Notes

Observational review from the success associated with spinal-cord injuries rehabilitation using the Spinal-cord Injury-Ability Understanding Measurement Index.
99 MRayl), the ultrasound transmission loss of the proposed patch was relatively low (∼0.002 dB). We also verified the use of the Ca-modified silk patch in various ultrasound applications, including ultrasound imaging, ultrasound heating, and transcranial ultrasound stimulation for neuromodulation. The comparable performance of the Ca-modified patch to that of a commercial ultrasound gel and its durability against various environmental conditions confirmed that the Ca-modified silk patch could be a promising candidate as a coupling medium for next-generation ultrasound patch systems.Lithium metal is considered as a strongly attractive anode candidate for the high-energy-storage field, but its dreadful dendrite growth has haunted its commercialization progress. Herein, we develop a lithiophilic Nb2O5-embedded three-dimensional (3D) carbon nanofiber network (Nb2O5-CNF) as a scaffold to preload molten Li for the fabrication of dendrite-free composite anode. The in situ lithiation reaction between molten Li and Nb2O5 nanocrystals results in the formation of nanosize LixNbyO nanoparticles, which can serve as preferred sites that regulate nucleation/growth behavior of Li during the plating process. Besides, due to its high structural stability and abundant internal inner space, the 3D CNF network can function as a reservoir to confine the dimensional expansion of "hostless Li". The resulting Li composite anodes exhibit enlarged active areas and reduced interfacial energy barriers, delivering a prolonged cycling of 1000 h with an ultralow hysteresis of 52 mV and dendrite-free morphology in a symmetric cell (1.0 mA cm-2). Coupled with the LiFePO4 cathode, the Li@Nb2O5-CNF anode sustains a reversible capacity of 163 mAh g-1 with an excellent capacity retention of 93.0% after 370 cycles at 0.5C. This all-around strategy of lithiophilic sites coupled with a 3D conductive nanofiber matrix may shed light on promising applications of high-capacity and dendrite-free Li-metal batteries.Temporal persistence is as important for nanocarriers as spatial accuracy. GSK-3 inhibitor However, because of the insufficient aggreagtion and short retention time of chemotherapy drugs in tumors, their clinical application is greatly limited. A drug delivery approach dependent on the sensitivity to an enzyme present in the microenvironment of the tumor is designed to exhibit different sizes in different sites, achieving enhanced drug permeability and retention to improve tumor nanotherapy efficacy. In this work, we report a small-molecule peptide drug delivery system containing both tumor-targeting groups and enzyme response sites. This system enables the targeted delivery of peptide nanocarriers to tumor cells and a unique response to alkaline phosphatase (ALP) in the tumor microenvironment to activate morphological transformation and drug release. The amphiphilic peptide AYR self-aggregated into a spherical nanoparticle structure after encapsulating the lipid-soluble model drug doxorubicin (DOX) and rapidly converted to nanofibers via the induction of ALP. This morphological transformation toward a high aspect ratio allowed rapid, as well as effective drug release to tumor location while enhancing specific toxicity to tumor cells. Interestingly, this "transformer"-like drug delivery strategy can enhance local drug accumulation and effectively inhibit drug efflux. In vitro along with in vivo experiments further proved that the permeability and retention of antitumor drugs in tumor cells and tissues were significantly enhanced to reduce toxic side effects, and the therapeutic effect was remarkably improved compared with that of nondeformable drug-loaded peptide nanocarriers. The developed AYR nanoparticles with the ability to undergo morphological transformation in situ can improve local drug aggregation and retention time at the tumor site. Our findings provide a new and simple method for nanocarrier morphology transformation in novel cancer treatments.Nitrogen doping carbon materials are considered to be promising candidates for Na+ storage anodes. However, hitherto, the effects and mechanism of specific single N configuration (among pyrrolic N, quaternary N, and pyridinic N), on the sodium storage behaviors of carbon materials, are still puzzling, owing to the difficulties in accurately synthesizing a certain type of single N configuration dominated carbon materials (NCDCMs). Here, various NCDCMs have been successfully controlled and synthesized by small molecule polymerization methods, and their synthesis process has been also verified by NMR, MOLDI-TOF, TG-MS, etc. When serving as sodium ion battery anodes, the NCDCMs dominated by a high concentration of pyrrolic N (>80.3%) exhibits a satisfactory reversible capacity (434.5 mA h g-1 at 50 mA g-1 and 146.7 mA h g-1 at 2000 mA g-1, respectively). It is revealed that pyrrolic N has more suitable adsorption energy and larger interlayer spacing, by density functional theory calculations and electron orbital theory, respectively, which synergistically makes the material obtain excellent electrochemical performance. This research exhibits a more efficient way to reveal the differences in the sodium ions storage behavior of different nitrogen configurations doped carbon, and provides new insight for the precise design and synthesis of a certain type of heteroatom doping to achieve satisfactory electrochemical performance.
In April 2018, CMS began reimbursing both clinical and community settings for providing the CDC-recognized Diabetes Prevention Program (DPP) to eligible Medicare beneficiaries. To better understand the process of offering the program to Medicare beneficiaries, we interviewed relevant stakeholders in a large, integrated health care delivery system.

Qualitative interview study.

We conducted semistructured interviews with 12 delivery system stakeholders. Data were analyzed following a thematic analysis approach.

Stakeholders described systemic challenges to the implementation of Medicare DPP (MDPP), including inadequate reimbursement for the health care system, low awareness of MDPP among patients and providers, and challenges with utilizing third-party vendors to connect patients to CDC-recognized MDPPs.

Although the reimbursement of DPP for Medicare beneficiaries was a landmark decision, the current structure and requirements make it difficult for health systems and community-based providers to implement and promote this benefit. This study highlights the challenges that even integrated health systems are facing to implement MDPP, as well as potential strategies to overcome these barriers and expand the reach of the program. Medicare should seek ways to increase the financial incentives and decrease the barriers associated with implementing MDPP.
Although the reimbursement of DPP for Medicare beneficiaries was a landmark decision, the current structure and requirements make it difficult for health systems and community-based providers to implement and promote this benefit. This study highlights the challenges that even integrated health systems are facing to implement MDPP, as well as potential strategies to overcome these barriers and expand the reach of the program. Medicare should seek ways to increase the financial incentives and decrease the barriers associated with implementing MDPP.
To assess the effectiveness of a proactive provider intervention in prompting prior authorization (PA) submissions or provider response prior to PA expiration for medically complex Medicaid patients.

Pre-post outreach study with data from pharmacy claims and provider outreach.

The intervention and historical comparison (control) groups included expired PAs from December 2019 to February 2020 and from December 2018 to February 2019, respectively. Provider outreach, including telephonic and fax attempts, was conducted over a 2-week period prior to PA expiration. Outcomes were classified as positive or negative based on provider conversation coupled with the result (eg, PA submission) for the intervention group and based solely on pharmacy claims for the control group. The primary end point was the percentage of positive outcomes between the groups, analyzed via χ2 test. The time from PA expiration to the new PA submission was evaluated via t test.

A total of 342 outreach attempts were conducted for 270 PAs representing 193 unique patients. Outreach was more likely to result in positive outcomes in the intervention group vs no outreach in the control group (87% vs 25%; P < .00001). On average, PAs were submitted 3.5 days prior to expiration in the intervention group vs 13.0 days after expiration in the control group (t = -7.50; P < .00001).

Proactive outreach resulted in a greater percentage of PA submissions and a significantly reduced time to PA submission. These findings provide important information for payers in guiding clinical programs to enhance continuity of care among at-risk populations.
Proactive outreach resulted in a greater percentage of PA submissions and a significantly reduced time to PA submission. These findings provide important information for payers in guiding clinical programs to enhance continuity of care among at-risk populations.
Therapeutic/clinical inertia is thought to be responsible for up to 80% of cardiovascular events. This study was conducted as a comprehensive scoping and bibliometric analysis of peer-reviewed scholarly documents reporting on factors associated with therapeutic/clinical inertia in caring for patients with hypertension. Additionally, this study identified the factors associated with therapeutic/clinical inertia in hypertension.

This study was a scoping and bibliometric analysis.

The databases MEDLINE/PubMed, Embase, CINAHL/EBSCO, Cochrane, and Scopus were searched from inception to September 23, 2020, using relevant keywords. Documents reporting on factors associated with therapeutic/clinical inertia in caring for patients with hypertension were selected based on inclusion criteria. Bibliometric indicators and VOSviewer were used to analyze and map citation and keyword networks.

Data were collected from 71 documents. Of those, 43 (60.6%) were original articles, 54 (76.1%) were published after 2010, andns of research into therapeutic/clinical inertia in hypertension.
This study examines 14 independent and diverse health care interventions funded under the second round of Health Care Innovation Awards by CMS to determine if any organizational, model, or implementation features were strongly associated with the programs' estimated impacts on total expenditures, hospitalizations, or emergency department visits.

We estimated program impacts using awardee-specific difference-in-differences models based on Medicare and Medicaid enrollment and claims data for treatment and matched comparison groups from 2012 to 2018.

We used 2 analytic approaches to identify program features associated with favorable impacts. The first method identified program characteristics that were common among programs that had estimated reductions in costs and service use and uncommon among those that did not. The second approach compared median impacts among awardees with a given distinguishing feature with median impacts among awardees that lacked the characteristic.

Of the 23 program features examined, 7 were associated with favorable estimated impacts 3 intervention components (behavioral health, telehealth, and health information technology) and 4 program design and organizational characteristics (having prior experience implementing similar programs, targeting patients with substantial nonmedical needs in addition to medical problems, being focused on individual patient care rather than transforming provider practice, and using nonclinical staff as frontline providers of the intervention).
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