Quality of life and clinical outcomes in Type 2 diabetes patients at the primary care clinics of the West Virginia University Hospital

This study examines relationships between quality of life (QoL) and clinical outcomes, specifically A1C, in Type 2 diabetes patients. Type 2 diabetes patients at the outpatient clinics of a university hospital completed the SF-12 and the Audit of Diabetes Dependent Quality of Life (ADDQoL), and this was merged with a retrospective collection of his/her clinical and utilization data, including A1C. Usable response rate was 44.3% (n = 385). Mean A1C of respondents was 7.2 (+1.4), mean diabetes duration was 10.2 (+9.1), and 62.1% were obese. Only ADDQoL scores showed significant correlation with A1C (r = -0.19, p \u3c 0.000). Hierarchical regression models were used to explain the effect of A1C on QoL controlling for demographics and clinical variables. A1C was not a significant predictor in any regression model, although univariate analyses indicated significantly lower ADDQoL and SF-12 PCS in the group with A1C \u3e 7.0. Obesity was a significant predictor in models explaining only the PCS and MCS scores. These results support complementary use of generic and disease-specific QoL measures in Type 2 diabetes populations. Patient\u27s perceptions of their own life may differ from what a biomedical measure like A1C suggests

Development and validation of a diabetes-specific health state classification system and valuation function based on the multi-attribute theory

Preference-Based Measures of Health (PBMH) provide \u27preference\u27 or \u27utility\u27 weights that enable the calculation of quality-adjusted life years for the economic evaluations of interventions. The Diabetes Utility Index (DUI) was developed as a two-page, self-administered diabetes-specific PBMH that can replace expensive time-consuming interviews with patients to estimate their health state utilities. Inputs from theory, an existing diabetes-specific measure of quality of life, and statistical analyses were submitted to a clinical expert panel. After three rounds of pilot surveys (n1=52, n2=65, n3=111) at primary care clinics in Morgantown, WV, five attributes and severity categories for each attribute were finalized on the basis of the results of Rasch Analysis and consultations with the panel. The final attributes were: \u27Physical Ability & Energy\u27, \u27Relationships\u27, \u27Mood & Feelings\u27, \u27Enjoyment of Diet\u27, and \u27Satisfaction with Management of diabetes\u27. The next step involved obtaining preferences for health states based on combinations of DUI attributes and severity levels from 100 individuals with diabetes, recruited from primary care and community settings in and around Morgantown, WV, in hour-long one-on-one interviews. These health states were anchor states, single-attribute level states including corner states, and marker states. The interviews provided data to calculate a Multi-Attribute Utility Function (MAUF) that calculates utilities for any of the 768 health states that can be defined by the DUI, on a scale where 1.00=Perfect Health and 0.00=the all worse \u27Pits\u27 state, from respondents\u27 answers to its five questions. In addition to an overall index score, attribute-level preference scores were also calculable by the function. Finally, a validation survey was conducted in collaboration with the West Virginia University (WVU) Diabetes Institute. For concurrent and construct validation purposes, the DUI was mailed to individuals with diabetes along with generic PBMH like the EuroQol EQ-5D, the SF-6D and other patient-reported outcomes measures like the Diabetes Symptoms Checklist-Revised, the Short Form 12 (SF-12) and the Well-Being Questionnaire (W-BQ12), and their surveys responses (n=396) were merged with a clinical database consisting of ICD-9 diagnosis codes. The DUI utilities were found to be largely free of socio-demographic effects and its scores were well distributed between 0.00 and 1.00. The DUI moderately correlated with generic PBMH and distinguished between severity groups based on diabetes symptoms and complications. The scoring function of the DUI calculated utilities favorably compared against cardinal Standard Gamble utilities obtained directly from patients for three DUI health states. These results show evidence of the feasibility and validity of the DUI. Further research is suggested to demonstrate the generalizability of these findings, to study the responsiveness of the DUI, and to examine the clinical meaningfulness of the DUI change scores

Modeling of Deposition Height in Localized Electrochemical Deposition Using Liquid Marbles

AbstractApplication of Localized Electrochemical Deposition (LECD) using liquid marbles for micro repair and micro additive manufacturing is being researched. A liquid marble is a droplet of liquid coated with hydrophobic micro or nano powders. When a suitable electrolyte is used as the liquid, a liquid marble can be used for the LECD process. A theoretical model to predict the deposition height using a liquid marble is developed in this work. The height of deposition is a critical output parameter as it determines the minimum layer height in electrochemical additive manufacturing (ECAM). A physics based mathematical model using Faraday's law of electrolysis and the knowledge of geometry of the tool and metal powder has been developed. Experimental verification was carried out to validate the theoretical model. Experimental values follow the trend predicted by the model

Effect of Ultra-High Pulse Frequency on the Resolution in the Electrochemical Deposition of Nickel

Using localized electrochemical deposition (LECD) as a mask-less direct writing methodology, metal shapes are printed. The electrochemical double-layer capacitance at ultra-high frequencies is hypothesized to cause a localized deposition and the effect of pulse frequency on the current density is modeled to predict the deposition resolution and rate of deposition. Experimental results confirm that the deposition resolution and efficiency of the LECD process increase with the increase of pulse frequency. Deposition resolution 80% smaller than the tool diameter is feasible in the LECD of nickel used with a ø 250 μm tool at 1 MHz pulsed power

EVALUATION OF DIGITAL MARKETING PERFORMANCE IN ELECTRONIC GOODS INDUSTRY: AN EMPIRICAL STUDY

The last two decades have witnessed a skyrocketing growth in digital marketing that made customers interested in purchasing products particularly electronic goods. However, it is not known whether those customers attained satisfaction through this purchase. To confirm the fact, this research has attempted to analyze the retention rate of digital marketing customers who have experience in purchasing electronic goods and for this purpose, 603 consumers of Tamilnadu (India) who have the purchase experience on a digital marketing basis were selected on a simple random basis. Tools like structural equation modeling, percentage analysis, one-way ANOVA, and paired sample ‘t’ test were applied and the result revealed that only customer satisfaction has mediated the influence of digital marketing on their loyalty but, the important parameter, trust has a negative role between these constructs. Marketers need to create trust about the product with the actual features as informed in digital marketing so that consumers can reach a high level of satisfaction and this may lead to a positive word of mouth. In addition, this enhances sales and enables marketers to attain profit maximization along with building consumer confidence

Novel Fabrication of Un-coated Super-hydrophobic Aluminum via Pulsed Electrochemical Surface Modification

AbstractSuper-hydrophobic and super-hydrophilic aluminum (Al) surfaces were fabricated via electrochemical surface modification (ECSM) in neutral NaClO3 electrolyte without the addition of secondary chemical coatings. The effects of processing time and applied potential on the surface roughness and wettability were studied. The aluminum surface was characterized using stylus profilometer and scanning electron microscope (SEM). Wettability was evaluated using Sessile Drop Test and a high resolution camera. Results show that surfaces obtained hierarchical rough features and super-hydrophilic behavior after pulse electrochemical machining. Heat treatment at 200°C transitioned the substrates to exhibit super-hydrophobic behavior due to the removal of all moisture from within the micro- and nano-meter scale features on the aluminum surfaces, allowing for the reformation of a natural passivation (oxide) layer with atmospheric interaction. The method proposed in this study for producing super-hydrophobic aluminum surfaces does not require the use of acid or base etching or chemical coatings, such as flouroalkylsilane (FAS). Experimental results reveal increase in contact angle, with increase in applied potential, and decrease in sliding angle

Electrochemical-mechanical phase field model for electroplating process

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Effect of angiotensin-converting enzyme inhibitor and angiotensin receptor blocker initiation on organ support-free days in patients hospitalized with COVID-19

IMPORTANCE Overactivation of the renin-angiotensin system (RAS) may contribute to poor clinical outcomes in patients with COVID-19. Objective To determine whether angiotensin-converting enzyme (ACE) inhibitor or angiotensin receptor blocker (ARB) initiation improves outcomes in patients hospitalized for COVID-19. DESIGN, SETTING, AND PARTICIPANTS In an ongoing, adaptive platform randomized clinical trial, 721 critically ill and 58 non–critically ill hospitalized adults were randomized to receive an RAS inhibitor or control between March 16, 2021, and February 25, 2022, at 69 sites in 7 countries (final follow-up on June 1, 2022). INTERVENTIONS Patients were randomized to receive open-label initiation of an ACE inhibitor (n = 257), ARB (n = 248), ARB in combination with DMX-200 (a chemokine receptor-2 inhibitor; n = 10), or no RAS inhibitor (control; n = 264) for up to 10 days. MAIN OUTCOMES AND MEASURES The primary outcome was organ support–free days, a composite of hospital survival and days alive without cardiovascular or respiratory organ support through 21 days. The primary analysis was a bayesian cumulative logistic model. Odds ratios (ORs) greater than 1 represent improved outcomes. RESULTS On February 25, 2022, enrollment was discontinued due to safety concerns. Among 679 critically ill patients with available primary outcome data, the median age was 56 years and 239 participants (35.2%) were women. Median (IQR) organ support–free days among critically ill patients was 10 (–1 to 16) in the ACE inhibitor group (n = 231), 8 (–1 to 17) in the ARB group (n = 217), and 12 (0 to 17) in the control group (n = 231) (median adjusted odds ratios of 0.77 [95% bayesian credible interval, 0.58-1.06] for improvement for ACE inhibitor and 0.76 [95% credible interval, 0.56-1.05] for ARB compared with control). The posterior probabilities that ACE inhibitors and ARBs worsened organ support–free days compared with control were 94.9% and 95.4%, respectively. Hospital survival occurred in 166 of 231 critically ill participants (71.9%) in the ACE inhibitor group, 152 of 217 (70.0%) in the ARB group, and 182 of 231 (78.8%) in the control group (posterior probabilities that ACE inhibitor and ARB worsened hospital survival compared with control were 95.3% and 98.1%, respectively). CONCLUSIONS AND RELEVANCE In this trial, among critically ill adults with COVID-19, initiation of an ACE inhibitor or ARB did not improve, and likely worsened, clinical outcomes. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT0273570

Study of novel micro EDM using foil electrodes

A novel micro groove machining technique by micro electro discharge machining using microfoils is proposed. Two novel flushing techniques were invented and experimentally validated. Studied the effect of flushing techniques vis-?-vis tool materials. Numerical studies were conducted to study the thermal effect of the micro EDM process on workmaterial.DOCTOR OF PHILOSOPHY (MPE

A Mathematical Model to Predict the Porosity of Locally Electrodeposited Nickel under Pulsed Voltage Conditions

Metal parts manufactured with engineered porosity offer advantages over traditional parts as they have excellent specific mechanical properties at a lower weight. This is especially of interest in the aerospace and automobile industries. Additive manufacturing allows for creating parts with computer aided design (CAD) modeled lattice structures that offer lightweight parts. However, there is a need for porous structures at the micron scale (\u3c50 µm) which cannot be achieved in a controlled manner using traditional powder-bed based metal additive manufacturing processes. Electrochemical Additive Manufacturing (ECAM) is a novel non-thermal metal additive manufacturing process capable of producing metal 3D parts with engineered porosity at the micron scale. There is a lack of understanding of the cause of porosity and controlling the porosity generated in the parts created using this process. In this paper, the effects of the electrical parameters of deposition, such as the pulse duty cycle and pulse frequency during electrodeposition, on the porosity of the manufactured parts were mathematically modeled. The model predicts that higher frequency electrodeposition leads to more porous structures. The model developed in this study can be used to predict the process parameters needed to deposit nickel microstructures with desired levels of porosity between 20 and 55 %. These model predictions were also validated by experiments. Two mechanisms for the cause of porosity in the deposits were identified. The diffusion-limited deposition phenomenon causing a lack of availability of cations results in larger sized pores and hollow structures to form on the part. The crystal growth and the nucleation process cause micron-scale pores