Design, implementation, and outcome of a hands-on arthrocentesis workshop.

INTRODUCTION: During a 4-week rheumatology elective at our institution, opportunities for internal medicine residents to perform arthrocentesis were limited, particularly for sites other than the knee. Consequently, residents were inadequately prepared and had less self-confidence to perform such procedures. To overcome these educational deficiencies, an arthrocentesis workshop was developed. We report our quality improvement data that was collected during the first year of workshop implementation. METHODS: We devised a structured half-day arthrocentesis workshop for rheumatology fellows as well as rotating internal medicine residents. This program consisted of a one hour lecture immediately followed by a hands-on workshop that used mannequin models for 5 anatomic sites. A self-assessment questionnaire and medical knowledge test were administered before and after each session. The accuracy of the self-assessment questionnaire was analyzed by comparing responses to an external objective measure of knowledge in the same content area. Finally, an optional postworkshop survey addressed resident satisfaction. RESULTS: Thirty-eight trainees participated in the workshop between July 2006 and June 2007. There were statistically significant improvements in self-confidence in 9 content areas (P < 0.0002), cognitive testing (P < 0.0001) and in self-assurance of procedural skill at all anatomic sites. A high degree of discordance was found between the perceived level of competence and the actual performance on the medical knowledge test during the preworkshop analysis. In contrast, the postworkshop analysis displayed modestly higher concordance. All residents completing a postworkshop survey believed that it was a useful exercise, and 96% stated that they would change their practice habits. CONCLUSION: The arthrocentesis workshop provided a solid foundation from which trainees can learn key concepts of joint injection, increase their self-confidence and refine their motor skills. The accuracy of resident self-reported confidence is poor and should therefore be used only to complement other means of competency assessment and medical knowledge acquisition.

Phonon populations and electrical power dissipation in carbon nanotube transistors.

Carbon nanotubes and graphene are candidate materials for nanoscale electronic devices. Both materials show weak acoustic phonon scattering and long mean free paths for low-energy charge carriers. However, high-energy carriers couple strongly to optical phonons, which leads to current saturation and the generation of hot phonons. A non-equilibrium phonon distribution has been invoked to explain the negative differential conductance observed in suspended metallic nanotubes, while Raman studies have shown the electrical generation of hot G-phonons in metallic nanotubes. Here, we present a complete picture of the phonon distribution in a functioning nanotube transistor including the G and the radial breathing modes, the Raman-inactive zone boundary K mode and the intermediate-frequency mode populated by anharmonic decay. The effective temperatures of the high- and intermediate-frequency phonons are considerably higher than those of acoustic phonons, indicating a phonon-decay bottleneck. Most importantly, inclusion of scattering by substrate polar phonons is needed to fully account for the observed electronic transport behaviour.

Energy dissipation in graphene field-effect transistors.

We measure the temperature distribution in a biased single-layer graphene transistor using Raman scattering microscopy of the 2D-phonon band. Peak operating temperatures of 1050 K are reached in the middle of the graphene sheet at 210 kW cm(-2) of dissipated electric power. The metallic contacts act as heat sinks, but not in a dominant fashion. To explain the observed temperature profile and heating rate, we have to include heat flow from the graphene to the gate oxide underneath, especially at elevated temperatures, where the graphene thermal conductivity is lowered due to umklapp scattering. Velocity saturation due to phonons with about 50-60 meV energy is inferred from the measured charge density via shifts in the Raman G-phonon band, suggesting that remote scattering (through field coupling) by substrate polar surface phonons increases the energy transfer to the substrate and at the same time limits the high-bias electronic conduction of graphene.

Doppler sonographic criteria for the diagnosis of inferior mesenteric artery stenosis.

OBJECTIVE: The purpose of this study was to define the optimal Doppler criteria for the diagnosis of inferior mesenteric artery (IMA) stenosis in patients with suspected chronic mesenteric ischemia (CMI). METHODS: A retrospective review of 205 dedicated color and pulsed Doppler sonographic studies of mesenteric arteries was performed in 205 patients. All studies were performed in patients with suspected CMI. Correlative angiography was available in 50 patients. RESULTS: The IMA was visualized in 176 of 205 Doppler sonographic examinations (86%) and in 92% of the correlative studies. The visualization rate for the detection of a patent IMA by Doppler sonography in this series was 90%. The ranges of the peak systolic velocity (PSV), end-diastolic velocity (EDV), and mesenteric-aortic velocity ratio (MAR) in the nonstenotic IMA were 70 to 200 cm/s, 0 to 33 cm/s, and 0.7 to 3.7, respectively. The ranges of the PSV, EDV, and MAR in IMA stenosis were 200 to 485 cm/s, 0 to 177 cm/s, and 0.69 to 8.1. The threshold values for severe IMA stenosis by logistic regression analysis (n = 42) were as follows: PSV, greater than 200 cm/s; EDV, greater than 25 cm/s; and MAR, greater than 2.5, with sensitivities of 90%, 40%, and 80%; specificities of 97%, 91%, and 88%; positive predictive values (PPVs) of 90%, 57%, and 67%; negative predictive values (NPVs) of 97%, 83%, and 93%; and accuracy of 95%, 79%, and 86%, respectively. CONCLUSIONS: We found that a PSV of greater than 200 cm/s was the best criterion for the diagnosis of IMA stenosis. The sensitivity, specificity, PPV, NPV, and accuracy for the PSV were 90%, 97%, 90%, 97%, and 95%, respectively.

Chemical doping and electron-hole conduction asymmetry in graphene devices.

We investigate poly(ethylene imine) and diazonium salts as stable, complementary dopants on graphene. Transport in graphene devices doped with these molecules exhibits asymmetry in electron and hole conductance. The conductance of one carrier is preserved, while the conductance of the other carrier decreases. Simulations based on nonequilibrium Green's function formalism suggest that the origin of this asymmetry is imbalanced carrier injection from the graphene electrodes caused by misalignment of the electrode and channel neutrality points.

Imaging of the Schottky barriers and charge depletion in carbon nanotube transistors.

The photovoltage produced by local illumination at the Schottky contacts of carbon nanotube field-effect transistors varies substantially with gate voltage. This is particularly pronounced in ambipolar nanotube transistors where the photovoltage switches sign as the device changes from p-type to n-type. The detailed transition through the insulating state can be recorded by mapping the open-circuit photovoltage as a function of excitation position. These photovoltage images show that the band-bending length can grow to many microns when the device is depleted. In our palladium-contacted devices, the Schottky barrier for electrons is much higher than that for holes, explaining the higher p-type current in the transistor. The depletion width is 1.5 mum near the n-type threshold and smaller than our resolution of 400 nm near the p-type threshold. Internal photoemission from the metal contact to the carbon nanotube and thermally assisted tunneling through the Schottky barrier are observed in addition to the photocurrent that is generated inside the carbon nanotube.

Electrically excited, localized infrared emission from single carbon nanotubes.

Carbon nanotube field-effect transistors (CNTFETs) produce band gap derived infrared emission under both ambipolar and unipolar transport conditions. We demonstrate here that heterogeneities/defects in the local environment of a CNTFET perturb the local potentials and, as a result, the characteristic bias dependent motion of the ambipolar light emission. Such defects can also introduce localized infrared emission due to impact excitation by carriers accelerated by a voltage drop at the defect. The correlation of the change in the motion of the ambipolarlight emission and of the stationary electroluminescence with the electrical characteristics of the CNTFETs shows that stationaryelectroluminescence can identify "environmental defects" in carbon nanotubes and help evaluate their influence on electrical transport and device operation. A number of different defects are studied involving local dielectric environment changes (partially polymer-covered nanotubes), nanotube-nanotube contacts in looped nanotubes, and nanotube segments close to the electronic contacts. Random defects due to local charging are also observed.

Mobile ambipolar domain in carbon-nanotube infrared emitters.

We spatially resolve the infrared light emission from ambipolar carbon-nanotube field-effect transistors with long-channel lengths. Electrons and holes are injected from opposite contacts into a single nanotube molecule. The ambipolar domain, where electron and hole currents overlap, forms a microscopic light emitter within the carbon nanotube. We can control its location by varying gate and drain voltages. At high electric fields, additional stationary spots appear due to defect-assisted Zener tunneling or impact ionization. The laterally resolved measurement provides valuable insight into the transistor behavior, complementary to electronic device characteristics.