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Prescription refill adherence before and after patient portal registration in among General Practice patients in England using the Clinical Practice Research Datalink: longitudinal observational study
No full textBackground: Patient portal use has been associated with improved patient health and improved adherence to medications, including statins. However, there is limited research on the association between patient portal registration and outcomes such as statin prescription refill adherence in the context of the National Health Service of England, where patient portals have been widely available since 2015.
Objective: We aimed to explore statin prescription refill adherence among general practice patients in England.
Methods: This study was approved by the Clinical Practice Research Datalink Independent Scientific Advisory Committee (ID: 21_000411). We used patient-level general practice data from the Clinical Practice Research Datalink in England. The data included patients with cardiovascular disease, diabetes, and chronic kidney disease, who were registered on the patient portal. The primary aim was to investigate whether statin prescription refill adherence, defined as ≥80% adherence based on the medication possession ratio, improved after patient portal registration. We used a multilevel logistic regression model to compare aggregate adherence 12 months before and 12 months after patient portal registration.
Results: We included 44,141 patients in the study. The analysis revealed a 16% reduction in the odds of prescription refill adherence 12 months after patient portal registration (odds ratio [OR]: 0.84, 95% CI 0.81-0.86) compared to 12 months before registration in the fully adjusted model for patient- and practice-level variables.
Conclusions:
This study evaluated prescription refill adherence after patient portal registration. Registering to the portal does not fully explain the mechanisms underlying the relationship between patient portal use and health-related outcomes such as medication adherence. Although a small reduction in prescription refill adherence was observed, this reduction disappeared when the follow up time was reduced to 6 months. Given the limitations of the study, reduction in prescription refill adherence cannot be entirely attributable to patient portal registration. However, there may be potential confounding factors influencing this association which should be explored through future research
Flash thermal racemization of chiral amine in continuous flow: an exploration of reaction space using doe and multivariate transient flow
No full textThe robustness of the flash thermal racemization of optically active 1-phenylethylamine over Pd/γ-Al2O3 was studied by applying split-plot design-of-experiments (DoE), where the effects of temperature, flow rate, and concentration (3-factors) on the e.e. and selectivity (2-responses) were examined and quantified. The same effects were also interrogated using multivariate ramps in transient flow to produce response surfaces for the reaction space. The same set of optimal conditions for the process was identified by both approaches, and the same relationships between the variables were observed: while the extent of racemization (e.e.) can be directly correlated to temperature, a more complex relationship between temperature and flow rate on the selectivity was uncovered
The utility of spirometry and single breath gas transfer measurements to identify low total lung capacity
No full textBackground
Measurement of total lung capacity (TLC) requires large and expensive equipment. We aimed to investigate whether spirometric restriction and low alveolar volume measured by single breath gas transfer (VA) can be used to identify those with a low TLC.
Methods
We retrospectively analysed data from adults referred to Cambridge University Hospitals between January 2016 and December 2023. We investigated the utility of spirometric restriction (FVC <LLN with FEV1/FVC ≥LLN) and reduced VA (<LLN), to discriminate low TLC measured by plethysmography (TLCpleth <LLN). We assessed agreement between definitions using the Cohen's Kappa coefficient and the discriminative ability of spirometric restriction and reduced VA to identify TLCpleth <LLN.
Results
Data from 7923 patients were included. The majority (94%) of patients were of European ancestry, 51% were female. Mean age was 58 years. 11% of patients had a TLCpleth <LLN, of which 27% also had spirometric restriction, and 95% had a VA <LLN. Agreement between spirometric restriction and TLCpleth <LLN was fair (kappa =0.37). Spirometric restriction had low sensitivity (27%) but high specificity (99%) for discriminating TLCpleth <LLN. Agreement between VA <LLN and TLCpleth <LLN was substantial (kappa=0.63). VA <LLN had good sensitivity (95%) and specificity (89%) for discriminating TLCpleth <LLN, except for in patients with the most severe airflow obstruction.
Conclusions
A FVC in the healthy range is an effective tool for ruling out restriction. Low VA can be used to accurately identify those with a low TLC, negating the need for formal measurement of static lung volumes when identifying restrictive lung disease
Cost-effectiveness of total shoulder arthroplasty compared to hemiarthroplasty. A study using data from the National Joint Registry
No full textObjectives The aim of this study was to compare the cost-effectiveness of total shoulder arthroplasty (TSA) and hemiarthroplasty (HA) and explore variation by age and gender.
Design Cost-effectiveness analysis using a lifetime cohort Markov model.
Setting National population registry data.
Participants Model parameters were informed by propensity score-matched comparisons of TSA and HA in patients with osteoarthritis and an intact rotator cuff using data from the National Joint Registry.
Interventions TSA and HA.
Primary outcome measures Quality-adjusted life years (QALYs) and healthcare costs for age and gender subgroups. A probabilistic sensitivity analysis was performed.
Results In all subgroups, TSA was more cost-effective, with the probability of being cost-effective about 70% for TSA versus 30% for HA at any willingness-to-pay threshold above £1100 per QALY. TSA was dominant in young patients (≤60 years) with a mean cost saving of £463 in men and £658 in women, and a mean QALY gain of 2 in both men and women. In patients aged 61–75 years, there was a mean cost saving following HA of £395 in men and £181 in women, while QALYs remained superior following TSA with a 1.3 gain in men and 1.4 in women. In the older cohort (> 75 years), the cost difference was highest and the QALY difference was lowest; there was a cost-saving following HA of £905 in men and £966 in women. The mean QALY gain remained larger after TSA: 0.7 in men and 0.9 in women.
Conclusion TSA was more cost-effective than HA in patients with osteoarthritis. QALYs were superior following TSA in all patient groups. Cost differences varied by age and TSA was dominant in young patients
Identification of barriers and needs in the discontinuation of benzodiazepine receptor agonists in elderly patients of a rural community—a qualitative study
No full textBackground/Objectives: The predictors of successful discontinuation of benzodiazepine agonist receptors (BZRA) in elderly patients are not well known due to lack of research on the subject, and there is a need for further investigation, with more focus from the patients’ point of view. No previous studies were identified that have been conducted in Portugal on this subject. We proposed to identify the barriers and facilitators in the discontinuation of BZRA from the perceptions of elderly patients under prolonged prescription of BZRA, belonging to the same rural community. The contributions for further research are intended to be the identification of potential intervention targets directed at patients to reduce the prevalence of elderly patients under prolonged prescription of BZRA. Methods: A set of 15 semi-structured interviews with patients under prolonged prescription of BZRA was conducted. Content analysis was done by the main researcher and a reviewer to identify original emerging themes for the two underlying domains. Results: Four themes were identified as barriers to the discontinuation of BZRA: (1) patient characteristics, (2) clinical factors, (3) medication-related factors, and (4) context and external factors. Seven themes were identified as facilitators to the discontinuation of BZRA: (1) motivation, (2) patients’ knowledge, (3) perception of BZRA insufficiency, (4) access to written information, (5) access to alternatives, (6) time for decision-making, and (7) attitudes of health professionals. Conclusions: The findings highlight the challenging nature of BZRA discontinuation and the range of barriers and facilitators that impact patients’ behaviour towards this purpose. We subdivided the elements identified in two areas, therefore aiming at producing significant knowledge to outline potential intervention targets
Heterogeneous graph neural networks with post-hoc explanations for multi-modal and explainable land use inference
No full textRecently, the increased use of sensor and location technologies has facilitated the collection of multi-modal mobility data, offering valuable insights into daily activity patterns. Many studies have adopted advanced data-driven techniques to explore the potential of these multi-modal mobility data in land use inference. However, existing studies often process samples independently, ignoring the spatial correlations among neighbouring objects and heterogeneity among different services. Furthermore, the inherently low interpretability of complex deep learning methods poses a significant barrier in urban planning, where transparency and extrapolability are crucial for making long-term policy decisions. To overcome these challenges, we introduce an explainable framework for inferring land use that synergises heterogeneous graph neural networks (HGNs) with Explainable AI techniques, enhancing both accuracy and explainability. We evaluate the proposed approach on three cities with different urban layout and mobility combinations: London (with tube, bus and bike sharing data sources), San Francisco (parking and bike sharing), and New York City (metro and bike sharing). The empirical experiments demonstrate that the proposed HGNs significantly outperform baseline graph neural networks for all six land use indicators, especially in terms of ‘office’ and ‘sustenance’. We then deploy feature attribution (at both temporal and spacial levels) and counterfactual explanations, which shed light on several important findings. The node-based feature attribution explanations show that the symmetrical nature of the ‘residence’ and ‘work’ categories predicted by the framework aligns well with the commuters’ ‘work’ and ‘recreation’ activities. Meanwhile, the spatial feature attribution explanations indicates that the heightened central importance of commercial categories and the dominance of residential influences in outer zones align closely with typical urban structures. Finally, the counterfactual explanations reveal that variations in node features and types are primarily responsible for the differences observed between the predicted land use distribution and the ideal mixed state. These analyses demonstrate that the proposed HGNs can suitably support urban stakeholders in their urban planning and policy-making. The source code is available at https://github.com/xuehao0806/GNN-land-use
The association between fibrotic diseases and treatment resistant hypertension in England
No full textAims
Multimorbidity has been identified as a research priority in recent years; fibrosis (progressive organ scarring) is one mechanism that may underpin multimorbidity. Some studies suggest hypertension could be fibrotic, particularly severe hypertension (uncontrollable with medications); however, it is not currently known whether severe hypertension is associated with fibrotic conditions. The objective is to investigate whether treatment-resistant hypertension is associated with fibrotic conditions.
Methods and results
We used the Clinical Practice Research Datalink Aurum primary care database to define a cohort of people with hypertension during 2015. We determined the percentage of people who had conditions with fibrotic manifestations and explored differences respective to hypertension control. We applied multivariable logistic regression to analyse associations (P < 0.001) between hypertension control and each fibrotic condition, respectively. Of 1 340 495 people with hypertension during 2015, 83.50% (n = 1 119 333) had managed hypertension either by lifestyle or by medication; 16.50% (n = 221 162) had treatment-resistant hypertension. Fibrotic conditions were more common {75.40% [95% confidence interval (CI): 75.20–75.60] vs. 68.90% (95% CI: 68.81–70.01)} in people with treatment-resistant hypertension compared with those with managed hypertension. We found that treatment-resistant hypertension was associated with cardiomyopathy (ORadj: 1.85, 95% CI: 1.81–1.90), both Type 1 and Type 2 diabetes (ORadj: 1.49, 95% CI: 1.44–1.55, ORadj: 1.61, 95% CI: 1.60–1.63, respectively), liver fibrosis (ORadj: 1.52, 95% CI: 1.46–1.58), valve fibrosis (ORadj: 1.41, 95% CI: 1.37–1.44), and urinary fibrosis (ORadj: 1.41, 95% CI: 1.36–1.47).
Conclusion
The proportion of people with fibrotic conditions was greater in those with treatment-resistant hypertension than managed hypertension. The identified associations between treatment-resistant hypertension and fibrotic conditions may point to common disease pathways, which should be further explored to understand shared mechanisms
AQUA-SLAM: tightly-coupled underwater acoustic-visual-Inertial SLAM with sensor calibration
No full textUnderwater environments pose significant challenges for visual simultaneous localization and mapping (SLAM) systems due to limited visibility, inadequate illumination, and sporadic loss of structural features in images. Addressing these challenges, this article introduces a novel, tightly coupled acoustic-visual-inertial SLAM approach, termed AQUA-SLAM, to fuse a Doppler velocity log (DVL), a stereo camera, and an inertial measurement unit (IMU) within a graph optimization framework. Moreover, we propose an efficient sensor calibration technique, encompassing the multisensor extrinsic calibration (among the DVL, camera, and IMU) and the DVL transducer misalignment calibration, with a fast linear approximation procedure for real-time online execution. The proposed methods are extensively evaluated in a tank environment with ground truth, and validated for offshore applications in the North Sea. The results demonstrate that our method surpasses current state-of-the-art underwater and visual-inertial SLAM systems in terms of localization accuracy and robustness. The proposed system will be made open-source for the community
Self-initiated humour protocol: a pilot study with an AI agent
No full textIntroduction: Non-hostile humour and laughter have been known for therapeutic benefits in an individual’s mental health and wellbeing. To this end, we evaluated the Self-Initiated Humour Protocol (SIHP), a new type of self-administrable laughter intervention that utilises spontaneous and self-induced laughter. Rooted in the core principles of the Self-Attachment Technique—in which an individual creates an affectional bond with their childhood self as represented by their childhood photo or personalised childhood avatar—SIHP provides an algorithmic framework for individuals to learn to laugh in a non-hostile manner and develop a sense of humour in all possible life contexts. This allows SIHP to be self-administered by interacting with an AI agent.
Methods: An 8-week intervention was conducted with N = 27 adult participants. Exclusion criteria: severe depression or anxiety (PHQ-9 and GAD-7 scores above 15). Participants’ measurements were collected in the areas of wellbeing, use of different humour styles, emotional self-regulation, self-compassion and psychological capital, and analysed to understand any changes over time. Measurements were taken immediately before, after the intervention, and at the 3-month follow-up. Throughout the intervention, participants were required to practise SIHP 20 min a day with the aid of an emotionally intelligent chatbot and their personalised child avatar in virtual reality (VR).
Results: Analysis of results at the 3-month follow-up showed significant improvements in the primary outcome of wellbeing with large effect size (
r
=
0.92
), as well as a range of secondary outcomes with large effect sizes, self-compassion (
r
=
0.93
), use of self-enhancing humour (
d
=
0.80
), and emotion regulation (
d
=
0.87
); the results also showed improvement to participant’s psychological capital with moderate effect size (
d
=
0.56
).
Discussion: This study shows the potential for the practice of SIHP as supported by an emotionally intelligent chatbot and personalised child avatar to have medium-term positive effects, which should be validated through future randomised trials