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Photo-electric measurements made in Leiden in the first part of 1955 and extended by one of us at the Observatoire de Haute Provence in October 1955, show that the light of the Crab nebula is strongly polarized. The presence of polarization was first suggested by Vashakidze  and was firmly established by photo-electric measures by Dombrovsky  in 1954. The present observations, which are much more detailed, show that 17 % of the light coming from the central part, with a mean radius of 0′·8, is linearly polarized. It may be seen that over the entire bright part of the nebula the polarizations are sensibly parallel, while in the outer parts they tend to be oriented at random.
To determine the outcomes of patients discharged from the emergency department (ED) with a bloodstream infection (BSI) and how these outcomes are influenced by antibiotic treatment.
We identified every BSI in adult patients discharged from our ED to the community between July 1, 2002, and March 31, 2011. The medical records of all cases were reviewed to determine antibiotic treatment in the ED and at discharge. Microorganism sensitivities were used to determine whether antibiotics were appropriate. These data were linked to population-based administrative data to determine specific patient outcomes within the subsequent 2-week period: death, urgent hospitalization, or an unplanned return to the ED.
A total of 480 adults with BSI were identified (1.49 cases per 1,000 adults discharged from the department). Compared to controls (321,048 patients), BSI patients had a significantly higher risk of urgent hospitalization (adjusted OR 2.1 [95% CI 1.6–2.8]) and unplanned return to the ED (adjusted OR 4.1 [95% CI 3.3–4.9]). Outcome risk was significantly lowered in BSI patients who received appropriate antibiotics in the ED and at discharge. In elderly patients, the risk of urgent hospitalization increased significantly as the time to appropriate antibiotics was delayed.
BSI patients discharged from the ED have a significantly increased risk of urgent hospitalization and unplanned return to the ED in the subsequent 2 weeks. These risks decrease significantly with the timely provision of appropriate antibiotics. Our results support the aggressive use of measures ensuring that such patients receive appropriate antibiotics as soon as possible.
Based on self-determination theory and adaptation theories, the study aim was to investigate the relationship between need fulfillment (of autonomy, relatedness, and competence), need importance, and depressive symptoms during the first months of living in a nursing home.
Eight-month longitudinal questionnaire study in which 75 persons newly admitted to units for physically frail residents participated at baseline. Twenty-three longitudinal participants were remaining at the third and final measurement wave.
The results show a main effect of need fulfillment and an interaction effect of need fulfillment and need importance on depressive symptoms over time. A prototypical plot shows that residents with low need fulfillment had higher initial levels of depressive symptoms that decreased modestly over time, regardless of their need importance. Residents with high need fulfillment had lower initial levels of depressive symptoms, but their trajectories differed for participants with low and high need importance. Residents with low need importance started with lower levels of depressive symptoms but remained stable over time, whereas residents with high need importance had more depressive symptoms at T1 that decreased slightly over time.
In general, depressive symptoms do not change over time. However, individual trajectories of depressive symptoms seem to depend on individual need fulfillment and need importance. The residents that consider need fulfillment to be highly important but experience low need fulfillment had higher initial levels of depressive symptoms that decreased modestly over time, although the level of depressive symptoms remained higher as compared to the other residents.
Two major problems associated with Si-based MEMS devices are stiction and wear. Surface modifications are needed to reduce both adhesion and friction in micromechanical structures to solve these problems. In this paper, we will present a process used to selectively coat MEMS devices with tungsten using a CVD (Chemical Vapor Deposition) process. The selective W deposition process results in a very conformal coating and can potentially solve both stiction and wear problems confronting MEMS processing. The selective deposition of tungsten is accomplished through silicon reduction of WF6, which results in a self-limiting reaction. The selective deposition of W only on polysilicon surfaces prevents electrical shorts. Further, the self-limiting nature of this selective W deposition process ensures the consistency necessary for process control. Selective tungsten is deposited after the removal of the sacrificial oxides to minimize process integration problems. This tungsten coating adheres well and is hard and conducting, requirements for device performance. Furthermore, since the deposited tungsten infiltrates under adhered silicon parts and the volume of W deposited is less than the amount of Si consumed, it appears to be possible to release stuck parts that are contacted over small areas such as dimples. Results from tungsten deposition on MEMS structures with dimples will be presented. The effect of wet and vapor phase cleans prior to the deposition will be discussed along with other process details. The W coating improved wear by orders of magnitude compared to uncoated parts. Tungsten CVD is used in the integrated-circuit industry, which makes this approach manufacturable.
Two major problems associated with Si-based MEMS (MicroElectroMechanical Systems) devices are stiction and wear. Surface modifications are needed to reduce both adhesion and friction in micromechanical structures to solve these problems. In this paper, we will present a CVD (Chemical Vapor Deposition) process that selectively coats MEMS devices with tungsten and significantly enhances device durability. Tungsten CVD is used in the integrated-circuit industry, which makes this approach manufacturable. This selective deposition process results in a very conformal coating and can potentially address both stiction and wear problems confronting MEMS processing. The selective deposition of tungsten is accomplished through the silicon reduction of WF6. The self-limiting nature of this selective W deposition process ensures the consistency necessary for process control. The tungsten is deposited after the removal of the sacrificial oxides to minimize stress and process integration problems. Tungsten coating adheres well and is hard and conducting, requirements for device performance. Furthermore, since the deposited tungsten infiltrates under adhered silicon parts and the volume of W deposited is less than the amount of Si consumed, it appears to be possible to release stuck parts that are contacted over small areas such as dimples. The wear resistance of selectively coated W parts has been shown to be significantly improved on microengine test structures.
Quality of life and wellbeing in nursing homes are becoming more important in research and practice. One of the main influences on residents' wellbeing is the interaction with their professional care-givers. The purpose of this study was to explore to what extent care-givers support the residents' needs of relatedness, autonomy and competence, and how this need support is related to wellbeing. Residents and their professional care-givers of four nursing homes in the Netherlands participated in an observational and questionnaire study. Three video-observations of each resident (with different care-givers) were made during morning care. Additional data were collected by means of questionnaires. The results show that the needs of residents were, on average, moderately fulfilled during care interactions. More need support by care-givers was related to higher resident wellbeing. Care-givers provided more need support to residents with stronger functional impairments. More need support was provided by higher-educated care-givers and care-givers in higher job functions. The results show the importance of need support for situational wellbeing, but the contribution to the general subjective wellbeing of residents remains unclear. Further (longitudinal) research is needed to investigate changes in wellbeing over time. Possible differences between subjective ratings and observations of need support and wellbeing should be taken into account.
To assess the impact of real-time polymerase chain reaction (PCR) detection of methicillin-resistant Staphylococcus aureus (MRSA) on nosocomial transmission and costs.
Monthly MRSA detection rates were measured from April 1, 2000, through December 31, 2005. Time series analysis was used to identify changes in MRSA detection rates, and decision analysis was used to compare the costs of detection by PCR and by culture.
A 1,200-bed, tertiary care hospital in Canada.
Admitted patients at high risk for MRSA colonization. MRSA detection using culture-based screening was compared with a commercial PCR assay.
The mean monthly incidence of nosocomial MRSA colonization or infection was 0.37 cases per 1,000 patient-days. The time-series model indicated an insignificant decrease of 0.14 cases per 1,000 patient-days per month (95% confidence interval, —0.18 to 0.46) after the introduction of PCR detection (P = .39). The mean interval from a reported positive result until contact precautions were initiated decreased from 3.8 to 1.6 days (P<.001). However, the cost of MRSA control increased from Can$605,034 to Can$771,609. Of 290 PCR-positive patients, 120 (41.4%) were placed under contact precautions unnecessarily because of low specificity of the PCR assay used in the study; these patients contributed 37% of the increased cost. The modeling study predicted that the cost per patient would be higher with detection by PCR (Can$96) than by culture (Can$67).
Detection of MRSA by the PCR assay evaluated in this study was more costly than detection by culture for reducing MRSA transmission in our hospital. The cost benefit of screening by PCR varies according to incidences of MRSA colonization and infection, the predictive values of the assay used, and rates of compliance with infection control measures.
To maintain continuity of care when a patient's care is transferred between physicians, continuity of patient information is required. This survey determined how, and how well, Ontario emergency departments (EDs) communicate patient information to physicians in the community.
We surveyed Ontario ED chiefs to determine the most common media and methods used for disseminating information. We measured the perceived quality of their system, which was regressed against the hospital teaching status and community size using generalized logits modelling. Finally, we elicited the components of an ideal communication system for the ED.
One hundred and forty-three (85.6%) Ontario ED chiefs participated. The ED record of treatment was the most commonly used medium (95%). Postal service was the most common (55%) method of disseminating information. Thirty-three chiefs (23%) perceived the quality of communicating patient information from their ED as unsatisfactory or inadequate. This perception was significantly more prevalent in larger communities (excellent v. unsatisfactory [odds ratio (OR) 44.9, 95% confidence interval (CI) 13.9-140] and satisfactory v. unsatisfactory [OR 2.9, 95% CI 1.6-5.1]) and in teaching hospitals (satisfactory v. unsatisfactory [OR 9.7, 95% CI 4.7-20.3]). Seventy-eight percent of responding chiefs felt that patient information should be disseminated using electronic means, either through email or server access.
To communicate patient information to community physicians, Ontario ED chiefs report that a copy of the ED record of treatment is sent by postal service. More than one-fifth of ED chiefs perceived communication from their department as unsatisfactory or inadequate. Studies that assess the completeness and accuracy of the record of treatment are required as a first step for measuring the quality of patient information communication in the Ontario ED system.
T. W. Hijmans, Van der Waals-Zeeman Laboratoriwn, Universiteit van Amsterdam, Valckenierstraat 65/67 1018 XE Amsterdam The Netherlands,
YU. Kagan, Permanent address: Russian Research Center, Kurchatov Institute, Moscow 123182, Russia.,
G. V. Shlyapnikov, Permanent address: Russian Research Center, Kurchatov Institute, Moscow 123182, Russia.,
J. T. M. Walraven, Van der Waals-Zeeman Laboratoriwn, Universiteit van Amsterdam, Valckenierstraat 65/67 1018 XE Amsterdam The Netherlands
We predict and analyze non-trivial relaxational behavior of magnetically trapped gases near the Bose condensation temperature Tc. Due to strong compression of the condensate by the inhomogeneous trapping field, particularly at low densities, the relaxation rate shows a strong, almost jump wise, increase below Tc. As a consequence the maximum fraction of condensate particles is limited to a few percent. This phenomenon can be called a “relaxation explosion”. We discuss its implications for the detectability of BEC in atomic hydrogen.
Magnetostatic traps offer the possibility to study gases of Bose particles in the truly dilute limit, and have proved particularly fruitful [1, 2, 3, 4, 5] in the study of atomic hydrogen (H). In these traps, proposed for H by Hess , the effective elimination of physical boundaries is accomplished by creating a magnetic field minimum in free space. This minimum forms a potential well for electron spin-up polarized atoms (H↑), called low-field seekers. The occurrence of Bose–Einstein condensation (BEC) in such systems introduces qualitatively different behavior from the case of a homogeneous Bose gas. This is related to the explosive increase of the dipolar relaxation rate associated with the strong compression of the condensate in an external potential.
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