Los profesionales de la salud ante la comunicación de final de vida en pacientes con enfermedad avanzada e incurable . La conspiración de silencio

La conspiración de silencio (CdS) es un fenómeno universal que hace referencia a un acuerdo tácito entre profesionales y familiares/cuidadores para ocultar información al paciente, relacionada con su situación clínica, sin considerar las necesidades de información del mismo. En circunstancias de enfermedad terminal, la ocultación del diagnóstico, pronóstico u objetivo de tratamiento no sólo tiene implicaciones éticas, sino que influye en la práctica asistencial. Las consecuencias de la CdS se producen tanto en el paciente, como en la familia, en los profesionales y en el propio sistema sanitario, siendo la barrera comunicativa que se establece, una de las mayores repercusiones negativas que afecta a todos los individuos implicados. La CdS impide al paciente la preparación para su próxima muerte. Los profesionales ante estas circunstancias, no pueden ofrecer cuidados óptimos debido a la imposibilidad de explorar aspectos emocionales en el paciente relacionados con la cercanía de la muerte. Estos aspectos adquieren una importancia esencial en cuidados de final de vida donde la comunicación efectiva es el vehículo primordial. La cantidad y calidad de información que reciben los pacientes está determinada por aspectos sociales, personales, psicológicos y culturales donde los profesionales de la salud son los principales implicados como parte integrante del proceso informativo. Es necesario hacer un análisis de los factores que precipitan la CdS, sus posibles repercusiones y los beneficios potenciales que conlleva la transmisión de malas noticias para lograr una comprensión del fenómeno. Es indudable que los médicos y enfermeras, a través de sus actitudes, pueden influir en la aparición o mantenimiento de este fenómeno, y que un buen conocimiento del mismo puede contribuir a su futuro manejo. Dada la importancia del tema en la práctica clínica, el presente estudio pretende clarificar el fenómeno y analizar las actitudes de los profesionales de la salud ante la CdS. El explorarlo es una tarea compleja ocasionada por la ausencia de instrumentos válidos y fiables para su cuantificación y análisis. Por este motivo uno de los objetivos centrales de este estudio es la elaboración de una escala que permita evaluar las actitudes de los profesionales ante la CdS en pacientes paliativos.

Surface states in template synthesized tin oxide nanoparticles

Tin-oxide nanoparticles with controlled narrow size distributions are synthesized while physically encapsulated inside silica mesoporous templates. By means of ultraviolet-visible spectroscopy, a redshift of the optical absorbance edge is observed. Photoluminescence measurements corroborate the existence of an optical transition at 3.2 eV. The associated band of states in the semiconductor gap is present even on template-synthesized nanopowders calcined at 800°C, which contrasts with the evolution of the gap states measured on materials obtained by other methods. The gap states are thus considered to be surface localized, disappearing with surface faceting or being hidden by the surface-to-bulk ratio decrease.

Shot-noise suppression in Schottky barrier diodes

We give a theoretical interpretation of the noise properties of Schottky barrier diodes based on the role played by the long range Coulomb interaction. We show that at low bias Schottky diodes display shot noise because the presence of the depletion layer makes the effects of the Coulomb interaction negligible on the current fluctuations. When the device passes from barrier to flat band conditions, the Coulomb interaction becomes active, thus introducing correlation between different current fluctuations. Therefore, the crossover between shot and thermal noise represents the suppression due to long range Coulomb interaction of the otherwise full shot noise. Similar ideas can be used to interpret the noise properties of other semiconductor devices.

Influence of the (111) twinning on the formation of diamond cubic/diamond hexagonal heterostructures in Cu-catalyzed Si nanowires

The occurrence of heterostructures of cubic silicon/hexagonal silicon as disks defined along the nanowire (111) growth direction is reviewed in detail for Si nanowires obtained using Cu as catalyst. Detailed measurements on the structural properties of both semiconductor phases and their interface are presented. We observe that during growth, lamellar twinning on the cubic phase along the (111) direction is generated. Consecutive presence of twins along the (111) growth direction was found to be correlated with the origin of the local formation of the hexagonal Si segments along the nanowires, which define quantum wells of hexagonal Si diamond. Finally, we evaluate and comment on the consequences of the twins and wurtzite in the final electronic properties of the wires with the help of the predicted energy band diagram.

Bipolar pulsed excitation of erbium-doped nanosilicon light emitting diodes

High quantum efficiency erbium doped silicon nanocluster (Si-NC:Er) light emitting diodes (LEDs) were grown by low-pressure chemical vapor deposition (LPCVD) in a complementary metal-oxide-semiconductor (CMOS) line. Erbium (Er) excitation mechanisms under direct current (DC) and bipolar pulsed electrical injection were studied in a broad range of excitation voltages and frequencies. Under DC excitation, Fowler-Nordheim tunneling of electrons is mediated by Er-related trap states and electroluminescence originates from impact excitation of Er ions. When the bipolar pulsed electrical injection is used, the electron transport and Er excitation mechanism change. Sequential injection of electrons and holes into silicon nanoclusters takes place and nonradiative energy transfer to Er ions is observed. This mechanism occurs in a range of lower driving voltages than those observed in DC and injection frequencies higher than the Er emission rate.

Sintesis por implantacion ionica de nanocristales semiconductores para dispositivos en tecnologia de Si

En este artículo se estudia la síntesis de nanocristales semiconductores elementales y compuestos elaborados por implantación iónica en SiO2. En el caso de los nanocristales de Si, se ha desarrollado un estudio sistemático que correlaciona las características de los precipitados y sus propiedades de luminiscencia. Nanopartículas de Ge, que presentan menor emisión pero mayor contraste en Microscopía Electrónica de Transmisión, han sido fabricadas para desarrollar un nuevo método de medida de la densidad de nanocristales en matrices amorfas. Por otro lado, nanopartículas de ZnS dopadas con Mn han sido elaboradas por primera vez con esta técnica, observando la emisión de un pico de luminescencia característico de una transición intra-Mn. Finalmente, se presentan los primeros resultados ópticos de capas coimplantadas con Si+ y C+, que muestran la presencia de tres picos intensos de luminescencia en las regiones roja, verde y azul del espectro visible, que ha sido relacionada con la presencia de diferentes tipos de nanopartículas. Cabe destacar que la emisión simultánea de los tres picos ha permitido la observación de una intensa emisión de luz blanca.

Nanocrystalline SnO2 by liquid pyrolisis

Liquid pyrolysis is presented as a new production method of SnO2 nanocrystalline powders suitable for gas sensor devices. The method is based on a pyrolytic reaction of high tensioned stressed drops of an organic solution of SnCl4·5(H2O). The main advantages of the method are its capability to produce SnO2 nanopowders with high stability, its accurate control over the grain size and other structural characteristics, its high level of repeatability and its low industrialization implementation cost. The characterization of samples of SnO2 nanoparticles obtained by liquid pyrolysis in the range between 200ºC and 900ºC processing temperature is carried out by X-ray diffraction, transmission electron microscopy, Raman and X-ray photoelectron spectroscopy. Results are analyzed and discussed so as to validate the advantages of the liquid pyrolysis method.

Polarization strategies to improve the emission of a Si-based light source emitting at 1.55 um

We present a electroluminescence (EL) study of the Si-rich silicon oxide (SRSO) LEDs with and without Er3+ ions under different polarization schemes: direct current (DC) and pulsed voltage (PV). The power efficiency of the devices and their main optical limitations are presented. We show that under PV polarization scheme, the devices achieve one order of magnitude superior performance in comparison with DC. Time-resolved measurements have shown that this enhancement is met only for active layers in which annealing temperature is high enough (>1000 ◦C) for silicon nanocrystal (Si-nc) formation. Modeling of the system with rate equations has been done and excitation cross-sections for both Si-nc and Er3+ ions have been extracted.

Gas-sensing properties of sprayed films of (CdO)x(ZnO)1-x mixed oxide

A novel NO2 sensor based on (CdO)x(ZnO)1-x mixed-oxide thin films deposited by the spray pyrolysis technique is developed. The sensor response to 3-ppm NO2 is studied in the range 50°C-350°C for three different film compositions. The device is also tested for other harmful gases, such as CO (300 ppm) and CH4 (3000 ppm). The sensor response to these reducing gases is different at different temperatures varying from the response typical for the p-type semiconductor to that typical for the n-type semiconductor. Satisfactory response to NO2 and dynamic behavior at 230°C, as well as low resistivity, are observed for the mixed-oxide film with 30% Cd. The response to interfering gas is poor at working temperature (230°C). On the basis of this study, a possible sensing mechanism is proposed.

A reusable smart interface for gas sensor resistance measurement

The advances of the semiconductor industry enable microelectromechanical systems sensors, signal conditioning logic and network access to be integrated into a smart sensor node. In this framework, a mixed-mode interface circuit for monolithically integrated gas sensor arrays was developed with high-level design techniques. This interface system includes analog electronics for inspection of up to four sensor arrays and digital logic for smart control and data communication. Although different design methodologies were used in the conception of the complete circuit, high-level synthesis tools and methodologies were crucial in speeding up the whole design cycle, enhancing reusability for future applications and producing a flexible and robust component.

Hydrogen-induced changes in the breakdown voltage of InP HEMTs

In this work, electrical measurements show that the breakdown voltage,BVDG, of InP HEMTs increases following exposure to H2. This BVDG shift is nonrecoverable. The increase in BVDG is found to be due to a decrease in the carrier concentration in the extrinsic portion of the device.We provide evidence that H2 reacts with the exposed InAlAs surface in the extrinsic region next to the gate, changing the underlying carrier concentration. Hall measurements of capped and uncapped HEMT samples show that the decrease in sheet carrier concentration can be attributed to a modification of the exposed InAlAs surface. Consistent with this, XPS experiments on uncapped heterostructures give evidence of As loss from the InAlAs surface upon exposure to hydrogen.

Impedance field and transition from thermal to shot noise in Cd1-xZnxTe semi-insulating Ohmic detectors

Within a drift-diffusion model we investigate the role of the self-consistent electric field in determining the impedance field of a macroscopic Ohmic (linear) resistor made by a compensated semi-insulating semiconductor at arbitrary values of the applied voltage. The presence of long-range Coulomb correlations is found to be responsible for a reshaping of the spatial profile of the impedance field. This reshaping gives a null contribution to the macroscopic impedance but modifies essentially the transition from thermal to shot noise of a macroscopic linear resistor. Theoretical calculations explain a set of noise experiments carried out in semi-insulating CdZnTe detectors.

Asymptotic analysis of the Gunn effect with realistic boundary conditions

A general asymptotic analysis of the Gunn effect in n-type GaAs under general boundary conditions for metal-semiconductor contacts is presented. Depending on the parameter values in the boundary condition of the injecting contact, different types of waves mediate the Gunn effect. The periodic current oscillation typical of the Gunn effect may be caused by moving charge-monopole accumulation or depletion layers, or by low- or high-field charge-dipole solitary waves. A new instability caused by multiple shedding of (low-field) dipole waves is found. In all cases the shape of the current oscillation is described in detail: we show the direct relationship between its major features (maxima, minima, plateaus, etc.) and several critical currents (which depend on the values of the contact parameters). Our results open the possibility of measuring contact parameters from the analysis of the shape of the current oscillation.