High Incident Research Articles

571 Ethnicity and Etiology in Burn Patients for the American Burn Association National Burn Repository (NBR)

IntroductionThe purpose of this study was to analyze data from the American Burn Association National Burn Repository (NBR)with particular focus on patient ethnicity and burn etiology. We hypothesize that burn etiology, severity and other characteristics will be significantly different between differing ethnic groups throughout the database. This information can be used to augment burn prevention strategies by targeting at risk ethnic groups.MethodsData on burn patients was derived from the American Burn Association National Burn Registry including all burn entries for a 10 year period (2009 to 2018) from 46 burn centers. The ethnic categories for this study were White, Black, Hispanic, Indigenous and Asian. The study also involved analysis of patient demographics, burn severity, context of injury, and hospital course.ResultsWhite patients were the largest group (64.0%), had the highest proportion of flame injury (53.1%) and shared the highest mortality rate with indigenous patients (3.1% compared with 2.6% for all other ethnicities). Black individuals (22.2%) had higher rates of scald burns (53.2%), the shortest average hospital stay (16.8 days) and along with indigenous patients the highest rates of assault/abuse (2.0% and 1.9% respectively). Hispanic patients (10.0%) had more scald burns (47%), the largest proportion of men (66.5%), the highest incident of work-related injuries (18.0%) and the largest average TBSA at 10.1%. Asian patients (2.7%) had the largest proportion of scald injury (63.1%) and the smallest proportion of male patients (54.5%). Indigenous patients (1.1%) had higher rates of flame burns, suffered full thickness burns at the highest rate (32.8%), had the longest average stays in hospital (21) and the ICU (15) and had the highest rates of blanks for data entry.ConclusionsThis study found multiple significant differences in burn populations when compared by ethnicity. We have found that the indigenous population suffered full thickness burns at the highest rate and have had the longest average hospital stay as well average ICU stay. We have also had the unexpected finding of higher rates of unknowns in the indigenous population which may reflect racial bias at an institutional level nationally.

The association between social network index, atrial fibrillation, and mortality in the Framingham Heart Study

Social isolation might be considered as a marker of poor health and higher mortality. The aim of our analysis was to assess the association of social network index (SNI) with incident AF and death. We selected participants aged ≥ 55 years without prevalent AF from the Framingham Heart Study. We evaluated the association between social isolation measured by the Berkman-Syme Social Network Index (SNI), incident AF, and mortality without diagnosed AF. We assessed the risk factor-adjusted associations between SNI (the sum of 4 components: marriage status, close friends/relatives, religious service attendance, social group participation), incident AF, and mortality without AF by using Fine-Gray competing risk regression models. We secondarily examined the outcome of all-cause mortality. We included 3454 participants (mean age 67 ± 10 years, 58% female). During 11.8 ± 5.2 mean years of follow-up, there were 686 incident AF cases and 965 mortality without AF events. Individuals with fewer connections had lower rates of incident AF (P = 0.04) but higher rates of mortality without AF (P = 0.03). Among SNI components, only social group participation was associated with higher incident AF (subdistribution hazards ratio [sHR] 1.35, 95% CI 1.16–1.57, P = 0.0001). For mortality without AF, social group participation (sHR = 0.81, 95% CI 0.71–0.93, P = 0.002) and regular religious service attendance sHR = 0.76, 95% CI 0.67–0.87, P < 0.0001) were associated with lower risk of death. Social isolation was associated with a higher rate of mortality without diagnosed AF. In contrast to our hypothesis, we observed that poor social connectedness was associated with a lower rate of incident AF. This finding should be interpreted cautiously since there were very few participants in the lowest social connectedness group. Additionally, the seemingly protective effect of social isolation on AF incidence may be simply an artifact of the strong association between social isolation and increased mortality rate in combination with the large number of deaths as compared to AF events in our study. Further study is warranted.

Characterization of 128 × 128 MM-PAD-2.1 ASIC: a fast framing hard x-ray detector with high dynamic range

We characterize a new x-ray Mixed-Mode Pixel Array Detector (MM-PAD-2.1) Application Specific Integrated Circuit (ASIC). Using an integrating pixel front-end with dynamic charge removal architecture, the MM-PAD-2.1 ASIC extends the maximum measurable x-ray signal (in 20 keV photon units) to > 107 x-rays/pixel/frame while maintaining a low read noise across the full dynamic range, all while imaging continuously at a frame rate of up to 10 kHz. The in-pixel dynamic charge removal mechanism prevents saturation of the input amplifier and proceeds in parallel with signal integration to achieve deadtime-less measurements with incident x-ray rates of > 1010 x-rays/pixel/s. The ASIC format consists of 128 × 128 square pixels each 150 μm on a side and is designed to be 3-side buttable so large arrays can be effectively tiled. Here we use both laboratory x-ray sources and the Cornell High Energy Synchrotron Source (CHESS) to characterize two single ASIC prototype detectors for both low (single x-ray) and high incident flux detection. In the first detector the ASIC was solder bump-bonded to a 500 μm thick Si sensor for efficient detection of x-rays below 20 keV, whereas the second detector used a 750 μm thick CdTe sensor for x-rays above ∼ 20 keV.

Down‐conversion materials for organic solar cells: Progress, challenges, and perspectives

AbstractOrganic solar cells (OSCs) in terms of power conversion efficiency (PCE) and operational lifetime have made remarkable progress during the last decade by improving the active layer materials and introducing new interlayers. The newly developed wide bandgap organic donor and low bandgap acceptor molecules covered the absorption from the visible to the near‐infrared region. Whereas the incident high energy region (UV) is not in favor of OSCs. Its absorption causes thermalization losses and photoinduced degradation, which hinders the PCE and lifetime of OSCs. Recently, lanthanide and non‐lanthanide‐based down‐conversion (DC) materials have been introduced, which can effectively convert the high‐energy photons (UV) to low‐energy photons (visible) and resolve the spectral mismatch losses that limit the absorption of OSCs in high energy incident spectrum. Furthermore, the DC materials also protect the OSCs from UV‐induced degradation. The DC materials were also proposed to cross the Shockley‐Queisser efficiency limit of the solar cell. In this review, the need for DC materials and their processing method for OSCs have been thoroughly discussed. However, the main emphasis has been given to developing lanthanides and non‐lanthanides‐based DC materials for OSCs, their applications, and their impact on photovoltaic device performance, stability, and future perspectives.

Editorial

In 1957 I was a school age kid attendingsegregated schools in NorthCarolina and barely understood whatwas occurring at Central High in LittleRock, Arkansas. Nine Arkansas highschools students decided to go to school,and to get to school safely, PresidentEisenhower had to enlist the services ofthe 101st Air Borne Division and a federalizedU.S. National Guard. I wasseven at the time and on that day, I roadto school in a bus and was guarded onlyby my taunting ten year old brother andthe supervision of community values. Itwas another ten years before the schoolsI attended opened their doors to allAmericans and it wasn’t until 1979 thatthe first seniors graduated from my highschool having never attended raciallysegregated schools. This edition of JITPcommemorates two very important anniversaries.First, it is the 50th anniversaryof the Central High incident. Second, itis the 25th anniversary of the Alliance forInvitational Education.

A Novel Coagulation Classification and Postoperative Bleeding in Severe Spontaneous Intracerebral Hemorrhage Patients on Antiplatelet Therapy.

Background and PurposeFor patients with severe spontaneous intracerebral hemorrhage on antiplatelet therapy (patients with APT-SICH), postoperative rebleeding (PR) is an important cause of poor outcomes after surgery. As impacted by coagulation disorder caused by APT, patients with APT-SICH are likely to suffer from PR. This study aimed to assess the risk of PR in patients with APT-SICH receiving emergency surgery using a novel coagulation classification.MethodsThis prospective, multicenter cohort study consecutively selected patients with APT-SICH between September 2019 and March 2021. The preoperative coagulation factor function was recorded, and the platelet function was assessed using thrombelastography. Based on platelet and coagulation factor function, a novel four-type coagulation classification, i.e., Type I (severe coagulation disorder), Type IIa (low platelet reserve capacity), Type IIb (normal coagulation), and Type III (hypercoagulation), was presented. The primary outcome was PR, defined as the rebleeding in the operative region or new intracerebral hemorrhage correlated with the operation.ResultsOf the included 197 patients with APT-SICH, PR occurred in 40 patients (20.3%). The novel coagulation classification categorized 28, 32, 122, and 15 patients into Type I, Type IIa, Type IIb, and Type III, respectively. The Type I patients had the highest incident rate of PR (39.3 per 100 persons), followed by the Type IIa patients (31.3 per 100 persons). In the PR-related analysis, the large hematoma volume (hazard ratio (HR): 1.02; 95% CI: 1.02–1.03; p < 0.001), Type I (HR: 9.72; 95% CI: 1.19–79.67; p = 0.034), and Type IIa (HR: 8.70; 95% CI: 1.09–69.61; p = 0.041) were correlated with the highest risk of PR. The coagulation classification could discriminate the PR patients from no PR (NPR) patients (p < 0.001), and it outperformed the conventional coagulation assessment (only considering platelet count and coagulation factor function) (c-statistic, 0.72 vs. 0.55).ConclusionThe novel coagulation classification could discriminate the patients with APT-SICH with the highest risk of PR preoperatively. For the Type I and Type IIa patients, emergency surgery should be performed carefully.

Inclusive electron scattering in the quasielastic region with the Korea-IBS-Daegu-SKKU density functional

With the framework of KIDS (Korea-IBS-Daegu-SKKU) density functional model, the isoscalar and isovector effective masses of nucleon and the effect of symmetry energy in nuclear medium are investigated in inclusive $(e,e')$ reaction in quasielastic region. The effective masses are varied in the range $(0.7 \sim 1.0)M$ with free nucleon mass $M$, and the symmetry energy is varied within the uncertainty allowed by nuclear data and neutron star observation. The wave functions of nucleons inside target nucleus are generated by solving Hartree-Fock equation with adjusting equation of state, binding energy and radius of various stable nuclei, and effective mass of nucleon in the KIDS model. With the obtained wave functions, we calculate the differential cross section for the inclusive $(e,e')$ reaction and compare the theoretical results with Bates, Saclay, and SLAC experimental data. Our model describes experimental data better at SLAC-type high incident electron energy than those measured from Bates and Saclay. The influence of the effective mass and symmetry energy appears to be precise on the longitudinal cross section.

Innovative liner concept using friction powder for increasing of broadband noise absorption. Applications for broadband noise absorption in fan duct

This paper presents research related influence of friction powders on enlarging the absorption band of acoustic liners used for reduction of tonal noise in fan duct of aero-engine. Kundt tube measurements done at COMOTI using fine powders (granules) made of various light-weight materials placed in the honeycomb cells of SDOF liners have shown a considerable broadening of the absorbed band of frequencies without a significant decreasing of absorption at the resonance frequency. Although the phenomenon is generally present for any type of powder, it was observed that for some powders the absorption is higher than for others. On the other hand, it was observed that the effect of the filling percentage of the cavity is important. Then, experiments done at the grazing flow facility of CNRS-Le Mans University have shown that the phenomenon is also present for high acoustic incident levels (up to 140dB) and M=0.13 while it still depends by the nature of powder material. The best results were obtained for the cork powder when the honeycomb is filled with powder at 66% of its height. For this material, the broadening of the transmission loss well was maximum. This phenomenon could be explained by the apparition of friction between powder granules which are taking place at very low scale consuming the noise power on a broader range of frequencies. It is supposed that the friction between the particles of powder have major influence because the best noise absorption was obtained for powders with a large distribution of particles’ dimensions while for particles with a small dimensional distribution (expanded polyester balls, for example) the transmission well broadening was smaller. The friction powders technology is simple and can be easily adapted to existing acoustic liner technologies with small manufacturing costs. This feature is conferred by the fact that powders can be easily poured in the honeycombs at the required height. The friction powder technology can be applied not only for the fan duct. In future, it could also be applied for reduction of jet noise reflected by pressure side of wing and for cabin noise reduction.

The Queerness of Touch: Mutual Recognition and Deep Intimacy in Moonlight

The Queerness of Touch: Mutual Recognition and Deep Intimacy in <i>Moonlight</i>

Large enhancement of total reaction cross sections at the edge of the island of inversion in Ti, Cr, and Fe isotopes

A systematic analysis of nuclear deformation is made for neutron-rich Ti, Cr, and Fe isotopes to explore the nuclear structure in the island of inversion near N = 40, where strong nuclear deformation is predicted. The nuclear ground states are obtained by the Skyrme Hartree-Fock method in three-dimensional coordinate space, which properly describes any nuclear shape. Three types of Skyrme interactions are employed to generate various deformed states in its isotopic chain. We find that in the island of inversion the occupation of highly elongated intruder orbits induces not only large quadrupole deformation but also large hexadecapole deformation. This appears as a sizable enhancement of the nuclear matter radius, showing the characteristic shell effect of the density profile near the nuclear surface. We show that the edge of the island of inversion, where the intruder orbit starts being occupied, can be determined by measuring the enhancement of the total reaction cross section at high incident energy. The possibility of constraining the hexadecapole deformation by a measurement of the total reaction cross sections is discussed.

Polarization and incidence insensitive analogue of electromagnetically induced reflection metamaterial with high group delay.

In this work, we demonstrate an analogue of electromagnetically induced reflection (EIR) effect with hybrid structure consisting of a silica (SiO2) square array layer embedded in graphene-dielectric-Au film constructed F-P cavity. It is shown that the SiO2 square array and F-P cavity create transverse waveguide with high quality factor (Q-factor) and longitudinal F-P modes, and their destructive interference effectively forms the EIR-like effect, which benefits for obtaining high group delay. In addition, the C4 symmetric structure ensures the polarization-independent for this EIR-like effect. With high Q-factor at the reflection window, the ultra-high group delay as high as 245 ps can be obtained. This structure will be useful to develop the EIT-like devices with excellent performance such as high group delay, polarization and incident insensitivity, and environmental stability.

After Action Report: Lessons Learned From Simulating Unified Command In Response to an Active Shooter Incident Using a Command Competency Laboratory.

On October 10, 2019, the Loudoun County Sheriff's Office (LCSO) and Loudoun County Fire and Rescue (LCFR) led one of the largest act of violence (AVI) exercises ever conducted in Loudoun County, Virginia. Over 300 participants and 50 role-players participated across 15 county departments and agencies within Loudoun County. The exercise identified an important recommendation: "future joint unified command trainings are needed throughout the fire and law enforcement command structures." Effective, unified command is an essential NFPA 3000 principle of responding to an AVI. "The success or failure of the response will hinge on the quality of unified command." After-action reports from AVIs across the United States emphasized the importance of unified command. A second exercise recommendation proposed "a joint AVI unified command competency scenario between LCFR and LCSO should be developed and delivered across all levels of supervision... this scenario should demonstrate 'best practices' for establishing and operating unified command between LCFR and LCSO." The authors developed two active shooter command competency simulations that require LCSO and LCFR to form unified command and manage the initial response. The simulations reinforced accepted response practices, such as identification of cold/warm/hot zones, early unified command, rescue task force team deployment, and protected corridor establishment. The simulations were packaged into a unified command competency training and simulation program. Through the facilitated debriefings with participants and facilitator debriefs, three types of lessons learned were identified: 1) high threat incident response lessons, 2) lessons for conducting AVIs in the command competency lab, and 3) active threat operational considerations for command officers.

Study of Electron Impact Ionization Cross-Sections of Nitrogen Molecule by Inelastic Collision

In this article, the calculation of ionization cross-section of N2 molecule by electron impact is reviewed. The work on ionization cross-sections from threshold to high (10 KeV) incident electron energies are calculated and their applications are discussed. To find exact values of total ionization cross-sections for the N2 molecule, a semiempirical approach of Jain and Khare (1976) is adopted which is a modification to eliminate the error factors, and then it is compared with the existing experimental and/or theoretical data which gives satisfactory results

Analisis Insiden Keselamatan Pasien di Rumah Sakit Berdasarkan Pendekatan Beban Kerja dan Komunikasi

Patient safety incidents at Ahmad Yani Islamic Hospital Surabaya increased by 0.3% in 2019. If not addressed immediately, these problems can give a negative image to hospitals and patients. An error that appears and has an impact on increasing patient safety incidents, stems from a high workload and poor communication. The purpose of this study was to analyze the role of workload and communication on the occurrence of patient safety incidents in hospitals. This study uses a unit of analysis as many as 18 work units that directly provide services to patients. Participants include the head of the work unit, the person in charge of the work unit and the person in charge of the quality of the work unit with a total of 90 people. The data was obtained primarily using the instrument contained in the google form. The communication measurement tool uses the Communication Openness Measurement (COM) and the workload uses the WISN calculation. Patient safety incident data was obtained from the PMKP RS team. The analysis was carried out by means of a simple cross tabulation with interpretation using the Pareto concept. The results showed that most work units (83.3%) had a low workload, most of the work unit communication (61.1%) was not good and 33.3% of work units had a high patient safety incident rate. In the Pareto concept, the results showed that workload had no effect on patient safety incidents, while communication influenced the number of patient safety incidents. Therefore, hospitals need to fix the pattern and flow of communication as well as the need for information disclosure so that the flow of information becomes more adequate, transfer of knowledge becomes better and employee understanding of the importance of patient safety in hospitals becomes better.

Penetration dynamics of steel spheres into a ballistic gelatin: Experiments, nondimensional analysis, and finite element modeling

Ballistic gelatin is widely used as a simulant of soft tissues, and its dynamic responses to high-speed projectile penetration are critical for understanding soft tissue damage, wound ballistics, and protection gear design. Here, we investigate penetration dynamics of spherical steel projectiles with different diameters into a ballistic gelatin at different incident velocities. The projectile diameter ranges from 1 mm to 5 mm, and the incident velocity, from 50 m s−1 to 400 m s−1. Penetration dynamics is captured with high-speed photography. A power-law relation is found between the maximum penetration depth and projectile kinetic energy at high incident velocities, but not at intermediate and low velocities. Nondimensional analysis is applied to the penetration depth; a general relation is established for nondimensional maximum penetration depth as a function of projectile density, projectile diameter and projectile incident velocity for low-, intermediate- and high-speed penetration, and this relation can accurately describe the experiments. The drag force of projectile is analyzed to explain the relation between projectile acceleration and velocity. In addition, a calibrated finite element model reproduces well experimental observations such as the maximum penetration depth and projectile trajectory.

INVESTIGATION OF OIL TANKER ACCIDENTS BY USING GIS

This study focuses on marine accident data regarding accidents that occurred between the years 1998-2010 for ships within the oil tanker category. Data in the study include accident reports, which are recorded in the Global Integrated Shipping Information System (GISIS) and country reports. Textual accident data in the GISIS database were tabulated, thus creating a systematic database. By using accident data from this database, a marine accidents map for oil tankers was developed via the ArcGIS 10 program, the areas with the highest accident incident rates were determined, and reasons for oil tanker accidents were revealed through the assessment of factors such as accident type, accident incident number, accident scope, ship tonnage, navigational sea area type, and accident’s impacts on the environment, economy and personnel. The study showed that very high risk areas for oil tanker marine accidents include the Singapore Strait and Oresund, and high risk areas are the Bristol Channel, Suez Channel, Strait of Hormuz, Great Belt, Piraeus, Hull, İstanbul Strait, and Amsterdam, respectively. The study also established that oil tanker accidents are related to ship tonnage and navigational sea area type.

Subharmonic Scattering of SonoVue Microbubbles Within 10-40-mmHg Overpressures In Vitro.

Ultrasound contrast agent microbubbles are considered promising sensors to measure portal vein pressure noninvasively. In this study, we investigated the subharmonic scattering power and optimal incident acoustic pressure of SonoVue microbubbles (concentration: [Formula: see text]/mL 0.9% NaCl solution) in the ambient pressure range of 10-40 mmHg with 10-mmHg increments at a temperature of 25 °C. The results demonstrated that the subharmonic response of the SonoVue microbubbles existed in three stages: the first growth stage (40-300 kPa), saturation (300-400 kPa), and the second growth stage (400-540 kPa). In the first growth stage, the subharmonic amplitude increased with ambient pressure. However, while the ambient pressure increased, the subharmonic amplitude decreased in the second growth stage. The best correlation of the subharmonic amplitudes with the ambient pressures was obtained at a high incident acoustic pressure of 520 kPa (sensitivity: 0.15 dB/mmHg, r2 = 0.99 , and root-mean-square error = 0.49 mmHg), which indicated that the subharmonic signals in the second growth stage might be suitable for estimating low ambient pressures. The results presented in our study may pave the way for portal vein pressure estimation using SonoVue microbubbles as sensors in clinical applications.

Spatial Clustering of County-Level COVID-19 Rates in the U.S.

Despite the widespread prevalence of cases associated with the coronavirus disease 2019 (COVID-19) pandemic, little is known about the spatial clustering of COVID-19 in the United States. Data on COVID-19 cases were used to identify U.S. counties that have both high and low COVID-19 incident proportions and clusters. Our results suggest that there are a variety of sociodemographic variables that are associated with the severity of COVID-19 county-level incident proportions. As the pandemic evolved, communities of color were disproportionately impacted. Subsequently, it shifted from communities of color and metropolitan areas to rural areas in the U.S. Our final period showed limited differences in county characteristics, suggesting that COVID-19 infections were more widespread. The findings might address the systemic barriers and health disparities that may result in high incident proportions of COVID-19 clusters.

Electron energy deposition in molecular hydrogen gas: a Monte Carlo simulation using convergent close-coupling cross sections

A Monte Carlo simulation of electron energy deposition in a gas of molecular hydrogen has been conducted with the aim of producing an ab initio estimate of energy deposition parameters such as the mean energy per ion pair. A set of cross sections obtained using the molecular convergent close-coupling method were used as input. At high incident electron energies the mean energy per ion pair was calculated to be 36.3 eV, agreeing with the recommended value of 36.5 ± 0.3 eV. This represents the first fully ab initio calculation of the mean energy per ion pair using a self consistent data set.

Harvesting Sub-bandgap Photons via Upconversion for Perovskite Solar Cells.

Lanthanide-based upconversion (UC) allows harvesting sub-bandgap near-infrared photons in photovoltaics. In this work, we investigate UC in perovskite solar cells by implementing UC single crystal BaF2:Yb3+, Er3+ at the rear of the solar cell. Upon illumination with high-intensity sub-bandgap photons at 980 nm, the BaF2:Yb3+, Er3+ crystal emits upconverted photons in the spectral range between 520 and 700 nm. When tested under terrestrial sunlight representing one sun above the perovskite's bandgap and sub-bandgap illumination at 980 nm, upconverted photons contribute a 0.38 mA/cm2 enhancement in the short-circuit current density at lower intensity. The current enhancement scales non-linearly with the incident intensity of sub-bandgap illumination, and at higher intensity, 2.09 mA/cm2 enhancement in current was observed. Hence, our study shows that using a fluoride single crystal like BaF2:Yb3+, Er3+ for UC is a suitable method to extend the response of perovskite solar cells to near-infrared illumination at 980 nm with a subsequent enhancement in current for very high incident intensity.