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To understand increasing rates of hepatitis C virus (HCV) infection in Tennessee, we conducted testing, risk factor analysis and a nested case–control study among persons who use drugs. During June–October 2016, HCV testing with risk factor assessment was conducted in sexually transmitted disease clinics, family planning clinics and an addiction treatment facility in eastern Tennessee; data were analysed by using multivariable logistic regression. A nested case–control study was conducted to assess drug-using risks and behaviours among persons who reported intranasal or injection drug use (IDU). Of 4753 persons tested, 397 (8.4%) were HCV-antibody positive. HCV infection was significantly associated with a history of both intranasal and IDU (adjusted odds ratio (aOR) 35.4, 95% confidence interval (CI) 24.1–51.9), IDU alone (aOR 52.7, CI 25.3–109.9), intranasal drug use alone (aOR 2.6, CI 1.8–3.9) and incarceration (aOR 2.7, CI 2.0–3.8). By 4 October 2016, 574 persons with a reported history of drug use; 63 (11%) were interviewed further. Of 31 persons who used both intranasal and injection drugs, 26 (84%) reported previous intranasal drug use, occurring 1–18 years (median 5.5 years) before their first IDU. Our findings provide evidence that reported IDU, intranasal drug use and incarceration are independent indicators of risk for past or present HCV infection in the study population.
The effects of shape and thickness of a tin surface layer and of the energy of a 170 ps neodymium:yttrium-aluminum-garnet laser pulse on the conversion efficiency (CE) into extreme ultraviolet emission in the 13.5 nm region is investigated. Whereas a CE of up to 1.16% into the 2% reflection band of multilayer Mo/Si optics was measured for a bulk Sn target at a laser energy of 25 mJ, significant CE enhancement up to 1.49% is demonstrated for a 200-nm-thick Sn layer on a microstructured porous alumina substrate.
With the UK population ageing, deciding upon a satisfactory and sustainable system for the funding of people’s long-term care (LTC) needs has long been a topic of political debate. Phase 1 of the Care Act 2014 (“the Act”) brought in some of the reforms recommended by the Dilnot Commission in 2011. However, the Government announced during 2015 that Phase 2 of “the Act” such as the introduction of a £72,000 cap on Local Authority care costs and a change in the means testing thresholds1 would be deferred until 2020. In addition to this delay, the “freedom and choice” agenda for pensions has come into force. It is therefore timely that the potential market responses to help people pay for their care within the new pensions environment should be considered. In this paper, we analyse whether the proposed reforms meet the policy intention of protecting people from catastrophic care costs, whilst facilitating individual understanding of their potential care funding requirements. In particular, we review a number of financial products and ascertain the extent to which such products might help individuals to fund the LTC costs for which they would be responsible for meeting. We also produce case studies to demonstrate the complexities of the care funding system. Finally, we review the potential impact on incentives for individuals to save for care costs under the proposed new means testing thresholds and compare these with the current thresholds. We conclude that:
∙Although it is still too early to understand exactly how individuals will respond to the pensions freedom and choice agenda, there are a number of financial products that might complement the new flexibilities and help people make provision for care costs.
∙The new care funding system is complex making it difficult for people to understand their potential care costs.
∙The current means testing system causes a disincentive to save. The new means testing thresholds provide a greater level of reward for savers than the existing thresholds and therefore may increase the level of saving for care; however, the new thresholds could still act as a barrier since disincentives still exist.
Prehospital care, including patient transport, is integral in the patient care process during the Ebola response. Transporting ill persons from the community to Ebola care facilities can stop community spread. Vehicles used for patient transport in infectious disease outbreaks should be evaluated for adequate infection prevention and control.
An ambulance driver in Sierra Leone attributed his Ebola infection to exposure to body fluids that leaked from the patient compartment to the driver cabin of the ambulance.
A convenience sample of 14 vehicles used to transport patients with suspected or confirmed Ebola in Sierra Leone were assessed. The walls separating the patient compartment and driver cabin in these vehicles were evaluated for structural integrity and potential pathways for body fluid leakage. Ambulance drivers and other staff were asked to describe their cleaning and decontamination practices. Ambulance construction and design standards from the National Fire Protection Association, US General Services Administration, and European Committee on Standardization (CEN) were reviewed.
Many vehicles used by ambulance staff in Sierra Leone were not traditional ambulances, but were pick-up trucks or sport-utility vehicles that had been assembled or modified for patient transport. The wall separating the patient compartment and driver cabin in many vehicles did not have a waterproof seal around the edges. Staff responsible for cleaning and disinfection did not thoroughly clean bulk body fluids with disposable towels before disinfection of the patient compartment. Pressure from chlorine sprayers used in the decontamination process may have pushed body fluids from the patient compartment into the driver cabin through gaps around the wall. Ambulance design standards do not require a waterproof seal between the patient compartment and driver cabin. Sealing the wall by tightening or replacing existing bolts is recommended, followed by caulking of all seams with a sealant.
Waterproof separation between the patient compartment and driver cabin may be essential for patient transport vehicles in infectious disease outbreaks, especially when chlorine sprayers are used for decontamination or in resource-limited settings where cleaning supplies may be limited.
CaseyML, NguyenDT, IdrissB, BennettS, DunnA, MartinS. Potential Exposure to Ebola Virus from Body Fluids due to Ambulance Compartment Permeability in Sierra Leone. Prehosp Disaster Med. 2015;30(6):625–627.
The emergence of invasive fungal wound infections (IFIs) in combat casualties led to development of a combat trauma-specific IFI case definition and classification. Prospective data were collected from 1133 US military personnel injured in Afghanistan (June 2009–August 2011). The IFI rates ranged from 0·2% to 11·7% among ward and intensive care unit admissions, respectively (6·8% overall). Seventy-seven IFI cases were classified as proven/probable (n = 54) and possible/unclassifiable (n = 23) and compared in a case-case analysis. There was no difference in clinical characteristics between the proven/probable and possible/unclassifiable cases. Possible IFI cases had shorter time to diagnosis (P = 0·02) and initiation of antifungal therapy (P = 0·05) and fewer operative visits (P = 0·002) compared to proven/probable cases, but clinical outcomes were similar between the groups. Although the trauma-related IFI classification scheme did not provide prognostic information, it is an effective tool for clinical and epidemiological surveillance and research.
Newell & Shanks (N&S) argue against the idea that any significant role for unconscious influences on decision making has been established by research to date. Inasmuch as this conclusion applies to the idea of an “intelligent cognitive unconscious,” we would agree. Our concern is that the article could lead the unwary to conclude that there are no unconscious influences on decision making – and never could be. We give reasons why this may not be the case.
EMU is a wide-field radio continuum survey planned for the new Australian Square Kilometre Array Pathfinder (ASKAP) telescope. The primary goal of EMU is to make a deep (rms ∼ 10 μJy/beam) radio continuum survey of the entire Southern sky at 1.3 GHz, extending as far North as +30° declination, with a resolution of 10 arcsec. EMU is expected to detect and catalogue about 70 million galaxies, including typical star-forming galaxies up to z ∼ 1, powerful starbursts to even greater redshifts, and active galactic nuclei to the edge of the visible Universe. It will undoubtedly discover new classes of object. This paper defines the science goals and parameters of the survey, and describes the development of techniques necessary to maximise the science return from EMU.
The passive film stability of several Fe-based amorphous metal formulations have been found to be comparable to that of high-performance Ni-based alloys, and superior to that of stainless steels, based on electrochemical measurements of the passive film breakdown potential and general corrosion rates. Chromium (Cr), molybdenum (Mo) and tungsten (W) provide corrosion resistance; boron (B) enables glass formation; and rare earths such as yttrium (Y) lower critical cooling rate (CCR). The high boron content of this particular amorphous metal also makes it an effective neutron absorber, and suitable for criticality control applications, as discussed in companion publications. Corrosion data for SAM2X5 (Fe49.7Cr17.7Mn1.9Mo7.4W1.6B15.2C3.8Si2.4) is discussed here.
Over extended periods, long-lived radionuclides (RN) or activation products within geologic disposal sites may be released from the fuel and migrate to the geo/biosphere. In the bedrock, contaminants will be transported along fractures by advection and retarded by sorption on mineral surfaces and by molecular diffusion into stagnant pore water in the matrix along a connected system of pores and micro-fissures.
The objective of this paper was to determine the connective porosity and mineral-specific porosities for three granite samples by 14C methylmethacrylate (14C-PMMA) autoradiography. Scanning electron microscopy and energy-dispersive X-ray analyses (FESEM/EDAX) were performed in order to study the pore apertures of porous regions in greater detail and to identify the corresponding minerals. Finally, the porosity results were used to evaluate the diffusion coefficients of RNs from previous experiments which determined apparent diffusion coefficients for the main minerals in three granite samples by the Rutherford Backscattering technique.
The total porosity of the Grimsel granite (0.75%) was significantly higher than the porosities of the El Berrocal and Los Ratones granites (0.3%). The porosities of the Grimsel granite feldspars were two to three times higher than the porosities of the El Berrocal and Los Ratones granites' feldspars. However, there was no significant difference between the porosities of the dark minerals. A clear difference was found between the various quartz grains. Quartz crystals were nonporous in the El Berrocal and Los Ratones granites when measured by the PMMA method, but the quartz crystals in the Grimsel granite showed 0.5% intra granular porosity. The apparent diffusion coefficients calculated for uranium diffusion within Grimsel granite on different minerals were very similar (210-13 ± 0.5 m2/s), but differences within both Spanish granites were found from one mineral to another (9 ± 110-14 m2/s in feldspars and 4.5 ± 0.510-14 m2/s in quartz) - always presenting lower diffusion values than in the Grimsel granite.
Major depressive disorder (MDD) is highly prevalent, is recurrent, and impairs people's work, relationships and leisure. Acute-phase treatments improve psychosocial impairment associated with MDD, but how these improvements occur is unclear. In this study, we tested the hypotheses that reductions in depressive symptoms exceed, precede and predict improvements in psychosocial functioning.
Patients with recurrent MDD (n=523; 68% women, 81% Caucasian, mean age 42 years) received acute-phase cognitive therapy (CT). We measured functioning and symptom severity with the Social Adjustment Scale – Self-Report (SAS-SR), Range of Impaired Functioning Tool (RIFT), Beck Depression Inventory (BDI), Hamilton Rating Scale for Depression (HAMD) and Inventory for Depressive Symptomatology – Self-Report (IDS-SR). We tested cross-lagged correlations between functioning and symptoms measured at baseline and the beginning, middle and end of acute-phase CT.
Pre- to post-treatment improvement in psychosocial functioning and depressive symptoms was large and intercorrelated. Depressive symptoms improved more and sooner than did psychosocial functioning. However, among four assessments across the course of treatment, improvements in functioning more strongly predicted later improvement in symptoms than vice versa.
Improvements in psychosocial functioning and depressive symptoms correlate substantially during acute-phase CT, and improvements in functioning may play a role in subsequent symptom reduction during acute-phase CT.
Three-dimensional (3D) battery architectures have emerged as a new direction for powering microelectromechanical systems and other small autonomous devices. Although there are few examples to date of fully functioning 3D batteries, these power sources have the potential to achieve high power density and high energy density in a small footprint. This overview highlights the various architectures proposed for 3D batteries, the advances made in the fabrication of components designed for these devices, and the remaining technical challenges. Efforts directed at establishing design rules for 3D architectures and modeling are providing insight concerning the energy density and current uniformity achievable with these architectures. The significant progress made on the fabrication of electrodes and electrolytes designed for 3D batteries is an indication that a number of these battery architectures will be successfully demonstrated within the next few years.
The effects of pulsed laser irradiation on silicon (111) single crystal thin samples were studied in a ultra-high vacuum transmission electron microscope. Samples were found to cleave along (110) planes under the laser beam. The formation of dislocation networks was also observed. The cleaving did not seem to originate from previously observed defect areas, but from random places, and is believed to be caused by thermal shock from laser beam heating. Bulk defects in the specimens, such as stacking fault tetrahedra and dislocations, were not observed to be affected by the laser treatment.
It is demonstrated by ultra-high vacuum transmission electron microscopy that subsurface dislocations and stacking faults strongly interact with the Au (001) (5×n) surface reconstruction. This effect is found in both bulk single crystal and thin fílm samples.
We investigate the evolution of the microstructure of a reconstructed Au (001) single crystal surface using ultra high vacuum transmission electron microscopy (UHV-TEM). Bulk single crystal Au (001) surfaces were prepared via standard metallographic techniques and sputter anneal cycles. After a clean surface was obtained, the (001) surface was found to reconstruct into two nearly orthogonal domains of dimensions (5 × ∼ 20 ) along the <110> directions of the unreconstructed F.C.C. (001) surface. Transmission electron diffraction patterns (TED) and dark field microscopy are the two primary techniques used to determine the symmetry and dimensions of the reconstructed surface.
Based on experimental findings obtained earlier by the authors , a model is devised in which the divergence of the vacancy flow created in the grain boundaries of Al-Si(1%) metallizations by high-density DC is attributed to temperature gradients and structural features. Void nuclei of critical size are created in areas of high vacancy concentration. These nuclei grow, fed by the electromigrational vacancy current. It is shown that stresses have only a negligible' effect on the vacancy diffusion but influence the nucleation process dramatically. Results expressed in terms of fraction of void area are calculated and then correlated with experimental results. Certain material parameters, whose values are not known, are derived from the experimental data. The physical significance of these parameters is discussed.
As integrated circuit sizes decrease below 0.25 microns, device performance will no longer improve at the same rate as for past generations because of RC interconnect delay which becomes significant as compared to the intrinsic gate delay. Parallel approaches to address this are to use a lower resistance metal (i.e., copper instead of aluminum) and to use a dielectric material with a dielectric constant significantly below that of dense silica (∼4). Recently, considerable progress has been made in development of thin films of nanoporous silica for these applications. Advantages include high thermal stability, small pore size, similarity to conventional spin-on deposition processes and spin-on glass precursors and final material (silica). The dielectric constant of nanoporous silica can be tailored between ∼1 and 3 which allows its’ implementation at multiple technology nodes in integrated circuit manufacture.
Recent development efforts have been focused on; 1) simpler and more reproducible deposition processes, 2) a more complete understanding of processing-property relationships for this material, 3) scale-up of manufacturing to yield a range of precursor products with stability for at least six months and very high purity, and 4) working with customers to integrate this material into both aluminum/gapfill and copper/damascene process flows. This paper targets several specific issues related to nanoporous silica use including water adsorption, pore size distribution control, processing at commercially viable throughputs, and obtaining thickness and dielectric uniformity across 200 mm wafers and wafer to wafer.
We present experimental results directed at understanding the growth and structure of metallic barrier layer and interconnect films. Numerical simulation results associated with this experimental work are presented in an accompanying paper in these proceedings. Here, thin films of Al, Ti, Cu and Ta have been grown by magnetron sputtering onto oxidized Si substrates. Using a specially-constructed substrate holder, the orientation of the substrate with respect to the growth direction was varied from horizontal to vertical. Films were grown at both low and high argon pressure; in the case of Ta, the cathode power was varied as well. The film structure and in particular the surface roughness was measured by X-ray reflectance and also by atomic force microscopy. We find that the surface roughness increases markedly with orientation angle in the case of Ta and Cu films, and in Ti films grown at high argon pressure. At low pressure, however, the Ti film surface roughness remains constant for all substrate orientations. No variation in roughness with either orientation angle or argon pressure was observed in the Al films. These results suggest that, under certain circumstances, shadowing effects and/or grain orientation (i.e., texture) competition during growth can give rise to lower density, more porous (and thus more rough) films, particularly at large orientation angles, as on sidewalls in sub-micron trenches.