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The Learning Health System Network clinical data research network includes academic medical centers, health-care systems, public health departments, and health plans, and is designed to facilitate outcomes research, pragmatic trials, comparative effectiveness research, and evaluation of population health interventions.
The Learning Health System Network is 1 of 13 clinical data research networks assembled to create, in partnership with 20 patient-powered research networks, a National Patient-Centered Clinical Research Network.
Results and Conclusions
Herein, we describe the Learning Health System Network as an emerging resource for translational research, providing details on the governance and organizational structure of the network, the key milestones of the current funding period, and challenges and opportunities for collaborative science leveraging the network.
We investigated how different models of HIV transmission, and assumptions regarding the distribution of unprotected sex and syringe-sharing events (‘risk acts’), affect quantitative understanding of HIV transmission process in people who inject drugs (PWID). The individual-based model simulated HIV transmission in a dynamic sexual and injecting network representing New York City. We constructed four HIV transmission models: model 1, constant probabilities; model 2, random number of sexual and parenteral acts; model 3, viral load individual assigned; and model 4, two groups of partnerships (low and high risk). Overall, models with less heterogeneity were more sensitive to changes in numbers risk acts, producing HIV incidence up to four times higher than that empirically observed. Although all models overestimated HIV incidence, micro-simulations with greater heterogeneity in the HIV transmission modelling process produced more robust results and better reproduced empirical epidemic dynamics.
Fixed hippocampal volume reductions and shape abnormalities are established findings in schizophrenia, but the relationship between hippocampal volume change and clinical outcome has been relatively unexplored in schizophrenia and other psychotic disorders. In light of recent findings correlating hippocampal volume change and clinical outcome in first-episode psychotic adults, we hypothesized that fewer decreases in hippocampal volume would be associated with better functional outcome and fewer psychotic symptoms in our rare and chronically ill population of childhood-onset schizophrenia (COS) patients.
We prospectively obtained 114 structural brain magnetic resonance images (MRIs) from 27 COS subjects, each with three or more scans between the ages of 10 and 30 years. Change in hippocampal volume, measured by fit slope and percentage change, was regressed against clinical ratings (Children's Global Assessment Scale, Scale for the Assessment of Positive Symptoms, Scale for the Assessment of Negative Symptoms) at last scan (controlling for sex, time between scans and total intracranial volume).
Fewer negative symptoms were associated with less hippocampal volume decrease (fit slope: p = 0.0003, and percentage change: p = 0.005) while positive symptoms were not related to hippocampal change. There was also a relationship between improved clinical global functioning and maintained hippocampal volumes (fit slope: p = 0.025, and percentage change: p = 0.043).
These results suggest that abnormal hippocampal development in schizophrenia can be linked to global functioning and negative symptoms. The hippocampus can be considered a potential treatment target for future therapies.
Self-report questionnaires are frequently used in clinical and epidemiologic studies to assess post-traumatic stress disorder (PTSD). A number of studies have evaluated these scales relative to clinician administered structured interviews; however, there has been no formal evaluation of their performance relative to non-clinician administered epidemiologic assessments such as the Composite International Diagnostic Interview (CIDI). We examined the diagnostic performance of two self-report PTSD scales, the PTSD checklist (PCL) and the Vietnam Era Twin Registry (VET-R) PTSD scale, compared to the CIDI.
Data were derived from a large epidemiologic follow-up study of PTSD in 5141 Vietnam Era Veterans. Measures included the PCL, VET-R PTSD scale and CIDI. For both the PCL and VET-R PTSD scale, ROC curves, areas under the curve (AUC), sensitivity, specificity, % correctly classified, likelihood ratios, predictive values and quality estimates were generated based on the CIDI PTSD diagnosis.
For the PCL and VET-R PTSD scale the AUCs were 89.0 and 87.7%, respectively. Optimal PCL cutpoints varied from the 31–33 range (when considering sensitivity and specificity) to the 36–56 range (when considering quality estimates). Similar variations were found for the VET-R PTSD, ranging from 31 (when considering sensitivity and specificity) to the 37–42 range (when considering quality estimates).
The PCL and VET-R PTSD scale performed similarly using a CIDI PTSD diagnosis as the criterion. There was a range of acceptable cutpoints, depending on the metric used, but most metrics suggested a lower PCL cutpoint than in previous studies in Veteran populations.
We present the first results of a dedicated search for Diffuse Interstellar Bands that have profiles with FWHM > 6 Å. Broad DIBs have been noticed in past surveys using averages of multiple sight lines (e.g. Jenniskens & Désert, 1994), but careful detection, measurement, and cataloguing for individual sight lines has not been done since the pioneering work of Herbig (1995). We have initiated an observing campaign using the Apache Point Observatory in order to obtain low-resolution spectra to search for such broad DIBs and monitor their behaviour from star to star. A first sample of 21 stars with 0.3 < E(B-V) < 3.3 mag, along with 15 matched low-reddening stars, were observed with the APO/DIS B400 (R ~ 450) and R300 (R ~ 1000) gratings to obtain spectra having S/N > 500.
Anomalously broad diffuse interstellar bands (DIBs) at 5780.5, 5797.1, 6196.0, and 6613.6 Å are found in absorption along the line of sight to Herschel 36, an O star system next to the bright Hourglass nebula of the Hii region Messier 8. Excited lines of CH and CH+ are seen as well. We show that the region is very compact and itemize other anomalies of the gas. An infrared-bright star within 400 AU is noted. The combination of these effects produces anomalous DIBs, interpreted by Oka et al. (2013, see also this volume) as being caused predominantly by infrared pumping of rotational levels of relatively small molecules.
The differential diagnosis of endolaryngeal mesenchymal neoplasms includes a wide spectrum of benign and malignant pathologies, which have been rarely photo-documented and assessed as a group.
Non-epithelial neoplasms of the endolarynx seen at our centre from 2002 to 2011 (n = 38; 36 treated at our institution) were retrospectively reviewed, with attention to clinical presentation, radiographic imaging, operative management, histology, and pre- and post-operative endoscopy. Submucosal squamous cell carcinomas, mucosal cysts, amyloid and Teflon granulomas were excluded.
Twenty-three of a total of 36 patients underwent definitive endoscopic surgical treatment. Supraglottic pathologies included lymphoma, lipoma, neuroendocrine carcinoma, lymphangioma, oncocytoma, haemangioma, synovial cell sarcoma and benign spindle cell neoplasm. Transglottic pathologies included synovial cell sarcoma and granular cell tumour. Glottic pathologies included granular cell tumour, osteoma, rhabdomyoma, rhabdomycosarcoma and myofibroblastic sarcoma. Subglottic pathologies included chondrosarcoma, neurofibroma, adenoid cystic carcinoma and vascular malformation.
The site of origin, degree of malignant behaviour and sensitivity to adjuvant treatment determined the course of surgical management, i.e. endolaryngeal versus transcervical, and limited removal versus wider resection.
Thousands of rescue and recovery workers descended on the World Trade Center (WTC) in the wake of the terrorist attack of September 11, 2001 (9/11). Recent studies show that respiratory illness and post-traumatic stress disorder (PTSD) are the hallmark health problems, but relationships between them are poorly understood. The current study examined this link and evaluated contributions of WTC exposures.
Participants were 8508 police and 12 333 non-traditional responders examined at the WTC Medical Monitoring and Treatment Program (WTC-MMTP), a clinic network in the New York area established by the National Institute for Occupational Safety and Health (NIOSH). We used structural equation modeling (SEM) to explore patterns of association among exposures, other risk factors, probable WTC-related PTSD [based on the PTSD Checklist (PCL)], physician-assessed respiratory symptoms arising after 9/11 and present at examination, and abnormal pulmonary functioning defined by low forced vital capacity (FVC).
Fewer police than non-traditional responders had probable PTSD (5.9% v. 23.0%) and respiratory symptoms (22.5% v. 28.4%), whereas pulmonary function was similar. PTSD and respiratory symptoms were moderately correlated (r=0.28 for police and 0.27 for non-traditional responders). Exposure was more strongly associated with respiratory symptoms than with PTSD or lung function. The SEM model that best fit the data in both groups suggested that PTSD statistically mediated the association of exposure with respiratory symptoms.
Although longitudinal data are needed to confirm the mediation hypothesis, the link between PTSD and respiratory symptoms is noteworthy and calls for further investigation. The findings also support the value of integrated medical and psychiatric treatment for disaster responders.
We used near-field magneto-photoluminescence scanning microscopy to study structural and optical properties of quantum-dot-like compositional fluctuations in GaAsN and InGaAsN alloys. We show that these fluctuations manifest themselves by the appearance of narrow emission lines (halfwidth 0.5−2 meV) at temperatures below 70K. We estimated the size, density, and nitrogen excess of individual compositional fluctuations (clusters), revealing phaseseparation effects in the distribution of nitrogen in GaAsN and InGaAsN. We found a dramatic difference in the Zeeman splitting of cluster lines between GaAsN and InGaAsN, indicating a strong effect of In on the exciton g-factor.
Nitrogen vibrational mode spectra, Hall mobilities, and minority carrier diffusion lengths are examined for InGaAsN (≈ 1.1 eV bandgap) grown by molecular beam epitaxy (MBE) and metal-organic chemical vapor deposition (MOCVD). Independent of growth technique, annealing promotes the formation of In-N bonding, and lateral carrier transport is limited by large scale (Ęmean free path ) material inhomogeneities. Comparing solar cell quantum efficiencies for devices grown by MBE and MOCVD, we find significant electron diffusion in the MBE material (reversed from the hole diffusion occurring in MOCVD material), and minority carrier diffusion in InGaAsN cannot be explained by a “universal”, nitrogen-related defect.
InAs/AlGaAs quantum dot infrared photodetectors based on bound-to-bound intraband transitions in undoped InAs quantum dots are reported. AlGaAs blocking layers were employed to achieve low dark current. The photoresponse peaked at 6.2 μm. At 77 K and –0.7 V bias the responsivity was 14 mA/W and the detectivtiy, D*, was 1010 cmHz1/2/W.
InGaAsP/InP multiple quantum wells have been prepared by Impurity-Free Vacancy Disordering (IFVD). The luminescent characteristics was investigated using photoluminescence (PL) and photoreflectance (PR), from which the band gap blue shift was observed. Si3N4, SiO2 and SOG were used for the dielectric layer to create the vacancies. All samples were annealed by rapid thermal anne aling (RTA). The results indicate that the band gap blue shift varies with the dielectric layers and annealing temperature. The SiO2 capping was successfully used with an InGaAs cladding layer to cause larger band tuning effect in the InGaAs/InP MQWs than the Si3N4 capping with an InGaAs cladding layer. On the other hand, samples with the Si3N4-InP cap layer combination also show larger energy shifts than that with SiO2-InP cap layer combination.
The luminescence properties of erbium oxide grown on crystalline and amorphous silicon substrates were studied by means of photo- and cathodoluminescence techniques. Differences in the luminescence spectra for samples grown on the two types of substrates used are explained in terms of the different types of erbium centers formed by taking into account the substrate properties and the thermal treatments during growth. For comparison, erbium implanted and oxygen coimplanted crystalline and amorphous silicon have been also investigated by luminescence techniques. In the implanted samples, the sharp transitions from erbium ions in the visible range were quenched and the main emission corresponds to the intraionic transitions in Er3+ ions in the infrared range peaked at 1,54 μm.
As modern circuit architecture features steadily decrease in size, more accurate tools are needed to meaningfully measure critical dimensions (CD). As a general rule, a metrology tool should be able to measure 1/10 of the product tolerance. An emerging technology for high speed, high accuracy CD measurement is scatterometry. This paper describes scatterometrybased measurements of metal features of 350 nm with a space of 450 nm (pitch of 800nm) on top of a complicated layer stack and compares them with the results of an atomic force microscope (AFM). We also looked into lithography cell monitoring and trending by measuring CDs on 3 daily litho cell monitors over a period of 40 days. Our long term results show excellent agreement with those of a scanning electron microscope (CD-SEM).