How Are Age, Gender, and Country Differences Associated With PROMIS Physical Function, Upper Extremity, and Pain Interference Scores?

BACKGROUND

The interpretation of patient-reported outcomes requires appropriate comparison data. Currently, no patient-specific reference data exist for the Patient-Reported Outcome Measurement Information System (PROMIS) Physical Function (PF), Upper Extremity (UE), and Pain Interference (PI) scales for individuals 50 years and older.

QUESTIONS/PURPOSES

(1) Can all PROMIS PF, UE, and PI items be used for valid cross-country comparisons in these domains among the United States, the United Kingdom, and Germany? (2) How are age, gender, and country related to PROMIS PF, PROMIS UE, and PROMIS PI scores? (3) What is the relationship of age, gender, and country across individuals with PROMIS PF, PROMIS UE, and PROMIS PI scores ranging from very low to very high?

METHODS

We conducted telephone interviews to collect custom PROMIS PF (22 items), UE (eight items), and PI (eight items) short forms, as well as sociodemographic data (age, gender, work status, and education level), with participants randomly selected from the general population older than 50 years in the United States (n = 900), United Kingdom (n = 905), and Germany (n = 921). We focused on these individuals because of their higher prevalence of surgeries and lower physical functioning. Although response rates varied across countries (14% for the United Kingdom, 22% for Germany, and 12% for the United States), we used existing normative data to ensure demographic alignment with the overall populations of these countries. This helped mitigate potential nonresponder bias and enhance the representativeness and validity of our findings. We investigated differential item functioning to determine whether all items can be used for valid crosscultural comparisons. To answer our second research question, we compared age groups, gender, and countries using median regressions. Using imputation of plausible values and quantile regression, we modeled age-, gender-, and country-specific distributions of PROMIS scores to obtain patient-specific reference values and answer our third research question.

RESULTS

All items from the PROMIS PF, UE, and PI measures were valid for across-country comparisons. We found clinically meaningful associations of age, gender, and country with PROMIS PF, UE, and PI scores. With age, PROMIS PF scores decreased (age ß Median = -0.35 [95% CI -0.40 to -0.31]), and PROMIS UE scores followed a similar trend (age ß Median = -0.38 [95% CI -0.45 to -0.32]). This means that a 10-year increase in age corresponded to a decline in approximately 3.5 points for the PROMIS PF score-a value that is approximately the minimum clinically important difference (MCID). Concurrently, we observed a modest increase in PROMIS PI scores with age, reaching half the MCID after 20 years. Women in all countries scored higher than men on the PROMIS PI and 1 MCID lower on the PROMIS PF and UE. Additionally, there were higher T-scores for the United States than for the United Kingdom across all domains. The difference in scores ranged from 1.21 points for the PROMIS PF to a more pronounced 3.83 points for the PROMIS UE. Participants from the United States exhibited up to half an MCID lower T-scores than their German counterparts for the PROMIS PF and PROMIS PI. In individuals with high levels of physical function, with each 10-year increase in age, there could be a decrease of up to 4 points in PROMIS PF scores. Across all levels of upper extremity function, women reported lower PROMIS UE scores than men by an average of 5 points.

CONCLUSION

Our study provides age-, gender-, and country-specific reference values for PROMIS PF, UE, and PI scores, which can be used by clinicians, researchers, and healthcare policymakers to better interpret patient-reported outcomes and provide more personalized care. These findings are particularly relevant for those collecting patient-reported outcomes in their clinical routine and researchers conducting multinational studies. We provide an internet application ( www.common-metrics.org/PROMIS_PF_and_PI_Reference_scores.php ) for user-friendly accessibility in order to perform age, gender, and country conversions of PROMIS scores. Population reference values can also serve as comparators to data collected with other PROMIS short forms or computerized adaptive tests.

LEVEL OF EVIDENCE

Level II, diagnostic study.

Clinical evaluation of a web-based personalized recommendation system with electronic health record interface to optimize healthcare resources during SARS-CoV-2 surges

During the SARS-CoV-2 pandemic, the German healthcare system faced challenges of efficiently allocating testing resources. To address this, we developed an open-source personalized recommendation system (PRS) called "CovApp". The PRS utilized a questionnaire to estimate the risk of infection, provided personalized recommendations such as testing, self-isolation, or quarantine, and featured QR code data transmission to electronic health records. The PRS served up to 2.5 million monthly users and received 67,000 backlinks from 1800 domains. We clinically evaluated the PRS at the SARS-CoV-2 testing facility at Charité and observed a 21.7% increase in patient throughput per hour and a 22.5% increase in patients per day. Patients using the PRS were twice as likely to belong to the High Risk group eligible for testing (18.6% vs. 8.9%, p < 0.0001), indicating successful compliance with CovApp's recommendations. CovApp served as a digital bridge between the population and medical staff and significantly improved testing efficiency. As an open-source platform, CovApp can be readily customized to address emerging public health crises. Further, given the EHR interface, the app is of great utility for other applications in clinical settings.

[Postoperative management following decompressive hemicraniectomy for malignant middle cerebral artery infarction-A German nationwide survey study]

BACKGROUND

Malignant middle cerebral artery infarction is a potentially life-threatening disease. Decompressive hemicraniectomy constitutes an evidence-based treatment practice, especially in patients under 60 years of age; however, recommendations with respect to postoperative management and particularly duration of postoperative sedation lack standardization.

OBJECTIVE

This survey study aimed to analyze the current situation of patients with malignant middle cerebral artery infarction following hemicraniectomy in the neurointensive care setting.

MATERIAL AND METHODS

From 20 September 2021 to 31 October 2021, 43 members of the initiative of German neurointensive trial engagement (IGNITE) network were invited to participate in a standardized anonymous online survey. Descriptive data analysis was performed.

RESULTS

Out of 43 centers 29 (67.4%) participated in the survey, including 24 university hospitals. Of the hospitals 21 have their own neurological intensive care unit. While 23.1% favored a standardized approach regarding postoperative sedation, the majority utilized individual criteria (e.g., intracranial pressure increase, weaning parameters, complications) to assess the need and duration. The timing of targeted extubation varied widely between hospitals (≤ 24 h 19.2%, ≤ 3 days in 30.8%, ≤ 5 days in 19.2%, > 5 days in 15.4%). Early tracheotomy (≤ 7 days) is performed in 19.2% and 80.8% of the centers aim for tracheotomy within 14 days. Hyperosmolar treatment is used on a regular basis in 53.9% and 22 centers (84.6%) agreed to participate in a clinical trial addressing the duration of postoperative sedation and ventilation.

CONCLUSION

The results of this nationwide survey among neurointensive care units in Germany reflect a remarkable heterogeneity in the treatment practices of patients with malignant middle cerebral artery infarction undergoing hemicraniectomy, especially with respect to the duration of postoperative sedation and ventilation. A randomized trial in this matter seems warranted.

Seasonal shifts in isoprenoid emission composition from three hyperdominant tree species in central Amazonia

Volatile isoprenoids regulate plant performance and atmospheric processes, and Amazon forests comprise the dominant source to the global atmosphere. Still, there is a poor understanding of how isoprenoid emission capacities vary in response to ecophysiological and environmental controls in Amazonian ecosystems. We measured isoprenoid emission capacities of three Amazonian hyperdominant tree species - Protium hebetatum, Eschweilera grandiflora, Eschweilera coriacea - across seasons and along a topographic and edaphic environmental gradient in the central Amazon. From wet to dry season, both photosynthesis and isoprene emission capacities strongly declined, while emissions increased among the heavier isoprenoids: monoterpenes and sesquiterpenes. Plasticity across habitats was most evident in P. hebetatum, which emitted sesquiterpenes only in the dry season, at rates that significantly increased along the hydro-topographic gradient from white sands (shallow root water access) to uplands (deep water table). We suggest that emission composition shifts are part of a plastic response to increasing abiotic stress (e.g. heat and drought) and reduced photosynthetic supply of substrates for isoprenoid synthesis. Our comprehensive measurements suggest that more emphasis should be placed on other isoprenoids, besides isoprene, in the context of abiotic stress responses. Shifting emission compositions have implications for atmospheric responses because of the strong variation in reactivity among isoprenoid compounds.

The ICHOM Standard Set for Pregnancy and Childbirth - Translation and Linguistic Adaptation for Germany

Introduction The gathering of health and quality-of-life issues that matter most to patients over so-called patient-reported outcomes (PROs) is a key aspect of patient-centered healthcare. In obstetrics, this approach has the potential to expand the current understanding of what quality entails by including patient perspectives. The International Consortium for Health Outcome Measures (ICHOM), founded in 2012, is a global organization which aims to standardise the collection of PROs and make the results comparable worldwide. A PRO Set for obstetrics, “Pregnancy and Childbirth”, was published in 2018. The aim of our work was to translate the instruments of this set that are not yet available in German into German.

Methods The instruments were translated from English into German using the Functional Assessment of Chronic Illness Therapy (FACIT) translation method. The translated instruments consisted of the Breastfeeding Self-Efficacy Scale – Short Form (BSES-SF), the Mother-to-Infant Bonding Scale (MIBS), and the Birth Satisfaction Scale – Revised (BSS-R) as well as a number of individual questions (items).

Results The final version of the German translations were found to be easily comprehensible by the target group. During the cognitive debriefing, it became clear that pregnant women and women who had just given birth often used a number of medically incorrect terms to refer to their symptoms or complaints. In the translations great care was taken to ensure that the wording was as close as possible to the general usage of the language while at the same time the terminology was medically correct. To achieve a precise but comprehensible translation, the response structure of the BSES-SF also had to be adapted.

Conclusions The instruments of the ICHOM Standard Set “Pregnancy and Childbirth”, which were not previously available in German, were successfully translated into German. This meant dealing with a few challenges such as adapting questions or response structures. The cultural and linguistic comprehensibility of the German translations were confirmed during the subsequent cognitive debriefing. The translations offer the possibility of implementing the complete ICHOM Set for Pregnancy and Childbirth. This would provide an opportunity to expand the existing understanding of quality by including the subjective experience of women during and after childbirth and, in future, to compare outcomes with those of other hospitals across the world.

Making Green(s) With Black and White: Constructing Soils for Urban Agriculture Using Earthworms, Organic and Mineral Wastes

Urban agriculture has been of growing interest for a decade because it can address many economic and societal issues in the development of modern cities. However, urban agriculture is often limited by the availability of fertile and non-contaminated soils in the cities. Recycling excavated mineral wastes from building activities to construct fertile soils may be a more sustainable alternative than the importation of topsoils from rural zones. The present study aims to evaluate the possibility to grow green vegetables on soils made with excavated deep horizon of soils and green waste compost. During three consecutive seasons, we tested in situ the effects of different amounts of compost (10, 20, and 30%) and the addition of an earthworm species (Lumbricus terrestris) on the production of lettuce (Lactuca sativa L.), arugula (Eruca sativa Mill.), and spinach (Spinacia oleracea L.) in mono- and co-culture. Our results demonstrate that it is possible to reuse mineral and organic urban wastes to engineer soils adapted to agriculture. Here, we observed that higher doses of compost significantly increased plant biomass, especially when earthworms were introduced. For example, in the autumn, going from 10 to 30% of compost in the soil mixture allows to multiply by 2 the arugula biomass, and even by 4 in the presence of earthworms. These results were partly due to the positive effects of these two factors on soil physical properties (micro- and macro-porosity). This preliminary study also showed that some plants (arugula) are more adapted than others (lettuce) to the soil properties and that it only takes few months to get the highest yields. These promising results for the development of urban agricultures encourage to test many other combination of plant and earthworm species but also to conduct experiments over long-term periods.

Experimental and numerical evaluation of the effect of micro-aeration on the thermal properties of chocolate

Thermal properties, such as thermal conductivity, specific heat capacity and latent heat, influence the melting and solidification of chocolate. The accurate prediction of these properties for micro-aerated chocolate products with varying levels of porosity ranging from 0% to 15% is beneficial for understanding and control of heat transfer mechanisms during chocolate manufacturing and food oral processing. The former process is important for the final quality of chocolate and the latter is associated with sensorial attributes, such as grittiness, melting time and flavour. This study proposes a novel multiscale finite element model to accurately predict the temporal and spatial evolution of temperature across chocolate samples. The model is evaluated via heat transfer experiments at temperatures varying from 16 °C to 45 °C. Both experimental and numerical results suggest that the rate of heat transfer within the micro-aerated chocolate is reduced by 7% when the 15% micro-aerated chocolate is compared to its solid counterpart. More specifically, on average, the thermal conductivity decreased by 20% and specific heat capacity increased by 10% for 15% micro-aeration, suggesting that micro-pores act as thermal barriers to heat flow. The latter trend is unexpected for porous materials and thus the presence of a third phase at the pore's interface is proposed which might store thermal energy leading to a delayed release to the chocolate system. The developed multiscale numerical model provides a design tool to create pore structures in chocolate with optimum melting or solidifying response.

Origin of Interface Limitation in Zn(O,S)/CuInS2-Based Solar Cells

Copper indium disulfide (CuInS₂) grown under Cu-rich conditions exhibits high optical quality but suffers predominantly from charge carrier interface recombination, resulting in poor solar cell performance. An unfavorable "cliff"-like conduction band alignment at the buffer/CuInS₂ interface could be a possible cause of enhanced interface recombination in the device. In this work, we exploit direct and inverse photoelectron spectroscopy together with electrical characterization to investigate the cause of interface recombination in chemical bath-deposited Zn(O,S)/co-evaporated CuInS₂-based devices. Temperature-dependent current-voltage analyses indeed reveal an activation energy of the dominant charge carrier recombination path, considerably smaller than the absorber bulk band gap, confirming the dominant recombination channel to be present at the Zn(O,S)/CuInS₂ interface. However, photoelectron spectroscopy measurements indicate a small (0.1 eV) "spike"-like conduction band offset at the Zn(O,S)/CuInS₂ interface, excluding an unfavorable energy-level alignment to be the prominent cause for strong interface recombination. The observed band bending upon interface formation also suggests Fermi-level pinning not to be the main reason, leaving near-interface defects (as recently observed in Cu-rich CuInSe₂) as the likely reason for the performance-limiting interface recombination.

Prospect of making XPS a high-throughput analytical method illustrated for a CuxNi1−xOy combinatorial material library

Combinatorial material science crucially depends on robust, high-throughput characterization methods. While X-ray photoelectron spectroscopy (XPS) may provide detailed information about chemical and electronic properties, it is a time-consuming technique and, therefore, is not viewed as a high-throughput method. Here we present preliminary XPS data of 169 measurement spots on a combinatorial 72 × 72 cm² Cu_xNi_1−xO_y compositional library to explore how characterization and evaluation routines can be optimized to improve throughput in XPS for combinatorial studies. In particular, two quantification approaches are compared. We find that a simple integration (of XPS peak regions) approach is suited for fast evaluation of, in the example system, the [Cu]/([Cu] + [Ni]) ratio. Complementary to that, the time-consuming (XPS peak-) fit approach provides additional insights into chemical speciation and oxidation state changes, without a large deviation of the [Cu]/([Cu] + [Ni]) ratio. This insight suggests exploiting the fast integration approach for ‘real time’ analysis during XPS data collection, paving the way for an ‘on-the-fly’ selection of points of interest (i.e., areas on the sample where sudden composition changes have been identified) for detailed XPS characterization. Together with the envisioned improvements when going from laboratory to synchrotron-based excitation sources, this will shorten the analysis time sufficiently for XPS to become a realistic characterization option for combinatorial material science.

Methods for fast quantification of XPS data of a Cu_xNi_1−xO_y combinatorial material library were evaluated in a step towards high-throughput analysis.

Chemical and electronic structure of the heavily intermixed (Cd,Zn)S:Ga/CuSbS2 interface

The interface formation and chemical and electronic structure of the (Cd,Zn)S:Ga/CuSbS2 thin-film solar cell heterojunction was studied using hard X-ray photoelectron spectroscopy (HAXPES) of the bare absorber and a buffer/absorber...

Use of antipsychotic agents in children and adolescents

OBJECTIVE: To describe the profile of pediatric patients undergoing regular treatment with antipsychotics agents. METHODS: Descriptive study of a case series with cross-sectional data collection of patients’ files using antipsychotics agents, under 14 years of age treated at a Neuropediatric service from April to July 2020. For statistical analysis, we used the Fisher exact test and the Pearson’s Chi-square test with a 5% significance level. RESULTS: We assessed 98 patients, and 74 (75.5%) were males, the median age in the evaluation period was 8.5 (2.5 to 14 years). The main diagnosis was Autism Spectrum Disorder (53%) and Intellectual Deficit (46.9%). The most frequent prescription indications were aggressiveness (76.5%) and restlessness (43.8%). The main drugs prescribed were Risperidone (85.7%) and Periciazine (6.1%). The most evident adverse effects were weight gain (15.3%) and increased appetite (10.2%). The MOAS (Modified Overt Aggression Scale) showed changes in 71 patients (72.4%). Clinical evolution was reported as favorable by parents for 95 patients (96.94%). CONCLUSIONS: The use of antipsychotics in pediatrics is constantly expanding, but studies on the effects on this population are still lacking and with that the off-label use becomes commonplace. Further studies on the use of antipsychotics in the pediatric age group are expected to be developed.

Fluoride Chemistry in Tin Halide Perovskites

Tin is the frontrunner for substituting toxic lead in perovskite solar cells. However, tin suffers the detrimental oxidation of Sn^II to Sn^IV . Most of reported strategies employ SnF₂ in the perovskite precursor solution to prevent Sn^IV formation. Nevertheless, the working mechanism of this additive remains debated. To further elucidate it, we investigate the fluoride chemistry in tin halide perovskites by complementary analytical tools. NMR analysis of the precursor solution discloses a strong preferential affinity of fluoride anions for Sn^IV over Sn^II , selectively complexing it as SnF₄ . Hard X-ray photoelectron spectroscopy on films shows the lower tendency of SnF₄ than SnI₄ to get included in the perovskite structure, hence preventing the inclusion of Sn^IV in the film. Finally, small-angle X-ray scattering reveals the strong influence of fluoride on the colloidal chemistry of precursor dispersions, directly affecting perovskite crystallization.

Effect of micro-aeration on the mechanical behaviour of chocolates and implications for oral processing

Aeration in foods has been widely utilised in the food industry to develop novel foods with enhanced sensorial characteristics. Specifically, aeration at the micron-sized scale has a significant impact on the microstructure where micro-bubbles interact with the other microstructural features in chocolates. This study aims to determine the effect of micro-aeration on the mechanical properties of chocolate products, which are directly correlated with textural attributes such as hardness and crumbliness. Uniaxial compression tests were performed to determine the mechanical properties such as Poisson's ratio, Young's modulus and macroscopic yield strength together with fracture tests to estimate the fracture toughness. In vivo mastication tests were also conducted to investigate the link between the fracture properties and fragmentation during the first two chewing cycles. The uniaxial stress-strain data were used to calibrate a viscoplastic constitutive law. The results showed that micro-aeration significantly affects mechanical properties such as Young's modulus, yield and fracture stresses, as well as fracture toughness. In addition, it enhances the brittle nature of the chocolate, as evidenced by lower fracture stress but also lower fracture toughness leading to higher fragmentation, in agreement with observations in the in vivo mastication tests. As evidenced by the XRT images and the stress-strain measurements micro-aeration hinders the re-arrangement of the microscopic features inside the chocolate during the material's deformation. The work provides a new insight of the role of bubbles on the bulk behaviour of complex multiphase materials, such as chocolates, and defines the mechanical properties which are important input parameters for the development of oral processing simulations.

Efficacy of Retreatment After Failed Direct-acting Antiviral Therapy in Patients With HCV Genotype 1-3 Infections

Hepatitis C virus infection is causing chronic liver disease, cirrhosis, and hepatocellular carcinoma. By combining direct-acting antivirals (DAAs), high sustained virologic response rates (SVRs) can be achieved. Resistance-associated substitutions (RASs) are commonly observed after DAA failure, and especially nonstructural protein 5A (NS5A) RASs may impact retreatment options.^1-3 Data on retreatment of DAA failure patients using first-generation DAAs are limited.^4-7 Recently, a second-generation protease- and NS5A-inhibitor plus sofosbuvir (voxilaprevir/velpatasvir/sofosbuvir [VOX/VEL/SOF]) was approved for retreatment after DAA failure.⁸ However, this and other second-generation regimens are not available in many resource-limited countries or are not reimbursed by regular insurance, and recommendations regarding the selection of retreatment regimens using first-generation DAAs are very important. This study aimed to analyze patients who were re-treated with first-generation DAAs after failure of a DAA combination therapy.

NaF/RbF-Treated Cu(In,Ga)Se2 Thin-Film Solar Cell Absorbers: Distinct Surface Modifications Caused by Two Different Types of Rubidium Chemistry

The underlying beneficial mechanism of heavy alkali postdeposition treatment (PDT) of Cu(In,Ga)Se₂ thin-film solar cell absorbers that led to new record efficiencies in recent years is studied using photoelectron spectroscopy. Excitation energies between 40.8 eV and 6 keV were used to examine the near-surface region of Cu(In,Ga)Se₂ thin-film solar cell absorbers that underwent NaF and combined NaF/RbF PDT. The already Cu-deficient surface region after NaF PDT, which is modeled as a Cu:(In + Ga):Se = 1:5:8 phase, shows further depletion after NaF/RbF PDT and seems to incorporate some Rb. Additionally, we have found strong indications for the NaF/RbF PDT-induced formation of a Rb-In-Se-type compound with a 1:1:2 stoichiometry partially covering the absorber surface. The electronic Cu(In,Ga)Se₂ structure is modified due to the RbF treatment, with a pronounced shift in the valence band maximum away from the Fermi level in the immediate vicinity of the surface.

Impact of SnF2 Addition on the Chemical and Electronic Surface Structure of CsSnBr3

We report on the chemical and electronic structure of cesium tin bromide (CsSnBr₃) and how it is impacted by the addition of 20 mol % tin fluoride (SnF₂) to the precursor solution, using both surface-sensitive lab-based soft X-ray photoelectron spectroscopy (XPS) and near-surface bulk-sensitive synchrotron-based hard XPS (HAXPES). To determine the reproducibility and reliability of conclusions, several (nominally identically prepared) sample sets were investigated. The effects of deposition reproducibility, handling, and transport are found to cause significant changes in the measured properties of the films. Variations in the HAXPES-derived compositions between individual sample sets were observed, but in general, they confirm that the addition of 20 mol % SnF₂ improves coverage of the titanium dioxide substrate by CsSnBr₃ and decreases the oxidation of Sn^II to Sn^IV while also suppressing formation of secondary Br and Cs species. Furthermore, the (surface) composition is found to be Cs-deficient and Sn-rich compared to the nominal stoichiometry. The valence band (VB) shows a SnF₂-induced redistribution of Sn 5s-derived density of states, reflecting the changing Sn^II/Sn^IV ratio. Notwithstanding some variability in the data, we conclude that SnF₂ addition decreases the energy difference between the VB maximum of CsSnBr₃ and the Fermi level, which we explain by defect chemistry considerations.

Diffuse glioneuronal tumour with oligodendroglioma-like features and nuclear clusters (DGONC) - a molecularly defined glioneuronal CNS tumour class displaying recurrent monosomy 14

AIMS

DNA methylation-based central nervous system (CNS) tumour classification has identified numerous molecularly distinct tumour types, and clinically relevant subgroups among known CNS tumour entities that were previously thought to represent homogeneous diseases. Our study aimed at characterizing a novel, molecularly defined variant of glioneuronal CNS tumour.

PATIENTS AND METHODS

DNA methylation profiling was performed using the Infinium MethylationEPIC or 450 k BeadChip arrays (Illumina) and analysed using the 'conumee' package in R computing environment. Additional gene panel sequencing was also performed. Tumour samples were collected at the German Cancer Research Centre (DKFZ) and provided by multinational collaborators. Histological sections were also collected and independently reviewed.

RESULTS

Genome-wide DNA methylation data from >25 000 CNS tumours were screened for clusters separated from established DNA methylation classes, revealing a novel group comprising 31 tumours, mainly found in paediatric patients. This DNA methylation-defined variant of low-grade CNS tumours with glioneuronal differentiation displays recurrent monosomy 14, nuclear clusters within a morphology that is otherwise reminiscent of oligodendroglioma and other established entities with clear cell histology, and a lack of genetic alterations commonly observed in other (paediatric) glioneuronal entities.

CONCLUSIONS

DNA methylation-based tumour classification is an objective method of assessing tumour origins, which may aid in diagnosis, especially for atypical cases. With increasing sample size, methylation analysis allows for the identification of rare, putative new tumour entities, which are currently not recognized by the WHO classification. Our study revealed the existence of a DNA methylation-defined class of low-grade glioneuronal tumours with recurrent monosomy 14, oligodendroglioma-like features and nuclear clusters.

The Doping Mechanism of Halide Perovskite Unveiled by Alkaline Earth Metals

Halide perovskites are a strong candidate for the next generation of photovoltaics. Chemical doping of halide perovskites is an established strategy to prepare the highest efficiency and most stable perovskite-based solar cells. In this study, we unveil the doping mechanism of halide perovskites using a series of alkaline earth metals. We find that low doping levels enable the incorporation of the dopant within the perovskite lattice, whereas high doping concentrations induce surface segregation. The threshold from low to high doping regime correlates to the size of the doping element. We show that the low doping regime results in a more n-type material, while the high doping regime induces a less n-type doping character. Our work provides a comprehensive picture of the unique doping mechanism of halide perovskites, which differs from classical semiconductors. We proved the effectiveness of the low doping regime for the first time, demonstrating highly efficient methylammonium lead iodide based solar cells in both n-i-p and p-i-n architectures.

Favourable growth conditions for the preparation of bulk AlN single crystals by PVT

A high seed temperature (2251 °C) reveals the highest deep UV transparency (α_265nm = 27 cm⁻¹), a high structural perfection (EPD = 9 × 10³ cm⁻²) and a suitable growth rate (R = 200 μm h⁻¹).

Tunability of MoO3 Thin-Film Properties Due to Annealing in Situ Monitored by Hard X-ray Photoemission

The chemical and electronic structure of MoO3 thin films is monitored by synchrotron-based hard X-ray photoelectron spectroscopy while annealing from room temperature to 310 °C. Color-coded 2D intensity maps of the Mo 3d and O 1s and valence band maximum (VBM) spectra show the evolution of the annealing-induced changes. Broadening of the Mo 3d and O 1s spectra indicate the reduction of MoO3. At moderate temperatures (120-200 °C), we find spectral evidence for the formation of Mo5+ and at higher temperatures (>165 °C) also of Mo4+ states. These states can be related to the spectral intensity above the VBM attributed to O vacancy induced gap states caused by partial filling of initially unoccupied Mo 4d-derived states. A clear relation between annealing temperature and the induced changes in the chemical and electronic structure suggests this approach as a route for deliberate tuning of MoO3 thin-film properties.

Abstract P4-12-05: First implementation of the International Consortium of Health Outcomes Measurement standard for breast cancer at a major German university hospital using a web-based tool to measure patient reported outcomes

Purpose:

Collecting patient reported outcome (PRO) data in a systematic way enables an objective evaluation of treatments and its related outcomes. By using the disease specific questionnaires developed by the International Consortium of Health Outcome Measurement (ICHOM) this allows for comparison between physicians, hospitals and even different countries.

Methods

In November 2016 we implemented a web-based system to collect PRO data at the breast center at Charité University hospital using the ICHOM data set. All new patients who are seen at the breast center are enrolled and are answering a predefined set of questions using a tablet computer. Once they start their treatment at Charité automated emails are sent to the patient at predefined treatment points. Those emails contain a web-based link through which they can access their questionnaires.

Results

Until now we have enrolled 834 patients and initiated 2470 questionnaires. 9.44% of patients were under 40 years of age, 49.7% between 40 and 60, 39.6% between 60-80 and 1.3% over the age of 80 years. The average return rate of questionnaires is 72% without any additional intervention. When asked about preference regarding paper versus online 7.9% of the patients 50 to 60 years of age would prefer paper, 18% in the 60-70 years of age group and 21.2 % in the age group over 70 years.

Conclusion

Measuring PRO in breast cancer patients in an automated electronic version is possible across all age ranges while simultaneously achieving a high return rate.

Citation Format: Karsten MM, Speiser D, Hartmann C, Lippold K, Kirchberger V, Blohmer J-U. First implementation of the International Consortium of Health Outcomes Measurement standard for breast cancer at a major German university hospital using a web-based tool to measure patient reported outcomes [abstract]. In: Proceedings of the 2018 San Antonio Breast Cancer Symposium; 2018 Dec 4-8; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2019;79(4 Suppl):Abstract nr P4-12-05.

Web-Based Patient-Reported Outcomes Using the International Consortium for Health Outcome Measurement Dataset in a Major German University Hospital: Observational Study

Background

Collecting patient-reported outcome (PRO) data systematically enables objective evaluation of treatment and its related outcomes. Using disease-specific questionnaires developed by the International Consortium for Health Outcome Measurement (ICHOM) allows for comparison between physicians, hospitals, and even different countries.

Objective

This pilot project aimed to establish a digital system to measure PROs for new patients with breast cancer who attended the Charité Breast Center This approach should serve as a blueprint to further expand the PRO measurement to other disease entities and departments.

Methods

In November 2016, we implemented a Web-based system to collect PRO data at Charité Breast Center using the ICHOM dataset. All new patients at the Breast Center were enrolled and answered a predefined set of questions using a tablet computer. Once they started their treatment at Charité, automated emails were sent to the patients at predefined treatment points. Those emails contained a Web-based link through which they could access and answer questionnaires.

Results

By now, 541 patients have been enrolled and 2470 questionnaires initiated. Overall, 9.4% (51/541) of the patients were under the age of 40 years, 49.7% (269/541) between 40 and 60 years, 39.6% (214/541) between 60 and 80 years, and 1.3% (7/541) over the age of 80 years. The average return rate of questionnaires was 67.0%. When asked about the preference regarding paper versus Web-based questionnaires, 6.0% (8/134) of the patients between 50 and 60 years, 6.0% (9/150) between 60 and 70 years, and 12.7% (9/71) over the age of 70 years preferred paper versions.

Conclusions

Measuring PRO in patients with breast cancer in an automated electronic version is possible across all age ranges while simultaneously achieving a high return rate.

Exciton-Dominated Core-Level Absorption Spectra of Hybrid Organic-Inorganic Lead Halide Perovskites

In a combined theoretical and experimental work, we investigate X-ray absorption near-edge structure spectroscopy of the I L₃ and the Pb M₅ edges of the methylammonium lead iodide (MAPbI₃) hybrid inorganic-organic perovskite and its binary phase PbI₂. The absorption onsets are dominated by bound excitons with sizable binding energies of a few hundred millielectronvolts and pronounced anisotropy. The spectra of both materials exhibit remarkable similarities, suggesting that the fingerprints of core excitations in MAPbI₃ are essentially given by its inorganic component, with negligible influence from the organic groups. The theoretical analysis complementing experimental observations provides the conceptual insights required for a full characterization of this complex material.

Rare compound heterozygous variants in PNKP identified by whole exome sequencing in a German patient with ataxia-oculomotor apraxia 4 and pilocytic astrocytoma

Ataxia-oculomotor apraxia type 4 (AOA4) is a rare autosomal recessive neurologic disorder. The phenotype is characterized by ataxia, oculomotor apraxia, peripheral neuropathy and dystonia. AOA4 is caused by biallelic pathogenic variants in the PNKP gene encoding a polynucleotide kinase 3'-phosphatase with an important function in DNA-damage repair. By whole exome sequencing, we identified 2 variants within the PNKP gene in a 27-year-old German woman with a clinical AOA phenotype combined with a cerebellar pilocytic astrocytoma diagnosed at 23 years of age. One variant, a duplication in exon 14 resulting in the frameshift c.1253_1269dup p.(Thr424fs*49), has previously been described as pathogenic, for example, in cases of AOA4. The second variant, representing a nonsense mutation in exon 17, c.1545C>G p.(Tyr515*), has not yet been described and is predicted to cause a loss of the 7 C-terminal amino acids. This is the first description of AOA4 in a patient with central European descent. Furthermore, the occurrence of a pilocytic astrocytoma has not been described before in an AOA4 patient. Our data demonstrate compound heterozygous PNKP germline variants in a German patient with AOA4 and provide evidence for a possible link with tumor predisposition. Localization of the 2 variants in human PNKP NP_009185.2. NM_007254.3:c.1253_1269dup p.(Thr424fs*49) is predicted to cause a frameshift within the kinase domain, NM_007254.3:c.1545C>G p.(Tyr515*) is predicted to cause loss of 2 C-terminal amino acids of the kinase domain and 5 additional C-terminal amino acids.

Measurement station for interim inspections of Lightbridge metallic fuel rods at the Halden Boiling Water Reactor

Lightbridge Corporation has developed a new Uranium-Zirconium based metallic fuel. The fuel rods aremanufactured via a co-extrusion process, and are characterized by their multi-lobed (cruciform-shaped) cross section. The fuel rods are also helically-twisted in the axial direction. Two experimental fuel assemblies, each containing four Lightbridge fuel rods, are scheduled to be irradiated in the Halden Boiling Water Reactor (HBWR) starting in 2018. In addition to on-line monitoring of fuel rod elongation and critical assembly conditions (e.g. power, flow rates, coolant temperatures, etc.) during the irradiation, several key parameters of the fuel will be measured out-of-core during interim inspections. An inspection measurement station for use in the irradiated fuel handling compartment at the HBWR has therefore been developed for this purpose. The multi-lobed cladding cross section combined with the spiral shape of the Lightbridge metallic fuel rods requires a high-precision guiding system to ensure good position repeatability combined with low-friction guiding. The measurement station is equipped with a combination of instruments and equipment supplied from third-party vendors and instruments and equipment developed at Institute for Energy Technology (IFE). Two sets of floating linear voltage differential transformer (LVDT) pairs are used to measure swelling and diameter changes between the lobes and the valleys over the length of the fuel rods. Eddy current probes are used to measure the thickness of oxide layers in the valleys and on the lobe tips and also to detect possible surface cracks/pores. The measurement station also accommodates gamma scans. Additionally, an eddy-current probe has been developed at IFE specifically to detect potential gaps or discontinuities in the bonding layer between the metallic fuel and the Zirconium alloy cladding. Potential gaps in the bonding layer will be hidden behind a 0.5-1.0 mm thick cladding wall. It has therefore been necessary to perform a careful design study of the probe geometry. For this, finite element analysis (FEA) has been performed in combination with practical validation tests on representative fuel dummies with machined flaws to find the probe geometry that best detects a hidden flaw. Tests performed thus far show that gaps down to 25 μm thickness can be detected with good repeatability and good discrimination from lift-off signals.

Preparation and in-system study of SnCl2 precursor layers: towards vacuum-based synthesis of Pb-free perovskites

Characterization of SnCl₂ thin-films, inorganic precursor to Sn-based perovskites, UHV-deposited on Mo reveals widespread chemical structure along film layer profile.