Patient Satisfaction and Healthcare Utilization with the Transition to Virtual Care in a Multidisciplinary Bariatric Program.

BACKGROUND: The COVID-19 pandemic saw an acceleration in virtual-visits (VV) for healthcare delivery. However, the impact of virtual care in metabolic/bariatric surgery (MBS) programs is not well described. METHODS: Appointment data from three time-points: pre-pandemic (1/1/19-3/15/20, n = 19,290), pandemic (3/16/20-10/31/21, n = 29,459) and current-state (11/1/21-12/31/2022, n = 24,270) was retrieved in our multi-hospital ambulatory MBS program. Appointments were grouped by health care provider (HCP) (MD, dietician, and psychologist) and type (VV and in-person). Surveys assessing patient satisfaction were distributed electronically. All pre-op and post-op appointment data was analyzed for the time-points above. Appointment completion rates and patient reported preferences were described. RESULTS: Our data showed an increase in scheduled VV from 0.5% for all HCP visits to 81% during the pandemic and a current VV visit of 77%. The number of completed VV increased for all HCPs, most prominently for dieticians. Parallel to this, the percentage of no-show visits also improved for all HCP, with MDs having the lowest no-show rate currently. Survey data revealed 89% of patients experience added benefits with VV and > 90% reported their VV experience as very good. VV were preferred over in-person visits for psychologists and dietitians (> 61%), but the majority preferred to see MDs in-person (70%). CONCLUSIONS: Our findings reveal significant changes in healthcare utilization trends since the transition to virtual care. While overall satisfaction with virtual care is high, most patients prefer in-person visits with MDs. Thus, multi-disciplinary MBS care can be performed effectively using a hybrid model to ensure efficient distribution of resources.

Solution-Processed Li2O-Al2O3/TiO2 Nanolaminate Stacks Containing Mobile Lithium Ions and with Increased Breakdown Voltages.

An aqueous solution approach has been utilized to prepare nanolaminates of TiO2 and ionically conductive Li2O-Al2O3 (LiAlO). This new approach utilizes low curing temperatures, resulting in fully oxidized films as demonstrated by Fourier-transform infrared spectroscopy and X-ray photoelectron spectroscopy. The layered structures have been characterized by scanning electron microscopy, X-ray diffraction, and X-ray reflectivity. Incorporation of sufficiently thick (13 and 27 nm) ion blocking TiO2 layers into nanolaminate structures with LiAlO layers resulted in an increase in breakdown voltage by more than a factor of two, relative to LiAlO. Nanolaminate structures also preserve the large double layer capacitance of the ionically conductive layer. Increased breakdown strength coupled with large capacitances results in a doubling of ultimate charge storage capacity, illustrating how nanolaminates can be used to improve properties relevant for energy/charge storage applications.

Telerehabilitation with live-feed biomedical sensor signals for patients with heart failure: a pilot study.

BACKGROUND: Integrating biomedical sensors to a telerehabilitation platform allowed clinicians to receive real-time transmissions of the electrocardiogram (ECG) signal, oxygen saturation, and heart rate during an exercise program. These clinical data could be helpful to adjust and personalize the intensity of exercises to each patient's condition. The purpose of this study was to evaluate the feasibility and usefulness of biomedical sensors in telerehabilitation in patients with heart failure (HF). METHODS: Four participants with HF (mean age 66 years) followed the 12-week cardiac program using telerehabilitation, including sensors to monitor real-time vital signs during sessions. The exercise program included cardiovascular, strengthening and flexibility exercises. Participants were evaluated before the intervention and one month after the end of the program. Functional capacity was measured with Cardiopulmonary Exercise Testing (CPX), the 6-minute walk test (6MWT), and the sit to stand test (STST). Quality of life was objectified using the Kansas City Cardiomyopathy Questionnaire (KCCQ). RESULTS: Our main objective demonstrated that real-time biomedical sensors can be safely used by clinicians during a telerehabilitation session. Most participants showed a tendency to improve their physical capacities such as walking distance and lower limb muscular strength. As a main outcome of cardiac rehabilitation (CR), quality of life seems to improve after the 12-week intervention. CONCLUSIONS: This study proved the feasibility of using telerehabilitation with real-time biomedical sensors as an alternative or a complement to the conventional CR program. Use of sensors allowed a safe environment for the patient and an adequate and personalized exercise prescription. Limitation in one-to-one supervision must be challenged in future clinical trials to demonstrate that telerehabilitation could be efficient for cardiac patients requiring more individual supervision than group sessions in a gymnasium.

Nonuniform Composition Profiles in Amorphous Multimetal Oxide Thin Films Deposited from Aqueous Solution.

Metal oxide thin films are ubiquitous in technological applications. Often, multiple metal components are used to achieve desired film properties for specific functions. Solution deposition offers an attractive route for producing these multimetal oxides because it allows for careful control of film composition through the manipulation of precursor stoichiometry. Although it has been generally assumed that homogeneous precursor solutions yield homogeneous thin films, we recently reported evidence of nonuniform electron density profiles in aqueous-deposited films. Herein, we show that nonuniform electron densities in lanthanum zirconium oxide (LZO) thin films are the result of inhomogeneous distributions of metal components. Specifically, La aggregates at the film surface, whereas Zr is relatively evenly distributed throughout single-layer films. This inhomogeneous metal distribution persists in stacked multilayer films, resulting in La-rich interfaces between the sequentially deposited layers. Testing of metal-insulator-semiconductor devices fabricated from single and multilayer LZO films shows that multilayer films have higher dielectric constants, indicating that La-rich interfaces in multilayer films do not detrimentally impact film properties. We attribute the enhanced dielectric properties of multilayer films to greater condensation and densification relative to single-layer films, and these results suggest that multilayer films may be preferred for device applications despite the presence of layering artifacts.

No Detectable Insecticide Resistance in Swallow Bugs (Hemiptera: Cimicidae) Following Long-Term Exposure to Naled (Dibrom 8).

The swallow bug, Oeciacus vicarius Horvath, is a hematophagous ectoparasite of the cliff swallow, Petrochelidon pyrrhonota Vieillot, and is closely related to bed bugs (Cimex spp.). Evolution of insecticide resistance has been documented for bed bugs but not studied in Oeciacus. For periods of 17 and 32 yr, two cliff swallow colonies in western Nebraska were treated during the summer breeding season using the organophosphate insecticide Dibrom. Despite continual treatments, O. vicarius has been observed frequently within these colonies. We evaluated the efficacy of Dibrom 8 on O. vicarius during the 2016 season at two treated colonies and four that had never experienced treatment. Dibrom 8 was found to be effective in 100% of trials, with immobilization within minutes and death within 72 h, for individuals from all colonies. In control treatments (water), individuals collected from treated colonies exhibited greater survival than individuals from untreated colonies, and those from active colonies (bugs fed) had greater survival than those from inactive colonies (bugs unfed). A residual effect was observed in both lab and field trials: 100% mortality occurred in the lab after exposure to filter paper substrates treated both 5 and 10 d earlier, and in the field, nests treated once early in the season had O. vicarius counts 43 d later that were <1% of those from untreated nests within the same colony. We hypothesize that the lack of resistance results from the limited potential for resistance allele fixation due to outbreeding and frequent immigration of insecticide-naïve individuals.

High-κ Lanthanum Zirconium Oxide Thin Film Dielectrics from Aqueous Solution Precursors.

Metal oxide thin films are critical components in modern electronic applications. In particular, high-κ dielectrics are of interest for reducing power consumption in metal-insulator-semiconductor (MIS) field-effect transistors. Although thin-film materials are typically produced via vacuum-based methods, solution deposition offers a scalable and cost-efficient alternative. We report an all-inorganic aqueous solution route to amorphous lanthanum zirconium oxide (La2Zr2O7, LZO) dielectric thin films. LZO films were spin-cast from aqueous solutions of metal nitrates and annealed at temperatures between 300 and 600 °C to produce dense, defect-free, and smooth films with subnanometer roughness. Dielectric constants of 12.2-16.4 and loss tangents <0.6% were obtained for MIS devices utilizing LZO as the dielectric layer (1 kHz). Leakage currents <10-7 A cm-2 at 4 MV cm-1 were measured for samples annealed at 600 °C. The excellent surface morphology, high dielectric constants, and low leakage current densities makes these LZO dielectrics promising candidates for thin-film transistor devices.

Same Precursor, Two Different Products: Comparing the Structural Evolution of In-Ga-O "Gel-Derived" Powders and Solution-Cast Films Using Pair Distribution Function Analysis.

Amorphous metal oxides are central to a variety of technological applications. In particular, indium gallium oxide has garnered attention as a thin-film transistor channel layer material. In this work we examine the structural evolution of indium gallium oxide gel-derived powders and thin films using infrared vibrational spectroscopy, X-ray diffraction, and pair distribution function (PDF) analysis of X-ray total scattering from standard and normal incidence thin-film geometries (tfPDF). We find that the gel-derived powders and films from the same aqueous precursor evolve differently with temperature, forming mixtures of Ga-substituted In2O3 and In-substituted ß-Ga2O3 with different degrees of substitution. X-ray total scattering and PDF analysis indicate that the majority phase for both the powders and films is an amorphous/nanocrystalline ß-Ga2O3 phase, with a minor constituent of In2O3 with significantly larger coherence lengths. This amorphous ß-Ga2O3 phase could not be identified using the conventional Bragg diffraction techniques traditionally used to study crystalline metal oxide thin films. The combination of Bragg diffraction and tfPDF provides a much more complete description of film composition and structure, which can be used to detail the effect of processing conditions and structure-property relationships. This study also demonstrates how structural features of amorphous materials, traditionally difficult to characterize by standard diffraction, can be elucidated using tfPDF.

Amorphous Mixed-Metal Oxide Thin Films from Aqueous Solution Precursors with Near-Atomic Smoothness.

Thin films with tunable and homogeneous composition are required for many applications. We report the synthesis and characterization of a new class of compositionally homogeneous thin films that are amorphous solid solutions of Al2O3 and transition metal oxides (TMOx) including VOx, CrOx, MnOx, Fe2O3, CoOx, NiO, CuOx, and ZnO. The synthesis is enabled by the rapid decomposition of molecular transition-metal nitrates TM(NO3)x at low temperature along with precondensed oligomeric Al(OH)x(NO3)3-x cluster species, both of which can be processed from aq solution. The films are dense, ultrasmooth (Rrms < 1 nm, near 0.1 nm in many cases), and atomically mixed amorphous metal-oxide alloys over a large composition range. We assess the chemical principles that favor the formation of amorphous homogeneous films over rougher phase-segregated nanocrystalline films. The synthesis is easily extended to other compositions of transition and main-group metal oxides. To demonstrate versatility, we synthesized amorphous V0.1Cr0.1Mn0.1Fe0.1Zn0.1Al0.5Ox and V0.2Cr0.2Fe0.2Al0.4Ox with Rrms ≈ 0.1 nm and uniform composition. The combination of ideal physical properties (dense, smooth, uniform) and broad composition tunability provides a platform for film synthesis that can be used to study fundamental phenomena when the effects of transition metal cation identity, solid-state concentration of d-electrons or d-states, and/or crystallinity need to be controlled. The new platform has broad potential use in controlling interfacial phenomena such as electron transfer in solar-cell contacts or surface reactivity in heterogeneous catalysis.

Is an in-home telerehabilitation program for people with proximal humerus fracture as effective as a conventional face-to face rehabilitation program? A study protocol for a noninferiority randomized clinical trial.

BACKGROUND: Proximal humerus fractures can be treated surgically (eg: pinning, plate and screws) or conservatively by wearing a splint or a cast. Following both of these approaches, rehabilitation has proven effective to prevent functional limitations and to re-establish normal shoulder function. However, access to these rehabilitation services and compliance tends to be limited in elderly patients due to travelling difficulties caused by their precarious health status and, in some cases, social and marital status. Since the majority of patients with a proximal humerus fracture are elderly, it becomes relevant to find a new way to offer quick, simple and suitable rehabilitation service. Thus, the use of promising alternative approaches, as in-home telerehabilitation, can enhance access to rehabilitation services for such population. The main objective of the study is to compare the clinical effects of the innovative telerehabilitation approach (TELE group) compared to face-to-face visits to a clinic (CLINIC group) for patients treated for a proximal humerus fracture. METHODS/DESIGN: In this randomized controlled trial, individuals who have had a proximal humerus fracture treated conservatively at the Centre intégré universitaire de santé et de services sociaux de l'Estrie - Centre hospitalier universitaire de Sherbrooke (CIUSSS de l'Estrie CHUS), and who are returning home will be included. Participants will be recruited during their visit to the emergency ward or outpatient clinic by the medical or research team and will then sign the informed consent form if they are interested to participate in the study. We expect to recruit 52 participants (26 per group). Randomization will be done by a random number generator with sealed envelopes. Each patient will be evaluated before the beginning of the rehabilitation (T1), and immediately after the 2-month intervention (T2). The following outcomes will be measured: 1) upper extremity function (Constant Shoulder Score and Disability of the Arm, Shoulder and Hand questionnaire [DASH]); 2) range of motion (conventional goniometer); 3) user satisfaction (Health Care Satisfaction questionnaire); and 4) cost of services to the public healthcare system. The difference between the two groups will be compared using a t-test or a chi-squared test, and through a cost-effectiveness economic analysis. DISCUSSION: We hypothesize that in-home telerehabilitation will provide a good alternative to conventional rehabilitation, in terms of its efficacy, simplicity, patient satisfaction, and low associated costs. TRIAL REGISTRATION: ClinicalTrials.gov: NCT02425267. April 22(nd), 2015.

Fluctuating survival selection explains variation in avian group size.

Most animal groups vary extensively in size. Because individuals in certain sizes of groups often have higher apparent fitness than those in other groups, why wide group size variation persists in most populations remains unexplained. We used a 30-y mark-recapture study of colonially breeding cliff swallows (Petrochelidon pyrrhonota) to show that the survival advantages of different colony sizes fluctuated among years. Colony size was under both stabilizing and directional selection in different years, and reversals in the sign of directional selection regularly occurred. Directional selection was predicted in part by drought conditions: birds in larger colonies tended to be favored in cooler and wetter years, and birds in smaller colonies in hotter and drier years. Oscillating selection on colony size likely reflected annual differences in food availability and the consequent importance of information transfer, and/or the level of ectoparasitism, with the net benefit of sociality varying under these different conditions. Averaged across years, there was no net directional change in selection on colony size. The wide range in cliff swallow group size is probably maintained by fluctuating survival selection and represents the first case, to our knowledge, in which fitness advantages of different group sizes regularly oscillate over time in a natural vertebrate population.

Non-uniform Composition Profiles in Inorganic Thin Films from Aqueous Solutions.

A variety of metal oxide films (InGaOx, AlOx, "HafSOx") prepared from aqueous solutions were found to have non-uniform electron density profiles using X-ray reflectivity. The inhomogeneity in HafSOx films (Hf(OH)4-2x-2y(O2)x(SO4)y·zH2O), which are currently under investigation as inorganic resists, were studied in more detail by high-angle annular dark-field scanning transmission electron microscopy (HAADF-STEM) and medium-energy ion scattering (MEIS). The HAADF-STEM images show a greater concentration of heavy atoms near the surface of a single-layer film. MEIS data confirm the aggregation of Hf at the film surface. The denser "crust" layer in HafSOx films may directly impact patterning resolution. More generally, the phenomenon of surface-layer inhomogeneity in solution-deposited films likely influences film properties and may have consequences in other thin-film systems under investigation as resists, dielectrics, and thin-film transistor components.

Predation by ants controls swallow bug (Hemiptera: Cimicidae: Oeciacus vicarius) infestations.

The swallow bug (Oeciacus vicarius) is the only known vector for Buggy Creek virus (BCRV), an alphavirus that circulates in cliff swallows (Petrochelidon pyrrhonota) and house sparrows (Passer domesticus) in North America. We discovered ants (Crematogaster lineolata and Formica spp.) preying on swallow bugs at cliff swallow colonies in western Nebraska, U.S.A. Ants reduced the numbers of visible bugs on active swallow nests by 74-90%, relative to nests in the same colony without ants. Ant predation on bugs had no effect on the reproductive success of cliff swallows inhabiting the nests where ants foraged. Ants represent an effective and presumably benign way of controlling swallow bugs at nests in some colonies. They may constitute an alternative to insecticide use at sites where ecologists wish to remove the effects of swallow bugs on cliff swallows or house sparrows. By reducing bug numbers, ant presence may also lessen BCRV transmission at the spatial foci (bird colony sites) where epizootics occur. The effect of ants on swallow bugs should be accounted for in studying variation among sites in vector abundance.

Lanthanum aluminum oxide thin-film dielectrics from aqueous solution.

Amorphous LaAlO3 dielectric thin films were fabricated via solution processing from inorganic nitrate precursors. Precursor solutions contained soluble oligomeric metal-hydroxyl and/or -oxo species as evidenced by dynamic light scattering (DLS) and Raman spectroscopy. Thin-film formation was characterized as a function of annealing temperature using Fourier transform infrared (FTIR), X-ray diffraction (XRD), X-ray reflectivity (XRR), scanning electron microscopy (SEM), and an array of electrical measurements. Annealing temperatures ≥500 °C result in thin films with low leakage-current densities (∼1 × 10(-8) A·cm(-2)) and dielectric constants ranging from 11.0 to 11.5. When incorporated as the gate dielectric layer in a-IGZO thin-film transistors (TFTs), LaAlO3 thin films annealed at 600 °C in air yielded TFTs with relatively low average mobilities (∼4.5 cm(2)·V(-1)·s(-1)) and high turn-on voltages (∼26 V). Interestingly, reannealing the LaAlO3 in 5%H2/95%N2 at 300 °C before deposition of a-IGZO channel layers resulted in TFTs with increased average mobilities (11.1 cm(2)·V(-1)·s(-1)) and lower turn-on voltages (∼6 V).

Blood conservation devices in critical care: a narrative review.

Anaemia is associated with inferior outcomes in critically ill patients. It is difficult to prevent and is treated commonly with the transfusion of packed red cells. However, transfusion to augment oxygen delivery has not been shown to consistently offer a survival advantage when the haemoglobin concentration exceeds 7 g/dL. Several studies point to inferior outcomes when patients are transfused. Observational studies have confirmed that critically ill patients have frequent blood draws as part of their routine daily care. Cumulatively large volumes of blood are frequently taken, which contribute significantly towards the development of anaemia. Reducing iatrogenic blood loss may reduce the risk of developing anaemia and possibly the need for transfusion. Blood conservation devices may help to achieve this goal. The integration of blood conservation devices into routine care has been relatively slow in critical care. This review summarises the current evidence base and confirms that blood conservation devices do reduce the volume of iatrogenic blood loss. In the most recent studies, these devices have been shown to reduce transfusion requirements even in those intensive care units that follow a restrictive transfusion strategy.

A CHO cell line engineered to express XBP1 and ERO1-Lα has increased levels of transient protein expression.

Transient gene expression (TGE) systems currently provide rapid and scalable (up to 100 L) methods for generating multigram quantities of recombinant heterologous proteins. Product titers of up to 1 g/L have been demonstrated in HEK293 cells but reported yields from Chinese hamster ovary (CHO) cells are lower at ∼300 mg/L. We report on the establishment of an engineered CHOS cell line, which has been developed for TGE. This cell line has been engineered to express both X-box binding protein (XBP-1S) and endoplasmic reticulum oxidoreductase (ERO1-Lα) and has been named CHOS-XE. CHOS-XE cells produced increased antibody (MAb) yields (5.3- 6.2 fold) in comparison to CHOS cells. Product quality was unchanged as assessed by size, charge, propensity to aggregate, major glycosylation species, and thermal stability. To further develop and test this TGE system, five commercial media were assessed, and one was shown to offer the greatest increase in antibody yields. With the addition of a commercial feed, MAb titers reached 875 mg/L.

Diffusion of dissolved ions from wet silica sol-gel monoliths: implications for biological encapsulation.

Divalent nickel (Ni(2+)), Cu(II)EDTA, methyl orange, and dichromate were used to investigate diffusion from hydrated silica sol-gel monoliths. The objective was to examine diffusion of compounds on a size regime relevant to supporting biological components encapsulated within silica gel prepared in a biologically compatible process space with no post-gelation treatments. With an initial sample set, gels prepared from tetraethoxysilane were explored in a factorial design with Ni(2+) as the tracer, varying water content during hydrolysis, acid catalyst present during hydrolysis, and the final concentration of silica. A second sample set explored diffusion of all four tracers in gels prepared with aqueous silica precursors and a variety of organically modified siloxanes. Excluding six outliers which displayed significant syneresis, the mean diffusion constant (D(gel)) across the entire process space of sample set 1 was 2.42×10(-10) m(2) s(-1); approximately 24% of the diffusion coefficient of Ni(2+) in unconfined aqueous solution. In sample set 2, the tracer size and not gel hydrophobicity was the primary determinant of changes in diffusion rates. A strong linear inverse correlation was found between tracer size and the magnitude of D(gel). Based on correlation with the tracers used in this investigation, the characteristic 1-h diffusion distance for carbonate species relevant to supporting active phototrophic organisms was approximately 1.5mm. These results support the notion that silica sol-gel formulations may be optimized for a given biological entity of interest with manageable impact to the diffusion of small ions and molecules.

Duration of Analgesia Induced by Acupuncture-Like TENS on Experimental Heat Pain.

Background. Acupuncture-like TENS (AL-TENS) is a treatment modality that can be used to temporarily reduce pain. However, there is no clear data in the literature regarding the specific duration of analgesia induced by AL-TENS. Objectives. To describe and quantify the duration and magnitude of AL-TENS analgesia on experimental heat pain in healthy subjects and verify if the duration or magnitude of analgesia induced by the AL-TENS was influenced by the duration of the application of the AL-TENS (15 versus 30 minutes). Methods. A repeated-measures, intrasubject randomized experimental design was used, where each participant was his/her own control. 22 healthy volunteers underwent heat pain stimulations with a contact thermode before (pretest) and after (posttest) AL-TENS application (15 and 30 minutes). Outcome measures included subjective pain during AL-TENS, duration, and magnitude of AL-TENS-induced analgesia. Results. Survival analysis showed that the median duration of AL-TENS analgesia was 10 minutes following the application of either 15 or 30 minutes of AL-TENS. The magnitude of analgesia following either application was comparable at all points in time (P values > 0.05) and ranged between -20% and -36% pain reduction. Conclusion. Only half of the participants still had heat-pain analgesia induced by the AL-TENS at 15 minutes postapplication.

In-home Telerehabilitation for Older Persons with Chronic Obstructive Pulmonary Disease: A Pilot Study.

The purpose of this pilot study was to investigate the efficacy of in-home telerehabilitation for people with Chronic Obstructive Pulmonary Disease (COPD). Three community-living elders with COPD were recruited in a rehabilitation outpatient group and by direct referrals from pneumologists with outpatients who have COPD. A pre/post-test design without a control group was used for this pilot study. Telerehabilitation sessions (15 sessions) were conducted by two trained physiotherapists from a service center to the patient's home. Locomotor function (walking performance) and quality of life were measured in person prior to and at the end of the treatment by an independent assessor. Clinical outcomes improved for all subjects except for locomotor function in the first participant. In-home telerehabilitation for people with COPD is a realistic alternative to dispense rehabilitation services for patients requiring physical therapy follow-up.