The hydrological regime of a forested tropical Andean catchment.

The hydrology of tropical mountain catchments plays a central role in ecological function, geochemical and biogeochemical cycles, erosion and sediment production, and water supply in globally important environments. There have been few studies quantifying the seasonal and annual water budgets in the montane tropics, particularly in cloud forests. We investigated the water balance and hydrologic regime of the Kosñipata catchment (basin area: 164.4 km2) over the period 2010–2011. The catchment spans over 2500 m in elevation in the eastern Peruvian Andes and is dominated by tropical montane cloud forest with some high-elevation puna grasslands. Catchment-wide rainfall was 3112 ± 414 mm yr−1, calculated by calibrating Tropical Rainfall Measuring Mission (TRMM) 3B43 rainfall with rainfall data from nine meteorological stations in the catchment. Cloud water input to streamflow was 316 ± 116 mm yr−1 (9.2% of total inputs), calculated from an isotopic mixing model using deuterium excess (Dxs) and δD of waters. Field streamflow was measured in 2010 by recording height and calibrating to discharge. River run-off was estimated to be 2796 ± 126 mm yr−1. Actual evapotranspiration (AET) was 688 ± 138 mm yr−1, determined using the Priestley and Taylor–Jet Propulsion Laboratory (PT-JPL) model. The overall water budget was balanced within 1.6 ± 13.7%. Relationships between monthly rainfall and river run-off follow an anticlockwise hysteresis through the year, with a persistence of high run-off after the end of the wet season. The size of the soil and shallow groundwater reservoir is most likely insufficient to explain sustained dry-season flow. Thus, the observed hysteresis in rainfall–run-off relationships is best explained by sustained groundwater flow in the dry season, which is consistent with the water isotope results that suggest persistent wet-season sources to streamflow throughout the year. These results demonstrate the importance of transient groundwater storage in stabilising the annual hydrograph in this region of the Andes

Impact of a Multicomponent Digital Therapeutic Mobile App on Medication Adherence in Patients with Chronic Conditions: Retrospective Analysis.

BACKGROUND:Strategies to improve medication adherence are widespread in the literature; however, their impact is limited in real practice. Few patients persistently engage long-term to improve health outcomes, even when they are aware of the consequences of poor adherence. Despite the potential of mobile phone apps as a tool to manage medication adherence, there is still limited evidence of the impact of these innovative interventions. Real-world evidence can assist in minimizing this evidence gap. OBJECTIVE:The objective of this study was to analyze the impact over time of a previously implemented digital therapeutic mobile app on medication adherence rates in adults with any chronic condition. METHODS:A retrospective observational study was performed to assess the adherence rates of patients with any chronic condition using Perx Health, a digital therapeutic that uses multiple components within a mobile health app to improve medication adherence. These components include gamification, dosage reminders, incentives, educational components, and social community components. Adherence was measured through mobile direct observation of therapy (MDOT) over 3-month and 6-month time periods. Implementation adherence, defined as the percentage of doses in which the correct dose of a medication was taken, was assessed across the study periods, in addition to timing adherence or percentage of doses taken at the appropriate time (±1 hour). The Friedman test was used to compare differences in adherence rates over time. RESULTS:We analyzed 243 and 130 patients who used the app for 3 months and 6 months, respectively. The average age of the 243 patients was 43.8 years (SD 15.5), and 156 (64.2%) were female. The most common medications prescribed were varenicline, rosuvastatin, and cholecalciferol. The median implementation adherence was 96.6% (IQR 82.1%-100%) over 3 months and 96.8% (IQR 87.1%-100%) over 6 months. Nonsignificant differences in adherence rates over time were observed in the 6-month analysis (Fr(2)=4.314, P=.505) and 3-month analysis (Fr(2)=0.635, P=.728). Similarly, the timing adherence analysis revealed stable trends with no significant changes over time. CONCLUSIONS:Retrospective analysis of users of a medication adherence management mobile app revealed a positive trend in maintaining optimal medication adherence over time. Mobile technology utilizing gamification, dosage reminders, incentives, education, and social community interventions appears to be a promising strategy to manage medication adherence in real practice

Comparison of Interventions to Improve Long-Term Medication Adherence Across Different Clinical Conditions: A Systematic Review With Network Meta-Analysis

Background: Medication non-adherence has a dynamic, temporal and multifactorial nature with a significant impact on economic and clinical outcomes. Interventions to improve adherence are complex and require adaptation to patients' needs, which may include patient's medical conditions. The aim of this study was to assess the comparative effectiveness of medication adherence interventions per type of clinical condition on adult patients.Methods: A systematic review with network meta-analysis was performed (PROSPERO registration number of CRD42018054598). An initial Pubmed search was conducted to select meta-analyses reporting results of interventions aiming to improve medication adherence. Primary studies were selected and those reporting results with a long-term follow up (≥10 months) on adult patients were included for data extraction. Study characteristics, description of interventions and adherence outcomes were extracted. Adherence interventions were classified in four groups: educational, attitudinal, technical, and rewards. Clinical conditions were classified in four groups: circulatory system and metabolic diseases, infectious diseases, musculoskeletal diseases, and mental, behavioral or neurodevelopmental disorders. Network meta-analyses with effect sizes expressed as odds ratio (OR) with a 95% credibility interval (CrI) were built. Ranking probabilities for each measure of adherence were calculated by using surface under the cumulative ranking analysis (SUCRA).Results: A total of 61 meta-analysis and 149 primary studies were included in the qualitative synthesis and 80 primary studies in the quantitative analysis. The most effective interventions were: educational + technical 79.6% [OR: 0.44 (CrI: 0.26, 0.73)] and 73.3% [OR: 0.56 (0.36, 0.84)] in circulatory system and metabolic diseases and infectious diseases respectively. Attitudinal intervention had the greatest probability for musculoskeletal diseases of 92.3% in SUCRA [OR: 0.30 (0.10, 0.86)]. Finally, educational + attitudinal interventions had the greatest effect (SUCRA 73.8%) for mental, behavioral or neurodevelopmental disorders, although this was not significant according to consistency analysis.Conclusion: Effectiveness of interventions seems to be related to the clinical condition. Educational and technical interventions resulted in a major effect on long-term management of medication adherence in patients with infectious diseases (HIV) and circulatory system and metabolic diseases whereas attitudinal components presented a higher effect on musculoskeletal and mental, behavioral or neurodevelopmental disorders

ANÁLISIS BIOLÓGICO Y PESQUERO DE LA EXTRACCIÓN DEL POLIQUETO AMERICONUPHIS REESEI EN EL GOLFO DE MONTIJO, PACÍFICO PANAMEÑO

The common polychaete, Americonuphis reesei is used to stimulate the reproductive process of broodstocks lines in shrimp farms. In accordance, the Aquatic Resources Authority of Panama (ARAP) regulates concessions for the harvest at different locations of the Panamanian Pacific, including the Gulf of Montijo. This motivated the present study to characterize the status of this fishery resource under the work frame of the management plan for the resources of the Montijo Gulf wetland assemblage.  Sampling campaigns were completed between March and October 2013 at the harvest sites to obtain samples and analyze size, weight, density and the catch unit effort (kg/tide∙fisherman).  Data on the total catch by locality was also obtained from the ARAP registry alongside records from the local concessionary fishing company. The results indicate that the density of polychaetes is low, averaging 0.38 ind/m2 (SD = 0.39, n = 42). Total length averaged 72.86 cm (SD = 20.33, N = 30), while the total weight 32.21 g (SD = 13.75, N = 30). The extraction biomass has shown variation over time with the maximum during 2013 at 10588.00 kg, highly above the mean annual value between 2008 and 2013 at 5411 kg. The Catch per unit effort remained between 4 to 5 kg /tide∙fisherman in 2013 as well as for the period 2008 to 2011.         El poliqueto, Americonuphis reesei es utilizado para estimular el proceso reproductivo en reproductores de fincas camaroneras. Debido a esto la Autoridad de los Recursos Acuáticos de Panamá (ARAP) otorga concesiones para su explotación en diferentes localidades del Pacífico panameño, incluyendo el Golfo de Montijo. Esto motivó que dentro de las prioridades del Plan de Manejo del Área de Recursos Manejados Humedal Golfo de Montijo, se hiciera una caracterización biológica y pesquera de este recurso con el objetivo de conocer su estado biológico pesquero. Para esto se hicieron giras entre marzo y octubre de 2013 a los sitios de extracción para obtener muestras para analizar tallas y pesos, estimar densidades  y la captura por unidad de esfuerzo (kg/marea∙extractor).  También se recopiló información sobre volúmenes anuales totales y por localidad a partir de datos de la ARAP y de la empresa cocesionaria. Los resultados indican que la densidad del poliqueto es baja, en promedio 0.38 ind/m2 (DE = 0.39, n = 42). En promedio la LT fue de 72.86 cm (DE = 20.33, N = 30) y el PT promedio fue de 32.21 g (DE = 13.75, N = 30). La biomasa extraída ha sido variable en el tiempo con el máximo en el 2013, con 10588.00 kg, muy por encima del promedio de extracción anual estimado  entre el 2008 y 2013 (5411 kg). La CPUE se mantuvo entre 4 y 5 kg /marea∙extractor, tanto para el 2013, como para el periodo 2009 al 2011

Impact of a Multicomponent Digital Therapeutic Mobile App on Medication Adherence in Patients with Chronic Conditions: Retrospective Analysis (Preprint)

BACKGROUND Strategies to improve medication adherence are widespread in the literature; however, their impact is limited in real practice. Few patients persistently engage long-term to improve health outcomes, even when they are aware of the consequences of poor adherence. Despite the potential of mobile phone apps as a tool to manage medication adherence, there is still limited evidence of the impact of these innovative interventions. Real-world evidence can assist in minimizing this evidence gap. OBJECTIVE The objective of this study was to analyze the impact over time of a previously implemented digital therapeutic mobile app on medication adherence rates in adults with any chronic condition. METHODS A retrospective observational study was performed to assess the adherence rates of patients with any chronic condition using Perx Health, a digital therapeutic that uses multiple components within a mobile health app to improve medication adherence. These components include gamification, dosage reminders, incentives, educational components, and social community components. Adherence was measured through mobile direct observation of therapy (MDOT) over 3-month and 6-month time periods. Implementation adherence, defined as the percentage of doses in which the correct dose of a medication was taken, was assessed across the study periods, in addition to timing adherence or percentage of doses taken at the appropriate time (±1 hour). The Friedman test was used to compare differences in adherence rates over time. RESULTS We analyzed 243 and 130 patients who used the app for 3 months and 6 months, respectively. The average age of the 243 patients was 43.8 years (SD 15.5), and 156 (64.2%) were female. The most common medications prescribed were varenicline, rosuvastatin, and cholecalciferol. The median implementation adherence was 96.6% (IQR 82.1%-100%) over 3 months and 96.8% (IQR 87.1%-100%) over 6 months. Nonsignificant differences in adherence rates over time were observed in the 6-month analysis (Fr(2)=4.314, &lt;i&gt;P&lt;/i&gt;=.505) and 3-month analysis (Fr(2)=0.635, &lt;i&gt;P&lt;/i&gt;=.728). Similarly, the timing adherence analysis revealed stable trends with no significant changes over time. CONCLUSIONS Retrospective analysis of users of a medication adherence management mobile app revealed a positive trend in maintaining optimal medication adherence over time. Mobile technology utilizing gamification, dosage reminders, incentives, education, and social community interventions appears to be a promising strategy to manage medication adherence in real practice. </sec

NB2O5 soportado en SBA-15 para la deshidratación de glicerol a acroleína

En este trabajo se evalúa la actividad catalítica del óxido de niobio soportado sobre sílice mesoporosa con estructura SBA-15 en la deshidratación de glicerol para la obtención de acroleínaLa producción industrial de la acroleína se basa en la oxidación selectiva del propeno, de origen fósil, en presencia de catalizadores complejos de BiMoOx . Debido a la disminución de los recursos petroquímicos, los recursos renovables se están haciendo más competitivos. Entre ellos destaca el glicerol, subproducto de la industria de producción de biodiésel. El glicerol tiene más de 1500 aplicaciones directas en las industrias farmacéuticas, alimentarias o cosmética. Entre las posibles reacciones que se están explorando destaca la deshidratación del glicerol a acroleína; debido a que la glicerina cruda se encuentra diluida en agua, es necesaria la búsqueda de catalizadores sólidos ácidos que sean activos y resistentes a la presencia de agua, evitando así el paso de separación y disminuyendo el coste de producción de acroleína. Con este fin, se han ensayado diferentes catalizadores sólidos ácidos, entre los que se encuentra el Nb2O5.Ministerio de Ciencia e Innovación (Proyecto ENE2009-12743-C04-03), Fondos FEDER y a la Junta de Andalucía (P09-FQM-5070) RMT al Ministerio de Ciencia e Innovación por la financiación dentro del Programa Ramón y Cajal (RYC-2008-03387

Effectiveness of a medication adherence management intervention in a community pharmacy setting: a cluster randomised controlled trial

BackgroundNon-adherence to medications continues to be a burden worldwide, with significant negative consequences. Community pharmacist interventions seem to be effective at improving medication adherence. However, more evidence is needed regarding their impact on disease-specific outcomes. The aim was to evaluate the impact of a community pharmacist-led adherence management intervention on adherence and clinical outcomes in patients with hypertension, asthma and chronic obstructive pulmonary disease (COPD).MethodsA 6-month cluster randomised controlled trial was conducted in Spanish community pharmacies. Patients suffering from hypertension, asthma and COPD were recruited. Patients in the intervention group received a medication adherence management intervention and the control group received usual care. The intervention was based on theoretical frameworks for changing patient behaviour. Medication adherence, disease-specific outcomes (Asthma Control Questionnaire (ACQ) scores, Clinical COPD Questionnaire (CCQ) scores and blood pressure levels) and disease control were evaluated. A multilevel regression model was used to analyse the data.ResultsNinety-eight pharmacies and 1186 patients were recruited, with 1038 patients completing the study. Patients receiving the intervention had an OR of 5.12 (95% CI 3.20 to 8.20, pConclusionsA community pharmacist-led medication adherence intervention was effective at improving medication adherence and clinical outcomes in patients suffering from hypertension, asthma and COPD. Future research should explore the implementation of these interventions in routine practice.Trial registration numberACTRN12618000410257

Relationship between Serum Concentration of Uric Acid and Insulin Secretion among Adults with Type 2 Diabetes Mellitus

To determine the relationship between serum concentrations of uric acid and insulin secretion with hyperglycaemic clamp technique among adults with type 2 diabetes mellitus (DM2) without hyperuricemia, we carried out a cross-sectional study on 45 patients of both gender. We observed correlation between uric acid with male gender r = 0.710 (P = 0.001). Also correlation between uric acid and total insulin secretion was positive r = 0.295 (P = 0.049). As well as a positive correlation adjusted for body mass index was demonstrated for the first, second, and total phases of insulin secretion, respectively, r = 0.438 (P = 0.022), r = 0.433 (P = 0.022), and r = 0.439 (P = 0.024). Serum concentration of uric acid showed a positive relationship with the total phase of insulin secretion; even in states prior to hyperuricemia, uric acid can play an important role in the function of the beta cell in patients with DM2

Cost-Utility Analysis of a Medication Adherence Management Service Alongside a Cluster Randomized Control Trial in Community Pharmacy.

Background: It is necessary to determine the cost utility of adherence interventions in chronic diseases due to humanistic and economic burden of non-adherence. Purpose: To evaluate, alongside a cluster-randomized controlled trial, the cost-utility of a pharmacist-led medication adherence management service (MAMS) compared with usual care in community pharmacies. Materials and Methods: The trial was conducted over six months. Patients with treatments for hypertension, asthma or chronic obstructive pulmonary disease (COPD) were included. Patients in the intervention group (IG) received a MAMS based on a brief complex intervention, whilst patients in the control group (CG) received usual care. The cost–utility analysis adopted a health system perspective. Costs related to medications, healthcare resources and adherence intervention were included. The effectiveness was estimated as quality-adjusted life years (QALYs), using a multiple imputation missing data model. The incremental cost–utility ratio (ICUR) was calculated on the total sample of patients. Results: A total of 1186 patients were enrolled (IG: 633; CG: 553). The total intervention cost was estimated to be € 27.33 ± 0.43 per patient for six months. There was no statistically significant difference in total cost of medications and healthcare resources per patient between IG and CG. The values of EQ-5D-5L at 6 months were significantly higher in the IG [IG: 0.881 ± 0.005 vs CG: 0.833 ± 0.006; p = 0.000]. In the base case, the service was more expensive and more effective than usual care, resulting in an ICUR of € 1,494.82/QALY. In the complete case, the service resulted in an ICUR of € 2,086.30/QALY, positioned between the north-east and south-east quadrants of the cost–utility plane. Using a threshold value of € 20,000/QALY gained, there is a 99% probability that the intervention is cost-effective. Conclusion: The medication adherence management service resulted in an improvement in the quality of life of the population with chronic disease, with similar costs compared to usual care. The service is cost-effective

Approach to the Spanish continental Neogene synthesis and paleoclimatic interpretation

Integrated studies on Neogene geology have been scarce in Spain, but attemps to stratigraphic and sedimentological analysis of continental Tertiary basins have increased considerably lately. The large extent of Neogene basins in Spain, the good quality of the outcrops and the abundance of fossil provide an excellent basis for this kind of studies