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Introduction: Situational awareness (SA) is the team understanding patient stability, presenting illness and future clinical course. Losing SA has been shown to increase safety-critical events in multiple industries. SA can be measured by the previously validated Situational Awareness Global Assessment Tool (SAGAT). Checklists are used in many safety-critical industries to reduce errors of omission and commission. An RSI checklist was developed from case review and published evidence.The New Brunswick Trauma Program supports an inter-professional simulation-based medical education program Methods: Simulations were facilitated in three hospitals in New Brunswick from April 2017 to October 2017. Learner profiles were collected. The SAGAT tool was completed by a research nurse at the end of each scenario. SAGAT scores were non-normally distributed, so results were expressed as medians and interquartile ranges. Mann Whitney U tests were used to calculate statistical significance. To understand the effect of the of an RSI checklist a comparison was made between SAGAT scores at baseline in scenario 1, and the same first scenario completed after a washout period. A Poisson regression analysis will be used to account for the effect of confounding variables in further analyses. Results: The group was composed of Registered Nurses (8), Physicians (7), and Respiratory Therapists (2). Situational awareness increased significantly with the use of an RSI checklist after 1 day of 4 simulations. The washout period ranged between 5 weeks and 8 weeks. The baseline situational awareness of the whole group during scenario 1 was 9 +/− 0.5 (median, IQR), and with the RSI checklist was 12 +/−1 (median, IQR). The difference was highly statistically significant, p=< 0.001. This level of situational awareness using checklist is comparable to the SAGAT scores after 10 scenarios. Conclusion: In this provisional analysis, the use of an RSI checklist was associated with an increase in measured situational awareness. Higher levels of situational awareness are associated with greater patient safety. A Poisson regression model will be used to understand the confounding effects of user expertise and the likely interaction with simulation exposure.
Labour constitutes a major and increasing cost on dairy farms, while at the same time, the availability of skilled labour is decreasing. In addition, younger farmers are placing an increasing emphasis on lifestyle. Consequently, there is an increased interest in milk production systems involving reduced labour inputs. In view of the fact that approximately 33% (O’Brien et al., 2002) of the daily labour input on dairy farms is associated with the milking routine (herding, milking and washing), the adoption of once daily milking would appear to offer considerable potential to reduce labour inputs. This study examined the effect of once-daily milking, in late lactation, on animal performance.
Previous findings have been mixed regarding the relationship between maternal depressive symptoms and child cognitive development. The objective of this study was to systematically review relevant literature and to perform a meta-analysis.
Three electronic databases (PubMed, EMBASE, PsycINFO) were searched. Initial screening was conducted independently by two reviewers. Studies selected for detailed review were read in full and included based on a set of criteria. Data from selected studies were abstracted onto a standardized form. Meta-analysis using the inverse variance approach and random-effects models was conducted.
The univariate analysis of 14 studies revealed that maternal depressive symptoms are related to lower cognitive scores among children aged ⩽56 months (Cohen's d = −0.25, 95% CI −0.39 to −0.12). The synthesis of studies controlling for confounding variables showed that the mean cognitive score for children 6–8 weeks post-partum whose mothers had high depressive symptoms during the first few weeks postpartum was approximately 4.2 units lower on the Mental Developmental Index (MDI) of the Bayley Scales of Infant and Toddler Development (BSID) compared with children with non-symptomatic mothers (B̂ = −4.17, 95% CI −8.01 to −0.32).
The results indicated that maternal depressive symptoms are related to lower cognitive scores in early infancy, after adjusting for confounding factors. An integrated approach for supporting child cognitive development may include program efforts that promote maternal mental health in addition to family economic wellbeing, responsive caregiving, and child nutrition.
Introduction: A novel bladder stimulation technique has been described for midstream urine (MSU) collection in well-feeding, inpatient newborns. We sought to determine the performance of this technique amongst infants presenting to the Emergency Department (ED). Methods: Our prospective ED-based study enrolled a convenience cohort of infants aged ≤ 90 days who required urine testing. Infants with significant feeding issues, moderate to severe dehydration, or critical illness were excluded. Bladder stimulation consisted of finger tapping on the lower abdomen with or without lower back massage while holding the child upright. Healthcare providers received standardized training in the technique. Primary outcome was the proportion of infants with successful MSU collection via the technique. Success was defined as adequate sample collection (≥ 1 mL urine) within 5 minutes of initiating stimulation. Secondary outcomes included the proportion of contaminated MSU samples, time required for MSU collection and full protocol completion, and patient discomfort as perceived by parent/guardian using a 100 mm visual analog scale [VAS]. Assuming success a priori in 50% of infants, a sample size of 115 allowed a 95% confidence interval of +/- 9.1% around the point estimate. Results: We enrolled 115 infants. Mean age was 53.0 days old (interquartile range [IQR] 26.7-68.0); 58.3% were male (69.2% uncircumcised). Midstream urine was successfully collected in 61 infants (53.0%; 95% CI 0.44,0.62). Thirty-one MSU samples (50.8%) were contaminated; uncircumcised males held the highest proportion (55.0%). Most contaminated samples (83.9%) were reported as “non-significant growth” or “growth of ≥ 3 organisms” and were easily identifiable as contaminants with minimal impact on clinical care. Only 4 (8.5%) of the 47 patients discharged home after successful MSU collection had a repeat ED visit for urine testing. Median stimulation time for MSU collection was 45 seconds (IQR 20-99 secs). Median time for full protocol completion was 30.83 minutes (IQR 24.42-46.83 mins). Mean VAS for infant discomfort was 20.2 mm (SD +/- 20.4 mm). Conclusion: Our pragmatic, ED-based study found the success rate of this bladder stimulation technique to be significantly lower (53%) than its published rate (86%). The contamination rate was high but most contaminated specimens were easily identifiable as such and had minimal clinical impact.
Building on research on cumulative risk and psychopathology, this study examines how cumulative risk exposure is associated with altered diurnal cortisol rhythms in an ethnically diverse, low-income sample of youth. In addition, consistent with a diathesis-stress perspective, this study explores whether the effect of environmental risk is moderated by allelic variation in the serotonin transporter linked polymorphic region (5-HTTLPR) gene. Results show that youth with greater cumulative risk exposure had flatter diurnal cortisol slopes, regardless of 5-HTTLPR genotype. However, the association of cumulative risk with average cortisol output (area under the curve [AUC]) was moderated by the 5-HTTLPR genotype. Among youth homozygous for the long allele, greater cumulative risk exposure was associated with lower cortisol AUC, driven by significant reductions in cortisol levels at waking. In contrast, there was a trend-level association between greater cumulative risk and higher cortisol AUC among youth carrying the short allele, driven by a trend-level increase in bedtime cortisol levels. Findings are discussed with regard to the relevance of dysregulated diurnal cortisol rhythms for the development of psychopathology and the implications of genetically mediated differences in psychophysiological adaptations to stress.
Develop and implement an effective program for hazard analysis and control of waterborne pathogens at a multicampus hospital with clinics.
A longitudinal study. Several-year study including analysis of results from monitoring and tests of 26 building water systems.
Outpatient and inpatient healthcare facilities network.
The hazard analysis and critical control point (HACCP) process was used to develop a water management program (WMP) for the hospital campuses. The HACCP method systematically addressed 3 questions: (1) What are the potential waterborne hazards in the building water systems of these facilities? (2) How are the hazards being controlled? (3) How do we know that the hazards have been controlled? Microbiological and chemical tests of building water samples were used to validate the performance of the WMP; disease surveillance data further validated effective hazard control.
Hazard analysis showed that waterborne pathogens were generally in good control and that the water quality was good in all facilities. The hospital network has had several legionellosis cases that were identified as presumptive hospital acquired, but none was confirmed or substantiated by water testing in follow-up investigations. Building water system studies unrelated to these cases showed that pressure tanks and electronic automatic faucets required additional hazard control.
Application of the HACCP process for long-term building water systems management was practical and effective. The need for critical control point management of temperature, flow, and oxidant (chlorine) residual concentration was emphasized. The process resulted in discovery of water system components requiring additional hazard control.
Efficient milking systems, in terms of labour demand, capital investment and cow udder health are critical to successful dairy herd expansion. The objective of this study was to establish the effect of two primary influencing factors on efficient milking performance, i.e. parlour size (number of milking units) and pre-milking routine (full and nil) of spring-calved cows, in a single-operator side-by-side, swing-over milking parlour. Efficiency parameters investigated in a 5×2 factorial design included milk-flow and yield, row time, over-milking duration and operator idle time. Five combinations of parlour size (14, 18, 22, 26 and 30 milking units) each with two different pre-milking routines (Full: spray, strip, wipe, attach clusters, and Nil: attach clusters) were examined with one milking operator. The trial was carried out over 40 milking sessions and cows (up to 120) were randomly assigned to groups (n=14, 18, 22, 26 or 30) before each milking session. Row within a milking session was the experimental unit. The experiment was carried out at both peak and late lactation. The data were analysed with a mixed model using GenStat 13.2. The full pre-milking routine reduced time to milk let-down and milking time, increased average flow rate but did not affect milk yield. As milking unit number increased, the duration of over-milking (defined as time at milk flow rate <0·2 kg/min) increased more with a full compared with nil routine. Thus, the use of pre-milking preparation decreased milking time per cow but as parlour size increased, milking row times, as well as the proportion of cows that were over-milked, also increased, thereby reducing overall efficiency. These results have implications for milking management in single-operator swing-over, tandem and rotary parlours with seasonally calved herds.
Atomic layer deposition (ALD) has been used to coat SBA-15 and functionalized SBA-15 with various metal oxides. Use of SBA-15 coated with 4-10 ALD cycles of titania, alumina, niobia, or zirconia in the acid-catalyzed dehydration of fructose to 5-hydroxymethylfurfural (HMF) resulted in 24-57% conversion, with 0-22% selectivity, at 130 °C with 2 wt % fructose in 4:1 THF:H2O. Propylsulfonic acid functionalized SBA-15 (SBA-15-PrSO3H) had a 25% conversion and 48% selectivity for HMF under the same conditions. SBA-15-PrSO3H was also coated with 2 ALD cycles of titania followed by 8 ALD cycles silica. The deactivation rate constant for SBA-15-PrSO3H was 2.7 x 10-2 h-1 for the dehydration of fructose to HMF in a flow reactor at 130 °C with a feed of 2 wt % fructose in 4:1 THF:H2O. In comparison, the deactivation rate constant for the ALD coated SBA-15-PrSO3H-ALD was 7.9 x 10-3 h-1.
The method of ion implantation and spike annealing for preparing shallow junctions suitable for the extension regions bridging the channel and source/drain contacts of CMOS transistors are studied by annealing blanket implants. Junction depths at a given sheet resistance for low energy B implants are minimized for the combination of a fast ramp with a sharp-spike anneal. This is shown to be physically based on activation energy phenomenology. The fraction of electrically activated B is insensitive to implant dose, unlike the case of transient enhanced diffusion. Arsenic implants show higher activation fraction than comparably annealed P implants, without the large transient enhanced diffusion which is attributed to P and Si-interstitial coupled diffusion. For targeted sheet resistance and junction depth, spiking temperature trends lower with implant dose, concomitant with decreasing fraction of activated dopant.
The spatial variation of current density in lines with model void defects fabricated using Focused-ion Beam (FIB) milling has been investigated using Magnetic Force Microscopy (MFM). The model defects were designed to systematically simulate the natural void shapes that occur in electromigration failure of current-carrying lines. Inhomogenous current density around the defects manifests itself in the form of atypical asymmetry in the MFM signal near the defects. The extent of the asymmetry is greatly dependent upon the defect geometry. At current densities of 3-5×106 A/cm2, an asymmetry in the MFM signal is clearly visible around defects, such as a (1×1) μ,2 notch and a (1×9) μm2 45°-slanted slit, at the edge of a 10μm wide line. We present a survey of MFM images of various defect structures in current-carrying lines that perturb the homogenous current flow of a straight line.
The creation of ultra-shallow junction for CMOS devices at the sub-100 nm node is driving significant efforts in developing thermal processing to give rise to high dopant activation in combination with limited diffusion. Flash-assist Rapid Thermal Annealing™ (fRTP™) is a promising new annealing technique, which involves the heating of the bulk of the wafer to an intermediate temperature using rather conventional spike RTP, followed by a short and intense pulse of light localized on the implanted wafer surface.
In this work, we have systematically investigated the junction formation of different implants under fRTP anneals in terms of profile and devices. Co-implanted Ge and F species provide more box-like profiles with improved activation. Although leakage currents are higher for fRTP-annealed junctions than for spike-annealed junctions, appropriate fRTP process parameters and correct process conditions provide a critical tool to control and reduce the leakage current of co-implanted fRTP junctions to acceptable levels. Proper implant and anneal are requested for minimizing pattern effect and improving device performance.
The free fall of a liquid-metal drop and heat transfer from the drop to its environment are described for both a gaseous atmosphere and vacuum. A simple model, in which the drop is assumed to fall rectilinearly with behavior like that of a rigid particle, is developed first, then possible causes of deviation from this behavior are discussed. The model is applied to describe solidification of drops in a drop tube. Possible future develop-ments of the model are suggested.
This report focuses on the prediction of materials performance for the carbon steel corrosion-allowance container as a function of thermal loading for the potential repository at Yucca Mountain. Low, intermediate and high thermal loads were evaluated as to their performance given assumptions regarding the temperature and humidity changes with time and the resultant depth of corrosion penetration. The reference case involved a kinetic relation for corrosion that was utilized in a sensitivity analysis to examine the impacts of time exponent, pitting, and microbiologically-influenced corrosion. As a result of this study, the high thermal load appears to offer the best corrosion performance. However, other factors must be considered in making the final thermal loading decision.
The Yucca Mountain Project (YMP) 1998 Total System Performance Assessment Viability Assessment (TSPA-VA) analyzed the degradation of Zircaloy clad commercial fuel rods and the resulting exposure of the fuel in the event of a waste package failure. The cladding degradation mechanisms considered were damage before emplacement, mechanical failure from drift collapse, localized corrosion, general corrosion, delayed hydride cracking (DHC), hydride reorientation, creep rupture, and stress corrosion cracking (SCC). The potential for further cladding degradation due to cladding rupture as a result of fuel oxidation was also considered in the modeling effort. These models have been improved for use in future TSPAs.
The current cladding degradation model divides the analysis into two phases, cladding failure (perforation) and cladding unzipping (crack propagation caused by the expansion of UO2 fuel after reaction with water). Cladding failure occurs during reactor operation, from creep strain failure during high temperature periods in dry storage or in the early periods in the repository, or localized corrosion. After a Waste Package (WP) containing spent nuclear fuel in the repository fails, moisture is assumed to enter the waste package and the failed cladding starts to unzip (tear open) from the formation of secondary uranium phases. This slowly exposes the fuel. In addition, the inventory of fission products located in the gap between the cladding and fuel pellet is rapidly released. The cladding model limits the amount of fuel that is exposed to moisture and becomes available for dissolution. As a result, the doses to the affected population are reduced (factor of 20 to 50 in TSPA-VA) from the case where cladding is not considered.
The dielectric elastomer, a particularly attractive type of electroactive polymer, uses commercial polymers such as acrylic and silicone elastomers. The technology has been limited in application by perceived lifetime issues. By addressing several lifetime issues, lifetimes of more than one million cycles, and in some cases beyond ten million cycles, were achieved with a variety of transducer configurations (including operation in generator mode) under a variety of operating conditions (including high humidity). Dielectric elastomers can produce maximum actuation strains of more than 100% and specific energy density exceeding that of known electric-field induced technology. Performance testing for dielectric elastomer actuators has typically been for peak-performance or “over-driven” conditions with short operational lifetimes (typically 100s or 1000s of cycles), particularly under conditions such as high humidity. By minimizing electric field and mechanical strain concentration factors, long lifetimes (>1 million cycles) with acrylic transducers were achieved with actuation strains as great as 40% areal strain (and up to 100% areal strain in generator mode). Actuators in a dry environment had an almost 20x increase in lifetime over actuators at ambient humidity (about 50% RH) at the same driving field conditions. Long actuation lifetimes were also achieved in a 100% RH environment and when fully submerged in salt water at reduced operating strain and field. In 100% RH, lifetimes of several million cycles were achieved at 4% strain. In underwater operation, 6 out of 11 actuators survived for >10 million cycles with an electric field limited to 32 MV/m and approximately 2% strain. The demonstrated lifecycle improvements are applicable to a variety of uses of dielectric elastomers, including haptic interface devices, pumps (implantable and external), optical positioners, and “artificial muscles” to replace small damaged muscles. Continued improvements in materials, actuator design, and packaging, combined with management of operational conditions as described here, should support new practical application of this promising technology.
Due to integration concerns, the use of meta-stable junction formation approaches like laser thermal annealing (LTA), solid phase epitaxial regrowth (SPER), and flash annealing has largely been avoided for the 90nm CMOS node. Instead fast-ramp spike annealing has been optimised along with co-implantation to satisfy the device requirements, often with the help from thin offset spacers. However for the 65nm and 45nm CMOS node it is widely accepted that this conventional approach will not provide the required pMOS junctions, even with changes in the transistor architecture.
In this work, we will compare junction performance and integratablity of fast-ramp spike, flash, SPER and laser annealing down to 45nm CMOS. The junction depth, abruptness and resistance offered by each approach are balanced against device uniformity, deactivation and leakage. Results show that the main contenders for the 45nm CMOS are SPER and flash annealing – but both have to be rigorously optimised for regrowth rates, amorphous positioning and dopant and co-implant profiles. From the two, SPER offers the best junction abruptness (<1nm/dec) with leakage suitable for low power applications, while the flash anneal has the benefit of higher solid solubility (>4E20at/cm3) and less transistor modifications. As expected, Ge and F co-implanted spike annealed junctions do not reach the 45nm node requirements. For full-melt LTA, poly deformation on isolation can be reduced but geometry effects result in unacceptable junction non-uniformity.
Low thermal budget annealing approaches, such as millisecond annealing or solid-phase epitaxy (SPE) of amorphized silicon, electrically activate implanted dopants while minimizing diffusion. However, it is also important to anneal damage to the crystal lattice in order to minimize junction leakage. Annealing experiments were performed on low-energy B implants into both crystalline silicon and into wafers pre-amorphized by Ge implantation. Some wafers also received As implants for halo-style doping, and in some cases the halo implants were pre-annealed at 1050°C before the B-doping. The B-implants were annealed by either SPE at 650°C, spike annealing at 1050°C, or by millisecond annealing with flash-assisted RTP™ (fRTP™) at temperatures between 1250°C and 1350°C. Residual damage was characterized by photoluminescence and non-contact junction leakage current measurements, which permit rapid assessment of damage removal efficacy. Damage from the heavy ions used for the halo and pre-amorphization implants dominates the defect annealing behaviour. The halo doping is the critical factor in determining junction leakage current. Millisecond annealing at high temperatures helps to minimize residual damage while limiting diffusion.