Primary care physicians' perceptions of barriers and facilitators to management of chronic kidney disease: A mixed methods study.

BackgroundGiven the high prevalence of chronic kidney disease (CKD), primary care physicians (PCPs) frequently manage early stage CKD. Nonetheless, there are challenges in providing optimal CKD care in the primary care setting. This study sought to understand PCPs' perceptions of barriers and facilitators to the optimal management of CKD.Study designMixed methods study.Settings and participantsCommunity-based PCPs in four US cities: Baltimore, MD; St. Louis, MO; Raleigh, NC and San Francisco, CA.MethodologyWe used a self-administered questionnaire and conducted 4 focus groups of PCPs (n = 8 PCPs/focus group) in each city to identify key barriers and facilitators to management of patients with CKD in primary care.Analytic approachWe conducted descriptive analyses of the survey data. Major themes were identified from audio-recorded interviews that were transcribed and coded by the research team.ResultsOf 32 participating PCPs, 31 (97%) had been in practice for >10 years, and 29 (91%) practiced in a non-academic setting. PCPs identified multiple barriers to managing CKD in primary care including at the level of the patient (e.g., low awareness of CKD, poor adherence to treatment recommendations), the provider (e.g., staying current with CKD guidelines), and the health care system (e.g., inflexible electronic medical record, limited time and resources). PCPs desired electronic prompts and lab decision support, concise guidelines, and healthcare financing reform to improve CKD care.ConclusionsPCPs face substantial but modifiable barriers in providing care to patients with CKD. Interventions that address these barriers and promote facilitative tools may improve PCPs' effectiveness and capacity to care for patients with CKD

Plant chemicals and the sexual behavior of male tephritid fruit flies

Plant compounds affect insects in many different ways. In addition to being a food source, plants also contain secondary metabolites that may have positive and negative impacts on insects. The influence of these compounds on sexual behavior, in particular, has been the focus of many recent studies. Here, we review the existing literature on the effects of plant compounds on the sexual behavior of tephritid fruit fly males. We put special focus on polyphagous species whose males congregate in leks, where females exert strong mate selection. We first summarize the main findings related to plant compounds that increase male signaling behavior and attraction of females and consequently increase mating frequency, a phenomenon that has been recorded mainly for species of Anastrepha and Ceratitis. In other tephritid species, males are attracted to phenylpropanoids produced by plants (such as methyl eugenol or raspberry ketone) that, upon encounter, are consumed and sequestered by males. These compounds, or metabolic derivatives, which normally have negligible nutritional value, are included in the pheromone and also confer advantages in a sexual context: enhanced female attraction and improved male mating success. These phenomena have been reported for several Bactrocera species as well as for Zeugodacus cucurbitae. Because many tephritid species are serious pests, the effect of plant compounds on male behavior has been explored for potential incorporation into control strategies such as the sterile insect technique (SIT). We conclude noting several factors, such as age and nutrition during larval and adult stage, that modulate the effect of plant compounds on male mating behavior as well as some prominent gaps that preclude a thorough understanding of the plant-mediated enhancement of male sexual performance and hence limit our ability to effectively utilize phytochemicals in pest control strategies.Instituto de GenéticaFil: Segura, Diego Fernando. Instituto Nacional de Tecnología Agropecuaria (INTA). Instituto de Genética. Laboratorio de Genética de Insectos de Importancia Económica; Argentina. Consejo Nacional de Investigaciones Científicas y Técnicas; ArgentinaFil: Belliard, Silvina A. Instituto Nacional de Tecnología Agropecuaria (INTA). Instituto de Genética. Laboratorio de Genética de Insectos de Importancia Económica; Argentina. Consejo Nacional de Investigaciones Científicas y Técnicas; ArgentinaFil: Vera, María Teresa. Consejo Nacional de Investigaciones Científicas y Técnicas; Argentina. Universidad Nacional de Tucumán. Facultad de Agronomía y Zootecnia; ArgentinaFil: Bachmann, Guillermo Enrique. Instituto Nacional de Tecnología Agropecuaria (INTA). Instituto de Genética. Laboratorio de Genética de Insectos de Importancia Económica; Argentina. Consejo Nacional de Investigaciones Científicas y Técnicas; ArgentinaFil: Ruiz, María Josefina. Consejo Nacional de Investigaciones Científicas y Técnicas; Argentina. Universidad Nacional de Tucumán. Facultad de Agronomía y Zootecnia; ArgentinaFil: Jofre-Barud, Flavia. Instituto Nacional de Tecnología Agropecuaria (INTA). Estación Experimental Agropecuaria San Juan; Argentina. Consejo Nacional de Investigaciones Científicas y Técnicas; ArgentinaFil: Fernández, Patricia. Instituto Nacional de Tecnología Agropecuaria (INTA). Estación Experimental Agropecuaria Delta del Paraná; Argentina. Consejo Nacional de Investigaciones Científicas y Técnicas; ArgentinaFil: Lopez, M. Liza. Instituto Nacional de Tecnología Agropecuaria (INTA). Estación Experimental Agropecuaria San Juan; Argentina. Consejo Nacional de Investigaciones Científicas y Técnicas; ArgentinaFil: Shelly, Todd E. United States Department of Agriculture. Animal and Plant Health Inspection Service; Estados Unido

an introduction to personalized ehealth

Personalized medicine can be defined as the adaptation of medical treatments to the specific characteristics of patients. This approach allows health providers to develop therapies and interventions by taking into account the heterogeneity of illnesses and external factors such as the environment, patients' needs, and lifestyle. Technology could play an important role to achieve this new approach to medicine. An example of technology's utility regards real-time monitoring of individual well-being (subjective and objective), in order to improve disease management through data-driven personalized treatment recommendations. Another important example is an interface designed based on patient's capabilities and preferences. These could improve patient-doctor communication: on one hand, patients have the possibility to improve health decision-making; on the other hand, health providers could coordinate care services more easily, because of continual access to patient's data. This contribution deepens these technologies and related opportunities for health, as well as recommendation for successful development and implementation

A dynamic programming algorithm for the buffer allocation problem in homogeneous asymptotically reliable serial production lines

<p>In this study, the buffer allocation problem (BAP) in homogeneous, asymptotically reliable serial production lines is considered. A known aggregation method, given by Lim, Meerkov, and Top (1990), for the performance evaluation (i.e., estimation of throughput) of this type of production lines when the buffer allocation is known, is used as an evaluative method in conjunction with a newly developed dynamic programming (DP) algorithm for the BAP. The proposed algorithm is applied to production lines where the number of machines is varying from four up to a hundred machines. The proposed algorithm is fast because it reduces the volume of computations by rejecting allocations that do not lead to maximization of the line's throughput. Numerical results are also given for large production lines.</p

Physiological and biological patterns of a highland and a coastal population of the European cherry fruit fly during diapause

Adult emergence of univoltine temperate insect species and its synchronization with specific host phenological stages is mainly regulated by obligatory pupal diapause. Although a few studies have investigated the factors affecting diapause intensity, little attention has been paid to the physiological alterations and metabolic regulation that take place during diapause. Here, we describe differences in diapause between a highland and a coastal Greek population of the European cherry fruit fly Rhagoletis cerasi, a major pest of sweet and sour cherries in many European countries. Pupae of both populations were exposed to the environmental conditions prevailing in the two areas and diapause termination was observed under laboratory conditions. The regulation of energetic metabolites during the long pupae stage was examined under both field and laboratory conditions. Differences in diapause intensity revealed that the two populations have adapted to the local geographical and climatic conditions and have different requirements for low temperatures to terminate diapause. The coastal population undergoes a shorter diapause and adults emerge more rapidly, especially in the highland area. The highland population failed to terminate diapause (<40% adult emergence) in the coastal area. Both populations draw on their major energetic reserves (lipids and protein) similarly during diapause. Nevertheless, regulation of carbohydrate and glycogen reserves seems to vary between the populations: major peaks of these stored nutrients occur on different dates in the two populations, suggesting a differential regulation. Differences in diapause intensity imply a genetic differentiation between the two populations. The importance of our findings in understanding the physiological patterns during obligatory diapause of a univoltine insect species, as well as the practical implications for the development of specific phenological models for the European cherry fruit fly are discussed. (C) 2010 Elsevier Ltd. All rights reserved

Estimating changes in mean population age using the death distributions of live-captured medflies

1. A simple, low-cost approach to estimating population ageing was introduced based on a modified version of the captive cohort method a technique developed earlier (Carey et al., Aging Cell, 7, 426437, 2008) in which information on the remaining lifespans of live-captured medflies of unknown age is used to estimate the overall population age structure. 2. To test this approach approximately 1200 medflies near Volos, Greece were live captured from daily sampling over a 3-month field season. 3. This simplified method reported: (i) an extraordinary post-capture longevity of wild medflies in early season (>200 days in longest lived); (ii) a decrease of 5075 days in the mean longevity from early-season to late-season flies; (iii) seasonality of frailty as indicated by the shorter-lived flies in late autumn; (iv) cessation of fly emergence in late season as indicated by the absence of long-lived individuals (indicating newly emerged at capture) sampled in the autumn; and (v) increase in mean age from about 20 days in early season to approximately 60 days in late season. 4. The applications of this simplified captive cohort method are discussed, including its use in the analysis of insect vector populations, Drosophila ecology and ageing in the wild, demographic toxicology, and age bias in sampling