Impact of community pharmacist intervention discussing patients’ beliefs to improve medication adherence

Background Adherence to evidence based medicines in patients who have experienced a myocardial infarction remains low. Individual’s beliefs towards their medicines are a strong predictor of adherence and may influence other factors that impact on adherence. Objective To investigate if community pharmacists discussing patients’ beliefs about their medicines improved medication adherence at 12 months post myocardial infarction. Setting This study included 200 patients discharged from a public teaching hospital in Queensland, Australia, following a myocardial infarction. Patients were randomised into intervention (n = 100) and control groups (n = 100) and followed for 12 months. Method All patients were interviewed between 5 to 6 weeks, at 6 and 12 months post discharge by the researcher using the repertory grid technique. This technique was used to elicit the patient’s individualised beliefs about their medicines for their myocardial infarction. In the intervention group, patients’ beliefs about their medicines were communicated by the researcher to their community pharmacist. The pharmacist used this information to tailor their discussion with the patient about their medication beliefs at designated time points (3 and 6 months post discharge). The control group was provided with usual care. Main outcome measure The difference in non-adherence measured using a medication possession ratio between the intervention and control groups at 12 months post myocardial infarction. Results There were 137 patients remaining in the study (intervention group n = 72, control group n = 65) at 12 months. In the intervention group 29 % (n = 20) of patients were non-adherent compared to 25 % (n = 16) of patients in control group. Conclusion Discussing patients’ beliefs about their medicines for their myocardial infarction did not improve medication adherence. Further research on patients beliefs should focus on targeting non-adherent patients whose reasons for their non-adherence is driven by their medication beliefs.

Global dissemination of a multidrug resistant Escherichia coli clone

Escherichia coli sequence type 131 (ST131) is a globally disseminated, multidrug resistant (MDR) clone responsible for a high proportion of urinary tract and bloodstream infections. The rapid emergence and successful spread of E. coli ST131 is strongly associated with several factors, including resistance to fluoroquinolones, high virulence gene content, the possession of the type 1 fimbriae FimH30 allele, and the production of the CTX-M-15 extended spectrum β-lactamase (ESBL). Here, we used genome sequencing to examine the molecular epidemiology of a collection of E. coli ST131 strains isolated from six distinct geographical locations across the world spanning 2000–2011. The global phylogeny of E. coli ST131, determined from whole-genome sequence data, revealed a single lineage of E. coli ST131 distinct from other extraintestinal E. coli strains within the B2 phylogroup. Three closely related E. coli ST131 sublineages were identified, with little association to geographic origin. The majority of single-nucleotide variants associated with each of the sublineages were due to recombination in regions adjacent to mobile genetic elements (MGEs). The most prevalent sublineage of ST131 strains was characterized by fluoroquinolone resistance, and a distinct virulence factor and MGE profile. Four different variants of the CTX-M ESBL–resistance gene were identified in our ST131 strains, with acquisition of CTX-M-15 representing a defining feature of a discrete but geographically dispersed ST131 sublineage. This study confirms the global dispersal of a single E. coli ST131 clone and demonstrates the role of MGEs and recombination in the evolution of this important MDR pathogen.

The association between the measurement of adherence to anti-diabetes medicine and the HbA1c

BACKGROUND: Adherence to medicines is important in subjects with diabetes, as nonadherence is associated with an increased risk of morbidity and mortality. However, it is not clear whether there is an association between adherence to medicines and glycaemic control, as not all studies have shown this. One of the reasons for this discrepancy may be that, although there is a standard measure of glycaemic control i.e. HbA1c, there is no standard measure of adherence to medicines. Adherence to medicines can be measured either qualitatively by Morisky or non-Morisky methods or quantitatively using the medicines possession ratio (MPR). AIMS OF THE REVIEW: The aims of this literature review are (1) to determine whether there is an association between adherence to anti-diabetes medicines and glycaemic control, and (2) whether any such association is dependent on how adherence is measured. Methods A literature search of Medline, CINAHL and the Internet (Google) was undertaken with search terms; 'diabetes' with 'adherence' (or compliance, concordance, persistence, continuation) with 'HbA1c' (or glycaemic control). RESULTS: Twenty-three studies were included; 10 qualitative and 12 quantitative studies, and one study using both methods. For the qualitative methods measurements of adherence to anti-diabetes medicines (non-Morisky and Morisky), eight out of ten studies show an association with HbA1c. Nine of ten studies using the quantitative MPR, and two studies using MPR for insulin only, have also shown an association between adherence to anti-diabetes medicines and HbA1c. However, the one study that used both Morisky and MPR did not show an association. Three of the four studies that did not show a relationship, did not use a range of HbA1c values in their regression analysis. The other study that did not show a relationship was specifically in a low income population. CONCLUSIONS: Most studies show an association between adherence to anti-diabetes medicines and HbA1c levels, and this seems to be independent of method used to measure adherence. However, to show an association it is necessary to have a range of HbA1c values. Also, the association is not always apparent in low income populations.

A methodological exploration to determine transportation disadvantage variables: the partial least square approach

Determining the key variables of transportation disadvantage remains a great challenge as the variables are commonly selected using ad-hoc techniques. In order to identify the variables, this research develops a transportation disadvantage framework by manipulating the capability approach. Developed framework is statistically analysed using partial least square-based software to determine the framework fitness. The statistical analysis identifies mobility and socioeconomic variables that significantly influence transportation disadvantage. The research reveals the key socioeconomic variables for transportation disadvantage in the case of Brisbane, Australia as household structure, presence of dependent family member, vehicle ownership, and driving licence possession.

Echolocation calls, wing shape, diet and phylogenetic diagnosis of the endemic Chinese bat Myotis pequinius

We describe the echolocation calls, flight morphology and diet of the endemic Chinese bat Myotis pequinius Thomas, 1908. Orientation calls are broadband, and reach low terminal frequencies. Diet comprised 80% beetles by volume. Wing shape and call design suggest that the bats fly in cluttered habitats, and the possession of moderately long ears and the dietary composition imply they forage at least sometimes by gleaning. Myotis pequinius resembles a larger Oriental version of the western Palaearctic species M. nattereri. Phylogenetic analysis based on sequences of the cytochrome b gene of mitochondrial DNA (1,140 base pairs) from a range of Palaearctic Myotis species confirmed that M. pequinius is close to the nattereri group, and is a sister-species to the eastern Palaearctic M. bombinus. One bat sequenced from China could not be identified from available species descriptions. It was smaller than M. pequinius, and also differed from it in sequence divergence by 6.7%, suggesting the existence of additional, cryptic taxonomic diversity in this group. Our phylogenetic analysis also supports the recognition of M. schaubi as a species distinct from M. nattereri in Transcaucasia and south-western Asia. Myotis nattereri tschuliensis is more closely related to M. schaubi than to M. nattereri, and is best considered either as a subspecies of M. schaubi, or possibly as a distinct species.

A subexponential construction of graph coloring for multiparty computation

We show the first deterministic construction of an unconditionally secure multiparty computation (MPC) protocol in the passive adversarial model over black-box non-Abelian groups which is both optimal (secure against an adversary who possesses any tpossession of the adversary. Unlike the deterministic constructions from Desmedt et al. (2012) our construction has subexponential complexity and is optimal at the same time, i.e., it is secure for any t

Representing places never visited: Landscape and the diasporic imagination

While landscape photography’s complicity with the colonial possession of new territory has been substantially discussed and well understood, this paper considers the role of the European landscape as the focus of diasporic desire. The interdisciplinary project, S2Q/Good Blood began as a social history map of Scandinavian and Nordic migration to Queensland in the nineteenth century, incorporating archival material from local collections with visual field trip data gathered in Denmark, Sweden, Norway and Finland. In 2011, some of this material found its way into the installation work, 'my mother is water, my father is wood'. What emerged from this experiment was an imaginary landscape, melding its loci through original photography and video footage in tandem with stock imagery and historical material. This juxtaposition reinforced the represented landscape as a narrative landscape and evidence of the performativity of belonging. This practitioner reflection utilizes Lynette Russell’s research into landscape archaeology to consider the significance of relationships with landscapes that are “not always empirically demonstrable.”

External administration in corporate insolvency and reorganisation: The insider alternative

This article considers the merits of alternative policy approaches to management of companies in insolvency administration, in particular from an identity economics theoretical perspective. The use of this perspective provides a novel assessment of the policy alternatives for insolvency administration, which can be characterized as either following the more flexible United States Chapter 11-style debtor-in-possession arrangement, or relying on the appointment of an external administrator or trustee to manage the insolvent company who automatically displaces incumbent management. This analysis indicates that stigma and reputational damage from automatic removal of managers in voluntary administration leaders to "identity loss" and that an insider alternative to the current external administration approach could be a beneficial policy change.

An analysis of TLS handshake proxying

Content delivery networks (CDNs) are an essential component of modern website infrastructures: edge servers located closer to users cache content, increasing robustness and capacity while decreasing latency. However, this situation becomes complicated for HTTPS content that is to be delivered using the Transport Layer Security (TLS) protocol: the edge server must be able to carry out TLS handshakes for the cached domain. Most commercial CDNs require that the domain owner give their certificate's private key to the CDN's edge server or abandon caching of HTTPS content entirely. We examine the security and performance of a recently commercialized delegation technique in which the domain owner retains possession of their private key and splits the TLS state machine geographically with the edge server using a private key proxy service. This allows the domain owner to limit the amount of trust given to the edge server while maintaining the benefits of CDN caching. On the performance front, we find that latency is slightly worse compared to the insecure approach, but still significantly better than the domain owner serving the content directly. On the security front, we enumerate the security goals for TLS handshake proxying and identify a subtle difference between the security of RSA key transport and signed-Diffie--Hellman in TLS handshake proxying; we also discuss timing side channel resistance of the key server and the effect of TLS session resumption.

Editorial of "International Journal of Critical Indigenous Studies Volume 2, Number 2, 2009"

This edition of the International Critical Indigenous Studies Journal, our second for 2009 takes alternative understandings as its theme. All four articles in this edition attend to citizenship and Indigenous sovereignty though in different ways...

Designing for collections : Building histories, sharing the spectacle

The hobby of collecting represents the passionate acquisition and possession of a specific type(s) of object; creating a ‘spectacle’, to be shared with others. The fundamentality of the physical objects in collections against the backdrop of the growing ubiquity of computing provides a unique and compelling avenue for design. Based on interviews with 11 self-identified collectors, this paper discusses the role collectors have in informing HCI design and in turn, the potential HCI has in designing technology to assist collectors in sharing what we term the ‘spectacle’ of collecting. Toward this, we suggest two ideas for future designs, including building personal histories of individual collectable items and developing a simple digital means of connecting proximate collectors with those who stand to benefit from collectors’ unique and item-specific knowledge.

The White Possessive : Property, Power and Indigenous Sovereignty

The White Possessive explores the links between race, sovereignty, and possession through themes of property: owning property, being property, and becoming propertyless. Focusing on the Australian Aboriginal context, Aileen Moreton-Robinson questions current race theory in the first world and its preoccupation with foregrounding slavery and migration. The nation, she argues, is socially and culturally constructed as a white possession. Moreton-Robinson reveals how the core values of Australian national identity continue to have roots in Britishness and colonization, built on the disavowal of Indigenous sovereignty. Whiteness studies are central to Moreton-Robinson’s reasoning, and she shows how blackness works as a white epistemological tool that bolsters the social production of whiteness—displacing Indigenous sovereignties and rendering them invisible in a civil rights discourse, sidestepping issues of settler colonialism. Throughout this critical examination Moreton-Robinson proposes a bold new agenda for critical Indigenous studies, one that involves deeper analysis of the prerogatives of white possession within the role of disciplines.

Res Communis? A critical legal geography of outer space, Antarctica, and the deep seabed

This chapter provides a critical legal geography of outer Space, charting the topography of the debates and struggles around its definition, management, and possession. As the emerging field of critical legal geography demonstrates, law is not a neutral organiser of space, but is instead a powerful cultural technology of spatial production. Drawing on legal documents such as the Outer Space Treaty and the Moon Treaty, as well as on the analogous and precedent-setting legal geographies of Antarctica and the deep seabed, the chapter addresses key questions about the legal geography of outer Space, questions which are of growing importance as Space’s available satellite spaces in the geostationary orbit diminish, Space weapons and mining become increasingly viable, Space colonisation and tourism emerge, and questions about Space’s legal status grow in intensity. Who owns outer Space? Who, and whose rules, govern what may or may not (literally) take place there? Is the geostationary orbit the sovereign property of the equatorial states it supertends, as these states argued in the 1970s? Or is it a part of the res communis, or common property of humanity, which currently legally characterises outer Space? Does Space belong to no one, or to everyone? As challenges to the existing legal spatiality of outer Space emerge from spacefaring states, companies, and non-spacefaring states, it is particularly critical that the current spatiality of Space is understood and considered.