Plasmonic resonances in metallic nanostructures can strongly enhance the emission from quantum emitters, as commonly used in surface-enhanced spectroscopy techniques. The extinction and scattering ...spectrum of these quantum emitter-metallic nanoantenna hybrid systems are often characterized by a sharp Fano resonance, which is usually expected to be symmetric when a plasmonic mode is resonant with an exciton of the quantum emitter. Here, motivated by recent experimental work showing an asymmetric Fano lineshape under resonant conditions, we study the Fano resonance found in a system composed of a single quantum emitter interacting resonantly with a single spherical silver nanoantenna or with a dimer nanoantenna composed of two gold spherical nanoparticles. To analyze in detail the origin of the resulting Fano asymmetry we develop numerical simulations, an analytical expression that relates the asymmetry of the Fano lineshape to the field enhancement and to the enhanced losses of the quantum emitter (Purcell effect), and a set of simple models. In this manner we identify the contributions to the asymmetry of different physical phenomena, such as retardation and the direct excitation and emission from the quantum emitter.
Abstract Background Context Blood transfusions in spine surgery are shown to be associated with increased patient morbidity. The association between transfusion performed using a liberal hemoglobin ...trigger—defined as an intraoperative hemoglobin level of ≥10 g/dL, a postoperative level of ≥8 g/dL, or a whole hospital nadir between 8-10 g/dL—and perioperative morbidity and cost in spine surgery patients is unknown and thus was investigated in this study. Purpose To describe the perioperative outcomes and economic cost associated with liberal hemoglobin trigger transfusion among spine surgery patients. Study Design/Setting Retrospective study. Patient Sample The surgical billing database at our institution was queried for inpatients discharged between 2008 and 2015 after the following procedures: atlantoaxial fusion, anterior cervical fusion, posterior cervical fusion, anterior lumbar fusion, posterior lumbar fusion, lateral lumbar fusion, other procedures, and tumor-related surgeries. In total, 6931 patients were included for analysis. Outcome Measures The primary outcome was composite morbidity which was comprised of: (1) infection (sepsis, surgical-site infection, Clostridium dificile, or drug-resistant infection), (2) thrombotic event (pulmonary embolus, deep venous thrombosis, or disseminated intravascular coagulation), (3) kidney injury, (4) respiratory event, and/or (5) ischemic event (transient ischemic attack, myocardial infarction, or cerebrovascular accident). Methods Data on intraoperative transfusion were obtained from an automated prospectively collected anesthesia data management system. Data on postoperative hospital transfusion was obtained through a Web-based intelligence portal. Based on previous research, we analyzed the data using three definitions of a liberal transfusion trigger in patients who received an RBC transfusion: a liberal intraoperative Hb trigger as a nadir Hb level of 10 g/dL or greater, a liberal postoperative Hb trigger as a nadir Hb level of 8 g/dL or greater, or a whole hospital nadir Hb level of 8-10 g/dL. Variables analyzed included in-hospital morbidity, mortality, length of stay, and total costs associated with a liberal transfusion strategy. Results Among patients with a whole hospital stay nadir hemoglobin between 8 to 10 g/dL, transfused patients demonstrated a longer in-hospital stay (median IQR, 6 5-9 vs. 4 3-6 days; P<0.0001) and a higher perioperative morbidity (n=145, 11.5% vs. n=74, 6.1%; P<0.0001) than those not transfused. Even after adjusting for age, gender, race, ASA class, CCI score, estimated blood loss, baseline hemoglobin value, number of operated levels, and surgery type, logistic regression analysis revealed that patients with a nadir hemoglobin of 8-10 g/dL who were transfused had an independently higher risk of perioperative morbidity (odds ratio OR = 2.12; 95% confidence interval CI, 1.24-3.64; P=0.006). Estimated additional costs associated with liberal trigger use, defined as a transfusion occurring in patients with a whole hospital stay nadir Hb of 8-10 g/dL, ranged from $202,675 to $700,151 annually. Conclusions Transfusion using a liberal trigger is associated with increased morbidity, even after controlling for possible confounders. Our results suggest that modification of transfusion practice may be a potential area for improving patient outcomes and reducing costs.
We present a comparison of fast-response instruments installed onboard the NASA DC-8 aircraft that measured nitrogen oxides (NO and NO2), nitrous acid (HONO), total reactive odd nitrogen (measured ...both as the total (NOy) and from the sum of individually measured species (ΣNOy)), and carbon monoxide (CO) in the troposphere during the 2019 Fire Influence on Regional to Global Environments and Air Quality (FIREX-AQ) campaign. By targeting smoke from summertime wildfires, prescribed fires, and agricultural burns across the continental United States, FIREX-AQ provided a unique opportunity to investigate measurement accuracy in concentrated plumes where hundreds of species coexist. Here, we compare NO measurements by chemiluminescence (CL) and laser-induced fluorescence (LIF); NO2 measurements by CL, LIF, and cavity-enhanced spectroscopy (CES); HONO measurements by CES and iodide-adduct chemical ionization mass spectrometry (CIMS); and CO measurements by tunable diode laser absorption spectrometry (TDLAS) and integrated cavity output spectroscopy (ICOS). Additionally, total NOy measurements using the CL instrument were compared withΣNOy (= NO + NO2 + HONO + nitric acid (HNO3) + acyl peroxy nitrates (APNs) + submicrometer particulate nitrate (pNO3)). Other NOy species were not included in ΣNOy as they either contributed minimally to it (e.g., C1–C5 alkyl nitrates, nitryl chloride (ClNO2), dinitrogen pentoxide (N2O5)) or were not measured during FIREX-AQ (e.g., higher oxidized alkyl nitrates, nitrate (NO3), non-acyl peroxynitrates, coarse-mode aerosol nitrate). The aircraft instrument intercomparisons demonstrate the following points: (1) NO measurements by CL and LIF agreed well within instrument uncertainties but with potentially reduced time response for the CL instrument; (2) NO2 measurements by LIF and CES agreed well within instrument uncertainties, but CL NO2 was on average 10 % higher; (3) CES and CIMS HONO measurements were highly correlated in each fire plume transect, but the correlation slope of CES vs. CIMS for all 1 Hz data during FIREX-AQ was 1.8, which we attribute to a reduction in the CIMS sensitivity to HONO in high-temperature environments; (4) NOy budget closure was demonstrated for all flights within the combined instrument uncertainties of 25 %. However, we used a fluid dynamic flow model to estimate that average pNO3 sampling fraction through the NOy inlet in smoke was variable from one flight to another and ranged between 0.36 and 0.99, meaning that approximately 0 %–24 % on average of the total measured NOy in smoke may have been unaccounted for and may be due to unmeasured species such as organic nitrates; (5) CO measurements by ICOS and TDLAS agreed well within combined instrument uncertainties, but with a systematic offset that averaged 2.87 ppbv; and (6) integrating smoke plumes followed by fitting the integrated values of each plume improved the correlation between independent measurements.
We present a nonlinear stochastic inverse algorithm that allows conditioning estimates of transient hydraulic heads, fluxes and their associated uncertainty on information about hydraulic ...conductivity (
K) and hydraulic head (
h) data collected in a randomly heterogeneous confined aquifer. Our algorithm is based on Laplace-transformed recursive finite-element approximations of exact nonlocal first and second conditional stochastic moment equations of transient flow. It makes it possible to estimate jointly spatial variations in natural log-conductivity
(
Y
=
ln
K
)
, the parameters of its underlying variogram, and the variance–covariance of these estimates. Log-conductivity is parameterized geostatistically based on measured values at discrete locations and unknown values at discrete “pilot points”. Whereas prior values of
Y at pilot point are obtained by generalized kriging, posterior estimates at pilot points are obtained through a maximum likelihood fit of computed and measured transient heads. These posterior estimates are then projected onto the computational grid by kriging. Optionally, the maximum likelihood function may include a regularization term reflecting prior information about
Y. The relative weight assigned to this term is evaluated separately from other model parameters to avoid bias and instability. We illustrate and explore our algorithm by means of a synthetic example involving a pumping well. We find that whereas
Y and
h can be reproduced quite well with parameters estimated on the basis of zero-order mean flow equations, all model quality criteria identify the second-order results as being superior to zero-order results. Identifying the weight of the regularization term and variogram parameters can be done with much lesser ambiguity based on second- than on zero-order results. A second-order model is required to compute predictive error variances of hydraulic head (and flux)
a posteriori. Conditioning the inversion jointly on conductivity and hydraulic head data results in lesser predictive uncertainty than conditioning on conductivity or head data alone.
The purpose of this randomized trial was to evaluate the efficacy of combination chemoimmunotherapy compared with chemotherapy alone. A total of 124 patients were randomized to receive intravenous ...cisplatin (35 mg m(-2), days 1-3), carmustine (150 mg m(-2), day 1, cycles 1 and 3 only), dacarbacine (220 mg m(-2), days 1-3) and oral tamoxifen (20 mg m(-2), daily) in combination with (n=64) or without (n=60) sequential subcutaneous IL-2 and IFN-alpha. In those patients who received sequential immunotherapy, each cycle of chemotherapy was followed by outpatient s.c. IL-2 (10 x 10(6) IU m(-2), days 3-5, week 4; 5 x 10(6) IU m(-2), days 1, 3, 5, week 5) and s.c. IFN-alpha (5 x 10(6) IU m(-2), day 1, week 4; days 1, 3, 5, week 5). The overall response rate of patients treated with the combination of chemotherapy and IL-2/IFN-alpha was 34.3% with seven complete responses (10.9%) and 15 partial responses (23.4%). In patients treated with chemotherapy, only, the overall response rate was 29.9% with eight complete responses (13.3%) and 10 partial responses (16.6%). There was no significant difference in median progression free survival (0 months vs 4 months) and in median overall survival (12 months vs 13 months) for combined chemoimmunotherapy and for chemotherapy, respectively.
Summary
Healthcare workers involved in aerosol‐generating procedures, such as tracheal intubation, may be at elevated risk of acquiring COVID‐19. However, the magnitude of this risk is unknown. We ...conducted a prospective international multicentre cohort study recruiting healthcare workers participating in tracheal intubation of patients with suspected or confirmed COVID‐19. Information on tracheal intubation episodes, personal protective equipment use and subsequent provider health status was collected via self‐reporting. The primary endpoint was the incidence of laboratory‐confirmed COVID‐19 diagnosis or new symptoms requiring self‐isolation or hospitalisation after a tracheal intubation episode. Cox regression analysis examined associations between the primary endpoint and healthcare worker characteristics, procedure‐related factors and personal protective equipment use. Between 23 March and 2 June 2020, 1718 healthcare workers from 503 hospitals in 17 countries reported 5148 tracheal intubation episodes. The overall incidence of the primary endpoint was 10.7% over a median (IQR range) follow‐up of 32 (18–48 0–116) days. The cumulative incidence within 7, 14 and 21 days of the first tracheal intubation episode was 3.6%, 6.1% and 8.5%, respectively. The risk of the primary endpoint varied by country and was higher in women, but was not associated with other factors. Around 1 in 10 healthcare workers involved in tracheal intubation of patients with suspected or confirmed COVID‐19 subsequently reported a COVID‐19 outcome. This has human resource implications for institutional capacity to deliver essential healthcare services, and wider societal implications for COVID‐19 transmission.
The sources and distribution of tropospheric nitrous acid (HONO) were examined using airborne measurements over the Southeast U.S. during the Southeast Nexus Experiment in June and July 2013. HONO ...was measured once per second using a chemical ionization mass spectrometer on the NOAA WP‐3D aircraft to assess sources that affect HONO abundance throughout the planetary boundary layer (PBL). The aircraft flew at altitudes between 0.12 and 6.4 km above ground level on 18 research flights that were conducted both day and night, sampling emissions from urban and power plant sources that were transported in the PBL. At night, HONO mixing ratios were greatest in plumes from agricultural burning, where they exceeded 4 ppbv and accounted for 2–14% of the reactive nitrogen emitted by the fires. The HONO to carbon monoxide ratio in these plumes from flaming stage fires ranged from 0.13 to 0.52%. Direct HONO emissions from coal‐fired power plants were quantified using measurements at night, when HONO loss by photolysis was absent. These direct emissions were often correlated with total reactive nitrogen with enhancement ratios that ranged from 0 to 0.4%. HONO enhancements in power plant plumes measured during the day were compared with a Lagrangian plume dispersion model, showing that HONO produced solely from the gas phase reaction of OH with NO explained the observations. Outside of recently emitted plumes from known combustion sources, HONO mixing ratios measured several hundred meters above ground level were indistinguishable from zero within the 15 parts per trillion by volume measurement uncertainty. The results reported here do not support the existence of a ubiquitous unknown HONO source that produces significant HONO concentrations in the lower troposphere.
Key Points
Large HONO emissions observed from biomass burning, with HONO accounting for 2 to 14% of emitted reactive nitrogen
Direct HONO emissions from power plants measured at night ranged from 0 to 0.4% of emitted NOx
Within 15 pptv uncertainty, HONO was indistinguishable from zero outside of recently emitted plumes from known combustion sources
Airborne and ground‐based measurements during the CalNex (California Research at the Nexus of Air Quality and Climate Change) field study in May/June 2010 show a weekend effect in ozone in the South ...Coast Air Basin (SoCAB) consistent with previous observations. The well‐known and much‐studied weekend ozone effect has been attributed to weekend reductions in nitrogen oxide (NOx = NO + NO2) emissions, which affect ozone levels via two processes: (1) reduced ozone loss by titration and (2) enhanced photochemical production of ozone due to an increased ratio of non‐methane volatile organic compounds (VOCs) to NOx. In accord with previous assessments, the 2010 airborne and ground‐based data show an average decrease in NOx of 46 ± 11% and 34 ± 4%, respectively, and an average increase in VOC/NOxratio of 48 ± 8% and 43 ± 22%, respectively, on weekends. This work extends current understanding of the weekend ozone effect in the SoCAB by identifying its major causes and quantifying their relative importance from the available CalNex data. Increased weekend production of a VOC‐NOxoxidation product, peroxyacetyl nitrate, compared to a radical termination product, nitric acid, indicates a significant contribution from increased photochemical production on weekends. Weekday‐to‐weekend differences in the products of NOx oxidation show 45 ± 13% and 42 ± 12% more extensive photochemical processing and, when compared with odd oxygen (Ox = O3 + NO2), 51 ± 14% and 22 ± 17% greater ozone production efficiency on weekends in the airborne and ground‐based data, respectively, indicating that both contribute to higher weekend ozone levels in the SoCAB.
Key Points
A weekend ozone effect is observed in the South Coast Air Basin
Reductions in NOx emissions drive weekday and weekend differences in ozone
Photochemical ozone production contributes to observed weekend ozone levels
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