Atomistic insights into metal hardening.

For millennia, humans have exploited the natural property of metals to get stronger or harden when mechanically deformed. Ultimately rooted in the motion of dislocations, mechanisms of metal hardening have remained in the cross-hairs of physical metallurgists for over a century. Here, we performed atomistic simulations at the limits of supercomputing that are sufficiently large to be statistically representative of macroscopic crystal plasticity yet fully resolved to examine the origins of metal hardening at its most fundamental level of atomic motion. We demonstrate that the notorious staged (inflection) hardening of metals is a direct consequence of crystal rotation under uniaxial straining. At odds with widely divergent and contradictory views in the literature, we observe that basic mechanisms of dislocation behaviour are the same across all stages of metal hardening.

Diabetes self-management education improves quality of care and clinical outcomes determined by a diabetes bundle measure.

PURPOSE: The purpose of this study was to determine the impact of diabetes self-management education (DSME) in improving processes and outcomes of diabetes care as measured by a five component diabetes bundle and HbA1c, in individuals with type 2 diabetes mellitus (T2DM). METHODS: A retrospective analysis was performed for adult T2DM patients who received DSME training in 2011-2012 from an accredited American Diabetes Association center at Intermountain Healthcare (IH) and had an HbA1c measurement within the prior 3 months and 2-6 months after completing their first DSME visit. Control patients were selected from the same clinics as case-patients using random number generator to achieve a 1 to 4 ratio. Case and control patients were included if 1) pre-education HbA1c was between 6.0%-14.0%; 2) their main provider was a primary care physician; 3) they met the national Healthcare Effectiveness Data and Information Set criteria for inclusion in the IH diabetes registry. The IH diabetes bundle includes retinal eye exam, nephropathy screening or prescription of angiotensin converting enzyme or angiotensin receptor blocker; blood pressure <140/90 mmHg, LDL <100 mg/dL, HbA1c <8.0%. RESULTS: DSME patients had a significant difference in achievement of the five element IH diabetes bundle and in HbA1c % compared to those without DSME. After adjusting for possible confounders in a multivariate logistic regression model, DSME patients had a 1.5 fold difference in improvement in their diabetes bundle and almost a 3 fold decline in HbA1c compared to the control group. CONCLUSION: Standardized DSME taught within an IH American Diabetes Association center is strongly associated with a substantial improvement in patients meeting all five elements of a diabetes bundle and a decline in HbA1c beyond usual care. Given the low operating cost of the DSME program, these results strongly support the value adding benefit of this program in treating T2DM patients.

Lattice refinement strategies.

This article quantitatively reconciles crystallographic and mechanics approaches to lattice refinement as part of X-ray diffraction procedures. The equivalence between the refinement based on unit-cell parameters to that based on a lattice deformation tensor is established from a fixed reference configuration. Justification for the small strain assumption, commonly employed in X-ray diffraction based stress analysis, is also derived. It is shown that relations based on infinitesimal strains are correct to within an error of quadratic order in strain. This error may be important to consider for high-precision or high-strain experiments. It is hoped that these results are of use for facilitating communication and collaboration between crystallography and experimental mechanics communities, for studies where X-ray diffraction data are the fundamental measurement.