Medicines availability among hypertensive patients in primary healthcare facilities in a rural province in South Africa

Background: Control of blood pressure (BP) remains a challenge among patients in the public health system in South Africa. The objective was to assess availability of all prescribed antihypertensive medicines among patients with raised BP on the day they attended rural primary healthcare facilities (PHCs) and determine the association between medicines availability, the number of prescribed antihypertensive medicines and BP control. Methods: Secondary data from an operational study from rural PHCs in South Africa including patients’ demographics and BP, as well as data on medicine availability. Data analysis included descriptive and inferential statistics. Results: 55 black African patients were assessed, with 89.1% being female. Some data were not available for all 55 patients. The mean age was 61.3 years, and 54.6% did not have formal education. Two thirds (67.2%) of patients received all their antihypertensive medications whilst 25.5% received some of their medicines during the three months study period with no record in 7.3% of the patients. There was no significant relationship between receiving all antihypertensive medicines and BP control. The majority of patients on one antihypertensive had better BP control; however, this did not reach significance (p=0.069). Concerns with the lack of BP recording on all occasions in some patients (20%). Conclusion: One third of patients went home without all their antihypertensive medicines from the PHC facilities. Other concerns included the lack of routine BP monitoring and the number of prescribed medicines. Studies are ongoing to explore key issues with medicines availability and concerns with adherence and BP control

Empowering hypertensive patients on chronic medicines at primary health care facilities in South Africa with knowledge to improve disease management

Objectives: Uncontrolled hypertension negatively impacts on mortality. This study aimed to evaluate the impact of a pharmacist-driven patient counselling and education model to empower hypertensive patients on chronic medication. Methods: An operational research project with a quasi-experimental design including an intervention group (55 patients) and a control group (31 patients) of chronic hypertensive patients. Data were collected with interview-administered questionnaires and analysed using SAS® version 9.4. Pharmacist interventions included an educational diary on hypertension management and patient counselling. Findings: There was a 34.7% improvement in patients’ understanding of what normal blood pressure (BP) is in the intervention group compared to the control group (p90%). Conclusions: A pharmacist driven patient counselling and education model can help improve patients’ hypertension knowledge and BP control. These should increasingly become routine, aiming to improve chronic disease management

DC and high-frequency conductivity of the organic metals beta"-(BEDT-TTF)2SF5RSO3 (R = CH2CF2 and CHF)

The temperature dependences of the electric-transport properties of the two-dimensional organic conductors beta"-(BEDT-TTF)2SF5CH2CF2SO3, beta"-(d8-BEDT-TTF)2SF5CH2CF2SO3, and beta"-(BEDT-TTF)2SF5CHFSO3 are measured by dc methods in and perpendicular to the highly-conducting plane. Microwave measurements are performed at 24 and 33.5 GHz to probe the high-frequency behavior from room temperature down to 2 K. Superconductivity is observed in beta"-(BEDT-TTF)2SF5CH2CF2SO3 and its deuterated analogue. Although all the compounds remain metallic down to low-temperatures, they are close to a charge-order transition. This leads to deviations from a simple Drude behavior of the optical conductivity which become obvious already in the microwave range. In beta"-(BEDT-TTF)2SF5CH2CF2SO3, for instance, charge fluctuations cause an increase in microwave resistivity for T < 20 K which is not detected in dc measurements. beta"-(BEDT-TTF)2SF5CHFSO3 exhibits a simple metallic behavior at all frequencies. In the dc transport, however, we observe indications of localization in the perpendicular direction.Comment: 8 pages, 9 figure

Six pelagic seabird species of the North Atlantic engage in a fly-and-forage strategy during their migratory movements

Funding Information: We thank all the fieldworkers for their hard work collecting data. Funding for this study was provided by the Norwegian Ministry for Climate and the Environment, the Norwegian Ministry of Foreign Affairs and the Norwegian Oil and Gas Association along with 8 oil companies through the SEATRACK project (www. seapop. no/ en/ seatrack). Fieldwork in Norwegian colonies (incl. Svalbard and Jan Mayen) was supported by the SEAPOP program (www.seapop.no, grant no. 192141). The French Polar Institute (IPEV project 330 to O.C.) supported field operation for Kongsfjord kittiwakes. The work on the Isle of May was also supported by the Natural Environment Research Council (Award NE/R016429/1 as part of the UK-SCaPE programme delivering National Capability). We thank Maria Bogdanova for field support and data processing. Finally, we thank 3 anonymous reviewers for their help improving the first version of the manuscript.Peer reviewedPublisher PD

Eastern philosophies of education : Buddhist, Hindu, Daoist, and Confucian readings of Plato’s cave

This chapter provides readers with an understanding of some basic principles of selected Eastern traditions and their relation to philosophy of education. The attempt to characterize such diverse traditions and understandings of education raises numerous hermeneutical issues which can only be addressed through a pedagogical reduction as a vehicle for understanding. In this case, we have employed Plato’s cave allegory as that methodological and pedagogical vehicle. We explore aspects of the ontology, epistemology, and ethics of Buddhist, Hindu (focused on classical yoga), Daoist, and Confucian traditions, interpreting elements from Plato’s allegory in order to throw light onto the educational ideas and implications of those Eastern traditions

Six pelagic seabird species of the North Atlantic engage in a fly-and-forage strategy during their migratory movements

Bird migration is commonly defined as a seasonal movement between breeding and non-breeding grounds. It generally involves relatively straight and directed large-scale movements, with a latitudinal change, and specific daily activity patterns comprising less or no foraging and more traveling time. Our main objective was to describe how this general definition applies to seabirds. We investigated migration characteristics of 6 pelagic seabird species (little auk Alle alle, Atlantic puffin Fratercula arctica, common guillemot Uria aalge, Brünnich’s guillemot U. lomvia, black-legged kittiwake Rissa tridactyla and northern fulmars Fulmarus glacialis). We analysed an extensive geolocator positional and saltwater immersion dataset from 29 colonies in the North-East Atlantic and across several years (2008-2019). We used a novel method to identify active migration periods based on segmentation of time series of track characteristics (latitude, longitude, net-squared displacement). Additionally, we used the saltwater immersion data of geolocators to infer bird activity. We found that the 6 species had, on average, 3 to 4 migration periods and 2 to 3 distinct stationary areas during the non-breeding season. On average, seabirds spent the winter at lower latitudes than their breeding colonies and followed specific migration routes rather than non-directionally dispersing from their colonies. Differences in daily activity patterns were small between migratory and stationary periods, suggesting that all species continued to forage and rest while migrating, engaging in a ‘fly-and-forage’ migratory strategy. We thereby demonstrate the importance of habitats visited during seabird migrations as those that are not just flown over, but which may be important for re-fuelling.publishedVersio

Global assessment of marine plastic exposure risk for oceanic birds

Plastic pollution is distributed patchily around the world’s oceans. Likewise, marine organisms that are vulnerable to plastic ingestion or entanglement have uneven distributions. Understanding where wildlife encounters plastic is crucial for targeting research and mitigation. Oceanic seabirds, particularly petrels, frequently ingest plastic, are highly threatened, and cover vast distances during foraging and migration. However, the spatial overlap between petrels and plastics is poorly understood. Here we combine marine plastic density estimates with individual movement data for 7137 birds of 77 petrel species to estimate relative exposure risk. We identify high exposure risk areas in the Mediterranean and Black seas, and the northeast Pacific, northwest Pacific, South Atlantic and southwest Indian oceans. Plastic exposure risk varies greatly among species and populations, and between breeding and nonbreeding seasons. Exposure risk is disproportionately high for Threatened species. Outside the Mediterranean and Black seas, exposure risk is highest in the high seas and Exclusive Economic Zones (EEZs) of the USA, Japan, and the UK. Birds generally had higher plastic exposure risk outside the EEZ of the country where they breed. We identify conservation and research priorities, and highlight that international collaboration is key to addressing the impacts of marine plastic on wide-ranging speciespublishedVersio

Association of stroke lesion shape with newly detected atrial fibrillation - Results from the MonDAFIS study

Paroxysmal Atrial fibrillation (AF) is often clinically silent and may be missed by the usual diagnostic workup after ischemic stroke. We aimed to determine whether shape characteristics of ischemic stroke lesions can be used to predict AF in stroke patients without known AF at baseline. Lesion shape quantification on brain MRI was performed in selected patients from the intervention arm of the Impact of standardized MONitoring for Detection of Atrial Fibrillation in Ischemic Stroke (MonDAFIS) study, which included patients with ischemic stroke or TIA without prior AF. Multiple morphologic parameters were calculated based on lesion segmentation in acute brain MRI data. Multivariate logistic models were used to test the association of lesion morphology, clinical parameters, and AF. A stepwise elimination regression was conducted to identify the most important variables. A total of 755 patients were included. Patients with AF detected within 2 years after stroke (n = 86) had a larger overall oriented bounding box (OBB) volume (p = 0.003) and a higher number of brain lesion components (p = 0.008) than patients without AF. In the multivariate model, OBB volume (OR 1.72, 95%CI 1.29–2.35, p < 0.001), age (OR 2.13, 95%CI 1.52–3.06, p < 0.001), and female sex (OR 2.45, 95%CI 1.41–4.31, p = 0.002) were independently associated with detected AF. Ischemic lesions in patients with detected AF after stroke presented with a more dispersed infarct pattern and a higher number of lesion components. Together with clinical characteristics, these lesion shape characteristics may help in guiding prolonged cardiac monitoring after stroke

Global assessment of marine plastic exposure risk for oceanic birds

Plastic pollution is distributed patchily around the world’s oceans. Likewise, marine organisms that are vulnerable to plastic ingestion or entanglement have uneven distributions. Understanding where wildlife encounters plastic is crucial for targeting research and mitigation. Oceanic seabirds, particularly petrels, frequently ingest plastic, are highly threatened, and cover vast distances during foraging and migration. However, the spatial overlap between petrels and plastics is poorly understood. Here we combine marine plastic density estimates with individual movement data for 7137 birds of 77 petrel species to estimate relative exposure risk. We identify high exposure risk areas in the Mediterranean and Black seas, and the northeast Pacific, northwest Pacific, South Atlantic and southwest Indian oceans. Plastic exposure risk varies greatly among species and populations, and between breeding and non-breeding seasons. Exposure risk is disproportionately high for Threatened species. Outside the Mediterranean and Black seas, exposure risk is highest in the high seas and Exclusive Economic Zones (EEZs) of the USA, Japan, and the UK. Birds generally had higher plastic exposure risk outside the EEZ of the country where they breed. We identify conservation and research priorities, and highlight that international collaboration is key to addressing the impacts of marine plastic on wide-ranging species