seem plausible for explaining non-adherence, but not very effective in improving adherence behaviour. Fourthly, effective components within promising theories could not be identified because of the complexity of many adherence interventions and the lack of studies that explicitly compare

  2. Predictors of adherence to safe handling practices for antineoplastic drugs: A survey of hospital nurses. (United States)

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


    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.

  3. Using communication skills to improve adherence in children with chronic disease : The adherence equation

    NARCIS (Netherlands)

    Brand, Paul L. P.; Klok, Ted; Kaptein, Adrian A.


    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

  4. Accurate reporting of adherence to inhaled therapies in adults with cystic fibrosis: methods to calculate normative adherence

    Directory of Open Access Journals (Sweden)

    Hoo ZH


    Full Text Available Zhe Hui Hoo,1,2 Rachael Curley,1,2 Michael J Campbell,1 Stephen J Walters,1 Daniel Hind,3 Martin J Wildman1,2 1School of Health and Related Research (ScHARR, University of Sheffield, 2Sheffield Adult Cystic Fibrosis Centre, Northern General Hospital, 3Sheffield Clinical Trials Research Unit, University of Sheffield, Sheffield, UK Background: Preventative inhaled treatments in cystic fibrosis will only be effective in maintaining lung health if used appropriately. An accurate adherence index should therefore reflect treatment effectiveness, but the standard method of reporting adherence, that is, as a percentage of the agreed regimen between clinicians and people with cystic fibrosis, does not account for the appropriateness of the treatment regimen. We describe two different indices of inhaled therapy adherence for adults with cystic fibrosis which take into account effectiveness, that is, “simple” and “sophisticated” normative adherence. Methods to calculate normative adherence: Denominator adjustment involves fixing a minimum appropriate value based on the recommended therapy given a person’s characteristics. For simple normative adherence, the denominator is determined by the person’s Pseudomonas status. For sophisticated normative adherence, the denominator is determined by the person’s Pseudomonas status and history of pulmonary exacerbations over the previous year. Numerator adjustment involves capping the daily maximum inhaled therapy use at 100% so that medication overuse does not artificially inflate the adherence level. Three illustrative cases: Case A is an example of inhaled therapy under prescription based on Pseudomonas status resulting in lower simple normative adherence compared to unadjusted adherence. Case B is an example of inhaled therapy under-prescription based on previous exacerbation history resulting in lower sophisticated normative adherence compared to unadjusted adherence and simple normative adherence

  5. Statistical Dynamics of Religions and Adherents

    CERN Document Server

    Ausloos, M; Ausloos, Marcel; Petroni, Filippo


    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'' view point: 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 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...

  6. Automated microinjection system for adherent cells (United States)

    Youoku, Sachihiro; Suto, Yoshinori; Ando, Moritoshi; Ito, Akio


    We have developed an automated microinjection system that can handle more than 500 cells an hour. Microinjection injects foreign agents directly into cells using a micro-capillary. It can randomly introduce agents such as DNA, proteins and drugs into various types of cells. However, conventional methods require a skilled operator and suffer from low throughput. The new automated microinjection techniques we have developed consist of a Petri dish height measuring method and a capillary apex position measuring method. The dish surface height is measured by analyzing the images of cells that adhere to the dish surface. The contrast between the cell images is minimized when the focus plane of an object lens coincides with the dish surface. We have developed an optimized focus searching method with a height accuracy of +/-0.2 um. The capillary apex position detection method consists of three steps: rough, middle, and precise. These steps are employed sequentially to cover capillary displacements of up to +/-2 mm, and to ultimately accomplish an alignment accuracy of less than one micron. Experimental results using this system we developed show that it can introduce fluorescent material (Alexa488) into adherent cells, HEK293, with a success rate of 88.5%.

  7. Statistical dynamics of religions and adherents (United States)

    Ausloos, M.; Petroni, F.


    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.

  8. Side effects, adherence self-efficacy, and adherence to antiretroviral treatment: a mediation analysis in a Chinese sample. (United States)

    Zhang, Liying; Li, Xiaoming; Lin, Zhenping; Jacques-Tiura, Angela J; Xu, Jinping; Zhou, Yuejiao; Qiao, Shan; Shen, Zhiyong; Stanton, Bonita


    Antiretroviral therapy (ART) is a lifelong treatment. To date, ART adherence is suboptimal for most patients in resource-poor settings. Previous research indicates that medication side effects are perceived to be a significant barrier of high ART adherence. Data regarding the role of adherence self-efficacy in mediating the relationship between side effects from ART and adherence to ART are limited; thus, this study examines this potential mediational role of self-efficacy. A cross-sectional survey of 2987 people living with HIV aged ≥18 years was conducted in 2012-2013 in Guangxi Autonomous Region (Guangxi) which has one of the fastest-growing HIV rates in China. Of the total sample, 2146 (72.1%) participants had initiated ART. Participants reported the number of days of completing the daily dose of ART in the past month; adherence was defined as completing the daily dose at least 28 days in the last month (≥90%). Side effects were significantly negatively related to adherence to ART. Mediation analyses indicated that adherence self-efficacy significantly mediated the side effects-adherence relationship. Future interventions to increase adherence self-efficacy and effective coping with side effects among HIV patients are needed in order to improve their ART adherence.

  9. Stability of adherence to highly active antiretroviral therapy over time among clients enrolled in the treatment adherence demonstration project. (United States)

    Tesoriero, James; French, Tyler; Weiss, Linda; Waters, Mark; Finkelstein, Ruth; Agins, Bruce


    Adherence to antiretroviral medications is essential to therapeutic success. Many published studies have investigated the degree of adherence or nonadherence, but sample sizes have generally been small, and adherence has seldom been viewed as a longitudinal process. This paper investigates the stability of adherence over time among HIV-infected individuals attending adherence support programs in New York State. The study cohort consists of 435 clients who were on HAART at baseline and who completed at least 2 follow-up interviews. Although cross-sectional nonadherence did not exceed 35%, nonadherence reached 54% when considered across all 3 interviews. Analysis of transition matricies revealed moderate stability in adherence over time (e.g., first follow-up adherence was 81.0% for clients adherent at baseline, compared with 58.3% for clients nonadherent at baseline). Second-order transition matricies offered additional predictive utility. Multivariate results indicated that, for some, it was the transition from a desirable to an undesirable state (e.g., from no illicit drug use to illicit drug use) that increased the likelihood of nonadherence, rather than the presence of these characteristics over time. Findings illustrate the importance of multiple, periodic assessments of adherence and the need to consider strategies to increase stability in the factors affecting adherence to HAART.

  10. [e-Health interventions and improvement in treatment adherence]. (United States)

    Sieben, Angelien; Bredie, S J H Bas; van Laarhoven, C J H M Kees; Schoonhoven, Lisette; Burger, David M; van Onzenoort, Hein A W


    Poor adherence to medication is one of the most important determinants in the treatment of patients with chronic disorders. e-Health-based interventions may be able to improve treatment adherence. This article gives an overview of the available e-Health interventions and the extent to which they can improve adherence. We searched in the PubMed, Cinahl, PsycInfo, and Embase databases for e-Health interventions that aimed at improving adherence to treatment. Of the 16 included studies, 15 used a website and one used an app. Ten studies showed a significant improvement in treatment adherence by using the intervention. e-Health interventions were generally complex. Simple interventions were the most successful in improving treatment adherence.

  11. Measuring insulin adherence among adults with type 2 diabetes. (United States)

    Osborn, Chandra Y; Gonzalez, Jeffery S


    Non-adherence to insulin is common and associated with suboptimal health. We adapted the Morisky Medication Adherence Scale to specify insulin adherence (MIAS) and compared it to the Adherence to Refills and Medication Scale for Diabetes (ARMS-D) and the Summary of Diabetes Self-Care Activities medications subscale (SDSCA-MS) and an insulin-specific (SDSCA-IS) version. A sample of 144 insulin-treated adults (58 % African American/Black, 34 % Caucasian/White, 8 % Other/Mixed race; 6.9 % Hispanic) completed these measures along with a HbA1C test. The internal consistency and factor structure of the MIAS were adequate; 59 % of participants forgot to take insulin and 46 % reported non-adherence. The MIAS was associated with the ARMS-D, SDSCA-MS, and SDSCA-IS (p insulin adherence assessment tool for practice and research applications.

  12. "Adoption Wisdom: A Guide to the Issues and Feelings of Adoption" by Marlou Russell. Book Review. (United States)

    Simonson, Tracy


    Reviews "Adoption Wisdom: A Guide to the Issues and Feelings of Adoption" by Marlou Russell. Maintains that its narrative/comment format and accounts of those involved in adoption validate the feelings of the adoption-triad members. Suggests that the book lacks information on individuals who contributed comments and contains few narratives from…

  13. What strategies do ulcerative colitis patients employ to facilitate adherence? (United States)

    Kawakami, Aki; Tanaka, Makoto; Naganuma, Makoto; Maeda, Shin; Kunisaki, Reiko; Yamamoto-Mitani, Noriko


    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

  14. Concern between medication non-adherence and diabetes associated depression


    Krishnan Vengadaragava Chary; Porchelvan Swaminathan


    Background: Diabetes mellitus is one of the health disorders that acquire mankind immensely. An ominous twin of diabetes mellitus is diabetes associated depression which is often unrecognised in routine diabetic care. The objective of this study was to find the prevalence and correlation between medication adherence and diabetes associated depression. Methods: It is a conducted as cross sectional study using Morisky medication adherence scale to evaluate treatment adherence of type II diab...


    Directory of Open Access Journals (Sweden)

    Inga RUSSU


    Full Text Available This article addresses a contemporary issue for the Republic of Moldova concerning psychological implications of the adoption process for prospective adopters. This demand is due to the fact that the majority of couples or people passing through the decision making adoption process are facing a number of conflicting emotions and spiritual states. Thereby, is significant to understand the adoption multidimensionality of social and intrapersonal components. Adoptive parents can feel themselves as victims of „the process”. For them, the assessment of living conditions, the assessment of moral and social guarantees, inclusion or exclusion as eligible adoptive parents, represent a procedure part, which generates frustrations and anxieties. Some of them, often suffer from lack of supporting and understanding, as family members point of view, friends and known people. Also, in this context, parents may face some frustrations related to the matching procedure harmonisation with long cogitation process of the child.

  16. The intrapersonal conflict particularities of potential adopters.

    Directory of Open Access Journals (Sweden)

    Inga Russu


    Full Text Available This article addresses a contemporary issue for the Republic of Moldova concerning psychological implications of the adoption process for prospective adopters. This demand is due to the fact that the majority of couples or people passing through the decision making adoption process are facing a number of conlicting emotions and spiritual states. Thereby, is signiicant to understand the adoption multidimensionality of social and intrapersonal components. Adoptive parents can feel themselves as victims of „the process”. For them, the assessment of living conditions, the assessment of moral and social guarantees, inclusion or exclusion as eligible adoptive parents, represent a procedure part, which generates frustrations and anxieties. Some of them, often suffer from lack of supporting and understanding, as family members point of view, friends and known people. Also, in this context, parents may face some frustrations related to the matching procedure harmonisation with long cogitation process of the child.

  17. The role of family caregivers in HIV medication adherence. (United States)

    Beals, K P; Wight, R G; Aneshensel, C S; Murphy, D A; Miller-Martinez, D


    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.

  18. The effect of reminder systems on patients' adherence to treatment

    Directory of Open Access Journals (Sweden)

    Fenerty SD


    Full Text Available Sarah D Fenerty1, Cameron West1, Scott A Davis1, Sebastian G Kaplan3, Steven R Feldman1,2,41Center for Dermatology Research, Department of Dermatology, 2Department of Pathology, 3Department of Psychiatry and Behavioral Medicine, 4Department of Public Health Sciences, Wake Forest University School of Medicine, Winston-Salem, North Carolina, USABackground: Patient adherence is an important component of the treatment of chronic disease. An understanding of patient adherence and its modulating factors is necessary to correctly interpret treatment efficacy and barriers to therapeutic success.Purpose: This meta-analysis aims to systematically review published randomized controlled trials of reminder interventions to assist patient adherence to prescribed medications.Methods: A Medline search was performed for randomized controlled trials published between 1968 and June 2011, which studied the effect of reminder-based interventions on adherence to self-administered daily medications.Results: Eleven published randomized controlled trials were found between 1999 and 2009 which measured adherence to a daily medication in a group receiving reminder interventions compared to controls receiving no reminders. Medication adherence was measured as the number of doses taken compared to the number prescribed within a set period of time. Meta-analysis showed a statistically significant increase in adherence in groups receiving a reminder intervention compared to controls (66.61% versus 54.71%, 95% CI for mean: 0.8% to 22.4%. Self-reported and electronically monitored adherence rates did not significantly differ (68.04% versus 63.67%, P = 1.0. Eight of eleven studies showed a statistically significant increase in adherence for at least one of the reminder group arms compared to the control groups receiving no reminder intervention.Limitations: The data are limited by imperfect measures of adherence due to variability in data collection methods. It is also likely

  19. Impact of prescription size on statin adherence and cholesterol levels

    Directory of Open Access Journals (Sweden)

    Mehler Phillip S


    Full Text Available Abstract Background Therapy with 3-Hydroxy-3-methylglutaryl Co-enzyme A reductase inhibitors (statins improve outcomes in a broad spectrum of patients with hyperlipidemia. However, effective therapy requires ongoing medication adherence; restrictive pharmacy policies may represent a barrier to successful adherence, particularly among vulnerable patients. In this study we sought to assess the relationship between the quantity of statin dispensed by the pharmacy with patient adherence and total cholesterol. Methods We analyzed a cohort of 3,386 patients receiving more than one fill of statin medications through an integrated, inner-city health care system between January 1, 2000 and December 31, 2002. Our measure of adherence was days of drug acquisition divided by days in the study for each patient, with adequate adherence defined as ≥ 80%. Log-binomial regression was used to determine the relative risk of various factors, including prescription size, on adherence. We also assessed the relationship between adherence and total cholesterol using multiple linear regression. Results After controlling for age, gender, race, co-payment, comorbidities, and insurance status, patients who obtained a majority of fills as 60-day supply compared with 30-day supply were more likely to be adherent to their statin medications (RR 1.41, 95% CI 1.28–1.55, P Conclusion In a healthcare system serving predominantly indigent patients, the provision of a greater quantity of statin medication at each prescription fill contributes to improved adherence and greater drug effectiveness.

  20. Methods to Improve Adoptive T-Cell Therapy for Melanoma

    DEFF Research Database (Denmark)

    Donia, Marco; Hansen, Morten; Sendrup, Sarah L


    Further development of adoptive T-cell therapy (ACT) with autologous tumor-infiltrating lymphocytes (TILs) has the potential to markedly change the long-term prognosis of patients with metastatic melanoma, and modifications of the original protocol that can improve its clinical efficacy are highly...... desirable. In this study, we demonstrated that a high in vitro tumor reactivity of infusion products was associated with clinical responses upon adoptive transfer. In addition, we systematically characterized the responses of a series of TIL products to relevant autologous short term-cultured melanoma cell...... lines from 12 patients. We provide evidence that antitumor reactivity of both CD8(+) and CD4(+) T cells could be enhanced in most TIL products by autologous melanoma sensitization by pretreatment with low-dose IFN-γ. IFN-γ selectively enhanced responses to tumor-associated antigens other than melanoma...

  1. ICT Adoption in Facilities Management Supply Chain

    DEFF Research Database (Denmark)

    Scupola, Ada


    This article involves a qualitative study of factors impacting the adoption of ICT solutions in the Danish facility management supply chain. The results show that there are a number of drivers and barriers that influence the adoption of ICT solutions in this service sector. These have been grouped...... concerned with ICT adoption, operations and service management (especially facilities management) as well as operation managers and ICT managers....

  2. Measures for Predictors of Innovation Adoption. (United States)

    Chor, Ka Ho Brian; Wisdom, Jennifer P; Olin, Su-Chin Serene; Hoagwood, Kimberly E; Horwitz, Sarah M


    Building on a narrative synthesis of adoption theories by Wisdom et al. (2013), this review identifies 118 measures associated with the 27 adoption predictors in the synthesis. The distribution of measures is uneven across the predictors and predictors vary in modifiability. Multiple dimensions and definitions of predictors further complicate measurement efforts. For state policymakers and researchers, more effective and integrated measurement can advance the adoption of complex innovations such as evidence-based practices.

  3. Measures for Predictors of Innovation Adoption


    Chor, Ka Ho Brian; Wisdom, Jennifer P.; Olin, Su-Chin Serene; Hoagwood, Kimberly E; Horwitz, Sarah M.


    Building on a narrative synthesis of adoption theories by Wisdom et al. (2013), this review identifies 118 measures associated with the 27 adoption predictors in the synthesis. The distribution of measures is uneven across the predictors and predictors vary in modifiability. Multiple dimensions and definitions of predictors further complicate measurement efforts. For state policymakers and researchers, more effective and integrated measurement can advance the adoption of complex innovations s...

  4. How to Adopt a Child from China

    Institute of Scientific and Technical Information of China (English)


    Foreigners who want to adopt a child from China should present the documents listed below, through their government or an adoption organization entrusted by their government, to a Chinese government empowered adoption organization. These documents should be notarized by the foreign affairs office of their country, or an organization it so empowers, as well as by the Chinese embassy or consulate in their country. These documents include:

  5. Business model elements impacting cloud computing adoption

    DEFF Research Database (Denmark)

    Bogataj, Kristina; Pucihar, Andreja; Sudzina, Frantisek

    The paper presents a proposed research framework for identification of business model elements impacting Cloud Computing Adoption. We provide a definition of main Cloud Computing characteristics, discuss previous findings on factors impacting Cloud Computing Adoption, and investigate technology a...... blocks are investigated: Product Innovation, Infrastructure management, Customer relationship, Financial Aspects.......The paper presents a proposed research framework for identification of business model elements impacting Cloud Computing Adoption. We provide a definition of main Cloud Computing characteristics, discuss previous findings on factors impacting Cloud Computing Adoption, and investigate technology...

  6. Adoption of the Creative Process According to the Immersive Method

    Directory of Open Access Journals (Sweden)

    Sonja Vuk


    Full Text Available The immersive method is a new concept of visual education that is better suited to the needs of students in contemporary post-industrial society. The features of the immersive method are: 1 it emerges from interaction with visual culture; 2 it encourages understanding of contemporary art (as an integral part of visual culture; and 3 it implements the strategies and processes of the dominant tendencies in contemporary art (new media art and relational art with the goal of adopting the creative process, expressing one’s thoughts and emotions, and communicating with the environment. The immersive method transfers the creative process from art to the process of creation by the students themselves. This occurs with the mediation of an algorithmic scheme that enables students to adopt ways to solve problems, to express thoughts and emotions, to develop ideas and to transfer these ideas to form, medium and material. The immersive method uses transfer in classes, the therapeutic aspect of art and “flow state” (the optimal experience of being immersed in an activity/aesthetic experience (a total experience that has a beginning, a process and a conclusion/immersive experience (comprehensive immersion in the present moment. This is a state leading to the sublimative effect of creation (identification with what has been expressed, as well as to self-actualisation. The immersive method teaches one to connect the context, social relations and the artwork as a whole in which one lives as an individual. The adopted creative process is implemented in a critical manner on one’s surrounding through analysis, aesthetic interventions, and ecologically and socially aware inclusion in the life of a community. The students gain the crucial meta-competence of a creative thinking process.

  7. Medication adherence and the use of new pharmaceutical formulations: the case of levothyroxine. (United States)

    Scavone, Cristina; Sportiello, Liberata; Cimmaruta, Daniela; Sullo, Maria G; Vitelli, Bonaventura; Rafaniello, Concetta; Fossati, Tiziano; Rossi, Francesco


    According to World Health Organization, medication adherence refers not only to pharmacological treatment, but also extends to all behaviors which guarantee patient's health. Poor medication adherence is the main cause of low efficacy of pharmacological therapy and it is more common in chronic diseases. For example, among hypothyroid patients, it was estimated that after 5 years of levothyroxine therapy 21.5% of patients still have a TSH level >5.0 mU/L due to poor medication adherence. Moreover, it was found that almost 40% of pediatric patients had at least one episode of non-compliance following thyroidectomia. Several strategies can be adopted in order to improve medication adherence. These include self-monitoring drug therapy and self-management programs, simplified dosing regimens, directly involving pharmacists in drug therapy management, use of pharmaceutical formulations more attractive to the patient and through the therapeutic drug monitoring. The effects mediated by the thyroid gland, the clinical symptoms of hypothyroidism and the main characteristics of levothyroxine therapy have been discussed. In order to give an overview of interactions with food and drinks, pharmacokinetic characteristics, efficacy/safety profile, as well as the impact on medication adherence of levothyroxine in oral solution and soft gel capsule formulations, a literature search was performed. The results of 21 clinical studies were reviewed. Levothyroxine oral solution and soft gel capsule formulations showed irrelevant interactions with food and drinks, with a dissolution profile minimally influenced by pH variations. According to pharmacokinetic study results, bioequivalence between these formulations and levothyroxine tablets was confirmed. Regarding the efficacy/safety profile, while some studies did not detect any difference between levothyroxine formulations, other studies suggested that oral solution and soft gel capsule were associated to a higher efficacy compared to

  8. Investigation of Adherence Degree of Agile Requirements Engineering Practices in Non-Agile Software Development Organizations

    Directory of Open Access Journals (Sweden)

    Mennatallah H. Ibrahim


    Full Text Available Requirements are critical for the success of software projects. Requirements are practically difficult to produce, as the hardest stage of building a software system is to decide what the system should do. Moreover, requirements errors are expensive to fix in the later phases of the software development life cycle. The rapidly changing business environment is highly challenging traditional Requirements Engineering (RE practices. Most of the software development organizations are working in such dynamic environment, as a result, either by or without their awareness agile methodologies are adopted in various phases of their software development cycles. The aim of this paper is to investigate the adherence degree of agile RE practices in various software development organizations that are classifying themselves as adopting traditional (i.e. non-agile software development methodologies. An approach is proposed for achieving this aim and it is applied on five different projects from four different organizations. The result shows that even the non-agile software development organizations are applying agile RE practices by different adherence degrees.

  9. Adherence to COPD guidelines in general practice

    DEFF Research Database (Denmark)

    Ulrik, Charlotte Suppli; Sørensen, Tina Brandt; Højmark, Torben Brunse


    BACKGROUND: The general practitioner (GP) is often the first healthcare contact for patients with chronic obstructive pulmonary disease (COPD). AIMS: To determine whether participating in a standardised educational programme delivered in the GP's own practice is associated with adherence to COPD...... guidelines. METHODS: A nationwide register-based observational before and after study was undertaken with a control group of propensity-matched practices (follow-up period 6 months). COPD was defined as age 40+ years and at least two prescriptions for inhaled medication. The educational programme consisted...... were used to compare the rate of spirometry testing, preventive consultations, and influenza vaccinations provided to COPD patients and the rate of spirometry testing in non-COPD individuals, assumed to reflect diagnostic activity. RESULTS: Data for 102 participating GP practices were analysed...

  10. Sister Carrie, an Adherent of Desires

    Institute of Scientific and Technical Information of China (English)



    Sister Carrie is one of the most controversial characters in American literature.Thought as a "fallen woman" firstly,she was defined as a "new woman" by some critics later. However, by digging into the motivaton behind the whole process of Carrie's "success", the relationship between Carrie and her creator (the author), the social conditions of then American, it can be found that Carrie has never been free-standing on her thought and she has never found her real-sdf even after becoming a famous actress. In a society dominated by mass consumerism Carrie is only an adherent of her own desires. She also is a representative of all those country girls flooded into cities, a symbol and a sacrifice of the urbanization of America in a time countryside was overcome by cities.

  11. Associations between patients' adherence and GPs' attitudes towards risk, statin therapy and management of non-adherence

    DEFF Research Database (Denmark)

    Barfoed, Benedicte L; Paulsen, Maja S; Christensen, Palle M;


    BACKGROUND: Previous studies suggest that doctors' personal lifestyle, risk taking personality and beliefs about risk reducing therapies may affect their clinical decision-making. Whether such factors are further associated with patients' adherence with medication is largely unknown. OBJECTIVE......: To estimate associations between GPs' attitudes towards risk, statin therapy and management of non-adherence and their patients' adherence, and to identify subgroups of GPs with poor patient adherence. METHODS: All Danish GPs were invited to participate in an online survey. We asked whether they regarded...

  12. Modelling imperfect adherence to HIV induction therapy

    Directory of Open Access Journals (Sweden)

    Smith? Robert J


    Full Text Available Abstract Background Induction-maintenance therapy is a treatment regime where patients are prescribed an intense course of treatment for a short period of time (the induction phase, followed by a simplified long-term regimen (maintenance. Since induction therapy has a significantly higher chance of pill fatigue than maintenance therapy, patients might take drug holidays during this period. Without guidance, patients who choose to stop therapy will each be making individual decisions, with no scientific basis. Methods We use mathematical modelling to investigate the effect of imperfect adherence during the inductive phase. We address the following research questions: 1. Can we theoretically determine the maximal length of a possible drug holiday and the minimal number of doses that must subsequently be taken while still avoiding resistance? 2. How many drug holidays can be taken during the induction phase? Results For a 180 day therapeutic program, a patient can take several drug holidays, but then has to follow each drug holiday with a strict, but fairly straightforward, drug-taking regimen. Since the results are dependent upon the drug regimen, we calculated the length and number of drug holidays for all fifteen protease-sparing triple-drug cocktails that have been approved by the US Food and Drug Administration. Conclusions Induction therapy with partial adherence is tolerable, but the outcome depends on the drug cocktail. Our theoretical predictions are in line with recent results from pilot studies of short-cycle treatment interruption strategies and may be useful in guiding the design of future clinical trials.

  13. Treatment adherence in multiple sclerosis: a survey of Belgian neurologists

    Directory of Open Access Journals (Sweden)

    Decoo D


    Full Text Available Danny Decoo,1 Mathieu Vokaer2 1Department of Neurology and Neurorehab, AZ Alma, Sijsele, Belgium; 2Multiple Sclerosis Clinic, Edith Cavell Hospital, CHIREC group, Brussels, Belgium Background: Poor treatment adherence is common among patients with multiple sclerosis (MS. This survey evaluated neurologists’ perception of treatment adherence among MS patients.Materials and methods: This questionnaire-based survey of Belgian neurologists treating MS patients was conducted between June and July 2014. Face-to-face interviews with the neurologists were based on a semistructured questionnaire containing questions regarding the perception of the treatment-adherence level.Results: A total of 41 neurologists participated in the survey. Of these, 88% indicated frequent discussions about treatment adherence as beneficial for treatment efficacy. The mean time spent on the treatment-adherence discussion during the initial consultation was 11 minutes, with 24% of doctors spending 5 minutes and 24% of doctors spending 10 minutes discussing this issue. The majority of neurologists (56% perceived the adherence level in MS as good, and 12% perceived it as excellent. The majority of neurologists (64% indicated intolerance as a main cause of poor adherence, and all neurologists reported insufficient efficacy as a consequence of nonadherence. The importance of adherence in the neurologists’ practice was evaluated on a scale of 1–10, with 1= “not very important” and 10= “very important”: 44% of doctors indicated a score of 10, and the mean score was 9.0.Conclusion: Belgian neurologists consider treatment adherence in MS as essential for the benefits of therapies. However, although neurologists are aware of the consequences of nonadherence, they generally spend limited time discussing the importance of treatment adherence with their patients. Keywords: multiple sclerosis, treatment adherence, physician survey

  14. Non-adherence to topical treatments for actinic keratosis (United States)

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


    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

  15. Methodological findings in studies on adoptive families

    Directory of Open Access Journals (Sweden)

    Kalus, Alicja


    Full Text Available The issue of adoptive families is the object of interest for many researchers, especially outside Polish borders. A critical analysis of previous studies on adoption shows that the scientific value of many of the existing studies raises doubts. The reasons of this are more or less significant methodological weaknesses, which significantly reduce their scientific value. Researchers often focus on the study of individuals in the adoptive family, e.g. mothers only, adopted children only or selected types of relationships within the family e.g. the mother – child relation. There is a little amount of studies on family systems. It seems worthy to note that numerous studies are conducted in the cause-effect model of explaining phenomena in the adoptive family. Such approach to the study of reality, which is the family, is regarded as too big simplification. Therefore, there is an important reason to undertake the scientific discourse on the research methodology on the adoptive family. Discussed in the paper issues include: theoretical models, arrangement of studies, especially the selection of the test group and the research methods used in the study on adoptive families. Conducting scientific research is essential for the adoption practice. Among psychologists-practitioners exists a disturbing belief that working with adoptive families can be based on the experience gained in psychological practice. This fact can be explained by the existing lack of willingness of adoptive families to cooperate in the field of scientific research. Lack of this cooperation significantly limits the access to the study population of adoptive families.

  16. Predictors of race, adoption, and sexual orientation related socialization of adoptive parents of young children. (United States)

    Goldberg, Abbie E; Smith, JuliAnna Z


    Using a sample of 125 lesbian, gay, and heterosexual adoptive parent couples with young children (M = 6.32 years), this study examined predictors of direct socialization (preparation for adoptism, racism, and heterosexism) and indirect socialization (modeling interactions by responding to outsiders' inquiries about their child's adoptive status, racial background, or family structure). In terms of direct socialization, parents of older children tended to engage in more socialization around adoptism and heterosexism, and parents of daughters tended to engage in more socialization around racism and heterosexism. Greater perceived child interest in adoption was related to more direct socialization around adoptism. Parents of color reported more direct socialization around racism. Having a child of color was related to more direct socialization around heterosexism. Regarding indirect socialization, sexual minority parents reported more socialization around adoption and race. Greater perceived child interest in adoption was related to more indirect adoption socialization. Being more "out" was related to more indirect socialization around parent sexual orientation.

  17. 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. (United States)

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


    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.

  18. Radionuclide transfer. Radionuklid Transfer

    Energy Technology Data Exchange (ETDEWEB)

    Gerber, G.B.


    The research project described here had the aim to obtain further information on the transfer of nuclides during pregnancy and lactation. The tests were carried out in mini-pigs and rats receiving unchanging doses of radionuclides with the food. The following findings were revealed for the elements examined: Fe, Se, Cs and Zn were characterized by very high transfer levels in the mother, infant and foetus. A substantial uptake by the mother alone was observed for Co, Ag and Mn. The uptake by the foetus and infant here was 1 to 10 times lower. A preferential concentration in certain tissues was seen for Sr and Tc; the thyroid levels of Tc were about equally high in mothers and infants, while Sr showed less accumulation in the maternal bone. The lanthanide group of substances (Ce, Eu and Gd as well as Y and Ru) were only taken up to a very limited extent. The uptake of the examined radionuclides (Fe, Co, Ag, Ce) with the food ingested was found here to be ten times greater in rats as compared to mini-pigs. This showed that great caution must be observed, if the behaviour of radionuclides in man is extrapolated from relevant data obtained in rodents. (orig./MG)

  19. Pinpointing differences in cisplatin-induced apoptosis in adherent and non-adherent cancer cells

    DEFF Research Database (Denmark)

    Tastesen, Hanne Sørup; Holm, Jacob Bak; Poulsen, Kristian Arild


    Platinum compounds are used in the treatment of cancer. We demonstrate that cisplatin-induced (10 µM) apoptosis (caspase-3 activity) is pronounced within 18 hours in non-adherent Ehrlich ascites tumour cells (EATC), whereas there is no increase in caspase-3 activity in the adherent Ehrlich Lettré...... ascites tumour cells (ELA). Loss of KCl and cell shrinkage are hallmarks in apoptosis and has been shown in EATC. However, we find no reduction in cell volume and only a minor loss of K(+) which is accompanied by net uptake of Na(+) following 18 hours cisplatin exposure in ELA. Glutathione and taurine...... have previously been demonstrated to protect cells from apoptosis. We find, however, that increase or decrease in the cellular content of glutathione and taurine has no effect on cisplatin-induced cell death in EATC and ELA. Nevertheless, knock-down of the taurine transporter TauT leads...

  20. Malaysian Service Sectors Adopt FEDI to Boost Exports and Imports

    Directory of Open Access Journals (Sweden)

    Saravanan Muthaiyah


    Full Text Available Financial Electronic Data Interchange (FEDI refers to making cash payments electronically rather than utilizing any form of traditional payment methods such as physical checks. The merger of two unique systems namely Electronic Fund Transfer (EFT and Electronic Data Interchange (EDI has brought about this new technology. The primary objective of this study is to ascertain how FEDI is currently being implemented by the Royal Customs and Excise department of Malaysia, which is the agency responsible for administrating indirect tax policies in the country. Specifically this study examines the implementation of FEDI, pre and post business processes that were facilitated, transfers of payment received from customs to its various agents and clearance of forms. The study also examines the efficiency of the facilitation and enhancement of business processes due to the implementation of FEDI. This is a classic case of business process reengineering within the department through technology adoption i.e. FEDI.

  1. ICT as an Enabler for Innovation Adoption

    NARCIS (Netherlands)

    M. Verkerk (Michel); G.J. van der Pijl (Gert); E. van Asperen (Eelco)


    textabstractIn this paper we investigate how two online services (a portal and a digital library) may influence the adoption of an innovation. It is known from prior surveys that the installation services branch of the Dutch building industry has a relatively slow adoption rate for innovations. We e

  2. Mother-infant attachment in adoptive families. (United States)

    Singer, L M; Brodzinsky, D M; Ramsay, D; Steir, M; Waters, E


    Data from 2 separate samples using the Strange Situation paradigm were combined to assess the quality of attachment relationships in adoptive and nonadoptive mother-infant pairs. Infants were between 13 and 18 months at the time of observation. Results indicated no differences in mother-infant attachment between nonadopted and intraracial adopted subjects or between intraracial and interracial adopted subjects. Interracial adoptive mother-infant pairs did show a higher incidence of insecure attachment in comparison to nonadoptive pairs. Mothers of interracial adopted infants also were less comfortable having others care for their babies and perceived less emotional support from extended family and friends for their decision to adopt a child prior to the actual adoption than did other mothers. No relation was found, however, between quality of mother-infant attachment and either perceived social support, infant developmental quotient, infant temperament, number of foster homes experienced by the infant, or infant's age at the time of adoption placement. It was suggested that the higher incidence of psychological problems found among adoptees in middle childhood and adolescence cannot be explained in terms of insecure attachment relationships during the infancy years.

  3. Euro adoption in Romania: Facts and perceptions

    Directory of Open Access Journals (Sweden)

    I.-C. Enache


    Full Text Available The aim of this paper is to link the nominal convergence criteria with Romanian citizens perceptions about euro adoption. Based on convergence reports and Euro-barometer data, the 2010 and 2012 years are analysed. It is shown that even if the nominal convergence achievements are improving, the perceptions regarding the euro adoption are deteriorating. A better communication strategy is advised.

  4. Adoption of communication technologies and national culture

    NARCIS (Netherlands)

    Hofstede, G.J.


    This paper investigates the question what attributes of countries influence the differential speed at which they adopt new communication technologies. On the basis of empirical data, it concludes that besides GNP per capita, cultural variables predict the speed of technology adoption. In particular,

  5. Intercountry Adoption Agencies and the HCIA

    NARCIS (Netherlands)

    P. Selman (Peter)


    textabstractThis report discusses concerns raised by participants of Thematic Area 3 (Intercountry Adoption Agencies and the HCIA) of the International Forum on Intercountry Adoption and Global Surrogacy held in August 2014. The aim is to report the views of those participating in this area on the i

  6. 32 CFR 584.4 - Adoption proceedings. (United States)


    ... 32 National Defense 3 2010-07-01 2010-07-01 true Adoption proceedings. 584.4 Section 584.4 National Defense Department of Defense (Continued) DEPARTMENT OF THE ARMY PERSONNEL FAMILY SUPPORT, CHILD CUSTODY, AND PATERNITY § 584.4 Adoption proceedings. (a) General. This chapter does not apply to...

  7. Holistic BIM Adoption and Diffusion in Malaysia

    Directory of Open Access Journals (Sweden)

    Mamter Shahela


    Full Text Available Building Information Modeling is modeling technology and associated set of processes to produce, communicate and analyze digital information models for construction life cycle. Although many benefits can gain by the implementation of BIM, the pace adoption of BIM in Malaysia is still slow. There is an abundance of theories and models purporting to describe the drivers and mechanisms of how new technologies are adopted or diffused into a particular section of society or by individuals or stake players. In addition, many acceptance theories, which imply the adoption of new technologies and can be applied in every sector. This paper aims to present a review of the existing literature of BIM adoption and diffusion theory/model/framework in Malaysia. Researcher revealed the list of driven factors of Holistic BIM Adoption. In addition, it will deal with how to work effectively with groups that initially are relatively

  8. 14 CFR 1260.72 - Adherence to original budget estimates. (United States)


    ... 14 Aeronautics and Space 5 2010-01-01 2010-01-01 false Adherence to original budget estimates. 1260.72 Section 1260.72 Aeronautics and Space NATIONAL AERONAUTICS AND SPACE ADMINISTRATION GRANTS AND COOPERATIVE AGREEMENTS General Post-Award Requirements § 1260.72 Adherence to original budget estimates....

  9. Concern between medication non-adherence and diabetes associated depression

    Directory of Open Access Journals (Sweden)

    Krishnan Vengadaragava Chary


    Conclusions: Unnoticed depression among diabetic individuals reduces treatment adherence and must be addressed in any patient showing poor response to the treatment. Improving treatment adherence helps to combat diabetes as well as depression. [Int J Basic Clin Pharmacol 2016; 5(2.000: 523-527

  10. Treatment Adherence among Latina Female Adolescent Suicide Attempters. (United States)

    Rotheram-Borus, Mary Jane; Piacentini, John; Van Rossem, Ronan; Graae, Flemming; Cantwell, Coleen; Castro-Blanco, David; Feldman, Julie


    Disenfranchised Latina adolescents (N=140) and their mothers presenting at a large urban emergency room after a suicide attempt by the adolescent were assessed to examine treatment adherence. Predictor variables for treatment adherence were established. Results are discussed in relation to treatment session attendance. Implications for the…

  11. Improving Adherence to Hand Hygiene among Health Care Workers (United States)

    Maskerine, Courtney; Loeb, Mark


    Increased adherence to hand hygiene is widely acknowledged to be the most important way of reducing infections in health care facilities. Despite evidence of benefit, adherence to hand hygiene among health care professionals remains low. Several behavioral and organizational theories have been proposed to explain this. As a whole, the success of…

  12. Associations between patient factors and medication adherence: A Jordanian experience

    Directory of Open Access Journals (Sweden)

    Basheti IA


    Full Text Available Objective: To explore the effect of patient characteristics and health beliefs on their medication adherence. Methods: Patients (n=167 with chronic conditions (mean age 58.9; SD=13.54, 53% males were recruited from March 2009- to March 2010 using a cross sectional study design. Data collected included patients’ demographics, medical conditions, medications therapeutic regimen, frequency of physician visits and health beliefs. Patient self-reported adherence to medications was assessed by the researcher using a validated and published scale. Treatment related problems (TRPs were evaluated for each patient by competent clinical pharmacists. Associations between patient characteristics/health beliefs with adherence were explored. Results: About half of the patients (46.1% were non-adherent. A significant association was found between lower adherence and higher number of disease states (p<0.001, higher number of medications (p=0.001, and higher number of identified TRPs (p = 0.003. Patient adherence was positively affected by older age, higher educational level, and higher number of physician visits per month, while it was negatively affected by reporting difficulties with getting prescription refills on time. Conclusion: This study identified different factors that may negatively affect adherence, including higher number of medications and disease states, higher number of identified TRPs and inability to getting prescription refills on time. Hence, more care needs to be provided to patients with complex therapeutic regimens in order to enhance adherence.

  13. Method for preventing micromechanical structures from adhering to another object (United States)

    Smith, J.H.; Ricco, A.J.


    A method for preventing micromechanical structures from adhering to another object includes the step of immersing a micromechanical structure and its associated substrate in a chemical species that does not stick to itself. The method can be employed during the manufacture of micromechanical structures to prevent micromechanical parts from sticking or adhering to one another and their associated substrate surface. 3 figs.

  14. Reliability of assessment of adherence to an antimicrobial treatment guideline

    NARCIS (Netherlands)

    Mol, PGM; Gans, ROB; Panday, PVN; Degener, JE; Laseur, M; Haaijer-Ruskamp, FM


    Assessment procedures for adherence to a guideline must be reliable and credible. The aim of this study was to explore the reliability of assessment of adherence, taking account of the professional backgrounds of the observers. A secondary analysis explored the impact of case characteristics on asse

  15. Unravelling adherence to prophylaxis in haemophilia : A patients' perspective

    NARCIS (Netherlands)

    Schrijvers, L. H.; Kars, M. C.; Beijlevelt-van der Zande, M.; Peters, M.; Schuurmans, M. J.; Fischer, K.


    Given the lifelong therapy in haemophilia patients, insight in non-adherence behaviour from a patient perspective is important to understand patients' difficulties with the following treatment recommendations. The aim of this study was to clarify the process underlying adherence (behaviour) to proph

  16. 42 CFR 447.304 - Adherence to upper limits; FFP. (United States)


    ... 42 Public Health 4 2010-10-01 2010-10-01 false Adherence to upper limits; FFP. 447.304 Section 447... Noninstitutional Services § 447.304 Adherence to upper limits; FFP. (a) The Medicaid agency must not pay more than... payments may be made only up to the reasonable charge under Medicare. (c) FFP is not available for a...

  17. Cognitive-Behavioral Therapy for HIV Medication Adherence and Depression (United States)

    Safren, Steven A.; Hendriksen, Ellen S.; Mayer, Kenneth H.; Mimiaga, Matthew J.; Pickard, Robert; Otto, Michael W.


    For patients with HIV, depression is a common, distressing condition that can interfere with a critical self-care behavior--adherence to antiretroviral therapy. The present study describes a cognitive-behavioral treatment designed to integrate cognitive-behavioral therapy for depression with our previously tested approach to improving adherence to…

  18. Adherence to Pharmacological Treatment for Juvenile Bipolar Disorder (United States)

    Drotar, Dennis; Greenley, Rachel Neff; Demeter, Christine A.; McNamara, Nora K.; Stansbrey, Robert J.; Calabrese, Joseph R.; Stange, Jonathan; Vijay, Priya; Findling, Robert L.


    Objective: The objective of this study was to describe the prevalence and correlates of adherence to divalproex sodium (DVPX) and lithium carbonate (Li) combination treatment during the initial stabilization treatment phase. Method: Adherence to Li/DVPX combination therapy was measured by the presence or absence of minimum serum concentrations of…

  19. Psychosocial factors and treatment adherence in paediatric HIV/AIDS. (United States)

    Naar-King, S; Arfken, C; Frey, M; Harris, M; Secord, E; Ellis, D


    A social ecological model provides a promising framework for understanding the individual, family, and societal factors contributing to non-adherence to treatment of paediatric HIV. This study explored which factors relevant to this model are associated with caregivers' adherence and child health outcomes. A cross-sectional design was utilized to assess relationships among current individual, familial, extra-familial factors, caregiver adherence, and viral load. Data were collected from 43 caregivers, and viral load data were obtained from the medical records of their HIV+ children. Caregiver drug and alcohol use and HIV+ status were associated with non-adherence and elevated viral load. Negative outcome expectancy was associated with lower adherence but was not significant in the multivariate analyses. Family factors were not significant, but these measures had low reliability in this sample. Extra-familial factors such as dissatisfaction with medical specialty care and more stressful life events were not directly associated with adherence but were related to increased caregiver substance use. Results of this first study to explore multiple predictors of adherence and health outcomes in paediatric HIV require replication with larger samples, but findings suggest caregiver characteristics that place children at risk for disease progression due to poor adherence to treatment.

  20. Towards tailored and targeted adherence assessment to optimise asthma management

    NARCIS (Netherlands)

    van Boven, Job F. M.; Trappenburg, Jaap C. A.; van der Molen, Thys; Chavannes, Niels H.


    In this paper, we aim to emphasise the need for a more comprehensive and tailored approach to manage the broad nature of non-adherence, to personalise current asthma management. Although currently several methods are available to measure the extent of asthma patients' adherence, the vast majority do

  1. 77 FR 20637 - Request for Information on Prescription Medication Adherence (United States)


    ... HUMAN SERVICES Request for Information on Prescription Medication Adherence AGENCY: Department of Health... potential solutions associated with the public health problem of prescription medication non-adherence in..., health care providers, and industry and private organizations in efforts to improve medication...

  2. Medication Adherence in Older Adults: A Qualitative Study (United States)

    Holt, Elizabeth W.; Rung, Ariane L.; Leon, Kyla A.; Firestein, Catherine; Krousel-Wood, Marie


    To effectively address medication adherence and improve cardiovascular health among older adults, a deeper understanding is needed of the barriers that this age group faces and of approaches that would be most effective and feasible for improving adherence. We conducted a focus group study (n = 25) in a diverse population of older adults with…

  3. Medication Adherence in a Comparative Effectiveness Trial for Bipolar Disorder (United States)

    Sylvia, Louisa G.; Reilly-Harrington, Noreen A.; Leon, Andrew C.; Kansky, Christine I.; Calabrese, Joseph R.; Bowden, Charles L.; Ketter, Terence A.; Friedman, Edward S.; Iosifescu, Dan V.; Thase, Michael E.; Ostacher, Michael J.; Keyes, Michelle; Rabideau, Dustin; Nierenberg, Andrew A.


    Objective Psychopharmacology remains the foundation of treatment for bipolar disorder, but medication adherence in this population is low (Range = 20% to 64%). We examined medication adherence in a multi-site, comparative effectiveness study of lithium. Method The Lithium Moderate Dose Use Study (LiTMUS) was a six-month, six-site, randomized effectiveness trial of adjunctive moderate dose lithium therapy compared to optimized treatment in adult outpatients with bipolar I or II disorder (N=283). Medication adherence was measured at each study visit with the Tablet Routine Questionnaire. Results We found that 4.50% of participants reported missing at least 30% of their medications in the past week at baseline and non-adherence remained low throughout the trial (< 7%). Poor medication adherence was associated with more manic symptoms and side effects as well as lower lithium serum levels at mid- and post-treatment, but not with poor quality of life, overall severity of illness, or depressive symptoms. Conclusion Participants in LiTMUS were highly adherent with taking their medications. The lack of association with possible predictors of adherence, such as depression and quality of life, could be explained by the limited variance or other factors as well as by not using an objective measure of adherence. PMID:24117232

  4. Patient adherence to medical treatment. A review of reviews.

    NARCIS (Netherlands)

    Dulmen, S. van; Sluijs, E.; Dijk, L. van; Ridder, D. de; Heerdink, R.; Bensing, J.


    BACKGROUND: Patients' non-adherence to medical treatment remains a persistent problem. Many interventions to improve patient adherence are unsuccessful and sound theoretical foundations are lacking. Innovations in theory and practice are badly needed. A new and promising way could be to review the e

  5. Moving Forward with School Nutrition Policies: A Case Study of Policy Adherence in Nova Scotia. (United States)

    McIsaac, Jessie-Lee D; Shearer, Cindy L; Veugelers, Paul J; Kirk, Sara F L


    Many Canadian school jurisdictions have developed nutrition policies to promote health and improve the nutritional status of children, but research is needed to clarify adherence, guide practice-related decisions, and move policy action forward. The purpose of this research was to evaluate policy adherence with a review of online lunch menus of elementary schools in Nova Scotia (NS) while also providing transferable evidence for other jurisdictions. School menus in NS were scanned and a list of commonly offered items were categorized, according to minimum, moderate, or maximum nutrition categories in the NS policy. The results of the menu review showed variability in policy adherence that depended on food preparation practices by schools. Although further research is needed to clarify preparation practices, the previously reported challenges of healthy food preparations (e.g., cost, social norms) suggest that many schools in NS are likely not able to use these healthy preparations, signifying potential noncompliance to the policy. Leadership and partnerships are needed among researchers, policy makers, and nutrition practitioners to address the complexity of issues related to food marketing and social norms that influence school food environments to inspire a culture where healthy and nutritious food is available and accessible to children.

  6. Factors related to adherence to treatment for systemic hypertension

    Directory of Open Access Journals (Sweden)

    Silvana Maria Coelho Leite Fava


    Full Text Available This study aimed to seek the evidence available in the literature regarding the factors related to adherence to treatment for systemic hypertension. It used the method of integrative review in the databases MEDLINE, CINAHL, and LILACS, using the keywords: hypertension, compliance, non-compliance, adherence, non-adherence, patient compliance, in the period 2004 – 2008, and articles in Portuguese, English and Spanish, with the use of a validated instrument and content analysis. 28 studies were selected, 64.3% of which had level of evidence VI. The following were identified as factors related to adherence to treatment: treatment costs, educational activities, sex, physician-patient relationship, physiological and behavioral aspects, drug therapy, attending checkups and lifestyle. The use of combined strategies is suggested in order to increase the individuals’ adherence to the treatment. Gaps point to the valorization of dialogic relationships for integrated and more efficacious health practices.

  7. Interventional tools to improve medication adherence: review of literature (United States)

    Costa, Elísio; Giardini, Anna; Savin, Magda; Menditto, Enrica; Lehane, Elaine; Laosa, Olga; Pecorelli, Sergio; Monaco, Alessandro; Marengoni, Alessandra


    Medication adherence and persistence is recognized as a worldwide public health problem, particularly important in the management of chronic diseases. Nonadherence to medical plans affects every level of the population, but particularly older adults due to the high number of coexisting diseases they are affected by and the consequent polypharmacy. Chronic disease management requires a continuous psychological adaptation and behavioral reorganization. In literature, many interventions to improve medication adherence have been described for different clinical conditions, however, most interventions seem to fail in their aims. Moreover, most interventions associated with adherence improvements are not associated with improvements in other outcomes. Indeed, in the last decades, the degree of nonadherence remained unchanged. In this work, we review the most frequent interventions employed to increase the degree of medication adherence, the measured outcomes, and the improvements achieved, as well as the main limitations of the available studies on adherence, with a particular focus on older persons. PMID:26396502

  8. Quantification of the Forgiveness of Drugs to Imperfect Adherence. (United States)

    Assawasuwannakit, P; Braund, R; Duffull, S B


    The circumstance of how sensitive therapeutic success is under imperfect adherence is driven by the property known as forgiveness. To date, no studies have considered variability in the pharmacokinetic-pharmacodynamic process in conjunction with imperfect adherence patterns in order to develop a comparative criterion to determine the forgiveness of a drug. In this study, we have proposed a criterion to quantify forgiveness; illustrated the criterion for a theoretical example and evaluated the forgiveness of a motivating example, namely warfarin. A forgiveness criterion, relative forgiveness, is defined as the number of times more likely that a target is successfully attained under perfect adherence compared to imperfect adherence; or when comparing two drugs under a standard setting of imperfect adherence. The relative forgiveness criterion may have important implications for both drug development and clinical practice since the choice of drug can account for the likely influence of its forgiveness.

  9. Forgiveness of non-adherence to HIV-1 antiretroviral therapy. (United States)

    Shuter, Jonathan


    Superior adherence to HIV-1 antiretroviral therapy is a mainstay of successful HIV management. Studies performed in the early era of highly active antiretroviral therapy demonstrated the need for > or =95% adherence in order to achieve and sustain viral suppression. High rates of viral suppression have been observed at more moderate levels of adherence with newer antiretroviral regimens. The term 'forgiveness' is being used to describe the ability of a regimen to achieve and sustain viral suppression, despite suboptimal adherence. A variety of pharmacological, viral and host properties determine the level of forgiveness of any specific regimen. As the choice of treatment options continues to expand, forgiveness of non-adherence is likely to emerge as an increasingly important factor in therapeutic decision-making.

  10. Enfermeras y adherencia farmacológica: discurso y conducta Nurses and pharmacological adherence: discourse and behaviour

    Directory of Open Access Journals (Sweden)

    María Jesús Rodríguez-García


    Full Text Available Objetivo principal: Conocer cuáles son los factores predictores del incumplimiento farmacológico y explorar qué actitudes adoptan las enfermeras ante la conducta no adherente. Metodología: Estudio cualitativo mediante grupos focales y entrevistas en profundidad. Resultados principales: Destacan como condicionantes de la conducta no adherente: a falta de conocimientos, comorbilidad y polimedicacción; b características sociodemográficas; c aspectos psicológicos; d pérdida de habilidades; y e modelo de relación profesional-paciente. Ante la conducta no adherente manifiestan diferentes actitudes que reflejan en la relación con el paciente y en el manejo de la adherencia farmacológica. Conclusión principal: Las enfermeras identifican diferentes predictores de incumplimiento farmacológico, aunque centran su atención en los relacionados con el paciente. Predomina el modelo paternalista en la relación con el paciente. Desaconsejan la disponibilidad de glucómetros y tensiómetros así como la lectura del prospecto por considerar que influyen negativamente en el cumplimiento. De la práctica de la automedicación solo destacan los aspectos negativos.Objective: To discover, according to nurses, which are the predictor factors for pharmacological non-adherence; and to explore what attitudes they adopt when dealing with non-adherence behaviors. Methods: A qualitative study including focal groups and in-depth interviews. Results: The determinant factors for non-adherence behaviors are: a lack of knowledge, comorbility and polypharmacy; b sociodemographic features; c psychological aspects; d skill loss; and e the professional-patient relationship model. When encountered with a non-adherent behavior, nurses exhibit different attitudes which have an impact on the relationship with the patient and on the positions they adopt when dealing with pharmacological adherence. Conclusions: Nurses identify several different predictor factors which

  11. Predictors of adherence to physical activity in the Lifestyle Interventions and Independence for Elders pilot study (LIFE-P

    Directory of Open Access Journals (Sweden)

    W Jack Rejeski


    Full Text Available W Jack Rejeski1, Michael E Miller2, Abby C King3, Stephanie A Studenski4, Jeffrey A Katula1, Roger A Fielding5, Nancy W Glynn4, Michael P Walkup2, Jamile A Ashmore6, For the LIFE Investigators (20061Department of Health and Exercise Science, Wake Forest University; 2Department of Biostatistics, Wake Forest University; 3Stanford University; 4University of Pittsburgh; 5Tuffs University; 6Cooper Institute Objectives: A prospective design was used to examine predictors of adherence to a physical activity intervention in older adults with compromised function.Methods: The sample included 213 men (31.1% and women (68.9% with an average age of 76.53 years.Results: The predictor variables accounted for 10% of the variance in percent attendance during adoption and transition, respectively. Adding percent attendance during adoption to the prediction of percent attendance during transition increased the explained variance in this phase to 21%. During maintenance, the predictors accounted for 13% of the variance in frequency of physical activity; this estimate increased to 46% when adding in percent attendance from the transition phase.Discussion: These results are encouraging in that the physical activity intervention appears to have been well tolerated by diverse subgroups of older adults. The role of prior behavior in predicting downstream adherence underscores the importance of developing proactive interventions for treating nonadherence in older adult populations.Keywords: Disability, Physical Activity, Older Adults, Adherence

  12. Characterisation of adopters and non-adopters of dairy technologies in Ethiopia and Kenya. (United States)

    Kebebe, E G; Oosting, S J; Baltenweck, I; Duncan, A J


    While there is a general consensus that using dairy technologies, such as improved breeds of dairy cows, can substantially increase farm productivity and income, adoption of such technologies has been generally low in developing countries. The underlying reasons for non-adoption of beneficial technologies in the dairy sector are not fully understood. In this study, we characterised adopters and non-adopters of dairy technologies in Ethiopia and Kenya based on farmers' resources ownership in order to identify why many farmers in Ethiopia and Kenya have not adopted improved dairy technologies. As compared to non-adopters, farmers who adopt dairy technology own relatively more farm resources. The result signals that differences in resource endowments could lead to divergent technology adoption scenarios. Results show that a higher proportion of sample smallholders in Kenya have adopted dairy technologies than those in Ethiopia. Except for the use of veterinary services, fewer than 10% of sample farmers in Ethiopia have adopted dairy technologies-less than half the number of adopters in Kenya. The higher level of dairy technology adoption in Kenya can be ascribed partly to the long history of dairy development, including improvements in the value chain for the delivery of inputs, services and fluid milk marketing. Interventions that deal with the constraints related to access to farm resources and input and output markets could facilitate uptake of dairy technology in developing countries.

  13. Korean Adoptee Identity: Adoptive and Ethnic Identity Profiles of Adopted Korean Americans (United States)

    Beaupre, Adam J.; Reichwald, Reed; Zhou, Xiang; Raleigh, Elizabeth; Lee, Richard M.


    Adopted Korean adolescents face the task of grappling with their identity as Koreans and coming to terms with their adoptive status. In order to explore these dual identities, the authors conducted a person-centered study of the identity profiles of 189 adopted Korean American adolescents. Using cluster analytic procedures, the study examined…

  14. Cultural Tourism in Transnational Adoption: "Staged Authenticity" and Its Implications for Adopted Children (United States)

    Quiroz, Pamela Anne


    The discursive practices of adoptive parents in two online transnational adoption forums (2006-2008) and observations of five international adoption workshops suggest that what Heather Jacobson described as "culture keeping", the cultural socialization of children that retains a sense of native group identity, is more aptly characterized as…

  15. Transfer Pricing

    DEFF Research Database (Denmark)

    Nielsen, Søren Bo


    Against a background of rather mixed evidence about transfer pricing practices in multinational enterprises (MNEs) and varying attitudes on the part of tax authorities, this paper explores how multiple aims in transfer pricing can be pursued across four different transfer pricing regimes. A MNE h...

  16. The Effect of a Novel Proactive First Day Prescription Counseling Program on Adherence to Select Cardiovascular Medications

    Directory of Open Access Journals (Sweden)

    Jamie L. McConaha, Pharm.D., CGP


    Full Text Available Objective: To determine the impact of a proactive first day prescription counseling program on medication adherence to new cardiovascular maintenance medicationsDesign: Cross-sectional studySetting: Regional chain community pharmacy in Pittsburgh, Pennsylvania; August 2009 through November 2010Patients: Data was collected from all patients aged 18-89 presenting with a new or transferred prescription or change in dosage within the study dates at four study locationsInterventions: Patients presenting with a new or transferred prescription or change in dosage were identified to receive pharmacist or student pharmacist counseling. Data from the counseling session was tracked weekly to determine if the program increased adherence to statins, ACEIs and/or ARBs.Main Outcome Measured: Adherence to statins, ACEIs and/or ARBs was determined by differences in proportion of days covered (PDC at six months and medication persistence to therapy.Results: Analysis was conducted using IDNA sm software. Results of the 6,916 prescriptions included in the study revealed that persistence rates for statins was 32.5% (intervention and 34.2% (control (p<0.001; ACEI/ARBs persistence was 37.3% (intervention and 43.2% (control (p<0.001. PDC was nonsignificant with respect to statins; 43.2% (intervention and 45.1% (control; and 50.2% (intervention and 57.1% (control (p<0.001 for the ACEI/ARBs.Conclusion: Results from this study showed no improvement in adherence of statins or ACEIs/ARBs with the D1TC program versus control pharmacies, although several important limitations were identified. It is clear that a variety of methods and programs are needed to consistently improve adherence to maintenance medications.

  17. Distributed PV Adoption in Maine Through 2021

    Energy Technology Data Exchange (ETDEWEB)

    Gagnon, Pieter; Sigrin, Ben


    NREL has used its dSolar (distributed solar) model to generate low-medium-high estimates of distributed PV adoption in Maine through 2021. This presentation gives a high-level overview of the model and modeling results.

  18. Improvisation during Process-Technology Adoption

    DEFF Research Database (Denmark)

    Tjørnehøj, Gitte; Mathiassen, Lars


    SPI technology adoption and events that causes the process to drift in unpredictable directions. To further understand how management's attempt to control the process is complemented by drifting, this article investigates the role of improvisation in adoption of SPI technology in a Danish software......Most software firms struggle to take advantage of the potential benefits of software process improvement (SPI) as they adopt this technology into the complex and dynamic realities of their day-to-day operation. Such efforts are therefore typically fluctuating between management's attempt to control...... in the adoption process despite constrained resources, and, most importantly, helped adapt SPI technology to the everyday practices at SmallSoft. However, we also identified un-called for improvisations and outcomes that were uncoordinated with SmallSoft's goals. Based on these findings we discuss how management...

  19. Adopt a Pixel Photographs: 2013-Present (United States)

    U.S. Geological Survey, Department of the Interior — The photographs in the Adopt a Pixel collection were provided by volunteers with a digital camera, a Global Positioning System (GPS), and a compass or a smart mobile...

  20. 76 FR 81 - Adoption of Recommendation (United States)


    ...; ] ADMINISTRATIVE CONFERENCE OF THE UNITED STATES Adoption of Recommendation AGENCY: Administrative Conference of... the attached recommendation at its Fifty-third Plenary Session. The recommendation addresses issues... makes recommendations for improvements to the agencies, collectively or individually, and to...

  1. Organizational Green IT Adoption: Concept and Evidence

    Directory of Open Access Journals (Sweden)

    Qi Deng


    Full Text Available Green IT has emerged as an important research topic in information systems and in other areas, such as business sustainability management. Some progress has been made in our understandings of green IT in a wide area of research topics, ranging from the green IT definition to the motivation for adopting green IT by organizations. This paper provides a holistic review and explanation of why organizations adopt green IT. Based on an extensive review of extant studies and a broad theoretical foundation, the paper presents a theoretical framework on organizational green IT adoption (OGITA. For researchers, the study provides a comprehensive review of previous green IT adoption studies and a roadmap for future research. For practitioners, the study provides managers and policy makers a systematic analytical framework in guiding their business decisions.

  2. Adopt a Pixel Photographs: 2013-Present (United States)

    U.S. Geological Survey, Department of the Interior — The photographs in the Adopt a Pixel collection were provided by volunteers with a digital camera, a Global Positioning System (GPS), and a compass or a smart...

  3. Improvisation during Process-Technology Adoption

    DEFF Research Database (Denmark)

    Tjørnehøj, Gitte; Mathiassen, Lars


    SPI technology adoption and events that causes the process to drift in unpredictable directions. To further understand how management's attempt to control the process is complemented by drifting, this article investigates the role of improvisation in adoption of SPI technology in a Danish software...... firm, SmallSoft, over a 10-year period (1996-2005). We found that micro-level and macro-level improvisations interacted, often in uncoordinated ways, to shape SPI technology adoption at SmallSoft. The improvisations enhanced employee creativity, motivation and empowerment, created momentum...... in the adoption process despite constrained resources, and, most importantly, helped adapt SPI technology to the everyday practices at SmallSoft. However, we also identified un-called for improvisations and outcomes that were uncoordinated with SmallSoft's goals. Based on these findings we discuss how management...

  4. Unravelling adherence to prophylaxis in haemophilia: a patients' perspective. (United States)

    Schrijvers, L H; Kars, M C; Beijlevelt-van der Zande, M; Peters, M; Schuurmans, M J; Fischer, K


    Given the lifelong therapy in haemophilia patients, insight in non-adherence behaviour from a patient perspective is important to understand patients' difficulties with the following treatment recommendations. The aim of this study was to clarify the process underlying adherence (behaviour) to prophylactic treatment, from a patients' perspective. To develop a grounded theory, a qualitative study using individual in-depth interviews was performed to understand experiences, perceptions and beliefs concerning adherence to prophylaxis. From two Dutch treatment centres, 21 adults with haemophilia using prophylaxis were interviewed. Patients were asked how they experience their task to administer prophylaxis and how they adhere to this. The interviews were transcribed, coded and analysed in an iterative process, leading to the development of the grounded theory. Adherence was determined by the position of prophylaxis in life. The position of prophylaxis was determined by the perception of prophylaxis and the ability to exert prophylaxis. Patients' perception was influenced by two main factors: acceptance of haemophilia and feeling/fearing symptoms. The ability to exert prophylaxis was influenced by understanding haemophilia and prophylaxis and planning/infusion skills. The combination of different perceptions and skills led to four main positions of prophylaxis in life: (i) prophylaxis integrated in life, (ii) prophylaxis according to doctors' advice, struggling with irregular situations, (iii) prophylaxis is too much to handle, (iv) prophylaxis is a confrontation with illness. The adherence level gradually decreased from position 1 to 4. This information can be used to design tailored interventions to promote adherence.

  5. Factors affecting adherence to a raw vegan diet. (United States)

    Link, Lilli B; Jacobson, Judith S


    The purpose of this study was to evaluate adherence and identify predictors of adherence to a raw vegan diet (i.e., uncooked plant foods) following a stay at a raw vegan institute. In this cohort study of guests at a raw vegan institute, subjects completed written questionnaires upon arrival and 12 weeks later. Of 107 eligible guests, 84 participated. Mean age was 54 years, 23 were male, and 73 white. Fifty-one completed the 12-week follow-up. Eight (16%) reported their diet to be 80% raw vegan at baseline and 14 (28%) at follow-up. Based on a raw vegan dietary adherence score (range 0-42) created for this study, mean adherence (SD) increased from 15.1 (5.4) to 17.0 (5.8) over 12 weeks (p=0.03). Baseline predictors of adherence included: education (beta=0.95), severity of disease (beta=0.98), and self-efficacy to adhere (beta=0.72). Future interventions that evaluate this diet should address self-efficacy, an important, potentially remediable predictor of adherence.

  6. Methodology for Web Services Adoption Based on Technology Adoption Theory and Business Process Analyses

    Institute of Scientific and Technical Information of China (English)

    AN Liping; YAN Jianyuan; TONG Lingyun


    Web services use an emerging service-oriented architecture for distributed computing. Many organizations are either in the process of adopting web services technology or evaluating this option for incorporation into their enterprise information architectures. Implementation of this new technology requires careful assessment of the needs and capabilities of an organization to formulate adoption strategies. This paper presents a methodology for web services adoption based on technology adoption theory and business process analyses. The methodology suggests that strategies, business areas, and functions within an organization should be considered based on the existing organizational information technology status during the process of adopting web services to support the business needs and requirements.

  7. Studies based on the Danish Adoption Register

    DEFF Research Database (Denmark)

    Petersen, Liselotte; Sørensen, Thorkild I A


    INTRODUCTION: The genetic and familial environmental influences making up familial correlations in traits and familial aggregation of diseases may be disentangled by adoption studies. Thus, resemblance between the adoptee and the biological relatives indicates a contribution of the segregating gene....... RESEARCH TOPICS: To illustrate the adoption study approach in research, we present results achieved in schizophrenia, body fatness, smoking, and mortality. Significantly higher prevalence of schizophrenia and related conditions were found in biological relatives to adoptees with schizophrenia than among...

  8. Herd behaviour, strategic complementarities and technology adoption



    In technology adoption, herd behaviour can lead to a suboptimal outcome. An example is given by Choi (1997): it is a model of technology choice under uncertainty where herding arises because of strategic complementarities and risk aversion. It causes a positive experimenting bias against the adoption of a more efficient (in terms of expected value) technology. We introduce in his model an additional element upon which firms base their technology decision: the economic environment. We investig...

  9. [adoption Of Standard Precautions: A Report].



    During 1993 and 1994, a recycling program on Standard Precautions was conducted for the nursing personnel at the Women's Health Centre (CAISM). In 1995, an evaluation was obtained through direct observation of these sectors regarding the adoption of these measures, the adequate use, access and availability of gloves and boxes for the disposal of perforating, sharp material. Sixty observations and 232 procedures were reported. One hundred sixty four procedures (71%) adopted these measures and ...

  10. The Adoption and Diffusion of Service Products


    Myung Joong Kwon


    The objective of this paper is to theoretically explore the innovation, adoption and diffusion of service product. A theoretical model of the diffusion of service product is developed that takes account of transportation, waiting and searching casts in the adoption of service product. The main results of the model are; (1) the diffusion of service product is slower than that of the manufacturing equivalent and (2) the delivery or retail distribution service speeds up the diffusion of the manu...

  11. The family romance fantasies of adopted children. (United States)

    Wieder, H


    Despite the absence of psychoanalytic studies to support the position, family romance fantasies have been assumed to be similar in form and function in both the adopted child and the blood kin child. My studies, documented herein from the analyses of three adoptees, reveal that knowing one is adopted results in modifications of the fantasy and that certain types of adoptees seem incapable of effectively creating the paradigmatic family romance fantasy.

  12. Spillover adherence effects of fixed-dose combination HIV therapy

    Directory of Open Access Journals (Sweden)

    Kauf TL


    Full Text Available Teresa L Kauf1, Keith L Davis2, Stephanie R Earnshaw2, E Anne Davis31Department of Pharmaceutical Outcomes and Policy, College of Pharmacy, University of Florida, Gainesville, FL, 2RTI Health Solutions, Research Triangle Park, NC, 3Independent consultant, Pittsboro, NC, USAAbstract: The impact of fixed-dose combination (FDC products on adherence to other, non-fixed regimen components has not been examined. We compared adherence to a third antiretroviral (ART component among patients receiving a nucleoside reverse transcriptase inhibitor (NRTI backbone consisting of the FDC Epzicom®, GlaxoSmithKline Inc, Research Triangle Park, NC (abacavir sulfate 600 mg + lamivudine 300 mg; FDC group versus NRTI combinations taken as two separate pills (NRTI Combo group using data from a national sample of 30 health plans covering approximately 38 million lives from 1997 to 2005. Adherence was measured as the medication possession ratio (MPR. Multivariate logistic regression compared treatment groups based on the likelihood of achieving ≥95% adherence, with sensitivity analyses using alternative thresholds. MPR was assessed as a continuous variable using multivariate linear regression. Covariates included age, gender, insurance payer type, year of study drug initiation, presence of mental health and substance abuse disorders, and third agent class. The study sample consisted of 650 FDC and 1947 NRTI Combo patients. Unadjusted mean adherence to the third agent was higher in the FDC group than the NRTI Combo group (0.92 vs 0.85; P < 0.0001. In regression analyses, FDC patients were 48% and 39% more likely to achieve 95% and 90% third agent adherence, respectively (P ≤ 0.03. None of the other MPR specifications achieved comparable results. Among managed care patients, use of an FDC appears to substantially improve adherence to a third regimen component and thus the likelihood of achieving the accepted standard for adherence to HIV therapy of 95%.Keywords

  13. Consumer Adoption Challenges To The Smart Grid

    Directory of Open Access Journals (Sweden)

    Anu Gupta


    Full Text Available The smart grid represents the next significant evolution of the power infrastructure with many enhancements and challenges. This paper provides a qualitative review of the key consumer adoption challenges of the smart grid. This literature review takes disparate pieces of work and identifies strategic research focal areas. Through existing research and media documents, it identifies the primary consumer adoption challenges as privacy, Radio Frequency (RF safety, and power rate increases. It also provides a review of each adoption challenge. The review is applied to the Canadian perspective drawing from smart grid experiences across North America. The review demonstrates that each of the challenge areas has a negative impact on the adoption and support of the smart grid. This paper recommends further in-depth research be conducted in the following areas: testing each of the consumer adoption challenges—privacy, RF Safety, and rate increases—separately with quantitative measures; testing the willingness to accept a power infrastructure with the security and stability level of a bank; and testing the impact that proactively educating the public would have on the smart grid adoption.

  14. Enhancing adoptive parenting: a randomized controlled trial. (United States)

    Rushton, Alan; Monck, Elizabeth; Leese, Morven; McCrone, Paul; Sharac, Jessica


    The aim was to conduct a pragmatic randomized controlled trial (RCT) to evaluate two parenting programmes designed for adopters of children late placed from care. Adoptive parents, with children between 3 and 8 years who were screened to have serious behavioural problems early in the placement, participated in home-based, manualized, parenting programmes delivered by trained and supervised family social workers. The adopters who agreed to join the study were randomly allocated to one of two parenting interventions or to a "services as usual" group. Baseline, immediate post-intervention and six-month follow-ups were assessed using questionnaires and adopter interviews. No cases were lost to follow-up at any point and satisfaction was high with both parenting interventions. At the six-month follow-up, a significant difference (p parenting" in favour of the intervention group (Effect Size d = 0.7). Negative parenting approaches were reduced in the intervention group. However, no significant differences in child problems were found between the intervention groups and control group, adjusting for baseline scores. Costs analysis showed that a relatively modest investment in post-adoption support would be well spent in improving adopters' satisfaction with parenting in the intervention group compared to the routine service group.

  15. Lessons from silage adoption studies in Honduras

    Directory of Open Access Journals (Sweden)

    Christoph Reiber


    Full Text Available To date, silage adoption has been low in the tropics, particularly under smallholder conditions. Innovation and adoption processes of silage technologies were promoted in drought-constrained areas of Honduras using a flexible, site-specific and participatory research and extension approach. A total of about 250 farmers participated in training workshops and field days conducted in 13 locations. Smallholders successfully ensiled maize, sorghum and/or Pennisetum spp., mainly in heap and earth silos, while adoption of little bag silage (LBS was low. LBS proved useful as a demonstration, experimentation and learning tool. A ‘silage boom’ occurred in 5 locations, where favorable adoption conditions included the presence of demonstration farms and involvement of key innovators, lack of alternative dry season feeds, perceived benefits of silage feeding, a favorable milk market and both extension continuity and intensity. The lack of chopping equipment was the main reason for non-adoption by poor smallholders. The study showed that, when targeting production system needs and farmer demands, silage promotion can lead to significant adoption, including at smallholder level, in the tropics. This experience could contribute to an increase in effectiveness and sustainability of silage extension in similar situations elsewhere.

  16. Beyond preadoptive risk: The impact of adoptive family environment on adopted youth's psychosocial adjustment. (United States)

    Ji, Juye; Brooks, Devon; Barth, Richard P; Kim, Hansung


    Adopted children often are exposed to preadoptive stressors--such as prenatal substance exposure, child maltreatment, and out-of-home placements--that increase their risks for psychosocial maladjustment. Psychosocial adjustment of adopted children emerges as the product of pre- and postadoptive factors. This study builds on previous research, which fails to simultaneously assess the influences of pre- and postadoptive factors, by examining the impact of adoptive family sense of coherence on adoptee's psychosocial adjustment beyond the effects of preadoptive risks. Using a sample of adoptive families (n = 385) taking part in the California Long Range Adoption Study, structural equation modeling analyses were performed. Results indicate a significant impact of family sense of coherence on adoptees' psychosocial adjustment and a considerably less significant role of preadoptive risks. The findings suggest the importance of assessing adoptive family's ability to respond to stress and of helping families to build and maintain their capacity to cope with stress despite the sometimes fractious pressures of adoption.

  17. Adherence to diabetes regimens: empirical status and clinical applications. (United States)

    Kurtz, S M


    Adherence to diabetes treatment regimens has proved to be a conceptual and empirical enigma. Consequently, reliable and valid applications to the clinical practice of diabetes care and education have been wanting. Rates of nonadherence are staggeringly high, regardless of the methodology employed, and verification of self-reports is complicated by social desirability to appear compliant. Low intertask correlations further complicate our understanding of adherence-metabolic control relationships. Studies relating to the Health Belief Model, social learning theory, and the psychology of interpersonal relationships that have sought to identify determinants of adherence behaviors have specific relevance to the clinical practice of diabetes education.

  18. Primary non-adherence to prescribed medication in general practice

    DEFF Research Database (Denmark)

    Linnet, Kristján; Halldórsson, Matthías; Thengilsdóttir, Gudrún


    prescriptions issued electronically by 140 physicians at 16 primary health care centres in the Reykjavik capital area during two periods before and after increases in copayment were matched with those dispensed in pharmacies, the difference constituting primary non-adherence (population: 200&emsp14......;000; patients: 21 571; prescriptions: 22 991). Eight drug classes were selected to reflect symptom relief and degree of copayment. Two-tailed chi-square test and odds ratios for non-adherence by patient copayment groups were calculated. RESULTS: The rate of primary non-adherence was 6...

  19. The Practice of Adoption: History, Trends, and Social Context (United States)

    Zamostny, Kathy P.; O'Brien, Karen M.; Baden, Amanda L.; Wiley, Mary O'Leary


    This article presents an overview of the practice of adoption to counseling psychologists to promote clinical understanding of the adoption experience and to stimulate research on adoption. The article includes definitions of adoption terminology, important historical and legal developments for adoption, a summary of adoption statistics,…

  20. Moses and Superman Come Home: Counseling Adoptees and Adoptive Families. (United States)

    Saiz, Stephen G.

    This paper looks at three parties impacted by adoption: the adoptive parents, the adopted child, and the adoptive family. When working with adoptive parents, counselors should respect the strength of the couple, their commitment to parenthood, and the closeness that may develop from weathering the issue of childlessness. Adoptive parents are…

  1. Fewer Bacteria Adhere to Softer Hydrogels. (United States)

    Kolewe, Kristopher W; Peyton, Shelly R; Schiffman, Jessica D


    Clinically, biofilm-associated infections commonly form on intravascular catheters and other hydrogel surfaces. The overuse of antibiotics to treat these infections has led to the spread of antibiotic resistance and underscores the importance of developing alternative strategies that delay the onset of biofilm formation. Previously, it has been reported that during surface contact, bacteria can detect surfaces through subtle changes in the function of their motors. However, how the stiffness of a polymer hydrogel influences the initial attachment of bacteria is unknown. Systematically, we investigated poly(ethylene glycol) dimethacrylate (PEGDMA) and agar hydrogels that were 20 times thicker than the cumulative size of bacterial cell appendages, as a function of Young's moduli. Soft (44.05-308.5 kPa), intermediate (1495-2877 kPa), and stiff (5152-6489 kPa) hydrogels were synthesized. Escherichia coli and Staphylococcus aureus attachment onto the hydrogels was analyzed using confocal microscopy after 2 and 24 h incubation periods. Independent of hydrogel chemistry and incubation time, E. coli and S. aureus attachment correlated positively to increasing hydrogel stiffness. For example, after a 24 h incubation period, there were 52 and 82% fewer E. coli adhered to soft PEGDMA hydrogels than to the intermediate and stiff PEGDMA hydrogels, respectively. A 62 and 79% reduction in the area coverage by the Gram-positive microbe S. aureus occurred after 24 h incubation on the soft versus intermediate and stiff PEGDMA hydrogels. We suggest that hydrogel stiffness is an easily tunable variable that could potentially be used synergistically with traditional antimicrobial strategies to reduce early bacterial adhesion and therefore the occurrence of biofilm-associated infections.

  2. Fewer Bacteria Adhere to Softer Hydrogels (United States)

    Kolewe, Kristopher W.; Peyton, Shelly R.; Schiffman, Jessica D.


    Clinically, biofilm-associated infections commonly form on intravascular catheters and other hydrogel surfaces. The overuse of antibiotics to treat these infections has led to the spread of antibiotic resistance and underscores the importance of developing alternative strategies that delay the onset of biofilm formation. Previously, it has been reported that during surface contact, bacteria can detect surfaces through subtle changes in the function of their motors. However, how the stiffness of a polymer hydrogel influences the initial attachment of bacteria is unknown. Systematically, we investigated poly(ethylene glycol) dimethacrylate (PEGDMA) and agar hydrogels that were twenty times thicker than the cumulative size of bacterial cell appendages, as a function of Young’s moduli. Soft (44.05 – 308.5 kPa), intermediate (1495 – 2877 kPa), and stiff (5152 – 6489 kPa) hydrogels were synthesized. Escherichia coli and Staphylococcus aureus attachment onto the hydrogels was analyzed using confocal microscopy after 2 and 24 hr incubation periods. Independent of hydrogel chemistry and incubation time, E. coli and S. aureus attachment correlated positively to increasing hydrogel stiffness. For example, after a 24 hr incubation period, there were 52% and 82% less E. coli adhered to soft PEGDMA hydrogels, than to the intermediate and stiff PEGDMA hydrogels, respectively. A 62% and 79% reduction in the area coverage by the Gram-positive microbe S. aureus occurred after 24 hr incubation on the soft versus intermediate and stiff PEGDMA hydrogels. We suggest that hydrogel stiffness is an easily tunable variable that, potentially, could be used synergistically with traditional antimicrobial strategies to reduce early bacterial adhesion, and therefore the occurrence of biofilm-associated infections. PMID:26291308

  3. Older Adults' Uptake and Adherence to Exercise Classes: Instructors' Perspectives. (United States)

    Hawley-Hague, Helen; Horne, Maria; Skelton, Dawn A; Todd, Chris


    Exercise classes provide a range of benefits for older adults, but adherence levels are poor. We know little of instructors' experiences of delivering exercise classes to older adults. Semistructured interviews, informed by the Theory of Planned Behavior (TPB), were conducted with instructors (n = 19) delivering multicomponent exercise classes to establish their perspectives on older adults' uptake and adherence to exercise classes. Analysis revealed 'barriers' to uptake related to identity, choice/control, cost, and venue, and 'solutions' included providing choice/control, relating exercise to identity, a personal touch, and social support. Barriers to adherence included unrealistic expectations and social influences, and solutions identified were encouraging commitment, creating social cohesion, and an emphasis on achieving outcomes. Older adults' attitudes were an underlying theme, which related to all barriers and solutions. The instructor plays an important, but not isolated, role in older adults' uptake and adherence to classes. Instructors' perspectives help us to further understand how we can design successful exercise classes.

  4. Method of detaching adherent cells for flow cytometry

    KAUST Repository

    Kaur, Mandeep


    In one aspect, a method for detaching adherent cells can include adding a cell lifting solution to the media including a sample of adherent cells and incubating the sample of adherent cells with the cell lifting solution. No scraping or pipetting is needed to facilitate cell detachment. The method do not require inactivation of cell lifting solution and no washing of detaching cells is required to remove cell lifting solution. Detached cells can be stained with dye in the presence of cell lifting solution and are further analyzed using flow cytometer. The method has been tested using 6 different cell lines, 4 different assays, two different plate formats (96 and 384 well plates) and two different flow cytometry instruments. The method is simple to perform, less time consuming, with no cell loss and makes high throughput flow cytometry on adherent cells a reality.

  5. In vitro adherence of Moraxella bovis to intact corneal epithelium. (United States)

    Jackman, S H; Rosenbusch, R F


    An in vitro assay is described using radiolabeled Moraxella bovis for studying adherence to intact bovine corneal epithelial surfaces. The assay was optimized for time (45 min) and for the ratio of epithelial cells to bacteria (1:1000) that demonstrated a significant difference in adherence between M. bovis strain 118F, a piliated organism and a nonpiliated variant, strain 118F/4-2. Adherence of these organisms correlated with previous pathogenicity studies involving experimental infection of calves. Scanning electron microscopy of tissues treated in the assay revealed a predilection of M. bovis for dark epithelial cells and for association with depressions in the tissue surface. This assay technique is discussed in comparison with other in vitro adherence assay methods.

  6. Predictors of duloxetine adherence and persistence in patients with fibromyalgia

    Directory of Open Access Journals (Sweden)

    Cui Z


    Full Text Available Zhanglin Cui, Yang Zhao, Diego Novick, Douglas FariesEli Lilly and Company, Indianapolis, IN, USAObjectives: Adherence to medication for the treatment of fibromyalgia (FM is predictive of lower overall health-care costs, and thus a lower burden on both patients and providers. The objectives of this study were to examine the predictors of adherence to and persistence with duloxetine therapy among commercially insured FM patients, and to identify subgroups of patients with high duloxetine persistence and adherence.Study design: This cross-sectional, retrospective study analyzed medical and pharmacy records over 1 year for patients in the US aged 18–64 years with FM who initiated (no prior 90-day use duloxetine treatment in 2008.Methods: Adherence to duloxetine was measured by medication possession ratio (MPR, with high adherence defined as MPR ≥ 0.8. Persistence was defined as the duration of therapy from the index date to the earliest of: the ending date of the last prescription, the date of the first gap of >15 days between prescriptions, or the end of the study period (12 months. Demographic and clinical predictors of adherence were examined via multiple logistic regression (MLR, and subgroups of duloxetine-persistent and -adherent patients were identified using classification and regression trees (CART.Results: Among 4660 duloxetine patients, 33% achieved high adherence. Factors associated with high adherence from MLR included older age, North Central and Northeast regions, prior venlafaxine, pregabalin, selective serotonin reuptake inhibitor (SSRI, or other antidepressant use, or comorbid dyslipidemia or osteoarthritis (all P < 0.05. CART analysis revealed that patients with prior antidepressant use, aged ≥46, or prior osteoarthritis had higher MPR (all P < 0.05, and patients aged ≥45 with a history of SSRI, venlafaxine, or anticonvulsant use had longer duration of therapy (all P < 0.05.Conclusions: Patients with high adherence to and

  7. Non-adherence to topical treatments for actinic keratosis

    Directory of Open Access Journals (Sweden)

    Shergill B


    Full Text Available Bav Shergill,1 Simon Zokaie,2 Alison J Carr3 1Department of Dermatology, Brighton and Sussex University Hospitals, Elm Grove, Brighton, UK; 2Leo Pharma, Princes Risborough, 3Hamell, London, UK 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

  8. Dermatologic conditions in internationally adopted children

    Directory of Open Access Journals (Sweden)

    Diane L. Whitaker-Worth, MD


    Full Text Available Over 200,000 children have been adopted into United States (US families from abroad since the year 2000. Health care providers who care for children adopted internationally should be aware of the spectrum of illnesses seen in this population, and should be prepared to encounter potentially unusual situations. An appreciation for the unique pre-adoption exposures and vulnerabilities inherent in international adoption is critical for proper diagnosis and treatment of this heterogeneous group of children. It is important to consider the impact of potential early childhood stressors such as nutritional, sensory, and emotional deprivation, trauma and abuse, as well as prenatal exposures to drugs, alcohol, and infectious diseases. Providers must also take into account international variation in health care practices, including immunization, treatment, surgical, and hygiene standards. The differential diagnosis for cutaneous eruptions in children adopted internationally is broad and must encompass endemic systemic illnesses with skin manifestations, such as measles, tuberculosis, leprosy, and congenital syphilis, and primary dermatologic diseases such as scabies and bacterial and fungal infections. The importance of maintaining a broad differential and open mind when addressing the dermatologic needs of these children cannot be overemphasized.

  9. Older adults' uptake and adherence to exercise classes: Instructors' perspectives.


    Hawley-Hague, Helen; Horne, Maria; Skelton, Dawn A; Todd, Chris


    Exercise classes provide a range of benefits for older adults, but adherence levels are poor. We know little of instructors' experiences of delivering exercise classes to older adults. Semistructured interviews, informed by the Theory of Planned Behavior (TPB), were conducted with instructors (n = 19) delivering multicomponent exercise classes to establish their perspectives on older adults' uptake and adherence to exercise classes. Analysis revealed 'barriers' to uptake related to identity, ...

  10. Elderly adherence to hypertension treatment and nursing interventions


    Jênifa Cavalcante dos Santos; Raquel Sampaio Florêncio; Célida Juliana de Oliveira; Thereza Maria Magalhães Moreira


    Adherence to the treatment of arterial hypertension is a challenge to health professionals. Thus, this study aimed at verifying adherence to treatment of hypertension of elderly patients followed in a group and describe the possible nursing interventions on the clientele. The descriptive research was developed in two phases: between December/2008 and January/2009, we used data collection instrument to assess compliance to treatment; from February to April/2009, we used the technique Focus Gro...

  11. Engineering adherent bacteria by creating a single synthetic curli operon. (United States)

    Drogue, Benoît; Thomas, Philippe; Balvay, Laurent; Prigent-Combaret, Claire; Dorel, Corinne


    The method described here consists in redesigning E. coli adherence properties by assembling the minimum number of curli genes under the control of a strong and metal-overinducible promoter, and in visualizing and quantifying the resulting gain of bacterial adherence. This method applies appropriate engineering principles of abstraction and standardization of synthetic biology, and results in the BBa_K540000 Biobrick (Best new Biobrick device, engineered, iGEM 2011). The first step consists in the design of the synthetic operon devoted to curli overproduction in response to metal, and therefore in increasing the adherence abilities of the wild type strain. The original curli operon was modified in silico in order to optimize transcriptional and translational signals and escape the "natural" regulation of curli. This approach allowed to test with success our current understanding of curli production. Moreover, simplifying the curli regulation by switching the endogenous complex promoter (more than 10 transcriptional regulators identified) to a simple metal-regulated promoter makes adherence much easier to control. The second step includes qualitative and quantitative assessment of adherence abilities by implementation of simple methods. These methods are applicable to a large range of adherent bacteria regardless of biological structures involved in biofilm formation. Adherence test in 24-well polystyrene plates provides a quick preliminary visualization of the bacterial biofilm after crystal violet staining. This qualitative test can be sharpened by the quantification of the percentage of adherence. Such a method is very simple but more accurate than only crystal violet staining as described previously with both a good repeatability and reproducibility. Visualization of GFP-tagged bacteria on glass slides by fluorescence or laser confocal microscopy allows to strengthen the results obtained with the 24-well plate test by direct observation of the phenomenon.

  12. Medication adherence: the critical step towards better patient outcome

    Directory of Open Access Journals (Sweden)

    Anish Desai


    Full Text Available Medication adherence is defined as patient's adherence to take their medications as prescribed and continue to take the prescribed medication for stipulated time frame. Medication non-adherence is a growing concern to physicians, healthcare systems, and other stakeholders (e.g., payers and there is an increasing evidence of its prevalence and is associated with adverse clinical outcomes eventually resulting into higher costs of care. The cost of non-adherence has been estimated at $100 billion to $300 billion annually, including costs from avoidable hospitalizations, nursing home admissions, and premature deaths. Improving adherence to medication is critical to improve the quality of health care, to encourage better chronic care management, and promote better health outcomes. Reasons for non-adherence are multiple and complex. Studies have reported that poor adherence to drug dosage is due to patient perception that the disease is non-significant, adverse drug effects, lack of treatment effectiveness, and the patient's poor or incomplete knowledge of the disease and (cost. A multifactorial approach is required to tackle this complex problem as a single approach will be ineffective for all patients. The most effective intervention is to use a combination of approaches and address literacy, behavior, and organizational issues. There are challenges as well as opportunities in addressing the public health issue of medication adherence. Changing healthcare reforms, advances in digital health media, social media and modern technologies can now provide alternatives to tackle this issue. [Int J Basic Clin Pharmacol 2014; 3(5.000: 748-754

  13. Adherence of human basophils to cultured umbilical vein endothelial cells.



    The mechanism by which circulating human basophils adhere to vascular endothelium and migrate to sites of allergic reactions is unknown. Agents have been identified which stimulate the adherence of purified basophils to cultured human umbilical vein vascular endothelial cells (HuVEC). Treatment of HuVEC with interleukin 1, tumor necrosis factor (TNF), bacterial endotoxin, and 12-O-tetradecanoylphorbol-13-acetate (TPA) resulted in time and dose-dependent increases of adhesiveness for basophils...

  14. Treatment non-adherence in pseudo-refractory epilepsy. (United States)

    Brodtkorb, Eylert; Samsonsen, Christian; Sund, Janne Kutschera; Bråthen, Geir; Helde, Grethe; Reimers, Arne


    Non-adherence to antiepileptic drug treatment strongly affects the outcome of epilepsy and is frequently clinically unrecognized. This review addresses current knowledge on medication-taking behavior in people with epilepsy, as well as the importance of tailoring interventions to the individual patterns of non-adherence. Non-adherence can be categorized as non-initiation, poor execution (accidental or intentional) or non-persistence and are related to clinical characteristics and health care barriers. All available methods to assess adherence are hampered by shortcomings. Self-reports are indirect and subjective. Pill-counts, electronic bottle-tops and pharmacy records are objective, but indirect measures of drug ingestion. Therapeutic drug monitoring is both direct and objective, but pharmacokinetic and diurnal variability must be taken into account. Young adults with generalized epilepsy may be particularly vulnerable to non-adherence. The drug burden in the form of polytherapy, multiple dosing and side effects are obvious obstacles. Poor understanding of the principles of prophylactic treatment as well as drug costs may be important in people with low socioeconomic status. Depression is also associated with low adherence. In people with multihandicaps, failed oral intake may be due to behavioral or physical problems, as well as insufficient education of the caregivers. Non-adherence often results in seizure breakthrough and hospital admissions, but the consequences may be more dramatic. It is the leading cause of status epilepticus in people with epilepsy, and the association with sudden death (SUDEP) is clear. The management of poor drug-taking behavior should be based on the identification of the specific causes in each individual and corresponding multiprofessional interventions. Non-adherence to antiepileptic drugs needs more clinical and scientific attention.

  15. Identification of factors that affect the adoption of an ergonomic intervention among Emergency Medical Service workers. (United States)

    Weiler, Monica R; Lavender, Steven A; Crawford, J Mac; Reichelt, Paul A; Conrad, Karen M; Browne, Michael W


    This study explored factors contributing to intervention adoption decisions among Emergency Medical Service (EMS) workers. Emergency Medical Service workers (n = 190), from six different organisations, participated in a two-month longitudinal study following the introduction of a patient transfer-board (also known as slide-board) designed to ease lateral transfers of patients to and from ambulance cots. Surveys administered at baseline, after one month and after two months sampled factors potentially influencing the EMS providers' decision process. 'Ergonomics Advantage' and 'Patient Advantage' entered into a stepwise regression model predicting 'intention to use' at the end of month one (R (2 )= 0.78). After the second month, the stepwise regression indicated only two factors were predictive of intention to use: 'Ergonomics Advantage,' and 'Endorsed by Champions' (R (2 )= 0.58). Actual use was predicted by: 'Ergonomics Advantage' and 'Previous Tool Experience.' These results relate to key concepts identified in the diffusion of innovation literature and have the potential to further ergonomics intervention adoption efforts. Practitioner Summary. This study explored factors that potentially facilitate the adoption of voluntarily used ergonomics interventions. EMS workers were provided with foldable transfer-boards (slideboards) designed to reduce the physical demands when laterally transferring patients. Factors predictive of adoption measures included perceived ergonomics advantage, the endorsement by champions, and prior tool experience.

  16. The Cloud Adoption Toolkit: Addressing the Challenges of Cloud Adoption in Enterprise

    CERN Document Server

    Greenwood, David; Smith, James; Sommerville, Ian


    Cloud computing promises a radical shift in the provisioning of computing resource within enterprise. This paper: i) describes the challenges that decision-makers face when attempting to determine the feasibility of the adoption of cloud computing in their organisations; ii) illustrates a lack of existing work to address the feasibility challenges of cloud adoption in enterprise; iii) introduces the Cloud Adoption Toolkit that provides a framework to support decision-makers in identifying their concerns, and matching these concerns to appropriate tools/techniques that can be used to address them. The paper adopts a position paper methodology such that case study evidence is provided, where available, to support claims. We conclude that the Cloud Adoption Toolkit, whilst still under development, shows signs that it is a useful tool for decision-makers as it helps address the feasibility challenges of cloud adoption in enterprise.

  17. Common mental health problems and antiretroviral therapy adherence. (United States)

    Nel, Adriaan; Kagee, Ashraf


    This paper reviews the literature on various mental health problems and their impact on adherence to antiretroviral therapy (ART). Depression, anxiety disorders, and disorders related to substance abuse were identified as key role-players influencing adherence. The severity of symptoms related to these disorders was found to be inversely related to ART adherence, with the possible exception of post-traumatic stress disorder (PTSD). PTSD was found to have both positive and negative implications for adherence, with severity of symptoms ranging from health-protective concern to disabling distress. Possible solutions aimed at addressing the adverse effects of mental health problems on adherence are discussed. Routine screening in ART settings is suggested in settings where follow-up of positive screen scores are possible, along with the necessary interventions to resolve the disorder of concern. Suggested interventions include utilising psychotherapeutic treatment, both in isolation and in conjunction with medication, to address mental health problems. Furthermore, finding effective ways of marshalling social support is recommended for ensuring optimal adherence, and possibly mitigating the adverse effects of mental health problems. Further research is needed to find feasible ways of identifying, assessing and treating patients with mental health problems in resource-constrained settings where HIV prevalence is highest.

  18. Coaches’ Adoption and Implementation of Sport Canada’s Long-Term Athlete Development Model

    Directory of Open Access Journals (Sweden)

    Charlotte Beaudoin


    Full Text Available This work explores the adoption and implementation of Sport Canada’s long-term athlete development (LTAD model by coaches and tries to understand the barriers to and enablers of these processes. LTAD adoption was studied in 14 coaches (5 female, 9 male in seven sports while implementation was assessed among 10 different coaches (2 female, 8 male from nine sports. Semistructured interviews ascertained coaches’ perceptions of and experiences with the LTAD model in their coaching practice. Coaches adhered to the global vision and general principles of LTAD. However, several barriers to LTAD adoption and implementation were identified. A mismatch between the model’s long-term and the short-term visions of results in sport was perceived as deterrent to LTAD adoption and implementation. Coaches involved in early development sports mentioned a lack of compatibility of LTAD with the demands of their sport. Coaches also perceived complexity in LTAD athlete’s developmental stage determination and the identification of “windows of opportunity” or critical periods. These barriers should be addressed to complete diffusion of LTAD among Canadian coaches.

  19. Breaking the addiction to technology adoption. (United States)

    Bryan, Stirling; Mitton, Craig; Donaldson, Cam


    A major driver of cost growth in health care is the rapid increase in the utilisation of existing technology and not simply the adoption of new technology. Health economists and their health technology assessment colleagues have become obsessed by technology adoption questions and have largely ignored 'technology management' questions. Technology management would include the life-cycle assessment of technologies in use, to assess their real-world performance; and monitoring of technology indication creep. A rebalancing of focus might serve to encourage a more self-critical and learning culture amongst those involved in technology evaluation analysis. Further, health economists and health technology assessment analysts could make a more significant contribution to system efficiency through rebalancing their efforts away from technology adoption questions towards technology management issues.

  20. The Consumer Health Information System Adoption Model. (United States)

    Monkman, Helen; Kushniruk, Andre W


    Derived from overlapping concepts in consumer health, a consumer health information system refers to any of the broad range of applications, tools, and educational resources developed to empower consumers with knowledge, techniques, and strategies, to manage their own health. As consumer health information systems become increasingly popular, it is important to explore the factors that impact their adoption and success. Accumulating evidence indicates a relationship between usability and consumers' eHealth Literacy skills and the demands consumer HISs place on their skills. Here, we present a new model called the Consumer Health Information System Adoption Model, which depicts both consumer eHealth literacy skills and system demands on eHealth literacy as moderators with the potential to affect the strength of relationship between usefulness and usability (predictors of usage) and adoption, value, and successful use (actual usage outcomes). Strategies for aligning these two moderating factors are described.

  1. Role of value compatibility in IT adoption

    DEFF Research Database (Denmark)

    Bunker, Deborah; Kautz, Karlheinz; Nguyen, Anne Luu Thanh


    Compatibility has been recognised as an important element in the adoption of IT innovations in organisations but as a concept it has been generally limited to technical or functional factors. Compatibility is also significant, however, with regard to value compatibility between the organisation......, and the adopted IT innovation. We propose a framework to determine value compatibility analysing the organisation's and information system's structure, practices and culture, and explore the value compatibility of an organisation with its adopted self-service computer-based information system. A case study...... was conducted to determine the congruence of an organisation's value and IT value compatibility. This study found that there was a high correspondence in the organisational structure and practice dimensions; however, there were organisational culture disparities. The cultural disparities reflected the self...

  2. Comparison of adherent and non-adherent staphylococci in the induction of polymorphonuclear leukocyte activation in vitro

    DEFF Research Database (Denmark)

    Riber, U; Espersen, F; Kharazmi, A


    The ability to consume complement and activate neutrophils was investigated for staphylococci adherent to silicone surfaces and non-adherent staphylococci. Staphylococcus epidermidis strain ATCC 14990 and Staphylococcus aureus strain E 2371 were used in this study. The bacteria were allowed...... at 37 degrees C. The bacteria consumed complement to approximately the same extent when adherent to the catheter segments, but more slowly in comparison with planktonic bacteria. When planktonic bacteria were compared, complement was consumed more quickly by S. epidermidis than by S. aureus. Measuring...... the induction of chemiluminescence by planktonic bacteria, S. epidermidis induced a lower response than S. aureus, while when adherent to the catheter segments the bacteria induced similar responses. These responses were only 15 to 20% of those induced by planktonic bacteria and only slightly higher than...

  3. Technology adoption in nonrenewable resource management

    Energy Technology Data Exchange (ETDEWEB)

    Cunha-e-Sa, Maria A.; Balcao Reis, Ana [Universidade Nova de Lisboa, Faculdade de Economia, Campus de Campolide, PT-1099-032, Lisboa (Portugal); Roseta-Palma, Catarina [Departamento de Economia, ISCTE, Avenida das Forcas Armadas, PT-1649-026, Lisboa (Portugal)


    Technological change has played an important role in models of nonrenewable resource management, since its presence mitigates the depletion effect on extraction costs over time. We formalize the problem of a competitive nonrenewable resource extracting firm faced with the possibility of technology adoption. Based on a quadratic extraction cost function, our results show that the expected net benefits from adoption increase both with the size of the resource stock and with prices. A boundary that separates the region where expected net benefits are positive from the one where they are negative is derived. (author)

  4. [Adoption of standard precautions: a report]. (United States)

    Lopes, M H; Moromizato, S S; Veiga, J F


    During 1993 and 1994, a recycling program on Standard Precautions was conducted for the nursing personnel at the Women's Health Centre (CAISM). In 1995, an evaluation was obtained through direct observation of these sectors regarding the adoption of these measures, the adequate use, access and availability of gloves and boxes for the disposal of perforating, sharp material. Sixty observations and 232 procedures were reported. One hundred sixty four procedures (71%) adopted these measures and 68 procedures (29%) did not. It was evident that the need to wash hands and not to use needles twice should be emphasized.

  5. Adopting Deverbalization in Interpreting Chinese Political Neologisms

    Institute of Scientific and Technical Information of China (English)



    Uniqueness of our political systems and tremendous changes brought about by reform and opening up are reflected in language use, so a boom of Chinese political neologisms is witnessed. Deverbalization, as the core concept of the Interpretive Theory should be adopted in interpreting such neologisms so as to convey the intended meaning of the speaker in a faithful and interpretive manner. This paper makes a tentative attempt at classifying those neologisms and elaborates through exemplification on adopting deverbalization in interpreting political neologisms, with a view to producing China English rather than Chinese English and facilitating political communication among countries.

  6. Development, dissemination, adherence, and effectiveness of a Smoking Cessation Programs offered in a public university

    Directory of Open Access Journals (Sweden)

    Fernanda Machado Lopes


    Full Text Available Smoking Cessation Programs (SCP must comprise factors that increase the chances of successful treatment, such as choice of approach and modality based on scientific evidence; adaptation of the intervention to the characteristics of target patients; records of procedures and efficacy rates; and the use of both active and reactive strategies to recruit smokers. Given this, this study was designed with the aim of describing the implementation of a SCP in a public university that has adopted a 100% smoke-free campus policy, including the evaluation of publicity methods and their possible impact in adherence rates and program success. There were 128 smokers enrolled in nine program groups offered over two years: 97 (76% attended the first meeting and 69 (71% effectively completed the SCP. The groups that underwent follow-up assessment (n = 58 achieved abstinence rates of 27% and 32%, greater than expected for solely psychological treatment and similar to rates that combined cognitive-behavioral approach to pharmacology. The recruitment strategies that combined active strategies (personal contacts, personal invitations, individual interviews and reactive strategies (posters, corporate e-mail, newspapers were the most effective to attract and gain the adherence of smokers to the SCP, corroborating the literature. We conclude that 100% smoke-free environment campaigns are opportunities that favor the effectiveness of SCPs, which can be developed and implemented by any trained health professional.

  7. Alcohol use, antiretroviral therapy adherence, and preferences regarding an alcohol-focused adherence intervention in patients with human immunodeficiency virus

    Directory of Open Access Journals (Sweden)

    Kekwaletswe CT


    Full Text Available Connie T Kekwaletswe,1 Neo K Morojele1,21Alcohol and Drug Abuse Research Unit, Medical Research Council, Pretoria, 2School of Public Health, University of the Witwatersrand, Johannesburg, South AfricaBackground: The primary objectives of this study were to determine the association between alcohol and antiretroviral therapy (ART adherence and the perceived appropriateness and acceptability of elements of an adherence counseling program with a focus on alcohol-related ART nonadherence among a sample of ART recipients in human immunodeficiency virus (HIV clinics in Tshwane, South Africa.Methods: We conducted a cross-sectional study with purposive sampling. The sample comprised 304 male and female ART recipients at two President's Emergency Plan For AIDS Relief-supported HIV clinics. Using an interview schedule, we assessed patients' alcohol use (Alcohol Use Disorders Identification Test, other drug use, level of adherence to ART, and reasons for missing ART doses (AIDS Clinical Trials Group adherence instrument. Additionally, patients’ views were solicited on: the likely effectiveness of potential facilitators; the preferred quantity, duration, format, and setting of the sessions; the usefulness of having family members/friends attend sessions along with the patient; and potential skill sets to be imparted.Results: About half of the male drinkers’ and three quarters of the female drinkers’ Alcohol Use Disorders Identification Test scores were suggestive of hazardous or harmful drinking. Average self-reported ART adherence was 89.7%. There was a significant association between level of alcohol use and degree of ART adherence. Overall, participants perceived two clinic-based sessions, each of one hour’s duration, in a group format, and facilitated by a peer or adherence counselor, as most appropriate and acceptable. Participants also had a favorable attitude towards family and friends accompanying them to the sessions. They also favored an

  8. Treatment adherence and quality of life in patients on antihypertensive medications in a Middle Eastern population: adherence

    Directory of Open Access Journals (Sweden)

    Alhaddad IA


    Full Text Available Imad A Alhaddad,1 Omar Hamoui,2 Ayman Hammoudeh,3 Samir Mallat4 1Cardiovascular Department, Jordan Hospital, Amman, Jordan; 2Cardiology Department, Clemenceau Medical Center, Beirut, Lebanon; 3Cardiology Department, Istishari Hospital, Amman, Jordan; 4Department of Internal Medicine, Nephrology Division, American University of Beirut Medical Center, Beirut, Lebanon Background: Poor adherence to antihypertensive treatment remains a clinical challenge worldwide. The objectives of this study were to assess the adherence level to antihypertensive treatment and to identify its associated factors in a sample of hypertensive patients in Lebanon and Jordan. Methods: We conducted an observational study between May 2011 and September 2012. A total of 1,470 eligible hypertensive patients were enrolled in our study and followed up for a period of 6 months. Data were collected regarding sociodemographic, health behavior, and hypertension-related characteristics. The adherence to treatment and the quality of life were self-reported using the Morisky, Green & Levine Scale and the Hypertension Quality of Life Questionnaire. Results: Our results revealed that 55.9 % of the patients were adherent to their antihypertensive medication. Older age was associated with better adherence, whereas being divorced or widowed, having a poorer quality of life, and being classified as having stage 1 or 2 hypertension at the end of the study were all associated with poorer adherence. Conclusion: Efforts should be exerted on all levels in order to increase the adherence to antihypertensive treatment through the implementation of educational campaigns. Keywords: adherence, NC 7 guidelines, Morisky, Green & Levine Scale, Hypertension Quality of Life Questionnaire, Lebanon, Jordan

  9. Implementation of patient charges at primary care facilities in Kenya: implications of low adherence to user fee policy for users and facility revenue. (United States)

    Opwora, Antony; Waweru, Evelyn; Toda, Mitsuru; Noor, Abdisalan; Edwards, Tansy; Fegan, Greg; Molyneux, Sassy; Goodman, Catherine


    With user fees now seen as a major hindrance to universal health coverage, many countries have introduced fee reduction or elimination policies, but there is growing evidence that adherence to reduced fees is often highly imperfect. In 2004, Kenya adopted a reduced and uniform user fee policy providing fee exemptions to many groups. We present data on user fee implementation, revenue and expenditure from a nationally representative survey of Kenyan primary health facilities. Data were collected from 248 randomly selected public health centres and dispensaries in 2010, comprising an interview with the health worker in charge, exit interviews with curative outpatients, and a financial record review. Adherence to user fee policy was assessed for eight tracer conditions based on health worker reports, and patients were asked about actual amounts paid. No facilities adhered fully to the user fee policy across all eight tracers, with adherence ranging from 62.2% for an adult with tuberculosis to 4.2% for an adult with malaria. Three quarters of exit interviewees had paid some fees, with a median payment of US dollars (USD) 0.39, and a quarter of interviewees were required to purchase additional medical supplies at a later stage from a private drug retailer. No consistent pattern of association was identified between facility characteristics and policy adherence. User fee revenues accounted for almost all facility cash income, with average revenue of USD 683 per facility per year. Fee revenue was mainly used to cover support staff, non-drug supplies and travel allowances. Adherence to user fee policy was very low, leading to concerns about the impact on access and the financial burden on households. However, the potential to ensure adherence was constrained by the facilities' need for revenue to cover basic operating costs, highlighting the need for alternative funding strategies for peripheral health facilities.

  10. Why don't patients take their analgesics? A meta-ethnography assessing the perceptions of medication adherence in patients with osteoarthritis. (United States)

    Dockerty, T; Latham, S K; Smith, T O


    Whilst analgesics and medications have demonstrated efficacy for people with osteoarthritis, their effectiveness is dependent on adherence. This has previously been reported as particularly low in this population. The purpose of this meta-ethnography was to explore possible perceptions for this. A systematic review of published and unpublished literature was undertaken. All qualitative studies assessing the attitudes or perceptions of people with osteoarthritis towards medication adherence were eligible. Study quality was assessed using the Critical Appraisal Skills Programme qualitative tool. Analysis was undertaken using a meta-ethnography approach, distilling to a third-order construct and developing a line of argument. From 881 citations, five studies met the eligibility criteria. The meta-ethnography generated a model where medication adherence for people with osteoarthritis is perceived as a balance between the willingness and preference to take medications with the alterative being toleration of symptoms. Motivators to influence this 'balance' may fluctuate and change over time but include: severity of symptoms, education and understanding of osteoarthritis and current medications, or general health which may raise issues for poly-pharmacy as other medications are added or substituted into the patient's formulary. Medicine adherence in people with osteoarthritis is complex, involving motivators which will fluctuate in impact on individuals at different points along the disease progression. Awareness of each motivator may better inform clinicians as to what education, support or change in prescription practice should be adopted to ensure that medicine adherence is individualised to better promote long-term behaviour change.

  11. Evaluating adherence to ocular hypotensives using the Travatan dosing aid

    Directory of Open Access Journals (Sweden)

    O'Dell L


    Full Text Available Leslie O'Dell1, Amy L Hennessy2,3, Alan L Robin2–41May Eye Care Center, Hanover, PA, USA; 2Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA; 3Glaucoma Specialists, Baltimore, MD, USA; 4Wilmer Eye Institute, Johns Hopkins School of Medicine, Baltimore, MD, USAPurpose: The Travatan™ Dosing Aid (TDA is the first commercially available device designed to aid in patients' adherence to their glaucoma therapies and to record patients' eyedrop administration, so that doctors can better assess adherence. No prior studies have objectively evaluated adherence to glaucoma medications and its relationship to the severity of glaucoma or the use of multiple systemic medications.Methods: We enrolled 100 consecutive subjects from a private glaucoma practice, all currently using topical travoprost 0.004%. Each subject was issued a TDA to record the time and date of each drop instilled. Informed consents were signed and the subjects were aware that their medication use was being monitored. Patients returned for follow-up 30–60 days after their initial exam.Results: 89 subjects completed the study: 44 were male, with a mean age of 67 years, and 69.7% were Caucasian. Overall, patient adherence was 74.8% (range 22%–100% improving to 85.4% on the day prior to follow-up. The mean number of missed doses per month was 6.24 ± 5.9. Only 7.9% of the study population never missed a dose and 23.6% ± 4.3% missed more than ten drops per month. No marked association was observed between the severity of glaucoma, race, or the number of systemic medications and adherence. A marked improvement in adherence was noted in patients using travoprost 0.004% as monocular therapy rather than binocular therapy, 84.0% ± 17.1% vs 67.4% ± 23.5% (P < 0.005.Conclusion: Patient adherence to glaucoma medical therapy is a major barrier in the management and treatment of glaucoma patients given the chronic nature and asymptomatic course of the disease. Until recently

  12. Transfer Pricing

    DEFF Research Database (Denmark)

    Rohde, Carsten; Rossing, Christian Plesner

    trade internally as the units have to decide what prices should be paid for such inter-unit transfers. One important challenge is to uncover the consequences that different transfer prices have on the willingness in the organizational units to coordinate activities and trade internally. At the same time...

  13. Inter-Organizational Information Systems Adoption

    DEFF Research Database (Denmark)

    Lyytinen, Kalle; Damsgaard, Jan


    In this article we propose a new complementary approach to investigate Inter-Organizational Information Systems (IOIS) adoption called configuration analysis. We motivate the need for a new approach by the common observation that the structure and the strategy of an IOIS are interdependent...

  14. Distributed PV Adoption - Sensitivity to Market Factors

    Energy Technology Data Exchange (ETDEWEB)

    Gagnon, Pieter; Sigrin, Ben


    NREL staff used the dSolar (distributed solar) model to forecast the adoption of distributed, behind-the-meter PV through the year 2050 for 9 different scenarios. The scenarios varied in their assumptions about a carbon tax, the cost of PV systems in the future, and what credit would be given for excess generation once current net metering policies expire.

  15. Adoption of Energy Conservation among California Homeowners. (United States)

    Leonard-Barton, Dorothy; Rogers, Everett M.

    In spring 1977, just as California was emerging from one of the worst droughts in its history, 215 Palo Alto homeowners were interviewed about their views on energy and water conservation, and about the extent to which they had adopted 11 energy-conserving practices (ECP) in the home. The objective was to discover variables both important to…

  16. Adoption of Precision farming in Denmark

    DEFF Research Database (Denmark)

    Pedersen, Søren Marcus; Fountas, S.; Blackmore, S.


    The adoption of precision farming (PF)in Denmark has been studied through two mail surveys, personal interviews and focus groups with farmers and other stakeholders. Farmers are in general optimistic about PF but it is difficult to verify the economic and environmental gains. It has been difficult...

  17. Overseas Adoptions in the U.S.

    Institute of Scientific and Technical Information of China (English)

    JerilynWatson; 刘保行


    Every year, thousands of Americans take a child into their home that was born in another country. Many husbands and wives in the USA want a child, but may not be able to have one. Or, such married couples may want to add an adopted (收养的) child to their other children. Single Americans may also want to become parents.

  18. Negotiating the Dance: Consulting with Adoptive Systems. (United States)

    Becker, Kent W.; Carson, David K.; Seto, Atsuko; Becker, Carol A.


    For marriage and family therapists and educators who train future marriage and family therapists, families formed by means of adoption offer an abundance of learning opportunities in both the areas of assessment and intervention. The following consultation case represents a composite family designed to highlight the unique features of adoptive…

  19. Outcomes of Children Adopted from Eastern Europe (United States)

    Miller, Laurie; Chan, Wilma; Tirella, Linda; Perrin, Ellen


    Behavioral problems are frequent among post-institutionalized Eastern European adoptees. However, risk factors related to outcomes have not been fully delineated. We evaluated 50 Eastern European adoptees, age 8-10 years, with their adoptive families for more than five years. Cognitive and behavioral outcomes and parenting stress were evaluated in…

  20. An exploration of factors influencing ambulance and emergency nurses protocol adherence in the Netherlands

    NARCIS (Netherlands)

    Ebben, Remco; Vloet, Lilian; Mintjes, Joke; Achterberg, Theo van


    Adherence to ambulance and ED protocols is often suboptimal. Insight into factors influencing adherence is a requisite for improvement of adherence. This study aims to gain an in-depth understanding of factors that influence ambulance and emergency nurses’ adherence to protocols.

  1. Factors influencing long-term adherence to two previously implemented hospital guidelines

    NARCIS (Netherlands)

    A.M. Knops; M.N. Storm-Versloot; A.P.M. Mank; D.T. Ubbink; H. Vermeulen; P.M.M. Bossuyt; A. Goossens


    After successful implementation, adherence to hospital guidelines should be sustained. Long-term adherence to two hospital guidelines was audited. The overall aim was to explore factors accounting for their long-term adherence or non-adherence. A fluid balance guideline (FBG) and body temperature gu

  2. The relationship between clinical outcomes and medication adherence in difficult-to-control asthma. (United States)

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


    Medication non-adherence and the clinical implications in difficult-to-control asthma were audited. Prescription issue data from 115 patients identified sub-optimal adherence (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.

  3. 76 FR 12969 - Campaign To Improve Poor Medication Adherence (U18) (United States)


    ... HUMAN SERVICES Food and Drug Administration Campaign To Improve Poor Medication Adherence (U18) AGENCY... ] importance of good medication adherence, a vital first step toward improved adherence behavior and better...' awareness of the importance of good medication adherence and provide tools to prescribers to help...

  4. Impact of an exercise program on adherence and fitness indicators. (United States)

    Carpenter, Roger; Gilleland, Diana


    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 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 those exercising.

  5. Perceived barriers to guideline adherence: A survey among general practitioners

    Directory of Open Access Journals (Sweden)

    Besters Casper F


    Full Text Available Abstract Background Despite considerable efforts to promote and support guideline use, adherence is often suboptimal. Barriers to adherence vary not only across guidelines but also across recommendations within guidelines. The aim of this study was to assess the perceived barriers to guideline adherence among GPs by focusing on key recommendations within guidelines. Methods We conducted a cross-sectional electronic survey among 703 GPs in the Netherlands. Sixteen key recommendations were derived from four national guidelines. Six statements were included to address the attitudes towards guidelines in general. In addition, GPs were asked to rate their perceived adherence (one statement and the perceived barriers (fourteen statements for each of the key recommendations, based on an existing framework. Results 264 GPs (38% completed the questionnaire. Although 35% of the GPs reported difficulties in changing routines and habits to follow guidelines, 89% believed that following guidelines leads to improved patient care. Perceived adherence varied between 52 and 95% across recommendations (mean: 77%. The most perceived barriers were related to external factors, in particular patient ability and behaviour (mean: 30% and patient preferences (mean: 23%. Lack of applicability of recommendations in general (mean: 22% and more specifically to individual patients (mean: 25% were also frequently perceived as barriers. The scores on perceived barriers differed largely between recommendations [minimum range 14%; maximum range 67%]. Conclusions Dutch GPs have a positive attitude towards the NHG guidelines, report high adherence rates and low levels of perceived barriers. However, the perceived adherence and perceived barriers varied largely across recommendations. The most perceived barriers across recommendations are patient related, suggesting that current guidelines do not always adequately incorporate patient preferences, needs and abilities. It may be

  6. Adherence to the Mediterranean dietary pattern among Balearic Islands adolescents. (United States)

    Martínez, Elisa; Llull, Rosa; Del Mar Bibiloni, Maria; Pons, Antoni; Tur, Josep A


    The aim of the present work was to assess the prevalence of the Mediterranean dietary pattern (MDP) in Balearic Islands adolescents, and socio-demographic and lifestyle factors that might determine adherence to the MDP. A cross-sectional nutritional survey was carried out in the Balearic Islands between 2007 and 2008. A random sample (n 1231) of the adolescent population (12-17 years old) was interviewed. Dietary questionnaires and a general questionnaire incorporating questions related to socio-economic status, parental education level and lifestyle factors were used. Dietary habits were assessed by means of two 24 h recalls and a quantitative FFQ. Adherence to the MDP was defined according to a score constructed considering the consumption of nine MDP characteristic components: high MUFA:SFA ratio, moderate ethanol consumption, high legumes, cereals and roots, fruits, vegetables and fish consumption, and low consumption of meat and milk. Then, socio-demographic, lifestyle and health status variables that could determine a higher or ower adherence were assessed. The mean adherence was 57.9 (sd 8.9) % and the median adherence was 57.3 %. Half of the Balearic Islands adolescents (50.5 %) showed an adherence to the MDP comprised between 52.7 and 62.8 %. By multivariate analyses, a high maternal level of education, increased physical activity, reduced alcohol intake and abstinence from smoking were independent associations of better adherence to the MDP. The promotion of not only the MDP but also the Mediterranean lifestyle, including greater physical activity, should be reinforced among the Balearic younger generations.

  7. Effects of the history of adoption in the emotional adjustment of adopted adolescents. (United States)

    Reppold, Caroline Tozzi; Hutz, Claudio Simon


    Since the decade of 1980, the model of stress and coping proposed for the assessment of vulnerability of adoptive families emphasizes that the emotional adjustment of those adopted is moderated by variables such as institutionalization, the manner and age at which the adoption was revealed, the change of first name, and the contact with the biological family. The objective of this study was to investigate the relationship of these variables to the perceived parenting style, mood, and self-esteem of the adopted adolescents. Participants in the study were 68 adolescents, between the ages of 14 and 15, adopted during infancy through judicial channels. The adolescents responded to a questionnaire about the history of adoption and to scales of Parenting Styles, Depression and Self-esteem. The main results indicated that the late revelation of adoption and the change of the first name are connected to higher levels of depression and low self-esteem and to more frequent perceptions of negligent or authoritarian parenting style. The contact with the biological family was frequently mentioned among those who perceived their parents as authoritative and presented the best indicator of mood and self-esteem. These findings were discussed in light of the necessity for multidisciplinary actions which can improve the psychological adaptation of the adopting families.

  8. The Social Construction of Adoption: Clinical and Community Perspectives. (United States)

    Miall, Charlene E.


    Discusses the social construction of adoptive parenting and adopted children as reflected in clinical and adoption triangle research. Although clinicians view adoptive families as second best to biologically related families, a random sample of 150 respondents did not differentiate between the functioning of adoptive and biologically related…

  9. Active Drivers of Adoption of Internet Banking

    Directory of Open Access Journals (Sweden)

    Pankaj Yadav


    Full Text Available Application of internet by banking sector in India has changed the definition of banking completely. The management of different banks has been making concrete efforts to facilitate the acceptance of i-banking by bringing out its benefits to the customers. This paper identifies the active factors that influence customers intention regarding use of internet banking in Himachal Pradesh  Data was collected from a sample of 120 respondents through a well structured questionnaire. The data was collected from Government employees of Shimla district of Himachal Pradesh by asking close ended questions regarding their attitude towards i-banking and their future intention about its use . For analysing and interpreting data in the present study, basic statistical tools, chi-square test (test of independence and logistical regression analysis was used with the help of SPSS 16.0 version. Out of seven factors i.e., perceived risk, perceived usefulness,  perceived quality of service, Perceived cost, Perceived ease of use, trust and awareness, three significant factors i.e., perceived risk, perceived usefulness  and perceived quality of service have been identified that actively influence future adoption intention to adopt internet banking . Further the study exhibited that perceived usefulness and perceived quality of service positively influence the intention to adopt i-banking while perceived risk negatively affect the future adoption intention of i-banking. This  model has the overall predictability of classifying 76.7 % cases correctly and exhibited that 87.2 % customers are classified for adopting i-banking service whereas 57.1 % customers for not having intention to use it in future

  10. A Disciplined Approach to Adopting Agile Practices: The Agile Adoption Framework

    CERN Document Server

    Sidky, Ahmed; Bohner, Shawn


    Many organizations aspire to adopt agile processes to take advantage of the numerous benefits that it offers to an organization. Those benefits include, but are not limited to, quicker return on investment, better software quality, and higher customer satisfaction. To date however, there is no structured process (at least in the public domain) that guides organizations in adopting agile practices. To address this problem we present the Agile Adoption Framework. The framework consists of two components: an agile measurement index, and a 4-Stage process, that together guide and assist the agile adoption efforts of organizations. More specifically, the agile measurement index is used to identify the agile potential of projects and organizations. The 4-Stage process, on the other hand, helps determine (a) whether or not organizations are ready for agile adoption, and (b) guided by their potential, what set of agile practices can and should be introduced.

  11. "Transfer Shock" or "Transfer Ecstasy?" (United States)

    Nickens, John M.

    The alleged characteristic drop in grade point average (GPA) of transfer students and the subsequent rise in GPA was investigated in this study. No statistically significant difference was found in first term junior year GPA between junior college transfers and native Florida State University students after the variance accounted for by the…

  12. Factors associated with suboptimal adherence to antiretroviral therapy in Asia

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    Awachana Jiamsakul


    Full Text Available Introduction: Adherence to antiretroviral therapy (ART plays an important role in treatment outcomes. It is crucial to identify factors influencing adherence in order to optimize treatment responses. The aim of this study was to assess the rates of, and factors associated with, suboptimal adherence (SubAdh in the first 24 months of ART in an Asian HIV cohort. Methods: As part of a prospective resistance monitoring study, the TREAT Asia Studies to Evaluate Resistance Monitoring Study (TASER-M collected patients’ adherence based on the World Health Organization-validated Adherence Visual Analogue Scale. SubAdh was defined in two ways: (i 14 days. Time was divided into four intervals: 0–6, 6–12, 12–18 and 18–24 months. Factors associated with SubAdh were analysed using generalized estimating equations. Results: Out of 1316 patients, 32% ever reported 2 assessments per patient per year had an odds ratio (OR=0.7 (95% confidence interval (CI (0.55 to 0.90, p=0.006, compared to sites with ≤2 assessments per patient per year. Compared to heterosexual exposure, SubAdh was higher in injecting drug users (IDUs (OR=1.92, 95% CI (1.23 to 3.00, p=0.004 and lower in homosexual exposure (OR=0.52, 95% CI (0.38 to 0.71, p<0.001. Patients taking a nucleoside transcriptase inhibitor and protease inhibitor (NRTI+PI combination were less likely to report adherence <100% (OR=0.36, 95% CI (0.20 to 0.67, p=0.001 compared to patients taking an NRTI and non-nucleoside transcriptase inhibitor (NRTI+NNRTI combination. SubAdh decreased with increasing time on ART (all p<0.001. Similar associations were found with adherence <95% as the outcome. Conclusions: We found that SubAdh, defined as either <100% and <95%, was associated with mode of HIV exposure, ART regimen, time on ART and frequency of adherence measurement. The more frequently sites assessed patients, the lower the SubAdh, possibly reflecting site resourcing for patient counselling. Although social

  13. Approaches to improve adherence to pharmacotherapy in patients with schizophrenia

    Directory of Open Access Journals (Sweden)

    Shuler KM


    Full Text Available Kimberly M Shuler Shuler Counseling and Consulting, Fayetteville, AR, USA Purpose: In patients with schizophrenia, nonadherence to prescribed medications increases the risk of patient relapse and hospitalization, key contributors to the costs associated with treatment. The objectives of this review were to evaluate the impact of nonadherence to pharmacotherapy in patients with schizophrenia as it relates to health care professionals, particularly social workers, and to identify effective team approaches to supporting patients based on studies assessing implementation of assertive community treatment teams. Materials and methods: A systematic review of the medical literature was conducted by searching the Scopus database to identify articles associated with treatment adherence in patients with schizophrenia. Articles included were published from January 1, 2003, through July 15, 2013, were written in English, and reported findings concerning any and all aspects of nonadherence to prescribed treatment in patients with schizophrenia. Results: Of 92 unique articles identified and formally screened, 47 met the inclusion criteria for the systematic review. The burden of nonadherence in schizophrenia is significant. Factors with the potential to affect adherence include antipsychotic drug class and formulation, patient-specific factors, and family/social support system. There is inconclusive evidence suggesting superior adherence with an atypical versus typical antipsychotic or with a long-acting injectable versus an oral formulation. Patient-specific factors that contribute to adherence include awareness/denial of illness, cognitive issues, stigma associated with taking medication, substance abuse, access to health care, employment/poverty, and insurance status. Lack of social or family support may adversely affect adherence, necessitating the assistance of health care professionals, such as social workers. Evidence supports the concept that an

  14. Value-based insurance design yields near- and long-term improvements in medication adherence. (United States)

    Collado, Megan


    Key findings. (1) Value-based insurance design (VBID) improves medication adherence by 1 to 3 percent in the first year after implementation; (2) Improvements in adherence were sustained and amplified in the second year post-implementation, ranging from 2 to 5 percent; (3) Adherence improvements varied ac­cording to VBID participants' baseline adherence, with greatest improve­ments evident in those with poorer baseline adherence

  15. Adherence with tobramycin inhaled solution and health care utilization

    Directory of Open Access Journals (Sweden)

    Sacco Patricia


    Full Text Available Abstract Background Adherence with tobramycin inhalation solution (TIS during routine cystic fibrosis (CF care may differ from recommended guidelines and affect health care utilization. Methods We analyzed 2001-2006 healthcare claims data from 45 large employers. Study subjects had diagnoses of CF and at least 1 prescription for TIS. We measured adherence as the number of TIS therapy cycles completed during the year and categorized overall adherence as: low ≤ 2 cycles, medium >2 to Results Among 804 individuals identified with CF and a prescription for TIS, only 7% (n = 54 received ≥ 4 cycles of TIS per year. High adherence with TIS was associated with a decreased risk of hospitalization when compared to individuals receiving ≤ 2 cycles (adjusted odds ratio 0.40; 95% confidence interval 0.19-0.84. High adherence with TIS was also associated with lower outpatient service costs (IQR: $2,159-$8444 vs. $2,410-$14,423 and higher outpatient prescription drug costs (IQR: $35,125-$60,969 vs. $10,353-$46,768. Conclusions Use of TIS did not reflect recommended guidelines and may impact other health care utilization.

  16. Determinants of CPAP Adherence in Hispanics with Obstructive Sleep Apnea

    Directory of Open Access Journals (Sweden)

    Montserrat Diaz-Abad


    Full Text Available Purpose. We hypothesized that socioeconomic factors and a language barrier would impact adherence with continuous positive airway pressure (CPAP among Hispanics with obstructive sleep apnea (OSA. Methods. Patients with OSA who were prescribed CPAP for at least 1 year and completed a questionnaire evaluating demographic data, socioeconomic status, and CPAP knowledge and adherence participated in the study. Results. Seventy-nine patients (26 males; 53±11 yrs; body mass index (BMI=45±9 kg/m2 with apnea-hypopnea index (AHI 33±30 events/hr completed the study. Included were 25 Hispanics, 39 African Americans, and 15 Caucasians, with no difference in age, AHI, CPAP use, or BMI between the groups. While there was a difference in educational level (P=0.006, income level (P<0.001, and employment status (P=0.03 between the groups, these did not influence CPAP adherence. Instead, overall improvement in quality of life and health status and perceived benefit from CPAP influenced adherence, both for the group as a whole (P=0.03, P=0.004, and P=0.001, resp., as well as in Hispanics (P=0.02, P=0.02, P=0.03, resp.. Conclusion. In Hispanic patients with OSA, perceived benefit with therapy, rather than socioeconomic status or a language barrier, appears to be the most important factor in determining CPAP adherence.

  17. Bacterial adherence to SiO2-based multifunctional bioceramics. (United States)

    Kinnari, Teemu J; Esteban, Jaime; Gomez-Barrena, Enrique; Zamora, Nieves; Fernandez-Roblas, Ricardo; Nieto, Alejandra; Doadrio, Juan C; López-Noriega, Adolfo; Ruiz-Hernández, Eduardo; Arcos, Daniel; Vallet-Regí, María


    The bacterial adherence onto different multifunctional silica-based bioceramics has been evaluated. Staphylococcus aureus and Staphylococcus epidermidis were chosen, as they cause the majority of the implant-related infections in this field. Two SiO2 mesoporous materials (MCM-41, SBA-15), an ordered SiO2-CaO-P2O5 mesoporous glass (OMG), and a biphasic magnetic bioceramic (BMB), were incubated with S. aureus and S. epidermidis for 90 min, and subsequently sonicated to quantify the number of adhered bacteria on each material. It was found that S. aureus and S. epidermidis (10(8) CFU/mL) adhered significantly less to BMB samples when compared to MCM-41, SBA-15, or OMG. However, when the material pores accessible for bacteria in each material were taken into account, the lowest bacterial adherence was found in MCM-41, and the highest in SBA-15. The results show that bacterial adherence is higher on mesoporous bioceramics, although this higher microbial attachment is mainly due to the intergranular porosity and grain size morphology rather than to the mesoporous structure.

  18. Improving patient outcomes in psoriasis: strategies to ensure treatment adherence

    Directory of Open Access Journals (Sweden)

    Yélamos O


    Full Text Available Oriol Yélamos, Sandra Ros, Lluís Puig Department of Dermatology, Hospital de la Santa Creu i Sant Pau – Universitat Autònoma de Barcelona, Barcelona, Catalonia, Spain Abstract: Psoriasis is a frequent inflammatory disease with a chronic and relapsing course. Therefore, patients with psoriasis are likely to undergo different treatments for long periods of time. Traditionally, therapies used in psoriasis have been associated with poor levels of adherence due to the complexity of the regimens and the poor results obtained with the topical therapies. These poor outcomes are associated with high levels of frustration and anxiety, which decrease adherence and worsen the disease. With the recent introduction of highly efficacious biologic therapies, patients can achieve very good and prolonged responses. However, most patients with psoriasis have mild disease and may be treated with skin-directed therapies. Therefore, it is important to develop strategies to improve adherence in order to achieve better outcomes, and to improve the overall quality of life. Hence, acknowledging the causes of nonadherence is crucial for implementing these strategies. In this summary, we review the causes of nonadherence, and we provide behavioral strategies in order to improve adherence and, ultimately, the outcome of patients with psoriasis. Keywords: psoriasis, adherence, outcome, drug therapy, psychotherapy

  19. The therapeutic relationship and adherence to antipsychotic medication in schizophrenia.

    Directory of Open Access Journals (Sweden)

    Rosemarie McCabe

    Full Text Available OBJECTIVE: Previous research has shown that a better therapeutic relationship (TR predicts more positive attitudes towards antipsychotic medication, but did not address whether it is also linked with actual adherence. This study investigated whether the TR is associated with adherence to antipsychotics in patients with schizophrenia. METHODS: 134 clinicians and 507 of their patients with schizophrenia or a related psychotic disorder participated in a European multi-centre study. A logistic regression model examined how the TR as rated by patients and by clinicians is associated with medication adherence, adjusting for clinician clustering and symptom severity. RESULTS: Patient and clinician ratings of the TR were weakly inter-correlated (r(s = 0.13, p = 0.004, but each was independently linked with better adherence. After adjusting for patient rated TR and symptom severity, each unit increase in clinician rated TR was associated with an increase of the odds ratio of good compliance by 65.9% (95% CI: 34.6% to 104.5%. After adjusting for clinician rated TR and symptom severity, for each unit increase in patient rated TR the odds ratio of good compliance was increased by 20.8% (95% CI: 4.4% to 39.8%. CONCLUSIONS: A better TR is associated with better adherence to medication among patients with schizophrenia. Patients' and clinicians' perspectives of the TR are both important, but may reflect distinct aspects.

  20. Evaluating IPv6 Adoption in the Internet (United States)

    Colitti, Lorenzo; Gunderson, Steinar H.; Kline, Erik; Refice, Tiziana

    As IPv4 address space approaches exhaustion, large networks are deploying IPv6 or preparing for deployment. However, there is little data available about the quantity and quality of IPv6 connectivity. We describe a methodology to measure IPv6 adoption from the perspective of a Web site operator and to evaluate the impact that adding IPv6 to a Web site will have on its users. We apply our methodology to the Google Web site and present results collected over the last year. Our data show that IPv6 adoption, while growing significantly, is still low, varies considerably by country, and is heavily influenced by a small number of large deployments. We find that native IPv6 latency is comparable to IPv4 and provide statistics on IPv6 transition mechanisms used.

  1. Treaty to Curb Mercury Pollution Adopted (United States)

    Showstack, Randy


    The international Minamata Convention on Mercury to protect human health and the environment from anthropogenic emissions and releases of mercury and mercury compounds was formally adopted at a 10 October meeting in Minamata, Japan. The legally binding treaty, currently signed by 92 countries, comes 57 years after the government of Japan officially acknowledged, in 1956, the existence of Minamata disease, which was caused by eating seafood contaminated with methylmercury compounds discharged into Minamata Bay in southern Japan.


    Directory of Open Access Journals (Sweden)

    Faizal Kurniawan


    Full Text Available Freedom of contract principle brings the contracting parties to sign into an agreement in such forms, including a standard contract. The standard contracts are made by one party, usually by business entities in the aim of doing efficiency. The contracts, however, potentially contains abuse of power in its application, known as adhesion contract. In term of adhesion contract, it contains prompt restrictions and/or transfer of responsibilities of the business risks to the adhered party. Therefore, good faith principle plays an important role to evaluate the implementation of the adhesion contract. This article discusses the adhesion contract in the light of the basic principles in contract law and explores the legal frameworks for adhered party to seek their contractual rights in conjunction with the implementation of the adhesion contract. We also compare the implementation of the adhesion contract, practically, both in Indonesia and international practices by examining the national laws and the model law e.g. Principles of International Commercial Contracts (PICC.

  3. Understanding Physicians' Adoption of Health Clouds

    Directory of Open Access Journals (Sweden)

    Tatiana Ermakova


    Full Text Available Recently proposed health applications are able to e nforce essential advancements in the healthcare sector. The design of these innovative s olutions is often enabled through the cloud computing model. With regards to this technology, h igh concerns about information security and privacy are common in practice. These concerns with respect to sensitive medical information could be a hurdle to successful adoptio n and consumption of cloud-based health services, despite high expectations and interest in these services. This research attempts to understand behavioural intentions of healthcare pro fessionals to adopt health clouds in their clinical practice. Based on different established t heories on IT adoption and further related theoretical insights, we develop a research model a nd a corresponding instrument to test the proposed research model using the partial least squ ares (PLS approach. We suppose that healthcare professionals’ adoption intentions with regards to health clouds will be formed by their outweighing two conflicting beliefs which are performance expectancy and medical information security and privacy concerns associate d with the usage of health clouds. We further suppose that security and privacy concerns can be explained through perceived risks.


    Directory of Open Access Journals (Sweden)

    Claudia Loredana Juncu


    Full Text Available Even if the Euro critics showed the warning that the change of the national currency brings a loose of the control and the decision power about the monetary problems and the flexibility of the decisions, many consider that the adoption of the single currency would allow us to protect the economies from the external shocks. We have to eliminate the uncertainty, the high costs and we have to be able to avoid and / or manage the monetary fluctuations especially in situations like today’s economic crisis. One of the effects the crisis has created throughout the European Union and especially in Romania is connected with the return back in the country of the population that works in Western Europe and the reflux of money it implies. The structural problems of the Romanian economy that creates this workforce dynamic is to continue to affect the Euro adoption plan until significant solutions will be addressed in order to maintain the workforce in the country.Europe is facing a dilemma. For now there is a significant distrust in Euro. Romania needs to acknowledge the fact that a single European currency allows first of all the overpass of the actual internal fragmentation of the market and so to strengthen the national position in relation with the international. Romania can still be optimistic about the objective of adopting Euro if an efficient financial policy will be implemented.

  5. Trust: A Requirement for Cloud Technology Adoption

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    Akinwale O. Akinwunmi


    Full Text Available Cloud computing is a recent model for enabling convenient, on-demand network access to a shared pool of configurable computing resources such as networks, servers, storage, applications, and services; that can be rapidly provisioned and released with minimal management effort or service provider interaction. Studies have shown that cloud computing has the potential to benefit establishments, industries, national and international economies. Despite the enormous benefits cloud computing technology has the potentials of offering, several issues are making intended users to pause in adopting the usage of the technology. Users need to be assured of the safety and reliability of the technology while using it. This is needed to build confidence around the technology and reduce the level of anxiety. This research attempts to investigate the effect of trust in the adoption of the technology by formulating a trust model based on Expectancy Disconfirmation Theory model and Bayesian network. A simulation experiment was carried out to determine the significance of trust in the adoption of cloud technology.

  6. SMS advertisements\\\\\\' adoption among Tehran mobile users

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    Manizheh Haghighinasab


    Full Text Available Mobile marketing and SMS (short message services advertising in particular, have been recently used. Even though SMS-based advertising is inexpensive, interactive, and able to yield a high response rate, middle or big size companies do not use it in Iran. For as much as its adoption was unclear, this study was organized to find it out. Since the most populated city in our country, Tehran, is a good multicultural instance to study in many fields, this research has aimed at its citizens' intention to use SMS advertisement. The statistical populations included are mobile users, who came to Mobile Customer Service located in north, south, west, east and centre of Tehran. From which 384 were considered as samples. Technology Acceptance Model (TAM was used for making hypothesizes. Survey's data was collected by questionnaire with cluster and random sampling. Collected data was analyzed regarding to the method: Structural Equation Modeling (SEM in order to do which, the technique Partial List Squares (PLS were used. The results revealed that: despite the lack of adoption for the SMS advertising among mobile users in Tehran, there could be chances to improve it by better perceived usefulness as well as its ease of use. Innovativeness of the people and their trust has indirect impact on their intention to use. Moreover, getting prior permission, making a profile, and individualizing the context with richness of information and entertainers are recommended. Using the new generation 3G and shortcuts will be able to improve SMS advertisement's adoption as well.

  7. Sonoporation of adherent cells under regulated ultrasound cavitation conditions. (United States)

    Muleki Seya, Pauline; Fouqueray, Manuela; Ngo, Jacqueline; Poizat, Adrien; Inserra, Claude; Béra, Jean-Christophe


    A sonoporation device dedicated to the adherent cell monolayer has been implemented with a regulation process allowing the real-time monitoring and control of inertial cavitation activity. Use of the cavitation-regulated device revealed first that adherent cell sonoporation efficiency is related to inertial cavitation activity, without inducing additional cell mortality. Reproducibility is enhanced for the highest sonoporation rates (up to 17%); sonoporation efficiency can reach 26% when advantage is taken of the standing wave acoustic configuration by applying a frequency sweep with ultrasound frequency tuned to the modal acoustic modes of the cavity. This device allows sonoporation of adherent and suspended cells, and the use of regulation allows some environmental parameters such as the temperature of the medium to be overcome, resulting in the possibility of cell sonoporation even at ambient temperature.

  8. Decisional capacity and medication adherence among youth with HIV. (United States)

    Chenneville, Tiffany; Clutter, Michiko Otsuki; Hintz, Stephanie; Walsh, Audra; Emmanuel, Patricia; Lujan-Zilberman, Jorge; Rodriguez, Carina


    This exploratory study examined the degree to which decisional capacity (DC) is associated with measures of self-reported medication adherence. We hypothesized that youth with higher levels of DC would report greater levels of antiretroviral medication adherence. Seventy-two (72) youth with HIV aged 13-24 participated in this study. Data collection included administration of the MacArthur Competence Tool for Treatment and measures of adherence (i.e., seven-day self-report interview, visual analog scale, and biological indicators). Data were analyzed using descriptive statistics, intercorrelations, and multiple and Poisson regression analyses. Youth with HIV who exhibited greater understanding of their disease were more likely to report fewer missed doses in the last seven days. Findings build upon literature in the areas of DC and health literacy and highlight the potential utility of enhancing HIV disease understanding among youth with HIV.

  9. Bridging the gap between antiretroviral access and adherence in Mexico. (United States)

    Campero, Lourdes; Herrera, Cristina; Kendall, Tamil; Caballero, Marta


    The goal in this article is to examine social problems associated with highly active antiretroviral therapy (HAART) adherence in Mexico and the related challenges for Mexican persons living with HIV/AIDS (PLWHAs). The study was conducted from the perspective of infected and affected individuals. The authors completed 64 in-depth interviews with heterosexual male and female PLWHAs, as well as with some key individuals from their social network. Following the principles of grounded theory, they carried out inductive analysis to create codes and organize central themes. The authors identified problems related to accessing HAART and found that conditions for implementing recommendations made in the international literature to improve adherence are poor. The findings highlight the importance of social factors, such as health care system irregularities, ineffective physician-patient communication, and availability of family and other sources of social support such as self-help groups for PLWHAs' access and adherence to antiretroviral therapy in Mexico.

  10. Stick to your gums: mechanisms of oral microbial adherence. (United States)

    Nobbs, A H; Jenkinson, H F; Jakubovics, N S


    Studies on the adherence properties of oral bacteria have been a major focus in microbiology research for several decades. The ability of bacteria to adhere to the variety of surfaces present in the oral cavity, and to become integrated within the resident microbial communities, confers growth and survival properties. Molecular analyses have revealed several families of Gram-positive bacterial surface proteins, including serine-rich repeat, antigen I/II, and pilus families, that mediate adherence to a variety of salivary and oral bacterial receptors. In Gram-negative bacteria, pili, auto-transporters, and extracellular matrix-binding proteins provide components for host tissue recognition and building of complex microbial communities. Future studies will reveal in greater detail the binding pockets for these adhesin families and their receptors. This information will be crucial for the development of new inhibitors or vaccines that target the functional regions of bacterial proteins that are involved in colonization and pathogenesis.

  11. Association of Continuity of Primary Care and Statin Adherence.

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    James R Warren

    Full Text Available Deficiencies in medication adherence are a major barrier to effectiveness of chronic condition management. Continuity of primary care may promote adherence. We assessed the association of continuity of primary care with adherence to long-term medication as exemplified by statins.We linked data from a prospective study of 267,091 Australians aged 45 years and over to national data sets on prescription reimbursements, general practice claims, hospitalisations and deaths. For participants having a statin dispense within 90 days of study entry, we computed medication possession ratio (MPR and usual provider continuity index (UPI for the subsequent two years. We used multivariate Poisson regression to calculate the relative risk (RR and 95% confidence interval (CI for the association between tertiles of UPI and MPR adjusted for socio-demographic and health-related patient factors, including age, gender, remoteness of residence, smoking, alcohol intake, fruit and vegetable intake, physical activity, prior heart disease and speaking a language other than English at home. We performed a comparison approach using propensity score matching on a subset of the sample.36,144 participants were eligible and included in the analysis among whom 58% had UPI greater than 75%. UPI was significantly associated with 5% increased MPR for statin adherence (95% CI 1.04-1.06 for highest versus lowest tertile. Dichotomised analysis using a cut-off of UPI at 75% showed a similar effect size. The association between UPI and statin adherence was independent of socio-demographic and health-related factors. Stratification analyses further showed a stronger association among those who were new to statins (RR 1.33, 95% CI 1.15-1.54.Greater continuity of care has a positive association with medication adherence for statins which is independent of socio-demographic and health-related factors.

  12. Characteristics of HIV antiretroviral regimen and treatment adherence

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    Vera Lúcia da Silveira


    Full Text Available The relationship between characteristics of HIV antiretroviral regimens and treatment adherence was studied in adolescent and adult patients who underwent antiretroviral therapy from January 1998 to September 2000, at the Service for Specialized Assistance in Pelotas. The patients were interviewed on two occasions, and the use of antiretrovirals during the previous 48 hours was investigated by a self-report. Adherence was defined as use of 95% or more of the prescribed medication. Social-demographic variables were collected through direct questionnaires. The antiretroviral regimen and clinical data were copied from the patients' records. Associations between the independent variables and adherence were analyzed by means of logistic regression. The multivariate analysis included characteristics of the antiretroviral regimens, social-demographic variables, as well as perception of negative effects, negative physiological states, and adverse effects of the treatment. Among the 224 selected patients, 194 participated in our study. Their ages varied from 17 to 67 years; most patients were men, with few years of schooling and a low family income. Only 49% adhered to the treatment. Adherence to treatment regimens was reduced when more daily doses were indicated: three to four doses (odds ratio of adherence to treatment (OR=0.47, 95% confidence interval (CI 0.22-1.01 and five to six (OR=0.24, 95% CI 0.09-0.62; two or more doses taken in a fasting state (OR=0.59, 95% CI 0.11-0.68, and for patients who reported adverse effects to the treatment (OR=0.39, 95% CI 0.19-0.77. Most of the regimens with more than two daily doses of medication included at least one dose apart from mealtimes. The results suggest that, if possible, regimens with a reduced number of doses should be chosen, with no compulsory fasting, and with few adverse effects. Strategies to minimize these effects should be discussed with the patients.

  13. Biofluid Flow Simulations of Embryo Transfer (United States)

    Shi, W. P.; Ding, D. L.


    The investigation of the fluid flow for embryo transfer (ET) procedure may find the way to increase the success rate of the assisted reproductive technologies. In this paper, the transferred liquid flow in the uterine cavity during ET procedure is simulated by a two dimensional multiphase flow model, and the discrete phase model is adopted to trace the embryo motion. Through the investigation on the transferred liquid outline and the track of each embryo in ET cases with different parameters, we summarize the effect of transferred liquid viscosity and distance between catheter tip and uterine fundus. According to the numerical results, we recommend the optimizing standard to perform the ET procedure.

  14. Adherence and neurocognitive screening in Romanian HIV patients

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    M Arbune


    Full Text Available Background: Adherence is critical for the effectiveness of antiretroviral HIV therapy (ART, accordingly decreasing the opportunistic diseases and increasing the quality of life. Neurocognitive disorders (NCD are still frequent in ART era and could impair the adherence, but how ethical is to refer ART in patients with NCD? Objective: To assess the relation between NCD and adherence in HIV Romanian patients. Material and methods: Cross-sectional screening study on 151 patients under ART, no drug users, from HIV Clinic - Galati, assessed by HIV-Associated Dementia Scale (HDS, Hospital Anxiety and Depression Scale (HADS [1], ART CNS-effectiveness Letendre scores [2] and adherence assessment questionnaire CNLAS- Romania. Normal values: HDS >10; anxiety/ depression <8. Statistical analysis performed: Chi-square test and Mann-Whitney test, with 5% significance level. Results: Characteristics of the patients: median age 22 [20; 56] years old; sex ratio F/M 1.17; median educational level 8 [0; >12] years; HBV co-infection 27.8%; AIDS stage 85.3%; current median CD4 526/mm3 [8; 1605] and 65% undetectable HIV-RNA levels. 49.6% (75/151 patients attain HDS scores <10 and imply probable NCD. Scores below 8 for anxiety are more frequent than for depression: 24% vs 13%. The median ART CNS penetration score is 8 [5; 12]. Adherence is considered for 66% patients and is correlating with CD4 number (p=0.001, educational level >4 years (p=0.001; OR=4.2, HDS >10 (p=0.01; OR=2.4 and ART-CNS penetration score >7 (p=0.023; OR=2.4. Low HDS are influenced by old age (p=0.003, depression (p=0.02 and ART-CNS penetration scores <7 (p=0.01. Anxiety is related neither with adherence nor with NCD by HDS, but females are obvious anxious than males (p<0.001. Conclusions: Basic educational level is sufficient for developing ART adherence. High scores of HDS screening should be predictors for ART adherence. Referring ART as well to patients with low HDS scores is rational and

  15. Treating depression in HIV-positive patients affects adherence

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    M Y H Moosa


    Full Text Available Aim. To determine changes in adherence to antiretroviral therapy (ART in HIV-positive patients with depression, following treatment with an antidepressant or psychotherapy. Methods. The study was prospective, randomised and controlled. Consenting volunteers aged ≥18 years and stable on ART for ≥6 months were included in the study. Sociodemographic data were obtained, and a clinical diagnostic evaluation and the Hamilton Depression rating scale (HAMD were performed on all subjects at entry to and at the end of the study. Participants found to be depressed were randomly assigned antidepressant treatment (20 mg citalopram or interpersonal psychotherapy (IPT (5 sessions. Medication was dispensed at each visit and patients were asked to return all unused medication to determine ART adherence. The study was approved by the University of the Witwatersrand. Results. Sixty-two HIV-positive persons receiving ART participated; 30 were not depressed (control group and 32 were depressed (patient group. No significant differences in demographic characteristics existed between the control and patient groups. Mean ART adherence at the start of the study was 99.5% (standard error (SE ±0.46 and 92.1% (SE ±1.69 in the control and patients groups, respectively. Mean ART adherence at the end of the study changed marginally in the control group (99.7%; SE ±0.46 and increased significantly in the patient group (99.5%; SE± 0.13 (p>0.05. The mean ART adherence rate of patients who received pharmacotherapy increased from 92.8% to 99.5%, and of those who received psychotherapy increased from 91.1% to 99.6% (p>0.05. There was no significant association between the increased adherence in the patient group and baseline demographic and clinical characteristics, irrespective of antidepressant therapy or IPT (p>0.05. Conclusion. Successful treatment of depression with an antidepressant or psychotherapy was associated with improved ART adherence, independent of the type

  16. Cell fusion through a microslit between adhered cells and observation of their nuclear behavior. (United States)

    Wada, Ken-Ichi; Hosokawa, Kazuo; Kondo, Eitaro; Ito, Yoshihiro; Maeda, Mizuo


    This paper describes a novel cell fusion method which induces cell fusion between adhered cells through a microslit for preventing nuclear mixing. For this purpose, a microfluidic device which had ∼ 100 cell pairing structures (CPSs) making cell pairs through microslits with 2.1 ± 0.3 µm width was fabricated. After trapping NIH3T3 cells with hydrodynamic forces at the CPSs, the cells were fused through the microslit by the Sendai virus envelope method. With following timelapse observation, we discovered that the spread cells were much less susceptible to nuclear migration passing through the microslit compared with round cells, and that cytoplasmic fraction containing mitochondria was transferred through the microslit without nuclear mixing. These findings will provide an effective method for cell fusion without nuclear mixing, and will lead to an efficient method for reprograming and transdifferentiation of target cells toward regenerative medicine.

  17. [Development of an electronic device to organize medications and promote treatment adherence]. (United States)

    Vieira, Liliana Batista; Ramos, Celso de Ávila; Castello, Matheus de Barros; Nascimento, Lorenzo Couto do


    This article describes the development of an electronic prototype to organize medications - the Electronic System for Personal and Controlled Use of Medications (Sistema Eletrônico de Uso Personalizado e Controlado de Medicamentos, SUPERMED). The prototype includes a drawer containing 1 month's supply of medicines, sound and visual medication timers, and a memory card for recording the times when the box was opened/closed (scheduled and unscheduled). This information is later transferred to a computer. Evolutionary prototyping was used to develop SUPERMED with the Arduino platform and C programming. To read alarm and box opening/closing data, software was developed in Java. Once the alarms are programmed (ideally by a health care professional), no additional adjustments are required by the patient. The prototype was tested during 31 days by the developers, with satisfactory functioning. The system seems adequate to organize medications and facilitate adherence to treatment. New studies will be carried out to validate and improve the prototype.

  18. Comforting an orphaned nation : Representations of international adoption and adopted Koreans in Korean popular culture


    Hübinette, Tobias


    This is a study of popular cultural representations of international adoption and adopted Koreans in Western countries. The study is carried out from a postcolonial perspective and uses a cultural studies reading of four feature films and four popular songs as primary sources. The aim is to examine how nationalism is articulated in various ways in light of the colonial experiences in modern Korean history and recent postcolonial developments within contemporary Korean society. The principal q...

  19. Promoting adherence to nebulized therapy in cystic fibrosis: poster development and a qualitative exploration of adherence

    Directory of Open Access Journals (Sweden)

    Jones S


    Full Text Available Stephen Jones,1 Nathan Babiker,2 Emma Gardner,2,3 Jane Royle,2 Rachael Curley,3,4 Zhe Hui Hoo,3,4 Martin J Wildman3,4 1Psychology Department, University of Sheffield, 2Psychological Services, Sheffield Teaching Hospitals NHS Foundation Trust, 3Adult Cystic Fibrosis Unit, Northern General Hospital, 4School of Health and Related Research (ScHARR, University of Sheffield, Sheffield, UK 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. Keywords: behavior change, social marketing, patient participation, nebulizers, medication adherence

  20. A systematic review of medication non-adherence in persons with dementia or cognitive impairment (United States)

    Weller, Carolina; Kennedy, Briohny; Winbolt, Margaret; Young, Carmel


    Background Adherence to medication is vital for disease management while simultaneously reducing healthcare expenditure. Older persons with cognitive impairment (CI) are at risk for non-adherence as cognitive processes are needed to manage medications. This systematic review focuses on the relationship between medication non-adherence and specific cognitive domains in persons with CI, and explores determinants of medication non-adherence. When available, relationships and factors are compared with cognitively intact populations. Methods A seven database systematic search of studies published between 1 January 1949–31 December 2015 examining medication non-adherence in community dwelling persons with CI or dementia was conducted. Articles reporting medication non-adherence in people with CI or dementia in the community, with or without caregiver supports were eligible for inclusion. Papers reporting adherence to treatments in cognitively intact populations, populations from hospital or institutional settings, for non-prescribed medication or those describing dementia as a factor predicting medication non-adherence were excluded. Data on study and population characteristics, research design, data sources and analysis, specific cognitive domains, non-adherence prevalence, measurement of adherence, salient findings, factors associated with adherence and strategies to improve medication adherence were extracted. Study limitations included inconsistencies between data sources and definitions, resulting in a loss of fidelity in the value and comprehensiveness of data, as well as exclusion of non-pharmacological treatments and regimens. Findings Fifteen studies met inclusion criteria. Adherence among CI subjects ranged from 10.7%-38% with better rates of adherence in non-CI individuals. Medication non-adherence definitions varied considerably. New-learning, memory and executive functioning were associated with improved adherence and formed the focus of most studies

  1. Enabling international adoption of LOINC through translation (United States)

    Vreeman, Daniel J.; Chiaravalloti, Maria Teresa; Hook, John; McDonald, Clement J.


    Interoperable health information exchange depends on adoption of terminology standards, but international use of such standards can be challenging because of language differences between local concept names and the standard terminology. To address this important barrier, we describe the evolution of an efficient process for constructing translations of LOINC terms names, the foreign language functions in RELMA, and the current state of translations in LOINC. We also present the development of the Italian translation to illustrate how translation is enabling adoption in international contexts. We built a tool that finds the unique list of LOINC Parts that make up a given set of LOINC terms. This list enables translation of smaller pieces like the core component “hepatitis c virus” separately from all the suffixes that could appear with it, such “Ab.IgG”, “DNA”, and “RNA”. We built another tool that generates a translation of a full LOINC name from all of these atomic pieces. As of version 2.36 (June 2011), LOINC terms have been translated into 9 languages from 15 linguistic variants other than its native English. The five largest linguistic variants have all used the Part-based translation mechanism. However, even with efficient tools and processes, translation of standard terminology is a complex undertaking. Two of the prominent linguistic challenges that translators have faced include: the approach to handling acronyms and abbreviations, and the differences in linguistic syntax (e.g. word order) between languages. LOINC’s open and customizable approach has enabled many different groups to create translations that met their needs and matched their resources. Distributing the standard and its many language translations at no cost worldwide accelerates LOINC adoption globally, and is an important enabler of interoperable health information exchange PMID:22285984

  2. Interventions for enhancing medication compliance/adherence with benefits in treatment outcomes

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    Hagen, Anja


    counseling in problem cases for diabetics, different family based interventions including repeated family counseling, education and "culturally modified family therapy" in patients with schizophrenia, repeated "compliance therapy" sessions for patients with acute psychosis. For other interventions the results should be viewed with more concern (because of the poor methodical quality of the underlying studies. The effect size of the interventions can not be estimated from the available data. From the available data, no reliable results can be provided concerning the cost-benefit relation of these strategies. Discussion: Many of the reported studies had a poor reporting and methodological quality. The reliability of the conclusions of the studies is restricted because of methodical shortcomings. Efficacy and cost estimates determined in the health economic studies are not transferable to the current situation in Germany. It has been discussed recently that the compliance or adherence enhancing interventions can restrict the autonomy and the privacy of the patients. Conclusions: In drug therapy some compliance or adherence enhancing interventions with concomitant positive effect on the treatment outcome may be used. The cost-benefit relation of these interventions is to be estimated. Using these interventions the patient’s autonomy and privacy are to be restricted as few as possible.

  3. Will Your Household Adopt Your New Robot?


    Bauwens, Valérie; Fink, Julia


    Domestic robots have slowly found their way into some of our homes and onto the shelves of major stores selling technical appliances. Who hasn’t already seen or heard of robots that vacuum or mow the lawn? As researchers in robotics, we feel this growing commercial success is a great opportunity to learn about robot adoption processes. Leaving the marketing buzz and usual fantasies about robot invasions aside, we are curious to find out how robots are perceived by users. Are robots revolution...

  4. Classification system adopted for fixed cutter bits

    Energy Technology Data Exchange (ETDEWEB)

    Winters, W.J.; Doiron, H.H.


    The drilling industry has begun adopting the 1987 International Association of Drilling Contractors' (IADC) method for classifying fixed cutter drill bits. By studying the classification codes on bit records and properly applying the new IADC fixed cutter dull grading system to recently run bits, the end-user should be able to improve the selection and usage of fixed cutter bits. Several users are developing databases for fixed cutter bits in an effort to relate field performance to some of the more prominent bit design characteristics.

  5. Technology Transfer (United States)

    Smith, Nanette R.


    The objective of this summer's work was to attempt to enhance Technology Application Group (TAG) ability to measure the outcomes of its efforts to transfer NASA technology. By reviewing existing literature, by explaining the economic principles involved in evaluating the economic impact of technology transfer, and by investigating the LaRC processes our William & Mary team has been able to lead this important discussion. In reviewing the existing literature, we identified many of the metrics that are currently being used in the area of technology transfer. Learning about the LaRC technology transfer processes and the metrics currently used to track the transfer process enabled us to compare other R&D facilities to LaRC. We discuss and diagram impacts of technology transfer in the short run and the long run. Significantly, it serves as the basis for analysis and provides guidance in thinking about what the measurement objectives ought to be. By focusing on the SBIR Program, valuable information regarding the strengths and weaknesses of this LaRC program are to be gained. A survey was developed to ask probing questions regarding SBIR contractors' experience with the program. Specifically we are interested in finding out whether the SBIR Program is accomplishing its mission, if the SBIR companies are providing the needed innovations specified by NASA and to what extent those innovations have led to commercial success. We also developed a survey to ask COTR's, who are NASA employees acting as technical advisors to the SBIR contractors, the same type of questions, evaluating the successes and problems with the SBIR Program as they see it. This survey was developed to be implemented interactively on computer. It is our hope that the statistical and econometric studies that can be done on the data collected from all of these sources will provide insight regarding the direction to take in developing systematic evaluations of programs like the SBIR Program so that they can

  6. The Relationships Between Selected Organizational Variables and ATM Technology Adoption in Campus Networking (United States)

    Yao, Engui


    ATM (Asynchronous Transfer Mode) is an emerging technology in computer networking, which, in turn, is the physical media of information systems and networking/telecommunication systems. The technology provides potentiality for universities to build their networks based on the future vision of uniting voice, data, and video communications on ATM-technology-based equipment. A review of the literature revealed that minimal evidence exists to indicate whether the size, type, financial factors, and information processing maturity of a university affect a university's high-tech innovation adoptions. No research of this nature has been undertaken in the study of ATM adoption in any institutions of higher learning, nor has any research of this nature been found in other organizations, either. Such evidence is needed by university administrators, information systems managers, and LAN managers to understand their universities better, whether they have or have not adopted ATM, and to evaluate their current administrative, academic, and financial situations and current campus networking situations. The purpose of this study was to determine the relationships between ATM adoption and four organizational variables: university size, type, finances, and information processing maturity. Another purpose of the study was to identify the current status of ATM adoption in campus networking in the United States. Logistic regression was used as the statistical data analysis method. The results of the study provided evidence to show that ATM adoption in campus networking is significantly related to university size, university type, university finances, and university information processing maturity.

  7. Motivations for enterprise system adoption in transition economies: insights from Poland (United States)

    Soja, Piotr; Weistroffer, Heinz Roland


    Enterprise system (ES) adoption can bring many benefits, but may also put tremendous strain on an organisation or business, sometimes with disastrous outcomes. The specific motivations and expectations that lead to ES adoption may impact the success or failure of these endeavours, and understanding these motivations may be useful in predicting the success of ES projects. Most of the published research on ES adoption motivation has been in the context of highly developed countries. The social, cultural, economic and political conditions in developing, emerging and transition economies make for a different business environment, and insights obtained from developed countries may not always transfer to these settings. This study seeks to identify and help understand the motivations for ES adoption specifically in transition economies, as these economies play a significant role in the global market, but have not been receiving adequate research attention. Drawing on the experience of 129 ES adopters in Poland, a transition economy, this study categorises motivations into coherent groups of issues and evaluates the influence of discovered motivations on ES adoption success. Further, motivations revealed by this study are compared with motivations reported by prior research conducted in developed countries.

  8. An Empirically Grounded Model of the Adoption of Intellectual Technologies. (United States)

    Wildemuth, Barbara M.


    Data on adoption of 43 user-developed computing applications in 3 large corporations were analyzed to develop an empirically grounded model of the adoption process for intellectual technologies. A five-stage model consisting of Resource Acquisition, Application Development, Adoption/Renewal, Routinization/Enhancement, and External Adoption was…

  9. Understanding Technology Adoption: Theory and Future Directions for Informal Learning (United States)

    Straub, Evan T.


    How and why individuals adopt innovations has motivated a great deal of research. This article examines individuals' computing adoption processes through the lenses of three adoption theories: Rogers's innovation diffusion theory, the Concerns-Based Adoption Model, the Technology Acceptance Model, and the United Theory of Acceptance and Use of…

  10. Partitioning the Adoption Process to Better Predict Permanency (United States)

    McDonald, Tom; Press, Alan; Billings, Peggy; Moore, Terry


    Under federal outcome standards established by the Adoption and Safe Families Act of 1997, discharges to adoption are expected to occur within 24 months of the most recent removal from home for at least 32% of cases. In the research recounted here, adoption is treated as a process composed of two discrete steps: adoptive placement, and adoption…

  11. Adoptive parenting and attachment: association of the internal working models between adoptive mothers and their late-adopted children during adolescence


    Cecilia Serena ePace; Simona eDi Folco; Viviana eGuerriero; Alessandra eSantona; Grazia eTerrone


    Introduction: Recent literature has shown that the good outcome of adoption would mostly depend on the quality of adoptive parenting, which is strongly associated with the security of parental internal working models (IWMs) of attachment. Specifically, attachment states-of-mind of adoptive mothers classified as free and autonomous and without lack of resolution of loss or trauma could represent a good protective factor for adopted children, previously maltreated and neglected. While most rese...

  12. Adoptive parenting and attachment: association of the Internal Working Models between adoptive mothers and their late-adopted children during adolescence

    Directory of Open Access Journals (Sweden)

    Cecilia Serena ePace


    Full Text Available Introduction. Recent literature has shown that the good outcome of adoption would mostly depend on the quality of adoptive parenting, which is strongly associated with the security of parental internal working models (IWMs of attachment. Specifically, attachment states-of-mind of adoptive mothers classified as free and autonomous and without lack of resolution of loss or trauma could represent a good protective factor for adopted children previously maltreated and neglected. While most research on adoptive families has focused on pre-school and school-aged children, the aim of this study was to assess the concordance of IWMs of attachment in adoptive dyads during adolescence.Method. Our pilot-study involved 76 participants: 30 adoptive mothers (mean age=51.5±4.3, and their 46 late-adopted adolescents (mean age = 13.9 ± 1.6, who were all aged four to nine years old at time of adoption (M = 6.3 ± 1.5. Attachment representations of adopted adolescents were assessed by the Friend and Family Interview (FFI, while adoptive mothers’ state-of-mind with respect to attachment was classified by the Adult Attachment Interview (AAI. Adolescents’ verbal intelligence was controlled.Results. Late-adopted adolescents were classified as follows: 67% secure, 26% dismissing and 7% preoccupied in the FFI, while their adoptive mothers’ AAI classifications were 70% free-autonomous, 7% dismissing, and 23% unresolved. We found a significant concordance of 70% (32 dyads between the secure-insecure FFI and AAI classifications. Specifically adoptive mothers with high coherence of transcript and low unresolved loss tend to have late-adopted children with high secure attachment, even if the adolescents’ verbal intelligence made a significant contribution to this prediction.Discussion. Our results provides an empirical contribution to the literature concerning the concordance of attachment in adoptive dyads, highlighting the beneficial impact of highly coherent

  13. Blastocyst Transfer




    ### Method: Blastocyst transfer is usually performed 24 hours after aggregation when the morulae have become expanded blastocysts and on the same day as injection. A little time is given between injection and transfer to allow blastocysts to re-expand. **The Recipient** Careful selection of the recipient is most important as the pups are the end result of a lot of hard work. Two strains of mice are used:RB Swiss and (CBA*C57BL6/J)f1. RB Swiss are quiet and make excellent mothers ...

  14. Heat transfer

    CERN Document Server

    Holman, J P


    As one of the most popular heat transfer texts, Jack Holman's "Heat Transfer" is noted for its clarity, accessible approach, and inclusion of many examples and problem sets. The new tenth edition retains the straight-forward, to-the-point writing style while covering both analytical and empirical approaches to the subject. Throughout the book, emphasis is placed on physical understanding while, at the same time, relying on meaningful experimental data in those situations that do not permit a simple analytical solution. New examples and templates provide students with updated resources for computer-numerical solutions.

  15. Medication adherence in schizophrenia: Exploring patients', carers' and professionals' views

    NARCIS (Netherlands)

    M.J. Kikkert; A.H. Schene; M.W.J. Koeter; D. Robson; A. Born; H. Helm; M. Nose; C. Goss; G. Thornicroft; R.J. Gray


    One of the major clinical problems in the treatment of people with schizophrenia is suboptimal medication adherence. Most research focusing on determinants of nonadherence use quantitative research methods. These studies have some important limitations in exploring the decision-making process of pat

  16. Novel Aggregative Adherence Fimbria Variant of Enteroaggregative Escherichia coli

    DEFF Research Database (Denmark)

    Jønsson, Rie; Struve, Carsten; Boisen, Nadia


    Enteroaggregative Escherichia coli (EAEC) organisms belong to a diarrheagenic pathotype known to cause diarrhea and can be characterized by distinct aggregative adherence (AA) in a stacked-brick pattern to cultured epithelial cells. In this study, we investigated 118 EAEC strains isolated from...

  17. Adherence of paclitaxel drug in magnetite chitosan nanoparticles

    Energy Technology Data Exchange (ETDEWEB)

    Escobar Zapata, Edna V.; Martinez Perez, Carlos A.; Rodriguez Gonzalez, Claudia A.; Castro Carmona, Javier S. [Instituto de Ingenieria y Tecnologia, Universidad Autonoma de Ciudad Juarez, Ave. Del Charro 610 norte, Col. Partido Romero, C.P. 32320, Cd. Juarez Chihuahua (Mexico); Quevedo Lopez, Manuel A. [Departamento de Polimeros y Materiales, Universidad de Sonora, Blvd. Luis Encinas y Rosales, Hermosillo, Sonora (Mexico); Garcia-Casillas, Perla E., E-mail: [Instituto de Ingenieria y Tecnologia, Universidad Autonoma de Ciudad Juarez, Ave. Del Charro 610 norte, Col. Partido Romero, C.P. 32320, Cd. Juarez Chihuahua (Mexico)


    Highlights: Black-Right-Pointing-Pointer Chitosan silica magnetite adsorbs antineoplastic drug. Black-Right-Pointing-Pointer Silica coating improve the drug adherence. - Abstract: Cancer treatment is a big challenge in medicine where chemotherapies and radiotherapies are aggressive and poorly effective having side effects as delirium, fatigue, insomnia, nausea and vomiting which are common problems for cancer patients. For this reason, during the last two decades, many researchers have developed several techniques to improve the current therapies; one of them is the functionalization of magnetic nanoparticles for drug delivery. In this work, magnetic nanoparticles with an average crystallite size 21.8 nm were covered in a core/shell type; magnetite/silica, magnetite/chitosan, and a double shell magnetite/silica/chitosan were developed for attaching an antineoplastic drug. The mechanism for the functionalization of the nanoparticles with a single and double shell was studied with Fourier transformed infrared spectroscopy (FTIR) and X-ray photoelectron spectroscopy (XPS). The adherence of an antineoplastic drug, paclitaxel, onto functionalized nanoparticles was analyzed with a UV-Visible spectroscopy at a wavelength of 253 nm. It was found that the adherence of the drug is improved up to 18% when magnetite nanoparticles are coated with a single chitosan shell, and when the nanoparticles are coated with a silica/chitosan shell the adherence increases up to 29%.

  18. Factors influencing adherence to an emergency department national protocol.

    NARCIS (Netherlands)

    Ebben, R.H.A.; Vloet, L.C.M.; Groot, J.M. de; Achterberg, T. van


    The objective of this study was to identify factors that influence emergency nurses' adherence to an emergency department national protocol (EDNP). A survey of emergency nurses (n=200) and physicians with medical end responsibility on an emergency department (n=103) was carried out. Emergency nurses

  19. Adherence to preventive statin therapy according to socioeconomic position

    DEFF Research Database (Denmark)

    Wallach-Kildemoes, Helle; Andersen, Morten; Diderichsen, Finn;


    AIM: To explore whether long-term adherence to preventive statin therapy depends on socioeconomic position (SEP). METHODS: A cohort of individuals without established cardiovascular disease (CVD) or diabetes initiating preventive statin therapy during 2002-2005 was followed in the individual...

  20. Telephone interventions for adherence to colpocytological examination 1 (United States)

    Lima, Thais Marques; Nicolau, Ana Izabel Oliveira; Carvalho, Francisco Herlânio Costa; Vasconcelos, Camila Teixeira Moreira; Aquino, Priscila de Souza; Pinheiro, Ana Karina Bezerra


    ABSTRACT Objective: to test the effects of behavioral and educational intervention by telephone on adherence of women with inappropriate periodicity to colpocytological examination. Method: quasi-experimental study with a sample of 524 women, selected with the following inclusion criteria: be aged between 25 and 64 years, have initiated sexual activity, have inappropriate periodicity of examination and have mobile or landline phone. The women were divided into two groups for application of behavioral and educational intervention by telephone. It was used an intervention script according to the principles of Motivational Interviewing. Results: on comparing the results before and after the behavioral and educational interventions, it was found that there was a statistically significant change (p = 0.0283) with increase of knowledge of women who participated in the educational intervention. There was no change in the attitude of women of any of the groups and there was an increase of adherence to colpocytological examination in both groups (p < 0.0001), with greater adherence of women participating in the behavioral group (66.8%). Conclusion: the behavioral and educational interventions by phone were effective in the adherence of women to colpocytological examination, representing important strategies for permanent health education and promotion of care for the prevention of cervical cancer. PMID:28177055

  1. Interaction of adhered metallic dust with transient plasma heat loads

    NARCIS (Netherlands)

    Ratynskaia, S.; Tolias, P.; I. Bykov,; Rudakov, D.; de Angeli, M.; Vignitchouk, L.; Ripamonti, D.; Riva, G.; Bardin, S.; van der Meiden, H.; Vernimmen, J.; Bystrov, K.; De Temmerman, G.


    The first study of the interaction of metallic dust (tungsten, aluminum) adhered on tungsten substrates with transient plasma heat loads is presented. Experiments were carried out in the Pilot-PSI linear device with transient heat fluxes up to 550 MW m −2 and in the DIII-D divertor tokamak. The cent

  2. Generic substitution of antihypertensive drugs : does it affect adherence?

    NARCIS (Netherlands)

    Van Wijk, Boris L G; Klungel, Olaf H; Heerdink, Eibert R; de Boer, Anthonius


    BACKGROUND: Generic substitution is an important opportunity to reduce the costs of pharmaceutical care. However, pharmacists and physicians often find that patients and brand-name manufacturers have doubt about the equivalence of the substituted drug. This may be reflected by decreased adherence to

  3. Adherence Process Research on Developmental Interventions: Filling in the Middle. (United States)

    Hogue, Aaron


    Presents a framework and some practical examples for using rigorous implementation research to inform program outcomes and foster program development for developmental interventions. Focuses on: (1) role of process research, specifically developing developmental interventions; (2) characteristics of adherence process research; and (3)…

  4. Intervention Adherence for Research and Practice: Necessity or Triage Outcome? (United States)

    Barnett, David; Hawkins, Renee; Lentz, F. Edward, Jr.


    Intervention integrity or adherence describes qualities of carrying out an intervention plan and in research is fundamentally linked to experimental validity questions addressed by measurement of independent and dependent variables. Integrity has been well described in conceptual writing but has been a continuing thorny subject in research and…

  5. Adherence with Universal Precautions after Immediate, Personalized Performance Feedback (United States)

    Luke, Molli M.; Alavosius, Mark


    We evaluated the effects of immediate, personalized performance feedback on adherence with hand hygiene by health-care staff in the context of a multiple baseline design across participants. Target behaviors reached mastery levels and were maintained near 100% throughout 2 months of maintenance probes. (Contains 1 table and 1 figure.)

  6. Noninfectious uveitis: strategies to optimize treatment compliance and adherence

    Directory of Open Access Journals (Sweden)

    Dolz-Marco R


    Full Text Available Rosa Dolz-Marco,1 Roberto Gallego-Pinazo,1 Manuel Díaz-Llopis,2 Emmett T Cunningham Jr,3–6 J Fernando Arévalo7,8 1Unit of Macula, Department of Ophthalmology, University and Polytechnic Hospital La Fe, 2Faculty of Medicine, University of Valencia, Spain; 3Department of Ophthalmology, California Pacific Medical Center, San Francisco, 4Department of Ophthalmology, Stanford University School of Medicine, Stanford, 5The Francis I Proctor Foundation, University of California San Francisco Medical Center, 6West Coast Retina Medical Group, San Francisco, CA, USA; 7Vitreoretina Division, King Khaled Eye Specialist Hospital, Riyadh, Saudi Arabia; 8Retina Division, Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, MD, USA Abstract: Noninfectious uveitis includes a heterogenous group of sight-threatening ocular and systemic disorders. Significant progress has been made in the treatment of noninfectious uveitis in recent years, particularly with regard to the effective use of corticosteroids and non-corticosteroid immunosuppressive drugs, including biologic agents. All of these therapeutic approaches are limited, however, by any given patient’s ability to comply with and adhere to their prescribed treatment. In fact, compliance and adherence are among the most important patient-related determinants of treatment success. We discuss strategies to optimize compliance and adherence. Keywords: noninfectious uveitis, intraocular inflammation, immunosuppressive treatment, adherence, compliance, therapeutic failure

  7. Saul Bellow’s Adherence and Breakthrough to Jewish Tradition

    Institute of Scientific and Technical Information of China (English)



    As one of the most significant American Jewish writers in the 20th century, Saul Bellow was influenced by the Jewish tradition and American mainstream thoughts in his writing creations. The conflicts and amalgamation between these two different cultures in his novels indicate that Bellow not only adheres to the Jewish traditional culture, but also breaks through the narrow-mindedness of it.

  8. Microfluidic bioreactors for culture of non-adherent cells

    DEFF Research Database (Denmark)

    Shah, Pranjul Jaykumar; Vedarethinam, Indumathi; Kwasny, Dorota


    Microfluidic bioreactors (μBR) are becoming increasingly popular for cell culture, sample preparation and analysis in case of routine genetic and clinical diagnostics. We present a novel μBR for non-adherent cells designed to mimic in vivo perfusion of cells based on diffusion of media through...

  9. Elder and Caregiver Solutions to Improve Medication Adherence (United States)

    O'Quin, K. E.; Semalulu, T.; Orom, H.


    Medication mismanagement is a growing public health concern, especially among elders. Annually, it is a major contributor to emergency hospitalization and nursing home placement. Elders and their caregivers, as healthcare consumers and stakeholders in this issue, are uniquely qualified to inform strategies to improve medication adherence. We…

  10. Adherence measured by microtiter assay as a virulence marker for Staphylococcus epidermidis infections. (United States)

    Deighton, M A; Balkau, B


    Staphylococcus epidermidis strains isolated from clinical sources showed a wide range of abilities to adhere to glass and plastic materials. The degree of adherence depended on a number of factors, most notably, the composition of the growth medium. Adherence was enhanced by the addition of glucose or oleic acid to the growth medium and inhibited by serum. We have demonstrated a statistically significant association between the quantitative assessment of adherence to polystyrene tissue culture plates and clinical relevance. No such association was found when adherence was assessed by the qualitative adherence assay. Possible new approaches for assessing the clinical relevance of coagulase-negative staphylococcal isolates are discussed.

  11. Adherence to Infliximab Treatment in a Pediatric Inflammatory Bowel Disease Cohort. (United States)

    Vitale, David S; Greenley, Rachel N; Lerner, Diana G; Mavis, Alisha M; Werlin, Steven L


    The aims of the study were to describe infliximab adherence in a pediatric inflammatory bowel disease cohort, to identify demographic and disease factors associated with adherence, and to examine differences in acute care use among adherent and nonadherent patients. Charts of patients who received infliximab at the Children's Hospital of Wisconsin (CHW) between October 2010 and October 2012 were retrospectively reviewed. A total of 151 patients met the inclusion criteria; 91.4% of the patients were adherent. Nonadherent patients had more emergency room visits and hospitalizations than adherent patients. The study is the first to show high adherence rates to infliximab in a pediatric cohort.

  12. Adoption: biological and social processes linked to adaptation. (United States)

    Grotevant, Harold D; McDermott, Jennifer M


    Children join adoptive families through domestic adoption from the public child welfare system, infant adoption through private agencies, and international adoption. Each pathway presents distinctive developmental opportunities and challenges. Adopted children are at higher risk than the general population for problems with adaptation, especially externalizing, internalizing, and attention problems. This review moves beyond the field's emphasis on adoptee-nonadoptee differences to highlight biological and social processes that affect adaptation of adoptees across time. The experience of stress, whether prenatal, postnatal/preadoption, or during the adoption transition, can have significant impacts on the developing neuroendocrine system. These effects can contribute to problems with physical growth, brain development, and sleep, activating cascading effects on social, emotional, and cognitive development. Family processes involving contact between adoptive and birth family members, co-parenting in gay and lesbian adoptive families, and racial socialization in transracially adoptive families affect social development of adopted children into adulthood.

  13. Endogenous Technology Adoption and Medical Costs. (United States)

    Lamiraud, Karine; Lhuillery, Stephane


    Despite the claim that technology has been one of the most important drivers of healthcare spending growth over the past decades, technology variables are rarely introduced explicitly in cost equations. Furthermore, technology is often considered exogenous. Using 1996-2007 panel data on Swiss geographical areas, we assessed the impact of technology availability on per capita healthcare spending covered by basic health insurance whilst controlling for the endogeneity of health technology availability variables. Our results suggest that medical research, patent intensity and the density of employees working in the medical device industry are influential factors for the adoption of technology and can be used as instruments for technology availability variables in the cost equation. These results are similar to previous findings: CT and PET scanner adoption is associated with increased healthcare spending, whilst increased availability of percutaneous transluminal coronary angioplasty facilities is associated with reductions in per capita spending. However, our results suggest that the magnitude of these relationships is much greater in absolute value than that suggested by previous studies that did not control for the possible endogeneity of the availability of technologies. Copyright © 2016 John Wiley & Sons, Ltd.


    Directory of Open Access Journals (Sweden)

    Guy-Emmanuel Rigo


    Full Text Available More and more organisations, from private to public sectors, are pursuing higher levels of customer satisfaction, loyalty and retention. With this intent, higher education institutions (HEI have adopted CRM – Customer Relationship Management. In order to analyse some of the interesting aspects of this phenomenon n, we conducted an action research in a European Institute. The main research question we answered is “how to adopt a CRM strategy in a Higher Education Institution?” Some of the main findings of this study are (1 even though HEI’s main customer is the student, there are others stakeholders that a CRM project must consider; (2 universities can use their internal resources to implement a CRM project successfully; and (3 using Agile software methodology is an effective way to define clearer, more objective and more assertive technical requirements which result in a CRM software that meet send user’s expectations and organizational strategic goals. These findings can help other HEIs

  15. Information architecture: Profile of adopted standards

    Energy Technology Data Exchange (ETDEWEB)



    The Department of Energy (DOE), like other Federal agencies, is under increasing pressure to use information technology to improve efficiency in mission accomplishment as well as delivery of services to the public. Because users and systems have become interdependent, DOE has enterprise wide needs for common application architectures, communication networks, databases, security, and management capabilities. Users need open systems that provide interoperability of products and portability of people, data, and applications that are distributed throughout heterogeneous computing environments. The level of interoperability necessary requires the adoption of DOE wide standards, protocols, and best practices. The Department has developed an information architecture and a related standards adoption and retirement process to assist users in developing strategies and plans for acquiring information technology products and services based upon open systems standards that support application software interoperability, portability, and scalability. This set of Departmental Information Architecture standards represents guidance for achieving higher degrees of interoperability within the greater DOE community, business partners, and stakeholders. While these standards are not mandatory, particular and due consideration of their applications in contractual matters and use in technology implementations Department wide are goals of the Chief Information Officer.

  16. Standardization in technology adoption: A comparison of broadcast TV cases


    Kim, Heejung


    Based on developments in the U.S. television, this study illustrates the choice of technical standards by the government. Broadcasting in the U.S. has been largely affected by the adoption of new technology. Technology adoptions have impacted economy, society, industry, and government policies of the U.S. broadcasting. The purpose of this study is to examine standard-setting development and policies for major technology adoptions in broadcasting: color TV adoption and digital TV adoption.

  17. Child-Adoption Matching: Preferences for Gender and Race


    Mariagiovanna Baccara; Allan Collard-Wexler; Leonardo Felli; Leeat Yariv


    This paper uses a new data set on child-adoption matching to estimate the preferences of potential adoptive parents over U.S.-born and unborn children relinquished for adoption. We identify significant preferences favoring girls and unborn children close to birth, and against African-American children put up for adoption. These attitudes vary in magnitudes across different adoptive parents - heterosexual, same-sex couples, and single women. We also consider the effects of excluding single wom...

  18. Child adoption matching: preferences for gender and race


    Baccara, Mariagiovanna; Collard-Wexler, Allan; Felli, Leonardo; Yariv, Leeat


    This paper uses a new dataset on child-adoption matching to estimate the preferences of potential adoptive parents over US-born and unborn children relinquished for adoption. We identify significant preferences favoring girls and against African American children put up for adoption. These attitudes vary in magnitudes across different adoptive parents—heterosexual, same-sex couples, and single women. We consider the effects of excluding single women and same-sex couples from the process, and ...

  19. Developing a generic, individualised adherence programme for chronic medication users

    Directory of Open Access Journals (Sweden)

    Herborg H


    Full Text Available Objective: The scope of this article is to describe the background for and content of an adherence counselling programme with a specific focus on an individualised, multi-dimensional adherence model for patients with a potential adherence problem (a so-called ‘individualised systems model’.Methods: An intervention programme based on WHO’s systems model for adherence was developed for implementation in primary health care and tested in a development project in Danish pharmacies in 2004-2005 in three pharmacies and 4 GP practices by 27 patients. Data were collected from the participants by registration forms, questionnaires, and focus groups. Since the programme was to support patients in the self-management process regarding choice and implementation of medication treatment, various strategies were used and different theoretical assumptions and choices made prior to setting up the study. These strategies include distinguishing between different types of non-adherence, a model for stages of change, self-efficacy, narratives, motivating interviewing strategies and coaching techniques. These strategic and theoretical choices are described in the article. Results: The strategies and theoretical reflections formed the platform for the creation of a counselling programme, which was tested in two forms, a basic and an extended version - provided by either a pharmaconomist or a pharmacist. The result section also describes a toolbox of instruments to enable pharmacy staff and GPs to tailor a counselling programme for patients individually called ‘Safe and effective use of medicines’. Besides, the results include a description of how the WHO-model is transformed into an individualised counselling model.

  20. Sophisticated transfer

    NARCIS (Netherlands)

    Reinhart, T.


    On the eve of the Iraq war, fears were expressed in different circles that under the cover of war, Israel may attempt a transfer of Palestinians in the “seam line” area of the northern West Bank (Kalkilya, Tulkarem). Last week, the army produced a scene from this scenario. On April 2 at 3 AM, a larg

  1. Facilitating Transfers

    DEFF Research Database (Denmark)

    Kjær, Poul F.

    that the essential functional and normative purpose of regulatory governance is to facilitate, stabilise and justify the transfer of condensed social components (such as economic capital and products, political decisions, legal judgements, religious beliefs and scientific knowledge) from one social contexts...

  2. Benchmarking Prehospital and Emergency Department Care for Argentine Children with Traumatic Brain Injury: For the South American Guideline Adherence Group (United States)

    Vavilala, Monica S.; Lujan, Silvia B.; Qiu, Qian; Petroni, Gustavo J.; Ballarini, Nicolás M.; Guadagnoli, Nahuel; Depetris, María Alejandra; Faguaga, Gabriela A.; Baggio, Gloria M.; Busso, Leonardo O.; García, Mirta E.; González Carrillo, Osvaldo R.; Medici, Paula L.; Sáenz, Silvia S.; Vanella, Elida E.; Fabio, Anthony; Bell, Michael J.


    Objective There is little information on the type of early care provided to children with traumatic brain injury (TBI) in low middle income countries. We benchmarked early prehospital [PH] and emergency department [ED] pediatric TBI care in Argentina. Methods We conducted a secondary analysis of data from patients previously enrolled in a prospective seven center study of children with TBI. Eligible participants were patients 0–18 years, and had diagnosis of TBI (admission Glasgow Coma scale score [GCS] 0). Outcomes were transport type, transport time, PH and ED adherence to best practice, and discharge Pediatric Cerebral Performance Category Scale (PCPC) and Pediatric Overall Performance category Scale (POPC). Results Of the 366 children, mean age was 8.7 (5.0) years, 58% were male, 90% had isolated TBI and 45.4% were transported by private vehicle. 50 (34.7%) of the 144 children with severe TBI (39.3% of all TBI patients) were transported by private vehicle. Most (267; 73%) patients received initial TBI care at an index hospital prior to study center admission, including children with severe (81.9%) TBI. Transport times were shorter for those patients who were directly transported by ambulance to study center than for the whole cohort (1.4 vs.5.5 hours). Ambulance blood pressure data were recorded in 30.9%. ED guideline adherence rate was higher than PH guideline adherence rate (84.8% vs. 26.4%). For patients directly transferred from scene to study trauma centers, longer transport time was associated with worse discharge outcome (PCPC aOR 1.10 [1.04, 1.18] and (POPC aOR 1.10 [1.04, 1.18]). There was no relationship between PH or ED TBI guideline adherence rate and discharge POPC and PCPC. Conclusion This study benchmarks early pediatric TBI care in Argentina and shows that many critically injured children with TBI do not receive timely or best practice PH care, that PH guideline adherence rate is low and that longer transport time was associated with poor

  3. Transfer of adhesive tape between calender rolls (United States)

    Johnson, K. L.; Kauzlarich, J. J.


    In the calendering process a tape or sheet of deformable material passes through the nip between hard cylindrical rollers. Usually the rolls are driven at the same peripheral speed, but small differences in speed, often referred to as 'creep', can occur if one of the rolls is externally driven and the other is driven by the friction in the contact. In these circumstances it has been observed that a tape that enters the nip adhering to the driven (slower) surface may transfer at exit to the driving (faster) surface but not the other way round. The mechanics of this transfer process is examined theoretically and experimentally in this paper for the case of double sided adhesive tape. It is argued that on emerging from the nip the tape will separate from the surface at which the shear strain in the adhesive is greater and that for transfer to occur the contact load must be sufficient to cause plastic extension of the tape.

  4. Assessment of a regulatory sanitization process in Egyptian dairy plants in regard to the adherence of some food-borne pathogens and their biofilms. (United States)

    Bayoumi, Mohamed A; Kamal, Rania M; Abd El Aal, Salah F; Awad, Esmat I


    Food-borne pathogens may develop certain strategies that enable them to defy harsh conditions such as chemical sanitization. Biofilm formation represents a prominent one among those adopted strategies, by which food-borne pathogens protect themselves against external threats. Thus, bacterial biofilm is considered as a major hazard for safe food production. This study was designed to investigate the adherence and the biofilm formation ability of some food-borne pathogens on stainless steel and polypropylene surfaces using chip assay, and to validate regular sanitizing process (sodium hypochlorite 250 mg/L) for effective elimination of those pathogens. Sixteen pathogenic bacterial strains, previously isolated from raw milk and dairy products at Zagazig city, Egypt (9 Staphylococcus aureus, 4 Cronobacter sakazakii and 3 Salmonella enterica serovar Typhimurium), were chosen for this study. Strains showed different patterns of adherence and biofilm formation on tested surfaces with minor significance between surfaces. The ability of sodium hypochlorite to completely eradicate either adhered or biofilm-embedded pathogens varied significantly depending on the strain and type of surface used. Whilst, sodium hypochlorite reduced tested pathogens counts per cm² of produced biofilms, but it was not able to entirely eliminate neither them nor adherent Cronobacter sakazakii to stainless steel surface. This study revealed that biofilm is considered as a sustainable source of contamination of dairy products with these pathogens, and also emphasized the need of paying more attention to the cleaning and sanitizing processes of food contact surfaces.

  5. Wide-Scale Adoption of Photovoltaic Energy

    DEFF Research Database (Denmark)

    Yang, Yongheng; Enjeti, Prasad; Blaabjerg, Frede


    Current grid standards largely require that low-power (e.g., several kilowatts) single-phase photovoltaic (PV) systems operate at unity power factor (PF) with maximum power point tracking (MPPT), and disconnect from the grid under grid faults by means of islanding detection. However, in the case...... of wide-scale penetration of single-phase PV systems in the distributed grid, disconnection under grid faults can contribute to 1) voltage flickers, 2) power outages, and 3) system instability. This article explores grid code modifications for a wide-scale adoption of PV systems in the distribution grid....... In addition, based on the fact that Italy and Japan have recently undertaken a major review of standards for PV power conversion systems connected to low-voltage networks, the importance of low voltage ride-through (LVRT) for single-phase PV power systems under grid faults is considered, along with three...


    Directory of Open Access Journals (Sweden)

    Flavia CAIA


    Full Text Available The economic conditions and market competition create pressures on companies to adopt new technologies that can provide more efficient information and can support decision-making better. The purpose of the research is to investigate the decision support information systems in order to apprise and enhance the capacity of the entities to apply the new knowledge that BI produces for organizational success and competitiveness. The importance of the conducted research consists in identifying solutions to improve reporting and stimulate the entities to start using business intelligence (BI technologies, which facilitate obtaining new information, in order to ensure flexibility, resilience and provide answers to questions that go beyond what the pre-defined reports can do to support decision-making. The estimated result is a technical and operational overview of the large companies in Romania, drawing future directions for an improved competitive behaviour and strategic awareness, and identifying the significant factors for optimizing the decision-making process.

  7. Green innovation adoption in automotive supply chain

    DEFF Research Database (Denmark)

    Zailani, Suhaiza; Govindan, Kannan; Iranmanesh, Mohammad;


    using the partial least squares technique. Environmental regulations, market demand, and firm internal initiatives have a positive effect on green innovation initiatives (GII), while GIIs have a positive effect on the three categories of sustainable performance (i.e., environmental, social, and economic......Green innovation has currently been receiving a great deal of international attention because of the growing concern of consumers, governments, and the community as a whole with regard to the degradation of natural resources and environmental pollution. The automotive sector is one of the leading...... generators of industrial waste that affect the quality of the natural environment. This study aims to investigate the determinants of green innovation adoption and its effect on firm performance. Data were gathered by surveying 153 firms in the Malaysian automotive supply chain industry. Data were analyzed...

  8. The Adoption of Innovations in Library Organizations

    Directory of Open Access Journals (Sweden)

    Su-may Sheih Chen


    Full Text Available To enhance the quality of library and information service, libraries have borrowed from business theory and practice in planning and evaluating library services. However, an area of business theory that has received relatively little attention in library science is organizational innovation. Reports in the business literature provide evidence that innovation is essential for both development and survival. In increasingly unstable times of rapidly changing information technology, libraries must use the literature of innovation as well as that of planning and evaluation to shape better libraries. This paper explores key issues related to innovation in libraries including the nature, the barriers, and the ways to adopt and implement innovative strategies successfully. [Article content in Chinese

  9. Home Energy Displays. Consumer Adoption and Response

    Energy Technology Data Exchange (ETDEWEB)

    LaMarche, Janelle [Fraunhofer Center for Sustainable Energy Systems, Cambridge, MA (United States); Cheney, K. [Fraunhofer Center for Sustainable Energy Systems, Cambridge, MA (United States); Akers, C. [Fraunhofer Center for Sustainable Energy Systems, Cambridge, MA (United States); Roth, K. [Fraunhofer Center for Sustainable Energy Systems, Cambridge, MA (United States); Sachs, O. [Fraunhofer Center for Sustainable Energy Systems, Cambridge, MA (United States)


    The focus of this project was to investigate the factors influencing consumer adoption of Home Energy Displays (HEDs) and to evaluate electricity consumption in households with basic HEDs versus enhanced feedback methods - web portals or alerts. The team hypothesized that providing flexible and relatable information to users, in addition to a basic HED, would make feedback more effective and achieve persistent energy savings. In Phase I, Fraunhofer conducted three user research studies and found preferences for aesthetically pleasing, easy to understand feedback that is accessible through multiple media and offered free of charge. The deployment of HEDs in 150 households planned for Phase II encountered major recruitment and HED field deployment problems. In light of these challenges, the team is pursuing a modified study investigating the energy savings of a web portal versus alert-based energy feedback instead of a physical HED.

  10. Is Transferring an Educational Innovation Actually a Process of Transformation? (United States)

    Varpio, Lara; Bell, Robert; Hollingworth, Gary; Jalali, Alireza; Haidet, Paul; Levine, Ruth; Regehr, Glenn


    Recent debates question the extent to which adopting an educational innovation requires compromise between the innovation's original design and the adoption site's context. Through compromises, the innovation's fundamental principles may be transferred, transformed, or abandoned. This paper analyzes such compromises during the piloting of…

  11. ART adherence changes among patients in community substance use treatment: a preliminary analysis from MACH14

    Directory of Open Access Journals (Sweden)

    Rosen Marc I


    Full Text Available Abstract Background Opiate substitution treatment has been associated with better adherence to lifesaving antiretroviral medications, but the impact of other substance abuse treatment on adherence is unknown. Findings In this study, 215 patients who had been in adherence-focused research studies provided electronically-measured adherence data and a measure of whether the patient had recently been in substance abuse treatment. Recent engagement in substance abuse treatment was independently associated with significantly higher adherence, after covarying for recent substance use and other factors potentially affecting adherence. Conclusions The findings suggest that substance abuse treatment is associated with better adherence. Potential mechanisms by which substance abuse treatment improves adherence, such as more stability or more future-orientation, require further study.

  12. Development of new concepts of non-adherence measurements among users of antihypertensives medicines

    DEFF Research Database (Denmark)

    Kjeldsen, Lene Juel; Bjerrum, Lars; Herborg, Hanne;


    nonadherence (associated with aspects of self-regulation and effect concerns, respectively) and one measure of non-intentional non-adherence. Prevalence of the developed measures of behaviour related non-adherence ranged from 10.3 to 34.9% depending on which type of non-adherence measure was used. Established...... measures of non-adherence resulted in prevalence between 2.2 and 39.6%. CONCLUSIONS: The study showed that concepts of non-adherence measurements could be determined including self-efficacy aspects, unintentional non-adherence and intentional non-adherence related to self-regulation and effect concerns......: Users of antihypertensive medication were included in the study. 2,914 medication users received questionnaires by mail. Participating patients were asked to fill in two questionnaire regarding demographics, self-reported blood pressure, and various adherence measures. Two factor analyses were conducted...

  13. Can the common-sense model predict adherence in chronically ill patients? A meta-analysis. (United States)

    Brandes, Kim; Mullan, Barbara


    The aim of this meta-analysis was to explore whether mental representations, derived from the common-sense model of illness representations (CSM), were able to predict adherence in chronically ill patients. Electronic databases were searched for studies that used the CSM and measured adherence behaviour in chronically ill patients. Correlations from the included articles were meta-analysed using a random-size effect model. A moderation analysis was conducted for the type of adherence behaviour. The effect sizes for the different mental representations and adherence constructs ranged from -0.02 to 0.12. Further analyses showed that the relationship between the mental representations and adherence did not differ by the type of adherence behaviour. The low-effect sizes indicate that the relationships between the different mental representations of the CSM and adherence are very weak. Therefore, the CSM may not be the most appropriate model to use in predictive studies of adherence.

  14. Adherence of Pseudomonas aeruginosa to tracheal cells injured by influenza infection or by endotracheal intubation. (United States)

    Ramphal, R; Small, P M; Shands, J W; Fischlschweiger, W; Small, P A


    Adherence of Pseudomonas aeruginosa to normal, injured, and regenerating tracheal mucosa was examined by scanning electron microscopy. Uninfected and influenza-infected murine tracheas were exposed to six strains of P. aeruginosa isolated from human sources and one strain of platn origin. All of the strains tested adhered to desquamating cells of the infected tracheas, but not to normal mucosa, the basal cell layer, or the regenerating epithelium. Adherence increased when the incubation time of the bacteria with the trachea was prolonged. Strains isolated from human tracheas appeared to adhere better than strains derived from the urinary tract. After endotracheal intubation of ferrets, P. aeruginosa adhered only to the injured cells and to areas of exposed basement membrane. We call this phenomenon "opportunistic adherence" and propose that alteration of the cell surfaces or cell injury facilitates the adherence of this bacterium and that adherence to injured cells may be a key to the pathogenesis of opportunistic Pseudomonas infections.

  15. Adherence to inhaled therapies, health outcomes and costs in patients with asthma and COPD

    DEFF Research Database (Denmark)

    Mäkelä, Mika J; Backer, Vibeke; Hedegaard, Morten;


    Suboptimal adherence to pharmacological treatment of asthma and chronic obstructive pulmonary disease (COPD) has adverse effects on disease control and treatment costs. The reasons behind non-adherence revolve around patient knowledge/education, inhaler device convenience and satisfaction, age...

  16. Adherence to a Yoga Program in Older Women with Knee Osteoarthritis. (United States)

    Cheung, Corjena; Wyman, Jean F; Savik, Kay


    Yoga is beneficial for osteoarthritis (OA) management in older adults; however, adherence to yoga practice is unknown. The purposes of this secondary analysis were to examine: (1) yoga adherence during the intervention and follow-up periods; (2) the relationship between social cognitive theory (SCT) constructs and adherence; and (3) the impact of adherence on OA-related symptoms in 36 community-dwelling older women with knee OA. SCT was used as a framework to promote adherence to a yoga intervention program that included both group/homebased practices. Adherence to yoga was high during the intervention period but decreased over time. Although SCT was a useful framework for reducing attrition during the intervention, self-efficacy was the only construct that correlated with class attendance. Higher yoga adherence was correlated with improved symptoms, physical function, sleep quality, and quality of life. Yoga adherers were likely to be older, less educated, and had a lower body mass index than nonadherers.

  17. Adoption of Mobile Banking Applications in Lebanon

    Directory of Open Access Journals (Sweden)

    Marc F Audi


    Full Text Available This research studied the impact of mobile banking adaptation in Lebanon. A brief overview of the Lebanese banking sector has shown how it is very dynamic and large. The overview also shows that the Lebanese banking sector is very competitive and changing with the development of new technologies and the availability of new services. To explain mobile banking applications in Lebanon two models were studied in the literature. The first is the innovation diffusion theory which has 5 different constructs: relative advantage, compatibility, communicability, trailability and complexity. The innovation diffusion theory talks about the path innovations take to reach final adopters. The technology acceptance model on the other hand relates the effects of it main components, perceived ease of use and perceived usefulness, on consumer attitude and intention to adopt. Our model is based on both theories and has 8 constructs. It shows the effect of the 5 constructs of the innovation diffusion theory merging perceived usefulness to relative advantage and replacing complexity with perceived ease of use. We have developed 8 hypotheses based on the construct of the model and to study the user-none user effect. A personal administered survey done using convenient sampling managed to gather 315 respondents from 5 different locations in Beirut after administering pilot testing. All variables were tested for validity and reliability using different tests. A biverate linear regression analysis was used to test the hypotheses and establish the relations between the different variables. We also did an independent t-test to analyze the user none-user effects. It is concluded that this paper with a discussion of the tests and recommending the best way to market mobile banking applications and designing a good version of mobile banking that looks appealing to consumers.

  18. Adoption of information technology by resident physicians. (United States)

    Parekh, Selene G; Nazarian, David G; Lim, Charles K


    The Internet represents a technological revolution that is transforming our society. In the healthcare industry, physicians have been typified as slow adopters of information technology. However, young physicians, having been raised in a computer-prevalent society, may be more likely to embrace technology. We attempt to characterize the use and acceptance of the Internet and information technology among resident physicians in a large academic medical center and to assess concerns regarding privacy, security, and credibility of information on the Internet. A 41-question survey was distributed to 150 pediatric, medical, and surgical residents at an urban, academic medical center. One hundred thirty-five residents completed the survey (response rate of 90%). Responses were evaluated and statistical analysis was done. The majority of resident physicians in our survey have adopted the tools of information technology. Ninety-eight percent used the Internet and 96% use e-mail. Two-thirds of the respondents used the Internet for healthcare-related purposes and a similar percentage thought that the Internet has affected their practice of medicine positively. The majority of residents thought that Internet healthcare services such as electronic medical records, peer-support websites, and remote patient monitoring would be beneficial for the healthcare industry. However, they are concerned about the credibility, privacy, and security of health and medical information online. The majority of resident physicians in our institution use Internet and information technology in their practice of medicine. Most think that the Internet will continue to have a beneficial role in the healthcare industry.

  19. Interventional tools to improve medication adherence: review of literature

    Directory of Open Access Journals (Sweden)

    Costa E


    Full Text Available Elísio Costa,1 Anna Giardini,2 Magda Savin,3 Enrica Menditto,4 Elaine Lehane,5 Olga Laosa,6 Sergio Pecorelli,7,8 Alessandro Monaco,7 Alessandra Marengoni9On behalf of the A1 Action group “Prescription and Adherence to Medical Plans”, European Innovation Partnership on Active and Healthy Ageing1UCIBIO, REQUIMTE, Faculty of Pharmacy, University of Porto, Porto, Portugal; 2Psychology Unit, Salvatore Maugeri Foundation, IRCCS, Scientific Institute of Montescano (PV, Pavia, Italy; 3European Association of Pharmaceutical Full-line Wholesalers, Brussels, Belgium; 4CIRFF/Center of Pharmacoeconomics, School of Pharmacy, University of Naples FedericoII, Nápoles, Italy; 5Catherine McAuley School of Nursing and Midwifery, Brookfield Health Sciences Complex, University College Cork, Cork, Ireland; 6Centro de Investigación Clínica del Anciano Fundación para la Investigación Biomédica, Hospital Universitario de Getafe, Madrid, Spain; 7Italian Medicines Agency – AIFA, Rome, Italy; 8University of Brescia, Brescia, Italy; 9Department of Clinical and Experimental Science, University of Brescia, Brescia, Italy Abstract: Medication adherence and persistence is recognized as a worldwide public health problem, particularly important in the management of chronic diseases. Nonadherence to medical plans affects every level of the population, but particularly older adults due to the high number of coexisting diseases they are affected by and the consequent polypharmacy. Chronic disease management requires a continuous psychological adaptation and behavioral reorganization. In literature, many interventions to improve medication adherence have been described for different clinical conditions, however, most interventions seem to fail in their aims. Moreover, most interventions associated with adherence improvements are not associated with improvements in other outcomes. Indeed, in the last decades, the degree of nonadherence remained unchanged. In this work, we

  20. Modeling the impact of increased adherence to asthma therapy.

    Directory of Open Access Journals (Sweden)

    Amory Schlender

    Full Text Available BACKGROUND: Nonadherence to medications occurs in up to 70% of patients with asthma. The effect of improving adherence is not well quantified. We developed a mathematical model with which to assess the population-level effects of improving medication prescribing and adherence for asthma. METHODS: A mathematical model, calibrated to clinical trial data from the U.S. NHLBI-funded SOCS trial and validated using data from the NHLBI SLIC trial, was used to model the effects of increased prescribing and adherence to asthma controllers. The simulated population consisted of 4,930 individuals with asthma, derived from a sample the National Asthma Survey. Main outcomes were controller use, reliever use, unscheduled doctor visits, emergency department (ED visits, and hospitalizations. RESULTS: For the calibration, simulated outcomes agreed closely with SOCS trial outcomes, with treatment failure hazard ratios [95% confidence interval] of 0.92 [0.58-1.26], 0.97 [0.49-1.45], and 1.01 [0-1.87] for simulation vs. trial in the in placebo, salmeterol, and triamcinolone arms, respectively. For validation, simulated outcomes predicted mid- and end-point treatment failure rates, hazard ratios 1.21 [0.08-2.34] and 0.83 [0.60-1.07], respectively, for patients treated with salmeterol/triamcinolone during the first half of the SLIC study and salmeterol monotherapy during the second half. The model performed less well for patients treated with salmeterol/triamcinolone during the entire study duration, with mid- and end-point hazard ratios 0.83 [0.00-2.12] and 0.37 [0.10-0.65], respectively. Simulation of optimal adherence and prescribing indicated that closing adherence and prescription gaps could prevent as many as nine million unscheduled doctor visits, four million emergency department visits, and one million asthma-related hospitalizations each year in the U.S. CONCLUSIONS: Improvements in medication adherence and prescribing could have a substantial impact on

  1. Significant improvement in statin adherence and cholesterol levels after acute myocardial infarction

    DEFF Research Database (Denmark)

    Brogaard, Hilde Vaiva Tonstad; Køhn, Morten Ganderup; Berget, Oline Sofie


    Not all patients recovering from acute myocardial infarction (AMI) are optimally treated with statin, and their adherence to statin treatment may be inadequate. We set out to describe changes in statin treatment adherence and cholesterol values over time.......Not all patients recovering from acute myocardial infarction (AMI) are optimally treated with statin, and their adherence to statin treatment may be inadequate. We set out to describe changes in statin treatment adherence and cholesterol values over time....

  2. Factors influencing adherence to paediatric antiretroviral therapy in Portharcourt, South- South Nigeria


    Ugwu, Rosemary; Eneh, Augusta


    Introduction The efficiency of antiretroviral therapy (ART) depends on a near-perfect level of patient's adherence. Adherence in children poses peculiar challenges. The aim of the study was to determine the adherence level and factors influencing adherence among HIV-infected children and adolescents in University of Port Harcourt Teaching Hospital, Nigeria. Methods A cross-sectional survey of HIV-infected children and adolescents on ART using self-report by the caregiver/child in the past one...

  3. Cognitive functioning, depression, and HIV medication adherence in India: a randomized pilot trial


    Cook, Ryan; Waldrop-Valverde, Drenna; Sharma, Aman; Vamos, Szonja; Mahajan, Biraaj; Weiss, Stephen M.; Kumar, Mahendra; Nehra, Ritu; Jones, Deborah L


    Objective: India is home to the third-largest number of people living with HIV in the world, and no-cost antiretroviral therapy (ART) has been available across the country since 2004. However, rates of adherence to ART are often subpar in India, and interventions to increase adherence are warranted. Cognitive impairment and depression have been associated with ART non-adherence, and may also limit the impact of behavioral interventions designed to improve adherence. Studies have not evaluated...

  4. Toward a Process View in Adoption of Interorganizational Information Systems

    DEFF Research Database (Denmark)

    Brandt, Charlotte J.


    review found four different streams of research: 1) studies explaining why organizations adopt or reject IOIS by investigating factors determining adoption of or barriers to IOIS adoption; 2) studies explaining how to create the desired organizational effects from IOIS; 3) studies explaining how IOIS...... are affecting the buyer-supplier relationship they are introduced into; and 4) studies categorizing the structure of IOIS adopters in different configurations. Seemingly only limited effort has been made to study the actual adoption process. This apparent lack of studies of the adoption process calls...


    Institute of Scientific and Technical Information of China (English)



    Adoption involves the process by which the existing par ents cease to be the legal parents of the child and the adopters are substituted for the parents as if the child was born to them. There are so many reasons for adoption,such as inability to conceive,parents not wanting a child,and inability to provide circumstances essential for the child's healthy development.However,as the number of children available for adoption in New Zealand decreases, an increas ing number of couples look to overseas countries to adopt. Therefore,the transnational adoptions are becoming common.

  6. Gender and racial biases: Evidence from child adoption


    Baccara, Mariagiovanna; Collard-Wexler, Allan; Felli, Leonardo; Yariv, Leeat


    This paper uses a new data set on domestic child adoption to document the preferences of potential adoptive parents over born and unborn babies relinquished for adoption by their birth mothers. We show that adoptive parents exhibit significant biases in favor of girls and against African-American babies. A non-African-American baby relinquished for adoption attracts the interest of potential adoptive parents with probability 11.5% if it is a girl and 7.9% if it is a boy. As for race, a non-Af...

  7. Single Parent Adoptions: An Issue of Difficulty and Import for Adoption Agencies. (United States)

    Rosenberg, Jeffrey

    Little theoretical and empirical knowledge is available in the social work field to guide practitioners in the area of single parent adoption. In the context of demographics, the single parent family is now conventional. However there is not yet conclusive research on the success or failure of single parent households. Research has suggested that…

  8. An exploration of patient perceptions of adherence to tuberculosis treatment in Tanzania.

    NARCIS (Netherlands)

    Boogaard, J. van den; Msoka, E.; Homfray, M.; Kibiki, G.S.; Heldens, J.J.; Felling, A.J.; Aarnoutse, R.E.


    In this study, we aimed to explore patient perceptions of adherence to tuberculosis (TB) treatment and construct a theoretical model of treatment adherence behavior. We conducted semistructured interviews with 11 adherent patients from Tanzania whom we recruited by purposive sampling. The interview

  9. Non-Adherence to Study Time Management Strategies among NOUN Students and Implications for Academic Stress (United States)

    Okopi, Fidel O.


    The study was designed to investigate the NOUN students' non-adherence to their time management strategies (TMS) during the course of their studies. The researcher also wanted to find out whether their gender, age, marital and employment statuses have influence on their adherence/non-adherence to the plan or not. The researcher also examined the…

  10. It's the adherence, stupid (that determines asthma control in preschool children)!

    NARCIS (Netherlands)

    Klok, Ted; Kaptein, Adrian A.; Duiverman, Eric J.; Brand, Paul L.


    Although guideline-based asthma care and adherence to inhaled corticosteroids are predictors of asthma control, the role of adherence in maintaining long-term asthma control is largely unknown. This study was designed to explore the relationship between adherence to inhaled corticosteroids and long-

  11. Refill adherence and polypharmacy among patients with type 2 diabetes in general practice

    NARCIS (Netherlands)

    van Bruggen, Rykel; Gorter, Kees; Stolk, Ronald P.; Zuithoff, Peter; Klungel, Olaf H.; Rutten, Guy E. H. M.


    Background and Aims Non-adherence is considered a major barrier to better outcomes of diabetes care. A relationship has been established between polypharmacy and patients' adherence. This study aims to investigate the occurrence of polypharmacy and non-adherence in general practice, their mutual rel

  12. Adherence to Inhaled Corticosteroids and Patient Perception : Towards a better understanding and individualised care

    NARCIS (Netherlands)

    Menckeberg, T.T.


    In this thesis we aimed to further deepen knowledge on factors associated with nonadherence to provide means to improve adherence. We evaluated several methods of assessing adherence. At first, we evaluated the accuracy of the Medication Adherence Rating Scale (MARS), a structured method for eliciti

  13. Factors Associated with the Accuracy of Physicians’ Predictions of Patient Adherence (United States)

    Phillips, L. Alison; Leventhal, Elaine A.; Leventhal, Howard


    Objective Physicians are inaccurate in predicting non-adherence in patients, a problem that interferes with physicians’: 1) appropriate prescribing decisions and 2) effective prevention/intervention of non-adherence. The purpose of the current study is to investigate potential reasons for the poor accuracy of physicians’ adherence-predictions and conditions under which their predictions may be more accurate. Methods After the medical encounter, predictions of patient-adherence and other ratings from primary-care physicians (n=24) regarding patient-factors that may have influenced their predictions were collected. Patients (n=288) rated their agreement regarding the prescribed treatment after the encounter and reported adherence one month later. Results Several factors were related to physicians’ adherence-predictions, including physicians’ perceptions of patient-agreement regarding treatment. However, some factors were not related to adherence and agreement-perceptions were inaccurate overall, potentially contributing to the poor accuracy of adherence-predictions. The degree to which physicians discussed treatment-specifics with the patient moderated agreement-perception accuracy but not adherence-prediction accuracy. Conclusions Training providers to discuss certain treatment-specifics with patients may improve their ability to perceive patient-agreement regarding treatment and may directly improve patient-adherence. Practice Implications Discussing treatment-specifics with patients may directly improve adherence, but providers should not rely on these discussions to give them accurate estimates of the patients’ likely adherence. PMID:21501943

  14. Identifying solutions to medication adherence in the visually impaired elderly. (United States)

    Smith, Miranda; Bailey, Trista


    Adults older than 65 years of age with vision impairment are more likely to have difficulty managing medications compared with people having normal vision. This patient population has difficulty reading medication information and may take the wrong medication or incorrect doses of medication, resulting in serious consequences, including overdose or inadequate treatment of health problems. Visually impaired patients report increased anxiety related to medication management and must rely on others to obtain necessary drug information. Pharmacists have a unique opportunity to pursue accurate medication adherence in this special population. This article reviews literature illustrating how severe medication mismanagement can occur in the visually impaired elderly and presents resources and solutions for pharmacists to take a larger role in adherence management in this population.

  15. A social work study on measuring adherence to religious values

    Directory of Open Access Journals (Sweden)

    Mahsa Allahyari


    Full Text Available This study aims to investigate the effects of demographic characteristics, including gender, marital status, level of education and age on adherence to religious values among young people in city of Shahin Dezh and Takab, located in province of West Azerbaijan, Iran in 2014. The study has accomplished between two groups of Turk and Kurd with the population of 85,000 and 89,000, respectively. The study uses a sample of 20 and 30 people from Turkish and Kurdish tribes, respectively, and uses t-student test as well as regression analysis to examine different hypotheses of the survey. The results show that there was a meaningful difference among various variables of gender, marital status, education level and age in adherence to religious values among the youth who live in this city.

  16. Clinical pharmacist interventions to support adherence to thrombopreventive therapy

    DEFF Research Database (Denmark)

    Hedegaard, Ulla

    individualised interventions and team-based care, e.g. integrating a clinical pharmacist with particular focus on patients’ drug-related problems. One approach with growing evidence of improving medication adherence is motivational interviewing (MI). So far, no clinical pharmacist intervention using MI has...... to the different results in the two trials is that the stroke patients - compared to the hypertension patients - may have been more motivated for taking their medication as they just experienced a serious event. Another factor is that a secondary prevention clinic was established during the stroke study, which may...... by the clinical pharmacists and the patients.  Sensitivity and specificity for the two scales of the adherence questionnaire demonstrating the best agreement with prescription-based measures were about 90% and 30%, and the agreement with refill data was fairly low with kappa values below 0.3, suggesting...

  17. Optimal shapes and stresses of adherent cells on patterned substrates

    CERN Document Server

    Banerjee, Shiladitya; Marchetti, M Cristina


    We investigate a continuum mechanical model for an adherent cell on two dimensional adhesive micropatterned substrates. The cell is modeled as an isotropic and homogeneous elastic material subject to uniform internal contractile stresses. The build-up of tension from cortical actin bundles at the cell periphery is incorporated by introducing an energy cost for bending of the cell boundary, resulting to a resistance to changes in local curvature. Integrin-based adhesions are modeled as harmonic springs, that pin the cell to adhesive patches of a predefined geometry. Using Monte Carlo simulations and analytical techniques we investigate the competing effects of bulk contractility and cortical bending rigidity in regulating cell shapes on non-adherent regions. We show that the crossover from convex to concave cell edges is controlled by the interplay between contractile stresses and boundary bending rigidity. In particular, the cell boundary becomes concave beyond a critical value of the contractile stress that ...

  18. Metacognition and medication adherence: how do older adults remember? (United States)

    Gould, O N; McDonald-Miszczak, L; King, B


    Fifty-one older adults (M age = 75.9 years, SD = 6.9) reported their use of memory strategies for taking of medication using the Prospective Memory for Medication Questionnaire. Older adults used internal strategies more often when the domain was restricted to medication taking but used external strategies more often when queried across a variety of everyday situations. Surprisingly, the hypothesis that medical factors would be the primary determinants of older adults' reports of memory strategy use and perceived adherence was not supported. Metamemorial variables of non-domain-specific memory self-efficacy and memory anxiety in everyday life were significant predictors of strategy use and perceived adherence over and above variables related to the domain of health.

  19. Asthma Education, Action Plans, Psychosocial Issues and Adherence

    Directory of Open Access Journals (Sweden)

    John Kolbe


    Full Text Available This article deals with four separate but not disparate topics. The first section discusses asthma education, reviews the current literature and attempts to challenge some of the dogma that is associated with this area. Knowledge alone does not guarantee appropriate behaviour, due to a variety of adverse socioeconomic and psychological factors that need to be considered for each patient. Action plans and peak flow monitoring have both been disappointing in terms of reducing asthma morbidity; the former needs to be individualized, and the latter may be useful in specific situations. Space precludes an in-depth discussion of psychological issues and adherence, but an attempt has been made to address salient issues, particularly related to the first two topics. Psychological factors, especially anxiety, play an important role in asthma outcome. Adherence to medication prescriptions and other management strategies need to be taken into account when an individual’s treatment program is planned.

  20. [Patients on chemotherapy: depression and adherence to treatment]. (United States)

    de Souza, Bianca Fresche; Pires, Flavia Helena; Dewulf, Nathalie de Lourdes Souza; Inocenti, Aline; Silva, Ana Elisa Bauer de Camargo; Miasso, Adriana Inocenti


    This analytical, cross-sectional study applied a quantitative approach to verify the presence of depression and the adherence to a chemotherapy treatment in patients with cancer at the central chemotherapy pharmacy of a university hospital. The sample consisted of 102 patients, and data were collected from October 2010 to May 2011. A structured interview was used to obtain sociodemographic, clinical and therapeutic data; the Morisky Test and Beck Depression Inventory were also applied. The results revealed that 10.8% and 1.9% of participants had moderate and severe depression, respectively. The presence of depression was significantly associated with variables such as income per capita, the number of surgeries, and disease duration. A lack of treatment adherence was identified in 48% of participants. These results indicate the need for health staff training to detect depressive disorders and chemotherapy treatment attrition among patients with cancer.

  1. Control and adherence: living with diabetes in Bangkok, Thailand. (United States)

    Naemiratch, Bhensri; Manderson, Lenore


    Diabetes is managed via a regimen of control. Physicians advise adults living with type 2 diabetes to control blood sugar levels by controlling diet, maintaining regular exercise, and complying with medication. The extent to which individuals are able to adhere to such recommendations varies. In this article, we explore lay perceptions of diabetes and its control, drawing on data from an ethnographic study conducted in Bangkok, Thailand. Between August 2001 and February 2003 the first author spent time with twelve man and women living with type 2 diabetes, their spouses, children and health providers. An additional 21 people were interviewed to extend the data and test for generalisibility. It was found that individual explanations of control, and adherence or resistance to medical advice, are interpreted and adapted in ways consistent with Buddhist philosophy and Thai norms that govern everyday life. Notions of moderation and cultural values of being and behaving, and ideals of interaction, provide a philosophical basis and practical guidelines for control.

  2. PET imaging of adoptive progenitor cell therapies.

    Energy Technology Data Exchange (ETDEWEB)

    Gelovani, Juri G.


    Objectives. The overall objective of this application is to develop novel technologies for non-invasive imaging of adoptive stem cell-based therapies with positron emission tomography (PET) that would be applicable to human patients. To achieve this objective, stem cells will be genetically labeled with a PET-reporter gene and repetitively imaged to assess their distribution, migration, differentiation, and persistence using a radiolabeled reporter probe. This new imaging technology will be tested in adoptive progenitor cell-based therapy models in animals, including: delivery pro-apoptotic genes to tumors, and T-cell reconstitution for immunostimulatory therapy during allogeneic bone marrow progenitor cell transplantation. Technical and Scientific Merits. Non-invasive whole body imaging would significantly aid in the development and clinical implementation of various adoptive progenitor cell-based therapies by providing the means for non-invasive monitoring of the fate of injected progenitor cells over a long period of observation. The proposed imaging approaches could help to address several questions related to stem cell migration and homing, their long-term viability, and their subsequent differentiation. The ability to image these processes non-invasively in 3D and repetitively over a long period of time is very important and will help the development and clinical application of various strategies to control and direct stem cell migration and differentiation. Approach to accomplish the work. Stem cells will be genetically with a reporter gene which will allow for repetitive non-invasive “tracking” of the migration and localization of genetically labeled stem cells and their progeny. This is a radically new approach that is being developed for future human applications and should allow for a long term (many years) repetitive imaging of the fate of tissues that develop from the transplanted stem cells. Why the approach is appropriate. The novel approach to

  3. The Effect of Customer Empowerment on Adherence to Expert Advice


    Camacho, Nuno; Jong, Martijn; Stremersch, Stefan


    textabstractCustomers often receive expert advice related to their health, finances, taxes or legal procedures, to name just a few. A noble stance taken by some is that experts should empower customers to make their own decisions. In this article, we distinguish informational from decisional empowerment and study whether empowerment leads customers to adhere more or less to expert advice. We empirically test our model using a unique dataset involving 11,735 respondents in 17 countries on four...

  4. Dirty Money: A Matter of Bacterial Survival, Adherence, and Toxicity. (United States)

    Vriesekoop, Frank; Chen, Jing; Oldaker, Jenna; Besnard, Flavien; Smith, Reece; Leversha, William; Smith-Arnold, Cheralee; Worrall, Julie; Rufray, Emily; Yuan, Qipeng; Liang, Hao; Scannell, Amalia; Russell, Cryn


    In this study we report the underlying reasons to why bacteria are present on banknotes and coins. Despite the use of credit cards, mobile phone apps, near-field-communication systems, and cryptocurrencies such as bitcoins which are replacing the use of hard currencies, cash exchanges still make up a significant means of exchange for a wide range of purchases. The literature is awash with data that highlights that both coins and banknotes are frequently identified as fomites for a wide range of microorganisms. However, most of these publications fail to provide any insight into the extent to which bacteria adhere and persist on money. We treated the various currencies used in this study as microcosms, and the bacterial loading from human hands as the corresponding microbiome. We show that the substrate from which banknotes are produced have a significant influence on both the survival and adherence of bacteria to banknotes. Smooth, polymer surfaces provide a poor means of adherence and survival, while coarser and more fibrous surfaces provide strong bacterial adherence and an environment to survive on. Coins were found to be strongly inhibitory to bacteria with a relatively rapid decline in survival on almost all coin surfaces tested. The inhibitory influence of coins was demonstrated through the use of antimicrobial disks made from coins. Despite the toxic effects of coins on many bacteria, bacteria do have the ability to adapt to the presence of coins in their environment which goes some way to explain the persistent presence of low levels of bacteria on coins in circulation.



    Lelogeais, M.; Ducarroir, M.; Berjoan, R.


    Coatings of silicon carbide with various compositions have been obtained in a r.f plasma assisted process using tetramethylsilane and argon as input gases. Some properties against mechanical applications of such deposits on steel have been investigated. Residual stresses and hardness are reported and discussed in relation with plasma parameters and deposit composition. By scratch testing, it was shown that the silicon carbide films on steel denote a good adherence when compared with previous ...

  6. Treating depression in HIV-positive patients affects adherence


    M Y H Moosa; F Y Jeenah


    Aim. To determine changes in adherence to antiretroviral therapy (ART) in HIV-positive patients with depression, following treatment with an antidepressant or psychotherapy. Methods. The study was prospective, randomised and controlled. Consenting volunteers aged ≥18 years and stable on ART for ≥6 months were included in the study. Sociodemographic data were obtained, and a clinical diagnostic evaluation and the Hamilton Depression rating scale (HAMD) were performed on all subjects at en...

  7. The adherence in the union stone-mortar

    Directory of Open Access Journals (Sweden)

    Rodríguez García, María Reyes


    Full Text Available Stones placates present a wide of problems that result in the fall of plates. One of the causes is the lack of adherence stone-mortar. We considered a study to determine the adherence between several cement mortars (1:3, 1:5, 1:7, 1:9 and a especial mortar prepared with latex and stones (white granite, pink granites, black granites, white marble and cream limestones. The results obtained suggest that only adequate adherence rates (higher than 3 kgf/cm2 achieved with cement mortar 1:3 and especial mortar. Besides it is observed that in the stones studied there is no relation between adherence and the absorption values.

    Los aplacados de piedra presentan una extensa patología que se traduce en la caída de las placas colocadas. Una de las causas es la falta de adherencia mortero-piedra. El estudio se realiza para determinar la tensión de adherencia entre diversos morteros de cemento (1:3, 1:5, 1:7, 1:9 y otro compuesto por mortero y látex y piedras (granito blanco, granitos rosa, granitos negros, mármol blanco y calizas crema. De los resultados obtenidos se deduce que los únicos morteros que permiten valores de adherencia aceptables (superiores a 3 kp/cm2 son el mortero de cemento 1:3 y el especial. Igualmente se comprueba que, en las piedras estudiadas, no existe relación alguna entre la adherencia y la absorción de agua.

  8. Conflicting medication information: prevalence, sources, and relationship to medication adherence. (United States)

    Carpenter, Delesha M; Elstad, Emily A; Blalock, Susan J; DeVellis, Robert F


    Conflicting medication information has been defined as contradictory information about a medication topic from two or more sources. The objective of this study was to determine whether arthritis patients are exposed to conflicting medication information, to document sources of conflicting information, and to explore whether conflicting information is associated with sociodemographic factors, clinical characteristics, and medication adherence. Using an online survey, arthritis patients (N = 328) reported how often they received conflicting information about 12 medication topics as well as sources of conflicting information, demographic/clinical characteristics, and medication adherence. A linear regression model, which controlled for various demographic/clinical factors, determined whether conflicting information was associated with medication adherence. The majority of patients (80.1%) received conflicting information and were most likely to receive conflicting information about medication risks. Physicians, media sources, and the Internet were the most common sources of conflicting information. Less conflicting information (B =-0.13, p information source use (B = 0.22, p information is pervasive, comes from a variety of sources, and may negatively affect patient health outcomes. To potentially decrease exposure to conflicting information, providers should direct patients to high-quality medication information sources.

  9. Surface nanocrystallization of stainless steel for reduced biofilm adherence

    Energy Technology Data Exchange (ETDEWEB)

    Yu Bin; Li, D Y [Department of Biomedical Engineering, University of Alberta, Edmonton, AB (Canada); Davis, Elisabeth M; Irvin, Randall T [Department of Medical Microbiology and Immunology, University of Alberta, Edmonton, AB, T6G 2H7 (Canada); Hodges, Robert S [Department of Biochemistry and Molecular Genetics, University of Colorado Health Sciences Center at Fitzsimons, RC1 South Tower, Room 9121, PO Box 6511 MS 8101, Aurora, CO 80045 (United States)], E-mail:


    Stainless steel is one of the most common metallic biomedical materials. For medical applications, its resistance to the adherence of biofilms is of importance to the elimination or minimization of bacterial infections. In this study, we demonstrate the effectiveness of a process combining surface nanocrystallization and thermal oxidation (or a recovery heat treatment in air) for reducing the biofilm's adherence to stainless steel. During this treatment, a target surface was sandblasted and the resultant dislocation cells in the surface layer were turned into nanosized grains by a subsequent recovery treatment in air. This process generated a more protective oxide film that blocked the electron exchange or reduced the surface activity more effectively. As a result, the biofilm's adherence to the treated surface was markedly minimized. A synthetic peptide was utilized as a substitute of biofilms to evaluate the adhesion between a treated steel surface and biofilms using an atomic force microscope (AFM) through measuring the adhesive force between the target surface and a peptide-coated AFM tip. It was shown that the adhesive force decreased with a decrease in the grain size of the steel. The corresponding surface electron work function (EWF) of the steel was also measured, which showed a trend of variation in EWF with the grain size, consistent with corresponding changes in the adhesive force.

  10. Adherence to Informed Consent Standards in Shiraz Hospitals: Matrons Perspective

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    Alireza Mohsenian Sisakht


    Full Text Available Background Informed consent is an important part of the patients’ rights and hospitals are assigned to obtain informed consent before any diagnostic or therapeutic procedures. Obtaining an informed consent enables patients to accept or reject their care or treatments and prevent future contentions among patients and medical staff. Methods This survey was carried out during 2011-2. We assessed adherence of 33 Shiraz hospitals (governmental and non-governmental to informed consent standards defined by Joint Commission International (JCI Accreditation, USA. The questionnaire was designed using the Delphi method and then filled out by hospital matrons. We calculated valid percent frequency for each part of the questionnaire and compared these frequencies in governmental and nongovernmental hospitals using analytical statistics. Results Considering 63% of the hospitals that filled out the questionnaire, no statistically significant difference was observed between the governmental and non-governmental hospitals in adherence to informed consent standards. Conclusion This study shows a relatively acceptable adherence to standards about informed consent in Shiraz hospitals but the implementation seems not to be as satisfactory.

  11. Effect of ultrasound on adherent microbubble contrast agents. (United States)

    Loughran, Jonathan; Sennoga, Charles; J Eckersley, Robert; Tang, Meng-Xing


    An investigation into the effect of clinical ultrasound exposure on adherent microbubbles is described. A flow phantom was constructed in which targeted microbubbles were attached using biotin-streptavidin linkages. Microbubbles were insonated by broadband imaging pulses (centred at 2.25 MHz) over a range of pressures (peak negative pressure (PNP) = 60-375 kPa). Individual adherent bubbles were observed optically and classified as either being isolated or with a single neighbouring bubble. It is found that bubble detachment and deflation are two significant effects, even during low amplitude ultrasound exposure. Specifically, while at very low acoustic pressure (PNP bubbles were not affected, at medium pressure (151 kPa bubbles detached and at higher pressures (301 kPa bubbles detached. In addition, more than 50% of the bubbles underwent deflation at pressures between 301 and 375 kPa. At pressures between 226 and 300 kPa, more adherent bubbles detached when there was a neighbouring bubble, suggesting the role of multiple scattering and secondary Bjerknes force on bubble detachment. The flow shear, primary and secondary Bjerknes forces exerted on each bubble were calculated and compared to the estimated forces acting on the bubble due to oscillations. The oscillation force is shown to be much higher than other forces. The mechanisms of bubble detachment are discussed.

  12. Adherence to a new oral anticoagulant treatment prescription: dabigatran etexilate

    Directory of Open Access Journals (Sweden)

    L Bellamy


    Full Text Available L Bellamy1, N Rosencher1, BI Eriksson21Anaesthesiology Department, Hôpital Cochin (AP-HP, René Descartes University, Paris 75014 France; 2Orthopaedic Department, University Hospital Sahlgrenska/Ostra, Gothenburg, SwedenAbstract: The recent development of new oral anticoagulants, of which dabigatran etexilate is currently at the most advanced stage of development, is the greatest advance in the provision of convenient anticoagulation therapy for many years. A new oral anticoagulation treatment, dabigatran etexilate, is already on the market in Europe. The main interest probably will be to improve the prescription and the adherence to an effective thromboprophylaxis in medical conditions such as atrial fibrillation without bleeding side effects, without the need for monitoring coagulation, and without drug and food interactions such as vitamin K anticoagulant (VKA treatment. Dabigatran is particularly interesting for extended thromboprophylaxis after major orthopedic surgery in order to avoid daily injection for a month. However, oral long-term treatments such as VKA are not systematically associated with a higher compliance level than injected treatments such as low-molecular-weight heparins. Indeed, adherence to an oral treatment, instead of the usual daily injection in major orthopedic surgery, is complex, and based not only on the frequency of dosing but also on patient motivation, understanding, and socio-economic status. New oral anticoagulants may be useful in this way but education and detection of risk factors of nonadherence to treatment are still essential.Keywords: oral anticoagulant, adherence, compliance, education, dabigatran

  13. Adoption of alternative transport technologies in the construction industry

    NARCIS (Netherlands)

    Habets, Thijs; Voordijk, Hans; Sijde, van der Peter


    This research examines how the construction industry adopts alternative transport technologies. This paper presents the general characteristics of the adopter and what his perceptions are towards innovative transport technologies. The study focused on four rates of innovation, related tot alternativ

  14. Investors’ Adoption of Internet Stock Trading: A Study

    Directory of Open Access Journals (Sweden)

    Arwinder Singh


    Full Text Available The purpose of this paper wa s to examine whether investors who adopted Internet stock trading perceived differently from those of non - adopters. The primary data based on 299 investors (149 adopters and 150 non - adopters were analyzed using advanced multivariate techniques like factor analysis and discriminant analysis besides percentages, means, and Z - test. Results indicated that a ttitude dimensions and demographic variabl es contributed significantly in classifying investors as adopters or non - adopters in Internet trading. As regards attitude dimensions, ‘ variety of financial products and safety’ contributed significantly in discriminating between adopters and non - adopters of Internet trading followed by the factor such as ‘ convenience and transparency’ . As far as the demographics were concerned, the mature/older, experienced, and businessmen investors were less likely to use Internet stock trading as compared to young, inex perienced, and non - businessmen investors

  15. Assessing multifunctional innovation adoption via an integrative model

    NARCIS (Netherlands)

    Sääksjärvi, M.; Samiee, S.


    This study proposes and tests an integrative model that incorporates the mental resources framework (MOA: motivation, opportunity, and ability) alongside traditional innovation adoption predictors for assessing the adoption of dual-functionality innovations (DFI), a special case of multifunctional i

  16. Multi-level analysis of electronic health record adoption by health care professionals: A study protocol

    Directory of Open Access Journals (Sweden)

    Labrecque Michel


    Full Text Available Abstract Background The electronic health record (EHR is an important application of information and communication technologies to the healthcare sector. EHR implementation is expected to produce benefits for patients, professionals, organisations, and the population as a whole. These benefits cannot be achieved without the adoption of EHR by healthcare professionals. Nevertheless, the influence of individual and organisational factors in determining EHR adoption is still unclear. This study aims to assess the unique contribution of individual and organisational factors on EHR adoption in healthcare settings, as well as possible interrelations between these factors. Methods A prospective study will be conducted. A stratified random sampling method will be used to select 50 healthcare organisations in the Quebec City Health Region (Canada. At the individual level, a sample of 15 to 30 health professionals will be chosen within each organisation depending on its size. A semi-structured questionnaire will be administered to two key informants in each organisation to collect organisational data. A composite adoption score of EHR adoption will be developed based on a Delphi process and will be used as the outcome variable. Twelve to eighteen months after the first contact, depending on the pace of EHR implementation, key informants and clinicians will be contacted once again to monitor the evolution of EHR adoption. A multilevel regression model will be applied to identify the organisational and individual determinants of EHR adoption in clinical settings. Alternative analytical models would be applied if necessary. Results The study will assess the contribution of organisational and individual factors, as well as their interactions, to the implementation of EHR in clinical settings. Conclusions These results will be very relevant for decision makers and managers who are facing the challenge of implementing EHR in the healthcare system. In addition


    Directory of Open Access Journals (Sweden)

    Chinmay Shah


    Full Text Available Learning results in gain of knowledge, skills and attitudes. Some like to learn by seeing, some by hearing and some by demonstration. Learning style influences the retention of information and depth of comprehension. Understanding their preferred learning styles as visual, auditory, read-write or kinesthetic learners will help improve the teaching methods adopted. Role of the educator necessitates making the most of each teaching opportunity by understanding the characteristics of the learning audience and incorporating demonstrated principles of adult educational design, with a focus on collaborative learning and variety in presentation techniques. The goal is to provide student oriented education, producing efficient doctors. A cross-sectional study among 92 medical students of the Govt. Medical College, Bhavnagar, conducted in 2009. VARK questionnaire was used to access their learning preference. Preference for different learning styles were, visual (V 1.08%, auditory (A 20.65%, reading/writing (R 2.17% and kinesthetic (K 17.39%. 41.30% of the total 92 students preferred a single mode of information presentation. Of the 92 students who preferred multiple modes of information presentation, some preferred two modes (bimodal, 31.52%, some preferred three modes (tri-modal, 27.13%, and only one student preferred quadri-modal.

  18. Adopting Collaborative Workflow Pattern : Use Case

    Directory of Open Access Journals (Sweden)

    Antonio Capodieci


    Full Text Available In recent years, the use of web 2.0 tools has incre ased in companies and organisation. This phenomenon, has modified common organisational and operative practices. This has led “knowledge workers” to change their working practic es through the use of Web 2.0 communication tools. Unfortunately, these tools hav e not been integrated with existing enterprise information systems. This is an importan t problem in an organisational context because knowledge of information exchanged is neede d. In previous works we demonstrate that it is possible to capture this knowledge using coll aboration processes, which are processes of abstraction created in accordance with design patte rns and applied to new organisational operative practices. In this article, we want to pr esent the experience of the adoption of the methodology and the catalog of patterns from some p attern designers of a company operating in Public Administration and Finance, with the aim of shaping an information system Enterprise 2.0, which takes into account the collaborative pro cesses.

  19. Home Energy Displays: Consumer Adoption and Response

    Energy Technology Data Exchange (ETDEWEB)

    LaMarche, J.; Cheney, K.; Akers, C.; Roth, K.; Sachs, O.


    The focus of this project was to investigate the factors influencing consumer adoption of Home Energy Displays (HEDs) and to evaluate electricity consumption in households with basic HEDs versus enhanced feedback methods - web portals or alerts. We hypothesized that providing flexible and relatable information to users, in addition to a basic HED, would make feedback more effective and achieve persistent energy savings. In Phase I, we conducted three user research studies and found preferences for aesthetically pleasing, easy to understand feedback that is accessible through multiple media and offered free of charge. The deployment of HEDs in 150 households planned for Phase II encountered major recruitment and HED field deployment problems. First, after extensive outreach campaigns to apartment complexes with 760 units, only 8% of building's tenants elected to receive a free HED in their homes as part of the field study. Second, the HED used, a leading market model, had a spectrum of problems, including gateway miscommunications, failure to post to a data-hosting third party, and display malfunctions. In light of these challenges, we are pursuing a modified study investigating the energy savings of a web portal versus alert-based energy feedback instead of a physical HED.

  20. Should health care managers adopt Theory Z? (United States)

    Safranski, S R; Kwon, I W; Walker, W R; Unger, M


    Health care administrators should carefully consider the situations in which they apply management methods used in industry, since such methods may not be effective in motivating certain groups of hospital employees. Physicians, for example, may display little loyalty to the health care organization, even though as a group they exert significant influence on policies, standards, and administration. As a result, management styles such as Theory Z that focus on holistic concern, individual decision-making responsibility, and long-term employment guarantees may fail to interest them. Nurses also may be reluctant to commit themselves to an organization because of the high rate of turnover in their profession in recent years. Support staff, however, probably would be receptive to management techniques that offer security through long-term employment guarantees. Other factors necessary for the effective use of Theory Z industrial management techniques are a clear hierarchy with well-defined reporting relationships, moderately specialized career paths, and trust among employees that the organization's concern for their welfare is genuine. The key consideration, however, in applying any theory is that only those aspects which best serve the organization's needs should be adopted.

  1. Adopting Intercultural Communication Issue in Teaching English

    Directory of Open Access Journals (Sweden)

    Hussain Ahmed Liton


    Full Text Available Cultural assimilation and intercultural awareness has been an important hub of modern language and communication studies, underlining a shift that reflects a greater significance of the inseparability of language and culture, and the need to prepare students for effective intercultural communication to thrive in a global work environment. A thriving global workplace requires effective communication skill across cultures in this era of globalization and mass migration. Under the tutelage of such backdrop, this article addresses the terrain of adopting intercultural awareness in EFL classroom teaching/learning and aims at linking culture with language in pursuit of excellence in borderless effective communication. The study, in other words, investigated the linguistic aspects that could be affected by certain cultural dimensions (e.g., beliefs, traditions, taboo words, habits, and norms, religion, social factors, etc. in intercultural communication. This paper uses a questionnaire device to receive some university teachers’ self-reported feedback. This article maintains qualitative and quantitative research methodology. The analytical research result shows that in teaching English, it is necessary to incorporate and develop aspects of cross-cultural awareness as a part of course curriculum to immerse students in effective intercultural communicative competence (ICC.

  2. Innovation Adoption: A Review of Theories and Constructs


    Wisdom, Jennifer P.; Chor, Ka Ho Brian; Hoagwood, Kimberly E; Horwitz, Sarah M.


    Many theoretical frameworks seek to describe the dynamic process of the implementation of innovations. Little is known, however, about factors related to decisions to adopt innovations and how the likelihood of adoption of innovations can be increased. Using a narrative synthesis approach, this paper compared constructs theorized to be related to adoption of innovations proposed in existing theoretical frameworks in order to identify characteristics likely to increase adoption of innovations....

  3. moisture transfer

    Directory of Open Access Journals (Sweden)

    Don Kulasiri


    model drying porous materials. Coupled partial differential equations governing the moisture and heat transfer can be solved using numerical techniques, and in this paper we solve them analytically in a setting suitable for industrial drying situations. We discuss the nature of the solutions using the physical properties of Pinus radiata. It is shown that the temperature gradients play a significant role in deciding the moisture profiles within the material when thickness is large and that models based only on moisture potential gradients may not be sufficient to explain the drying phenomena in moist porous materials.

  4. Heat transfer

    CERN Document Server

    Jorge, Kubie; Thomas, Grassie


    A core task of engineers is to analyse energy related problems. The analytical treatment is usually based on principles of thermodynamics, fluid mechanics and heat transfer, but is increasingly being handled computationally.This unique resource presents a practical textbook, written for both undergraduates and professionals, with a series of over 60 computer workbooks on an accompanying CD.The book emphasizes how complex problems can be deconstructed into a series of simple steps. All thermophysical property computations are illustrated using diagrams within text and on the compani

  5. Inside the black box of internet adoption: the role of migration and networking in internet penetration in West Africa

    NARCIS (Netherlands)

    L. Taylor


    Research on the role of international networking and mobility in technology transfer to developing countries has focused on the firm level, looking at either spillovers from clusters of foreign firms or international trade. However this leaves micro-level processes of adoption in more marginal areas

  6. Adenoviral Delivery of Tumor Necrosis Factor-α and Interleukin-2 Enables Successful Adoptive Cell Therapy of Immunosuppressive Melanoma. (United States)

    Siurala, Mikko; Havunen, Riikka; Saha, Dipongkor; Lumen, Dave; Airaksinen, Anu J; Tähtinen, Siri; Cervera-Carrascon, Víctor; Bramante, Simona; Parviainen, Suvi; Vähä-Koskela, Markus; Kanerva, Anna; Hemminki, Akseli


    Adoptive T-cell transfer is a promising treatment approach for metastatic cancer, but efficacy in solid tumors has only been achieved with toxic pre- and postconditioning regimens. Thus, adoptive T-cell therapies would benefit from complementary modalities that enable their full potential without excessive toxicity. We aimed to improve the efficacy and safety of adoptive T-cell transfer by using adenoviral vectors for direct delivery of immunomodulatory murine cytokines into B16.OVA melanoma tumors with concomitant T-cell receptor transgenic OT-I T-cell transfer. Armed adenoviruses expressed high local and low systemic levels of cytokine when injected into B16.OVA tumors, suggesting safety of virus-mediated cytokine delivery. Antitumor efficacy was significantly enhanced with adenoviruses coding for murine interleukin-2 (mIL-2) and tumor necrosis factor-α (mTNFα) when compared with T-cell transfer alone or viruses alone. Further improvement in efficacy was achieved with a triple combination of mIL-2, mTNFα, and OT-I T-cells. Mechanistic studies suggest that mIL-2 has an important role in activating T-cells at the tumor, while mTNFα induces chemokine expression. Furthermore, adenovirus treatments enhanced tumor-infiltration of OT-I T-cells as demonstrated by SPECT/CT imaging of (111)In-labeled cells. Our results suggest the utility of cytokine-coding adenoviruses for improving the efficacy of adoptive T-cell therapies.

  7. Antiretroviral treatment adherence among HIV patients in KwaZulu-Natal, South Africa

    Directory of Open Access Journals (Sweden)

    Ramlagan Shandir


    Full Text Available Abstract Background Successful antiretroviral treatment is dependent on sustaining high rates of adherence. In the southern African context, only a handful of studies (both quantitative and qualitative have looked at the determinants including a health behaviour theory of adherence to antiretroviral therapy. The aim of this study is to assess factors including the information, motivation and behavioural skills model (IMB contributing to antiretroviral (ARV adherence six months after commencing ARVs at three public hospitals in KwaZulu-Natal, South Africa. Methods Using systematic sampling, 735 HIV-positive patients were selected prior to commencing on ART from outpatient departments from three hospitals and followed-up at six months and interviewed with a questionnaire. Results A good proportion of patients were found to be adherent using both adherence instruments (visual analog scale = VAS 82.9%; Adult AIDS Clinical Trials Group = AATCG 70.8%. After adjusting for significant socio-economic variables, both the VAS and the dose, schedule and food adherence indicator found levels of adherence amongst urban residents to be almost 3 times greater than that of rural residents. After adjusting for health-related variables, for both indicators better adherence was associated with low depression and poorer adherence was associated with poor environmental factors. Adjusted odds ratios for adherence when taking into account different behavioural variables were for both adherence indicators, discrimination experiences were associated with lower adherence, and higher scores in adherence information and behavioural skills were associated with higher adherence. For the VAS adherence indicator, higher social support scores were associated with higher adherence. For the dose, schedule and food adherence indicator, using herbal medicines for HIV was associated with lower adherence. Conclusion For the patients in this study, particularly those not living in

  8. Barriers to adherence in adolescents and young adults with cystic fibrosis

    DEFF Research Database (Denmark)

    Bregnballe, Vibeke; Schiøtz, Peter Oluf; Boisen, Kirsten A;


    Treatment adherence is crucial in patients with cystic fibrosis, but poor adherence is a problem, especially during adolescence. Identification of barriers to treatment adherence and a better understanding of how context shapes barriers is of great importance in the disease. Adolescent reports of...... of barriers to adherence have been studied, but studies of their parents' experience of such barriers have not yet been carried out. The aim of the present study was to explore barriers to treatment adherence identified by young patients with cystic fibrosis and by their parents....

  9. Counseling Adopted Persons in Adulthood: Integrating Practice and Research (United States)

    Baden, Amanda L.; O'Leary Wiley, Mary


    For the past 50 years, adults who were adopted during infancy have been research participants for empirical studies with goals ranging from twin studies for heritability, to adjustment following adoption, to attachment. While the research body is broad, it has given little attention to counseling practices with adopted adults. Because empirical…

  10. Development and Adjustment of Adopted Adolescents : Longitudinal and Concurrent Factors

    NARCIS (Netherlands)

    Jaffari-Bimmel, Nicole


    The first study of this thesis (Chapter 2) showed that the majority of the internationally adopted children are well adjusted, although a relatively large minority of adopted children had behavior problems of clinical significance or were referred to mental health services compared with non-adopted

  11. Factors leading to inflation targeting : The impact of adoption

    NARCIS (Netherlands)

    Samarina, Anna; Sturm, Jan-Egbert


    This paper examines how the analysis of inflation targeting (IT) adoption is affected by allowing for a structural change after adoption, using panel probit models for 60 countries over the period 1985-2008. Our findings suggest that there is a structural change after IT adoption. Including the post

  12. Stepwise innovation adoption : a neglected concept in innovation research

    NARCIS (Netherlands)

    Huizingh, K.R.E.; Brand, M.J.


    Most innovation researchers tend to consider innovation adoption as a binary process, implying that companies have either adopted an innovation or not. In this paper we focus on e-commerce as an innovation that can be adopted stepwise. We distinguish between two levels of e-commerce, basic and advan

  13. Real Parents, Real Children: Parenting the Adopted Child. (United States)

    van Gulden, Holly; Bartels-Rabb, Lisa M.

    Parenting an adopted child is, for the most part, the same as parenting any other child, but is different in some unique and critical ways related to the child's separation from birth parents and genetic roots. Understanding how a child interprets, understands, and feels about adoption, and why, can help the parent guide the adopted child…

  14. Our Own: Adopting and Parenting the Older Child. (United States)

    Maskew, Trish

    Children adopted when they are older come with histories, fully formed personalities, and intense anger over what they have lost. Drawing on stories of families who have adopted older children, as well as research, interviews with professionals, and opinions of adults who were adopted as children, this book explores the joys and challenges of…

  15. Post-Adoption Depression: Clinical Windows on an Emerging Concept (United States)

    Speilman, Eda


    In recent years, the concept of post-adoption depression--with both parallels and differences from postpartum depression--has emerged as a salient descriptor of the experience of a significant minority of newly adoptive parents. This article offers a clinical perspective on post-adoption depression through the stories of several families seen in…

  16. Enhancing Transfer of Knowledge in Physics through Effective Teaching Strategies (United States)

    Akinbobola, Akinyemi Olufunminiyi


    The study assessed the enhancement of transfer of knowledge in physics through the use of effective teaching strategies in Nigerian senior secondary schools. Non-randomized pretest-posttest control group design was adopted for the study. A total of 278 physics students took part in the study. Transfer of Knowledge Test in Physics (TKTP) with the…

  17. Predicting Portuguese Psychology Students' Attitudes Toward the Psychological Development of Children Adopted by Lesbians and Gay Men. (United States)

    Gato, Jorge; Fontaine, Anne Marie


    The present study seeks to ascertain the attitudes of Portuguese psychology students (future psychologists) toward the development of children adopted by lesbian and gay parents. Each participant (N = 182) read a vignette describing an adoption of a child by lesbian and gay persons. After reading the vignette, participants rated four different aspects of the future development of the adopted child (psychosocial adjustment, victimization, psychological disturbance, and normative sexuality). Furthermore, participants were asked about their gender, interpersonal contact with lesbians and gay men, gender role attitudes, and attitudes toward lesbians and gay men. Future psychologists' attitudes toward the developmental outcomes of children adopted by lesbians and gay men were associated with negative attitudes toward non-heterosexuals, which in turn correlated to interpersonal contact with lesbians and gay men and adherence to gender conservative values. These results clearly highlight the central role of social attitudes and the need for cultural competence training of future psychologists that encourages interpersonal contact with non-heterosexuals and discourages traditional gender roles and negative attitudes toward lesbian and gay men.

  18. Adoptive TIL Transfer in the Adjuvant Setting for Melanoma: Long-Term Patient Survival

    Directory of Open Access Journals (Sweden)

    Amir Khammari


    Full Text Available Two first analyses of our clinical trial on TIL as adjuvant therapy for melanoma were published in 2002 and 2007. We present here an update of the clinical results after a 17-year median followup. In this trial, disease-free patients were randomly assigned to receive either TIL/IL-2 or IL-2. The relapse-free survival (RFS was the primary objective. Eighty-eight patients were enrolled. A new analysis performed in May 2013 did not show significant changes in RFS or OS duration. However, our first finding on the association between the number of invaded lymph nodes and TIL effectiveness was strengthened. The Cox model adjusted on this interaction showed for the first time a significant treatment effect when considering the overall population, both on the RFS and OS. Patients treated with TIL had a longer RFS (P=0.023 or OS (P=0.020. This study being with a very long followup (17 years, confirmed the association between TIL effectiveness and the number of invaded lymph nodes, indicating that a low tumor burden could be a crucial factor enhancing the curative effect of TIL in possible microscopic residual disease. Moreover, we confirmed that a prolonged survival was associated with the presence of specific TIL and a decrease in Foxp3 expression.

  19. Combinational targeting offsets antigen escape and enhances effector functions of adoptively transferred T cells in glioblastoma. (United States)

    Hegde, Meenakshi; Corder, Amanda; Chow, Kevin K H; Mukherjee, Malini; Ashoori, Aidin; Kew, Yvonne; Zhang, Yi Jonathan; Baskin, David S; Merchant, Fatima A; Brawley, Vita S; Byrd, Tiara T; Krebs, Simone; Wu, Meng Fen; Liu, Hao; Heslop, Helen E; Gottschalk, Stephen; Gottachalk, Stephen; Yvon, Eric; Ahmed, Nabil


    Preclinical and early clinical studies have demonstrated that chimeric antigen receptor (CAR)-redirected T cells are highly promising in cancer therapy. We observed that targeting HER2 in a glioblastoma (GBM) cell line results in the emergence of HER2-null tumor cells that maintain the expression of nontargeted tumor-associated antigens. Combinational targeting of these tumor-associated antigens could therefore offset this escape mechanism. We studied the single-cell coexpression patterns of HER2, IL-13Rα2, and EphA2 in primary GBM samples using multicolor flow cytometry and immunofluorescence, and applied a binomial routine to the permutations of antigen expression and the related odds of complete tumor elimination. This mathematical model demonstrated that cotargeting HER2 and IL-13Rα2 could maximally expand the therapeutic reach of the T cell product in all primary tumors studied. Targeting a third antigen did not predict an added advantage in the tumor cohort studied. We therefore generated bispecific T cell products from healthy donors and from GBM patients by pooling T cells individually expressing HER2 and IL-13Rα2-specific CARs and by making individual T cells to coexpress both molecules. Both HER2/IL-13Rα2-bispecific T cell products offset antigen escape, producing enhanced effector activity in vitro immunoassays (against autologous glioma cells in the case of GBM patient products) and in an orthotopic xenogeneic murine model. Further, T cells coexpressing HER2 and IL-13Rα2-CARs exhibited accentuated yet antigen-dependent downstream signaling and a particularly enhanced antitumor activity.

  20. 77 FR 1555 - Administrative Simplification: Adoption of Standards for Health Care Electronic Funds Transfers... (United States)


    ... in this general background discussion because it includes a broad spectrum of transmission vehicles... being paid, identification of the payer and payee, bank accounts of the payer and payee, routing... information and the arrival of the ERA to the provider; and the problems regarding reassociation of the...