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Lebanon has a need for innovative approaches to increase access to mental health care to meet the country's current high demand. E-mental health has been included in its national mental health strategy while in parallel the World Health Organization has produced an online intervention called ‘Step-by-Step’ to treat symptoms of depression that is being tested in Lebanon over the coming years.
The primary aim of this study is to conduct bottom-up, community-driven qualitative cognitive interviewing from a multi-stakeholder perspective to inform the cultural adaptation of an Internet-delivered mental health intervention based on behavioural activation in Lebanon.
National Mental Health Programme staff conducted a total of 11 key informant interviews with three mental health professionals, six front-line workers in primary health care centres (PHCCs) and two community members. Also, eight focus group discussions, one with seven front-line workers and seven others with a total of 66 community members (Lebanese, Syrians and Palestinians) were conducted in several PHCCs to inform the adaptation of Step-by-Step. Results were transcribed and analysed thematically by the project coordinator and two research assistants.
Feedback generated from the cognitive interviewing mainly revolved around amending the story, illustrations and the delivery methods to ensure relevance and sensitivity to the local context. The results obtained have informed major edits to the content of Step-by-Step and also to the model of provision. Notably, the intervention was made approximately 30% shorter; it includes additional videos of content alongside the originally proposed comic book-style delivery; there is less emphasis on total inactivity as a symptom of low mood and more focus on enjoyable activities to lift mood; the story and ways to contact participants to provide support were updated in line with local gender norms; and many of the suggested or featured activities have been revised in line with suggestions from community members.
These findings promote and advocate the use of community-driven adaptation of evidence-based psychological interventions. Some of the phenomena recorded mirror findings from other research about barriers to care seeking in the region and so changes made to the intervention should be useful in improving utility and uptake of ‘Step-by-Step’.
To assess variability in antimicrobial use and associations with infection testing in pediatric ventilator-associated events (VAEs).
Descriptive retrospective cohort with nested case-control study.
Pediatric intensive care units (PICUs), cardiac intensive care units (CICUs), and neonatal intensive care units (NICUs) in 6 US hospitals.
Children≤18 years ventilated for≥1 calendar day.
We identified patients with pediatric ventilator-associated conditions (VACs), pediatric VACs with antimicrobial use for≥4 days (AVACs), and possible ventilator-associated pneumonia (PVAP, defined as pediatric AVAC with a positive respiratory diagnostic test) according to previously proposed criteria.
Among 9,025 ventilated children, we identified 192 VAC cases, 43 in CICUs, 70 in PICUs, and 79 in NICUs. AVAC criteria were met in 79 VAC cases (41%) (58% CICU; 51% PICU; and 23% NICU), and varied by hospital (CICU, 20–67%; PICU, 0–70%; and NICU, 0–43%). Type and duration of AVAC antimicrobials varied by ICU type. AVAC cases in CICUs and PICUs received broad-spectrum antimicrobials more often than those in NICUs. Among AVAC cases, 39% had respiratory infection diagnostic testing performed; PVAP was identified in 15 VAC cases. Also, among AVAC cases, 73% had no associated positive respiratory or nonrespiratory diagnostic test.
Antimicrobial use is common in pediatric VAC, with variability in spectrum and duration of antimicrobials within hospitals and across ICU types, while PVAP is uncommon. Prolonged antimicrobial use despite low rates of PVAP or positive laboratory testing for infection suggests that AVAC may provide a lever for antimicrobial stewardship programs to improve utilization.
The discovery of the first electromagnetic counterpart to a gravitational wave signal has generated follow-up observations by over 50 facilities world-wide, ushering in the new era of multi-messenger astronomy. In this paper, we present follow-up observations of the gravitational wave event GW170817 and its electromagnetic counterpart SSS17a/DLT17ck (IAU label AT2017gfo) by 14 Australian telescopes and partner observatories as part of Australian-based and Australian-led research programs. We report early- to late-time multi-wavelength observations, including optical imaging and spectroscopy, mid-infrared imaging, radio imaging, and searches for fast radio bursts. Our optical spectra reveal that the transient source emission cooled from approximately 6 400 K to 2 100 K over a 7-d period and produced no significant optical emission lines. The spectral profiles, cooling rate, and photometric light curves are consistent with the expected outburst and subsequent processes of a binary neutron star merger. Star formation in the host galaxy probably ceased at least a Gyr ago, although there is evidence for a galaxy merger. Binary pulsars with short (100 Myr) decay times are therefore unlikely progenitors, but pulsars like PSR B1534+12 with its 2.7 Gyr coalescence time could produce such a merger. The displacement (~2.2 kpc) of the binary star system from the centre of the main galaxy is not unusual for stars in the host galaxy or stars originating in the merging galaxy, and therefore any constraints on the kick velocity imparted to the progenitor are poor.
Adult ventilator-associated event (VAE) definitions include ventilator-associated conditions (VAC) and subcategories for infection-related ventilator-associated complications (IVAC) and possible ventilator-associated pneumonia (PVAP). We explored these definitions for children.
Pediatric, cardiac, or neonatal intensive care units (ICUs) in 6 US hospitals
Patients ≤18 years old ventilated for ≥1 day
We identified patients with pediatric VAC based on previously proposed criteria. We applied adult temperature, white blood cell count, antibiotic, and culture criteria for IVAC and PVAP to these patients. We matched pediatric VAC patients with controls and evaluated associations with adverse outcomes using Cox proportional hazards models.
In total, 233 pediatric VACs (12,167 ventilation episodes) were identified. In the cardiac ICU (CICU), 62.5% of VACs met adult IVAC criteria; in the pediatric ICU (PICU), 54.2% of VACs met adult IVAC criteria; and in the neonatal ICU (NICU), 20.2% of VACs met adult IVAC criteria. Most patients had abnormal white blood cell counts and temperatures; we therefore recommend simplifying surveillance by focusing on “pediatric VAC with antimicrobial use” (pediatric AVAC). Pediatric AVAC with a positive respiratory diagnostic test (“pediatric PVAP”) occurred in 8.9% of VACs in the CICU, 13.3% of VACs in the PICU, and 4.3% of VACs in the NICU. Hospital mortality was increased, and hospital and ICU length of stay and duration of ventilation were prolonged among all pediatric VAE subsets compared with controls.
We propose pediatric AVAC for surveillance related to antimicrobial use, with pediatric PVAP as a subset of AVAC. Studies on generalizability and responsiveness of these metrics to quality improvement initiatives are needed, as are studies to determine whether lower pediatric VAE rates are associated with improvements in other outcomes.
Carbapenem-resistant Enterobacteriaceae (CRE) are a growing problem in the United States. We explored the feasibility of active laboratory-based surveillance of CRE in a metropolitan area not previously considered to be an area of CRE endemicity. We provide a framework to address CRE surveillance and to monitor changes in the incidence of CRE infection over time.
We investigate the occurrence of water vapour signatures in a total of 10 red giants in the solar neighbourhood at mid-infrared wavelengths (12 μm). With the use of high resolution spectra from TEXES and synthesized spectra based on MARCS model atmospheres, we analyse the differences and discuss plausible causes. These include abundance adjustments, the addition of non-photospheric components (MOLspheres) and a different temperature profile.
Treatment options for large subglottic haemangioma include steroids, laser ablation, open excision, tracheostomy and, more recently, propranolol. This article aims to present the Great Ormond Street Hospital guidelines for using propranolol to treat infantile isolated subglottic haemangioma by ENT surgeons.
The vascular malformations multidisciplinary team at Great Ormond Street Hospital has developed guidelines for treating infantile haemangioma with propranolol.
The Great Ormond Street Hospital guidelines for propranolol treatment for infantile subglottic haemangioma include investigation, treatment and follow up. Propranolol is started at 1 mg/kg/day divided into three doses, increasing to 2 mg/kg/day one week later. On starting propranolol and when increasing the dose, the pulse rate and blood pressure must be checked every 30 minutes for the first 2 hours. Lesion response to treatment is assessed via serial endoscopy.
Recent reports of dramatic responses to oral propranolol in children with haemangioma and acute airway obstruction have led to increased use. We advocate caution, and have developed guidelines (including pre-treatment investigation and monitoring) to improve treatment safety. Propranolol may in time prove to be the best medical treatment for subglottic haemangioma, but at present is considered to be still under evaluation.
Sputter etching normally removes material with an overall composition equal to the target composition. At room temperature, this steady-state removal process is usually quickly established by the formation of an altered surface layer which compensates for preferential sputtering, together with an altered subsurface layer which reflects the existence of bombardment-induced Gibbsian segregation (GS). At elevated temperature, ordinary GS, diffusion and the presence of compound phases may strongly affect the development of the steady-state condition. In this paper, we describe two cases in which diffusion and GS become significant processes during sputter etching of a compound material AxB1−x on an underlying substrate of B atoms. In the first case, diffusion is dominated by the substrate species. This case is demonstrated by the sputtering of TiSi2 on (100) Si by 300 eV Ar+. At room temperature, normal sputtering of the TiSi2 layer occurs. At elevated temperature (500–700°C), however, Si diffuses from the substrate to the surface, where it undergoes GS. This allows the development of a steady-state highly selective sputtering of Si atoms, accompanied by movement of the TiSi2 layer into the substrate. In the second case, diffusion is dominated by the non-substrate species. This case is demonstrated by CoSi2, for which the development of steady-state etching occurs in two distinct stages which are strongly temperature-dependent. In this material, Co is the dominant diffusing species, and it is unclear whether or not Si GS occurs. What is clear, however, is that Ar+ bombardment at 500–600°C leads to partial decomposition of the CoSi2 layer and diffusion of Co towards the substrate Si, where new CoSi2 is formed. The combination of sputter etching and elevated temperature is shown to be a controllable environment for compound phase formation at a buried interface.
The temperature dependence of 300 eV argon ion sputtering of CoSi2 thin films in the range 50–600°C has been investigated. At temperatures above 400°C, the etch rate of CoSi2 on Si is significantly reduced, while the underlying Si reacts with the Co atoms diffusing from the silicide surface. As a result, the silicide layer effectively moves into the substrate during Ar bombardment. During sputtering of CoSi2 on Sio2, the thickness of the silicide layer decreases almost linearly with bombarding time until all the silicide is removed. Similar behavior is observed in low temperature sputtering of CoSi2 on (100) Si and evaporated Si. However, at elevated temperatures (400°C< <600°C), sputtering of CoSi2 on Si undergoes two consecutive stages. During the initial stage, the thickness of the silicide layer decreases at the same rate as that of the silicide on SiO2, and is accompanied by an enrichment in Co concentration near the surface. During the second stage, the etch rate of the silicide is reduced to only one third of the rate during the initial stage.
The thermally-induced Co/SixGe1-x reaction has been studied for a series of isochronal (25–600°C/20 min) and isothermal (600°C/u-240 min) annealing sequences using Rutherford backscattering spectrometry, transmission electron microscopy and sheet resistance measurements. Annealing at 600°C yields a reacted surface layer comprised of Si-rich CoSixGe1-x, Ge-rich SiyGe1-y and possibly CoSi2, with the two former constituents exhibiting a degree of epitaxial alignment with the substrate. The formation of Co/SiSixGe1-x alloys is discussed in terms of the ternary phase diagram.
Differential scanning calorimetry (DSC) has been used to study the temperatures, kinetics and phase formation mechanisms in Cu/Mg multilayer thin films. When the Cu:Mg layer thickness ratio was 1:4, CuMg2 was the only phase that formed. Cu/Mg films with a layer thickness ratio of 1:1 first form CuMg2 at 215°C with an activation energy of 1.0 ± 0.04 eV and then Cu2Mg at 380°C with an activation energy of 0.73 ± 0.04 eV. The temperatures at which the two phases form decrease as the layer thicknesses decrease due to the shorter reaction times needed in thinner films. The constant scan rate DSC data from films with a layer thickness ratio of 1:1 show three exothermic peaks. The first peak is extremely sharp and results from the formation of isolated nuclei of CuMg2 at the Cu/Mg interface. The formation of CuMg2 is thus shown to be nucleation controlled. The second peak is a growth peak due to the heat released during the growth of CuMg2. The third peak corresponds to the formation and growth of Cu2Mg.
Tungsten (W) films were deposited onto InP in a cold wall, rapid thermal low-pressure chemical vapor deposition (RT-LPCVD) reactor, from a tungsten hexafluoride (WF6) gas reduced by hydrogran (H2). W films of thickness 50 to 450 nm were deposited in the temperature range of 350° to 550°C, pressure range of 0.5 to 4.5 Torr and deposition rates up to 4 nm/sec with an apparent activation energy of about 1.12 eV. The film stress varied depending upon the deposition pressure, from low compressive for deposition at 0.5 Torr to moderate tensile for deposition at about 4.5 Torr. The films were aged at temperatures as high as 300°C for about 800 hr and exhibited an excellent mechanical stability. Post-deposition sintering of the W films at temperatures up to 600°C led to reduction of the resistivity with a minimum value of about 55μΩ-crn as a result of heating at 500°C. Conditions for both selective and blanket deposition were defined, and a dry etching process for further geometrical definitions of the films was developed, providing etch rates of 40 to 50 nm·sec-1. This report reflects the first attempt to deposit W films onto III-V semiconductor at a very high rate by means of RT-LPCVD.
A process has been developed for the deposition of patterned adherent metal on diamond substrates using low temperature processing conditions. CVD diamond films on Si wafers were oxidized with an RFO2 plasma and subsequently functionalized by attachment of self-assembled ultrathin films (UTFs) to the oxidized diamond surface. The UTFs were exposed to patterned deep UV radiation, and selectively metallized by electroless (EL) deposition. EL Ni and Co patterns, with feature sizes to 20 μm linewidth have been produced. Oxidized and UTF-modified surfaces were characterized by surface spectroscopie and wettability techniques. The EL metal deposits on the diamond substrate passed the Scotch tape adhesion peel test.
Picosecond ultrasonics is employed to study the titanium silicide formation sequence for evaporated Ti films on silicon substrates annealed at temperatures between 300 and 800 °C. The measurements show significant differences in the ultrasonic echo pattern before and after the structural phases C49 and C54 are formed, thus indicating that picosecond ultrasonics is a sensitive non-destructive probe of silicide formation. The longitudinal sound velocity has been found to be (8.3 ± 0.2) × 105 cm/sec for C49 TiSi2, and about 5% lower for the C54 phase.
The angle of incidence of ion bombardment is an important processing parameter, which can strongly affect the shape, composition and microstructure of bombarded surfaces. We describe several phenomena directly related to the angle of ion incidence during ion beam etching and ion beam assisted deposition. First, the development of surface ripple topography during ion beam etching is modeled. Surface perturbations are shown to grow under ion bombardment, while surface selfdiffusion acts to select a characteristic wavelength. The orientation of these characteristic ripples changes by 90° as the angle of ion incidence is varied from near-normal to near-glancing angle. The second example is the effect of angle of incidence on the etching rate of Ta under mixed Ar-O2 ion bombardment. For pure Ar bombardment, the sputtering yield of Ta increases with angle of ion incidence slower than secθ, producing a maximum etch rate at normal incidence. Above a critical pressure of O2, however, the yield increases faster than secθ dependence, producing a maximum etch rate at a non-normal angle of incidence. The third example is the effect of angle of incidence on the preferential sputtering of Al relative to Cu in Al-5% Cu thin films. Films deposited by evaporation with simultaneous Ar ion bombardment at 500 eV show a depletion of Al relative to Cu. This composition change is enhanced by increasing the angle of incidence away from normal, resulting in a higher Cu concentration in a film deposited on a tilted surface. Finally, a mechanism is described for the generation of oriented microstructure in films deposited under simultaneous glancing-angle ion bombardment, demonstrated previously for Nb. Grain orientations are selected which allow channelling of the ion beam. These results show that the shape, composition and microstructure of films deposited under ion bombardment respond to changes in angle of incidence, and that these effects need further study and modeling.
The results of our recent research on the ohmic contact formation mechanism in furnace alloyed Au/Te/Au/GaAs contacts are summarized, and preliminary Raman measurements on annealed Ge/Pd/GaAs structures are presented. The data and those reported in literature on the AuGe- and Ge/Pd- GaAs systems are argued to be more in agreement with the graded crystalline heterojunction concept (the formation of n+-Ge/GaAs, n+Ga2Te3/GaAs junctions) than with the doping model (the formation of n+-GaAs).