The development of EUV lithography is critically based on the availability of suitable metrology equipment. To meet industry's requirements, the Physikalisch-Technische Bundesanstalt (PTB) operates an EUV reflectometry facility at the electron storage ring BESSY II. It is designed for at-wavelength metrology of full-sized EUVL optics with a maximum weight of 50 kg and a linear dimension of up to 1 m. With the development of EUV lithography tools, the requirements for lower measurement uncertainty are steadily increasing. For small test samples at near normal incidence, a total uncertainty of 0.10 % for peak reflectance is achieved with a reproducibility of 0.05 % and the uncertainty in the center wavelength of 2 pm is mainly given by the uncertainty for the reference wavelength of the Kr 3d5/2-5p resonance. For real optical elements like PO-box mirrors and collectors for EUV pulsed plasma sources it is also essential to measure at the exact location on the mirror because of gradients in the layer thickness and also to measure at the correct local angle of incidence (LAOI) which may deviate significantly from normal. Thus alignment becomes critical for achieving low measurement uncertainties. Here we present PTB's experience in measuring large EUV optical components.

Background The literature has mixed results regarding the relationship between antibiotic prescribing and patient satisfaction in the emergency department (ED) for antibiotic-inappropriate respiratory diagnoses. The objective of the study was to determine if ED patients who receive nonindicated antibiotic prescriptions for respiratory tract conditions have increased Press Ganey patient satisfaction scores compared with those who do not receive antibiotics. Methods This was a retrospective observational study. Using an administrative electronic health record data set from 2 EDs in the Midwest, we identified 619 ED encounters resulting in discharge for antibiotic-inappropriate respiratory diagnoses with a corresponding Press Ganey patient satisfaction survey. We compared sociodemographics, encounter variables, and overall Press Ganey patient satisfaction scores between those who did and did not receive antibiotics. We analyzed Press Ganey scores by categorical score distribution and as a dichotomized scale of top box (5) vs other scores. A logistic regression estimated the odds of a top box Press Ganey patient satisfaction score based on antibiotic prescribing while controlling for other covariates. Results In the final sample, 158 (26%) encounters involving antibiotic-inappropriate respiratory diagnoses involved an antibiotic prescription. There were no differences in sociodemographic, encounter or categorical, or top box Press Ganey overall patient satisfaction scores between the groups that did and did not receive inappropriate antibiotics. In the fully adjusted regression model, antibiotic prescriptions were not associated with increased odds of top box Press Ganey patient satisfaction score (odds ratio, 0.78; 95% CI, 0.53–1.14). Conclusions Our findings suggest that nonindicated antibiotic prescribing for respiratory tract conditions is not a primary driver of overall Press Ganey scores in the ED.

Objective: Skin and soft-tissue infections (SSTIs) account for 3% of all emergency department (ED) encounters and are frequently associated with inappropriate antibiotic prescribing. We characterized barriers and facilitators to optimal antibiotic use for SSTIs in the ED using a systems engineering framework and matched them with targeted stewardship interventions. Design and participants: We conducted semistructured interviews with a purposefully selected sample of emergency physicians. Methods: An interview guide was developed using the Systems Engineering Initiative for Patient Safety (SEIPS) framework. Interviews were recorded, transcribed, and analyzed iteratively until conceptual saturation was achieved. Themes were identified using deductive directed content analysis guided by the SEIPS model. Results: We conducted 20 interviews with physicians of varying experience and from different practice settings. Identified barriers to optimal antibiotic prescribing for SSTIs included poor access to follow-up (organization), need for definitive diagnostic tools (tools and technology) and fear over adverse outcomes related to missed infections (person). Identified potential interventions included programs to enhance follow-up care; diagnostic aides (eg, rapid MRSA assays for purulent infections and surface thermal imaging for cellulitis); and shared decision-making tools. Conclusions: Using a systems engineering informed qualitative approach, we successfully characterized barriers and developed targeted antibiotic stewardship interventions for SSTIs managed in the ED work system. The interventions span multiple components of the ED work system and should inform future efforts to improve antibiotic stewardship for SSTIs in this challenging care setting.