Patient perceptions of epinephrine auto-injectors: Exploring barriers to use

Background: In recent years, government initiatives have proposed that patient self-care should serve as a key resource in response to the anticipated increase in global demand for health care. However, if patients are to be empowered as self-carers, barriers to engagement must be identified and overcome. Anaphylaxis is an increasingly common life threatening allergic reaction. Patients at risk of anaphylaxis are prescribed epinephrine auto-injectors and play a crucial role in delivering their own care and management of this condition. One key recommendation is that patients routinely carry an epinephrine auto-injector with them, and deploy the device when needed. However, only a small proportion of patients that require epinephrine actually receive it. Objective: To explore the reasons why patients who have been prescribed epinephrine auto-injectors fail to adhere to self-care and management recommendations. Methods: In-depth interviews with 15 adults who have been prescribed epinephrine auto-injectors were carried out to explore the barriers that exist in the provision of effective self-care and management of anaphylaxis. Results: Inconsistent health professional advice, perceived stigma of carrying a ‘weapon-like’ device, poor device design and limited patient training were identified as barriers to carriage or use. Patients were reluctant to carry devices in public because of perceived and observed stigma and suspicion. They were happy to ignore expiry dates and some participants were confident that the emergency services would provide them with the appropriate care they needed, and therefore did not carry the device in urban areas. Conclusions and clinical implications: Improved training of patients, the public and health professionals around both the carriage and use of auto-injectors are areas for urgent attention if improved levels of self-care are to be attained. The design of epinephrine auto-injectors should also receive attention as patients often fail to carry them due to size and aesthetics. Key words: Adherence, allergy, anaphylaxis, empowerment, epinephrine, self-care, self-management, patient perspectivesThis study was funded by grant number Ref: GR/S29874/01 from the Engineering and Physical Sciences Research Council

Is slower early growth beneficial for long-term cardiovascular health?

Background - Accelerated neonatal growth increases the later propensity to cardiovascular disease (CVD) in animals, whereas slower growth is thought to have a beneficial effect. To test this hypothesis in humans, we measured flow-mediated endothelium-dependent dilation (FMD) in a population subject to slower early growth and in healthy controls.Methods and Results - High-resolution vascular ultrasound was used to measure the change in brachial artery diameter in response to reactive hyperemia in adolescents age 13 to 16 years who were either part of a cohort born preterm and followed up prospectively (n = 216) or controls born at term ( n = 61). Greater weight gain or linear growth in the first 2 weeks postnatally was associated with lower FMD at adolescence ( regression coefficient, - 0.026-mm change in mean arterial diameter per 100-g increase in weight; 95% CI, - 0.040 to - 0.012 mm; P = 0.0003) independent of birthweight and potential confounding factors. Mean FMD in the half of the preterm population with the lowest rates of early growth was higher than in both the half with the greatest growth ( P = 0.001) and subjects born at term ( P = 0.03).Conclusions - FMD was 4% lower in adolescents with the highest compared with the lowest rate of weight gain in the first 2 weeks after birth, a substantial negative effect similar to that for insulin-dependent diabetes mellitus or smoking in adults. Our findings are consistent with the adverse effects of accelerated neonatal growth on long-term cardiovascular health and suggest that postnatal growth patterns could explain the previously reported association between birthweight and later CVD

Multimedia broadcast and internet satellite system design and user trial results

The EU funded project, System for Advanced Multimedia Broadcast and IT Services (SAMBITS), has created an enhanced and synchronised, multimedia terminal for merging satellite broadcast and internet telecommunication services in a way that efficiently combines the large bandwidth of the broadcast channel and the interactivity of the internet. This paper proposes a novel broadcast and internet service concept, illustrates this concept with two service scenarios and develops a system architecture to demonstrate the range of key benefits provided by these new technologies. It then describes the interactive multimedia terminal that was used for consuming this new service concept. Finally, the results of the user trials on the terminal are presented and discussed

Near-Field Radio Holography of Large Reflector Antennas

We summarise the mathematical foundation of the holographic method of measuring the reflector profile of an antenna or radio telescope. In particular, we treat the case, where the signal source is located at a finite distance from the antenna under test, necessitating the inclusion of the so-called Fresnel field terms in the radiation integrals. We assume a ``full phase'' system with reference receiver to provide the reference phase. We describe in some detail the hardware and software implementation of the system used for the holographic measurement of the 12m ALMA prototype submillimeter antennas. We include a description of the practicalities of a measurement and surface setting. The results for both the VertexRSI and AEC (Alcatel-EIE-Consortium) prototype ALMA antennas are presented.Comment: 14 pages, 14 figures, to appear in IEEE Antennas and Propagation Magazine, Vol. 49, No. 5, October 2007. Version 2 includes nice mug-shots of the author

Acoustic and aerodynamic performance of a 6-foot-diameter fan for turbofan engines. 2 - Performance of QF-1 fan in nacelle without acoustic suppression

Low noise turbofan engine without aerodynamic blade loadin

Clustering of spectra and fractals of regular graphs

We exhibit a characteristic structure of the class of all regular graphs of degree d that stems from the spectra of their adjacency matrices. The structure has a fractal threadlike appearance. Points with coordinates given by the mean and variance of the exponentials of graph eigenvalues cluster around a line segment that we call a filar. Zooming-in reveals that this cluster splits into smaller segments (filars) labeled by the number of triangles in graphs. Further zooming-in shows that the smaller filars split into subfilars labelled by the number of quadrangles in graphs, etc. We call this fractal structure, discovered in a numerical experiment, a multifilar structure. We also provide a mathematical explanation of this phenomenon based on the Ihara-Selberg trace formula, and compute the coordinates and slopes of all filars in terms of Bessel functions of the first kind.Comment: 10 pages, 5 figure