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We read with interest the recent editorial, “The Hennepin Ketamine Study,” by Dr. Samuel Stratton commenting on the research ethics, methodology, and the current public controversy surrounding this study.1 As researchers and investigators of this study, we strongly agree that prospective clinical research in the prehospital environment is necessary to advance the science of Emergency Medical Services (EMS) and emergency medicine. We also agree that accomplishing this is challenging as the prehospital environment often encounters patient populations who cannot provide meaningful informed consent due to their emergent conditions. To ensure that fellow emergency medicine researchers understand the facts of our work so they may plan future studies, and to address some of the questions and concerns in Dr. Stratton’s editorial, the lay press, and in social media,2 we would like to call attention to some inaccuracies in Dr. Stratton’s editorial, and to the lay media stories on which it appears to be based.
Ho JD, Cole JB, Klein LR, Olives TD, Driver BE, Moore JC, Nystrom PC, Arens AM, Simpson NS, Hick JL, Chavez RA, Lynch WL, Miner JR. The Hennepin Ketamine Study investigators’ reply. Prehosp Disaster Med. 2019;34(2):111–113
We assessed whether paternal demographic, anthropometric and clinical factors influence the risk of an infant being born large-for-gestational-age (LGA). We examined the data on 3659 fathers of term offspring (including 662 LGA infants) born to primiparous women from Screening for Pregnancy Endpoints (SCOPE). LGA was defined as birth weight >90th centile as per INTERGROWTH 21st standards, with reference group being infants ⩽90th centile. Associations between paternal factors and likelihood of an LGA infant were examined using univariable and multivariable models. Men who fathered LGA babies were 180 g heavier at birth (P<0.001) and were more likely to have been born macrosomic (P<0.001) than those whose infants were not LGA. Fathers of LGA infants were 2.1 cm taller (P<0.001), 2.8 kg heavier (P<0.001) and had similar body mass index (BMI). In multivariable models, increasing paternal birth weight and height were independently associated with greater odds of having an LGA infant, irrespective of maternal factors. One unit increase in paternal BMI was associated with 2.9% greater odds of having an LGA boy but not girl; however, this association disappeared after adjustment for maternal BMI. There were no associations between paternal demographic factors or clinical history and infant LGA. In conclusion, fathers who were heavier at birth and were taller were more likely to have an LGA infant, but maternal BMI had a dominant influence on LGA.
SNP in the vitamin D receptor (VDR) gene is associated with risk of lower respiratory infections. The influence of genetic variation in the vitamin D pathway resulting in susceptibility to upper respiratory infections (URI) has not been investigated. We evaluated the influence of thirty-three SNP in eleven vitamin D pathway genes (DBP, DHCR7, RXRA, CYP2R1, CYP27B1, CYP24A1, CYP3A4, CYP27A1, LRP2, CUBN and VDR) resulting in URI risk in 725 adults in London, UK, using an additive model with adjustment for potential confounders and correction for multiple comparisons. Significant associations in this cohort were investigated in a validation cohort of 737 children in Manchester, UK. In all, three SNP in VDR (rs4334089, rs11568820 and rs7970314) and one SNP in CYP3A4 (rs2740574) were associated with risk of URI in the discovery cohort after adjusting for potential confounders and correcting for multiple comparisons (adjusted incidence rate ratio per additional minor allele ≥1·15, Pfor trend ≤0·030). This association was replicated for rs4334089 in the validation cohort (Pfor trend=0·048) but not for rs11568820, rs7970314 or rs2740574. Carriage of the minor allele of the rs4334089 SNP in VDR was associated with increased susceptibility to URI in children and adult cohorts in the United Kingdom.
Access to transition-related medical interventions (TRMIs) for transgender veterans has been the subject of substantial public interest and debate. To better inform these important conversations, the current study investigated whether undergoing hormone or surgical transition intervention(s) relates to the frequency of recent suicidal ideation (SI) and symptoms of depression in transgender veterans.
This study included a cross-sectional, national sample of 206 self-identified transgender veterans. They self-reported basic demographics, TRMI history, recent SI, and symptoms of depression through an online survey.
Significantly lower levels of SI experienced in the past year and 2-weeks were seen in veterans with a history of both hormone intervention and surgery on both the chest and genitals in comparison with those who endorsed a history of no medical intervention, history of hormone therapy but no surgical intervention, and those with a history of hormone therapy and surgery on either (but not both) the chest or genitals when controlling for sample demographics (e.g., gender identity and annual income). Indirect effect analyses indicated that lower depressive symptoms experienced in the last 2-weeks mediated the relationship between the history of surgery on both chest and genitals and SI in the last 2-weeks.
Results indicate the potential protective effect that TRMI may have on symptoms of depression and SI in transgender veterans, particularly when both genitals and chest are affirmed with one's gender identity. Implications for policymakers, providers, and researchers are discussed.
Hearing loss can impair effective communication between caregivers and individuals with cognitive impairment. However, hearing loss is not often measured or addressed in care plans for these individuals. The aim of this study is to measure the prevalence of hearing loss and the utilization of hearing aids in a sample of individuals with cognitive impairment in a tertiary care memory clinic.
A retrospective review of 133 charts of individuals >50 years who underwent hearing assessment at a tertiary care memory clinic over a 12-month period (June 2014–June 2015) was undertaken. Using descriptive statistics, the prevalence of hearing loss was determined and associations with demographic variables, relevant medical history, cognitive status, and hearing aid utilization were investigated.
Results indicate that hearing loss is highly prevalent among this sample of cognitively impaired older adults. Sixty percent of the sample had at least a mild hearing loss in the better hearing ear. Among variables examined, age, MMSE, and medical history of diabetes were strongly associated with hearing impairment. Hearing aid utilization increased in concordance with severity of hearing loss, from 9% to 54% of individuals with a mild or moderate/severe hearing loss, respectively.
Hearing loss is highly prevalent among older adults with cognitive impairment. Despite high prevalence of hearing loss, hearing aid utilization remains low. Our study highlights the importance of hearing evaluation and rehabilitation as part of the cognitive assessment and care management plan in this vulnerable population.
Factors responsible for the onset of dislocation generation in the fields of localized high stresses have been studied in LOCOS-isolated test structures by means of preferential etching, junction leakage analysis, and computer simulation. A strong correlation between densities of stacking faults and dislocations was observed in the experiments. Defect distributions also correlated to leakage currents. 2D simulations of stresses, interstitial injection, and stacking fault growth during field oxidation showed that maximum resolved shear stress in the structures did not exceed the critical level for dislocation generation and that the agglomeration of silicon interstitial atoms did not play a notable role in dislocation nucleation. Dislocation and stacking fault formation was attributed to surface mechanical damage introduced during plasma processing.
The relatively poor efficiency of phosphor materials in cathodoluminescence with low accelerating voltages is a major concern in the design of field emission flat panel displays operated below 5 kV. Our research on rare-earth-activated phosphors indicates that mechanisms involving interactions of excited activators have a significant impact on phosphor efficiency. Persistence measurements in photoluminescence (PL) and cathodoluminescence (CL) show significant deviations from the sequential relaxation model. This model assumes that higher excited manifolds in an activator de-excite primarily by phonon-mediated sequential relaxation to lower energy manifolds in the same activator ion. In addition to sequential relaxation, there appears to be strong coupling between activators, which results in energy transfer interactions. Some of these interactions negatively impact phosphor efficiency by nonradiatively de-exciting activators. Increasing activator concentration enhances these interactions. The net effect is a significant degradation in phosphor efficiency at useful activator concentrations, which is exaggerated when low–energy electron beams are used to excite the emission.
We are studying carbon thin films by using a pulsed excimer laser to ablate pyrolytic graphite targets to form highly tetrahedral coordinated amorphous carbon (at-C) films. These films have been grown on room temperature p-type Si (100) substrates without the intentional incorporation of hydrogen. In order to understand and optimize the growth of at-C films, parametric studies of the growth parameters have been performed. We have also introduced various background gases (H2, N2 and Ar) and varied the background gas pressure during deposition. The residual compressive stress levels in the films have been measured and correlated to changes in the Raman spectra of the at-C band near 1565 cm−1. The residual compressive stress falls with gas pressure, indicating a decreasing atomic sp3-bonded carbon fraction. We find that reactive gases such as hydrogen and nitrogen significantly alter the Raman spectra at higher pressures. These effects are due to a combination of chemical incorporation of nitrogen and hydrogen into the film as well as collisional cooling of the ablation plume. In contrast, films grown in non-reactive Ar background gases show much less dramatic changes in the Raman spectra at similar pressures.
Highly tetrahedral-coordinated-amorphous-carbon (a-tC) films deposited by pulsed-laser deposition (PLD) on silicon substrates are studied. These films are grown at room-temperatures in a high-vacuum ambient. a-tC films grown in this manner have demonstrated stability to temperatures in excess of T = 1000°C, more than sufficient for any post-processing treatment or application. Film surfaces are optically smooth as determined both visually and by atomic-force microscopy. PLD growth parameters can be controlled to produce films with a range of sp2 - sp3 carbon-carbon bond ratios. Films with the highest yield of sp3 C-C bonds have high resistivity, with a dielectric permittivity constant s σ 4, measured capacitively at low frequencies (1 – 100 kHz). These a-tC films are p-type semiconductors as grown. Schottky barrier diode structures have been fabricated.
Carbon Nitride (CNX) films have been grown by ion-assisted pulsed-laser deposition (IAPLD). Graphite targets were laser ablated while bombarding the substrate with ions from a broad-beam Kaufman-type ion source. the ion voltage, current density, substrate temperature, and feed gas composition (N2 in ar) have been varied. the resultant films were characterized by Raman, Fourier transform infrared (FTIR), and Rutherford back scattering (RBS) spectroscopy.
Samples with -30% N/C ratio have been fabricated. the corresponding Raman and FTIR spectra indicate that nitrogen is incorporated into the samples by insertion into sp2-bonded structures. a low level of C=N triple bonds is also found. as the ion current and voltage are increased with a pure ar ion beam, Raman peaks associated with nanocrystalline graphite appear in the spectr A. adding low levels of nitrogen to the ion beam first reduces the Raman intensity in the vicinity of the graphite disorder peak without adding detectable amounts of nitrogen to the films (as measured by RBS). at higher nitrogen levels in the ion beam, significant amounts of nitrogen are incorporated into the samples, and the magnitude of the "disorder" peak increases. by increasing the temperature of the substrate during deposition, the broad peak due mainly to sp2-bonded C-N in the FTIR spectra is shifted to lower wavenumber. This could be interpreted as evidence of single-bonded C-N; however, it is more likely that the character of the sp2 bonding is changing.
We report the integration of six levels of Cu interconnects using dual inlaid patterning in a 0.2 μm logic technology. A review of process technology as well as device performance shortcomings using conventional aluminum metallization has been presented. Two tantalum based barriers, TaNx and Ta-Si-N as well as a titanium based barrier, CVD TiN, have been evaluated for their applicability. The use of embedded barriers wherein the barrier is formed below the surface of the dielectric has also been discussed as a potential option. No degradation to the device front-end parametrics were found with the choice of an appropriate barrier. Planarization by Cu CMP introduces surface topography that needs to be minimized in order to process multiple levels of interconnects within specified sheet resistance distributions for a range of line widths. Excellent results with highly planarized levels of metallization have consistently been achieved through an optimization of the unit processes and device integration.
Molecular modeling and dielectric measurements are being used to identify mechanisms governing piezoelectric behavior in polyimides such as dipole orientation during poling, as well as degree of piezoelectricity achievable. Molecular modeling on polyimides containing pendant, polar nitrile (CN) groups has been completed to determine their remanent polarization. Experimental investigation of their dielectric properties evaluated as a function of temperature and frequency has substantiated numerical predictions. With this information in hand, we are then able to suggest changes in the molecular structures, which will then improve upon the piezoelectric response.
We performed in-situ photoluminescence and Raman measurements on an anodized silicon surface in the HF/ethanol solution used for anodization. The porous silicon thereby produced, while resident in HF/ethanol, does not immediately exhibit intense photoluminescence. Intense photoluminescence develops spontaneously in HF/ethanol after 18–24 hours or with replacement of the HF/ethanol with water. These results support a quantum confinement mechanism in which exciton migration to traps and nonradiative recombination dominates the de-excitation pathways until silicon nanocrystals are physically separated and energetically decoupled by hydrofluoric acid etching or surface oxidation. The porous silicon surface, as produced by anodization, shows large differences in photoluminescence intensity and peak wavelength over millimeter distances. Parallel Raman measurements implicate nanometer-size silicon particles in the photoluminescence mechanism.
ITN Energy Systems, Inc., (ITN) and Global Solar Energy, Inc., (GSE) have continued the advancement of copper indium gallium diselenide (CIGS) production technology through the development of a number of activities, including fault-tolerant control, in-situ sensors, and process improvements, with the goal of enabling uninterrupted continuous manufacturing of high quality CIGS materials that are very sensitive to processing conditions. In this paper real-time sensor fault detection and diagnosis strategies developed by ITN and GSE to enable fault-tolerant controllers for thin-film CIGS deposition process are presented. The results indicate that these strategies are very effective and they would play a major role in improving system reliability, thereby also improving yield, throughput, and efficiency. Sensing process reconfiguration methodologies that lead to fault-tolerant controllers also are briefly discussed.
The characteristics of TNT (trinitrotoluene) crystals in the fracture surface of Composition B (a melt-cast mixture of TNT and RDX) have been studied using atomic force microscopy (AFM). The size of TNT crystals has been examined by analyzing the surface structure that is exhibited after mechanical failure of the Composition B. The failure occurs when the material is subjected to high acceleration in an ultracentrifuge and the shear or tensile strength is exceeded. AFM examination of the topography of the Composition B fracture surface reveals fracture across columnar grains of the TNT. The width of the columnar TNT grains ranges in size from ∼ 1 μm to ∼ 2 μm. Their height ranges in size from ∼ 50 nm to ∼ 300 nm. Flat TNT columns alternate with TNT columns containing river patterns that identify the direction of crack growth. Steps in the river patterns are a few nanometers in depth. The TNT constitutent fracture surface morphology is shown to occur on such fine scale, beginning from adjacent columnar crystals only 1–2 μm in width, and including river marking step heights of only a few nanometers, that AFM-type resolution is required.
The European rabbit flea Spilopsyllus cuniculi (Dale) was first released on Macquarie Island in December 1968. The flea has survived and bred on the island and about 30% of the rabbits sampled from the original release area in January 1972 were flea-infested.