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The aim of this paper is to examine Canadian key informants’ perceptions of intrapersonal (within an individual) and interpersonal (among individuals) factors that influence successful primary care and public health collaboration.
Primary health care systems can be strengthened by building stronger collaborations between primary care and public health. Although there is literature that explores interpersonal factors that can influence successful inter-organizational collaborations, a few of them have specifically explored primary care and public health collaboration. Furthermore, no papers were found that considered factors at the intrapersonal level. This paper aims to explore these gaps in a Canadian context.
This interpretative descriptive study involved key informants (service providers, managers, directors, and policy makers) who participated in one h telephone interviews to explore their perceptions of influences on successful primary care and public health collaboration. Transcripts were analyzed using NVivo 9.
A total of 74 participants [from the provinces of British Columbia (n=20); Ontario (n=19); Nova Scotia (n=21), and representatives from other provinces or national organizations (n=14)] participated. Five interpersonal factors were found that influenced public health and primary care collaborations including: (1) trusting and inclusive relationships; (2) shared values, beliefs and attitudes; (3) role clarity; (4) effective communication; and (5) decision processes. There were two influencing factors found at the intrapersonal level: (1) personal qualities, skills and knowledge; and (2) personal values, beliefs, and attitudes. A few differences were found across the three core provinces involved. There were several complex interactions identified among all inter and intra personal influencing factors: One key factor – effective communication – interacted with all of them. Results support and extend our understanding of what influences successful primary care and public health collaboration at these levels and are important considerations in building and sustaining primary care and public health collaborations.
Multidrug-resistant organisms (MDROs) are increasingly reported in residential care homes for the elderly (RCHEs). We assessed whether implementation of directly observed hand hygiene (DOHH) by hand hygiene ambassadors can reduce environmental contamination with MDROs.
From July to August 2017, a cluster-randomized controlled study was conducted at 10 RCHEs (5 intervention versus 5 nonintervention controls), where DOHH was performed at two-hourly intervals during daytime, before meals and medication rounds by a one trained nurse in each intervention RCHE. Environmental contamination by MRDOs, such as methicillin-resistant Staphylococcus aureus (MRSA), carbapenem-resistant Acinetobacter species (CRA), and extended-spectrum β-lactamse (ESBL)–producing Enterobacteriaceae, was evaluated using specimens collected from communal areas at baseline, then twice weekly. The volume of alcohol-based hand rub (ABHR) consumed per resident per week was measured.
The overall environmental contamination of communal areas was culture-positive for MRSA in 33 of 100 specimens (33%), CRA in 26 of 100 specimens (26%), and ESBL-producing Enterobacteriaceae in 3 of 100 specimens (3%) in intervention and nonintervention RCHEs at baseline. Serial monitoring of environmental specimens revealed a significant reduction in MRSA (79 of 600 [13.2%] vs 197 of 600 [32.8%]; P<.001) and CRA (56 of 600 [9.3%] vs 94 of 600 [15.7%]; P=.001) contamination in the intervention arm compared with the nonintervention arm during the study period. The volume of ABHR consumed per resident per week was 3 times higher in the intervention arm compared with the baseline (59.3±12.9 mL vs 19.7±12.6 mL; P<.001) and was significantly higher than the nonintervention arm (59.3±12.9 mL vs 23.3±17.2 mL; P=.006).
The direct observation of hand hygiene of residents could reduce environmental contamination by MDROs in RCHEs.
Evidence suggests that autism and schizophrenia share similarities in genetic, neuropsychological and behavioural aspects. Although both disorders are associated with theory of mind (ToM) impairments, a few studies have directly compared ToM between autism patients and schizophrenia patients. This study aimed to investigate to what extent high-functioning autism patients and schizophrenia patients share and differ in ToM performance.
Thirty high-functioning autism patients, 30 schizophrenia patients and 30 healthy individuals were recruited. Participants were matched in age, gender and estimated intelligence quotient. The verbal-based Faux Pas Task and the visual-based Yoni Task were utilised to examine first- and higher-order, affective and cognitive ToM. The task/item difficulty of two paradigms was examined using mixed model analyses of variance (ANOVAs). Multiple ANOVAs and mixed model ANOVAs were used to examine group differences in ToM.
The Faux Pas Task was more difficult than the Yoni Task. High-functioning autism patients showed more severely impaired verbal-based ToM in the Faux Pas Task, but shared similar visual-based ToM impairments in the Yoni Task with schizophrenia patients.
The findings that individuals with high-functioning autism shared similar but more severe impairments in verbal ToM than individuals with schizophrenia support the autism–schizophrenia continuum. The finding that verbal-based but not visual-based ToM was more impaired in high-functioning autism patients than schizophrenia patients could be attributable to the varied task/item difficulty between the two paradigms.
Improving neurocognitive outcomes following treatment for brain metastases have become increasingly important. We propose that a brief telephone-based neurocognitive assessment may improve follow-up cognitive assessments in this palliative population. Aim: To prospectively assess the feasibility and reliability of a telephone based brief neurocognitive assessment compared to the same tests delivered face-to-face. Methods: Brain metastases patients to be treated with whole brain radiotherapy (WBRT) were assessed using a brief validated neurocognitive battery at baseline, at 1 month and 3 months following WBRT (in person and over the phone). The primary outcome was feasibility and inter-procedural (in person versus telephone) reliability. The secondary objective was to evaluate the change in neurocognitive function before and after WBRT. Results: Out of 39 patients enrolled, 82% of patients completed the baseline in-person and telephone neurocognitive assessments. However, at 1 month, only 41% of enrolled patients completed the in-person and telephone cognitive assessments and at 3 months, only 10% of patients completed them. Results pertaining to reliability and change in neurocognitive function will be updated. Conclusion: The pre-defined definition of feasibility (at least 80% completion for face to face and telephone neurocognitive assessments) was met at baseline. However, a large proportion of participants did not complete either telephone or in person neurocognitive follow-up at 1 month and at 3 months post-WBRT. Attrition remained a challenge for neurocognitive testing in this population even when a telephone-based brief assessment was used.
During the past three years radiocarbon assay has emerged as a primary tool in the quantitative assignment of sources of urban and rural particulate pollution. Its use in several major field studies has come about because of its excellent (fossil/biogenic) discriminating power, because of advances in 14C measurements of small samples, and because of the increased significance of carbonaceous particles in the atmosphere. The problem is especially important in the cities, where increased concentrations of fine particles lead to pollution episodes characterized by poor visibility and changes in the radiation balance (absorption, scattering), and immediate and possibly long-term health effects. Efforts in source apportionment in such affected areas have been based on emissions inventories, dispersion modeling, and receptor modeling – ie, chemical and physical (and statistical) characterization of particles collected at designated receptor sites. It is in the last category that 14C has become quite effective in helping to resolve particle sources. Results are presented for studies carried out in Los Angeles, Denver, and Houston which incorporated 14C measurements, inorganic and organic chemical characterization, and receptor modeling. The 14C data indicated wide ranging contributions of biogenic and fossil carbon sources – eg, <10% to 60% contemporary (biogenic) in Houston – depending on meteorological, biological, and anthropological activity. The combined (chemical, isotopic, statistical) data point to sources such as vehicles, wood combustion, power plants, and vegetation.
Carbapenem-resistant Acinetobacter baumannii (CRAB) with diverse multilocus sequence typing emerged among our nursing home residents (6.5%) with a high background rate of MRSA (32.2%). Rectal swabs yielded a higher rate of CRAB detection than axillary or nasal swabs. Bed-bound status, use of adult diapers, and nasogastric tube were risk factors for CRAB colonization.
During the early stage of an epidemic, timely and reliable estimation of the severity of infections are important for predicting the impact that the influenza viruses will have in the population. We obtained age-specific deaths and hospitalizations for patients with laboratory-confirmed H1N1pdm09 infections from June 2009 to December 2009 in Hong Kong. We retrospectively obtained the real-time estimates of the hospitalization fatality risk (HFR), using crude estimation or allowing for right-censoring for final status in some patients. Models accounting for right-censoring performed better than models without adjustments. The risk of deaths in hospitalized patients with confirmed H1N1pdm09 increased with age. Reliable estimates of the HFR could be obtained before the peak of the first wave of H1N1pdm09 in young and middle-aged adults but after the peak in the elderly. In the next influenza pandemic, timely estimation of the HFR will contribute to risk assessment and disease control.
To identify predictive factors and mortality of patients with influenza admitted to intensive care units (ICU) we carried out a prospective cohort study of patients hospitalized with laboratory-confirmed influenza in adult ICUs in a network of Canadian hospitals between 2006 and 2012. There were 626 influenza-positive patients admitted to ICUs over the six influenza seasons, representing 17·9% of hospitalized influenza patients, 3·1/10 000 hospital admissions. Variability occurred in admission rate and proportion of hospital influenza patients who were admitted to ICUs (proportion range by year: 11·7–29·4%; 21·3% in the 2009–2010 pandemic). In logistic regression models ICU patients were younger during the pandemic and post-pandemic period, and more likely to be obese than hospital non-ICU patients. Influenza B accounted for 14·2% of all ICU cases and had a similar ICU admission rate as influenza A. Influenza-related mortality was 17·8% in ICU patients compared to 2·0% in non-ICU patients.
Chromoblastomycosis is a chronic fungal infection of the skin and subcutaneous tissue that most commonly affects the feet and lower limbs. It is rare for this infection to occur on the face, and it is exceptionally rare for it to involve the nose and sinuses. This paper reports a rare case of nasal chromoblastomycosis in a 50-year-old Malaysian male.
The patient, who was a rubber plantation worker in the southern state of Johor, presented to the ENT clinic with a history of epistaxis. He did not recall any history of injury to the nose. Nasal endoscopy showed a pale yellowish lesion at the inferior edge of the left middle turbinate. Histology revealed that this was a case of chromoblastomycosis.
Chromoblastomycosis of the nasal cavity is very rare and can be mistaken for other granulomatous conditions in the nose. It progresses very slowly over many years. Our patient was managed conservatively, as he was not keen on undergoing surgical intervention. Lesion size remained the same at five months' follow up, with no recurrence of epistaxis.
Continued monitoring of the seriousness of influenza viruses is a public health priority. We applied time-series regression models to data on cardio-respiratory mortality rates in Hong Kong from 2001 to 2011. We used surveillance data on outpatient consultations for influenza-like illness, and laboratory detections of influenza types/subtypes to construct proxy measures of influenza activity. In the model we allowed the regression coefficients for influenza to drift over time, and adjusted for temperature and humidity. The regression coefficient for influenza A(H3N2) increased significantly in 2005. The regression coefficients for influenza A(H1N1) and B were relatively stable over the period. Our model suggested an increase in seriousness of A(H3N2) in 2005, the year after the appearance of the A/Fujian/411/2002(H3N2)-like virus when the drifted A/California/7/2004(H3N2)-like virus appeared. Ongoing monitoring of mortality and influenza activity could permit identification of future changes in seriousness of influenza virus infections.
For over three decades, bone conduction hearing aids have been changing the lives of patients with impaired hearing. The size, appearance and fitting discomfort of early generations of bone conduction hearing aids made them unpopular. The advent of bone-anchored hearing aids in the 1970s offered patients improved sound quality and fitting comfort, due to the application of osseointegration. However, the issue of post-operative peri-abutment pin tract wound infection persisted. The Bonebridge system incorporates the first active bone conduction device, and aims to resolve peri-abutment issues. Implantation of this system in an Asian patient is presented.
Aluminum (Al) gate fill has been implemented in Replacement Metal Gate (RMG) due to its low resistivity. Titanium (Ti) has been widely used as wetting layer for Al to fill the gates. For low resistance gate fill in structures with small feature size and high aspect ratio, Ti-Al metal fill becomes increasingly more challenging as we move from 20nm into 14nm FinFET and 3D type structures.
Cobalt (Co) is a good wetting film for Al with better fill performance and lower resistance than Ti-Al based process. However, due to the difference in corrosion potential between Al and Co, Chemical Mechanical Planarization (CMP) creates pitting type defects on Al-Co film that increases resistance variability across pattern density. CMP induced corrosion is separated in two parts; first is the static Co corrosion happened in the acidic chemical environment in the Al slurry. Second is the galvanic corrosion from Co-Al metal boundary due to high metal electrical potential. Static corrosion can be resolved by adding a Co corrosion inhibitor in the slurry formulation1. Galvanic corrosion can be minimized by controlling Co thickness deposition and formation of complete intermetallic phase. By controlling the removal rate with respect to corrosion rate we were able to suppress corrosion significantly.
We looked into compositions where the corrosion potential (Ecorr) gap between Al and Co is reduced to ≤10mV leading to reduced galvanic currents. Stabilization of the corrosion currents in both Al and Co was observed using potentiodynamic scans. The effect of pH, several oxidizers and additives on the open circuit potentials (Eoc) of Al and Co was investigated and it was found that solutions of KMnO4, saccharides and sulfonate group containing compounds help reduce the Ecorr gap in between Al and Co to ∼10 mV.
Controlling the Al gate height across pattern densities and gate lengths to within few nm is another challenge for Al CMP. The industry widely used approach is to clear all Al using a slurry with high selectivity to dielectric, followed by a CMP step using a non-selective Al-to-oxide slurry. Both polishing steps need to be optimized in parallel in order to remove the incoming spacer SiN divot, minimize Al loss on gates with high pattern density or long gate length, minimize oxide loss on large open areas while maintaining low defectivity.
In this paper we are presenting an innovate Al CMP process that demonstrated low gate resistance with tight distribution up to 80% pattern density. This work has been supported by the independent Bulk CMOS and SOI technology development projects at the IBM Microelectronics Division Semiconductor Research & Development Center, Hopewell Junction, NY 12533.
The cold, dry, and stable air above the summits of the Antarctic plateau provides the best ground-based observing conditions from optical to sub-millimetre wavelengths to be found on the Earth. Pathfinder for an International Large Optical Telescope (PILOT) is a proposed 2 m telescope, to be built at Dome C in Antarctica, able to exploit these conditions for conducting astronomy at optical and infrared wavelengths. While PILOT is intended as a pathfinder towards the construction of future grand-design facilities, it will also be able to undertake a range of fundamental science investigations in its own right. This paper provides the performance specifications for PILOT, including its instrumentation. It then describes the kinds of projects that it could best conduct. These range from planetary science to the search for other solar systems, from star formation within the Galaxy to the star formation history of the Universe, and from gravitational lensing caused by exo-planets to that produced by the cosmic web of dark matter. PILOT would be particularly powerful for wide-field imaging at infrared wavelengths, achieving near diffraction-limited performance with simple tip–tilt wavefront correction. PILOT would also be capable of near diffraction-limited performance in the optical wavebands, as well be able to open new wavebands for regular ground-based observation, in the mid-IR from 17 to 40 μm and in the sub-millimetre at 200 μm.
The use of the stapes coupling technique, employed in the Vibrant Soundbridge system, is technically less demanding than the vibroplasty technique, and is more likely to generate a positive outcome without significantly changing residual hearing or resulting in medical or surgical complication.
We report a patient with repeated left ossiculoplasty failure, who was successfully implanted with a Vibrant Soundbridge.
We believe that the stapes coupling technique can provide natural stimulation to the inner ear, resulting in a better perceived sound quality.
The interplay of melting equilibria and reaction kinetics is important during formation of the Ba2YCu3O6+x (Y-213) phase from starting materials in the quaternary reciprocal system Ba,Y,Cu//O,F. For experimental investigation of the process we used a combination of differential thermal analysis (DTA) for study of melting equilibria, and in-situ high-temperature x-ray diffraction (HTXRD) for study of the phase formation and reaction kinetics. DTA investigation of compositions spaced along compositional vectors extending from the oxide end to the fluoride end of the reciprocal system have given evidence of low melting liquids (∼600 °C) near the fluorine-rich end. Work is continuing to determine whether similar thermal events observed in the interior of the system also indicate low temperature liquids, and on the extent to which low-melting liquids could be involved in Y-213 phase formation. HTXRD investigations have been initiated on the conversion of 0.3 μm and 1.0 μm thick BaF2-Y-Cu precursor films to Y-213 in the presence of water vapor. Preliminary results indicated that the thickness of film has a strong influence on the texture of the Y-213 film: a 0.3 μm film showed mainly (001) texture, whereas a 1.0 μm film showed a greater volume fraction of (h00) texture. While the HTXRD method cannot directly reveal the presence of liquid, we are working to combine DTA and HTXRD data for a unified picture of Y-213 phase formation during the “BaF2 ex-situ” process for coated-conductor fabrication.
This paper presents UV imaging results for a 256×256 AlGaN Focal Plane Array that uses a back-illuminated AlGaN heterostructure p-i-n photodiode array, with 30×30 μm2 unit cells, operating at zero bias voltage, with a narrow-band UV response between 310 and 325 nm. The 256×256 array was fabricated from a multilayer AlGaN film grown by MOCVD on a sapphire substrate. The UV response operability (>0.4×average) was 94.8%, and the UV response uniformity (σ/μ) was 16.8%. Data are also presented for back-illuminated AlGaN p-i-n photodiodes from other films with cutoff wavelengths ranging between 301 and 364 nm. Data for variable-area diagnostic arrays of p-i-n AlGaN photodiodes with a GaN absorber (cutoff=364 nm) show: (1) high external quantum efficiency (50% at V=0 and 62% at V=-9 V); (2) the dark current is proportional to junction area, not perimeter; (3) the forward and reverse currents are uniform (σ/μ=50% for forty 30×30 μm2 diodes at V=−40 V); (4) the reverse-bias dark current data versus temperature and bias voltage can be fit very well by a hopping conduction model; and (5) capacitance versus voltage data are consistent with nearly full depletion of the unintentionally-doped 0.4 μm thick GaN absorber layer and imply a donor concentration of 3-4×1016 cm−3.
Processable polymeric nonlinear optical materials can be synthesized by functionalizing a glassy macromolecule with chromophores having large quadratic hyperpolarizabilities, followed by poling in an electric field. In the present case, the functionalization of polystyrene with 4- (4-nitrophenylaza)(N-ethyl)(2-hydroxyethyl))aniline, 4-(4-N,N-dimethylaminostyryl) pyridine, and N-(4-nitrophenyl)-L-prolinol is described. Particularly noteworthy is the high level of chromophore units that can be incorporated into transparent films of these materials, the high second harmonic coefficients that can be achieved (as high as d33 – 11 × 10-9 esu at 1064 nm), and the long-term temporal stability of the second harmonic generation capacity.