Multimodal interventions to enhance adherence to secondary preventive medication after stroke: a systematic review and meta-analyses

Summary: Introduction: Nonadherence to secondary preventative medications after stroke is common and is associated with poor outcomes. Numerous strategies exist to promote adherence. We performed a systematic review and meta-analysis to describe the efficacy of strategies to improve adherence to stroke secondary prevention. Methods: We created a sensitive search strategy and searched multiple electronic databases (MEDLINE, EMBASE, CINAHL, PsycINFO, CENTRAL, and Web of Knowledge) for studies of interventions that aimed to enhance adherence to secondary preventative medication after stroke. We assessed quality of included studies using the Cochrane tool for assessing risk of bias. We performed narrative review and performed meta-analysis where data allowed. Results: From 12,237 titles, we included seventeen studies in our review. Eleven studies were considered to have high risk of bias, 3 with unclear risk, and 3 of low risk. Meta-analysis of available data suggested that these interventions improved adherence to individual medication classes (blood pressure-lowering drugs – OR, 2.21; 95% CI (1.63, 2.98), [P < 0.001], lipid-lowering drugs – OR, 2.11; 95% CI (1.00, 4.46), [P = 0.049], and antithrombotic drugs – OR, 2.32; 95% CI (1.18, 4.56, [P = 0.014]) but did not improve adherence to an overall secondary preventative medication regimen (OR, 1.96; 95% CI (0.50, 7.67), [P = 0.332]). Conclusion: Interventions can lead to improvement in adherence to secondary preventative medication after stroke. However, existing data is limited as several interventions, duration of follow-up, and various definitions were used. These findings need to be interpreted with caution

An experimental and numerical investigation of the effect of aero gas turbine test facility aspect ratio on thrust measurement

This work describes the outcome of research program investigating thrust measurements in enclosed test facility for modern aero gas turbine engines. Literature work, experimental work and a description of Computational fluid dynamics simulation system have been developed to improve the accuracy of test bed thrust measurement. The key parameters covered in the research include test house size in relation to engine size. The effect of the distance of engine to detuner on the thrust correction factor was also investigated. The rule of loss mechanism within the test facility to include intake momentum drag, cradle drag, base drag, recirculation on loss and intake exhaust losses loss. The thrust correction factor prediction technique available in the open literature are compared with the result given by this research and conclusion are drawn. CFD predictions show that the biggest difference with experimental data is only 1 % in TCF for the largest test cell size. For the smallest test cell this difference increases to only 2%. These results in terms of accuracy are lower than what would normally be expected for general CFD work. The major contributions to thrust measurement technology include the following: 1. The research was able to ascertain that as engine size increases it will become more risky to rely on test bed results as giving an accurate prediction of static thrust. 2. The work has enabled confident prediction that test bed results can give test bed static thrust compared to free air testing with an accuracy of one half of 1%. 3. Using Fluent it has been possible to reproduce a comparable comparison with test bed results. This will give the user of the research a higher level of confidence in predicting thrust measurements for test beds whose size is small in comparison with engine size. 4. It is of course an ambition for all those working in the field to eliminate engine testing. However this is unachievable ambition. This research has shown the way to improve CFD prediction towards achieving this ambition. Finally detailed recommendations are given for continuation for this research program.EThOS - Electronic Theses Online ServiceGBUnited Kingdo

A research paper recommender system using a dynamic normalized tree of concepts model for user modelling

The enormous growth of information on the Internet makes finding information challenging and time consuming. Recommender systems provide a solution to this problem by automatically capturing user interests and recommending related information the user may also find interesting. In this paper, we present a novel recommender system for the research paper domain using a Dynamic Normalized Tree of Concepts (DNTC) model. Our system improves existing vector and tree of concepts models to be adaptable with a complex ontology and a large number of papers. The proposed system uses the 2012 version of the ACM Computing Classification System (CCS) ontology. This ontology has a much deeper structure than previous versions, which makes it challenging for previous ontology-based approaches to recommender systems. We performed offline evaluations using papers provided by ACM digital library for classifier training, and papers provided by CiteSeerX digital library for measuring the performance of the proposed DNTC model. Our evaluation results show that the novel DNTC model significantly outperforms the other two models: non-normalized tree of concepts and the vector of concepts models. Further, our DNTC model provides high average precision and reliable results when used in a context which the user has multiple interests and reads a large quantity of papers over time

Crystal structures of 4-phenylpiperazin-1-ium 6-chloro-5-ethyl-2,4-dioxopyrimidin-1-ide and 4-phenylpiperazin-1-ium 6-chloro-5-isopropyl-2,4-dioxopyrimidin-1-ide

The title molecular salts, C10H15N2+·C6H6ClN2O2−, (I), and C10H15N2+·C7H8ClN2O2−, (II), consist of 4-phenylpiperazin-1-ium cations with a 6-chloro-5-ethyl-2,4-dioxopyrimidin-1-ide anion in (I) and a 6-chloro-5-isopropyl-2,4-dioxopyrimidin-1-ide anion in (II). Salt (I) crystallizes with two independent cations and anions in the asymmetric unit. In the crystal structures of both salts, the ions are linked via N—H...O and N—H...N hydrogen bonds, forming sheets which are parallel to (100) in (I) and to (001) in (II). In (I), the sheets are linked via C—H...Cl hydrogen bonds, forming a three-dimensional framework

Systematic review of the safety of medication use in inpatient, outpatient and primary care settings in the Gulf Cooperation Council countries

Background Errors in medication use are a patient safety concern globally, with different regions reporting differing error rates, causes of errors and proposed solutions. The objectives of this review were to identify, summarise, review and evaluate published studies on medication errors, drug related problems and adverse drug events in the Gulf Cooperation Council (GCC) countries. Methods A systematic review was carried out using six databases, searching for literature published between January 1990 and August 2016. Research articles focussing on medication errors, drug related problems or adverse drug events within different healthcare settings in the GCC were included. Results Of 2094 records screened, 54 studies met our inclusion criteria. Kuwait was the only GCC country with no studies included. Prescribing errors were reported to be as high as 91% of a sample of primary care prescriptions analysed in one study. Of drug-related admissions evaluated in the emergency department the most common reason was patient non-compliance. In the inpatient care setting, a study of review of patient charts and medication orders identified prescribing errors in 7% of medication orders, another reported prescribing errors present in 56% of medication orders. The majority of drug related problems identified in inpatient paediatric wards were judged to be preventable. Adverse drug events were reported to occur in 8.5–16.9 per 100 admissions with up to 30% judged preventable, with occurrence being highest in the intensive care unit. Dosing errors were common in inpatient, outpatient and primary care settings. Omission of the administered dose as well as omission of prescribed medication at medication reconciliation were common. Studies of pharmacists’ interventions in clinical practice reported a varying level of acceptance, ranging from 53% to 98% of pharmacists’ recommendations. Conclusions Studies of medication errors, drug related problems and adverse drug events are increasing in the GCC. However, variation in methods, definitions and denominators preclude calculation of an overall error rate. Research with more robust methodologies and longer follow up periods is now required.Peer reviewe

Vibration Control of Fractionally-Damped Beam Subjected to a Moving Vehicle and Attached to Fractionally-Damped Multiabsorbers

This paper presents the dynamic response of Bernoulli-Euler homogeneous isotropic fractionally-damped simply-supported beam. The beam is attached to multi single-degree-of-freedom (SDOF) fractionally-damped systems, and it is subjected to a vehicle moving with a constant velocity. The damping characteristics of the beam and SDOF systems are described in terms of fractional derivatives. Three coupled second-order fractional differential equations are produced and then they are solved by combining the Laplace transform with the decomposition method. The obtained numerical results show that the dynamic response decreases as (a) the number of absorbers attached to the beam increases and (b) the damping-ratios of used absorbers and beam increase. However, there are some critical values of fractional derivatives which are different from unity at which the beam has less dynamic response than that obtained for the full-order derivatives model. Furthermore, the obtained results show very good agreements with special case studies that were published in the literature

Microsatellite-Based Genetic Structure and Diversity of Local Arabian Sheep Breeds

The genetic diversity of the sheep breeds in the Arab countries might be considered to be a mirror of the ecology of the region. In this study, the genetic structure and diversity of sheep breeds from Saudi Arabia (Harri, Najdi, Naemi, Arb, and Rufidi) and Awassi sheep from Jordan as an out-group were investigated using 19 microsatellites. All the breeds had high intra-population genetic diversity expressed as allelic number (7.33) and richness (2.9) and, expected heterozygosity (0.77). Structure analysis revealed three main gene pools underlying the ancestral genetic diversity of the study populations. The first pool had Harri, Najdi, and Rufidi breeds; the second had Naemi and Awassi breeds, and the third had the Arb breed which was significantly differentiated from the other breeds. Factorial correspondence analysis lent further support to the presence of the three gene pools. Although the outgroup Awassi sheep was more clearly differentiated, it still genetically close to Naemi sheep. The differentiation of the Arb breed could have been resulted from geographic and reproductive isolation. On the other hand, the genetic structure of the other two gene pools could be the result of the past and recent gene flow between individuals reared in the region known to be the center for animal husbandry and trading until the current time

Thermoregulatory and Physiological Responses of Najdi Sheep Exposed to Environmental Heat Load Prevailing in Saudi Arabia

The objective of this study was to evaluate the thermoregulatory and physiological responses of Najdi rams raised under hot summer conditions prevailing in Kingdom Saudi Arabia. The core temperature (Tcore) showed circadian rhythm characterized by biphasic achrophases, which were associated with the feeding times during both seasons. Average daily Tcore was significantly (P<0.05) higher under hot summer conditions. However, the amplitudes of the rhythmic oscillation during winter and summer seasons were 0.85 and 0.56C, respectively. Rectal (Tre) and skin temperatures (Tsk) were significantly (P<0.05) higher under hot summer conditions and exhibited similar patterns during both seasons concurrent with the pattern of temperature humidity index (THI), reaching the maximum values late in the afternoon and the minimum values early in the morning. Respiratory rate (RR) and heart rate (HR) showed the same pattern of the thermal parameters and were significantly (P<0.05) higher under hot summer conditions. Serum concentrations of total protein, globulin, glucose, sodium and chloride were significantly (P<0.05) increased while those of albumin and calcium were decreased under hot summer conditions. The results obtained from this study indicate that hot summer conditions of Saudi Arabia is thermally stressful to Najdi rams. Therefore, Najdi sheep production under such conditions would require environmental and/or nutritional modification to alleviate the impact of heat stress