Observation of band structure and density of states effects in Co-based magnetic tunnel junctions

Utilizing Co/Al$_2$O$_3$/Co magnetic tunnel junctions (MTJs) with Co electrodes of different crystalline phases, a clear relationship between electrode structure and junction transport properties is presented. For junctions with one fcc(111) textured and one polycrystalline (poly-phase and poly-directional) Co electrode, a strong asymmetry is observed in the magnetotransport properties, while when both electrodes are polycrystalline the magnetotransport is essentially symmetric. These observations are successfully explained within a model based on ballistic tunneling between the calculated band structures (DOS) of fcc-Co and hcp-Co.Comment: 4 pages, 3 figures, submitted to Phys. Rev. Let

Mortality and pulmonary complications in patients undergoing surgery with perioperative SARS-CoV-2 infection: an international cohort study

Background: The impact of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) on postoperative recovery needs to be understood to inform clinical decision making during and after the COVID-19 pandemic. This study reports 30-day mortality and pulmonary complication rates in patients with perioperative SARS-CoV-2 infection. Methods: This international, multicentre, cohort study at 235 hospitals in 24 countries included all patients undergoing surgery who had SARS-CoV-2 infection confirmed within 7 days before or 30 days after surgery. The primary outcome measure was 30-day postoperative mortality and was assessed in all enrolled patients. The main secondary outcome measure was pulmonary complications, defined as pneumonia, acute respiratory distress syndrome, or unexpected postoperative ventilation. Findings: This analysis includes 1128 patients who had surgery between Jan 1 and March 31, 2020, of whom 835 (74·0%) had emergency surgery and 280 (24·8%) had elective surgery. SARS-CoV-2 infection was confirmed preoperatively in 294 (26·1%) patients. 30-day mortality was 23·8% (268 of 1128). Pulmonary complications occurred in 577 (51·2%) of 1128 patients; 30-day mortality in these patients was 38·0% (219 of 577), accounting for 81·7% (219 of 268) of all deaths. In adjusted analyses, 30-day mortality was associated with male sex (odds ratio 1·75 [95% CI 1·28–2·40], p\textless0·0001), age 70 years or older versus younger than 70 years (2·30 [1·65–3·22], p\textless0·0001), American Society of Anesthesiologists grades 3–5 versus grades 1–2 (2·35 [1·57–3·53], p\textless0·0001), malignant versus benign or obstetric diagnosis (1·55 [1·01–2·39], p=0·046), emergency versus elective surgery (1·67 [1·06–2·63], p=0·026), and major versus minor surgery (1·52 [1·01–2·31], p=0·047). Interpretation: Postoperative pulmonary complications occur in half of patients with perioperative SARS-CoV-2 infection and are associated with high mortality. Thresholds for surgery during the COVID-19 pandemic should be higher than during normal practice, particularly in men aged 70 years and older. Consideration should be given for postponing non-urgent procedures and promoting non-operative treatment to delay or avoid the need for surgery. Funding: National Institute for Health Research (NIHR), Association of Coloproctology of Great Britain and Ireland, Bowel and Cancer Research, Bowel Disease Research Foundation, Association of Upper Gastrointestinal Surgeons, British Association of Surgical Oncology, British Gynaecological Cancer Society, European Society of Coloproctology, NIHR Academy, Sarcoma UK, Vascular Society for Great Britain and Ireland, and Yorkshire Cancer Research

Controversies in acute kidney injury: conclusions from a Kidney Disease: Improving Global Outcomes (KDIGO) conference

In 2012, Kidney Disease: Improving Global Outcomes (KDIGO) published a guideline on the classification and management of acute kidney injury (AKI). The guideline was derived from evidence available through February 2011. Since then, new evidence has emerged that has important implications for clinical practice in diagnosing and managing AKI. In April of 2019, KDIGO held a controversies conference entitled Acute Kidney Injury with the following goals: determine best practices and areas of uncertainty in treating AKI; review key relevant literature published since the 2012 KDIGO AKI guideline; address ongoing controversial issues; identify new topics or issues to be revisited for the next iteration of the KDIGO AKI guideline; and outline research needed to improve AKI management. Here, we present the findings of this conference and describe key areas that future guidelines may address

Reducing the environmental impact of surgery on a global scale: systematic review and co-prioritization with healthcare workers in 132 countries

Abstract Background Healthcare cannot achieve net-zero carbon without addressing operating theatres. The aim of this study was to prioritize feasible interventions to reduce the environmental impact of operating theatres. Methods This study adopted a four-phase Delphi consensus co-prioritization methodology. In phase 1, a systematic review of published interventions and global consultation of perioperative healthcare professionals were used to longlist interventions. In phase 2, iterative thematic analysis consolidated comparable interventions into a shortlist. In phase 3, the shortlist was co-prioritized based on patient and clinician views on acceptability, feasibility, and safety. In phase 4, ranked lists of interventions were presented by their relevance to high-income countries and low–middle-income countries. Results In phase 1, 43 interventions were identified, which had low uptake in practice according to 3042 professionals globally. In phase 2, a shortlist of 15 intervention domains was generated. In phase 3, interventions were deemed acceptable for more than 90 per cent of patients except for reducing general anaesthesia (84 per cent) and re-sterilization of ‘single-use’ consumables (86 per cent). In phase 4, the top three shortlisted interventions for high-income countries were: introducing recycling; reducing use of anaesthetic gases; and appropriate clinical waste processing. In phase 4, the top three shortlisted interventions for low–middle-income countries were: introducing reusable surgical devices; reducing use of consumables; and reducing the use of general anaesthesia. Conclusion This is a step toward environmentally sustainable operating environments with actionable interventions applicable to both high– and low–middle–income countries

Large magnetoresistance in hybrid spin filter devices

Spin electronic ("spintronic") devices, based on utilizing the spin as well as the charge of electrons, open up an entirely new class of electronics. Such devices could include nonvolatile magnetic memories, re-programmable logic, and quantum computers. One thing hampering the development of spin electronic devices so far is the lack of sufficiently polarized (nearing 100% spin polarization) current sources for spin injection into semiconductors. So-called "half-metallic ferromagnets" would circumvent this problem, but true half-metals have proven extremely difficult to realize in practice. However, the phenomenon of spin filtering may also be exploited to create near 100% polarization. Here we propose and demonstrate a different approach, combining spin filter tunnel barriers and spin-dependent tunneling, similar to a device proposed by Worledge et al. (2000). The combination of a non-magnetic electrode with a spin filter tunnel barrier is used to effectively mimic a half-metallic tunneling electrode and achieve nearly 100% spin polarization. Using this, "artificial half-metal" bilayer, we additionally use a second magnetic electrode, creating a nonmagnetic metal/ferromagnetic insulator/ferromagnetic metal (M-FI-F) device. We utilize EuS as the magnetic insulator, with Gd ferromagnetic and Al nonmagnetic electrodes. The, tunnel current in this case depends on the relative magnetization orientation of the EuS filter and the Gd "analyzer," in analogy to a half-metallic ferromagnet/insulator/ferromagnet tunnel junction. The spin filtering in this configuration yields a previously unobserved magnetoresistance effect, exceeding 100%, suggesting a filtering efficiency close to 100%. The present scheme would also circumvent impedance mismatch problems with semiconducting counter electrodes, and thus potentially allow spin injection from even a non-magnetic metal into a semiconductor