The Impact of Disease-Modifying Therapy Access Barriers on People With Multiple Sclerosis: Mixed-Methods Study.

BACKGROUND: In the United States, people with relapsing-remitting multiple sclerosis (RRMS) can face difficulty accessing disease-modifying therapies (DMTs) because of insurance, pharmacy, or provider policies. These barriers have been associated with poor adherence and negative health outcomes. OBJECTIVE: The goals of this study were to describe the overall occurrence of difficulties and delays associated with gaining access to DMTs among people with RRMS, to assess DMT adherence during periods of reduced access, and to contextualize the patients\u27 journey from receipt of a prescription for DMT to obtaining and taking their medication when faced with access barriers. METHODS: We recruited US-based adults self-reporting RRMS from a Web-based health data-sharing social network, PatientsLikeMe. Individuals were invited to complete a Web-based survey if they reported a diagnosis of RRMS and were prescribed a DMT for MS. Follow-up phone interviews were conducted with 10 respondents who reported experiencing an MS-related relapse during the time they had experienced challenges accessing DMTs. RESULTS: Among 507 survey completers, nearly half were either currently experiencing an issue related to DMT assess or had difficulty accessing a DMT in the past (233/507, 46.0%). The most frequently reported reasons for access difficulty were authorization requirements by insurance companies (past issues: 78/182, 42.9%; current issues: 9/42, 21%) and high out-of-pocket costs (past issues: 54/182, 29.7%; current issues: 13/42, 31%). About half (20/39, 51%) of participants with current access issues and over a third (68/165, 41.2%) of those with past issues went without their medication until they could access their prescribed DMT. Relapses were reported during periods of reduced DMT access for almost half (56/118, 47.5%) of those with past issues and nearly half (22/45, 49%) of those with current issues. Resolving access issues involved multiple stakeholder agents often coordinated in a patient-led effort. Among those who had resolved issues, about half (57/119, 47.9%) reported that doctors or office staff were involved, under half (48/119, 40.3%) were involved themselves, and about a third (39/119, 32.8%) reported the drug manufacturer was involved in resolving the issue. Follow-up interviews revealed that the financial burden associated with obtaining a prescribed DMT led to nonadherence. Additionally, participants felt that DMT treatment delays and stress associated with obtaining the DMT triggered relapses or worsened their MS. CONCLUSIONS: This study expands current research by using a patient-centered, mixed-methods approach to describe barriers to MS treatment, the process to resolve barriers, and the perceived impact of treatment barriers on outcomes. Issues related to DMT access occur frequently, with individuals often serving as their own agents when navigating access difficulties to obtain their medication(s). Support for resolution of DMT access is needed to prevent undue stress and nonadherence

Fast Mold Filling Simulation Based on the Geodesic Distance Calculation Algorithm for Liquid Composite Molding Processes

In Liquid Composite Molding (LCM) processes, resin is introduced into a stationary fiber reinforcement placed in the mold, until the reinforcement gets fully saturated with resin and all volatiles are vented out of the part. Finite element based software packages have been developed to simulate the mold filling process and eliminate expensive and tedious trial and error practices to arrive at a successful mold filling without any voids. However, the non-homogeneity of the fiber reinforcement material and its placement and layup in the mold creates a large degree of variability of flow patterns during the resin impregnation process. Executing simulations for every possible permutation of flow scenarios, which is required to devise a robust process design is computationally expensive. Therefore, it is necessary to find faster approximate mold filling simulation methods so that all simulations can be performed within a reasonable time frame. In this paper, a discretized one-dimensional flow model is developed to predict the fill time based on the distance resin travels. Combined with Dijkstra’s algorithm, this model is then implemented on spatial surface meshes to calculate fill time for each node and generate flow development pattern. The computational model developed can predict the mold filling pattern for complex parts even with variable permeability or thickness of the fiber preform, and can capture the disturbed flow behavior along any difficult geometric features at a fraction of the computational cost. Case studies are presented to demonstrate the efficiency and accuracy of the distance-based model

A two-phase flow model to simulate mold filling and saturation in Resin Transfer Molding

The final publication is available at Springer via http://dx.doi.org/10.1007/s12289-015-1225-zThis paper addresses the numerical simulation of void formation and transport during mold filling in Resin Transfer Molding (RTM). The saturation equation, based on a two-phase flow model resin/air, is coupled with Darcy s law and mass conservation to simulate the unsaturated filling flow that takes place in a RTM mold when resin is injected through the fiber bed. These equations lead to a system composed of an advection diffusion equation for saturation including capillary effects and an elliptic equation for pressure taking into account the effect of air residual saturation. The model introduces the relative permeability as a function of resin saturation. When capillary effects are omitted, the hyperbolic nature of the saturation equation and its strong coupling with Darcy equation through relative permeability represent a challenging numerical issue. The combination of the constitutive physical laws relating permeability to saturation with the coupled system of the pressure and saturation equations allows predicting the saturation profiles. The model was validated by comparison with experimental data obtained for a fiberglass reinforcement injected in a RTM mold at constant flow rate. The saturation measured as a function of time during the resin impregnation of the fiber bed compared very well with numerical predictions.The authors acknowledge financial support of the Spanish Government (Projects DPI2010-20333 and DPI2013-44903-R-AR), of the National Science and Research Council of Canada (NSERC) and of the Canada Reseach Chair (CRC) program.Gascón Martínez, ML.; García Manrique, JA.; Lebel, F.; Ruiz, E.; Trochu, F. (2016). A two-phase flow model to simulate mold filling and saturation in Resin Transfer Molding. International Journal of Material Forming. 9(2):229-239. doi:10.1007/s12289-015-1225-zS22923992Patel N, Lee LJ (1996) Modeling of void formation and removal in liquid composite molding. Part I: wettability analysis. Polym Compos 17(1):96–103Ruiz E, Achim V, Soukane S, Trochu F, Bréard J (2006) Optimization of injection flow rate to minimize micro/macro-voids formation in resin transfer molded composites. Compos Sci Technol 66(3–4):475–486Trochu F, Ruiz E, Achim V, Soukane S (2006) Advanced numerical simulation of liquid composite molding for process analysis and optimization. Compos A: Appl Sci Manuf 37(6):890–902Park CH, Lee W (2011) Modeling void formation and unsaturated flow in liquid composite molding processes: a survey and review. J Reinf Plast Compos 30(11):957–977Pillai KM (2004) Modeling the unsaturated flow in liquid composite molding processes: a review and some thoughts. J Compos Mater 38(23):2097–2118Breard J, Saouab A, Bouquet G (2003) Numerical simulation of void formation in LCM. Compos A: Appl Sci Manuf 34:517–523Breard J, Henzel Y, Trochu F, Gauvin R (2003) Analysis of dynamic flows through porous media. Part I: comparison between saturated and unsaturated flows in fibrous reinforcements. Polym Compos 24(3):391–408Parnas RS, Phelan FR Jr (1991) The effect of heterogeneous porous media on mold filling in Resin Transfer Molding. SAMPE Q 22(2):53–60Parseval DY, Pillai KM, Advani SG (1997) A simple model for the variation of permeability due to partial saturation in dual scale porous media. Transp Porous Media 27(3):243–264Pillai KM (2002) Governing equations for unsaturated flow through woven fiber mats. Part 1. Isothermal flows. Compos A: Appl Sci Manuf 33(7):1007–1019Simacek P, Advani SG (2003) A numerical model to predict fiber tow saturation during Liquid Composite Molding. Compos Sci Technol 63:1725–1736García JA, Gascón L, Chinesta F (2010) A flux limiter strategy for solving the saturation equation in RTM process simulation. Compos A: Appl Sci Manuf 41:78–82Chui WK, Glimm J, Tangerman FM, Jardine AP, Madsen JS, Donnellan TM, Leek R (1997) Process modeling in Resin Transfer Molding as a method to enhance product quality. SIAM Rev 39(4):714–727Nordlund M, Michaud V (2012) Dynamic saturation curve measurement for resin flow in glass fibre reinforcement. Compos A: Appl Sci Manuf 43:333–343García JA, Ll G, Chinesta F (2003) A fixed mesh numerical method for modelling the flow in liquid composites moulding processes using a volume of fluid technique. Comput Methods Appl Mech Eng 192(7–8):877–893García JA, Ll G, Chinesta F, Trochu F, Ruiz E (2010) An efficient solver of the saturation equation in liquid composite molding processes. Int J Mater Form 3(2):1295–1302Lebel F (2012) Contrôle de la fabrication des composites par injection sur renforts. École Polytechnique de Montréal, CanadaVan Genuchten MT (1980) Closed-form equation for predicting the hydraulic conductivity of unsaturated soils. Soil Sci Soc Am J 44(5):892–898Buckley SE, Leverett MC (1942) Mechanism of fluid displacement in sands. Pet Trans AWME 146:107–116Lundstrom TS, Gebart BR (1994) Influence from process parameters on void formation in Resin Transfer Molding. Polym Compos 15(1):25–33Lundstrom TS (1997) Measurement of void collapse during Resin Transfer Molding. Compos A: Appl Sci Manuf 28(3):201–214Lundstrom TS, Frishfelds V, Jakovics A (2010) Bubble formation and motion in non-crimp fabrics with perturbed bundle geometry. Compos A: Appl Sci Manuf 41:83–92Lebel F, Fanaei A, Ruiz E, Trochu F (2012) Experimental characterization by fluorescence of capillary flows in the fiber tows of engineering fabrics. Open J Inorg Non-Metallic Mater 2(3):25–45Brooks RH, Corey AT (1964) Hydraulic properties of porous media. Colorado State University. Hydrology Papers 1–37Corey AT (1954) The interrelation between gas and oil relative permeabilities. Prod Monthly 19(1):38–4

Telehealth as a Model for Providing Behaviour Analytic Interventions to Individuals with Autism Spectrum Disorder:A Systematic Review

Interventions based on applied behaviour analysis are considered evidence based practice for autism spectrum disorders. Due to the shortage of highly qualified professionals required for their delivery, innovative models should be explored, such as telehealth. Telehealth utilises technology for remote training and supervision. The purpose of our study was to systematically review the literature researching telehealth and ABA. We analysed intervention characteristics, outcomes and research quality in 28 studies and identified gaps. Intervention characteristics were: (1) research design (2) participants (3) technology (4) dependent variables (5) aims. Outcomes were favourable with all studies reporting improvements in at least one variable. Quality ratings were significantly low. Implications for future research and practice are discussed in light of identified methodological downfalls.</p

Use of Flow Simulation to Develop Robust Injection and Vent Schemes that Account for Process and Material Variability in Liquid Composite Molding Process

In Liquid Composite Molding (LCM) processes, the process design requires an infusion and venting scheme which will saturate all the empty spaces between the fibers during mold filling resulting in a composite part without voids. However, the inherent material and process variability can change the filling patterns significantly which complicate this task. The objective of this work is to develop methodologies and tools to automate infusion process design and integrate it within the CAD design environment. The methodologies and algorithms developed examine the designed part geometry and material layups for ease of manufacturing with feasible infusion schemes by accounting for the inherent variability of the material and preform layup during the infusion processes. To accomplish this, the integrated tool has to automatically identify possible regions that are likely to introduce variability in resin flow, such as racetracking channels near corners, edges and inserts, which will cause dramatically different resin flow patterns and could result in voids. These possible scenarios are then simulated and evaluated to formulate an injection and venting scheme that is sufficiently robust to manufacture a part without any voids despite these variations. An example is presented to demonstrate the methodology of infusion design which identifies and accounts for material variability introduced due to geometric features