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1. Examining the uptake of COVID-19 vaccine booster doses among healthcare workers in South Africa: A mixed-methods study.

Author

Gavin George, Phiwe Nota, Michael Strauss, Emma Lansdell, Remco P H Peters, Petra Brysiewicz, Nisha Nadesan-Reddy, and Douglas Wassenaar

Subjects
Public aspects of medicine, RA1-1270
Abstract

This study aimed examin the factors associated with the uptake and non-acceptance of COVID-19 vaccine booster doses among healthcare workers (HCWs) in South Africa. We used a mixed-methods design with data from a web-based self-administered survey followed by semi-structured in-depth interviews (IDIs) with selected participants. Of the 6235 HCWs included in our analysis who had fully vaccinated, 3470 (56%) had taken their booster dose with a further 17% intending to get the booster. HCWs aged 35 to 49 years (OR = 1.30 [95% CI: 1.15-1.46]), and those aged 50 years or older (OR = 2.66 [95% CI: 2.32-3.05]) were more likely to get the booster dose. Females were less likely to have received the booster dose (OR = 0.88 [95% CI: 0.79-0.98]) with doctors more likely (OR = 1.58 [95% CI: 1.35-1.84]) than Nurses to have received the booster dose. HCWs in direct contact with patients (OR = 1.17 [95% CI: 1.00-1.38]) and who had previously received a flu vaccine (OR = 1.99 [95% CI: 1.56-2.55]) were more likely to have received the booster dose. Four themes emerged from the qualitative data analysis: (1) Vaccination as routine practice among HCWs; (2) Emergence of new COVID-19 variants necessitating vaccine boosters; (3) Fear of potential side-effects; and (4) Limited value of COVID-19 vaccine boosters. Some HCWs broadly accepted the value of vaccination, and believed that boosters were necessary to effectively combat emergent new virus strains, which contrasted with peers who believed that boosters offered little defence against virus mutations. Fear prohibited some HCWs from getting the booster, with some having experienced adverse side effects from their initial vaccination, whilst others were concerned about future complications. Waning booster uptake rates could be arrested through invigorated communication strategies, while effective evidence-based training can potentially create positive normative vaccination practices amongst HCWs.

Published
2023
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2. Preferences, beliefs, and attitudes about oral fluid and blood-based HIV self-testing among truck drivers in Kenya choosing not to test for HIV

Author

Joanne E. Mantell, Aleya Khalifa, Stephanie N. Christian, Matthew L. Romo, Eva Mwai, Gavin George, Michael Strauss, Kaymarlin Govender, and Elizabeth A. Kelvin

Subjects
HIV, HIV testing, HIV self-testing (HIVST), HIV/AIDS (acquired immunodeficiency syndrome), implementation science, truck driver, Public aspects of medicine, RA1-1270
Abstract

IntroductionClinical trials in sub-Saharan Africa support that HIV self-testing (HIVST) can increase testing rates in difficult-to-reach populations. However, trials mostly evaluate oral fluid HIVST only. We describe preferences for oral fluid vs. blood-based HIVST to elucidate prior trial results and inform testing programs.MethodsParticipants were recruited from a HIVST randomized controlled trial in Nakuru County, Kenya, which aimed to test the effect of choice between oral HIVST and facility-based testing compared to standard-of-care on HIV testing among truck drivers. We conducted in-depth interviews (IDIs) with purposively sampled trial participants who declined HIV testing at baseline or who were offered access to oral fluid HIVST and chose not to pick up the kit during follow-up. IDIs were conducted with all consenting participants. We first describe IDI participants compared to the other study participants, assessing the statistical significance of differences in characteristics between the two samples and then describe preferences, beliefs, and attitudes about HIVST biospecimen type expressed in the IDIs.ResultsThe final sample consisted of 16 men who refused HIV testing at baseline and 8 men who did not test during follow-up. All IDI participants had tested prior to study participation; mean number of years since last HIV test was 1.55, vs. 0.98 among non-IDI participants (p = 0.093). Of the 14 participants who answered the question about preferred type of HIVST, nine preferred blood-based HIVST, and five, oral HIVST. Preference varied by study arm with four of five participants who answered this question in the Choice arm and five of nine in the SOC arm preferring blood-based HIVST. Six key themes characterized truckers' views about test type: (1) Rapidity of return of test results. (2) Pain and fear associated with finger prick. (3) Ease of use. (4) Trust in test results; (5) fear of infection by contamination; and (6) Concerns about HIVST kit storage and disposal.ConclusionWe found no general pattern in the themes for preference for oral or blood-based HIVST, but if blood-based HIVST had been offered, some participants in the Choice arm might have chosen to self-test. Offering choices for HIVST could increase testing uptake.

Published
2022
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3. Understanding COVID-19 Vaccine Hesitancy among Healthcare Workers in South Africa

Author

Gavin George, Phiwe Babalo Nota, Michael Strauss, Emma Lansdell, Remco Peters, Petra Brysiewicz, Nisha Nadesan-Reddy, and Douglas Wassenaar

Subjects
healthcare workers, vaccine hesitancy, South Africa, COVID-19, Medicine
Abstract

Healthcare workers (HCWs) were the first population group offered coronavirus disease 2019 (COVID-19) vaccines in South Africa because they were considered to be at higher risk of infection and required protecting as they were a critical resource to the health system. In some contexts, vaccine uptake among HCWs has been slow, with several studies citing persistent concerns about vaccine safety and effectiveness. This study aimed to determine vaccine uptake among HCWs in South Africa whilst identifying what drives vaccine hesitancy among HCWs. We adopted a multimethod approach, utilising both a survey and in-depth interviews amongst a sample of HCWs in South Africa. In a sample of 7763 HCWS, 89% were vaccinated, with hesitancy highest among younger HCWs, males, and those working in the private sector. Among those who were hesitant, consistent with the literature, HCWs raised concerns about the safety and effectiveness of the vaccine. Examining this further, our data revealed that safety and effectiveness concerns were formed due to first-hand witnessing of patients presenting with side-effects, concern over perceived lack of scientific rigor in developing the vaccine, confidence in the body’s immune system to stave off serious illness, and both a general lack of information and distrust in the available sources of information. This study, through discursive narratives, provides evidence elucidating what drives safety and effectiveness concerns raised by HCWs. These concerns will need to be addressed if HCWs are to effectively communicate and influence public behaviour. HCWs are key role players in the national COVID-19 vaccination programme, making it critical for this workforce to be well trained, knowledgeable, and confident if they are going to improve the uptake of vaccines among the general population in South Africa, which currently remains suboptimal.

Published
2023
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4. Menstrual health management and schooling experience amongst female learners in Gauteng, South Africa: a mixed method study

Author

Tamaryn L. Crankshaw, Michael Strauss, and Bongiwe Gumede

Subjects
Menstrual health management, MHM, Menarche, School absenteeism, Sexuality education, Sexual and reproductive health, Gynecology and obstetrics, RG1-991
Abstract

Abstract Background There has been increased attention to the menstrual health management (MHM) needs of girls and young women in Eastern and Southern Africa, relating to dignity, and to the potential link between the lack of access to sanitary products and school absenteeism. In the South Africa, there is inadequate evidence to guide appropriate national responses. This study explored the extent of access to modern sanitary products amongst female high school learners and the range of needs and challenges that they face in managing their menses in school settings in Gauteng, South Africa. Methods We collected mixed method data from 10 schools in Sedibeng district between June and August 2018. The qualitative component consisted of in-depth interviews with female learners (n = 30), educators (n = 8) and mothers of female learners (n = 9) and focus group discussions (FGDs) with male learners (n = 7) and female learners (n = 10). Five hundred and five female learners were recruited into the quantitative component consisting of a self-administered survey focussing on factors associated with access to sanitary products. Results The median age of survey participants was 17 years (interquartile range 16–18 years) and average age at menarche was 13.36 years. One in seven female learners reported not having enough sanitary products for every period in the last 3 months and this was reflected across the school quintiles. There was a complex interaction between menstrual-related challenges (physical discomfort, teasing, and feeling distracted in class) experienced by female learners, often amplified or compounded by factors in the school environment (unhygienic sanitation facilities and inadequate rest areas), and schooling participation and attendance. Girls who did not have enough products for every period in the last 3 months more likely reported missing school than those who reported sufficient products (46.27% vs 22.49% respectively, p

Published
2020
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6. South African University Staff and Students’ Perspectives, Preferences, and Drivers of Hesitancy Regarding COVID-19 Vaccines: A Multi-Methods Study

Author

Gavin George, Michael Strauss, Emma Lansdell, Nisha Nadesan-Reddy, Nomfundo Moroe, Tarylee Reddy, Ingrid Eshun-Wilsonova, and Mosa Moshabela

Subjects
vaccine hesitancy, youth, South Africa, discrete choice experiment, Medicine
Abstract

COVID-19 vaccine hesitancy poses a threat to the success of vaccination programmes currently being implemented. Concerns regarding vaccine effectiveness and vaccine-related adverse events are potential barriers to vaccination; however, it remains unclear whether tailored messaging and vaccination programmes can influence uptake. Understanding the preferences of key groups, including students, could guide the implementation of youth-targeted COVID-19 vaccination programmes, ensuring optimal uptake. This study examined university staff and students’ perspectives, preferences, and drivers of hesitancy regarding COVID-19 vaccines. A multi-methods approach was used—an online convenience sample survey and discrete choice experiment (DCE)—targeting staff and students at the University of KwaZulu-Natal, South Africa. The survey and DCE were available for staff and students, and data were collected from 18 November to 24 December 2021. The survey captured demographic characteristics as well as attitudes and perspectives of COVID-19 and available vaccines using modified Likert rating questions adapted from previously used tools. The DCE was embedded within the survey tool and varied critical COVID-19 vaccine programme characteristics to calculate relative utilities (preferences) and determine trade-offs. A total of 1836 staff and students participated in the study (541 staff, 1262 students, 33 undisclosed). A total of 1145 (62%) respondents reported that they had been vaccinated against COVID-19. Vaccination against COVID-19 was less prevalent among students compared with staff (79% of staff vs. 57% of students). The vaccine’s effectiveness (22%), and its safety (21%), ranked as the two dominant reasons for not getting vaccinated. These concerns were also evident from the DCE, with staff and students being significantly influenced by vaccine effectiveness, with participants preferring highly effective vaccines (90% effective) as compared with those listed as being 70% or 50% effective (β = −3.72, 95% CI = −4.39 to −3.04); this characteristic had the strongest effect on preferences of any attribute. The frequency of vaccination doses was also found to have a significant effect on preferences with participants deriving less utility from choice alternatives requiring two initial vaccine doses compared with one dose (β = −1.00, 95% CI = −1.42 to −0.58) or annual boosters compared with none (β = −2.35, 95% CI = −2.85 to −1.86). Notably, an incentive of ZAR 350 (USD 23.28) did have a positive utility (β = 1.14, 95% CI = 0.76 to 1.53) as compared with no incentive. Given the slow take-up of vaccination among youth in South Africa, this study offers valuable insights into the factors that drive hesitancy among this population. Concerns have been raised around the safety and effectiveness of vaccines, although there remains a predilection for efficient services. Respondents were not enthusiastic about the prospect of having to take boosters, and this has played out in the roll-out data. Financial incentives may increase both the uptake of the initial dose of vaccines and see a more favourable response to subsequent boosters. Universities should consider tailored messaging regarding vaccine effectiveness and facilitate access to vaccines, to align services with the stated preferences of staff and students.

Published
2022
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7. Stated and revealed preferences for HIV testing: can oral self-testing help to increase uptake amongst truck drivers in Kenya?

Author

Michael Strauss, Gavin George, Joanne E. Mantell, Matthew L. Romo, Eva Mwai, Eston N. Nyaga, Jacob O. Odhiambo, Kaymarlin Govender, and Elizabeth A. Kelvin

Subjects
HIV, HIV testing, Truck drivers, Discrete choice experiment, Kenya, Public aspects of medicine, RA1-1270
Abstract

Abstract Background Long-distance truck drivers in Africa are particularly at risk of HIV acquisition and offering self-testing could help increase testing coverage in this hard-to-reach population. The aims of this study are twofold: (1) to examine the preference structures of truck drivers in Kenya regarding HIV testing service delivery models and what they mean for the roll-out of HIV self-testing, and (2) to compare the preference data collected from a hypothetical discrete choice experiment with the actual choices made by participants in the intervention arm of a randomised controlled trial (RCT) who were offered HIV testing choices. Methods Using data from 150 truck drivers, this paper examines whether the stated preferences regarding HIV testing in a discrete choice experiment predict the actual test selected when offered HIV testing choices. Conditional logit models were used for main effects analysis and stratified models were run by HIV testing choices made in the trial to assess if the attributes preferred differed by test chosen. Results The strongest driver of stated preference among all participants was cost. However, two preferences diverged between those who actually chose self-testing in the RCT and those who chose a provider administered test: the type of test (p

Published
2018
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8. Employment preferences of healthcare workers in South Africa: Findings from a discrete choice experiment.

Author

Alexandra Mumbauer, Michael Strauss, Gavin George, Phuti Ngwepe, Charl Bezuidenhout, Lindsey de Vos, and Andrew Medina-Marino

Subjects
Medicine, Science
Abstract

There is a maldistribution of human resources for health globally, with many Lower- and Middle-Income Countries experiencing significant shortages. We examined healthcare workers' job preferences in South Africa to identify factors which potentially influence employment decisions. A discrete choice experiment was conducted among 855 South African healthcare workers critical to its national HIV testing and treatment programs. Job characteristics included workload, workplace culture, availability of equipment, training opportunities, sector and facility type, location, salary and benefits. Main effects analysis was conducted using fixed effects logistic regression. Interaction effects identified divergence in preferences. Heavy workload (OR = 0.78; 95% C.I. 0.74-0.83), poor workplace culture (odds ratio 0.66; 95% C.I. 0.62-0.69), insufficient availability of equipment (OR = 0.67; 95% C.I. 0.63-0.70) and infrequent training opportunities (OR = 0.75; 95% C.I. 0.71-0.80) had large, significant effects on worker preferences. An increase in salary of 20% (OR = 1.29; 95% C.I. 1.16-1.44) had a positive effect on preferences, while a salary decrease of 20% (OR = 0.55; 95% C.I. 0.49-0.60) had a strong negative effect. Benefits packages had large positive effects on preferences: respondents were twice as likely to choose a job that included medical aid, pension and housing contributions worth 40% of salary (OR = 2.06; 95% C.I. 1.87-2.26), holding all else constant. Although salary was important across all cadres, benefits packages had larger effects on job preferences than equivalent salary increases. Improving working conditions is critical to attracting and retaining appropriate health cadres responsible for the country's HIV services, especially in the public sector and underserved, often rural, communities. Crucially, our evidence suggests that factors amenable to improvement such as workplace conditions and remuneration packages have a greater influence on healthcare workers employment decisions than employment sector or location.

Published
2021
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9. Optimizing differentiated treatment models for people living with HIV in urban Zimbabwe: Findings from a mixed methods study.

Author

Miriam Rabkin, Michael Strauss, Joanne E Mantell, Munyaradzi Mapingure, Tsitsi B Masvawure, Matthew R Lamb, Jennifer M Zech, Godfrey Musuka, Innocent Chingombe, Martin Msukwa, Rodrigo Boccanera, Clorata Gwanzura, Gavin George, and Tsitsi Apollo

Subjects
Medicine, Science
Abstract

INTRODUCTION:Zimbabwe is scaling up HIV differentiated service delivery (DSD) to improve treatment outcomes and health system efficiencies. Shifting stable patients into less-intensive DSD models is a high priority in order to accommodate the large numbers of newly-diagnosed people living with HIV (PLHIV) needing treatment and to provide healthcare workers with the time and space needed to treat people with advanced HIV disease. DSD is also seen as a way to improve service quality and enhance retention in care. National guidelines support five differentiated antiretroviral treatment models (DART) for stable HIV-positive adults, but little is known about patient preferences, a critical element needed to guide DART scale-up and ensure person-centered care. We designed a mixed-methods study to explore treatment preferences of PLHIV in urban Zimbabwe. METHODS:The study was conducted in Harare, and included 35 health care worker (HCW) key informant interviews (KII); 8 focus group discussions (FGD) with 54 PLHIV; a discrete choice experiment (DCE) in which 500 adult DART-eligible PLHIV selected their preferences for health facility (HF) vs. community location, individual vs. group meetings, provider cadre and attitude, clinic operation times, visit frequency, visit duration and cost to patient; and a survey with the 500 DCE participants exploring DART knowledge and preferences. RESULTS:Patient preferences were consistent in the FGDs, DCE and survey. Participants strongly preferred respectful HCWs, HF-based services, individual DART models, and less costly services. Patients also preferred less frequent visits and shorter wait times. They were indifferent to variations in HCW cadre and distances from home to HF. These preferences were mostly homogenous, with only minor differences between male vs. female and older vs. younger patients. HCWs in the KII correctly characterized facility-based individual models as the one most favored by patients; HCWs also preferred this model, which they felt decongested HFs and reduced their workload. CONCLUSIONS:DART-eligible PLHIV in Harare found it relatively easy to access HFs, and preferred attributes associated with facility-based individual models. Prioritizing these for scale-up in urban areas may be the most efficient way to sustain positive patient outcomes and increase health system performance.

Published
2020
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10. The Stepping Stones and Creating Futures intervention to prevent intimate partner violence and HIV-risk behaviours in Durban, South Africa: study protocol for a cluster randomized control trial, and baseline characteristics

Author

Andrew Gibbs, Laura Washington, Samantha Willan, Nolwazi Ntini, Thobani Khumalo, Nompumelelo Mbatha, Yandisa Sikweyiya, Nwabisa Shai, Esnat Chirwa, Michael Strauss, Giulia Ferrari, and Rachel Jewkes

Subjects
Intimate Partner Violence, Sexual Violence, Informal Settlement, Physical Intimate Partner Violence, Intimate Partner Violence Perpetration, Public aspects of medicine, RA1-1270
Abstract

Abstract Background Preventing intimate partner violence (IPV) remains a global public health challenge. Studies suggest urban informal settlements have particularly high levels of IPV and HIV-prevalence and these settlements are rapidly growing. The current evidence base of effective approaches to preventing IPV recognizes the potential of combining economic strengthening and gender transformative interventions. However, few of these interventions have been done in urban informal settlements, and almost none have included men as direct recipients of these interventions. Methods Stepping Stones and Creating Futures intervention is a participatory gender transformative and livelihoods strengthening intervention. It is being evaluated through a cluster randomized control trial amongst young women and men (18–30) living in urban informal settlements in eThekwini Municipality, South Africa. The evaluation includes a qualitative process evaluation and cost-effectiveness analysis. A comparison of baseline characteristics of participants is also included. Discussion This is one of the first large trials to prevent IPV and HIV-vulnerability amongst young women and men in urban informal settlements. Given the mixed methods evaluation, the results of this trial have the ability to develop a stronger understanding of what works to prevent violence against women and the processes of change in interventions. Trial registration NCT03022370 . Registered 13 January 2017, retrospectively registered.

Published
2017
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11. Depression and sexual risk behavior among long-distance truck drivers at roadside wellness clinics in Kenya

Author

Matthew L. Romo, Gavin George, Joanne E. Mantell, Eva Mwai, Eston Nyaga, Michael Strauss, Jacob O. Odhiambo, Kaymarlin Govender, and Elizabeth A. Kelvin

Subjects
Kenya, Mental health, Depressive disorder, Sexual behavior, Self efficacy, Medicine, Biology (General), QH301-705.5
Abstract

Background Truck drivers in sub-Saharan Africa are at high risk for both mental health disorders and sexually transmitted infections. We sought to determine the prevalence of depression among a sample of long-distance truck drivers seeking services at roadside wellness clinics in Kenya and explore the relationship between depression and sexual risk behavior. Methods We used data from an interviewer-administered questionnaire from 284 truck drivers in Kenya who participated in a randomized controlled trial evaluating whether offering oral HIV self-testing could increase HIV test uptake. Depression was categorized based on the Patient Health Questionnaire-9 score, with a score ≥10 indicative of probable major depressive disorder (MDD). Sexual risk behavior was operationalized as the number of condomless sex partners in the past 6 months. Results The mean participant age was 36.9 years, 83.0% were married, and 37.0% had a secondary school education or higher. Overall, 24% of participants had probable MDD, and 58.2% reported having one condomless sex partner in the past 6 months, whereas 27.3% reported having had two or more. In a multivariable Poisson regression model adjusted for demographic and other relevant variables, including number of sex partners, MDD was significantly associated with a greater number of condomless sex partners (adjusted prevalence ratio 1.63, 95% confidence interval [1.25–2.12], p < 0.001). General self-efficacy significantly mediated the association between MDD and number of condomless sex partners. Conclusions The high prevalence of depression highlights the need to test the feasibility and acceptability of mental healthcare interventions for this population, possibly integrated with HIV prevention services. Future research is needed to better understand the association between depression and sexual risk behavior, as well as the role of self-efficacy.

Published
2019
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12. One-step Management of Severely Deformed, Long-Neglected Club Feet

Author

Michael Strauss MD and Isabella van Dalen MD, PhD

Subjects
Orthopedic surgery, RD701-811
Abstract

Category: Other Introduction/Purpose: Early management of the club foot using the Ponsetti technique has almost eliminated severe residual deformities from this problem. Unfortunately, in remote regions of the world patients may not have been afforded the benefits of this technique. The consequences are severely deformed, long-neglected foot deformities. Interventions to mitigate this problem have included talectomies, osteotomies, tendon transfers, gradual corrections using Ilizarov principles and as a last resort, transtibial amputations. All have undesirable features such as inadequate corrections with residual deformities, need for additional surgeries, intensive post-operative management and/or need for custom orthotics or prostheses. We propose a one-stage, single setting approach to this problem that fully realigns the foot and requires minimum of post-operative management. Methods: During a 2017 humanitarian mission to Vietnam, six patients with severely deformed, long-neglected club feet were managed at a remote orthopaedic rehabilitation facility using our one-stage, single surgery approach. The six-step procedure included: 1) Percutaneous tri-hemisections (Hoke) of the Achilles tendon, 2) Excision of lateral ulcers/bursas, 3) Minimally invasive releases of all constricting soft tissues structures, 4) Closing wedge osteotomy at apex of deformity, 5) Manual reduction to achieve plantigrade foot, and 6) Maintenance of correction with temporary spanning external fixation in five patients and percutaneous Steinmann pins in a four-year old patient. No tendon transfers were done. No tourniquets or perioperative antibiotics were used with these minimally invasive and percutaneous interventions. At six weeks, the external fixation was removed, walking casts were applied with minimal manipulations to optimally position the feet. At 12 weeks the casts were removed, patients allowed to use footwear of their choosing. Results: Follow-ups initially obtained weekly, then monthly through e-mails by a co-author fluent in Vietnamese were supplemented with photographs. Near-plantigrade feet axially aligned with the leg were obtained with all the initial corrections. By 48 hours pain was reported as minimal even though marked tension occurred across intact joint capsules in order to achieve the corrections. One skin, pin tract infection was reported that resolved once the pin was removed. Follow-up information at six months report that the corrections have been maintained with high satisfaction in all patients. Conclusion: Our innovative approach to deformed, neglected club feet is supported by appreciating the biomechanics of the problems. Dynamic deforming forces (tendons and muscles) must be released. Tendon transfers are inadequate to correct contractures. Bony deformities must be osteotomized. Viscoelasticity of ligaments and joint capsules deform with time and need not be released; corrections initially obtained using the fixators become permanent with time. Our experiences support the use of our approach for the patient population with which we dealt and suggest that earlier soft tissue releases of dynamic deforming forces be done in conjunction with the Ponsetti technique.

Published
2018
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13. Objectifying the Assessment of Pain

Author

Michael Strauss MD and Wendy Strauss PharmD

Subjects
Orthopedic surgery, RD701-811
Abstract

Category: Other Introduction/Purpose: Pain is a pervasive problem that accounts for a high percentage of referrals to health care providers including foot and ankle surgeons and is an important factor in narcotic addictions and their related deaths. Unfortunately, the analogue pain scores are determined by subjective (SUB) responses of the patient and fail to utilize objective criteria for making the assessments. In an attempt to resolve the subjectivity/objectivity concerns, we developed a scoring system that uses objective (OBJ) criteria based on three 0-to-10 scales. The measurements include the patients’ requirements for analgesics, how the pain affects their levels of activity and how it affects their thought processes. Methods: Over an 18 month period and as part of a physician pain management group’s initial assessment of their patients, the study group was asked to rate their pain using the three SUB scales (Numerical Rating Scale, Visual Analogue Scale and Verbal Rating Scale) as well as our three OBJ scales. Each of our three OBJ (analgesics, activities and thought processes) scales used precise terms to quantify the numerical value for the scale. For example, the analgesics requirement ranged from no drug (0-points) to requirement for hospitalization for pain management (10-points). The activity scale ranged from no limitations (0-points) to pain noticed only with activity (4-points) to total limitation of activities (10-points). Analogous objective criteria were used for the third scale, how pain affects thought processes. Data analysis included patients’ responses to the objective pain measurements as well as correlations between OBJ and SUB evaluation scoring systems. Results: Data was collected prospectively on 109 patients. The mean scores (summation of the3 SUB pain scales divided by 3 and doing likewise for the OBJ pain scales was significantly higher for the SUB scores (6.4 vs. 4.2, p < 0.001). The lowest correlations between the SUB scores and each OBJ scale was with analgesic use (r = .36 vs. r’s = .53 for the other 2 OBJ scales). In general patients who scored highest on the SUB scores, preferred them to the OBJ measurements. Differences between the scores on the OBJ activity scale versus the OBJ thought processes scale helped distinguish pain of central versus peripheral origins. Ninety percent of patients completed the SUB plus OBJ scoring in less than 3 minutes. Conclusion: Our OBJ Pain Score helped differentiate those patients who magnified their pain symptom from those who did not. Patients with higher scores on the thought processes scale would appear to be best managed by central nervous system acting drugs. Conversely those with higher OBJ activity scores would likely respond to peripheral acting agents such as non-steroidal analgesics, local injections or analgesic patches. In summary, our scoring system moves the evaluation of pain from subjective to objective. This has important ramifications for pain management, analgesic selection and avoidance of narcotic dependency.

Published
2018
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14. Limb-threatening Deep Infections Associated With Hardware Complications After Intramedullary Hindfoot Nailing in Charcot Feet

Author

Michael Strauss MD and David Lee MD

Subjects
Orthopedic surgery, RD701-811
Abstract

Category: Diabetes Introduction/Purpose: Multiple experiences with hindfoot intramedullary nailing (HINs) have demonstrated their usefulness for salvage of even the most severe ankle and foot deformities. However, special precautions must be employed when using this procedure in the diabetic with sensory neuropathy and advanced Charcot neuroarthropathy (CN) bone changes. A series of limb threatening complications after using the HIN in this subset of patients occurred. All failures were due to further bone collapse associated with the CN and penetration of the distal interlocking screws through the skin. This has led to the establishment of a protocol for reducing the chances of adverse occurrences when utilizing HIN in the named patient group. Methods: Three index cases in diabetes with failed HINs, two resulting in below knee amputations, were analyzed retrospectively. All initially presented with severe deformities with impending ulcerations at the apices of the deformities. Satisfactory realignments of the foot and ankle were achieved with lateral malleolus resections and tibia-talus osteotomies to restore the foot to the plantigrade position. The corrected position was maintained with the HIR and patients were allowed to fully weight bear in protective diabetic equipment 3 months after the surgeries. Results: Twelve to 18 months later, one or more of the tips of the distal interlocking screws of the HIRs penetrated the skin of the foot. Even with immediate removal of interlocking screws, two of the three patients subsequently required transtibial amputations. The patient in whom a transtibial amputation was avoided continues to ambulate with a CROW boot more than three years after complications of the rodding were managed. This experience has led to the generation of a protocol to potentially minimize the risk of limb-threatening complications related to hardware. Conclusion: The proposed protocol includes: First, proximal interlocking screws are not inserted to allow proximal migration of the rod in anticipation of further CN bone collapse. Second, the hindfoot interlocking screws are removed one year post-op and protective footwear continued. Third, if there is skin breakdown by screw, all hardware is removed and the medullary canal is reamed, plus antibiotic course and wound care. After this if infection markers are negative, 2nd-stage revision surgery is considered. The protocol seeks to minimize deep infections associated with HINs of severe CN foot deformities and further study to assess its impact is needed.

Published
2018
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15. Last Resort Salvage of Failed Below Knee Amputations

Author

Michael Strauss MD

Subjects
Orthopedic surgery, RD701-811
Abstract

Category: Other Introduction/Purpose: The consequences of failed transtibial amputations especially if the remaining tibia is less than 5 cm is revision to an above knee amputation (AKA). This has important ramifications regarding mobility, energy requirements for ambulation and function. An innovative management protocol has been employed to maximize the likelihood of healing and maintaining a functional knee joint. Methods: Five severely vasculopathic patients with failed short transtibial (TT) amputations and greater than 60 degree knee flexion contractures were followed progressively using the protocol of resecting the remaining fibula, releasing the hamstring insertions, debridement of bursa & cicatrix, osteotomy & beveling of the distal end of the tibia, creative flap closures, and maintenance of knee extension with pins or external fixation across the knee joint. The patient’s courses were followed prospectively. All patients were referred for more proximal amputations, but wanted everything possible be done to salvage their knee joints and avoid AKAs. Four of the five patients were diabetic; one was a smoker with osteomyelitis at the end of the tibia. Results: Salvage of the knee joint occurred in 4 of 5 patients (80%) even though the remaining tibia lengths were 5 cm or less. Threaded 3/16th inch Steinmann pins placed cross-wise through the knee joints were used in 4 patients and an external fixator in a 5th patient. The pins remained for 3 to 6 weeks. Four of the 5 patients achieved healing with 2 of the 4 having initial minor wound dehiscences. The failed case occurred in a diabetic patient with renal failure and only collateral circulation below the groin. There was insufficient viable muscle/fascia in this patient to cover the tibia. The 4 patients who avoided an AKA were able to be fitted with TT prostheses and use them in a functional capacity. Conclusion: The use of temporary pin fixation across the knee joint and removal of the remaining fibula to salvage “end stage” failed TT amputations served the purposes of maintaining knee extension during the healing period, allowing closure & healing of threatened and/or dehisced flaps and maintaining knee function. Motivated, compliant patients with failed, otherwise considered non salvageable TT amputations should be considered for using our protocol in deference to proceeding to an AKA.

Published
2018
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16. Costing analysis of an SMS-based intervention to promote HIV self-testing amongst truckers and sex workers in Kenya.

Author

Gavin George, Taruna Chetty, Michael Strauss, Silas Inoti, Samuel Kinyanjui, Eva Mwai, Matthew L Romo, Faith Oruko, Jacob O Odhiambo, Eston Nyaga, Joanne E Mantell, Kaymarlin Govender, and Elizabeth A Kelvin

Subjects
Medicine, Science
Abstract

OBJECTIVE:HIV testing rates in many sub-Saharan African countries have remained suboptimal, and there is an urgent need to explore strategic yet cost-effective approaches to increase the uptake of HIV testing, especially among high-risk populations. METHODS:A costing analysis was conducted for a randomized controlled trial (RCT) with male truckers and female sex workers (FSWs) registered in the electronic health record system (EHRS) of the North Star Alliance, which offers healthcare services at major transit hubs in Southern and East Africa. The RCT selected a sample of truckers and FSWs who were irregular HIV testers, according to the EHRS, and evaluated the effect of SMSs promoting the availability of HIV self-testing (HIVST) kits in Kenyan clinics (intervention program) versus a general SMS reminding clients to test for HIV (enhanced and standard program) on HIV testing rates. In this paper, we calculated costs from a provider perspective using a mixed-methods approach to identify, measure, and value the resources utilized within the intervention and standard programs. The results of the analysis reflect the cost per client tested. RESULTS:The cost of offering HIVST was calculated to be double that of routine facility-based testing (USD 10.13 versus USD 5.01 per client tested), primarily due to the high price of the self-test kit. In the two study arms that only offered provider-administered HIV testing in the clinic, only 1% of truckers and 6% of FSWs tested during the study period, while in the intervention arm, which also offered HST, approximately 4% of truckers and 11% of FSWs tested. These lower than expected outcomes resulted in relatively high cost per client estimates for all three study arms. Within the intervention arm, 65% of truckers and 72% of FSWs who tested chose the HIVST option. However, within the intervention arm, the cost per additional client tested was lower for FSWs than for truckers, at USD 0.15 per additional client tested versus USD 0.58 per additional client tested, driven primarily by the higher response rates. CONCLUSION:Whilst the availability of HIVST increased HIV testing among both truckers and FSWs, the cost of providing HIVST is higher than that of a routine health facility-based test, driven primarily by the price of the HIV self-test kit. Future research needs to identify strategies which increase demand for HIVST, and determine whether these strategies and the subsequent increased demand for HIVST are cost-effective in relation to the conventional facility based testing currently available.

Published
2018
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17. The cost of demand creation activities and voluntary medical male circumcision targeting school-going adolescents in KwaZulu-Natal, South Africa.

Author

Gavin George, Michael Strauss, and Elias Asfaw

Subjects
Medicine, Science
Abstract

Voluntary medical male circumcision is an integral part of the South African government's response to the HIV and AIDS epidemic. However, there remains a limited body of economic analysis on the cost of VMMC programming, and the demand creation activities used to mobilize males, especially among adolescent boys in school. This study addresses this gap by presenting the costs of a VMMC program which adopted two demand creation strategies targeting school-going males in South Africa.Cost data was collected from a VMMC program in the KwaZulu-Natal province of South Africa. A retrospective, micro-costing ingredient approach was applied to identify, measure and value resources of two demand creation strategies targeting young males.The program circumcised 4987 young males between May 2011 and February 2013, at a cost of $127.68 per circumcision. Demand creation activities accounted for 32% of the total cost, HCT contributing 10% with the medical circumcision procedure accounting for 58% of the total cost. Using the first demand creation strategy, 2168 circumcisions were performed at a cost of $149.57 per circumcision. Following this first strategy, a second demand creation strategy was adopted which saw the cost fall to $110.85 per circumcision. More young males were recruited following the second strategy with clinic services more efficiently utilized. Whilst the cost per circumcision of demand activities rose slightly between the first ($39.94) and second ($41.65) strategy, there was a substantial reduction in the cost of the circumcision procedure; $90.01 under the first strategy falling to $60.60 following the adoption of the second demand creation strategy.Ensuring the optimal use of clinic facilities was the primary driver in reducing the cost per circumcision. This VMMC program has illustrated the value of evaluating progress and instituting changes to attain better cost efficiencies. This adjustment resulted in a substantial reduction in the cost per circumcision.

Published
2017
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18. Implementation of Ultrasonic Sensing for High Resolution Measurement of Binary Gas Mixture Fractions

Author

Richard Bates, Michele Battistin, Stephane Berry, Alexander Bitadze, Pierre Bonneau, Nicolas Bousson, George Boyd, Gennaro Bozza, Olivier Crespo-Lopez, Enrico Da Riva, Cyril Degeorge, Cecile Deterre, Beniamino DiGirolamo, Martin Doubek, Gilles Favre, Jan Godlewski, Gregory Hallewell, Ahmed Hasib, Sergey Katunin, Nicolas Langevin, Didier Lombard, Michel Mathieu, Stephen McMahon, Koichi Nagai, Benjamin Pearson, David Robinson, Cecilia Rossi, Alexandre Rozanov, Michael Strauss, Michal Vitek, Vaclav Vacek, and Lukasz Zwalinski

Subjects
ultrasonic, binary gas analysis, leak detection, Chemical technology, TP1-1185
Abstract

We describe an ultrasonic instrument for continuous real-time analysis of the fractional mixture of a binary gas system. The instrument is particularly well suited to measurement of leaks of a high molecular weight gas into a system that is nominally composed of a single gas. Sensitivity < 5 × 10−5 is demonstrated to leaks of octaflouropropane (C3F8) coolant into nitrogen during a long duration (18 month) continuous study. The sensitivity of the described measurement system is shown to depend on the difference in molecular masses of the two gases in the mixture. The impact of temperature and pressure variances on the accuracy of the measurement is analysed. Practical considerations for the implementation and deployment of long term, in situ ultrasonic leak detection systems are also described. Although development of the described systems was motivated by the requirements of an evaporative fluorocarbon cooling system, the instrument is applicable to the detection of leaks of many other gases and to processes requiring continuous knowledge of particular binary gas mixture fractions.

Published
2014
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19. Reconciling the science and policy divide: The reality of scaling up antiretroviral therapy in South Africa

Author

Alan Whiteside, Jamie Cohen, and Michael Strauss

Subjects
HIV, Health, Treatment, Health Policy, South Africa, Public aspects of medicine, RA1-1270, Infectious and parasitic diseases, RC109-216
Abstract

With the world’s largest national treatment programme and over 340 000 incident casesannually, the response to HIV in South Africa is hotly contested and there is sometimes adissonance between activism, science and policy. Too often, policy, whilst well intentioned, isinformed only by epidemiological data. The state of the healthcare system and socioculturalfactors drive and shape the epidemic and its response. By analysis of the financial,infrastructural, human resources for health, and governance landscape in South Africa,we assess the feasibility and associated costs of implementing a universal test and treatprogramme. We situate a universal test and treat strategy within the governance, fiscal,human resources for health, and infrastructural landscape in South Africa. We argue that theresponse to the epidemic must be forward thinking, progressive and make the most of thebenefits from treatment as prevention. However, the logistics of implementing a universaltest and treat strategy mean that this option is problematic in the short term. We recommenda health systems strengthening HIV treatment and prevention approach that includes scalingup treatment (for treatment and prevention) along with a range of other prevention strategies.

Published
2015
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20. An interaction between glutathione and the capsid is required for the morphogenesis of C-cluster enteroviruses.

Author

Hsin-Chieh Ma, Ying Liu, Chunling Wang, Michael Strauss, Nina Rehage, Ying-Han Chen, Nihal Altan-Bonnet, James Hogle, Eckard Wimmer, Steffen Mueller, Aniko V Paul, and Ping Jiang

Subjects
Immunologic diseases. Allergy, RC581-607, Biology (General), QH301-705.5
Abstract

Glutathione (GSH) is the most abundant cellular thiol playing an essential role in preserving a reduced cellular environment. Cellular GSH levels can be efficiently reduced by the GSH biosynthesis inhibitor, L-buthionine sulfoximine (BSO). The aim of our study was to determine the role of GSH in the growth of two C-cluster enteroviruses, poliovirus type 1 (PV1) and coxsackievirus A20 (CAV20). Our results show that the growth of both PV1 and CAV20 is strongly inhibited by BSO and can be partially reversed by the addition of GSH. BSO has no effect on viral protein synthesis or RNA replication but it strikingly reduces the accumulation of 14S pentamers in infected cells. GSH-pull down assays show that GSH directly interacts with capsid precursors and mature virus made in the absence of BSO whereas capsid precursors produced under GSH-depletion do not bind to GSH. In particular, the loss of binding of GSH may debilitate the stability of 14S pentamers, resulting in their failure to assemble into mature virus. Immunofluorescence cell imaging demonstrated that GSH-depletion did not affect the localization of viral capsid proteins to the replication complex. PV1 BSO resistant (BSOr) mutants evolved readily during passaging of the virus in the presence of BSO. Structural analyses revealed that the BSOr mutations, mapping to VP1 and VP3 capsid proteins, are primarily located at protomer/protomer interfaces. BSOr mutations might, in place of GSH, aid the stability of 14S particles that is required for virion maturation. Our observation that BSOr mutants are more heat resistant and need less GSH than wt virus to be protected from heat inactivation suggests that they possess a more stable capsid. We propose that the role of GSH during enterovirus morphogenesis is to stabilize capsid structures by direct interaction with capsid proteins both during and after the formation of mature virus particles.

Published
2014
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21. Concepts in Gene Therapy

Author

Michael Strauss, John A. Barranger, Michael Strauss, John A. Barranger and Michael Strauss, John A. Barranger, Michael Strauss, John A. Barranger

Published
2020

24. Netzwerkarchitektur mobiler Systeme zwischen Security, Usability und begrenzten Ressourcen

Author

Eike Lyczkowski, Michael Strauss, and Hochschule für Technik, Wirtschaft und Kultur Leipzig

Subjects
Netzwerkarchitektur, Security, verteilte Systeme
Abstract

Moderne mobile Systeme in der Smart Factory werden über WLAN oder Zellfunk angebunden und stationäre Teilnehmer finden sich üblicherweise in einer kabelgebundenen LAN-Infrastruktur. Eine Vielzahl unterschiedlicher Steuerungen und Leitsysteme verteilen sich auf lokale Rechenressourcen, Rechenzentren der Anlagenbetreiber oder zunehmend auch auf public Clouds. In diesem Umfeld ergibt sich besonders für mobile Systeme ein Spannungsfeld zwischen Usability, Security und den begrenzten Systemressourcen spezialisierter Controller. In diesem Kurzbetrag und seinem zugehörigen Vortrag werden Lösungsansätze und deren inheränte Widersprüche aufgezeigt.

Published
2023

25. Dictionary of Christianity and Science

Author

Zondervan, Paul Copan, Tremper Longman III, Christopher L. Reese, Michael Strauss and Zondervan, Paul Copan, Tremper Longman III, Christopher L. Reese, Michael Strauss

Published
2017

27. Rubin Observatory Plans for an Early Science Program

Author

Leanne P. Guy, Eric Bellm, Bob Blum, Melissa L. Graham, Željko Ivezić, Michael Strauss, Keith Bechtol, Phil Marshall, and Robert Lupton

Subjects
Early Science, LSST, Rubin Observatory
Abstract

Rubin Observatory is committed to enabling high-impact science during the first year of operation of the Legacy Survey of Space and Time (LSST). This document provides the plans for a dedicated Early Science Program designed to realize that goal. It outlines the strategy for obtaining observations during commissioning to enhance opportunities for Early Science and presents plans to implement incremental template generation to augment alert production in the early phases of the survey. The Rubin Operations team will work closely with the science community to design the Early Science Program so as to maximize the time-domain and solar system science achievable in the first year of operations. This is a living document; both it and the Early Science Program will continue to evolve over the course of commissioning and pre-operations in response to the state of the as-built system and to community guidance.

Published
2022
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28. OP02 The Use Of Discrete Choice Experiments For Measuring Patient Preferences In Health Technology Assessment

Author

Michael Strauss, Gavin George, Yael Hirsch-Moverman, Joanne Mantell, Miriam Rabkin, and Elizabeth Kelvin

Subjects
Health Policy
Abstract

IntroductionUnderstanding patient preferences and the demand for healthcare interventions and technology is critical for health technology assessment (HTA). New health technologies have potential for savings and increased efficiency but even the most cost-effective and efficacious interventions can fail if patient preferences are not properly accounted for. Patient preferences in HTA are primarily limited to representation in appraisal committees; however, more robust methods are available and should be incorporated into the assessment of interventions.MethodsUsing data from three discrete choice experiments (DCEs), we reflect on the importance of patient preferences in the design of healthcare interventions. We draw insights from three studies which investigated preferences relating to HIV self-testing amongst long distance truck drivers in Kenya; differentiated antiretroviral therapy services amongst stable HIV patients in Zimbabwe; and tuberculosis preventive therapy for children in Eswatini.ResultsWe highlight three key findings. First, understanding patient preferences is crucial when designing services, and providers sometimes underestimate behavioural barriers and overestimate the extent to which people are motivated simply by health benefits. Optimism is often driven by evidence showing high acceptability, but when preference structures are incorporated in intervention design, there are important insights into how patients plan to utilize services. Second, trade-offs matter in determining which characteristics are perceived to be most important to patients – a key strength of the DCE methodology. Understanding of these trade-offs can help prioritize which characteristics of interventions to target. Finally, disentangling the effect of different characteristics of service delivery models on preferences is important for rethinking how interventions are delivered. If services are designed to better align with preferences, implementers can ensure new interventions have the desired effect on health and economic outcomes.ConclusionsThese findings highlight the value of behavioural economic approaches for investigating preferences for health interventions and providing insights into the demand for services, which must feed into the HTA analyses. Incorporating DCEs into HTA is inexpensive and provides robust data for improving HTA.

Published
2022

33. HIV testing preferences among pregnant women attending antenatal care and their male partners: a discrete choice experiment in Uganda

Author

Gavin George, Rose Kisa, Harriet Chemusto, Rhoda K. Wanyenze, Jeffrey E. Korte, Caroline J. Vrana-Diaz, Joseph K. B. Matovu, Michael Strauss, Aissatou Ba, Angela M. Malek, William Musoke, and Esther Buregyeya

Subjects
Adult, Male, East Africa, randomized controlled trial, couples testing, Service delivery framework, HIV Infections, Prenatal care, Affect (psychology), Ambulatory Care Facilities, Article, law.invention, 03 medical and health sciences, 0302 clinical medicine, Randomized controlled trial, Pregnancy, law, Virology, Humans, Mass Screening, Medicine, Uganda, 030212 general & internal medicine, 030505 public health, business.industry, Public Health, Environmental and Occupational Health, Patient Preference, Prenatal Care, General Medicine, medicine.disease, Preference, Test (assessment), Sexual Partners, Infectious Diseases, Incentive, Female, Pregnant Women, 0305 other medical science, business, Demography
Abstract

HIV testing rates remain stubbornly low among men – a crucial target population for reaching the ambitious global and regional goals of the HIV programme. In an era of declining donor funding, identifying cost-effective strategies to increase testing rates amongst men remains paramount. Antenatal care is an effective entry-point for the delivery of HIV testing services for women, and partner testing presents an important opportunity to reach their male partners. We present the results of a discrete choice experiment in Uganda, examining preferences among 824 pregnant women and 896 male partners regarding service delivery characteristics of HIV testing. Both men and women preferred nurse administered testing to self-testing (OR = 0.835; p < 0.001), oral testing over a finger-prick test (OR = 1.176; p < 0.001) and testing with a partner over testing alone (OR = 1.230; p < 0.001). Men had a preference for testing at home compared to testing at a clinic (OR = 1.099; p = 0.024), but women were indifferent regarding the testing location. The cost of testing had the biggest effect on preferences. Free testing was preferred over a cost of US$2.90 (OR = 0.781; p < 0.001) or US$2.00 (OR = 0.670; p < 0.001). Offering an incentive of US$3.40 increased men’s preferences compared to a free test (OR = 1.168; p < 0.001), although this did not affect women’s preferences. Partner testing linked to antenatal care is a potential strategy to increase testing coverage among men, particularly given the preference for partner testing – provided costs to clients remain low. Future cost-effectiveness evaluations should investigate the economic impact of reaching men using these strategies.Keywords: East Africa, randomized controlled trial, couples testing

Published
2019

34. Rubin Observatory Plans for an Early Science Program

Author

Leanne P. Guy, Eric Bellm, Bob Blum, Melissa L. Graham, Željko Ivezić, and Michael Strauss

Subjects
Early Science, LSST, Rubin Observatory
Abstract

Rubin Observatory is committed to enabling high-impact science during the first year of operation of the Legacy Survey of Space and Time (LSST). This document provides the plans for a dedicated Early Science Program designed to realize that goal. It outlines the strategy for obtaining observations during commissioning to enhance opportunities for Early Science and presents plans to implement incremental template generation to augment alert production in the early phases of the survey. The Rubin Operations team will work closely with the science community to design the Early Science Program so as to maximize the time-domain and solar system science achievable in the first year of operations. This is a living document; both it and the Early Science Program will continue to evolve over the course of commissioning and pre-operations in response to the state of the as-built system and to community guidance.

Published
2021
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35. Layered Structures of Assembled Imine-Linked Macrocycles and Two-Dimensional Covalent Organic Frameworks Give Rise to Prolonged Exciton Lifetimes

Author

Waleed Helweh, Nathan Flanders, Shiwei Wang, Brian Phelan, Pyosang Kim, Michael Strauss, Rebecca Li, Matthew Kelley, Matthew Kirschner, Dillon Edwards, Austin Spencer, George Schatz, Richard Schaller, William Dichtel, and Lin Chen

Subjects
Condensed Matter::Materials Science, Condensed Matter::Mesoscopic Systems and Quantum Hall Effect
Abstract

Ordered organic materials and assemblies have great potential to be tailored to have desirable properties for optoelectronic applications, such as long exciton lifetime and high directional exciton mobility. Framework materials, such as twodimensional covalent organic frameworks (2D COFs), as well as their truncated macrocyclic analogues, are versatile platforms to organize functional aromatic systems into designed assemblies and robust materials. Here we investigate the exciton dynamics in a 2D COF, its corresponding hexagonal macrocycle, and extended nanotubes comprised of stacked macrocycles. The excitonic behavior of these three systems provide an understanding of excitonic processes that occur in the plane of the covalently bonded 2D macromolecules and between layers of the nanotubes and 2D COF. The nanotube and analogous 2D COF exhibit longer excited-state lifetimes (~100 ps) compared to the individual, solvated macrocycles (

Published
2021

37. Lithium-Conducting Self-Assembled Organic Nanotubes

Author

Michael Strauss, Insu Hwang, Austin Evans, Anusree Natraj, Xavier Aguilar-Enriquez, Ioannina Castano, Emily Roesner, Jang Wook Choi, and William Dichtel

Abstract

Supramolecular polymers are compelling platforms for the design of stimuli-responsive materials with emergent functions. Here, we report the assembly of an amphiphilic nanotube for Li-ion conduction that exhibits high ionic conductivity, mechanical integrity, electrochemical stability, and solution processability. Imine condensation of a pyridine-containing diamine with a triethylene glycol functionalized isophthalaldehyde yields pore-functionalized macrocycles. Atomic force microscopy, scanning electron microscopy, and in solvo X-ray diffraction reveal that macrocycle protonation under their mild synthetic conditions drives assembly into high-aspect ratio (>103) nanotubes with three interior triethylene glycol groups. Electrochemical impedance spectroscopy demonstrates that lithiated nanotubes are efficient Li+ conductors, with an activation energy of 0.42 eV and a peak room temperature conductivity of 3.91 × 10-5 S cm-1. 7Li NMR and Raman spectroscopy demonstrate that lithiation occurs exclusively within the nanotube interior and implicates the glycol groups in facilitating efficient Li+ transduction. Linear sweep voltammetry and galvanostatic lithium plating-stripping tests reveal that this nanotube-based electrolyte is stable over a wide potential range and supports long-term cyclability. These findings demonstrate how coupling synthetic design and supramolecular structural control can yield high-performance ionic transporters that are amenable to device relevant fabrication. More broadly, these results demonstrate the technological potential of chemically designed self-assembled nanotubes.

Published
2021

38. Search for heavy charged long-lived particles in proton–proton collisions at s=13TeV using an ionisation measurement with the ATLAS detector

Author

Ming Chung Chu, Mikhail Mineev, Paul Hanke, Stephane Jezequel, Miaoran Lu, Sina Bahrasemani, Vasilis Konstantinides, Dai Kobayashi, Christian Weiser, Juan Pedro Araque Espinosa, Marcella Bona, Allan G Clark, Sebastian Mergelmeyer, Bertrand Laforge, Laura Jeanty, Andrea Coccaro, Simone Pagan Griso, Julia Isabell Djuvsland, Jun Su, Sarah Jones, Markus Cristinziani, Eric Drechsler, Michel Vetterli, Francesco Ragusa, Xiangyang Ju, Marcin Pawel Guzik, Jun Gao, Benoit Lefebvre, Alexander Milov, Cyril Becot, Philip Sommer, Laura La Rotonda, Sharka Todorova-Nova, Josef Pacalt, Paul de Jong, Takashi Mitani, Dingane Reward Hlaluku, Satoshi Higashino, K. Peters, Sophio Pataraia, Dilip Jana, Fernando Barreiro, Christopher Willis, Akshat Puri, Emanuel Demetrio Mendes Gouveia, Peter Watkins, Andrea Ventura, Dorothee Schaile, Marisa Sandhoff, Odette Benary, Giancarlo Spigo, Matthew Glenn Kurth, Driss Goujdami, Christophe Pol A Roland, Lidia Dell'Asta, Othmane Rifki, Roberto Cardarelli, Agostino Lanza, Fabienne Ledroit-Guillon, Igor Boyko, Ilia Ravinovich, Eleni Mountricha, Ikuo Ueda, Giulia Di Gregorio, Hannah Arnold, Oscar Estrada Pastor, Andreas Petridis, Sanmay Ganguly, Daniela Salvatore, Jorn Grosse-Knetter, Stefan Schlenker, Esteban Fullana Torregrosa, Mikhail Demichev, Gustavo Otero y Garzon, Kehinde Gbenga Tomiwa, Ishan Pokharel, Anthony Weidberg, Hans Krueger, David Berge, Federica Fabbri, Anatoli Romaniouk, Stephen Weber, Oleg Bulekov, Konstantinos Bachas, Alison Lister, Colleen Jennifer Treado, Daniel Hayden, Francisco Alonso, Benjamin Bordy Tannenwald, Miriam Diamond, Ewan Hill, Walter Howard Hopkins, Michael Strauss, Zhen Yan, Ivo van Vulpen, Mirta Dumancic, Anthony Keith Morley, Keisuke Yoshihara, Evelina Vassileva Bouhova-Thacker, Gavin Grant Hesketh, Antonella De Santo, Xin Wu, Jan Schaeffer, Joseph Haley, Maria Giulia Ratti, Agni Bethani, Ina Carli, Tomas Sykora, Elmar Ritsch, Thorwald Klapdor-kleingrothaus, Alex Martyniuk, Elizabeth Brost, Kalliopi Iordanidou, Robert Kehoe, Yu Zhang, Antonio Ferrer, Kirill Prokofiev, Nikolina Ilic, Clara Nellist, Isabel Marian Trigger, Laurie Iain McClymont, Frederick Dallaire, Nan Lu, Pedro Henrique Sales De Bruin, Laurelle Maria Veloce, Koji Nakamura, Vladimir Lyubushkin, Stefano Terzo, Michel Lefebvre, Hans-Christian Schultz-Coulon, Peter Loch, Liang Li, Barry King, Aaron James Armbruster, Yufeng Wang, Samuel Joseph Crawley, Alexey Kharlamov, Chen Zhou, Simon Holm Stark, Ana Maria Henriques Correia, George Victor Andrei, Jianbei Liu, Srinivasan Rajagopalan, D. Amidei, Olaf Nackenhorst, Michele Faucci Giannelli, Dms Sultan, Davide Caforio, John Derek Chapman, Johannes Donatus Mellenthin, Marco Bruschi, Samuel Meehan, Sergey Kuleshov, Vincenzo Cavasinni, Yorihito Sugaya, Marek Palka, Antonios Leisos, Krzysztof Sliwa, Naim Bora Atlay, Korbinian Ralf Schmidt-Sommerfeld, Bartlomiej Zabinski, Tomoaki Nakamura, Paolo Camarri, Victor Solovyev, Alan Peyaud, Christoph Rembser, Katja Hannele Mankinen, Andrew Buckley, Xiandong Zhao, Jaroslav Guenther, Jonathan Thomas Peter Burr, David Paul Yallup, Jonathan Shlomi, Thomas Daniel Weston, Bijan Haney, Ryan White, C. Santoni, Amy Selvi Tee, Kamil Augsten, Javier Montejo Berlingen, Giovanni Maccarrone, Donatas Ramilas Zaripovas, Javier Sánchez, Konstantinos Nikolopoulos, Swagato Banerjee, Jelena Jovicevic, Oleh Kivernyk, Ariel Schwartzman, Simon Molander, Speranza Falciano, Bernd Stelzer, David Miller, Giovanni Siragusa, John Morris, Werner Wiedenmann, Haichen Wang, Zoya Karpova, Mikhail Ivanovitch Gostkin, John Myers, Tim Michael Heinz Wolf, Arnaud Lucotte, Sally Seidel, Gregorio Bernardi, Markus Nordberg, Peter Steinberg, Benjamin Freund, Shunsuke Adachi, Marcello Fanti, Ligang Xia, Vladimir Tikhomirov, Shunsuke Honda, Knut Zoch, Alberto Cervelli, Jean-Baptiste De Vivie De Regie, Nicolas Morange, Grygorii Sokhrannyi, Takashi Yamanaka, Cheng Chen, Bibhuti Parida, Guy Koren, Igor Mandic, Akira Yamamoto, Soshi Tsuno, Cong Geng, Ilaria Luise, Erez Etzion, Wenhao Xu, Timon Frank-thomas Heim, Melissa Ridel, Calliope Louisa Sotiropoulou, Federica Legger, Pavol Bartos, Adam James Bozson, Kelsey O'connor, Maria Josefina Alconada Verzini, Martin Aleksa, Tamara Vazquez Schroeder, Mario Antonelli, Zvi Hirsh Citron, Sarah Louise Barnes, Michael Pitt, Manuel Patrice Geisler, Hong Ma, Stefano Camarda, Nicola Abraham, Rongkun Wang, Alexey Anisenkov, Ann Miao Wang, Steven Schramm, Luis March Ruiz, Andrei Artamonov, Jason Lea Oliver, Judith Katzy, Chase Owen Shimmin, Xin Chen, Michael Solar, Marjorie Shapiro, Vasiliki A Mitsou, Shikma Bressler, Itsuo Nakano, Junji Tojo, Per Edvin Sidebo, Katharine Leney, Yee Chinn Yap, Ulrike Blumenschein, Pavol Strizenec, Graham Cree, Filippo Maria Giorgi, Pepijn Johannes Bakker, Thomas LeCompte, Nimrod Taiblum, Debarati Roy, Juan Antonio Aguilar Saavedra, Shih-Chieh Hsu, Olga Bessidskaia Bylund, Leonor Cerda Alberich, Gerhard Brandt, James Catmore, Haonan Lu, Zach Marshall, Nikolaos Tsirintanis, Benjamin Philip Nachman, Rustem Ospanov, Adriaan Koenig, Jue Chen, Goeran Jarlskog, Massimo Della Pietra, Edson Carquin, Gerald Oakham, Steven Farrell, Muhammad Alhroob, Tobias Flick, Jorge Andres Lopez Lopez, Francisca Javiela Munoz Sanchez, Tamar Djobava, Simon George, Ksenia Gasnikova, Elemer Nagy, Simone Amoroso, Gerjan Bobbink, Joaquin Hoya, Michal Dubovsky, Alexis Roger Louis Vallier, Konstantin Vorobev, Ruiqi Zhang, Atsuhiko Ochi, Marc Weber, Tomoe Kishimoto, Yuri Kulchitsky, Christopher Bee, Zuzana Blenessy, Arnulf Quadt, Giovanni Darbo, Nils-Arne Rosien, Tatsuya Masubuchi, Marcus Morgenstern, Samuel Silverstein, Gianluca Introzzi, Giora Mikenberg, Franziska Iltzsche Speiser, Aranzazu Ruiz-Martinez, Weiming Yao, Baptiste Abeloos, Nikolaos Rompotis, Andrea Sciandra, Christian Johann Riegel, Kevin De Vasconcelos Corga, Stavros Maltezos, Thomas Naumann, Tobias Kupfer, Alexander Gavrilyuk, Johannes Balz, Carl Suster, Anne-luise Poley, Pierre-Antoine Delsart, Susumu Oda, Romain Madar, Zinonas Zinonos, Yanwen Liu, Tibor Zenis, Tomas Javurek, Rima El Kosseifi, Alexandre Rozanov, Garrin Mc Goldrick, Daniel Stefaniak Nielsen, Lian Liang Ma, Xueyao Zhang, Yun-Ju Lu, Matthew Smith, Yan Benhammou, Laura Jean Bergsten, Ademar Tavares Delgado, Horst Severini, Francesco Maria Follega, Luca Fiorini, Teresa Barillari, Zhengguo Zhao, Gabriel John Facini, Michael Tuts, Edmund Dawe, Ilias Panagoulias, Rotem Barnea, Vitaliano Chiarella, Olga Novgorodova, Vakhtang Tsulaia, Patricia Conde Muiño, Christopher Blake Martin, Hidetoshi Otono, Uli Schaefer, Javier Llorente Merino, Royer Edson Ticse Torres, Sara Ghasemi, Santiago Juan Batista, Chikuma Kato, Federico Meloni, Roman Lysak, Jumpei Maeda, Stefania Xella, Yuji Enari, Vincenzo Canale, Carlos Alberto Chavez Barajas, Alessia Bruni, Gabriele D'amen, Gabriele Chiodini, Bernardo Sotto-Maior Peralva, Nima Sherafati, Luca Pizzimento, Alexandros Marantis, Emlyn Hughes, Nikita Belyaev, Gabriela Navarro, Dave Britton, Kuan-yu Lin, Saime Gurbuz, Zongchang Yang, Johannes Erdmann, Koji Sato, Dave Sankey, Hoang Dai Nghia Nguyen, Nicolas Ellis, Sebastian Artz, Lucrezia Stella Bruni, Viktor Kramarenko, Umberto De Sanctis, Daniela Paredes Hernandez, Jean-Yves Hostachy, Jennifer Kathryn Roloff, Norman Gee, Abraham De Benedetti, Luka Kanjir, Sergio Calvente Lopez, Douglas Schaefer, Alberto Stabile, Maria Smizanska, Craig Buttar, Bo Liu, Vivek Jain, Josh Mcfayden, Maria Moreno Llacer, Bobby Samir Acharya, Carlos Sandoval Usme, Mark Sutton, Umar Gul, Xinchou Lou, Daniele De Pedis, Magda Anna Chelstowska, Smita Darmora, Robert Les, Toshiaki Kaji, Remi Zaidan, Milena Bajic, Enrico Pasqualucci, Alexander Kupco, Louis Guillaume Gagnon, Daniela Bortoletto, Daiki Yamaguchi, Robert Adam Vallance, Andrea Gabrielli, Serena Palazzo, Auke-Pieter Colijn, Matej Melo, Usha Mallik, Adrian John Bevan, Christophe Raymond Goudet, Sebastian Grinstein, Eduard Simioni, Yoshiji Yasu, Alexander Solodkov, Luis Flores Castillo, Fabien Jeanneau, Daniel Whiteson, Fido Dittus, Nadezda Proklova, Matthias Wittgen, David Freeborn, Tomoya Iizawa, Shu Li, Koji Terashi, Paul Mircea Gravila, Artem Maevskiy, 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Korcyl, Denis Oliveira Damazio, Bernard Brickwedde, Xiao-yan Li, Anjishnu Bandyopadhyay, Michael David Werner, Dennis Perepelitsa, Krzysztof Wozniak, Ulrike Schnoor, Tamsin Nooney, Emma Winkels, Petr Sicho, Kristian Gregersen, Alessandra Doria, Karl Gellerstedt, Marcel Michael Stanitzki, David Richard Shope, Karl Jakobs, Yan Wing Ng, Laura Fabbri, Kurt Keys Hill, Christos Vergis, Daniel Lellouch, Yichen Li, Dewen Zhong, Yoichi Ikegami, Alan Litke, Rachael Ann Creager, Giuseppe Salamanna, Jose Ocariz, Peter Jenni, Miles Wu, Matteo Mantoani, David William Casper, Kyle James Read Cormier, Alexander Madsen, Vincent Wai Sum Wong, Laura Perini, Jessica Metcalfe, Manuel Neumann, Andrej Gorisek, Marco Milesi, Masahiko Saito, Jochen Jens Heinrich, Mark Stockton, Kosuke Takeda, Maurizio De Santis, Carlo Enrico Pandini, Stephen Burns Menary, Edoardo Gorini, Christian Luedtke, Uwe Bratzler, Namig Javadov, David Cameron, Giulia Ripellino, Julian Constantin Schmoeckel, Abigail Alexandra O'Rourke, Evangelos Gazis, Ofir Gabizon, Thorsten Kuhl, S. J. Chen, Michele Pinamonti, Anne Marie Sickles, Craig Sawyer, Albert Francis Casha, Souad Batlamous, Martine Bosman, Michael Begel, Ivan Lopez Paz, Vladimir Vinogradov, Wladyslaw Dabrowski, Karel Smolek, Joao Saraiva, Marcela Mikestikova, Anatoly Kozhin, Maximilian Georg Herrmann, David Dodsworth, Martin White, Judita Mamuzic, Andrei Salnikov, Stefanie Morgenstern, Veronica Wallangen, Kayla Dawn McLean, Richard Nisius, Enrico Tassi, Giordon Holtsberg Stark, Sabrina Groh, Francesco Lo Sterzo, Edoardo Rossi, Santiago Rafael Paredes Saenz, Roland Jansky, Declan Andrew Millar, Syed Haider Abidi, Jannik Geisen, Grzegorz Pawel Gach, Lawrence Lee Jr, Mario Jose Da Cunha Sargedas De Sousa, Robert Henderson, Evgeniy Khramov, Dmitri Dedovich, Clara Troncon, Etienne Dreyer, Val O'Shea, Attila Krasznahorkay, Thibault Guillemin, Victoria Castillo Gimenez, Tatsumi Nitta, Giacinto Piacquadio, and Pawel Malecki

Subjects
Physics, Nuclear and High Energy Physics, Luminosity (scattering theory), Large Hadron Collider, Proton, 010308 nuclear & particles physics, Atlas detector, Astrophysics::High Energy Astrophysical Phenomena, High Energy Physics::Phenomenology, Supersymmetry, 01 natural sciences, Nuclear physics, medicine.anatomical_structure, Atlas (anatomy), Ionization, 0103 physical sciences, medicine, Physics::Accelerator Physics, High Energy Physics::Experiment, Nuclear Experiment, 010306 general physics
Abstract

This Letter presents a search for heavy charged long-lived particles produced in proton-proton collisions at root s= 13 TeV at the LHC using a data sample corresponding to an integrated luminosity ...

Published
2019

39. Diverse Proton-Conducting Nanotubes via a Tandem Macrocyclization and Assembly Strategy

Author

William Dichtel, Marco Rolandi, J. Fraser Stoddart, Alan E. Enciso, Anton Chavez, Jeremy Swartz, Emily Roesner, Xavier Aguilar-Enriquez, Rebecca Li, Ioannina Castano, Austin Evans, Manping Jia, and Michael Strauss

Abstract

Macrocycles that assemble into nanotubes exhibit emergent properties stemming from their low dimensionality, structural regularity, and distinct interior environments. Here, we report a versatile strategy to synthesize diverse nanotube structures in a single, efficient reaction by using a conserved building block bearing a pyridine ring. Imine condensation of a 2,4,6-triphenylpyridine-based diamine with various aromatic dialdehydes yields chemically distinct pentagonal [5+5], hexagonal [3+3], and diamond-shaped [2+2] macrocycles depending on the substitution pattern of the aromatic dialdehyde monomer. Atomic force microscopy and in solvo X-ray diffraction demonstrate that protonation of the macrocycles under the mild conditions used for their synthesis drives assembly into high-aspect ratio nanotubes. Each of the pyridine-containing nanotube assemblies exhibited measurable proton conductivity by electrochemical impedance spectroscopy, with values as high as 10-3 S m-1 (90% R.H., 25°C) that we attribute to differences in their internal pore sizes. This synthetic strategy represents a general method to access robust nanotube assemblies from a universal pyridine-containing monomer, which will enable systematic investigations of their emergent properties.

Published
2021

40. Accuracy assessment between on-product and on-optical-target overlay metrology with SEM and STEM

Author

Philippe Leray, Ofer Adan, Laurens Kwakman, Guy Levin, Jason Arjavac, Sandip Halder, Shimon Levi, Michael Strauss, Lior Lior Sarig, Yaniv Abramovitz, and Ashley Tilson

Subjects
business.industry, Computer science, Node (networking), Line (geometry), Wafer, Overlay, business, Lithography, Computer hardware, Metrology
Abstract

Optical overlay metrology has been used for years as the baseline for overlay control, measuring an optical target in the scribe line with optimized design to best match the on-product overlay. However, matching the optical target overlay measurements to the real on-product overlay becomes a serious challenge for most advanced technology nodes and forces the industry to develop different or complementary solutions. To identify and better quantify the different, well-known overlay accuracy detractors, in this work we have used optical and state-of-the-art electron beam technologies (eBeam) to measure on-product and on-optical target overlay errors of a wafer processed at imec using 5 nm technology node design rules and intentionally introduced overlay skews of +10 and -10 nm in x and y axis. The overlay errors as measured by the SEM eBeam system, equipped with elluminator™ technology which enables fast see through measurements of overlay which has been compared with (X-sectional) STEM-HAADF reference overlay metrology data. The on-product and optical target SEM overlay measurements show very similar wafer maps, in line with the applied overlay errors during the lithography exposure step. eBeam and TEM data show excellent correlation for the on-product overlay errors and the eBeam data also reveal a significant bias of ~ 6 nm between on-product and on-target overlay errors. From these results it can be concluded that manufacturing of advanced devices which require accurate OPO control, will need new metrology strategies that combine eBeam and optical or, eventually, use only eBeam technologies to guarantee effective overlay control with sufficient accuracy.

Published
2020

41. Supramolecular Polymerization Provides Non-Equilibrium Product Distributions of Imine-Linked Macrocycles

Author

Michael Strauss, Austin Evans, Ioannina Castano, Rebecca Li, and William Dichtel

Abstract

Supramolecular polymerization of imine-linked macrocycles has been coupled to dynamic imine bond exchange within a series of macrocycles and oligomers. In this way, macrocycle synthesis is driven by supramolecular assembly, either into small aggregates supported by π-π interactions, or high-aspect ratio nanotubes stabilized primarily by electrostatic and solvophobic interactions. For the latter, supramolecular polymerization into nanotubes restricts imine exchange, thereby conferring chemical stability to the assemblies and their constituent macrocycles. Competition in the formation and component exchange among macrocycles favored pyridine-2,6-diimine-linked species due to their rapid synthesis, thermodynamic stability, and assembly into high-aspect ratio nanotubes under the reaction conditions. In addition, the pyridine-containing nanotubes inhibit the formation of similar macrocycles containing benzene-1,3-diimine-linkages, presumably by disrupting their assembly and templation. Finally, we exploit rapid imine exchange within weak, low-aspect ratio macrocycle aggregates to carry out monomer exchange reactions to macrocycles bearing pyridine moieties. Once a pyridine-containing dialdehyde has exchanged into a macrocycle, the macrocycle becomes capable of nanotube formation, which dramatically slows further imine exchange. This kinetic trap provides chemically diverse macrocycles that are not attainable by direct synthetic methods. Together these findings provide new insights into coupling supramolecular polymerization and dynamic covalent bond-forming processes and leverages this opportunity to target asymmetric nanotubes. We envision these findings spurring further research efforts in the synthesis of nanostructures with designed and emergent properties.

Published
2019

42. Estimating Collective Attention toward a Public Display

Author

Otto Weichselbaum, Peter Holzkorn, Roland Haring, Gustav Pomberger, Michael Strauss, Wolfgang Narzt, Markus Hofmarcher, and Monika Sturm

Subjects
Human-Computer Interaction, Rest (physics), Social group, Audio signal, Finite-state machine, Action (philosophy), Artificial Intelligence, Computer science, Group (mathematics), Strengths and weaknesses, Collective attention, Cognitive psychology
Abstract

Enticing groups of passers-by to focused interaction with a public display requires the display system to take appropriate action that depends on how much attention the group is already paying to the display. In the design of such a system, we might want to present the content so that it indicates that a part of the group that is looking head-on at the display has already been registered and is addressed individually, whereas it simultaneously emits a strong audio signal that makes the inattentive rest of the group turn toward it. The challenge here is to define and delimit adequate mixed attention states for groups of people, allowing for classifying collective attention based on inhomogeneous variants of individual attention, i.e., where some group members might be highly attentive, others even interacting with the public display, and some unperceptive. In this article, we present a model for estimating collective human attention toward a public display and investigate technical methods for practical implementation that employs measurement of physical expressive features of people appearing within the display's field of view (i.e., the basis for deriving a person's attention). We delineate strengths and weaknesses and prove the potentials of our model by experimentally exerting influence on the attention of groups of passers-by in a public gaming scenario.

Published
2018

43. Paediatric tuberculosis preventive treatment preferences among HIV-positive children, caregivers and healthcare providers in Eswatini: a discrete choice experiment

Author

Anthony Mutiti, Gloria Sisi Dube, Michael Strauss, Wafaa El Sadr, Andrea A. Howard, Arnold Mafukidze, Joanne E. Mantell, Siphesihle Shongwe, Yael Hirsch-Moverman, and Gavin George

Subjects
medicine.medical_specialty, Tuberculosis, Service delivery framework, Health Personnel, HIV Infections, Logistic regression, Ambulatory Care Facilities, Patient-Centred Medicine, Health care, Humans, health economics, Medicine, Child, Health economics, business.industry, Public health, public health, General Medicine, medicine.disease, Caregivers, tuberculosis, Pill, Family medicine, business, Eswatini, Qualitative research
Abstract

ObjectiveIsoniazid preventive therapy initiation and completion rates are suboptimal among children. Shorter tuberculosis (TB) preventive treatment (TPT) regimens have demonstrated safety and efficacy in children and may improve adherence but are not widely used in high TB burden countries. Understanding preferences regarding TPT regimens’ characteristics and service delivery models is key to designing services to improve TPT initiation and completion rates. We examined paediatric TPT preferences in Eswatini, a high TB burden country.DesignWe conducted a sequential mixed-methods study utilising qualitative methods to inform the design of a discrete choice experiment (DCE) among HIV-positive children, caregivers and healthcare providers (HCP). Drug regimen and service delivery characteristics included pill size and formulation, dosing frequency, medication taste, treatment duration and visit frequency, visit cost, clinic wait time, and clinic operating hours. An unlabelled, binary choice design was used; data were analysed using fixed and mixed effects logistic regression models, with stratified models for children, caregivers and HCP.SettingThe study was conducted in 20 healthcare facilities providing TB/HIV care in Manzini, Eswatini, from November 2018 to December 2019.ParticipantsNinety-one stakeholders completed in-depth interviews to inform the DCE design; 150 children 10–14 years, 150 caregivers and 150 HCP completed the DCE.ResultsDespite some heterogeneity, the results were fairly consistent among participants, with palatability of medications viewed as the most important TPT attribute; fewer and smaller pills were also preferred. Additionally, shorter waiting times and cost of visit were found to be significant drivers of choices.ConclusionPalatable medication, smaller/fewer pills, low visit costs and shorter clinic wait times are important factors when designing TPT services for children and should be considered as new paediatric TPT regimens in Eswatini are rolled out. More research is needed to determine the extent to which preferences drive TPT initiation, adherence and completion rates.

Published
2021

45. Optimizing differentiated treatment models for people living with HIV in urban Zimbabwe: Findings from a mixed methods study

Author

Godfrey Musuka, Tsitsi Apollo, Munyaradzi Mapingure, Jennifer M. Zech, Miriam Rabkin, Innocent Chingombe, Tsitsi B. Masvawure, Gavin George, Martin Msukwa, Clorata Gwanzura, Michael Strauss, Matthew R. Lamb, Joanne E. Mantell, and Rodrigo Boccanera

Subjects
Male, RNA viruses, Urban Population, Economics, Social Sciences, HIV Infections, Transportation, 030312 virology, Pathology and Laboratory Medicine, Choice Behavior, 0302 clinical medicine, Health facility, Immunodeficiency Viruses, Sociology, Surveys and Questionnaires, Health care, Ambulatory Care, Medicine and Health Sciences, Confidentiality, Public and Occupational Health, 030212 general & internal medicine, Young adult, Duration (project management), Human Families, Health Systems Strengthening, 0303 health sciences, Multidisciplinary, Antimicrobials, Pharmaceutics, Drugs, Antiretrovirals, Workload, Focus Groups, Antivirals, Vaccination and Immunization, Medical Microbiology, Viral Pathogens, Viruses, Medicine, Engineering and Technology, Female, Pathogens, Research Article, Adult, Zimbabwe, Employment, medicine.medical_specialty, Adolescent, Anti-HIV Agents, Science, Immunology, MEDLINE, Antiretroviral Therapy, Microbiology, 03 medical and health sciences, Young Adult, Antiviral Therapy, Drug Therapy, Microbial Control, Virology, Retroviruses, medicine, Humans, Microbial Pathogens, Pharmacology, Health Care Policy, business.industry, Lentivirus, Organisms, Biology and Life Sciences, HIV, Focus group, Health Care, Family medicine, Labor Economics, Preventive Medicine, business
Abstract

Introduction Zimbabwe is scaling up HIV differentiated service delivery (DSD) to improve treatment outcomes and health system efficiencies. Shifting stable patients into less-intensive DSD models is a high priority in order to accommodate the large numbers of newly-diagnosed people living with HIV (PLHIV) needing treatment and to provide healthcare workers with the time and space needed to treat people with advanced HIV disease. DSD is also seen as a way to improve service quality and enhance retention in care. National guidelines support five differentiated antiretroviral treatment models (DART) for stable HIV-positive adults, but little is known about patient preferences, a critical element needed to guide DART scale-up and ensure person-centered care. We designed a mixed-methods study to explore treatment preferences of PLHIV in urban Zimbabwe. Methods The study was conducted in Harare, and included 35 health care worker (HCW) key informant interviews (KII); 8 focus group discussions (FGD) with 54 PLHIV; a discrete choice experiment (DCE) in which 500 adult DART-eligible PLHIV selected their preferences for health facility (HF) vs. community location, individual vs. group meetings, provider cadre and attitude, clinic operation times, visit frequency, visit duration and cost to patient; and a survey with the 500 DCE participants exploring DART knowledge and preferences. Results Patient preferences were consistent in the FGDs, DCE and survey. Participants strongly preferred respectful HCWs, HF-based services, individual DART models, and less costly services. Patients also preferred less frequent visits and shorter wait times. They were indifferent to variations in HCW cadre and distances from home to HF. These preferences were mostly homogenous, with only minor differences between male vs. female and older vs. younger patients. HCWs in the KII correctly characterized facility-based individual models as the one most favored by patients; HCWs also preferred this model, which they felt decongested HFs and reduced their workload. Conclusions DART-eligible PLHIV in Harare found it relatively easy to access HFs, and preferred attributes associated with facility-based individual models. Prioritizing these for scale-up in urban areas may be the most efficient way to sustain positive patient outcomes and increase health system performance.

Published
2019

46. Restrukturierungs- und Turnaround-Management

Author

Mario Situm, Markus W. Exler, Ernst Chalupsky, Lothar Czaja, Nina Dohrau, Fritz Ecker, Paul Eßlinger, Elisabeth Forstner, Michael George, Thilo Grundmann, Helmut Haberl, Karl Ibscher, Mike Jaeschke, Julia Jaud, Klaus Josef Kammerhofer, Tobias Kirchlechner, Thomas Klöckner, Anette Köcher, Gunter Leoprechting, Alexandra Mayr, Christine Mitter, Wilibald Pölt, Jacques Reijniers, Tobias Riegger, Frank Romeike, Florian Schatz, Sabine Siegl, Jan Spitzner, Michael Strauß, Martin Tschandl, Peter Vogler, Stefan Waldherr, and André Wortmann

Abstract

Handeln, wenn noch Spielraum ist: Um Krisensituationen in Unternehmen frühzeitig zu erkennen und geeignete Reorganisationsmaßnahmen zur Erhaltung von Rendite- und Wettbewerbsfähigkeit einzuleiten, sind heute äußerst vielseitige strategische, operative und kommunikative Qualitäten erforderlich. In der 2. Auflage ihres Praxisbuchs vermitteln Ihnen die Experten um Markus W. Exler und Mario Situm alle für Turnaround- und Transformationsprozesse typischen Perspektiven aus Geschäftsleitung und Interim Management, von Kreditinstituten und weiteren Stakeholdern.

Published
2019

47. Nucleation-Elongation Dynamics of Two-Dimensional Covalent Organic Frameworks

Author

Haoyuan Li, Austin Evans, Ioannina Castano, Michael Strauss, William Dichtel, and Jean-Luc Bredas

Abstract

Homogeneous two-dimensional (2D) polymerization is a poorly understood process in which topologically planar monomers react to form planar macromolecules, often termed 2D covalent organic frameworks (COFs). While these COFs have traditionally been limited to weakly crystalline aggregated powders, they were recently grown as micron-sized single crystals by temporally resolving the growth and nucleation processes. Here, we present a quantitative analysis of the nucleation and growth rates of 2D COFs via kinetic Monte Carlo (KMC) simulations, which show that nucleation and growth have second-order and first-order dependences on monomer concentration, respectively. The computational results were confirmed experimentally by systematic measurements of COF nucleation and growth rates performed via in situ X-ray scattering, which validated the respective monomer concentration dependences of the nucleation and elongation processes. A major consequence is that there exists a threshold monomer concentration below which growth dominates over nucleation. Our computational and experimental findings rationalize recent empirical observations that, in the formation of 2D COF single crystals, growth dominates over nucleation when monomers are added slowly, so as to limit their steady-state concentration. This mechanistic understanding of the nucleation and growth processes will inform the rational control of polymerization in two dimensions and ultimately enable access to high-quality samples of designed two-dimensional polymers.

Published
2019

48. Increasing HIV testing demand among Kenyan truck drivers and female sex workers

Author

Joanne E. Mantell, Kaymarlin Govender, Taruna Chetty, Samuel Kinyanjui, Gavin George, Eva Mwai, Faith Oruko, Silas Inoti, Elizabeth A. Kelvin, Jacob Odhiambo, Michael Strauss, Matthew L. Romo, and Eston Nyaga

Subjects
Truck, Kenya, business.industry, Environmental health, Female sex, Medicine, Hiv testing, business
Published
2019

49. Scatterometry and AFM measurement combination for area selective deposition process characterization

Author

Roy Koret, Mohamed Saib, Michael Strauss, Shaoren Deng, Andrea Illiberi, Philippe Leray, Gabriel Woodworth, Jan Willem Maes, Avron Ger, Alain Moussa, Joey Hung, Igor Turovets, and Anne-Laure Charley

Subjects
010302 applied physics, Materials science, business.industry, Nucleation, Nanoparticle, 02 engineering and technology, 021001 nanoscience & nanotechnology, 01 natural sciences, Metrology, Characterization (materials science), 0103 physical sciences, Optoelectronics, Deposition (phase transition), Wafer, Sensitivity (control systems), 0210 nano-technology, business, Layer (electronics)
Abstract

With the Area Selective Deposition (ASD) technique, the material is deposited on desired areas of the sample surface. The control of such process implies accurate characterization of the deposited material on both growth and non-growth surfaces. This requires, first a good measurement capability to quantify the geometry of the deposited layer, and second, a proper assessment of the process selectivity. In this work, we show how to combine two complementary measurement techniques to overcome their individual inherent limitations1 for ASD applications. Scatterometry, the first measurement technique, has been applied to the characterization of the deposited layer geometry properties because of its high sensitivity to dimensional features and material. To complement the ASD performance characterization with the local information, Atomic Force Microscopy (AFM) has been used to access the topography details of the analyzed surfaces. We have analyzed the AFM images with the power spectral density (PSD) approach to identify undesired material deposition in the non-growth area and thus to characterize process selectivity through the comparison to a reference sample. Experimental validation of the scatterometry and AFM techniques for ASD applications has been done on wafers having various selectivity levels. The scatterometry metrology measured accurately the thickness of the deposited layer on both growth and non-growth areas when the deposited layer became uniform. The lateral overgrowth was quantified as well with the same technique and showed some changes from process condition to another. In addition, the PSD analysis applied to the AFM images was able to probe minutely the nanoparticles nucleation on the non-growth area and as result has revealed the selectivity transition regimes. Later, we have built a hybrid model by the combination of the 2 metrologies results and validated its predictions on test wafers.

Published
2019

50. Evaluation of the accuracy and precision of STEM and EDS metrology on horizontal GAA nanowire devices

Author

Chris Hakala, Anne Kenslea, Michael Strauss, Laurens Kwakman, Hayley Johanesen, Hans Mertens, Kathy Barla, Werner Boullart, and Yong Kong Siew

Subjects
Semiconductor industry, Accuracy and precision, Software, business.industry, Computer science, Detector, Electronic engineering, Nanowire, NAND gate, Degree of precision, business, Metrology
Abstract

The scaling of device dimensions has resulted in a need for high resolution metrology techniques capable of measuring small CDs with a high degree of precision and accuracy. Scanning transmission electron microscopy (STEM) has previously been demonstrated to be a metrology technique capable of measuring small CDs and gathering large volumes of accurate and precise metrology data. In addition, energy dispersive X-ray spectroscopy (EDS) metrology has also been demonstrated to be a powerful technique enabling the detection and measurement of low contrast layers, specifically for 3D NAND devices. Benchmarking EDS metrology against STEM metrology in terms of precision and accuracy is important to further investigate the capabilities of EDS metrology for the semiconductor industry. This study was performed using the latest technology in EDS detectors, along with automated acquisition and metrology software to generate large metrology data sets on horizontal nanowire structures. In this paper, we present data to support our finding that EDS metrology is well-matched with STEM metrology in terms of both precision and accuracy. In addition, we discuss the capability of EDS and STEM metrology to detect subtle process variations in next-generation logic devices.

Published
2019

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