Non-adherence to cardiovascular pharmacotherapy in Iraq assessed using 8-items Morisky questionnaire and analysis of dried blood spot samples

open access journalThe study evaluated the non-adherence to selected cardiovascular medications, atenolol, atorvastatin, bisoprolol, diltiazem, lisinopril, simvastatin and valsartan in Iraqi patients by applying a standardized Morisky questionnaire (8-MMAS) and by measuring therapeutic drug concentrations in dried blood spots (DBS) analyzed by liquid chromatography - high resolution mass spectrometry (LC-HRMS). Sixty-nine patients, on continued use of one or more of the selected drugs, were evaluated. The questionnaire showed that 21.7% of participants were non-adherent whereas DBS analysis showed that 49.3% were non-adherent to their medications. No significant correlation between medication non-adherence and gender was detected, but adherence was negatively correlated with the number of medications in the regimen. The 8-items questionnaire was unable to differentiate non-adherence to multiple medications in the prescribed pharmacotherapy regimens. DBS is an alternative to conventional methods to monitor non-adherence objectively. Agreement between the two approaches was weak (Kappa =0.269, p-value 0.05)

Application of digital particle image velocimetry to insect aerodynamics: measurement of the leading-edge vortex and near wake of a Hawkmoth.

Some insects use leading-edge vortices to generate high lift forces, as has been inferred from qualitative smoke visualisations of the flow around their wings. Here we present the first Digital Particle Image Velocimetry (DPIV) data and quantitative analysis of an insect’s leading-edge vortex and near wake at two flight speeds. This allows us to describe objectively 2D slices through the flow field of a tethered Tobacco Hawkmoth (Manduca sexta). The near-field vortex wake appears to braodly resemble elliptical vortex loops. The presence of a leading-edge vortex towards the end of the downstroke is found to coincide with peak upward force production measured by a six-component force–moment balance. The topology of Manduca’s leading-edge vortex differs from that previously described because late in the downstroke, the structure extends continuously from wingtip across the thorax to the other wingtip

Minimum degree of shear connection in composite beams in buildings

[EN] Composite floors are often used in building construction where beams typically span from 6 to 18 m. They are commonly used together with decking of 50 to 80 mm depth that spans 3 to 4.5 m between the beams. Rules for the minimum degree of shear connection in composite beams are presented in Eurocode 4 and other international Codes, and were derived for beams in propped construction.Eurocode 4 defines a minimum limit for the degree of shear connection, primarily to ensure that slip at the steel-concrete interface does not exceed a limiting value. This limit is proportionate to the beam span and also depends on the steel strength and the asymmetry of the flange areas of the section. Currently, many designs cannot achieve the codified degree of shear connection demands, since it is not possible to accommodate a sufficient number of shear connectors on the span as dictated by the spacing of the deck ribs. However, there are special cases which are not explicitly accounted for in Codes. This paper aims to investigate the degree of shear connection requirements in such cases, including beams that are unpropped in construction, beams that are not fully utilised in bending because serviceability criteria govern their design and beams that are predominantly loaded by point loads rather than uniform loading.The results from parametric finite element analyses carried out using ANSYS for beams in the span range of 6 to 18 m are presented. The finite element models have been calibrated against composite beam tests. Comparisons are made with the current Eurocode 4 provisions and modifications are proposed where appropriate.Aggelopoulos, E.; Couchman, G.; Lawson, M. (2018). Minimum degree of shear connection in composite beams in buildings. En Proceedings of the 12th International Conference on Advances in Steel-Concrete Composite Structures. ASCCS 2018. Editorial Universitat Politècnica de València. 129-135. https://doi.org/10.4995/ASCCS2018.2018.7127OCS12913

Demonstration of a partially automated assessment approach to create an individualised, open-ended modelling worksheet

\ua9 2023 The Author(s). Published by Informa UK Limited, trading as Taylor & Francis Group. Partially automated assessment is implemented via the ‘Printable worksheet’ mode in the Numbas e-assessment system to create a mathematical modelling worksheet which is individualised with random parameters but completed and marked as if it were a non-automated piece of coursework, preserving validity while reducing the risk of academic misconduct via copying and collusion. A simple modelling scenario is used for this demonstration. A cylindrical tank of water is draining through a small hole in its base, with the size of the tank, size of the hole and initial volume of water randomised so that the details are different for each student. Students are guided through deriving a model of the movement of water out of their version of the tank, asked to compute the expected time for it to empty and asked to discuss some aspects of the model and their findings in a discursive narrative report

Adherence to cardiovascular pharmacotherapy by patients in Iraq: a mixed methods assessment using quantitative dried blood spot analysis and the 8-item Morisky Medication Adherence Scale

open access articleThis study evaluated the adherence to prescribed cardiovascular therapy medications among cardiovascular disease patients attending clinics in Misan, Amara, Iraq. Mixed methods were used to assess medication adherence comprising the Arabic version of the eight-item Morisky Medication Adherence Scale (MMAS-8) and determination of drug concentrations in patient dried blood spot (DBS) samples by liquid chromatography-high resolution mass spectrometry. Three hundred and three Iraqi patients (median age 53 years, 50.5% female) who had been taking one or more of the nine commonly prescribed cardiovascular medications (amlodipine, atenolol, atorvastatin, bisoprolol, diltiazem, lisinopril, losartan, simvastatin and valsartan) for at least six months were enrolled. For each patient MMAS-8 scores were determined alongside drug concentrations in their dried blood spot samples. Results from the standardized questionnaire showed that adherence was 81.8% in comparison with 50.8% obtained using the laboratory-based microsample analysis. The agreement between the indirect (MMAS-8) and direct (DBS analysis) assessment approaches to assessing medication adherence showed significantly poor agreement (kappa = 0.28, P=0.001). The indirect and direct assessment approaches showed no significant correlation between nonadherence to prescribed cardiovascular pharmacotherapy and age and gender, but were significantly associated with the number of medications in the patient’s treatment regimen (MMAS-8: Odds Ratio (OR) 1.947, 95% CI, P=0.001; DBS analysis: OR 2.164, 95% CI, P=0.001). The MMAS-8 results highlighted reasons for nonadherence to prescribed cardiovascular pharmacotherapy in this patient population whilst the objective DBS analysis approach gave valuable information about nonadherence to each medication in the patient’s treatment regimen. DBS sampling, due its minimally invasive nature, convenience and ease of transport is a useful alternative matrix to monitor adherence objectively in Iraq to cardiovascular pharmacotherapy. This information combined with MMAS-8 can provide clinicians with an evidence-based novel approach to implement intervention strategies to optimise and personalise cardiovascular pharmacotherapy in the Iraqi population and thereby improve patient health outcomes

Origin and significance of 'dispersed facies' basal ice: Svínafellsjökull, Iceland

Dispersed facies basal ice - massive (i.e. structureless) ice with dispersed debris aggregates - is present at the margins of many glaciers and, as a product of internal glacial processes, has the potential to provide important information about the mechanisms of glacier flow and the nature of the subglacial environment. The origin of dispersed facies is poorly understood, with several hypotheses having been advanced for its formation, and there is disagreement as to whether it is largely a sedimentary or a tectonic feature. We test these established hypotheses at the temperate glacier Svfnafellsjokull, Iceland, and find that none fully account for dispersed facies characteristics at this location. Instead, dispersed facies physical, sedimentological and stable-isotope (5180, 8D) characteristics favour a predominantly tectonic origin that we suggest comprises the regelation and straininduced metamorphism of debris-rich basal ice that has been entrained into an englacial position by tectonic processes operating at the base of an icefall. Further thickening of the resultant dispersed facies may also occur tectonically as a result of ice flow against the reverse bed slope of a terminal overdeepening. Lack of efficient subglacial drainage in the region of the overdeepening may limit basal melting and thus favour basal ice preservation, including the preservation of dispersed facies. Despite the relatively low sediment content of dispersed facies (~1.6% by volume), its thickness (up to 25 m) and ubiquity at Svfnafellsjokull results in a significant contribution to annual sediment discharge (1635-3270 m3 a"1) that is ~6.5 times that contributed by debris-rich stratified facies basal ice

Projected expansion of Trichodesmium’s geographical distribution and increase of growth potential in response to climate change

Estimates of marine N₂ fixation range from 52 to 73 Tg N yr‾¹, of which we calculate up to 84% is from Trichodesmium based on previous measurements of nifH gene abundance and our new model of Trichodesmium growth. Here we assess the likely effects of four major climate change‐related abiotic factors on the spatiotemporal distribution and growth potential of Trichodesmium for the last glacial maximum (LGM), the present (2006‐2015) and the end of this century (2100) by mapping our model of Trichodesmium growth onto inferred global surface ocean fields of pCO₂, temperature, light and Fe. We conclude that growth rate was severely limited by low pCO₂ at the LGM, that current pCO₂ levels do not significantly limit Trichodesmium growth and thus, the potential for enhanced growth from future increases of CO₂ is small. We also found that the area of the ocean where sea surface temperatures (SST) are within Trichodesmium’s thermal niche increased by 32% from the LGM to present, but further increases in SST due to continued global warming will reduce this area by 9%. However, the range reduction at the equator is likely to be offset by enhanced growth associated with expansion of regions with optimal or near optimal Fe and light availability. Between now and 2100, the ocean area of optimal SST and irradiance is projected to increase by 7%, and the ocean area of optimal SST, irradiance and iron is projected to increase by 173%. Given the major contribution of this keystone species to annual N₂ fixation and thus pelagic ecology, biogeochemistry and CO₂ sequestration, the projected increase in the geographical range for optimal growth could provide a negative feedback to increasing atmospheric CO₂ concentrations