Challenges for room temperature operation of electrically pumped GeSn lasers.

Recent demonstrations of room-temperature lasing in optically pumped GeSn show promise for future CMOS compatible lasers for Si-photonics applications. However, challenges remain for electrically pumped devices. Investigation of the processes that limit device performance is therefore vital in aiding the production of future commercial devices. In this work, a combined experimental and modelling approach is utilised to explore the dominant loss processes in current devices. By manipulating the band structure of functioning devices using high hydrostatic pressure techniques at low temperature, the dominant carrier recombination pathways are identified. This reveals that 93 ± 5% of the threshold current is attributable to defect-related recombination at a temperature, T = 85 K. Furthermore, carrier occupation of L-valley states (carrier leakage) is responsible for 1.1 ± 0.3% of the threshold current, but this sharply increases to 50% with a decrease of just 30 meV in the L- Γ separation energy. This indicates that thermal broadening of a similar order may reproduce these adverse effects, limiting device performance at higher temperatures. Temperature dependent calculations show that carrier occupation of indirect valley L-states strongly affects the transparency carrier density and is therefore very sensitive to the Sn composition, leading to an effective operational temperature range for given Sn compositions and strain values. Recommendations for future device designs are proposed based on band structure and growth optimisations.

Assessment of corticospinal excitability after traumatic spinal cord injury using MEP recruitment curves: a preliminary TMS study.

STUDY DESIGN: Transcranial magnetic stimulation study. OBJECTIVES: To further investigate the corticospinal excitability changes after spinal cord injury (SCI), as assessed by means of transcranial magnetic stimulation (TMS). SETTING: Merano (Italy) and Salzburg (Austria). METHODS: We studied resting motor threshold (RMT), motor evoked potential (MEP) amplitude and recruitment curve in five subjects with good recovery after traumatic incomplete cervical SCI. RESULTS: RMT did not differ significantly between patients and controls, whereas the slope of MEP recruitment curve was significantly increased in the patients. CONCLUSION: This abnormal finding may represent an adaptive response after SCI. The impaired ability of the motor cortex to generate proper voluntary movement may be compensated by increasing spinal excitability. The easily performed measurement of MEP recruitment curve may provide a useful additional tool to improve the assessment and monitoring of motor cortical function in subjects with SCI. Increasing our knowledge of the corticospinal excitability changes in the functional recovery after SCI may also support the development of effective therapeutic strategies.

Precision alignment of integrated optics in hybrid microsystems.

We achieve submicrometer precision in the integration of micro-optics with surface electrode ion traps. The high-precision alignment is accomplished using off-axis linear Fresnel zone plates (FZPs). Four pairs of FZPs are fabricated on the optics chip that contains the high numerical aperture microlens, a diffractive optical element (DOE). The four pairs of FZPs enable alignment in six translational and rotational degrees of freedom. Four corresponding alignment rulers are etched in the top metal layer of the ion trap, enabling quantification of misalignment. The integration of optics for efficient light delivery and the collection of fluorescence from trapped ions are key to achieving scalability in quantum information processing. An accurate and precise approach to the integration of DOEs advances the scalability of surface electrode ion traps and many other hybrid microsystems.

Thermodynamic scaling and the characteristic relaxation time at the phase transition of liquid crystals.

The longitudinal relaxation time tau of a series of alkyl-isothiocyanato-biphenyls (nBT) liquid crystals in the smectic E phase was measured as a function of temperature T and pressure P using dielectric spectroscopy. This relaxation time was found to become essentially constant, independent of T and P, at both the clearing point and the lower temperature crystalline transition. tau(T,P) could also be superposed as a function of the product TV(gamma), where V is the specific volume and gamma is a material constant. It then follows from the invariance of the relaxation time at the transition that the exponent gamma superposing tau(T,V) can be identified with the thermodynamic ratio Gamma=- partial differential log(T(c)) partial differential log(V(c)), where the subscript c denotes the value at the phase transition. Analysis of literature data on other liquid crystals shows that they likewise exhibit a constant tau at their phase transitions. Thus, there is a surprising relationship between the thermodynamic conditions defining the stability limits of a liquid crystalline phase and the dynamic properties reflected in the magnitude of the longitudinal relaxation time.

Variation in GH and IGF-I assays limits the applicability of international consensus criteria to local practice.

BACKGROUND: There is increasing reliance on consensus criteria for decision making. Recent criteria state that acromegaly is excluded by a nadir GH during an oral glucose tolerance test (OGTT) of < 1 microg/l and a normal level of IGF-I. OBJECTIVE: To study GH and IGF-I assay performance close to cut-off values for active acromegaly. DESIGN AND METHODS: Two serum samples known to give borderline results were sent to all centres participating in the UK National External Quality Assessment Service (NEQAS). Sample A was assigned to be a nadir during an OGTT and sent for GH assessment to 104 centres. Sample B, with a clinical scenario, was sent to 23 centres that measure IGF-I, and these centres were asked to measure IGF-I, interpret the result and provide the source of their reference ranges (RRs). RESULTS: For sample A, the median GH was 2.6 mU/l (range 1.04-3.5 mU/l). Applying a conversion factor (CF) of 2.0 (1 microg/l = 2 mU/l), the most negatively biased method classified 10% of the values consistent with acromegaly, while the most positively biased method classified all values as consistent with the diagnosis. Applying a CF of 3.0 (1 microg/l = 3 mU/l), only 11% of results were consistent with acromegaly. For sample B, the median IGF-I was 50.8 nmol/l (range 24.3-60.9 nmol/l). All centres used age-related RRs. There was a 50% variation in the upper limit of the RRs between centres. Overall, 30% of the IGF-I results were against the diagnosis. There was little agreement in the RRs quoted by centres using the same method. CONCLUSION: Variability in assay performance, coupled with use of inappropriate CFs and RRs, undermines the applicability of international consensus criteria to local practice.

Standardization of FSH, LH and hCG--current position and future prospects.

Gonadotropin measurements contribute significantly to patient management in both endocrinology and oncology. Differences in calibration, antibody specificities and assay design mean that gonadotropin results obtained in different methods are still not comparable. Comparing patient results obtained in different methods therefore remains problematic, whether for individual patient care, when assessing the results of multicentre clinical trials, or when formulating national and international guidelines and recommendations. Achieving improved comparability of results for these important analytes will require clear descriptive nomenclature, accurate calibration with highly purified standards, careful characterization of what gonadotropin isoforms methods are measuring, broad recommendations about the most clinically appropriate antibody combinations, and increased awareness of clinically relevant interferences and the action required to minimise their effect. Encouraging manufacturers to standardize and carefully describe the evaluation methods they use, such that data from different manufacturers can readily be compared, is also a pre-requisite for future progress.

Macroprolactin(s): composition and reactivity in immunoassays and laboratory interpretation of results of an unusual patient serum.

BACKGROUND: Macroprolactin is a high molecular mass complex of prolactin that may be the cause of elevated serum prolactin as determined by immunoassay. The composition of macroprolactin and its reactivity in immunoassays are variable but the complex has minimal bioactivity in vivo. Hyperprolactinaemia due to unrecognized macroprolactinaemia can lead to misdiagnosis and mistreatment. METHODS: Serum from a patient with an unusual pattern of immunoreactivity was distributed to three users of each of the most popular immunoassays represented in the UK National External Quality Assessment Scheme (NEQAS) for prolactin. Clinical details were provided and participating centres were invited to investigate the prolactin content of the specimen according to their local protocol, and to comment on their results. The nature of the macroprolactin in the specimen was investigated in detail by gel filtration chromatography of the native serum and of the serum after adsorption of IgG with protein A, and by affinity chromatography with concanavalin A. RESULTS: Gel filtration studies revealed two peaks of macroprolactin in this serum. These macroprolactins were shown to be different in their IgG content and degree of glycosylation. All eight immunoassays reacted strongly with the macroprolactin present. The majority (78%) of centres that interpreted their results either demonstrated the presence of macroprolactin in the specimen, or suggested it as a likely cause of the hyperprolactinaemia. However, two centres inappropriately excluded macroprolactinaemia as the cause of the elevated prolactin, and a further two did not consider it at all. Data from previous UK NEQAS distributions (between 1996 and 2003) of macroprolactin containing sera are presented which suggest that the frequency of recognition of macroprolactin as a possible cause of hyperprolactinaemia has increased over time. CONCLUSIONS: Very high molecular mass forms of prolactin and the presence of multiple molecular mass forms, as detected in the case presented here, are uncommon. Also, the pattern of immunoreactivity reported in this specimen was unusual as most macroprolactins studied previously react less strongly in, for example, the Bayer ADVIA Centaur assay compared to the Roche E170 assay. Both peaks of macroprolactin in this serum reacted in all assays tested. This case highlights the variable nature and immunoreactive behaviour of macroprolactin species.

Macroprolactin; high molecular mass forms of circulating prolactin.

Two high molecular mass forms of prolactin (PRL) in serum have been identified by gel filtration chromatography (GFC): macroprolactin (big-big PRL, > 100 kDa) and big PRL (40-60 kDa). Macroprolactin has a variable composition and structure, but is most frequently a complex of PRL and IgG, with a molecular mass of 150-170 kDa. It is formed in the circulation following pituitary secretion of monomeric PRL but has a longer half-life, and the PRL in the complex remains reactive to a variable extent in immunoassays. In the majority of subjects little or no macroprolactin can be detected in serum, but in some individuals it may be the predominant immunoreactive component of circulating PRL and the cause of apparent hyperprolactinaemia. Owing to its high molecular mass, macroprolactin appears to be confined to the intravascular compartment and much evidence indicates that it has minimal bioactivity in vivo and is not of pathological significance. Nevertheless, hyperprolactinaemia due to macroprolactin can lead to diagnostic confusion and unnecessary further investigation and treatment if it is not recognized as such. Macroprolactin is a common cause of apparent hyperprolactinaemia with some assays and it is essential that laboratories introduce screening programmes to examine samples with elevated total immunoreactive PRL for the presence of macroprolactin and determine the monomeric PRL component which is known to be bioactive in vivo. A number of screening tests have been described; that based on the precipitation of macroprolactin with polyethylene glycol has been the most widely validated and applied. The reference technique of GFC should be available for confirmation and further investigation of samples, giving equivocal results in screening tests. In comparison with macroprolactin, little is known about big PRL. It is a more consistent component of total serum PRL but rarely, if ever, the cause of hyperprolactinaemia. Further research is required into the nature of macroprolactin and big PRL, the relationships between high molecular mass forms of PRL, and their clinical significance.

Correlates of family burden under medicaid managed mental health care.

This study examined predictors of family burden (assistance in daily living, supervision, and subjective concern) for family members of Medicaid recipients with severe mental illness in two regions of Virginia. In the Richmond area, mental health services were provided on a no-risk fee-for-service basis, while in Tidewater these services were provided through a risk-based capitated contract with a managed care organization. No differences in family burden were attributable to the risk-based payment system. Predictors of increased family burden were (a) more reported client symptoms and disruptive behaviors, (b) status as a parent, and (c) living with the client.

Family physicians' role in recruitment of organ donors.

OBJECTIVE: To determine if family physicians can increase the commitment of patients to organ donation. DESIGN: Prospective, systematically randomized, cross-sectional study. SETTING: Family practice residency medical center associated with an urban, community-based teaching institution. PATIENTS: A total of 300 patients aged 18 years or older, able to give consent, and being seen for non-life-threatening visits; 247 patients returned valid second questionnaires. INTERVENTIONS: Instruments included 2 self-administered questionnaires. All patients received questionnaire 1 to be completed in the examination room. They also received an informational brochure, a Michigan Secretary of State driver's license sticker (donor sticker) and questionnaire 2. Group 1 received the written materials only. Group 2 received written materials plus a brief verbal discussion by the investigators following a standard protocol. Questionnaire 2 was to be completed and returned after the interventions. MAIN OUTCOME MEASURES: Self-reported completion of donor sticker was used to evaluate commitment to organ donation. Knowledge scores were summed for preintervention and postintervention means. RESULT: Thirty-three percent of patients had already committed to organ donation prior to the study. Of those not previously committed, 40% decided to do so after the interventions. There was no statistical difference in the recruitment of donors between the 2 intervention groups. Of new donors identified, 65% stated their decision was due to written materials provided, while 34% attributed this to discussion with a physician. Thirty-five percent of the family members made arrangements to donate their own organs after the discussion with the patient. There was a significant difference between mean pretest and posttest knowledge scores (10 questions; 7.9 vs 9.2; P<.01). CONCLUSION: Family physicians can increase the commitment to organ donation through a relatively simple intervention.

Comparing provider perceptions of access and utilization management in full-risk and no-risk Medicaid programs for adults with serious mental illness.

This article compares provider perceptions of access to services and utilization management (UM) procedures in two Medicaid programs in the same state: a full-risk capitated managed care (MC) program and a no-risk, fee-for-service (FFS) program. Survey data were obtained from 198 mental health clinicians and administrators. The only difference found between respondents in the FFS and MC sites was that outpatient providers in the MC site reported significantly lower levels of access to high-intensity services than did providers in the FFS site (p < .001). Respondents in the two sites reported similar attitudes toward UM procedures, including a strong preference for internal over external UM procedures. These findings support the conclusion that through diffusion of UM procedures, all care in the Medicaid program for persons with a serious mental illness is managed, regardless of risk arrangement. Implications for mental health services and further research are discussed.

Validation of target values in external quality assessment schemes for peptide hormones and tumour markers.

Consensus means are tacitly assumed to provide correct target values in many external quality assessment schemes EQAS for peptide hormones and tumour markers. We suggest, however, that such targets should not be used without some evidence of their validity. Comparison of the expected and found increments in the target value on adding known quantities of International Standards to serum pools can provide confirmation of the correctness of target values or, in some cases, identify clearly incorrect targets. Validation of targets is important if EQAS are to stimulate use of correctly calibrated assays, rather than those that simply agree with the most commonly used method(s).

External quality assessment of immunoassays of peptide hormones and tumour markers: principles and practice.

External quality assessment schemes (EQAS) have traditionally emphasised the achievement of between-laboratory consensus. Although this is important, the application of EQAS to relatively new and evolving techniques such as immunoassay calls for a wider and more searching remit if the goals of accurate assays, properly used, are to be achieved. This article outlines the principles of EQAS for peptide hormones and tumour markers, emphasising key aspects such as validation of target values, dependency of results on sample type, and assessment of method characteristics such as vulnerability to interfering factors. The latter are considered to be important as they can affect patient care more seriously than modest degrees of imprecision or inaccuracy. EQAS play a unique role in providing objective data on assays performed in many laboratories under routine conditions and the data they provide can guide improvement in diagnostic reagents and laboratory practice.