Eurasia: The Rivalry of Global Integration Projects

Directory of Open Access Journals (Sweden)

Olesia Kobenko

2016-05-01

Full Text Available The article reveals the Eurasian integration projects as major drivers of world globalization. Eurasian regionalism seems to be gaining attention in the scientific literature. Under the current political circumstance many regions are accelerating integration and many countries are opting for regional associations as a mechanism to help them overcome the global recession. Moreover, the global political leaders , some developed countries - the U.S., China, and the European Union (EU are interested to set up regional economic blocs such as Eurasian Economic Union (The EEU, the China's project 'One Belt One Road', the U.S's projects - The Trans-Pacific Partnership (TPP and The Transatlantic Trade and Investment Partnership (TTIP. The goal of this paper is to introduce a number of integration initiatives and to analyze the current strategies of Eurasian regionalism.

Constraints of fossil fuels depletion on global warming projections

International Nuclear Information System (INIS)

Chiari, Luca; Zecca, Antonio

2011-01-01

A scientific debate is in progress about the intersection of climate change with the new field of fossil fuels depletion geology. Here, new projections of atmospheric CO 2 concentration and global-mean temperature change are presented, should fossil fuels be exploited at a rate limited by geological availability only. The present work starts from the projections of fossil energy use, as obtained from ten independent sources. From such projections an upper bound, a lower bound and an ensemble mean profile for fossil CO 2 emissions until 2200 are derived. Using the coupled gas-cycle/climate model MAGICC, the corresponding climatic projections out to 2200 are obtained. We find that CO 2 concentration might increase up to about 480 ppm (445-540 ppm), while the global-mean temperature increase w.r.t. 2000 might reach 1.2 deg. C (0.9-1.6 deg. C). However, future improvements of fossil fuels recovery and discoveries of new resources might lead to higher emissions; hence our climatic projections are likely to be underestimated. In the absence of actions of emissions reduction, a level of dangerous anthropogenic interference with the climate system might be already experienced toward the middle of the 21st century, despite the constraints imposed by the exhaustion of fossil fuels. - Highlights: → CO 2 and global temperature are projected under fossil fuels exhaustion scenarios. → Temperature is projected to reach a minimum of 2 deg. C above pre-industrial. → Temperature projections are possibly lower than the IPCC ones. → Fossil fuels exhaustion will not avoid dangerous global warming.

Constraints of fossil fuels depletion on global warming projections

Energy Technology Data Exchange (ETDEWEB)

Chiari, Luca, E-mail: chiari@science.unitn.it [Department of Physics, University of Trento, Via Sommarive 14, 38123 Povo (Italy); Zecca, Antonio, E-mail: zecca@science.unitn.it [Department of Physics, University of Trento, Via Sommarive 14, 38123 Povo (Italy)

2011-09-15

A scientific debate is in progress about the intersection of climate change with the new field of fossil fuels depletion geology. Here, new projections of atmospheric CO{sub 2} concentration and global-mean temperature change are presented, should fossil fuels be exploited at a rate limited by geological availability only. The present work starts from the projections of fossil energy use, as obtained from ten independent sources. From such projections an upper bound, a lower bound and an ensemble mean profile for fossil CO{sub 2} emissions until 2200 are derived. Using the coupled gas-cycle/climate model MAGICC, the corresponding climatic projections out to 2200 are obtained. We find that CO{sub 2} concentration might increase up to about 480 ppm (445-540 ppm), while the global-mean temperature increase w.r.t. 2000 might reach 1.2 deg. C (0.9-1.6 deg. C). However, future improvements of fossil fuels recovery and discoveries of new resources might lead to higher emissions; hence our climatic projections are likely to be underestimated. In the absence of actions of emissions reduction, a level of dangerous anthropogenic interference with the climate system might be already experienced toward the middle of the 21st century, despite the constraints imposed by the exhaustion of fossil fuels. - Highlights: > CO{sub 2} and global temperature are projected under fossil fuels exhaustion scenarios. > Temperature is projected to reach a minimum of 2 deg. C above pre-industrial. > Temperature projections are possibly lower than the IPCC ones. > Fossil fuels exhaustion will not avoid dangerous global warming.

Furthering patient adherence: A position paper of the international expert forum on patient adherence based on an internet forum discussion

OpenAIRE

van Dulmen, Sandra; Sluijs, Emmy; van Dijk, Liset; de Ridder, Denise; Heerdink, Rob; Bensing, Jozien

2008-01-01

Abstract Background As the problem of patient non-adherence persists and a solution appears hard to be found, it continues to be important to look for new ways to further the issue. We recently conducted a meta-review of adherence intervention studies which yielded a preliminary agenda for future research, practice and theory development in patient adherence. The objective of the present project was to find out to what extent adherence experts consider this agenda relevant and feasible. Metho...

Current Situation of Medication Adherence in Hypertension.

Science.gov (United States)

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

2017-01-01

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

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

Science.gov (United States)

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

2016-09-01

Poor adherence to long-term antipsychotic injectable (LAI) medication in patients with psychotic disorders is associated with a range of negative outcomes. No psychosocial intervention has been found to be consistently effective in improving adherence. To test whether or not offering financial incentives is effective and cost-effective in improving adherence and to explore patient and clinician experiences with such incentives. A cluster randomised controlled trial with economic and nested qualitative evaluation. The intervention period lasted for 12 months with 24 months' follow-up. The unit of randomisation was mental health teams in the community. Community teams in secondary mental health care. Patients with a diagnosis of schizophrenia, schizoaffective psychosis or bipolar illness, receiving ≤ 75% of their prescribed LAI medication. In total, 73 teams with 141 patients (intervention n = 78 and control n = 63) were included. Participants in the intervention group received £15 for each LAI medication. Patients in the control group received treatment as usual. adherence to LAI medication (the percentage of received out of those prescribed). percentage of patients with at least 95% adherence; clinical global improvement; subjective quality of life; satisfaction with medication; hospitalisation; adverse events; and costs. Qualitative evaluation: semistructured interviews with patients in the intervention group and their clinicians. outcome data were available for 131 patients. Baseline adherence was 69% in the intervention group and 67% in the control group. During the intervention period, adherence was significantly higher in the intervention group than in the control group (85% vs. 71%) [adjusted mean difference 11.5%, 95% confidence interval (CI) 3.9% to 19.0%; p = 0.003]. Secondary outcome: patients in the intervention group showed statistically significant improvement in adherence of at least 95% (adjusted odds ratio 8.21, 95% CI 2.00 to 33

 Project Management as a Global Trend for Organization Work

DEFF Research Database (Denmark)

Kampf, Constance

in multination and global companies, understanding the power of visual rhetoric, genre and writing processes in the context of project management documentation can be an advantage for technical communicators.  In addition, project management tools and online documentation spaces are objects which cross...... Project Management as a Global Trend for Organization Work: Implications for Technical Communication Project Management tools and processes offer a visual approach to producing knowledge about a project in order to complete it.  As project management practices are used with increasing frequency......-cultural teams use to function.  This presentation will explore the potential of Project Management to be tightly integrated in Technical Communication curricula through a communications approach to project management.  Questions for discussion include: How tightly is project management integrated into different...

Globalization And Knowledge Management In Projects

Directory of Open Access Journals (Sweden)

Bubel Dagmara

2015-06-01

Full Text Available Knowledge management is a field of management dealing with the use of knowledge, methods, and tools to effectively coordinate complex and unique projects. In accordance with this definition, project knowledge can be treated as a useful resource of information that allows projects to be implemented in compliance with its objectives: time, costs, and quality of results. Knowledge in the activity of an organization, including in the implementation of projects, has for many years been an area of interest to researchers, who confirmed its key importance for building permanent competitive advantages of companies and enterprises. In project management, this issue takes on a new character, as it is transferred to the field of dynamic, time restricted, temporary, and team-implemented projects. The aim of this paper is to present the results of a survey regarding the use of practices of knowledge management in projects in international organizations and to show that the concept of knowledge management in projects is a tool conducive to spreading the process of globalization.

Patient non-adherence: an interpretative phenomenological analysis.

Science.gov (United States)

Dalvi, Vidya; Mekoth, Nandakumar

2017-04-18

Purpose While interpretative phenomenological analysis (IPA) has been used in health psychology research, it has so far not been applied to seek deeper insights into the patients' experiences about treatment. The purpose of this paper is to address this gap by using IPA to understand patient non-adherence. Design/methodology/approach In total, 18 patients with chronic conditions seeking healthcare services in Goa and Karnataka, India, were selected by using the snowball sampling method. In-depth interviews were conducted face to face. A semi-structured questionnaire developed by the researchers was used to collect the data. IPA was used to explore the themes to predict patient non-adherence. Findings The study results indicate that economic factors, health system related factors, social factors and psychological factors impact patient non-adherence. Patient non-adherence includes medication non-adherence and lifestyle modification non-adherence. Research limitations/implications Being cross sectional in design, the results may not be as appropriate as the results derived from a longitudinal study given that non-adherence occurs over time. Practical implications Patient non-adherence is a global health issue. Multidisciplinary approach to enhance patient adherence to treatment should form part of public healthcare policy. Social implications Exploring the factors influencing patient non-adherence will help the health-care industry stakeholders to reduce healthcare cost and improve patient's quality of life. Originality/value Although there is extensive quantitative research on the prevalence of non-adherence, qualitative research is limited. This paper addresses this gap by using IPA to understand patient non-adherence and its factors and dimensions.

Global energy / CO2 projections

International Nuclear Information System (INIS)

Sinyak, Y.

1990-09-01

Section headings are: (1) Social and economic problems of the 21 st century and the role of energy supply systems (2) Energy-environment interactions as a central point of energy research activities (3) New ways of technological progress and its impacts on energy demand and supply (4) Long-term global energy projections (5) Comparative analysis of global long-term energy / CO 2 studies (6) Conclusions. The author shows that, in order to alleviate the negative impacts of energy systems on the climate, it will be necessary to undertake tremendous efforts to improve the energy use efficiency, to drastically change the primary energy mix, and, at the same time, to take action to reduce greenhouse emissions from other sources and increase the CO 2 sink through enhanced reforestation. (Quittner)

GLobal Ocean Data Analysis Project (GLODAP) version 1.1 (NODC Accession 0001644)

Data.gov (United States)

National Oceanic and Atmospheric Administration, Department of Commerce — The GLobal Ocean Data Analysis Project (GLODAP) is a cooperative effort to coordinate global synthesis projects funded through NOAA/DOE and NSF as part of the Joint...

The Cultural Challenges of Managing Global Project Teams: A Study of Brazilian Multinationals

Directory of Open Access Journals (Sweden)

Ivete Rodrigues

2013-04-01

Full Text Available The internationalization of Brazilian companies brings a new reality: the need for implementation of global projects that bring, in turn, the challenge of managing multicultural teams. Since this is a recent phenomenon with little theoretical development, this study sought to understand the relationships between cultural characteristics and management teams of global projects in Brazilian multinationals. To carry this discussion forward, we studied six cases of Brazilian multinational companies, with the aim of deepening the understanding of the management of global teams, involving the planning, deployment, development and management of human resources. Among the projects studied, it was found that there is very little concern with the specific issue of multiculturalism and little inter-cultural incentive to the development of team members, which ends up hindering the construction of a global mindset, important for the Brazilian multinational companies to perform successfully abroad. Faced with this situation, each of the managerial processes mentioned were presented with a number of actions to be undertaken by the project manager in three different dimensions: the project itself, the organization and the global environment. The work contributes, thus, to enable Brazilian multinational companies to manage their global teams in order to maximize the advantages of global teams, such as increased creativity and innovative capacity, but avoid the problems that multiculturalism can bring, ranging from conflicts between people to project failure.

Global consequences of a local Casimir force : Adhered cantilever

NARCIS (Netherlands)

Svetovoy, V. B.; Melenev, A. E.; Lokhanin, M. V.; Palasantzas, G.

2017-01-01

Although stiction is a cumbersome problem for microsystems, it stimulates investigations of surface adhesion. In fact, the shape of an adhered cantilever carries information of the adhesion energy that locks one end to the substrate. We demonstrate here that the system is also sensitive to the

Global projections of extreme sea levels in view of climate change

Science.gov (United States)

Vousdoukas, M. I.; Feyen, L.; Voukouvalas, E.; Mentaschi, L.; Verlaan, M.; Jevrejeva, S.; Jackson, L. P.

2017-12-01

Global warming is expected to drive increasing extreme sea levels (ESLs) and flood risk along the world's coasts. The present contribution aims to present global ESL projections obtained by combining dynamic simulations of all the major ESL components during the present century, considering the latest CMIP5 projections for RCP4.5 and RCP8.5. Baseline values are obtained combining global re-analyses of tides, waves, and storm surges, including the effects of tropical cyclones. The global average RSLR is projected around 20 and 24 cm by the 2050s under RCP4.5 and RCP8.5, respectively and is projected to reach 46 and 67 cm by the year 2100. The largest increases in MSL are projected along the South Pacific, Australia and West Africa, while the smaller RSLR is projected around East North America, and Europe. Contributions from waves and storm surges show a very weak increasing global trend, which becomes statistically significant only towards the end of the century and under RCP8.5. However, for areas like the East China Sea, Sea of Japan, Alaska, East Bering Sea, as well as the Southern Ocean, climate extremes could increase up to 15%. By the end of this century the 100-year event ESL along the world's coastlines will on average increase by 48 cm for RCP4.5 and 75 cm for RCP8.5. The strongest rise is projected along the Southern Ocean exceeding 1 m under RCP8.5 by the end of the century. Increase exceeding 80 cm is projected for East Asia, West North America, East South America, and the North Indian Ocean. Considering always the business as usual and the year 2100, the lowest increase in ESL100 is projected along the East North America and Europe (below 50 cm). The present findings indicate that, under both RCPs, by the year 2050 the present day 100-year event will occur every 5 years along a large part of the tropics, rendering coastal zones exposed to intermittent flood hazard.

Global artificial photosynthesis project: a scientific and legal introduction.

Science.gov (United States)

Faunce, Thomas

2011-12-01

With the global human population set to exceed 10 billion by 2050, its collective energy consumption to rise from 400 to over 500 EJ/yr and with the natural environment under increasing pressure from these sources as well as from anthropogenic climate change, political solutions such as the creation of an efficient carbon price and trading scheme may arrive too late. In this context, the scientific community is exploring technological remedies. Central to these options is artificial photosynthesis--the creation, particularly through nanotechnology, of devices capable to doing what plants have done for millions of years - transforming sunlight, water and carbon dioxide into food and fuel. This article argues that a Global Artificial Photosynthesis (GAP) project can raise the public profile and encourage the pace, complexity and funding of scientific collaborations in artificial photosynthesis research. The legal structure of a GAP project will be critical to prevent issues such as state sovereignty over energy and food resources and corporate intellectual monopoly privileges unduly inhibiting the important contribution of artificial photosynthesis to global public health and environmental sustainability. The article presents an introduction to the scientific and legal concepts behind a GAP project.

Global Rural-Urban Mapping Project (GRUMP), Alpha Version

Data.gov (United States)

National Aeronautics and Space Administration — The Global Rural-Urban Mapping Project (GRUMP), Alpha Version consists of estimates of human population for the years 1990, 1995, and 2000 by 30 arc-second (1km)...

What is excellence for Project Management knowledge in the context of globalization?

DEFF Research Database (Denmark)

Kampf, Constance; Longo, Bernadette

2009-01-01

How can technical writers understand not only excellence in Project Management knowledge, but also the effects of globalization on how project management knowledge is used in project conception and project planning when major stakeholders live in third world countries? This study focuses in parti......How can technical writers understand not only excellence in Project Management knowledge, but also the effects of globalization on how project management knowledge is used in project conception and project planning when major stakeholders live in third world countries? This study focuses...... in particular on project conception for the use of cell phone and web 2.0 technologies with an NGO based in the Democratic Republic of Congo. We found that students were able to use knowledge management and knowledge communication concepts to shape their project titles, goals and objectives, as well...

Thinking Globally, Interviewing Locally: Using an Intensive Interview Project to Teach Globalization and Social Change

Science.gov (United States)

Anderson, Norma J.

2017-01-01

In this article, I connect globalization and qualitative methodological practice, describing a semester-long intensive interview project about the anti-apartheid movement. I provide a detailed overview of the project as well as considerations for those who might want to adapt it for their own courses. Using students' reflections on the projects…

The ugly twins: Failed global sourcing projects and their substitutes

NARCIS (Netherlands)

Schiele, Holger; Horn, Philipp; Horn, Philipp; Werner, Welf

2010-01-01

Purpose of the paper and literature addressed: Analyzing the impact of failed global sourcing projects on the entire commodity group and exploring isomorphism as potential antecedent to the observed phenomenon. The paper is embedded in the global sourcing literature, as well as isomorphism and total

Coordination and Control of Globally Distributed Software Projects

NARCIS (Netherlands)

P.C. van Fenema (Paul)

2002-01-01

textabstractRecently, software development and implementation projects have globalized at a rapid pace. Companies in North America, Europe, and the Far East are beginning to integrate international Information Technology (IT) resources to support operations across the globe. Offshore IT services

Management of Globally Distributed Software Development Projects in Multiple-Vendor Constellations

Science.gov (United States)

Schott, Katharina; Beck, Roman; Gregory, Robert Wayne

Global information systems development outsourcing is an apparent trend that is expected to continue in the foreseeable future. Thereby, IS-related services are not only increasingly provided from different geographical sites simultaneously but beyond that from multiple service providers based in different countries. The purpose of this paper is to understand how the involvement of multiple service providers affects the management of the globally distributed information systems development projects. As research on this topic is scarce, we applied an exploratory in-depth single-case study design as research approach. The case we analyzed comprises a global software development outsourcing project initiated by a German bank together with several globally distributed vendors. For data collection and data analysis we have adopted techniques suggested by the grounded theory method. Whereas the extant literature points out the increased management overhead associated with multi-sourcing, the analysis of our case suggests that the required effort for managing global outsourcing projects with multiple vendors depends among other things on the maturation level of the cooperation within the vendor portfolio. Furthermore, our data indicate that this interplay maturity is positively impacted through knowledge about the client that has been derived based on already existing client-vendor relationships. The paper concludes by offering theoretical and practical implications.

Risk Factors for Non-Adherence to cART in Immigrants with HIV Living in the Netherlands: Results from the ROtterdam ADherence (ROAD Project.

Directory of Open Access Journals (Sweden)

Sabrina K Been

Full Text Available In the Netherlands, immigrant people living with HIV (PLWH have poorer psychological and treatment outcomes than Dutch PLWH. This cross-sectional field study examined risk factors for non-adherence to combination Antiretroviral Therapy (cART among immigrant PLWH. First and second generation immigrant PLWH attending outpatient clinics at two HIV-treatment centers in Rotterdam were selected for this study. Socio-demographic and clinical characteristics for all eligible participants were collected from an existing database. Trained interviewers subsequently completed questionnaires together with consenting participants (n = 352 to gather additional data on socio-demographic characteristics, psychosocial variables, and self-reported adherence to cART. Univariable and multivariable logistic regression analyses were conducted among 301 participants who had used cART ≥6 months prior to inclusion. Independent risk factors for self-reported non-adherence were (I not having attended formal education or only primary school (OR = 3.25; 95% CI: 1.28-8.26, versus University, (II experiencing low levels of social support (OR = 2.56; 95% CI: 1.37-4.82, and (III reporting low treatment adherence self-efficacy (OR = 2.99; 95% CI: 1.59-5.64. Additionally, HIV-RNA >50 copies/ml and internalized HIV-related stigma were marginally associated (P<0.10 with non-adherence (OR = 2.53; 95% CI: 0.91-7.06 and OR = 1.82; 95% CI: 0.97-3.43. The findings that low educational attainment, lack of social support, and low treatment adherence self-efficacy are associated with non-adherence point to the need for tailored supportive interventions. Establishing contact with peer immigrant PLWH who serve as role models might be a successful intervention for this specific population.

Education projects: an opportunity for student fieldwork in global health academic programs.

Science.gov (United States)

Fyfe, Molly V

2012-01-01

Universities, especially in higher-income countries, increasingly offer programs in global health. These programs provide different types of fieldwork projects, at home and abroad, including: epidemiological research, community health, and clinical electives. I illustrate how and why education projects offer distinct learning opportunities for global health program fieldwork. As University of California students, we partnered in Tanzania with students from Muhimbili University of Health and Allied Science (MUHAS) to assist MUHAS faculty with a curricular project. We attended classes, clinical rounds, and community outreach sessions together, where we observed teaching, materials used, and the learning environment; and interviewed and gathered data from current students, alumni, and health professionals during a nationwide survey. We learned together about education of health professionals and health systems in our respective institutions. On the basis of this experience, I suggest some factors that contribute to the productivity of educational projects as global health fieldwork.

Global Analysis of Climate Change Projection Effects on Atmospheric Rivers

Science.gov (United States)

Espinoza, Vicky; Waliser, Duane E.; Guan, Bin; Lavers, David A.; Ralph, F. Martin

2018-05-01

A uniform, global approach is used to quantify how atmospheric rivers (ARs) change between Coupled Model Intercomparison Project Phase 5 historical simulations and future projections under the Representative Concentration Pathway (RCP) 4.5 and RCP8.5 warming scenarios. The projections indicate that while there will be 10% fewer ARs in the future, the ARs will be 25% longer, 25% wider, and exhibit stronger integrated water vapor transports (IVTs) under RCP8.5. These changes result in pronounced increases in the frequency (IVT strength) of AR conditions under RCP8.5: 50% (25%) globally, 50% (20%) in the northern midlatitudes, and 60% (20%) in the southern midlatitudes. The models exhibit systematic low biases across the midlatitudes in replicating historical AR frequency ( 10%), zonal IVT ( 15%), and meridional IVT ( 25%), with sizable intermodel differences. A more detailed examination of six regions strongly impacted by ARs suggests that the western United States, northwestern Europe, and southwestern South America exhibit considerable intermodel differences in projected changes in ARs.

Can a digital medicine system improve adherence to antipsychotic treatment?

Science.gov (United States)

Papola, D; Gastaldon, C; Ostuzzi, G

2018-06-01

A substantial proportion of people with mental health conditions do not adhere to prescribed pharmacological treatments. Poor adherence is probably one of the most critical elements contributing to relapse in people with schizophrenia and other severe mental disorders. In order to tackle this global issue, in November 2017 the Food and Drug Administration approved a tablet formulation of the atypical antipsychotic aripiprazole embedded with a novel digital adherence-assessment device. In this commentary, we critically appraised the potential beneficial and harmful consequences of this new digital formulation of aripiprazole, and we highlighted expected implications for clinical practice.

Beliefs about medications predict adherence to antidepressants in older adults.

Science.gov (United States)

Fawzi, Waleed; Abdel Mohsen, Mohamed Yousry; Hashem, Abdel Hamid; Moussa, Suaad; Coker, Elizabeth; Wilson, Kenneth C M

2012-01-01

Adherence to treatment is a complex and poorly understood phenomenon. This study investigates the relationship between older depressed patients' adherence to antidepressants and their beliefs about and knowledge of the medication. Assessment was undertaken of 108 outpatients over the age of 55 years diagnosed with depressive disorder and treated for at least four weeks with antidepressants. Adherence was assessed using two self-report measures: the Medication Adherence Rating Scale (MARS) and a Global Adherence Measure (GAM). Potential predictors of adherence investigated included sociodemographic, medication and illness variables. In addition, 33 carers were interviewed regarding general medication beliefs. 56% of patients reported 80% or higher adherence on the GAM. Sociodemographic variables were not associated with adherence on the MARS. Specific beliefs about medicines, such as "my health depends on antidepressants" (necessity) and being less worried about becoming dependant on antidepressants (concern) were highly correlated with adherence. General beliefs about medicines causing harm or being overprescribed, experiencing medication side-effects and severity of depression also correlated with poor adherence. Linear regression with the MARS as the dependent variable explained 44.3% of the variance and showed adherence to be higher in subjects with healthy specific beliefs who received more information about antidepressants and worse with depression severity and autonomic side-effects. Our findings strongly support a role for specific beliefs about medicines in adherence. Challenging patients' beliefs, providing information about treatment and discussing side-effects could improve adherence. Poor response to treatment and medication side-effects can indicate poor adherence and should be considered before switching medications.

Knowledge and Adherence to Medications among Palestinian Geriatrics Living with Chronic Diseases in the West Bank and East Jerusalem

Science.gov (United States)

Najjar, Anas; Amro, Yazan; Kitaneh, Islam; Abu-Sharar, Salam; Sawalha, Maryam; Jamous, Abrar; Qiq, Muhannad; Makharzeh, Enas; Subb Laban, Bayan; Amro, Wafa; Amro, Ahmad

2015-01-01

Background Adequate patient knowledge about medications is essential for appropriate drug taking behavior and patient adherence. This study aims to assess and quantify the level of knowledge and adherence to medications among Palestinian geriatrics living with chronic diseases and to investigate possible associated socio-demographic characteristics. Methods and Findings We conducted a cross-sectional study during June 2013 and January 2014 among Palestinian geriatrics ≥60 years old living with chronic disease in the West Bank and East Jerusalem. A stratified random sample was selected and a questionnaire-assisted interview was applied for data collection. T-test was applied for bivariate analyzing and one-way ANOVA test was applied for multivariate analyses. Results A total of 1192 Palestinian geriatrics were studied. The average age was 70.3 (SD=8.58) years and ranged from 60-110 years. The sample comprised 659 (55.3%) females and 533 (44.7%) males. The global knowledge and global adherence scores were (67.57%) and (89.29%), respectively. Adequate levels of knowledge were 71.4%, and of adherence 75%, which were recorded for 705 (59.1%) and 1088 (91.3%) participants, respectively. Significant higher levels of global knowledge and global adherence were recorded for males, and for participants who hold a Bachelor’s degree, those who live on their own, and did physical activity for more than 40 hours/week (p-value <0.05). Furthermore, workers, participants with a higher monthly income, and non-smokers have a higher knowledge level with (p-value <0.05). We found positive correlation between participants’ global adherence and global knowledge (r=0.487 and p-value <0.001). Negative correlation was found between participants’ global knowledge and adherence with age (r= -0.236, p-value <0.001 and r= -0.211 and p-value <0.001, respectively. Negative correlation between global knowledge and the number of drugs taken (r= -0.130, p-value <0.001) was predicted

Global emission projections for the transportation sector using dynamic technology modeling

Science.gov (United States)

Yan, F.; Winijkul, E.; Streets, D. G.; Lu, Z.; Bond, T. C.; Zhang, Y.

2014-06-01

In this study, global emissions of gases and particles from the transportation sector are projected from the year 2010 to 2050. The Speciated Pollutant Emission Wizard (SPEW)-Trend model, a dynamic model that links the emitter population to its emission characteristics, is used to project emissions from on-road vehicles and non-road engines. Unlike previous models of global emission estimates, SPEW-Trend incorporates considerable detail on the technology stock and builds explicit relationships between socioeconomic drivers and technological changes, such that the vehicle fleet and the vehicle technology shares change dynamically in response to economic development. Emissions from shipping, aviation, and rail are estimated based on other studies so that the final results encompass the entire transportation sector. The emission projections are driven by four commonly-used IPCC (Intergovernmental Panel on Climate Change) scenarios (A1B, A2, B1, and B2). With global fossil-fuel use (oil and coal) in the transportation sector in the range of 128-171 EJ across the four scenarios, global emissions are projected to be 101-138 Tg of carbon monoxide (CO), 44-54 Tg of nitrogen oxides (NOx), 14-18 Tg of non-methane total hydrocarbons (THC), and 3.6-4.4 Tg of particulate matter (PM) in the year 2030. At the global level, a common feature of the emission scenarios is a projected decline in emissions during the first one or two decades (2010-2030), because the effects of stringent emission standards offset the growth in fuel use. Emissions increase slightly in some scenarios after 2030, because of the fast growth of on-road vehicles with lax or no emission standards in Africa and increasing emissions from non-road gasoline engines and shipping. On-road vehicles and non-road engines contribute the most to global CO and THC emissions, while on-road vehicles and shipping contribute the most to NOx and PM emissions. At the regional level, Latin America and East Asia are the two

CooMan - a global collaborative project management system

International Nuclear Information System (INIS)

Souza, J.M. de; Palma, S.

1994-01-01

Project Coordination and Management have long been recognized as an area with growing problems and unsatisfactory solutions. Conciliating flexibility with target achievements is historically the main problem to face. The difficulties have been growing at more than linear ratio with the size and complexity of the Projects being developed in the present days. The HEP communities suffer additional challenges because of the distributed nature of the collaborations, the novelty of each project; and the less authoritarian form of leadership and management of team and individual. This prevents the adoption of more centralized focus on decision. CooMan intends to be a Global Collaborative Project Management System. This paper discusses the basic aspects of the concepts involved, outlining how task coordination, acts of speech, and World-Wide hyper media can be used to support project management activities. A distributed tool to implement such proposition is described, and a first prototype is presented

Security in the Baltic region as a Projection of Global Confrontation between Russia and the USA

Directory of Open Access Journals (Sweden)

Vadim Volovoj

2017-03-01

Full Text Available This article considers the problem of security in the Baltic region, namely, that of Poland and the Baltics. The authors rely on the works of Karl Deutsch, Emanuel Adler, on Michael Barnett’s theory of security communities and Barry Buzan’s re­gional security complex theory, address Steven Mann’s controlled chaos theory and the concept of Intermarium. Their starting assumption is that the situation in the Baltic depends largely on the politics of external powers — Russia and the United States, — being a projection of their global geopolitical confrontation. The US strategy thus becomes a major part of the equation. The authors believe that since the end of the second Iraq war the American elite has been divided along ideological lines into adherents of the chaos theory and traditionalists thinking in terms of sharing control with the other centres of global power. The US strategy in the Baltic region does not seek an open military conflict with Russia. On the contrary, the US strives to preserve the current level of confrontation between Russia and the EU, convincing the latter of the reality of the Russian threat. Countries that traditionally support confrontation with Russia, Poland and the Bal­tics, serve as a conduit for Washington strategy in Europe and a cordon sanitaire. This function is implemented through the Intermarium project meant to separate Russia from the EU. The four countries are rather active in this area, striving to attain the status of the US principal partners in the region and Europe in general. To retaliate, Moscow does everything within its power to ‘separate’ Brussels from Washington, yet the US influence is still very strong in Europe.

Global Database of Events, Language, and Tone (GDELT Project)

Data.gov (United States)

World Wide Human Geography Data Working Group — The Global Database of Events, Language, and Tone (GDELT Project) monitors the world's broadcast, print, and web news from nearly every corner of every country in...

Cultural Issue and its Influence in the Management of Global Project Teams

Directory of Open Access Journals (Sweden)

Nadia Lima

2016-04-01

Full Text Available The interactions between the project manager and team members may be affected by several variables, such as culture, leadership style of the project manager, and the complexity of the developed tasks. Focused in this context, the objective of this paper is to investigate and describe how the culture issue can affect the anagement of global project teams. It is a qualitative, descriptive study conducted in a large multinational company in the automotive sector. The results of this research show that cultural issues can influence both positively and negatively the management of project global teams and the managers of these projects have to deal with several management challenges that require the adoption of certain ways of dealing with culture impacts in managing their teams to minimize potential problems in this context.

Global Precipitation Climatology Project (GPCP) - Daily, Version 1.2

Data.gov (United States)

National Oceanic and Atmospheric Administration, Department of Commerce — The Global Precipitation Climatology Project (GPCP) comprises a total of 27 products. The Version 1.2 Daily product covers the period October 1998 to the present,...

Global Precipitation Climatology Project (GPCP) - Pentad, Version 2.2

Data.gov (United States)

National Oceanic and Atmospheric Administration, Department of Commerce — The Global Precipitation Climatology Project (GPCP) comprises a total of 27 products. The Version 2.2 Pentad product covers the period January 1979 to the present,...

Systematic procedures to promote U.S. HIV medication adherence via Photovoice.

Science.gov (United States)

Teti, Michelle; Shaffer, Victoria; Majee, Wilson; Farnan, Rose; Gerkovich, Mary

2017-06-21

Medication adherence is essential to promote the health of people living with HIV (PL-HIV) and prevent HIV transmission in the U.S. Novel medication health promotion interventions are needed that address patient-centeredness, understandability, and communication with providers. The aims of this article are to define the systematic stages we used to develop an effective health promotion intervention via the products (e.g. images and stories) of Photovoice. We designed an intervention to improve HIV adherence knowledge, attitudes, and communication with providers through Photovoice. 16 PL-HIV used Photovoice strategies to describe their experiences with medication via images and captions and create an intervention (10 adherence promotion posters) that integrated photo-stories of their adherence motivators, journeys from sickness to health, and how they manage and counter HIV stigma. We outline the systematic process we used to adapt Photovoice to create the effective intervention for replication. The process included six stages: (i) identify scope of the project; (ii) create collaborative project team; (iii) design project materials; (iv) review and revise materials with team members; (v) disseminate materials; and (vi) evaluate materials. Photovoice is used traditionally as a social action research method. In this project, it was adapted to create patient-driven images and stories for health promotion posters. Poster viewers experienced improved self-efficacy for HIV medication adherence. Describing the adaptation of the Photovoice process in a deliberate and transparent way can support fidelity to the essence of the participant-driven method, while also allowing researchers and practitioners to replicate Photovoice as a successful health promotion intervention. © The Author 2017. Published by Oxford University Press. All rights reserved. For Permissions, please email: journals.permissions@oup.com.

Factors influencing adherence to guidelines in general practice

NARCIS (Netherlands)

Stewart, RE; Vroegop, S; van der Werf, GT; Meyboom-de Jong, B; Kamps, G.

2003-01-01

Objectives: To identify and assess the effects of general practitioner and patient characteristics on global adherence to pharmacotherapeutic guidelines. Methods: In a cross-sectional study in the northern Netherlands, a two-level multilevel model was applied to patients (n = 269,067) in 190

Does the projected pathway to global warming targets matter?

Science.gov (United States)

Bärring, Lars; Strandberg, Gustav

2018-02-01

Since the ‘Paris agreement’ in 2015 there has been much focus on what a +1.5 °C or +2 °C warmer world would look like. Since the focus lies on policy relevant global warming targets, or specific warming levels (SWLs), rather than a specific point in time, projections are pooled together to form SWL ensembles based on the target temperature rather than emission scenario. This study uses an ensemble of CMIP5 global model projections to analyse how well SWL ensembles represent the stabilized climate of global warming targets. The results show that the SWL ensembles exhibit significant trends that reflect the transient nature of the RCP scenarios. These trends have clear effect on the timing and clustering of monthly cold and hot extremes, even though the effect on the temperature of the extreme months is less visible. In many regions there is a link between choice of RCP scenario used in the SWL ensemble and climate change signal in the highest monthly temperatures. In other regions there is no such clear-cut link. From this we conclude that comprehensive analyses of what prospects the different global warming targets bring about will require stabilization scenarios. Awaiting such targeted scenarios we suggest that prudent use of SWL scenarios, taking their characteristics and limitations into account, may serve as reasonable proxies in many situations.

The Global Precipitation Climatology Project (GPCP) Combined Precipitation Dataset

Science.gov (United States)

Huffman, George J.; Adler, Robert F.; Arkin, Philip; Chang, Alfred; Ferraro, Ralph; Gruber, Arnold; Janowiak, John; McNab, Alan; Rudolf, Bruno; Schneider, Udo

1997-01-01

The Global Precipitation Climatology Project (GPCP) has released the GPCP Version 1 Combined Precipitation Data Set, a global, monthly precipitation dataset covering the period July 1987 through December 1995. The primary product in the dataset is a merged analysis incorporating precipitation estimates from low-orbit-satellite microwave data, geosynchronous-orbit -satellite infrared data, and rain gauge observations. The dataset also contains the individual input fields, a combination of the microwave and infrared satellite estimates, and error estimates for each field. The data are provided on 2.5 deg x 2.5 deg latitude-longitude global grids. Preliminary analyses show general agreement with prior studies of global precipitation and extends prior studies of El Nino-Southern Oscillation precipitation patterns. At the regional scale there are systematic differences with standard climatologies.

Global Climate Change Pilot Course Project

Science.gov (United States)

Schuenemann, K. C.; Wagner, R.

2011-12-01

In fall 2011 a pilot course on "Global Climate Change" is being offered, which has been proposed to educate urban, diverse, undergraduate students about climate change at the introductory level. The course has been approved to fulfill two general college requirements, a natural sciences requirement that focuses on the scientific method, as well as a global diversity requirement. This course presents the science behind global climate change from an Earth systems and atmospheric science perspective. These concepts then provide the basis to explore the effect of global warming on regions throughout the world. Climate change has been taught as a sub-topic in other courses in the past solely using scientific concepts, with little success in altering the climate change misconceptions of the students. This pilot course will see if new, innovative projects described below can make more of an impact on the students' views of climate change. Results of the successes or failures of these projects will be reported, as well as results of a pre- and post-course questionnaire on climate change given to students taking the course. Students in the class will pair off and choose a global region or country that they will research, write papers on, and then represent in four class discussions spaced throughout the semester. The first report will include details on the current climate of their region and how the climate shapes that region's society and culture. The second report will discuss how that region is contributing to climate change and/or sequestering greenhouse gases. Thirdly, students will discuss observed and predicted changes in that region's climate and what impact it has had, and could have, on their society. Lastly, students will report on what role their region has played in mitigating climate change, any policies their region may have implemented, and how their region can or cannot adapt to future climate changes. They will also try to get a feel for the region

GRIN-Global: An International Project to Develop a Global Plant Genebank Information Management System

Science.gov (United States)

The mission of the GRIN-Global Project is to create a new, scalable version of the Germplasm Resource Information System (GRIN) to provide the world’s crop genebanks with a powerful, flexible, easy-to-use plant genetic resource (PGR) information management system. The system will help safeguard PGR ...

Ace Project as a Project Management Tool

Science.gov (United States)

Cline, Melinda; Guynes, Carl S.; Simard, Karine

2010-01-01

The primary challenge of project management is to achieve the project goals and objectives while adhering to project constraints--usually scope, quality, time and budget. The secondary challenge is to optimize the allocation and integration of resources necessary to meet pre-defined objectives. Project management software provides an active…

A Quantitative Study of Global Software Development Teams, Requirements, and Software Projects

Science.gov (United States)

Parker, Linda L.

2016-01-01

The study explored the relationship between global software development teams, effective software requirements, and stakeholders' perception of successful software development projects within the field of information technology management. It examined the critical relationship between Global Software Development (GSD) teams creating effective…

What puts heart failure patients at risk for poor medication adherence?

Directory of Open Access Journals (Sweden)

Knafl GJ

2014-07-01

Full Text Available George J Knafl,1 Barbara Riegel2,31School of Nursing, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA; 2School of Nursing, University of Pennsylvania, Philadelphia, PA, USA; 3Leonard Davis Institute, University of Pennsylvania, Philadelphia, PA, USABackground: Medication nonadherence is a major cause of hospitalization in patients with heart failure (HF, which contributes enormously to health care costs. We previously found, using the World Health Organization adherence dimensions, that condition and patient level factors predicted nonadherence in HF. In this study, we assessed a wider variety of condition and patient factors and interactions to improve our ability to identify those at risk for hospitalization. Materials and methods: Medication adherence was measured electronically over the course of 6 months, using the Medication Event Monitoring System (MEMS. A total of 242 HF patients completed the study, and usable MEMS data were available for 218 (90.1%. Participants were primarily white (68.3%, male (64.2%, and retired (44.5%. Education ranged from 8–29 years (mean, 14.0 years; standard deviation, 2.9 years. Ages ranged from 30–89 years (mean, 62.8 years; standard deviation, 11.6 years. Analyses used adaptive methods based on heuristic searches controlled by cross-validation scores. First, individual patient adherence patterns over time were used to categorize patients in poor versus better adherence types. Then, risk factors for poor adherence were identified. Finally, an effective model for predicting poor adherence was identified based on identified risk factors and possible pairwise interactions between them. Results: A total of 63 (28.9% patients had poor adherence. Three interaction risk factors for poor adherence were identified: a higher number of comorbid conditions with a higher total number of daily medicines, older age with poorer global sleep quality, and fewer months since diagnosis of HF with poorer

Finite-time analysis of global projective synchronization on coloured ...

Indian Academy of Sciences (India)

A novel finite-time analysis is given to investigate the global projective synchronization on coloured networks. Some less conservative conditions are derived by utilizing finite-time control techniques and Lyapunov stability theorem. In addition, two illustrative numerical simulations are provided to verify the effectiveness of ...

Furthering patient adherence: a position paper of the international expert forum on patient adherence based on an internet forum discussion.

Science.gov (United States)

van Dulmen, Sandra; Sluijs, Emmy; van Dijk, Liset; de Ridder, Denise; Heerdink, Rob; Bensing, Jozien

2008-02-27

As the problem of patient non-adherence persists and a solution appears hard to be found, it continues to be important to look for new ways to further the issue. We recently conducted a meta-review of adherence intervention studies which yielded a preliminary agenda for future research, practice and theory development in patient adherence. The objective of the present project was to find out to what extent adherence experts consider this agenda relevant and feasible. The thirty-five corresponding authors of the review studies included in the meta-review were invited to join the International Expert Forum on Patient Adherence and to participate in a four-week web-based focus group discussion. The discussion was triggered by the points on the preliminary agenda presented as propositions to which forum members could react. Two researchers analysed the transcripts and selected relevant phrases. Twenty adherence experts participated. Various ideas and viewpoints were raised. After the closure of the web-site, the expert forum was asked to authorize the synthesis of the discussion, to list the propositions in order of priority and to answer a few questions on the use of the web-based focus group as a tool to obtain expert opinions. Their ranking showed that the development of simple interventions is the most promising step to take in fostering patient adherence, preferably within a multidisciplinary setting of medical, pharmaceutical, social and technical science and, not in the least, by incorporating patients' perspectives. For enhancing adherence, the development of simple interventions originating from a multidisciplinary perspective including patients' input, appears most promising. Disclosing patients' perspectives requires open communication about patients' expectations, needs and experiences in taking medication and about what might help them to become and remain adherent.

Furthering patient adherence: A position paper of the international expert forum on patient adherence based on an internet forum discussion

Directory of Open Access Journals (Sweden)

Heerdink Rob

2008-02-01

Full Text Available Abstract Background As the problem of patient non-adherence persists and a solution appears hard to be found, it continues to be important to look for new ways to further the issue. We recently conducted a meta-review of adherence intervention studies which yielded a preliminary agenda for future research, practice and theory development in patient adherence. The objective of the present project was to find out to what extent adherence experts consider this agenda relevant and feasible. Methods The thirty-five corresponding authors of the review studies included in the meta-review were invited to join the International Expert Forum on Patient Adherence and to participate in a four-week web-based focus group discussion. The discussion was triggered by the points on the preliminary agenda presented as propositions to which forum members could react. Two researchers analysed the transcripts and selected relevant phrases. Results Twenty adherence experts participated. Various ideas and viewpoints were raised. After the closure of the web-site, the expert forum was asked to authorize the synthesis of the discussion, to list the propositions in order of priority and to answer a few questions on the use of the web-based focus group as a tool to obtain expert opinions. Their ranking showed that the development of simple interventions is the most promising step to take in fostering patient adherence, preferably within a multidisciplinary setting of medical, pharmaceutical, social and technical science and, not in the least, by incorporating patients' perspectives. Conclusion For enhancing adherence, the development of simple interventions originating from a multidisciplinary perspective including patients' input, appears most promising. Disclosing patients' perspectives requires open communication about patients' expectations, needs and experiences in taking medication and about what might help them to become and remain adherent.

Projections of global mortality and burden of disease from 2002 to 2030.

Science.gov (United States)

Mathers, Colin D; Loncar, Dejan

2006-11-01

Global and regional projections of mortality and burden of disease by cause for the years 2000, 2010, and 2030 were published by Murray and Lopez in 1996 as part of the Global Burden of Disease project. These projections, which are based on 1990 data, continue to be widely quoted, although they are substantially outdated; in particular, they substantially underestimated the spread of HIV/AIDS. To address the widespread demand for information on likely future trends in global health, and thereby to support international health policy and priority setting, we have prepared new projections of mortality and burden of disease to 2030 starting from World Health Organization estimates of mortality and burden of disease for 2002. This paper describes the methods, assumptions, input data, and results. Relatively simple models were used to project future health trends under three scenarios-baseline, optimistic, and pessimistic-based largely on projections of economic and social development, and using the historically observed relationships of these with cause-specific mortality rates. Data inputs have been updated to take account of the greater availability of death registration data and the latest available projections for HIV/AIDS, income, human capital, tobacco smoking, body mass index, and other inputs. In all three scenarios there is a dramatic shift in the distribution of deaths from younger to older ages and from communicable, maternal, perinatal, and nutritional causes to noncommunicable disease causes. The risk of death for children younger than 5 y is projected to fall by nearly 50% in the baseline scenario between 2002 and 2030. The proportion of deaths due to noncommunicable disease is projected to rise from 59% in 2002 to 69% in 2030. Global HIV/AIDS deaths are projected to rise from 2.8 million in 2002 to 6.5 million in 2030 under the baseline scenario, which assumes coverage with antiretroviral drugs reaches 80% by 2012. Under the optimistic scenario, which

Projections of global mortality and burden of disease from 2002 to 2030.

Directory of Open Access Journals (Sweden)

Colin D Mathers

2006-11-01

Full Text Available BACKGROUND: Global and regional projections of mortality and burden of disease by cause for the years 2000, 2010, and 2030 were published by Murray and Lopez in 1996 as part of the Global Burden of Disease project. These projections, which are based on 1990 data, continue to be widely quoted, although they are substantially outdated; in particular, they substantially underestimated the spread of HIV/AIDS. To address the widespread demand for information on likely future trends in global health, and thereby to support international health policy and priority setting, we have prepared new projections of mortality and burden of disease to 2030 starting from World Health Organization estimates of mortality and burden of disease for 2002. This paper describes the methods, assumptions, input data, and results. METHODS AND FINDINGS: Relatively simple models were used to project future health trends under three scenarios-baseline, optimistic, and pessimistic-based largely on projections of economic and social development, and using the historically observed relationships of these with cause-specific mortality rates. Data inputs have been updated to take account of the greater availability of death registration data and the latest available projections for HIV/AIDS, income, human capital, tobacco smoking, body mass index, and other inputs. In all three scenarios there is a dramatic shift in the distribution of deaths from younger to older ages and from communicable, maternal, perinatal, and nutritional causes to noncommunicable disease causes. The risk of death for children younger than 5 y is projected to fall by nearly 50% in the baseline scenario between 2002 and 2030. The proportion of deaths due to noncommunicable disease is projected to rise from 59% in 2002 to 69% in 2030. Global HIV/AIDS deaths are projected to rise from 2.8 million in 2002 to 6.5 million in 2030 under the baseline scenario, which assumes coverage with antiretroviral drugs

Projections of Global Mortality and Burden of Disease from 2002 to 2030

Science.gov (United States)

Mathers, Colin D; Loncar, Dejan

2006-01-01

Background Global and regional projections of mortality and burden of disease by cause for the years 2000, 2010, and 2030 were published by Murray and Lopez in 1996 as part of the Global Burden of Disease project. These projections, which are based on 1990 data, continue to be widely quoted, although they are substantially outdated; in particular, they substantially underestimated the spread of HIV/AIDS. To address the widespread demand for information on likely future trends in global health, and thereby to support international health policy and priority setting, we have prepared new projections of mortality and burden of disease to 2030 starting from World Health Organization estimates of mortality and burden of disease for 2002. This paper describes the methods, assumptions, input data, and results. Methods and Findings Relatively simple models were used to project future health trends under three scenarios—baseline, optimistic, and pessimistic—based largely on projections of economic and social development, and using the historically observed relationships of these with cause-specific mortality rates. Data inputs have been updated to take account of the greater availability of death registration data and the latest available projections for HIV/AIDS, income, human capital, tobacco smoking, body mass index, and other inputs. In all three scenarios there is a dramatic shift in the distribution of deaths from younger to older ages and from communicable, maternal, perinatal, and nutritional causes to noncommunicable disease causes. The risk of death for children younger than 5 y is projected to fall by nearly 50% in the baseline scenario between 2002 and 2030. The proportion of deaths due to noncommunicable disease is projected to rise from 59% in 2002 to 69% in 2030. Global HIV/AIDS deaths are projected to rise from 2.8 million in 2002 to 6.5 million in 2030 under the baseline scenario, which assumes coverage with antiretroviral drugs reaches 80% by 2012

Psychological and behavioral barriers to ART adherence among PLWH in China: role of self-efficacy.

Science.gov (United States)

Zhou, Guangyu; Li, Xiaoming; Qiao, Shan; Zhou, Yuejiao; Shen, Zhiyong

2017-12-01

Globally, optimal adherence to antiretroviral therapy (ART) is insufficient despite it is critical for maximum clinical benefits and treatment success among people living with HIV (PLWH). Many factors have been evidenced to influence medication adherence, including perceived barriers and self-efficacy. However, limited data are available regarding to psychological and behavioral barriers to ART adherence in China. Moreover, few studies have examined the mechanism of these two factors underlying HIV medication adherence. The aim of the current study is to examine the mediating role of adherence self-efficacy between perceived barriers and ART adherence among PLWH. Cross-sectional data were obtained from 2095 PLWH in Guangxi China who provided data on ART adherence. Participants reported their medication adherence, self-efficacy, barriers to ART adherence, as well as background characteristics. Results indicated a significant indirect effect from perceived barriers to medication adherence through adherence self-efficacy. Higher perceived psychological and behavioral barriers to ART adherence were related to lower adherence self-efficacy, which in turn was related to lower ART adherence. Self-efficacy could buffer the negative effects of perceived barriers on ART adherence. Future interventions to promote HIV medication adherence are recommended to focus on eliminating psychological and behavioral barriers, as well as increasing adherence self-efficacy.

Consistency of climate change projections from multiple global and regional model intercomparison projects

Science.gov (United States)

Fernández, J.; Frías, M. D.; Cabos, W. D.; Cofiño, A. S.; Domínguez, M.; Fita, L.; Gaertner, M. A.; García-Díez, M.; Gutiérrez, J. M.; Jiménez-Guerrero, P.; Liguori, G.; Montávez, J. P.; Romera, R.; Sánchez, E.

2018-03-01

We present an unprecedented ensemble of 196 future climate projections arising from different global and regional model intercomparison projects (MIPs): CMIP3, CMIP5, ENSEMBLES, ESCENA, EURO- and Med-CORDEX. This multi-MIP ensemble includes all regional climate model (RCM) projections publicly available to date, along with their driving global climate models (GCMs). We illustrate consistent and conflicting messages using continental Spain and the Balearic Islands as target region. The study considers near future (2021-2050) changes and their dependence on several uncertainty sources sampled in the multi-MIP ensemble: GCM, future scenario, internal variability, RCM, and spatial resolution. This initial work focuses on mean seasonal precipitation and temperature changes. The results show that the potential GCM-RCM combinations have been explored very unevenly, with favoured GCMs and large ensembles of a few RCMs that do not respond to any ensemble design. Therefore, the grand-ensemble is weighted towards a few models. The selection of a balanced, credible sub-ensemble is challenged in this study by illustrating several conflicting responses between the RCM and its driving GCM and among different RCMs. Sub-ensembles from different initiatives are dominated by different uncertainty sources, being the driving GCM the main contributor to uncertainty in the grand-ensemble. For this analysis of the near future changes, the emission scenario does not lead to a strong uncertainty. Despite the extra computational effort, for mean seasonal changes, the increase in resolution does not lead to important changes.

Global Rural-Urban Mapping Project, Version 1 (GRUMPv1): Coastlines

Data.gov (United States)

National Aeronautics and Space Administration — The Global Rural-Urban Mapping Project, Version 1 (GRUMPv1) consists of estimates of human population for the years 1990, 1995, and 2000 by 30 arc-second (1km) grid...

Divergent surface and total soil moisture projections under global warming

Science.gov (United States)

Berg, Alexis; Sheffield, Justin; Milly, Paul C.D.

2017-01-01

Land aridity has been projected to increase with global warming. Such projections are mostly based on off-line aridity and drought metrics applied to climate model outputs but also are supported by climate-model projections of decreased surface soil moisture. Here we comprehensively analyze soil moisture projections from the Coupled Model Intercomparison Project phase 5, including surface, total, and layer-by-layer soil moisture. We identify a robust vertical gradient of projected mean soil moisture changes, with more negative changes near the surface. Some regions of the northern middle to high latitudes exhibit negative annual surface changes but positive total changes. We interpret this behavior in the context of seasonal changes in the surface water budget. This vertical pattern implies that the extensive drying predicted by off-line drought metrics, while consistent with the projected decline in surface soil moisture, will tend to overestimate (negatively) changes in total soil water availability.

Bacterial adherence to anodized titanium alloy

International Nuclear Information System (INIS)

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

2010-01-01

The aim of this study was to evaluate Staphylococcus sp adhesion to modified surfaces of anodized titanium alloy (Ti-6Al-4V). Surface modification involved generation of fluoride-containing titanium oxide nanotube films. Specimens of Ti-6Al-4V alloy 6-4 ELI-grade 23- meets the requirements of ASTM F136 2002A (AMS 2631B class A1) were anodized in a mixture of sulphuric/hydrofluoric acid at 20 V for 5 and 60 min to form a 100 nm-thick porous film of 20 nm pore diameter and 230 nm-thick nanotube films of 100 nm in diameter. The amount of fluorine in the oxide films was of 6% and of 4%, respectively. Collection strains and six clinical strains each of Staphylococcus aureus and Staphylococcus epidermidis were studied. The adherence study was performed using a previously published protocol by Kinnari et al. The experiments were performed in triplicates. As a result, lower adherence was detected for collection strains in modified materials than in unmodified controls. Differences between clinical strains were detected for both species (p<0.0001, Kruskal-Wallis test), although global data showed similar results to that of collection strains (p<0.0001, Kruskal-Wallis test). Adherence of bacteria to modified surfaces was decreased for both species. The results also reflect a difference in the adherence between S. aureus and S. epidermidis to the modified material. As a conclusion, not only we were able to confirm the decrease of adherence in the modified surface, but also the need to test multiple clinical strains to obtain more realistic microbiological results due to intraspecies differences.

How do glacier inventory data aid global glacier assessments and projections?

Science.gov (United States)

Hock, R.

2017-12-01

Large-scale glacier modeling relies heavily on datasets that are collected by many individuals across the globe, but managed and maintained in a coordinated fashion by international data centers. The Global Terrestrial Network for Glaciers (GTN-G) provides the framework for coordinating and making available a suite of data sets such as the Randolph Glacier Inventory (RGI), the Glacier Thickness Dataset or the World Glacier Inventory (WGI). These datasets have greatly increased our ability to assess global-scale glacier mass changes. These data have also been vital for projecting the glacier mass changes of all mountain glaciers in the world outside the Greenland and Antarctic ice sheet, a total >200,000 glaciers covering an area of more than 700,000 km2. Using forcing from 8 to 15 GCMs and 4 different emission scenarios, global-scale glacier evolution models project multi-model mean net mass losses of all glaciers between 7 cm and 24 cm sea-level equivalent by the end of the 21st century. Projected mass losses vary greatly depending on the choice of the forcing climate and emission scenario. Insufficiently constrained model parameters likely are an important reason for large differences found among these studies even when forced by the same emission scenario, especially on regional scales.

CHILDREN'S ADHERENCE TO HAART ADHERENCE

African Journals Online (AJOL)

han or equal IQ 2 log" and in 64% of children wirh smaller man 2 log,o decrease in viral load. Secondly, i caregivers are not well prepared for adherence issues before starting HAART, or if regimens are too onerous to follow, treatment is likely to fail. Every effort should be made to see the burden of adherence from the.

Orally disintegrating olanzapine review: effectiveness, patient preference, adherence, and other properties

Directory of Open Access Journals (Sweden)

Montgomery W

2012-02-01

Full Text Available William Montgomery1, Tamas Treuer2, Jamie Karagianis3, Haya Ascher-Svanum4, Gavan Harrison51Global Health Outcomes, Eli Lilly and Company, Sydney, Australia; 2Emerging Markets Business Unit (Neuroscience, Eli Lilly and Company, Budapest, Hungary; 3Eli Lilly and Company, Indianapolis, IN, USA; 4Global Health Outcomes, Eli Lilly and Company, Indianapolis, IN, USA; 5Asia-Pacific Medical Communications, Eli Lilly and Company, Sydney, AustraliaAbstract: Orally disintegrating olanzapine (ODO is a rapid-dissolving formulation of olanzapine which disintegrates in saliva almost immediately, developed as a convenient and adherence-enhancing alternative to the standard olanzapine-coated tablet (SOT. Clinical studies, which form the basis of this review, have shown ODO and SOT to have similar efficacy and tolerability profiles. However, ODO appears to have a number of advantages over SOT in terms of adherence, patient preference, and reduction in nursing burden. Overall, the existing clinical data suggests that compared to SOT, ODO is not only well-suited for difficult-to-treat, agitated, and/or nonadherent patients but, due to its potential ability to improve adherence and greater patient preference, may also be an appropriate formulation for the majority of patients for which olanzapine is the antipsychotic of choice.Keywords: orodispersible formulation, orally disintegrating, olanzapine, atypical antipsychotics, patient adherence, preference, schizophrenia, bipolar disorder

Adherence policy, education and practice - an international perspective.

Science.gov (United States)

Marie-Schneider, Paule; Aslani, Parisa

2010-10-01

Nonadherence to chronic therapy has become a large burden on the healthcare system of many countries. Community pharmacists are well positioned to address nonadherence as part of their overall patient care activities, and contribute to patients' quality use of medicines. Between 2008 and 2010, a series of narrative, peer-reviewed articles were published in Pharmacy Practice which focused on community pharmacists' activities in medication adherence, specifically in the areas of the education they receive, their practice, the research conducted and national or local policies. This editorial aims to summarise the key findings presented in the series, and highlight the pertinent issues and gaps in the literature. There is a need to implement global and long-term objectives focussing on enhancing the quality of education and competencies of community pharmacists and the research conducted in medication adherence, to develop guidelines for pharmacists and enhance the uptake of adherence promoting services in routine care.

Computer-based intervention in HIV clinical care setting improves antiretroviral adherence: the LifeWindows Project.

Science.gov (United States)

Fisher, Jeffrey D; Amico, K Rivet; Fisher, William A; Cornman, Deborah H; Shuper, Paul A; Trayling, Cynthia; Redding, Caroline; Barta, William; Lemieux, Anthony F; Altice, Frederick L; Dieckhaus, Kevin; Friedland, Gerald

2011-11-01

We evaluated the efficacy of LifeWindows, a theory-based, computer-administered antiretroviral (ARV) therapy adherence support intervention, delivered to HIV + patients at routine clinical care visits. 594 HIV + adults receiving HIV care at five clinics were randomized to intervention or control arms. Intervention vs. control impact in the intent-to-treat sample (including participants whose ARVs had been entirely discontinued, who infrequently attended care, or infrequently used LifeWindows) did not reach significance. Intervention impact in the On Protocol sample (328 intervention and control arm participants whose ARVs were not discontinued, who attended care and were exposed to LifeWindows regularly) was significant. On Protocol intervention vs. control participants achieved significantly higher levels of perfect 3-day ACTG-assessed adherence over time, with sensitivity analyses maintaining this effect down to 70% adherence. This study supports the utility of LifeWindows and illustrates that patients on ARVs who persist in care at clinical care sites can benefit from adherence promotion software.

Age, Stigma, Adherence and Clinical Indicators in HIV-Infected Women

OpenAIRE

McCoy, Katryna; Higgins, Melinda; Zuñiga, Julie Ann; Holstad, Marcia McDonnell

2015-01-01

Stigma has become a gendered phenomenon that affects increasing numbers of HIV-infected women worldwide. This study examined the role of age as a possible moderator of the relationship between stigma and antiretroviral therapy adherence, CD4% and viral load among 120 HIV-infected women. A secondary analysis was conducted using data from the Keeping Healthy and Active with Risk Reduction and Medication Adherence (KHARMA) Project, an National Institutes of Health (NIH) funded randomized control...

Exercise after Stroke: Patient Adherence and Beliefs after Discharge from Rehabilitation.

Science.gov (United States)

Miller, Kristine K; Porter, Rebecca E; DeBaun-Sprague, Erin; Van Puymbroeck, Marieke; Schmid, Arlene A

2017-03-01

Most people complete post-stroke rehabilitation within the first 6 months after stroke even though benefits from exercise are believed to persist well beyond 6 months. Physical and Occupational therapists provide home exercise programs (HEP) to instruct patients on exercises to continue after discharge from rehabilitation. Unfortunately, there is little known about HEP adherence rates in adults with stroke. The objectives of this project were to (1) determine the adherence rate with post-rehabilitation HEP and reasons for non-adherence, (2) assess for interactions between HEP adherence and self-report of depression and fatigue, and (3) determine patient beliefs about the benefit of exercise during stroke recovery. This was a cross-sectional, survey study. A survey was developed and distributed during stroke support group meetings to determine adherence rates with post rehabilitation HEP, reasons for non-adherence, and patient beliefs about the benefit of exercise. Eighty-nine percent of participants reported receiving a HEP and 65.3% of those reported being adherent with at least part of the HEP. Several reasons for non-adherence were identified, including 'doing different exercises than the ones given by the physical therapist', as the most frequently given reason. Study participants identified positive roles of exercise in their recovery from stroke. Patient adherence with HEP after discharge from rehabilitation is less than ideal. Reasons for non-adherence are varied. Rehabilitation therapists need to be able to identify and help patients manage barriers to HEP adherence to promote management of residual deficits.

Projection of Heat Waves over China under Different Global Warming Targets

Science.gov (United States)

Guo, Xiaojun; Luo, Yong; Huang, Jianbin; Zhao, Zongci

2015-04-01

Global warming targets, which are determined in terms of global mean temperature increases relative to pre-industrial temperature levels, have been one of the heated issues recently. And the climate change (especially climate extremes) and its impacts under different targets have been paid extensive concerns. In this study, evaluation and projection of heat waves in China were carried out by five CMIP5 global climate models (GCMs) with a 0.5°×0.5° horizontal resolution which were derived from EU WATCH project. A new daily observed gridded dataset CN05.1 (0.5°×0.5°) was also used to evaluate the GCMs. And four indices (heat waves frequency, longest heat waves duration, heat waves days and high temperature days) were adopted to analyze the heat waves. Compared with the observations, the five GCMs and its Multi-Model Ensemble (MME) have a remarkable capacity of reproducing the spatial and temporal characteristic of heat waves. The time correlation coefficients between MME and the observation results can all reach 0.05 significant levels. Based on the projection data of five GCMs, both the median year of crossing 1.5°C, 2°C, 2.5°, 3°C, 3.5°C, 4°C, 4.5°C and 5°C global warming targets and the corresponding climate change over China were analyzed under RCP 4.5 and RCP 8.5 scenarios, respectively. The results show that when the global mean surface air temperature rise to different targets with respect to the pre-industrial times (1861-1880), the frequency and intensity of heat waves will increase dramatically. To take the high emission scenario RCP8.5 as an example, under the RCP8.5 scenario, the warming rate over China is stronger than that over the globe, the temperature rise(median year) over China projected by MME are 1.77°C(2025), 2.63°C(2039), 3.39°C(2050), 3.97°C(2060), 4.82°C(2070), 5.47°C(2079) and 6.2°C(2089) under 1.5°C, 2°C, 2.5°C, 3°C, 3.5°C, 4°C and 4.5°C global warming targets, respectively. With the increase of the global

Adherence to antidepressants

Directory of Open Access Journals (Sweden)

Abimbola Farinde

2013-01-01

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.

Global asymptotic stability of density dependent integral population projection models.

Science.gov (United States)

Rebarber, Richard; Tenhumberg, Brigitte; Townley, Stuart

2012-02-01

Many stage-structured density dependent populations with a continuum of stages can be naturally modeled using nonlinear integral projection models. In this paper, we study a trichotomy of global stability result for a class of density dependent systems which include a Platte thistle model. Specifically, we identify those systems parameters for which zero is globally asymptotically stable, parameters for which there is a positive asymptotically stable equilibrium, and parameters for which there is no asymptotically stable equilibrium. Copyright © 2011 Elsevier Inc. All rights reserved.

Projected impacts of climate change on regional capacities for global plant species richness.

Science.gov (United States)

Sommer, Jan Henning; Kreft, Holger; Kier, Gerold; Jetz, Walter; Mutke, Jens; Barthlott, Wilhelm

2010-08-07

Climate change represents a major challenge to the maintenance of global biodiversity. To date, the direction and magnitude of net changes in the global distribution of plant diversity remain elusive. We use the empirical multi-variate relationships between contemporary water-energy dynamics and other non-climatic predictor variables to model the regional capacity for plant species richness (CSR) and its projected future changes. We find that across all analysed Intergovernmental Panel on Climate Change emission scenarios, relative changes in CSR increase with increased projected temperature rise. Between now and 2100, global average CSR is projected to remain similar to today (+0.3%) under the optimistic B1/+1.8 degrees C scenario, but to decrease significantly (-9.4%) under the 'business as usual' A1FI/+4.0 degrees C scenario. Across all modelled scenarios, the magnitude and direction of CSR change are geographically highly non-uniform. While in most temperate and arctic regions, a CSR increase is expected, the projections indicate a strong decline in most tropical and subtropical regions. Countries least responsible for past and present greenhouse gas emissions are likely to incur disproportionately large future losses in CSR, whereas industrialized countries have projected moderate increases. Independent of direction, we infer that all changes in regional CSR will probably induce on-site species turnover and thereby be a threat to native floras.

Nation state and the challenge of globalization: Project draft

Directory of Open Access Journals (Sweden)

Obrenović Zoran G.

2002-01-01

Full Text Available This project draft discusses the issues facing a nation state in the dynamic processes of globalization. First, the term globalization is tentatively defined as a decentralized process of condensation and homogenization of space and time. Then, the ambivalent structure of the globalization discourse, i.e. its semantic and pragmatic dimensions, are shown. The neo-liberal viewpoint is explored of the erosion and weakening of the nation state within the global capitalist power, both in terms of its (state's traditional functions, and in terms of its internal and external sovereignty. Against the neo-liberal thesis about the decline of the nation state many empirical arguments have been offered. Some of these are presented in this text. The main point of this argumentation consists in a general view that the decline of the nation state is strongly linked with the process of globalization. In view of the critical argumentation included in the paper, it is argued that in the environment of global processes only the societies which have a strong state behind them have a chance to succeed. Politics, not economy, still dominates international relations. Emphasis on state politics opens a new perspective in discussing the process of globalization. Current globalization processes cannot be judged accurately unless geopolitical interests and the changing balance of world power are understood. Finally, the paper points to the ideological nature of the neo-liberal discourse of globalization, questioning another basic assumption of the latter, namely, the idea that the process of globalization is at the same time a process of emancipation. By challenging the positing of a necessary link between globalization and emancipation we formulate a position that allows for a normative critique of current processes.

A Tri-Country Marketing Project--Preparing Students for the Realities of a Global Marketplace

Science.gov (United States)

Freeman, Ina; Knight, Peter; Butt, Irfan

2011-01-01

With rapidly increasing globalization, business students are required to understand complex global markets and adapt to the rapid changes in the global landscape. This paper discusses a project where students from International Marketing courses in Pakistan, the United States, and France used an interactive platform as a base to jointly explore…

An App Supporting Psoriasis Patients Improves Adherence to Topical Treatment

DEFF Research Database (Denmark)

Svendsen, M T; Andersen, F; Pottegård, A

2018-01-01

Physician's Global Assessment (LS-PGA), and quality of life was measured by Dermatology Life Quality Index (DLQI) scales at all visits. RESULTS: Intention to treat analyses using regression was performed. PRIMARY OUTCOME: more patients in the intervention group were adherent to Cal/BD cutaneous foam...

Non-adherence in patients on peritoneal dialysis: a systematic review.

Science.gov (United States)

Griva, Konstadina; Lai, Alden Yuanhong; Lim, Haikel Asyraf; Yu, Zhenli; Foo, Marjorie Wai Yin; Newman, Stanton P

2014-01-01

It has been increasingly recognized that non-adherence is an important factor that determines the outcome of peritoneal dialysis (PD) therapy. There is therefore a need to establish the levels of non-adherence to different aspects of the PD regimen (dialysis procedures, medications, and dietary/fluid restrictions). A systematic review of peer-reviewed literature was performed in PubMed, PsycINFO and CINAHL databases using PRISMA guidelines in May 2013. Publications on non-adherence in PD were selected by two reviewers independently according to predefined inclusion and exclusion criteria. Relevant data on patient characteristics, measures, rates and factors associated with non-adherence were extracted. The quality of studies was also evaluated independently by two reviewers according to a revised version of the Effective Public Health Practice Project assessment tool. The search retrieved 204 studies, of which a total of 25 studies met inclusion criteria. Reported rates of non-adherence varied across studies: 2.6-53% for dialysis exchanges, 3.9-85% for medication, and 14.4-67% for diet/fluid restrictions. Methodological differences in measurement and definition of non-adherence underlie the observed variation. Factors associated with non-adherence that showed a degree of consistency were mostly socio-demographical, such as age, employment status, ethnicity, sex, and time period on PD treatment. Non-adherence to different dimensions of the dialysis regimen appears to be prevalent in PD patients. There is a need for further, high-quality research to explore these factors in more detail, with the aim of informing intervention designs to facilitate adherence in this patient population.

The GED4GEM project: development of a Global Exposure Database for the Global Earthquake Model initiative

Science.gov (United States)

Gamba, P.; Cavalca, D.; Jaiswal, K.S.; Huyck, C.; Crowley, H.

2012-01-01

In order to quantify earthquake risk of any selected region or a country of the world within the Global Earthquake Model (GEM) framework (www.globalquakemodel.org/), a systematic compilation of building inventory and population exposure is indispensable. Through the consortium of leading institutions and by engaging the domain-experts from multiple countries, the GED4GEM project has been working towards the development of a first comprehensive publicly available Global Exposure Database (GED). This geospatial exposure database will eventually facilitate global earthquake risk and loss estimation through GEM’s OpenQuake platform. This paper provides an overview of the GED concepts, aims, datasets, and inference methodology, as well as the current implementation scheme, status and way forward.

Global Software and IT A Guide to Distributed Development, Projects, and Outsourcing

CERN Document Server

Ebert, Christof

2011-01-01

Global software engineering, implying both internal and outsourced development, is a fast-growing scenario within industry; the growth rates in some sectors are more than 20% per year. However, half of all offshoring activities are cancelled within the first 2 years, at tremendous unanticipated cost to the organization.   This book will provide a more balanced framework for planning global development, covering topics such as managing people in distributed sites, managing a project across locations, mitigating the risk of offshoring, processes for global development, practical outsourcin

Adherence policy, education and practice – an international perspective

Directory of Open Access Journals (Sweden)

Schneider MP

2010-12-01

Full Text Available Nonadherence to chronic therapy has become a large burden on the healthcare system of many countries. Community pharmacists are well positioned to address nonadherence as part of their overall patient care activities, and contribute to patients’ quality use of medicines. Between 2008 and 2010, a series of narrative, peer-reviewed articles were published in Pharmacy Practice which focused on community pharmacists’ activities in medication adherence, specifically in the areas of the education they receive, their practice, the research conducted and national or local policies. This editorial aims to summarise the key findings presented in the series, and highlight the pertinent issues and gaps in the literature. There is a need to implement global and long-term objectives focussing on enhancing the quality of education and competencies of community pharmacists and the research conducted in medication adherence, to develop guidelines for pharmacists and enhance the uptake of adherence promoting services in routine care.  

Perspectives Regarding Adherence to Prescribed Treatment in Highly Adherent HIV-Infected Gay Men.

Science.gov (United States)

Brion, John M; Menke, Edna M

2008-01-01

Focus group methodology was used to describe the medication adherence experience of 24 HIV-infected gay men who reported being adherent to their medication regimens. A conceptualization of medication adherence as an evolving process consisted of challenges to adherence (learning the diagnosis, starting the medications, struggling with the medications, dealing with side effects, coping with stigma) as well as those factors supportive of adherence (believing in medications, finding motivating factors, using reminders, depending on others, owning the disease). Themes associated with challenges to adherence focused on diagnosis and the physical and emotional adjustments individuals made to incorporate antiretroviral medications into their daily lives and move toward medication adherence. The factors supportive of adherence were related to the ongoing behaviors identified with establishing and maintaining adherence behaviors. What can be taken from the study is that adherence is a complex and dynamic process rather than a static behavior.

A global cleanout project

International Nuclear Information System (INIS)

Edlow, J.; Gruber, G.

2004-01-01

Once upon a time there was a great dream of a atomic age for mankind. The technically advanced nations of the world promised amazing opportunities for all and promoted their materials and equipment often by supplying them throughout the world in the race to gain market share. For a time, the dream was fulfilled, as many countries embraced the new technologies initially for research and later for medical, power and even transport opportunities. In due course, the demand subsided and in some countries has even been reversed with plans to terminate outdated or unneeded facilities. This brings up the issue of nuclear waste disposal. It was not until post 'Sept 11', that the US and other countries and NGOs began to seriously think about the larger implications of terrorist use of 'Dirty Bombs'. This has led to the potential of a wider program aimed at the possible return of a larger amount of 'abandoned' materials. Thus the 'GLOBAL CLEANOUT PROJECT' was borne. Many in the nuclear fuel cycle will have a stake in this and can play a role in an international community to deal with the issue and it has to be started now. (author)

Predicting Malawian Women's Intention to Adhere to Antiretroviral Therapy.

Science.gov (United States)

McKinney, Ogbochi; Modeste, Naomi N; Lee, Jerry W; Gleason, Peter C

2015-07-16

With the increase in scaling up of antiretroviral therapy (ART), knowledge of the need for adherence to ART is pivotal for successful treatment outcomes. A cross-sectional study was carried out between October and December 2013. We administered theory of planned behaviour (TPB) and adherence questionnaires to 358 women aged 18-49 years, from a rural and urban ART-clinics in southern Malawi. Hierarchical linear regression models were used to predict intentions to adhere to ART. Regression models show that attitude (β=0.47), subjective norm (β=0.31) and perceived behavioural control (β=0.12) explain 55% of the variance in intentions to adhere to ART. The relationship between both food insecurity and perceived side effects with intentions to adhere to ART is mediated by attitude, subjective norm, and perceived behavioural control. Household (r=0.20) and individual (r=0.21) food insecurity were positively and significantly correlated with perceived behavioural control. Household food insecurity had a negative correlation with perceived side effects (r=-0.11). Perceived side effects were positively correlated with attitude (r=0.25). There was no statistically significant relationship between intentions to adhere to ART in the future and one month self-report of past month adherence. These interactions suggest that attitude predicted adherence only when food insecurity is high or perception of side effects is strong. This study shows that modification might be needed when using TPB constructs in resource constraint environments. Significance for public healthThe knowledge of the rates of adherence to antiretroviral therapy (ART) could be used to evaluate planning and project, which could lead to better outcomes predicted by treatment efficacy data. In addition, knowledge of adherence behaviour could help the development of interventions focusing on collaboration between healthcare providers and Malawian government to provide food support for patients on ART. The

Association Between Adherence to Statins, Illness Perception, Treatment Satisfaction, and Quality of Life among Lebanese patients.

Science.gov (United States)

Haddad, Christine; Hallit, Souheil; Salhab, Mohammad; Hajj, Aline; Sarkis, Antoine; Nasser Ayoub, Eliane; Jabbour, Hicham; Rabbaa Khabbaz, Lydia

2018-01-01

The main objective of this study was to evaluate treatment adherence to statin and health-related quality of life (QOL) in Lebanese patients with dyslipidemia. Secondary objectives were to examine associations between treatment adherence, QOL, treatment satisfaction, and illness perception. This cross-sectional study, conducted in 20 community pharmacies from all districts of Lebanon between August 2016 and April 2017, enrolled 247 adult patients taking any statin. The mean age of the participants was 52.63 ± 11.92 years (57.5% males); the mean duration of treatment with a statin was 59.72 months. A significant association was found between adherence and marital status ( P salary, the marital status, the educational level, smoking cigarettes or waterpipes, and drinking alcohol were all associated with the Illness Perception Questionnaire scores ( P < 0.0001 for all variables). Secondary level of education (β = 13.43), smoking more than 3 waterpipes per week (β = 14.06), global satisfaction score (β = 0.32), convenience score (β = 0.29), and effectiveness score (β = 0.27) would significantly increase the adherence score. Smoking more than 15 cigarettes per day (β = -11.15) and a divorced status (β = -14.81) would however significantly decrease the adherence score. Significant associations were found between the illness perception score, the QOL domains, and the satisfaction domains ( P < .05 for all variables). This study showed that global satisfaction with treatment, convenience, and effectiveness are important factors that increase treatment adherence. Patient adherence results in patient satisfaction and improved QOL and is an important criterion for achieving desired therapeutic outcomes.

High-resolution global climate modelling: the UPSCALE project, a large-simulation campaign

Directory of Open Access Journals (Sweden)

M. S. Mizielinski

2014-08-01

Full Text Available The UPSCALE (UK on PRACE: weather-resolving Simulations of Climate for globAL Environmental risk project constructed and ran an ensemble of HadGEM3 (Hadley Centre Global Environment Model 3 atmosphere-only global climate simulations over the period 1985–2011, at resolutions of N512 (25 km, N216 (60 km and N96 (130 km as used in current global weather forecasting, seasonal prediction and climate modelling respectively. Alongside these present climate simulations a parallel ensemble looking at extremes of future climate was run, using a time-slice methodology to consider conditions at the end of this century. These simulations were primarily performed using a 144 million core hour, single year grant of computing time from PRACE (the Partnership for Advanced Computing in Europe in 2012, with additional resources supplied by the Natural Environment Research Council (NERC and the Met Office. Almost 400 terabytes of simulation data were generated on the HERMIT supercomputer at the High Performance Computing Center Stuttgart (HLRS, and transferred to the JASMIN super-data cluster provided by the Science and Technology Facilities Council Centre for Data Archival (STFC CEDA for analysis and storage. In this paper we describe the implementation of the project, present the technical challenges in terms of optimisation, data output, transfer and storage that such a project involves and include details of the model configuration and the composition of the UPSCALE data set. This data set is available for scientific analysis to allow assessment of the value of model resolution in both present and potential future climate conditions.

Evaluation of Adherence to Nutritional Intervention Through Trajectory Analysis.

Science.gov (United States)

Sevilla-Villanueva, B; Gibert, K; Sanchez-Marre, M; Fito, M; Covas, M I

2017-05-01

Classical pre-post intervention studies are often analyzed using traditional statistics. Nevertheless, the nutritional interventions have small effects on the metabolism and traditional statistics are not enough to detect these subtle nutrient effects. Generally, this kind of studies assumes that the participants are adhered to the assigned dietary intervention and directly analyzes its effects over the target parameters. Thus, the evaluation of adherence is generally omitted. Although, sometimes, participants do not effectively adhere to the assigned dietary guidelines. For this reason, the trajectory map is proposed as a visual tool where dietary patterns of individuals can be followed during the intervention and can also be related with nutritional prescriptions. The trajectory analysis is also proposed allowing both analysis: 1) adherence to the intervention and 2) intervention effects. The analysis is made by projecting the differences of the target parameters over the resulting trajectories between states of different time-stamps which might be considered either individually or by groups. The proposal has been applied over a real nutritional study showing that some individuals adhere better than others and some individuals of the control group modify their habits during the intervention. In addition, the intervention effects are different depending on the type of individuals, even some subgroups have opposite response to the same intervention.

Non-adherence in patients on peritoneal dialysis: a systematic review.

Directory of Open Access Journals (Sweden)

Konstadina Griva

Full Text Available BACKGROUND: It has been increasingly recognized that non-adherence is an important factor that determines the outcome of peritoneal dialysis (PD therapy. There is therefore a need to establish the levels of non-adherence to different aspects of the PD regimen (dialysis procedures, medications, and dietary/fluid restrictions. METHODS: A systematic review of peer-reviewed literature was performed in PubMed, PsycINFO and CINAHL databases using PRISMA guidelines in May 2013. Publications on non-adherence in PD were selected by two reviewers independently according to predefined inclusion and exclusion criteria. Relevant data on patient characteristics, measures, rates and factors associated with non-adherence were extracted. The quality of studies was also evaluated independently by two reviewers according to a revised version of the Effective Public Health Practice Project assessment tool. RESULTS: The search retrieved 204 studies, of which a total of 25 studies met inclusion criteria. Reported rates of non-adherence varied across studies: 2.6-53% for dialysis exchanges, 3.9-85% for medication, and 14.4-67% for diet/fluid restrictions. Methodological differences in measurement and definition of non-adherence underlie the observed variation. Factors associated with non-adherence that showed a degree of consistency were mostly socio-demographical, such as age, employment status, ethnicity, sex, and time period on PD treatment. CONCLUSION: Non-adherence to different dimensions of the dialysis regimen appears to be prevalent in PD patients. There is a need for further, high-quality research to explore these factors in more detail, with the aim of informing intervention designs to facilitate adherence in this patient population.

Non-Adherence in Patients on Peritoneal Dialysis: A Systematic Review

Science.gov (United States)

Griva, Konstadina; Lai, Alden Yuanhong; Lim, Haikel Asyraf; Yu, Zhenli; Foo, Marjorie Wai Yin; Newman, Stanton P.

2014-01-01

Background It has been increasingly recognized that non-adherence is an important factor that determines the outcome of peritoneal dialysis (PD) therapy. There is therefore a need to establish the levels of non-adherence to different aspects of the PD regimen (dialysis procedures, medications, and dietary/fluid restrictions). Methods A systematic review of peer-reviewed literature was performed in PubMed, PsycINFO and CINAHL databases using PRISMA guidelines in May 2013. Publications on non-adherence in PD were selected by two reviewers independently according to predefined inclusion and exclusion criteria. Relevant data on patient characteristics, measures, rates and factors associated with non-adherence were extracted. The quality of studies was also evaluated independently by two reviewers according to a revised version of the Effective Public Health Practice Project assessment tool. Results The search retrieved 204 studies, of which a total of 25 studies met inclusion criteria. Reported rates of non-adherence varied across studies: 2.6–53% for dialysis exchanges, 3.9–85% for medication, and 14.4–67% for diet/fluid restrictions. Methodological differences in measurement and definition of non-adherence underlie the observed variation. Factors associated with non-adherence that showed a degree of consistency were mostly socio-demographical, such as age, employment status, ethnicity, sex, and time period on PD treatment. Conclusion Non-adherence to different dimensions of the dialysis regimen appears to be prevalent in PD patients. There is a need for further, high-quality research to explore these factors in more detail, with the aim of informing intervention designs to facilitate adherence in this patient population. PMID:24586478

Religious affiliation at time of death - Global estimates and projections.

Science.gov (United States)

Skirbekk, Vegard; Todd, Megan; Stonawski, Marcin

2018-03-01

Religious affiliation influences societal practices regarding death and dying, including palliative care, religiously acceptable health service procedures, funeral rites and beliefs about an afterlife. We aimed to estimate and project religious affiliation at the time of death globally, as this information has been lacking. We compiled data on demographic information and religious affiliation from more than 2500 surveys, registers and censuses covering 198 nations/territories. We present estimates of religious affiliation at the time of death as of 2010, projections up to and including 2060, taking into account trends in mortality, religious conversion, intergenerational transmission of religion, differential fertility, and gross migration flows, by age and sex. We find that Christianity continues to be the most common religion at death, although its share will fall from 37% to 31% of global deaths between 2010 and 2060. The share of individuals identifying as Muslim at the time of death increases from 21% to 24%. The share of religiously unaffiliated will peak at 17% in 2035 followed by a slight decline thereafter. In specific regions, such as Europe, the unaffiliated share will continue to rises from 14% to 21% throughout the period. Religious affiliation at the time of death is changing globally, with distinct regional patterns. This could affect spatial variation in healthcare and social customs relating to death and dying.

Mediterranean Agricultural Soil Conservation under global Change: The MASCC project.

Science.gov (United States)

Raclot, Damien; Ciampalini, Rossano

2017-04-01

The MASCC project (2016-2019, http://mascc-project.org) aims to address mitigation and adaptation strategies to global change by assessing current and future development of Mediterranean agricultural soil vulnerability to erosion in relation to projected land use, agricultural practices and climate change. It targets to i) assess the similarities/dissimilarities in dominant factors affecting the current Mediterranean agricultural soil vulnerability by exploring a wide range of Mediterranean contexts; ii) improve the ability to evaluate the impact of extreme events on both the current and projected agricultural soil vulnerability and the sediment delivery at catchment outlet; iii) evaluate the vulnerability and resilience of agricultural production to a combination of potential changes in a wide range of Mediterranean contexts, iv) and provide guidelines on sustainable agricultural conservation strategies adapted to each specific agro-ecosystem and taking into consideration both on- and off-site erosion effects and socio-economics issues. To achieve these objectives, the MASCC project consortium gather researchers from six Mediterranean countries (France, Morocco, Tunisia, Italy, Spain and Portugal) which monitor mid- to long-term environmental catchments and benefit from mutual knowledge created from previous projects and network. The major assets for MASCC are: i) the availability of an unrivalled database on catchment soil erosion and innovative agricultural practices comprising a wide range of Mediterranean contexts, ii) the capacity to better evaluate the impact of extreme events on soil erosion, iii) the expert knowledge of the LANDSOIL model, a catchment-scale integrated approach of the soil-landscape system that enables to simulate both the sediment fluxes at the catchment outlet and the intra-catchment soil evolving properties and iv) the multi-disciplinarity of the involved researchers with an international reputation in the fields of soil science

Lithium Resources and Production: Critical Assessment and Global Projections

Directory of Open Access Journals (Sweden)

Steve H. Mohr

2012-03-01

Full Text Available This paper critically assesses if accessible lithium resources are sufficient for expanded demand due to lithium battery electric vehicles. The ultimately recoverable resources (URR of lithium globally were estimated at between 19.3 (Case 1 and 55.0 (Case 3 Mt Li; Best Estimate (BE was 23.6 Mt Li. The Mohr 2010 model was modified to project lithium supply. The Case 1 URR scenario indicates sufficient lithium for a 77% maximum penetration of lithium battery electric vehicles in 2080 whereas supply is adequate to beyond 2200 in the Case 3 URR scenario. Global lithium demand approached a maximum of 857 kt Li/y, with a 100% penetration of lithium vehicles, 3.5 people per car and 10 billion population.

GMMIP (v1.0) contribution to CMIP6: Global Monsoons Model Inter-comparison Project

Energy Technology Data Exchange (ETDEWEB)

Zhou, Tianjun; Turner, Andrew G.; Kinter, James L.; Wang, Bin; Qian, Yun; Chen, Xiaolong; Wu, Bo; Wang, Bin; Liu, Bo; Zou, Liwei; He, Bian

2016-10-10

The Global Monsoons Model Inter-comparison Project (GMMIP) has been endorsed by the panel of Coupled Model Inter-comparison Project (CMIP) as one of the participating model inter-comparison projects (MIPs) in the sixth phase of CMIP (CMIP6). The focus of GMMIP is on monsoon climatology, variability, prediction and projection, which is relevant to four of the “Grand Challenges” proposed by the World Climate Research Programme. At present, 21 international modeling groups are committed to joining GMMIP. This overview paper introduces the motivation behind GMMIP and the scientific questions it intends to answer. Three tiers of experiments, of decreasing priority, are designed to examine (a) model skill in simulating the climatology and interannual-to-multidecadal variability of global monsoons forced by the sea surface temperature during historical climate period; (b) the roles of the Interdecadal Pacific Oscillation and Atlantic Multidecadal Oscillation in driving variations of the global and regional monsoons; and (c) the effects of large orographic terrain on the establishment of the monsoons. The outputs of the CMIP6 Diagnostic, Evaluation and Characterization of Klima experiments (DECK), “historical” simulation and endorsed MIPs will also be used in the diagnostic analysis of GMMIP to give a comprehensive understanding of the roles played by different external forcings, potential improvements in the simulation of monsoon rainfall at high resolution and reproducibility at decadal timescales. The implementation of GMMIP will improve our understanding of the fundamental physics of changes in the global and regional monsoons over the past 140 years and ultimately benefit monsoons prediction and projection in the current century.

Biomass burning studies and the International Global Atmospheric Chemistry (IGAC) Project

International Nuclear Information System (INIS)

Prinn, R.G.

1991-01-01

The perturbations to local and regional atmospheric chemistry caused by biomass burning also have global significance. The International Global Atmospheric Chemistry (IGAC) Project was created by scientists from over twenty countries in response to the growing interest concern about atmospheric chemical changes and their potential impact on mankind. The goal of the IGAC is to develop a fundamental understanding of the natural and anthropogenic processes that determine the chemical composition of the atmosphere and the interactions between atmospheric composition and biospheric and climatic processes. A specific objective is to accurately predict changes over the next century in the composition and chemistry of the global atmosphere. Current activities, leaders and scientists involved are presented in this chapter

The Sea Around Us Project: documenting and communicating global fisheries impacts on marine ecosystems.

Science.gov (United States)

Pauly, Daniel

2007-06-01

The Sea Around Us Project, initiated by the Pew Charitable Trusts in Philadelphia, PA, and located at the Fisheries Centre, University of British Columbia, Vancouver, Canada, started in mid 1999. Its goal was (and still is) to investigate the impact of fisheries on marine ecosystems and to propose policies to mitigate these impacts. Although conceived as a global activity, the project first emphasized the data-rich North Atlantic as a test bed for developing its approaches, which rely on mapping of catch data and indicators of ecosystem health derived from the analysis of long catch time series data. Initial achievements included mapping the decline, throughout the North Atlantic basin, of high-trophic level fishes from 1900 to the present and the presentation of compelling evidence of change in the functioning of the North Atlantic ecosystems, summarized in a 2003 book. The Central and South Atlantic were the next basins to be tackled, with emphasis on the distant-water fleet off West Africa, culminating in a major conference in Dakar, Senegal, in 2002. The project then emphasized the North Pacific, Antarctica, and marine mammals and the multiplicity of tropical Indo-Pacific fisheries before it turned completely global, with all our major analyses and reports (e.g., on the interactions between marine mammals and fisheries, on fuel consumption by fleets, on the catches of small-scale fisheries, on subsidies to fisheries) being based on global studies. Broadly, the work of the project is aimed at a reappraisal of fisheries, from the benign activity that many interested people still perceive them to be, to a realization that they have become the driver for massive loss of biodiversity in the ocean. Moreover, the emphasis on global estimates (rather than local estimates of dubious generality) has allowed the project to contribute to various global initiatives (e.g., developing the Marine Trophic Index for the Convention on Biological Diversity, quantifying marine

Assessment of global and individual reproducibility of projective mapping with consumers

OpenAIRE

VIDAL, LETICIA; CADENA, RAFAEL SILVA; CORREA, SILVANA; ÁBALOS, ROSA A.; GÓMEZ, BEATRIZ; GIMÉNEZ, ANA; Varela, Paula; Ares, Gaston

2014-01-01

The popularity of projective mapping with consumers for sensory characterization has markedly increased in the last 5 years. To have confidence in this methodology,it is necessary to ensure that a similar product profile would emerge if the test was repeated. Also, deciding whether the study should be replicated or not is a key issue in test implementation. In this context, the aim of the present work was to evaluate global and individual reproducibility of projective mapping for sensory char...

Global projections of drought hazard in a warming climate: a prime for disaster risk management

Science.gov (United States)

Carrão, Hugo; Naumann, Gustavo; Barbosa, Paulo

2018-03-01

Projections of drought hazard ( dH) changes have been mapped from five bias-corrected climate models and analyzed at the global level under three representative concentration pathways (RCPs). The motivation for this study is the observation that drought risk is increasing globally and the effective regulation of prevention and adaptation measures depends on dH magnitude and its distribution for the future. Based on the Weighted Anomaly of Standardized Precipitation index, dH changes have been assessed for mid-(2021-2050) and late-century (2071-2099). With a few exceptions, results show a likely increase in global dH between the historical years (1971-2000) and both future time periods under all RCPs. Notwithstanding this worsening trend, it was found that projections of dH changes for most regions are neither robust nor significant in the near-future. By the end of the century, greater increases are projected for RCPs describing stronger radiative forcing. Under RCP8.5, statistically significant dH changes emerge for global Mediterranean ecosystems and the Amazon region, which are identified as possible hotspots for future water security issues. Taken together, projections of dH changes point towards two dilemmas: (1) in the near-term, stake-holders are left worrying about projected increasing dH over large regions, but lack of actionable model agreement to take effective decisions related to local prevention and adaptation initiatives; (2) in the long-term, models demonstrate remarkable agreement, but stake-holders lack actionable knowledge to manage potential impacts far distant from actual human-dominated environments. We conclude that the major challenge for risk management is not to adapt human populations or their activities to dH changes, but to progress on global initiatives that mitigate their impacts in the whole carbon cycle by late-century.

The global sustainability project and the LLNL China energy systems model

International Nuclear Information System (INIS)

Harris, N; Lamont, A; Stewart, J; Woodrow, C.

1999-01-01

The sustainability of our modern way of life is becoming a major concern of both our domestic and international policy. The Rio conference on the environment and the recent Kyoto conference on global climate change are two indications of the importance of solving global environmental problem. Energy is a key component in global sustainability since obtaining and using it has major environmental effects. If our energy systems are to be sustainable in the long run, they must be structured using technologies that have a minimal impact on our environment and resources. At the same time, they must meet practical economic requirements: they must be reasonably economical, they must meet the needs of society and they must be tailored to the resources that are available in a particular region or country. Because economic considerations and government policies both determine the development of the energy system, economic and systems modeling can help us better understand ways that new technologies and policies can be used to obtain a more sustainable system. The Global Sustainability Project has developed both economic modeling software and models to help us better understand these issues and has applied them to the analysis of energy and environmental problems in China. In the past year, the models and data developed by the project have been used to support other projects investigating the interaction of technologies and the environment. The project this year has focused on software development to improve our modeling tools and on the refinement and application of the China Energy System model. The major thrust of the software development has been improvements in the METANet economic software system. We have modified its solution algorithm to improve speed and accuracy of the solutions and to make it compatible with the SuperCode modeling system. It is planned to eventually merge the two systems to take advantage of the faster, more flexible solution algorithms of Super

Facilitators and barriers to antiretroviral therapy adherence among adolescents in Ghana

NARCIS (Netherlands)

Ankrah, D.; Koster, E.S.; Teeuwisse, A.K.; Arhinful, D.K.; Agyepong, I.A.; Lartey, Margaret

2016-01-01

INTRODUCTION: Adherence to antiretroviral therapy (ART) is known to be challenging among adolescents living with HIV/AIDS, notwithstanding the life-saving importance of this therapy. Of the global total number of adolescents living with HIV in 2013, 83% reside in sub-Saharan Africa. The study aimed

Medication Adherence Among Elderly Patients with High Blood Pressure in Gweru, Zimbabwe.

Science.gov (United States)

Wariva, Elizabeth; January, James; Maradzika, Julita

2014-02-04

High blood pressure is a global health concern which is mainly managed by taking anti-hypertensive medications. Although medication is available to control high blood pressure, adhering to treatment is a major problem among hypertensive patients. The purpose of the study was to assess the predisposing, enabling and reinforcing factors to medication adherence among hypertensive patients in Gweru urban aged 40-70 years. A descriptive cross sectional study was used with a sample size of 110 conveniently sampled hypertensive patients. We used an interviewer administered questionnaire designed using phase 4 of the PRECEDE model. The modal age was 70 years and mean age was 58 years (SD=10.29). There were 61.8% females and 38.2% males. Variables associated with medication adherence were: age (P=0.0059), marital status (P=0.015), average monthly income (P=0.0002), support group (P=0.027) and knowledge (P=0.0058). Providing information to patients with high blood pressure and having a good patient-provider relationship improves medication adherence. There is need to focus on the predisposing, enabling and reinforcing factors of medication adherence since demographic and socio-economic factors may be more difficult to change.

Projections of global emissions of fluorinated greenhouse gases in 2050

Energy Technology Data Exchange (ETDEWEB)

Gschrey, Barbara; Schwarz, Winfried [Oeko-Recherche Buero fuer Umweltforschung und -beratung GmbH, Frankfurt/Main (Germany)

2009-11-15

Emissions of fluorinated greenhouse gases are currently covered under the Montreal Protocol, which focuses on ozone-depleting substances such as CFCs (chlorofluorocarbons) and HCFCs (hydrochlorofluorocarbons), and under the Kyoto Protocol, which controls emissions of HFCs (hydrofluorocarbons), PFCs (perfluorocarbons) and SF{sub 6} (sulfur hexafluoride). This study bridges the gap between political regimes and their reporting systems by giving an overview of banks and emissions of all fluorinated gases in 2005, and projections of banks and emissions of fluorinated gases in 2050. The Montreal Protocol and its amendments will eventually result in the full phase out of CFCs and HCFCs. Developed countries have already completed the phase out of CFCs and will reach full phase out of HCFCs by 2020. Developing countries, in contrast, will phase out CFCs by 2010 and HCFCs by 2030. Although climate-friendly technology is available for most applications, the risk occurs that substitutes for ozone-depleting substances rely on HFCs, which cause global warming. This study determines global emissions of HFCs, PFCs and SF{sub 6} (Kyoto F-gases) in 2050 in a ''business-as-usual'' scenario. The global population is expected to increase to ca. 8.7 billion people, and high economic growth of 3.5% per year is assumed. Emissions in 2050 are quantified for each sector of application as well as for developed and developing countries based on growth rates of each sector. In 2050, total global emissions of fluorinated greenhouse gases are projected to amount to 4 GT CO{sub 2} eq. which equals ca. 5.9% of the total greenhouse gas emissions at this time. Compared to a relatively small share of F-gas emissions ranging around 1.3% of total greenhouse gas emissions in 2004, this percentage reflects an enormous increase. Relative to projected direct CO{sub 2} emissions alone, the 2050 F-gas emissions will even account for ca. 7.9%. In case of CO{sub 2} mitigation, this share

Globalization of nuclear activities and global governance

International Nuclear Information System (INIS)

Sefidvash, Farhang

1997-01-01

The safe production of nuclear energy as well as the disarmament of nuclear weapons and the peaceful utilization of nuclear materials resulting from dismantling of such weapons are some of the formidable problems of global governance. The Commission on Global Governance was established in 1992 in the belief that international developments had created a unique opportunity for strengthening global co-operation to meet the challenge of securing peace, achieving sustainable development, and universalizing democracy. Here a summary of their proposals on the globalization of nuclear activities to face challenges of the coming century is given. To follow up their activities by the worlds community in general. The research Centre for Global Governance (RCGG) at the Federal University of Rio Grande do Sul was established. Already a great number of researchers from many different countries have adhered to the Centre. Here the program of the RCGG is described. (author)

Globalization of nuclear activities and global governance

Energy Technology Data Exchange (ETDEWEB)

Sefidvash, Farhang [Rio Grande do Sul Univ., Porto Alegre, RS (Brazil). Dept. de Engenharia Nuclear

1997-07-01

The safe production of nuclear energy as well as the disarmament of nuclear weapons and the peaceful utilization of nuclear materials resulting from dismantling of such weapons are some of the formidable problems of global governance. The Commission on Global Governance was established in 1992 in the belief that international developments had created a unique opportunity for strengthening global co-operation to meet the challenge of securing peace, achieving sustainable development, and universalizing democracy. Here a summary of their proposals on the globalization of nuclear activities to face challenges of the coming century is given. To follow up their activities by the worlds community in general. The research Centre for Global Governance (RCGG) at the Federal University of Rio Grande do Sul was established. Already a great number of researchers from many different countries have adhered to the Centre. Here the program of the RCGG is described. (author)

Kenya public weather processed by the Global Yield Gap Atlas project

NARCIS (Netherlands)

Groot, de Hugo; Adimo, Ochieng; Claessens, Lieven; Wart, Van Justin; Bussel, van Lenny G.J.; Grassini, Patricio; Wolf, Joost; Guilpart, Nicolas; Boogaard, Hendrik; Oort, van Pepijn A.J.; Yang, Haishun S.; Ittersum, van Martin K.; Cassman, Kenneth G.

2017-01-01

The Global Yield Gap Atlas project (GYGA - http://yieldgap.org) has undertaken a yield gap assessment following the protocol recommended by van Ittersum et al. (2013). One part of the activities consists of collecting and processing weather data as an input for crop simulation models in sub-Saharan

Barriers and facilitators of interventions for improving antiretroviral therapy adherence: a systematic review of global qualitative evidence.

Science.gov (United States)

Ma, Qingyan; Tso, Lai Sze; Rich, Zachary C; Hall, Brian J; Beanland, Rachel; Li, Haochu; Lackey, Mellanye; Hu, Fengyu; Cai, Weiping; Doherty, Meg; Tucker, Joseph D

2016-01-01

Qualitative research on antiretroviral therapy (ART) adherence interventions can provide a deeper understanding of intervention facilitators and barriers. This systematic review aims to synthesize qualitative evidence of interventions for improving ART adherence and to inform patient-centred policymaking. We searched 19 databases to identify studies presenting primary qualitative data on the experiences, attitudes and acceptability of interventions to improve ART adherence among PLHIV and treatment providers. We used thematic synthesis to synthesize qualitative evidence and the CERQual (Confidence in the Evidence from Reviews of Qualitative Research) approach to assess the confidence of review findings. Of 2982 references identified, a total of 31 studies from 17 countries were included. Twelve studies were conducted in high-income countries, 13 in middle-income countries and six in low-income countries. Study populations focused on adults living with HIV (21 studies, n =1025), children living with HIV (two studies, n =46), adolescents living with HIV (four studies, n =70) and pregnant women living with HIV (one study, n =79). Twenty-three studies examined PLHIV perspectives and 13 studies examined healthcare provider perspectives. We identified six themes related to types of interventions, including task shifting, education, mobile phone text messaging, directly observed therapy, medical professional outreach and complex interventions. We also identified five cross-cutting themes, including strengthening social relationships, ensuring confidentiality, empowerment of PLHIV, compensation and integrating religious beliefs into interventions. Our qualitative evidence suggests that strengthening PLHIV social relationships, PLHIV empowerment and developing culturally appropriate interventions may facilitate adherence interventions. Our study indicates that potential barriers are inadequate training and compensation for lay health workers and inadvertent disclosure of

Risk factors for antipsychotic medication non-adherence behaviors and attitudes in adult-onset psychosis.

Science.gov (United States)

Hui, Christy Lai Ming; Poon, Venessa Wing Yan; Ko, Wai Tung; Miao, Ho Yee; Chang, Wing Chung; Lee, Edwin Ho Ming; Chan, Sherry Kit Wa; Lin, Jingxia; Chen, Eric Yu Hai

2016-07-01

Research on antipsychotic medication non-adherence in first-episode psychosis patients tends to examine non-adherence behaviors and attitudes together. Nonetheless, attitudes do not always directly translate into behaviors. We examined the baseline predictors for antipsychotics non-adherence behaviors and attitudes separately in a first-episode psychosis cohort. We also included cognitive impairments as one of the predictor variables as this domain is rarely explored in adherence studies. Participants were 313 adult-onset psychosis patients recruited from the Jockey Club Early Psychosis project in Hong Kong. Demographic, premorbid, clinical, and cognitive characteristics were first assessed at baseline. Six months later, participants completed a 14-item Medication Compliance Questionnaire, which was a modified and Cantonese-translated version of the Medication Adherence Rating Scale that includes items pertaining to both adherence behaviors and attitudes. Rates of poor adherence behaviors and negative adherence attitudes were 17.6% and 27.8%, respectively. Determinants of poor adherence behavior included more severe positive symptoms, hospitalization at onset of illness, and poorer engagement in extended social network. As for negative adherence attitude, determinants included more severe general psychopathology, poorer insight, more psychic medication side-effects, and poorer performance on backward digit span test and WAIS-R information test. The risk factors for non-adherence behaviors and attitudes are different and they should all be taken into careful consideration while formulating appropriate intervention programs to tackle the adherence problem in adult onset psychosis. Copyright © 2016 Elsevier B.V. All rights reserved.

Factors affecting treatment adherence to atomoxetine in ADHD: a systematic review

Directory of Open Access Journals (Sweden)

Treuer T

2016-05-01

Full Text Available Tamás Treuer,1 Luis Méndez,2 William Montgomery,3 Shenghu Wu4 1Neuroscience Research, Eli Lilly and Company, Budapest, Hungary; 2Eli Lilly de Mexico, Mexico City, Mexico; 3Global Patient Outcomes and Real World Evidence, Eli Lilly Australia Pty Ltd, West Ryde, NSW, Australia; 4Neuroscience Research, Eli Lilly Asia, Inc, Shanghai, People’s Republic of China Abstract: The purpose of this paper was to systematically review the literature related to research about the factors affecting treatment adherence and discontinuation of atomoxetine in pediatric, adolescent, and adult patients with attention-deficit/hyperactivity disorder (ADHD. Medline was systematically searched using the following prespecified terms: “ADHD”, “Adherence”, “Compliance”, “Discontinuation”, and “Atomoxetine”. We identified 31 articles that met all inclusion and exclusion criteria. The findings from this review indicate that persistence and adherence to atomoxetine treatment were generally high. Factors found to influence adherence and nonadherence to atomoxetine treatment in ADHD in this review include age, sex, the definition of response used, length of treatment, initial dose of treatment, comorbid conditions, and reimbursement. Tolerability was cited as an important reason for treatment discontinuation. More research is needed to understand those factors that can help to identify patients at risk for poor adherence and interventions that could improve treatment adherence early in the stage of this illness to secure a better long-term prognosis. Keywords: atomoxetine, treatment discontinuation, adherence, compliance, ADHD medication, relapse

Impact of the Provider and Healthcare team Adherence to Treatment Guidelines (PHAT-G) intervention on adherence to national obesity clinical practice guidelines in a primary care centre.

Science.gov (United States)

Barnes, Emily R; Theeke, Laurie A; Mallow, Jennifer

2015-04-01

Obesity is significantly underdiagnosed and undertreated in primary care settings. The purpose of this clinical practice change project was to increase provider adherence to national clinical practice guidelines for the diagnosis and treatment of obesity in adults. Based upon the National Institutes of Health guidelines for the diagnosis and treatment of obesity, a clinical change project was implemented. Guided by the theory of planned behaviour, the Provider and Healthcare team Adherence to Treatment Guidelines (PHAT-G) intervention includes education sessions, additional provider resources for patient education, a provider reminder system and provider feedback. Primary care providers did not significantly increase on documentation of diagnosis and planned management of obesity for patients with body mass index (BMI) greater than or equal to 30. Medical assistants increased recording of height, weight and BMI in the patient record by 13%, which was significant. Documentation of accurate BMI should lead to diagnosis of appropriate weight category and subsequent care planning. Future studies will examine barriers to adherence to clinical practice guidelines for obesity. Interventions are needed that include inter-professional team members and may be more successful if delivered separately from routine primary care visits. © 2015 John Wiley & Sons, Ltd.

Cognitive Behavioral Therapy for Adherence and Depression (CBT-AD) in HIV-Infected Injection Drug Users: A Randomized Controlled Trial

Science.gov (United States)

Safren, Steven A.; O'Cleirigh, Conall M.; Bullis, Jacqueline R.; Otto, Michael W.; Stein, Michael D.; Pollack, Mark H.

2012-01-01

Objective: Depression and substance use, the most common comorbidities with HIV, are both associated with poor treatment adherence. Injection drug users comprise a substantial portion of individuals with HIV in the United States and globally. The present study tested cognitive behavioral therapy for adherence and depression (CBT-AD) in patients…

SONG-China Project: A Global Automated Observation Network

Science.gov (United States)

Yang, Z. Z.; Lu, X. M.; Tian, J. F.; Zhuang, C. G.; Wang, K.; Deng, L. C.

2017-09-01

Driven by advancements in technology and scientific objectives, data acquisition in observational astronomy has been changed greatly in recent years. Fully automated or even autonomous ground-based network of telescopes has now become a tendency for time-domain observational projects. The Stellar Observations Network Group (SONG) is an international collaboration with the participation and contribution of the Chinese astronomy community. The scientific goal of SONG is time-domain astrophysics such as asteroseismology and open cluster research. The SONG project aims to build a global network of 1 m telescopes equipped with high-precision and high-resolution spectrographs, and two-channel lucky-imaging cameras. It is the Chinese initiative to install a 50 cm binocular photometry telescope at each SONG node sharing the network platform and infrastructure. This work is focused on design and implementation in technology and methodology of SONG/50BiN, a typical ground-based network composed of multiple sites and a variety of instruments.

Distributed team cohesion – not an oxymoron. The impact of information and communications technologies on teamness in globally distributed IT projects

Directory of Open Access Journals (Sweden)

Olga Stawnicza

2015-01-01

Full Text Available Globally distributed IT projects are common practice in today’s globalized world. Typically, project team members’ work on interdependent tasks, with a common goal to be achieved as one team. However, being split between multiple locations impedes communication among team members and hampers the development of trust. Information and communications media enable communication between geographically distributed project team members and help to create and maintain trust within project units. Communication and trust are particularly significant for fostering a feeling of oneness among project team members. Oneness, also referred to as “teamness”, is repeatedly mentioned as one of the challenges facing global project teams. However, prior literature on teamness is very scarce and its importance is underrepresented. This research contributes to the field in two ways. First, the theoretical study based on a systematic literature review examines available evidence of teamness in globally distributed projects. Secondly, an empirical study based on interviews conducted with global project managers fills the current gap in literature on the link between use of ICT and establishing a sense of team unity. This paper draws practitioners’ attention to the importance of striving for teamness in spite of the geographical distance that exists between project team members.

Global Precipitation Climatology Project (GPCP) Climate Data Record (CDR), Version 2.3 (Monthly)

Data.gov (United States)

National Oceanic and Atmospheric Administration, Department of Commerce — The Global Precipitation Climatology Project (GPCP) consists of monthly satellite-gauge and associated precipitation error estimates and covers the period January...

Global protected area expansion is compromised by projected land-use and parochialism.

Science.gov (United States)

Montesino Pouzols, Federico; Toivonen, Tuuli; Di Minin, Enrico; Kukkala, Aija S; Kullberg, Peter; Kuusterä, Johanna; Lehtomäki, Joona; Tenkanen, Henrikki; Verburg, Peter H; Moilanen, Atte

2014-12-18

Protected areas are one of the main tools for halting the continuing global biodiversity crisis caused by habitat loss, fragmentation and other anthropogenic pressures. According to the Aichi Biodiversity Target 11 adopted by the Convention on Biological Diversity, the protected area network should be expanded to at least 17% of the terrestrial world by 2020 (http://www.cbd.int/sp/targets). To maximize conservation outcomes, it is crucial to identify the best expansion areas. Here we show that there is a very high potential to increase protection of ecoregions and vertebrate species by expanding the protected area network, but also identify considerable risk of ineffective outcomes due to land-use change and uncoordinated actions between countries. We use distribution data for 24,757 terrestrial vertebrates assessed under the International Union for the Conservation of Nature (IUCN) 'red list of threatened species', and terrestrial ecoregions (827), modified by land-use models for the present and 2040, and introduce techniques for global and balanced spatial conservation prioritization. First, we show that with a coordinated global protected area network expansion to 17% of terrestrial land, average protection of species ranges and ecoregions could triple. Second, if projected land-use change by 2040 (ref. 11) takes place, it becomes infeasible to reach the currently possible protection levels, and over 1,000 threatened species would lose more than 50% of their present effective ranges worldwide. Third, we demonstrate a major efficiency gap between national and global conservation priorities. Strong evidence is shown that further biodiversity loss is unavoidable unless international action is quickly taken to balance land-use and biodiversity conservation. The approach used here can serve as a framework for repeatable and quantitative assessment of efficiency, gaps and expansion of the global protected area network globally, regionally and nationally, considering

Insulin adherence behaviours and barriers in the multinational Global Attitudes of Patients and Physicians in Insulin Therapy study.

Science.gov (United States)

Peyrot, M; Barnett, A H; Meneghini, L F; Schumm-Draeger, P-M

2012-05-01

To examine patient and physician beliefs regarding insulin therapy and the degree to which patients adhere to their insulin regimens. Internet survey of 1250 physicians (600 specialists, 650 primary care physicians) who treat patients with diabetes and telephone survey of 1530 insulin-treated patients (180 with Type 1 diabetes, 1350 with Type 2 diabetes) in China, France, Japan, Germany, Spain, Turkey, the UK or the USA. One third (33.2%) of patients reported insulin omission/non-adherence at least 1 day in the last month, with an average of 3.3 days. Three quarters (72.5%) of physicians report that their typical patient does not take their insulin as prescribed, with a mean of 4.3 days per month of basal insulin omission/non-adherence and 5.7 days per month of prandial insulin omission/non-adherence. Patients and providers indicated the same five most common reasons for insulin omission/non-adherence: too busy; travelling; skipped meals; stress/emotional problems; public embarrassment. Physicians reported low patient success at initiating insulin in a timely fashion and adjusting insulin doses. Most physicians report that many insulin-treated patients do not have adequate glucose control (87.6%) and that they would treat more aggressively if not for concern about hypoglycaemia (75.5%). Although a majority of patients (and physicians) regard insulin treatment as restrictive, more patients see insulin treatment as having positive than negative impacts on their lives. Glucose control is inadequate among insulin-treated patients, in part attributable to insulin omission/non-adherence and lack of dose adjustment. There is a need for insulin regimens that are less restrictive and burdensome with lower risk of hypoglycaemia. © 2012 The Authors. Diabetic Medicine © 2012 Diabetes UK.

Exploring the Role of Social Software in Global Software Development Projects

DEFF Research Database (Denmark)

Giuffrida, Rosalba; Dittrich, Y.

2011-01-01

We present a PhD project that investigates the use of Social Software (SoSo) in Global Software Development (GSD) teams. Since SoSo in unstructured and informal in its own nature, we explore how informal communication, which is challenging in GSD, is supported by SoSo in distributed teams and how...

The Shaky Legal Foundations of the Global Human Rights Education Project

Science.gov (United States)

Vlaardingerbroek, Barend

2015-01-01

School students should be taught about the law and this includes rights education. The global human rights education (HRE) project focuses on universal human rights and has a strongly utopian orientation, drawing as it does on international declarations and principles of human rights law. International human rights law is, however, at best a…

Episodic medication adherence in adolescents and young adults with perinatally acquired HIV: a within-participants approach.

Science.gov (United States)

Hawkins, Amy; Evangeli, Michael; Sturgeon, Kate; Le Prevost, Marthe; Judd, Ali

2016-01-01

Due to the success of antiretroviral (ART) medications, young people living with perinatally acquired HIV (PHIV+) are now surviving into adolescence and young adulthood. Understanding factors influencing ART non-adherence in this group is important in developing effective adherence interventions. Most studies of ART adherence in HIV-positive populations assess differences in adherence levels and adherence predictors between participants, over a period of time (global adherence). Many individuals living with HIV, however, including PHIV+ young people, take medication inconsistently. To investigate this pattern of adherence, a within-participants design, focussing on specific episodes of adherence and non-adherence, is suitable (episodic adherence). A within-participants design was used with 29 PHIV+ young people (17 female, median age 17 years, range 14-22 years), enrolled in the UK Adolescents and Adults Living with Perinatal HIV cohort study. Participants were eligible if they could identify one dose of medication taken and one dose they had missed in the previous two months. For each of the two episodes (one adherent, one non-adherent), behavioural factors (whom they were with, location, routine, day, reminders) and psychological factors at the time of the episode (information about medication, adherence motivation, perceived behavioural skills to adhere to medication - derived from the Information-Motivation-Behavioural Skills (IMB) Model - and affect) were assessed in a questionnaire. Non-adherence was significantly associated with weekend days (Friday to Sunday versus Monday to Thursday, p = .001), lack of routine (p = .004), and being out of the home (p = .003), but not with whom the young person was with or whether they were reminded to take medication. Non-adherence was associated with lower levels of behavioural skills (p ART, or ART motivation. The use of situationally specific strategies to enhance adherence in young people who take their

A GLOBAL ASSESSMENT OF SOLAR ENERGY RESOURCES: NASA's Prediction of Worldwide Energy Resources (POWER) Project

Science.gov (United States)

Zhang, T.; Stackhouse, P. W., Jr.; Chandler, W.; Hoell, J. M.; Westberg, D.; Whitlock, C. H.

2010-12-01

NASA's POWER project, or the Prediction of the Worldwide Energy Resources project, synthesizes and analyzes data on a global scale. The products of the project find valuable applications in the solar and wind energy sectors of the renewable energy industries. The primary source data for the POWER project are NASA's World Climate Research Project (WCRP)/Global Energy and Water cycle Experiment (GEWEX) Surface Radiation Budget (SRB) project (Release 3.0) and the Global Modeling and Assimilation Office (GMAO) Goddard Earth Observing System (GEOS) assimilation model (V 4.0.3). Users of the POWER products access the data through NASA's Surface meteorology and Solar Energy (SSE, Version 6.0) website (http://power.larc.nasa.gov). Over 200 parameters are available to the users. The spatial resolution is 1 degree by 1 degree now and will be finer later. The data covers from July 1983 to December 2007, a time-span of 24.5 years, and are provided as 3-hourly, daily and monthly means. As of now, there have been over 18 million web hits and over 4 million data file downloads. The POWER products have been systematically validated against ground-based measurements, and in particular, data from the Baseline Surface Radiation Network (BSRN) archive, and also against the National Solar Radiation Data Base (NSRDB). Parameters such as minimum, maximum, daily mean temperature and dew points, relative humidity and surface pressure are validated against the National Climate Data Center (NCDC) data. SSE feeds data directly into Decision Support Systems including RETScreen International clean energy project analysis software that is written in 36 languages and has greater than 260,000 users worldwide.

Correlates of Pediatric CPAP Adherence

Science.gov (United States)

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

2016-01-01

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

[Globalization, the Camisea Project and the Matsigenkas health].

Science.gov (United States)

Torres-Slimming, Paola

2010-09-01

Globalization has been the consequence of an important opening of the economies, achieved through the reduction in the obstacles to commerce, elimination of the capital controls and exchange restrictions. The impact of the Camisea Project in the Peruvian economy has aroused great interest and controversy with respect to the future social and economic national impact, and especially, in the Matsigenka population, located in the 88 and 56 lots, where gas extraction is being done. The area of Camisea gas exploitation offers the challenge of a complex sanitary problem, not only because of the impacts and risks produced by the hidrocarbon exploitation, but also due to a legacy of economical and sanitary precariousness that has accumulated from other times. At the same time, this area offers the opportunity to rethink the public health system according to the indigenous reality. It is necessary to take action in the social determinants of inequity and poverty in order to reach the positive effects the globalization can have in health, ensuring the interests of developing countries and vulnerable populations.

Risk factors for non-adherence to antidepressant treatment in patients with mood disorders.

Science.gov (United States)

De las Cuevas, Carlos; Peñate, Wenceslao; Sanz, Emilio J

2014-01-01

Adherence to antidepressant therapy by patients with depressive disorders is essential not only to achieve a positive patient outcome but also to prevent a relapse. The aim of this study was to identify potential modelling factors influencing adherence to antidepressant treatment by patients with mood disorders in the community mental health care setting A total of 160 consecutive psychiatric outpatients attending two Community Mental Health Centres on Tenerife Island between September 2011 and May 2012 were asked to participate in the study; of these, 145 accepted. The Morisky self-report scale was used to assess adherence. The potential predictors examined included socio-demographic, clinical and therapeutic variables. The Clinical Global Impression-Severity and -Improvement scales and the Beck Depression Inventory were used for clinical assessment. Drug treatment side-effects were assessed using the "Self-report Antidepressant Side-Effect Checklist." All participants were also asked to complete the "Drug Attitude Inventory" (DAI), "Beliefs about Medicine Questionnaire" (BMQ), and "Leeds Attitude towards concordance Scale". Discriminant analyses were performed to predict non-adherence. There was no clear correlation between adherence and the socio-demographic variables examined, but adherence was related to a positive attitude of the patients towards his/her treatment (DAI) and low scores in the BMQ-Harm and -Concern subscales. Non-adherence was also related to an increasing severity of depression and to the presence and severity of side-effects. Among our study cohort, the profiles of adherent patients to antidepressant treatment were more closely associated with each patient's attitudes and beliefs than to objective socio-demographic variables. The severity of depression played a relevant role in adherence, but whether this role is direct or an interaction with several concurrent factors is not yet clear. Side-effects were also closely related to adherence, as

Improving Adherence to Treatment and Reducing Economic Costs of Hypertension: The Role of Olmesartan-Based Treatment.

Science.gov (United States)

Costa, Francesco Vittorio

2017-09-01

Poor adherence to antihypertensive treatment is the single most important factor of unsatisfactory blood pressure (BP) control. This review focuses on therapy-related factors affecting adherence and suggests how to improve it with a wise choice of treatment schedule. Complex drug treatment schemes, poor tolerability and drug substitutions are frequent causes of poor adherence which, in turn, causes insufficient BP control, greater incidence of cardiovascular events and, finally, higher global health costs. The effects of prescribing generic drugs and of drug substitutions on adherence is also discussed. In terms of adherence, generic drugs do not seem to be better than branded drugs, unless patients have to bear very high "out of pocket" expenses to buy original drugs, suggesting no advantages in switching drug with the mere goal of reducing the cost of therapy. An important role in improving adherence (and thus cardiovascular events and health expenditure) is also played by the availability of fixed-dose combinations; among antihypertensive drugs, angiotensin receptor blockers (ARBs) are those associated with higher levels of adherence and persistence. Among ARBs, olmesartan stands out for a wide choice of effective fixed-dose combinations.

Detailed assessment of global transport-energy models’ structures and projections

Energy Technology Data Exchange (ETDEWEB)

Yeh, Sonia; Mishra, Gouri Shankar; Fulton, Lew; Kyle, Page; McCollum, David L.; Miller, Joshua; Cazzola, Pierpaolo; Teter, Jacob

2017-08-01

This paper focuses on comparing the frameworks and projections from four major global transportation models with considerable transportation technology and behavioral detail. We analyze and compare the modeling frameworks, underlying data, assumptions, intermediate parameters, and projections to identify the sources of divergence or consistency, as well as key knowledge gaps. We find that there are significant differences in the base-year data and key parameters for future projections, especially for developing countries. These include passenger and freight activity, mode shares, vehicle ownership rates, and even energy consumption by mode, particularly for shipping, aviation and trucking. This may be due in part to a lack of previous efforts to do such consistency-checking and “bench-marking.” We find that the four models differ in terms of the relative roles of various mitigation strategies to achieve a 2°C / 450 ppm CO2e target: the economics-based integrated assessment models favor the use of low carbon fuels as the primary mitigation option followed by efficiency improvements, whereas transport-only and expert-based models favor efficiency improvements of vehicles followed by mode shifts. We offer recommendations for future modeling improvements focusing on (1) reducing data gaps; (2) translating the findings from this study into relevant policy implications such as feasibility of current policy goals, additional policy targets needed, regional vs. global reductions, etc.; (3) modeling strata of demographic groups to improve understanding of vehicle ownership levels, travel behavior, and urban vs. rural considerations; and (4) conducting coordinated efforts in aligning input assumptions and historical data, policy analysis, and modeling insights.

U.S. Naval Academy Officials Did Not Adhere to Contracting and Gift Policies

Science.gov (United States)

2011-11-07

Report No. DODIG-2012-017 November 7, 2011 U.S. Naval Academy Officials Did Not Adhere to Contracting and Gift Policies...Contracting and Gift Policies 5a. CONTRACT NUMBER 5b. GRANT NUMBER 5c. PROGRAM ELEMENT NUMBER 6. AUTHOR(S) 5d. PROJECT NUMBER 5e. TASK NUMBER 5f. WORK...HERITAGE AND HISTORY COMMAND SUBJECT: U.S. Naval Academy Officials Did Not Adhere to Contracting and Gift Policies (Report No. DODIG-2012-017) We are

Predicting Malawian Women’s Intention to Adhere to Antiretroviral Therapy

Science.gov (United States)

McKinney, Ogbochi; Modeste, Naomi N.; Lee, Jerry W.; Gleason, Peter C.

2015-01-01

Background With the increase in scaling up of antiretroviral therapy (ART), knowledge of the need for adherence to ART is pivotal for successful treatment outcomes. Design and Methods A cross-sectional study was carried out between October and December 2013. We administered theory of planned behaviour (TPB) and adherence questionnaires to 358 women aged 18-49 years, from a rural and urban ART-clinics in southern Malawi. Hierarchical linear regression models were used to predict intentions to adhere to ART. Results Regression models show that attitude (β=0.47), subjective norm (β=0.31) and perceived behavioural control (β=0.12) explain 55% of the variance in intentions to adhere to ART. The relationship between both food insecurity and perceived side effects with intentions to adhere to ART is mediated by attitude, subjective norm, and perceived behavioural control. Household (r=0.20) and individual (r=0.21) food insecurity were positively and significantly correlated with perceived behavioural control. Household food insecurity had a negative correlation with perceived side effects (r=-0.11). Perceived side effects were positively correlated with attitude (r=0.25). There was no statistically significant relationship between intentions to adhere to ART in the future and one month self-report of past month adherence. These interactions suggest that attitude predicted adherence only when food insecurity is high or perception of side effects is strong. Conclusions This study shows that modification might be needed when using TPB constructs in resource constraint environments. Significance for public health The knowledge of the rates of adherence to antiretroviral therapy (ART) could be used to evaluate planning and project, which could lead to better outcomes predicted by treatment efficacy data. In addition, knowledge of adherence behaviour could help the development of interventions focusing on collaboration between healthcare providers and Malawian government to

Medication Adherence Survey: A First Year Pharmacy Immersion Students’ Perspective

Directory of Open Access Journals (Sweden)

Claudia F Ortiz Lopez

2016-09-01

Full Text Available First year pharmacy Immersion students from University of North Carolina Eshelman School of Pharmacy used a three question survey during their rotation at Moses H. Cone Hospital that analyzed patients’ medication adherence. Data collection revealed common trends that have been shown in the literature and areas for improvement. This method of evaluation was used by Phase I Immersion students to gain perspective on the problems we continue to have with medication adherence. Conflict of Interest We do not have any potential conflicts of interest with respect to the research, authorship, and/or publication of this article.   Type: Student Project

Medication adherence and its associated factors among diabetic patients at Zewditu Memorial Hospital, Addis Ababa, Ethiopia.

Science.gov (United States)

Ali, Muhammed; Alemu, Tigestu; Sada, Oumer

2017-12-04

Diabetes is a global problem with devastating human, social and economic impact. Anti-diabetic medications play a major role in the glycemic control of patients with diabetes. However, inadequate adherence compromises safety and treatment effectiveness, leading to increased mortality and morbidity. The aim of this study was to assess adherence to anti-diabetic medications and associated factors among patient with diabetes mellitus receiving care at Zewditu Memorial Hospital. Among the total of 146 diabetic patients (mean age 46.5 ± 14.7), the level of adherence to anti diabetic medication was 54.8% (80) whilst 45.2% (66) of the participants were non adherent. Multiple logistic regression showed that knowledge of medication (AOR = 4.905, 95% CI 1.64-14.62, medication availability (AOR = 0.175, 95% CI 0.031-0.987) and education level (AOR = 13.65, 95% CI 1.45-128.456) were reasons for non-adherence.

Non-adherence to standard treatment guidelines in a rural paediatric hospital in Sierra Leone.

Science.gov (United States)

De Bruycker, M; Van den Bergh, R; Dahmane, A; Khogali, M; Schiavetti, B; Nzomukunda, Y; Alders, P; Allaouna, M; Cloquet, C; Enarson, D A; Satyarayanan, S; Magbity, E; Zachariah, R

2013-06-21

A rural paediatric hospital in Bo, Sierra Leone. To assess the level of adherence to standard treatment guidelines among clinicians prescribing treatment for children admitted with a diagnosis of malaria and/or lower respiratory tract infection (LRTI), and determine the association between (non) adherence and hospital outcomes, given that non-rational use of medicines is a serious global problem. Secondary analysis of routine programme data. Data were collected for 865 children admitted with an entry diagnosis of malaria and 690 children with LRTI during the period January to April 2011; some patients were classified in both categories. Non-adherence to guidelines comprised use of non-standard drug regimens, dosage variations, non-standard frequency of administration and treatment duration. Cumulative non-adherence to guidelines for LRTI cases was 86%. For malaria, this involved 12% of patients. Potentially harmful non-adherence was significantly associated with an unfavourable hospital outcome, both for malaria and for LRTI cases. Overall non-adherence to standard treatment guidelines by clinicians in a routine hospital setting is very high and influences hospital outcomes. This study advocates for the implementation of routine measures to monitor and improve rational drug use and the quality of clinical care in such hospitals.

A Canonical Response in Rainfall Characteristics to Global Warming: Projections by IPCC CMIP5 Models

Science.gov (United States)

Lau, William K. M.; Wu, H. T.; Kim, K. M.

2012-01-01

Changes in rainfall characteristics induced by global warming are examined based on probability distribution function (PDF) analysis, from outputs of 14 IPCC (Intergovernmental Panel on Climate Change), CMIP (5th Coupled Model Intercomparison Project) models under various scenarios of increased CO2 emissions. Results show that collectively CMIP5 models project a robust and consistent global and regional rainfall response to CO2 warming. Globally, the models show a 1-3% increase in rainfall per degree rise in temperature, with a canonical response featuring large increase (100-250 %) in frequency of occurrence of very heavy rain, a reduction (5-10%) of moderate rain, and an increase (10-15%) of light rain events. Regionally, even though details vary among models, a majority of the models (>10 out of 14) project a consistent large scale response with more heavy rain events in climatologically wet regions, most pronounced in the Pacific ITCZ and the Asian monsoon. Moderate rain events are found to decrease over extensive regions of the subtropical and extratropical oceans, but increases over the extratropical land regions, and the Southern Oceans. The spatial distribution of light rain resembles that of moderate rain, but mostly with opposite polarity. The majority of the models also show increase in the number of dry events (absence or only trace amount of rain) over subtropical and tropical land regions in both hemispheres. These results suggest that rainfall characteristics are changing and that increased extreme rainfall events and droughts occurrences are connected, as a consequent of a global adjustment of the large scale circulation to global warming.

Implementation of targeted medication adherence interventions within a community chain pharmacy practice: The Pennsylvania Project.

Science.gov (United States)

Bacci, Jennifer L; McGrath, Stephanie Harriman; Pringle, Janice L; Maguire, Michelle A; McGivney, Melissa Somma

2014-01-01

To identify facilitators and barriers to implementing targeted medication adherence interventions in community chain pharmacies, and describe adaptations of the targeted intervention and organizational structure within each individual pharmacy practice. Qualitative study. Central and western Pennsylvania from February to April 2012. Rite Aid pharmacists staffed at the 118 Pennsylvania Project intervention sites. Qualitative analysis of pharmacists' perceptions of facilitators and barriers experienced, targeted intervention and organizational structure adaptations implemented, and training and preparation prior to implementation. A total of 15 key informant interviews were conducted from February to April 2012. Ten pharmacists from "early adopter" practices and five pharmacists from "traditionalist" practices were interviewed. Five themes emerged regarding the implementation of targeted interventions, including all pharmacists' need to understand the relationship of patient care programs to their corporation's vision; providing individualized, continual support and mentoring to pharmacists; anticipating barriers before implementation of patient care programs; encouraging active patient engagement; and establishing best practices regarding implementation of patient care services. This qualitative analysis revealed that there are a series of key steps that can be taken before the execution of targeted interventions that may promote successful implementation of medication therapy management in community chain pharmacies.

Risk factors for non-adherence to cART in immigrants with HIV living in the Netherlands: Results from the Rotterdam ADherence (ROAD) project

NARCIS (Netherlands)

S.K. Been; D.A.M.C. van de Vijver (David); P.T. Nieuwkerk (Pythia); Brito, I. (Inês); J. Stutterheim (Janine); A.E.R. Bos (Arjan); M.E.G. Wolfers (Mireille); K. Pogány (Katalin); A. Verbon (Annelies)

2016-01-01

textabstractIn the Netherlands, immigrant people living with HIV (PLWH) have poorer psychological and treatment outcomes than Dutch PLWH. This cross-sectional field study examined risk factors for non-adherence to combination Antiretroviral Therapy (cART) among immigrant PLWH. First and second

Risk Factors for Non-Adherence to cART in Immigrants with HIV Living in the Netherlands: Results from the ROtterdam ADherence (ROAD) Project

NARCIS (Netherlands)

Been, Sabrina K.; van de Vijver, David A. M. C.; Nieuwkerk, Pythia T.; Brito, Inês; Stutterheim, Sarah E.; Bos, Arjan E. R.; Wolfers, Mireille E. G.; Pogány, Katalin; Verbon, Annelies

2016-01-01

In the Netherlands, immigrant people living with HIV (PLWH) have poorer psychological and treatment outcomes than Dutch PLWH. This cross-sectional field study examined risk factors for non-adherence to combination Antiretroviral Therapy (cART) among immigrant PLWH. First and second generation

Adherence to dietary guidelines and cardiovascular disease risk in the EPIC-NL cohort

NARCIS (Netherlands)

Struijk, E.A.; May, A.M.; Wezenbeek, N.L.W.J.; Fransen, H.; Soedamah-Muthu, S.S.; Geelen, A.; Boer, J.; Schouw, van der Y.T.; Bueno de Mesquita, H.B.; Beulens, J.W.J.

2014-01-01

Background Global and national dietary guidelines have been created to lower chronic disease risk. The aim of this study was to assess whether greater adherence to the WHO guidelines (Healthy Diet Indicator (HDI)); the Dutch guidelines for a healthy diet (Dutch Healthy Diet-index (DHD-index)); and

Using tools and technology to promote education and adherence to oral agents for cancer.

Science.gov (United States)

Burhenn, Peggy S; Smudde, Josephine

2015-06-01

The use of oral agents for cancer (OACs) is increasing, and oncology nurses are in an ideal position to educate patients about them and suggest methods to improve adherence. Once an OAC is ordered, the administration is the responsibility of the patient. Oncology nurses can use tools and technology to assist with education, which may promote adherence, and suggest reminder tools that can be used. Many electronic tools have been developed, such as smartphone applications, text messaging, electronic alarms, and glowing pill bottles. The researchers reviewed electronic devices, as well as traditional methods such as calendars and pillboxes, that can assist patients in remembering to take the medication they are administering at home. A literature search was compiled and websites were searched for patient education tools, reminder tools (electronic and manual), and smartphone applications. The project was part of the Oncology Nursing Society Putting Evidence Into Practice effort on oral adherence. Education alone is insufficient to promote adherence to oral medication regimens. Multicomponent interventions have demonstrated improved adherence, and tools and technology directed at improving adherence to oral agents can be used. The researchers found multiple reminder aids to assist patients in adhering to an oral regimen. They are highlighted in this article.

Interventions combining motivational interviewing and cognitive behaviour to promote medication adherence: a literature review.

Science.gov (United States)

Spoelstra, Sandra L; Schueller, Monica; Hilton, Melissa; Ridenour, Kimberly

2015-05-01

This article presents an integrative review of the evidence for combined motivational interviewing and cognitive behavioural interventions that promote medication adherence. We undertook this review to establish a scientific foundation for development of interventions to promote medication adherence and to guide clinical practice. The World Health Organization has designated medication adherence as a global problem. Motivational interviewing and cognitive behaviour interventions have been found to individually promote medication adherence. However, there is a gap in the literature on the effect of combined motivational interviewing and cognitive behavioural approaches to promote medication adherence. Integrative review. COCHRANE, PubMed and CINAHL were searched to access relevant studies between 2004-2014. Inclusion criteria were interventions combining motivational interviewing and cognitive behavioural therapy with medication adherence as the outcome. Articles were assessed for measures of adherence and methodological rigour. Analysis was performed using an integrative review process. Six articles met the inclusion criteria. A randomised controlled trial reported pretreatment missed doses of 5·58 and post-treatment of 0·92 and trended towards significance. Four cohort studies had effect sizes of 0·19-0·35 (p motivational interviewing and cognitive behavioural interventions, five out of six were effective at improving medication adherence. Future studies with large rigorous randomised trials are needed. This review provides clinicians with the state of the science in relation to combined motivational interviewing and cognitive behavioural therapy interventions that promote medication adherence. A summary of intervention components and talking points are provided to aid nurses in informing decision-making and translating evidence into practice. © 2014 John Wiley & Sons Ltd.

Super Global Projects and Environmentally Friendly Technologies Used in Space Exploration: Realities and Prospects of the Space Age

Directory of Open Access Journals (Sweden)

Sergey Krichevsky

2018-02-01

Full Text Available The 60th anniversary of the Space Age is an important intermediate finishing point on the way of a man and the whole humanity to space. Along with the outstanding achievements, there are a number of challenges and contradictions in space exploration due to the aggravation of the global crisis on Earth, low efficiency and the backlog of space research in the transition to a new technology based reality and clean technologies. Both the international astronautics and the space exploration area nowadays face difficulties in choosing a new paradigm and a development strategy that is becoming even more complicated due to the current unstable and turbulent situation on Earth. The article reveals the optimistic scenario of further space exploration, as well as the methodological and practical aspects of new projects and technologies. The periodization of the Space Age history has been conducted. It has been also proposed a new classification of the “space” phenomenon due to concretizing the concept of “global” in the form of a three-scale structure encompassing the following levels: 1 planetary global; 2 super global; 3 universally global. The notion of “super global space exploration project” has been introduced. The concept of further space exploration is proposed, which includes four interrelated super global projects:1 Earth Protection System from Asteroid and Comet Threat; 2 Moon Exploration; 3 Mars Exploration; 4 Cosmic Humanity. Since the humanity is embarking on the practical implementation of these super global projects, it is urgent to make a transition towards a new technology based order, as well as up-to-date technologies. A couple of ecological projects and space exploration technologies of the 20th and 21st centuries have been exemplified and analyzed. It has been also worked out the list of new environmentally friendly space technologies and projects. The research makes an emphasis upon a great potential of clean and green

Freedom and Responsibility in Synthetic Genomics: The Synthetic Yeast Project.

Science.gov (United States)

Sliva, Anna; Yang, Huanming; Boeke, Jef D; Mathews, Debra J H

2015-08-01

First introduced in 2011, the Synthetic Yeast Genome (Sc2.0) PROJECT is a large international synthetic genomics project that will culminate in the first eukaryotic cell (Saccharomyces cerevisiae) with a fully synthetic genome. With collaborators from across the globe and from a range of institutions spanning from do-it-yourself biology (DIYbio) to commercial enterprises, it is important that all scientists working on this project are cognizant of the ethical and policy issues associated with this field of research and operate under a common set of principles. In this commentary, we survey the current ethics and regulatory landscape of synthetic biology and present the Sc2.0 Statement of Ethics and Governance to which all members of the project adhere. This statement focuses on four aspects of the Sc2.0 PROJECT: societal benefit, intellectual property, safety, and self-governance. We propose that such project-level agreements are an important, valuable, and flexible model of self-regulation for similar global, large-scale synthetic biology projects in order to maximize the benefits and minimize potential harms. Copyright © 2015 by the Genetics Society of America.

The GIOD Project-Globally Interconnected Object Databases

CERN Document Server

Bunn, J J; Newman, H B; Wilkinson, R P

2001-01-01

The GIOD (Globally Interconnected Object Databases) Project, a joint effort between Caltech and CERN, funded by Hewlett Packard Corporation, has investigated the use of WAN-distributed Object Databases and Mass Storage systems for LHC data. A prototype small- scale LHC data analysis center has been constructed using computing resources at Caltechs Centre for advanced Computing Research (CACR). These resources include a 256 CPU HP Exemplar of ~4600 SPECfp95, a 600 TByte High Performance Storage System (HPSS), and local/wide area links based on OC3 ATM. Using the exemplar, a large number of fully simulated CMS events were produced, and used to populate an object database with a complete schema for raw, reconstructed and analysis objects. The reconstruction software used for this task was based on early codes developed in preparation for the current CMS reconstruction program, ORCA. (6 refs).

Global Energy and Water Cycle Experiment (GEWEX) and the Continental-scale International Project (GCIP)

Science.gov (United States)

Vane, Deborah

1993-01-01

A discussion of the objectives of the Global Energy and Water Cycle Experiment (GEWEX) and the Continental-scale International Project (GCIP) is presented in vugraph form. The objectives of GEWEX are as follows: determine the hydrological cycle by global measurements; model the global hydrological cycle; improve observations and data assimilation; and predict response to environmental change. The objectives of GCIP are as follows: determine the time/space variability of the hydrological cycle over a continental-scale region; develop macro-scale hydrologic models that are coupled to atmospheric models; develop information retrieval schemes; and support regional climate change impact assessment.

The WACMOS-ET project - Part 2: Evaluation of global terrestrial evaporation data sets

NARCIS (Netherlands)

Gonzalez Miralles, D.; Jiménez, C.; Jung, M.; Michel, D.; Ershadi, A.; McCabe, M.F.; Hirschi, M.; Martens, B.; Dolman, A.J.; Fisher, J.B.; Mu, Q.; Seneviratne, S.I.; Wood, E.F.; Fernández-Prieto, D.

2016-01-01

The WAter Cycle Multi-mission Observation Strategy - EvapoTranspiration (WACMOS-ET) project aims to advance the development of land evaporation estimates on global and regional scales. Its main objective is the derivation, validation, and intercomparison of a group of existing evaporation retrieval

Perceptions and acceptability of short message services technology to improve treatment adherence amongst tuberculosis patients in Peru: a Focus Group Study.

Directory of Open Access Journals (Sweden)

Sandra Albino

Full Text Available Tuberculosis (TB is global health concern and a leading infectious cause of mortality. Reversing TB incidence and disease-related mortality is a major global health priority. Infectious disease mortality is directly linked to failure to adhere to treatments. Using technology to send reminders by short message services have been shown to improve treatment adherence. However, few studies have examined tuberculosis patient perceptions and attitudes towards using SMS technology to increase treatment adherence. In this study, we sought to investigate perceptions related to feasibility and acceptability of using text messaging to improve treatment adherence among adults who were receiving treatment for TB in Callao, Peru.We conducted focus group qualitative interviews with current TB positive and non-contagious participants to understand the attitudes, perceptions, and feasibility of using short message service (SMS reminders to improve TB treatment adherence. Subjects receiving care through the National TB Program were recruited through public health centers in Ventanilla, Callao, Peru. In four focus groups, we interviewed 16 patients. All interviews were recorded and transcribed verbatim. Thematic network analysis and codebook techniques were used to analyze data.Three major themes emerged from the data: limits on health literacy and information posed challenges to successful TB treatment adherence, treatment motivation at times facilitated adherence to TB treatment, and acceptability of SMS including positive perceptions of SMS to improve TB treatment adherence. The majority of patients shared considerations about how to effectively and confidentially administer an SMS intervention with TB positive participants.The overall perceptions of the use of SMS were positive and indicated that SMS technology may be an efficient way to transmit motivational texts on treatment, health education information, and simple reminders to increase treatment adherence

Perceptions and acceptability of short message services technology to improve treatment adherence amongst tuberculosis patients in Peru: a Focus Group Study.

Science.gov (United States)

Albino, Sandra; Tabb, Karen M; Requena, David; Egoavil, Miguel; Pineros-Leano, Maria F; Zunt, Joseph R; García, Patricia J

2014-01-01

Tuberculosis (TB) is global health concern and a leading infectious cause of mortality. Reversing TB incidence and disease-related mortality is a major global health priority. Infectious disease mortality is directly linked to failure to adhere to treatments. Using technology to send reminders by short message services have been shown to improve treatment adherence. However, few studies have examined tuberculosis patient perceptions and attitudes towards using SMS technology to increase treatment adherence. In this study, we sought to investigate perceptions related to feasibility and acceptability of using text messaging to improve treatment adherence among adults who were receiving treatment for TB in Callao, Peru. We conducted focus group qualitative interviews with current TB positive and non-contagious participants to understand the attitudes, perceptions, and feasibility of using short message service (SMS) reminders to improve TB treatment adherence. Subjects receiving care through the National TB Program were recruited through public health centers in Ventanilla, Callao, Peru. In four focus groups, we interviewed 16 patients. All interviews were recorded and transcribed verbatim. Thematic network analysis and codebook techniques were used to analyze data. Three major themes emerged from the data: limits on health literacy and information posed challenges to successful TB treatment adherence, treatment motivation at times facilitated adherence to TB treatment, and acceptability of SMS including positive perceptions of SMS to improve TB treatment adherence. The majority of patients shared considerations about how to effectively and confidentially administer an SMS intervention with TB positive participants. The overall perceptions of the use of SMS were positive and indicated that SMS technology may be an efficient way to transmit motivational texts on treatment, health education information, and simple reminders to increase treatment adherence for low

Global Rural-Urban Mapping Project, Version 1 (GRUMPv1): Urban Extent Polygons, Revision 01

Data.gov (United States)

National Aeronautics and Space Administration — The primary output of the Global Rural Urban Mapping Project, Version 1 (GRUMPv1) are a series of grids representing estimated population counts and density for the...

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

2016-05-01

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

Patient adherence to tuberculosis treatment: a systematic review of qualitative research.

Science.gov (United States)

Munro, Salla A; Lewin, Simon A; Smith, Helen J; Engel, Mark E; Fretheim, Atle; Volmink, Jimmy

2007-07-24

Tuberculosis (TB) is a major contributor to the global burden of disease and has received considerable attention in recent years, particularly in low- and middle-income countries where it is closely associated with HIV/AIDS. Poor adherence to treatment is common despite various interventions aimed at improving treatment completion. Lack of a comprehensive and holistic understanding of barriers to and facilitators of, treatment adherence is currently a major obstacle to finding effective solutions. The aim of this systematic review of qualitative studies was to understand the factors considered important by patients, caregivers and health care providers in contributing to TB medication adherence. We searched 19 electronic databases (1966-February 2005) for qualitative studies on patients', caregivers', or health care providers' perceptions of adherence to preventive or curative TB treatment with the free text terms "Tuberculosis AND (adherence OR compliance OR concordance)". We supplemented our search with citation searches and by consulting experts. For included studies, study quality was assessed using a predetermined checklist and data were extracted independently onto a standard form. We then followed Noblit and Hare's method of meta-ethnography to synthesize the findings, using both reciprocal translation and line-of-argument synthesis. We screened 7,814 citations and selected 44 articles that met the prespecified inclusion criteria. The synthesis offers an overview of qualitative evidence derived from these multiple international studies. We identified eight major themes across the studies: organisation of treatment and care; interpretations of illness and wellness; the financial burden of treatment; knowledge, attitudes, and beliefs about treatment; law and immigration; personal characteristics and adherence behaviour; side effects; and family, community, and household support. Our interpretation of the themes across all studies produced a line

Patient adherence to tuberculosis treatment: a systematic review of qualitative research.

Directory of Open Access Journals (Sweden)

Salla A Munro

2007-07-01

Full Text Available BACKGROUND: Tuberculosis (TB is a major contributor to the global burden of disease and has received considerable attention in recent years, particularly in low- and middle-income countries where it is closely associated with HIV/AIDS. Poor adherence to treatment is common despite various interventions aimed at improving treatment completion. Lack of a comprehensive and holistic understanding of barriers to and facilitators of, treatment adherence is currently a major obstacle to finding effective solutions. The aim of this systematic review of qualitative studies was to understand the factors considered important by patients, caregivers and health care providers in contributing to TB medication adherence. METHODS AND FINDINGS: We searched 19 electronic databases (1966-February 2005 for qualitative studies on patients', caregivers', or health care providers' perceptions of adherence to preventive or curative TB treatment with the free text terms "Tuberculosis AND (adherence OR compliance OR concordance". We supplemented our search with citation searches and by consulting experts. For included studies, study quality was assessed using a predetermined checklist and data were extracted independently onto a standard form. We then followed Noblit and Hare's method of meta-ethnography to synthesize the findings, using both reciprocal translation and line-of-argument synthesis. We screened 7,814 citations and selected 44 articles that met the prespecified inclusion criteria. The synthesis offers an overview of qualitative evidence derived from these multiple international studies. We identified eight major themes across the studies: organisation of treatment and care; interpretations of illness and wellness; the financial burden of treatment; knowledge, attitudes, and beliefs about treatment; law and immigration; personal characteristics and adherence behaviour; side effects; and family, community, and household support. Our interpretation of the

Cost of medication adherence and persistence in type 2 diabetes mellitus: a literature review

Directory of Open Access Journals (Sweden)

Kennedy-Martin T

2017-06-01

Full Text Available Tessa Kennedy-Martin,1 Kristina S Boye,2 Xiaomei Peng2 1Kennedy-Martin Health Outcomes Ltd, Brighton, UK; 2Global Health Outcomes, Eli Lilly and Company, Indianapolis, IN, USA Purpose: To explore published evidence on health care costs associated with adherence or persistence to antidiabetes medications in adults with type 2 diabetes mellitus (T2DM.Methods: Primary research studies published between January 2006 and December 2015 on compliance, adherence, or persistence and treatment in patients with T2DM that document a link with health care costs were identified through literature searches in bibliographic databases and 2015 abstract books for relevant DM congresses. Results were assessed for relevance by two reviewers. The review was part of a larger overview evaluating the impact of adherence and persistence on a range of clinical and economic outcomes; only findings from the cost element are reported herein.Results: A total of 4,662 de-duplicated abstracts were identified and 110 studies included in the wider review. Of these, 19 reported an association between adherence (n=13, persistence (n=5, or adherence and persistence (n=1, and health care costs. All studies were retrospective, with sample sizes ranging from 301 to 740,195. Medication possession ratio was the most commonly employed adherence measure (n=11. The majority of adherence studies (n=9 reported that medication adherence was associated with lower total health care costs. Pharmacy costs were often increased in adherent patients but this was offset by beneficial effects on other costs. Findings were more variable in persistence studies; three reported that higher pharmacy costs in persistent patients were not sufficiently offset by savings in other areas to result in a reduction in total health care costs.Conclusions: Few studies have evaluated the relationship between adherence, persistence, and health care costs in T2DM. However, it has been consistently shown that medication

Proteomic Response of Pseudomonas aeruginosa PAO1 Adhering to Solid Surfaces

Directory of Open Access Journals (Sweden)

Morgan Guilbaud

2017-08-01

Full Text Available Pseudomonas aeruginosa is a pathogenic micro-organism responsible for many hospital-acquired infections. It is able to adhere to solid surfaces and develop an immobilized community or so-called biofilm. Many studies have been focusing on the use of specific materials to prevent the formation of these biofilms, but the reactivity of the bacteria in contact to surfaces remains unknown. The aim of this study was to evaluate the impact of the abiotic surface on the physiology of adherent bacteria. Three different materials, stainless steel (SS, glass (G, and polystyrene (PS that were relevant to industrial or medical environments were characterized at the physicochemical level in terms of their hydrophobicity and roughness. We showed that SS was moderately hydrophilic and rough, potentially containing crevices, G was hydrophilic and smooth while PS was hydrophobic and smooth. We further showed that P. aeruginosa cells were more likely able to adhere to SS and G rather than PS surfaces under our experimental conditions. The physiological response of P. aeruginosa when adhering to each of these materials was then evaluated by global proteomic analysis. The abundance of 70 proteins was shown to differ between the materials suggesting that their abundance was modified as a function of the material to which bacteria adhered. Our data lead to enabling the identification of abundance patterns that appeared to be specific to a given surface. Taken together, our data showed that P. aeruginosa is capable of sensing and responding to a surface probably via specific programmes to adapt its physiological response accordingly.

Kenya public weather processed by the Global Yield Gap Atlas project (old version)

NARCIS (Netherlands)

Groot, de H.L.E.; Adimo, A.O.; Claessens, L.F.G.; Wart, van J.; Bussel, van L.G.J.; Grassini, P.; Wolf, J.; Guilpart, Nicolas; Boogaard, H.L.; Oort, van P.A.J.; Yang, H.; Ittersum, van M.K.; Cassman, K.G.

2015-01-01

The Global Yield Gap Atlas project (GYGA - http://yieldgap.org ) has undertaken a yield gap assessment following the protocol recommended by van Ittersum et. al. (van Ittersum et. al., 2013). One part of the activities consists of collecting and processing weather data as an input for crop

Impact of mHealth chronic disease management on treatment adherence and patient outcomes: a systematic review.

Science.gov (United States)

Hamine, Saee; Gerth-Guyette, Emily; Faulx, Dunia; Green, Beverly B; Ginsburg, Amy Sarah

2015-02-24

Adherence to chronic disease management is critical to achieving improved health outcomes, quality of life, and cost-effective health care. As the burden of chronic diseases continues to grow globally, so does the impact of non-adherence. Mobile technologies are increasingly being used in health care and public health practice (mHealth) for patient communication, monitoring, and education, and to facilitate adherence to chronic diseases management. We conducted a systematic review of the literature to evaluate the effectiveness of mHealth in supporting the adherence of patients to chronic diseases management ("mAdherence"), and the usability, feasibility, and acceptability of mAdherence tools and platforms in chronic disease management among patients and health care providers. We searched PubMed, Embase, and EBSCO databases for studies that assessed the role of mAdherence in chronic disease management of diabetes mellitus, cardiovascular disease, and chronic lung diseases from 1980 through May 2014. Outcomes of interest included effect of mHealth on patient adherence to chronic diseases management, disease-specific clinical outcomes after intervention, and the usability, feasibility, and acceptability of mAdherence tools and platforms in chronic disease management among target end-users. In all, 107 articles met all inclusion criteria. Short message service was the most commonly used mAdherence tool in 40.2% (43/107) of studies. Usability, feasibility, and acceptability or patient preferences for mAdherence interventions were assessed in 57.9% (62/107) of studies and found to be generally high. A total of 27 studies employed randomized controlled trial (RCT) methods to assess impact on adherence behaviors, and significant improvements were observed in 15 of those studies (56%). Of the 41 RCTs that measured effects on disease-specific clinical outcomes, significant improvements between groups were reported in 16 studies (39%). There is potential for mHealth tools to

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

Science.gov (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

2015-11-01

Poor adherence to medication is a major public health challenge. Here, we aimed to determine the adherence to oral and topical medications and to analyze underlying associated factors using the translated Japanese version of Morisky Medication Adherence Scale-8 regarding urticaria treatment. Web-based questionnaires were performed for 3096 registered dermatological patients, along with a subanalysis of 751 registered urticaria patients in this study. The adherence to oral medication was significantly associated with the frequency of hospital visits. Variables that affected the adherence to topical medication included age and experience of drug effectiveness. The rate of responses that "It felt like the symptoms had improved" varied significantly among the dermatological diseases treated with oral medications. Dermatologists should be aware that adherence to the treatment of urticaria is quite low. Regular visits and active education for patients with urticaria are mandatory in order to achieve a good therapeutic outcome by increasing the adherence. © 2015 The Authors. The Journal of Dermatology published by Wiley Publishing Asia Pty Ltd on behalf of Japanese Dermatological Association.

Path integral for spinning particle in the plane wave field: Global and local projections

International Nuclear Information System (INIS)

Boudiaf, N.; Boudjedaa, T.; Chetouani, L.

2001-01-01

The Green function related to the problem of a Dirac particle interacting with a plane wave is calculated via the path integral formalism proposed recently by Alexandrou et al. according to the two so-called global and local projections. With the help of the incorporation of two simple identities, it is shown that the contribution to the calculation of the integrals comes essentially from classical solutions projected along the direction of wave propagation. (orig.)

The Adherence Estimator: a brief, proximal screener for patient propensity to adhere to prescription medications for chronic disease.

Science.gov (United States)

McHorney, Colleen A

2009-01-01

To conceptualize, develop, and provide preliminary psychometric evidence for the Adherence Estimator--a brief, three-item proximal screener for the likelihood of non-adherence to prescription medications (medication non-fulfillment and non-persistence) for chronic disease. Qualitative focus groups with 140 healthcare consumers and two internet-based surveys of adults with chronic disease, comprising a total of 1772 respondents, who were self-reported medication adherers, non-persisters, and non-fulfillers. Psychometric tests were performed on over 150 items assessing 14 patient beliefs and skills hypothesized to be related to medication non-adherence along a proximal-distal continuum. Psychometric tests included, but were not limited to, known-groups discriminant validity at the scale and item level. The psychometric analyses sought to identify: (1) the specific multi-item scales that best differentiated self-reported adherers from self-reported non-adherers (non-fulfillers and non-persisters) and, (2) the single best item within each prioritized multi-item scale that best differentiated self-reported adherers from self-reported non-adherers (non-fulfillers and non-persisters). The two rounds of psychometric testing identified and cross-validated three proximal drivers of self-reported adherence: perceived concerns about medications, perceived need for medications, and perceived affordability of medications. One item from each domain was selected to include in the Adherence Estimator using a synthesis of psychometric results gleaned from classical and modern psychometric test theory. By simple summation of the weights assigned to the category responses of the three items, a total score is obtained that is immediately interpretable and completely transparent. Patients can be placed into one of three segments based on the total score--low, medium, and high risk for non-adherence. Sensitivity was 88%--of the non-adherers, 88% would be accurately classified as medium

eHealth in the future of medications management: personalisation, monitoring and adherence.

Science.gov (United States)

Car, Josip; Tan, Woan Shin; Huang, Zhilian; Sloot, Peter; Franklin, Bryony Dean

2017-04-05

Globally, healthcare systems face major challenges with medicines management and medication adherence. Medication adherence determines medication effectiveness and can be the single most effective intervention for improving health outcomes. In anticipation of growth in eHealth interventions worldwide, we explore the role of eHealth in the patients' medicines management journey in primary care, focusing on personalisation and intelligent monitoring for greater adherence. eHealth offers opportunities to transform every step of the patient's medicines management journey. From booking appointments, consultation with a healthcare professional, decision-making, medication dispensing, carer support, information acquisition and monitoring, to learning about medicines and their management in daily life. It has the potential to support personalisation and monitoring and thus lead to better adherence. For some of these dimensions, such as supporting decision-making and providing reminders and prompts, evidence is stronger, but for many others more rigorous research is urgently needed. Given the potential benefits and barriers to eHealth in medicines management, a fine balance needs to be established between evidence-based integration of technologies and constructive experimentation that could lead to a game-changing breakthrough. A concerted, transdisciplinary approach adapted to different contexts, including low- and middle-income contries is required to realise the benefits of eHealth at scale.

A quantitative systematic review of the efficacy of mobile phone interventions to improve medication adherence.

Science.gov (United States)

Park, Linda G; Howie-Esquivel, Jill; Dracup, Kathleen

2014-09-01

To evaluate the characteristics and efficacy of mobile phone interventions to improve medication adherence. Secondary aims are to explore participants' acceptability and satisfaction with mobile phone interventions and to evaluate the selected studies in terms of study rigour, impact, cost and resource feasibility, generalizability and implications for nursing practice and research. Medication non-adherence is a major global challenge. Mobile phones are the most commonly used form of technology worldwide and have the potential to promote medication adherence. Guidelines from the Centre for Reviews and Dissemination were followed for this systematic review. A comprehensive search of databases (PubMed, Web of Science, CINAHL, PsycInfo, Google Chrome and Cochrane) and bibliographies from related articles was performed from January 2002-January 2013 to identify the included studies. A quantitative systematic review without meta-analysis was conducted and the selected studies were critically evaluated to extract and summarize pertinent characteristics and outcomes. The literature search produced 29 quantitative research studies related to mobile phones and medication adherence. The studies were conducted for prevention purposes as well as management of acute and chronic illnesses. All of the studies used text messaging. Eighteen studies found significant improvement in medication adherence. While the majority of investigators found improvement in medication adherence, long-term studies characterized by rigorous research methodologies, appropriate statistical and economic analyses and the test of theory-based interventions are needed to determine the efficacy of mobile phones to influence medication adherence. © 2014 John Wiley & Sons Ltd.

Patient adherence with COPD therapy

Directory of Open Access Journals (Sweden)

C. S. Rand

2005-12-01

Full Text Available Although there are very few published studies on adherence to treatment regimens in chronic obstructive pulmonary disease (COPD, the evidence that exists suggests that, as with asthma therapy, adherence is poor. Patient beliefs about COPD, as well as their motivation and expectations about the likelihood of success of medical interventions, can influence adherence rates. Other critical factors include the patient's understanding of their illness and therapy, and the complexity of the prescribed treatment regimen. Incorrect inhaler technique is also a common failing. When prescribing in primary or specialist care, healthcare professionals should address adherence as a vital part of the patient consultation. Improved patient education may also increase adherence rates.

Probabilistic 21st and 22nd Century Sea-Level Projections at a Global Network of Tide-Gauge Sites

Science.gov (United States)

Kopp, Robert E.; Horton, Radley M.; Little, Christopher M.; Mitrovica, Jerry X.; Oppenheimer, Michael; Rasmussen, D. J.; Strauss, Benjamin H.; Tebaldi, Claudia

2014-01-01

Sea-level rise due to both climate change and non-climatic factors threatens coastal settlements, infrastructure, and ecosystems. Projections of mean global sea-level (GSL) rise provide insufficient information to plan adaptive responses; local decisions require local projections that accommodate different risk tolerances and time frames and that can be linked to storm surge projections. Here we present a global set of local sea-level (LSL) projections to inform decisions on timescales ranging from the coming decades through the 22nd century. We provide complete probability distributions, informed by a combination of expert community assessment, expert elicitation, and process modeling. Between the years 2000 and 2100, we project a very likely (90% probability) GSL rise of 0.5–1.2?m under representative concentration pathway (RCP) 8.5, 0.4–0.9?m under RCP 4.5, and 0.3–0.8?m under RCP 2.6. Site-to-site differences in LSL projections are due to varying non-climatic background uplift or subsidence, oceanographic effects, and spatially variable responses of the geoid and the lithosphere to shrinking land ice. The Antarctic ice sheet (AIS) constitutes a growing share of variance in GSL and LSL projections. In the global average and at many locations, it is the dominant source of variance in late 21st century projections, though at some sites oceanographic processes contribute the largest share throughout the century. LSL rise dramatically reshapes flood risk, greatly increasing the expected number of “1-in-10” and “1-in-100” year events.

Response to "The Shaky Legal Foundations of the Global Human Rights Education Project"

Science.gov (United States)

Tibbitts, Felisa

2015-01-01

This article is a response to "The Shaky Legal Foundations of the Global Human Rights Education Project," an article written by Barend Vlaardingerbroek, in which Vlaardingerbroek characterizes current practices of human rights education (HRE) as having an overriding agenda of activism, one that can draw on an ideologically-driven…

Medication adherence in inflammatory bowel disease

Directory of Open Access Journals (Sweden)

Webber Chan

2017-10-01

Full Text Available Inflammatory bowel disease (IBD is a chronic idiopathic inflammatory condition with intestinal and extraintestinal manifestations. Medications are the cornerstone of treatment of IBD. However, patients often adhere to medication poorly. Adherence to medications is defined as the process by which patients take their medications as prescribed. Treatment non-adherence is a common problem among chronic diseases, averaging 50% in developed countries and is even poorer in developing countries. In this review, we will examine the adherence data in IBD which vary greatly depending on the study population, route of administration, and methods of adherence measurement used. We will also discuss the adverse clinical outcomes related to non-adherence to medical treatment including increased disease activity, flares, loss of response to anti-tumor necrosis factor therapy, and so forth. There are many methods to measure medication adherence namely direct and indirect methods, each with their advantages and drawbacks. Finally, we will explore different intervention strategies to improve adherence to medications.

The EUSTACE project: delivering global, daily information on surface air temperature

Science.gov (United States)

Ghent, D.; Rayner, N. A.

2017-12-01

Day-to-day variations in surface air temperature affect society in many ways; however, daily surface air temperature measurements are not available everywhere. A global daily analysis cannot be achieved with measurements made in situ alone, so incorporation of satellite retrievals is needed. To achieve this, in the EUSTACE project (2015-2018, https://www.eustaceproject.eu) we have developed an understanding of the relationships between traditional (land and marine) surface air temperature measurements and retrievals of surface skin temperature from satellite measurements, i.e. Land Surface Temperature, Ice Surface Temperature, Sea Surface Temperature and Lake Surface Water Temperature. Here we discuss the science needed to produce a fully-global daily analysis (or ensemble of analyses) of surface air temperature on the centennial scale, integrating different ground-based and satellite-borne data types. Information contained in the satellite retrievals is used to create globally-complete fields in the past, using statistical models of how surface air temperature varies in a connected way from place to place. This includes developing new "Big Data" analysis methods as the data volumes involved are considerable. We will present recent progress along this road in the EUSTACE project, i.e.: • identifying inhomogeneities in daily surface air temperature measurement series from weather stations and correcting for these over Europe; • estimating surface air temperature over all surfaces of Earth from surface skin temperature retrievals; • using new statistical techniques to provide information on higher spatial and temporal scales than currently available, making optimum use of information in data-rich eras. Information will also be given on how interested users can become involved.

Changes in climate extremes, fresh water availability and vulnerability to food insecurity projected at 1.5°C and 2°C global warming with a higher-resolution global climate model

Science.gov (United States)

Alfieri, Lorenzo; Bradshaw, Catherine; Caesar, John; Feyen, Luc; Friedlingstein, Pierre; Gohar, Laila; Koutroulis, Aristeidis; Lewis, Kirsty; Morfopoulos, Catherine; Papadimitriou, Lamprini; Richardson, Katy J.; Tsanis, Ioannis; Wyser, Klaus

2018-01-01

We projected changes in weather extremes, hydrological impacts and vulnerability to food insecurity at global warming of 1.5°C and 2°C relative to pre-industrial, using a new global atmospheric general circulation model HadGEM3A-GA3.0 driven by patterns of sea-surface temperatures and sea ice from selected members of the 5th Coupled Model Intercomparison Project (CMIP5) ensemble, forced with the RCP8.5 concentration scenario. To provide more detailed representations of climate processes and impacts, the spatial resolution was N216 (approx. 60 km grid length in mid-latitudes), a higher resolution than the CMIP5 models. We used a set of impacts-relevant indices and a global land surface model to examine the projected changes in weather extremes and their implications for freshwater availability and vulnerability to food insecurity. Uncertainties in regional climate responses are assessed, examining ranges of outcomes in impacts to inform risk assessments. Despite some degree of inconsistency between components of the study due to the need to correct for systematic biases in some aspects, the outcomes from different ensemble members could be compared for several different indicators. The projections for weather extremes indices and biophysical impacts quantities support expectations that the magnitude of change is generally larger for 2°C global warming than 1.5°C. Hot extremes become even hotter, with increases being more intense than seen in CMIP5 projections. Precipitation-related extremes show more geographical variation with some increases and some decreases in both heavy precipitation and drought. There are substantial regional uncertainties in hydrological impacts at local scales due to different climate models producing different outcomes. Nevertheless, hydrological impacts generally point towards wetter conditions on average, with increased mean river flows, longer heavy rainfall events, particularly in South and East Asia with the most extreme

Changes in climate extremes, fresh water availability and vulnerability to food insecurity projected at 1.5°C and 2°C global warming with a higher-resolution global climate model.

Science.gov (United States)

Betts, Richard A; Alfieri, Lorenzo; Bradshaw, Catherine; Caesar, John; Feyen, Luc; Friedlingstein, Pierre; Gohar, Laila; Koutroulis, Aristeidis; Lewis, Kirsty; Morfopoulos, Catherine; Papadimitriou, Lamprini; Richardson, Katy J; Tsanis, Ioannis; Wyser, Klaus

2018-05-13

We projected changes in weather extremes, hydrological impacts and vulnerability to food insecurity at global warming of 1.5°C and 2°C relative to pre-industrial, using a new global atmospheric general circulation model HadGEM3A-GA3.0 driven by patterns of sea-surface temperatures and sea ice from selected members of the 5th Coupled Model Intercomparison Project (CMIP5) ensemble, forced with the RCP8.5 concentration scenario. To provide more detailed representations of climate processes and impacts, the spatial resolution was N216 (approx. 60 km grid length in mid-latitudes), a higher resolution than the CMIP5 models. We used a set of impacts-relevant indices and a global land surface model to examine the projected changes in weather extremes and their implications for freshwater availability and vulnerability to food insecurity. Uncertainties in regional climate responses are assessed, examining ranges of outcomes in impacts to inform risk assessments. Despite some degree of inconsistency between components of the study due to the need to correct for systematic biases in some aspects, the outcomes from different ensemble members could be compared for several different indicators. The projections for weather extremes indices and biophysical impacts quantities support expectations that the magnitude of change is generally larger for 2°C global warming than 1.5°C. Hot extremes become even hotter, with increases being more intense than seen in CMIP5 projections. Precipitation-related extremes show more geographical variation with some increases and some decreases in both heavy precipitation and drought. There are substantial regional uncertainties in hydrological impacts at local scales due to different climate models producing different outcomes. Nevertheless, hydrological impacts generally point towards wetter conditions on average, with increased mean river flows, longer heavy rainfall events, particularly in South and East Asia with the most extreme

Changes in climate extremes, fresh water availability and vulnerability to food insecurity projected at 1.5°C and 2°C global warming with a higher-resolution global climate model

Science.gov (United States)

Betts, Richard A.; Alfieri, Lorenzo; Bradshaw, Catherine; Caesar, John; Feyen, Luc; Friedlingstein, Pierre; Gohar, Laila; Koutroulis, Aristeidis; Lewis, Kirsty; Morfopoulos, Catherine; Papadimitriou, Lamprini; Richardson, Katy J.; Tsanis, Ioannis; Wyser, Klaus

2018-05-01

We projected changes in weather extremes, hydrological impacts and vulnerability to food insecurity at global warming of 1.5°C and 2°C relative to pre-industrial, using a new global atmospheric general circulation model HadGEM3A-GA3.0 driven by patterns of sea-surface temperatures and sea ice from selected members of the 5th Coupled Model Intercomparison Project (CMIP5) ensemble, forced with the RCP8.5 concentration scenario. To provide more detailed representations of climate processes and impacts, the spatial resolution was N216 (approx. 60 km grid length in mid-latitudes), a higher resolution than the CMIP5 models. We used a set of impacts-relevant indices and a global land surface model to examine the projected changes in weather extremes and their implications for freshwater availability and vulnerability to food insecurity. Uncertainties in regional climate responses are assessed, examining ranges of outcomes in impacts to inform risk assessments. Despite some degree of inconsistency between components of the study due to the need to correct for systematic biases in some aspects, the outcomes from different ensemble members could be compared for several different indicators. The projections for weather extremes indices and biophysical impacts quantities support expectations that the magnitude of change is generally larger for 2°C global warming than 1.5°C. Hot extremes become even hotter, with increases being more intense than seen in CMIP5 projections. Precipitation-related extremes show more geographical variation with some increases and some decreases in both heavy precipitation and drought. There are substantial regional uncertainties in hydrological impacts at local scales due to different climate models producing different outcomes. Nevertheless, hydrological impacts generally point towards wetter conditions on average, with increased mean river flows, longer heavy rainfall events, particularly in South and East Asia with the most extreme

System for integrated adherence monitoring: real-time non-adherence risk assessment in pediatric kidney transplantation.

Science.gov (United States)

Pai, Ahna L H; Rausch, Joseph; Tackett, Alayna; Marsolo, Keith; Drotar, Dennis; Goebel, Jens

2012-06-01

This study reports initial results of the development of the SIAM, a non-adherence risk assessment system for tacrolimus and sirolimus for the pediatric kidney transplant population. Forty-eight youths between 10 and 25 yr of age diagnosed with chronic kidney disease or a kidney transplant used an electronic pill bottle (EM; time stamps each bottle opening) to dispense their medication for at least 30 days or until their next clinic appointment. Youth also completed a self-report adherence measure, and standard deviations were calculated for the last four medication serum trough levels obtained for each patient. Estimation models were developed for each medication (i.e., SIAM(TACRO) and SIAM(SIRO) ) to assign weights to these clinically available adherence measures (self-report and trough levels) for the calculation of a non-adherence risk composite score. SIAM(TACRO) models included both self-report and tacrolimus trough levels and significantly predicted EM. For sirolimus, the model predictive of adherence as measured by EM consisted of the standard deviation of sirolimus trough levels only (SIAM(SIRO) ). Non-adherence risk can be effectively assessed using clinically available assessment tools. However, the best methods for using self-report and trough levels to predict non-adherence likely differ based on the medication for which adherence is being assessed. © 2012 John Wiley & Sons A/S.

Global Warning: Project-Based Science Inspired by the Intergovernmental Panel on Climate Change

Science.gov (United States)

Colaianne, Blake

2015-01-01

Misconceptions about climate change are common, which suggests a need to effectively address the subject in the classroom. This article describes a project-based science activity in which students report on the physical basis, adaptations, and mitigation of this global problem, adapting the framework of the United Nations' Intergovernmental Panel…

Yield risks in global maize markets: Historical evidence and projections in key regions of the world

Directory of Open Access Journals (Sweden)

Nelson B. Villoria

2018-03-01

Full Text Available Simultaneous worldwide crop failures stemming from a more unstable climate may reduce the scope for international trade to compensate food shortages and stabilize food prices across the various regions of the world. Understanding the effects of changes in crop productivity on global markets requires knowledge about the extent to which crop yields may be systematically related across producing and consuming centers. This short communication contributes to this knowledge by investigating the potential changes in the strength of two key sources of supply risks in global maize markets: yield variance and cross-country yield correlation. We focus on the largest producing and consuming countries of the world. We capitalize on yield projections from the Global Gridded Crop Model Intercomparison project. Exploratory analysis of the skill of the underlying GGCMI models in reproducing key moments of the distribution of observed yields reveals that they overstate observed variances but faithfully reproduce observed patterns of cross-country correlations. We find no evidence of an increase in the degree of cross-country dependency of maize yields. We also find a higher incidence of what would be considered extremely low maize yields by present-time standards stemming from the projected downward trend in yields levels toward mid-century. The weak dependency of maize yields across countries, an the possibility of reducing the higher incidence of extremes through policies aimed to reverse the climate-induced downward trends in yields, suggest that international trade can become a valuable tool to ameliorate the effects of more unstable crop yields. Keywords: Extremely low yields, Maize markets, Food prices, Agricultural yields, Systemic risk in agriculture, Global agriculture, AgMIP, Global gridded crop model intercomparison

Associations between adherence and outcomes among older, type 2 diabetes patients: evidence from a Medicare Supplemental database

Directory of Open Access Journals (Sweden)

Boye KS

2016-08-01

Full Text Available Kristina Secnik Boye,1 Sarah E Curtis,1 Maureen J Lage,2 Luis-Emilio Garcia-Perez3 1Global Patient Outcomes and Real World Evidence, Eli Lilly and Company, Lilly Corporate Center, Indianapolis, IN, 2HealthMetrics Outcomes Research, LLC, Bonita Springs, FL, 3Global Medical Affairs, Lilly Diabetes, Eli Lilly and Company, Lilly Corporate Center, Indianapolis, IN, USA Objective: To examine the association between adherence to glucose-lowering agents and patient outcomes, including costs, acute-care resource utilization, and complications, in an older, type 2 diabetic population.Data and methods: The study used Truven’s Medicare Supplemental database from July 1, 2009 to June 30, 2014. Patients aged 65 years or older were included if they had at least two type 2 diabetes diagnoses and received a glucose-lowering agent from July 1, 2010 through June 30, 2011. Multivariable analyses examined the relationships among 3-year patient outcomes and levels of adherence, proxied by the proportion of days covered. Outcomes included all-cause medical costs, diabetes-related medical costs, acute-care resource utilization, and acute complications.Results: In this study (N=123,235, higher adherence was linked to reduced costs and improved health outcomes. For example, comparing an individual with adherence of proportion of days covered <20% to one with proportion of days covered ≥80% illustrates an average saving of $28,824 in total 3-year costs. Furthermore, a 1% increase in adherence among 1,000 patients was associated with all-cause savings of $65,464 over 3 years. The probability of a hospitalization, an emergency room (ER visit, or an acute complication decreased monotonically as adherence levels got higher, as did the number of hospitalizations, ER visits, and days hospitalized (P<0.005.Conclusion: Higher adherence was associated with substantially less need for acute care, as indicated by a lowered probability of hospitalization or ER use, a reduced

Adherence with Preventive Medication in Childhood Asthma

Directory of Open Access Journals (Sweden)

Scott Burgess

2011-01-01

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.

A Framework for Effective Assessment of Model-based Projections of Biodiversity to Inform the Next Generation of Global Conservation Targets

Science.gov (United States)

Myers, B.; Beard, T. D.; Weiskopf, S. R.; Jackson, S. T.; Tittensor, D.; Harfoot, M.; Senay, G. B.; Casey, K.; Lenton, T. M.; Leidner, A. K.; Ruane, A. C.; Ferrier, S.; Serbin, S.; Matsuda, H.; Shiklomanov, A. N.; Rosa, I.

2017-12-01

Biodiversity and ecosystems services underpin political targets for the conservation of biodiversity; however, previous incarnations of these biodiversity-related targets have not relied on integrated model based projections of possible outcomes based on climate and land use change. Although a few global biodiversity models are available, most biodiversity models lie along a continuum of geography and components of biodiversity. Model-based projections of the future of global biodiversity are critical to support policymakers in the development of informed global conservation targets, but the scientific community lacks a clear strategy for integrating diverse data streams in developing, and evaluating the performance of, such biodiversity models. Therefore, in this paper, we propose a framework for ongoing testing and refinement of model-based projections of biodiversity trends and change, by linking a broad variety of biodiversity models with data streams generated by advances in remote sensing, coupled with new and emerging in-situ observation technologies to inform development of essential biodiversity variables, future global biodiversity targets, and indicators. Our two main objectives are to (1) develop a framework for model testing and refining projections of a broad range of biodiversity models, focusing on global models, through the integration of diverse data streams and (2) identify the realistic outputs that can be developed and determine coupled approaches using remote sensing and new and emerging in-situ observations (e.g., metagenomics) to better inform the next generation of global biodiversity targets.

Remotely controlled biking is associated with improved adherence to prescribed cycling speed.

Science.gov (United States)

Jeong, In Cheol; Finkelstein, Joseph

2015-01-01

Individuals with mobility impairment may benefit from passive exercise mode which can be subsequently enhanced by an active exercise program. However, it is unclear which exercise mode promotes higher adherence to prescribed exercise intensity. The goal of this project was to compare adherence to prescribed speed during passive and active cycling exercise. We used cross-over study design in which subjects followed the same cycling intensity prescription for passive and active exercise modes in a random sequence. Coefficient of variation (CV) and speed differences were used to estimate extent of deviation from the prescribed trajectory. CV varied from 5.2% to 20.4% for the active mode and from 2.8% to 4.5% for the passive mode respectively. Though the CV differences did not reach statistical significance, analysis of cycling speed adherence of 120-second periods showed significantly higher cycling adherence during passive mode for each target cycling speed. Our results indicated that the passive mode may promote exercise safety and efficacy by helping patients who have safety concerns such as the frail elderly, patients with cardiovascular conditions or people with other contraindications for excessive exertion during exercise, in following the optimal intensity trajectory prescribed by their provider.

Current challenges in adherence to clinical guidelines for antibiotic prophylaxis in surgery.

Science.gov (United States)

Khan, Sohail Ahmad; Rodrigues, Gabrial; Kumar, Pramod; Rao, Padma G M

2006-06-01

To study the impact of guidelines on surgical antibiotic prophylaxis in clinical practice, barriers involved in adherence to guidelines and how to overcome the same. Literature pertaining to prophylactic antibiotic usage was searched. Medscape, Medline, Cochrane, Surgical Infection Prevention (SIP) project databases were reviewed. Recent articles from relevant journals, texts, and standard guidelines were also studied. Local guidelines seem more likely to be accepted and followed than those developed nationally. Major barriers involved in adherence to guidelines include lack of awareness about the guidelines, general perception of guideline as a bureaucratic rather than educational tool. Some practitioners perceive guidelines as "cookbook medicine" that does not permit them to make their own medical decisions. Other barriers are complex, multi-step systems that create confusion, decrease accountability. Methods for guideline adherence include surveillance and data analysis, new systems to facilitate documentation and improving workflow, education regarding current evidence-based guidelines and promoting the development of local guidelines or protocol, development and implementation of reminders to facilitate adherence to the local guidelines. A multidisciplinary steering team of surgeons, infectious disease specialists, pharmacists, anesthesiologists, microbiologists and nurses should develop local guidelines suitable to their institution and methods for adherence to prevent the surgical site infections. The gap between evidence-based guidelines and practice must be addressed in order to achieve optimal practice in this domain.

Hotspots of uncertainty in land-use and land-cover change projections: a global-scale model comparison.

Science.gov (United States)

Prestele, Reinhard; Alexander, Peter; Rounsevell, Mark D A; Arneth, Almut; Calvin, Katherine; Doelman, Jonathan; Eitelberg, David A; Engström, Kerstin; Fujimori, Shinichiro; Hasegawa, Tomoko; Havlik, Petr; Humpenöder, Florian; Jain, Atul K; Krisztin, Tamás; Kyle, Page; Meiyappan, Prasanth; Popp, Alexander; Sands, Ronald D; Schaldach, Rüdiger; Schüngel, Jan; Stehfest, Elke; Tabeau, Andrzej; Van Meijl, Hans; Van Vliet, Jasper; Verburg, Peter H

2016-12-01

Model-based global projections of future land-use and land-cover (LULC) change are frequently used in environmental assessments to study the impact of LULC change on environmental services and to provide decision support for policy. These projections are characterized by a high uncertainty in terms of quantity and allocation of projected changes, which can severely impact the results of environmental assessments. In this study, we identify hotspots of uncertainty, based on 43 simulations from 11 global-scale LULC change models representing a wide range of assumptions of future biophysical and socioeconomic conditions. We attribute components of uncertainty to input data, model structure, scenario storyline and a residual term, based on a regression analysis and analysis of variance. From this diverse set of models and scenarios, we find that the uncertainty varies, depending on the region and the LULC type under consideration. Hotspots of uncertainty appear mainly at the edges of globally important biomes (e.g., boreal and tropical forests). Our results indicate that an important source of uncertainty in forest and pasture areas originates from different input data applied in the models. Cropland, in contrast, is more consistent among the starting conditions, while variation in the projections gradually increases over time due to diverse scenario assumptions and different modeling approaches. Comparisons at the grid cell level indicate that disagreement is mainly related to LULC type definitions and the individual model allocation schemes. We conclude that improving the quality and consistency of observational data utilized in the modeling process and improving the allocation mechanisms of LULC change models remain important challenges. Current LULC representation in environmental assessments might miss the uncertainty arising from the diversity of LULC change modeling approaches, and many studies ignore the uncertainty in LULC projections in assessments of LULC

Clarifying the Concept of Adherence to eHealth Technology: Systematic Review on When Usage Becomes Adherence.

Science.gov (United States)

Sieverink, Floor; Kelders, Saskia M; van Gemert-Pijnen, Julia Ewc

2017-12-06

In electronic health (eHealth) evaluations, there is increasing attention for studying the actual usage of a technology in relation to the outcomes found, often by studying the adherence to the technology. On the basis of the definition of adherence, we suggest that the following three elements are necessary to determine adherence to eHealth technology: (1) the ability to measure the usage behavior of individuals; (2) an operationalization of intended use; and (3) an empirical, theoretical, or rational justification of the intended use. However, to date, little is known on how to operationalize the intended usage of and the adherence to different types of eHealth technology. The study aimed to improve eHealth evaluations by gaining insight into when, how, and by whom the concept of adherence has been used in previous eHealth evaluations and finding a concise way to operationalize adherence to and intended use of different eHealth technologies. A systematic review of eHealth evaluations was conducted to gain insight into how the use of the technology was measured, how adherence to different types of technologies was operationalized, and if and how the intended use of the technology was justified. Differences in variables between the use of the technology and the operationalization of adherence were calculated using a chi-square test of independence. In total, 62 studies were included in this review. In 34 studies, adherence was operationalized as "the more use, the better," whereas 28 studies described a threshold for intended use of the technology as well. Out of these 28, only 6 reported a justification for the intended use. The proportion of evaluations of mental health technologies reporting a justified operationalization of intended use is lagging behind compared with evaluations of lifestyle and chronic care technologies. The results indicated that a justification of intended use does not require extra measurements to determine adherence to the technology. The

Medication adherence in patients with psychotic disorders: an observational survey involving patients before they switch to long-acting injectable risperidone

Directory of Open Access Journals (Sweden)

Baylé FJ

2015-09-01

Full Text Available Franck Jean Baylé,1 Arnaud Tessier,2,3 Sophie Bouju,4 David Misdrahi2,3 1Sainte-Anne Hospital (SHU, Paris V-Descartes University, Paris, 2Hôpital Charles Perrens, Pôle de Psychiatrie Adulte, 3CNRS UMR 5287-INCIA, Bordeaux University, Bordeaux, 4Janssen-Cilag France, Issy Les Moulineaux, Paris, France Background: Maintaining antipsychotic therapy in psychosis is important in preventing relapse. Long-acting depot preparations can prevent covert non-adherence and thus potentially contribute to better patient outcomes. In this observational survey the main objective is to evaluate medication adherence and its determinants for oral treatment in a large sample of patients with psychosis.Methods: In this cross-sectional survey medication adherence for oral treatment was assessed by patients using the patient-rated Medication Adherence Questionnaire (MAQ. Data were collected by physicians on patients with a recent acute psychotic episode before switching to long-acting injectable risperidone. Other evaluations included disease severity (Clinical Global Impression – Severity, patients’ insight (Positive and Negative Syndrome Scale item G12, treatment acceptance (clinician-rated Compliance Rating Scale, and therapeutic alliance (patient-rated 4-Point ordinal Alliance Scale.Results: A total of 399 psychiatrists enrolled 1,887 patients (mean age 36.8±11.9 years; 61.6% had schizophrenia. Adherence to oral medication was “low” in 53.2% of patients, “medium” in 29.5%, and “high” in 17.3%. Of patients with psychiatrist-rated active acceptance of treatment, 70% had “medium” or “high” MAQ scores (P<0.0001. Medication adherence was significantly associated with therapeutic alliance (4-Point ordinal Alliance Scale score; P<0.0001. Patient age was significantly associated with adherence: mean age increased with greater adherence (35.6, 36.7, and 38.6 years for patients with “low”, “medium”, and “high” levels of adherence

Variations in infant and childhood vitamin D supplementation programmes across Europe and factors influencing adherence

Directory of Open Access Journals (Sweden)

Suma Uday

2017-10-01

Full Text Available Background: Nutritional rickets is a growing global public health concern despite existing prevention programmes and health policies. We aimed to compare infant and childhood vitamin D supplementation policies, implementation strategies and practices across Europe and explore factors influencing adherence. Methods: European Society for Paediatric Endocrinology Bone and Growth Plate Working Group members and other specialists completed a questionnaire on country-specific vitamin D supplementation policy and child health care programmes, socioeconomic factors, policy implementation strategies and adherence. Factors influencing adherence were assessed using Kendall’s tau-b correlation coefficient. Results: Responses were received from 29 of 30 European countries (97%. Ninety-six per cent had national policies for infant vitamin D supplementation. Supplements are commenced on day 1–5 in 48% (14/29 of countries, day 6–21 in 48% (14/29; only the UK (1/29 starts supplements at 6 months. Duration of supplementation varied widely (6 months to lifelong in at-risk populations. Good (≥80% of infants, moderate (50–79% and low adherence (<50% to supplements was reported by 59% (17/29, 31% (9/29 and 10% (3/29 of countries, respectively. UK reported lowest adherence (5–20%. Factors significantly associated with good adherence were universal supplementation independent of feeding mode (P = 0.007, providing information at neonatal unit (NNU discharge (P = 0.02, financial family support (P = 0.005; monitoring adherence at surveillance visits (P = 0.001 and the total number of factors adopted (P < 0.001. Conclusions: Good adherence to supplementation is a multi-task operation that works best when parents are informed at birth, all babies are supplemented, and adherence monitoring is incorporated into child health surveillance visits. Implementation strategies matter for delivering efficient prevention policies.

Determinants of adherence to methylphenidate and the impact of poor adherence on maternal and family measures.

Science.gov (United States)

Gau, Susan S F; Shen, Hsin-Yi; Chou, Miao-Churn; Tang, Ching-Shu; Chiu, Yen-Nan; Gau, Churn-Shiouh

2006-06-01

The aim of this study was to examine the association between adherence to immediate-release methylphenidate (IR MPH) and maternal psychological distress, parenting style, parent- child relationship, and perceived family support. The sample consisted of 307 children with attention-deficit hyperactivity disorder (ADHD) (271 boys and 36 girls), 6-17 years of age, who had been treated with IR MPH for the past 6 months. The measures included the Chinese Health Questionnaire, Parental Bonding Instrument, Family APGAR, and Home Behaviors of the Social Adjustment Inventory for Children and Adolescents. Reasons for poor adherence (n = 79; 25.7%) included forgetting medication (72.7%), the medication having no effect (20.0%), and refusing medication (12.7%). Increased age and three-times-daily administration were the major predictors for poor adherence to IR MPH. Poor adherence was associated with increased degree of maternal psychological distress, indifferent parenting, maternal overprotection/control, poor family support, decreased interaction with parents, and increased problems at home. Findings indicate that multiple daily dosing of MPH increases the likelihood of poor adherence, particularly in adolescents, and that poor adherence is associated with impaired maternal/family process. Once-daily administration of MPH is necessary to improve adherence and to decrease the possible exacerbation of tense parent-child relationships caused by poor drug adherence.

Strengthening global health security capacity--Vietnam demonstration project, 2013.

Science.gov (United States)

Tran, Phu Dac; Vu, Long Ngoc; Nguyen, Hien Tran; Phan, Lan Trong; Lowe, Wayne; McConnell, Michelle S; Iademarco, Michael F; Partridge, Jeffrey M; Kile, James C; Do, Trang; Nadol, Patrick J; Bui, Hien; Vu, Diep; Bond, Kyle; Nelson, David B; Anderson, Lauren; Hunt, Kenneth V; Smith, Nicole; Giannone, Paul; Klena, John; Beauvais, Denise; Becknell, Kristi; Tappero, Jordan W; Dowell, Scott F; Rzeszotarski, Peter; Chu, May; Kinkade, Carl

2014-01-31

Over the past decade, Vietnam has successfully responded to global health security (GHS) challenges, including domestic elimination of severe acute respiratory syndrome (SARS) and rapid public health responses to human infections with influenza A(H5N1) virus. However, new threats such as Middle East respiratory syndrome coronavirus (MERS-CoV) and influenza A(H7N9) present continued challenges, reinforcing the need to improve the global capacity to prevent, detect, and respond to public health threats. In June 2012, Vietnam, along with many other nations, obtained a 2-year extension for meeting core surveillance and response requirements of the 2005 International Health Regulations (IHR). During March-September 2013, CDC and the Vietnamese Ministry of Health (MoH) collaborated on a GHS demonstration project to improve public health emergency detection and response capacity. The project aimed to demonstrate, in a short period, that enhancements to Vietnam's health system in surveillance and early detection of and response to diseases and outbreaks could contribute to meeting the IHR core capacities, consistent with the Asia Pacific Strategy for Emerging Diseases. Work focused on enhancements to three interrelated priority areas and included achievements in 1) establishing an emergency operations center (EOC) at the General Department of Preventive Medicine with training of personnel for public health emergency management; 2) improving the nationwide laboratory system, including enhanced testing capability for several priority pathogens (i.e., those in Vietnam most likely to contribute to public health emergencies of international concern); and 3) creating an emergency response information systems platform, including a demonstration of real-time reporting capability. Lessons learned included awareness that integrated functions within the health system for GHS require careful planning, stakeholder buy-in, and intradepartmental and interdepartmental coordination and

Adherence of Pseudomonas aeruginosa to contact lenses

International Nuclear Information System (INIS)

Miller, M.J.

1988-01-01

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

Global projects and Astronomy awareness activities in Nepal

Science.gov (United States)

Gautam, Suman

2015-08-01

Modern astronomy is a crowning achievement of human civilization which inspires teenagers to choose career in science and technology and is a stable of adult education. It is a unique and cost effective tool for furthering sustainable global development because of its technological, scientific and cultural dimensions which allow us to reach with the large portion of the community interact with children and inspire with our wonderful cosmos.Using astronomy to stimulate quality and inspiring education for disadvantaged children is an important goal of Nepal Astronomical Society (NASO) since its inception. NASO is carrying out various awareness activities on its own and in collaboration with national and international organizations like Central Department of Physics Tribhuvan University (TU), International astronomical Union (IAU), Department of Physics Prithvi Narayan Campus Pokhara, Nepal academy of science and technology (NAST), Global Hands on Universe (GHOU), EU- UNAWE and Pokhara Astronomical Society (PAS) to disseminate those activities for the school children and teachers in Nepal. Our experiences working with kids, students, teachers and public in the field of universe Awareness Activities for the school children to minimize the abstruse concept of astronomy through some practical approach and the project like Astronomy for the visually impaired students, Galileo Teacher Training program and International School for young astronomers (ISYA) outskirts will be explained which is believed to play vital role in promoting astronomy and space science activities in Nepal.

Combined equations for estimating global solar radiation: Projection of radiation field over Japan under global warming conditions by statistical downscaling

International Nuclear Information System (INIS)

Iizumi, T.; Nishimori, M.; Yokozawa, M.

2008-01-01

For this study, we developed a new statistical model to estimate the daily accumulated global solar radiation on the earth's surface and used the model to generate a high-resolution climate change scenario of the radiation field in Japan. The statistical model mainly relies on precipitable water vapor calculated from air temperature and relative humidity on the surface to estimate seasonal changes in global solar radiation. On the other hand, to estimate daily radiation fluctuations, the model uses either a diurnal temperature range or relative humidity. The diurnal temperature range, calculated from the daily maximum and minimum temperatures, and relative humidity is a general output of most climate models, and pertinent observation data are comparatively easy to access. The statistical model performed well when estimating the monthly mean value, daily fluctuation statistics, and regional differences in the radiation field in Japan. To project the change in the radiation field for the years 2081 to 2100, we applied the statistical model to the climate change scenario of a high-resolution Regional Climate Model with a 20-km mesh size (RCM20) developed at the Meteorological Research Institute based on the Special Report for Emission Scenario (SRES)-A2. The projected change shows the following tendency: global solar radiation will increase in the warm season and decrease in the cool season in many areas of Japan, indicating that global warming may cause changes in the radiation field in Japan. The generated climate change scenario for the radiation field is linked to long-term and short-term changes in air temperature and relative humidity obtained from the RCM20 and, consequently, is expected to complement the RCM20 datasets for an impact assessment study in the agricultural sector

Clustering based on adherence data.

Science.gov (United States)

Kiwuwa-Muyingo, Sylvia; Oja, Hannu; Walker, Sarah A; Ilmonen, Pauliina; Levin, Jonathan; Todd, Jim

2011-03-08

Adherence to a medical treatment means the extent to which a patient follows the instructions or recommendations by health professionals. There are direct and indirect ways to measure adherence which have been used for clinical management and research. Typically adherence measures are monitored over a long follow-up or treatment period, and some measurements may be missing due to death or other reasons. A natural question then is how to describe adherence behavior over the whole period in a simple way. In the literature, measurements over a period are usually combined just by using averages like percentages of compliant days or percentages of doses taken. In the paper we adapt an approach where patient adherence measures are seen as a stochastic process. Repeated measures are then analyzed as a Markov chain with finite number of states rather than as independent and identically distributed observations, and the transition probabilities between the states are assumed to fully describe the behavior of a patient. The patients can then be clustered or classified using their estimated transition probabilities. These natural clusters can be used to describe the adherence of the patients, to find predictors for adherence, and to predict the future events. The new approach is illustrated and shown to be useful with a simple analysis of a data set from the DART (Development of AntiRetroviral Therapy in Africa) trial in Uganda and Zimbabwe.

Medication adherence among adult patients on hemodialysis

Directory of Open Access Journals (Sweden)

Abdulmalik M Alkatheri

2014-01-01

Full Text Available Medication adherence was assessed in 89 patients on hemodialysis (HD at the King Abdul Aziz Medical City using an Arabic version of the Morisky Medication Adherence Scale (MASS-8. The results of the study revealed that 31.46% and 40.45% of the participants showed low and medium adherence, respectively, while 28.09% showed high medication adherence. Accordingly, 71.91% of the patients visiting the dialysis unit were considered medication non-adherent. While being of older age (P = 0.012, being married (P = 0.012 increased the level of adherence, being of medium level of education (P = 0.024 decreased adherence levels. On the other hand, gender, presence of a care-giver, number of members in the household and employment status seems to have no effect on the level of medication adherence. These results call upon the practitioners in HD units to develop intervention programs that can increase the level of medication adherence.

Assessment of global cloud datasets from satellites: Project and database initiated by the GEWEX radiation panel

OpenAIRE

Stubenrauch , C.J.; Rossow , W.B.; Kinne , S.; Ackerman , S.; Cesana , G.; Chepfer , H.; Di Girolamo , L.; Getzewich , B.; Guignard , A.; Heidinger , A.; Maddux , B.C.; Menzel , W.P.; Minnis , P.; Pearl , C.; Platnick , S.

2013-01-01

International audience; The Global Energy and Water Cycle Experiment (GEWEX) Radiation Panel initiated the GEWEX Cloud Assessment in 2005 to compare available, global, long-term cloud data products with the International Satellite Cloud Climatology Project (ISCCP). The GEWEX Cloud Assessment database included cloud properties retrieved from different satellite sensor measurements, taken at various local times and over various time periods. The relevant passive satellite sensors measured radia...

Global assessment of internal audit competence

African Journals Online (AJOL)

kirstam

of Accountants (IFAC) and the Global Accounting Alliance (GAA), adhere to the requirements as set out in the international education standards published by IFAC. (GAA 2015). These education standards emphasise the importance of competency- based professional development in the accounting and auditing professions ...

Age, Stigma, Adherence and Clinical Indicators in HIV-Infected Women.

Science.gov (United States)

McCoy, Katryna; Higgins, Melinda; Zuñiga, Julie Ann; Holstad, Marcia McDonnell

Stigma has become a gendered phenomenon that affects increasing numbers of HIV-infected women worldwide. This study examined the role of age as a possible moderator of the relationship between stigma and antiretroviral therapy adherence, CD4% and viral load among 120 HIV-infected women. A secondary analysis was conducted using data from the Keeping Healthy and Active with Risk Reduction and Medication Adherence (KHARMA) Project, an National Institutes of Health (NIH) funded randomized controlled trial to improve Antiretroviral treatment (ART) adherence and reduce risky behaviors in HIV-infected women at five clinical sites in a South-eastern city from 2005 to 2008. Stigma was measured using the Perceived Personal Stigma of Human Immunodeficiency Virus and Acquired Immune Deficiency Syndrome (HIV/AIDS) scale. Among participants stigma was negatively associated with CD4% (r =-.26, p=.02). For the 30 participants >50 years old, age was not significantly associated with viral load, stigma or CD4%, and there was no significant association between stigma and CD4% (r=.07, p=.70). These findings indicate the need for further study regarding this potential moderating effect and possible interventions to address the susceptibility of younger women to the harmful effects of stigma.

7 CFR 1484.34 - Must Cooperators adhere to specific standards of ethical conduct?

Science.gov (United States)

2010-01-01

... Cooperators adhere to specific standards of ethical conduct? (a) A Cooperator shall conduct its business in... funds to promote private self interests or conduct private business, except as members of sales teams... advertising. Deceptive or misleading promotions may result in cancellation or termination of a project...

Child and Adolescent Adherence With Cognitive Behavioral Therapy for Anxiety: Predictors and Associations With Outcomes.

Science.gov (United States)

Lee, Phyllis; Zehgeer, Asima; Ginsburg, Golda S; McCracken, James; Keeton, Courtney; Kendall, Philip C; Birmaher, Boris; Sakolsky, Dara; Walkup, John; Peris, Tara; Albano, Anne Marie; Compton, Scott

2017-04-27

Cognitive behavioral therapy (CBT) for anxiety disorders is effective, but nonadherence with treatment may reduce the benefits of CBT. This study examined (a) four baseline domains (i.e., demographic, youth clinical characteristics, therapy related, family/parent factors) as predictors of youth adherence with treatment and (b) the associations between youth adherence and treatment outcomes. Data were from 279 youth (7-17 years of age, 51.6% female; 79.6% White, 9% African American), with Diagnostic and Statistical Manual of Mental Disorders (4th ed., text rev.) diagnoses of separation anxiety disorder, generalized anxiety disorder, and/or social phobia, who participated in CBT in the Child/Adolescent Anxiety Multimodal Study. Adherence was defined in three ways (session attendance, therapist-rated compliance, and homework completion). Multiple regressions revealed several significant predictors of youth adherence with CBT, but predictors varied according to the definition of adherence. The most robust predictors of greater adherence were living with both parents and fewer youth comorbid externalizing disorders. With respect to outcomes, therapist ratings of higher youth compliance with CBT predicted several indices of favorable outcome: lower anxiety severity, higher global functioning, and treatment responder status after 12 weeks of CBT. Number of sessions attended and homework completion did not predict treatment outcomes. Findings provide information about risks for youth nonadherence, which can inform treatment and highlight the importance of youth compliance with participating in therapy activities, rather than just attending sessions or completing homework assignments.

NEWS Climatology Project: The State of the Water Cycle at Continental to Global Scales

Science.gov (United States)

Rodell, Matthew; LEcuyer, Tristan; Beaudoing, Hiroko Kato; Olson, Bill

2011-01-01

NASA's Energy and Water Cycle Study (NEWS) program fosters collaborative research towards improved quantification and prediction of water and energy cycle consequences of climate change. In order to measure change, it is first necessary to describe current conditions. The goal of the NEWS Water and Energy Cycle Climatology project is to develop "state of the global water cycle" and "state of the global energy cycle" assessments based on data from modern ground and space based observing systems and data integrating models. The project is a multiinstitutional collaboration with more than 20 active contributors. This presentation will describe results of the first stage of the water budget analysis, whose goal was to characterize the current state of the water cycle on mean monthly, continental scales. We examine our success in closing the water budget within the expected uncertainty range and the effects of forcing budget closure as a method for refining individual flux estimates.

Fadama III Beneficiaries' Adherence to Project Guidelines in Ogun ...

African Journals Online (AJOL)

It was recommended that the implementers should keep up their efforts at sensitising beneficiaries on the implementation guidelines of the project, re-work their strategies at addressing procurement and FUEF inadequacies among the beneficiaries and fast-track the delivery of project benefits in the communities. Key words: ...

Adherence as a language game.

Science.gov (United States)

Kolberg, Espen Skarstein

2017-04-01

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.

Medicine non-adherence in kidney transplantation.

Science.gov (United States)

Williams, Allison Fiona; Manias, Elizabeth; Gaskin, Cadeyrn J; Crawford, Kimberley

2014-06-01

The increasing prevalence of chronic kidney disease, the relative shortage of kidney donors and the economic- and health-related costs of kidney transplant rejection make the prevention of adverse outcomes following transplantation a healthcare imperative. Although strict adherence to immunosuppressant medicine regimens is key to preventing kidney rejection, evidence suggests that adherence is sub-optimal. Strategies need to be developed to help recipients of kidney transplants adhere to their prescribed medicines. This review has found that a number of factors contribute to poor adherence, for example, attitudes towards medicine taking and forgetfulness. Few investigations have been conducted, however, on strategies to enhance medicine adherence in kidney transplant recipients. Strategies that may improve adherence include pharmacist-led interventions (incorporating counselling, medicine reviews and nephrologist liaison) and nurse-led interventions (involving collaboratively working with recipients to understand their routines and offering solutions to improve adherence). Strategies that have shown to have limited effectiveness include supplying medicines free of charge and providing feedback on a participant's medicine adherence without any educational or behavioural interventions. Transplantation is the preferred treatment option for people with end-stage kidney disease. Medicine non-adherence in kidney transplantation increases the risk of rejection, kidney loss and costly treatments. Interventions are needed to help the transplant recipient take all their medicines as prescribed to improve general well-being, medicine safety and reduce healthcare costs. © 2014 European Dialysis and Transplant Nurses Association/European Renal Care Association.

The global unified parallel file system (GUPFS) project: FY 2002 activities and results

Energy Technology Data Exchange (ETDEWEB)

Butler, Gregory F.; Lee, Rei Chi; Welcome, Michael L.

2003-04-07

The Global Unified Parallel File System (GUPFS) project is a multiple-phase, five-year project at the National Energy Research Scientific Computing (NERSC) Center to provide a scalable, high performance, high bandwidth, shared file system for all the NERSC production computing and support systems. The primary purpose of the GUPFS project is to make it easier to conduct advanced scientific research using the NERSC systems. This is to be accomplished through the use of a shared file system providing a unified file namespace, operating on consolidated shared storage that is directly accessed by all the NERSC production computing and support systems. During its first year, FY 2002, the GUPFS project focused on identifying, testing, and evaluating existing and emerging shared/cluster file system, SAN fabric, and storage technologies; identifying NERSC user input/output (I/O) requirements, methods, and mechanisms; and developing appropriate benchmarking methodologies and benchmark codes for a parallel environment. This report presents the activities and progress of the GUPFS project during its first year, the results of the evaluations conducted, and plans for near-term and longer-term investigations.

Immunosuppressive medication adherence in kidney transplant patients.

Science.gov (United States)

Lalić, Jelena; Veličković-Radovanović, Radmila; Mitić, Branka; Paunović, Goran; Cvetković, Tatjana

2014-01-01

To assess the degree of immunosuppressive medication adherence in kidney transplant patients (KTPs) and to determine if there is a difference in the rate of adherence to tacrolimus (Tac), cyclosporine (CsA) and sirolimus (Sir). From a total of 63 KTPs treated at the Clinic of Nephrology, Clinical Centre Niš, Serbia, 60 participated in the study by responding to questionnaires. They were divided into the adherence group (n = 43) and the nonadherence group (n = 17) according to their degree of adherence which was measured using a validated survey form, the simplified medication adherence questionnaire. The KTP adherence to the different immunosuppressive regimens (Tac, CsA and Sir) was compared. Statistical analysis was performed using the Student t test. Adherence was observed in 43 (71.7%) patients, and only 17 (28.3%) did not follow the prescribed therapy. The estimated glomerular filtration rate was significantly lower in the nonadherence group (38.52 ± 18.22 ml/min) than in the adherence group (52.43 ± 16.91 ml/min, p adherers and the nonadherers (6.30 ± 2.06 vs. 5.0 ± 1.52 ng/ml, p adherence. Nonadherence was associated with worse graft function and a lower Tac level. Knowledge about the degree of adherence could help the early identification of nonadherent patients and the development of strategies to improve this. © 2014 S. Karger AG, Basel

Recent Trends of the Tropical Hydrological Cycle Inferred from Global Precipitation Climatology Project and International Satellite Cloud Climatology Project data

Science.gov (United States)

Zhou, Y. P.; Xu, Kuan-Man; Sud, Y. C.; Betts, A. K.

2011-01-01

Scores of modeling studies have shown that increasing greenhouse gases in the atmosphere impact the global hydrologic cycle; however, disagreements on regional scales are large, and thus the simulated trends of such impacts, even for regions as large as the tropics, remain uncertain. The present investigation attempts to examine such trends in the observations using satellite data products comprising Global Precipitation Climatology Project precipitation and International Satellite Cloud Climatology Project cloud and radiation. Specifically, evolving trends of the tropical hydrological cycle over the last 20-30 years were identified and analyzed. The results show (1) intensification of tropical precipitation in the rising regions of the Walker and Hadley circulations and weakening over the sinking regions of the associated overturning circulation; (2) poleward shift of the subtropical dry zones (up to 2deg/decade in June-July-August (JJA) in the Northern Hemisphere and 0.3-0.7deg/decade in June-July-August and September-October-November in the Southern Hemisphere) consistent with an overall broadening of the Hadley circulation; and (3) significant poleward migration (0.9-1.7deg/decade) of cloud boundaries of Hadley cell and plausible narrowing of the high cloudiness in the Intertropical Convergence Zone region in some seasons. These results support findings of some of the previous studies that showed strengthening of the tropical hydrological cycle and expansion of the Hadley cell that are potentially related to the recent global warming trends.

Contributions of projected land use to global radiative forcing ascribed to local sources

Science.gov (United States)

Ward, D. S.; Mahowald, N. M.; Kloster, S.

2013-12-01

With global demand for food expected to dramatically increase and put additional pressures on natural lands, there is a need to understand the environmental impacts of land use and land cover change (LULCC). Previous studies have shown that the magnitude and even the sign of the radiative forcing (RF) of biogeophysical effects from LULCC depends on the latitude and forest ecology of the disturbed region. Here we ascribe the contributions to the global RF by land-use related anthropogenic activities to their local sources, organized on a grid of 1.9 degrees latitude by 2.5 degrees longitude. We use RF estimates for the year 2100, using five future LULCC projections, computed from simulations with the National Center for Atmospheric Research Community Land Model and Community Atmosphere Models and additional offline analyses. Our definition of the LULCC RF includes changes to terrestrial carbon storage, methane and nitrous oxide emissions, atmospheric chemistry, aerosol emissions, and surface albedo. We ascribe the RF to gridded locations based on LULCC-related emissions of relevant trace gases and aerosols, including emissions from fires. We find that the largest contributions to the global RF in year 2100 from LULCC originate in the tropics for all future scenarios. In fact, LULCC is the largest tropical source of anthropogenic RF. The LULCC RF in the tropics is dominated by emissions of CO2 from deforestation and methane emissions from livestock and soils. Land surface albedo change is rarely the dominant forcing agent in any of the future LULCC projections, at any location. By combining the five future scenarios we find that deforested area at a specific tropical location can be used to predict the contribution to global RF from LULCC at that location (the relationship does not hold as well in the extratropics). This information could support global efforts like REDD (Reducing Emissions from Deforestation and Forest Degradation), that aim to reduce greenhouse gas

Global optimization of maintenance and surveillance testing based on reliability and probabilistic safety assessment. Research project

International Nuclear Information System (INIS)

Martorell, S.; Serradell, V.; Munoz, A.; Sanchez, A.

1997-01-01

Background, objective, scope, detailed working plan and follow-up and final product of the project ''Global optimization of maintenance and surveillance testing based on reliability and probabilistic safety assessment'' are described

Project GRACE A grid based search tool for the global digital library

CERN Document Server

Scholze, Frank; Vigen, Jens; Prazak, Petra; The Seventh International Conference on Electronic Theses and Dissertations

2004-01-01

The paper will report on the progress of an ongoing EU project called GRACE - Grid Search and Categorization Engine (http://www.grace-ist.org). The project participants are CERN, Sheffield Hallam University, Stockholm University, Stuttgart University, GL 2006 and Telecom Italia. The project started in 2002 and will finish in 2005, resulting in a Grid based search engine that will search across a variety of content sources including a number of electronic thesis and dissertation repositories. The Open Archives Initiative (OAI) is expanding and is clearly an interesting movement for a community advocating open access to ETD. However, the OAI approach alone may not be sufficiently scalable to achieve a truly global ETD Digital Library. Many universities simply offer their collections to the world via their local web services without being part of any federated system for archiving and even those dissertations that are provided with OAI compliant metadata will not necessarily be picked up by a centralized OAI Ser...

Projecting the Global Distribution of the Emerging Amphibian Fungal Pathogen, Batrachochytrium dendrobatidis, Based on IPCC Climate Futures.

Directory of Open Access Journals (Sweden)

Gisselle Yang Xie

Full Text Available Projected changes in climate conditions are emerging as significant risk factors to numerous species, affecting habitat conditions and community interactions. Projections suggest species range shifts in response to climate change modifying environmental suitability and is supported by observational evidence. Both pathogens and their hosts can shift ranges with climate change. We consider how climate change may influence the distribution of the emerging infectious amphibian chytrid fungus, Batrachochytrium dendrobatidis (Bd, a pathogen associated with worldwide amphibian population losses. Using an expanded global Bd database and a novel modeling approach, we examined a broad set of climate metrics to model the Bd-climate niche globally and regionally, then project how climate change may influence Bd distributions. Previous research showed that Bd distribution is dependent on climatic variables, in particular temperature. We trained a machine-learning model (random forest with the most comprehensive global compilation of Bd sampling records (~5,000 site-level records, mid-2014 summary, including 13 climatic variables. We projected future Bd environmental suitability under IPCC scenarios. The learning model was trained with combined worldwide data (non-region specific and also separately per region (region-specific. One goal of our study was to estimate of how Bd spatial risks may change under climate change based on the best available data. Our models supported differences in Bd-climate relationships among geographic regions. We projected that Bd ranges will shift into higher latitudes and altitudes due to increased environmental suitability in those regions under predicted climate change. Specifically, our model showed a broad expansion of areas environmentally suitable for establishment of Bd on amphibian hosts in the temperate zones of the Northern Hemisphere. Our projections are useful for the development of monitoring designs in these areas

Global Threat Reduction Initiative Fuel Thermo-Physical Characterization Project: Sample Management Plan

Energy Technology Data Exchange (ETDEWEB)

Casella, Amanda J. [Pacific Northwest National Lab. (PNNL), Richland, WA (United States); Pereira, Mario M. [Pacific Northwest National Lab. (PNNL), Richland, WA (United States); Steen, Franciska H. [Pacific Northwest National Lab. (PNNL), Richland, WA (United States)

2013-01-01

This sample management plan provides guidelines for sectioning, preparation, acceptance criteria, analytical path, and end-of-life disposal for the fuel element segments utilized in the Global Threat Reduction Initiative (GTRI), Fuel Thermo-Physical Characterization Project. The Fuel Thermo-Physical Characterization Project is tasked with analysis of irradiated Low Enriched Uranium (LEU) Molybdenum (U-Mo) fuel element samples to support the GTRI conversion program. Sample analysis may include optical microscopy (OM), scanning electron microscopy (SEM) fuel-surface interface analysis, gas pycnometry (density) measurements, laser flash analysis (LFA), differential scanning calorimetry (DSC), thermogravimetry and differential thermal analysis with mass spectroscopy (TG /DTA-MS), Inductively Coupled Plasma Spectrophotometry (ICP), alpha spectroscopy, and Thermal Ionization Mass Spectroscopy (TIMS). The project will utilize existing Radiochemical Processing Laboratory (RPL) operating, technical, and administrative procedures for sample receipt, processing, and analyses. Test instructions (TIs), which are documents used to provide specific details regarding the implementation of an existing RPL approved technical or operational procedure, will also be used to communicate to staff project specific parameters requested by the Principal Investigator (PI). TIs will be developed, reviewed, and issued in accordance with the latest revision of the RPL-PLN-700, RPL Operations Plan. Additionally, the PI must approve all project test instructions and red-line changes to test instructions.

Benefits of adherence to psychotropic medications on depressive symptoms and antiretroviral medication adherence among men and women living with HIV/AIDS.

Science.gov (United States)

Cruess, Dean G; Kalichman, Seth C; Amaral, Christine; Swetzes, Connie; Cherry, Chauncey; Kalichman, Moira O

2012-04-01

Psychotropic medications are commonly used for depressive symptoms among people living with HIV/AIDS. We examined the relationships between adherence to psychotropic medications, depressive symptoms, and antiretroviral adherence. We assessed depressive symptoms among 324 people living with HIV/AIDS across a 3-month period (70% men; mean age 45 years; 90% African-American). Psychotropic and antiretroviral adherence was assessed using monthly, unannounced telephone pill counts. Multiple-regression and mediation analyses were utilized to examine associations under investigation. Greater depressive symptoms were associated with lower antiretroviral and psychotropic medication adherence. Greater adherence to psychotropic medications regardless of medication class was positively related to higher antiretroviral adherence. Greater adherence to psychotropic medications also significantly mediated the association between depressive symptoms and antiretroviral adherence. This study demonstrates the benefits of adherence to psychotropic medications on both depressive symptoms and antiretroviral adherence. Future work examining psychotropic medication adherence on disease outcomes in people living with HIV/AIDS is warranted.

How Social Software Supports Cooperative Practices in a Globally Distributed Software Project

DEFF Research Database (Denmark)

Giuffrida, Rosalba; Dittrich, Yvonne

2014-01-01

In Global Software Development (GSD), the lack of face- to-face communication is a major challenge and effective computer-mediated practices are necessary. This paper analyzes cooperative practices supported by Social Software (SoSo) in a GSD student project. The empirical results show...... that the role of SoSo is to support informal communication, enabling social talks and metawork, both necessary for establishing and for maintaining effective coordination mechanisms, thus successful cooperation....

Self-reported Medication Adherence and CKD Progression

Directory of Open Access Journals (Sweden)

Esteban A. Cedillo-Couvert

2018-05-01

Full Text Available Introduction: In the general population, medication nonadherence contributes to poorer outcomes. However, little is known about medication adherence among adults with chronic kidney disease (CKD. We evaluated the association of self-reported medication adherence with CKD progression and all-cause death in patients with CKD. Methods: In this prospective observational study of 3305 adults with mild-to-moderate CKD enrolled in the Chronic Renal Insufficiency Cohort (CRIC Study, the baseline self-reported medication adherence was assessed by responses to 3 questions and categorized as high, medium, and low. CKD progression (50% decline in eGFR or incident end-stage renal disease and all-cause death were measured using multivariable Cox proportional hazards. Results: Of the patients, 68% were categorized as high adherence, 17% medium adherence, and 15% low adherence. Over a median follow-up of 6 years, there were 969 CKD progression events and 675 deaths. Compared with the high-adherence group, the low-adherence group experienced increased risk for CKD progression (hazard ratio = 1.27, 95% confidence interval = 1.05, 1.54 after adjustment for sociodemographic and clinical factors, cardiovascular medications, number of medication types, and depressive symptoms. A similar association existed between low adherence and all-cause death, but did not reach standard statistical significance (hazard ratio = 1.14 95% confidence interval = 0.88, 1.47. Conclusion: Baseline self-reported low medication adherence was associated with an increased risk for CKD progression. Future work is needed to better understand the mechanisms underlying this association and to develop interventions to improve adherence. Keywords: CKD, death, medication adherence, progression

A Systematic Review of CPAP Adherence Across Age Groups: Clinical and Empiric Insights for Developing CPAP Adherence Interventions

Science.gov (United States)

Sawyer, A.M.; Gooneratne, N.; Marcus, C.L.; Ofer, D.; Richards, K.C.; Weaver, T.E.

2011-01-01

Continuous positive airway pressure (CPAP) is a highly efficacious treatment for obstructive sleep apnea (OSA) but adherence to the treatment limits its overall effectiveness across all age groups of patients. Factors that influence adherence to CPAP include disease and patient characteristics, treatment titration procedures, technological device factors and side effects, and psychological and social factors. These influential factors have guided the development of interventions to promote CPAP adherence. Various intervention strategies have been described and include educational, technological, psychosocial, pharmacological, and multi-dimensional approaches. Though evidence to date has led to innovative strategies that address adherence in CPAP-treated children, adults, and older adults, significant opportunities exist to develop and test interventions that are clinically applicable, specific to subgroups of patients likely to demonstrate poor adherence, and address the multifactorial nature of CPAP adherence. The translation of CPAP adherence promotion interventions to clinical practice is imperative to improve health and functional outcomes in all persons with CPAP-treated OSA. PMID:21652236

Changes in precipitation extremes projected by a 20-km mesh global atmospheric model

Directory of Open Access Journals (Sweden)

Akio Kitoh

2016-03-01

Full Text Available High-resolution modeling is necessary to project weather and climate extremes and their future changes under global warming. A global high-resolution atmospheric general circulation model with grid size about 20 km is able to reproduce climate fields as well as regional-scale phenomena such as monsoonal rainfall, tropical and extratropical cyclones, and heavy precipitation. This 20-km mesh model is applied to project future changes in weather and climate extremes at the end of the 21st century with four different spatial patterns in sea surface temperature (SST changes: one with the mean SST changes by the 28 models of the Coupled Model Intercomparison Project Phase 5 (CMIP5 under the Representative Concentration Pathways (RCP-8.5 scenario, and the other three obtained from a cluster analysis, in which tropical SST anomalies derived from the 28 CMIP5 models were grouped. Here we focus on future changes in regional precipitation and its extremes. Various precipitation indices averaged over the Twenty-two regional land domains are calculated. Heavy precipitation indices (maximum 5-day precipitation total and maximum 1-day precipitation total increase in all regional domains, even where mean precipitation decrease (Southern Africa, South Europe/Mediterranean, Central America. South Asia is the domain of the largest extreme precipitation increase. In some domains, different SST patterns result in large precipitation changes, possibly related to changes in large-scale circulations in the tropical Pacific.

Code Team Training: Demonstrating Adherence to AHA Guidelines During Pediatric Code Blue Activations.

Science.gov (United States)

Stewart, Claire; Shoemaker, Jamie; Keller-Smith, Rachel; Edmunds, Katherine; Davis, Andrew; Tegtmeyer, Ken

2017-10-16

Pediatric code blue activations are infrequent events with a high mortality rate despite the best effort of code teams. The best method for training these code teams is debatable; however, it is clear that training is needed to assure adherence to American Heart Association (AHA) Resuscitation Guidelines and to prevent the decay that invariably occurs after Pediatric Advanced Life Support training. The objectives of this project were to train a multidisciplinary, multidepartmental code team and to measure this team's adherence to AHA guidelines during code simulation. Multidisciplinary code team training sessions were held using high-fidelity, in situ simulation. Sessions were held several times per month. Each session was filmed and reviewed for adherence to 5 AHA guidelines: chest compression rate, ventilation rate, chest compression fraction, use of a backboard, and use of a team leader. After the first study period, modifications were made to the code team including implementation of just-in-time training and alteration of the compression team. Thirty-eight sessions were completed, with 31 eligible for video analysis. During the first study period, 1 session adhered to all AHA guidelines. During the second study period, after alteration of the code team and implementation of just-in-time training, no sessions adhered to all AHA guidelines; however, there was an improvement in percentage of sessions adhering to ventilation rate and chest compression rate and an improvement in median ventilation rate. We present a method for training a large code team drawn from multiple hospital departments and a method of assessing code team performance. Despite subjective improvement in code team positioning, communication, and role completion and some improvement in ventilation rate and chest compression rate, we failed to consistently demonstrate improvement in adherence to all guidelines.

ASEAN-India and ASEAN-Korea FTA: Global Trade Analysis Project

Directory of Open Access Journals (Sweden)

Ana Shohibul Manshur Al Ahmad

2014-04-01

Full Text Available The aim of this research is to investigate the effects of the free trade agreement between ASEAN-India (AIFTA and ASEAN-Korea (AKFTA. The Computable General Equilibrium (CGE model was applied in this paper with a Global Trade Analysis Project (GTAP database version 8. The GTAP simulations results show that AIFTA provides a greater positive impact than the AKFTA for each region. The greater improvement in terms of welfare, GDP, trade and investment is generated under the AIFTA scheme. Implication of this research is required of any reallocation of resources shared by each country heading on sectors which have a comparative advantage.

Asthma and Adherence to Inhaled Corticosteroids

DEFF Research Database (Denmark)

Bårnes, Camilla Boslev; Ulrik, Charlotte Suppli

2015-01-01

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...

Predictors of Vitamin Adherence After Bariatric Surgery.

Science.gov (United States)

Sunil, Supreet; Santiago, Vincent A; Gougeon, Lorraine; Warwick, Katie; Okrainec, Allan; Hawa, Raed; Sockalingam, Sanjeev

2017-02-01

Vitamin supplementation in bariatric aftercare is essential to prevent nutrient deficiencies; however, rates of vitamin adherence have been as low as 30 % 6 months post-surgery. Preliminary literature suggests non-adherence to prescribed treatments can be linked to demographic and psychological factors. We aimed to determine the relationship between these factors to vitamin adherence in post-bariatric surgery patients. A total of 92 bariatric patients were assessed 6 months post-surgery. Patients were administered a questionnaire collecting demographic information, psychological scores, and self-reported adherence. Nutrient deficiencies were analyzed through serum vitamin levels measured 3 and 6 months after surgery. Wilcoxon rank-sum and chi-square tests were used for analysis. Non-adherence was associated with male sex and full-time employment (p = 0.027, p = 0.015). There were no differences with respect to living situation, education level, or relationship type. Non-adherent patients did not have significantly higher scores for generalized anxiety, depressive symptoms, or avoidant behaviors. However, non-adherent patients displayed greater attachment anxiety than their adherent counterparts (p = 0.0186). Non-adherence was also associated with lower vitamin B12 levels 6 months post-surgery (p = 0.001). Male gender and full-time work have previously been shown to be associated with non-adherence. This is the first study to demonstrate that attachment anxiety is associated with poor multivitamin adherence in the post-surgical bariatric population. This result is concordant with recent literature that has demonstrated attachment anxiety is associated with poor adherence to dietary recommendations in bariatric patients 6 months postoperatively. Presurgical screening for attachment anxiety could facilitate early interventions to promote better bariatric aftercare in this group.

Mental models of adherence: parallels in perceptions, values, and expectations in adherence to prescribed home exercise programs and other personal regimens.

Science.gov (United States)

Rizzo, Jon; Bell, Alexandra

2018-05-09

A mental model is the collection of an individual's perceptions, values, and expectations about a particular aspect of their life, which strongly influences behaviors. This study explored orthopedic outpatients mental models of adherence to prescribed home exercise programs and how they related to mental models of adherence to other types of personal regimens. The study followed an interpretive description qualitative design. Data were collected via two semi-structured interviews. Interview One focused on participants prior experiences adhering to personal regimens. Interview Two focused on experiences adhering to their current prescribed home exercise program. Data analysis followed a constant comparative method. Findings revealed similarity in perceptions, values, and expectations that informed individuals mental models of adherence to personal regimens and prescribed home exercise programs. Perceived realized results, expected results, perceived social supports, and value of convenience characterized mental models of adherence. Parallels between mental models of adherence for prescribed home exercise and other personal regimens suggest that patients adherence behavior to prescribed routines may be influenced by adherence experiences in other aspects of their lives. By gaining insight into patients adherence experiences, values, and expectations across life domains, clinicians may tailor supports that enhance home exercise adherence. Implications for Rehabilitation A mental model is the collection of an individual's perceptions, values, and expectations about a particular aspect of their life, which is based on prior experiences and strongly influences behaviors. This study demonstrated similarity in orthopedic outpatients mental models of adherence to prescribed home exercise programs and adherence to personal regimens in other aspects of their lives. Physical therapists should inquire about patients non-medical adherence experiences, as strategies patients

Global Collaborative STEM Education

Science.gov (United States)

Meabh Kelly, Susan; Smith, Walter

2016-04-01

Global Collaborative STEM Education, as the name suggests, simultaneously supports two sets of knowledge and skills. The first set is STEM -- science, technology, engineering and math. The other set of content knowledge and skills is that of global collaboration. Successful global partnerships require awareness of one's own culture, the biases embedded within that culture, as well as developing awareness of the collaborators' culture. Workforce skills fostered include open-mindedness, perseverance when faced with obstacles, and resourceful use of technological "bridges" to facilitate and sustain communication. In respect for the 2016 GIFT Workshop focus, Global Collaborative STEM Education projects dedicated to astronomy research will be presented. The projects represent different benchmarks within the Global Collaborative STEM Education continuum, culminating in an astronomy research experience that fully reflects how the global STEM workforce collaborates. To facilitate wider engagement in Global Collaborative STEM Education, project summaries, classroom resources and contact information for established international collaborative astronomy research projects will be disseminated.

Improving adherence to antiretroviral therapy

Directory of Open Access Journals (Sweden)

Nischal K

2005-01-01

Full Text Available Antiretroviral therapy (ART has transformed HIV infection into a treatable, chronic condition. However, the need to continue treatment for decades rather than years, calls for a long-term perspective of ART. Adherence to the regimen is essential for successful treatment and sustained viral control. Studies have indicated that at least 95% adherence to ART regimens is optimal. It has been demonstrated that a 10% higher level of adherence results in a 21% reduction in disease progression. The various factors affecting success of ART are social aspects like motivation to begin therapy, ability to adhere to therapy, lifestyle pattern, financial support, family support, pros and cons of starting therapy and pharmacological aspects like tolerability of the regimen, availability of the drugs. Also, the regimen′s pill burden, dosing frequency, food requirements, convenience, toxicity and drug interaction profile compared with other regimens are to be considered before starting ART. The lack of trust between clinician and patient, active drug and alcohol use, active mental illness (e.g. depression, lack of patient education and inability of patients to identify their medications, lack of reliable access to primary medical care or medication are considered to be predictors of inadequate adherence. Interventions at various levels, viz. patient level, medication level, healthcare level and community level, boost adherence and overall outcome of ART.

[Transcultural adaptation of scales for treatment adherence in hemodialysis: Renal Adherence Behaviour Questionnaire(RABQ) and Renal Adherence Attitudes Questionnaire(RAAQ)].

Science.gov (United States)

Machado, Inês Maria de Jesus; Bandeira, Marina Bittencourt; Pinheiro, Hélady Sanders; Dutra, Nathália Dos Santos

2015-10-01

Treatment adherence in hemodialysis is important for guaranteeing better results for patients, but Brazil still lacks validated assessment tools for this purpose. The current study aimed to perform a cross-cultural adaptation of the Renal Adherence Behaviour Questionnaire (RABQ) and the Renal Adherence Attitudes Questionnaire (RAAQ). The two questionnaires were submitted to the following cross-cultural adaptation procedures: translation, back-translation, expert panel review, and pilot study. Changes were made in the items' wording and application, which requires a face-to-face interview. It was not necessary to change the choices of answers. The Brazilian versions of the RABQ and RAAQ showed semantic and cultural equivalence to the original versions and are easy for the target population to understand. The two scales still require validity and reliability studies before use in the field.

Media Memories in Focus Group Discussions - Methodological Reflections Instancing the Global Media Generations Project

Directory of Open Access Journals (Sweden)

Theo Hug

2010-06-01

Full Text Available Medienereignisse wie auch die Einführung und Verbreitung neuer Medientechnologien und Formate bringen mannigfaltige Wege des „Eintretens von Medien ins Leben“ mit sich. Im Projekt Globale Mediengenerationen (GMG wurden Medienerinnerungen aus der Kindheit im Kontext von Gruppendiskussionen am Beispiel dreier Generationen aus verschiedenen Ländern aller Kontinente untersucht. Dabei wurden medienbezogene Wissensbestände von drei Alterskohorten globaler Generationen analysiert. Der Artikel diskutiert methodologische Aspekte des Projekts und komplexe und selektive Prozesse des Erinnerns vergangener Ereignisse. Er untersucht Gemeinsamkeiten und Unterschiede des GMG-Ansatzes mit dem dokumentarischen Ansatz von Ralf Bohnsack, die beide in der Wissenssoziologie von Karl Mannheim verwurzelt sind. Darüber hinaus wird Medialität als basale methodologische Kategorie in Erwägung gezogen, nicht nur im Hinblick auf die Klärung begrifflicher Grundlagen, sondern auch als inhärente Dimension von Forschungsprozessen. Media events in general and the introduction and divulgence of new media technologies and formats in particular implicate various (new ways of “media entering life.” In the Global Media Generations (GMG research project, articulation of individuals’ memories of childhood experiences with the media was afforded by context of focus groups of three generations in different countries of six continents. In this project media related knowledge segments of different age cohorts have been analyzed and interpreted. The article deals with methodological questions of the project and complex processes of ‘remembering’ past events. It explores commonalities and differences of the GMG approach with Ralf Bohnsack’s documentary approach, both rooted in the sociology of knowledge of Karl Mannheim. Furthermore, mediality is taken into consideration as a basic methodological category, which means that it is perceived not only as subject matter to

PISA and Global Educational Governance--A Critique of the Project, Its Uses and Implications

Science.gov (United States)

Sjøberg, Svein

2015-01-01

The PISA project has steadily increased its influence on the educational discourse and educational policies in the now 70 participating countries. The educational debate has become global, and the race to improve PISA-rankings has become high priority in many countries. For governments the PISA-test is a high-stake test. Governments are blamed for…

External Confirmation of Adherence to Standards: As Applicable to Academic Programmes as to Business and Industry

Science.gov (United States)

Hughey, Aaron W.; Burke, Monica G.

2010-01-01

The development of, and adherence to, performance standards is imperative for success in today's competitive global market. This is as true for academic programmes in higher education as it is for the manufacturing and service sectors. Just like their counterparts in business and industry, it is important that graduate career preparation…

Optimizing adherence in HIV prevention product trials: Development and psychometric evaluation of simple tools for screening and adherence counseling.

Science.gov (United States)

Tolley, Elizabeth E; Guthrie, Kate Morrow; Zissette, Seth; Fava, Joseph L; Gill, Katherine; Louw, Cheryl E; Kotze, Philip; Reddy, Krishnaveni; MacQueen, Kathleen

2018-01-01

Low adherence in recent HIV prevention clinical trials highlights the need to better understand, measure, and support product use within clinical trials. Conventional self-reported adherence instruments within HIV prevention trials, often relying on single-item questions, have proven ineffective. While objective adherence measures are desirable, none currently exist that apply to both active and placebo arms. Scales are composed of multiple items in the form of questions or statements that, when combined, measure a more complex construct that may not be directly observable. When psychometrically validated, such measures may better assess the multiple factors contributing to adherence/non-adherence. This study aimed to develop and psychometrically evaluate tools to screen and monitor trial participants' adherence to HIV prevention products within the context of clinical trial research. Based on an extensive literature review and conceptual framework, we identified and refined 86 items assessing potential predictors of adherence and 48 items assessing adherence experience. A structured survey, including adherence items and other variables, was administered to former ASPIRE and Ring Study participants and similar non-trial participants (n = 709). We conducted exploratory factor analyses (EFA) to identify a reduced set of constructs and items that could be used at screening to predict potential adherence, and at follow-up to monitor and intervene on adherence. We examined associations with other variables to assess content and construct validity. The EFA of screener items resulted in a 6-factor solution with acceptable to very good internal reliability (α: .62-.84). Similar to our conceptual framework, factors represent trial-related commitment (Distrust of Research and Commitment to Research); alignment with trial requirements (Visit Adherence and Trial Incompatibility); Belief in Trial Benefits and Partner Disclosure. The EFA on monitoring items resulted in 4

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

Directory of Open Access Journals (Sweden)

Mordechai Kedar

2011-12-01

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.  

The value of human life in contemporary society. The global biography project.

Science.gov (United States)

Nary, G

1997-12-01

The closing address at the 1997 First International Conference on Healthcare Resource Allocation for HIV/AIDS and Other Life-Threatening Illnesses is presented. The address discusses the extrinsic value of life and the three forms of material value: spiritual, economic, and political, placed on life by an outside source. It is argued that if spiritual currency, rather than economic or political currency, drove public policy there would be greater progress in reducing the global rate of HIV and more options for care. Further, lack of identity of those afflicted with HIV reduces them to mere statistics, thus decreasing their economic and political clout. Giving identities to people who are sick not only increases empathy but also increases their survivability. The establishment of the Global Biography Project seeks to reestablish spiritual currency as the international currency that underlies every nation's healthcare policies.

Can human error theory explain non-adherence?

Science.gov (United States)

Barber, Nick; Safdar, A; Franklin, Bryoney D

2005-08-01

To apply human error theory to explain non-adherence and examine how well it fits. Patients who were taking chronic medication were telephoned and asked whether they had been adhering to their medicine, and if not the reasons were explored and analysed according to a human error theory. Of 105 patients, 87 were contacted by telephone and they took part in the study. Forty-two recalled being non-adherent, 17 of them in the last 7 days; 11 of the 42 were intentionally non-adherent. The errors could be described by human error theory, and it explained unintentional non-adherence well, however, the application of 'rules' was difficult when considering mistakes. The consideration of error producing conditions and latent failures also revealed useful contributing factors. Human error theory offers a new and valuable way of understanding non-adherence, and could inform interventions. However, the theory needs further development to explain intentional non-adherence.

Multi-Model Projections of River Flood Risk in Europe under Global Warming

Directory of Open Access Journals (Sweden)

Lorenzo Alfieri

2018-01-01

Full Text Available Knowledge on the costs of natural disasters under climate change is key information for planning adaptation and mitigation strategies of future climate policies. Impact models for large scale flood risk assessment have made leaps forward in the past few years, thanks to the increased availability of high resolution climate projections and of information on local exposure and vulnerability to river floods. Yet, state-of-the-art flood impact models rely on a number of input data and techniques that can substantially influence their results. This work compares estimates of river flood risk in Europe from three recent case studies, assuming global warming scenarios of 1.5, 2, and 3 degrees Celsius from pre-industrial levels. The assessment is based on comparing ensemble projections of expected damage and population affected at country level. Differences and common points between the three cases are shown, to point out main sources of uncertainty, strengths, and limitations. In addition, the multi-model comparison helps identify regions with the largest agreement on specific changes in flood risk. Results show that global warming is linked to substantial increase in flood risk over most countries in Central and Western Europe at all warming levels. In Eastern Europe, the average change in flood risk is smaller and the multi-model agreement is poorer.

Adherence to Biobehavioral Recommendations in Pediatric Migraine as Measured by Electronic Monitoring: The Adherence in Migraine (AIM) Study.

Science.gov (United States)

Kroon Van Diest, Ashley M; Ramsey, Rachelle; Aylward, Brandon; Kroner, John W; Sullivan, Stephanie M; Nause, Katie; Allen, Janelle R; Chamberlin, Leigh A; Slater, Shalonda; Hommel, Kevin; LeCates, Susan L; Kabbouche, Marielle A; O'Brien, Hope L; Kacperski, Joanne; Hershey, Andrew D; Powers, Scott W

2016-07-01

The purpose of this investigation was to examine treatment adherence to medication and lifestyle recommendations among pediatric migraine patients using electronic monitoring systems. Nonadherence to medical treatment is a significant public health concern, and can result in poorer treatment outcomes, decreased cost-effectiveness of medical care, and increased morbidity. No studies have systematically examined adherence to medication and lifestyle recommendations in adolescents with migraine outside of a clinical trial. Participants included 56 adolescents ages 11-17 who were presenting for clinical care. All were diagnosed with migraine with or without aura or chronic migraine and had at least 4 headache days per month. Medication adherence was objectively measured using electronic monitoring systems (Medication Event Monitoring Systems technology) and daily, prospective self-report via personal electronic devices. Adherence to lifestyle recommendations of regular exercise, eating, and fluid intake were also assessed using daily self-report on personal electronic devices. Electronic monitoring indicates that adolescents adhere to their medication 75% of the time, which was significantly higher than self-reported rates of medication adherence (64%). Use of electronic monitoring of medication detected rates of adherence that were significantly higher for participants taking once daily medication (85%) versus participants taking twice daily medication (59%). Average reported adherence to lifestyle recommendations of consistent noncaffeinated fluid intake (M = 5 cups per day) was below recommended levels of a minimum of 8 cups per day. Participants on average also reported skipping 1 meal per week despite recommendations of consistently eating three meals per day. Results suggest that intervention focused on adherence to preventive treatments (such as medication) and lifestyle recommendations may provide more optimal outcomes for children and adolescents with

A therapist-focused knowledge translation intervention for improving patient adherence in musculoskeletal physiotherapy practice.

Science.gov (United States)

Babatunde, Folarin Omoniyi; MacDermid, Joy Christine; MacIntyre, Norma

2017-01-01

Nonadherence to treatment remains high among patients with musculoskeletal conditions with negative impact on the treatment outcomes, use of personal and cost of care. An active knowledge translation (KT) strategy may be an effective strategy to support practice change. The purpose of this study was to deliver a brief, interactive, multifaceted and targeted KT program to improve physiotherapist knowledge and confidence in performing adherence enhancing activities related to risk, barriers, assessment and interventions. We utilised a 2-phase approach in this KT project. Phase 1 involved the development of an adherence tool kit following a synthesis of the literature and an iterative process involving 47 end-users. Clinicians treating patients with musculoskeletal conditions were recruited from two Physiotherapy and Occupational therapy national conferences in Canada. The intervention, based on the acronym SIMPLE TIPS was tested on 51 physiotherapists in phase 2. A pre- and post-repeated measures design was used in Phase 2. Graham's knowledge-to-action cycle was used as the conceptual framework. Participants completed a pre-intervention assessment, took part in a 1-h educational session and completed a post-intervention assessment. A questionnaire was used to measure knowledge of evidence-based treatment adherence barriers, interventions and measures and confidence to perform evidence-based adherence practice activities. Data was analysed using descriptive statistics (frequency and percentage), Fisher's exact test and Wilcoxon Sign-Ranked tests. Barriers and facilitators of adherence were identified under three domains (therapist, patient, health system) in phase 1. Seventy percent of the participants completed the questionnaire. Results indicated that 46.8% of respondents explored barriers including the use of behaviour change strategies and 45.7% reported that they measured adherence but none reported the use of validated outcomes. A significant improvement in

Psychosocial and demographic predictors of adherence and non-adherence to health advice accompanying air quality warning systems: a systematic review.

Science.gov (United States)

D'Antoni, Donatella; Smith, Louise; Auyeung, Vivian; Weinman, John

2017-09-22

Although evidence shows that poor air quality can harm human health, we have a limited understanding about the behavioural impact of air quality forecasts. Our aim was to understand to what extent air quality warning systems influence protective behaviours in the general public, and to identify the demographic and psychosocial factors associated with adherence and non-adherence to the health advice accompanying these warnings. In August 2016 literature was systematically reviewed to find studies assessing intended or actual adherence to health advice accompanying air quality warning systems, and encouraging people to reduce exposure to air pollution. Predictors of adherence to the health advice and/or self-reported reasons for adherence or non-adherence were also systematically reviewed. Studies were included only if they involved participants who were using or were aware of these warning systems. Studies investigating only protective behaviours due to subjective perception of bad air quality alone were excluded. The results were narratively synthesised and discussed within the COM-B theoretical framework. Twenty-one studies were included in the review: seventeen investigated actual adherence; three investigated intended adherence; one assessed both. Actual adherence to the advice to reduce or reschedule outdoor activities during poor air quality episodes ranged from 9.7% to 57% (Median = 31%), whereas adherence to a wider range of protective behaviours (e.g. avoiding busy roads, taking preventative medication) ranged from 17.7% to 98.1% (Median = 46%). Demographic factors did not consistently predict adherence. However, several psychosocial facilitators of adherence were identified. These include knowledge on where to check air quality indices, beliefs that one's symptoms were due to air pollution, perceived severity of air pollution, and receiving advice from health care professionals. Barriers to adherence included: lack of understanding of the indices

Notification: Audit of EPA's Adherence to Policies, Procedures and Oversight Controls Pertaining to the Administrator’s Travel

Science.gov (United States)

Project #OA-FY17-0382, August 28, 2017. The EPA OIG plans to begin preliminary research on the EPA’s adherence to policies, procedures and oversight controls pertaining to the Administrator’s travel to Oklahoma.

Antihypertensive Medications Adherence Among Nigerian ...

African Journals Online (AJOL)

Hospital, Ogbomosho, 2Goshen Heart Clinic, Osogbo, 3Department of Economics, Osun State University, Osogbo, Nigeria ... significant impact of antihypertensive medication adherence.[13]. The level of information provided to patients may also impact ..... Muntner P. New medication adherence scale versus pharmacy.

Microbial adherence to cosmetic contact lenses.

Science.gov (United States)

Chan, Ka Yin; Cho, Pauline; Boost, Maureen

2014-08-01

To investigate whether cosmetic contact lenses (CCL) with surface pigments affect microbial adherence. Fifteen brands of CCL were purchased from optical, non-optical retail outlets, and via the Internet. A standardized rub-off test was performed on each CCL (five lenses per brand) to confirm the location of the pigments. The rub-off test comprised gentle rubbing on the surfaces of each CCL with wetted cotton buds for a maximum of 20 rubs per surface. A new set of CCL (five lenses per brand) were incubated in Pseudomonas aeruginosa overnight. Viable counts of adhered bacteria were determined by the number of colony-forming units (CFU) on agar media on each lens. The adherence of P. aeruginosa as well as Staphylococcus aureus and Serratia marcescens to three brands of CCL (A-C) (five lenses per brand) were also compared to their adherences on their clear counterparts. Only two of the 15 brands of CCL tested (brands B and C) had pigments that did not detach with the rub-off test. The remaining 13 brands of CCL all failed the rub-off test and these lenses showed higher P. aeruginosa adherence (8.7 × 10(5)-1.9 × 10(6) CFU/lens). Brands B and C lenses showed at least six times less bacterial adhesion than the other 13 brands. Compared to their clear counterparts, bacterial adherence to brands B and C lenses did not differ significantly, whereas brand A lenses showed significantly higher adherence. Surface pigments on CCL resulted in significantly higher bacterial adherence. Copyright © 2013 British Contact Lens Association. Published by Elsevier Ltd. All rights reserved.

Improving Adherence to Web-Based and Mobile Technologies for People With Psychosis: Systematic Review of New Potential Predictors of Adherence.

Science.gov (United States)

Killikelly, Clare; He, Zhimin; Reeder, Clare; Wykes, Til

2017-07-20

Despite the boom in new technologically based interventions for people with psychosis, recent studies suggest medium to low rates of adherence to these types of interventions. The benefits will be limited if only a minority of service users adhere and engage; if specific predictors of adherence can be identified then technologies can be adapted to increase the service user benefits. The study aimed to present a systematic review of rates of adherence, dropout, and approaches to analyzing adherence to newly developed mobile and Web-based interventions for people with psychosis. Specific predictors of adherence were also explored. Using keywords (Internet or online or Web-based or website or mobile) AND (bipolar disorder or manic depression or manic depressive illness or manic-depressive psychosis or psychosis or schizophr* or psychotic), the following databases were searched: OVID including MedLine, EMBASE and PsychInfo, Pubmed and Web of Science. The objectives and inclusion criteria for suitable studies were defined following PICOS (population: people with psychosis; intervention: mobile or Internet-based technology; comparison group: no comparison group specified; outcomes: measures of adherence; study design: randomized controlled trials (RCT), feasibility studies, and observational studies) criteria. In addition to measurement and analysis of adherence, two theoretically proposed predictors of adherence were examined: (1) level of support from a clinician or researcher throughout the study, and (2) level of service user involvement in the app or intervention development. We provide a narrative synthesis of the findings and followed the preferred reporting items for systematic reviews and meta-analyses (PRISMA) guidelines for reporting systematic reviews. Of the 20 studies that reported a measure of adherence and a rate of dropout, 5 of these conducted statistical analyses to determine predictors of dropout, 6 analyzed the effects of specific adherence

Adherence to diet, physical activity and body weight recommendations and breast cancer incidence in the Black Women's Health Study.

Science.gov (United States)

Nomura, Sarah J O; Dash, Chiranjeev; Rosenberg, Lynn; Yu, Jeffrey; Palmer, Julie R; Adams-Campbell, Lucile L

2016-12-15

Adherence to cancer prevention recommendations has been associated with lower incidence of breast cancer in previous studies, but evidence in African American women is limited. This project evaluated the association between adherence to the World Cancer Research Fund/American Institute for Cancer Research (WCRF/AICR) cancer prevention recommendations and breast cancer incidence among African American women. The Black Women's Health Study (analytic cohort = 49,103) is an ongoing prospective cohort study of African American women, ages 21-69 years at baseline (1995). Adherence scores for seven WCRF/AICR recommendations (adherent = 1, partial adherence = 0.5, non-adherence = 0) were calculated using questionnaire data and summed for overall (maximum = 7) and diet only (maximum = 5) scores. Associations between baseline and time-varying adherence scores and breast cancer incidence (N = 1,827 incident cases through 2011) were evaluated using proportional hazards regression. In this cohort, 8.5% adhered >4 recommendations. Adherence at baseline was not associated with breast cancer incidence. Higher overall time-varying adherence (per 0.5 point increase) was associated with lower breast cancer incidence (HR: 0.90, 95% CI: 0.84-0.96). Adherence to physical activity, sugar beverage and red and processed meat recommendations were also associated with reduced risk. Adherence to the WCRF/AICR recommendations was low and may be associated with lower breast cancer incidence in African American women. © 2016 UICC.

Predictors of adherence to antiretroviral therapy among HIV-infected persons: a prospective study in Southwest Ethiopia

Directory of Open Access Journals (Sweden)

Girma Belaineh

2008-07-01

Full Text Available Abstract Background The devastating impact of AIDS in the world especially in sub-Saharan Africa has led to an unprecedented global effort to ensure access to antiretroviral (ARV drugs. Given that medication-taking behavior can immensely affect an individual's response; ART adherence is now widely recognized as an 'Achilles heel' for the successful outcome. The present study was undertaken to investigate the rate and predictors of adherence to antiretroviral therapy among HIV-infected persons in southwest Ethiopia. Methods The study was conducted in the antiretroviral therapy unit of Jimma University Specialized Hospital. A prospective study was undertaken on a total of 400 HIV infected person. Data were collected using a pre-tested interviewer-administered structured questionnaire at first month (M0 and third month (M3 follow up visits. Results A total of 400 and 383 patients at baseline (M0 and at follow up visit (M3 respectively were interviewed. Self-reported dose adherence in the study area was 94.3%. The rate considering the combined indicator (dose, time and food was 75.7%. Within a three month follow up period, dose adherence decreased by 2% and overall adherence rate decreased by more than 3%. Adherence was common in those patients who have a social support (OR, 1.82, 95%CI, 1.04, 3.21. Patients who were not depressed were two times more likely to be adherent than those who were depressed (OR, 2.13, 95%CI, 1.18, 3.81. However, at the follow up visit, social support (OR, 2.42, 95%CI, 1.29, 4.55 and the use of memory aids (OR, 3.29, 95%CI, 1.44, 7.51 were found to be independent predictors of adherence. The principal reasons reported for skipping doses in this study were simply forgetting, feeling sick or ill, being busy and running out of medication in more than 75% of the cases. Conclusion The self reported adherence rate was high in the study area. The study showed that adherence is a dynamic process which changes overtime and cannot

COPD patients' self-reported adherence, psychosocial factors and mild cognitive impairment in pulmonary rehabilitation.

Science.gov (United States)

Pierobon, Antonia; Sini Bottelli, Elisa; Ranzini, Laura; Bruschi, Claudio; Maestri, Roberto; Bertolotti, Giorgio; Sommaruga, Marinella; Torlaschi, Valeria; Callegari, Simona; Giardini, Anna

2017-01-01

In addition to clinical comorbidities, psychological and neuropsychological problems are frequent in COPD and may affect pulmonary rehabilitation delivery and outcome. The aims of the study were to describe a COPD population in a rehabilitative setting as regards the patients depressive symptoms, anxiety, mild cognitive impairment (MCI) and self-reported adherence and to analyze their relationships; to compare the COPD sample MCI scores with normative data; and to investigate which factors might predict adherence to prescribed physical exercise. This was a multicenter observational cross-sectional study. Of the 117 eligible stable COPD inpatients, 84 were enrolled according to Global initiative for chronic Obstructive Lung Disease (GOLD) criteria (mainly in Stage III-IV). The assessment included Mini Mental State Examination (MMSE), Montreal Cognitive Assessment (MoCA), anxiety, depression and self-reported pharmacological and nonpharmacological adherence. From the MMSE, 3.6% of patients were found to be impaired, whereas from the MoCA 9.5% had a likely MCI. Patients referred had mild-severe depression (46.7%), anxiety (40.5%), good pharmacological adherence (80.3%) and difficulties in following prescribed diet (24.1%) and exercise (51.8%); they struggled with disease acceptance (30.9%) and disease limitations acceptance (28.6%). Most of them received good family (89%) or social (53%) support. Nonpharmacological adherence, depression, anxiety and MCI showed significant relations with 6-minute walking test, body mass index (BMI) and GOLD. Depression was related to autonomous long-term oxygen therapy modifications, disease perception, family support and MCI. In the multivariate logistic regression analysis, higher BMI, higher depression and lower anxiety predicted lower adherence to exercise prescriptions ( P =0.0004, odds ratio =0.796, 95% CI =0.701, 0.903; P =0.009, odds ratio =0.356, 95% CI =0.165, 0.770; and P =0.05, odds ratio =2.361, 95% CI =0.995, 5

WHE-PAGER Project: A new initiative in estimating global building inventory and its seismic vulnerability

Science.gov (United States)

Porter, K.A.; Jaiswal, K.S.; Wald, D.J.; Greene, M.; Comartin, Craig

2008-01-01

The U.S. Geological Survey’s Prompt Assessment of Global Earthquake’s Response (PAGER) Project and the Earthquake Engineering Research Institute’s World Housing Encyclopedia (WHE) are creating a global database of building stocks and their earthquake vulnerability. The WHE already represents a growing, community-developed public database of global housing and its detailed structural characteristics. It currently contains more than 135 reports on particular housing types in 40 countries. The WHE-PAGER effort extends the WHE in several ways: (1) by addressing non-residential construction; (2) by quantifying the prevalence of each building type in both rural and urban areas; (3) by addressing day and night occupancy patterns, (4) by adding quantitative vulnerability estimates from judgment or statistical observation; and (5) by analytically deriving alternative vulnerability estimates using in part laboratory testing.

Projection of heat waves over China for eight different global warming targets using 12 CMIP5 models

Science.gov (United States)

Guo, Xiaojun; Huang, Jianbin; Luo, Yong; Zhao, Zongci; Xu, Ying

2017-05-01

Simulation and projection of the characteristics of heat waves over China were investigated using 12 CMIP5 global climate models and the CN05.1 observational gridded dataset. Four heat wave indices (heat wave frequency, longest heat wave duration, heat wave days, and high temperature days) were adopted in the analysis. Evaluations of the 12 CMIP5 models and their ensemble indicated that the multi-model ensemble could capture the spatiotemporal characteristics of heat wave variation over China. The inter-decadal variations of heat waves during 1961-2005 can be well simulated by multi-model ensemble. Based on model projections, the features of heat waves over China for eight different global warming targets (1.5, 2.0, 2.5, 3.0, 3.5, 4.0, 4.5, and 5.0 °C) were explored. The results showed that the frequency and intensity of heat waves would increase more dramatically as the global mean temperature rise attained higher warming targets. Under the RCP8.5 scenario, the four China-averaged heat wave indices would increase from about 1.0 times/year, 2.5, 5.4, and 13.8 days/year to about 3.2 times/year, 14.0, 32.0, and 31.9 days/year for 1.5 and 5.0 °C warming targets, respectively. Those regions that suffer severe heat waves in the base climate would experience the heat waves with greater frequency and severity following global temperature rise. It is also noteworthy that the areas in which a greater number of severe heat waves occur displayed considerable expansion. Moreover, the model uncertainties exhibit a gradual enhancement with projected time extending from 2006 to 2099.

Patient Medication Knowledge Governing Adherence to Asthma ...

African Journals Online (AJOL)

Samuel Olaleye

disturbing levels of patients adherence with management recommendations. Asthma education strategies need to be modified to engage ... and quick procedure. ... Participants' medication adherence and skills at using .... In this study 17 of the 67 patients studied .... adherence: changing behaviour to promote better self-.

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

Science.gov (United States)

Jones, Stephen; Babiker, Nathan; Gardner, Emma; Royle, Jane; Curley, Rachael; Hoo, Zhe Hui; Wildman, Martin J

2015-01-01

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. 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. 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. 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.

Low Use and Adherence to Maintenance Medication in Chronic Obstructive Pulmonary Disease in the General Population

DEFF Research Database (Denmark)

Ingebrigtsen, Truls S; Marott, Jacob L; Nordestgaard, Børge G

2015-01-01

OBJECTIVE: We tested the hypothesis that use of and adherence to maintenance medication is low among individuals in the general population who have chronic obstructive pulmonary disease (COPD) , even in cases of severe and very severe COPD. DESIGN AND PARTICIPANTS: We identified 5,812 individuals...... with COPD from the Copenhagen General Population Study, and classified them according to the Global Initiative for Obstructive Lung Disease (GOLD) airflow limitation grades 1-4. Dispensing of fixed-dose combinations of inhaled corticosteroids with long-acting beta2-agonists, long-acting anti...... for COPD in the general population was associated with the severity of COPD as defined by GOLD, but even in severe and very severe COPD, use and adherence was low....

A global conversation about energy from biomass: the continental conventions of the global sustainable bioenergy project

Science.gov (United States)

Lynd, Lee Rybeck; Aziz, Ramlan Abdul; de Brito Cruz, Carlos Henrique; Chimphango, Annie Fabian Abel; Cortez, Luis Augusto Barbosa; Faaij, Andre; Greene, Nathanael; Keller, Martin; Osseweijer, Patricia; Richard, Tom L.; Sheehan, John; Chugh, Archana; van der Wielen, Luuk; Woods, Jeremy; van Zyl, Willem Heber

2011-01-01

The global sustainable bioenergy (GSB) project was formed in 2009 with the goal of providing guidance with respect to the feasibility and desirability of sustainable, bioenergy-intensive futures. Stage 1 of this project held conventions with a largely common format on each of the world's continents, was completed in 2010, and is described in this paper. Attended by over 400 persons, the five continental conventions featured presentations, breakout sessions, and drafting of resolutions that were unanimously passed by attendees. The resolutions highlight the potential of bioenergy to make a large energy supply contribution while honouring other priorities, acknowledge the breadth and complexity of bioenergy applications as well as the need to take a systemic approach, and attest to substantial intra- and inter-continental diversity with respect to needs, opportunities, constraints and current practice relevant to bioenergy. The following interim recommendations based on stage 1 GSB activities are offered: — Realize that it may be more productive, and also more correct, to view the seemingly divergent assessments of bioenergy as answers to two different questions rather than the same question. Viewed in this light, there is considerably more scope for reconciliation than might first be apparent, and it is possible to be informed rather than paralysed by divergent assessments.— Develop established and advanced bioenergy technologies such that each contributes to the other's success. That is, support and deploy in the near-term meritorious, established technologies in ways that enhance rather than impede deployment of advanced technologies, and support and deploy advanced technologies in ways that expand rather than contract opportunities for early adopters and investors.— Be clear in formulating policies what mix of objectives are being targeted, measure the results of these policies against these objectives and beware of unintended consequences

Securing classification and regulatory approval for deepwater projects: management challenges in a global environment

Energy Technology Data Exchange (ETDEWEB)

Feijo, Luiz P.; Burton, Gareth C. [American Bureau of Shipping (ABS), Rio de Janeiro, RJ (Brazil)

2008-07-01

As the offshore industry continues to develop and move into increasingly deeper waters, technological boundaries are being pushed to new limits. Along with these advances, the design, fabrication and installation of deepwater oil and gas projects has become an increasingly global endeavor. After providing an overview of the history and role of Classification Societies, this paper reviews the challenges of securing classification and regulatory approval in a global environment. Operational, procedural and technological changes which one Classification Society; the American Bureau of Shipping, known as ABS, has implemented to address these challenges are presented. The result of the changes has been a more customized service aiming at faster and more streamlined classification approval process. (author)

Identification of barriers to medication adherence in a Latino population.

Science.gov (United States)

Compton, Sheryl; Haack, Sally; Phillips, Charles R

2010-12-01

Barriers to medication adherence may present differently in diverse patient populations. Because of changing U.S. demographics, health care providers will be required to identify alternative strategies for managing increasingly diverse patient populations. This pilot project identified barriers that may hinder medication adherence in a Latino population. The results of the survey may identify trends in barriers allowing for the development of interventions aimed at improving medication adherence. The study used a convenience sample of Spanish-labeled prescriptions that had not been picked up from a community pharmacy after a 2-week period to identify study subjects. Patients were contacted by phone and surveyed regarding reasons for not picking up their prescription medication. The 24-item survey instrument consisted of demographic and medication-related questions, reasons for, and associated barriers with failure to pick up medications. The most common classes of medications patients failed to pick up were chronic medications. More than 90% of the patients thought that the medication in question was helpful to them, and nearly 80% thought that the medicine was still needed. Patients cited communication issues (ie, content matter, such as when the prescription was ready), logistics, and limited hours of pharmacy operation as the primary barriers in picking up their medications, whereas nearly 40% failed to identify any barriers. Barriers identified by patients that could be improved included confusion regarding when their prescription was ready and limited hours of pharmacy operation. Most of the patients were comfortable using the American health care system. The barriers to medication adherence identified did not appear to be the result of cultural influences. This could be because the community pharmacy had bilingual staff and interpreters available for patient education and prescription processing. Alternative methods are needed to further identify reasons for

Adherence to vitamin supplementation following adolescent bariatric surgery.

Science.gov (United States)

Modi, Avani C; Zeller, Meg H; Xanthakos, Stavra A; Jenkins, Todd M; Inge, Thomas H

2013-03-01

Adolescents with extreme obesity, who have undergone bariatric surgery, must adhere to many lifestyle and nutritional recommendations, including multivitamin therapy. Little is known about multivitamin adherence following adolescent bariatric surgery. The present study aims to document self-reported and electronically-monitored adherence to multivitamins, determine convergence between self-report and electronic monitoring adherence for multivitamins, and identify barriers to multivitamin adherence for adolescents who have undergone bariatric surgery. The study used a prospective, longitudinal observational design to assess subjective (self-reported) and objective (electronic monitors) multivitamin adherence in a cohort of 41 adolescents (Mean age = 17.1 ± 1.5; range = 13-19) who have undergone bariatric surgery at Cincinnati Children's Hospital Medical Center. Mean adherence as derived from electronic monitoring for the entire 6-month study period was 29.8% ± 23.9. Self-reported adherence was significantly higher than electronically monitored adherence across both the 1 and 6-month assessment points (z = 4.5, P bariatric surgery, high rates of nonadherence to multivitamin therapy were observed in adolescents who had undergone bariatric surgery with forgetting and difficulty swallowing pills as reported barriers to adherence. These high rates of nonadherence to multivitamin therapy should be considered when devising treatment and family education pathways for adolescents considering weight loss surgery. Copyright © 2012 The Obesity Society.

Adherence therapy improves medication adherence and quality of life in people with Parkinson's disease: a randomised controlled trial.

Science.gov (United States)

Daley, D J; Deane, K H O; Gray, R J; Clark, A B; Pfeil, M; Sabanathan, K; Worth, P F; Myint, P K

2014-08-01

Many factors are associated with medication non-adherence in Parkinson's disease (PD), including complex treatment regimens, mood disorders and impaired cognition. However, interventions to improve adherence which acknowledge such factors are lacking. A phase II randomised controlled trial was conducted investigating whether Adherence Therapy (AT) improves medication adherence and quality of life (QoL) compared with routine care (RC) in PD. Eligible PD patients and their spouse/carers were randomised to intervention (RC plus AT) or control (RC alone). Primary outcomes were change in adherence (Morisky Medication Adherence Scale) and QoL (Parkinson's Disease Questionnaire-39) from baseline to week-12 follow up. Secondary outcomes were MDS-UPDRS (part I, II, IV), Beliefs about Medication Questionnaire (BMQ), EuroQol (EQ-5D) and the Caregiving Distress Scale. Blinded data were analysed using logistic and linear regression models based on the intention-to-treat principle. Seventy-six patients and 46 spouse/carers completed the study (intervention: n = 38 patients, n = 24 spouse/carers). At week-12 AT significantly improved adherence compared with RC (OR 8.2; 95% CI: 2.8, 24.3). Numbers needed to treat (NNT) were 2.2 (CI: 1.6, 3.9). Compared with RC, AT significantly improved PDQ-39 (-9.0 CI: -12.2, -5.8), BMQ general harm (-1.0 CI: -1.9, -0.2) and MDS-UPDRS part II (-4.8 CI: -8.1, -1.4). No significant interaction was observed between the presence of a spouse/carer and the effect of AT. Adherence Therapy improved self-reported adherence and QoL in a PD sample. The small NNT suggests AT may be cost-effective. A larger pragmatic trial to test the efficacy and cost-effectiveness of AT by multiple therapists is required. © 2014 John Wiley & Sons Ltd.

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

2016-01-01

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...... statin treatment as important, how they managed non-adherence and whether non-adherence annoyed them. The Jackson Personality Inventory-revised was used to measure risk attitude. The GPs' responses were linked to register data on their patients' redeemed statin prescriptions. Mixed effect logistic...

Self-replenishing low-adherence coatings

NARCIS (Netherlands)

Dikic, T.; Ming, W.; Benthem, van R.A.T.M.; With, de G.; Schmets, A.J.M.; Zwaag, van der S.

2007-01-01

Low-adherence coatings are widely used today since their water/oil repellency makes them easily cleanable (a well-known example is PTFE). The low surface tension is provided by fluorine- or silicon-containing species that are present at the film surface. Low adherence coatings have already been

Behavioral and Pharmacological Adherence in Pediatric Sickle Cell Disease: Parent-Child Agreement and Family Factors Associated With Adherence.

Science.gov (United States)

Klitzman, Page H; Carmody, Julia K; Belkin, Mary H; Janicke, David M

2018-01-01

This study aimed to evaluate agreement between children and parents on a measure of behavioral and pharmacological adherence in children with sickle cell disease (SCD), and the associations among family factors (i.e., problem-solving skills, routines, communication) and adherence behaviors. In all, 85 children (aged 8-18 years) with SCD and their parents completed questionnaires assessing individual and family factors. Overall parent-child agreement on an adherence measure was poor, particularly for boys and older children. Greater use of child routines was associated with better overall child-reported adherence. Open family communication was associated with higher overall parent-reported adherence. While further research is needed before definitive conclusions can be drawn, results suggest the need to assess child adherence behaviors via both child and parent reports. Findings also suggest that more daily family routines and open family communication may be protective factors for better disease management. © The Author 2017. Published by Oxford University Press on behalf of the Society of Pediatric Psychology. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com

Preliminary investigation of adherence to antiretroviral therapy ...

African Journals Online (AJOL)

Treatment of HIV with highly active antiretroviral therapy (HAART) has resulted in declining morbidity and mortality rates from HIV-associated diseases, but concerns regarding access and adherence are growing. To determine the adherence level and the reasons for non-adhering to antiretroviral therapy (ART) among ...

Evaluating the Impact of Two Globalization Projects on College Students' Cultural Competence and Cultural Intelligence (CQ)

Science.gov (United States)

Lopes-Murphy, Solange A.

2013-01-01

Cultural competence and CQ involve awareness of cultural similarities and differences, knowledge of differences in cultural values, and intercultural encounters. To assess college students' cultural competence and cultural intelligence gains, this experimental study evaluated the impact of two globalization projects on these two constructs. The…

Reliability ensemble averaging of 21st century projections of terrestrial net primary productivity reduces global and regional uncertainties

Science.gov (United States)

Exbrayat, Jean-François; Bloom, A. Anthony; Falloon, Pete; Ito, Akihiko; Smallman, T. Luke; Williams, Mathew

2018-02-01

Multi-model averaging techniques provide opportunities to extract additional information from large ensembles of simulations. In particular, present-day model skill can be used to evaluate their potential performance in future climate simulations. Multi-model averaging methods have been used extensively in climate and hydrological sciences, but they have not been used to constrain projected plant productivity responses to climate change, which is a major uncertainty in Earth system modelling. Here, we use three global observationally orientated estimates of current net primary productivity (NPP) to perform a reliability ensemble averaging (REA) method using 30 global simulations of the 21st century change in NPP based on the Inter-Sectoral Impact Model Intercomparison Project (ISIMIP) business as usual emissions scenario. We find that the three REA methods support an increase in global NPP by the end of the 21st century (2095-2099) compared to 2001-2005, which is 2-3 % stronger than the ensemble ISIMIP mean value of 24.2 Pg C y-1. Using REA also leads to a 45-68 % reduction in the global uncertainty of 21st century NPP projection, which strengthens confidence in the resilience of the CO2 fertilization effect to climate change. This reduction in uncertainty is especially clear for boreal ecosystems although it may be an artefact due to the lack of representation of nutrient limitations on NPP in most models. Conversely, the large uncertainty that remains on the sign of the response of NPP in semi-arid regions points to the need for better observations and model development in these regions.

Validating the Modified Drug Adherence Work-Up (M-DRAW) Tool to Identify and Address Barriers to Medication Adherence.

Science.gov (United States)

Lee, Sun; Bae, Yuna H; Worley, Marcia; Law, Anandi

2017-09-08

Barriers to medication adherence stem from multiple factors. An effective and convenient tool is needed to identify these barriers so that clinicians can provide a tailored, patient-centered consultation with patients. The Modified Drug Adherence Work-up Tool (M-DRAW) was developed as a 13-item checklist questionnaire to identify barriers to medication adherence. The response scale was a 4-point Likert scale of frequency of occurrence (1 = never to 4 = often). The checklist was accompanied by a GUIDE that provided corresponding motivational interview-based intervention strategies for each identified barrier. The current pilot study examined the psychometric properties of the M-DRAW checklist (reliability, responsiveness and discriminant validity) in patients taking one or more prescription medication(s) for chronic conditions. A cross-sectional sample of 26 patients was recruited between December 2015 and March 2016 at an academic medical center pharmacy in Southern California. A priming question that assessed self-reported adherence was used to separate participants into the control group of 17 "adherers" (65.4%), and into the intervention group of nine "unintentional and intentional non-adherers" (34.6%). Comparable baseline characteristics were observed between the two groups. The M-DRAW checklist showed acceptable reliability (13 item; alpha = 0.74) for identifying factors and barriers leading to medication non-adherence. Discriminant validity of the tool and the priming question was established by the four-fold number of barriers to adherence identified within the self-selected intervention group compared to the control group (4.4 versus 1.2 barriers, p tool will include construct validation.

Trends and determining factors associated with adherence to antiretroviral therapy (ART in Cameroon: a systematic review and analysis of the CAMPS trial

Directory of Open Access Journals (Sweden)

Mbuagbaw Lawrence

2012-12-01

Full Text Available Abstract Background The benefits of antiretroviral therapy (ART cannot be experienced if they are not taken as prescribed. Yet, not all causes of non-adherence are dependent on the patient. Having to pay for medication reduces adherence rates. Non- adherence has severe public health implications which must be addressed locally and globally. This paper seeks to describe the trends in adherence rates reported in Cameroon and to investigate the determinants of adherence to ART in the Cameroon Mobile Phone SMS (CAMPS trial. Methods We conducted a systematic review of electronic databases (PubMed, Google Scholar, Web of Science, CINAHL, EMBASE and PSYCINFO for publications on adherence to ART in Cameroon (from January 1999 to May 2012 and described the trend in reported adherence rates and the factors associated with adherence. Data were extracted in duplicate. We used multivariable analyses on the baseline data for 200 participants in the CAMPS trial to determine the factors associated with adherence in four models using different measures of adherence (more than 90% or 95% on the visual analogue scale, no missed doses and a composite measure: 100% on the visual analogue scale, no missed doses and all pills taken on time. Results We identified nine studies meeting our inclusion criteria. Adherence to ART in Cameroon has risen steadily between 2000 and 2010, corresponding to reductions in the cost of medication. The factors associated with adherence to ART in Cameroon are grouped into patient, medication and disease related factors. We also identified factors related to the health system and the patient-provider relationship. In the CAMPS trial, education, side effects experienced and number of reminder methods were found to improve adherence, but only using multiple reminder methods was associated with better adherence in all the regression models (Adjusted Odds Ratio [AOR] 4.11, 95% Confidence Interval [CI] 1.89, 8.93; p Conclusions Reducing the

Exploring the role of instant messaging in a global software development project

DEFF Research Database (Denmark)

Dittrich, Y.; Giuffrida, Rosalba

2011-01-01

Communication plays a vital role in software devel- opment projects. Globally distributed teams use a mix of dif- ferent communication channels to get the work done. In this paper, we report on an empirical study of a team distributed across Denmark and India. This paper explores the integration...... documentation. Our analysis provides an indication that IM can play a special role in such socio-technical communication systems: IM acts as a real time glue between different chan- nels. The communication through IM also provides a means to build trust and social relationships with co-workers....

Sleep Quality, Short-Term and Long-Term CPAP Adherence

Science.gov (United States)

Somiah, Manya; Taxin, Zachary; Keating, Joseph; Mooney, Anne M.; Norman, Robert G.; Rapoport, David M.; Ayappa, Indu

2012-01-01

Study Objectives: Adherence to CPAP therapy is low in patients with obstructive sleep apnea/hypopnea syndrome (OSAHS). The purpose of the present study was to evaluate the utility of measures of sleep architecture and sleep continuity on the CPAP titration study as predictors of both short- and long-term CPAP adherence. Methods: 93 patients with OSAHS (RDI 42.8 ± 34.3/h) underwent in-laboratory diagnostic polysomnography, CPAP titration, and follow-up polysomnography (NPSG) on CPAP. Adherence to CPAP was objectively monitored. Short-term (ST) CPAP adherence was averaged over 14 days immediately following the titration study. Long-term (LT) CPAP adherence was obtained in 56/93 patients after approximately 2 months of CPAP use. Patients were grouped into CPAP adherence groups for ST ( 4 h) and LT adherence ( 4 h). Sleep architecture, sleep disordered breathing (SDB) indices, and daytime outcome variables from the diagnostic and titration NPSGs were compared between CPAP adherence groups. Results: There was a significant relationship between ST and LT CPAP adherence (r = 0.81, p CPAP adherence groups had significantly lower %N2 and greater %REM on the titration NPSG. A model combining change in sleep efficiency and change in sleep continuity between the diagnostic and titration NPSGs predicted 17% of the variance in LT adherence (p = 0.006). Conclusions: These findings demonstrate that characteristics of sleep architecture, even on the titration NPSG, may predict some of the variance in CPAP adherence. Better sleep quality on the titration night was related to better CPAP adherence, suggesting that interventions to improve sleep on/prior to the CPAP titration study might be used as a therapeutic intervention to improve CPAP adherence. Citation: Somiah M; Taxin Z; Keating J; Mooney AM; Norman RG; Rapoport DM; Ayappa I. Sleep quality, short-term and long-term CPAP adherence. J Clin Sleep Med 2012;8(5):489-500. PMID:23066359

Detailed Urban Heat Island Projections for Cities Worldwide: Dynamical Downscaling CMIP5 Global Climate Models

Directory of Open Access Journals (Sweden)

Dirk Lauwaet

2015-06-01

Full Text Available A new dynamical downscaling methodology to analyze the impact of global climate change on the local climate of cities worldwide is presented. The urban boundary layer climate model UrbClim is coupled to 11 global climate models contained in the Coupled Model Intercomparison Project 5 archive, conducting 20-year simulations for present (1986–2005 and future (2081–2100 climate conditions, considering the Representative Concentration Pathway 8.5 climate scenario. The evolution of the urban heat island of eight different cities, located on three continents, is quantified and assessed, with an unprecedented horizontal resolution of a few hundred meters. For all cities, urban and rural air temperatures are found to increase strongly, up to 7 °C. However, the urban heat island intensity in most cases increases only slightly, often even below the range of uncertainty. A potential explanation, focusing on the role of increased incoming longwave radiation, is put forth. Finally, an alternative method for generating urban climate projections is proposed, combining the ensemble temperature change statistics and the results of the present-day urban climate.

Projected Changes in the Asian-Australian Monsoon Region in 1.5°C and 2.0°C Global-Warming Scenarios

Science.gov (United States)

Chevuturi, Amulya; Klingaman, Nicholas P.; Turner, Andrew G.; Hannah, Shaun

2018-03-01

In light of the Paris Agreement, it is essential to identify regional impacts of half a degree additional global warming to inform climate adaptation and mitigation strategies. We investigate the effects of 1.5°C and 2.0°C global warming above preindustrial conditions, relative to present day (2006-2015), over the Asian-Australian monsoon region (AAMR) using five models from the Half a degree Additional warming, Prognosis and Projected Impacts (HAPPI) project. There is considerable intermodel variability in projected changes to mean climate and extreme events in 2.0°C and 1.5°C scenarios. There is high confidence in projected increases to mean and extreme surface temperatures over AAMR, as well as more-frequent persistent daily temperature extremes over East Asia, Australia, and northern India with an additional 0.5°C warming, which are likely to occur. Mean and extreme monsoon precipitation amplify over AAMR, except over Australia at 1.5°C where there is uncertainty in the sign of the change. Persistent daily extreme precipitation events are likely to become more frequent over parts of East Asia and India with an additional 0.5°C warming. There is lower confidence in projections of precipitation change than in projections of surface temperature change. These results highlight the benefits of limiting the global-mean temperature change to 1.5°C above preindustrial, as the severity of the above effects increases with an extra 0.5°C warming.

Improving intercultural competency in global IT projects through recognition of culture-based behaviors

Directory of Open Access Journals (Sweden)

Richard Amster

2016-01-01

Full Text Available The success of global IT projects is highly influenced by culture-based behaviors. Issues between individuals arise when behaviors are (mis-perceived, (mis-interpreted, and (mis-judged by using the perceiver’s expectations, beliefs, and values. Misperception results when the behavior is not anticipated because it would not occur in ones own culture. As a result, behavior should be the starting point for cross-cultural research. But, studies have primarily focused on belief and value systems which are more abstract and less specific than behaviors. This paper presents a study that analyzed cultural behavioral differences between Indian project managers and their counterparts in other countries. The conducted qualitative, semi-structured interviews revealed insights into cross-cultural challenges and shed light on the complex ways that culture-based behaviors impact IT projects. The study identified 127 behaviors that significantly affected project success and cross-cultural cooperation between Indian managers and managers from all over the world. These behaviors were grouped into 19 behavior clusters. Understanding these behavior clusters, and correlating these behaviors to values and beliefs, will improve project collaboration, and inform cross-cultural training strategies. In addition, existing cultural dimensions were reduced in scope, additional dimensions were defined for clarity, and new business-related dimensions were identified. Finally, based on the study’s results, the paper suggests four important components that should be added to cross-cultural training programs for international project managers.

Family relations, mental health and adherence to nutritional guidelines in patients facing dialysis initiation.

Science.gov (United States)

Untas, Aurélie; Rascle, Nicole; Idier, Laetitia; Lasseur, Catherine; Combe, Christian

2012-01-01

This study investigated the effect of family relations on patients' adjustment to dialysis. The two main aims were to develop a family typology, and to explore the influence of family profile on the patient's anxiety, depression and adherence to nutritional guidelines. The sample consisted of 120 patients (mean age 63 years; 67.5% of men). They completed several measures 1, 6 and 12 months after dialysis initiation. The scales used were the Family Relationship Index and the Hospital Anxiety and Depression Scale. Perceived adherence to nutritional guidelines was assessed using two visual analogical scales. Results showed that family relations remained stable over time. Cluster analysis yielded three family profiles, which were named conflict, communicative and supportive families. Patients belonging to conflict families perceived themselves as less adhering to nutritional guidelines. For these patients, anxiety and depressive moods increased significantly over time, whereas mental health remained stable over time for communicative and supportive families. This research underlines that family relations are essential in global consideration of the care of patients treated by dialysis. Conflict families seem especially at risk. They should be identified early to help them adapt to this stressful treatment.

Predictors of medication non-adherence for vasculitis patients

Science.gov (United States)

Hogan, Susan L.; DeVellis, Robert F.

2013-01-01

The primary purpose of this article is to document whether demographic, clinical, regimen-related, intrapersonal, and interpersonal factors predict medication non-adherence for vasculitis patients. A secondary purpose is to explore whether adherence varies by medication type and whether patients experienced drug-related side effects. Vasculitis patients (n=228) completed online baseline and 3-month follow-up surveys. Demographic (age, gender, education, race, marital status, and insurance status), clinical (perceived vasculitis severity, disease duration, vasculitis type, and relapse/remission status), regimen-related (experience of side effects), intrapersonal (depressive symptoms), and interpersonal (adherence-related support from family and friends) factors were measured at baseline. Medication non-adherence was assessed at follow-up using the Vasculitis Self-Management Survey medication adherence sub-scale (α=0.89). Variables that significantly correlated (pvasculitis medication types, patients who experienced side effects were less adherent than patients who did not experience side effects. Multiple factors are associated with medication non-adherence for vasculitis patients. Providers should discuss medication adherence and drug-related side effects with vasculitis patients. Providers may want to particularly target younger patients and patients with clinical signs of depression. PMID:23314654

Adherence of pediatric patients to automated peritoneal dialysis.

Science.gov (United States)

Chua, Annabelle N; Warady, Bradley A

2011-05-01

Little information is available on adherence to a home automated peritoneal dialysis (APD) prescription for children with end-stage renal disease. We have therefore retrospectively reviewed HomeChoice PRO Card data from patients Adherence was characterized as occurring ≥ 95%, 90-94%, or treatment adherence and patient age, gender, race and if the patient had received training, respectively, was assessed. Of the 51 patients (57% male), with a mean age at peritoneal dialysis (PD) onset of 11.8 ± 5.3 years, 28 (55%) were adherent for all variables. No difference in mean age or if patients were trained existed between the two groups. Males were more likely to be non-adherent (p = 0.026) as were African Americans (p = 0.048). The majority of patients were adherent to duration (96%) and number of cycles (92%), whereas non-adherence was more common with number of sessions (82%) and dialysate volume (78%). In conclusion, 45% of the pediatric patients in our study cohort exhibited some non-adherence to their prescribed APD regimen, emphasizing the value of closely monitoring the performance of home dialysis in children.

Bacterial adherence to polymethylmethacrylate posterior chamber IOLs

Directory of Open Access Journals (Sweden)

Tyagi Shalini

2001-01-01

Full Text Available Purpose: Bacterial adherence to intraocular lenses (IOLs has been incriminated in the pathogenesis of postoperative endophthalmitis. Staphylococcus epidermidis is the most common organism isolated. We studied the in-vitro adhesion of Staphylococcus epidermidis to Polymethylmethacrylate (PMMA IOLs and the effect of duration of exposure to adherence. Methods: Two groups of 10 IOLs each were incubated in Staphylococcus epidermidis suspension for 2 minutes and 20 minutes respectively. Adhesion of bacterial cells was determined by counting the number of viable bacteria attached to IOLs. Results: The mean bacterial adherence with 2 minutes incubation was 12,889 ± 7,150 bacteria / IOL and with 20 minutes incubation was 84,226 ± 35,024 bacteria/IOL (P< 0.01. Conclusion: Our results show that Staphylococcus epidermidis adheres to PMMA IOLs in vitro and the degree of adherence is less for shorter duration of exposure. We conclude that viable bacteria irreversibly adherent to IOLs may play a role in the pathogenesis of postoperative endophthalmitis. Shorter duration of operative manipulation and exposure to contaminating sources may decrease the chances of postoperative endophthalmitis.

Review on Factors Influencing Physician Guideline Adherence in Cardiology.

Science.gov (United States)

Hoorn, C J G M; Crijns, H J G M; Dierick-van Daele, A T M; Dekker, L R C

2018-04-09

Cardiovascular disease is the most common cause of death in Western countries. Physician adherence to guidelines is often suboptimal, resulting in impaired patient outcome and prognosis. Multiple studies have been conducted to evaluate patterns and the influencing factors of patient adherence, but little is known about factors influencing physician guideline adherence. This review aims to identify factors influencing physician guideline adherence relevant to cardiology and to provide insights and suggestions for future improvement. Physician adherence was measured as adherence to standard local medical practice and applicable guidelines. Female gender and older age had a negative effect on physician guideline adherence. In addition, independent of the type of heart disease, physicians without cardiologic specialization were linked to physician noncompliance. Also, guideline adherence in primary care centers was at a lower level compared to secondary or tertiary care centers. The importance of guideline adherence increases as patients age, and complex diseases and comorbidity arise. Appropriate resources and interventions, taking important factors for nonadherence in account, are necessary to improve guideline adoption and adherence in every level of the chain. This in turn should improve patient outcome.

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

Science.gov (United States)

Kekwaletswe, Connie T; Morojele, Neo K

2014-01-01

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. 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. 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 alcohol-focused adherence counseling program that employs motivational interviewing and cognitive behavioral therapy-type approaches. The association between alcohol use and ART nonadherence points to a need for alcohol-focused ART adherence

Adherence to gout management recommendations of Chinese patients.

Science.gov (United States)

Sheng, Feng; Fang, Weigang; Zhang, Bingqing; Sha, Yue; Zeng, Xuejun

2017-11-01

Though efficacious and affordable treatments for gout are widely available, gout is still not well controlled in many countries of the world including China.To investigate patient adherence to gout management recommendations and potential barriers in Chinese male gout patients, a survey was carried out by telephone interview in male patients registered in the gout clinic at Peking Union Medical College Hospital. Adherence to dietary and medication recommendations was measured by a food frequency questionnaire and proportion of cumulative time adherent to chemical urate-lowering therapy (ULT), respectively. Dietary adherence was defined as consumption of alcohol, seafood and animal organs less than once per month, and reduced red meat after dietary counseling. Medication adherence was defined as ULT ≥80% of time in the past 12 months for patients with indications. Logistic regression models were used to identify patient characteristics associated with management adherence. Reasons for nonadherence were also sought by open-end questions.Dietary and medication adherence were 44.2% and 21.9%, respectively. Older age (odds ratio [OR] 7.90, 95% confidence interval [CI] 2.49-25.04 for age ≥60), higher serum uric acid (sUA) levels (OR 3.53, 95% CI 1.42-8.75 for the highest quartile), and tophi (OR 2.31, 95% CI 1.12-4.77) were associated with dietary adherence independently, while tophi (OR 14.05, 95% CI 2.67-74.08) and chronic kidney disease (OR 16.66, 95% CI 2.63-105.37) were associated with medication adherence independently. Reasons that patients reported for nonadherence to medication included remission after treatment (35.3%), concerns for potential side effects (22.7%), insufficient patient education (8.7%), and adverse events (8.2%).Patient adherence to gout management recommendations is poor in China. Older age, increased disease burden, and specific comorbidities were associated with management adherence.

Medication adherence in patients with juvenile idiopathic arthritis

Directory of Open Access Journals (Sweden)

Liana Silveira Adriano

Full Text Available ABSTRACT Objective: The aim of this study was to investigate pharmacological treatment adherence of patients with juvenile idiopathic arthritis, attended in an outpatient pharmacy at a tertiary hospital in northeastern Brazil. Methods: The analysis of adherence was performed along with caregivers, through a structured questionnaire based on Morisky, Green and Levine, which enabled the categorization of adherence in “highest”, “moderate” or “low” grades, and through evaluating medication dispensing registers, which classified the act of getting medications at the pharmacy as “regular” or “irregular”. Drug Related Problems (DRP were identified through the narrative of caregivers and classified according to the Second Granada Consensus. Then, a pharmaceutical orientation chart with information about the therapeutic regimen was applied, in order to function as a guide for issues that influenced adherence. Results: A total of 43 patients was included, with a mean age of 11.12 years, and 65.1% (n = 28 were female. Applying the questionnaire, it was found “highest” adherence in 46.5% (n = 20 patients, “moderate” adherence in 48.8% (n = 21, and “low” adherence in 4.7% (n = 2. Through an analysis of the medication dispensing registers, a lower level of adherence was observed: only 25.6% (n = 11 of the participants received “regularly” the medications. Twenty-six DRP was identified, and 84.6% (n = 22 were classified as real. There were no significant associations between socio-demographic variables and adherence, although some caregivers have reported difficulty in accessing the medicines and in understanding the treatment. Conclusion: Our findings showed problems in the adherence process related to inattention, forgetfulness and irregularity in getting medicines, reinforcing the need for the development of strategies to facilitate a better understanding of treatment and to ensure adherence.

Medication adherence beliefs of U.S community pharmacists.

Science.gov (United States)

Witry, Matthew J

2018-05-01

There is increasing attention on the role of community pharmacists in improving medication adherence. There is a need to better understand pharmacist attitudes and experiences related to this role. To assess community pharmacist perceptions of patient reasons for non-adherence, characterize the adherence beliefs of community pharmacists, and test if there are demographic predictors of pharmacists' self-efficacy, outcome expectations, and role beliefs related to intervening on medication non-adherence. A cross-sectional survey was mailed using a 4-contact approach to 1000 pharmacists practicing in 5 Midwestern U.S. States. The survey included seven domains to address the study objectives. Descriptive statistics were calculated for demographic items, coefficient alphas tested the internal consistency of scales, and multiple regression was used to test the relationship between demographics and scale means. There were 261 usable responses giving a 29% response rate. Pharmacists perceived forgetting and instructions changing without a new prescription to be the most common reasons for late refills. A minority of pharmacists agreed that non-adherence involves a deliberate decision or that negative medication beliefs were common reasons for late refills. Pharmacists were confident, had positive outcome expectations, and positive role beliefs related to interacting with patients who have adherence issues. Barriers to adherence intervention included difficulties with follow-up and documentation. Also, over half of the pharmacists reported that discussing adherence makes patients defensive. Pharmacists had positive attitudes toward intervening on medication non-adherence although barriers to intervention are present. Pharmacists perceived non-intentional reasons for late refills to be more prevalent than intentional reasons. Pharmacists may benefit from additional non-adherence communication training and support targeted at identifying a broader range of non-adherence

[Predictors of medication non-adherence among a Moroccan sample of patients with schizophrenia: A cross sectional study].

Science.gov (United States)

El Ammouri, A; Kisra, H

2017-12-01

Schizophrenia is a chronic, relapsing, mental disorder, and lack of adherence is a common and severe problem in such patients leadingto global and heavy consequences for patients (relapses, hospitalizations, impaired quality of life…), for the family and for society. Improved understanding of the underlying reasons will help to form intervention strategies relevant to the context. We aimed to assess medication adherence among stable patients suffering from schizophrenia and to identify factors associated with non-adherence. This is a retrospective cohort study of outpatients with schizophrenia at the psychiatric hospital Ar-razi of Salé (Maroc). The patients were aged over 18, clinically stabilized under the same treatment during the three months prior to inclusion. Data (demographic, clinical and therapeutic) was collected by a questionnaire developed for this purpose. Assessment of adherence and awareness of the disorder (insight) were performed respectively by two validated scales: Medication Adherence Rating Scale the (MARS) and scale Q8. Fourty percent of schizophrenic patients included in our study were not compliant to treatment. Compared to adherent patients, non-adherent patients had history of substance use (57.6 % vs. 42.4 %, P<0.05), were less aware of their disorder (77.8 % vs. 22.2 %, P<0.01), had significantly more drug intake per day (2.4 vs. 1.9, P<0.01), took significantly more tablets per day (2.8 vs. 2.2; P<0.05) and complained of significantly more side effects (43.2 vs. 56.8, P<0.05). A logistic regression model had shown that only side effects, lack of insight, and a history of substances use are significant predictors of poor adherence in patients with schizophrenia. The results of this work should guide our efforts to improve adherence in patients with schizophrenia. Waiting for new drugs with fewer side effects and better benefit/risk, some strategies would help to improve adherence to treatment. For example: implementation of

Evaluation of factors affecting adherence to asthma controller ...

African Journals Online (AJOL)

Background: Adherence to controller therapy in asthma is a major concern during the management of the disease. ... The adherence to asthma treatment was rated using Morisky Medication Adherence Scale. A ..... in an outpatient setting.

Examination of the Link Between Medication Adherence and Use of Mail-Order Pharmacies in Chronic Disease States.

Science.gov (United States)

Fernandez, Elena V; McDaniel, Jennifer A; Carroll, Norman V

2016-11-01

selecting mail-order pharmacies) depends on how well the statistical controls adjusted for the substantial differences between the mail and retail samples. While the research strongly indicates that consumers who use mail-order pharmacies are more likely to be adherent, more research is needed before it can be conclusively determined that use of mail-order pharmacies causes higher adherence. No outside funding supported this study. Fernandez was partially funded by a Virginia Commonwealth University School of Pharmacy PharmD/PhD Summer Fellowship for work on this project. The authors declare no other potential conflicts of interest. Study concept and design were contributed by Carroll and Fernandez. Fernandez took the lead in data collection, along with Carroll and McDaniel, and data interpretation was performed by Carroll and Fernandez. The manuscript was written and revised by Carroll and Fernandez, with assistance from McDaniel.

Project JOINTS: what factors affect bundle adoption in a voluntary quality improvement campaign?

Science.gov (United States)

Khodyakov, Dmitry; Ridgely, M Susan; Huang, Christina; DeBartolo, Katherine O; Sorbero, Melony E; Schneider, Eric C

2015-01-01

Diffusion and adoption of effective evidence-based clinical practices can be slow, especially if complex changes are required to implement new practices. To examine how hospital adherence to quality improvement (QI) methods and hospital engagement with a large-scale QI campaign could facilitate the adoption of an enhanced prevention bundle designed to reduce surgical site infection (SSI) rates after orthopaedic surgery (hip and knee arthroplasty). We conducted telephone interviews with hospital QI leaders from 73 of the 109 hospitals (67% response rate) in five states that participated in Project JOINTS (Joining Organizations IN Tackling SSIs), a QI campaign run by Institute for Healthcare Improvement (IHI). Using QI methods grounded in the IHI Model for Improvement, this campaign encouraged hospitals to implement an enhanced SSI prevention bundle. Hospital QI leaders reported on their hospital's adherence to the Project JOINTS QI methods; their level of engagement with Project JOINTS activities; and adoption of the SSI prevention bundle components. Interview data were analysed quantitatively and qualitatively. Both adherence to the QI methods and hospital engagement were positively associated with complete bundle adoption. Hospital engagement, especially the use of project materials and tools, was also positively associated with the initiation of and improved adherence to individual bundle components. Our findings suggest that greater adherence to the QI methods and active hospital engagement in a QI campaign facilitate adoption of evidence-based patient safety bundles in orthopaedic practice. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.

Operational research within a Global Fund supported tuberculosis project in India: why, how and its contribution towards change in policy and practice

Science.gov (United States)

Sagili, Karuna D; Satyanarayana, Srinath; Chadha, Sarabjit S; Wilson, Nevin C; Kumar, Ajay M V; Oeltmann, John E; Chadha, Vineet K; Nagaraja, Sharath Burugina; Ghosh, Smita; Q Lo, Terrence; Volkmann, Tyson; Willis, Matthew; Shringarpure, Kalpita; Reddy, Ravichandra Chinnappa; Kumar, Prahlad; Nair, Sreenivas A; Rao, Raghuram; Yassin, Mohammed; Mwangala, Perry; Zachariah, Rony; Tonsing, Jamhoih; Harries, Anthony D; Khaparde, Sunil

2018-01-01

ABSTRACT Background: The Global Fund encourages operational research (OR) in all its grants; however very few reports describe this aspect. In India, Project Axshya was supported by a Global Fund grant to improve the reach and visibility of the government Tuberculosis (TB) services among marginalised and vulnerable communities. OR was incorporated to build research capacity of professionals working with the national TB programme and to generate evidence to inform policies and practices. Objectives: To describe how Project Axshya facilitated building OR capacity within the country, helped in addressing several TB control priority research questions, documented project activities and their outcomes, and influenced policy and practice. Methods: From September 2010 to September 2016, three key OR-related activities were implemented. First, practical output-oriented modular training courses were conducted (n = 3) to build research capacity of personnel involved in the TB programme, co-facilitated by The Union, in collaboration with the national TB programme, WHO country office and CDC, Atlanta. Second, two large-scale Knowledge, Attitude and Practice (KAP) surveys were conducted at baseline and mid-project to assess the changes pertaining to TB knowledge, attitudes and practices among the general population, TB patients and health care providers over the project period. Third, studies were conducted to describe the project’s core activities and outcomes. Results: In the training courses, 44 participant teams were supported to develop research protocols on topics of national priority, resulting in 28 peer-reviewed scientific publications. The KAP surveys and description of project activities resulted in 14 peer-reviewed publications. Of the published papers at least 12 have influenced change in policy or practice. Conclusions: OR within a Global Fund supported TB project has resulted in building OR capacity, facilitating research in areas of national priority and

Influence Of Globalization On Human Resource Development In ...

African Journals Online (AJOL)

The paper addressed the influence of Globalization on human resource development in Nigeria. It traced the origin of human resource development in Nigeria to the coming of the missionaries who spiritually colonized Africa and also educated their adherents. The human resource produced from the education offered were ...

Adherence to the Mediterranean diet during pregnancy and offspring adiposity and cardiometabolic traits in childhood.

Science.gov (United States)

Chatzi, L; Rifas-Shiman, S L; Georgiou, V; Joung, K E; Koinaki, S; Chalkiadaki, G; Margioris, A; Sarri, K; Vassilaki, M; Vafeiadi, M; Kogevinas, M; Mantzoros, C; Gillman, M W; Oken, E

2017-08-01

In adults, adherence to the Mediterranean diet has been inversely associated with cardiovascular risk, but the extent to which diet in pregnancy is associated with offspring adiposity is unclear. We aimed to investigate the association between adherence to Mediterranean diet in pregnancy and offspring cardiometabolic traits in two pregnancy cohorts. We studied 997 mother-child pairs from Project Viva in Massachusetts, USA, and 569 pairs from the Rhea study in Crete, Greece. We estimated adherence to the Mediterranean diet with an a priori defined score (MDS) of nine foods and nutrients (0 to 9). We measured child weight, height, waist circumference, skin-fold thicknesses, blood pressure, and blood levels of lipids, c-reactive protein and adipokines in mid-childhood (median 7.7 years) in Viva, and in early childhood (median 4.2 years) in Rhea. We calculated cohort-specific effects and pooled effects estimates with random-effects models for cohort and child age. In Project Viva, the mean (SD, standard deviation) MDS was 2.7 (1.6); in Rhea it was 3.8 (1.7). In the pooled analysis, for each 3-point increment in the MDS, offspring BMI z-score was lower by 0.14 units (95% CI, -0.15 to -0.13), waist circumference by 0.39 cm (95% CI, -0.64 to -0.14), and the sum of skin-fold thicknesses by 0.63 mm (95% CI, -0.98 to -0.28). We also observed lower offspring systolic (-1.03 mmHg; 95% CI, -1.65 to -0.42) and diastolic blood pressure (-0.57 mmHg; 95% CI, -0.98 to -0.16). Greater adherence to Mediterranean diet during pregnancy may protect against excess offspring cardiometabolic risk. © 2017 World Obesity Federation.

Influence of intention to adhere, beliefs and satisfaction about medicines on adherence in solid organ transplant recipients.

Science.gov (United States)

Hugon, Amélie; Roustit, Matthieu; Lehmann, Audrey; Saint-Raymond, Christel; Borrel, Elisabeth; Hilleret, Marie-Noëlle; Malvezzi, Paolo; Bedouch, Pierrick; Pansu, Pascal; Allenet, Benoît

2014-07-27

Nonadherence to immunosuppressive (IS) therapy is associated with poor outcomes. Identifying factors predicting poor adherence is therefore essential. The primary objective of this study was to test whether parameters of a model adapted from the theory of planned behavior, and more specifically attitudes that are influenced by beliefs and satisfaction with medication, could predict adherence in solid organ transplant patients. Adherence was assessed with a self-reported medication adherence scale and IS blood trough concentrations over 6 months, in four transplant units. Satisfaction and beliefs were assessed using the Treatment Satisfaction with Medicines Questionnaire (SATMED-Q) and Beliefs about Medicines Questionnaire (BMQ), respectively. Theory of planned behavior was assessed with a specific questionnaire exploring intentions, subjective norms, attitudes and perceived behavioral control. Treatment characteristics and socioeconomic data were also collected. One hundred and fifty-three solid organ transplant patients were enrolled, including lung (n=33), heart (n=43), liver (n=42), and kidney (n=44) patients. Satisfaction and positive beliefs about medication were higher in adherent than those in nonadherent patients. Factors independently associated with an increased risk of nonadherence were negative general beliefs about medications (odds ratio [OR]=0.89 [0.83-0.97]), living alone (OR=2.78 [1.09-7.09]), heart transplantation (OR=3.49 [1.34-9.09]), and being on everolimus (OR=5.02 [1.21-20.8]). Negative beliefs toward medications were shown to be an independent risk factor of poor adherence. Therefore, the BMQ could be an effective, easy to implement tool, for use in everyday practice, to identify patients needing interventions to improve adherence to IS.

Adherence to oral and topical medication in 445 patients with tinea pedis as assessed by the Morisky Medication Adherence Scale-8.

Science.gov (United States)

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

2015-01-01

Adherence is defined as the extent to which a person's behavior corresponds with recommendations from health care providers. Adherence to treatment is an important factor for a good therapeutic outcome. This study aimed to examine the adherence of patients with tinea pedis and to clarify the factors related to it. We assessed medication adherence for oral and topical drugs using a translated version of the Morisky Medication Adherence Scale-8 (MMAS-8) together with other background factors in 445 Japanese patients with tinea pedis, using a questionnaire in a web-based monitoring system. Overall, high, medium and low adherence rates as assessed by MMAS-8 were 8.7%, 31.7% and 59.6% for oral medication, and 8.6%, 17.4% and 74.0% for topical medication, respectively. The adherence level was significantly higher for oral medication than for topical medication. Subgroup analyses showed that the adherence level for topical medication was significantly higher when topical and oral medications were used in combination than when topical medication was used alone. A low adherence level was shown in employed patients, those for whom their oral medication had not been effective and those with topical medication who had visited their hospital less often than once every six months. Patient adherence to therapy can be effectively improved by selecting highly effective medication while considering the prescription of topical and oral antifungal medications concomitantly, by carefully selecting a therapy plan for employed patients and by encouraging patients to visit their doctor regularly.

New Regional and Global HFC Projections and Effects of National Regulations and Montreal Protocol Amendment Proposals

Science.gov (United States)

Velders, G. J. M.

2015-12-01

Hydrofluorocarbons (HFCs) are used as substitutes for ozone-depleting substances that are being phased out globally under Montreal Protocol regulations. New global scenarios of HFC emissions reach 4.0-5.3 GtCO2-eq yr-1 in 2050, which corresponds to a projected growth from 2015 to 2050 which is 9% to 29% of that for CO2 over the same time period. New baseline scenarios are formulated for 10 HFC compounds, 11 geographic regions, and 13 use categories. These projections are the first to comprehensively assess production and consumption of individual HFCs in multiple use sectors and geographic regions with emission estimates constrained by atmospheric observations. In 2050, in percent of global HFC emissions, China (~30%), India and the rest of Asia (~25%), Middle East and northern Africa (~10%), and USA (~10%) are the principal source regions; and refrigeration and stationary air conditioning are the major use sectors. National regulations to limit HFC use have been adopted recently in the European Union, Japan and USA, and four proposals have been submitted in 2015 to amend the Montreal Protocol to substantially reduce growth in HFC use. Calculated baseline emissions are reduced by 90% in 2050 by implementing the North America Montreal Protocol amendment proposal. Global adoption of technologies required to meet national regulations would be sufficient to reduce 2050 baseline HFC consumption by more than 50% of that achieved with the North America proposal for most developed and developing countries. The new HFC scenarios and effects of national regulations and Montreal Protocol amendment proposals will be presented.

10 rules for managing global innovation.

Science.gov (United States)

Wilson, Keeley; Doz, Yves L

2012-10-01

More and more companies recognize that their dispersed, global operations are a treasure trove of ideas and capabilities for innovation. But it's proving harder than expected to unearth those ideas or exploit those capabilities. Part of the problem is that companies manage global innovation the same way they manage traditional, single-location projects. Single-location projects draw on a large reservoir of tacit knowledge, shared context, and trust that global projects lack. The management challenge, therefore, is to replicate the positive aspects of colocation while harnessing the opportunities of dispersion. In this article, Insead's Wilson and Doz draw on research into global strategy and innovation to present a set of guidelines for setting up and managing global innovation. They explore in detail the challenges that make global projects inherently different and show how these can be overcome by applying superior project management skills across teams, fostering a strong collaborative culture, and using a robust array of communications tools.

The NASA Global Climate Change Education Project: An Integrated Effort to Improve the Teaching and Learning about Climate Change (Invited)

Science.gov (United States)

Chambers, L. H.; Pippin, M. R.; Welch, S.; Spruill, K.; Matthews, M. J.; Person, C.

2010-12-01

The NASA Global Climate Change Education (GCCE) Project, initiated in 2008, seeks to: - improve the teaching and learning about global climate change in elementary and secondary schools, on college campuses, and through lifelong learning; - increase the number of people, particularly high school and undergraduate students, using NASA Earth observation data, Earth system models, and/or simulations to investigate and analyze global climate change issues; - increase the number of undergraduate students prepared for employment and/or to enter graduate school in technical fields relevant to global climate change. Through an annual solicitation, proposals are requested for projects that address these goals using a variety of approaches. These include using NASA Earth system data, interactive models and/or simulations; providing research experiences for undergraduate or community college students, or for pre- or in-service teachers; or creating long-term teacher professional development experiences. To date, 57 projects have been funded to pursue these goals (22 in 2008, 18 in 2009, and 17 in 2010), each for a 2-3 year period. The vast majority of awards address either teacher professional development, or use of data, models, or simulations; only 7 awards have been made for research experiences. NASA, with assistance from the Virginia Space Grant Consortium, is working to develop these awardees into a synergistic community that works together to maximize its impact. This paper will present examples of collaborations that are evolving within this developing community. It will also introduce the opportunities available in fiscal year 2011, when a change in emphasis is expected for the project as it moves within the NASA Office of Education Minority University Research and Education Program (MUREP).

Harmonization in CSR reporting: MNEs and global CSR standards

NARCIS (Netherlands)

Fortanier, F.; Kolk, A.; Pinkse, J.

2011-01-01

This paper focuses on MNEs’ corporate social responsibility (CSR) reporting, which previous studies have found to exhibit strong country-of-origin effects. It examines whether MNEs’ adherence to global standards (as adopted by e.g. ILO, OECD, UN, ISO) is associated with smaller cross-country

Bacterial adherence to extended wear soft contact lenses

International Nuclear Information System (INIS)

Aswad, M.I.; John, T.; Barza, M.; Kenyon, K.; Baum, J.

1990-01-01

The authors studied the adherence of Pseudomonas aeruginosa and Staphylococcus aureus to extended wear soft contact lenses (EWSCLs) with and without focal deposits using both a radiolabeling technique and electron microscopy. P. aeruginosa showed significant adherence to contact lenses in vitro. In contrast, S. aureus failed to show significant adherence to contact lenses in vitro (i.e., the radioactive uptake was not significantly above background). The extent of adherence of Pseudomonas was proportional to the number of focal deposits on the lenses. Results of electron microscopic examination showed the bacteria to be adherent primarily to large focal deposits (greater than or equal to 150 microns). There was no pseudomonal adherence to the small focal deposits (less than or equal to 50 microns) and little adherence to the areas in between the focal deposits. The authors hypothesize that worn lenses, especially those with large focal deposits, serve as a vehicle for the transport of P. aeruginosa to the cornea. This hypothesis could be a partial explanation for the high incidence of keratitis caused by P. aeruginosa in EWSCL patients

Factors affecting adherence to a raw vegan diet.

Science.gov (United States)

Link, Lilli B; Jacobson, Judith S

2008-02-01

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.

Factors affecting adherence to a raw vegan diet

Science.gov (United States)

Link, Lilli B.; Jacobson, Judith S.

2008-01-01

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 (β=0.95), severity of disease (β=0.98), and self-efficacy to adhere (β=0.72). Future interventions that evaluate this diet should address self-efficacy, an important, potentially remediable predictor of adherence. PMID:18243943

Medication adherence among transgender women living with HIV

OpenAIRE

Baguso, Glenda N.; Gay, Caryl L.; Lee, Kathryn A.

2016-01-01

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...

Does Prescription Drug Adherence Reduce Hospitalizations and Costs?

OpenAIRE

William Encinosa; Didem Bernard; Avi Dor

2010-01-01

We estimate the impact of diabetic drug adherence on hospitalizations, ER visits, and hospital costs, using insurance claims from MarketScan® employer data. However, it is often difficult to measure the impact of drug adherence on hospitalizations since both adherence and hospitalizations may be correlated with unobservable patient severity. We control for such unobservables using propensity score methods and instrumental variables for adherence such as drug coinsurance levels and direct-to- ...

Microbicide clinical trial adherence: insights for introduction.

Science.gov (United States)

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

2013-04-08

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.

A New Breed of Database System: Volcano Global Risk Identification and Analysis Project (VOGRIPA)

Science.gov (United States)

Crosweller, H. S.; Sparks, R. S.; Siebert, L.

2009-12-01

VOGRIPA originated as part of the Global Risk Identification Programme (GRIP) that is being co-ordinated from the Earth Institute of Columbia University under the auspices of the United Nations and World Bank. GRIP is a five-year programme aiming at improving global knowledge about risk from natural hazards and is part of the international response to the catastrophic 2004 Asian tsunami. VOGRIPA is also a formal IAVCEI project. The objectives of VOGRIPA are to create a global database of volcanic activity, hazards and vulnerability information that can be analysed to identify locations at high risk from volcanism, gaps in knowledge about hazards and risk, and will allow scientists and disaster managers at specific locations to analyse risk within a global context of systematic information. It is this added scope of risk and vulnerability as well as hazard which sets VOGRIPA apart from most previous databases. The University of Bristol is the central coordinating centre for the project, which is an international partnership including the Smithsonian Institution, the Geological Survey of Japan, the Earth Observatory of Singapore (Chris Newhall), the British Geological Survey, the University of Buffalo (SUNY) and Munich Re. The partnership is intended to grow and any individuals or institutions who are able to contribute resources to VOGRIPA objectives are welcome to participate. Work has already begun (funded principally by Munich Re) on populating a database of large magnitude explosive eruptions reaching back to the Quaternary, with extreme-value statistics being used to evaluate the magnitude-frequency relationship of such events, and also an assessment of how the quality of records affect the results. The following 4 years of funding from the European Research Council for VOGRIPA will be used to establish further international collaborations in order to develop different aspects of the database, with the data being accessible online once it is sufficiently

Method of detaching adherent cells for flow cytometry

KAUST Repository

Kaur, Mandeep; Esau, Luke E.

2015-01-01

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

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

2014-03-01

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

Concordance of Adherence Measurement Using Self-Reported Adherence Questionnaires and Medication Monitoring Devices: An Updated Review.

Science.gov (United States)

Monnette, Alisha; Zhang, Yichen; Shao, Hui; Shi, Lizheng

2018-01-01

As medication adherence continues to be a prevalent issue in today's society, the methods used to monitor medication-taking behaviors are constantly being re-evaluated and compared in search of the 'gold standard' measure. Our review aimed to assess the current literature surrounding the correlation between self-reported questionnaires (SRQs) and electronic monitoring devices to determine if these measures produce similar results. We performed a literature search from 2009 to 2017 using PubMed, PubMed In-Process and Non-Indexed, EMBASE, Ovid MEDLINE, and Ovid MEDLINE In-Process. A keyword search using the terms 'patient compliance', 'treatment compliance', 'medication adherence', 'drug monitoring', 'drug therapy', 'electronic', 'digital', 'computer', 'monitor', 'monitoring', 'drug', 'pharmaceutical preparations', 'compliance', and 'medications' was done to capture all articles. We included articles measuring adherence using both monitoring devices and SRQs. Thirty-five articles were included in this review. The average difference in measured adherence rates between the two measures was 9.2% (range -66.3 to 61.5). A majority (62.7%) of articles reported moderate (n = 12; 27.9%), high (n = 5, 11.6%), or significant (n = 10, 23.3%) correlations between SRQs and monitoring devices. Results from our review are consistent with previous studies, as we found that many of our studies produced moderate to high correlation between both SRQs and monitoring devices [Farmer, Clin Ther 21(6):1074-90 (1999), IMS Institute for Healthcare Informatics. Avoidable costs in US health care (2012), Patel et al., Respirology 18(3):546-52 (2013), Siracusa et al., J Cyst Fibros 14(5):621-6 (2015), Smith et al., Int J Cardiol 145(1):122-3 (2010)]. Our findings demonstrate that self-reported adherence produces comparable results to electronic monitoring devices. As there is not yet a 'gold standard' measure for monitoring patient adherence, SRQs and Medication Event Monitoring Systems

Assessing the impacts of 1.5°C of global warming - The Inter-Sectoral Impact Model Intercomparison Project (ISIMIP) approach

Science.gov (United States)

Frieler, Katja; Warszawski, Lila; Zhao, Fang

2017-04-01

In Paris, France, December 2015 the Conference of Parties (COP) to the United Nations Framework Convention on Climate Change (UNFCCC) invited the IPCC to provide a "special report in 2018 on the impacts of global warming of 1.5°C above pre-industrial levels and related global greenhouse gas emission pathways". In Nairobi, Kenya, April 2016 the IPCC panel accepted the invitation. Here we describe the model simulations planned within the Inter-Sectoral Impact Model Intercomparison Project (ISIMIP) to address the request by providing tailored cross-sectoral consistent impacts projections. The protocol is designed to allow for 1) a separation of the impacts of the historical warming starting from pre-industrial conditions from other human drivers such as historical land use changes (based on pre-industrial and historical impact model simulations), 2) a quantification of the effects of an additional warming to 1.5°C including a potential overshoot and long term effects up to 2300 in comparison to a no-mitigation scenario (based on the low emissions Representative Concentration Pathway RCP2.6 and a no-mitigation scenario RCP6.0) keeping socio-economic conditions fixed at year 2005 levels, and 3) an assessment of the climate effects based on the same climate scenarios but accounting for parallel changes in socio-economic conditions following the middle of the road Shared Socioeconomic Pathway (SSP2) and differential bio-energy requirements associated with the transformation of the energy system to reach RCP2.6 compared to RCP6.0. To provide the scientific basis for an aggregation of impacts across sectors and an analysis of cross-sectoral interactions potentially damping or amplifying sectoral impacts the protocol is designed to provide consistent impacts projections across a range of impact models from different sectors (global and regional hydrological models, global gridded crop models, global vegetation models, regional forestry models, global and regional marine

Medication Adherence Apps: Review and Content Analysis.

Science.gov (United States)

Ahmed, Imran; Ahmad, Niall Safir; Ali, Shahnaz; Ali, Shair; George, Anju; Saleem Danish, Hiba; Uppal, Encarl; Soo, James; Mobasheri, Mohammad H; King, Dominic; Cox, Benita; Darzi, Ara

2018-03-16

Medication adherence is an expensive and damaging problem for patients and health care providers. Patients adhere to only 50% of drugs prescribed for chronic diseases in developed nations. Digital health has paved the way for innovative smartphone solutions to tackle this challenge. However, despite numerous apps available claiming to improve adherence, a thorough review of adherence apps has not been carried out to date. The aims of this study were to (1) review medication adherence apps available in app repositories in terms of their evidence base, medical professional involvement in development, and strategies used to facilitate behavior change and improve adherence and (2) provide a system of classification for these apps. In April 2015, relevant medication adherence apps were identified by searching the Apple App Store and the Google Play Store using a combination of relevant search terms. Data extracted included app store source, app price, documentation of health care professional (HCP) involvement during app development, and evidence base for each respective app. Free apps were downloaded to explore the strategies used to promote medication adherence. Testing involved a standardized medication regimen of three reminders over a 4-hour period. Nonadherence features designed to enhance user experience were also documented. The app repository search identified a total of 5881 apps. Of these, 805 fulfilled the inclusion criteria initially and were tested. Furthermore, 681 apps were further analyzed for data extraction. Of these, 420 apps were free for testing, 58 were inaccessible and 203 required payment. Of the 420 free apps, 57 apps were developed with HCP involvement and an evidence base was identified in only 4 apps. Of the paid apps, 9 apps had HCP involvement, 1 app had a documented evidence base, and 1 app had both. In addition, 18 inaccessible apps were produced with HCP involvement, whereas 2 apps had a documented evidence base. The 420 free apps were

A randomized trial comparing in person and electronic interventions for improving adherence to oral medications in schizophrenia.

Science.gov (United States)

Velligan, Dawn; Mintz, Jim; Maples, Natalie; Xueying, Li; Gajewski, Stephanie; Carr, Heather; Sierra, Cynthia

2013-09-01

Poor adherence to medication leads to symptom exacerbation and interferes with the recovery process for patients with schizophrenia. Following baseline assessment, 142 patients in medication maintenance at a community mental health center were randomized to one of 3 treatments for 9 months: (1) PharmCAT, supports including pill containers, signs, alarms, checklists and the organization of belongings established in weekly home visits from a PharmCAT therapist; (2) Med-eMonitor (MM), an electronic medication monitor that prompts use of medication, cues the taking of medication, warns patients when they are taking the wrong medication or taking it at the wrong time, record complaints, and, through modem hookup, alerts treatment staff of failures to take medication as prescribed; (3) Treatment as Usual (TAU). All patients received the Med-eMonitor device to record medication adherence. The device was programmed for intervention only in the MM group. Data on symptoms, global functioning, and contact with emergency services and police were obtained every 3 months. Repeated measures analyses of variance for mixed models indicated that adherence to medication was significantly better in both active conditions than in TAU (both p<0.0001). Adherence in active treatments ranged from 90-92% compared to 73% in TAU based on electronic monitoring. In-person and electronic interventions significantly improved adherence to medication, but that did not translate to improved clinical outcomes. Implications for treatment and health care costs are discussed.

Adherence of coagulase-negative staphylococci to plastic tissue culture plates: a quantitative model for the adherence of staphylococci to medical devices.

OpenAIRE

Christensen, G D; Simpson, W A; Younger, J J; Baddour, L M; Barrett, F F; Melton, D M; Beachey, E H

1985-01-01

The adherence of coagulase-negative staphylococci to smooth surfaces was assayed by measuring the optical densities of stained bacterial films adherent to the floors of plastic tissue culture plates. The optical densities correlated with the weight of the adherent bacterial film (r = 0.906; P less than 0.01). The measurements also agreed with visual assessments of bacterial adherence to culture tubes, microtiter plates, and tissue culture plates. Selected clinical strains were passed through ...

Non-adherence to topical treatments for actinic keratosis

Directory of Open Access Journals (Sweden)

Shergill B

2013-12-01

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

Global power: Markets and strategies

International Nuclear Information System (INIS)

Poirer, J.L.

1998-01-01

The author will first present an updated view of the global power market activity, including opportunities in power generation, transmission and distribution. This will include a review of the trends in closings and transaction flowed by type of activity and geographic area. Estimates will be based on Hagler Bailly's comprehensive database on global power transactions and project announcements. The firm has also worked with dozens of global power companies since 1990. Second, the author will review trends in terms of regulatory changes, project cost trends, developers' project experiences, and financing issues. This systematic review will be the foundation for projection of future market activity (e.g., number of closing by type of project through 2000). A forecast of future greenfield and privatization activity will be provided and the key markets will be highlighted. Third, the author will present an updated view of the competition in the global power market (including the various types of competitors and changes in their respective market posture). Finally, the author will discuss the various types of strategies and business models that are followed by key global power players

Does good medication adherence really save payers money?

Science.gov (United States)

Stuart, Bruce C; Dai, Mingliang; Xu, Jing; Loh, Feng-Hua E; S Dougherty, Julia

2015-06-01

Despite a growing consensus that better adherence with evidence-based medications can save payers money, assertions of cost offsets may be incomplete if they fail to consider additional drug costs and/or are biased by healthy adherer behaviors unobserved in typical medical claims-based analyses. The objective of this study was to determine whether controlling for healthy adherer bias (HAB) materially affected estimated medical cost offsets and additional drug spending associated with higher adherence. A total of 1273 Medicare beneficiaries with diabetes enrolled in Part D plans between 2006 and 2009. Using survey and claims data from the Medicare Current Beneficiary Survey, we measured medical and drug costs associated with good and poor adherence (proportion of days covered ≥ 80% and <80%, respectively) to oral antidiabetic drugs, ACE inhibitors/ARBs, and statins over 2 years. To test for HAB, we estimated pairs of regression models, one set containing variables typically controlled for in conventional claims analysis and a second set with survey-based variables selected to capture HAB effects. We found consistent evidence that controlling for HAB reduces estimated savings in medical costs from better adherence, and likewise, reduces estimates of additional adherence-related drug spending. For ACE inhibitors/ARBs we estimate that controlling for HAB reduced adherence-related medical cost offsets from $6389 to $4920 per person (P<0.05). Estimates of additional adherence-related drug costs were 26% and 14% lower in HAB-controlled models (P < 0.05). These results buttress the economic case for action by health care payers to improve medication adherence among insured persons with chronic disease. However, given the limitations of our research design, further research on larger samples with other disease states is clearly warranted.

Evaluating Patient Interest in an Adherence-Focused Smartphone App to Improve HIV Care

Directory of Open Access Journals (Sweden)

Joshua W Gaborcik

2017-02-01

Full Text Available Objective: Evaluate patient interest in a smartphone mobile application (app to assist in medication adherence. Methods: In January 2014, a 19-question, anonymous, paper survey was distributed to a convenience sample of patients in the reception area of a nonprofit HIV primary care clinic and pharmacy. Results: Of the 101 patients surveyed, 72.3% had a smartphone and 70.3% were interested in downloading and using an adherence app if one was available. If an app was customizable, patients desired appointment reminders (87%, notifications to schedule appointments (85%, refill notifications (83%, medication reminders (79%, and adherence tracked by pharmacy (59%. Conclusions: Results share insights on the potential use of technology to assist an HIV patient population with medication adherence. Conflict of Interest Dr. Jennifer Rodis is the creator and director of the Partner For Promotion (PFP program otherwise she has no additional conflicts of interest or financial interests that the authors or members of their immediate families have in any product or service discussed in the manuscript, including grants (pending or received, employment, gifts, stock holdings or options, honoraria, consultancies, expert testimony, patents and royalties. All other authors declare no conflicts of interest or financial interests that the authors or members of their immediate families have in any product or service discussed in the manuscript, including grants (pending or received, employment, gifts, stock holdings or options, honoraria, consultancies, expert testimony, patents and royalties   Type: Student Project

Adherence of Helicobacter pylori to the Gastric Mucosa

Directory of Open Access Journals (Sweden)

Marguerite Clyne

1997-01-01

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.

Health behavior change: can genomics improve behavioral adherence?

Science.gov (United States)

McBride, Colleen M; Bryan, Angela D; Bray, Molly S; Swan, Gary E; Green, Eric D

2012-03-01

The National Human Genome Research Institute recommends pursuing "genomic information to improve behavior change interventions" as part of its strategic vision for genomics. The limited effectiveness of current behavior change strategies may be explained, in part, by their insensitivity to individual variation in adherence responses. The first step in evaluating whether genomics can inform customization of behavioral recommendations is evidence reviews to identify adherence macrophenotypes common across behaviors and individuals that have genetic underpinnings. Conceptual models of how biological, psychological, and environmental factors influence adherence also are needed. Researchers could routinely collect biospecimens and standardized adherence measurements of intervention participants to enable understanding of genetic and environmental influences on adherence, to guide intervention customization and prospective comparative effectiveness studies.

Exploring 'generative mechanisms' of the antiretroviral adherence club intervention using the realist approach: a scoping review of research-based antiretroviral treatment adherence theories.

Science.gov (United States)

Mukumbang, Ferdinand C; Van Belle, Sara; Marchal, Bruno; van Wyk, Brian

2017-05-04

Poor retention in care and non-adherence to antiretroviral therapy (ART) continue to undermine the success of HIV treatment and care programmes across the world. There is a growing recognition that multifaceted interventions - application of two or more adherence-enhancing strategies - may be useful to improve ART adherence and retention in care among people living with HIV/AIDS. Empirical evidence shows that multifaceted interventions produce better results than interventions based on a singular perspective. Nevertheless, the bundle of mechanisms by which multifaceted interventions promote ART adherence are poorly understood. In this paper, we reviewed theories on ART adherence to identify candidate/potential mechanisms by which the adherence club intervention works. We searched five electronic databases (PubMed, EBSCOhost, CINAHL, PsycARTICLES and Google Scholar) using Medical Subject Headings (MeSH) terms. A manual search of citations from the reference list of the studies identified from the electronic databases was also done. Twenty-six articles that adopted a theory-guided inquiry of antiretroviral adherence behaviour were included for the review. Eleven cognitive and behavioural theories underpinning these studies were explored. We examined each theory for possible 'generative causality' using the realist evaluation heuristic (Context-Mechanism-Outcome) configuration, then, we selected candidate mechanisms thematically. We identified three major sets of theories: Information-Motivation-Behaviour, Social Action Theory and Health Behaviour Model, which explain ART adherence. Although they show potential in explaining adherence bebahiours, they fall short in explaining exactly why and how the various elements they outline combine to explain positive or negative outcomes. Candidate mechanisms indentified were motivation, self-efficacy, perceived social support, empowerment, perceived threat, perceived benefits and perceived barriers. Although these candidate

Meeting patient needs trumps adherence. A cross-sectional study of adherence and adaptations when national guidelines are used in practice.

Science.gov (United States)

Kakeeto, Mikael; Lundmark, Robert; Hasson, Henna; von Thiele Schwarz, Ulrica

2017-08-01

In the evidence-to-practice pathway, guidelines are developed to provide a practical summary of evidence and stimulate change. However, when guidelines are used in practice, adherence to the recommendations in guidelines is limited, and adaptations are common. Thus, we need more detailed knowledge about adherence and adaptations when guidelines are used in practice to understand the end of the evidence-to-practice pathway. Subsequently, the aim is to examine adherence to and adaptations of recommendations in the Swedish National Guidelines for Methods of Preventing Disease. A questionnaire was sent to healthcare professionals and managers in Stockholm between January and March 2014. Adherence to the recommendations was compared between practice settings, and the frequency of different adaptations and reasons for adaptations was analysed. Partial adherence to the guidelines was found. The adherence was significantly greater within primary care than at the hospitals (P guidelines are used in practice. Work with lifestyle habits was partially done in accordance with the guidelines. Lack of time and lack of resources were not the most common reasons for adaptations. Rather, the findings suggest that when patient needs and capabilities contrast with guideline recommendations, patient needs trump adherence to guidelines. © 2017 John Wiley & Sons, Ltd.

A holistic conceptual framework model to describe medication adherence in and guide interventions in diabetes mellitus.

Science.gov (United States)

Jaam, Myriam; Awaisu, Ahmed; Mohamed Ibrahim, Mohamed Izham; Kheir, Nadir

2018-04-01

Nonadherence to medications in patients with diabetes, which results in poor treatment outcomes and increased healthcare costs, is commonly reported globally. Factors associated with medication adherence have also been widely studied. However, a clear and comprehensive, disease-specific conceptual framework model that captures all possible factors has not been established. This study aimed to develop a conceptual framework that addresses the complex network of barriers to medication adherence in patients with diabetes. Fourteen databases and grey literature sources were systematically searched for systematic reviews reporting barriers to medication adherence in patients with diabetes. A thematic approach was used to categorize all identified barriers from the reviews and to create a matrix representing the complex network and relations of the different barriers. Eighteen systematic reviews were identified and used for the development of the conceptual framework. Overall, six major themes emerged: patient-, medication-, disease-, provider-, system-, and societal-related factors. Each of these themes was further classified into different sub-categories. It was noted that most interactions were identified to be within the patient-related factors, which not only interact with other themes but also within the same theme. Patient's demographics as well as cultural beliefs were the most notable factors in terms of interactions with other categories and themes. The intricate network and interaction of factors identified between different themes and within individual themes indicate the complexity of the problem of adherence. This framework will potentially enhance the understanding of the complex relation between different barriers for medication adherence in diabetes and will facilitate design of more effective interventions. Future interventions for enhancing medication adherence should look at the overall factors and target multiple themes of barriers to improve patient

Genetic factors in exercise adoption, adherence and obesity.

Science.gov (United States)

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

2014-01-01

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. © 2013 The Authors. obesity reviews © 2013 International Association for the Study of Obesity.

Oral anticancer agent medication adherence by outpatients.

Science.gov (United States)

Kimura, Michio; Usami, Eiseki; Iwai, Mina; Nakao, Toshiya; Yoshimura, Tomoaki; Mori, Hiromi; Sugiyama, Tadashi; Teramachi, Hitomi

2014-11-01

In the present study, medication adherence and factors affecting adherence were examined in patients taking oral anticancer agents. In June 2013, 172 outpatients who had been prescribed oral anticancer agents by Ogaki Municipal Hospital (Ogaki, Gifu, Japan) completed a questionnaire survey, with answers rated on a five-point Likert scale. The factors that affect medication adherence were evaluated using a customer satisfaction (CS) analysis. For patients with good and insufficient adherence to medication, the median ages were 66 years (range, 21-85 years) and 73 years (range, 30-90 years), respectively (P=0.0004), while the median dosing time was 131 days (range, 3-3,585 days) and 219 days (24-3,465 days), respectively (P=0.0447). In 36.0% (62 out of 172) of the cases, there was insufficient medication adherence; 64.5% of those cases (40 out of 62) showed good medication compliance (4-5 point rating score). However, these patients did not fully understand the effects or side-effects of the drugs, giving a score of three points or less. The percentage of patients with good medication compliance was 87.2% (150 out of 172). Through the CS analysis, three items, the interest in the drug, the desire to consult about the drug and the condition of the patient, were extracted as items for improvement. Overall, the medication compliance of the patients taking the oral anticancer agents was good, but the medication adherence was insufficient. To improve medication adherence, a better understanding of the effectiveness and necessity of drugs and their side-effects is required. In addition, the interest of patients in their medication should be encouraged and intervention should be tailored to the condition of the patient. These steps should lead to improved medication adherence.

Communicating solutions for a greener world - a case study of the Bellona Foundation's communication process within the hydrogen project

International Nuclear Information System (INIS)

Loene, Cecilie

2001-01-01

The world is facing increasing energy and global climate change problems. Facing future depletion of fossil fuels and the threat of increased temperatures on earth due to air pollution from the burning of fossil fuels, there is a need for a clean alternative. The Norwegian environmental organization The Bellona Foundation believes that hydrogen as an energy carrier coupled with hydrogen technology is the solution and the only road to a 0-emissions society-a hydrogen society. Under the slogan, ''From Talking to Walking the Hy-way,'' Bellona is through their Hydrogen Project working to achieve this green society. In a case study of Bellona's Hydrogen Project, this thesis aims to examine how Bellona communicates with the intended target groups within this project and how the organization perceives the communication process. As the slogan suggests, in order for the Hydrogen Project to be completely successful, Bellona has to not only inform people about the hydrogen solution but also convince them and get them to begin implementing hydrogen technology. This is conducted through a communication process. The communication process includes both internal and external activities and is divided into four stages: translation, strategy, channels and feedback. Through contrasting the communication process with science communication models, the need for an interactive, multi-directional approach that makes problematic the receiver and recognizes the receiver as an active participant in addition to adhering to the correlation between message and context of the receiver. The case study aims to look at how Bellona conducts and perceives the different stages in the communication process and find out whether Bellona recognizes these features in or adheres to these factors within the Hydrogen Project. (Author)

Global Land Use Implications of Dietary Trends: A Tragedy of the Commons

OpenAIRE

Anand, Madhur; Pagnutti, Chris; Bauch, Chris; Rizvi, Sarah

2017-01-01

Global food security and agricultural land management represent two urgent and intimately related challenges that humans must face in the coming decades. Here, we quantify the changes in the global agricultural land footprint if the world were to adhere to the dietary guidelines put forth by the United States Department of Agriculture (USDA), while accounting for the land use change incurred by import/export required to meet those guidelines. We analyze data at country, continent, and global ...

Adherence to phosphate binders in hemodialysis patients: prevalence and determinants.

Science.gov (United States)

Van Camp, Yoleen P M; Vrijens, Bernard; Abraham, Ivo; Van Rompaey, Bart; Elseviers, Monique M

2014-12-01

Phosphate control is a crucial treatment goal in end-stage renal disease, but poor patient adherence to phosphate binder therapy remains a challenge. This study aimed to estimate the extent of phosphate binder adherence in hemodialysis patients and to identify potential determinants. Phosphate binder adherence was measured blindly in 135 hemodialysis patients for 2 months using the medication event monitoring system. Patient data, gathered at inclusion through medical records, ad hoc questionnaires and the short form (SF)-36 health survey, included: (1) demographics, (2) perceived side-effects, belief in benefit, self-reported adherence to the therapy, (3) knowledge about phosphate binder therapy, (4) social support, and (5) quality of life (SF-36). Phosphatemia data was collected from charts. 'Being adherent' was defined as missing adherent' as missing adherent. Over the entire 8-week period, 22 % of patients were totally adherent. Mean phosphatemia levels were 0.55 mg/dl lower in adherent than nonadherent patients (4.76 vs. 5.31 mg/dl). Determinants for being totally adherent were living with a partner, higher social support (both were interrelated) and higher physical quality of life. Experiencing intake-related inconvenience negatively affected adherence. The social support and quality of life physical score explained 26 % of the variance in adherence. Phosphate binder nonadherence remains a major problem. Interventions should aim, at least, to improve social support. With few associated factors found and yet low adherence, an individualized approach seems indicated.

Psychosocial influencers and mediators of treatment adherence in haemodialysis patients.

Science.gov (United States)

Oh, Hyun Soo; Park, Ji Suk; Seo, Wha Sook

2013-09-01

This article is a report of the development and testing of the hypothetical model that illustrates relationships between treatment adherence and its psychosocial influencing factors and to elucidate the direct and indirect (mediating) effects of factors on treatment adherence. Poor adherence has been consistently reported in haemodialysis patients. Much research has showed various influencing factors of adherence, but these studies have failed to identify consistent influencing factors. This study was performed using a non-experimental, cross-sectional design. The study subjects were 150 end-stage renal failure patients on haemodialysis at a university hospital located in Incheon, South Korea. Data were collected over 10 months (June 2010-April 2011). The hypothetical model provided a good fit with data. Haemodialysis-related knowledge, perceived barrier to adherence, self-efficacy on adherence, and healthcare provider support had significant effects on adherence. Self-efficacy was found to mediate barrier-adherence and family support-adherence relationships. Self-efficacy in combination with barrier, family support, and healthcare provider support was found to mediate the depression-adherence relationship. Strategies aimed at the development of successful adherence interventions should focus on reducing perceived barriers and enhancing self-efficacy and knowledge. It can be suggested that efforts to improve the healthcare provider-patient relationship would enhance adherence. In depressive patients, strategies that promote self-efficacy and the support of family or healthcare providers could diminish the negative impact of depression on adherence. © 2013 Blackwell Publishing Ltd.

Determinants of Adherence to Antiretroviral Treatment among HIV ...

African Journals Online (AJOL)

This study investigated factors of adherence to Antiretroviral Treatment (ART), factors or variables that can discriminate between adherent and non-adherent patients on ART were selected. Simple structured questionnaire was employed. The study sample consisted of 145 HIV patients who received ART in the Shashemene ...

100% adherence study: educational workshops vs. video sessions to improve adherence among ART-naïve patients in Salvador, Brazil.

Science.gov (United States)

Sampaio-Sa, Marcia; Page-Shafer, Kimberly; Bangsberg, David R; Evans, Jennifer; Dourado, Maria de Lourdes; Teixeira, Celia; Netto, Eduardo M; Brites, Carlos

2008-07-01

We conducted a randomized trial to test an intervention aimed at increasing adherence to antiretroviral therapy (ART) among HIV-positive, ART-naïve patients in Salvador, Brazil. Participants (N = 107) were randomized to either educational workshops based on the information-motivation-behavioral skills model (n = 52) or a control video session (n = 55). Changes in self-reported ART adherence, viral load, CD4 cell counts and ART pharmacy records were measured periodically over 12 months. After 3-6 months, ART adherence (> or = 95%) was 77.8% in the workshop group and 85.7% in video group (as treated) and 53.8% and 65.5%, respectively, using intention-to-treat (ITT) analysis (both P > 0.05) At 9-12 months, ART adherence decreased to 73.7% in the workshop group and 79.1% in the video group (as treated) and 53.8% and 61.8% using ITT, respectively. No differences were found in self-reported adherence, viral load or pharmacy records between groups. We found that the educational workshop intervention does not increase adherence to ART.

Ethno-Cultural Considerations in Cardiac Patients' Medication Adherence.

Science.gov (United States)

King-Shier, K M; Singh, S; Khan, N A; LeBlanc, P; Lowe, J C; Mather, C M; Chong, E; Quan, H

2017-10-01

We aimed to develop an in-depth understanding about factors that influence cardiac medication adherence among South Asian, Chinese, and European White cardiac patients. Sixty-four patients were purposively sampled from an ongoing study cohort. Interviews were audio-recorded and transcribed for analyses. Physicians' culturally sensitive communication and patients' motivation to live a symptom-free and longer life enhanced adherence. European Whites were motivated to enhance personal well-being and enjoy family life. South Asians' medication adherence was influenced by the desire to fulfill the will of God and family responsibilities. The Chinese were motivated to avoid pain, illness, and death, and to obey a health care provider. The South Asians and Chinese wanted to ultimately reduce medication use. Previous positive experiences, family support, and establishing a routine also influenced medication adherence. Deterrents to adherence were essentially the reverse of the motivators/facilitators. This analysis represents an essential first step forward in developing ethno-culturally tailored interventions to optimize adherence.

Evaluation of factors affecting adherence to asthma controller ...

African Journals Online (AJOL)

Evaluation of factors affecting adherence to asthma controller therapy in chest clinics in a sub-Saharan African setting: a cross-sectional study. ... Background: Adherence to controller therapy in asthma is a major concern during the management of the disease. Objective: To determine the adherence rate and identify the ...

Global Dynamical Systems Involving Generalized -Projection Operators and Set-Valued Perturbation in Banach Spaces

Directory of Open Access Journals (Sweden)

Yun-zhi Zou

2012-01-01

Full Text Available A new class of generalized dynamical systems involving generalized f-projection operators is introduced and studied in Banach spaces. By using the fixed-point theorem due to Nadler, the equilibrium points set of this class of generalized global dynamical systems is proved to be nonempty and closed under some suitable conditions. Moreover, the solutions set of the systems with set-valued perturbation is showed to be continuous with respect to the initial value.

The Version 2 Global Precipitation Climatology Project (GPCP) Monthly Precipitation Analysis (1979-Present)

Science.gov (United States)

Adler, Robert F.; Huffman, George J.; Chang, Alfred; Ferraro, Ralph; Xie, Ping-Ping; Janowiak, John; Rudolf, Bruno; Schneider, Udo; Curtis, Scott; Bolvin, David

2003-01-01

The Global Precipitation Climatology Project (GPCP) Version 2 Monthly Precipitation Analysis is described. This globally complete, monthly analysis of surface precipitation at 2.5 degrees x 2.5 degrees latitude-longitude resolution is available from January 1979 to the present. It is a merged analysis that incorporates precipitation estimates from low-orbit-satellite microwave data, geosynchronous-orbit-satellite infrared data, and rain gauge observations. The merging approach utilizes the higher accuracy of the low-orbit microwave observations to calibrate, or adjust, the more frequent geosynchronous infrared observations. The data set is extended back into the premicrowave era (before 1987) by using infrared-only observations calibrated to the microwave-based analysis of the later years. The combined satellite-based product is adjusted by the raingauge analysis. This monthly analysis is the foundation for the GPCP suite of products including those at finer temporal resolution, satellite estimate, and error estimates for each field. The 23-year GPCP climatology is characterized, along with time and space variations of precipitation.

An information-motivation-behavioral skills model of adherence to antiretroviral therapy.

Science.gov (United States)

Fisher, Jeffrey D; Fisher, William A; Amico, K Rivet; Harman, Jennifer J

2006-07-01

HIV-positive persons who do not maintain consistently high levels of adherence to often complex and toxic highly active antiretroviral therapy (HAART) regimens may experience therapeutic failure and deterioration of health status and may develop multidrug-resistant HIV that can be transmitted to uninfected others. The current analysis conceptualizes social and psychological determinants of adherence to HAART among HIV-positive individuals. The authors propose an information-motivation-behavioral skills (IMB) model of HAART adherence that assumes that adherence-related information, motivation, and behavioral skills are fundamental determinants of adherence to HAART. According to the model, adherence-related information and motivation work through adherence-related behavioral skills to affect adherence to HAART. Empirical support for the IMB model of adherence is presented, and its application in adherence-promotion intervention efforts is discussed.

Identification of documented medication non-adherence in physician notes.

Science.gov (United States)

Turchin, Alexander; Wheeler, Holly I; Labreche, Matthew; Chu, Julia T; Pendergrass, Merri L; Einbinder, Jonathan S; Einbinder, Jonathan Seth

2008-11-06

Medication non-adherence is common and the physicians awareness of it may be an important factor in clinical decision making. Few sources of data on physician awareness of medication non-adherence are available. We have designed an algorithm to identify documentation of medication non-adherence in the text of physician notes. The algorithm recognizes eight semantic classes of documentation of medication non-adherence. We evaluated the algorithm against manual ratings of 200 randomly selected notes of hypertensive patients. The algorithm detected 89% of the notes with documented medication non-adherence with specificity of 84.7% and positive predictive value of 80.2%. In a larger dataset of 1,000 documents, notes that documented medication non-adherence were more likely to report significantly elevated systolic (15.3% vs. 9.0%; p = 0.002) and diastolic (4.1% vs. 1.9%; p = 0.03) blood pressure. This novel clinically validated tool expands the range of information on medication non-adherence available to researchers.

Adherence to the Mediterranean Diet and Inflammatory Markers

Directory of Open Access Journals (Sweden)

Antoni Sureda

2018-01-01

Full Text Available The aim was to assess inflammatory markers among adults and adolescents in relation to the adherence to the Mediterranean diet. A random sample (219 males and 379 females of the Balearic Islands population (12–65 years was anthropometrically measured and provided a blood sample to determine biomarkers of inflammation. Dietary habits were assessed and the adherence to the Mediterranean dietary pattern calculated. The prevalence of metabolic syndrome increased with age in both sexes. The adherence to the Mediterranean diet in adolescent males was 51.3% and 45.7% in adults, whereas in females 53.1% and 44.3%, respectively. In males, higher adherence to the Mediterranean diet was associated with higher levels of adiponectin and lower levels of leptin, tumor necrosis factor alpha (TNF-α, plasminogen activator inhibitor 1 (PAI-1 and high-sensitivity C-reactive protein (hs-CRP in adults, but not in young subjects. In females, higher adherence was associated with lower levels of leptin in the young group, PAI-1 in adults and hs-CRP in both groups. With increasing age in both sexes, metabolic syndrome increases, but the adherence to the Mediterranean diet decreases. Low adherence to the Mediterranean dietary pattern (MDP is directly associated with a worse profile of plasmatic inflammation markers.

Worsening of Heat Stress Due To Global Warming in South Korea Based on Multi-RCM Ensemble Projections

Science.gov (United States)

Im, Eun-Soon; Choi, Yeon-Woo; Ahn, Joong-Bae

2017-11-01

This study assesses the future changes in summer (June-July-August; JJA) heat stress over South Korea under global warming. To better resolve the region-specific changes in terms of geographical patterns and severity of heat stress in the Korean peninsula, four regional climate models (RCMs) are used for dynamical downscaling of Hadley Centre Global Environmental Model version 2—Atmosphere and Ocean global projections forced by two Representative Concentration Pathway (RCP4.5 and RCP8.5) scenarios. Dynamically downscaled simulations (horizontal resolution of 12.5 km and output interval of 3 h) facilitate in-depth analysis of diurnal variation and extremes over South Korea, as well as focusing on the particular location, Daegu, that is characterized by high vulnerability to rising temperature. Both maximum temperature and heat stress indices such as wet bulb globe temperature and apparent temperature, which include the effect of humidity, are examined in order to comprehensively interpret the behaviors of heat stress in response to anthropogenic climate change. Ensemble projections reveal robust patterns of temperature and resultant humidity increases that are roughly constrained by the approximate 7%/K increase in the moisture holding capacity. The changes in temperature and humidity are directly transmitted to the heat stress indices, showing a significant increase. The heat stress is exacerbated in a differentiated way, with more intensification in diurnal variation at nighttime and in regional variation at low-elevation basins. Both RCP4.5 and RCP8.5 scenarios project the statistical likelihood of a notable increase of extreme heat stress indices, much stronger and more extended heat waves, and the emergence of a long period of consecutive tropical nights.

[Adherence to pharmacological treatment in adult patients undergoing hemodialysis].

Science.gov (United States)

Sgnaolin, Vanessa; Figueiredo, Ana Elizabeth Prado Lima

2012-06-01

Adherence to treatment in patients on hemodialysis is not a simple process. Strategies to promote adherence will meet the need for improvements in the process of orientation concerning the disease and its pharmacological treatment. To identify compliance with pharmacological treatment of patients on hemodialysis and the main factors related to it we used the Adherence Scale. Observational, descriptive and cross-sectional study. Interviews were conducted to collect socioeconomic, pharmacological data, as well as those regarding self-reported adherence to drug. Out of the 65 participants, 55.4% showed non-compliance. The mean number of drugs used was 4.1 ± 2.5 (self-report) and 6.2 ± 3.0 (prescription). Statistical analysis showed significant differences concerning compliance at different ages (> 60 years are more adherent). A significant proportion of patients have difficulty to comply with treatment and the main factor was forgetfulness. Regarding age, elderly patients are more adherent to treatment. The low level of knowledge about the used drugs may be one of the reasons for the lack of adherence, and the patient's orientation process by a team of multiprofessionals involved in assisting is a strategy to promote adherence.

Adherence of Moraxella bovis to cell cultures of bovine origin.

Science.gov (United States)

Annuar, B O; Wilcox, G E

1985-09-01

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.

CMIP5-based global wave climate projections including the entire Arctic Ocean

Science.gov (United States)

Casas-Prat, M.; Wang, X. L.; Swart, N.

2018-03-01

This study presents simulations of the global ocean wave climate corresponding to the surface winds and sea ice concentrations as simulated by five CMIP5 (Coupled Model Intercomparison Project Phase 5) climate models for the historical (1979-2005) and RCP8.5 scenario future (2081-2100) periods. To tackle the numerical complexities associated with the inclusion of the North Pole, the WAVEWATCH III (WW3) wave model was used with a customized unstructured Spherical Multi-Cell grid of ∼100 km offshore and ∼50 km along coastlines. The climate model simulated wind and sea ice data, and the corresponding WW3 simulated wave data, were evaluated against reanalysis and hindcast data. The results show that all the five sets of wave simulations projected lower waves in the North Atlantic, corresponding to decreased surface wind speeds there in the warmer climate. The selected CMIP5 models also consistently projected an increase in the surface wind speed in the Southern Hemisphere (SH) mid-high latitudes, which translates in an increase in the WW3 simulated significant wave height (Hs) there. The higher waves are accompanied with increased peak wave period and increased wave age in the East Pacific and Indian Oceans, and a significant counterclockwise rotation in the mean wave direction in the Southern Oceans. The latter is caused by more intense waves from the SH traveling equatorward and developing into swells. Future wave climate in the Arctic Ocean in summer is projected to be predominantly of mixed sea states, with the climatological mean of September maximum Hs ranging mostly 3-4 m. The new waves approaching Arctic coasts will be less fetch-limited as ice retreats since a predominantly southwards mean wave direction is projected in the surrounding seas.

Exploring ‘generative mechanisms’ of the antiretroviral adherence club intervention using the realist approach: a scoping review of research-based antiretroviral treatment adherence theories

Directory of Open Access Journals (Sweden)

Ferdinand C. Mukumbang

2017-05-01

Full Text Available Abstract Background Poor retention in care and non-adherence to antiretroviral therapy (ART continue to undermine the success of HIV treatment and care programmes across the world. There is a growing recognition that multifaceted interventions – application of two or more adherence-enhancing strategies – may be useful to improve ART adherence and retention in care among people living with HIV/AIDS. Empirical evidence shows that multifaceted interventions produce better results than interventions based on a singular perspective. Nevertheless, the bundle of mechanisms by which multifaceted interventions promote ART adherence are poorly understood. In this paper, we reviewed theories on ART adherence to identify candidate/potential mechanisms by which the adherence club intervention works. Methods We searched five electronic databases (PubMed, EBSCOhost, CINAHL, PsycARTICLES and Google Scholar using Medical Subject Headings (MeSH terms. A manual search of citations from the reference list of the studies identified from the electronic databases was also done. Twenty-six articles that adopted a theory-guided inquiry of antiretroviral adherence behaviour were included for the review. Eleven cognitive and behavioural theories underpinning these studies were explored. We examined each theory for possible ‘generative causality’ using the realist evaluation heuristic (Context-Mechanism-Outcome configuration, then, we selected candidate mechanisms thematically. Results We identified three major sets of theories: Information-Motivation-Behaviour, Social Action Theory and Health Behaviour Model, which explain ART adherence. Although they show potential in explaining adherence bebahiours, they fall short in explaining exactly why and how the various elements they outline combine to explain positive or negative outcomes. Candidate mechanisms indentified were motivation, self-efficacy, perceived social support, empowerment, perceived threat, perceived

Addressing drug adherence using an operations management model.

Science.gov (United States)

Nunlee, Martin; Bones, Michelle

2014-01-01

OBJECTIVE To provide a model that enables health systems and pharmacy benefit managers to provide medications reliably and test for reliability and validity in the analysis of adherence to drug therapy of chronic disease. SUMMARY The quantifiable model described here can be used in conjunction with behavioral designs of drug adherence assessments. The model identifies variables that can be reproduced and expanded across the management of chronic diseases with drug therapy. By creating a reorder point system for reordering medications, the model uses a methodology commonly seen in operations research. The design includes a safety stock of medication and current supply of medication, which increases the likelihood that patients will have a continuous supply of medications, thereby positively affecting adherence by removing barriers. CONCLUSION This method identifies an adherence model that quantifies variables related to recommendations from health care providers; it can assist health care and service delivery systems in making decisions that influence adherence based on the expected order cycle days and the expected daily quantity of medication administered. This model addresses the possession of medication as a barrier to adherence.

HIV Medication Adherence

Science.gov (United States)

... AIDS Drugs Clinical Trials Apps skip to content HIV Treatment Home Understanding HIV/AIDS Fact Sheets HIV ... 4 p.m. ET) Send us an email HIV Medication Adherence Last Reviewed: January 17, 2018 Key ...

Validation of the Brazilian version of the VERITAS-Pro scale to assess adherence to prophylactic regimens in hemophilia

Directory of Open Access Journals (Sweden)

Adriana Aparecida Ferreira

2018-01-01

Full Text Available Introduction: Prophylaxis is the treatment of choice for patients with severe hemophilia. Low adherence may limit the effectiveness of the prophylactic regimen, thereby compromising outcomes. Objective: The objective of this study was to validate the Brazilian version of the VERITAS-Pro prophylaxis adherence scale, originally an American questionnaire that can be answered by the individual responsible for prophylaxis as well as by an observer. Methods: The scale has 24 questions divided into six subscales: Routine, Dosage, Plan, Remember, Skip and Communicate. Participants were recruited at a blood center in southeastern Brazil for validation and reliability analyses. Validation measures included the results obtained using analog visual scales of adherence, interval between medication dispensed by the treatment center pharmacy and the percentage of recommended doses administered and infusions registered in the patients’ logs. Results: The study included 32 individuals responsible for prophylaxis and five observers. The internal consistency was very good for the VERITAS-Pro total score, excellent for the Remember, Skip and Communicate subscales, good for the Dosage subscale, and acceptable for the Routine and Plan subscales. Twelve participants answered the questionnaire on more than one occasion to evaluate reproducibility. The intraclass correlation coefficient was excellent. Regarding convergent validity, the VERITAS-Pro scores were moderately correlated with the global adherence scale and with infusion log records, but showed a weak correlation with pharmacy dispensation records. Conclusion: The Brazilian version of VERITAS-Pro is a valid and reliable instrument, enabling the understanding of specific factors related to non-adherence and allowing targeted interventions for proper treatment. Keywords: Hemophilia, Medication adherence, Questionnaire, Validation study

76 FR 12969 - Campaign To Improve Poor Medication Adherence (U18)

Science.gov (United States)

2011-03-09

... the root causes for inadequate medication adherence, and effecting changes in knowledge and behaviors... adherence, a vital first step toward improved adherence behavior and better public health outcomes. DATES... adherence behavior and better health outcomes. Relevance Inadequate medication adherence is a $290 billion...

Antidiabetic medication adherence and associated factors among ...

African Journals Online (AJOL)

Godfrey Mutashambara Rwegerera

2017-03-06

Mar 6, 2017 ... tive of the study was to determine current antidiabetic medication adherence in ...... A systematic review of adherence with medications for diabetes. .... Pascal IGU, Ofoedu JN, Uchenna NP, Nkwa AA, Uchamma GUE.

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

2010-01-01

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...

The Relationship Between Treatment Adherence and Non-picked Up Medications in Community Pharmacies

Directory of Open Access Journals (Sweden)

Vu Phan Hoang Nguyen

2016-10-01

Full Text Available Medication adherence is one of the major factors that determine an outcome of a treatment. Despite the effort of healthcare providers to improve the adherence rate, it still remains a serious issue in our health care system today. Many patients do not take their medications as directed or just simply do not want to fill or refill their prescriptions. A small survey performed by pharmacy students at Temple School of Pharmacy showed that there is a significant number of patients did not pick up their medications. Cardiovascular medications are the most common non-picked up drugs. There are various reasons that patients use to justify for this non-adherence behavior. However, they are unaware that their actions create a tremendous negative effect not only on the treatment itself but also on the entire health care system. The consequences include expensive therapies, inaccurate research data, and poor treatment outcomes. Many solutions have been utilized to solve this problem, but it is still the major problem for healthcare providers to keep in mind when planning a drug regimen. Although many people believed that pharmacists are responsible for solving this problem, it should be a multidisciplinary effort of all healthcare providers to improve the medication adherence. Conflict of Interest We declare no conflicts of interest or financial interests that the authors or members of their immediate families have in any product or service discussed in the manuscript, including grants (pending or received, employment, gifts, stock holdings or options, honoraria, consultancies, expert testimony, patents and royalties.   Type: Student Project

COPD patients’ self-reported adherence, psychosocial factors and mild cognitive impairment in pulmonary rehabilitation

Directory of Open Access Journals (Sweden)

Pierobon A

2017-07-01

Full Text Available Antonia Pierobon,1 Elisa Sini Bottelli,1 Laura Ranzini,1 Claudio Bruschi,2 Roberto Maestri,3 Giorgio Bertolotti,4 Marinella Sommaruga,5 Valeria Torlaschi,1 Simona Callegari,1 Anna Giardini1 1Psychology Unit, 2Department of Pulmonary Rehabilitation, 3Department of Biomedical Engineering, Istituti Clinici Scientifici Maugeri, IRCCS, Montescano, 4Psychology Unit, Istituti Clinici Scientifici Maugeri, IRCCS, Tratate, 5Clinical Psychology and Social Support Unit, Istituti Clinici Scientifici Maugeri, IRCCS, Camaldoli, Italy Abstract: In addition to clinical comorbidities, psychological and neuropsychological problems are frequent in COPD and may affect pulmonary rehabilitation delivery and outcome. The aims of the study were to describe a COPD population in a rehabilitative setting as regards the patients depressive symptoms, anxiety, mild cognitive impairment (MCI and self-reported adherence and to analyze their relationships; to compare the COPD sample MCI scores with normative data; and to investigate which factors might predict adherence to prescribed physical exercise. This was a multicenter observational cross-sectional study. Of the 117 eligible stable COPD inpatients, 84 were enrolled according to Global initiative for chronic Obstructive Lung Disease (GOLD criteria (mainly in Stage III–IV. The assessment included Mini Mental State Examination (MMSE, Montreal Cognitive Assessment (MoCA, anxiety, depression and self-reported pharmacological and nonpharmacological adherence. From the MMSE, 3.6% of patients were found to be impaired, whereas from the MoCA 9.5% had a likely MCI. Patients referred had mild-severe depression (46.7%, anxiety (40.5%, good pharmacological adherence (80.3% and difficulties in following prescribed diet (24.1% and exercise (51.8%; they struggled with disease acceptance (30.9% and disease limitations acceptance (28.6%. Most of them received good family (89% or social (53% support. Nonpharmacological adherence

Measurement complexity of adherence to medication

Directory of Open Access Journals (Sweden)

Galato D

2012-04-01

Full Text Available Dayani Galato, Fabiana Schuelter-Trevisol, Anna Paula PiovezanMaster Program in Health Sciences, University of Southern Santa Catarina (Unisul Tubarão, Santa Catarina, BrazilAdherence to pharmacologic therapy is a major challenge for the rational use of medicines, particularly when it comes to antiretroviral drugs that require adherence to at least 95% of prescribed doses.1 Studies in this area are always important and contribute to medication adherence understanding, even though there is no reference test for measuring this. Recently, an article was published in this journal that proposes the determination of lamivudine plasma concentration to validate patient self-reported adherence to antiretroviral treatment.2 In that study, serum levels obtained after 3 hours of ingestion of the last dose of the drug were compared with patient reports that were classified into different levels of adherence, based on their recall of missed doses in the previous 7 days.It was hypothesized by the authors that the use of a biological marker for drug adherence was extremely important, given the relevance of the topic. However, we would like to draw attention to some points that may determine the success of the use of similar methods for this purpose. The formation of groups with similar anthropometric characteristics is relevant since the dose of lamivudine may have to be changed, depending, for example, on sex, weight, and age.3 Even information considered important by the authors of that study was not provided. There is a need for greater clarity on the eligibility criteria, especially with regard to the clinical stage of the disease, CD4 counts and viral load, associated diseases, and comorbidity, as well as the evaluation of kidney function and other medications used that can affect lamivudine pharmacokinetics.3View original paper by Minzi and colleagues

Determinants of Adherence to Living on Dialysis for Mexican Americans

Directory of Open Access Journals (Sweden)

Shirley A. Wells

2015-03-01

Full Text Available This study explores perceptions that affect adherence behaviors among Mexican Americans living with dialysis. In-depth narrative interviews were conducted with 15 Mexican Americans with end-stage renal disease (ESRD living on dialysis, 15 family members, and 6 health care personnel who provided care to them. Four themes emerged: (a positive influences to adherence, (b obstacles to adherence, (c daily activity losses, and (d fears about living with dialysis. From the findings, the perceptions given for non-adherence with the dialysis regimen ranged from denial of the condition, lack of pre-education, to cultural factors. Those given for adherence included prolonged life, family, and hope of getting a transplant. Health care providers were the reminder to adhere. Several cultural factors influenced their adherence perceptions. Strategies to enhance adherence behaviors should focus on knowledge about dialysis, use of the collective efficacy of the family, and the inclusion of cultural values.

Tritrichomonas foetus adhere to superhydrophilic vertically aligned multi-walled carbon nanotube surface

Energy Technology Data Exchange (ETDEWEB)

Moreira Machado, Susane [Laboratorio de Biologia Celular e Tecidual, Instituto de Pesquisa e Desenvolvimento, Universidade do Vale do Paraiba, Av. Shishima Hifumi 2911, 12244-000, Sao Jose dos Campos, SP (Brazil); Oliveira Lobo, Anderson, E-mail: loboao@yahoo.com [Laboratorio de Nanotecnologia Biomedica (NanoBio), Instituto de Pesquisa e Desenvolvimento, Universidade do Vale do Paraiba, Av. Shishima Hifumi 2911, Sao Jose dos Campos, 12244-000, SP (Brazil); Laboratorio de Espectroscopia Vibracional Biomedica, Instituto de Pesquisa e Desenvolvimento, Universidade do Vale do Paraiba, Avenida Shishima Hifumi, 2911, CEP 12244-000, Sao Jose dos Campos, SP (Brazil); Bueno Loureiro Sapucahy, Ariel [Laboratorio de Biologia Celular e Tecidual, Instituto de Pesquisa e Desenvolvimento, Universidade do Vale do Paraiba, Av. Shishima Hifumi 2911, 12244-000, Sao Jose dos Campos, SP (Brazil); Marciano, Fernanda Roberta [Laboratorio de Nanotecnologia Biomedica (NanoBio), Instituto de Pesquisa e Desenvolvimento, Universidade do Vale do Paraiba, Av. Shishima Hifumi 2911, Sao Jose dos Campos, 12244-000, SP (Brazil); Laboratorio de Espectroscopia Vibracional Biomedica, Instituto de Pesquisa e Desenvolvimento, Universidade do Vale do Paraiba, Avenida Shishima Hifumi, 2911, CEP 12244-000, Sao Jose dos Campos, SP (Brazil); Corat, Evaldo Jose [Instituto Nacional de Pesquisas Espaciais (INPE), Laboratorio Associado de Sensores e Materiais (LAS), Av. dos Astronautas 1758, Sao Jose dos Campos, 12227-010 SP (Brazil); Soares da Silva, Newton [Laboratorio de Biologia Celular e Tecidual, Instituto de Pesquisa e Desenvolvimento, Universidade do Vale do Paraiba, Av. Shishima Hifumi 2911, 12244-000, Sao Jose dos Campos, SP (Brazil)

2011-10-10

For the first time, we show that Tritrichomonas foetus can adhere on superhydrophilic vertically aligned carbon nanotubes (VACNT) films. Scanning electron microscopy shows an unusual adhesion with a higher membrane filopodium projection in all directions, directly attached to superhydrophilic VACNT tips. Highlights: {yields} This is a new method to study the T. foetus adhesion mechanism. {yields} SEM images and interfacial adhesion force show a high adhesion level. {yields} It is very important for future understanding mechanism adhesion and protein expression.

Tritrichomonas foetus adhere to superhydrophilic vertically aligned multi-walled carbon nanotube surface

International Nuclear Information System (INIS)

Moreira Machado, Susane; Oliveira Lobo, Anderson; Bueno Loureiro Sapucahy, Ariel; Marciano, Fernanda Roberta; Corat, Evaldo Jose; Soares da Silva, Newton

2011-01-01

For the first time, we show that Tritrichomonas foetus can adhere on superhydrophilic vertically aligned carbon nanotubes (VACNT) films. Scanning electron microscopy shows an unusual adhesion with a higher membrane filopodium projection in all directions, directly attached to superhydrophilic VACNT tips. Highlights: → This is a new method to study the T. foetus adhesion mechanism. → SEM images and interfacial adhesion force show a high adhesion level. → It is very important for future understanding mechanism adhesion and protein expression.

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

Directory of Open Access Journals (Sweden)

Jones S

2015-08-01

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

Comparison between project-based learning and discovery learning toward students' metacognitive strategies on global warming concept

Science.gov (United States)

Tumewu, Widya Anjelia; Wulan, Ana Ratna; Sanjaya, Yayan

2017-05-01

The purpose of this study was to know comparing the effectiveness of learning using Project-based learning (PjBL) and Discovery Learning (DL) toward students metacognitive strategies on global warming concept. A quasi-experimental research design with a The Matching-Only Pretest-Posttest Control Group Design was used in this study. The subjects were students of two classes 7th grade of one of junior high school in Bandung City, West Java of 2015/2016 academic year. The study was conducted on two experimental class, that were project-based learning treatment on the experimental class I and discovery learning treatment was done on the experimental class II. The data was collected through questionnaire to know students metacognitive strategies. The statistical analysis showed that there were statistically significant differences in students metacognitive strategies between project-based learning and discovery learning.

New global ICT-based business models

DEFF Research Database (Denmark)

The New Global Business model (NEWGIBM) book describes the background, theory references, case studies, results and learning imparted by the NEWGIBM project, which is supported by ICT, to a research group during the period from 2005-2011. The book is a result of the efforts and the collaborative ...... The NEWGIBM Cases Show? The Strategy Concept in Light of the Increased Importance of Innovative Business Models Successful Implementation of Global BM Innovation Globalisation Of ICT Based Business Models: Today And In 2020......The New Global Business model (NEWGIBM) book describes the background, theory references, case studies, results and learning imparted by the NEWGIBM project, which is supported by ICT, to a research group during the period from 2005-2011. The book is a result of the efforts and the collaborative....... The NEWGIBM book serves as a part of the final evaluation and documentation of the NEWGIBM project and is supported by results from the following projects: M-commerce, Global Innovation, Global Ebusiness & M-commerce, The Blue Ocean project, International Center for Innovation and Women in Business, NEFFICS...

Notification: Audit of EPA’s Adherence to Policies, Procedures and Oversight Controls Pertaining to the Administrator’s Travel (2nd notification)

Science.gov (United States)

Project #OA-FY17-0382, October 6, 2017 - The EPA OIG plans to expand the scope of preliminary research on the EPA’s adherence to policies, procedures and oversight controls pertaining to the Administrator’s travel.

Adherence treatment factors in hypertensive African American women

Directory of Open Access Journals (Sweden)

Marie N Fongwa

2008-02-01

Full Text Available Marie N Fongwa1, Lorraines S Evangelista1, Ron D Hays2, David S Martins3, David Elashoff4, Marie J Cowan1, Donald E Morisky51University of California Los Angeles School of Nursing, Los Angeles, CA, USA; 2University of California Los Angeles School of Medicine, Division of General Internal Medicine and Health Services Research, Los Angeles, CA, USA; 3To Help Everyone Clinic Inc. Los Angeles, CA, USA; 4University of California Los Angeles Public Health, Los Angeles, CA, USA; 5University of California Los Angeles School of Public Health, CA, USABackground: Hypertension among African American women is of epidemic proportions. Nonadherence to treatment contributes to uncontrolled blood pressure in this population. Factors associated with adherence to treatment in African American women are unknown. The purpose of this study was to identify factors associated with adherence to hypertension treatment in African American women.Methods: Five audio-taped focus groups were conducted with hypertensive African American women, 35 years and older receiving treatment for hypertension from an inner-city free clinic. All transcripts from the tapes were analyzed for content describing adherence to treatment factors.Findings: Factors associated with adherence to treatment in hypertensive African American women were in three main categories including: beliefs about hypertension, facilitators of adherence to treatment, and barriers to adherence to treatment.Implications: The study supports the need for education on managing hypertension and medication side effects, early screening for depression in hypertensive African Americans, development of culturally sensitive hypertension educational material, and formation of support groups for promoting adherence to treatment among African American women with hypertension.Keywords: adherence, African American, hypertension treatment factors

Psychosocial adjustment and adherence to dialysis treatment regimes.

Science.gov (United States)

Brownbridge, G; Fielding, D M

1994-12-01

Sixty children and adolescents in end-stage renal failure who were undergoing either haemodialysis or continuous ambulatory peritoneal dialysis at one of five United Kingdom dialysis centres were assessed on psychosocial adjustment and adherence to their fluid intake, diet and medication regimes. Parental adjustment was also measured and data on sociodemographic and treatment history variables collected. A structured family interview and standardised questionnaire measures of anxiety, depression and behavioural disturbance were used. Multiple measures of treatment adherence were obtained, utilising children's and parents' self-reports, weight gain between dialysis, blood pressure, serum potassium level, blood urea level, dietitians' surveys and consultants' ratings. Correlational analyses showed that low treatment adherence was associated with poor adjustment to diagnosis and dialysis by children and parents (P adherence than younger children, P dialysis (P treatment of this group of children. Future research should develop and evaluate psychosocial interventions aimed at improving treatment adherence.

Introducing the Adherence Strategy Engineering Framework (ASEF)

DEFF Research Database (Denmark)

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

2013-01-01

. Methods: Key concepts related to self-care and adherence were defined, discussed, and implemented as part of the ASEF framework. ASEF was applied to seven self-care case studies, and the perceived usefulness and feasibility of ASEF was evaluated in a questionnaire study by the case study participants...... resulting in reduced data quality and suboptimal treatment. Objectives: The aim of this paper is to introduce the Adherence Strategy Engineering Framework (ASEF) as a method for developing novel technology-based adherence strategies to assess and improve patient adherence levels in the unsupervised setting....... Finally, we reviewed the individual case studies usage of ASEF. Results: A range of central self-care concepts were defined and the ASEF methodological framework was introduced. ASEF was successfully used in seven case studies with a total of 25 participants. Of these, 16 provided answers...

[Family adherence in serious mental disorder].

Science.gov (United States)

Martín Padilla, Ernesto; Obando Posada, Diana; Sarmiento Medina, Pedro

2017-10-09

Identify attitudes and behaviors that evidence and characterize family adherence to treatment in patients with severe mental disorder. Qualitative descriptive, from an interpretative social approach. Chia, Colombia, with professionals in the psychiatric and geriatric settings. Twelve professionals in psychiatry, nursing and psychology, with experience in care of patients with serious mental disorder and their families. Intentional sampling. Twelve semi-structured interviews were carried out. The analysis strategy was made from the procedures of constant comparison and open coding of the grounded theory. As validation strategies, triangulation was done between researchers and methods, as interviews and results survey. Two categories of family adherence were defined: family and treatment (treatment cooperation, knowledge about the disease and attention to the disease evolution), and family attitudes towards the patient (patient's care, patient's promotion of autonomy, and affective attachment with the patient). A third category showed aspects that diminished family adherence, such as lack or distortion of information regarding mental disorder, or family and patient endurance attitudes. Participants agree about the relevance of the construct named «family adherence», which describes the behaviors and attitudes of the family regarding the treatment of patients with severe mental disorder. Family adherence can be seen as active participation behavior, but also as a process of strengthening relationships, which can reduce the burden and suffering on family members, caregivers and patients. Copyright © 2017 Elsevier España, S.L.U. All rights reserved.

Communication strategies to improve HIV treatment adherence.

Science.gov (United States)

Rochon, Donna; Ross, Michael W; Looney, Carol; Nepal, Vishnu P; Price, Andrea J; Giordano, Thomas P

2011-01-01

Although antiretroviral therapy has increased the survival of HIV-positive patients, traditional approaches to improving medication adherence have failed consistently. Acknowledging the role of communication in health behavior, we conducted a qualitative study to learn about patients' HIV treatment adherence experiences and to identify which communication strategies might influence adherence. Findings indicate that five constructs--cultural beliefs/language, stigma, cues to action, self-efficacy, and mood state--are potentially modifiable by improved communication. Results will be used to create a direct marketing campaign targeted to HIV-infected patients. Copyright © Taylor & Francis Group, LLC

Predictors of adherence to antiretroviral therapy among people living with HIV and AIDS at the regional hospital of Sokodé, Togo.

Science.gov (United States)

Yaya, Issifou; Landoh, Dadja Essoya; Saka, Bayaki; Patchali, P'Niwè Massoubayo; Wasswa, Peter; Aboubakari, Abdoul-Samadou; N'Dri, Mathias Kouamé; Patassi, Akouda Akessiwe; Kombaté, Koussake; Pitche, Palokinam

2014-12-19

Adherence to antiretroviral therapy (ART) is beneficial in reducing the risk of emergence of HIV resistant strains. Adherence to ART among Persons Living with HIV/AIDS (PLWHA) is influenced by several factors related to the patient, the medication, and health facilities. In Togo, previous studies on adherence to ART have reported good adherence to ART during the first year of follow-up. However these may hide many disparities dues to cultural specificities which may differ across geographic areas of the country. We sought to determine the level of adherence to ART and document the associated factors among PLWHA at the regional hospital of Sokodé, Togo. This was an analytical cross-sectional study conducted from May to July 2013 at the regional hospital of Sokodé among 291 PLWHA who had been on ART for at least three months before the study. A total of 291 PLWHA on ART were enrolled in the study. The mean age (±SD) was 37.3 ± 9.3 years and the sex ratio (Male/Female) was 0.4. Among them, 195 (67.0%) were living with their partners and 210 (72.2%) had formal education. Two-thirds (194/291; 66.7%) of the PLWHA interviewed lived in urban areas. The global adherence to ART was 78.4%; the factors associated with ART adherence were: level of education (aOR = 3.54; p = 0.027), alcohol consumption (aOR = 0.43; p = 0.033), ART perception (aOR = 2.90; p = 0.026) and HIV status disclosure to sexual partner (aOR = 7.19; p ≤ 0.001). Although the level of adherence to ART in this study was higher than those reported in some studies in Sub-Saharan Africa, it remains sub-optimal and needs improvement. This may therefore hinder the implementation of efficient interventions related to access to ART services.

Evaluation of adherence and depression among patients on peritoneal dialysis.

Science.gov (United States)

Yu, Zhen Li; Yeoh, Lee Ying; Seow, Ying Ying; Luo, Xue Chun; Griva, Konstadina

2012-07-01

It is challenging for dialysis patients to maintain adherence to their medical regimen, and symptoms of depression are prevalent among them. Limited data is available about adherence and depression among patients receiving peritoneal dialysis (PD). This study aimed to examine the rates of treatment non-adherence and depression in PD patients. A total of 20 PD patients (response rate 71.4%; mean age 64.4 ± 11.6 years) were assessed using the Beliefs about Medicines Questionnaire, Self Efficacy for Managing Chronic Disease Scale, Hospital Anxiety and Depression Scale (HAD) and Kidney Disease Quality of Life-Short Form. A self-reported adherence (PD exchanges, medication and diet) scale developed for the study was also included. Medical information (e.g. most recent biochemistry results) was obtained from chart review. The mean self-reported scores indicated an overall high level of adherence, although a significant proportion of patients were non-adherent. Among the latter, 20% of patients were non-adherent to medication and 26% to diet due to forgetfulness, while 15% and 26% of patients admitted to deliberate non-adherence to medication and diet, respectively. Treatment modality, employment, self-care status and self-efficacy were associated with overall adherence. Using a cutoff point of 8 for HAD depression and anxiety subscales, 40% of patients were found to be depressed and 30% had symptoms of anxiety. This is the first study to document treatment adherence and depression among PD patients in Singapore. Findings of high prevalence of depression and anxiety, and reports of poor adherence warrant development of intervention programmes.

GLOBATO: An enhanced global relief model at 30 arc-seconds resolution

Science.gov (United States)

O'Leary, V.; Amante, C.

2017-12-01

The National Centers for Environmental Information (NCEI), an office of the National Oceanic and Atmospheric Administration (NOAA), first developed a digital bathymetric and elevation model, ETOPO5, from publicly available data in 1993. For nearly 25 years, NCEI's ETOPO family of global relief models have supported research at a planetary scale, including tsunami forecasting, ocean circulation modeling, visualization of the seafloor, understanding geological phenomena, and aiding the development of other global and regional elevation models. GLOBATO (GLObal BAThymetry and TOpography) is now the most detailed version released by NCEI with a horizontal resolution of 30 arc-seconds and succeeds ETOPO1 with the inclusion of several new or updated data-sets for the seafloor as well as land areas. GLOBATO is a compilation of data derived from models of satellite measurements, ship depth soundings, and multibeam surveys, as well as regional models developed for Greenland and Antarctica. These data were converted from different formats, resolutions, spatial distributions, and projections into a single global model using GDAL v2.2 and MB-System v5.5. As with previous NCEI models, GLOBATO is available in two formats, "bedrock elevation" (measured as the base of major ice sheets) and "ice surface elevation" (measured as the surface of major ice sheets) which provides comprehensive topographic and bathymetric coverage between +- 90 degrees latitude and +- 180 degrees longitude. Adhering to best practices, GLOBATO, all related digital products, and any supporting documentation are available online through the NCEI data portal. These new, high resolution models will better support the variety of research ETOPO1 has made possible.

A Randomized Trial of a Multicomponent Intervention to Promote Medication Adherence: The Teen Adherence in Kidney Transplant Effectiveness of Intervention Trial (TAKE-IT).

Science.gov (United States)

Foster, Bethany J; Pai, Ahna L H; Zelikovsky, Nataliya; Amaral, Sandra; Bell, Lorraine; Dharnidharka, Vikas R; Hebert, Diane; Holly, Crystal; Knauper, Baerbel; Matsell, Douglas; Phan, Veronique; Rogers, Rachel; Smith, Jodi M; Zhao, Huaqing; Furth, Susan L

2018-03-15

Poor adherence to immunosuppressive medications is a major cause of premature graft loss among children and young adults. Multicomponent interventions have shown promise but have not been fully evaluated. Unblinded parallel-arm randomized trial to assess the efficacy of a clinic-based adherence-promoting intervention. Prevalent kidney transplant recipients 11 to 24 years of age and 3 or more months posttransplantation at 8 kidney transplantation centers in Canada and the United States (February 2012 to May 2016) were included. Adherence was electronically monitored in all participants during a 3-month run-in, followed by a 12-month intervention. Participants assigned to the TAKE-IT intervention could choose to receive text message, e-mail, and/or visual cue dose reminders and met with a coach at 3-month intervals when adherence data from the prior 3 months were reviewed with the participant. "Action-Focused Problem Solving" was used to address adherence barriers selected as important by the participant. Participants assigned to the control group met with coaches at 3-month intervals but received no feedback about adherence data. The primary outcomes were electronically measured "taking" adherence (the proportion of prescribed doses of immunosuppressive medications taken) and "timing" adherence (the proportion of doses of immunosuppressive medications taken between 1 hour before and 2 hours after the prescribed time of administration) on each day of observation. Secondary outcomes included the standard deviation of tacrolimus trough concentrations, self-reported adherence, acute rejection, and graft failure. 81 patients were assigned to intervention (median age, 15.5 years; 57% male) and 88 to the control group (median age, 15.8 years; 61% male). Electronic adherence data were available for 64 intervention and 74 control participants. Participants in the intervention group had significantly greater odds of taking prescribed medications (OR, 1.66; 95% CI, 1

Primary non-adherence to prescribed medication in general practice

DEFF Research Database (Denmark)

Linnet, Kristján; Halldórsson, Matthías; Thengilsdóttir, Gudrún

2013-01-01

Primary non-adherence refers to the patient not redeeming a prescribed medication at some point during drug therapy. Research has mainly focused on secondary non-adherence. Prior to this study, the overall rate of primary non-adherence in general practice in Iceland was not known....

Measuring the speed of light using Jupiter's moons: a global citizen science project for International Year of Light 2015

Science.gov (United States)

Hendry, Martin A.; Hammond, Giles; Simmons, Mike

2015-08-01

2015 represents both the centenary of General Relativity and International Year of Light - the latter marking the 150th anniversary of James Clerk Maxwell's ground-breaking paper on "A dynamical theory of the electromagnetic field". These landmark dates provide an exciting opportunity to set up a global citizen science project that re-enacts the seminal 1675 experiment of Ole Romer: to measure the speed of light by observing the time eclipses of the satellites of Jupiter. This project - which has been set up by astronomers at the University of Glasgow, UK in partnership with Astronomers without Borders - is an ideal platform for engaging the amateur astronomy community, schools and the wider public across the globe. It requires only simple observations, with a small spotting scope or telescope, and can be carried out straightforwardly in both cities and dark-sky locations. It highlights a fascinating chapter in astronomical history, as well as the ongoing importance of accurate astrometry, orbital motion, the concept of longitude and knowing one's position on the Earth. In the context of the GR centenary, it also links strongly to the science behind GPS satellites and a range of important topics in the high school curriculum - from the electromagnetic spectrum to the more general principles of the scientific method.In this presentation we present an overview of our global citizen science project for IYL2015: its scope and motivation, the total number and global distribution of its participants to date and how astronomers around the world can get involved. We also describe the intended legacy of the project: a extensive database of observations that can provide future astronomy educators with an accessible and historically important context in which to explore key principles for analysing large astronomical datasets.

Adherence to cognitive behavioral therapy for insomnia: a systematic review.

Science.gov (United States)

Matthews, Ellyn E; Arnedt, J Todd; McCarthy, Michaela S; Cuddihy, Leisha J; Aloia, Mark S

2013-12-01

Chronic insomnia is a significant public health problem worldwide, and insomnia has considerable personal and social costs associated with serious health conditions, greater healthcare utilization, work absenteeism, and motor-vehicle accidents. Cognitive behavioral therapy for insomnia (CBTI) is an efficacious treatment, yet attrition and suboptimal adherence may diminish its impact. Despite the increasing use of CBTI, surprisingly little attention has been devoted to understanding the role of adherence. This review describes a comprehensive literature search of adherence to CBTI. The search revealed 15 studies that evaluated adherence to CBTI in adults using valid and reliable measures of sleep, and measure of adherence other than study withdrawals. The primary purposes of this review were to 1) synthesize current study characteristics, methodology, adherence rates, contributing factors, and impact on outcomes, 2) discuss measurement issues, and 3) identify future practice and research directions that may lead to improved outcomes. Strong patterns and inconsistencies were identified among the studies, which complicate an evaluation of the role of adherence as a factor and outcome of CBTI success. The importance of standardized adherence and outcome measures is discussed. In light of the importance of adherence to behavior change, this systematic review may better inform future intervention efforts. Copyright © 2013 Elsevier Ltd. All rights reserved.

Self-reported adherence to treatment: A study of socioeconomic ...

African Journals Online (AJOL)

Objective: Adherence to treatment is important and relevant in HIV treatment. Previous studies in sub Sahara Africa and south western Nigeria reported that psychiatric morbidity influence treatment adherence. The present study was to examine treatment adherence among the male and the female patients with HIV infection ...

Spousal Involvement and CPAP Adherence: A Dyadic Perspective

Science.gov (United States)

Ye, Lichuan; Malhotra, Atul; Kayser, Karen; Willis, Danny G.; Horowitz, June; Aloia, Mark; Weaver, Terri E.

2014-01-01

Summary Poor adherence to continuous positive airway pressure (CPAP) treatment is associated with substantial health care costs, morbidity and mortality, and has been a leading obstacle in the effective management of obstructive sleep apnea (OSA). Successful interventions to improve CPAP adherence may ultimately include a variety of components. For patients living with spouses (refers to all domestic partners), the spouse will likely be an integral component to any successful intervention. Developing understanding of the role of spouses in adherence to CPAP has been identified to be a critical research need. This review expands the investigation of CPAP adherence to a broader context, from an exclusive focus on individual patients to a dyadic perspective encompassing both patients and their spouses. A conceptual framework based on social support and social control theories is proposed to understand spousal involvement in CPAP adherence. Methodologies for future investigations are discussed, along with implications for developing interventions that engage both patients and their spouses to improve CPAP use. PMID:24906222

Global assessment of water policy vulnerability under uncertainty in water scarcity projections

Science.gov (United States)

Greve, Peter; Kahil, Taher; Satoh, Yusuke; Burek, Peter; Fischer, Günther; Tramberend, Sylvia; Byers, Edward; Flörke, Martina; Eisner, Stephanie; Hanasaki, Naota; Langan, Simon; Wada, Yoshihide

2017-04-01

Water scarcity is a critical environmental issue worldwide, which has been driven by the significant increase in water extractions during the last century. In the coming decades, climate change is projected to further exacerbate water scarcity conditions in many regions around the world. At present, one important question for policy debate is the identification of water policy interventions that could address the mounting water scarcity problems. Main interventions include investing in water storage infrastructures, water transfer canals, efficient irrigation systems, and desalination plants, among many others. This type of interventions involve long-term planning, long-lived investments and some irreversibility in choices which can shape development of countries for decades. Making decisions on these water infrastructures requires anticipating the long term environmental conditions, needs and constraints under which they will function. This brings large uncertainty in the decision-making process, for instance from demographic or economic projections. But today, climate change is bringing another layer of uncertainty that make decisions even more complex. In this study, we assess in a probabilistic approach the uncertainty in global water scarcity projections following different socioeconomic pathways (SSPs) and climate scenarios (RCPs) within the first half of the 21st century. By utilizing an ensemble of 45 future water scarcity projections based on (i) three state-of-the-art global hydrological models (PCR-GLOBWB, H08, and WaterGAP), (ii) five climate models, and (iii) three water scenarios, we have assessed changes in water scarcity and the associated uncertainty distribution worldwide. The water scenarios used here are developed by IIASA's Water Futures and Solutions (WFaS) Initiative. The main objective of this study is to improve the contribution of hydro-climatic information to effective policymaking by identifying spatial and temporal policy

Factors affecting medication adherence in elderly people

Directory of Open Access Journals (Sweden)

Jin HK

2016-10-01

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

Global contract automation for E and P: project overview; Contrato global de automacao para E e P: visao geral do projeto

Energy Technology Data Exchange (ETDEWEB)

Arruda, Luiz Alberto Barbosa; Cintra, Paulo Cesar Vogel; Gaban, Allan Rodrigo Martins [Petroleo Brasileiro S.A. (PETROBRAS), Rio de Janeiro, RJ (Brazil); Corazza, Andre [Altus Sistemas de Automacao S.A., Sao Leopoldo, RS (Brazil)

2012-07-01

This paper aims to present a technical overview of Global Contract for Automation (CGA in Portuguese) for the segment of E and P (Exploration and Production) in Oil and Gas. This paper presents the theory of this type of contract showing the first contract of its kind in Brazil, ongoing for Pre-Salt FPSOs. The idea of using this contract as a reference is relate theory to practice. In the study is done an analysis of 'win-win' relationship in when performing pre-detailing and detail engineering, project development and automation directly with the manufacturer of the automation solution. The project herein includes automation and control of eight FPSOs (Float Production Storage and Offloading), to be produced in series. The system contracted in CGA consists of 12 systems and integrated sub-systems related to production process, fire and gas detection and emergency shutdown (shutdown). The eight FPSO have the same design, are replicas of a single project. The CGA has in its scope to interface simultaneously with different contractors: FEED project; hull constructor; construction and assembly of modules; integration of the FPSO and direct contracts with equipment suppliers. It will also be detail in this paper the scope of supply of subsystems equipment, pre-detail and detail engineering services, automation and control systems integration, consistency and testing of automation system and technical assistance for pre operation and operation of the FPSO. (author)

Predictors and outcomes of non-adherence in patients receiving maintenance hemodialysis.

Science.gov (United States)

Tohme, Fadi; Mor, Maria K; Pena-Polanco, Julio; Green, Jamie A; Fine, Michael J; Palevsky, Paul M; Weisbord, Steven D

2017-08-01

Predictors of and outcomes associated with non-adherent behavior among patients on chronic hemodialysis (HD) have been incompletely elucidated. We conducted a post hoc analysis of data from the SMILE trial to identify patient factors associated with non-adherence to dialysis-related treatments and the associations of non-adherence with clinical outcomes. We defined non-adherence as missed HD and abbreviated HD. We used negative binomial regression to model the associations of demographic and clinical factors with measures of non-adherence, and negative binomial and Cox regression to analyze the associations of non-adherence with hospitalizations and mortality, respectively. We followed 286 patients for up to 24 months. Factors independently associated with missing HD included Tuesday/Thursday/Saturday HD schedule [incident rate ratio (IRR) 1.85, p adherence to HD-related treatments, and independent associations of non-adherence with hospitalization and mortality. These findings should inform the development and implementation of interventions to improve adherence and reduce health resource utilization.

Family strategies for achieving medication adherence in pediatric kidney transplantation.

Science.gov (United States)

Ingerski, Lisa; Perrazo, Lauren; Goebel, Jens; Pai, Ahna L H

2011-01-01

Although nonadherence is well documented and strategies for adherence have been shown to be critical to overcoming barriers and improving overall adherence rates, it is unknown how family strategy use is related to adherence in the pediatric renal transplant population. The aims of this study were to assess (a) the strategies used by adolescents with kidney transplants and their caregivers to adhere to the posttransplant oral medication regimen and (b) the relationship of these strategies to objective adherence rates. Semistructured interviews to assess self-management were administered to 17 adolescents (14-18 years) and 17 caregivers. Adherence to oral immunosuppressant medication, measured via electronic monitors, was determined also for a subset of 13 dyads. Common strategies endorsed by families included the following: making it part of the routine (88.2%), verbal reminders by caregiver (82.4%), caregiver verifying medication was taken (76.5%), placing medication in a convenient location (76.5%), and using a pillbox (70.6%). A greater number of family-endorsed strategies were correlated with higher levels of adherence. Of those strategies spontaneously endorsed, only caregiver reminders to take medication and caregiver verification that medications were taken were related significantly to higher adherence rates. The findings highlight the importance of identification and use of specific strategies to improve adherence rates of pediatric renal transplant recipients and emphasize the need for continued caregiver involvement in the promotion of adherence to the treatment regimen.

Factors associated with medication adherence in school-aged children with asthma

Directory of Open Access Journals (Sweden)

Amy H.Y. Chan

2016-03-01

Full Text Available Adherence to preventive asthma treatment is poor, particularly in children, yet the factors associated with adherence in this age group are not well understood. Adherence was monitored electronically over 6 months in school-aged children who attended a regional emergency department in New Zealand for an asthma exacerbation and were prescribed twice-daily inhaled corticosteroids. Participants completed questionnaires including assessment of family demographics, asthma responsibility and learning style. Multivariable analysis of factors associated with adherence was conducted. 101 children (mean (range age 8.9 (6–15 years, 51% male participated. Median (interquartile range preventer adherence was 30% (17–48% of prescribed. Four explanatory factors were identified: female sex (+12% adherence, Asian ethnicity (+19% adherence, living in a smaller household (−3.0% adherence per person in the household, and younger age at diagnosis (+2.7% for every younger year of diagnosis (all p<0.02. In school-aged children attending the emergency department for asthma, males and non-Asian ethnic groups were at high risk for poor inhaled corticosteroid adherence and may benefit most from intervention. Four factors explained a small proportion of adherence behaviour indicating the difficulty in identifying adherence barriers. Further research is recommended in other similar populations.

Treatment agreement, adherence, and outcome in cognitive behavioral treatments for insomnia.

Science.gov (United States)

Dong, Lu; Soehner, Adriane M; Bélanger, Lynda; Morin, Charles M; Harvey, Allison G

2018-03-01

Patient adherence has been identified as an important barrier to the implementation of evidence-based psychological treatments. In cognitive behavioral treatments (CBT) for insomnia, the current study examined (a) the validity of therapist ratings of patient agreement and adherence against an established behavioral measure of adherence, and (b) the relationship between treatment agreement, adherence, and outcome. Participants were 188 adults meeting DSM-IV-TR criteria for chronic insomnia who were randomized to receive behavior therapy, cognitive therapy, or CBT for insomnia. Treatment agreement/adherence was measured by (a) weekly therapist ratings of patient agreement and homework completion, and (b) adherence to behavioral strategies (ABS) derived from patient-reported sleep diary. Outcome measures were Insomnia Severity Index and insomnia remission (Insomnia Severity Index adherence, and ABS measures during treatment significantly predicted insomnia remission at posttreatment, and all but therapist rating of homework completion predicted remission at 6-month follow-up. Greater patient agreement and adherence (therapist ratings and ABS) during treatment predicted better treatment outcome. Therapist-rated treatment agreement and adherence correspond well with patient-reported sleep diary-derived adherence measure. These simple, deployable therapist-rated patient agreement and adherence can potentially be useful for treatments for other disorders. (PsycINFO Database Record (c) 2018 APA, all rights reserved).

Fuzzy multi-project rough-cut capacity planning

NARCIS (Netherlands)

Masmoudi, Malek; Hans, Elias W.; Leus, Roel; Hait, Alain; Sotskov, Yuri N.; Werner, Frank

2014-01-01

This chapter studies the incorporation of uncertainty into multi-project rough-cut capacity planning. We use fuzzy sets to model uncertainties, adhering to the so-called possibilistic approach. We refer to the resulting proactive planning environment as Fuzzy Rough Cut Capacity Planning (FRCCP).

Explaining adherence success in sub-Saharan Africa: an ethnographic study.

Directory of Open Access Journals (Sweden)

Norma C Ware

2009-01-01

Full Text Available Individuals living with HIV/AIDS in sub-Saharan Africa generally take more than 90% of prescribed doses of antiretroviral therapy (ART. This number exceeds the levels of adherence observed in North America and dispels early scale-up concerns that adherence would be inadequate in settings of extreme poverty. This paper offers an explanation and theoretical model of ART adherence success based on the results of an ethnographic study in three sub-Saharan African countries.Determinants of ART adherence for HIV-infected persons in sub-Saharan Africa were examined with ethnographic research methods. 414 in-person interviews were carried out with 252 persons taking ART, their treatment partners, and health care professionals at HIV treatment sites in Jos, Nigeria; Dar es Salaam, Tanzania; and Mbarara, Uganda. 136 field observations of clinic activities were also conducted. Data were examined using category construction and interpretive approaches to analysis. Findings indicate that individuals taking ART routinely overcome economic obstacles to ART adherence through a number of deliberate strategies aimed at prioritizing adherence: borrowing and "begging" transport funds, making "impossible choices" to allocate resources in favor of treatment, and "doing without." Prioritization of adherence is accomplished through resources and help made available by treatment partners, other family members and friends, and health care providers. Helpers expect adherence and make their expectations known, creating a responsibility on the part of patients to adhere. Patients adhere to promote good will on the part of helpers, thereby ensuring help will be available when future needs arise.Adherence success in sub-Saharan Africa can be explained as a means of fulfilling social responsibilities and thus preserving social capital in essential relationships.

The global campus project: using e-learning to extend access to new polpulations of students.

OpenAIRE

Milankovic-Atkinson, Maya; Sadler, Chris

2009-01-01

The Global Campus (GC) project started in May 1999 between the School of Computing Science (SCS) of Middlesex University (MU) and the Regional Information Technology and Software Engineering Centre (RITSEC) in Cairo[1]. RITSEC were keen to further develop their collaboration with Middlesex University and it was decided to launch a complete MSc programme in Distance Learning (DL) mode. This was in line with the University strategy to expand its provision overseas to meet the vast demand for Br...

Psychological distress and treatment adherence among children on dialysis.

Science.gov (United States)

Simoni, J M; Asarnow, J R; Munford, P R; Koprowski, C M; Belin, T R; Salusky, I B

1997-10-01

Among 23 pediatric renal dialysis patients, we obtained self-reported assessments of psychological adjustment and biochemical and subjective ratings of adherence. Findings indicate elevated levels of depressive symptoms and substantial nonadherence. Depressive symptoms were associated with higher levels of hopelessness, more negative self-perceptions, and more depressogenic attributional style. The psychological adjustment measures did not significantly correlate with adherence. Nonsignificant associations among different measures of adherence underscore its multifaceted nature. Implications for monitoring the adjustment of children on dialysis, assessing adherence, and future research are discussed.

Poor adherence to medication as assessed by the Morisky Medication Adherence Scale-8 and low satisfaction with treatment in 237 psoriasis patients.

Science.gov (United States)

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

2015-04-01

Previously we assessed the medication adherence for oral and topical remedies by a translated Japanese version of the Morisky Medication Adherence Scale-8 (MMAS-8) together with socioeconomic backgrounds in 3096 Japanese dermatological patients, and found the medication adherence, especially to topical drugs, was poor in these patients. In order to elucidate the disease-specific sociomedical factors, we further sub-analyzed the medication adherence in 237 psoriasis patients and compared it with that in other dermatological diseases such as atopic dermatitis, urticaria or tinea. This study was conducted among patients registered in monitoring system and 3096 eligible patients were enrolled. Our web-based questionnaire included the following items such as age, sex, annual income, main health-care institution, experience of effectiveness by oral or topical medication, overall satisfaction with treatment, and MMAS-8 for oral or topical medication. Mean adherence score by MMAS-8 was 5.2 for oral and 4.3 for topical medication. More patients with psoriasis used a university hospital and fewer used a private clinic compared with those with the other skin disease patients. Experience of drug effectiveness by oral medication and overall satisfaction with treatment was lower in psoriasis patients than in other patients. In oral medication, significantly better adherence was observed in those of higher age and with higher annual income. The adherence to medication, especially to topical drugs, was poor in 237 psoriasis patients. We speculated that some severe psoriasis patients were not sufficiently treated systemically and were resistant to topical therapy, leading to poor adherence. © 2015 Japanese Dermatological Association.

Increasing diabetic patient engagement and self-reported medication adherence using a web-based multimedia program.

Science.gov (United States)

Elsabrout, Kerri

2018-05-01

Evidence-based, multimedia applications to supplement clinical care can improve patient engagement and clinical outcomes. Patients with diabetes with potentially devastating complication of foot ulcers present a substantial opportunity to improve engagement. This project examines how providing an online, multimedia self-management program affects patient engagement and self-reported medication adherence scores within 4-6 weeks compared with preprogram scores. Participants included 14 adult, diabetic outpatients receiving care at a Wound Care Center in suburban New York. Participants watched a Type 2 diabetes Emmi educational module on an electronic tablet during a routine wound treatment visit. Self-reported medication adherence was measured immediately before and at 4-6 weeks after the educational intervention. Patient engagement was measured immediately before, immediately after, and at 4-6 weeks postintervention. Self-reported medication adherence results demonstrated a modest increase at the delayed postintervention time. In addition, there was a large increase in engagement scores at the delayed postintervention time. The direction of change for both measures was consistent with the intervention being effective. Incorporating this type of novel, multimedia patient education resource may provide opportunities to enhance diabetes care.

Examining the Efficacy of Project-Based Learning on Cultivating the 21st Century Skills among High School Students in a Global Context

Science.gov (United States)

Lin, Chi-Syan; Ma, Jung-Tsan; Kuo, Karen Yi-Chwen; Chou, Chien-Tzu Candace

2015-01-01

The goal of the study is to explore the opportunities and challenges associated with Project-Based Learning strategy in a global context on the aspects of both fostering learning community of practices and nurturing the 21st century skills. For collecting empirical data, the study implements and administers an online international project-based…

Effects of adherence to antiretroviral therapy on body mass index ...

African Journals Online (AJOL)

S.A. Olowookere

2015-06-19

Jun 19, 2015 ... ure, development of drug resistance and subsequent virological and immunological .... adherence during counseling sessions, although 95% adher- ence is sufficient .... evaluation and adherence measurement by self report.

What are validated self-report adherence scales really measuring?: a systematic review.

Science.gov (United States)

Nguyen, Thi-My-Uyen; La Caze, Adam; Cottrell, Neil

2014-03-01

Medication non-adherence is a significant health problem. There are numerous methods for measuring adherence, but no single method performs well on all criteria. The purpose of this systematic review is to (i) identify self-report medication adherence scales that have been correlated with comparison measures of medication-taking behaviour, (ii) assess how these scales measure adherence and (iii) explore how these adherence scales have been validated. Cinahl and PubMed databases were used to search articles written in English on the development or validation of medication adherence scales dating to August 2012. The search terms used were medication adherence, medication non-adherence, medication compliance and names of each scale. Data such as barriers identified and validation comparison measures were extracted and compared. Sixty articles were included in the review, which consisted of 43 adherence scales. Adherence scales include items that either elicit information regarding the patient's medication-taking behaviour and/or attempts to identify barriers to good medication-taking behaviour or beliefs associated with adherence. The validation strategies employed depended on whether the focus of the scale was to measure medication-taking behaviour or identify barriers or beliefs. Supporting patients to be adherent requires information on their medication-taking behaviour, barriers to adherence and beliefs about medicines. Adherence scales have the potential to explore these aspects of adherence, but currently there has been a greater focus on measuring medication-taking behaviour. Selecting the 'right' adherence scale(s) requires consideration of what needs to be measured and how (and in whom) the scale has been validated. © 2013 The British Pharmacological Society.

Parental Depression and Pancreatic Enzymes Adherence in Children With Cystic Fibrosis.

Science.gov (United States)

Barker, David H; Quittner, Alexandra L

2016-02-01

Treatment adherence in cystic fibrosis (CF) is often poor, however, less is known about adherence to pancreatic enzymes, a critical component of the CF treatment regimen. Parent caregivers often report elevations in depression, and parental depression may adversely affect children's adherence. This prospective study evaluated adherence to pancreatic enzymes in 83 patients (1-13 years) . Adherence was measured across 3 months with electronic pill-caps . Weight was measured at baseline and a 3-month follow-up. Parental depressive symptoms were evaluated by using the Center for Epidemiologic Studies Depression Scale (CES-D). Adherence to pancreatic enzymes was 49.4% ± 3.4%. Adherence was higher at school (94.4% ± 6.1%) than at home (42.3% ± 3.1%), and higher for toddlers (50.6% ± 5.2%) than for school-aged children (37.5% ± 3.7%). Parents reported high rates of depressive symptoms (30% in the clinical range, 18% with moderate symptoms). Children of parents with symptoms of depression versus those without were less adherent (34.8% ± 4.5% vs 48.5% ± 4.1%), and adherence to enzymes was significantly related to 3-month weight outcomes. Average gain in weight z scores across 3 months was 0.5 ± 0.2for children who were >50% adherent and -0.1 ± 6.1for children who were <33% adherent. Parental depression had a signifcant, indirect effect on weight via adherence (-0.005 ± 0.003 gain in weight z score per CES-D unit ). High rates of parental depressive symptoms, coupled with its negative effects on adherence, suggest that measuring and treating parental depression may improve children's adherence to therapy. Copyright © 2016 by the American Academy of Pediatrics.

External force back-projective composition and globally deformable optimization for 3-D coronary artery reconstruction

International Nuclear Information System (INIS)

Yang, Jian; Cong, Weijian; Fan, Jingfan; Liu, Yue; Wang, Yongtian; Chen, Yang

2014-01-01

The clinical value of the 3D reconstruction of a coronary artery is important for the diagnosis and intervention of cardiovascular diseases. This work proposes a method based on a deformable model for reconstructing coronary arteries from two monoplane angiographic images acquired from different angles. First, an external force back-projective composition model is developed to determine the external force, for which the force distributions in different views are back-projected to the 3D space and composited in the same coordinate system based on the perspective projection principle of x-ray imaging. The elasticity and bending forces are composited as an internal force to maintain the smoothness of the deformable curve. Second, the deformable curve evolves rapidly toward the true vascular centerlines in 3D space and angiographic images under the combination of internal and external forces. Third, densely matched correspondence among vessel centerlines is constructed using a curve alignment method. The bundle adjustment method is then utilized for the global optimization of the projection parameters and the 3D structures. The proposed method is validated on phantom data and routine angiographic images with consideration for space and re-projection image errors. Experimental results demonstrate the effectiveness and robustness of the proposed method for the reconstruction of coronary arteries from two monoplane angiographic images. The proposed method can achieve a mean space error of 0.564 mm and a mean re-projection error of 0.349 mm. (paper)

Software project management tools in global software development: a systematic mapping study.

Science.gov (United States)

Chadli, Saad Yasser; Idri, Ali; Ros, Joaquín Nicolás; Fernández-Alemán, José Luis; de Gea, Juan M Carrillo; Toval, Ambrosio

2016-01-01

Global software development (GSD) which is a growing trend in the software industry is characterized by a highly distributed environment. Performing software project management (SPM) in such conditions implies the need to overcome new limitations resulting from cultural, temporal and geographic separation. The aim of this research is to discover and classify the various tools mentioned in literature that provide GSD project managers with support and to identify in what way they support group interaction. A systematic mapping study has been performed by means of automatic searches in five sources. We have then synthesized the data extracted and presented the results of this study. A total of 102 tools were identified as being used in SPM activities in GSD. We have classified these tools, according to the software life cycle process on which they focus and how they support the 3C collaboration model (communication, coordination and cooperation). The majority of the tools found are standalone tools (77%). A small number of platforms (8%) also offer a set of interacting tools that cover the software development lifecycle. Results also indicate that SPM areas in GSD are not adequately supported by corresponding tools and deserve more attention from tool builders.

Global crop exposure to critical high temperatures in the reproductive period: historical trends and future projections

International Nuclear Information System (INIS)

Gourdji, Sharon M; Sibley, Adam M; Lobell, David B

2013-01-01

Long-term warming trends across the globe have shifted the distribution of temperature variability, such that what was once classified as extreme heat relative to local mean conditions has become more common. This is also true for agricultural regions, where exposure to extreme heat, particularly during key growth phases such as the reproductive period, can severely damage crop production in ways that are not captured by most crop models. Here, we analyze exposure of crops to physiologically critical temperatures in the reproductive stage (T crit ), across the global harvested areas of maize, rice, soybean and wheat. Trends for the 1980–2011 period show a relatively weak correspondence (r = 0.19) between mean growing season temperature and T crit exposure trends, emphasizing the importance of separate analyses for T crit . Increasing T crit exposure in the past few decades is apparent for wheat in Central and South Asia and South America, and for maize in many diverse locations across the globe. Maize had the highest percentage (15%) of global harvested area exposed to at least five reproductive days over T crit in the 2000s, although this value is somewhat sensitive to the exact temperature used for the threshold. While there was relatively little sustained exposure to reproductive days over T crit for the other crops in the past few decades, all show increases with future warming. Using projections from climate models we estimate that by the 2030s, 31, 16, and 11% respectively of maize, rice, and wheat global harvested area will be exposed to at least five reproductive days over T crit in a typical year, with soybean much less affected. Both maize and rice exhibit non-linear increases with time, with total area exposed for rice projected to grow from 8% in the 2000s to 27% by the 2050s, and maize from 15 to 44% over the same period. While faster development should lead to earlier flowering, which would reduce reproductive extreme heat exposure for wheat on a

Nuclear security: A global response to a global threat

International Nuclear Information System (INIS)

Amano, Yukiya

2016-01-01

The threat of nuclear terrorism is real. The possibility of criminals getting hold of nuclear and other radioactive material cannot be ruled out. Much progress has been made in tackling this threat nationally, regionally and globally, but more needs to be done. International cooperation is vital. As the global platform for cooperation in nuclear security, the IAEA helps countries to establish and maintain robust and sustainable national nuclear security regimes. We help ensure that measures are taken to protect nuclear and other radioactive material, as well as the facilities in which such material is housed, from malicious acts. This has been an important year for nuclear security with the entry into force of the Amendment to the Convention on the Physical Protection of Nuclear Material. This establishes legally binding commitments for countries to protect nuclear facilities as well as nuclear material in domestic use, storage and transport. I encourage all countries that have not yet done so to adhere to this Amendment and thereby contribute to a stronger global nuclear security regime. In this edition of the IAEA Bulletin, you will learn about the different areas of security where our work is making a real difference. We highlight the progress made in a number of countries.

The Role of Theory in Increasing Adherence to Prescribed Practice

Science.gov (United States)

Richardson, Julie; Wishart, Laurie; Hanna, Steven

2009-01-01

ABSTRACT Purpose: The purpose of this article is to apply theoretical frameworks to adherence behaviour and to guide the development of an intervention to increase adherence to prescribed home programmes. Summary of Key Points: Delivering an effective intervention requires establishing one that is evidence based and of adequate dosage. Two-thirds of patients who receive home exercise prescriptions do not adhere to their home programme, which may contribute to their physiotherapy's being ineffective. The mediating concepts of self-efficacy (SE) and outcome expectations (OE) are common to the five relevant theories used to explain adherence to exercise: the health belief model, protection motivation theory, theory of reasoned action, theory of planned behaviour, and social cognitive theory. Conclusion/Recommendations: Few intervention studies with any theoretical underpinning have examined adherence to exercise. Even fewer have been designed to affect and measure change in the theoretical mediators of SE and OE in patient populations. Physiotherapists must consider increasing adherence as a component of effective physiotherapy. Ongoing research is needed to increase our understanding of adherence to prescribed home programmes and to design interventions to affect theoretical mediators for increasing adherence. PMID:20190989

Adherence in pediatric kidney transplant recipients: solutions for the system.

Science.gov (United States)

Steinberg, Elizabeth A; Moss, Mary; Buchanan, Cindy L; Goebel, Jens

2018-03-01

Non-adherence remains a significant problem among pediatric (and adult) renal transplant recipients. Non-adherence among solid organ transplant recipients results in US$15-100 million annual costs. Estimates of non-adherence range from 30 to 70% among pediatric patients. Research demonstrates that a 10% decrement in adherence is associated with 8% higher hazard of graft failure and mortality. Focus has begun to shift from patient factors that impact adherence to the contributing healthcare and systems factors. The purpose of this review is to describe problems within the systems implicated in non-adherence and potential solutions that may be related to positive adherence outcomes. Systems issues include insurance and legal regulations, provider and care team barriers to optimal care, and difficulties with transitioning to adult care. Potential solutions include recognition of how systems can work together to improve patient outcomes through improvements in insurance programs, a multi-disciplinary care team approach, evidence-based medical management, pharmacy-based applications and interventions to simplify medication regimens, improved transition protocols, and telehealth/technology-based multi-component interventions. However, there remains a significant lack of reliability in the application of these potential solutions to systems issues that impact patient adherence. Future efforts should accordingly focus on these efforts, likely by leveraging quality improvement and related principles, and on the investigation of the efficacy of these interventions to improve adherence and graft outcomes.

Promoting homework adherence in cognitive-behavioral therapy for adolescent depression.

Science.gov (United States)

Jungbluth, Nathaniel J; Shirk, Stephen R

2013-01-01

This study used prospective, observational methods to evaluate six features of therapist behavior as predictors of homework adherence in cognitive-behavioral therapy for adolescent depression, with the goal of identifying therapist strategies with the potential to improve adolescent adherence. Therapist behaviors were expected to interact with initial levels of client resistance or adherence to predict subsequent homework completion. Participants were 50 referred adolescents (33 female, 54% ethnic minority) ages 14 to 18 (M = 15.9) meeting diagnostic criteria for a depressive disorder, and without comorbid psychotic disorder, bipolar disorder, autism spectrum disorder, intellectual disability, or concurrent treatments. Therapist homework-related behaviors were coded from audiotapes of Sessions 1 and 2 and used to predict adolescents' homework adherence, coded from audiotapes of Sessions 2 and 3. Several therapist behaviors were predictive of subsequent homework adherence, particularly for initially resistant or nonadherent adolescents. Stronger homework rationale and greater time allocated to explaining homework in Session 1 predicted greater adherence at Session 2, particularly for initially resistant adolescents. Stronger rationale and eliciting reactions/troubleshooting obstacles in Session 2 predicted greater adherence at Session 3, particularly for adolescents who were less adherent to prior homework. Strategies such as providing a strong rationale, allocating more time to assigning homework, and eliciting reactions/troubleshooting obstacles may be effective ways to bolster homework adherence among initially less engaged, depressed teens.

Factors influencing adherence to routine iron supplementation ...

African Journals Online (AJOL)

Anemia in pregnancy is a common problem especially in developing countries. and has been linked with feotal and maternal complications. Taking iron supplements could reduce anaemia in pregnancy but some pregnant women do not adhere to this. The study identified some factors associated with non adherence ...

Social Support, Treatment Adherence and Outcome among ...

African Journals Online (AJOL)

2017-06-02

Jun 2, 2017 ... Access to family support did not positively influence medication adherence, while access to financial support marginally impacted on outcome among hypertensive and T2D patients. However, un- wavering tendency for therapy affordability significantly influenced adherence and outcome, thus, the need for ...

Ethical Review of Undergraduate Student Research Projects: A Proportionate, Transparent and Efficient Process?

Science.gov (United States)

Hack, Catherine J.

2012-01-01

Undergraduate research projects in the life sciences encompass a broad range of studies, some of which may require the participation of human subjects or other activities which may raise ethical concerns. As universities are accountable for all projects undertaken under their auspices they must ensure that these projects adhere to legal…

Treatment adherence in multiple sclerosis: a survey of Belgian neurologists

Directory of Open Access Journals (Sweden)

Decoo D

2015-11-01

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

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

NARCIS (Netherlands)

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

2010-01-01

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

What strategies do ulcerative colitis patients employ to facilitate adherence?

Directory of Open Access Journals (Sweden)

Kawakami A

2017-01-01

Full Text Available Aki Kawakami,1,2 Makoto Tanaka,3 Makoto Naganuma,4 Shin Maeda,5 Reiko Kunisaki,1 Noriko Yamamoto-Mitani2 1Inflammatory Bowel Disease Center, Yokohama City University Medical Center, Minami-ku, Yokohama, Japan; 2Department of Gerontological Home Care and Long-term Care Nursing, Graduate School of Medicine, University of Tokyo, Bunkyo-ku, Tokyo, Japan; 3Ramathibodi School of Nursing, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Ratchathewi, Bangkok, Thailand; 4Division of Gastroenterology and Hepatology, Keio University, Shinjuku-ku, Tokyo, Japan; 5Department of Gastroenterology, Yokohama City University Graduate School of Medicine, Kanazawa-ku, Yokohama, Japan 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

[Improving treatment adherence in kidney transplantation: a major challenge].

Science.gov (United States)

Kessler, Michèle

2014-06-01

The kidney transplant recipient is faced not only with the perspective of taking immunosuppressive drugs lifelong, but also the possibility of other long-term treatments prescribed for preexisting conditions, complications, or side effects. Proper management, and most importantly patient adherence, can become a complex challenge. Here we recall current definitions and describe methods for measuring treatment adherence, followed by a discussion on the prevalence of non-adherence in kidney transplant recipients, its effect on graft survival, and factors predictive of non-adherence. Ways of improving adherence are examined, leading to the conviction that helping patients take their medications regularly would probably have a greater impact on graft survival than marketing a new immunosuppressive agent. Copyright © 2014 Association Société de néphrologie. Published by Elsevier SAS. All rights reserved.

Response of precipitation extremes to idealized global warming in an aqua-planet climate model: Towards robust projection across different horizontal resolutions

Energy Technology Data Exchange (ETDEWEB)

Li, F.; Collins, W.D.; Wehner, M.F.; Williamson, D.L.; Olson, J.G.

2011-04-15

Current climate models produce quite heterogeneous projections for the responses of precipitation extremes to future climate change. To help understand the range of projections from multimodel ensembles, a series of idealized 'aquaplanet' Atmospheric General Circulation Model (AGCM) runs have been performed with the Community Atmosphere Model CAM3. These runs have been analysed to identify the effects of horizontal resolution on precipitation extreme projections under two simple global warming scenarios. We adopt the aquaplanet framework for our simulations to remove any sensitivity to the spatial resolution of external inputs and to focus on the roles of model physics and dynamics. Results show that a uniform increase of sea surface temperature (SST) and an increase of low-to-high latitude SST gradient both lead to increase of precipitation and precipitation extremes for most latitudes. The perturbed SSTs generally have stronger impacts on precipitation extremes than on mean precipitation. Horizontal model resolution strongly affects the global warming signals in the extreme precipitation in tropical and subtropical regions but not in high latitude regions. This study illustrates that the effects of horizontal resolution have to be taken into account to develop more robust projections of precipitation extremes.

Validating the Modified Drug Adherence Work-Up (M-DRAW Tool to Identify and Address Barriers to Medication Adherence

Directory of Open Access Journals (Sweden)

Sun Lee

2017-09-01

Full Text Available Barriers to medication adherence stem from multiple factors. An effective and convenient tool is needed to identify these barriers so that clinicians can provide a tailored, patient-centered consultation with patients. The Modified Drug Adherence Work-up Tool (M-DRAW was developed as a 13-item checklist questionnaire to identify barriers to medication adherence. The response scale was a 4-point Likert scale of frequency of occurrence (1 = never to 4 = often. The checklist was accompanied by a GUIDE that provided corresponding motivational interview-based intervention strategies for each identified barrier. The current pilot study examined the psychometric properties of the M-DRAW checklist (reliability, responsiveness and discriminant validity in patients taking one or more prescription medication(s for chronic conditions. A cross-sectional sample of 26 patients was recruited between December 2015 and March 2016 at an academic medical center pharmacy in Southern California. A priming question that assessed self-reported adherence was used to separate participants into the control group of 17 “adherers” (65.4%, and into the intervention group of nine “unintentional and intentional non-adherers” (34.6%. Comparable baseline characteristics were observed between the two groups. The M-DRAW checklist showed acceptable reliability (13 item; alpha = 0.74 for identifying factors and barriers leading to medication non-adherence. Discriminant validity of the tool and the priming question was established by the four-fold number of barriers to adherence identified within the self-selected intervention group compared to the control group (4.4 versus 1.2 barriers, p < 0.05. The current study did not investigate construct validity due to small sample size and challenges on follow-up with patients. Future testing of the tool will include construct validation.

Global assimilation of X Project Loon stratospheric balloon observations

Science.gov (United States)

Coy, L.; Schoeberl, M. R.; Pawson, S.; Candido, S.; Carver, R. W.

2017-12-01

Project Loon has an overall goal of providing worldwide internet coverage using a network of long-duration super-pressure balloons. Beginning in 2013, Loon has launched over 1600 balloons from multiple tropical and middle latitude locations. These GPS tracked balloon trajectories provide lower stratospheric wind information over the oceans and remote land areas where traditional radiosonde soundings are sparse, thus providing unique coverage of lower stratospheric winds. To fully investigate these Loon winds we: 1) compare the Loon winds to winds produced by a global data assimilation system (DAS: NASA GEOS) and 2) assimilate the Loon winds into the same comprehensive DAS. Results show that in middle latitudes the Loon winds and DAS winds agree well and assimilating the Loon winds have only a small impact on short-term forecasting of the Loon winds, however, in the tropics the loon winds and DAS winds often disagree substantially (8 m/s or more in magnitude) and in these cases assimilating the loon winds significantly improves the forecast of the loon winds. By highlighting cases where the Loon and DAS winds differ, these results can lead to improved understanding of stratospheric winds, especially in the tropics.

In vitro adherence of bacteria to prosthetic grafting materials

International Nuclear Information System (INIS)

Brewer, A.R.; Stromberg, B.V.

1990-01-01

Adherence of bacteria to prosthetic grafting material is thought to play an important role in the ultimate development of prosthetic infections. To evaluate the role of bacterial adherence in the initiation and colonization of prosthetic materials, Proplast II, Gore-Tex, and silicone were evaluated for adherence of Escherichia coli and Staphylococcus aureus. Bacteria were radiolabeled and incubated with the study material. Adherence was determined by scintillation. Adherence to Proplast II and Gore-Tex reached a maximum at approximately 45 minutes of incubation and demonstrated a detachment phenomenon with E. coli. Similar results were noted with S. aureus, but with a maximal attachment at approximately 30 minutes. Interestingly, bacterial attachment to silicone continued to increase throughout the time of the incubation. In addition, adherence of S. aureus was at a faster rate than E. coli. Attachment of bacteria is a multifactorial process. However, the PTFE graft demonstrates a slower rate of attachment, lower total number of attached bacteria, and faster detachment. The importance of this phenomenon may help explain the foreign body effect of increased susceptibility to infection of foreign materials

Optimising adherence to childhood pneumonia treatment: the design and development of patient instructions and a job aid for amoxicillin dispersible tablets.

Science.gov (United States)

Ebels, Kelly; Faulx, Dunia; Gerth-Guyette, Emily; Murunga, Peninah; Mahapatro, Samarendra; Das, Manoja Kumar; Ginsburg, Amy Sarah

2016-01-01

Pneumonia is the leading cause of death from infection in children worldwide. Despite global treatment recommendations that call for children with pneumonia to receive amoxicillin dispersible tablets, only one-third of children with pneumonia receive any antibiotics and many do not complete the full course of treatment. Poor adherence to antibiotics may be driven in part by a lack of user-friendly treatment instructions. In order to optimise childhood pneumonia treatment adherence at the community level, we developed a user-friendly product presentation for caregivers and a job aid for healthcare providers (HCPs). This paper aims to document the development process and offers a model for future health communication tools. We employed an iterative design process that included document review, key stakeholder interviews, engagement with a graphic designer and pre-testing design concepts among target users in India and Kenya. The consolidated criteria for reporting qualitative research were used in the description of results. Though resources for pneumonia treatment are available in some countries, their content is incomplete and inconsistent with global recommendations. Document review and stakeholder interviews provided the information necessary to convey to caregivers and recommendations for how to present this information. Target users in India and Kenya confirmed the need to support better treatment adherence, recommended specific modifications to design concepts and suggested the development of a companion job aid. There was a consensus among caregivers and HCPs that these tools would be helpful and improve adherence behaviours. The development of user-friendly instructions for medications for use in low-resource settings is a critically important but time-intensive and resource-intensive process that should involve engagement with target audiences. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence

Dietary and fluid adherence among haemodialysis patients ...

African Journals Online (AJOL)

comparison with major infectious diseases such as AIDS, tuberculosis ... dietary and fluid adherence is of crucial importance to the quality of life and survival of ... behaviours such as medication adherence among psychiatric ... or nursing sister and introduced to one of the study personnel who .... Children per household. 61.

Positive airway pressure adherence and subthreshold adherence in posttraumatic stress disorder patients with comorbid sleep apnea

Directory of Open Access Journals (Sweden)

Krakow BJ

2017-11-01

Full Text Available Barry J Krakow,1–3 Jessica J Obando,2 Victor A Ulibarri,1,2 Natalia D McIver1,2 1Sleep & Human Health Institute, 2Maimonides Sleep Arts & Sciences, Albuquerque, 3Los Alamos Medical Center, Los Alamos, NM, USA Study objectives: Patients with comorbid posttraumatic stress disorder (PTSD and obstructive sleep apnea (OSA manifest low adherence to continuous positive airway pressure (CPAP due to fixed, pressure-induced expiratory pressure intolerance (EPI, a subjective symptom and objective sign aggravated by anxiety sensitivity and somatosensory amplification. As advanced PAP therapy modes (ie, auto-bilevel PAP [ABPAP] or adaptive servo-ventilation [ASV] may address these side effects, we hypothesized such treatment would be associated with decreased expiratory intolerance and increased adherence in posttraumatic stress patients with co-occurring OSA.Methods: We reviewed charts of 147 consecutive adult patients with moderately severe posttraumatic stress symptoms and objectively diagnosed OSA. All patients failed or rejected CPAP and were manually titrated on auto-adjusting, dual-pressure ABPAP or ASV modes in the sleep laboratory, a technique to eliminate flow limitation breathing events while resolving EPI. Patients were then prescribed either mode of therapy. Follow-up encounters assessed patient use, and objective data downloads (ODDs measured adherence.Results: Of 147 charts reviewed, 130 patients were deemed current PAP users, and 102 provided ODDs: 64 used ASV and 38 used ABPAP. ODDs yielded three groups: 59 adherent per insurance conventions, 19 subthreshold compliant partial users, and 24 noncompliant. Compliance based on available downloads was 58%, notably higher than recently reported rates in PTSD patients with OSA. Among the 19 partial users, 17 patients were minutes of PAP use or small percentages of nights removed from meeting insurance compliance criteria for PAP devices.Conclusion: Research is warranted on advanced PAP modes in

Pattern and Determinants of Antiretroviral Drug Adherence among Nigerian Pregnant Women

Directory of Open Access Journals (Sweden)

S. O. Ekama

2012-01-01

Full Text Available Background. The need for a high level of adherence to antiretroviral drugs has remained a major hurdle to achieving maximal benefit from its use in pregnancy. This study was designed to determine the level of adherence and identify factors that influence adherence during pregnancy. Method. This is a cross-sectional study utilizing a semistructured questionnaire. Bivariate and multiple logistic regression models were used to determine factors independently associated with good drug adherence during pregnancy. Result. 137 (80.6% of the interviewed 170 women achieved adherence level of ≥95% using 3 day recall. The desire to protect the unborn child was the greatest motivation (51.8% for good adherence. Fear of being identified as HIV positive (63.6% was the most common reason for nonadherence. Marital status, disclosure of HIV status, good knowledge of ART, and having a treatment supporter were found to be significantly associated with good adherence at bivariate analysis. However, after controlling for confounders, only HIV status disclosure and having a treatment partner retained their association with good adherence. Conclusion. Disclosure of HIV status and having treatment support are associated with good adherence. Maternal desire to protect the child was the greatest motivator for adherence.

Sport and globalization

DEFF Research Database (Denmark)

Gems, Gerald R.; Pfister, Gertrud Ursula

2014-01-01

The authors describe, analyze and evaluate sport related globalization processes with a focus on transnationalism, colonialism, imperialism, and, more generally, geopolitical developments. They provide a variety of theoretical frameworks as they explore the emergence of modern sport and its...... dissemination around the world. In spite of resistance by the adherents of gymnastics or traditional movement cultures, sport with its focus on competition and records became popular all over the world. Both Great Britain and the United States induced their political and cultural hegemony via the soft power...... of modern sport which caused reactions, e.g. resistances or adaptations of indigenous, colonized, and other affected populations....

Biodiversity and global change. Adaptative responses to global change: results and prospective. IFB-GICC restitution colloquium; Biodiversite et changement global. Reponses adaptatives au changement global: resultats et prospective. Colloque de restitution IFB-GICC

Energy Technology Data Exchange (ETDEWEB)

Despres, L; Hossaert-Mckey, M; Martin, J F; Pont, D; Valero, M; Chave, J; Benizri, E; Amiaud, B; Boury-Esnault, N; Fritz, H; Lavelle, P; Martin, F; Poulet, S; Blanchard, F; Cheddadi, R; Dupouey, J L; Hulle, M; Michaux, J; Souissi, S; Bridault, A; Dambrine, E; Gomez, B; Thevenard, F; Legendre, S; Suc, J P; Zeitoun, V; Bezancon, G; Frascaria-Lacoste, N; Ponsard, S; Bourguet, D; Vigne, J D; Doyen, L; Joly, P; Gourlet-Fleury, S; Garnier, E; Lebaron, Ph; Boulinier, Th; Chuine, I; Jiguet, F; Couvet, D; Soussana, J F; Weimerskirsch, H; Grosbois, V; Bretagnolle, V

2006-07-01

Global change is the consequence of the worldwide human print on ecology. The uncontrolled use of fossil fuels, the urbanization, the intensifying of agriculture, the homogenization of life styles and cultures, the homogenization of fauna and vegetation, the commercial trades, the bio-invasions, the over-exploitation of resources and the emergence of new economic powers (China, India, Brazil..) represent an adaptative dynamics of interactions which affects the overall biosphere and the adaptative capacities and the future of all species. Biodiversity is an ecological and societal insurance against the risks and uncertainties linked with global change. The French institute of biodiversity (IFB) has created a working group in charge of a study on global change and biodiversity, in particular in terms of: speed and acceleration of processes, interaction between the different organization levels of the world of living, scale changes, and adaptative capacities. 38 projects with an interdisciplinary approach have been retained by the IFB and the Ministry of ecology and sustainable development. The conclusion of these projects were presented at this restitution colloquium and are summarized in this document. The presentations are organized in 7 sessions dealing with: global changes and adaptation mechanisms; functional responses to global changes; spatial responses to global changes; temporal responses to global changes; selective answers to global changes; available tools and ecological services; scenarios and projections. (J.S.)

Resilience, religiosity and treatment adherence in hemodialysis patients: a prospective study.

Science.gov (United States)

Freire de Medeiros, Camila Maroni Marques; Arantes, Eder Pinheiro; Tajra, Rafael Dib de Paulo; Santiago, Hendrio Reginaldo; Carvalho, André Ferrer; Libório, Alexandre Braga

2017-06-01

Resilience and religiosity have received attention as an important process in the experience and management of chronic comorbidities; however, there is no study evaluating resilience in hemodialysis patients and its association with other psychological dimensions or with treatment adherence. This observational prospective study assessed resilience (25 item Wagnild and Young Resilience Scale), religiosity under three dimensions (organizational, non-organizational and intrinsic) using DUREL scale, depressive symptoms (Patient Health Questionnaire-9) and health-related quality of life (Short Form-36 questionnaire). The main outcomes were medication adherence using the Morisky Medication Adherence Scale-8 (MMAR-8) and the missing/shortened dialysis sessions in the following six months. Of 208 patients approached, 202 (97.1%) agreed to participate. One hundred twenty-three patients (60.9%) were males and mean age was 52.8 ± 14.8 years-old. The median time on hemodialysis was 36 months (IQR, 12, 84). 82 (40.6%) patients obtained a MMAS-8 score adherence'. Overall, the mean score of medication adherence was low (5.7 ± 2.1). About adherence to hemodialysis sessions, patients missed a total of 234 (1.6%) hemodialysis sessions. Forty-eight patients (23.7%) missed an average of at least three sessions in six months. Regarding adherence to medication, there was no association in the uni- or multivariate analysis between religiosity dimensions and MMAS-8 score. After adjustment, resilience was positively associated with MMAS-8 score (standardized β coefficient .239, p = .016). Organized and intrinsic religiosity were associated with adherence to dialysis sessions (standardized β coefficient .258, p = .004 and .231, p = .026, respectively). Interestingly, opposite to medication adherence, more resilient patients were associated with less adherence to hemodialysis sessions (standardized β coefficient -.296, p = .001). Religiosity was associated with dialysis

Assessing the impacts of 1.5 °C global warming - simulation protocol of the Inter-Sectoral Impact Model Intercomparison Project (ISIMIP2b)

Science.gov (United States)

Frieler, Katja; Lange, Stefan; Piontek, Franziska; Reyer, Christopher P. O.; Schewe, Jacob; Warszawski, Lila; Zhao, Fang; Chini, Louise; Denvil, Sebastien; Emanuel, Kerry; Geiger, Tobias; Halladay, Kate; Hurtt, George; Mengel, Matthias; Murakami, Daisuke; Ostberg, Sebastian; Popp, Alexander; Riva, Riccardo; Stevanovic, Miodrag; Suzuki, Tatsuo; Volkholz, Jan; Burke, Eleanor; Ciais, Philippe; Ebi, Kristie; Eddy, Tyler D.; Elliott, Joshua; Galbraith, Eric; Gosling, Simon N.; Hattermann, Fred; Hickler, Thomas; Hinkel, Jochen; Hof, Christian; Huber, Veronika; Jägermeyr, Jonas; Krysanova, Valentina; Marcé, Rafael; Müller Schmied, Hannes; Mouratiadou, Ioanna; Pierson, Don; Tittensor, Derek P.; Vautard, Robert; van Vliet, Michelle; Biber, Matthias F.; Betts, Richard A.; Bodirsky, Benjamin Leon; Deryng, Delphine; Frolking, Steve; Jones, Chris D.; Lotze, Heike K.; Lotze-Campen, Hermann; Sahajpal, Ritvik; Thonicke, Kirsten; Tian, Hanqin; Yamagata, Yoshiki

2017-11-01

In Paris, France, December 2015, the Conference of the Parties (COP) to the United Nations Framework Convention on Climate Change (UNFCCC) invited the Intergovernmental Panel on Climate Change (IPCC) to provide a special report in 2018 on the impacts of global warming of 1.5 °C above pre-industrial levels and related global greenhouse gas emission pathways. In Nairobi, Kenya, April 2016, the IPCC panel accepted the invitation. Here we describe the response devised within the Inter-Sectoral Impact Model Intercomparison Project (ISIMIP) to provide tailored, cross-sectorally consistent impact projections to broaden the scientific basis for the report. The simulation protocol is designed to allow for (1) separation of the impacts of historical warming starting from pre-industrial conditions from impacts of other drivers such as historical land-use changes (based on pre-industrial and historical impact model simulations); (2) quantification of the impacts of additional warming up to 1.5 °C, including a potential overshoot and long-term impacts up to 2299, and comparison to higher levels of global mean temperature change (based on the low-emissions Representative Concentration Pathway RCP2.6 and a no-mitigation pathway RCP6.0) with socio-economic conditions fixed at 2005 levels; and (3) assessment of the climate effects based on the same climate scenarios while accounting for simultaneous changes in socio-economic conditions following the middle-of-the-road Shared Socioeconomic Pathway (SSP2, Fricko et al., 2016) and in particular differential bioenergy requirements associated with the transformation of the energy system to comply with RCP2.6 compared to RCP6.0. With the aim of providing the scientific basis for an aggregation of impacts across sectors and analysis of cross-sectoral interactions that may dampen or amplify sectoral impacts, the protocol is designed to facilitate consistent impact projections from a range of impact models across different sectors (global

Is Inconsistent Pre-treatment Bedtime Related to CPAP Non-Adherence?

Science.gov (United States)

Sawyer, Amy M.; King, Tonya S.; Sawyer, Douglas A.; Rizzo, Albert

2014-01-01

Lack of adherence to continuous positive airway pressure therapy (CPAP) limits the effectiveness of treatment of obstructive sleep apnea (OSA). We hypothesized that an irregular bedtime would be negatively related to regular use of CPAP treatment. If so, modifying bedtime schedule may address the persistent problem of inconsistent CPAP use in adults with OSA. In a prospective longitudinal study, we examined whether inconsistent self-reported bedtime before initiation of CPAP treatment, operationalized as bedtime variability, was (1) different among those adherent (≥ 4 hours per night) and non-adherent to CPAP treatment at one week and one month; and/or (2) was related to one-week and one-month CPAP use when other variables were accounted for. Consecutively-recruited newly-diagnosed OSA adults (N=79) completed sleep diaries prior to CPAP treatment. One-week and one-month objective CPAP use data were collected. Pre-treatment bedtime variability was different among CPAP non-adherers and adherers at one month and was a significant predictor of non-adherence at one month in multivariate analyses. The odds of one-month CPAP non-adherence were 3.5 times greater in those whose pre-treatment bedtimes varied by >75 minutes. Addressing sleep schedule prior to CPAP initiation may be an opportunity to improve CPAP adherence. PMID:25353159

Medication non-adherence and uncertainty

DEFF Research Database (Denmark)

Kriegbaum, Margit; Lau, Sofie Rosenlund

2017-01-01

BACKGROUND: Statins are widely prescribed to lower cardiovascular morbidity and mortality. However, statin non-adherence is very high. PURPOSE: The aim of this paper was to investigate reasons for stopping statin treatment in the general population and to study how aspects of information-seeking ......BACKGROUND: Statins are widely prescribed to lower cardiovascular morbidity and mortality. However, statin non-adherence is very high. PURPOSE: The aim of this paper was to investigate reasons for stopping statin treatment in the general population and to study how aspects of information......-seeking and processing is associated with statin non-adherence. METHODS: This study used a population survey on 3050 Danish residents aged 45-65 years. Reasons for statin discontinuation was studied among those who were previous statin users. The association between information seeking and processing and statin...... from information disseminated by media outlets. Side effects and fear of side effects should be addressed in clinical practice. Health care professionals should pay attention to emotional aspects of how information is disseminated and perceived by statin users....

Impact of the financial crisis on adherence to treatment of a rural population in Crete, Greece.

Science.gov (United States)

Tsiligianni, Ioanna G; Papadokostakis, Polyvios; Prokopiadou, Dimitra; Stefanaki, Ioanna; Tsakountakis, Nikolaos; Lionis, Christos

2014-01-01

The global economic crisis has affected Greece. Data on patients' adherence to medications for chronic diseases are missing. The objective of this study was to identify to what extent the financial crisis and the repeated pharmacists strike have influenced patients adherence to therapy. A quantitative and qualitative study in rural Crete was designed and implemented in February 2013 with the use of a pretested questionnaire with opened and closed questions. Setting Rural practices in a well-defined geographical area of Crete. The questionnaire was addressed in all patients that visited the rural practices with chronic or acute diseases for two consecutive weeks. Main Outcome(s) and Measure(s): Age, annual income, adherence to therapy, patient's views and feelings. 288 patients participated. The mean age was 68±6.87. The majority of the patients have lowered the doses of several medications by themselves as they weren't able to afford the cost ie; all patients receiving insulin had lowered the dosages; 46.42% of patients with COPD or asthma had stopped their medications completely, decreased dosages or used similar medications that had in the past; patients with dislipidemia received their medications as suggested only in 51.8%. Patients with cardiovascular diseases received their medications as suggested in 75.6% while the rest have dismissed or skipped dosages. Most common emotions reported were those of sadness, fear, stress, anxiety and isolation. The economic crisis has influenced patients' adherence to therapy in rural areas as well as their psychological and emotional status. There is an urgent need for action within the context of primary care.

Factors associated with false-positive self-reported adherence to antihypertensive drugs.

Science.gov (United States)

Tedla, Y G; Bautista, L E

2017-05-01

Self-reported medication adherence is known to overestimate true adherence. However, little is known about patient factors that may contribute to the upward bias in self-reported medication adherence. The objective of this study is to examine whether demographic, behavioral, medication and mood factors are associated with being a false-positive self-reported adherer (FPA) to antihypertensive drug treatment. We studied 175 patients (mean age: 50 years; 57% men) from primary-care clinics starting antihypertensive drug treatment. Self-reported adherence (SRA) was measured with the Medication Adherence Report Scale (MARS) and by the number of drug doses missed in the previous week/month, and compared with pill count adherence ratio (PCAR) as gold standard. Data on adherence, demographic, behavioral, medication and mood factors were collected at baseline and every 3 months up to 1 year. FPA was defined as being a non-adherer by PCAR and an adherer by self-report. Mixed effect logistic regression was used for the analysis. Twenty percent of participants were FPA. Anxiety increased (odds ratio (OR): 3.00; P=0.01), whereas smoking (OR: 0.40; P=0.03) and drug side effects (OR: 0.46, P=0.03) decreased the probability for FPA by MARS. Education below high-school completion increased the probability of being an FPA as measured by missing doses in the last month (OR: 1.66; P=0.04) and last week (OR: 1.88; P=0.02). The validity of SRA varies significantly according to drug side effects, behavioral factors and patient's mood. Careful consideration should be given to the use of self-reported measures of adherence among patients likely to be false-positive adherers.

Measuring medication adherence in patients with incident hypertension: a retrospective cohort study.

Science.gov (United States)

Tang, Karen L; Quan, Hude; Rabi, Doreen M

2017-02-13

Though pharmacy claims data are commonly used to study medication adherence, there remains no standard operational definition for adherence especially for patients on multiple medications. Even when studies use the same terminology, the actual methods of calculating adherence can differ drastically. It is unclear whether the use of different definitions results in different conclusions regarding adherence and associated outcomes. The objective of our study was to compare adherence rates and associations with mortality using different operational definitions of adherence, and using various methods of handling concurrent medication use. We conducted a cohort study of patients aged ≥65 years from Manitoba, Canada, with incident hypertension diagnosed in 2004 and followed to 2009. We calculated adherence rates to anti-hypertensive medications using different operational definitions of medication adherence (including interval and prescription based medication possession ratios [MPR] and proportion of days covered [PDC]). For those on concurrent medications, we calculated adherence rates using the different methods of handling concurrent medication use, for each definition. We used logistic regression to determine the association between adherence and mortality for each operational definition. Among 2199 patients, 24.1% to 90.5% and 71.2% to 92.7% were considered adherent when using fixed interval and prescription-based interval medication possession ratios [MPRi and MPRp] respectively, depending on how concurrent medications were handled. Adherence was inversely associated with death, with the strongest association for MPRp measures. This association was significant only when considering adherence to any anti-hypertensive [aOR 0.70, 95% CI 0.51, 0.97], or when the mean of the class-specific MPRp's [adjusted OR 0.71, 95% CI 0.53, 0.95] was used. No significant association existed when the highest or lowest class-specific MPRp was used as the adherence estimate. The

Adherence of fluid interfaces and colloidal aggregation in emulsions

International Nuclear Information System (INIS)

Poulin, Philippe

1995-01-01

This research thesis addresses some aspects of the behaviour of emulsions in which droplets are adhesive, and are thus characterised by their ability to stick to one another or on surfaces. The objective is also to identify various adhesive systems while describing their behaviour in order to start to build up a rationale of these phenomena. The author mainly focuses on the adherence of single layers of adsorbed surfactants: by inducing and controlling this adherence, it is possible to make the droplets stick. After a brief presentation of the wetting phenomenon and of the adherence of emulsion droplets, the author presents theoretical backgrounds of adherence, and describes the thermodynamics of liquid films. He presents the general approach which has been adopted to search for and control adherence phenomena in emulsions, and outlines challenges and difficulties related to the use of adhesive particles in industrial applications. A method of measurement of the contact angle between droplets of some tens of microns is described. In the next part, the author reports the characterisation of adherence properties of different emulsions: measurement of adherence energy with respect to some parameters by using contact angle measurements, study of mixed systems (mixtures of surfactants) to illustrate the applicability to industrial formulas. In a last part, the author reports measurements of film thickness between stuck droplets by using experiments of small angle neutron scattering [fr

Adherence to internet-based mobile-supported stress management

DEFF Research Database (Denmark)

Zarski, A C; Lehr, D.; Berking, M.

2016-01-01

of this study was to investigate the influence of different guidance formats (content-focused guidance, adherence-focused guidance, and administrative guidance) on adherence and to identify predictors of nonadherence in an Internet-based mobile-supported stress management intervention (ie, GET.ON Stress......) for employees. Methods: The data from the groups who received the intervention were pooled from three randomized controlled trials (RCTs) that evaluated the efficacy of the same Internet-based mobile-supported stress management intervention (N=395). The RCTs only differed in terms of the guidance format...... of the predictors significantly predicted nonadherence. Conclusions: Guidance has been shown to be an influential factor in promoting adherence to an Internet-based mobile-supported stress management intervention. Adherence-focused guidance, which included email reminders and feedback on demand, was equivalent...

Transcultural adaptation and validation of the Celiac Dietary Adherence Test: a simple questionnaire to measure adherence to a gluten-free diet

Directory of Open Access Journals (Sweden)

Ricardo Fueyo-Díaz

Full Text Available Background and aims: A gluten-free diet is to date the only treatment available to celiac disease sufferers. However, systematic reviews indicate that, depending on the method of evaluation used, only 42% to 91% of patients adhere to the diet strictly. Transculturally adapted tools that evaluate adherence beyond simple self-informed questions or invasive analyses are, therefore, of importance. The aim is to obtain a Spanish transcultural adaption and validation of Leffler's Celiac Dietary Adherence Test. Methods: A two-stage observational transversal study: translation and back translation by four qualified translators followed by a validation stage in which the questionnaire was administered to 306 celiac disease patients aged between 12 and 72 years and resident in Aragon. Factorial structure, criteria validity and internal consistency were evaluated. Results: The Spanish version maintained the 7 items in a 3-factor structure. Feasibility was very high in all the questions answered and the floor and ceiling effects were very low (4.3% and 1%, respectively. The Spearman correlation with the self-efficacy and life quality scales and the self-informed question were statistically significant (p < 0.01. According to the questionnaire criteria, adherence was 72.3%. Conclusion: The Spanish version of the Celiac Dietary Adherence Test shows appropriate psychometric properties and is, therefore, suitable for studying adherence to a gluten-free diet in clinical and research environments.

Adherence to treatment of patients with past ischemic stroke.

Directory of Open Access Journals (Sweden)

V. Je. Azarenko

2018-05-01

Full Text Available The main task of the general practitioner is managing patients with the effects of ischemic stroke. The improvement of patients adherence to treatment in a significant way contributes to successful secondary prevention of ischemic stroke. Adherence to treatment can be determined through various questionnaires, including Morissky-Green. Currently, the adherence to a long-term drug therapy remains insufficient.

It's the adherence, stupid (that determines asthma control in preschool children)!

Science.gov (United States)

Klok, Ted; Kaptein, Adrian A; Duiverman, Eric J; Brand, Paul L

2014-03-01

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-term asthma control in young children with asthma. In this observational study, 81 2-6-year-old asthmatic children, using inhaled corticosteroids, closely followed-up in a programme with extensive self-management training, were enrolled. Adherence was measured daily for 12 months using Smartinhaler (Nexus6 Ltd, Auckland, New Zealand) devices. Long-term asthma control was assessed by parents and physicians and included clinical assessment, an asthma control questionnaire and lung function measurement. We examined the association of adherence to asthma control, adjusting for seasonal influences and clinical characteristics. Median (interquartile range) adherence was 87% (70-94%), and 64 (79%) children had well-controlled asthma throughout follow-up. Adherence >80% was associated with better asthma control, and we found no important confounders of this association. Children with persistent mild symptoms had lower adherence rates (p=0.028). Guideline-based asthma care was associated with good asthma control in most children. Adherence to inhaled corticosteroids was an independent strong predictor of long-term asthma control, with highest levels of asthma control found in children with adherence >80% of doses prescribed.

Improving medication adherence: a framework for community pharmacy-based interventions

Directory of Open Access Journals (Sweden)

Pringle J

2015-11-01

Full Text Available Janice Pringle,1 Kim C Coley2 1Program Evaluation and Research Unit, Department of Pharmacy and Therapeutics, School of Pharmacy, University of Pittsburgh, Pittsburgh, PA, USA; 2Department of Pharmacy and Therapeutics, School of Pharmacy, University of Pittsburgh, Pittsburgh, PA, USA Abstract: Evidence supports that patient medication adherence is suboptimal with patients typically taking less than half of their prescribed doses. Medication nonadherence is associated with poor health outcomes and higher downstream health care costs. Results of studies evaluating pharmacist-led models in a community pharmacy setting and their impact on medication adherence have been mixed. Community pharmacists are ideally situated to provide medication adherence interventions, and effective strategies for how they can consistently improve patient medication adherence are necessary. This article suggests a framework to use in the community pharmacy setting that will significantly improve patient adherence and provides a strategy for how to apply this framework to develop and test new medication adherence innovations. The proposed framework is composed of the following elements: 1 defining the program's pharmacy service vision, 2 using evidence-based, patient-centered communication and intervention strategies, 3 using specific implementation approaches that ensure fidelity, and 4 applying continuous evaluation strategies. Within this framework, pharmacist interventions should include those services that capitalize on their specific skill sets. It is also essential that the organization's leadership effectively communicates the pharmacy service vision. Medication adherence strategies that are evidence-based and individualized to each patient's adherence problems are most desirable. Ideally, interventions would be delivered repeatedly over time and adjusted when patient's adherence circumstances change. Motivational interviewing principles are particularly well

Predictors of duloxetine adherence and persistence in patients with fibromyalgia

Directory of Open Access Journals (Sweden)

Cui Z

2012-06-01

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

Assessing adolescent asthma symptoms and adherence using mobile phones.

Science.gov (United States)

Mulvaney, Shelagh A; Ho, Yun-Xian; Cala, Cather M; Chen, Qingxia; Nian, Hui; Patterson, Barron L; Johnson, Kevin B

2013-07-17

Self-report is the most common method of measuring medication adherence but is influenced by recall error and response bias, and it typically does not provide insight into the causes of poor adherence. Ecological momentary assessment (EMA) of health behaviors using mobile phones offers a promising alternative to assessing adherence and collecting related data that can be clinically useful for adherence problem solving. To determine the feasibility of using EMA via mobile phones to assess adolescent asthma medication adherence and identify contextual characteristics of adherence decision making. We utilized a descriptive and correlational study design to explore a mobile method of symptom and adherence assessment using an interactive voice response system. Adolescents aged 12-18 years with a diagnosis of asthma and prescribed inhalers were recruited from an academic medical center. A survey including barriers to mobile phone use, the Illness Management Survey, and the Pediatric Asthma Quality of Life Questionnaire were administered at baseline. Quantitative and qualitative assessment of asthma symptoms and adherence were conducted with daily calls to mobile phones for 1 month. The Asthma Control Test (ACT) was administered at 2 study time points: baseline and 1 month after baseline. The sample consisted of 53 adolescents who were primarily African American (34/53, 64%) and female (31/53, 58%) with incomes US$40K/year or lower (29/53, 55%). The majority of adolescents (37/53, 70%) reported that they carried their phones with them everywhere, but only 47% (25/53) were able to use their mobile phone at school. Adolescents responded to an average of 20.1 (SD 8.1) of the 30 daily calls received (67%). Response frequency declined during the last week of the month (b=-0.29, PMobile phones provided a feasible method to assess asthma symptoms and adherence in adolescents. The EMA method was consistent with the ACT, a widely established measure of asthma control, and results

ADHERENCE TO ANTIRETROVIRAL THERAPY IN A TERTIARY CARE HOSPITAL

Directory of Open Access Journals (Sweden)

Muralidhara Panigrahi

2017-03-01

Full Text Available BACKGROUND The Million Death Study Collaborators in the British Medical Journal have estimated that the people living with HIV/AIDS population to be between 1.4-1.6 million. Development of Antiretroviral Therapy (ART has been one of the dramatic advances in the history of medicine. Among several factors that can affect the ART outcome, adherence to the ART has been cited as a major factor associated with poor outcomes. For ART to have maximum effect greater than 95%, adherence has been suggested. Additionally, non adherence to ART is a major cause of HIV drug resistance. Especially, in the Indian context, adherence to ART is very important due to the sheer number of HIV/AIDS cases, the socioeconomic status, diversity of the population and regions. That is, the socioeconomic challenges faced by patients contribute to nonadherence to ART in India. With this background, this study was done with the primary objective of assessing the level of adherence to the given regimen of ART as per the NACO guidelines and factors influencing adherence. MATERIALS AND METHODS This is a prospective patient record-based study conducted in the Antiretroviral Therapy Centre at MKCG Medical College, Berhampur, from January 2016 to June 2016. Simple random sampling technique was used to select 150 patients’ records from the ART Centre of the medical college. The data was collected in a predesigned case record form from the patient card available at antiretroviral therapy centre. The patients were followed up through the patient card for six months from their recruitment. The adherence to treatment was evaluated using the adherence score adopted by NACO where a score of 1, 2 and 3 implied that 95%, 80-95% and 95% medication taken. Persons with primary education, married individuals and persons without employment had better improvement in adherence score than other groups. Anaemia was the predominant adverse drug reaction encountered. CONCLUSION The findings of this