A New Quantitative Triage System for Hospitalized Neonates to Assist with Decisions of Hospital Evacuation Priorities.

INTRODUCTION: Hospitalized neonates are vulnerable to natural and man-made disasters because of their persistent requirement for medical resources and may need to be evacuated to safe locations when electricity and medical gas supply become unreliable. In Japan, a triage system for hospitalized neonates, or the Simple Triage and Rapid Treatment for Neonates, Revised (START-Neo-R), has been used to determine whether neonates are in suitable conditions for transportation. However, this scale is not useful to determine the evacuation order of neonates because a considerable number of evacuees are classified into the same categories. STUDY OBJECTIVE: To solve this problem, a novel triage system, Neonatal Extrication Triage (NEXT) was developed. This study tested the validity and reproducibility of both triages and compared them with a standardized prognostic scoring system for hospitalized neonates, the Neonatal Therapeutic Intervention Scoring System (NTISS). METHODS: In this retrospective observational study, physicians and nurses independently assessed each neonate hospitalized at a tertiary neonatal intensive care unit (NICU) twice weekly using NEXT and START-Neo-R. The NEXT system comprises six questionnaires regarding medical resources required during transition and transportation, providing composite scores on a 12-point scale. The START-Neo-R classified neonates into five levels based on the severity of disease and dependence on medical care. Inter-rater reliability of both systems was assessed using Cohen's kappa coefficient, whereas the criterion validity with NTISS was assessed using Spearman's correlation coefficient. RESULTS: Overall, 162 neonates were assessed for 49 days, resulting in triage data for 1,079 accumulated patients. Both NEXT scores and START-Neo-R ranks were well-dispersed across different levels without excessive accumulation in specific categories. Inter-rater reliability of NEXT (kappa coefficient, 0.973; 95% confidence interval, 0.969-0.976) and START-Neo-R (kappa coefficient, 0.952; 95% confidence interval, 0.946-0.957) between physicians and nurses was sufficiently high. The correlation coefficient of NEXT and START-Neo-R scores with NTISS scores were 0.889 (P <.001) and 0.850 (P <.001), respectively. CONCLUSIONS: Both START-Neo-R and NEXT had good reproducibility and correlation with the severity of neonates indicated by NTISS. With its well-dispersed scores across different levels, the NEXT system might be a powerful tool to determine the priority of evacuation objectively.

Subwavelength resist patterning using interference exposure with a deep ultraviolet grating mask: Bragg angle incidence versus normal incidence.

Interference lithography using a deep-ultraviolet (DUV) laser is instrumental in the manufacture of subwavelength patterns used at visible wavelengths. We investigated a grating mask strategy for exposure in terms of how to set and illuminate masks. To obtain high aspect ratio patterns, high fringe visibility, and high exposure uniformity are essential, and for that purpose the use of only two beams with liquid immersion is necessary but not sufficient. It needs to be addressed whether the grating should face air or liquid to achieve index matching without affecting its beam-splitting properties. Currently, the most feasible solution to produce sub-200 nm periods requires the use of a fused-silica grating under Bragg geometry (not normal incidence geometry) and filling the gap between the grating and resist with a high-index liquid.

High-efficiency diffractive beam splitters surface-structured on submicrometer scale using deep-UV interference lithography.

We report highly efficient diffractive beam splitters intended for high-power laser applications. Submicron relief structures that work as an antireflective layer are formed on the surfaces of a splitter to improve its transmitted efficiency. Surface structuring is performed using deep-UV interference lithography and reactive ion etching. As immersed in an index-matching liquid, the resist layer coated on diffractive surfaces is exposed to the interference fringes that are set intersecting the grooves on the surfaces. Rigorously designed structures with a period of 140 nm and a depth of 55 nm are lithographed onto fused-silica splitters. Splitting efficiencies at 266 nm are increased by 8% to compare favorably with a theoretical value, while Fresnel reflections are considerably reduced.