Remote delivery of a weight management intervention for adults with intellectual disabilities: Results from a randomized non-inferiority trial.

BACKGROUND: Remote delivery of multi-component weight management interventions results in clinically meaningful weight loss in adults without intellectual disabilities (ID), but the effectiveness of remotely delivered weight management interventions in adults with ID has not previously been evaluated. OBJECTIVE: To determine if a weight management intervention delivered remotely could achieve weight loss (kg) at 6 months that is non-inferior to in-person visits in adults with ID and overweight or obesity (BMI ≥25 kg/m2). METHODS: Participants were randomized to a 24-mo. trial (6 mos weight loss,12 mos weight maintenance, 6 mos. no-contact follow up) to compare weight loss achieved with the same multicomponent intervention delivered to individual participants in their home either remotely (RD) or during face-to-face home visits (FTF). RESULTS: One hundred twenty adults with ID (∼32 years of age, 53 % females) were randomized to the RD (n = 60) or the FTF arm (n = 60). Six-month weight loss in the RD arm (-4.9 ± 7.8 kg) was superior to 6-month weight loss achieved in the FTF arm (-2.1 ± 6.7 kg, p = 0.047). However, this may be partially attributed to the COVID-19 pandemic, since weight loss in the FTF arm was greater in participants who completed the intervention entirely pre-COVID (n = 33,-3.2 %) compared to post-COVID (n = 22, -0.61 %). Weight loss across did not differ significantly between intervention arms at 18 (p = 0.33) or 24 months (p = 0.34). CONCLUSION: Our results suggest that remote delivery is a viable option for achieving clinically relevant weight loss and maintenance in adults with ID. NCT REGISTRATION: NCT03291509.

Intrapersonal, interpersonal and environmental correlates of moderate to vigorous physical activity and sedentary time in adolescents with intellectual and developmental disabilities.

BACKGROUND: Although correlates of physical activity (PA) have been extensively examined in both children and adolescents who are typically developing, little is known about correlates of moderate to vigorous physical activity (MVPA) and sedentary time in adolescents with intellectual and developmental disabilities (IDD). Therefore, we examined intrapersonal, interpersonal and environmental factors and their association with device-based MVPA and sedentary time in adolescents with IDD. METHODS: MVPA and sedentary time was assessed using a hip-worn ActiGraph model wGT3x-BT tri-axial accelerometer across a 7-day period in adolescents with IDD and one of their parents. Pearson and point-biserial correlations were calculated to inspect the associations of PA (MVPA, sedentary time) with intrapersonal factors (demographic characteristic, BMI, waist circumference, motor ability, muscle strength, grip strength, cardiovascular fitness and self-efficacy for PA), interpersonal factors (parent demographics, parent BMI, parent MVPA and sedentary time, family social support for PA, parent barriers and support for PA, parent's beliefs/attitudes towards PA and number of siblings), and environmental factors (meteorologic season and COVID-19). Ordinary least squares regression was used to estimate the unique contributions of key factors to PA after controlling for participants' age, sex, race, waist circumference and total wear time. RESULTS: Ninety-two adolescents (15.5 ± 3.0 years old, 21.7% non-White, 6.5% Hispanic, 56.5% female) provided valid accelerometer data. Average sedentary time was 494.6 ± 136.4 min/day and average MVPA was 19.8 ± 24.2 min/day. Age (r = 0.27, P = 0.01), diagnosis of congenital heart disease (r = -0.26, P = 0.01) and parent sedentary time (r = 0.30, P = 0.01) were correlated with sedentary time. BMI (r = -0.24, P = 0.03), waist circumference (r = -0.28, P = 0.01), identifying as White (r = -0.23, P = 0.03) and parent MVPA (r = 0.56, P < 0.001) were correlated with MVPA. After adjusting for the adolescent's age, sex, race, waist circumference, and total wear time, the association between parent and adolescent MVPA remained significant (b = 0.55, P < 0.01, partial η2  = 0.11). CONCLUSION: The results of this study provide evidence that race, waist circumference and parental MVPA may influence the amount of MVPA in adolescents with IDD. The limited available information and the potential health benefits of increased MVPA highlight the need to evaluate the effectiveness of multi-component interventions targeting both intrapersonal and interpersonal levels to promote increased PA in adolescents with IDD.

Comparison of energy intake assessed by image-assisted food records to doubly labelled water in adolescents with intellectual and developmental disabilities: a feasibility study.

BACKGROUND: There are currently no validated methods for energy intake assessment in adolescents with intellectual and developmental disabilities (IDD). The purpose of this study was to determine the feasibility of collecting 3-day image-assisted food records (IARs) and doubly labelled water (TDEEDLW ) data in adolescents with IDD and to obtain preliminary estimates of validity and reliability for energy intake estimated by IAR. METHODS: Adolescents with IDD completed a 14-day assessment of mean daily energy expenditure using doubly labelled water. Participants were asked to complete 3-day IARs twice during the 14-day period. To complete the IAR, participants were asked to fill out a hard copy food record over three consecutive days (two weekdays/one weekend day) and to take before and after digital images of all foods and beverages consumed using an iPad tablet provided by the study. Energy intake from the IAR was calculated using Nutrition Data System for Research. Mean differences, intraclass correlations and Bland-Altman limits of agreement were performed. RESULTS: Nineteen adolescents with IDD, mean age 15.1 years, n = 6 (31.6%) female and n = 6 (31.6%) ethnic/racial minorities, enrolled in the trial. Participants successfully completed their 3-day food records and self-collected doubly labelled water urine samples for 100% of required days. Images were captured for 67.4 ± 30.1% of all meals recorded at assessment 1 and 72.3 ± 29.5% at assessment 2. The energy intake measured by IAR demonstrated acceptable test-retest reliability (intraclass correlation = 0.70). On average, IAR underestimated total energy intake by -299 ± 633 kcal/day (mean per cent error = -9.6 ± 22.2%); however, there was a large amount of individual variability in differences between the IAR and TDEEDLW (range = -1703 to 430). CONCLUSIONS: The collection of IAR and TDEEDLW is feasible in adolescents with IDD. While future validation studies are needed, the preliminary estimates obtained by this study suggest that in adolescents with IDD, the IAR method has acceptable reliability and may underestimate energy intake by ~9%.

Exploring the effectiveness of an 18-month weight management intervention in adults with Down syndrome using propensity score matching.

BACKGROUND: Down syndrome (DS) is one of the most common birth defects in the USA associated with high levels of overweight and obesity. Unique characteristics of adults with DS that may contribute to the high levels of obesity are high rates of hypothyroidism, poor muscle tone, altered gait and lower resting metabolic rate. Due to these factors, it is unknown if the same weight management interventions that are effective in adults with intellectual or developmental disability (IDD) without DS are as effective in those with DS. Therefore, the purpose of this secondary analysis was to compare changes in weight, diet and physical activity between participants with DS-related and non-DS-related IDD participating in an 18-month weight management trial. METHODS: We used propensity score methods to adjust baseline variables of overweight/obese adults with and without DS participating in an 18-month effectiveness trial with 6 months weight loss and 12 months weight maintenance. Participants followed one of two reduced calorie diet plans, obtained 150 min of moderate-vigorous intensity physical activity (MVPA) per week, and logged dietary intake daily. A health educator held monthly at-home visits with participants and a caregiver to give feedback on intervention compliance. RESULTS: Out of the 124 participants that met the criteria for inclusion, 21 were diagnosed with DS and 103 with non-DS-related IDD. Twenty out of 21 participants with DS were successfully matched. Clinically significant weight loss was seen at 18 months in participants with DS (-5.2%) and non-DS-related IDD (-6.8%), with no difference between groups (P = 0.53). Significant reductions in energy intake were seen across the 18-month intervention in both DS and non-DS-related IDD groups with between-group differences at 12 months only (1119 vs. 1492 kcal/day, respectively; P = 0.003). Although MVPA did not increase in either group across the intervention, those with non-DS-related IDD had higher levels of MVPA compared with those with DS across 18 months. CONCLUSION: Participants with DS lost a clinically significant amount of weight across the 18-month intervention. Compared with those with non-DS-related IDD, those with DS lost similar amounts of weight, had similar decreases in energy intake and participated in less MVPA across the 18-month intervention. Although individuals with DS have physiological factors that may contribute to obesity, weight management interventions designed for individuals with IDD may be equally effective in this population.

Atomically precise bottom-up synthesis of π-extended [5]triangulene.

The zigzag-edged triangular graphene molecules (ZTGMs) have been predicted to host ferromagnetically coupled edge states with the net spin scaling with the molecular size, which affords large spin tunability crucial for next-generation molecular spintronics. However, the scalable synthesis of large ZTGMs and the direct observation of their edge states have been long-standing challenges because of the molecules' high chemical instability. Here, we report the bottom-up synthesis of π-extended [5]triangulene with atomic precision via surface-assisted cyclodehydrogenation of a rationally designed molecular precursor on metallic surfaces. Atomic force microscopy measurements unambiguously resolve its ZTGM-like skeleton consisting of 15 fused benzene rings, while scanning tunneling spectroscopy measurements reveal edge-localized electronic states. Bolstered by density functional theory calculations, our results show that [5]triangulenes synthesized on Au(111) retain the open-shell π-conjugated character with magnetic ground states.

Individual and family-based approaches to increase physical activity in adolescents with intellectual and developmental disabilities: Rationale and design for an 18 month randomized trial.

Adolescents with intellectual and developmental disabilities (IDD) are less physically active and have lower cardiovascular fitness compared with their typically developing peers. This population faces additional barriers to participation in moderate-to-vigorous physical activity (MVPA) such as reliance on parents, lack of peer-support, and lack of inclusive physical activity opportunities. Previous interventions to increase MVPA in adolescents with IDD have met with limited success, at least in part due to requiring parents to transport their adolescent to an exercise facility. We recently developed a remote system to deliver MVPA to groups of adolescents with IDD in their homes via video conferencing on a tablet computer. This approach eliminates the need for transportation and provides social interaction and support from both a health coach and other participants. We will conduct a 18-mo. trial (6 mos. active, 6 mos. maintenance, 6 mos. no-contact follow-up) to compare changes in objectively assessed MVPA in 114 adolescents with IDD randomized to a single level intervention delivered only to the adolescent (AO) or a multi-level intervention delivered to both the adolescent and a parent (A + P). Our primary aim is to compare increases in MVPA (min/d) between the AO and A + P groups from 0 to 6 mos. Secondarily we will compare changes in MVPA, sedentary time, cardiovascular fitness, muscular strength, motor ability, quality of life, and the percentage of adolescents achieving the US recommendation of 60 min. MVPA/d across 18 mos. We will also explore the influence of process variables/participant characteristics on changes in MVPA across 18 mos. NCT registration: NCT03684512.

Observation of Gap Opening in 1T' Phase MoS2 Nanocrystals.

Two-dimensional (2D) transition metal dichalcogenides (TMDs) manifest in various polymorphs, which deliver different electronic properties; the most prominent among them include the semiconducting 2H phase and metallic 1T (or distorted 1T' phase) phase. Alkali metal intercalation or interface strain has been used to induce semiconductor-to-metal transition in a monolayer MoS2 sheet, leading to exotic quantum states or improved performance in catalysis. However, the direct growth of 1T or 1T' phase MoS2 is challenging due to its metastability. Here, we report MBE growth of isolated 1T' and 2H MoS2 nanocrystals on a Au substrate; these nanocrystals can be differentiated unambiguously by their electronic states using scanning tunneling microscopy (STM) and scanning tunneling spectroscopy (STS). By studying the initial stages of nucleation during molecular beam epitaxy (MBE) of MoS2, we could identify atomic clusters (30-50 atoms) with intralayer stacking corresponding to 1T' and 2H separately, which suggests a deterministic growth mechanism from initial nuclei. Furthermore, a topological insulator type behavior was observed for the 1T' MoS2 crystals, where an energy gap opening of 80 meV was measured by STS in the basal plane at 5 K, with the edge of the nanocrystals remaining metallic.

Tailoring sample-wide pseudo-magnetic fields on a graphene-black phosphorus heterostructure.

Spatially tailored pseudo-magnetic fields (PMFs) can give rise to pseudo-Landau levels and the valley Hall effect in graphene. At an experimental level, it is highly challenging to create the specific strain texture that can generate PMFs over large areas. Here, we report that superposing graphene on multilayer black phosphorus creates shear-strained superlattices that generate a PMF over an entire graphene-black phosphorus heterostructure with edge size of tens of micrometres. The PMF is intertwined with the spatial period of the moiré pattern, and its spatial distribution and intensity can be modified by changing the relative orientation of the two materials. We show that the emerging pseudo-Landau levels influence the transport properties of graphene-black phosphorus field-effect transistor devices with Hall bar geometry. The application of an external magnetic field allows us to enhance or reduce the effective field depending on the valley polarization with the prospect of developing a valley filter.

Intrinsic hydrophilic nature of epitaxial thin-film of rare-earth oxide grown by pulsed laser deposition.

Herein, we report a systematic study of water contact angle (WCA) of rare-earth oxide thin-films. These ultra-smooth and epitaxial thin-films were grown using pulsed laser deposition and then characterized using X-Ray diffraction (XRD), Rutherford backscattering spectroscopy (RBS), and atomic force microscopy (AFM). Through both the traditional sessile drop and the novel f-d method, we found that the films were intrinsically hydrophilic (WCA < 10°) just after being removed from the growth chamber, but their WCAs evolved with an exposure to the atmosphere with time to reach their eventual saturation values near 90° (but always stay 'technically' hydrophilic). X-Ray photoelectron spectroscopy analysis was used to further investigate qualitatively the nature of hydrocarbon contamination on the freshly prepared as well as the environmentally exposed REO thin-film samples as a function of the exposure time after they were removed from the deposition chamber. A clear correlation between the carbon coverage of the surface and the increase in WCA was observed for all of the rare-earth films, indicating the extrinsic nature of the surface wetting properties of these films and having no relation to the electronic configuration of the rare-earth atoms as proposed by Azimi et al.

Homoepitaxial Growth of Large-Scale Highly Organized Transition Metal Dichalcogenide Patterns.

Controllable growth of highly crystalline transition metal dichalcogenide (TMD) patterns with regular morphology and unique edge structure is highly desired and important for fundamental research and potential applications. Here, single-crystalline MoS2 flakes are reported with regular trigonal symmetric patterns that can be homoepitaxially grown on MoS2 monolayer via chemical vapor deposition. The highly organized MoS2 patterns are rhombohedral (3R)-stacked with the underlying MoS2 monolayer, and their boundaries are predominantly terminated by zigzag Mo edge structure. The epitaxial MoS2 crystals can be tailored from compact triangles to fractal flakes, and the pattern formation can be explained by the anisotropic growth rates of the S and Mo edges under low sulfur chemical potential. The 3R-stacked MoS2 pattern demonstrates strong second and third-harmonic-generation signals, which exceed those reported for monolayer MoS2 by a factor of 6 and 4, correspondingly. This homoepitaxial growth approach for making highly organized TMD patterns is also demonstrated for WS2 .

Mo-Terminated Edge Reconstructions in Nanoporous Molybdenum Disulfide Film.

The catalytic and magnetic properties of molybdenum disulfide (MoS2) are significantly enhanced by the presence of edge sites. One way to obtain a high density of edge sites in a two-dimensional (2D) film is by introducing porosity. However, the large-scale bottom-up synthesis of a porous 2D MoS2 film remains challenging and the correlation of growth conditions to the atomic structures of the edges is not well understood. Here, using molecular beam epitaxy, we prepare wafer-scale nanoporous MoS2 films under conditions of high Mo flux and study their catalytic and magnetic properties. Atomic-resolution electron microscopy imaging of the pores reveals two new types of reconstructed Mo-terminated edges, namely, a distorted 1T (DT) edge and the Mo-Klein edge. Nanoporous MoS2 films are magnetic up to 400 K, which is attributed to the presence of Mo-terminated edges with unpaired electrons, as confirmed by density functional theory calculation. The small hydrogen adsorption free energy at these Mo-terminated edges leads to excellent activity for the hydrogen evolution reaction.

Resolving the Spatial Structures of Bound Hole States in Black Phosphorus.

Understanding the local electronic properties of individual defects and dopants in black phosphorus (BP) is of great importance for both fundamental research and technological applications. Here, we employ low-temperature scanning tunnelling microscope (LT-STM) to probe the local electronic structures of single acceptors in BP. We demonstrate that the charge state of individual acceptors can be reversibly switched by controlling the tip-induced band bending. In addition, acceptor-related resonance features in the tunnelling spectra can be attributed to the formation of Rydberg-like bound hole states. The spatial mapping of the quantum bound states shows two distinct shapes evolving from an extended ellipse shape for the 1s ground state to a dumbbell shape for the 2px excited state. The wave functions of bound hole states can be well-described using the hydrogen-like model with anisotropic effective mass, corroborated by our theoretical calculations. Our findings not only provide new insight into the many-body interactions around single dopants in this anisotropic two-dimensional material but also pave the way to the design of novel quantum devices.

Surface Functionalization of Black Phosphorus via Potassium toward High-Performance Complementary Devices.

Two-dimensional black phosphorus configured field-effect transistor devices generally show a hole-dominated ambipolar transport characteristic, thereby limiting its applications in complementary electronics. Herein, we demonstrate an effective surface functionalization scheme on few-layer black phosphorus, through in situ surface modification with potassium, with a view toward high performance complementary device applications. Potassium induces a giant electron doping effect on black phosphorus along with a clear bandgap reduction, which is further corroborated by in situ photoelectron spectroscopy characterizations. The electron mobility of black phosphorus is significantly enhanced to 262 (377) cm2 V-1 s-1 by over 1 order of magnitude after potassium modification for two-terminal (four-terminal) measurements. Using lithography technique, a spatially controlled potassium doping technique is developed to establish high-performance complementary devices on a single black phosphorus nanosheet, for example, the p-n homojunction-based diode achieves a near-unity ideality factor of 1.007 with an on/off ratio of ∼104. Our findings coupled with the tunable nature of in situ modification scheme enable black phosphorus as a promising candidate for further complementary electronics.

Gate-Tunable Giant Stark Effect in Few-Layer Black Phosphorus.

Two-dimensional black phosphorus (BP) has sparked enormous research interest due to its high carrier mobility, layer-dependent direct bandgap and outstanding in-plane anisotropic properties. BP is one of the few two-dimensional materials where it is possible to tune the bandgap over a wide energy range from the visible up to the infrared. In this article, we report the observation of a giant Stark effect in electrostatically gated few-layer BP. Using low-temperature scanning tunnelling microscopy, we observed that in few-layer BP, when electrons are injected, a monotonic reduction of the bandgap occurs. The injected electrons compensate the existing defect-induced holes and achieve up to 35.5% bandgap modulation in the light-doping regime. When probed by tunnelling spectroscopy, the local density of states in few-layer BP shows characteristic resonance features arising from layer-dependent sub-band structures due to quantum confinement effects. The demonstration of an electrical gate-controlled giant Stark effect in BP paves the way to designing electro-optic modulators and photodetector devices that can be operated in a wide electromagnetic spectral range.

Large Area Synthesis of 1D-MoSe2 Using Molecular Beam Epitaxy.

Large area synthesis of 1D-MoSe2 nanoribbons on both insulating and conducting substrates via molecular beam epitaxy is presented. Dimensional controlled growth of 2D, 1D-MoSe2 , and 1D-2D-MoSe2 hybrid heterostructure is achieved by tuning the growth temperature or Mo:Se precursor ratio.

Chemical Vapor Deposition of Large-Size Monolayer MoSe2 Crystals on Molten Glass.

We report the fast growth of high-quality millimeter-size monolayer MoSe2 crystals on molten glass using an ambient pressure CVD system. We found that the isotropic surface of molten glass suppresses nucleation events and greatly improves the growth of large crystalline domains. Triangular monolayer MoSe2 crystals with sizes reaching ∼2.5 mm, and with a room-temperature carrier mobility up to ∼95 cm2/(V·s), can be synthesized in 5 min. The method can also be used to synthesize millimeter-size monolayer MoS2 crystals. Our results demonstrate that "liquid-state" glass is a highly promising substrate for the low-cost growth of high-quality large-size 2D transition metal dichalcogenides (TMDs).

Chemical Stabilization of 1T' Phase Transition Metal Dichalcogenides with Giant Optical Kerr Nonlinearity.

The 2H-to-1T' phase transition in transition metal dichalcogenides (TMDs) has been exploited to phase-engineer TMDs for applications in which the metallicity of the 1T' phase is beneficial. However, phase-engineered 1T'-TMDs are metastable; thus, stabilization of the 1T' phase remains an important challenge to overcome before its properties can be exploited. Herein, we performed a systematic study of the 2H-to-1T' phase evolution by lithiation in ultrahigh vacuum. We discovered that by hydrogenating the intercalated Li to form lithium hydride (LiH), unprecedented long-term (>3 months) air stability of the 1T' phase can be achieved. Most importantly, this passivation method has wide applicability for other alkali metals and TMDs. Density functional theory calculations reveal that LiH is a good electron donor and stabilizes the 1T' phase against 2H conversion, aided by the formation of a greatly enhanced interlayer dipole-dipole interaction. Nonlinear optical studies reveal that air-stable 1T'-TMDs exhibit much stronger optical Kerr nonlinearity and higher optical transparency than the 2H phase, which is promising for nonlinear photonic applications.

Oscillating edge states in one-dimensional MoS2 nanowires.

Reducing the dimensionality of transition metal dichalcogenides to one dimension opens it to structural and electronic modulation related to charge density wave and quantum correlation effects arising from edge states. The greater flexibility of a molecular scale nanowire allows a strain-imposing substrate to exert structural and electronic modulation on it, leading to an interplay between the curvature-induced influences and intrinsic ground-state topology. Herein, the templated growth of MoS2 nanowire arrays consisting of the smallest stoichiometric MoS2 building blocks is investigated using scanning tunnelling microscopy and non-contact atomic force microscopy. Our results show that lattice strain imposed on a nanowire causes the energy of the edge states to oscillate periodically along its length in phase with the period of the substrate topographical modulation. This periodic oscillation vanishes when individual MoS2 nanowires join to form a wider nanoribbon, revealing that the strain-induced modulation depends on in-plane rigidity, which increases with system size.

Analyzing Dirac Cone and Phonon Dispersion in Highly Oriented Nanocrystalline Graphene.

Chemical vapor deposition (CVD) is one of the most promising growth techniques to scale up the production of monolayer graphene. At present, there are intense efforts to control the orientation of graphene grains during CVD, motivated by the fact that there is a higher probability for oriented grains to achieve seamless merging, forming a large single crystal. However, it is still challenging to produce single-crystal graphene with no grain boundaries over macroscopic length scales, especially when the nucleation density of graphene nuclei is high. Nonetheless, nanocrystalline graphene with highly oriented grains may exhibit single-crystal-like properties. Herein, we investigate the spectroscopic signatures of graphene film containing highly oriented, nanosized grains (20-150 nm) using angle-resolved photoemission spectroscopy (ARPES) and high-resolution electron energy loss spectroscopy (HREELS). The robustness of the Dirac cone, as well as dispersion of its phonons, as a function of graphene's grain size and before and after film coalescence, was investigated. In view of the sensitivity of atomically thin graphene to atmospheric adsorbates and intercalants, ARPES and HREELS were also used to monitor the changes in spectroscopic signatures of the graphene film following exposure to the ambient atmosphere.