We describe the investigations and management of a Cryptosporidium parvum outbreak of linked to consumption of pasteurised milk from a vending machine. Multiple locus variable number of tandem repeats analysis was newly used, confirming that C. parvum detected in human cases was indistinguishable from that in a calf on the farm. This strengthened the evidence for milk from an on-farm vending machine as the source of the outbreak because of post-pasteurisation contamination. Bacteriological indicators of post-pasteurisation contamination persisted after the initial hygiene improvement notice. We propose that on-farm milk vending machines may represent an emerging public health risk.

Introduction: Although use of point of care ultrasound (PoCUS) protocols for patients with undifferentiated hypotension in the Emergency Department (ED) is widespread, our previously reported SHoC-ED study showed no clear survival or length of stay benefit for patients assessed with PoCUS. In this analysis, we examine if the use of PoCUS changed fluid administration and rates of other emergency interventions between patients with different shock types. The primary comparison was between cardiogenic and non-cardiogenic shock types. Methods: A post-hoc analysis was completed on the database from an RCT of 273 patients who presented to the ED with undifferentiated hypotension (SBP <100 or shock index > 1) and who had been randomized to receive standard care with or without PoCUS in 6 centres in Canada and South Africa. PoCUS-trained physicians performed scans after initial assessment. Shock categories and diagnoses recorded at 60 minutes after ED presentation, were used to allocate patients into subcategories of shock for analysis of treatment. We analyzed actual care delivered including initial IV fluid bolus volumes (mL), rates of inotrope use and major procedures. Standard statistical tests were employed. Sample size was powered at 0.80 (α:0.05) for a moderate difference. Results: Although there were expected differences in the mean fluid bolus volume between patients with non-cardiogenic and cardiogenic shock, there was no difference in fluid bolus volume between the control and PoCUS groups (non-cardiogenic control 1878 mL (95% CI 1550 – 2206 mL) vs. non-cardiogenic PoCUS 1687 mL (1458 – 1916 mL); and cardiogenic control 768 mL (194 – 1341 mL) vs. cardiogenic PoCUS 981 mL (341 – 1620 mL). Likewise there were no differences in rates of inotrope administration, or major procedures for any of the subcategories of shock between the control group and PoCUS group patients. The most common subcategory of shock was distributive. Conclusion: Despite differences in care delivered by subcategory of shock, we did not find any significant difference in actual care delivered between patients who were examined using PoCUS and those who were not. This may help to explain the previously reported lack of outcome difference between groups.

Introduction: Point of care ultrasound has been reported to improve diagnosis in non-traumatic hypotensive ED patients. We compared diagnostic performance of physicians with and without PoCUS in undifferentiated hypotensive patients as part of an international prospective randomized controlled study. The primary outcome was diagnostic performance of PoCUS for cardiogenic vs. non-cardiogenic shock. Methods: SHoC-ED recruited hypotensive patients (SBP < 100 mmHg or shock index > 1) in 6 centres in Canada and South Africa. We describe previously unreported secondary outcomes relating to diagnostic accuracy. Patients were randomized to standard clinical assessment (No PoCUS) or PoCUS groups. PoCUS-trained physicians performed scans after initial assessment. Demographics, clinical details and findings were collected prospectively. Initial and secondary diagnoses including shock category were recorded at 0 and 60 minutes. Final diagnosis was determined by independent blinded chart review. Standard statistical tests were employed. Sample size was powered at 0.80 (α:0.05) for a moderate difference. Results: 273 patients were enrolled with follow-up for primary outcome completed for 270. Baseline demographics and perceived category of shock were similar between groups. 11% of patients were determined to have cardiogenic shock. PoCUS had a sensitivity of 80.0% (95% CI 54.8 to 93.0%), specificity 95.5% (90.0 to 98.1%), LR+ve 17.9 (7.34 to 43.8), LR-ve 0.21 (0.08 to 0.58), Diagnostic OR 85.6 (18.2 to 403.6) and accuracy 93.7% (88.0 to 97.2%) for cardiogenic shock. Standard assessment without PoCUS had a sensitivity of 91.7% (64.6 to 98.5%), specificity 93.8% (87.8 to 97.0%), LR+ve 14.8 (7.1 to 30.9), LR- of 0.09 (0.01 to 0.58), Diagnostic OR 166.6 (18.7 to 1481) and accuracy of 93.6% (87.8 to 97.2%). There was no significant difference in sensitivity (-11.7% (-37.8 to 18.3%)) or specificity (1.73% (-4.67 to 8.29%)). Diagnostic performance was also similar between other shock subcategories. Conclusion: As reported in other studies, PoCUS based assessment performed well diagnostically in undifferentiated hypotensive patients, especially as a rule-in test. However performance was similar to standard (non-PoCUS) assessment, which was excellent in this study.

In this paper new materials and substrate approaches are discussed which have potential to provide (Al)GaN buffers with a better crystal quality, higher critical electrical field, or thickness and have the potential to offer co-integration of GaN switches at different reference potentials, while maintaining lower wafer bow and maintaining complementary metal–oxide semiconductor (CMOS) compatibility. Engineered silicon substrates, silicon on insulator (SOI) and coefficient of thermal expansion (CTE)-matched substrates have been investigated and benchmarked with respect to each other. SOI and CTE-matched offer benefits for scaling to higher voltage, while a trench isolation process combined with an oxide interlayer substrate allows co-integration of GaN components in a GaN-integrated circuit (IC).

Introduction: Point of care ultrasound (PoCUS) has become an established tool in the initial management of patients with undifferentiated hypotension in the emergency department (ED). Current established protocols (e.g. RUSH and ACES) were developed by expert user opinion, rather than objective, prospective data. Recently the SHoC Protocol was published, recommending 3 core scans; cardiac, lung, and IVC; plus other scans when indicated clinically. We report the abnormal ultrasound findings from our international multicenter randomized controlled trial, to assess if the recommended 3 core SHoC protocol scans were chosen appropriately for this population. Methods: Recruitment occurred at seven centres in North America (4) and South Africa (3). Screening at triage identified patients (SBP<100 or shock index>1) who were randomized to PoCUS or control (standard care with no PoCUS) groups. All scans were performed by PoCUS-trained physicians within one hour of arrival in the ED. Demographics, clinical details and study findings were collected prospectively. A threshold incidence for positive findings of 10% was established as significant for the purposes of assessing the appropriateness of the core recommendations. Results: 138 patients had a PoCUS screen completed. All patients had cardiac, lung, IVC, aorta, abdominal, and pelvic scans. Reported abnormal findings included hyperdynamic LV function (59; 43%); small collapsing IVC (46; 33%); pericardial effusion (24; 17%); pleural fluid (19; 14%); hypodynamic LV function (15; 11%); large poorly collapsing IVC (13; 9%); peritoneal fluid (13; 9%); and aortic aneurysm (5; 4%). Conclusion: The 3 core SHoC Protocol recommendations included appropriate scans to detect all pathologies recorded at a rate of greater than 10 percent. The 3 most frequent findings were cardiac and IVC abnormalities, followed by lung. It is noted that peritoneal fluid was seen at a rate of 9%. Aortic aneurysms were rare. This data from the first RCT to compare PoCUS to standard care for undifferentiated hypotensive ED patients, supports the use of the prioritized SHoC protocol, though a larger study is required to confirm these findings.

Introduction: Point of care ultrasound (PoCUS) is an established tool in the initial management of patients with undifferentiated hypotension in the emergency department (ED). While PoCUS protocols have been shown to improve early diagnostic accuracy, there is little published evidence for any mortality benefit. We report the findings from our international multicenter randomized controlled trial, assessing the impact of a PoCUS protocol on survival and key clinical outcomes. Methods: Recruitment occurred at 7 centres in North America (4) and South Africa (3). Scans were performed by PoCUS-trained physicians. Screening at triage identified patients (SBP<100 or shock index>1), randomized to PoCUS or control (standard care and no PoCUS) groups. Demographics, clinical details and study findings were collected prospectively. Initial and secondary diagnoses were recorded at 0 and 60 minutes, with ultrasound performed in the PoCUS group prior to secondary assessment. The primary outcome measure was 30-day/discharge mortality. Secondary outcome measures included diagnostic accuracy, changes in vital signs, acid-base status, and length of stay. Categorical data was analyzed using Fishers test, and continuous data by Student T test and multi-level log-regression testing. (GraphPad/SPSS) Final chart review was blinded to initial impressions and PoCUS findings. Results: 258 patients were enrolled with follow-up fully completed. Baseline comparisons confirmed effective randomization. There was no difference between groups for the primary outcome of mortality; PoCUS 32/129 (24.8%; 95% CI 14.3-35.3%) vs. Control 32/129 (24.8%; 95% CI 14.3-35.3%); RR 1.00 (95% CI 0.869 to 1.15; p=1.00). There were no differences in the secondary outcomes; ICU and total length of stay. Our sample size has a power of 0.80 (α:0.05) for a moderate effect size. Other secondary outcomes are reported separately. Conclusion: This is the first RCT to compare PoCUS to standard care for undifferentiated hypotensive ED patients. We did not find any mortality or length of stay benefits with the use of a PoCUS protocol, though a larger study is required to confirm these findings. While PoCUS may have diagnostic benefits, these may not translate into a survival benefit effect.

Introduction: Point of Care Ultrasound (PoCUS) protocols are commonly used to guide resuscitation for emergency department (ED) patients with undifferentiated non-traumatic hypotension. While PoCUS has been shown to improve early diagnosis, there is a minimal evidence for any outcome benefit. We completed an international multicenter randomized controlled trial (RCT) to assess the impact of a PoCUS protocol on key resuscitation markers in this group. We report diagnostic impact and mortality elsewhere. Methods: The SHoC-ED1 study compared the addition of PoCUS to standard care within the first hour in the treatment of adult patients presenting with undifferentiated hypotension (SBP<100 mmHg or a Shock Index >1.0) with a control group that did not receive PoCUS. Scans were performed by PoCUS-trained physicians. 4 North American, and 3 South African sites participated in the study. Resuscitation outcomes analyzed included volume of fluid administered in the ED, changes in shock index (SI), modified early warning score (MEWS), venous acid-base balance, and lactate, at one and four hours. Comparisons utilized a T-test as well as stratified binomial log-regression to assess for any significant improvement in resuscitation amount the outcomes. Our sample size was powered at 0.80 (α:0.05) for a moderate effect size. Results: 258 patients were enrolled with follow-up fully completed. Baseline comparisons confirmed effective randomization. There was no significant difference in mean total volume of fluid received between the control (1658 ml; 95%CI 1365-1950) and PoCUS groups (1609 ml; 1385-1832; p=0.79). Significant improvements were seen in SI, MEWS, lactate and bicarbonate with resuscitation in both the PoCUS and control groups, however there was no difference between groups. Conclusion: SHOC-ED1 is the first RCT to compare PoCUS to standard of care in hypotensive ED patients. No significant difference in fluid used, or markers of resuscitation was found when comparing the use of a PoCUS protocol to that of standard of care in the resuscitation of patients with undifferentiated hypotension.

Introduction: Point of care ultrasonography (PoCUS) is an established tool in the initial management of hypotensive patients in the emergency department (ED). It has been shown rule out certain shock etiologies, and improve diagnostic certainty, however evidence on benefit in the management of hypotensive patients is limited. We report the findings from our international multicenter RCT assessing the impact of a PoCUS protocol on diagnostic accuracy, as well as other key outcomes including mortality, which are reported elsewhere. Methods: Recruitment occurred at 4 North American and 3 Southern African sites. Screening at triage identified patients (SBP<100 mmHg or shock index >1) who were randomized to either PoCUS or control groups. Scans were performed by PoCUS-trained physicians. Demographics, clinical details and findings were collected prospectively. Initial and secondary diagnoses were recorded at 0 and 60 minutes, with ultrasound performed in the PoCUS group prior to secondary assessment. Final chart review was blinded to initial impressions and PoCUS findings. Categorical data was analyzed using Fishers two-tailed test. Our sample size was powered at 0.80 (α:0.05) for a moderate effect size. Results: 258 patients were enrolled with follow-up fully completed. Baseline comparisons confirmed effective randomization. The perceived shock category changed more frequently in the PoCUS group 20/127 (15.7%) vs. control 7/125 (5.6%); RR 2.81 (95% CI 1.23 to 6.42; p=0.0134). There was no significant difference in change of diagnostic impression between groups PoCUS 39/123 (31.7%) vs control 34/124 (27.4%); RR 1.16 (95% CI 0.786 to 1.70; p=0.4879). There was no significant difference in the rate of correct category of shock between PoCUS (118/127; 93%) and control (113/122; 93%); RR 1.00 (95% CI 0.936 to 1.08; p=1.00), or for correct diagnosis; PoCUS 90/127 (70%) vs control 86/122 (70%); RR 0.987 (95% CI 0.671 to 1.45; p=1.00). Conclusion: This is the first RCT to compare PoCUS to standard care for undifferentiated hypotensive ED patients. We found that the use of PoCUS did change physicians’ perceived shock category. PoCUS did not improve diagnostic accuracy for category of shock or diagnosis.

Within the EURECA project (Towards self-sustainable EUropean REgional CAttle breeds), we interviewed a total of 371 farmers of 15 local cattle breeds in eight European countries. Besides collecting data on farmers, land use, herd composition and economic role of cattle, we aimed at understanding farmers' motives and values in keeping local cattle. The most frequent first reason to keep the local breed was productivity, followed by tradition. When comparing the local breed with a mainstream breed, only in four breeds was productivity considered the same, while in three breeds more than 50 percent of farmers valued the local breed as more profitable. The local breed was valued as always superior or the same on functional traits. Farmers were asked which type of appreciation they thought representatives of various stakeholders had on their local breed: a positive appreciation was observed in 33 percent of farmers. On average across breeds, 39 percent of farmers expect to increase the size of their herd in the next few years and 5 percent plan to give up farming. The degree of dependence of farmers on economic incentives was estimated by asking farmers their expected behaviour under three scenarios of change of subsidies. Most farmers demanded activities for promoting local breed farming. The results are discussed in terms of breed sustainability and conservation.

It is known that porous organosilicate glass (OSG) dielectrics tend to lose functional groups and become denser upon the chemical and physical action of the plasmas, but an accurate analysis and estimation of the depth and degree of film densification is not straightforward. In this study, we show that the combination of techniques like x-ray reflectivity, surface acoustic waves, and nanoindentation in depth-sensing and modulus mapping mode allow a complete and self-consistent physical analysis of the damage induced by the direct exposure of porous OSG films to different plasma ambients in reactive ion etching mode. We demonstrate for the chosen dielectric that the characteristics of the damage regions such as density and elastic modulus are very similar regardless of the reducing or oxidizing nature of the plasma. Nevertheless, the physical depth of the damage region shows large variation. Capabilities and limitations of each of the chosen analysis techniques are also discussed.

We measure the hydrostatic stress, uniaxial stress, and photo induced dependence of the channel conductance of two-dimensional electron gas AlGaN/GaN heterostructures grown on c-axis sapphire. The structures examined are grown by nitrogen-plasma molecular beam epitaxy and metal organic chemical vapor deposition. Electrical conductance measurements are made with four point probes on Hall bar samples. Both, hydrostatic stress and uniaxial stress result in changes in the conductance. Moreover, these changes in conductance have long settling times after the stress is applied and may be due to deep level defects, the energy levels of which change with stress. Stress coefficients extracted from the samples are partially attributed to deep level defects and to the piezoelectric effect resulting from different piezoelectric coefficients of GaN and AlN. Photo induced changes of the two-dimensional electron gas are also observed. We find that pulsed illumination produces long transient times in the conductance. These transients are reduced by thermal heating in some samples. However, they can still be present at 153°C.

Gallium nitride wafer epitaxy on large diameter substrates is critical for the future fabrication of large area UV linear or 2D imaging arrays, as well as for the economical production of other GaN-based devices. Typical group III-nitride deposition is now performed on 2-inch diameter or smaller sapphire substrates. Reported here are visible blind, UV GaN p-i-n photodetectors which have been fabricated on 3-inch diameter (0001) sapphire substrates by RF atomic nitrogen plasma MBE. The uniformity across the wafer of spectral responsivity and shunt resistance (R0) for the p-i-n photodetectors has been characterized. Spectral responsivity and 1/f noise as a function of temperature exceeding 250°C will be presented for the GaN p-i-n photodetectors. Spectral response with >0.17 A/W at peak wavelength and having 4-6 orders of magnitude visible rejection has been achieved. 1/f noise typically less than 10−14 A/Hz1/2 at room temperature also has been achieved with GaN p-i-n photodiodes. The results have been correlated with proposed models for dark current and 1/f noise in GaN diodes.

Gallium nitride wafer epitaxy on large diameter substrates is critical for the future fabrication of large area UV linear or 2D imaging arrays, as well as for the economical production of other GaN-based devices. Typical group III-nitride deposition is now performed on 2-inch diameter or smaller sapphire substrates. Reported here are visible blind, UV GaN p-in photodetectors which have been fabricated on 3-inch diameter (0001) sapphire substrates by RF atomic nitrogen plasma MBE. The uniformity across the wafer of spectral responsivity and shunt resistance (R0) for the p-i-n photodetectors has been characterized. Spectral responsivity and 1/f noise as a function of temperature exceeding 250°C will be presented for the GaN p-i-n photodetectors. Spectral response with >0.17 A/W at peak wavelength and having 4-6 orders of magnitude visible rejection has been achieved. 1/f noise typically less than 10-14 A/Hz1/2 at room temperature also has been achieved with GaN p-i-n photodiodes. The results have been correlated with proposed models for dark current and 1/f noise in GaN diodes.

A GaN/AlGaN heterojunction bipolar transistor has been fabricated using Cl2/Ar dry etching for mesa formation. As the hole concentration increases due to more efficient ionization of the Mg acceptors at elevated temperatures (> 250°C), the device shows improved gain. Future efforts should focus on methods for reducing base resistance, which are briefly summarized.

In-situ cathodoluminescence (CL) is presented as a technique to optimize GaN, and AlGaN films deposited by MBE using an RF plasma as a source of reactive nitrogen. Excitation of the MBE grown nitride films is conveniently achieved in the preparation chamber using an Auger electron gun. The photoemission is monitored through a side port and dispersed with a 1/8 m monochromator with a typical resolution of 3 nm. The in-situ CL spectra of AlGaN and GaN films provides quick determination of both material composition, doping, and quality from the position and width of the band edge emission. The use of CL for the assessment of material composition in the growth of nitride materials is extremely beneficial since the complementary technique of RHEED oscillations is not routinely observed for these systems. The determination of material quality using CL has been used to optimize growth conditions for GaN PIN junction photovoltaic detectors on (0001) sapphire. Detectors having peak responsivity of 0.175 AAV at the GaN band edge of 365 nm and a UV to visible rejection ratio of greater than 105 have been fabricated. The high rejection ratio is accredited to the reduction of the yellow defect levels in the MBE grown material. Material optimization using in-situ CL for growth of AlGaN MODFETs having drain currents of 425 ma/mm and gm of 66 mS/mm is discussed.

AlGaN photodiode detectors are grown on (0001) sapphire by RF atomic nitrogen plasma molecular beam epitaxy. Both individual detectors and 1 × 10 element arrays are fabricated. The individual detectors have active areas of 0.5 mm2, 1.0 mm2, and 2.0 mm2. Individual elements in the l × 10 detector arrays range in size from 250×250 μm to 450×450 μm. The detectors are fabricated using a chlorine-based reactive ion etch (RIE) and refractory metal ohmic contacts. At room temperature, GaN p-i-n photovoltaic detectors show peak responsivity at 360 nm as high as 0.198 A/W, corresponding to an internal quantum efficiency of 85%. These detectors also exhibit five orders of magnitude of rejection for radiation longer than 500 nm. The electrical and spectral characteristics of these detectors are examined at elevated temperatures. The short wavelength UV responsivity remains fairly constant at elevated temperatures, while the peak responsivity actually increases with increasing temperature. The smooth surface morphology of heavily doped p-type material grown by MBE makes possible diode structures with a p-type bottom layer. The effect of the spectrally broader p-type material in the photodiode responsivity will be discussed.

X-band performance, high temperature DC operation, and uniformity have been evaluated for 1 μm gate AlGaN/GaN HEMTs grown by RF atomic nitrogen plasma MBE. Deposition and fabrication were performed on 2-inch (0001) saphirre substrates to determine process uniformity. HEMTs with 300 μm total gate width and dual gate finger geometry have been fabricated with 650–700 cm2/V s mobility. Maximum frequency cut-offs on the order of of 8–10 were achieved. DC performance at room temperature was >500 mA/mm, and external transconductance was >70mS/mn. The transistors operated at test temperatures of 425°C.

We have investigated the influence of the deposition of a passivating silicon nitride layer on the electron transport in InAlAs/InGaAs/InAlAs quantum wells capped with a thin InGaAs layer. This structure is grown by Molecure Beam Epitaxy lattice-matched on InP substrates for the fabrication of High Electron Mobility Transistors. The InGaAs cap layer is added to reduce the ohmic contact resistance. In a first step to illuminate the complicated structural changes involved when passivating fully processed devices, we studied the influence of silicon nitride layer deposition on the virgin epilayers. The electrical transport properties were characterised by resistance, mobility, carrier concentration and magnetoresistance measurements, while Raman spectroscopy was used to probe the vibrational properties which are influenced by the free carriers. Because of the small penetration depth of the laser light mainly the lattice vibrations in the InGaAs ohmic contact layer were observed in the Raman spectra. Before passivation this thin highly doped cap layer is depleted, as confirmed by magnetoresistance measurements, that show a single conducting path in the two-dimensional electron gas formed in the InAlAs/InGaAs/InAlAs QW, and only bulk-like InGaAs phonons are observed in the cap layer. After passivation a shift to lower frequencies of the GaAs-like mode indicates a high electron concentration in the InGaAs cap. The results of the Raman analysis are in good agreement with the electrical transport data that show a considerably lower resistance after passivation. Magnetoresistance measurements on passivated layers confirmed the creation of an additional conducting path in the InGaAs cap layer introduced by the silicon nitride deposition process.

The Ge/Pd/n-GaAs ohmic contact structure constitutes a near-ideal model system to test the applicability of the different metal/GaAs ohmic contact models. After annealing, an atomically flat interface between the GaAs substrate and a regrown Ge layer is obtained. A main point of discussion is whether the ohmic conduction across this junction either occurs by an enhanced Ge-doping of the GaAs (regrown) substrate surface layers (the doping model), and/or by a degenerate As-doping ot the Ge overlayer (the heterojunction hypothesis). In order to examine the applicability of both models, a Raman study of this system is undertaken. By a backside thinning procedure, a metallization/60 nm GaAs structure is preserved, allowing for a backside optical analysis of the regrown Ge/GaAs interface region.

In this paper the electrical properties of epitaxial CoSi2 on Si obtained by solid-state reaction of a Ti/Co bimetallic layer are investigated. Low temperature resistivity, magnetoresistance and Hall data are presented. The CoSi2ISi Schottky diodes are characterised by current - voltage and capacitance - voltage measurements at temperatures varying between - 100°C and 60°C.