An economic evaluation of a self-care intervention in persons with heart failure and diabetes.

BACKGROUND: Persons with concomitant heart failure (HF) and diabetes mellitus constitute a growing population whose quality of life is encumbered with worse clinical outcomes as well as high health resource use (HRU) and costs. METHODS AND RESULTS: Extensive data on HRU and costs were collected as part of a prospective cost-effectiveness analysis of a self-care intervention to improve outcomes in persons with both HF and diabetes. HRU costs were assigned from a Medicare reimbursement perspective. Patients (n = 134) randomized to the self-care intervention and those receiving usual care/attention control were followed for 6 months, revealing significant differences in the number of hospitalization days and associated costs between groups. The mean number of inpatient days was 3 with bootstrapped bias-corrected (BCa) confidence intervals (CIs) of 1.8-4.4 d for the intervention group and 7.3 d (BCa CI 4.1-10.9 d) in the control group: P = .044. Total direct HRU costs per participant were an estimated $9,065 (BCa CI $6,496-$11,936) in the intervention and $16,712 (BCa CI 8,200-$26,621) in the control group, for a mean difference of -$7,647 (BCa CI -$17,588 to $809; P = .21) in favor of the intervention, including intervention costs estimated to be $130.67 per patient. CONCLUSIONS: The self-care intervention demonstrated dominance in lowering costs without sacrificing quality-adjusted life-years.

Enhanced Step Coverage of TiO2 Deposited on High Aspect Ratio Surfaces by Plasma-Enhanced Atomic Layer Deposition.

Plasma-enhanced atomic layer deposition (PEALD) provides multiple benefits compared to thermal ALD including lower possible process temperature and a wider palette of possible materials. However, coverage of high aspect ratio (AR) structures is limited due to the recombination rates of the radical plasma species. We study the limits of conformality in 1:30 AR structures for TiO2 based on tetrakis(dimethylamido)titanium (TDMA-Ti) and O2 plasma through variation in plasma exposure and substrate temperature. Extending plasma exposure duration and decreasing substrate temperature within the ALD window both serve to improve the conformality of the deposited film, with coverage >95% achievable. Additionally, the changes in morphology of the TiO2 were examined with crystallites of anatase and brookite found.

Revealing large room-temperature Nernst coefficients in 2D materials by first-principles modeling.

Two-dimensional (2D) materials have attracted significant attention owing to their distinctive electronic, thermal, and mechanical characteristics. Recent advancements in both theoretical understanding and experimental methods have greatly contributed to the understanding of thermoelectric properties in 2D materials. However, thermomagnetic properties of 2D materials have not yet received the same amount of attention. In this work, we select promising 2D materials guided by the physics of the Nernst effect and present a thorough first-principles study of their electronic structures, carrier mobilities, and Nernst coefficients as a function of carrier concentration. Specifically, we reveal that trilayer graphene with an ABA stacking exhibits an exceptionally large Nernst coefficient of 112 µV (KT)-1 at room temperature. We further demonstrate that monolayer graphene, ABC-stacked trilayer graphene, and trilayer phosphorene (AAA stacking) have large Nernst coefficients at room temperature. This study establishes an ab initio framework for the quantitative study of the thermomagnetic effects in 2D materials and demonstrates high fidelity with previous experimental data.

Electrolyte Coatings for High Adhesion Interfaces in Solid-State Batteries from First Principles.

We introduce an adhesion parameter that enables rapid screening for materials interfaces with high adhesion. This parameter is obtained by density functional theory calculations of individual single-material slabs rather than slabs consisting of combinations of two materials, eliminating the need to calculate all configurations of a prohibitively vast space of possible interface configurations. Cleavage energy calculations are used as an upper bound for electrolyte and coating energies and implemented in an adapted contact angle equation to derive the adhesion parameter. In addition to good adhesion, we impose further constraints in electrochemical stability window, abundance, bulk reactivity, and stability to screen for coating materials for next-generation solid-state batteries. Good adhesion is critical in combating delamination and resistance to lithium diffusivity in solid-state batteries. Here, we identify several promising coating candidates for the Li7La3Zr2O12 and sulfide electrolyte systems including the previously investigated electrode coating materials LiAlSiO4 and Li5AlO8, making them especially attractive for experimental optimization and commercialization.

Novel Ultrabright and Air-Stable Photocathodes Discovered from Machine Learning and Density Functional Theory Driven Screening.

The high brightness, low emittance electron beams achieved in modern X-ray free-electron lasers (XFELs) have enabled powerful X-ray imaging tools, allowing molecular systems to be imaged at picosecond time scales and sub-nanometer length scales. One of the most promising directions for increasing the brightness of XFELs is through the development of novel photocathode materials. Whereas past efforts aimed at discovering photocathode materials have typically employed trial-and-error-based iterative approaches, this work represents the first data-driven screening for high brightness photocathode materials. Through screening over 74 000 semiconducting materials, a vast photocathode dataset is generated, resulting in statistically meaningful insights into the nature of high brightness photocathode materials. This screening results in a diverse list of photocathode materials that exhibit intrinsic emittances that are up to 4x lower than currently used photocathodes. In a second effort, multiobjective screening is employed to identify the family of M2 O (M = Na, K, Rb) that exhibits photoemission properties that are comparable to the current state-of-the-art photocathode materials, but with superior air stability. This family represents perhaps the first intrinsically bright, visible light photocathode materials that are resistant to reactions with oxygen, allowing for their transport and storage in dry air environments.

Direct Integration of Strained-Pt Catalysts into Proton-Exchange-Membrane Fuel Cells with Atomic Layer Deposition.

The design and fabrication of lattice-strained platinum catalysts achieved by removing a soluble core from a platinum shell synthesized via atomic layer deposition, is reported. The remarkable catalytic performance for the oxygen reduction reaction (ORR), measured in both half-cell and full-cell configurations, is attributed to the observed lattice strain. By further optimizing the nanoparticle geometry and ionomer/carbon interactions, mass activity close to 0.8 A mgPt -1 @0.9 V iR-free is achievable in the membrane electrode assembly. Nevertheless, active catalysts with high ORR activity do not necessarily lead to high performance in the high-current-density (HCD) region. More attention shall be directed toward HCD performance for enabling high-power-density hydrogen fuel cells.

Surface Photovoltage-Induced Ultralow Work Function Material for Thermionic Energy Converters.

Low work function materials are essential for efficient thermionic energy converters (TECs), electronics, and electron emission devices. Much effort has been put into finding thermally stable material combinations that exhibit low work functions. Submonolayer coatings of alkali metals have proven to significantly reduce the work function; however, a work function less than 1 eV has not been reached. We report a record-low work function of 0.70 eV by inducing a surface photovoltage (SPV) in an n-type semiconductor with an alkali metal coating. Ultraviolet photoelectron spectroscopy indicates a work function of 1.06 eV for cesium/oxygen-activated GaAs consistent with density functional theory model predictions. By illuminating with a 532 nm laser we induce an additional shift down to 0.70 eV due to the SPV. Further, we apply the SPV to the collector of an experimental TEC and demonstrate an I-V curve shift consistent with the collector work function reduction. This method opens an avenue toward efficient TECs and next-generation electron emission devices.

Electrical Properties of Ultrathin Platinum Films by Plasma-Enhanced Atomic Layer Deposition.

The ability to deposit thin and conformal films has become of great importance because of downscaling of devices. However, because of nucleation difficulty, depositing an electrically stable and thin conformal platinum film on an oxide nucleation layer has proven challenging. By using plasma-enhanced atomic layer deposition (PEALD) and TiO2 as a nucleation layer, we achieved electrically continuous PEALD platinum films down to a thickness of 3.7 nm. Results show that for films as thin as 5.7 nm, the Mayadas-Shatzkes (MS) model for electrical conductivity and the Tellier-Tosser model for temperature coefficient of resistance hold. Although the experimental values start to deviate from the MS model below 5.7 nm because of incomplete Pt coverage, the films still show root mean square electrical stability better than 50 ppm over time, indicating that these films are not only electrically continuous but also sufficiently reliable for use in many practical applications.

The Process of Intrapartum Care Among Skilled Birth Attendants in the Dominican Republic and Maternal Perceptions of Care During Labor and Birth: A Case Report.

INTRODUCTION: The World Health Organization calls for situation analyses of maternity settings globally to improve maternal-newborn health. This study evaluated the care processes of skilled birth attendants and women's satisfaction with the care in a public hospital in the Dominican Republic. The purpose of the assessment was to establish a baseline to build quality improvements. METHODS: A cross-sectional, mixed-methods, observational study was conducted by an international team. Eighty-four participants were included in the Intrapartum Data Set (American College of Nurse-Midwives), and 55 participants completed the Chilean Maternal Well-Being Scale. The data set was analyzed using descriptive statistics. Three focus groups were conducted with health providers, and 4 focus groups were conducted with postpartum women. Themes were derived using content analysis. RESULTS: Nurses were the skilled birth attendants (SBAs) for 54% of women; 46% were attended by either obstetricians or family medicine residents. Ninety-one percent of newborns with nurse attendants had immediate skin-to-skin contact, compared to 79% of newborns with physician attendants. Newborns breastfed within the first hour of life for 67% of the dyads with nurse SBAs, whereas 24% of newborns attended by physicians did so. The well-being survey indicated most women perceived care was adequate or better, irrespective of attending provider. Nevertheless, 67% of rural women perceived care negatively. Qualitative findings indicated that some women felt neither respected nor heard. DISCUSSION: When nurses managed the labor and birth, their care was comparable to that of physicians. Moreover, women were more likely to receive evidence-based newborn care, including skin-to-skin contact, immediate breastfeeding, and discharge instructions. Qualitative findings highlighted the discrepancy between health care providers' perception of the care they provided and patients' perceptions of that care. Reflexive practice and frequent communication with patients about their experience of care should be a part of every practitioner's toolkit, wherever that care is provided.

Plasma-Enhanced Atomic Layer Deposition of SiN-AlN Composites for Ultra Low Wet Etch Rates in Hydrofluoric Acid.

The continued scaling in transistors and memory elements has necessitated the development of atomic layer deposited (ALD) of hydrofluoric acid (HF) etch resistant and electrically insulating films for sidewall spacer processing. Silicon nitride (SiN) has been the prototypical material for this need and extensive work has been conducted into realizing sufficiently lower wet etch rates (WERs) as well as leakage currents to meet industry needs. In this work, we report on the development of plasma-enhanced atomic layer deposition (PEALD) composites of SiN and AlN to minimize WER and leakage current density. In particular, the role of aluminum and the optimum amount of Al contained in the composite structures have been explored. Films with near zero WER in dilute HF and leakage currents density similar to pure PEALD SiN films could be simultaneously realized through composites which incorporate ≥13 at. % Al, with a maximum thermal budget of 350 °C.

Midwifery practice and maternity services: A multisite descriptive study in Latin America and the Caribbean.

OBJECTIVE: over the past three decades there has been a social movement in Latin American countries (LAC) to support humanised, physiologic birth. Rates of caesarean section overall in Latin America are approximately 35%, increasing up to 85% in some cases. There are many factors related to poor outcomes with regard to maternal and newborn/infant health in LAC countries. Maternal and perinatal outcome data within and between countries is scarce and inaccurate. The aims of this study were to: i) describe selected obstetric and neonatal outcomes of women who received midwifery care, ii) identify the level of maternal well-being after experiencing midwifery care in 6 Latin America countries. DESIGN: this was a cross sectional and descriptive study, conducted in selected maternity units in Argentina, Brazil, Chile, the Dominican Republic, Peru, and Uruguay. Quantitative methods were used to measure midwifery processes of care and maternal perceptions of well-being in labour and childbirth through a validated survey of maternal well-being and an adapted version of the American College of Nurse-Midwives (ACNM) standardized antepartum and intrapartum data set. SETTING: Maternity units from 6 Latin American countries. PARTICIPANTS: the final sample was a convenience sample, and the total participants for all sites in the six countries was 3009 low risk women. FINDINGS: for the countries reporting, overall, 82% of these low risk women had spontaneous vaginal deliveries. The rate of caesarean section was 16%; the Dominican Republic had the highest rate of Caesarean sections (30%) and Peru had the lowest rate (4%). The use of oxytocin in labour was widely variable, although overall there was a high proportion of women whose labour was augmented or induced. Ambulation was common, with the lowest proportion (48%) of women ambulating in labour in Chile, Uruguay (50%), Peru (65%), Brazil (85%). The presence of continuous support was highest in Uruguay (93%), Chile (75%) and Argentina (55%), and Peru had the lowest (22%). Episiotomies are still prevalent in all countries, the lowest rate was reported in the Dominican Republic (22%), and the highest rates were 52 and 53% (Chile and Peru, respectively). The Optimal Maternal well-being score had a prevalence of 43.5%, adequate score was 30.8%; 25% of the total sample of women rated their well-being during labour and childbirth as poor. KEY CONCLUSIONS: despite evidence-based guidelines and recommendations, birth is not managed accordingly in most cases. Women feel that care is adequate, although some women report mistreatment. IMPLICATIONS FOR PRACTICE: More research is needed to understand why such high levels of intervention exist and to test the implementation of evidence-based practices in local settings.

Biochemistry and pharmacology of novel anthranilic acid derivatives activating heme-oxidized soluble guanylyl cyclase.

The heme-enzyme soluble guanylyl cyclase (sGC) is an ubiquitous NO receptor, which mediates NO downstream signaling by the generation of cGMP. We studied the mechanism of action of the anthranilic acid derivatives 5-chloro-2-(5-chloro-thiophene-2-sulfonylamino-N-(4-(morpholine-4-sulfonyl)-phenyl)-benzamide sodium salt (HMR1766) (proposed international nonproprietary name, ataciguat sodium) and 2-(4-chloro-phenylsulfonylamino)-4,5-dimethoxy-N-(4-(thiomorpholine-4-sulfonyl)-phenyl)-benzamide (S3448) as a new class of sGC agonists. Both compounds activated different sGC preparations (purified from bovine lung, or crude from human corpus cavernosum) in a concentration-dependent and quickly reversible fashion (EC50 = 0.5-10 microM), with mixed-type activation kinetics. Activation of sGC by these compounds was additive to activation by NO donors, but instead of being inhibited, it was potentiated by the heme-iron oxidants 1H-[1,2,4]-oxdiazolo[3,4-a]quinoxalin-1-one (ODQ) and 4H-8-bromo-1,2,4-oxadiazolo(3,4-d) benz(b)(1,4)oxazin-1-one (NS2028), suggesting that the new compounds target the ferric heme sGC isoform. Protoporphyrin IX acted as a competitive activator, and zinc-protoporphyrin IX inhibited activation of heme-oxidized sGC by HMR1766 and S3448, whereas heme depletion of sGC by Tween 20 treatment reduced activation. Both compounds increased cGMP levels in cultured rat aortic smooth muscle cells; induced vasorelaxation of isolated endothelium-denuded rat aorta, porcine coronary arteries, and human corpus cavernosum (EC50 1 to 10 microM); and elicited phosphorylation of the cGMP kinase substrate vasodilator-stimulated phosphoprotein at Ser239. HMR1766 intravenous bolus injection decreased arterial blood pressure in anesthetized pigs. All of these pharmacological responses to the new compounds were enhanced by ODQ and NS2028. Our findings suggest that HMR1766 and S3448 preferentially activate the NO-insensitive heme-oxidized form of sGC, which exists to a variable extent in vascular tissues, and is a pharmacological target for these new vasodilator drugs.