Intentional and unintentional non-adherence in community dwelling people with type 2 diabetes: the effect of varying numbers of medicines

People with type 2 diabetes are often prescribed multiple medicines which can be difficult to manage. Nonadherence to medicines can be intentional (e.g. active decision) or unintentional (e.g. forgetting). The objective of this study was to measure intentional and unintentional non-adherence to differing numbers of medicines prescribed in type 2 diabetes. A cross sectional survey using the Morisky medication adherence scale (with intentional and unintentional non-adherence subscales) was completed by 480 people prescribed oral antidiabetic drugs (OADs), antihypertensive agents and statins. A within-subject analysis of variance (ANOVA) showed that intentional non-adherence did not vary between OADs, anti-hypertensives and statins. Intentional non-adherence to statins significantly increased when the number of medicines prescribed was included as a between-subjects variable (p<0.05). Another within-subject ANOVA on unintentional non-adherence found a significant difference between OADs, anti-hypertensives and statins; unintentional non-adherence to OADs was significantly higher (p<0.05). When the number of medicines was added as a between-subject variable unintentional non-adherence was associated with higher numbers of medicines. This study shows the difference between intentional and unintentional non-adherence behaviours, and the effect that varying numbers of medicines can have on these behaviours

How to Establish and Follow up a Large Prospective Cohort Study in the 21st Century - Lessons from UK COSMOS.

Large-scale prospective cohort studies are invaluable in epidemiology, but they are increasingly difficult and costly to establish and follow-up. More efficient methods for recruitment, data collection and follow-up are essential if such studies are to remain feasible with limited public and research funds. Here, we discuss how these challenges were addressed in the UK COSMOS cohort study where fixed budget and limited time frame necessitated new approaches to consent and recruitment between 2009-2012. Web-based e-consent and data collection should be considered in large scale observational studies, as they offer a streamlined experience which benefits both participants and researchers and save costs. Commercial providers of register and marketing data, smartphones, apps, email, social media, and the internet offer innovative possibilities for identifying, recruiting and following up cohorts. Using examples from UK COSMOS, this article sets out the dos and don'ts for today's cohort studies and provides a guide on how best to take advantage of new technologies and innovative methods to simplify logistics and minimise costs. Thus a more streamlined experience to the benefit of both research participants and researchers becomes achievable

The impact of COVID-19 social isolation on aspects of emotional and social cognition

The present study aimed to examine the impact of COVID-19 social isolation upon aspects of emotional and social cognitive function. We predicted that greater impairments in emotional and social cognition would be observed in people who experienced more disruption to their usual social connectivity during COVID-19 social isolation. Healthy volunteers (N = 92) without prior mental health problems completed assessments online in their own homes during the most stringent period of the first COVID-19 "lockdown" in the UK (March - May 2020). Measures included two questionnaires probing levels of social isolation, anxiety levels, as well as five neuropsychological tasks assessing emotional and social cognition. Reduced positive bias in emotion recognition was related to reduced contact with friends, household size and communication method during social isolation. In addition, reduced positive bias for attention to emotional faces was related to frequency of contact with friends during social isolation. Greater cooperative behaviour in an ultimatum game was associated with more frequent contact with both friends and family during social isolation. The present study provides important insights into the detrimental effects of subjective and objective social isolation upon affective cognitive processes

Effects of reduced energy availability on bone metabolism in women and men

Background: The short-term effects of low energy availability (EA) on bone metabolism in physically active women and men are currently unknown. Purpose: We evaluated the effects of low EA on bone turnover markers (BTMs) in a cohort of women and a cohort of men, and compared effects between sexes. Methods: These studies were performed using a randomised, counterbalanced, crossover design. Eleven eumenorrheic women and eleven men completed two 5-day protocols of controlled (CON; 45 kcal·kgLBM-1.d-1) and restricted (RES; 15 kcal.kgLBM-1·d-1) EAs. Participants ran daily on a treadmill at 70% of their peak aerobic capacity (VO2 peak) resulting in an exercise energy expenditure of 15 kcal·kgLBM-1·d-1 and consumed diets providing 60 and 30 kcal·kgLBM-1·d-1. Blood was analysed for BTMs [β-carboxyl-terminal cross-linked telopeptide of type I collagen (β-CTX) and amino-terminal propeptide of type 1 procollagen (P1NP)], markers of calcium metabolism [( parathyroid hormone (PTH), albumin-adjusted calcium (ACa), magnesium (Mg) and phosphate (PO4)] and regulatory hormones [sclerostin, insulin-like growth factor 1 (IGF-1), triiodothyronine (T3), insulin, leptin, glucagon-like- peptide-2 (GLP-2)]. Results: In women,β-CTX AUC was significantly higher P=0.03) and P1NP AUC was significantly lower (P=0.01) in RES compared to CON. In men, neither β-CTX (P=0.46) n or P1NP (P=0.12) AUCs were significantly different between CON and RES. There were no significant differences between sexes for any BTM AUCs (all P values>0.05). Insulin and leptin AUCs were significantly lower following RES in women only (for both P=0.01). There were no differences in any AUCs of regulatory hormones or markers of calcium metabolism between men and women following RES (all P values>0.05). Conclusions: When comparing within groups, five days of low EA (15 kcal·kgLBM-1·d-1) decreased bone formation and increased bone resorption in women, but not in men, and no sex specific differences were detected

Bone metabolic responses to low energy availability achieved by diet or exercise in active eumenorrheic women

Purpose: We aimed to explore the effects of low energy availability (EA)[15 kcal·kg lean body mass (LBM)−1·d−1] achieved by diet or exercise on bone turnover markers in active, eumenorrheic women. Methods: By using a crossover design, ten eumenorrheic women (VO2 peak: 48.1 ± 3.3 ml·kg−1·min−1) completed all three, 3-day conditions in a randomised order: controlled EA (CON; 45 kcal·kgLBM−1·d−1), low EA through dietary energy restriction (D-RES; 15 kcal·kgLBM−1·d−1) and low EA through increasing exercise energy expenditure (E-RES; 15 kcal·kgLBM−1·d−1), during the follicular phase of three menstrual cycles. In CON, D-RES and E-RES, participants consumed diets providing 45, 15 and 45 kcal·kgLBM−1·d−1. In E-RES only, participants completed supervised running sessions (129 ± 10 min·d−1) at 70% of their VO2 peak that resulted in an exercise energy expenditure of 30 kcal·kg LBM−1·d−1. Blood samples were collected at baseline (BASE) and at the end of the 3-day period (D6) and analysed for bone turnover markers (β-CTX and P1NP), markers of calcium metabolism (PTH, albumin-adjusted Ca, Mg and PO4) and hormones (IGF-1, T3, insulin, leptin and 17β-oestradiol). Results: In D-RES, P1NP concentrations at D6 decreased by 17% (BASE: 54.8 ± 12.7 μg·L−1, D6: 45.2 ± 9.3 μg·L−1, P < 0.001, d = 0.91) and were lower than D6 concentrations in CON (D6: 52.5 ± 11.9 μg·L−1, P = 0.001). P1NP did not change significantly in E-RES (BASE: 55.3 ± 14.4 μg·L−1, D6: 50.9 ± 15.8 μg·L−1, P = 0.14). β-CTX concentrations did not change following D-RES (BASE: 0.48 ± 0.18 μg·L−1, D6: 0.55 ± 0.17 μg·L−1) or E-RES (BASE: 0.47 ± 0.24 μg·L−1, D6: 0.49 ± 0.18 μg·L−1) (condition × time interaction effect, P = 0.17). There were no significant differences in P1NP (P = 0.25) or β-CTX (P = 0.13) responses between D-RES and E-RES. Both conditions resulted in reductions in IGF-1 (−13% and − 23% from BASE in D-RES and E-RES, both P < 0.01) and leptin (−59% and − 61% from BASE in D-RES and E-RES, both P < 0.001); T3 decreased in D-RES only (−15% from BASE, P = 0.002) and PO4 concentrations decreased in E-RES only (−9%, P = 0.03). Conclusions: Low EA achieved through dietary energy restriction resulted in a significant decrease in bone formation but no change in bone resorption, whereas low EA achieved through exercise energy expenditure did not significantly influence bone metabolism. Both low EA conditions elicited significant and similar changes in hormone concentrations

Agency and intentionality-dependent experiences of moral emotions

Moral emotions are thought to influence moral behaviour by providing a driving force to do good and to avoid doing bad. In this study we examined moral emotions; specifically, guilt, shame, annoyance and feeling “bad” from two different perspectives in a moral scenario; the agent and the victim whilst manipulating the intentionality of the harm; intentional and unintentional. Two hundred participants completed a moral emotions task, which utilised cartoons to depict everyday moral scenarios. As expected, we found that self-blaming emotions such as shame and guilt were much more frequent when taking on the perspective of the agent whilst annoyance was more frequent from the victim perspective. Feeling bad, however, was not agency-specific. Notably, when the harm was intentional, we observed significantly greater shame ratings from the perspective of the agent compared to when the harm was unintentional. In addition, we also found clear gender differences and further observed correlations between moral emotions and personality variables such as psychoticism and neuroticism

Omnidirectional acoustic absorber with a porous core and a metamaterial matching layer

An omnidirectional sound absorber based on the acoustic analogy of the electromagnetic metamaterial “black hole” has been developed and tested. The resulting structure is composed of a hollow cylindrical porous absorbing core and a graded index matching layer which employs multiple rods of varying size and spacing to gradually adjust the impedance of the air to that of the porous absorbing core. A semi-analytical model is developed, and the practical challenges and their implications with respect to performance are considered. A full size device is built and tested in an anechoic chamber and the semi-analytical model used in the design process is validated. Finally, the theory is extended to allow for losses in the metamaterial matching layer, and it is shown that improved performance may be achieved with a dual purpose layer which acts as an absorber whilst also providing the required impedance matching condition