The Aston Medication Adherence Study:mapping the adherence patterns of an inner-city population

Background: The Aston Medication Adherence Study was designed to examine non-adherence to prescribed medicines within an inner-city population using general practice (GP) prescribing data. Objective: To examine non-adherence patterns to prescribed oralmedications within three chronic disease states and to compare differences in adherence levels between various patient groups to assist the routine identification of low adherence amongst patients within the Heart of Birmingham teaching Primary Care Trust (HoBtPCT). Setting: Patients within the area covered by HoBtPCT (England) prescribed medication for dyslipidaemia, type-2 diabetes and hypothyroidism, between 2000 and 2010 inclusively. HoBtPCT's population was disproportionately young,with seventy per cent of residents fromBlack and Minority Ethnic groups. Method: Systematic computational analysis of all medication issue data from 76 GP surgeries dichotomised patients into two groups (adherent and non-adherent) for each pharmacotherapeutic agent within the treatment groups. Dichotomised groupings were further analysed by recorded patient demographics to identify predictors of lower adherence levels. Results were compared to an analysis of a self-reportmeasure of adherence [using the Modified Morisky Scale© (MMAS-8)] and clinical value data (cholesterol values) from GP surgery records. Main outcome: Adherence levels for different patient demographics, for patients within specific longterm treatment groups. Results: Analysis within all three groups showed that for patients with the following characteristics, adherence levels were statistically lower than for others; patients: younger than 60 years of age; whose religion is coded as "Islam"; whose ethnicity is coded as one of the Asian groupings or as "Caribbean", "Other Black" and "African"; whose primary language is coded as "Urdu" or "Bengali"; and whose postcodes indicate that they live within the most socioeconomically deprived areas of HoBtPCT. Statistically significant correlations between adherence status and results from the selfreport measure of adherence and of clinical value data analysis were found. Conclusion: Using data fromGP prescribing systems, a computerised tool to calculate individual adherence levels for oral pharmacotherapy for the treatment of diabetes, dyslipidaemia and hypothyroidism has been developed.The tool has been used to establish nonadherence levels within the three treatment groups and the demographic characteristics indicative of lower adherence levels, which in turn will enable the targeting of interventional support within HoBtPCT. © Koninklijke Nederlandse Maatschappij ter bevordering der Pharmacie 2013.

Dietary analysis and patterns of nutritional supplement use in normal and age-related macular disease affected subjects:a prospective cross-sectional study

Background: Poor diet is thought to be a risk factor for many diseases, including age-related macular disease (ARMD), which is the leading cause of blind registration in those aged over 60 years in the developed world. The aims of this study were 1) to evaluate the dietary food intake of three subject groups: participants under the age of 50 years without ARMD (U50), participants over the age of 50 years without ARMD (O50), and participants with ARMD (AMD), and 2) to obtain information on nutritional supplement usage. Methods: A prospective cross-sectional study designed in a clinical practice setting. Seventy-four participants were divided into three groups: U50; 20 participants aged < 50 years, from 21 to 40 (mean ± SD, 37.7 ± 10.1 years), O50; 27 participants aged > 50 years, from 52 to 77 (62.7 ± 6.8 years), and ARMD; 27 participants aged > 50 years with ARMD, from 55 to 79 (66.0 ± 5.8 years). Participants were issued with a three-day food diary, and were also asked to provide details of any daily nutritional supplements. The diaries were analysed using FoodBase 2000 software. Data were input by one investigator and statistically analysed using Microsoft Excel for Microsoft Windows XP software, employing unpaired t-tests. Results: Group O50 consumed significantly more vitamin C (t = 3.049, p = 0.005) and significantly more fibre (t = 2.107, p = 0.041) than group U50. Group ARMD consumed significantly more protein (t = 3.487, p = 0.001) and zinc (t = 2.252, p = 0.029) than group O50. The ARMD group consumed the highest percentage of specific ocular health supplements and the U50 group consumed the most multivitamins. Conclusions: We did not detect a deficiency of any specific nutrient in the diets of those with ARMD compared with age- and gender-matched controls. ARMD patients may be aware of research into use of nutritional supplementation to prevent progression of their condition.

The application of counter immunoelectrophoresis (CIE) in ocular protein studies. Part I:time dependent deposition patterns of immunoregulatory proteins on anionic hydrogel contact lenses

This paper focuses on the effects of wear regime on the deposition pattern of important immunoregulatory proteins on FDA Group IV etafilcon-A lenses. Specifically, the aim was to assess the extent to which the daily disposable wear modality produces a different deposition of proteins from the conventional daily wear regime which is coupled with cleaning and disinfection. Counter immunoelectrophoresis (CIE) was employed to detect individual proteins in lens extracts from individual patients and focused on the analysis of five proteins, IgA, IgG, lactoferrin, albumin and kininogen. Deposition was monitored as a function of time; significantly lower deposition was detected on the daily disposable lenses. cr 2002 British Contact Lens Association. Published by Elsevier Science Ltd. All rights reserved.

Entrepreneurship in the neighborhood:shifting patterns of economic activities in residential neighborhoods in five dutch cities

Cities are oftentimes seen as undergoing a process of "emergence" in the "new economy." However, this process has largely remained empirically underdetermined. This article examines the intra-city geography of emerging businesses in newly dominant sectors of the urban economy. The change in dominant sectors coincides with a shift towards small- and medium-sized businesses, creating new economic opportunities for urban residential areas. The residential neighborhood is introduced as a place where supply and demand side drivers operate to attract or limit such new economic activity. Allen Scott's perspective of the cognitive-cultural economy is used to analyze which neighborhoods are flourishing sites of the cognitive-cultural sectors. His perspective on industries that are on the rise in urban environments and their growth potential proves very valuable. Social demographic characteristics on the level of the neighborhood are used as predictors of the composition of the local economy. The analyses show that in particular wealthy, gentrified neighborhoods are more prone than others to becoming "hubs" of the cognitive-cultural economy. However, disadvantaged neighborhoods may under certain conditions serve as incubators for business start-ups as they offer low-rent office spaces. This has important consequences for their future economic growth potential as well as the distribution of successful businesses in the city. © 2013 Urban Affairs Association.

Early predictors of phonological and morphological awareness and the link with reading:evidence from children with different patterns of early deficit

This study examines the contribution of early phonological processing (PP) and language skills on later phonological awareness (PA) and morphological awareness (MA), as well as the links among PA, MA, and reading. Children 4-6 years of age with poor PP at the start of school showed weaker PA and MA 3 years later (age 7-9), regardless of their language skills. PA and phonological and morphological strategies predict reading accuracy, whereas MA predicts reading comprehension. Our findings suggest that children with poor early PP are more at risk of developing deficits in MA and PA than children with poor language. They also suggest that there is a direct link between PA and reading accuracy and between MA and reading comprehension that cannot be accounted for by strategy use at the word level.

A comparison of spatial patterns of TDP-43 cellular inclusions in familial and sporadic frontotemporal lobar degeneration with TDP-43 proteinopathy

Abnormal protein aggregates of transactive response (TAR) DNA-binding protein (TDP-43) in the form of neuronal cytoplasmic inclusions (NCI), oligodendroglial inclusions (GI), neuronal internuclear inclusions (NII), and dystrophic neurites (DN) are the pathological hallmark of frontotemporal lobar degeneration with TDP-43 proteinopathy (FTLD-TDP). To investigate the role of phosphorylated TDP-43 (pTDP-43) in neurodegeneration in FTLD-TDP, the spatial patterns of the pTDP-43-immunoreactive NCI, GI, NII, and DN were studied in frontal and temporal cortex in three groups of cases: (1) familial FTLD-TDP caused by progranulin (GRN) mutation, (2) a miscellaneous group of familial cases containing cases caused by valosin-containing protein (VCP) mutation, ubiquitin associated protein 1 (UBAP1) mutation, and cases not associated with currently known genes, and (3) sporadic FTLD-TDP. In a significant number of brain regions, the pTDP-43-immunoreactive inclusions developed in clusters and the clusters were distributed regularly parallel to the tissue boundary. The spatial patterns of the inclusions were similar to those revealed by a phosphorylation-independent anti-TDP-43 antibody. The spatial patterns and cluster sizes of the pTDP-43-immunoreactive inclusions were similar in GRN mutation cases, remaining familial cases, and in sporadic FTLD-TDP. Hence, pathological changes initiated by different genetic factors in familial cases and by unknown causes in sporadic FTLD-TDP appear to follow a parallel course resulting in very similar patterns of degeneration of frontal and temporal lobes.

The spatial patterns of β-amyloid (Aβ) deposits and neurofibrillary tangles (NFT) in late-onset sporadic Alzheimer's disease

The spatial patterns of β-amyloid (Aβ) deposits and neurofibrillary tangles (NFT) were studied in areas of the cerebral cortex in 16 patients with the late-onset, sporadic form of Alzheimer's disease (AD). Diffuse, primitive, and classic Aβ deposits and NFT were aggregated into clusters; the clusters being regularly distributed parallel to the pia mater in many areas. In a significant proportion of regions, the sizes of the regularly distributed clusters approximated to those of the cells of origin of the cortico-cortical projections. The diffuse and primitive Aβ deposits exhibited a similar range of spatial patterns but the classic Aβ deposits occurred less frequently in large clusters >6400m. In addition, the NFT often occurred in larger regularly distributed clusters than the Aβ deposits. The location, size, and distribution of the clusters of Aβ deposits and NFT supports the hypothesis that AD is a 'disconnection syndrome' in which degeneration of specific cortico-cortical and cortico-hippocampal pathways results in synaptic disconnection and the formation of clusters of NFT and Aβ deposits. © 2011 Nova Science Publishers, Inc.

Spatial patterns of neuronal cytoplasmic inclusions in the tauopathies: A comparative study of five disorders

The tauopathies are a major molecular group of neurodegenerative disorders characterised by the deposition of abnormal cellular aggregates of the microtubule associated protein (MAP) tau in the form of neuronal cytoplasmic inclusions (NCI). Recent research suggests that cell to cell propagation of pathogenic tau may be involved in the neurodegeneration of these disorders. If pathogenic tau spreads along anatomical pathways it may give rise to specific spatial patterns of the NCI in brain tissue. To test this hypothesis, the spatial patterns of NCI in cerebral cortical regions were compared in tissue sections taken from five major tauopathies: (1) argyrophilic grain disease (AGD), (2) Alzheimer's disease (AD), (3) corticobasal degeneration (CBD), (4) Pick's disease (PiD), and (5) progressive supranuclear palsy (PSP). In the cerebral cortex of these disorders, NCI were frequently aggregated into clusters and the clusters were regularly distributed parallel to the pia mater. In a significant proportion of regions, the mean size of the regularly distributed clusters of NCI was in the range 400 – 800 m, measured parallel to the pia mater, approximating to the dimension of cell columns associated with the cortico-cortical anatomical pathways. Hence, the data suggest that cortical NCI in the tauopathies exhibit a spatial pattern in the cortex which could result from the spread of pathogenic tau along anatomical pathways. Treatments designed to protect the cortex from tau propagation may therefore be applicable across several different disorders within this molecular group.

Consumer behaviour and lifestyle patterns of Hungarian students in view of environmental awareness

The aim of this paper is to describe the consumer behaviour and everyday lifestyle patterns of Hungarian university and college students. The results are gained from an international survey, carried out by the Department of Environmental Economics and Technology at the Corvinus University of Budapest, supported by the Norwegian Financial Mechanism. As background literature, characteristics of the consumer society and the development of sustainable consumption as a concept are interpreted in the paper. The empirical analysis aims to describe the most important clusters of students, based on the factors of their consumer behaviour, environmental activism and pro-environmental everyday habits. Our results identify two extreme clusters which most significantly differ from each other: the environmental activists and the indifferent group. However, a third cluster has the most modest consumer behaviour, namely the group which considers product features, energy consumption and the behaviour of producers. They spend the least on consumer goods. The three other clusters show quite mixed lifestyle patterns.

Spatial and temporal patterns of true bug assemblages extracted with Berlese funnels (Data to the knowledge on the ground-living Heteroptera of Hungary, No. 2)

A rich material of Heteroptera extracted with Berlese funnels by Dr. I. Loksa between 1953–1974 in Hungary, has been examined. Altogether 157 true bug species have been identified. The ground-living heteropteran assemblages collected in different plant communities, substrata, phytogeographical provinces and seasons have been compared with multivariate methods. Because of the unequal number of samples, the objects have been standardized with stochastic simulation. There are several true bug species, which have been collected in almost all of the plant communities. However, characteristic ground-living heteropteran assemblages have been found in numerous Hungarian plant community types. Leaf litter and debris seem to have characteristic bug assemblages. Some differences have also been recognised between the bug fauna of mosses growing on different surfaces. Most of the species have been found in all of the great phytogeographical provinces of Hungary. Most high-dominance species, which have been collected, can be found at the ground-level almost throughout the year. Specimens of many other species have been collected with Berlese funnels in spring, autumn and/or winter. The diversities of the ground-living heteropteran assemblages of the examined objects have also been compared.

The European Patterns of "Homo Academicus“ and The Chances of Its Evolution In Current Hungarian Higher Education

In the recent four or five years, there have been abrupt and radical changes in the governance of Hungarian higher education. It can then be interesting to assess the state of “homo academicus“ as it looks currently in Hungary. The notion of “homo academicus“ is obvious: it concerns participants in the system of a country’s higher education. The paper as follows still comes back to the definition of “homo academicus“ by referring first to it as occupation, or rather as a profession that can be interpreted in terms of sociology. Secondly, some historic patterns can also be mobilised, based on the assumption that university is a very European institutions that is even rooted in the tradition of the Middle Ages. The elbow-room of seeking for identity and the role to be filled by academics are limited by the effective system of the governance of higher education. It is a key to the chances of academics of meeting the historically corroborated professional standards that they exercise academic freedom. As it cannot be done individually, but in cooperation (through a collegial system), academic freedom is always combined with collective action. The field where this freedom can be exercised can be specified through university autonomy, the lack of which makes a serious barrier to the full development of a character of “homo academicus“. This is now the case in Hungary, the paper suggests. The paper seeks to gain deeper understanding of the character of academics, their vocation and professional roles, and the governance of higher education, serving as the environment for academic activity, by creating a conceptual framework. The paper is established on the results of sociological research and the experience of legal management, although it remains to be of theoretical nature. It criticises the current Hungarian situation of the governance of higher education, arguing for the reconstruction of university autonomy and financial stability. It also emphasises the importance of predictable regulations.

Patterns of diagnostic comorbidity in children and adolescents with anxiety

Comorbidity is defined as the co-occurrence of two or more psychological disorders and has been identified as one of the most pressing issues facing child psychologists today. Unfortunately, research on comorbidity in anxious children is rare. The purpose of this research was to examine how specific comorbid patterns in children and adolescents referred with anxiety disorders affected clinical presentation. In addition, the effects of gender, age and total number of diagnoses were also examined.^ Three hundred fifty-five children and adolescents (145 girls and 210 boys, hereafter referred to as "children") aged 6 to 17 who presented to the Child Anxiety and Phobia Program during the years 1987 through 1996 were assessed through a structured clinical interview administered to both the children and their families. Based on information from both children and parents, children were assigned up to five DSM diagnoses. Global ratings of severity were also obtained. While children were interviewed, parents completed a number of questionnaires pertaining to their child's overall functioning, anxiety, thoughts and behaviors. Similarly, while parents were interviewed, children completed a number of self-report questionnaires concerning their own thoughts, feelings and behaviors.^ In general, children with only anxiety disorders were rated as severe as children who met criteria for both anxiety and externalizing disorders. Children with both anxiety and externalizing disorders were mostly young (i.e. age 6 through 11) and mostly male. These children tended to rate themselves (and be rated by their parents) equally as anxious as children with only anxiety disorders. Global ratings of severity tended to be associated with the type of comorbid pattern versus the number of diagnoses assigned to a child. The theoretical, development and clinical implications of these findings will be discussed. ^

A comparison of breathing patterns of normal full term infants in supine versus right side-lying during quiet and active behavioral sleep states

This study investigated the effect of sleep position on breathing patterns of normal full term infants during quiet and active behavioral sleep states. Tidal volume, percent contribution of rib cage to tidal volume, and respiration rate were measured via respiratory inductive plethysmography (RIP) and pneumotachograph (PNT) in ten infants sleeping in supine versus right side-lying. Data was collected immediately following two consecutive feedings. Paired t tests and ANOVA comparisons showed no significant differences between the two postures (p $<$.05) in mean tidal volume (supine, M = 19.16, right side, M = 22.45), percent contribution of rib cage to tidal volume (supine, M = 30.55, right side M = 33.20), or respiration rate (supine, M = 49.13, right side, M = 49.37) during quiet sleep. Comparisons also showed no significant differences between the two postures (p $<$.05) in mean tidal volume (supine, M = 18.89, right side, M = 20.12), percent contribution of rib cage to tidal volume (supine, M = 6.43, right side, M = 6.97) or respiration rate (supine, M = 62.18, right side, M = 61.04) during active sleep. Therefore, no differences were found in the three respiratory variables measured between the supine and right side-lying positions. These findings suggest that infants may be positioned in either sleep position without detriment to respiratory function. This information may benefit occupational therapists and other health professionals involved in the education of parents on infant positioning and their respective advantages. ^

Alternative service organizations: Funding environment, strategies, and patterns of adaptation

This study explored the strategies that community-based, consumer-focused advocacy, alternative service organizations (ASOs), implemented to adapt to the changes in the nonprofit funding environment (Oliver & McShane, 1979; Perlmutter, 1988a, 1994). It is not clear as to the extent to which current funding trends have influenced ASOs as little empirical research has been conducted in this area (Magnus, 2001; Marquez, 2003; Powell, 1986). ^ This study used a qualitative research design to investigate strategies implemented by these organizations to adapt to changes such as decreasing government, foundation, and corporate funding and an increasing number of nonprofit organizations. More than 20 community informants helped to identify, locate, and provide information about ASOs. Semi-structured interviews were conducted with a sample of 30 ASO executive directors from diverse organizations in Miami-bade and Broward Counties, in South Florida. ^ Data analysis was facilitated by the use of ATLAS.ti, version 5, a qualitative data analysis computer software program designed for grounded theory research. This process generated five major themes: Funding Environment; Internal Structure; Strategies for Survival; Sustainability; and Committing to the Cause, Mission, and Vision. ^ The results indicate that ASOs are struggling to survive financially by cutting programs, decreasing staff, and limiting service to consumers. They are also exploring ways to develop fundraising strategies; for example, increasing the number of proposals written for grants, focusing on fund development, and establishing for-profit ventures. Even organizations that state that they are currently financially stable are concerned about their financial vulnerability. There is little flexibility or cushioning to adjust to "funding jolts." The fear of losing current funding levels and being placed in a tenuous financial situation is a constant concern for these ASOs. ^ Further data collected from the self-administered Funding Checklist and demographic forms were coded and analyzed using Statistical Package for the Social Sciences (SPSS). Descriptive information and frequencies generated findings regarding the revenue, staff compliment, use of volunteers and fundraising consultants, and fundraising practices. The study proposes a model of funding relationships and presents implications for social work practice, and policy, along with recommendations for future research. ^