Validity of the modified Rankin Scale in patients with aneurysmal subarachnoid hemorrhage: a randomized study.

PURPOSE: The modified Rankin Scale (mRS), a clinician-reported outcome measure of global disability, has never been validated in patients with aneurysmal subarachnoid hemorrhage (aSAH). The aims of this study are to assess: (1) convergent validity of the mRS; (2) responsiveness of the mRS; and (3) the distribution of mRS scores across patient-reported outcome measures (PROMs). METHODS: This is a prospective randomized multicenter study. The mRS was scored by a physician for all patients, and subsequently by structured interview for half of the patients and by self-assessment for the other half. All patients completed EuroQoL 5D-5L, RAND-36, Stroke Specific Quality of Life scale (SS-QoL) and Global Perceived Effect (GPE) questionnaires. Convergent validity and responsiveness were assessed by testing hypotheses. RESULTS: In total, 149 patients with aSAH were included for analysis. The correlation of the mRS with EQ-5D-5L was r = - 0.546, while with RAND-36 physical and mental component scores the correlation was r = - 0.439and r = - 0.574 respectively, and with SS-QoL it was r = - 0.671. Three out of four hypotheses for convergent validity were met. The mRS assessed through structured interviews was more highly correlated with the mental component score than with the physical component score of RAND-36. Improvement in terms of GPE was indicated by 83% of patients; the mean change score of these patients on the mRS was - 0.08 (SD 0.915). None of the hypotheses for responsiveness were met. CONCLUSION: The results show that the mRS generally correlates with other instruments, as expected, but it lacks responsiveness. A structured interview of the mRS is best for detecting disabling neuropsychological complaints. REGISTRATION: URL: https://trialsearch.who.int ; Unique identifier: NL7859, Date of first administration: 08-07-2019.

The SOS-SAH questionnaire in clinical practice: a multi-method evaluation study.

BACKGROUND: In patients with mild disabilities after aneurysmal subarachnoid hemorrhage (aSAH), invisible symptoms might be easily overlooked during consultations in the outpatient clinic. We hypothesize that the Questionnaire for the Screening of Symptoms in aneurysmal Subarachnoid Hemorrhage (SOS-SAH), a disease-specific patient-reported outcome measure, might aid in screening for symptoms after aSAH. The objective of this explorative study is to evaluate the perceived impact of using the SOS-SAH in daily clinical practice for patients after aSAH, as well as to explore potential barriers to further implementation. METHODS: This multi-method study consists of a quantitative and a qualitative component. To evaluate differences in quality of care, a patient experience survey was sent to patients receiving usual care and to patients who received the SOS-SAH. A multiple linear regression model was applied, with the intervention group and case mix adjusters as independent variables. We described differences in the number of symptoms discussed between patients receiving usual care and those receiving care post-implementation. Following implementation, 16 patients and 6 healthcare professionals were interviewed about their perceptions concerning the impact of and barriers to using the SOS-SAH. A thematic analysis was performed to identify the main themes. RESULTS: The survey did not reveal any differences between the usual-care group and the post-implementation group on the scales of the patient experience survey. After implementation of the SOS-SAH, the number of symptoms discussed during consultation did not increase. The interviews suggest that the SOS-SAH may improve the preparation of patients by providing them with greater insight into their complaints and by raising issues for the consultation. It could also enhance the structure and efficiency of consultation, in addition to improving communication about issues that matter to patients. All patients and healthcare professionals recommended continuing the use of the SOS-SAH in daily practice. CONCLUSIONS: Although no quantitative improvements were found in patient experience and symptoms discussed during consultation, implementation of the SOS-SAH could aid in screening for symptoms in patients after aSAH, and it might have a positive influence on patient preparation, while helping to structure consultations between patients and healthcare professionals.

Inter-method reliability of the modified Rankin Scale in patients with subarachnoid hemorrhage.

BACKGROUND AND OBJECTIVES: The modified Rankin Scale (mRS) is one of the most frequently used outcome measures in trials in patients with an aneurysmal subarachnoid hemorrhage (aSAH). The assessment method of the mRS is often not clearly described in trials, while the method used might influence the mRS score. The aim of this study is to evaluate the inter-method reliability of different assessment methods of the mRS. METHODS: This is a prospective, randomized, multicenter study with follow-up at 6 weeks and 6 months. Patients aged ≥ 18 years with aSAH were randomized to either a structured interview or a self-assessment of the mRS. Patients were seen by a physician who assigned an mRS score, followed by either the structured interview or the self-assessment. Inter-method reliability was assessed with the quadratic weighted kappa score and percentage of agreement. Assessment of feasibility of the self-assessment was done by a feasibility questionnaire. RESULTS: The quadratic weighted kappa was 0.60 between the assessment of the physician and structured interview and 0.56 between assessment of the physician and self-assessment. Percentage agreement was, respectively, 50.8 and 19.6%. The assessment of the mRS through a structured interview and by self-assessment resulted in systematically higher mRS scores than the mRS scored by the physician. Self-assessment of the mRS was proven feasible. DISCUSSION: The mRS scores obtained with different assessment methods differ significantly. The agreement between the scores is low, although the reliability between the assessment methods is good. This should be considered when using the mRS in clinical trials. TRIAL REGISTRATION: www.trialregister.nl ; Unique identifier: NL7859.

[Cerebral amyloid angiopathy: an easily missed diagnosis in patients with transient neurological deficits]. / Cerebrale amyloïdangiopathie.

Cerebral amyloid angiopathy (CAA) is a degenerative neurovascular disease in which the protein amyloid-beta accumulates in the vessel wall of cortical and leptomeningeal arteries. This may lead to acute lobar cerebral haemorrhage, which in case of CAA is fatal in 10-30% of cases. CAA may also present with transient focal neurological episodes (TFNE), the symptoms of which may mimic a transient ischaemic attack (TIA). Distinction between the two has important implications for therapy, as antithrombotics are relatively contra-indicated in CAA, but indicated after a TIA. We describe a patient with transient focal neurological deficits who was initially treated with antithrombotic therapy for a suspected TIA. Eventually, the diagnosis CAA was made and antithrombotic treatment was ceased. This case stresses the importance of considering the diagnosis CAA with TFNE in patients presenting with transient neurological deficits, in order to avoid an unnecessarily increased risk of symptomatic and possibly fatal cerebral haemorrhage.

Controlling the shape of a tapered nanowire: lessons from the Burton-Cabrera-Frank model.

The propagation of sidewall steps during the growth of nanowires is calculated in the frame of the Burton-Cabrera-Frank model. The stable shape of the nanowire comprises a cylinder section on top of a cone section: their characteristics are obtained as a function of the radius of the catalyst-nanowire area, the desorption-limited diffusion length of adatoms on the terraces, and the sticking of adatoms at step edges. The comparison with experimental data allows us to evaluate these last two parameters for InP and ZnTe nanowires; it reveals a different behavior for the two materials, related to a difference by an order of magnitude of the desorption-limited diffusion length.

Assessment of AlGaN/AlN superlattices on GaN nanowires as active region of electron-pumped ultraviolet sources.

In this paper, we describe the design and characterization of 400 nm long (88 periods) Al x Ga1-x N/AlN (0 ≤ x ≤ 0.1) quantum dot superlattices deposited on self-assembled GaN nanowires for application in electron-pumped ultraviolet sources. The optical performance of GaN/AlN superlattices on nanowires is compared with the emission of planar GaN/AlN superlattices with the same periodicity and thickness grown on bulk GaN substrates along the N-polar and metal-polar crystallographic axes. The nanowire samples are less sensitive to nonradiative recombination than planar layers, attaining internal quantum efficiencies (IQE) in excess of 60% at room temperature even under low injection conditions. The IQE remains stable for higher excitation power densities, up to 50 kW cm-2. We demonstrate that the nanowire superlattice is long enough to collect the electron-hole pairs generated by an electron beam with an acceleration voltage V A = 5 kV. At such V A, the light emitted from the nanowire ensemble does not show any sign of quenching under constant electron beam excitation (tested for an excitation power density around 8 kW cm-2 over the scale of minutes). Varying the dot/barrier thickness ratio and the Al content in the dots, the nanowire peak emission can be tuned in the range from 340 to 258 nm.

Effect of Bias on the Response of GaN Axial p-n Junction Single-Nanowire Photodetectors.

We present a comprehensive study of the performance of GaN single-nanowire photodetectors containing an axial p-n junction. The electrical contact to the p region of the diode is made by including a p+/n+ tunnel junction as cap structure, which allows the use of the same metal scheme to contact both ends of the nanowire. Single-nanowire devices present the rectifying current-voltage characteristic of a p-n diode but their photovoltaic response to ultraviolet radiation scales sublinearly with the incident optical power. This behavior is attributed to the dominant role of surface states. Nevertheless, when the junction is reverse biased, the role of the surface becomes negligible in comparison to the drift of photogenerated carriers in the depletion region. Therefore, the responsivity increases by about 3 orders of magnitude and the photocurrent scales linearly with the excitation. These reverse-biased nanowires display decay times in the range of ∼10 µs, limited by the resistor-capacitor time constant of the setup. Their ultraviolet/visible contrast of several orders of magnitude is suitable for applications requiring high spectral selectivity. When the junction is forward biased, the device behaves as a GaN photoconductor with an increase of the responsivity at the price of a degradation of the time response. The presence of leakage current in some of the wires can be modeled as a shunt resistance which reacts to the radiation as a photoconductor and can dominate the response of the wire even under reverse bias.

Probing the light hole/heavy hole switching with correlated magneto-optical spectroscopy and chemical analysis on a single quantum dot.

A whole series of complementary studies have been performed on the same single nanowire containing a quantum dot: cathodoluminescence spectroscopy and imaging, micro-photoluminescence spectroscopy under magnetic field and as a function of temperature, and energy-dispersive x-ray spectrometry and imaging. The ZnTe nanowire was deposited on a Si3N4 membrane with Ti/Al patterns. The complete set of data shows that the CdTe quantum dot features the heavy-hole state as a ground state, although the compressive mismatch strain promotes a light-hole ground state as soon as the aspect ratio is larger than unity (elongated dot). A numerical calculation of the whole structure shows that the transition from the heavy-hole to the light-hole configuration is pushed toward values of the aspect ratio much larger than unity by the presence of a (Zn, Mg)Te shell, and that the effect is further enhanced by a small valence band offset between the semiconductors in the dot and around it.

Monolithic Axial and Radial Metal-Semiconductor Nanowire Heterostructures.

The electrical and optical properties of low-dimensional nanostructures depend critically on size and geometry and may differ distinctly from those of their bulk counterparts. In particular, ultrathin semiconducting layers as well as nanowires have already proven the feasibility to realize and study quantum size effects enabling novel ultrascaled devices. Further, plasmonic metal nanostructures attracted recently a lot of attention because of appealing near-field-mediated enhancement effects. Thus, combining metal and semiconducting constituents in quasi one-dimensional heterostructures will pave the way for ultrascaled systems and high-performance devices with exceptional electrical, optical, and plasmonic functionality. This Letter reports on the sophisticated fabrication and structural properties of axial and radial Al-Ge and Al-Si nanowire heterostructures, synthesized by a thermally induced exchange reaction of single-crystalline Ge-Si core-shell nanowires and Al pads. This enables a self-aligned metallic contact formation to Ge segments beyond lithographic limitations as well as ultrathin semiconducting layers wrapped around monocrystalline Al core nanowires. High-resolution transmission electron microscopy, energy dispersive X-ray spectroscopy, and µ-Raman measurements proved the composition and perfect crystallinity of these metal-semiconductor nanowire heterostructures. This exemplary selective replacement of Ge by Al represents a general approach for the elaboration of radial and axial metal-semiconductor heterostructures in various Ge-semiconductor heterostructures.

Tuning Electroluminescence from a Plasmonic Cavity-Coupled Silicon Light Source.

The combination of Moore's law and Dennard's scaling rules have constituted the fundamental guidelines for the silicon-based semiconductor industry for decades. Furthermore, the enormous growth of global data volume has pushed the demand for complex and densely packed devices. In recent years, it has become clear that wired interconnects impose increasingly severe speed and power limitations onto integrated circuits as scaling slows toward a halt. To overcome these limitations, there is a clear need for optical data processing. Despite significant progress in the development of silicon photonics, light sources remain challenging owing to the indirect bandgap of group IV materials. It is therefore highly desirable to develop new concepts for a silicon light source that meets efficiency and footprint requirements similar to their electronic counterparts. Here, we demonstrate an electrically driven and tunable silicon light source by matching the resonant modes of a silver nanocavity with the hot luminescence spectrum of an avalanching p-n junction. The cavity significantly enhances phonon-assisted recombination of hot carriers by tailoring the local density of states at the size-tunable resonance. Such tunable nanoscale emitter may be of great interest for short-reach communications, microdisplays or lab-on-chip applications.

Intersubband absorption in GaN nanowire heterostructures at mid-infrared wavelengths.

In this paper, we study intersubband characteristics of GaN/AlN and GaN/Al0.4Ga0.6N heterostructures in GaN nanowires structurally designed to absorb in the mid-infrared wavelength region. Increasing the GaN well width from 1.5 to 5.7 nm leads to a red shift of the intersubband absorption from 1.4 to 3.4 µm. The red shift in larger quantum wells is amplified by the fact that one of the GaN/AlN heterointerfaces (corresponding to the growth of GaN on AlN) is not sharp but rather a graded alloy extending around 1.5-2 nm. Using AlGaN instead of AlN for the same barrier dimensions, we observe the effects of reduced polarization, which blue shifts the band-to-band transitions and red shifts the intersubband transitions. In heavily doped GaN/AlGaN nanowires, a broad absorption band is observed in the 4.5-6.4 µm spectral region.

Effect of doping on the intersubband absorption in Si- and Ge-doped GaN/AlN heterostructures.

In this paper, we study band-to-band and intersubband (ISB) characteristics of Si- and Ge-doped GaN/AlN heterostructures (planar and nanowires) structurally designed to absorb in the short-wavelength infrared region, particularly at 1.55 µm. Regarding the band-to-band properties, we discuss the variation of the screening of the internal electric field by free carriers, as a function of the doping density and well/nanodisk size. We observe that nanowire heterostructures consistently present longer photoluminescence decay times than their planar counterparts, which supports the existence of an in-plane piezoelectric field associated to the shear component of the strain tensor in the nanowire geometry. Regarding the ISB characteristics, we report absorption covering 1.45-1.75 µm using Ge-doped quantum wells, with comparable performance to Si-doped planar heterostructures. We also report similar ISB absorption in Si- and Ge-doped nanowire heterostructures indicating that the choice of dopant is not an intrinsic barrier for observing ISB phenomena. The spectral shift of the ISB absorption as a function of the doping concentration due to many body effects confirms that Si and Ge efficiently dope GaN/AlN nanowire heterostructures.

Determination of the Optimal Shell Thickness for Self-Catalyzed GaAs/AlGaAs Core-Shell Nanowires on Silicon.

We present a set of experimental results showing a combination of various effects, that is, surface recombination velocity, surface charge traps, strain, and structural defects, that govern the carrier dynamics of self-catalyzed GaAs/AlGaAs core-shell nanowires (NWs) grown on a Si(111) substrate by molecular beam epitaxy. Time-resolved photoluminescence of NW ensemble and spatially resolved cathodoluminescence of single NWs reveal that emission intensity, decay time, and carrier diffusion length of the GaAs NW core strongly depend on the AlGaAs shell thickness but in a nonmonotonic fashion. Although 7 nm AlGaAs shell can efficiently suppress the surface recombination velocity of the GaAs NW core, the influence of the surface charge traps and the strain between the core and the shell that redshift the luminescence of the GaAs NW core remain observable in the whole range of the shell thickness. In addition, the band bending effect induced by the surface charge traps can alter the scattering of the excess carriers inside the GaAs NW core at the core/shell interface. If the AlGaAs shell thickness is larger than 50 nm, the luminescence efficiency of the GaAs NW cores deteriorates, ascribed to defect formation inside the AlGaAs shell evidenced by transmission electron microscopy.

Quantitative Reconstructions of 3D Chemical Nanostructures in Nanowires.

Energy dispersive X-ray spectrometry is used to extract a quantitative 3D composition profile of heterostructured nanowires. The analysis of hypermaps recorded along a limited number of projections, with a preliminary calibration of the signal associated with each element, is compared to the intensity profiles calculated for a model structure with successive shells of circular, elliptic, or faceted cross sections. This discrete tomographic technique is applied to II-VI nanowires grown by molecular beam epitaxy, incorporating ZnTe and CdTe and their alloys with Mn and Mg, with typical size down to a few nanometers and Mn or Mg content as low as 10%.

Abrupt Schottky Junctions in Al/Ge Nanowire Heterostructures.

In this Letter we report on the exploration of axial metal/semiconductor (Al/Ge) nanowire heterostructures with abrupt interfaces. The formation process is enabled by a thermal induced exchange reaction between the vapor-liquid-solid grown Ge nanowire and Al contact pads due to the substantially different diffusion behavior of Ge in Al and vice versa. Temperature-dependent I-V measurements revealed the metallic properties of the crystalline Al nanowire segments with a maximum current carrying capacity of about 0.8 MA/cm(2). Transmission electron microscopy (TEM) characterization has confirmed both the composition and crystalline nature of the pure Al nanowire segments. A very sharp interface between the ⟨111⟩ oriented Ge nanowire and the reacted Al part was observed with a Schottky barrier height of 361 meV. To demonstrate the potential of this approach, a monolithic Al/Ge/Al heterostructure was used to fabricate a novel impact ionization device.

Structure and morphology in diffusion-driven growth of nanowires: the case of ZnTe.

Gold-catalyzed ZnTe nanowires were grown at low temperature by molecular beam epitaxy on a ZnTe(111) B buffer layer, under different II/VI flux ratios, including with CdTe insertions. High-resolution electron microscopy and energy-dispersive X-ray spectroscopy (EDX) gave information about the crystal structure, polarity, and growth mechanisms. We observe, under stoichiometric conditions, the simultaneous presence of zinc-blende and wurtzite nanowires spread homogeneously on the same sample. Wurtzite nanowires are cylinder-shaped with a pyramidal-structured base. Zinc-blende nanowires are cone-shaped with a crater at their base. Both nanowires and substrate show a Te-ended polarity. Te-rich conditions favor zinc-blende nanowires, while Zn-rich suppress nanowire growth. Using a diffusion-driven growth model, we present a criterion for the existence of a crater or a pyramid at the base of the nanowires. The difference in nanowire morphology indicates lateral growth only for zinc-blende nanowires. The role of the direct impinging flux on the nanowire's sidewall is discussed.

The metabolic response of cultured tomato cells to low oxygen stress.

The storage of fruits and vegetables under a controlled atmosphere can induce low oxygen stress, which can lead to post-harvest losses through the induction of disorders such as core breakdown and browning. To gain better understanding of the metabolic response of plant organs to low oxygen, cultured tomato cells (Lycopersicum esculentum) were used as a model system to study the metabolic stress response to low oxygen (0 and 1 kPa O2). By adding 13C labelled glucose, changes in the levels of polar metabolites and their 13C label accumulation were quantified. Low oxygen stress altered the metabolite profile of tomato cells, with the accumulation of the intermediates of glycolysis in addition to increases in lactate and sugar alcohols. 13C label data showed reduced label accumulation in almost all metabolites except lactate and some sugar alcohols. The results showed that low oxygen stress in tomato cell culture activated fermentative metabolism and sugar alcohol synthesis while inhibiting the activity of the TCA cycle and the biosynthesis of metabolites whose precursors are derived from central metabolism, including fluxes to most organic acids, amino acids and sugars.

Correlation of polarity and crystal structure with optoelectronic and transport properties of GaN/AlN/GaN nanowire sensors.

GaN nanowires (NWs) with an AlN insertion were studied by correlated optoelectronic and aberration-corrected scanning transmission electron microscopy (STEM) characterization on the same single NW. Using aberration-corrected annular bright field and high angle annular dark field STEM, we identify the NW growth axis to be the N-polar [000-1] direction. The electrical transport characteristics of the NWs are explained by the polarization-induced asymmetric potential profile and by the presence of an AlN/GaN shell around the GaN base of the wire. The AlN insertion blocks the electron flow through the GaN core, confining the current to the radial GaN outer shell, close to the NW sidewalls, which increases the sensitivity of the photocurrent to the environment and in particular to the presence of oxygen. The desorption of oxygen adatoms in vacuum leads to a reduction of the nonradiative surface trap density, increasing both dark current and photocurrent.

Ultrafast room temperature single-photon source from nanowire-quantum dots.

Epitaxial semiconductor quantum dots are particularly promising as realistic single-photon sources for their compatibility with manufacturing techniques and possibility to be implemented in compact devices. Here, we demonstrate for the first time single-photon emission up to room temperature from an epitaxial quantum dot inserted in a nanowire, namely a CdSe slice in a ZnSe nanowire. The exciton and biexciton lines can still be resolved at room temperature and the biexciton turns out to be the most appropriate transition for single-photon emission due to a large nonradiative decay of the bright exciton to dark exciton states. With an intrinsically short radiative decay time (≈300 ps) this system is the fastest room temperature single-photon emitter, allowing potentially gigahertz repetition rates.

Effect of HCl on the doping and shape control of silicon nanowires.

The introduction of hydrogen chloride during the in situ doping of silicon nanowires (SiNWs) grown using the vapor-liquid-solid (VLS) mechanism was investigated. Compared with non-chlorinated atmospheres, the use of HCl with dopant gases considerably improves the surface morphology of the SiNWs, leading to extremely smooth surfaces and a greatly reduced tapering. Variations in the wire diameter are massively reduced for boron doping, and cannot be measured at 600 °C for phosphorous over several tens of micrometers. This remarkable feature is accompanied by a frozen gold migration from the catalyst, with no noticeable levels of gold clusters observed using scanning electron microscopy. A detailed study of the apparent resistivity of the NWs reveals that the dopant incorporation is effective for both types of doping. A graph linking the apparent resistivity to the dopant to silane dilution ratio is built for both types of doping and discussed in the frame of the previous results.