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Where, on the face of a contract, the existence of a debt is conditional on the occurrence of a particular fact, and that fact has not occurred, because the person who promised payment has prevented it from occurring, does the debt arise nevertheless on the notion that the condition is then to be deemed fulfilled? In King Crude Carriers SA v Ridgebury November LLC,1 a unanimous Court of Appeal, reversing the judge, endorsed the effect of that notion while appearing to resituate it as a matter of contractual construction, based upon the objective intention of the contracting parties. That would be a step in the right direction. The precise nature of that notion remains murky, however, and would profit from further clarification.
Few studies have explored a stepped care model for delivering mental health care to persons with tuberculosis (TB). Here, we evaluated depression screening and remote low-intensity mental health interventions for persons initiating TB treatment in Lima, Peru during the COVID-19 pandemic.
Methods
We used the Patient Health Questionnaire 9 (PHQ-9) to screen participants for depressive symptoms (PHQ-9 ≥ 5). Participants with PHQ-9, 5–14 received remote Psychological First Aid (PFA) or Problem Management Plus (PM+). Participants were reevaluated 6 months after intervention completion. We then compared the change in median PHQ-9 scores before and after intervention completion. Those with PHQ-9 ≥ 15 were referred to higher-level care.
Findings
We found that 62 (45.9%) of the 135 participants had PHQ-9 ≥ 5 at baseline. Then, 54 individuals with PHQ-9, 5–9 received PFA, of which 44 (81.5%) were reevaluated. We observed significant reductions in median PHQ-9 scores from 6 to 2 (r = 0.98; p < 0.001). Four participants with PHQ-9, 10–14 received PM+ but were unable to be reevaluated. Four participants with PHQ-9 ≥ 15 were referred to higher-level care.
Conclusions
Depressive symptoms were common among persons recently diagnosed with TB. We observed improvements in depressive symptoms 6 months later for most participants who received remote sessions of PFA.
Mental disorders are common among persons with tuberculosis (TB), and the COVID-19 pandemic has only amplified the mental and physical health consequences of this deadly synergy. Here, we call to attention the immense vulnerability of people with TB to mental disorders during the pandemic and highlight the unique challenges and opportunities that the pandemic brings to the future integration of global TB and mental healthcare. We argue that the pandemic era is an ideal period to accelerate this integration and we provide research and policy recommendations to actualise this urgent need.
Two independent temporal-spatial clusters of hospital-onset Rhizopus infections were evaluated using whole-genome sequencing (WGS). Phylogenetic analysis confirmed that isolates within each cluster were unrelated despite epidemiological suspicion of outbreaks. The ITS1 region alone was insufficient for accurate analysis. WGS has utility for rapid rule-out of suspected nosocomial Rhizopus outbreaks.
Gravitational waves from coalescing neutron stars encode information about nuclear matter at extreme densities, inaccessible by laboratory experiments. The late inspiral is influenced by the presence of tides, which depend on the neutron star equation of state. Neutron star mergers are expected to often produce rapidly rotating remnant neutron stars that emit gravitational waves. These will provide clues to the extremely hot post-merger environment. This signature of nuclear matter in gravitational waves contains most information in the 2–4 kHz frequency band, which is outside of the most sensitive band of current detectors. We present the design concept and science case for a Neutron Star Extreme Matter Observatory (NEMO): a gravitational-wave interferometer optimised to study nuclear physics with merging neutron stars. The concept uses high-circulating laser power, quantum squeezing, and a detector topology specifically designed to achieve the high-frequency sensitivity necessary to probe nuclear matter using gravitational waves. Above 1 kHz, the proposed strain sensitivity is comparable to full third-generation detectors at a fraction of the cost. Such sensitivity changes expected event rates for detection of post-merger remnants from approximately one per few decades with two A+ detectors to a few per year and potentially allow for the first gravitational-wave observations of supernovae, isolated neutron stars, and other exotica.
Abnormal effort-based decision-making represents a potential mechanism underlying motivational deficits (amotivation) in psychotic disorders. Previous research identified effort allocation impairment in chronic schizophrenia and focused mostly on physical effort modality. No study has investigated cognitive effort allocation in first-episode psychosis (FEP).
Method
Cognitive effort allocation was examined in 40 FEP patients and 44 demographically-matched healthy controls, using Cognitive Effort-Discounting (COGED) paradigm which quantified participants’ willingness to expend cognitive effort in terms of explicit, continuous discounting of monetary rewards based on parametrically-varied cognitive demands (levels N of N-back task). Relationship between reward-discounting and amotivation was investigated. Group differences in reward-magnitude and effort-cost sensitivity, and differential associations of these sensitivity indices with amotivation were explored.
Results
Patients displayed significantly greater reward-discounting than controls. In particular, such discounting was most pronounced in patients with high levels of amotivation even when N-back performance and reward base amount were taken into consideration. Moreover, patients exhibited reduced reward-benefit sensitivity and effort-cost sensitivity relative to controls, and that decreased sensitivity to reward-benefit but not effort-cost was correlated with diminished motivation. Reward-discounting and sensitivity indices were generally unrelated to other symptom dimensions, antipsychotic dose and cognitive deficits.
Conclusion
This study provides the first evidence of cognitive effort-based decision-making impairment in FEP, and indicates that decreased effort expenditure is associated with amotivation. Our findings further suggest that abnormal effort allocation and amotivation might primarily be related to blunted reward valuation. Prospective research is required to clarify the utility of effort-based measures in predicting amotivation and functional outcome in FEP.
We report the utility of whole-genome sequencing (WGS) conducted in a clinically relevant time frame (ie, sufficient for guiding management decision), in managing a Streptococcus pyogenes outbreak, and present a comparison of its performance with emm typing.
SETTING
A 2,000-bed tertiary-care psychiatric hospital.
METHODS
Active surveillance was conducted to identify new cases of S. pyogenes. WGS guided targeted epidemiological investigations, and infection control measures were implemented. Single-nucleotide polymorphism (SNP)–based genome phylogeny, emm typing, and multilocus sequence typing (MLST) were performed. We compared the ability of WGS and emm typing to correctly identify person-to-person transmission and to guide the management of the outbreak.
RESULTS
The study included 204 patients and 152 staff. We identified 35 patients and 2 staff members with S. pyogenes. WGS revealed polyclonal S. pyogenes infections with 3 genetically distinct phylogenetic clusters (C1–C3). Cluster C1 isolates were all emm type 4, sequence type 915 and had pairwise SNP differences of 0–5, which suggested recent person-to-person transmissions. Epidemiological investigation revealed that cluster C1 was mediated by dermal colonization and transmission of S. pyogenes in a male residential ward. Clusters C2 and C3 were genomically diverse, with pairwise SNP differences of 21–45 and 26–58, and emm 11 and mostly emm120, respectively. Clusters C2 and C3, which may have been considered person-to-person transmissions by emm typing, were shown by WGS to be unlikely by integrating pairwise SNP differences with epidemiology.
CONCLUSIONS
WGS had higher resolution than emm typing in identifying clusters with recent and ongoing person-to-person transmissions, which allowed implementation of targeted intervention to control the outbreak.
Kuratite, ideally Ca4(Fe2+10Ti2)O4[Si8Al4O36], the Fe2+-analogue of rhönite and a new member of the sapphirine supergroup, was identified from the D'Orbigny angrite meteorite by electron microscopy and micro-Raman spectroscopy. Based on the least-squares refinement of 25 d-spacings measured from selected-area electron diffraction patterns of 11 zone axes, the symmetry of kuratite was shown to be triclinic (space group by analogy to rhönite) with a = 10.513(7), b = 10.887(7), c = 9.004(18) Å, α = 105.97(13), β = 96.00(12), γ = 124.82(04)°, V = 767 ± 2 Å3 and Z = 1 for the 40 oxygen formula. The empirical formula based on eight electron microprobe analyses is (Ca3.88Na0.02REE3+0.03Mn0.03Mg0.01Ni0.02Zn0.01Sr0.01)∑4.01 (Fe2+9.989.9Ti2.00)∑11.98(Si7.80Al3.52Fe3+0.64P0.05S0.02)∑12.03O39.98F0.01Cl0.01. The simplified formula is Ca4(Fe2+10Ti2)O4[Si8Al4O36]. Micro-Raman spectroscopy showed four main bands resembling those of lunar rhönite but with higher frequencies due to different chemical composition. Analogous to the occurrence of kuratite in terrestrial basaltic rocks, kuratite coexisting with Al, Ti-bearing hedenbergite, ulvöspinel, iron-sulfide, tsangpoite, Ca-rich fayalite and kirschsteinite in D'Orbigny angrite most probably was formed at >1000°C by rapid cooling of an interstitial melt, which is subsilicic, almost Mg-free but enriched in Al-P-Ca-Ti-Fe.
TAOS II is a next-generation occultation survey with the goal of measuring the size distribution of the small end of the Kuiper Belt (objects with diameters 0.5–30 km). Such objects have magnitudes r > 30, and are thus undetectable by direct imaging. The project will operate three telescopes at San Pedro Mártir Observatory in Baja California, México. Each telescope will be equipped with a custom-built camera comprised of a focal-plane array of CMOS imagers. The cameras will be capable of reading out image data from 10,000 stars at a cadence of 20 Hz. The telescopes will monitor the same set of stars simultaneously to search for coincident occultation detections, thus minimising the false-positive rate. This talk described the project, and reported on the progress of the development of the survey infrastructure.
Introduction: A novel bladder stimulation technique has been described for midstream urine (MSU) collection in well-feeding, inpatient newborns. We sought to determine the performance of this technique amongst infants presenting to the Emergency Department (ED). Methods: Our prospective ED-based study enrolled a convenience cohort of infants aged ≤ 90 days who required urine testing. Infants with significant feeding issues, moderate to severe dehydration, or critical illness were excluded. Bladder stimulation consisted of finger tapping on the lower abdomen with or without lower back massage while holding the child upright. Healthcare providers received standardized training in the technique. Primary outcome was the proportion of infants with successful MSU collection via the technique. Success was defined as adequate sample collection (≥ 1 mL urine) within 5 minutes of initiating stimulation. Secondary outcomes included the proportion of contaminated MSU samples, time required for MSU collection and full protocol completion, and patient discomfort as perceived by parent/guardian using a 100 mm visual analog scale [VAS]. Assuming success a priori in 50% of infants, a sample size of 115 allowed a 95% confidence interval of +/- 9.1% around the point estimate. Results: We enrolled 115 infants. Mean age was 53.0 days old (interquartile range [IQR] 26.7-68.0); 58.3% were male (69.2% uncircumcised). Midstream urine was successfully collected in 61 infants (53.0%; 95% CI 0.44,0.62). Thirty-one MSU samples (50.8%) were contaminated; uncircumcised males held the highest proportion (55.0%). Most contaminated samples (83.9%) were reported as “non-significant growth” or “growth of ≥ 3 organisms” and were easily identifiable as contaminants with minimal impact on clinical care. Only 4 (8.5%) of the 47 patients discharged home after successful MSU collection had a repeat ED visit for urine testing. Median stimulation time for MSU collection was 45 seconds (IQR 20-99 secs). Median time for full protocol completion was 30.83 minutes (IQR 24.42-46.83 mins). Mean VAS for infant discomfort was 20.2 mm (SD +/- 20.4 mm). Conclusion: Our pragmatic, ED-based study found the success rate of this bladder stimulation technique to be significantly lower (53%) than its published rate (86%). The contamination rate was high but most contaminated specimens were easily identifiable as such and had minimal clinical impact.
Loss of cortical volume in frontotemporal regions occurs in patients with first-episode psychosis (FEP) and longitudinal studies have reported progressive brain volume changes at different stages of the disease, even if cognitive deficits remain stable over time. We investigated cortical changes in patients over the 2 years following their FEP and their associations with clinical and cognitive measures.
Method
Twenty-seven patients after their FEP (20 with schizophrenia, seven with schizo-affective disorder) and 25 healthy controls matched for age and gender participated in this study. Magnetic resonance imaging (MRI) was performed on a 1.5-T scanner both at baseline and after 2 years. Area and thickness of the cortex were measured using surface-based morphometry (SBM). Patients also underwent neuropsychological testing at these two time points.
Results
Progressive cortical thinning in the superior and inferior frontal and, to a lesser extent, superior temporal cortex was observed in patients. Cortical area remained constant. Cortical thinning was associated with duration of treatment at a trend level and was predicted by baseline measures of IQ and working memory. Cortical thinning occurred in the absence of clinical or cognitive deterioration.
Conclusions
The clinical implications of these cortical changes remain uncertain, but patients with less cognitive reserve may be more vulnerable to developing cortical abnormalities when exposed to medication or other disease-related biological factors.
Background: The Consortium to Establish a Registry for Alzheimer's Disease Neuropsychological Assessment Battery (CERAD-NAB) offers information on the clinical diagnosis of Alzheimer's disease (AD) and gives a profile of cognitive functioning. This study explores the effects of age, education and gender on participants' performance on eight subtests in the Chinese-Cantonese version of the CERAD-NAB.
Methods: The original English version of the CERAD-NAB was translated and content-validated into a Chinese-Cantonese version to suit the Hong Kong Chinese population. The battery was administered to 187 healthy volunteers aged 60 to 94 years. Participants were excluded if they had neurological, medical or psychiatric disorders (including dementia). Stepwise multiple linear regression analyses were performed to assess the relative contribution of the demographic variables to the scores on each subtest.
Results: The Cantonese version of CERAD-NAB was shown to have good content validity and excellent inter-rater reliability. Stepwise multiple regression analyses revealed that performances on seven and four out of eight subtests in the CERAD-NAB were significantly influenced by education level and age, respectively. Age and education had significant effects on participants' performance on many tests. Gender also showed a significant effect on one subtest.
Conclusions: The preliminary data will serve as an initial phase for clinical interpretation of the CERAD-NAB for Cantonese-speaking Chinese elders.
This paper adopts a three-dimensional (3D) finite element method to simulate the injection molding of organic 3D stacked-chip assemblies. The geometry model of the assembly is simplified to a five-layered structure of stacked-chips with no solder bumps. The injection molding process incorporates 3D stacked-chip packaging and encapsulation techniques, and comprises primarily of multi-layer cavity-filling and reactive-thermosetting curing processes. The current investigation considers the effects of specifying different entrances on the resultant flow fronts, air-traps, and weld-lines. In general, the present results confirm the value of performing numerical simulations of the 3D stacked-chip packaging process to support the injection molding CAE approaches which are commonly applied nowadays to improve the packaging assembly design and to facilitate the rapid set up of mass-production conditions. The simulation results indicate that the best packaging results are obtained when the melt is introduced either at the center of the periphery side of the stacked-chip modulus or at its corner.
An ion implantation-wafer bonding-layer splitting based 2-D nanostructure material fabrication method using polysilicon sacrificial layer for forming nanothick SOI materials without using post-thinning processes is presented in this paper. Polysilicon layer was initially deposited on the thermal oxidized surface of silicon wafer prior to the ion implantation step to achieve the hydrogen-rich buried layer which depth from the top surface is less than 100 nm in the as-implanted silicon wafer. Before this as-implanted wafer being bonded with a handle wafer, the polysilicon layer was removed by a wet etching method. A nanothick silicon layer was then successfully transferred onto a handle wafer after wafer bonding and layer splitting steps. The thickness of the final transferred silicon layer was 100 nm measured by transmission electron microscopy (TEM).
Magnetotransport properties of Al0.22Ga0.78N/GaN modulation-doped heterostructures have been studied at low temperatures and high magnetic fields. The inter-subband scattering of the two-dimensional electron gas was observed. The inter-subband scattering is very weak and depends weakly on temperature when temperature is between 1.3 K and 10 K and becomes stronger with increasing temperature when temperature is higher than 10 K. The strain relaxation of the Al0.22Ga0.78N layer influences the inter-subband scattering. It is suggested that the inter-subband scattering is dominant by the elastic scattering when temperature is lower than 10 K, and changes to be dominant by the inelastic scattering of the acoustic phonons when temperature is higher than 10 K.
High quality Ga-face and N-face AlGaN/GaN based heterostructures have been grown by plasma induced molecular beam epitaxy. By using Ga-face material we are able to fabricate conventional heterojunction field effect transistors. Because the N-face material confines electrons at a different heterojunction, the resulting transistors are called inverted. The Ga-face structures use a high temperature AlN nucleation layer to establish the polarity. Structures from these materials, relying only on polarization induced interface charge effects to create the two-dimensional electron gases, are used to confirm the polarity of the material as well as test the electrical properties of the layers. The resulting sheet concentrations of the two dimensional electron gases agree very well with the piezoelectric theory for this materials system. Hall mobilities of the two-dimensional gases for the N-face structures are as high as 1150 cm2/Vs and 3440 cm2/Vs for 300 K and 77 K respectively, while the Ga–face structures yield room temperature mobilities of 1190 cm2/Vs. Both structures were then fabricated into transistors and characterized. The inverted transistors, which were fabricated from the N-face material, yielded a maximum transconductance of 130 mS/mm and a current density of 905 mA/mm. Microwave measurements gave an ft of 7 GHz and an fmax of 12 GHz for a gate length of 1 µm. The normal transistors, fabricated from the Ga-face material, produced a maximum transconductance of 247 mS/mm and a current density of 938 mA/mm. Microwave measurements gave an ft of 50 GHz and an fmax of 97 GHz for a gate length of 0.25 µm. This shows that using plasma induced molecular beam epitaxy N-face and Ga(Al)-face AlGaN/GaN heterostructures can be grown with structural and electrical properties very suitable for high power field effect transistors.
High quality Ga-face and N-face AlGaN/GaN based heterostructures have been grown by plasma induced molecular beam epitaxy. By using Ga-face material we are able to fabricate conventional heterojunction field effect transistors. Because the N-face material confines electrons at a different heterojunction, the resulting transistors are called inverted. The Ga-face structures use a high temperature AIN nucleation layer to establish the polarity. Structures from these materials, relying only on polarization induced interface charge effects to create the two-dimensional electron gases, are used to confirm the polarity of the material as well as test the electrical properties of the layers. The resulting sheet concentrations of the two dimensional electron gases agree very well with the piezoelectric theory for this materials system. Hall mobilities of the two-dimensional gases for the N-face structures are as high as 1150 cm2/Vs and 3440 cm2/Vs for 300 K and 77 K respectively, while the Ga-face structures yield room temperature mobilities of 1190 cm2/Vs. Both structures were then fabricated into transistors and characterized. The inverted transistors, which were fabricated from the N-face material, yielded a maximum transconductance of 130 mS/mm and a current density of 905 mA/mm. Microwave measurements gave an ft of 7 GHz and an fmax of 12 GHz for a gate length of 1 μm. The normal transistors, fabricated from the Ga-face material, produced a maximum transconductance of 247 mS/mm and a current density of 938 mA/mm. Microwave measurements gave an ft of 50 GHz and an fmax of 97 GHz for a gate length of 0.25 μm. This shows that using plasma induced molecular beam epitaxy N-face and Ga(A1)-face AlGaN/GaN heterostructures can be grown with structural and electrical properties very suitable for high power field effect transistors.
A void of cross sectional area A may spread perpendicular to the applied electric field Ea during electromigration because its leading surface develops a facet whose advance is limited by the supply of steps. If the facet is immobile (no step source) and the remaining surface is free to move, and if EaA is less than a threshold value, then the void assumes a stationary elongated shape dictated by a balance between capillarity and electric field. If EaA exceeds the threshold value, however, a balance is no longer possible, and the void spreads along the facet without arrest. If the facet has limited mobility, a balance is possible for all values of EaA, resulting in an elongated moving steady-state shape. The treatment simplifies the void shape as rectangular but preserves the essential features of capillarity and surface electromigration. We argue that the motion of a facet on a void along the outward normal requires defects (e.g. intersecting screw dislocations) that act as step sources since homogeneous nucleation of steps on the facet is expected to be negligible. Since voids in fine-line interconnects are often observed to be partially faceted, restricted void motion and resultant spreading which depend sensitively on crystallographic features, such as defect structure and grain orientation, may indeed limit the lifetime of fine-line interconnects in electronic devices.