Factors associated with medication adherence in school-aged children with asthma

Adherence to preventive asthma treatment is poor, particularly in children, yet the factors associated with adherence in this age group are not well understood. Adherence was monitored electronically over 6 months in school-aged children who attended a regional emergency department in New Zealand for an asthma exacerbation and were prescribed twice-daily inhaled corticosteroids. Participants completed questionnaires including assessment of family demographics, asthma responsibility and learning style. Multivariable analysis of factors associated with adherence was conducted. 101 children (mean (range) age 8.9 (6-15) years, 51% male) participated. Median (interquartile range) preventer adherence was 30% (17-48%) of prescribed. Four explanatory factors were identified: female sex (+12% adherence), Asian ethnicity (+19% adherence), living in a smaller household (-3.0% adherence per person in the household), and younger age at diagnosis (+2.7% for every younger year of diagnosis) (all p<0.02). In school-aged children attending the emergency department for asthma, males and non-Asian ethnic groups were at high risk for poor inhaled corticosteroid adherence and may benefit most from intervention. Four factors explained a small proportion of adherence behaviour indicating the difficulty in identifying adherence barriers. Further research is recommended in other similar populations

Exploring athletic identity in elite-level English youth football: a cross-sectional approach.

This study is the first empirical investigation that has explored levels of athletic identity in elite-level English professional football. The importance of understanding athletes' psychological well-being within professional sport has been well documented. This is especially important within the professional football industry, given the high attrition rate (Anderson, G., & Miller, R. M. (2011). The academy system in English professional football: Business value or following the herd? University of Liverpool, Management School Research Paper Series. Retrieved from http://www.liv.ac.uk/managementschool/research/working%20papers/wp201143.pdf ) and distinct occupational practices (Roderick, M. (2006). The work of professional football. A labour of love? London: Routledge). A total of 168 elite youth footballers from the English professional football leagues completed the Athletic Identity Measurement Scale (AIMS). Multilevel modelling was used to examine the effect of playing level, living arrangements and year of apprentice on the total AIMS score and its subscales (i.e., social identity, exclusivity and negative affectivity). Football club explained 30% of the variance in exclusivity among players (P = .022). Mean social identity was significantly higher for those players in the first year of their apprenticeship compared to the second year (P = .025). All other effects were not statistically significant (P > .05). The novel and unique findings have practical implications in the design and implementation of career support strategies with respect to social identity. This may facilitate the maintenance of motivation over a 2-year apprenticeship and positively impact on performance levels within the professional football environment

Occupational asthma: a review.

Occupational asthma is the most common form of occupational lung disease in the developed world at the present time. In this review, the epidemiology, pathogenesis/mechanisms, clinical presentations, management, and prevention of occupational asthma are discussed. The population attributable risk of asthma due to occupational exposures is considerable. Current understanding of the mechanisms by which many agents cause occupational asthma is limited, especially for low-molecular-weight sensitizers and irritants. The diagnosis of occupational asthma is generally established on the basis of a suggestive history of a temporal association between exposure and the onset of symptoms and objective evidence that these symptoms are related to airflow limitation. Early diagnosis, elimination of exposure to the responsible agent, and early use of inhaled steroids may play important roles in the prevention of long-term persistence of asthma. Persistent occupational asthma is often associated with substantial disability and consequent impacts on income and quality of life. Prevention of new cases is the best approach to reducing the burden of asthma attributable to occupational exposures. Future research needs are identified

Pseudotumors in association with well-functioning metal-on-metal hip prostheses: a case-control study using three-dimensional computed tomography and magnetic resonance imaging.

Many papers have been published recently on the subject of pseudotumors surrounding metal-on-metal hip resurfacing and replacement prostheses. These pseudotumors are sterile, inflammatory lesions within the periprosthetic tissues and have been variously termed masses, cysts, bursae, collections, or aseptic lymphocyte-dominated vasculitis-associated lesions (ALVAL). The prevalence of pseudotumors in patients with a well-functioning metal-on-metal hip prosthesis is not well known. The purpose of this study was to quantify the prevalence of pseudotumors adjacent to well-functioning and painful metal-on-metal hip prostheses, to characterize these lesions with use of magnetic resonance imaging, and to assess the relationship between their presence and acetabular cup position with use of three-dimensional computed tomography

Electronic adherence monitoring device performance and patient acceptability: a randomized control trial

BACKGROUND: To investigate the performance and patient acceptability of an inhaler electronic monitoring device in a real-world childhood asthma population. METHODS: Children 6 to 15 years presenting with asthma to the hospital emergency department and prescribed inhaled corticosteroids were included. Participants were randomized to receive a device with reminder features enabled or disabled for use with their preventer. Device quality control tests were conducted. Questionnaires on device acceptability, utility and ergonomics were completed at six months. RESULTS: A total of 1306 quality control tests were conducted; 84% passed pre-issue and 87% return testing. The most common failure reason was actuation under-recording. Acceptability scores were high, with higher scores in the reminder than non-reminder group (median, 5th-95th percentile: 4.1, 3.1–5.0 versus 3.7, 2.3–4.8; p 90%) rated the device easy to use. Feedback was positive across five themes: device acceptability, ringtone acceptability, suggestions for improvement, effect on medication use, and effect on asthma control. CONCLUSIONS: This study investigates electronic monitoring device performance and acceptability in children using quantitative and qualitative measures. Results indicate satisfactory reliability, although failure rates of 13–16% indicate the importance of quality control. Favorable acceptability ratings support the use of these devices in children

The patient acceptability of a remotely delivered pain management programme for people with persistent musculoskeletal pain: A qualitative evaluation.

INTRODUCTION: Remotely delivered pain management programmes have been offered in place of in-person programmes by many chronic pain services since the onset of the COVID-19 pandemic. There is a lack of evidence regarding the acceptability of these programmes. In this evaluation, we have explored patients' acceptability of a remotely delivered pain management programme for patients with persistent musculoskeletal pain. METHODS: Qualitative data were collected using focus groups with participants who had previously attended the remote pain management programme. Data were analysed using abductive analysis. RESULTS: Three focus groups were conducted with a total of 13 participants. The programmme was either entirely acceptable, had some acceptable components or was not acceptable to patients. Factors leading to the programme being acceptable include learning to manage pain from home, receiving high quality care from home, enhancing the potential of rehabilitation using technology, enabling attendance on a pain management programme from home, overcoming social distancing requirements of COVID-19 using technology, and virtual peer support. Factors leading to the programme not being acceptable include having an inappropriate home environment for virtual therapy, communication challenges with virtual therapy, technological issues and concerns regarding the quality of care. CONCLUSIONS: There is a spectrum of acceptability with respect to the remote programme. The factors that influence this are dynamic, individual and situational. Hybrid programmes have the potential to enhance access to pain management programmes and improve patient experience and programme outcomes in the future

Stability of Spatial Optical Solitons

We present a brief overview of the basic concepts of the soliton stability theory and discuss some characteristic examples of the instability-induced soliton dynamics, in application to spatial optical solitons described by the NLS-type nonlinear models and their generalizations. In particular, we demonstrate that the soliton internal modes are responsible for the appearance of the soliton instability, and outline an analytical approach based on a multi-scale asymptotic technique that allows to analyze the soliton dynamics near the marginal stability point. We also discuss some results of the rigorous linear stability analysis of fundamental solitary waves and nonlinear impurity modes. Finally, we demonstrate that multi-hump vector solitary waves may become stable in some nonlinear models, and discuss the examples of stable (1+1)-dimensional composite solitons and (2+1)-dimensional dipole-mode solitons in a model of two incoherently interacting optical beams.Comment: 34 pages, 9 figures; to be published in: "Spatial Optical Solitons", Eds. W. Torruellas and S. Trillo (Springer, New York

Dark Mode Excitation in Three-Dimensional Interlaced Metallic Meshes

This is the final version. Available on open access from the American Chemical Society via the DOI in this recordData Availability. The data that support the findings of this study are available from the corresponding author upon reasonable request.Interlaced metallic meshes form a class of three-dimensional metamaterials that exhibit nondispersive, broadband modes at low frequencies, without the low frequency cutoff typical of generic wire grid geometries. However, the experimental observation of these modes has remained an open challenge, both due to the difficulties in fabricating such complex structures and also because the broadband mode is longitudinal and does not couple to free-space radiation (dark mode). Here we report the first experimental observation of the low frequency modes in a block of interlaced meshes fabricated through 3D printing. We demonstrate how the addition of monopole antennas to opposing faces of one of the meshes enables coupling of a plane wave to the low frequency “dark mode” and use this to obtain the dispersion of the mode. In addition, we utilize orthogonal antennas on opposite faces to achieve polarization rotation as well as phase shifting of radiation passing through the structure. Our work paves the way toward further experimental study into interlaced meshes and other complex 3D metamaterials.Royal Academy of Engineering (RAE)Engineering and Physical Sciences Research Council (EPSRC

Learning Moore Machines from Input-Output Traces

The problem of learning automata from example traces (but no equivalence or membership queries) is fundamental in automata learning theory and practice. In this paper we study this problem for finite state machines with inputs and outputs, and in particular for Moore machines. We develop three algorithms for solving this problem: (1) the PTAP algorithm, which transforms a set of input-output traces into an incomplete Moore machine and then completes the machine with self-loops; (2) the PRPNI algorithm, which uses the well-known RPNI algorithm for automata learning to learn a product of automata encoding a Moore machine; and (3) the MooreMI algorithm, which directly learns a Moore machine using PTAP extended with state merging. We prove that MooreMI has the fundamental identification in the limit property. We also compare the algorithms experimentally in terms of the size of the learned machine and several notions of accuracy, introduced in this paper. Finally, we compare with OSTIA, an algorithm that learns a more general class of transducers, and find that OSTIA generally does not learn a Moore machine, even when fed with a characteristic sample