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

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