Fabrication of nanometer single crystal metallic CoSi2 structures on Si

Amorphous Co:Si (1:2 ratio) films are electron gun-evaporated on clean Si(111), such as in a molecular beam epitaxy system. These layers are then crystallized selectively with a focused electron beam to form very small crystalline Co/Si2 regions in an amorphous matrix. Finally, the amorphous regions are etched away selectively using plasma or chemical techniques

Adverse events in veterans affairs inpatient psychiatric units: Staff perspectives on contributing and protective factors.

OBJECTIVES: This study sought to identify risk factors and protective factors in hospital-based mental health settings in the Veterans Health Administration (VHA), with the goal of informing interventions to improve care of persons with serious mental illness. METHODS: Twenty key informants from a stratified sample of 7 VHA inpatient psychiatric units were interviewed to gain their insights on causes of patient safety events and the factors that constrain or facilitate patient safety efforts. RESULTS: Respondents identified threats to patient safety at the system-, provider-, and patient-levels. Protective factors that, when in place, made patient safety events less likely to occur included: promoting a culture of safety; advocating for patient-centeredness; and engaging administrators and organizational leadership to champion these changes. CONCLUSIONS: Findings highlight the impact of systems-level policies and procedures on safety in inpatient mental health care. Engaging all stakeholders, including patients, in patient safety efforts and establishing a culture of safety will help improve the quality of inpatient psychiatric care. Successful implementation of changes require the knowledge of local experts most closely involved in patient care, as well as support and buy-in from organizational leadership

Evaluation of an Interprofessional Continuing Professional Development Course on Comprehensive Diabetes Care: A Mixed-Methods Approach

RATIONALE: Since there are only 33 endocrinologists within the Department of Defence and over 150 000 beneficiaries with diabetes, most patients with diabetes will be treated by primary care providers (PCPs). Comprehensive diabetes care visits are extensive and the clinical practice guidelines (CPGs) routinely change; thus, providing current evidence-based care is difficult. Most professional development courses aim to update PCPs on CPGs but are often inadequate as they focus on only the PCPs (not the interdisciplinary team) without a plan to implement changes into practice. OBJECTIVE: To evaluate the biannual (twice yearly), 3-day, interprofessional Diabetes Champion Course (DCC) developed by the US Air Force Diabetes Center of Excellence on comprehensive diabetes care. METHODS: A mixed-methods approach was used to evaluate three iterations of the DCC course (Sept 2014-Sept 2015). Quantitatively, pre-course and post-course surveys were used to obtain impact on knowledge, skills, and intention to change clinical practice. Qualitatively, semi-structured phone interviews were conducted with participants to obtain benefits to their clinic related to attending the DCC and barriers to implementation of the CPG process improvement project. RESULTS: Twelve of 19 responding clinics (63%) reported implementing all or part of their original CPG project developed at the DCC, and 17 of 19 clinics (89%) reported improvements associated with attending the DCC. Post-course surveys, from on location participants, revealed significant improvements in knowledge (P \u3c 0.01). Likewise, foot exam skills and ability to demonstrate glucose meters to patients improved. Even with high pre-course confidence, 97% of providers reported acquiring new knowledge about prescribing and titrating insulin. CONCLUSION: The DCC is innovative as it employs a team-based, interprofessional, didactic, and interactive approach that is effective in improving knowledge, skills, and intention to change clinical practice, which should translate to better care for patients with diabetes

Orbital operations study. Appendix B: Operational procedures

Operational procedures for each alternate approach for each interfacing activity of the orbital operations study are presented. The applicability of the procedures to interfacing element pairs is identified

Long-wavelength PTSI infrared detectors and method of fabrication thereof

Extended cutoff wavelengths of PtSi Schottky infrared detectors in the long wavelength infrared (LWIR) regime have been demonstrated for the first time. This result was achieved by incorporating a 1-nm-thick p+ doping spike at the PtSi/Si interface. The extended cutoff wavelengths resulted from the combined effects of an increased electric field near the silicide/Si interface due to the p+ doping spike and the Schottky image force. The p+ doping spikes were grown by molecular beam epitaxy at 450 degrees Celsius using elemental boron as the dopant source, with doping concentrations ranging from 1.times.10.sup.19 to 1.times.10.sup.21 cm.sup.-3. The cutoff wavelengths were shown to increase with increasing doping concentrations of the p+ spikes

Is It Distress, Depression, or Both? Exploring Differences in the Diabetes Distress Scale and the Patient Health Questionnaire in a Diabetes Specialty Clinic

IN BRIEF Patients (n = 314) completed the Patient Health Questionnaire and the Diabetes Distress Scale as part of standard care. Although most patients (70.4%) had no symptoms of depression or diabetes-related distress, 23.9% scored high on the distress questionnaire in at least one of its four domains. Regular screening for distress related to the demands of living with diabetes is crucial in identifying and preventing poor health outcomes associated with diabetes-related distress

When Military Fitness Standards No Longer Apply: The High Prevalence of Metabolic Syndrome in Recent Air Force Retirees

BACKGROUND: Metabolic syndrome (MetS) is strongly associated with cardiovascular disease. With MetS prevalence rates increasing in the U.S. population, prevention efforts have largely focused on diet and exercise interventions. Before retirement, military service members have met fitness requirements for at least 20 years, and have lower MetS rates compared to age-matched U.S. population controls (23.4% vs. 39.0%), which suggests a protective effect of the lifestyle associated with military service. However, MetS rates in military retirees have not been previously reported, so it is unknown whether this protective effect extends beyond military service. The purpose of this study was to examine the prevalence of MetS and individual diagnostic criteria in a population of recent U.S. Air Force (USAF) retirees. METHODS: We obtained institutional review board approval for all participating sites at Wilford Hall Ambulatory Surgical Center. From December 2011 to May 2013, USAF retirees within 8 years of their date of retirement were recruited at five USAF bases. Consenting subjects underwent examination and laboratory studies to assess the five diagnostic criteria measures for MetS. We used binary logistic regression to examine the relationship between various factors and the presence of MetS. RESULTS: The study population (n = 381) was primarily male (81.9%), enlisted (71.1%) and had a mean age of 48.2 years. When applying the American Heart Association MetS diagnostic criteria to this population, the MetS prevalence was 37.2%. When using alternative diagnostic criteria found in other published studies that did not include the use of cholesterol medications, the MetS prevalence was 33.6%. Per American Heart Association criteria, the prevalence of each of the MetS diagnostic criteria was as follows: central obesity, 39.8%; elevated fasting glucose, 32.4%; high blood pressure, 56.8%; low-high-density lipoproteins cholesterol, 33.3%; and elevated triglycerides, 42.7%. MetS was more common among males (odds ratio [OR] = 4.05; confidence interval [CI] = 1.94, 8.48) and enlisted (OR = 2.23; CI = 1.24, 4.01). It was also strongly associated with a history of participating in the Air Force Weight Management Program (OR = 2.82; CI = 1.41, 5.63) and increased weight since retirement (OR = 4.00; CI = 1.84, 8.70). However, the study did not find an association between the presence of MetS and time since retirement or self-reported diet and exercise changes since retirement. CONCLUSIONS: The MetS prevalence among recent USAF retirees represents a shift from age-matched active duty rates toward higher rates described in the overall U.S. POPULATION: This finding suggests the protective health effects of fitness standards may be reduced shortly after retirement. This is true despite activities such as screening before and during military service and exposure to USAF health promotion efforts and fitness standards throughout a period of active duty service lasting at least 20 years. In general, military members should be counseled that on retirement, efforts to maintain a healthy weight have continued benefit and should not be forgotten. The risk of MetS after retirement is particularly increased for those identified as being overweight during their active duty careers. Interventions that prevent and reduce unhealthy weight gain may be an appropriate investment of resources and should be studied further

Evaluation of the Group Lifestyle Balance Program in a Military Setting: An Investment Worth Expanding

Introduction: The Diabetes Prevention Program (DPP) demonstrated that lifestyle intervention programs were effective in preventing or delaying the onset of diabetes. The Group Lifestyle Balance (GLB) program translated the DPP curriculum into a 12-wk group intervention for those at risk for diabetes. This retrospective evaluation examined clinical outcomes for patients in the Diabetes Center of Excellence GLB program located at Wilford Hall Ambulatory Surgical Center from 2009 to 2013. Objectives included determining rates of retention, demographic characteristics of program completers, and changes in metabolic surrogates of disease prevalence. Study Design: Adults with prediabetes or metabolic syndrome (MetS) were referred to the GLB program. Updated participant metabolic data were collected at regular intervals during their participation. Results: During the 5-yr study, 704 patients attended the initial class. Overall, 52% of all participants completed the program with the greatest decline in participation occurring by the fourth week (30%). Baseline prevalence of conditions of interest for those who completed the program was prediabetes (93.2%), obesity (56.1%), and MetS (31.5%). GLB completers were older and retired (p \u3c 0.05). A significant number of active duty military members (44.9%, p \u3c 0.01, n = 53) dropped out of the program before the fourth week. Furthermore, those who completed the program saw a 2.0% reduction in prediabetes prevalence (p \u3c 0.001), obesity decreased by 8.7% (p \u3c 0.001), and MetS decreased by 6.8% (p \u3c 0.01). Significant differences were found for central obesity, triglycerides, and fasting blood sugar (p \u3c 0.001). Conclusions: The GLB program is a valuable DPP and was effective at improving clinical outcomes and reducing the incidence of prediabetes, obesity, and MetS for participants who completed the program. Every effort should be made to support and encourage GLB participants to complete the program