Health beliefs and compliance with inhaled corticosteroids by asthmatic patients in primary care practices

AbstractThe aim of this study was to determine factors associated with regular use of inhaled corticosteroids (ICS) by asthmatic patients in primary care practices. A cross-sectional survey was carried out over 12 family practices in the Philadelphia greater Metropolitan area. A total of 394 patients aged 18–49 years, who received medical care for asthma from their primary care physician and had been prescribed ICS between 1 January 1995 and 31 December 1996, were included.The study measured self-reported demographics, experience with asthma, use of and attitudes about ICS, and health beliefs in six domains.Only 38% of patients reported using ICS at least twice a day almost every day. The most frequently cited reasons for inconsistent or non-use of ICS were related to a belief that ICS were unnecessary during asymptomatic periods and to a general concern about side-effects. By logistic regression, factors associated with regular use of ICS were two patient health beliefs, namely the health belief of ‘Active’ participation in clinical decision-making with their physician (OR=4·6, 95% CI 2·8, 7·5), and the health belief that asthma was a ‘Serious’ health problem (OR=2·3, 95% CI 1·4, 3·7), and hospitalization for asthma within the previous 12 months (OR=2·3, 95% CI 1·6, 4·6).Patients were more likely to report regular use of ICS if they saw themselves as active participants in their treatment planning and conceptualized asthma as a potentially serious illness. These results support the themes of patient education and shared decision-making between patients and physicians that are promoted by the Asthma Guidelines from the National Heart, Lung and Blood Institute (NHLBI)

Comment on Experiments Related to the Aharonov-Bohm Phase Shift

Recent experiments undertaken by Caprez, Barwick, and Batelaan should clarify the connections between classical and quantum theories in connection with the Aharonov-Bohm phase shift. It is pointed out that resistive aspects for the solenoid current carriers play a role in the classical but not the quantum analysis for the phase shift. The observed absence of a classical lag effect for a macroscopic solenoid does not yet rule out the possibility of a lag explanation of the observed phase shift for a microscopic solenoid.Comment: 9 page

First-principles study of nucleation, growth, and interface structure of Fe/GaAs

We use density-functional theory to describe the initial stages of Fe film growth on GaAs(001), focusing on the interplay between chemistry and magnetism at the interface. Four features appear to be generic: (1) At submonolayer coverages, a strong chemical interaction between Fe and substrate atoms leads to substitutional adsorption and intermixing. (2) For films of several monolayers and more, atomically abrupt interfaces are energetically favored. (3) For Fe films over a range of thicknesses, both Ga- and As-adlayers dramatically reduce the formation energies of the films, suggesting a surfactant-like action. (4) During the first few monolayers of growth, Ga or As atoms are likely to be liberated from the interface and diffuse to the Fe film surface. Magnetism plays an important auxiliary role for these processes, even in the dilute limit of atomic adsorption. Most of the films exhibit ferromagnetic order even at half-monolayer coverage, while certain adlayer-capped films show a slight preference for antiferromagnetic order.Comment: 11 two-column pages, 12 figures, to appear in Phys. Rev.

First Principles Calculations of Fe on GaAs (100)

We have calculated from first principles the electronic structure of 0.5 monolayer upto 5 monolayer thick Fe layers on top of a GaAs (100) surface. We find the Fe magnetic moment to be determined by the Fe-As distance. As segregates to the top of the Fe film, whereas Ga most likely is found within the Fe film. Moreover, we find an asymmetric in-plane contraction of our unit-cell along with an expansion perpendicular to the surface. We predict the number of Fe 3d-holes to increase with increasing Fe thickness on $p$-doped GaAs.Comment: 9 pages, 14 figures, submitted to PR

Mapping pediatric palliative care development in the WHO-European Region: children living in low-middle income countries are less likely to access it

Context: Approximately 170,000 children in need of palliative care die every year in Europe without access to it. This field remains an evolving specialty with unexplored development. Objectives: To conduct the first regional assessment of pediatric palliative care (PPC) development and provision using data from the European Association for Palliative Care atlas of palliative care 2019. Methods: Two surveys were conducted. The first one included a single question regarding PPC service provision and was addressed by European Association for Palliative Care atlas informants. The second one included 10 specific indicators derived from an open-ended interview and rating process; a specific network of informants was enabled and used as respondents. Data were analyzed and presented in the map of the figure. Results: Data on PPC service provision were gathered from 51 of 54 (94%) European countries. Additional data were collected in 34 of 54 (62%) countries. A total of 680 PPC services were identified including 133 hospices, 385 home care services, and 162 hospital services. Nineteen countries had specific standards and norms for the provision of PPC. Twenty-two countries had a national association, and 14 countries offered education for either pediatric doctors or nurses. In seven countries, specific neonatal palliative care referral services were identified. Conclusion: PPC provision is flourishing across the region; however, development is less accentuated in low-to-middle-income countries. Efforts need to be devoted to the conceptualization and definition of the models of care used to respond to the unmet need of PPC in Europe. The question whether specialized services are required or not should be further explored. Strategies to regulate and cover patients in need should be adapted to each national health system

Type 2 diabetes mellitus-associated transcriptome alterations in cortical neurones and associated neurovascular unit cells in the ageing brain

Type 2 diabetes mellitus (T2D), characterised by peripheral insulin resistance, is a risk factor for dementia. In addition to its contribution to small and large vessel disease, T2D may directly damage cells of the brain neurovascular unit. In this study, we investigated the transcriptomic changes in cortical neurones, and associated astrocytes and endothelial cells of the neurovascular unit, in the ageing brain. Neurone, astrocyte, and endothelial cell-enriched mRNA, obtained by immuno-laser capture microdissection of temporal cortex (Brodmann area 21/22) from 6 cases with self-reported T2D in the Cognitive Function and Ageing Study neuropathology cohort, and an equal number of age and sex-matched controls, was assessed by microarray analysis. Integrated Molecular Pathway Level Analysis was performed using the Kyoto Encyclopaedia of Genes and Genomes database on significantly differentially expressed genes, defined as P < 0.05 and fold-change ± 1.2. Hub genes identified from Weighted Gene Co-expression Network Analysis were validated in neurones using the NanoString nCounter platform. The expression and cellular localisation of proteins encoded by selected candidate genes were confirmed by immunohistochemistry. 912, 2202, and 1227 genes were significantly differentially expressed between cases with self-reported T2D and controls in neurones, astrocytes, and endothelial cells respectively. Changes in cortical neurones included alterations in insulin and other signalling pathways, cell cycle, cellular senescence, inflammatory mediators, and components of the mitochondrial respiratory electron transport chain. Impaired insulin signalling was shared by neurovascular unit cells with, additionally, apoptotic pathway changes in astrocytes and dysregulation of advanced glycation end-product signalling in endothelial cells. Transcriptomic analysis identified changes in key cellular pathways associated with T2D that may contribute to neuronal damage and dysfunction. These effects on brain cells potentially contribute to a diabetic dementia, and may provide novel approaches for therapeutic intervention

The role of superficial geology in controlling groundwater recharge in the weathered crystalline basement of semi-arid Tanzania

Study region Little Kinyasungwe River Catchment, central semi-arid Tanzania. Study focus The structure and hydraulic properties of superficial geology can play a crucial role in controlling groundwater recharge in drylands. However, the pathways by which groundwater recharge occurs and their sensitivity to environmental change remain poorly resolved. Geophysical surveys using Electrical Resistivity Tomography (ERT) were conducted in the study region and used to delineate shallow subsurface stratigraphy in conjunction with borehole logs. Based on these results, a series of local-scale conceptual hydrogeological models was produced and collated to generate a 3D conceptual model of groundwater recharge to the wellfield. New hydrological insights for the region We propose that configurations of superficial geology control groundwater recharge in dryland settings as follows: 1) superficial sand deposits act as collectors and stores that slowly feed recharge into zones of active faulting; 2) these fault zones provide permeable pathways enabling greater recharge to occur; 3) ‘windows’ within layers of smectitic clay that underlie ephemeral streams may provide pathways for focused recharge via transmission losses; and 4) overbank flooding during high intensity precipitation events increases the probability of activating such permeable pathways. These conceptual models provide a physical basis to improve numerical models of groundwater recharge in drylands, and a conceptual framework to evaluate strategies (e.g., Managed Aquifer Recharge) to artificially enhance the availability of groundwater resources in these regions

Residual N effects from livestock manure inputs to soils

Organic inputs including livestock manures provide nitrogen (N) to crops beyond the year of their application. This so-called residual N effect should be taken into account when making decisions on N rates for individual fields, but also when interpreting N response trials in preparation of recommendations. This paper addresses general principles of residual N effects, gives literature-based estimates of them, and reviews to which extent residual N effects are included in recommendations and regulations in selected countries

Against all odds? Forming the planet of the HD196885 binary

HD196885Ab is the most "extreme" planet-in-a-binary discovered to date, whose orbit places it at the limit for orbital stability. The presence of a planet in such a highly perturbed region poses a clear challenge to planet-formation scenarios. We investigate this issue by focusing on the planet-formation stage that is arguably the most sensitive to binary perturbations: the mutual accretion of kilometre-sized planetesimals. To this effect we numerically estimate the impact velocities $dv$ amongst a population of circumprimary planetesimals. We find that most of the circumprimary disc is strongly hostile to planetesimal accretion, especially the region around 2.6AU (the planet's location) where binary perturbations induce planetesimal-shattering $dv$ of more than 1km/s. Possible solutions to the paradox of having a planet in such accretion-hostile regions are 1) that initial planetesimals were very big, at least 250km, 2) that the binary had an initial orbit at least twice the present one, and was later compacted due to early stellar encounters, 3) that planetesimals did not grow by mutual impacts but by sweeping of dust (the "snowball" growth mode identified by Xie et al., 2010b), or 4) that HD196885Ab was formed not by core-accretion but by the concurent disc instability mechanism. All of these 4 scenarios remain however highly conjectural.Comment: accepted for publication by Celestial Mechanics and Dynamical Astronomy (Special issue on EXOPLANETS