Search

BackgroundAdverse drug events are a major safety issue in ambulatory care. Improving medication self-management could reduce these adverse events. Researchers have developed medication applications for tethered personal health records (PHRs), but little has been reported about medication applications for interoperable PHRs. ObjectiveOur objective was to develop two complementary personal health applications on a common PHR platform: one to assist children with complex health needs (MyMediHealth), and one to assist older adults in care transitions (Colorado Care Tablet). MethodsThe applications were developed using a user-centered design approach. The two applications shared a common PHR platform based on a service-oriented architecture. MyMediHealth employed Web and mobile phone user interfaces. Colorado Care Tablet employed a Web interface customized for a tablet PC. ResultsWe created complementary medication management applications tailored to the needs of distinctly different user groups using common components. Challenges were addressed in multiple areas, including how to encode medication identities, how to incorporate knowledge bases for medication images and consumer health information, how to include supplementary dosing information, how to simplify user interfaces for older adults, and how to support mobile devices for children. ConclusionsThese prototypes demonstrate the utility of abstracting PHR data and services (the PHR platform) from applications that can be tailored to meet the needs of diverse patients. Based on the challenges we faced, we provide recommendations on the structure of publicly available knowledge resources and the use of mobile messaging systems for PHR applications.

BackgroundOlder adults often have multiple chronic problems requiring them to manage complex medication regimens overseen by various clinicians. Personal health applications (PHAs) show promise assisting in medication self-management, but adoption of new computer technologies by this population is challenging. Optimizing the utility of PHAs requires a thorough understanding of older adults’ needs, preferences, and practices. ObjectiveThe objective of our study was to understand the medication self-management issues faced by older adults and caregivers that can be addressed by an electronic PHA. MethodsWe conducted a qualitative analysis of a series of individual and group semistructured interviews with participants who were identified through purposive sampling. ResultsWe interviewed 32 adult patients and 2 adult family caregivers. We identified 5 core themes regarding medication self-management challenges: seeking reliable medication information, maintaining autonomy in medication treatment decisions, worrying about taking too many medications, reconciling information discrepancies between allopathic and alternative medical therapies, and tracking and coordinating health information between multiple providers. ConclusionsThis study provides insights into the latent concerns and challenges faced by older adults and caregivers in managing medications. The results suggest that PHAs should have the following features to accommodate the management strategies and information preferences of this population: (1) provide links to authoritative and reliable information on side effects, drug interactions, and other medication-related concerns in a way that is clear, concise, and easy to navigate, (2) facilitate communication between patients and doctors and pharmacists through electronic messaging and health information exchange, and (3) provide patients the ability to selectively disclose medication information to different clinicians.

Using methods comparable to those used previously to test closely-related taxa (Pan troglodytes and Macaca mulatta), our aim was to better understand how gorillas (Gorilla gorilla gorilla) and Japanese macaques (M. fuscata) learn sequences. Using a disappearing-type simultaneous chain, we trained five gorillas and eight macaques on a two-item list of colored stimuli presented via touchscreens. There was no difference across species in the number of trials required to learn the two-item list. We added a third item to the list as each subject reached criterion. We then analyzed the subjects’ first 30 trials with the three-item list and found that the rate of successfully sequencing the list varied by subject but not by species. In their first 30 trials of the three-item list, subjects selected the second item correctly only at chance, suggesting they had only encoded the first symbol when learning the two-item list. One gorilla, tested on longer sequences, showed similar responses: when first presented with a newly-lengthened list, he only selected the penultimate item at chance levels. Thus, the primates’ errors with newly-lengthened lists is suggestive of the chaining theory of learning. These results highlight similarities in list learning of these two distantly-related primate species as well as the clear intra-species variation in learning.

Device scaling for future semiconductor technologies is driving the adoption of innovative methods for miniaturizing semiconductor chips. One promising approach that has garnered significant interest for sub-10 nm device scaling is area selective deposition (ASD). In this study, we demonstrate the feasibility of ASD of silicon dioxide (SiO2) on –OH terminated surfaces (silicon oxide: SiOx) but not on –NH terminated surfaces (silicon nitride: SiNx) for 2D blanket, 2D patterned, and 3D stacks using a novel precursor: Orthrus. To achieve this, we optimized the SiOx and SiNx layers to enhance the –OH and –NH surface bonds, respectively. Using x-ray photo spectroscopy analysis, we showed that SiO2 selectively deposits on SiOx without any nucleation delay compared to SiNx. We have demonstrated the inherent selective deposition of approximately ∼4 nm on 2D patterned structures and ∼3.7 nm on 3D stacks by fine-tuning the atomic layer deposition process. This selective thickness is >250% compared to a previously shown selective SiO2 deposition process in the literature. Finally, we also showed that the step coverage of selective SiO2 growth in 3D stacks is ∼1. This study highlights the potential pathway for performing ASD of commonly used SiO2 in 3D high-aspect-ratio stacks. [ABSTRACT FROM AUTHOR]

While studies have examined the effects of schools offering in-person learning during the pandemic, this study provides analysis of student enrollment decisions (remote versus in-person) in response to schools providing in-person learning opportunities. In Connecticut during the 2020-21 school year, we find that student take-up of in-person learning opportunities was low with students on average enrolled in-person for only half of the days offered, and take-up was even lower in schools with larger shares of disadvantaged students. The provision of in-person learning opportunities has been previously shown to mitigate pandemic learning losses. By exploiting data on actual enrollment, we show that the protective benefits of in-person learning are twice as large as previously estimated once we account for the low rates of student take-up. Finally, we provide evidence suggesting that a key mechanism behind the benefits of in-person learning is alleviating the burden faced by schools and teachers in delivering remote education. First, we show that the benefits to individual students of their in-person learning are substantially smaller than the overall benefits a student receives from their school average level of in-person enrollment. Second, we show that a combination of remote and in-person learning (hybrid) with a full-time on-line presence of students when at home was worse than hybrid learning with students never or only partially online. This second finding is consistent with qualitative evidence showing that teachers found hybrid learning especially challenging when having to manage both in-person and remote students for the entire class period. [ABSTRACT FROM AUTHOR]