Detection of Nonadherence to Antihypertensive Treatment by Measurements of Serum Drug Concentrations

Nonadherence to drugs is a challenge in hypertension treatment. We aimed to assess the prevalence of nonadherence by serum drug concentrations compared with 2 indirect methods and relate to the prescribed drug regimens in a nationwide multicenter study. Five hundred fifty patients with hypertension using ≥2 antihypertensive agents participated. We measured concentrations of 23 antihypertensive drugs using ultra high performance liquid chromatography tandem mass-spectrometry and compared with patients’ self-reports and investigators’ assessment based on structured interview. We identified 40 nonadherent patients (7.3%) using serum drug concentrations. They had higher office diastolic blood pressure (90 versus 83 mm Hg, P<0.01) and daytime diastolic blood pressure (85 versus 80 mm Hg, P<0.01) though systolic blood pressures did not differ significantly. They had more prescribed daily antihypertensive pills (2.5 versus 2.1 pills, P<0.01) and total daily pills (5.5 versus 4.4 pills, P=0.03). Prescription of fixed-dose combination pills were lower among the nonadherent patients identified by serum concentrations (45.0 versus 67.1%, P<0.01). Fifty-three patients self-reported nonadherence, while the investigators suspected 69 nonadherent patients. These groups showed no or few differences in drug regimens, respectively. In summary, we detected 7.3% prevalence of nonadherence by serum drug measurements in patients using ≥2 antihypertensive agents in a nationwide study; they had higher office and ambulatory diastolic blood pressures, higher number of prescribed daily pills, more daily antihypertensive pills, and less frequent prescriptions of fixed-dose combination pills. Indirect methods showed poor overlap with serum drugs concentrations and no or minimal medication differences. Thus, serum measurements of drugs were useful in detection and characterization of nonadherence to antihypertensive treatment.acceptedVersio

Formation of Very Large Conductance Channels by Bacillus cereus Nhe in Vero and GH4 Cells Identifies NheA + B as the Inherent Pore-Forming Structure

The nonhemolytic enterotoxin (Nhe) produced by Bacillus cereus is a pore-forming toxin consisting of three components, NheA, -B and -C. We have studied effects of Nhe on primate epithelial cells (Vero) and rodent pituitary cells (GH4) by measuring release of lactate dehydrogenase (LDH), K+ efflux and the cytosolic Ca2+ concentration ([Ca2+]i). Plasma membrane channel events were monitored by patch-clamp recordings. Using strains of B. cereus lacking either NheA or -C, we examined the functional role of the various components. In both cell types, NheA + B + C induced release of LDH and K+ as well as Ca2+ influx. A specific monoclonal antibody against NheB abolished LDH release and elevation of [Ca2+]i. Exposure to NheA + B caused a similar K+ efflux and elevation of [Ca2+]i as NheA + B + C in GH4 cells, whereas in Vero cells the rate of K+ efflux was reduced by 50% and [Ca2+]i was unaffected. NheB + C had no effect on either cell type. Exposure to NheA + B + C induced large-conductance steps in both cell types, and similar channel insertions were observed in GH4 cells exposed to NheA + B. In Vero cells, NheA + B induced channels of much smaller conductance. NheB + C failed to insert membrane channels. The conductance of the large channels in GH4 cells was about 10 nS. This is the largest channel conductance reported in cell membranes under quasi-physiological conditions. In conclusion, NheA and NheB are necessary and sufficient for formation of large-conductance channels in GH4 cells, whereas in Vero cells such large-conductance channels are in addition dependent on NheC

Incentivizing the Dynamic Workforce: Learning Contracts in the Gig-Economy

In principal-agent models, a principal offers a contract to an agent to perform a certain task. The agent exerts a level of effort that maximizes her utility. The principal is oblivious to the agent's chosen level of effort, and conditions her wage only on possible outcomes. In this work, we consider a model in which the principal is unaware of the agent's utility and action space. She sequentially offers contracts to identical agents, and observes the resulting outcomes. We present an algorithm for learning the optimal contract under mild assumptions. We bound the number of samples needed for the principal obtain a contract that is within $\epsilon$ of her optimal net profit for every $\epsilon>0$

European Position Paper on Rhinosinusitis and Nasal Polyps 2020

The European Position Paper on Rhinosinusitis and Nasal Polyps 2020 is the update of similar evidence based position papers published in 2005 and 2007 and 2012. The core objective of the EPOS2020 guideline is to provide revised, up-to-date and clear evidence-based recommendations and integrated care pathways in ARS and CRS. EPOS2020 provides an update on the literature published and studies undertaken in the eight years since the EPOS2012 position paper was published and addresses areas not extensively covered in EPOS2012 such as paediatric CRS and sinus surgery. EPOS2020 also involves new stakeholders, including pharmacists and patients, and addresses new target users who have become more involved in the management and treatment of rhinosinusitis since the publication of the last EPOS document, including pharmacists, nurses, specialised care givers and indeed patients themselves, who employ increasing self-management of their condition using over the counter treatments. The document provides suggestions for future research in this area and offers updated guidance for definitions and outcome measurements in research in different settings. EPOS2020 contains chapters on definitions and classification where we have defined a large number of terms and indicated preferred terms. A new classification of CRS into primary and secondary CRS and further division into localized and diffuse disease, based on anatomic distribution is proposed. There are extensive chapters on epidemiology and predisposing factors, inflammatory mechanisms, (differential) diagnosis of facial pain, allergic rhinitis, genetics, cystic fibrosis, aspirin exacerbated respiratory disease, immunodeficiencies, allergic fungal rhinosinusitis and the relationship between upper and lower airways. The chapters on paediatric acute and chronic rhinosinusitis are totally rewritten. All available evidence for the management of acute rhinosinusitis and chronic rhinosinusitis with or without nasal polyps in adults and children is systematically reviewed and integrated care pathways based on the evidence are proposed. Despite considerable increases in the amount of quality publications in recent years, a large number of practical clinical questions remain. It was agreed that the best way to address these was to conduct a Delphi exercise. The results have been integrated into the respective sections. Last but not least, advice for patients and pharmacists and a new list of research needs are included.Peer reviewe

Il. Vekttap, hvitekvalitet og holdbarhet under lagring

Inneholder flere artiklerDenne meldinga omhandler 7 forsøk med i alt 6200 egg. Hensikten med forsøkene var å undersøke virkning av vasking slik den kan utføres hos produsent. Det ble i alle forsøkene brukt en Rotomaid vaskemaskin som ved hjelp av varmeelement og termostat holdt en temperatur på ca. 40°C på vaskevannet. I ett av forsøkene ble også brukt en lignende maskin fra 'America', Thisted

Norsk landbruksforskning : virkningen av vasking på eggkvaliteten

Denne meldinga omhandler 7 forsøk med i alt 6200 egg. Hensikten med forsøkene var å undersøke virkning av vasking slik den kan utføres hos produsent. Det ble i alle forsøkene brukt en Rotomaid vaskemaskin som ved hjelp av varmeelement og termostat holdt en temperatur på ca. 40°C på vaskevannet. I ett av forsøkene ble også brukt en lignende maskin fra 'America', Thisted

Norsk landbruksforskning : effekt av antibiotika og enzymer til broiler

Tilsetning av avoparcin (Avotan) eller virginiamycin (Stafac) i foret førte til ca. 4,7 % økt tilvekst og 5,8 % nedgang i fôrforbruk til 39 dagers alder i et forsøk med god tilvekst. Tilsvarende tall til 20 dagers alder var 11,0 og 7,2 %. Sinkbacitracin (Albac) og avoparcin gav samme tilvekstøkning, ca. 2 % til 40 dager, i et forsøk med noe lågere tilvekst.· Nedgangen i fôrforbruk var henholdsvis 3,8 og 6,7 % . Til 20 dagers alder var tilvekstøkningen 5,6 % og nedgangen i fôrforbruk 10,3 % for avoparcin og 4,6 % for sinkbacitracin.Det var ingen forskjell i dødelighet enten det ble gitt antibiotika eller ikke. Tilsetting av beta-glukanase og Avizymemultienzympremiks hadde positiv virkning på tilvekst og forforbruk i perioden 0-20 dager, og på strøkonsistensen. Det var positivt samspill mellom antibiotika og enzymer når det gjaldt strøkvaliteten og for pr. kg tilvekst 0-20 d

Norsk landbruksforskning : effekt av antibiotika og enzymer til broiler

Inneholder flere artiklerTilsetning av avoparcin (Avotan) eller virginiamycin (Stafac) i foret førte til ca. 4,7 % økt tilvekst og 5,8 % nedgang i fôrforbruk til 39 dagers alder i et forsøk med god tilvekst. Tilsvarende tall til 20 dagers alder var 11,0 og 7,2 %. Sinkbacitracin (Albac) og avoparcin gav samme tilvekstøkning, ca. 2 % til 40 dager, i et forsøk med noe lågere tilvekst.· Nedgangen i fôrforbruk var henholdsvis 3,8 og 6,7 % . Til 20 dagers alder var tilvekstøkningen 5,6 % og nedgangen i fôrforbruk 10,3 % for avoparcin og 4,6 % for sinkbacitracin.Det var ingen forskjell i dødelighet enten det ble gitt antibiotika eller ikke. Tilsetting av beta-glukanase og Avizymemultienzympremiks hadde positiv virkning på tilvekst og forforbruk i perioden 0-20 dager, og på strøkonsistensen. Det var positivt samspill mellom antibiotika og enzymer når det gjaldt strøkvaliteten og for pr. kg tilvekst 0-20 d

Negotiation of commercial leases in multi-tenant buildings

Denne oppgaven omhandler kontraktsinngåelser mellom gårdeiere og leietakere ved flerbruksbygg i det norske kontorsegmentet. Hensikten med denne undersøkelsen er å se om aktørene i dette markedet følger standardkontraktsgrunnlaget til Huseiernes Landsforbund m. fl. eller om enkelte forhandler seg bort fra bestemte kontraktspunkter og bilag. Husleieloven som bakgrunnsrett gir profesjonelle parter stor handlefrihet, men eventuelle avvik kan få betydelig innvirkning for verdivurderinger av eiendommene. Det er skrevet lite om forhandlingsaspektet når det gjelder lokalleie i Norge, men det finnes tilgjengelig litteratur på kryss av fagfelt som belyser temaet. Oppgaven vil legge vekt på hvorfor forhandlinger oppstår og eventuelt hvordan disse gjennomføres. Datagrunnlaget er skaffet ved bruk av et todelt forskningsdesign. Del A tar for seg et pilotcasestudie der inngåtte kontrakter sammenlignes opp mot standardkontraktsgrunnlaget. Disse funnene er benyttet som grunnlag for å gjennomføre informantintervjuer rettet mot næringsmeglere i del B. Funnene tyder først og fremst på at det er graden av utleiernes profesjonalitet, størrelse og servicenivå som er utslagsgivende for forhandlingene. På den andre siden kan standard, arealeffektivitet og markedsvilkår også ha påvirkninger på resultatet, men disse faktorene kan delvis kontrolleres ved å ha et bevisst forhold til forhandlingsprosessen.This study deals with leases between landlords and tenants in multi‐purpose buildings in the Norwegian office segment. The purpose of this study is to see if the players in this market follows the standard form lease or whether they actually negotiates away from certain specific contract clauses and appendices. Norwegian law gives the professional parties involved great freedom but aberrancies can have a significant impact on the valuation of commercial property. There is not much written about the negotiation aspect of leases in Norway, but there is available literature across different subjects that illustrates the theme. The target will be to investigate why negotiations occur, and if they do, how they actually are done. The datamaterial is obtained through a pilotcasestudy where actual contracts are compared against the standard form lease. These findings have been used as the basis for conducting informant interviews aimed at commercial realestatebrokers. The findings suggest that the degree of professionalism, size and services included from the landlords have much to say regarding how negotiations actually are implemented. On the other hand, also the object's standard, space efficiency and market will most likely influence the final results of the negotiations.2018-12-152018-12-15M-L