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To evaluate the utility and impact of using a declination form in the context of an influenza immunization program for healthcare workers.
A combined form for documentation of vaccination consent, medical contraindication(s) for vaccination, or vaccination declination was used during the 2006-2007 influenza season in a healthcare system employing approximately 9,200 nonphysician employees in 3 hospitals; a skilled nursing care facility; a large, multisite, faculty-practice plan; and an administrative building. Responses were entered into a database that contained files from human resources departments, which allowed correlation with job category and work location.
The overall levels of influenza vaccination coverage of employees increased from 43% (3,892 of 9,050) during the 2005-2006 season to 66.5% (6,123 of 9,214) during the 2006-2007 season. Of 9,214 employees, 1,898 (20.6%) signed the declination statement. Among the occupation groups, nurses had the lowest rate of declining vaccination (13.2% [393 of 2,970]; P < .0001), followed by pharmacy personnel (18.1% [40 of 221]), ancillary personnel with frequent patient contact (21.9% [169 of 771), and all others (24.7% [1,296 of 5,252]). Among the employees who declined vaccination, nurses were the least likely to select the reasons “afraid of needles” (3.8% [15 of 393], vs. 9.1% [137 of 1,505] for all other groups; P < .001) and “fear of getting influenza from the vaccine” (13.5% [53 of 393], vs. 20.5% [309 of 1,505]; P = .002). Seven pregnant nurses had been advised by their obstetricians to avoid vaccination. When declination of influenza vaccination was analyzed by age, 16% of personnel (797 of 4,980) 50 years of age and older declined to be vaccinated, compared with 26% of personnel (1,101 of 4,234) younger than 50 years of age {P < .0001).
Implementing use of the declination form during the 2006-2007 influenza season was one of several measures that led to a 55% increase in the acceptance of influenza vaccination by healthcare workers in our healthcare system. Although we cannot determine to what degree use of the declination form contributed to the increased rate of vaccination, use of this form helped the vaccination program assess the reasons for declination and will help to focus future vaccination campaigns.
Second to silicon (Si), the most highly developed technology for semiconductor processing exists for gallium arsenide (GaAs). Unfortunately, GaAs processing is more complex than that of Si, mainly because GaAs is a compound semiconductor. Additionally, the lack of a stable native GaAS oxide and other disadvantages relative to Si have prevented this material from expanding beyond the small niche of applications where its high intrinsic electron mobility, superior radiation hardness, and direct bandgap are essential. Adequate understanding and modeling of the process physics are important for extending the “process window” available to GaAs manufacturers and for increasing the appeal of this material. This article deals with one of the most important process events: dopant diffusion.
In the next section we briefly describe device-fabrication technology and show the importance of diffusion modeling in the prediction of device characteristics. We then review some elementary diffusion mechanisms and outline the dopants that are important in GaAs-processing technology as well as the methods by which these dopants are introduced into the substrate. In subsequent sections we review the research community's current understanding of diffusion mechanisms as well as model parameters for specific dopants. Much work has been done in this field, at Stanford and by other groups, since the publication of a major review of the subject by Tan et al. in 1991. In this article, we focus on these recent contributions.
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