Polymorphonuclear leukocytes CH138+apoptosis evaluation in milk with high and low somatic cell count - preliminary data

Polymorphonuclear leukocyte (PMNL) apoptosis is central to the successful resolution of inflammation. Since Somatic Cell Count (SCC) is an indicator of the mammary gland's immune status, this study sought to clarify the influence that these factors have on each other and on the evolution of the inflammatory process. Milk samples were stained with annexin-V, propidium iodide (PI), primary antibody anti-CH138A. Negative correlation between SCC and PMNL apoptosis was found, and a statistical difference between high SCC group and low SCC group was observed concerning the rate of viable PMNL, apoptotic PMNL, necrotic PMNL and necrotic and/or apoptotic PMNL. Overall, the high cellularity group presented lower proportions of CH138+ cells undergoing apoptosis and higher proportions of viable and necrotic CH138+ cells. Thus, it can be concluded that PMNL apoptosis and SCC are related factors, and that in high SCC, milk apoptosis is delayed. Although there is a greater amount of active phagocytes in this situation, apoptosis' anti-inflammatory effects are decreased, while necrosis' pro-inflammatory effects are increased, which can contribute to chronic inflammation.

Time sequence of the intensification of the liver glucose production induced by high-fat diet in mice

It is well established that the development of insulin resistance shows a temporal sequence in different organs and tissues. Moreover, considering that the main aspect of insulin resistance in liver is a process of glucose overproduction from gluconeogenesis, we investigated if this metabolic change also shows temporal sequence. For this purpose, a well-established experimental model of insulin resistance induced by high-fat diet (HFD) was used. The mice received HFD (HFD group) or standard diet (COG group) for 1, 7, 14 or 56?days. The HFD group showed increased (P?<?0.05 versus COG) epididymal, retroperitoneal and inguinal fat weight from days 1 to 56. In agreement with these results, the HFD group also showed higher body weight (P?<?0.05 versus COG) from days 7 to 56. Moreover, the changes induced by HFD on liver gluconeogenesis were progressive because the increment (P?<?0.05 versus COG) in glucose production from l-lactate, glycerol, l-alanine and l-glutamine occurred 7, 14, 56 and 56 days after the introduction of the HFD schedule, respectively. Furthermore, glycaemia and cholesterolemia increased (P?<?0.05 versus COG) 14?days after starting the HFD schedule. Taken together, the results suggest that the intensification of liver gluconeogenesis induced by an HFD is not a synchronous all-or-nothing process but is specific for each gluconeogenic substrate and is integrated in a temporal manner with the progressive augmentation of fasting glycaemia. Copyright (c) 2012 John Wiley & Sons, Ltd.

Monocyte Chemoattractant-1 as a Urinary Biomarker for the Diagnosis of Activity of Lupus Nephritis in Brazilian Patients

Objective. Monocyte chemotactic protein (MCP-1), involved in the pathogenesis of lupus nephritis (LN), has recently been indicated as a new biomarker of kidney activity in systemic lupus erythematosus (SLE). Our aim was to assess urinary MCP-1 (uMCP-1) as a biomarker of renal activity in patients with SLE and to compare it to other disease activity markers, using the ELISA. Methods. Seventy-five female Brazilian patients with SLE and a control group participated in our study. Patients with SLE were distributed among 3 groups according to kidney involvement and classified according to disease activity based on clinical and laboratory measures such as urinary sediment, proteinuria, kidney function, C3, C4, anti-dsDNA, disease activity index, and renal SLE disease activity index. The serum and uMCP-1 concentrations were measured by sandwich ELISA. Results. In the A-LN group (active lupus nephritis: SLE with kidney involvement), the concentration of uMCP-1 was significantly higher than in other groups. A cutoff point was established using the results of the control group to apply this test in the detection of LN. A-LN had a higher frequency of positive results for uMCP-1 in comparison to the other groups (p < 0.001). To detect disease activity in patients with LN, a new cutoff was determined based on the results of patients with SLE with kidney involvement. Setting specificity at 90%, the sensitivity of the test was 50%. Conclusion. The high specificity makes uMCP-1 a useful test as a predictor of kidney activity in SLE, especially when associated to other measures used in clinical practice. (First Release Sept 1 2012; J Rheumatol 2012;39:1948-54; doi :10.3899/jrheum.110201)

Obesity and risk of recurrence or death after adjuvant endocrine therapy with letrozole or tamoxifen in the breast international group 1-98 trial

To examine the association of baseline body mass index (BMI) with the risk of recurrence or death in postmenopausal women with early-stage breast cancer receiving adjuvant tamoxifen or letrozole in the Breast International Group (BIG) 1-98 trial at 8.7 years of median follow-up.

Identifying breast cancer patients at risk for Central Nervous System (CNS) metastases in trials of the International Breast Cancer Study Group (IBCSG)

BACKGROUND: We sought to determine whether a high-risk group could be defined among patients with operable breast cancer in whom a search of occult central nervous system (CNS) metastases was justified. PATIENTS AND METHODS: We evaluated data from 9524 women with early breast cancer (42% node-negative) who were randomized in International Breast Cancer Study Group clinical trials between 1978 and 1999, and treated without anthracyclines, taxanes, or trastuzumab. We identified patients whose site of first event was CNS and those who had a CNS event at any time. RESULTS: Median follow-up was 13 years. The 10-year incidence (10-yr) of CNS relapse was 5.2% (1.3% as first recurrence). Factors predictive of CNS as first recurrence included: node-positive disease (10-yr = 2.2% for > 3 N+), estrogen receptor-negative (2.3%), tumor size > 2 cm (1.7%), tumor grade 3 (2.0%), < 35 years old (2.2%), HER2-positive (2.7%), and estrogen receptor-negative and node-positive (2.6%). The risk of subsequent CNS recurrence was elevated in patients experiencing lung metastases (10-yr = 16.4%). CONCLUSION: Based on this large cohort we were able to define risk factors for CNS metastases, but could not define a group at sufficient risk to justify routine screening for occult CNS metastases.

Neoadjuvant interstitial high-dose-rate (HDR) brachytherapy combined with systemic chemotherapy in patients with breast cancer

BACKGROUND AND PURPOSE: This is the first study investigating neoadjuvant interstitial high-dose-rate (HDR) brachytherapy combined with chemotherapy in patients with breast cancer. The goal was to evaluate the type of surgical treatment, histopathologic response, side effects, local control, and survival. PATIENTS AND METHODS: 53 patients, who could not be treated with breast-conserving surgery due to initial tumor size (36/53) or due to an unfavorable breast-tumor ratio (17/53), were analyzed retrospectively. All but one were in an intermediate/high-risk group (St. Gallen criteria). The patients received a neoadjuvant protocol consisting of systemic chemotherapy combined with fractionated HDR brachytherapy (2 x 5 Gy/day, total dose 30 Gy). In cases, where breast-conserving surgery was performed, patients received additional external-beam radiotherapy (EBRT, 1.8 Gy/day, total dose 50.4 Gy). In patients, who underwent mastectomy but showed an initial tumor size of T3/T4 and/or more than three infiltrated lymph nodes, EBRT was also performed. RESULTS: In 30/53 patients (56.6%) breast-conserving surgery could be performed. The overall histopathologic response rate was 96.2% with a complete remission in 28.3% of patients. 49/53 patients were evaluable for follow-up. After a median of 58 months (45-72 months), one patient showed a mild fibrosis of the breast tissue, three patients had mild to moderate lymphatic edema of the arm. 6/49 (12.2%) patients died of distant metastases, 4/49 (8.2%) were alive with disease, and 39/49 (79.6%) were free from disease. Local recurrence was observed in only one case (2%) 40 months after primary therapy. After mastectomy, this patient is currently free from disease. CONCLUSION: The combination of interstitial HDR brachytherapy and chemotherapy is a well-tolerated and effective neoadjuvant treatment in patients with breast cancer. Compared to EBRT, treatment time is short. Postoperative EBRT of the whole breast -- if necessary -- is still possible after neoadjuvant brachytherapy. Even though the number of patients does not permit definite conclusions, the results are promising regarding survival and the very low rate of local recurrences.

Perioperative fluid management: comparison of high, medium and low fluid volume on tissue oxygen pressure in the small bowel and colon

BACKGROUND AND OBJECTIVE: Insufficient blood flow and oxygenation in the intestinal tract is associated with increased incidence of postoperative complications after bowel surgery. High fluid volume administration may prevent occult regional hypoperfusion and intestinal tissue hypoxia. We tested the hypothesis that high intraoperative fluid volume administration increases intestinal wall tissue oxygen pressure during laparotomy. METHODS: In all, 27 pigs were anaesthetized, ventilated and randomly assigned to one of the three treatment groups (n = 9 in each) receiving low (3 mL kg-1 h-1), medium (7 mL kg-1 h-1) or high (20 mL kg-1 h-1) fluid volume treatment with lactated Ringer's solution. All animals received 30% and 100% inspired oxygen in random order. Cardiac index was measured with thermodilution and tissue oxygen pressure with a micro-oximetry system in the jejunum and colon wall and subcutaneous tissue. RESULTS: Groups receiving low and medium fluid volume treatment had similar systemic haemodynamics. The high fluid volume group had significantly higher mean arterial pressure, cardiac index and subcutaneous tissue oxygenation. Tissue oxygen pressures in the jejunum and colon were comparable in all three groups. CONCLUSIONS: The three different fluid volume regimens tested did not affect tissue oxygen pressure in the jejunum and colon, suggesting efficient autoregulation of intestinal blood flow in healthy subjects undergoing uncomplicated abdominal surgery.

Effects of cognitive behavioral stress management on HIV-1 RNA, CD4 cell counts and psychosocial parameters of HIV-infected persons

OBJECTIVE: To determine the effects of cognitive-behavioral stress management (CBSM) training on clinical and psychosocial markers in HIV-infected persons. METHODS: A randomized controlled trial in four HIV outpatient clinics of 104 HIV-infected persons taking combination antiretroviral therapy (cART), measuring HIV-1 surrogate markers, adherence to therapy and well-being 12 months after 12 group sessions of 2 h CBSM training. RESULTS: Intent-to-treat analyses showed no effects on HIV-1 surrogate markers in the CBSM group compared with the control group: HIV-1 RNA < 50 copies/ml in 81.1% [95% confidence interval (CI), 68.0-90.6] and 74.5% (95% CI, 60.4-85.7), respectively (P = 0.34), and mean CD4 cell change from baseline of 53.0 cells/microl (95% CI, 4.1-101.8) and 15.5 cells/microl (95% CI, -34.3 to 65.4), respectively (P = 0.29). Self-reported adherence to therapy did not differ between groups at baseline (P = 0.53) or at 12 month's post-intervention (P = 0.47). Significant benefits of CBSM over no intervention were observed in mean change of quality of life scores: physical health 2.9 (95% CI, 0.7-5.1) and -0.2 (95% CI, -2.1 to 1.8), respectively (P = 0.05); mental health 4.8 (95% CI, 1.8-7.3) and -0.5 (95% CI, -3.3 to 2.2) (P = 0.02); anxiety -2.1 (95% CI, -3.6 to -1.0) and 0.3 (95% CI, -0.7 to 1.4), respectively (P = 0.002); and depression -2.1 (95% CI, -3.2 to -0.9) and 0.02 (95% CI, -1.0 to 1.1), respectively (P = 0.001). Alleviation of depression and anxiety symptoms were most pronounced among participants with high psychological distress at baseline. CONCLUSION: CBSM training of HIV-infected persons taking on cART does not improve clinical outcome but has lasting effects on quality of life and psychological well-being.

First-trimester glycosylated hemoglobin in women at high risk for gestational diabetes.

INTRODUCTION Our aim was to investigate the prognostic value of first-trimester glycosylated hemoglobin (HbA1c) in pregnant women with risk factors for developing gestational diabetes mellitus (GDM). MATERIAL AND METHODS This is an observational retrospective cohort study conducted at the Department of Obstetrics and Gynecology, University Hospital Bern, Switzerland. We included pregnant women at high risk for GDM (n = 208), who had an HbA1c measurement in the first trimester. We compared HbA1c values of women who later developed GDM with those who did not develop GDM. Diagnosis of GDM was made on the basis of a 75-g oral glucose tolerance test performed between 24 and 28 weeks of gestation. We further examined the prevalence of GDM in relation to the first-trimester HbA1c value. RESULTS The prevalence of GDM in our high-risk group was 14.7%. Women who developed GDM had significantly higher first-trimester HbA1c values [5.43 ± 0.31% (36 ± 3 mmol/mol) vs. 5.23 ± 0.28% (34 ± 3 mmol/mol); p = 0.0026]. Moreover, all pregnant women with HbA1c ≥6.0% (42 mmol/mol) developed GDM, whereas those with <4.5% (26 mmol/mol) did not. CONCLUSIONS Women at risk for GDM have higher first-trimester HbA1c levels and values ≥6.0% (42 mmol/mol) are predictive of GDM. This information may be useful for counseling these women and providing appropriate advice on diet and lifestyle modification early in pregnancy.

Sociodemographic characteristics as predictors of successful smoking cessation among a group of Hispanic Spanish speaking smokers

Few studies have examined predictors of smoking abstinence among Hispanic groups. The purpose of this dissertation was to examine the relations of sociodemographic characteristics and smoking related factors with smoking abstinence among a group of Hispanic Spanish speaking smokers. This study utilized previously collected data from Hispanic Spanish-speaking smokers (N = 246) who participated in a study entitled Smoking Cessation Services for Hispanic Smokers in Texas. ^ The first study examined sociodemographic characteristics and smoking related mechanisms that predicted smoking abstinence among this group. Two of the characteristics were related to smoking abstinence, marital status and acculturation level. Being unmarried increased the likelihood of being abstinent at the 12 week assessment (OR = 1.80). Those in the high acculturation group were twice as likely to be abstinent (OR = 2.24). Of the smoking related mechanisms, those with higher positive reinforcement expectancies were less likely to be abstinent (OR = .86), as were those with a higher level of affiliative attachment (OR = .86), a higher level of craving (OR = .78) and a higher tolerance to the effect of smoking (OR = .74). The second study was to examine the relationship of objective measures of socioeconomic status (SES) (income, education, or employment) with smoking abstinence among this group. This study also compared the relationship of a subjective measure of SES (Social Status Ladder) to smoking abstinence. None of the objective measures of SES were related to smoking abstinence at the 12 week assessment. The subjective measure of SES did predict smoking abstinence (OR = 1.9) indicting that those that rated themselves ≤4 on the SES scale were more likely to be abstinent. ^ Although this group was recruited using various methods across the state of Texas, the fact that they preferred to interact with the counselor in Spanish may limit the study findings. The results of this study highlight the need for research to examine specific subgroups of people and understand the special circumstances that influence their health behaviors. Furthering our knowledge of the relations between sociodemographic characteristics and smoking cessation could lead to interventions that reduce disparities in smoking cessation. ^

The impact of nutrition intervention on glycemic control in a pediatric type 1 diabetes mellitus population

Aim: The goal of this study was to evaluate the change in hemoglobin A1C and glycemic control after nutrition intervention among a population of type 1 diabetic pediatric patients. Methods: Data was collected from all type 1 diabetic patients who were scheduled for a consultation with the diabetes/endocrine RD from January 2006 through December 2006. Two groups were compared, those who kept their RD appointment and those who did not keep their appointment. The main outcome measure was HgbA1C. An independent samples t-test compared the two groups with respect to change in HbgA1C before and after the most recent scheduled appointment with the RD. Baseline characteristics were used as covariates and analyzed and controlled for using analysis of covariance (ANCOVA). Results: There was no difference in HgbA1c after either attending an RD appointment or not having attended an RD appointment. Those who arrived for and attended their RD appointment and those who did not arrive for and attend their RD appointment, had statistically different HgbA1C's before their scheduled appointment as well as after the RD appointment. However, the two groups were not equal at the beginning of the study period. Discussion: A study design with inclusion criteria of a specified range of HgbA1C values within which the study subjects needed to fall, would have potentially eliminated the difference between the two groups at the beginning of the study period. Conducting either another retrospective study that controlled for the initial HgbA1C value or conducting a prospective study that designated a range of HgbA1C values would be worth investigating to evaluate the impact of medical nutrition therapy intervention and the role of the RD in diabetes management. It is an interesting finding that there was a significant difference in the initial HgbA1c for those who came to the RD appointment compared to those who did not come. The fact that in this study those who did not arrive for their RD appointment had worse control of their diabetes suggests that this is a high-risk group. Targeting diabetes education toward this group of patients may prove to be beneficial. ^

The association of HSV 1 and 2 with atherosclerosis defined by CRP level

A study of the association of Herpes simplex virus 1 and 2 exposure to early atherosclerosis using high C-reactive protein level as a marker was carried out in US born, non-pregnant, 20-49 year olds participating in a national survey between 1999 and 2004. Participants were required to have valid results for Herpes simplex virus 1 and 2 and C-Reactive Protein for inclusion. Cases were those found to have a high C-reactive protein level of 0.3-1 mg/dL, while controls had low to normal values (0.01-0.29 mg/dL). Overall, there were 1211 cases and 2870 controls. Mexican American and non-Hispanic black women were much more likely to fall into the high cardiac risk group than the other sex race groups with proportions of 44% and 39%, respectively. ^ Herpesvirus exposure was categorized such that Herpes simplex virus 1 and 2 exposure could be studied simultaneously within the same individual and models. The HSV 1+, HSV 2- category included the highest percentage (45.63%) of participants, followed by HSV 1-, HSV 2- (30.16%); HSV 1+, HSV 2+ (15.09%); and HSV 1-, HSV 2+ (9.12%) respectively. The proportion of participants in the HSV 1+, HSV 2- category was substantially higher in Mexican Americans (63%-66%). Further, the proportion in the HSV 1+, HSV 2+ category was notably higher in the non-Hispanic black participants (23%-44%). Non-Hispanic black women also had the highest percentage of HSV 1-, HSV 2+ exposure of all the sex race groups at 17%. ^ Overall, the unadjusted odds ratios for atherosclerotic disease defined by C-reactive protein with HSV 1-, HSV 2- as the referent group was 1.62 (95% CI 1.23-2.14) for HSV 1 +, HSV 2+; 1.3 (95% CI 1.10-1.69 for HSV 1+, HSV 2-; and 1.52 (95% CI 1.14-2.01). When the study was stratified into sex-race groups, only HSV 1+, HSV 2- in the Non-Hispanic white men remained significant (OR=1.6; 95% CI 1.06-2.43). Adjustment for selected covariates was made in the multivariate model for both the overall and sex-race stratified studies. High C-reactive protein values were not associated with any of the Herpesvirus exposure levels in either the overall or stratified analyses. ^

Observations of muskoxen and caribou in the high Arctic

Summary: Summer daily activity and movement patterns and habitat selectivity by Peary caribou (Rangifer tarandus pearyi) and muskoxen (Ovibos moschatus) were studied at two sites in Canada's High Arctic. Caribou showed a greater mobility and broader selection of habitat than muskoxen. Muskoxen fed more than they rested in contrast to the greater amount of time spent resting than feeding by caribou. The sedge-producing hydric-meadow vegetalion type was highly selected for by muskoxen at both study areas; caribou selected against the hydric-meadow type and preferred the polar desert and mesic-meadow types. Caribou displayed a greater variety in plant species selection than muskoxen, favouring willow (Salix arctica), grasses, forbs, and the flowers of vascular plants- Muskoxen feci extensively on sedges in the hydric-meadow. It is suggested the abundance and distribution of sedge-producing meadows may control the regional abundance and distribution of muskoxen. Winter climate is probably the ultimate factor controlling densities of muskoxen and caribou in the High Arctic.

Technology and characterization of GaN-HEMTs devices: high temperature and trapping effects

Los transistores de alta movilidad electrónica basados en GaN han sido objeto de una extensa investigación ya que tanto el GaN como sus aleaciones presentan unas excelentes propiedades eléctricas (alta movilidad, elevada concentración de portadores y campo eléctrico crítico alto). Aunque recientemente se han incluido en algunas aplicaciones comerciales, su expansión en el mercado está condicionada a la mejora de varios asuntos relacionados con su rendimiento y habilidad. Durante esta tesis se han abordado algunos de estos aspectos relevantes; por ejemplo, la fabricación de enhancement mode HEMTs, su funcionamiento a alta temperatura, el auto calentamiento y el atrapamiento de carga. Los HEMTs normalmente apagado o enhancement mode han atraído la atención de la comunidad científica dedicada al desarrollo de circuitos amplificadores y conmutadores de potencia, ya que su utilización disminuiría significativamente el consumo de potencia; además de requerir solamente una tensión de alimentación negativa, y reducir la complejidad del circuito y su coste. Durante esta tesis se han evaluado varias técnicas utilizadas para la fabricación de estos dispositivos: el ataque húmedo para conseguir el gate-recess en heterostructuras de InAl(Ga)N/GaN; y tratamientos basados en flúor (plasma CF4 e implantación de F) de la zona debajo de la puerta. Se han llevado a cabo ataques húmedos en heteroestructuras de InAl(Ga)N crecidas sobre sustratos de Si, SiC y zafiro. El ataque completo de la barrera se consiguió únicamente en las muestras con sustrato de Si. Por lo tanto, se puede deducir que la velocidad de ataque depende de la densidad de dislocaciones presentes en la estructura, ya que el Si presenta un peor ajuste del parámetro de red con el GaN. En relación a los tratamientos basados en flúor, se ha comprobado que es necesario realizar un recocido térmico después de la fabricación de la puerta para recuperar la heteroestructura de los daños causados durante dichos tratamientos. Además, el estudio de la evolución de la tensión umbral con el tiempo de recocido ha demostrado que en los HEMTs tratados con plasma ésta tiende a valores más negativos al aumentar el tiempo de recocido. Por el contrario, la tensión umbral de los HEMTs implantados se desplaza hacia valores más positivos, lo cual se atribuye a la introducción de iones de flúor a niveles más profundos de la heterostructura. Los transistores fabricados con plasma presentaron mejor funcionamiento en DC a temperatura ambiente que los implantados. Su estudio a alta temperatura ha revelado una reducción del funcionamiento de todos los dispositivos con la temperatura. Los valores iniciales de corriente de drenador y de transconductancia medidos a temperatura ambiente se recuperaron después del ciclo térmico, por lo que se deduce que dichos efectos térmicos son reversibles. Se han estudiado varios aspectos relacionados con el funcionamiento de los HEMTs a diferentes temperaturas. En primer lugar, se han evaluado las prestaciones de dispositivos de AlGaN/GaN sobre sustrato de Si con diferentes caps: GaN, in situ SiN e in situ SiN/GaN, desde 25 K hasta 550 K. Los transistores con in situ SiN presentaron los valores más altos de corriente drenador, transconductancia, y los valores más bajos de resistencia-ON, así como las mejores características en corte. Además, se ha confirmado que dichos dispositivos presentan gran robustez frente al estrés térmico. En segundo lugar, se ha estudiado el funcionamiento de transistores de InAlN/GaN con diferentes diseños y geometrías. Dichos dispositivos presentaron una reducción casi lineal de los parámetros en DC en el rango de temperaturas de 25°C hasta 225°C. Esto se debe principalmente a la dependencia térmica de la movilidad electrónica, y también a la reducción de la drift velocity con la temperatura. Además, los transistores con mayores longitudes de puerta mostraron una mayor reducción de su funcionamiento, lo cual se atribuye a que la drift velocity disminuye más considerablemente con la temperatura cuando el campo eléctrico es pequeño. De manera similar, al aumentar la distancia entre la puerta y el drenador, el funcionamiento del HEMT presentó una mayor reducción con la temperatura. Por lo tanto, se puede deducir que la degradación del funcionamiento de los HEMTs causada por el aumento de la temperatura depende tanto de la longitud de la puerta como de la distancia entre la puerta y el drenador. Por otra parte, la alta densidad de potencia generada en la región activa de estos transistores conlleva el auto calentamiento de los mismos por efecto Joule, lo cual puede degradar su funcionamiento y Habilidad. Durante esta tesis se ha desarrollado un simple método para la determinación de la temperatura del canal basado en medidas eléctricas. La aplicación de dicha técnica junto con la realización de simulaciones electrotérmicas han posibilitado el estudio de varios aspectos relacionados con el autocalentamiento. Por ejemplo, se han evaluado sus efectos en dispositivos sobre Si, SiC, y zafiro. Los transistores sobre SiC han mostrado menores efectos gracias a la mayor conductividad térmica del SiC, lo cual confirma el papel clave que desempeña el sustrato en el autocalentamiento. Se ha observado que la geometría del dispositivo tiene cierta influencia en dichos efectos, destacando que la distribución del calor generado en la zona del canal depende de la distancia entre la puerta y el drenador. Además, se ha demostrado que la temperatura ambiente tiene un considerable impacto en el autocalentamiento, lo que se atribuye principalmente a la dependencia térmica de la conductividad térmica de las capas y sustrato que forman la heterostructura. Por último, se han realizado numerosas medidas en pulsado para estudiar el atrapamiento de carga en HEMTs sobre sustratos de SiC con barreras de AlGaN y de InAlN. Los resultados obtenidos en los transistores con barrera de AlGaN han presentado una disminución de la corriente de drenador y de la transconductancia sin mostrar un cambio en la tensión umbral. Por lo tanto, se puede deducir que la posible localización de las trampas es la región de acceso entre la puerta y el drenador. Por el contrario, la reducción de la corriente de drenador observada en los dispositivos con barrera de InAlN llevaba asociado un cambio significativo en la tensión umbral, lo que implica la existencia de trampas situadas en la zona debajo de la puerta. Además, el significativo aumento del valor de la resistencia-ON y la degradación de la transconductancia revelan la presencia de trampas en la zona de acceso entre la puerta y el drenador. La evaluación de los efectos del atrapamiento de carga en dispositivos con diferentes geometrías ha demostrado que dichos efectos son menos notables en aquellos transistores con mayor longitud de puerta o mayor distancia entre puerta y drenador. Esta dependencia con la geometría se puede explicar considerando que la longitud y densidad de trampas de la puerta virtual son independientes de las dimensiones del dispositivo. Finalmente se puede deducir que para conseguir el diseño óptimo durante la fase de diseño no sólo hay que tener en cuenta la aplicación final sino también la influencia que tiene la geometría en los diferentes aspectos estudiados (funcionamiento a alta temperatura, autocalentamiento, y atrapamiento de carga). ABSTRACT GaN-based high electron mobility transistors have been under extensive research due to the excellent electrical properties of GaN and its related alloys (high carrier concentration, high mobility, and high critical electric field). Although these devices have been recently included in commercial applications, some performance and reliability issues need to be addressed for their expansion in the market. Some of these relevant aspects have been studied during this thesis; for instance, the fabrication of enhancement mode HEMTs, the device performance at high temperature, the self-heating and the charge trapping. Enhancement mode HEMTs have become more attractive mainly because their use leads to a significant reduction of the power consumption during the stand-by state. Moreover, they enable the fabrication of simpler power amplifier circuits and high-power switches because they allow the elimination of negativepolarity voltage supply, reducing significantly the circuit complexity and system cost. In this thesis, different techniques for the fabrication of these devices have been assessed: wet-etching for achieving the gate-recess in InAl(Ga)N/GaN devices and two different fluorine-based treatments (CF4 plasma and F implantation). Regarding the wet-etching, experiments have been carried out in InAl(Ga)N/GaN grown on different substrates: Si, sapphire, and SiC. The total recess of the barrier was achieved after 3 min of etching in devices grown on Si substrate. This suggests that the etch rate can critically depend on the dislocations present in the structure, since the Si exhibits the highest mismatch to GaN. Concerning the fluorine-based treatments, a post-gate thermal annealing was required to recover the damages caused to the structure during the fluorine-treatments. The study of the threshold voltage as a function of this annealing time has revealed that in the case of the plasma-treated devices it become more negative with the time increase. On the contrary, the threshold voltage of implanted HEMTs showed a positive shift when the annealing time was increased, which is attributed to the deep F implantation profile. Plasma-treated HEMTs have exhibited better DC performance at room temperature than the implanted devices. Their study at high temperature has revealed that their performance decreases with temperature. The initial performance measured at room temperature was recovered after the thermal cycle regardless of the fluorine treatment; therefore, the thermal effects were reversible. Thermal issues related to the device performance at different temperature have been addressed. Firstly, AlGaN/GaN HEMTs grown on Si substrate with different cap layers: GaN, in situ SiN, or in situ SiN/GaN, have been assessed from 25 K to 550 K. In situ SiN cap layer has been demonstrated to improve the device performance since HEMTs with this cap layer have exhibited the highest drain current and transconductance values, the lowest on-resistance, as well as the best off-state characteristics. Moreover, the evaluation of thermal stress impact on the device performance has confirmed the robustness of devices with in situ cap. Secondly, the high temperature performance of InAlN/GaN HEMTs with different layouts and geometries have been assessed. The devices under study have exhibited an almost linear reduction of the main DC parameters operating in a temperature range from room temperature to 225°C. This was mainly due to the thermal dependence of the electron mobility, and secondly to the drift velocity decrease with temperature. Moreover, HEMTs with large gate length values have exhibited a great reduction of the device performance. This was attributed to the greater decrease of the drift velocity for low electric fields. Similarly, the increase of the gate-to-drain distance led to a greater reduction of drain current and transconductance values. Therefore, this thermal performance degradation has been found to be dependent on both the gate length and the gate-to-drain distance. It was observed that the very high power density in the active region of these transistors leads to Joule self-heating, resulting in an increase of the device temperature, which can degrade the device performance and reliability. A simple electrical method have been developed during this work to determine the channel temperature. Furthermore, the application of this technique together with the performance of electro-thermal simulations have enabled the evaluation of different aspects related to the self-heating. For instance, the influence of the substrate have been confirmed by the study of devices grown on Si, SiC, and Sapphire. HEMTs grown on SiC substrate have been confirmed to exhibit the lowest self-heating effects thanks to its highest thermal conductivity. In addition to this, the distribution of the generated heat in the channel has been demonstrated to be dependent on the gate-to-drain distance. Besides the substrate and the geometry of the device, the ambient temperature has also been found to be relevant for the self-heating effects, mainly due to the temperature-dependent thermal conductivity of the layers and the substrate. Trapping effects have been evaluated by means of pulsed measurements in AlGaN and InAIN barrier devices. AlGaN barrier HEMTs have exhibited a de crease in drain current and transconductance without measurable threshold voltage change, suggesting the location of the traps in the gate-to-drain access region. On the contrary, InAIN barrier devices have showed a drain current associated with a positive shift of threshold voltage, which indicated that the traps were possibly located under the gate region. Moreover, a significant increase of the ON-resistance as well as a transconductance reduction were observed, revealing the presence of traps on the gate-drain access region. On the other hand, the assessment of devices with different geometries have demonstrated that the trapping effects are more noticeable in devices with either short gate length or the gate-to-drain distance. This can be attributed to the fact that the length and the trap density of the virtual gate are independent on the device geometry. Finally, it can be deduced that besides the final application requirements, the influence of the device geometry on the performance at high temperature, on the self-heating, as well as on the trapping effects need to be taken into account during the device design stage to achieve the optimal layout.

Comparison of the predictability of refractive cylinder correction by laser in situ keratomileusis in eyes with low or high ocular residual astigmatism

Purpose: To compare the manifest refractive cylinder (MRC) predictability of myopic astigmatism laser in situ keratomileusis (LASIK) between eyes with low and high ocular residual astigmatism (ORA). Setting: London Vision Clinic, London, United Kingdom. Design: Retrospective case study. Methods: The ORA was considered the vector difference between the MRC and the corneal astigmatism. The index of success (IoS), difference vector ÷ MRC, was analyzed for different groups as follows: stage 1, low ORA (ORA ÷ MRC <1), high ORA (ORA ÷ MRC ≥1); stage 2, low ORA group reduced to match the high ORA group for MRC; stage 3, grouped by ORA magnitude with low ORA (<0.50 diopters [D]), mid ORA (0.50 to 1.24 D), and high ORA (≥1.25 D); stage 4, high ORA group subdivided into low (<0.75 D) and high (≥0.75 D) corneal astigmatism. Results: For stage 1, the mean preoperative MRC and mean IoS were −1.32 D ± 0.65 (SD) (range −0.55 to −3.77 D) and 0.27, respectively, for low ORA and −0.79 ± 0.20 D (range −0.56 to −2.05 D) and 0.37, respectively, for high ORA. For stage 2, the mean IoS increased to 0.32 for low ORA. For stage 3, the mean IoS was 0.28, 0.29, and 0.31 for low ORA, mid ORA, and high ORA, respectively. For stage 4, the mean IoS was 0.20 for high ORA/low corneal astigmatism and 0.35 for high ORA/high corneal astigmatism. Conclusions: The MRC predictability was slightly worse in eyes with high ORA when grouped by the ORA ÷ MRC. Matching for the MRC and grouping by ORA magnitude resulted in similar predictability; however, eyes with high ORA and high corneal astigmatism were less predictable.