A systematic review of factors influencing treatment adherence in chronic inflammatory skin disease – strategies for optimizing treatment outcome

Adherence describes how a patient follows a medical regime recommended by a healthcare provider. Poor treatment adherence represents a complex and challenging problem of international healthcare systems, as it has a substantial impact on clinical outcomes and patient safety and constitutes an important financial burden. Since it is one of the most common causes of treatment failure, it is extremely important for physicians to reliably distinguish between non‐adherence and non‐response. This systematic review aims to summarize the current literature on treatment adherence in dermatology, focusing on chronic inflammatory skin diseases such as psoriasis, atopic dermatitis and acne. A systematic literature search was performed using the PubMed Database, including articles from 2008 to 2018. Low treatment adherence is a multidimensional phenomenon defined by the interplay of numerous factors and should under no circumstances be considered as the patient's fault alone. Factors influencing treatment adherence in dermatology include patient characteristics and beliefs, treatment efficacy and duration, administration routes, disease chronicity and the disease itself. Moreover, the quality of the physician‐patient relationship including physician‐time available for the patient plays an important role. Understanding patients’ adherence patterns and the main drivers of non‐adherence creates opportunities to improve adherence in the future. Strategies to increase treatment adherence range from reminder programs to simplifying prescriptions or educational interventions. Absolute adherence to treatment may not be realistically achievable, but efforts need to be made to raise awareness in order to maximize adherence as far as possible

Methods for identifying low emissions development options for agriculture

Low emissions development strategies (LEDS) are national economic and social development plans that promote sustainable development while reducing GHG emissions. While LEDS programs have helped to mainstream economy-wide planning for low emissions, planning for low emissions agriculture has remained nascent. Low-emissions development (LED) in agriculture acknowledges that the primary purpose of agriculture is to produce food and other goods for human needs, and that climate change mitigation is a secondary goal that should not compromise production. This paper describes a research process and protocol to identify high potential LED options in agriculture at the United States Agency for International Development (USAID). The case study illustrates the steps for the identification and prioritization of LED options including: idea generation, concept development, and evidence building. Each stage is designed to gather and analyze data that specifically enable managers and stakeholders to make informed evaluations. The method gathers not only emission and mitigation information but also food security and income generation data, lending process legitimacy to the research. The incorporation of institutional factors and local contextual systems in the LED concept development stage improves the output credibility and salience. In the final process phase, stakeholders are given an active role in determining the criteria for prioritization and building evidence. The LED option identification and prioritization process illustrates how careful evidence-building can increase the credibility and salience of outputs and legitimacy of the overall results

Mercury emission from a temperate lake during autumn turnover

Lakes in temperate regions stratify during summer and winter months, creating distinct Positive correlations between dissolved mercury and iron and manganese also suggest a role for these elements in mercury transport within the lake, but iron and manganese did not demonstrate a relationship with emission rates. This research indicates that consideration of seasonal processes in lakes is important when evaluating mercury cycling in aquatic systems. © 2009 Elsevier B.V. All rights reserved. Keywords: Mercury emission Lake turnover Dynamic flux chamber Introduction Mercury in aquatic systems bioaccumulates in the food web and has toxic effects at all trophic levels. The reduction of dissolved Hg(II) to Hg 0 often results in partitioning of mercury from terrestrial or aquatic surfaces to the atmosphere where J Hg is the calculated mercury flux, Q is the air sampling flow rate, A is the water surface area within the chamber, an

Human Vault Nanoparticle Targeted Delivery of Antiretroviral Drugs to Inhibit Human Immunodeficiency Virus Type 1 Infection.

"Vaults" are ubiquitously expressed endogenous ribonucleoprotein nanoparticles with potential utility for targeted drug delivery. Here, we show that recombinant human vault nanoparticles are readily engulfed by certain key human peripheral blood mononuclear cells (PBMC), predominately dendritic cells, monocytes/macrophages, and activated T cells. As these cell types are the primary targets for human immunodeficiency virus type 1 (HIV-1) infection, we examined the utility of recombinant human vaults for targeted delivery of antiretroviral drugs. We chemically modified three different antiretroviral drugs, zidovudine, tenofovir, and elvitegravir, for direct conjugation to vaults. Tested in infection assays, drug-conjugated vaults inhibited HIV-1 infection of PBMC with equivalent activity to free drugs, indicating vault delivery and drug release in the cytoplasm of HIV-1-susceptible cells. The ability to deliver functional drugs via vault nanoparticle conjugates suggests their potential utility for targeted drug delivery against HIV-1

Agricultural development addresses food loss and waste while reducing greenhouse gas emissions

Food loss and waste (FLW) reduce food available for consumption and increase the environmental burden of production. Reducing FLW increases agricultural and value-chain productivity and may reduce greenhouse gas emissions associated with feeding the global population. Although studies of interventions that reduce FLW exist, almost no research systematically investigates FLW interventions across multiple value chains or countries, most likely due to challenges in collecting and synthesizing data and estimates, let alone estimating greenhouse gas emissions. Our research team investigated changes in FLW in projects supported by the United States Agency for International Development\u27s (USAID) global hunger and food security initiative, Feed the Future. This was a unique opportunity to conduct ex-ante estimates of the impacts of FLW interventions across 20 value chains in 12 countries, based on project documents and interviews with USAID and project staff. This paper describes specific interventions in each value chain and country context, providing insight to interventions that decrease FLW at multiple points along food value chains, from upstream producer-dominated stages to downstream consumer-dominated stages. Amongst the sub-sectors studied, FLW interventions directed at extensive dairy systems could decrease FLW by 4–10%, providing meaningful greenhouse gas mitigation, since these systems are both emission-intensive and experience high FLW. More modest emissions reductions were found for other key agricultural products, including maize, rice, vegetables, fruits and market goods

Scaling up sustainability in commodity agriculture: Transferability of governance mechanisms across the coffee and cattle sectors in Brazil

A number of governance mechanisms address socio-environmental challenges associated with commodity agriculture in tropical forested countries. Governance mechanisms that prove effective in one agricultural sector are often applied to other sectors as well. For example, voluntary certification programs have been adopted by producers of commodities as diverse as beef, coffee, palm oil, and soy. However, there are substantial differences in the extent to which governance mechanisms scale up and achieve impact in different sectors. This paper analyzes how the potential for scaling up a particular governance mechanism is influenced by environmental, market, and social geographies that differ between sectors. Through stakeholder interviews, farm-level surveys, and a literature review, we examine two types of voluntary governance mechanisms (third-party certification, and sustainable intensification programs) in the coffee and cattle sectors in Brazil, to understand why the two governance mechanisms have scaled differently between these two sectors. We find that third-party certification programs have scaled up relatively well in Brazil\u27s coffee sector, more so than its cattle sector, in part owing to differences in sustainability priorities, market orientations, supply chain traceability, and social networks between the two sectors. We also find that pilot sustainable intensification programs in the cattle sector have had more success than certification in engaging farmers, in part because they involve less investment from participating farmers. We conclude that the distribution and quality of environmental resources, markets, knowledge, actors, and networks can play an important role in the ability of a governance mechanism to effectively take root

Analysis of chromosome positions in the interphase nucleus of Chinese hamster cells by laser-UV-microirradiation experiments

Unsynchronized cells of an essentially diploid strain of female Chinese hamster cells derived from lung tissue (CHL) were laser-UV-microirradiated (=257 nm) in the nucleus either at its central part or at its periphery. After 7–9 h postincubation with 0.5 mM caffeine, chromosome preparations were made in situ. Twenty-one and 29 metaphase spreads, respectively, with partial chromosome shattering (PCS) obtained after micro-irradiation at these two nuclear sites, were Q-banded and analyzed in detail. A positive correlation was observed between the frequency of damage of chromosomes and both their DNA content and length at metaphase. No significant difference was observed between the frequencies of damage obtained for individual chromosomes at either site of microirradiation. The frequency of joint damage of homologous chromosomes was low as compared to nonhomologous ones. Considerable variation was noted in different cells in the combinations of jointly shattered chromosomes. Evidence which justifies an interpretation of these data in terms of an interphase arrangement of chromosome territories is discussed. Our data strongly argue against somatic pairing as a regular event, and suggest a considerable variability of chromosome positions in different nuclei. However, present data do not exclude the possibility of certain non-random chromosomal arrangements in CHL-nuclei. The interphase chromosome distribution revealed by these experiments is compared with centromere-centromere, centromere-center and angle analyses of metaphase spreads and the relationship between interphase and metaphase arrangements of chromosomes is discussed