Giant energy storage and power density negative capacitance superlattices.

Dielectric electrostatic capacitors1, because of their ultrafast charge-discharge, are desirable for high-power energy storage applications. Along with ultrafast operation, on-chip integration can enable miniaturized energy storage devices for emerging autonomous microelectronics and microsystems2-5. Moreover, state-of-the-art miniaturized electrochemical energy storage systems-microsupercapacitors and microbatteries-currently face safety, packaging, materials and microfabrication challenges preventing on-chip technological readiness2,3,6, leaving an opportunity for electrostatic microcapacitors. Here we report record-high electrostatic energy storage density (ESD) and power density, to our knowledge, in HfO2-ZrO2-based thin film microcapacitors integrated into silicon, through a three-pronged approach. First, to increase intrinsic energy storage, atomic-layer-deposited antiferroelectric HfO2-ZrO2 films are engineered near a field-driven ferroelectric phase transition to exhibit amplified charge storage by the negative capacitance effect7-12, which enhances volumetric ESD beyond the best-known back-end-of-the-line-compatible dielectrics (115 J cm-3) (ref. 13). Second, to increase total energy storage, antiferroelectric superlattice engineering14 scales the energy storage performance beyond the conventional thickness limitations of HfO2-ZrO2-based (anti)ferroelectricity15 (100-nm regime). Third, to increase the storage per footprint, the superlattices are conformally integrated into three-dimensional capacitors, which boosts the areal ESD nine times and the areal power density 170 times that of the best-known electrostatic capacitors: 80 mJ cm-2 and 300 kW cm-2, respectively. This simultaneous demonstration of ultrahigh energy density and power density overcomes the traditional capacity-speed trade-off across the electrostatic-electrochemical energy storage hierarchy1,16. Furthermore, the integration of ultrahigh-density and ultrafast-charging thin films within a back-end-of-the-line-compatible process enables monolithic integration of on-chip microcapacitors5, which can unlock substantial energy storage and power delivery performance for electronic microsystems17-19.

A novel artificial intelligence approach to detect the breast cancer using KNNet technique with EPM gene profiling.

Women's most frequent type of cancer is breast cancer, second only to lung cancer. This paper summarizes changes in genomics and epigenetics and incremental biological activities. A tumour develops through a series of phases involving a separate abnormal gene. Even though many diseases cause DNA mutations, most treatments are designed to relieve symptoms rather than change the DNA. Clustering short palindromic repeats (CRISPR) or Cas9 is the primary approach for discovering and confirming tumorigenic genomic targets. A Kohonen neural network with an expression programming model was developed for gene selection. The main problem in genetic selection is reducing the number of features chosen while maintaining accuracy. This purpose is accomplished systematically. In the end, the approach method performed better than the existing quantum squirrel-inspired algorithm and the recurrent neural network oppositional call search algorithm for genetic selection. The KNNet-EPM model used an expression programming approach to identify gene biomarkers for breast cancer. This method was achieved with RAE of 42%, sensitivity of 93%, f1 score of 88%, accuracy of 98%, kappa score of 83%, specificity of 92% and MAE of 30%.

Extremely large area (88 mm × 88 mm) superconducting integrated circuit (ELASIC).

Superconducting integrated circuit is a promising "beyond-CMOS" device technology enables speed-of-light, nearly lossless communications to advance cryogenic (4 K or lower) computing. However, the lack of large-area superconducting IC has hindered the development of scalable practical systems. Herein, we describe a novel approach to interconnect 16 high-resolution deep UV (DUV EX4, 248 nm lithography) full reticle circuits to fabricate an extremely large (88 mm × 88 mm) area superconducting integrated circuit (ELASIC). The fabrication process starts by interconnecting four high-resolution DUV EX4 (22 mm × 22 mm) full reticles using a single large-field (44 mm × 44 mm) I-line (365 nm lithography) reticle, followed by I-line reticle stitching at the boundaries of 44 mm × 44 mm fields to fabricate the complete ELASIC field (88 mm × 88 mm). The ELASIC demonstrated a 2X-12X reduction in circuit features and maintained high-stitched line superconducting critical currents. We examined quantum flux parametron circuits to demonstrate the viability of common active components used for data buffering and transmission. Considering that no stitching requirement for high-resolution EX4 DUV reticles is employed, the present fabrication process has the potential to advance the scaling of superconducting qubits and other tri-layer junction-based devices.

Ultrathin ferroic HfO2-ZrO2 superlattice gate stack for advanced transistors.

With the scaling of lateral dimensions in advanced transistors, an increased gate capacitance is desirable both to retain the control of the gate electrode over the channel and to reduce the operating voltage1. This led to a fundamental change in the gate stack in 2008, the incorporation of high-dielectric-constant HfO2 (ref. 2), which remains the material of choice to date. Here we report HfO2-ZrO2 superlattice heterostructures as a gate stack, stabilized with mixed ferroelectric-antiferroelectric order, directly integrated onto Si transistors, and scaled down to approximately 20 ångströms, the same gate oxide thickness required for high-performance transistors. The overall equivalent oxide thickness in metal-oxide-semiconductor capacitors is equivalent to an effective SiO2 thickness of approximately 6.5 ångströms. Such a low effective oxide thickness and the resulting large capacitance cannot be achieved in conventional HfO2-based high-dielectric-constant gate stacks without scavenging the interfacial SiO2, which has adverse effects on the electron transport and gate leakage current3. Accordingly, our gate stacks, which do not require such scavenging, provide substantially lower leakage current and no mobility degradation. This work demonstrates that ultrathin ferroic HfO2-ZrO2 multilayers, stabilized with competing ferroelectric-antiferroelectric order in the two-nanometre-thickness regime, provide a path towards advanced gate oxide stacks in electronic devices beyond conventional HfO2-based high-dielectric-constant materials.

Exploring indicators of extremity pain of spinal source as identified by Mechanical Diagnosis and Therapy (MDT): a secondary analysis of a prospective cohort study.

OBJECTIVE: To explore indicators that predict whether patients with extremity pain have a spinal or extremity source of pain. METHODS: The data were from a prospective cohort study (n = 369). Potential indicators were gathered from a typical Mechanical Diagnosis and Therapy (MDT) history and examination. A stepwise logistic regression with a backward elimination was performed to determine which indicators predict classification into spinal or extremity source groups. A Receiver Operating Characteristic (ROC) curve was constructed to examine the number of significant indicators that could predict group classification. RESULTS: Five indicators were identified to predict group classification. Classification into the spinal group was associated with the presence of paresthesia [odds ratio (OR) 1.984], change in symptoms with sitting/neck or trunk flexion/turning neck/when still (OR 2.642), change in symptoms with posture change (OR 3.956), restrictions in spinal movements (OR 2.633), and no restrictions in extremity movements (OR 2.241). The optimal number of indicators for classification was two (sensitivity = 0.638, specificity = 0.807). DISCUSSION: This study provides guidance on clinical indicators that predict the source of symptoms for isolated extremity pain. The clinical indicators will allow clinicians to supplement their decision-making process in regard to spinal and extremity differentiation so as to appropriately target their examinations and interventions.

A study exploring the prevalence of Extremity Pain of Spinal Source (EXPOSS).

OBJECTIVES: To investigate the proportion of patients that present with isolated extremity pain who have a spinal source of symptoms and evaluate the response to spinal intervention. METHODS: Participants (n = 369) presenting with isolated extremity pain and who believed that their pain was not originating from their spine, were assessed using a Mechanical Diagnosis and Therapy differentiation process. Numerical Pain Rating Scale, Upper Extremity/Lower Extremity Functional Index and the Orebro Questionnaire were collected at the initial visit and at discharge. Global Rating of Change outcomes were collected at discharge. Clinicians provided MDT 'treatment as usual'. A chi-square test examined the overall significance of the comparison within each region. Effect sizes between spinal and extremity source groups were calculated for the outcome scores at discharge. RESULTS: Overall, 43.5% of participants had a spinal source of symptoms. Effect sizes indicated that the spinal source group had improved outcomes at discharge for all outcomes compared to the extremity source group. DISCUSSION: Over 40% of patients with isolated extremity pain, who believed that their pain was not originating from the spine, responded to spinal intervention and thus were classified as having a spinal source of symptoms. These patients did significantly better than those whose extremity pain did not have a spinal source and were managed with local extremity interventions. The results suggest the spine is a common source of extremity pain and adequate screening is warranted to ensure the patients ́ source of symptoms is addressed.

Longitudinal Analysis of Real-World Performance of an Implantable Continuous Glucose Sensor over Multiple Sensor Insertion and Removal Cycles.

The Eversense® Continuous Glucose Monitoring (CGM) System, with the first long-term, implantable glucose sensor, has been commercially available in Europe and South Africa since 2016 for adults with diabetes. The performance of the sensor over multiple, sequential 90- or 180-day cycles from either real-world experience or clinical studies has not been previously published. The Eversense Data Management System (DMS) was used to evaluate the accuracy of General Data Protection Regulation (GDPR)-compliant sensor glucose (SG) values against self-monitoring of blood glucose (SMBG) from June 2016 through August 2019 among patients with at least four sensor cycles from European and South African health care practices. Mean SG and associated measures of variability, glucose management indicator (GMI), and percent and time in various hypoglycemic, euglycemic, and hyperglycemic ranges were calculated for the 24-h time period over each cycle. In addition, transmitter wear time was evaluated across each sensor wear cycle. Among the 945 users included in the analysis, the mean absolute relative difference (standard deviation [SD]) using 152,206, 174,645, 206,024, and 172,587 calibration matched pairs against SMBG was 11.9% (3.6%), 11.5% (4.0%), 11.8% (4.7%), and 11.5% (4.1%) during the first four sensor cycles, respectively. Mean values of the CGM metrics over the first sensor cycle were 156.5 mg/dL for SG, 54.7 mg/dL for SD, 0.35 for coefficient of variation, and 7.04% for GMI. Percent SG at different glycemic ranges was as follows: <54 mg/dL was 1.1% (16 min), <70 mg/dL was 4.6% (66 min), ≥70-180 mg/dL (time in range) was 64.5% (929 min), >180-250 mg/dL was 22.8% (328 min), and >250 mg/dL was 8.1% (117 min). The median transmitter wear time over the first cycle was 83.2%. CGM metrics and wear time were similar over the subsequent three cycles. This real-world evaluation of adult patients with diabetes using the Eversense CGM System in the home setting demonstrated that the implantable sensor provides consistent stable accuracy and CGM metrics over multiple, sequential sensor cycles with no indication of degradation of sensor performance.

Inter-rater reliability of the McKenzie System of Mechanical Diagnosis and Therapy in the examination of the knee.

OBJECTIVE: The McKenzie System of Mechanical Diagnosis and Therapy (MDT) is a widely used method of classification and management of musculoskeletal problems. Although MDT has been investigated for its reliability and efficacy in the management of spinal pain, few studies have evaluated the system when applying it to musculoskeletal problems in the extremities, in particular the knee. The purpose of this study was to investigate the inter-rater reliability of MDT when classifying clinical vignettes describing patients with musculoskeletal knee pain. METHODS: This study was divided into two phases. First, 10 clinicians experienced in the use of MDT were recruited to write a total of 60 clinical vignettes based upon the initial assessment of their past patients with knee pain. Second, six different MDT raters were recruited to rate 53 selected vignettes and reliability was determined using Fleiss Kappa. RESULTS: There was 'substantial agreement' among six MDT raters classifying the clinical vignettes into one of four categories (κ = 0.72). There was no statistically significant difference between therapists with different levels of training. DISCUSSION: MDT demonstrated acceptable reliability among trained raters to classify clinical vignettes describing patients with musculoskeletal knee pain. To generalize the use of the system to more users, future research should continue to investigate the reliability of MDT using raters with lower levels of training and experience and assess reliability in real patients. LEVEL OF EVIDENCE: 5.

Efficacy of exercise intervention as determined by the McKenzie System of Mechanical Diagnosis and Therapy for knee osteoarthritis: a randomized controlled trial.

STUDY DESIGN: Randomized controlled trial. Objectives To examine the efficacy of exercise intervention in patients with knee osteoarthritis (OA), as directed by Mechanical Diagnosis and Therapy (MDT) assessment, and, secondarily, to explore outcomes between MDT assessment-defined subgroups within the exercise group. BACKGROUND: Due to the high physical and economic burden of knee OA, the effectiveness of conservative interventions and determining those patients who will respond to them should be investigated. METHODS: Patients with knee OA (n = 180) were randomized to an exercise intervention group or a control group. The intervention group, in which patients classified as having knee derangements (MDT derangement) received MDT directional exercises and patients classified as nonresponders (MDT nonresponders) received evidence-based exercises, was compared to a control group that received no exercise intervention. Pain and function were assessed at baseline, 2 weeks, and 3 months, using the P4 pain scale and Knee injury and Osteoarthritis Outcome Score (KOOS) pain and function subscales. Two-way analysis of covariance was used to examine treatment and time effects. Multiple comparisons were examined, and mean differences with 95% confidence intervals (CIs) were reported. RESULTS: The exercise intervention group had significantly improved P4 scores (mean difference, -6; 95% CI: -8, -3), KOOS pain scores (mean difference, 9; 95% CI: 5, 13), and KOOS function scores (mean difference, 11; 95% CI: 7, 15) compared to those of the control group at 2 weeks. At 3 months, the exercise intervention group had significantly improved KOOS pain scores (mean difference, 7; 95% CI: 3, 11) and KOOS function scores (mean difference, 5; 95% CI: 1, 9) compared to controls. CONCLUSION: Patients with knee OA who were prescribed exercises based on an MDT assessment had superior outcomes compared to those of wait-list controls. The MDT subgroup of knee derangement may warrant further investigation in patients with knee OA. Protocol registered at ClinicalTrials.gov (NCT01641874). LEVEL OF EVIDENCE: Therapy, level 1b-.

Predicting acute recovery of physical function following total knee joint arthroplasty.

The objective was to explore predictors of physical function during acute in-patient rehabilitation within a few days after TKA. Physical function status of participants (n = 72) three days after total knee arthroplasty (TKA) was measured using the Timed Up and Go Test (TUG) and the function subscale of the Western Ontario McMaster Universities Index of Osteoarthritis (WOMAC-function). Potential predictors of physical function were measured day one post-TKA. Their relationship with physical function was examined using backward elimination, multiple regression analyses. Older age and increased comorbidity were associated (R(2) = 0.20) with worse TUG times. Increased pain severity was associated (R(2) = 0.08) with worse WOMAC-function scores. Age, comorbidity, and pain severity should be considered when predicting which patients will struggle with acute recovery post-TKA.

Toward an improved haptic zooming algorithm for graphical information accessed by individuals who are blind and visually impaired.

An increasing amount of information content used in school, work, and everyday living is presented in graphical form. Unfortunately, it is difficult for people who are blind or visually impaired to access this information, especially when many diagrams are needed. One problem is that details, even in relatively simple visual diagrams, can be very difficult to perceive using touch. With manually created tactile diagrams, these details are often presented in separate diagrams which must be selected from among others. Being able to actively zoom in on an area of a single diagram so that the details can be presented at a reasonable size for exploration purposes seems a simpler approach for the user. However, directly using visual zooming methods have some limitations when used haptically. Therefore, a new zooming method is proposed to avoid these pitfalls. A preliminary experiment was performed to examine the usefulness of the algorithm compared to not using zooming. The results showed that the number of correct responses improved with the developed zooming algorithm and participants found it to be more usable than not using zooming for exploration of a floor map.

Dynamic tactile diagram simplification on refreshable displays.

The increasing use of visual diagrams in educational and work environments, and even our daily lives, has created obstacles for individuals who are blind or visually impaired to independently access the information they represent. Although physical tactile pictures can be created to convey the visual information, it is typically a slow, cumbersome, and costly process. Refreshable haptic displays, which interact with computers, promise to make this access quicker, easier, and cheaper. One important aspect in converting visual to tactile diagrams is to simplify the diagram as otherwise it can be too difficult to interpret with touch. Enabling this to be under user control in an interactive environment, such as with refreshable displays, could allow users to avoid being overwhelmed by the diagrams at any instant in time while still retaining access to all information in "storage". Through this article the authors investigate whether two types of diagram simplification--boundary simplification and contextual simplification--showed potential utility in an interactive environment. Boundary simplification was found to be significantly helpful in answering general questions about borders on a geographic map, and contextual simplification was helpful in answering relational questions, as compared to using the original map unchanged.

Intuitive tactile zooming for graphics accessed by individuals who are blind and visually impaired.

One possibility of providing access to visual graphics for those who are visually impaired is to present them tactually: unfortunately, details easily available to vision need to be magnified to be accessible through touch. For this, we propose an "intuitive" zooming algorithm to solve potential problems with directly applying visual zooming techniques to haptic displays that sense the current location of a user on a virtual diagram with a position sensor and, then, provide the appropriate local information either through force or tactile feedback. Our technique works by determining and then traversing the levels of an object tree hierarchy of a diagram. In this manner, the zoom steps adjust to the content to be viewed, avoid clipping and do not zoom when no object is present. The algorithm was tested using a small, "mouse-like" display with tactile feedback on pictures representing houses in a community and boats on a lake. We asked the users to answer questions related to details in the pictures. Comparing our technique to linear and logarithmic step zooming, we found a significant increase in the correctness of the responses (odds ratios of 2.64:1 and 2.31:1, respectively) and usability (differences of 36% and 19%, respectively) using our "intuitive" zooming technique.

Neck and shoulder disability following reconstruction with the pectoralis major pedicled flap.

OBJECTIVES/HYPOTHESIS: To conduct a comprehensive assessment of shoulder and neck function following the pectoralis major pedicled flap (PMPF) for head and neck reconstruction. DESIGN: Case-control study. METHODS: The study group consisted of laryngectomized patients who underwent PMPF and a control group of those who underwent standard laryngectomy. Bilateral quantitative measurements of shoulder strength and range of motion (ROM) and neck ROM by a blinded physiotherapist and subjective quality-of-life assessment using the Shoulder Pain and Disability Index (SPADI) and Neck Disability Index (NDI) questionnaires were collected. Lateral cervical radiographs in the neutral, flexion, and extension positions were evaluated by a blinded neuroradiologist. The main outcome measures were shoulder ROM, strength, and SPADI scores; physical and radiologic measurements of neck ROM; and NDI Score. RESULTS: Shoulder analysis showed a significantly reduced flexion angle (P = .043) and combined internal/external rotation angle on the operated side (P = .027) and a significant strength reduction for the flexion, external rotation, and adduction domains (P < .05). SPADI score analysis showed a significantly higher disability score (P = .017) and total score (P = .009) on the PMPF side. Neck physical analysis showed significant differences in extension (P = .013) and total ROM distances (P = .002) but not flexion (P = .184). The total flexion/extension angular ROM was reduced in the PMPF population (P = .05) due to a reduced neck extension excursion angle from a neutral position (P = .04). CONCLUSIONS: The PMPF for head and neck reconstruction is associated with a limitation in neck ROM attributed to a loss in extension and reduced shoulder strength and ROM.

Issues of using tactile mice by individuals who are blind and visually impaired.

Tactile mice, computer mice modified to have tactile pin displays on their upper surface, have been developed to enable access to 2-D graphical information for individuals who are blind or visually impaired; however, they have yet to really be adopted by the community. We suggest that this is due to the significant lack of accuracy in the haptic position information, which is critical for individuals to haptically piece together a 2-D graphic. We have identified two main design issues that affect this accuracy. Making simple modifications to correct these problems, we show a significant improvement in performance.

Change in patient concerns following total knee arthroplasty described with the International Classification of Functioning, Disability and Health: a repeated measures design.

BACKGROUND: There is no published evidence of how patient concerns change during the first six weeks following total knee arthroplasty (TKA). An understanding of the recovery process from the patient's perspective will inform clinicians on how to best educate patients about their post-operative concerns. Our objectives were to (1) quantify the level of importance for each of 32 previously identified concerns pre-operatively, and across the first six weeks following primary TKA and, (2) convey this change in importance post-operatively using the components of the International Classification of Functioning, Disability and Health (ICF). METHODS: The objectives were achieved using a repeated measures design. Convenience sampling was used to recruit 54 consecutive patients undergoing primary TKA at a hospital in Ontario, Canada. Pre-operatively and at two, four and six weeks post-operatively subjects rated the level of importance for each of the 32 previously identified patient concerns RESULTS: The importance rating of patient concerns in all four ICF components changed from before surgery to two weeks after surgery. Patient concerns in the Participation component became increasingly important after the first two weeks following surgery. Post-operatively from week two to week four, changes in importance ratings were also found in the Body Function and Activity components, but not in the Environmental Factors component. CONCLUSION: Changes in patient concerns mirror their early recovery from TKA surgery. Consistent with this, Participation restrictions become increasingly important to patients after discharge from acute care suggesting that clinicians should think of managing patient expectations for return to societal roles early in post-operative rehabilitation.

A cross-sectional look at patient concerns in the first six weeks following primary total knee arthroplasty.

BACKGROUND: To date, no researchers have investigated patient concerns in the first six weeks following primary total knee arthroplasty (TKA). An understanding of patient concerns at a time when physical therapists are involved in the treatment of these patients will aid clinicians in providing patient-centered care. Linking of items to the International Classification of Functioning, Disability and Health (ICF) allows for comparison and sharing of data amongst researchers, as the ICF is the accepted framework for evaluating disability in rehabilitation. The objective of this study was to identify patient concerns in the first six weeks following primary TKA and link these concerns to components of the ICF and map them to commonly used outcome measures. METHODS: Individual interviews were conducted to identify patient concerns during their recovery following primary TKA. Concerns identified by patients were analysed for content and linked to the components of the ICF using the operational definitions of the ICF components. These concerns were mapped to the WOMAC, KOOS and Oxford Knee Scale. RESULTS: Thirty patients (18 female) with an average age (SD) of 68.4 (11.1) years completed the study. Patients identified 32 concerns. Twenty-two percent (n = 7) of the concerns linked to Body Function and Structure, 47% (n = 15) to Activity, 13% (n = 4) to Participation, and 13% (n = 4) to the Environmental Factors component of the ICF. Six percent (n = 2) of the concerns did not link to the ICF. Of the 32 concerns identified by patients 14 mapped to the KOOS, 11 to the WOMAC and 4 to the Oxford Knee Scale. CONCLUSION: Patient concerns linked to four different components of the ICF indicating that patients are involved in or are thinking of multiple aspects of life even in this early phase of recovery. The KOOS was found to be the most appropriate for use based on the patients' perspective. However, less than half of the concerns identified by patients were covered by the KOOS, WOMAC or Oxford Knee Scale indicating that other existing measures that evaluate the concepts identified as important to patients should be considered when evaluating outcomes during this acute phase of recovery following primary TKA.

Hepatoprotection by 3-bromo-6-(4-chlorophenyl)-4-methylthio-2H-pyran-2-one against experimentally induced liver injury in rats.

Hepatoprotective activity of 3-bromo-6-(4-chlorophenyl)-4-methylthio-2H-pyran-2-one, an isostere of dimethyl ricinine, was evaluated in adult male albino rats intoxicated with carbon tetrachloride, paracetamol or thioacetamide. The test compound showed significant hepatoprotection at 6.0 mg kg(-1) body mass daily dose, given to the rats for seven consecutive days. The carbon tetrachloride, paracetamol and thioacetamide were given, respectively, on days 3, 5, and 7, on day 6 and on day 6 post treatment with the test compound. The protective effect was evident in a battery of serum and liver biochemical parameters related to hepatotoxicity.