Suboptimal patient adherence to pharmacological therapy of type 2 diabetes may be due in part to pill burden. One way to reduce pill burden in patients who need multiple medications is to use ...fixed-dose combinations. Our study aimed to compare the effects of fixed-dose combination versus loose-dose combination therapy on medication adherence and persistence, health care utilization, therapeutic safety, morbidities, and treatment modification in patients with type 2 diabetes over three years.
Using administrative data, we conducted a retrospective controlled cohort study comparing type 2 diabetes patients who switched from monotherapy to either a fixed-dose combination or a loose-dose combination. Adherence was assessed as the primary endpoint and calculated as the proportion of days covered with medication. After using entropy balancing to eliminate differences in observable baseline characteristics between the two groups, we applied difference-in-difference estimators for each outcome to account for time-invariant unobservable heterogeneity.
Of the 990 type 2 diabetes patients included in our analysis, 756 were taking a fixed-dose combination and 234 were taking a loose-dose combination. We observed a statistically significantly higher change in adherence (year one: 0.22, p<0.001, year two: 0.25, p<0.001, and year three: 0.29, p<0.001) as well as higher persistence and a smaller change in the number of drug prescriptions in each of the three years in the fixed-dose combination group compared to the loose-dose combination group. The differences were most pronounced in patients who were poorly adherent, had a high pill burden, or did not have a severe concomitant disease.
Our results indicate that taking a fixed-dose combination can lead to a significant improvement in adherence to pharmacological therapy of type 2 diabetes compared to a loose-dose combination. In particular, these findings suggest that reducing pill burden may improve disease management among patients with more complex medication demand and patients who have demonstrated poor medication adherence.
Abstract This article classifies 30 OECD healthcare systems according to a deductively generated typology by Rothgang and Wendt 1 . This typology distinguishes three core dimensions of the healthcare ...system: regulation, financing, and service provision, and three types of actors: state, societal, and private actors. We argue that there is a hierarchical relationship between the three dimensions, led by regulation, followed by financing and finally service provision, where the superior dimension restricts the nature of the subordinate dimensions. This hierarchy rule limits the number of theoretically plausible types to ten. To test our argument, we classify 30 OECD healthcare systems, mainly using OECD Health Data and WHO country reports. The classification results in five system types: the National Health Service, the National Health Insurance, the Social Health Insurance, the Etatist Social Health Insurance, and the Private Health System. All five types belong to the group of healthcare system types considered theoretically plausible. Merely Slovenia does not comply with our assumption of a hierarchy among dimensions and typical actors due to its singular transformation history.
The Neo-Tethys margin evolution is preserved in the Northern Calcareous Alps (Eastern Alps), from Late Permian crustal stretching to Late Triassic oceanization. The Northern Calcareous Alps represent ...the salt-floored fold-and-thrust belt developed from the salt-influenced Triassic carbonate sedimentary cover of the ancestral European margin of the Neo-Tethys Ocean. A crustal scale model for the margin has been obtained by restoration of regional cross-sections of the Northern Calcareous Alps carbonate platforms. Lithospheric break-up was investigated from remnants of exhumed mantle found within an evaporitic melange, suggesting hyperextended crust underneath the distal Triassic platforms of the Northern Calcareous Alps preceding breakup. By modelling the thermal evolution of the margin in combination with excellent stratigraphic control, a detailed timeline has been established for the evolution of the Neo-Tethys margin, especially around the period of rapid mantle exhumation. Our study indicates that salt-floored carbonate shelfs can be used as a proxy to characterize the margins evolution, from crustal stretching to continental breakup. Diagnostic stratigraphic records are preserved in the carbonate platforms: pre- mantle exhumation carbonates are represented by aggrading isolated carbonate platforms first, followed by expanding and margin wide prograding carbonate shelfs once thermal subsidence dominates. In addition, a distinct clastic sequence is deposited as an immediate response to mantle exhumation, in between the pre- and post-mantle exhumation carbonate factory. Our study proposes a new refined model for the formation of the Neo-Tethys margin and provides new insights for the dynamic coupling of salt-controlled carbonate shelfs and the underlying lithosphere during continental breakup.
► Pretreatment of 169 samples for respiration activity tests. ► Measurement of these pretreated samples by Sapromat. ► Measurement of the same pretreated samples by OxiTop. ► Evaluation of ...differences in results. ► Correlation of results. ► As a very clear tendency OxiTop® results in lower amounts than Sapromat®.
In the run-up for amending the Austrian landfill ordinance, parameters were developed to assess the stability/reactivity of mechanically–biologically pretreated residual wastes. The Landfill Ordinance 2008 regulates limit values for Respiration Activity (=“Atmungsaktivität”) RA4 (AT4)<7mgO2*(g dry matter (DM))−1, Gas Generation Sum GS21<20Nl*kgDM−1 and alternatively Gas Evolution (=“Gasbildung”) GB21<20Nl*kgDM−1. Methods for analysing these parameters were established by the Austrian Standards Institute (2004). As laboratory practice shows, these methods also are used for the assessment of other wastes (sewage sludge, commercial waste, material from abandoned sites, biowaste compost). For measurement of respiration activity in Austria mainly two methods are used: the Sapromat®-method and the OxiTop®-method. Whether respectively to what extent these two methods give same results, is discussed in this paper.
Since 2009 at ABF-BOKU 169 respiration activity tests of samples taken from different stages of MBT – as well as biowaste composting processes, materials from landfills as well as abandoned sites and residues from anaerobic treatment plants were analysed parallel by Sapromat® and OxiTop®. The results manifest very strong correlation between the Sapromat® and OxiTop® method. The correlation coefficient is 0.993. As a very clear tendency OxiTop® gives lower amounts than Sapromat®. In average the lower values of OxiTop® are around 88%.
•FT-IR spectroscopy can be used to monitor leachate from operating and abandoned landfills.•Determination of NH4-N, NO3-N, SO4-S and DOC of leachate by FT-IR spectroscopy.•FT-IR prediction models are ...time-saving and less error prone.•Get an insight on processes in the waste-body by landfill leachate investigations.•Reactivity of organic matter in waste material is reflected by landfill leachate.
Controlling and monitoring of emissions from municipal solid waste (MSW) landfills is important to reduce environmental damage and health risks. Therefore, simple and meaningful monitoring tools are required. This paper presents how Fourier Transform Infrared (FT-IR) Spectroscopy can be used to monitor leachate from various landfill sites. The composition of percolated leachate provides information about reactivity or stability of organic matter in landfills. Chemical compounds of investigated leachate are depicted by distinct spectral pattern. Partial least squares regression (PLS-R) models, a multivariate analysis tool, were developed based on infrared spectra to determine simultaneously conventional parameters such as ammonium, nitrate, sulfate, and dissolved organic carbon. The developed models are appropriate for application in waste management practice with respect to their excellent coefficients of determination, namely R2=0.99, 0.99, 0.98, and 0.98, their low errors of cross-validation and their high ratios of performance to deviation (RPD=9.3, 12.5, 6.5, 7.3). Thus, FT-IR spectroscopy turned out to be a reliable, time-saving tool to determine four parameters relevant for landfill aftercare monitoring by one single easy adaptable measurement.
Wie können Lehramtsstudierende besser auf ihren Beruf vorbereitet werden? Die explorative Studie befasst sich mit der Entwicklung und Evaluation einer universitären Professionalisierungsmaßnahme im ...Rahmen des Praxissemesters. Ziel ist es, angehende Lehrkräfte sukzessiv für die Planung und Durchführung von inklusivem Unterricht im Fach Englisch vor dem Hintergrund des Universal Design for Learning (UDL) und eines Planungsleitfadens zu qualifizieren. U.a. zeigt sich eine signifikante Steigerung der studentischen Selbstwirksamkeitserwartungen bezogen auf inklusive Unterrichtsgestaltung. Die Studie leistet einen ersten Beitrag zur Erforschung des Potenzials von inklusionsorientierten Professionalisierungsmaßnahmen vor dem Hintergrund des UDL im Fach Englisch. (DIPF/Orig.)
Wie können Lehramtsstudierende besser auf ihren Beruf vorbereitet
werden? Die explorative Studie befasst sich mit der Entwicklung und
Evaluation einer universitären Professionalisierungsmaßnahme im
...Rahmen des Praxissemesters. Ziel ist es, angehende Lehrkräfte
sukzessiv für die Planung und Durchführung von inklusivem
Unterricht im Fach Englisch vor dem Hintergrund des Universal
Design for Learning (UDL) und eines Planungsleitfadens zu
qualifizieren. U.a. zeigt sich eine signifikante Steigerung der
studentischen Selbstwirksamkeitserwartungen bezogen auf inklusive
Unterrichtsgestaltung. Die Studie leistet einen ersten Beitrag zur
Erforschung des Potenzials von inklusionsorientierten
Professionalisierungsmaßnahmen vor dem Hintergrund des UDL im Fach
Englisch.
How can teacher training students be prepared better for their profession? This explorative study deals with the development and evaluation of a university-based professionalization measure in the ...context of the internship semester. The aim is to qualify prospective teachers successively for the planning and implementation of inclusive teaching in the subject English against the background of the Universal Design for Learning (UDL) and a planning guide. Among other findings, a significant increase in students' self-efficacy expectations related to inclusive instructional design was observed. The study makes a first contribution to researching the potential of inclusion-oriented professionalization measures against the background of the UDL in the school subject English.
Wie können Lehramtsstudierende besser auf ihren Beruf vorbereitet werden? Die explorative Studie befasst sich mit der Entwicklung und Evaluation einer universitären Professionalisierungsmaßnahme im Rahmen des Praxissemesters. Ziel ist es, angehende Lehrkräfte sukzessiv für die Planung und Durchführung von inklusivem Unterricht im Fach Englisch vor dem Hintergrund des Universal Design for Learning (UDL) und eines Planungsleitfadens zu qualifizieren. U.a. zeigt sich eine signifikante Steigerung der studentischen Selbstwirksamkeitserwartungen bezogen auf inklusive Unterrichtsgestaltung. Die Studie leistet einen ersten Beitrag zur Erforschung des Potenzials von inklusionsorientierten Professionalisierungsmaßnahmen vor dem Hintergrund des UDL im Fach Englisch.
Objectives
While the coronavirus disease 2019 (COVID-19) pandemic captures healthcare resources worldwide, data on the impact of prioritization strategies in urology during pandemic are absent. We ...aimed to quantitatively assess the global change in surgical and oncological clinical practice in the early COVID-19 pandemic.
Methods
In this cross-sectional observational study, we designed a 12-item online survey on the global effects of the COVID-19 pandemic on clinical practice in urology. Demographic survey data, change of clinical practice, current performance of procedures, and current commencement of treatment for 5 conditions in medical urological oncology were evaluated.
Results
235 urologists from 44 countries responded. Out of them, 93% indicated a change of clinical practice due to COVID-19. In a 4-tiered surgery down-escalation scheme, 44% reported to make first cancellations, 23% secondary cancellations, 20% last cancellations and 13% emergency cases only. Oncological surgeries had low cancellation rates (%): transurethral resection of bladder tumor (27%), radical cystectomy (21–24%), nephroureterectomy (21%), radical nephrectomy (18%), and radical orchiectomy (8%). (Neo)adjuvant/palliative treatment is currently not started by more than half of the urologists. COVID-19 high-risk-countries had higher total cancellation rates for non-oncological procedures (78% vs. 68%,
p
= 0.01) and were performing oncological treatment for metastatic diseases at a lower rate (35% vs. 48%,
p
= 0.02).
Conclusion
The COVID-19 pandemic has affected clinical practice of 93% of urologists worldwide. The impact of implementing surgical prioritization protocols with moderate cancellation rates for oncological surgeries and delay or reduction in (neo)adjuvant/palliative treatment will have to be evaluated after the pandemic.
The Santonian–Campanian boundary interval close to the village of Göynük in northwestern Turkey (Bolu province) was recorded and examined with respect to nannofossil and foraminiferal ...biostratigraphy, magnetic polarity and magnetic susceptibility. During the Late Cretaceous, the Mudurnu–Göynük Basin was located on the Sakarya continent situated in the northwestern Tethyan Realm, north of the Neo-Tethys.
The sections assessed for the present study comprise hemipelagic to pelagic deposits. Five localities were examined and a composite record spanning the Santonian–Campanian boundary was established. The stratigraphically older parts are characterised by uniform reddish limestone, while we frequently recorded shaly marls and marly limestones with recurrent tuff intercalations in the younger subsections.
A biostratigraphic investigation of planktonic foraminifera and calcareous nannoplankton assemblages, together with magnetostratigraphy, provides a stratigraphic framework that allows to home in on the Santonian–Campanian boundary. Thus, biostratigraphic data suggest an age that ranges from the late Santonian Dicarinella asymetrica to the early Campanian Globotruncanita elevata planktonic foraminifera biozones, and calcareous nannofossil zones UC12–UC14 and CC16–CC18. The magnetostratigraphic assessment finds a palaeomagnetic reversal that can be recognised as the basal Campanian reversal C33r above polarity chron 34n, the Long Cretaceous Normal.
Field magnetic susceptibility (MS) data show a distinct cyclic pattern in the lower Campanian. Sinusoidal patterns in the MS signature curve can presumably be interpreted as the 400 kyr orbital eccentricity cycle, and subsequent smaller-scale cycles of obliquity and precession can be identified even though volcanic activity impacted sedimentation. A sediment accumulation rate of 12 mm/kyr can be inferred for one of the sections.
Summary of main conclusions. Display omitted
•First detailed Santonian–Campanian boundary biostratigraphy and magnetostratigraphy from NW Turkey.•Composite pelagic section includes planktonic foraminifera and calcareous nannoplankton bioevents.•Cyclostratigraphy reveals long- and short-eccentricity, obliquity, and two precession cycles.•Frequent fine-grained volcaniclastics do not weaken orbital climate signal.
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