Search

The pressure in a series of Hydrothermal Diamond Anvil Cell (HDAC) experiments with water plus haplogranite was determined via in-situ observation of the alpha to beta quartz transformation in the range 130–900 MPa and 600–800 °C, by means of laser interferometry. The pressures measured at the alpha-beta quartz transformation temperature are found to be similar or less than the values estimated using the EOS of pure water (including the error) for runs where the transition temperature is ≤ 665 °C. On the contrary, at ~ 780 °C the pressure in the HDAC is ~ 100 MPa greater than that estimated using pure water isochore. A simplified model of haplogranite dissolution in water for an isochoric sample chamber is proposed to explain the negative sign and the variation of the observed discrepancy between measured and calculated pressure. We suggest that, beyond the change in the intrinsic properties of the fluid phase with increasing solute concentration, two factors control the P – T path in the HDAC: (1) hydration of the glass prior to the glass transition; and (2) changing volume of the aqueous pressure medium. The measurements made in this study demonstrate that laser interferometry on quartz inversion is an effective tool for precise pressure determination in HDAC experiments aimed at the investigation of physical and chemical properties of quartz-saturated hydrous melts in the mid and upper continental crust (i.e., P < 1 GPa). [ABSTRACT FROM AUTHOR]

• Historic cohorts suggested that supply of inhaled medicines may exceed actual use. • This is the first study to directly compare medicine supply (MPR) against adherence. • Among 275 adults in 12 CF centres, MPR over-estimates adherence by a median of 14%. • Even with 20% contingency, mean annual cost of excess supply was £1,124/patient. • Excess supply cost was higher in those with adherence <50% (mean £2,017/patient). Studies in separate cohorts suggest possible discrepancies between inhaled medicines supplied (median 50-60%) and medicines used (median 30-40%). We performed the first study that directly compares CF medicine supply against use to identify the cost of excess medicines supply. This cross-sectional study included participants from 12 UK adult centres with ≥1 year of continuous adherence data from data-logging nebulisers. Medicine supply was measured as medication possession ratio (MPR) for a 1-year period from the first suitable supply date. Medicine use was measured as electronic data capture (EDC) adherence over the same period. The cost of excess medicines was calculated as whole excess box(es) supplied after accounting for the discrepancy between EDC adherence and MPR with 20% contingency. Among 275 participants, 133 (48.4%) were females and mean age was 30 years (95% CI 29-31 years). Median EDC adherence was 57% (IQR 23-86%), median MPR was 74% (IQR 46-96%) and the discrepancy between measures was median 14% (IQR 2-29%). Even with 20% contingency, mean potential cost of excess medicines was £1,124 (95% CI £855-1,394), ranging from £183 (95% CI £29-338) for EDC adherence ≥80% to £2,017 (95% CI £1,507-2,526) for EDC adherence <50%. This study provides a conservative estimate of excess inhaled medicines supply cost among adults with CF in the UK. The excess supply cost was highest among those with lowest EDC adherence, highlighting the importance of adherence support and supplying medicine according to actual use. MPR provides information about medicine supply but over-estimates actual medicine use. [ABSTRACT FROM AUTHOR]

Background Extra-oesophageal reflux (EOR) may lead to microaspiration in patients with cystic fibrosis (CF), a probable cause of deteriorating lung function. Successful clinical trials of ivacaftor highlight opportunities to understand EOR in a real world study. Methods Data from 12 patients with CF and the G551D mutation prescribed ivacaftor (150 mg bd) was collected at baseline, 6, 26 and 52 weeks. The changes in symptoms of EOR were assessed by questionnaire (reflux symptom index (RSI) and Hull airway reflux questionnaire (HARQ)). Results Six patients presented EOR at baseline (RSI > 13; median 13; range 2–29) and 5 presented airway reflux (HARQ > 13; median 12; range 3 to 33). Treatment with ivacaftor was associated with a significant reduction of EOR symptoms (P < 0 ∙ 04 versus baseline) denoted by the reflux symptom index and Hull airway reflux questionnaire. Conclusion Ivacaftor treatment was beneficial for patients with symptoms of EOR, thought to be a precursor to microaspiration. [ABSTRACT FROM AUTHOR]