Preventative tele-health supported services for early stage chronic obstructive pulmonary disease: a protocol for a pragmatic randomized controlled trial pilot

Background Chronic Obstructive Pulmonary Disease (COPD) is a prevalent debilitating long term condition. It is the second most common cause of emergency admission to hospital in the UK and remains one of the most costly conditions to treat through acute care. Tele-health monitoring offers potential to reduce the rates of re-hospitalisation and emergency department visits and improve quality of life for people with COPD. However, the current evidence base to support technology adoption and implementation is limited and the resource implications for implementing tele-health in practice can be very high. This trial will employ tele-health monitoring in a preventative capacity for patients diagnosed with early stage COPD following discharge from hospital to determine whether it reduces their need for additional health service support or hospital admission and improves their quality of life. Methods/Design We describe a pilot study for a two arm, one site randomized controlled trial (RCT) to determine the effect of tele-health monitoring on self-management, quality of life and patient satisfaction. Sixty patients who have been discharged from one acute trust with a primary diagnosis of COPD and who have agreed to receive community clinical support following discharge from acute care will be randomly assigned to one of two groups: (a) Tele-health supported Community COPD Service; or (b) Usual Care. The tele-health supported service involves the patient receiving two home visits with a specialist COPD clinician (nurse or physiotherapist) then participating in daily tele-monitoring over an eight week period. Usual care consists of six home visits to the patient by specialist COPD clinicians again over eight successive weeks. Health status and quality of life data for all participants will be measured at baseline, on discharge from the service and at six months post discharge from the service. Discussion The tele-health service under study is a complex service delivered through a collaboration between local authority and health care partners. The implementation of this service demanded significant changes to established working patterns and has been a challenging process requiring considerable planning - a challenge that many providers are likely to face in the future. Trial registration Current Controlled Trials ISRCTN6885601

Unexpected Effect of Internal Degrees of Freedom on Transverse Phonons in Supercooled Liquids

We show experimentally that in a supercooled liquid composed of molecules with internal degrees of freedom the internal modes contribute to the frequency dependent shear viscosity and damping of transverse phonons, which results in an additional broadening of the transverse Brillouin lines. Earlier, only the effect of internal modes on the frequency dependent bulk viscosity and damping of longitudinal phonons was observed and explained theoretically in the limit of weak coupling of internal degrees of freedom to translational motion. A new theory is needed to describe this new effect. We also demonstrate, that the contributions of structural relaxation and internal processes to the width of the Brillouin lines can be separated by measurements under high pressure

Dynamic structure factors of a dense mixture

We compute the dynamic structure factors of a dense binary liquid mixture. These describe dynamics on molecular length scales, where structural relaxation is important. We find that the presence of a few large particles in a dense fluid of small particles slows down the dynamics considerably. We also observe a deep narrowing of the spectrum for a disordered mixture composed of a nearly equal packing of the two species. In contrast, a few small particles diffuse easily in the background of a dense fluid of large particles. We expect our results to describe neutron scattering from a dense mixture

Evidence of two viscous relaxation processes in the collective dynamics of liquid lithium

New inelastic X-ray scattering experiments have been performed on liquid lithium in a wide wavevector range. With respect to the previous measurements, the instrumental resolution, improved up to 1.5 meV, allows to accurately investigate the dynamical processes determining the observed shape of the the dynamic structure factor, $S(Q,\omega)$. A detailed analysis of the lineshapes shows the co-existence of relaxation processes with both a slow and a fast characteristic timescales, and therefore that pictures of the relaxation mechanisms based on a simple viscoelastic model must be abandoned.Comment: 5 pages, 4 .PS figure

Optimum Monte Carlo Simulations: Some Exact Results

We obtain exact results for the acceptance ratio and mean squared displacement in Monte Carlo simulations of the simple harmonic oscillator in $D$ dimensions. When the trial displacement is made uniformly in the radius, we demonstrate that the results are independent of the dimensionality of the space. We also study the dynamics of the process via a spectral analysis and we obtain an accurate description for the relaxation time.Comment: 17 pages, 8 figures. submitted to J. Phys.

The Approach to Ergodicity in Monte Carlo Simulations

The approach to the ergodic limit in Monte Carlo simulations is studied using both analytic and numerical methods. With the help of a stochastic model, a metric is defined that enables the examination of a simulation in both the ergodic and non-ergodic regimes. In the non-ergodic regime, the model implies how the simulation is expected to approach ergodic behavior analytically, and the analytically inferred decay law of the metric allows the monitoring of the onset of ergodic behavior. The metric is related to previously defined measures developed for molecular dynamics simulations, and the metric enables the comparison of the relative efficiencies of different Monte Carlo schemes. Applications to Lennard-Jones 13-particle clusters are shown to match the model for Metropolis, J-walking and parallel tempering based approaches. The relative efficiencies of these three Monte Carlo approaches are compared, and the decay law is shown to be useful in determining needed high temperature parameters in parallel tempering and J-walking studies of atomic clusters.Comment: 17 Pages, 7 Figure

Coupling of thermal and mass diffusion in regular binary thermal lattice-gases

We have constructed a regular binary thermal lattice-gas in which the thermal diffusion and mass diffusion are coupled and form two nonpropagating diffusive modes. The power spectrum is shown to be similar in structure as for the one in real fluids, in which the central peak becomes a combination of coupled entropy and concentration contributions. Our theoretical findings for the power spectra are confirmed by computer simulations performed on this model.Comment: 5 pages including 3 figures in RevTex

Decoupling of diffusion from structural relaxation and spatial heterogeneity in a supercooled simple liquid

We report a molecular dynamics simulation of a supercooled simple monatomic glass-forming liquid. It is found that the onset of the supercooled regime results in formation of distinct domains of slow diffusion which are confined to the long-lived icosahedrally structured clusters associated with deeper minima in the energy landscape. As these domains, possessing a low-dimensional geometry, grow with cooling and percolate below $T_c$, the critical temperature of the mode coupling theory, a sharp slowing down of the structural relaxation relative to diffusion is observed. It is concluded that this latter anomaly cannot be accounted for by the spatial variation in atomic mobility; instead, we explain it as a direct result of the configuration-space constraints imposed by the transient structural correlations. We also conjecture that the observed tendency for low-dimensional clustering may be regarded as a possible mechanism of fragility.Comment: To be published in PR

Growing spatial correlations of particle displacements in a simulated liquid on cooling toward the glass transition

We define a correlation function that quantifies the spatial correlation of single-particle displacements in liquids and amorphous materials. We show for an equilibrium liquid that this function is related to fluctuations in a bulk dynamical variable. We evaluate this function using computer simulations of an equilibrium glass-forming liquid, and show that long range spatial correlations of displacements emerge and grow on cooling toward the mode coupling critical temperature

High-Temperature series for the RPn−1RP^{n-1} lattice spin model (generalized Maier-Saupe model of nematic liquid crystals) in two space dimensions and with general spin dimensionality n

High temperature series expansions of the spin-spin correlation functions of the RP^{n-1} spin model on the square lattice are computed through order beta^{8} for general spin dimensionality n. Tables are reported for the expansion coefficients of the energy per site, the susceptibility and the second correlation moment.Comment: 6 pages, revtex, IFUM 419/FT, 2 figures not include