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Many institutions are attempting to implement patient-reported outcome (PRO) measures. Because PROs often change clinical workflows significantly for patients and providers, implementation choices can have major impact. While various implementation guides exist, a stepwise list of decision points covering the full implementation process and drawing explicitly on a sociotechnical conceptual framework does not exist.
To facilitate real-world implementation of PROs in electronic health records (EHRs) for use in clinical practice, members of the EHR Access to Seamless Integration of Patient-Reported Outcomes Measurement Information System (PROMIS) Consortium developed structured PRO implementation planning tools. Each institution pilot tested the tools. Joint meetings led to the identification of critical sociotechnical success factors.
Three tools were developed and tested: (1) a PRO Planning Guide summarizes the empirical knowledge and guidance about PRO implementation in routine clinical care; (2) a Decision Log allows decision tracking; and (3) an Implementation Plan Template simplifies creation of a sharable implementation plan. Seven lessons learned during implementation underscore the iterative nature of planning and the importance of the clinician champion, as well as the need to understand aims, manage implementation barriers, minimize disruption, provide ample discussion time, and continuously engage key stakeholders.
Highly structured planning tools, informed by a sociotechnical perspective, enabled the construction of clear, clinic-specific plans. By developing and testing three reusable tools (freely available for immediate use), our project addressed the need for consolidated guidance and created new materials for PRO implementation planning. We identified seven important lessons that, while common to technology implementation, are especially critical in PRO implementation.
In this study we examine patterns of change and stability in loneliness among 108 women who had participated in a friendship enrichment programme during the year after the programme. We distinguished seven groups of participants in which different levels of loneliness significantly declined, remained stable or increased. These were reduced to the following groups: those recovered, significantly improved and not improved. We then examined whether resources such as age, education, partner status, health, initially available friendships and developments in friendships were related to these loneliness patterns. The data were collected using face-to-face semi-structured interviews, a loneliness scale and the personal convoy model. The results indicate that none of the demographic characteristics, nor health, were associated with the patterns of loneliness. Friendship availability and development did differ among the groups. Recovery from loneliness after a year was associated with the presence of a friend in the outer circle of the convoy and having more variation in one's friendships initially and one year later. It was also associated with the presence of a friend in the inner circle and reporting improvement in friendship later. The absence of these qualities initially or subsequently was more characteristic of those whose loneliness was stable or increased. Thus, the maintenance of companionate friendship and the development of intimacy in one's friendships seem advantageous for recovery from loneliness. While this study illustrates that recovery from, and significant reduction of loneliness are possible, we are not yet able to predict who will benefit and who will not benefit from a friendship enrichment programme.
Hepatitis C virus (HCV) has become a global public health problem. Many studies have been conducted to identify risk factors for HCV infection. However, some of these studies reported inconsistent results. Using data collected from 11 methadone clinics, we fit both a non-spatial logistical regression and a geographically weighted logistic regression to analyse the association between HCV infection and some factors at the individual level. This study enrolled 5401 patients with 30·0% HCV infection prevalence. The non-spatial logistical regression found that injection history, drug rehabilitation history and senior high-school education or above were related to HCV infection; and being married was negatively associated with HCV infection. Using the spatial model, we found that Yi ethnicity was negatively related to HCV infection in 62·0% of townships, and being married was negatively associated with HCV infection in 81·0% of townships. Senior high-school education or above was positively associated with HCV infection in 55·2% of townships of the Yi Autonomous Prefecture. The spatial model offers better understanding of the geographical variations of the risk factors associated with HCV infection. The geographical variations may be useful for customizing intervention strategies for local regions for more efficient allocation of limited resources to control transmission of HCV.
Both the input directed to the child, and the child's ability to process that input, are likely to impact the child's language acquisition. We explore how these factors inter-relate by tracking the relationships among: (a) lexical properties of maternal child-directed speech to prelinguistic (7-month-old) infants (N = 121); (b) these infants' abilities to segment lexical targets from conversational child-directed utterances in an experimental paradigm; and (c) the children's vocabulary outcomes at age 2;0. Both repetitiveness in maternal input and the child's speech segmentation skills at age 0;7 predicted language outcomes at 2;0; moreover, while these factors were somewhat inter-related, they each had independent effects on toddler vocabulary skill, and there was no interaction between the two.
IAU Commission 40 for Radio Astronomy (hereafter C40) brought together scientists and engineers who carry out observational and theoretical research in radio astronomy and who develop and operate the ground and space-based radio astronomy facilities and instrumentation. As of June 2015, the Commission had approximately 1,100 members from 49 countries, corresponding to nearly 10 per cent of the total IAU membership.
Driven by the unprecedented wealth of high quality data that is accumulating for the Frontier Fields, they are becoming some of the best-studied strong lensing clusters to date, and probably the next few years. As will be discussed intensively in this focus meeting, the FF prove transformative for many fields: from studies of the high redshift Universe, to the assembly and structure of the clusters themselves. The FF data and the extensive collaborative effort around this program will also allow us to examine and improve upon current lens modeling techniques. Strong lensing is a powerful tool for mass reconstruction of the cores of galaxy clusters of all scales, providing an estimate of the total (dark and seen) projected mass density distribution out to 0.5 Mpc. Though SL mass may be biased by contribution from structures along the line of sight, its strength is that it is relatively insensitive to assumptions on cluster baryon astrophysics and dynamical state. Like the Frontier Fields clusters, the most “famous” strong lensing clusters are at the high mass end; they lens dozens of background sources into multiple images, providing ample lensing constraints. In this talk, I will focus on how we can leverage what we learn from modeling the FF clusters in strong lensing studies of the hundreds of clusters that will be discovered in upcoming surveys. In typical clusters, unlike the Frontier Fields, the Bullet Cluster and A1689, we observe only one to a handful of background sources, and have limited lensing constraints. I will describe the limitations that such a configuration imposes on strong lens modeling, highlight measurements that are robust to the richness of lensing evidence, and address the sources of uncertainty and what sort of information can help reduce those uncertainties. This category of lensing clusters is most relevant to the wide cluster surveys of the future.
Polymer-based, degradable microparticles (MP) are attractive delivery vehicles for vaccines as the polymer properties can be specifically tailored and the carrier can be loaded with adjuvant. For all newly developed carrier systems it is important to analyze cellular uptake efficiency and the specific effects mediated by the encapsulated agent when phagocytosed by the cells, which is barely reported so far. By the encapsulation of N-acetylmuramyl-L-alanyl-D-isoglutamine (MDP) labeled with fluoresceinisothiocyanat (FITC) in poly[(rac-lactide)-co-glycolide] (PLGA) MP, the MP was fluorescent and used to visualize the phagocytic uptake. Since encapsulated MDP can activate dendritic cells (DC) via the cytosolic nucleotide-binding oligomerization domain receptors (NOD), it can be investigated whether only cells that have phagocytosed the MP are activated or whether bystander effects occur, resulting in activation of cells, which did not take up MDP-FITC loaded MP. Here, it is demonstrated that increasing MP concentrations in the culture medium had no impact on the viability of DC and that the MP uptake efficiency was dose dependent. Interestingly, it could be shown by the CD86 expression, that only DC, which had engulfed MP, were significantly stronger activated than DC, which had not phagocytosed MDP-FITC loaded MP. On the one hand these results indicate that sufficient amounts of MDP were released from the PLGA carriers into the cytosol of the DC. On the other hand, based on the correlation of uptake and activation on the single cell level, minimal MP induced bystander effects may be expected for in vivo applications.
Biomaterials require thorough in vitro testing before being applied in vivo. Unwanted contaminations of biomaterials but also their intrinsic properties can cause uncontrolled immune response leading to severe consequences for the patient. Therefore, immunological evaluation of materials for biomedical applications is mandatory before entering clinical application. In order to introduce physical netpoints, the aromatic compounds desaminotyrosine (DAT) and desaminotyrosyl-tyrosine (DATT) were successfully used to functionalize linear and star-shaped oligoethylene glycol (lOEG and sOEG) as previously described. The materials showed properties of surfactants and have potential to be used for solubilization of lipophilic drugs in water. Furthermore, the materials are susceptible for H2O2 degradation as determined by MALDI-ToF MS analyses. This is important for potential in vivo applications, as macrophages can release reactive oxygen species (ROS) under inflammatory conditions. As it is known that surfactant solutions of high concentration can lead to cell lysis, the effects of OEG-DAT(T) solutions on murine RAW macrophages were investigated. Even at highest OEG-DAT(T) concentration of 1000 µg·mL-1 the viability of the RAW cells was not significantly impaired. Additionally, the polymers were incubated with whole human blood and the production of inflammatory cytokines such as the tumor necrosis factor (TNF)-α and interleukin (IL)-6 was determined. Only at high concentrations, the OEG-DAT(T) solution induced low levels of TNF-α and IL-6, indicating that a mild inflammatory reaction could be expected when such high OEG-DAT(T) concentrations are applied in vivo. Similarly, the OEG-DAT(T) solution did not induce ROS in monocytes and neutrophils after incubation with whole human blood. Conclusively, the data presented here demonstrate that OEG-DAT(T) do not lead to a substantial activation of the innate immune mechanisms and could therefore be investigated for solubilizing pharmaceutical agents.
Cadmium sulfide (CdS) films were deposited onto glass substrates by chemical bath deposition (CBD) from a bath containing cadmium acetate, ammonium acetate, thiourea, and ammonium hydroxide. The CdS thin films were annealed in argon (neutral atmosphere) or hydrogen (reducing atmosphere) for 1 h at various temperatures (300, 350, 400, 450 and 500 °C). The changes in optical and electrical properties of annealed treated CdS thin films were analyzed. The results showed that, the band-gap and resistivity depend on the post-deposition annealing atmosphere and temperatures. Thus, it was found that these properties of the films, were found to be affected by various processes with opposite effects, some beneficial and others unfavorable. The energy gap and resistivity for different annealing atmospheres was seen to oscillate by thermal annealing. Recrystallization, oxidation, surface passivation, sublimation and materials evaporation were found the main factors of the heat-treatment process responsible for this oscillating behavior. Annealing over 400 °C was seen to degrade the optical and electrical properties of the film.
A major goal in the field of regenerative medicine is to improve our understanding of how biomaterial properties affect cells of the immune system. Systematic variation of defined chemical properties could help to understand which factors determine and modulate cellular responses. A series of copolymers poly[acrylonitrile-co-(N-vinylpyrrolidone)]s (P(AN-co-NVP)) served as model system, in which increasing hydrophilicity was adjusted by increasing the content related to the NVP based repeating units (nNVP) (0, 4.6, 11.8, 22.3, and 29.4 mol%). The influence of increasing nNVP contents on cellular response of human primary monocyte derived dendritic cells (DC), which play a key role in the initiation of immune responses, was investigated. It was shown using the LAL-Test as well as a macrophage-based assay, that the materials were free of endotoxins and other microbial contaminations, which could otherwise bias the readout of the DC experiments. The increasing nNVP content led to a slightly increased cell death of DC, whereas the activation status of DC was not systematically altered by the different P(AN-co-NVP)s as demonstrated by the expression of co-stimulatory molecule and cytokine secretion. Similarly, under inflammatory conditions mimicked by the addition of lipopolysaccharides (LPS), neither the expression of co-stimulatory molecules nor the release of cytokines was influenced by the different copolymers. Conclusively, our data showed that this class of copolymers does not substantially influence the viability and the activation status of DC.
We report the photochromism (PC) in Eu3+ doped Sr2SnO4. The Sr2SnO4:Eu3+ is sensitive to UV light (λ < 350 nm) and turns to purple color. When visible light (λ= 400-700 nm) is irradiated, the colored Sr2SnO4:Eu3+ is bleached. From the results of absorption spectrum, Sr vacancies in the host lattice and charge transfer transition between Eu3+-O2- is responsible for PC process of Sr2SnO4:Eu3+.
In a constant effort to capture effectively more of the spectral range from the sun, multi-junction cells are being investigated. In this context, the marriage of thin film and dye-sensitized solar cells (DSC) PV technologies may be able to offer greater efficiency whilst maintaining the benefits of each individual technology. DSC devices offer advantages in the nature of both the metal oxide photo-electrode and dye absorption bands, which can be tuned to vary the optical performance of this part of a tandem device, while CdTe cells absorb the majority of light above their band-gap in only a few microns of thickness. The key challenge is to assess the optical losses with the goal of reaching a net gain in photocurrent and consequently increased conversion efficiency. This study reports on the influence of optical losses from various parts of the stacked tandem structure using UV-VIS spectrometry and EQE measurements. A net gain in photocurrent was achieved from a model developed for the DSC/CdTe mechanically stacked tandem structure.
We report mechanoluminescence (ML) in Sm3+-doped Sr3Sn2O7 phosphors with perovskite-related structure. The ML from Sr3Sn2O7:Sm3+, emitted strong reddish-orange light upon compression, is clearly observable by naked eyes. Based on the comparison between ML spectrum and photoluminescence spectrum, the ML emission was identified to be due to electron transition from an excited state 4G5/2 to the ground state 6HJ (J = 5/2, 7/2, 9/2) in Sm3+ ions. Although the ML emission was gradually decayed as compressive load was applied repeatedly, it recovered completely upon irradiation with UV light (254 nm). This behavior indicating that ML of Sr3Sn2O7:Sm3+ is intimately related to the charge traps. The charge transfer state (CTS) band in the PL excitation spectra was observed for Sr3Sn2O7:Sm3+, indicating that the efficient energy transfer from the host to the Sm3+ ions. The formation of CTS and the charge traps may be responsible for this ML performance.
This paper investigates the trend in sport participation among retirees between 1983 and 2007. Sport participation is important for retirees because of its health benefits and the opportunities it offers for social interaction. Factors that influence sport participation such as educational level, physical limitations, and occupational background have changed during the last decades, possibly accounting for changes in sport participation. Data are from the Amenities and Services Utilization Survey (AVO), a nationally representative Dutch survey with seven observations between 1983 and 2007. The trend in sport involvement, sports club membership, and competition was investigated in a sample of 2,497 male and 1,559 female retirees aged 58–67 years. Increases in participation were observed in sport involvement and sports club membership. This trend can partially be explained by increases in educational level, decreases in the number of retirees with physical limitations, and in those retiring from sedentary jobs. Yet, sport participation seems to have increased for all retirees, regardless of their socio-economic background and health status. Alternative explanations for the observed trend are discussed.
Here we report rich and new resonant Raman spectral features for several sub-nanometer diameter single wall carbon nanotubes (sub-nm SWNTs) samples grown using chemical vapor deposition technique operating at different temperatures. We find that the high curvature in sub-nm SWNTs leads to (i) an unusual S-like dispersion of the G‑band frequency due to perturbations caused by the strong electron-phonon coupling, and (ii) an activation of diameter-selective intermediate frequency modes that are as intense as the radial breathing modes (RBMs). Furthermore, an analytical approach which includes the effects of curvature into the overlap integral and the energy gap between the van Hove singularities is discussed. Lastly, we show that the phonon spectra for sub-nm SWNTs obtained from the molecular dynamic simulations which employs a curvature-dependent force field concur with our experimental observations.
Measuring elastic properties of cells has gained importance in the study of malignant transformations. The stiffness of a cell, which is technically referred to as the modulus of elasticity or Young's Modulus, E, is the measure of the amount of cell deformation caused by an applied known force. In vitro studies have shown that cancer cells have much lower elastic stiffness than normal cells. These stiffness measurements and their differences can be used to study the behavioral mechanics of how cancer cells grow, profligate, and die in a patient. Another important use of this difference in elasticity is in cancer detection.
In this study, we explore the viability of measuring the elastic modulus of cancer cells by using a method that only requires the use of a low magnification microscope and a digital camera. In particular we are interested in applying the previously reported relationship between the wrinkling of thin films and the elastic properties of freely floating polystyrene (PS) films. Our work extends the scope of previous thin film studies by evaluating wrinkle formation in floating polystyrene films coated with biological cells. Our results show that the wrinkle formation is modified, both in morphology and in size, by the presence of a cellular monolayer on top of the PS film.
The availability of large, single crystals of cadmium zinc telluride (CZT) with uniform properties would lead to improved performance of gamma radiation detectors fabricated from them. However, even though CZT crystals are the central element of these systems, there remains relatively little fundamental understanding about how these crystals grow and, especially, how crystal growth conditions affect the properties of grown crystals. This paper discusses the many challenges of growing better CZT crystals and how modeling may favorably impact these challenges. Our thesis is that crystal growth modeling is a powerful tool to complement experiments and characterization. It provides an important approach to close the loop between materials discovery, device research, systems performance, and producibility. Specifically, we discuss our efforts to model gradient freeze furnaces used to grow large CZT crystals at Pacific Northwest National Laboratories and Washington State University. Model results are compared with experimental measurements, and the insight gained from modeling is discussed.