Acute surgical wound-dressing procedure: Description of the steps involved in the development and validation of an observational metric

The aim of this study was to develop an observational metric that could be used to assess the performance of a practitioner in completing an acute surgical wound-dressing procedure using aseptic non-touch technique (ANTT). A team of clinicians, academics, and researchers came together to develop an observational metric using an iterative six-stage process, culminating in a Delphi panel meeting. A scoping review of the literature provided a background empirical perspective relating to wound-dressing procedure performance. Video recordings of acute surgical wound-dressing procedures performed by nurses in clinical (n = 11) and simulated (n = 3) settings were viewed repeatedly and were iteratively deconstructed by the metric development group. This facilitated the identification of the discrete component steps, potential errors, and sentinel (serious) errors, which characterise a wound dressing procedure and formed part of the observational metric. The ANTT wound-dressing observational metric was stress tested for clarity, the ability to be scored, and interrater reliability, calculated during a further phase of video analysis. The metric was then subjected to a process of cyclical evaluation by a Delphi panel (n = 21) to obtain face and content validity of the metric. The Delphi panel deliberation verified the face and content validity of the metric. The final metric has three phases, 31 individual steps, 18 errors, and 27 sentinel errors. The metric is a tool that identifies the standard to be attained in the performance of acute surgical wound dressings. It can be used as both an adjunct to an educational programme and as a tool to assess a practitioner's performance of a wound-dressing procedure in both simulated and clinical practice contexts

Optical Identification of Materials Transformations in Oxide Thin Films

Recent advances in high-throughput experimentation for combinatorial studies have accelerated the discovery and analysis of materials across a wide range of compositions and synthesis conditions. However, many of the more powerful characterization methods are limited by speed, cost, availability, and/or resolution. To make efficient use of these methods, there is value in developing approaches for identifying critical compositions and conditions to be used as a-priori knowledge for follow-up characterization with high-precision techniques, such as micron-scale synchrotron based X-ray diffraction (XRD). Here we demonstrate the use of optical microscopy and reflectance spectroscopy to identify likely phase-change boundaries in thin film libraries. These methods are used to delineate possible metastable phase boundaries following lateral-gradient Laser Spike Annealing (lg-LSA) of oxide materials. The set of boundaries are then compared with definitive determinations of structural transformations obtained using high-resolution XRD. We demonstrate that the optical methods detect more than 95% of the structural transformations in a composition-gradient La-Mn-O library and a Ga$_2$O$_3$ sample, both subject to an extensive set of lg-LSA anneals. Our results provide quantitative support for the value of optically-detected transformations as a priori data to guide subsequent structural characterization, ultimately accelerating and enhancing the efficient implementation of $\mu$m-resolution XRD experiments

Effect of angiotensin-converting enzyme inhibitor and angiotensin receptor blocker initiation on organ support-free days in patients hospitalized with COVID-19

IMPORTANCE Overactivation of the renin-angiotensin system (RAS) may contribute to poor clinical outcomes in patients with COVID-19. Objective To determine whether angiotensin-converting enzyme (ACE) inhibitor or angiotensin receptor blocker (ARB) initiation improves outcomes in patients hospitalized for COVID-19. DESIGN, SETTING, AND PARTICIPANTS In an ongoing, adaptive platform randomized clinical trial, 721 critically ill and 58 non–critically ill hospitalized adults were randomized to receive an RAS inhibitor or control between March 16, 2021, and February 25, 2022, at 69 sites in 7 countries (final follow-up on June 1, 2022). INTERVENTIONS Patients were randomized to receive open-label initiation of an ACE inhibitor (n = 257), ARB (n = 248), ARB in combination with DMX-200 (a chemokine receptor-2 inhibitor; n = 10), or no RAS inhibitor (control; n = 264) for up to 10 days. MAIN OUTCOMES AND MEASURES The primary outcome was organ support–free days, a composite of hospital survival and days alive without cardiovascular or respiratory organ support through 21 days. The primary analysis was a bayesian cumulative logistic model. Odds ratios (ORs) greater than 1 represent improved outcomes. RESULTS On February 25, 2022, enrollment was discontinued due to safety concerns. Among 679 critically ill patients with available primary outcome data, the median age was 56 years and 239 participants (35.2%) were women. Median (IQR) organ support–free days among critically ill patients was 10 (–1 to 16) in the ACE inhibitor group (n = 231), 8 (–1 to 17) in the ARB group (n = 217), and 12 (0 to 17) in the control group (n = 231) (median adjusted odds ratios of 0.77 [95% bayesian credible interval, 0.58-1.06] for improvement for ACE inhibitor and 0.76 [95% credible interval, 0.56-1.05] for ARB compared with control). The posterior probabilities that ACE inhibitors and ARBs worsened organ support–free days compared with control were 94.9% and 95.4%, respectively. Hospital survival occurred in 166 of 231 critically ill participants (71.9%) in the ACE inhibitor group, 152 of 217 (70.0%) in the ARB group, and 182 of 231 (78.8%) in the control group (posterior probabilities that ACE inhibitor and ARB worsened hospital survival compared with control were 95.3% and 98.1%, respectively). CONCLUSIONS AND RELEVANCE In this trial, among critically ill adults with COVID-19, initiation of an ACE inhibitor or ARB did not improve, and likely worsened, clinical outcomes. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT0273570

Phylogenetically diverse grasslands are associated with pairwise interspecific processes that increase biomass

Biodiversity is an important determinant of primary productivity in experimental ecosystems. We combine two streams of research on understanding the effects of biodiversity on ecosystem function: quantifying phylogenetic diversity as a predictor of biodiversity effects in species-rich systems and the contribution of pairwise interspecific interactions to ecosystem function. We developed a statistical model that partitions the effect of biodiversity into effects due to community phylogenetic diversity and other community properties (e.g., average pairwise interaction, between- and within-functional-group effects, and so forth). The model provides phylogenetically based species-level explanations of differences in ecosystem response for communities with differing species composition. In two well-known grassland experiments, the model approach provides a parsimonious description of the effects of diversity as being due to the joint effect of the average pairwise statistical interaction and to community phylogenetic diversity. Effects associated with functional groupings of species in communities are largely explained by community phylogenetic diversity. The model approach quantifies a direct link between a measure of the evolutionary diversity of species and their interactive contribution to ecosystem function. It proves a useful tool in developing a mechanistic understanding of variation in ecosystem function

Data from: Initial nucleation of metastable γ -Ga2O3 during sub-millisecond thermal anneals of amorphous Ga2O3

Please cite as: Katie Gann, Celesta Chang, Ming-Chiang Chang, Duncan Sutherland, Aine Connolly, David Muller, Robert van Dover, and Michael Thompson. (2022) Data from: Initial nucleation of metastable γ-Ga2O3 during sub-millisecond thermal anneals of amorphous Ga2O3. [Dataset] Cornell University eCommons Repository. https://doi.org/10.7298/e0s4-0w24These files contain the data supporting all of the results in Katie Gann, et. al, Initial nucleation of metastable γ -Ga2O3 during sub-millisecond thermal anneals of amorphous Ga2O3. In this work, we found: Beta-phase gallium oxide (β-Ga2O¬3) is a promising semiconductor for high frequency, high temperature, and high voltage applications. In addition to the β-phase, numerous other polymorphs also exist and understanding the competition between phases is critical to control practical devices. The phase formation sequence of Ga2O3, starting from amorphous thin films, was determined using lateral-gradient laser spike annealing at peak temperatures of 500-1400 °C on 400 μs to 10 ms timescales, with transformations characterized by optical microscopy, X-ray diffraction, and transmission electron microscopy (TEM). The resulting phase processing map showed the γ-phase, a defect-spinel structure, first nucleating under all annealing times for temperatures from 650-800 °C. Cross-sectional TEM at the onset of γ-phase formation showed nucleation near the film center with no evidence of heterogeneous nucleation at the interfaces. For temperatures above 850 °C, the thermodynamically stable β-phase was observed. For anneals of 1-4 ms, and for all anneals below 1200 °C, small randomly oriented grains were observed. Large grains were observed for anneals below 1 ms and above 1200 °C, with textured films resulting from anneals above 4 ms and 1200 °C. The formation of the γ-phase prior to β-phase, coupled with the observed grain structure, suggests that the γ-phase is kinetically preferred during thermal annealing of amorphous films, with β-phase formation subsequently forming by nucleation at higher temperatures. The low surface energy of the γ-phase implied by these results suggests an explanation for the widely observed γ-phase inclusions in β-phase Ga2O3 films grown by a variety of synthesis methods.This research was supported by the Air Force Research Laboratory-Cornell Center for Epitaxial Solutions (ACCESS) under Grant No. FA9550-18-1-0529, and by the SARA MURI funded by the Air Force Office of Scientific Research under award number FA9550-18-1-0136. We also acknowledge use of the Cornell Center for Materials Research Shared Facilities supported through the NSF MRSEC program (DMR-1719875), the Materials Solutions Network at CHESS (MSN-C) supported by the Air Force Research Laboratory under award FA8650-19-2-5220, and the Cornell NanoScale Facility, a member of the National Nanotechnology Coordinated Infrastructure (NNCI), which is supported by the National Science Foundation (Grant NNCI-2025233)

Infiltrated Zinc Oxide in Poly(methyl methacrylate): An Atomic Cycle Growth Study

We have investigated the growth of zinc oxide in a polymer matrix by sequential infiltration synthesis (SiS). The atomic cycle-by-cycle self-terminating reaction growth investigation was done using photoluminescence (PL), Raman, and X-ray photoemission spectroscopy (XPS). Results show clear differences between Zn atom configurations at the initial stages of growth. Mono Zn atoms (O–Zn and O–Zn–O) exhibit pure UV emission with little evidence of deep level oxygen vacancy states (V_O). Dimer Zn atoms (O–Zn–O–Zn and O–Zn–O–Zn–O) show strong UV and visible PL emission from V_O states 20 times greater than that from the mono Zn atom configuration. After three precursor cycles, the PL emission intensity drops significantly exhibiting first evidence of crystal formation as observed with Raman spectroscopy via the presence of longitudinal optical phonons. We also report a first confirmation of energy transfer between polymer and ZnO where the polymer absorbs light at 241 nm and emits at 360 nm, which coincides with the ZnO UV emission peak. Our work shows that ZnO dimers are unique ZnO configurations with high PL intensity, unique O_1s oxidation states, and sub-10 ps absorption and decay, which are interesting properties for novel quantum material applications

High levels of psychological distress, sleep disturbance, and alcohol use disorder in adults with atopic dermatitis.

BACKGROUND: The burden of illness associated with atopic dermatitis (AD) is significant and multidimensional, especially in those with moderate to severe disease. OBJECTIVE: Our objective was to evaluate the disease burden of patients with AD in relation to psychological distress, sleep disturbance, and alcohol misuse. METHODS: Patients with AD, attending 2 tertiary referral centers in Dublin, Ireland, were recruited. A series of validated questionnaires were used including the Patient-Oriented Eczema Measure, Dermatology Life Quality Index (DLQI), Center for Epidemiologic Studies-Depression Scale, Quality of Life in Atopic Dermatitis Questionnaire, Alcohol Use Disorders Identification Test, and Pittsburgh Sleep Quality Index. The Eczema Area and Severity Index was calculated contemporaneously with the questionnaire completion. RESULTS: One hundred patients completed the questionnaire, of whom 52% were female. Sixty-three percent of patients experienced impaired quality of life as measured by the DLQI. Higher DLQI scores correlated with decreasing age. Thirty percent were found to be at risk of clinical depression, and higher Center for Epidemiologic Studies-Depression Scale scores correlated with a younger age and eczema severity. Sleep disturbance was greater in those at risk of depression. Patients with moderate to severe AD were more likely to score higher on the Alcohol Use Disorders Identification Test, and 25% met the criteria for alcohol use disorder. In relation to sleep, 73% of patients scored higher than 5 on the Pittsburgh Sleep Quality Index, which signifies poor sleep quality. CONCLUSIONS: Patients with AD endure a significant burden on health with regard to mental well-being, alcohol use, and sleep quality. Clinicians should consider screening patients for these comorbidities

Readability of online COVID-19 health information: a comparison between four English speaking countries

Background: The internet is now the first line source of health information for many people worldwide. In the current Coronavirus Disease 2019 (COVID-19) global pandemic, health information is being produced, revised, updated and disseminated at an increasingly rapid rate. The general public are faced with a plethora of misinformation regarding COVID-19 and the readability of online information has an impact on their understanding of the disease. The accessibility of online healthcare information relating to COVID-19 is unknown. We sought to evaluate the readability of online information relating to COVID-19 in four English speaking regions: Ireland, the United Kingdom, Canada and the United States, and compare readability of website source provenance and regional origin.Methods: The Google® search engine was used to collate the first 20 webpage URLs for three individual searches for 'COVID', 'COVID-19', and 'coronavirus' from Ireland, the United Kingdom, Canada and the United States. The Gunning Fog Index (GFI), Flesch-Kincaid Grade (FKG) Score, Flesch Reading Ease Score (FRES), Simple Measure of Gobbledygook (SMOG) score were calculated to assess the readability.Results: There were poor levels of readability webpages reviewed, with only 17.2% of webpages at a universally readable level. There was a significant difference in readability between the different webpages based on their information source (p Conclusion: Much of the general public have relied on online information during the pandemic. Information on COVID-19 should be made more readable, and those writing webpages and information tools should ensure universal accessibility is considered in their production. Governments and healthcare practitioners should have an awareness of the online sources of information available, and ensure that readability of our own productions is at a universally readable level which will increase understanding and adherence to health guidelines.</div