Deep Ultraviolet Optical Anisotropy of ß-Gallium Oxide Thin Films.

ß-Crystalline phase gallium oxide (ß-Ga2O3) is an ultrawide bandgap material with prospective applications in electronics and deep ultraviolet (DUV) optoelectronics and optics. The monoclinic crystal structure of ß-Ga2O3 results in optical anisotropy to incident light with different polarization states. This attribute can lead to different optical applications in the DUV. In this article, we investigated the optical properties of ß-Ga2O3 thin films grown by pulsed laser deposition technique on sapphire substrates with different crystallographic orientations. Marked in-plane polarization anisotropy, determined by reflectance and Raman spectroscopy, was observed for ß-Ga2O3 films deposited on an r-cut sapphire substrate. In contrast, isotropic optical properties were observed in ß-Ga2O3 films deposited on a c-cut sapphire substrate.

The Maryland (USA) Critical Care Coordination Center (C4): From Pandemic to Permanence.

INTRODUCTION: The 2019 coronavirus disease (COVID-19) pandemic created overwhelming demand for critical care services within Maryland's (USA) hospital systems. As intensive care units (ICUs) became full, critically ill patients were boarded in hospital emergency departments (EDs), a practice associated with increased mortality and costs. Allocation of critical care resources during the pandemic requires thoughtful and proactive management strategies. While various methodologies exist for addressing the issue of ED overcrowding, few systems have implemented a state-wide response using a public safety-based platform. The objective of this report is to describe the implementation of a state-wide Emergency Medical Services (EMS)-based coordination center designed to ensure timely and equitable access to critical care. METHODS: The state of Maryland designed and implemented a novel, state-wide Critical Care Coordination Center (C4) staffed with intensivist physicians and paramedics purposed to ensure appropriate critical care resource management and patient transfer assistance. A narrative description of the C4 is provided. A retrospective cohort study design was used to present requests to the C4 as a case series report to describe the results of implementation. RESULTS: Providing a centralized asset with regional situational awareness of hospital capability and bed status played an integral role for directing the triage process of critically ill patients to appropriate facilities during and after the COVID-19 pandemic. A total of 2,790 requests were received by the C4. The pairing of a paramedic with an intensivist physician resulted in the successful transfer of 67.4% of requests, while 27.8% were managed in place with medical direction. Overall, COVID-19 patients comprised 29.5% of the cohort. Data suggested increased C4 usage was predictive of state-wide ICU surges. The C4 usage volume resulted in the expansion to pediatric services to serve a broader age range. The C4 concept, which leverages the complimentary skills of EMS clinicians and intensivist physicians, is presented as a proposed public safety-based model for other regions to consider world-wide. CONCLUSION: The C4 has played an integral role in the State of Maryland's pledge to its citizens to deliver the right care to the right patient at the right time and can be considered as a model for adoption by other regions world-wide.

Tunable near-infrared Gires-Tournois resonators based on vanadium dioxide on gold film.

Vanadium dioxide (VO2) has been proposed as a phase-change material in tunable photonic and optoelectronic devices. In such devices, a thin layer of VO2 is typically deposited on metallic or insulating surfaces. In this Letter, we report the reflectance spectra of a subwavelength structure consisting of a thin layer of VO2 deposited on a gold film in the near-infrared spectral range, particularly near the wavelength of 1550 nm, which is significant for telecommunication applications. Our results indicate that in the insulating phase of VO2, the air/VO2/Au structure can be considered as a Gires-Tournois resonant cavity whose maximum absorption wavelength can be tuned by adjusting the thickness of the VO2 layer. In contrast, in the metallic phase of VO2, the reflectance of the structure increases by an amount of the order of a few tens of units. The proposed structure can prospectively lead to new design concepts in tunable photonic and optoelectronic devices.

Pertinencia de la solicitud del dímero D en pacientes de un servicio de urgencias / Pertinence of D-dimer request in patients in emergency services / Relevância da solicitação de D-dímero em pacientes de um setor de emergência

Introducción. El tromboembolismo pulmonar y la trombosis venosa profunda son urgencias cardiovasculares relativamente comunes, se han descrito diferentes predictores clínicos para la estratificación del riesgo, biomarcadores séricos y pruebas de imagenología. Dentro de los biomarcadores séricos se ha descrito el dímero D. Debido a que la enfermedad tromboembólica venosa es un reto diagnóstico para el clínico, el objetivo del presente estudio fue evaluar la pertinencia de la solicitud del dímero D, en el servicio de urgencias de un centro de tercer nivel en la ciudad de Bogotá durante los años 2018-2019. Metodología. Estudio observacional, descriptivo y transversal retrospectivo de pacientes que consultaron al servicio de urgencias, de una clínica de tercer nivel, de la ciudad de Bogotá, durante el periodo 2018-2019. Resultados. Se revisaron 583 historias clínicas, se excluyeron 107 pacientes, con un total final de 474 (57.3% mujeres y 42.6% hombres). De estos, 21 pacientes presentaron estudios positivos (angiotomografía y Doppler venoso). El dímero D presentó un valor predictivo negativo inferior al 50%. Discusión. A pesar de los resultados y de ser un estudio de un solo centro se evidencian las dificultades que tienen los médicos de los servicios de urgencias al momento de solicitar pruebas diagnósticas. Conclusiones. Este estudio evidencia la dificultad que existe en los servicios de urgencias al momento de la evaluación diagnóstica y cómo la solicitud de los paraclínicos tiene que ser un proceso estandarizado, guiado por los motivos de consulta y hallazgos al examen físico, y así no perder las características operativas de las pruebas diagnósticas y su utilidad al momento de la evaluación clínica.

Introduction. Pulmonary thromboembolisms and deep vein thromboses are relatively common cardiovascular emergencies. Various clinical predictors, serial biomarkers and imaging tests have been described for the stratification of the risk. D-dimer has been described within the serial biomarkers. Since venous thromboembolic disease is a diagnostic challenge for doctors, the objective of this study was to assess the pertinence of the D-dimer request in emergency services in a level three center in Bogotá during 2018-2019. Methodology. An observational, descriptive and cross-sectional retrospective study of patients who resorted to emergency services in a level three clinic in Bogotá during 2018-2019. Results. 583 medical records were reviewed, and 107 patients were excluded, with a final total of 474 patients (57.3% women and 42.6% men). Of these, 21 patients had positive studies (angiotomography and venous doppler ultrasound). D-dimer had a negative predictive value of less than 50%. Discussion. Despite the results and it being a study in a single clinic, the difficulties emergency service doctors experience when requesting diagnostic tests can be observed. Conclusions. This study shows the difficulties in emergency services when performing a diagnosis. The request for complementary tests has to be a standardized process guided by the reasons for the consultation and findings from the physical exam, in order not to lose the operational characteristics of the diagnostic tests and their usefulness during the clinical evaluation.

Introdução. Tromboembolismo pulmonar e trombose venosa profunda são emergências cardiovasculares relativamente comuns. Têm sido descritos diferentes preditores clínicos para estratificação de risco, biomarcadores séricos e testes de imagem. Entre os biomarcadores séricos, foi descrito o D-dímero. Considerando que a doença tromboembólica venosa é um desafio diagnóstico para o clínico, o objetivo deste estudo foi avaliar a relevância da solicitação de D-dímero no serviço de emergência de um centro de terceiro nível na cidade de Bogotá ao longo dos anos 2018-2019. Metodologia. Estudo observacional, descritivo e transversal retrospectivo de pacientes que consultaram o serviço de emergência de uma clínica de terceiro nível na cidade de Bogotá, no período de 2018-2019. Resultados. Foram revisados 583 prontuários, excluídos 107 pacientes, totalizando 474 (57.3% mulheres e 42.6% homens). Destes, 21 pacientes apresentaram estudos positivos (angiotomografia e Doppler venoso). D-dímero apresentou valor preditivo negativo inferior a 50%. Discussão. Apesar dos resultados e do fato de se tratar de um estudo só de um centro, são evidentes as dificuldades que os médicos de emergência apresentam ao solicitarem exames diagnósticos. Conclusões. Este estudo mostra a dificuldade que existe nos serviços de emergência no momento da avaliação diagnóstica e como a solicitação dos testes paraclínicos tem que ser um processo padronizado, orientado pelos motivos da consulta e pelos resultados do exame físico, e assim não perder as características operacionais dos exames diagnósticos e sua utilidade no momento da avaliação clínica.

Exaggerated IL-17A activity in human in vivo recall responses discriminates active tuberculosis from latent infection and cured disease.

Host immune responses at the site of Mycobacterium tuberculosis infection can mediate pathogenesis of tuberculosis (TB) and onward transmission of infection. We hypothesized that pathological immune responses would be enriched at the site of host-pathogen interactions modeled by a standardized tuberculin skin test (TST) challenge in patients with active TB compared to those without disease, and interrogated immune responses by genome-wide transcriptional profiling. We show exaggerated interleukin-17A (IL-17A) and T helper 17 (TH17) responses among 48 individuals with active TB compared to 191 with latent TB infection, associated with increased neutrophil recruitment and matrix metalloproteinase-1 expression, both involved in TB pathogenesis. Curative antimicrobial treatment reversed these observed changes. Increased IL-1ß and IL-6 responses to mycobacterial stimulation were evident both in circulating monocytes and in molecular changes at the site of TST in individuals with active TB, supporting a model in which monocyte-derived IL-1ß and IL-6 promote TH17 differentiation within tissues. Modulation of these cytokine pathways may provide a rational strategy for host-directed therapy in active TB.

EMS utilization predictors in a Mobile Integrated Health (MIH) program.

BACKGROUND: The provision of unnecessary Emergency Medical Services care remains a challenge throughout the US and contributes to Emergency Department overcrowding, delayed services and lower quality of care. New EMS models of care have shown promise in improving access to health services for patients who do not need urgent care. The goals of this study were (1) to identify factors associated with EMS utilization (911) and (2) their effects on total EMS calls and transports in an MIH program. METHODS: The study sample included 110 MIH patients referred to the program or considered high-users of EMS services between November 2016 and September 2018. The study employed descriptive statistics and Poisson regressions to estimate the effects of covariates on total EMS calls and transports. RESULTS: The typical enrollee is a 60-year-old single Black male living with two other individuals. He has a PCP, takes 12 medications and is compliant with his treatment. The likelihood of calling and/or being transported by EMS was higher for males, patients at high risk for falls, patients with asthma/COPD, psychiatric or behavioral illnesses, and longer travel times to a PCP. Each prescribed medication increased the risk for EMS calls or transports by 4%. The program achieved clear reductions in 911 calls and transports and savings of more than 140,000 USD in the first month. CONCLUSIONS: This study shows that age, marital status, high fall risk scores, the number of medications, psychiatric/behavioral illness, asthma/COPD, CHF, CVA/stroke and medication compliance may be good predictors of EMS use in an MIH setting. MIH programs can help control utilization of EMS care and reduce both EMS calls and transports.

Correlation between Emergency Medical Services Suspected COVID-19 Patients and Daily Hospitalizations.

Objective: We sought to determine if Emergency Medical Services (EMS) identified Persons Under Investigation (PUI) for COVID-19 are associated with hospitalizations for COVID-19 disease for the purposes of serving as a potential early indicator of hospital surge. Methods: A retrospective analysis was conducted using data from the Maryland statewide EMS electronic medical records and daily COVID-19 hospitalizations from March 13, 2020 through July 31, 2020. All unique EMS patients who were identified as COVID-19 PUIs during the study period were included. Descriptive analysis was performed. The Box-Jenkins approach was used to evaluate the relationship between EMS transports and daily new hospitalizations. Separate Auto Regressive Integrated Moving Average (ARIMA) models were constructed to transform the data into a series of independent, identically distributed random variables. Fit was measured using the Akaike Information Criterion (AIC). The Box-Ljung white noise test was utilized to ensure there was no autocorrelation in the residuals. Results: EMS units in Maryland identified a total of 26,855 COVID-19 PUIs during the 141-day study period. The median patient age was 62 years old, and 19,111 (71.3%) were 50 years and older. 6,886 (25.6%) patients had an abnormal initial pulse oximetry (<92%). A strong degree of correlation was observed between EMS PUI transports and new hospitalizations. The correlation was strongest and significant at a 9-day lag from time of EMS PUI transports to new COVID-19 hospitalizations, with a cross correlation coefficient of 0.26 (p < .01). Conclusions: A strong correlation between EMS PUIs and COVID-19 hospitalizations was noted in this state-wide analysis. These findings demonstrate the potential value of incorporating EMS clinical information into the development of a robust syndromic surveillance system for COVID-19. This correlation has important utility in the development of predictive tools and models that seek to provide indicators of an impending surge on the healthcare system at large.

COMPARISON OF RADON MASS EXHALATION RATE MEASUREMENTS FROM BUILDING MATERIALS BY TWO DIFFERENT METHODS.

The aim of this study is to measure the radon mass exhalation rate from common granite building materials used in the east and northeast part of Portugal. Twelve cubic shaped samples were measured. Nine of them without any coating and three coated with different materials (varnish, hydrorepellent and liquid silicone). The radon measurements were performed with two different techniques: one using passive detectors and other using an active detector. For the passive method, CR-39 solid-state nuclear track detectors were used. The active method used the RAD7 DURRIDGE detector. Radon mass exhalation rates obtained from both methods present relatively low values in the 11-45 mBq kg-1 h-1 range for the analysed samples. Concerning the coated samples, the measured values are on average four times lower than the ones without coating. Overall, the measured values for both methods present a good agreement.

Exact quasi-relativistic wavefunctions of Hydrogen-like atoms.

Exact solutions of a novel quasi-relativistic quantum mechanical wave equation are found for Hydrogen-like atoms. This includes both, an exact analytical expression for the energies of the bound states, and exact analytical expressions for the wavefunctions, which successfully describe quantum particles with mass and spin-0 up to energies comparable to the energy associated to the mass of the particle. These quasi-relativistic atomic orbitals may be used for improving ab-initio software packages dedicated to numerical simulations in physical-chemistry and atomic and solid-state physics.

Scanning diffracted-light microscopy.

Scanning the direction of the light that is diffracted by a sample permits the achievement of image diversity, which is necessary for implementing the Fourier ptychographic microscopy technique (FPM) using only perpendicular illumination. We also demonstrated that the same method allows for implementation of the illumination-direction-multiplexing FPM technique when the sample is illuminated using a ring-shaped condenser.

Subwavelength resolution scanning diffracted-light microscopy using plasmonic ultra-thin condensers.

We used a rotating slit placed at the back focal plane of the microscope's objective lens to scan the light diffracted by a plasmonic crystal, which had a period smaller than the resolution limit of the optical microscope. A set of images were collected at different orientations of the slit. A high-resolution image of the plasmonic crystal was obtained by processing the experimental images using a numerical Fourier ptychographic algorithm. Supporting simulations of the experiments are also presented.

The effects of primary prevention policies on mortality from motor-vehicle crashes among children in the United States.

INTRODUCTION: Every year, 4500 children die in motor-vehicle crashes in the United States, with estimated costs of more than $40,000 and $240 billion in productivity losses. The majority of deaths and injuries are associated with improper use of restraint devices, alcohol, high speeds, and built environments. METHODOLOGY: This is a retrospective study using U.S. panel data from 1997 through 2005. Data sources included the Fatality Analysis Reporting System, the Insurance Institute for Highway Safety, the U.S. Census Bureau, the Atlas of Presidential Elections, and the U.S. Bureau of Labor Statistics. This study used conditional fixed effects negative binomial regression to analyze the effect of the covariates on mortality by state and year. RESULTS: A total of 32,893 children died in motor-vehicle crashes (MVCs). States that allowed fines greater than $50 for lack of restraint use experienced significant reductions in mortality as well as states with laws allowing the use of red light cameras. Graduate licensing programs requiring a minimum age of 16 for the intermediate-level experienced mortality reductions as much as 90% compared with a minimum age of 14. Higher posted speeds were associated with higher mortality rates, particularly on local roads. CONCLUSION: This research focuses on the effects injury prevention laws have on mortality, but not on how effectively these laws are implemented and/or enforced. Results may be useful to policy-makers and public health practitioners involved in injury prevention and public health. Practical applications: Design appropriate education and training programs in road safety, implement effective road safety interventions and improve traffic safety legislation.

Imaging photonic crystals using hemispherical digital condensers and phase-recovery techniques.

We describe experiments where Fourier ptychographic microscopy (FPM) and dual-space microscopy (DSM) are implemented for imaging photonic crystals using a hemispherical digital condenser (HDC). Phase-recovery imaging simulations show that both techniques should be able to image photonic crystals with a period below the Rayleigh resolution limit. However, after processing the experimental images using both phase-recovery algorithms, we found that DSM can, but FPM cannot, image periodic structures with a period below the diffraction limit. We studied the origin of this apparent contradiction between simulations and experiments, and we concluded that the occurrence of unwanted reflections in the HDC is the source of the apparent failure of FPM. We thereafter solved the problem of reflections by using a single-directional illumination source and showed that FPM can image photonic crystals with a period below the Rayleigh resolution limit.

Potentiation of capsaicin-induced neurogenic inflammation by 5-HT7 receptors in the rat hind paw: Involvement of calcitonin gen-related peptide.

A decrease in the activation threshold of primary sensory neurons to transient receptor potential V1 (TRPV1) stimulation by serotonin 5-HT7 receptors has been reported but no confirmation if this might translate into facilitation of neurogenic inflammation has been provided. We analysed the modulation of capsaicin (CAP)-induced neurogenic inflammation in the rat hind paw by the selective 5-HT7 receptor agonist, LP-44, and the involvement of calcitonin gen-related peptide (CGRP) in this effect. Animals received intra-plantar injections (30 µL) of vehicle, CAP (0.05%, 0.1% and 0.2%), LP-44 (7.5 and 15 nmol) and the combination of LP-44 + CAP; then, the time course of the inflammatory responses was measured. The effect of the 5-HT7 receptor antagonist, SB-269970 (3 mg/kg, s.c.), on responses produced by LP-44 alone and combined with CAP was tested. As expected, CAP produced concentration- and time-dependent inflammatory responses in the hind paw. Interestingly, LP-44 by itself also produced inflammation in a concentration- and time-dependent manner, and magnified CAP-induced responses. Systemic pre-treatment with SB-269970 significantly blunted LP-44 (15 nmol)-induced inflammation as well as magnified inflammatory responses produced by the combination of LP-44 (7.5 and 15 nmol) + CAP (0.1%) thus confirming the involvement of 5-HT7 receptors. Finally, the non-peptide CGRP receptor antagonist, BIBN4096 (3 mg/kg, s.c.), strongly inhibited the potentiated inflammatory responses induced by LP-44 (7.5 and 15 nmol) + CAP (0.1%) thus substantiating their neurogenic nature. Thus, sensitization of CAP-sensitive primary sensory neurons by 5-HT7 receptors may result in facilitation of neurogenic inflammation involving CGRP in the rat hind paw.

Síndrome metabólico en el climaterio

enfermedades cardiovasculares una de las más prevalentes. Una de las principales causas de morbilidad es el síndrome metabólico. Es necesario orientar al médico y a sus pacientes sobre las consecuencias de esta patología. Son los varones quienes son más tratados, dejando de lado a las mujeres por la errada percepción de que tienen un riesgo cardiovascular bajo. La fisiopatología de la resistencia a la insulina abre un abanico de conocimientos relacionados al incremento de los triglicéridos en sangre y con el mayor aclaramiento del HDL-colesterol por parte del hígado. La obesidad abdominal y la hipertensión arterial completan los elementos de diagnóstico del síndrome metabólico, el cual se hace cuando existen tres de los cinco factores mencionados. Durante la transición menopáusica hay un rápido incremento en la severidad de este síndrome, lo que provoca un aumento del riesgo cardiovascular. En la obesidad hay un estado proinflamatorio inducido por la mayor producción de citoquinas inflamatorias como TNF-alfa, resistina, leptina, por el adipocito obeso, las cuales están vinculadas con la mayoría de las enfermedades crónicas y con el cáncer. En relación a la hipertensión arterial, hay muchas pacientes que desconocen que son portadoras de esta patología y no se hacen tratar, aumentando su riesgo cardiovascular. Por todo lo anterior, el médico ginecólogo debe de familiarizarse con esta patología y tener una actitud activa al respecto con relación a su diagnóstico y manejo.

The increase in the life expectancy of women results in more morbidity and mortality in older women, with cardiovascular diseases being one of the most prevalent diseases. Among the main causes of morbidity is the metabolic syndrome. Thus, it is necessary to guide both physicians and patients in the consequences of this pathology. Males receive treatment more frequently because of the mistaken perception that women have a low cardiovascular risk. The pathophysiology of insulin resistance is linked to the increase of triglycerides in blood and the clearance of HDL-cholesterol by the liver. Abdominal obesity and arterial hypertension complete the diagnostic elements of the metabolic syndrome, which is based on the presence of three of the five factors mentioned. During the menopausal transition, there is a rapid increase in the severity of this syndrome, which gives rise to an increased cardiovascular risk. Obesity is a pro inflammatory state with increased production of inflammatory cytokines, such as TNF-alpha, resistin and leptin, by the obese adipocyte, all linked to most chronic diseases and cancer. In relation to arterial hypertension, there are many patients who do not know that they are carriers of this pathology and are not treated, increasing their cardiovascular risk. Therefore, gynecologists must become familiar with this pathology and have an active attitude in its diagnosis and management.

Scanning diffracted-light photography using white-light and thermal radiation sources.

A 4-f imaging arrangement of lenses with a camera and a rotating slit placed at the Fourier plane of the system was used to obtain the optical disturbance produced by a macroscopic sample. The sample was illuminated by collimated beams from white-light and thermal radiation sources. The agreement between simulated and experimental results, obtained by processing the captured images using a Fourier ptychographic algorithm, demonstrates that scanning with the slit the direction of the light diffracted by the sample permits achieving the image diversity necessary for successful implementation of the scanning diffracted-light imaging technique.

La Profesionalización Profesoral en las Ciencias de la Salud / Teacher Professionalization in Health Sciences

To have a starting point should be understood to the sciences of education as a whole, as sciences that have an epistemic dimension with structured scientific knowledge, which includes its own theories, laws, principles, regularities, categorial systems and feeds other related sciences, including Didactics and Pedagogy; the latter aims to educate the human being as a social institution and includes in its field of study a broad categorial apparatus, pretending the social transformation of man.

Para tener un punto de partida se debe entender a las ciencias de la educación en su conjunto, como ciencias que tienen una dimensión epistémica con conocimiento científico estructurado, que contempla sus propias teorías, leyes, principios, regularidades, sistemas categoriales y se alimenta de otras ciencias afines, entre ellas la Didáctica y la Pedagogía; esta última, tiene por objeto, a la educación del ser humano como institución social e incluye en su campo de estudio, un amplio aparato categorial, pretendiendo la transformación social del hombre.

Illumination-direction multiplexing Fourier ptychographic microscopy using hemispherical digital condensers.

Simulations were conducted to explore a broader collection of possible illumination patterns realizable using a white-light-emitting hemispherical digital condenser. Several simple, but practical, illumination patterns were selected and used in experiments where a sample was illuminated simultaneously from different directions. The illumination-direction multiplexing (IDM) Fourier ptychographic microscopy (FPM) method was successfully used for imaging and phase recovery. This study suggests that IDM-FPM can be used for imaging photonic crystals with subwavelength periods using traditional microscope condensers with variable numerical aperture.

Simulation study of dual-space microscopy.

We explore the convergence of the dual-space microscopy (DSM) phase-recovery algorithm. DSM is an optical microscopy technique based on simultaneous observation of an object in the position and momentum spaces. We present one-dimensional (1D) simulations of this technique, demonstrating that the DSM technique is capable to resolve periodic and nonperiodic structures with a resolution well below the Rayleigh resolution limit. Using a simple and faster 1D version of the full 2D DSM algorithm, we simulated the DSM technique for thousands of different samples. Our results demonstrate that the DSM algorithm always converges rapidly to the correct optical disturbance.

Fourier ptychographic microscopy using an infrared-emitting hemispherical digital condenser.

Fourier ptychographic microscopy is demonstrated in the near-infrared spectral range using a computer-controlled hemispherical digital condenser comprising multiple 940 nm wavelength light emitting diodes. This technique was used to image periodic patterned samples (photonic crystals). Experimental and simulated results using a phase retrieval algorithm were found to be in excellent correspondence. We show that for samples with a single period in each direction, the resolution of the obtained high-resolution near-infrared images is limited by the Rayleigh criteria.