Factors determining patients’ intentions to use point-of-care testing medical devices for self-monitoring: The case of international normalised ratio self-testing

This is an Open Access article which permits unrestricted noncommercial use, provided the original work is properly cited. - Copyright @ 2012 Dove Medical Press LtdThis article has been made available through the Brunel Open Access Publishing Fund.Purpose: To identify factors that determine patients' intentions to use point-of-care medical devices, ie, portable coagulometer devices for self-testing of the international normalized ratio (INR) required for ongoing monitoring of blood-coagulation intensity among patients on long-term oral anticoagulation therapy with vitamin K antagonists, eg, warfarin. Methods: A cross-sectional study that applied the technology-acceptance model through a self-completed questionnaire, which was administered to a convenience sample of 125 outpatients attending outpatient anticoagulation services at a district general hospital in London, UK. Data were analyzed using descriptive statistics, factor analyses, and structural equation modeling. Results: The participants were mainly male (64%) and aged ≥ 71 years (60%). All these patients were attending the hospital outpatient anticoagulation clinic for INR testing; only two patients were currently using INR self-testing, 84% of patients had no knowledge about INR self-testing using a portable coagulometer device, and 96% of patients were never offered the option of the INR self-testing. A significant structural equation model explaining 79% of the variance in patients’ intentions to use INR self-testing was observed. The significant predictors that directly affected patients' intention to use INR self-testing were the perception of technology (β = 0.92, P < 0.001), trust in doctor (β = −0.24, P = 0.028), and affordability (β = 0.15, P = 0.016). In addition, the perception of technology was significantly affected by trust in doctor (β = 0.43, P = 0.002), age (β = −0.32, P < 0.001), and affordability (β = 0.23, P = 0.013); thereby, the intention to use INR self-testing was indirectly affected by trust in doctor (β = 0.40), age (β = −0.29), and affordability (β = 0.21) via the perception of technology. Conclusion: Patients’ intentions to use portable coagulometers for INR self-testing are affected by patients' perceptions about the INR testing device, the cost of device, trust in doctors/clinicians, and the age of the patient, which need to be considered prior to any intervention involving INR self-testing by patients. Manufacturers should focus on increasing the affordability of INR testing devices for patients’ self-testing and on the potential role of medical practitioners in supporting use of these medical devices as patients move from hospital to home testing.This study is funded by the Multidisciplinary Assessment of Technology Centre for Healthcare (MATCH) program (EPSRC grant EP/GO12393/1)

A technique for correcting ERTS data for solar and atmospheric effects

The author has identified the following significant results. Based on processing ERTS CCTs and ground truth measurements collected on Michigan test site for January through June 1973 the following results are reported: (1) atmospheric transmittance varies from: 70 to 85% in band 4, 77 to 90% in band 5, 80 to 94% in band 6, and 84 to 97% in band 7 for one air mass; (2) a simple technique was established to determine atmospheric scattering seen by ERTS-1 from ground-based measurements of sky radiance. For March this scattering was found to be equivalent to that produced by a target having a reflectance of 11% in band 4, 5% in band 5, 3% in band 6, and 1% in band 7; (3) computer ability to classify targets under various atmospheric conditions was determined. Classification accuracy on some targets (i.e. bare soil, tended grass, etc.) hold up even under the most severe atmospheres encountered, while performance on other targets (trees, urban, rangeland, etc.) degrades rapidly when atmospheric conditions change by the smallest amount

Development of a three-dimensional time-dependent flow field model

A three-dimensional, time-dependent mathematical model to represent Mobile Bay was developed. Computer programs were developed which numerically solve the appropriate conservation equations for predicting bay and estuary flow fields. The model is useful for analyzing the dispersion of sea water into fresh water and the transport of sediment, and for relating field and physical model data

Probabilistic analysis of bladed turbine disks and the effect of mistuning

Probabilistic assessment of the maximum blade response on a mistuned rotor disk is performed using the computer code NESSUS. The uncertainties in natural frequency, excitation frequency, amplitude of excitation and damping are included to obtain the cumulative distribution function (CDF) of blade responses. Advanced mean value first order analysis is used to compute CDF. The sensitivities of different random variables are identified. Effect of the number of blades on a rotor on mistuning is evaluated. It is shown that the uncertainties associated with the forcing function parameters have significant effect on the response distribution of the bladed rotor

Balancing Local Order and Long-Ranged Interactions in the Molecular Theory of Liquid Water

A molecular theory of liquid water is identified and studied on the basis of computer simulation of the TIP3P model of liquid water. This theory would be exact for models of liquid water in which the intermolecular interactions vanish outside a finite spatial range, and therefore provides a precise analysis tool for investigating the effects of longer-ranged intermolecular interactions. We show how local order can be introduced through quasi-chemical theory. Long-ranged interactions are characterized generally by a conditional distribution of binding energies, and this formulation is interpreted as a regularization of the primitive statistical thermodynamic problem. These binding-energy distributions for liquid water are observed to be unimodal. The gaussian approximation proposed is remarkably successful in predicting the Gibbs free energy and the molar entropy of liquid water, as judged by comparison with numerically exact results. The remaining discrepancies are subtle quantitative problems that do have significant consequences for the thermodynamic properties that distinguish water from many other liquids. The basic subtlety of liquid water is found then in the competition of several effects which must be quantitatively balanced for realistic results.Comment: 8 pages, 6 figure