Nurse-led dexmedetomidine sedation for magnetic resonance imaging in children: a 6-year quality improvement project.

We aimed to safely introduce dexmedetomidine into a nurse-led sedation service for magnetic resonance imaging in children. Secondary aims were to increase the number of children eligible for sedation and to increase the actual number of children having sedation performed by our nurse sedation team. We analysed 1768 consecutive intravenous and 219 intranasal dexmedetomidine sedation episodes in infants, children and adolescents having magnetic resonance imaging scans between March 2016 and March 2022. The overall sedation success rate was 98.4%, with a 98.9% success rate for intravenous dexmedetomidine and a 95.0% success rate for intranasal dexmedetomidine. The incidence of scan interruption during intravenous and intranasal dexmedetomidine sedation was 8.8% and 21.9%, respectively. We conclude that paediatric sedation with dexmedetomidine for magnetic resonance scanning is safe and successful.

Observation of the non-linear Meissner effect.

A long-standing theoretical prediction is that in clean, nodal unconventional superconductors the magnetic penetration depth λ, at zero temperature, varies linearly with magnetic field. This non-linear Meissner effect is an equally important manifestation of the nodal state as the well studied linear-in-T dependence of λ, but has never been convincingly experimentally observed. Here we present measurements of the nodal superconductors CeCoIn5 and LaFePO which clearly show this non-linear Meissner effect. We further show how the effect of a small dc magnetic field on λ(T) can be used to distinguish gap nodes from non-nodal deep gap minima. Our measurements of KFe2As2 suggest that this material has such a non-nodal state.

Charge density waves and Fermi surface reconstruction in the clean overdoped cuprate superconductor Tl2Ba2CuO6+δ.

Hall effect and quantum oscillation measurements on high temperature cuprate superconductors show that underdoped compositions have small Fermi surface pockets whereas when heavily overdoped, a single much larger pocket is found. The origin of this change in electronic structure has been unclear, but may be related to the high temperature superconductivity. Here we show that the clean overdoped single-layer cuprate Tl2Ba2CuO6+δ (Tl2201) displays CDW order with a remarkably long correlation length ξ ≈ 200 Å which disappears above a hole doping of pCDW ≈ 0.265. We show that the evolution of the electronic properties of Tl2201 as the doping is lowered may be explained by a Fermi surface reconstruction which accompanies the emergence of the CDW below pCDW. Our results demonstrate importance of CDW correlations in understanding the electronic properties of overdoped cuprates.

Incoherent transport across the strange-metal regime of overdoped cuprates.

Strange metals possess highly unconventional electrical properties, such as a linear-in-temperature resistivity1-6, an inverse Hall angle that varies as temperature squared7-9 and a linear-in-field magnetoresistance10-13. Identifying the origin of these collective anomalies has proved fundamentally challenging, even in materials such as the hole-doped cuprates that possess a simple bandstructure. The prevailing consensus is that strange metallicity in the cuprates is tied to a quantum critical point at a doping p* inside the superconducting dome14,15. Here we study the high-field in-plane magnetoresistance of two superconducting cuprate families at doping levels beyond p*. At all dopings, the magnetoresistance exhibits quadrature scaling and becomes linear at high values of the ratio of the field and the temperature, indicating that the strange-metal regime extends well beyond p*. Moreover, the magnitude of the magnetoresistance is found to be much larger than predicted by conventional theory and is insensitive to both impurity scattering and magnetic field orientation. These observations, coupled with analysis of the zero-field and Hall resistivities, suggest that despite having a single band, the cuprate strange-metal region hosts two charge sectors, one containing coherent quasiparticles, the other scale-invariant 'Planckian' dissipators.

Machine Learning to Quantitate Neutrophil NETosis.

We introduce machine learning (ML) to perform classification and quantitation of images of nuclei from human blood neutrophils. Here we assessed the use of convolutional neural networks (CNNs) using free, open source software to accurately quantitate neutrophil NETosis, a recently discovered process involved in multiple human diseases. CNNs achieved >94% in performance accuracy in differentiating NETotic from non-NETotic cells and vastly facilitated dose-response analysis and screening of the NETotic response in neutrophils from patients. Using only features learned from nuclear morphology, CNNs can distinguish between NETosis and necrosis and between distinct NETosis signaling pathways, making them a precise tool for NETosis detection. Furthermore, by using CNNs and tools to determine object dispersion, we uncovered differences in NETotic nuclei clustering between major NETosis pathways that is useful in understanding NETosis signaling events. Our study also shows that neutrophils from patients with sickle cell disease were unresponsive to one of two major NETosis pathways. Thus, we demonstrate the design, performance, and implementation of ML tools for rapid quantitative and qualitative cell analysis in basic science.

Electron-Hole Tunneling Revealed by Quantum Oscillations in the Nodal-Line Semimetal HfSiS.

We report a study of quantum oscillations in the high-field magnetoresistance of the nodal-line semimetal HfSiS. In the presence of a magnetic field up to 31 T parallel to the c axis, we observe quantum oscillations originating both from orbits of individual electron and hole pockets, and from magnetic breakdown between these pockets. In particular, we reveal a breakdown orbit enclosing one electron and one hole pocket in the form of a "figure of eight," which is a manifestation of Klein tunneling in momentum space, although in a regime of partial transmission due to the finite separation between the pockets. The observed very strong dependence of the oscillation amplitude on the field angle and the cyclotron masses of the orbits are in agreement with the theoretical predictions for this novel tunneling phenomenon.

Full-Gap Superconductivity Robust against Disorder in Heavy-Fermion CeCu_{2}Si_{2}.

A key aspect of unconventional pairing by the antiferromagnetic spin-fluctuation mechanism is that the superconducting energy gap must have the opposite sign on different parts of the Fermi surface. Recent observations of non-nodal gap structure in the heavy-fermion superconductor CeCu_{2}Si_{2} were then very surprising, given that this material has long been considered a prototypical example of a superconductor where the Cooper pairing is magnetically mediated. Here we present a study of the effect of controlled point defects, introduced by electron irradiation, on the temperature-dependent magnetic penetration depth λ(T) in CeCu_{2}Si_{2}. We find that the fully gapped state is robust against disorder, demonstrating that low-energy bound states, expected for sign-changing gap structures, are not induced by nonmagnetic impurities. This provides bulk evidence for s_{++}-wave superconductivity without sign reversal.

Reducing re-admissions at St. Ann’s psychiatric hospital

OBJECTIVE: This study addressed the psychoeducational approach to understand mental illness, illness self-management and social skills. It evaluated the effects of a structured-mannualized psychoeducation programme that taught inpatients about their illness and how to maintain remission after discharge and avoid re-admissions. DESIGN AND METHODS: A total of 505 inpatients admitted with mental disorders were randomly assigned to either an experimental group or control group. The psychoeducation programme consisted of six teaching modules distributed in 219 sessions of 45-minute-sessions in each of 5 wards, on a continuous, five-day-a-week schedule. The effects were measured reviewing the records of admissions and re-admissions after discharge. RESULTS: Results indicated that inpatients of the experimental group significantly improved their knowledge and performance of the skills taught in sessions, compared with the control group who did not participate in the educational group sessions. Re-admissions of participants of the experimental group were significantly less than the control group (2.1 percent versus 16.6 percent). CONCLUSIONS: Not only can patients learn relatively complex material during a typical inpatient stay despite the acuteness of their illness, but they can also meaningfully improve the continuity of their own care by participating in brief and highly structured teaching programmes in inpatient and outpatient settings.

Landscaping employment services for the mentally ill

OBJECTIVE: This project was intended to compare the quality of life of rehabilitees engaged in the Landscaping Employment Services programme with an unemployed group of rehabilitees. DESIGN AND METHODS: A total of 26 rehabilitees were invited to participate in the study with a diagnosis of schizophrenia, schizoaffective disorder, and bipolar disorder. An experimental group of 13 rehabilitees was assigned to the Landscaping Employment Services for Rehabilitees, and a control group of 13 rehabilitees were also evaluated. The landscaping programme consisted of seven days of activity. The effects were measured using a ‘Quality of Life Inventory’ applied to rehabilitees. Patients' knowledge and performance of the specific materials taught in the Landscaping Employment Services for Rehabilitees programme was ascertained through assessments conducted before and after training. RESULTS: Results indicated that participants of the Landscaping Employment Services for Rehabilitees programme significantly improved their knowledge, performance of the skills and their quality of life. CONCLUSIONS: Not only can patients learn relatively complex material, but they can also meaningfully improve the continuity of their employment capability by participating in a brief and highly structured employment training programme.

Visual acuity screening of patients who are institutionalized and suffering from mental disorders

OBJECTIVE: Visual problems in persons who are institutionalized suffering from mental disorders are overwhelmingly under-recognized. The aim of this study was therefore to screen for visual acuity among 285 patients at the St. Ann’s Psychiatric Hospital (SAH) and 27 at the Arima Rehabilitation Centre (ARC). The projected number of patients to be screened was 427 persons. However, only 312 inpatients were included to participate in the study. The study evaluated the patients who were chosen to assess their visual acuity. The project was conducted from August to December, 2011. DESIGN AND METHODS: A total of 312 inpatients admitted to the hospital and rehabilitation centre with mental disorders were evaluated using either the Snellen or Lea Charts by trained technicians from the Lions Club of Trinidad and Tobago. The evaluations were conducted for four months on 25 wards and at the Arima Rehabilitation Centre. A Stereo Optical Vision Tester was used for the evaluation of patients using a Snellen Chart and/or a Lea Chart. Analysis was done using SPSS version 20.0. RESULTS: One hundred and twenty-five (125) patients were found to have visual acuity problems and recommended for further evaluation by an ophthalmologist. This represents 40.1% of the sample tested. CONCLUSIONS: Our findings coincided with the existing literature that visual impairment appears to be an area of physical health which is under-recognized, under-diagnosed and under-treated in people with severe mental health problems, even though certain psychiatric medications are known to cause visual problems as a side effect.

Anomalous critical fields in quantum critical superconductors.

Fluctuations around an antiferromagnetic quantum critical point (QCP) are believed to lead to unconventional superconductivity and in some cases to high-temperature superconductivity. However, the exact mechanism by which this occurs remains poorly understood. The iron-pnictide superconductor BaFe2(As(1-x)P(x))2 is perhaps the clearest example to date of a high-temperature quantum critical superconductor, and so it is a particularly suitable system to study how the quantum critical fluctuations affect the superconducting state. Here we show that the proximity of the QCP yields unexpected anomalies in the superconducting critical fields. We find that both the lower and upper critical fields do not follow the behaviour, predicted by conventional theory, resulting from the observed mass enhancement near the QCP. Our results imply that the energy of superconducting vortices is enhanced, possibly due to a microscopic mixing of antiferromagnetism and superconductivity, suggesting that a highly unusual vortex state is realized in quantum critical superconductors.

Quasiparticle mass enhancement close to the quantum critical point in BaFe2(As(1-x)P(x))2.

We report a combined study of the specific heat and de Haas-van Alphen effect in the iron-pnictide superconductor BaFe2(As(1-x)P(x))2. Our data when combined with results for the magnetic penetration depth give compelling evidence for the existence of a quantum critical point close to x=0.30 which affects the majority of the Fermi surface by enhancing the quasiparticle mass. The results show that the sharp peak in the inverse superfluid density seen in this system results from a strong increase in the quasiparticle mass at the quantum critical point.

Upper critical magnetic field far above the paramagnetic pair-breaking limit of superconducting one-dimensional Li0:9Mo6O17 single crystals.

The upper critical field H(c2) of purple bronze Li0:9Mo6O17 is found to exhibit a large anisotropy, in quantitative agreement with that expected from the observed electrical resistivity anisotropy. With the field aligned along the most conducting axis, H(c2) increases monotonically with decreasing temperature to a value 5 times larger than the estimated paramagnetic pair-breaking field. Theories for the enhancement of H(c2) invoking spin-orbit scattering or strong-coupling superconductivity are shown to be inadequate in explaining the observed behavior, suggesting that the pairing state in Li0:9Mo6O17 is unconventional and possibly spin triplet.

A sharp peak of the zero-temperature penetration depth at optimal composition in BaFe2(As(1-x)P(x))2.

In a superconductor, the ratio of the carrier density, n, to its effective mass, m*, is a fundamental property directly reflecting the length scale of the superfluid flow, the London penetration depth, λ(L). In two-dimensional systems, this ratio n/m* (~1/λ(L)(2)) determines the effective Fermi temperature, T(F). We report a sharp peak in the x-dependence of λ(L) at zero temperature in clean samples of BaFe(2)(As(1)(-x)P(x))(2) at the optimum composition x = 0.30, where the superconducting transition temperature T(c) reaches a maximum of 30 kelvin. This structure may arise from quantum fluctuations associated with a quantum critical point. The ratio of T(c)/T(F) at x = 0.30 is enhanced, implying a possible crossover toward the Bose-Einstein condensate limit driven by quantum criticality.

de Haas-van Alphen study of the Fermi surfaces of superconducting LiFeP and LiFeAs.

We report a de Haas-van Alphen oscillation study of the 111 iron pnictide superconductors LiFeAs with T(c) ≈ 18 K and LiFeP with T(c) ≈ 5 K. We find that for both compounds the Fermi surface topology is in good agreement with density functional band-structure calculations and has almost nested electron and hole bands. The effective masses generally show significant enhancement, up to ~3 for LiFeP and ~5 for LiFeAs. However, one hole Fermi surface in LiFeP shows a very small enhancement, as compared with its other sheets. This difference probably results from k-dependent coupling to spin fluctuations and may be the origin of the different nodal and nodeless superconducting gap structures in LiFeP and LiFeAs, respectively.

Nodal versus nodeless behaviors of the order parameters of LiFeP and LiFeAs superconductors from magnetic penetration-depth measurements.

High-precision measurements of magnetic penetration depth λ in clean single crystals of LiFeAs and LiFeP superconductors reveal contrasting behaviors. In LiFeAs the low-temperature λ(T) shows a flat dependence indicative of a fully gapped state, which is consistent with previous studies. In contrast, LiFeP exhibits a T-linear dependence of superfluid density infinity λ(-2), indicating a nodal superconducting order parameter. A systematic comparison of quasiparticle excitations in the 1111, 122, and 111 families of iron-pnictide superconductors implies that the nodal state is induced when the pnictogen height from the iron plane decreases below a threshold value of ~1.33 Å.

Acylation stimulating protein reduction precedes insulin sensitization after BPD-DS bariatric surgery in severely obese women.

OBJECTIVE: The mechanisms involved in early resolution of insulin resistance and type 2 diabetes mellitus after biliopancreatic diversion with duodenal switch (BPD-DS) surgery are still unknown. We evaluated early effects of BPD-DS on plasma acylation stimulating protein (ASP), an adipokine involved in lipid and glucose metabolism. SUBJECTS: 32 non-diabetic and 22 diabetic severely obese women (BMI40 kg m(-2)) were evaluated for body composition and plasma parameters before, 24 h, 5 days, 6 and 12 months after surgery. RESULTS: Within the early postoperative period (24 h), ASP decreased 25 and 30% in non-diabetic and diabetic women, respectively (P<0.001). Twenty-four hours after surgery, triglyceride, cholesterol, HDL-Chol, LDL-Chol and C3 also decreased, while glucose, insulin and high-sensitivity C-reactive protein (hsCRP) increased (all P<0.001). By 5 days, without significant weight loss, the decreases in ASP, cholesterol, HDL-Chol and LDL-Chol levels were all maintained. At this time, glucose, insulin and HOMA-IR also decreased 11 to 52% (all P<0.001). At 6 and 12 months, with pronounced weight loss and decreased per cent fat mass, there were further decreases in ASP (maximal -56% non-diabetic, -61% diabetic, P<0.001), as well as in glucose, insulin, HOMA-IR, triglyceride, cholesterol, LDL-Chol, HDL-Chol and hsCRP levels. Improved insulin resistance/diabetes at 5 days was predicted by 24 h changes as follows: per cent change ASP, HDL-Chol, hsCRP and total cholesterol predicted HOMA-IR (5 days) (r(2)=0.454, P<0.001), and per cent change ASP, HDL-Chol and hsCRP predicted change (5 days vs baseline) in HOMA-IR (r(2)=0.351, P<0.001). CONCLUSION: Acute postoperative decreases in ASP are associated with early improvement of insulin resistance/diabetes after BPD-DS surgery.

Evolution of the Fermi surface of BaFe2(As1-xPx){2} on entering the superconducting dome.

Using the de Haas-van Alphen effect we have measured the evolution of the Fermi surface of BaFe2(As1-xPx){2} as a function of isoelectric substitution (As/P) for 0.41

Fermi surface of SrFe2P2 determined by the de Haas-van Alphen effect.

We report measurements of the Fermi surface (FS) of the ternary iron-phosphide SrFe2P2 using the de Haas-van Alphen effect. The calculated FS of this compound is very similar to SrFe2As2, the parent compound of the high temperature superconductors. Our data show that the Fermi surface is composed of two electron and two hole sheets in agreement with band-structure calculations. Several of the sheets show strong c-axis warping emphasizing the importance of three dimensionality in the nonmagnetic state of the ternary pnictides. We find that the electron and hole pockets have a different topology, implying that this material does not satisfy a (pi, pi) nesting condition.

Topological change of the Fermi surface in ternary iron pnictides with reduced c/a ratio: a de Haas-van Alphen study of CaFe2P2.

We report a de Haas-van Alphen effect study of the Fermi surface of CaFe2P2 using low-temperature torque magnetometry up to 45 T. This system is a close structural analog of the collapsed tetragonal nonmagnetic phase of CaFe2As2. We find the Fermi surface of CaFe2P2 to differ from other related ternary phosphides in that its topology is highly dispersive in the c axis, being three dimensional in character and with identical mass enhancement on both electron and hole pockets ( approximately 1.5). This suggests that when the bonding between pnictogen layers becomes important nesting conditions are not fulfilled.