Dry rainfed conditions are key drivers of the effect of conservation tillage and a nitrification inhibitor on N fate and N2O emissions: A field 15N tracing study

The sustainability of rainfed crops under semiarid conditions is threatened by low plant nitrogen (N) recovery as well as the potential loss of reactive N to the environment. A field 15N tracing experiment on barley (Hordeum vulgare L.) under rainfed conditions was carried out to study how different tillage management practices and the use of the nitrification inhibitor DMPSA affected the fate of N. The experiment consisted of a factorial combination of tillage (i.e., no tillage, NT, and conventional tillage, T) and fertilizer treatments (unfertilized control and ammonium nitrate, AN, with or without DMPSA). Single-labelled ammonium nitrate (15NH4NO3, 15AN, or NH415NO3, A15N) was applied at top-dressing to microplots at a rate of 80 kg N ha−1. Our results show out that DMPSA modulates the nitrification process from both fertilizer-N and endogenous soil-N (which was the main contributor to plant N uptake and N2O emissions), affecting soil residual N at the end of the cropping period (i.e., higher topsoil retention of 15AN in DMPSA-amended plots). Generally, cumulative N2O emissions from fertilizer were derived from 15AN rather than from A15N, thus confirming the site-specific choice of the source of synthetic N as an effective N2O mitigation strategy. Two months after harvest, a rewetting event produced a remarkable N2O emission peak that drove total cumulative N2O emissions and was also mainly derived from endogenous N. These results suggest that dry seasons could decrease N2O losses after fertilization while causing critical peaks after rewetting, thus potentially limiting the effectiveness of mitigation strategies. The average plant N recovery from the synthetic fertilizer was 22.6%, while the use of DMPSA combined with NT enhanced plant N uptake from endogenous soil-N. This could be a result of the improved crop development and plant N acquisition under NT, consistent with the decrease of soil N retention for A15N in the deeper layer at the end of the experiment in the nontilled plots. This study contributes to the mechanistic understanding of the effect of nitrification inhibitors and tillage on N2O emissions, soil N dynamics and N plant recovery, revealing relevant effects of both management strategies and a critical role of endogenous soil-N under dry rainfed conditions. It can be concluded that, under the conditions of our study, combining DMPSA with NT could help to improve plant N recovery, thus resulting in positive impacts on reactive N loss and climate change mitigation and adaptation

Sustainability of innovations in healthcare: A systematic review and conceptual framework for professional pharmacy services.

BACKGROUND: Implementation science emerged to address the challenges associated with the incorporation of evidence-based innovations into practice. Once the challenge is overcome, the ultimate goal is to achieve the sustainability of innovations to promote their continuity and long-term integration. Assessment tools and measures have been designed to assess the sustainability of innovations in research and practice environments. However, the variability of assessment tools available becomes a challenge for policy makers, researchers and practitioners, particularly when deciding how to evaluate the sustainability of innovations. OBJECTIVES: to identify conceptual approaches and assessment tools for the sustainability of healthcare innovations and to develop a specific discipline-based framework for the sustainability of professional pharmacy services. METHODS: A systematic literature review was conducted in January of 2019 using PubMed, Scopus, and Web of Science. General information regarding the conceptual approaches (based on Nilsen's classification), assessment tools and the factors affecting the sustainability of the healthcare innovations was retrieved. RESULTS: From 3123 articles screened, 132 articles were selected from which 106 conceptual approaches and 26 assessment tools were identified. Several key factors moderating the sustainability of the innovations in healthcare were identified (e.g. funding, adaptation). A framework for the sustainability of professional pharmacy services is proposed based on these factors. It presents three performance domains influencing the service sustainability (i.e. environment, social and economic). CONCLUSIONS: The identified approaches in different healthcare settings have allowed the adaptation and design of a specific framework for pharmacy. The core factors included in the proposed framework are moderators of the sustainability process and should be considered in sustainability studies and evaluations. This framework will guide pharmacy practice researchers and practitioners to measure and achieve the sustainability of professional pharmacy services. Furthermore, the adaptation of this framework will allow its application to other healthcare settings. (Registration number CRD42018092160)

Economic impact of medication non-adherence by disease groups: A systematic review

© Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2018. All rights reserved. No commercial use is permitted unless otherwise expressly granted. Objective To determine the economic impact of medication non-adherence across multiple disease groups. Design Systematic review. Evidence review A comprehensive literature search was conducted in PubMed and Scopus in September 2017. Studies quantifying the cost of medication non-adherence in relation to economic impact were included. Relevant information was extracted and quality assessed using the Drummond checklist. Results Seventy-nine individual studies assessing the cost of medication non-adherence across 14 disease groups were included. Wide-scoping cost variations were reported, with lower levels of adherence generally associated with higher total costs. The annual adjusted disease-specific economic cost of non-adherence per person ranged from 949 to 44 190 (in 2015 US). Costs attributed to 'all causes' non-adherence ranged from 5271 to 52 341. Medication possession ratio was the metric most used to calculate patient adherence, with varying cut-off points defining non-adherence. The main indicators used to measure the cost of non-adherence were total cost or total healthcare cost (83% of studies), pharmacy costs (70%), inpatient costs (46%), outpatient costs (50%), emergency department visit costs (27%), medical costs (29%) and hospitalisation costs (18%). Drummond quality assessment yielded 10 studies of high quality with all studies performing partial economic evaluations to varying extents. Conclusion Medication non-adherence places a significant cost burden on healthcare systems. Current research assessing the economic impact of medication non-adherence is limited and of varying quality, failing to provide adaptable data to influence health policy. The correlation between increased non-adherence and higher disease prevalence should be used to inform policymakers to help circumvent avoidable costs to the healthcare system. Differences in methods make the comparison among studies challenging and an accurate estimation of true magnitude of the cost impossible. Standardisation of the metric measures used to estimate medication non-adherence and development of a streamlined approach to quantify costs is required. PROSPERO registration number CRD42015027338

PANIC: the new panoramic NIR camera for Calar Alto

PANIC is a wide-field NIR camera, which is currently under development for the Calar Alto observatory (CAHA) in Spain. It uses a mosaic of four Hawaii-2RG detectors and covers the spectral range from 0.8-2.5 micron(z to K-band). The field-of-view is 30x30 arcmin. This instrument can be used at the 2.2m telescope (0.45arcsec/pixel, 0.5x0.5 degree FOV) and at the 3.5m telescope (0.23arcsec/pixel, 0.25x0.25 degree FOV). The operating temperature is about 77K, achieved by liquid Nitrogen cooling. The cryogenic optics has three flat folding mirrors with diameters up to 282 mm and nine lenses with diameters between 130 mm and 255 mm. A compact filter unit can carry up to 19 filters distributed over four filter wheels. Narrow band (1%) filters can be used. The instrument has a diameter of 1.1 m and it is about 1 m long. The weight limit of 400 kg at the 2.2m telescope requires a light-weight cryostat design. The aluminium vacuum vessel and radiation shield have wall thicknesses of only 6 mm and 3 mm respectively.Comment: This paper has been presented in the SPIE of Astronomical Telescopes and Instrumentation 2008 in Marseille (France

Pharmacy practice research - A call to action.

Pharmacists have a societal duty of care. How to best provide that type of care requires scientific study. Pharmacy practice is a scientific discipline that studies the different aspects of the practice of pharmacy, and its impact on health care systems, medicine use, and patient care. Its scope has expanded globally to encompass clinical, behavioural, economic, and humanistic implications of the practice of pharmacy, as well as practice change and implementation in routine practice of innovations such as health interventions and patient-care services. The development, impact evaluation, implementation, and sustainability of health interventions and patient-care services represents a key research area for pharmacy practice. An approach for conducting these is provided. There is evidence that collaborative national and international research in this area is growing, showing an increased contribution to global health research. The role of universities and pharmacy professional associations in supporting the advancement of pharmacy through pharmacy practice research is also discussed. Finally, a call to action for pharmacy practice research, education, and practice is made

Chemical composition, physicochemical evaluation and sensory analysis of yogurt added with extract of polyphenolic compounds from Quercus crassifolia oak bark

Introduction: A diet high in calories and saturated fats has been associated with health problems that have been increasing worldwide. Therefore, it is required to increase the number of formulated foods that generate well-being to health. Yogurt is a widely consumed food by all sectors of the population and it can be used as a vehicle to incorporate bioactive compounds. The phenolic compounds present in forest residues, such as those from oak bark, can be used and incorporated into yogurt, to increase its benefits as a functional food. Objective: The objective of this study was to develop a multifunctional yogurt enriched with vegetable oil (2.3% w/w) as a source of omega 6 and 3 and adding nanocapsules (24.5% w/w) of an extract of oak bark from Quercus crassifolia, rich in in phenolic compounds and high antioxidant capacity. Methods: Three yogurt formulations were prepared: F1: yogurt was made with non-fat milk, used as a control, F2: yogurt was prepared with non-fat milk and added with vegetable palm oil, and F3: non-fat yogurt was added with vegetable oil and nanoencapsulated oak bark phenolic extract. The yogurts were characterized in their chemical composition, microbiological analysis, and sensory analysis. Results: The multifunctional product F3 and product F2 presented lactic acid bacteria in concentration of 3.01X106 and 4.73x106, respectively, preserving characteristics of probiotic food. Product F3 presented low levels of syneresis (7.34%) and it was significantly different from the control yogurt (9.01%). The viscosity increased from 150 cP in the control yogurt to 341 cP in F3, due to the increase in the concentrations of solids by nanoencapsulating the phenolic. The wall material used for nanoencapsulation was sodium caseinate and mantodextrin. However, this increase in viscosity did not affect the sensory evaluation of the product. There were no significant differences between the control yogurt and the F2 and F3 products. Conclusion: A yogurt added with vegetable oil and nanoencapsulated oak bark phenolic extract was obtained. It was enhanced by the presence of probiotics, bioactive compounds, and essential fatty acids, and then evaluated and accepted by a sensory panel. Nanoencapsulation is a viable alternative to mask the characteristic astringent taste of phenolic compounds because it was not detected by the panelists

Cost-Utility Analysis of a Medication Review with Follow-Up Service for Older Adults with Polypharmacy in Community Pharmacies in Spain: The conSIGUE Program

© 2015, Springer International Publishing Switzerland. Background: The concept of pharmaceutical care is operationalized through pharmaceutical professional services, which are patient-oriented to optimize their pharmacotherapy and to improve clinical outcomes. Objective: The objective of this study was to estimate the incremental cost-effectiveness ratio (ICER) of a medication review with follow-up (MRF) service for older adults with polypharmacy in Spanish community pharmacies against the alternative of having their medication dispensed normally. Methods: The study was designed as a cluster randomized controlled trial, and was carried out over a time horizon of 6 months. The target population was older adults with polypharmacy, defined as individuals taking five or more medicines per day. The study was conducted in 178 community pharmacies in Spain. Cost-utility analysis adopted a health service perspective. Costs were in euros at 2014 prices and the effectiveness of the intervention was estimated as quality-adjusted life-years (QALYs). In order to analyze the uncertainty of ICER results, we performed a non-parametric bootstrapping with 5000 replications. Results: A total of 1403 older adults, aged between 65 and 94 years, were enrolled in the study: 688 in the intervention group (IG) and 715 in the control group (CG). By the end of the follow-up, both groups had reduced the mean number of prescribed medications they took, although this reduction was greater in the IG (0.28 ± 1.25 drugs; p < 0.001) than in the CG (0.07 ± 0.95 drugs; p = 0.063). Older adults in the IG saw their quality of life improved by 0.0528 ± 0.20 (p < 0.001). In contrast, the CG experienced a slight reduction in their quality of life: 0.0022 ± 0.24 (p = 0.815). The mean total cost was €977.57 ± 1455.88 for the IG and €1173.44 ± 3671.65 for the CG. In order to estimate the ICER, we used the costs adjusted for baseline medications and QALYs adjusted for baseline utility score, resulting in a mean incremental total cost of −€250.51 ± 148.61 (95 % CI −541.79 to 40.76) and a mean incremental QALY of 0.0156 ± 0.004 (95 % CI 0.008–0.023). Regarding the results from the cost-utility analysis, the MRF service emerged as the dominant strategy. Conclusion: The MRF service is an effective intervention for optimizing prescribed medication and improving quality of life in older adults with polypharmacy in community pharmacies. The results from the cost-utility analysis suggest that the MRF service is cost effective

Cost-Utility Analysis of a Medication Adherence Management Service Alongside a Cluster Randomized Control Trial in Community Pharmacy.

Background: It is necessary to determine the cost utility of adherence interventions in chronic diseases due to humanistic and economic burden of non-adherence. Purpose: To evaluate, alongside a cluster-randomized controlled trial, the cost-utility of a pharmacist-led medication adherence management service (MAMS) compared with usual care in community pharmacies. Materials and Methods: The trial was conducted over six months. Patients with treatments for hypertension, asthma or chronic obstructive pulmonary disease (COPD) were included. Patients in the intervention group (IG) received a MAMS based on a brief complex intervention, whilst patients in the control group (CG) received usual care. The cost–utility analysis adopted a health system perspective. Costs related to medications, healthcare resources and adherence intervention were included. The effectiveness was estimated as quality-adjusted life years (QALYs), using a multiple imputation missing data model. The incremental cost–utility ratio (ICUR) was calculated on the total sample of patients. Results: A total of 1186 patients were enrolled (IG: 633; CG: 553). The total intervention cost was estimated to be € 27.33 ± 0.43 per patient for six months. There was no statistically significant difference in total cost of medications and healthcare resources per patient between IG and CG. The values of EQ-5D-5L at 6 months were significantly higher in the IG [IG: 0.881 ± 0.005 vs CG: 0.833 ± 0.006; p = 0.000]. In the base case, the service was more expensive and more effective than usual care, resulting in an ICUR of € 1,494.82/QALY. In the complete case, the service resulted in an ICUR of € 2,086.30/QALY, positioned between the north-east and south-east quadrants of the cost–utility plane. Using a threshold value of € 20,000/QALY gained, there is a 99% probability that the intervention is cost-effective. Conclusion: The medication adherence management service resulted in an improvement in the quality of life of the population with chronic disease, with similar costs compared to usual care. The service is cost-effective