Adherence to treatment in children and adolescents with cystic fibrosis: a cross-sectional, multi-method study investigating the influence of beliefs about treatment and parental depressive symptoms

BACKGROUND: Adherence to treatment is often reported to be low in children with cystic fibrosis. Adherence in cystic fibrosis is an important research area and more research is needed to better understand family barriers to adherence in order for clinicians to provide appropriate intervention. The aim of this study was to evaluate adherence to enzyme supplements, vitamins and chest physiotherapy in children with cystic fibrosis and to determine if any modifiable risk factors are associated with adherence.

METHODS: A sample of 100 children (≤18 years) with cystic fibrosis (44 male; median [range] 10.1 [0.2-18.6] years) and their parents were recruited to the study from the Northern Ireland Paediatric Cystic Fibrosis Centre. Adherence to enzyme supplements, vitamins and chest physiotherapy was assessed using a multi-method approach including; Medication Adherence Report Scale, pharmacy prescription refill data and general practitioner prescription issue data. Beliefs about treatments were assessed using refined versions of the Beliefs about Medicines Questionnaire-specific. Parental depressive symptoms were assessed using the Center for Epidemiologic Studies Depression Scale.

RESULTS: Using the multi-method approach 72% of children were classified as low-adherers to enzyme supplements, 59% low-adherers to vitamins and 49% low-adherers to chest physiotherapy. Variations in adherence were observed between measurement methods, treatments and respondents. Parental necessity beliefs and child age were significant independent predictors of child adherence to enzyme supplements and chest physiotherapy, but parental depressive symptoms were not found to be predictive of adherence.

CONCLUSIONS: Child age and parental beliefs about treatments should be taken into account by clinicians when addressing adherence at routine clinic appointments. Low adherence is more likely to occur in older children, whereas, better adherence to cystic fibrosis therapies is more likely in children whose parents strongly believe the treatments are necessary. The necessity of treatments should be reinforced regularly to both parents and children.

Modelling of Organic Rankine Cycle for Waste Heat Recovery Process in Supercritical Condition

Organic Rankine Cycle (ORC) is the most commonly used method for recovering energy from small sources of heat. The investigation of the ORC in supercritical condition is a new research area as it has a potential to generate high power and thermal efficiency in a waste heat recovery system. This paper presents a steady state ORC model in supercritical condition and its simulations with a real engine’s exhaust data. The key component of ORC, evaporator, is modelled using finite volume method, modelling of all other components of the waste heat recovery system such as pump, expander and condenser are also presented. The aim of this paper is to investigate the effects of mass flow rate and evaporator outlet temperature on the efficiency of the waste heat recovery process. Additionally, the necessity of maintaining an optimum evaporator outlet temperature is also investigated. Simulation results show that modification of mass flow rate is the key to changing the operating temperature at the evaporator outlet.

The importance of understanding the behavioural phenotypes of genetic syndromes associated with intellectual disability

Behavioural phenotype research is of benefit to a large number of children with genetic syndromes and associated developmental delay. This article presents an overview of this research area and demonstrates how understanding pathways between gene disorders and behaviour can inform our understanding of the difficulties individuals with genetic syndromes and developmental delay experience, including self-injurious behaviour, social exploitation, social anxiety, social skills deficits, sensory differences, temper outbursts and repetitive behaviours. In addition, physical health difficulties and their interaction with behaviour are considered. The article demonstrates the complexity involved in assessing a child with a rare genetic syndrome.

On the Limits of Exceptionalism: Principles and Practice in the Pursuit of Alternatives to Full EU Membership

Few states have been less uncomfortable with the relationship they have with the EU than the United Kingdom as a member and Turkey as an associate and would-be member. Both states currently find themselves questioning the substance and future of these relationships with domestic actors and, notably in the Turkish case, external EU voices actively advocating alternatives. While much discussion, particularly in the UK case, has focused on the advantages and disadvantages of particular existing arrangements (e.g. European Economic Area, Swiss bilateralism), this paper considers the broader principles and practices that the EU has to date either explicitly developed or implicitly established to govern the nature and substance of alternatives to [full] EU membership. It assesses the principled, practical and political limitations that exist in establishing alternatives to full membership for states seeking – or having sought for them – the accommodation of their exceptionalism. In doing so the paper considers the potential limits to a renegotiated EU membership for the UK and to an alternative short of full membership for Turkey. It also reflects on the precedent-setting consequences of any new arrangements that the EU might reach with either state for what forms membership and a relationship short of membership might take in the future.

Advanced materials for recognition and capture of whole cells and microorganisms

Selective cell recognition and capture has recently attracted significant interest due to its potential importance for clinical, diagnostic, environmental, and security applications. Current methods for cell isolation from complex samples are largely dependent on cell size and density, with limited application scope as many of the target cells do not exhibit appreciable differences in this respect. The most recent and forthcoming developments in the area of selective recognition and capture of whole cells, based on natural receptors, as well as synthetic materials utilising physical and chemical properties of the target cell or microorganism, are highlighted. Particular focus is given to the development of cell complementary surfaces using the cells themselves as templating agents, by means of molecular imprinting, and their combination with sensing platforms for rapid cell detection in complex media. The benefits and challenges of each approach are discussed and a perspective of the future of this research area is given.

Advances in single-shot, dry drilling of composite/metal stacks

Carbon fibre reinforced polymers (CFRP) are increasingly being used in the aerospace, automotive and defence industry due to their high specific stiffness and good corrosion resistance. In a modern aircraft, 50-60% of its structure is made up of CFRP material while the remainder is mostly a combination of metallic alloys (typically aluminium or titanium alloys). Mechanical fastening (bolting or riveting) of CFRP and metallic components has thus created a pressing requirement of drilling several thousand holes per aircraft. Drilling of stacks in a single-shot not only saves time, but also ensures proper alignment when fasteners are inserted, achieving tighter geometric tolerances. However, this requirement poses formidable manufacturing challenges due to the fundamental differences in the material properties of CFRP and metals e.g. a drill bit entering into the stack encounters brittle and abrasive CFRP material as well as the plastic behaviour of the metallic alloy, making the drilling process highly non-linear.

Over the past few years substantial efforts have been made in this direction and majority of the research has tried to establish links between how the process parameters (feed, depth of cut, cutting speed), tooling (geometry, material and coating) and the wear of the cutting tool affect the hole quality. Similarly, multitudes of investigations have been conducted to determine the effects of non-traditional drilling methods (orbital, helical and vibration assisted drilling), cutting zone temperatures and efficiency of chip extraction on the hole quality and rate of tool wear during single shot drilling of CFRP/alloy stacks.

In a timely effort, this paper aims at reviewing the manufacturing challenges and barriers faced when drilling CFRP/alloy stacks and to summarise various factors influencing the drilling process while detailing the advances made in this fertile research area of single-shot drilling of stack materials. A survey of the key challenges associated with avoiding workpiece damage and the effect these challenges have on tool design and process optimisation is presented. An in depth critique of suitable hole making methods and their aptness for commercialisation follows. The paper concludes by summarising the future work required to achieve repeatable, high quality single shot drilled holes in CFRP/alloy stacks.