Impact of Proactive Integrated Care on Chronic Obstructive Pulmonary Disease.

BACKGROUND: Up to 50% of chronic obstructive pulmonary disease (COPD) patients do not receive recommended care for COPD. To address this issue, we developed Proactive Integrated Care (Proactive iCare), a health care delivery model that couples integrated care with remote monitoring. METHODS: We conducted a prospective, quasi-randomized clinical trial in 511 patients with advanced COPD or a recent COPD exacerbation, to test whether Proactive iCare impacts patient-centered outcomes and health care utilization. Patients were allocated to Proactive iCare (n=352) or Usual Care ( =159) and were examined for changes in quality of life using the St George's Respiratory Questionnaire (SGRQ), symptoms, guideline-based care, and health care utilization. FINDINGS: Proactive iCare improved total SGRQ by 7-9 units (p < 0.0001), symptom SGRQ by 9 units (p<0.0001), activity SGRQ by 6-7 units (p<0.001) and impact SGRQ by 7-11 units (p<0.0001) at 3, 6 and 9 months compared with Usual Care. Proactive iCare increased the 6-minute walk distance by 40 m (p<0.001), reduced annual COPD-related urgent office visits by 76 visits per 100 participants (p<0.0001), identified unreported exacerbations, and decreased smoking (p=0.01). Proactive iCare also improved symptoms, the body mass index-airway obstruction-dyspnea-exercise tolerance (BODE) index and oxygen titration (p<0.05). Mortality in the Proactive iCare group (1.1%) was not significantly different than mortality in the Usual Care group (3.8%; p=0.08). INTERPRETATION: Linking integrated care with remote monitoring improves the lives of people with advanced COPD, findings that may have been made more relevant by the coronavirus 2019 (COVID-19) pandemic.

Field-effect transistors based on silicon nanowire arrays: effect of the good and the bad silicon nanowires.

Aligned arrays of silicon nanowires (aa-Si NWs) allow the exploitation of Si NWs in a scalable way. Previous studies explored the influence of the Si NWs' number, doping density, and diameter on the related electrical performance. Nevertheless, the origin of the observed effects still not fully understood. Here, we aim to provide an understanding on the effect of channel number on the fundamental parameters of aa-Si NW field effect transistors (FETs). Toward this end, we have fabricated and characterized 87 FET devices with varied number of Si NWs, which were grown by chemical vapor deposition with gold catalyst. The results show that FETs with Si NWs above a threshold number (n > 80) exhibit better device uniformity, but generally lower device performance, than FETs with lower number of Si NWs (3 ≤ n < 80). Complementary analysis indicates that the obtained discrepancies could be explained by a weighted contribution of two main groups of Si NWs: (i) a group of gold-free Si NWs that exhibit high and uniform electrical characteristics; and (ii) a group of gold-doped Si NWs that exhibit inferior electrical characteristics. These findings are validated by a binomial model that consider the aa-Si NW FETs via a weighted combination of FETs of individual Si NWs. Overall, the obtained results suggest that the criterions used currently for evaluating the device performance (e.g., uniform diameter, length, and shape of Si NWs) do not necessarily guarantee uniform or satisfying electrical characteristics, raising the need for new growth processes and/or advanced sorting techniques of electrically homogeneous Si NWs.

Spray-coating route for highly aligned and large-scale arrays of nanowires.

Technological implementation of nanowires (NWs) requires these components to be organized with controlled orientation and density on various substrates. Here, we report on a simple and efficient route for the deposition of highly ordered and highly aligned NW arrays on a wide range of receiver substrates, including silicon, glass, metals, and flexible plastics with controlled density. The deposition approach is based on spray-coating of a NW suspension under controlled conditions of the nozzle flow rate, droplet size of the sprayed NWs suspension, spray angle, and the temperature of the receiver substrate. The dynamics of droplet generation is understood by a combined action of shear forces and capillary forces. Provided that the size of the generated droplet is comparable to the length of the single NW, the shear-driven elongation of the droplets results presumably in the alignment of the confined NW in the spraying direction. Flattening the droplets upon their impact with the substrate yields fast immobilization of the spray-aligned NWs on the surface due to van der Waals attraction. The availability of the spray-coating technique in the current microelectronics technology would ensure immediate implementation in production lines, with minimal changes in the fabrication design and/or auxiliary tools used for this purpose.

Molecular gating of silicon nanowire field-effect transistors with nonpolar analytes.

Silicon nanowire field-effect transistors (Si NW FETs) have been used as powerful sensors for chemical and biological species. The detection of polar species has been attributed to variations in the electric field at the conduction channel due to molecular gating with polar molecules. However, the detection of nonpolar analytes with Si NW FETs has not been well understood to date. In this paper, we experimentally study the detection of nonpolar species and model the detection process based on changes in the carrier mobility, voltage threshold, off-current, off-voltage, and subthreshold swing of the Si NW FET. We attribute the detection of the nonpolar species to molecular gating, due to two indirect effects: (i) a change in the dielectric medium close to the Si NW surface and (ii) a change in the charged surface states at the functionality of the Si NW surface. The contribution of these two effects to the overall measured sensing signal is determined and discussed. The results provide a launching pad for real-world sensing applications, such as environmental monitoring, homeland security, food quality control, and medicine.

Enhanced sensing of nonpolar volatile organic compounds by silicon nanowire field effect transistors.

Silicon nanowire field effect transistors (Si NW FETs) are emerging as powerful sensors for direct detection of biological and chemical species. However, the low sensitivity of the Si NW FET sensors toward nonpolar volatile organic compounds (VOCs) is problematic for many applications. In this study, we show that modifying Si NW FETs with a silane monolayer having a low fraction of Si-O-Si bonds between the adjacent molecules greatly enhances the sensitivity toward nonpolar VOCs. This can be explained in terms of an indirect sensor-VOC interaction, whereby the nonpolar VOC molecules induce conformational changes in the organic monolayer, affecting (i) the dielectric constant and/or effective dipole moment of the organic monolayer and/or (ii) the density of charged surface states at the SiO(2)/monolayer interface. In contrast, polar VOCs are sensed directly via VOC-induced changes in the Si NW charge carriers, most probably due to electrostatic interaction between the Si NW and polar VOCs. A semiempirical model for the VOC-induced conductivity changes in the Si NW FETs is presented and discussed.

Catalyst-free functionalization for versatile modification of nonoxidized silicon structures.

Here, we report on a simple, catalyst-free route for obtaining highly versatile subsequent functionalization on Si nanowires and Si(111) substrates. The versatility of this approach allows subsequent functionalization not only for organic species but also for inorganic (nanomaterial) species. The method has the advantage of controlling the density of reactive cross-linkers without affecting the stability of the Si samples and without having metallic (or catalyst) residues on the surface. This method also allows formation of monolayers with a variety of termination groups and is expected to open up a wide range of opportunities for producing stable molecule-based (opto)electronic and (bio)sensing devices. Immobilization of inorganic nanomaterial on the Si samples offers advanced opportunities in molecular switches, (bio)sensors, molecular scale memory, and Si-based nanoelectronic devices.

Silver coated platinum core-shell nanostructures on etched Si nanowires: atomic layer deposition (ALD) processing and application in SERS.

A new method to prepare plasmonically active noble metal nanostructures on large surface area silicon nanowires (SiNWs) mediated by atomic layer deposition (ALD) technology has successfully been demonstrated for applications of surface-enhanced Raman spectroscopy (SERS)-based sensing. As host material for the plasmonically active nanostructures we use dense single-crystalline SiNWs with diameters of less than 100 nm as obtained by a wet chemical etching method based on silver nitrate and hydrofluoric acid solutions. The SERS active metal nanoparticles/islands are made from silver (Ag) shells as deposited by autometallography on the core nanoislands made from platinum (Pt) that can easily be deposited by ALD in the form of nanoislands covering the SiNW surfaces in a controlled way. The density of the plasmonically inactive Pt islands as well as the thickness of noble metal Ag shell are two key factors determining the magnitude of the SERS signal enhancement and sensitivity of detection. The optimized Ag coated Pt islands on SiNWs exhibit great potential for ultrasensitive molecular sensing in terms of high SERS signal enhancement ability, good stability and reproducibility. The plasmonic activity of the core-shell Pt//Ag system that will be experimentally realized in this paper as an example was demonstrated in numerical finite element simulations as well as experimentally in Raman measurements of SERS activity of a highly diluted model dye molecule. The morphology and structure of the core-shell Pt//Ag nanoparticles on SiNW surfaces were investigated by scanning- and transmission electron microscopy. Optimized core-shell nanoparticle geometries for maximum Raman signal enhancement is discussed essentially based on the finite element modeling.

Lithographically patterned silicon nanowire arrays for matrix free LDI-TOF/MS analysis of lipids.

Silicon nanowire arrays were patterned onto silicon chips by a combination of lithography and chemical vapor deposition using the vapor-liquid-solid growth method. Thus, highly reproducible sample deposition zones were obtained that were used for laser desorption ionization (LDI) mass spectrometric analysis of lipidic species with lithium salts as dopants. Using a conventional UV laser (337 nm), hydrocarbons and numerous lipids (triglycerides, diglycerides, wax esters) could be effectively lithiated yielding [M + Li](+) ions. Upon doping with lithium hydroxide the SiNW arrays yielded high signal-to-noise ratios with low limits of detection (e.g. 750 pg tripalmitin on target with S/N 5) and efficient ionization for a range of fatty acids (FA), mono-, di- and triglycerides and hydrocarbons (HC), in the form of [FA-H + 2Li](+), [mono- or diglyceride-H(2)O + Li](+), or [triglyceride + Li](+) and [HC + Li](+), respectively. It is expected that these chips will find a broad range of applications in the analysis of natural compounds and food control.

Silicon nanowires terminated with methyl functionalities exhibit stronger Si-C bonds than equivalent 2D surfaces.

Silicon nanowires (Si NWs) terminated with methyl functionalities exhibit higher oxidation resistance under ambient conditions than equivalent 2D Si(100) and 2D Si(111) surfaces having similar or 10-20% higher initial coverage. The kinetics of methyl adsorption as well as complementary surface analysis by XPS and ToF SIMS attribute this difference to the formation of stronger Si-C bonds on Si NWs, as compared to 2D Si surfaces. This finding offers the possibility of functionalising Si NWs with minimum effect on the conductance of the near-gap channels leading towards more efficient Si NW electronic devices.

Stable scaffolds for reacting Si nanowires with further organic functionalities while preserving Si-C passivation of surface sites.

We report on Si NWs modified by covalent scaffolds, via SiC bonds, that give nearly full coverage of the Si atop sites and, at the same time, provide a route for subsequent functionalization. The obtained CH(3)CHCHSi NWs exhibit superior oxidation resistance over Si NWs that are modified with CH(3) or CH(3)CC functionalities, which give nearly full coverage of the Si atop site too.

Nanowires enabling signal-enhanced nanoscale Raman spectroscopy.

Silicon nanowires grown by the vapor-liquid-solid (VLS) mechanism catalyzed by gold show gold caps (droplets) approximately 20-500 nm in diameter with a half spherical towards almost spherical shape. These gold droplets are well suited to exploit the surface-enhanced Raman scattering (SERS) effect and could be used for tip-enhanced Raman spectroscopy (TERS). The gold droplet of a nanowire attached to an atomic force microscopy (AFM) tip could locally enhance the Raman signal and increase the spatial resolution. Used as a SERS template, an ensemble of self-organizing nanowires grown bottom up on a silicon substrate could allow highly sensitive signal-enhanced Raman spectroscopy of materials that show a characteristic Raman signature. A combination of a nanowire-based TERS probe and a nanowire-based SERS substrate promises optimized signal enhancement so that the detection of highly dilute species, even single molecules or single bacteria or DNA strands, and other soft matter is within reach. Potential applications of this novel nanowire-based SERS and TERS solution lie in the fields of biomedical and life sciences, as well as security and solid-state research such as silicon technology.