Efficiency, Efficacy, and Power in the Implementation of a Medication Adherence Aid.

Nonadherence to medication regimens is common, with approximately 50% of patients not taking their medications as prescribed. The Universal Medication Schedule (UMS) is a set of standardized, evidence-based, and patient-centered instructions for pill-form medications that has demonstrated improvements in adherence by promoting patient comprehension. An urban, publicly funded, integrated health care system attempted to adopt UMS labeling but had limited success at its largest pilot site, which was a safety-net health care system's outpatient pharmacy. To assess barriers to implementation, we engaged pharmacists at this site in group interviews. We thematically analyzed transcripts by integrating sociological work on standardization with grounded theory methodologies. In addition to lacking technological infrastructure, tensions among efficiency, efficacy, and effectiveness, and tension between individual/biomedical versus population health perspectives emerged as barriers to implementation. Additionally, we discovered that hierarchies of professional power impeded uptake. For successful implementation of evidence-based practices for vulnerable populations in resource-poor settings, efforts must anticipate and reconcile the tensions among conflicting demands, professional hierarchies, and divergent orientations to patient care. [HLRP: Health Literacy Research and Practice. 2018;2(3):e128-e131.]

Role of Poly (ADP-Ribose) Polymerase inhibitors beyond BReast CAncer Gene-mutated ovarian tumours: definition of homologous recombination deficiency?

Purpose of review: PARP inhibitors have transformed the management of BRCA mutant (BRCAmut) high-grade serous and endometroid ovarian cancer (HGOC). However, it is clear that the benefit can be extended beyond this subgroup, particularly to those cancers with homologous recombination repair deficiency (HRD). We review emerging molecular and clinical data to support the use of PARP inhibitors in HRD HGOC and discuss the advantages and disadvantages of different HRD assays. Recent findings: Several phase 3 trials support the use of PARP inhibitor maintenance therapy beyond those patients with BRCAmut in the first-line and platinum-sensitive relapse setting. Many of these studies included HRD testing and it is clear, regardless of the assay used, that an incremental reduction in benefit is observed from BRCAmut tumours to HRD to homologous recombination proficient tumours. However, although currently available HRD assays predict the magnitude of benefit from PARP inhibitors, they consistently fail to identify a subgroup of patients who do not benefit. Summary: Clinical data support the use of PARP inhibitor maintenance therapy beyond BRCAmut patients. Current HRD tests lack negative predictive value and more research is required to develop a composite HRD assay that provides a dynamic readout of HRD status

Phosphorus Fertilizer and Stocking Rate Effects on Soil Microbial Biomass of a Long-Term Dairy Farmlet Experiment

The effects of a range of P fertilizer rates and dairy cow stocking rates on microbial biomass carbon and phosphorus were compared in a long-term farmlet trial in southeastern Australia. Pastures were stocked at 2, 3, or 4 cows/ha and received fertilizer at rates of 0, 35, 70 or 140 kgP/ha. There was no effect of either P fertilizer rate or stocking rate on microbial biomass C from 1995 to 1998. Increasing P application rate significantly increased the chloroform-released microbial P flush measured, but stocking rate had no effect on microbial P. There were significant temporal changes, with the seasonal effects of soil temperature and moisture overriding treatment effects on these microbial measurements

Responses to Nitrogen Fertilizer in Dairy Pastures with Differing Phosphorus Fertility in South Eastern Australia

The application of nitrogen (N) fertilizer to temperate pastures is an increasingly popular management tool for boosting pasture production on dairy farms in Australia. However, limited information is available about N fertilizer responses that can be obtained from pastures with varying levels of phosphorus (P) fertility. A field experiment examining the initial and residual response of pasture growth to urea was carried out within a large dairy farmlet study, in October 1998. The four P fertility treatments (Olsen P values) ranged from 9 to 32 mg/kg. Dry matter yields increased with increasing N rates in all treatments, at both harvests. Only pastures with Olsen P values of \u3c 12 mg/kg had a significantly lower response to N fertilizer

Grazing Management Impacts on the Riparian Zone and Water Quality

Inappropriate farm management activities such as stock access to creeks, and poor fertiliser and effluent management can negatively impact riparian zones and waterways, contributing to increased in-stream nutrient, sediment and microbiological loads and loss of riparian biodiversity, amongst other impacts. Nutrient budgets for dairy systems indicate that on-farm nutrient accumulation and redistribution is common (Gourley 2004), which in large part is due to the uneven distribution of dairy cow dung and the nutrients they contain (Aarons et al., 2004). The \u27Gippsland Dairy Riparian Project Environmental Monitoring module\u27 was established in Jan. 2003 to monitor the impact of dairy farm management and changed riparian zone management on the riparian zone and water quality