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The goals of the present study were to examine the associations between depressive symptoms, sleep problems and the risk of developing heart disease in a Canadian community sample.
Baseline data were from the CARTaGENE study, a community health survey of adults aged 40–69 years in Quebec, Canada. Incidence of heart disease was examined in N = 33 455 participants by linking survey data with administrative health insurance data. Incident heart disease was identified using the World Health Organization's International Classification of Diseases, 9th or 10th edition (ICD-9 and ICD-10) diagnostic codes for heart disease. Sleep problems were assessed with diagnostic codes for sleep disorders within the 2 years preceding the baseline assessment. Average sleep duration was assessed by self-report. Depressive symptoms were assessed with the nine-item Patient Health Questionnaire.
In total, 2448 (7.3%) participants developed heart disease over an average follow-up period of 4.6 years. Compared to those without depressive symptoms and with no sleep disorders, those with elevated depressive symptoms and a sleep disorder (HR = 2.60, 95% CI 1.83–3.69), those with depressive symptoms alone (HR = 1.40, 95% CI 1.25–1.57) and those with sleep disorders alone (HR = 1.33, 95% CI 1.03–1.73) were more likely to develop heart disease. Test of additive interaction suggested a synergistic interaction between depressive symptoms and sleep disorders (synergy index = 2.17 [95% CI 1.01–4.64]). When sleep duration was considered, those with long sleep duration and elevated depressive symptoms were more likely to develop heart disease than those with long sleep alone (HR = 1.77, 95% CI 1.37–2.28; and HR = 1.16, 95% CI 0.99–1.36, respectively).
Depression and diagnosed sleep disorders or long sleep duration are independent risk factors for heart disease and are associated with a stronger risk of heart disease when occurring together.
The US Veterans Health Administration’s Disaster Emergency Medical Personnel System (DEMPS) is a team of employee disaster response volunteers who provide clinical and non-clinical staffing assistance when local systems are overwhelmed. This study evaluated attitudes and recommendations of the DEMPS program to understand the impact of multi-modal training on volunteer perceptions.
DEMPS volunteers completed an electronic survey in 2012 (n=2120). Three training modes were evaluated: online, field exercise, and face-to-face. Measures included: “Training Satisfaction,” “Attitudes about Training,” “Continued Engagement in DEMPS.” Data were analyzed using χ2 and logistic regression. Open-ended questions were evaluated in a manner consistent with grounded theory methodology.
Most respondents participated in DEMPS training (80%). Volunteers with multi-modal training who completed all 3 modes (14%) were significantly more likely to have positive attitudes about training, plan to continue as volunteers, and would recommend DEMPS to others (P-value<0.001). Some respondents requested additional interactive activities and suggested increased availability of training may improve volunteer engagement.
A blended learning environment using multi-modal training methods, could enhance satisfaction and attitudes and possibly encourage continued engagement in DEMPS or similar programs. DEMPS training program modifications in 2015 expanded this blended learning approach through new interactive online learning opportunities. (Disaster Med Public Health Preparedness. 2018;12:744-751)
The Wisconsin Plasma Astrophysics Laboratory (WiPAL) is a flexible user facility designed to study a range of astrophysically relevant plasma processes as well as novel geometries that mimic astrophysical systems. A multi-cusp magnetic bucket constructed from strong samarium cobalt permanent magnets now confines a
, fully ionized, magnetic-field-free plasma in a spherical geometry. Plasma parameters of
provide an ideal testbed for a range of astrophysical experiments, including self-exciting dynamos, collisionless magnetic reconnection, jet stability, stellar winds and more. This article describes the capabilities of WiPAL, along with several experiments, in both operating and planning stages, that illustrate the range of possibilities for future users.
For the growth of an electrically pumped lasing nitride emitter, the development of the MOCVD equipment and the process are mutually dependent. Most important is the implementation of the rapid temperature changes that are required between the growth of the different layers of a device structure. Equally important is to provide a reaction chamber that develops a stable gas phase at all growth temperatures used in the process. In this paper we will give insight in the technology and the relationship between processes and equipment. The development of the reation chamber was supported by mathematical modeling that formed the basis for the selection of appropriate process parameters for growth of group-III nitrides. The modeling consists of the numerical solution of the Navier-Stokes equations coupled with heat transfer and mass transport of the chemical species. The modeling of radiative heat transfer takes into account the effect of changing surface radiative properties. These changes result from the coating of the reactor inner surfaces during the growth run. Coupled flow dynamics and chemistry including homogeneous and heterogeneous reactions play an important role for predicting growth rate distributions on the susceptor area. At the practically used high temperatures, group-III metalorganics turn out to be almost entirely decomposed and it is the mass transport of these decomposition products to the growing layer that is assumed to control the growth rate in accordance with experimental observations.
This collection of original essays, from both established scholars and newcomers, takes up a recent debate in philosophy, sociology, and disability studies on whether disability is intrinsically a harm that lowers a person's quality of life. While this is a new question in disability scholarship, it also touches on one of the oldest philosophical questions: what is the good human life? Historically, philosophers have not been interested in the topic of disability, and when they are it is usually only in relation to questions such as euthanasia, abortion, or the moral status of disabled people. Consequently disability has been either ignored by moral and political philosophers or simply equated with a bad human life, a life not worth living. This collection takes up the challenge that disability poses to basic questions of political philosophy and bioethics, among others, by focusing on fundamental issues and practical implications of the relationship between disability and the good human life.
Scholarship has traditionally portrayed transnational NGOs (TNGOs) as ‘principled’ actors animated by global norms to advance human rights, sustainable development, humanitarian relief, environmental stewardship, and conflict resolution. However, scholarship has also identified instances in which TNGOs appear to act ‘instrumentally’ by engaging in resource-maximising behaviour seemingly inconsistent with their principled nature. Moreover, prior scholarship addressing this puzzle has been constrained by the limitations of small-n case studies examining relatively narrow subsectors of the TNGO community. Addressing these limitations, we reexamine the logic of TNGO behaviour in light of findings from an interdisciplinary, mixed-method research initiative consisting of in-depth, face-to-face interviews with a diverse sample of 152 top organisational leaders from all major sectors of TNGO activity. Using an inductive approach to discover how TNGO leaders understand their own behaviour, we introduce the heuristic of ‘principled instrumentalism’ and specify our framework with a formal model.
We present a radio survey of molecules in a sample of Galactic center molecular clouds, including M0.25 + 0.01, the clouds near Sgr A, and Sgr B2. The molecules detected are primarily NH3 and HC3N; in Sgr B2-N we also detect non-metastable NH3, vibrationally-excited HC3N, torsionally-excited CH3OH, and numerous isotopologues of these species. 36 GHz Class I CH3OH masers are ubiquitous in these fields, and in several cases are associated with new NH3 (3,3) maser candidates. We also find that NH3 and HC3N are depleted or absent toward several of the highest dust column density peaks identified in submillimeter observations, which are associated with water masers and are thus likely in the early stages of star formation.
The main aim of the primary treatment of polytraumatized patients at the accident site is the stabilization and maintenance of vital functions, especially the cardiocirculatory and the respiratory systems. The next step in the rescue chain is rapid transport to the nearest hospital with the ability to manage critically injured patients. Because of the difficulty in carrying out measurements in such critical situations, very little reliable data concerning trauma induced changes in respiratory function and metabolism is available. Clinical experience has shown that even after successfully recovering from the acute stress phase, a trauma related progressive respiratory distress syndrome can nevertheless develop during the first few days following injury.
Recent studies led to the conclusion that the late development of respiratory distress syndrome is already induced during the early shock phase. Early discovery and adequate treatment of trauma related metabolic and respiratory dysfunctions have a decisive influence on current status and outcome.
The possibility of preference reversals according to the Kaldor-Hicks (KH) criterion in benefit-cost analysis has concerned economists since Scitovsky (1941) first published his results. Lawyers and philosophers have argued that the potential of reversals calls the use of benefit-cost analysis into question, implying elimination of its use. We demonstrate that reversals occur only with inferior goods in the case of static production possibilities and that reversals occur under changing production possibilities only when production possibilities frontiers cross, which is a myopic characterization that ignores practical cases of global production possibilities.
This paper addresses the optimization of ion implantation and rapid thermal annealing for the fabrication of shallow junctions and the activation of polycrystalline silicon gates in deepsubmicron CMOS transistors. Achieving ultrashallow, low-resistance junctions was studied by combining low-energy B and As implantation with spike annealing. In addition, experiments using B doping marker superlattices were performed to identify the critical physical effects underlying dopant activation and diffusion. The combination of high ramp rates (∼100 °C/s) and ∼1 s cycles at temperatures as high as 1100 °C can be used to improve dopant activation without inducing significant thermal diffusion after TED has completed. MOS capacitors were used to identify the implantation and annealing conditions needed for adequate activation of the gate electrode. In comparison to the conventional recrystallized amorphous Si gates, it was found that fine-grained poly-Si allows for the use of lower processing temperatures or shorter annealing times while improving the gate activation level. The fine-grained crystal structure enhances the de-activation of B dopants in PMOS gates during the thermal treatments following gate activation. Yet, the resulting dopant loss stays within acceptable limits as verified by excellent 0.18 μm device performance. The feasibility of spike annealing and poly-Si gate materials for 100-nm technology was proven by full integration using gate lengths down to 80 nm.
AlInAs and GaInAs lattice matched to InP and grown by MBE over a temperature range of 200 to 350°C (normal growth temperature of 500°C) has been used to enhance the device performance of inverted (where the donor layer lies below the channel) High Electron Mobility Transistors (HEMTs) and Heterojunction Bipolar Transistors (HBTs), respectively. We will show that an AlInAs spacer grown over a temperature range of 300 to 350°C and inserted between the AlInAs donor layer and GaInAs channel significantly reduces Si movement from the donor layer into the channel. This produces an inverted HEMT with a channel charge of 3.0×1012 cm−2 and mobility of 9131 cm2/V-s, as compared to the same HEMT with a spacer grown at 500 °C resulting in a channel charge of 2.3×1012 cm−2 and mobility of 4655 cm2/V-s. We will also show that a GaInAs spacer grown over a temperature range of 300 to 350°C and inserted between the AlInAs emitter and GalnAs base of an npn HBT significantly reduces Be movement from the base into the emitter, thereby allowing higher Be base dopings (up to 1×1020 cm−3) confined to 500 Å base widths, resulting in an AlInAs/GaInAs HBT with an fmax of 73 GHz and ft of 110 GHz.