116 research outputs found
Diffusion-emission theory of photon enhanced thermionic emission solar energy harvesters
Numerical and semi-analytical models are presented for
photon-enhanced-thermionic-emission (PETE) devices. The models take diffusion
of electrons, inhomogeneous photogeneration, and bulk and surface recombination
into account. The efficiencies of PETE devices with silicon cathodes are
calculated. Our model predicts significantly different electron affinity and
temperature dependence for the device than the earlier model based on a
rate-equation description of the cathode. We show that surface recombination
can reduce the efficiency below 10% at the cathode temperature of 800 K and the
concentration of 1000 suns, but operating the device at high injection levels
can increase the efficiency to 15%.Comment: 5 pages, 4 figure
Modeling the effect of mobile ion contamination on the stability of a microelectromechanical resonator
We present a theoretical model for mobile ion contamination in a silicon microelectromechanical resonator. In the model both drift and diffusion of the mobile charge in dielectric films are taken into account. The model is verified through a comparison to existing experimental data. We show that the model can describe the frequency drift of resonators in a wide temperature range.Peer reviewe
Time Dependence of Charge Transfer Processes in Diamond Studied with Positrons
We have developed a method called optical transient positron spectroscopy and apply it to study the optically induced carrier trapping and charge transfer processes in natural brown type IIa diamond. By measuring the positron lifetime with continuous and pulsed illumination, we present an estimate of the optical absorption cross section of the vacancy clusters causing the brown color. The vacancy clusters accept electrons from the valence band in the absorption process, giving rise to photoconductivity.Peer reviewe
Impact of cardiac surgery and neurosurgery patients on variation in severity-adjusted resource use in intensive care units
Publisher Copyright: © 2022Purpose: The resource use of cardiac surgery and neurosurgery patients likely differ from other ICU patients. We evaluated the relevance of these patient groups on overall ICU resource use. Methods: Secondary analysis of 69,862 patients in 17 ICUs in Finland, Estonia, and Switzerland in 2015–2017. Direct costs of care were allocated to patients using daily Therapeutic Intervention Scoring System (TISS) scores and ICU length of stay (LOS). The ratios of observed to severity-adjusted expected resource use (standardized resource use ratios; SRURs), direct costs and outcomes were assessed before and after excluding cardiac surgery or cardiac and neurosurgery. Results: Cardiac surgery and neurosurgery, performed only in university hospitals, represented 22% of all ICU admissions and 15–19% of direct costs. Cardiac surgery and neurosurgery were excluded with no consistent effect on SRURs in the whole cohort, regardless of cost separation method. Excluding cardiac surgery or cardiac surgery plus neurosurgery had highly variable effects on SRURs of individual university ICUs, whereas the non-university ICU SRURs decreased. Conclusions: Cardiac and neurosurgery have major effects on the cost structure of multidisciplinary ICUs. Extending SRUR analysis to patient subpopulations facilitates comparison of resource use between ICUs and may help to optimize resource allocation.Peer reviewe
Variation in Severity-Adjusted Resource use and Outcome for Neurosurgical Emergencies in the Intensive Care Unit.
BACKGROUND
The correlation between the standardized resource use ratio (SRUR) and standardized hospital mortality ratio (SMR) for neurosurgical emergencies is not known. We studied SRUR and SMR and the factors affecting these in patients with traumatic brain injury (TBI), nontraumatic intracerebral hemorrhage (ICH), and subarachnoid hemorrhage (SAH).
METHODS
We extracted data of patients treated in six university hospitals in three countries (2015-2017). Resource use was measured as SRUR based on purchasing power parity-adjusted direct costs and either intensive care unit (ICU) length of stay (costSRURlength of stay) or daily Therapeutic Intervention Scoring System scores (costSRURTherapeutic Intervention Scoring System). Five a priori defined variables reflecting differences in structure and organization between the ICUs were used as explanatory variables in bivariable models, separately for the included neurosurgical diseases.
RESULTS
Out of 28,363 emergency patients treated in six ICUs, 6,162 patients (22%) were admitted with a neurosurgical emergency (41% nontraumatic ICH, 23% SAH, 13% multitrauma TBI, and 23% isolated TBI). The mean costs for neurosurgical admissions were higher than for nonneurosurgical admissions, and the neurosurgical admissions corresponded to 23.6-26.0% of all direct costs related to ICU emergency admissions. A higher physician-to-bed ratio was associated with lower SMRs in the nonneurosurgical admissions but not in the neurosurgical admissions. In patients with nontraumatic ICH, lower costSRURs were associated with higher SMRs. In the bivariable models, independent organization of an ICU was associated with lower costSRURs in patients with nontraumatic ICH and isolated/multitrauma TBI but with higher SMRs in patients with nontraumatic ICH. A higher physician-to-bed ratio was associated with higher costSRURs for patients with SAH. Larger units had higher SMRs for patients with nontraumatic ICH and isolated TBI. None of the ICU-related factors were associated with costSRURs in nonneurosurgical emergency admissions.
CONCLUSIONS
Neurosurgical emergencies constitute a major proportion of all emergency ICU admissions. A lower SRUR was associated with higher SMR in patients with nontraumatic ICH but not for the other diagnoses. Different organizational and structural factors seemed to affect resource use for the neurosurgical patients compared with nonneurosurgical patients. This emphasizes the importance of case-mix adjustment when benchmarking resource use and outcomes
Scandinavian clinical practice guideline on fluid and drug therapy in adults with acute respiratory distress syndrome.
To access publisher's full text version of this article, please click on the hyperlink in Additional Links field or click on the hyperlink at the top of the page marked Files.
This article is open access.The objective of the Scandinavian Society of Anaesthesiology and Intensive Care Medicine (SSAI) task force on fluid and drug therapy in adults with acute respiratory distress syndrome (ARDS) was to provide clinically relevant, evidence-based treatment recommendations according to standards for trustworthy guidelines.The guideline was developed according to standards for trustworthy guidelines, including a systematic review of the literature and use of the GRADE methodology for assessment of the quality of evidence and for moving from evidence to recommendations.A total of seven ARDS interventions were assessed. We suggest fluid restriction in patients with ARDS (weak recommendation, moderate quality evidence). Also, we suggest early use of neuromuscular blocking agents (NMBAs) in patients with severe ARDS (weak recommendation, moderate quality evidence). We recommend against the routine use of other drugs, including corticosteroids, beta2 agonists, statins, and inhaled nitric oxide (iNO) or prostanoids in adults with ARDS (strong recommendations: low- to high-quality evidence). These recommendations do not preclude the use of any drug or combination of drugs targeting underlying or co-existing disorders.This guideline emphasizes the paucity of evidence of benefit - and potential for harm - of common interventions in adults with ARDS and highlights the need for prudence when considering use of non-licensed interventions in this patient population.Scandinavian Society of Anaesthesiology and Intensive Care Medicine (SSAI
Thermal radiation and near-field energy density of thin metallic films
We study the properties of thermal radiation emitted by a thin dielectric
slab, employing the framework of macroscopic fluctuational electrodynamics.
Particular emphasis is given to the analytical construction of the required
dyadic Green's functions. Based on these, general expressions are derived for
both the system's Poynting vector, describing the intensity of propagating
radiation, and its energy density, containing contributions from
non-propagating modes which dominate the near-field regime. An extensive
discussion is then given for thin metal films. It is shown that the radiative
intensity is maximized for a certain film thickness, due to Fabry-Perot-like
multiple reflections inside the film. The dependence of the near-field energy
density on the distance from the film's surface is governed by an interplay of
several length scales, and characterized by different exponents in different
regimes. In particular, this energy density remains finite even for arbitrarily
thin films. This unexpected feature is associated with the film's low-frequency
surface plasmon polariton. Our results also serve as reference for current
near-field experiments which search for deviations from the macroscopic
approach
High-k GaAs metal insulator semiconductor capacitors passivated by ex-situ plasma-enhanced atomic layer deposited AlN for Fermi-level unpinning
This paper examines the utilization of plasma-enhanced atomic layer deposition grown AlN in the fabrication of a high-kinsulator layer on GaAs. It is shown that high-kGaAsMIS capacitors with an unpinned Fermi level can be fabricated utilizing a thin ex-situ deposited AlNpassivation layer. The illumination and temperature induced changes in the inversion side capacitance, and the maximum band bending of 1.2 eV indicates that the MIS capacitor reaches inversion. Removal of surface oxide is not required in contrast to many common ex-situ approaches.Peer reviewe
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Effect of Inhaled Xenon on Cerebral White Matter Damage in Comatose Survivors of Out-of-Hospital Cardiac Arrest: A Randomized Clinical Trial
IMPORTANCE: Evidence from preclinical models indicates that xenon gas can prevent the development of cerebral damage after acute global hypoxic-ischemic brain injury but, thus far, these putative neuroprotective properties have not been reported in human studies. OBJECTIVE: To determine the effect of inhaled xenon on ischemic white matter damage assessed with magnetic resonance imaging (MRI). DESIGN, SETTING, AND PARTICIPANTS: A randomized single-blind phase 2 clinical drug trial conducted between August 2009 and March 2015 at 2 multipurpose intensive care units in Finland. One hundred ten comatose patients (aged 24-76 years) who had experienced out-of-hospital cardiac arrest were randomized. INTERVENTIONS: Patients were randomly assigned to receive either inhaled xenon combined with hypothermia (33°C) for 24 hours (n = 55 in the xenon group) or hypothermia treatment alone (n = 55 in the control group). MAIN OUTCOMES AND MEASURES: The primary end point was cerebral white matter damage as evaluated by fractional anisotropy from diffusion tensor MRI scheduled to be performed between 36 and 52 hours after cardiac arrest. Secondary end points included neurological outcome assessed using the modified Rankin Scale (score 0 [no symptoms] through 6 [death]) and mortality at 6 months. RESULTS: Among the 110 randomized patients (mean age, 61.5 years; 80 men [72.7%]), all completed the study. There were MRI data from 97 patients (88.2%) a median of 53 hours (interquartile range [IQR], 47-64 hours) after cardiac arrest. The mean global fractional anisotropy values were 0.433 (SD, 0.028) in the xenon group and 0.419 (SD, 0.033) in the control group. The age-, sex-, and site-adjusted mean global fractional anisotropy value was 3.8% higher (95% CI, 1.1%-6.4%) in the xenon group (adjusted mean difference, 0.016 [95% CI, 0.005-0.027], P = .006). At 6 months, 75 patients (68.2%) were alive. Secondary end points at 6 months did not reveal statistically significant differences between the groups. In ordinal analysis of the modified Rankin Scale, the median (IQR) value was 1 (1-6) in the xenon group and 1 (0-6) in the control group (median difference, 0 [95% CI, 0-0]; P = .68). The 6-month mortality rate was 27.3% (15/55) in the xenon group and 34.5% (19/55) in the control group (adjusted hazard ratio, 0.49 [95% CI, 0.23-1.01]; P = .053). CONCLUSIONS AND RELEVANCE: Among comatose survivors of out-of-hospital cardiac arrest, inhaled xenon combined with hypothermia compared with hypothermia alone resulted in less white matter damage as measured by fractional anisotropy of diffusion tensor MRI. However, there was no statistically significant difference in neurological outcomes or mortality at 6 months. These preliminary findings require further evaluation in an adequately powered clinical trial designed to assess clinical outcomes associated with inhaled xenon among survivors of out-of-hospital cardiac arrest. TRIAL REGISTRATION: clinicaltrials.gov Identifier: NCT00879892
Mortality prediction in intensive care units including premorbid functional status improved performance and internal validity
Objective: Prognostic models are key for benchmarking intensive care units (ICUs). They require up-to-date predictors and should report transportability properties for reliable predictions. We developed and validated an in-hospital mortality risk prediction model to facilitate benchmarking, quality assurance, and health economics evaluation. Study Design and Setting: We retrieved data from the database of an international (Finland, Estonia, Switzerland) multicenter ICU cohort study from 2015 to 2017. We used a hierarchical logistic regression model that included age, a modified Simplified Acute Physiology Score-II, admission type, premorbid functional status, and diagnosis as grouping variable. We used pooled and meta-analytic cross-validation approaches to assess temporal and geographical transportability. Results: We included 61,224 patients treated in the ICU (hospital mortality 10.6%). The developed prediction model had an area under the receiver operating characteristic curve 0.886, 95% confidence interval (CI) 0.882-0.890; a calibration slope 1.01, 95% CI (0.99-1.03); a mean calibration -0.004, 95% CI (-0.035 to 0.027). Although the model showed very good internal validity and geographic discrimination transportability, we found substantial heterogeneity of performance measures between ICUs (I-squared: 53.4-84.7%). Conclusion: A novel framework evaluating the performance of our prediction model provided key information to judge the validity of our model and its adaptation for future use. (c) 2021 The Authors. Published by Elsevier Inc. This is an open access article under the CC BY license ( http:// creativecommons.org/ licenses/ by/ 4.0/ )Peer reviewe
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