Effects on blood pressure and cardiovascular risk of variations in patients' adherence to prescribed antihypertensive drugs: role of duration of drug action.

P>Aim: To determine the effects of imperfect adherence (i.e. occasionally missing prescribed doses), and the influence of rate of loss of antihypertensive effect during treatment interruption, on the predicted clinical effectiveness of antihypertensive drugs in reducing mean systolic blood pressure (SBP) and cardiovascular disease (CVD) risk.Method:The effects of imperfect adherence to antihypertensive treatment regimens were estimated using published patterns of missed doses, and taking into account the rate of loss of antihypertensive effect when doses are missed (loss of BP reduction in mmHg/day; the off-rate), which varies between drugs. Outcome measures were the predicted mean SBP reduction and CVD risk, determined from the Framingham Risk Equation for CVD.Results:In patients taking 75% of prescribed doses (typical of clinical practice), only long-acting drugs with an off-rate of similar to 1 mmHg/day were predicted to maintain almost the full mean SBP-lowering effect throughout the modelled period. In such patients, using shorter-acting drugs (e.g. an off-rate of similar to 5-6 mmHg/day) was predicted to lead to a clinically relevant loss of mean SBP reduction of > 2 mmHg. This change also influenced the predicted CVD risk reduction; in patients with a baseline 10-year CVD risk of 27.0% and who were taking 75% of prescribed doses, a difference in off-rate from 1 to 5 mmHg/day led to a predicted 0.5% absolute increase in 10-year CVD risk.Conclusions:In patients who occasionally miss doses of antihypertensives, modest differences in the rate of loss of antihypertensive effect following treatment interruption may have a clinically relevant impact on SBP reduction and CVD risk. While clinicians must make every effort to counsel and encourage each of their patients to adhere to their prescribed medication, it may also be prudent to prescribe drugs with a low off-rate to mitigate the potential consequences of missing doses.

Iowa Civil Rights Commission Agency Performance Plan and Action Plan, FY 2014

Agency performancce plan and action plan for the Iowa Civil Rights Commission

Frost Action in Rocks and Concrete, HR-258, 1986

The objectives of the project were to develop methodologies for (i) prediction and measurement of the magnitude of pressure which develops within pores of saturated porous materials upon freezing, (ii) determination of pore structure (pore size distribution) of porous materials; (iii) prediction and measurement of the rate with which pore ice grows; and (iv) prediction of frost susceptibility of porous materials with varying pore structures. As with all research endeavors solution of one problem leads to another one and this project was no exception. Emergence of new problems and the measures taken as the work progressed were discussed in progress reports submitted to the board. This final report will discuss only the conclusive finds and suggest measures to be taken for future investigations. The theory discussed in the proposal is not repeated in this report for the sake of brevity. However, the paper published as part of this project containing the theory is attached as Appendix I for the reader interested in the theory. In conformity with the objectives, this report consists of four parts. In accordance with the project contract two ice porosimeters were built and one will be delivered to the Iowa DOT after training of a DOT technician under the supervision of Mr. Wendell Dubberke with assistance from ISU researchers. During the training period debugging and further improvements in software will continue.

Lottery Action, Vol. 20, No. 5, March 24-April 6, 2014

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Embodying feminist research: learning from action research, political practices, diffractions and collective knowledge.

In the past three decades, feminists and critical theorists have discussed and argued the importance of deconstructing and problematizing social science research methodology in order to question normalized hierarchies concerning the production of knowledge and the status of truth claims. Nevertheless, often, these ideas have basically remained theoretical propositions not embodied in research practices. In fact there is very little published discussion about the difficulties and limits of their practical application. In this paper we introduce some interconnected reflections starting from two different but related experiences of embodying 'feminist activist research'. Our aim is to emphasise the importance of attending to process, making mistakes and learning during fieldwork, as well as experimenting with personalized forms of analysis, such as the construction of narratives and the story-telling process.

Iowa Lottery Action, Vol. 20, No. 4, March 10-23, 2014

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Iowa Lottery Action, Vol. 20, No. 1, Jan. 27-Feb. 9, 2014

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Iowa Lottery Action, Vo. 20, No. 3 Feb. 24 - March 9, 2014

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Iowa Lottery Action, Vol. 20, No. 2, Feb. 10-23, 2014

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Iowa Lottery Action, Vol. 19, No. 1, Jan. 6-26, 2014

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Iowa Lottery Action, Vol. 19, NO. 24, Dec. 16, 2013 - Jan. 5, 2014

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Iowa Lottery Action, Vol. 19, No. 23, Dec. 2-15, 2013

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