Development of a Topological-Insulator-Based Quantum Resistance Standard.

This paper describes the characterization of the quantum anomalous Hall (QAH) effect resistor with Chromium-doped Bismuth Antimony Telluride with the efforts in coupling directly to a programmable Josephson voltage standard (PJVS) at zero magnetic field. The precision measurement of the QAH resistance was performed under the presence of microwave signal biased to the PJVS. Understanding such effect will help to improve the experimental set-up for integrating multiple quantum electrical standards in a single system.

Treatment of Pain in Cirrhosis: Advice to Caregivers of Those with Rock Livers.

PURPOSE: When one considers the significant role of the liver in medication absorption and metabolism, clinicians must appreciate the important ramifications for medication dosing and monitoring in patients with cirrhosis. For many medications, dose adjustments may be necessary to minimize toxicities or avoid adverse effects from drug accumulation. Clinicians could be well served if they can understand in some detail how pharmacokinetic properties are altered in cirrhosis. METHODS: A PubMed search of the English medical literature starting with 1980 using keywords cirrhosis, pain management, and analgesics was performed, and additional papers were found using references from the first round of papers. FINDINGS: Patients with cirrhosis often have significant reductions in first-pass metabolism, altered volumes of distribution, and marked reductions in both renal and hepatic elimination of drugs. These factors may contribute to much higher levels of drug exposure compared to the general population. In terms of drug dosing, FDA labeling is often ambiguous and even incongruous with observed pharmacokinetic changes. IMPLICATIONS: This article may provide guidance for clinicians to optimize pain management in people living with cirrhosis. KEY MESSAGE: Current FDA labeling for dosing analgesic drugs in patients with cirrhosis is either vague or not consistent with findings from newer pharmacokinetic research. With this review, we hope to provide insight and guidance to clinicians on how to dose-adjust medications commonly utilized in pain management in these patients.

Conformity Experiment on Inelastic Scattering Exponent of Electrons in Two Dimensions.

The quantum Hall (QH) effect is one of the most widely studied physical phenomenon in two dimensions. The plateau-plateau transition within this effect can be comprehensively described by the scaling theory, which encompasses three pivotal exponents: the critical exponent κ, the inelastic scattering exponent p, and the universal exponent γ. Prior studies have focused on measuring κ and estimating γ, assuming a constant p value of 2 across magnetic fields. Here, our work marks a significant advancement by measuring all three exponents within a single graphene device and a conventional two-dimensional electron system. This study uniquely determines p at low magnetic fields (weak localization region and well outside the QH regime) and high magnetic fields (in the vicinity of the QH regime). Employing a comprehensive analytical approach that includes weak localization, plateau-plateau transitions, and variable range hopping, we have directly determined κ, p, and γ. Our findings reveal a distinct variation in p, shifting from 1 in the low magnetic field regime to 2 in the QH regime in graphene.

Potential of dietary polyphenols for protection from age-related decline and neurodegeneration: a role for gut microbiota?

Many epidemiological studies have shown the beneficial effects of a largely plant-based diet, and the strong association between the consumption of a Mediterranean-type diet with healthy aging including a lower risk of cognitive decline. The Mediterranean diet is characterized by a high intake of olive oil, fruits and vegetables and is rich in dietary fiber and polyphenols - both of which have been postulated to act as important mediators of these benefits. Polyphenols are large molecules produced by plants to protect them from environmental threats and injury. When ingested by humans, as little as 5% of these molecules are absorbed in the small intestine with the majority metabolized by the gut microbiota into absorbable simple phenolic compounds. Flavan-3-ols, a type of flavonoid, contained in grapes, berries, pome fruits, tea, and cocoa have been associated with many beneficial effects on several risk factors for cardiovascular disease, cognitive function and brain regions involved in memory formation. Both preclinical and clinical studies suggest that these brain and heart benefits can be attributed to endothelial vascular effects and anti-inflammatory properties among others. More recently the gut microbiota has emerged as a potential modulator of the aging brain and intriguingly polyphenols have been shown to alter microbiota composition and be metabolized by different microbial species. However, there is a need for well controlled studies in large populations to identify predictors of response, particularly given the vast inter-individual variation of human gut microbiota.

Effectiveness of Upadacitinib for Patients With Acute Severe Ulcerative Colitis: A Multicenter Experience.

INTRODUCTION: A significant proportion of patients with acute severe ulcerative colitis (ASUC) require colectomy. METHODS: Patients with ASUC treated with upadacitinib and intravenous corticosteroids at 5 hospitals are presented. The primary outcome was 90-day colectomy rate. Secondary outcomes included frequency of steroid-free clinical remission, adverse events, and all-cause readmissions. RESULTS: Of the 25 patients with ASUC treated with upadacitinib, 6 (24%) patients underwent colectomy, 15 (83%) of the 18 patients with available data and who did not undergo colectomy experienced steroid-free clinical remission (1 patient did not have complete data), 1 (4%) patient experienced a venous thromboembolic event, while 5 (20%) patients were readmitted. DISCUSSION: Upadacitinib along with intravenous corticosteroids may be an effective treatment for ASUC.

Daily fosfomycin versus levofloxacin for complicated urinary tract infections.

IMPORTANCE: Concerns over resistance and safety have been identified in the current treatment regimen for complicated urinary tract infections. Fosfomycin is a drug that is routinely used for the treatment of uncomplicated cystitis. This study shows that fosfomycin could be an oral alternative as step-down therapy for the treatment of complicated urinary tract infections, with a clinical cure rate comparable to levofloxacin but a lower microbiological success rate 3 weeks from start of antibiotics.

Methodology and implementation of a tunable deep-ultraviolet laser source for photoemission electron microscopy.

Photoemission electron microscopy (PEEM) is a unique and powerful tool for studying the electronic properties of materials and surfaces. However, it requires intense and well-controlled light sources with photon energies ranging from the UV to soft X-rays for achieving high spatial resolution and image contrast. Traditionally, many PEEMs were installed at synchrotron light sources to access intense and tunable soft X-rays. More recently, the maturation of solid-state lasers has opened a new avenue for laboratory-based PEEMs using laser-based UV light at lower photon energies. Here, we report on the characteristics of a laser-based UV light source that was recently integrated with a PEEM instrument. The system consists of a high repetition rate, tunable wavelength laser coupled to a harmonics generation module, which generates deep-UV radiation from 192 nm to 210 nm. We comment on the spectral characteristics and overall laser system stability, as well as on the effects of space charge within the PEEM microscope at high UV laser fluxes. Further, we show an example of imaging on gallium nitride, where the higher UV photon energy and flux of the laser provides considerably improved image quality, compared to a conventional light source. These results demonstrate the capabilities of laser-based UV light sources for advancing laboratory-based PEEMs.

Glycolipid Metabolite ß-Glucosylceramide Is a Neutrophil Extracellular Trap-Inducing Ligand of Mincle Released during Bacterial Infection and Inflammation.

Neutrophil extracellular traps (NETs) are implicated in host defense and inflammatory pathologies alike. A wide range of pathogen- and host-derived factors are known to induce NETs, yet the knowledge about specific receptor-ligand interactions in this response is limited. We previously reported that macrophage-inducible C-type lectin (Mincle) regulates NET formation. In this article, we identify glycosphingolipid ß-glucosylceramide (ß-GlcCer) as a specific NET-inducing ligand of Mincle. We found that purified ß-GlcCer induced NETs in mouse primary neutrophils in vitro and in vivo, and this effect was abrogated in Mincle deficiency. Cell-free ß-GlcCer accumulated in the lungs of pneumonic mice, which correlated with pulmonary NET formation in wild-type, but not in Mincle-/-, mice infected intranasally with Klebsiella pneumoniae Although leukocyte infiltration by ß-GlcCer administration in vivo did not require Mincle, NETs induced by this sphingolipid were important for bacterial clearance during Klebsiella infection. Mechanistically, ß-GlcCer did not activate reactive oxygen species formation in neutrophils but required autophagy and glycolysis for NET formation, because ATG4 inhibitor NSC185058, as well as glycolysis inhibitor 2-deoxy-d-glucose, abrogated ß-GlcCer-induced NETs. Forced autophagy activation by tamoxifen could overcome the inhibitory effect of glycolysis blockage on ß-GlcCer-mediated NET formation, suggesting that autophagy activation is sufficient to induce NETs in response to this metabolite in the absence of glycolysis. Finally, ß-GlcCer accumulated in the plasma of patients with systemic inflammatory response syndrome, and its levels correlated with the extent of systemic NET formation in these patients. Overall, our results posit ß-GlcCer as a potent NET-inducing ligand of Mincle with diagnostic and therapeutic potential in inflammatory disease settings.

Short- vs Standard-Course Outpatient Antibiotic Therapy for Community-Acquired Pneumonia in Children: The SCOUT-CAP Randomized Clinical Trial.

IMPORTANCE: Childhood community-acquired pneumonia (CAP) is usually treated with 10 days of antibiotics. Shorter courses may be effective with fewer adverse effects and decreased potential for antibiotic resistance. OBJECTIVE: To compare a short (5-day) vs standard (10-day) antibiotic treatment strategy for CAP in young children. DESIGN, SETTING, AND PARTICIPANTS: Randomized double-blind placebo-controlled clinical trial in outpatient clinic, urgent care, or emergency settings in 8 US cities. A total of 380 healthy children aged 6 to 71 months with nonsevere CAP demonstrating early clinical improvement were enrolled from December 2, 2016, to December 16, 2019. Data were analyzed from January to September 2020. INTERVENTION: On day 6 of their originally prescribed therapy, participants were randomized 1:1 to receive 5 days of matching placebo or 5 additional days of the same antibiotic. MAIN OUTCOMES AND MEASURES: The primary end point was the end-of-treatment response adjusted for duration of antibiotic risk (RADAR), a composite end point that ranks each child's clinical response, resolution of symptoms, and antibiotic-associated adverse effects in an ordinal desirability of outcome ranking (DOOR). Within each DOOR rank, participants were further ranked by the number of antibiotic days, assuming that shorter antibiotic durations were more desirable. Using RADAR, the probability of a more desirable outcome was estimated for the short- vs standard-course strategy. In a subset of children, throat swabs were collected between study days 19 and 25 to quantify antibiotic resistance genes in oropharyngeal flora. RESULTS: A total of 380 children (189 randomized to short course and 191 randomized to standard course) made up the study population. The mean (SD) age was 35.7 (17.2) months, and 194 participants (51%) were male. Of the included children, 8 were Asian, 99 were Black or African American, 234 were White, 32 were multiracial, and 7 were of unknown or unreported race; 33 were Hispanic or Latino, 344 were not Hispanic or Latino, and 3 were of unknown or unreported ethnicity. There were no differences between strategies in the DOOR or its individual components. Fewer than 10% of children in either strategy had an inadequate clinical response. The short-course strategy had a 69% (95% CI, 63-75) probability of a more desirable RADAR outcome compared with the standard-course strategy. A total of 171 children were included in the resistome analysis. The median (range) number of antibiotic resistance genes per prokaryotic cell (RGPC) was significantly lower in the short-course strategy compared with the standard-course strategy for total RGPC (1.17 [0.35-2.43] vs 1.33 [0.46-11.08]; P = .01) and ß-lactamase RGPC (0.55 [0.18-1.24] vs 0.60 [0.21-2.45]; P = .03). CONCLUSIONS AND RELEVANCE: In this study, among children responding to initial treatment for outpatient CAP, a 5-day antibiotic strategy was superior to a 10-day strategy. The shortened approach resulted in similar clinical response and antibiotic-associated adverse effects, while reducing antibiotic exposure and resistance. TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT02891915.

Graphene quantum Hall effect parallel resistance arrays.

As first recognized in 2010, epitaxial graphene on SiC(0001) provides a platform for quantized Hall resistance (QHR) metrology unmatched by other two-dimensional structures and materials. Here we report graphene parallel QHR arrays, with metrologically precise quantization near 1000 Ω. These arrays have tunable carrier densities, due to uniform epitaxial growth and chemical functionalization, allowing quantization at the robust ν = 2 filling factor in array devices at relative precision better than 10-8. Broad tunability of the carrier density also enables investigation of the ν = 6 plateau. Optimized networks of QHR devices described in this work suppress Ohmic contact resistance error using branched contacts and avoid crossover leakage with interconnections that are superconducting for quantizing magnetic fields up to 13.5 T. Our work enables more direct scaling of resistance for quantized values in arrays of arbitrary network geometry.

Characterizing the Changes in Material Use due to Vehicle Electrification.

Modern automobiles are composed of more than 2000 different compounds comprising 76 different elements. Identifying supply risks across this palette of materials is important to ensure a smooth transition to more sustainable transportation technologies. This paper provides insight into how electrification is changing vehicle composition and how that change drives supply risk vulnerability by providing the first comprehensive, high-resolution (elemental and compound level) snapshot of material use in both conventional and hybrid electric vehicles (HEVs) using a consistent methodology. To make these contributions, we analyze part-level data of material use for seven current year models, ranging from internal combustion engine vehicles (ICEV) to plug-in hybrid vehicles (PHEVs). With this data set, we apply a novel machine learning algorithm to estimate missing or unreported composition data. We propose and apply a metric of vulnerability, referred to as exposure, which captures economic importance and susceptibility to price changes. We find that exposure increases from $874 per vehicle for ICEV passenger vehicles to $2344 per vehicle for SUV PHEVs. The shift to a PHEV fleet would double automaker exposure adding approximately $1 billion per year of supply risk to a hypothetical fleet of a million vehicles. The increase in exposure is largely not only due to the increased use of battery elements like cobalt, graphite, and nickel but also some more commonly used materials, most notably copper.

Tofacitinib for Biologic-Experienced Hospitalized Patients With Acute Severe Ulcerative Colitis: A Retrospective Case-Control Study.

BACKGROUND & AIMS: Despite rescue therapy, more than 30% of patients with acute severe ulcerative colitis (ASUC) require colectomy. Tofacitinib is a rapidly acting Janus kinase inhibitor with proven efficacy in ulcerative colitis. Tofacitinib may provide additional means for preventing colectomy in patients with ASUC. METHODS: A retrospective case-control study was performed evaluating the efficacy of tofacitinib induction in biologic-experienced patients admitted with ASUC requiring intravenous corticosteroids. Tofacitinib patients were matched 1:3 to controls according to gender and date of admission. Using Cox regression adjusted for disease severity, we estimated the 90-day risk of colectomy. Rates of complications and steroid dependence were examined as secondary outcomes. RESULTS: Forty patients who received tofacitinib were matched 1:3 to controls (n = 113). Tofacitinib was protective against colectomy at 90 days compared with matched controls (hazard ratio [HR], 0.28, 95% confidence interval [CI], 0.10-0.81; P = .018). When stratifying according to treatment dose, 10 mg three times daily (HR, 0.11; 95% CI, 0.02-0.56; P = .008) was protective, whereas 10 mg twice daily was not significantly protective (HR, 0.66; 95% CI, 0.21-2.09; P = .5). Rate of complications and steroid dependence were similar between tofacitinib and controls. CONCLUSIONS: Tofacitinib with concomitant intravenous corticosteroids may be an effective induction strategy in biologic-experienced patients hospitalized with ASUC. Prospective trials are needed to identify the safety, optimal dose, frequency, and duration of tofacitinib for ASUC.

Graphene Quantum Hall Effect Devices for AC and DC Electrical Metrology.

A new type of graphene-based quantum Hall standards is tested for electrical quantum metrology applications at alternating current (ac) and direct current (dc). The devices are functionalized with Cr(CO)3 to control the charge carrier density and have branched Hall contacts based on NbTiN superconducting material. The work is an in-depth study about the characteristic capacitances and related losses in the ac regime of the devices and about their performance during precision resistance measurements at dc and ac.

Onsager-Casimir frustration from resistance anisotropy in graphene quantum Hall devices.

We report on nonreciprocity observations in several configurations of graphene-based quantum Hall devices. Two distinct measurement configurations were adopted to verify the universality of the observations (i.e., two-terminal arrays and four-terminal devices). Our findings determine the extent to which epitaxial graphene anisotropies contribute to the observed asymmetric Hall responses. The presence of backscattering induces a device-dependent asymmetry rendering the Onsager-Casimir relations limited in their capacity to describe the behavior of such devices, except in the low-field classical regime and the fully quantized Hall state. The improved understanding of this quantum electrical process broadly limits the applicability of the reciprocity principle in the presence of quantum phase transitions and for anisotropic two-dimensional materials.

Highly sensitive broadband binary photoresponse in gateless epitaxial graphene on 4H-SiC.

Due to weak light-matter interaction, standard chemical vapor deposition (CVD)/exfoliated single-layer graphene-based photodetectors show low photoresponsivity (on the order of mA/W). However, epitaxial graphene (EG) offers a more viable approach for obtaining devices with good photoresponsivity. EG on 4H-SiC also hosts an interfacial buffer layer (IBL), which is the source of electron carriers applicable to quantum optoelectronic devices. We utilize these properties to demonstrate a gate-free, planar EG/4H-SiC-based device that enables us to observe the positive photoresponse for (405-532) nm and negative photoresponse for (632-980) nm laser excitation. The broadband binary photoresponse mainly originates from the energy band alignment of the IBL/EG interface and the highly sensitive work function of the EG. We find that the photoresponsivity of the device is > 10 A/W under 405 nm of power density 7.96 mW/cm2 at 1 V applied bias, which is three orders of magnitude greater than the obtained values of CVD/exfoliated graphene and higher than the required value for practical applications. These results path the way for selective light-triggered logic devices based on EG and can open a new window for broadband photodetection.

Magnetotransport in hybrid InSe/monolayer graphene on SiC.

The magnetotransport properties of a hybrid InSe/monolayer graphene in a SiC system are systematically studied. Compared to those of its bare graphene counterpart, in InSe/graphene, we can effectively modify the carrier density, mobility, effective mass, and electron-electron (e-e) interactions enhanced by weak disorder. We show that in bare graphene and hybrid InSe/graphene systems, the logarithmic temperature (lnT) dependence of the Hall slope R H = Î´R xy /δB = Î´ρ xy /δB can be used to probe e-e interaction effects at various temperatures even when the measured resistivity does not show a lnT dependence due to strong electron-phonon scattering. Nevertheless, one needs to be certain that the change of R H is not caused by an increase of the carrier density by checking the magnetic field position of the longitudinal resistivity minimum at different temperatures. Given the current challenges in gating graphene on SiC with a suitable dielectric layer, our results suggest that capping a van der Waals material on graphene is an effective way to modify the electronic properties of monolayer graphene on SiC.

Pathway-Based Approaches for Assessing Biological Hazards of Complex Mixtures of Contaminants: A Case Study in the Maumee River.

Assessment of ecological risks of chemicals in the field usually involves complex mixtures of known and unknown compounds. We describe the use of pathway-based chemical and biological approaches to assess the risk of chemical mixtures in the Maumee River (OH, USA), which receives a variety of agricultural and urban inputs. Fathead minnows (Pimephales promelas) were deployed in cages for 4 d at a gradient of sites along the river and adjoining tributaries in 2012 and during 2 periods (April and June) in 2016, in conjunction with an automated system to collect composite water samples. More than 100 industrial chemicals, pharmaceuticals, and pesticides were detected in water at some of the study sites, with the greatest number typically found near domestic wastewater treatment plants. In 2016, there was an increase in concentrations of several herbicides from April to June at upstream agricultural sites. A comparison of chemical concentrations in site water with single chemical data from vitro high-throughput screening (HTS) assays suggested the potential for perturbation of multiple biological pathways, including several associated with induction or inhibition of different cytochrome P450 (CYP) isozymes. This was consistent with direct effects of water extracts in an HTS assay and induction of hepatic CYPs in caged fish. Targeted in vitro assays and measurements in the caged fish suggested minimal effects on endocrine function (e.g., estrogenicity). A nontargeted mass spectroscopy-based analysis suggested that hepatic endogenous metabolite profiles in caged fish covaried strongly with the occurrence of pesticides and pesticide degradates. These studies demonstrate the application of an integrated suite of measurements to help understand the effects of complex chemical mixtures in the field. Environ Toxicol Chem 2021;40:1098-1122. © 2020 SETAC. This article has been contributed to by US Government employees and their work is in the public domain in the USA.

Pharmacokinetic and Pharmacodynamic Profiling of Minocycline for Injection following a Single Infusion in Critically Ill Adults in a Phase IV Open-Label Multicenter Study (ACUMIN).

Intravenous (i.v.) minocycline is increasingly used to treat infections caused by multidrug-resistant (MDR) Acinetobacter baumannii Despite its being approved nearly 50 years ago, published information on its pharmacokinetic (PK) profile is limited. This multicenter study examined the PK and probability of pharmacokinetic-pharmacodynamic (PK-PD) target attainment profile of i.v. minocycline in critically ill patients, with suspected or documented infection with Gram-negative bacteria. The PK study population included 55 patients who received a single 200-mg i.v. dose of minocycline. Plasma PK samples were collected predose and 1, 4, 12, 24, 36, and 48 h after initiation of minocycline. Total and unbound minocycline concentrations were determined at each time point. Probabilities of achieving the PK-PD targets associated with stasis and 1-log killing (free area under the curve above the MIC [fAUC:MIC] of 12 and 18, respectively) in an immunocompetent animal pneumonia infection model of A. baumannii were evaluated. A two-compartment population PK model with zero-order i.v. input and first-order elimination, which estimated a constant fraction unbound (fub) for minocycline, best characterized the total and unbound plasma minocycline concentration-time data. The only two covariates retained in the final PK model were body surface area (associated with central volume of distribution) and albumin (associated with fub). In the PK-PD probability of target attainment analyses, minocycline 200 mg i.v. every 12 h (Q12H) was predicted to result in a suboptimal PK-PD profile for patients with A. baumannii infections with MIC values of >1 mg/liter. Like all PK-PD profiling studies of this nature, these findings need clinical confirmation.

Abrikosov vortex corrections to effective magnetic field enhancement in epitaxial graphene.

Here, we report the effects of enhanced magnetic fields resulting from type-II superconducting NbTiN slabs adjacent to narrow Hall bar devices fabricated from epitaxial graphene. Observed changes in the magnetoresistances were found to have minimal contributions from device inhomogeneities, magnet hysteresis, electron density variations along the devices, and transient phenomena. We hypothesize that Abrikosov vortices, present in type-II superconductors, contribute to these observations. By determining the London penetration depth, coupled with elements of Ginzburg-Landau theory, one can approximate an upper bound on the effect that vortex densities at low fields (< 1T) have on the reported observations. These analyses offer insights into device fabrication and how to utilize the Meissner effect for any low-field and low-temperature applications using superconductors.