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.

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.

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.

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.

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%.

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.

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.

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.

STM patterned nanowire measurements using photolithographically defined implants in Si(100).

Using photolithographically defined implant wires for electrical connections, we demonstrate measurement of a scanning tunneling microscope (STM) patterned nanoscale electronic device on Si(100). By eliminating onerous alignment and complex lithography techniques, this approach is accessible to researchers in smaller efforts who may not have access to tools like electron beam lithography. Electrical contact to the nanodevices is achieved by implanting patterned, degenerately doped wires in the substrate using photolithography and commercial low energy ion implantation. We bring several isolated, implanted wires to within the STM scanner's field of view where the STM can detect and smoothly draw contiguous patterns that directly overlap with implant lines for electrical connections. This overlapping provides a two-dimensional (2D) overlap interface with the 2D electron system, in contrast to many state-of-the-art methods that rely on contacting an exposed edge. After the STM pattern is phosphine dosed and overgrown with silicon, photolithography is then used again to align (≈ 160 µm)2 aluminum contact pads onto (≈ 200 µm)2 implanted areas at the ends of the wires. We present detailed results that optimize the spacing of neighboring wires while maintaining electrical isolation after heating to > 1200 °C, a step required for in situ Si surface preparation.

Evaluation of the wrist-worn ActiGraph wGT3x-BT for estimating activity energy expenditure in preschool children.

BACKGROUND/OBJECTIVES: Easy-to-use and accurate methods to assess free-living activity energy expenditure (AEE) in preschool children are required. The aims of this study in healthy preschool children were to (a) evaluate the ability of the wrist-worn ActiGraph wGT3x-BT to predict free-living AEE and (b) assess wear compliance using a 7-day, 24-h protocol. SUBJECTS/METHODS: Participants were 40 Swedish children (5.5±0.2 years) in the Mobile-based intervention intended to stop obesity in preschoolers (MINISTOP) obesity prevention trial. Total energy expenditure (TEE) was assessed using the doubly labeled water method during 14 days. AEE was calculated as (TEEx0.9) minus predicted basal metabolic rate. The ActiGraph accelerometer was worn on the wrist for 7 days and outputs used were mean of the daily and awake filtered vector magnitude (mean VM total and mean VM waking). RESULTS: The ActiGraph was worn for 7 (n=34, 85%), 6 (n=4, 10%), 5 (n=1, 2.5%) and 4 (n=1, 2.5%) days (a valid day was ⩾600 awake minutes). Alone, mean VM total and mean VM waking were able to explain 14% (P=0.009) and 24% (P=0.001) of the variation in AEE, respectively. By incorporating fat and fat-free mass in the models 58% (mean VM total) and 62% (mean VM waking) in the variation of AEE was explained (P<0.001). CONCLUSIONS: The wrist-worn ActiGraph wGT3x-BT in combination with body composition variables explained up to the 62% of the variation in AEE. Given the high wear compliance, the wrist-worn ActiGraph has the potential to provide useful information in studies where physical activity in preschool children is measured.

Parental body mass index and its association with body composition, physical fitness and lifestyle factors in their 4-year-old children: results from the MINISTOP trial.

BACKGROUND/OBJECTIVES: To examine the association between parental body mass index (BMI) and their offspring's body composition, physical fitness and lifestyle factors (that is, sedentary time, physical activity and diet). SUBJECTS/METHODS: A total of 307 preschoolers (4.5±0.1 years) and their parents (fathers: 38.1±5.1 years and mothers: 35.6±4.2 years) participated in this study. Parental BMI was calculated using self-reported weight and height. Preschoolers body composition was assessed using: BMI, fat mass percentage, fat mass index, fat-free mass index (measured via air-displacement plethysmography) and waist circumference. Physical fitness was assessed by the PREFIT fitness battery. Lifestyle factors were assessed using the ActiGraph wGT3x-BT (sedentary time and physical activity), and the mobile-phone based tool for energy balance in children (diet). RESULTS: Parental BMI were positively associated with their offspring's BMI (paternal BMI: standardised beta, ß=0.233, P<0.001; maternal BMI: ß=0.186, P=0.001), fat mass index (paternal BMI: ß=0.130, P=0.026; maternal BMI: ß=0.163, P=0.005), fat-free mass index (paternal BMI: ß=0.214, P<0.001; maternal BMI: ß=0.119, P=0.036) and waist circumference (paternal BMI: ß=0.178, P=0.001; maternal BMI: ß=0.179, P=0.001). A negative association was found between maternal BMI and their offspring's standing long jump test (ß=-0.132, P=0.022). Paternal BMI was associated with their offspring's sedentary time (ß=0.100, P=0.026), whereas parental BMI was not associated with neither physical activity nor diet (all P⩾0.104). CONCLUSIONS: Parental BMI was positively associated with their offspring's BMI, fat as well as fat-free mass index and waist circumference. Moreover, a higher paternal and maternal BMI were related to higher levels of sedentary time and a lower performance in the standing long jump test of their offspring, respectively.

Temperature dependent 29Si incorporation during deposition of highly enriched 28Si films.

In this study, we examine the mechanisms leading to 29Si incorporation into highly enriched 28Si films deposited by hyperthermal ion beams at elevated temperatures in the dilute presence of natural abundance silane (SiH4) gas. Enriched 28Si is a critical material in the development of quantum information devices because 28Si is free of nuclear spins that cause decoherence in a quantum system. We deposit epitaxial thin films of 28Si enriched in situ beyond 99.99998 % 28Si onto Si(100) using an ion beam deposition system and seek to develop the ability to systematically vary the enrichment and measure the impact on quantum coherence. We use secondary ion mass spectrometry to measure the residual 29Si isotope fraction in enriched samples deposited from ≈ 250 °C up to 800 °C. The 29Si isotope fraction is found to increase from < 1 × 10-6 at the lower temperatures, up to > 4 × 10-6 at around 800 °C. From these data, we estimate the temperature dependence of the incorporation fraction, s, of SiH4, which increases sharply from about 2.9 × 10-4 at 500 °C to 2.3 × 10-2 at 800 °C. We determine an activation energy of 1.00(8) eV associated with the abrupt increase in incorporation and conclude that below 500 °C, a temperature independent mechanism such as activation from ion collisions with adsorbed SiH4 molecules is the primary incorporation mechanism. Direct incorporation from the adsorbed state is found to be minimal.

Reduced resistance drift in tunnel junctions using confined tunnel barriers.

Metal-insulator-metal (MIM) tunnel junctions with the aluminum oxide tunnel barriers confined between cobalt electrodes exhibit less resistance drift over time than junctions that utilize a thick, unconfined aluminum electrode. The improved long time stability is attributed to better initial oxide quality achieved through confinement (use of a potential energy well for the oxygen) and plasma oxidation. In this work, Co/AlOx/Co and Co/Al/AlOx/Co tunnel junction aging is compared over a period of approximately 9 months using transport measurements and Wentzel-Kramers-Brillouin (WKB) based modelling. The Co/AlOx/Co (confined) tunnel junction resistance increased by (32 ± 6) % over 5400 h, while Co/Al/AlOx/Co (unconfined) tunnel junction resistance increased by (85 ± 23) % over 5200 h. Fit parameters for the tunnel barrier width and potential energy barriers were extracted using WKB transport modelling. These values change only a small amount in the confined Co/AlOx/Co tunnel junction but show a significant drift in the unconfined Co/AlOx/Co tunnel junction.

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.