Moral injury syndrome (MIS) is a mental health (MH) problem that substantially affects resilience; the presence of MIS reduces responsiveness to psychotherapy and increases suicide risk. Evidence-based treatment for MIS is available; however, it often goes untreated. This project uses principles of the Consolidated Framework for Implementation Research (CFIR) to assess barriers and facilitators to the implementation of Building Spiritual Strength (BSS), a multi-disciplinary treatment for MIS. Interviews were conducted with chaplains and mental health providers who had completed BSS facilitator training at six sites in the VA. Data were analyzed using the Hamilton Rapid Turnaround method. Findings included multiple facilitators to the implementation of BSS, including its accessibility and appeal to VA chaplains; leadership by VA chaplains trained in the intervention; and effective collaboration between the chaplains and mental health providers. Barriers to the implementation of BSS included challenges in engaging mental health providers and incorporating them as group leaders, veterans' lack of familiarity with the group format of BSS, and the impact of the COVID-19 pandemic. Results highlight the need for increased trust and collaboration between VA chaplains and mental health providers in the implementation of BSS and treatment of MIS.
Skutterudite compounds have been studied as potential thermoelectric materials due to their high thermoelectric efficiency, which makes them attractive candidates for applications in thermoelectric power generation. In this study, the effects of double-filling on the thermoelectric properties of the CexYb0.2-xCo4Sb12 skutterudite material system were investigated through the process of melt spinning and spark plasma sintering (SPS). By replacing Yb with Ce, the carrier concentration was compensated for by the extra electron from Ce donors, leading to optimized electrical conductivity, Seebeck coefficient, and power factor of the CexYb0.2-xCo4Sb12 system. However, at high temperatures, the power factor showed a downturn due to bipolar conduction in the intrinsic conduction regime. The lattice thermal conductivity of the CexYb0.2-xCo4Sb12 skutterudite system was clearly suppressed in the range between 0.025 and 0.1 for Ce content, due to the introduction of the dual phonon scattering center from Ce and Yb fillers. The highest ZT value of 1.15 at 750 K was achieved for the Ce0.05Yb0.15Co4Sb12 sample. The thermoelectric properties could be further improved by controlling the secondary phase formation of CoSb2 in this double-filled skutterudite system.
In this study, we investigated the effect of the stacking order of metal precursors on the formation of volume defects, such as blisters and nanopores, in CZTSSe thin-film solar cells. We fabricated CZTSSe thin films using three types of metal-precursor combinations, namely, Zn/Cu/Sn/Mo, Cu/Zn/Sn/Mo, and Sn/Cu/Zn/Mo, and studied the blister formation. The blister-formation mechanism was based on the delamination model, taking into consideration the compressive stress and adhesion properties. A compressive stress could be induced during the preferential formation of a ZnSSe shell. Under this stress, the adhesion between the ZnSSe film and the Mo substrate could be maintained by the surface tension of a metallic liquid phase with good wettability, or by the functioning of ZnSSe pillars as anchors, depending on the type of metal precursor used. Additionally, the nanopore formation near the back-contact side was found to be induced by the columnar microstructure of the metal precursor with the Cu/Zn/Mo stacking order and its dezincification. Based on the two volume-defect-formation mechanisms proposed herein, further development of volume-defect-formation suppression technology is expected to be made.
The bevel structure of organic multilayers produced by finely controlled Ar gas cluster ion beam sputtering preserves both the molecular distribution and chemical states. Nevertheless, there is still an important question of whether this method can be applicable to organic multilayer structures composed of complex or ambiguous interfaces used in real organic optoelectronic devices. Herein, various bevel structures are fabricated from different types of organic semiconductors using a solution-based deposition technique: complicatedly intermixed electron-donor and electron-acceptor bulk heterojunction structure, thin film structure with an internal donor-acceptor concentration gradient, and multi-layered structure with more than three layers. For these organic material combinations listed above, the bevel structure is fabricated with finely tuned Ar gas cluster ion beam sputtering. The location-dependent X-ray photoelectron spectroscopy (XPS) results obtained for each bevel structure exactly correspond to the XPS depth profiles. This result demonstrates that the bevel structure analysis is a powerful method to distinguish subtle differences in chemical component distributions and chemical states of organic semiconductors even with complex or ambiguous interfaces. Ultimately, due to its reliability as verified by this study, the proposed bevel structure analysis is expected to greatly expand other analytical techniques with a limited spatial or depth resolution.
Facile strategies in flexible transparent conductive electrode materials that can sustain their electrical conductivities under 1 mm-scale radius of curvature are required for wider applications such as foldable devices. We propose a rational design as well as a fabrication process for a silver nanowire-based transparent conductive electrode with low sheet resistance and high transmittance even after prolonged cyclic bending. The electrode is fabricated on a poly(ethylene terephthalate) film through the hybridization of silver nanowires with silver nanoparticles-anchored RuO2 nanosheets. This hybridization significantly improves the performance of the silver nanowire network under severe bending strain and creates an electrically percolative structure between silver nanowires and RuO2 nanosheets in the presence of anchored silver nanoparticles on the surface of RuO2 nanosheets. The resistance change of this hybrid transparent conductive electrode is 8.8% after 200,000 bending cycles at a curvature radius of 1 mm, making it feasible for use in foldable devices.
The number of older adults admitted to nursing homes is steadily increasing, and the health management for them is a very important issue in Korean society. This study aimed to examine the effects of Yangsaeng (health management) therapy on physical health status, depression, life satisfaction, and Yangsaeng (health management) of Korean older adults in nursing homes. A quasi-experimental study design using a pretest-posttest control group was employed. Study participants were a total of 80 older adults (intervention: n = 40, control: n = 40) in a nursing home in Seoul, South Korea. Yangsaeng therapy as an intervention consisted of the Meridian therapy and Qi-gong therapy. Yangsaeng therapy was conducted for 50 min per one time, twice a week, and for 10 weeks. Measures were general characteristics of study participants, Cornell Medical Index, Geriatric Depression Scale, life satisfaction scale, and Yangsaeng scale. Data were collected from April 2018 to March 2019. There were statistically significant differences on physical health status, depression, life satisfaction, and Yangsaeng between the two groups. Yangsaeng therapy was an effective intervention for improving physical health status, life satisfaction, and Yangsaeng, and for decreasing depression of older adults in nursing homes. Health care providers need to pay attention to Yangsaeng therapy as a Korean traditional intervention method for the health management of the older adults residing in nursing homes.
Disease Management , Health Status , Nursing Homes , Aged , Female , Health Behavior , Humans , Male , Republic of Korea , Seoul , Skilled Nursing Facilities
In this study, a 5-nm thick Al2O3 layer was patterned onto the Mo electrode in the form of a dot to produce a local rear contact, which looked at the effects of this contact structure on Cu2ZnSn(S1-xSex)4 (CZTSSe) growth and solar cell devices. Mo was partially exposed through open holes having a square dot shape, and the closed-ratios of Al2O3 passivated areas were 56%, 75%, and 84%. The process of synthesizing CZTSSe is the same as that of the previous process showing 12.62% efficiency. When the 5-nm-Al2O3 dot patterning was applied to the Mo surface, we observed that the MoSSe formation was well suppressed under the area coated of 5-nm-Al2O3 film. The self-alignment phenomenon was observed in the back-contact area. CZTSSe was easily formed in the Mo-exposed area, while voids were formed near the Al2O3-coated area. The efficiency of the CZTSSe solar cell decreased when the Al2O3 passivated area increased. The exposure area and pitch of Mo, the collecting path of the hole, and the supplying path of Na seemed to be related to efficiency. Thus, it was suggested that the optimization of the Mo-exposed pattern and the additional Na supply are necessary to develop the optimum self-aligned CZTSSe light absorber.
In this study, to control the formation of non-uniformly distributed large voids and Cu-Sn alloy agglomeration, which leads to local compositional misfit and secondary phase formation, a SnS compound precursor was applied instead of metal Sn to avoid compositional non-uniformity. Using a Cu/Zn/SnS stacked precursor, a temperature tracking experiment was conducted to confirm the formation controllability of the void and the secondary phase. According to the results of this temperature-profile tracking experiment, it was confirmed that the large void was successfully controlled; however, an additional ZnSSe secondary phase layer was formed in the middle of the CZTSSe upper layer and small voids were distributed relatively uniformly in the bottom CZTSSe layer. An efficiency of approximately 8% was obtained when the Cu/Zn/SnS stacked precursor was used. The origins of the low short-circuit current and fill factor are posited to be caused by the increase of the energy bandgap of the CZTSSe layer due to the SnS precursor, the thin top CZTSSe layer (around 600 nm) of the triple CZTSSe layer, and the diffusion length extension of the minor carriers caused by bypassing the ZnSSe phase.
We prepared the hybrid conductor of the Ag nanowire (NW) network and irregularly patterned graphene (GP) mesh with enhanced optical transmittance (~98.5%) and mechano-electric stability (ΔR/Ro: ~42.4% at 200,000 (200k) cycles) under 6.7% strain. Irregularly patterned GP meshes were prepared with a bottom-side etching method using chemical etchant (HNO3). The GP mesh pattern was judiciously and easily tuned by the regulation of treatment time (0-180 min) and concentration (0-20 M) of chemical etchants. As-formed hybrid conductor of Ag NW and GP mesh exhibit enhanced/controllable electrical-optical properties and mechano-electric stabilities; hybrid conductor exhibits enhanced optical transmittance (TT = 98.5%) and improved conductivity (ΔRs: 22%) compared with that of a conventional hybrid conductor at similar TT. It is also noteworthy that our hybrid conductor shows far superior mechano-electric stability (ΔR/Ro: ~42.4% at 200k cycles; TT: ~98.5%) to that of controls (Ag NW (ΔR/Ro: ~293% at 200k cycles), Ag NW-pristine GP hybrid (ΔR/Ro: ~121% at 200k cycles)) ascribed to our unique hybrid structure.
Doping is known as an effective way to modify both electrical and thermal transport properties of thermoelectric alloys to enhance their energy conversion efficiency. In this project, we report the effect of Pd doping on the electrical and thermal properties of n-type Cu0.008Bi2Te2.7Se0.3 alloys. Pd doping was found to increase the electrical conductivity along with the electron carrier concentration. As a result, the effective mass and power factors also increased upon the Pd doping. While the bipolar thermal conductivity was reduced with the Pd doping due to the increased carrier concentration, the contribution of Pd to point defect phonon scattering on the lattice thermal conductivity was found to be very small. Consequently, Pd doping resulted in an enhanced thermoelectric figure of merit, zT, at a high temperature, due to the enhanced power factor and the reduced bipolar thermal conductivity.
When CZTSSe is synthesized using a metal precursor, large voids of nonuniform size form at Mo back contact side. Herein, we demonstrate that the voids and CZTSSe in the lower part of the CZTSSe double layer can be controlled by using an Al2O3-patterned Mo substrate. The CZTSSe in the lower part self-aligns on the Mo-exposed area, while the voids self-align on the Al2O3-coated area. The origin of the self-alignment is expected to be the difference in bonding characteristics between liquid Sn and the metal or oxide surface, e.g., Al2O3. Good wettability generally forms between nonreactive liquid metals and metal surfaces due to the strong metallic bonding. By contrast, poor wettability generally forms between nonreactive liquid metals and oxide surfaces due to the weak van der Waals bonding between the liquid metal and the oxide layer. When the patterning was added, the device efficiency tended to decrease from 8.6% to 10.5%.
For kesterite copper zinc tin sulfide/selenide (CZTSSe) solar cells to enter the market, in addition to efficiency improvements, the technological capability to produce flexible and large-area modules with homogeneous properties is necessary. Here, we report a greater than 10% efficiency for a cell area of approximately 0.5 cm2 and a greater than 8% efficiency for a cell area larger than 2 cm2 of certified flexible CZTSSe solar cells. By designing a thin and multi-layered precursor structure, the formation of defects and defect clusters, particularly tin-related donor defects, is controlled, and the open circuit voltage value is enhanced. Using statistical analysis, we verify that the cell-to-cell and within-cell uniformity characteristics are improved. This study reports the highest efficiency so far for flexible CZTSSe solar cells with small and large areas. These results also present methods for improving the efficiency and enlarging the cell area.
Metals/chemistry , Solar Energy , Spectrometry, X-Ray Emission
Recently, highly efficient CZTS solar cells using pure metal precursors have been reported, and our group created a cell with 12.6% efficiency, which is equivalent to the long-lasting world record of IBM. In this study, we report a new secondary phase formation mechanism in the back contact interface. Previously, CZTSSe decomposition with Mo has been proposed to explain the secondary phase and void formation in the Mo-back contact region. In our sulfo-selenization system, the formation of voids and secondary phases is well explained by the unique wetting properties of Mo and the liquid metal above the peritectic reaction (η-Cu6Sn5 â ε-Cu3Sn + liquid Sn) temperature. Good wetting between the liquid Sn and the Mo substrate was observed because of strong metallic bonding between the liquid metal and Mo layer. Thus, some ε-Cu3Sn and liquid Sn likely remained on the Mo layer during the sulfo-selenization process, and Cu-SSe and Cu-Sn-SSe phases formed on the Mo side. When bare soda lime glass (SLG) was used as a substrate, nonwetting adhesion was observed because of weak van der Walls interactions between the liquid metal and substrate. The Cu-Sn alloy did not remain on the SLG surface, and Cu-SSe and Cu-Sn-SSe phases were not observed after the final sulfo-selenization process. Additionally, Mo/SLG substrates coated with a thin Al2O3 layer (1-5 nm) were used to control secondary phase formation by changing the wetting properties between Mo and the liquid metal. A 1 nm Al2O3 layer was enough to control secondary phase formation at the CZTSSe/Mo and void/Mo interfaces, and a 2 nm Al2O3 layer was enough to perfectly control secondary phase formation at the Mo interface and Mo-SSe formation.
During the outbreak of Middle East respiratory syndrome coronavirus(MERS-CoV) in 2015, one hemodialysis patient was infected with MERS-CoV, and the remaining hemodialysis(HD) patients (n = 83) and medical staff (n = 12) had to undergo dialysis treatment in an isolated environment. This study was performed to investigate the effects of stress caused by dialysis treatment under isolation. Plasma samples from the HD patients and medical staff were collected at the time of isolation(M0), the following month(M1), and three months after isolation(M3). Parameters for stress included circulating cell-free genomic DNA(ccf-gDNA), circulating cell-free mitochondria DNA(ccf-mtDNA), and pentraxin-3(PTX-3). Decreased values of Hct, kt/v and ca x p were recovered after the end of two weeks of isolation. The levels of ccf-gDNA and ccf-mtDNA were the highest at M0 and decreased gradually in both HD patients and the medical staff. The normalization of ccf-gDNA and ccf-mtDNA was significantly delayed in HD patients compared with the response in the medical staff. PTX-3 increased only in HD patients and was highest at M0, and it then gradually decreased. Medical isolation and subnormal quality of care during the MERS outbreak caused extreme stress in HD patients. Plasma cell-free DNA and PTX-3 seems to be good indicators of stress and quality of care in HD patients.
Biomarkers/blood , Cell-Free Nucleic Acids/blood , Coronavirus Infections/blood , Coronavirus Infections/virology , DNA, Mitochondrial/blood , Middle East Respiratory Syndrome Coronavirus/pathogenicity , Adult , Cross Infection/blood , Cross Infection/virology , Disease Outbreaks , Female , Humans , Male , Middle Aged , Renal Dialysis/methods , Republic of Korea
Endocan is a water-soluble proteoglycan exclusively secreted by vascular endothelium. Endocan levels may be elevated in kidney transplant recipients experiencing antibody-mediated rejection (ABMR), which is characterized by vascular inflammation in transplanted kidney. We evaluated the clinical relevance of endocan as markers of microvascular inflammation in patients who underwent kidney transplantation. Plasma and urinary endocan levels were measured in 203 kidney transplant recipients and were compared across different etiologies of allograft dysfunction and various pathologic scores. Both plasma and urinary endocan levels were significantly higher in patients with acute ABMR than those in patients with normal pathology, acute tubular necrosis (ATN), acute pyelonephritis, BK virus associated nephropathy (BKVN), and T-cell mediated rejection (TCMR). Patients with chronic active ABMR also exhibited significantly higher plasma and urinary endocan levels than patients with long-term graft survival. Scores of glomerulitis and peritubular capillaritis, which are typical features of microvascular inflammation, were significantly elevated in patients with higher plasma and/or urinary endocan levels. Furthermore, plasma and urinary endocan levels could effectively discriminate ABMR from ATN, BKVN, and TCMR. Finally, patients exhibiting high urinary and plasma endocan levels in acute ABMR group showed significantly worse renal survival. Altogether, plasma and urinary endocan levels may serve as potential markers of microvascular inflammation in kidney transplant recipients.
Inflammation/immunology , Kidney Failure, Chronic/surgery , Kidney Transplantation , Microcirculation/immunology , Neoplasm Proteins/blood , Neoplasm Proteins/urine , Proteoglycans/blood , Proteoglycans/urine , Adult , Area Under Curve , Biopsy , Female , Graft Rejection , Humans , Male , Middle Aged , Necrosis , Polyomavirus Infections/metabolism , Pyelonephritis/immunology , ROC Curve , Retrospective Studies , T-Lymphocytes/cytology , Transplant Recipients , Treatment Outcome , Tumor Virus Infections/immunology
Exposure therapy for social anxiety disorder (SAD) utilizes fear extinction, a memory process enhanced by sleep. We investigated whether naps following exposure sessions might improve symptoms and biomarkers in response to social stress in adults undergoing 5-week exposure-based group SAD therapy. Thirty-two participants aged 18-39 (18 females) with SAD were randomized. Before and after treatment, participants completed the Liebowitz Social Anxiety Scale (LSAS) and underwent a Trier Social Stress Test with psychophysiological monitoring (mpTSST) that included skin conductance (SCL), electromyographic (EMG) and electrocardiographic recording, and an auditory startle procedure while anticipating the social stressor. At sessions 3 and 4, exposure was followed by either a 120-min polysomnographically monitored sleep opportunity (Nap, Nâ¯=â¯17) or wakefulness (Wake, Nâ¯=â¯15). Primary hypotheses about SAD symptom change (LSAS) and EMG blink-startle response failed to differ with naps, despite significant symptom improvement (LSAS) with therapy. Some secondary biomarkers, however, provided preliminary support for enhanced extinction learning with naps, with trend-level Time (pre-, post-treatment)â¯×â¯Arm interactions and significant reduction from pre- to post treatment in the Nap arm alone for mpTSST SCL and salivary cortisol rise. Because of the small sample size and limited sleep duration, additional well-powered studies with more robust sleep interventions are indicated.
Implosive Therapy/methods , Phobia, Social/therapy , Psychotherapy, Group/methods , Adolescent , Adult , Female , Humans , Hydrocortisone/metabolism , Male , Middle Aged , Phobia, Social/psychology , Polysomnography , Saliva/metabolism , Sleep/physiology , Treatment Outcome , Wakefulness/physiology , Young Adult
Authors report an effect of F substitution on layered SnSe2 through the successful synthesis of polycrystalline SnSe2-δF x (0.000 ≤ x ≤ 0.010) by solid-state reaction. Accompanied with density functional theory calculations, the blue shift of A1g peak in Raman spectra reveal that F- ions are substituted at Se vacancy sites as decreasing the reduced mass of vibrational mode associated with Sn-Se bonding. From the measurements of electrical parameters, conductivity as well as carrier concentration are governed by thermally activated behavior, while such behavior is suppressed in Hall mobility, which occurs as F ratio increases. Based on Arrhenius relation, it is found that the potential barrier height at the grain boundary is suppressed with increasing F amount, suggesting that the F- ion is a promising candidate for the grain boundary passivation in the two-dimensional dichalcogenide system.
BACKGROUND: Several epidemiologic studies have suggested that the urine sodium excretion (USE) can be estimated in lieu of performing 24-hour urine collection. However, this method has not been verified in patients with chronic kidney disease (CKD) or in an interventional study. The purpose of this study was to evaluate the usefulness of estimating USE in a prospective low-salt diet education cohort (ESPECIAL). METHODS: A new formula was developed on the basis of morning fasting urine samples from 228 CKD patients in the ESPECIAL cohort. This formula was compared to the previous four formulas in the prediction of 24-hour USE after treatment with olmesartan and low-salt diet education. RESULTS: Most previously reported formulas had low predictability of the measured USE based on the ESPECIAL cohort. Only the Tanaka formula showed a small but significant bias (9.8 mEq/day, P < 0.05) with a low correlation (r = 0.34). In contrast, a new formula showed improved bias (-0.1 mEq/day) and correlation (r = 0.569) at baseline. This formula demonstrated no significant bias (-1.2 mEq/day) with the same correlation (r = 0.571) after 8 weeks of treatment with olmesartan. Intensive low-salt diet education elicited a significant decrease in the measured USE. However, none of the formulas predicted this change in the measured urine sodium after diet adjustment. CONCLUSION: We developed a more reliable formula for estimating the USE in CKD patients. Although estimating USE is applicable in an interventional study, it may be unsuitable for estimating the change of individual sodium intake in a low-salt intervention study.
The electrical conductivity and Seebeck coefficient of RuO2 nanosheets are enhanced by metal nanoparticle doping using Ag-acetate solutions. In this study, RuO2 monolayer and bilayer nanosheets exfoliated from layered alkali metal ruthenates are transferred to Si substrates for device fabrication, and the temperature dependence of their conductivity and Seebeck coefficients is investigated. For pristine RuO2 nanosheets, the sign of the Seebeck coefficient changes with temperature from 350-450 K. This indicates that the dominant type of charge carrier is dependent on the temperature, and the RuO2 nanosheets show ambipolar carrier transport behavior. By contrast, the sign of the Seebeck coefficient for Ag nanoparticle-doped RuO2 nanosheets does not change with temperature, indicating that the extra charge carriers from metal nanoparticles promote n-type semiconductor behavior.
Urinary mRNA analysis with three-gene set (18S rRNA, CD3ε, and IP-10) has been suggested as a non-invasive biomarker of acute rejection (AR) in kidney transplant recipients using quantitative real-time PCR (qPCR). Application of droplet digital PCR (ddPCR), which has been suggested to provide higher sensitivity, accuracy, and absolute quantification without standard curves, could be a useful method for the quantifying low concentration of urinary mRNA. We investigated the urinary expression of these three genes in Korean patients with kidney transplantation and also evaluated the usefulness of ddPCR. 90 urine samples were collected at time of allograft biopsy in kidney recipients (n = 67) and from patients with stable renal function more than 10 years (n = 23). Absolute quantification with both PCR system showed significant higher mRNA levels of CD3ε and IP-10 in AR patients compared with stable transplants (STA), but there was no difference in 18S rRNA expression across the patient groups. To evaluate discrimination between AR and STA, ROC curve analyses of CTOT-4 formula yielded area under the curve values of 0.72 (95% CI 0.60-0.83) and 0.77 (95% CI 0.66-0.88) for qPCR and ddPCR, respectively. However, 18S normalization of absolute quantification and relative quantification with 18S showed better discrimination of AR from STA than those of the absolute method. Our data indicate that ddPCR system without standard curve would be useful to determine the absolute quantification of urinary mRNA from kidney transplant recipients. However, comparative method also could be useful and convenient in both qPCR and ddPCR analysis.
CD3 Complex/urine , Chemokine CXCL10/urine , Graft Rejection/diagnosis , Kidney Transplantation , RNA, Ribosomal, 18S/urine , Adult , Biomarkers/urine , Female , Graft Rejection/urine , Humans , Male , Middle Aged , RNA, Messenger/urine
