Nonadherence to antihypertensive medication is common, especially in those with apparent treatment-resistant hypertension (true treatment-resistant hypertension requires exclusion of nonadherence), ...and its routine detection is supported by clinical guidelines. Chemical adherence testing is a reliable and valid method to detect adherence, yet methods are unstandardized and are not ubiquitous. This article describes the principles of chemical adherence testing for hypertensive patients and provides a set of recommendations for centers wishing to develop the test. We recommend testing should be done in either of two instances: (1) in those who have resistant hypertension or (2) in those on 2 antihypertensives who have a less than 10 mm Hg drop in systolic blood pressure on addition of the second antihypertensive medication. Furthermore, we recommend that verbal consent is secured before undertaking the test, and the results should be discussed with the patient. Based on medications prescribed in United Kingdom, European Union, and United States, we list top 20 to 24 drugs that cover >95% of hypertension prescriptions which may be included in the testing panel. Information required to identify these medications on mass spectrometry platforms is likewise provided. We discuss issues related to ethics, sample collection, transport, stability, urine versus blood samples, qualitative versus quantitative testing, pharmacokinetics, instrumentation, validation, quality assurance, and gaps in knowledge. We consider how to best present, interpret, and discuss chemical adherence test results with the patient. In summary, this guidance should help clinicians and their laboratories in the development of chemical adherence testing of prescribed antihypertensive drugs.
Abstract
The dissolved-phase hydrocarbon recovery can be the first step in decontaminating the soil–water system if spilled with light/dense non-aqueous phase liquid (L/D-NAPL). This study proposes a ...temporal moment-based approach to investigate the effectiveness of groundwater table manipulations for recovering dissolved-phase byproducts of light non-aqueous phase liquid (LNAPL) from the subsurface system. Temporal moments were computed utilizing experimentally observed and HYDRUS-simulated dissolved-phase toluene concentration data, representative of LNAPL, under stable and dynamic groundwater table fluctuation (GWTF) scenarios. Zeroth temporal moment (ZTM) showed that the hydrocarbon mass recovery varied from 1,804 to 5,190.6 mg/L × h, with the highest variation for the rapid GWTF scenario. An increase in the ZTM of hydrocarbon was observed with an increase in the rate of change of magnitude of the water table and pore velocity fluctuation as in the case of a rapid GWTF as compared to a stable GWTF case. The value of mean residence time for the stable groundwater table case was highest for the entire experimental duration, followed by slow, general, and rapid cases. Temporal moment analysis revealed that the high dissolved-phase hydrocarbon recovery could be achieved by manipulating groundwater table conditions. The present study provides a powerful technique to improve dissolved hydrocarbon remediation in mineral aquifers using hydrological restorations.
We developed a three-dimensional (3D) synthetic animated mouse based on computed tomography scans that is actuated using animation and semirandom, joint-constrained movements to generate synthetic ...behavioral data with ground-truth label locations. Image-domain translation produced realistic synthetic videos used to train two-dimensional (2D) and 3D pose estimation models with accuracy similar to typical manual training datasets. The outputs from the 3D model-based pose estimation yielded better definition of behavioral clusters than 2D videos and may facilitate automated ethological classification.
Rule‐guided behavior depends on the ability to strategically update and act on content held in working memory. Proactive and reactive control strategies were contrasted across two experiments using ...an adapted input/output gating paradigm (Neuron, 81, 2014 and 930). Behavioral accuracies of 3‐, 5‐, and 7‐year‐olds were higher when a contextual cue appeared at the beginning of the task (input gating) rather than at the end (output gating). This finding supports prior work in older children, suggesting that children are better when input gating but rely on the more effortful output gating strategy for goal‐oriented action selection (Cognition, 155, 2016 and 8). A manipulation was added to investigate whether children's use of working memory strategies becomes more flexible when task goals are specified internally rather than externally provided by the experimenter. A shift toward more proactive control was observed when children chose the task goal among two alternatives. Scan path analyses of saccadic eye movement indicated that giving children agency and choice over the task goal resulted in less use of a reactive strategy than when the goal was determined by the experimenter.
Choice over a task goal allowed 3 – 7‐year‐old children to shift towards more proactive control. Scan path analyses of saccadic eye movement indicated that giving children agency and choice resulted in less use of a reactive strategy than when the goal was determined by the experimenter.
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Gallbladder (GB) wall thickening is a frequent finding caused by a spectrum of conditions. It is observed in many extracholecystic as well as intrinsic GB conditions. GB wall thickening can either be ...diffuse or focal. Diffuse wall thickening is a secondary occurrence in both extrinsic and intrinsic pathologies of GB, whereas, focal wall thickening is mostly associated with intrinsic GB pathologies. In the absence of specific clinical features, accurate etiological diagnosis can be challenging. The survival rate in GB carcinoma (GBC) can be improved if it is diagnosed at an early stage, especially when the tumor is confined to the wall. The pattern of wall thickening in GBC is often confused with benign diseases, especially chronic cholecystitis, xanthogranulomatous cholecystitis, and adenomyomatosis. Early recognition and differentiation of these conditions can improve the prognosis. In this minireview, the authors describe the patterns of abnormalities on various imaging modalities (conventional as well as advanced) for the diagnosis of GB wall thickening. This paper also illustrates an algorithmic approach for the etiological diagnosis of GB wall thickening and suggests a formatted reporting for GB wall abnormalities.
Objective of the present study is to determine an optimum range of turning parameters using merged wavelet denoising and local mean decomposition (WDLMD) technique in order to establish stable ...turning settings in computer numerical control (CNC) lathe. In this method, the embedded ambient noise and other disturbances in experimentally acquired chatter signals are removed using wavelet denoising (WD). Further, local mean decomposition (LMD) technique is applied on denoised signals to extract a series of product functions (PFs). Thereafter, fast Fourier transformation (FFT) of these PFs is done and then considering these FFTs, prominent PFs containing the chatter information are selected. These prominent PFs are combined to reconstruct the signal containing rich information of chatter. Finally, reconstructed signal has been explored by evaluating statistical indexes in order to extract tool chatter features and stability regimes in CNC turning. More experiments have been performed to corroborate the ascertained stability zone.
Seemingly, a paradox exists between reports of wide-scale task-dependent cortical activity and the causal requirement for only a restricted number of motor and sensory cortical areas in some ...behavioral studies. In this issue of Neuron, Pinto et al. (2019) indicate that scenarios where mice must accumulate evidence and hold it during a delay period are causally linked to wide regions of cortex.
Seemingly, a paradox exists between reports of wide-scale task-dependent cortical activity and the causal requirement for only a restricted number of motor and sensory cortical areas in some behavioral studies. In this issue of Neuron, Pinto et al. (2019) indicate that scenarios where mice must accumulate evidence and hold it during a delay period are causally linked to wide regions of cortex.
To assess the prevalence and severity of neurocognitive impairment in adult survivors of pediatric CNS tumors and to examine associated treatment exposures.
Participants included 224 survivors of CNS ...tumors who were treated at St Jude Children's Research Hospital (current median age range, 26 years 19 to 53 years; time from diagnosis, 18 years 11 to 42 years) and completed neurocognitive testing. Information on cranial radiation therapy (CRT) doses and parameters of delivery were abstracted from medical records. The prevalence of severe impairment (ie, at least two standard deviations below normative mean) was compared across radiation treatment groups (no CRT, focal irradiation, craniospinal irradiation) using the χ(2) test. Log-binomial models were used to estimate risk ratios (RRs) and corresponding 95% CIs for severe impairment.
In multivariable models, craniospinal irradiation was associated with a 1.5- to threefold increased risk of severe impairment compared with no CRT (eg, intelligence: RR = 2.70; 95% CI, 1.37 to 5.34; memory: RR = 2.93; 95% CI, 1.69 to 5.08; executive function: RR = 1.74; 95% CI, 1.24 to 2.45). Seizures were associated with impaired academic performance (RR = 1.48; 95% CI, 1.02 to 2.14), attention (RR = 1.54; 95% CI, 1.12 to 2.13), and memory (RR = 1.44; 95% CI, 1.04 to 1.99). Hydrocephalus with shunt placement was associated with impaired intelligence (RR = 1.78; 95% CI, 1.12 to 2.82) and memory (RR = 1.42; 95% CI, 1.03 to 1.95). Differential follow-up time contributed to variability in prevalence estimates between survivors treated with older nonconformal and those treated with more contemporary conformal radiation therapy methods. Neurocognitive impairment was significantly associated with lower educational attainment, unemployment, and nonindependent living.
Survivors of pediatric CNS tumors are at risk of severe neurocognitive impairment in adulthood. The prevalence of severe impairment is greater than expected in the general population, even in the absence of CRT, and is associated with disrupted attainment of adult social milestones.
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