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Equivalency of the diagnostic accuracy of the PHQ-8 and PHQ-9: a systematic review and individual participant data meta-analysis – ERRATUM
- Yin Wu, Brooke Levis, Kira E. Riehm, Nazanin Saadat, Alexander W. Levis, Marleine Azar, Danielle B. Rice, Jill Boruff, Pim Cuijpers, Simon Gilbody, John P.A. Ioannidis, Lorie A. Kloda, Dean McMillan, Scott B. Patten, Ian Shrier, Roy C. Ziegelstein, Dickens H. Akena, Bruce Arroll, Liat Ayalon, Hamid R. Baradaran, Murray Baron, Charles H. Bombardier, Peter Butterworth, Gregory Carter, Marcos H. Chagas, Juliana C. N. Chan, Rushina Cholera, Yeates Conwell, Janneke M. de Manvan Ginkel, Jesse R. Fann, Felix H. Fischer, Daniel Fung, Bizu Gelaye, Felicity Goodyear-Smith, Catherine G. Greeno, Brian J. Hall, Patricia A. Harrison, Martin Härter, Ulrich Hegerl, Leanne Hides, Stevan E. Hobfoll, Marie Hudson, Thomas Hyphantis, Masatoshi Inagaki, Nathalie Jetté, Mohammad E. Khamseh, Kim M. Kiely, Yunxin Kwan, Femke Lamers, Shen-Ing Liu, Manote Lotrakul, Sonia R. Loureiro, Bernd Löwe, Anthony McGuire, Sherina Mohd-Sidik, Tiago N. Munhoz, Kumiko Muramatsu, Flávia L. Osório, Vikram Patel, Brian W. Pence, Philippe Persoons, Angelo Picardi, Katrin Reuter, Alasdair G. Rooney, Iná S. Santos, Juwita Shaaban, Abbey Sidebottom, Adam Simning, Lesley Stafford, Sharon Sung, Pei Lin Lynnette Tan, Alyna Turner, Henk C. van Weert, Jennifer White, Mary A. Whooley, Kirsty Winkley, Mitsuhiko Yamada, Andrea Benedetti, Brett D. Thombs
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- Journal:
- Psychological Medicine / Volume 50 / Issue 16 / December 2020
- Published online by Cambridge University Press:
- 19 August 2019, p. 2816
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Equivalency of the diagnostic accuracy of the PHQ-8 and PHQ-9: a systematic review and individual participant data meta-analysis
- Yin Wu, Brooke Levis, Kira E. Riehm, Nazanin Saadat, Alexander W. Levis, Marleine Azar, Danielle B. Rice, Jill Boruff, Pim Cuijpers, Simon Gilbody, John P.A. Ioannidis, Lorie A. Kloda, Dean McMillan, Scott B. Patten, Ian Shrier, Roy C. Ziegelstein, Dickens H. Akena, Bruce Arroll, Liat Ayalon, Hamid R. Baradaran, Murray Baron, Charles H. Bombardier, Peter Butterworth, Gregory Carter, Marcos H. Chagas, Juliana C. N. Chan, Rushina Cholera, Yeates Conwell, Janneke M. de Man-van Ginkel, Jesse R. Fann, Felix H. Fischer, Daniel Fung, Bizu Gelaye, Felicity Goodyear-Smith, Catherine G. Greeno, Brian J. Hall, Patricia A. Harrison, Martin Härter, Ulrich Hegerl, Leanne Hides, Stevan E. Hobfoll, Marie Hudson, Thomas Hyphantis, Masatoshi Inagaki, Nathalie Jetté, Mohammad E. Khamseh, Kim M. Kiely, Yunxin Kwan, Femke Lamers, Shen-Ing Liu, Manote Lotrakul, Sonia R. Loureiro, Bernd Löwe, Anthony McGuire, Sherina Mohd-Sidik, Tiago N. Munhoz, Kumiko Muramatsu, Flávia L. Osório, Vikram Patel, Brian W. Pence, Philippe Persoons, Angelo Picardi, Katrin Reuter, Alasdair G. Rooney, Iná S. Santos, Juwita Shaaban, Abbey Sidebottom, Adam Simning, Lesley Stafford, Sharon Sung, Pei Lin Lynnette Tan, Alyna Turner, Henk C. van Weert, Jennifer White, Mary A. Whooley, Kirsty Winkley, Mitsuhiko Yamada, Andrea Benedetti, Brett D. Thombs
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- Journal:
- Psychological Medicine / Volume 50 / Issue 8 / June 2020
- Published online by Cambridge University Press:
- 12 July 2019, pp. 1368-1380
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Background
Item 9 of the Patient Health Questionnaire-9 (PHQ-9) queries about thoughts of death and self-harm, but not suicidality. Although it is sometimes used to assess suicide risk, most positive responses are not associated with suicidality. The PHQ-8, which omits Item 9, is thus increasingly used in research. We assessed equivalency of total score correlations and the diagnostic accuracy to detect major depression of the PHQ-8 and PHQ-9.
MethodsWe conducted an individual patient data meta-analysis. We fit bivariate random-effects models to assess diagnostic accuracy.
Results16 742 participants (2097 major depression cases) from 54 studies were included. The correlation between PHQ-8 and PHQ-9 scores was 0.996 (95% confidence interval 0.996 to 0.996). The standard cutoff score of 10 for the PHQ-9 maximized sensitivity + specificity for the PHQ-8 among studies that used a semi-structured diagnostic interview reference standard (N = 27). At cutoff 10, the PHQ-8 was less sensitive by 0.02 (−0.06 to 0.00) and more specific by 0.01 (0.00 to 0.01) among those studies (N = 27), with similar results for studies that used other types of interviews (N = 27). For all 54 primary studies combined, across all cutoffs, the PHQ-8 was less sensitive than the PHQ-9 by 0.00 to 0.05 (0.03 at cutoff 10), and specificity was within 0.01 for all cutoffs (0.00 to 0.01).
ConclusionsPHQ-8 and PHQ-9 total scores were similar. Sensitivity may be minimally reduced with the PHQ-8, but specificity is similar.
Probability of major depression diagnostic classification using semi-structured versus fully structured diagnostic interviews
- Brooke Levis, Andrea Benedetti, Kira E. Riehm, Nazanin Saadat, Alexander W. Levis, Marleine Azar, Danielle B. Rice, Matthew J. Chiovitti, Tatiana A. Sanchez, Pim Cuijpers, Simon Gilbody, John P. A. Ioannidis, Lorie A. Kloda, Dean McMillan, Scott B. Patten, Ian Shrier, Russell J. Steele, Roy C. Ziegelstein, Dickens H. Akena, Bruce Arroll, Liat Ayalon, Hamid R. Baradaran, Murray Baron, Anna Beraldi, Charles H. Bombardier, Peter Butterworth, Gregory Carter, Marcos H. Chagas, Juliana C. N. Chan, Rushina Cholera, Neerja Chowdhary, Kerrie Clover, Yeates Conwell, Janneke M. de Man-van Ginkel, Jaime Delgadillo, Jesse R. Fann, Felix H. Fischer, Benjamin Fischler, Daniel Fung, Bizu Gelaye, Felicity Goodyear-Smith, Catherine G. Greeno, Brian J. Hall, John Hambridge, Patricia A. Harrison, Ulrich Hegerl, Leanne Hides, Stevan E. Hobfoll, Marie Hudson, Thomas Hyphantis, Masatoshi Inagaki, Khalida Ismail, Nathalie Jetté, Mohammad E. Khamseh, Kim M. Kiely, Femke Lamers, Shen-Ing Liu, Manote Lotrakul, Sonia R. Loureiro, Bernd Löwe, Laura Marsh, Anthony McGuire, Sherina Mohd Sidik, Tiago N. Munhoz, Kumiko Muramatsu, Flávia L. Osório, Vikram Patel, Brian W. Pence, Philippe Persoons, Angelo Picardi, Alasdair G. Rooney, Iná S. Santos, Juwita Shaaban, Abbey Sidebottom, Adam Simning, Lesley Stafford, Sharon Sung, Pei Lin Lynnette Tan, Alyna Turner, Christina M. van der Feltz-Cornelis, Henk C. van Weert, Paul A. Vöhringer, Jennifer White, Mary A. Whooley, Kirsty Winkley, Mitsuhiko Yamada, Yuying Zhang, Brett D. Thombs
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- Journal:
- The British Journal of Psychiatry / Volume 212 / Issue 6 / June 2018
- Published online by Cambridge University Press:
- 02 May 2018, pp. 377-385
- Print publication:
- June 2018
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Background
Different diagnostic interviews are used as reference standards for major depression classification in research. Semi-structured interviews involve clinical judgement, whereas fully structured interviews are completely scripted. The Mini International Neuropsychiatric Interview (MINI), a brief fully structured interview, is also sometimes used. It is not known whether interview method is associated with probability of major depression classification.
AimsTo evaluate the association between interview method and odds of major depression classification, controlling for depressive symptom scores and participant characteristics.
MethodData collected for an individual participant data meta-analysis of Patient Health Questionnaire-9 (PHQ-9) diagnostic accuracy were analysed and binomial generalised linear mixed models were fit.
ResultsA total of 17 158 participants (2287 with major depression) from 57 primary studies were analysed. Among fully structured interviews, odds of major depression were higher for the MINI compared with the Composite International Diagnostic Interview (CIDI) (odds ratio (OR) = 2.10; 95% CI = 1.15–3.87). Compared with semi-structured interviews, fully structured interviews (MINI excluded) were non-significantly more likely to classify participants with low-level depressive symptoms (PHQ-9 scores ≤6) as having major depression (OR = 3.13; 95% CI = 0.98–10.00), similarly likely for moderate-level symptoms (PHQ-9 scores 7–15) (OR = 0.96; 95% CI = 0.56–1.66) and significantly less likely for high-level symptoms (PHQ-9 scores ≥16) (OR = 0.50; 95% CI = 0.26–0.97).
ConclusionsThe MINI may identify more people as depressed than the CIDI, and semi-structured and fully structured interviews may not be interchangeable methods, but these results should be replicated.
Declaration of interestDrs Jetté and Patten declare that they received a grant, outside the submitted work, from the Hotchkiss Brain Institute, which was jointly funded by the Institute and Pfizer. Pfizer was the original sponsor of the development of the PHQ-9, which is now in the public domain. Dr Chan is a steering committee member or consultant of Astra Zeneca, Bayer, Lilly, MSD and Pfizer. She has received sponsorships and honorarium for giving lectures and providing consultancy and her affiliated institution has received research grants from these companies. Dr Hegerl declares that within the past 3 years, he was an advisory board member for Lundbeck, Servier and Otsuka Pharma; a consultant for Bayer Pharma; and a speaker for Medice Arzneimittel, Novartis, and Roche Pharma, all outside the submitted work. Dr Inagaki declares that he has received grants from Novartis Pharma, lecture fees from Pfizer, Mochida, Shionogi, Sumitomo Dainippon Pharma, Daiichi-Sankyo, Meiji Seika and Takeda, and royalties from Nippon Hyoron Sha, Nanzando, Seiwa Shoten, Igaku-shoin and Technomics, all outside of the submitted work. Dr Yamada reports personal fees from Meiji Seika Pharma Co., Ltd., MSD K.K., Asahi Kasei Pharma Corporation, Seishin Shobo, Seiwa Shoten Co., Ltd., Igaku-shoin Ltd., Chugai Igakusha and Sentan Igakusha, all outside the submitted work. All other authors declare no competing interests. No funder had any role in the design and conduct of the study; collection, management, analysis and interpretation of the data; preparation, review or approval of the manuscript; and decision to submit the manuscript for publication.
Contributors
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- By Mitchell Aboulafia, Frederick Adams, Marilyn McCord Adams, Robert M. Adams, Laird Addis, James W. Allard, David Allison, William P. Alston, Karl Ameriks, C. Anthony Anderson, David Leech Anderson, Lanier Anderson, Roger Ariew, David Armstrong, Denis G. Arnold, E. J. Ashworth, Margaret Atherton, Robin Attfield, Bruce Aune, Edward Wilson Averill, Jody Azzouni, Kent Bach, Andrew Bailey, Lynne Rudder Baker, Thomas R. Baldwin, Jon Barwise, George Bealer, William Bechtel, Lawrence C. Becker, Mark A. Bedau, Ernst Behler, José A. Benardete, Ermanno Bencivenga, Jan Berg, Michael Bergmann, Robert L. Bernasconi, Sven Bernecker, Bernard Berofsky, Rod Bertolet, Charles J. Beyer, Christian Beyer, Joseph Bien, Joseph Bien, Peg Birmingham, Ivan Boh, James Bohman, Daniel Bonevac, Laurence BonJour, William J. Bouwsma, Raymond D. Bradley, Myles Brand, Richard B. Brandt, Michael E. Bratman, Stephen E. Braude, Daniel Breazeale, Angela Breitenbach, Jason Bridges, David O. Brink, Gordon G. Brittan, Justin Broackes, Dan W. Brock, Aaron Bronfman, Jeffrey E. Brower, Bartosz Brozek, Anthony Brueckner, Jeffrey Bub, Lara Buchak, Otavio Bueno, Ann E. Bumpus, Robert W. Burch, John Burgess, Arthur W. Burks, Panayot Butchvarov, Robert E. Butts, Marina Bykova, Patrick Byrne, David Carr, Noël Carroll, Edward S. Casey, Victor Caston, Victor Caston, Albert Casullo, Robert L. Causey, Alan K. L. Chan, Ruth Chang, Deen K. Chatterjee, Andrew Chignell, Roderick M. Chisholm, Kelly J. Clark, E. J. Coffman, Robin Collins, Brian P. Copenhaver, John Corcoran, John Cottingham, Roger Crisp, Frederick J. Crosson, Antonio S. Cua, Phillip D. Cummins, Martin Curd, Adam Cureton, Andrew Cutrofello, Stephen Darwall, Paul Sheldon Davies, Wayne A. Davis, Timothy Joseph Day, Claudio de Almeida, Mario De Caro, Mario De Caro, John Deigh, C. F. Delaney, Daniel C. Dennett, Michael R. DePaul, Michael Detlefsen, Daniel Trent Devereux, Philip E. Devine, John M. Dillon, Martin C. Dillon, Robert DiSalle, Mary Domski, Alan Donagan, Paul Draper, Fred Dretske, Mircea Dumitru, Wilhelm Dupré, Gerald Dworkin, John Earman, Ellery Eells, Catherine Z. Elgin, Berent Enç, Ronald P. Endicott, Edward Erwin, John Etchemendy, C. Stephen Evans, Susan L. Feagin, Solomon Feferman, Richard Feldman, Arthur Fine, Maurice A. Finocchiaro, William FitzPatrick, Richard E. Flathman, Gvozden Flego, Richard Foley, Graeme Forbes, Rainer Forst, Malcolm R. Forster, Daniel Fouke, Patrick Francken, Samuel Freeman, Elizabeth Fricker, Miranda Fricker, Michael Friedman, Michael Fuerstein, Richard A. Fumerton, Alan Gabbey, Pieranna Garavaso, Daniel Garber, Jorge L. A. Garcia, Robert K. Garcia, Don Garrett, Philip Gasper, Gerald Gaus, Berys Gaut, Bernard Gert, Roger F. Gibson, Cody Gilmore, Carl Ginet, Alan H. Goldman, Alvin I. Goldman, Alfonso Gömez-Lobo, Lenn E. Goodman, Robert M. Gordon, Stefan Gosepath, Jorge J. E. Gracia, Daniel W. Graham, George A. Graham, Peter J. Graham, Richard E. Grandy, I. Grattan-Guinness, John Greco, Philip T. Grier, Nicholas Griffin, Nicholas Griffin, David A. Griffiths, Paul J. Griffiths, Stephen R. Grimm, Charles L. Griswold, Charles B. Guignon, Pete A. Y. Gunter, Dimitri Gutas, Gary Gutting, Paul Guyer, Kwame Gyekye, Oscar A. Haac, Raul Hakli, Raul Hakli, Michael Hallett, Edward C. Halper, Jean Hampton, R. James Hankinson, K. R. Hanley, Russell Hardin, Robert M. Harnish, William Harper, David Harrah, Kevin Hart, Ali Hasan, William Hasker, John Haugeland, Roger Hausheer, William Heald, Peter Heath, Richard Heck, John F. Heil, Vincent F. Hendricks, Stephen Hetherington, Francis Heylighen, Kathleen Marie Higgins, Risto Hilpinen, Harold T. Hodes, Joshua Hoffman, Alan Holland, Robert L. Holmes, Richard Holton, Brad W. Hooker, Terence E. Horgan, Tamara Horowitz, Paul Horwich, Vittorio Hösle, Paul Hoβfeld, Daniel Howard-Snyder, Frances Howard-Snyder, Anne Hudson, Deal W. Hudson, Carl A. Huffman, David L. Hull, Patricia Huntington, Thomas Hurka, Paul Hurley, Rosalind Hursthouse, Guillermo Hurtado, Ronald E. Hustwit, Sarah Hutton, Jonathan Jenkins Ichikawa, Harry A. Ide, David Ingram, Philip J. Ivanhoe, Alfred L. Ivry, Frank Jackson, Dale Jacquette, Joseph Jedwab, Richard Jeffrey, David Alan Johnson, Edward Johnson, Mark D. Jordan, Richard Joyce, Hwa Yol Jung, Robert Hillary Kane, Tomis Kapitan, Jacquelyn Ann K. Kegley, James A. Keller, Ralph Kennedy, Sergei Khoruzhii, Jaegwon Kim, Yersu Kim, Nathan L. King, Patricia Kitcher, Peter D. Klein, E. D. Klemke, Virginia Klenk, George L. Kline, Christian Klotz, Simo Knuuttila, Joseph J. Kockelmans, Konstantin Kolenda, Sebastian Tomasz Kołodziejczyk, Isaac Kramnick, Richard Kraut, Fred Kroon, Manfred Kuehn, Steven T. Kuhn, Henry E. Kyburg, John Lachs, Jennifer Lackey, Stephen E. Lahey, Andrea Lavazza, Thomas H. Leahey, Joo Heung Lee, Keith Lehrer, Dorothy Leland, Noah M. Lemos, Ernest LePore, Sarah-Jane Leslie, Isaac Levi, Andrew Levine, Alan E. Lewis, Daniel E. Little, Shu-hsien Liu, Shu-hsien Liu, Alan K. L. Chan, Brian Loar, Lawrence B. Lombard, John Longeway, Dominic McIver Lopes, Michael J. Loux, E. J. Lowe, Steven Luper, Eugene C. Luschei, William G. Lycan, David Lyons, David Macarthur, Danielle Macbeth, Scott MacDonald, Jacob L. Mackey, Louis H. Mackey, Penelope Mackie, Edward H. Madden, Penelope Maddy, G. B. Madison, Bernd Magnus, Pekka Mäkelä, Rudolf A. Makkreel, David Manley, William E. Mann (W.E.M.), Vladimir Marchenkov, Peter Markie, Jean-Pierre Marquis, Ausonio Marras, Mike W. Martin, A. P. Martinich, William L. McBride, David McCabe, Storrs McCall, Hugh J. McCann, Robert N. McCauley, John J. McDermott, Sarah McGrath, Ralph McInerny, Daniel J. McKaughan, Thomas McKay, Michael McKinsey, Brian P. McLaughlin, Ernan McMullin, Anthonie Meijers, Jack W. Meiland, William Jason Melanson, Alfred R. Mele, Joseph R. Mendola, Christopher Menzel, Michael J. Meyer, Christian B. Miller, David W. Miller, Peter Millican, Robert N. Minor, Phillip Mitsis, James A. Montmarquet, Michael S. Moore, Tim Moore, Benjamin Morison, Donald R. Morrison, Stephen J. Morse, Paul K. Moser, Alexander P. D. Mourelatos, Ian Mueller, James Bernard Murphy, Mark C. Murphy, Steven Nadler, Jan Narveson, Alan Nelson, Jerome Neu, Samuel Newlands, Kai Nielsen, Ilkka Niiniluoto, Carlos G. Noreña, Calvin G. Normore, David Fate Norton, Nikolaj Nottelmann, Donald Nute, David S. Oderberg, Steve Odin, Michael O’Rourke, Willard G. Oxtoby, Heinz Paetzold, George S. Pappas, Anthony J. Parel, Lydia Patton, R. P. Peerenboom, Francis Jeffry Pelletier, Adriaan T. Peperzak, Derk Pereboom, Jaroslav Peregrin, Glen Pettigrove, Philip Pettit, Edmund L. Pincoffs, Andrew Pinsent, Robert B. Pippin, Alvin Plantinga, Louis P. Pojman, Richard H. Popkin, John F. Post, Carl J. Posy, William J. Prior, Richard Purtill, Michael Quante, Philip L. Quinn, Philip L. Quinn, Elizabeth S. Radcliffe, Diana Raffman, Gerard Raulet, Stephen L. Read, Andrews Reath, Andrew Reisner, Nicholas Rescher, Henry S. Richardson, Robert C. Richardson, Thomas Ricketts, Wayne D. Riggs, Mark Roberts, Robert C. Roberts, Luke Robinson, Alexander Rosenberg, Gary Rosenkranz, Bernice Glatzer Rosenthal, Adina L. Roskies, William L. Rowe, T. M. Rudavsky, Michael Ruse, Bruce Russell, Lilly-Marlene Russow, Dan Ryder, R. M. Sainsbury, Joseph Salerno, Nathan Salmon, Wesley C. Salmon, Constantine Sandis, David H. Sanford, Marco Santambrogio, David Sapire, Ruth A. Saunders, Geoffrey Sayre-McCord, Charles Sayward, James P. Scanlan, Richard Schacht, Tamar Schapiro, Frederick F. Schmitt, Jerome B. Schneewind, Calvin O. Schrag, Alan D. Schrift, George F. Schumm, Jean-Loup Seban, David N. Sedley, Kenneth Seeskin, Krister Segerberg, Charlene Haddock Seigfried, Dennis M. Senchuk, James F. Sennett, William Lad Sessions, Stewart Shapiro, Tommie Shelby, Donald W. Sherburne, Christopher Shields, Roger A. Shiner, Sydney Shoemaker, Robert K. Shope, Kwong-loi Shun, Wilfried Sieg, A. John Simmons, Robert L. Simon, Marcus G. Singer, Georgette Sinkler, Walter Sinnott-Armstrong, Matti T. Sintonen, Lawrence Sklar, Brian Skyrms, Robert C. Sleigh, Michael Anthony Slote, Hans Sluga, Barry Smith, Michael Smith, Robin Smith, Robert Sokolowski, Robert C. Solomon, Marta Soniewicka, Philip Soper, Ernest Sosa, Nicholas Southwood, Paul Vincent Spade, T. L. S. Sprigge, Eric O. Springsted, George J. Stack, Rebecca Stangl, Jason Stanley, Florian Steinberger, Sören Stenlund, Christopher Stephens, James P. Sterba, Josef Stern, Matthias Steup, M. A. Stewart, Leopold Stubenberg, Edith Dudley Sulla, Frederick Suppe, Jere Paul Surber, David George Sussman, Sigrún Svavarsdóttir, Zeno G. Swijtink, Richard Swinburne, Charles C. Taliaferro, Robert B. Talisse, John Tasioulas, Paul Teller, Larry S. Temkin, Mark Textor, H. S. Thayer, Peter Thielke, Alan Thomas, Amie L. Thomasson, Katherine Thomson-Jones, Joshua C. Thurow, Vzalerie Tiberius, Terrence N. Tice, Paul Tidman, Mark C. Timmons, William Tolhurst, James E. Tomberlin, Rosemarie Tong, Lawrence Torcello, Kelly Trogdon, J. D. Trout, Robert E. Tully, Raimo Tuomela, John Turri, Martin M. Tweedale, Thomas Uebel, Jennifer Uleman, James Van Cleve, Harry van der Linden, Peter van Inwagen, Bryan W. Van Norden, René van Woudenberg, Donald Phillip Verene, Samantha Vice, Thomas Vinci, Donald Wayne Viney, Barbara Von Eckardt, Peter B. M. Vranas, Steven J. Wagner, William J. Wainwright, Paul E. Walker, Robert E. Wall, Craig Walton, Douglas Walton, Eric Watkins, Richard A. Watson, Michael V. Wedin, Rudolph H. Weingartner, Paul Weirich, Paul J. Weithman, Carl Wellman, Howard Wettstein, Samuel C. Wheeler, Stephen A. White, Jennifer Whiting, Edward R. Wierenga, Michael Williams, Fred Wilson, W. Kent Wilson, Kenneth P. Winkler, John F. Wippel, Jan Woleński, Allan B. Wolter, Nicholas P. Wolterstorff, Rega Wood, W. Jay Wood, Paul Woodruff, Alison Wylie, Gideon Yaffe, Takashi Yagisawa, Yutaka Yamamoto, Keith E. Yandell, Xiaomei Yang, Dean Zimmerman, Günter Zoller, Catherine Zuckert, Michael Zuckert, Jack A. Zupko (J.A.Z.)
- Edited by Robert Audi, University of Notre Dame, Indiana
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- The Cambridge Dictionary of Philosophy
- Published online:
- 05 August 2015
- Print publication:
- 27 April 2015, pp ix-xxx
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Developing a New, National Approach to Surveillance for Ventilator-Associated Events: Executive Summary
- Shelley S. Magill, Michael Klompas, Robert Balk, Suzanne M. Burns, Clifford S. Deutschman, Daniel Diekema, Scott Fridkin, Linda Greene, Alice Guh, David Gutterman, Beth Hammer, David Henderson, Dean R. Hess, Nicholas S. Hill, Teresa Horan, Marin Kollef, Mitchell Levy, Edward Septimus, Carole VanAntwerpen, Don Wright, Pamela Lipsett
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- Journal:
- Infection Control & Hospital Epidemiology / Volume 34 / Issue 12 / December 2013
- Published online by Cambridge University Press:
- 02 January 2015, pp. 1239-1243
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- December 2013
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This article is an executive summary of a report from the Centers for Disease Control and Prevention Ventilator-Associated Pneumonia Surveillance Definition Working Group, entitled “Developing a new, national approach to surveillance for ventilator-associated events” and published in Critical Care Medicine. The full report provides a comprehensive description of the Working Group process and outcome.
In September 2011, the Centers for Disease Control and Prevention (CDC) convened a Ventilator-Associated Pneumonia (VAP) Surveillance Definition Working Group to organize a formal process for leaders and experts of key stakeholder organizations to discuss the challenges of VAP surveillance definitions and to propose new approaches to VAP surveillance in adult patients (Table 1).
Contributors
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- By Waiel Almoustadi, Brian J. Anderson, David B. Auyong, Michael Avidan, Michael J. Avram, Roland J. Bainton, Jeffrey R. Balser, Juliana Barr, W. Scott Beattie, Manfred Blobner, T. Andrew Bowdle, Walter A. Boyle, Eugene B. Campbell, Laura F. Cavallone, Mario Cibelli, C. Michael Crowder, Ola Dale, M. Frances Davies, Mark Dershwitz, George Despotis, Clifford S. Deutschman, Brian S. Donahue, Marcel E. Durieux, Thomas J. Ebert, Talmage D. Egan, Helge Eilers, E. Wesley Ely, Charles W. Emala, Alex S. Evers, Heidrun Fink, Pierre Foëx, Stuart A. Forman, Helen F. Galley, Josephine M. Garcia-Ferrer, Robert W. Gereau, Tony Gin, David Glick, B. Joseph Guglielmo, Dhanesh K. Gupta, Howard B. Gutstein, Robert G. Hahn, Greg B. Hammer, Brian P. Head, Helen Higham, Laureen Hill, Kirk Hogan, Charles W. Hogue, Christopher G. Hughes, Eric Jacobsohn, Roger A. Johns, Dean R. Jones, Max Kelz, Evan D. Kharasch, Ellen W. King, W. Andrew Kofke, Tom C. Krejcie, Richard M. Langford, H. T. Lee, Isobel Lever, Jerrold H. Levy, J. Lance Lichtor, Larry Lindenbaum, Hung Pin Liu, Geoff Lockwood, Alex Macario, Conan MacDougall, M. B. MacIver, Aman Mahajan, Nándor Marczin, J. A. Jeevendra Martyn, George A. Mashour, Mervyn Maze, Thomas McDowell, Stuart McGrane, Berend Mets, Patrick Meybohm, Charles F. Minto, Jonathan Moss, Mohamed Naguib, Istvan Nagy, Nick Oliver, Paul S. Pagel, Pratik P. Pandharipande, Piyush Patel, Andrew J. Patterson, Robert A. Pearce, Ronald G. Pearl, Misha Perouansky, Kristof Racz, Chinniampalayam Rajamohan, Nilesh Randive, Imre Redai, Stephen Robinson, Richard W. Rosenquist, Carl E. Rosow, Uwe Rudolph, Francis V. Salinas, Robert D. Sanders, Sunita Sastry, Michael Schäfer, Jens Scholz, Thomas W. Schnider, Mark A. Schumacher, John W. Sear, Frédérique S. Servin, Jeffrey H. Silverstein, Tom De Smet, Martin Smith, Joe Henry Steinbach, Markus Steinfath, David F. Stowe, Gary R. Strichartz, Michel M. R. F. Struys, Isao Tsuneyoshi, Robert A. Veselis, Arthur Wallace, Robert P. Walt, David C. Warltier, Nigel R. Webster, Jeanine Wiener-Kronish, Troy Wildes, Paul Wischmeyer, Ling-Gang Wu, Stephen Yang
- Edited by Alex S. Evers, Washington University School of Medicine, St Louis, Mervyn Maze, University of California, San Francisco, Evan D. Kharasch, Washington University School of Medicine, St Louis
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- Anesthetic Pharmacology
- Published online:
- 11 April 2011
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- 10 March 2011, pp viii-xiv
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Real-Time Spectroscopic Ellipsometry Studies of Zinc Oxide Deposition
- Christian Carl Fesenmaier, Xiaonan S. Li, Bobby To, Dean H. Levi
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- MRS Online Proceedings Library Archive / Volume 1074 / 2008
- Published online by Cambridge University Press:
- 01 February 2011, 1074-I07-11
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- 2008
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Zinc oxide is increasingly being studied as an eventual replacement for indium tin oxide as a transparent conducting oxide (TCO) for thin film solar cells. In order to better understand the growth process of ZnO, as well as provide for accurate control on the National Renewable Energy Laboratory's TCO deposition system, undoped RF-magnetron sputtered ZnO films on silicon were analyzed in situ using real-time spectroscopic ellipsometry (RTSE). A large wavelength range (245-994 nm) was measured in order to derive information about optical properties both below and above the bandgap. Atomic force microscopy (AFM) measurements were also taken to confirm ellipsometry surface roughness results and provide additional insight into the surface morphology.
In light of observed poor fit of typical two-layer optical models to in situ ellipsometry data, we propose a model film structure consisting of two layers: a bulk ZnO layer of graded density that increases in thickness as the growth proceeds and a growth zone at the top of the film of approximately constant thickness with a slightly larger bandgap, lower density, and decreased excitonic absorption. Unfortunately, this model is insufficient to explain the evolution of the film during the early growth period, corresponding to film thicknesses less than 100 nm. Nevertheless, the presence of a growth zone for films above a certain thickness should provide some insight into the growth process of RF-magnetron sputtered ZnO.
Materials Optimization for Silicon Heterojunction Solar Cells Using Spectroscopic Ellipsometry
- Dean Levi, Eugene Iwanizcko, Steve Johnston, Qi Wang, Howard M Branz
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- Journal:
- MRS Online Proceedings Library Archive / Volume 989 / 2007
- Published online by Cambridge University Press:
- 01 February 2011, 0989-A24-04
- Print publication:
- 2007
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Our research team has used hot wire chemical vapor deposition (HWCVD) to fabricate silicon heterojunction (SHJ) solar cells on p-type FZ silicon substrates with efficiencies as high as 18.2%. The best cells are deposited on anisotropically-textured (100) silicon substrates where an etching process creates pyramidal facets with (111) crystal faces. Texturing increases Jsc through enhanced light trapping, yet our highest Voc devices are deposited on un-textured (100) substrates. One of the key factors in maximizing the efficiency of our SHJ devices is the process of optimization of the material properties of the 3 - 5 nm thick hydrogenated amorphous silicon (a-Si:H) layers used to create the junction and back contact in these cells. Such optimization is technically challenging because of the difficulty in measuring the properties of extremely thin layers. This difficulty is compounded by the fact that the properties of such amorphous layers are substrate- and thickness-dependent. In this study, we have utilized spectroscopic ellipsometry (SE) and photoconductivity decay to conclude that a-Si:H films grown on (111) substrates are substantially similar to films grown on (100) substrates. In addition, analysis of the substrate temperature dependence of surface roughness evolution reveals a substrate-independent mechanism of surface smoothening with an activation energy of 0.28 eV. Analysis of the substrate temperature dependence of surface passivation reveals a passivation mechanism with an activation energy of 0.63 eV.
High Open-Circuit Voltage in Silicon Heterojunction Solar Cells
- Qi Wang, Matt R. Page, Eugene Iwancizko, Yueqin Xu, Lorenzo Roybal, Russell Bauer, Dean Levi, Yanfa Yan, Tihu Wang, Howard M. Branz
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- Journal:
- MRS Online Proceedings Library Archive / Volume 989 / 2007
- Published online by Cambridge University Press:
- 01 February 2011, 0989-A03-04
- Print publication:
- 2007
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High open-circuit voltage (Voc) silicon heterojunction (SHJ) solar cells are fabricated in double-heterojunction a-Si:H/c-Si/a-Si:H structures using low temperature (<225°C) hydrogenated amorphous silicon (a-Si:H) contacts deposited by hot-wire chemical vapor deposition (HWCVD). On p-type c-Si float-zone wafers, we used an amorphous n/i contact to the top surface and an i/p contact to the back surface to obtain a Voc of 667 mV in a 1 cm2 cell with an efficiency of 18.2%. This is the best reported p-type SHJ voltage. In our labs, it improves over the 652 mV cell obtained with a front amorphous n/i heterojunction emitter and a high-temperature alloyed Al back-surface-field contact. On n-type c-Si float-zone wafers, we used an a Si:H (p/i) front emitter and an a-Si:H (i/n) back contact to achieve a Voc of 691 mV on 1 cm2 cell. Though not as high as the 730 mV reported by Sanyo on n-wafers, this is the highest reported Voc for SHJ c-Si cells processed by the HWCVD technique. We found that effective c-Si surface cleaning and a double-heterojunction are keys to obtaining high Voc. Transmission electron microscopy reveals that high Voc cells require an abrupt interface from c-Si to a-Si:H. If the transition from the base wafer to the a-Si:H incorporates either microcrystalline or epitaxial Si at c Si interface, a low Voc will result. Lifetime measurement shows that the back-surface-recombination velocity (BSRV) can be reduced to ~15 cm/s through a-Si:H passivation. Amorphous silicon heterojunction layers on crystalline wafers thus combine low-surface recombination velocity with excellent carrier extraction.
17.8%-efficient Amorphous Silicon Heterojunction Solar Cells on p-type Silicon Wafers
- Qi Wang, Matt P. Page, Eugene Iwancizko, Yueqin Xu, Yanfa Yan, Lorenzo Roybal, Dean Levi, Russell Bauer, Howard M. Branz, Qi Wang
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- Journal:
- MRS Online Proceedings Library Archive / Volume 910 / 2006
- Published online by Cambridge University Press:
- 01 February 2011, 0910-A26-05
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- 2006
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We have achieved an independently-confirmed 17.8% conversion efficiency in a 1-cm2, p-type, float-zone silicon (FZ-Si) based heterojunction solar cell. Both the front emitter and back contact are hydrogenated amorphous silicon (a-Si:H) deposited by hot-wire chemical vapor deposition (HWCVD). This is the highest reported efficiency for a HWCVD silicon heterojunction (SHJ) solar cell. Two main improvements lead to our most recent increases in efficiency: 1) the use of textured Si wafers, and 2) the application of a-Si:H heterojunctions on both sides of the cell. Despite the use of textured c-Si to increase the short-circuit current, we were able to maintain the same 0.65 V open-circuit voltage as on flat c-Si. This is achieved by coating a-Si:H conformally on the c-Si surfaces, including covering the tips of the anisotropically-etched pyramids. A brief atomic H treatment before emitter deposition is not necessary on the textured wafers, though it was helpful in the flat wafers. It is essential to high efficiency SHJ solar cells that the emitter grows abruptly as amorphous silicon, instead of as microcrystalline or epitaxial Si. The contact on each side of the cell comprises a thin (< 5 nm) low substrate temperature (~100°C) intrinsic a-Si:H layer, followed by a doped layer. Our intrinsic layers are deposited at 0.3-1.2 nm/s. The doped emitter and back-contact layers were deposited at a higher temperature (>200°C) and grown from PH3/SiH4/H2 and B2H6/SiH4/H2 doping gas mixtures, respectively. This combination of low (intrinsic) and high (doped layer) growth temperatures was optimized by lifetime and surface recombination velocity measurements. Our rapid efficiency advance suggests that HWCVD may have advantages over plasma-enhanced (PE) CVD in fabrication of high-efficiency heterojunction c-Si cells; there is no need for process optimization to avoid plasma damage to the delicate, high-quality, Si wafers.
Molecular Multilayer Organic Solar Cells with Large Excitonic Diffusion Length
- Seunghyup Yoo, William J Potscavage, Benoit Domercq, Sung-Ho Han, Dean Levi, Bernard Kippelen
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- Journal:
- MRS Online Proceedings Library Archive / Volume 965 / 2006
- Published online by Cambridge University Press:
- 26 February 2011, 0965-S11-01
- Print publication:
- 2006
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We report on the photovoltaic properties of organic solar cells based on pentacene and C60 thin films. A peak external quantum efficiency (EQE) of 69 % at a wavelength of λ = 668 nm is achieved upon optimization of the exciton blocking layer (EBL) thickness. Complex optical functions of pentacene films are measured as a function of wavelength by spectroscopic ellipsometry and used to analyze the EQE spectra. Detailed analysis of the EQE spectra indicate that the pentacene layers exhibit large excitonic diffusion lengths of ∼70 nm and that the performance improvement in EQE can be attributed to the influence of the thickness of the EBL layer on the carrier collection efficiency.
Effect of Cu Deficiency on CuIn1-xGaxSe2 and High-efficiency Photovoltaic Solar Cells
- Sung-Ho Han, Falah S. Hasoon, Joel W. Pankow, Allen M. Hermann, Dean H. Levi
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- Journal:
- MRS Online Proceedings Library Archive / Volume 865 / 2005
- Published online by Cambridge University Press:
- 01 February 2011, F1.3
- Print publication:
- 2005
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We report the results of our studies on the optical and electronic structure of a wide range of polycrystalline thin-film CuIn1-xGaxSe2 (CIGS) alloys. The composition range includes CIS and nearly stoichiometric (slightly Cu-poor) (24.3±0.3 at.% Cu) CIGS with x values located around the value that has the best efficiency (x ∼ 0.28). Relative to nearly stoichiometric CIS and CIGS, we find a reduction in the absorption strength in the spectral range 1-3 eV. This reduction can be explained in terms of the predominance of Cu 3d and Se 4p states at the valence band maximum (VBM). In addition, Cu-poor CIS and CIGS materials show an increase in bandgap because the p-d repulsive interaction in Cu-poor CIGS is less than that in nearly stoichiometric CIGS. High efficiency is discussed in terms of optical properties.
11 - Public education and social reconstruction in Bosnia and Herzegovina and Croatia
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- By Sarah Warshauer Freedman, Professor of Education and Research Fellow of the Human Rights Center, The University of California, Berkeley, USA, Dinka Corkalo, Assistant Professor in the Department of Psychology, Faculty of Philosophy, The University of Zagreb, Croatia, Naomi Levy, Graduate student in the Department of Political Science, University of California, Berkeley, USA, Dino Abazovic, Member of the Faculty of Political Sciences and Director of the Center for Human Rights, University of Sarajevo, Bosnia and Herzegovina, Bronwyn Leebaw, Assistant Professor in the Department of Political Science, University of California, Riverside, USA, Dean Ajdukovic, Professor of Psychology and Director of the Postgraduate Psychology Program, University of Zagreb, Croatia, Dino Djipa, Research Director of Prism Research, Sarajevo, Bosnia and Herzegovina, Harvey M. Weinstein, Associate Director of the Human Rights Center and Clinical Professor of Public Health, University of California, Berkeley, USA
- Edited by Eric Stover, University of California, Berkeley, Harvey M. Weinstein, University of California, Berkeley
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- Book:
- My Neighbor, My Enemy
- Published online:
- 05 May 2010
- Print publication:
- 02 December 2004, pp 226-247
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Summary
Throughout history, governments of all political stripes have used history and literature curricula to reinforce national ideologies and identities. The promulgation of official memory through the school system can be an effective form of propaganda. The educational setting can become a conduit for the government or leaders' views, presenting political ideas and beliefs as either “correct” or “incorrect.” Textbooks and curricula can be used to justify or deny past state crimes, create revisionist history, present on-going injustices as natural, or perpetuate attitudes that replicate the conditions under which injustices are committed. Where school systems remain segregated and unequal, education can be manipulated to perpetuate inequalities that are a legacy of past conflicts, dispossession, or repression.
If public education can function to inflame hatreds, mobilize for war, and teach acceptance of injustice, it can be used also as a powerful tool for the cultivation of peace, democratic change, and respect for others. This premise has been a prominent focus of the United Nations (UN) Office of the High Representative (OHR) in Bosnia and Herzegovina (BiH), as well as numerous non-governmental organizations (NGOs) throughout the Balkans and in conflict zones around the world. If children living in divided societies can come together in the schools, this contact can be used to help them question the prejudices and stereotypes in their surrounding environment.
In-situ Observation of Silicon Epitaxy Breakdown with Real-Time Spectroscopic Ellipsometry
- Charles W. Teplin, Dean H. Levi, Qi Wang, Eugene Iwaniczko, Kim M. Jones, Howard M. Branz
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- Journal:
- MRS Online Proceedings Library Archive / Volume 808 / 2004
- Published online by Cambridge University Press:
- 21 March 2011, A5.1
- Print publication:
- 2004
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We use in-situ real-time spectroscopic ellipsometry to observe the breakdown of silicon epitaxy during growth by hot-wire chemical vapor deposition (HWCVD) on Si (100) substrates. Representative data is presented for the two types of epitaxy breakdown that we have observed: 1) an immediate transition to hydrogenated amorphous silicon (a-Si:H), and 2) a slower transition where a-Si:H cones nucleate and grow until they eclipse further epitaxial growth. Simple models, consistent with transmission-electron and atomic-force micrographs, describe the evolution of both types of breakdown showing that real-time spectroscopic ellipsometry is a useful tool for monitoring the growth of epitaxial silicon.
Optical Functions of Thin-Film Polycrystalline Chalcopyrite CuIn1-xGaxSe2
- Sung-Ho Han, Dean H. Levi, Hamda A. Althani, Falah S. Hasoon, Raghu N. Bhattacharya, Allen M. Hermann
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- Journal:
- MRS Online Proceedings Library Archive / Volume 763 / 2003
- Published online by Cambridge University Press:
- 01 February 2011, B1.8
- Print publication:
- 2003
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The highest efficiency CuIn1-xGaxSe2 (CIGS) solar cells use thin-film polycrystalline CIGS absorber layers. We have applied variable angle spectroscopic ellipsometry (VASE) to characterize the dielectric functions of polycrystalline thin films of CIGS with Ga: (In + Ga) ratios ranging from 0.18 to 1.0. The Cu: (In + Ga) ratios in these films are approximately 0.90, which is the ratio that yields the highest efficiency CIGS devices. Spectra were measured over the energy range 0.7 to 5.0 eV at room temperatures. Models used to analyze the ellipsometry data include the full multi-layer structure of the sample, which enables us to report the actual dielectric function rather than the pseudo-dielectric function. We present data on how the critical points change with composition, and compare and contrast our results with measurements of single-crystal and bulk polycrystalline samples reported in the literature. Auger electron spectroscopy, atomic force microscopy, and X-ray diffraction have been used to verify the homogeneity, surface roughness, and phase purity, respectively.
Mapping the Phase-Change Parameter Space of Hot-Wire CVD Si:H Films Using In-Situ Real Time Spectroscopic Ellipsometry
- Dean H. Levi, Brent P. Nelson, John D. Perkins
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- Journal:
- MRS Online Proceedings Library Archive / Volume 715 / 2002
- Published online by Cambridge University Press:
- 01 February 2011, A25.2
- Print publication:
- 2002
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In-situ real-time spectroscopic ellipsometry (RTSE) provides detailed information on the evolution of the structural and optical properties of Si:H films during film growth. We have used in-situ RTSE to characterize the film morphology and crystallinity of hot-wire CVD (HWCVD) Si:H films as a function of hydrogen dilution R=[H]/[H+SiH4], substrate temperature Ts, and film thickness db. Transitions from one mode of film growth to another are indicated by abrupt changes in the magnitude of the surface roughness during film growth. The degree of crystallinity of the film can be determined from the bulk dielectric function. We have studied the growth parameter space consisting of R from 0 to 12, Ts from 150°C to 550°C, and db from 0 to 1 um. For each set of R and Ts values, the structural evolution of the film can be characterized by the shape of the surface roughness thickness ds versus bulk thickness db curve. In contrast to studies done by Collins et al on PECVD growth of Si:H films, our studies of HWCVD growth find no conditions where ds remains constant after coalescence of the initial nucleation centers. Most of the films grown within the range of parameters studied exhibit a secondary nucleation and coalescence signature. The transition between a-Si:H and uc-Si:H growth is near the R=3 to R=4 dividing line. Initial coalescence of purely uc-Si:H material doesn't occur until R>8. We have verified the RTsE crystallinity classification using ex-situ Raman scattering.
Real Time Spectroscopic Ellipsometry of Amorphous Silicon Grown at High Deposition Rates by Hot-Wire CVD
- Brent P. Nelson, Dean H. Levi
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- Journal:
- MRS Online Proceedings Library Archive / Volume 715 / 2002
- Published online by Cambridge University Press:
- 01 February 2011, A17.3
- Print publication:
- 2002
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We use real-time spectroscopic ellipsometry (RTSE) for in-situ characterization of the optical properties and surface roughness (Rs) of hydrogenated amorphous silicon (a-Si:H) grown by hot-wire chemical vapor deposition (HWCVD) with varying deposition rates (5 to 120 Å/s). Early time evolution of the Rs during growth is remarkably similar for all deposition rates. During the first few Ås of growth, there is a sharp increase in Rs as the a-Si:H nucleates in separate islands. This is followed by a reduction of Rs as these areas coalesce into a bulk film, which occurs at an average thickness of 100 Å. After coalescence the Rs rises to a stable value that is dependent upon growth conditions with a general tendency for the Rs to increase with growth rate. However, neither the Rs nor the material electronic properties are unique for a given deposition rate. Films grown under high silane flow and low pressure have a better photoresponse and a lower Rs than films grown at the same deposition rate but with low silane flow and high pressure. We observe a stronger correlation of film properties with Rs than with deposition rate; namely a monotonic decrease in photo-response, and increase in optical gap, with increasing Rs.