A mixed-methods study of the implementation of medication adherence policy solutions: how do European countries compare?

Wendy Clyne,1 Sarah McLachlan2 1Faculty of Health and Life Sciences, Coventry University, Priory Street, Coventry, UK; 2Primary Care and Health Sciences, Keele University, Staffordshire, UK Objectives: We describe a key informant study that invited national medicines policy leads for the European Union member states to self-assess the level of implementation of medicines adherence initiatives in their country and the adequacy of that implementation. Interviews with medicines policy leads enabled in-depth understanding of the variation in adherence support across nations and the ways in which different nations prioritize, plan, and implement medicines adherence systems and services.Methods: Ten national policy leads (Bulgaria, Denmark, Estonia, Finland, Germany, Ireland, Latvia, Lithuania, Malta, and the Netherlands) completed a self-assessment survey, and seven (Estonia, Finland, Germany, Ireland, Lithuania, Malta, and the Netherlands) engaged in a follow-up interview.Key findings: Policy leads varied in the level of implementation of medication adherence solutions that they reported in their nations; most initiatives were aimed directly at patients with few initiatives at government or health care commissioner levels of action. Policy leads reported insufficient implementation of medication adherence initiatives across all potential domains. Barriers to implementation included lack of resources, strategic planning, evidence to support action, the “hidden” nature of medication adherence within policy work, and dispersed responsibility for medication adherence as a policy and practice theme.Conclusion: This study has international significance and summarizes the emergent characteristics of nations with and without coordinated medication adherence activity. We highlight the importance of sharing good practice in policy formulation and implementation for medication adherence. Keywords: medication adherence, policy implementation, medicines policy, health care polic

A MERLIN Observation of PSR B1951+32 and its associated Plerion

In an investigative 16 hour L band observation using the MERLIN radio interferometric array, we have resolved both the pulsar PSR B1951+32 and structure within the flat spectral radio continuum region, believed to be the synchrotron nebula associated with the interaction of the pulsar and its `host' supernova remnant CTB 80. The extended structure we see, significant at $\sim$ 4.5 $\sigma$, is of dimensions 2.5" $\times$ 0.75", and suggests a sharp bow shaped arc of shocked emission, which is correlated with similar structure observed in lower resolution radio maps and X-ray images. Using this MERLIN data as a new astrometric reference for other multiwavelength data we can place the pulsar at one edge of the HST reported optical synchrotron knot, ruling out previous suggested optical counterparts, and allowing an elementary analysis of the optical synchrotron emission which appears to trail the pulsar. The latter is possibly a consequence of pulsar wind replenishment, and we suggest that the knot is a result of magnetohydrodynamic (MHD) instabilities. These being so, it suggests a dynamical nature to the optical knot, which will require high resolution optical observations to confirm.Comment: 12 pages, 2 figures. Accepted for publication in ApJ

Exposure of Bifidobacterium longum subsp. infantis to Milk Oligosaccharides Increases Adhesion to Epithelial Cells and Induces a Substantial Transcriptional Response

Devon Kavanaugh is in receipt of a Teagasc Walsh Fellowship. The authors would also like to acknowledge the support of Science Foundation Ireland under Grant No. 08/SRC/B1393 and the Alimentary Glycoscience Research Cluster (AGRC).peer-reviewedIn this study, we tested the hypothesis that milk oligosaccharides may contribute not only to selective growth of bifidobacteria, but also to their specific adhesive ability. Human milk oligosaccharides (3′sialyllactose and 6′sialyllactose) and a commercial prebiotic (Beneo Orafti P95; oligofructose) were assayed for their ability to promote adhesion of Bifidobacterium longum subsp. infantis ATCC 15697 to HT-29 and Caco-2 human intestinal cells. Treatment with the commercial prebiotic or 3′sialyllactose did not enhance adhesion. However, treatment with 6′sialyllactose resulted in increased adhesion (4.7 fold), while treatment with a mixture of 3′- and 6′-sialyllactose substantially increased adhesion (9.8 fold) to HT-29 intestinal cells. Microarray analyses were subsequently employed to investigate the transcriptional response of B. longum subsp. infantis to the different oligosaccharide treatments. This data correlated strongly with the observed changes in adhesion to HT-29 cells. The combination of 3′- and 6′-sialyllactose resulted in the greatest response at the genetic level (both in diversity and magnitude) followed by 6′sialyllactose, and 3′sialyllactose alone. The microarray data was further validated by means of real-time PCR. The current findings suggest that the increased adherence phenotype of Bifidobacterium longum subsp. infantis resulting from exposure to milk oligosaccharides is multi-faceted, involving transcription factors, chaperone proteins, adhesion-related proteins, and a glycoside hydrolase. This study gives additional insight into the role of milk oligosaccharides within the human intestine and the molecular mechanisms underpinning host-microbe interactions.Science Foundation IrelandTeagasc Walsh Fellowship Programm

A Constitutive Stress–Strain Law for Metals with Sigmoidal Curves

A formulation is proposed for true stress–true strain relationships in the plastic regime that exhibit sigmoidal shapes, such as those of certain metastable austenitic stainless steels (MASS). It contains two terms, broadly accounting for contributions to hardening from conventional plasticity and from mechanical stimulation of martensite formation. It is a continuous function, designed to cover the plastic strain range from zero up to several tens of percent. It is shown that it is suitable for capture of a range of curve shapes of this type—experimental data from tensile testing of a MASS alloy over a range of temperature, with good fidelity. The formulation incorporates six independent parameters, although there may be scope for limiting the range of values that they can have, facilitating convergence operations. Information is presented about how convergence is obtained. The equation is thus expected to be suitable for use in finite element method (FEM) models for simulation of plastic deformation in various scenarios, including indentation. Future work will involve exploration of the details of this.</jats:sec

Magnetohydrodynamic activity inside a sphere

We present a computational method to solve the magnetohydrodynamic equations in spherical geometry. The technique is fully nonlinear and wholly spectral, and uses an expansion basis that is adapted to the geometry: Chandrasekhar-Kendall vector eigenfunctions of the curl. The resulting lower spatial resolution is somewhat offset by being able to build all the boundary conditions into each of the orthogonal expansion functions and by the disappearance of any difficulties caused by singularities at the center of the sphere. The results reported here are for mechanically and magnetically isolated spheres, although different boundary conditions could be studied by adapting the same method. The intent is to be able to study the nonlinear dynamical evolution of those aspects that are peculiar to the spherical geometry at only moderate Reynolds numbers. The code is parallelized, and will preserve to high accuracy the ideal magnetohydrodynamic (MHD) invariants of the system (global energy, magnetic helicity, cross helicity). Examples of results for selective decay and mechanically-driven dynamo simulations are discussed. In the dynamo cases, spontaneous flips of the dipole orientation are observed.Comment: 15 pages, 19 figures. Improved figures, in press in Physics of Fluid

Wavelet Decomposition of Forced Turbulence: Applicability of the Iterative Donoho-Johnstone Threshold

We examine the decomposition of forced Taylor-Green and Arn’old-Beltrami- Childress (ABC) flows into coherent and incoherent components using an orthonormal wavelet decomposition. We ask whether wavelet coefficient thresh- olding based on the Donoho-Johnstone criterion can extract a coherent vortex signal while leaving behind Gaussian random noise. We find that no threshold yields a strictly Gaussian incoherent component, and that the most Gaussian incoherent flow is found for data compression lower than that achieved with the fully iterated Donoho-Johnstone threshold. Moreover, even at such low compression, the incoherent component shows clear signs of large-scale spatial correlations that are signatures of the forcings used to drive the flows

An accelerated buoyancy adhesion assay combined with 3-D morphometric analysis for assessing osteoblast adhesion on microgrooved substrata.

An accelerated negative buoyancy method has been developed to assess cell adhesion strength. This method has been used in conjunction with 3-D morphometric analysis to understand the effects of surface topology on cell response. Aligned micro-grooved surface topographies (with a range of groove depths) were produced on stainless steel 316L substrates by laser ablation. An investigation was carried out on the effect of the micro-grooved surface topography on cell adhesion strength, cell and nucleus volumes, cell phenotypic expression and attachment patterns. Increased hydrophobicity and anisotropic wettability was observed on surfaces with deeper grooves. A reduction was noted in cell volume, projected areas and adhesion sites for deeper grooves, linked to lower cell proliferation and differentiation rates and also to reduced adhesion strength. The results suggest that the centrifugation assay combined with three-dimensional cell morphometric analysis has considerable potential for obtaining improved understanding of the cell/substrate interface.Financial support for this work has been provided by the EPSRC (grant GR/R95364/01) and by the ERC (grant No. 240446). The authors are grateful to Dr. Tim Nunney, of Thermo-Fisher Scientific, for carrying out the XPS measurements.This is the final version of the article. It first appeared from Elsevier via https://doi.org/ /10.1016/j.jmbbm.2015.12.03

Impact of global warming on the rise of volcanic plumes and implications for future volcanic aerosol forcing

©2016. American Geophysical Union. All Rights Reserved. Volcanic eruptions have a significant impact on climate when they inject sulfur gases into the stratosphere. The dynamics of eruption plumes is also affected by climate itself, as atmospheric stratification impacts plumes' height. We use an integral plume model to assess changes in volcanic plume maximum rise heights as a consequence of global warming, with atmospheric conditions from an ensemble of global climate models, using three representative concentration pathways (RCP) scenarios. Predicted changes in atmospheric temperature profiles decrease the heights of tropospheric and lowermost stratospheric volcanic plumes and increase the tropopause height, for the RCP4.5 and RCP8.5 scenarios in the coming three centuries. Consequently, the critical mass eruption rate required to cross the tropopause increases by up to a factor of 3 for tropical regions and up to 2 for high-latitude regions. A number of recent lower stratospheric plumes, mostly in the tropics (e.g., Merapi, 2010), would be expected to not cross the tropopause starting from the late 21st century, under RCP4.5 and RCP8.5 scenarios. This effect could result in a ≃5–25% decrease in the average SO2 flux into the stratosphere carried by small plumes, the frequency of which is larger than the rate of decay of volcanic stratospheric aerosol, and a ≃2–12% decrease of the total flux. Our results suggest the existence of a positive feedback between climate and volcanic aerosol forcing. Such feedback may have minor implications for global warming rate but can prove to be important to understand the long-term evolution of volcanic atmospheric inputs