Perovskite-Based X-ray Detectors.

X-ray detection has widespread applications in medical diagnosis, non-destructive industrial radiography and safety inspection, and especially, medical diagnosis realized by medical X-ray detectors is presenting an increasing demand. Perovskite materials are excellent candidates for high-energy radiation detection based on their promising material properties such as excellent carrier transport capability and high effective atomic number. In this review paper, we introduce X-ray detectors using all kinds of halide perovskite materials along with various crystal structures and discuss their device performance in detail. Single-crystal perovskite was first fabricated as an active material for X-ray detectors, having excellent performance under X-ray illumination due to its superior photoelectric properties of X-ray attenuation with µm thickness. The X-ray detector based on inorganic perovskite shows good environmental stability and high X-ray sensitivity. Owing to anisotropic carrier transport capability, two-dimensional layered perovskites with a preferred orientation parallel to the substrate can effectively suppress the dark current of the device despite poor light response to X-rays, resulting in lower sensitivity for the device. Double perovskite applied for X-ray detectors shows better attenuation of X-rays due to the introduction of high-atomic-numbered elements. Additionally, its stable crystal structure can effectively lower the dark current of X-ray detectors. Environmentally friendly lead-free perovskite exhibits potential application in X-ray detectors by virtue of its high attenuation of X-rays. In the last section, we specifically introduce the up-scaling process technology for fabricating large-area and thick perovskite films for X-ray detectors, which is critical for the commercialization and mass production of perovskite-based X-ray detectors.

Visualization of Ion Migration in an Inorganic Mixed Halide Perovskite by One-Photon and Multiphoton Absorption: Effect of Guanidinium A-Site Cation Incorporation.

In this work, we present the ion migration of CsPbIBr2 under illumination and impede it by incorporating the large cations of guanidinium (GA). A series of "probe-set-probe" operations are applied to assess the photoluminescence (PL) behavior spectrally and spatially, which is correlated to the ion migration-induced phase separation, of CsPbIBr2 and GAxCs1-xPbIBr2 perovskites. The local lattice distortion introduced by GA could reduce the strain gradient in GAxCs1-xPbIBr2 to inhibit the ion migration, leading to a stable PL spectrum and enhanced device stability under light stimulation. A solar cell with an optimized stoichiometric composition of GA0.1Cs0.9PbIBr2 delivers comparable photovoltaic performance and improved stability compared to those of CsPbIBr2-based perovskite solar cells, retaining 80% of its initial power conversion efficiency after being continuously bathed in light for 8 h under ambient conditions without encapsulation, while the CsPbIBr2 counterpart shows an efficiency that is <30% of its initial value under the same test condition.

Automatic Inverse Design of High-Performance Beam-Steering Metasurfaces via Genetic-type Tree Optimization.

We introduce a genetic-type tree search (GTTS) algorithm combined with unsupervised clustering for the automatic inverse design of high-performance metasurfaces. With the proposed method, we realize highly directive beam-steering metasurfaces via the cooptimization of the amplitude and phase. In comparison with previous topology optimization approaches, the developed GTTS algorithm optimizes the organization of subwavelength nanoantennas and, thus, is applicable to the design of both passive and active metasurfaces. The optimized beam-steering metasurface specifically exhibits a nearly constant directivity when the steering angle varies from 5° to 30°. Furthermore, the optimized nonintuitive reflectance and phase profiles assist in achieving highly directive beam steering when the phase modulation range is <180°, which was previously challenging. Our approach can diminish the requirements of scattering light properties with substantially enhanced angular resolution of beam-steering metasurfaces, which enables the realization of high-performance metasurfaces that will be promising for a wide range of advanced nanophotonic applications.

Reduced nosocomial infection rate in a neonatal intensive care unit during a 4-year surveillance period.

BACKGROUND: Hospital-acquired infections are a leading cause of morbidity and mortality in neonatal intensive care units (NICU). The aim of the study was to investigate the change of nosocomial infection rate in a NICU during a 4-year surveillance period. METHODS: We investigated the changes in nosocomial infection rates, infection sites, and microorganism species in a NICU before and after the unit was moved to a new location, extending from November 2008 to October 2012.The new facility was opened on November 1, 2010 and the old NICU was closed on the same day. In the meantime, three catheter-based bundles were implemented in the new NICU and all intensive care units in our hospital due to the new policy. Data collection was performed by independent, experienced infection control nurses. RESULTS: A total of 512 neonates were admitted to the NICU and enrolled in this study. There were 242 infants who were admitted to the old NICU, and 270 infants in the new facility. During the study period, the rate of infection episodes decreased from 19.0% to 11.1% (P = 0.01). Additionally, the average hospital-acquired infection rate decreased from 6.26 cases per 1000 patient-days to 4.09 cases per 1000 patient-days (P = 0.03). The most common infection site was blood stream infection, which decreased from 8.3% to 3.7% (P = 0.03). The total catheter-related infection rates of the blood stream, lower respiratory tract, and urinary tract decreased from 13.6% to 5.9% (P = 0.003). Klebsiella pneumonia, E. coli, Methicillin-resistant Staphylococcus aureus (MRSA), and Coagulase-negative Staphylococci (CoNS) were the most frequently found pathogens in the old NICU, whereas MRSA, CoNS, E. faecalis, and A. baumannii were the most frequently found pathogens in the new NICU. CONCLUSION: The change in the environment and implementation of device bundles in the NICU might be associated with the nosocomial infection rate.

Extended-gate field-effect transistor packed in micro channel for glucose, urea and protein biomarker detection.

This study developed a packaging method to integrate the extended-gate field-effect transistor (EGFET) into a microfluidic chip as a biological sensor. In addition, we present two immobilization approaches for the bio-recognition that are appropriate to this chip, allowing it to measure the concentrations of hydrogen ions, glucose, urea, and specific proteins in a solution. Alginate-calcium microcubes were used to embed the enzymes and magnetic powder (enzyme carrier). When the sensing chip needs the enzyme for the catalytic reaction, the alginate microcubes containing the corresponding enzymes enter through the flow channel and are immobilized on the EGFET surface with an external magnet. High sensing performance of the chip is achieved, with 37.45 mV/mM for measuring hydrogen ions at pH 6-8 with a linearity of 0.9939, 7.00 mV/mM for measuring glucose with a linearity of 0.9962, and 8.01 mV/mM for measuring urea with a linearity of 0.9809. In addition, based on the principle of the immunoassay, the magnetic beads with the specific antibody were used to capture the target protein in the sample. Then, negatively charged DNA fragments bound to a secondary antibody were used to amplify the signal for EGFET measurement. The magnetic beads with completed immune response bonding were then fixed on the surface of the sensor by an external magnetic field. Therefore, the measured object can directly contact the sensor surface, and quantitative detection of the protein concentration can be achieved. Apolipoprotein A1 (APOA1) was detected as a target protein, with a minimum detection limit of approximately 12.5 ng/mL.

Quantiferon TB-Gold conversion can predict active tuberculosis development in elderly nursing home residents.

AIM: The study was carried out on elderly nursing home residents in Taiwan. We assessed whether the serial QuantiFERON-TB Gold (QFT-G) assay and serial tuberculin skin test (TST) were reliable tools to predict or exclude the development of active tuberculosis (TB). METHODS: This prospective observational cohort study involved non-bacillus Calmette-Guérin-vaccinated 259 elderly nursing home residents free of active TB at baseline. Of these, 147 were eligible for follow up. Participants underwent serial QFT-G and TST at baseline and 2-year follow up, and were monitored for active TB over 5 years. Agreement between QFT-G and TST, incidence rate ratio, positive predictive value, and negative predictive value for progression to active TB were measured. RESULTS: During 5-year follow up, three participants developed active TB. The agreement between these two tests was 54.13% (ĸ = 0.167, P = 0.001). The incidence rate ratio was 15.8 (P = 0.016) for the QFT-G-conversion group compared with the TST-positive group at baseline. Positive predictive value for QFT-G conversion groups was 25%. Negative predictive value was 100% for the TST-negative group at baseline. CONCLUSION: In the elderly nursing home residents, QFT-G conversion is a more reliable tool to predict the development of active TB. Meanwhile, TST is a valuable tool for predicting the chance of not developing active TB.

A reduction in anti-tuberculosis drug resistance after the implementation of the national "STOP TB" program in central Taiwan, 2003-2007.

The aim of this study was to determine the performance of the national "STOP TB" program in central Taiwan during 2003-2007 by examining trends in the combined drug resistance to first-line anti-tuberculosis (TB) drugs among clinical Mycobacterium tuberculosis isolates. Using 4,819 clinical M. tuberculosis isolates obtained from two mycobacteriology referral laboratories, the resistance to drugs was measured and analyzed along with the treatment outcomes in notified TB patients. The proportion of isolates showing total resistance and multidrug-resistant tuberculosis (MDR-TB) isolates were 17.7% and 3.67%, respectively. More number of MDR-TB isolates showed high-level resistance to isoniazid (84.18%) and streptomycin (SM) (30.51%); low-level resistance to ethambutol (EMB) (61.58%), SM (41.81%), and pyrazinamide (66.1%); and resistance to ofloxacin (30.4%). However, fewer isolates showed high-level resistance to EMB (19.77%), levofloxacin (17.9%), moxifloxacin (19.6%), kanamycin (8.9%), amikacin (8.9%), and capreomycin (8.9%). Of these MDR-TB isolates, 7.1% were extensively drug-resistant. Trends in combined drug resistance to all the first-line anti-TB drugs and the incidence of MDR-TB were stable during the 2 years (2003-2004) before the implementation of the national "STOP TB" program. After the "STOP TB" program, there were significant declines in the incidence of MDR-TB during 2005-2007 in central Taiwan as well as improved TB-treatment outcomes. Thus, the national "STOP TB" program had a significant positive impact on TB control in central Taiwan.

High efficacy of clofazimine and its synergistic effect with amikacin against rapidly growing mycobacteria.

The aim of this study was to determine whether clofazimine, dapsone and cycloserine may be suitable antimicrobial agents for the treatment of infections due to rapidly growing mycobacteria (RGM). The antimicrobial activity of the three drugs against 117 Mycobacterium abscessus isolates, 48 Mycobacterium fortuitum isolates and 20 Mycobacterium chelonae isolates was evaluated based on their broth microdilution minimal inhibitory concentrations (MICs) against the isolates. Clofazimine was highly efficacious against these RGM. The vast majority of M. abscessus, M. fortuitum and M. chelonae isolates (99.1%, 91.7% and 100%, respectively) had clofazimine MICs of

Microbiologic spectrum and susceptibility pattern of clinical isolates from the pediatric intensive care unit in a single medical center - 6 years' experience.

BACKGROUND AND PURPOSE: Nosocomial infection contributes to the morbidity and mortality of patients in hospital. Timely microbiologic surveillance and assessment of antimicrobial resistance is important for dealing with nosocomial infections. This retrospective review was conducted to evaluate the microbiologic spectrum and susceptibility pattern in the pediatric intensive care unit from 2001 to 2006. METHODS: The microbiologic data and antimicrobial susceptibility of all clinical isolates in the pediatric intensive care unit between 2001 and 2006 were reviewed. The incidence and distribution of nosocomial infections and the associated pathogens were also analyzed. RESULTS: 1163 clinical isolates were analyzed. The frequencies of Gram-positive and Gram-negative bacteria were 30.4% and 56.2%, respectively. Staphylococcus aureus was the most common isolate among the Gram-positive organisms, while Pseudomonas aeruginosa, Escherichia coli, and Klebsiella pneumoniae were the 3 leading Gram-negative isolates. The proportion of methicillin-resistant S. aureus (MRSA) to all S. aureus was 65.2%. Six vancomycin-resistant enterococci were isolated in 2003. Extended-spectrum beta-lactamase (ESBL)-producing K. pneumoniae accounted for 20% of K. pneumoniae isolates since 2005. Carbapenem-resistant P. aeruginosa accounted for 34% of P. aeruginosa isolates. The nosocomial infection rate was not reduced after moving to a new hospital building in 2003. Urinary tract infection (30.2%) was the most common nosocomial infection, followed by bloodstream infection (26.5%) and lower respiratory tract infection (25.3%). CONCLUSIONS: MRSA, carbapenem-resistant P. aeruginosa, and ESBL-producing K. pneumoniae were the major concerns in this study. Good hand hygiene and strict aseptic procedures remain the most important factors for infection control.

Nationwide surveillance of antimicrobial resistance among non-fermentative Gram-negative bacteria in Intensive Care Units in Taiwan: SMART programme data 2005.

A nationwide surveillance of the antimicrobial susceptibilities of glucose non-fermentative Gram-negative bacteria isolates was conducted from 1 September 2005 to 30 November 2005 in Taiwan. A total of 456 isolates were recovered from patients hospitalised in the Intensive Care Units (ICUs) of ten major teaching hospitals. Rates of resistant pathogens, such as ciprofloxacin-resistant Pseudomonas aeruginosa (19%) and imipenem-resistant Acinetobacter baumannii (25%), were higher than those reported in 2000 (8% and 22%, respectively). Increased rates of isolates with resistant phenotypes correlated with prolonged length of ICU stay (48h to 7 days) for ceftazidime-non-susceptible P. aeruginosa (20.0% and 29.7%, respectively), imipenem-non-susceptible P. aeruginosa (4.0% and 13.5%, respectively) and imipenem-non-susceptible A. baumannii (15.4% and 29.8%, respectively), but not for ciprofloxacin-resistant P. aeruginosa. Alarming rates of emergence of extensively drug-resistant (XDR) A. baumannii (15%) and XDR P. aeruginosa (1.8%) were found, particularly among those isolates that were not susceptible to tigecycline and colistin. Interhospital dissemination of some clones of XDR A. baumannii in different ICUs was also noted. This study illustrates the crucial nature of continuous nationwide surveillance of resistant pathogens and implementation of effective strategies for ICU infection control and antibiotic restriction.

Do serological tests provide adequate rapid diagnosis of Mycoplasma pneumoniae infection?

This study was designed to evaluate the serologic response to Mycoplasma pneumoniae infection. A total of 589 children < or =18 years (190 in the year 2004; 399 in 2005) and 2,073 adults > or = 18 years of age (980 in the year 2004; 1,093 in 2005) with respiratory symptoms underwent serological testing for M. pneumoniae infection. The tests included passive particle agglutination (PA) and enzyme-linked immunosorbent assay (ELISA). The seroprevalence rates of M. pneumoniae infection in the years 2004 and 2005 were 6.9 and 10.1%, respectively. The seropositivity rate was significantly higher in children (29.6% in 2005; 23.7% in 2004) than in adults (2.9% in 2005; 3.7% in 2004) (odds ratio, 8.138 in 2004; 13.923 in 2005; 95% confidence interval, 5.077-13.045 in 2004; 9.220-21.026 in 2005). Paired sera for the PA test were obtained from 32 of 399 children, and 22 of them demonstrated at least fourfold rises in antibody titer. ELISA had a sensitivity of 77.3% and a specificity of 40.0%; PA had a sensitivity of 9.5% and a specificity of 80%. The ELISA test was superior to the PA test in diagnosing acute M. pneumoniae infection in children. Both tests were significantly more sensitive when they were performed 1 week after the onset of infection.

In vitro activities of various piperacillin and sulbactam combinations against bacterial pathogens isolated from Intensive Care Units in Taiwan: SMART 2004 programme data.

We investigated the in vitro activity of various piperacillin and sulbactam combinations against Gram-negative bacterial isolates from Intensive Care Units (ICUs) in Taiwan. Antimicrobial susceptibility testing of 1030 bacterial isolates recovered from ICUs of nine major teaching hospitals was performed using the agar dilution method. Sulbactam was added to piperacillin either at a fixed sulbactam concentration of 4 mg/L and 8 mg/L or at a piperacillin:sulbactam ratio of 2:1 and 4:1. Piperacillin/sulbactam at a ratio of 2:1 or a fixed 8 mg/L concentration of sulbactam had better activities against Escherichia coli, Klebsiella pneumoniae, Proteus mirabilis and Serratia marcescens than other piperacillin/sulbactam formulations. For Pseudomonas aeruginosa, piperacillin/sulbactam (2:1 or 4:1 ratios) had MIC(90) values (minimum inhibitory concentration for 90% of the organisms) of 64 mg/L (>90% susceptibility) compared with 64 mg/L for cefoperazone/sulbactam (68% susceptibility) and 128 mg/L for piperacillin/tazobactam (82% susceptibility). For Acinetobacter baumannii, both piperacillin/sulbactam (either 2:1 ratio or a fixed 8 mg/L sulbactam) and cefoperazone/sulbactam were the most potent agents. Adding sulbactam to piperacillin resulted in increased susceptibility rates among piperacillin-resistant P. aeruginosa (53-57% in either 2:1 or 4:1 ratios) and A. baumannii (38-46% in either 2:1 ratio or a fixed 8 mg/L concentration of sulbactam) isolates. Results of susceptibility tests with piperacillin/sulbactam are dependent on the method used. Piperacillin/sulbactam combinations possessed better in vitro activities than piperacillin alone or piperacillin/tazobactam against P. aeruginosa and A. baumannii.

Microfluidic pH-sensing chips integrated with pneumatic fluid-control devices.

This paper presents a microfluidic chip capable of performing precise continuous pH measurements in an automatic mode. The chip is fabricated using micro-electro-mechanical-systems (MEMS)-based techniques and incorporates polydimethylsiloxane (PDMS) microstructures, pH-sensing electrodes and pneumatic fluid-control devices. Through its enhanced microchannel design and use of pneumatic fluid-control devices, the microfluidic chip reduces the dead volume of the sample and increases the pumping rate. The maximum pumping rate of the developed micro-pump is 28 microL/min at an air pressure of 10 psi and a driving frequency of 10 Hz. The total sample volume consumed in each sensing operation is just 0.515 microL. As a result, the developed chip reduces the sample volume compared to conventional large-scale pH-sensing systems. The microfluidic chip employs the electrochemical sensing method to conduct precise pH level measurements. The sensing electrodes are fabricated by sputtering a layer of SiO(2)-LiO(2)-BaO-TiO(2)-La(2)O(3) (SLBTLO) onto platinum (Pt) electrodes and the pH value of the sample is evaluated by measuring the potential difference between the sensing electrodes and a reference electrode. Additionally, the integration of the microfluidic chip with a pneumatic fluid-control device facilitates automatic sample injection and a continuous sensing operation. The developed system provides a valuable tool with which to examine pH values in a wide range of biomedical and industrial applications.

Comparison of animal models with soft tissue infection by different bacilli.

In clinical medicine improved diagnostic methods for the detection of infection are needed. A good infectious animal model is very important for the development of a new diagnostic method or drug. The purpose of this study was to establish a good animal model with soft tissue infection. Twenty-four SD rats were divided into four groups (6 in each group). Various bacilli including Staphylococcus aureus (S. aureus), Streptococcus pneumoniae (S. pneumoniae), and Escherichia coli (E. coli) were injected intramuscularly into the left caudal thighs of three groups of rats to create soft tissue infection. In addition, normal saline was injected into the left caudal thighs of ten rats which were used as controls. Before and 48 hr after inoculation of the bacilli, a blood sample (0.5 ml) was taken from each rat and analyzed to determine the white blood cell count and differentiated cell count. In addition, 48 hr after the inoculation, 0.2 mCi of gallium-67 was injected via the tail vein. Gallium scan was performed at 24 hr and 48 hr after administration of the radiotracer. The dorsal view of both hind legs was imaged and analyzed by computers to calculate the lesion-to-normal (L/N) ratio. After imaging, all rats were sacrificed and specimens from portions of the infected thigh muscle were sent for histopathologic investigation to confirm the infection. The increase in both the WBC counts and the segmented polymorphonuclear leukocytes (PMNs) were most significant in the S. aureus group, followed by the S. pneumoniae group, E. coli group and normal control groups. The rats with S. aureus infection had significant gallium uptake at the site of infection and the highest L/N ratio of 2.14 on the 24-hr image and 2.0 on the 48-hr image. The rats with S. pneumoniae had the second highest L/N ratio (1.41 at 24 hr, and 1.48 at 48 hr). The L/N ratio for the E. coli group was 1.27 at 24 hr and 1.35 at 48 hr. No obviously abnormal gallium uptake was demonstrated in the normal controls. We conclude that all three bacilli induced a soft tissue infection in SD rats. S. aureus resulted in the most significant infectious signs.