Stigma and the in(visible) perspectives and expectations of home oxygen therapy among people with chronic breathlessness syndrome: A qualitative study

© The Author(s) 2018. Background: Chronic breathlessness syndrome in the context of advancing disease is distressing for all concerned. Oxygen is commonly prescribed in this setting; however, little is known about the perspectives of breathless people who either are on oxygen or are yet to have it prescribed. Aim: To understand and describe the perspectives and experiences of breathless people towards oxygen use at home. Design: This qualitative study utilised an interpretive description approach using semi-structured interviews and thematic analysis. Setting/participants: A total of 19 people with chronic breathlessness syndrome living in South Australia participated in semi-structured interviews. Participants were divided into sub-groups according to whether they were chronically breathless and (1) not using home oxygen (n = 6), (2) using funded home oxygen for severe hypoxaemia (n = 7) and (3) using home oxygen for palliation outside of funding guidelines (n = 6). Results: Three main themes were identified: (1) managing distress and living with chronic breathlessness syndrome, with or without oxygen, requires a range of self-management strategies; (2) expectations of oxygen use: ‘Not as good as I thought it would be’; and (3) the stigma of using oxygen: the visible and invisible. Conclusion: People living with chronic breathlessness struggle daily with both the progression of the underlying disease and the distressing nature of the syndrome. While oxygen does provide benefit for some people, its use and the perceptions of its use are often associated with both the visible and invisible manifestations of stigma. Clinicians need to promote self-management strategies and give careful thought to the prescribing of home oxygen, especially outside the current funding guidelines

Impact of Endogenous Bile Salts on the Thermodynamics of Supersaturated Active Pharmaceutical Ingredient Solutions

A variety of formulation strategies have been developed to mitigate the inadequate aqueous solubility of certain therapeutic agents. Among these, achieving supersaturation in vivo is a promising approach to improve the extent of oral absorption. Because of the thermodynamic instability of supersaturated solutions, inhibitors are needed to kinetically hinder crystallization. In addition to commonly used polymeric additives, bile salts, naturally present in the gastrointestinal tract, have been shown to exhibit crystallization inhibition properties. However, the impact of bile salts on solution thermodynamics is not well understood, although this knowledge is essential in order to explore the mechanism of crystallization inhibition. To better describe solution thermodynamics in the presence of bile salts, a side-by-side diffusion cell was used to evaluate solute flux for solutions of telaprevir in the absence and presence of the six most abundant bile salts in human intestinal fluid at various solute concentrations; flux measurements provide information about the solute thermodynamic activity and hence can provide an improved measurement of supersaturation in complex solutions. Trihydroxy bile salts had minimal impact on solution phase boundaries as well as solute flux, while micellar dihydroxy bile salts solubilized telaprevir leading to reduced solute flux across the membrane. An inconsistency between the concentration-based supersaturation ratio and that based on solute thermodynamic activity (the fundamental driving force for crystallization) was noted, suggesting that the activity-based supersaturation should be determined to better interpret any modification in crystallization kinetics in the presence of these additives. These findings indicate that bile salts are not interchangeable from a thermodynamic perspective and provide a foundation for further studies evaluating the mechanism of crystallization inhibition

First order isotropic - smectic-A transition in liquid crystal-aerosil gels

The short-range order which remains when the isotropic to smectic-A transition is perturbed by a gel of silica nanoparticles (aerosils) has been studied using high-resolution synchrotron x-ray diffraction. The gels have been created \textit{in situ} in decylcyanobiphenyl (10CB), which has a strongly first-order isotropic to smectic-A transition. The effects are determined by detailed analysis of the temperature and gel density dependence of the smectic structure factor. In previous studies of the continuous nematic to smectic-A transition in a variety of thermotropic liquid crystals the aerosil gel appeared to pin, at random, the phase of the smectic density modulation. For the isotropic to smectic-A transition the same gel perturbation yields different results. The smectic correlation length decreases more slowly with increasing random field variance in good quantitative agreement with the effect of a random pinning field at a transition from a uniform phase directly to a phase with one-dimensional translational order. We thus compare the influence of random fields on a \textit{freezing} transition with and without an intervening orientationally ordered phase.Comment: 8 pages, 8 figure

Harmonic crossover exponents in O(n) models with the pseudo-epsilon expansion approach

We determine the crossover exponents associated with the traceless tensorial quadratic field, the third- and fourth-harmonic operators for O(n) vector models by re-analyzing the existing six-loop fixed dimension series with pseudo-epsilon expansion. Within this approach we obtain the most accurate theoretical estimates that are in optimum agreement with other theoretical and experimental results.Comment: 12 pages, 1 figure. Final version accepted for publicatio

Dynamics of Weak First Order Phase Transitions

The dynamics of weak vs. strong first order phase transitions is investigated numerically for 2+1 dimensional scalar field models. It is argued that the change from a weak to a strong transition is itself a (second order) phase transition, with the order parameter being the equilibrium fractional population difference between the two phases at the critical temperature, and the control parameter being the coefficient of the cubic coupling in the free-energy density. The critical point is identified, and a power law controlling the relaxation dynamics at this point is obtained. Possible applications are briefly discussed.Comment: 11 pages, 4 figures in uuencoded compressed file (see instructions in main text), RevTeX, DART-HEP-94/0

A lattice model for the kinetics of rupture of fluid bilayer membranes

We have constructed a model for the kinetics of rupture of membranes under tension, applying physical principles relevant to lipid bilayers held together by hydrophobic interactions. The membrane is characterized by the bulk compressibility (for expansion), the thickness of the hydrophobic part of the bilayer, the hydrophobicity and a parameter characterizing the tail rigidity of the lipids. The model is a lattice model which incorporates strain relaxation, and considers the nucleation of pores at constant area, constant temperature, and constant particle number. The particle number is conserved by allowing multiple occupancy of the sites. An equilibrium ``phase diagram'' is constructed as a function of temperature and strain with the total pore surface and distribution as the order parameters. A first order rupture line is found with increasing tension, and a continuous increase in proto-pore concentration with rising temperature till instability. The model explains current results on saturated and unsaturated PC lipid bilayers and thicker artificial bilayers made of diblock copolymers. Pore size distributions are presented for various values of area expansion and temperature, and the fractal dimension of the pore edge is evaluated.Comment: 15 pages, 8 figure

Critical structure factors of bilinear fields in O(N)-vector models

We compute the two-point correlation functions of general quadratic operators in the high-temperature phase of the three-dimensional O(N) vector model by using field-theoretical methods. In particular, we study the small- and large-momentum behavior of the corresponding scaling functions, and give general interpolation formulae based on a dispersive approach. Moreover, we determine the crossover exponent $\phi_T$ associated with the traceless tensorial quadratic field, by computing and analyzing its six-loop perturbative expansion in fixed dimension. We find: $\phi_T=1.184(12)$, $\phi_T=1.271(21)$, and $\phi_T=1.40(4)$ for $N=2,3,5$ respectively.Comment: 27 page

Shear induced instabilities in layered liquids

Motivated by the experimentally observed shear-induced destabilization and reorientation of smectic A like systems, we consider an extended formulation of smectic A hydrodynamics. We include both, the smectic layering (via the layer displacement u and the layer normal p) and the director n of the underlying nematic order in our macroscopic hydrodynamic description and allow both directions to differ in non equilibrium situations. In an homeotropically aligned sample the nematic director does couple to an applied simple shear, whereas the smectic layering stays unchanged. This difference leads to a finite (but usually small) angle between n and p, which we find to be equivalent to an effective dilatation of the layers. This effective dilatation leads, above a certain threshold, to an undulation instability of the layers. We generalize our earlier approach [Rheol. Acta, vol.39(3), 15] and include the cross couplings with the velocity field and the order parameters for orientational and positional order and show how the order parameters interact with the undulation instability. We explore the influence of various material parameters on the instability. Comparing our results to recent experiments and molecular dynamic simulations, we find a good qualitative agreement.Comment: 15 pages, 12 figures, accepted for publication in PR

Morphology of supported polymer electrolyte ultra-thin films: a numerical study

Morphology of polymer electrolytes membranes (PEM), e.g., Nafion, inside PEM fuel cell catalyst layers has significant impact on the electrochemical activity and transport phenomena that determine cell performance. In those regions, Nafion can be found as an ultra-thin film, coating the catalyst and the catalyst support surfaces. The impact of the hydrophilic/hydrophobic character of these surfaces on the structural formation of the films has not been sufficiently explored yet. Here, we report about Molecular Dynamics simulation investigation of the substrate effects on the ionomer ultra-thin film morphology at different hydration levels. We use a mean-field-like model we introduced in previous publications for the interaction of the hydrated Nafion ionomer with a substrate, characterized by a tunable degree of hydrophilicity. We show that the affinity of the substrate with water plays a crucial role in the molecular rearrangement of the ionomer film, resulting in completely different morphologies. Detailed structural description in different regions of the film shows evidences of strongly heterogeneous behavior. A qualitative discussion of the implications of our observations on the PEMFC catalyst layer performance is finally proposed

Model driven design for integrated twin screw granulator and fluid bed dryer via flowsheet modelling

This paper presents a flowsheet modelling of an integrated twin screw granulation (TSG) and fluid bed dryer (FBD) process using a Model Driven Design (MDD) approach. The MDD approach is featured by appropriate process models and efficient model calibration workflow to ensure the product quality. The design space exploration is driven by the physics of the process instead of extensive experimental trials. By means of MDD, the mechanistic-based process kernels are first defined for the TSG and FBD processes. With the awareness of the underlying physics, the complementary experiments are carried out with relevance to the kinetic parameters in the defined models. As a result, the experiments are specifically purposeful for model calibration and validation. The L/S ratio (liquid to solid ratio) and inlet air temperature are selected as the Critical Process Parameters (CPPs) in TSG and FBD for model validation, respectively. Global System Analysis (GSA) is further performed to assess the uncertainty of CPPs imposed on the Critical Quality Attributes (CQAs), which provides significant insights to the exploration of the design space considering both TSG and FBD process parameters