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In this study, we report results of a survey of U.S. state senators about their experiences of psychological abuse, physical violence, and sexualized abuse and violence on the job, as well as gender differences among senators. Overall, our results indicate that more than 80% of state senators reported having faced abuse and violence, and women senators reported more physical violence than men. Moreover, we found differences in the factors that contributed to abuse and violence among women and men state senators. Most notably, women with higher levels of power (party or committee leaders) were more likely than other women to experience psychological abuse and sexualized abuse and violence, and Democratic women senators faced more sexualized abuse and violence than Republican women. The implications for continued service by state senators in the face of these experiences, the likelihood of attracting future candidates, and the implications for gender diversity in office are explored.
Many newborns with pulmonary atresia/intact ventricular septum require intervention to establish pulmonary flow and sufficient cardiac output. The resulting haemodynamic changes are not well characterised and may have unintended consequences.
This is a 30-year (1988–2018) retrospective study of patients with pulmonary atresia intact ventricular septum.
Eighty-nine patients were included, and median follow-up was 8 years. Fifty-five per cent had coronary sinusoids and 27% had right ventricular-dependent coronary circulation. Most patients were managed with surgical aortopulmonary or modified Blalock–Taussig shunt (73%), and 12 patients underwent balloon atrial septostomy before surgical intervention. The remaining patients (27%) underwent only transcatheter interventions; 7 required an atrial septostomy and 17 required ductal stentings. All-cause mortality was 10%, most deaths (89%) occurred before 18 months of age. Of these early deaths, 87% required a balloon atrial septostomy and 85% had right ventricular-dependent coronary sinusoids. Eighteen-month mortality was significantly higher for patients who required a balloon atrial septostomy compared to those who did not (36% versus 1.4% p < 0.0001).
Patients with pulmonary atresia/intact ventricular septum who require balloon atrial septostomy in the newborn period have significantly higher 18-month mortality. Quantifying the mortality difference may help guide prognostication and expectation setting. Infants who had septostomy and a surgical shunt in the newborn period fared better than those who only underwent septostomy (even when accompanied by ductal stenting). For infants with right ventricular-dependent circulation, atrial septostomy should only be performed on an urgent or emergent basis and these patients should be considered for early surgical intervention and neonatal transplant.
Background: Effective medical device reprocessing (MDR) is essential in preventing the spread of microorganisms and maintaining patient safety. Alberta Health Services (AHS) is an Alberta-wide, integrated health system, responsible for delivering health services to >4.3 million people living in the province. In 2010, periodic province-wide MDR reviews were initiated by the provincial health system to verify that the cleaning, disinfection, and sterilization of reusable critical and semicritical medical devices met established standards. To date, there have been 3 review cycles; in cycle 3, a follow-up process for tracking and reporting corrective actions was initiated. Methods: As in previous MDR review cycles, cycle 3 included the use of a standardized suite of tools to measure compliance with standards set by Accreditation Canada, the Canadian Standards Association, and the Government of Alberta. Each cycle involved a review of MDR areas completed by trained reviewers. Interrater reliability among reviewers was maintained through training and debriefings following reviews to ensure agreement. Following reviews, reports were generated for areas, zones, and AHS. As part of the corrective actions and follow-up process, identified deficiencies were categorized into 5 themes. Corrective actions were tracked and periodic reports were generated showing the progress of deficiency resolution. Resolution rates (number of resolved deficiencies divided by total number of of deficiencies) were calculated for each of the identified themes as well as overall for cycle 3. Results: Overall compliance for cycle 3 was 93%. Cycle 3 reviews revealed that more than half of the deficiencies (58%) were identified previously in cycle 2. The resolution rates ranged from 78% to 95% for identified deficiencies for 4 of the 5 themes: documentation, technique, PPE/attire/hand hygiene, and other. The theme related to physical infrastructure showed a considerably lower resolution rate of 49%. The corrective action follow-up process showed increased overall resolution rate from 59% at the start of the follow-up process to 82% at its completion. When this resolution rate was applied to the initial survey compliance rate for cycle 3, overall compliance increased to 99%. Conclusions: Monitoring quality of MDR practices is essential in maintaining and improving patient safety. The standardized provincial review process identified common themes and a coordinated approach to support the resolution of many identified deficiencies. Most of those deficiencies were resolved; however, those deficiencies related to physical infrastructure of the MDR department continue to be seen across review cycles. This review process with follow up of these deficiencies can help bring attention to organization leadership and Funding: authorities during budget cycles.
Monks writing at Saint-Clément, Metz, over roughly two hundred years produced conflicting images of Bishop Theodoric I (965–84). In earlier texts, he is the monks’ benefactor, in later sources, their foe. Historians have sought to flatten this contrast, partly because of their assumptions about monastic reform. This paper offers an alternative reading that questions those assumptions. It suggests that the evolution of Theodoric's image reflects changing ideas about monastic reform and the proper relationship between bishops and monks. It also cautions against accepting narratives – medieval or modern – that obscure the fluidity of such ideas and relationships.
The Arizona Department of Health Services identified unusually high levels of influenza activity and severe complications during the 2015–2016 influenza season leading to concerns about potential increased disease severity compared with prior seasons. We estimated state-level burden and severity to compare across three seasons using multiple data sources for community-level illness, hospitalisation and death. Severity ratios were calculated as the number of hospitalisations or deaths per community case. Community influenza-like illness rates, hospitalisation rates and mortality rates in 2015–2016 were higher than the previous two seasons. However, ratios of severe disease to community illness were similar. Arizona experienced overall increased disease burden in 2015–2016, but not increased severity compared with prior seasons. Timely estimates of state-specific burden and severity are potentially feasible and may provide important information during seemingly unusual influenza seasons or pandemic situations.
Differences in bottled v. tap water intake may provide insights into health disparities, like risk of dental caries and inadequate hydration. We examined differences in plain, tap and bottled water consumption among US adults by sociodemographic characteristics.
Cross-sectional analysis. We used 24 h dietary recall data to test differences in percentage consuming the water sources and mean intake between groups using Wald tests and multiple logistic and linear regression models.
National Health and Nutrition Examination Survey (NHANES), 2007–2014.
A nationally representative sample of 20 676 adults aged ≥20 years.
In 2011–2014, 81·4 (se 0·6) % of adults drank plain water (sum of tap and bottled), 55·2 (se 1·4) % drank tap water and 33·4 (se 1·4) % drank bottled water on a given day. Adjusting for covariates, non-Hispanic (NH) Black and Hispanic adults had 0·44 (95 % CI 0·37, 0·53) and 0·55 (95 % CI 0·45, 0·66) times the odds of consuming tap water, and consumed B=−330 (se 45) ml and B=−180 (se 45) ml less tap water than NH White adults, respectively. NH Black, Hispanic and adults born outside the fifty US states or Washington, DC had 2·20 (95 % CI 1·79, 2·69), 2·37 (95 % CI 1·91, 2·94) and 1·46 (95 % CI 1·19, 1·79) times the odds of consuming bottled water than their NH White and US-born counterparts. In 2007–2010, water filtration was associated with higher odds of drinking plain and tap water.
While most US adults consumed plain water, the source (i.e. tap or bottled) and amount differed by race/Hispanic origin, nativity status and education. Water filters may increase tap water consumption.
While there is much research examining gender gaps in political attitudes, there is less examining how gender gaps differ within social groups. This article helps fill that void by examining gender gaps among American Indians. Using two surveys, the initial findings suggest that among American Indians, women have a stronger American Indian identity, are more likely to support women's/compassion issues, and are more likely to be Democrats. It further finds that the gender gap in party is more likely the result of the gender gap in compassion issues than in American Indian identity. Additional analysis finds that among American Indians who prioritize their American Indian identity, the partisan gender gap is reversed, with men being significantly more likely to be Democrats. Although this study finds some similarities between the gaps among American Indians and whites, it also finds some unique gaps among American Indians. This suggests the need to look at the intersectionality of gender and social groups to fully understand the gender gaps.
OBJECTIVES/SPECIFIC AIMS: Women with GDM have a 7-fold higher risk of developing T2DM, and rates of GDM are higher among racial and ethnic minorities and women of lower socio-economic status. There are no data on postpartum diabetes screening after the first postpartum year or among women receiving care in FQHCs. We aim to address this gap in the literature by (1) defining the rates of follow-up screening for T2DM at 6–12 weeks and 1–3 years postpartum and (2) characterizing patient, provider, and healthcare system attributes that are associated with lack of follow-up screening for T2DM in a population of low-income women with GDM. METHODS/STUDY POPULATION: This is a retrospective cohort study of women with GDM during pregnancy receiving care in Missouri FQHCs from 2010 to 2015. Electronic health records (EHR) data from 26 FQHCs is housed in a central repository through the Missouri Primary Care Association (MPCA). This includes patient demographic, lab, and medication information as well as encounter level patient and provider data for the prenatal and postpartum period. EHR data does not include accurate delivery information, however. Pregnancies during the study time frame were identified using CPT and ICD9/10 codes. Deidentified data on individuals with a pregnancy was utilized to identify a subpopulation of “GDM candidates,” using a broad definition of glucose abnormalities as follows: ICD-9/ICD-10 codes for diabetes, medications and testing supplies used for diabetes, infant birth weight ≥4000 g or 8 lb or 13 oz, or abnormal glucose labs [defined as fasting glucose≥95, gestational glucose screen≥130, 1 h test≥130 (or ≥180 if 2 h test and 3 h test recorded on same day), 2 h test≥155, 3 h test≥140, A1C≥6, any glucose≥130, or any positive urine glucose]. This subpopulation was then linked to Medicaid administrative claims data [housed at the University of Missouri Office of Social and Economic Development Analysis (OSEDA)], providing detailed information on delivery, to further characterize patients with GDM in the time frame and provide all dates necessary to classify pregnancy and postpartum periods. RESULTS/ANTICIPATED RESULTS: From the de-identified pregnancy data set including 45,810 individuals, we identified 8008 “GDM candidates.” EHR data were linked to Medicaid claims data for these individuals from 2010 to 2015. Utilizing the enhanced data set, we are defining a pregnancy for each individual by the delivery date in the Medicaid record and an algorithm using lab and ultrasound record dates to define gestational age at delivery. This will result in a pregnancy level data set linked with individual encrypted identifiers with each record representing 1 pregnancy and postpartum period. GDM in pregnancy will be defined as having a baby with birth weight≥4000 g or 8 lb or 13 oz, ICD-9 or ICD-10 code for GDM during pregnancy or at delivery, or an oral glucose tolerance test (oGTT) 12–16 weeks before delivery with 2 or more abnormal results by Carpenter and Coustan criteria. We anticipate that our final GDM data set will include 2000–3000 individuals. We will then calculate the percentage of individuals receiving recommended screening tests at 6–12 weeks (fasting glucose or 2 h oGTT) and 1–3 years postpartum (fasting glucose, 2 h oGTT, HbA1C). We will use multivariable regression techniques to identify risk factors for lack of screening. We will be able to incorporate predictors not previously evaluated including distance from home to health center, access to public transport, specialty and training of the patient’s providers, pregnancy weight gain, postpartum appointment time of day, and number of various types of office visits. DISCUSSION/SIGNIFICANCE OF IMPACT: The creation of a linked data set of pregnancies complicated by GDM in women receiving care in FQHCs in Missouri is the first step toward better characterizing follow-up diabetes screening rates in this population and understanding patient, provider, and healthcare system variables that affect postpartum screening. The ultimate goal is to translate evidence-based patient-centered sustainable interventions into practice for low-income women with a history of GDM and improve population outcomes with the ability to track progress prospectively over time.
Acknowledgements: The authors thank Susan Wilson (MPCA), Jill Lucht, and Bhawani Mishra (OSEDA).
Declines in populations of the Critically Endangered Spoon-billed Sandpiper Calidris pygmaeus have been rapid, with the breeding population now perhaps numbering fewer than 120 pairs. The reasons for this decline remain unresolved. Whilst there is evidence that hunting in wintering areas is an important factor, loss of suitable habitat on passage and wintering areas is also of concern. While some key sites for the species are already documented, many of their wintering locations are described here for the first time. Their wintering range primarily stretches from Bangladesh to China. Comprehensive surveys of potential Spoon-billed Sandpiper wintering sites from 2005 to 2013 showed a wide distribution with three key concentrations in Myanmar and Bangladesh, but also regular sites in China, Vietnam and Thailand. The identification of all important non-breeding sites remains of high priority for the conservation of the species. Here, we present the results of field surveys of wintering Spoon-billed Sandpipers that took place in six countries between 2005 and 2013 and present species distribution models which map the potential wintering areas. These include known and currently unrecognised wintering locations. Our maximum entropy model did not identify any new extensive candidate areas within the winter distribution, suggesting that most key sites are already known, but it did identify small sites on the coast of eastern Bangladesh, western Myanmar, and the Guangxi and Guangdong regions of China that may merit further investigation. As no extensive areas of new potential habitat were identified, we suggest that the priorities for the conservation of this species are habitat protection in important wintering and passage areas and reducing hunting pressure on birds at these sites.
Diabetes is a growing public health problem, and the environment in which people live and work may affect diabetes risk. The goal of the present study was to examine the association between multiple aspects of environment and diabetes risk in an employee population.
This was a retrospective cross-sectional analysis. Home environment variables were derived using employees’ zip code. Descriptive statistics were run on all individual- and zip-code-level variables, stratified by diabetes risk and worksite. A multivariable logistic regression analysis was then conducted to determine the strongest associations with diabetes risk.
Data were collected from employee health fairs in a Midwestern health system, 2009–2012.
The data set contains 25 227 unique individuals across four years of data. From this group, using an individual’s first entry into the database, 15 522 individuals had complete data for analysis.
The prevalence of high diabetes risk in this population was 2·3 %. There was significant variability in individual- and zip-code-level variables across worksites. From the multivariable analysis, living in a zip code with higher percentage of poverty and higher walk score was positively associated with high diabetes risk, while living in a zip code with higher supermarket density was associated with a reduction in high diabetes risk.
Our study underscores the important relationship between poverty, home neighbourhood environment and diabetes risk, even in a relatively healthy employed population, and suggests a role for the employer in promoting health.
Process-induced defects in electroplated Au interconnect metallization on GaAs devices were detected during the course of reliability testing. Abnormally high lognormal sigma values (σ > 0.7) indicated the existence of a bi-modal failure mechanism. A distinct early lifetime failure mode was observed along with the intrinsic electromigration metallization wear-out failure mode. Physical characterization of the electroplated Au film revealed as-deposited nanoscale voids. Elimination of these voids through process improvement as well as suggested mechanisms for the early failures are discussed.
In this work, we have reported the interface characterization of rf sputtered ZnO/HfO2 in thin film transistor structure by dc current-voltage and admittance spectroscopy. The interface state density (Dit) of 1013 eV−1cm−2 was extracted from the Gp/ω vs ω plot was comparable to value obtained from the subthreshold behavior. The grain boundary trap density (NGB) of 9.12×1012 cm−2 was estimated using Levinson’s model. The interface state density distribution below the conduction band edge shows a decreasing trend with energy below the conduction band edge. We also studied the impact of introducing MgO interfacial layer between ZnO and HfO2 interface as an approach towards decreasing the interface state density.
Strontium titanate (SrTiO3) is a wide-band-gap semiconductor with a variety of novel properties. In this work, bulk single crystal SrTiO3 samples were heated to 1200°C, resulting in the creation of point defects. These thermally treated samples showed large persistent photoconductivity (PPC) at room temperature. Illumination with sub-gap light (>2.9 eV) caused an increase in free-electron concentration by over two orders of magnitude. After the light is turned off, the conductivity persists at room temperature, with essentially zero decay over several days. The results of electron paramagnetic resonance (EPR) measurements suggest that a point defect is responsible for PPC because the photo-induced response of one of the EPR signals is similar to that seen for the PPC. Due to a large barrier for recapture, the photo-excited electron remains in the conduction band, where it contributes to the conductivity.
In this paper, we discuss the characteristics of the InGaP/GaAs heterojunction phototransistors (HPTs) before and after the electrical stress at room temperature and assess the effectiveness of the emitter-ledge passivation. Although an electrical stress given to the phototransistors by keeping a collector current density of 37 A/cm2 for 1 hour at room temperature was too small to affect the room-temperature common-emitter current gain and photocurrent of both HPTs with and without the emitter-ledge passivation, they showed a significant decrease at 420 K due to the room-temperature electrical stress. Nevertheless, the room-temperature common-emitter current gain and photocurrent of the HPT with the emitter-ledge passivation were still higher than those of the HPT without the emitter-ledge passivation. The effectiveness of the emitter-ledge passivation against the electrical stress was more significant than that on the current gain in the dark. In addition to the electrical stress experiment, for a potential application of the InGaP/GaAs HPTs in space, we will irradiate the HPTs with 1-MeV electrons at the Japan Atomic Energy Agency. Both current gain and photocurrent decreased significantly after the electron irradiation. In contrast to the electrical stress, the damage due to the high-energy electron irradiation is a bulk-related phenomenon, and the emitter-ledge passivation does not seem to suppress the degradation.
The influence of threading dislocations (TDs) on the dry thermal oxidation of c-plane gallium nitride (GaN) is investigated for oxidation temperatures above 800°C. The transformation of GaN to gallium oxide (Ga2O3) is preferably found at TDs and grain boundaries, showing enhanced vertical oxidation, compared to defect free surface sites. Therefore, the increase in surface roughness commonly obtained upon oxidation is explained by an inhomogeneous chemical reactivity associated with those crystal defects. Additionally, annealing in an N2 atmosphere showed that also decomposition is favored at such chemically reactive spots. Comparison between decomposition and oxidation suggests that at temperatures above 950°C, the Ga2O3 formation is supported by the decomposition of GaN and subsequent oxidation of the metallic gallium.
Cu (In, Ga) Se2 (CIGS) thin-film solar cells are optimal solar cells for spacecraft, since they have high efficiency, lightweight, flexible and high radiation tolerance. The CIGS solar module without a coverglass to prevent degradation in space has been demonstrated with a small satellite and its electrical performance indicates no degradation as predicted from ground tests. However, the cells need to prevent the damages from other effects in space. The paper introduces some space environment tests and how to improve performance in CIGS cells for spacecraft.
Reliability and degradation processes in broad-area InGaAs-AlGaAs strained quantum well (QW) lasers are under intensive investigation because these lasers are the key components for fiber lasers and amplifiers that have found both industrial and military applications in recent years. Unlike single-mode lasers that were developed for high reliability telecom applications, broad-area lasers were mainly targeted for applications that require less stringent reliability of the lasers until recently. Especially, the lack of field reliability data is a concern for satellite communication systems where high reliability is required of lasers for long-term duration. For our present study, we addressed this concern by performing long-term life-tests of broad-area InGaAs-AlGaAs strained QW lasers and also by studying mechanisms that are responsible for catastrophic degradation of the lasers.
Cadmium Zinc Telluride (CZT) semiconductor crystal properties have been studied extensively with a focus on correlations to their radiation detector performance. The need for defect-free CZT crystal is imperative for optimal detector performance. Extended defects like Tellurium (Te) inclusions, twins, sub-grain boundaries, and dislocations are common defects found in CZT crystals; they alter the electrical properties and, therefore, the crystal's response to high energy radiation. In this research we studied the extended defects in CZT crystals from two separate ingots grown using the low-pressure Bridgman technique. We fabricated several detectors cut from wafers of two separate ingots by dicing, lapping, polishing, etching and applying gold metal contacts on the main surfaces of the crystals. Using infrared (IR) transmission microscope we analyzed the defects observed in the CZT detectors, showing three dimensional scans and plot size distributions of Te inclusions, twins and sub-grain boundaries observed in particular regions of the CZT detectors. We characterized electrical properties of the detectors by measuring bulk resistivity and detector response to gamma radiation. We observed that CZT detectors with more extended defects showed poor opto-electrical properties compared to detectors with fewer defects.