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Introduction: Competence in procedural skills is vital within the emergency department. Challenging procedures such as cricothyroidotomy are difficult to master as they are rare and hard to train for. Additionally, common procedures such as chest tube insertions require practice to become sufficiently competent. Opportunities to hone these skills are essential in residency training. This project aimed to create instructional video modules for specific emergency medicine (EM) procedures and gauge their utility as adjunctive resources for procedural learning in the EM residency curriculum. Methods: Tutorial videos for clamshell thoracotomy, cricothyroidotomy, and chest tube insertion were filmed within a cadaver lab with step-by-step instructions. The footage was edited and overlaid with a pre-prepared audio narration using Camtasia®/Apple® Video Editing software. These videos were embedded within modules that included foundational knowledge relevant to the procedures, including anatomy, physiology and pathophysiology. The modules were peer-edited by licensed EM staff physicians and distributed to EM residents and staff physicians for analysis. Qualitative and quantitative analysis relied upon participants’ answers to questions and a Modified Task Value Scale, respectively. Results: Ten participants were included in the analysis, including EM residents (n = 6) and staff emergency physicians (n = 4). Qualitative feedback suggested that positive aspects of the modules included visuals, content, narration, and review of anatomy. Negative aspects included the lack of indications for procedures, technical details, real patient examples, and a speed up function. Quantitative feedback resulted in scores of 4 and above out of 5 on the Motivated Task Value Scale across all aspects for all the modules. Furthermore, analysis revealed an average score of 3.9 for inclination to access more modules such as these, and a score of 4.4 for overall perception of the modules. Conclusion: Participants found the video modules valuable to their learning, both qualitatively and quantitatively. This study was limited by a small sample size of modules and a low number of participants. Furthermore, a more detailed analysis with further measures, including self-efficacy and self-confidence, would yield more comprehensive conclusions. However, video-based modules provide an effective and easily accessible adjunctive tool to acquire skill and confidence with EM procedures, for medical learners and staff physicians.
Recent work has implicated one type of horizontal strabismus (exotropia) as a risk factor for schizophrenia. This new insight raises questions about a potential common developmental origin of the two diseases. Seasonality of births is well established for schizophrenia. Seasonal factors such as light exposure affect eye growth and can cause vision abnormalities, but little is known about seasonality of births in strabismus. We examined birth seasonality in people with horizontal strabismus in a retrospective study in Washoe County, Nevada, and re-examined similar previously obtained data from Osaka, Japan. We then compared seasonal patterns of births between strabismus, refractive error, schizophrenia and congenital toxoplasmosis. Patients with esotropia had a significant seasonality of births, with a deficit in March, then increasing to an excess in September, while patients with exotropia had a distinctly different pattern, with an excess of births in July, gradually decreasing to a deficit in November. These seasonalities were statistically significant with either χ2 or Kolmogorov–Smirnov-type statistics. The birth seasonality of esotropia resembled that for hyperopia, with an increase in amplitude, while the seasonality for myopia involved a phase-shift. There was no correlation between seasonality of births between strabismus and congenital toxoplasmosis. The pattern of an excess of summer births for people with exotropia was remarkably similar to the well-established birth seasonality of one schizophrenia subtype, the deficit syndrome, but not schizophrenia as a whole. This suggests a testable hypothesis: that exotropia may be a risk factor primarily for the deficit type of schizophrenia.
Here, we present initial results from the ALFABURST radio transient survey, which is currently running in a commensal mode with the ALFA receiver at the Arecibo telescope. We observed for a total of 1400 hours and have detected single pulses from known pulsars but did not detect any FRBs. The non-detection of FRBs is consistent with the current FRB sky rates.
Soybean is a leading oilseed crop in India, which contains about 40% of protein and 20% of oil. Core collection will accelerate the management and utilization of soybean genetic resources in breeding programmes. In the present study, eight agromorphological traits of 3443 soybean germplasm were analysed for the development of core collection using the principal component score (PCS) strategy and the power core method. The PCS strategy yielded core collection (CC1) of 576 accessions, which accounted for 16.72% of the entire collection (EC). The analysis based on the power core programme resulted in CC2 of 402 accessions, which accounted for 11.67% of the EC. Statistical analysis showed similar trends for the mean and range estimated in both core collections and EC. In addition, the variance, standard deviation and coefficient of variance were in general higher in core collections than in the EC. The correlations observed in the EC in general were preserved in core collections. A total of 311 and 137 unique accessions were found in CC1 and CC2 in addition to 265 accessions that were found to be common in both core collections. These 265 common accessions were the most diverse core sets, which accounted for 7.64% of the EC. We proposed to constitute an integrated core collection (ICC) by integrating both common and unique accessions. The ICC comprised 713 accessions, which accounted for about 20.62% of the EC. Statistical analysis indicated that the ICC captured maximum variation than CC1 and CC2. Therefore, the ICC can be extensively evaluated for a large number of economically important traits for the identification of desirable genotypes and for the development of mini core collection in soybean.
This study aimed to assess the prevalence and profile of ear diseases in children from Delhi, India.
A population-based cross-sectional door-to-door survey was carried out in two districts of Delhi, and involved children of all demographic sections of the region. A total of 4626 children aged between 18 days and 15 years underwent examinations including otoscopy, impedance audiometry and hearing screening.
In all, 14.8 per cent of the study sample was diagnosed with one or more ear morbidities, the most common being cerumen impaction (7.5 per cent) and chronic suppurative otitis media (3.6 per cent). There was clinical evidence of otitis media with effusion in 2 per cent of children, and 0.96 per cent had otitis externa (bacterial and fungal). The point prevalence of acute suppurative otitis media was 0.39 per cent. In all, 0.45 per cent of children were found to have an undiagnosed foreign body within the ear canal.
The high prevalence of ear disease poses a significant public health problem in Delhi.
Objective: To report the autosomal dominant inheritance of the Jervell and Lange-Nielsen syndrome in a highly inbred family, the initiation of Torsades de Pointes, and the natural history of the syndrome based on a 16-year follow-up of the kindred. Method: A family tree was constructed that included 66 blood relatives from three successive generations. Electrocardiograms were obtained from 59 living members including the proband, four members from a nuclear family, and 54 from the extended family. Evoked response audiometry was recorded for the proband and the nuclear family. All 59 family members were followed up regularly for 16 years. Results: A total of 24 living members were affected – QTc: 480–680 ms. The proband had long QTc, bilateral high-tone sensorineural deafness, recurrent syncope, and Torsades de Pointes. The asymptomatic father had long QTc and unilateral high-tone sensorineural deafness that involved specifically the left ear. One asymptomatic sibling of the proband had long QTc and normal hearing. The mother and another sibling were asymptomatic; QTc and hearing were normal in both. A total of 21 affected members from the extended family had only long QTc, and all were asymptomatic. There were three congenitally deaf first cousins who had recurrent syncope and adrenergic-triggered sudden death. In all, seven of 10 parents had consanguineous marriage to a first cousin. Each affected offspring had at least one affected parent. The severely symptomatic proband who received only β-blocker therapy and the 23 affected members without antiadrenergic therapy, all remained asymptomatic throughout the 16-year follow-up period. Conclusion: Jervell and Lange-Nielsen syndrome was inherited as autosomal dominant in this kindred. The majority of the affected members had a mild phenotype. The severity of auditory and cardiac phenotypes corresponded.
This paper details the development of a technique to improve the minority carrier lifetime of 4H-SiC thick (≥ 100 μm) n-type epitaxial layers through multiple thermal oxidations. A steady improvement in lifetime is seen with each oxidation step, improving from a starting ambipolar carrier lifetime of 1.09 µs to 11.2 µs after 4 oxidation steps and a high-temperature anneal. This multiple-oxidation lifetime enhancement technique is compared to a single high-temperature oxidation step, and a carbon implantation followed by a high-temperature anneal, which are traditional ways to achieve high ambipolar lifetime in 4H-SiC n-type epilayers. The multiple oxidation treatment resulted in a high minimum carrier lifetime of 6 µs, compared to < 2 µs for other treatments. The implications of lifetime enhancement to high-voltage/high-current 4H-SiC power devices are also discussed.
There is a considerable scarcity of reliable population-based data on the prevalence of preventable ear disorders in developing countries. This study was conducted to determine the prevalence of preventable ear disorders in primary school children (aged 5 to 12 years) in northern India.
A pro forma questionnaire was used to screen 15 718 primary school children in New Delhi for ear disorders. Ear examinations were conducted using otoscopy and impedance audiometry.
Impacted cerumen was prevalent in 7.93 per cent of schoolchildren, 4.79 per cent suffered from chronic otitis media and 3.06 per cent suffered from otitis media with effusion. Acute otitis media was detected in 0.65 per cent and foreign bodies were found in 0.34 per cent of the children.
Preventable ear diseases posed a significant health problem among children at primary school level. Regular screening of children during this stage would ensure that their school lives were not affected by hearing impairments or preventable ear disorders. Information gathered in this study will help in effective treatment prioritisation of ear disorders, planning and resource allocation.
Deep level majority and minority carrier traps in p+/n and n+/p junction diodes have been investigated. The junctions were fabricated on n- and p- type silicon which was intentionally and uniformly doped with heavy metals Cr, Fe, Ni, and Au during Czochralski crystal growth. The activation energies of the traps in these devices has been determined using a computer based Deep Level Transient Spectroscopy system which stores and analyzes entire capacitance-time transients. The capacitance-time data sets have been analyzed using the standard rate-window method as well as by a new algorithm which is able to test for the existence of a single exponential. The new algorithm has shown that only one of the ten traps measured contained a single exponential. Rate-window analysis of all the data sets, however, yielded energy levels based on the expectation of a single-exponential, despite the inherent non-exponentiality of the transients. Implications on the reliability of results obtained by the rate window method have been discussed. Possible reasons for the observed non-exponentiality in the data have been suggested based on a study of simulated data.
The present cross-sectional study was conducted to determine the vitamin D status of pregnant Indian women and their breast-fed infants. Subjects were recruited from the Department of Obstetrics, Armed Forces Clinic and Army Hospital (Research and Referral), Delhi. A total of 541 apparently healthy women with uncomplicated, single, intra-uterine gestation reporting in any trimester were consecutively recruited. Of these 541 women, 299 (first trimester, ninety-seven; second trimester, 125; third trimester, seventy-seven) were recruited in summer (April–October) and 242 (first trimester, fifty-nine, second trimester, ninety-three; third trimester, ninety) were recruited in winter (November–March) to study seasonal variations in vitamin D status. Clinical, dietary, biochemical and hormonal evaluations for the Ca–vitamin D–parathormone axis were performed. A subset of 342 mother–infant pairs was re-evaluated 6 weeks postpartum. Mean serum 25-hydroxyvitamin D (25(OH)D) of pregnant women was 23·2 (sd 12·2) nmol/l. Hypovitaminosis D (25(OH)D < 50 nmol/l) was observed in 96·3 % of the subjects. Serum 25(OH)D levels were significantly lower in winter in the second and third trimesters, while serum intact parathormone (iPTH) and alkaline phosphatase levels were significantly higher in winter in all three trimesters. A significant negative correlation was found between serum 25(OH)D and iPTH in mothers (r − 0·367, P = 0·0001) and infants (r − 0·56, P = 0·0001). A strong positive correlation was observed between 25(OH)D levels of mother–infant pairs (r 0·779, P = 0·0001). A high prevalence of hypovitaminosis D was observed in pregnancy, lactation and infancy with no significant inter-trimester differences in serum 25(OH)D levels.
We have synthesized nickel by means of pulsed laser ablation. A nickel disc was used for ablation with the focused output of fundamental harmonic from Nd:YAG laser. X-ray diffraction result shows that the synthesized nanoparticles are of pure metallic nickel with a face-centred cubic structure and the average particle size is 35 nm. The extended X-ray absorption fine structure (EXAFS) studies of pure nickel foil and the synthesized nanoparticles show similar structures. The position of the main peak is same in these nanoparticles with reference to the nickel foil. The only difference was observed in the reduction of the amplitude. The nearest-neighbour distance is similar as for pure nickel foil. The Debye–Waller factor is also similar. There is no trace of oxide and hydroxide in the EXAFS data, suggesting that the synthesized nanoparticles contain only nickel metal.
The effects of post-implant anneal conditions on the level of residual damage resulting from nitrogen and boron implants after different anneal processes are investigated using the Positron Annihilation Spectroscopy (PAS) technique. It is shown that after implantation there is a substantial defect concentration significantly below the range of the implants. However such damage is almost completely recovered after anneal in contrast with the damage close to the implant range point. Such residual damage has a strong effect on the electrical characteristics of double implanted bipolar transistors - principally though reduction in carrier mobility and lifetime. It is shown that the precise implant and anneal conditions play a strong role in the level of such damage and the subsequent electrical performance of bipolar devices.
We have investigated the structural and electrical properties of as-prepared and rapid thermal oxynitride films on C+ implanted solid phase epitaxially grown SiC. The oxynitride was grown using N2O. The C concentration of the samples was estimated to be 1, 2 and 5 at. %. From the infrared spectra, samples with 1 and 2 at. % carbon showed that the carbon was substitutionally incorporated into the silicon. No precipitation of SiC was detected. However, for the 5 at. % C sample, some precipitation was observed as indicated by a broad peak at ∼800 cm−1. The oxynitride films showed the Si-O-Si stretching mode at ∼1100 cm−1. The shoulder at 980–1067 cm−1 was due to the O-Si-N bond. The peak at 830 cm−1 was due to the Si-N and Si-C bonds and C-O complex vibrational mode was observed at 663 cm−1. Electrical characterization of the oxynitride films was carried out using the MOS capacitor structure. The interface state density was found to range between 5.7×1011 to 3.35×1012 cm−2eV−1 and increased with an increase in the C concentration. The electrical breakdown field was found to be in the range of 5–7 MV cm−1 and reduced with an increase in C concentration. The charge-to-breakdown value was measured and decreased with an increase in C concentration.
The point defect injection from arsenic precipitation was studied using boron marker layers and antimony doped superlattices. Comparisons of arsenic and germanium amorphizing implants showed similar boron marker layer diffusion enhancements after spike annealing. The results indicate that the end of range damage caused by the implants was the source of the diffusion enhancement. Additional annealing cycles showed that there was retardation in the diffusion enhancement of the boron marker layers for precipitation range arsenic implants. Antimony marker layers showed no diffusion enhancement due to vacancy injection. The results of the experiments indicate that arsenic-interstitial complexes are the cause of the decrease flux of interstitials to the bulk.
In the present work, we investigated sputtered titanium tungsten (TiW) contacts for Ohmic contacts to both n- and p-type 4H-SiC with long-term stability under high temperature (500°C).. Epitaxial layers with a doping concentration of 1.3×1019 and 6×1018 cm−3 were used. After high temperature annealing (>950°C) sputtered TiW contacts showed Ohmic behavior with good uniform distribution of the specific contact resistance. We obtained an average specific contact resistance (pc) of 4×10−5 Ωcm2 and 1.2 ∼ 1.7×10−4 Ωcm2 for p- and n-type, respectively from linear TLM measurement. We also found some variation of the specific contact resistance and the sheet resistance from our TLM measurement for p-type contacts. We will discuss this behavior with the measurement of SIMS. Long-term stability with a top-cap layer is also discussed
This paper describes the development of a nitrogen-based passivation technique for interface states near the conduction band edge [Dit(Ec)] in 4H-SiC/SiO2. These states have been observed and characterized in several laboratories for n- and p-SiC since their existence was first proposed by Schorner, et al. . The origin of these states remains a point of discussion, but there is now general agreement that these states are largely responsible for the lower channel mobilities that are reported for n-channel, inversion mode 4H-SiC MOSFETs. Over the past year, much attention has been focused on finding methods by which these states can be passivated. The nitrogen passivation process that is described herein is based on post-oxidation, high temperature anneals in nitric oxide. An NO anneal at atmospheric pressure, 1175°C and 200–400sccm for 2hr reduces the interface state density at Ec-E ≅0.1eV in n-4H-SiC by more than one order of magnitude - from > 3×1013 to approximately 2×1012cm−2eV−1. Measurements for passivated MOSFETs yield effective channel mobilities of approximately 30–35cm2/V-s and low field mobilities of around 100cm2/V-s. These mobilities are the highest yet reported for MOSFETs fabricated with thermal oxides on standard 4H-SiC and represent a significant improvement compared to the single digit mobilities commonly reported for 4H inversion mode devices. The reduction in the interface state density is associated with the passivation of carbon cluster states that have energies near the conduction band edge. However, attempts to optimize the the passivation process for both dry and wet thermal oxides do not appear to reduce Dit(Ec) below about 2×1012cm−2eV−1 (compared to approximately 1010cm−2eV−1 for passivated Si/SiO2). This may be an indication that two types of interface states exist in the upper half of the SiC band gap – one type that is amenable to passivation by nitrogen and one that is not. Following NO passivation, the average breakdown field for dry oxides on p-4H-SiC is higher than the average field for wet oxides (7.6MV/cm compared to 7.1MV/cm at room temperature). However, both breakdown fields are lower than the average value of 8.2MV/cm measured for wet oxide layers that were not passivated. The lower breakdown fields can be attributed to donor-like states that appear near the valence band edge during passivation.