An automated system for mounting and dismounting pre‐frozen crystals has been implemented at the Stanford Synchrotron Radiation Laboratory (SSRL). It is based on a small industrial robot and compact ...cylindrical cassettes, each holding up to 96 crystals mounted on Hampton Research sample pins. For easy shipping and storage, the cassette fits inside several popular dry‐shippers and long‐term storage Dewars. A dispensing Dewar holds up to three cassettes in liquid nitrogen adjacent to the beamline goniometer. The robot uses a permanent magnet tool to extract samples from, and insert samples into a cassette, and a cryo‐tong tool to transfer them to and from the beamline goniometer. The system is simple, with few moving parts, reliable in operation and convenient to use.
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The aim of this study was to examine the independent associations between actionable bleeding (AB) and coronary thrombotic events (CTE) on mortality risk after percutaneous coronary intervention ...(PCI).
The independent impact of AB and CTE on mortality risk after PCI remains poorly characterized.
A post hoc analysis was conducted of the PARIS (Patterns of Non-Adherence to Dual Antiplatelet Therapy in Stented Patients) registry, a real-world cohort of 5,018 patients undergoing PCI with stent implantation. CTE included definite or probable stent thrombosis or myocardial infarction. AB was defined as Bleeding Academic Research Consortium type 2 or 3. Associations between CTE and AB, both of which were modeled as time-dependent covariates, and 2-year mortality risk were examined using extended Cox regression.
Over 2 years, the cumulative incidence of CTE, AB, and all-cause mortality was 5.9% (n = 289), 8.1% (n = 391), and 4.7% (n = 227), respectively. Adjusted hazard ratios for mortality associated with CTE and AB were 3.3 (95% confidence interval: 2.2 to 4.9) and 3.5 (95% confidence interval: 2.3 to 5.4), respectively. Temporal gradients in risk after either event were highest in the first 30 days and declined rapidly thereafter. Thrombotic events occurring while patients were on versus off dual-antiplatelet therapy were associated with a higher mortality risk, whereas risk related to AB was not influenced by dual-antiplatelet therapy status at the time of bleeding.
Intracoronary thrombosis and AB are associated with mortality risks of comparable magnitude over a 2-year period after PCI, findings that might inform risk/benefit calculations for extension versus discontinuation of dual-antiplatelet therapy.
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GEOZS, IJS, IMTLJ, KILJ, KISLJ, NLZOH, NUK, OILJ, PNG, SAZU, SBCE, SBJE, UILJ, UL, UM, UPCLJ, UPUK, ZAGLJ, ZRSKP
Background
The Department of Veterans Affairs (VA) healthcare system routinely screens Veterans for food insecurity, housing instability, and intimate partner violence, but does not systematically ...screen for other health-related social needs (HRSNs).
Objectives
To (1) develop a process for systematically identifying and addressing Veterans’ HRSNs, (2) determine reported prevalence of HRSNs, and (3) assess the acceptability of HRSN screening among Veterans.
Design
“Assessing Circumstances and Offering Resources for Needs” (ACORN) is a Veteran-tailored HRSN screening and referral quality improvement initiative. Veterans were screened via electronic tablet for nine HRSNs (food, housing, utilities, transportation, legal needs, social isolation, interpersonal violence, employment, and education) and provided geographically tailored resource guides for identified needs. Two-week follow-up interviews with a purposive sample of Veterans explored screening experiences.
Participants
Convenience sample of Veterans presenting for primary care at a VA urban women’s health clinic and suburban community-based outpatient clinic (October 2019–May 2020).
Main Measures
Primary outcomes included prevalence of HRSNs, Veteran-reported acceptability of screening, and use of resources guides. Data were analyzed using descriptive statistics, chi-square tests, and rapid qualitative analysis.
Key Results
Of 268 Veterans screened, 50% reported one or more HRSNs. Social isolation was endorsed most frequently (29%), followed by educational needs (19%), interpersonal violence (12%), housing instability (9%), and utility concerns (7%). One in five Veterans reported at least one form of material hardship. In follow-up interviews (
n
= 15), Veterans found screening acceptable and felt VA should continue screening. No Veterans interviewed had contacted recommended resources at two-week follow-up, although several planned to use resource guides in the future.
Conclusion
In a VA HRSN screening and referral program, Veterans frequently reported HRSNs, felt screening was important, and thought VA should continue to screen for these needs. Screening for HRSNs is a critical step towards connecting patients with services, identifying gaps in service delivery, and informing future resource allocation.
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EMUNI, FIS, FZAB, GEOZS, GIS, IJS, IMTLJ, KILJ, KISLJ, MFDPS, NLZOH, NUK, OILJ, PNG, SAZU, SBCE, SBJE, SBMB, SBNM, UKNU, UL, UM, UPUK, VKSCE, ZAGLJ
Context.
In 2020 May-June, six solar energetic ion events were observed by the Parker Solar Probe/IS⊙IS instrument suite at ≈0.35 AU from the Sun. From standard velocity-dispersion analysis, the ...apparent ion path length is ≈0.625 AU at the onset of each event.
Aims.
We develop a formalism for estimating the path length of random-walking magnetic field lines to explain why the apparent ion path length at an event onset greatly exceeds the radial distance from the Sun for these events.
Methods.
We developed analytical estimates of the average increase in path length of random-walking magnetic field lines, relative to the unperturbed mean field. Monte Carlo simulations of field line and particle trajectories in a model of solar wind turbulence were used to validate the formalism and study the path lengths of particle guiding-center and full-orbital trajectories. The formalism was implemented in a global solar wind model, and the results are compared with ion path lengths inferred from IS⊙IS observations.
Results.
Both a simple estimate and a rigorous theoretical formulation are obtained for field-lines’ path length increase as a function of path length along the large-scale field. From simulated field line and particle trajectories, we find that particle guiding centers can have path lengths somewhat shorter than the average field line path length, while particle orbits can have substantially longer path lengths due to their gyromotion with a nonzero effective pitch angle.
Conclusions.
The long apparent path length during these solar energetic ion events can be explained by (1) a magnetic field line path length increase due to the field line random walk and (2) particle transport about the guiding center with a nonzero effective pitch angle due to pitch angle scattering. Our formalism for computing the magnetic field line path length, accounting for turbulent fluctuations, may be useful for application to solar particle transport in general.
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Previous observations have driven the prevailing assumption in the field that energetic ions measured by an instrument using a bare solid state detector (SSD) are predominantly protons. However, new ...near‐equatorial energetic particle observations obtained between 7 and 12 RE during Phase 1 of the Magnetospheric Multiscale mission challenge the validity of this assumption. In particular, measurements by the Energetic Ion Spectrometer (EIS) instruments have revealed that the intensities of heavy ion species (specifically oxygen and helium) dominate those of protons at energies
≳150–220 keV in the middle to outer (>7 RE) magnetosphere. Given that relative composition measurements can drift as sensors degrade in gain, quality cross‐calibration agreement between EIS observations and those from the SSD‐based Fly's Eye Energetic Particle Spectrometer (FEEPS) sensors provides critical support to the veracity of the measurement. Similar observations from the Radiation Belt Storm Probes Ion Composition Experiment (RBSPICE) instruments aboard the Van Allen Probes spacecraft extend the ion composition measurements into the middle magnetosphere and reveal a strongly proton‐dominated environment at
L≲6 but decreasing proton intensities at
L≳6. It is concluded that the intensity dominance of the heavy ions at higher energies (>150 keV) arises from the existence of significant populations of multiply‐charged heavy ions, presumably of solar wind origin.
Plain Language Summary
Previous observations have shown that protons tend to be the dominant ion species in the magnetosphere. Because of this, it is generally accepted that “total ion” measurements made by instruments without the capability to determine the ion composition will predominantly measure protons. However, new observations from the Magnetospheric Multiscale (MMS) mission have shown that this is not the case at high energies (>150 keV). The unexpected result was discovered during efforts to cross calibrate the two sensors that comprise the Energetic Particle Detector investigation: the Energetic Ion Spectrometer (EIS) and the Fly's Eye Energetic Particle Spectrometer (FEEPS). Comparison of the FEEPS total ion measurements to the EIS proton‐only measurements showed large disagreement at higher energies. It was concluded that this was due to the prevalence of heavier ions (primarily helium and oxygen) at higher energies. Statistically strong agreement between FEEPS total ion and calculated EIS total ion measurements supports this conclusion. This study further concludes that these high‐energy heavy ions are mainly composed of multiply‐charged constituencies, such as He++ and O6+, presumably of solar wind origin. These results have significant impact on future techniques to obtain measurements and whether underlying assumptions made when interpreting and analyzing the data are valid.
Key Points
MMS observations have revealed the intensity dominance of >150 keV heavy ions in the magnetosphere
Quality cross calibration between different EPD sensor types was critical to support this finding
This heavy ion dominance at higher energies results from significant multiply‐charged populations
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Background & Aims:
Eosinophilic esophagitis is an increasingly recognized disorder with distinctive endoscopic, histologic, and allergic features. Although several therapies are advocated, no ...placebo-controlled trials have been conducted. We aimed to determine the efficacy of swallowed fluticasone propionate (FP) in the treatment of eosinophilic esophagitis.
Methods:
We conducted a randomized, double-blind, placebo-controlled trial of swallowed FP in pediatric patients with active eosinophilic esophagitis. Thirty-six patients were randomly assigned to receive either 880 μg of FP (21 patients) or placebo (15 patients) divided twice daily for 3 months. The primary end point was histologic remission, defined by a peak eosinophil count of ≤1 eosinophil in all 400× fields in both the proximal and distal esophagus.
Results:
Fifty percent of FP-treated patients achieved histologic remission compared with 9% of patients receiving placebo (
P = .047). FP decreased esophageal eosinophil levels, with a more pronounced effect in nonallergic individuals (65.9 ± 25.3 vs 1.4 ± 1.1 eosinophils/high-power field in the proximal esophagus
P = .03 and 84.6 ± 19.7 vs 19.6 ± 12.9 eosinophils/high-power field in the distal esophagus
P = .04). Resolution of vomiting occurred more frequently with FP than placebo (67% vs 27%;
P = .04). FP-induced resolution of mucosal eosinophilia was associated with resolution of endoscopic findings, epithelial hyperplasia, younger age (
P = .0003), shorter height (
P = .002), and lighter weight (
P = .02). Effective treatment with FP decreased the number of CD8
+ T lymphocytes and mast cells in both the proximal and distal esophagus (
P < .05).
Conclusions:
Swallowed FP is effective in inducing histologic remission in eosinophilic esophagitis, with a more pronounced effect in nonallergic and younger individuals, especially in the proximal esophagus.
In the TWILIGHT trial, ticagrelor monotherapy after a short course of dual antiplatelet therapy (DAPT) was shown to be a safe bleeding avoidance strategy in high-risk patients undergoing percutaneous ...coronary intervention (PCI) with drug-eluting stents (DES).
The aim of this study was to evaluate the effects of ticagrelor monotherapy after three-month DAPT in patients undergoing PCI, according to DES type.
In the current sub-analysis from TWILIGHT, patients were stratified into three groups based on DES type: durable polymer everolimus-eluting stents (DP-EES), durable polymer zotarolimus-eluting stents (DP-ZES), and biodegradable polymer DES (BP-DES). Bleeding and ischaemic outcomes were assessed at one year after randomisation.
Out of 5,769 patients, 3,014 (52.2%) had DP-EES, 1,350 (23.4%) had DP-ZES and 1,405 (24.4%) had BP-DES. Compared with ticagrelor plus aspirin, ticagrelor monotherapy had significantly lower BARC type 2, 3 or 5 bleeding compared with DAPT; DP-EES (3.8% vs 6.7%; HR 0.56, 95% CI: 0.41-0.78), DP-ZES (4.6% vs 6.9%; HR 0.66, 95% CI: 0.42-1.04) and BP-DES (4.2% vs 7.9%; HR 0.52, 95% CI: 0.33-0.81; p
=0.76). Ticagrelor monotherapy resulted in similar rates of death, MI, or stroke: DP-EES (4.2% vs 4.3%; HR 0.97; 95% CI: 0.68-1.37); DP-ZES (4.1% vs 3.1%; HR 1.32; 95% CI: 0.75-2.33); BP-DES (3.9% vs 4.2%; HR 0.92; 95% CI: 0.54-1.55; p
=0.60). In both unadjusted and covariate-adjusted analyses, DES type was not associated with any differences in ischaemic or bleeding complications.
As compared with ticagrelor plus aspirin, ticagrelor monotherapy after a short DAPT duration lowered bleeding complications without increasing the ischaemic risk, irrespective of DES type. We observed no significant differences among DES types.
BACKGROUND:High bleeding risk (HBR) patients undergoing percutaneous coronary intervention have been widely excluded from randomized device registration trials. The LF study (LEADERS FREE) reported ...superior outcomes of HBR patients receiving 30-day dual antiplatelet therapy after percutaneous coronary intervention with a polymer-free drug-coated stent (DCS). LFII was designed to assess the reproducibility and generalizability of the benefits of DCS observed in LF to inform the US Food and Drug Administration in a device registration decision.
METHODS:LFII was a single-arm study using HBR inclusion/exclusion criteria and 30-day dual antiplatelet therapy after percutaneous coronary intervention with DCS, identical to LF. The 365-day rates of the primary effectiveness (clinically indicated target lesion revascularization) and safety (composite cardiac death and myocardial infarction) end points were reported using a propensity-stratified analysis compared with the LF bare metal stent arm patients as controls.
RESULTS:A total of 1203 LFII patients were enrolled with an average 1.7 HBR criteria per patient, including 60.7% >75 years of age, 34.1% on anticoagulants, and 14.7% with renal failure. Propensity-adjusted 365-day clinically indicated target lesion revascularization was significantly lower with DCS (7.2% versus 9.2%; hazard ratio, 0.72 95% CI, 0.52–0.98; P=0.0338 for superiority), as was the primary safety (cardiac death and myocardial infarction) composite (9.3% versus 12.4%; hazard ratio, 0.72 95% CI, 0.55–0.94; P=0.0150 for superiority). Stent thrombosis rates were 2.0% DCS and 2.2% bare metal stent. Major bleeding at 1 year occurred in 7.2% DCS patients and 7.2% bare metal stent.
CONCLUSIONS:LFII reproduces the results of the DCS arm of LF in an independent, predominantly North American cohort of HBR patients.
Omidubicel (nicotinamide-expanded cord blood) is a potential alternative source for allogeneic hematopoietic cell transplantation (HCT) when an HLA-identical donor is lacking. A phase I/II trial with ...standalone omidubicel HCT showed rapid and robust neutrophil and platelet engraftment. In this study, we evaluated the immune reconstitution (IR) of patients receiving omidubicel grafts during the first 6 months post-transplant, as IR is critical for favorable outcomes of the procedure. Data was collected from the omidubicel phase I-II international, multicenter trial. The primary endpoint was the probability of achieving adequate CD4+ T-cell IR (CD4IR: > 50 × 10
/L within 100 days). Secondary endpoints were the recovery of T-cells, natural killer (NK)-cells, B-cells, dendritic cells (DC), and monocytes as determined with multicolor flow cytometry. LOESS-regression curves and cumulative incidence plots were used for data description. Thirty-six omidubicel recipients (median 44; 13-63 years) were included, and IR data was available from 28 recipients. Of these patients, 90% achieved adequate CD4IR. Overall, IR was complete and consisted of T-cell, monocyte, DC, and notably fast NK- and B-cell reconstitution, compared to conventional grafts. Our data show that transplantation of adolescent and adult patients with omidubicel results in full and broad IR, which is comparable with IR after HCT with conventional graft sources.
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EMUNI, FIS, FZAB, GEOZS, GIS, IJS, IMTLJ, KILJ, KISLJ, MFDPS, NLZOH, NUK, OILJ, PNG, SAZU, SBCE, SBJE, SBMB, SBNM, UKNU, UL, UM, UPUK, VKSCE, ZAGLJ
We provide analysis of a coronal mass ejection (CME) that passed over Parker Solar Probe (PSP) on January 20, 2020 when the spacecraft was at just 0.32 AU. The Integrated Science Investigation of the ...Sun instrument suite measures energetic particle populations associated with the CME before, during, and after its passage over the spacecraft. We observe a complex evolution of energetic particles, including a brief ~2 h period where the energetic particle fluxes are enhanced and the nominal orientation of the energetic particle streaming outward from the Sun (from 30 to 100 keV nuc
−1
) abruptly reverses inward toward the Sun. This transient and punctuated evolution highlights the importance of magnetic field structures that connect the spacecraft to different acceleration sites, one of which is likely more distant from the Sun than PSP during the evolution of the CME. We discuss these characteristics and what they tell us about the source of the energetic particles. During this period, PSP was radially aligned with the Solar Terrestrial Relations Observatory A (STEREO-A), which measured the same CME when it passed 1 AU. The magnetic field measurements at both spacecraft are remarkably similar, indicating that the spacecraft are likely encountering the same portion of the magnetic structure that has not evolved significantly in transit. The energetic particle observations on the other hand, are quite different at STEREO-A, showing how transport effects have acted on the energetic particle populations and obscured the detailed properties present earlier in the development of the CME. This event provides a unique case study in how energetic particle populations evolve as CMEs propagate through the heliosphere.
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