The aim of this research was to look at the emergence of wearable technology and the internet of things (IoT) and their current and potential use in the health and care area. There is a wide and ever-expanding range of wearables, devices, apps, data aggregators and platforms allowing the measurement, tracking and aggregation of a multitude of health and lifestyle measures, information and behaviours. The use and application of such technology and the corresponding richness of data that it can provide bring the health and care insurance market both potential opportunities and challenges. Insurers across a range of fields are already engaging with this type of technology in their proposition designs in areas such as customer engagement, marketing and underwriting. However, it seems like we are just at the start of the journey, on a learning curve to find the optimal practical applications of such technology with many aspects as yet untried, tested or indeed backed up with quantifiable evidence. It is clear though that technology is only part of the solution, on its own it will not engage or change behaviours and insurers will need to consider this in terms of implementation and goals. In the first weeks of forming this working party, it became evident that the potential scope of this technology, the information already out there and the pace of development of it, is almost overwhelming. With many yet-unanswered questions the paper focuses on pulling together in one place relevant information for the consideration of the health and care actuary, and also to open the reader’s eyes to potential future innovations by drawing on use of the technology in other markets and spheres, and the “science fiction–like” new technology that is just around the corner. The paper explores:

• an overview of wearables and IoT and available measures,
• examples of how this technology is currently being used,
• data considerations,
• risks and challenges,
• future technology developments and
• what this may mean for the future of insurance.

Innovation Concept: The outcome of emergency medicine training is to produce physicians who can competently run an emergency department (ED) shift. While many workplace-based ED assessments focus on discrete tasks of the discipline, others emphasize assessment of performance across the entire shift. However, the quality of assessments is generally poor and these tools often lack validity evidence. The use of entrustment scale anchors may help to address these psychometric issues. The aim of this study was to develop and gather validity evidence for a novel tool to assess a resident's ability to independently run an ED shift. Methods: Through a nominal group technique, local and national stakeholders identified dimensions of performance reflective of a competent ED physician. These dimensions were included in a new tool that was piloted in the Department of Emergency Medicine at the University of Ottawa during a 4-month period. Psychometric characteristics of the items were calculated, and a generalizability analysis used to determine the reliability of scores. An ANOVA was conducted to determine whether scores increased as a function of training level (junior = PGY1-2, intermediate = PGY3, senior = PGY4-5), and varied by ED treatment area. Safety for independent practice was analyzed with a dichotomous score. Curriculum, Tool or Material: The developed Ottawa Emergency Department Shift Observation Tool (O-EDShOT) includes 12-items rated on a 5-point entrustment scale with a global assessment item and 2 short-answer questions. Eight hundred and thirty-three assessment were completed by 78 physicians for 45 residents. Mean scores differed significantly by training level (p < .001) with junior residents receiving lower ratings (3.48 ± 0.69) than intermediate residents who received lower ratings (3.98 ± 0.48) than senior residents (4.54 ± 0.42). Scores did not vary by ED treatment area (p > .05). Residents judged to be safe to independently run the shift had significantly higher mean scores than those judged not to be safe (4.74 ± 0.31 vs 3.75 ± 0.66; p < .001). Fourteen observations per resident, the typical number recorded during a 1-month rotation, were required to achieve a reliability of 0.80. Conclusion: The O-EDShOT successfully discriminated between junior, intermediate and senior-level residents regardless of ED treatment area. Multiple sources of evidence support the O-EDShOT producing valid scores for assessing a resident's ability to independently run an ED shift.

Type 2 diabetes (T2D) is a chronic disease that disproportionately affects Indigenous Australians. We have previously reported the localization of a novel T2D locus by linkage analysis to chromosome 2q24 in a large admixed Indigenous Australian pedigree (Busfield et al. (2002). American Journal of Human Genetics, 70, 349–357). Here we describe fine mapping of this region in this pedigree, with the identification of SNPs showing strong association with T2D: rs3845724 (diabetes p = 7 × 10−4), rs4668106 (diabetes p = 9 × 10−4) and rs529002 (plasma glucose p = 3 × 10−4). These associations were successfully replicated in an independent collection of Indigenous Australian T2D cases and controls. These SNPs all lie within the gene encoding ceramide synthase 6 (CERS6) and thus may regulate ceramide synthesis.

Genetic diversity of Trypanosoma cruzi may play a role in pathogenesis of Chagas disease forms. Natural populations are classified into 6 Discrete Typing Units (DTUs) Tc I-VI with taxonomical status. This study aimed to identify T. cruzi DTUs in bloodstream and tissue samples of Argentinean patients with Chagas disease. PCR-based strategies allowed DTU identification in 256 clinical samples from 239 Argentinean patients. Tc V prevailed in blood from both asymptomatic and symptomatic cases and Tc I was more frequent in bloodstream, cardiac tissues and chagoma samples from immunosuppressed patients. Tc II and VI were identified in a minority of cases, while Tc III and Tc IV were not detected in the studied population. Interestingly, Tc I and Tc II/VI sequences were amplified from the same skin biopsy slice from a kidney transplant patient suffering Chagas disease reactivation. Further data also revealed the occurrence of mixed DTU populations in the human chronic infection. In conclusion, our findings provide evidence of the complexity of the dynamics of T. cruzi diversity in the natural history of human Chagas disease and allege the pathogenic role of DTUs I, II, V and VI in the studied population.

Genes in the TGF9 signaling pathway play important roles in the regulation of ovarian follicle growth and ovulation rate. Mutations in three genes in this pathway, growth differentiation factor 9 (GDF9), bone morphogenetic protein 15 (BMP15) and the bone morphogenetic protein receptor B 1 (BMPRB1), influence dizygotic (DZ) twinning rates in sheep. To date, only variants in GDF9 and BMP15, but not their receptors transforming growth factor ß receptor 1 (TGFBR1), bone morphogenetic protein receptor 2 (BMPR2) and BMPR1B, have been investigated with respect to their roles in human DZ twinning. We screened for rare and novel variants in TGFBR1, BMPR2 and BMPR1B in mothers of dizygotic twins (MODZT) from twin-dense families, and assessed association between genotyped and imputed variants and DZ twinning in another large sample of MODZT. Three novel variants were found: a deep intronic variant in BMPR2, and one intronic and one non-synonymous exonic variant in BMPRB1 which would result in the replacement of glutamine by glutamic acid at amino acid position 294 (p.Gln294Glu). None of these variants were predicted to have major impacts on gene function. However, the p.Gln294Glu variant changes the same amino acid as a sheep BMPR1B functional variant and may have functional consequences. Six BMPR1B variants were marginally associated with DZ twinning in the larger case-control sample, but these were no longer significant once multiple testing was taken into account. Our results suggest that variation in the TGF9 signaling pathway type II receptors has limited effects on DZ twinning rates in humans.

Relaxed, high Ge content SiGe layers have been realized using stress balance on acompliant borophosphorosilicate glass (BPSG). A 30-nm fully-strained Si0.7Ge0.3 layer wastransferred onto a 1 μm BPSG film by wafer-bonding and Smart-cutρ processes, after which thecontinuous Si0.7Ge0.3 film was patterned into small islands to allow for lateral expansion. Afterthe strain in Si0.7Ge0.3 islands was released by the lateral expansion resulting from the flow of theBPSG, a Si0.4Ge0.6 layer was commensurately deposited under compression. Upon equilibriumafter an annealing, stress balance was formed between the SiGe films, resulting in a larger inplanelattice constant than that of relaxed Si0.7Ge0.3. With a thiner (6 nm) Si0.7Ge0.3 starting film,an in-plane lattice constant equivalent to fully-relaxed Si0.45Ge0.55 has been obtained.

In this work we investigate the diffusion of high-concentration ultrashallow boron, fluorine, phosphorus, and arsenic profiles in amorphous silicon. We demonstrate that boron diffuses at high concentrations in amorphous silicon during low-temperature thermal annealing. Isothermal and isochronal anneal sequences indicate that there is an initial transient enhancement of diffusion. We have observed this transient diffusion characteristic both in amorphous silicon preamorphized by germanium ion implantation and also in amorphous silicon preamorphized by silicon ion implantation. We also show that the boron diffusivity in the amorphous region is similar with and without fluorine, and that the lack of diffusion for low-concentration boron profiles indicates that boron diffusion in amorphous silicon is driven by high concentrations. Ultrashallow high-concentration fluorine profiles diffuse quite rapidly in amorphous silicon, and like boron, undergo a definite transient enhancement. In contrast, ultrashallow high- concentration phosphorus and arsenic profiles did not significantly diffuse in our experiments.

Interfaces can be considered at a variety of length scales. All interfaces except grain boundaries are dielectric interfaces. In many cases, the geometric constraints of matching two lattices must be considered, together with the misfit strains that are often present. Continuum mechanics is useful for tackling such problems. In many cases, however, the local ordering of ions must also be considered. Atomistic simulation is therefore necessary, together with the problems associated with large length scales and long time scales. We discuss a number of examples to illustrate the issues involved and the compromises between different approaches that must be made.

The Advanced Photon Source (APS) is a third-generation synchrotron now in operation at Ar-gonne National Laboratory. A national user facility for research in the Earth sciences is being constructed by the GeoSoilEnviro group of the Consortium for Advanced Radiation Sources (GSECARS). One component of this effort is the program for diamond anvil cell (DAC) research, to study materials at ultrahigh pressure and temperature conditions using a variety of techniques.

In this paper, we describe the DAC facility that is being developed at the GSECARS. Recent progress in developing a laser heating system is presented.

Lattice strains have been measured as a function of the angle, ψ, from the diamond cell stress axis in a sample of gold and rhenium at pressures of 15–37 GPa. Experiments were conducted using X-ray transparent gaskets made from beryllium. The differential stresses supported by gold and rhenium have been characterized to 37 GPa. It is also shown that proper choice of the diffraction geometry allows recovery of a quasi-hydrostatic compression curve under these highly non-hydrostatic conditions. X-ray elastic moduli have also been determined, and while good agreement with previous data is achieved for gold, there is a large discrepancy between the present results and extrapolated ultrasonic data for rhenium.

In recent years there have been major advances in our understanding of the energetics, Ostwald ripening and transformations between various types of extended self-interstitial defect in Si and Ge ion-implanted silicon. As a result we can now predict the detailed time- and temperature-dependent supersaturation of interstitials during thermal evolution of these defects. This opens the way to predictive simulation of transient enhanced diffusion and dose loss in preamorphized ultrashallow junctions, where dopant movement is driven by free interstitials emitted by self-interstitial “end-of-range” defects. We present recent progress on this topic, emphasizing novel effects in highly doped ultrashallow junctions. Two key influences – the chemical pump effect due to the high concentration of dopants in ultrashallow junctions, and the ‘long hop’ behaviour of the dopant – are discussed in detail. The paper concludes by presenting simulation results that explain the recent observation of ‘uphill diffusion’ of B ultrashallow junction profiles.

Relaxed, high Ge content SiGe layers have been realized using stress balance on a compliant borophosphorosilicate glass (BPSG). A 30-nm fully-strained Si0.7Ge0.3 layer was transferred onto a 1 μm BPSG film by wafer-bonding and Smart-cut® processes, after which the continuous Si0.7Ge0.3 film was patterned into small islands to allow for lateral expansion. After the strain in Si0.7Ge0.3 islands was released by the lateral expansion resulting from the flow of the BPSG, a Si0.4Ge0.6 layer was commensurately deposited under compression. Upon equilibrium after an annealing, stress balance was formed between the SiGe films, resulting in a larger in-plane lattice constant than that of relaxed Si0.7Ge0.3. With a thiner (6 nm) Si0.7Ge0.3 starting film, an in-plane lattice constant equivalent to fully-relaxed Si0.45Ge0.55 has been obtained.