BACKGROUND:The effect of a shared decision-making approach on patients' code status decisions remains unknown. We compared an approach for shared decision-making with usual care to evaluate the effect on patients' code status preferences and quality of decision-making. METHODS:In a pragmatic cluster-randomized controlled trial conducted in six teaching hospitals in Switzerland, we randomly assigned residents to conduct code status discussions based on either an approach incorporating didactic teaching, observation, and feedback and a shared decision-making checklist with a decision aid, or usual care. The primary end point was patients choosing a do-not-resuscitate (DNR) code status in the event of a cardiac arrest. The key secondary end point was patients' decisional uncertainty, measured by the Decisional Conflict Scale (range 0 to 100, with lower scores indicating lower decisional uncertainty). RESULTS:A total of 206 residents caring for 2663 medical patients were included in the trial. Compared with patients in the usual care group, patients in the intervention group had a significantly higher frequency of choosing DNR as their code status (685/1370 (50.0%) vs. 481/1293 (37.2%); adjusted risk ratio, 1.37 (95% confidence interval, 1.25 to 1.50); P<0.001). The intervention was associated with lower decisional uncertainty (Decisional Conflict Scale score, 14.4±15.3 vs. 21.8±20.2 points; adjusted difference, -7.06 (95% confidence interval, -9.43 to -4.68). CONCLUSIONS:An approach for shared decision-making that included the discussion of expected outcomes had a significant influence on the code status of medical patients, with a higher preference for DNR code status, and was associated with less uncertainty around the decision. (Funded by the Swiss National Science Foundation and the Swiss Society of General Internal Medicine; ClinicalTrials.gov number, NCT03872154.).

Thermal oxidation is a key step for the fabrication of vertical gate-all-around nanowire field-effect transistors (GAA-NW-FETs). It is used after the etching of nanopillars from the silicon substrate to further thin the nanowire diameter, remove the etching damage and have good control of the geometry. It can also be used to grow a gate oxide. Thermal oxidation of silicon nanowires is a self-limiting process. Self-limiting effects, which are due to the mechanical stress in the structure, need to be accurately modeled to obtain predictive simulations of nanowire geometry, and so of the GAA-NW-FET channel dimensions, after thermal oxidation. Moreover, boron segregation during thermal oxidation into the growing oxide results in a considerable dopant loss from the nanowire. Correct modeling of such effects is also paramount for the investigation and simulation of the electrical characteristics of nanowire transistors, especially for p-type junctionless GAA-NW-FETs. In this work, we present a comparison of 2D and 3D TCAD process simulations of the oxidation of silicon nanowires with experimental data. Based on that, we suggest novel sets of calibrated parameters for stress-dependent oxidation, relevant particularly for nanowire diameters below 60 nm, and for boron segregation.

This multi-partner-project contribution introduces the midway results of the Horizon 2020 FVLLMONTI project. In this project we develop a new and ultra-efficient class of ANN accelerators, the neural network compute cube ((NC2)-C-2), which is specifically designed to execute complex machine learning tasks in a 3D technology, in order to provide the high computing power and ultra-high efficiency needed for future edgeAI applications. We showcase its effectiveness by targeting the challenging class of Transformer ANNs, tailored for Automatic Speech Recognition and Machine Translation, the two fundamental components of speech-to-speech translation. To gain the full benefit of the accelerator design, we develop disruptive vertical transistor technologies and execute design-technology-co-optimization (DTCO) loops from single device, to cell and compute cube level. Further, a hardware-software-co-optimization is executed, e.g. by compressing the executed speech recognition and translation models for energy efficient executing without substantial loss in precision.

Background:The standard of care for Lassa fever is the use of ribavirin with supportive therapy. There is little information on the course of viremia and its relationship with clinical outcomes in patients treated with ribavirin. Methods:We conducted a retrospective analysis of virologic and clinical parameters of 152 reverse transcription polymerase chain reaction-confirmed Lassa fever cases admitted and treated with ribavirin therapy. We describe the Lassa virus RNA kinetics in blood in relation to the clinical course of the patients. Results:The overall mortality was 9%. The median duration (interquartile range [IQR]) of illness before admission was 8 (5-12) days. Median (IQR) Ct values on admission (t0 ) were lower among patients who died (21 [20-27]) than in those who survived (34 [30-37]; P < .01). The receiver operating characteristics curve of the association between outcome and Ct value at t0 had a high classification performance, with an AUC of 0.92 (95% CI, 0.86-0.98). The median time to viral clearance (IQR) was 10 (5-15) days. The viral load decreased steadily with the duration of treatment, and all survivors achieved viral clearance within 25 days of hospitalization. Conclusions:Our study demonstrates that the Ct value on admission has prognostic value and Lassa fever patients treated with ribavirin typically clear the virus within 3-4 weeks of hospitalization. This kinetics has implications for the design of clinical case management and future clinical trial protocols.

Lassa virus (LASV) outbreaks in West Africa pose a significant public health threat. We investigated the infection phenotype and transmission (horizontal and vertical) of LASV strain Ba366 in its natural host, Mastomys natalensis. Here we analyze viral RNA levels in body fluids, virus titers in organs and antibody presence in blood. In adults and 2-week-old animals, LASV causes transient infections with subsequent seroconversion. However, mice younger than two weeks exhibit persistent infections lasting up to 16 months despite antibody presence. LASV can be detected in various body fluids, organs, and cell types, primarily in lung, kidney, and gonadal epithelial cells. Despite the systemic virus presence, no pathological alterations in organs are observed. Infected animals efficiently transmit the virus throughout their lives. Our findings underscore the crucial role of persistently infected individuals, particularly infected females and their progeny, in LASV dissemination within the host population. Mastomys natalensis, a mouse found closely to rural human dwellings in Sub-Saharan Africa, is a major reservoir for Lassa Virus (LASV). Here, the authors show that LASV causes transient infections in adult M. natalensis, but persistent infections in young animals despite antibodies. LASV is found in various organs without causing pathology and infected animals efficiently transmit the virus.

Ultraviolet nanosecond laser annealing (UV‐NLA) proves to be an important technique, particularly when tightly controlled heating and melting are necessary. In the realm of semiconductor technologies, the significance of NLA grows in tandem with the escalating intricacy of integration schemes in nanoscaled devices. Silicon–germanium alloys are studied for decades for their compatibility with silicon devices. Indeed, they enable the manipulation of properties like strain, carrier mobilities, and bandgap. In this framework, they can for instance boost the performances of p‐type MOSFETs but also enable near infrared absorption and emission for applications in photodetection and photonics. Laser melting on such types of layers, however, results, up to now, in the development of extended defects and poor control over layer morphology and homogeneity. Herein, the laser melting of ≈700 nm‐thick relaxed silicon–germanium samples coated with SiO2 nanoarrays, observing the resulting material to maintain an unaltered lattice, is investigated. It is found that the geometrical parameters of the silicon oxide have an impact on the thermal budget samples, influencing melt threshold, melt depth, and germanium distribution.

IntroductionAdvances in spine surgery enable safe interventions in elderly patients, but perioperative neurocognitive disorders (pNCD), such as post-operative delirium (POD) and cognitive dysfunction (POCD), remain a serious concern. Pre-operative cognitive impairment is a major risk factor for pNCD. Comprehensive pre-operative cognitive assessments are not feasible in clinical practice, making effective screening methods desirable. This study investigates whether pre-operative cerebrovascular duplex sonography can assess subcortical (vascular) cognitive impairment and the risk for POD.MethodsThis prospective single-center study recruited patients aged ≥60 years scheduled for elective spine surgery at a German university hospital. Patients underwent pre-operative assessments including cognitive abilities (CERAD test battery), structural MRI, and cerebrovascular duplex sonography. POD screening was conducted three times daily for at least 3 days. The primary hypothesis, that the mean pulsatility index (PI) of both internal carotid arteries (ICA) predicts POD risk, was tested using logistic regression. Secondary analyses examined the association between POD risk and ICA flow (time-averaged peak velocities, TAPV) and correlations with cognitive profiles and MRI characteristics.ResultsPOD occurred in 22% of patients (n = 22/99) within three postoperative days. Patients with POD were significantly older (75.9 ± 5.4 vs. 70.0 ± 6.9 years, p < 0.01) but did not differ by gender (p = 0.51). ICA PI significantly predicted POD risk (OR = 5.46 [95%CI: 1.81–16.49], p = 0.003), which remained significant after adjustment for age and duration of surgery (ORadj = 6.38 [95% CI: 1.77–23.03], p = 0.005). TAPV did not inform the POD risk (p = 0.68). ICA PI Pre-operative cognitive scores were significantly associated with ICA PI (mean CERAD score: r = −0.32, p < 0.001). ICA PI was also significantly associated with total white matter lesion volume (τ = 0.19, p = 0.012) and periventricular white matter lesion volume (τ = 0.21, p = 0.007).DiscussionThis is the first study to demonstrate that cerebrovascular duplex sonography can assess the risk for POD in elderly spine surgery patients. Increased ICA PI may indicate subcortical impairment, larger white matter lesion load, and lower white matter volume, predisposing factors for POD. Pre-operative cerebrovascular duplex sonography of the ICA is widely available, easy-to-use, and efficient, offering a promising screening method for POD risk. Increased ICA PI could supplement established predictors like age to adjust surgical and peri-operative procedures to individual risk profiles.

Background Patients may prefer different levels of involvement in decision-making regarding their medical care which may influence their medical knowledge. Objective We investigated associations of patients’ decisional control preference (DCP) with their medical knowledge, ward round performance measures (e.g., duration, occurrence of sensitive topics), and perceived quality of care measures (e.g., trust in the healthcare team, satisfaction with hospital stay). Design This is a secondary analysis of a randomized controlled multicenter trial conducted between 2017 and 2019 at 3 Swiss teaching hospitals. Participants Adult patients that were hospitalized for inpatient care. Main Measures The primary outcome was patients’ subjective average knowledge of their medical care (rated on a visual analog scale from 0 to 100). We classified patients as active, collaborative, and passive according to the Control Preference Scale. Data collection was performed before, during, and after the ward round. Key Results Among the 761 included patients, those with a passive DCP had a similar subjective average (mean ± SD) knowledge (81.3 ± 19.4 points) compared to patients with a collaborative DCP (78.7 ± 20.3 points) and active DCP (81.3 ± 21.5 points), p = 0.25. Regarding patients’ trust in physicians and nurses, we found that patients with an active vs. passive DCP reported significantly less trust in physicians (adjusted difference, − 5.08 [95% CI, − 8.69 to − 1.48 points], p = 0.006) and in nurses (adjusted difference, − 3.41 [95% CI, − 6.51 to − 0.31 points], p = 0.031). Also, patients with an active vs. passive DCP were significantly less satisfied with their hospital stay (adjusted difference, − 7.17 [95% CI, − 11.01 to − 3.34 points], p < 0.001). Conclusion Patients with active DCP have lower trust in the healthcare team and lower overall satisfaction despite similar perceived medical knowledge. The knowledge of a patient’s DCP may help to individualize patient-centered care. A personalized approach may improve the patient-physician relationship and increase patients’ satisfaction with medical care. Trial Registration ClinicalTrials.gov (NCT03210987).

Light emission of europium (Eu 3+ ) ions placed in the vicinity of optically resonant nanoantennas is usually controlled by tailoring the local density of photon states (LDOS). We show that the polarization and shape of the excitation beam can also be used to manipulate light emission, as azimuthally or radially polarized cylindrical vector beam offers to spatially shape the electric and magnetic fields, in addition to the effect of silicon nanorings (Si-NRs) used as nanoantennas. The photoluminescence (PL) mappings of the Eu 3+ transitions and the Si phonon mappings are strongly dependent of both the excitation beam and the Si-NR dimensions. The experimental results of Raman scattering and photoluminescence are confirmed by numerical simulations of the near-field intensity in the Si nanoantenna and in the Eu 3+ -doped film, respectively. The branching ratios obtained from the experimental PL maps also reveal a redistribution of the electric and magnetic emission channels. Our results show that it could be possible to spatially control both electric and magnetic dipolar emission of Eu 3+ ions by switching the laser beam polarization, hence the near field at the excitation wavelength, and the electric and magnetic LDOS at the emission wavelength. This paves the way for optimized geometries taking advantage of both excitation and emission processes.

Communication of “bad news” (such as a new cancer diagnosis) to patients may have a major impact on their well-being. We aimed to investigate differences in psychological distress of breaking bad news in person compared to by telephone in a systematic review and meta-analysis. We included all studies that investigated breaking bad news (such as a new cancer diagnosis or genetic risk for life-limiting diseases) in person compared to by telephone in adult patients regardless of diagnosis regarding the association with symptoms of anxiety, depression or post-traumatic stress disorder. We systematically searched PubMed, Embase, PsycINFO and CINAHL from the inception of each database to June 1, 2021. We included randomized and non-randomized trials. We screened 3625 studies and included eleven studies in the qualitative analysis and nine in the meta-analyses, including four randomized controlled trials. Overall, quality of studies was moderate to good. There was no mean difference regarding psychological distress when bad news was disclosed by telephone compared to in person with similar symptom levels of anxiety (3 studies, 285 participants; standardized mean difference [SMD] 0.10 [95% CI -0.15 to 0.35]), depression (3 studies, 248 participants; SMD 0.10 [95% CI -0.30 to 0.49]), and symptom levels of PTSD (2 studies, 171 participants; SMD -0.01 [95% CI -0.48 to 0.36]). Results: were similar for satisfaction with care. We did not find a difference in psychological distress if breaking bad news was done in person or by telephone but there were too few studies to draw more definite conclusions. Future research is needed to understand in which situation a telephone consultation is appropriate to disclose bad news with a patient.

In this article, we present the first detailed experimental study of electrothermal effects in 3-D vertical gate-all-around (GAA) junctionless nanowire transistors (JLNTs). In contrast with conventional CMOS technologies, JLNTs exhibit steady increase of current with temperature owing to weak mobility degradation in the highly doped nanowires. Consequently, in this work, we proposed novel experimental methods for extracting thermal resistance using dc and low-frequency (LF) S-parameter measurements. Experimental results obtained from different methods are validated against theoretical as well as simulated values obtained from multiphysics simulation of JLNTs.

Study Design. Prospective quasi-experimental observational study. Objective. The objective of this study was to evaluate whether duration of surgery is a modifiable risk factor for postoperative delirium (POD) after spine surgery and explore further modifiable risk factors. In addition, we sought to investigate the association between POD and postoperative cognitive dysfunction and persistent neurocognitive disorders. Summary of Background Data. Advances in spine surgery enable technically safe interventions in elderly patients with disabling spine disease. The occurrence of POD and delayed neurocognitive complications (e.g. postoperative cognitive dysfunction/persistent neurocognitive disorder) remain a concern since these contribute to inferior functional outcomes and long-term care dependency after spine surgery. Materials and Methods. This prospective single-center study recruited patients aged 60 years or above and scheduled for elective spine surgery between February 2018 and March 2020. Functional (Barthel Index, BI) and cognitive outcomes [Consortium to Establish a Registry for Alzheimer’s Disease (CERAD) test battery; telephone Montréal Cognitive Assessment] were assessed at baseline, three (V3), and 12 months postoperatively. The primary hypothesis was that the duration of surgery predicts POD. Multivariable predictive models of POD included surgical and anesthesiological parameters. Results. Twenty-two percent of patients developed POD (n=22/99). In a multivariable model, duration of surgery [ORadj=1.61/h (95% CI, 1.20–2.30)], age [ORadj=1.22/yr (95% CI, 1.10–1.36)], and baseline deviations of intraoperative systolic blood pressure [25th percentile: ORadj=0.94/mm Hg (95% CI, 0.89–0.99); 90th percentile: ORadj=1.07/mm Hg (95% CI, 1.01–1.14)] were significantly associated with POD. Postoperative cognitive scores generally improved (V3, ΔCERAD total z-score: 0.22±0.63). However, this positive group effect was counteracted by POD [beta: −0.87 (95% CI, −1.31 to 0.42)], older age [beta: −0.03/yr (95% CI, −0.05 to 0.01)], and lack of functional improvement [ΔBI; beta: −0.04/point (95% CI, −0.06 to 0.02)]. Cognitive scores at twelve months remained inferior in the POD group, adjusted for baseline cognition/age. Conclusions. This study identified distinct neurocognitive effects after spine surgery, which are influenced by perioperative risk factors. Potential cognitive benefits are counteracted by POD, rendering its prevention critical in an aging population.

Background Communicating bad news such as a new cancer diagnosis to patients may have a major impact on their well-being. We investigated differences in patients’ psychological distress due to the disclosure of bad news by telephone compared to in person in a systematic review and meta-analysis. Methods We included all studies that investigated anxiety, depressive or post-traumatic stress disorder (PTSD) symptoms in adult patients in whom bad news by telephone compared to in person were disclosed. We systematically searched PubMed, Embase, PsycINFO and CINAHL from the inception of each database to October 18, 2022. We included randomized and non-randomized trials. Results We screened 5944 studies and included 11 studies in the qualitative analysis and 9 in the meta-analyses, including four randomized controlled trials. Overall, the quality of studies was moderate to good. There was no difference regarding psychological distress when bad news was disclosed by telephone compared to in person with similar symptom levels of anxiety (3 studies, 285 participants; standardized mean difference [SMD] 0.10 [95% CI -0.15 to 0.35]), depression (3 studies, 284 participants; SMD 0.10 [95% CI -0.30 to 0.49]), and PTSD (2 studies, 171 participants; SMD -0.01 [95% CI -0.48 to 0.36]). Results were similar for satisfaction with care. Discussion This meta-analysis found no difference regarding psychological distress regardless if bad news were disclosed by telephone or in person, but there were overall only few and heterogeneous studies with a small number of eligible patients. The findings suggest that the modality of disclosure might play a secondary role and the way in which the bad news are communicated might be more important.

Today, extensive research has focused on heat propagation in emerging nanoelectronic devices. With advances in the fabrication of nanowire (NW) transistors, thermal management has become a critical issue in cooling strategies and conducting materials. In this article, we present a novel multiphysics analysis of the nanoscale thermal transport in 18-nm vertical junctionless gate-all-around (GAA) silicon NW transistors. Based on this multiphysics analysis, we developed a new computational model derived from the Guyer–Krumhansl equation (GKE) for describing heat transport within the nanoscale device. Our simulations results agree well with available theoretical approaches as well as measurement data.

Optical Mie resonators based on silicon nanostructures allow tuning of light-matter-interaction with advanced design concepts based on complementary metal–oxide–semiconductor (CMOS) compatible nanofabrication. Optically active materials such as transition-metal dichalcogenide (TMD) monolayers can be placed in the near-field region of such Mie resonators. Here, we experimentally demonstrate and verify by numerical simulations coupling between a MoSe 2 monolayer and the near-field of dielectric nanoresonators. Through a comparison of dark-field (DF) scattering spectroscopy and photoluminescence excitation experiments (PLE), we show that the MoSe 2 absorption can be enhanced via the near-field of a nanoresonator. We demonstrate spectral tuning of the absorption via the geometry of individual Mie resonators. We show that we indeed access the optical near-field of the nanoresonators, by measuring a spectral shift between the typical near-field resonances in PLE compared to the far-field resonances in DF scattering. Our results prove that using MoSe 2 as an active probe allows accessing the optical near-field above photonic nanostructures, providing complementary information to sophisticated near-field microscopy equipment.

Gate-all-around (GAA) transistors are anticipated to have a substantial impact in achieving logic scaling in the nanometer technology node range, serving as a substitute for the current FinFET technology which lacks acceptable immunity against short channel effect at such miniaturization. GAA transistors offer several advantages over older transistor designs, such as better performance, lower leakage, and reduced energy consumption. This makes them a more sustainable and environmentally friendly alternative to current architectures. In term of integration, vertical gate-all-around devices offer extreme density capability, surpassing equivalent planar technologies. Nevertheless, the development of vertical technology requires rethinking the entire development chain from design to technology. Here, we will present an overview of this technology with a particular focus on the engineering of 3D nanostructured channels and on the integration of S/D contacts on such vertical channels.

The development of non-planar structures such as arrays of nanowires (NWs), poses a significant challenge for dopant concentration determination. Techniques that can be readily used for 3D structures usually lack the desired sensitivity whereas secondary ion mass spectrometry (SIMS), known for its excellent detection limits, is designed to analyze flat samples. In this work, we overcome the limitation of standard SIMS approaches. NWs are covered with photoresist forming a flat surface. For high incident angle bombardment, the sputtering process becomes self-flattening, i.e. the ions collide with the sidewalls of the exposed tips of NWs at much lower angles and sputter them significantly faster. Thus, reliable information about the dopant distribution along the height of NWs can be obtained. The SIMS analysis can be performed on an array of 1000 x 1000 nanowires with a detection limit of about 5 x 1016 atoms/cm3 and a reasonable signal-to-noise ratio of about 10 dB.

Spatially-disaggregated projections of new solar photovoltaic (PV) installations are essential for planning electricity grids and managing the electricity system at large scale. Such projections at sub-national level can be obtained by statistical models or by electricity system optimization models, but there is barely any study that compares the performances of these approaches. This study aims to compare methods for projecting PV installations at a level of 143 districts in Switzerland, using a simple extrapolation method (as a benchmark of the common practice today), a multiple linear regression model, two spatial regression models, and a spatially-explicit optimization model (EXPANSE) with various features to account for policy. The performance of different approaches is evaluated retrospectively for 2012–2020, using multiple accuracy indicators. The evaluation results show that statistical regression models, which account for socio-demographic and techno-economic characteristics as predictors of future PV growth, overall perform better than simple extrapolation or optimization. Although commonly used, extrapolation has the highest variability in accuracy, indicating the least robust performance. The optimization model tends to underestimate PV installations in its least-cost scenarios, if the role of policy is not considered. Incorporating solar PV policies and renewable electricity generation targets increases the overall accuracy of the optimization model at a national level, but not necessarily at a spatially-explicit level. We thus conclude that statistical models are preferred over extrapolation or optimization models for projecting future PV installations at a sub-national scale.

Devolvement of high-performance logic application in sub-20 nm technology node has gained significant attention due to their improved electrostatic and thermal control. In this work, we investigate electro-thermal transport in vertical junctionless nanowire transistors (VNWFET) at cryogenic temperatures to understand thermal effects in nanoscale regime. It highlights that heat dissipation and thermal stability are more efficient compared to planar Finfet configuration.