Correction: A Feasible and Efficacious Mobile-Phone Based Lifestyle Intervention for Filipino Americans with Type 2 Diabetes: Randomized Controlled Trial.

[This corrects the article DOI: 10.2196/diabetes.8156.]

Recognizing and Tackling Inhaler Technique Decay in Asthma and Chronic Obstructive Pulmonary Disesase (COPD) Clinical Practice

A poor inhaler technique continues to represent a substantial barrier to effective asthma and chronic obstructive pulmonary disease management. It can result in perceived lack of treatment effectiveness even with apparent adherence to a prescribed regimen of inhaled maintenance therapies, potentially resulting in an unnecessary change or escalation of treatment. Many patients are not trained to inhaler mastery in real-world practice; furthermore, even where mastery is initially achieved, an ongoing assessment and education are seldom maintained. In this review, we present an overview of the evidence for deterioration of the inhaler technique over time after training, investigate the factors that contribute to this deterioration, and explore innovative approaches to addressing the problem. We also propose steps forward drawn from the literature and our clinical insights.</p

Dust Streamers in the Virgo Galaxy M86 from Ram Pressure Stripping of its Companion VCC 882

The giant elliptical galaxy M86 in Virgo has a ~28 kpc long dust trail inside its optical halo that points toward the nucleated dwarf elliptical galaxy, VCC 882. The trail seems to be stripped material from the dwarf. Extinction measurements suggest that the ratio of the total gas mass in the trail to the blue luminosity of the dwarf is about unity, which is comparable to such ratios in dwarf irregular galaxies. The ram pressure experienced by the dwarf galaxy in the hot gaseous halo of M86 was comparable to the internal gravitational binding energy density of the presumed former gas disk in VCC 882. Published numerical models of this case are consistent with the overall trail-like morphology observed here. Three concentrations in the trail may be evidence for the predicted periodicity of the mass loss. The evaporation time of the trail is comparable to the trail age obtained from the relative speed of the galaxies and the trail length. Thus the trail could be continuously formed from stripped replenished gas if the VCC 882 orbit is bound. However, the high gas mass and the low expected replenishment rate suggest that this is only the first stripping event. Implications for the origin of nucleated dwarf ellipticals are briefly discussed.Comment: 22 pages, 7 figures, Astronomical Journal, August 2000, in pres

Use of RE-AIM to develop a multi-media facilitation tool for the patient-centered medical home

<p>Abstract</p> <p>Background</p> <p>Much has been written about how the medical home model can enhance patient-centeredness, care continuity, and follow-up, but few comprehensive aids or resources exist to help practices accomplish these aims. The complexity of primary care can overwhelm those concerned with quality improvement.</p> <p>Methods</p> <p>The RE-AIM planning and evaluation model was used to develop a multimedia, multiple-health behavior tool with psychosocial assessment and feedback features to facilitate and guide patient-centered communication, care, and follow-up related to prevention and self-management of the most common adult chronic illnesses seen in primary care.</p> <p>Results</p> <p>The <it>Connection to Health </it>Patient Self-Management System, a web-based patient assessment and support resource, was developed using the RE-AIM factors of reach (<it>e.g</it>., allowing input and output via choice of different modalities), effectiveness (<it>e.g</it>., using evidence-based intervention strategies), adoption (<it>e.g</it>., assistance in integrating the system into practice workflows and permitting customization of the website and feedback materials by practice teams), implementation (<it>e.g</it>., identifying and targeting actionable priority behavioral and psychosocial issues for patients and teams), and maintenance/sustainability (<it>e.g</it>., integration with current National Committee for Quality Assurance recommendations and clinical pathways of care). <it>Connection to Health </it>can work on a variety of input and output platforms, and assesses and provides feedback on multiple health behaviors and multiple chronic conditions frequently managed in adult primary care. As such, it should help to make patient-healthcare team encounters more informed and patient-centered. Formative research with clinicians indicated that the program addressed a number of practical concerns and they appreciated the flexibility and how the <it>Connection to Health </it>program could be customized to their office.</p> <p>Conclusions</p> <p>This primary care practice tool based on an implementation science model has the potential to guide patients to more healthful behaviors and improved self-management of chronic conditions, while fostering effective and efficient communication between patients and their healthcare team. RE-AIM and similar models can help clinicians and media developers create practical products more likely to be widely adopted, feasible in busy medical practices, and able to produce public health impact.</p

Adapting adaptive design methods to accelerate adoption of a digital asthma management intervention

Investigators conducting translational research in real-world settings may experience changes that create challenges to the successful completion of the trial as well as post-trial adoption and implementation. Adaptive designs support translational research by systematically adapting content and methods to meet the needs of target populations, settings and contexts. This manuscript describes an adaptive implementation research model that provides strategies for changing content, delivery processes, and research methods to correct course when anticipated and unanticipated circumstances occur during a pragmatic trial. The Breathewell Program included two large pragmatic trials of the effectiveness of a digital communication technology intervention to improve symptom management and medication adherence in asthma care. The first trial targeted parents of children with asthma; the second targeted adults with asthma. Adaptations were made iteratively to adjust to dynamic conditions within the healthcare setting, informed by prospectively collected stakeholder input, and were categorized retrospectively by the authors as proactive or reactive. Study outcomes demonstrated improved treatment adherence and clinical efficiency. Kaiser Permanente Colorado, the setting for both studies, adopted the speech recognition intervention into routine care, however, both interventions required numerous adaptations, including changes to target population, intervention content, and internal workflows. Proactive and reactive adaptations assured that both trials were successfully completed. Adaptive research designs will continue to provide an important pathway to move healthcare delivery research into practice while conducting ongoing effectiveness evaluation.Ye

Transition to Virtual Asthma Care During the COVID-19 Pandemic: An Observational Study

BACKGROUND: The COVID-19 pandemic increased reliance on virtual care for patients with persistent asthma. OBJECTIVE: This retrospective cohort study assessed changes from in-person to virtual care during the pandemic. In patients with persistent asthma, compared with the same period before the pandemic. METHODS: Kaiser Permanente Colorado members aged 18 to 99 years with persistent asthma were evaluated during two periods (March to October 2019 and March to October 2020). Comparison of asthma exacerbations (hospitalizations, emergency department visits, and courses of oral prednisone) and asthma medication metrics were evaluated between the two periods and by type of care received during the pandemic (no care, virtual care only, in-person care only, or a mix of virtual and in-person care). Population characteristics by type of care received during the pandemic were also evaluated. RESULTS: Among 7,805 adults with persistent asthma, those who used more virtual care or sought no care during the pandemic were younger and had fewer comorbidities, mental health diagnoses, or financial barriers. Exacerbations decreased (0.264 to 0.214; P <.001) as did courses of prednisone (0.213 to 0.169). Asthma medication adherence (0.53 to 0.54; P <.001) and the asthma medication ratio, a quality-of-care metric (0.755 to 0.762; P [ .019), increased slightly. Patients receiving a mix of in-person and virtual care had the highest rate of exacerbations (0.83) and a lower asthma medication ratio (0.74) despite having the highest adherence (.57). CONCLUSIONS: Despite an increase in virtual care, asthma exacerbations decreased except among individuals who received both in-person and virtual care, likely because they had more severe disease.Ye

Third order dielectric susceptibility in a model quantum paraelectric

In the context of perovskite quantum paraelectrics, we study the effects of a quadrupolar interaction $J_q$, in addition to the standard dipolar one $J_d$. We concentrate here on the nonlinear dielectric response $\chi_{P}^{(3)}$, as the main response function sensitive to quadrupolar (in our case antiquadrupolar) interactions. We employ a 3D quantum four-state lattice model and mean-field theory. The results show that inclusion of quadrupolar coupling of moderate strength ($J_q \sim {{1}\over{4}} J_d$) is clearly accompanied by a double change of sign of $\chi_{P}^{(3)}$ from negative to positive, near the quantum temperature $T_Q$ where the quantum paraelectric behaviour sets in. We fit our $\chi_{P}^{(3)}$ to recent experimental data for SrTiO$_3$, where the sign change is identified close to $T_Q \sim 37 K$.Comment: 22 page

Planning for Implementation Success Using RE-AIM and CFIR Frameworks: A Qualitative Study

Background: RE-AIM (Reach, Effectiveness, Adoption, Implementation, Maintenance) and CFIR (Consolidated Framework for Implementation Research) dissemination and implementation frameworks define theory-based domains associated with the adoption, implementation and maintenance of evidence-based interventions. Used together, the two frameworks identify metrics for evaluating implementation success, i.e., high reach and effectiveness resulting in sustained practice change (RE-AIM), and modifiable factors that explain and enhance implementation outcomes (CFIR). We applied both frameworks to study the implementation planning process for a technology-delivered asthma care intervention called Breathewell within an integrated care organization. The goal of the Breathewell intervention is to increase the efficiency of delivering resource-intensive asthma care services. Methods: We reviewed historical documents (i.e., meeting agendas; minutes) from 14 months of planning to evaluate alignment of implementation team priorities with RE-AIM domains. Key content was extracted and analyzed on topics, frequency and amount of discussion within each RE-AIM domain. Implementation team members were interviewed using questions adapted from the CFIR Interview Guide Tool to focus their reflection on the process and contextual factors considered during pre-implementation planning. Documents and transcripts were initially coded using RE-AIM domain definitions, and recoded using CFIR constructs, with intent to help explain how team decisions and actions can contribute to adoption, implementation and maintenance outcomes. Results: Qualitative analysis of team documents and interviews demonstrated strong alignment with the RE-AIM domains: Reach, Effectiveness, and Implementation; and with the CFIR constructs: formal inclusion of provider and staff stakeholders in implementation planning, compatibility of the intervention with workflows and systems, and alignment of the intervention with organizational culture. Focus on these factors likely contributed to RE-AIM outcomes of high implementation fidelity. However, team members expressed low confidence that Breathewell would be adopted and maintained post-trial. A potential explanation was weak alignment with several CFIR constructs, including tension for change, relative priority, and leadership engagement that contribute to organizational receptivity and motivation to sustain change. Conclusions: While RE-AIM provides a practical framework for planning and evaluating practice change interventions to assure their external validity, CFIR explains why implementation succeeded or failed, and when used proactively, identifies relevant modifiable factors that can promote or undermine adoption, implementation, and maintenance.Ye