Long J.A.,1201 Blockley Hall |
Jahnle E.C.,1002 Blockley Hall |
Richardson D.M.,3900 Woodland Avenue |
Loewenstein G.,5000 Forbes Avenue |
Volpp K.G.,1120 Blockley Hall
Annals of Internal Medicine | Year: 2012
Background: Compared with white persons, African Americans have a greater incidence of diabetes, decreased control, and higher rates of micro vascular complications. A peer mentorship model could be a scalable approach to improving control in this population and reducing disparities in diabetic outcomes. Objective: To determine whether peer mentors or financial incentives are superior to usual care in helping African American veterans decrease their hemoglobin A 1c (HbA 1c) levels. Design: A 6-month randomized, controlled trial. (ClinicalTrials.gov registration number: NCT01125956) Setting: Philadelphia Veterans Affairs Medical Center. Patients: African American veterans aged 50 to 70 years with persistently poor diabetes control. Intervention: 118 patients were randomly assigned to 1 of 3 groups: usual care, a peer mentoring group, and a financial incentives group. Usual care patients were notified of their starting HbA 1c level and recommended goals for HbA 1c. Those in the peer mentoring group were assigned a mentor who formerly had poor glycemic control but now had good control (HbA 1c level <7.5%). The mentor was asked to talk with the patient at least once per week. Peer mentors were matched by race, sex, and age. Patients in the financial incentive group could earn $100 by decreasing their HbA 1c level by 1% and $200 by decreasing it by 2% or to an HbA 1c level of 6.5%. Measurements: Change in HbA 1c level at 6 months. Results: Mentors and mentees talked the most in the first month (mean calls, 4; range, 0 to 30), but calls decreased to a mean of 2 calls (range, 0 to 10) by the sixth month. Levels of HbA 1c decreased from 9.9% to 9.8% in the control group, from 9.8% to 8.7% in the peer mentor group, and from 9.5% to 9.1% in the financial incentive group. Mean change in HbA 1c level from baseline to 6 months relative to control was -1.07% (95% CI, -1.84% to -0.31%) in the peer mentor group and -0.45% (CI, -1.23% to 0.32%) in the financial incentive group. Limitation: The study included only veterans and lasted only 6 months. Conclusion: Peer mentorship improved glucose control in a cohort of African American veterans with diabetes Primary Funding Source: National Institute on Aging Roybal Center. © 2012 American College of Physicians.
Balasubramanian A.,5000 Forbes Avenue |
Morhard R.,5000 Forbes Avenue |
Bettinger C.J.,5000 Forbes Avenue |
Bettinger C.J.,McGowan Institute for Regenerative Medicine
Advanced Functional Materials | Year: 2013
Materials with embedded vascular networks afford rapid and enhanced control over bulk material properties including thermoregulation and distribution of active compounds such as healing agents or stimuli. Vascularized materials have a wide range of potential applications in self-healing systems and tissue engineering constructs. Here, the application of vascularized materials for accelerated phase transitions in stimuli-responsive microfluidic networks is reported. Poly(ester amide) elastomers are hygroscopic and exhibit thermo-mechanical properties (Tg ≈ 37 °C) that enable heating or hydration to be used as stimuli to induce glassy-rubbery transitions. Hydration-dependent elasticity serves as the basis for stimuli-responsive shape-memory microfluidic networks. Recovery kinetics in shape-memory microfluidics are measured under several operating modes. Perfusion-assisted delivery of stimulus to the bulk volume of shape-memory microfluidics dramatically accelerates shape recovery kinetics compared to devices that are not perfused. The recovery times are 4.2 ± 0.1 h and 8.0 ± 0.3 h in the perfused and non-perfused cases, respectively. The recovery kinetics of the shape-memory microfluidic devices operating in various modes of stimuli delivery can be accurately predicted through finite element simulations. This work demonstrates the utility of vascularized materials as a strategy to reduce the characteristic length scale for diffusion, thereby accelerating the actuation of stimuli-responsive bulk materials. Vascularization in complex organisms plays an important role in reducing the characteristic diffusion length scale of tissue structures with large dimensions. This strategy is recapitulated in synthetic shape-memory materials. Vascular networks accelerate phase transitions and increase recovery rates in stimuli-responsive polymers by reducing the characteristic diffusion length scale of the bulk material. Copyright © 2013 WILEY-VCH Verlag GmbH & Co. KGaA, Weinheim.
Kustra S.,5000 Forbes Avenue |
Kustra S.,McGowan Institute for Regenerative Medicine |
Wu H.,5000 Forbes Avenue |
Wu H.,McGowan Institute for Regenerative Medicine |
And 4 more authors.
Small | Year: 2012
High-throughput fabrication and characterization of nanomaterials represents an opportunity to discover optimal processing conditions for desired application-specific properties. Microfluidic devices used in combination with thermal annealing gradients produce high-throughput arrays of silver nanowire networks for screening optimal parameters in transparent conducting electrodes. A complementary technique to parallel characterization of nanowire network topology is also introduced. Copyright © 2012 WILEY-VCH Verlag GmbH & Co. KGaA, Weinheim.