Efficacy Studies of Home-Based Occupational Therapy Services Following Stroke: A Scoping Review.

The aim of this scoping review was to review and assess recent studies on the efficacy of home-based occupational therapy interventions for adults post-stroke. The number of efficacy studies is limited. The few studies available suggest that occupational therapy delivered in home settings may improve outcomes for stroke patients. There is also limited use of occupation-based assessments, interventions, and outcome measures in studies addressing home-based occupational therapy. Methodologies should be improved to include contexts, caregiver training, and self-efficacy. Further high-quality studies are needed on the efficacy home-based occupational therapy services.

Primary Care Practice Transformation in the Era of COVID-19 and Beyond: Key Principles for General Internal Medicine Practitioners.

As members of the Clinical Practice Committee (CPC) of the Society for General Internal Medicine (SGIM), we support practice innovation and transformation to achieve a more just system by which all people can achieve and maintain optimal health. The COVID-19 pandemic has tested the US healthcare delivery system and sharpened our national awareness of long-standing and ingrained system shortcomings. In the face of crisis, SGIM members innovated and energetically mobilized to focus on the immediate needs of our patients and communities. Reflecting on these experiences, we are called to consider what was learned from the pandemic that applies to the future of healthcare delivery. CPC members include leaders in primary care delivery, practice finance, quality of care, patient safety, hospital practice, and health policy. CPC members provide expertise in clinical practice, serving as primary care doctors, hospitalists, and patient advocates who understand the intensity of care needed for those with severe COVID-19 infections, the disproportionate impact of the pandemic on Black and Brown communities, the struggles created for those with poor access to care, and the physical and emotional impact it has placed on patients, families, and clinicians. In this consensus statement, we summarize lessons learned from the 2020-2021 pandemic and their broader implications for reform in healthcare delivery. We provide a platform for future work by identifying many interactive elements of healthcare delivery that must be simultaneously addressed in order to ensure that care is accessible, equitably provided, patient-centered, and cost-effective.

Diffraction properties of cylindrically bent KAP crystals in energy range of 2.3-7.5 keV using synchrotron radiation.

Verification of physics models and computer simulations are heavily reliant upon the accuracy of experimental measurements. Calibration of instrument responses becomes an important step to achieve this goal. This paper presents systematic studies of bent potassium acid phthalate (KAP) crystals using Lawrence Berkeley National Laboratories, Advanced Light Source, beamline 9.3.1 in the energy range of 2.3 to 7.5 keV. A set of KAP crystals, gradually bent from flat up to a 50.8 mm cylindrical curvature. The measured integrated reflectivity for this set of KAP crystals shows good agreement with the X-ray Oriented Program (XOP) calculations when adjusting the Debye-Waller temperature factor and using the multilamellar model in the calculations. Significant differences in rocking curve profiles were observed between experimental measurements and theory. A forward convolution model and software code were developed to include experimental parameters, allowing the investigation of the difference between measurements and calculations. After considering the experimental parameters, good agreements were obtained for the rocking curve profiles for all bending radii with a unique set of parameters. Our results show that XOP can be a useful and reliable tool to predict performance of cylindrically bent KAP crystals in this energy range.

Health literacy and asthma management among African-American adults: an interpretative phenomenological analysis.

OBJECTIVE: African-Americans share a disproportionate burden of asthma and low health literacy and have higher asthma morbidity and mortality. Factors that link the relationship between health literacy and health outcomes are unclear. This study aimed to use patients' experiences of managing asthma to better understand the relationship between health literacy and health outcomes. METHODS: This study was the qualitative component of a mixed methods study. Following quantitative data collection, four participants, two with low print-related health literacy and two with adequate print-related health literacy, completed semi-structured interviews. Interview data were analyzed using interpretative phenomenological analysis. RESULTS: Three themes emerged from the analysis: information desired versus information received, trial and error, and expectations of the patient-provider relationship. Individuals with adequate print-related health literacy had different strategies for overcoming barriers related to communicating with their providers, learning about their disease and experiences of discrimination within the healthcare system. CONCLUSIONS: Individuals with adequate print-related health literacy may be more equipped to participate in shared decision making and feel more confident to successfully manage their disease. It is also important that health literacy is discussed in the context of the cultural and racial background of the population of interest. This interdependent relationship between health literacy and culture is particularly important for African-Americans.

Optimizing Interfacial Energetics for Conjugated Polyelectrolyte Electron Injection Layers in High Efficiency and Fast Responding Polymer Light Emitting Diodes.

Modification of the π-conjugated backbone structure of conjugated polyelectrolytes (CPEs) for use as electron injection layers (EILs) in polymer light emitting diodes (PLEDs) has previously brought conflicted results in the literature in terms of device efficiency and turn-on response time. Herein, we determine the energetics at the CPE and the light emitting polymer (LEP) interface as a key factor for PLED device performance. By varying the conjugated backbone structure of both the LEP and CPE, we control the nature of the CPE/LEP interface in terms of optical energy gap offset, interfacial energy level offset, and location of the electron-hole recombination zone. We use a wide gap CPE with a shallow LUMO (F8im-Br) and one with a smaller gap and deeper LUMO (F8imBT-Br), in combination with three different LEPs. We find that the formation of a type II heterojunction at the CPE/LEP interfaces causes interfacial luminance quenching, which is responsible for poor efficiency in PLED devices. The effect is exacerbated with increased energy level offset from ionic rearrangement and hole accumulation occurring near the CPE/LEP interface. However, a deep CPE LUMO is found to be beneficial for fast current and luminance turn-on times of devices. This work provides important CPE molecular design rules for EIL use, offering progress toward a universal PLED-compatible CPE that can simultaneously deliver high efficiency and fast response times. In particular, engineering the LUMO position to be deep enough for fast device turn-on while avoiding the creation of a large energy level offset at the CPE/LEP interface is shown to be highly desirable.

High-Efficiency Polymer LEDs with Fast Response Times Fabricated via Selection of Electron-Injecting Conjugated Polyelectrolyte Backbone Structure.

Imidazolium ionic side-group-containing fluorene-based conjugated polyelectrolytes (CPEs) with different π-conjugated structures, poly[(9,9-bis(8'-(3″-methyl-1″-imidazolium)octyl)-2,7-fluorene)-alt-2,7-(9,9-dioctylfluorene)] dibromide (F8im-Br) and poly[(9,9-bis(8'-(3″-methyl-1″-imidazolium)octyl)-2,7-fluorene)-alt-(benzo(2,1,3)thiadiazol-4,8-diyl) dibromide (F8imBT-Br), are synthesized and utilized as an electron injection layer (EIL) in green-emitting F8BT polymer light-emitting diodes (PLEDs). Both CPE EIL devices significantly outperform Ca cathode devices; 17.9 cd A(-1) (at 3.8 V) and 16.6 lm W(-1) (at 3.0 V) for F8imBT-Br devices, 11.1 cd A(-1) (at 4.2 V) and 9.1 lm W(-1) (at 3.4 V) for F8im-Br devices, and 7.2 cd A(-1) (at 3.6 V) and 7.0 lm W(-1) (at 3.0 V) for Ca devices. Importantly, unlike the F8im-Br EIL devices, F8imBT-Br PLEDs exhibit much faster electroluminescence turn-on times (<10 µs) despite both EILs possessing the same tethered imidazolium and mobile bromide ions. The F8imBT-Br devices represent, to the best of our knowledge, the highest efficiency in thin (70 nm) single-layer F8BT PLEDs in conventional device architecture with the fastest EL response time using CPE EIL with mobile ions. Our results clearly indicate the importance of an additional factor of EIL materials, specifically the conjugated backbone structure, to determine the device efficiency and response times.

Incremental direct medical expenditures associated with anxiety disorders for the U.S. adult population: evidence from the Medical Expenditure Panel Survey.

Data from the 2009 and 2010 Medical Expenditure Panel Survey (MEPS) were used to estimate the annual incremental healthcare expenditures associated with anxiety disorders, for the ambulatory adult population of the U.S. Individuals 18 years and older, who reported a diagnosis of, or had a medical event associated with anxiety disorder(s), were classified as anxiety population. Multivariate regression analyses, using generalized linear models, were conducted to calculate incremental costs associated with anxiety disorders. 8.74% of adult respondents reported being diagnosed with anxiety disorder(s). The annual overall healthcare expenditure associated with anxiety disorders was estimated at $1657.52 per person (SE: $238.83; p<0.001). Inpatient visits, prescription medications, and office-based visits together accounted for almost 93% of the overall cost. Given the prevalence of self-reported anxiety disorders in MEPS, their total direct medical expenditure is estimated at approximately $33.71 billion in 2013 US dollars, meaning this category of mental illnesses absorbs a significant portion of the U.S. healthcare resources.