Comparison of different strategies to measure medication adherence via claims data in patients with chronic heart failure

Medication adherence correlates with morbidity and mortality in patients with chronic heart failure (CHF), but is difficult to assess. We conducted a retrospective methodological cohort study in 3,808 CHF patients, calculating adherence as proportion of days covered (PDC) utilizing claims data from 2010 to 2015. We aimed to compare different parameters’ influence on the PDC of elderly CHF patients exemplifying a complex chronic disease. Investigated parameters were the assumed prescribed daily dose (PDD), stockpiling, and periods of hospital stay. Thereby, we investigated a new approach using the PDD assigned to different percentiles. The different dose assumptions had the biggest influence on the PDC, with variations from 41.9% to 83.7%. Stockpiling and hospital stays increased the values slightly. These results queries that a reliable PDC can be calculated with an assumed PDD. Hence, results based on an assumed PDD have to be interpreted carefully and should be presented with sensitivity analyses to show the PDC's possible range

Patients’ handling of a standardized medication plan: a pilot study and method development

Purpose: The Action Plan for Medication Safety by the German Federal Ministry of Health introduced a standardized medication plan (MP), a printable document for the patient. The practical handling needs to be tested before the nationwide implementation in Germany. Therefore, the aims of our study were 1) to develop an instrument to evaluate the usage of the standardized MP, 2) to assess if patients can locate, and 3) understand important information. Moreover, we explored patients’ opinion and suggestions regarding the standardized MP template. Patients and methods: We conducted a cross-sectional study to evaluate the practical handling of the standardized MP. We interviewed 40 adult patients in seven community pharmacies in Germany, who took at least five medicines regularly and gave their written informed consent. The interview consisted of questions regarding finding and understanding information provided on a mock-up MP, patients’ opinion and the execution of the information on the MP by filling pill boxes. We eventually developed a new evaluation method to quantify the practical handling of the MP by rating the pill boxes filled by the patients. Results: Overall, the participants rated the MP positively. Thirty-nine (98%) participants found important information on a mock-up standardized MP. Patients were questioned to identify if they understood information on medical intake as it relates to meals. In particular, they were questioned about medicine intake “1 hour before a meal”, which 98% (n=39) interpreted correctly, and “during a meal”, which 100% (n=40) interpreted correctly. The less precise advice of “before a meal” was interpreted correctly by 73% (n=29), and only 15% (n=6) correctly interpreted the term “after the meal”. The evaluation of the filled pill boxes resulted in the “Evaluation Tool to test the handling of the Medication Plan” (ET-MP) – a weighted scoring system. Conclusion: The standardized MP is clearly arranged, and patients are able to find important information. The findings of this study resulted in minor but important revisions of the standardized MP template. The developed evaluation tool ET-MP may serve as an objective instrument to assess patients’ ability to transfer written information on the MP into practical handling of medicines

Extra-Thymic Physiological T Lineage Progenitor Activity Is Exclusively Confined to Cells Expressing either CD127, CD90, or High Levels of CD117

T cell development depends on continuous recruitment of progenitors from bone marrow (BM) to the thymus via peripheral blood. However, both phenotype and functional characteristics of physiological T cell precursors remain ill-defined. Here, we characterized a putative CD135+CD27+ T cell progenitor population, which lacked expression of CD127, CD90, and high levels of CD117 and was therefore termed triple negative precursor (TNP). TNPs were present in both BM and blood and displayed robust T lineage potential, but virtually no myeloid or B lineage potential, in vitro. However, TNPs did not efficiently generate T lineage progeny after intravenous or intrathymic transfer, suggesting that a physiological thymic microenvironment does not optimally support T cell differentiation from TNPs. Thus, we propose that physiological T cell precursors are confined to populations expressing either CD127, CD90, or high levels of CD117 in addition to CD135 and CD27 and that TNPs may have other physiological functions

mir-181A/B-1 controls thymic selection of treg cells and tunes their suppressive capacity

The interdependence of selective cues during development of regulatory T cells (Treg cells) in the thymus and their suppressive function remains incompletely understood. Here, we analyzed this interdependence by taking advantage of highly dynamic changes in expression of microRNA 181 family members miR-181a-1 and miR-181b-1 (miR-181a/b-1) during late T-cell development with very high levels of expression during thymocyte selection, followed by massive down-regulation in the periphery. Loss of miR-181a/b-1 resulted in inefficient de novo generation of Treg cells in the thymus but simultaneously permitted homeostatic expansion in the periphery in the absence of competition. Modulation of T-cell receptor (TCR) signal strength in vivo indicated that miR-181a/b-1 controlled Treg-cell formation via establishing adequate signaling thresholds. Unexpectedly, miR-181a/b-1–deficient Treg cells displayed elevated suppressive capacity in vivo, in line with elevated levels of cytotoxic T-lymphocyte–associated 4 (CTLA-4) protein, but not mRNA, in thymic and peripheral Treg cells. Therefore, we propose that intrathymic miR-181a/b-1 controls development of Treg cells and imposes a developmental legacy on their peripheral function

Receiver function study in northern Sumatra and the Malaysian peninsula

International audienceIn this receiver function study, we investigate the structure of the crust beneath six seismic broadband stations close to the Sunda Arc formed by subduction of the Indo-Australian under the Sunda plate. We apply three different methods to analyse receiver functions at single stations. A recently developed algorithm determines absolute shear-wave velocities from observed frequency-dependent apparent incidence angles of P waves. Using waveform inversion of receiver functions and a modified Zhu and Kanamori algorithm, properties of discontinuities such as depth, velocity contrast, and sharpness are determined. The combination of the methods leads to robust results. The approach is validated by synthetic tests. Stations located on Malaysia show high-shear-wave velocities () near the surface in the range of 3.4-3.6 km s attributed to crystalline rocks and 3.6-4.0 km s in the lower crust. Upper and lower crust are clearly separated, the Moho is found at normal depths of 30-34 km where it forms a sharp discontinuity at station KUM or a gradient at stations IPM and KOM. For stations close to the subduction zone (BSI, GSI and PSI) complexity within the crust is high. Near the surface low of 2.6-2.9 km s indicate sediment layers. High of 4.2 km s are found at depth greater than 6 and 2 km at BSI and PSI, respectively. There, the Moho is located at 37 and 40 km depth. At station GSI, situated closest to the trench, the subducting slab is imaged as a north-east dipping structure separated from the sediment layer by a 10 km wide gradient in between 10 and 20 km depth. Within the subducting slab ≈ 4.7 km s. At station BSI, the subducting slab is found at depth between 90 and 110 km dipping 20° ± 8° in approximately N 60° E. A velocity increase in similar depth is indicated at station PSI, however no evidence for a dipping layer is found

METERON Analog-1: A Touch Remote

The METERON project (Multipurpose End-To-End Robotics Operations Network) was implemented by the European Space Agency as an initiative to prepare Europe for future humanrobotic exploration scenarios that in particular, focused on examination of the human-robotic partnership, and how this partnership could be optimized through an evaluation of the tools and methodologies utilized in the experiments in the domains of operations, communications and robotics (specifically with respect to control strategies)

Asymmetric Labor Markets, Southern Wages, and the Location of Firms

This paper studies the behavior of firms towards weak labor rights in developing countries (South). A less than perfectly elastic labor supply in the South gives firms oligopsonistic power tempting them to strategically reduce output to cut wages. In an open economy, competitors operating in perfectly competitive labor markets meanwhile enjoy less aggressive competitors and raise output. Finally, competition effect reduces the ex-post output of a relocating firm. These effects reduce relative profitability of the South casting doubts on traditional beliefs that multinationals are attracted to regions with lower wages. Adopting a minimum wage unambiguously enhances Southern competitiveness and welfare