Women’s beliefs about medicines and adherence to pharmacotherapy in pregnancy: Opportunities for community pharmacists?

Background During pregnancy women might weigh benefits of treatment against potential risks to the unborn child. However, non-adherence to necessary treatment can adversely affect both mother and child. To optimize pregnant women’s beliefs and medication adherence, community pharmacists are ideally positioned to play an important role in primary care. Objective This narrative review aimed to summarize the evidence on 1) pregnant women’s beliefs, 2) medication adherence in pregnancy, and 3) community pharmacists’ counselling during pregnancy. Method Three search strategies were used in Medline and Embase to find original studies evaluating women’s beliefs, medication adherence and community pharmacists’ counselling during pregnancy. All original descriptive and analytic epidemiological studies performed in Europe, North America and Australia, written in English and published from 2000 onwards were included. Results We included 14 studies reporting on women’s beliefs, 11 studies on medication adherence and 9 on community pharmacists’ counselling during pregnancy. Women are more reluctant to use medicines during pregnancy and tend to overestimate the teratogenic risk of medicines. Risk perception varies with type of medicine, level of health literacy, education level and occupation. Furthermore, low medication adherence during pregnancy is common. Finally, limited evidence showed current community pharmacists’ counselling is insufficient. Barriers hindering pharmacists are insufficient knowledge and limited access to reliable information. Conclusion Concerns about medication use and non-adherence are widespread among pregnant women. Community pharmacists’ counselling during pregnancy is insufficient. Further education, training and research are required to support community pharmacists in fulfilling all the opportunities they have when counselling pregnant women

Search for R-parity Violating Decays of Supersymmetric Particles in e+e−e^+ e^- Collisions at LEP

A search, in $e^+ e^-$ collisions, for chargino, neutralino, scalar lepton and scalar quark pair-production is performed, without assuming R-parity conservation in decays, in the case that only one of the coupling constants $\lambda_{ijk}$ or $\lambda''_{ ijk}$ is non-negligible. No signal is found in data up to a centre-of-mass energy of 208 \GeV. Limits on the production cross sections and on the masses of supersymmetric particles are derived.A search, in e + e − collisions, for chargino, neutralino, scalar lepton and scalar quark pair-production is performed, without assuming R-parity conservation in decays, in the case that only one of the coupling constants λ or λ ″ is non-negligible. No signal is found in data up to a centre-of-mass energy of 208 GeV. Limits on the production cross sections and on the masses of supersymmetric particles are derived.A search, in e^+e^- collisions, for chargino, neutralino, scalar lepton and scalar quark pair-production is performed, without assuming R-parity conservation in decays, in the case that only one of the coupling constants lambda_ijk or lambda''_ijk is non-negligible. No signal is found in data up to a centre-of-mass energy of 208GeV. Limits on the production cross sections and on the masses of supersymmetric particles are derived

Design & assessing the flood risk management paradigm shift: an interdisciplinary study of Vlissingen, the Netherlands

Mean sea level rise (SLR) could increase up to 2m by 2100, which would see damage caused by coastal flooding in Europe increase from €1.25bn per annum currently to €961bn in just over 80 years. Urban areas situated along the North Sea coastline are particularly vulnerable to extreme sea level rise (a combination of SLR, tide and storm surges). The main goal of this study is to assess the paradigm shift in flood risk management from reducing probability of the flood event to reducing its consequences in the city of Vlissingen, in the Netherlands. Two spatial adaptation strategies are modeled and compared by using spatial, climatic, and socioeconomic projections for the year 2100: the “Vlissings Model” and the “Spuikom Model”. The Vlissings Model is about increased coastal protection through the heightening of existing grey infrastructure by 3 m, which includes the dike and buildings constructed on top of it. The Spuikom Model is accepting and rerouting overtopping water towards an existing former backshore water basin. The study brings forth an interdisciplinary "Design & Assess" framework that brings together design strategies with flood damage models and cost/benefit analyses to compare the effectiveness of two paradigms in dealing with extreme SLR. Results show that raising the dike would ensure full protection from extreme events against an initial investment and maintenance cost of €215 mil. Accepting and rerouting overtopping water would, on the contrary, reduce the impact of the flood to €8,6 million damage and less than a hundred affected inhabitants, without requiring the construction of major infrastructure but of a flood retention basin integrated to the new urban development. On the other hand, the comparison between the two strategies remains complex in quantitative terms given the different cost-benefit assessment models for such interventions.Environmental Technology and DesignHydraulic Structures and Flood Ris

Independent Component Analysis Filter for Small Vessel Contrast Imaging During Fast Tissue Motion

Suppressing tissue clutter is an essential step in blood flow estimation and visualization, even when using ultrasound contrast agents. Blind source separation (BSS)-based clutter filter for high-framerate ultrasound imaging has been reported to perform better in tissue clutter suppression than the conventional frequency-based wall filter and nonlinear contrast pulsing schemes. The most notable BSS technique, singular value decomposition (SVD) has shown compelling results in cases of slow tissue motion. However, its performance degrades when the tissue motion is faster than the blood flow speed, conditions that are likely to occur when imaging the small vessels, such as in the myocardium. Independent component analysis (ICA) is another BSS technique that has been implemented as a clutter filter in the spatiotemporal domain. Instead, we propose to implement ICA in the spatial domain where motion should have less impact. In this work, we propose a clutter filter with the combination of SVD and ICA to improve the contrast-to-background ratio (CBR) in cases where tissue velocity is significantly faster than the flow speed. In an in vitro study, the range of fast tissue motion velocity was 5-25 mm/s and the range of flow speed was 1-12 mm/s. Our results show that the combination of ICA and SVD yields 7-10 dB higher CBR than SVD alone, especially in the tissue high-velocity range. The improvement is crucial for cardiac imaging where relatively fast myocardial motions are expected.ImPhys/Medical Imagin