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This SHEA white paper identifies knowledge gaps and challenges in healthcare epidemiology research related to COVID-19 with a focus on core principles of healthcare epidemiology. These gaps, revealed during the worst phases of the COVID-19 pandemic, are described in 10 sections: epidemiology, outbreak investigation, surveillance, isolation precaution practices, personal protective equipment (PPE), environmental contamination and disinfection, drug and supply shortages, antimicrobial stewardship, healthcare personnel (HCP) occupational safety, and return to work policies. Each section highlights three critical healthcare epidemiology research questions with detailed description provided in supplemental materials. This research agenda calls for translational studies from laboratory-based basic science research to well-designed, large-scale studies and health outcomes research. Research gaps and challenges related to nursing homes and social disparities are included. Collaborations across various disciplines, expertise and across diverse geographic locations will be critical.
Objectives: The Tower of London (TOL) test has probably become the most often used task to assess planning ability in clinical and experimental settings. Since its implementation, efforts were made to provide a task version with adequate psychometric properties, but extensive normative data are not publicly available until now. The computerized TOL-Freiburg Version (TOL-F) was developed based on theory-grounded task analyses, and its psychometric adequacy has been repeatedly demonstrated in several studies but often with small and selective samples. Method: In the present study, we now report reliability estimates and normative data for the TOL-F stratified for age, sex, and education from a large population-representative sample collected in the Gutenberg Health Study in Mainz, Germany (n=7703; 40–80 years). Results: The present data confirm previously reported adequate indices of reliability (>.70) of the TOL-F. We also provide normative data for the TOL-F stratified for age (5-year intervals), sex, and education (low vs. high education). Conclusions: Together, its adequate reliability and the representative age-, sex-, and education-fair normative data render the computerized TOL-F a suitable diagnostic instrument to assess planning ability. (JINS, 2019, 25, 520–529)
This paper presents a fully-integrated direct-conversion fundamentally-operated mixer-first quadrature receiver module with a tunable LO in the 219–266 GHz band. It has been implemented in a 0.13-μm SiGe heterojunction bipolar transistor technology. It includes an on-chip LO path driven externally from the printed circuit board (PCB) connector level at 13.6–16.7 GHz. A hybrid coupler generates the quadrature LO signal, which drives a pair of double-balanced fundamentally-operated down-conversion mixers, whose RF ports are connected to a wideband lens-integrated on-chip ring antenna. The chip-on-lens assembly is placed in the recess of a high-speed PCB and wire-bonded. To compensate the inductive behavior of the wire-bond interconnection between the chip and the PCB at the high-speed IF outputs, an on-board 8-section step-impedance low-pass filter has been implemented. The module shows a 47 GHz 3-dB radio frequency/local oscillator operation bandwidth (BW), a peak conversion gain of 7.8 dB, a single-side-band noise figure of 11.3 dB, and a 3-dB IF BW of 13 GHz. The in-phase and quadrature amplitude imbalance stays below 1.58 dB for the 210–280 GHz band. The down-conversion and the baseband stages consume together 75.5 mW, while the LO path 378 mW. The maximum data-rate achieved with this receiver in combination with the transmitter presented in [1–3] is 60 Gbps for quadrature phase shift keying modulation.
Pb-based organometal halide perovskite solar cells have passed the threshold of 20 % power conversion efficiency (PCE). However, the main issues hampering commercialization are toxic Pb contained in these cells and their instability in ambient air. Therefore, great attention is devoted to replace Pb by Sn or Bi, which are less harmful and - in the case of Bi - also expected to yield enhanced stability. In literature, the most efficient hybrid organic-inorganic methylammonium bismuth iodide (MBI) perovskite solar cells reach PCE up to 0.2 %. In this work, we present spin-coated MBI perovskite solar cells and highlight the impact of the concentration of the perovskite solution on the layer morphology and photovoltaic (PV) characteristics. The solar cells exhibit open-circuit voltages of 0.73 V, which is the highest value published for this type of solar cell. The PCE increases from 0.004 % directly after processing to 0.17 % after 48 h of storage in air. 300 h after exposure to air, the cells still yield 56 % of their peak PCE and 84 % of their maximum open-circuit voltage.
Major depression and anxiety disorders are known to negatively influence cognitive performance. Moreover, there is evidence for greater cognitive decline in older adults with generalized anxiety disorder. Except for clinical studies, complex executive planning functions and subclinical levels of anxiety have not been examined in a population-based sample with a broad age range.
Planning performance was assessed using the Tower of London task in a population-based sample of 4240 participants aged 40–80 years from the Gutenberg Health Study (GHS) and related to self-reported anxiety and depression by means of multiple linear regression analysis.
Higher anxiety ratings were associated with lower planning performance (β = −0.20; p < 0.0001) independent of age (β = 0.03; p = 0.47). When directly comparing the predictive value of depression and anxiety on cognition, only anxiety attained significance (β = −0.19; p = 0.0047), whereas depression did not (β = −0.01; p = 0.71).
Subclinical levels of anxiety but not of depression showed negative associations with cognitive functioning independent of age. Our results demonstrate that associations observed in clinical groups might differ from those in population-based samples, also with regard to the trajectory across the life span. Further studies are needed to uncover causal interrelations of anxiety and cognition, which have been proposed in the literature, in order to develop interventions aimed at reducing this negative affective state and to improve executive functioning.
To determine the scope, source, and mode of transmission of a multifacility outbreak of extensively drug-resistant (XDR) Acinetobacter baumannii.
SETTING AND PARTICIPANTS
Residents and patients in skilled nursing facilities, long-term acute-care hospital, and acute-care hospitals.
A case was defined as the incident isolate from clinical or surveillance cultures of XDR Acinetobacter baumannii resistant to imipenem or meropenem and nonsusceptible to all but 1 or 2 antibiotic classes in a patient in an Oregon healthcare facility during January 2012–December 2014. We queried clinical laboratories, reviewed medical records, oversaw patient and environmental surveillance surveys at 2 facilities, and recommended interventions. Pulsed-field gel electrophoresis (PFGE) and molecular analysis were performed.
We identified 21 cases, highly related by PFGE or healthcare facility exposure. Overall, 17 patients (81%) were admitted to either long-term acute-care hospital A (n=8), or skilled nursing facility A (n=8), or both (n=1) prior to XDR A. baumannii isolation. Interfacility communication of patient or resident XDR status was not performed during transfer between facilities. The rare plasmid-encoded carbapenemase gene blaOXA-237 was present in 16 outbreak isolates. Contact precautions, chlorhexidine baths, enhanced environmental cleaning, and interfacility communication were implemented for cases to halt transmission.
Interfacility transmission of XDR A. baumannii carrying the rare blaOXA-237 was facilitated by transfer of affected patients without communication to receiving facilities.
Currently it is estimated that about 1 billion people globally have non-alcoholic fatty liver disease (NAFLD), a condition in which liver fat exceeds 5 % of liver weight in the absence of significant alcohol intake. Due to the central role of the liver in metabolism, the prevalence of NAFLD is increasing in parallel with the prevalence of obesity, insulin resistance and other risk factors of metabolic diseases. However, the contribution of liver fat to the risk of type 2 diabetes mellitus and CVD, relative to other ectopic fat depots and to other risk markers, is unclear. Various studies have suggested that the accumulation of liver fat can be reduced or prevented via dietary changes. However, the amount of liver fat reduction that would be physiologically relevant, and the timeframes and dose–effect relationships for achieving this through different diet-based approaches, are unclear. Also, it is still uncertain whether the changes in liver fat per se or the associated metabolic changes are relevant. Furthermore, the methods available to measure liver fat, or even individual fatty acids, differ in sensitivity and reliability. The present report summarises key messages of presentations from different experts and related discussions from a workshop intended to capture current views and research gaps relating to the points above.
We have investigated organic light emitting diode (OLED) backside contacting for the enhancement of luminance uniformity as a superior alternative to gridlines. In this approach, the low-conductivity OLED anode is supported by a high-conductivity auxiliary electrode and vertically contacted through via holes. Electrical simulations of large-area OLEDs have predicted that this method allows comparable luminance uniformity while sacrificing significantly less active area compared to the common gridline approach.
The method for fabricating backside contacts is comprised of five steps: (1) Thin-film encapsulation of the OLED, (2) Patterning of the OLED surface with lithography (resist mask defining via hole positions), (3) Via hole formation to the bottom anode by a plasma etching process, (4) Organic residues removal and sidewall insulation. (5) Contacting of the anode with a high-conductivity auxiliary electrode.
Backside-contacted OLEDs processed by organic vapor phase deposition show high luminance uniformity. Scanning electron microscopy pictures and electrical breakthrough measurements confirm efficient sidewall insulation.
Recently, organometal halide perovskite solar cells have passed the threshold of 20 % power conversion efficiency (PCE). While such PCE values of perovskite solar cells are already competitive to those of other photovoltaic technologies, processing of large-area devices is still a challenge. Most of the devices reported in literature are prepared by small-scale solution-based processing techniques (e.g. spin-coating). Perovskite solar cells processed by vacuum thermal evaporation (VTE), which show uniform layers and achieve higher PCE and better reproducibility, have also been presented. Regarding the co-evaporation of the perovskite constituents, this technology suffers from large differences in the thermodynamic characteristics of the two species. While the organic components evaporate instantaneously at room temperature at pressures in the range of 10−6 hPa, significantly higher temperatures are needed for reasonable deposition rates of the metal halide compound. In addition, hybrid vapor phase deposition techniques have been developed employing a carrier gas to deposit the organic compound on the previously solution-processed metal halide compound. Generally, vapor phase processes have proven to be a desirable choice for industrial large-area production. In this work, we present a setup for the direct chemical vapor phase deposition (CVD) of methylammonium lead iodide (MAPbI3) employing nitrogen as carrier gas. X-ray diffraction (XRD) and scanning electron microscopy (SEM) measurements are carried out to investigate the crystal quality and structural properties of the resulting perovskite. By optimizing the deposition parameters, we have produced perovskite films with a deposition rate of 30 nm/h which are comparable to those fabricated by solution processing. Furthermore, the developed CVD process can be easily scaled up to higher deposition rates and larger substrates sizes, thus rendering this technique a promising candidate for manufacturing large-area devices. Moreover, CVD of perovskite solar cells can overcome most of the limitations of liquid processing, e.g. the need for appropriate and orthogonal solvents.
We demonstrate Ag-free transparent OLED (TOLED) fabricated by organic vapor phase
deposition (OVPD) using thin Au contacts. Three types of TOLED devices have been
studied. The first one has been deposited on ITO substrates to compare thin Ag
and Au films as top cathodes. A 6-fold increase in operational lifetime
(LT50, 4 mA/cm2) from 27 h to 172 h can be observed
when replacing Ag by Au while maintaining similar electro-optical
characteristics. Furthermore, a second type of TOLED on thin Au films, replacing
ITO and suppressing laterally guided modes , has been studied. TOLED on ITO
substrates and on thin Au films exhibit very low onset voltages of 2.2 V. Both
types show about 30% transparency in the VIS light region and emit orange light
with a peak wavelength of 608 nm from either side with a total EQE of about 9%
(measured at 1000 cd/m2 in sum). The third type of TOLED was
fabricated with an inverted structure, with the aim to further increase
operational lifetime by burying the reactive LiF/Al electron injection layer
(EIL). This will make the EIL less accessible for oxygen and moisture. Our
results show difficulties in electron injection when depositing the organic
stack on Al/LiF, which may be attributed to an insufficient thermal activation
of the EIL.
To establish a statewide network to detect, control, and prevent the spread of carbapenem-resistant Enterobacteriaceae (CRE) in a region with a low incidence of CRE infection.
Implementation of the Drug Resistant Organism Prevention and Coordinated Regional Epidemiology (DROP-CRE) Network.
Setting and Participants.
Oregon infection prevention and microbiology laboratory personnel, including 48 microbiology laboratories, 62 acute care facilities, and 140 long-term care facilities.
The DROP-CRE working group, comprising representatives from academic institutions and public health, convened an interdisciplinary advisory committee to assist with planning and implementation of CRE epidemiology and control efforts. The working group established a statewide CRE definition and surveillance plan; increased the state laboratory capacity to perform the modified Hodge test and polymerase chain reaction for carbapenemases in real time; and administered surveys that assessed the needs and capabilities of Oregon infection prevention and laboratory personnel. Results of these inquiries informed CRE education and the response plan.
Of 60 CRE reported from November 2010 through April 2013, only 3 were identified as carbapenemase producers; the cases were not linked, and no secondary transmission was found. Microbiology laboratories, acute care facilities, and long-term care facilities reported lacking carbapenemase testing capability, reliable interfacility communication, and CRE awareness, respectively. Survey findings informed the creation of the Oregon CRE Toolkit, a state-specific CRE guide booklet.
A regional epidemiology surveillance and response network has been implemented in Oregon in advance of widespread CRE transmission. Prospective surveillance will determine whether this collaborative approach will be successful at forestalling the emergence of this important healthcare-associated pathogen.
Laser processing of thin-film silicon is a promising approach for the realization of polycrystalline silicon for large area electronics and solar cell applications. In this study we investigate the material modification of amorphous hydrogenated silicon (a-Si:H) with different hydrogen content (30%, 13% and <1%) by means of femtosecond (fs) laser pulses. Depending on the peak fluence applied, hydrogen diffusion/effusion, layer crystallization or material ablation can be achieved. Despite the low absorption coefficient of a-Si:H at the center wavelength of an amplified Titanium Sapphire laser at 790 nm a high local energy deposition close to the surface of the a-Si:H layer is observed, which can be attributed to a nonlinear absorption process.
We review the scientific literature, especially from the past decade, on the impacts of human activities on the Antarctic environment. A range of impacts has been identified at a variety of spatial and temporal scales. Chemical contamination and sewage disposal on the continent have been found to be long-lived. Contemporary sewage management practices at many coastal stations are insufficient to prevent local contamination but no introduction of non-indigenous organisms through this route has yet been demonstrated. Human activities, particularly construction and transport, have led to disturbances of flora and fauna. A small number of non-indigenous plant and animal species has become established, mostly on the northern Antarctic Peninsula and southern archipelagos of the Scotia Arc. There is little indication of recovery of overexploited fish stocks, and ramifications of fishing activity on bycatch species and the ecosystem could also be far-reaching. The Antarctic Treaty System and its instruments, in particular the Convention for the Conservation of Antarctic Marine Living Resources and the Environmental Protocol, provide a framework within which management of human activities take place. In the face of the continuing expansion of human activities in Antarctica, a more effective implementation of a wide range of measures is essential, in order to ensure comprehensive protection of the Antarctic environment, including its intrinsic, wilderness and scientific values which remains a fundamental principle of the Antarctic Treaty System. These measures include effective environmental impact assessments, long-term monitoring, mitigation measures for non-indigenous species, ecosystem-based management of living resources, and increased regulation of National Antarctic Programmes and tourism activities.
The Schistosoma mansoni protein, SPRM1lc, is a light chain member of a new family of heterodimeric amino acid
permeases. These proteins require covalent association with a type II glycoprotein (like h4F2hc) for functional surface
localization when expressed in Xenopus oocytes. We previously reported that, when co-expressed with h4F2hc, the
transport properties of SPRM1lc resemble system y and y+ while its human homologue, E16, functions as an L-type
permease. Here we extend the functional characterization of SPRM1lc in oocytes and show by competitor studies that its
amino acid transport capacity is similar to that of whole adult schistosomes. We demonstrate by Northern and Western
analysis that SPRM1lc is expressed within both larval and adult schistosomes. In all stages, SPRM1lc is associated into
a high molecular weight complex that can be disrupted by reducing agents, consistent with the hypothesis that a significant
fraction of the endogenous SPRM1lc is linked by a disulphide bond to an uncharacterized schistosome amino acid
transporter heavy chain. Immunofluorescence localization detects SPRM1lc in miracidia, daughter sporocysts and adult
worms. Confocal microscopy demonstrates that SPRM1lc is found in the apical membrane of the syncytial, double-lipid
bilayer tegument which surrounds adult worms. Aqueous biotinylation studies on living worms show that SPRM1lc is
exposed on the host-interactive surface of this tegumental membrane. Host exposed, functionally important surface
proteins such as SPRM1lc could form the basis of an effective schistosomiasis vaccine. These studies are the first to
describe a helminth amino acid transporter, and the first to characterize an invertebrate heterodimeric amino acid
The ZZ Ceti stars form a class of variable white dwarfs: the hydrogen dominated atmosphere ones, which do pulsate in an instability strip in the effective temperature range 13000K-11500K. We know 22 such ZZ Ceti white dwarfs. Their variations are caused by nonradial g-mode pulsations with periods are in the range 100-1000 seconds.
A subsample of the ZZ Ceti stars shows amplitude variations on time scales of the order of one month. These variations could be driven by nonlinear phenomena.
Perturbed Angular Correlation (PAC) and Hall measurements were used to investigate the stability of the passivating Cd-H complex in GaAs after low energy H implantation (150 eV, 1014 cm−2) at 300 K. From the observed Cd-H pair formation and reduction of hole concentration it is deduced that about 10 % of the implanted H atoms form pairs with the Cd atoms. The influence of the dopant depth profile on the apparent stability in zero bias isochronal annealing experiments is reported. After H loading a reduction of carrier mobility is observed, which is stable up to about 400 K. The formation of Cd-H pairs after low energy H implantation into InP was studied by PAC. By measuring the fraction of pairs in an isochronal annealing experiment, the stability of the pairs is deduced yielding a dissociation energy of ED = 1.8 (1) eV.
We report on the characterization of Low Temperature (LT) epitaxial growth of GaAs photoconductors. Samples were characterized using electro-optic sampling, transient femtosecond reflectivity, transmission electron microscopy, and pulsed terahertz spectroscopy as a function of growth temperature, As4 flux, doping and anneal conditions. We find the strongest effect on pulsewidth to be the temperature of an ex-situ rapid thermal anneal. In addition we find evidence of a temperature threshold for As precipitation. For more than an order of magnitude change in As precipitate density we find no corresponding change in electrical pulsewidth. Doping to 1017/cm3 also produces no change in the measured electrical response.
Measurements of the complex electric permitttivity for the Sm C* and for three highly ordered smectic phases: Sm I*, Sm J* and Sm K* of 4- (2 - methylbutyl)-phenyl-4′-(octyloxy)-(1,1′)-biphenyl-4-carboxylate (8 OSI) have been done in the frequency range from 5 Hz to 13 MHz. For the first three chiral phases the Goldstone mode was found with temperature independent critical frequencies, νc = 1.5kHz and the relaxation time τG = 106 μs - for the Sm C* phase, and νc = 1 kHz and τG - 160 μs - for the Sm I* one. In two highly ordered smectics, i.e. Sm J* and Sm K* with inter-layer correlations, the Goldstone mode seems to be suppressed. By applying a D.C. bias field of 1.4 kV/cm the Goldstone mode has been suppressed and shifted towards higher frequencies in both the Sm C* and Sm I* phase. For the Sm J* phase the Goldstone mode is very weak and practically insensitive to the bias field used. In the Sm K* phase there is no Goldstone mode like relaxation, and the only contribution to electric permittivity comes from the fast molecular motion connected with reorientation of molecules about their long axis.
A pilot production Zone-melting Recrystallization system was designed and built with a capability to handle 25 wafer batches of 4“, 5“and 6“wafers. The design addresses several production requirements including high throughput, batch processing and automation. Measurements on product wafers indicate that material quality was not sacrificed to achieve production throughput levels. Exceptional structural quality and good electrical properties have been obtained on SOI wafers produced within this system. Specifically, defect densities as low as 5 X 104 /cm2 a level an order of magnitude lower than previously reported, have been achieved while the minority carrier lifetime of up to 30 microseconds, intrinsic dopant level < 2 X 1015 /cm3 and junction leakage below 1 X 1016 amperes/cm2 are either as good as or better than previously reported values. We believe that defect free ZMR material will become a reality.