A systematic review and thematic synthesis of patients' experience of medicines adherence

Background: Medicines non-adherence continues to be problematic in health care practice. After decades of research, few interventions have a robust evidence-based demonstrating their applicability to improve adherence. Phenomenology has a place within the health care research environment. Objective: To explore patients’ lived experiences of medicines adherence reported in the phenomenonologic literature. Methods: A systematic literature search was conducted to identify peer-reviewed and published phenomenological investigations in adults that aimed to investigate patients’ lived experiences of medicines adherence. Studies were appraised using the Critical Appraisal Skills Programme (CASP) Qualitative Research Tool. Thematic synthesis was conducted using a combination of manual coding and NVivo10 [QSR International, Melbourne] coding to aid data management. Results: Descriptive themes identified included i) dislike for medicines, ii) survival, iii) perceived need, including a) symptoms and side-effects and b) cost, and iv) routine. Analytic themes identified were i) identity and ii) interaction. Conclusions: This work describes adherence as a social interaction between the identity of patients and medicines, mediated by interaction with family, friends, health care professionals, the media and the medicine, itself. Health care professionals and policy makers should seek to re-locate adherence as a social phenomenon, directing the development of interventions to exploit patient interaction with wider society, such that patients ‘get to know’ their medicines, and how they can be taken, throughout the life of the patient and the prescription

Verification Testing To Confirm VO2max Attainment in Inactive Women With Obesity

International Journal of Exercise Science 13(4): 1448-1458, 2020. Incidence of obesity is increasing worldwide which is deleterious to health due to its association with increased risk of cardiovascular disease, diabetes, and some cancers. Completion of regular physical activity in individuals with obesity increases maximal oxygen uptake (VO2max). However, whether individuals with obesity can exhibit ‘true’ VO2max is unresolved. This study examined efficacy of verification testing (VER) to identify ‘true’ VO2max in 17 inactive women with obesity (age, body fat, and VO2max = 37 ± 10 yr, 48.7 ± 3.5 %, and 19.4 ± 3.0 mL/kg/min, respectively). They performed ramp exercise (RAMP) to volitional fatigue followed by VER at 105 percent peak power output (%PPO) at baseline and after 3 and 6 wk of high intensity interval training. Results showed no difference in ramp and verification-derived VO2max (1.99 ± 0.37 L/min vs. 1.98 ± 0.32 L/min, 2.00 ± 0.40 L/min vs. 2.04 ± 0.38 L/min, and 2.08 ± 0.34 L/min vs. 2.08 ± 0.32 L/min at 0, 3 and 6 wk of training), although in 40 % of VER tests, VO2max was greater than the RAMP value. Overall, verification testing may be adopted as an additional approach to confirm ‘true’ VO2max attainment in obese women as ramp exercise frequently underestimates VO2max in this population

Thymocyte regulatory variant alters transcription factor binding and protects from type 1 diabetes in infants

We recently mapped a genetic susceptibility locus on chromosome 6q22.33 for type 1 diabetes (T1D) diagnosed below the age of 7 years between the PTPRK and thymocyte-selection-associated (THEMIS) genes. As the thymus plays a central role in shaping the T cell repertoire, we aimed to identify the most likely causal genetic factors behind this association using thymocyte genomic data. In four thymocyte populations, we identified 253 DNA sequence motifs underlying histone modifications. The G insertion allele of rs138300818, associated with protection from diabetes, created thymocyte motifs for multiple histone modifications and thymocyte types. In a parallel approach to identifying variants that alter transcription factor binding motifs, the same variant disrupted a predicted motif for Rfx7, which is abundantly expressed in the thymus. Chromatin state and RNA sequencing data suggested strong transcription overlapping rs138300818 in fetal thymus, while expression quantitative trait locus and chromatin conformation data associate the insertion with lower THEMIS expression. Extending the analysis to other T1D loci further highlighted rs66733041 affecting the GATA3 transcription factor binding in the AFF3 locus. Taken together, our results support a role for thymic THEMIS gene expression and the rs138300818 variant in promoting the development of early-onset T1D.Peer reviewe

Framing Scientific Analyses for Risk Management of Environmental Hazards by Communities: Case Studies with Seafood Safety Issues

Risk management provides a context for addressing environmental health hazards. Critical to this approach is the identification of key opportunities for participation. We applied a framework based on the National Research Council’s (NRC) analytic–deliberative risk management dialogue model that illustrates two main iterative processes: informing and framing. The informing process involves conveying information from analyses of risk issues, often scientific, to all parties so they can participate in deliberation. In the framing process, ideas and concerns from stakeholder deliberations help determine what and how scientific analyses will be carried out. There are few activities through which affected parties can convey their ideas from deliberative processes for framing scientific analyses. The absence of participation results in one-way communication. The analytic–deliberative dialogue, as envisioned by the NRC and promoted by the National Institute of Environmental Health Sciences (NIEHS), underscores the importance of two-way communication. In this article we present case studies of three groups—an Asian and Pacific Islander community coalition and two Native American Tribes—active in framing scientific analyses of health risks related to contaminated seafood. Contacts with these organizations were established or enhanced through a regional NIEHS town meeting. The reasons for concern, participation, approaches, and funding sources were different for each group. Benefits from their activities include increased community involvement and ownership, better focusing of analytical processes, and improved accuracy and appropriateness of risk management. These examples present a spectrum of options for increasing community involvement in framing analyses and highlight the need for increased support of such activities

Differential effects of hydrocortisone, prednisone, and dexamethasone on hormonal and pharmacokinetic profiles: a pilot study in children with congenital adrenal hyperplasia

BACKGROUND: Little is known about the comparative effects of different glucocorticoids on the adrenal and growth hormone (GH) axes in children with congenital adrenal hyperplasia (CAH). We sought to compare the effects of hydrocortisone (HC), prednisone (PDN), and dexamethasone (DEX) in children with classic CAH and to investigate a potential role of pharmacogenetics. METHODS: Subjects were randomly assigned to three sequential 6-week courses of HC, PDN, and DEX, each followed by evaluation of adrenal hormones, IGF-1, GH, and body mass index (BMI). Single nucleotide polymorphism (SNP) analysis of genes in the glucocorticoid pathway was also performed. RESULTS: Nine prepubertal subjects aged 8.1 ± 2.3 years completed the study. Mean ACTH, androstenedione, and 17-hydroxyprogesterone (17-OHP) values were lower following the DEX arm of the study than after subjects received HC (p ≤ 0.016) or PDN (p ≤ 0.002). 17-OHP was also lower after HC than PDN (p < 0.001). There was no difference in IGF-1, GH, or change in BMI. SNP analysis revealed significant associations between hormone concentrations, pharmacokinetic parameters, and variants in several glucocorticoid pathway genes (ABCB1, NR3C1, IP013, GLCCI1). CONCLUSIONS: DEX resulted in marked adrenal suppression suggesting that its potency relative to hydrocortisone and prednisone was underestimated. SNPs conferred significant differences in responses between subjects. Although preliminary, these pilot data suggest that incorporating pharmacogenetics has the potential to eventually lead to targeted therapy in children with CAH

Collection of human genomic DNA from neonates: a comparison between umbilical cord blood and buccal swabs

OBJECTIVE: To compare DNA yield from neonatal umbilical cord blood and buccal swab specimens. STUDY DESIGN: Umbilical cord blood was obtained at birth in a cohort of women enrolled in a preterm labor study. If cord blood was not obtained, neonatal buccal samples were obtained using the Oragene saliva kits. DNA was extracted from all samples using the QIAamp extraction kits. DNA concentration and yield were compared between umbilical cord blood and buccal swabs. RESULTS: DNA concentrations from umbilical cord blood (n = 35) was greater than that obtained from buccal swabs (n = 20) (total sample: 209.0 ± 110.7 ng/μL vs 6.9 ± 6.7 ng/μL respectively, P < .001; partial sample: n = 30 cord blood vs n = 11 buccal, 70.0 ± 51.4 ng/μL vs 11.3 ± 6.7 ng/μL, respectively, P < .001) and produced more total DNA (total sample: 116.5 ± 70.8 μg vs 4.2 ± 4.0 μg, P < .001; partial:14.0 ± 10.3 μg vs 1.1 ± 0.7 μg, respectively, P < .001). CONCLUSION: Buccal swabs yield less neonatal DNA than umbilical cord blood specimens

Key Lessons Learned from Moffitt's Molecular Tumor Board: The Clinical Genomics Action Committee Experience

The increasing practicality of genomic sequencing technology has led to its incorporation into routine clinical practice. Successful identification and targeting of driver genomic alterations that provide proliferative and survival advantages to tumor cells have led to approval and ongoing development of several targeted cancer therapies. Within many major cancer centers, molecular tumor boards are constituted to shepherd precision medicine into clinical practice

Synthesis, photophysics and molecular structures of luminescent 2,5-bis(phenylethynyl)thiophenes (BPETs)

International audienceThe Sonogashira cross-coupling of two equivalents of para-substituted ethynylbenzenes with 2,5-diiodothiophene provides a simple synthetic route for the preparation of 2,5-bis(para-R-phenylethynyl)thiophenes (R = H, Me, OMe, CF3, NMe2, NO2, CN and CO2Me) (1a-h). Likewise, 2,5-bis(pentafluorophenylethynyl)thiophene (2) was prepared by the coupling of 2,5-diiodothiophene with pentafluorophenylacetylene. All compounds were characterised by NMR, IR, Raman and mass spectroscopy, elemental analysis, and their absorption and emission spectra, quantum yields and lifetimes were also measured. The spectroscopic studies of 1a-h and 2 show that both electron donating and electron withdrawing para-subsituents on the phenyl rings shift the absorption and emission maxima to lower energies, but that acceptors are more efficient in this regard. The short singlet lifetimes and modest fluorescence quantum yields (ca. 0.2-0.3) observed are characteristic of rapid intersystem crossing. The single-crystal structures of 2,5-bis(phenylethynyl)thiophene, 2,5-bis(para-carbomethoxyphenylethynyl)thiophene, 2,5-bis(para-methylphenylethynyl)thiophene and 2,5-bis(pentafluorophenylethynyl)thiophene were determined by X-ray diffraction at 120 K. DFT calculations show that the all-planar form of the compounds is the lowest in energy, although rotation of the phenyl groups about the C[triple bond, length as m-dash]C bond is facile and TD-DFT calculations suggest that, similar to 1,4-bis(phenylethynyl)benzene analogues, the absorption spectra in solution arise from a variety of rotational conformations. Frequency calculations confirm the assignments of the compounds' IR and Raman spectra

Defining Ecological Drought for the Twenty-First Century

THE RISING RISK OF DROUGHT. Droughts of the twenty-first century are characterized by hotter temperatures, longer duration, and greater spatial extent, and are increasingly exacerbated by human demands for water. This situation increases the vulnerability of ecosystems to drought, including a rise in drought-driven tree mortality globally (Allen et al. 2015) and anticipated ecosystem transformations from one state to another—for example, forest to a shrubland (Jiang et al. 2013). When a drought drives changes within ecosystems, there can be a ripple effect through human communities that depend on those ecosystems for critical goods and services (Millar and Stephenson 2015). For example, the “Millennium Drought” (2002–10) in Australia caused unanticipated losses to key services provided by hydrological ecosystems in the Murray–Darling basin—including air quality regulation, waste treatment, erosion prevention, and recreation. The costs of these losses exceeded AUD $800 million, as resources were spent to replace these services and adapt to new drought-impacted ecosystems (Banerjee et al. 2013). Despite the high costs to both nature and people, current drought research, management, and policy perspectives often fail to evaluate how drought affects ecosystems and the “natural capital” they provide to human communities. Integrating these human and natural dimensions of drought is an essential step toward addressing the rising risk of drought in the twenty-first century