Ferromagnetic Film on a Superconducting Substrate

We study the equilibrium domain structure and magnetic flux around a ferromagnetic (FM) film with perpendicular magnetization M_0 on a superconducting (SC) substrate. At 4{\pi}M_0<H_{c1} the SC is in the Meissner state and the equilibrium domain width in the film, l, scales as (l/4{\pi}{\lambda}_{L}) = (l_{N}/4{\pi}{\lambda}_{L})^{2/3} with the domain width on a normal (non-superconducting) substrate, l_{N}/4\pi\lambda_L >> 1. Here \lambda_L is the London penetration length. For 4{\pi}M_0 > H_{c1} and l_{N} in excess of about 35 {\lambda}_{L}, the domains are connected by SC vortices. We argue that pinning of vortices by magnetic domains in FM/SC multilayers can provide high critical currents.Comment: 4 pages, 2 figures, submitted to PR

Adult Acute Sinusitis Antimicrobial Stewardship Program in a Primary Care Setting

BACKGROUND: Inappropriate antibiotic prescribing is a well-documented global health crisis (Centers for Disease Control, CDC, 2013). Antimicrobial stewardship (AS) is the purposeful selection of the correct drug, dose, route and duration of antimicrobial treatment to decrease microbial resistance, adverse drug effects and cost while improving patient outcomes (Dellit et al., 2007; CDC, 2016). Antimicrobial Stewardship Programs (ASP) are multidisciplinary programs designed to improve AS. PURPOSE: To describe baseline prescribing patterns and evaluate the effect of an antimicrobial stewardship program (ASP) for adult acute sinusitis on provider knowledge and antibiotic prescribing practice. among primary care providers in an internal medicine clinic in an academic medical center in Kentucky METHODS: In this pre/post-test quasi-experimental design study a baseline chart audit was conducted to determine baseline prescribing practices. An evidence based ASP was developed and implemented to assess pre/post provider knowledge as determined by changes survey scores after the education based ASP. Following the ASP, a focus group structured on the Health Belief Model was conducted to elicit perceived barriers to deliver guideline recommended care. RESULTS: The sample contained 22 patient chats for the baseline chart audit. The chart audits revealed that care was concordant the majority (59.1%) of the time, the lowest scoring component of the chart audit was timing (50%) and was significantly different between concordant and unconcordant care. Eleven providers completed the pretest and participated in the ASP and focus group 9 of the 11 providers completed the post-test 1 week after the ASP. Overall knowledge increased from after the ASP (M = 52.27, SD =26.11) vs. (M = 55.56, SD = 24.3). Concordant care was delivered in 59.1% of cases. Providers reported a desire for support in appropriate prescribing and in educating patients on appropriate antibiotic use. CONCLUSION: Care was concordant the majority (59.1%) of the time, and correct antibiotic selection occurred 100%. Key areas for improvement include waiting for long enough symptom duration … correct symptom duration. The ASP was feasible to implement and was well received by attendees. Future ASP sessions should include a multidisciplinary team, multiple sessions which include active participation, and communication skills. Future studies should identify specific provider, clinical and patient components that influence the effectiveness of outpatient stewardship programs

Lattice dynamics of anharmonic solids from first principles

An accurate and easily extendable method to deal with lattice dynamics of solids is offered. It is based on first-principles molecular dynamics simulations and provides a consistent way to extract the best possible harmonic - or higher order - potential energy surface at finite temperatures. It is designed to work even for strongly anharmonic systems where the traditional quasiharmonic approximation fails. The accuracy and convergence of the method are controlled in a straightforward way. Excellent agreement of the calculated phonon dispersion relations at finite temperature with experimental results for bcc Li and bcc Zr is demonstrated

Alveolar macrophages and Toll-like receptor 4 mediate ventilated lung ischemia reperfusion injury in mice.

BackgroundIschemia-reperfusion (I-R) injury is a sterile inflammatory process that is commonly associated with diverse clinical situations such as hemorrhage followed by resuscitation, transient embolic events, and organ transplantation. I-R injury can induce lung dysfunction whether the I-R occurs in the lung or in a remote organ. Recently, evidence has emerged that receptors and pathways of the innate immune system are involved in recognizing sterile inflammation and overlap considerably with those involved in the recognition of and response to pathogens.MethodsThe authors used a mouse surgical model of transient unilateral left pulmonary artery occlusion without bronchial involvement to create ventilated lung I-R injury. In addition, they mimicked nutritional I-R injury in vitro by transiently depriving cells of all nutrients.ResultsCompared with sham-operated mice, mice subjected to ventilated lung I-R injury had up-regulated lung expression of inflammatory mediator messenger RNA for interleukin-1β, interleukin-6, and chemokine (C-X-C motif) ligand-1 and -2, paralleled by histologic evidence of lung neutrophil recruitment and increased plasma concentrations of interleukin-1β, interleukin-6, and high-mobility group protein B1 proteins. This inflammatory response to I-R required toll-like receptor-4 (TLR4). In addition, the authors demonstrated in vitro cooperativity and cross-talk between human macrophages and endothelial cells, resulting in augmented inflammatory responses to I-R. Remarkably, the authors found that selective depletion of alveolar macrophages rendered mice resistant to ventilated lung I-R injury.ConclusionsThe data reveal that alveolar macrophages and the pattern recognition receptor toll-like receptor-4 are involved in the generation of the early inflammatory response to lung I-R injury

Rationing and Disability: The Civil Rights and Wrongs of State Triage Protocols

The COVID-19 pandemic and the unprecedented natural disasters of 2020 remind us of the importance of emergency preparedness. This Article contributes to our legal and ethical readiness by examining state “Crisis Standards of Care,” which are the standards that determine how medical resources are allocated in times of scarcity. The Article identifies a flaw in the policy choice at the heart of the standards: the standards focus on saving as many lives as possible but, in so doing, will predictably disadvantage the ability of people with disabilities and racial minorities to access life-saving care. To date, scholarly attention has focused on explicit exclusions of people with particular medical conditions or the standards’ failure to be sufficiently individualized. Amending the protocols to address these concerns, while important, will simply tinker at the margins. The more consequential and harder question is how states should balance the demand to save as many lives as possible while also ensuring that people with disabilities and other vulnerable groups are treated fairly. To answer that question, this Article distills and analyzes four rationing principles that animate the state standards and contends that none ultimately balances these two important aims in a manner consistent with the Americans with Disabilities Act (ADA) and the moral commitments on which it rests. It thus provides a moral and legal framework to guide the ongoing revision of the standards. The Article concludes by proposing a novel, alternative rationing system that reserves resources to accommodate both efficiency and equity, thereby better instantiating the balance that undergirds the ADA