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© 2020 Published by Elsevier España, S.L.U. on behalf of Sociedade Portuguesa de Pneumologia. This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/)., Introduction and objectives: Asthma is a chronic and heterogeneous disease that affects people of all ages and has a high estimated increase in prevalence worldwide. Asthma control represents a main goal in the disease management. International studies revealed low levels of disease control resulting in a significant burden for healthcare systems, not only in terms of quality of life, but also in terms of health costs. Modifiable and non-modifiable factors have been identified as relating to poor asthma control level. In this study we evaluated the distribution of asthma control levels in Portuguese adult population and examine the determinants associated with uncontrolled asthma. Materials and methods: Using a similar methodology to the one employed in the Asthma Insights and Reality in Europe (AIRE) survey, 327 active asthmatic patients were identified by random phone number and completed a questionnaire during 2011 to 2012. Asthma control was assessed by the evaluation of GINA based symptom control, by Asthma Control Test.äó (ACT) and by self-perception of control. To examine the relationship between uncontrolled asthma and its determinants, univariate logistic regression analysis, sequential multivariable regression and population attributable risk percentage were determinate. Results: 35.2% active asthmatic patients had uncontrolled asthma, 64.8% partially controlled and none of the individuals had total control of asthma assessed by ACT test. Factors significantly associated with poor asthma control scores were: age (OR 1.02 per year of age; 95% CI: 1.01.Çô1.03), female sex (OR 1.87; 95% CI: 1.15.Çô3.04), educational level (OR 0.5; 95% CI: 0.28.Çô0.89 at high school level or over), occupation (OR 4.92; 95% CI: 2.12.Çô11.42 if looking for a first job or unemployed) (OR 2.51; 95% CI: 1.35.Çô4.65 if being retired), income (OR 0.23; 95% CI: 0.07.Çô0.72 if >619 euros), BMI (OR 1.09 per BMI unit; 95% CI: 1.03.Çô1.14), having rhinitis symptoms (OR 4.40; 95% CI: 2.56.Çô7.58) and using inhaled corticosteroids (OR 0.44; 95%CI: 0.24.Çô0.82 if used in the past or never used). Looking for a first job or being unemployed, BMI and having rhinitis symptoms remained significant after multivariate adjustments. Conclusions: Uncontrolled asthma was associated with several determinants. Their identification can contribute to improve asthma care both from clinical and from public health perspectives., This study was supported by a grant from the General Directorate of Health (DGS) of the Portuguese Health Ministry and by a scientific grant from AstraZeneca Foundation.

This essay explores assumptions underwriting literary categorization, focusing on Jewish American literary history in particular (mostly), and considers the scalar logic that allows us to link the singular text, with all of its luminous possibility, with the particular world of a given literary category. The essay’s first section critiques major claims about Jewish American literary history made over the last 20 years by observing the persistently underexamined use of a metaphorical and metaphysical concept of identity, and then lays out problems with scaling up between select texts and the larger category of a given field of literature. Problems of scale in Jewish American literary history are highlighted by comparison with recent critiques of African American literary history. Scale itself harbors problems of commensurability insofar as scaling between a single object and a set to which the object belongs requires acts of comparison which leap over differences of kind, a problem explored in the essay’s second section through analogies with problems of commensurability in the discipline of physics. The third section locates those problems of commensurability in Nicole Krauss’s novel Forest Dark (2017) and reads that novel’s direct confrontation with literary history as exemplifying how literary scholars can foreground multiplicity and possibility, precisely through the foregrounding of their own situated practice as interested agents. Rather than reproduce that figment by projecting a historically continuous and recognizable Jewishness across two centuries of literature, Jewish American literary studies should ally and coordinate itself with the field-questioning work occurring among Black and Latinx studies scholars who substantiate the salience of their field’s identity-based study, even as they depart from its historical formation.

Se ha observado que algunos grupos de pacientes tenían la percepción de que si se enfermaban por el COVID-19 podían tener mayores complicaciones. El objetivo de este estudio fue determinar la asociación entre las ideas fatalistas ante el posible contagio del coronavirus según el tipo de enfermedad que padecían los pacientes peruanos. Se realizó un estudio analítico de datos secundarios, que usó una data previa para obtener a encuestados que padecían alguna enfermedad (según 9 grupos/especialidades médicas), se cruzó esto según el pensamiento fatalista (de una prueba validada). De los 4483 encuestados, 15% tuvo una enfermedad. Los que padecían una enfermedad respiratoria percibían que se complicarían post infección (p

El haberse infectado previamente no garantiza que uno esté a salvo en esta pandemia, por lo que, es importante estimar el cambio de las percepciones. El objetivo fue determinar la percepción fatalista de los pacientes recuperados de COVID-19 en el Perú e identificar las diferencias sociodemográficas que influyen en la percepción fatalista de los pacientes recuperados y los no infectados. Estudio observacional, de cohorte retrospectiva. La variable exposición fue el si ya se contagió por COVID-19, la variable dependiente fue la percepción fatalista por si se enfermase de COVID-19 (en el caso de los que ya se enfermaron se preguntó ante la reinfección); esta se midió con una prueba validada y se definió el ser fatalista a los que estuvieron en el tercio superior de los puntajes; se obtuvo estadísticos analíticos. De los 8957 encuestados, el 37% reportó que ya se había infectado por COVID-19. En el análisis bivariado no se encontró diferencias del fatalismo según el haberse infectado previamente (p=0,426). En el multivariado, hubo menos riesgo de tener fatalismo entre los hombres (RRa: 0,85; IC95%: 0,80-0,90; valor p

The Plant Clinics (PCs), with CABI Plantwise Program (Centre for Agricultural Bioscience International), were officially initiated in Peru in 2012 by an agreement signed with the INIA (National Institute of Agrarian Innovation). Under this Agreement, PCs were originally established in four Experimental Stations (EEA) located in four regions of Peru, to subsequently include 4 more, making a total of 8 regions with different agro-ecologies (Jungle: Tarapoto; Sierra: Cajamarca, Huancayo, Ayacucho, Cusco and Puno; Coast: Chiclayo and Lima). These PCs have the presence of a "Plant Doctor" (PDs), an INIA technician, duly trained in Plant Health, who once a week at a certain place provides services to farmers who bring samples of their "sick" crops”. Examined the sample by the PDs, records the symptoms and diagnosis in a database platform. Then PDs provide the farmer with the most convenient recommendations within an Integrated Management of the relevant crop. The PDs also carry out “Health Campaigns” on the main problems detected in the CPs, as well as field visits, providing “Flying Sheets”, written in a simple and precise way for the identification of phytosanitary problems and their respective management. The information kept in a Data Bank has allowed to know crops with the highest demand and the incidence and severity of their pests and diseases in the eight regions of Perú.

Pulmonary arterial hypertension has evolved from a fatal disease with few treatment options to a chronic condition with improved survival. This improvement is possible through development of effective therapies as well as the expansion of risk stratification scores to assist clinical decision making. Despite improved disease control, quality of life, and overall prognosis, many challenges remain. The treatment itself is burdensome, with significant impact on quality of life. Many patients with pulmonary arterial hypertension still present with advanced, often end-stage disease. Increased use of mechanical circulatory support and catheter-based interventions have expanded use of extracorporeal life support and right ventricle assist devices. For these reasons as well as the long-term relationships pulmonary hypertension physicians have with patients and their families, navigating the course of the illness in a considered, proactive way is essential. Understanding individual goals and revisiting them as they change over time requires comfort with the conversation itself. There are many barriers and challenges to having effective, compassionate conversations in the clinical setting with time constraints being the most often cited. Compressed visits are necessarily focused on the clinical aspects, therapy and medication adherence and tolerance. Clinicians are sometimes wary of diminishing hope in the face of ongoing treatment. Having sufficient experience and comfort with these discussions can be empowering. In this paper, we discuss the challenges involved and propose a framework to assist in incorporating these discussions into clinical care.

Introduction and objectives Acute heart failure (AHF), can occur as decompensated chronic heart failure (HF) or as a first episode, “new onset”. The aim of this study was to analyse the clinical characteristics and prognosis at one-year in a cohort of patients with new onset AHF. Methods Prospective observational study of 3550 patients with AHF. We compared patients with new onset HF with the others. Restricting the analysis to new onset AHF patients, we analysed the clinical characteristics, readmissions, mortality and impact of left ventricular ejection fraction on the prognosis. Results A total of 1105 (31%) patients fulfil the criteria for new onset AHF. These patients versus the rest, were younger, had a higher aetiology of hypertension and preserved left ventricular ejection fraction, less global comorbidity and better baseline overall functional status. After one year, mortality in new onset HF was less than chronic decompensated HF (15 vs. 27%; p Conclusions New onset AHF shows a clinical profile and prognosis different to that of chronic decompensated HF. Higher comorbidity, renal function and treatment post-discharge predict a higher risk of mortality.

Resumen Introduccion y objetivos La insuficiencia cardiaca aguda (ICA) puede suceder como una descompensacion de una IC cronica o como un primer episodio “de novo”. Nuestro objetivo fue analizar las caracteristicas clinicas y el pronostico al ano, en una cohorte de ICA de novo. Metodos Estudio observacional y prospectivo de 3550 pacientes con ICA. Se analizan las caracteristicas clinicas, la fraccion de eyeccion ventricular izquierda, los reingresos y factores asociados a mayor mortalidad al ano de los pacientes con ICA de novo y se comparan con el resto. Resultados Un total de 1105 (31%) pacientes, presentaron ICA de novo. Este grupo fue mas joven, con mayor etiologia hipertensiva y fraccion de eyeccion ventricular izquierda preservada, mejor estado funcional y menor comorbilidad que el resto de la cohorte. Al ano de seguimiento, la mortalidad fue menor en ICA de novo frente a IC cronica descompensada (el 15 vs. el 27%; p Conclusiones Los pacientes con ICA de novo tienen un perfil clinico diferente a la IC cronica descompensada, con un mejor pronostico. Los principales factores predictores de mortalidad al ano en ICA de novo fueron la comorbilidad global, la funcion renal y el tipo de tratamiento al alta hospitalaria.

Objective Several studies have reported that a higher degree of hemoconcentration in patients admitted for the treatment of acute heart failure (HF) constitutes a favorable prognostic factor in the year following the index episode. The objective of this study was to evaluate whether the highest degree of hemoconcentration at 3 months after admission for HF is also a prognostic factor for mortality and/or readmission in the 12 months after admission. Patients and method The hemoconcentration group was the upper quartile of the sample distributed according to hemoglobin increase at month 3 after discharge with respect to hemoglobin at the time of admission for HF in a multicenter prospective cohort of 1659 subjects with HF. Results The mean follow-up until the first event was 294 days, and a total of 487 deaths and 1125 readmissions were recorded. The hemoconcentration group had a lower risk of mortality or readmission for any cause (RR = 0.75, 95% CI: 0.51–1.09 and RR = 0.86, 95% CI: 0.70–1.05), although statistical significance was lost after multivariate analysis, while it was retained for other factors with recognized negative impact on the prognosis of patients with HF, such as age and functional class. Conclusions The degree of hemoconcentration at 3 months after admission for HF is not prognostic of readmission or death in the subsequent year.

Resumen Objetivo Diferentes estudios senalan que la consecucion de una mayor hemoconcentracion en pacientes ingresados por insuficiencia cardiaca (IC) aguda mejora el pronostico a lo largo del ano siguiente al episodio indice. El objetivo de este estudio es evaluar si el grado de hemoconcentracion a los 3 meses tras el ingreso por IC tambien tiene valor pronostico de reingreso y/o mortalidad en los 12 meses siguientes al ingreso. Pacientes y metodo Cohorte prospectiva multicentrica de 1.659 pacientes con IC. El grupo hemoconcentracion (305 pacientes) se situo en el cuartil superior de la muestra distribuida en funcion del aumento de la hemoglobina en el mes 3 tras el alta con respecto a la hemoglobina en el ingreso por IC. Resultados Seguimiento medio hasta el primer evento fue de 294 dias, fallecieron 487 pacientes y reingresaron 1.125. El grupo hemoconcentracion mostro un riesgo menor de mortalidad o de reingreso por cualquier causa (RR = 0,75; IC 95%: 0,51-1,09 y RR = 0,86; IC 95%: 0,70-1,05), si bien la significacion estadistica se perdio tras el analisis multivariado. Sin embargo, esta significacion se mantuvo para otros factores con reconocido efecto negativo sobre el pronostico en pacientes con IC, como son la edad y la clase funcional. Conclusiones El grado de hemoconcentracion a los 3 meses tras el ingreso por IC no tiene valor pronostico de reingreso o muerte en el ano siguiente.

Dengue virus (DENV) is a flavivirus associated with clinical manifestations ranging in severity from self-limiting dengue fever, to the potentially life threatening condition, severe dengue. There are currently no approved antiviral therapies for the treatment of DENV. Here, we evaluated the antiviral potential of four broad-spectrum antivirals, UV-4B, interferon-alpha (IFN), sofosbuvir (SOF), and favipiravir (FAV) against DENV serotype 2 as mono- and combination therapy in cell lines that are physiologically relevant to human infection. Cell lines derived from human liver (HUH-7), neurons (SK-N-MC), and skin (HFF-1) were infected with DENV and treated with UV-4B, IFN, SOF, or FAV. Viral supernatant was sampled daily and infectious viral burden was quantified by plaque assay on Vero cells. Drug effect on cell proliferation in uninfected and infected cells was also assessed. UV-4B inhibited DENV in HUH-7, SK-N-MC, and HFF-1 cells yielding EC50 values of 23.75, 49.44, and 37.38 µM, respectively. Clinically achievable IFN concentrations substantially reduced viral burden in HUH-7 (EC50 = 102.7 IU/mL), SK-N-MC (EC50 = 86.59 IU/mL), and HFF-1 (EC50 = 163.1 IU/mL) cells. SOF potently inhibited DENV in HUH-7 cells but failed to produce the same effect in SK-N-MC and HFF-1 cells. Finally, FAV provided minimal suppression in HUH-7 and SK-N-MC cells, but was ineffective in HFF-1 cells. The two most potent anti-DENV agents, UV-4B and IFN, were also assessed in combination. UV-4B + IFN treatment enhanced antiviral activity in HUH-7, SK-N-MC, and HFF-1 cells relative to monotherapy. Our results demonstrate the antiviral potential of UV-4B and IFN against DENV in multiple physiologically relevant cell types.

Brain injuries that are induced by external forces are particularly challenging to model experimentally. In recent decades, the domestic pig has been gaining popularity as a highly relevant animal model to address the pathophysiological mechanisms and the biomechanics associated with head injuries. Understanding cognitive, motor, and sensory aspects of pig behavior throughout development is crucial for evaluating cognitive and motor deficits after injury. We have developed a comprehensive battery of tests to characterize the behavior and physiological function of the Yucatan minipig throughout maturation. Behavioral testing included assessments of learning and memory, executive functions, circadian rhythms, gait analysis, and level of motor activity. We applied traditional behavioral apparatus and analysis methods, as well as state-of-the-art sensor technologies to report on motion and activity, and artificial intelligent approaches to analyze behavior. We studied pigs from 16 weeks old through sexual maturity at 35 weeks old. The results show multidimensional characterization of minipig behavior, and how it develops and changes with age. This animal model may capitulate the biomechanical consideration and phenotype of head injuries in the developing brain and can drive forward the field of understanding pathophysiological mechanisms and developing new therapies to accelerate recovery in children who have suffered head trauma.

Background Cancer is the second leading cause of mortality worldwide. Integrating different levels of care by implementing screening programmes, extending diagnostic tools and applying therapeutic advances may increase survival. We implemented a cancer fast-track programme (CFP) to shorten the time between suspected cancer symptoms, diagnosis and therapy initiation. Patients and methods Descriptive data were collected from the 10 years since the CFP was implemented (2009-2019) at the Clinico-Malvarrosa Health Department in Valencia, Spain. General practitioners (GPs), an oncology coordinator and 11 specialists designed guidelines for GP patient referral to the CFP, including criteria for breast, digestive, gynaecological, lung, urological, dermatological, head and neck, and soft tissue cancers. Patients with enlarged lymph nodes and constitutional symptoms were also considered. On identifying patients with suspected cancer, GPs sent a case proposal to the oncology coordinator. If criteria were met, an appointment was quickly made with the patient. We analysed the timeline of each stage of the process. Results A total of 4493 suspected cancer cases were submitted to the CFP, of whom 4019 were seen by the corresponding specialist. Cancer was confirmed in 1098 (27.3%) patients: breast cancer in 33%, urological cancers in 22%, gastrointestinal cancer in 19% and lung cancer in 15%. The median time from submission to cancer testing was 11 days, and diagnosis was reached in a median of 19 days. Treatment was started at a median of 34 days from diagnosis. Conclusions The findings of this study show that the interval from GP patient referral to specialist testing, cancer diagnosis and start of therapy can be reduced. Implementation of the CFP enabled most patients to begin curative intended treatment, and required only minimal resources in our setting., Highlights • Our CFP easily connects GPs and hospital specialists. • Our CFP shortens assessment time in patients with suspected cancer, adding to quality care. • Our CFP decreases emotional stress in patients without cancer.

El conocimiento es pieza clave para afrontar cualquier enfermedad, pero se tiene pocos estudios basales de cuando empezó la pandemia del COVID-19. El objetivo fue el determinar la asociación entre ser población vulnerable y el bajo conocimiento que tuvieron los pobladores en 17 ciudades del Perú al inicio de la pandemia. Se midió el conocimiento mediante una escala de nueve preguntas, que indaga acerca del mecanismo, los síntomas y las consecuencias; esto se cruzó versus variables socio-demográficas mediante la estadística analítica. De los 3913 encuestados, los menores conocimientos fueron acerca de cómo reaccionar ante síntomas de un resfrío y qué tratamiento debe seguir una persona que tiene infección inicial no grave por coronavirus (37% y 53% de respuestas correctas; respectivamente). En el análisis multivariado, los que tuvieron menores porcentajes de un mal nivel de conocimiento de la enfermedad fueron los que tenían estudios superiores (RPa: 0,74; IC95%: 0,62-0,88; valor p=0,001), entre los que tenían algún post grado (RPa: 0,59; IC95%: 0,43-0,68; valor p

Introduction: Fear is a natural response to something unknown. In the current scenario, it is important to assess it in relation to the coronavirus disease-19 (COVID-19) pandemic in Latin American countries. Objective: To determine the fear perception according to factors associated with the COVID-19 pandemic in Peru. Methods: An analytical cross-sectional study was conducted based on a virtual questionnaire. The main question was “how much fear people had of COVID-19?”, using a scale from zero (without fear) to 10 (very fear). This scale was divided into tertiles, and the upper tertile was the reference category (compared to the middle and lower tertiles). Statistical significances between fear perception of COVID-19 and sociodemographic data were calculated. Results: A total of 3887 participants responded the questionnaire about fear perception. In the multivariate analysis was found that women (adjusted prevalence ratio (aPR): 1.37; 95% confidence interval (CI) : 1.26-1.48; p

La crisis sanitaria causada por la COVID-19 ha forzado una reorganización de los servicios de salud mental. El presente artículo describe una propuesta de reorganización aplicada en una unidad de salud mental infanto-juvenil (atención ambulatoria y comunitaria). Se exponen las estrategias concretas de intervención desarrolladas en las distintas fases de la pandemia según las medidas de restricción sanitarias y los distintos niveles de intervención requeridos (prevención, atención primaria y atención especializada). Además, se compara el número de visitas hechas durante el periodo de Marzo-Julio de 2020 con el mismo periodo en 2019. Concluimos que se ha producido una rápida adaptación del marco asistencial presencial a la metodología telemática mediante una reorganización flexible. Sin embargo, la disminución de la asistencia presencial y la cancelación de grupos terapéuticos han incrementado la presión asistencial notablemente. Se ha observado un incremento de conductas autolíticas y de problemas relacionados con la conducta alimentaria que deberán ser investigados en futuros estudios. Palabras clave: Psicología clínica infanto-juvenil, Salud mental, COVID-19, Salud mental infanto-juvenil, Organización servicios.

Ahora que contamos con las vacunas contra la COVID-19 para mujeres embarazadas, es importante conocer su percepción y su intención de vacunarse. El objetivo fue determinar la actitud de las mujeres embarazadas hacia la vacunación contra la COVID-19 en el Perú y los factores asociados a esta. Estudio del tipo transversal analítico, esto se realizó en los 24 departamentos peruanos durante los meses de diciembre del 2020 y enero del 2021. El 50% de las encuestadas aún no decidía si se vacunaría, el 36% mencionaban que sí se vacunarían, el 8% mencionó que por ninguna circunstancia lo haría y el 6% lo haría solo si la obligaban. En el análisis multivariado se encontró que no se vacunarían debido a que no confían en el sistema de salud (valor p=0,002; siendo más las gestantes que desconfiaban del sector salud), en cambio, en los motivos por los que si se vacunarían, se encontró que esta vacunación mejoraría la salud de su familia o seres queridos (valor p=0,005; fueron menos las gestantes que se vacunarían por esta razón). Se concluye que el porcentaje de mujeres embarazadas que sí se vacunarían es bajo, siendo la principal razón por la mejora de la salud de su familia, mientras que la desconfianza en el sistema de salud, el desconocimiento de la elaboración de las vacunas y el no considerarse una población de riesgo fueron los principales factores asociados a la resistencia a la vacunación.

integration requires development of low thermal budget process modules. High-quality SiO 2 interfacial layer (IL), obtained up to now only by high-temperature (≥850°C) oxidation or exposure, is crucial for pMOS NBTI reliability. In unannealed IL’s grown at reduced temperatures, we show that unrelaxed interface strain induces high defect densities, with physics-based NBTI modeling suggesting excessive hydroxyl-E’ defect formation due to Si-O bond stretch. Based on ab-initio theoretical insights, we demonstrate an atomic hydrogen treatment to passivate SiO 2 defects at low temperatures (100-300°C), which is shown to be vastly more effective than high pressure molecular hydrogen exposure, and to yield an SiO 2 quality and reliability surpassing a 900°C oxide.

Study design This is a level IV retrospective descriptive study at a single institution. Objective The objective of the study was to determine the preoperative signs or symptoms prompting cervicomedullary imaging in Jeune syndrome. Summary of background data Jeune syndrome is a rare autosomal recessive disorder that results in pulmonary compromise from abnormal development of the thorax. Multiple medical comorbidities complicate timely diagnosis of cervicomedullary stenosis, which neurologically jeopardizes this patient population with regards to improper cervical manipulation. Currently, explicit screening of the cervicomedullary junction is not advocated in national guidelines. Methods The User Reporting Workbench and Center for Thoracic Insufficiency Syndrome (CTIS) Safety Registry was queried for patients with Jeune syndrome under the age of 18 with cervicomedullary stenosis with or without suboccipital craniectomy/craniotomy evaluated at the authors' institution from January 1, 2007 to August 21, 2018. The primary outcome was the clinical reason for cervicomedullary screening. Secondary outcomes were: age at time of surgery, preoperative myelopathy (spasticity, urinary retention), hydrocephalus, postoperative deficits (respiratory, motor, swallowing difficulty), and need for cervical fusion. Results Of 32 patients with Jeune syndrome, four (12.5%) had cervicomedullary stenosis requiring decompression. The average age at surgery was 5.25 months (2-9 mo). Two patients underwent imaging due to desaturation events while the other two patients were diagnosed with cervical stenosis as an incidental finding. No patients exhibited clinical myelopathy. Two patients had baseline preoperative swallowing difficulties. None of the patients postoperatively required cervical fusions, nor did they exhibit respiratory deficits, motor deficits, or worsening swallowing difficulties. Conclusion Jeune patients should be routinely screened for cervicomedullary stenosis and undergo subsequent prophylactic decompression to minimize or eliminate the development of irreversible neurologic compromise. Level of evidence 4.

© 2019, Springer Science+Business Media, LLC, part of Springer Nature. Dangling bond defects (DBs) in silicon-passivated (1- or 3-nm thick Si cap) strained-(100)Si 1−x Ge x (x = 0.25–0.55) layers at interfaces with 1.8-nm thick HfO 2 gate dielectric are studied by means of Electron Spin Resonance (ESR) spectroscopy. The results suggest a dominant contribution of Si DBs (P b0 centers), a considerable fraction of which is located at the interface between the Si substrate crystal and the pseudomorphic Si 1−x Ge x film. The density of Si DBs in the Ge containing samples is significantly lower than at the reference (100)Si/ HfO 2 interface and decreases below the ESR detection limit (≈ 0.8 × 10 11 cm −2 ) with increasing thickness and Ge concentration in the Si 1−x Ge x layer. However, the beneficial effect of Ge becomes less pronounced when the thickness of the Si cap is reduced to 1 nm or in the case of direct deposition of HfO 2 on top of uncapped Si 1−x Ge x . From these observations we conclude that DBs are eliminated due to in-diffusion of Ge from the Si 1−x Ge x channel into interfacial Si layers, bringing the concentration of Ge to the range in which generation of Si DBs becomes energetically unfavourable, in agreement with previous observations on condensation-grown Si 1−x Ge x layers. ispartof: JOURNAL OF MATERIALS SCIENCE-MATERIALS IN ELECTRONICS vol:31 issue:1 ispartof: location:FRANCE, Strasbourg status: Published online

International audience; In harsh radiation environments, it is well known that the angle of incidence of impinging particles against the surface of the operating devices has significant effects on their sensitivity. This article discusses the sensitivity underestimations that are made if particle isotropy is not taken into account, by means of an analytical study made with a single-event upset predictive platform. To achieve this goal, experimental results carried out with a commercial-off-the-shelf (COTS) bulk 130-nm nonvolatile static random access memory (SRAM) for various incident angles on 14.2 MeV neutrons are first discussed. Then, a modeling tool called multiscales single-event phenomena predictive platform (MUSCA-SEP3) is used to predict the sensitivity of this memory under the same environmental conditions. Predictions and experimental results will be cross-checked, and therefore, the feasibility of this tool will be demonstrated for testing any other incident angle. Finally, an isotropic environment and an XY SRAM array will be emulated with MUSCA in order to demonstrate that the asymmetrical cross sections that were observed experimentally for various incidence angles are due to the underlying asymmetry of the metalization/passivation layers within the device with respect to its active silicon. Conclusions will finally be drawn as for the importance of taking into account particle isotropy in radiation-ground tests.

International audience; A sensitivity characterization of a Xilinx Artix-7 field programmable gate array (FPGA) against 14.2-MeV neutrons is presented. The content of the internal static random access memories (SRAMs) and flip-flops was downloaded in a PC and compared with a golden version of it. Flipped cells were identified and classified as cells of the configuration RAM, block RAM (BRAM), or flip-flops. Single bit upsets (SBUs) and multiple cell upsets (MCUs) with multiplicities ranging from 2 to 8 were identified using a statistical method. Possible shapes of multiple events are also investigated, showing a trend to follow wordlines. Finally, MUlti-Scales Single Event Phenomena Predictive Platform (MUSCA SEP3) was used to make assessment of actual environments and an improvement of single event upset (SEU) injection test is proposed.

3-D sequential integration requires top MOSFETs processed at a low thermal budget, which can impair the device reliability. In this paper, top junctionless (JL) devices are fabricated with a maximum processing temperature of 525 °C. The devices feature high k/metal replacement gate and low-temperature Si:P and SiGe:B 60% raised source and drain for nMOS and pMOS fabrication, respectively. Device matching, analog, and RF performance of the top tier devices are in-line with the state-of-the-art Si technology processed at high temperature (>1000 °C). JL devices operate at reduced electric field and can meet in specification reliability (10-year reliable operation at ${V}_{\textsf {G}}= {V}_{\textsf {th}}+ 0.6$ V, 125 °C), even without the use of “reliability” anneal. The top Si layer is transferred on CMOS planar bulk wafers with W metal-1 interconnects, using a SiCN to SiCN direct wafer bonding. Comparison with silicon-on-insulator devices fabricated with the same low-temperature flow shows no impact on device electrical performance from the Si layer transfer.

In Mexico, previous studies performed to evaluate the image quality in 2D digital mammography facilities show a poor image quality that is not compatible with mammography screening that may modify breast cancer mortality rate. Image quality is lost due to the quality assurance programs are not implemented. We carried out an exploratory survey of thirty-six new (FFDM) units from a single manufacturer installed in several cities of the Mexican Republic with two types of target/filter combination (Mo/Mo and W/Rh). Tests were performed according to NOM-041-SSA1–2011 (Mexico), the regulation indicates that all facilities using digital mammography systems must maintain a QC program equal to the QC program recommended by the manufacturer. However, QC program recommended by the manufacturer meets with FDA and ACR Regulations. Digital mammography units evaluated exceeds quality image standards established by the ACR and FDA, even though, the W/Rh combination achieved a higher performance and reduces the average glandular dose. All mammography units met the quality control standards established by ACR, FDA and Mexican regulations. Then, the objective of this study was to evaluate the initial image quality and compliances with the manufacturer's quality control specifications before use it in patients in new full-field 2D digital mammography (FFDM) units and compares average glandular dose (AGD) with FFDM units using different anode/filter combinations (Mo/Mo and W/Rh).

Carpometacarpal (CMC) arthroplasty surgery, although modifications have occurred over time, continues to be commonly performed and has provided patients with their desired pain relief and return of function. The complications of primary surgery, although relatively rare, can present in various clinical ways. An understanding of the underlying anatomy, pathology of coexisting conditions, and specific techniques used in the primary surgery is required to make the best recommendation for a patient with residual pain following primary CMC arthroplasty. The purpose of this review is to provide insights into the history of CMC arthroplasty and reasons for failure and to offer an algorithmic treatment approach for the clinical problem of persistent postoperative symptoms.

Background: The COVID-19 pandemic has disrupted many aspects of clinical practice in oncology, particularly in making timely cancer diagnosis. Our public health system has been concerned about potential delays leading to a higher proportion of patients with advanced stages. Our cancer diagnosis fast-track program (CFP) in the Clinic-Malvarrosa Health department in Valencia (Spain) is connecting primary care (PC) with different specialists to speed cancer diagnosis and treatment upon well founded suspicion. A 10-year evaluation of our CFP has recently been published. The aim of this analysis was to investigate the impact of the COVID-19 pandemic on the CFP. Methods: We analysed the programme flow during the state of emergency starting on March 16, 2020 for one year. Results: During that year, 975 suspected cancer cases were submitted to the CFP. The submissions only decreased during the times of highest COVID-19 incidence and stricter lockdown (March, April and October 2020). However, referrals were slightly higher than in the two previous years (average 877). Of those 975 patients, 817 were seen by the corresponding specialist. A cancer diagnosis was confirmed in 197 (24.1%) with 33% urological, 23% breast, 16% gastrointestinal and 9% lung cancer. Median time from referral to the specialist visit was 13 (interquartile range, 8 to 22 days) days and a diagnosis was reached in a median of 18 days (interquartile range, 10 to 30 days). In cancer patients, treatment was started in around 30 days (interquartile range, 13.5 to 51 days) from the time of diagnosis. Sixty-one percent of cancers were found in an early stage, 20% in a locally advanced stage, and 19% in an advanced stage. These intervals and proportions were similar to the previous years. Conclusions: Our programme has proven to be a reliable tool to help PC physicians referring patients with cancer suspicion cancer, maintaining its normal flow and efficacy despite the current pandemic. Legal entity responsible for the study: The authors. Funding: Has not received any funding. Disclosure: All authors have declared no conflicts of interest.

Patients with advanced melanoma have a high propensity to metastasize to the brain and numerous investigational treatments with targeted agents have shown modest response in melanoma brain metastatic patients. Therefore, there is an urgent need to develop innovative therapies for such tumors. Oncolytic herpes simplex virus (oHSV) that selectively replicate in tumor cells and illicit an antitumor effect via oncolysis and production of neoantigens is among the recently approved promising therapies for primary melanoma patients. However, virus neutralization, and inefficient extravasation are the major barriers to the effective systemic delivery of oHSV to target metastatic tumor lesions in the brain. We have previously shown that mesenchymal stem cells (MSC) armed with different oHSV variants (MSC-oHSV) home to metastatic tumor lesions and have therapeutic benefits in melanoma brain metastases (MBM) models. To enhance therapeutic efficacy for metastasis melanoma, we investigated the novel combined therapy using MSC loaded with oHSV and simultaneously MSC releasing GM-CSF. Based on our TCGA data indicating significant loss of PTEN expression in late-stage metastatic melanoma, we tested MSC based therapeutics in PTEN mutant mouse melanomas. We show that MSC loaded oHSV effectively kills PTEN mutant syngeneic tumor cells in vitro. Next, we established MSC secreting GM-CSF and tested the abscopal effects as well as the antitumor efficacy in combination with MSC-oHSV in PTEN mutant syngeneic bilateral subcutaneous tumor model. The combined MSC based therapy showed significant therapeutic effects at both the treated and untreated site compared to control therapies. Interestingly, when these mice after combination therapy were re-challenged with mouse melanoma cells injected into brain, all mice remained tumor free. The combined MSC therapy induced effector memory CD8 and central memory CD8 cells in spleen and there was no toxicity in major organs post-therapy. In conclusion, our data indicate that combined MSC-oHSV/GM-CSF therapy is a promising novel therapy for advanced melanomas. Citation Format: Nobuhiko Kanaya, Maria Lopez Vazquez, Arnaldo J. Franco Torres, Yohei Kitamura, Genevieve M. Boland, Khalid Shah. MSC loaded oncolytic virus and expressing immunomodulators have therapeutic efficacy in advanced melanomas [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2021; 2021 Apr 10-15 and May 17-21. Philadelphia (PA): AACR; Cancer Res 2021;81(13_Suppl):Abstract nr 77.

SiGe quantum-well pMOSFETs have recently been introduced for enhanced performance of transistors. Quite surprisingly, a significant reduction in negative bias temperature instability (NBTI) was also found in these devices. Furthermore, a stronger oxide field acceleration of the degradation in SiGe devices compared with Si devices was reported. These observations were speculated to be a consequence of the energetical realignment of the SiGe channel with respect to the dielectric stack. As these observations were made on large-area devices, only the average contribution of many defects to NBTI could be studied. In order to reveal the microscopic reasons responsible for the improved reliability, a detailed study of single defects is performed in nanoscale devices. To provide a detailed picture of single charge trapping, the step-height distributions for different device variants are measured and found to follow a unimodal and bimodal distribution. This finding suggests two conducting channels, one in the SiGe and one in the thin Si cap layer. We, furthermore, demonstrate that similar trap depth distributions are present among the device variants supported by a similar stress bias dependence of the capture times of the identified single defects. We conclude that NBTI is primarily determined by the dielectric stack and not by the device technology.

The susceptibility of conventional silicon p-channel MOS transistors to negative bias temperature instabilities (NBTIs) is a serious threat to further device scaling. One possible solution to this problem is the use of a SiGe quantum-well channel. The introduction of a SiGe layer, which is separated from the insulator by a thin Si cap layer, not only results in high mobilities but also superior reliability with respect to NBTI. In part one of this paper, we provide experimental evidence for reduced NBTI by thoroughly studying single traps in nanoscale devices. In this paper, we present detailed TCAD simulations and employ the four-state nonradiative multiphonon model to determine the energetical and spatial positions of the identified single traps. The found trap levels agree with the defect bands estimated in large-area devices. Our conclusions are also supported by the observation of similar activation energies for defects present in transistors of various device geometries. From the calibrated TCAD simulations data, an impressive boost of the time-to-failure for the SiGe transistor can be predicted and explained.

Resumen La administracion del anestesico local en el tejido conectivo que une los componentes tibial y peroneo del nervio ciatico a nivel de su division en el hueco popliteo produce una distribucion muy eficiente de anestesico para conseguir un bloqueo efectivo. Mediante ecografia en 3 dimensiones podemos cuantificar este volumen de contacto en una longitud determinada del nervio. Metodos Se incluyo a 20 pacientes consecutivos programados para cirugia de hallux valgus. En todos los casos se realizo un bloqueo popliteo ecoguiado en la division del nervio ciatico, en abordaje «fuera de plano» con el paciente en decubito prono. Se administraron 30 ml de anestesico local y se evaluo su difusion. Se realizo una adquisicion volumetrica del nervio ciatico antes e inmediatamente despues de finalizar la inyeccion del farmaco para cuantificar el volumen del nervio ciatico y el volumen contenido en el interior del tejido conectivo que envuelve ambos componentes del nervio ciatico; todo ello en un segmento de 5 cm de nervio. Resultados Todos los bloqueos fueron efectivos a los 20 min. El volumen de anestesico local contenido en el interior del tejido conectivo fue de 6,8 ± 2,6 cm3. De este volumen, 4,4 ± 1,7 cm3 se situaban en el halo que envolvia los componentes del nervio y 2,4 ± 1,7 cm3 se ubicaban en el interior del nervio ciatico o sus componentes. Conclusiones El volumen en contacto con el nervio ciatico puede ser estimado mediante la adquisicion volumetrica. Nuestros resultados indican que el volumen para el bloqueo efectivo del nervio ciatico a nivel popliteo quizas se podra reducir de forma significativa en un futuro.

Local anaesthetic injection between the tibial and commmon peroneal nerves within connective tissue sheath results in a predictable diffusion and allows for a reduction in the volume needed to achieve a consistent sciatic popliteal block. Using 3D ultrasound volumetric acquisition, we quantified the visible volume in contact with the nerve along a 5 cm segment. Methods We included 20 consecutive patients scheduled for bunion surgery. Ultrasound guided popliteal block was performed using a posterior, out of plane approach at the level of division of the sciatic nerve. Thirty mL of mepivacaine 1.5% and levobupivacaine 0.5% were slowly injected while assessing the injection pressure and the diffusion of the local anaesthetic. Volumetric acquisition was performed before and after the block to quantify the volume of the sciatic nerve and the volume of the surrounding hypoechoic halo contained inside the connective tissue in a 5 cm segment. Results All blocks were successful within 20 min after the injection. The total estimated volume contained inside the common connective tissue sheath was 6.8 ± 2.6 cm 3 . Of this, the volume of the halo surrounding the nerve was 4.4 ± 1.7 cm 3 and the volume inside the sciatic nerve was 2.4 ± 1.7 cm 3 . Conclusions The volume of local anaesthetic in close contact with the sciatic nerve can be estimated by volumetric acquisition. Our results suggest that the effective volume of local anaesthetic needed for a successful sciatic popliteal block could be reduced to less than 7 mL.

We have validated that the electrical performances of the In0.53Ga0.47As MOSFETs such as sub-threshold slope (SS) and electron mobility were dependent on interfacial reactions in the metal/highk/InGaAs gate stacks which could be controlled remotely by choice of the metal electrodes. We demonstrated In0.53Ga0.47As MOSFETs with high mobility (peak mobility ~1300 cm2/Vs) and superior SS performance (SS 76.4 mV/dec) at the scaled CET region owing to the remote reduction of the native III-V oxide by the TiN electrodes.

3D sequential integration is shown to be compatible with a back gate implementation suitable for dynamic V th tuning of the FDSOI top tier devices. The back gate is inserted seamlessly into the 3D sequential process flow during the top Si layer transfer, providing a close proximity to the top tier device, as well as a uniform and high quality thermal back oxide. A threshold voltage tuning of ~103mV/V and ~139mV/V is obtained in p-and nMOS top tier junction-less devices, respectively, over a back gate bias range of +/-2V. BTI reliability measurements show no detrimental impact of the back gate bias. Back-gating can therefore be used to enhance the $I_{ON}$ performance with no reliability penalty. The buried metal line is also shown to lower crosstalk by metal shielding insertion between top and bottom tier metal lines, with a reduction larger than 10dB up to 45GHz.

Potential solutions for the reliability challenges of high- k metal gate (HKMG) integration into DRAM high-voltage peripheral logic devices are reported. A detailed study of Negative Bias Temperature Instability (NBTI)-degradation, supported by physical analysis, assessing the impact of various tuning components within the stack (interface layer, high-k fluorination and/or cap, metal gate) is presented. The presence of Nitrogen throughout the HKMG stack can originate either from high-k processing or metal-nitride gate electrode. It is shown that preventing nitrogen diffusion towards the Si/SiO 2 interface region, together with AIO x (and F) incorporation at the HKMG interface, can tune device threshold voltage and modulate access to donor trap-defect bands. The result of these effects is a vast improvement in NBTI performance.

Low thermal budget gate stacks will be required for novel integration schemes, such as 3D sequential stacking of CMOS tiers. We study the impact of a reduced thermal budget on BTI reliability, and we demonstrate two strategies to tolerate the inherently large high-k defect densities: i) replacing inversion mode devices with highly doped junction-less transistors, or ii) engineering dipoles at the interface between SiO 2 and HfO 2 to suppress the carrier-defect interaction. The latter approach is demonstrated for nMOS PBTI and, for the first time here, also for pMOS NBTI, as even this aging mechanism is controlled by high-k defects in ultra-thin EOT low thermal budget gate stacks.

3 Dstacking using a sequential integration approach is demonstrated for finfet devices on 300mm wafers at a 45nm fin pitch and 110nm poly pitch technology. This demonstrates the compatibility of the 3D sequential approach for aggressive device density stacking at advanced nodes thanks to the tight alignment precision of the first processed top layer to the last processed bottom layer through the top silicon channel and bonding stack during 193nm immersion lithography. The top devices are junction-less devices fabricated at low temperature $(\mathrm{T}\leq 525^{\circ}\mathrm{C})$ in a top Si layer transferred by wafer-to-wafer bonding with a bonding dielectric stack down to 170nm. The top devices offer similar performance as the high temperature bulk finfet technology for LSTP applications. The use of TiN/TiA1/TiN/HfO 2 gate stack provides the proper threshold voltage adjustment while the insertion of the LaSiO x dipole improves device performance and brings the BTI reliability within specification at low temperature.

IntroductionGlucagon-like peptide-1 (GLP-1) is an endogenous peptide that stimulates insulin secretion and decreases glucagon secretion. The use of GLP-1 receptor agonists (GLP-1RA) showed efficacy reducing the weight and glucose levels in patients with and without type 2 diabetes. This effect was also associated with a decreased risk of major cardiovascular events.ObjectivesOur aim is to review the role of GLP-1RA in psychiatric patients at cardio-metabolic risk due to antipsychotics treatment.Methods We reviewed articles published in PubMed using the keywords: “GLP-1” “glucagon like peptide” “antipsychotics” and “psychiatry”.ResultsThe number need to treat (NNT) to achieve clinical meaningful weight loss was 3.8. GLP-1RA treatment was also associated with greater reductions in body mass index, fasting glucose, HbA1c and visceral fat. This effect is true for antipsychotic treatment in general and for those on clozapine and olanzapine in particular. Overall, the GLP-1RA are well tolerated with nausea being the most common related adverse effect. Other variables such as age, sex, psychosis severity, nausea or any adverse drug reaction did not affect the weight loss.ConclusionsStudies showed a promising role in the management of antipsychotics induced weight gain, particularly in clozapine and olanzapine treated patients. Although these promising results, the route of administration, with a daily or weekly subcutaneous injection, and the GLP-1RA associated financial costs, can be viewed as important factors which can limit the wide use of this type of treatment in psychiatric patients.DisclosureNo significant relationships.

Objective: To determine the perception of possible infection caused by the severe acute respiratory syndrome coronavirus (SARS-CoV-2) and associated complications according to the labor sector in Peru Methods: We performed an observational, cross sectional, and secondary data analysis The study had three dependent variables that were obtained from a locally validated questionnaire, in which it is asked whether the professionals had the perception that they could be infected with SARS-CoV-2 at work, or could transmit the virus to their family/friends, and regarding the possibility of complications related to the infection Results: Of the 2843 workers participating in the study, those in the health sector perceived that they were more likely to be infected at work In the multivariate analysis, adjusted for four variables, health sector workers also perceived that they could be infected more frequently at work (adjusted prevalence ratio (aPR): 1 74;95% confidence interval (CI): 1 40-2 15;p

Background With complete plexus injuries or late presentation, free functional muscle transfer (FFMT) becomes the primary option of functional restoration. Our purpose is to review cases over a 10-year period of free functioning gracilis muscle transfer after brachial plexus injury to evaluate the effect of different donor nerves used to reinnervate the FFMT on functional outcome. Methods A retrospective study from April 2001 to January 2011 of a single surgeon's practice was undertaken. During this time period 22 patients underwent FFMT at Washington University in St Louis, Missouri for elbow flexion. Results Thirteen patients for whom FFMT was performed for elbow flexion met all of the requirements for inclusion in this study. Average time from injury to first operation was 12.8 months (range 4–60), and average time from injury to FFMT was 29 months (range 8–68). Average follow-up was 31.8 months (range 11–84). The nerve donors utilized included the distal accessory nerve, intercostal with or without rectus abdominis nerves, medial pectoral nerves, thoracodorsal nerve, and flexor carpi ulnaris fascicle of ulnar nerve. Functional recovery of elbow flexion was measured using the MRC grading system which showed 1 M5/5, 5 M4, 4 M3, and 3 M2 outcomes. Conclusion Intraplexal donor motor nerves if available will provide better transferred muscle function because they are higher quality donors closer to the muscle and can be done in one stage without a nerve graft. Otherwise, intercostal, rectus abdominis, or the distal accessory nerve should be used in a staged fashion.

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We present a review of our recent studies of Bias Temperature Instability (BTI) in Metal-Oxide-Semiconductor Field-Effect-Transistors (MOSFETs) fabricated with different material systems, highlighting the reliability opportunities and challenges of each novel device family. We discuss first the intrinsic reliability improvement offered by SiGe and Ge p-channel technologies, if a Si cap is used to passivate the channel, in order to fabricate a standard SiO2/HfO2 gate stack. We focus on SiGe gate stack optimizations for maximum BTI reliability, and on a simple physics-based model able to reproduce the experimental trends. This model framework is then used to understand the suboptimal BTI reliability and excessive time-dependent variability induced by oxide defect charging in different high-mobility channel gate stacks, such as Ge/GeOx/high-k and InGaAs/high-k. Finally we discuss how to pursue a reduction of charge trapping in alternative material systems in order to boost the device reliability and minimize time-dependent variability.

3D sequential integration requires top MOSFETs processed at low thermal budget, which can impair the device reliability. In this work, top junction-less device are fabricated with a maximum processing temperature of 525°C. The devices feature high k /metal replacement gate and low temperature Si:P and SiGe:B 60% raised SD for NMOS and PMOS respectively. Device matching, analog and RF performance of the top tier devices are in-line with state-of-the-art Si technology processed at high temperature (>1000°C). The top Si layer is transferred on CMOS planar bulk wafers with W metal-1 interconnects, using a SiCN to SiCN direct wafer bonding.