Add-on Device Research Articles

Delivery Efficiency of Albuterol Pressurized Metered Dose Inhaler Through Small Size Laryngeal Mask Airways in an Infant and Child Model.

Intraoperative bronchospasm in pediatric patients supported through laryngeal mask airways (LMAs) is commonly treated with pressurized metered-dose inhaler (pMDI) albuterol. The aim of the study was to evaluate delivery of pMDI albuterol through LMAs under different conditions in a model of infant/child supported with a ventilator. We compared drug delivery efficiency of 4 actuations of albuterol pMDI (captured on a filter placed between the LMA and a test lung), drug deposition in the circuit (elbow) and in the LMA under different experimental conditions. Outcomes were expressed of percentage of nominal dose. We compared devices (valved holding chamber [VHC] and adapter), timing of administration (inspiration and expiration), tidal volumes (50 mL and 100 mL), mode of actuation (single and multiple), and LMA sizes (1, 1.5, and 2). Multiple regression analysis was used to evaluate the contribution of each to these components to the outcomes. P < .05 was considered statistically significant. Results are expressed as median (interquartile range) of pooled data. Drug delivery efficiency was 0% (0-1.1) and 6.3% (3.2-14.7) for adapter and VHC, respectively. Elbow deposition was 25.8% (19.2-63.3) and 2.9% (1.4-6.4) for adapter and VHC, respectively. LMA deposition was 2.6% (1.3-4.6) and 4.6% (2.9-6.1) for adapter and VHC, respectively. Multiple regression analysis showed that device, timing of actuation, and LMA size explained 33%, 17%, and 8% of the observed variation in delivery efficiency (R2 0.63), respectively. Multiple regression analysis showed that device and timing of actuation explained 52% and 16% of the observed variation, respectively (R2 0.70). Multiple regression analysis poorly explained factors associated with LMA deposition (R2 0.22). Using a VHC, actuating the pMDI during exhalation, and using a small LMA size increased drug delivery efficiency. The adapter was an inefficient add-on device for aerosol delivery with a pMDI through an LMA that caused significant circuit deposition.

Add-On Device Powered by Parallelized Adsorption Traps for Preconcentrator-GC-MS Measurement of sub-pmol/mol Levels of NF3.

In this study, an add-on preconcentration device powered by parallelized pretraps (PPTs) was utilized to measure the sub-pmol/mol levels of NF3 in N2. The add-on preconcentrator was coupled to the detachable trap preconcentrator (DTP) with a gas chromatograph-mass spectrometer [Anal. Chem. 2019, 91, 3342-3349]. The breakthrough volume of the parallel configuration was found to be substantially higher than that of the serial configuration with the same amount of adsorbent (HayeSep D). Liquid oxygen (LO2) cooling (-183 °C) exhibited better preconcentration performance for NF3 in N2 compared to NF3 in air (N2 + O2) with liquid nitrogen cooling (-195 °C) and NF3 in air with LO2 cooling. The DTP unit was essential to discriminate residual species, such as N2, O2, CO2, and CF4, of which the preconcentrated portion in the PPT can be excessive, enabling the overwhelm filtering capability of the quadrupole mass spectrometer. The limit of detection of NF3 in N2 of the PPT/DTP/gas chromatograph-mass spectrometer was 0.01 ppt, which is significantly better than that determined without using the add-on preconcentration device (0.21 ppt).

Effect of Roll Angle Configurations of a Reverse Delta Type Add-on Device on Wing Tip Vortex Alleviation

An add-on device in the shape of a reverse delta has shown the ability to alleviate wake vortices. The present work studies the interaction of the wing tip vortex and the reverse delta type add-on device vortices. This paper looks at the vortex interactions generated downstream of the wing tip in planes perpendicular to the free stream direction and their dependence on roll angles φ at a mean chord-based Reynolds number of Rec=2.75×105. The study reveals that the add-on device causes a reduction in the tangential velocity V and vorticity of the resultant vortex by up to 44.1% and 59.4%, respectively. Also, it is found that the resultant vortex core radius increased by 305%. The results indicate that the reverse delta type add-on device implants countersign vorticity into the wing tip vortex and modifies its roll-up process.

Novel inductively coupled ear-bars (ICEs) to enhance restored fMRI signal from susceptibility compensation in rats.

Functional magnetic resonance imaging faces inherent challenges when applied to deep-brain areas in rodents, e.g. entorhinal cortex, due to the signal loss near the ear cavities induced by susceptibility artifacts and reduced sensitivity induced by the long distance from the surface array coil. Given the pivotal roles of deep brain regions in various diseases, optimized imaging techniques are needed. To mitigate susceptibility-induced signal losses, we introduced baby cream into the middle ear. To enhance the detection sensitivity of deep brain regions, we implemented inductively coupled ear-bars, resulting in approximately a 2-fold increase in sensitivity in entorhinal cortex. Notably, the inductively coupled ear-bar can be seamlessly integrated as an add-on device, without necessitating modifications to the scanner interface. To underscore the versatility of inductively coupled ear-bars, we conducted echo-planner imaging-based task functional magnetic resonance imaging in rats modeling Alzheimer's disease. As a proof of concept, we also demonstrated resting-state-functional magnetic resonance imaging connectivity maps originating from the left entorhinal cortex-a central hub for memory and navigation networks-to amygdala hippocampal area, Insular Cortex, Prelimbic Systems, Cingulate Cortex, Secondary Visual Cortex, and Motor Cortex. This work demonstrates an optimized procedure for acquiring large-scale networks emanating from a previously challenging seed region by conventional magnetic resonance imaging detectors, thereby facilitating improved observation of functional magnetic resonance imaging outcomes.

Thermal imaging based pre-diagnostics tool for Graves’ disease

Infrared thermography Images of the facial region are taken from sixty persons. Scintigraphy and standard thyroid blood test are used to categorize these persons into thirty-three females and thirteen males suffering from Graves’ disease. This study is approved by the All-India Institute of Medical Science Rishikesh Ethics Committee with reference number AIIMS/IEC/19/997. Eleven Females and three males are found to be in healthy conditions and used as control. A convolutional neural networks (CNN) model is developed to automatically segment and extract the histogram-associated information within the thyroid and cheek region from the collected images. The sub-surface temperature of the thyroid gland and control is extracted using these set of images. We have acquired moderately correlated imaging biomarker with respect to age and gender from this sparse data. An Artificial Intelligence-based app is developed and deployed in a clinical environment to enrich the prognosis model in real time. An affordable Thermal plug-and-play addon device is developed to connect with any smartphone for faster diagnosis at the patient end to carry out this test now. This smartphone and AI-based app combination is successfully deployed as a point-of-care device. It is expected that this IR based preliminary test will automatically categorize healthy cases from patients. This step may save the clinicians to unnecessarily recommending the radioactive contamination-prone Scintigraphy and/or expensive and relatively slower thyroid blood tests. Such preliminary tests may (a) save costs to the patients and (b) relieve the burden on pathology labs. These two points are impactful for the healthcare industry, particularly in densely populated countries having low per capita income.

Development and Testing of a Data Capture Device for Use With Clinical Incentive Spirometers: Testing and Usability Study.

The incentive spirometer is a basic and common medical device from which electronic health care data cannot be directly collected. As a result, despite numerous studies investigating clinical use, there remains little consensus on optimal device use and sparse evidence supporting its intended benefits such as prevention of postoperative respiratory complications. The aim of the study is to develop and test an add-on hardware device for data capture of the incentive spirometer. An add-on device was designed, built, and tested using reflective optical sensors to identify the real-time location of the volume piston and flow bobbin of a common incentive spirometer. Investigators manually tested sensor level accuracies and triggering range calibrations using a digital flowmeter. A valid breath classification algorithm was created and tested to determine valid from invalid breath attempts. To assess real-time use, a video game was developed using the incentive spirometer and add-on device as a controller using the Apple iPad. In user testing, sensor locations were captured at an accuracy of 99% (SD 1.4%) for volume and 100% accuracy for flow. Median and average volumes were within 7.5% (SD 6%) of target volume sensor levels, and maximum sensor triggering values seldom exceeded intended sensor levels, showing a good correlation to placement on 2 similar but distinct incentive spirometer designs. The breath classification algorithm displayed a 100% sensitivity and a 99% specificity on user testing, and the device operated as a video game controller in real time without noticeable interference or delay. An effective and reusable add-on device for the incentive spirometer was created to allow the collection of previously inaccessible incentive spirometer data and demonstrate Internet-of-Things use on a common hospital device. This design showed high sensor accuracies and the ability to use data in real-time applications, showing promise in the ability to capture currently inaccessible clinical data. Further use of this device could facilitate improved research into the incentive spirometer to improve adoption, incentivize adherence, and investigate the clinical effectiveness to help guide clinical care.

Slurry Activation for Enhanced Surface Redox Reactions in CMP

A novel add-on hardware device is placed near the point of slurry dispense that can instantaneously activate slurry performance during polishing via megasonic irradiation. This new technology (Flucto-CMP® is able to overcome the inherent polisher-slurry weaknesses such as wafer-level defects, process vibrations, cost of ownership, slurry waste, remval rate (RR), and RR selectivity. Flucto-CMP® has been successfully applied to various types of CMP slurries resulting in significant increases in the removal rates of copper, SiC, borosilicate hard mask, ILD, TiN, and silicon carbide through chemical alteration of the passivation layer needed for material removal. Specifically, for copper CMP, using Flucto-CMP®, we see an up to 31% boost in RR which is well correlated with the amount of reactive oxidizing species generated through irradiation as well as the measured relative indentation depth of the passivation layer. In addition to boosts in RR, for copper, we see a 50X drop in the variance of shear force and a 5X drop in the variance of normal force when Flucto-CMP® is used. This dramatic reduction in process vibration for copper soft-landing processes ought to reduce wafer-level defects. Much greater rate improvements are observed when polishing SiC, and borosilicate hard masks.

A smart device of data acquisition with emergency safety features for laboratory furnaces

Laboratory furnaces or ovens are found in scientific, forensic, medicinal, and material processing labs. They provide precise temperature control and homogenous heating for samples in industrial and research applications but cannot measure the sample's interior temperature and most of them do not have the facility to store temperature data. Moreover, a furnace cannot promptly shut off if a sample or the furnace catches fire due to overheating or an electrical failure. To solve these problems, in this work, an intelligent, automated add-on device with wireless monitoring and emergency safety features to use with any commercial furnace or oven is presented. The device can individually measure furnace and sample temperatures at the same time using a two-channel K-type thermocouple unit. The system can store the real-time temperature data generated by the thermocouples, display it on LCD (Liquid Crystal Display) and give the facility to observe this real-time data from anywhere within an area of 800–1000-m radius using the portable wireless monitor device without the need for Wi-Fi or internet. Additionally, the device can quickly detect fire or overheating, immediately cuts the power automatically, activates a loud alarm and dials the user's phone itself using Global System for Mobile Communication (GSM) technology to warn them.

Colorectal endoscopic submucosal dissection using a concealable robotic add-on device: A comparative in vivo feasibility study.

128 Background: Appropriate tissue tension and clear visibility of the dissection area using traction are essential for effective and safe colonic endoscopic submucosal dissection (ESD). In this preclinical ex vivo and in vivo animal study, we developed a concealable robotic-assisted traction device and evaluated its performance in colorectal ESD. Methods: An experienced endoscopist performed ESD on an ex vivo porcine colon 18 times using our robot and 18 times using the conventional method. The outcome measures were procedure time, dissection speed, procedure-related adverse events, and blind dissection rate. We also conducted an in vivo feasibility study in live pigs. Robotic ESD was performed by experienced and novice endoscopist groups (n = 2, each). The outcomes included time to complete each ESD step, total procedure time, size of the dissected mucosa, rate of en bloc resection, and major adverse events. Results: Thirty-six colonic lesions were resected from ex vivo porcine colon samples. The total procedure time was significantly shorter in robotic ESD (RESD) than in conventional ESD (CESD) (20.1±4.1 vs. 34.3±8.3; P &lt; 0.05). The submucosal dissection speed was significantly higher in the RESD group than in the CESD group (36.8±9.2 vs. 18.1±4.7; P &lt; 0.05). The blind dissection rate was also significantly lower in the robotic group (12.8±3.4% vs. 35.1±3.9%; P &lt; 0.05). In an in vivo feasibility study, the robot was attached to the colonoscope and successfully inserted into the proximal colon without damaging the colonic wall, and ESD was successfully performed. There was no significant difference in the submucosal dissection speed between the groups (P = 0.465). Conclusions: When the concealable robot assisted the colonic ESD procedure, the dissection speed and safety profile improved significantly. Thus, our robotic device can provide a simple, effective, and safe multidirectional traction during colonic ESD. When the robot was assisting in the ESD procedure, the dissection speed improved significantly, especially in the novice endoscopists.

Design, realization, control, and validation of a smart tether system for a robotic guide for blind and visually impaired users

This paper describes the design, the realization, the controller synthesis, and the validation of a smart tether system (STS). The STS is an add-on active device for autonomous moving robots allowing them to be employed as guides for blind and visually-impaired users. The paper illustrates the mechanical structure of the STS, the model identification campaign, and the control synthesis. Validation experiments are also provided to evaluate the effectiveness of the proposed device.

Radiation exposure to fetus from extremity CBCT examinations

PurposeTo evaluate fetal doses from extremity CBCT examinations at different stages of pregnancy and to investigate different methods of fetal dose optimization. MethodFetal doses were measured in an anthropomorphic phantom for two CBCT examination protocols – knee and elbow. The measurements were made at three different heights representing the three trimesters during pregnancy and three different depths in the phantom. The effect of soft tissue layer, tube voltage, add-on device shield and body angulation on fetal dose were investigated. ResultsThe fetal doses in clinical examination protocols were in the range of 3.4 to 6.0 µGy during knee examinations and 2.9 to 7.7 µGy during elbow examinations depending on the depth of the fetus and the stage of pregnancy. A soft tissue layer representing variative body composition above abdomen region decreased the fetal dose up to 19 % in knee and up to 21 % in elbow examinations. Using lower tube voltage decreased the fetal doses up to 45 % (knee) and 51 % (elbow). An add-on device shield decreased the fetal doses up to 91 % (knee) and up to 75 % (elbow). Turning the body away from the device bore reduced the fetal doses up to 62 %. The conversion factor to convert an entrance surface dose to the fetal dose ranged from 0.4 to 0.6. ConclusionsThe fetal doses from CBCT examinations of extremities are low and do not produce a concern about radiation detriment to the fetus. The most efficient way found to reduce the fetal dose was to use the add-on device shielding.

Development of an Add-On Device Using 3D Printing for the Enhancement of Drug Administration Efficiency of Dry Powder Inhalers (Accuhaler).

The goal of this study was to develop an add-on device for dry powder inhalers (Accuhaler) via 3D printing to improve drug administration efficiency in patients with limited inspiratory capacity, including young children, the elderly, and those with chronic obstructive pulmonary disease. With salmeterol xinafoate and fluticasone propionate as model active pharmaceutical ingredients (API), the emitted API doses were used to assess the effectiveness of the add-on device. The APIs were quantified by an HPLC assay validated for specificity, range, linearity, accuracy, and precision. The motor power of the add-on device could be regulated to moderate fan speed and the air flow in the assembled device. When 50–100% of the fan motor power of the add-on device was used, the emitted dose from the attached dry powder inhaler (DPI) was increased. A computational fluid dynamics application was used to simulate the air and particle flow in the DPI with the add-on device in order to elucidate the operating mechanism. The use of the add-on device combined with a sufficient inhalation flow rate resulted in a larger pressure drop and airflow velocity at the blister pocket. As these characteristics are associated with powder fluidization, entrainment, and particle re-suspension, this innovative add-on device might be utilized to enhance the DPI emitted drug dose for patients with low inspiratory rates and to facilitate the provision of adequate drug doses to achieve the treatment outcomes.

Image processing-based braille document copying system as additional feature for ITS’s braille printer

Nowadays, there are huge numbers of old braille documents found in libraries which are getting obsolete and needs reproducing. Unfortunately, they don’t have their original alphabetical text so that can’t be re-printed by any braille printer unless we have to translate them manually one by one. This research develops braille duplicator system as Institut Teknologi Sepuluh Nopember (ITS) braille printer’s additional feature. It works by photographing braille on smartphone, translating it into text, and sending result wirelessly to add-on device installed on braille printer’s interface. Translation is done by image processing. Test result shows its accuracy reach 99%. Thus, braille document can be duplicated without needing its original text.

Low-cost optofluidic add-on enables rapid selective plane illumination microscopy of C. elegans with a conventional wide-field microscope.

.Significance: Selective plane illumination microscopy (SPIM) is an emerging fluorescent imaging technique suitable for noninvasive volumetric imaging of C. elegans. These promising microscopy systems, however, are scarce in academic and research institutions due to their high cost and technical complexities. Simple and low-cost solutions that enable conversion of commonplace wide-field microscopes to rapid SPIM platforms promote widespread adoption of SPIM by biologist for studying neuronal expressions of C. elegans.Aim: We sought to develop a simple and low-cost optofluidic add-on device that enables rapid and immobilization-free volumetric SPIM imaging of C. elegans with conventional fluorescent microscopes.Approach: A polydimethylsiloxane (PDMS)-based device with integrated optical and fluidic elements was developed as a low-cost and miniaturized SPIM add-on for the conventional wide-field microscope. The developed optofluidic chip contained an integrated PDMS cylindrical lens for on-chip generation of the light-sheet across a microchannel. Cross-sectional SPIM images of C. elegans were continuously acquired by the native objective of microscope as worms flowed in an L-shape microchannel and through the light sheet.Results: On-chip SPIM imaging of C. elegans strains demonstrated possibility of visualizing the entire neuronal system in few seconds at single-neuron resolution, with high contrast and without worm immobilization. Volumetric visualization of neuronal system from the acquired cross-sectional two-dimensional images is also demonstrated, enabling the standard microscope to acquire three-dimensional fluorescent images of C. elegans. The full-width at half-maximum width of the point spread function was measured as 1.1 and in the lateral and axial directions, respectively.Conclusion: The developed low-cost optofluidic device is capable of continuous SPIM imaging of C. elegans model organism with a conventional fluorescent microscope, at high speed, and with single neuron resolution.

Image Processing Technique for Improving the Sensitivity of Mechanical Register Water Meters to Very Small Leaks.

Discovering very small water leaks at the household level is one of the most challenging goals of smart metering. While many solutions for sudden leakage detection have been proposed to date, the small leaks are still giving researchers a hard time. Even if some devices can be found on the market, their capability to detect a water leakage barely reaches the sensitivity of the employed mechanical water meter, which was not designed for detecting small water leakages. This paper proposes a technique for improving the sensitivity of the mechanical register water meters. By implementing this technique in a suitable electronic add-on device, the improved sensitivity could detect very small leaks. This add-on device continuously acquires the mechanical register’s digital images and, thanks to suitable image processing techniques and metrics, allows very small flows to be detected even if lower than the meter starting flow rate. Experimental tests were performed on two types of mechanical water meters, multijet and piston, whose starting flow rates are 8 L/h and 1 L/h, respectively. Results were very interesting in the leakage range of [1.0, 10.0] L/h for the multijet and even in the range [0.25, 1.00] L/h for the piston meter.

Long-term brain-on-chip: Multielectrode array recordings in 3D neural cell cultures

This study presents sensing of network bursts in a three-dimensional (3D) cell culture system consisting of a microbioreactor and a multielectrode array (MEA), i.e., brain-on-chip, to interpret neural network dynamics in a label-free manner. While our initial results reported an increased single spiking activity already over the course of days 7, 14, and 21 in vitro, the advanced long-term analysis of the data set (including a last timepoint at day 79) here demonstrates a proof-of-principle for following bursting patterns upon maturation of the network in the microbioreactor as an add-on device for a commercial MEA recording system. These quantitative electrophysiological findings, including mean bursting rate, mean burst duration, and network burst dynamics, confirm a 2D to 3D transition in coherence with the literature.

Drag Reduction by Application of Different Shape Designs in a Sport Utility Vehicle

Road vehicles drag is a direct consequence of a large wake area generated behind. This area is created owing to the vehicle shape, which is determined by the class, functional and aesthetic of the vehicle. Aerodynamic characteristics are a ramification and not the reason for the vehicle architecture. To enhance pressure recovery in the wake region, hence reduce drag, three different passive flow control techniques were applied to sport-utility-vehicle (SUV). A three-dimensional SUV was designed in CATIA, and a numerical flow simulation was conducted using Ansys-Fluent to evaluate the aerodynamic effectiveness of the proposed flow control approaches. A closed rectangular flap as an add-on device modifies the wake vortex system topology, enhances vortex merging, and increases base pressure which leads to a drag reduction of 15.87%. The perforated roof surface layer was used to delay flow separation. The measured base pressure values indicate a higher-pressure recovery, which globally reflected in a drag reduction of 19.82%. Finally, air guided through side rams was used as steady blowing. A steady passive air jet introduced at the core of the longitudinal trailing vortices leads to a confined wake area. The net effects appear in a global increase in the base pressure values and the pronounced drag reduction of 22.67%.

Effects of Add-On Left Ventricular Assist Device to Extracorporeal Membrane Oxygenation During Refractory Cardiac Arrest in a Porcine Model.

This study evaluated the effects of extracorporeal membrane oxygenation (ECMO) in combination with a percutaneous adjunctive left ventricular assist device (LVAD) in a porcine model during 60 minutes of refractory cardiac arrest (CA). Twenty-four anesthetized swine were randomly allocated into three groups given different modes of circulatory assist: group 1: ECMO 72 ml/kg/min and LVAD; group 2: ECMO 36 ml/kg/min and LVAD; and group 3: ECMO 72 ml/kg/min. During CA and extracorporeal cardiopulmonary resuscitation (ECPR), mean left ventricular pressure (mLVP) was lower in group 1 (p = 0.013) and in group 2 (p = 0.003) versus group 3. Mean aortic pressure (mAP) and coronary perfusion pressure (CPP) were higher in group 1 compared with the other groups. In group 3, mean pulmonary artery flow (mPAf) was lower versus group 1 (p = 0.003) and group 2 (p = 0.039). If the return of spontaneous circulation (ROSC) was achieved after defibrillation, up to 180 minutes of unsupported observation followed. All subjects in groups 1 and 3, and 5 subjects in group 2 had ROSC. All subjects in group 1, five in group 2 and four in group 3 had sustained cardiac function after 3 hours of spontaneous circulation. Subjects that did not achieve ROSC or maintained cardiac function post-ROSC had lower mAP (p < 0.001), CPP (p = 0.002), and mPAf (p = 0.004) during CA and ECPR. Add-on LVAD may improve hemodynamics compared with ECMO alone during refractory CA but could not substitute reduced ECMO flow. Increased mAP and CPP could be related to ROSC rate and sustained cardiac function. Increased mLVP was related to poor post-ROSC cardiac function.

Design and characterization of a prototype tertiary device for proton beam stereotactic radiosurgery

Though potentially beneficial, proton beam stereotactic radiosurgery has not been adopted widely secondary to the technical challenge of safely delivering multiple focused beams of proton radiation. In this study, we describe the design and characterization of a proton beam stereotactic radiosurgery system that can be adopted by existing passive scattering systems. This system utilizes a helmet-like device in which patient-specific brass apertures required for final beam collimation are positioned on a scaffold that is separate from the treatment gantry. The proton snout is then fitted with a generic aperture to focus the primary proton beam onto the patient specific apertures that are in the helmet-like device. The patient-specific apertures can all be placed at the start of the treatment, thus treatment with multiple beams can be accomplished without the delay of switching the apertures. In this report we describe a prototype design of this collimation system and dosimetric testing to verify efficacy. Subsequently, we describe a custom 3D printing of a prototype device and report on overall localization accuracy using Winston-Lutz tests. Our results show that it is possible to develop an add-on device for proton beam radiosurgery that is safe and efficient and capable of wide adoption on existing proton delivery systems.

Maximizing Adherence and Gaining New Information For Your Chronic Obstructive Pulmonary Disease (MAGNIFY COPD): Study Protocol for the Pragmatic, Cluster Randomized Trial Evaluating the Impact of Dual Bronchodilator with Add-On Sensor and Electronic Monitoring on Clinical Outcomes.

BackgroundPoor treatment adherence in COPD patients is associated with poor clinical outcomes and increased healthcare burden. Personalized approaches for adherence management, supported with technology-based interventions, may offer benefits to patients and providers but are currently unproven in terms of clinical outcomes as opposed to adherence outcomes.MethodsMaximizing Adherence and Gaining New Information For Your COPD (MAGNIFY COPD study), a pragmatic cluster randomized trial, aims to evaluate the impact of an adherence technology package (interventional package), comprising an adherence review, ongoing provision of a dual bronchodilator but with an add-on inhaler sensor device and a connected mobile application. This will compare time to treatment failure and other clinical outcomes in patients identified at high risk of exacerbations with historic poor treatment adherence as measured by prescription collection to mono/dual therapy over one year (1312 patients) versus usual care. Treatment failure is defined as the first occurrence of one of the following: (1) moderate/severe COPD exacerbation, (2) prescription of triple therapy (inhaled corticosteroid/long-acting β2-agonist/long-acting muscarinic antagonist [ICS/LABA/LAMA]), (3) prescription of additional chronic therapy for COPD, or (4) respiratory-related death. Adherence, moderate/severe exacerbations, respiratory-related healthcare resource utilization and costs, and intervention package acceptance rate will also be assessed. Eligible primary care practices (N=176) participating in the Optimum Patient Care Quality Improvement Program will be randomized (1:1) to either adherence support cluster arm (suitable patients already receiving or initiated Ultibro® Breezhaler® [indacaterol/glycopyrronium] will be offered interventional package) or the control cluster arm (suitable patients continue to receive usual clinical care). Patients will be identified and outcomes collected from anonymized electronic medical records within the Optimum Patient Care Research Database. On study completion, electronic medical record data will be re-extracted to analyze outcomes in both study groups.Registration NumberISRCTN10567920.ConclusionMAGNIFY will explore patient benefits of technology-based interventions for electronic adherence monitoring.