Supporting Treatment Adherence Readiness through Training (START) for patients with HIV on antiretroviral therapy: study protocol for a randomized controlled trial.

BackgroundFew HIV antiretroviral adherence interventions target patients before they start treatment, assess adherence readiness to determine the timing of treatment initiation, or tailor the amount of adherence support. The Supporting Treatment Adherence Readiness through Training (START) intervention, based on the information-motivation-behavioral skills model of behavior change, is designed to address these gaps with the inclusion of (1) brief pill-taking practice trials for enhancing pretreatment adherence counseling and providing a behavioral criterion for determining adherence readiness and the timing of treatment initiation and (2) a performance-driven dose regulation mechanism to tailor the amount of counseling to the individual needs of the patient and conserve resources. The primary aim of this randomized controlled trial is to examine the effects of START on antiretroviral adherence and HIV virologic suppression.Methods/designA sample of 240 patients will be randomized to receive START or usual care at one of two HIV clinics. Primary outcomes will be optimal dose-taking adherence (>85 % prescribed doses taken), as measured with electronic monitoring caps, and undetectable HIV viral load. Secondary outcomes will include dose-timing adherence (>85 % prescribed doses taken on time) and CD4 count. Primary endpoints will be month 6 (short-term effect) and month 24 (to test durability of effect), though electronic monitoring will be continuous and a fully battery of assessments will be administered every 6 months for 24 months.DiscussionIf efficacious and cost-effective, START will provide clinicians with a model for assessing patient adherence readiness and helping patients to achieve and sustain readiness and optimal treatment benefits.Trial registrationClinicalTrials.gov identifier NCT02329782 . Registered on 22 December 2014

A microscopic Ginzburg--Landau theory and singlet ordering in Sr2_2RuO4_4

The long-standing quest to determine the superconducting order of Sr$_2$RuO$_4$ (SRO) has received renewed attention after recent nuclear magnetic resonance (NMR) Knight shift experiments have cast doubt on the possibility of spin-triplet pairing in the superconducting state. As a putative solution, encompassing a body of experiments conducted over the years, a $d+ig$-wave order parameter caused by an accidental near-degeneracy has been suggested [S. A. Kivelson et al., npj Quantum Materials $\bf{5}$, 43 (2020)]. Here we develop a general Ginzburg--Landau theory for multiband superconductors. We apply the theory to SRO and predict the relative size of the order parameter components. The heat capacity jump expected at the onset of the second order parameter component is found to be above the current threshold deduced by the experimental absence of a second jump. Our results tightly restrict theories of $d+ig$ order, and other candidates caused by a near-degeneracy, in SRO. We discuss possible solutions to the problem.Comment: 13 pages, 8 figure

Skyrmions in Twisted Bilayer Graphene: Stability, Pairing, and Crystallization

We study the excitations that emerge upon doping the translationally invariant correlated insulating states in magic-angle twisted bilayer graphene at various integer filling factors ν. We identify parameter regimes where these are excitations associated with skyrmion textures in the spin or pseudospin degrees of freedom, and explore both short-distance pairing effects and the formation of long-range ordered skyrmion crystals. We perform a comprehensive analysis of the pseudospin skyrmions that emerge upon doping insulators at even ν, delineating the regime in parameter space where these are the lowest-energy charged excitations by means of self-consistent Hartree-Fock calculations on the interacting Bistritzer-MacDonald model. We explicitly demonstrate the purely electron-mediated pairing of skyrmions, a key ingredient behind a recent proposal of skyrmion superconductivity. Building upon this, we construct hopping models to extract the effective masses of paired skyrmions, and discuss our findings and their implications for skyrmion superconductivity in relation to experiments, focusing on the dome-shaped dependence of the transition temperature on the twist angle. We also investigate the properties of spin skyrmions about the quantized anomalous Hall insulator at ν=+3. In both cases, we demonstrate the formation of robust spin or pseudospin skyrmion crystals upon doping to a finite density away from integer filling

Coulomb-driven band unflattening suppresses KK-phonon pairing in moir\'e graphene

It is a matter of current debate whether the gate-tunable superconductivity in twisted bilayer graphene is phonon-mediated or arises from electron-electron interactions. The recent observation of the strong coupling of electrons to so-called $K$-phonon modes in angle-resolved photoemission spectroscopy experiments has resuscitated early proposals that $K$-phonons drive superconductivity. We show that the bandwidth-enhancing effect of interactions drastically weakens both the intrinsic susceptibility towards pairing as well as the screening of Coulomb repulsion that is essential for the phonon attraction to dominate at low temperature. This rules out purely $K$-phonon-mediated superconductivity with the observed transition temperature of $\sim 1$ K. We conclude that the unflattening of bands by Coulomb interactions challenges any purely phonon-driven pairing mechanism, and must be addressed by a successful theory of superconductivity in moir\'e graphene.Comment: 8 pages, 2 figures (+16 pages, 8 figures supplement

Electron-phonon coupling and competing Kekul\'e orders in twisted bilayer graphene

Recent scanning tunneling microscopy experiments [K.P. Nuckolls et al., arXiv:2303.00024] have revealed the ubiquity of Kekul\'e charge-density wave order in magic-angle twisted bilayer graphene. Most samples are moderately strained and show `incommensurate Kekul\'e spiral' (IKS) order involving a graphene-scale charge density distortion uniaxially modulated on the scale of the moir\'e superlattice, in accord with theoretical predictions. However, ultra-low strain samples instead show graphene-scale Kekul\'e charge order that is uniform on the moir\'e scale. This order, especially prominent near filling factor $\nu=-2$, is unanticipated by theory which predicts a time-reversal breaking Kekul\'e current order at low strain. We show that including the coupling of moir\'e electrons to graphene-scale optical zone-corner (ZC) phonons stabilizes a uniform Kekul\'e charge ordered state at $|\nu|=2$ with a quantized topological (spin or anomalous Hall) response. Our work clarifies how this phonon-driven selection of electronic order emerges in the strong-coupling regime of moir\'e graphene.Comment: 5+4 page

A perpetual switching system in pulmonary capillaries

Of the 300 billion capillaries in the human lung, a small fraction meet normal oxygen requirements at rest, with the remainder forming a large reserve. The maximum oxygen demands of the acute stress response require that the reserve capillaries are rapidly recruited. To remain primed for emergencies, the normal cardiac output must be parceled throughout the capillary bed to maintain low opening pressures. The flow-distributing system requires complex switching. Because the pulmonary microcirculation contains contractile machinery, one hypothesis posits an active switching system. The opposing hypothesis is based on passive switching that requires no regulation. Both hypotheses were tested ex vivo in canine lung lobes. The lobes were perfused first with autologous blood, and capillary switching patterns were recorded by videomicroscopy. Next, the vasculature of the lobes was saline flushed, fixed by glutaraldehyde perfusion, flushed again, and then reperfused with the original, unfixed blood. Flow patterns through the same capillaries were recorded again. The 16-min-long videos were divided into 4-s increments. Each capillary segment was recorded as being perfused if at least one red blood cell crossed the entire segment. Otherwise it was recorded as unperfused. These binary measurements were made manually for each segment during every 4 s throughout the 16-min recordings of the fresh and fixed capillaries (>60,000 measurements). Unexpectedly, the switching patterns did not change after fixation. We conclude that the pulmonary capillaries can remain primed for emergencies without requiring regulation: no detectors, no feedback loops, and no effectors-a rare system in biology. NEW & NOTEWORTHY The fluctuating flow patterns of red blood cells within the pulmonary capillary networks have been assumed to be actively controlled within the pulmonary microcirculation. Here we show that the capillary flow switching patterns in the same network are the same whether the lungs are fresh or fixed. This unexpected observation can be successfully explained by a new model of pulmonary capillary flow based on chaos theory and fractal mathematics

Building crystalline topological superconductors from Shiba lattices

Localized or propagating Majorana boundary modes are the key feature of topological superconductors. While being a rarity in natural compounds, the tailored manipulation of quantum matter offers novel opportunities for their realization. Specifically, lattices of Shiba bound states that arise when magnetic adatoms are placed on the surface of a conventional superconductor can be used to create topological minibands within the superconducting gap of the substrate. Here, we exploit the possibilities of scanning tunneling microscopy to create and probe adatom lattices with single atom precision to create topological crystalline superconductors. Their topological character and boundary modes are protected by the spatial symmetries of the adatom lattice. We combine scanning probe spectroscopy, spin-sensitive measurements, first principle calculations, and theoretical modeling to to reveal signatures consistent with the realization of two types of mirror-symmetry protected topological superconductors: (i) with full bulk gap and topological edge as well as higher-order corner states and (ii) with symmetry-protected bulk nodal points. Our results show the immense versatility of Shiba lattices to design the topology and sample geometry of 2D superconductors.Comment: Published in Nature Physics (https://doi.org/10.1038/s41567-023-02104-5

Geodetic VLBI Observations of EGRET Blazars

We present VLBI observations of the EGRET quasars 0202+149, CTA 26, and 1606+106, as well as additional analysis of VLBI observations of 1156+295 presented in Piner & Kingham (1997b). We have produced 8 and 2 GHz VLBI images at 11 epochs, 8 epochs, and 12 epochs, spanning the years 1989 to 1996, of 0202+149, CTA 26, and 1606+106 respectively. The VLBI data have been taken from the Washington VLBI correlator's geodetic database. We have measured the apparent velocities of the jet components and find that CTA 26 and 1606+106 are superluminal sources, with average apparent speeds of 8.9 and 2.9 h^{-1}c respectively (H_{0}=100h km s^{-1} Mpc^{-1}, q_{0}=0.5). The components in 0202+149 are stationary, and we identify this source as a compact F double. These sources all have apparently bent jets, and we detected non-radial motion of components in CTA 26 and 1156+295. We have not yet detected any components emerging subsequent to the gamma-ray flares in CTA 26, 1156+295, and 1606+106, and we derive lower limits on the ejection times of any such components. The misalignment angle distribution of the EGRET sources is compared to the distribution for blazars as a whole, and we find that EGRET sources belong preferentially to neither the aligned nor the misaligned population. We also compare the average values for the apparent velocities and Doppler beaming factors for the EGRET and non-EGRET blazars, and find no significant differences. We thus find no indication, within the measurement errors, that EGRET blazars are any more strongly beamed than their counterparts which have not been detected in gamma-rays.Comment: 47 pages, including 13 figures; accepted for publication in the Astrophysical Journa