Background Using a mobile health (mHealth) intervention, consisting of a smartphone and compatible medical device, has the potential to enhance chronic obstructive pulmonary disease (COPD) treatment outcomes while mitigating health care costs. Objective The aim of this study was to explore the potential facilitators and barriers among health care providers (HCPs) regarding the use of mHealth interventions for COPD management. Methods This was a qualitative study. Semistructured individual interviews were conducted with HCPs, including nurses, pharmacists, and physicians who work directly with patients with COPD. A flexible prompts guide was used to facilitate discussions. Interview topics included the following: demographics, mHealth usage, perceptions toward challenges of mHealth adoption, factors facilitating mHealth adoption, and preferences regarding features of the mHealth intervention for COPD management. Interviews were conversational in nature, and items were not asked verbatim or in the order presented. The interviews were transcribed verbatim and compared against the digital recordings to ensure the accuracy of the content. After creating a codebook for analysis, 2 researchers independently coded the remaining interview data using pattern coding. They discussed commonalities and differences in coding until a consensus was reached. Results A total of 30 nurses, physicians, and pharmacists participated. The main facilitators to mHealth adoption are possible health benefits for patients, ease of use, educating patients and their HCPs, credibility, and reducing cost to the health care system. Alternatively, the barriers to adoption are technical issues, privacy and confidentiality issues, lack of awareness, potential limited uptake from the elderly, potential limited connection between patients and HCPs, and finances. Conclusions It is important to understand the perceptions of HCPs regarding the adoption of innovative mHealth interventions for COPD management. This study identifies some potential facilitators and barriers that may inform the successful development and implementation of mHealth interventions for COPD management.

A six-issue, four-fetch, out-of-order execution, 6OOMHz Alpha microprocessor achieves an estimated 40SpecInt95,60SpecFP95 and 1800MB/s on McCalpin Stream. The 16.7x18.8mmz die contains 15.2M transistors and dissipates an estimated 72W. It is in 2.0V, 6-metal, 0.35pm CMOS with CMP planarization (Table 1) [ll. The chip is in a 587-pin ceramic IPGA with 198 pins for VDD/ VSS that includes a CuW heat slug for low thermal resistance between die and detachable heat sink. An on-chip PLL performs frequency multiplication of a differential PECL reference and synchronizes I/O by phase-aligning a CPU clock to the reference. Figure 1 is a detailed floorplan of the chip. Figure 2 depicts a blockf pipeline diagram of major sections and functions.The instruction fetcher ( Figure 3) reads four instructions per cycle plus a next-address pointer from a 64kB, 2-way pseudo-set associative, virtual instruction cache. The next-address pointer predicts the address of the subsequent four instructions and indexes the cache in the next cycle. In parallel, a branch predictor resolves the prediction. It contains three tables: a PC-indexed prediction table, a path-indexed prediction table, and a pathindexed table that dynamically chooses one of the former two predictions, based on the success of previous predictions. Fetched instructions are dispatched to integedmemory (INT/ MEM) and floating point (FP) pipelines, issued and executed outof order and retired in order. During dispatch, register specifiers are renamed to eliminate false dependencies by two twelve-port register mappers that dynamically map the architectural registers into a pool of physical registers (80 integer and 72 FP). Resulting map state is retained in an array until the instruction retires. Pre-retire map state is used to generate alist of remaining free physical registers. Buffered map state is restored when the CPU is redirected following a branch mispredict or exception.Mapped instructions enter a 20-entry INTMEM or a 15-entry FP issue queue. The INTMEM queue arbiter identifies the 4 oldest data-ready instructions. They issue to the integer execution unit (EBOX) and are removed from the INTMEM queue. Similarly, the FP queue issues the 2 oldest data-ready instructions to the FP execution unit (FBOX) and removes them from the FP queue.The EBOX (Figure 4) is divided into two clusters, CLO and CL1; each cluster contains 2 independent execution pipelines surrounding an 80-entry register file. Coherency between the two register file copies is maintained by broadcasting results across intercluster buses. Each of the four pipelines executes and bypasses arithmetic and logical operations in one cycle. Bypassed results between clusters take an additional cycle. The upper pipelines handle branches and shifts; CLO contains a pipelined multimedia engine (3-cycle latency) and CL1 contains a pipelined multiplier (7-cycle latency). The lower pipelines handle displacement address calculations for memory operations. The FBOX contains 2 independent execution pipelines surrounding a 72-en...

Background Asthma and obesity are two common health problems in the pediatric population. Obesity is associated with several comorbidities which are of great consequence. Excess adipose tissue has been linked to asthma in a number of studies. However, little is known about childhood body mass index (BMI) trajectories and the development of asthma phenotypes. Objective The current study aims to investigate the significance of BMI trajectories over childhood and the risk of asthma phenotypes. Methods The current study is a prospective cohort of children aged 0-2 years who were followed every two years for eight years through cycles one to five in the National Longitudinal Survey of Children and Youths (NLSCY). Statistical analysis: a latent class growth modelling (LCGM) method was used to identify BMI trajectory patterns from cycles one to five. Multiple imputation (number of imputations=5) was carried out to impute children with missing values on height or weight information. Sampling weights and 1,000 bootstrap weights were used in SAS PROC SURVEYLOGISTIC to examine the association between BMI trajectory and asthma phenotypes (persistent or transient asthma) in a multivariate analysis. Results The study consisted of 571,790 males and 549,230 females. Among them, 46% of children showed an increasing trajectory in terms of change in BMI percentile during childhood, followed by the stable-trajectory group (41%) and decreasing-trajectory group (13%). After controlling for confounding factors, females in the increasing BMI trajectory group were four times more likely to be associated with persistent asthma (OR = 4.09; 95% CI:1.04-16.15; p = 0.0442) than females in the stable BMI trajectory group. No such relationship was found in males. The BMI trajectory was not significantly associated with risk of transient asthma for either sex. Conclusion We report a female-specific association between increasing adiposity, measured by BMI, and persistent asthma.

Strongly lineated terrain outside of Iceland's active plate boundary zones is created by faults and dikes aligned with the rift zones where they formed, similar to the spreading fabric defined by abyssal hills generated at mid‐ocean ridge spreading centers. As expected, rift‐parallel normal faults and fissures dominate in the active rift zones, but in older crust to the east and west, faults with strike‐slip and oblique‐slip displacements dominate. Some areas have widespread, small‐scale, strike‐slip, and oblique‐slip faults, while others have more widely spaced, larger, strike‐slip fault zones. In most cases, the strike‐slip and oblique‐slip faults strike subparallel to nearby older dikes and normal faults assumed to indicate the orientation of the rift zones where they formed. Strike‐slip displacements overprinting normal faults and along dike margins suggest reactivation of spreading‐related zones of weakness. More complicated fault geometries and kinematics occur near the oblique rifts and the major transform fault zones. The sense of movement on the strike‐slip and oblique‐slip faults is broadly systematic with respect to the active Northern and Eastern Rift Zones supporting the interpretation that they are the result of crustal block rotations on either side of rift zones that propagate to the north and south away from the center of the Iceland hot spot. Similar fault kinematics may occur along mid‐ocean ridges and other magmatic rifts where rift propagation occurs on a range of scales.

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