Targeting medication non-adherence behavior in selected autoimmune diseases: a systematic approach to digital health program development

Background 29 autoimmune diseases, including Rheumatoid Arthritis, gout, Crohn’s Disease, and Systematic Lupus Erythematosus affect 7.6-9.4% of the population. While effective therapy is available, many patients do not follow treatment or use medications as directed. Digital health and Web 2.0 interventions have demonstrated much promise in increasing medication and treatment adherence, but to date many Internet tools have proven disappointing. In fact, most digital interventions continue to suffer from high attrition in patient populations, are burdensome for healthcare professionals, and have relatively short life spans. Objective Digital health tools have traditionally centered on the transformation of existing interventions (such as diaries, trackers, stage-based or cognitive behavioral therapy programs, coupons, or symptom checklists) to electronic format. Advanced digital interventions have also incorporated attributes of Web 2.0 such as social networking, text messaging, and the use of video. Despite these efforts, there has not been little measurable impact in non-adherence for illnesses that require medical interventions, and research must look to other strategies or development methodologies. As a first step in investigating the feasibility of developing such a tool, the objective of the current study is to systematically rate factors of non-adherence that have been reported in past research studies. Methods Grounded Theory, recognized as a rigorous method that facilitates the emergence of new themes through systematic analysis, data collection and coding, was used to analyze quantitative, qualitative and mixed method studies addressing the following autoimmune diseases: Rheumatoid Arthritis, gout, Crohn’s Disease, Systematic Lupus Erythematosus, and inflammatory bowel disease. Studies were only included if they contained primary data addressing the relationship with non-adherence. Results Out of the 27 studies, four non-modifiable and 11 modifiable risk factors were discovered. Over one third of articles identified the following risk factors as common contributors to medication non-adherence (percent of studies reporting): patients not understanding treatment (44%), side effects (41%), age (37%), dose regimen (33%), and perceived medication ineffectiveness (33%). An unanticipated finding that emerged was the need for risk stratification tools (81%) with patient-centric approaches (67%). Conclusions This study systematically identifies and categorizes medication non-adherence risk factors in select autoimmune diseases. Findings indicate that patients understanding of their disease and the role of medication are paramount. An unexpected finding was that the majority of research articles called for the creation of tailored, patient-centric interventions that dispel personal misconceptions about disease, pharmacotherapy, and how the body responds to treatment. To our knowledge, these interventions do not yet exist in digital format. Rather than adopting a systems level approach, digital health programs should focus on cohorts with heterogeneous needs, and develop tailored interventions based on individual non-adherence patterns.

Joint use of attribute importance rankings and non-attendance data in choice experiments

The joint and alternative uses of attribute non-attendance and importance ranking data within discrete choice experiments are investigated using data from Lebanon examining consumers’ preferences for safety certification in food. We find that both types of information; attribute non-attendance and importance rankings, improve estimates of respondent utility. We introduce a method of integrating both types of information simultaneously and find that this outperforms models where either importance ranking or non-attendance data are used alone. As in previous studies, stated non-attendance of attributes was not found to be consistent with respondents having zero marginal utility for those attributes

English compound and non-compound processing in bilingual and multilingual speakers: effects of dominance and sequential multilingualism

This article reports on a study investigating the relative influence of the first and dominant language on L2 and L3 morpho-lexical processing. A lexical decision task compared the responses to English NV-er compounds (e.g., taxi driver) and non-compounds provided by a group of native speakers and three groups of learners at various levels of English proficiency: L1 Spanish-L2 English sequential bilinguals and two groups of early Spanish-Basque bilinguals with English as their L3. Crucially, the two trilingual groups differed in their first and dominant language (i.e., L1 Spanish-L2 Basque vs. L1 Basque-L2 Spanish). Our materials exploit an (a)symmetry between these languages: while Basque and English pattern together in the basic structure of (productive) NV-er compounds, Spanish presents a construction that differs in directionality as well as inflection of the verbal element (V[3SG] + N). Results show between and within group differences in accuracy and response times that may be ascribable to two factors besides proficiency: the number of languages spoken by a given participant and their dominant language. An examination of response bias reveals an influence of the participants' first and dominant language on the processing of NV-er compounds. Our data suggest that morphological information in the nonnative lexicon may extend beyond morphemic structure and that, similarly to bilingualism, there are costs to sequential multilingualism in lexical retrieval.

Civilian casualties – do we really care? The failure of the revolution in military affairs of non-lethal weapons in the U.S., Russia and Israel

Causing civilian casualties during military operations has become a much politicised topic in international relations since the Second World War. Since the last decade of the 20th century, different scholars and political analysts have claimed that human life is valued more and more among the general international community. This argument has led many researchers to assume that democratic culture and traditions, modern ethical and moral issues have created a desire for a world without war or, at least, a demand that contemporary armed conflicts, if unavoidable, at least have to be far less lethal forcing the military to seek new technologies that can minimise civilian casualties and collateral damage. Non-Lethal Weapons (NLW) – weapons that are intended to minimise civilian casualties and collateral damage – are based on the technology that, during the 1990s, was expected to revolutionise the conduct of warfare making it significantly less deadly. The rapid rise of interest in NLW, ignited by the American military twenty five years ago, sparked off an entirely new military, as well as an academic, discourse concerning their potential contribution to military success on the 21st century battlefields. It seems, however, that except for this debate, very little has been done within the military forces themselves. This research suggests that the roots of this situation are much deeper than the simple professional misconduct of the military establishment, or the poor political behaviour of political leaders, who had sent them to fight. Following the story of NLW in the U.S., Russia and Israel this research focuses on the political and cultural aspects that have been supposed to force the military organisations of these countries to adopt new technologies and operational and organisational concepts regarding NLW in an attempt to minimise enemy civilian casualties during their military operations. This research finds that while American, Russian and Israeli national characters are, undoubtedly, products of the unique historical experience of each one of these nations, all of three pay very little regard to foreigners’ lives. Moreover, while it is generally argued that the international political pressure is a crucial factor that leads to the significant reduction of harmed civilians and destroyed civilian infrastructure, the findings of this research suggest that the American, Russian and Israeli governments are well prepared and politically equipped to fend off international criticism. As the analyses of the American, Russian and Israeli cases reveal, the political-military leaderships of these countries have very little external or domestic reasons to minimise enemy civilian casualties through fundamental-revolutionary change in their conduct of war. In other words, this research finds that employment of NLW have failed because the political leadership asks the militaries to reduce the enemy civilian casualties to a politically acceptable level, rather than to the technologically possible minimum; as in the socio-cultural-political context of each country, support for the former appears to be significantly higher than for the latter.

Wide-band tracheids (WBTs) of photosynthetic and non-photosynthetic stems in species of Cactaceae

ARRUDA, E. AND G. F. A. MELO-DE-PINNA (Departamento de Botanica, Instituto de Biociencias. Universidade de Sao Paulo, Rua do Matao, travessa 14, Cidade Universitaria, Butanta, Caixa Postal 11461, 05422-970. Sao Paulo, SP, Brasil). Wide-band tracheids (WBTs) of the photosynthetic and non-photosynthetic stems in species of Cactaceae. J. Torrey Bat. Soc. 137: 16-29. 2010.-The absence of WBTs and wood polymorphisms in some species of the Caryophyllales may be related to the particular area of plant analyzed. The present research has the objective of studying the photosynthetic and non-photosynthetic stems of different species and stages of differentiation to register wood polymorphisms and to understand the distribution and occurrence of WBTs. Wood polymorphism was observed in the non-photosynthetic stern of young and adult plants of Opuntioideae and Cactoideae and is also found in the photosynthetic stem of young plants of some species of Cactoideae. Cactoideae present WBT/fibrous dimorphic wood that can be related to cambial variation associated with growth habits and plant development. As expected, in the photosynthetic stem of the adult columnar cacti the wood is monomorphic fibrous in which WBTs were not found. This wood contains a great amount of fibers due to necessity of the mechanical support. In contrast, the globular species do not possess fibers in this area of the stem in either adult or young plants. Opuntia monacantha Haw. had non-fibrous wood in which WBTs were observed in the axial system and in the inner parts of the rays. Fiber clusters were present in the axial system. This wood represents a variation in the wood types described for Opuntioideae. Also, in O. monacantha, cells similar to the WBTs were observed in the pith, which can be interpreted as variation in the morphogenic processes during the ontogeny of the plant, probably a case of homeosis. Monomorphic fibrous wood without WBTs was found along the entire stem of Pereskia bahiensis Gurke. This feature has been observed in other pereskias, and in addition to the others, indicates its proximity to the ancestral cacti.

Non-lignified parenchyma in Cactaceae and Portulacaceae

This work describes the occurrence and distribution pattern of non-lignified parenchyma in species of Cactaceae and Portulacaceae, of which samples of roots and stems of six species of Cactaceae and four species of Portulacaceae were analysed. The first records of non-lignified parenchyma in Portulacaceae were obtained and, in the case of Cactaceae, an in-depth discussion is given on the characterization of this tissue by various authors, as well as new information on the occurrence and distribution pattern of the non-lignified parenchyma. The terminology used to characterize the non-lignified parenchyma cells in the wood of Cactaceae is extremely diversified and often not very descriptive, which makes it difficult to establish homologies and better characterize this tissue. Non-lignified parenchyma cells in the secondary xylem in Cactaceae and Portulacaceae occur in association with the fibrous phase of the wood, often forming true continuous bands. This resembles what some authors call parenchyma wood. The proposal of this study is to demonstrate that, independent of the distribution pattern of the non-lignified parenchyma cells, the terminology used should follow that of the International Association of Wood Anatomists (IAWA) Committee as non-lignified parenchyma and not refer to a parenchymous phase of the wood. (C) 2009 The Linnean Society of London, Botanical Journal of the Linnean Society, 2009, 159, 322-329.

Coherent states of non-relativistic electron in the magnetic-solenoid field

In the present work we construct coherent states in the magnetic-solenoid field, which is a superposition of the Aharonov-Bohm field and a collinear uniform magnetic field. In the problem under consideration there are two kinds of coherent states, those which correspond to classical trajectories which embrace the solenoid and those which do not. The constructed coherent states reproduce exactly classical trajectories, maintain their form under the time evolution and form a complete set of functions, which can be useful in semiclassical calculations. In the absence of the solenoid field these states are reduced to the well known in the case of uniform magnetic field Malkin-Man`ko coherent states.

Identification of non-zein proteins in BR473 maize protein bodies by LC-nanoESI-MS/MS

The nutritional value of maize seed is limited due to its high content of storage proteins (zeins), which are deficient in essential amino acids such as lysine and tryptophan. In a previous paper, we showed that protein bodies obtained from BR473 maize variety, developed by Embrapa (Brazilian Agricultural Research Corporation), were mainly constituted by Z27 and a smaller quantity of Z50 gamma-zeins. Besides zein proteins, other not identified protein band in the SDS/PAGE was also observed, which could indicate the presence of non-zein proteins additionally to gamma-zeins. In the present paper, we have demonstrated the presence of non-zein proteins in BR473 maize protein bodies by LC-nanoESI-MS/MS and database searching. This fact could be related to the excellent energetic value and higher protein quality of BR473 maize grains, since high lysine concentration in some maize varieties has been related to the presence of cytoskeleton proteins that are non-zeins. We have identified the following proteins: Brittle-1 protein (chloroplast precursor), Legumin-1, glyceroldehyde-3-phosphate dehydrogenase, and elongation factor 1-alpha.

Solving the non-convexity problem in some shopping-time and human-capital models

Several works in the shopping-time and in the human-capital literature, due to the nonconcavity of the underlying Hamiltonian, use Örst-order conditions in dynamic optimization to characterize necessity, but not su¢ ciency, in intertemporal problems. In this work I choose one paper in each one of these two areas and show that optimality can be characterized by means of a simple aplication of Arrowís (1968) su¢ ciency theorem.