The relationship of individual comorbid chronic conditions to diabetes care quality.

ObjectiveMultimorbidity affects 26 million persons with diabetes, and care for comorbid chronic conditions may impact diabetes care quality. The aim of this study was to determine which chronic conditions were related to lack of achievement or achievement of diabetes care quality goals to determine potential targets for future interventions.Research design and methodsThis is an exploratory retrospective analysis of electronic health record data for 23 430 adults, aged 18-75, with diabetes who were seen at seven Midwestern US health systems. The main outcome measures were achievement of six diabetes quality metrics in the reporting year, 2011 (glycated haemoglobin (HbA1c) control and testing, low-density lipoprotein control and testing, blood pressure control, kidney testing). Explanatory variables were 62 chronic condition indicators. Analyses were adjusted for baseline patient sociodemographic and healthcare utilization factors.ResultsThe 62 chronic conditions varied in their relationships to diabetes care goal achievement for specific care goals. Congestive heart failure was related to lack of achievement of cholesterol management goals. Obesity was related to lack of HbA1c and BP control. Mental health conditions were related to both lack of achievement and achievement of different care goals. Three conditions were related to lack of cholesterol testing, including congestive heart failure and substance-use disorders. Of 17 conditions related to achieving control goals, 16 were related to achieving HbA1c control. One-half of the comorbid conditions did not predict diabetes care quality.ConclusionsFuture interventions could target patients at risk for not achieving diabetes care for specific care goals based on their individual comorbidities

Surface composition of BaTiO3/SrTiO3(001) films grown by atomic oxygen plasma assisted molecular beam epitaxy

We have investigated the growth of BaTiO3 thin films deposited on pure and 1% Nb-doped SrTiO3(001) single crystals using atomic oxygen assisted molecular beam epitaxy (AO-MBE) and dedicated Ba and Ti Knudsen cells. Thicknesses up to 30 nm were investigated for various layer compositions. We demonstrate 2D growth and epitaxial single crystalline BaTiO3 layers up to 10 nm before additional 3D features appear; lattice parameter relaxation occurs during the first few nanometers and is completed at {\guillemotright}10 nm. The presence of a Ba oxide rich top layer that probably favors 2D growth is evidenced for well crystallized layers. We show that the Ba oxide rich top layer can be removed by chemical etching. The present work stresses the importance of stoichiometry and surface composition of BaTiO3 layers, especially in view of their integration in devices.Comment: In press in J. Appl. Phy

Study of the Effect of L-PBF Technique Temporal Evolution on Microstructure, Surface Texture, and Fatigue Performance of Ti gr. 23 Alloy

Titanium alloys are widely used in various technological fields due to their excellent performance. Since the early stages of the 3D printing concept, these alloys have been intensively used as materials for these processes. In this work, the evolution of the performance of the 3D printing process has been studied by analysing the microstructure and the mechanical properties, fatigue and tensile, of the Ti gr. 23 alloy produced by two different models of Concept Laser M2 Cusing machines (an old model and a more recent one). The process parameters recommended by the manufacturer were adopted for each machine. Both microstructural and surface texture characterisations were carried out to better correlate the differences with the production process technique. For the same purpose, tensile tests and microhardness profiles were obtained, while the dynamic mechanical properties were evaluated by means of fatigue tests aimed at determining the fatigue limit of the material using a staircase approach. The mechanical tests were carried out on specimens with three different orientations with respect to the building platform, using two different SLM techniques. The fatigue behaviour was then analysed by evaluating the fracture surfaces and, in particular, the crack nucleation sites. By comparing the calculated fatigue values with the results of local fatigue calculations, an estimate of the residual stresses near the crack nucleation site was obtained. The results showed that the specimens produced on a newer machine had lower roughness (about 10%), slightly higher ductility, and a higher fatigue limit (10–20 MPa) compared to the specimens produced with the same material but on older equipment

Transport and Magnetic Properties of R1-xAxCoO3 (R=La, Pr and Nd; A=Ba, Sr and Ca)

Transport and magnetic measurements have been carried out on perovskite Co-oxides R1-xAxCoO3 (R=La, Pr, and Nd; A=Ba, Sr and Ca; 0<x<0.5: All sets of the R and A species except Nd1-xBaxCoO3 have been studied.). With increasing the Sr- or Ba-concentration x, the system becomes metallic ferromagnet with rather large magnetic moments. For R=Pr and Nd and A=Ca, the system approaches the metal- insulator phase boundary but does not become metallic. The magnetic moments of the Ca-doped systems measured with the magnetic field H=0.1 T are much smaller than those of the Ba- and Sr-doped systems. The thermoelectric powers of the Ba- and Sr-doped systems decrease from large positive values of lightly doped samples to negative ones with increasing doping level, while those of Ca-doped systems remain positive. These results can be understood by considering the relationship between the average ionic radius of R1-xAx and the energy difference between the low spin and intermediate spin states. We have found the resistivity-anomaly in the measurements of Pr1-xCaxCoO3 under pressure in the wide region of x, which indicates the existence of a phase transition different from the one reported in the very restricted region of x~0.5 at ambient pressure [Tsubouchi et al. Phys. Rev. B 66 (2002) 052418.]. No indication of this kind of transition has been observed in other species of R.Comment: 9 pages, 8 figures. J. Phys. Soc. Jpn. 72 (2003) No.

External fixation for displaced intra-articular fractures of the calcaneum

A minimally-invasive procedure using percutaneous reduction and external fixation can be carried out for Sanders' type II, III and IV fractures of the os calcis. We have treated 54 consecutive closed displaced fractures of the calcaneum involving the articular surface in 52 patients with the Orthofix Calcaneal Mini-Fixator. Patients were followed up for a mean of 49 months (27 to 94) and assessed clinically with the Maryland Foot Score and radiologically with radiographs and CT scans, evaluated according to the Score Analysis of Verona. The clinical results at follow-up were excellent or good in 49 cases (90.7%), fair in two (3.7%) and poor in three (5.6%). The mean pre-operative Böhler's angle was 6.98° (5.95° to 19.86°), whereas after surgery the mean value was 21.94° (12.58° to 31.30°) (p < 0.01). Excellent results on CT scanning were demonstrated in 24 cases (44.4%), good in 25 (46.3%), fair in three (5.6%) and poor in two (3.7%). Transient local osteoporosis was observed in ten patients (18.5%), superficial pin track infection in three (5.6%), and three patients (5.6%) showed thalamic displacement following unadvised early weight-bearing. The clinical results appear to be comparable with those obtainable with open reduction and internal fixation, with the advantages of reduced risk using a minimally-invasive technique

The use of ALD and PVD coatings as defect sealants to increase the corrosion resistance of thermal spray coatings

Thermal spray coatings are widely used to improve the surface properties of materials, in particular the wear and oxidation resistance. Nevertheless, the corrosion resistance is slightly increased due to the fact that this type of coatings present some internal defects (pores, cracks) that allow the corrosive media to penetrate up to the substrate, that undergoes to corrosion degradation. The amount of these defects is strongly influenced by both the deposition technique and the material deposited. The aim of this work is to seal the internal porosities of the thermal spray coatings by the use of both PVD and ALD coatings or the combination of the two. The thermal spray coating analysed in this work is a pure alumina coating, deposited by Air Plasma Spray (APS) technique, that has been sealed with CrN coating, deposited by PVD (Physical Vapour Deposition) technique, and/or TiO2 coatings, deposited by ALD (Atomic Layer Deposition). The substrate used is a common medium C steel. The samples were then characterized in order to determine the microstructure (SEM+EDXS, light microscope) and the chemical composition (Rf-GDOES elemental profiling), that is important to determine the depth of penetration of the PVD and/or ALD coating inside the thermal spray deposit. Afterwards, a detailed electrochemical characterization in 3,5wt% NaCl aqueous solution was performed to verify the efficiency of the sealant treatment. In detail, a monitor in function of the time of the OCP potential was performed up to 24h of immersion time. In addition, potentiodynamic tests were performed using a 3 electrode electrochemical cell (CE: Pt wire, RE: Ag/AgCl). The same tests were then performed on the same samples that present an artificial defect produced by Rf-GDOES. The main goal of these tests is to determine the maximum depth of a defect that can allow the corrosive media to penetrate the thermal spray coating. Preliminary results showed that the use of PVD and ALD coatings as sealants can reduce the permeation of the corrosive media on the substrate

The Use of Thin Films as Defect Sealants to Increase the Corrosion Resistance of Thermal Spray Coatings

Thermal spray-coated components are widely used as wear-resistant coatings in many applications. However, these coatings have high levels of discontinuities that affect the corrosion resistance of the coated system. To reduce this problem, these coatings are usually sealed with liquid sealants (metals, organic or inorganic). The aim of this work is to seal the surface discontinuities of thermal-sprayed coatings using PVD and/or ALD coatings. To this end, CrN (arc deposition PVD) and TiO2 (ALD) coatings were deposited on thermal-sprayed alumina coatings. The samples produced were then analysed in both cross-sectional and planar views to detect the possible permeation of the thin film coatings into the thermal spray defects. Rf-GDOES measurements were performed to detect the very thin ALD deposit on the surface. The corrosion resistance of the sealed coatings was verified with immersion tests, wherein the OCP was monitored for 24 h, and potentiodynamic tests were performed after 15 min and 24 h immersions. The results showed that the thin films were not able to block the permeation of corrosive media, but they could reduce the permeation of corrosive media with a beneficial behaviour on corrosion resistance