Drug adherence in chronic kidney diseases and dialysis.

Poor long-term adherence and persistence to drug therapy is universally recognized as one of the major clinical issues in the management of chronic diseases, and patients with renal diseases are also concerned by this important phenomenon. Chronic kidney disease (CKD) patients belong to the group of subjects with one of the highest burdens of daily pill intake with up to >20 pills per day depending on the severity of their disease. The purpose of the present review is to discuss the difficulties encountered by nephrologists in diagnosing and managing poor adherence and persistence in CKD patients including in patients receiving maintenance dialysis. Our review will also attempt to provide some clues and new perspectives on how drug adherence could actually be addressed and possibly improved. Working on drug adherence may look like a long and tedious path, but physicians and healthcare providers should always be aware that drug adherence is in general much lower than what they may think and that there are many ways to improve and support drug adherence and persistence so that renal patients obtain the full benefits of their treatments

Atmospheric depositional fluxes of \u3csup\u3e7\u3c/sup\u3eBe and \u3csup\u3e210\u3c/sup\u3ePb at Galveston and College Station, Texas

The bulk depositional fluxes of 210Pb and 7Be were measured at a coastal (Galveston) and an inland (College Station) station for about 3 years, between 1989 and 1991. The annual depositional fluxes of 7Be and 210Pb at Galveston during this period varied by a factor of about 2.5, between 8.9 and 23.2 disintegrations per minute (dpm) cm−2 yr−1, with a mean of 14.7 dpm cm−2 yr−1 for 7Be, and 0.67 and 1.71 dpm cm−2 yr−1, with a mean of 1.03 dpm cm−2 yr−1 for 210Pb, respectively. The precipitation-normalized 7Be flux increases with increasing amount of precipitation. There is no systematic and consistent seasonal trend in the depositional fluxes for 7Be or for 210Pb. The volume-weighted 210Pb concentrations, when normalized to the amount of precipitation, seem to be constant over the time period of this study. Four to six heavy rain events (\u3e 5 cm) in a single day account for 20–30% of the annual deposition of 7Be and 210Pb. Such events account, however, for only about 4–6% of the total number of rainy days in a year. The dry depositional fluxes of these nuclides appear to be a significant fraction of the bulk depositional flux only during the months when there is very little rain. The fraction of dry to total depositional flux of 210Pb appears to be higher than that of 7Be. The strong positive correlation between 7Be and 210Pb depositional fluxes indicates that the flux of both nuclides is controlled by scavenging processes by local precipitation. This correlation also indicates that a major portion of the air masses that brings precipitation to Galveston and College Station is of continental origin. Our data therefore suggest that 7Be and 210Pb cannot be used as independent atmospheric tracers in our coastal station. This observation is consistent with those observed at many other continental and coastal stations

Improving blood pressure control through pharmacist interventions: a meta-analysis of randomized controlled trials.

BACKGROUND: Control of blood pressure (BP) remains a major challenge in primary care. Innovative interventions to improve BP control are therefore needed. By updating and combining data from 2 previous systematic reviews, we assess the effect of pharmacist interventions on BP and identify potential determinants of heterogeneity. METHODS AND RESULTS: Randomized controlled trials (RCTs) assessing the effect of pharmacist interventions on BP among outpatients with or without diabetes were identified from MEDLINE, EMBASE, CINAHL, and CENTRAL databases. Weighted mean differences in BP were estimated using random effect models. Prediction intervals (PI) were computed to better express uncertainties in the effect estimates. Thirty-nine RCTs were included with 14 224 patients. Pharmacist interventions mainly included patient education, feedback to physician, and medication management. Compared with usual care, pharmacist interventions showed greater reduction in systolic BP (-7.6 mm Hg, 95% CI: -9.0 to -6.3; I(2)=67%) and diastolic BP (-3.9 mm Hg, 95% CI: -5.1 to -2.8; I(2)=83%). The 95% PI ranged from -13.9 to -1.4 mm Hg for systolic BP and from -9.9 to +2.0 mm Hg for diastolic BP. The effect tended to be larger if the intervention was led by the pharmacist and was done at least monthly. CONCLUSIONS: Pharmacist interventions - alone or in collaboration with other healthcare professionals - improved BP management. Nevertheless, pharmacist interventions had differential effects on BP, from very large to modest or no effect; and determinants of heterogeneity could not be identified. Determining the most efficient, cost-effective, and least time-consuming intervention should be addressed with further research

Sodium intake and blood pressure in children with clinical conditions: A systematic review with meta-analysis.

Little is known on the effect of sodium intake on BP of children with clinical conditions. Our objective was therefore to review systematically studies that have assessed the association between sodium intake and BP in children with various clinical conditions. A systematic search of several databases was conducted and supplemented by a manual search of bibliographies and unpublished studies. Experimental and observational studies assessing the association between sodium intake and BP and involving children or adolescents between 0 and 18 years of age with any clinical condition were included. Out of the 6861 records identified, 51 full texts were reviewed, and 16 studies (10 experimental and 6 observational), involving overall 2902 children and adolescents, were included. Ten studies were conducted in children with elevated BP without identifiable cause, two in children with familial hypertension, one in children with at least one cardiovascular risk factor, one in children with chronic renal insufficiency, one in children with urolithiasis, and one in premature infants. A positive association between sodium intake and BP was found in all studies, except one. The meta-analysis of six studies among children with elevated BP without identifiable cause revealed a difference of 6.3 mm Hg (95% CI 2.9-9.6) and 3.5 mm Hg (95% CI 1.2-5.7) in systolic and diastolic BP, respectively, for every additional gram of sodium intake per day. In conclusion, our results indicate that the BP response to salt is greater in children with clinical conditions, mainly hypertension, than in those without associated clinical conditions

Interdigital 50 nm Ti Electrode Arrays Fabricated Using XeF2 Enhanced Focused Ion Beam Etching

The fabrication of interdigitated titanium nanoelectrode arrays of 50 nm in width and spacing is described in this work. The nanoarrays have been realized using a Ga+ focused ion beam (FIB). FIB milling is typically accompanied by redeposition of removed material, which represents an important hindrance for milling closely spaced nanostructures. Redeposition effects have been reduced by means of XeF2 gas assistance, which increases the etch yield by a factor of seven compared with pure ion milling. Furthermore, we used a simple adsorption model, which led to the conclusion that dwell time and refresh time should be 30 ms, respectively, for optimized XeF2 assisted Ti milling. The measured resistance R of the electrodes is higher than 1 G ohm

Clinical evaluation of IDAS II, a new electronic device enabling drug adherence monitoring.

OBJECTIVE: The goal of this study was to evaluate clinically the acceptability of the IDAS II (Intelligent Drug Administration System), a new electronic device that enables drug adherence monitoring. METHODS: IDAS II was compared to another electronic monitor, the Medication Event Monitoring System (MEMS) in a randomised two-way cross-over study involving 24 hypertensive patients treated with irbesartan. Patients used each device for 2 months. The main parameter of evaluation was the patients' opinion on both devices. Rates of adherence and blood pressure were also assessed. RESULTS: Most patients considered both devices to be reliable reminders (IDAS II: 75%;MEMS: 84%, p = ns). Ten patients (42%) preferred the MEMS, while 11 (46%) preferred the IDAS II; three (12%) expressed no preference. Patients found the MEMS device easier to use than the IDAS device (p < 0.001) but appreciated the IDAS blister packs better than the MEMS bulk packaging (p < 0.01). Over the 4-month period, the median "taking adherence" was excellent (99.2%) and comparable with both devices. However, the regularity of drug intake timing was higher with the IDAS II (p < 0.01). CONCLUSION: IDAS II, a new electronic device enabling drug adherence monitoring without reconditioning of the drugs appears to be a well-accepted device. Overall, practicability and acceptability of the IDAS II and the MEMS device were similar. Thus, IDAS II could be a useful tool for the management of long-term therapies

Census politics in deeply divided societies

Population censuses in societies that are deeply divided along ethnic, religious or linguistic lines can be sensitive affairs – particularly where political settlements seek to maintain peace through the proportional sharing of power between groups. This brief sets out some key findings from a research project investigating the relationship between census politics and the design of political institutions in Bosnia and Herzegovina, Kenya, Lebanon and Northern Ireland

Thorium speciation in seawater

Author Posting. © The Authors, 2006. This is the author's version of the work. It is posted here by permission of Elsevier B.V. for personal use, not for redistribution. The definitive version was published in Marine Chemistry 100 (2006): 250-268, doi:10.1016/j.marchem.2005.10.024.Since the 1960’s, thorium isotopes occupy a special place in the oceanographer’s toolbox as tracers for determining rates and mechanisms of oceanic scavenging, particle dynamics, and carbon fluxes. Due to their unique and constant production rates from soluble parent nuclides of uranium and radium, their disequilibrium can be used to calculate rates and time scales of sinking particles. In addition, by ratio-ing particulate 234Th (as well, in principle, other Thnuclides) to carbon (and other elements), and linking this ratio to the parent-daughter disequilibrium in the water column, it is possible to calculate fluxes of carbon and other elements. Most of these applications are possible with little knowledge of the dissolved chemical properties of thorium, other than its oxidation state (IV) and tendency to strongly sorb to surfaces, i.e., its “particle- or surface-activity”. However, the use of any tracer is hindered by a lack of knowledge of its chemical properties. Recent observations in the variability of carbon to 234Th ratios in different particle types, as well as of associations of Th(IV) with various marine organic biomolecules has led to the need for a review of current knowledge and what future endeavors should be taken to understand the marine chemistry of thorium.The writing of this paper was supported, in parts by NSF (OCE-0351559; OCE-0350758, and OCE 0354757)

A Sensor-Driven Visit Detection System in Older Adults Homes: Towards Digital Late-Life Depression Marker Extraction

Modern sensor technology is increasingly used in older adults to not only provide additional safety but also to monitor health status, often by means of sensor derived digital measures or biomarkers. Social isolation is a known risk factor for late-life depression, and a potential component of social-isolation is the lack of home visits. Therefore, home visits may serve as a digital measure for social isolation and late-life depression. Late-life depression is a common mental and emotional disorder in the growing population of older adults. The disorder, if untreated, can significantly decrease quality of life and, amongst other effects, leads to increased mortality. Late-life depression often goes undiagnosed due to associated stigma and the incorrect assumption that it is a normal part of ageing. In this work, we propose a visit detection system that generalizes well to previously unseen apartments - which may differ largely in layout, sensor placement, and size from apartments found in the semi-annotated training dataset. We find that by using a self-training-based domain adaptation strategy, a robust system to extract home visit information can be built (ROC AUC=0.773). We further show that the resulting visit information correlates well with the common geriatric depression scale screening tool (=-0.87, p=0.001), providing further support for the idea of utilizing the extracted information as a potential digital measure or even as a digital biomarker to monitor the risk of late-life depression