The journey to concordance for patients with hypertension: a qualitative study in primary care

Objective: We aimed to explore, using qualitative methods, the perspectives of patients with hypertension on issues relating to concordance in prescribing.

Method: This study took place in NHS general practices in Northern Ireland. A purposeful sample of patients who had been prescribed anti-hypertensive medication for at least one year were invited to participate in focus groups or semi-structured interviews; data were analysed using constant comparison.

Main outcome measures: The perspectives of patients with hypertension on issues relating to concordance in prescribing.

Results: Twenty-five individuals participated in five focus groups; two participated in semi-structured interviews. Participants felt they could make valuable contributions to consultations regarding their management. They were prepared to negotiate with GPs regarding their medication, but most deferred to their doctor’s advice, perceiving doctors’ attitudes and time constraints as barriers to their greater involvement in concordant decision-making. They had concerns about taking anti-hypertensive drugs, were aware of lifestyle influences on hypertension and reported using personal strategies to facilitate adherence and reduce the need to take medication.

Conclusions: Participants indicated a willingness to be?involved in concordance in prescribing anti- hypertensive medication but needed health professionals to address their concerns and confusion about the nature of hypertension. These findings suggest that there is a need for doctors and other healthcare professionals with responsibility for prescribing to develop skills specifically to explore the beliefs and views underlying an individual’s medication use. Such skills may need to be developed through specific training programmes at both undergraduate and postgraduate level.

Infection control strategies for preventing the transmission of meticillin-resistant Staphylococcus aureus (MRSA) in nursing homes for older people

Background

Microbicide delivery: formulation technologies and strategies

Purpose of review: The aim of this article is to summarize the latest information on microbicide formulations for prevention of sexual transmission of HIV infection in women. Recent findings: Although early microbicide formulations were conventionally coitally dependent gel products, new technologies are being developed for vaginal delivery of anti-HIV agents. Intravaginal rings for delivery of microbicides, for example, are being developed and evaluated clinically. Safety and acceptability data are available for many microbicide gels and for one microbicide intravaginal ring. Other microbicide formulations in development for once daily or other vaginal administration strategies include films, tablets, and ovules. Various microbicide formulations for rectal administration are also in development. Summary: New microbicide formulations in development are addressing many of the issues with the original gels such as coital dependency, frequency of use, acceptability, compliance, cost, and adaptability to large-scale production. All of these dosage forms are promising options for safe, effective, and acceptable microbicide products.

Design strategies for dual-band class-e power amplifier using composite right/left-handed transmission lines

In this article we propose a technique for dual-band Class-E power amplifier design using composite right/left-handed transmission lines, CRLH TLs. Design equations are presented and design procedures are elaborated. Because of the nonlinear phase dispersion characteristic of CRLH TLs, the single previous attempt at applying this method to dual bond Class-E amplifier design was not sufficient to simultaneously satisfy, the minimum requirement of Class-E impedances at both the fundamental and the second harmonic frequencies. This article rectifies this situation. A design example illustrating the synthesis procedure for a 0.5W-5V dual band Class-E amplifier circuit simultaneously operated at 900 MHz and 2.4 GHz is given and compared with ADS simulation.

Learning soft computing control strategies in a modular neural network architecture

Modelling and control of nonlinear dynamical systems is a challenging problem since the dynamics of such systems change over their parameter space. Conventional methodologies for designing nonlinear control laws, such as gain scheduling, are effective because the designer partitions the overall complex control into a number of simpler sub-tasks. This paper describes a new genetic algorithm based method for the design of a modular neural network (MNN) control architecture that learns such partitions of an overall complex control task. Here a chromosome represents both the structure and parameters of an individual neural network in the MNN controller and a hierarchical fuzzy approach is used to select the chromosomes required to accomplish a given control task. This new strategy is applied to the end-point tracking of a single-link flexible manipulator modelled from experimental data. Results show that the MNN controller is simple to design and produces superior performance compared to a single neural network (SNN) controller which is theoretically capable of achieving the desired trajectory. (C) 2003 Elsevier Ltd. All rights reserved.

The importance of reproductive strategies in population genetic approaches to conservation: an example from the marine angiosperm genus Zostera

Knowledge of the levels of genetic diversity maintained in natural populations can play a central role in conservation programmes, particularly in threatened habitats or species. Fluctuations in population size can lead to loss of variation and, consequently, increase the risk of extinction. We have examined whether such a genetic bottleneck has occurred in populations of two species in the seagrass genus Zostera, which are believed to have been affected by an outbreak of wasting disease at the start of the last century. A test for heterozygote excess at five nuclear microsatellite loci did not suggest the occurrence of a genetic bottleneck, but analysis of seven chloroplast microsatellite loci and sequence data from two regions did suggest a bottleneck in the chloroplast genome. Extremely low levels of between-population diversity suggest that all subpopulations can be treated as a single management unit for each species. Comparable levels of nuclear genetic diversity were found in the three populations of the primarily sexual Zostera marina var. angustifolia studied but a wider range of within-population diversity was found in Zostera noltii, which displays both. sexual and vegetative reproductive strategies. This may be due to an increase in sexual recruitment due to localised fresh water inflow into the study site near to the most diverse population. Such populations should be prioritised as source material for any replanting or remediation due to natural or anthropogenic loss of Zostera beds in the area.

One-pot multistep synthetic strategies for the production of fenpropimorph using an ionic liquid solvent

The one-pot synthesis of the fungicide fenpropimorph has been achieved using two different synthetic strategies in an ionic liquid. The first pathway consists of a Heck coupling followed by reductive amination; the second pathway consists of an aldol condensation followed by hydrogenation/reductive amination. Homogeneous and heterogeneous palladium catalysts have been utilised in the ionic liquid to provide a catalyst/solvent system that is suitable for recycling and process optimisation.