The transplant patient's therapeutic regimen consists of a lifelong drug therapy, including immunosuppressive drugs, prophylactic antimicrobials and often medications for the treatment of hypertension, diabetes mellitus and other comorbid diseases. Regular clinic appointments are required to monitor for signs and symptoms of immunological injury, recurrent disease and adverse drug effects. Patients are instructed to avoid risk factors for cardiovascular disease and cancer (e.g. diet, exercise, sun protection and not smoking). Noncompliance with all aspects of this regimen is substantial. Medication noncompliance leads to an increased incidence of acute rejection, chronic rejection and graft loss. Undoubtedly, many practitioners fail to appreciate the extent of noncompliance as the signs are often subtle and most patients are unwilling to disclose deliberate or widespread disregard for medication use. Newer immunosuppressive agents, particularly once-daily medications and long-acting antibody preparations offer convenience and monitoring that may improve compliance. This review focuses on the prevalence, correlates and consequences of medication nonadherence after organ transplantation. Current recommendations to enhance adherence are discussed.

No abstract

This paper presents a protocol study conducted with mechanical engineering students, where the participants developed a function structure model for a novel design problem. A modeling activity video was recorded for each participant and coded using a protocol analysis. Pauses in the modeling process were analyzed to identify patterns based on pause time and frequency, distribution of pauses over the modeling activity, events following the pauses, and elements added after pauses. Results show that participants used an average of 38% of the modeling time in pauses with a pause frequency of 41%. Moreover, participants were also found to spend more time in pauses during the second and third quarters of the modeling activity. Subsequently, an analysis of pause lengths revealed three different pause groups corresponding to short, intermediate, and long pauses. Participants added elements to the model significantly more frequently, compared to editing and deleting elements. Instances of deleting were found to be more likely to occur after longer pauses, whereas editing was done more frequently after shorter pauses. Participants paused more frequently before adding flows, and more frequent pauses were observed before labeling function compared to adding function blocks. The flows were found to be labeled after pauses infrequently. Finally, limitations of the study are discussed, and future research questions have been identified.

No abstract

This paper presents a behavior-based protocol study conducted with mechanical engineering students, where the participants developed function–structure models for a novel design problem. A modeling activity video was recorded for each participant and coded using a protocol analysis that captured the modeling sequence, actions, and elements. Pauses in the modeling process were analyzed to identify patterns based on pause time and frequency, the distribution of pauses over the modeling activity, and events preceding and following the pauses. In this study, a pause is characterized as an interruption in the modeling process lasting at least 2 s. Participants were found to spend an average of 38% of the modeling time in pauses, with more of it being allotted to the middle of the modeling activity and less toward the start and end. Three pause types are defined (short, intermediate, and long pauses) based on an analysis of pause lengths, which are then used to analyze events before and after pauses. Participants added elements to the model more frequently, compared to editing and deleting elements. Longer pauses were observed before participants before elements are removed from the model, whereas editing was done more frequently after shorter pauses. Several modeling element pairs are identified that are infrequently separated by pauses, such as the “edge” and “edge text” pair, suggesting that the designer thinks about these as paired elements rather than distinct elements. Limitations of the research methods are discussed, and finally, new research questions are identified as continuing work for this research.