Novel electronic adherence monitoring devices in children with asthma: a mixed-methods study

Introduction: Adherence monitoring to inhaled corticosteroids is an essential component of asthma management. Electronic monitoring devices (EMD) provide objective data on date, time and number of actuations. However, most give no information on inhalation. Novel EMD (NEMD) platforms have the potential to monitor both activation and inhalation. Aim: To assess the feasibility of NEMDs, in terms of usability, acceptability to patients and healthcare professionals and accuracy. Methods: This was an open-label, prospective, mixedmethods, pragmatic randomised study. Children with asthma attending specialist tertiary care were randomised to one of four NEMD: Remote Directly Observed Therapy (R-DOT), Hailie Smartinhaler, INhaler Compliance Assessment device (INCA) and the Rafi-tone App. Following monitoring, participants were invited to focus groups or one-to-one interviews. Usability and acceptability were evaluated using themes identified from the focus groups and interviews. Adherence accuracy was determined using adherence data from each NEMD. Results: Thirty-five children were recruited; 18 (51%), (11 males, median age 13.5 (7–16) years) completed monitoring, 14 (78%) provided feedback. Participants identified various features such as ease of use and minimal effort as desirable criteria for an NEMD. The Hailie and INCA fulfilled these criteria and were able to record both actuation and inhalation. Negative themes included a ‘Big Brother’ effect and costs. Conclusion: There was no ‘one size fits all’, as participants identified advantages and disadvantages for each NEMD. Devices that can easily calculate adherence to activation and inhalation have the potential to have greatest utility in clinical practice. Each NEMD has different functionality and therefore choice of platform should be determined by the needs of the patient and healthcare professional

Penetration of Projectiles in Composite Laminates

This paper deals with the prediction of the penetration phenomenon of a cylindro-conical impactor on the ke;labepoxy-laminated composites using C eight-nded serendipity q&drilateral finite elementbased on first-order shear deformation theory (FSDT). Local as well as global deformations during impact is considered in the evaluation of indentation, penetration, and perforation phases. Local strainsduring impact have been evaluated using the hypothesis made from the available experimental observations of bulging during penetration. A detailed parametric study, considering various projectilesand target plate variables, has been carried out to find their effect on the response of the plate, and ballistic parameters, such as ballistic limit and absorbed energy

Bending and vibration of functionally graded material sandwich plates using an accurate theory

In this paper, the bending and the free flexural vibration behaviour of sandwich functionally graded material (FGM) plates are investigated using QUAD-8 shear flexible element developed based on higher order structural theory. This theory accounts for the realistic variation of the displacements through the thickness. The governing equations obtained here are solved for static analysis considering two types of sandwich FGM plates, viz., homogeneous face sheets with FGM core and FGM face sheets with homogeneous hard core. The in-plane and rotary inertia terms are considered for vibration studies. The accuracy of the present formulation is tested considering the problems for which three-dimensional elasticity solutions are available. A detailed numerical study is carried out based on various higher-order models to examine the influence of the gradient index and the plate aspect ratio on the global/local response of different sandwich FGM plates.Comment: 28 pages, 6 figures, 9 table

Retraumatization in Undergraduate Medical Education: Evaluating the Prevalence and Support Resources Available to Students

BACKGROUND: Retraumatization is the conscious or unconscious reminder of past trauma that results in a re-experiencing of the initial traumatic event. This phenomenon has been well-studied in primary and secondary education and has been shown to negatively impact the learning environment. Retraumatization in the context of undergraduate medical education has yet to be evaluated. Therefore, we sought to explore the prevalence of retraumatization in medical students, identify specific areas of UME that are retraumatizing, and evaluate effectiveness of psychological support available to students. METHODS: A survey was created by a multidisciplinary team of health professions educators, revised through an iterative process, and distributed to all medical students at a single, large, academic institution. Respondents who endorsed prior trauma exposure met inclusion criteria for completing the survey. Data was analyzed using Microsoft Excel. RESULTS: Of the school’s 1400 students, 85 responses were recorded for a response rate of 6.07%; this consisted of 20 males (23.5%), 46 females (54.1%), and 19 nonbinary (22.4%) students. 32 (37.6%) students reported no prior trauma and were excluded from survey completion. Of the 53 (62.4%) students completing the survey, retraumatization was experienced by 32 students (60.4%), which represents a prevalence of 37.6% among all medical students surveyed. 50% of females (n=23), 10% of males (n=2), and 36.8% of nonbinary (n=7) students reported retraumatization. Clinical rotations were identified as a retraumatizing setting by 59.3% (n=19) of students. Despite the availability of support services, 11 students (20.8%) reported being unaware of them when experiencing retraumatization. When asked about utilization of services, the majority of those who had experienced retraumatization did not utilize them (65.6%, n=21). CONCLUSION: Retraumatization is occurring in undergraduate medical education, particularly in the clinical years. Medical schools should attempt to enhance the ease of utilization of support resources to improve the learning environment for students

Novel electronic adherence monitoring devices in children with asthma: a mixed-methods study

INTRODUCTION: Adherence monitoring to inhaled corticosteroids is an essential component of asthma management. Electronic monitoring devices (EMD) provide objective data on date, time and number of actuations. However, most give no information on inhalation. Novel EMD (NEMD) platforms have the potential to monitor both activation and inhalation. AIM: To assess the feasibility of NEMDs, in terms of usability, acceptability to patients and healthcare professionals and accuracy. METHODS: This was an open-label, prospective, mixed-methods, pragmatic randomised study. Children with asthma attending specialist tertiary care were randomised to one of four NEMD: Remote Directly Observed Therapy (R-DOT), Hailie Smartinhaler, INhaler Compliance Assessment device (INCA) and the Rafi-tone App. Following monitoring, participants were invited to focus groups or one-to-one interviews. Usability and acceptability were evaluated using themes identified from the focus groups and interviews. Adherence accuracy was determined using adherence data from each NEMD. RESULTS: Thirty-five children were recruited; 18 (51%), (11 males, median age 13.5 (7-16) years) completed monitoring, 14 (78%) provided feedback. Participants identified various features such as ease of use and minimal effort as desirable criteria for an NEMD. The Hailie and INCA fulfilled these criteria and were able to record both actuation and inhalation. Negative themes included a 'Big Brother' effect and costs. CONCLUSION: There was no 'one size fits all', as participants identified advantages and disadvantages for each NEMD. Devices that can easily calculate adherence to activation and inhalation have the potential to have greatest utility in clinical practice. Each NEMD has different functionality and therefore choice of platform should be determined by the needs of the patient and healthcare professional

Harmonic response analysis of symmetric laminated composite beams with different boundary conditions

This study deals with the determination of the harmonic response of symmetric laminated composite beams by the finite element method. The structural stiffness of the composite beam is determined by the classical laminated plate theory. Four different ply orientations, namely, [0]2s, [0/90]s, [45/-45]s, and [90]2s are used to examine the effect of the stacking sequence on the harmonic response of the beam. Proportional damping is used to model the structural damping, and the damped harmonic responses of the composite beams are obtained to show the effect of the damping on the harmonic response. The effect of the boundary conditions on the harmonic response is also investigated. The displacement maps calculated for varying excitation points are obtained for different boundary conditions and damping ratios at different vibrational modes. The numerical results presented in this study show that the magnitudes of the harmonic response of the composite beam increase as the flexural rigidity decreases, and the vibration magnitudes reduce considerably with damping. The vibration patterns created for varying excitation and observation locations change as the damping ratio and excitation frequency change

A cross-sectional, observational study of the clinico-epidemiological profile of female pattern hair loss in Western India and its association with metabolic syndrome

Background: The increasing prevalence of female pattern hair loss (FPHL) is an alarming concern. There are many studies on FPHL in the world literature but there is a dearth of Indian data on the same. Aims and objectives: The present study aims to ascertain the demographic variables and clinical features of FPHL in Western India and its association with metabolic syndrome (MetS) to add over and above the existing data. Materials and Methods: Ninety females who were diagnosed with FPHL were included after approval of the institutional ethics committee. Demographic details, detailed history, and clinical features were noted, following which a few blood investigations for diagnosis of MetS were advised and evaluated. Results: Our study population's age ranged from 17 to 65 years, with the mean age of 34.7 ± 1.3 years. According to the Basic and Specific (BASP) classification, The basic pattern prevalence as found in our study was 46.7% for M type, 35.6% for L type, and 17.7% for C type. The FPHL severity score revealed that 82 (91.1%) had advanced disease at presentation. Prevalence of MetS was found to be 34.4% and had a significant correlation with age of onset in years (p=0.041) and severity score (p=0.013) implying that it leads to an early onset and greater severity of FPHL. Conclusion: FPHL is increasingly common among Indian women, who frequently present with a bitemporal recession of the hairline. Calculation of the female pattern hair loss severity index (FPHL-SI) can help in the categorization of patients and assessment of prognosis. MetS should be actively looked for in patients of FPHL and managed accordingly

Drivers of Employee Engagement in Global Virtual Teams

Global Virtual Teams (GVTs) comprise geographically distributed groups of people collaborating with each other through technology-mediated communication. Members of GVTs are from different cultural backgrounds and time zones, who may (or may not) meet in person to take complex decisions or to deliver on the tasks that are of strategic importance. Though technology has enabled GVTs in almost all multinational organisations across all industries, keeping the members of GVTs engaged over the duration of the team's task or project could still pose a challenge for organisations. Employee engagement is defined as an employee's cognitive, behavioural and physical state directed towards organisational outcomes. While employee engagement has been researched in a collocated team context, it remains an under-researched area in the context of GVTs. Given that there are several characteristics of GVTs which are distinct from the collocated team, it warrants a separate inquiry, which we undertake in this study. This study uses the Job Demands-Resources theory of employee engagement to derive the drivers of employee engagement in GVTs. Through interpretive analysis of the lived experiences of members working in an organisation which extensively uses GVTs for achieving its strategic goals, we conceptualise five drivers of employee engagement, namely, cultural intelligence, communication (formal and informal), technology, trust and individual maturity