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When physicians admit patients to a hospital, their decisions about where--and to whose professional stewardship and services--those patients belong are influenced by federal policies, of which many clinicians are not aware. The distinction between observation and admission has clinical and ethical implications for patients and practices. The evolution of "observation status" from a clinical tool to a catchall of vague and imprecise meaning has been driven by changes to physician payment and compensation structures, particularly Current Procedural Terminology codes and Centers for Medicare and Medicaid Services regulations, and its current value to clinicians and patients is questionable. This article contextualizes clinicians' admission and observation practices and considers how metrics influence patient costs and how clinicians and organizations are compensated. [ABSTRACT FROM AUTHOR]

The objectives of this study were to evaluate parental confidence and attitudes towards immunization in urban Guatemala between private versus public health systems and their impact on vaccination timeliness in their children. A cross-sectional survey was conducted in parents 6–18-month-old children who attended well-child outpatient clinics from two health systems (public employee-based insurance and private health care) in Guatemala City from November 2017 through August 2018. Parental demographics, household characteristics, food insecurity, vaccine hesitancy using the WHO SAGE Vaccine Hesitancy Scale, and information on parental use of social media platforms and vaccine information sources were collected. Five hundred-three parents were surveyed, most of them mothers. Only 9 parents reported they had previously refused a vaccine for their child: 8 (3.2 %) from private clinics and 1 (0.4 %) from the public clinic (p = 0.02). Significantly more children attending private clinics (226, 90.4 %) were shown to have a delay in any of their vaccines scheduled for the first 2 years of life compared to those in the public clinic (169, 66.8 %; p < 0.01). Children of parents having a college degree (84.5 vs 70.1 %; p < 0.001), earning more than US$ 1,000 per month (81.5 vs 70.7 %; p < 0.001), and having a computer at home (81.4 vs 70.2; p = 0.007) were more likely to have any delays in the scheduled vaccines. Parents seeking care at private clinics were 1.14 times more at risk of delaying a vaccine compared to those at the public clinic, adjusted for other covariates (p = 0.03, 95 % CI: 1.01, 1.28). In Guatemala, children receiving immunizations at private clinics were significantly more likely than those attending public clinics to be delayed in their immunization schedule and to remain more days without the recommended protection, especially for third doses of the primary vaccine series. [ABSTRACT FROM AUTHOR]

• CdTe-based solar cell with Sb 2 S 3 HTL has been modeled by SCAPS-1D. • PV Performances of CdTe solar cells without and with HTL are investigated. • Recombination loss at back side is reduced by adding Sb 2 S 3 HTL into CdTe solar cell. • Enhanced efficiency of proposed CdTe solar cell with HTL is obtained to be 28.41%. In this work, we design a novel cadmium telluride (CdTe)-based solar structure with antimony sulfide (Sb 2 S 3) as hole transport layer (HTL). One Dimensional Solar Cell Capacitance Simulator (SCAPS-1D) program is used to perform comparison studies on the photovoltaic performances between the standard thin-film cadmium sulfide (CdS)/CdTe solar cell and the proposed Al/FTO/CdS/CdTe/Sb 2 S 3 /Ni heterojunction structure. The solar cell outputs such as open-circuit voltage (V oc), short-circuit current density (J sc), fill-factor (FF), and efficiency have been evaluated by varying impacts of thickness, electron affinity, carrier concentration, and bulk defect density of different layers. In addition, we have analyzed the effect of interface defects at both CdS/CdTe and CdTe/Sb 2 S 3 interfaces. This study reveals that the introduction of Sb 2 S 3 as HTL improves the V oc appreciably by creating appropriate band alignment with the CdTe absorber and thus remarkably enhance the efficiency of solar cell by lowering carrier recombination at back contact surface. Moreover, the impacts of working temperature, back contact metal work function, and surface recombination velocity are elucidated. The absorber thickness is optimized to be 1.0 µm with doping concentration of 2.1 × 1015 cm−3. Best efficiency of 28.41% together with other parameters such as V oc of 1.15 V, J sc of 28.74 mA/cm2, and FF of 86.03% is achieved for the optimized device. These results lead to suggest that the Sb 2 S 3 as HTL can be employed to fabricate highly efficient and inexpensive thin-film CdTe heterojunction solar devices. [ABSTRACT FROM AUTHOR]

The present work investigates a tin-based highly efficient perovskite solar cell (PSC) by a solar cell capacitance simulator in one dimension. Molybdenum disulfide is introduced as hole transport layer in the proposed solar cell device structure. The photovoltaic performances of the proposed solar cell are investigated by varying thickness, doping concentration, and bulk defect density of various layers. Furthermore, the operating temperature and the series and shunt resistances are analyzed systematically. A higher conversion efficiency of 25.99% is obtained at the absorber thickness of 2000 nm. The optimum doping density of 1017 cm−3 is estimated for the absorber, electron transport layer (ETL), and hole transport layer (HTL), respectively. The optimum thicknesses of 50 nm, 1000 nm, and 60 nm are also found for the titanium dioxide as ETL, methylammonium tin triiodide (CH3NH3SnI3) as absorber layer, and molybdenum disulfide as HTL, respectively. The efficiency of the proposed lead-free CH3NH3SnI3-based solar cell with the alternative molybdenum disulfide HTL is calculated to be 24.65% with open-circuit voltage of 0.89 V, short-circuit current density of 34.04 mA/cm2, and fill-factor of 81.46% for the optimum parameters of all layers. These findings would contribute to fabricate low-cost, non-toxic, stable, and durable lead-free PSCs for the next generation. [ABSTRACT FROM AUTHOR]

In this study, a hole transport layer (HTL)-free perovskite solar cell (PSC) structure with CH3NH3SnI3 as an active layer and TiO2 as an electron transport layer (ETL) has been proposed for the first time. The solar cell capacitance simulator in one dimension program has been carried out to design the proposed HTL-free CH3NH3SnI3-based PSC and simulate its performance. The output parameters of the proposed PSC, such as open circuit voltage (Voc), short-circuit current density (Jsc), fill factor (FF), power conversion efficiency, and quantum efficiency, are evaluated by varying the physical parameters of various layers. The thermal stability of the proposed cell has also been analyzed. The thicknesses of the ETL and the absorber are optimized to be 0.05 and 1.0 µm, respectively. A conversion efficiency of 26.33% along with Voc of 0.98 V, Jsc of 31.93 mA/cm2, and an FF of 84.34% is obtained for the proposed HTL-free CH3NH3SnI3-based PSC. These simulation results would be helpful in fabricating highly efficient and inexpensive PSCs. [ABSTRACT FROM AUTHOR]

The occlusion of a cerebral artery by a thrombus accounts for about 80% of strokes. Reperfusion can save hypoperfused brain tissue from early cerebral blood flow restoration (CBF), thus limiting neurological impairment. The most successful treatments for stroke care have proven to be reperfusion techniques. One of the key drawbacks of these treatment methods is that early ischemic brain tissue reperfusion can lead to adverse effects, including blood-brain barrier breakdown, which can lead to cerebral oedema, haemorrhage of the brain, or both. Haemorrhages are especially devastating after reperfusion and are associated with exceptionally high morbidity and mortality. Fear of haemorrhage-related reperfusion greatly restricts the use of stroke therapies. Reperfusion injury, a mechanism that further damages brain cells, the ischemic arterial wall, and the microvasculature, is due to the deleterious effects of early restoration of cerebral blood flow following stroke. It seems clear that the brain will benefit from therapies to restore CBF to an ischemic region. The brain's reliance on normal CBF levels is underlined by the sensitivity of the brain to relatively short ischaemic cycles. Experimental and clinical data, however, suggests that tissue damage can be aggravated by organ reperfusion. [1] Studies have failed to prove that infarct size is increased by reperfusion. Reperfusion can aggravate the formation of oedema and lead to abnormal blood flow patterns and microvascular lesions within the reperfused areas. [ABSTRACT FROM AUTHOR]

Gaucher’s disease (GD) is a lysosomal storage disorder due to glucocerebrosidase deficiency; it’s one of the rare genetic diseases for which therapy is now available. Lysosomal storage of the substrate in cells of the reticuloendothelial system leads to multisystem manifestations, including involvement of the liver, spleen, bone marrow, lungs, and nervous system. Three different subtypes have been identified: Type 1, non-neuropathic form, adult onset; type 2, acute neuropathic form, infantile onset; type 3, neuropathic form, juvenile onset. The diagnosis is confirmed by presence of less than 15% activity of the enzyme Glucocerebrosidase in peripheral leucocyte with presence of Gaucher cells in macrophase monocyte system, is the pathological hallmark. Enzyme replacement therapy (ERT) is now available. We are reporting a case here which presented with cytopenia and massive splenomegaly. This case has been presented to focus on the importance of clinical examinations, differentiating from other diseases of similar manifestations, enzyme activity and bone marrow study for early diagnosis. [ABSTRACT FROM AUTHOR]

Gaucher's disease (GD) is a lysosomal storage disorder due to glucocerebrosidase deficiency; it's one of the rare genetic diseases for which therapy is now available. Lysosomal storage of the substrate in cells of the reticuloendothelial system leads to multisystem manifestations, including involvement of the liver, spleen, bone marrow, lungs, and nervous system. Three different subtypes have been identified: Type 1, non-neuropathic form, adult onset; type 2, acute neuropathic form, infantile onset; type 3, neuropathic form, juvenile onset. The diagnosis is confirmed by presence of less than 15% activity of the enzyme Glucocerebrosidase in peripheral leucocyte with presence of Gaucher cells in macrophase monocyte system, is the pathological hallmark. Enzyme replacement therapy (ERT) is now available. We are reporting a case here which presented with cytopenia and massive splenomegaly. This case has been presented to focus on the importance of clinical examinations, differentiating from other diseases of similar manifestations, enzyme activity and bone marrow study for early diagnosis. [ABSTRACT FROM AUTHOR]

This commentary discusses the effect of misuse of intravenous sedation regimens in lowering the systemic blood pressure in mechanically ventilated neurosurgical patients in the intensive care unit. [ABSTRACT FROM AUTHOR]

First, the scope of literature in movement disorders is expanding every day and changing the landscape of how we diagnose and treat disorders. Here, we describe some key points that, together with the study of Khoury I et al. i [1], may help us gain a better understanding of spinal cord lesions and movement disorders. To the Editor, We read with great interest the recent article by Khoury I et al. i [1] titled 'Tremor as a symptom of degenerative cervical myelopathy: a systematic review'. [Extracted from the article]

Background: Erythema induratum of Bazin is a rare manifestation of cutaneous tuberculosis. It may mimic some systemic disorders like sarcoidosis, poly arteritis nodosa, lymphoproliferative disorder, Histoplasmosis, and lupus profundus. Case Presentation: A 38-year young female, diabetic, and hypertensive presented with multiple painful skin lesion over anterior part of her leg for 3 months. These skin lesion used to appear as painful erythematous nodules of variable size and shape over the anterior and lateral aspects of both legs that became ulcerate, healed with hyperpigmentation. On examinations, all of her systemic examinations revealed unremarkable except skin lesion. Punch biopsy from skin lesion revealed lobular panniculitis with granuloma suggestive of erythema induratum and MTB gene Xpert from skin lesion found positive. Thereafter, she was put on anti TB therapy six-month regimens according to the national TB guideline, Bangladesh. After 2 and half months of treatment, her skin lesion disappeared. Conclusion: In a TB prevalent country, erythema induratum should be kept in differential diagnosis along with others. As it is usually underdiagnosed or misdiagnosed because of the absence of typical clinical features of TB, therefore comprehensive investigations like skin biopsy with histopathology, detecting DNA of Mycobacterium tuberculosis by PCR, positive Mantoux test are the cornerstone for confirmatory diagnosis. [ABSTRACT FROM AUTHOR]

In the present work, antimony selenide (Sb 2 Se 3)-based solar cell with a back surface field (BSF) layer has been designed and studied. The purpose of this research is to improve the performance of the Sb 2 Se 3 -based solar cell by introducing low-cost and widely available barium silicide (BaSi 2) material as the BSF layer into the basic Sb 2 Se 3 -based heterojunction solar structure. A comparative study on the performance of the conventional Sb 2 Se 3 solar cell structure consisting of Al/FTO/CdS/Sb 2 Se 3 /Mo and the proposed structure of Al/FTO/CdS/Sb 2 Se 3 /BaSi 2 /Mo is made. The photovoltaic parameters such as open circuit voltage, short-circuit current density, fill-factor, power conversion efficiency, and quantum efficiency of heterojunction structures are analyzed intensively by using the Solar Cell Capacitance Simulator in One Dimension (SCAPS-1D) program. To optimize the device, the thickness of Sb 2 Se 3 absorber layer is varied from 0.1 to 2 μm. In addition, the effects of acceptor ion and bulk defect densities in Sb 2 Se 3 absorber layer, interface defect density of buffer/absorber and absorber/BSF, back surface recombination velocity, operating temperature, and cell resistances on the overall performances are investigated. The thicknesses of BaSi 2 BSF and Sb 2 Se 3 absorber layers are optimized to be 0.3 μm and 1 μm, respectively. The efficiency of the proposed solar structure with a thin 1 μm Sb 2 Se 3 absorber layer is obtained to be 29.35%. The simulation results lead to suggest that the BaSi 2 material as a BSF layer would be effective to fabricate low cost and high-efficient Sb 2 Se 3 -based thin-film solar cells. • Numerical study of Sb 2 Se 3 -based solar cell with a BaSi 2 BSF layer has been performed by SCAPS-1D simulator. • A comparative study on performances between conventional and proposed Sb 2 Se 3 solar cells is made. • Significant improvement of solar cell characteristics has been achieved by introducing BaSi 2 BSF layer at back contact in conventional Sb 2 Se 3 solar cells. • Carrier recombination loss can be reduced at back contact surface of heterojunction solar structure with BSF layer. • Conversion efficiency of proposed Sb 2 Se 3 solar cell is increased from 23.99 to 29.35%. [ABSTRACT FROM AUTHOR]

Background: Globally, studies have shown conflicting results regarding the association of blood groups with SARS CoV-2 infection. Objective: To observe the association between ABO blood groups and the presentation and outcomes of confirmed COVID-19 cases. Design, setting, and participants: This was a prospective cohort study of patients with mild-to-moderately severe COVID-19 infections who presented in the COVID-19 unit of Dhaka Medical College Hospital and were enrolled between 01 June and 25 August, 2020. Patients were followed up for at least 30 days after disease onset. We grouped participants with A-positive and A-negative blood groups into group I and participants with other blood groups into group II. Results: The cohort included 438 patients; 52 patients were lost to follow-up, five died, and 381 completed the study. The prevalence of blood group A [144 (32.9%)] was significantly higher among COVID-19 patients than in the general population (p < 0.001). The presenting age [mean (SD)] of group I [42.1 (14.5)] was higher than that of group II [38.8 (12.4), p = 0.014]. Sex (p = 0.23) and co-morbidity (hypertension, p = 0.34; diabetes, p = 0.13) did not differ between the patients in groups I and II. No differences were observed regarding important presenting symptoms, including fever (p = 0.72), cough (p = 0.69), and respiratory distress (p = 0.09). There was no significant difference in the median duration of symptoms in the two group (12 days), and conversion to the next level of severity was observed in 26 (20.6%) and 36 patients (13.8%) in group I and II, respectively. However, persistent positivity of RT-PCR at 14 days of initial positivity was more frequent among the patients in group I [24 (19%)] than among those in group II [29 (11.1%)]. Conclusions: The prevalence of blood group A was higher among COVID-19 patients. Although ABO blood groups were not associated with the presentation or recovery period of COVID-19, patients with blood group A had delayed seroconversion. [ABSTRACT FROM AUTHOR]

8% of UK students have an 'unseen disability': a specific learning difficulty, autistic spectrum condition, or mental ill health. A department with 1000 students has, on average, 80 students with such unseen disabilities. These students have a variety of potential sources of legal redress if they consider a university has failed properly to accommodate their disability. The most plausible is a claim under the Equality Act 2010. We have experienced a lack of clarity in understanding the nature and extent of those Equality Act entitlements, and the corresponding obligations that fall upon universities, and their staff. These confusions occur in many contexts, but the one that is most important to students is their entitlements where assessments are concerned. We set out to explain the relevant law, and to consider how it applies to some, perhaps typical, unseen disabilities in the context of a range of approaches taken by universities in assessing their students. Our principal and important conclusion is that there is no 'quick fix' approach according to which someone may say that they are Equality Act compliant. However, there are several considerations which will increase (or decrease) the likelihood of compliance. In brief, these constitute: effective communication; procedures that secure individual decisions, rather than blanket policies or approaches; and what amounts to no more than good inclusive educational practice for all students. [ABSTRACT FROM AUTHOR]

• A novel heterojunction Al/FTO/WS 2 /Cu 2 Te/Ni solar cell has been designed. • Comparison of outputs between Cu 2 Te solar cells with CdS and WS 2 buffers is provided. • Cd-free WS 2 buffer with Cu 2 Te absorber enhances PV outputs by reducing carrier recombination. • Improved efficiency of 24.23 % with V oc of 0.68 V, J sc of 42.95 mA/cm2, and FF of 82.77 % is evaluated. In this work, the Cd-free tungsten disulfide (WS 2) material as the buffer layer is proposed in the copper telluride (Cu 2 Te)-based heterojunction solar structure. The Cu 2 Te thin-film photovoltaic organization of Ni/Cu 2 Te/CdS or WS 2 /SnO 2 :F(FTO)/Al has been designed and evaluated numerically by using the One Dimensional Solar Cell Capacitance Simulator. The WS 2 buffer layer provides a significant improvement in the output parameters of the Cu 2 Te solar device compared to the cell with the CdS buffer. A high efficiency of 24.23% with V oc of 0.68 V, J sc of 42.95 mA/cm2, and FF of 82.77% is obtained for the designed Cu 2 Te-based solar cell with WS 2 buffer. The 'spike-like' band structure formed at Cu 2 Te/WS 2 interface plays an important function in the enhancement of the outputs by minimizing carrier recombination. The thicknesses of 0.05 μm for buffer and 1.0 μm for absorber are optimized by considering the low fabrication cost. Moreover, the photovoltaic parameters of the Cu 2 Te solar cell are evaluated by varying the doping concentration, bulk and interface defects, operative temperature, rear contact work function, and cell resistances. The data outcomes imply that the anticipated Cu 2 Te-based photovoltaic device with a non-toxic WS 2 buffer can be an efficient substitute to the toxic CdS for cost-effective and stable thin-film solar devices. [ABSTRACT FROM AUTHOR]