Investigating the Temporal Relationships between Symptoms and Nebuliser Adherence in People with Cystic Fibrosis: A Series of N-of-1 Observations

Treatment adherence in adults with cystic fibrosis (CF) is poor. One of the reasons identified for lack of adherence to nebulised treatments is that patients may not experience any immediate relief in their symptoms or notice changes as a result of taking their treatment, thus many report that they do not perceive there to be consequences of non adherence. The aim of the study was to investigate the temporal relationships between symptoms and adherence to nebulised treatments in adults with CF using an N-of-1 observational design. Six participants were recruited for a six-week period during which time they completed a daily online respiratory symptom questionnaire. Adherence to treatment was measured throughout the duration of the study using an eTrack® nebuliser that logged date and time of treatments taken. Data generated from each participant was analysed separately. There were significant relationships between pain and adherence for three participants, tiredness and adherence for one participant and cough and adherence for one participant. For all of these findings, the symptom and adherence were experienced on the same day. Extending the monitoring period beyond six weeks may provide increased insight into the complex relationship between symptoms and adherence in CF

Understanding patient activation and adherence to nebuliser treatment in adults with cystic fibrosis: responses to the UK version of PAM-13 and a think aloud study

Background Patient activation refers to patients’ knowledge, skills, and confidence in self-managing health conditions. In large cross-sectional studies, individuals with higher patient activation are observed to have better health outcomes with the assumption that they are more engaged in health self-management. However, the association between patient activation and objectively measured self-care indicators in individuals can be inconsistent. This research investigated the role of patient activation as measured by the UK Patient Activation Measure (PAM-13) in adults with Cystic Fibrosis (CF). The aims were twofold: to explore how adults with CF interpret and respond to the PAM-13; and to investigate the association between PAM-13 and objectively measured nebuliser adherence in UK adults with CF. Methods This article describes two studies which examined the PAM-13 from different perspectives. Study 1 comprised ‘think aloud’ interviews with 15 adults with CF. The data were analysed using an a priori coding framework. Study 2 examined the association between PAM-13 and objectively measured nebuliser adherence in 57 adults with CF. Results Study 1 showed that adults with CF encountered several difficulties while completing the PAM-13. The difficulties were related to understanding how to interpret aspects of CF in order to respond (i.e., control over the condition, ability to exercise) and item wording. Some adults with CF responded to the PAM-13 in an optimistic way in relation to what they thought they should do rather than what they actually do. These findings were echoed by the results of Study 2, which showed that PAM-13 scores were not significantly correlated with objective medication adherence in a different sample. This article synthesises the results of both studies, providing insights into influences and associations of patient activation as measured by the UK PAM-13 in adults with CF. Conclusions There were some significant difficulties created by the wording of the UK PAM-13 for adults with CF. This may partly explain the finding that PAM-13 scores were not related to objectively measured nebuliser adherence in this study. The UK PAM-13 would benefit from further research to verify its validity and reliability in different patient populations against objective measures of behaviour rather than simply self-report

Exact solution of a one-dimensional Boltzmann equation for a granular tracer particle

We consider a one-dimensional system consisting of a granular tracer particle of mass $M$ in a bath of thermalized particles each of mass $m$. When the mass ratio, $M/m$, is equal to the coefficient of restitution, $\alpha$, the system maps to a a one-dimensional elastic gas. In this case, Boltzmann equation can be solved exactly. We also obtain expressions for the velocity autocorrelation function and the diffusion coefficient. Numerical simulations of the Boltzmann equation are performed for $M/m\neq \alpha$ where no analytical solution is available. It appears that the dynamical features remain qualitatively similar to those found in the exactly solvable case.Comment: 17 pages, 3 figures, Accepted in Physica

Shape complexity and process energy consumption in electron beam melting: a case of something for nothing in additive manufacturing?

Additive manufacturing (AM) technology is capable of building up component geometry in a layer-by-layer process, entirely without tools, molds, or dies. One advantage of the approach is that it is capable of efficiently creating complex product geometry. Using experimental data collected during the manufacture of a titanium test part on a variant of AM technology, electron beam melting (EBM), this research studies the effect of a variation in product shape complexity on process energy consumption. This is done by applying a computationally quantifiable convexity-based characteristic associated with shape complexity to the test part and correlating this quantity with per-layer process energy consumption on the EBM system. Only a weak correlation is found between the complexity metric and energy consumption (ρ = .35), suggesting that process energy consumption is indeed not driven by shape complexity. This result is discussed in the context of the energy consumption of computer-controlled machining technology, which forms an important substitute to EBM. This article further discusses the impact of available additional shape complexity at the manufacturing process level on the incentives toward minimization of energy inputs, additional benefits arising later within the product’s life cycle, and its implications for value creation possibilities

Thermalization of an anisotropic granular particle

We investigate the dynamics of a needle in a two-dimensional bath composed of thermalized point particles. Collisions between the needle and points are inelastic and characterized by a normal restitution coefficient $\alpha<1$. By using the Enskog-Boltzmann equation, we obtain analytical expressions for the translational and rotational granular temperatures of the needle and show that these are, in general, different from the bath temperature. The translational temperature always exceeds the rotational one, though the difference decreases with increasing moment of inertia. The predictions of the theory are in very good agreement with numerical simulations of the model.Comment: 7 pages, 6 Figures, submitted to PRE. Revised version (Fig1, Fig5 and Fig6 corrected + minor typos

Breakdown of Energy Equipartition in a 2D Binary Vibrated Granular Gas

We report experiments on the equipartition of kinetic energy between grains made of two different materials in a mixture of grains vibrated in 2 dimensions. In general, the two types of grains do not attain the same granular temperature, Tg = 1/2m v^2. However, the ratio of the two temperatures is constant in the bulk of the system and independent of the vibration velocity. The ratio depends strongly on the ratio of mass densities of the grains, but is not sensitive to the inelasticity of grains. Also, this ratio is insensitive to compositional variables of the mixture such as the number fraction of each component and the total number density. We conclude that a single granular temperature, as traditionally defined, does not characterize a multi-component mixture.Comment: 4 pages, 5 figures, submitted to Physical Review Letters, updated reference

Epigenetic predictors of all-cause mortality are associated with objective measures of neighborhood disadvantage in an urban population

BACKGROUND: Neighborhood characteristics are robust predictors of overall health and mortality risk for residents. Though there has been some investigation of the role that molecular indicators may play in mediating neighborhood exposures, there has been little effort to incorporate newly developed epigenetic biomarkers into our understanding of neighborhood characteristics and health outcomes. METHODS: Using 157 participants of the Detroit Neighborhood Health Study with detailed assessments of neighborhood characteristics and genome-wide DNA methylation profiling via the Illumina 450K methylation array, we assessed the relationship between objective neighborhood characteristics and a validated DNA methylation-based epigenetic mortality risk score (eMRS). Associations were adjusted for age, race, sex, ever smoking, ever alcohol usage, education, years spent in neighborhood, and employment. A secondary model additionally adjusted for personal neighborhood perception. We summarized 19 neighborhood quality indicators assessed for participants into 9 principal components which explained over 90% of the variance in the data and served as metrics of objective neighborhood quality exposures. RESULTS: Of the nine principal components utilized for this study, one was strongly associated with the eMRS (β = 0.15; 95% confidence interval = 0.06-0.24; P = 0.002). This principal component (PC7) was most strongly driven by the presence of abandoned cars, poor streets, and non-art graffiti. Models including both PC7 and individual indicators of neighborhood perception indicated that only PC7 and not neighborhood perception impacted the eMRS. When stratified on neighborhood indicators of greenspace, we observed a potentially protective effect of large mature trees as this feature substantially attenuated the observed association. CONCLUSION: Objective measures of neighborhood disadvantage are significantly associated with an epigenetic predictor of mortality risk, presenting a potential novel avenue by which neighborhood-level exposures may impact health. Associations were independent of an individual's perception of their neighborhood and attenuated by neighborhood greenspace features. More work should be done to determine molecular risk factors associated with neighborhoods, and potentially protective neighborhood features against adverse molecular effects

On the Einstein relation in a heated granular gas

Recent computer simulation results [Barrat {\em et al.}, Physica A 334 (2004) 513] for granular mixtures subject to stochastic driving have shown the validity of the Einstein relation $\epsilon\equiv D/(T_0\lambda)=1$ between the diffusion $D$ and mobility $\lambda$ coefficients when the temperature of the gas $T$ is replaced by the temperature of the impurity $T_0$ in the usual Einstein relation. This problem is analyzed in this paper by solving analytically the Boltzmann-Lorentz equation from the Chapman-Enskog method. The gas is heated by the action of an external driving force (thermostat) which does work to compensate for the collisional loss of energy. Two types of thermostats are considered: (a) a deterministic force proportional to the particle velocity (Gaussian thermostat), and (b) a white noise external force (stochastic thermostat). The diffusion and mobility coefficients are given in terms of the solutions of two linear integral equations, which are approximately solved up to the second order in a Sonine polynomial expansion. The results show that the violation of the Einstein relation ($\epsilon\neq 1$) is only due to the non-Maxwellian behavior of the impurity velocity distribution function (absence of the Gibbs state). At a quantitative level, the kinetic theory results also show that the deviation of $\epsilon$ from 1 is more significant in the case of the Gaussian thermostat than in the case of the stochastic one, in which case the deviation of the Einstein relation is in general smaller than 1%. This conclusion agrees quite well with the results found in computer simulations.Comment: 7 figures. to appear in Physica

Role of habit in treatment adherence among adults with cystic fibrosis

Among adults with cystic fibrosis (CF), medication adherence is low and reasons for low adherence are poorly understood. Our previous exploratory study showed that stronger 'habit' (ie, automatically experiencing an urge to use a nebuliser) was associated with higher nebuliser adherence. We performed a secondary analysis of pilot trial data (n=61) to replicate the earlier study and determine whether habit-adherence association exists in other cohorts of adults with CF. In this study, high adherers also reported stronger habit compared with low adherers. Habit may be a promising target for self-management interventions. ACtiF pilot, ISRCTN13076797. [Abstract copyright: © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2018. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

Changing practice in cystic fibrosis: Implementing objective medication adherence data at every consultation, a learning health system and quality improvement collaborative

Background: Medication adherence data are an important quality indicator in cystic fibrosis (CF) care, yet real‐time objective data are not routinely available. An online application (CFHealthHub) has been designed to deliver these data to people with CF and their clinical team. Adoption of this innovation is the focus of an National Health Service England‐funded learning health system and Quality Improvement Collaborative (QIC). This study applies the capability, opportunity, and motivation model of behavior change to assess whether the QIC had supported healthcare professionals' uptake of accessing patient adherence data. Method: This was a mixed‐method study, treating each multidisciplinary team as an individual case. Click analytic data from CFHealthHub were collected between January 1, 2018, and September 22, 2019. Thirteen healthcare practitioners participated in semi‐structured interviews, before and after establishing the QIC. Qualitative data were analyzed using the behavior change model. Results: The cases showed varied improvement trajectories. While two cases reported reduced barriers, one faced persistent challenges. Participation in the QIC led to enhanced confidence in the platform's utility. Reduced capability, opportunity, and motivation barriers correlated with increased uptake, demonstrating value in integrating behavior change theory into QICs. Conclusion: QICs can successfully reduce barriers and enable uptake of e‐health innovations such as adherence monitoring technology. However, ongoing multi‐level strategies are needed to embed changes. Further research should explore sustainability mechanisms and their impact on patient outcomes.</p