Outpatient Care Among Users and Nonusers of Direct-to-Patient Telehealth: Observational Study.

BACKGROUND: Expansion of telehealth insurance coverage is hampered by concerns that such coverage may encourage excessive use and spending. OBJECTIVE: The aim of this paper is to examine whether users of telehealth services rely more on other forms of outpatient care than nonusers, and to estimate the differences in payment rates. METHODS: We examined claims data from a large national insurer in 2017. We limited our analysis to patients with visits for 3 common diagnoses (N=660,546). We calculated the total number of visits per patient, overall, and by setting, and adjusted for patient- and county-level factors. RESULTS: After multivariable adjustment, telehealth-visit users, compared to nonusers, had 0.44 fewer visits to primary care, 0.11 fewer visits to emergency departments, and 0.17 fewer visits to retail and urgent care. All estimates are statistically significant at P<.001. Average payment rates for telehealth visits were lower than all other settings. CONCLUSIONS: These findings suggest that telehealth visits may substitute rather than add to in-person care for some types of care. Our study suggests that telehealth visits may offer an efficient and less costly alternative.

Physical activity in rheumatoid arthritis: relationship to cardiovascular risk factors, subclinical atherosclerosis, and disease activity.

Objective: To investigate associations between physical activity and risk factors for cardiovascular disease (CVD), subclinical atherosclerosis, and disease activity in patients with early and long-standing rheumatoid arthritis (RA).Method: This cross-sectional study included 84 patients with early and 37 with long-standing RA (disease duration, mean ± sd: 1.4 ± 0.4 and 16.3 ± 2.3 years, respectively). Physical activity was measured using a combined accelerometer and heart-rate monitor. Further assessments were disease activity (erythrocyte sedimentation rate, Disease Activity Score in 28 joints), functional ability (Health Assessment Questionnaire), risk factors for CVD (blood lipids, i.e. triglycerides, high-density lipoprotein, low-density lipoprotein; blood glucose, blood pressure, sleeping heart rate, waist circumference, body mass index, and body fat), and subclinical atherosclerosis (pulse-wave velocity, augmentation index, and carotid intima-media thickness).Results: Physical activity variables did not differ between patients with early and long-standing RA. However, 37% of the patients with early and 43% of those with long-standing RA did not reach the World Health Organization's recommended levels of moderate to vigorous physical activity (MVPA). In a final multiple regression model, adjusted for age, gender, disease duration, and activity monitor wear time, higher total physical activity was associated with lower body fat and higher functional ability. With the same adjustments, more time spent in MVPA was associated with lower high-density lipoprotein and lower sleeping heart rate.Conclusions: Physical activity was associated with more favourable risk factors for CVD. However, many patients were physically inactive, stressing the importance of promoting physical activity in RA.

Linking mass measured by the quartz crystal microbalance to the SI.

Despite ubiquitous implementation of the quartz crystal microbalance (QCM) for measuring thin film thickness throughout industry and academia, a direct link to the SI (International System of Units) does not exist. Confidence in QCM measurements relies on over a half-a-century of academic and industrial research used to understand the resonant frequency change due to loading mass onto a quartz crystal. Here, we use before and after gravimetric mass measurements, linked directly to the SI, to measure mass change. A custom vacuum metal deposition system is used to deposit gold films of various masses onto a series of quartz crystals while the mass dependent frequency change is monitored in real time. The gravimetric (known) mass changes are compared to three analytical methods (frequency, time and energy) used to convert resonant frequency shifts to mass changes, none of which rely on the material properties of the deposited material. Additionally, we evaluate the reversible and irreversible contributions to mass change from the loading into, and removal from, the vacuum environment. We find the "energy-based" method for frequency to mass conversion has the best accuracy over the longest range, at 0.36 % to > 1 mg. Only for mass changes below 100 µg are deviations > 2 % observed. A complete uncertainty budget is provided.

Physical activity intensity, sedentary behavior, body composition and physical fitness in 4-year-old children: results from the ministop trial.

BACKGROUND: Existing knowledge on associations of physical activity (PA) and sedentary behavior (SB) with body composition and physical fitness in preschoolers is limited. OBJECTIVE: To examine associations of PA and SB with body composition and physical fitness in healthy Swedish 4-year-old children. METHODS: We utilized baseline data collected in 2014 for the population-based MINISTOP trial (n=307). Light-intensity PA (LPA), moderate-intensity PA (MPA), vigorous-intensity PA (VPA), moderate-to-vigorous PA (MVPA) and SB were measured using accelerometry (ActiGraph-wGT3x-BT). Body composition was measured using air-displacement plethysmography, and physical fitness (that is, cardiorespiratory fitness, lower and upper body muscular strength and motor fitness) was measured using the PREFIT fitness test battery. Multiple linear regression models adjusted for relevant confounders, and in addition, isotemporal substitution models were applied. RESULTS: Greater MVPA was associated with lower fat mass percent (%FM, P=0.015), and greater VPA and MVPA were associated with higher fat-free mass index (FFMI, P=0.002 and P=0.011). In addition, greater VPA and MVPA were associated with higher scores for all physical fitness tests (P=0.042 to P<0.001). The results for MVPA were primarily due to VPA. SB was associated with weaker handgrip strength (P=0.031) when PA was not adjusted, but after adjusting also for VPA, the significant association disappeared (P=0.25). Substituting 5 min per day of SB, LPA or MPA with 5 min per day of VPA was associated with higher FFMI and better scores for cardiorespiratory fitness and motor fitness. Correspondingly, substituting 5 min per day of VPA with SB or LPA was associated with weaker performance for lower muscular strength. CONCLUSIONS: Time spent on VPA was associated with higher FFMI and better physical fitness. The results suggest that promoting VPA may be important to improve childhood body composition and physical fitness already at an early age.

Analysis of Thickness and Quality factor of a Double Paddle Oscillator at Room Temperature.

In this paper, we evaluate the quality (Q) factor and the resonance frequency of a double paddle oscillator (DPO) with different thickness using analytical, computational and experimental methods. The study is carried out for the 2nd anti-symmetric resonance mode that provides extremely high experimental Q factors on the order of 105. The results show that both the Q factor and the resonance frequency of a DPO increase with the thickness at room temperature.

Associations between diet and cardiometabolic risk among Yup'ik Alaska Native people using food frequency questionnaire dietary patterns.

BACKGROUND AND AIMS: In previous analyses, we identified three dietary patterns from food frequency questionnaire data among a sample of Yup'ik Alaska Native people living in Southwest Alaska: a "subsistence foods" dietary pattern and two market-based dietary patterns "processed foods" and "fruits and vegetables". In this analysis, we aimed to characterize the association between the dietary patterns and cardiometabolic (CM) risk factors (lipids, blood pressure, glucose, adiposity). METHODS AND RESULTS: We used multilevel linear regression to estimate the mean of each CM risk factor, comparing participants in the 4th to the 1st quartile of each dietary pattern (n = 637). Models were adjusted for age, sex, past smoking, current smoking, and physical activity. Mean log triglyceride levels were significantly higher among participants in the 4th compared to the 1st quartile of the processed foods dietary pattern (ß = 0.11). Mean HbA1c percent was significantly lower (ß = -0.08) and mean diastolic blood pressure (DBP) mm Hg was significantly higher (ß = 2.87) among participants in the 4th compared to the 1st quartile of the fruits and vegetables dietary pattern. Finally, mean log triglyceride levels and mean DBP mm Hg were significantly lower among participants in the 4th compared to the 1st quartile of the subsistence foods dietary pattern (ß = -0.10 and ß = -3.99 respectively). CONCLUSIONS: We found increased CM risk, as reflected by increased triglycerides, associated with eating a greater frequency of processed foods, and reduced CM risk, as reflected by lower triglycerides and DBP, associated with eating a greater frequency of subsistence foods.

Testing three-body quantum electrodynamics with trapped Ti20+ ions: evidence for a Z-dependent divergence between experiment and calculation.

We report a new test of quantum electrodynamics (QED) for the w (1s2p(1)P(1)→1s(2)(1)S(0)) x-ray resonance line transition energy in heliumlike titanium. This measurement is one of few sensitive to two-electron QED contributions. Systematic errors such as Doppler shifts are minimized in our experiment by trapping and stripping Ti atoms in an electron beam ion trap and by applying absolute wavelength standards to calibrate the dispersion function of a curved-crystal spectrometer. We also report a more general systematic discrepancy between QED theory and experiment for the w transition energy in heliumlike ions for Z>20. When all of the data available in the literature for Z=16-92 are taken into account, the divergence is seen to grow as approximately Z(3) with a statistical significance on the coefficient that rises to the level of 5 standard deviations. Our result for titanium alone, 4749.85(7) eV for the w line, deviates from the most recent ab initio prediction by 3 times our experimental uncertainty and by more than 10 times the currently estimated uncertainty in the theoretical prediction.

Incorporating the Concept of Relevance in Clinical Rehabilitation Research and Its Reviews May Improve Uptake by Stakeholders.

ABSTRACT: The "relevance" of research to stakeholders is an important factor in influencing the uptake of new knowledge into practice; however, this concept is neither well defined nor routinely incorporated in clinical rehabilitation research. Developing a uniform definition, measurement standards, stakeholder engagement strategies, and guiding frameworks that bolster relevance may help incorporate the concept as a key element in research planning and design. This article presents a conceptual argument for why relevance matters, proposes a working definition, and suggests strategies for operationalizing the construct in the context of clinical rehabilitation research. We place special emphasis on the importance of promoting relevance to patients, caregivers, and clinicians and provide preliminary frameworks and innovative study designs that can assist clinical rehabilitation researchers in doing so. We argue that researchers who include a direct statement regarding why and to whom a study is relevant and who incorporate considerations of relevance throughout all phases of study design produce more useful research for patients, caregivers, and clinicians, increasing its chance of uptake into practice. Consistent consideration of relevance, particularly to nonacademic audiences, during the conceptualization, study design, presentation, and dissemination of clinical rehabilitation research may promote the uptake of findings by patients, caregivers, and providers.

Access, Utilization, and Implementation of Research Among Rehabilitation Nurses: A Qualitative Study.

PURPOSE: This study aimed to understand rehabilitation nurses' perceptions of research information, related barriers, and avenues for future research, specifically in those caring for individuals with burn injury, spinal cord injury, or traumatic brain injury. DESIGN: Qualitative semistructured interviews were conducted. METHODS: Eighteen interviews were conducted. A thematic network approach identified codes and developed basic, organizing, and global themes. RESULTS: Researchers identified factors that facilitated research uptake, determined organizational structures that support research culture, and described nurse engagement with literature. CONCLUSIONS: Although participants desired to engage with the research literature, they identified barriers including time constraints, heavy workloads, and lack of access. To facilitate research uptake, research must be easily accessible, be easily digestible, and include clinical practice recommendations. Research must expand its scope to address issues relevant to the rehabilitation population. CLINICAL RELEVANCE: Our findings may be used to drive improvements in research competence, facilitate knowledge translation, and support evidence-based practice among rehabilitation nurses.

Charge state dependent energy deposition by ion impact.

We report on a measurement of craters in thin dielectric films formed by Xe(Q+) (26 ≤ Q ≤ 44) projectiles. Tunnel junction devices with ion-irradiated barriers were used to amplify the effect of charge-dependent cratering through the exponential dependence of tunneling conductance on barrier thickness. Electrical conductance of a crater σ(c)(Q) increased by 4 orders of magnitude (7.9 × 10(-4) µS to 6.1 µS) as Q increased, corresponding to crater depths ranging from 2 to 11 Å. By employing a heated spike model, we determine that the energy required to produce the craters spans from 8 to 25 keV over the investigated charge states. Considering energy from preequilibrium nuclear and electronic stopping as well as neutralization, we find that at least (27 ± 2)% of available projectile neutralization energy is deposited into the thin film during impact.

Developing Single Layer MOS Quantum Dots for Diagnostic Qubits.

The design, fabrication and characterization of single metal gate layer, metal-oxide-semiconductor (MOS) quantum dot devices robust against dielectric breakdown are presented as prototypes for future diagnostic qubits. These devices were developed as a preliminary solution to a longer term goal of a qubit platform for intercomparison between materials or for in-line diagnostics, and to provide a testbed for establishing classical measurements predictive of coherence performance. For this stage, we seek a robust MOS design that is compatible with wafer and chip architectures, that has a reduced process overhead and is sufficiently capable of challenging and advancing our measurement capabilities. In this report, we present our initial batch of silicon MOS devices using a single gate layer, which have not exhibited any failures with gate voltage excursions > 10 V, but do exhibit the reduced electrostatic control expected of a single gate layer design. We observe quantum dot formation, capacitive charge sensing between channels, and reasonable effective electron temperatures that enable spin qubit studies. The costs and benefits of the trade-off between device performance and fabrication efficiency will be discussed, as well as opportunities for future improvements.

Alternatives to aluminum gates for silicon quantum devices: defects and strain.

Gate-defined quantum dots (QD) benefit from the use of small grain size metals for gate materials because it aids in shrinking the device dimensions. However, it is not clear what differences arise with respect to process-induced defect densities and inhomogeneous strain. Here, we present measurements of fixed charge, Q f , interface trap density, D it , the intrinsic film stress, σ, and the coefficient of thermal expansion, α as a function of forming gas anneal temperature for Al, Ti/Pd, and Ti/Pt gates. We show D it is minimal at an anneal temperature of 350 °C for all materials but Ti/Pd and Ti/Pt have higher Q f and D it compared to Al. In addition, σ and α increase with anneal temperature for all three metals with α larger than the bulk value. These results indicate that there is a tradeoff between minimizing defects and minimizing the impact of strain in quantum device fabrication.

Disruption of contactin 4 in three subjects with autism spectrum disorder.

BACKGROUND: Autism spectrum disorder (ASD) is a developmental disorder of the central nervous system of largely unknown aetiology. The prevalence of the syndrome underscores the need for biological markers and a clearer understanding of pathogenesis. For these reasons, a genetic study of idiopathic ASD was undertaken. METHODS AND RESULTS: Array based comparative genomic hybridisation identified a paternally inherited chromosome 3 copy number variation (CNV) in three SUBJECTS: a deletion in two siblings and a duplication in a third, unrelated individual. These variations were fluorescence in situ hybridisation (FISH) validated and the end points further delineated using a custom fine tiling oligonucleotide array. Polymerase chain reaction (PCR) products unique to the rearrangements were amplified and sequence analysis revealed the variations to have resulted from Alu Y mediated unequal recombinations interrupting contactin 4 (CNTN4). CONCLUSION: CNTN4 plays an essential role in the formation, maintenance, and plasticity of neuronal networks. Disruption of this gene is known to cause developmental delay and mental retardation. This report suggests that mutations affecting CNTN4 function may be relevant to ASD pathogenesis.

Targeted enrichment of 28Si thin films for quantum computing.

We report on the growth of isotopically enriched 28Si epitaxial films with precisely controlled enrichment levels, ranging from natural abundance ratio of 92.2% all the way to 99.99987% (0.83 × 10-6 mol mol-1 29Si). Isotopically enriched 28Si is regarded as an ideal host material for semiconducting quantum computing due to the lack of 29Si nuclear spins. However, the detailed mechanisms for quantum decoherence and the exact level of enrichment needed for quantum computing remain unknown. Here we use hyperthermal energy ion beam deposition with silane gas to deposit epitaxial 28Si. We switch the mass selective magnetic field periodically to control the 29Si concentration. We develop a model to predict the residual 29Si isotope fraction based on deposition parameters and measure the deposited film using secondary ion mass spectrometry (SIMS). The measured 29Si concentrations show excellent agreement with the prediction, deviating on average by only 10%.

Intervention to promote physical activation and improve sleep and response feeding in infants for preventing obesity early in life, the baby-act trial: Rationale and design.

Infant obesity is increasing in the US, particularly among Hispanics. Rapid weight gain during infancy increases the risk of obesity later in life and could be prevented through multi-modal interventions addressing multiple risk factors through population-level programs. OBJECTIVES: 1) determine the extent to which the intervention, compared with the usual care control condition, improves healthy weight gain and specific behaviors (physical activity, sleep, diet) in the first year of life and 2) evaluate the cost of the intervention as a modification of the current WIC standard of care. METHODS: The lifestyle intervention focuses on age-appropriate infant physical activation, healthy sleep and sedentary patterns, and response feeding, by improving parenting skills delivered through a combination of technology (web-platform and text messages) and phone counseling. It is being tested among caregivers of infant participants of the Puerto Rico WIC program through a cluster-randomized controlled trial in 14 WIC clinics in San Juan starting in pregnancy until the infant is 12 months of age. The main outcome is infant rate of weight gain at 12 months; secondary outcomes include objectively measured hours of infant movement, sedentary behaviors and sleep, diet quality score and response feeding behaviors. We are also recording fees, time and personnel involved in the intervention development, maintenance and dissemination. CONCLUSIONS: If successful, the intervention could be incorporated as a 'best practice' through WIC policy as a means to strengthen obesity prevention efforts to improve minority health and eliminate health disparities among Hispanics and possibly other at-risk groups beyond the childhood period. Clinicaltrials.gov registration: NCT03517891.

Reduction of charge offset drift using plasma oxidized aluminum in SETs.

Aluminum oxide ([Formula: see text])-based single-electron transistors (SETs) fabricated in ultra-high vacuum (UHV) chambers using in situ plasma oxidation show excellent stabilities over more than a week, enabling applications as tunnel barriers, capacitor dielectrics or gate insulators in close proximity to qubit devices. Historically, [Formula: see text]-based SETs exhibit time instabilities due to charge defect rearrangements and defects in [Formula: see text] often dominate the loss mechanisms in superconducting quantum computation. To characterize the charge offset stability of our [Formula: see text]-based devices, we fabricate SETs with sub-1 e charge sensitivity and utilize charge offset drift measurements (measuring voltage shifts in the SET control curve). The charge offset drift ([Formula: see text]) measured from the plasma oxidized [Formula: see text] SETs in this work is remarkably reduced (best [Formula: see text] over [Formula: see text] days and no observation of [Formula: see text] exceeding [Formula: see text]), compared to the results of conventionally fabricated [Formula: see text] tunnel barriers in previous studies (best [Formula: see text] over [Formula: see text] days and most [Formula: see text] within one day). We attribute this improvement primarily to using plasma oxidation, which forms the tunnel barrier with fewer two-level system (TLS) defects, and secondarily to fabricating the devices entirely within a UHV system.

Paucity of Clinical Practice Guidelines for the Rehabilitation of Burn Survivors.

Clinical practice guidelines (CPGs) provide an efficient route from research to practice because they follow a prescribed, vetted process for evidence collection. CPGs offer underserved fields, such as burn rehabilitation, an accessible approach to reliable treatment. A literature search was performed using the terms "Burns AND CPGs AND Rehabilitation." Three reviewers determined whether guideline development followed an established vetting process. "Rehabilitation" required evidence of treatment to improve, maintain, or restore human function and provide treatment to facilitate recovery. Only 160 articles were obtained and, after adding the term "functional outcome," 62 remained for full-text review, of which 21 were eligible. When articles were scored for inclusion of both rehabilitation AND function or functional outcome AND guideline vetting, seven articles remained. One was community based. Nine articles had no recorded vetting process but addressed rehabilitation as an outcome. There is a paucity of CPGs relevant to clinical rehabilitation for burn survivors, likely a result of very few published intervention trials, rare randomized controlled trials addressing rehabilitation, absence of data to establish an evidence base for practice recommendations, an inadequate number of community-based intervention trials, and little patient input. It is likely that rehabilitation of burn survivors will improve if more people gain skills in meeting the needs of people with burn injury. An increase in trained professionals may lead to an increase in intervention trials and research to establish evidence for CPGs. People engaged in burn research have an opportunity to devise a systematic, generally agreed-upon approach toward evaluating burn patients and treatment outcomes that will permit data sharing across the world and assess patients throughout the acute and chronic phases of burn injury.

A compact, ultra-high vacuum ion source for isotopically enriching and depositing 28Si thin films.

An ultrahigh vacuum (UHV) compatible Penning ion source for growing pure, highly enriched 28Si epitaxial thin films is presented. Enriched 28Si is a critical material for quantum information due to the elimination of nuclear spins. In some cases, the material must be grown by low temperature molecular beam epitaxy, e.g., scanning tunneling microscopy hydrogen lithography-based devices. Traditional high-purity physical vapor methods typically deliver a very small fraction of source material onto the target substrate, making the cost for use with highly enriched source materials very high. Thus, directed beam sources provide an efficient alternative. This UHV Penning source uses all metal or ceramic parts and a removable electromagnet to allow bake-out. The source gas is a commercial (natural isotope abundance) silane gas (SiH4), an inexpensive source material. High enrichment levels up to 99.999 87% (8.32 × 10-7 mol/mol 29Si) and high chemical purity of 99.965% are shown without postprocessing. We present and discuss the discharge properties of this new source, the ion mass spectrum when coupled to our mass filter, and the secondary ion mass spectroscopy of the grown films.

Use of quantum effects as potential qualifying metrics for "quantum grade silicon".

Across solid state quantum information, materials deficiencies limit performance through enhanced relaxation, charge defect motion or isotopic spin noise. While classical measurements of device performance provide cursory guidance, specific qualifying metrics and measurements applicable to quantum devices are needed. For quantum applications, new materials metrics, e.g., enrichment, are needed, while existing, classical metrics like mobility might be relaxed compared to conventional electronics. In this work, we examine locally grown silicon superior in enrichment, but inferior in chemical purity compared to commercial-silicon, as part of an effort to underpin the materials standards needed for quantum grade silicon and establish a standard approach for intercomparison of these materials. We use a custom, mass-selected ion beam deposition technique, which has produced isotopic enrichment levels up to 99.99998 % 28Si, to isotopically enrich 28Si, but with chemical purity > 99.97% due the MBE techniques used. From this epitaxial silicon, we fabricate top-gated Hall bar devices simultaneously on the 28Si and on the adjacent natural abundance Si substrate for intercomparison. Using standard-methods, we measure maximum mobilities of ≈(1740±2)cm2/(V⋅s) at an electron density of (2.7×1012±3×108) cm-2 and ≈(6040±3)cm2/(V⋅s) at an electron density of (1.2×1012±5×108) cm-2 at T=1.9 K for devices fabricated on 28Si and natSi, respectively. For magnetic fields B>2 T, both devices demonstrate well developed Shubnikov-de Haas (SdH) oscillations in the longitudinal magnetoresistance. This provides transport characteristics of isotopically enriched 28Si, and will serve as a benchmark for classical transport of 28Si at its current state, and low temperature, epitaxially grown Si for quantum devices more generally.