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.]

Muon spin rotation study of the topological superconductor SrxBi2Se3

We report transverse-field (TF) muon spin rotation experiments on single crystals of the topological superconductor Sr$_x$Bi$_2$Se$_3$ with nominal concentrations $x=0.15$ and $0.18$ ($T_c \sim 3$ K). The TF spectra ($B= 10$ mT), measured after cooling to below $T_c$ in field, did not show any additional damping of the muon precession signal due to the flux line lattice within the experimental uncertainty. This puts a lower bound on the magnetic penetration depth $\lambda \geq 2.3 ~\mu$m. However, when we induce disorder in the vortex lattice by changing the magnetic field below $T_c$ a sizeable damping rate is obtained for $T \rightarrow 0$. The data provide microscopic evidence for a superconducting volume fraction of $\sim 70~ \%$ in the $x=0.18$ crystal and thus bulk superconductivity.Comment: 6 pages, includes 4 figure

The effect of distance on observed mortality, childhood pneumonia and vaccine efficacy in rural Gambia.

We investigated whether straight-line distance from residential compounds to healthcare facilities influenced mortality, the incidence of pneumonia and vaccine efficacy against pneumonia in rural Gambia. Clinical surveillance for pneumonia was conducted on 6938 children living in the catchment areas of the two largest healthcare facilities. Deaths were monitored by three-monthly home visits. Children living >5 km from the two largest healthcare facilities had a 2·78 [95% confidence interval (CI) 1·74-4·43] times higher risk of all-cause mortality compared to children living within 2 km of these facilities. The observed rate of clinical and radiological pneumonia was lower in children living >5 km from these facilities compared to those living within 2 km [rate ratios 0·65 (95% CI 0·57-0·73) and 0·74 (95% CI 0·55-0·98), respectively]. There was no association between distance and estimated pneumococcal vaccine efficacy. Geographical access to healthcare services is an important determinant of survival and pneumonia in children in rural Gambia

Early-Onset Epileptic Encephalopathies: Ohtahara Syndrome and Early Myoclonic Encephalopathy

AbstractOhtahara syndrome and early myoclonic encephalopathy are the earliest presenting of the epileptic encephalopathies. They are typically distinguished from each other according to specific clinical and etiologic criteria. Nonetheless, considerable overlap exists between the two syndromes in terms of clinical presentation, prognosis, and electroencephalographic signature. Newer understandings of underlying etiologies of these conditions may support the previously suggested concept that they represent a single spectrum of disease rather than two distinct disorders. We review both syndromes, with particular focus on the underlying genetics and pathophysiology and implications regarding the classification of these conditions

Examination of aerosol distributions and radiative effects over the Bay of Bengal and the Arabian Sea region during ICARB using satellite data and a general circulation model

In this paper we analyse aerosol loading and its direct radiative effects over the Bay of Bengal (BoB) and Arabian Sea (AS) regions for the Integrated Campaign on Aerosols, gases and Radiation Budget (ICARB) undertaken during 2006, using satellite data from the MODerate Resolution Imaging Spectroradiometer (MODIS) on board the Terra and Aqua satellites, the Aerosol Index from the Ozone Monitoring Instrument (OMI) on board the Aura satellite, and the European-Community Hamburg (ECHAM5.5) general circulation model extended by Hamburg Aerosol Module (HAM). By statistically comparing with large-scale satellite data sets, we firstly show that the aerosol properties measured during the ship-based ICARB campaign and simulated by the model are representative for the BoB and AS regions and the pre-monsoon season. In a second step, the modelled aerosol distributions were evaluated by a comparison with the measurements from the ship-based sunphotometer, and the satellite retrievals during ICARB. It is found that the model broadly reproduces the observed spatial and temporal variability in aerosol optical depth (AOD) over BoB and AS regions. However, AOD was systematically underestimated during high-pollution episodes, especially in the BoB leg. We show that this underprediction of AOD is mostly because of the deficiencies in the coarse mode, where the model shows that dust is the dominant component. The analysis of dust AOD along with the OMI Aerosol Index indicate that missing dust transport that results from too low dust emission fluxes over the Thar Desert region in the model caused this deficiency. Thirdly, we analysed the spatio-temporal variability of AOD comparing the ship-based observations to the large-scale satellite observations and simulations. It was found that most of the variability along the track was from geographical patterns, with a minor influence by single events. Aerosol fields were homogeneous enough to yield a good statistical agreement between satellite data at a 1° spatial, but only twice-daily temporal resolution, and the ship-based sunphotometer data at a much finer spatial, but daily-average temporal resolution. Examination of the satellite data further showed that the year 2006 is representative for the five-year period for which satellite data were available. Finally, we estimated the clear-sky solar direct aerosol radiative forcing (DARF). We found that the cruise represents well the regional-seasonal mean forcings. Constraining simulated forcings using the observed AOD distributions yields a robust estimate of regional-seasonal mean DARF of −8.6, −21.4 and +12.9 W m<sup>−2</sup> at the top of the atmosphere (TOA), at the surface (SUR) and in the atmosphere (ATM), respectively, for the BoB region, and over the AS, of, −6.8, −12.8, and +6 W m<sup>−2</sup> at TOA, SUR, and ATM, respectively

First-order structural transition in the magnetically ordered phase of Fe1.13Te

Specific heat, resistivity, magnetic susceptibility, linear thermal expansion (LTE), and high-resolution synchrotron X-ray powder diffraction investigations of single crystals Fe1+yTe (0.06 < y < 0.15) reveal a splitting of a single, first-order transition for y 0.12. Most strikingly, all measurements on identical samples Fe1.13Te consistently indicate that, upon cooling, the magnetic transition at T_N precedes the first-order structural transition at a lower temperature T_s. The structural transition in turn coincides with a change in the character of the magnetic structure. The LTE measurements along the crystallographic c-axis displays a small distortion close to T_N due to a lattice striction as a consequence of magnetic ordering, and a much larger change at T_s. The lattice symmetry changes, however, only below T_s as indicated by powder X-ray diffraction. This behavior is in stark contrast to the sequence in which the phase transitions occur in Fe pnictides.Comment: 6 page

Adrenal lesions found incidentally: how to improve clinical and cost-effectiveness

Introduction Adrenal incidentalomas are lesions that are incidentally identified while scanning for other conditions. While most are benign and hormonally non-functional, around 20% are malignant and/or hormonally active, requiring prompt intervention. Malignant lesions can be aggressive and life-threatening, while hormonally active tumours cause various endocrine disorders, with significant morbidity and mortality. Despite this, management of patients with adrenal incidentalomas is variable, with no robust evidence base. This project aimed to establish more effective and timely management of these patients. Methods We developed a web-based, electronic Adrenal Incidentaloma Management System (eAIMS), which incorporated the evidence-based and National Health Service–aligned 2016 European guidelines. The system captures key clinical, biochemical and radiological information necessary for adrenal incidentaloma patient management and generates a pre-populated outcome letter, saving clinical and administrative time while ensuring timely management plans with enhanced safety. Furthermore, we developed a prioritisation strategy, with members of the multidisciplinary team, which prioritised high-risk individuals for detailed discussion and management. Patient focus groups informed process-mapping and multidisciplinary team process re-design and patient information leaflet development. The project was partnered by University Hospital of South Manchester to maximise generalisability. Results Implementation of eAIMS, along with improvements in the prioritisation strategy, resulted in a 49% reduction in staff hands-on time, as well as a 78% reduction in the time from adrenal incidentaloma identification to multidisciplinary team decision. A health economic analysis identified a 28% reduction in costs. Conclusions The system’s in-built data validation and the automatic generation of the multidisciplinary team outcome letter improved patient safety through a reduction in transcription errors. We are currently developing the next stage of the programme to proactively identify all new adrenal incidentaloma cases

Preliminary non-invasive study of Roman glasses from Jesolo (Venice), Italy

Archaeological excavations at ‘Le Mure’ site (Jesolo, VE, Italy) have followed each other since the sixties, when the first evidence of an Early Medieval church (6th–7th century AD) was found under the ruins of a Medieval Cathedral (11th–12th AD). The last few years of investigations by Ca’Foscari University have led to the collection of large amounts of glass fragments, including many tesserae, dating between the 4th and the 12th centuries AD. A selection of glass fragments and mosaic tesserae taken from the excavations performed in 2013–14 at this site were studied by means of reflectance spectroscopy in order to identify their chromophore ions, in particular Cu0, Cu2+, Co2+, Fe2+ and Fe3+, which were detected in both transparent and opaque samples. In addition, the use of high resolution close-up images allowed for the attribution of surface characteristics to specific manufacturing techniques, while glass chemistry was studied in order to group them into known compositional classes. This study, carried out by non-invasive analytical techniques that allowed for the acquisition of preliminary data, will prove useful in driving further methodologies involving other non-invasive and micro-invasive analysis in order to obtain archaeometric information that can be related to concurrent archaeological results

Transport of organic solvents through natural rubber/nitrile rubber/organically modified montmorillonite nanocomposites

International audienceThe article describes the transport phenomenon of some commonly used laboratory organic solvents which differ in their solubility parameter value through polymer blend nanocomposites membrane prepared by melt mixing. The three solvents that were used are hexane, toluene and xylene which differed widely in their solubility parameter values. The motivation for the study was to know the effect of solubility parameter on the diffusion transport properties of NR/NBR (natural rubber/nitrile rubber) blends. The solvent uptake, diffusion, sorption and permeation constants were investigated and were found to decrease with organically modified montmorillonite (OMt) content at lower loading. The mode of transport through NR/NBR nano-composites was found to be anomalous. The difference in solubility parameter value greatly influenced the transport properties. The dependence of various properties on OMt content was supported by morphological analysis data. The effect of blend ratio, solvent size and OMt loading on the diffusion of aromatic and aliphatic solvents through NR/ NBR blend systems were investigated. The swelling coefficient values also decreased upon the addition of fillers indicating the presence of hindered path for solvents to diffuse into the polymer matrix. The better reinforcement at lower filler loading was confirmed from the cross-link density values and mechanical properties. The transport data obtained were applied to mathematical models for predicting the diffusion behaviour through nanocomposite membranes and to elucidate the physical mechanism of transport

Dynamical spin injection at a quasi-one-dimensional ferromagnet-graphene interface

We present a study of dynamical spin injection from a three-dimensional ferromagnet into two-dimensional single-layer graphene. Comparative ferromagnetic resonance (FMR) studies of ferromagnet/graphene strips buried underneath the central line of a coplanar waveguide show that the FMR linewidth broadening is the largest when the graphene layer protrudes laterally away from the ferromagnetic strip, indicating that the spin current is injected into the graphene areas away from the area directly underneath the ferromagnet being excited. Our results confirm that the observed damping is indeed a signature of dynamical spin injection, wherein a pure spin current is pumped into the single-layer graphene from the precessing magnetization of the ferromagnet. The observed spin pumping efficiency is difficult to reconcile with the expected backflow of spins according to the standard spin pumping theory and the characteristics of graphene, and constitutes an enigma for spin pumping in two-dimensional structures