Association Between Partial Pressure of Arterial Carbon Dioxide and Survival to Hospital Discharge Among Patients Diagnosed With Sepsis in the Emergency Department.

OBJECTIVE: The objective of this study was to test the association between the partial pressure of arterial carbon dioxide and survival to hospital discharge among mechanically ventilated patients diagnosed with sepsis in the emergency department. DESIGN: Retrospective cohort study of a single center trial registry. SETTING: Academic medical center. PATIENTS: Mechanically ventilated emergency department patients. INCLUSION CRITERIA: age 18 years and older, diagnosed with sepsis in the emergency department, and mechanical ventilation initiated in the emergency department. INTERVENTIONS: Arterial blood gases obtained after initiation of mechanical ventilation were analyzed. The primary outcome was survival to hospital discharge. We tested the association between partial pressure of arterial carbon dioxide and survival using multivariable logistic regression adjusting for potential confounders. Sensitivity analyses, including propensity score matching were also performed. MEASUREMENTS AND MAIN RESULTS: Six hundred subjects were included, and 429 (72%) survived to hospital discharge. The median (interquartile range) partial pressure of arterial carbon dioxide was 42 (34-53) mm Hg for the entire cohort and 44 (35-57) and 39 (31-45) mm Hg among survivors and nonsurvivors, respectively (p < 0.0001 Wilcox rank-sum test). On multivariable analysis, a 1 mm Hg rise in partial pressure of arterial carbon dioxide was associated with a 3% increase in odds of survival (adjusted odds ratio, 1.03; 95% CI, 1.01-1.04) after adjusting for tidal volume and other potential confounders. These results remained significant on all sensitivity analyses. CONCLUSION: In this sample of mechanically ventilated sepsis patients, we found an association between increasing levels of partial pressure of arterial carbon dioxide and survival to hospital discharge. These findings justify future studies to determine the optimal target partial pressure of arterial carbon dioxide range for mechanically ventilated sepsis patients.

A Quasi-Experimental, Before-After Trial Examining the Impact of an Emergency Department Mechanical Ventilator Protocol on Clinical Outcomes and Lung-Protective Ventilation in Acute Respiratory Distress Syndrome.

OBJECTIVES: To evaluate the impact of an emergency department mechanical ventilation protocol on clinical outcomes and adherence to lung-protective ventilation in patients with acute respiratory distress syndrome. DESIGN: Quasi-experimental, before-after trial. SETTING: Emergency department and ICUs of an academic center. PATIENTS: Mechanically ventilated emergency department patients experiencing acute respiratory distress syndrome while in the emergency department or after admission to the ICU. INTERVENTIONS: An emergency department ventilator protocol which targeted variables in need of quality improvement, as identified by prior work: 1) lung-protective tidal volume, 2) appropriate setting of positive end-expiratory pressure, 3) oxygen weaning, and 4) head-of-bed elevation. MEASUREMENTS AND MAIN RESULTS: A total of 229 patients (186 preintervention group, 43 intervention group) were studied. In the emergency department, the intervention was associated with significant changes (p < 0.01 for all) in tidal volume, positive end-expiratory pressure, respiratory rate, oxygen administration, and head-of-bed elevation. There was a reduction in emergency department tidal volume from 8.1 mL/kg predicted body weight (7.0-9.1) to 6.4 mL/kg predicted body weight (6.1-6.7) and an increase in lung-protective ventilation from 11.1% to 61.5%, p value of less than 0.01. The intervention was associated with a reduction in mortality from 54.8% to 39.5% (odds ratio, 0.38; 95% CI, 0.17-0.83; p = 0.02) and a 3.9 day increase in ventilator-free days, p value equals to 0.01. CONCLUSIONS: This before-after study of mechanically ventilated patients with acute respiratory distress syndrome demonstrates that implementing a mechanical ventilator protocol in the emergency department is feasible and associated with improved clinical outcomes.

Lung-Protective Ventilation Initiated in the Emergency Department (LOV-ED): A Quasi-Experimental, Before-After Trial.

STUDY OBJECTIVE: We evaluated the efficacy of an emergency department (ED)-based lung-protective mechanical ventilation protocol for the prevention of pulmonary complications. METHODS: This was a quasi-experimental, before-after study that consisted of a preintervention period, a run-in period of approximately 6 months, and a prospective intervention period. The intervention was a multifaceted ED-based mechanical ventilator protocol targeting lung-protective tidal volume, appropriate setting of positive end-expiratory pressure, rapid oxygen weaning, and head-of-bed elevation. A propensity score-matched analysis was used to evaluate the primary outcome, which was the composite incidence of acute respiratory distress syndrome and ventilator-associated conditions. RESULTS: A total of 1,192 patients in the preintervention group and 513 patients in the intervention group were included. Lung-protective ventilation increased by 48.4% in the intervention group. In the propensity score-matched analysis (n=490 in each group), the primary outcome occurred in 71 patients (14.5%) in the preintervention group compared with 36 patients (7.4%) in the intervention group (adjusted odds ratio 0.47; 95% confidence interval [CI] 0.31 to 0.71). There was an increase in ventilator-free days (mean difference 3.7; 95% CI 2.3 to 5.1), ICU-free days (mean difference 2.4; 95% CI 1.0 to 3.7), and hospital-free days (mean difference 2.4; 95% CI 1.2 to 3.6) associated with the intervention. The mortality rate was 34.1% in the preintervention group and 19.6% in the intervention group (adjusted odds ratio 0.47; 95% CI 0.35 to 0.63). CONCLUSION: Implementing a mechanical ventilator protocol in the ED is feasible and is associated with significant improvements in the delivery of safe mechanical ventilation and clinical outcome.

Genome Modeling System: A Knowledge Management Platform for Genomics.

In this work, we present the Genome Modeling System (GMS), an analysis information management system capable of executing automated genome analysis pipelines at a massive scale. The GMS framework provides detailed tracking of samples and data coupled with reliable and repeatable analysis pipelines. The GMS also serves as a platform for bioinformatics development, allowing a large team to collaborate on data analysis, or an individual researcher to leverage the work of others effectively within its data management system. Rather than separating ad-hoc analysis from rigorous, reproducible pipelines, the GMS promotes systematic integration between the two. As a demonstration of the GMS, we performed an integrated analysis of whole genome, exome and transcriptome sequencing data from a breast cancer cell line (HCC1395) and matched lymphoblastoid line (HCC1395BL). These data are available for users to test the software, complete tutorials and develop novel GMS pipeline configurations. The GMS is available at https://github.com/genome/gms.

Optical, Structural, and Synchrotron X-ray Absorption Studies for GaN Thin Films Grown on Si by Molecular Beam Epitaxy.

GaN on Si plays an important role in the integration and promotion of GaN-based wide-gap materials with Si-based integrated circuits (IC) technology. A series of GaN film materials were grown on Si (111) substrate using a unique plasma assistant molecular beam epitaxy (PA-MBE) technology and investigated using multiple characterization techniques of Nomarski microscopy (NM), high-resolution X-ray diffraction (HR-XRD), variable angular spectroscopic ellipsometry (VASE), Raman scattering, photoluminescence (PL), and synchrotron radiation (SR) near-edge X-ray absorption fine structure (NEXAFS) spectroscopy. NM confirmed crack-free wurtzite (w-) GaN thin films in a large range of 180-1500 nm. XRD identified the w- single crystalline structure for these GaN films with the orientation along the c-axis in the normal growth direction. An optimized 700 °C growth temperature, plus other corresponding parameters, was obtained for the PA-MBE growth of GaN on Si, exhibiting strong PL emission, narrow/strong Raman phonon modes, XRD w-GaN peaks, and high crystalline perfection. VASE studies identified this set of MBE-grown GaN/Si as having very low Urbach energy of about 18 meV. UV (325 nm)-excited Raman spectra of GaN/Si samples exhibited the GaN E2(low) and E2(high) phonon modes clearly without Raman features from the Si substrate, overcoming the difficulties from visible (532 nm) Raman measurements with strong Si Raman features overwhelming the GaN signals. The combined UV excitation Raman-PL spectra revealed multiple LO phonons spread over the GaN fundamental band edge emission PL band due to the outgoing resonance effect. Calculation of the UV Raman spectra determined the carrier concentrations with excellent values. Angular-dependent NEXAFS on Ga K-edge revealed the significant anisotropy of the conduction band of w-GaN and identified the NEXAFS resonances corresponding to different final states in the hexagonal GaN films on Si. Comparative GaN material properties are investigated in depth.

Structural, Surface and Optical Studies of m- and c-Face AlN Crystals Grown by Physical Vapor Transport Method.

Bulk aluminum nitride (AlN) crystals with different polarities were grown by physical vapor transport (PVT). The structural, surface, and optical properties of m-plane and c-plane AlN crystals were comparatively studied by using high-resolution X-ray diffraction (HR-XRD), X-ray photoelectron spectroscopy (XPS), and Raman spectroscopy. Temperature-dependent Raman measurements showed that the Raman shift and the full width at half maximum (FWHM) of the E2 (high) phonon mode of the m-plane AlN crystal were larger than those of the c-plane AlN crystal, which would be correlated with the residual stress and defects in the AlN samples, respectively. Moreover, the phonon lifetime of the Raman-active modes largely decayed and its line width gradually broadened with the increase in temperature. The phonon lifetime of the Raman TO-phonon mode was changed less than that of the LO-phonon mode with temperature in the two crystals. It should be noted that the influence of inhomogeneous impurity phonon scattering on the phonon lifetime and the contribution to the Raman shift came from thermal expansion at a higher temperature. In addition, the trend of stress with increasing 1000/temperature was similar for the two AlN samples. As the temperature increased from 80 K to ~870 K, there was a temperature at which the biaxial stress of the samples transformed from compressive to tensile stress, while their certain temperature was different.

Optical and Structural Properties of Aluminum Nitride Epi-Films at Room and High Temperature.

The high-quality aluminum nitride (AlN) epilayer is the key factor that directly affects the performance of semiconductor deep-ultraviolet (DUV) photoelectronic devices. In this work, to investigate the influence of thickness on the quality of the AlN epilayer, two AlN-thick epi-film samples were grown on c-plane sapphire substrates. The optical and structural characteristics of AlN films are meticulously examined by using high-resolution X-ray diffraction (HR-XRD), scanning electron microscopy (SEM), a dual-beam ultraviolet-visible spectrophotometer, and spectroscopic ellipsometry (SE). It has been found that the quality of AlN can be controlled by adjusting the AlN film thickness. The phenomenon, in which the thicker AlNn film exhibits lower dislocations than the thinner one, demonstrates that thick AlN epitaxial samples can work as a strain relief layer and, in the meantime, help significantly bend the dislocations and decrease total dislocation density with the thicker epi-film. The Urbach's binding energy and optical bandgap (Eg) derived by optical transmission (OT) and SE depend on crystallite size, crystalline alignment, and film thickness, which are in good agreement with XRD and SEM results. It is concluded that under the treatment of thickening film, the essence of crystal quality is improved. The bandgap energies of AlN samples obtained from SE possess larger values and higher accuracy than those extracted from OT. The Bose-Einstein relation is used to demonstrate the bandgap variation with temperature, and it is indicated that the thermal stability of bandgap energy can be improved with an increase in film thickness. It is revealed that when the thickness increases to micrometer order, the thickness has little effect on the change of Eg with temperature.

Angle-Dependent Raman Scattering Studies on Anisotropic Properties of Crystalline Hexagonal 4H-SiC.

Raman scattering spectroscopy (RSS) has the merits of non-destructiveness, fast analysis, and identification of SiC polytype materials. By way of angle-dependent Raman scattering (ADRS), the isotropic characteristics are confirmed for c-face 4H-SiC, while the anisotropic properties of a-face 4H-SiC are revealed and studied in detail via combined experiments and theoretical calculation. The variation functional relationship of the angle between the incident laser polarization direction and the parallel (perpendicular) polarization direction was well established. The selection rules of wurtzite 4H-SiC are deduced, and the intensity variations of the A1, E2, and E1 Raman phonon modes dependent on the incident angle are calculated, and well-matched with experimental data. Raman tensor elements of various modes are determined.

Synthesis, Structural and Magnetic Properties of Cobalt-Doped GaN Nanowires on Si by Atmospheric Pressure Chemical Vapor Deposition.

GaN nanowires (NWs) grown on silicon via atmospheric pressure chemical vapor deposition were doped with Cobalt (Co) by ion implantation, with a high dose concentration of 4 × 1016 cm-2, corresponding to an average atomic percentage of ~3.85%, and annealed after the implantation. Co-doped GaN showed optimum structural properties when annealed at 700 °C for 6 min in NH3 ambience. From scanning electron microscopy, X-ray diffraction, high resolution transmission electron microscope, and energy dispersive X-ray spectroscopy measurements and analyses, the single crystalline nature of Co-GaN NWs was identified. Slight expansion in the lattice constant of Co-GaN NWs due to the implantation-induced stress effect was observed, which was recovered by thermal annealing. Co-GaN NWs exhibited ferromagnetism as per the superconducting quantum interference device (SQUID) measurement. Hysteretic curves with Hc (coercivity) of 502.5 Oe at 5 K and 201.3 Oe at 300 K were obtained. Applied with a magnetic field of 100 Oe, the transition point between paramagnetic property and ferromagnetic property was determined at 332 K. Interesting structural and conducive magnetic properties show the potential of Co-doped GaN nanowires for the next optoelectronic, electronic, spintronic, sensing, optical, and related applications.

Neutron detection performance of gallium nitride based semiconductors.

Neutron detection is crucial for particle physics experiments, nuclear power, space and international security. Solid state neutron detectors are of great interest due to their superior mechanical robustness, smaller size and lower voltage operation compared to gas detectors. Gallium nitride (GaN), a mature wide bandgap optoelectronic and electronic semiconductor, is attracting research interest for neutron detection due to its radiation hardness and thermal stability. This work investigated thermal neutron scintillation detectors composed of GaN thin films with and without conversion layers or rare-earth doping. Intrinsic GaN-based neutron scintillators are demonstrated via the intrinsic 14N(n, p) reaction, which has a small thermal neutron cross-section at low neutron energies, but is comparable to other reactions at high neutron energies (>1 MeV). Gamma discrimination is shown to be possible with pulse-height in intrinsic GaN-based scintillation detectors. Additionally, GaN-based scintillation detector with a 6LiF neutron conversion layer and Gd-doped GaN detector are compared with intrinsic GaN detectors. These results indicate GaN scintillator is a suitable candidate neutron detector in high-flux applications.

Strain-stress study of AlxGa1-xN/AlN heterostructures on c-plane sapphire and related optical properties.

This work presents a systematic study of stress and strain of AlxGa1-xN/AlN with composition ranging from GaN to AlN, grown on a c-plane sapphire by metal-organic chemical vapor deposition, using synchrotron radiation high-resolution X-ray diffraction and reciprocal space mapping. The c-plane of the AlxGa1-xN epitaxial layers exhibits compressive strain, while the a-plane exhibits tensile strain. The biaxial stress and strain are found to increase with increasing Al composition, although the lattice mismatch between the AlxGa1-xN and the buffer layer AlN gets smaller. A reduction in the lateral coherence lengths and an increase in the edge and screw dislocations are seen as the AlxGa1-xN composition is varied from GaN to AlN, exhibiting a clear dependence of the crystal properties of AlxGa1-xN on the Al content. The bandgap of the epitaxial layers is slightly lower than predicted value due to a larger tensile strain effect on the a-axis compared to the compressive strain on the c-axis. Raman characteristics of the AlxGa1-xN samples exhibit a shift in the phonon peaks with the Al composition. The effect of strain on the optical phonon energies of the epitaxial layers is also discussed.

N-Terminal pro-Brain Natriuretic Peptide and Associations With Brain Magnetic Resonance Imaging (MRI) Features in Middle Age: The CARDIA Brain MRI Study.

OBJECTIVE: As part of research on the heart-brain axis, we investigated the association of N-terminal pro-brain natriuretic peptide (NT-proBNP) with brain structure and function in a community-based cohort of middle-aged adults from the Brain Magnetic Resonance Imaging sub-study of the Coronary Artery Risk Development in Young Adults (CARDIA) Study. APPROACH AND RESULTS: In a cohort of 634 community-dwelling adults with a mean (range) age of 50.4 (46-52) years, we examined the cross-sectional association of NT-proBNP to total, gray (GM) and white matter (WM) volumes, abnormal WM load and WM integrity, and to cognitive function tests [the Digit Symbol Substitution Test (DSST), the Stroop test, and the Rey Auditory-Verbal Learning Test]. These associations were examined using linear regression models adjusted for demographic and cardiovascular risk factors and cardiac output. Higher NT-proBNP concentration was significantly associated with smaller GM volume (ß = -3.44; 95% CI = -5.32, -0.53; p = 0.003), even after additionally adjusting for cardiac output (ß = -2.93; 95% CI = -5.32, -0.53; p = 0.017). Higher NT-proBNP levels were also associated with lower DSST scores. NT-proBNP was not related to WM volume, WM integrity, or abnormal WM load. CONCLUSION: In this middle-aged cohort, subclinical levels of NT-proBNP were related to brain function and specifically to GM and not WM measures, extending similar findings in older cohorts. Further research is warranted into biomarkers of cardiac dysfunction as a target for early markers of a brain at risk.

Partial pressure of arterial carbon dioxide and survival to hospital discharge among patients requiring acute mechanical ventilation: A cohort study.

PURPOSE: To describe the prevalence of hypocapnia and hypercapnia during the earliest period of mechanical ventilation, and determine the association between PaCO2 and mortality. MATERIALS AND METHODS: A cohort study using an emergency department registry of mechanically ventilated patients. PaCO2 was categorized: hypocapnia (<35mmHg), normocapnia (35-45mmHg), and hypercapnia (>45mmHg). The primary outcome was survival to hospital discharge. RESULTS: A total of 1,491 patients were included. Hypocapnia occurred in 375 (25%) patients and hypercapnia in 569 (38%). Hypercapnia (85%) had higher survival rate compared to normocapnia (74%) and hypocapnia (66%), P<0.001. PaCO2 was an independent predictor of survival to hospital discharge [hypocapnia (aOR 0.65 (95% confidence interval [CI] 0.48-0.89), normocapnia (reference category), hypercapnia (aOR 1.83 (95% CI 1.32-2.54)]. Over ascending ranges of PaCO2, there was a linear trend of increasing survival up to a PaCO2 range of 66-75mmHg, which had the strongest survival association, aOR 3.18 (95% CI 1.35-7.50). CONCLUSIONS: Hypocapnia and hypercapnia occurred frequently after initiation of mechanical ventilation. Higher PaCO2 levels were associated with increased survival. These data provide rationale for a trial examining the optimal PaCO2 in the critically ill.

Device design and simulation for GaN based dual wavelength LEDs.

A comprehensive optical model for dual wavelength LEDs is developed using optical ray tracing programs. Optical dispersion of GaN, InGaN, and AlGaN is also included in this numerical model. The light extraction efficiency of LEDs can be calculated based on LED structure and material properties. Moreover, a LED device structure can be optimized to improve the light extraction efficiency.

Simultaneous detection of ultraviolet and infrared radiation in a single GaN/GaAlN heterojunction.

Results are presented for a dual-band detector that simultaneously detects UV radiation in the 250-360 nm and IR radiation in the 5-14 microm regions with near zero spectral cross talk. In this detector having separate UV- and IR-active regions with three contacts (one common contact for both regions) allows the separation of the UV and IR generated photocurrent components, identifying the relative strength of each component. This will be an important development in UV-IR dual-band applications such as fire-flame detection, solar astronomy, and military sensing, eliminating the difficulties of employing several individual detectors with separate electronics-cooling mechanisms.

GaN-based distributed Bragg reflector for high-brightness LED and solid-state lighting.

A comprehensive numerical model for distributed Bragg reflectors (DBRs) based on thin-film optics is developed. Detailed refractive-index calculations for GaN, AlN, AlGaN, and InGaN can also be included in this numerical model. This model can predict DBR performances for refractive-index variations, layer-thickness fluctuations, and the number of quarter-wave stack pairs in DBR as well different light polarizations.