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This paper examines the performance of a Gate-Engineered Gate-All-Around Charge Plasma Nanowire Field Effect Transistor (GAA-DMG-GS-CP NW-FET) and the implementation of a common source (CS) amplifier circuit. The proposed GAA-DMG-GS-CP NW-FET incorporates dual-material gate (DMG) and gate stack (GS) as gate engineering techniques and its analog/RF performance parameters are compared to those of the Gate-All-Around Single-Material Gate Charge Plasma Nanowire Field Effect Transistor (GAA-SMG-CP NW-FET) device. Both Gate-All-Around (GAA) devices are designed using the Silvaco TCAD tool. GAA structures have demonstrated good gate control because the gate holds the channel, which is an inherent advantage for both devices discussed herein. The charge plasma dopingless technique is used, in which the source and drain regions are formed using metal contacts and necessary work functions rather than doping. This dopingless technique eliminates the need for doping, reducing fluctuations caused by random dopants and lowering the device’s thermal budget. Gate engineering techniques such as DMG and GS significantly improved the current characteristics which played a crucial role in obtaining maximum gain for circuit designs. The lookup table (LUT) approach is used in the implementation of the CS amplifier circuit with the proposed device. The transient response of the circuit is analyzed with both the device structures where the gain achieved for the CS amplifier circuit using the proposed GAA-DMG-GS-CP NW-FET is 15.06 dB. The superior performance showcased by the proposed GAA-DMG-GS-CP NW-FET device with analog, RF and circuit analysis proves its strong candidature for future nanoscale and low-power applications.

A negative-capacitance (NC)-induced junctionless gate-all-around (GAA) nanowire field-effect transistor (FET) is proposed by deploying the ferroelectric material (FE) lead zirconium titanate (PZT) between the gate electrode and metal, referred to as the NC JLNWFET. The FE material is used as a gate dielectric in addition to a high-K dielectric. The PZT gate stacking develops a negative capacitance owing to the alignment of dipoles with biasing, which is responsible for improving the direct-current (DC) and linearity performance compared with the conventional JLNWFET. The parameters ION, IOFF, ION/IOFF, and Vth are considered for the DC analysis, whereas gm, gm2, gm3, and VIP2 are considered for the linearity analysis. The results show that ION and the ION/IOFF ratio are improved in the NC JLNWFET by a factor of 12.5 and 6.38. The impact of design parameters such as the channel doping, drain voltage, and interface trap charge on the electrical performance and linearity parameters is analyzed in detail. The improvement in the linearity results in a distortionless structure. The high ION/IOFF ratio and low Vth of the proposed structure mitigate the static and dynamic power in digital circuits and make the device suitable for use in low-power applications. Thus, the proposed NC JLNWFET can be used in distortionless and low-power applications.

(1) Importance: Abnormal left ventricular (LV) diastolic function, with or without a diagnosis of heart failure, is a common finding that can be easily diagnosed by intra-operative transesophageal echocardiography (TEE). The association of diastolic function with duration of hospital stay after coronary artery bypass (CAB) is unknown. (2) Objective: To determine if selected TEE parameters of diastolic dysfunction are associated with length of hospital stay after coronary artery bypass surgery (CAB). (3) Design: Prospective observational study. (4) Setting: A single tertiary academic medical center. (5) Participants: Patients with normal systolic function undergoing isolated CAB from September 2017 through June 2018. (6) Exposures: LV function during diastole, as assessed by intra-operative TEE prior to coronary revascularization. (7) Main Outcomes and Measures: The primary outcome was duration of postoperative hospital stay. Secondary intermediate outcomes included common postoperative cardiac, respiratory, and renal complications. (8) Results: The study included 176 participants (mean age 65.2 ± 9.2 years, 73% male); 105 (60.2%) had LV diastolic dysfunction based on selected TEE parameters. Median time to hospital discharge was significantly longer for subjects with selected parameters of diastolic dysfunction (9.1/IQR 6.6–13.5 days) than those with normal LV diastolic function (6.5/IAR 5.3–9.7 days) (p < 0.001). The probability of hospital discharge was 34% lower (HR 0.66/95% CI 0.47–0.93) for subjects with diastolic dysfunction based on selected TEE parameters, independent of potential confounders, including a baseline diagnosis of heart failure. There was a dose–response relation between severity of diastolic dysfunction and probability of discharge. LV diastolic dysfunction based on those selected TEE parameters was also associated with postoperative cardio-respiratory complications; however, these complications did not fully account for the relation between LV diastolic dysfunction and prolonged length of hospital stay. (9) Conclusions and Relevance: In patients with normal systolic function undergoing CAB, diastolic dysfunction based on selected TEE parameters is associated with prolonged duration of postoperative hospital stay. This association cannot be explained by baseline comorbidities or common post-operative complications. The diagnosis of diastolic dysfunction can be made by TEE.

The unique properties like wide band gap and high electron mobility makes GaN an interesting material to be used in building devices at the nanoscale in recent times. This paper first time proposed a charge plasma (CP) based dopingless gate all around (GAA) GaN Nanowire FET (NWFET) (CP-GaN). The advantages of CP device over junctionless (JL) in NWFET structure along with properties of GaN material, results in a highly efficient structure of CP-GaN. The CP-GaN is compared with JL-GaN and silicon counterparts of CP & JL. Results reveal that CP-GaN is showing outstanding performance as Ion of 3.95 × 10−5 A, Ioff of 5.36 × 10−13 A and Ion/Ioff of 7.37 × 107. The proposed device CP-GaN shows better performance than CP-Si based device. When compared with JL-GaN, CP-GaN shows 55% less DIBL. The figure of merit Q = gm/SS of 0.85 μS/μm-dec/mV, is highest for our proposed CP-GaN. This makes CP-GaN an attractive design to be explored for high switching & low voltage applications with reduced SCEs and lower thermal budget. The other design parameters viz. gate length, gate dielectric, gate and source/drain work functions, nanowire radius and interface trap charges effect are also investigated for further optimization of the proposed design.

In this paper, gate all around (GAA) nanowire P-channel FET label free biosensor is proposed with cavity. Proposed structure is label free so it doesn’t require selective material for specific biomolecule enzymes. High surface to volume ratio provide good sensitivity which is crucial for any biosensor application. To sense the kind of biomolecule, there is a cavity created at the gate, so biological elements like enzymes interact with cavity and it changes the carrier concentration which in turn changes the current. In addition to this, first biosensor structure is analyzed with cavity at the source side and second structure is analyzed with cavity at the drain side. Length of cavity is varied from 10 nm to 40 nm for optimization of the proposed biosensor structure. This biosensor is used to find the amount of biomolecule present in aqueous solution through their enzymes. To estimate the sensing capability of this sensor, testing is done using glucose molecules. We observed comparatively better sensitivity when cavity is placed at drain side.

In this treatise, we have proposed a Single Material Gate–Dual Gate Impact Ionization Metal Oxide Semiconductor (SMG DG-IMOS) based Pressure Sensor. The pressure sensor has the most notable role in both the electrical and mechanical emerging fields. This article grants the outline and scrutiny of pressure sensors on SMG-DG IMOS technology. The proposed device uncovers the hypothetical and practical concepts that can be effective for the future pressure sensor. Different ranges of bending: Low, Medium and High, have been employed to the proposed pressure sensor device. Several performance parameters under the ranges of bending have been investigated. The device structure has been developed with SiO2 as the gate oxide, a gate metal with work function 4.26 eV and a gate length of 130 nm while proposing the IMOS based pressure sensor design. The proposed sensor design is then investigated for different metals to explore the compatibility of the IMOS structure for different ranges of bending. The optimization of the proposed IMOS based pressure sensor has been carried out for broad sensing range and better sensitivity.

In this paper, we demonstrate a nanoelectro-mechanical system (NEMS) diaphragm pressure sensor based on dopingless charge plasma-gate all around (GAA) silicon Nanowire Field Effect Transistor (NWFET). By incorporating the advantages of GAA configuration i.e. better electrostatics and reduced short channel effects (SCEs) with those of dopingless configurations like reduced random dopant fluctuations (RDFs) give rise to an ultrasensitive pressure sensor with higher reliability. The surrounded gate in GAA behaves as the diaphragm. The applied pressure on the diaphragm bends the diaphragm that changes the metal-dielectric thickness of oxide layer that in turn affects the electrical characteristics of the device. The diaphragm bendings considered are 1, 1.5, 2 and 2.5 nm. Various device characteristics including potential, energy band diagrams, electron-hole concentrations, Ion, Ion/Ioff ratio etc. are evaluated which can be used as performance parameters of the proposed structure. Further investigation of the device’s design parameters for optimized sensor designing viz. dielectric material of spacer and length of the spacer is carried out. Results reveal that this ultrasensitive pressure sensor with lower SCEs shows higher reliability and yield comparatively higher sensitivity towards applied low pressures as low as 0.73 pN/nm2. The drain current could be increased by using high-k material at spacer (HfO2) and also spacer length around 10 nm provides better switching. Thus, with ease of fabrication, this sensor could be used in low-pressure sensing applications for the biomedical field.

Background: Abnormal left ventricular (LV) echocardiographic parameters during non-systolic phase, with or without a diagnosis of heart failure, is a common finding that can be easily diagnosed by intra-operative transesophageal echocardiography (TEE). However, its association with duration of hospital stay after coronary artery bypass (CAB) is unknown. Objective: To determine if Abnormal left ventricular (LV) echocardiographic parameters during non-systolic phase is associated with length of hospital stay after coronary artery bypass surgery (CAB). Method: Prospective observational study at a single tertiary academic medical center Result: Median time to hospital discharge was significantly longer for subjects with abnormal left ventricular (LV) echocardiographic parameters during non-systolic phase (9.1/IQR 6.6-13.5 days) than those with normal LV non-systolic function (6.5/IAR 5.3-9.7days) (P< 0.001). The probability of hospital discharge was 34% lower (HR 0.66/95% CI 0.47-0.93) for subjects with abnormal LV function even during non-systole despite a normal LV systolic function, independent of potential confounders, including a baseline diagnosis of heart failure Conclusions and Relevance: In patients with normal systolic function undergoing CAB, non-systolic LV dysfunction is associated with prolonged duration of postoperative hospital stay. This association cannot be explained by baseline comorbidities or common post-operative complications.

Objective: Research on continuous electro-encephalographic monitoring (cEEG) in the intensive care unit (ICU) has previously focused on neuroscience ICUs. This study determines cEEG utilization within a sample of specialty ICUs world-wide. Methods: A cross-sectional electronic survey of attending level physicians across various intensive care settings. Twenty-five questions developed from consensus statements on the use of cEEG in the critically ill sent as an electronic survey. Results: Of all, 9344 were queried and 417 (4.5%) responses were analyzed with 309 (74%) from the United States and 74 (18%) internationally. Intensive care units were: medical (10%), surgical (6%), neurologic/neurosurgical (12%), cardiac (4%), trauma (3%), pediatrics (29%), burn (Conclusions: Despite guideline recommendations for cEEG use, there is a discordance between availability, night coverage, and immediate interpretation. Only 27% have institutional protocols for indications and duration of cEEG monitoring. Furthermore, cEEG may be underutilized in nonneurologic ICUs as well as ICUs in smaller nonacademic affiliated hospitals and those outside of the United States.

In this paper, Dopingless Gate All Around (GAA) Vertical Nanowire Field Effect Transistor (VNWFET) is designed with artificial material Indium Gallium Zinc Oxide (IGZO) as a channel material. IGZO channel has high electron mobility compared to more traditional amorphous semiconductors. In VNWFETs, since the channel length (Lch) is characterized vertically, it can be relaxed without area penalty on-chip, which in turn also allows some relaxation in the nanowire diameter while keeping optimum short-channel-effects control. Electrostatic-Charge Plasma technique is used to form a source-drain region on an intrinsic body of IGZO material. At the source side, the N+ region is formed by selecting the appropriate work function of the metal electrode, and at the drain side, the N+ region is formed by giving biasing to the metal electrode. N+ channel dopingless VNWFET with the catalytic metal gate is proposed for ammonia gas sensing. Cobalt, Molybdenum, and Ruthenium are used as a gate electrode in ammonia gas detection due to their high reactivity towards ammonia. Also, we have compared their ON and OFF sensitivity of the proposed device toward the gas adsorption. Due to the presence of gas on the gate, the metal work function of gate metal changes which varies the OFF-current (IOFF), ON-current (ION) and Threshold voltage (Vth) as these are considered as sensitivity parameters for sensing the ammonia gas molecules. The dimensional parameters (radius, and length) and dielectric materials are varied to check the change in device sensitivities. Results show that as the work function varies increases 50, 100, 150, 200 meV and 250 meV for catalytic metal at the gate, the sensitivity is increased.

This case-control study investigates the association between nasal microbial profiles and odds of infection after elective surgical procedures., Key Points Question Can characterization of microbiota present on preoperative nasal swab estimate risk for postoperative infection in patients undergoing elective surgical procedures? Findings In this case-control study, 167 patients were classified to nasal microbial profile cluster 1 and 30 patients to cluster 2 based on 16S ribosomal RNA gene sequencing. Classification to cluster 2 was associated with statistically significantly higher odds of infection (ie, deep surgical site infection, bacteremia, or pneumonia) after surgical procedure, independent of covariates, including nasal carriage of Staphylococcus aureus on preoperative culture and intrasample microbial diversity (ie, α diversity). Meaning These findings suggest that the nasal microbiome is an independent risk factor associated with infectious outcomes after elective surgical procedures., Importance The association of the nasal microbiome with outcomes in surgical patients is poorly understood. Objective To characterize the composition of nasal microbiota in patients undergoing clean elective surgical procedures and to examine the association between characteristics of preoperative nasal microbiota and occurrence of postoperative infection. Design, Setting, and Participants Using a nested matched case-control design, 53 individuals who developed postoperative infection were matched (approximately 3:1 by age, sex, and surgical procedure) with 144 individuals who were not infected (ie, the control group). The 2 groups were selected from a prospective cohort of patients undergoing surgical procedures at 2 tertiary care university hospitals in Baltimore, Maryland, who were at high risk for postoperative infectious complications. Included individuals were aged 40 years or older; had no history of autoimmune disease, immunocompromised state, immune-modulating medication, or active infection; and were scheduled to undergo elective cardiac, vascular, spinal, or intracranial surgical procedure. Data were analyzed from October 2015 through September 2020. Exposures Nasal microbiome cluster class served as the main exposure. An unsupervised clustering method (ie, grades of membership modeling) was used to classify nasal microbial samples into 2 groups based on features derived from 16S ribosomal RNA gene sequencing. The microbiome cluster groups were derived independently and agnostic of baseline clinical characteristics and infection status. Main Outcomes and Measures Composite of surgical site infection, bacteremia, and pneumonia occurring within 6 months after surgical procedure. Results Among 197 participants (mean [SD] age, 64.1 [10.6] years; 63 [37.7%] women), 553 bacterial taxa were identified from preoperative nasal swab samples. A 2-cluster model (with 167 patients in cluster 1 and 30 patients in cluster 2) accounted for the largest proportion of variance in microbial profiles using grades of membership modeling and was most parsimonious. After adjusting for potential confounders, the probability of assignment to cluster 2 was associated with 6-fold higher odds of infection after surgical procedure (odds ratio [OR], 6.18; 95% CI, 3.33-11.7; P

Importance: Abnormal left ventricular (LV) diastolic function, with or without a diagnosis of heart failure, is a common finding that can be easily diagnosed by intra-operative transesophageal echocardiography (TEE). The association of diastolic function with duration of hospital stay after coronary artery bypass (CAB) is unknown. Objective: To determine if abnormal LV diastolic function (diastolic dysfunction) is associated with length of hospital stay after coronary artery bypass surgery (CAB). Design: Prospective observational studySetting: A single tertiary academic medical centerParticipants: Patients with normal systolic function undergoing isolated CAB from September 2017 through June 2018. Exposures: LV function during diastole, as assessed by intra-operative TEE prior to coronary revascularization. Main Outcomes and Measures: The primary outcome was duration of postoperative hospital stay. Secondary intermediate outcomes included common postoperative cardiac, respiratory, and renal complications. Results: The study included 176 participants (mean age 65.2 +/- 9.2 years, 73% male); 106 (60.2%) had LV diastolic dysfunction. Median time to hospital discharge was significantly longer for subjects with diastolic dysfunction (9.1/IQR 6.6-13.5 days) than those with normal LV diastolic function (6.5/IAR 5.3-9.7days) (P< 0.001). The probability of hospital discharge was 34% lower (HR 0.66/95% CI 0.47-0.93) for subjects with diastole dysfunction, independent of potential confounders, including a baseline diagnosis of heart failure. There was a dose-response relation between severity of diastolic dysfunction and probability of discharge. LV diastolic dysfunction was also associated with postoperative cardio-respiratory complications; however, these complications did not fully account for the relation between LV diastolic dysfunction and prolonged length of hospital stay.Conclusions and Relevance: In patients with normal systolic function undergoing CAB, diastolic dysfunction is associated with prolonged duration of postoperative hospital stay. This association cannot be explained by baseline comorbidities or common post-operative complications.

This paper offers the study of the noise performance of four devices namely junctionless dual-gate FET (JL-DGFET), junctionless nanowire FET (JL-NWFET), charge-plasma based dopingless dual-gate FET (DL-DGFET) and dopingless nanowire FET (DL-NWFET). This work examines the maximum Noise-Figure (NFmax.), Auto-correlation factor ( )/( ), cross-correlation factor ( ), and output impedance (real Zo). To understand the performance of devices, analog characteristics of all four devices and effect on these characteristics with the variations of different device structure parameters are analyzed and compared. Internal physics of device is understood by device design parameters such as electric field, channel potential, carrier mobility and carrier concentration. It is observed from the simulated results that JL-DGFET has better noise performance, highest ION/IOFF current ratio than other devices.

Supplemental Material, sccmeeg.surveysupplement1 for Continuous Electroencephalographic Monitoring in the Intensive Care Unit: A Cross-Sectional Study by Lauren Koffman, Fred Rincon, Joao Gomes, Sarabdeep Singh, Yitian He, Eva Ritzl, Thomas P. Bleck, Peter W. Kaplan and Paul Nyquist in Journal of Intensive Care Medicine

In this paper, a gate-all-around (GAA) charge plasma-based dopingless dual material gate nanowire FET is proposed (CP-DM). This structure is further explored by adding gate-stack (high-k + SiO2) feature (CP-GS-DM). In these dopingless structures, source/drain is induced using a charge plasma concept by an appropriate selection of work functions for source/drain electrodes. The dopingless devices offer low thermal budget with easier fabrication steps and reduced random dopant fluctuations effect. Both the dopingless structures are investigated for analog performance, and results are compared with those obtained from the GAA junctionless dual material (JL-DM) gate and the JL gate-stacked DM gate (JL-GS-DM), respectively. The charge plasma-based dopingless devices when compared with their JL counterpart show improvement in drive current ( ${I}_{\text {D}}$ ), transconductance ( ${g}_{m}$ ), transconductance gain factor ( ${g}_{m}/{I}_{D}$ ), output conductance ( ${g}_{\text {ds}}$ ), early voltage ( ${V}_{\text {AE}}$ ), intrinsic gain ( $A_{\text {v}}$ ), drain-induced barrier lowering, and subthreshold slope. Thus, dopingless structures show enhanced analog performance with reduced short channel effects. The charge plasma based dopingless gate stacked dual material gate (CP-GS-DM) shows the best performance of all the structures. The analysis is further carried out for investigating the device design parameters effect on performance, namely, total gate length, ${L}_{G}$ , and ratio of control gate length to total gate length, $L_{\text {M1}}/{L}_{G}$ . This way dopingless charge plasma-based devices incorporate DM and GS features that make these devices interesting and reliable candidates for analog application with cost-effective fabrication.

Objective To examine the association between family companion presence during pre-surgical visits to discuss major cancer surgery and patient-provider communication and satisfaction. Methods Secondary analysis of 61 pre-surgical visit recordings with eight surgical oncologists at an academic tertiary care hospital using the Roter Interaction Analysis System (RIAS). Surgeons, patients, and companions completed post-visit satisfaction questionnaires. Poisson and logistic regression models assessed differences in communication and satisfaction when companions were present vs. absent. Results There were 46 visits (75%) in which companions were present, and 15 (25%) in which companions were absent. Companion communication was largely emotional and facilitative, as measured by RIAS. Companion presence was associated with more surgeon talk (IRR 1.29, p = 0.006), and medical information-giving (IRR 1.41, p = 0.001). Companion presence was associated with less disclosure of lifestyle/psychosocial topics by patients (IRR 0.55, p = 0.037). In adjusted analyses, companions’ presence was associated with lower levels of patient-centeredness (IRR 0.77, p 0.004). There were no differences in patient or surgeon satisfaction based on companion presence. Conclusion Companions’ presence during pre-surgical visits was associated with patient-surgeon communication but was not associated with patient or surgeon satisfaction. Practice implications Future work is needed to develop interventions to enhance patient-companion-provider interactions in this setting.

This paper proposes a gate-all-around silicon nanowire dopingless field-effect transistor (FET), utilizing a gate-stacked technique. The source and drain regions are formed by employing a charge plasma concept, with the application of appropriate work functions for metal contacts. The charge plasma approach reduces the need for doping control during fabrication, and thus reduces the thermal budget, while the gate-stacked structure solves the problem of scaling limitations with respect to the $$\hbox {SiO}_{2}$$ dielectric thickness (

Purpose Genetic deletions decreasing serum alpha-Klotho (alpha-KL) have been associated with rapid aging, multi-organ failure and increased mortality in experimental sepsis. We hypothesized that lower alpha-KL obtained at the onset of septic shock correlates with higher mortality. Materials and methods Prospective cohort of 104 adult patients with septic shock. Alpha-KL was measured via ELISA on serum collected on the day of enrollment (within 72 h from the onset of shock). Relationship between alpha-KL and clinical outcome measures was evaluated in uni- and multi-variable models. Results Median (IQR) alpha-KL was 816 (1020.4) pg/mL and demonstrated a bimodal distribution with two distinct populations, Cohort A [n = 97, median alpha-KL 789.3 (767.1)] and Cohort B [n = 7, median alpha-KL 4365.1(1374.4), > 1.5 IQR greater than Cohort A]. Within Cohort A, ICU non-survivors had significantly higher serum alpha-KL compared to survivors as well as significantly higher APACHE II and SOFA scores, rates of mechanical ventilation, and serum BUN, creatinine, calcium, phosphorus and lactate (all p ≤ 0.05). Serum alpha-KL ≥ 1005, the highest tertile, was an independent predictor of ICU mortality when controlling for co-variates (p = 0.028, 95% CI 1.143–11.136). Conclusions Elevated serum alpha-KL in patients with septic shock is independently associated with higher mortality. Further studies are needed to corroborate these findings.

Background Maternal infection is a risk factor for periventricular leukomalacia and cerebral palsy (CP) in neonates. We have previously demonstrated hypomyelination and motor deficits in newborn rabbits, as seen in patients with cerebral palsy, following maternal intrauterine endotoxin administration. This was associated with increased microglial activation, primarily involving the periventricular region (PVR). In this study we hypothesized that maternal intrauterine inflammation leads to a pro-inflammatory environment in the PVR that is associated with microglial activation in the first 2 postnatal weeks. Methods Timed pregnant New Zealand white rabbits underwent laparotomy on gestational day 28 (G28). They were randomly divided to receive lipopolysaccharide (LPS; 20 μg/kg in 1 mL saline) (Endotoxin group) or saline (1 mL) (control saline, CS group), administrated along the wall of the uterus. The PVR from the CS and Endotoxin kits were harvested at G29 (1 day post-injury), postnatal day1 (PND1, 3 day post-injury) and PND5 (7 days post-injury) for real-time PCR, ELISA and immunohistochemistry. Kits from CS and Endotoxin groups underwent longitudinal MicroPET imaging, with [11C]PK11195, a tracer for microglial activation. Results We found that intrauterine endotoxin exposure resulted in pro-inflammatory microglial activation in the PVR of rabbits in the first postnatal week. This was evidenced by increased TSPO (translocator protein) expression co-localized with microglia/macrophages in the PVR, and changes in the microglial morphology (ameboid soma and retracted processes). In addition, CD11b level significantly increased with a concomitant decline in the CD45 level in the PVR at G29 and PND1. There was a significant elevation of pro-inflammatory cytokines and iNOS, and decreased anti-inflammatory markers in the Endotoxin kits at G29, PND1 and PND5. Increased [11C]PK11195 binding to the TSPO measured in vivo by PET imaging in the brain of Endotoxin kits was present up to PND14–17. Conclusions Our results indicate that a robust pro-inflammatory microglial phenotype/brain milieu commenced within 24 h after LPS exposure and persisted through PND5 and in vivo TSPO binding was found at PND14–17. This suggests that there may be a window of opportunity to treat after birth. Therapies aimed at inducing an anti-inflammatory phenotype in microglia might promote recovery in maternal inflammation induced neonatal brain injury.

In this paper, Cylindrical Gate Nanowire FET (CGNWFET) is designed with highly doped III-V group compound Indium-gallium-arsenide (In1-xGaxAs) as the channel material. Based on the proposed structure, the hydrogen (H2) and oxygen (O2) gas sensors are designed for enhanced sensitivity. Palladium (Pd) is used as a gate electrode in H2 gas detection whereas silver (Ag) in O2 gas detection because of their sensitivity towards that gas. As the metal work function at gate changes with the presence of gas on it, there is a change in Ioff, Ion and threshold voltage (Vth) which can be taken as sensitivity parameters for sensing the gas molecules. The dimensional parameters varied to check the sensitivities are radius and length of the device. When the sensitivity of proposed In1-xGaxAs CGNWFET is compared with conventional Silicon (Si) CGNWFET, In1-xGaxAs CGNWFET shows enhanced sensitivity. Result shows that as work function varies as 50, 100, 150 and 200 meV for Pd/Ag-metal at gate, the sensitivity enhancement with In1-xGaxAs CGNWFET based H2/O2 gas sensors are 3.27%, 9.11%, 17.02%, 30.18% and 2.59%, 5.78%, 7.11%, 12.17% respectively. Different dielectric materials at the gate are also analyzed. Higher sensitivity is observed for higher dielectric value. Thus, In1-xGaxAs proves to be a strong candidate for designing CGNWFET based sensors for enhanced sensitivity.

Little evidence exists to support the effects of a preceptor–mentor program for orienting newly hired certified registered nurse anesthetists (CRNAs). The literature suggests that participation in a preceptorship–mentorship program will increase the satisfaction, confidence, and comfort of both preceptors and newly hired orientees. The purpose of this project was to determine the effects of these outcomes. This program was developed based on best evidence and implemented as a quality improvement project. Three sessions were held to educate preceptors ( N = 12) in the following areas: communication skills, providing constructive feedback, and assessing learner's styles and needs. The results suggested that participation significantly increased CRNA preceptor satisfaction and comfort in the precepting experience. The newly hired CRNAs answered that they were mostly or very much satisfied and confident at the completion of their orientation period. This program can be expanded to include additional preceptors and be sustained with future new hires. J Contin Educ Nurs. 2017;48(10):464–473.

Objective The purpose of this study was to assess the correlation between skin-to-epidural space depth, as measured on cervical magnetic resonance imaging (MRI), and actual needle depth, as measured by Tuohy needle markings during cervical epidural steroid injections. Methods We conducted a retrospective review of cervical MRI images to determine estimated depth from skin to epidural space. Of the 121 reviewed patients who underwent cervical epidural steroid injections, 81 met inclusion criteria and were retained for data analysis. Results At the C6-C7 level, the estimated needle depth according to MRI images was 6.03 ± 1.15 cm (mean ± SD) and the actual needle depth was 5.62 ± 0.77 cm. At the C7-T1 level, the estimated needle depth based on MRI images was 5.90 ± 1.05 cm and the actual needle depth was 5.73 ± 0.98 cm. At both C6-C7 and C7-T1, MRI depth (P

The left ventricular ejection time is routinely measured from a peripheral arterial waveform. However, the arterial waveform undergoes constant transformation as the pulse wave propagates along the arterial tree. Our goal was to determine if the left ventricular ejection time measured peripherally in the arterial tree accurately reflected the ejection time measured through the aortic valve. Moreover, we examined/accessed the modulating influence of hemodynamics on ejection time measurements. Continuous wave Doppler waveform images through the aortic valve and the simultaneously obtained radial artery pressure waveforms were analyzed to determine central and peripheral ejection times, respectively. The peripheral ejection time was significantly longer than the simultaneously measured central ejection time (174.5±25.2 ms vs. 120.7±14.4 ms; P

Context Measuring What Matters (MWM) quality indicators support measurement of the percentage of patients who have spiritual discussions, if desired. Objectives The objective of this study was to 1) determine the ease of, and barriers to, prospectively collecting MWM spirituality quality measure data and 2) further explore the importance of spirituality in a seriously ill, hospitalized population of critically ill patients and their family members. Methods Electronic medical record (EMR) review and cross-sectional survey of intensive care unit (ICU) patients and their family members from October to December 2015. Participants were in four adult ICUs totaling 68 beds at a single academic, urban, tertiary care center which has ICU-assigned chaplains and an in-house, 24-hour, on-call chaplain. Results All patients had a "Spiritual Risk Screen" which included two questions identifying patient religion and whether a chaplain visit was desired. Approximately 2/3 of ICU patients were eligible, and there were 144 respondents (50% female; 57% patient and 43% family member), with the majority being Caucasian or African American (68% and 21%, respectively). Common religious identifications were Christian or no faith tradition (76% and 11%, respectively). Approximately half of patients had an EMR chaplain note although it did not document presence of a "spiritual discussion." No study patients received palliative care consultation. A majority (85%) noted that spirituality was "important to them" and that prevalence remained high across respondent age, race, faith tradition, or admitting ICU. Conclusion Operationalizing the MWM spirituality quality indicator was challenging as elements of a "spiritual screening" or documentation of a "spiritual discussion" were not clearly documented in the EMR. The high prevalence of spirituality among respondents validates the importance of spirituality as a potential quality metric.

This paper proposes a designing of a directional pressure sensor based on NEMS nanocantilever structure embedded on uniformly and highly doped junctionless triple gate (TG) cuboidal nanowire-FET (TG-JL NWFET) device. In the designed device, each gate electrode is used as nanocantilever beam structure and the magnitude of pressure on the cantilever is measured by observing different electrical characteristics on bending of the cantilever beam, i.e., for 0 nm, 0.90 nm and 1.75 nm bending of the cantilever, respectively. To detect the direction of pressure, the performance of the pressure sensor for bending in single, dual and triple directions is compared with each other. In single direction bending, the top of the cantilever completely bends and the rest of the cantilevers remain in an equilibrium position. In the dual direction, bending right and left cantilevers are completely bent and the top cantilevers remain in an equilibrium position; in triple bending, all the three cantilevers completely bend simultaneously. The device parameters such as electric field, energies of conduction and valence band and recombination rate are observed to study the device physics. ON to OFF current ratio, threshold voltage, drain-induced barrier leakage and subthreshold slope are used as performance parameters for analyzing the performance of single, dual and triple direction bending with respect to different bending of the cantilever. The ON current obtained for triple direction bending is 14.7 and 12.5% higher than the dual direction and single direction bending of the cantilever, respectively.

The purpose of this quality improvement project was to determine whether a 4-hour Certified Registered Nurse Anesthetist (CRNA) preceptor workshop would significantly increase staff CRNA preceptors' satisfaction, confidence, and/or comfort, to better prepare CRNAs to precept. A review of the literature, interviews with experienced CRNA preceptors, and a needs assessment survey were completed and used to develop the workshop's curriculum. For evaluation of the impact of this quality improvement project, attendees were asked to complete preworkshop and postworkshop surveys. Because scores were skewed, the significance of the differences from presurvey to postsurvey was determined with the Wilcoxon signed-rank test for the median difference. The median for all scores increased significantly from presurvey to the postsurvey. Because 94% of attendees had never attended a CRNA preceptor education course and 82% had never participated in any type of preceptor education or preparation, the results from this project suggest that this program fulfilled an unmet need for CRNA preceptors at this institution.

Opioid prescriptions in the surgical setting have been implicated as contributors to the opioid epidemic. The authors hypothesized that a multidisciplinary approach to perioperative pain management for patients on chronic opioid therapy could decrease postoperative opioid requirements while reducing postoperative pain scores and improving functional outcomes. Therefore, a Perioperative Pain Program (PPP) for chronic opioid users was implemented. This study presents outcomes from the first 9 months of the PPP. Sixty-one patients met the inclusion criteria. Opioid consumption in morphine milligram equivalent (MME) was calculated and physical and health status of patients was assessed with the Brief Pain Inventory, Short-Form McGill Pain Questionnaire, and Short Form-12. Preliminary results showed significant reduction in MME, improved pain scores, and improved function for surgical patients on chronic opioids. PPP effectively reduced opioid usage without negatively influencing patient-reported outcomes, such as physical pain score assessment and health-related quality of life.

Background: Preoperative advance care planning (ACP) may benefit patients undergoing major surgery. Objective: To evaluate feasibility, safety, and early effectiveness of video-based ACP i...

This paper demonstrate the comparative study of various linearity as well as intermodulation distortion (IMD) parameters for junctionless (JL) and charge plasma (CP) dopingless nanowire FETs with dual material gate (DM). The various parameters considered for analysis includes higher order transconductance coefficients: gm2 (second-order) & gm3 (third-order), second-third order harmonic distortion HD2 &HD3, third order current intercept point (IIP3), third order IMD (IMD3), higher order voltage intercept points (VIP2 & VIP3) etc. The simulation study results reveals that analog parameters namely transconductance gm and transconductance gain factor (TGF) along with cut-off frequency f T are better for CP_DM. The other parameters including Cgg, gm3, HD2, HD3, IIP3 and VIP3 for JL_DM shows enhanced performance over CP_DM.

sccmeeg.surveysupplement1 for Continuous Electroencephalographic Monitoring in the Intensive Care Unit: A Cross-Sectional Study by Lauren Koffman, Fred Rincon, Joao Gomes, Sarabdeep Singh, Yitian He, Eva Ritzl, Thomas P. Bleck, Peter W. Kaplan and Paul Nyquist in Journal of Intensive Care Medicine

A dopingless Cylindrical Nanowire Field Effect Transistor is proposed by implementing the charge plasma technique. The charge plasma technique helped in the necessary doping of the source/drain regions. The significance of using charge plasma based Nanowire FET for low-noise and higher sensing applications is investigated by analyzing the linearity parameters and compared with the Junctionless Nanowire FET. The proposed device is optimized as per the practical conditions by taking the interface trap charges into account. The interface trap charges are considered at the gate oxide-channel interface. The variation of interface trap charge (ITCs) density varies the device performance depending on the ITC polarity. The presence of ITCs can enhance device performance by tweaking the ITCs amplitude with positive polarity. The work function of the source/drain metal for the charge plasma technique is varied to get an optimized value. The higher value of source/drain metal degrades the device performance. The voltage interception point of the proposed device is greater than 5 times the actual value of the input signal. The drain current decreases drastically with the increase of source/drain work function independent of the gate bias.

Rett syndrome (RTT) is a pervasive developmental disorder that is progressive and has no effective cure. Immune dysregulation, oxidative stress, and excess glutamate in the brain mediated by glial dysfunction have been implicated in the pathogenesis and worsening of symptoms of RTT. In this study, we investigated a new nanotherapeutic approach to target glia for attenuation of brain inflammation/injury both in vitro and in vivo using a Mecp2-null mouse model of Rett syndrome.To determine whether inflammation and immune dysregulation were potential targets for dendrimer-based therapeutics in RTT, we assessed the immune response of primary glial cells from Mecp2-null and wild-type (WT) mice to LPS. Using dendrimers that intrinsically target activated microglia and astrocytes, we studied N-acetyl cysteine (NAC) and dendrimer-conjugated N-acetyl cysteine (D-NAC) effects on inflammatory cytokines by PCR and multiplex assay in WT vs Mecp2-null glia. Since the cysteine-glutamate antiporter (XcWe demonstrated that the mixed glia derived from Mecp2-null mice have an exaggerated inflammatory and oxidative stress response to LPS stimulation when compared to WT glia. Expression of XcThese results suggest that delivery of drugs using dendrimer nanodevices offers a potential strategy for targeting glia and modulating oxidative stress and immune responses in RTT.

Background: The Revised National Tuberculosis Control Programme (RNTCP) is implementing the External Quality assurance (EQA) and Random blinded re-checking (RBRC) as one of its important component. This nationwide study was conducted to determine (1) the number and types of RBRC errors and (2) the sensitivity and specificity among rechecked slides. Materials and Methods: The study was based on the monthly RBRC reports submitted by ~13,000 designated microscopy centres (DMCs) across the country under routine programmatic settings in 2010. The DMCs reports were compiled at district, state and national level. Results: A total of 11, 89,564 slides were rechecked from 11,039 DMCs. Of which 99.5% of rechecked slides did not have any errors. The sensitivity and specificity of the rechecked slides had 98% sensitivity and 100% specificity. Conclusion: RBRC is the crucial component of EQA and the results from the programme are found to be satisfactory. Based on the study findings, the earlier value of 80% sensitivity used for calculation of annual sample size for RBRC has been increased to 90% sensitivity. The annual RBRC sample size for DMCs has been increased by 1.5–2 folds.

OBJECTIVE: X-linked adrenoleukodystrophy (ALD) is a neurodegenerative disorder due to mutations in the peroxisomal very long-chain fatty acyl-CoA transporter, ABCD1, with limited therapeutic options. ALD may manifest in a slowly progressive adrenomyeloneuropathy (AMN) phenotype, or switch to rapid inflammatory demyelinating cerebral disease (cALD), in which microglia have been shown to play a pathophysiological role. The aim of this study was to determine the role of patient phenotype in the immune response of ex vivo monophagocytic cells to stimulation, and to evaluate the efficacy of polyamidoamine dendrimer conjugated to the antioxidant precursor N-acetyl-cysteine (NAC) in modulating this immune response. METHODS: Human monophagocytic cells were derived from fresh whole blood, from healthy (n = 4), heterozygote carrier (n = 4), AMN (n = 7), and cALD (n = 4) patients. Cells were exposed to very long-chain fatty acids (VLCFAs; C24:0 and C26:0) and treated with dendrimer-NAC (D-NAC). RESULTS: Ex vivo exposure to VLCFAs significantly increased tumor necrosis factor α (TNFα) and glutamate secretion from cALD patient macrophages. Additionally, a significant reduction in total intracellular glutathione was observed in cALD patient cells. D-NAC treatment dose-dependently reduced TNFα and glutamate secretion and replenished total intracellular glutathione levels in cALD patient macrophages, more efficiently than NAC. Similarly, D-NAC treatment decreased glutamate secretion in AMN patient cells. INTERPRETATION: ALD phenotypes display unique inflammatory profiles in response to VLCFA stimulation, and therefore ex vivo monophagocytic cells may provide a novel test bed for therapeutic agents. Based on our findings, D-NAC may be a viable therapeutic strategy for the treatment of cALD.

Objective Response to lumbar epidural steroid injection in lumbar radicular pain varies. The purpose of this study is to characterize the changes in quantitative sensory testing (QST) phenotypes of subjects and compare the QST characteristics in patients who do respond to treatment of radicular pain with a lumbar epidural steroid injection (ESI). Design Prospective, observational pilot study. Setting Outpatient pain center. Methods Twenty subjects with a lower extremity (LE) radicular pain who were scheduled to have an ESI were recruited. At the visit prior to and four weeks following an ESI, subjects underwent QST measurements of both the affected LE and the contralateral unaffected UE. Results Following an ESI, nine subjects reported a greater than 30% reduction in radicular pain and 11 reported a less than 30% reduction in radicular pain. Subjects who had less than 30% pain reduction response (nonresponders) to an ESI had increased pre-injection warm sensation threshold (37.30 °C, SD = 2.51 vs 40.39, SD = 3.36, P = 0.03) and heat pain threshold (47.22 °C, SD = 1.38, vs 48.83 °C, SD = 2.10, P = 0.04). Further, the nonresponders also showed increased pre-injection warm sensation threshold as measured in the difference of warm sensation detection threshold difference in the affected limb and the unaffected arm (2.68 °C, SD = 2.92 vs 5.67 °C, SD = 3.22, P = 0.045). Other QST parameters were not affected. Conclusions The results show that the nonresponders to ESIs have increased detection threshold to heat pain and warm sensation, suggesting that a preexisting dysfunction in the C fibers in this group of subjects who can be detected by QST. Such altered QST characteristics may prognosticate the response to ESIs.

Neurobehavioral Scoring Scheme. Table of neurobehavioral subscores and their scoring scheme used to determine phenotypic severity in Mecp2-null mice. (PDF 40Â kb)

Gene duplication is widely accepted as a key evolutionary process, leading to new genes and novel protein functions. By providing the raw genetic material necessary for functional expansion, the mechanisms that involve the retention and functional diversification of duplicate genes are one of the central topics in evolutionary and comparative genomics. One proposed source of retention and functional diversification is protein subcellular relocalization (PSR). PSR postulates that changes in the subcellular location of eukaryotic duplicate proteins can positively modify function and therefore be beneficial to the organism. As such, PSR would promote retention of those relocalized duplicates and result in significantly lower death rates compared with death rates of nonrelocalized duplicate pairs. We surveyed both relocalized and nonrelocalized duplicate proteins from the available genomes and proteomes of 59 eukaryotic species and compared their relative death rates over a Ks range between 0 and 1. Using the Cox proportional hazard model, we observed that the death rates of relocalized duplicate pairs were significantly lower than the death rates of the duplicates without relocalization in most eukaryotic species examined in this study. These observations suggest that PSR significantly increases retention of duplicate genes and that it plays an important, but currently underappreciated, role in the evolution of eukaryotic genomes.

SummaryBackground Hypothermia in neonatal intensive care unit patients is associated with morbidity. Perioperative normothermia is the standard of care. Aims We hypothesized that a quality improvement intervention (transport protocol, transport education, ongoing monitoring) would decrease the incidence of perioperative hypothermia. Secondarily, we hypothesized that patients undergoing surgery at a postmenstrual age of