Medication adherence and activity patterns underlying uncontrolled hypertension: Assessment and recommendations by practicing pharmacists using digital health care

AbstractObjectivesThis report summarizes the first use of a digital health feedback system (DHFS) by practicing pharmacists to establish evidence-based blood pressure (BP) management recommendations.SettingFifteen commercial pharmacies and 39 patients in the Isle of Wight participated.Practice descriptionThe pharmacists were experienced in providing New Medicine Services to patients in their communities.Practice innovationThe pharmacists utilized a commercially available DHFS. The DHFS utilized FDA-cleared and CE-marked class 2 medical devices passively captured and shared information about medication-taking using an ingestible sensor, and daily patterns of rest, activity, and exercise using a wearable patch that incorporates an accelerometer.InterventionsPharmacists provided targeted counselling for BP management as guided by the digital information.EvaluationBlood pressure was measured serially, and patient and provider experiences with DHFS use were assessed using satisfaction surveys.ResultsThe mean change in SBP over the 2-week evaluation period was -7.9 ± 22.1; mean change in DBP was -2.8 ± 12.9. A root cause for persistent hypertension was determined for all of these 34 patients: 68% had pharmaceutical resistance, and 32% had inadequate medication use. Specifically, 29% were found to be capable to achieving blood pressure control on their currently prescribed medications, 68% were found to have a need for additional pharmacological treatment, and 3% needed additional adherence support. Pharmacists found that the DHFD helped in targeting specific recommendations, and to create a collaborative experience with their patients. Patients found the experience to be positive and helpful.ConclusionDHFS that provides confirmation of medication taking and objective measures of lifestyle patterns can help pharmacists to identify specific factors contributing to uncontrolled hypertension, to make evidence-based prescribing and lifestyle recommendations for achieving treatment goals, and to create a collaborative experience for patients in the management of their self-care

Testing interactive effects of global environmental changes on soil nitrogen cycling

Responses of soil nitrogen (N) cycling to simultaneous and potentially interacting global environmental changes are uncertain. Here, we investigated the combined effects of elevated CO2, warming, increased precipitation and enhanced N supply on soil N cycling in an annual grassland ecosystem as part of the Jasper Ridge Global Change Experiment (CA, USA). This field experiment included four treatments-CO2, temperature, precipitation, nitrogen-with two levels per treatment (ambient and elevated), and all their factorial combinations replicated six times. We collected soil samples after 7 and 8 years of treatments, and measured gross rates of N mineralization, N immobilization and nitrification, along with potential rates of ammonia oxidation, nitrite oxidation and denitrification. We also determined the main drivers of these microbial activities (soil ammonium and nitrate concentrations, soil moisture, soil temperature, soil pH, and soil CO2 efflux, as an indicator of soil heterotrophic activity). We found that gross N mineralization responded to the interactive effects of the CO2, precipitation and N treatments: N addition increased gross N mineralization when CO2 and precipitation were either both at ambient or both at elevated levels. However, we found limited evidence for interactions among elevated CO2, warming, increased precipitation, and enhanced N supply on the other N cycling processes examined: statistically significant interactions, when found, tended not to persist across multiple dates. Soil N cycling responded mainly to single-factor effects: long-term N addition increased gross N immobilization, potential ammonia oxidation and potential denitrification, while increased precipitation depressed potential nitrite oxidation and increased potential ammonia oxidation and potential denitrification. In contrast, elevated CO2 and modest warming did not significantly affect any of these microbial N transformations. These findings suggest that global change effects on soil N cycling are primarily additive, and therefore generally predictable from single factor studies

Tunneling into Ferromagnetic Quantum Hall States: Observation of a Spin Bottleneck

We explore the characteristics of equilibrium tunneling of electrons from a 3D electrode into a high mobility 2D electron system. For most 2D Landau level filling factors, we find that tunneling can be characterized by a single, well-defined tunneling rate. However, for spin-polarized quantum Hall states (nu = 1, 3 and 1/3) tunneling occurs at two distinct rates that differ by up to 2 orders of magnitude. The dependence of the two rates on temperature and tunnel barrier thickness suggests that slow in-plane spin relaxation creates a bottleneck for tunneling of electrons.Comment: 5 pages, 4 figures, submitted to PR

Identifying uncertainties in scenarios and models of socio-ecological systems in support of decision-making

There are many sources of uncertainty in scenarios and models of socio-ecological systems, and understanding these uncertainties is critical in supporting informed decision-making about the management of natural resources. Here, we review uncertainty across the steps needed to create socio-ecological scenarios, from narrative storylines to the representation of human and biological processes in models and the estimation of scenario and model parameters. We find that socio-ecological scenarios and models would benefit from moving away from “stylized” approaches that do not consider a wide range of direct drivers and their dependency on indirect drivers. Indeed, a greater focus on the social phenomena is fundamental in understanding the functioning of nature on a human-dominated planet. There is no panacea for dealing with uncertainty, but several approaches to evaluating uncertainty are still not routinely applied in scenario modeling, and this is becoming increasingly unacceptable. However, it is important to avoid uncertainties becoming an excuse for inaction in decision-making when facing environmental challenges.</p

TRY plant trait database - enhanced coverage and open access

Plant traits-the morphological, anatomical, physiological, biochemical and phenological characteristics of plants-determine how plants respond to environmental factors, affect other trophic levels, and influence ecosystem properties and their benefits and detriments to people. Plant trait data thus represent the basis for a vast area of research spanning from evolutionary biology, community and functional ecology, to biodiversity conservation, ecosystem and landscape management, restoration, biogeography and earth system modelling. Since its foundation in 2007, the TRY database of plant traits has grown continuously. It now provides unprecedented data coverage under an open access data policy and is the main plant trait database used by the research community worldwide. Increasingly, the TRY database also supports new frontiers of trait-based plant research, including the identification of data gaps and the subsequent mobilization or measurement of new data. To support this development, in this article we evaluate the extent of the trait data compiled in TRY and analyse emerging patterns of data coverage and representativeness. Best species coverage is achieved for categorical traits-almost complete coverage for 'plant growth form'. However, most traits relevant for ecology and vegetation modelling are characterized by continuous intraspecific variation and trait-environmental relationships. These traits have to be measured on individual plants in their respective environment. Despite unprecedented data coverage, we observe a humbling lack of completeness and representativeness of these continuous traits in many aspects. We, therefore, conclude that reducing data gaps and biases in the TRY database remains a key challenge and requires a coordinated approach to data mobilization and trait measurements. This can only be achieved in collaboration with other initiatives

Global Change Could Amplify Fire Effects on Soil Greenhouse Gas Emissions

Background: Little is known about the combined impacts of global environmental changes and ecological disturbances on ecosystem functioning, even though such combined impacts might play critical roles in shaping ecosystem processes that can in turn feed back to climate change, such as soil emissions of greenhouse gases.[br/] Methodology/Principal Findings: We took advantage of an accidental, low-severity wildfire that burned part of a long-term global change experiment to investigate the interactive effects of a fire disturbance and increases in CO(2) concentration, precipitation and nitrogen supply on soil nitrous oxide (N(2)O) emissions in a grassland ecosystem. We examined the responses of soil N(2)O emissions, as well as the responses of the two main microbial processes contributing to soil N(2)O production - nitrification and denitrification - and of their main drivers. We show that the fire disturbance greatly increased soil N(2)O emissions over a three-year period, and that elevated CO(2) and enhanced nitrogen supply amplified fire effects on soil N(2)O emissions: emissions increased by a factor of two with fire alone and by a factor of six under the combined influence of fire, elevated CO(2) and nitrogen. We also provide evidence that this response was caused by increased microbial denitrification, resulting from increased soil moisture and soil carbon and nitrogen availability in the burned and fertilized plots. [br/] Conclusions/Significance: Our results indicate that the combined effects of fire and global environmental changes can exceed their effects in isolation, thereby creating unexpected feedbacks to soil greenhouse gas emissions. These findings highlight the need to further explore the impacts of ecological disturbances on ecosystem functioning in the context of global change if we wish to be able to model future soil greenhouse gas emissions with greater confidence

Oscillating Transverse Voltage in a Channel with Quantum Point Contact Voltage Probes

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