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Sample records for cooperatively control adherence

  1. Adherence to Cooperative Principles among Agricultural ...

    African Journals Online (AJOL)

    User

    Abstract. This study assessed agricultural cooperatives' level of adherence to cooperative guiding principles in Oyo State, Nigeria. Multi stage sampling procedure was used to select 126 respondents for the study. Data on group characteristics, level of awareness, adherence and constraints to adherence to cooperative ...

  2. Adherence to cooperative principles among agricultural ...

    African Journals Online (AJOL)

    Agricultural cooperatives in the area largely adhered to the cooperatives principles. However, capacity building on innovative financial sourcing and loan recovery mechanisms should be embarked upon by management to enhance the adherence. Keywords: Cooperatives principles, loan recovery, agricultural cooperatives ...

  3. Staff Knowledge, Adherence to Infection Control Recommendations ...

    African Journals Online (AJOL)

    Introduction: We evaluated hemodialysis (HD) staff knowledge, adherence to infection control recommendations and seroconversion rates for hepatitis B virus (HBV) and hepatitis C virus (HCV) in 13 centers that continuously provided HD services in Khartoum State between June 2009 and November 2010. Methods: The ...

  4. Treatment non-adherence among patients with poorly controlled ...

    African Journals Online (AJOL)

    2014-03-01

    adherence among patients with poorly controlled type 2 diabetes in am- bulatory .... diet and exercise (5; 3.0%). Patterns of medication non-adherence behavior among patients are shown in Table 2. African Health sciences Vol 14 No.

  5. Co-operatives and Normative Control

    DEFF Research Database (Denmark)

    Bregn, Kirsten; Jagd, Søren

    1992-01-01

    This paper explores the conditions for applying normative control in co-operatives. For normative control to be effective two conditions are found particularly important: Individuals must be morally involved and the organization must have a system of making it possible to link common norms...... and individual action. If these conditions are not fulfilled, as may be the case in many co-operatives, normative control cannot be expected to work. The problems of normative control in co-operatives may then not be caused by the use of normative control as such, but may instead be a problem of securing...... the conditions necessary for normative control. This is illustrated by a case study of control in a Danish producers co-operative. The analysis of the case study leads to the hypothesis of a paradox of normative control in co-operatives: The need of information tends to be greater in co-operatives comparet...

  6. The Patient's Perspective: Adherence or Non-adherence to Asthma Controller Therapy?

    DEFF Research Database (Denmark)

    Ulrik, Charlotte Suppli; Backer, V; Soes-Petersen, U

    2006-01-01

    )-guidelines' symptom severity classification, 85% should have been on ICS. Accidental and intentional non-adherence with ICS at least twice a week was reported by 27% and 24%, respectively. In case of deterioration, 60% of the patients preferred to take more reliever medication, instead of increasing the ICS dose....... Having a fixed daily routine with regard to medication and following the advice given by their doctor were the main reasons for adherence, whereas lack of perceived symptoms was the main reason for non-adherence. Non-adherence was associated with increasing disagreement with the statements......STUDY OBJECTIVE: Adherence with controller therapy poses a major challenge to the effective management of persistent asthma. The aim of this study was to explore the patient-related aspects of adherence among adult asthmatics. DESIGN AND PARTICIPANTS: The participants (n = 509 adult asthmatics...

  7. Recent developments in cooperative control and optimization

    CERN Document Server

    Murphey, Robert; Pardalos, Panos

    2004-01-01

    Over the past several years, cooperative control and optimization has un­ questionably been established as one of the most important areas of research in the military sciences. Even so, cooperative control and optimization tran­ scends the military in its scope -having become quite relevant to a broad class of systems with many exciting, commercial, applications. One reason for all the excitement is that research has been so incredibly diverse -spanning many scientific and engineering disciplines. This latest volume in the Cooperative Systems book series clearly illustrates this trend towards diversity and creative thought. And no wonder, cooperative systems are among the hardest systems control science has endeavored to study, hence creative approaches to model­ ing, analysis, and synthesis are a must! The definition of cooperation itself is a slippery issue. As you will see in this and previous volumes, cooperation has been cast into many different roles and therefore has assumed many diverse meanings. P...

  8. A Note on Cooperative Linear Quadratic Control

    NARCIS (Netherlands)

    Engwerda, J.C.

    2007-01-01

    In this note we consider the cooperative linear quadratic control problem. That is, the problem where a number of players, all facing a (different) linear quadratic control problem, decide to cooperate in order to optimize their performance. It is well-known, in case the performance criteria are

  9. Medication adherence and glycemic control among newly diagnosed diabetes patients.

    Science.gov (United States)

    Lin, Lee-Kai; Sun, Yan; Heng, Bee Hoon; Chew, Daniel Ek Kwang; Chong, Phui-Nah

    2017-01-01

    Poor medication adherence can have negative consequences for the patients, the provider, the physician, and the sustainability of the healthcare system. To our knowledge, the association between medication adherence and glycemic control among newly diagnosed diabetes patients has not been studied. This study aims to bridge the gap. This is a retrospective cohort study of 2463 patients managed in the National Healthcare Group in Singapore with newly diagnosed diabetes. Patients were followed up for the first two years from their first medication dispensed for measuring medication adherence, proportion of days covered (PDC); and for another three years for investigating outcomes of glycemic control, emergency department visit, and hospitalization. Multivariable regressions were performed to study the association between medication adherence and the outcomes as well as the risk factors of poor adherence. The prevalence of medication adherence (PDC≥80%) was 65.0% (95% CI 63.1% to 66.9%) among newly diagnosed diabetes patients in Singapore. Male, Indian, or patients without hypertension or dyslipidemia were associated with poorer medication adherence. The HbA1c level of poor adherent patients (PDC adherent patients (PDC=100%). The medication adherence in the early stage of diabetes is important for maximizing the effectiveness of pharmaceutical therapy. Health policies or interventions targeting the improvement of medication adherence among newly diagnosed diabetes patients are in need.

  10. Poison control center communication and impact on patient adherence.

    Science.gov (United States)

    Ellington, Lee; Matwin, Sonia; Jasti, Srichand; Williamson, Jacquee; Crouch, Barbara; Caravati, Martin; Dudley, William

    2008-02-01

    This project explored the communication processes associated with poison control center calls. In this preliminary study, we adapted the Roter Interaction Analysis System to capture staff-caller dialogue. This involved case selection, wherein adherence and non-adherence cases were selected; call linkage to medical records, where case records were linked with voice recordings; and application of Roter Interaction Analysis System to calls. Results indicate that communications are predominantly provider-driven. Patient age and percentage of staff partnership statements were significantly associated with adherence at the 0.05 level. Increases in age were associated with decreases in adherence to recommendations (p < 0.001). Increases in percentage of staff partnership statements (over all staff talk) were associated with increases in adherence (p = 0.013). This line of research could lead to evidence-based guidelines for effective staff-caller communication, increased adherence rates, and improved health outcomes.

  11. Design principles of a cooperative robot controller

    Science.gov (United States)

    Hayward, Vincent; Hayati, Samad

    1987-01-01

    The paper describes the design of a controller for cooperative robots being designed at McGill University in a collaborative effort with the Jet Propulsion Laboratory. The first part of the paper discusses the background and motivation for multiple arm control. Then, a set of programming primitives, which are based on the RCCL system and which permit a programmer to specify cooperative tasks are described. The first group of primitives are motion primitives which specify asynchronous motions, master/slave motions, and cooperative motions. In the context of cooperative robots, trajectory generation issues will be discussed and the implementation described. A second set of primitives provides for the specification of spatial relationships. The relations between programming and control in the case of multiple robot are examined. Finally, the paper describes the allocation of various tasks among a set of microprocessors sharing a common bus.

  12. Guidelines Adherence and Hypertension Control in an Outpatient ...

    African Journals Online (AJOL)

    Purpose: To evaluate doctors' adherence to Malaysian Clinical Practice Guideline (CPG) 2008 in established hypertensive patients with cardiovascular diseases and factors associated with guideline adherence and hypertension control in Pulau Pinang Hospital, Malaysia. Methods: Prescriptions written by 13 doctors for ...

  13. Effect of medication adherence on blood pressure control and risk factors for antihypertensive medication adherence.

    Science.gov (United States)

    Yue, Zhao; Bin, Wang; Weilin, Qi; Aifang, Yang

    2015-02-01

    We aim to investigate a range of risk factors associated with medication adherence among Chinese hypertensive patients. We also aim to investigate the association between medication adherence and blood pressure control. A cross-sectional study was conducted among Chinese hypertensive patients in a comprehensive teaching hospital in Shanghai, China, using a validated scale, a self-designed questionnaire and patients' medical records. Of the 232 eligible participants, 61 (26.3%), 51 (22.0%) and 120 (51.7%) showed low, medium and high adherence, respectively. Adjusted for socio-demographic, clinical and patient-related factors, antihypertensive medication adherence was significantly associated with better systolic blood pressure control (P=0.001), whereas the association with diastolic blood pressure control was relatively weak (P=0.334). In the multivariate analysis, patients with longer duration of drug use [P=0.012, odds ratio (OR)=0.46, 95% confidence interval (CI) 0.25-0.84], combination of antiplatelet agents (0.002, 0.38, 0.20-0.71), less concerns of medical cost (0.001, 0.18, 0.02-0.51), more availability of professional guidance (0.002, 0.34, 0.17-0.66) and more availability of family support (0.036, 0.51, 0.27-0.96) were more likely to adhere to their drug regimens. The rate of suboptimal medication adherence among Chinese hypertensive patients is quite high. Interventions could focus upon the risk factors to improve antihypertensive medication adherence in clinical practice. © 2014 John Wiley & Sons, Ltd.

  14. Negative affect, medication adherence, and asthma control in children.

    Science.gov (United States)

    Bender, Bruce; Zhang, Lening

    2008-09-01

    Negative affect including depression is known to be associated with asthma control, but whether and how it influences control in children with asthma is not understood. The objective of this investigation was to evaluate whether negative affect and medication nonadherence each predict decreased symptom control, and whether the relationship between negative affect and disease control is explained by children's adherence to asthma medications. Participants included 104 children 8 to 18 years old being treated with an inhaled corticosteroid delivered by metered-dose inhaler for asthma diagnosed by their health care providers. Children and parents independently rated asthma symptoms and completed questionnaires assessing sad and anxious affect. Electronic devices were attached to each participant's metered-dose inhaler to measure adherence. At study completion, records were collected to confirm reports of health events. Both child and parent negative affect scores predicted symptom scores, whether reported by child or parent, and child negative affect scores predicted school absence because of asthma. In a lagged analysis taking into account time sequence, medication adherence predicted prednisone bursts but not subjective symptom scores. Nonadherence did not explain the relationship between negative affect and symptom scores, but parent negative affect predicted prednisone bursts even when controlling for level of adherence. Although both negative affect and adherence were predictive of asthma control, the relationship of each to asthma control was distinctly different. Accuracy of symptom perception may be influenced by patient and parent affect characteristics.

  15. Distributed cooperative control of AC microgrids

    Science.gov (United States)

    Bidram, Ali

    In this dissertation, the comprehensive secondary control of electric power microgrids is of concern. Microgrid technical challenges are mainly realized through the hierarchical control structure, including primary, secondary, and tertiary control levels. Primary control level is locally implemented at each distributed generator (DG), while the secondary and tertiary control levels are conventionally implemented through a centralized control structure. The centralized structure requires a central controller which increases the reliability concerns by posing the single point of failure. In this dissertation, the distributed control structure using the distributed cooperative control of multi-agent systems is exploited to increase the secondary control reliability. The secondary control objectives are microgrid voltage and frequency, and distributed generators (DGs) active and reactive powers. Fully distributed control protocols are implemented through distributed communication networks. In the distributed control structure, each DG only requires its own information and the information of its neighbors on the communication network. The distributed structure obviates the requirements for a central controller and complex communication network which, in turn, improves the system reliability. Since the DG dynamics are nonlinear and non-identical, input-output feedback linearization is used to transform the nonlinear dynamics of DGs to linear dynamics. Proposed control frameworks cover the control of microgrids containing inverter-based DGs. Typical microgrid test systems are used to verify the effectiveness of the proposed control protocols.

  16. Cooperative Control Method of Active and Semiactive Control: New Framework for Vibration Control

    OpenAIRE

    Kazuhiko Hiramoto

    2014-01-01

    A new control design framework for vibration control, the cooperative control of active and semiactive control, is proposed in the paper. In the cooperative control, a structural system having both of an actuator and a semiactive control device, for example, MR damper and so forth, is defined as the control object. In the proposed control approach, the higher control performance is aimed by the cooperative control between the active control with the actuator and the semiactive control with th...

  17. Evaluation of factors affecting adherence to asthma controller ...

    African Journals Online (AJOL)

    ahs.v16i1.26. Cite as: Ngahane BHM, Pefura-Yone EW, Mama M, Tengang B, Nganda MM, Wandji A, Olinga U, Nyankiyé E, Afane Ze E, Kuaban. C. Evaluation of factors affecting adherence to asthma controller therapy in chest clinics in a ...

  18. Association of adherence to epilepsy quality standards with seizure control.

    Science.gov (United States)

    Moura, Lidia M V R; Mendez, Diego Yacaman; Jesus, Jonathan De; Andrade, Rogger A; Weissman, Joel S; Vickrey, Barbara G; Hoch, Daniel B

    2015-11-01

    We assessed the relationship between adherence to epilepsy quality measures (EQM) and seizure control over 2-3 years in a retrospective cohort study. 6150 patients were identified at two large academic medical centers with a primary or secondary diagnosis of epilepsy, were 18-85 years old and seen in outpatient general neurology or epilepsy units between June 2011 and May 2014. Patients were included if: their initial visit was between June 2011 and June 2012, treatment was with ≥1 anti-seizure drug, there was ≥1 visit per year during the timeframe, and seizure frequency was documented at initial and final visits, yielding 162 patients/1055 visits from which socio-demographic, clinical and care quality data were abstracted. Quality care was assessed as (1) percent adherence to up to 8 eligible EQM, and (2) defect-free care (DFC: adherence to all eligible EQM). Seizure control (SC) was defined as ≥50% reduction in average seizures/month between initial and final visits. Chi-square and t-test compared care quality with seizure control. Logistic regression was used to assess the relationships between SC, quality of care and subspecialist involvement. Care quality, reflected by documentation of seizure frequency, addressing therapeutic interventions, and referral to a comprehensive epilepsy center, all exceeded 80% adherence. Care quality as reflected by documentation of seizure type, etiology or syndrome; assessment of side effects, counseling about epilepsy safety and women's issues, and screening for psychiatric disorders ranged from 40 to 57%. Mean EQM adherence across all applicable measures was associated with greater seizure control (p=0.0098). DFC was low (=8%) and did not covary with seizure control (p=0.55). The SC and non-SC groups only differed on epilepsy etiology (p=0.04). Exploratory analysis showed that mean quality scores are associated with seizure control (OR=4.9 [1.3-18.5], p=0.017) while controlling for the effect of subspecialty involvement

  19. Analysis and control of distributed cooperative systems.

    Energy Technology Data Exchange (ETDEWEB)

    Feddema, John Todd; Parker, Eric Paul; Wagner, John S.; Schoenwald, David Alan

    2004-09-01

    As part of DARPA Information Processing Technology Office (IPTO) Software for Distributed Robotics (SDR) Program, Sandia National Laboratories has developed analysis and control software for coordinating tens to thousands of autonomous cooperative robotic agents (primarily unmanned ground vehicles) performing military operations such as reconnaissance, surveillance and target acquisition; countermine and explosive ordnance disposal; force protection and physical security; and logistics support. Due to the nature of these applications, the control techniques must be distributed, and they must not rely on high bandwidth communication between agents. At the same time, a single soldier must easily direct these large-scale systems. Finally, the control techniques must be provably convergent so as not to cause undo harm to civilians. In this project, provably convergent, moderate communication bandwidth, distributed control algorithms have been developed that can be regulated by a single soldier. We have simulated in great detail the control of low numbers of vehicles (up to 20) navigating throughout a building, and we have simulated in lesser detail the control of larger numbers of vehicles (up to 1000) trying to locate several targets in a large outdoor facility. Finally, we have experimentally validated the resulting control algorithms on smaller numbers of autonomous vehicles.

  20. 7 CFR 1484.34 - Must Cooperators adhere to specific standards of ethical conduct?

    Science.gov (United States)

    2010-01-01

    ... a mutual fund. A Cooperator may collect check-off funds and membership fees that are required for... the terms of a project agreement. Neither a Cooperator nor its affiliates shall charge a fee for... funds to promote private self interests or conduct private business, except as members of sales teams...

  1. Impact of an integrated intervention program on atorvastatin adherence: a randomized controlled trial

    Directory of Open Access Journals (Sweden)

    Goswami NJ

    2013-07-01

    Full Text Available Nilesh J Goswami,1 Mitch DeKoven,2 Andreas Kuznik,3 Jack Mardekian,3 Michelle R Krukas,2 Larry Z Liu,3,4 Patrick Bailey,1 Cynthia Deitrick,5 John Vincent3 1Prairie Heart Cardiovascular Consultants, Springfield, IL, USA; 2Health Economics and Outcomes Research, IMS Health, Alexandria, VA, USA; 3Pfizer Inc, New York, NY, USA; 4Weill Cornell Medical College, Cornell University, New York, NY, USA; 5Prairie Heart Education and Research Cooperative, Springfield, IL, USA Background: This trial evaluated the effectiveness of an integrated intervention program that included a 3-to-5-minute nurse counseling session, copay relief cards, and a monthly newsletter on adherence to atorvastatin treatment. Methods and results: A prospective, integrated (composed of nurse counseling, adherence tip sheet, copay relief card, opportunity to enroll in 12-week cholesterol management program randomized interventional study was designed involving patients >21 years of age who were prescribed atorvastatin at a large single-specialty cardiovascular physician practice in Illinois from March 2010 to May 2011. Data from the practice's electronic medical record were matched/merged to IMS Health's longitudinal data. A total of 500 patients were enrolled (125 in the control arm; 375 in the intervention arm. After data linkage, 53 control patients and 155 intervention patients were included in the analysis. Results: Mean age was 67.8 years (control and 69.5 years (intervention; 67.9% and 58.7%, respectively, were male. The mean 6-month adherence rate was 0.82 in both arms. The mean proportion of days covered for both the new-user control and intervention groups was the same, averaging 0.70 day (standard deviation [SD], 0.27 day; for continuing users, the proportion of days covered for the control group was 0.83 (SD, 0.24 and for the intervention group was 0.84 (SD, 0.22. For continuing users, the control group had mean persistent days of 151.6 (SD, 50.2 compared with 150.9 days

  2. Dissemination Protocols to Support Cooperative Adaptive Cruise Control (CACC) Merging

    NARCIS (Netherlands)

    Klein Wolterink, W.; Heijenk, Geert; Karagiannis, Georgios

    2011-01-01

    Cooperative adaptive cruise control (CACC) is a form of cruise control in which vehicles cooperatively control their speed using wireless communication. Previously we have implemented CACC using beaconing: the regular broadcasting of status information using 802.11p. Currently we are concerned with

  3. Improving adherence to glaucoma medication: a randomised controlled trial of a patient-centred intervention (The Norwich Adherence Glaucoma Study)

    OpenAIRE

    Cate, Heidi; Bhattacharya, Debi; Clark, Allan; Fordham, Richard; Holland, Richard; David C Broadway

    2014-01-01

    Background Improving adherence to ocular hypertension (OH)/glaucoma therapy is highly likely to prevent or reduce progression of optic nerve damage. The present study used a behaviour change counselling intervention to determine whether education and support was beneficial and cost-effective in improving adherence with glaucoma therapy. Methods A randomised controlled trial with a 13-month recruitment and 8-month follow-up period was conducted. Patients with OH/glaucoma attending a glaucoma c...

  4. Cooperative system and method using mobile robots for testing a cooperative search controller

    Science.gov (United States)

    Byrne, Raymond H.; Harrington, John J.; Eskridge, Steven E.; Hurtado, John E.

    2002-01-01

    A test system for testing a controller provides a way to use large numbers of miniature mobile robots to test a cooperative search controller in a test area, where each mobile robot has a sensor, a communication device, a processor, and a memory. A method of using a test system provides a way for testing a cooperative search controller using multiple robots sharing information and communicating over a communication network.

  5. Treatment non-adherence among patients with poorly controlled ...

    African Journals Online (AJOL)

    2014-03-01

    Mar 1, 2014 ... as possible barriers to medication adherence include practical (145; 40.1%), ... approach as a reasonable strategy in resolving non-adherence ..... Eat moderate quantity of carbohydrate-containing food. 9 .... meta-analysis.

  6. Evaluation of factors affecting adherence to asthma controller ...

    African Journals Online (AJOL)

    The adherence to asthma treatment was rated using Morisky Medication Adherence Scale. A multivariate logistic regression analysis was performed for the identification of factors associated with adherence to asthma treatment. Results: Among the 201 asthma patients included, 133 (66.2%) were female. The mean age of ...

  7. Interventions to Improve Medication Adherence among Older Adults: Meta-Analysis of Adherence Outcomes among Randomized Controlled Trials

    Science.gov (United States)

    Conn, Vicki S.; Hafdahl, Adam R.; Cooper, Pamela S.; Ruppar, Todd M.; Mehr, David R.; Russell, Cynthia L.

    2009-01-01

    Purpose: This study investigated the effectiveness of interventions to improve medication adherence (MA) in older adults. Design and Methods: Meta-analysis was used to synthesize results of 33 published and unpublished randomized controlled trials. Random-effects models were used to estimate overall mean effect sizes (ESs) for MA, knowledge,…

  8. Cooperative path following control of multiple nonholonomic mobile robots.

    Science.gov (United States)

    Cao, Ke-Cai; Jiang, Bin; Yue, Dong

    2017-11-01

    Cooperative path following control problem of multiple nonholonomic mobile robots has been considered in this paper. Based on the framework of decomposition, the cooperative path following problem has been transformed into path following problem and cooperative control problem; Then cascaded theory of non-autonomous system has been employed in the design of controllers without resorting to feedback linearization. One time-varying coordinate transformation based on dilation has been introduced to solve the uncontrollable problem of nonholonomic robots when the whole group's reference converges to stationary point. Cooperative path following controllers for nonholonomic robots have been proposed under persistent reference or reference target that converges to stationary point respectively. Simulation results using Matlab have illustrated the effectiveness of the obtained theoretical results. Copyright © 2017 ISA. Published by Elsevier Ltd. All rights reserved.

  9. Cooperative Control Simulation Validation Using Applied Probability Theory

    National Research Council Canada - National Science Library

    Schulz, Christopher

    2003-01-01

    ...; however, these simulations lack a method to validate their output. This research presents a method to validate the performance of a decentralized cooperative control simulation environment for an autonomous Wide Area Search Munition (WASM...

  10. Vehicle-to-infrastructure program cooperative adaptive cruise control.

    Science.gov (United States)

    2015-03-01

    This report documents the work completed by the Crash Avoidance Metrics Partners LLC (CAMP) Vehicle to Infrastructure (V2I) Consortium during the project titled Cooperative Adaptive Cruise Control (CACC). Participating companies in the V2I Cons...

  11. Hierarchical cooperative control for multiagent systems with switching directed topologies.

    Science.gov (United States)

    Hu, Jianqiang; Cao, Jinde

    2015-10-01

    The hierarchical cooperative control problem is concerned for a two-layer networked multiagent system under switching directed topologies. The group cooperative objective is to achieve finite-time formation control for the upper layer of leaders and containment control for the lower layer of followers. Two kinds of cooperative strategies, including centralized-distributed control and distributed-distributed control, are proposed for two types of switching laws: 1) random switching law with the dwell time and 2) Markov switching law with stationary distribution. Utilizing the state transition matrix methods and matrix measure techniques, some sufficient conditions are derived for asymptotical containment control and exponential almost sure containment control, respectively. Finally, some numerical examples are provided to demonstrate the effectiveness of the proposed control schemes.

  12. Mother, father, and adolescent self-control and adherence in adolescents with Type 1 diabetes.

    Science.gov (United States)

    Lansing, Amy Hughes; Crochiere, Rebecca; Cueto, Carrie; Wiebe, Deborah J; Berg, Cynthia A

    2017-06-01

    This study explored whether shared self-control across a family system, including adolescent, mother, and father self-control, as well as the interaction of mother and father self-control, was associated with ease of completing adherence tasks and the completion of adherence behaviors related to the Type 1 diabetes (T1D) regimen. One hundred thirty-seven adolescents (M = 13.48 years), mothers, and fathers completed a self-report measure of self-control, while adolescents also self-reported on ease of completing adherence tasks and the frequency with which they completed adherence tasks. Higher adolescent, mother, father, and the interaction of mother and father self-control were each associated with greater adolescent perceptions of ease of completing adherence tasks. Also, greater adolescent perception of ease of adherence mediated the association of higher adolescent, father, and the interaction of mother and father self-control on more frequent adherence behaviors. The results are consistent with the idea that family members may share the load of self-control within the family system. The results point to the importance of assessing and intervening within the entire family system to support improved quality of life and better adherence to the medical regimen in adolescents with Type 1 diabetes. (PsycINFO Database Record (c) 2017 APA, all rights reserved).

  13. Cooperative airframe/propulsion control for supersonic cruise aircraft

    Science.gov (United States)

    Schweikhard, W. G.; Berry, D. T.

    1974-01-01

    Interactions between propulsion systems and flight controls have emerged as a major control problem on supersonic cruise aircraft. This paper describes the nature and causes of these interactions and the approaches to predicting and solving the problem. Integration of propulsion and flight control systems appears to be the most promising solution if the interaction effects can be adequately predicted early in the vehicle design. Significant performance, stability, and control improvements may be realized from a cooperative control system.

  14. Patient and Partner Feedback Reports to Improve Statin Medication Adherence: A Randomized Control Trial.

    Science.gov (United States)

    Reddy, Ashok; Huseman, Tiffany L; Canamucio, Anne; Marcus, Steven C; Asch, David A; Volpp, Kevin; Long, Judith A

    2017-03-01

    Simple nudges such as reminders and feedback reports to either a patient or a partner may facilitate improved medication adherence. To test the impact of a pill bottle used to monitor adherence, deliver a daily alarm, and generate weekly medication adherence feedback reports on statin adherence. Three-month, three-arm randomized clinical trial (ClinicalTrials.gov identifier: NCT02480530). One hundred and twenty-six veterans with known coronary artery disease and poor adherence (medication possession ratio medication adherence feedback report; and (3) a partner feedback group (n = 54) that received an alarm and a weekly feedback report that was shared with a friend, family member, or a peer. The intervention continued for 3 months, and participants were followed for an additional 3 months after the intervention period. Adherence as measured by pill bottle. Secondary outcomes included change in LDL (mg/dl), patient activation, and social support. During the 3-month intervention period, medication adherence was higher in both feedback arms than in the control arm (individual feedback group 89 %, partner feedback group 86 %, control group 67 %; p medication adherence between either of the feedback groups and the control (individual feedback 60 %, partner feedback 52 %, control group 54 %; p = 0.75 and 0.97). Daily alarms combined with individual or partner feedback reports improved statin medication adherence. While neither an individual feedback nor partner feedback strategy created a sustainable medication adherence habit, the intervention itself is relatively easy to implement and low cost.

  15. Automated Merging in a Cooperative Adaptive Cruise Control (CACC) System

    NARCIS (Netherlands)

    Klein Wolterink, W.; Karagiannis, Georgios; Brogle, Marc; Masip Bruin, Xavier; Braun, Torsten; Heijenk, Gerhard J.

    Cooperative Adaptive Cruise Control (CACC) is a form of cruise control in which a vehicle maintains a constant headway to its preceding vehicle using radar and vehicle-to-vehicle (V2V) communication. Within the Connect & Drive1 project we have implemented and tested a prototype of such a system,

  16. Automated Merging in a Cooperative Adaptive Cruise Control (CACC) System

    NARCIS (Netherlands)

    Klein Wolterink, W.; Heijenk, Geert; Karagiannis, Georgios

    2011-01-01

    Cooperative Adaptive Cruise Control (CACC) is a form of cruise control in which a vehicle maintains a constant headway to its preceding vehicle using radar and vehicle-to-vehicle (V2V) communication. Within the Connect & Drive1 project we have implemented and tested a prototype of such a system,

  17. Cooperative Frequency Control for Autonomous AC Microgrids

    DEFF Research Database (Denmark)

    Shafiee, Qobad; Quintero, Juan Carlos Vasquez; Guerrero, Josep M.

    2015-01-01

    Distributed secondary control strategies have been recently studied for frequency regulation in droop-based AC Microgrids. Unlike centralized secondary control, the distributed one might fail to provide frequency synchronization and proportional active power sharing simultaneously, due to having...... not require measuring the system frequency as compared to the other presented methods. An ac Microgrid with four sources is used to verify the performance of the proposed control methodology....

  18. Distributed Cooperative Secondary Control of Microgrids Using Feedback Linearization

    DEFF Research Database (Denmark)

    Bidram, Ali; Davoudi, Ali; Lewis, Frank

    2013-01-01

    This paper proposes a secondary voltage control of microgrids based on the distributed cooperative control of multi-agent systems. The proposed secondary control is fully distributed; each distributed generator (DG) only requires its own information and the information of some neighbors. The dist......This paper proposes a secondary voltage control of microgrids based on the distributed cooperative control of multi-agent systems. The proposed secondary control is fully distributed; each distributed generator (DG) only requires its own information and the information of some neighbors...... parameters can be tuned to obtain a desired response speed. The effectiveness of the proposed control methodology is verified by the simulation of a microgrid test system....

  19. Health locus of control: Its relationship with medication adherence and medication wastage.

    Science.gov (United States)

    West, Lorna Marie; Borg Theuma, Ruth; Cordina, Maria

    2017-12-09

    Non-adherence is a significant factor contributing to medication wastage. Whilst there is some evidence on the influence of patients' health locus of control in relation to adherence, there has been little inquiry into its relationship with mediation wastage. To determine the relationship between medication adherence and health locus of control as well as medication wastage and health locus of control in patients with chronic conditions. Outpatients having a diagnosis of asthma, cardiovascular conditions, or diabetes participated in a cross-sectional study employing a self-administered questionnaire. The questionnaire determined presence of unused medication (wastage), adherence using 'Tool for Adherence Behaviour Screening' (TABS), and health locus of control using 'Multidimensional Health Locus of Control' (MHLC) scale Form C. Logistic regression was performed to ascertain the effects of MHLC and demographics in relation to adherence and wastage. MHLC beliefs were divided into 8 types of health locus of control. One-Way ANOVA was used to assess differences between conditions and belief types. P-values ≤ .05 were considered significant. There were 330 patients recruited (58% male; age, mean±(SD): 61 ± 15 years; 110 asthma, 110 cardiovascular, 110 diabetes). In terms of health locus of control, females had higher 'doctors' beliefs (p = .054) and significantly lower 'other people' beliefs (p = adherence. Lower 'doctors' beliefs and higher 'other people' beliefs were significantly associated with wastage (p = adherence (p = medication, followed by 'pure internal' believers. 'Pure powerful others external' had the highest presence of unused medication. Healthcare professionals should take into account patients' health locus of control beliefs whilst conducting an intervention with patients; this can impact positively medication adherence and minimisation of medication wastage. Copyright © 2017 Elsevier Inc. All rights reserved.

  20. Treatment non-adherence among patients with poorly controlled ...

    African Journals Online (AJOL)

    quarter (153; 88.4%) were not aware of indication for each of the prescribed medications, 26 (15.3%) correctly described regimen as prescribed. The factor(s) identified as possible barriers to medication adherence include practical (145; 40.1%), ...

  1. [Infection control team (ICT) in cooperation with microbiology laboratories].

    Science.gov (United States)

    Okazaki, Mitsuhiro

    2012-10-01

    Infection control as a medical safety measure is an important issue in all medical facilities. In order to tackle this measure, cooperation between the infection control team (ICT) and microbiological laboratory is indispensable. Multiple drug-resistant bacteria have shifted from Gram-positive bacteria to Gram-negative bacilli within the last ten years. There are also a variety of bacilli, complicating the examination method and test results further. Therefore, cooperation between the ICT and microbiological laboratory has become important to understand examination results and to use them. In order to maintain functional cooperation, explanatory and communicative ability between the microbiological laboratory and ICT is required every day. Such positive information exchange will develop into efficient and functional ICT activity.

  2. Shaping Societal Impact: between control and cooperation

    NARCIS (Netherlands)

    Messemaker, M.; Wolbers, J.J.; Treurniet, W.; Boersma, F.K.; Comes, T; Fiedrich, F; Fortier, S; Geldermann, J; Muller, T

    2013-01-01

    In our modern society, the impact of large-scale safety and security incidents can be large and diverse. Yet, this societal impact is makeable and controllable to a limited extent. At best, the effect of concrete response actions is that the direct damage is somewhat reduced and that the recovery is

  3. Cooperative Control in Production and Logistics

    OpenAIRE

    Monostori, László; Valckenaers, Paul; Dolgui, Alexandre; Panetto, Hervé; Brdys, Mietek; Csanád Csáji, Balázs

    2015-01-01

    International audience; Classical applications of control engineering and information and communication technology (ICT) in production and logistics are often done in a rigid, centralized and hierarchical way. These inflexible approaches are typically not able to cope with the complexities of the manufacturing environment, such as the instabilities, uncertainties and abrupt changes caused by internal and external disturbances, or a large number and variety of interacting, interdependent eleme...

  4. Is patient empowerment the key to promote adherence? A systematic review of the relationship between self-efficacy, health locus of control and medication adherence.

    Science.gov (United States)

    Náfrádi, Lilla; Nakamoto, Kent; Schulz, Peter J

    2017-01-01

    Current health policies emphasize the need for an equitable doctor-patient relationship, and this requires a certain level of patient empowerment. However, a systematic review of the empirical evidence on how empowerment affects medication adherence-the extent to which patients follow the physician's prescription of medication intake-is still missing. The goal of this systematic review is to sum up current state-of-the-art knowledge concerning the relationship between patient empowerment and medication adherence across medical conditions. As our conceptualization defines health locus of control and self-efficacy as being crucial components of empowerment, we explored the relationship between these two constructs and medication adherence. Relevant studies were retrieved through a comprehensive search of Medline and PsychINFO databases (1967 to 2017). In total, 4903 publications were identified. After applying inclusion and exclusion criteria and quality assessment, 154 articles were deemed relevant. Peer-reviewed articles, written in English, addressing the relationship between empowerment (predictor) and medication adherence (outcome) were included. High levels of self-efficacy and Internal Health Locus of Control are consistently found to promote medication adherence. External control dimensions were found to have mainly negative (Chance and God attributed control beliefs) or ambiguous (Powerful others attributed control beliefs) links to adherence, except for Doctor Health Locus of Control which had a positive association with medication adherence. To fully capture how health locus of control dimensions influence medication adherence, the interaction between the sub-dimensions and the attitudinal symmetry between the doctor and patient, regarding the patient's control over the disease management, can provide promising new alternatives. The beneficial effect of patients' high internal and concurrent physician-attributed control beliefs suggests that a so

  5. Blood Pressure Treatment Adherence and Control after Participation in the ReHOT

    Directory of Open Access Journals (Sweden)

    Nathália Silva de Jesus

    Full Text Available Abstract Background: Lack of adherence to pharmacological treatment is one of the main causes of low control rates in hypertension. Objective: To verify treatment adherence and associated factors, as well as blood pressure (BP control in participants of the Resistant Hypertension Optimal Treatment (ReHOT clinical trial. Method: Cross-sectional study including all 109 patients who had completed the ReHOT for at least 6 months. We excluded those participants who failed to respond to the new recruitment after three phone contact attempts. We evaluated the BP control by ambulatory BP monitoring (ABPM; controlled levels: 24-hour systolic and diastolic BP < 130 x 80 mmHg and analyzed the patients' treatment adherence using the Morisky Medication Adherence Scale (MMAS questionnaire validated by Bloch, Melo, and Nogueira (2008. The statistical analysis was performed with the software IBM SPSS statistics 21.0. We tested the normality of the data distribution with kurtosis and skewness. The variables tested in the study are presented with descriptive statistics. Comparisons between treatment adherence and other variables were performed with Student's t test for independent variables and Pearson's chi-square or Fisher's exact test. To conduct analyses among patients considering adherence to treatment and BP control, we created four groups: G0, G1, G2, and G3. We considered a 5% significance level in all tests. Results: During the ReHOT, 80% of the patients had good BP control and treatment adherence. Of 96 patients reevaluated in the present study, only 52.1% had controlled hypertension when assessed by ABPM, while 31.3% were considered adherent by the MMAS. Regarding other ABPM measures, we observed an absence of a nocturnal dip in 64.6% of the patients and a white-coat effect and false BP control in 23% and 12.5%, respectively. Patients' education level showed a trend towards being a determinant factor associated with lack of adherence (p = 0

  6. Independence/cooperative remote control support system

    Science.gov (United States)

    Makuni, Kazuki; Miwa, Masafumi; Fujigaki, Motoharu; Tanikawa, Hiroki; Soga, Masato; Nakashima, Atsushi

    2003-03-01

    When we do aerial photography and an environmental research, a remote control helicopter (R/C helicopter) is excellent tool in the next point. For example, the cost of aerial photography and an environmental research work by R/C helicopter are low, also R/C helicopter pilot reservation fee are low price, and free from aviation law in Japan. But, R/C helicopter maneuvering and aerial photographing skills are necessary, and these are difficult to learn. Additionally, if the visibility of R/C helicopter is getting bad when it goes far away, operation is getting difficult. These problems are caused by the badness of autonomous stability on R/C helicopter system. In this study, we propose a new angle detection sensor for 3 axial rotations which is based on the development of the easy and safe steering system for the operation person.

  7. Locus of control and anti-hypertensive medication adherence in Ghana.

    Science.gov (United States)

    Kretchy, Irene Akwo; Owusu-Daaku, Frances Thelma; Danquah, Samuel

    2014-01-01

    Medication non-adherence is a major public health problem in Ghana. Locus of control (LoC) may influence adherence to medication. In this study we examine the association between locus orientation and adherence to hypertensive medication among adult patients. We also take into account the role of medication side effects. We conducted a hospital-based cross-sectional study involving two tertiary hospitals in southern and northern Ghana. Data were collected from 400 hypertensive patients using a structured questionnaire. We gathered information on patient's sociodemographic characteristics, health LoC, side effects of anti-hypertensive medication and adherence to anti-hypertensive medication. Participants exhibited features of mixed LoC (both internal and external) usually referred to as bi-local expectancy. However, orientation was skewed towards external LoC. Females were marginally more likely than males to have an internal LoC. Education was associated with a greater likelihood of internal LoC. While most patients (93.3%) poorly adhered to antihypertensive medications, logistic regression model revealed that non-adherence was significantly associated with low internal LoC, medication side effects and the combined effect of medication side effects and external LoC. Medication non-adherence, experiences of medication side effects and LoC are associated. Multifaceted intervention programmes highlighting personality characteristics like LoC may improve anti-hypertensive medication adherence.

  8. Is patient empowerment the key to promote adherence? A systematic review of the relationship between self-efficacy, health locus of control and medication adherence

    Science.gov (United States)

    2017-01-01

    Background Current health policies emphasize the need for an equitable doctor-patient relationship, and this requires a certain level of patient empowerment. However, a systematic review of the empirical evidence on how empowerment affects medication adherence—the extent to which patients follow the physician’s prescription of medication intake—is still missing. The goal of this systematic review is to sum up current state-of-the-art knowledge concerning the relationship between patient empowerment and medication adherence across medical conditions. As our conceptualization defines health locus of control and self-efficacy as being crucial components of empowerment, we explored the relationship between these two constructs and medication adherence. Methods Relevant studies were retrieved through a comprehensive search of Medline and PsychINFO databases (1967 to 2017). In total, 4903 publications were identified. After applying inclusion and exclusion criteria and quality assessment, 154 articles were deemed relevant. Peer-reviewed articles, written in English, addressing the relationship between empowerment (predictor) and medication adherence (outcome) were included. Findings High levels of self-efficacy and Internal Health Locus of Control are consistently found to promote medication adherence. External control dimensions were found to have mainly negative (Chance and God attributed control beliefs) or ambiguous (Powerful others attributed control beliefs) links to adherence, except for Doctor Health Locus of Control which had a positive association with medication adherence. To fully capture how health locus of control dimensions influence medication adherence, the interaction between the sub-dimensions and the attitudinal symmetry between the doctor and patient, regarding the patient’s control over the disease management, can provide promising new alternatives. Discussion The beneficial effect of patients’ high internal and concurrent physician

  9. Caregiver's Health Locus of Control and Medication Adherence in Sickle Cell Disease.

    Science.gov (United States)

    Viswanathan, Kusum; Swaminathan, Neeraja; Viswanathan, Ramaswamy; Lakkaraja, Madhavi

    2015-03-01

    The authors would like to thank Dr. Morisky for giving us permission to use the Morisky Medication Adherence Scale To explore caregivers' Health Locus of Control's relationship to self-reported adherence to penicillin prophylaxis or hydroxyurea in children with sickle cell disease (SCD). A questionnaire-based study was conducted of caregivers of children with SCD who visited a comprehensive sickle cell center in an inner city hospital, who were either on penicillin prophylaxis or hydroxyurea or both. Multidimensional Health Locus of Control Scale (MHLC) and the Morisky Medication Adherence Scale (MMAS-8) questionnaires were used for the study. Caregivers of 43 children (27 on penicillin prophylaxis, 13 on hydroxyurea, and 3 on both) completed the MHLC and the MMAS-8. There was no significant difference in adherence between the penicillin and the hydroxyurea groups. The mean Powerful Others score of caregivers of the hydroxyurea only group (25.5+5.6) was higher than that of the penicillin only group (21.2+6.1, p=0.043). Regression analysis revealed an inverse relationship of Chance Locus of Control to adherence in the entire group (Beta = -0.306, R2=0.093, F[1,40]=4.12, p=0.049). Chance Locus of control may identify caregivers of children with SCD at risk for non-adherence to treatment. © 2015 National Medical Association. Published by Elsevier Inc. All rights reserved.

  10. Control of cooperative manipulators in holding deformable objects

    Science.gov (United States)

    Alkathiri, A. A.; Azlan, N. Z.

    2017-11-01

    This paper presents the implementation of a control system to control cooperative manipulators to hold deformable objects. The aim is to hold the deformable object without having information on the shape and stiffness of the deformable object beforehand. The prototype of a pair of manipulators has been designed and built to test the controller. A force sensor and a rotary encoder are used to give feedback to the controller, which controls the DC motor actuators accordingly. A position proportional-integral-derivative (PID) controller technique has been applied for one of the manipulators and a PID force control technique is applied to the other. Simulations and experimental tests have been conducted on models and the controller has been implemented on the real plant. Both simulation and test results prove that the implemented control technique has successfully provided the desired position and force to hold the deformable object with maximum experimental errors of 0.34mm and 50mN respectively.

  11. Educational interventions for knowledge on the disease, treatment adherence and control of diabetes mellitus

    OpenAIRE

    Figueira, Ana Laura Galhardo; Boas, Lilian Cristiane Gomes Villas; Coelho, Anna Claudia Martins; de Freitas, Maria Cristina Foss; Pace, Ana Emilia

    2017-01-01

    Abstract Objective: to assess the effect of educational interventions for knowledge on the disease, medication treatment adherence and glycemic control of diabetes mellitus patients. Method: evaluation research with "before and after" design, developed in a sample of 82 type 2 diabetes mellitus patients. To collect the data, the Brazilian version of the Diabetes Knowledge Scale (DKN-A), the Measure of Adherence to Treatments and the electronic system at the place of study were used. The d...

  12. Cooperative Game for Fish Harvesting and Pollution Control

    KAUST Repository

    Dia, Ben Mansour

    2015-01-07

    We study fishery strategies in a shallow river subject to agricultural and industrial pollution. The flowing pollutants in the river are modeled by a nonlinear stochastic differential equation in a general manner. The logistic growth model for the fish population is modified to cover the pollution impact on the fish growth rate. A stochastic cooperative game is formulated to design strategies for preserving the fish population by controlling the pollution as well as the harvesting fish.

  13. ROLE OF COUNSELING ON MEDICAL ADHERENCE AND GLYCEMIC CONTROL IN PATIENTS WITH TYPE 2 DIABETES MELLITUS

    Directory of Open Access Journals (Sweden)

    Anoop Kumar

    2015-11-01

    Full Text Available BACKGROUND: Diabetes Mellitus (DM refers to a group of common metabolic disorders that share the phenotype of hyperglycemia. It is the leading cause of of end stage renal disease, non-traumatic limb amputation and adult blindness. The studies have shown that complications of DM can be prevented by the proper control of blood glucose, which is dependent on the patient’s adherence to medication, life style modification, frequent monitoring of blood glucose etc. and can be influenced by proper education and counseling of the patient. The patients with DM should receive education about exercise, care of DM during illness and medications to lower plasma glucose1 . This study aims to assess the impact of patients counseling on the medication adherence in type 2DM. METHOD: This is a prospective randomized study that includes 100 patients with type 2 DM in the out-patient department of internal medicine in a tertiary care teaching hospital, north Kerala. After getting informed consent, they were kept in two groups by simple randomization technique and were assessed and followed at 4 weeks interval. Data related to the medication adherence was collected using Morisky Medication Adherence Scale questionnaire (MMAS-8. RESULTS: Out of 100 patients 33% were male and 67% female. Both baseline and 1st follow up showed a low adherence value (<6 both in control and intervention group. In the second follow up most of the patients in intervention group showed a moderate adherence (6-8, whereas control group did not show any improvement. CONCLUSION: It can be concluded that there is a stastically significant improvement in the adherence level after patient counseling and education. Knowledge about the disease and treatment has improved the patient’s adherence to medication.

  14. The Role of Health Beliefs in the Regimen Adherence and Metabolic Control of Adolescents and Adults with Diabetes Mellitus.

    Science.gov (United States)

    Brownlee-Duffeck, Martha; And Others

    1987-01-01

    Examined the role of health beliefs in diabetic regimen adherence and metabolic control. Health beliefs accounted for a statistically significant portion of the variance in both. For older patients perceived benefits of adhering to the diabetic regimen was most significant. For younger patients costs figured prominently in adherence and perceived…

  15. A telemedicine intervention to improve adherence to continuous positive airway pressure: a randomised controlled trial.

    Science.gov (United States)

    Sparrow, David; Aloia, Mark; Demolles, Deborah A; Gottlieb, Daniel J

    2010-12-01

    Continuous positive airway pressure (CPAP) is the most widely prescribed treatment for obstructive sleep apnoea syndrome (OSAS). Although it has been shown to improve the symptoms of OSAS, many patients have difficulty adhering to this treatment. The purpose of this study was to investigate the effectiveness of an automated telemedicine intervention to improve adherence to CPAP. A randomised clinical trial was undertaken in 250 patients being started on CPAP therapy for OSAS. Patients were randomly assigned to use a theory-driven interactive voice response system designed to improve CPAP adherence (telephone-linked communications for CPAP (TLC-CPAP), n=124) or to an attention placebo control (n=126) for 12 months. TLC-CPAP monitors patients' self-reported behaviour and CPAP-related symptoms and provides feedback and counselling through a structured dialogue to enhance motivation to use CPAP. A Sleep Symptoms Checklist, the Functional Outcomes of Sleep Questionnaire, the Center for Epidemiological Studies Depression Scale and the Psychomotor Vigilance Task were administered at study entry and at 6-month and 12-month follow-up. Hours of CPAP usage at effective mask pressure were measured by the CPAP device stored in its memory and retrieved at each visit. Median observed CPAP use in patients randomised to TLC-CPAP was approximately 1 h/night higher than in the control subjects at 6 months and 2 h/night higher at 12 months. Using generalised estimating equation modelling, the intervention had a significant effect on CPAP adherence. For secondary analysis, the effect of CPAP adherence on the secondary outcomes was analysed. CPAP adherence was significantly associated with a greater reduction in sleep apnoea symptoms and depressive symptoms and a greater improvement in functional status. No significant association was observed between CPAP adherence and reaction time. The TLC-CPAP intervention resulted in improved CPAP adherence, which was associated with improved

  16. Automated Merging in a Cooperative Adaptive Cruise Control (CACC) System

    OpenAIRE

    Klein Wolterink, W.; Heijenk, Geert; Karagiannis, Georgios

    2011-01-01

    Cooperative Adaptive Cruise Control (CACC) is a form of cruise control in which a vehicle maintains a constant headway to its preceding vehicle using radar and vehicle-to-vehicle (V2V) communication. Within the Connect & Drive1 project we have implemented and tested a prototype of such a system, with IEEE 802.11p as the enabling communication technology. In this paper we present an extension of our CACC system that allows vehicles to merge inside a platoon of vehicles at a junction, i.e., at ...

  17. [Self-Knowledge, Adherence to Treatment, and Control of Arterial Hypertension in Peru: a Narrative Review].

    Science.gov (United States)

    Herrera-Añazco, Percy; Pacheco-Mendoza, Josmel; Valenzuela-Rodríguez, Germán; Málaga, Germán

    2017-01-01

    This non-systematic bibliographic review examines the published Peruvian medical literature on arterial hypertension (HTN) as of December 2016. The results were divided into three thematic areas: self-knowledge, adherence to treatment, and control. We identified 197 articles, although only 15 were used for the analysis. Despite improvement in recent years, we found that the level of self-knowledge about HTN is poor. The level is better in urban areas, but is generally worse than in other Latin American cities. Moreover, despite improvement, HTN control is insufficient and worse than in other Latin American countries. Finally, adherence to treatment may be worse in the provinces.

  18. Cooperative motion control for multi-target observation

    Energy Technology Data Exchange (ETDEWEB)

    Parker, L.E.

    1997-08-01

    An important issue that arises in the automation of many security, surveillance, and reconnaissance tasks is that of monitoring (or observing) the movements of targets navigating in a bounded area of interest. A key research issue in these problems is that of sensor placement--determining where sensors should be located to maintain the targets in view. In complex applications involving limited-range sensors, the use of multiple sensors dynamically moving over time is required. In this paper, the author investigates the use of a cooperative team of autonomous sensor-based robots for the observation of multiple moving targets. The focus is primarily on developing the distributed control strategies that allow the robot team to attempt to minimize the total time in which targets escape observation by some robot team member in the area of interest. This paper first formalizes the problem and discusses related work. The author then presents a distributed approximate approach to solving this problem that combines low-level multi-robot control with higher-level reasoning control based on the ALLIANCE formalism. The effectiveness of the approach is analyzed by comparing it to three other feasible algorithms for cooperative control, showing the superiority of the approach for a large class of problems.

  19. Multi-robot motion control for cooperative observation

    Energy Technology Data Exchange (ETDEWEB)

    Parker, L.E. [Oak Ridge National Lab., TN (United States). Center for Engineering Systems Advanced Research

    1997-06-01

    An important issue that arises in the automation of many security, surveillance, and reconnaissance tasks is that of monitoring (or observing) the movements of targets navigating in a bounded area of interest. A key research issue in these problems is that of sensor placement--determining where sensors should be located to maintain the targets in view. In complex applications involving limited-range sensors, the use of multiple sensors dynamically moving over time is required. In this paper, the authors investigate the use of a cooperative team of autonomous sensor-based robots for the observation of multiple moving targets. They focus primarily on developing the distributed control strategies that allow the robot team to attempt to minimize the total time in which targets escape observation by some robot team member in the area of interest. This paper first formalizes the problem and discusses related work. The authors then present a distributed approximate approach to solving this problem that combines low-level multi-robot control with higher-level reasoning control based on the ALLIANCE formalism. They analyze the effectiveness of the approach by comparing it to 3 other feasible algorithms for cooperative control, showing the superiority of the approach for a large class of problems.

  20. A note on cooperative versus non-cooperative strategies in international pollution control

    Energy Technology Data Exchange (ETDEWEB)

    Rubio, Santiago J.; Casino, Begona [Department of Economic Analysis, University of Valencia, Avda. de los Naranjos s/n, Edificio Departamental Oriental, 46022 Valencia (Spain)

    2002-06-01

    In this note, we evaluate the scope of Dockner and Long's [Journal of Environment Economics and Management 24 (1993) 13] conclusion on the efficiency of the non-cooperative outcome in a differential game of international pollution control. We also complete the study of the different equilibria the differential game can present. Our results show that their conclusion requires that the initial value of the stock of pollution be higher than the Pareto-efficient pollution stock so that the equilibrium path of emissions involves a decreasing stock of pollution. Our results also show that the application of the procedure proposed by Tsutsui and Mino [Journal of Economic Theory 52 (1990) 136] to construct a Markov-perfect equilibrium using non-linear strategies is problematic when the initial pollution stock is lower than the Pareto-efficient pollution stock.

  1. Geographic Variation in Antidiabetic Agent Adherence and Glycemic Control Among Patients with Type 2 Diabetes.

    Science.gov (United States)

    Tan, Eleonora; Yang, Wenya; Pang, Bo; Dai, Mingliang; Loh, F Ellen; Hogan, Paul

    2015-12-01

    Medication nonadherence is an imperative public health concern. Among patients with type 2 diabetes mellitus (T2DM), poor adherence to antidiabetic agents is strongly associated with suboptimal glycemic control. Poor adherence and hyperglycemia greatly increase diabetes-related morbidity and mortality. At a national level, diabetes drug adherence using average proportion of days covered (PDC) is estimated to range between 36% and 81%, with an estimated range for diabetes control between 38% and 47%. At a state level no such studies exist. To estimate the level of medication adherence to antidiabetic agents and of diabetes control, and their association among patients with T2DM receiving medication treatment at the state and the Metropolitan Statistical Area (MSA) levels among the populations covered by commercial insurance, Medicare, or Medicaid. The study population included adults with T2DM aged ≥18 years who were identified using ICD-9-CM code 250.xx, who received diabetes medication, and who were covered by private insurance, Medicare, or Medicaid in each state, the District of Columbia, and the top 50 MSAs. Medication adherence was measured by average PDC and the percentage of population that had a PDC ≥ 80%. Diabetes control was identified using ICD-9-CM diagnosis codes. Patients who were not diagnosed with uncontrolled diabetes (250.x2 and 250.x3) were identified as being under control. The administrative claims databases used for this study included the 2012 medical and pharmacy claims from a large U.S. health plan, the complete 2011 Medicare Standard Analytical File linked with Part D claims, and the 2008 Mini-Medicaid Analytic eXtract (Mini-Max). Medication adherence and diabetes control were adjusted for age and sex to allow comparison across insurance coverage, states, and MSAs. For an insured patient population with T2DM that received diabetic drug treatment, average PDC was 79%. However, 35% of patients did not achieve an adherence of at least

  2. Adherence to two methods of education and metabolic control in ...

    African Journals Online (AJOL)

    BACKGROUND: Education in diabetes optimizes metabolic control, prevents acute and chronic complications, and improves quality of life. Our main objective was to evaluate if a better metabolic control is achieved in diabetic patients undergoing a program of intensive interactive care than in those with traditional care and ...

  3. 36 CFR 211.4 - Cooperation for fire prevention and control.

    Science.gov (United States)

    2010-07-01

    ... 36 Parks, Forests, and Public Property 2 2010-07-01 2010-07-01 false Cooperation for fire prevention and control. 211.4 Section 211.4 Parks, Forests, and Public Property FOREST SERVICE, DEPARTMENT OF AGRICULTURE ADMINISTRATION Cooperation § 211.4 Cooperation for fire prevention and control. The Forest Service...

  4. Model predictive control for cooperative control of space robots

    Science.gov (United States)

    Kannan, Somasundar; Alamdari, Seyed Amin Sajadi; Dentler, Jan; Olivares-Mendez, Miguel A.; Voos, Holger

    2017-01-01

    The problem of Orbital Manipulation of Passive body is discussed here. Two scenarios including passive object rigidly attached to robotic servicers and passive body attached to servicers through manipulators are discussed. The Model Predictive Control (MPC) technique is briefly presented and successfully tested through simulations on two cases of position control of passive body in the orbit.

  5. Cooperative photoinduced metastable phase control in strained manganite films

    Science.gov (United States)

    Zhang, Jingdi; Tan, Xuelian; Liu, Mengkun; Teitelbaum, S. W.; Post, K. W.; Jin, Feng; Nelson, K. A.; Basov, D. N.; Wu, Wenbin; Averitt, R. D.

    2016-09-01

    A major challenge in condensed-matter physics is active control of quantum phases. Dynamic control with pulsed electromagnetic fields can overcome energetic barriers, enabling access to transient or metastable states that are not thermally accessible. Here we demonstrate strain-engineered tuning of La2/3Ca1/3MnO3 into an emergent charge-ordered insulating phase with extreme photo-susceptibility, where even a single optical pulse can initiate a transition to a long-lived metastable hidden metallic phase. Comprehensive single-shot pulsed excitation measurements demonstrate that the transition is cooperative and ultrafast, requiring a critical absorbed photon density to activate local charge excitations that mediate magnetic-lattice coupling that, in turn, stabilize the metallic phase. These results reveal that strain engineering can tune emergent functionality towards proximal macroscopic states to enable dynamic ultrafast optical phase switching and control.

  6. Research on cooperative vehicle intersection control scheme without using traffic lights under the connected vehicles environment

    National Research Council Canada - National Science Library

    Zheng, Yi; Jin, Lisheng; Jiang, Yuying; Wang, Fangrong; Guan, Xin; Ji, Shengyuan; Xu, Jun

    2017-01-01

    To improve traffic congestion of urban intersections, this article presents a cooperative vehicle intersection control scheme without using any traffic lights, based on model predictive control theory...

  7. The Significance of Asthma Follow-Up Consultations for Adherence to Asthma Medication, Asthma Medication Beliefs, and Asthma Control

    OpenAIRE

    Malin Axelsson; Linda Ekerljung; Bo Lundbäck

    2015-01-01

    Objective. The aim was to investigate adherence to asthma medication treatment, medication beliefs, and asthma control in relation to asthma follow-up consultations in asthmatics in the general population. A further aim was to describe associations between adherence, medication beliefs, and asthma control. Method. In the population-based West Sweden Asthma Study, data allowing calculation of adherence for 4.5 years based on pharmacy records were obtained from 165 adult asthmatics. Additional ...

  8. Cooperative control of multi-agent systems optimal and adaptive design approaches

    CERN Document Server

    Lewis, Frank L; Hengster-Movric, Kristian; Das, Abhijit

    2014-01-01

    Task complexity, communication constraints, flexibility and energy-saving concerns are all factors that may require a group of autonomous agents to work together in a cooperative manner. Applications involving such complications include mobile robots, wireless sensor networks, unmanned aerial vehicles (UAVs), spacecraft, and so on. In such networked multi-agent scenarios, the restrictions imposed by the communication graph topology can pose severe problems in the design of cooperative feedback control systems.  Cooperative control of multi-agent systems is a challenging topic for both control theorists and practitioners and has been the subject of significant recent research. Cooperative Control of Multi-Agent Systems extends optimal control and adaptive control design methods to multi-agent systems on communication graphs.  It develops Riccati design techniques for general linear dynamics for cooperative state feedback design, cooperative observer design, and cooperative dynamic output feedback design.  B...

  9. Effectiveness of a medication-adherence tool: study protocol for a randomized controlled trial

    NARCIS (Netherlands)

    Hilbink-Smolders, M.; Lacroix, J.; Bremer-van der Heiden, L.; Halteren, A. van; Teichert, M.; Lieshout, J. van

    2016-01-01

    BACKGROUND: Research shows that more than half of the people taking medication for a chronic condition are non-adherent. Nonadherence hinders disease control with a burden on patient quality of life and healthcare systems. We developed a tool that provides insight into nonadherence risks and

  10. Hypertension control, predictors for medication adherence and gender differences in older Chinese immigrants.

    Science.gov (United States)

    Li, Wen-Wen; Wallhagen, Margaret I; Froelicher, Erika S

    2008-02-01

    This paper is a report of a study to explore the relationship between demographic and cultural factors and antihypertensive medication adherence in older Chinese immigrants. Hypertension is a well-known controllable risk factor for cardiovascular diseases worldwide, but only 20-80% of patients who take antihypertensive medications adhere adequately to their treatment regimen. A cross-sectional study was conducted between 2002 and 2003, with a convenience sample of 75 older men and 69 older women (n = 144, response rate 80%). Medication adherence was defined as > or =80% of the total score on the Morisky scale. Age (75.2 +/- 5.7 vs. 75.9 +/- 7.0 years, P = 0.51) and length of stay in the United States of America (12.7 +/- 6.4 vs. 12.7 +/- 6.6 years, P = 0.97) were similar for men and women. More men were married (85% vs. 46%, P religion (49% vs. 70%, P = 0.01), and could speak no English (32% vs. 57%, P Chinese herbs to treat hypertension (4% vs.13%). Hypertension control was low for men and women (53% and 48%, P = 0.51). Adherence in men and women was 69% and 75% (P = 0.42) respectively. For men, shorter length of stay in the United States of America was negatively associated with non-adherence (OR = 0.16; 95% CI: 0.05, 0.57). No association between length of stay and non-adherence was found for women. More research, including gender-specific studies, is needed to understand better how to develop an effective and culturally sensitive strategy to help older Chinese immigrants manage their hypertension.

  11. Human-FES cooperative control for wrist movement: a preliminary study

    Directory of Open Access Journals (Sweden)

    Kai Gui

    2016-07-01

    Full Text Available Functional electrical stimulation (FES sometimes applies to patients with partial paralysis, so human voluntary control and FES control both exist. Our study aims to build a cooperative controller to achieve human-FES cooperation. This cooperative controller is formed by a classical FES controller and an impedance controller. The FES controller consists of a back propagation (BP neural network-based feedforward controller and a PID-based feedback controller. The function of impedance controller is to convert volitional force/torque, which is estimated from a three-stage filter based on EMG, into additional angle. The additional angle can reduce the FES intensity in our cooperative controller, comparing to that in classical FES controller. Some assessment experiments are designed to test the performance of the cooperative controller.

  12. Tailored health messaging improves contraceptive continuation and adherence: results from a randomized controlled trial.

    Science.gov (United States)

    Garbers, Samantha; Meserve, Allison; Kottke, Melissa; Hatcher, Robert; Chiasson, Mary Ann

    2012-11-01

    Discontinuation and incorrect use of contraceptive methods may contribute to as many as 1 million unintended pregnancies annually in the United States. Interventions to improve contraceptive method continuation and adherence are needed. A three-arm randomized controlled trial was conducted at two family planning sites testing the efficacy of a computer-based contraceptive assessment module in increasing the proportion of patients who continued use of their chosen contraceptive method 4 months after the family planning visit (n=224). In analyses adjusting for clinical site of recruitment, family planning patients who used the module and received individually tailored health materials (n=78), compared to those in the control group (n=70), were significantly more likely to continue use of their chosen contraceptive method [95% compared to 77%; odds ratio (OR)=5.48; 95% confidence interval (CI): 1.72-17.42] and to adhere to their method (86% compared to 69%; OR=2.74; 95% CI: 1.21-6.21). No significant differences in these outcomes were found for participants who used the module but did not receive tailored materials (n=76), compared to the control group. Tailored health materials significantly improved contraceptive method continuation and adherence. Additional research on the impact of the intervention on continuation and adherence in a larger sample and over a longer follow-up period is merited. Copyright © 2012 Elsevier Inc. All rights reserved.

  13. Locus of pain control associated with medication adherence behaviors among patients after an orthopedic procedure

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    Porto TM

    2014-07-01

    Full Text Available Thaisy Mendes Porto,1 Daniele Caferatti Machado,1 Rafael Olívio Martins,2 Dayani Galato,3 Anna Paula Piovezan31Course of Pharmacy, 2Course of Medicine, 3Post-Graduation in Health Sciences, University of Southern Santa Catarina, Tubarão, Santa Catarina, BrazilBackground: Locus of pain control (LPC is characterized by the behavior of people coping with their health problems, as a result of their own actions (internal control or external factors or other people (external control. This parameter can be associated with medication adherence, in addition to other psychosocial factors that may also influence this behavior. This study was performed to investigate the influence of the LPC on medication adherence in patients undergoing an orthopedic procedure. Subjects and methods: We conducted a prospective cohort study on patients who attended an orthopedic clinic for arthroscopy treatment. The patients’ LPC and pain intensity data were obtained on the day of admission through the use of the LPC scale and the visual analog scale (VAS, respectively, both being validated tools. After arthroscopic surgery, the patients received drug prescriptions and were reassessed after 15 days regarding treatment adherence, using the Morisky test. A P-value <0.05 was considered statistically significant. Results: We assessed 79 individuals from both the internal LPC group (n=35 and external LPC group (n=44 and found that there were no group differences in sex, affected limb, cause of injury, repetitive strain injury, duration of pain, or pain intensity. However, there was a higher proportion of patients in the external LPC group that adhered to the prescribed medication compared with the internal LPC group (P>0.01. Conclusion: The results showed that among patients who underwent an orthopedic procedure, there was a higher adherence rate to prescribed medication in the external LPC group compared with the internal LPC group.Keywords: behavior, locus of control

  14. Using daily text-message reminders to improve adherence with oral contraceptives: a randomized controlled trial.

    Science.gov (United States)

    Hou, Melody Y; Hurwitz, Shelley; Kavanagh, Erin; Fortin, Jennifer; Goldberg, Alisa B

    2010-09-01

    To estimate whether women receiving daily text-message reminders have increased oral contraceptive pill adherence compared with women not receiving reminders. This randomized controlled trial estimated whether there was an effect of daily text-message reminders on oral contraceptive pill adherence of new oral contraceptive pill users. Pill-taking was tracked for 3 months by an electronic monitoring device with wireless data collection. During the study period, participants assigned the intervention received a daily reminder text message. Eighty-two women were assigned randomly to detect a 1.6+/-2.0 pill difference (90% power, 5% alpha, 15% dropout). Participants were 79% white, non-Hispanic, 99% high school graduates, and 99% nulliparous with a mean age of 22 years. Most reported condom use with past coital activity, and more than half reported prior emergency contraception use. The mean number of missed pills per cycle did not differ significantly between the groups: 4.9+/-3.0 for the text-message group and 4.6+/-3.5 for the control group (P=.60). The number of missed pills per cycle increased over the course of the study, but this pattern did not increase differentially between the groups. Adherence recorded by the electronic monitoring device indicated much poorer adherence than that recorded by patient diaries. Despite poor pill-taking, there were no pregnancies. Daily text-message reminders did not improve oral contraceptive pill adherence. Although the lack of benefit may be attributed to the frequent use of alternative reminder systems in the control group, the rate of missed pills when measured objectively was still very high in both groups. Clinicaltrials.gov, www.clinicaltrials.gov, NCT00733707. I.

  15. A cooperative control algorithm for camera based observational systems.

    Energy Technology Data Exchange (ETDEWEB)

    Young, Joseph G.

    2012-01-01

    Over the last several years, there has been considerable growth in camera based observation systems for a variety of safety, scientific, and recreational applications. In order to improve the effectiveness of these systems, we frequently desire the ability to increase the number of observed objects, but solving this problem is not as simple as adding more cameras. Quite often, there are economic or physical restrictions that prevent us from adding additional cameras to the system. As a result, we require methods that coordinate the tracking of objects between multiple cameras in an optimal way. In order to accomplish this goal, we present a new cooperative control algorithm for a camera based observational system. Specifically, we present a receding horizon control where we model the underlying optimal control problem as a mixed integer linear program. The benefit of this design is that we can coordinate the actions between each camera while simultaneously respecting its kinematics. In addition, we further improve the quality of our solution by coupling our algorithm with a Kalman filter. Through this integration, we not only add a predictive component to our control, but we use the uncertainty estimates provided by the filter to encourage the system to periodically observe any outliers in the observed area. This combined approach allows us to intelligently observe the entire region of interest in an effective and thorough manner.

  16. Self-efficacy beliefs, locus of control, religiosity and non-adherence to immunosuppressive medications in kidney transplant patients.

    Science.gov (United States)

    Silva, Andresa Nascimento; Moratelli, Lucas; Tavares, Paula Liziero; Marsicano, Elisa De Oliveira; Pinhati, Renata Romanholi; Colugnati, Fernando Antonio Basile; Lucchetti, Giancarlo; Sanders-Pinheiro, Helady

    2016-11-01

    Adherence to immunosuppressive medication is essential for favourable kidney transplant outcomes. The present study aims to investigate how self-efficacy beliefs, health locus of control and religiosity are associated with adherence to immunosuppressives in post kidney transplant recipients. This is a cross-sectional study with 88 recipients with more than 1 year after transplantation. Three methods were used to classify patients as adherent or non-adherent: Basel Assessment of Adherence Scale for Immunosuppressives - BAASIS, the collateral report and blood levels of immunosuppressive medications. Self-efficacy, health locus of control, and religiosity were evaluated applying General Perceived Self-Efficacy Scale, Multidimensional Health Locus of Control Scale and Duke University Religion Index, respectively. Non-adherence was modelled by uni- and multivariated analysis. Sixty-three percent of the patients were male, age 47.2 ± 12.9 years, and median post-transplant time 108.71 (49.0-266.0) months. We found 70.5% of patients were non-adherent through at least one method. Adherent patients presented higher self-efficacy scores (45.1 ± 4.9 vs 38.3 ± 8.6; P locus of control (OR 1.23, IC 1.04-1.45, P = 0.016) and lower intrinsic religiosity (OR 0.56, IC 0.38-0.84, P = 0.006). Our study showed that self-efficacy, chance locus of control, and intrinsic religiosity were associated with non-adherence to immunosuppressives. A broader perception of the kidney transplant patient´s integrality can help health professionals to design strategies to promote adherence in this population. © 2015 Asian Pacific Society of Nephrology.

  17. Dynamic Cooperative Clustering Based Power Assignment: Network Capacity and Lifetime Efficient Topology Control in Cooperative Ad Hoc Networks

    Directory of Open Access Journals (Sweden)

    Xiao-Hong Li

    2014-01-01

    Full Text Available Cooperative communication (CC is used in topology control as it can reduce the transmission power and expand the transmission range. However, all previous research on topology control under the CC model focused on maintaining network connectivity and minimizing the total energy consumption, which would lead to low network capacity, transmission interruption, or even network paralysis. Meanwhile, without considering the balance of energy consumption in the network, it would reduce the network lifetime and greatly affect the network performance. This paper tries to solve the above problems existing in the research on topology control under the CC model by proposing a power assignment (DCCPA algorithm based on dynamic cooperative clustering in cooperative ad hoc networks. The new algorithm clusters the network to maximize network capacity and makes the clusters communicate with each other by CC. To reduce the number of redundant links between clusters, we design a static clustering method by using Kruskal algorithm. To maximize the network lifetime, we also propose a cluster head rotating method which can reach a good tradeoff between residual energy and distance for the cluster head reselection. Experimental results show that DCCPA can improve 80% network capacity with Cooperative Bridges algorithm; meanwhile, it can improve 20% network lifetime.

  18. Evolutionary Fuzzy Control and Navigation for Two Wheeled Robots Cooperatively Carrying an Object in Unknown Environments.

    Science.gov (United States)

    Juang, Chia-Feng; Lai, Min-Ge; Zeng, Wan-Ting

    2015-09-01

    This paper presents a method that allows two wheeled, mobile robots to navigate unknown environments while cooperatively carrying an object. In the navigation method, a leader robot and a follower robot cooperatively perform either obstacle boundary following (OBF) or target seeking (TS) to reach a destination. The two robots are controlled by fuzzy controllers (FC) whose rules are learned through an adaptive fusion of continuous ant colony optimization and particle swarm optimization (AF-CACPSO), which avoids the time-consuming task of manually designing the controllers. The AF-CACPSO-based evolutionary fuzzy control approach is first applied to the control of a single robot to perform OBF. The learning approach is then applied to achieve cooperative OBF with two robots, where an auxiliary FC designed with the AF-CACPSO is used to control the follower robot. For cooperative TS, a rule for coordination of the two robots is developed. To navigate cooperatively, a cooperative behavior supervisor is introduced to select between cooperative OBF and cooperative TS. The performance of the AF-CACPSO is verified through comparisons with various population-based optimization algorithms for the OBF learning problem. Simulations and experiments verify the effectiveness of the approach for cooperative navigation of two robots.

  19. The impact of cognitive distortions, stress, and adherence on metabolic control in youths with type 1 diabetes.

    Science.gov (United States)

    Farrell, Stephanie P; Hains, Anthony A; Davies, W Hobart; Smith, Philip; Parton, Elaine

    2004-06-01

    To investigate the role of cognitive distortions in the relationship between adherence behavior, diabetes-specific stress, general stress, and metabolic control. Obtained questionnaire data, glucometer readings, and glycosylated hemoglobin (HbgA(1c)) assays from 143 youths (11-18 years old) with type 1 diabetes. Examined path model of relationships between cognitive distortions, stress, adherence behavior, and metabolic control. Data were analyzed using path analysis. Higher levels of negative cognitive distortions were associated with more stress (both diabetes-specific and general). Higher levels of general stress then led to less adherent behavior and subsequently poorer metabolic control (higher HbgA(1c)). More diabetes-specific stress also led to poorer metabolic control, as well as general stress. The findings indicate an indirect role of negative cognitive distortions in metabolic control. The current findings suggest that instead of the proposed direct link between cognitive distortions and adherence behavior, an indirect relationship may exist through stress.

  20. Determinants of exercise adherence and contamination in a randomized controlled trial in cancer patients during and after allogeneic HCT.

    Science.gov (United States)

    Kuehl, Rea; Schmidt, Martina E; Dreger, Peter; Steindorf, Karen; Bohus, Martin; Wiskemann, Joachim

    2016-10-01

    Evidence from randomized controlled trials is growing that exercise interventions are beneficial in cancer patients receiving allogeneic stem cell transplantation (allo-HCT). However, information about adherence to exercise interventions and exercise contamination in control groups is lacking. This information is crucial for the interpretation of study results. We therefore examined the determinants of exercise adherence and contamination in different treatment periods during (inpatient) and after (outpatient) allo-HCT. One hundred fifty-three patients scheduled for allo-HCT were randomized to a 1-year partly supervised exercise intervention (endurance and resistance exercise) or to a control group. Adherence was assessed via exercise logs and contamination via questionnaires. Adherence varied between 66 % (inpatient) and 78 % (outpatient) in different treatment periods. During (inpatient) transplantation period, higher adherence was significantly associated with lower fatigue (P = 0.004) and with having children at home (P = 0.049). Adherence after discharge was positively associated with endurance performance (P = 0.003); higher adherence after day 100 was associated with exercise activity prior allo-HCT (P = 0.010) and higher adherence after discharge (P = 0.001). Contamination among controls was high with 54 % and significantly associated with muscle strength (P = 0.025) and fatigue (P = 0.050). Exercise adherence in different treatment periods was determined by different variables, and contamination among controls was evident. These findings may have important implications for correct interpretation of randomized exercise intervention trials.

  1. Cooperative control of multi-agent systems a consensus region approach

    CERN Document Server

    Li, Zhongkui

    2014-01-01

    Distributed controller design is generally a challenging task, especially for multi-agent systems with complex dynamics, due to the interconnected effect of the agent dynamics, the interaction graph among agents, and the cooperative control laws. Cooperative Control of Multi-Agent Systems: A Consensus Region Approach offers a systematic framework for designing distributed controllers for multi-agent systems with general linear agent dynamics, linear agent dynamics with uncertainties, and Lipschitz nonlinear agent dynamics.Beginning with an introduction to cooperative control and graph theory,

  2. Educational interventions for knowledge on the disease, treatment adherence and control of diabetes mellitus

    Directory of Open Access Journals (Sweden)

    Ana Laura Galhardo Figueira

    Full Text Available Abstract Objective: to assess the effect of educational interventions for knowledge on the disease, medication treatment adherence and glycemic control of diabetes mellitus patients. Method: evaluation research with "before and after" design, developed in a sample of 82 type 2 diabetes mellitus patients. To collect the data, the Brazilian version of the Diabetes Knowledge Scale (DKN-A, the Measure of Adherence to Treatments and the electronic system at the place of study were used. The data were collected before and after the end of the educational interventions. The educational activities were developed within 12 months, mediated by the Diabetes Conversation Maps, using the Cognitive Social Theory to conduct the interventions. Results: the knowledge on the disease (p<0.001, the medication treatment (oral antidiabetics (p=0.0318 and the glycated hemoglobin rates (p=0.0321 improved significantly. Conclusion: the educational interventions seem to have positively contributed to the participants' knowledge about diabetes mellitus, the medication treatment adherence and the glycated hemoglobin rates.

  3. Educational interventions for knowledge on the disease, treatment adherence and control of diabetes mellitus

    Science.gov (United States)

    Figueira, Ana Laura Galhardo; Boas, Lilian Cristiane Gomes Villas; Coelho, Anna Claudia Martins; de Freitas, Maria Cristina Foss; Pace, Ana Emilia

    2017-01-01

    Abstract Objective: to assess the effect of educational interventions for knowledge on the disease, medication treatment adherence and glycemic control of diabetes mellitus patients. Method: evaluation research with "before and after" design, developed in a sample of 82 type 2 diabetes mellitus patients. To collect the data, the Brazilian version of the Diabetes Knowledge Scale (DKN-A), the Measure of Adherence to Treatments and the electronic system at the place of study were used. The data were collected before and after the end of the educational interventions. The educational activities were developed within 12 months, mediated by the Diabetes Conversation Maps, using the Cognitive Social Theory to conduct the interventions. Results: the knowledge on the disease (p<0.001), the medication treatment (oral antidiabetics) (p=0.0318) and the glycated hemoglobin rates (p=0.0321) improved significantly. Conclusion: the educational interventions seem to have positively contributed to the participants' knowledge about diabetes mellitus, the medication treatment adherence and the glycated hemoglobin rates. PMID:28443992

  4. Assessing Adherence in the CAPRISA 004 Tenofovir Gel HIV Prevention Trial: Results of a Nested Case–Control Study

    OpenAIRE

    MacQueen, Kathleen M.; Weaver, Mark A.; van Loggerenberg, Francois; Succop, Stacey; Majola, Nelisle; Taylor, Doug; Karim, Quarraisha Abdool; Karim, Salim Abdool

    2014-01-01

    Adherence undeniably impacts product effectiveness in microbicide trials, but the connection has proven challenging to quantify using routinely collected behavioral data. We explored this relationship using a nested case–control study in the CAPRISA 004 Tenofovir (TFV) gel HIV prevention trial. Detailed 3-month recall data on sex events, condom and gel use were collected from 72 incident cases and 205 uninfected controls. We then assessed how the relationship between self-reported adherence a...

  5. Adherence: Its Role in Achieving Control Over Bronchial Asthma in Children

    Directory of Open Access Journals (Sweden)

    G. A. Novik

    2015-01-01

    Full Text Available This article is concerned with the problem of obtaining control over bronchial asthma in children. The goal of treating any allergic disease is to gain control over the symptoms and a maximum decrease in future risks (both aggravations and negative therapy side effects. The authors present an algorithm of determining the level of control over bronchial asthma. A complex approach towards treatment is shown. It has been noted that, despite a significant movement towards the understanding different aspects of child asthma and the current efforts in creating guides concerning its treatment, a great number of patients are still incapable of controlling the illness. One of the main reasons is the lack of adherence demonstrated by the patients and their parents towards medical recommendations. This article deals with the main reasons why the patients do not follow the recommendations of doctors. The authors no only discuss the ways of increasing the patient-doctor collaboration, but also offer modern and innovative solutions which should help to increase the adherence to the designated therapy and thus the control over child asthma.  

  6. The Effect of Group Psychoeducation Program on Medication Adherence in Patients with Bipolar Mood Disorders: a Randomized Controlled Trial.

    Science.gov (United States)

    Rahmani, Farnaz; Ebrahimi, Hossein; Ranjbar, Fatemeh; Razavi, Seyed Sajjad; Asghari, Elnaz

    2016-12-01

    Introduction: Medication nonadherence is highly prevalent in patients with bipolar disorders and often results in worsening disease prognosis. The purpose of this study was to investigate the effect of group psychoeducation on medication adherence in female patients with bipolar mood disorder type I. Methods: This randomized controlled trial was conducted on 76 patients with bipolar mood disorder admitted in female psychiatric wards of Razi teaching hospital, Tabriz, Iran. The participants were selected by convenience sampling method and were randomly assigned to experimental and control groups. Patients in experimental group received 10 continuous 90 minutes sessions of psychoeducation, two times a week. Medication adherence was measured using the medicine check list and medication adherence rating scale (MARS) before and after intervention. Data analysis was performed with SPSS ver.13. Results: There was no significant difference between two groups regarding medication adherence before the intervention. After the study intervention, the mean scores of medication adherence check list and medication adherence rating scale in the experimental group were significantly higher than the control group. Conclusion: Since group psychoeducation was effective in improving patients' medication adherence, it could be recommended for psychiatric nurses to apply this intervention in the clinical setting.

  7. The Effect of Group Psychoeducation Program on Medication Adherence in Patients with Bipolar Mood Disorders: a Randomized Controlled Trial

    Directory of Open Access Journals (Sweden)

    Farnaz Rahmani

    2016-12-01

    Full Text Available Introduction: Medication nonadherence is highly prevalent in patients with bipolar disorders and often results in worsening disease prognosis. The purpose of this study was to investigate the effect of group psychoeducation on medication adherence in female patients with bipolar mood disorder type I. Methods: This randomized controlled trial was conducted on 76 patients with bipolar mood disorder admitted in female psychiatric wards of Razi teaching hospital, Tabriz, Iran. The participants were selected by convenience sampling method and were randomly assigned to experimental and control groups. Patients in experimental group received 10 continuous 90 minutes sessions of psychoeducation, two times a week. Medication adherence was measured using the medicine check list and medication adherence rating scale (MARS before and after intervention. Data analysis was performed with SPSS ver.13. Results: There was no significant difference between two groups regarding medication adherence before the intervention. After the study intervention, the mean scores of medication adherence check list and medication adherence rating scale in the experimental group were significantly higher than the control group. Conclusion: Since group psychoeducation was effective in improving patients' medication adherence, it could be recommended for psychiatric nurses to apply this intervention in the clinical setting.

  8. Randomized controlled trial of a mobile phone intervention for improving adherence to naltrexone for alcohol use disorders.

    Directory of Open Access Journals (Sweden)

    Susan A Stoner

    Full Text Available Naltrexone is a front-line treatment for alcohol use disorders, but its efficacy is limited by poor medication adherence. This randomized controlled trial evaluated whether a mobile health intervention could improve naltrexone adherence.Treatment-seeking participants with an alcohol use disorder (N = 76 were randomized to intervention and control conditions. All participants received naltrexone (50 mg/day with a medication event monitoring system (MEMS and a prepaid smartphone, and received a daily text message querying medication side effects, alcohol use, and craving. Those in the intervention arm received additional medication reminders and adherence assessment via text message.The primary outcome, proportion of participants with adequate adherence (defined as ≥80% of prescribed doses taken through Week 8, did not differ between groups in intent-to-treat analyses (p = .34. Mean adherence at study midpoint (Week 4 was 83% in the intervention condition and 77% in the control condition (p = .35. Survival analysis found that the intervention group sustained adequate adherence significantly longer (M = 19 days [95% CI = 0.0-44.0] than those in the control group (M = 3 days [95% CI = 0.0-8.1] during the first month of treatment (p = .04. Medication adherence did not predict drinking outcomes.These results suggest that in the context of daily monitoring and assessment via cell phone, additional text message reminders do not further improve medication adherence. Although this initial trial does not provide support for the efficacy of text messaging to improve adherence to pharmacotherapy for alcohol use disorders, additional trials with larger samples and alternate designs are warranted.ClinicalTrials.gov: NCT01349985.

  9. A Robust Cooperated Control Method with Reinforcement Learning and Adaptive H∞ Control

    Science.gov (United States)

    Obayashi, Masanao; Uchiyama, Shogo; Kuremoto, Takashi; Kobayashi, Kunikazu

    This study proposes a robust cooperated control method combining reinforcement learning with robust control to control the system. A remarkable characteristic of the reinforcement learning is that it doesn't require model formula, however, it doesn't guarantee the stability of the system. On the other hand, robust control system guarantees stability and robustness, however, it requires model formula. We employ both the actor-critic method which is a kind of reinforcement learning with minimal amount of computation to control continuous valued actions and the traditional robust control, that is, H∞ control. The proposed system was compared method with the conventional control method, that is, the actor-critic only used, through the computer simulation of controlling the angle and the position of a crane system, and the simulation result showed the effectiveness of the proposed method.

  10. Determinants of medication adherence and blood pressure control among hypertensive patients in Hong Kong: a cross-sectional study.

    Science.gov (United States)

    Kang, Candy D; Tsang, Prilla P M; Li, Winson T L; Wang, Harry H X; Liu, Kirin Q L; Griffiths, Sian M; Wong, Martin C S

    2015-03-01

    Despite effective treatments, suboptimal medication adherence substantially hinders blood pressure (BP) control among hypertensive patients. This study aimed to evaluate the determinants of medication adherence and BP control among hypertensive patients in Hong Kong. A cross-sectional study was conducted. Adult patients aged>18years taking at least one type of antihypertensive drugs were recruited from four clinics in Hong Kong. Each patient completed a self-administered questionnaire, including socio-demographic variables and items related to knowledge, illness perception and medication adherence. Medication adherence was measured by the eight-item Morisky Medication Adherence Scale (MMAS-8), with a score>6 defined as "good adherence". BP was measured, and optimal control was defined as systolic BPmedication adherence and BP control, respectively. Binary logistic regression analyses were conducted with optimal medication adherence and BP control, respectively, as the outcome variables. Advanced age (adjusted odds ratio [aOR] 1.012, 95% CI 1.002-1.022, p=0.014), unemployment (aOR for employed 0.782, 95% CI 0.628-0.975, p=0.029), and good self-perceived health status (aOR 2.155, 95% CI 1.711-2.714, padherence; whereas being married (aOR 1.265, 95% CI 1.038-1.542, p=0.020) and having no co-morbidity (aOR for morbidity count 0.713, 95% CI 0.639-0.796, padherence-enhancing interventions should be targeted on younger subjects; employed patients; and those with poor self-perceived health status. Patients who are single and those with comorbidities should be closely monitored for their BP control. Copyright © 2014 Elsevier Ireland Ltd. All rights reserved.

  11. Regimen-Related Distress, Medication Adherence, and Glycemic Control in Rural African American Women With Type 2 Diabetes Mellitus.

    Science.gov (United States)

    Cummings, Doyle M; Lutes, Lesley; Littlewood, Kerry; DiNatale, Emily; Hambidge, Bertha; Schulman, Kathleen; Morisky, Donald E

    2014-08-01

    Regimen-related emotional distress in patients with type 2 diabetes mellitus (T2DM) is associated with poor glycemic control, but the mediators of this relationship are not well described. This cross-sectional study at baseline examines these relationships, including the specific role of medication adherence in rural African American women. At baseline in the EMPOWER randomized trial, the investigators collected the following data: Regimen-Related Distress (RRD; subscale of the validated Diabetes Distress Scale), diabetes medications, medication adherence using the Morisky Medication Adherence Scale, and hemoglobin A1C (A1C). The study enrolled 189 rural African American women with T2DM (mean age = 53 ± 11 years, A1C = 9.1% ± 1.8%, body mass index = 37.7% ± 8.2%; 61% on insulin); 56% reported elevated RRD (mean ≥ 3.0), and this was associated with significantly lower medication adherence (4.4 vs 6.4, P 2.1; 95% CI = 1.1-4.2; P medication adherence (exp β = 3.3; 95% CI = 1.1-9.6; P medication adherence was a significant mediator of the effects of RRD on A1C. Among rural African American women with T2DM, elevated levels of RRD were common and were associated with higher A1C values, in part via effects on medication adherence. Complex treatment regimens accompanied by psychological distress may be associated with poorer glycemic control. © The Author(s) 2014.

  12. Adherence to thromboprophylaxis guidelines in elderly patients with hospital acquired venous thromboembolism: a case control study.

    Science.gov (United States)

    Suh, Jason; Desai, Amishi; Desai, Anish; Cruz, Josephine Dela; Mariampillai, Anusiyanthan; Hindenburg, Alexander

    2017-02-01

    Venous thromboembolism (VTE) remains the number one preventable cause of hospital acquired mortality and morbidity. Each year, more than 12 million patients are at risk for VTE. The delivery of appropriate and timely VTE prophylaxis is still suboptimal in many healthcare institutions and can lead to increased readmissions, morbidity, as well as costs. To clarify this issue further, we performed a retrospective case control study at our institution to determine if poor adherence to the VTE prophylaxis guidelines could lead to an increase in VTE events. This was a retrospective case control study conducted at Winthrop-University Hospital from January 2007 to December 2011. Exclusion criteria were age < 18 and concurrent use of anticoagulant agents. Out of 322 cases of hospital acquired VTE or readmission with VTE within 30 days of discharge, 289 cases were selected for final analysis and paired with age and sex matched controls. Patients with a hospital acquired VTE or a readmission for VTE within 30 days of discharge had a significantly reduced rate of VTE prophylaxis when compared to the control group (54.0 vs. 79.2 %, p < 0.0001). The VTE risk assessment rate was also lower in the VTE group (77.2 vs. 85.5 %, p = 0.035). No difference was noted in the time to prophylaxis administration between the two groups (34.8 vs. 33.1 h, p = 0.34). Lastly, sequential compression device (SCD) documentation rate was not different: 68/116 (58.6 %) vs. 44/87 (50.6 %), p = 0.32, between the two arms. Low adherence to the American College of Chest Physician (ACCP) guidelines for VTE prophylaxis correlated with an increase in hospital acquired VTE. The decreased adherence may be linked to a lower VTE risk assessment rate, and other barriers including incorrect identification of contraindications to pharmacologic prophylaxis, and poor documentation of mechanical prophylaxis. There was no difference in SCD documentation rate and timeliness to

  13. Differences in Knowledge, Stress, Sensation Seeking and Locus of Control Linked to Dietary Adherence In Hemodialysis Patients

    Directory of Open Access Journals (Sweden)

    Edward Leigh Gibson

    2016-11-01

    Full Text Available Patients with chronic kidney disease often require regular hemodialysis to prolong life. However, between hemodialysis sessions, patients have to restrict their diets carefully to avoid excess accumulation of potassium, phosphate, sodium and fluid, which their diseased kidneys can no longer regulate. Failure to adhere to their renal dietary regimes can be fatal; nevertheless, non-adherence is common, and yet little is known about the psychological variables that might predict this dietary behavior. Thus, this study aimed to assess whether dietary adherence might be affected by a variety of psychological factors including stress, personality, and health locus of control, as well as dietary knowledge, in chronic hemodialysis patients. Fifty-one patients (30 men; age range 25-85 who had undergone hemodialysis for at least 3 months and had been asked to restrict at least one of potassium, phosphate or fluid, were recruited from a hospital renal unit. Measures of adherence to each of potassium, phosphate and fluid were derived from standard criteria for these physiological indices in renal patients. Knowledge of food/drink sources of these dietary factors, and their medical implications in relation to hemodialysis and chronic kidney disease were assessed by a bespoke questionnaire. Psychological factors including stress, personality and health locus of control beliefs were measured by standardized questionnaires. Having to restrict a particular nutrient was associated with better knowledge of both food sources and medical complications for that nutrient; however, greater dietary knowledge was not linked to adherence, and knowledge of medical complications tended to be associated with poorer adherence to potassium and phosphate levels. Adherence to these two nutrient requirements was also associated with lower reported stress in the past week. Adherence was associated with differences in locus of control: these differences varied across indices

  14. The effects of yoga on psychosocial variables and exercise adherence: a randomized, controlled pilot study.

    Science.gov (United States)

    Bryan, Stephanie; Pinto Zipp, Genevieve; Parasher, Raju

    2012-01-01

    Physical inactivity is a serious issue for the American public. Because of conditions that result from inactivity, individuals incur close to $1 trillion USD in health-care costs, and approximately 250 000 premature deaths occur per year. Researchers have linked engaging in yoga to improved overall fitness, including improved muscular strength, muscular endurance, flexibility, and balance. Researchers have not yet investigated the impact of yoga on exercise adherence. The research team assessed the effects of 10 weeks of yoga classes held twice a week on exercise adherence in previously sedentary adults. The research team designed a randomized controlled pilot trial. The team collected data from the intervention (yoga) and control groups at baseline, midpoint, and posttest (posttest 1) and also collected data pertaining to exercise adherence for the yoga group at 5 weeks posttest (posttest 2). The pilot took place in a yoga studio in central New Jersey in the United States. The pretesting occurred at the yoga studio for all participants. Midpoint testing and posttesting occurred at the studio for the yoga group and by mail for the control group. Participants were 27 adults (mean age 51 y) who had been physically inactive for a period of at least 6 months prior to the study. Interventions The intervention group (yoga group) received hour-long hatha yoga classes that met twice a week for 10 weeks. The control group did not participate in classes during the research study; however, they were offered complimentary post research classes. Outcome Measures The study's primary outcome measure was exercise adherence as measured by the 7-day Physical Activity Recall. The secondary measures included (1) exercise self-efficacy as measured by the Multidimensional Self-Efficacy for Exercise Scale, (2) general well-being as measured by the General Well-Being Schedule, (3) exercise-group cohesion as measured by the Group Environment Questionnaire (GEQ), (4) acute feeling response

  15. Living on the wedge: female control of paternity in a cooperatively polyandrous cichlid

    OpenAIRE

    Kohda, Masanori; Heg, Dik; Makino, Yoshimi; Takeyama, Tomohiro; Shibata, Jun-ya; Watanabe, Katsutoshi; Munehara, Hiroyuki; Hori, Michio; Awata, Satoshi

    2009-01-01

    Theories suggest that, in cooperatively breeding species, female control over paternity and reproductive output may affect male reproductive skew and group stability. Female paternity control may come about through cryptic female choice or female reproductive behaviour, but experimental studies are scarce. Here, we show a new form of female paternity control in a cooperatively polyandrous cichlid fish (Julidochromis transcriptus), in which females prefer wedge-shaped nesting sites. Wedge-shap...

  16. Assessing adherence in the CAPRISA 004 tenofovir gel HIV prevention trial: results of a nested case-control study.

    Science.gov (United States)

    MacQueen, Kathleen M; Weaver, Mark A; van Loggerenberg, Francois; Succop, Stacey; Majola, Nelisle; Taylor, Doug; Karim, Quarraisha Abdool; Karim, Salim Abdool

    2014-05-01

    Adherence undeniably impacts product effectiveness in microbicide trials, but the connection has proven challenging to quantify using routinely collected behavioral data. We explored this relationship using a nested case-control study in the CAPRISA 004 Tenofovir (TFV) gel HIV prevention trial. Detailed 3-month recall data on sex events, condom and gel use were collected from 72 incident cases and 205 uninfected controls. We then assessed how the relationship between self-reported adherence and HIV acquisition differed between the TFV and placebo gel groups, an interaction effect that should exist if effectiveness increases with adherence. The CAPRISA 004 trial determined that randomization to TFV gel was associated with a significant reduction in risk of HIV acquisition. In our nested case-control study, however, we did not observe a meaningful decrease in the relative odds of infection-TFV versus placebo-as self-reported adherence increased. To the contrary, exploratory sub-group analysis of the case-control data identified greater evidence for a protective effect of TFV gel among participants reporting less than 80 % adherence to the protocol-defined regimen (odds ratio (OR) 0.30; 95 % CI 0.11-0.78) than among those reporting ≥ 80 % adherence (Odds Ratio 0.81; 95 % CI 0.34-1.92). The small number of cases may have inhibited our ability to detect the hypothesized interaction between adherence and effectiveness. Nonetheless, our results re-emphasize the challenges faced by investigators when adherence may be miss-measured, miss-reported, or confounded with the risk of HIV.

  17. Adherence and metabolic control in patients with Type 2 Diabetes Mellitus in a hospital of Medellin (Colombia); 2011

    OpenAIRE

    Martínez Sánchez, Lina María; Universidad pontificia bolivariana; Martínez Domínguez, Gloria Inés; Universidad pontificia bolivariana; Rodríguez Gázquez, María de los Angeles; Universidad pontificia bolivariana; Agudelo Vélez, Camilo Andrés; Universidad Pontificia Bolivariana; jiménez Jiménez, Juan Guillermo; Universidad pontificia bolivariana; Vargas Grisales, Natalia; Universidad pontificia bolivariana; Lopera Valle, Johan Sebastián; Universidad pontificia bolivariana

    2014-01-01

    Explore the relationship between the therapeutic adherence and metabolic control in patients with Diabetes Mellitus type 2 (DM-2), which consulted to a hospital institution in Medellin-Colombia. Materials and Methods: Cross-sectional study. Thewho signed informed consent. Sampling was not probabilistic, sample was taken to convenience. The Summary of Diabetes Self-Care Activities was applied to assess therapeutic adherence and Duke-Unc to assess social support. Hemoglobin glycosylated(HbA1c) ...

  18. A comparison of measures used to describe adherence to glaucoma medication in a randomised controlled trial

    OpenAIRE

    Cate, Heidi; Bhattacharya, Debi; Clark, Allan; Holland, Richard; Broadway, David

    2015-01-01

    Background: Understanding the magnitude of non-adherence in pre-marketing clinical trials and clinical practice is essential. However, accurately measuring non-adherence to medication is problematic, and the variety of adherence measures and/or calculation methods has led to highly variable results. Purpose: To compare commonly used methods for measuring adherence to eye drop therapy in order to assess which methods achieve the most complete datasets over an 8-month monitoring period, to quan...

  19. Structured pharmacist-led intervention programme to improve medication adherence in COPD patients: A randomized controlled study.

    Science.gov (United States)

    Abdulsalim, Suhaj; Unnikrishnan, Mazhuvancherry Kesavan; Manu, Mohan K; Alrasheedy, Alian A; Godman, Brian; Morisky, Donald E

    2017-10-26

    COPD is characterised by a progressive airflow limitation in the lungs. However, adherence to therapy improves management of symptoms and delays disease progression. Therefore, patients' knowledge and awareness about the disease are important. Hence, pharmacist-led educational interventions could achieve this and improve medication adherence. This study evaluated the effectiveness of a clinical pharmacist-led intervention on medication adherence in COPD patients in a teaching hospital. In an open-labelled randomized controlled study at Kasturba Medical College Hospital, Manipal, India, patients were randomly assigned to two groups (Intervention group [IG] and Control group [CG]), and were matched for socio-demographics and clinical characteristics. Medication adherence was assessed by the Morisky, Green and Levine Medication Adherence Questionnaire (MAQ). In IG, pharmacist intervention placed emphasis on (1) compliance, (2) smoking cessation, (3) exercise, (4) inhaler use and (5) need for timely follow up. The MAQ assessment was repeated at 6, 12, 18 and 24 months. Data were analysed statistically by SPSS version 20.0. Out of 328 patients screened during March 2012 to June 2013, 260 were recruited. Of these, 206 completed the follow-up (98 in CG and 104 in IG). Medication adherence improved significantly after pharmacist intervention in IG at all follow-up time points (P adherence in COPD patients, but was effectively reduced by the intervention. This is the first randomized controlled trial in India that demonstrates the pivotal role of pharmacist-led educational intervention in improving medication adherence in COPD. Involving non-physician health professionals could be the best strategy, for resource-poor nations like India, because the current physician-centric healthcare has no emphasis on patient education and counselling. Copyright © 2017 Elsevier Inc. All rights reserved.

  20. Lacunae in noncommunicable disease control program: Need to focus on adherence issues!

    Directory of Open Access Journals (Sweden)

    Tarundeep Singh

    2017-01-01

    Full Text Available Introduction: Chronic non communicable diseases in India have increased in magnitude with earlier onset and more likelihood of complications. Much emphasis is given to early diagnosis and timely treatment. Additionally, tertiary prevention through medication adherence is needed to limit disability and prevent early onset of complications. This study was aimed to assess the magnitude of medication and lifestyle adherence among elderly patients suffering from diabetes and hypertension in rural areas of Punjab. Methodology: This was a clinic based study in district Fatehgarh Sahib, Punjab. Patients were subjected to regular blood pressure and blood glucose monitoring. Thereafter they were offered free medications through weekly clinic held at Community Health Center, Bassi Pathana. Along with treatment, Public Health Nurse conducted counselling on diet and lifestyle. Frequency and process of taking medications was explained in local language and records duly maintained during visits. Results: Nearly 70% of study subjects were more than 50 years old. Males constituted 26% of the sample and 60% of subjects were illiterate. Large majority of study subjects did not consumed tobacco (98.08% or alcohol (89.42% in past thirty days. In-sufficient physical activity and poor compliance to diet was reported by 10.5% (Males: 7.4%, Females: 11.7% and 23.5% (Males: 31.5%, Females: 20.8% subjects. Nearly 46.15% of study subjects reported missing prescribed medications. Nearly 61.54% of study subjects were very sure that they will be able to take medicines as directed by physician. Conclusion: National Program for Control of Diabetes, Cardio-vascular Disease and Stroke relies on early diagnosis and treatment non- communicable diseases. However, with reported levels of adherence to medication and lifestyle interventions, there is an urgent need of exploring innovative ways to ensure compliance and improve treatment outcomes.

  1. Simulation improves procedural protocol adherence during central venous catheter placement: a randomized-controlled trial

    Science.gov (United States)

    Peltan, Ithan D.; Shiga, Takashi; Gordon, James A.; Currier, Paul F.

    2015-01-01

    Background Simulation training may improve proficiency at and reduces complications from central venous catheter (CVC) placement, but the scope of simulation’s effect remains unclear. This randomized controlled trial evaluated the effects of a pragmatic CVC simulation program on procedural protocol adherence, technical skill, and patient outcomes. Methods Internal medicine interns were randomized to standard training for CVC insertion or standard training plus simulation-based mastery training. Standard training involved a lecture, a video-based online module, and instruction by the supervising physician during actual CVC insertions. Intervention-group subjects additionally underwent supervised training on a venous access simulator until they demonstrated procedural competence. Raters evaluated interns’ performance during internal jugular CVC placement on actual patients in the medical intensive care unit. Generalized estimating equations were used to account for outcome clustering within trainees. Results We observed 52 interns place 87 CVCs. Simulation-trained interns exhibited better adherence to prescribed procedural technique than interns who received only standard training (p=0.024). There were no significant differences detected in first-attempt or overall cannulation success rates, mean needle passes, global assessment scores or complication rates. Conclusions Simulation training added to standard training improved protocol adherence during CVC insertion by novice practitioners. This study may have been too small to detect meaningful differences in venous cannulation proficiency and other clinical outcomes, highlighting the difficulty of patient-centered simulation research in settings where poor outcomes are rare. For high-performing systems, where protocol deviations may provide an important proxy for rare procedural complications, simulation may improve CVC insertion quality and safety. PMID:26154250

  2. Effects of a pharmaceutical care model on medication adherence and glycemic control of people with type 2 diabetes.

    Science.gov (United States)

    Chung, Wen Wei; Chua, Siew Siang; Lai, Pauline Siew Mei; Chan, Siew Pheng

    2014-01-01

    Diabetes mellitus is a lifelong chronic condition that requires self-management. Lifestyle modification and adherence to antidiabetes medications are the major determinants of therapeutic success in the management of diabetes. To assess the effects of a pharmaceutical care (PC) model on medication adherence and glycemic levels of people with type 2 diabetes mellitus. A total of 241 people with type 2 diabetes were recruited from a major teaching hospital in Malaysia and allocated at random to the control (n=121) or intervention (n=120) groups. Participants in the intervention group received PC from an experienced pharmacist, whereas those in the control group were provided the standard pharmacy service. Medication adherence was assessed using the Malaysian Medication Adherence Scale, and glycemic levels (glycated hemoglobin values and fasting blood glucose [FBG]) of participants were obtained at baseline and after 4, 8, and 12 months. At baseline, there were no significant differences in demographic data, medication adherence, and glycemic levels between participants in the control and intervention groups. However, statistically significant differences in FBG and glycated hemoglobin values were observed between the control and intervention groups at months 4, 8, and 12 after the provision of PC (median FBG, 9.0 versus 7.2 mmol/L [P2 months). Medication adherence was also significantly associated with the provision of PC, with a higher proportion in the intervention group than in the control group achieving it (75.0% versus 58.7%; P=0.007). The provision of PC has positive effects on medication adherence as well as the glycemic control of people with type 2 diabetes. Therefore, the PC model used in this study should be duplicated in other health care settings for the benefit of more patients with type 2 diabetes.

  3. A packet loss compliant logic-based communication alogoritham for cooperative path following control

    Digital Repository Service at National Institute of Oceanography (India)

    Rego, F.; Aguiar, A.P.; Pascoal, A.M.

    the overall closed loop system is input-to-state practically stable. The communication logic is applied to a cooperative path-following control system of multiple underactuated autonomous marine robots. Simulation results are presented and discussed...

  4. Cooperative Remote Monitoring, Arms control and nonproliferation technologies: Fourth quarter 1995

    Energy Technology Data Exchange (ETDEWEB)

    Alonzo, G M [ed.

    1995-01-01

    The DOE`s Cooperative Remote Monitoring programs integrate elements from research and development and implementation to achieve DOE`s objectives in arms control and nonproliferation. The contents of this issue are: cooperative remote monitoring--trends in arms control and nonproliferation; Modular Integrated Monitoring System (MIMS); Authenticated Tracking and Monitoring Systems (ATMS); Tracking and Nuclear Materials by Wide-Area Nuclear Detection (WAND); Cooperative Monitoring Center; the International Remote Monitoring Project; international US and IAEA remote monitoring field trials; Project Dustcloud: monitoring the test stands in Iraq; bilateral remote monitoring: Kurchatov-Argonne-West Demonstration; INSENS Sensor System Project.

  5. A study to assess the feasibility of undertaking a randomized controlled trial of adherence with eye drops in glaucoma patients.

    Science.gov (United States)

    Richardson, Cliff; Brunton, Lisa; Olleveant, Nicola; Henson, David B; Pilling, Mark; Mottershead, Jane; Fenerty, Cecilia H; Spencer, Anne Fiona; Waterman, Heather

    2013-01-01

    Adherence with therapy could influence the progression of glaucoma and ultimately affect the onset of visual impairment in some individuals. This feasibility study evaluated the measures to be used for a future randomized controlled trial assessing the effects of group-based education on adherence with eye drops. People diagnosed with glaucoma within the previous 12 months attending a regional ophthalmology clinic in the North West of England were recruited. A two-session education program delivered one week apart had been devised as part of a previous project. A combined adult learning and health needs approach to education was taken. Outcomes measured were knowledge of glaucoma, self-report of adherence, illness perception, beliefs about medicines, patient enablement, and general health (Short Form-12). Adherence was also measured objectively using a Medical Events Monitoring System device. Twenty-six participants consented to undertake the educational program and 19 produced analyzable data. Knowledge of glaucoma, illness perception, beliefs about medicine, and patient enablement all showed statistically significant improvements after education. Mean adherence with eye drops was maintained above 85% before and for 3 months after attendance at the educational program. Self-report exaggerated adherence by at least 10% when compared with the objective Medical Events Monitoring System data, and in fact the kappa agreement was zero. All questionnaires other than the Short Form-12 were considered to be valuable measures and use of a Medical Events Monitoring System device was considered to be an objective surrogate measure for adherence with eye drops. A multicenter, randomized, controlled equivalence trial of group versus individualized education using adherence as the primary outcome is the next step.

  6. Association Between Metformin Adherence and All-Cause Mortality Among New Users of Metformin: A Nested Case-Control Study.

    Science.gov (United States)

    Simard, Patrice; Presse, Nancy; Roy, Louise; Dorais, Marc; White-Guay, Brian; Räkel, Agnès; Perreault, Sylvie

    2017-11-01

    Metformin presents better survival rates than other oral antidiabetics in the treatment of type 2 diabetes. However, these benefits may be dampened by inadequate treatment adherence. We aimed to investigate the relationship between adherence level to metformin therapy and all-cause mortality over 10 years in incident metformin users. A nested case-control study was conducted using a large cohort of beneficiaries of the Quebec public drug insurance plan, aged 45 to 85 years, who initiated metformin between 2000 and 2009. Each case of all-cause death during follow-up was matched with up to 10 controls. Adherence to metformin was measured using the medication possession ratio (MPR). Conditional logistic regression models were used to estimate rate ratios (RRs) for mortality between adherent (MPR ≥ 80%) and nonadherent patients (MPR < 80%). Subgroup analyses were conducted according to age (45-64 and 65-85 years) and comedication use (antihypertensive/cardiovascular drugs and statins). The cohort included 82 720 incident metformin users, followed up for 2.4 [0.8-4.4] years (median [interquartile range]) and 4747 cases of all-cause deaths. Analyses revealed decreased mortality risks after long-term adherence to metformin. Specifically, RRs were 0.84 (95% CI = [0.71-0.98]) and 0.69 [0.57-0.85] after 4 to 6 and ≥6 years of adherence to metformin, respectively. Survival benefits of long-term adherence (≥4 years) were also observed across most subgroups and particularly in patients using neither antihypertensive/cardiovascular drugs nor statins (0.57 [0.41-0.77]). Long-term adherence to metformin is associated with decreased risks of all-cause mortality in incident metformin users. Further research should investigate whether survival benefits vary according to the comorbidity burden of patients.

  7. Cooperative Control of Regenerative Braking and Antilock Braking for a Hybrid Electric Vehicle

    OpenAIRE

    Guodong Yin; XianJian Jin

    2013-01-01

    A new cooperative braking control strategy (CBCS) is proposed for a parallel hybrid electric vehicle (HEV) with both a regenerative braking system and an antilock braking system (ABS) to achieve improved braking performance and energy regeneration. The braking system of the vehicle is based on a new method of HEV braking torque distribution that makes the antilock braking system work together with the regenerative braking system harmoniously. In the cooperative braking control strategy, a sli...

  8. An educational intervention to improve adherence to high-dosage patching regimen for amblyopia: a randomised controlled trial.

    Science.gov (United States)

    Pradeep, Archana; Proudlock, Frank Antony; Awan, Musarat; Bush, Glen; Collier, Jacqueline; Gottlob, Irene

    2014-07-01

    Previous reports suggest that adherence to patching is a major issue in amblyopia treatment. We tested with an unmasked randomised controlled clinical trial whether an intense educational/motivational intervention improves adherence when a high-dose regime is prescribed. 62 children with newly diagnosed amblyopia were randomly allocated into two treatment arms with and without educational/motivational intervention material. Both were prescribed patching 10 h/day, 6 days/week for a fixed period of 12 weeks. The intervention arm received an educational/motivational intervention before patching which included information booklets, video, a cartoon story book, sticker charts and a dedicated session with a researcher. The control arm received the usual clinical information. The primary outcome measure was adherence measured using electronic occlusion dose monitors where a success/failure binary outcome was used to account for participants who dropped out of the study defined as patching >4 h/day. Visual outcome, expressed as percentage visual deficit, was measured as secondary outcome. The intervention increased adherence success rate from 45.2% in the control group to 80.6% in the intervention group (p=0.0027). However, visual outcome was not significantly better in the intervention group (p=0.190). Our study shows that an intense educational/motivational intervention can improve adherence to patching to high prescribed doses although no significant improvement in visual outcome was observed. TRIALS REGISTRATION NUMBER: ISRCTN05346737 (International Standard Randomised Controlled Trial Number Register).

  9. Maintaining Control of Chronic Obstructive Airway Disease: Adherence to Inhaled Therapy and Risks and Benefits of Switching Devices.

    Science.gov (United States)

    Melani, Andrea S; Paleari, Davide

    2016-01-01

    Asthma and chronic obstructive pulmonary disease (COPD) are major obstructive airway diseases that involve underlying airway inflammation. The most widely used pharmacotherapies for asthma and COPD are inhaled agents that have been shown to be effective and safe in these patients. However, despite the availability of effective pharmacologic treatment and comprehensive treatment guidelines, the prevalence of inadequately controlled asthma and COPD is high. A main reason for this is poor adherence. Adherence is a big problem for all chronic diseases, but in asthma and COPD patients there are some additional difficulties because of poor inhalation technique and inhaler choice. Easier-to-use devices and educational strategies on proper inhaler use from health caregivers can improve inhaler technique. The type of device used and the concordance between patient and physician in the choice of inhaler can also improve adherence and are as important as the drug. Adherence to inhaled therapy is absolutely necessary for optimizing patient control. If disease control is not adequate despite good adherence, switching to a more appropriate inhaled therapy is recommended. By contrast, uninformed switching or switching to less user-friendly inhaler may impact disease control negatively. This critical review of the available literature is aimed to provide a guidance protocol on when a switch may be recommended in individual patients.

  10. Novel Trajectory Control for Human Cooperation Robot Based on Behavior Mode Switching

    Science.gov (United States)

    Seki, Hirokazu; Takahashi, Kazuki; Tadakuma, Susumu

    This paper describes a novel trajectory control system for human cooperation robots based on behavior mode switching. Human cooperation robots have the great possibility to serve as useful support systems for elderly people and physically handicapped people and it is expected to realize the smooth and human-friendly support movements. This study defines three behavior modes in human cooperation motion and their respective trajectory control system are designed. In the trajectory design, minimum jerk model is introduced to realize the smooth and human-friendly cooperation movements. In addition, the initial value compensation at the mode switching is also developed. Some experiments on two-axis plane robot and performance evaluation by trial subjects show the effectiveness of the proposed trajectory control system.

  11. Improving the adherence of type 2 diabetes mellitus patients with pharmacy care: a systematic review of randomized controlled trials.

    Science.gov (United States)

    Antoine, Sunya-Lee; Pieper, Dawid; Mathes, Tim; Eikermann, Michaela

    2014-07-07

    Oral medication for patients with type 2 diabetes mellitus plays an important role in diabetes care and is associated with a high level self-care behavior and self-management. However, poor adherence to diabetes treatment is common which causes severe health complications and increased mortality. Barriers to adherence may consist of complex treatment regimens often along with long-term multi-therapies, side effects due to the medication as well as insufficient, incomprehensible or confusing information or instructions provided by the health care provider. Multidisciplinary approaches can support adherence success and can enable a more effective management of diabetes care. One approach in diabetes care can be the involvement of a pharmacist. The aim was to analyze the effectiveness of adherence-enhancing pharmacist interventions for oral medication in type 2 diabetes mellitus. A systematic review of randomized controlled trials. The study quality was assessed with the Cochrane risk of bias tool. Of 491 hits, six publications were included. Two studies mainly examining educational interventions showed a significant improvement in adherence. Moreover, the quality of the included studies was deficient. Although pharmacist interventions might potentially improve adherence to type 2 diabetes mellitus medication, high-quality studies are needed to assess effectiveness.

  12. A Randomised Controlled Trial to Test the Effectiveness of Planning Strategies to Improve Medication Adherence in Patients with Cardiovascular Disease.

    Science.gov (United States)

    Meslot, Carine; Gauchet, Aurélie; Hagger, Martin S; Chatzisarantis, Nikos; Lehmann, Audrey; Allenet, Benoît

    2017-03-01

    Low levels of adherence to medication prescribed to treat and manage chronic disease may lead to maladaptive health outcomes. Theory-based, easy-to-administer interventions that promote patients' effective self-regulation of their medication-taking behaviour are needed if adherence is to be maximised. We tested the effectiveness of an intervention adopting planning techniques to promote medication adherence. Outpatients with cardiovascular disease (N = 71) were allocated to either an experimental condition, in which participants were asked to form implementation intentions and coping plans related to their treatment, or to a no-planning control condition, in which participants received no treatment. Patients also completed self-report measures of medication adherence, self-efficacy, and beliefs in medication necessity and concerns. Measures were administered at baseline and at 6-week follow-up. Results revealed no overall main effect for the intervention on medication adherence. Post-hoc moderator analyses revealed that the intervention was effective in patients with lower necessity beliefs compared to those with higher necessity beliefs. While current findings have promise in demonstrating the conditional effects of planning interventions, there is a need to replicate these findings by manipulating planning and beliefs independently and testing their direct and interactive effects on medication adherence. © 2016 The International Association of Applied Psychology.

  13. The patient education - Learning and Coping Strategies - improves adherence in cardiac rehabilitation (LC-REHAB): A randomised controlled trial.

    Science.gov (United States)

    Lynggaard, Vibeke; Nielsen, Claus Vinther; Zwisler, Ann-Dorthe; Taylor, Rod S; May, Ole

    2017-06-01

    Despite proven benefits of cardiac rehabilitation (CR), adherence to CR remains suboptimal. This trial aimed to assess the impact of the patient education 'Learning and Coping Strategies' (LC) on patient adherence to an eight-week CR program. 825 patients with ischaemic heart disease or heart failure were open label randomised to either the LC arm (LC plus CR) or the control arm (CR alone) across three hospital units in Denmark. Both arms received same amount of training and education hours. LC consisted of individual clarifying interviews, participation of experienced patients as co-educators, situational, reflective and inductive teaching. The control arm received structured deductive teaching. The primary outcomes were patient adherence to at least 75% of the exercise training or education sessions. We tested for subgroup effects on the primary outcomes using interaction terms. The primary outcomes were compared across arms using logistic regression. More patients in the LC arm adhered to at least 75% of the exercise training sessions than control (80% versus 73%, adjusted odds ratio (OR):1.48; 95% CI:1.07 to 2.05, P=0.018) and 75% of education sessions (79% versus 70%, adjusted OR:1.61, 1.17 to 2.22, P=0.003). Some evidence of larger effects of LC on adherence was seen for patients with heart failure, low education and household income. Addition of LC strategies improved adherence in rehabilitation both in terms of exercise training and education. Patients with heart failure, low levels of education and household income appear to benefit most from this adherence promoting intervention. www.clinicaltrials.gov identifier NCT01668394. Copyright © 2017 Elsevier B.V. All rights reserved.

  14. Adherence to Two Methods of Education and Metabolic Control in Type 2 Diabetics.

    Science.gov (United States)

    Gutiérrez Herrera, Verónica R; Zerón, Hugo Mendieta; Mendieta Alcántara, Martha R

    2015-04-01

    Education in diabetes optimizes metabolic control, prevents acute and chronic complications, and improves quality of life. Our main objective was to evaluate if a better metabolic control is achieved in diabetic patients undergoing a program of intensive interactive care than in those with traditional care and written information. Patients with type 2 diabetes mellitus (T2DM), aged 20-60 years, education level at least of primary school, serum creatinine ≤ 2.5 mg/dl, self-sufficient and HbA1c ≥ 7.1% were allocated in two groups of education, 1) minimal education (MEG) and 2) full education (FEG). The MEG patients followed predefined diet; FEG patients chose the diet by selecting foods from each group in a list of matches, teaching them to count nutrients, kilocalories (kcal) and percentage of nutrients. A follow-up of 31 patients in each group was obtained. The proportion of patients who had initial adherence was 13.33% in the MEG group and 9.67% in the FEG group while, at the end of the study, these percentages were of 73.3% and 58.38% respectively. The final HbA1c decreased in both groups, with or without good adherence. The FEG group had a higher decline in the values of cholesterol (p = 0.036) and LDL (p = 0.002) than the MEG group. Education programs in T2DM contribute to a decrease in HbA1c within six months, but an intensive program is more effective in reducing cholesterol and LDL.

  15. Barriers to Medication Adherence and Links to Cardiovascular Disease Risk Factor Control: The Framingham Heart Study.

    Science.gov (United States)

    Hennein, Rachel; Hwang, Shih-Jen; Au, Rhoda; Levy, Daniel; Muntner, Paul; Fox, Caroline S; Ma, Jiantao

    2017-11-30

    In the elderly, impaired cognition may weaken medication adherence and compromise treatment for cardiovascular disease (CVD). We examined risk factors for medication adherence and the relationship between adherence and levels of CVD risk factors among older participants with hypertension, dyslipidemia, and diabetes in the Framingham Heart Study. The four-item Morisky Medication Adherence Scale was administered to 1,559 participants, median age 70 years, 53% women. We created an adherence score, ranging from 0-4, with low adherence defined as a score ≥2. CVD risk factors were assessed using standard protocols. Cognition was measured using the Mini-Mental State Examination (MMSE) and depressive symptoms were measured using the Center for Epidemiologic Studies of Depression (CES-D) scale. Among participants who self-reported taking antihypertensive, lipid-lowering, and/or hyperglycemic medication(s), 12% (n=191) had low medication adherence. The risk of low adherence increased by 45% (9%CI: 25-68%, Pmedication (n=1,017), low adherence was associated with higher mean diastolic blood pressure (73 mmHg, 95%CI: 71-75 vs. 71 mmHg, 95CI: 70-71; P=0.04) after adjusting for covariates. Among participants taking lipid-lowering medication (n=937), low adherence was associated with higher mean low-density lipoprotein cholesterol (92 mg/dL, 95%CI: 87-96 vs. 86 mg/dL, 95%CI: 84-88; P=0.03). Low adherence was not associated with fasting plasma glucose (P=0.10) or hemoglobin A1c (P=0.68) in the subgroup of participants (n=192) taking hypoglycemic medication. Depressive symptoms might act as a barrier for medication adherence, which exacerbates CVD risk factors in older-aged adults. This article is protected by copyright. All rights reserved.

  16. Referral from primary care to a physical activity programme: establishing long-term adherence? A randomized controlled trial. Rationale and study design

    Directory of Open Access Journals (Sweden)

    Puig-Ribera Anna

    2009-01-01

    Full Text Available Abstract Background Declining physical activity is associated with a rising burden of global disease. There is little evidence about effective ways to increase adherence to physical activity. Therefore, interventions are needed that produce sustained increases in adherence to physical activity and are cost-effective. The purpose is to assess the effectiveness of a primary care physical activity intervention in increasing adherence to physical activity in the general population seen in primary care. Method and design Randomized controlled trial with systematic random sampling. A total of 424 subjects of both sexes will participate; all will be over the age of 18 with a low level of physical activity (according to the International Physical Activity Questionnaire, IPAQ, self-employed and from 9 Primary Healthcare Centres (PHC. They will volunteer to participate in a physical activity programme during 3 months (24 sessions; 2 sessions a week, 60 minutes per session. Participants from each PHC will be randomly allocated to an intervention (IG and control group (CG. The following parameters will be assessed pre and post intervention in both groups: (1 health-related quality of life (SF-12, (2 physical activity stage of change (Prochaska's stages of change, (3 level of physical activity (IPAQ-short version, (4 change in perception of health (vignettes from the Cooperative World Organization of National Colleges, Academies, and Academic Associations of Family Physicians, COOP/WONCA, (5 level of social support for the physical activity practice (Social Support for Physical Activity Scale, SSPAS, and (6 control based on analysis (HDL, LDL and glycated haemoglobin. Participants' frequency of visits to the PHC will be registered over the six months before and after the programme. There will be a follow up in a face to face interview three, six and twelve months after the programme, with the reduced version of IPAQ, SF-12, SSPAS, and Prochaska's stages

  17. An interprovincial cooperative game model for air pollution control in China.

    Science.gov (United States)

    Xue, Jian; Zhao, Laijun; Fan, Longzhen; Qian, Ying

    2015-07-01

    The noncooperative air pollution reduction model (NCRM) that is currently adopted in China to manage air pollution reduction of each individual province has inherent drawbacks. In this paper, we propose a cooperative air pollution reduction game model (CRM) that consists of two parts: (1) an optimization model that calculates the optimal pollution reduction quantity for each participating province to meet the joint pollution reduction goal; and (2) a model that distribute the economic benefit of the cooperation (i.e., pollution reduction cost saving) among the provinces in the cooperation based on the Shapley value method. We applied the CRM to the case of SO2 reduction in the Beijing-Tianjin-Hebei region in China. The results, based on the data from 2003-2009, show that cooperation helps lower the overall SO2 pollution reduction cost from 4.58% to 11.29%. Distributed across the participating provinces, such a cost saving from interprovincial cooperation brings significant benefits to each local government and stimulates them for further cooperation in pollution reduction. Finally, sensitivity analysis is performed using the year 2009 data to test the parameters' effects on the pollution reduction cost savings. China is increasingly facing unprecedented pressure for immediate air pollution control. The current air pollution reduction policy does not allow cooperation and is less efficient. In this paper we developed a cooperative air pollution reduction game model that consists of two parts: (1) an optimization model that calculates the optimal pollution reduction quantity for each participating province to meet the joint pollution reduction goal; and (2) a model that distributes the cooperation gains (i.e., cost reduction) among the provinces in the cooperation based on the Shapley value method. The empirical case shows that such a model can help improve efficiency in air pollution reduction. The result of the model can serve as a reference for Chinese government

  18. Benefits of University-Industry Cooperation for Innovations of Sustainable Biological Control

    Directory of Open Access Journals (Sweden)

    Daniela Althoff Philippi

    2015-04-01

    Full Text Available This study aims to identify the benefits of technological cooperation between the College of Agriculture Luiz de Queiroz – University of São Paulo (Esalq/USP and the start-up Bug, a company that operates in the biological control of pests as a sustainable alternative to traditional methods. This research was based on a case study regarding a technological cooperation, which resulted in sustainable innovation involving a biological control of pests through the use of a parasite wasp that naturally parasitize the sugarcane borer’s eggs, preventing the growth of caterpillars in field crops. The technological cooperation led the company to extend its cooperation to other educational and research institutions.

  19. A Dynamic Geocast Solution to Support Cooperative Adaptive Cruise Control (CACC) Merging

    NARCIS (Netherlands)

    Klein Wolterink, W.; Karagiannis, Georgios; Heijenk, Geert

    2010-01-01

    Cooperative Adaptive Cruise Control (CACC) is a type of cruise control in which the speed of a vehicle is controlled based on wireless communication between vehicles. In this paper we tackle the communication needed in case of fully automatic CACC merging at a junction. The first contribution of our

  20. Hierarchical Control Strategy for the Cooperative Braking System of Electric Vehicle

    OpenAIRE

    Jiankun Peng; Hongwen He; Wei Liu; Hongqiang Guo

    2015-01-01

    This paper provides a hierarchical control strategy for cooperative braking system of an electric vehicle with separated driven axles. Two layers are defined: the top layer is used to optimize the braking stability based on two sliding mode control strategies, namely, the interaxle control mode and signal-axle control strategies; the interaxle control strategy generates the ideal braking force distribution in general braking condition, and the single-axle control strategy can ensure braking s...

  1. Effects of a pharmaceutical care model on medication adherence and glycemic control of people with type 2 diabetes

    Directory of Open Access Journals (Sweden)

    Chung WW

    2014-09-01

    Full Text Available Wen Wei Chung,1,2 Siew Siang Chua,1 Pauline Siew Mei Lai,3 Siew Pheng Chan4 1Department of Pharmacy, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia; 2Pharmacy Department, University Malaya Medical Centre, Kuala Lumpur, Malaysia; 3Department of Primary Care Medicine, University Malaya Primary Care Research Group, 4Department of Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia Background: Diabetes mellitus is a lifelong chronic condition that requires self-management. Lifestyle modification and adherence to antidiabetes medications are the major determinants of therapeutic success in the management of diabetes.Purpose: To assess the effects of a pharmaceutical care (PC model on medication adherence and glycemic levels of people with type 2 diabetes mellitus. Patients and methods: A total of 241 people with type 2 diabetes were recruited from a major teaching hospital in Malaysia and allocated at random to the control (n=121 or intervention (n=120 groups. Participants in the intervention group received PC from an experienced pharmacist, whereas those in the control group were provided the standard pharmacy service. Medication adherence was assessed using the Malaysian Medication Adherence Scale, and glycemic levels (glycated hemoglobin values and fasting blood glucose [FBG] of participants were obtained at baseline and after 4, 8, and 12 months. Results: At baseline, there were no significant differences in demographic data, medication adherence, and glycemic levels between participants in the control and intervention groups. However, statistically significant differences in FBG and glycated hemoglobin values were observed between the control and intervention groups at months 4, 8, and 12 after the provision of PC (median FBG, 9.0 versus 7.2 mmol/L [P<0.001]; median glycated hemoglobin level, 9.1% versus 8.0% [P<0.001] at 12 months. Medication adherence was also significantly associated with the

  2. A Pharmaceutical Care Program to Improve Adherence to Statin Therapy : A Randomized Controlled Trial

    NARCIS (Netherlands)

    Eussen, Simone R. B. M.; van der Elst, Menno E.; Klungel, Olaf H.; Rompelberg, Cathy J. M.; Garssen, Johan; Oosterveld, Marco H.; de Boer, Anthonius; de Gier, Johan J.; Bouvy, Marcel L.

    2010-01-01

    BACKGROUND: Despite the well-known beneficial effects of statins, many patients do not adhere to chronic medication regimens. OBJECTIVE: To implement and assess the effectiveness of a community pharmacy based pharmaceutical care program developed to improve patients' adherence to statin therapy.

  3. Motivational Interviewing (MINT) Improves Continuous Positive Airway Pressure (CPAP) Acceptance and Adherence: A Randomized Controlled Trial

    Science.gov (United States)

    Olsen, Sara; Smith, Simon S.; Oei, Tian P. S.; Douglas, James

    2012-01-01

    Objective: Adherence to continuous positive airway pressure (CPAP) therapy for obstructive sleep apnoea (OSA) is poor. We assessed the effectiveness of a motivational interviewing intervention (motivational interview nurse therapy [MINT]) in addition to best practice standard care to improve acceptance and adherence to CPAP therapy in people with…

  4. Psychiatrist's adherence: a new factor in relapse prevention of schizophrenia. A randomized controlled study on relapse control through telemedicine system.

    Science.gov (United States)

    Spaniel, F; Novak, T; Bankovska Motlova, L; Capkova, J; Slovakova, A; Trancik, P; Matejka, M; Höschl, C

    2015-12-01

    Exposure to psychotic states has detrimental effects on the long-term outcome of schizophrenia and brain integrity. Therefore, improving relapse prevention is a key component of long-term management of schizophrenia. Previous studies using continuous monitoring of an individual's early signs of relapse and adopting preventative pharmacological interventions, when early signs are detected, showed promising clinical results in terms of relapse risk reduction. This 18-month multi-centre parallel randomized controlled, open label, trial with telemedicine relapse prevention programme ITAREPS failed to show superiority of maintenance plus prodrome-based targeted medication strategy over treatment as usual. The study, marked by low investigator's adherence, confirmed that absence of pharmacological intervention at early stage of prodrome, critically influenced the risk of relapse. This and previous randomized controlled trials with telemedicine programme ITAREPS suggested that substantial improvement in relapse prevention in schizophrenia is likely to be unattainable under current clinical settings. Future preventive strategies in schizophrenia would require rapid pharmacological intervention upon occurrence of subclinical prodromal symptoms that are undetectable under conventional outpatient practice. Studies with ITAREPS suggested that integration of telemedicine relapse prevention systems and visiting nurse service might together represent practical solution capable to address those requirements. The Information Technology Aided Relapse Prevention Programme in Schizophrenia (ITAREPS) presents a telemedicine solution for weekly monitoring and management of schizophrenia. This study aims to evaluate the effectiveness of the programme in reducing the number of hospitalizations during the 18-month multi-centre parallel randomized controlled, open label, trial. Outpatients with schizophrenia or schizoaffective disorder were randomized to the active (n = 74) or control group

  5. Cooperative Operating Control Based on Virtual Resources and User-Suited HCI

    Science.gov (United States)

    Choinski, Dariusz; Metzger, Mieczyslaw; Nocon, Witold

    The paper presents concept of virtual resources (VR) which improve multilevel, remote Internet-based operation of real-time controlled industrial processes. In comparison to classical directly connected-to-plant operations, the VR-based system introduces all typical features of its flexible nature, hiding the unnecessary implementation details from the process operators. The user-suited, human-computer interfaces (HCI) improve cooperation between specialists who must carry out operating control of the process. Realisation of such a system is based on the concept of maximal usage of particular specialist’s skills improving theirs cooperation. Although the proposed concept is dedicated to remote operating experimentation on real-time controlled industrial plants, it has also a more general aspect. As a case example, the cooperative operating control of a biotechnological pilot-plant is presented.

  6. A Combined Cooperative Braking Model with a Predictive Control Strategy in an Electric Vehicle

    Directory of Open Access Journals (Sweden)

    Hongqiang Guo

    2013-12-01

    Full Text Available Cooperative braking with regenerative braking and mechanical braking plays an important role in electric vehicles for energy-saving control. Based on the parallel and the series cooperative braking models, a combined model with a predictive control strategy to get a better cooperative braking performance is presented. The balance problem between the maximum regenerative energy recovery efficiency and the optimum braking stability is solved through an off-line process optimization stream with the collaborative optimization algorithm (CO. To carry out the process optimization stream, the optimal Latin hypercube design (Opt LHD is presented to discrete the continuous design space. To solve the poor real-time problem of the optimization, a high-precision predictive model based on the off-line optimization data of the combined model is built, and a predictive control strategy is proposed and verified through simulation. The simulation results demonstrate that the predictive control strategy and the combined model are reasonable and effective.

  7. Disease related knowledge, medication adherence and glycaemic control among patients with type 2 diabetes mellitus in Pakistan.

    Science.gov (United States)

    Nazir, Saeed Ur Rashid; Hassali, Mohamed Azmi; Saleem, Fahad; Bashir, Sajid; Aljadhey, Hisham

    2016-04-01

    The purpose of this study was to investigate the association of diabetes-related knowledge and treatment adherence with glycaemic control among patients with type 2 diabetes mellitus (T2DM) in Pakistan. The study was designed as a questionnaire-based, cross-sectional analysis. T2DM patients attending a public outpatient clinic in Sargodha, Pakistan, were targeted for the study. In addition to the demographic information, the Urdu version of Michigan Diabetes Knowledge Test and Morisky Medication Adherence Scale was used for data collection. Patients' medical records were reviewed for glycated haemoglobin levels (HbA1c). Descriptive statistics were used to elaborate sociodemographic characteristics. The Spearman's Rho correlation was used to measure association of disease-related knowledge and treatment adherence with glycaemic control. SPSS V 20.0 was used for data analysis and p2 T2DM patients were included in the study. The mean age (SD) of these patients was 50.77±9.671 years, 56.6% were males and 90% (n=353) of respondents were married. The mean (SD) duration of disease was 5.58 (4.09) years with median HbA1c of 9.00 (IQR=8.20-10.40). The median knowledge score was 8.0 (IQR=6.0-10.0), while the median adherence score was 4.7 (IQR=3.0-6.0). HbA1c had non-significant and weak negative association with diabetes-related knowledge (r=-0.036, p=0.404) and treatment adherence (r=-0.071, p=0.238). There was negative association reported between HbA1c, treatment adherence and diabetes-related knowledge. Greater efforts are clearly required to investigate other factors affecting glycaemic control among T2DM patients in Pakistan. Copyright © 2015 Primary Care Diabetes Europe. Published by Elsevier Ltd. All rights reserved.

  8. A study to assess the feasibility of undertaking a randomized controlled trial of adherence with eye drops in glaucoma patients

    Directory of Open Access Journals (Sweden)

    Richardson C

    2013-10-01

    Full Text Available Cliff Richardson,1 Lisa Brunton,1 Nicola Olleveant,1 David B Henson,1 Mark Pilling,1 Jane Mottershead,2 Cecilia H Fenerty,2 Anne Fiona Spencer,2 Heather Waterman1 1School of Nursing, Midwifery and Social Work, University of Manchester, 2Royal Manchester Eye Hospital, Central Manchester Foundation Trust, Manchester, United Kingdom Background: Adherence with therapy could influence the progression of glaucoma and ultimately affect the onset of visual impairment in some individuals. This feasibility study evaluated the measures to be used for a future randomized controlled trial assessing the effects of group-based education on adherence with eye drops. Methods: People diagnosed with glaucoma within the previous 12 months attending a regional ophthalmology clinic in the North West of England were recruited. A two-session education program delivered one week apart had been devised as part of a previous project. A combined adult learning and health needs approach to education was taken. Outcomes measured were knowledge of glaucoma, self-report of adherence, illness perception, beliefs about medicines, patient enablement, and general health (Short Form-12. Adherence was also measured objectively using a Medical Events Monitoring System device. Results: Twenty-six participants consented to undertake the educational program and 19 produced analyzable data. Knowledge of glaucoma, illness perception, beliefs about medicine, and patient enablement all showed statistically significant improvements after education. Mean adherence with eye drops was maintained above 85% before and for 3 months after attendance at the educational program. Self-report exaggerated adherence by at least 10% when compared with the objective Medical Events Monitoring System data, and in fact the kappa agreement was zero. Conclusion: All questionnaires other than the Short Form-12 were considered to be valuable measures and use of a Medical Events Monitoring System device was

  9. State of South Carolina Cooperative Aquatic Plant Control Program.

    Science.gov (United States)

    1980-11-01

    of a diquat and copper sulfate pentahydrate herbicide combination for hydrilla control was carried out by Yeo et. al. (1974). The copper was applied at...effective combination to control egeria and hydrilla (Gangstad, 1976). A diquat- copper sulfate combination is more effective in controlling hydrilla than the... copper resulting from the use of algacides or herbicides basic copper carbonate (malachite), copper sulfate , and copper tri- ethanolamine to control

  10. Tackling cancer control in the Gulf Cooperation Council Countries.

    Science.gov (United States)

    Al-Othman, Saleh; Haoudi, Abdelali; Alhomoud, Samar; Alkhenizan, Abdullah; Khoja, Tawfik; Al-Zahrani, Ali

    2015-05-01

    Cancer is a major health problem in both high income and middle-to-low income countries, and is the second leading cause of death in the world. Although more than a third of cancer could be prevented and another third could be cured if diagnosed early, it remains a huge challenge to health-care systems worldwide. Despite substantial improvements in health services some of the countries in the Gulf region, the burden of non-communicable diseases is a major threat, primarily due to the rapid socioeconomic shifts that have led to unfavourable changes in lifestyle such as increased tobacco use, decreased physical activity, and consumption of unhealthy food. In the Gulf Cooperation Council states (United Arab Emirates, Bahrain, Saudi Arabia, Oman, Qatar, and Kuwait), advanced breast cancer, colorectal cancer, leukaemia, thyroid cancer, and non-Hodgkin lymphomas are the most common cancers affecting younger populations compared with other countries. By contrast with cancer prevalence in developed countries, prostate, lung, and cervical cancers are not among the most common cancers in the Gulf region. In view of the increased cost of cancer management worldwide, integrated approaches between primary, secondary, and tertiary health-care systems with special focus on prevention and early detection is an essential step in the countries' efforts in the fight against cancer. Copyright © 2015 Elsevier Ltd. All rights reserved.

  11. Adherence of type 1-fimbriated Escherichia coli to uroepithelial cells: more in diabetic women than in control subjects

    NARCIS (Netherlands)

    Geerlings, Suzanne E.; Meiland, Ruby; van Lith, Emiel C.; Brouwer, Ellen C.; Gaastra, Wim; Hoepelman, Andy I. M.

    2002-01-01

    OBJECTIVE: Women with diabetes have bacteriuria more often than women without diabetes. Because Escherichia coli adhere better to vaginal cells of nondiabetic patients with recurrent urinary tract infections (UTIs) than to those obtained from healthy control subjects, it was hypothesized that E.

  12. Electronic Monitoring-Based Counseling to Enhance Adherence Among HIV-Infected Patients: A Randomized Controlled Trial

    NARCIS (Netherlands)

    de Bruin, Marijn; Hospers, Harm J.; van Breukelen, Gerard J. P.; Kok, Gerjo; Koevoets, William M.; Prins, Jan M.

    2010-01-01

    Objective: To investigated the effectiveness of an adherence intervention (AIMS) designed to fit HIV-clinics' routine care procedures. Design: Through block randomization, patients were allocated to the intervention or control group. The study included 2 months baseline measurement, 3 months

  13. Risk factor control, adherence to medication and follow up visit, five years after coronary artery bypass graft surgery

    Directory of Open Access Journals (Sweden)

    Arsalan Salari

    2016-12-01

    Results: 196 patients were recruited to the study. Uncontrolled blood pressure, blood glucose and low-density lipoprotein (LDLwere reported in 48%, 61% and 32% of patients, respectively. More than 63% of former smokers restarted smoking during 6-12 months after bypass. Poor medication adherence was present in 10.7% in the study population. The last follow up visit time for 30% of patients was later than 12 months after CABG. Conclusion: Poor risk factors control and adherence to follow up visits was common among patients undergoing CABG.

  14. A practice-based randomized controlled trial to improve medication adherence among Latinos with hypertension: study protocol for a randomized controlled trial.

    Science.gov (United States)

    Schoenthaler, Antoinette; De La Calle, Franzenith; Barrios-Barrios, Miguel; Garcia, Aury; Pitaro, Maria; Lum, Audrey; Rosal, Milagros

    2015-07-02

    Latinos experience disproportionately higher rates of uncontrolled hypertension as compared to Blacks and Whites. While poor adherence is a major contributor to disparities in blood pressure control, data in Latino patients are scant. More importantly, translation of interventions to improve medication adherence in community-based primary care practices, where the majority of Latino patients receive their care is non-existent. Using a randomized controlled design, this study evaluates the effectiveness of a culturally tailored, practice-based intervention compared to usual care on medication adherence, among 148 Latino patients with uncontrolled hypertension who are non-adherent to their antihypertensive medications. Bilingual medical assistants trained as Health Coaches deliver the intervention using an electronic medical record system-embedded adherence script. Patients randomized to the intervention group receive patient-centered counseling with a Health Coach to develop individualized self-monitoring strategies to overcome barriers and improve adherence behaviors. Health Coach sessions are held biweekly for the first 3 months (6 sessions total) and then monthly for the remaining 3 months (3 sessions total). Patients randomized to the usual care group receive standard hypertension treatment recommendations as determined by their primary care providers. The primary outcome is the rate of medication adherence at 6 months. The secondary outcome is reduction in systolic and diastolic blood pressure at 6 months. If successful, findings from this study will provide salient information on the translation of culturally tailored, evidence-based interventions targeted at medication adherence and blood pressure control into practice-based settings for this high-risk population. NCT01643473 on 16 July 2012.

  15. Cooperative Monitoring Center Occasional Paper/4: Missile Control in South Asia and the Role of Cooperative Monitoring Technology

    Energy Technology Data Exchange (ETDEWEB)

    Kamal, N.; Sawhney, P.

    1998-10-01

    The succession of nuclear tests by India and Pakistan in May 1998 has changed the nature of their missile rivalry, which is only one of numerous manifestations of their relationship as hardened adversaries, deeply sensitive to each other's existing and evolving defense capabilities. The political context surrounding this costly rivalry remains unmediated by arms control measures or by any nascent prospect of detente. As a parallel development, sensible voices in both countries will continue to talk of building mutual confidence through openness to avert accidents, misjudgments, and misinterpretations. To facilitate a future peace process, this paper offers possible suggestions for stabilization that could be applied to India's and Pakistan's missile situation. Appendices include descriptions of existing missile agreements that have contributed to better relations for other countries as well as a list of the cooperative monitoring technologies available to provide information useful in implementing subcontinent missile regimes.

  16. Repackaged sodium valproate tablets--Meeting quality and adherence to ensure seizure control.

    Science.gov (United States)

    Redmayne, Nichola; Robertson, Sherryl; Kockler, Jutta; Llewelyn, Victoria; Haywood, Alison; Glass, Beverley

    2015-09-01

    Sodium valproate, which is commonly repacked to assist with adherence to ensure seizure control, is hygroscopic and therefore sensitive to moisture. The aim of this study was thus to determine the stability implications of removing the enteric coated tablets from their original packaging and repackaging into a Dose Administration Aid (DAA) with storage under various environmental conditions. Physicochemical stability of enteric coated sodium valproate tablets repackaged into a DAA and stored at controlled room temperature, accelerated and refrigerated conditions was evaluated for 28 days. A validated high performance liquid chromatography method was used for the quantitation of the drug content. Although the chemical stability (sodium valproate between 95 and 105% of labelled content) was maintained for 28 days for all storage conditions, for those tablets stored under accelerated conditions the integrity of the enteric coat was compromised after only 8 days. Repackaging of enteric coated sodium valproate should be undertaken with caution and be informed by storage climate. This is particularly relevant for those patients living in hot, humid environments where they should be advised to store their DAA in a refrigerator. Copyright © 2015 British Epilepsy Association. Published by Elsevier Ltd. All rights reserved.

  17. The impact of knowledge and attitudes on adherence to tuberculosis treatment: a case-control study in a Moroccan region

    Science.gov (United States)

    Tachfouti, Nabil; Slama, Katia; Berraho, Mohammed; Nejjari, Chakib

    2012-01-01

    Background Although tuberculosis (TB) care is provided free of charge in Morocco, a high number of patients voluntarily interrupt their treatment before the end. Treatment Default is a major obstacle in the fight against the disease. The purpose of this study was to describe the impact of knowledge and attitudes toward TB on treatment adherence. Methods Case-control study of 290 TB patients (85 defaulters and 205 controls). A defaulter was defined as a TB patient who interrupted treatment for two months or longer. Socio-demographic measurements, knowledge and attitude were collected by face to face anonymous questionnaire. Khi-square test was conducted to examine differences in TB attitudes and knowledge according to treatment adherence. Results The mean age of participants was 31.7 ± 12.0 years. Monthly income was under 2000 MAD (180 €) for 82% of them. Over sixty four percent were illiterate or had a basic educational level. Microbial cause was known by 17.2% respondents; 20.5% among adherent patients versus 9.4% (p=0.02). The fact that the disease is curable was more known by adherent patients: 99.0% versus 88.2% (p < 0.01). Eighty tree per cent of patients had been informed about treatment duration and consequences of not completing treatment: 89.0% among adherent patients versus 69.7% (p<0.001). The main reason evoked for defaulting was the sensation of being cured (72.9% of defaulters). Conclusion This study shows a poor knowledge on TB especially among non adherent patients. This finding justifies the need to incorporate patient's education into current TB case management. PMID:22937192

  18. A CRITICAL-APPRAISAL OF POSITIVE COOPERATIVITY IN ORAL STREPTOCOCCAL ADHESION - SCATCHARD ANALYSES OF ADHESION DATA VERSUS ANALYSES OF THE SPATIAL ARRANGEMENT OF ADHERING BACTERIA

    NARCIS (Netherlands)

    VANDERMEI, HC; COX, SD; GEERTSEMADOORNBUSCH, GI; DOYLE, RJ; BUSSCHER, HJ

    Positive cooperativity is a mechanism proposed to account for the adhesion of bacteria to surfaces. In this paper, two methods that both claim to assess experimentally cooperative phenomena, viz. Scatchard analysis of adhesion data (using adhesion to vials) and analysis of the spatial arrangement of

  19. Cooperative Control for Uncertain Multiagent Systems via Distributed Output Regulation

    Directory of Open Access Journals (Sweden)

    Lu Yu

    2013-01-01

    Full Text Available The distributed robust output regulation problem for multiagent systems is considered. For heterogeneous uncertain linear systems and a linear exosystem, the controlling aim is to stabilize the closed-loop system and meanwhile let the regulated outputs converge to the origin asymptotically, by the help of local interaction. The communication topology considered is directed acyclic graphs, which means directed graphs without loops. With distributed dynamic state feedback controller and output feedback controller, respectively, the solvability of the problem and the algorithm of controller design are both investigated. The solvability conditions are given in terms of linear matrix inequalities (LMIs. It is shown that, for polytopic uncertainties, the distributed controllers constructed by solving LMIs can satisfy the requirements of output regulation property.

  20. In patients with severe uncontrolled asthma, does knowledge of adherence and inhaler technique using electronic monitoring improve clinical decision making? A protocol for a randomised controlled trial.

    LENUS (Irish Health Repository)

    Mokoka, Matshediso C

    2017-06-15

    Many patients with asthma remain poorly controlled despite the use of inhaled corticosteroids and long-acting beta agonists. Poor control may arise from inadequate adherence, incorrect inhaler technique or because the condition is refractory. Without having an objective assessment of adherence, clinicians may inadvertently add extra medication instead of addressing adherence. This study aims to assess if incorporating objectively recorded adherence from the Inhaler Compliance Assessment (INCA) device and lung function into clinical decision making provides more cost-effective prescribing and improves outcomes.

  1. Cooperation-Controlled Learning for Explicit Class Structure in Self-Organizing Maps

    Science.gov (United States)

    Kamimura, Ryotaro

    2014-01-01

    We attempt to demonstrate the effectiveness of multiple points of view toward neural networks. By restricting ourselves to two points of view of a neuron, we propose a new type of information-theoretic method called “cooperation-controlled learning.” In this method, individual and collective neurons are distinguished from one another, and we suppose that the characteristics of individual and collective neurons are different. To implement individual and collective neurons, we prepare two networks, namely, cooperative and uncooperative networks. The roles of these networks and the roles of individual and collective neurons are controlled by the cooperation parameter. As the parameter is increased, the role of cooperative networks becomes more important in learning, and the characteristics of collective neurons become more dominant. On the other hand, when the parameter is small, individual neurons play a more important role. We applied the method to the automobile and housing data from the machine learning database and examined whether explicit class boundaries could be obtained. Experimental results showed that cooperation-controlled learning, in particular taking into account information on input units, could be used to produce clearer class structure than conventional self-organizing maps. PMID:25309950

  2. Cooperation-Controlled Learning for Explicit Class Structure in Self-Organizing Maps

    Directory of Open Access Journals (Sweden)

    Ryotaro Kamimura

    2014-01-01

    Full Text Available We attempt to demonstrate the effectiveness of multiple points of view toward neural networks. By restricting ourselves to two points of view of a neuron, we propose a new type of information-theoretic method called “cooperation-controlled learning.” In this method, individual and collective neurons are distinguished from one another, and we suppose that the characteristics of individual and collective neurons are different. To implement individual and collective neurons, we prepare two networks, namely, cooperative and uncooperative networks. The roles of these networks and the roles of individual and collective neurons are controlled by the cooperation parameter. As the parameter is increased, the role of cooperative networks becomes more important in learning, and the characteristics of collective neurons become more dominant. On the other hand, when the parameter is small, individual neurons play a more important role. We applied the method to the automobile and housing data from the machine learning database and examined whether explicit class boundaries could be obtained. Experimental results showed that cooperation-controlled learning, in particular taking into account information on input units, could be used to produce clearer class structure than conventional self-organizing maps.

  3. Dynamic tensegrity based cooperative control of uninhabited vehicles

    Energy Technology Data Exchange (ETDEWEB)

    Lau, Sook Yen; Naeem, Wasif [Queen' s Univ., Belfast (United Kingdom). School of Electronics, Electrical Engineering and Computer Science

    2013-07-01

    A new formation control methodology is presented in this paper. The proposed technique is modelled by using the concept of cross-tensegrity structures. The main task is to regulate the desired formation of a group of vehicles and to perform point-to-point manoeuvring in the plane. The position of the controlled vehicles in the formation changes with respect to the admissible tendon forces by varying the lengths of bars in the dynamic tensegrity structure modelling. This change of bars' dimensions for geometric transformation is not possible in the application of tensegrity concept in the physical structural engineering. It has been demonstrated that this control method allows more flexibility over a wide range of different shape switching tasks using the predictable tendon control forces under the limited communication's range. The proposed approach is also scalable to any number of pairs of autonomous vehicles in the formation.

  4. Cooperative Control of Regenerative Braking and Antilock Braking for a Hybrid Electric Vehicle

    Directory of Open Access Journals (Sweden)

    Guodong Yin

    2013-01-01

    Full Text Available A new cooperative braking control strategy (CBCS is proposed for a parallel hybrid electric vehicle (HEV with both a regenerative braking system and an antilock braking system (ABS to achieve improved braking performance and energy regeneration. The braking system of the vehicle is based on a new method of HEV braking torque distribution that makes the antilock braking system work together with the regenerative braking system harmoniously. In the cooperative braking control strategy, a sliding mode controller (SMC for ABS is designed to maintain the wheel slip within an optimal range by adjusting the hydraulic braking torque continuously; to reduce the chattering in SMC, a boundary-layer method with moderate tuning of a saturation function is also investigated; based on the wheel slip ratio, battery state of charge (SOC, and the motor speed, a fuzzy logic control strategy (FLC is applied to adjust the regenerative braking torque dynamically. In order to evaluate the performance of the cooperative braking control strategy, the braking system model of a hybrid electric vehicle is built in MATLAB/SIMULINK. It is found from the simulation that the cooperative braking control strategy suggested in this paper provides satisfactory braking performance, passenger comfort, and high regenerative efficiency.

  5. Blood pressure control and treatment adherence in hypertensive patients with metabolic syndrome: protocol of a randomized controlled study based on home blood pressure telemonitoring vs. conventional management and assessment of psychological determinants of adherence (TELEBPMET Study

    Directory of Open Access Journals (Sweden)

    Parati Gianfranco

    2013-01-01

    Full Text Available Abstract Background Inadequate blood pressure control and poor adherence to treatment remain among the major limitations in the management of hypertensive patients, particularly of those at high risk of cardiovascular events. Preliminary evidence suggests that home blood pressure telemonitoring (HBPT might help increasing the chance of achieving blood pressure targets and improve patient’s therapeutic adherence. However, all these potential advantages of HBPT have not yet been fully investigated. Methods/design The purpose of this open label, parallel group, randomized, controlled study is to assess whether, in patients with high cardiovascular risk (treated or untreated essential arterial hypertension - both in the office and in ambulatory conditions over 24 h - and metabolic syndrome, long-term (48 weeks blood pressure control is more effective when based on HBPT and on the feedback to patients by their doctor between visits, or when based exclusively on blood pressure determination during quarterly office visits (conventional management (CM. A total of 252 patients will be enrolled and randomized to usual care (n=84 or HBPT (n=168. The primary study endpoint will be the rate of subjects achieving normal daytime ambulatory blood pressure targets ( Discussion The TELEBPMET Study will show whether HBPT is effective in improving blood pressure control and related medical and economic outcomes in hypertensive patients with metabolic syndrome. It will also provide a comprehensive understanding of the psychological determinants of medication adherence and blood pressure control of these patients. Trial registration Clinical Trials.gov: NCT01541566

  6. A Web-Based and Mobile Health Social Support Intervention to Promote Adherence to Inhaled Asthma Medications: Randomized Controlled Trial

    Science.gov (United States)

    Koufopoulos, Justin T; Conner, Mark T; Gardner, Peter H

    2016-01-01

    Background Online communities hold great potential as interventions for health, particularly for the management of chronic illness. The social support that online communities can provide has been associated with positive treatment outcomes, including medication adherence. There are few studies that have attempted to assess whether membership of an online community improves health outcomes using rigorous designs. Objective Our objective was to conduct a rigorous proof-of-concept randomized controlled trial of an online community intervention for improving adherence to asthma medicine. Methods This 9-week intervention included a sample of asthmatic adults from the United Kingdom who were prescribed an inhaled corticosteroid preventer. Participants were recruited via email and randomized to either an “online community” or “no online community” (diary) condition. After each instance of preventer use, participants (N=216) were required to report the number of doses of medication taken in a short post. Those randomized to the online community condition (n=99) could read the posts of other community members, reply, and create their own posts. Participants randomized to the no online community condition (n=117) also posted their medication use, but could not read others’ posts. The main outcome measures were self-reported medication adherence at baseline and follow-up (9 weeks postbaseline) and an objective measure of adherence to the intervention (visits to site). Results In all, 103 participants completed the study (intervention: 37.8%, 39/99; control: 62.2%, 64/117). MANCOVA of self-reported adherence to asthma preventer medicine at follow-up was not significantly different between conditions in either intention-to-treat (P=.92) or per-protocol (P=.68) analysis. Site use was generally higher in the control compared to intervention conditions. Conclusions Joining an online community did not improve adherence to preventer medication for asthma patients. Without

  7. Distributed cooperating processes in a mobile robot control system

    Science.gov (United States)

    Skillman, Thomas L., Jr.

    1988-01-01

    A mobile inspection robot has been proposed for the NASA Space Station. It will be a free flying autonomous vehicle that will leave a berthing unit to accomplish a variety of inspection tasks around the Space Station, and then return to its berth to recharge, refuel, and transfer information. The Flying Eye robot will receive voice communication to change its attitude, move at a constant velocity, and move to a predefined location along a self generated path. This mobile robot control system requires integration of traditional command and control techniques with a number of AI technologies. Speech recognition, natural language understanding, task and path planning, sensory abstraction and pattern recognition are all required for successful implementation. The interface between the traditional numeric control techniques and the symbolic processing to the AI technologies must be developed, and a distributed computing approach will be needed to meet the real time computing requirements. To study the integration of the elements of this project, a novel mobile robot control architecture and simulation based on the blackboard architecture was developed. The control system operation and structure is discussed.

  8. Cooperative Control for A Hybrid Rehabilitation System Combining Functional Electrical Stimulation and Robotic Exoskeleton.

    Science.gov (United States)

    Zhang, Dingguo; Ren, Yong; Gui, Kai; Jia, Jie; Xu, Wendong

    2017-01-01

    Functional electrical stimulation (FES) and robotic exoskeletons are two important technologies widely used for physical rehabilitation of paraplegic patients. We developed a hybrid rehabilitation system (FEXO Knee) that combined FES and an exoskeleton for swinging movement control of human knee joints. This study proposed a novel cooperative control strategy, which could realize arbitrary distribution of torque generated by FES and exoskeleton, and guarantee harmonic movements. The cooperative control adopted feedfoward control for FES and feedback control for exoskeleton. A parameter regulator was designed to update key parameters in real time to coordinate FES controller and exoskeleton controller. Two muscle groups (quadriceps and hamstrings) were stimulated to generate active torque for knee joint in synchronization with torque compensation from exoskeleton. The knee joint angle and the interactive torque between exoskeleton and shank were used as feedback signals for the control system. Central pattern generator (CPG) was adopted that acted as a phase predictor to deal with phase confliction of motor patterns, and realized synchronization between the two different bodies (shank and exoskeleton). Experimental evaluation of the hybrid FES-exoskeleton system was conducted on five healthy subjects and four paraplegic patients. Experimental results and statistical analysis showed good control performance of the cooperative control on torque distribution, trajectory tracking, and phase synchronization.

  9. Cooperative Control for A Hybrid Rehabilitation System Combining Functional Electrical Stimulation and Robotic Exoskeleton

    Directory of Open Access Journals (Sweden)

    Dingguo Zhang

    2017-12-01

    Full Text Available Functional electrical stimulation (FES and robotic exoskeletons are two important technologies widely used for physical rehabilitation of paraplegic patients. We developed a hybrid rehabilitation system (FEXO Knee that combined FES and an exoskeleton for swinging movement control of human knee joints. This study proposed a novel cooperative control strategy, which could realize arbitrary distribution of torque generated by FES and exoskeleton, and guarantee harmonic movements. The cooperative control adopted feedfoward control for FES and feedback control for exoskeleton. A parameter regulator was designed to update key parameters in real time to coordinate FES controller and exoskeleton controller. Two muscle groups (quadriceps and hamstrings were stimulated to generate active torque for knee joint in synchronization with torque compensation from exoskeleton. The knee joint angle and the interactive torque between exoskeleton and shank were used as feedback signals for the control system. Central pattern generator (CPG was adopted that acted as a phase predictor to deal with phase confliction of motor patterns, and realized synchronization between the two different bodies (shank and exoskeleton. Experimental evaluation of the hybrid FES-exoskeleton system was conducted on five healthy subjects and four paraplegic patients. Experimental results and statistical analysis showed good control performance of the cooperative control on torque distribution, trajectory tracking, and phase synchronization.

  10. Cooperative Control of Swarms of Unmanned Aerial Vehicles

    NARCIS (Netherlands)

    De Vries, E.; Subbarao, K.

    2011-01-01

    Potential function based swarm control is a technique using artificial potential functions to generate steering commands resulting in swarming behavior. This means that the vehicles in the swarm autonomously take care of flying in formation, resulting in steering the swarm, instead of all the

  11. A Probabilistic and Highly Efficient Topology Control Algorithm for Underwater Cooperating AUV Networks

    Science.gov (United States)

    Li, Ning; Cürüklü, Baran; Bastos, Joaquim; Sucasas, Victor; Fernandez, Jose Antonio Sanchez; Rodriguez, Jonathan

    2017-01-01

    The aim of the Smart and Networking Underwater Robots in Cooperation Meshes (SWARMs) project is to make autonomous underwater vehicles (AUVs), remote operated vehicles (ROVs) and unmanned surface vehicles (USVs) more accessible and useful. To achieve cooperation and communication between different AUVs, these must be able to exchange messages, so an efficient and reliable communication network is necessary for SWARMs. In order to provide an efficient and reliable communication network for mission execution, one of the important and necessary issues is the topology control of the network of AUVs that are cooperating underwater. However, due to the specific properties of an underwater AUV cooperation network, such as the high mobility of AUVs, large transmission delays, low bandwidth, etc., the traditional topology control algorithms primarily designed for terrestrial wireless sensor networks cannot be used directly in the underwater environment. Moreover, these algorithms, in which the nodes adjust their transmission power once the current transmission power does not equal an optimal one, are costly in an underwater cooperating AUV network. Considering these facts, in this paper, we propose a Probabilistic Topology Control (PTC) algorithm for an underwater cooperating AUV network. In PTC, when the transmission power of an AUV is not equal to the optimal transmission power, then whether the transmission power needs to be adjusted or not will be determined based on the AUV’s parameters. Each AUV determines their own transmission power adjustment probability based on the parameter deviations. The larger the deviation, the higher the transmission power adjustment probability is, and vice versa. For evaluating the performance of PTC, we combine the PTC algorithm with the Fuzzy logic Topology Control (FTC) algorithm and compare the performance of these two algorithms. The simulation results have demonstrated that the PTC is efficient at reducing the transmission power

  12. A Probabilistic and Highly Efficient Topology Control Algorithm for Underwater Cooperating AUV Networks.

    Science.gov (United States)

    Li, Ning; Cürüklü, Baran; Bastos, Joaquim; Sucasas, Victor; Fernandez, Jose Antonio Sanchez; Rodriguez, Jonathan

    2017-05-04

    The aim of the Smart and Networking Underwater Robots in Cooperation Meshes (SWARMs) project is to make autonomous underwater vehicles (AUVs), remote operated vehicles (ROVs) and unmanned surface vehicles (USVs) more accessible and useful. To achieve cooperation and communication between different AUVs, these must be able to exchange messages, so an efficient and reliable communication network is necessary for SWARMs. In order to provide an efficient and reliable communication network for mission execution, one of the important and necessary issues is the topology control of the network of AUVs that are cooperating underwater. However, due to the specific properties of an underwater AUV cooperation network, such as the high mobility of AUVs, large transmission delays, low bandwidth, etc., the traditional topology control algorithms primarily designed for terrestrial wireless sensor networks cannot be used directly in the underwater environment. Moreover, these algorithms, in which the nodes adjust their transmission power once the current transmission power does not equal an optimal one, are costly in an underwater cooperating AUV network. Considering these facts, in this paper, we propose a Probabilistic Topology Control (PTC) algorithm for an underwater cooperating AUV network. In PTC, when the transmission power of an AUV is not equal to the optimal transmission power, then whether the transmission power needs to be adjusted or not will be determined based on the AUV's parameters. Each AUV determines their own transmission power adjustment probability based on the parameter deviations. The larger the deviation, the higher the transmission power adjustment probability is, and vice versa. For evaluating the performance of PTC, we combine the PTC algorithm with the Fuzzy logic Topology Control (FTC) algorithm and compare the performance of these two algorithms. The simulation results have demonstrated that the PTC is efficient at reducing the transmission power

  13. A Probabilistic and Highly Efficient Topology Control Algorithm for Underwater Cooperating AUV Networks

    Directory of Open Access Journals (Sweden)

    Ning Li

    2017-05-01

    Full Text Available The aim of the Smart and Networking Underwater Robots in Cooperation Meshes (SWARMs project is to make autonomous underwater vehicles (AUVs, remote operated vehicles (ROVs and unmanned surface vehicles (USVs more accessible and useful. To achieve cooperation and communication between different AUVs, these must be able to exchange messages, so an efficient and reliable communication network is necessary for SWARMs. In order to provide an efficient and reliable communication network for mission execution, one of the important and necessary issues is the topology control of the network of AUVs that are cooperating underwater. However, due to the specific properties of an underwater AUV cooperation network, such as the high mobility of AUVs, large transmission delays, low bandwidth, etc., the traditional topology control algorithms primarily designed for terrestrial wireless sensor networks cannot be used directly in the underwater environment. Moreover, these algorithms, in which the nodes adjust their transmission power once the current transmission power does not equal an optimal one, are costly in an underwater cooperating AUV network. Considering these facts, in this paper, we propose a Probabilistic Topology Control (PTC algorithm for an underwater cooperating AUV network. In PTC, when the transmission power of an AUV is not equal to the optimal transmission power, then whether the transmission power needs to be adjusted or not will be determined based on the AUV’s parameters. Each AUV determines their own transmission power adjustment probability based on the parameter deviations. The larger the deviation, the higher the transmission power adjustment probability is, and vice versa. For evaluating the performance of PTC, we combine the PTC algorithm with the Fuzzy logic Topology Control (FTC algorithm and compare the performance of these two algorithms. The simulation results have demonstrated that the PTC is efficient at reducing the

  14. ALLIANCE: An architecture for fault tolerant, cooperative control of heterogeneous mobile robots

    Energy Technology Data Exchange (ETDEWEB)

    Parker, L.E.

    1995-02-01

    This research addresses the problem of achieving fault tolerant cooperation within small- to medium-sized teams of heterogeneous mobile robots. The author describes a novel behavior-based, fully distributed architecture, called ALLIANCE, that utilizes adaptive action selection to achieve fault tolerant cooperative control in robot missions involving loosely coupled, largely independent tasks. The robots in this architecture possess a variety of high-level functions that they can perform during a mission, and must at all times select an appropriate action based on the requirements of the mission, the activities of other robots, the current environmental conditions, and their own internal states. Since such cooperative teams often work in dynamic and unpredictable environments, the software architecture allows the team members to respond robustly and reliably to unexpected environmental changes and modifications in the robot team that may occur due to mechanical failure, the learning of new skills, or the addition or removal of robots from the team by human intervention. After presenting ALLIANCE, the author describes in detail experimental results of an implementation of this architecture on a team of physical mobile robots performing a cooperative box pushing demonstration. These experiments illustrate the ability of ALLIANCE to achieve adaptive, fault-tolerant cooperative control amidst dynamic changes in the capabilities of the robot team.

  15. Distributed control of multi-robot teams: Cooperative baton passing task

    Energy Technology Data Exchange (ETDEWEB)

    Parker, L.E.

    1998-11-01

    This research addresses the problem of achieving fault tolerant cooperation within small- to medium-sized teams of heterogeneous mobile robots. The author describes a novel behavior-based, fully distributed architecture, called ALLIANCE, that utilizes adaptive action selection to achieve fault tolerant cooperative control. The robots in this architecture possess a variety of high-level functions that they can perform during a mission, and must at all times select an appropriate action based on the requirements of the mission, the activities of other robots, the current environmental conditions, and their own internal states. Since such cooperative teams often work in dynamic and unpredictable environments, the software architecture allows the team members to respond robustly and reliably to unexpected environmental changes and modifications in the robot team that may occur due to mechanical failure, the learning of new skills, or the addition or removal of robots from the team by human intervention. After presenting ALLIANCE, they describe the implementation of this architecture on a team of physical mobile robots performing a cooperative baton passing task. These experiments illustrate the ability of ALLIANCE to achieve adaptive, fault-tolerant cooperative control amidst dynamic changes during the task.

  16. Adaptive Opportunistic Cooperative Control Mechanism Based on Combination Forecasting and Multilevel Sensing Technology of Sensors for Mobile Internet of Things

    Directory of Open Access Journals (Sweden)

    Yong Jin

    2014-01-01

    Full Text Available In mobile Internet of Things, there are many challenges, including sensing technology of sensors, how and when to join cooperative transmission, and how to select the cooperative sensors. To address these problems, we studied the combination forecasting based on the multilevel sensing technology of sensors, building upon which we proposed the adaptive opportunistic cooperative control mechanism based on the threshold values such as activity probability, distance, transmitting power, and number of relay sensors, in consideration of signal to noise ratio and outage probability. More importantly, the relay sensors would do self-test real time in order to judge whether to join the cooperative transmission, for maintaining the optimal cooperative transmission state with high performance. The mathematical analyses results show that the proposed adaptive opportunistic cooperative control approach could perform better in terms of throughput ratio, packet error rate and delay, and energy efficiency, compared with the direct transmission and opportunistic cooperative approaches.

  17. A Dynamic Geocast Solution to Support Cooperative Adaptive Cruise Control (CACC) Merging

    OpenAIRE

    Klein Wolterink, W.; Karagiannis, Georgios; Heijenk, Geert

    2010-01-01

    Cooperative Adaptive Cruise Control (CACC) is a type of cruise control in which the speed of a vehicle is controlled based on wireless communication between vehicles. In this paper we tackle the communication needed in case of fully automatic CACC merging at a junction. The first contribution of our paper is to show that to target the vehicles involved we need a special kind of geocast that takes both the geographical location and the dynamics (speed, acceleration) of a vehicle into account. ...

  18. Cooperative Output Regulation of Heterogeneous Linear Multi-Agent Systems by Event-Triggered Control.

    Science.gov (United States)

    Hu, Wenfeng; Liu, Lu

    2017-01-01

    In this paper, we consider the cooperative output regulation problem of heterogeneous linear multi-agent systems (MASs) by event-triggered control. We first develop an event-triggering mechanism for leader-following consensus of homogeneous MASs. Then by proposing an internal reference model for each agent, a novel distributed event-triggered control scheme is developed to solve the cooperative output regulation problem of heterogeneous MASs. Furthermore, a novel self-triggered control scheme is also proposed, such that continuous monitoring of measurement errors can be avoided. The feasibility of both proposed control schemes is studied by excluding Zeno behavior for each agent. An example is finally provided to demonstrate the effectiveness of the control schemes.

  19. The Role of Inhibitory Control in Children's Cooperative Behaviors during a Structured Puzzle Task

    Science.gov (United States)

    Giannotta, Fabrizia; Burk, William J.; Ciairano, Silvia

    2011-01-01

    This study examined the role of inhibitory control (measured by Stroop interference) in children's cooperative behaviors during a structured puzzle task. The sample consisted of 250 8-, 10-, and 12-year-olds (117 girls and 133 boys) attending classrooms in three primary schools in Northern Italy. Children individually completed an elaborated…

  20. Automatic Access Control Based on Face and Hand Biometrics in A Non-Cooperative Context

    DEFF Research Database (Denmark)

    Jahromi, Mohammad Naser Sabet; Bonderup, Morten Bojesen; Nasrollahi, Kamal

    2018-01-01

    Automatic access control systems (ACS) based on the human biometrics or physical tokens are widely employed in public and private areas. Yet these systems, in their conventional forms, are restricted to active interaction from the users. In scenarios where users are not cooperating with the system...

  1. Towards on-the-road implementation of cooperative adaptive cruise control

    NARCIS (Netherlands)

    Naus, G.J.L.; Vugts, R.; Ploeg, J.; Molengraft, R. van de; Steinbuch, M.

    2009-01-01

    This paper presents a setup for cooperative adaptive cruise control for which feasibility of the actual implementation is one of the main objectives. The approach considers communication with the directly preceding vehicle only, can deal with heterogeneous traffic, accounts for communication delay,

  2. Simplifying regimens promotes greater adherence and outcomes with topical acne medications: a randomized controlled trial.

    Science.gov (United States)

    Yentzer, Brad A; Ade, Rachel A; Fountain, Julie M; Clark, Adele R; Taylor, Sarah L; Fleischer, Alan B; Feldman, Steven R

    2010-08-01

    New combination topical formulations for the treatment of acne may improve outcomes by increasing adherence. We assessed adherence to and efficacy of a combination topical medication for acne applied once daily compared with daily applications of 2 separate generic subcomponents. Twenty-six participants with mild to moderate acne vulgaris were randomized to 12 weeks of once daily application of clindamycin phosphate 7.2%-tretinoin 0.025% gel (CTG) combination product or separate daily applications of clindamycin phosphate gel 1% and tretinoin cream 0.025% (C gel + T cream) for a total of 2 applications daily. Disease severity was measured at baseline and weeks 4, 8, and 12. Adherence was monitored using electronic monitoring caps on the medication tubes. Of the 26 participants enrolled, 21 completed the 12-week study. Median adherence in the CTG group was 88% compared with 61% in the C gel + T cream group. There was a 51% mean reduction in total lesions for the CTG group versus a 32% mean reduction for the C gel + T cream group by the end of the study. Both CTG and separate applications of C gel + T cream improved mild to moderate acne. The use of a once daily combination product has the advantage of promoting better adherence and clinical outcomes.

  3. [Modifying habits and treatment adherence, essential for controlling the chronic disease].

    Science.gov (United States)

    Pisano González, Marta M; González Pisano, Ana

    2014-01-01

    Therapeutic adherence is defined as the extent to which a person's behavior (taking medications, following a diet and changes in lifestyle) coincides with health recommendations (WHO, 2004). We can deduce that is a multiple, complex and changing phenomenon, that there can be total or partial adherence to a treatment, and depending on timing and circumstances. Lack of adherence is a worrying problem; due to its great magnitude and complexity (over two hundred factors) it is responsible for the increased morbid-mortality, complications, hospital admissions, health costs, and dissatisfaction of the user and health professionals. In this paper we develop effective interventions in changing habits and improving adherence: cognitive (education and improved communication), behavior and motivation. Interventions areas include pharmacological treatments, habits and life style, as well as social and family support. The most effective model emphasizes self-care and self-responsibility of the user to manage their disease and increase adherence. Copyright © 2013 Elsevier España, S.L. All rights reserved.

  4. Knowledge, adherence and control among patients with hypertension attending a peri-urban primary health care clinic, KwaZulu-Natal.

    Science.gov (United States)

    Olowe, Olumuyiwa A; Ross, Andrew J

    2017-10-19

    Despite hypertension being a common condition among patients attending primary health care (PHC) clinics, blood pressure (BP) control is often poor. Greater insight into patient-related factors that influence the control of hypertension will assist in the development of an intervention to address the issues identified. The aim of the study was to assess patient-related variables associated with hypertension control among patients attending a peri-urban PHC clinic. The setting for this study was a peri-urban PHC clinic in KwaZulu-Natal. This was an observational, descriptive and cross-sectional study with 348 patients selected over a 1-month period. A validated questionnaire was used to collect data on patients' hypertension knowledge and self-reported adherence, and BP recordings from their medical record were recorded to ascertain control. Of the 348 participants, only 49% had good BP control and 44% (152/348) had concurrent diabetes mellitus. The majority of patients had moderate levels of knowledge on hypertension and exhibited moderate adherence. There was a significant relationship between knowledge and reported adherence, between reported adherence and control, but not between reported knowledge and control. Despite over 90% of the study population having moderate knowledge, and 62% with moderate reported adherence, BP was well controlled in only less than 50% of the study population. These findings suggest a need to emphasise adherence and explore new ways of approaching adherence.

  5. Medication adherence and blood pressure control amongst adults with primary hypertension attending a tertiary hospital primary care clinic in Eastern Nigeria

    Directory of Open Access Journals (Sweden)

    Gabriel UP. Iloh

    2013-02-01

    Full Text Available Background: As the case detection rates of hypertension increase in adult Nigerians, achieving target blood pressure (BP control has become an important management challenge.Objectives: To describe medication adherence and BP control amongst adult Nigerians with primary hypertension attending a primary care clinic of a tertiary hospital in a resource-poor environment in Eastern Nigeria.Methods: A cross-sectional study was carried out in 140 adult patients with primary hypertension who have been on treatment for at least 6 months at the primary care clinic of Federal Medical Centre, Umuahia. A patient was said to have achieved goal BP control if the BP was < 140 per 90 mmHg. Adherence was assessed in the previous 30 days using a pretested researcher-administered questionnaire on 30 days of self-reported therapy. Adherence was graded using an ordinal scoring system of 0–4; an adherent patient was one who scored 4 points in the previous 30 days. Reasons for non-adherence were documented.Results: Adherence to medication and BP control rates were 42.9% and 35.0% respectively. BP control was significantly associated with medication adherence (p = 0.03, antihypertensive medication duration ≥3 years (p = 0.042, and taking ≥ one form of antihypertensive medication (p = 0.04. BP at the recruitment visit was significantly higher than at the end of the study (p = 0.036. The most common reason for non-adherence was forgetfulness (p = 0.046. Conclusion: The rate of BP control amongst the study population was low, which may be connected with low medication adherence. This study urges consideration of factors relating to adherence alongside other factors driving goal BP control.

  6. The relationship of psychological reactance, health locus of control and sense of self-efficacy with adherence to treatment in psychiatric outpatients with depression.

    Science.gov (United States)

    De Las Cuevas, Carlos; Peñate, Wenceslao; Sanz, Emilio J

    2014-11-21

    Although non-adherence to antidepressant medications is a significant barrier to the successful treatment of depression in clinical practice, few potentially modifiable predictors of poor adherence to antidepressant treatment are known. The aim of this study was to examine the relationship of psychological reactance, health locus of control and the sense of self-efficacy on adherence to treatment regimen among psychiatric outpatients with depression. One hundred and forty-five consecutive psychiatric outpatients suffering from depressive disorders were invited to participate in a cross-sectional study and 119 accepted. Patients completed a series of self-reported questionnaires assessing psychological reactance, health locus of control, self-efficacy, and adherence to prescribed medication in addition to socio-demographic and clinical variables. Logistic regression analyses were performed to determine which factors better correlate to treatment adherence. Age was found to be the best correlate of adherence to prescribed treatment. As regards psychological dimension studied, medication adherence was negatively associated with both cognitive and affective psychological reactance; patients with higher psychological reactance were more likely to be noncompliant than patients showing a low level of psychological reactance. Regarding health locus of control, only the external dimension of doctor-attributed health locus of control was positively associated with medications adherence. No effect on adherence was observed for the self-efficacy scale. Psychological reactance is an important correlate of adherence to treatment in patients with depressive disorders and this needs to be considered when giving clinical advice in order to avoid inducing reactance and thus non-adherence to prescribed treatments. Mental health professionals need to learn about communication techniques and counseling skills that enable them to deal with the psychological reactance of their patients.

  7. Glycemic control and adherence to basal insulin therapy in Taiwanese patients with type 2 diabetes mellitus.

    Science.gov (United States)

    Chien, Ming-Nan; Chen, Yen-Ling; Hung, Yi-Jen; Wang, Shu-Yi; Lu, Wen-Tsung; Chen, Chih-Hung; Lin, Ching-Ling; Huang, Tze-Pao; Tsai, Ming-Han; Tseng, Wei-Kung; Wu, Ta-Jen; Ho, Cheng; Lin, Wen-Yu; Chen, Bill; Chuang, Lee-Ming

    2016-11-01

    The aim of the present study was to assess the glycemic control, adherence and treatment satisfaction in a real-world setting with basal insulin therapy in type 2 diabetes patients in Taiwan. This was a multicenter, prospective, observational registry. A total of 836 patients with type 2 diabetes taking oral antidiabetic drugs with glycated hemoglobin (HbA1c) >7% entered the study. Basal insulin was given for 24 weeks. All treatment choices and medical instructions were at the physician's discretion to reflect real-life practice. After 24-week treatment, 11.7% of patients reached set HbA1c goals without severe hypoglycemia (primary effectiveness end-point). HbA1c and fasting blood glucose were significantly decreased from (mean ± SD) 10.1 ± 1.9% to 8.7 ± 1.7% (-1.4 ± 2.1%, P 230.6 ± 68.8 mg/dL to 159.1 ± 55.6 mg/dL (-67.4 ± 72.3 mg/dL, P 2.4 kg) and a low incidence of adverse drug reactions (0.4%) were also noted. The score of 7-point treatment satisfaction rated by patients was significantly improved by 1.9 ± 1.7 (P type 2 diabetes, but findings pointed out the need to reinforce the early and appropriate uptitration to achieve treatment targets. © 2016 The Authors. Journal of Diabetes Investigation published by Asian Association for the Study of Diabetes (AASD) and John Wiley & Sons Australia, Ltd.

  8. Co-robotic ultrasound imaging: a cooperative force control approach

    Science.gov (United States)

    Finocchi, Rodolfo; Aalamifar, Fereshteh; Fang, Ting Yun; Taylor, Russell H.; Boctor, Emad M.

    2017-03-01

    Ultrasound (US) imaging remains one of the most commonly used imaging modalities in medical practice. However, due to the physical effort required to perform US imaging tasks, 63-91% of ultrasonographers develop musculoskeletal disorders throughout their careers. The goal of this work is to provide ultrasonographers with a system that facilitates and reduces strain in US image acquisition. To this end, we propose a system for admittance force robot control that uses the six-degree-of-freedom UR5 industrial robot. A six-axis force sensor is used to measure the forces and torques applied by the sonographer on the probe. As the sonographer pushes against the US probe, the robot complies with these forces, following the user's desired path. A one-axis load cell is used to measure contact forces between the patient and the probe in real time. When imaging, the robot augments the axial forces applied by the user, lessening the physical effort required. User studies showed an overall decrease in hand tremor while imaging at high forces, improvements in image stability, and a decrease in difficulty and strenuousness.

  9. Perturbed cooperative-state feedback strategy for model predictive networked control of interconnected systems.

    Science.gov (United States)

    Tran, Tri; Ha, Q P

    2018-01-01

    A perturbed cooperative-state feedback (PSF) strategy is presented for the control of interconnected systems in this paper. The subsystems of an interconnected system can exchange data via the communication network that has multiple connection topologies. The PSF strategy can resolve both issues, the sensor data losses and the communication network breaks, thanks to the two components of the control including a cooperative-state feedback and a perturbation variable, e.g., u i =K ij x j +w i . The PSF is implemented in a decentralized model predictive control scheme with a stability constraint and a non-monotonic storage function (ΔV(x(k))≥0), derived from the dissipative systems theory. Numerical simulation for the automatic generation control problem in power systems is studied to illustrate the effectiveness of the presented PSF strategy. Copyright © 2017 ISA. Published by Elsevier Ltd. All rights reserved.

  10. The Effects of Disease Management on Glycemic Control and Adherence to American Diabetes Association Guidelines in an Air Force Population

    Science.gov (United States)

    2001-04-24

    this study, glycemic control was measured by glycated hemoglobin levels ( hemoglobin AIC). This is a measure of the amount of glucose bound to hemoglobin ...A IC values are scale data in the form of percentages of glycated hemoglobin calculated by the facility’s laboratory. The study instrument, Adherence...Accordance With AFI 35-205/AFIT Sup 1 13. SUPPLEMENTARY NOTES 14. ABSTRACT 200o*1720 024 15. SUBJECT TERMS 16. SECURITY CLASSIFICATION OF: 17. LIMITATION

  11. Cooperative Control of Active Power Filters in Power Systems without Mutual Communication

    Directory of Open Access Journals (Sweden)

    Josef Tlustý

    2010-01-01

    Full Text Available The procedure for calculating controller parameters of the APFs implemented into a multibus industrial power system for harmonic voltage mitigation is presented. The node-voltage-detection control strategy is applied and the basic controller parameters are found under the condition that the demanded THD factors at the buses where the APFs are placed will be obtained. A cooperative control of several APFs without mutual communication is proposed, simulated, and experimentally verified. By tuning the controller gains without considering the power circuit parameters, all APFs used tend to share harmonic load currents approximately equally regardless of the operation modes of the nonlinear loads in different parts of the power system.

  12. Cooperative vehicle control, feature tracking and ocean sampling

    Science.gov (United States)

    Fiorelli, Edward A.

    This dissertation concerns the development of a feedback control framework for coordinating multiple, sensor-equipped, autonomous vehicles into mobile sensing arrays to perform adaptive sampling of observed fields. The use of feedback is central; it maintains the array, i.e. regulates formation position, orientation, and shape, and directs the array to perform its sampling mission in response to measurements taken by each vehicle. Specifically, we address how to perform autonomous gradient tracking and feature detection in an unknown field such as temperature or salinity in the ocean. Artificial potentials and virtual bodies are used to coordinate the autonomous vehicles, modelled as point masses (with unit mass). The virtual bodies consist of linked, moving reference points called virtual leaders. Artificial potentials couple the dynamics of the vehicles and the virtual bodies. The dynamics of the virtual body are then prescribed allowing the virtual body, and thus the vehicle group, to perform maneuvers that include translation, rotation and contraction/expansion, while ensuring that the formation error remains bounded. This methodology is called the Virtual Body and Artificial Potential (VBAP) methodology. We then propose how to utilize these arrays to perform autonomous gradient climbing and front tracking in the presence of both correlated and uncorrelated noise. We implement various techniques for estimation of gradients (first-order and higher), including finite differencing, least squares error minimization, averaging, and Kalman filtering. Furthermore, we illustrate how the estimation error can be used to optimally choose the formation size. To complement our theoretical work, we present an account of sea trials performed with a fleet of autonomous underwater gliders in Monterey Bay during the Autonomous Ocean Sampling Network (AOSN) II project in August 2003. During these trials, Slocum autonomous underwater gliders were coordinated into triangle

  13. Cooperative Interface Agents for Networked Command, Control, and Communications: Phase II

    Science.gov (United States)

    2006-04-01

    interaction notion of model-view-controller ( MVC ) where representational aids assist with viewing and 10 perceiving relevant aspects of the model...cooperative elements assist with controlling the system and manipulating the model, and cognitive tools assist with understanding the model. Following the MVC ...of the AAAI Spring Symposium on Computational Organization Design. Bradshaw, J. M., Dutfield, S., Benoit, P., & Woolley, J. D. (1997). KAoS: Toward an

  14. Mobile phones to support adherence to antiretroviral therapy: what would it cost the Indian National AIDS Control Programme?

    Directory of Open Access Journals (Sweden)

    Rashmi Rodrigues

    2014-09-01

    Full Text Available Introduction: Adherence to antiretroviral treatment (ART is critical to maintaining health and good clinical outcomes in people living with HIV/AIDS. To address poor treatment adherence, low-cost interventions using mobile communication technology are being studied. While there are some studies that show an effect of mobile phone reminders on adherence to ART, none has reported on the costs of such reminders for national AIDS programmes. This paper aims to study the costs of mobile phone reminder strategies (mHealth interventions to support adherence in the context of India's National AIDS Control Program (NACP. Methods: The study was undertaken at two tertiary level teaching hospitals that implement the NACP in Karnataka state, South India. Costs for a mobile phone reminder application to support adherence, implemented at these sites (i.e. weekly calls, messages or both were studied. Costs were collected based on the concept of avoidable costs specific to the application. The costs that were assessed were one-time costs and recurrent costs that included fixed and variable costs. A sequential procedure for costing was used. Costs were calculated at national-programme level, individual ART-centre level and individual patient level from the NACP's perspective. The assessed costs were pooled to obtain an annual cost per patient. The type of application, number of ART centres and number of patients on ART were varied in a sensitivity analysis of costs. Results: The Indian NACP would incur a cost of between 79 and 110 INR (USD 1.27–1.77 per patient per year, based on the type of reminder, the number of patients on ART and the number of functioning ART centres. The total programme costs for a scale-up of the mHealth intervention to reach the one million patients expected to be on treatment by 2017 is estimated to be 0.36% of the total five-year national-programme budget. Conclusions: The cost of the mHealth intervention for ART-adherence support in

  15. Allocation of control rights in the PPP Project: a cooperative game model

    Science.gov (United States)

    Zhang, Yunhua; Feng, Jingchun; Yang, Shengtao

    2017-06-01

    Reasonable allocation of control rights is the key to the success of Public-Private Partnership (PPP) projects. PPP are services or ventures which are financed and operated through cooperation between governmental and private sector actors and which involve reasonable control rights sharing between these two partners. After professional firm with capital and technology as a shareholder participating in PPP project firms, the PPP project is diversified in participants and input resources. Meanwhile the allocation of control rights of PPP project tends to be complicated. According to the diversification of participants and input resources of PPP projects, the key participants are divided into professional firms and pure investors. Based on the cost of repurchase of different input resources in markets, the cooperative game relationship between these two parties is analyzed, on the basis of which the allocation model of the cooperative game for control rights is constructed to ensure optimum allocation ration of control rights and verify the share of control rights in proportion to the cost of repurchase.

  16. The impact of peer support and mp3 messaging on adherence to inhaled corticosteroids in minority adolescents with asthma: a randomized, controlled trial.

    Science.gov (United States)

    Mosnaim, Giselle; Li, Hong; Martin, Molly; Richardson, DeJuran; Belice, Paula Jo; Avery, Elizabeth; Ryan, Norman; Bender, Bruce; Powell, Lynda

    2013-01-01

    Poor adherence to inhaled corticosteroids (ICS) is a critical risk factor contributing to asthma morbidity among low-income minority adolescents. This trial tested whether peer support group meetings and peer asthma messages delivered via mp3 players improved adherence to ICS. Low-income African American and/or Hispanic adolescents, ages 11-16 years old, with persistent asthma, and poor (≤ 48%) adherence to prescription ICS during the 3-week run-in were randomized to intervention or attention control groups (ATG) for the 10-week treatment. During treatment, the intervention arm subjects participated in weekly coping peer group support sessions and received mp3 peer-recorded asthma messages that promoted adherence. The ATG participated in weekly meetings with a research assistant and received an equivalent number of mp3 physician-recorded asthma messages. Adherence was measured by using self-report and the Doser CT, an electronic dose counter. The primary outcome was the difference in adherence at 10 weeks between the 2 arms. Thirty-four subjects were randomized to each arm. At 10 weeks, no statistical difference in objectively measured adherence could be detected between the 2 arms when adjusting for baseline adherence (P = .929). Adherence declined in both groups over the course of the active treatment period. In both study arms, self-reported adherence by participants was significantly higher than their objectively measured adherence at week 10 (P < .0001). Improving medication adherence in longitudinal studies is challenging. Peer support and mp3-delivered peer asthma messages may not be of sufficient dose to improve outcomes. Copyright © 2013 American Academy of Allergy, Asthma & Immunology. Published by Elsevier Inc. All rights reserved.

  17. Technology and Adherence in Web-based Intervantions for Weight Control: a Systematic Review

    NARCIS (Netherlands)

    Kelders, Saskia Marion; Haugtvedt, C.P.; Stibe, A.; Kok, Robin N.; van Gemert-Pijnen, Julia E.W.C.

    2011-01-01

    While technology based health interventions can be effective, high attrition rates are commonly observed in research and practice and are a major issue in eHealth. Research on adherence has recently gained some scientific attention, but little has been done as to how technology itself engages users.

  18. Distributed Finite-Time Cooperative Control of Multiple High-Order Nonholonomic Mobile Robots.

    Science.gov (United States)

    Du, Haibo; Wen, Guanghui; Cheng, Yingying; He, Yigang; Jia, Ruting

    2017-12-01

    The consensus problem of multiple nonholonomic mobile robots in the form of high-order chained structure is considered in this paper. Based on the model features and the finite-time control technique, a finite-time cooperative controller is explicitly constructed which guarantees that the states consensus is achieved in a finite time. As an application of the proposed results, finite-time formation control of multiple wheeled mobile robots is studied and a finite-time formation control algorithm is proposed. To show effectiveness of the proposed approach, a simulation example is given.

  19. Distributed Cooperative Control of Nonlinear and Non-identical Multi-agent Systems

    DEFF Research Database (Denmark)

    Bidram, Ali; Lewis, Frank; Davoudi, Ali

    2013-01-01

    This paper exploits input-output feedback linearization technique to implement distributed cooperative control of multi-agent systems with nonlinear and non-identical dynamics. Feedback linearization transforms the synchronization problem for a nonlinear and heterogeneous multi-agent system...... to the synchronization problem for an identical linear multi-agent system. The controller for each agent is designed to be fully distributed, such that each agent only requires its own information and the information of its neighbors. The proposed control method is exploited to implement the secondary voltage control...

  20. Exploring ART intake scenes in a human rights-based intervention to improve adherence: a randomized controlled trial.

    Science.gov (United States)

    Basso, Cáritas Relva; Helena, Ernani Tiaraju Santa; Caraciolo, Joselita Maria Magalhães; Paiva, Vera; Nemes, Maria Ines Battistela

    2013-01-01

    To assess the effectiveness of a psychosocial individual intervention to improve adherence to ART in a Brazilian reference-center, consenting PLHIV with viral load >50 copies/ml were selected. After 4 weeks of MEMS cap use, participants were randomized into an intervention group (IG) (n = 64) or control group (CG) (n = 57). CG received usual care only. The IG participated in a human rights-based intervention approach entailing four dialogical meetings focused on medication intake scenes. Comparison between IG and CG revealed no statistically significant difference in adherence measured at weeks 8, 12, 16, 20 and 24. Viral load (VL) decreased in both groups (p < 0.0001) with no significant difference between study groups. The lower number of eligible patients than expected underpowered the study. Ongoing qualitative analysis should provide deeper understanding of the trial results. NIH Clinical Trials: NCT00716040.

  1. Intelligent Control System Taking Account of Cooperativeness Using Weighting Information on System Objective

    Directory of Open Access Journals (Sweden)

    Masaki Takahashi

    2004-08-01

    Full Text Available This study considers an intelligent control system to integrate flexibly its components by using weighted information where the system evaluation is reflected. Such system evaluates the information flowing through the components and converts them by weighting depending on the degree of importance. Integration of components based on the system evaluation enables a system consisting of them to realize various, flexible and adaptive control. In this study, the intelligent control method is applied to a swing up and stabilization control problem of a number of cart and pendulum systems on a restricted straight guide. To stabilize the pendulum in a restricted environment, each system should realize not only a swing-up and stabilization control of the pendulum, but also a position control of the cart to avoid collision or deadlock. The experiment using a real apparatus demonstrated that the controller learning light interaction acquires egoistic character, the controller learning heavy interaction behaves altruistically, and the controller equally considering self cart and another cart becomes cooperative. In other words, these autonomous decentralized controllers can acquire various characters and flexibility for cooperation.

  2. The efficacy of a brief motivational enhancement education program on CPAP adherence in OSA: a randomized controlled trial.

    Science.gov (United States)

    Lai, Agnes Y K; Fong, Daniel Y T; Lam, Jamie C M; Weaver, Terri E; Ip, Mary S M

    2014-09-01

    Poor adherence to CPAP treatment in OSA adversely affects the effectiveness of this therapy. This randomized controlled trial (RCT) examined the efficacy of a brief motivational enhancement education program in improving adherence to CPAP treatment in subjects with OSA. Subjects with newly diagnosed OSA were recruited into this RCT. The control group received usual advice on the importance of CPAP therapy and its care. The intervention group received usual care plus a brief motivational enhancement education program directed at enhancing the subjects' knowledge, motivation, and self-efficacy to use CPAP through the use of a 25-min video, a 20-min patient-centered interview, and a 10-min telephone follow-up. Self-reported daytime sleepiness adherence-related cognitions and quality of life were assessed at 1 month and 3 months. CPAP usage data were downloaded at the completion of this 3-month study. One hundred subjects with OSA (mean ± SD, age 52 ± 10 years; Epworth Sleepiness Scales [ESS], 9 ± 5; median [interquartile range] apnea-hypopnea index, 29 [20, 53] events/h) prescribed CPAP treatment were recruited. The intervention group had better CPAP use (higher daily CPAP usage by 2 h/d [Cohen d = 1.33, P CPAP for ≥ 70% of days with ≥ 4 h/d [P motivational enhancement education in addition to usual care were more likely to show better adherence to CPAP treatment, with greater improvements in treatment self-efficacy and daytime sleepiness. ClinicalTrials.gov; No.: NCT01173406; URL: www.clinicaltrials.gov.

  3. Effectiveness of educational or behavioral interventions on adherence to phosphate control in adults receiving hemodialysis: a systematic review.

    Science.gov (United States)

    Milazi, Molly; Bonner, Ann; Douglas, Clint

    2017-04-01

    People with end-stage kidney disease (ESKD) develop impaired excretion of phosphate. Hyperphosphatemia develops in ESKD as a result of the kidney's reduced ability to excrete ingested phosphate load and is characterized by high bone turnover and increased musculoskeletal morbidity including bone pain and muscle weakness. Increased serum phosphate levels are also associated with cardiovascular disease and associated mortality. These effects are significant considering that cardiovascular disease is the leading cause of death in ESKD, making phosphate control a crucial treatment goal. To determine the effectiveness of education or behavioral interventions on adherence to phosphate control in adults with ESKD receiving hemodialysis (HD). Adults aged over 18 years with ESKD undergoing HD, attending dialysis facilities regardless of frequency and duration of treatment sessions per week. Studies with participants receiving hemodiafiltration were excluded. All types of educational and behavioral interventions aimed at improving adherence to dietary phosphate restriction, phosphate binder medication and HD. Randomized controlled trials (RCTs), non-RCTs, before and after and cohort studies. Outcome measures included serum phosphate levels, patient knowledge and adherence to phosphate control methods, chronic kidney disease (CKD) self-management behavior and perceived self-efficacy for CKD related to phosphate control. A search was conducted in CINAHL, MEDLINE, The Cochrane Library, Embase, Web of Science, PsycINFO and ProQuest Dissertations and Theses Global to find published studies between January 2005 and December 2015. Risk of bias was assessed by three reviewers prior to inclusion in the review using standardized critical appraisal instruments from the Joanna Briggs Institute Meta-Analysis of Statistics Assessment and Review Instrument (JBI-MAStARI). Data were extracted using the standardized data extraction tool from JBI-MAStARI. Data were pooled using JBI software

  4. Cooperative Control to Enhance the Frequency Stability of Islanded Microgrids with DFIG-SMES

    Directory of Open Access Journals (Sweden)

    Wu Chen

    2013-08-01

    Full Text Available The issue of frequency stability of microgrids under islanded operation mode and mode transfer has attracted particular attention recently. In this paper, a cooperative frequency control method, which consists of a microgrid central control (MGCC and microgrid local control (MGLC, is proposed to achieve a seamless transfer from grid-connected to islanded mode, and hence increase the frequency stability of islanded microgrids during both primary and secondary frequency control. A power deficiency prediction and distribution method is proposed in MGCC to effectively distribute and utilize the power and loads, and accomplish the cooperative control of all microgrid units. With regards to MGLC, a Hopfield fuzzy neural network control (HFNNC is applied to make the corresponding frequency control of DFIG-SMES more adaptive. Meanwhile a state of capacity (SOC control is utilized in battery energy storage (BES to extend battery life. Simulation results indicate that the proposed frequency control approach can maintain the frequency stability of islanded microgrids even in emergency conditions.

  5. Ultrasound guided robotic biopsy using augmented reality and human-robot cooperative control.

    Science.gov (United States)

    Freschi, C; Troia, E; Ferrari, V; Megali, G; Pietrabissa, A; Mosca, F

    2009-01-01

    Ultrasound-guided biopsy is a proficient mininvasive approach for tumors staging but requires very long training and particular manual and 3D space perception abilities of the physician, for the planning of the needle trajectory and the execution of the procedure. In order to simplify this difficult task, we have developed an integrated system that provides the clinician two types of assistance: an augmented reality visualization allows accurate and easy planning of needle trajectory and target reaching verification; a robot arm with a six-degree-of-freedom force sensor allows the precise positioning of the needle holder and allows the clinician to adjust the planned trajectory (cooperative control) to overcome needle deflection and target motion. Preliminary tests have been executed on an ultrasound phantom showing high precision of the system in static conditions and the utility and usability of the cooperative control in simulated no-rigid conditions.

  6. Patient perspectives on triggers, adherence to medical recommendations, and disease control in atopic dermatitis: the DATOP study.

    Science.gov (United States)

    Ortiz de Frutos, F J; Torrelo, A; de Lucas, R; González, M A; Alomar, A; Vera, Á; Ros, S; Mora, A M; Cuervo, J

    2014-06-01

    To analyze the triggers of atopic dermatitis (AD), adherence to medical recommendations, disease control, and health-related quality of life (HRQOL) from the patient's perspective. This was a multicenter, cross-sectional, epidemiological study with the participation of adults (age >16 years; n=125) and children (age, 2-15 years, n=116). Patients had a history of at least 12 months of moderate to severe AD with a moderate to severe flare (Investigator Global Assessment score>2) at the time of recruitment. The Mann-Whitney U test was used to evaluate relationships between disease severity, determined according to the Scoring in Atopic Dermatitis index, and triggers reported by patients, adherence to recommendations and pharmacological therapy, HRQOL, and patient-perceived control. The most common triggers were cosmetic products, clothing, mites, detergents/soaps, and changes in temperature. In 47.2% of adults and 39.7% of children, pharmacological therapy was not initiated at flare onset. Adherence was highest to pharmacological therapy, skin moisturizing, and medical care recommendations. Disease control was considered insufficient by 41.6% of adults and 27. 6% of pediatric patients and, in adults, this was associated with the severity of AD (P=.014). The therapeutic control of AD is susceptible to improvement, especially in adults. Although patients state that they follow medical recommendations, a significant percentage of patients do not apply recommended treatments correctly. Better education about the disease and its management would appear to be necessary to improve disease control and HRQOL. Copyright © 2013 Elsevier España, S.L. and AEDV. All rights reserved.

  7. Controlling the cooperative behavior of a system of automous mobile robots

    OpenAIRE

    Stilwell, Daniel J.

    1993-01-01

    A novel material transport system is presented that uses 'swarms' of small autonomous mobile robots to collectively lift and move palletized loads. The robots are relatively unsophisticated in design and have no advanced sensory or communications capability. There is no central or supervisory controller directing the robots. Each robot must be able react to its environment autonomously, yet cooperate within a team of similarly designed robots. Reactive and behavior-based pri...

  8. Adherence to the CONSORT Statement in the Reporting of Randomized Controlled Trials on Pharmacological Interventions Published in Iranian Medical Journals

    Directory of Open Access Journals (Sweden)

    Pooneh Sarveravan

    2017-11-01

    Full Text Available Background: Among manuscripts submitted to biomedical journals, randomized controlled trials (RCTs form the backbone of evidence-based medicine. Hence, their protocol should be designed rigorously and their results should be reported clearly. To improve the quality of RCT reporting, researchers developed the CONSORT Statement in 1996 and updated it in 2010. This study was designed to assess the quality of RCT reporting vis-à-vis adherence to CONSORT among articles published in Iranian medical journals (English, Persian, CONSORT-endorsing, and non-CONSORT-endorsing. Methods: In this cross-sectional study, all RCTs published in all Iranian medical journals from September 2012 to September 2013 were retrieved to evaluate their adherence to CONSORT. The journals’ instructions for authors were also reviewed to find out whether or not they endorsed CONSORT. The CONSORT 2010 Checklist was used. Microsoft Excel 2007 was applied to analyze the data, and MedCalc was employed to compare the groups. Results: Totally, 492 pharmacological RCTs that met our inclusion criteria were identified. Twenty-five items were reported in fewer than 50% of the articles. The differences between the articles published in Persian and English language journals were statistically significant in 17 items. The differences between the articles published in the CONSORT-endorsing and non-CONSORT-endorsing journals were significant in 8 items. Conclusion: Our findings showed very weak adherence to CONSORT. Authors, reviewers, and editors should be trained to use standards expressed by the CONSORT Group in reporting RCTs.

  9. Tangible Cooperative Gestures: Improving Control and Initiative in Digital Photo Sharing

    Directory of Open Access Journals (Sweden)

    Elise van den Hoven

    2015-09-01

    Full Text Available This paper focuses on co-present digital photo sharing on a notebook and investigates how this could be supported. While analyzing the current digital photo sharing situation we noticed that there was a high threshold for visitors to take control of the personal computer of the photo owner, resulting in inequity of participation. It was assumed that visitors would have the opportunity to interact with the notebook more freely if this threshold was lowered by distributing the user interface and creating a more public, instead of personal, interaction space. This, in turn, could make them feel more involved and in control during a session, creating a more enjoyable experience. To test these assumptions a design prototype was created that stimulates participants to use tangible artifacts for cooperative gestures, a promising direction for the future of HCI. The situation with the cooperative gestures was compared with the regular digital photo sharing situation, which makes use of a keyboard. In dyads, visitors felt more involved and in control in the design prototype cooperative gestures condition (especially during storytelling, resulting in a more enjoyable digital photo sharing experience.

  10. Distributed Cooperative Search Control Method of Multiple UAVs for Moving Target

    Directory of Open Access Journals (Sweden)

    Chang-jian Ru

    2015-01-01

    Full Text Available To reduce the impact of uncertainties caused by unknown motion parameters on searching plan of moving targets and improve the efficiency of UAV’s searching, a novel distributed Multi-UAVs cooperative search control method for moving target is proposed in this paper. Based on detection results of onboard sensors, target probability map is updated using Bayesian theory. A Gaussian distribution of target transition probability density function is introduced to calculate prediction probability of moving target existence, and then target probability map can be further updated in real-time. A performance index function combining with target cost, environment cost, and cooperative cost is constructed, and the cooperative searching problem can be transformed into a central optimization problem. To improve computational efficiency, the distributed model predictive control method is presented, and thus the control command of each UAV can be obtained. The simulation results have verified that the proposed method can avoid the blindness of UAV searching better and improve overall efficiency of the team effectively.

  11. Hierarchical Control Strategy for the Cooperative Braking System of Electric Vehicle.

    Science.gov (United States)

    Peng, Jiankun; He, Hongwen; Liu, Wei; Guo, Hongqiang

    2015-01-01

    This paper provides a hierarchical control strategy for cooperative braking system of an electric vehicle with separated driven axles. Two layers are defined: the top layer is used to optimize the braking stability based on two sliding mode control strategies, namely, the interaxle control mode and signal-axle control strategies; the interaxle control strategy generates the ideal braking force distribution in general braking condition, and the single-axle control strategy can ensure braking safety in emergency braking condition; the bottom layer is used to maximize the regenerative braking energy recovery efficiency with a reallocated braking torque strategy; the reallocated braking torque strategy can recovery braking energy as much as possible in the premise of meeting battery charging power. The simulation results show that the proposed hierarchical control strategy is reasonable and can adapt to different typical road surfaces and load cases; the vehicle braking stability and safety can be guaranteed; furthermore, the regenerative braking energy recovery efficiency can be improved.

  12. Graph theoretic framework based cooperative control and estimation of multiple UAVs for target tracking

    Science.gov (United States)

    Ahmed, Mousumi

    Designing the control technique for nonlinear dynamic systems is a significant challenge. Approaches to designing a nonlinear controller are studied and an extensive study on backstepping based technique is performed in this research with the purpose of tracking a moving target autonomously. Our main motivation is to explore the controller for cooperative and coordinating unmanned vehicles in a target tracking application. To start with, a general theoretical framework for target tracking is studied and a controller in three dimensional environment for a single UAV is designed. This research is primarily focused on finding a generalized method which can be applied to track almost any reference trajectory. The backstepping technique is employed to derive the controller for a simplified UAV kinematic model. This controller can compute three autopilot modes i.e. velocity, ground heading (or course angle), and flight path angle for tracking the unmanned vehicle. Numerical implementation is performed in MATLAB with the assumption of having perfect and full state information of the target to investigate the accuracy of the proposed controller. This controller is then frozen for the multi-vehicle problem. Distributed or decentralized cooperative control is discussed in the context of multi-agent systems. A consensus based cooperative control is studied; such consensus based control problem can be viewed from the algebraic graph theory concepts. The communication structure between the UAVs is represented by the dynamic graph where UAVs are represented by the nodes and the communication links are represented by the edges. The previously designed controller is augmented to account for the group to obtain consensus based on their communication. A theoretical development of the controller for the cooperative group of UAVs is presented and the simulation results for different communication topologies are shown. This research also investigates the cases where the communication

  13. Patient-cooperative control increases active participation of individuals with SCI during robot-aided gait training

    Directory of Open Access Journals (Sweden)

    Duschau-Wicke Alexander

    2010-09-01

    Full Text Available Abstract Background Manual body weight supported treadmill training and robot-aided treadmill training are frequently used techniques for the gait rehabilitation of individuals after stroke and spinal cord injury. Current evidence suggests that robot-aided gait training may be improved by making robotic behavior more patient-cooperative. In this study, we have investigated the immediate effects of patient-cooperative versus non-cooperative robot-aided gait training on individuals with incomplete spinal cord injury (iSCI. Methods Eleven patients with iSCI participated in a single training session with the gait rehabilitation robot Lokomat. The patients were exposed to four different training modes in random order: During both non-cooperative position control and compliant impedance control, fixed timing of movements was provided. During two variants of the patient-cooperative path control approach, free timing of movements was enabled and the robot provided only spatial guidance. The two variants of the path control approach differed in the amount of additional support, which was either individually adjusted or exaggerated. Joint angles and torques of the robot as well as muscle activity and heart rate of the patients were recorded. Kinematic variability, interaction torques, heart rate and muscle activity were compared between the different conditions. Results Patients showed more spatial and temporal kinematic variability, reduced interaction torques, a higher increase of heart rate and more muscle activity in the patient-cooperative path control mode with individually adjusted support than in the non-cooperative position control mode. In the compliant impedance control mode, spatial kinematic variability was increased and interaction torques were reduced, but temporal kinematic variability, heart rate and muscle activity were not significantly higher than in the position control mode. Conclusions Patient-cooperative robot-aided gait training

  14. The Dynamics and Sliding Mode Control of Multiple Cooperative Welding Robot Manipulators

    Directory of Open Access Journals (Sweden)

    Bin Zi

    2012-08-01

    Full Text Available This paper deals with the design, dynamic modelling and sliding mode control of multiple cooperative welding robot manipulators (MWRMs. The MWRMs can handle complex tasks that are difficult or even impossible for a single manipulator. The kinematics and dynamics of the MWRMs are studied on the basis of the Denavit-Hartenberg and Lagrange method. Following that, considering the MWRM system with nonlinear and unknown disturbances, a non-singular terminal sliding mode control strategy is designed. By means of the Lyapunov function, the stability of the controller is proved. Simulation results indicate that the good control performance of the MWRMs is achieved by the non-singular terminal sliding mode controller, which also illustrates the correctness of the dynamic modelling and effectiveness of the proposed control strategy.

  15. Cooperation between health personnel and schools for the identification and control of dengue

    Directory of Open Access Journals (Sweden)

    Pablo Cordeiro da Silva

    2014-05-01

    Full Text Available Objective: To analyze the process of cooperation between health personnel and the school in potential dengue vector breeding sites in households. Methods: This is an exploratory and descriptive research using a quantitative and qualitative design. Data were obtained in three visits to 93 households of students from a public elementary school in Teófilo Otoni, MG. The visits were performed every 30 days through the cooperation between health personnel and researchers who identified potential Aedes aegypti breeding sites by using a checklist. A health education campaign was held at the school to foster debate on dengue prevention and vector control. Two visits were performed after the campaign to verify possible changes in the students’ households. After that, the health personnel were questioned about their perceptions regarding the participation in the investigation process. Results: It could be observed, during the first visit, that 83 (89.3% households had some kind of container suitable for the dengue vector breeding. During the second and third visits – after the health education campaign – the number of households with potential breeding sites decreased to 65 (70% and 63 (68% respectively, showing the important role of such campaigns in the vector control. Conclusion: The study shows the power of health education campaigns developed by health personnel in cooperation with elementary public schools to foster intersectoral actions for dengue prevention. doi:10.5020/18061230.2013.p404

  16. STAAR: a randomised controlled trial of electronic adherence monitoring with reminder alarms and feedback to improve clinical outcomes for children with asthma.

    Science.gov (United States)

    Morton, Robert W; Elphick, Heather E; Rigby, Alan S; Daw, William J; King, David A; Smith, Laurie J; Everard, Mark L

    2017-04-01

    Suboptimal adherence to inhaled steroids is common in children with asthma and is associated with poor disease control, reduced quality of life and even death. Previous studies using feedback of electronically monitored adherence data have demonstrated improved adherence, but have not demonstrated a significant impact on clinical outcomes. The aim of this study was to determine whether introduction of this approach into routine practice would result in improved clinical outcomes. Children with asthma aged 6-16 years were randomised to the active intervention consisting of electronic adherence monitoring with daily reminder alarms together with feedback in the clinic regarding their inhaled corticosteroid (ICS) use or to the usual care arm with adherence monitoring alone. All children had poorly controlled asthma at baseline, taking ICS and long-acting β-agonists. Subjects were seen in routine clinics every 3 months for 1 year. The primary outcome was the Asthma Control Questionnaire (ACQ) score. Secondary outcomes included adherence and markers of asthma morbidity. 77 of 90 children completed the study (39 interventions, 38 controls). Adherence in the intervention group was 70% vs 49% in the control group (p≤0.001). There was no significant difference in the change in ACQ, but children in the intervention group required significantly fewer courses of oral steroids (p=0.008) and fewer hospital admissions (p≤0.001). The results indicate that electronic adherence monitoring with feedback is likely to be of significant benefit in the routine management of poorly controlled asthmatic subjects. NCT02451709; pre-result. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/.

  17. Humanoid Robot RH-1 for Collaborative Tasks: A Control Architecture for Human-Robot Cooperation

    Directory of Open Access Journals (Sweden)

    Concepción A. Monje

    2008-01-01

    Full Text Available The full-scale humanoid robot RH-1 has been totally developed in the University Carlos III of Madrid. In this paper we present an advanced control system for this robot so that it can perform tasks in cooperation with humans. The collaborative tasks are carried out in a semi-autonomous way and are intended to be put into operation in real working environments where humans and robots should share the same space. Before presenting the control strategy, the kinematic model and a simplified dynamic model of the robot are presented. All the models and algorithms are verified by several simulations and experimental results.

  18. Fuzzy variable impedance control based on stiffness identification for human-robot cooperation

    Science.gov (United States)

    Mao, Dachao; Yang, Wenlong; Du, Zhijiang

    2017-06-01

    This paper presents a dynamic fuzzy variable impedance control algorithm for human-robot cooperation. In order to estimate the intention of human for co-manipulation, a fuzzy inference system is set up to adjust the impedance parameter. Aiming at regulating the output fuzzy universe based on the human arm’s stiffness, an online stiffness identification method is developed. A drag interaction task is conducted on a 5-DOF robot with variable impedance control. Experimental results demonstrate that the proposed algorithm is superior.

  19. Investigating a TELEmedicine solution to improve MEDication adherence in chronic Heart Failure (TELEMED-HF: study protocol for a randomized controlled trial

    Directory of Open Access Journals (Sweden)

    Widdershoven Jos

    2011-10-01

    Full Text Available Abstract Background Frequent rehospitalisations and poorer survival chances in heart failure (HF patients may partly be explained by poor medication adherence. There are multiple medication-related reasons for suboptimal adherence, but psychological reasons may also be important. A novel TELEmonitoring device may improve MEDication adherence in HF patients (TELEMED-HF. TELEMED-HF is a randomized, controlled clinical intervention trial designed to examine (1 the efficacy and cost-efficiency of an electronic medication adherence support system in improving and monitoring HF patients' medication adherence; (2 the effect of medication adherence on hospitalizations and health care consumption; as well as on (3 clinical characteristics, and Quality of Life (QoL; and (4 clinical, sociodemographic, and psychological determinants of medication adherence. Methods/Design Consecutive patients with chronic, systolic HF presenting to the outpatient clinic of the TweeSteden Hospital, The Netherlands, will be approached for study participation and randomly assigned (1:1 following blocked randomization procedures to the intervention (n = 200 or usual care arm (n = 200. Patients in the intervention arm use the medication support device for six months in addition to usual care. Post-intervention, patients return to usual care only and all patients participate in four follow-up occasions over 12 months. Primary endpoints comprise objective and subjective medication adherence, healthcare consumption, number of hospitalizations, and cost-effectiveness. Secondary endpoints include disease severity, physical functioning, and QoL. Discussion The TELEMED-HF study will provide us a comprehensive understanding of medication adherence in HF patients, and will show whether telemonitoring is effective and cost-efficient in improving adherence and preventing hospitalization in HF patients. Trial registration number NCT01347528.

  20. Adherence to AHA Guidelines When Adapted for Augmented Reality Glasses for Assisted Pediatric Cardiopulmonary Resuscitation: A Randomized Controlled Trial.

    Science.gov (United States)

    Siebert, Johan N; Ehrler, Frederic; Gervaix, Alain; Haddad, Kevin; Lacroix, Laurence; Schrurs, Philippe; Sahin, Ayhan; Lovis, Christian; Manzano, Sergio

    2017-05-29

    The American Heart Association (AHA) guidelines for cardiopulmonary resuscitation (CPR) are nowadays recognized as the world's most authoritative resuscitation guidelines. Adherence to these guidelines optimizes the management of critically ill patients and increases their chances of survival after cardiac arrest. Despite their availability, suboptimal quality of CPR is still common. Currently, the median hospital survival rate after pediatric in-hospital cardiac arrest is 36%, whereas it falls below 10% for out-of-hospital cardiac arrest. Among emerging information technologies and devices able to support caregivers during resuscitation and increase adherence to AHA guidelines, augmented reality (AR) glasses have not yet been assessed. In order to assess their potential, we adapted AHA Pediatric Advanced Life Support (PALS) guidelines for AR glasses. The study aimed to determine whether adapting AHA guidelines for AR glasses increased adherence by reducing deviation and time to initiation of critical life-saving maneuvers during pediatric CPR when compared with the use of PALS pocket reference cards. We conducted a randomized controlled trial with two parallel groups of voluntary pediatric residents, comparing AR glasses to PALS pocket reference cards during a simulation-based pediatric cardiac arrest scenario-pulseless ventricular tachycardia (pVT). The primary outcome was the elapsed time in seconds in each allocation group, from onset of pVT to the first defibrillation attempt. Secondary outcomes were time elapsed to (1) initiation of chest compression, (2) subsequent defibrillation attempts, and (3) administration of drugs, as well as the time intervals between defibrillation attempts and drug doses, shock doses, and number of shocks. All these outcomes were assessed for deviation from AHA guidelines. Twenty residents were randomized into 2 groups. Time to first defibrillation attempt (mean: 146 s) and adherence to AHA guidelines in terms of time to other

  1. Towards cooperative guidance and control of highly automated vehicles: H-Mode and Conduct-by-Wire.

    Science.gov (United States)

    Flemisch, Frank Ole; Bengler, Klaus; Bubb, Heiner; Winner, Hermann; Bruder, Ralph

    2014-01-01

    This article provides a general ergonomic framework of cooperative guidance and control for vehicles with an emphasis on the cooperation between a human and a highly automated vehicle. In the twenty-first century, mobility and automation technologies are increasingly fused. In the sky, highly automated aircraft are flying with a high safety record. On the ground, a variety of driver assistance systems are being developed, and highly automated vehicles with increasingly autonomous capabilities are becoming possible. Human-centred automation has paved the way for a better cooperation between automation and humans. How can these highly automated systems be structured so that they can be easily understood, how will they cooperate with the human? The presented research was conducted using the methods of iterative build-up and refinement of framework by triangulation, i.e. by instantiating and testing the framework with at least two derived concepts and prototypes. This article sketches a general, conceptual ergonomic framework of cooperative guidance and control of highly automated vehicles, two concepts derived from the framework, prototypes and pilot data. Cooperation is exemplified in a list of aspects and related to levels of the driving task. With the concept 'Conduct-by-Wire', cooperation happens mainly on the guidance level, where the driver can delegate manoeuvres to the automation with a specialised manoeuvre interface. With H-Mode, a haptic-multimodal interaction with highly automated vehicles based on the H(orse)-Metaphor, cooperation is mainly done on guidance and control with a haptically active interface. Cooperativeness should be a key aspect for future human-automation systems. Especially for highly automated vehicles, cooperative guidance and control is a research direction with already promising concepts and prototypes that should be further explored. The application of the presented approach is every human-machine system that moves and includes high

  2. Spacecraft Stabilization and Control for Capture of Non-Cooperative Space Objects

    Science.gov (United States)

    Joshi, Suresh; Kelkar, Atul G.

    2014-01-01

    This paper addresses stabilization and control issues in autonomous capture and manipulation of non-cooperative space objects such as asteroids, space debris, and orbital spacecraft in need of servicing. Such objects are characterized by unknown mass-inertia properties, unknown rotational motion, and irregular shapes, which makes it a challenging control problem. The problem is further compounded by the presence of inherent nonlinearities, signi cant elastic modes with low damping, and parameter uncertainties in the spacecraft. Robust dissipativity-based control laws are presented and are shown to provide global asymptotic stability in spite of model uncertainties and nonlinearities. It is shown that robust stabilization can be accomplished via model-independent dissipativity-based controllers using thrusters alone, while stabilization with attitude and position control can be accomplished using thrusters and torque actuators.

  3. Psychological and Educational Intervention to Improve Tuberculosis Treatment Adherence in Ethiopia Based on Health Belief Model: A Cluster Randomized Control Trial.

    Directory of Open Access Journals (Sweden)

    Habteyes Hailu Tola

    Full Text Available Treatment non-adherence results in treatment failure, prolonged transmission of disease and emergence of drug resistance. Although the problem widely investigated, there remains an information gap on the effectiveness of different methods to improve treatment adherence and the predictors of non-adherence in resource limited countries based on theoretical models. This study aimed to evaluate the impact of psychological counseling and educational intervention on tuberculosis (TB treatment adherence based on Health Belief Model (HBM.A cluster randomized control trial was conducted in Addis Ababa from May to December, 2014. Patients were enrolled into study consecutively from 30 randomly selected Health Centers (HCs (14 HCs intervention and 16 HCs control groups. A total of 698 TB patients, who were on treatment for one month to two months were enrolled. A structured questionnaire was administered to both groups of patients at baseline and endpoint of study. Control participants received routine directly-observed anti-TB therapy and the intervention group additionally received combined psychological counseling and adherence education. Treatment non-adherence level was the main outcome of the study, and multilevel logistic regression was employed to assess the impact of intervention on treatment adherence.At enrollment, the level of non-adherence among intervention (19.4% and control (19.6% groups was almost the same. However, after intervention, non-adherence level decreased among intervention group from 19.4 (at baseline to 9.5% (at endpoint, while it increased among control group from 19.4% (baseline to 25.4% (endpoint. Psychological counseling and educational interventions resulted in significant difference with regard to non-adherence level between intervention and control groups (Adjusted OR = 0.31, 95% Confidence Interval (CI (0.18-0.53, p < 0.001.Psychological counseling and educational interventions, which were guided by HBM, significantly

  4. Psychological and Educational Intervention to Improve Tuberculosis Treatment Adherence in Ethiopia Based on Health Belief Model: A Cluster Randomized Control Trial.

    Science.gov (United States)

    Tola, Habteyes Hailu; Shojaeizadeh, Davoud; Tol, Azar; Garmaroudi, Gholamreza; Yekaninejad, Mir Saeed; Kebede, Abebaw; Ejeta, Luche Tadesse; Kassa, Desta; Klinkenberg, Eveline

    2016-01-01

    Treatment non-adherence results in treatment failure, prolonged transmission of disease and emergence of drug resistance. Although the problem widely investigated, there remains an information gap on the effectiveness of different methods to improve treatment adherence and the predictors of non-adherence in resource limited countries based on theoretical models. This study aimed to evaluate the impact of psychological counseling and educational intervention on tuberculosis (TB) treatment adherence based on Health Belief Model (HBM). A cluster randomized control trial was conducted in Addis Ababa from May to December, 2014. Patients were enrolled into study consecutively from 30 randomly selected Health Centers (HCs) (14 HCs intervention and 16 HCs control groups). A total of 698 TB patients, who were on treatment for one month to two months were enrolled. A structured questionnaire was administered to both groups of patients at baseline and endpoint of study. Control participants received routine directly-observed anti-TB therapy and the intervention group additionally received combined psychological counseling and adherence education. Treatment non-adherence level was the main outcome of the study, and multilevel logistic regression was employed to assess the impact of intervention on treatment adherence. At enrollment, the level of non-adherence among intervention (19.4%) and control (19.6%) groups was almost the same. However, after intervention, non-adherence level decreased among intervention group from 19.4 (at baseline) to 9.5% (at endpoint), while it increased among control group from 19.4% (baseline) to 25.4% (endpoint). Psychological counseling and educational interventions resulted in significant difference with regard to non-adherence level between intervention and control groups (Adjusted OR = 0.31, 95% Confidence Interval (CI) (0.18-0.53), p educational interventions, which were guided by HBM, significantly decreased treatment non-adherence level

  5. Health literacy, cognitive function, proper use, and adherence to inhaled asthma controller medications among older adults with asthma.

    Science.gov (United States)

    O'Conor, Rachel; Wolf, Michael S; Smith, Samuel G; Martynenko, Melissa; Vicencio, Daniel P; Sano, Mary; Wisnivesky, Juan P; Federman, Alex D

    2015-05-01

    We sought to investigate the degree to which cognitive skills explain associations between health literacy and asthma-related medication use among older adults with asthma. Patients aged ≥ 60 years receiving care at eight outpatient clinics (primary care, geriatrics, pulmonology, allergy, and immunology) in New York, New York, and Chicago, Illinois, were recruited to participate in structured, in-person interviews as part of the Asthma Beliefs and Literacy in the Elderly (ABLE) study (n = 425). Behaviors related to medication use were investigated, including adherence to prescribed regimens, metered-dose inhaler (MDI) technique, and dry powder inhaler (DPI) technique. Health literacy was measured using the Short Test of Functional Health Literacy in Adults. Cognitive function was assessed in terms of fluid (working memory, processing speed, executive function) and crystallized (verbal) ability. The mean age of participants was 68 years; 40% were Hispanic and 30% non-Hispanic black. More than one-third (38%) were adherent to their controller medication, 53% demonstrated proper DPI technique, and 38% demonstrated correct MDI technique. In multivariable analyses, limited literacy was associated with poorer adherence to controller medication (OR, 2.3; 95% CI, 1.29-4.08) and incorrect DPI (OR, 3.51; 95% CI, 1.81-6.83) and MDI (OR, 1.64; 95% CI, 1.01-2.65) techniques. Fluid and crystallized abilities were independently associated with medication behaviors. However, when fluid abilities were added to the model, literacy associations were reduced. Among older patients with asthma, interventions to promote proper medication use should simplify tasks and patient roles to overcome cognitive load and suboptimal performance in self-care.

  6. Predictors of Medication Adherence and Blood Pressure Control among Saudi Hypertensive Patients Attending Primary Care Clinics: A Cross-Sectional Study.

    Directory of Open Access Journals (Sweden)

    Sarah M Khayyat

    Full Text Available To assess the level of medication adherence and to investigate predictors of medication adherence and blood pressure control among hypertensive patients attending primary healthcare clinics in Makkah, Saudi Arabia.Hypertensive patients meeting the eligibility criteria were recruited from eight primary care clinics between January and May 2016 for this study. The patients completed Arabic version of Morisky Medication Adherence Scale (MMAS-8, an eight-item validated, self-reported measure to assess medication adherence. A structured data collection form was used to record patients' sociodemographic, medical and medication data.Two hundred and four patients, of which 71.6% were females, participated in the study. Patients' mean age was 59.1 (SD 12.2. The mean number of medication used by patients was 4.4 (SD 1.89. More than half (110; 54% of the patients were non-adherent to their medications (MMAS score 65 years (OR 2.0 [95% CI: 1.0-4.2; P = 0.04], and being diabetic (OR 0.25 [95% CI: 0.1-0.6; P = 0.04] were found to be independent predictors of medication adherence.Medication adherence is alarmingly low among hypertensive patients attending primary care clinics in Saudi Arabia which may partly explain observed poor blood pressure control. There is a clear need to educate patients about the importance of medication adherence and its impact on improving clinical outcomes. Future research should identify barriers to medication adherence among Saudi hypertensive patients.

  7. Physiological hemostasis based intelligent integrated cooperative controller for precise fault-tolerant control of redundant parallel manipulator

    Science.gov (United States)

    Hao, Kuangrong; Guo, Chongbin; Ding, Yongsheng

    2014-10-01

    This paper focuses on precise fault-tolerant control for actual redundant parallel manipulator. Based on kinematic redundancy, some unnoticed influences such as mechanical clearance have been considered to design a more precise and intelligent fault-tolerant plan for actual plants. According to regulation principles in human hemostasis system, a bio-inspired intelligent integrated cooperative controller (BIICC) is developed including system structure, algorithm and step in parameter tuning. The proposed BIICC optimises partial error signal and improves control performance in each sub-channel. Moreover, the new controller transfers and disposes cooperative control signals among different sub-channels to achieve an intelligent integrated fault-tolerant system. The proposed BIICC is applied to an actual 2-DOF (degrees of freedom) redundant parallel manipulator where the feasibility of the new controller is demonstrated. The BIICC is beneficial to control precision and fault-tolerant capability of redundant plant. The improvements are more obvious in cases where extra actuators of redundant manipulator are broken.

  8. Effect of text messages to improve health literacy on medication adherence in patients with type 2 diabetes mellitus: A randomized controlled pilot trial

    OpenAIRE

    Yamagata, Zentaro; Suzuki,Kohta; Yokomichi, Hiroshi; Shinohara, Ryoji; Sugita, Hideki

    2017-01-01

    ABSTRACT It has been suggested that low health literacy (HL) is associated with poor medication adherence. This study aimed to examine the effect of a text message-based HL intervention to promote medication adherence, compared with text messages that only sent medication reminders, in patients with type 2 diabetes. This was a single-center, open-label, randomized (1:1) controlled pilot study. The study period was 6 months. Intervention group was sent HL related text messages, compared to the...

  9. Prevalence of Blood Pressure Self-Monitoring, Medication Adherence, Self-Efficacy, Stage of Change, and Blood Pressure Control Among Municipal Workers With Hypertension

    OpenAIRE

    Breaux-Shropshire, Tonya L.; Brown, Kathleen C.; Pryor, Erica R.; Maples, Elizabeth H.

    2012-01-01

    Despite the availability of effective medications, hypertension remains inadequately managed in the United States. It has been established that medication adherence is a major strategy for controlling blood pressure. Combined interventions to promote adherence are promising, but further research is needed to understand which behaviors to target. The frequency of self-monitoring of blood pressure among municipal workers is unknown, and the literature is limited regarding assessing individuals’...

  10. [South-South cooperation to strengthen the medicines control laboratories of the Caribbean community (CARICOM)].

    Science.gov (United States)

    Parisi, José María; Castro, José Luis; Luque, María Celina; Spinetto, Marta; Saidón, Patricia; Fitzgerald, James

    2016-05-01

    Objective To describe the benefits obtained through South-South and triangular cooperation as a potential tool for strengthening medicine quality control in official medicines control laboratories (OMCLs) of the Region of the Americas. Methods Descriptive study of the project for strengthening drug quality control in OMCLs of the Caribbean community (CARICOM). Results Staff members of Argentina's National Administration for Drugs, Food, and Medical Technology (ANMAT) provided training to professionals from Guyana, Jamaica, Suriname, and Trinidad and Tobago. The project was funded by the Argentine Fund for South-South and Triangular Cooperation (FO.AR) and coordinated by the Pan American Health Organization (PAHO). Documents on good laboratory practice (GLP) developed by the World Health Organization (WHO) and the Pan American Network for Drug Regulatory Harmonization (PANDRH) were reviewed, and the area of physical and chemical controls was strengthened, primarily for drugs to treat tuberculosis, malaria, and HIV/AIDS, all of which are strategically important to those countries. Conclusion This type of collaboration makes it possible to share experiences, optimize resources, harmonize procedures and regulations, and strengthen human resource capacities. In addition, it is a valuable tool for reducing asymmetries in various areas among the different countries of our Region.

  11. On position/force tracking control problem of cooperative robot manipulators using adaptive fuzzy backstepping approach.

    Science.gov (United States)

    Baigzadehnoe, Barmak; Rahmani, Zahra; Khosravi, Alireza; Rezaie, Behrooz

    2017-09-01

    In this paper, the position and force tracking control problem of cooperative robot manipulator system handling a common rigid object with unknown dynamical models and unknown external disturbances is investigated. The universal approximation properties of fuzzy logic systems are employed to estimate the unknown system dynamics. On the other hand, by defining new state variables based on the integral and differential of position and orientation errors of the grasped object, the error system of coordinated robot manipulators is constructed. Subsequently by defining the appropriate change of coordinates and using the backstepping design strategy, an adaptive fuzzy backstepping position tracking control scheme is proposed for multi-robot manipulator systems. By utilizing the properties of internal forces, extra terms are also added to the control signals to consider the force tracking problem. Moreover, it is shown that the proposed adaptive fuzzy backstepping position/force control approach ensures all the signals of the closed loop system uniformly ultimately bounded and tracking errors of both positions and forces can converge to small desired values by proper selection of the design parameters. Finally, the theoretic achievements are tested on the two three-link planar robot manipulators cooperatively handling a common object to illustrate the effectiveness of the proposed approach. Copyright © 2017 ISA. Published by Elsevier Ltd. All rights reserved.

  12. Consensus-Based Cooperative Control Based on Pollution Sensing and Traffic Information for Urban Traffic Networks

    Directory of Open Access Journals (Sweden)

    Antonio Artuñedo

    2017-04-01

    Full Text Available Nowadays many studies are being conducted to develop solutions for improving the performance of urban traffic networks. One of the main challenges is the necessary cooperation among different entities such as vehicles or infrastructure systems and how to exploit the information available through networks of sensors deployed as infrastructures for smart cities. In this work an algorithm for cooperative control of urban subsystems is proposed to provide a solution for mobility problems in cities. The interconnected traffic lights controller (TLC network adapts traffic lights cycles, based on traffic and air pollution sensory information, in order to improve the performance of urban traffic networks. The presence of air pollution in cities is not only caused by road traffic but there are other pollution sources that contribute to increase or decrease the pollution level. Due to the distributed and heterogeneous nature of the different components involved, a system of systems engineering approach is applied to design a consensus-based control algorithm. The designed control strategy contains a consensus-based component that uses the information shared in the network for reaching a consensus in the state of TLC network components. Discrete event systems specification is applied for modelling and simulation. The proposed solution is assessed by simulation studies with very promising results to deal with simultaneous responses to both pollution levels and traffic flows in urban traffic networks.

  13. Consensus-Based Cooperative Control Based on Pollution Sensing and Traffic Information for Urban Traffic Networks.

    Science.gov (United States)

    Artuñedo, Antonio; Del Toro, Raúl M; Haber, Rodolfo E

    2017-04-26

    Nowadays many studies are being conducted to develop solutions for improving the performance of urban traffic networks. One of the main challenges is the necessary cooperation among different entities such as vehicles or infrastructure systems and how to exploit the information available through networks of sensors deployed as infrastructures for smart cities. In this work an algorithm for cooperative control of urban subsystems is proposed to provide a solution for mobility problems in cities. The interconnected traffic lights controller (TLC) network adapts traffic lights cycles, based on traffic and air pollution sensory information, in order to improve the performance of urban traffic networks. The presence of air pollution in cities is not only caused by road traffic but there are other pollution sources that contribute to increase or decrease the pollution level. Due to the distributed and heterogeneous nature of the different components involved, a system of systems engineering approach is applied to design a consensus-based control algorithm. The designed control strategy contains a consensus-based component that uses the information shared in the network for reaching a consensus in the state of TLC network components. Discrete event systems specification is applied for modelling and simulation. The proposed solution is assessed by simulation studies with very promising results to deal with simultaneous responses to both pollution levels and traffic flows in urban traffic networks.

  14. Conflictual cooperation

    DEFF Research Database (Denmark)

    Axel, Erik

    2011-01-01

    This paper explores cooperation as contradictory and therefore with a constant possibility for conflict. Consequently it is called conflictual cooperation. The notion is presented on the basis of a participatory observation in a control room of a district heating system. In the investigation......, cooperation appeared as the continuous reworking of contradictions in the local arrangement of societal con- ditions. Subjects were distributed and distributed themselves according to social privileges, resources, and dilemmas in cooperation. Here, the subjects’ activities and understandings took form from...... on regulating who can use what in what way. Contradictions in the observed activity are discussed. It is argued that for the participants the connec- tions of acts appear in such contradictions in cooperation. This conception is dis- cussed in relationship to the notions of practice, as expounded by Bourdieu...

  15. Adherence to a Depression Self-Care Intervention among Primary Care Patients with Chronic Physical Conditions: A Randomised Controlled Trial

    Science.gov (United States)

    McCusker, Jane; Cole, Martin G.; Yaffe, Mark; Strumpf, Erin; Sewitch, Maida; Sussman, Tamara; Ciampi, Antonio; Lavoie, Kim; Belzile, Eric

    2016-01-01

    Objective: Among primary care patients with chronic physical conditions and comorbid depressive symptoms, to assess (1) the effect of lay telephone coaching on adherence to a psycho-educational intervention for depression, (2) demographic characteristics that predict adherence and (3) the association between adherence and 6-month outcomes. Design:…

  16. A Randomized Controlled Trial of Real-Time Electronic Adherence Monitoring With Text Message Dosing Reminders in People Starting First-Line Antiretroviral Therapy.

    Science.gov (United States)

    Orrell, Catherine; Cohen, Karen; Mauff, Katya; Bangsberg, David R; Maartens, Gary; Wood, Robin

    2015-12-15

    There are conflicting findings about whether mobile phone text message reminders impact on antiretroviral adherence. We hypothesized that text reminders sent when dosing was late would improve adherence and HIV viral suppression. Antiretroviral therapy (ART)-naive participants, from a South African outpatient ART clinic, were randomized to standard of care (SoC, 3 pretreatment education sessions), or intervention (SoC and automated text reminders if dosing >30 minutes late). Dosing time was recorded by real-time electronic adherence monitoring devices, given to participants at ART start. CD4 cell count and HIV RNA were determined at baseline, 16 and 48 weeks. Primary outcome was cumulative adherence execution by electronic adherence monitoring device. HIV-1 viral suppression (TIs) >72 hours were secondary outcomes. Analysis was by intention to treat (missing = failure). Registration was with the Pan-African Clinical Trials Registry: PACTR201311000641402. A total of 230 participants were randomly assigned to control (n = 115) or intervention (n = 115) arms. Median adherence was 82.1% (interquartile range, 56.6%-94.6%) in the intervention arm, compared with 80.4% (interquartile range, 52.8%-93.8%) for SoC [adjusted odds ratio for adherence 1.08; 95% confidence interval (CI): 0.77 to 1.52]. Suppressed HIV RNA (TIs of >72 hours was reduced (adjusted incident rate ratio, 0.84; 95% CI: 0.75 to 0.94). Text message reminders linked to late doses detected by real-time adherence monitoring reduced the number of prolonged TIs, but did not significantly improve adherence or viral suppression.

  17. Use of participant focus groups to identify barriers and facilitators to worksite exercise therapy adherence in randomized controlled trials involving firefighters

    Directory of Open Access Journals (Sweden)

    Mayer JM

    2013-03-01

    Full Text Available John M Mayer,1 James L Nuzzo,1 Simon Dagenais2 1School of Physical Therapy and Rehabilitation Sciences, College of Medicine, University of South Florida, Tampa, FL, 2Palladian Health, West Seneca, NY, USA Background: Firefighters are at increased risk for back injuries, which may be mitigated through exercise therapy to increase trunk muscle endurance. However, long-term adherence to exercise therapy is generally poor, limiting its potential benefits. Focus groups can be used to identify key barriers and facilitators to exercise adherence among study participants. Objective: To explore barriers and facilitators to worksite exercise therapy adherence among firefighters to inform future randomized controlled trials (RCTs. Methods: Participants enrolled in a previous RCT requiring twice-weekly worksite exercise therapy for 24 weeks were asked to take part in moderated focus group discussions centered on eight open-ended questions related to exercise adherence. Responses were analyzed qualitatively using a social ecological framework to identify key intrapersonal, interpersonal, and institutional barriers and potential facilitators to exercise adherence. Results: A total of 27 participants were included in the four focus group discussions, representing 50% of those assigned to a worksite exercise therapy group in the previous RCT, in which only 67% of scheduled exercise therapy sessions were completed. Lack of self-motivation was cited as the key intrapersonal barrier to adherence, while lack of peer support was the key interpersonal barrier reported, and lack of time to exercise during work shifts was the key institutional barrier identified. Conclusion: Focus group discussions identified both key barriers and potential facilitators to increase worksite exercise therapy adherence among firefighters. Future studies should consider educating and reminding participants about the benefits of exercise, providing individual and group incentives based on

  18. Transcription factors SOX4 and SOX9 cooperatively control development of bile ducts.

    Science.gov (United States)

    Poncy, Alexis; Antoniou, Aline; Cordi, Sabine; Pierreux, Christophe E; Jacquemin, Patrick; Lemaigre, Frédéric P

    2015-08-15

    In developing liver, cholangiocytes derive from the hepatoblasts and organize to form the bile ducts. Earlier work has shown that the SRY-related High Mobility Group box transcription factor 9 (SOX9) is transiently required for bile duct development, raising the question of the potential involvement of other SOX family members in biliary morphogenesis. Here we identify SOX4 as a new regulator of cholangiocyte development. Liver-specific inactivation of SOX4, combined or not with inactivation of SOX9, affects cholangiocyte differentiation, apico-basal polarity and bile duct formation. Both factors cooperate to control the expression of mediators of the Transforming Growth Factor-β, Notch, and Hippo-Yap signaling pathways, which are required for normal development of the bile ducts. In addition, SOX4 and SOX9 control formation of primary cilia, which are known signaling regulators. The two factors also stimulate secretion of laminin α5, an extracellular matrix component promoting bile duct maturation. We conclude that SOX4 is a new regulator of liver development and that it exerts a pleiotropic control on bile duct development in cooperation with SOX9. Copyright © 2015 Elsevier Inc. All rights reserved.

  19. Cooperative Control of Heterogeneous Uncertain Dynamical Networks: An Adaptive Explicit Synchronization Framework.

    Science.gov (United States)

    Wang, Bohui; Wang, Jingcheng; Zhang, Langwen; Zhang, Bin; Li, Xiaocheng

    2017-06-01

    This paper proposes an adaptive explicit synchronization framework to address the cooperative control for heterogeneous uncertain dynamical networks under switching communication topologies. The main contribution is to develop an adaptive explicit synchronization algorithm, in which the synchronization state can be completely tracked by each agent in real time rather than only be measured after the synchronization process of all agents is over. By introducing appropriate assumptions, a class of adaptive explicit synchronization protocols is designed by using a combination of the virtual leader's states, the neighboring agents' relative information, distributed feedback gain, and distributed average weighted parameters. It is proved in the sense of Lyapunov that, if the dwell time is larger than a positive threshold, the cooperative control problem for the closed-loop heterogeneous uncertain dynamical networks under switching of strongly-connected communication topologies can be solved by the proposed adaptive explicit synchronization algorithm. Furthermore, by assuming that the topology is frequently strongly-connected, it shows that intermittent adaptive explicit synchronization can be achieved with well-designed control parameters. Two examples are presented to demonstrate the effectiveness of the proposed theory.

  20. Living on the wedge: female control of paternity in a cooperatively polyandrous cichlid.

    Science.gov (United States)

    Kohda, Masanori; Heg, Dik; Makino, Yoshimi; Takeyama, Tomohiro; Shibata, Jun-ya; Watanabe, Katsutoshi; Munehara, Hiroyuki; Hori, Michio; Awata, Satoshi

    2009-12-07

    Theories suggest that, in cooperatively breeding species, female control over paternity and reproductive output may affect male reproductive skew and group stability. Female paternity control may come about through cryptic female choice or female reproductive behaviour, but experimental studies are scarce. Here, we show a new form of female paternity control in a cooperatively polyandrous cichlid fish (Julidochromis transcriptus), in which females prefer wedge-shaped nesting sites. Wedge-shaped sites allowed females to manipulate the siring success of the group member males by spawning the clutch at the spot where the large males were just able to enter and fertilize the outer part of the clutch. Small males fertilized the inner part of the clutch, protected from the large aggressive males, leading to low male reproductive skew. Small males provided more brood care than large males. Multiple paternity induced both males to provide brood care and reduced female brood care accordingly. This is, to our knowledge, the first documented case in a species with external fertilization showing female mating behaviour leading to multiple male paternity and increased male brood care as a result.

  1. Optimal control of cooperative multi-vehicle systems; Optimalsteuerung kooperierender Mehrfahrzeugsysteme

    Energy Technology Data Exchange (ETDEWEB)

    Reinl, Christian; Stryk, Oskar von [Technische Univ. Darmstadt (Germany). FB Informatik; Glocker, Markus [Trimble Terrasat GmbH, Hoehenkirchen (Germany)

    2009-07-01

    Nonlinear hybrid dynamical systems for modeling optimal cooperative control enable a tight and formal coupling of discrete and continuous state dynamics, i.e. of dynamic role and task assignment with switching dynamics of motions. In the resulting mixed-integer multi-phase optimal control problems constraints on the discrete and continuous state and control variables can be considered, e.g., formation or communication requirements. Two numerical methods are investigated: a decomposition approach using branch-and-bound and direct collocation methods as well as an approximation by large-scale, mixed-integer linear problems. Both methods are applied to example problems: the optimal simultaneous waypoint sequencing and trajectory planning of a team of aerial vehicles and the optimization of role distribution and trajectories in robot soccer. (orig.)

  2. Distributed Cooperative Control of Multi Flywheel Energy Storage System for Electrical Vehicle Fast Charging Stations

    DEFF Research Database (Denmark)

    Sun, Bo; Dragicevic, Tomislav; Quintero, Juan Carlos Vasquez

    2015-01-01

    Plug-in electrical vehicles will play a critical role in future smart grid and sudden connection of electrical vehicles chargers may cause huge power-peaks with high slew-rates on grid. In order to cope with this issue, this paper applies a distributed cooperative control for fast charging station...... with dedicated paralleled flywheel-based energy storage system. The distributed DC-bus signaling method is employed in the power coordination of grid and flywheel converters, and a distributed secondary controller generates DC voltage correction term to adjust the local voltage set-point through a dynamic...... consensus based voltage observer by communicating with its neighbors. The control system can realize the power balancing and DC voltage regulation with low reliance on communications. Finally, real-time hardware-in-the-loop results have been reported in order to verify the feasibility of proposed approach....

  3. Optimal control for competitive-cooperative systems: Modeling flexible coalitions in tomorrow`s competitive world

    Energy Technology Data Exchange (ETDEWEB)

    Lenhart, S. [Oak Ridge National Lab., TN (United States)]|[Tennessee Univ., Knoxville, TN (United States). Dept. of Mathematics; Protopopescu, V. [Oak Ridge National Lab., TN (United States)

    1994-09-01

    The last years have witnessed a dramatic shift of the world`s military, political, and economic paradigm from a bi-polar competitive gridlock to a more fluid, multi-player environment. This change has necessarily been followed by a re-evaluation of the strategic thinking and by a reassessment of mutual positions, options, and decisions. The essential attributes of the new situation are modeled by a system of nonlinear evolution equations with competitive/cooperative interactions. The mathematical setting is quite general to accommodate models related to military confrontation, arms control, economic competition, political negotiations, etc. Irrespective of the specific details, all these situations share a common denominator, namely the presence of various players with different and often changing interests and goals. The interests, ranging from conflicting to consensual, are defined in a context of interactions between the players that vary from competitive to cooperative. Players with converging interests tend to build up cooperative coalitions while coalitions with diverging interests usually compete among themselves, but this is not an absolute requirement (namely, one may have groups with converging interests and competitive interactions, and vice-versa). Appurtenance to a coalition may change in time according to the shift in one`s perceptions, interests, or obligations. During the time evolution, the players try to modify their strategies as to best achieve their respective goals. An objective functional quantifying the rate of success (payoff) vs. effort (cost) measures the degree of goal attainment for all players involved, thus selecting an optimal strategy based on optimal controls. While the technical details may vary from problem to problem, the general approach described here establishes a standard framework for a host of concrete situations that may arise from tomorrow`s {open_quotes}next competition{close_quotes}.

  4. Effectiveness of a mobile cooperation intervention during the clinical practicum of nursing students: a parallel group randomized controlled trial protocol.

    Science.gov (United States)

    Strandell-Laine, Camilla; Saarikoski, Mikko; Löyttyniemi, Eliisa; Salminen, Leena; Suomi, Reima; Leino-Kilpi, Helena

    2017-06-01

    The aim of this study was to describe a study protocol for a study evaluating the effectiveness of a mobile cooperation intervention to improve students' competence level, self-efficacy in clinical performance and satisfaction with the clinical learning environment. Nursing student-nurse teacher cooperation during the clinical practicum has a vital role in promoting the learning of students. Despite an increasing interest in using mobile technologies to improve the clinical practicum of students, there is limited robust evidence regarding their effectiveness. A multicentre, parallel group, randomized, controlled, pragmatic, superiority trial. Second-year pre-registration nursing students who are beginning a clinical practicum will be recruited from one university of applied sciences. Eligible students will be randomly allocated to either a control group (engaging in standard cooperation) or an intervention group (engaging in mobile cooperation) for the 5-week the clinical practicum. The complex mobile cooperation intervention comprises of a mobile application-assisted, nursing student-nurse teacher cooperation and a training in the functions of the mobile application. The primary outcome is competence. The secondary outcomes include self-efficacy in clinical performance and satisfaction with the clinical learning environment. Moreover, a process evaluation will be undertaken. The ethical approval for this study was obtained in December 2014 and the study received funding in 2015. The results of this study will provide robust evidence on mobile cooperation during the clinical practicum, a research topic that has not been consistently studied to date. © 2016 John Wiley & Sons Ltd.

  5. Exercise motivation and adherence in cancer survivors after participation in a randomized controlled trial: an attribution theory perspective.

    Science.gov (United States)

    Courneya, Kerry S; Friedenreich, Christine M; Sela, Rami A; Quinney, H Arthur; Rhodes, Ryan E; Jones, Lee W

    2004-01-01

    The purpose of this study was to examine postprogram exercise motivation and adherence in cancer survivors who participated in the Group Psychotherapy and Home-Based Physical Exercise (GROUP-HOPE; Courneya, Friedenreich, Sela, Quinney, & Rhodes, 2002) trial. At the completion of the GROUP-HOPE trial, 46 of 51 (90%) participants in the exercise group completed measures of attribution theory constructs. A 5-week follow-up self-report of exercise was then completed by 30 (65%) participants. Correlational analyses indicated that program exercise, perceived success, expected success, and affective reactions were strong predictors of postprogram exercise. In multivariate stepwise regression analyses, program exercise and perceived success were the strongest predictors of postprogram exercise. Additionally, perceived success was more important than objective success in understanding the attribution process, and it interacted with personal control to influence expected success and negative affect. Finally, postprogram quality of life and changes in physical fitness were correlates of perceived success. We concluded that attribution theory may have utility for understanding postprogram exercise motivation and adherence in cancer survivors.

  6. Fault tolerant cooperative control for UAV rendezvous problem subject to actuator faults

    Science.gov (United States)

    Jiang, T.; Meskin, N.; Sobhani-Tehrani, E.; Khorasani, K.; Rabbath, C. A.

    2007-04-01

    This paper investigates the problem of fault tolerant cooperative control for UAV rendezvous problem in which multiple UAVs are required to arrive at their designated target despite presence of a fault in the thruster of any UAV. An integrated hierarchical scheme is proposed and developed that consists of a cooperative rendezvous planning algorithm at the team level and a nonlinear fault detection and isolation (FDI) subsystem at individual UAV's actuator/sensor level. Furthermore, a rendezvous re-planning strategy is developed that interfaces the rendezvous planning algorithm with the low-level FDI. A nonlinear geometric approach is used for the FDI subsystem that can detect and isolate faults in various UAV actuators including thrusters and control surfaces. The developed scheme is implemented for a rendezvous scenario with three Aerosonde UAVs, a single target, and presence of a priori known threats. Simulation results reveal the effectiveness of our proposed scheme in fulfilling the rendezvous mission objective that is specified as a successful intercept of Aerosondes at their designated target, despite the presence of severe loss of effectiveness in Aerosondes engine thrusters.

  7. Radiometric compensation for cooperative distributed multi-projection system through 2-DOF distributed control.

    Science.gov (United States)

    Tsukamoto, Jun; Iwai, Daisuke; Kashima, Kenji

    2015-11-01

    This paper proposes a novel radiometric compensation technique for cooperative projection system based-on distributed optimization. To achieve high scalability and robustness, we assume cooperative projection environments such that 1. each projector does not have information about other projectors as well as target images, 2. the camera does not have information about the projectors either, while having the target images, and 3. only a broadcast communication from the camera to the projectors is allowed to suppress the data transfer bandwidth. To this end, we first investigate a distributed optimization based feedback mechanism that is suitable for the required decentralized information processing environment. Next, we show that this mechanism works well for still image projection, however not necessary for moving images due to the lack of dynamic responsiveness. To overcome this issue, we propose to implement an additional feedforward mechanism. Such a 2 Degree Of Freedom (2-DOF) control structure is well-known in control engineering community as a typical method to enhance not only disturbance rejection but also reference tracking capability, simultaneously. We theoretically guarantee and experimentally demonstrate that this 2-DOF structure yields the moving image projection accuracy that is overwhelming the best achievable performance only by the distributed optimization mechanisms.

  8. Interleukin-1β and transforming growth factor-β cooperate to induce neurosphere formation and increase tumorigenicity of adherent LN-229 glioma cells.

    Science.gov (United States)

    Wang, Lei; Liu, Ziyan; Balivada, Sivasai; Shrestha, Tej; Bossmann, Stefan; Pyle, Marla; Pappan, Loretta; Shi, Jishu; Troyer, Deryl

    2012-02-10

    Glioma stem cells (GSCs) have the property of self-renewal and appear to be a driving force for the initiation and recurrence of gliomas. We recently found that the human tumorigenic LN-229 glioma cell line failed to form neurospheres in serum-free conditions and generated mostly small tumors in vivo, suggesting that either LN-229 GSCs are not active in these conditions or GSCs are absent in the LN-229 cell line. Using self-renewal assay, soft-agar colony assay, cell proliferation assay, invasion assay, real time PCR analysis, ELISA and in vivo tumorigenic assay, we investigated the effects of interleukin (IL)-1β and transforming growth factor (TGF)-β on the development of GSCs from LN-229 cells. Here, we demonstrate that the combination of IL-1β and TGF-β can induce LN-229 cells to form neurospheres in serum-free medium. IL-1β/TGF-β-induced neurospheres display up-regulated expression of stemness factor genes (nestin, Bmi-1, Notch-2 and LIF), and increased invasiveness, drug resistance and tumor growth in vivo: hallmarks of GSCs. These results indicate that IL-1β and TGF-β cooperate to induce a GSC phenotype in the LN-229 cell line. Induction of nestin, LIF and Notch-2 by IL-1β/TGF-β can be reverted after cytokine withdrawal. Remarkably, however, up-regulated Bmi-1 levels remained unchanged after cytokine withdrawal; and the cytokine-withdrawn cells maintained strong clonogenicity, suggesting that Bmi-1 may play a crucial role in tumorigenesis. Our finding indicates that glioma cells without self-renewal capability in standard conditions could also contribute to glioma malignancy when cytokines, such as IL-1β and TGF-β, are present in the tumor environment. Targeting GSC-promoting cytokines that are highly expressed in glioblastomas may contribute to the development of more effective glioma therapies.

  9. Hybrid FES-robot cooperative control of ambulatory gait rehabilitation exoskeleton.

    Science.gov (United States)

    del-Ama, Antonio J; Gil-Agudo, Angel; Pons, José L; Moreno, Juan C

    2014-03-04

    Robotic and functional electrical stimulation (FES) approaches are used for rehabilitation of walking impairment of spinal cord injured individuals. Although devices are commercially available, there are still issues that remain to be solved. Control of hybrid exoskeletons aims at blending robotic exoskeletons and electrical stimulation to overcome the drawbacks of each approach while preserving their advantages. Hybrid actuation and control have a considerable potential for walking rehabilitation but there is a need of novel control strategies of hybrid systems that adequately manage the balance between FES and robotic controllers. Combination of FES and robotic control is a challenging issue, due to the non-linear behavior of muscle under stimulation and the lack of developments in the field of hybrid control. In this article, a cooperative control strategy of a hybrid exoskeleton is presented. This strategy is designed to overcome the main disadvantages of muscular stimulation: electromechanical delay and change in muscle performance over time, and to balance muscular and robotic actuation during walking.Experimental results in healthy subjects show the ability of the hybrid FES-robot cooperative control to balance power contribution between exoskeleton and muscle stimulation. The robotic exoskeleton decreases assistance while adequate knee kinematics are guaranteed. A new technique to monitor muscle performance is employed, which allows to estimate muscle fatigue and implement muscle fatigue management strategies. Kinesis is therefore the first ambulatory hybrid exoskeleton that can effectively balance robotic and FES actuation during walking. This represents a new opportunity to implement new rehabilitation interventions to induce locomotor activity in patients with paraplegia.Acronym list: 10 mWT: ten meters walking test; 6 MWT: six minutes walking test; FSM: finite-state machine; t-FSM: time-domain FSM; c-FSM: cycle-domain FSM; FES: functional electrical

  10. Hierarchical Control Strategy for the Cooperative Braking System of Electric Vehicle

    Directory of Open Access Journals (Sweden)

    Jiankun Peng

    2015-01-01

    Full Text Available This paper provides a hierarchical control strategy for cooperative braking system of an electric vehicle with separated driven axles. Two layers are defined: the top layer is used to optimize the braking stability based on two sliding mode control strategies, namely, the interaxle control mode and signal-axle control strategies; the interaxle control strategy generates the ideal braking force distribution in general braking condition, and the single-axle control strategy can ensure braking safety in emergency braking condition; the bottom layer is used to maximize the regenerative braking energy recovery efficiency with a reallocated braking torque strategy; the reallocated braking torque strategy can recovery braking energy as much as possible in the premise of meeting battery charging power. The simulation results show that the proposed hierarchical control strategy is reasonable and can adapt to different typical road surfaces and load cases; the vehicle braking stability and safety can be guaranteed; furthermore, the regenerative braking energy recovery efficiency can be improved.

  11. Hierarchical Control Strategy for the Cooperative Braking System of Electric Vehicle

    Science.gov (United States)

    Peng, Jiankun; He, Hongwen; Guo, Hongqiang

    2015-01-01

    This paper provides a hierarchical control strategy for cooperative braking system of an electric vehicle with separated driven axles. Two layers are defined: the top layer is used to optimize the braking stability based on two sliding mode control strategies, namely, the interaxle control mode and signal-axle control strategies; the interaxle control strategy generates the ideal braking force distribution in general braking condition, and the single-axle control strategy can ensure braking safety in emergency braking condition; the bottom layer is used to maximize the regenerative braking energy recovery efficiency with a reallocated braking torque strategy; the reallocated braking torque strategy can recovery braking energy as much as possible in the premise of meeting battery charging power. The simulation results show that the proposed hierarchical control strategy is reasonable and can adapt to different typical road surfaces and load cases; the vehicle braking stability and safety can be guaranteed; furthermore, the regenerative braking energy recovery efficiency can be improved. PMID:26236772

  12. Cooperative Mmonitoring Center Occasional Paper/5: Propspects of Conventional Arms Control in South Asia

    Energy Technology Data Exchange (ETDEWEB)

    Gupta, Amit; Kamal, Nazir

    1998-11-01

    The intensely adversarial relationship between India and Pakistan is marked by military rivalry, mutual distrust, and suspicion. The most dividing disagreement has been over the Kashmir region. An inability to discuss the Kashmir issue has prevented discussion on other important issues. Since there is little prospect of detente, at least in the near-term, the question is whether this rivalry can be contained by other means, such as arms control approaches. Conventional arms control has been applied flexibly and successfully in some regions to reduce threat-perceptions and achieve reassuring military stability. Some lessons from other international models might be applied to the India/Pakistan context. This paper discusses the status of conventional arms control in South Asia, the dominant Indian and Pakistani perceptions about arms control, the benefits that could be derived from arms control, as well as the problems and prospects of arms control. It also discusses existing conventional arms control agreements at the regional and global levels as well as the potential role of cooperative monitoring technology.

  13. Man-Robot Symbiosis: A Framework For Cooperative Intelligence And Control

    Science.gov (United States)

    Parker, Lynne E.; Pin, Francois G.

    1988-10-01

    The man-robot symbiosis concept has the fundamental objective of bridging the gap between fully human-controlled and fully autonomous systems to achieve true man-robot cooperative control and intelligence. Such a system would allow improved speed, accuracy, and efficiency of task execution, while retaining the man in the loop for innovative reasoning and decision-making. The symbiont would have capabilities for supervised and unsupervised learning, allowing an increase of expertise in a wide task domain. This paper describes a robotic system architecture facilitating the symbiotic integration of teleoperative and automated modes of task execution. The architecture reflects a unique blend of many disciplines of artificial intelligence into a working system, including job or mission planning, dynamic task allocation, man-robot communication, automated monitoring, and machine learning. These disciplines are embodied in five major components of the symbiotic framework: the Job Planner, the Dynamic Task Allocator, the Presenter/Interpreter, the Automated Monitor, and the Learning System.

  14. Self-organized control in cooperative robots using a pattern formation principle

    Energy Technology Data Exchange (ETDEWEB)

    Starke, Jens, E-mail: j.starke@mat.dtu.d [Department of Mathematics, Technical University of Denmark, Matematiktorvet, Building 303 S, DK-2800 Kongens Lyngby (Denmark); Ellsaesser, Carmen [Institute of Applied Mathematics and Interdisciplinary Center for Scientific Computing, University of Heidelberg, Im Neuenheimer Feld 294, D-69120 Heidelberg (Germany); Fukuda, Toshio [Center for Cooperative Research in Advanced Science and Technology, Nagoya University, Furo-cho, Chikusa-ku, Nagoya 464-8603 (Japan)

    2011-05-23

    Self-organized modular approaches proved in nature to be robust and optimal and are a promising strategy to control future concepts of flexible and modular manufacturing processes. We show how this can be applied to a model of flexible manufacturing based on time-dependent robot-target assignment problems where robot teams have to serve manufacturing targets such that an objective function is optimized. Feasibility of the self-organized solutions can be guaranteed even for unpredictable situations like sudden changes in the demands or breakdowns of robots. As example an uncrewed space mission is visualized in a simulation where robots build a space station. - Highlights: Adapting a pattern formation principle to control cooperative robots in a robust way. Flexible manufacturing systems are modelled by time-dependent assignment problems. Coupled selection equations guarantee feasibility of solutions. Solution structure (permutations) is not destroyed by inhomogeneous growth rates. Example of an uncrewed space mission shows effectivity and robustness.

  15. Material protection, control, and accounting enhancements through the Russian/US cooperative MPC & A program

    Energy Technology Data Exchange (ETDEWEB)

    Scott, S.C. [Los Alamos National Lab., NM (United States); Sude, S. [Brookhaven National Lab., Upton, NY (United States); Buckley, W.M. [Lawrence Livremore National Lab., CA (United States)] [and others

    1997-11-01

    The cooperative Russian/US Mining and Chemical Combine (Gorno-Khimichesky Kombinat, GKhK, also referred to as Krasnoyarsk-26) Materials Protection, Control, and Accounting (MPC & A) project was initiated in June 1996. Since then, the GKhK has collaborated with Brookhaven, Lawrence Livermore, Los Alamos, Oak Ridge, Pacific Northwest, and Sandia National Laboratories to test, evaluate, and implement MPC & A elements including bar codes, computerized nuclear material accounting software, nondestructive assay technologies, bulk measurement systems, seals, video surveillance systems, radio communication systems, metal detectors, vulnerability assessment tools, personnel access control systems, and pedestrian nuclear material portal monitors. This paper describes the strategy for implementation of these elements at the GKhK and the status of the collaborative efforts. 8 refs., 7 figs., 1 tab.

  16. Cooperative Control with Virtual Selective Harmonic Capacitance for Harmonic Voltage Compensation in Islanded MicroGrids

    DEFF Research Database (Denmark)

    Micallef, A.; Apap, M.; Spitero-Stanies, C.

    2012-01-01

    or active filters to selectively compensate harmonic frequencies. However, by adding suitable control strategies to the inverters connected to the microgrid, the power quality of the microgrid can be improved without the installation of any additional equipment. In this paper, a capacitive virtual impedance......This paper focuses on the islanded operation of microgrids. In this mode of operation, the microsources are required to cooperate autonomously to regulate the local grid voltage and frequency. Droop control is typically used to achieve this autonomous voltage and frequency regulation. Inverters...... having LCL output filters would cause voltage distortion to be present at the PCC of the local load when non-linear current is supplied to the load due to the voltage drop across the grid side inductor. Techniques to reduce the output voltage distortion typically consist of installing either passive...

  17. Interventions with adherence-promoting components in pediatric type 1 diabetes: meta-analysis of their impact on glycemic control.

    Science.gov (United States)

    Hood, Korey K; Rohan, Jennifer M; Peterson, Claire M; Drotar, Dennis

    2010-07-01

    To review interventions with adherence-promoting components and document their impact on glycemic control via meta-analysis. Data from 15 studies that met the following criteria were subjected to meta-analysis: 1) randomized, controlled trial, 2) study sample included youth aged change for the intervention versus control group comparison was 0.11 (95% CI -0.01 to 0.23). This is a small effect, demonstrating very modest improvements in glycemic control. However, analysis for the pre- to posttreatment effects for the intervention group alone did show significant variability [Q(14) = 33.11; P processes that facilitate diabetes management, were more potent than interventions just targeting a direct, behavioral process (e.g., increase in blood glucose monitoring frequency). Interventions that focus on direct, behavioral processes and neglect emotional, social, and family processes are unlikely to have an impact on glycemic control; multicomponent interventions showed more robust effects on A1C. Future clinical research should focus on refining interventions and gathering more efficacy and effectiveness data on health outcomes of the pediatric patients treated with these interventions.

  18. Prevalence of blood pressure self-monitoring, medication adherence, self-efficacy, stage of change, and blood pressure control among municipal workers with hypertension.

    Science.gov (United States)

    Breaux-Shropshire, Tonya L; Brown, Kathleen C; Pryor, Erica R; Maples, Elizabeth H

    2012-06-01

    Despite the availability of effective medications, hypertension remains inadequately managed in the United States. It has been established that medication adherence is a major strategy for controlling blood pressure. Combined interventions to promote adherence are promising, but further research is needed to understand which behaviors to target. The frequency of self-monitoring of blood pressure among municipal workers is unknown, and the literature is limited regarding assessing individuals' readiness and confidence to engage in medication adherence. The purpose of this study was to determine the prevalence of medication adherence, readiness, self-efficacy, self-monitoring of blood pressure, and blood pressure control among hypertensive municipal workers. The study population was enrolled in a wellness program established more than 20 years ago to promote health and safety for a work force in a large southeastern U.S. city. The majority of the study participants (75.7%) demonstrated controlled blood pressure, reported adherence to antihypertensive medication (70%), and self-monitored blood pressure (70%). Copyright 2012, SLACK Incorporated.

  19. Design and implementation of co-operative control strategy for hybrid AC/DC microgrids

    Science.gov (United States)

    Mahmud, Rasel

    This thesis is mainly divided in two major sections: 1) Modeling and control of AC microgrid, DC microgrid, Hybrid AC/DC microgrid using distributed co-operative control, and 2) Development of a four bus laboratory prototype of an AC microgrid system. At first, a distributed cooperative control (DCC) for a DC microgrid considering the state-of-charge (SoC) of the batteries in a typical plug-in-electric-vehicle (PEV) is developed. In DC microgrids, this methodology is developed to assist the load sharing amongst the distributed generation units (DGs), according to their ratings with improved voltage regulation. Subsequently, a DCC based control algorithm for AC microgrid is also investigated to improve the performance of AC microgrid in terms of power sharing among the DGs, voltage regulation and frequency deviation. The results validate the advantages of the proposed methodology as compared to traditional droop control of AC microgrid. The DCC-based control methodology for AC microgrid and DC microgrid are further expanded to develop a DCC-based power management algorithm for hybrid AC/DC microgrid. The developed algorithm for hybrid microgrid controls the power flow through the interfacing converter (IC) between the AC and DC microgrids. This will facilitate the power sharing between the DGs according to their power ratings. Moreover, it enables the fixed scheduled power delivery at different operating conditions, while maintaining good voltage regulation and improved frequency profile. The second section provides a detailed explanation and step-by-step design and development of an AC/DC microgrid testbed. Controllers for the three-phase inverters are designed and tested on different generation units along with their corresponding inductor-capacitor-inductor (LCL) filters to eliminate the switching frequency harmonics. Electric power distribution line models are developed to form the microgrid network topology. Voltage and current sensors are placed in the proper

  20. Congestion Avoidance Control through Non-cooperative Games between Customers and Service Providers

    Science.gov (United States)

    Charilas, Dimitris E.; Panagopoulos, Athanasios D.; Vlacheas, Panagiotis; Markaki, Ourania I.; Constantinou, Philip

    Congestion avoidance control refers to controlling the load of the network by restricting the admission of new user’s sessions and resolving the unwanted overload situations. Admission control and Load control constitute key mechanisms regarding Radio Resource Management. As the wireless world is moving towards heterogeneous wireless networks, these types of control are facing more challenges, since efficiency and fairness are required. Game theory provides an appropriate framework for formulating fair and efficient congestion avoidance control problems. In this paper we formulate a non-cooperative game between service providers and customers. On the one hand, the service providers wish to maximize their revenue, but on the other hand, the users wish to maximize the quality of service received, keeping at the same time the expenses as low as possible. Therefore a balance has to be established among these contradictory demands. Our effort also concentrates in the proper modeling of the user’s level of satisfaction, so as to provide a logical decision-taking framework. The proposed scheme is then tested using the ns2 simulator. Results show that both parties can benefit from this mechanism.

  1. Consensus-based distributed cooperative learning from closed-loop neural control systems.

    Science.gov (United States)

    Chen, Weisheng; Hua, Shaoyong; Zhang, Huaguang

    2015-02-01

    In this paper, the neural tracking problem is addressed for a group of uncertain nonlinear systems where the system structures are identical but the reference signals are different. This paper focuses on studying the learning capability of neural networks (NNs) during the control process. First, we propose a novel control scheme called distributed cooperative learning (DCL) control scheme, by establishing the communication topology among adaptive laws of NN weights to share their learned knowledge online. It is further proved that if the communication topology is undirected and connected, all estimated weights of NNs can converge to small neighborhoods around their optimal values over a domain consisting of the union of all state orbits. Second, as a corollary it is shown that the conclusion on the deterministic learning still holds in the decentralized adaptive neural control scheme where, however, the estimated weights of NNs just converge to small neighborhoods of the optimal values along their own state orbits. Thus, the learned controllers obtained by DCL scheme have the better generalization capability than ones obtained by decentralized learning method. A simulation example is provided to verify the effectiveness and advantages of the control schemes proposed in this paper.

  2. Optimal Control of Holding Motion by Nonprehensile Two-Cooperative-Arm Robot

    Directory of Open Access Journals (Sweden)

    Changan Jiang

    2016-01-01

    Full Text Available Recently, more researchers have focused on nursing-care assistant robot and placed their hope on it to solve the shortage problem of the caregivers in hospital or nursing home. In this paper, a nonprehensile two-cooperative-arm robot is considered to realize holding motion to keep a two-rigid-link object (regarded as a care-receiver stable on the robot arms. By applying Newton-Euler equations of motion, dynamic model of the object is obtained. In this model, for describing interaction behavior between object and robot arms in the normal direction, a viscoelastic model is employed to represent the normal forces. Considering existence of friction between object and robot arms, LuGre dynamic model is applied to describe the friction. Based on the obtained model, an optimal regulator is designed to control the holding motion of two-cooperative-arm robot. In order to verify the effectiveness of the proposed method, simulation results are shown.

  3. Active and Inactive Enhancers Cooperate to Exert Localized and Long-Range Control of Gene Regulation

    Directory of Open Access Journals (Sweden)

    Charlotte Proudhon

    2016-06-01

    Full Text Available V(DJ recombination relies on the presence of proximal enhancers that activate the antigen receptor (AgR loci in a lineage- and stage-specific manner. Unexpectedly, we find that both active and inactive AgR enhancers cooperate to disseminate their effects in a localized and long-range manner. Here, we demonstrate the importance of short-range contacts between active enhancers that constitute an Igk super-enhancer in B cells. Deletion of one element reduces the interaction frequency between other enhancers in the hub, which compromises the transcriptional output of each component. Furthermore, we establish that, in T cells, long-range contact and cooperation between the inactive Igk enhancer MiEκ and the active Tcrb enhancer Eβ alters enrichment of CBFβ binding in a manner that impacts Tcrb recombination. These findings underline the complexities of enhancer regulation and point to a role for localized and long-range enhancer-sharing between active and inactive elements in lineage- and stage-specific control.

  4. Post-Discharge Adherence With Venous Thromboembolism Prophylaxis After Orthopedic Trauma: Results From a Randomized Controlled Trial of Aspirin vs. Low Molecular Weight Heparin.

    Science.gov (United States)

    Haac, Bryce E; Van Besien, Richard; OʼHara, Nathan N; Slobogean, Gerard P; Manson, Theodore T; OʼToole, Robert V; Johal, Herman; Berger, Peter Z; Reahl, George B; Marinos, Dimitrius; Degani, Yasmin; Mascarenhas, Daniel; Connelly, Daniel; Scalea, Thomas M; Stein, Deborah M

    2017-12-14

    Orthopedic trauma patients are often treated with venous thromboembolism (VTE) chemoprophylaxis with aspirin or low molecular weight heparin (LMWH) after discharge from their index admission, but adherence patterns are not known. We hypothesized that overall adherence would be moderate and greater with aspirin compared to LMWH. We conducted a randomized controlled trial of adult trauma patients with an operative extremity fracture or any pelvic/acetabular fracture requiring VTE prophylaxis. Patients were randomized to receive either LMWH 30mg BID or aspirin 81mg BID. Patients prescribed outpatient prophylaxis were contacted between 10 to 21 days after discharge to assess adherence measured by the validated Morisky Medication Adherence Scale (MMAS-8). Adherence scores were compared between the two treatment arms with similar results for intention-to-treat and as-treated analyses. As-treated multivariable logistic regression was performed to determine factors associated with low-medium adherence scores. 150 patients (64 on LMWH, 86 on aspirin) on chemoprophylaxis at time of follow-up completed the questionnaire. As-treated analysis showed that adherence was high overall (mean MMAS 7.2 out of 8, SD 1.5) and similar for the two regimens (LMWH: 7.4 vs. aspirin: 7.0, p=0.13). However, patients on LMWH were more likely to feel hassled by their regimen (23% vs. 9%, p=0.02). In a multivariable model, low-medium adherence was associated with taking LMWH as the prophylaxis medication (aOR 2.34, CI 1.06 - 5.18, p=0.04), having to self-administer the prophylaxis (aOR 4.44, CI 1.45 - 13.61, p<0.01), being of male sex (aOR 2.46, CI 1.10 - 5.49, p=0.03) and of younger age (aOR 0.72 per additional 10 years of age, CI 0.57-0.91, p<0.01). Overall post-discharge adherence with VTE prophylaxis was high. Several factors, including prophylaxis by LMWH, were associated with decreased adherence. These factors should be considered when managing patients and designing efficacy trials. Level

  5. Super twisting controller for on-orbit servicing to non-cooperative target

    Directory of Open Access Journals (Sweden)

    Binglong Chen

    2015-02-01

    Full Text Available A relative position and attitude coupled controller is proposed for rendezvous and docking between two docking ports located in different spacecraft. It is concerned with servicing to a tumbling non-cooperative target spacecraft in arbitrary orbit subjected to external disturbances. By considering both kinematic and dynamical coupled effects of relative rotation on relative translation, a coupled dynamic model is established to represent the relative motion of docking port on target spacecraft with respect to another on the service spacecraft. The spacecraft control is based on the second order sliding mode algorithm of super twisting (ST. It is schemed to manipulate the relative position and attitude synchronously. A formal proof of the finite time convergence property of the closed-loop system is derived theoretically by the second method of Lyapunov. Numerical simulations with the designed ST controller are presented to validate the analytic analysis by contrast with the twisting control algorithm. Simulation results demonstrate that the proposed relative position and attitude integrated controller is characterized by high precision, strong robustness and high reliability.

  6. An improved cooperative adaptive cruise control (CACC) algorithm considering invalid communication

    Science.gov (United States)

    Wang, Pangwei; Wang, Yunpeng; Yu, Guizhen; Tang, Tieqiao

    2014-05-01

    For the Cooperative Adaptive Cruise Control (CACC) Algorithm, existing research studies mainly focus on how inter-vehicle communication can be used to develop CACC controller, the influence of the communication delays and lags of the actuators to the string stability. However, whether the string stability can be guaranteed when inter-vehicle communication is invalid partially has hardly been considered. This paper presents an improved CACC algorithm based on the sliding mode control theory and analyses the range of CACC controller parameters to maintain string stability. A dynamic model of vehicle spacing deviation in a platoon is then established, and the string stability conditions under improved CACC are analyzed. Unlike the traditional CACC algorithms, the proposed algorithm can ensure the functionality of the CACC system even if inter-vehicle communication is partially invalid. Finally, this paper establishes a platoon of five vehicles to simulate the improved CACC algorithm in MATLAB/Simulink, and the simulation results demonstrate that the improved CACC algorithm can maintain the string stability of a CACC platoon through adjusting the controller parameters and enlarging the spacing to prevent accidents. With guaranteed string stability, the proposed CACC algorithm can prevent oscillation of vehicle spacing and reduce chain collision accidents under real-world circumstances. This research proposes an improved CACC algorithm, which can guarantee the string stability when inter-vehicle communication is invalid.

  7. Tracking and Formation Control of Leader-Follower Cooperative Mobile Robots Based on Trilateration Data

    Directory of Open Access Journals (Sweden)

    Endah Suryawati Ningrum

    2016-04-01

    Full Text Available This research deals with formation control of swarm robot based on changing of robot’s relative positional data. A follow the leader movement with simple triangle formation case is applied with three robots; a leader with two followers. Trilateration method is used as a method of determining the position of the leader robot from the follower robots using the distance to the reference point (local positioning. Follower robots are designed to follow every movement of the leader on a formation position. The controller is designed to maintain the formation position of the follower robots relatively to the leader. As a uniqueness, a relative positional control method by using bearing angle and distance error is proposed instead of the common Cartesian positional error control. From the experiment which conducted in maximum distance between the robots,it was obtained a maximum error approximately 56%. The follower robots are able to follow any changes in motion of the robot leader with average distance error of 36%. Keywords: Cooperative mobile robot, formation control, trilateration, follow the leader

  8. A Human-Machine-Cooperative-Driving Controller Based on AFS and DYC for Vehicle Dynamic Stability

    Directory of Open Access Journals (Sweden)

    Jian Wu

    2017-10-01

    Full Text Available It is a difficult and important project to coordinate active front steering (AFS and direct yaw moment control (DYC, which has great potential to improve vehicle dynamic stability. Moreover, the balance between driver’s operation and advanced technologies’ intervention is a critical problem. This paper proposes a human-machine-cooperative-driving controller (HMCDC with a hierarchical structure for vehicle dynamic stability and it consists of a supervisor, an upper coordination layer, and two lower layers (AFS and DYC. The range of AFS additional angle is constrained, with consideration of the influence of AFS on drivers’ feeling. First, in the supervisor, a nonlinear vehicle model was utilized to predict vehicle states, and the reference yaw rate, and side slip angle values were calculated. Then, the upper coordination layer decides the control object and control mode. At last, DYC and AFS calculate brake pressures and the range of active steering angle, respectively. The proposed HMCDC is evaluated by co-simulation of CarSim and MATLAB. Results show that the proposed controller could improve vehicle dynamic stability effectively for the premise of ensuring the driver’s intention.

  9. A Cooperative Congestion Control Approach within VANETs: Formal Verification and Performance Evaluation

    Directory of Open Access Journals (Sweden)

    Bouassida MohamedSalah

    2010-01-01

    Full Text Available The main objective of congestion control is to best exploit the available network resources while preventing sustained overloads of network nodes and links. Appropriate congestion control mechanisms are essential to provide effcient operation of a network. Ensuring congestion control within vehicular ad hoc networks faces special challenges, due to the specificities of such environment (High mobility of nodes, high rate of topology changes, high variability in nodes density and neighborhood configuration, broadcast/geocast communication nature, etc.. In this context, we present in this paper a cooperative and fully distributed congestion control approach, based on dynamic scheduling and transmission of priority-based messages, to ensure reliable and safe communication architecture within VANET. Messages priorities are dynamically evaluated according to their types, the network context, and the neighboring nodes configuration. Considering the context of high reliability and real-time response required for intervehicular communications (including emergency breaking notification for example, we propose a complete validation method of our congestion control algorithms, taking into account reliability, temporal, and operational aspects.

  10. A cooperative reduction model for regional air pollution control in China that considers adverse health effects and pollutant reduction costs.

    Science.gov (United States)

    Xie, Yujing; Zhao, Laijun; Xue, Jian; Hu, Qingmi; Xu, Xiang; Wang, Hongbo

    2016-12-15

    How to effectively control severe regional air pollution has become a focus of global concern recently. The non-cooperative reduction model (NCRM) is still the main air pollution control pattern in China, but it is both ineffective and costly, because each province must independently fight air pollution. Thus, we proposed a cooperative reduction model (CRM), with the goal of maximizing the reduction in adverse health effects (AHEs) at the lowest cost by encouraging neighboring areas to jointly control air pollution. CRM has two parts: a model of optimal pollutant removal rates using two optimization objectives (maximizing the reduction in AHEs and minimizing pollutant reduction cost) while meeting the regional pollution control targets set by the central government, and a model that allocates the cooperation benefits (i.e., health improvement and cost reduction) among the participants according to their contributions using the Shapley value method. We applied CRM to the case of sulfur dioxide (SO2) reduction in Yangtze River Delta region. Based on data from 2003 to 2013, and using mortality due to respiratory and cardiovascular diseases as the health endpoints, CRM saves 437 more lives than NCRM, amounting to 12.1% of the reduction under NCRM. CRM also reduced costs by US $65.8×106 compared with NCRM, which is 5.2% of the total cost of NCRM. Thus, CRM performs significantly better than NCRM. Each province obtains significant benefits from cooperation, which can motivate them to actively cooperate in the long term. A sensitivity analysis was performed to quantify the effects of parameter values on the cooperation benefits. Results shown that the CRM is not sensitive to the changes in each province's pollutant carrying capacity and the minimum pollutant removal capacity, but sensitive to the maximum pollutant reduction capacity. Moreover, higher cooperation benefits will be generated when a province's maximum pollutant reduction capacity increases. Copyright

  11. The Nurse-Led Telephone Follow-Up on Medication and Dietary Adherence among Patients after Myocardial Infarction: A Randomized Controlled Clinical Trial.

    Science.gov (United States)

    Najafi, Seyed Saeed; Shaabani, Maryam; Momennassab, Marzieh; Aghasadeghi, Kamran

    2016-07-01

    Adherence to dietary and medication regimen plays an important role in successful treatment and reduces the negative complications and severity of the disease. Therefore, the present study aimed to investigate the effect of nurse-led telephone follow-up on the level of adherence to dietary and medication regimen among patients after Myocardial Infarction (MI). This non-blinded randomized controlled clinical trial was conducted on 100 elderly patients with MI who had referred to the cardiovascular clinics in Shiraz. Participants were selected and randomly assigned to intervention and control groups using balanced block randomization method. The intervention group received a nurse-led telephone follow-up. The data were collected using a demographic questionnaire, Morisky's 8-item medication adherence questionnaire, and dietary adherence questionnaire before and three months after the intervention. Data analysis was done by the SPSS statistical software (version 21), using paired t-test for intra-group and Chi-square and t-test for between groups comparisons. Significance level was set at0.05). However, a statistically significant difference was found between the two groups in this regard after the intervention (Ptele-nursing on improvement of adherence to dietary and medication regimen in the patients with MI. IRCT201409148505N8.

  12. Impact of symptomatic hypoglycemia on medication adherence, patient satisfaction with treatment, and glycemic control in patients with type 2 diabetes

    Directory of Open Access Journals (Sweden)

    Walz L

    2014-04-01

    Full Text Available Lotta Walz,1,3 Billie Pettersson,2,3 Ulf Rosenqvist,4 Anna Deleskog,3,5 Gunilla Journath,6 Per Wändell7 1Department of Oncology-Pathology, Karolinska Institutet, Stockholm, 2Center for Medical Technology Assessment, Linköping University, Linköping, 3Merck Sharp and Dohme (Sweden AB, Sollentuna, 4Department of Internal Medicine, Motala Hospital, Motala, 5Department of Molecular Medicine and Surgery, 6Department of Medicine, Karolinska Institutet, Stockholm, 7Department of Neurobiology, Care Sciences and Society, Centre for Family Medicine, Karolinska Institutet, Huddinge, Sweden Background: The purpose of this study was to evaluate the impact of symptomatic hypoglycemia on medication adherence, satisfaction with treatment, and glycemic control in patients with type 2 diabetes based on the treatment goals stated in the Swedish national guidelines. Methods: This cross-sectional, multicenter study was carried out between January and August 2009 in 430 consecutive primary health care patients on stable doses of metformin and sulfonylureas for at least 6 months. The patients completed questionnaires covering their experiences of low blood glucose and adherence, as well as barriers to and satisfaction with drug treatment (using the Treatment Satisfaction Questionnaire for Medication. Physicians collected the data from medical records. Results: Patients who experienced moderate or worse symptoms of hypoglycemia reported poorer adherence to medication (46% versus 67%; P<0.01 and were more likely to perceive barriers such as “bothered by medication side effects” (36% versus 14%; P<0.001 compared with patients with no or mild symptoms. Patients with moderate or worse symptoms of hypoglycemia were less satisfied with their treatment than those with no or mild symptoms as determined by the Treatment Satisfaction Questionnaire for Medication-Global satisfaction (67.0 versus 71.2; P<0.05. Overall, achievement of target glycated hemoglobin

  13. Application of statistical process control methods to monitor guideline adherence: a case study

    NARCIS (Netherlands)

    Peek, Niels; Goud, Rick; Abu-Hanna, Ameen

    2008-01-01

    Control charts are tools from the field of statistical process control for visualizing the longitudinal development of quality indicators, and detecting whether the underlying process is changing. They have been used in critical care and disease management settings to monitor and improve patient

  14. The impact of pharmacist-led medication therapy management on medication adherence in patients with type 2 diabetes mellitus: a randomized controlled study.

    Science.gov (United States)

    Erku, Daniel A; Ayele, Asnakew A; Mekuria, Abebe B; Belachew, Sewunet A; Hailemeskel, Bisrat; Tegegn, Henok G

    2017-01-01

    Poor adherence to antidiabetic medications leads to a higher rate of hospital admissions and adverse health outcomes in type 2 diabetes mellitus patients. This study aims to evaluate whether a pharmacist-led medication therapy management, compared to the usual care, could enhance medication adherence and reduce hospital admission in patients with type 2 diabetes mellitus. A prospective randomized controlled study was conducted in patients with type 2 diabetes mellitus from February 1 to July 30, 2016. Patients in the control group (n=65) received the usual care while patients in the intervention group (n=62) received a personalized pharmacotherapeutic care plan and diabetes education. The two groups were compared by repeated measure ANOVA at 3 and 6-months with medication adherence (using Morisky medication adherence scale) and number of hospital admissions as the main outcome variables. A total of 127 patients were included in the study. A marked and statistically significant increase in medication adherence from baseline to 3 and 6 months were noted in the intervention group (increased from 9.2% at baseline to 61% at 6 month) compared with the control group (increased from 13.2% at baseline (to 30.2% at 6 month; p-value23 patients in MTM group with poorly controlled blood glucose levels resulted in hospital admissions compared to 48 patients in non-MTM group, resulting in a 52.1% fewer hospital admissions (pmedication therapy management might improve medication adherence and reduce number of hospitalizations in patients with type 2 diabetes mellitus. Hence, policies and guidelines should be in place in order for clinical pharmacists to fully engage in patient care and improve the medication therapy outcomes.

  15. The impact of pharmacist-led medication therapy management on medication adherence in patients with type 2 diabetes mellitus: a randomized controlled study

    Directory of Open Access Journals (Sweden)

    Erku DA

    2017-09-01

    Full Text Available Background: Poor adherence to antidiabetic medications leads to a higher rate of hospital admissions and adverse health outcomes in type 2 diabetes mellitus patients. Objective: This study aims to evaluate whether a pharmacist-led medication therapy management, compared to the usual care, could enhance medication adherence and reduce hospital admission in patients with type 2 diabetes mellitus. Methods: A prospective randomized controlled study was conducted in patients with type 2 diabetes mellitus from February 1 to July 30, 2016. Patients in the control group (n=65 received the usual care while patients in the intervention group (n=62 received a personalized pharmacotherapeutic care plan and diabetes education. The two groups were compared by repeated measure ANOVA at 3 and 6‐months with medication adherence (using Morisky medication adherence scale and number of hospital admissions as the main outcome variables. Results: A total of 127 patients were included in the study. A marked and statistically significant increase in medication adherence from baseline to 3 and 6 months were noted in the intervention group (increased from 9.2% at baseline to 61% at 6 month compared with the control group (increased from 13.2% at baseline (to 30.2% at 6 month; p-value<0.01. Furthermore, at the 6-month follow-up, only 23 patients in MTM group with poorly controlled blood glucose levels resulted in hospital admissions compared to 48 patients in non-MTM group, resulting in a 52.1% fewer hospital admissions (p< 0.001. Conclusions: The findings of this study implied that pharmacist-led medication therapy management might improve medication adherence and reduce number of hospitalizations in patients with type 2 diabetes mellitus. Hence, policies and guidelines should be in place in order for clinical pharmacists to fully engage in patient care and improve the medication therapy outcomes.

  16. A role for the RNA chaperone Hfq in controlling adherent-invasive Escherichia coli colonization and virulence.

    Directory of Open Access Journals (Sweden)

    Karina T Simonsen

    Full Text Available Adherent-invasive Escherichia coli (AIEC has been linked with the onset and perpetuation of inflammatory bowel diseases. The AIEC strain LF82 was originally isolated from an ileal biopsy from a patient with Crohn's disease. The pathogenesis of LF82 results from its abnormal adherence to and subsequent invasion of the intestinal epithelium coupled with its ability to survive phagocytosis by macrophages once it has crossed the intestinal barrier. To gain further insight into AIEC pathogenesis we employed the nematode Caenorhabditis elegans as an in vivo infection model. We demonstrate that AIEC strain LF82 forms a persistent infection in C. elegans, thereby reducing the host lifespan significantly. This host killing phenotype was associated with massive bacterial colonization of the nematode intestine and damage to the intestinal epithelial surface. C. elegans killing was independent of known LF82 virulence determinants but was abolished by deletion of the LF82 hfq gene, which encodes an RNA chaperone involved in mediating posttranscriptional gene regulation by small non-coding RNAs. This finding reveals that important aspects of LF82 pathogenesis are controlled at the posttranscriptional level by riboregulation. The role of Hfq in LF82 virulence was independent of its function in regulating RpoS and RpoE activity. Further, LF82Δhfq mutants were non-motile, impaired in cell invasion and highly sensitive to various chemical stress conditions, reinforcing the multifaceted function of Hfq in mediating bacterial adaptation. This study highlights the usefulness of simple non-mammalian infection systems for the identification and analysis of bacterial virulence factors.

  17. Impact of interview mode on accuracy of child and parent report of adherence with asthma-controller medication.

    Science.gov (United States)

    Bender, Bruce G; Bartlett, Susan J; Rand, Cynthia S; Turner, Charles; Wamboldt, Frederick S; Zhang, Lening

    2007-09-01

    Parents and children often overreport adherence to treatment regimens, which in turn complicates interpretation and application of clinical trial findings. The objective of this investigation was to test the effect of reporting mode on accuracy of inhaled corticosteroid-adherence reporting in children with asthma and their parents under conditions similar to those of an asthma clinical trial. Participants included 104 children who were being treated with an inhaled corticosteroid delivered by a metered-dose inhaler for asthma diagnosed by their health care provider. Each parent and child dyad was randomly assigned to 1 of 3 self-report adherence-assessment modes: (1) audio computer-assisted self-interviewing; (2) face-to-face interview with study staff; or (3) self-administered paper-and-pencil questionnaire. At the 4 monthly visits, the parent and child were interviewed separately and asked questions about adherence on the previous day and in the past week. Electronic devices were attached to the each participant's metered-dose inhaler to provide an objective record of actual daily medication activations. Both children and parents greatly overreported their inhaled corticosteroid adherence when queried about either time frame (1 day or 1 week) in any of the 3 interview modes. One of 3 responses reported full adherence when no medication had been taken. Inconsistent with the study hypothesis, discrepancy between self-report and objectively measured adherence was greatest in the computer-interview condition. In the optimal circumstance where children were interviewed by study staff about their adherence within the previous 24 hours, reported adherence was within the +/-25% accuracy range for only half of the participants. Larger discrepancy scores were observed for both parents and children when reporting by computer or questionnaire. Under the best of conditions in this study, accuracy of self-report was insufficient to provide a stand-alone measure of adherence

  18. Adherence to A Diabetic Care Plan Provides Better Glycemic Control in Ambulatory Patients With Type 2 Diabetes

    Directory of Open Access Journals (Sweden)

    Yi-Wen Chiu

    2009-04-01

    Full Text Available Tight control of blood sugar improves the outcomes for diabetic patients, but it can only be achieved by adhering to a well-organized care plan. To evaluate the effect of a diabetes care plan with reinforcement of glycemic control in diabetic patients, 98 ambulatory patients with type 2 diabetes who visited our diabetes clinic every 3–4 months and who completed four education courses given by certified diabetes educators within 3 months after the first visit, were defined as the Intervention group. A total of 82 patients fulfilling the inclusion criteria for the Intervention group but who missed at least half of the diabetes education sessions were selected as controls. Both groups had comparable mean hemoglobin A1c (HbA1c levels at baseline, which decreased significantly at 3 months and were maintained at approximately constant levels at intervals for up to 1 year. The HbA1c decrement in the Intervention group was significantly greater than that in the Control group over the 1-year follow-up period (HbA1c change: −2.5 ± 1.8% vs. −1.1 ± 1.7%, p < 0.01. The maximal HbA1c decrement occurred during the first 3 months, and accounted for 95.6% and 94.6% of the total HbA1c decrements in the Intervention and Control groups, respectively. In the multiple regression model, after adjustment for age, body mass index, and duration of diabetes, the Intervention group may still have a 12.6% improvement in HbA1c from their original value to the end of 1 year treatment compared with the Control group (p < 0.05. Diabetes care, with reinforcement from certified diabetes educators, significantly improved and maintained the effects on glycemic control in ambulatory patients with type 2 diabetes.

  19. A randomized controlled trial to evaluate the effectiveness of a cognitive behavioural group approach to improve patient adherence to peritoneal dialysis fluid restrictions: a pilot study.

    Science.gov (United States)

    Hare, Jennifer; Clark-Carter, David; Forshaw, Mark

    2014-03-01

    Peritoneal dialysis (PD) requires patients to take an active role in their adherence to fluid restrictions. Although fluid non-adherence had been identified among this patient group, no specific interventions have been researched or published with in the PD population. The current study sought to investigate whether an applied cognitive behavioural therapy (CBT-based intervention) used among haemodialysis patients would improve fluid adherence among PD patients; utilizing clinical indicators used in practice. Fifteen PD patients identified as fluid non-adherent were randomly assigned to an intervention group (IG) or a deferred-entry control group (CG). The study ran for a total of 21 weeks, with five data collection points; at baseline, post-intervention and at three follow-up points; providing a RCT phase and a combined longitudinal analysis phase. The content of the group intervention encompassed educational, cognitive and behavioural components, aimed to assist patients' self-management of fluid. No significant differences in weight (kg) reduction were found in either phase and undesirable changes in blood pressure (BP) were observed. However, in the longitudinal phase, a statistically significant difference in oedematous status was observed at 6-week follow-up; which may be indicative of fluid adherence. Positive and significant differences were observed in the desired direction for measures of psychological well-being, quality of life and health beliefs; areas correlated with enhanced fluid adherence in other research. This study reveals encouraging and significant changes in predictors of fluid adherence. Although there were no significant changes in weight as a crude clinical measure of fluid intake, significant reductions in oedematous status were observed as a consequence of this CBT-based group intervention.

  20. The Relationship Between Food Insecurity and Depression, Diabetes Distress and Medication Adherence Among Low-Income Patients with Poorly-Controlled Diabetes.

    Science.gov (United States)

    Silverman, Julie; Krieger, James; Kiefer, Meghan; Hebert, Paul; Robinson, June; Nelson, Karin

    2015-10-01

    Food insecurity- lack of dependable access to adequate food-may play a role in poor diabetes control. We aimed to determine the relationship between food security status and depression, diabetes distress, medication adherence and glycemic control. Secondary analysis of baseline data from Peer Support for Achieving Independence in Diabetes, a randomized controlled trial that enrolled patients from November 2011 to October 2013. Participants had poorly controlled type 2 diabetes (A1c ≥ 8.0 % on eligibility screen), household income poverty level, were 30-70 years old, and were recruited from a large public hospital, a VA medical center and a community-health center in King County, Washington. We measured food insecurity determined by the Department of Agriculture's 6-Item Food Security Module. Depression, diabetes distress and medication adherence measured by PHQ-8, Diabetes Distress Scale and Morisky Medication Adherence Scale, respectively. Diet was assessed through Summary of Diabetes Self-Care Activities and Starting the Conversation tool. Incidence of hypoglycemic episodes was by patient report. Glycemic control was assessed with glycosylated hemoglobin (A1c) values from fingerstick blood sample. The prevalence of food insecurity was 47.4 %. Chi-square tests revealed participants with food insecurity were more likely to be depressed (40.7 % vs. 15.4 %, p diabetes distress (55.2 % vs. 33.8 %, p diabetes distress and low medication adherence. Almost half of participants had food insecurity. Food insecurity was associated with depression, diabetes distress, low medication adherence and worse glycemic control. Even with adjustment, people with food insecurity had higher mean A1c levels than their food-secure counterparts, suggesting there may be other mediating factors, such as diet, that explain the relationship between food security status and diabetes control.

  1. Efficacy of brief motivational interviewing to improve adherence to inhaled corticosteroids among adult asthmatics: results from a randomized controlled pilot feasibility trial

    Directory of Open Access Journals (Sweden)

    Lavoie KL

    2014-11-01

    Full Text Available Kim L Lavoie,1–3 Gregory Moullec,1,2,4 Catherine Lemiere,2 Lucie Blais,2 Manon Labrecque,2 Marie-France Beauchesne,2 Veronique Pepin,2,4 André Cartier,2 Simon L Bacon1,2,41Montreal Behavioural Medicine Centre, 2Research Centre, Hôpital du Sacré-Cœur de Montréal – A University of Montreal Affiliated Hospital, Montréal, 3Department of Psychology, University of Quebec at Montreal (UQAM, Succursale Center-Ville, Montreal, 4Department of Exercise Science, Concordia University, Montreal, Quebec, CanadaPurpose: Daily adherence to inhaled corticosteroid (ICS regimens is one of the most important factors linked to achieving optimal asthma control. Motivational interviewing (MI is a client-centered communication style that focuses on enhancing intrinsic motivation to engage in appropriate self-management behaviors. MI has been shown to improve a variety of health behaviors including medication adherence in other disorders, but its efficacy for the improvement of ICS adherence in asthmatics has yet to be examined. This pilot “proof of concept” trial assessed the feasibility of MI to improve daily ICS adherence and asthma control levels in adult asthmatics.Methods: Fifty-four poorly controlled (Asthma Control Questionnaire [ACQ] score ≥1.5, highly nonadherent (filled <50% of ICS medication in the last year adult asthmatics were recruited from the outpatient asthma clinic of a university-affiliated hospital. Participants underwent baseline assessments and were randomly assigned to MI (3×30 minutes sessions within a 6-week period, n=26 or a usual care (UC control group (n=28. ICS adherence (% pharmacy refills and asthma control (ACQ, Asthma Control Test [ACT] were measured at 6 and 12 months postintervention. Mixed model repeated measure analyses for both intent-to-treat and per-protocol were used. Results were adjusted for a priori-defined covariates including baseline adherence. Patients in the MI group also reported their impressions of

  2. Adherence with Preventive Medication in Childhood Asthma

    Directory of Open Access Journals (Sweden)

    Scott Burgess

    2011-01-01

    Full Text Available Suboptimal adherence with preventive medication is common and often unrecognised as a cause of poor asthma control. A number of risk factors for nonadherence have emerged from well-conducted studies. Unfortunately, patient report a physician's estimation of adherence and knowledge of these risk factors may not assist in determining whether non-adherence is a significant factor. Electronic monitoring devices are likely to be more frequently used to remind patients to take medication, as a strategy to motivate patients to maintain adherence, and a tool to evaluate adherence in subjects with poor disease control. The aim of this paper is to review non-adherence with preventive medication in childhood asthma, its impact on asthma control, methods of evaluating non-adherence, risk factors for suboptimal adherence, and strategies to enhance adherence.

  3. Excellent adherence and no contamination by physiotherapists involved in a randomized controlled trial on reactivation of COPD patients: a qualitative process evaluation study

    NARCIS (Netherlands)

    Effing, T.W.; Krabbenbos, M.; Pieterse, Marcel E.; van der Valk, P.; Zielhuis, G.A.; Kerstjens, H.A.M.; van der Palen, J.; van der Palen, J.

    2012-01-01

    Objective: To assess the adherence of physiotherapists to the study protocol and the occurrence of contamination bias during the course of a randomized controlled trial with a recruitment period of 2 years and a 1-year follow-up (COPE-II study). Study design and setting: In the COPE-II study,

  4. Excellent adherence and no contamination by physiotherapists involved in a randomized controlled trial on reactivation of COPD patients : a qualitative process evaluation study

    NARCIS (Netherlands)

    Effing, Tanja W.; Krabbenbos, Manon; Pieterse, Marcel E.; van der Valk, Paul D. L. P. M.; Zielhuis, Gerhard A.; Kerstjens, Huib A. M.; van der Palen, Job

    2012-01-01

    Objective: To assess the adherence of physiotherapists to the study protocol and the occurrence of contamination bias during the course of a randomized controlled trial with a recruitment period of 2 years and a 1-year follow-up (COPE-II study). Study design and setting: In the COPE-II study,

  5. Analyzing effects of providing performance feedback at ward rounds on guideline adherence - the importance of feedback usage analysis and statistical control charts.

    Science.gov (United States)

    Abu-Hanna, Ameen; Eslami, Saeid; Schultz, Marcus J; de Jonge, Evert; de Keizer, Nicolette F

    2010-01-01

    Feedback to clinicians on their past performance is often aimed at increasing adherence to guidelines. We investigate how various analytical approaches influence the interpretation of adherence data. The analytical approaches vary in considering the actual or the intended use of the feedback, and whether outcomes are inspected over time. At base line, a computerized decision support system was employed at the ICU bedside to increase adherence to a mechanical ventilation strategy. We intervened by providing feedback about adherence to the guideline at the daily ward rounds. The outcome measure was the percentage of ventilation time (VT) in excess of the guideline's recommendation. Actual usage of the feedback was logged and data analysis was carried out using two approaches: classical statistics, and statistical process control (SPC) that inspect progress of an outcome over time. Prospective, before/after study. The classical analysis stated that the percentage of ventilation time in excess of the guideline's recommendation decreased significantly due to the feedback (5% reduction, p analysis of the outcome was applied, the effect was deemed not significant. When the actual delivery of feedback over time was also included it showed that the experiment does not allow for conclusive results. The concluded effect of providing feedback on adherence to a guideline depends on whether the actual usage pattern of the feedback and the inspection of the outcome over time are considered. Future evaluative studies should report on usage patterns and progression of outcomes over time.

  6. Adherence to Hunger Training over 6 Months and the Effect on Weight and Eating Behaviour: Secondary Analysis of a Randomised Controlled Trial.

    Science.gov (United States)

    Jospe, Michelle R; Taylor, Rachael W; Athens, Josie; Roy, Melyssa; Brown, Rachel C

    2017-11-17

    Monitoring blood glucose prior to eating can teach individuals to eat only when truly hungry, but how adherence to 'hunger training' influences weight loss and eating behaviour is uncertain. This exploratory, secondary analysis from a larger randomized controlled trial examined five indices of adherence to 'hunger training', chosen a priori, to examine which adherence measure best predicted weight loss over 6 months. We subsequently explored how the best measure of adherence influenced eating behavior in terms of intuitive and emotional eating. Retention was 72% ( n = 36/50) at 6 months. Frequency of hunger training booklet entry most strongly predicted weight loss, followed by frequency of blood glucose measurements. Participants who completed at least 60 days of booklet entry (of recommended 63 days) lost 6.8 kg (95% CI: 2.6, 11.0; p eating scores than those who completed 30 days or less of booklet entry; a difference (95% CI) of 0.73 (0.12, 1.35) in body-food choice congruence and 0.79 (0.06, 1.51) for eating for physical rather than emotional reasons. Adherent participants also reported significantly lower scores for emotional eating of -0.70 (-1.13, -0.27). Following hunger training and focusing on simply recording ratings of hunger on a regular basis can produce clinically significant weight loss and clinically relevant improvements in eating behaviour.

  7. Formation-Based Control Scheme for Cooperative Transportation by Multiple Mobile Robots

    Directory of Open Access Journals (Sweden)

    Alpaslan Yufka

    2015-09-01

    Full Text Available This paper presents a motion-planning and control scheme for a cooperative transportation system comprising a single rigid object and multiple autonomous non-holonomic mobile robots. A leader-follower formation control strategy is used for the transportation system in which the object is assumed to be the virtual leader; the robots carrying the object are considered to be followers. A smooth trajectory between the current and desired locations of the object is generated considering the constraints of the virtual leader. In the leader-follower approach, the origin of the coordinate system attached to the centre of gravity of the object, which is known as the virtual leader, moves along the generated trajectory while the real robots, which are known as followers, maintain a desired distance and orientation in relation to the leader. An asymptotically stable tracking controller is used for trajectory tracking. The proposed approach is verified by simulations and real applications using Pioneer P3-DX mobile robots.

  8. Banks’ internal controls and risk management: Value-added functions in Italian credit cooperative banks

    Directory of Open Access Journals (Sweden)

    Rosaria Cerrone

    2013-12-01

    Full Text Available A critical component of safe and sound bank management is constituted by an effective and efficient system of internal controls, which help to ensure that the goals and objectives of a bank will be met, that long-term profitability targets will be achieved, and maintain reliable financial and managerial reporting. Such a system can also ensure that the bank will comply with laws and regulations as well as policies, plans, internal rules and procedures, and decrease the risk of unexpected losses or damage to the bank’s reputation. The paper describes the essential elements of a sound internal control system and through a qualitative approach, it shows how is tied to the rules attaining capital requirements and, above all, to the purpose of the Internal Capital Adequacy Assessment Process (ICAAP which aims at determining the adequate capitalisation of a bank given the risks endured as well as future risks arising from growth, and new business lines. After the recent financial crisis ICAAP is becoming more and more relevant and a central component of an effective strategy for managing risk and creating value. All principles and considerations are referred to Italian Credit Cooperative Banks particular both for dimension and for governance and risk management. They have been contacted though local federations and the results confirm the existing of weakness in internal controls.

  9. Exercise training in older patients with systolic heart failure: Adherence, exercise capacity, inflammation and glycemic control

    DEFF Research Database (Denmark)

    Prescott, Eva; Hjardem-Hansen, Rasmus; Dela, Flemming

    2009-01-01

    markers of glycemic control (glucose, insulin, glycerol, free fatty acids, HbA1c), inflammation and endothelial function (hsCRP, orosomucoid, interleukin 6, TNF-alpha, urine-orosomucoid and -albumin/creatinin), lipid metabolism, NT-proBNP or other regulatory hormones (cortisol, epinephrine and IGF-1...

  10. Determinants of adherence to diabetes treatment.

    Science.gov (United States)

    Larkin, Amy T; Hoffman, Christina; Stevens, Adrienne; Douglas, Andrew; Bloomgarden, Zachary

    2015-11-01

    Understanding and improving medication adherence is crucial in diabetes management. Adherence to a diabetes regimen can improve glucose control and limit the development of complications. The aim of the present study was to evaluate the extent to which a variety of factors influence diabetes medication adherence. A medication adherence survey was made available on WebMD, a medical information website for patients and/or consumers. Respondents were residents of the US, ≥18 years old, and diagnosed with either type 1 or type 2 diabetes mellitus (self-reported). Behavioral adherence (self-reported doses missed per week) correlated with perceived adherence (patients' self-report of their overall impression of medication adherence, ranked 0-5; P Adherent patients (very few [0%-10%] issues with adherence) were more likely to report having received information from their physician. Mostly adherent patients (few [11%-26%] issues with adherence) were less likely to obtain information from their physician, but reported more medication self-titration. Somewhat non-adherent patients (some [27%-46%] adherence issues) reported more "self-consciousness factors" and hypoglycemia. Non-adherent patients (many [47%-88%] adherence issues) were more likely to report worries about medication side effects. Receiving information from a healthcare provider is associated with greater diabetes medication adherence, suggesting the importance of clinicians making time to provide patient education. © 2015 Ruijin Hospital, Shanghai Jiaotong University School of Medicine and Wiley Publishing Asia Pty Ltd.

  11. Spatially and temporally controlled gene transfer by electroporation into adherent cells on plasmid DNA-loaded electrodes.

    Science.gov (United States)

    Yamauchi, Fumio; Kato, Koichi; Iwata, Hiroo

    2004-12-21

    Functional characterization of human genes is one of the most challenging tasks in current genomics. Owing to a large number of newly discovered genes, high-throughput methodologies are greatly needed to express in parallel each gene in living cells. To develop a method that allows efficient transfection of plasmids into adherent cells in spatial- and temporal-specific manners, we studied electric pulse-triggered gene transfer using a plasmid-loaded electrode. A plasmid was loaded on a gold electrode surface having an adsorbed layer of poly(ethyleneimine), and cells were then plated directly onto this modified surface. The plasmid was detached from the electrode by applying a short electric pulse and introduced into the cells cultured on the electrode, resulting in efficient gene expression, even in primary cultured cells. The location of transfected cells could be restricted within a small area on a micropatterned electrode, showing the versatility of the method for spatially controlled transfection. Plasmid transfection could also be performed in a temporally controlled manner without a marked loss of the efficiency when an electric pulse was applied within 3 days after cell plating. The method described here will provide an efficient means to transfer multiple genes, in parallel, into cultured mammalian cells for high-throughput reverse genetics research.

  12. The Nurse-Led Telephone Follow-Up on Medication and Dietary Adherence among Patients after Myocardial Infarction: A Randomized Controlled Clinical Trial

    Directory of Open Access Journals (Sweden)

    Seyed Saeed Najafi

    2016-07-01

    Full Text Available Background: Adherence to dietary and medication regimen plays an important role in successful treatment and reduces the negative complications and severity of the disease. Therefore, the present study aimed to investigate the effect of nurse-led telephone follow-up on the level of adherence to dietary and medication regimen among patients after Myocardial Infarction (MI. Methods: This non-blinded randomized controlled clinical trial was conducted on 100 elderly patients with MI who had referred to the cardiovascular clinics in Shiraz. Participants were selected and randomly assigned to intervention and control groups using balanced block randomization method. The intervention group received a nurse-led telephone follow-up. The data were collected using a demographic questionnaire, Morisky’s 8-item medication adherence questionnaire, and dietary adherence questionnaire before and three months after the intervention. Data analysis was done by the SPSS statistical software (version 21, using paired t-test for intra-group and Chi-square and t-test for between groups comparisons. Significance level was set at0.05. However, a statistically significant difference was found between the two groups in this regard after the intervention (P<0.05. The mean differences of dietary and medication adherence scores between pre- and post-tests were significantly different between the two groups. Independent t-test showed these differences (P=0.001. Conclusion: The results of the present study confirmed the positive effects of nurse-led telephone follow-up as a method of tele-nursing on improvement of adherence to dietary and medication regimen in the patients with MI.

  13. Effect of text messages to improve health literacy on medication adherence in patients with type 2 diabetes mellitus: A randomized controlled pilot trial.

    Science.gov (United States)

    Sugita, Hideki; Shinohara, Ryoji; Yokomichi, Hiroshi; Suzuki, Kohta; Yamagata, Zentaro

    2017-08-01

    It has been suggested that low health literacy (HL) is associated with poor medication adherence. This study aimed to examine the effect of a text message-based HL intervention to promote medication adherence, compared with text messages that only sent medication reminders, in patients with type 2 diabetes. This was a single-center, open-label, randomized (1:1) controlled pilot study. The study period was 6 months. Intervention group was sent HL related text messages, compared to the reminder messages that were sent to the control group. The primary outcome was the difference in the change rate of scores on the Morisky Eight-Item Medication Adherence Scale (MMAS-8). Forty-one participants were randomized into the intervention (n = 21) and control (n = 20) groups and completed the 6-month follow-up. Although almost participants read and understood the information provided in the messages, no significant difference was observed between groups for the primary outcome (p = 0.78). Our results suggested that medication adherence at 6 months after discharge in patients with type 2 diabetes did not significantly change by text messages, which aimed to improve their HL levels.

  14. Disappointment and adherence among parents of newborns allocated to the control group

    DEFF Research Database (Denmark)

    Meinich Petersen, Sandra; Zoffmann, Vibeke; Kjærgaard, Jesper

    2014-01-01

    BACKGROUND: When a child participates in a clinical trial, informed consent has to be given by the parents. Parental motives for participation are complex, but the hope of getting a new and better treatment for the child is important. We wondered how parents react when their child is allocated...... among parents of newborns who were randomized to the control group, but also a broad expression of understanding and accepting the idea of randomization. The trial staff might use the model of reactions in understanding the parents' disappointment and in this way support their motives for participation...

  15. Cooperative actions to achieve malaria control without the use of DDT.

    Science.gov (United States)

    Chanon, Keith E; Méndez-Galván, Jorge F; Galindo-Jaramillo, Jose Manuel; Olguín-Bernal, Hector; Borja-Aburto, Victor H

    2003-08-01

    The success of regional networks to provide incentives and mechanisms for sharing information is illustrated through the North American Regional Action Plan on DDT (NARAP). This NARAP was designed to reduce human and environmental exposure to DDT and its metabolites in North America through cooperative efforts. The increasing role of environmental concerns in the planning and design of Mexico's DDT phase-out program motivated the Mexican Ministry of Health to undertake an alternative program for malaria control maximizing community participation without negatively affecting human and ecosystem health. This program relies on: 1) elimination of parasites in people, 2) improvement of personal and household hygiene, and 3) use of environmental management practices to eliminate mosquito breeding sites. This new strategy resulted in the elimination of DDT for malaria control in Mexico in the year 2000. While malaria and its corresponding vectors show considerable variability within a single country and certainly around the globe, the case example of Mexico provides a methodology for developing alternatives to DDT.

  16. Competition-Cooperation as a Mediator of Locus of Control and Achievement.

    Science.gov (United States)

    Nowicki, Stephen, Jr.

    1982-01-01

    Tested the hypothesis that internals will achieve more than externals in situations where competition is preeminent but not where cooperation is requried. Children (N=300) were divided into internals and externals, placed in situations varying in competition and cooperation, and readministered digit-symbol task. The general hypothesis was…

  17. Cooperative control of VSC-HVDC connected offshore wind farm with Low-Voltage Ride-Through capability

    DEFF Research Database (Denmark)

    Liu, Yan; Wang, Xiongfei; Chen, Zhe

    2012-01-01

    The Low-Voltage Ride-Through (LVRT) has become an important grid requirement for offshore wind farms connecting with Voltage Source Converter based High Voltage Direct Current (VSC-HVDC) links. In this paper, a cooperative control strategy with LVRT ability is proposed for a VSC-HVDC connected...

  18. A randomized controlled trial of cognitive behavioral therapy for adherence and depression (CBT-AD) in patients with uncontrolled type 2 diabetes.

    Science.gov (United States)

    Safren, Steven A; Gonzalez, Jeffrey S; Wexler, Deborah J; Psaros, Christina; Delahanty, Linda M; Blashill, Aaron J; Margolina, Aleksandra I; Cagliero, Enrico

    2014-01-01

    To test cognitive behavioral therapy for adherence and depression (CBT-AD) in type 2 diabetes. We hypothesized that CBT-AD would improve adherence; depression; and, secondarily, hemoglobin A1c (A1C). Eighty-seven adults with unipolar depression and uncontrolled type 2 diabetes received enhanced treatment as usual (ETAU), including medication adherence, self-monitoring of blood glucose (SMBG), and lifestyle counseling; a provider letter documented psychiatric diagnoses. Those randomized to the intervention arm also received 9-11 sessions of CBT-AD. Immediately after acute treatment (4 months), adjusting for baseline, CBT-AD had 20.7 percentage points greater oral medication adherence on electronic pill cap (95% CI -31.14 to -10.22, P = 0.000); 30.2 percentage points greater SMBG adherence through glucometer downloads (95% CI -42.95 to -17.37, P = 0.000); 6.44 points lower depression scores on the Montgomery-Asberg Depression Rating Scale (95% CI 2.33-10.56, P = 0.002); 0.74 points lower on the Clinical Global Impression (95% CI 0.16-1.32, P = 0.01); and 0.72 units lower A1C (95% CI 0.29-1.15, P = 0.001) relative to ETAU. Analyses of 4-, 8-, and 12-month follow-up time points indicated that CBT-AD maintained 24.3 percentage points higher medication adherence (95% CI -38.2 to -10.3, P = 0.001); 16.9 percentage points greater SMBG adherence (95% CI -33.3 to -0.5, P = 0.043); and 0.63 units lower A1C (95% CI 0.06-1.2, P = 0.03) after acute treatment ended. For depression, there was some evidence of continued improvement posttreatment, but no between-group differences. CBT-AD is an effective intervention for adherence, depression, and glycemic control, with enduring and clinically meaningful benefits for diabetes self-management and glycemic control in adults with type 2 diabetes and depression.

  19. Adherence to Cooperative Principles among Agricultural ...

    African Journals Online (AJOL)

    User

    , 15-22. Badiru, I. O.(2010): Review of Small Farmer Access to Agricultural Credit in. Nigeria. NSSP. Brief No. 25. International Food Policy Research. Institute. Enhancing Financial Innovation and Access (EFInA). (2012). Understanding.

  20. The effect of dental health education on pregnant women's adherence with toothbrushing and flossing - A randomized control trial.

    Science.gov (United States)

    Al Khamis, Suad; Asimakopoulou, Koula; Newton, Tim; Daly, Blanaid

    2017-10-01

    In a three-arm randomized control trial, this study compared the efficacy of dental health education (DHE) with or without a planning intervention on adherence to oral health-related behaviours. Women (N=154) in their second trimester of pregnancy attending three maternal healthcare clinics in Kuwait completed an assessment of social cognitions and oral health behaviours before a debris and gingival assessment (Plaque Index [PI], Gingival Index [GI]) was undertaken; this was repeated at 1 month. In addition to treatment as usual (TAU), which was a demonstration of OH practices, intervention participants received one of two interventions: (i) DHE, which targeted social cognitions; or (ii) DHE and planning (DHE&P), which targeted social cognitions and intentions to undertake oral health behaviours. The TAU group was given a standard oral hygiene leaflet. At Time one (T1) 154 women were eligible and randomly allocated to the three groups, respectively: treatment as usual (TAU)=53; DHE=53; DHE and planning=48. At Time two (T2), the number of women in each group completing the intervention (N=90) was, respectively, as follows TAU=28; DHE=30; DHE&P=32. There were no demographic differences between the groups at baseline. The mean age of women was 27.80±SD 5.40; 43% (n=38) had a high school level education. A mixed factor ANOVA analysis demonstrated that all women improved their PI (F=94.343 df=1 P=.001) and GI (F=73.138 df=1 P=.001) scores. There were no differences in self-reported oral hygiene and PI and GI by intervention group. The social cognition models (SCM) constructs changed over time in all women (N=90) except barriers to attendance (F=1.067 df=1 P=.305). There were no statistically significant differences in SCM constructs by intervention group at T2. All women reported increasing the frequency of toothbrushing and flossing. The provision of information using a simple leaflet improved the adherence of Kuwaiti pregnant with toothbrushing and flossing advice

  1. Manual control theory applied to air traffic controller-pilot cooperation

    Science.gov (United States)

    Graham, D.; Clement, W. F.; Hofmann, L. G.

    1972-01-01

    Reduced runway separation standards are among the means which have been proposed for increasing airport capacity. The probability of a blunder will dominate the calculation of safe separation standards. Then the determinant of safe system performance will be the system reaction time comprised of the air traffic controller's detection, decision and communication delays, and the response times of the pilot and aircraft in executing a collision avoidance manuever. Estimates of these times, based on existing data, show that the delays ascribable to the human portions of the man-machine system are comparatively unimportant. New developments in radar, computers, and data links will be required to provide any substantial improvement of the existing system, and the goal of 2500 ft of separation may not be achievable.

  2. Improving the adherence of type 2 diabetes mellitus patients with pharmacy care: a systematic review of randomized controlled trials

    OpenAIRE

    Antoine, Sunya-Lee; Pieper, Dawid; Mathes, Tim; Eikermann, Michaela

    2014-01-01

    Background Oral medication for patients with type 2 diabetes mellitus plays an important role in diabetes care and is associated with a high level self-care behavior and self-management. However, poor adherence to diabetes treatment is common which causes severe health complications and increased mortality. Barriers to adherence may consist of complex treatment regimens often along with long-term multi-therapies, side effects due to the medication as well as insufficient, incomprehensible or ...

  3. A 3-Year Prospective Study of Parent–Child Communication in Early Adolescents With Type 1 Diabetes: Relationship to Adherence and Glycemic Control

    Science.gov (United States)

    Rohan, Jennifer M.; Pendley, Jennifer Shroff; Delamater, Alan; Drotar, Dennis

    2015-01-01

    Objective To examine changes in parent–child communication patterns and their relation to glycemic control and treatment adherence using observational data in a 3-year prospective multisite study of youth with type 1 diabetes aged 9–11 years at baseline and their families (n = 217). Methods Adolescents and caregivers participated in a diabetes problem-solving discussion. Families were rated on negative and positive communication and interactions using the Interaction Behavior Code. Results Maternal and paternal negative communication decreased over time, whereas adolescent and maternal positive communication and positive reciprocity increased. Baseline preadolescent youth and maternal positive communication predicted adherence 3 years later. Changes in family communication did not predict changes in glycemic control or adherence. Conclusions During the transition to adolescence, family communication changed in unexpected and positive ways. Additionally, the relationship of baseline family communication to subsequent adherence suggests the need to assess family communication concerning diabetes-related management during preadolescence. PMID:24839292

  4. Proof of Concept of a Mobile Health Short Message Service Text Message Intervention That Promotes Adherence to Oral Anticancer Agent Medications: A Randomized Controlled Trial.

    Science.gov (United States)

    Spoelstra, Sandra L; Given, Charles W; Sikorskii, Alla; Coursaris, Constantinos K; Majumder, Atreyee; DeKoekkoek, Tracy; Schueller, Monica; Given, Barbara A

    2016-06-01

    This multisite, randomized controlled trial assigned 75 adult cancer patients prescribed an oral anticancer agent to either an experimental group that received daily text messages for adherence for 21 days plus usual care or a control group that received usual care. Measures were administered at baseline, weekly (Weeks 1-8), and at exit (Week 9). A satisfaction survey was conducted following the intervention. Acceptability, feasibility, and satisfaction were examined. Primary outcomes were adherence and symptoms. Secondary outcomes were depressive symptoms, self-efficacy, cognition, physical function, and social support. Mixed or general linear models were used for the analyses comparing trial groups. Effect sizes (ES) were estimated to gauge clinical significance. Regarding acceptability, 57.2% (83 of 145) of eligible patients consented, 88% (n = 37 of 42) receiving text messages read them most or all of the time, and 90% (n = 38) were satisfied. The differences between experimental and control groups' ES were 0.29 for adherence, 0.21 for symptom severity, and 0.21 for symptom interference, and differences were not statistically significant. Furthermore, perceived social support was higher (p = 0.04; ES = 0.54) in the experimental group. Proof of concept and preliminary efficacy of a mobile health intervention using text messages to promote adherence for patients prescribed oral anticancer agents were demonstrated. Patients accepted and had high satisfaction with the intervention, and adherence improved after the intervention. Text messages show promise. Additional research is needed prior to use in practice.

  5. Adherence to self-monitoring via interactive voice response technology in an eHealth intervention targeting weight gain prevention among Black women: randomized controlled trial.

    Science.gov (United States)

    Steinberg, Dori M; Levine, Erica L; Lane, Ilana; Askew, Sandy; Foley, Perry B; Puleo, Elaine; Bennett, Gary G

    2014-04-29

    eHealth interventions are effective for weight control and have the potential for broad reach. Little is known about the use of interactive voice response (IVR) technology for self-monitoring in weight control interventions, particularly among populations disproportionately affected by obesity. This analysis sought to examine patterns and predictors of IVR self-monitoring adherence and the association between adherence and weight change among low-income black women enrolled in a weight gain prevention intervention. The Shape Program was a randomized controlled trial comparing a 12-month eHealth behavioral weight gain prevention intervention to usual care among overweight and obese black women in the primary care setting. Intervention participants (n=91) used IVR technology to self-monitor behavior change goals (eg, no sugary drinks, 10,000 steps per day) via weekly IVR calls. Weight data were collected in clinic at baseline, 6, and 12 months. Self-monitoring data was stored in a study database and adherence was operationalized as the percent of weeks with a successful IVR call. Over 12 months, the average IVR completion rate was 71.6% (SD 28.1) and 52% (47/91) had an IVR completion rate ≥80%. At 12 months, IVR call completion was significantly correlated with weight loss (r =-.22; P=.04) and participants with an IVR completion rate ≥80% had significantly greater weight loss compared to those with an IVR completion rate self-monitoring. Adherence to IVR self-monitoring was high among socioeconomically disadvantaged black women enrolled in a weight gain prevention intervention. Higher adherence to IVR self-monitoring was also associated with greater weight change. IVR is an effective and useful tool to promote self-monitoring and has the potential for widespread use and long-term sustainability. Clinicaltrials.gov NCT00938535; http://www.clinicaltrials.gov/ct2/show/NCT00938535.

  6. Hybrid motion control of humanoid robot for leader-follower cooperative tasks

    Directory of Open Access Journals (Sweden)

    Savić Srđan Ž.

    2016-01-01

    Full Text Available This paper presents a framework for leader-follower type cooperative transportation of an object by multiple humanoid robots or a single robot and a human. The emphasis in this paper is on the hybrid control algorithm and motion generation of the follower robot, while the influence of the leader has been simulated as external force acting on the follower’s hands. The presented approach uses impedance controller to provide compliant behavior of robot arms and it is an extension of our previous work on dual-mode impedance controller for safe human-robot interaction. Synthesis of the follower’s legs and trunk motion is based on the reconfigurable adaptive motion primitives, which are defined as simple, parameterized motion building blocks that can be combined in a sequence or in parallel to generate complex motion. It has been already proven that motion generation, based on reconfigurable adaptive primitives enables the robot to modify gait parameters online, at any time instant, and to synthesize dynamically balanced walk. Motion of the follower is based on the reactive approach, where the gait parameters (walking velocity, direction and step length depend on the intensity and the direction of the external force vector. Robot end-effectors are compliant in the horizontal plain, adapting to the physical guidance of the leader, while being stiff in the vertical direction in order to compensate the external force in negative Z direction. The proposed framework has been tested by numerical simulations involving a dynamic robot model. [Projekat Ministarstva nauke Republike Srbije, br. III44008 and by Provincial secretariat for science and technological development under contract 114-451-2116/2011

  7. A Cooperative Control Method for Fully Mechanized Mining Machines Based on Fuzzy Logic Theory and Neural Networks

    Directory of Open Access Journals (Sweden)

    Chao Tan

    2015-01-01

    Full Text Available In a fully mechanized mining face, the coordinated control of coal mining machines has a significant promoting effect to perfect the mining environment and improve the efficiency of coal production and has become a research focus all over the world. In this paper, a cooperative control method based on the integration of fuzzy logic theory and neural networks was proposed. The improved Elman neural network (ENN through a threshold strategy was presented to predict the running parameters of coal mining machines. On the basis of coupling analysis of coal mining machines, the expert knowledge base of scraper conveyor was established based on fuzzy logic theory. Furthermore, the probabilistic neural network (PNN was applied to evaluate the running status of scraper conveyor, and the cooperative control flow was designed and analyzed. Finally, a simulation example was provided and the comparison results illustrated that the proposed method was feasible and superior to the manual control.

  8. Adherence to physical and mental activity interventions: Coping plans as a mediator and prior adherence as a moderator.

    NARCIS (Netherlands)

    Evers, A.W.M.; Klusmann, V.; Schwarzer, R.; Heuser, I.

    2012-01-01

    Objective. Adherence to behavioural intervention programmes is a necessary condition for beneficial outcomes to be achieved. This study tested whether social cognitive variables and coping plans predict adherence. Design and methods. Adherence was examined in a randomized controlled trial with

  9. Drug Control in Fragile States: Regional Cooperation and Differing Legal Responses to the Afghan Opiate Epidemic

    DEFF Research Database (Denmark)

    Afsah, Ebrahim

    in one such decade-long EU project in support of regional counter-narcotic cooperation seeking to foster closer operational cooperation with the two main transit countries Iran and Pakistan. The original premise saw the relatively modest degree of cooperation between the law enforcement and counter......-narcotic collaboration. Drastically different national policy choices regarding the penalisation of consumption and drug-demand strategies have furthermore yielded dramatically different social outcomes, further complicating regional efforts. Work on legal harmonisation is, therefore, deemed at best a relatively...

  10. Adherence to the Western Pattern Is Potentially an Unfavorable Indicator of Asthenozoospermia Risk: A Case-Control Study.

    Science.gov (United States)

    Eslamian, Ghazaleh; Amirjannati, Naser; Rashidkhani, Bahram; Sadeghi, Mohammad-Reza; Baghestani, Ahmad-Reza; Hekmatdoost, Azita

    2016-01-01

    The aim of this case-control study was to examine the relationship between dietary patterns and asthenozoospermia risk. In total, 107 incident asthenozoospermic men and 235 age-matched controls were interviewed through the infertility clinics in Tehran, Iran, from January 2012 to November 2013. Usual dietary intakes were collected using a semiquantitative food frequency questionnaire and semen quality data were analyzed according to the fifth edition of the World Health Organization (WHO) guidelines. Dietary patterns were derived using factor analysis. The first tertile served as the reference category for regression analyses. In principal component analysis, 2 dietary patterns emerged: a "prudent pattern" (leafy green vegetables, yellow vegetables, other vegetables, tomatoes, fish and other seafood, fruits and natural fruit juices, legumes, whole grains, poultry, tea and coffee, low-fat dairy products, and vegetable oils) and a "Western pattern" (organ meats, red and processed meats, sugar, soft drinks and confectionary, pasta, rice and refined grains, potatoes, french fries and fast foods, high-fat dairy products, hydrogenated fats, mayonnaise and fatty sauces, and snacks). After adjustment for potential confounders, participants in the highest tertile of the prudent pattern scores had 54% lower risk of asthenozoospermia compared to those in the lowest (p for trend: 0.003). Being in the highest tertile of the Western pattern was positively associated with asthenozoospermia risk (odds ratio [OR] = 2.86; 95% confidence interval [CI], 1.83-2.97). Our findings suggest that adherence to the Western pattern is potentially an unfavorable indicator of asthenozoospermia risk and a diet composed mainly of plant-based foods may be associated with a reduced risk.

  11. Assessing treatment-as-usual provided to control groups in adherence trials: Exploring the use of an open-ended questionnaire for identifying behaviour change techniques.

    Science.gov (United States)

    Oberjé, Edwin J M; Dima, Alexandra L; Pijnappel, Frank J; Prins, Jan M; de Bruin, Marijn

    2015-01-01

    Reporting guidelines call for descriptions of control group support in equal detail as for interventions. However, how to assess the active content (behaviour change techniques (BCTs)) of treatment-as-usual (TAU) delivered to control groups in trials remains unclear. The objective of this study is to pre-test a method of assessing TAU in a multicentre cost-effectiveness trial of an HIV-treatment adherence intervention. HIV-nurses (N = 21) completed a semi-structured open-ended questionnaire enquiring about TAU adherence counselling. Two coders independently coded BCTs. Completeness and clarity of nurse responses, inter-coder reliabilities and the type of BCTs reported were examined. The clarity and completeness of nurse responses were adequate. Twenty-three of the 26 identified BCTs could be reliably coded (mean κ = .79; mean agreement rate = 96%) and three BCTs scored below κ = .60. Total number of BCTs reported per nurse ranged between 7 and 19 (M = 13.86, SD = 3.35). This study suggests that the TAU open-ended questionnaire is a feasible and reliable tool to capture active content of support provided to control participants in a multicentre adherence intervention trial. Considerable variability in the number of BCTs provided to control patients was observed, illustrating the importance of reliably collecting and accurately reporting control group support.

  12. Evaluating counseling outcome on adherence to prophylaxis and follow-up after sexual HIV-risk exposure: a randomized controlled trial.

    Science.gov (United States)

    Bentz, L; Enel, P; Dunais, B; Durant, J; Poizot-Martin, I; Tourette-Turgis, C; Rebillon, M; Le Duff, F; Dellamonica, P; Pradier, C

    2010-12-01

    Post-exposure prophylaxis (PEP) is recommended for the management of sexual HIV-risk exposure. However, a high percentage of exposed patients discontinue both their 28-day prophylaxis course before 15 days and HIV testing follow-up before M3. The objective of this study is to assess the efficacy of a counseling intervention in enhancing both adherence to PEP and HIV testing follow-up. Between 1 June 2004 and 31 December 2005, 54 patients exposed to sexual HIV-risk exposure were included in a multicenter, prospective, controlled, randomized trial, comparing a group receiving a counseling intervention in addition to traditional medical management (intervention group (IG), n=28) vs. a control group (CG, n=26). Patients in the IG received interactive counseling interventions focused on adherence to PEP and to HIV testing follow-up, led by specially trained nurses. The main outcome measures were proportion of patients achieving 100% adherence to PEP as evaluated on D15 by a self-completed patient questionnaire and on HIV testing on D45 and M3. Groups were well balanced at baseline for age, sex, and circumstances of exposure. The proportion of 100% adherent patients to PEP was significantly higher in the IG compared to the CG (54% vs. 23%, p=0.036). Patients in the IG were more likely to complete the HIV testing follow-up at D45 (86% vs. 54%, p=0.023) and M3 (68% vs. 38%, p=0.056). This study suggests the effectiveness of a counseling program to enhance adherence to both PEP and HIV testing follow-up after sexual exposure.

  13. Impact of an education program on patient anxiety, depression, glycemic control, and adherence to self-care and medication in Type 2 diabetes

    Directory of Open Access Journals (Sweden)

    Ayman A Al Hayek

    2013-01-01

    Full Text Available Background: Diabetes mellitus (DM requires continuous medical care, patients′ self-management, education, and adherence to prescribed medication to reduce the risk of long-term complications. The aim of this study was to assess the benefits of an education program on diabetes, patient self-management, adherence to medication, anxiety, depression and glycemic control in type 2 diabetics in Saudi Arabia. Materials and Methods: This was a prospective study, conducted among 104 diabetic patients at a major tertiary hospital in Riyadh, Saudi Arabia, between May 2011 and October 2012. Education materials given to diabetic patients included pamphlets/handouts written in Arabic, the national language. Special videotapes about DM were made and distributed to all participants. In addition, specific educational programs through the diabetes educators and one-on-one counseling sessions with the doctor were also arranged. Patients were interviewed using a structured interview schedule both during the baseline, and after 6 months of the program. The interview schedule included, socio-demographics, clinical characteristics, diabetes self-management, adherence to medication, anxiety, and depression. Glycemic control was considered poor, if hemoglobin A1c (HbA1c was ≥ 7%. Results: The mean age of the study population was 57.3 ΁ 14.4 years. Seventy one were males (68.3% and 33 (31.7% were females. After six months of the diabetes education program, there were significant improvements in patients′ dietary plan (P = 0.0001, physical exercise (P = 0.0001, self-monitoring of blood glucose (SMBG (P = 0.0001, HbA1c (P = 0.04, adherence to medication (P = 0.007, and depression (P = 0.03. Conclusions: Implementation of education programs on diabetes among type 2 diabetic patients is associated with better outcomes such as their dietary plan, physical exercise, SMBG, adherence to medication, HbA1c and depression.

  14. Test and evaluation of vehicle platooning proof-of-concept based on cooperative adaptive cruise control

    Science.gov (United States)

    2017-04-01

    This report presents a high-level test and evaluation framework for cooperative driving automation systems that have the potential to significantly improve mobility and enhance traffic flow stability with better safety. It focuses on the test and eva...

  15. Adherence to Hunger Training over 6 Months and the Effect on Weight and Eating Behaviour: Secondary Analysis of a Randomised Controlled Trial

    Science.gov (United States)

    Taylor, Rachael W.; Athens, Josie; Brown, Rachel C.

    2017-01-01

    Monitoring blood glucose prior to eating can teach individuals to eat only when truly hungry, but how adherence to ‘hunger training’ influences weight loss and eating behaviour is uncertain. This exploratory, secondary analysis from a larger randomized controlled trial examined five indices of adherence to ‘hunger training’, chosen a priori, to examine which adherence measure best predicted weight loss over 6 months. We subsequently explored how the best measure of adherence influenced eating behavior in terms of intuitive and emotional eating. Retention was 72% (n = 36/50) at 6 months. Frequency of hunger training booklet entry most strongly predicted weight loss, followed by frequency of blood glucose measurements. Participants who completed at least 60 days of booklet entry (of recommended 63 days) lost 6.8 kg (95% CI: 2.6, 11.0; p hunger training and focusing on simply recording ratings of hunger on a regular basis can produce clinically significant weight loss and clinically relevant improvements in eating behaviour. PMID:29149038

  16. A Review of NEPA, a Novel Fixed Antiemetic Combination with the Potential for Enhancing Guideline Adherence and Improving Control of Chemotherapy-Induced Nausea and Vomiting.

    Science.gov (United States)

    Hesketh, Paul J; Aapro, Matti; Jordan, Karin; Schwartzberg, Lee; Bosnjak, Snezana; Rugo, Hope

    2015-01-01

    Combination antiemetic regimens targeting multiple molecular pathways associated with emesis have become the standard of care for prevention of chemotherapy-induced nausea and vomiting (CINV) related to highly and moderately emetogenic chemotherapies. Antiemetic consensus guidelines from several professional societies are widely available and updated regularly as new data emerges. Unfortunately, despite substantial research supporting the notion that guideline conformity improves CINV control, adherence to antiemetic guidelines is unsatisfactory. While studies are needed to identify specific barriers to guideline use and explore measures to enhance adherence, a novel approach has been taken to improve clinician adherence and patient compliance, with the development of a new combination antiemetic. NEPA is an oral fixed combination of a new highly selective NK1 receptor antagonist (RA), netupitant, and the pharmacologically and clinically distinct 5-HT3 RA, palonosetron. This convenient antiemetic combination offers guideline-consistent prophylaxis by targeting two critical pathways associated with CINV in a single oral dose administered only once per cycle. This paper will review and discuss the NEPA data in the context of how this first combination antiemetic may overcome some of the barriers interfering with adherence to antiemetic guidelines, enhance patient compliance, and offer a possible advance in the prevention of CINV for patients.

  17. A Review of NEPA, a Novel Fixed Antiemetic Combination with the Potential for Enhancing Guideline Adherence and Improving Control of Chemotherapy-Induced Nausea and Vomiting

    Directory of Open Access Journals (Sweden)

    Paul J. Hesketh

    2015-01-01

    Full Text Available Combination antiemetic regimens targeting multiple molecular pathways associated with emesis have become the standard of care for prevention of chemotherapy-induced nausea and vomiting (CINV related to highly and moderately emetogenic chemotherapies. Antiemetic consensus guidelines from several professional societies are widely available and updated regularly as new data emerges. Unfortunately, despite substantial research supporting the notion that guideline conformity improves CINV control, adherence to antiemetic guidelines is unsatisfactory. While studies are needed to identify specific barriers to guideline use and explore measures to enhance adherence, a novel approach has been taken to improve clinician adherence and patient compliance, with the development of a new combination antiemetic. NEPA is an oral fixed combination of a new highly selective NK1 receptor antagonist (RA, netupitant, and the pharmacologically and clinically distinct 5-HT3 RA, palonosetron. This convenient antiemetic combination offers guideline-consistent prophylaxis by targeting two critical pathways associated with CINV in a single oral dose administered only once per cycle. This paper will review and discuss the NEPA data in the context of how this first combination antiemetic may overcome some of the barriers interfering with adherence to antiemetic guidelines, enhance patient compliance, and offer a possible advance in the prevention of CINV for patients.

  18. Excessive daytime sleepiness and adherence to antihypertensive medications among Blacks: analysis of the counseling African Americans to control hypertension (CAATCH trial

    Directory of Open Access Journals (Sweden)

    Williams NJ

    2014-03-01

    Full Text Available Natasha J Williams,1 Girardin Jean-Louis,1 Abhishek Pandey,2 Joseph Ravenell,1 Carla Boutin-Foster,3 Gbenga Ogedegbe1 1Center for Healthful Behavior Change, Division of Internal Medicine, NYU Medical Center, New York, 2Department of Family Medicine, SUNY Downstate Medical Center, Brooklyn, 3Center of Excellence in Disparities Research, Weill Cornell Medical College, New York, NY, USA Background: Excessive daytime sleepiness (EDS often occurs as a result of insufficient sleep, sleep apnea, illicit substance use, and other medical and psychiatric conditions. This study tested the hypothesis that blacks exhibiting EDS would have poorer self-reported adherence to hypertensive medication using cross-sectional data from the Counseling African-Americans to Control Hypertension (CAATCH trial. Methods: A total of 1,058 hypertensive blacks (average age 57±12 years participated in CAATCH, a randomized controlled trial evaluating the effectiveness of a multilevel intervention for participants who receive care from community health centers in New York City. Data analyzed in this study included baseline sociodemographics, medical history, EDS, and medication adherence. We used the Epworth Sleepiness Scale, with a cutoff score of ≥10, to define EDS. Medication adherence was measured using an abbreviated Morisky Medication Adherence scale, with a score >0 indicating nonadherence. Results: Of the sample, 71% were female, 72% received at least a high school education, 51% reported a history of smoking, and 33% had a history of alcohol consumption. Overall, 27% of the participants exhibited EDS, and 44% of those who exhibited EDS were classified as adherent to prescribed antihypertensive medications. Multivariable logistic regression analysis, adjusting for effects of age, body mass index, sex, education, and smoking and drinking history indicated that participants who exhibited EDS were more than twice as likely to be nonadherent (odds ratio 2.28, 95

  19. Money for medication: a randomized controlled study on the effectiveness of financial incentives to improve medication adherence in patients with psychotic disorders.

    Science.gov (United States)

    Noordraven, Ernst L; Audier, Charlotte H; Staring, Anton B P; Wierdsma, Andre I; Blanken, Peter; van der Hoorn, Bas E A; Roijen, Leona Hakkaart-van; Mulder, Cornelis L

    2014-12-02

    Non-adherence with antipsychotic medication is a frequently occurring problem, particularly among patients with psychotic disorders. Prior research has generally shown encouraging results for interventions based on 'Contingency Management' (CM), in which desirable behaviour is encouraged by providing rewards contingent upon the behaviour. However, little is known about the application of CM on medication adherence in patients with psychotic disorders. An earlier pilot-study by our study group showed promising results in reducing admission days and increasing adherence. The current study is a randomized controlled trial concerning the effectiveness of a CM procedure called 'Money for Medication' (M4M), aimed at improving adherence with antipsychotic depot medication in psychotic disorder patients. Outpatients (n =168) with a psychotic disorder will be randomly assigned to either the experimental group (n =84), receiving a financial reward for each accepted antipsychotic medication depot, or the control group (n =84), receiving treatment as usual without financial rewards. Patients are included regardless of their previous adherence. The intervention has a duration of twelve months. During the subsequent six months follow-up, the effects of discontinuing the intervention on depot acceptance will be assessed. The primary goal of this study is to assess the effectiveness of providing financial incentives for improving adherence with antipsychotic depot medication (during and after the intervention). The primary outcome measure is the percentage of accepted depots in comparison to prescription. Secondary, we will consider alternative measures of medication acceptance, i.e. the longest period of uninterrupted depot acceptance and the time expired before depot is taken. Additionally, the effectiveness of the experimental intervention will be assessed in terms of psychosocial functioning, substance use, medication side-effects, quality of life, motivation, cost-utility and

  20. Integration of Provider, Pharmacy, and Patient-Reported Data to Improve Medication Adherence for Type 2 Diabetes: A Controlled Before-After Pilot Study.

    Science.gov (United States)

    Dixon, Brian E; Alzeer, Abdullah H; Phillips, Erin O'Kelly; Marrero, David G

    2016-02-08

    Patients with diabetes often have poor adherence to using medications as prescribed. The reasons why, however, are not well understood. Furthermore, most health care delivery processes do not routinely assess medication adherence or the factors that contribute to poor adherence. The objective of the study was to assess the feasibility of an integrated informatics approach to aggregating and displaying clinically relevant data with the potential to identify issues that may interfere with appropriate medication utilization and facilitate patient-provider communication during clinical encounters about strategies to improve medication use. We developed a clinical dashboard within an electronic health record (EHR) system that uses data from three sources: the medical record, pharmacy claims, and a patient portal. Next, we implemented the dashboard into three community health centers. Health care providers (n=15) and patients with diabetes (n=96) were enrolled in a before-after pilot to test the system's impact on medication adherence and clinical outcomes. To measure adherence, we calculated the proportion of days covered using pharmacy claims. Demographic, laboratory, and visit data from the EHR were analyzed using pairwise t tests. Perceived barriers to adherence were self-reported by patients. Providers were surveyed about their use and perceptions of the clinical dashboard. Adherence significantly and meaningfully improved (improvements ranged from 6%-20%) consistently across diabetes as well as cardiovascular drug classes. Clinical outcomes, including HbA1c, blood pressure, lipid control, and emergency department utilization remained unchanged. Only a quarter of patients (n=24) logged into the patient portal and completed psychosocial questionnaires about their barriers to taking medications. Integrated approaches using advanced EHR, clinical decision support, and patient-controlled technologies show promise for improving appropriate medication use and supporting

  1. The influence of wearing schemes and supportive telephone calls on adherence in accelerometry measurement: results of a randomized controlled trial

    Directory of Open Access Journals (Sweden)

    van den Berg N

    2017-03-01

    Full Text Available Neeltje van den Berg,1,2 Sabina Ulbricht,2,3 Thea Schwaneberg,1,2 Kerstin Weitmann,1,2 Franziska Weymar,1–3 Stefan Groß,2,4 Marcus Dörr,2,4 Wolfgang Hoffmann1,2 1Institute for Community Medicine, University Medicine Greifswald, 2German Centre for Cardiovascular Research (DZHK, Partner Site Greifswald, 3Institute of Social Medicine and Prevention, University Medicine Greifswald, 4Department of Internal Medicine B, University Medicine Greifswald, Greifswald, Germany Background: Physical activity (PA can be assessed by accelerometer monitors. However, a high adherence to wearing this device is essential to obtain valid data. In this study, the influence of different wearing schemes and additional supportive phone calls (SPCs on adherence was examined. Methods: A randomized study with four groups was conducted in the context of a health examination program among participants aged 40–75 years without a history of cardiovascular diseases. Participants were recruited in different settings (general medical practices, job center, and health insurance. The participants were asked to wear an accelerometer for 7 consecutive days according to the wearing scheme “day and night” or “day only” and received or did not receive SPCs. Full adherence was defined as a total wearing time of 98 hours (between 8 am and 10 pm during 7 days. A generalized linear model was used to calculate the difference between the maximum possible and the observed adherence. Results: Adherence could be assessed for 249 participants (mean age: 56.40 years; standard deviation [SD] 9.83, 40% males. The mean wearing time was 84.04 hours (SD 20.75. Participants with the wearing scheme day and night were significantly more adherent than participants with the wearing scheme day only (incidence rate ratio [IRR] 0.63; P=0.005. SPCs had no additional effect on adherence (IRR 0.80; P=0.168. Conclusion: To assess PA, the wearing scheme day and night provides the best possible

  2. Impact of late-to-refill reminder calls on medication adherence in the Medicare Part D population: evaluation of a randomized controlled study

    Directory of Open Access Journals (Sweden)

    Taitel MS

    2017-02-01

    Full Text Available Michael S Taitel, Ying Mu, Angshuman Gooptu, Youbei Lou Health Analytics, Research & Reporting, Walgreen Co., Deerfield, IL, USA Objectives: This study evaluates a nationwide pharmacy chain’s late-to-refill (LTR reminder program that entails local pharmacists placing reminder calls to Medicare Part D patients. Methods: We conducted a randomized controlled study among 735,218 patients who exhibited nonadherent behavior by not refilling a maintenance medication 3 days from an expected refill date. Patients were randomly assigned to an intervention group who received LTR reminder calls or to a control group. We used Walgreens pharmaceutical claims data from 2015 to estimate the impact of LTR calls on short-term and annual adherence. Results: The initial refill rate within the first 14 days of the expected refill date significantly increased in the intervention group by 22.8% (6.09 percentage points compared to the control group (P<0.001. The proportion of days covered (PDC in the intervention group increased significantly by 1.5% (0.856 percentage points relative to the control group (P<0.001 over 365 days. Patients in the intervention group were significantly more adherent (PDC ≥80% by 3% (0.97 percentage points compared to the control group (P<0.001. Over a 270-day follow-up period, persistence significantly increased by 2.15 days in the intervention group (P<0.001. Conclusion: Results from this study suggest that LTR reminder calls increased adherence for Medicare Part D patients who are late in refilling their medications and therefore have the potential to reduce their risk for hospitalization and health care costs. Additionally, the intervention increased the number of patients with PDC ≥80% by ~3%, positively impacting Medicare Part D plan quality rating. Keywords: reminder system, tailored intervention, Medicare Part D, adherence, persistence

  3. The ceramic coatings bonding under ultrasonic control; L'adherence des revetements ceramiques sous controle ultrasonore

    Energy Technology Data Exchange (ETDEWEB)

    Bossuat, B. [Cetim-Centre Technique des Industries Mecaniques, 30 - Senlis (France)

    2001-07-01

    The plasma spaying of ceramic coating is largely used in the nuclear and aeronautic industries. To control these coatings integrity destructive tests are today used. In correlation with the destructive tests, an ultrasonic testing has been developed. It is presented and discussed in this paper. (A.L.B.)

  4. A culturally adapted telecommunication system to improve physical activity, diet quality, and medication adherence among hypertensive African-Americans: a randomized controlled trial.

    Science.gov (United States)

    Migneault, Jeffrey P; Dedier, Julien J; Wright, Julie A; Heeren, Timothy; Campbell, Marci Kramish; Morisky, Donald E; Rudd, Peter; Friedman, Robert H

    2012-02-01

    Hypertension is more prevalent and clinically severe among African-Americans than whites. Several health behaviors influence blood pressure (BP) control, but effective, accessible, culturally sensitive interventions that target multiple behaviors are lacking. We evaluated a culturally adapted, automated telephone system to help hypertensive, urban African-American adults improve their adherence to their antihypertensive medication regimen and to evidence-based guidelines for dietary behavior and physical activity. We randomized 337 hypertensive primary care patients to an 8-month automated, multi-behavior intervention or to an education-only control. Medication adherence, diet, physical activity, and BP were assessed at baseline and every 4 months for 1 year. Data were analyzed using longitudinal modeling. The intervention was associated with improvements in a measure of overall diet quality (+3.5 points, p telecommunications systems can promote self-management of diet and energy balance in urban African-Americans.

  5. Functional deficiency of splenic adherent cells in New Zealand black mice.

    Science.gov (United States)

    McCombs, C; Hom, J; Talal, N; Mishell, R I

    1975-12-01

    New Zealand Black (NZB) mice hyporespond after in vitro immunization to sheep erythrocytes but not after in vivo immunization. The difference between in vitro and in vivo immunization was found to involve a non-antigen-specific change in the spleen which occurs in vivo soon after priming. Adherent spleen cells from young NZB or control strain mice were compared in their ability to cooperate with nonadherent cells in the induction of a primary immune response to sheep erythrocytes in vitro. The results support the hypothesis that there is a functional deficiency of adherent cells in the spleens of unprimed NZB mice.

  6. Adherence to Dietary Approaches to Stop Hypertension (DASH) Dietary Pattern in Relation to Chronic Obstructive Pulmonary Disease (COPD): A Case-Control Study.

    Science.gov (United States)

    Ardestani, Mohammad Emami; Onvani, Shokouh; Esmailzadeh, Ahmad; Feizi, Awat; Azadbakht, Leila

    2017-01-01

    This case-control study was designed to investigate the association between adherences to the Dietary Approaches to Stop Hypertension (DASH) diet in patients with chronic obstructive pulmonary disease (COPD) in comparison to subjects without COPD. This is a case-control study. Usual dietary intake was assessed using a validated food frequency questionnaire. Lung function was evaluated with spirometry testing, and one of the researchers inquired about other respiratory symptoms, including chronic cough, sputum, and breathlessness. Adherence to the DASH dietary pattern was assessed according to the Fung method. This study was conducted at Alzahra University Hospital of Isfahan, Iran, in 2015. Eight-four patients with COPD and 80 subjects without a history of COPD participated in study. The mean age of participants was 57 years. Average smoking in the case group was about 27.5 pack-years. Spirometry tests including forced expiratory volume in 1 second (FEV1), forced vital capacity (FVC), and FEV1/FVC were significantly lower in patients with COPD (p = 0.0001). Among COPD symptoms, cough was significantly decreased across tertiles of DASH score (p = 0.03). Significant differences were found for DASH score between patients with COPD and control subjects (19.82 + 3.63 vs 21.13 + 3.82, p = 0.02). Vitamin C, vitamin E, and dietary fiber intake were lower in patients with COPD (144.32 + 70.51 vs 166.97 + 71.88, p = 0.04, 7.49 + 3.91 vs 8.72 + 3.21, p = 0.02 and 19.34 + 7.05 vs 22.19 + 7.87, p = 0.01, respectively). We observed that adherence to a DASH dietary pattern among patients with COPD was significantly lower compared to the control group. Cough was significantly decreased by increments in adherence to a DASH dietary pattern.

  7. Adherence to Hunger Training over 6 Months and the Effect on Weight and Eating Behaviour: Secondary Analysis of a Randomised Controlled Trial

    Directory of Open Access Journals (Sweden)

    Michelle R. Jospe

    2017-11-01

    Full Text Available Monitoring blood glucose prior to eating can teach individuals to eat only when truly hungry, but how adherence to ‘hunger training’ influences weight loss and eating behaviour is uncertain. This exploratory, secondary analysis from a larger randomized controlled trial examined five indices of adherence to ‘hunger training’, chosen a priori, to examine which adherence measure best predicted weight loss over 6 months. We subsequently explored how the best measure of adherence influenced eating behavior in terms of intuitive and emotional eating. Retention was 72% (n = 36/50 at 6 months. Frequency of hunger training booklet entry most strongly predicted weight loss, followed by frequency of blood glucose measurements. Participants who completed at least 60 days of booklet entry (of recommended 63 days lost 6.8 kg (95% CI: 2.6, 11.0; p < 0.001 more weight than those who completed fewer days. They also had significantly higher intuitive eating scores than those who completed 30 days or less of booklet entry; a difference (95% CI of 0.73 (0.12, 1.35 in body-food choice congruence and 0.79 (0.06, 1.51 for eating for physical rather than emotional reasons. Adherent participants also reported significantly lower scores for emotional eating of −0.70 (−1.13, −0.27. Following hunger training and focusing on simply recording ratings of hunger on a regular basis can produce clinically significant weight loss and clinically relevant improvements in eating behaviour.

  8. Excellent adherence and no contamination by physiotherapists involved in a randomized controlled trial on reactivation of COPD patients: a qualitative process evaluation study

    Directory of Open Access Journals (Sweden)

    Effing TW

    2012-05-01

    Full Text Available Tanja W Effing,1,2 Manon Krabbenbos,3 Marcel E Pieterse,4 Paul DLPM van der Valk,3 Gerhard A Zielhuis,5 Huib AM Kerstjens,6 Job van der Palen,371Repatriation General Hospital, Department of Respiratory Medicine, Daw Park, 2Flinders University, School of Medicine, Adelaide, South Australia, Australia; 3Medisch Spectrum Twente, Department of Pulmonology, Enschede, 4Department of Psychology, Health and Technology, Enschede, 5Department of Epidemiology, Biostatistics and HTA, Radboud University Nijmegen, Nijmegen, 6Department of Pulmonology, University Medical Center Groningen, University of Groningen, Groningen, 7Department of Research Methodology, Measurement and Data Analysis, University of Twente, The Netherlands Objective: To assess the adherence of physiotherapists to the study protocol and the occurrence of contamination bias during the course of a randomized controlled trial with a recruitment period of 2 years and a 1-year follow-up (COPE-II study.Study design and setting: In the COPE-II study, intervention patients received a standardized physiotherapeutic reactivation intervention (COPE-active and control patients received usual care. The latter could include regular physiotherapy treatment. Information about the adherence of physiotherapists with the study protocol was collected by performing a single interview with both intervention and control patients. Patients were only interviewed when they were currently receiving physiotherapy. Interviews were performed during two separate time periods, 10 months apart. Nine characteristics of the COPE-active intervention were scored. Scores were converted into percentages (0%, no aspects of COPE-active; 100%, full implementation of COPE-active.Results: Fifty-one patients were interviewed (first period: intervention n = 14 and control n = 10; second period: intervention n = 18 and control n = 9. Adherence with the COPE-active protocol was high (median scores: period 1, 96.8%; period 2, 92.1%, and

  9. Would older adults with mild cognitive impairment adhere to and benefit from a structured lifestyle activity intervention to enhance cognition?: a cluster randomized controlled trial.

    Directory of Open Access Journals (Sweden)

    Linda Chiu-Wa Lam

    Full Text Available Epidemiologic evidence suggests that cognitive and physical activities are associated with better cognition in late life. The present study was conducted to examine the possible benefits of four structured lifestyle activity interventions and compare their effectiveness in optimizing cognition for older adults with mild cognitive impairment (MCI.This was a 12-month cluster randomized controlled trial. 555 community-dwelling Chinese older adults with MCI (295 with multiple-domain deficits (mdMCI, 260 with single-domain deficit (sdMCI were recruited. Participants were randomized into physical exercise (P, cognitive activity (C, integrated cognitive and physical exercise (CP, and social activity (S, active control groups. Interventions comprised of one-hour structured activities three times per week. Primary outcome was Clinical Dementia Rating sum of boxes (CDR-SOB scores. Secondary outcomes included Chinese versions of Alzheimer's Disease Assessment Scale - Cognitive subscale (ADAS-Cog, delayed recall, Mini-Mental State Examination, Category Verbal Fluency Test (CVFT and Disability Assessment for Dementia - Instrumental Activities of Daily Living (DAD-IADL. Percentage adherence to programs and factors affecting adherence were also examined. At 12th month, 423 (76.2% completed final assessment. There was no change in CDR-SOB and DAD-IADL scores across time and intervention groups. Multilevel normal model and linear link function showed improvement in ADAS-Cog, delayed recall and CVFT with time (p<0.05. Post-hoc subgroup analyses showed that the CP group, compared with other intervention groups, had more significant improvements of ADAS-Cog, delayed recall and CVFT performance with sdMCI participants (p<0.05. Overall adherence rate was 73.3%. Improvements in ADAS-Cog and delayed recall scores were associated with adherence after controlling for age, education, and intervention groups (univariate analyses.Structured lifestyle activity interventions

  10. Adaptive Task-Space Cooperative Tracking Control of Networked Robotic Manipulators Without Task-Space Velocity Measurements.

    Science.gov (United States)

    Liang, Xinwu; Wang, Hesheng; Liu, Yun-Hui; Chen, Weidong; Hu, Guoqiang; Zhao, Jie

    2016-10-01

    In this paper, the task-space cooperative tracking control problem of networked robotic manipulators without task-space velocity measurements is addressed. To overcome the problem without task-space velocity measurements, a novel task-space position observer is designed to update the estimated task-space position and to simultaneously provide the estimated task-space velocity, based on which an adaptive cooperative tracking controller without task-space velocity measurements is presented by introducing new estimated task-space reference velocity and acceleration. Furthermore, adaptive laws are provided to cope with uncertain kinematics and dynamics and rigorous stability analysis is given to show asymptotical convergence of the task-space tracking and synchronization errors in the presence of communication delays under strongly connected directed graphs. Simulation results are given to demonstrate the performance of the proposed approach.

  11. Long-term effect of a low-intensity smoking intervention embedded in an adherence program for patients with hypercholesterolemia: Randomized controlled trial.

    Science.gov (United States)

    Muckelbauer, Rebecca; Englert, Heike; Rieckmann, Nina; Chen, Chih-Mei; Wegscheider, Karl; Völler, Heinz; Katus, Hugo A; Willich, Stefan N; Müller-Nordhorn, Jacqueline

    2015-08-01

    We evaluated the long-term effect of a smoking intervention embedded in an adherence program in patients with an increased risk for cardiovascular disease. Secondary analysis of a randomized controlled trial: In 2002-2004, 8108 patients with hypercholesterolemia were enrolled from general practices in Germany. Patients received a 12-month adherence program and statin medication (intervention) or statin medication only (control). The program aimed to improve adherence to medication and lifestyle by educational material, mailings, and phone calls. Smoking was self-reported at baseline and every 6months during the 3-year follow-up. In total, 7640 patients were analyzed. At baseline, smoking prevalence was 21.7% in the intervention and 21.5% in the control group. Prevalence decreased in both groups to 16.6% vs. 19.5%, 15.3% vs. 16.8%, and 14.2% vs. 15.6% at the 12-, 24-, and 36-month follow-up. The intervention had a beneficial effect on smoking differing over time (group×time: P=0.005). The effect was largest after 6 and 12months [odds ratios (95% confidence intervals): 0.67 (0.54-0.82) and 0.63 (0.51-0.78)]. The effect decreased until the 18-month follow-up [0.72 (0.58-0.90)] and was not significant after 24months. A low-intensity smoking intervention embedded in an adherence program can contribute to smoking cessation although the intervention effect diminished over time. ClinicalTrials.gov (www.clinicaltrials.gov): NCT00379249. Copyright © 2015 Elsevier Inc. All rights reserved.

  12. Web-based computer-tailoring for practice nurses aimed to improve smoking cessation guideline adherence: A study protocol for a randomized controlled effectiveness trial.

    Science.gov (United States)

    de Ruijter, D; Smit, E S; de Vries, H; Hoving, C

    2016-05-01

    Dutch practice nurses sub-optimally adhere to evidence-based smoking cessation guidelines. Web-based computer-tailoring could be effective in improving their guideline adherence. Therefore, this paper aims to describe the development of a web-based computer-tailored program and the design of a randomized controlled trial testing its (cost-)effectiveness. Theoretically grounded in the I-Change Model and Self-Determination Theory, and based on the results of a qualitative needs assessment among practice nurses, a web-based computer-tailored program was developed including three modules with tailored advice, an online forum, modules with up-to-date information about smoking cessation, Frequently Asked Questions (FAQs) and project information, and a counseling checklist. The program's effects are assessed by comparing an intervention group (access to all modules) with a control group (access to FAQs, project information and counseling checklist only). Smoking cessation guideline adherence and behavioral predictors (i.e. intention, knowledge, attitude, self-efficacy, social influence, action and coping planning) are measured at baseline and at 6- and 12-month follow-up. Additionally, the program's indirect effects on smokers' quit rates and the number of quit attempts are assessed after 6 and 12months. This paper describes the development of a web-based computer-tailored adherence support program for practice nurses and the study design of a randomized controlled trial testing its (cost-)effectiveness. This program potentially contributes to improving the quality of smoking cessation care in Dutch general practices. If proven effective, the program could be adapted for use by other healthcare professionals, increasing the public health benefits of improved smoking cessation counseling for smokers. Copyright © 2016 Elsevier Inc. All rights reserved.

  13. Community cooperatives and insecticide-treated materials for malaria control: a new experience in Latin America.

    Science.gov (United States)

    Kroeger, Axel; Aviñna, Ana; Ordoñnez-Gonzalez, José; Escandon, Celia

    2002-11-15

    Insecticide-treated materials (ITMs) are effective in substantially reducing the burden of malaria and other vector-borne diseases; but how can high coverage rates of ITMs be achieved and maintained? In south Mexico and on the Pacific and Atlantic coasts of Colombia 14 community-based cooperatives offering three different kinds of ITM services (sale of impregnation services; sale of impregnated nets; production of nets and sale of impregnated nets) were formed and supervised by a national health service (IMSS-SOLIDARIDAD, Mexico) and by an academic institution (the Colombian Institute of Tropical Medicine) along with local district health services. The objectives of this research were to analyse the processes and results of this approach and to identify the favourable and limiting factors. The methods used for data collection and analysis were group discussions, individual and semi-structured interviews with users and non-users of ITMs, individual in-depth interviews with cooperative members and supervisors, checks of sales book and observation of impregnation services. Coverage with unimpregnated nets was above 50% in all study areas. The fastest increase of ITM coverage was achieved through the exclusive sale of impregnation services. Low-cost social marketing techniques were used to increase demand. The large-scale production of nets in two cooperatives was only possible with the aid of an international NGO which ordered impregnated bednets for their target group. A number of favourable and limiting factors relating to the success of ITM cooperatives were identified. Of particular importance for the more successful Mexican cooperatives were: a) support by health services, b) smaller size, c) lesser desire for quick returns and d) lower ITM unit costs. ITM community cooperatives supported and supervised by the health services have good potential in the Latin American context for achieving and maintaining high impregnation rates.

  14. Community cooperatives and insecticide-treated materials for malaria control: a new experience in Latin America

    Directory of Open Access Journals (Sweden)

    Ordoñnez-Gonzalez José

    2002-11-01

    Full Text Available Abstract Background and objectives Insecticide-treated materials (ITMs are effective in substantially reducing the burden of malaria and other vector-borne diseases; but how can high coverage rates of ITMs be achieved and maintained? In south Mexico and on the Pacific and Atlantic coasts of Colombia 14 community-based cooperatives offering three different kinds of ITM services (sale of impregnation services; sale of impregnated nets; production of nets and sale of impregnated nets were formed and supervised by a national health service (IMSS-SOLIDARIDAD, Mexico and by an academic institution (the Colombian Institute of Tropical Medicine along with local district health services. The objectives of this research were to analyse the processes and results of this approach and to identify the favourable and limiting factors. Methods The methods used for data collection and analysis were group discussions, individual and semi-structured interviews with users and non-users of ITMs, individual in-depth interviews with cooperative members and supervisors, checks of sales book and observation of impregnation services. Results Coverage with unimpregnated nets was above 50% in all study areas. The fastest increase of ITM coverage was achieved through the exclusive sale of impregnation services. Low-cost social marketing techniques were used to increase demand. The large-scale production of nets in two cooperatives was only possible with the aid of an international NGO which ordered impregnated bednets for their target group. A number of favourable and limiting factors relating to the success of ITM cooperatives were identified. Of particular importance for the more successful Mexican cooperatives were: a support by health services, b smaller size, c lesser desire for quick returns and d lower ITM unit costs. Conclusions ITM community cooperatives supported and supervised by the health services have good potential in the Latin American context for achieving

  15. [Treatment adherence: a key element].

    Science.gov (United States)

    Bastida, Guillermo; Sánchez Montes, Cristina; Aguas, Mariam

    2011-12-01

    A substantial percentage of patients fail to follow health professionals' recommendations, which affects the management of chronic diseases, reducing the effectiveness of therapeutic interventions and increasing the costs of the disease. Lack of adherence is a multidimensional phenomenon and is influenced by numerous factors that should be identified. A multiplicity of measures is available to improve adherence, such as simplifying treatment administration, but none of these measures is effective when used alone. One way of tackling lack of adherence is by identifying patients' barriers to medication and involving them in decision making. Ulcerative colitis (UC) poses a risk for lack of treatment adherence. In this disease, poor adherence correlates with poor disease control (drug effectiveness) and with higher costs. As in other chronic diseases, the causes associated with poor adherence are multiple, including psychosocial factors, the physician-patient relationship and patients' prejudices toward medication. A single dose of aminosalycylates (5-ASA) should be recommended, as this dose is as safe and effective as other regimens. However, by itself, this recommendation does not seem to improve adherence. Identifying the scale of the problem and developing strategies to involve the patient in decision making is crucial to improve treatment adherence. Copyright © 2011 Elsevier España, S.L.U. All rights reserved.

  16. Protocol for SAMS (Support and Advice for Medication Study: A randomised controlled trial of an intervention to support patients with type 2 diabetes with adherence to medication

    Directory of Open Access Journals (Sweden)

    Sutton Stephen

    2008-04-01

    Full Text Available Abstract Background Although some interventions have been shown to improve adherence to medication for diabetes, results are not consistent. We have developed a theory-based intervention which we will evaluate in a well characterised population to test efficacy and guide future intervention development and trial design. Methods and Design The SAMS (Supported Adherence to Medication Study trial is a primary care based multi-centre randomised controlled trial among 200 patients with type 2 diabetes and an HbA1c of 7.5% or above. It is designed to evaluate the efficacy of a two-component motivational intervention based on the Theory of Planned Behaviour and volitional action planning to support medication adherence compared with standard care. The intervention is delivered by practice nurses. Nurses were trained using a workshop approach with role play and supervised using assessment of tape-recorded consultations. The trial has a two parallel groups design with an unbalanced three-to-two individual randomisation eight weeks after recruitment with twelve week follow-up. The primary outcome is medication adherence measured using an electronic medication monitor over 12 weeks and expressed as the difference between intervention and control in mean percentage of days on which the correct number of medication doses is taken. Subgroup analyses will explore impact of number of medications taken, age, HbA1c, and self-reported adherence at baseline on outcomes. The study also measures the effect of dispensing medication to trial participants packaged in the electronic medication-monitoring device compared with conventional medication packaging. This will be achieved through one-to-one randomisation at recruitment to these conditions with assessment of the difference between groups in self-report of medication adherence and change in mean HbA1c from baseline to eight weeks. Anonymised demographic data are collected on non-respondents. Central randomisation

  17. Financial incentives for improving adherence to maintenance treatment in patients with psychotic disorders (Money for Medication): a multicentre, open-label, randomised controlled trial.

    Science.gov (United States)

    Noordraven, Ernst L; Wierdsma, André I; Blanken, Peter; Bloemendaal, Anthony F T; Staring, Anton B P; Mulder, Cornelis L

    2017-03-01

    Provision of financial incentives is a promising intervention for improving adherence in patients taking antipsychotic medication. We aimed to assess the effectiveness of this intervention for improving adherence to antipsychotic depot medication in patients with psychotic disorders, irrespective of their previous compliance. We did this multicentre, open-label, randomised controlled trial at three mental health-care institutions in secondary psychiatric care services in the Netherlands. Eligible patients were aged 18-65 years, had been diagnosed with schizophrenia or another psychotic disorder, had been prescribed antipsychotic depot medication or had an indication to start using depot medication, and were participating in outpatient treatment. Patients were randomly assigned (1:1), via computer-generated randomisation with a block size of four, to receive 12 months of either treatment as usual plus a financial reward for each depot of medication received (€30 per month if fully compliant; intervention group) or treatment as usual alone (control group). Randomisation was stratified by treatment site and suspected prognostic factors: sex, comorbid substance-use disorder (absent vs present), and compliance with antipsychotic medication in the 4 months before baseline (improving adherence to antipsychotic depot medication among patients with psychotic disorders. Further research is needed to study the long-term effects of this intervention. Dual Diagnosis Center. Copyright © 2017 Elsevier Ltd. All rights reserved.

  18. Would older adults with mild cognitive impairment adhere to and benefit from a structured lifestyle activity intervention to enhance cognition?: a cluster randomized controlled trial.

    Science.gov (United States)

    Lam, Linda Chiu-Wa; Chan, Wai Chi; Leung, Tony; Fung, Ada Wai-Tung; Leung, Edward Man-Fuk

    2015-01-01

    Epidemiologic evidence suggests that cognitive and physical activities are associated with better cognition in late life. The present study was conducted to examine the possible benefits of four structured lifestyle activity interventions and compare their effectiveness in optimizing cognition for older adults with mild cognitive impairment (MCI). This was a 12-month cluster randomized controlled trial. 555 community-dwelling Chinese older adults with MCI (295 with multiple-domain deficits (mdMCI), 260 with single-domain deficit (sdMCI)) were recruited. Participants were randomized into physical exercise (P), cognitive activity (C), integrated cognitive and physical exercise (CP), and social activity (S, active control) groups. Interventions comprised of one-hour structured activities three times per week. Primary outcome was Clinical Dementia Rating sum of boxes (CDR-SOB) scores. Secondary outcomes included Chinese versions of Alzheimer's Disease Assessment Scale - Cognitive subscale (ADAS-Cog), delayed recall, Mini-Mental State Examination, Category Verbal Fluency Test (CVFT) and Disability Assessment for Dementia - Instrumental Activities of Daily Living (DAD-IADL). Percentage adherence to programs and factors affecting adherence were also examined. At 12th month, 423 (76.2%) completed final assessment. There was no change in CDR-SOB and DAD-IADL scores across time and intervention groups. Multilevel normal model and linear link function showed improvement in ADAS-Cog, delayed recall and CVFT with time (peveryday functioning, albeit with some improvements in cognitive scores across time. Higher adherence was associated with greater improvement in cognitive scores. Factors to enhance adherence should be specially considered in the design of psychosocial interventions for older adults with cognitive decline. ClinicalTrials.gov ChiCTR-TRC-11001359.

  19. A feasible method to improve adherence of Hawley retainer in adolescent orthodontic patients: a randomized controlled trial

    Directory of Open Access Journals (Sweden)

    Lin FO

    2015-10-01

    Full Text Available Feiou Lin,1 Hao Sun,1 Zhenyu Ni,1 Minling Zheng,1 Linjie Yao2 1Orthodontic Department, 2Pedodontic Department, School of Stomatology, Wenzhou Medical University, Wenzhou, Zhejiang, People’s Republic of China Background: Retention is an important component of orthodontic treatment; however, poor compliance with retainer use is often encountered, especially in adolescents. The purpose of this study was to prove the hypothesis that verbal instructions combined with images showing the severe consequences of poor compliance can increase retainer use. Methods: This study was a randomized controlled trial. The sample was recruited from Wenzhou, People’s Republic of China, between February 2013 and May 2014, and 326 participants were randomized into three groups. Patients and parents in Group A (n=106 were given routine retainer wear instructions only; in Group B (n=111, images illustrating the severe consequences of poor compliance with Hawley retainer use were shown to patients, combined with routine instructions; and in Group C (n=109, images illustrating the severe consequences of poor compliance with Hawley retainer use were shown to patients and parents, combined with routine instructions. Three months after debonding, questionnaires were used to investigate daily wear time and the reasons for poor compliance. Differences in means between the groups were tested by one-way analysis of variance. Results: The mean daily wear time in Group C (15.09±4.13 hours was significantly greater than in Group A (12.37±4.58 hours, P<0.01 or Group B (13.50±4.22 hours, P<0.05; the mean daily wear time in Group B was greater than in Group A, but was not significant (P=0.67. Reasons for nonusage were forgetting to wear the retainer (51% and finding the retainer bothersome to frequently insert and remove (42%. Conclusion: Verbal instructions combined with images showing the severe consequences of poor compliance can increase retainer use. Parents play an

  20. Improving adherence to surveillance and screening recommendations for people with colorectal cancer and their first degree relatives: a randomized controlled trial

    Directory of Open Access Journals (Sweden)

    Carey Mariko

    2012-02-01

    Full Text Available Abstract Background Colorectal cancer (CRC is among the leading causes of cancer-related morbidity and mortality worldwide. Despite clinical practice guidelines to guide surveillance care for those who have completed treatment for this disease as well as screening for first degree relatives of people with CRC, the level of uptake of these recommendations remains uncertain. If outcomes for both patients and their families are to be improved, it is important to establish systematic and cost-effective interventions to improve adherence to guideline recommendations for CRC surveillance and screening. Methods/Design A randomized controlled trial will be used to test the effectiveness of a print-based intervention to improve adherence to colonoscopy surveillance among people with CRC and adherence to CRC screening recommendations among their first degree relatives (FDRs. People diagnosed with CRC in the past 10 months will be recruited through a population-based cancer registry. Consenting participants will be asked if their first degree relatives might also be willing to participate in the trial. Information on family history of CRC will be obtained from patients at baseline. Patients and their families will be randomized to either minimal ethical care or the print-based intervention. The print-based intervention for FDRs will be tailored to the participant's level of risk of CRC as determined by the self-reported family history assessment. Follow up data on surveillance and screening participation will be collected from patients and their FDRs respectively at 12, 24 and 36 months' post recruitment. The primary analyses will relate to comparing levels of guideline adherence in usual care group versus print-based group in the patient sample and the FDR sample respectively. Discussion Results of this study will provide contribute to the evidence base about effective strategies to a improve adherence to surveillance recommendation for people with CRC

  1. The effectiveness bundling of zinc with Oral Rehydration Salts (ORS) for improving adherence to acute watery diarrhea treatment in Ethiopia: cluster randomised controlled trial.

    Science.gov (United States)

    Gebremedhin, Samson; Mamo, Girma; Gezahign, Henock; Kung'u, Jacqueline; Adish, Abdulaziz

    2016-05-31

    Presumably bundling/co-packaging of zinc with ORS encourages the combined use of the products for diarrhea treatment; however, empirical evidences are scarce. The purpose of this work is to evaluate whether co-packing using a plastic pouch can enhance the joint adherence to the treatment or not. The study also compares the cost effectiveness (CE) of two co-packaging options: 'central' and 'health center (HC)' level bundling. This cluster-randomised controlled trial was conducted in 2015 in eight districts of Ethiopia. Thirty two HCs were randomly assigned to one of the following four intervention arms: (i) 'Central bundling' (zinc and ORS bundled using a pouch that had instructional message, distributed to HCs); (ii) 'HC level bundling' (zinc, ORS and a similar pouch distributed to the HCs and bundled by health workers); (iii) 'Bundling without message' (zinc, ORS and plain pouch distributed and bundled by the health workers); and, (iv) 'Status quo' (zinc and ORS co-administered without bundling). In each of the four arms, 176 children 6-59 months of age, presented with acute diarrhea were enrolled. Twelve days after enrollment, level of adherence was assessed. A composite scale of adherence was developed and modeled using mixed effects linear regression analysis. The unit costs associated with the arms were estimated using secondary data sources. Incremental CE analysis was made by taking the cost and level of adherence in fourth arm as a base value. The follow-up rate was 95.6 %. As compared with the 'status quo' arm, the joint adherences in the 'central' and 'HC level' bundling arms raised substantially by 14.8 and 15.7 percentage points (PP), respectively (P < 0.05). No significant difference was observed between 'bundling without message' and the 'status quo' arms. The unit cost incurred by the 'central bundling' is relatively higher (USD 0.658/episode) as compared with the 'HC level bundling' approach (USD 0.608/episode). The incremental CE ratio in the

  2. MEDication reminder APPs to improve medication adherence in Coronary Heart Disease (MedApp-CHD) Study: a randomised controlled trial protocol.

    Science.gov (United States)

    Santo, Karla; Chow, Clara K; Thiagalingam, Aravinda; Rogers, Kris; Chalmers, John; Redfern, Julie

    2017-10-08

    The growing number of smartphone health applications available in the app stores makes these apps a promising tool to help reduce the global problem of non-adherence to long-term medications. However, to date, there is limited evidence that available medication reminder apps are effective. This study aims to determine the impact of medication reminder apps on adherence to cardiovascular medication when compared with usual care for people with coronary heart disease (CHD) and to determine whether an advanced app compared with a basic app is associated with higher adherence. Randomised controlled trial with follow-up at 3 months to evaluate the feasibility and effectiveness of medication reminder apps on medication adherence compared with usual care. An estimated sample size of 156 patients with CHD will be randomised to one of three groups (usual care group, basic medication reminder app group and advanced medication reminder app group). The usual care group will receive standard care for CHD with no access to a medication reminder app. The basic medication reminder app group will have access to a medication reminder app with a basic feature of providing simple daily reminders with no interactivity. The advanced medication reminder app group will have access to a medication reminder app with additional interactive and customisable features. The primary outcome is medication adherence measured by the eight-item Morisky Medication Adherence Scale at 3 months. Secondary outcomes include clinical measurements of blood pressure and cholesterol levels, and medication knowledge. A process evaluation will also be performed to assess the feasibility of the intervention by evaluating the acceptability, utility and engagement with the apps. Ethical approval has been obtained from the Western Sydney Local Health Network Human Research Ethics Committee (AU/RED/HREC/1/WMEAD/3). Study findings will be disseminated via usual scientific forums. ACTRN12616000661471; Pre-results.

  3. Adherence to the Tobacco Control Act, 2007: presence of a workplace policy on tobacco use in bars and restaurants in Nairobi, Kenya.

    Science.gov (United States)

    Karimi, K J; Ayah, R; Olewe, T

    2016-09-28

    Despite extensive knowledge about effective tobacco control interventions, the prevalence of tobacco use in many middle- and low-income countries continues to rise. In these countries, public appreciation of levels of protection provided by laws and regulations on tobacco use and exposure to tobacco smoke is limited. After ratification of the Framework Convention on Tobacco Control, Kenya enacted the Tobacco Control Act, 2007, banning smoking in public places except in designated smoking areas. To assess adherence to the Tobacco Control Act, 2007 by determining the presence of a workplace policy on tobacco use in bars and restaurants. A survey of 176 liquor licensed bars and restaurants in Nairobi County was carried out. Their managers were asked about the presence of a workplace policy governing smoking of tobacco, and observations made on provisions that determine adherence to the Tobacco Control Act, 2007. Smoking took place in almost all bars and restaurants (150 (85%)). Half the establishments (86 (49%)) had a workplace policy governing tobacco use among employees, although a difference between bars (11 (23%)) and restaurants (75 (58%)) was recorded (phospitality workers to the dangers of tobacco smoke. Bar and restaurants managers should have a minimum post-secondary education level. The Tobacco Control Act, 2007 requires strengthening to ensure that bars and restaurants have a smoke-free environment. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/

  4. Cooperative synthesis of control and display augmentation for a STOL aircraft in the approach and landing task

    Science.gov (United States)

    Garg, Sanjay; Schmidt, David K.

    1988-01-01

    Application of the Cooperative methodology to synthesize control/display augmentation systems for the piloted longitudinal landing task with a modern, statically-unstable, fighter aircraft is considered. Starting with a control augmentation law which yields augmented vehicle dynamics that meet Level I handling qualities specifications, the effect of time-delay in the Head-up-display is studied using model-based criterion. This evaluation showed that even with 'good' conventional dynamics, a realistic value of display time-delay will cause significant deterioration in pilot workload and piloted-system performance. Application of the Cooperative methodology to control augmentation alone resulted in augmented vehicle dynamics which provide direct control of the flight path from the pilot stick. Analytical evaluation of these dynamics indicates that such dynamics might lead to improved pilot ratings over conventional dynamics, especially in the presence of time-delays in the system. Also, application of the methodology to simultaneous synthesis of control augmentation and flight director laws revealed that it might be advantageous to consider the control/display trade-off in the early design stages.

  5. Healthy Beyond Pregnancy, a Web-Based Intervention to Improve Adherence to Postpartum Care: Randomized Controlled Feasibility Trial.

    Science.gov (United States)

    Himes, Katherine Park; Donovan, Heidi; Wang, Stephanie; Weaver, Carrie; Grove, Jillian Rae; Facco, Francesca Lucia

    2017-10-10

    During the postpartum visit, health care providers address issues with short- and long-term implications for maternal and child health. Women with Medicaid insurance are less likely to return for a postpartum visit compared with women with private insurance. Behavioral economics acknowledges that people do not make exclusively rational choices, rather immediate gratification, cognitive and psychological biases, and social norms influence decision making. Drawing on insights from decision science, behavioral economists have examined how these biases can be modulated through carefully designed interventions. We have developed a Web-based tool, Healthy Beyond Pregnancy, that incorporates empirically derived concepts of behavioral economics to improve adherence rates to the postpartum visit. The primary objectives of this pilot study were to (1) refine and assess the usability of Healthy Beyond Pregnancy and (2) assess the feasibility of a randomized controlled trial (RCT) of the intervention. We used a multistep process and multidisciplinary team of maternal-fetal medicine physicians, a behavioral economist, and researchers with expertise in behavioral interventions to design Healthy Beyond Pregnancy. We assessed the usability of the program with the Post-Study System Usability Questionnaire (PSSUQ), a validated 7-point scale, and semistructured interviews with postpartum women. We then conducted a feasibility trial to determine the proportion of eligible women who were willing to participate in an RCT of Healthy Beyond Pregnancy and the proportion of women willing to complete the Web-based program. Exploratory outcomes of the pilot trial included attendance at the postpartum visit, uptake of long-acting reversible contraception, and uptake of any contraception. The median PSSUQ score for Healthy Beyond Pregnancy was 6.5 (interquartile range: 6.1-7) demonstrating high usability. Semistructured interviews (n=10) provided in-depth comments about users' experience and

  6. A Role for the RNA Chaperone Hfq in Controlling Adherent-Invasive Escherichia coli Colonization and Virulence

    DEFF Research Database (Denmark)

    Simonsen, Karina T; Nielsen, Gorm; Bjerrum, Janni Vester

    2011-01-01

    to and subsequent invasion of the intestinal epithelium coupled with its ability to survive phagocytosis by macrophages once it has crossed the intestinal barrier. To gain further insight into AIEC pathogenesis we employed the nematode Caenorhabditis elegans as an in vivo infection model. We demonstrate that AIEC...... strain LF82 forms a persistent infection in C. elegans, thereby reducing the host lifespan significantly. This host killing phenotype was associated with massive bacterial colonization of the nematode intestine and damage to the intestinal epithelial surface. C. elegans killing was independent of known......Adherent-invasive Escherichia coli (AIEC) has been linked with the onset and perpetuation of inflammatory bowel diseases. The AIEC strain LF82 was originally isolated from an ileal biopsy from a patient with Crohn's disease. The pathogenesis of LF82 results from its abnormal adherence...

  7. Policy on Hazard Analysis and Critical Control Point (HACCP) and adherence to food preparation guidelines: a cross sectional survey of stakeholders in food service in Kumasi, Ghana.

    Science.gov (United States)

    Agyei-Baffour, Peter; Sekyere, Kofi Boateng; Addy, Ernestine Akosua

    2013-11-04

    Food borne diseases claim more lives and are growing public health concerns. Simple preventive techniques such as adoption and adherence to hazard analysis and critical control point (HACCP) policy can significantly reduce this disease burden. Though food screening and inspection are done, the ultimate regulation, Hazard Analysis and Critical Control Point, which is known and accepted worldwide, appears not to be popular among food operators in Ghana. This paper examines the level of awareness of the existence of policy on hazard analysis and critical control point (HACCP) and its adherence to food preparation guidelines among food service providers in Ghana. The results revealed the mean age of food providers as 33.1 years with a standard deviation of 7.5, range of 18-55 years, more females, in full time employment and with basic education. Of the fifty institutional managers, 42 (84%) were senior officers and had worked for more than five years. Education and type of food operator had strong statistically significant relationship with the implementation of HCCP policy and adherence with food preparation guidelines. The enforcement of HACCP policy and adherence with food safety guidelines was led by the Ghana Tourist Board, Public Health officers, and KMA, respectively. While a majority of food operators 373/450 (83.3%) did not know HACCP policy is part of food safety guidelines, staff of food safety law enforcement 44/50 (88%) confirmed knowing that food operators were not aware of the HACCP policy. The study documents evidence on the practice of food safety principles or HACCP policy or adherence to food preparation guidelines. Existing food safety guidelines incorporate varying principles of HACCP, however, awareness is low among food operators. The implication is that food production is likely to fall short of acceptable standards and not be wholesome putting consumers at health risk. Repeating this study in rural and urban areas in Ghana is necessary to

  8. Spatially and temporally controlled gene transfer by electroporation into adherent cells on plasmid DNA-loaded electrodes

    OpenAIRE

    Yamauchi, Fumio; Kato, Koichi; Iwata, Hiroo

    2004-01-01

    Functional characterization of human genes is one of the most challenging tasks in current genomics. Owing to a large number of newly discovered genes, high-throughput methodologies are greatly needed to express in parallel each gene in living cells. To develop a method that allows efficient transfection of plasmids into adherent cells in spatial- and temporal-specific manners, we studied electric pulse-triggered gene transfer using a plasmid-loaded electrode. A plasmid was loaded on a gold e...

  9. Adherence to a lifestyle programme in overweight/obese pregnant women and effect on gestational diabetes mellitus: a randomized controlled trial.

    Science.gov (United States)

    Bruno, Raffaele; Petrella, Elisabetta; Bertarini, Valentina; Pedrielli, Giulia; Neri, Isabella; Facchinetti, Fabio

    2017-07-01

    This study aims to determine whether the prescription of a detailed lifestyle programme in overweight/obese pregnant women influences the occurrence of gestational diabetes (GDM), and if this kind of prescription increases the adherence to a healthier lifestyle in comparison to standard care. The study was designed as a randomized controlled trial, with open allocation, enrolling women at 9-12 weeks of pregnancy with a BMI ≥ 25 kg/m 2 . The women assigned to the Intervention group (I = 96) received a hypocaloric, low-glycaemic, low-saturated fat diet and physical activity recommendations. Those assigned to the Standard Care group (SC = 95) received lifestyle advices regarding healthy nutrition and exercise. Follow-up was planned at the 16 th , 20 th , 28 th and 36 th weeks. A total of 131 women completed the study (I = 69, SC = 62). The diet adherence was higher in the I (57.9%) than in the SC (38.7%) group. GDM occurred less frequently in the I (18.8%) than in the SC (37.1%, P = 0.019) group. The adherent women from either groups showed a lower GDM rate (12.5% vs. 41.8%, P  4000 g were significantly lower in I group. The incidence of small for gestational age babies was not different. These findings demonstrate that the adherence to a personalized, hypocaloric, low-glycaemic, low-saturated fat diet started early in pregnancy prevents GDM occurrence, in women with BMI ≥ 25 kg/m 2 . © 2016 John Wiley & Sons Ltd.

  10. Combining malaria control with house electrification: adherence to recommended behaviours for proper deployment of solar-powered mosquito trapping systems, Rusinga Island, western Kenya.

    Science.gov (United States)

    Oria, Prisca A; Alaii, Jane; Ayugi, Margaret; Takken, Willem; Leeuwis, Cees

    2015-08-01

    To investigate community adherence to recommended behaviours for proper deployment of solar-powered mosquito trapping systems (SMoTS) after 3- to 10-week use. Solar-powered mosquito trapping system, which also provided power for room lighting and charging mobile phones, were installed in houses in Rusinga Island, western Kenya. We used a structured checklist for observations and a semi-structured questionnaire for interviews in 24 homesteads. We also analysed the subject of 224 community calls to the project team for technical maintenance of SMoTS. Most respondents cared for SMoTS by fencing, emptying and cleaning the trap. Our observations revealed that most traps were fenced, clean and in good working condition. A significantly higher proportion of community calls was lighting-related. Lighting was the main reason respondents liked SMoTS because it reduced or eliminated expenditure on kerosene. However, some respondents observed they no longer heard sounds of mosquitoes inside their houses. All respondents reportedly slept under insecticide-treated nets (ITNs) before receiving SMoTS. After receiving SMoTS, most respondents reportedly continued to use ITNs citing that the project advised them to do so. Some beach residents stopped using ITNs because they no longer heard mosquitoes or due to heat discomfort caused by lights. Electricity-related incentives played a greater role in encouraging adherence to recommended behaviours for proper deployment of SMoTS than the potential health benefits in the early stages of the intervention. Although energy-related financial incentives may play a role, they are insufficient to ensure adherence to health advice, even in the short term. Ongoing community engagement and research monitors and addresses adherence to recommended behaviours including continuation of current malaria control strategies. © 2015 John Wiley & Sons Ltd.

  11. A randomized-controlled trial with a Canadian electronic pill dispenser used to measure and improve medication adherence in patients with schizophrenia

    OpenAIRE

    Emmanuel eStip; Emmanuel eStip; Emmanuel eStip; Philippe D. Vincent; Philippe D. Vincent; Philippe D. Vincent; Catherine eGuevremont; Simon eZhornitsky; Constantin eTranulis; Constantin eTranulis; Constantin eTranulis; Juliette eSablier; Juliette eSablier

    2013-01-01

    Objective: Medication adherence is extremely important in preventing relapse and lowering symptoms in schizophrenic patients. However, estimates show that nearly half of these patients have poor adherence. The Brief Adherence Rating Scale (BARS) seems to be the most reliable tool assessing adherence in schizophrenia and shows that the antipsychotic adherence ratio (AAR) is about 49.5 % in schizophrenia. The aim of the study was to test if an electronic pill dispenser named DoPill® improv...

  12. A randomized controlled trial with a Canadian electronic pill dispenser used to measure and improve medication adherence in patients with schizophrenia

    OpenAIRE

    Stip, Emmanuel; Vincent, Philippe D.; Sablier, Juliette; Guevremont, Catherine; Zhornitsky, Simon; Tranulis, Constantin

    2013-01-01

    Objective: Medication adherence is extremely important in preventing relapse and lowering symptoms in schizophrenic patients. However, estimates show that nearly half of these patients have poor adherence. The Brief Adherence Rating Scale (BARS) seems to be the most reliable tool assessing adherence in schizophrenia and shows that the antipsychotic adherence ratio (AAR) is about 49.5% in schizophrenia. The aim of the study was to test if an electronic pill dispenser named DoPill® improved AAR...

  13. JV Task 122 - Assessment of Mercury Control Options for the San Miguel Electric Cooperative Power Plant

    Energy Technology Data Exchange (ETDEWEB)

    Nicholas Lentz; Brandon Pavlish; John Kay; Michael Jones

    2009-02-01

    In the United States, testing has been under way at electric coal-fired power plants to find viable and economical mercury control strategies to meet pending regulations. San Miguel Electric Cooperative (SMEC) engaged the Energy & Environmental Research Center (EERC) through a request for proposal (RFP) to perform research tests to evaluate sorbent-based technologies at its coal-fired San Miguel Generating Station to identify possible technology options that could be used by SMEC to meet the mercury reduction requirements of future U.S. federal standards. The goal of the testing was to target a mercury removal of {ge}90%. The EERC has successfully field-tested several sorbent-based technologies in previous projects that offer promise and potential to achieve a target removal of {ge}90%. Based on these field test results, yet recognizing that fuel type and plant operating conditions affect mercury capture significantly, the EERC proposed research tests to evaluate potential sorbent-based technologies provided by Norit Americas and the EERC that could potentially meet SMEC's mercury control objectives. Over the period of May through mid-June 2008, the EERC tested injection of both treated and nontreated activated carbon (AC) provided by Norit Americas and sorbent enhancement additives (SEAs) provided by the EERC. Tests were performed at San Miguel Unit 1 (450 MW) and included injection at the inlet of the air heater (AH) (temperature of 720 F). The test coal was a Texas lignite fuel with an average moisture content of 31.19%, an ash content of 26.6%, a heating value of 5,094 Btu/lb, a sulfur content of 2.7%, and a mercury concentration of 0.182 ppm, all reported on an as-received basis. Pilot-scale testing results identified DARCO{reg_sign} Hg-LH, SEA2 + DARCO{reg_sign} Hg, and the ChemMod sorbents as technologies with the potential to achieve the target mercury removal of {ge}90% at the full-scale test. Mercury concentrations were tracked with continuous

  14. Towards reducing traffic congestion using cooperative adaptive cruise control on a freeway with a ramp

    Directory of Open Access Journals (Sweden)

    Georges Arnaout

    2011-12-01

    Full Text Available Purpose: In this paper, the impact of Cooperative Adaptive Cruise Control (CACC systems on traffic performance is examined using microscopic agent-based simulation. Using a developed traffic simulation model of a freeway with an on-ramp - created to induce perturbations and to trigger stop-and-go traffic, the CACC system’s effect on the traffic performance is studied. The previously proposed traffic simulation model is extended and validated. By embedding CACC vehicles in different penetration levels, the results show significance and indicate the potential of CACC systems to improve traffic characteristics and therefore can be used to reduce traffic congestion. The study shows that the impact of CACC is positive but is highly dependent on the CACC market penetration. The flow rate of the traffic using CACC is proportional to the market penetration rate of CACC equipped vehicles and the density of the traffic.Design/methodology/approach: This paper uses microscopic simulation experiments followed by a quantitative statistical analysis. Simulation enables researchers manipulating the system variables to straightforwardly predict the outcome on the overall system, giving researchers the unique opportunity to interfere and make improvements to performance. Thus with simulation, changes to variables that might require excessive time, or be unfeasible to carry on real systems, are often completed within seconds.Findings: The findings of this paper are summarized as follow:•\tProvide and validate a platform (agent-based microscopic traffic simulator in which any CACC algorithm (current or future may be evaluated.•\tProvide detailed analysis associated with implementation of CACC vehicles on freeways.•\tInvestigate whether embedding CACC vehicles on freeways has a significant positive impact or not.Research limitations/implications: The main limitation of this research is that it has been conducted solely in a computer laboratory. Laboratory

  15. Control of a two-dimensional molecular structure by cooperative halogen and hydrogen bonds

    OpenAIRE

    Yasuda, Satoshi; Furuya, Atom; Murakoshi, Kei

    2014-01-01

    The cooperative effect of hydrogen and halogen bonds on the two-dimensional (2D) molecular arrangement on highly oriented pyrolytic graphite (HOPG) was studied by scanning tunneling microscopy. The terephthalic acid (TPA) molecule, which has two carboxyl groups attached at the para positions of a benzene ring, formed a one-dimensional (1D) linear non-covalent network structure on HOPG by hydrogen bonds between the carboxyl groups of neighboring molecules. However, unlike the TPA molecule, Br ...

  16. Assessment of biological, psychological and adherence factors in the prediction of step-down treatment for patients with well-controlled asthma.

    Science.gov (United States)

    Saito, N; Kamata, A; Itoga, M; Tamaki, M; Kayaba, H; Ritz, T

    2017-04-01

    Inhaled corticosteroids (ICS) and inhaled corticosteroids combined with long-acting beta2-agonist (ICS/LABA) are standard treatments for asthma. However, factors that might help reduce medication in well-controlled asthma are unknown. We classified problems of asthma patients into biological, psychological and adherence factors, and investigated factors associated with the indication and failure of a medication step-down treatment. Two hundred twenty two well-controlled asthma patients receiving ICS or ICS/LABA were assessed for physical and psychiatric problems and followed up for one year from adjustment of their treatment step. Factor B was defined as a presence of chronic upper airway complications. Factor P was defined as presence of psychiatric complications such as sleep disorder, depression, anxiety and somatoform disorders. Factor A was defined as poor adherence to ICS or ICS/LABA inhaler of 75% or less. Success in step-down treatment was defined as maintenance of well-controlled status for over one year after step-down. Factor B was the most important single negative predictive factor for indication for step-down treatment (Odds ratio; 0.19). Factor A increased the risk of failure to maintain step-down treatment most significantly by 23-fold, and factor B increased it by 11-fold. The combination of factors B and A increased failure by 24-fold, factors P and A by 21-fold, all three factors by 36-fold. Factor P only interacted with the other factors to reduce chances of stepping down, but did not constitute a problem factor when present alone. The evaluation of biological, psychological and adherence problems may lead to a more proactive and targeted approach to step-down treatment for patients with well-controlled asthma. © 2017 John Wiley & Sons Ltd.

  17. Advisory and autonomous cooperative driving systems

    NARCIS (Netherlands)

    Broek, T.H.A. van den; Ploeg, J.; Netten, B.D.

    2011-01-01

    In this paper, the traffic efficiency of an advisory cooperative driving system, Advisory Acceleration Control is examined and compared to the efficiency of an autonomous cooperative driving system, Cooperative Adaptive Cruise Control. The algorithms and implementation thereof are explained. The

  18. The Effect of Using Assessment Instruments on Substance-abuse Outpatients' Adherence to Treatment: a Multi-centre Randomised Controlled Trial

    Directory of Open Access Journals (Sweden)

    Broekaert Eric

    2011-05-01

    Full Text Available Abstract Background Drop-out is an important problem in the treatment of substance use disorder. The focus of this study was to investigate the effectiveness of within treatment assessment with feedback directly to patients with multiple substance use disorder on outpatient individual treatment adherence. Feedback consisted of personal resources' and readiness to change status and progress that facilitate or hinder change, thereby using graphical representation. Methods Informed consent was obtained from both the control and experimental groups to be involved in research and follow-up. Following Zelen's single consent design, baseline participants (n = 280 were randomised (sample-size-estimation: 80%power, p=.05, 2-sided and treatment consent was obtained from those allocated to the experiment (n = 142. In both groups, equal numbers of patients did not attend sessions after allocation. So, 227 persons were analyzed according to intention-to-treat analysis (ITT: experiment n = 116;control n = 111. Excluding refusals 211 participants remained for per-protocol analysis (PP: experiment n = 100; control n = 111, The study was conducted in five outpatient treatment-centres of a large network (De Sleutel in Belgium. Participants were people with multiple substance use disorder -abuse and dependence- who had asked for treatment and who had been advised to start individual treatment after a standardised admission assessment with the European Addiction Severity Index. The experimental condition consisted of informing the patient about the intervention and of subsequent assessments plus feedback following a protocol within the first seven sessions. Assessments were made with the Readiness to Change Questionnaire and the Personal Resources Diagnostic System. The control group received the usual treatment without within treatment assessment with feedback. The most important outcome measure in this analysis of the study was the level of adherence to treatment

  19. Assessment of adherence to the statistical components of consolidated standards of reporting trials statement for quality of reports on randomized controlled trials from five pharmacology journals

    Directory of Open Access Journals (Sweden)

    Sachin Satpute

    2016-01-01

    Full Text Available Background: The Consolidated Standards of Reporting Trials (CONSORT statement is a device to standardize reporting and improve the quality of controlled trials. However, little attention is paid to the statistical components in the CONSORT checklist. The present study evaluates the randomized controlled trials [RCTs] published in five high impact pharmacology journals with respect to its statistical methods. Methods: Randomized Controlled Trials [RCTs] published in the years 2013 & 2014 in five pharmacology journals with high impact factor, The Journal of Clinical Pharmacology (JCP, British Journal of Clinical Pharmacology (BJCP, European Journal of Clinical Pharmacology (EJCP, Journal of Pharmacology & Pharmacotherapeutics (JPP and Indian Journal of Pharmacology (IJP were assessed for adherence to the statistical components of CONSORT statement. Results: Of the 174 RCTs analysed, 103 described the method of sample size calculation. Of the five journals, maximum reports in JCP (34/50 and minimum in IJP (13/31 adhered to the CONSORT checklist [item 7a-sample size calculation]. Most reports mentioned the statistical methods used for analysis of data. (171/174 as per the checklist [item 12=statistical methods used]. Analysis of variance (ANOVA was the most commonly used test (88/174. The software used for statistical analysis was mentioned in 111 RCTs and SPSS was used more frequently (58/111. The exact p value was stated in 108 reports. Certain errors in statistical analysis were also noted (40/174. Conclusion: These findings show inconsistencies and non- adherence to the statistical components of the CONSORT statement especially with respect to sample size calculation. Special attention must be paid to the statistical accuracy of the reports.

  20. Cooperative Control of Ecdysone Biosynthesis in Drosophila by Transcription Factors Séance, Ouija board, and Molting Defective.

    Science.gov (United States)

    Uryu, Outa; Ou, Qiuxiang; Komura-Kawa, Tatsuya; Kamiyama, Takumi; Iga, Masatoshi; Syrzycka, Monika; Hirota, Keiko; Kataoka, Hiroshi; Honda, Barry M; King-Jones, Kirst; Niwa, Ryusuke

    2017-11-29

    Insect ecdysteroids are steroid hormones that control many aspects of development and physiology. During larval development, ecdysone is synthesized in an endocrine organ called the prothoracic gland (PG) through a series of ecdysteroidogenic enzymes encoded by the Halloween genes. The expression of the Halloween genes is highly restricted and dynamic, indicating that their spatiotemporal regulation is mediated by their tight transcriptional control. In this study, we report that three ZAD-C2H2 zinc finger transcription factors-Séance (Séan), Ouija board (Ouib), and Molting defective (Mld)-cooperatively control ecdysone biosynthesis in the fruit fly Drosophila melanogaster Séan and Ouib act in cooperation with Mld to positively regulate the transcription of neverland and spookier, respectively, two Halloween genes. Remarkably, loss-of-function mutations in séan, ouib, or mld can be rescued by the expression of neverland,spookier, or both, respectively. These results suggest that the three transcription factors have distinct roles in coordinating the expression of just two genes in Drosophila Given that neverland and spookier are located in constitutive heterochromatin, Séan, Ouib, and Mld represent the first example of a transcription factor subset that regulates genes located in constitutive heterochromatin. Copyright © 2017, Genetics.

  1. Adesão ao tratamento e controle da pressão arterial em idosos com hipertensão Treatment adherence and blood pressure control in older individuals with hypertension

    Directory of Open Access Journals (Sweden)

    Rachel G. Bastos-Barbosa

    2012-07-01

    Full Text Available FUNDAMENTO: A não adesão ao tratamento tem sido identificada como a causa principal da Pressão Arterial (PA não controlada, e pode representar um risco maior em idosos. OBJETIVO: O objetivo deste estudo foi avaliar e comparar a taxa de adesão ao tratamento da hipertensão arterial por diferentes métodos, para estimar a taxa de controle da PA, e observar se há uma associação entre controle da pressão arterial e adesão. MÉTODOS: A adesão ao tratamento foi avaliada em pacientes idosos com hipertensão, acompanhados pelo serviço público de saúde, por meio de quatro métodos, incluindo o teste de Morisky-Green (referência, o questionário sobre atitudes referentes à ingestão de medicação (AMI, uma avaliação da adesão por parte do enfermeiro em consultório (AEC, e avaliação domiciliar da adesão (ADA. A ingestão de sal foi estimada pela excreção urinária de sódio de 24 horas. O controle da pressão arterial foi avaliado pelo monitorização ambulatorial da pressão arterial na vigília. RESULTADOS: A concordância entre o teste de Morisky-Green e o AMI (Kappa = 0,27 ou a AEC (Kappa = 0,05 foi pobre. Houve uma concordância moderada entre o teste de Morisky-Green e a ADA. Oitenta por cento tinham a PA controlada, incluindo 42% com efeito do jaleco branco. O grupo com menor excreção de sal relatou evitar o consumo de sal mais vezes (p BACKGROUND: Non-adherence to treatment has been identified as the main cause of uncontrolled blood pressure (BP, and may represent a greater risk in older individuals. OBJECTIVE: The aim of this study was to evaluate and compare the rate of adherence to hypertension treatment using different methods, to estimate the BP control rate, and to observe if there is an association between BP control and adherence. METHODS: Treatment adherence was evaluated in older patients with hypertension, followed by the public primary health care, through four methods, including the Morisky-Green test

  2. Controlling Cooperative CO2Adsorption in Diamine-Appended Mg2(dobpdc) Metal-Organic Frameworks.

    Science.gov (United States)

    Siegelman, Rebecca L; McDonald, Thomas M; Gonzalez, Miguel I; Martell, Jeffrey D; Milner, Phillip J; Mason, Jarad A; Berger, Adam H; Bhown, Abhoyjit S; Long, Jeffrey R

    2017-08-02

    In the transition to a clean-energy future, CO 2 separations will play a critical role in mitigating current greenhouse gas emissions and facilitating conversion to cleaner-burning and renewable fuels. New materials with high selectivities for CO 2 adsorption, large CO 2 removal capacities, and low regeneration energies are needed to achieve these separations efficiently at scale. Here, we present a detailed investigation of nine diamine-appended variants of the metal-organic framework Mg 2 (dobpdc) (dobpdc 4- = 4,4'-dioxidobiphenyl-3,3'-dicarboxylate) that feature step-shaped CO 2 adsorption isotherms resulting from cooperative and reversible insertion of CO 2 into metal-amine bonds to form ammonium carbamate chains. Small modifications to the diamine structure are found to shift the threshold pressure for cooperative CO 2 adsorption by over 4 orders of magnitude at a given temperature, and the observed trends are rationalized on the basis of crystal structures of the isostructural zinc frameworks obtained from in situ single-crystal X-ray diffraction experiments. The structure-activity relationships derived from these results can be leveraged to tailor adsorbents to the conditions of a given CO 2 separation process. The unparalleled versatility of these materials, coupled with their high CO 2 capacities and low projected energy costs, highlights their potential as next-generation adsorbents for a wide array of CO 2 separations.

  3. Glycolysis and glutaminolysis cooperatively control T cell function by limiting metabolite supply to N-glycosylation.

    Science.gov (United States)

    Araujo, Lindsey; Khim, Phillip; Mkhikian, Haik; Mortales, Christie-Lynn; Demetriou, Michael

    2017-01-06

    Rapidly proliferating cells switch from oxidative phosphorylation to aerobic glycolysis plus glutaminolysis, markedly increasing glucose and glutamine catabolism. Although Otto Warburg first described aerobic glycolysis in cancer cells >90 years ago, the primary purpose of this metabolic switch remains controversial. The hexosamine biosynthetic pathway requires glucose and glutamine for de novo synthesis of UDP-GlcNAc, a sugar-nucleotide that inhibits receptor endocytosis and signaling by promoting N-acetylglucosamine branching of Asn (N)-linked glycans. Here, we report that aerobic glycolysis and glutaminolysis co-operatively reduce UDP-GlcNAc biosynthesis and N-glycan branching in mouse T cell blasts by starving the hexosamine pathway of glucose and glutamine. This drives growth and pro-inflammatory T H 17 over anti-inflammatory-induced T regulatory (iTreg) differentiation, the latter by promoting endocytic loss of IL-2 receptor-α (CD25). Thus, a primary function of aerobic glycolysis and glutaminolysis is to co-operatively limit metabolite supply to N-glycan biosynthesis, an activity with widespread implications for autoimmunity and cancer.

  4. Impact on Congestion and Fuel Consumption of a Cooperative Adaptive Cruise Control System with Lane-Level Position Estimation

    Directory of Open Access Journals (Sweden)

    Edgar Talavera

    2018-01-01

    Full Text Available In recent years, vehicular communications systems have evolved and allowed for the improvement of adaptive cruise control (ACC systems to make them cooperative (cooperative adaptive cruise control, CACC. Conventional ACC systems use sensors on the ego-vehicle, such as radar or computer vision, to generate their behavioral decisions. However, by having vehicle-to-X (V2X onboard communications, the need to incorporate perception in the vehicle is drastically reduced. Thus, in this paper a CACC solution is proposed that only uses communications to make its decisions with the help of previous road mapping. At the same time, a method to develop these maps is presented, combining the information of a computer vision system to correct the positions obtained from the navigation system. In addition, the cut-in and cut-out maneuvers for a CACC platoon are taken into account, showing the tests of these situations in real environments with instrumented vehicles. To show the potential of the system in a larger-scale implementation, simulations of the behavior are provided under dense traffic conditions where the positive impact on the reduction of traffic congestion and fuel consumption is appreciated.

  5. Attrition and Adherence in a Web-Based Distress Management Program for Implantable Cardioverter Defibrillator Patients (WEBCARE): Randomized Controlled Trial

    DEFF Research Database (Denmark)

    Habibovic, M.; Cuijpers, P.; Alings, M.

    2014-01-01

    encountered problems with attrition and adherence. Objective: In the current study, we focus on the patient characteristics, reasons, and motivation of (1) completers, (2) those who quit the intervention, and (3) those who quit the intervention and the study in the treatment arm of WEBCARE. Methods......: Consecutive first-time ICD patients from six Dutch referral hospitals were approached for participation. After signing consent and filling in baseline measures, patients were randomized to either the WEBCARE group or the Usual Care group. Results: The treatment arm of WEBCARE contained 146 patients....... Of these 146, 34 (23.3%) completed the treatment, 88 (60.3%) dropped out of treatment but completed follow-up, and 24 (16.4%) dropped out of treatment and study. Results show no systematic differences in baseline demographic, clinical, or psychological characteristics between groups. A gradual increase...

  6. Assessment of the relationship between adherence with antiemetic drug therapy and control of nausea and vomiting in breast cancer patients receiving anthracycline-based chemotherapy.

    Science.gov (United States)

    Chan, Alexandre; Low, Xiu Hui; Yap, Kevin Yi-Lwern

    2012-06-01

    There are little prevalence data in the literature on nonadherence to outpatient antiemetic regimens for prophylaxis of chemotherapy-induced nausea and vomiting (CINV). It is unclear whether adherence with outpatient antiemetic regimens is associated with better CINV control. Our previous survey research supports the work of clinical pharmacists in collaborative practice with medical oncologists in improving adherence with antiemetic therapy in women undergoing highly emetic chemotherapy for breast cancer. To (a) evaluate the impact of adherence to delayed antiemetics (days 2-4 following anthracycline-based chemotherapy) on CINV control in breast cancer patients after anthracycline-based chemotherapy and (b) identify patient-related factors associated with nonadherence to delayed antiemetics. A single-center, prospective, observational study was conducted from December 2006 to January 2011 in breast cancer patients receiving anthracycline-based chemotherapy (doxorubicin or epirubicin) and antiemetics at the National Cancer Centre Singapore (NCCS), the largest ambulatory cancer center in Singapore. Included patients were aged 21 years or older with confirmed diagnoses of breast cancer and receiving anthracycline-containing chemotherapy with antiemetics. Patients were excluded if they (a) were diagnosed with intestinal obstruction or received concurrent radiotherapy that predisposed them to nausea and vomiting, (b) had vomited in the 24 hours preceding chemotherapy, or (c) had brain metastases that would impair their judgment. Patients documented in a standardized diary their emesis events, severity of nausea, use of rescue therapy with metoclopramide, and compliance with dose instructions for antiemetic drug therapy for 5 days: day 1 was the day of chemotherapy and first day of antiemetic therapy, and day 5 was the day after completion of delayed antiemetic therapy (days 2-4). Three definitions were used to describe the CINV outcomes: (a) complete response (no

  7. A Landscape of Therapeutic Cooperativity in KRAS Mutant Cancers Reveals Principles for Controlling Tumor Evolution

    Directory of Open Access Journals (Sweden)

    Grace R. Anderson

    2017-07-01

    Full Text Available Combinatorial inhibition of effector and feedback pathways is a promising treatment strategy for KRAS mutant cancers. However, the particular pathways that should be targeted to optimize therapeutic responses are unclear. Using CRISPR/Cas9, we systematically mapped the pathways whose inhibition cooperates with drugs targeting the KRAS effectors MEK, ERK, and PI3K. By performing 70 screens in models of KRAS mutant colorectal, lung, ovarian, and pancreas cancers, we uncovered universal and tissue-specific sensitizing combinations involving inhibitors of cell cycle, metabolism, growth signaling, chromatin regulation, and transcription. Furthermore, these screens revealed secondary genetic modifiers of sensitivity, yielding a SRC inhibitor-based combination therapy for KRAS/PIK3CA double-mutant colorectal cancers (CRCs with clinical potential. Surprisingly, acquired resistance to combinations of growth signaling pathway inhibitors develops rapidly following treatment, but by targeting signaling feedback or apoptotic priming, it is possible to construct three-drug combinations that greatly delay its emergence.

  8. Control Algorithm Trajectory Planning for Dual Cooperative Manipulators with Experimental Verification

    Directory of Open Access Journals (Sweden)

    Omar Ahmed

    2016-01-01

    Full Text Available In order to achieve cooperation of multi-robots simultaneously, this paper presents an approach of Trajectory planning for two decoupled robots with six degrees of freedom (DOF each to execute packing task. The Denavit-Hartenberg (D-H representation is used to model robot links and solve the transformation matrices of each joint. The inverse kinematics solution using for a 6- DOF Robotic arm is presented, for given initial and final configurations of the robots, the robots are placed so that their workspaces overlap. An algorithm successfully finds a set of configurations to ensure, collision free transition from start to end configuration. Simulation and experiments based on 6-dof robot are carried out and the results verified the effectiveness of the proposed algorithm.

  9. Cooperative jamming power control to enhance secrecy communications of AF Relaying systems for Rayleigh fading channel

    KAUST Repository

    Park, Kihong

    2012-09-01

    In this paper, we investigate secrecy communications in two-hop wireless relaying networks which consist of one source, one amplify-and-forward (AF) relay, one legitimate destination, and one eavesdropper. To prevent the eavesdropper from intercepting the source message, we make the destination send the intended noise to the AF relay during the first phase. This is referred to as cooperative jamming. According to the channel information at the destination, we address two types of jamming power allocation; (i) rate-optimal power allocation and (ii) outage-optimal power allocation. More specifically, without the instantaneous channel knowledge for the eavesdropper side, the outage probability of the secrecy rate is minimized with respect to the intended noise power level. We show that the outage-optimal allocation gives almost the same outage probability as the rateoptimal one. In addition, the jamming power consumption can be significantly reduced compared to the fixed and rate-optimal power allocation methods. © 2012 IEEE.

  10. Associations between major life events and adherence, glycemic control, and psychosocial characteristics in teens with type 1 diabetes.

    Science.gov (United States)

    Commissariat, Persis V; Volkening, Lisa K; Guo, Zijing; ElBach, Jessica L; Butler, Deborah A; Laffel, Lori M

    2017-04-19

    This cross-sectional study assessed the type of major life events occurring in a contemporary sample of teens with type 1 diabetes and the association between event frequency and demographic, diabetes management, and psychosocial characteristics. Parents of 178 teens completed the Life Events Checklist to report major events teens had experienced in the last year: 42% experienced 0 to 1 event (n = 75), 32% experienced 2 to 3 events (n = 57), and 26% experienced 4+ events (n = 46). Teens and parents completed validated measures of treatment adherence, diabetes-specific self-efficacy, quality of life, and diabetes-specific family conflict. Parent-youth interview and chart review provided demographics and diabetes management data. Mean number of events/teen was 2.6 ± 2.7 (range = 0-15). The most common events were "Hospitalization of a family member" (24%), "Getting a bad report card" (20%), "Serious arguments between parents" (19%), and "Serious illness/injury in a family member" (19%). Compared with teens experiencing 0 to 1 event, teens experiencing 4+ events were less likely to have married parents (P = .01) and a parent with a college degree (P = .006). Teens with 4+ events had significantly poorer adherence (P = .002 teen, P = .02 parent), lower self-efficacy (P = .03 teen, P events. In a multivariate model (R 2  = 0.21, P events was associated with lower A1c (P = .0009). Occurrence of more major life events was associated with poorer diabetes care and A1c and more negative psychosocial qualities in teens with type 1 diabetes. © 2017 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

  11. Predictors and impact of non-adherence in adults with attention-deficit/hyperactivity disorder receiving OROS methylphenidate: results from a randomized, placebo-controlled trial

    NARCIS (Netherlands)

    Kooij, J.J.; Rosler, M.; Philipsen, A.; Wachter, S.; Dejonckheere, J.; Kolk, A. van der; Agthoven, M. van; Schauble, B.

    2013-01-01

    BACKGROUND: Medication non-adherence has an important impact on treatment efficacy and healthcare burden across a range of conditions and therapeutic areas. The aim of this analysis was to determine predictors of non-adherence and impact of non-adherence on treatment response in adults with

  12. The effect of perceived adherence to the Bobath concept on physiotherapists' choice of intervention used to treat postural control after stroke.

    Science.gov (United States)

    Tyson, S F; Selley, A B

    2007-03-15

    The Bobath concept is the predominant stroke physiotherapy approach in the UK but there is little literature about its operationalization. The aim of this study was to assess the effect of perceived adherence to the Bobath concept on interventions used by physiotherapists to treat postural control problems after stroke. The physiotherapists' experience, clinical grade and the type of patients treated were also compared. The design was a cross sectional survey involving 11 NHS Trusts. The participants were 35 stroke physiotherapists who recorded the treatment of 132 patients in 644 sessions using the Stroke Physiotherapy Intervention Recording Tool. Descriptive statistics, independent t-tests and Chi-squares were used in the analysis to describe the physiotherapists and patients, and compare the effects of perceived adherence to the Bobath concept on intervention choice, clinical grade, experience and the type of patient treated. Most physiotherapists perceived their practice to be eclectic but the interventions used followed a traditional Bobath model. Perceived adherence to the Bobath concept had little effect on the choice of intervention. The only significant difference was that 'preparation for treatment' techniques were used more frequently by 'strongly Bobath' physiotherapists then 'eclectic' physiotherapists. There were no other significant differences, nor were there any differences in the physiotherapists' clinical grade, post-graduate training or the type of patient treated except that 'eclectic' physiotherapists' patients were older. Most of the 'strongly Bobath' physiotherapists were experienced and most of the 'eclectic' physiotherapists were novices (pBobath model; recent developments of the Bobath concept were not incorporated into clinical practice. The reasons for the mismatch between physiotherapists' perception and their actual practice are discussed.

  13. Designing for cooperation - cooperating in design

    DEFF Research Database (Denmark)

    Kyng, Morten

    1991-01-01

    This article will discuss how to design computer applications that enhance the quality of work and products, and will relate the discussion to current themes in the field of Computer-Supported Cooperative Work (CSCW). Cooperation is a key element of computer use and work practice, yet here...... a specific "CSCW approach is not taken." Instead the focus is cooperation as an important aspect of work that should be integrated into most computer support efforts in order to develop successful computer support, however, other aspects such as power, conflict and control must also be considered....

  14. Impact of a pharmacist led diabetes mellitus intervention on HbA1c, medication adherence and quality of life: A randomised controlled study.

    Science.gov (United States)

    Butt, Mubashra; Mhd Ali, Adliah; Bakry, Mohd Makmor; Mustafa, Norlaila

    2016-01-01

    Malaysia is situated in Western Pacific region which bears 36.17% of total diabetes mellitus population. Pharmacist led diabetes interventions have been shown to improve the clinical outcomes amongst diabetes patients in various parts of the world. Despite high prevalence of disease in this region there is a lack of reported intervention outcomes from this region. The aim of this study was to evaluate the impact of a pharmacist led intervention on HbA1c, medication adherence, quality of life and other secondary outcomes amongst type 2 diabetes patients. Type 2 diabetes mellitus patients (n = 73) attending endocrine clinic at Universiti Kebangsaan Malaysia Medical Centre (UKMMC) were randomised to either control (n = 36) or intervention group (n = 37) after screening. Patients in the intervention group received an intervention from a pharmacist during the enrolment, after three and six months of the enrolment. Outcome measures such as HbA1c, BMI, lipid profile, Morisky scores and quality of life (QoL) scores were assessed at the enrolment and after 6 months of the study in both groups. Patients in the control group did not undergo intervention or educational module other than the standard care at UKMMC. HbA1c values reduced significantly from 9.66% to 8.47% (P = 0.001) in the intervention group. However, no significant changes were noted in the control group (9.64-9.26%, P = 0.14). BMI values showed significant reduction in the intervention group (29.34-28.92 kg/m(2); P = 0.03) and lipid profiles were unchanged in both groups. Morisky adherence scores significantly increased from 5.83 to 6.77 (P = 0.02) in the intervention group; however, no significant change was observed in the control group (5.95-5.98, P = 0.85). QoL profiles produced mixed results. This randomised controlled study provides evidence about favourable impact of a pharmacist led diabetes intervention programme on HbA1c, medication adherence and QoL scores amongst type 2 diabetes

  15. Improving hand hygiene adherence among nursing staff.

    Science.gov (United States)

    Harne-Britner, Sarah; Allen, Marianne; Fowler, Kimberly A

    2011-01-01

    This quasi-experimental study explored initial and sustained effects of educational and behavioral interventions on hand hygiene adherence and the relationships between hand hygiene adherence and health care-associated infections. Education paired with positive reinforcement behavioral interventions significantly improved hand hygiene adherence after the first month (χ² = 4.27; P = .039); however, the improvement was not sustained over 6 months. There were no significant differences in infection rates between the treatment and control groups.

  16. A pilot controlled trial to determine the feasibility, acceptability and effectiveness of a PAPA-based online intervention to address practical and perceptual barriers to medication adherence in Inflammatory Bowel Disease.

    Directory of Open Access Journals (Sweden)

    Sarah Chapman

    2015-11-01

    The intervention was effective in addressing perceptual barriers to adherence, as well as having a positive impact on IBD-related illness perceptions: increasing treatment control beliefs, and reducing concerns and emotional response. Fewer episodes of non-adherence were reported in the Intervention Group compared to the Control Group. Satisfaction with information about IBD medication improved following the intervention. However, the number of reported practical barriers was similar between the Intervention and Control groups, suggesting that other support might need to be incorporated into the intervention. Limitations of this study include potential bias due to drop-out, potential lack of generalisability to patient populations not recruited online and a reliance on self-report rather than objective outcome measures. However, this controlled trial suggests that the IBD-Helper intervention may be an effective, feasible and acceptable method of addressing perceptual barriers to adherence.

  17. Anxiety, locus of control and sociodemographic factors associated with adherence to an annual clinical skin monitoring: a cross-sectional survey among 1000 high-risk French patients involved in a pilot-targeted screening programme for melanoma.

    Science.gov (United States)

    Rat, Cédric; Hild, Sandrine; Gaultier, Aurelie; Khammari, Amir; Bonnaud-Antignac, Angelique; Quereux, Gaelle; Dreno, Brigitte; Nguyen, Jean Michel

    2017-10-05

    The aim of the study was to assess whether adherence to annual clinical skin monitoring is dependent on patient sociodemographic characteristics or personality traits. The study was a questionnaire survey. Data were collected between February and April 2013 in a sample of 1000 patients at high risk of melanoma who participated in a pilot-targeted screening programme in western France. Sociodemographic data, overall anxiety level (State-Trait Anxiety Inventory questionnaire), locus of control (Multidimensional Health Locus of Control scale) and levels of anxiety specifically associated with screening and melanoma were collected. Actual participation in the skin monitoring examination was reported by 78 general practitioner investigators. Statistical analysis was performed using R statistical software. Factors associated with non-adherence were identified by multivariate analysis. Our analysis included 687 responses (526 adherent patients and 161 non-adherent patients). Non-adherence was higher in younger patients and in men (OR=0.63 (0.41-0.99)). Viewing health status as dependent on external persons (OR=0.90, 95% CI 0.83 to 0.97) or determined by chance (OR=0.89, 95% CI 0.80 to 0.98) and overall anxiety (OR=0.98, 95% CI 0.97 to 0.99) were also factors associated with non-adherence. In contrast, there was no link between anxiety specifically associated with the screening performed or melanoma and patient adherence to monitoring. Adherence was higher in married patients (OR=1.68 95% CI 1.08 to 2.60). The results of this study suggest that sociodemographic and psychological characteristics should be considered when including patients at elevated risk of melanoma in a targeted screening programme. NCT01610531; Post-results. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2017. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

  18. A Multicomponent Intervention to Improve Primary Care Provider Adherence to Chronic Opioid Therapy Guidelines and Reduce Opioid Misuse: A Cluster Randomized Controlled Trial Protocol.

    Science.gov (United States)

    Lasser, Karen E; Shanahan, Christopher; Parker, Victoria; Beers, Donna; Xuan, Ziming; Heymann, Orlaith; Lange, Allison; Liebschutz, Jane M

    2016-01-01

    Prescription opioid misuse is a significant public health problem as well as a patient safety concern. Primary care providers (PCPs) are the leading prescribers of opioids for chronic pain, yet few PCPs follow standard practice guidelines regarding assessment and monitoring. This cluster randomized controlled trial will determine whether four implementation strategies; nurse care management, use of a patient registry, academic detailing, and electronic tools, will increase PCP adherence to chronic opioid therapy guidelines and reduce opioid misuse among patients, relative to electronic tools alone. The implementation strategies and intervention content are based on the chronic care model. We include 53 PCPs from three Boston-area community health centers and one urban safety-net hospital-based primary care practice who have at least four patients meeting the following inclusion criteria: 1) age≥18; 2) one or more completed visits to the primary care practice in the past year; 3) long-term opioid treatment defined as three or more opioid prescriptions written at least 21days apart within 6months and 4) an inpatient or outpatient ICD-9-CM diagnosis for musculoskeletal or neuropathic pain. We consider PCPs to be study subjects, and obtained a waiver of informed consent for patients because the study is promoting an established standard of care. We enrolled participants (PCPs) from December 2012 through March 2015. PCPs were randomized to receive the intervention, which includes four components: 1) nurse care management, 2) use of a patient registry, 3) academic detailing, and 4) electronic tools, or a control condition, which includes only the use of the electronic tools. The intervention PCPs receive the services of a nurse-managed registry for planning individual patient care and conducting population-based care for patients receiving opioids for chronic pain. In academic detailing visits, trained co-investigators provide intervention PCPs with individualized

  19. Measurement of adherence in a randomised controlled trial of a complex intervention: supported self-management for adults with learning disability and type 2 diabetes.

    Science.gov (United States)

    Graham, Liz; Wright, Judy; Walwyn, Rebecca; Russell, Amy M; Bryant, Louise; Farrin, Amanda; House, Allan

    2016-10-06

    Reporting adherence to intervention delivery and uptake is a detailed way of describing what was actually delivered and received, in comparison to what was intended. Measuring and reporting adherence is not routinely done well in complex interventions. The OK Diabetes trial (ISRCTN41897033) aimed to develop and subsequently test the feasibility of implementing a supported self-management intervention in adults with a learning disability and type 2 diabetes. A key study objective was to develop a measure of adherence to the intervention. We conducted a systematic review of published literature, extracting data from included papers using a standardised proforma. We undertook a narrative synthesis of papers to determine the form and content of methods for adherence measurement for self-management interventions in this population that had already been developed. We used the framework and data extraction form developed for the review as the basis for an adherence measurement tool that we applied in the OK Diabetes trial. The literature review found variability in the quality and content of adherence measurement and reporting, with no standardised approach. We were able to develop an adherence measure based upon the review, and populate it with data collected during the OK Diabetes trial. The adherence tool proved satisfactory for recording and measuring adherence in the trial. There remains a need for a standardised approach to adherence measurement in the field of complex interventions. We have shown that it is possible to produce a simple, feasible measure for assessing adherence in the OK Diabetes trial.

  20. Cooperative control for self-organizing microgrids and game strategies for optimal dispatch of distributed renewable generations

    Energy Technology Data Exchange (ETDEWEB)

    Maknouninejad, Ali; Lin, Wei; Harno, Hendra G.; Qu, Zhihua; Simaan, Marwan A. [University of Central Florida, Department of EECS, Orlando, FL (United States)

    2012-03-15

    The small size, extensively dispersed and decentralized, and high penetration level of renewable energy sources in the future smart grids make the application of conventional optimal power flow (OPF) neither practical nor economical. In this paper, a practical approach is proposed to realize high penetration of distributed generators (DGs) by organizing them in some groups within a microgrid and dispatching the generated power aggregately. Each group may have virtual leaders which define the power policy of the group, and all other DGs cooperatively follow that policy. A fair utilization ratio is defined and will be introduced to the group by the virtual leaders. The utilization ratio indicates what percentage of the available power each DG has to feed to the grid, and this ratio will also be propagated within the group using cooperative control. As such, a smartgrid may treat microgrids as individually dispatchable loads or generators. Meanwhile, the interaction between each microgrid and the main grid can be formulated as a Stackelberg game. The main grid as the leader, by offering proper energy price to the micro grid, minimizes its cost and secures the power supply that the microgrid, as the follower, is willing to dispatch. It is shown that this game theoretic approach not only guarantees profit optimization, but also provides a convenient technique to optimize power flow from microgrids to the main grid. Numerical and simulation results for a case of study are provided to demonstrate the effectiveness of the proposed techniques. (orig.)

  1. Active and inactive enhancers co-operate to exert localized and long-range control of gene regulation

    Science.gov (United States)

    Proudhon, Charlotte; Snetkova, Valentina; Raviram, Ramya; Lobry, Camille; Badri, Sana; Jiang, Tingting; Hao, Bingtao; Trimarchi, Thomas; Kluger, Yuval; Aifantis, Iannis; Bonneau, Richard; Skok, Jane A

    2016-01-01

    V(D)J recombination relies on the presence of proximal enhancers that activate the antigen receptor (AgR) loci in a lineage and stage specific manner. Unexpectedly we find that both active and inactive AgR enhancers co-operate to disseminate their effects in a localized and long-range manner. Here we demonstrate the importance of short-range contacts between active enhancers that constitute an Igk super-enhancer in B cells. Deletion of one element reduces the interaction frequency between other enhancers in the hub, which compromises the transcriptional output of each component. We further establish that in T cells long-range contact and co-operation between the inactive Igk enhancer, MiEκ and the active Tcrb enhancer, Eβ, alters enrichment of CBFβ binding in a manner that impacts Tcrb recombination. These findings underline the complexities of enhancer regulation and point to a role for localized and long-range enhancer-sharing between active and inactive elements in lineage and stage specific control. PMID:27239026

  2. Accomplishments and challenges in tobacco control endeavors – Report from the Gulf Cooperation Council countries

    Directory of Open Access Journals (Sweden)

    Kamran Habib Awan

    2018-01-01

    Conclusion: Application and implementation of measures outline in the MPOWER package, formulation and enforcement of sturdy laws on tobacco control, and development of infrastructure and trained workforce are fundamental to manage and reinforce tobacco control measures in the GCC region.

  3. Determinants of medication adherence to antihypertensive medications among a Chinese population using Morisky Medication Adherence Scale.

    Directory of Open Access Journals (Sweden)

    Gabrielle K Y Lee

    Full Text Available BACKGROUND AND OBJECTIVES: Poor adherence to medications is one of the major public health challenges. Only one-third of the population reported successful control of blood pressure, mostly caused by poor drug adherence. However, there are relatively few reports studying the adherence levels and their associated factors among Chinese patients. This study aimed to study the adherence profiles and the factors associated with antihypertensive drug adherence among Chinese patients. METHODS: A cross-sectional study was conducted in an outpatient clinic located in the New Territories Region of Hong Kong. Adult patients who were currently taking at least one antihypertensive drug were invited to complete a self-administered questionnaire, consisting of basic socio-demographic profile, self-perceived health status, and self-reported medication adherence. The outcome measure was the Morisky Medication Adherence Scale (MMAS-8. Good adherence was defined as MMAS scores greater than 6 points (out of a total score of 8 points. RESULTS: From 1114 patients, 725 (65.1% had good adherence to antihypertensive agents. Binary logistic regression analysis was conducted. Younger age, shorter duration of antihypertensive agents used, job status being employed, and poor or very poor self-perceived health status were negatively associated with drug adherence. CONCLUSION: This study reported a high proportion of poor medication adherence among hypertensive subjects. Patients with factors associated with poor adherence should be more closely monitored to optimize their drug taking behavior.

  4. MICU1 controls both the threshold and cooperative activation of the mitochondrial Ca2+ uniporter

    Science.gov (United States)

    Csordás, György; Golenár, Tünde; Seifert, Erin L.; Kamer, Kimberli J.; Sancak, Yasemin; Perocchi, Fabiana; Moffat, Cynthia; Weaver, David; Perez, Sergio de la Fuente; Bogorad, Roman; Koteliansky, Victor; Adijanto, Jeffrey; Mootha, Vamsi K.; Hajnóczky, György

    2013-01-01

    Summary Mitochondrial Ca2+ uptake via the uniporter is central to cell metabolism, signaling and survival. Recent studies identified MCU as the uniporter’s likely pore and MICU1, an EF-hand protein, as its critical regulator. How this complex decodes dynamic cytoplasmic [Ca2+] ([Ca2+]c) signals, to tune out small [Ca2+]c increases yet permit pulse transmission, remains unknown. We report that loss of MICU1 in mouse liver and cultured cells causes mitochondrial Ca2+ accumulation during small [Ca2+]c elevations, yet an attenuated response to agonist-induced [Ca2+]c pulses. The latter reflects loss of positive cooperativity, likely via the EF-hands. MICU1 faces the intermembrane space and responds to [Ca2+]c changes. Prolonged MICU1 loss leads to an adaptive increase in matrix Ca2+ binding, yet cells show impaired oxidative metabolism and sensitization to Ca2+ overload. Collectively, the data indicate that MICU1 senses the [Ca2+]c to establish the uniporter’s threshold and gain, thereby allowing mitochondria to properly decode different inputs. PMID:23747253

  5. Psychotropic Medications in Swedish Homicide Victims and Offenders: A Forensic-Toxicological Case-Control Study of Adherence and Recreational Use.

    Science.gov (United States)

    Hedlund, Jonatan; Forsman, Jonas; Sturup, Joakim; Masterman, Thomas

    2017-07-01

    We aimed to assess the extent to which adherence to, and recreational use of, psychotropic medications influence the risk of homicide offending and victimization. We conducted a population-based case-control study by way of linking a nationwide registry of dispensed prescriptions with a forensic-toxicological database. Homicide victims (n = 200) and offenders (n = 105) were identified for the years 2007-2009 and vehicle-accident controls (n = 1,643) for the years 2006-2013. The occurrence of congruence and incongruence between dispensed prescriptions and toxicology was used as a measure of adherence and recreational use. For antidepressants, incongruence-but not congruence-between dispensed prescriptions and toxicology was associated with a significantly increased risk of homicide offending (odds ratio adjusted for age and sex [aOR] = 6.2; 95% confidence interval [CI], 3.3-11.6) but not homicide victimization (aOR = 0.8; 95% CI, 0.3-2.0). For antipsychotics and mood stabilizers, a significantly increased risk of homicide offending was associated with incongruence between prescriptions and toxicology (aOR = 7.0; 95% CI, 2.8-17.7), whereas risk estimates for congruence were not significantly elevated for either homicide offending or victimization. For GABAergic hypnotics, congruence and incongruence were significantly associated with increased risks of both homicide offending (aOR = 5.4; 95% CI, 2.6-11.0 and aOR = 4.9; 95% CI, 2.6-9.3, respectively) and homicide victimization (aOR = 2.1; 95% CI, 1.1-4.2 and aOR = 3.2; 95% CI, 1.7-6.1, respectively). Sensitivity analyses with a subset of controls yielded similar estimates. Nonadherence to medications used to treat affective and psychotic disorders appears to elevate the risk of homicide offending. Both medicinal and recreational use of GABAergic hypnotics appears to elevate the risk of homicide offending and victimization. In summary, vigilance regarding adherence to medications prescribed for mood disorders and

  6. A novel nonlinear control for tracking and rendezvous with a rotating non-cooperative target with translational maneuver

    Science.gov (United States)

    Zhang, Dayu; Luo, Jianjun; Gao, Dengwei; Ma, Weihua; Yuan, Jianping

    2017-09-01

    This paper studies the control of flexible chaser spacecraft to track and rendezvous with a rotating non-cooperative target accompanied by translational maneuver. The problem is formulated that the chaser spacecraft is required to track target position and be synchronized with its attitude precisely. Meanwhile, the elastic vibration, induced by large angular maneuver in the tracking process, needs to be reduced. With respect to this unique movement of target, a novel modified θ - D control method, derived by standard θ - D algorithm and Lyapunov min-max value theorem, is proposed to incorporate position, attitude and flexural motion into one united control frame. The modification term in the proposed control method is dealt with target translational maneuver, which is the primary contribution in this paper. The asymptotically stability of closed-loop system is proved via the Lyapunov theory and Lyapunov min-max value theorem. Numerical results demonstrate an excellent tracking performance of proposed united control frame even under large inertia uncertainties.

  7. Determinantes da adesão ao tratamento anti-retroviral em Brasília, DF: um estudo de caso-controle Determinants of antiretroviral treatment adherence in Brasília, Federal District: a case-control study

    Directory of Open Access Journals (Sweden)

    Cláudio Viveiros de Carvalho

    2007-10-01

    Full Text Available Buscou-se avaliar os fatores relacionados à adesão ao tratamento anti-retroviral no Distrito Federal. De 150 pacientes entrevistados em sete centros de referência, 35 não aderentes foram definidos como casos, sendo selecionados 70 controles aderentes, pareados por idade. Avaliaram-se variáveis sócio-demográficas, hábitos, suporte social, qualidade de vida, questões relacionadas a doença, estado clínico, tratamento e serviço. Na análise bivariada, houve associação da adesão com raça/cor, escolaridade, centros de referência em que faz acompanhamento e renda familiar. Após ajuste, cor parda, centros de referência localizado no Plano Piloto, escolaridade alta e receber apoio dos amigos quanto às necessidades permaneceram associados com adesão. Retirando raça/cor do modelo, mantiveram-se centros de referência, escolaridade, profissão, renda, apoio (contar com alguém que demonstre gostar de você e satisfação com o atendimento na farmácia de dispensação. Além dos fatores já consolidados na literatura, questões relacionadas ao apoio no âmbito micro-social e aos serviços de assistência mostraram-se associados à observância terapêutica.We sought to evaluate factors relating to adherence to antiretroviral treatment in the Federal District. Out of 150 patients interviewed at seven reference centers; 35 non-adherent subjects were considered to be cases; we selected 70 age-matched adherent individuals as controls. Variables relating to sociodemographics, habits, social support, quality of life, disease-related issues, clinical conditions, treatment and healthcare services were evaluated. Bivariate analysis showed that adherence was associated with race/color, educational level, the reference center where the patient was followed up and familial income. After adjustments, mixed race (parda, reference center location in central Brasília, high educational level and friends’ support for needs remained associated with

  8. Passivity-based control of robotic manipulators for safe cooperation with humans

    Science.gov (United States)

    Zanchettin, Andrea Maria; Lacevic, Bakir; Rocco, Paolo

    2015-02-01

    This paper presents a novel approach to the control of articulated robots in unstructured environments. The proposed control ensures several properties. First, the controller guarantees the achievement of a goal position without getting stuck in local minima. Then, the controller makes the closed-loop system passive, which renders the approach attractive for applications where the robot needs to safely interact with humans. Finally, the control law is explicitly shaped by the safety measure - the danger field. The proposed control law has been implemented and validated in a realistic experimental scenario, demonstrating the effectiveness in driving the robot to a given configuration in a cluttered environment, without any offline planning phase. Furthermore, the passivity of the system enables the robot to easily accommodate external forces on the tool, when a physical contact between the robot and the environment is established.

  9. Adesão ao tratamento e controle da pressão arterial por meio da monitoração ambulatorial de 24 horas Blood pressure treatment adherence and control through 24-hour ambulatory monitoring

    Directory of Open Access Journals (Sweden)

    Guilherme Brasil Grezzana

    2013-04-01

    Full Text Available FUNDAMENTO: A hipertensão arterial sistêmica (HAS é um importante fator de risco cardiovascular, no entanto os níveis de controle pressórico persistem inadequados. A avaliação da adesão ao tratamento anti-hipertensivo com a utilização da monitoração ambulatorial da pressão arterial (MAPA de 24 horas pode representar um importante auxílio na busca de metas de controle da HAS. OBJETIVO: Avaliar a adesão ao tratamento anti-hipertensivo e a sua relação com os valores de PA obtidos pela MAPA de 24 horas entre pacientes hipertensos de centros de atenção primária à saúde (APS. MÉTODOS: Estudo transversal com 143 pacientes hipertensos de amostra representativa de serviço de APS do município de Antônio Prado, RS. Foi realizada aplicação do teste de Morisky e Green para avaliar a aderência ao tratamento e a verificação do número de medicamentos utilizados, seguida pela aplicação da MAPA de 24 horas. RESULTADOS: Observou-se que 65,7% da amostra foram considerados aderentes ao tratamento proposto, 20,3% eram moderadamente aderentes, enquanto somente 14% foram classificados como não aderentes. Do total de 143 pacientes avaliados, 79 (55,2% foram identificados como HAS controlada (130/80 mmHg, 103 (72% apresentaram ausência de descenso noturno da PA e 60 (41,9% não estavam controlados durante o período de vigília. CONCLUSÃO: Verificamos, no presente estudo, que não há um controle adequado da HAS, com consequente perda de oportunidade dos profissionais envolvidos na APS de ajuste adequado das metas de PA preconizados. Esse fato ocorre a despeito de apropriada adesão ao tratamento anti-hipertensivo dos pacientes vinculados ao ambulatório de APS.BACKGROUND: Although systemic arterial hypertension (SAH is an important cardiovascular risk factor, blood pressure level control often remains inadequate. Assessment of adherence to antihypertensive treatment through 24-hour ambulatory blood pressure monitoring (ABPM may

  10. Cooperation between Magnesium and Metabolite Controls Collapse of the SAM-I Riboswitch.

    Science.gov (United States)

    Roy, Susmita; Onuchic, José N; Sanbonmatsu, Karissa Y

    2017-07-25

    The S-adenosylmethionine (SAM)-I riboswitch is a noncoding RNA that regulates the transcription termination process in response to metabolite (SAM) binding. The aptamer portion of the riboswitch may adopt an open or closed state depending on the presence of metabolite. Although the transition between the open and closed states is critical for the switching process, its atomistic details are not well understood. Using atomistic simulations, we calculate the effect of SAM and magnesium ions on the folding free energy landscape of the SAM-I riboswitch. These molecular simulation results are consistent with our previous wetlab experiments and aid in interpreting the SHAPE probing measurements. Here, molecular dynamics simulations explicitly identify target RNA motifs sensitive to magnesium ions and SAM. In the simulations, we observe that, whereas the metabolite mostly stabilizes the P1 and P3 helices, magnesium serves an important role in stabilizing a pseudoknot interaction between the P2 and P4 helices, even at high metabolite concentrations. The pseudoknot stabilization by magnesium, in combination with P1 stabilization by SAM, explains the requirement of both SAM and magnesium to form the fully collapsed metabolite-bound closed state of the SAM-I riboswitch. In the absence of SAM, frequent open-to-closed conformational transitions of the pseudoknot occur, akin to breathing. These pseudoknot fluctuations disrupt the binding site by facilitating fluctuations in the 5'-end of helix P1. Magnesium biases the landscape toward a collapsed state (preorganization) by coordinating pseudoknot and 5'-P1 fluctuations. The cooperation between SAM and magnesium in stabilizing important tertiary interactions elucidates their functional significance in transcription regulation. Published by Elsevier Inc.

  11. Short- and long-term effects of real-time medication monitoring with short message service (SMS) reminders for missed doses on the refill adherence of people with Type 2 diabetes: evidence from a randomised controlled trial.

    NARCIS (Netherlands)

    Vervloet, M.; Dijk, L. van; Bakker, D.H. de; Souverein, P.C.; Santen-Reestman, J.; Vlijmen, B. van; Aarle, M.C.W. van; Hoek, L.S. van der; Bouvy, M.L.

    2014-01-01

    Aims: To investigate short- and long-term effects of real-time monitoring medication use combined with short message service (SMS) reminders for missed doses on refill adherence to oral anti-diabetic medication. Methods: A randomized controlled trial with two intervention groups and one control

  12. [Informational cooperation of the complex of software and hardware tools in automatization of state disease control management].

    Science.gov (United States)

    Akimkin, V G; Muzychenko, F V; Malinovskiĭ, A A; Moiseev, A N; Shvedov, D V

    2008-09-01

    Nowadays, taking into account new tasks, that should be resolved by the medical service, could be marked enlargement of informational cooperation at the expense of perspective program-technical solutions, put in the complex of program-technical means of automatization of administration of state disease control CPTMADC during it's creating. It's planed to elaborate an additional programmatic module for the purpose of using in CPTMADC the methodology of valuation of risk for resolving of tasks of socially-hygienic monitoring. Before it's elaborating, there was examined a capacity to conversion of patterns of weekly reports about the sanitarian condition of objects and it's following using for informational transporting using electronic means of connection of the complex CPTMADC by the way of including in patterns the data about the staff under the influence of adverse factor, and following rangering the objects by the level of risk for staff.

  13. Distributed Cooperative Control of Multiple Nonlinear Systems with Nonholonomic Constraints and Uncertainty

    Science.gov (United States)

    2015-04-04

    1689–1700, 1999. [107] F. W. Lewis, S. Jagannathan , and A. Yesildirak, Neural Network Control Of Robot Manipulators And Non-Linear Systems. Taylor...in IEEE Conf Deci Contr, 2010, pp. 4492–4497. [130] T. Dierks and S. Jagannathan , “Control of nonholonomic mobile robot formations: Backstepping

  14. A randomized controlled trial of interventions to enhance patient-physician partnership, patient adherence and high blood pressure control among ethnic minorities and poor persons: study protocol NCT00123045

    Directory of Open Access Journals (Sweden)

    Larson Susan M

    2009-02-01

    Full Text Available Abstract Background Disparities in health and healthcare are extensively documented across clinical conditions, settings, and dimensions of healthcare quality. In particular, studies show that ethnic minorities and persons with low socioeconomic status receive poorer quality of interpersonal or patient-centered care than whites and persons with higher socioeconomic status. Strong evidence links patient-centered care to improvements in patient adherence and health outcomes; therefore, interventions that enhance this dimension of care are promising strategies to improve adherence and overcome disparities in outcomes for ethnic minorities and poor persons. Objective This paper describes the design of the Patient-Physician Partnership (Triple P Study. The goal of the study is to compare the relative effectiveness of the patient and physician intensive interventions, separately, and in combination with one another, with the effectiveness of minimal interventions. The main hypothesis is that patients in the intensive intervention groups will have better adherence to appointments, medication, and lifestyle recommendations at three and twelve months than patients in minimal intervention groups. The study also examines other process and outcome measures, including patient-physician communication behaviors, patient ratings of care, health service utilization, and blood pressure control. Methods A total of 50 primary care physicians and 279 of their ethnic minority or poor patients with hypertension were recruited into a randomized controlled trial with a two by two factorial design. The study used a patient-centered, culturally tailored, education and activation intervention for patients with active follow-up delivered by a community health worker in the clinic. It also included a computerized, self-study communication skills training program for physicians, delivered via an interactive CD-ROM, with tailored feedback to address their individual

  15. Results of a randomized controlled trial to assess the effects of a mobile SMS-based intervention on treatment adherence in HIV/AIDS-infected Brazilian women and impressions and satisfaction with respect to incoming messages.

    Science.gov (United States)

    da Costa, Thiago Martini; Barbosa, Bárbara Jaqueline Peres; Gomes e Costa, Durval Alex; Sigulem, Daniel; de Fátima Marin, Heimar; Filho, Adauto Castelo; Pisa, Ivan Torres

    2012-04-01

    To assess whether a warning system based on mobile SMS messages increases the adherence of HIV-infected Brazilian women to antiretroviral drug-based treatment regimens and their impressions and satisfaction with respect to incoming messages. A randomized controlled trial was conducted from May 2009 to April 2010 with HIV-infected Brazilian women. All participants (n=21) had a monthly multidisciplinary attendance; each participant was followed over a 4-month period, when adherence measures were obtained. Participants in the intervention group (n=8) received SMS messages 30 min before their last scheduled time for a dose of medicine during the day. The messages were sent every Saturday and Sunday and on alternate days during the working week. Participants in the control group (n=13) did not receive messages. Self-reported adherence, pill counting, microelectronic monitors (MEMS) and an interview about the impressions and satisfaction with respect to incoming messages. The HIV Alert System (HIVAS) was developed over 7 months during 2008 and 2009. After the study period, self-reported adherence indicated that 11 participants (84.62%) remained compliant in the control group (adherence exceeding 95%), whereas all 8 participants in the intervention group (100.00%) remained compliant. In contrast, the counting pills method indicated that the number of compliant participants was 5 (38.46%) for the control group and 4 (50.00%) for the intervention group. Microelectronic monitoring indicated that 6 participants in the control group (46.15%) were adherent during the entire 4-month period compared to 6 participants in the intervention group (75.00%). According to the feedback of the 8 participants who completed the research in the intervention group, along with the feedback of 3 patients who received SMS for less than 4 months, that is, did not complete the study, 9 (81.81%) believed that the SMS messages aided them in treatment adherence, and 10 (90.90%) responded that they

  16. Development and Evaluation of Bus Operation Control System Based on Cooperative Speed Guidance

    Directory of Open Access Journals (Sweden)

    Jing Teng

    2015-01-01

    Full Text Available Buses often have strong bunching or large interval tendency when traveling further along the route. To restrain this further deterioration of operation service, this paper developed a bus operation control system to dynamically adjust bus speed, bus dwell time, and traffic signal timings along the running path. In addition, a simulation platform was developed to evaluate the proposed control system with the actual data collected from bus route number 210 in Shanghai. The simulation results show that the proposed control system can mitigate the amplification trend of the headway deviation along the route to produce headways within a given tolerance.

  17. The governance of cooperative societies

    Directory of Open Access Journals (Sweden)

    Yaiza Juanes Sobradillo

    2005-12-01

    Full Text Available The present work aims to expose the appropriate legislation for cooperative societies to which Article 129 of the Spanish Constitution refers, deepen the analysis of the organs of management and control based on the Spanish and Basque Laws on Cooperatives and the Statute for the European Cooperative Societies.

  18. Antihypertensive Medications Adherence Among Nigerian ...

    African Journals Online (AJOL)

    way to reduce the morbidity and mortality associated with hypertension.[1,2] Hypertension is the most common cardiovascular risk factor in Nigeria.[3] A large percentage of hypertensive subjects have poor blood pressure control due to many reasons.[2-4] One major reason is due to poor medication adherence. Treatment ...

  19. Cooperative Energy Management of Hybrid DC Renewable Grid Using Decentralized Control Strategies

    Directory of Open Access Journals (Sweden)

    Mehrdad Beykverdi

    2016-10-01

    Full Text Available This paper attempted to control a hybrid DC microgrid in islanded operation mode using decentralized power management strategies. Proposed adaptive I/V characteristic for hybrid photovoltaic (PV and battery energy storage system (BESS and wind turbine generator (WTG adapts the distributed energy resources (DER behavior independently in accordance with the load demand. Hence, the PV module can spend its maximum power on load demand and spend the extra power for charging the BESS, which will regulate DC bus voltage and maintain the power balance within the microgrid. When load demand is beyond the maximum generation power of PV unit, WTG will supply the energy shortage. The proposed control system was applied on the DC microgrid in order to achieve control objectives through a decentralized procedure, without telecommunication links. In order to validate the proposed strategies, the control system was implemented on a DC microgrid within MATLAB/SIMULINK, where the simulation results were analyzed and validated.

  20. Consensus-Based Cooperative Control Based on Pollution Sensing and Traffic Information for Urban Traffic Networks

    National Research Council Canada - National Science Library

    Antonio Artuñedo; Raúl M del Toro; Rodolfo E Haber

    2017-01-01

    .... The interconnected traffic lights controller (TLC) network adapts traffic lights cycles, based on traffic and air pollution sensory information, in order to improve the performance of urban traffic networks...

  1. Cooperative Control of Unmanned Surface Vessels and Unmanned Underwater Vessels for Asset Protection

    Science.gov (United States)

    2015-05-18

    this vector and will be elaborated in Chapter 5.3. 5.3 Artificial Potential Field Theory Artificial potential field ( APF ) techniques draw from...vector generated from APF theory as mentioned Chapter 5.3. In Figure 7.6, capability desired was achieved in the relatively same time frame as the...controllers were defined separately for the USVs and the UUVs. However, included in the secondary control was an avoidance behavior based on APF for

  2. FY1995 distributed control of man-machine cooperative multi agent systems; 1995 nendo ningen kyochogata multi agent kikai system no jiritsu seigyo

    Energy Technology Data Exchange (ETDEWEB)

    NONE

    1997-03-01

    In the near future, distributed autonomous systems will be practical in many situations, e.g., interactive production systems, hazardous environments, nursing homes, and individual houses. The agents which consist of the distributed system must not give damages to human being and should be working economically. In this project man-machine cooperative multi agent systems are studied in many kind of respects, and basic design technology, basic control technique are developed by establishing fundamental theories and by constructing experimental systems. In this project theoretical and experimental studies are conducted in the following sub-projects: (1) Distributed cooperative control in multi agent type actuation systems (2) Control of non-holonomic systems (3) Man-machine Cooperative systems (4) Robot systems learning human skills (5) Robust force control of constrained systems In each sub-project cooperative nature between machine agent systems and human being, interference between artificial multi agents and environment and new function emergence in coordination of the multi agents and the environment, robust force control against for the environments, control methods for non-holonomic systems, robot systems which can mimic and learn human skills were studied. In each sub-project, some problems were hi-lighted and solutions for the problems have been given based on construction of experimental systems. (NEDO)

  3. Patient's adherence in asthma.

    Science.gov (United States)

    Gillisen, Adrian

    2007-11-01

    Nonadherence in asthma treatment results in increasing mortality, morbidity, and it is associated with increasing treatment costs. In asthma, adherence rates are often below 50%. Understanding of the needs and behaviors of asthma patients as well as treatment barriers to comply with asthma guidelines is important in developing programs to promote adherence. This article presents information on common types of nonadherence in asthma patients, the causes, and it reviews the literature on interventions to overcome these factors to maximize adherence rates. Although several interventions are effective in improving medication adherence in asthma, only few significantly enhance adherence rates and clinical outcomes of these patients. An improvement in treatment adherence is a complex task, requiring asthma self-management, education programs coupled with educational reinforcements, simplifying treatment planes and applications forms. Good communications skills among clinicians and patient education are also central for improving adherence. Methods to overcoming physician barriers ensure consistency in implementing guideline recommendations in practice.

  4. Motivation and Treatment Credibility Predicts Dropout, Treatment Adherence, and Clinical Outcomes in an Internet-Based Cognitive Behavioral Relaxation Program: A Randomized Controlled Trial

    National Research Council Canada - National Science Library

    Alfonsson, Sven; Olsson, Erik; Hursti, Timo

    2016-01-01

    In previous research, variables such as age, education, treatment credibility, and therapeutic alliance have shown to affect patients' treatment adherence and outcome in Internet-based psychotherapy...

  5. Sensitivity-controllable refractive index sensor based on reflective θ-shaped microfiber resonator cooperated with Vernier effect.

    Science.gov (United States)

    Xu, Zhilin; Luo, Yiyang; Liu, Deming; Shum, Perry Ping; Sun, Qizhen

    2017-08-29

    In this paper, we report a sensitivity-controllable refractive index (RI) sensor based on a reflective θ-shaped microfiber resonator cooperated with Vernier effect. The θ-shaped microfiber resonator is a reflective all-fiber device with comb spectrum under weak coupling condition. By cascading it with a fiber Fabry-Perot interferometer, Vernier effect is generated to demodulate surrounding RI with enhanced sensitivity. Theoretical analysis reveals that RI sensitivity of the combined structure with Vernier effect is m times higher than the sensitivity of singular θ-shaped microfiber resonator. Moreover, by adjusting cavity length of the θ-shaped microfiber resonator, magnification factor M = (m + 1) can be tuned which enables the RI sensitivity to be controlled. Experimental result demonstrates that the RI sensitivity can be widely tuned from 311.77 nm/RIU (Reflective index unit) to 2460.07 nm/RIU when the cavity length of the θ-shaped microfiber resonator is adjusted from 9.4 mm to 8.7 mm. The θ-shaped microfiber resonator based all-fiber RI sensor featuring controllable sensitivity and compact size can be widely used for chemical and biological detections. The proposed scheme of generating Vernier effect also offers a universal idea to increase measurement sensitivity for optical fiber sensing structures with comb spectrum.

  6. Development of Autonomous Optimal Cooperative Control in Relay Rover Configured Small Unmanned Aerial Systems

    Science.gov (United States)

    2013-03-01

    zero for a plane as it would result in the plane losing control in turns. For a plane please use the default value of 1.0. AHRS_GPS_USE 1...attitude AHRS_WIND_M AX 0 0 127 This sets the maximum allowable difference between ground speed and airspeed. This allows the plane to cope with a...compensate for the loss of lift due to roll control. 0 = 0 %, 1 = 100% KFF_RDDRMIX 0.5 0 1 The amount of rudder mix to apply during aileron movement 0 = 0

  7. Tailored message interventions versus typical messages for increasing participation in colorectal cancer screening among a non-adherent population: A randomized controlled trial.

    Science.gov (United States)

    Hirai, Kei; Ishikawa, Yoshiki; Fukuyoshi, Jun; Yonekura, Akio; Harada, Kazuhiro; Shibuya, Daisuke; Yamamoto, Seiichiro; Mizota, Yuri; Hamashima, Chisato; Saito, Hiroshi

    2016-05-24

    The purpose of this study was to examine the effectiveness and cost-efficiency of a tailored message intervention compared with a non-tailored message intervention for increasing colorectal cancer (CRC) screening rates among a non-adherent population, in a community-based client reminder program. After a baseline survey for psychological segmentation, 2140 eligible individuals were randomly assigned either to a group with a tailored matched-message condition (N = 356), a group with a non-tailored unmatched-message condition (N = 355), or to two control groups, one using a typical message with a professional design (N = 717) and one without a professional design (N = 712). The main outcome measure was attendance rates in a community-organized CRC screening program within five months of receiving a print reminder. There was a significant difference in fecal occult blood test (FOBT) attendance rates at follow-up assessments between the tailored matched-message condition (14.0 %) and the control (9.9 %; OR = 1.48, p = 0.026), while there was no significant difference between the unmatched-message condition (11.0 %) and the control (OR = 1.12, p = 0.558), and between the matched-message condition and the unmatched-message condition (OR = 1.32, p = 0.219). The cost of a one-person increase in FOBT screening was 3,740 JPY for the tailored matched-message condition, while it was 2,747 JPY for the control. A tailored-message intervention for segmented individuals designed to increase CRC screening rates in a community-based client reminder program was significantly effective compared to a usual reminder, but not more effective than an unmatched message in a randomized controlled trial, and was not sufficiently effective to highlight its value from a cost perspective. Therefore, the tailored intervention including target segmentation needs to be improved for future implementation in a CRC screening program for a non-adherent

  8. Medication-related issues associated with adherence to long-term tyrosine kinase inhibitors for controlling chronic myeloid leukemia: a qualitative study

    Directory of Open Access Journals (Sweden)

    Tan BK

    2017-06-01

    Full Text Available Bee Kim Tan,1,2 Seng Beng Tan,3 Li-Chia Chen,4 Kian Meng Chang,5 Siew Siang Chua,1,6 Sharmini Balashanker,7 Habiba Nazeera Begum Kamarul Jaman,5 Syed Carlo Edmund,8 Ping Chong Bee3 1Department of Pharmacy, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia; 2Department of Clinical Pharmacy, Faculty of Pharmaceutical Sciences, UCSI University, Kuala Lumpur, Malaysia; 3Department of Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia; 4Division of Pharmacy and Optometry, School of Health Sciences, University of Manchester, Manchester, UK; 5Department of Hematology, Ampang Hospital, Ampang, Selangor, Malaysia; 6School of Pharmacy, Faculty of Health and Medical Sciences, Taylor’s University, Lakeside Campus, Subang, Selangor, Malaysia; 7School of Pharmacy, University of Nottingham Malaysia Campus, Semenyih, Selangor, Malaysia; 8Clinical Research Center, Ampang Hospital, Ampang, Selangor, Malaysia Purpose: Poor adherence to tyrosine kinase inhibitors (TKIs could compromise the control of chronic myeloid leukemia (CML and contributes to poorer survival. Little is known about how medication-related issues affect CML patients’ adherence to TKI therapy in Malaysia. This qualitative study aimed to explore these issues.Patients and methods: Individual face-to-face, semistructured interviews were conducted at the hematology outpatient clinics of two medical centers in Malaysia from August 2015 to January 2016. CML patients aged ≥18 years who were prescribed a TKI were invited to participate in the study. Interviews were audio-recorded, transcribed verbatim, and thematically analyzed.Results: Four themes were identified from 18 interviews: 1 concerns about adverse reactions to TKIs, 2 personal beliefs regarding the use of TKIs, 3 mismanagement of TKIs in daily lives, and 4 financial burden in accessing treatment. Participants skipped their TKIs due to ineffective emesis control measures and perceived wastage of

  9. Arms Control and Missile Defense: Explaining Success and Failure in U.S.-Russian Cooperation

    Science.gov (United States)

    2013-09-01

    Tsypkin Thesis Co-Advisor: Michael Glosny THIS PAGE INTENTIONALLY LEFT BLANK i REPORT DOCUMENTATION PAGE Form Approved OMB No. 0704-0188 Public...the socialization received during their time as KGB or FSB officers. 14. SUBJECT TERMS Russia, United States, BMD, Arms Control...as KGB or FSB officers. vi THIS PAGE INTENTIONALLY LEFT BLANK vii TABLE OF CONTENTS I. INTRODUCTION

  10. Locus of control and learning to cooperate in a prisoner's dilemma game

    NARCIS (Netherlands)

    Boone, C; De Brabander, B; Carree, M; de Jong, G; van Olffen, W; van Witteloostuijn, A

    2002-01-01

    Boone et al. (Boone, C., De Brabander, B., & van Witteloostuijn, A. (1999a). Locus of control and strategic behaviour in a prisoner's dilemma game. Personality and Individual Differences. 27, 695-706; Boone, C., De Brabander, B., & van Witteloostuijn, A. (1999b). The impact of personality on

  11. Cooperative Intelligence for Remotely Piloted Vehicle Fleet Control. Analysis and Simulation

    Science.gov (United States)

    1986-10-01

    Packet Radio Technology," Proceedings of the IEEE, Vol. 66, No. 11, November 1978, pp. 1468-1496. Kiviat, P., R. Villanueva , and H. Markowitz, The... Cesar , and S. Turner, TWIRL: Tactical Warfare in the ROSS Language, The Rand Corporation, R-3158-AF, October 1984. Klass, P., "Multi-Drone Control Unit in

  12. Cellular Controlled Short-Range Communication for Cooperative P2P Networking

    DEFF Research Database (Denmark)

    Fitzek, Frank H. P.; Katz, Marcos; Zhang, Qi

    2009-01-01

    This article advocates a novel communication architecture and associated collaborative framework for future wireless communication systems. In contrast to the dominating cellular architecture and the upcoming peer-to-peer architecture, the new approach envisions a cellular controlled short-range ...

  13. Randomized controlled trial of a pictorial aid intervention for medication adherence among HIV-positive patients with comorbid diabetes or hypertension.

    Science.gov (United States)

    Monroe, A K; Pena, J S; Moore, R D; Riekert, K A; Eakin, M N; Kripalani, S; Chander, G

    2018-02-01

    As the HIV-infected population ages and the burden of chronic comorbidities increases, adherence to medications for HIV and diabetes and hypertension is crucial to improve outcomes. We pilot-tested a pictorial aid intervention to improve medication adherence for both HIV and common chronic conditions. Adult patients with HIV and diabetes (DM) and/or hypertension (HTN) attending a clinic for underserved patients and at risk for poor health outcomes were enrolled. Patients were randomized to receive either a pictorial aid intervention (a photographic representation of their medications, the indications, and the dosing schedule) or a standard clinic visit discharge medication list. Adherence to antiretroviral therapy (ART) for HIV and therapy for DM or HTN was compared. Predictors of ART adherence at baseline were determined using logistic regression. Medication adherence was assessed using medication possession ratio (MPR) for the 6-month interval before and after the intervention. Change in adherence by treatment group was compared by ANOVA. Among the 46 participants, there was a trend towards higher adherence to medications for HIV compared with medications for hypertension/diabetes (baseline median MPR for ART 0.92; baseline median MPR for the medication for the comorbid condition 0.79, p = 0.07). The intervention was feasible to implement and satisfaction with the intervention was high. With a small sample size, the intervention did not demonstrate significant improvement in adherence to medications for HIV or comorbid conditions. Patients with HIV are often medically complex and may have multiple barriers to medication adherence. Medication adherence is a multifaceted process and adherence promotion interventions require an approach that targets patient-specific barriers.

  14. Educational video to improve CPAP use in patients with obstructive sleep apnoea at risk for poor adherence: a randomised controlled trial.

    Science.gov (United States)

    Guralnick, Amy S; Balachandran, Jay S; Szutenbach, Shane; Adley, Kevin; Emami, Leila; Mohammadi, Meelad; Farnan, Jeanne M; Arora, Vineet M; Mokhlesi, Babak

    2017-12-01

    Suboptimal adherence to CPAP limits its clinical effectiveness in patients with obstructive sleep apnoea (OSA). Although rigorous behavioural interventions improve CPAP adherence, their labour-intensive nature has limited widespread implementation. Moreover, these interventions have not been tested in patients at risk of poor CPAP adherence. Our objective was to determine whether an educational video will improve CPAP adherence in patients at risk of poor CPAP adherence. Patients referred by clinicians without sleep medicine expertise to an urban sleep laboratory that serves predominantly minority population were randomised to view an educational video about OSA and CPAP therapy before the polysomnogram, or to usual care. The primary outcome was CPAP adherence during the first 30 days of therapy. Secondary outcomes were show rates to sleep clinic (attended appointment) and 30-day CPAP adherence after the sleep clinic visit date. A total of 212 patients met the eligibility criteria and were randomised to video education (n=99) or to usual care (n=113). There were no differences in CPAP adherence at 30 days (3.3, 95% CI 2.8 to 3.8 hours/day video education; vs 3.5, 95% CI 3.1 to 4.0 hours/day usual care; p=0.44) or during the 30 days after sleep clinic visit. Sleep clinic show rate was 54% in the video education group and 59% in the usual care group (p=0.41). CPAP adherence, however, significantly worsened in patients who did not show up to the sleep clinic. In patients at risk for poor CPAP adherence, an educational video did not improve CPAP adherence or show rates to sleep clinic compared with usual care. ClinicalTrials.gov Identifier: NCT02553694. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2017. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

  15. Adherence to Diabetes Medication in Individuals with Schizophrenia: A Systematic Review of Rates and Determinants of Adherence.

    Science.gov (United States)

    Gorczynski, Paul; Patel, Hiren; Ganguli, Rohan

    2017-01-01

    Despite the importance of medication adherence for the effective treatment of type II diabetes mellitus (T2DM), little research has examined adherence with diabetes medication treatment in schizophrenia. The purpose of this systematic review was to: 1) evaluate rates of adherence and determinants of adherence with medication for T2DM in individuals with schizophrenia; and, where possible, 2) examine the relationship between medication adherence and glycemic control. Studies were included if they presented information on dosing regimens and adherence or compliance rates for T2DM and included samples where at least 50% of the participants were individuals with schizophrenia. Six studies were included in this review that predominantly examined men over the age of 50 years. Studies confirmed that many individuals with schizophrenia were not adhering to their diabetes medication as adherence rates ranged from 51-85%. Two studies that compared medication adherence in individuals with and without schizophrenia found those with the mental illness had higher rates of adherence. One study reported that blood glucose control levels were not statistically different between those who did and did not adhere to their medication, indicating more research is necessary in this area. Factors that improved adherence included disease and medical service and medication-related factors. Interventions to increase diabetes medication adherence in schizophrenia need to address disease and medical service and medication-related factors. Further research needs to examine diabetes medication adherence in women, younger individuals, and those recently diagnosed with diabetes as these individuals have been underrepresented in the literature.

  16. Adherence to antidepressants

    Directory of Open Access Journals (Sweden)

    Abimbola Farinde

    2013-01-01

    Full Text Available While major depression is considered a frequent mental illness there are ongoing reports of high non-adherence to antidepressant medications which places suffers at high risk for relapse, recurrence, or greater impairment,. The World Health Organization (WHO defines adherence as the extent to which a person′s behavior (e.g. taking medications can align with the agreed recommendations of a health care provider. Unfortunately while patient may recognize the importance of adherence to antidepressant medications the majority of patients do not adhere to their prescribed antidepressants. Some of the factors that may contribute to or lead to non-adherence include knowingly or unknowingly missing doses, taking extra doses, delaying administration times, or taking drug holidays. Pharmacists have the unique ability to deter non-adherence through the performance of continuous assessment and monitoring of adherence in this population given these accessibility. Additionally, pharmacists are able to develop therapeutic alliances with patients that can help to increase the likelihood of achieving positive patient outcomes. Antidepressant non-adherence can be viewed as a significant public health concern so it is important for patients to be educated about the importance of adherence, and health care professionals should be aware of factors or patient characteristics that can serve as barriers to non-adherence.

  17. Implementing Cooperative Behavior & Control Using Open Source Technology Across Heterogeneous Vehicles

    Science.gov (United States)

    2015-03-26

    Degree of Master of Science in Systems Engineering Stefan L. Hardy, BS 1st Lieutenant, USAF March 2015 DISTRIBUTION STATEMENT A. APPROVED...usability, adequacy, autonomy, and reliability. Usability is associated with efficiency, memorability , errors, and user satisfaction [19]. Adequacy is...order. LiveView for GoPro: Select this option to stream live video from a GoPro HERO onto a wireless monitor attached to your X8+ controller. This

  18. Evolution of cooperation and control of cheating in a social microbe

    Science.gov (United States)

    Strassmann, Joan E.; Queller, David C.

    2011-01-01

    Much of what we know about the evolution of altruism comes from animals. Here, we show that studying a microbe has yielded unique insights, particularly in understanding how social cheaters are controlled. The social stage of Dictylostelium discoideum occurs when the amoebae run out of their bacterial prey and aggregate into a multicellular, motile slug. This slug forms a fruiting body in which about a fifth of cells die to form a stalk that supports the remaining cells as they form hardy dispersal-ready spores. Because this social stage forms from aggregation, it is analogous to a social group, or a chimeric multicellular organism, and is vulnerable to internal conflict. Advances in cell labeling, microscopy, single-gene knockouts, and genomics, as well as the results of decades of study of D. discoideum as a model for development, allow us to explore the genetic basis of social contests and control of cheaters in unprecedented detail. Cheaters are limited from exploiting other clones by high relatedness, kin discrimination, pleiotropy, noble resistance, and lottery-like role assignment. The active nature of these limits is reflected in the elevated rates of change in social genes compared with nonsocial genes. Despite control of cheaters, some conflict is still expressed in chimeras, with slower movement of slugs, slightly decreased investment in stalk compared with spore cells, and differential contributions to stalk and spores. D. discoideum is rapidly becoming a model system of choice for molecular studies of social evolution. PMID:21690338

  19. Standard care quality determines treatment outcomes in control groups of HAART-adherence intervention studies: implications for the interpretation and comparison of intervention effects.

    Science.gov (United States)

    de Bruin, Marijn; Viechtbauer, Wolfgang; Hospers, Harm J; Schaalma, Herman P; Kok, Gerjo

    2009-11-01

    Clinical trials of behavioral interventions seek to enhance evidence-based health care. However, in case the quality of standard care provided to control conditions varies between studies and affects outcomes, intervention effects cannot be directly interpreted or compared. The objective of the present study was to examine whether standard care quality (SCQ) could be reliably assessed, varies between studies of highly active antiretroviral HIV-adherence interventions, and is related to the proportion of patients achieving an undetectable viral load ("success rate"). Databases were searched for relevant articles. Authors of selected studies retrospectively completed a checklist with standard care activities, which were coded to compute SCQ scores. The relationship between SCQ and the success rates was examined using meta-regression. Cronbach's alpha, variability in SCQ, and relation between SCQ and success rate. Reliability of the SCQ instrument was high (Cronbach's alpha = .91). SCQ scores ranged from 3.7 to 27.8 (total range = 0-30) and were highly predictive of success rate (p = .002). Variation in SCQ provided to control groups may substantially influence effect sizes of behavior change interventions. Future trials should therefore assess and report SCQ, and meta-analyses should control for variability in SCQ, thereby producing more accurate estimates of the effectiveness of behavior change interventions. PsycINFO Database Record (c) 2009 APA, all rights reserved.

  20. THE EFFECT OF TELE-MONITORING ON EXERCISE TRAINING ADHERENCE, FUNCTIONAL CAPACITY, QUALITY OF LIFE AND GLYCEMIC CONTROL IN PATIENTS WITH TYPE II DIABETES

    Directory of Open Access Journals (Sweden)

    Tracy Marios

    2012-03-01

    Full Text Available We used tele-monitoring to attempt to improve exercise adherence (number of hours of exercise completed, peak VO2, HbA1c% and quality of life in an unsupervised, home based exercise program in people with type II diabetes, a cost analysis was also conducted. Thirty-nine patients with type II diabetes were randomized to tele-monitoring (TELE or control (CON groups. All patients were asked to complete 6 months exercise training and complete an exercise activity diary. The TELE group was instructed to record their exercise heart rates using a monitor and received weekly telephone calls from an exercise physiologist. Six TELE patients and seven CON patients did not complete the 6 month testing. TELE patients completed a mean weekly volume of 138 minutes, moderate intensity exercise, while CON patients completed 58 minutes weekly (p < 0.02. Neither group achieved the American Heart Association statement guideline for weekly exercise volume of 150 minutes. TELE patients improved peak VO2 (5.5 %, but neither group improved HbA1c% or quality of life. The CON group showed a 4.9% reduction in peak VO2. While tele-monitored patients completed more hours of exercise and demonstrated improved peak VO2 compared to controls, the exercise volume completed was insufficient to improve glycemic control. There is the potential via tele-monitoring to enable people with diabetes to meet exercise training guidelines.

  1. Cognitive Behavioral Therapy for Adherence and Depression (CBT-AD) in HIV-Infected Injection Drug Users: A Randomized Controlled Trial

    Science.gov (United States)

    Safren, Steven A.; O'Cleirigh, Conall M.; Bullis, Jacqueline R.; Otto, Michael W.; Stein, Michael D.; Pollack, Mark H.

    2012-01-01

    Objective: Depression and substance use, the most common comorbidities with HIV, are both associated with poor treatment adherence. Injection drug users comprise a substantial portion of individuals with HIV in the United States and globally. The present study tested cognitive behavioral therapy for adherence and depression (CBT-AD) in patients…

  2. Analyzing effects of providing performance feedback at ward rounds on guideline adherence - The importance of feedback usage analysis and statistical control charts

    NARCIS (Netherlands)

    Abu-Hanna, Ameen; Eslami, Saeid; Schultz, Marcus J.; de Jonge, Evert; de Keizer, Nicolette F.

    2010-01-01

    Objective: Feedback to clinicians on their past performance is often aimed at increasing adherence to guidelines. We investigate how various analytical approaches influence the interpretation of adherence data. The analytical approaches vary in considering the actual or the intended use of the

  3. Web-based computer-tailoring for practice nurses aimed to improve smoking cessation guideline adherence: A study protocol for a randomized controlled effectiveness trial

    NARCIS (Netherlands)

    de Ruijter, D.; Smit, E. S.; de Vries, H.; Hoving, C.

    Background Dutch practice nurses sub-optimally adhere to evidence-based smoking cessation guidelines. Web-based computer-tailoring could be effective in improving their guideline adherence. Therefore, this paper aims to describe the development of a web-based computer-tailored program and the design

  4. Retinal Expression of the Drosophila eyes absent Gene Is Controlled by Several Cooperatively Acting Cis-regulatory Elements.

    Directory of Open Access Journals (Sweden)

    Bonnie M Weasner

    2016-12-01

    Full Text Available The eyes absent (eya gene of the fruit fly, Drosophila melanogaster, is a member of an evolutionarily conserved gene regulatory network that controls eye formation in all seeing animals. The loss of eya leads to the complete elimination of the compound eye while forced expression of eya in non-retinal tissues is sufficient to induce ectopic eye formation. Within the developing retina eya is expressed in a dynamic pattern and is involved in tissue specification/determination, cell proliferation, apoptosis, and cell fate choice. In this report we explore the mechanisms by which eya expression is spatially and temporally governed in the developing eye. We demonstrate that multiple cis-regulatory elements function cooperatively to control eya transcription and that spacing between a pair of enhancer elements is important for maintaining correct gene expression. Lastly, we show that the loss of eya expression in sine oculis (so mutants is the result of massive cell death and a progressive homeotic transformation of retinal progenitor cells into head epidermis.

  5. Self-organized control in cooperative robots using a pattern formation principle

    DEFF Research Database (Denmark)

    Starke, Jens; Ellsaesser, Carmen; Fukuda, Toshio

    2011-01-01

    Self-organized modular approaches proved in nature to be robust and optimal and are a promising strategy to control future concepts of flexible and modular manufacturing processes. We show how this can be applied to a model of flexible manufacturing based on time-dependent robot-target assignment...... problems where robot teams have to serve manufacturing targets such that an objective function is optimized. Feasibility of the self-organized solutions can be guaranteed even for unpredictable situations like sudden changes in the demands or breakdowns of robots. As example an uncrewed space mission...

  6. Peer Physical Aggression and Its Association with Aggressive Beliefs, Empathy, Self-Control, and Cooperation Skills among Students in a Rural Town of China

    Science.gov (United States)

    Wang, Fu Man; Chen, Jing Qi; Xiao, Wan Qing; Ma, Ya Ting; Zhang, Man

    2012-01-01

    This study explored the prevalence of peer physical aggression (PPA) and its association with aggressive beliefs, empathy, self-control, and cooperation skills among 1,719 7th-to-9th-grade students in a rural town in the central China province of Henan. The data were collected by the self-administered questionnaire anonymously. Results showed that…

  7. Salivary gland carcinoma : Independent prognostic factors for locoregional control, distant metastases, and overall survival: Results of the Dutch Head and Neck Oncology Cooperative Group

    NARCIS (Netherlands)

    Terhaard, CHJ; Lubsen, H; Van der Tweel, [No Value; Hilgers, FJM; Eijkenboom, WMH; Marres, HAM; Tjho-Heslinga, RE; de Jong, JMA; Roodenburg, JLN

    Background. We analyzed the records of patients with malignant salivary gland tumors, as diagnosed in centers of the Dutch Head and Neck Oncology Cooperative Group, in search of independent prognostic factors for locoregional control, distant metastases, and overall survival. Methods. In 565

  8. Successful Industry/Academia Cooperation

    DEFF Research Database (Denmark)

    Stoustrup, Jakob

    2013-01-01

    The control literature is rich on impressive applications of advanced control, and within almost any industrial sector there are numerous examples of successful advanced control applications. Nevertheless, there is a widespread belief that there is still a wide potential for increased cooperation...... between academia and industry within this area. In this position paper, it is advocated that one of the enablers for successful cooperation between industry and academia within the control area is a proper framework for cooperation projects between companies and universities. Some suggestions...... by less complex but industrially feasible solutions. The proposed approach is illustrated by three case studies of successful industrial/academic cooperation....

  9. Using cooperative control to manage uncertainties for Aquifer Thermal Energy Storage (ATES)

    Science.gov (United States)

    Jaxa-Rozen, Marc; Rostampour, Vahab; Kwakkel, Jan; Bloemendal, Martin

    2017-04-01

    Aquifer Thermal Energy Storage (ATES) technology can lead to major reductions in energy demand for heating and cooling in buildings. ATES systems rely on shallow aquifers to seasonally store thermal energy and have become popular in the Netherlands, where a combination of easily accessible aquifers and strict energy regulations makes the technology especially relevant. However, this rapid adoption has made their management in dense urban areas more challenging. For instance, thermal interferences between neighboring systems can degrade storage efficiency. Policies for the permitting and spatial layout of ATES thus tend to be conservative to ensure the performance of individual systems, but this limits the space available for new systems - leading to a trade-off between individual system performance, and the overall energy savings obtained from ATES in a given area. Furthermore, recent studies show that operational uncertainties contribute to poor outcomes under current planning practices; systems in the Netherlands typically use less than half of their permitted water volume. This further reduces energy savings compared to expectations and also leads to an over-allocation of subsurface space. In this context, this work investigates the potential of a more flexible approach for ATES planning and operation, under which neighboring systems coordinate their operation. This is illustrated with a three-building idealized case, using a model predictive control approach for two control schemes: a decoupled formulation, and a centralized scheme that aims to avoid interferences between neighboring systems (assuming perfect information exchange). These control schemes are compared across a range of scenarios for spatial layout, building energy demand, and climate, using a coupled agent-based/geohydrological simulation. The simulation indicates that centralized operation could significantly improve the spatial layout efficiency of ATES systems, by allowing systems to be placed

  10. Fuzzy logic controller for cooperative mobile robotics implemented in leader-follower formation approach

    Directory of Open Access Journals (Sweden)

    Manuel Alejandro Molina-Villa

    2015-01-01

    Full Text Available Este artículo presenta el diseño de un controlador de lógica difusa implementandoel método líder-seguidor para un sistema de robótica cooperativa móvil, que permita a ungrupo de robots establecer y mantener una formación geométrica especifi ca mientras sedesplazan siguiendo una trayectoria de referencia. Como resultado de la investigación, seprobó mediante simulación un sistema de control cooperativo, que permite a un grupo derobots mantener una formación específi ca mientras desarrollan una misión determinada.Este controlador permite evadir obstáculos cambiando la formación o cambiando el líder delgrupo en cualquier momento.

  11. Maternal Fetal Attachment, Locus of Control and Adherence to STI/HIV Prevention and Prenatal Care Promotion Behaviors in Urban Women.

    Science.gov (United States)

    Kornfield, Sara L; Geller, Pamela A; Epperson, C Neill

    Young women of childbearing age are disproportionately affected by sexually transmitted infections (STIs) including HIV. In particular, young women have more frequent and more serious health problems from STI or HIV infection than men, and among women, African American women have especially high rates of infection. Pregnancy is an important time for beginning or continued STI and HIV prevention behaviors as discontinuing condom use when the contraceptive motivation is gone puts women and their fetuses at risk for contraction of STIs and HIV if they remain sexually active. There are many personal attributes that predict adherence to STI risk reduction behaviors including health related locus of control. The current study surveyed a group of 100 low-income, urban dwelling minority women during their pregnancies to determine whether maternal-fetal attachment, a characteristic specific to pregnancy, favorably influences pregnant women's health related locus of control such that women might be more inclined to engage in preventative STI/HIV risk reduction behaviors. Our findings revealed that while our sample has very high levels of MFA despite the high rate of unplanned pregnancy, condom use is not the method used to reduce the risk of contracting STIs/HIV. Rather, women are more likely to limit their number of sexual partners during pregnancy. While this is beneficial, pregnant women in non-monogamous relationships may discount the importance of condom use during pregnancy. Prenatal care providers can provide education about condom use as a beneficial prenatal care behavior similar to taking prenatal vitamins.

  12. Randomized Controlled Trial of a Computer-Based Education Program in the Home for Solid Organ Transplant Recipients: Impact on Medication Knowledge, Satisfaction, and Adherence.

    Science.gov (United States)

    Harrison, Jennifer J; Badr, Souzi; Hamandi, Bassem; Kim, Sang Joseph

    2017-06-01

    De novo solid organ transplant recipients (SOTR) have a steep learning curve to acquire medication knowledge. Without adequate knowledge, SOTR are at risk of nonadherence and poor transplant outcomes. In this nonblinded, randomized controlled trial, de novo SOTR received standard teaching with or without postdischarge computer-based education (CBE) at home. Primary outcomes were change in knowledge (quiz and recall) and satisfaction, assessed by questionnaires at baseline and 3 months. Adherence was evaluated via self-report and immunosuppressant levels. Two hundred forty-six patients were randomized and 209 completed the 3-month analysis. In the intervention arm, 73 (57.9%) used the CBE program. Change in knowledge quiz score did not differ between groups (4.9% vs 0.6%; P = 0.084), despite a significant increase within the intervention (72.4% vs 77.3%, P = 0.007) but not the control (76.0% vs 76.6%, P = 0.726) arms. Both groups had a significant improvement in recall (intervention, 56.7% vs 82.1%, P home and to develop effective strategies for posttransplant education.

  13. Adherence to nutrition-based cancer prevention guidelines and breast, prostate and colorectal cancer risk in the MCC-Spain case-control study.

    Science.gov (United States)

    Romaguera, Dora; Gracia-Lavedan, Esther; Molinuevo, Amaia; de Batlle, Jordi; Mendez, Michelle; Moreno, Victor; Vidal, Carmen; Castelló, Adela; Pérez-Gómez, Beatriz; Martín, Vicente; Molina, Antonio J; Dávila-Batista, Verónica; Dierssen-Sotos, Trinidad; Gómez-Acebo, Inés; Llorca, Javier; Guevara, Marcela; Castilla, Jesús; Urtiaga, Carmen; Llorens-Ivorra, Cristóbal; Fernández-Tardón, Guillermo; Tardón, Adonina; Lorca, José Andrés; Marcos-Gragera, Rafael; Huerta, José María; Olmedo-Requena, Rocío; Jimenez-Moleon, José Juan; Altzibar, Jone; de Sanjosé, Silvia; Pollán, Marina; Aragonés, Núria; Castaño-Vinyals, Gemma; Kogevinas, Manolis; Amiano, Pilar

    2017-07-01

    Prostate, breast and colorectal cancer are the most common tumours in Spain. The aim of the present study was to evaluate the association between adherence to nutrition-based guidelines for cancer prevention and prostate, breast and colorectal cancer, in the MCC-Spain case-control study. A total of 1,718 colorectal, 1,343 breast and 864 prostate cancer cases and 3,431 population-based controls recruited between 2007 and 2012, were included in the present study. The World Cancer Research Fund/American Institute for Cancer Research (WCRC/AICR) score based on six recommendations for cancer prevention (on body fatness, physical activity, foods and drinks that promote weight gain, plant foods, animal foods and alcoholic drinks; score range 0-6) was constructed. We used unconditional logistic regression analysis adjusting for potential confounders. One-point increment in the WCRF/AICR score was associated with 25% (95% CI 19-30%) lower risk of colorectal, and 15% (95% CI 7-22%) lower risk of breast cancer; no association with prostate cancer was detected, except for cases with a Gleason score ≥7 (poorly differentiated/undifferentiated tumours) (OR 0.87, 95% CI 0.76-0.99). These results add to the wealth of evidence indicating that a great proportion of common cancer cases could be avoided by adopting healthy lifestyle habits. © 2017 UICC.

  14. [Effects of Education about Action Plans according to Self-Monitoring on Self-Management Adherence, Knowledge, Symptom Control, and Quality of Life among Adult Asthma Patients: A Randomized Controlled Trial].

    Science.gov (United States)

    Choi, Ja Yun; Kweon, Young Ran

    2017-10-01

    This study was conducted to identify the effects of education regarding action plans according to a self-monitoring program on self-management adherence, knowledge, symptom control, and health-related quality of life (HRQoL) among adults with asthma. Thirty-four patients were randomly assigned to the intervention group and thirty-two to the control group in this study. A tailored 50-minute intervention based on the contents of self-monitoring and action plans developed by the National Heart Lung and Blood Institute was provided to the intervention group. Structured and well developed questionnaires were used to measure the dependent variables. There were no differences in all general and clinical characteristics, and the dependent variables between two groups in the pre-test. In the post-test, there were differences in the level of self-management adherence (t=4.41, pcontrol (t=-2.56, p=.013), and total HRQoL (t=2.14, p=.036) between the two groups, although there was a difference only in the sub-domain of emotion (t=2.03, p=.047) in HRQoL. This study found that action plans according to self-monitoring that enhance a participatory interaction in the treatment and care could help patients with moderate to severe asthma to engagead equately in self-care, to control their symptoms, and to improve their HRQoL. Further studies are still needed to identify longitudinal effects of this program.

  15. Endoplasmic reticulum glucosidases and protein quality control factors cooperate to establish biotrophy in Ustilago maydis.

    Science.gov (United States)

    Fernández-Álvarez, Alfonso; Elías-Villalobos, Alberto; Jiménez-Martín, Alberto; Marín-Menguiano, Miriam; Ibeas, José I

    2013-11-01

    Secreted fungal effectors mediate plant-fungus pathogenic interactions. These proteins are typically N-glycosylated, a common posttranslational modification affecting their location and function. N-glycosylation consists of the addition, and subsequent maturation, of an oligosaccharide core in the endoplasmic reticulum (ER) and Golgi apparatus. In this article, we show that two enzymes catalyzing specific stages of this pathway in maize smut (Ustilago maydis), glucosidase I (Gls1) and glucosidase II β-subunit (Gas2), are essential for its pathogenic interaction with maize (Zea mays). Gls1 is required for the initial stages of infection following appressorium penetration, and Gas2 is required for efficient fungal spreading inside infected tissues. While U. maydis Δgls1 cells induce strong plant defense responses, Δgas2 hyphae are able to repress them, showing that slight differences in the N-glycoprotein processing can determine the extent of plant-fungus interactions. Interestingly, the calnexin protein, a central element of the ER quality control system for N-glycoproteins in eukaryotic cells, is essential for avoiding plant defense responses in cells with defective N-glycoproteins processing. Thus, N-glycoprotein maturation and this conserved checkpoint appear to play an important role in the establishment of an initial biotrophic state with the plant, which allows subsequent colonization.

  16. Amino acids and autophagy: cross-talk and co-operation to control cellular homeostasis.

    Science.gov (United States)

    Carroll, Bernadette; Korolchuk, Viktor I; Sarkar, Sovan

    2015-10-01

    Maintenance of amino acid homeostasis is important for healthy cellular function, metabolism and growth. Intracellular amino acid concentrations are dynamic; the high demand for protein synthesis must be met with constant dietary intake, followed by cellular influx, utilization and recycling of nutrients. Autophagy is a catabolic process via which superfluous or damaged proteins and organelles are delivered to the lysosome and degraded to release free amino acids into the cytoplasm. Furthermore, autophagy is specifically activated in response to amino acid starvation via two key signaling cascades: the mammalian target of rapamycin (mTOR) complex 1 (mTORC1) and the general control nonderepressible 2 (GCN2) pathways. These pathways are key regulators of the integration between anabolic (amino acid depleting) and catabolic (such as autophagy which is amino acid replenishing) processes to ensure intracellular amino acid homeostasis. Here, we discuss the key roles that amino acids, along with energy (ATP, glucose) and oxygen, are playing in cellular growth and proliferation. We further explore how sophisticated methods are employed by cells to sense intracellular amino acid concentrations, how amino acids can act as a switch to dictate the temporal and spatial activation of anabolic and catabolic processes and how autophagy contributes to the replenishment of free amino acids, all to ensure cell survival. Relevance of these molecular processes to cellular and organismal physiology and pathology is also discussed.

  17. The cameroon mobile phone sms (CAMPS trial: a protocol for a randomized controlled trial of mobile phone text messaging versus usual care for improving adherence to highly active anti-retroviral therapy

    Directory of Open Access Journals (Sweden)

    Mba Robert

    2011-01-01

    Full Text Available Abstract Background This trial aims at testing the efficacy of weekly reminder and motivational text messages, compared to usual care in improving adherence to Highly Active Antiretroviral Treatment in patients attending a clinic in Yaoundé, Cameroon. Methods and Design This is a single-centered randomized controlled single-blinded trial. A central computer generated randomization list will be generated using random block sizes. Allocation will be determined by sequentially numbered sealed opaque envelopes. 198 participants will either receive the mobile phone text message or usual care. Our hypothesis is that weekly motivational text messages can improve adherence to Highly Active Antiretroviral Treatment and other clinical outcomes in the control group by acting as a reminder, a cue to action and opening communication channels. Data will be collected at baseline, three months and six months. A blinded program secretary will send out text messages and record delivery. Our primary outcomes are adherence measured by the visual analogue scale, self report, and pharmacy refill data. Our secondary outcomes are clinical: weight, body mass index, opportunistic infections, all cause mortality and retention; biological: Cluster Designation 4 count and viral load; and quality of life. Analysis will be by intention-to-treat. Covariates and subgroups will be taken into account. Discussion This trial investigates the potential of SMS motivational reminders to improve adherence to Highly Active Antiretroviral Treatment in Cameroon. The intervention targets non-adherence due to forgetfulness and other forms of non-adherence. Trial Registration Pan-African Clinical Trials Registry PACTR201011000261458 http://clinicaltrials.gov/NCT01247181

  18. Efficacy of Pseudomonas fluorescens (Pf-CL145A) spray dried powder for controlling zebra mussels adhering to test substrates

    Science.gov (United States)

    Luoma, James A.; Severson, Todd J.; Weber, Kerry L.; Mayer, Denise A.

    2015-01-01

    A mobile bioassay trailer was used to assess the efficacy of Pseudomonas fluorescens (Pf-CL145A) spray dried powder (SDP) formulation for controlling zebra mussels (Dreissena polymorpha) from two midwestern lakes: Lake Carlos (Alexandria, Minnesota) and Shawano Lake (Shawano, Wisconsin). The effects of SDP exposure concentration and exposure duration on zebra mussel survival were evaluated along with the evaluation of a benthic injection application technique to reduce the amount of SDP required to induce zebra mortality.

  19. Individualised motivational counselling to enhance adherence to antiretroviral therapy is not superior to didactic counselling in South African patients: Findings of the CAPRISA 058 randomised controlled trial

    Science.gov (United States)

    van Loggerenberg, Francois; Grant, Alison D.; Naidoo, Kogieleum; Murrman, Marita; Gengiah, Santhanalakshmi; Gengiah, Tanuja N.; Fielding, Katherine; Karim, Salim S. Abdool

    2014-01-01

    Concerns that standard didactic adherence counselling may be inadequate to maximise antiretroviral therapy (ART) adherence led us to evaluate more intensive individualised motivational adherence counselling. We randomised 297 HIV-positive ART-naïve patients in Durban, South Africa, to receive either didactic counselling, prior to ART initiation (n=150), or an intensive motivational adherence intervention after initiating ART (n=147). Study arms were similar for age (mean 35.8 years), sex (43.1% male), CD4+ cell count (median 121.5 cells/μl) and viral load (median 119 000 copies/ml). Virologic suppression at nine months was achieved in 89.8% of didactic and 87.9% of motivational counselling participants (risk ratio [RR] 0.98, 95% confidence interval [CI] 0.90-1.07, p=0.62). 82.9% of didactic and 79.5% of motivational counselling participants achieved >95% adherence by pill count at six months (RR 0.96, 95%CI 0.85-1.09, p=0.51). Participants receiving intensive motivational counselling did not achieve higher treatment adherence or virological suppression than those receiving routinely provided didactic adherence counselling. These data are reassuring that less resource intensive didactic counselling was adequate for excellent treatment outcomes in this setting. PMID:24696226

  20. The use of mobile applications to support self-management for people with asthma: a systematic review of controlled studies to identify features associated with clinical effectiveness and adherence.

    Science.gov (United States)

    Hui, Chi Yan; Walton, Robert; McKinstry, Brian; Jackson, Tracy; Parker, Richard; Pinnock, Hilary

    2017-05-01

    Telehealth is promoted as a strategy to support self-management of long-term conditions. The aim of this systematic review is to identify which information and communication technology features implemented in mobile apps to support asthma self-management are associated with adoption, adherence to usage, and clinical effectiveness. We systematically searched 9 databases, scanned reference lists, and undertook manual searches (January 2000 to April 2016). We include randomized controlled trials (RCTs) and quasiexperimental studies with adults. All eligible papers were assessed for quality, and we extracted data on the features included, health-related outcomes (asthma control, exacerbation rate), process/intermediate outcomes (adherence to monitoring or treatment, self-efficacy), and level of adoption of and adherence to use of technology. Meta-analysis and narrative synthesis were used. We included 12 RCTs employing a range of technologies. A meta-analysis (n = 3) showed improved asthma control (mean difference -0.25 [95% CI, -0.37 to -0.12]). Included studies incorporated 10 features grouped into 7 categories (education, monitoring/electronic diary, action plans, medication reminders/prompts, facilitating professional support, raising patient awareness of asthma control, and decision support for professionals). The most successful interventions included multiple features, but effects on health-related outcomes were inconsistent. No studies explicitly reported adoption of and adherence to the technology system. Meta-analysis of data from 3 trials showed improved asthma control, though overall the clinical effectiveness of apps, typically incorporating multiple features, varied. Further studies are needed to identify the features that are associated with adoption of and adherence to use of the mobile app and those that improve health outcomes.

  1. Evaluation of the impacts of cooperative adaptive cruise control on reducing rear-end collision risks on freeways.

    Science.gov (United States)

    Li, Ye; Wang, Hao; Wang, Wei; Xing, Lu; Liu, Shanwen; Wei, Xueyan

    2017-01-01

    Although plenty of studies have been conducted recently about the impacts of cooperative adaptive cruise control (CACC) system on traffic efficiency, there are few researches analyzing the safety effects of this advanced driving-assistant system. Thus, the primary objective of this study is to evaluate the impacts of the CACC system on reducing rear-end collision risks on freeways. The CACC model is firstly developed, which is based on the Intelligent Driver Model (IDM). Then, two surrogated safety measures, derived from the time-to-collision (TTC), denoting time exposed time-to-collision (TET) and time integrated time-to-collision (TIT), are introduced for quantifying the collision risks. And the safety effects are analyzed both theoretically and experimentally, by the linear stability analysis and simulations. The theoretical and simulation results conformably indicate that the CACC system brings dramatic benefits for reducing rear-end collision risks (TET and TIT are reduced more than 90%, respectively), when the desired time headway and time delay are set properly. The sensitivity analysis indicates there are few differences among different values of the threshold of TTC and the length of a CACC platoon. The results also show that the safety improvements weaken with the decrease of the penetration rates of CACC on the market and the increase of time delay between platoons. We also evaluate the traffic efficiency of the CACC system with different desired time headway. Copyright © 2016 Elsevier Ltd. All rights reserved.

  2. Referral for psychological therapy of people with long term conditions improves adherence to antidepressants and reduces emergency department attendance: Controlled before and after study

    Science.gov (United States)

    de Lusignan, Simon; Chan, Tom; Tejerina Arreal, Maria C.; Parry, Glenys; Dent-Brown, Kim; Kendrick, Tony

    2013-01-01

    Background Referral to psychological therapies is recommended for people with common mental health problems (CMHP) however its impact on healthcare utilisation in people with long term conditions (LTCs) is not known. Method Routinely collected primary care, psychological therapy clinic and hospital data were extracted for the registered population of 20 practices (N = 121199). These data were linked using the SAPREL (Secure and Private Record Linkage) method. We linked the 1118 people referred to psychological therapies with 6711 controls, matched for age, gender and practice. We compared utilisation of healthcare resources by people with LTCs, 6 months before and after referral, and conducted a controlled before and after study to compare health utilisation with controls. We made the assumption that collection of a greater number of repeat prescriptions for antidepressants was associated with greater adherence. Results Overall 21.8% of people with an LTC had CMHP vs. 18.8% without (p < 0.001). People with LTCs before referral were more likely to use health care resources (2-tailed t-test p < 0.001). Cases with LTCs showed referral to the psychological therapies clinic was associated with increased antidepressant medication prescribing (mean differences 0.62, p < 0.001) and less use of emergency department than controls (mean difference −0.21, p = 0.003). Conclusions Referral to improved access to psychological therapies (IAPT) services appears of value to people with LTC. It is associated with the issue of a greater number of prescriptions for anti-depressant medicines and less use of emergency services. Further studies are needed to explore bed occupancy and outpatient attendance. PMID:23639304

  3. Medication adherence interventions that target subjects with adherence problems: Systematic review and meta-analysis.

    Science.gov (United States)

    Conn, Vicki S; Ruppar, Todd M; Enriquez, Maithe; Cooper, Pam

    2016-01-01

    Inadequate medication adherence is a pervasive, under-recognized cause of poor health outcomes. Many intervention trials designed to improve medication adherence have targeted adults with adherence problems. No previous reviews have synthesized the effectiveness of medication adherence interventions focused on subjects with medication adherence difficulties. This systematic review and meta-analysis synthesized findings from medication adherence intervention studies conducted among adults with medication adherence difficulties. Primary research studies were eligible for inclusion if they tested an intervention designed to increase medication adherence among adults with documented adherence difficulties and reported medication adherence behavior outcomes. Comprehensive search strategies of 13 computerized databases, author and ancestry searches, and hand searches of 57 journals were used to locate eligible primary research. Participant demographics, intervention characteristics, and methodological features were reliably coded from reports along with medication adherence outcomes. Effect sizes for outcomes were calculated as standardized mean differences, and random effects models were used to estimate overall mean effects. Exploratory dichotomous and continuous variable moderator analyses were employed to examine potential associations between medication adherence effect size and sample, intervention, and methodological characteristics. Data were extracted from 53 reports of studies involving 8243 individual primary study participants. The overall standardized mean difference effect size for treatment vs. control subjects was 0.301. For treatment pre- vs. post-intervention comparisons, the overall effect size was 0.533. Significantly larger effect sizes were associated with interventions incorporating prompts to take medications than interventions lacking medication prompts (0.497 vs. 0.234). Larger effect sizes were also found for interventions that linked

  4. Medication Adherence Interventions That Target Subjects with Adherence Problems: Systematic Review and Meta-analysis

    Science.gov (United States)

    Conn, Vicki S.; Ruppar, Todd M.; Enriquez, Maithe; Cooper, Pam

    2015-01-01

    Background Inadequate medication adherence is a pervasive, under-recognized cause of poor health outcomes. Many intervention trials designed to improve medication adherence have targeted adults with adherence problems. No previous reviews have synthesized the effectiveness of medication adherence interventions focused on subjects with medication adherence difficulties. Objective This systematic review and meta-analysis synthesized findings from medication adherence intervention studies conducted among adults with medication adherence difficulties. Methods Primary research studies were eligible for inclusion if they tested an intervention designed to increase medication adherence among adults with documented adherence difficulties and reported medication adherence behavior outcomes. Comprehensive search strategies of 13 computerized databases, author and ancestry searches, and hand searches of 57 journals were used to locate eligible primary research. Participant demographics, intervention characteristics, and methodological features were reliably coded from reports along with medication adherence outcomes. Effect sizes for outcomes were calculated as standardized mean differences, and random effects models were used to estimate overall mean effects. Exploratory dichotomous and continuous variable moderator analyses were employed to examine potential associations between medication adherence effect size and sample, intervention, and methodological characteristics. Results Data were extracted from 53 reports of studies involving 8,243 individual primary study participants. The overall standardized mean difference effect size for treatment vs. control subjects was 0.301. For treatment pre- vs. post-intervention comparisons, the overall effect size was 0.533. Significantly larger effect sizes were associated with interventions incorporating prompts to take medications than interventions lacking medication prompts (0.497 vs. 0.234). Larger effect sizes were also found

  5. The Role of User Control in Adherence to and Knowledge Gained from a Website: Randomized Comparison Between a Tunneled Version and a Freedom-of-Choice Version

    Science.gov (United States)

    Cyr, Dianne; de Vries, Nanne K

    2012-01-01

    Background Internet-delivered interventions can effectively change health risk behaviors and their determinants, but adherence to these interventions once they are accessed is very low. Therefore, it is relevant and necessary to systematically manipulate website characteristics to test their effect on website use. This study focuses on user control as a website characteristic. Objective To test whether and how user control (the freedom of choice to skip pages) can increase website use and knowledge gained from the website. Methods Participants older than 18 years were drawn from the Dutch Internet population (in June 2011) and completed a hepatitis knowledge questionnaire. Subsequently, they were randomly assigned to three groups: (1) a tunneled version of the website with less user control; (2) a high user control version of the website where visitors had the freedom of choice to skip pages; and (3) a control group that was not exposed to the website. Participants completed (1) a questionnaire of validated measures regarding user perceptions immediately after exposure to the website (except for the control group), and (2) a hepatitis knowledge questionnaire after one week to test whether participants in the experimental groups only clicked through the website or actually processed and learned its content. Server registrations were used to assess website use. Analyses of covariance (ANCOVA) using all available data were conducted to determine whether user control increases website use. Structural equation models (SEM) using all available data were constructed to test how user control increases website use—a latent variable derived from number of pages visited and time on website. Results Of the 1044 persons invited to participate, 668 took part (668/1044, 64.0%). One half of participants (332/668 49.7%) were female and the mean age was 49 years (SD 16). A total of 571 participants completed the one-week follow-up measure regarding hepatitis knowledge (571/668, 85

  6. [Family adherence in serious mental disorder].

    Science.gov (United States)

    Martín Padilla, Ernesto; Obando Posada, Diana; Sarmiento Medina, Pedro

    2017-10-09

    Identify attitudes and behaviors that evidence and characterize family adherence to treatment in patients with severe mental disorder. Qualitative descriptive, from an interpretative social approach. Chia, Colombia, with professionals in the psychiatric and geriatric settings. Twelve professionals in psychiatry, nursing and psychology, with experience in care of patients with serious mental disorder and their families. Intentional sampling. Twelve semi-structured interviews were carried out. The analysis strategy was made from the procedures of constant comparison and open coding of the grounded theory. As validation strategies, triangulation was done between researchers and methods, as interviews and results survey. Two categories of family adherence were defined: family and treatment (treatment cooperation, knowledge about the disease and attention to the disease evolution), and family attitudes towards the patient (patient's care, patient's promotion of autonomy, and affective attachment with the patient). A third category showed aspects that diminished family adherence, such as lack or distortion of information regarding mental disorder, or family and patient endurance attitudes. Participants agree about the relevance of the construct named «family adherence», which describes the behaviors and attitudes of the family regarding the treatment of patients with severe mental disorder. Family adherence can be seen as active participation behavior, but also as a process of strengthening relationships, which can reduce the burden and suffering on family members, caregivers and patients. Copyright © 2017 Elsevier España, S.L.U. All rights reserved.

  7. An internet-based virtual coach to promote physical activity adherence in overweight adults: randomized controlled trial.

    Science.gov (United States)

    Watson, Alice; Bickmore, Timothy; Cange, Abby; Kulshreshtha, Ambar; Kvedar, Joseph

    2012-01-26

    Addressing the obesity epidemic requires the development of effective, scalable interventions. Pedometers and Web-based programs are beneficial in increasing activity levels but might be enhanced by the addition of nonhuman coaching. We hypothesized that a virtual coach would increase activity levels, via step count, in overweight or obese individuals beyond the effect observed using a pedometer and website alone. We recruited 70 participants with a body mass index (BMI) between 25 and 35 kg/m(2) from the Boston metropolitan area. Participants were assigned to one of two study arms and asked to wear a pedometer and access a website to view step counts. Intervention participants also met with a virtual coach, an automated, animated computer agent that ran on their home computers, set goals, and provided personalized feedback. Data were collected and analyzed in 2008. The primary outcome measure was change in activity level (percentage change in step count) over the 12-week study, split into four 3-week time periods. Major secondary outcomes were change in BMI and participants' satisfaction. The mean age of participants was 42 years; the majority of participants were female (59/70, 84%), white (53/70, 76%), and college educated (68/70, 97%). Of the initial 70 participants, 62 completed the study. Step counts were maintained in intervention participants but declined in controls. The percentage change in step count between those in the intervention and control arms, from the start to the end, did not reach the threshold for significance (2.9% vs -12.8% respectively, P = .07). However, repeated measures analysis showed a significant difference when comparing percentage changes in step counts between control and intervention participants over all time points (analysis of variance, P = .02). There were no significant changes in secondary outcome measures. The virtual coach was beneficial in maintaining activity level. The long-term benefits and additional applications of

  8. Adherence to ART in PLWHA

    African Journals Online (AJOL)

    Women were less adhering than men and adherence was related to depression among drug users (10). A study in. Brazil showed the cumulative incidence of non- adherence to be 36.9% (11). Adherence among patients in Soweto, South Africa was 88% (12). In Cape Town;. 63% of patients maintained adherence levels of ...

  9. Money for medication : A randomized controlled study on the effectiveness of financial incentives to improve medication adherence in patients with psychotic disorders

    NARCIS (Netherlands)

    E.L. Noordraven (Ernst); C.H. Audier (Charlotte); A.B.P. Staring (Anton); A.I. Wierdsma (André); P. Blanken (Peter); B.E.A. van der Hoorn (Bas); L. van Hakkaart-van Roijen (Leona); C.L. Mulder (Niels)

    2014-01-01

    markdownabstractBackground: Non-adherence with antipsychotic medication is a frequently occurring problem, particularly among patients with psychotic disorders. Prior research has generally shown encouraging results for interventions based on ‘Contingency Management’ (CM), in which desirable

  10. Adherence to infection prevention and control guidelines: A vignette-based study of decision-making and risk-taking in young adults with cystic fibrosis.

    Science.gov (United States)

    Bowmer, Grace; Latchford, Gary; Duff, Alistair; Denton, Miles; Dye, Louise; Lawton, Clare; Lee, Tim

    2017-01-01

    Balancing cystic fibrosis (CF) care with demands of normal life is associated with decreased adherence to infection prevention and control (IPC) guidelines. Adults with CF, aged 18-25years, were invited to participate via UK CF Trust social media platforms. An online survey evaluated participants' decision-making in nine clinician-rated vignettes and assessed the perceived influence of infection-related information sources. Participants (n=87, mean 21.4years [SD=2.45]; 75% female) were less likely to engage in the high-risk scenarios, although demonstrated greater awareness of cross-infection than environmental risks. Associations between risk-perception and willingness to participate in five vignette-based hypothetical activities were significant (p<0.05). Thematic analysis emphasised influences of past experience and a need to achieve good quality of life. Knowledge gaps were evident. People with CF make decisions that discriminate between risk-levels but are not always based on robust knowledge. They also show some inclination towards engaging in risky behaviours. Copyright © 2016 European Cystic Fibrosis Society. Published by Elsevier B.V. All rights reserved.

  11. The efficacy and stability of an information and communication technology-based centralized monitoring system of adherence to immunosuppressive medication in kidney transplant recipients: study protocol for a randomized controlled trial.

    Science.gov (United States)

    Jung, Hee-Yeon; Seong, Sook Jin; Choi, Ji-Young; Cho, Jang-Hee; Park, Sun-Hee; Kim, Chan-Duck; Yoon, Young-Ran; Kim, Hyung-Kee; Huh, Seung; Yoon, Se-Hee; Lee, Jong Soo; Kim, Yong-Lim

    2017-10-16

    Immunosuppression non-adherence in kidney transplant recipients (KTRs) not only increases the risk of medical intervention due to acute rejection and graft loss but burdens the socioeconomic system in the form of increased healthcare costs. An aggressive preemptive effort by healthcare professionals, geared to ensure adherence to immunosuppressants in KTRs, is significant and imperative. This study was designed as a prospective, open-label, multicenter, randomized controlled study aimed at evaluating the efficacy and stability of an information and communication technology (ICT)-based centralized monitoring system in boosting medication adherence in KTRs. One hundred fourteen KTRs registered throughout the year 2017 to 2018 are randomized into either the ICT-based centralized home monitoring system or to ambulatory follow-up. The planned follow-up duration is 6 months. The ICT-based centralized home monitoring system described consists of a smart pill box equipped with personal identification system, a home monitoring system, an electronic Case Report Form (eCRF) system, and a comprehensive clinical trial management system (CTMS). It alerts both patients and medical staff with texts and pill box alarms if there is a dosage/dosing time error or a missed dose. Medication adherence and transplant outcomes for the follow-up period are compared between the two groups, while patient satisfaction as well as the stability and cost-effectiveness of the ICT-based monitoring system are to be evaluated. This on-going study is expected to determine if consistent use of the ICT-based centralized monitoring system described could maximize mediation adherence and subsequently enhance transplant outcomes in KTRs. Further, it would lay the foundation for successful implementation of this ICT-based monitoring system for effective management of medication adherence in KTRs. ClinicalTrials.gov, Identifier: NCT03136588 . Registered on 20 April 2017.

  12. A randomized-controlled trial with a Canadian electronic pill dispenser used to measure and improve medication adherence in patients with schizophrenia

    Directory of Open Access Journals (Sweden)

    Emmanuel eStip

    2013-08-01

    Full Text Available Objective: Medication adherence is extremely important in preventing relapse and lowering symptoms in schizophrenic patients. However, estimates show that nearly half of these patients have poor adherence. The Brief Adherence Rating Scale (BARS seems to be the most reliable tool assessing adherence in schizophrenia and shows that the antipsychotic adherence ratio (AAR is about 49.5 % in schizophrenia. The aim of the study was to test if an electronic pill dispenser named DoPill® improved AAR of schizophrenic patients. Furthermore, we compared AAR obtained by the DoPill® and the BARS, in order to verify whether the DoPill® provides reliable assessment of medication adherence. Methods: The DoPill® is a smart pill dispenser that beeps and flashes at the appropriate time of the day. Each of its 28 compartments is covered by a plastic lamina that, when taken off, sends a signal to the pharmacist. Patients were randomized to the DoPill® or Treatment As Usual group (TAU for six weeks. The BARS was used as a reference measure. Results: Forty-six percent of patients were deemed to be non-adherent with antipsychotic medication. The mean AAR was 67 % after six weeks. DoPill® recorded better AAR than some of those found in the literature and were lower than the BARS estimate we found. Conclusion: These results suggest that DoPill® is a valid tool that provides more reliable and objective data for the clinician about their patient’s adherence, than existing assessment tools like the BARS. Furthermore, the device may help patients successfully manage their medication regimen.

  13. Increasing Adherence to Follow-up of Breast Abnormalities in Low-Income Korean American Women: A Randomized Controlled Trial. Addendum

    Science.gov (United States)

    2009-09-01

    AD_________________ AWARD NUMBER: DAMD17-03-1-0676 TITLE: Increasing Adherence to Follow-up of...TITLE AND SUBTITLE 5a. CONTRACT NUMBER Increasing Adherence to Follow-up of Breast Abnormalities in Low-Income Korean American Women: A...who refused participation, could never be contacted or dropped out, self-reported completion of follow-up was 61% in the intervention arm and 46% in

  14. A randomized controlled trial with a Canadian electronic pill dispenser used to measure and improve medication adherence in patients with schizophrenia.

    Science.gov (United States)

    Stip, Emmanuel; Vincent, Philippe D; Sablier, Juliette; Guevremont, Catherine; Zhornitsky, Simon; Tranulis, Constantin

    2013-01-01

    Medication adherence is extremely important in preventing relapse and lowering symptoms in schizophrenic patients. However, estimates show that nearly half of these patients have poor adherence. The Brief Adherence Rating Scale (BARS) seems to be the most reliable tool assessing adherence in schizophrenia and shows that the antipsychotic adherence ratio (AAR) is about 49.5% in schizophrenia. The aim of the study was to test if an electronic pill dispenser named DoPill(®) improved AAR of schizophrenic patients. Furthermore, we compared AAR obtained by the DoPill(®) and the BARS, in order to verify whether the DoPill(®) provides reliable assessment of medication adherence. The DoPill(®) is a smart pill dispenser that beeps and flashes at the appropriate time of the day. Each of its 28 compartments is covered by a plastic lamina that, when taken off, sends a signal to the pharmacist. Patients were randomized to the DoPill(®) or treatment as usual groups for 6 weeks. The BARS was used as a reference measure. Forty-six percent of patients were deemed to be non-adherent with antipsychotic medication. The mean AAR was 67% after 6 weeks. DoPill(®) recorded better AAR than some of those found in the literature and were lower than the BARS estimate we found. These results suggest that DoPill(®) is a valid tool that provides more reliable and objective data for the clinician about their patient's adherence, than existing assessment tools like the BARS. Furthermore, the device may help patients successfully manage their medication regimen.

  15. Combining Text Messaging and Telephone Counseling to Increase Varenicline Adherence and Smoking Abstinence Among Cigarette Smokers Living with HIV: A Randomized Controlled Study.

    Science.gov (United States)

    Tseng, Tuo-Yen; Krebs, Paul; Schoenthaler, Antoinette; Wong, Selena; Sherman, Scott; Gonzalez, Mirelis; Urbina, Antonio; Cleland, Charles M; Shelley, Donna

    2017-07-01

    Smoking represents an important health risk for people living with HIV (PLHIV). Low adherence to smoking cessation pharmacotherapy may limit treatment effectiveness. In this study, 158 participants recruited from three HIV care centers in New York City were randomized to receive 12-weeks of varenicline (Chantix) either alone as standard care (SC) or in combination with text message (TM) support or TM plus cell phone-delivered adherence-focused motivational and behavioral therapy (ABT). Generalized linear mixed-effect models found a significant decline in varenicline adherence from week 1-12 across treatment groups. At 12-weeks, the probability of smoking abstinence was significantly higher in SC+TM+ABT than in SC. The study demonstrates the feasibility of delivering adherence-focused interventions to PLHIV who smoke. Findings suggest intensive behavioral support is an important component of an effective smoking cessation intervention for this population, and a focus on improving adherence self-efficacy may lead to more consistent adherence and higher smoking abstinence.

  16. Assessment of the quality of reporting of randomised controlled trials in otorhinolaryngologic literature - adherence to the CONSORT statement.

    Directory of Open Access Journals (Sweden)

    Jeroen P M Peters

    Full Text Available Randomised Controlled Trials (RCTs are the preferred study design when comparing therapeutical interventions in medicine. To improve clarity, consistency and transparency of reporting RCTs, the Consolidated Standards of Reporting Trials (CONSORT statement was developed.(1 To assess the quality of reports and abstracts of RCTs in otorhinolaryngologic literature by using CONSORT checklists, (2 to compare the quality of reports and abstracts of otorhinolaryngologic RCTs between the top 5 general medical journals and top 5 otorhinolaryngologic journals, and (3 to formulate recommendations for authors and editors of otorhinolaryngologic ('ENT' journals.Based on 2012 ISI Web of Knowledge impact factors, the top 5 general medical and ENT journals were selected. On 25 June 2014, using a highly sensitive Cochrane RCT filter and ENT filter, possibly relevant articles since January 1st, 2010 were retrieved and relevant RCTs were selected. We assessed how many CONSORT items were reported adequately in reports and abstracts and compared the two journal types.Otorhinolaryngologic RCTs (n = 15 published in general medical journals reported a mean of 92.1% (95% confidence interval: 89.5%-94.7% of CONSORT items adequately, whereas RCTs (n = 18 published in ENT journals reported a mean of 71.8% (66.7%-76.8% adequately (p < 0.001. For abstracts, means of 70.0% (63.7%-76.3% and 32.3% (26.6-38.0% were found respectively (p < 0.001. Large differences for specific items exist between the two journal types.The quality of reporting of RCTs in otorhinolaryngologic journals is suboptimal. RCTs published in general medical journals have a higher quality of reporting than RCTs published in ENT journals. We recommend authors to report their trial according to the CONSORT Statement and advise editors to endorse the CONSORT Statement and implement the CONSORT Statement in the editorial process to ensure more adequate reporting of RCTs and their abstracts.

  17. Diabetes conflict outstrips the positive impact of self-efficacy on youth adherence and glycemic control in type 1 diabetes.

    Science.gov (United States)

    Noser, Amy E; Huffhines, Lindsay; Clements, Mark A; Patton, Susana R

    2017-11-01

    To examine whether self-efficacy buffers the deleterious consequences of diabetes-specific family conflict on self-monitoring blood glucose (SMBG) and glycated hemoglobin (HbA1c) in youth with type 1 diabetes mellitus (T1DM). A total of 129 youth with T1DM (aged 10-16 years) completed measures of diabetes-specific family conflict and self-efficacy for diabetes management, and their blood glucose meter data and HbA1c were extracted from the electronic medical record. We preformed moderation analyses to examine whether self-efficacy moderated the association that diabetes-specific family conflict had with SMBG and HbA1c. We used simple slopes analyses to probe significant interactions. Our results indicated that self-efficacy moderated the association that diabetes-specific family conflict had with SMBG and HbA1c. The pattern of these findings showed that high self-efficacy buffered the negative impact of diabetes conflict on HbA1c. However, benefits of high self-efficacy for more frequent SMBG was only apparent in the context of low diabetes-specific family conflict. Study findings highlight the interactive relationship between diabetes-specific family conflict and self-efficacy in relation to SMBG and glycemic control. These findings suggest that family functioning and youth's self-efficacy are promising intervention targets for families having trouble with SMBG and HbA1c. © 2016 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

  18. Improving adherence to PALS septic shock guidelines.

    Science.gov (United States)

    Paul, Raina; Melendez, Elliot; Stack, Anne; Capraro, Andrew; Monuteaux, Michael; Neuman, Mark I

    2014-05-01

    Few studies have demonstrated improvement in adherence to Pediatric Advanced Life Support guidelines for severe sepsis and septic shock. We sought to improve adherence to national guidelines for children with septic shock in a pediatric emergency department with poor guideline adherence. Prospective cohort study of children presenting to a tertiary care pediatric emergency department with septic shock. Quality improvement (QI) interventions, including repeated plan-do-study-act cycles, were used to improve adherence to a 5-component sepsis bundle, including timely (1) recognition of septic shock, (2) vascular access, (3) administration of intravenous (IV) fluid, (4) antibiotics, and (5) vasoactive agents. The intervention focused on IV fluid delivery as a key driver impacting bundle adherence, and adherence was measured using statistical process control methodology. Two-hundred forty-two patients were included: 126 subjects before the intervention (November 2009 to March 2011), and 116 patients during the QI intervention (October 2011 to May 2013). We achieved 100% adherence for all metrics, including (1) administration of 60 mL/kg IV fluid within 60 minutes (increased from baseline adherence rate of 37%), (2) administration of vasoactive agents within 60 minutes (baseline rate of 35%), and (3) 5-component bundle adherence (baseline rate of 19%). Improvement was sustained over 9 months. The number of septic shock cases between each death from this condition increased after implementation of the QI intervention. Using QI methodology, we have demonstrated improved adherence to national guidelines for severe sepsis and septic shock. Copyright © 2014 by the American Academy of Pediatrics.

  19. Cognitive cooperation groups mediated by computers and internet present significant improvement of cognitive status in older adults with memory complaints: a controlled prospective study

    Directory of Open Access Journals (Sweden)

    Rodrigo de Rosso Krug

    Full Text Available ABSTRACT Objective To estimate the effect of participating in cognitive cooperation groups, mediated by computers and the internet, on the Mini-Mental State Examination (MMSE percent variation of outpatients with memory complaints attending two memory clinics. Methods A prospective controlled intervention study carried out from 2006 to 2013 with 293 elders. The intervention group (n = 160 attended a cognitive cooperation group (20 sessions of 1.5 hours each. The control group (n = 133 received routine medical care. Outcome was the percent variation in the MMSE. Control variables included gender, age, marital status, schooling, hypertension, diabetes, dyslipidaemia, hypothyroidism, depression, vascular diseases, polymedication, use of benzodiazepines, exposure to tobacco, sedentary lifestyle, obesity and functional capacity. The final model was obtained by multivariate linear regression. Results The intervention group obtained an independent positive variation of 24.39% (CI 95% = 14.86/33.91 in the MMSE compared to the control group. Conclusion The results suggested that cognitive cooperation groups, mediated by computers and the internet, are associated with cognitive status improvement of older adults in memory clinics.

  20. Cooperation of p300 and PCAF in the control of microRNA 200c/141 transcription and epithelial characteristics.

    Directory of Open Access Journals (Sweden)

    Yoshiaki Mizuguchi

    Full Text Available Epithelial to mesenchymal transition (EMT not only occurs during embryonic development and in response to injury, but is an important element in cancer progression. EMT and its reverse process, mesenchymal to epithelial transition (MET is controlled by a network of transcriptional regulators and can be influenced by posttranscriptional and posttranslational modifications. EMT/MET involves many effectors that can activate and repress these transitions, often yielding a spectrum of cell phenotypes. Recent studies have shown that the miR-200 family and the transcriptional suppressor ZEB1 are important contributors to EMT. Our previous data showed that forced expression of SPRR2a was a powerful inducer of EMT and supports the findings by others that SPRR gene members are highly upregulated during epithelial remodeling in a variety of organs. Here, using SPRR2a cells, we characterize the role of acetyltransferases on the microRNA-200c/141 promoter and their effect on the epithelial/mesenchymal status of the cells. We show that the deacetylase inhibitor TSA as well as P300 and PCAF can cause a shift towards epithelial characteristics in HUCCT-1-SPRR2a cells. We demonstrate that both P300 and PCAF act as cofactors for ZEB1, forming a P300/PCAF/ZEB1 complex on the miR200c/141 promoter. This binding results in lysine acetylation of ZEB1 and a release of ZEB1 suppression on miR-200c/141 transcription. Furthermore, disruption of P300 and PCAF interactions dramatically down regulates miR-200c/141 promoter activity, indicating a PCAF/P300 cooperative function in regulating the transcriptional suppressor/activator role of ZEB1. These data demonstrate a novel mechanism of miRNA regulation in mediating cell phenotype.

  1. Evaluation of medication adherence in Lebanese hypertensive patients.

    Science.gov (United States)

    Yassine, Mohammad; Al-Hajje, Amal; Awada, Sanaa; Rachidi, Samar; Zein, Salam; Bawab, Wafa; Bou Zeid, Mayssam; El Hajj, Maya; Salameh, Pascale

    2016-09-01

    Controlling hypertension is essential in cardiovascular diseases. Poor medication adherence is associated with poor disease outcomes, waste of healthcare resources, and contributes to reduced blood pressure control. This study evaluates treatment adherence to antihypertensive therapy in Lebanese hypertensive patients by estimating the proportion of adherent hypertensive patients using a validated tool and investigates what factors predict this behavior. A questionnaire-based cross-sectional study was conducted on a random sample of 210 hypertensive outpatients selected from clinics located in tertiary-care hospitals and from private cardiology clinics located in Beirut. Adherence level was measured using a validated 8-item Modified Morisky Medication Adherence Scale (MMMAS). Among 210 patients, 50.5% showed high adherence, 27.1% medium adherence, and 22.4% low adherence to medication. Mean MMMAS score was 6.59±2.0. In bivariate analyses, having controlled blood pressure (p=0.003) and taking a combination drug (p=0.023) were predictors of high adherence. Forgetfulness (padherence after multiple liner regression. Logistic regression results showed that calcium channel blockers (p=0.030) were associated with increased adherence levels. In conclusion, developing multidisciplinary intervention programs to address the factors identified, in addition to educational strategies targeting healthcare providers, are necessary to enhance patient adherence. Copyright © 2015 Ministry of Health, Saudi Arabia. Published by Elsevier Ltd. All rights reserved.

  2. Stepwise strategy to improve Cervical Cancer Screening Adherence (SCAN-CC): automated text messages, phone calls and face-to-face interviews: protocol of a population-based randomised controlled trial.

    Science.gov (United States)

    Firmino-Machado, João; Mendes, Romeu; Moreira, Amélia; Lunet, Nuno

    2017-10-05

    Screening is highly effective for cervical cancer prevention and control. Population-based screening programmes are widely implemented in high-income countries, although adherence is often low. In Portugal, just over half of the women adhere to cervical cancer screening, contributing for greater mortality rates than in other European countries. The most effective adherence raising strategies are based on patient reminders, small/mass media and face-to-face educational programmes, but sequential interventions targeting the general population have seldom been evaluated. The aim of this study is to assess the effectiveness of a stepwise approach, with increasing complexity and cost, to improve adherence to organised cervical cancer screening: step 1a-customised text message invitation; step 1b-customised automated phone call invitation; step 2-secretary phone call; step 3-family health professional phone call and face-to-face appointment. A population-based randomised controlled trial will be implemented in Portuguese urban and rural areas. Women eligible for cervical cancer screening will be randomised (1:1) to intervention and control. In the intervention group, women will be invited for screening through text messages, automated phone calls, manual phone calls and health professional appointments, to be applied sequentially to participants remaining non-adherent after each step. Control will be the standard of care (written letter). The primary outcome is the proportion of women adherent to screening after step 1 or sequences of steps from 1 to 3. The secondary outcomes are: proportion of women screened after each step (1a, 2 and 3); proportion of text messages/phone calls delivered; proportion of women previously screened in a private health institution who change to organised screening. The intervention and control groups will be compared based on intention-to-treat and per-protocol analyses. The study was approved by the Ethics Committee of the Northern Health

  3. Stepwise strategy to improve Cervical Cancer Screening Adherence (SCAN-CC): automated text messages, phone calls and face-to-face interviews: protocol of a population-based randomised controlled trial

    Science.gov (United States)

    Mendes, Romeu; Moreira, Amélia; Lunet, Nuno

    2017-01-01

    Introduction Screening is highly effective for cervical cancer prevention and control. Population-based screening programmes are widely implemented in high-income countries, although adherence is often low. In Portugal, just over half of the women adhere to cervical cancer screening, contributing for greater mortality rates than in other European countries. The most effective adherence raising strategies are based on patient reminders, small/mass media and face-to-face educational programmes, but sequential interventions targeting the general population have seldom been evaluated. The aim of this study is to assess the effectiveness of a stepwise approach, with increasing complexity and cost, to improve adherence to organised cervical cancer screening: step 1a—customised text message invitation; step 1b—customised automated phone call invitation; step 2—secretary phone call; step 3—family health professional phone call and face-to-face appointment. Methods A population-based randomised controlled trial will be implemented in Portuguese urban and rural areas. Women eligible for cervical cancer screening will be randomised (1:1) to intervention and control. In the intervention group, women will be invited for screening through text messages, automated phone calls, manual phone calls and health professional appointments, to be applied sequentially to participants remaining non-adherent after each step. Control will be the standard of care (written letter). The primary outcome is the proportion of women adherent to screening after step 1 or sequences of steps from 1 to 3. The secondary outcomes are: proportion of women screened after each step (1a, 2 and 3); proportion of text messages/phone calls delivered; proportion of women previously screened in a private health institution who change to organised screening. The intervention and control groups will be compared based on intention-to-treat and per-protocol analyses. Ethics and dissemination The study was

  4. A Gene Regulatory Network Cooperatively Controlled by Pdx1 and Sox9 Governs Lineage Allocation of Foregut Progenitor Cells

    DEFF Research Database (Denmark)

    Shih, Hung Ping; Seymour, Philip A; Patel, Nisha A

    2015-01-01

    The generation of pancreas, liver, and intestine from a common pool of progenitors in the foregut endoderm requires the establishment of organ boundaries. How dorsal foregut progenitors activate pancreatic genes and evade the intestinal lineage choice remains unclear. Here, we identify Pdx1 and Sox......9 as cooperative inducers of a gene regulatory network that distinguishes the pancreatic from the intestinal lineage. Genetic studies demonstrate dual and cooperative functions for Pdx1 and Sox9 in pancreatic lineage induction and repression of the intestinal lineage choice. Pdx1 and Sox9 bind...... to regulatory sequences near pancreatic and intestinal differentiation genes and jointly regulate their expression, revealing direct cooperative roles for Pdx1 and Sox9 in gene activation and repression. Our study identifies Pdx1 and Sox9 as important regulators of a transcription factor network that initiates...

  5. Autonomous Co-operation and Control in Complex Adaptive Logistic Systems - Contributions and Limitations for the Innovation Capability of International Supply Networks

    Science.gov (United States)

    Hülsmann, Michael; Cordes, Philip

    This paper aims to analyze the potential contributions of the organization principle autonomous co-operation and control to the innovation capabilities of logistics systems and their sub-systems like single organizations. Therefore, the concept of Complex Adaptive Logistics Systems (CALS) will be introduced and the essentiality of the heterogeneity of the elements within logistics systems for their innovation capabilities will be emphasized. One possible driver for homogeneity is the so-called dominant logic.

  6. Internet-based incentives increase blood glucose testing with a non-adherent, diverse sample of teens with type 1 diabetes mellitus: a randomized controlled Trial.

    Science.gov (United States)

    Raiff, Bethany R; Barrry, Victoria B; Ridenour, Ty A; Jitnarin, Natinee

    2016-06-01

    Non-adherence with self-monitoring blood glucose (SMBG) among teenagers with type 1 diabetes can be a problem. The purpose of this study was to investigate the feasibility, acceptability, and preliminary efficacy of using Internet-based incentives to improve adherence with SMBG in non-adherent teenagers. Participants were randomly assigned to contingent (CS; N = 23), where they had to meet web camera-verified SMBG goals to earn incentives, or non-contingent (NS) groups (N = 18), where they earned incentives independent of adherence. Brief motivational interviewing (MI) was given prior to the intervention. Attrition was 15 % in the CS group. Participants and parents endorsed the intervention on all intervention dimensions. Daily SMBG increased after one MI session, and further increased when incentives were added, but significantly more for so for older participants. SMBG declined slowly over time, but only returned to baseline levels for younger NS participants. Internet-based incentive interventions are feasible, acceptable, and show promise for improving adherence with SMBG.

  7. Comparing the effectiveness of the BPMAP (Blood Pressure Management Application) and usual care in self-management of primary hypertension and adherence to treatment in patients aged 30-60 years: study protocol for a randomized controlled trial.

    Science.gov (United States)

    Ashoorkhani, Mahnaz; Bozorgi, Ali; Majdzadeh, Reza; Hosseini, Hamed; Yoonessi, Ali; Ramezankhani, Ali; Eftekhar, Hassan

    2016-10-21

    Hypertension is one of the most important and well-known risk factors for cardiovascular diseases. Unfortunately, in spite of effective treatments, adherence to the regular use of drugs and other nondrug treatments, such as lifestyle improvement, is often poor. This study evaluates the effectiveness of an educational, supportive intervention - in the form of a Blood Pressure Management Application (BPMAP) - on self-management in patients with primary hypertension on controlling the determinant factors of hypertension, and on adherence to treatment. A two-arm, parallel-design randomized controlled clinical trial will be conducted on 30 to 60 year-old patients with primary hypertension who are attending the Tehran Heart Center. One hundred and thirty-two (132) patients will be randomly assigned to the intervention and control (usual method) groups. The most important inclusion criteria are, having primary hypertension and being pharmacologically treated for it, and not having developed the complications of hypertension, such as myocardial infarction, cerebral stroke and cardiac insufficiency. The participants should be able to read Persian and be able to use the application. The most important outcomes of the study include adherence to treatment, weight control, and regular monitoring of blood pressure which are assessed in the primary assessment (baseline data questionnaire) and again at the 8 th and 24 th weeks. The intervention is a mobile application that has capabilities such as reminders and scientific and supportive information. This application has been programmed to reduce many of the nonadherence factors of hypertension treatment. Therefore, the findings may contribute to a rise in adherence to treatment. If proven to have an appropriate impact, it may be extended for use in the national hypertension control plan. This study was registered in the Iran Randomized Clinical Trial Center under the number IRCT2015111712211N2 on 1 January 2016.

  8. The Influence of Wireless Self-Monitoring Program on the Relationship Between Patient Activation and Health Behaviors, Medication Adherence, and Blood Pressure Levels in Hypertensive Patients: A Substudy of a Randomized Controlled Trial.

    Science.gov (United States)

    Kim, Ju Young; Wineinger, Nathan E; Steinhubl, Steven R

    2016-06-22

    Active engagement in the management of hypertension is important in improving self-management behaviors and clinical outcomes. Mobile phone technology using wireless monitoring tools are now widely available to help individuals monitor their blood pressure, but little is known about the conditions under which such technology can effect positive behavior changes or clinical outcomes. To study the influence of wireless self-monitoring program and patient activation measures on health behaviors, medication adherence, and blood pressure levels as well as control of blood pressure in hypertensive patients. We examined a subset of 95 hypertensive participants from a 6-month randomized controlled trial designed to determine the utility of a wireless self-monitoring program (n=52 monitoring program, n=43 control), which consisted of a blood pressure monitoring device connected with a mobile phone, reminders for self-monitoring, a Web-based disease management program, and a mobile app for monitoring and education, compared with the control group receiving a standard disease management program. Study participants provided measures of patient activation, health behaviors including smoking, drinking, and exercise, medication adherence, and blood pressure levels. We assessed the influence of wireless self-monitoring as a moderator of the relationship between patient activation and health behaviors, medication adherence, and control of blood pressure. Improvements in patient activation were associated with improvements in cigarette smoking (beta=-0.46, Pself-monitoring program. No differences were observed with respect to medication adherence. Participation in a wireless self-monitoring program provides individuals motivated to improve their health management with an added benefit above and beyond that of motivation alone. Hypertensive individuals eager to change health behaviors are excellent candidates for mobile health self-monitoring.. ClinicalTrials.gov NCT01975428, https

  9. HIV Medication Adherence

    Science.gov (United States)

    ... AIDS Drugs Clinical Trials Apps skip to content HIV Treatment Home Understanding HIV/AIDS Fact Sheets HIV ... 4 p.m. ET) Send us an email HIV Medication Adherence Last Reviewed: January 17, 2018 Key ...

  10. I. Enabling Single-Chain Surfactants to Form Vesicles by Nonamphiphilic Liquid Crystals in Water II. Controlling Attachment and Ligand-Mediated Adherence of Candida albicans on Monolayers

    Science.gov (United States)

    Varghese, Nisha

    . Adhesion of C. albicans to a surface is a complex process and is governed by nonspecific attachment or multiple ligand-receptor interactions. The work demonstrates that the multiple ligand-receptor interactions used by C. albicans for adherence to a surface can be individually studied using self-assembled monolayers (SAMs) decorated with minimal motif of the ligands. The SAMs were also used to differentiate between the interactions of the two different morphological forms of C. albicans.. Chapter 5 presents a study on small molecules that were used to inhibit biofilm formed by C. albicans. The acyclic triazoles used in the study were not toxic to the C. albicans and were capable of inhibiting biofilm formed by C. albicans. The acyclic triazole can be used as promising candidates to design new antifungal agents. The chapter also reports the synthesis of squarylated homoserine lactones (SHLs) structural mimics of bacterial acyl homoserine lactones (AHLs) to study the inhibitory effects of SHLs on fungal biofilm. The bacterial AHLs are known to repress the growth of C. albicans and control fungal biofilm in native host environment. The synthesized SHLs were non-toxic to C. albicans and failed to inhibit biofilm formed by C. albicans. . Chapter 6 uses gradient nanotopography combined with controlled surface chemistry to confine bacterial biofilm formed by Escherichia coli. The E. coli biofilm were confined within micrometer sized regions of hydrophobic SAMs surrounded by polyol-terminated SAMs. The study reveals that surface with higher topography enhances the ability of the bioinert SAMs to resist bacterial adherence to surface.

  11. Communication style and exercise compliance in physiotherapy (CONNECT. A cluster randomized controlled trial to test a theory-based intervention to increase chronic low back pain patients’ adherence to physiotherapists’ recommendations: study rationale, design, and methods

    Directory of Open Access Journals (Sweden)

    Lonsdale Chris

    2012-06-01

    Full Text Available Abstract Background Physical activity and exercise therapy are among the accepted clinical rehabilitation guidelines and are recommended self-management strategies for chronic low back pain. However, many back pain sufferers do not adhere to their physiotherapist’s recommendations. Poor patient adherence may decrease the effectiveness of advice and home-based rehabilitation exercises. According to self-determination theory, support from health care practitioners can promote patients’ autonomous motivation and greater long-term behavioral persistence (e.g., adherence to physiotherapists’ recommendations. The aim of this trial is to assess the effect of an intervention designed to increase physiotherapists’ autonomy-supportive communication on low back pain patients’ adherence to physical activity and exercise therapy recommendations. Methods/Design This study will be a single-blinded cluster randomized controlled trial. Outpatient physiotherapy centers (N =12 in Dublin, Ireland (population = 1.25 million will be randomly assigned using a computer-generated algorithm to either the experimental or control arm. Physiotherapists in the experimental arm (two hospitals and four primary care clinics will attend eight hours of communication skills training. Training will include handouts, workbooks, video examples, role-play, and discussion designed to teach physiotherapists how to communicate in a manner that promotes autonomous patient motivation. Physiotherapists in the waitlist control arm (two hospitals and four primary care clinics will not receive this training. Participants (N = 292 with chronic low back pain will complete assessments at baseline, as well as 1 week, 4 weeks, 12 weeks, and 24 weeks after their first physiotherapy appointment. Primary outcomes will include adherence to physiotherapy recommendations, as well as low back pain, function, and well-being. Participants will be blinded to treatment allocation, as

  12. A mobile application improves therapy-adherence rates in elderly patients undergoing rehabilitation: A crossover design study comparing documentation via iPad with paper-based control.

    Science.gov (United States)

    Mertens, Alexander; Brandl, Christopher; Miron-Shatz, Talya; Schlick, Christopher; Neumann, Till; Kribben, Andreas; Meister, Sven; Diamantidis, Clarissa Jonas; Albrecht, Urs-Vito; Horn, Peter; Becker, Stefan

    2016-09-01

    Medication adherence is crucial for success in the management of patients with chronic conditions. This study analyzes whether a mobile application on a tablet aimed at supporting drug intake and vital sign parameter documentation affects adherence in elderly patients.Patients with coronary heart disease and no prior knowledge of tablet computers were recruited. They received a personal introduction to the mobile application Medication Plan, installed on an Apple iPad. The study was conducted using a crossover design with 3 sequences: initial phase, interventional phase (28 days of using the app system), and comparative phase (28 days of using a paper diary). Users experienced the interventional and comparative phases alternately.A total of 24 patients (12 males; mean age 73.8 years) were enrolled in the study. The mean for subjectively assessed adherence (A14-scale; 5-point Likert scale, from "never" to "very often" which results in a score from 0 to 56) before the study was 50.0 (SD = 3.44). After both interventions there was a significant increase, which was more pronounced after the interventional phase (54.0; SD = 2.01) than after the comparative phase (52.6; SD = 2.49) (for all pairs after both interventions, P mobile app for medication adherence increased objectively and subjectively measured adherence in elderly users undergoing rehabilitation. The findings have promising clinical implications: digital tools can assist chronic disease patients achieve adherence to medication and to blood pressure measurement. Although this requires initial offline training, it can reduce complications and clinical overload because of nonadherence.

  13. A Randomized Controlled Trial Protocol to Evaluate the Effectiveness of an Integrated Care Management Approach to Improve Adherence Among HIV-Infected Patients in Routine Clinical Care: Rationale and Design.

    Science.gov (United States)

    Crane, Heidi M; Fredericksen, Rob J; Church, Anna; Harrington, Anna; Ciechanowski, Paul; Magnani, Jennifer; Nasby, Kari; Brown, Tyler; Dhanireddy, Shireesha; Harrington, Robert D; Lober, William B; Simoni, Jane; Safren, Stevan A; Edwards, Todd C; Patrick, Donald L; Saag, Michael S; Crane, Paul K; Kitahata, Mari M

    2016-10-05

    Adherence to antiretroviral medications is a key determinant of clinical outcomes. Many adherence intervention trials investigated the effects of time-intensive or costly interventions that are not feasible in most clinical care settings. We set out to evaluate a collaborative care approach as a feasible intervention applicable to patients in clinical care including those with mental illness and/or substance use issues. We developed a randomized controlled trial (RCT) investigating an integrated, clinic-based care management approach to improve clinical outcomes that could be integrated into the clinical care setting. This is based on the routine integration and systematic follow-up of a clinical assessment of patient-reported outcomes targeting adherence, depression, and substance use, and adapts previously developed and tested care management approaches. The primary health coach or care management role is provided by clinic case managers allowing the intervention to be generalized to other human immunodeficiency virus (HIV) clinics that have case managers. We used a stepped-care approach to target interventions to those at greatest need who are most likely to benefit rather than to everyone to maintain feasibility in a busy clinical care setting. The National Institutes of Health funded this study and had no role in study design, data collection, or decisions regarding whether or not to submit manuscripts for publication. This trial is currently underway, enrollment was completed in 2015, and follow-up time still accruing. First results are expected to be ready for publication in early 2017. This paper describes the protocol for an ongoing clinical trial including the design and the rationale for key methodological decisions. There is a need to identify best practices for implementing evidence-based collaborative care models that are effective and feasible in clinical care. Adherence efficacy trials have not led to sufficient improvements, and there remains

  14. Communication style and exercise compliance in physiotherapy (CONNECT): a cluster randomized controlled trial to test a theory-based intervention to increase chronic low back pain patients' adherence to physiotherapists' recommendations: study rationale, design, and methods.

    Science.gov (United States)

    Lonsdale, Chris; Hall, Amanda M; Williams, Geoffrey C; McDonough, Suzanne M; Ntoumanis, Nikos; Murray, Aileen; Hurley, Deirdre A

    2012-06-15

    Physical activity and exercise therapy are among the accepted clinical rehabilitation guidelines and are recommended self-management strategies for chronic low back pain. However, many back pain sufferers do not adhere to their physiotherapist's recommendations. Poor patient adherence may decrease the effectiveness of advice and home-based rehabilitation exercises. According to self-determination theory, support from health care practitioners can promote patients' autonomous motivation and greater long-term behavioral persistence (e.g., adherence to physiotherapists' recommendations). The aim of this trial is to assess the effect of an intervention designed to increase physiotherapists' autonomy-supportive communication on low back pain patients' adherence to physical activity and exercise therapy recommendations. This study will be a single-blinded cluster randomized controlled trial. Outpatient physiotherapy centers (N =12) in Dublin, Ireland (population = 1.25 million) will be randomly assigned using a computer-generated algorithm to either the experimental or control arm. Physiotherapists in the experimental arm (two hospitals and four primary care clinics) will attend eight hours of communication skills training. Training will include handouts, workbooks, video examples, role-play, and discussion designed to teach physiotherapists how to communicate in a manner that promotes autonomous patient motivation. Physiotherapists in the waitlist control arm (two hospitals and four primary care clinics) will not receive this training. Participants (N = 292) with chronic low back pain will complete assessments at baseline, as well as 1 week, 4 weeks, 12 weeks, and 24 weeks after their first physiotherapy appointment. Primary outcomes will include adherence to physiotherapy recommendations, as well as low back pain, function, and well-being. Participants will be blinded to treatment allocation, as they will not be told if their physiotherapist has

  15. A single session of motivational interviewing as an additive means to improve adherence in periodontal infection control: a randomized controlled trial.

    Science.gov (United States)

    Stenman, Jane; Lundgren, Jesper; Wennström, Jan L; Ericsson, Jessica S; Abrahamsson, Kajsa H

    2012-10-01

    To evaluate the effect of a single session of motivational interviewing (MI) on self-performed periodontal infection control. A randomized, examiner masked, controlled clinical trial of 6-month duration was performed involving 44 patients with chronic periodontitis, referred for periodontal treatment. At baseline, all subjects were examined concerning marginal gingival bleeding (MBI) and plaque (PI). Test subjects received a single MI-session before initiation of the periodontal treatment. Otherwise, all patients followed the same treatment protocol for conventional educational intervention and non-surgical periodontal therapy. Efficacy variables for evaluation of self-performed periodontal infection control were MBI (primary variable) and PI. The MI intervention resulted in a negligible decrease (3-4%) in MBI and PI that was not significantly different from the changes observed in the control group without any intervention. Neither was any additive effect of the initial MI-session found on the standard of oral hygiene subsequent to conventional treatment. A desirable MBI score of ≤20% at the end of treatment was associated with being a female patient, whereas high plaque scores at baseline counteracted a corresponding desirable final PI of ≤20%. A single freestanding MI session as a prelude to conventional periodontal treatment had no significant effect on the individuals' standard of self-performed periodontal infection control in a short-term perspective. © 2012 John Wiley & Sons A/S.

  16. Danish Breast Cancer Cooperative Group

    Directory of Open Access Journals (Sweden)

    Christiansen P

    2016-10-01

    Full Text Available Peer Christiansen,1 Bent Ejlertsen,2,3 Maj-Britt Jensen,3 Henning Mouridsen3 1Department of Surgery P, Breast Surgery Unit, Aarhus University Hospital/Randers Regional Hospital, Aarhus C, 2Department of Oncology, Rigshospitalet, Copenhagen University Hospital, 3DBCG-secretariat, Department 2501, Rigshospitalet, Copenhagen Ø, Denmark Aim of database: Danish Breast Cancer Cooperative Group (DBCG, with an associated database, was introduced as a nationwide multidisciplinary group in 1977 with the ultimate aim to improve the prognosis in breast cancer. Since then, the database has registered women diagnosed with primary invasive nonmetastatic breast cancer. The data reported from the departments to the database included details of the characteristics of the primary tumor, of surgery, radiotherapy, and systemic therapies, and of follow-up reported on specific forms from the departments in question. Descriptive data: From 1977 through 2014, ~110,000 patients are registered in the nationwide, clinical database. The completeness has gradually improved to more than 95%. DBCG has continuously prepared evidence-based guidelines on diagnosis and treatment of breast cancer and conducted quality control studies to ascertain the degree of adherence to the guidelines in the different departments. Conclusion: Utilizing data from the DBCG database, a long array of high-quality DBCG studies of various designs and scope, nationwide or in international collaboration, have contributed to the current updating of the guidelines, and have been an instrumental resource in the improvement of management and prognosis of breast cancer in Denmark. Thus, since the establishment of DBCG, the prognosis in breast cancer has continuously improved with a decrease in 5-year mortality from ~37% to 15%. Keywords: breast cancer, database, guidelines, quality control, research

  17. Micronutrient deficiency and treatment adherence in a randomized controlled trial of micronutrient supplementation in ART-naïve persons with HIV.

    Directory of Open Access Journals (Sweden)

    Louise Balfour

    Full Text Available The MAINTAIN study is an on-going RCT comparing high-dose micronutrient and anti-oxidant supplementation versus recommended daily allowance (RDA vitamins in slowing HIV immune deficiency progression in ART-naïve people with HIV infection.We planned analysis of the first 127 participants to determine the baseline prevalence of serum micronutrient deficiencies and correlates, as well as tolerance and adherence to study interventions.Participants receive eight capsules twice daily of 1 high-dose or 2 RDA supplements for two years and are followed-up quarterly for measures of immune deficiency progression, safety and tolerability. Regression analysis was used to identify correlates of micronutrient levels at baseline. Adherence was measured by residual pill count, self-report using the General Treatment Scale (GTS and short-term recall HIV Adherence Treatment Scale (HATS.Prior micronutrient supplementation (within 30 days was 27% at screening and 10% of study population, and was not correlated with baseline micronutrient levels. Low levels were frequent for carotene (24%80% in 75% of participants.Micronutrient levels in asymptomatic HIV+ persons are in keeping with population norms, but micronutrient deficiencies are frequent. Adherence levels are high, and will permit a valid evaluation of treatment effects.ClinicalTrials.gov NCT00798772.

  18. Can we improve cognitive-behavioral therapy for chronic back pain treatment engagement and adherence? A controlled trial of tailored versus standard therapy.

    Science.gov (United States)

    Kerns, Robert D; Burns, John W; Shulman, Marc; Jensen, Mark P; Nielson, Warren R; Czlapinski, Rebecca; Dallas, Mary I; Chatkoff, David; Sellinger, John; Heapy, Alicia; Rosenberger, Patricia

    2014-09-01

    This study evaluated whether tailored cognitive-behavioral therapy (TCBT) that incorporated preferences for learning specific cognitive and/or behavioral skills and used motivational enhancement strategies would improve treatment engagement and participation compared with standard CBT (SCBT). We hypothesized that participants receiving TCBT would show a lower dropout rate, attend more sessions, and report more frequent intersession pain coping skill practice than those receiving SCBT. We also hypothesized that indices of engagement and adherence would correlate with pre- to posttreatment changes in outcome factors. One hundred twenty-eight of 161 consenting persons with chronic back pain who completed baseline measures were allocated to either TCBT or SCBT using a modified randomization procedure. Participants completed daily ratings of pain coping skill practice and goal accomplishment during treatment, as well as measures of pain severity, disability, and other key outcomes at the end of treatment. No significant differences between treatment groups were noted on measures of treatment engagement or adherence. However, these factors were significantly related to some pre- to posttreatment improvements in outcomes, regardless of treatment condition. Participants in this study evidenced a high degree of participation and adherence, but treatment tailored to take into account participant preferences, and that employed motivational enhancement strategies, failed to increase treatment participation over and above SCBT for chronic back pain. Evidence that participation and adherence were associated with positive outcomes supports continued clinical and research efforts focusing on these therapeutic processes. (PsycINFO Database Record (c) 2014 APA, all rights reserved).

  19. Combining malaria control with house electrification: adherence to recommended behaviours for proper deployment of solar-powered mosquito trapping systems, Rusinga Island, western Kenya

    NARCIS (Netherlands)

    Oria, P.A.; Alaii, J.; Ayugi, M.; Takken, W.; Leeuwis, C.

    2015-01-01

    objective To investigate community adherence to recommended behaviours for proper deployment of solar-powered mosquito trapping systems (SMoTS) after 3- to 10-week use. methods Solar-powered mosquito trapping system, which also provided power for room lighting and charging mobile phones, were

  20. Compensatory Beliefs about Glucose Testing are Associated with Low Adherence to Treatment and Poor Metabolic Control in Adolescents with Type 1 Diabetes

    Science.gov (United States)

    Rabiau, Marjorie A.; Knauper, Barbel; Nguyen, Thien-Kim; Sufrategui, Maria; Polychronakos, Constantin

    2009-01-01

    The goal of this research was to investigate whether compensatory beliefs (CBs) regarding glucose testing predict blood glucose levels and adherence to treatment in adolescents with type 1 diabetes. CBs are convictions that the negative effects of one behavior (e.g. not testing one's glucose level) can be compensated for by engaging in another…

  1. How Group-Based Cardiovascular Health Education Affects Treatment Adherence and Blood Pressure Control among Insured Hypertensive Nigerians: A Pre-Test, Post-Test Study

    NARCIS (Netherlands)

    Odusola, A.O.; Nelissen, H.; Hendriks, M.; Schultsz, C.; Wit, F.; Bolarinwa, O.A.; Akande, T.; Agyemang, C.; Ogedegbe, G.; Agbede, K.; Adenusi, P.; Osibogun, A.; Stronks, K.; Haafkens, J.

    2015-01-01

    In sub Saharan Africa (SSA), access to affordable hypertension care through health insurance is increasing. But due to poor adherence, hypertension treatment outcomes often remain poor. Patient-centered educational interventions may reverse this trend. Using a pre-test/post-test design, in this

  2. Cooperative Mobile Sensing Networks

    Energy Technology Data Exchange (ETDEWEB)

    Roberts, R S; Kent, C A; Jones, E D; Cunningham, C T; Armstrong, G W

    2003-02-10

    A cooperative control architecture is presented that allows a fleet of Unmanned Air Vehicles (UAVs) to collect data in a parallel, coordinated and optimal manner. The architecture is designed to react to a set of unpredictable events thereby allowing data collection to continue in an optimal manner.

  3. Adherence to internet-based mobile-supported stress management

    DEFF Research Database (Denmark)

    Zarski, A C; Lehr, D.; Berking, M.

    2016-01-01

    Background: Nonadherence to treatment is a prevalent issue in Internet interventions. Guidance from health care professionals has been found to increase treatment adherence rates in Internet interventions for a range of physical and mental disorders. Evaluating different guidance formats of varying...... of this study was to investigate the influence of different guidance formats (content-focused guidance, adherence-focused guidance, and administrative guidance) on adherence and to identify predictors of nonadherence in an Internet-based mobile-supported stress management intervention (ie, GET.ON Stress...... (content-focused guidance vs waitlist control, adherence-focused guidance vs waitlist control, administrative guidance vs waitlist control). Adherence was defined by the number of completed treatment modules (0-7). An ANOVA was performed to compare the adherence rates from the different guidance formats...

  4. Comparing the Effects of a Novel and a Traditional Proprioceptive Balance Training Program on Activity Adherence and Balance Control in a Healthy University Population: A Preliminary Study.

    Science.gov (United States)

    Melong, Chauntelle; Keats, Melanie R

    2013-10-01

    This study explored balance performance and participant adherence to either the Wii Fit™ (Nintendo of America, Redmond, WA) or a proprioceptive BOSU(®) (Ashland, OH) ball balance program. Twenty university-aged participants were randomly allocated to either a Wii Fit or BOSU ball balance training program. Participants engaged in one of the two training regimens for 20 minutes, three times a week, for 4 weeks. Adherence was measured by recording attendance and time spent at each session. Motivational factors associated with adherence were assessed using the Physical Activity Enjoyment Scale. Balance was measured using a stabilometer. No significant difference in participant adherence was found between the groups. Significantly higher levels of activity enjoyment were reported from participants assigned to the Wii Fit intervention, and a positive correlation was found between physical activity enjoyment and adherence. A significant main effect for time demonstrating improved balance scores for both groups was found. No significant interaction between program type and time was found. Although both interventions led to balance improvements, Wii Fit participants reported significantly higher levels of activity enjoyment. Although these higher levels of enjoyment did not lead to a statistically significant difference between the groups with regard to the number of sessions attended, participants assigned to the Wii Fit group spent more time engaged in the balance training activities than those allocated to the BOSU group. Although this study is preliminary and has the limitations of being statistically underpowered and dissimilar from the unsupervised home-based programs often prescribed by health professionals, results suggest that exergaming-based balance training may be an important adjunct to traditional training programs.

  5. Cooperative design

    DEFF Research Database (Denmark)

    Schmidt, Kjeld

    1998-01-01

    In the contemporary world, engineers and designers face huge challenges as they shift towards novel organizational concepts such as ‘concurrent engineering’ in order to manage increasing product diversity so as to satisfy customer demands while trying to accelerate the design process to deal...... with the competitive realities of a global market and decreasing product life cycles. In this environment, the coordination and integration of the myriads of interdependent and yet distributed and concurrent design activities becomes enormously complex. It thus seems as if CSCW technologies may be indispensable...... if concurrent engineering is to succeed. On the basis of ethnographic studies of cooperative design, the paper attempts to characterize cooperative work in the domain of design and to outline a set of crucial research problems to be addressed if CSCW is to help engineers and de-signers meet the challenges...

  6. The effect of providing feedback on inhaler technique and adherence from an electronic audio recording device, INCA®, in a community pharmacy setting: study protocol for a randomised controlled trial.

    Science.gov (United States)

    O'Dwyer, Susan Mary; MacHale, Elaine; Sulaiman, Imran; Holmes, Martin; Hughes, Cian; D'Arcy, Shona; Rapcan, Viliam; Taylor, Terence; Boland, Fiona; Bosnic-Anticevich, Sinthia; Reilly, Richard B; Ryder, Sheila A; Costello, Richard W

    2016-05-04

    Poor adherence to inhaled medication may lead to inadequate symptom control in patients with respiratory disease. In practice it can be difficult to identify poor adherence. We designed an acoustic recording device, the INCA® (INhaler Compliance Assessment) device, which, when attached to an inhaler, identifies and records the time and technique of inhaler use, thereby providing objective longitudinal data on an individual's adherence to inhaled medication. This study will test the hypothesis that providing objective, personalised, visual feedback on adherence to patients in combination with a tailored educational intervention in a community pharmacy setting, improves adherence more effectively than education alone. The study is a prospective, cluster randomised, parallel-group, multi-site study conducted over 6 months. The study is designed to compare current best practice in care (i.e. routine inhaler technique training) with the use of the INCA® device for respiratory patients in a community pharmacy setting. Pharmacies are the unit of randomisation and on enrolment to the study they will be allocated by the lead researcher to one of the three study groups (intervention, comparator or control groups) using a computer-generated list of random numbers. Given the nature of the intervention neither pharmacists nor participants can be blinded. The intervention group will receive feedback from the acoustic recording device on inhaler technique and adherence three times over a 6-month period along with inhaler technique training at each of these times. The comparator group will also receive training in inhaler use three times over the 6-month study period but no feedback on their habitual performance. The control group will receive usual care (i.e. the safe supply of medicines and advice on their use). The primary outcome is the rate of participant adherence to their inhaled medication, defined as the proportion of correctly taken doses of medication at the correct

  7. Improvement in medication adherence and self-management of diabetes with a clinical pharmacy program: a randomized controlled trial in patients with type 2 diabetes undergoing insulin therapy at a teaching hospital

    Directory of Open Access Journals (Sweden)

    Catarina Gomes Cani

    2015-02-01

    Full Text Available OBJECTIVE: To evaluate the impact of a clinical pharmacy program on health outcomes in patients with type 2 diabetes undergoing insulin therapy at a teaching hospital in Brazil. METHOD: A randomized controlled trial with a 6-month follow-up period was performed in 70 adults, aged 45 years or older, with type 2 diabetes who were taking insulin and who had an HbA1c level ≥8%. Patients in the control group (CG (n = 36 received standard care, patients in the intervention group (IG (n = 34 received an individualized pharmacotherapeutic care plan and diabetes education. The primary outcome measure was change in HbA1c. Secondary outcomes included diabetes and medication knowledge, adherence to medication, insulin injection and home blood glucose monitoring techniques and diabetes-related quality of life. Outcomes were evaluated at baseline and 6 months using questionnaires. RESULTS: Diabetes knowledge, medication knowledge, adherence to medication and correct insulin injection and home blood glucose monitoring techniques significantly improved in the intervention group but remained unchanged in the control group. At the end of the study, mean HbA1c values in the control group remained unchanged but were significantly reduced in the intervention group. Diabetes-related quality of life significantly improved in the intervention group but worsened significantly in the control group. CONCLUSION: The program improved health outcomes and resulted in better glycemic control in patients with type 2 diabetes undergoing insulin therapy.

  8. Movement Performance of Human-Robot Cooperation Control Based on EMG-Driven Hill-Type and Proportional Models for an Ankle Power-Assist Exoskeleton Robot.

    Science.gov (United States)

    Ao, Di; Song, Rong; Gao, JinWu

    2017-08-01

    Although the merits of electromyography (EMG)-based control of powered assistive systems have been certified, the factors that affect the performance of EMG-based human-robot cooperation, which are very important, have received little attention. This study investigates whether a more physiologically appropriate model could improve the performance of human-robot cooperation control for an ankle power-assist exoskeleton robot. To achieve the goal, an EMG-driven Hill-type neuromusculoskeletal model (HNM) and a linear proportional model (LPM) were developed and calibrated through maximum isometric voluntary dorsiflexion (MIVD). The two control models could estimate the real-time ankle joint torque, and HNM is more accurate and can account for the change of the joint angle and muscle dynamics. Then, eight healthy volunteers were recruited to wear the ankle exoskeleton robot and complete a series of sinusoidal tracking tasks in the vertical plane. With the various levels of assist based on the two calibrated models, the subjects were instructed to track the target displayed on the screen as accurately as possible by performing ankle dorsiflexion and plantarflexion. Two measurements, the root mean square error (RMSE) and root mean square jerk (RMSJ), were derived from the assistant torque and kinematic signals to characterize the movement performances, whereas the amplitudes of the recorded EMG signals from the tibialis anterior (TA) and the gastrocnemius (GAS) were obtained to reflect the muscular efforts. The results demonstrated that the muscular effort and smoothness of tracking movements decreased with an increase in the assistant ratio. Compared with LPM, subjects made lower physical effort