S. K. Park

Background Older adults often face challenges in self-managing their medication owing to physical and cognitive limitations, complex medication regimens, and packaging of medications. Emerging smart medication dispensing and adherence products (SMAPs) offer the options of automated dispensing, tracking medication intake in real time, and reminders and notifications. A 2021 review identified 51 SMAPs owing to the rapid influx of digital technology; an update to this review is required. Objective This review aims to identify new products and summarize and compare the key features of SMAPs. Methods Gray and published literature and videos were searched using Google, YouTube, PubMed, Embase, and Scopus. The first 10 pages of Google and the first 100 results of YouTube were screened using 4 and 5 keyword searches, respectively. SMAPs were included if they were able to store and allowed for the dispensation of medications, tracked real-time medication intake data, and could automatically analyze data. Products were excluded if they were stand-alone software applications, not marketed in English, not for in-home use, or only used in clinical trials. In total, 5 researchers independently screened and extracted the data. Results This review identified 114 SMAPs, including 80 (70.2%) marketed and 34 (29.8%) prototypes, grouped into 15 types. Among the marketed products, 68% (54/80) were available for consumer purchase. Of these products, 26% (14/54) were available worldwide and 78% (42/54) were available in North America. There was variability in the hardware, software, data collection and management features, and cost of the products. Examples of hardware features include battery life, medication storage capacity, availability of types and number of alarms, locking features, and additional technology required for use of the product, whereas software features included reminder and notification capabilities and availability of manufacturer support. Data capture methods included the availability of sensors to record the use of the product and data-syncing capabilities with cloud storage with short-range communications. Data were accessible to users via mobile apps or web-based portals. Some SMAPs provided data security assurance with secure log-ins (use of personal identification numbers or facial recognition), whereas other SMAPs provided data through registered email addresses. Although some SMAPs were available at set prices or free of cost to end users, the cost of other products varied based on availability, shipping fees, and subscription fees. Conclusions An expanding market for SMAPs with features specific to at-home patient use is emerging. Health care professionals can use these features to select and suggest products that meet their patients’ unique requirements.

The CMS muon system includes in both the barrel and endcap region Resistive Plate Chambers (RPC). They mainly serve as trigger detectors and also improve the reconstruction of muon parameters. Over the years, the instantaneous luminosity of the Large Hadron Collider gradually increases. During the LHC Phase 1 (~first 10 years of operation) an ultimate luminosity is expected above its design value of 10^34/cm^2/s at 14 TeV. To prepare the machine and also the experiments for this, two long shutdown periods are scheduled for 2013-2014 and 2018-2019. The CMS Collaboration is planning several detector upgrades during these long shutdowns. In particular, the muon detection system should be able to maintain a low-pT threshold for an efficient Level-1 Muon Trigger at high particle rates. One of the measures to ensure this, is to extend the present RPC system with the addition of a 4th layer in both endcap regions. During the first long shutdown, these two new stations will be equipped in the region |eta|<1.6 with 144 High Pressure Laminate (HPL) double-gap RPCs operating in avalanche mode, with a similar design as the existing CMS endcap chambers. Here, we present the upgrade plans for the CMS RPC system for the fist long shutdown, including trigger simulation studies for the extended system, and details on the new HPL production, the chamber assembly and the quality control procedures.

The HL-LHC phase is designed to increase by an order of magnitude the amount of data to be collected by the LHC experiments. To achieve this goal in a reasonable time scale the instantaneous luminosity would also increase by an order of magnitude up to 6 · 1034 cm−2s−1. The region of the forward muon spectrometer (|η| > 1.6) is not equipped with RPC stations. The increase of the expected particles flux up to 2 kHz/cm2 (including a safety factor 3) motivates the installation of RPC chambers to guarantee redundancy with the CSC chambers already present. The current CMS RPC technology cannot sustain the expected background level. The new technology that will be chosen should have a high rate capability and provide a good spatial and timing resolution. A new generation of Glass-RPC (GRPC) using low-resistivity glass is proposed to equip at least the two most far away of the four high η muon stations of CMS. First the design of small size prototypes and studies of their performance in high-rate particles flux are presented. Then the proposed designs for large size chambers and their fast-timing electronic readout are examined and preliminary results are provided.

We report on a systematic study of double-gap and four-gap phenolic resistive plate chambers (RPCs) for the Phase-2 upgrade of the CMS muon system at high η. In the present study, we constructed real-sized double-gap and four-gap RPCs with gap thicknesses of 1.6 and 0.8 mm, respectively, with 2-mm-thick phenolic high-pressure-laminated (HPL) plates. We examined the prototype RPCs with cosmic rays and with 100-GeV muons provided by the SPS H4 beam line at CERN. To examine the rate capability of the prototype RPCs both at Korea University and at the CERN GIF++ facility, the chambers were irradiated with 137Cs sources providing maximum gamma rates of about 1.5 kHz cm−2. For the 1.6-mm-thick double-gap RPCs, we found the relatively high threshold on the produced detector charge was conducive to effectively suppressing the rapid increase of strip cluster sizes of muon hits with high voltage, especially when measuring the narrow-pitch strips. The gamma-induced currents drawn in the four-gap RPC were about one-fourth of those drawn in the double-gap RPC. The rate capabilities of both RPC types, proven through the present testing using gamma-ray sources, far exceeded the maximum rate expected in the new high-η endcap RPCs planned for future phase-II runs of the Large Hadron Collider (LHC).

<h3>Context:</h3> To ensure older adults with multiple chronic conditions can age comfortably at home, safe and effective medication management is crucial. However, complex medication routines and functional limitations often make adherence challenging. Although medication adherence technologies hold promise, the absence of a standardized classification system based on attributes impedes effective communication, and comparison by clinicians and researchers, as well as the selection of the most suitable technologies for older adults based on their abilities. <h3>Objective:</h3> To develop a classification system for medication adherence technologies based on an inventory of characteristics and features of existing technology. <h3>Study Design and Analysis:</h3> The study used the Taxonomy Development Method. Five research team members defined the users of the taxonomy, determined the meta-characteristics, ending conditions, and utilized both the empirical-to-conceptual and conceptual-to-empirical approaches. A subset of 23 medication adherence devices were examined to identify common characteristics. These characteristics were then organized into dimensions and sub-dimensions to create the taxonomy. A Delphi consensus survey process with a team of 13 field experts was used to attain consensus (&gt; 70% agreement) on the taxonomy. <h3>Setting:</h3> University of Waterloo, Canada. <h3>Outcome Measures:</h3> The primary outcome measure was the proposed taxonomy. <h3>Results:</h3> The initial inventory of characteristics and features yielded 7 dimensions, 23 sub-dimensions, and 96 characteristics. Following the first Delphi consensus survey, 4 sub-dimensions did not achieve 70% consensus. Feedback received during the consensus process led to the addition of new sub-dimensions such as non-slip features, screen size, and privacy, and modifications to existing subdimensions such as connectivity and power source. In the second round of Delphi consensus, over 70% agreement was achieved for all sub-dimensions, resulting in the final taxonomy comprising 7 dimensions, 24 sub-dimensions, and 105 characteristics. <h3>Conclusions:</h3> The developed taxonomy provides a valuable tool for distinguishing among medication adherence technologies available in the market and facilitates their comparison. This classification system allows for an examination of the usability of products by patients with functional limitations, potentially enhancing medication management for older adults with multiple chronic conditions.

<sec> <title>BACKGROUND</title> Older adults often face challenges in self-managing their medication owing to physical and cognitive limitations, complex medication regimens, and packaging of medications. Emerging &lt;i&gt;smart&lt;/i&gt; medication dispensing and adherence products (SMAPs) offer the options of automated dispensing, tracking medication intake in real time, and reminders and notifications. A 2021 review identified 51 SMAPs owing to the rapid influx of digital technology; an update to this review is required. </sec> <sec> <title>OBJECTIVE</title> This review aims to identify new products and summarize and compare the key features of SMAPs. </sec> <sec> <title>METHODS</title> Gray and published literature and videos were searched using Google, YouTube, PubMed, Embase, and Scopus. The first 10 pages of Google and the first 100 results of YouTube were screened using 4 and 5 keyword searches, respectively. SMAPs were included if they were able to store and allowed for the dispensation of medications, tracked real-time medication intake data, and could automatically analyze data. Products were excluded if they were stand-alone software applications, not marketed in English, not for in-home use, or only used in clinical trials. In total, 5 researchers independently screened and extracted the data. </sec> <sec> <title>RESULTS</title> This review identified 114 SMAPs, including 80 (70.2%) marketed and 34 (29.8%) prototypes, grouped into 15 types. Among the marketed products, 68% (54/80) were available for consumer purchase. Of these products, 26% (14/54) were available worldwide and 78% (42/54) were available in North America. There was variability in the hardware, software, data collection and management features, and cost of the products. Examples of hardware features include battery life, medication storage capacity, availability of types and number of alarms, locking features, and additional technology required for use of the product, whereas software features included reminder and notification capabilities and availability of manufacturer support. Data capture methods included the availability of sensors to record the use of the product and data-syncing capabilities with cloud storage with short-range communications. Data were accessible to users via mobile apps or web-based portals. Some SMAPs provided data security assurance with secure log-ins (use of personal identification numbers or facial recognition), whereas other SMAPs provided data through registered email addresses. Although some SMAPs were available at set prices or free of cost to end users, the cost of other products varied based on availability, shipping fees, and subscription fees. </sec> <sec> <title>CONCLUSIONS</title> An expanding market for SMAPs with features specific to at-home patient use is emerging. Health care professionals can use these features to select and suggest products that meet their patients’ unique requirements. </sec>

Based on previous experience and attempt, a real-size mosaic Multi-gap Resistive Plate Chamber (MRPC) has been developed within the framework of the CMS muon upgrade efforts. The chamber is a 5-gap with plates made each of 6 pieces of low resistive glass. Cosmic ray test at CERN 904 shows that its efficiency can reach above 95% with a gas mixture of 90% C2H2F4, 5% i-C4H10 and 5% SF6. The chamber was also tested with CMS dry gas(95.2% C2H2F4, 4.5% i-C4H10, 0.3% SF6) at the CERN Gamma Irradiation Facility (GIF++). Efficiency results calculated by a simple tracking method show that the good performance is maintained at rates up to 10 kHz/cm2.