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IN BRIEF Basal insulin therapy is well established for glycemic control in patients with diabetes but often is not optimally implemented, leading to poor clinical outcomes and adherence. Primary care providers can and should work together with other members of the diabetes care team to allow for effective titration of basal insulin that involves patients and their caregivers. Adequate guidance and monitoring during the titration process can minimize some of the adverse effects caused by basal insulin administration, while improving glycemic control in a timely manner.

Primary care teams provide the majority of poststroke care. When optimally configured, these teams provide patient-centered care to prevent recurrent stroke, maximize function, prevent late complications, and optimize quality of life. Patient-centered primary care after stroke begins with establishing the foundation for poststroke management while engaging caregivers and family members in support of the patient. Screening for complications (eg, depression, cognitive impairment, and fall risk) and unmet needs is both a short-term and long-term component of poststroke care. Patients with ongoing functional impairments may benefit from referral to appropriate services. Ongoing care consists of managing risk factors such as high blood pressure, atrial fibrillation, diabetes, carotid stenosis, and dyslipidemia. Recommendations to reduce risk of recurrent stroke also include lifestyle modifications such as healthy diet and exercise. At the system level, primary care practices can use quality improvement strategies and available resources to enhance the delivery of evidence-based care and optimize outcomes.

In principle, a patterned dielectric back contact structure in a GaAs thermophotovoltaic device boosts the sub-bandgap reflectance. Rigorous coupled wave analysis method is used to study the three dimensional (3D) periodic grating effects of metal point contact diameter and spacing on sub-bandgap reflectance of the device.

Thermophotovoltaic (TPV) devices convert thermal radiation directly into electricity using semiconductor diodes and have a variety of uses from waste heat recovery to energy storage to primary power conversion. Recent results have demonstrated promising cells nearing and surpassing 30% conversion efficiency. As TPV cells continue to increase in efficiency, they become attractive for a wider range of applications. Their efficiencies must be quantified in a standardized fashion to compare results accurately across research groups. Here, we outline and quantify the most important characteristics of an accurate and precise TPV efficiency measurement. Using a custom-built measurement apparatus that takes these characteristics into account, we report 19 cells with greater than 30% conversion efficiency and 2 cells with greater than 35% conversion efficiency. This confirms that our reported cell efficiencies are not simply those of hero cells but rather of a distribution of cells that can be produced in a consistent, high-quality process.

Jeffrey Gudin,1,2 Lynn R Webster,3 Emileigh Greuber,4 Kip Vought,4 Kalpana Patel,4 Louis Kuritzky5 1Department of Anesthesiology, Rutgers New Jersey Medical School, Newark, NJ, USA; 2Department of Anesthesiology and Pain Management, Englewood Hospital and Medical Center, Englewood, NJ, USA; 3Scientific Affairs Neurosciences, PRA Health Sciences, Salt Lake City, UT, USA; 4Global Research and Development and Medical Affairs, Scilex Pharmaceuticals Inc, Palo Alto, CA, USA; 5Community Health and Family Medicine, University of Florida Community Health & Family Medicine, Gainesville, FL, USACorrespondence: Lynn R WebsterVice President Scientific Affairs, PRA Health Sciences, Salt Lake City, UT, 84103, USATel +1 801 904 4593Email WebsterLynn@Prahs.comPurpose: The primary objective was to evaluate adhesion performance of the lidocaine topical system 1.8% for 12 hours in healthy human subjects in three studies: as a single product (Study 1) and versus other lidocaine topical products (lidocaine patch 5% and lidocaine medicated plaster 5% [Study 2] and generic lidocaine patch 5% [Study 3]). Safety of the lidocaine topical system 1.8%, with a skin irritation focus, was a secondary objective.Patients and Methods: All three studies were open-label, randomized, Phase 1 adhesion performance studies in healthy adult volunteers (N=125). Lidocaine topical products were applied for 12 hours per test, per study arm. Adhesion of all test products was scored at 0, 3, 6, 9, and 12 hours post-application. Skin irritation was scored after product removal or when a product detached.Results: Overall, the majority (≥ 75%) of subjects treated with the lidocaine topical system 1.8% demonstrated ≥ 90% adhesion (FDA adhesion score 0) throughout the 12-hour administration period versus 13.6% of subjects treated with lidocaine patch 5%, 15.9% of subjects treated with lidocaine medicated plaster 5%, and 0% of subjects treated with the generic lidocaine patch 5%. There were no complete detachments with the lidocaine topical system 1.8%, whereas 4.5% of lidocaine patch 5% and lidocaine medicated plaster 5% detached, and 29% of generic lidocaine patch 5% detached. Minimal skin irritation was observed with each lidocaine topical product.Conclusion: Across three studies, lidocaine topical system 1.8% demonstrated superior adhesion performance versus the three other products tested. Skin irritation was minimal across products and studies.Clinicaltrials.gov: NCT04312750, NCT04320173, NCT04319926.Keywords: lidocaine topical system, lidocaine patch, lidocaine medicated plaster, adhesion, postherpetic neuralgia

Many patients with type 2 diabetes will ultimately require the inclusion of basal insulin in their treatment regimen. Since most people with type 2 diabetes are managed in the community, it is important that primary care providers understand and correctly manage the initiation and titration of basal insulins, and help patients to self-manage insulin injections. Newer, long-acting basal insulins provide greater stability and flexibility than older preparations and improved delivery systems. Basal insulin is usually initiated at a conservative dose of 10 units/day or 0.1–0.2 units/kg/day, then titrated thereafter over several weeks or months, based on patients’ self-measured fasting plasma glucose, to achieve an individualized target (usually 80–130 mg/dL). Through a shared decision-making process, confirmation of appropriate goals and titration methods should be established, including provisions for events that might alter scheduled titration (e.g. travel, dietary change, illness, hospitalization, etc.). Although switching between basal insulins is usually easily accomplished, pharmacokinetic and pharmacodynamic differences between formulations require clinicians to provide explicit guidance to patients. Basal insulin is effective long-term, but overbasalization (continuing to escalate dose without a meaningful reduction in fasting plasma glucose) should be avoided.Key messagesPrimary care providers often initiate basal insulin for people with type 2 diabetes.Basal insulin is recommended to be initiated at 10 units/day or 0.1–0.2 units/kg/day, and doses must be titrated to agreed fasting plasma glucose goals, usually 80–130 mg/dL. A simple rule is to gradually increase the initial dose by 1 unit per day (NPH, insulin detemir, and glargine 100 units/mL) or 2–4 units once or twice per week (NPH, insulin detemir, glargine 100 and 300 units/mL, and degludec) until FPG levels remain consistently within the target range. If warranted, switching between basal insulins can be done using simple regimens.The dose of basal insulin should be increased as required up to approximately 0.5–1.0 units/kg/day in some cases. Overbasalization (continuing to escalate dose without a meaningful reduction in fasting plasma glucose) is not recommended; rather re-evaluation of individual therapy, including consideration of more concentrated basal insulin preparations and/or short-acting prandial insulin as well as other glucose-lowering therapies, is suggested. Primary care providers often initiate basal insulin for people with type 2 diabetes. Basal insulin is recommended to be initiated at 10 units/day or 0.1–0.2 units/kg/day, and doses must be titrated to agreed fasting plasma glucose goals, usually 80–130 mg/dL. A simple rule is to gradually increase the initial dose by 1 unit per day (NPH, insulin detemir, and glargine 100 units/mL) or 2–4 units once or twice per week (NPH, insulin detemir, glargine 100 and 300 units/mL, and degludec) until FPG levels remain consistently within the target range. If warranted, switching between basal insulins can be done using simple regimens. The dose of basal insulin should be increased as required up to approximately 0.5–1.0 units/kg/day in some cases. Overbasalization (continuing to escalate dose without a meaningful reduction in fasting plasma glucose) is not recommended; rather re-evaluation of individual therapy, including consideration of more concentrated basal insulin preparations and/or short-acting prandial insulin as well as other glucose-lowering therapies, is suggested.

Objective: Diabetes is a prevalent and growing problem in the United States (U.S.); primary care physicians need to be prepared to initiate and progressively advance treatment. The objective of thi...

The diffusion coefficient of holes can provide knowledge about carrier localization in ($\mathrm{In}$,$\mathrm{Ga}$)$\mathrm{N}$, where the carrier dynamics are altered by randomly fluctuating potential landscape. In group-III nitrides, the diffusivity of holes is difficult to measure by electrical methods but it can be studied using optical techniques. Here, we investigate the dependence of the hole diffusion coefficient on direction and carrier density in $c$-plane and $m$-plane ($\mathrm{In}$,$\mathrm{Ga}$)$\mathrm{N}$ structures by employing the light-induced transient-grating technique. We show that the hole diffusion coefficient is anisotropic in the $m$-plane structure, where it is several times larger along the $a$ crystallographic direction than along the $c$ direction. Such anisotropy is observed within the broad range of carrier densities from ${10}^{18}$ to ${10}^{20}\phantom{\rule{0.2em}{0ex}}{\mathrm{cm}}^{\ensuremath{-}3}$. The diffusivity changes nonmonotonously with increasing photoexcitation, this dependence being different in thick and thin layers. We argue that an unexpectedly high diffusion coefficient at low carrier densities in thick quantum wells can be a signature of efficient hole transport via percolative paths occurring due to compositional disorder. In turn, a decrease of diffusivity with the excitation can reflect the effect of Coulomb blockade of these paths. Finally, we demonstrate that disorder impacts carrier diffusivity even at carrier densities above ${10}^{19}\phantom{\rule{0.2em}{0ex}}{\mathrm{cm}}^{\ensuremath{-}3}$, where the overflow of localized states must be included to explain the observed increase of the diffusion coefficient with the carrier density.

Los adultos mayores en el sur de Ecuador a menudo desconfian de los consejos de los nutricionistas cuando implementan cambios en sus practicas dieteticas. Esta desconfianza no es un desprecio manifiesto por el conocimiento nutricional experto, sino mas bien el resultado de practicas estructurales y situadas que combinan sospechas, desinformacion, limitaciones financieras y cuidado familiar. En este articulo, examinamos las practicas alimentarias de los adultos mayores del sur de Ecuador para comprender como se construye la desconfianza nutricional. Al hacerlo, nuestro objetivo es comprender como los adultos mayores incorporan, o no, conocimientos nutricionales expertos en sus practicas alimentarias. Al documentar etnograficamente las practicas alimentarias diarias entre los adultos mayores en sus hogares, junto con los discursos nutricionales de expertos, nuestros hallazgos revelan que, en primer lugar, existe una comprension local de "comer sano" conectado a las realidades vividas (por ejemplo, practicas agricolas, toxicidad agricola, edad, educacion, etc.). polifarmacia, lazos de parentesco) y, en segundo lugar, una desconexion entre el conocimiento nutricional experto y las practicas alimentarias vinculadas a como se produce y difunde el conocimiento (por ejemplo, relaciones de poder, vocabulario cientifico, percepciones de la salud). Comprender como los adultos mayores generan confianza en torno a la alimentacion puede ser un terreno fertil para promover un asesoramiento dietetico mas eficaz y adecuado entre comunidades o grupos especificos, como los adultos mayores.

We have demonstrated world-record thermophotovoltaic (TPV) conversion efficiency in two materials systems operating at two different thermal emitter temperatures. A GaAs-based PV device under a 2330 °C thermal emitter produced an efficiency of (31 ± 2)%, and an In 0.53 Ga 0.47 As -based PV device under a 1300 °C thermal emitter produced an efficiency of (30 ± 2)%. The electrical output power densities of the cells were 2.45 W/cm2 and 0.658 W/cm2, respectively. Critical to these high efficiencies were the cells' high reflectance of photon energies below the absorber band gap. Unlike solar PV, for which sub-band gap (SBG) light is lost, a TPV cell can reflect SBG light back to the thermal emitter where it can be recycled. The demonstrations were made on a custom-built measurement platform in which a ~ 100 cm2 graphite thermal emitter was heated under vacuum. The TPV efficiencies were evaluated by comparing the measured electrical output power of the cell with the total power absorbed by the cell. The measured TPV efficiencies as a function of thermal emitter temperature were corroborated by our full system modeling. As far as the authors are aware, these are the highest TPV conversion efficiencies ever measured, and device improvements should yield > 40% efficiency in the near future.