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BACKGROUND: Vancomycin infusion reaction (VIR), reportedly mediated through Mas-Related G Protein-Coupled Receptor-X2 (MRGPRX2), is the primary vancomycin-induced immediate drug reaction (IDR). Clinically, distinguishing the underlying drug-induced IDR mechanisms is crucial for future treatment strategies, including drug restriction, re-administration, and pretreatment considerations. However, the lack of validated diagnostic tests makes this challenging, often leading to unnecessary drug restriction. OBJECTIVE: To determine if intradermal tests (IDTs) and, separately, the basophil activation test (BAT) differentiate VIR from vancomycin-tolerant subjects. METHODS: Cross-sectional study of vancomycin-exposed adults with and without a history of VIR. Demographics, allergy-related comorbidities, history of vancomycin exposures, and VIR characteristics were collected. IDT with vancomycin was performed. IDT dose responses EC50, IDT-related local symptoms, and BAT were compared between groups. RESULTS: 11 VIR and 10 vancomycin-tolerant subjects were enrolled. The most reported VIR symptoms were pruritus (82%), flushing (82%), hives (46%), hives (46%), angioedema (27%), and dyspnea (19%). The IDT dose response mean EC50 was 328 µg/mL (95% CI 296, 367) in the VIR vs. 1,166 µg/mL (95% CI 1029, 1379) in the tolerant group (p<0.0001). All VIR subjects reported IDT-related local pruritus compared to 60% of tolerant subjects (p=0.0185). The %CD63+ basophils were consistently <2%, without significant differences between groups (p < 0.54). CONCLUSIONS: Variations in skin test methodologies could help identify other IDR mechanisms beyond IgE. This skin test protocol holds the potential for identifying VIR, particularly in cases where patients have received multiple drugs while BAT is insufficient. Future studies will validate and delineate its predictive value, assessing the risk of VIR.
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Forming a hetero-interface is a materials-design strategy that can access an astronomically large phase space. However, the immense phase space necessitates a high-throughput approach for an optimal interface design. Here we introduce a high-throughput computational framework, InterMatch, for efficiently predicting charge transfer, strain, and superlattice structure of an interface by leveraging the databases of individual bulk materials. Specifically, the algorithm reads in the lattice vectors, density of states, and the stiffness tensors for each material in their isolated form from the Materials Project. From these bulk properties, InterMatch estimates the interfacial properties. We benchmark InterMatch predictions for the charge transfer against experimental measurements and supercell density-functional theory calculations. We then use InterMatch to predict promising interface candidates for doping transition metal dichalcogenide MoSe2. Finally, we explain experimental observation of factor of 10 variation in the supercell periodicity within a few microns in graphene/α-RuCl3 by exploring low energy superlattice structures as a function of twist angle using InterMatch. We anticipate our open-source InterMatch algorithm accelerating and guiding ever-growing interfacial design efforts. Moreover, the interface database resulting from the InterMatch searches presented in this paper can be readily accessed online.
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PURPOSE: This study examined the impact of traumatic brain injury (TBI) on self-perceived hearing and suprathreshold binaural processing in young and middle-age adults. METHOD: Ninety-three adults with normal hearing (thresholds ≤ 25 dB HL, 250-4000 Hz) participated in one of four groups: 38 young adults, 23 young adults with TBI, 16 middle-age adults, and 16 middle-age adults with TBI. Self-perceived hearing difficulty was measured via questionnaires. Binaural processing was measured using dichotic word recognition, the Listening in Spatialized Noise-Sentences Test (LiSN-S), and the 500-Hz masking level difference (MLD). For each participant, a composite binaural processing (CBP) score was calculated to obtain a global metric of binaural processing performance. The CBP was composed of six measures from the three behavioral tests, including the S0N0 and SπN0 thresholds from the 500-Hz MLD, the low- and high-cue speech recognition thresholds from the LiSN-S, and the free and directed recall ear advantages from the dichotic word test. RESULTS: The middle-age TBI group reported significantly greater degrees of self-perceived hearing difficulty than the other groups. On average, the middle-age TBI group performed poorer on the individual binaural processing tests; however, the differences were significant for the S0N0 and SπN0 MLD thresholds only. Results for the global metric of binaural processing revealed significantly poorer CBP scores for the middle-age TBI group compared to the other groups. CONCLUSIONS: Results demonstrate that both age and a positive history of TBI contributed to deficits in suprathreshold binaural processing. Middle-age adults with a history of TBI are at risk for experiencing presenescent deficits in suprathreshold binaural processing deficits, despite having clinically normal hearing.
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Charge modulations have been widely observed in cuprates, suggesting their centrality for understanding the high-Tc superconductivity in these materials. However, the dimensionality of these modulations remains controversial, including whether their wavevector is unidirectional or bidirectional, and also whether they extend seamlessly from the surface of the material into the bulk. Material disorder presents severe challenges to understanding the charge modulations through bulk scattering techniques. We use a local technique, scanning tunneling microscopy, to image the static charge modulations on Bi2-zPbzSr2-yLayCuO6+x. The ratio of the phase correlation length ξCDW to the orientation correlation length ξorient points to unidirectional charge modulations. By computing new critical exponents at free surfaces including that of the pair connectivity correlation function, we show that these locally 1D charge modulations are actually a bulk effect resulting from classical 3D criticality of the random field Ising model throughout the entire superconducting doping range.
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The cuprate high-temperature superconductors exhibit many unexplained electronic phases, but the superconductivity at high doping is often believed to be governed by conventional mean-field Bardeen-Cooper-Schrieffer theory1. However, it was shown that the superfluid density vanishes when the transition temperature goes to zero2,3, in contradiction to expectations from Bardeen-Cooper-Schrieffer theory. Our scanning tunnelling spectroscopy measurements in the overdoped regime of the (Pb,Bi)2Sr2CuO6+δ high-temperature superconductor show that this is due to the emergence of nanoscale superconducting puddles in a metallic matrix4,5. Our measurements further reveal that this puddling is driven by gap filling instead of gap closing. The important implication is that it is not a diminishing pairing interaction that causes the breakdown of superconductivity. Unexpectedly, the measured gap-to-filling correlation also reveals that pair breaking by disorder does not play a dominant role and that the mechanism of superconductivity in overdoped cuprate superconductors is qualitatively different from conventional mean-field theory.
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A Kondo lattice is often electrically insulating at low temperatures. However, several recent experiments have detected signatures of bulk metallicity within this Kondo insulating phase. In this study, we visualized the real-space charge landscape within a Kondo lattice with atomic resolution using a scanning tunneling microscope. We discovered nanometer-scale puddles of metallic conduction electrons centered around uranium-site substitutions in the heavy-fermion compound uranium ruthenium silicide (URu2Si2) and around samarium-site defects in the topological Kondo insulator samarium hexaboride (SmB6). These defects disturbed the Kondo screening cloud, leaving behind a fingerprint of the metallic parent state. Our results suggest that the three-dimensional quantum oscillations measured in SmB6 arise from Kondo-lattice defects, although we cannot exclude other explanations. Our imaging technique could enable the development of atomic-scale charge sensors using heavy-fermion probes.
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Topological metamaterials have robust properties engineered from their macroscopic arrangement, rather than their microscopic constituency. They can be designed by starting from Dirac metamaterials with either symmetry-enforced or accidental degeneracy. The latter case provides greater flexibility in the design of topological switches, waveguides, and cloaking devices, because a large number of tuning parameters can be used to break the degeneracy and induce a topological phase. However, the design of a topological logic element-a switch that can be controlled by the output of a separate switch-remains elusive. Here we numerically demonstrate a topological logic gate for ultrasound by exploiting the large phase space of accidental degeneracies in a honeycomb lattice. We find that a degeneracy can be broken by six physical parameters, and we show how to tune these parameters to create a phononic switch that transitions between a topological waveguide and a trivial insulator by ultrasonic heating. Our design scheme is directly applicable to photonic crystals and may guide the design of future electronic topological transistors.
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Anthropogenic disturbances associated with urban ecosystems can create favorable conditions for populations of some invasive plant species. Light pollution is one of these disturbances, but how it affects the growth and establishment of invasive plant populations is unknown. Cheatgrass (Bromus tectorum) is a problematic invasive species where it has displaced native grassland communities in the United States, but to our knowledge, there have been no studies of the ecological factors that affect cheatgrass presence in urban ecosystems. We conducted field surveys in urban alleys in Denver, Colorado, to compare the presence of cheatgrass at sites with and without artificial light at night (hereafter artificial light) from streetlights. These streetlights are mounted on utility poles, which cause ground disturbance when installed in alleys; we were able to test the independent effect of poles on cheatgrass establishment because not all poles have streetlights on them. We found that cheatgrass was positively associated with the presence of streetlights and to a lesser extent poles. In addition to cheatgrass, we also found that other plants were positively associated with the presence of both poles and streetlights. Our results suggest that artificial light may benefit the occurrence of cheatgrass and other plant species in urban settings. While invasive populations of cheatgrass in wild habitats attract the most attention from managers, we suggest more consideration for this grass in urban environments where its growth and establishment benefit from anthropogenic changes.
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Background: Recently, we discovered a new glucogenic and centrally acting orexigenic hormone - asprosin. Asprosin is elevated in metabolic syndrome (MS) patients, and its genetic loss results in reduced appetite, leanness, and blood glucose burden, leading to protection from MS. Methods: We generated three independent monoclonal antibodies (mAbs) that recognize unique asprosin epitopes and investigated their preclinical efficacy and tolerability in the treatment of MS. Results: Anti-asprosin mAbs from three distinct species lowered appetite and body weight, and reduced blood glucose in a dose-dependent and epitope-agnostic fashion in three independent MS mouse models, with an IC50 of ~1.5 mg/kg. The mAbs displayed a half-life of over 3days in vivo, with equilibrium dissociation-constants in picomolar to low nanomolar range. Conclusions: We demonstrate that anti-asprosin mAbs are dual-effect pharmacologic therapy that targets two key pillars of MS - over-nutrition and hyperglycemia. This evidence paves the way for further development towards an investigational new drug application and subsequent human trials for treatment of MS, a defining physical ailment of our time. Funding: DK118290 and DK125403 (R01; National Institute of Diabetes and Digestive and Kidney Diseases), DK102529 (K08; National Institute of Diabetes and Digestive and Kidney Diseases), Caroline Wiess Law Scholarship (Baylor College of Medicine, Harrington Investigatorship Harrington Discovery Institute at University Hospitals, Cleveland); Chao Physician Scientist Award (Baylor College of Medicine); RP150551 and RP190561 (Cancer Prevention and Research Institute of Texas [CPRIT]).
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Anticorpos Monoclonais/uso terapêutico , Fibrilina-1/imunologia , Síndrome Metabólica/terapia , Fragmentos de Peptídeos/imunologia , Hormônios Peptídicos/imunologia , Animais , Anticorpos Monoclonais/imunologia , Apetite , Glicemia/análise , Peso Corporal , Relação Dose-Resposta Imunológica , Ensaio de Imunoadsorção Enzimática , Humanos , Masculino , Camundongos , Camundongos Endogâmicos C57BLRESUMO
Many modern nanofabrication and imaging techniques require an ultra-quiet environment to reach optimal resolution. Isolation from ambient vibrations is often achieved by placing the sensitive instrument atop a massive block that floats on air springs and is surrounded by acoustic barriers. Because typical building noise drops off above 120 Hz, it is advantageous to raise the flexural resonance frequencies of the inertia block and instrument far above 120 Hz. However, it can be challenging to obtain a high fundamental frequency of the floating block using a simple rectangular design. Here, we design, construct, and characterize a vibration isolation system with a cylindrical inertia block, whose lowest resonance frequency of 249 Hz shows good agreement between finite element analysis simulation and directly measured modes. Our simulations show that a cylindrical design can achieve a higher fundamental resonance frequency than a rectangular design of the same mass.
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New classes of drugs to treat type 2 diabetes are continually being developed and marketed. The FDA has issued guidance to the pharmaceutical industry that newer hypoglycemic agents should not be associated with unacceptable increases in cardiovascular risk. To date, five trials have assessed specific cardiovascular endpoints for these newer agents. Empagliflozin and liraglutide have been found to improve cardiovascular outcomes.
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Compostos Benzidrílicos/farmacologia , Sistema Cardiovascular/efeitos dos fármacos , Diabetes Mellitus Tipo 2/tratamento farmacológico , Glucosídeos/farmacologia , Hipoglicemiantes/farmacologia , Liraglutida/farmacologia , Diabetes Mellitus Tipo 2/complicações , Diabetes Mellitus Tipo 2/fisiopatologia , Angiopatias Diabéticas/etiologia , Cardiomiopatias Diabéticas/etiologia , Humanos , Fatores de RiscoRESUMO
The pseudogap (PG) state and its related intra-unit-cell symmetry breaking remain the focus in the research of cuprate superconductors. Although the nematicity has been studied in Bi2Sr2CaCu2O8+δ, especially underdoped samples, its behavior in other cuprates and different doping regions is still unclear. Here we apply a scanning tunneling microscope to explore an overdoped (Bi, Pb)2Sr2CuO6+δ with a large Fermi surface (FS). The establishment of a nematic order and its real-space distribution is visualized as the energy scale approaches the PG.
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Risk of HIV acquisition varies, and some individuals are highly HIV-1-exposed, yet, persistently seronegative (HESN). The immunologic mechanisms contributing to this phenomenon are an area of intense interest. As immune activation and inflammation facilitate disease progression in HIV-1-infected persons and gastrointestinal-associated lymphoid tissue is a highly susceptible site for transmission, we hypothesized that reduced gut mucosal immune reactivity may contribute to reduced HIV-1 susceptibility in HESN men with a history of numerous rectal sexual exposures. To test this, we used ex vivo mucosal explants from freshly acquired colorectal biopsies from healthy control and HESN subjects who were stimulated with specific innate immune ligands and inactivated whole pathogens. Immune reactivity was then assessed via cytokine arrays and proteomic analysis. Mucosal immune cell compositions were quantified via immunohistochemistry. We found that explants from HESN subjects produced less proinflammatory cytokines compared with controls following innate immune stimulation; while noninflammatory cytokines were similar between groups. Proteomic analysis identified several immune response proteins to be differentially expressed between HIV-1-stimulated HESN and control explants. Immunohistochemical examination of colorectal mucosa showed similar amounts of T cells, macrophages, and dendritic cells between groups. The results of this pilot study suggest that mucosal innate immune reactivity is dampened in HESN versus control groups, despite presence of similar densities of immune cells in the colorectal mucosa. This observed modulation of the rectal mucosal immune response may contribute to lower risk of mucosal HIV-1 transmission in these individuals.
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Resistência à Doença , Infecções por HIV/imunologia , HIV-1/imunologia , Imunidade Inata , Imunidade nas Mucosas , Adulto , Idoso , Biópsia , Humanos , Imuno-Histoquímica , Masculino , Pessoa de Meia-Idade , Projetos Piloto , Proteoma/análise , Reto/imunologiaRESUMO
We report a detailed three-step roadmap for the fabrication and characterization of bulk Cr tips for spin-polarized scanning tunneling microscopy. Our strategy uniquely circumvents the need for ultra-high vacuum preparation of clean surfaces or films. First, we demonstrate the role of ex situ electrochemical etch parameters on Cr tip apex geometry, using scanning electron micrographs of over 70 etched tips. Second, we describe the suitability of the in situ cleaved surface of the layered antiferromagnet La1.4Sr1.6Mn2O7 to evaluate the spin characteristics of the Cr tip, replacing the ultra-high vacuum-prepared test samples that have been used in prior studies. Third, we outline a statistical algorithm that can effectively delineate closely spaced or irregular cleaved step edges, to maximize the accuracy of step height and spin-polarization measurements.
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Helium ion beams (HIB) focused to subnanometer scales have emerged as powerful tools for high-resolution imaging as well as nanoscale lithography, ion milling, or deposition. Quantifying irradiation effects is an essential step toward reliable device fabrication, but most of the depth profiling information is provided by computer simulations rather than the experiment. Here, we demonstrate the use of atomic force microscopy (AFM) combined with scanning near-field optical microscopy (SNOM) to provide three-dimensional (3D) dielectric characterization of high-temperature superconductor devices fabricated by HIB. By imaging the infrared dielectric response obtained from light demodulation at multiple harmonics of the AFM tapping frequency, we find that amorphization caused by the nominally 0.5 nm HIB extends throughout the entire 26.5 nm thickness of the cuprate film and by â¼500 nm laterally. This unexpectedly widespread damage in morphology and electronic structure can be attributed to a helium depth distribution substantially modified by the internal device interfaces. Our study introduces AFM-SNOM as a quantitative tomographic technique for noninvasive 3D characterization of irradiation damage in a wide variety of nanoscale devices.
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The properties of iron-based superconductors (Fe-SCs) can be varied dramatically with the introduction of dopants and atomic defects. As a pressing example, FeSe, parent phase of the highest-Tc Fe-SC, exhibits prevalent defects with atomic-scale "dumbbell" signatures as imaged by scanning tunneling microscopy (STM). These defects spoil superconductivity when their concentration exceeds 2.5%. Resolving their chemical identity is a prerequisite to applications such as nanoscale patterning of superconducting/nonsuperconducting regions in FeSe as well as fundamental questions such as the mechanism of superconductivity and the path by which the defects destroy it. We use STM and density functional theory to characterize and identify the dumbbell defects. In contrast to previous speculations about Se adsorbates or substitutions, we find that an Fe-site vacancy is the most energetically favorable defect in Se-rich conditions and reproduces our observed STM signature. Our calculations shed light more generally on the nature of Se capping, the removal of Fe vacancies via annealing, and their ordering into a â5 × â5 superstructure in FeSe and related alkali-doped compounds.
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We use scanning tunneling spectroscopy to investigate the filled and empty electronic states of superconducting single-unit-cell FeSe deposited on SrTiO3(001). We map the momentum-space band structure by combining quasiparticle interference imaging with decay length spectroscopy. In addition to quantifying the filled-state bands, we discover a Γ-centered electron pocket 75 meV above the Fermi energy. Our density functional theory calculations show the orbital nature of empty states at Γ and explain how the Se height is a key tuning parameter of their energies, with broad implications for electronic properties.
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BACKGROUND: Adverse drug event (ADE) detection is an important priority for patient safety research. Trigger tools have been developed to help identify ADEs. In previous work we developed seven concurrent, action-oriented, electronic trigger algorithms designed to prompt clinicians to address ADEs in outpatient care. OBJECTIVES: We assessed the potential adoption and usefulness of the seven triggers by testing the positive predictive validity and obtaining stakeholder input. METHODS: We adapted ADE triggers, "bone marrow toxin-white blood cell count (BMT-WBC)," "bone marrow toxin - platelet (BMT-platelet)," "potassium raisers," "potassium reducers," "creatinine," "warfarin," and "sedative hypnotics," with logic to suppress flagging events with evidence of clinical intervention and applied the triggers to 50,145 patients from three large health care systems. Four pharmacists assessed trigger positive predictive value (PPV) with respect to ADE detection (conservatively excluding ADEs occurring during clinically appropriate care) and clinical usefulness (i.e., whether the trigger alert could change care to prevent harm). We measured agreement between raters using the free kappa and assessed positive PPV for the trigger's detection of harm, clinical usefulness, and both. Stakeholders from the participating health care systems rated the likelihood of trigger adoption and the perceived ease of implementation. FINDINGS: Agreement between pharmacist raters was moderately high for each ADE trigger (kappa free > 0.60). Trigger PPVs for harm ranged from 0 (Creatinine, BMT-WBC) to 17 percent (potassium raisers), while PPV for care change ranged from 0 (WBC) to 60 percent (Creatinine). Fifteen stakeholders rated the triggers. Our assessment identified five of the seven triggers as good candidates for implementation: Creatinine, BMT-Platelet, Potassium Raisers, Potassium Reducers, and Warfarin. CONCLUSIONS: At least five outpatient ADE triggers performed well and merit further evaluation in outpatient clinical care. When used in real time, these triggers may promote care changes to ameliorate patient harm.
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The highest-temperature superconductors are electronically inhomogeneous at the nanoscale, suggesting the existence of a local variable that could be harnessed to enhance the superconducting pairing. Here we report the relationship between local doping and local strain in the cuprate superconductor Bi(2)Sr(2)CaCu(2)O(8+x). We use scanning tunneling microscopy to discover that the crucial oxygen dopants are periodically distributed in correlation with local strain. Our picoscale investigation of the intraunit-cell positions of all oxygen dopants provides essential structural input for a complete microscopic theory.