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We investigate the current-phase relations of Al/InAs-quantum well planar Josephson junctions fabricated using nanowire shadowing technique. Based on several experiments, we conclude that the junctions exhibit an unusually large second-order Josephson harmonic, the $\sin(2\varphi)$ term. First, superconducting quantum interference devices (dc-SQUIDs) show half-periodic oscillations, tunable by gate voltages as well as magnetic flux. Second, Josephson junction devices exhibit kinks near half-flux quantum in supercurrent diffraction patterns. Third, half-integer Shapiro steps are present in the junctions. Similar phenomena are observed in Sn/InAs quantum well devices. We perform data fitting to a numerical model with a two-component current phase relation. Analysis including a loop inductance suggests that the sign of the second harmonic term is negative. The microscopic origins of the observed effect remain to be understood. We consider alternative explanations which can account for some but not all of the evidence.

Majorana zero modes are predicted to emerge in semiconductor/superconductor interfaces, such as InAs/Al. Majorana modes could be utilized for fault tolerant topological qubits. However, their realization is hindered by materials challenges. The coupling between the superconductor and the semiconductor may be too strong for Majorana modes to emerge, due to effective doping of the semiconductor by the metallic contact. This could be mediated by adding a tunnel barrier of controlled thickness. We use density functional theory (DFT) with Hubbard U corrections, whose values are machine-learned via Bayesian optimization (BO), to assess ZnTe and CdSe as prospective tunnel barriers for the InAs/Al interface. The results of DFT+U(BO) for ZnTe are validated by comparison to angle resolved photoemission spectroscopy (ARPES). We then study bilayer interfaces of the three semiconductors with each other and with Al, as well as trilayer interfaces with a varying number of ZnTe or CdSe layers inserted between InAs and Al. We find that 16 atomic layers of either material completely insulate the InAs from metal induced gap states (MIGS). However, ZnTe and CdSe differ significantly in their band alignment, such that ZnTe forms an effective barrier for electrons, whereas CdSe forms a barrier for holes. Because of Fermi level pinning in the conduction band at the interface, only electron transport is relevant for InAs-based Majorana devices. Therefore, ZnTe is the better choice. Based on the results of our simulations, we suggest conducting experiments with ZnTe barriers in the thickness range of 6-18 atomic layers.

Background: Minimally invasive parathyroidectomy is the treatment of choice in patients with primary hyperparathyroidism (PHP), but it needs a reliable preoperative localization method to detect hyperfunctioning parathyroid tissue. Higher sensitivity and lower radiation exposure was demonstrated for [ 18 F]fluorocholine PET/CT (FCh-PET/CT) in comparison to [ 99m Tc]sestamibi (MIBI) scintigraphy. However, data of its efficiency in resource use and patient outcomes is lacking. The aim of our study was to determine the resource efficiency and patient outcomes of FCh-PET/CT in comparison to conventional MIBI scintigraphy., Patients and Methods: A group of 234 patients who underwent surgery after MIBI scintigraphy was compared to a group of 163 patients who underwent surgery after FCh-PET/CT. The whole working process from the implementation of imaging to the completion of surgical treatment was analyzed. The economic burden was expressed in the time needed for the required procedures., Results: The time needed to perform imaging was reduced by 83% after FCh-PET/CT in comparison to MIBI scintigraphy. The time needed to perform surgery was reduced by 41% when intraoperative parathyroid hormone monitoring was not used. There was no significant difference in the time of surgery between FCh-PET/CT and MIBI scintigraphy., Conclusions: FCh-PET/CT reduces the time of imaging, the time of surgery and potentially reduces the number of reoperations for persistent disease., (© 2024 Sebastijan Rep et al., published by Sciendo.)

Aim: To compare the efficacy of a postoperative continuous adductor canal block (cACB) with and without a steroid adjuvant to that of epidural analgesia (EA)., Methods: Patients who underwent primary total TKA at a single institution between July 2011-November 2017 were included for retrospective analysis. TKA patients were stratified into one of the three analgesia approaches: EA, cACB without steroid adjuvant, and cACB with steroid adjuvant. Hospital length of stay (LOS), discharge disposition, incidence of postoperative adverse events, and total milligram morphine equivalents (MME) requirements were compared between strata. Logistic regressions were performed to assess the independent effect of analgesia approach on prolonged LOS greater than 3 days (pLOS), non-home discharge, and total and daily MME requirements (tMME and dMME) following TKA., Results: Of the 4345 patients undergoing TKA, 1556 (35.83%) received EA, 2087 (48.03%) received cACB without steroids, and 702 (16.13%) cACB with steroids. cACB patients experienced lower rates of pLOS, higher rates of discharge to home than EA patients, and lower tMME and dMME. On multivariable analysis, cACB groups were at a lower odds of experiencing a pLOS compared to EA patients without steroids (OR = 0.64; 95% CI 0.49-0.84; with steroids: OR = 0.54; 95% CI 0.38-0.76). cACB groups had lower odds of a non-home discharge when compared to EA patients (without steroids OR = 0.42; 95% CI 0.36-0.48; with steroids: OR 0.22; 95% CI 0.18-0.27). On multivariable analysis, cACB groups required less tMME compared to the EA group (without steroids β=-290 mmE; 95% CI: -313 to -268 mmE; with steroids: β=-261 mmE; 95% CI: -289 to -233 mmE) as well as lower dMME (without steroids: β=-66 mmE/day; 95% CI -72 to -60 mmE/day; with steroids: β=-48 mmE/day; 95% CI -55 to -40 mmE/day)., Conclusion: cACB was associated with greater discharge to home rates, lower rates of pLOS, and lower tMME and dMME consumption., Level of Evidence: Level III., Competing Interests: The following disclosures have been collected and reported per International Committee of Medical Journal Editors (ICMJE) reporting standards. Dr. Isaac G. Freedman has nothing to disclose. Dr. Michael R. Mercier has nothing to disclose. Dr. Anoop R. Galivanche has nothing to disclose. Dr. Mani Ratnesh S. Sandhu has nothing to disclose. Mr. Mark Hocevar has nothing to disclose. Dr. Harold G. Moore has nothing to disclose. Dr. Jonathan N. Grauer reports personal fees from TIDI products, personal fees from the North American Spine Society, is the Editor-in-Chief of the North American Spine Society Journal outside the submitted work. Dr. Jinlei Li has nothing to disclose. Dr. Lee E. Rubin reports personal fees from DePuy Synthes, personal fees from ConvaTec, personal fees from Innovative Medical Products, personal fees from Thompson Surgical Instruments, personal fees from SLACK, Inc. Publishers, personal fees from Johns Hopkins University Press, other from 3D Surgical, Inc., outside the submitted work. None pertaining to the subject or content of this work., (© 2024 Freedman et al.)

Study objective The purpose of this study is to investigate the analgesic efficacy of ultrasound-guided fascial plane blocks (FPBs) versus local infiltration in patients undergoing laparoscopic non-donor nephrectomy. This study specifically compares the efficacy of FPBs with liposomal bupivacaine (LB) versus FPBs with dexamethasone sodium phosphate (DXP) and methylprednisolone acetate (MPA) versus surgical site local anesthetic infiltration without FPBs.  Design This is a retrospective cohort study conducted over a five-year period (January 2018-December 2022). Setting The study was conducted in a tertiary care, academic, multi-hospital healthcare system.  Participants Patients who underwent elective radical or partial laparoscopic non-donor nephrectomy were included in the study. Intervention Patients either received preoperative FPBs without intraoperative surgical site local anesthetic infiltration or received surgical site local anesthetic infiltration without FPBs (n = 141) at participating hospitals. Measurements The primary endpoint of this study was postoperative opioid use, measured as oral milligram morphine equivalents (MME). Secondary endpoints included postoperative pain scores, length of hospital stays, and significant adverse events within 30 days. The impact of medications utilized in FPBs was determined by univariate and multivariable analyses with covariates balancing propensity score weighting. Main results Patients undergoing non-donor laparoscopic radical or partial nephrectomy who received FPBs with bupivacaine or ropivacaine plus glucocorticoids DXP and MPA were more likely to be opioid-free 24-48 hours postoperatively compared to those who received FPBs with LB or surgical site local anesthetic infiltration without FPBs (40.5% vs. 30% vs. 13.9%, respectively; p = 0.017). Patients who received FPBs with glucocorticoids also reported the lowest pain scores at rest and with activity 0-12 hours postoperatively as compared to patients who received LB or local infiltration (p = 0.006 and p = 0.014, respectively). Additionally, patients who received FPBs with glucocorticoids received over 30% fewer opioids during the first 48 hours postoperatively compared to patients who received surgical site local anesthetic infiltration alone (30 MME vs. 44 MME, respectively). However, there was no significant difference in total opioid use during the first 48 hours postoperatively between patients who received FPBs with bupivacaine plus glucocorticoids and those who received FPBs with bupivacaine plus LB (mean ratio: 0.91, (95% CI: 0.05 ~ 15.97); p = 0.948). There was also no difference in the length of hospital stays or rate of adverse events between the groups. Conclusion Perioperative FPBs for non-donor laparoscopic nephrectomy using glucocorticoids as an adjuvant to long-acting local anesthetics may decrease postoperative opioid use and reduce pain scores as compared to FPBs with LB or surgical site local anesthetic infiltration. Bupivacaine or ropivacaine combined with DXP and MPA is a safe and effective alternative to LB for FPBs in laparoscopic nephrectomy., Competing Interests: Human subjects: Consent was obtained or waived by all participants in this study. Yale School of Medicine Institutional Review Board (IRB) issued approval (2000029282). Animal subjects: All authors have confirmed that this study did not involve animal subjects or tissue. Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work., (Copyright © 2024, Sobhani et al.)

Background: The most common route of opioid delivery is nurse-administered pills. However, there are numerous challenges such as nursing burden, opioid diversion, medication delay, and patient dissatisfaction. In this study, we conducted two surveys, first to assess patients' and nurses' opinions on the current administration of opioids in pill form, followed by their attitudes towards an innovative concept of oral medication delivery based on a medical device currently undergoing research and development within the University, patient-controlled dispenser and deactivator (PCDD) that allows patients to self-administer liquid oral opioids on demand based on physician prescription., Methods: Questionnaires were developed, verified and deployed to assess nurse and post-surgical patient opinions on the current administration of opioids in pill form, as well as the proposed new concept of patient -controlled administration of oral liquid medication via an illustration of PCDD, from September 2022 through July 2023 at a major academic tertiary care center. Quantitative and qualitative data were collected from postoperative patients and nurses from surgical specialties including General Surgery, Surgical Oncology, Trauma Surgery, Orthopedics, and Neurosurgery., Results: Forty-three patients and 53 nurses were interviewed. Seventy percent of patients frequently called nurses for pain medication post-surgery 1-4 times daily, and 32% of patients were told each day by nurses that they could not receive medication because they were not due yet. Medication delay caused 24% of patients to worry about nursing availability for medication delivery. Likewise, nurses reported that half of patients receive delayed medication (22 minutes median delay time) and half of nursing time was spent administering pain medication. Nurses expressed moderate satisfaction with their current delivery of medication (median satisfaction score 6.5 out of 10). When being introduced to the concept of PCDD via a product illustration, 15% of patients said that they prefer liquid medication and 51% said they prefer PCDD or were interested in trying it., Conclusion: Nurse-administered pills are a common but suboptimal method for postoperative pain management. Based on patient and nurse feedback, patient controlled self-administered liquid oral opioid delivery is conceptually innovative, practically viable and potentially a preferred alternative for timely and less nurse-exhaustive pain management., Competing Interests: Daniel Wiznia, Jinlei Li, and Claudia See report a patent “Patient-controlled liquid oral medicine dispenser and deactivation system (US11857504B1)” issued. All authors report no other conflicts of interest relevant to this manuscript., (© 2024 Mirza et al.)

Background: Isolated limb perfusion (ILP) is a well-established surgical procedure for the administration of high dose chemotherapy to a limb for the treatment of advanced extremity malignancy. Although the technique of ILP was first described over 60 years ago, ILP is utilised in relatively few specialist centres, co-located with tertiary or quaternary cancer centres. The combination of high dose cytotoxic chemotherapy and the cytokine tumour necrosis factor alpha (TNFα), mandates leakage monitoring to prevent potentially serious systemic toxicity. Since the procedure is performed at relatively few specialist centres, an ILP working group was formed with the aim of producing technical consensus guidelines for the procedure to streamline practice and to provide guidance for new centres commencing the technique., Methods: Between October 2021 and October 2023 a series of face to face online and hybrid meetings were held in which a modified Delphi process was used to develop a unified consensus document. After each meeting the document was modified and recirculated and then rediscussed at subsequent meeting until a greater than 90% consensus was achieved in all recommendations., Results: The completed consensus document comprised 23 topics in which greater than 90% consensus was achieved, with 83% of recommendations having 100% consensus across all members of the working group. The consensus recommendations covered all areas of the surgical procedure including pre-operative assessment, drug dosing and administration, perfusion parameters, hyperthermia, leakage monitoring and theatre logistics, practical surgical strategies and also post-operative care, response evaluation and staff training., Conclusion: We present the first joint expert-based consensus statement with respect to the technical aspects of ILP that can serve as a reference point for both existing and new centres in providing ILP., Competing Interests: Declaration of competing interest Angela Märten works as a consultant for Belpharma SA., (© 2024 Published by Elsevier Ltd.)

Metal deposition with cryogenic cooling is a common technique in the condensed matter community for producing ultra-thin epitaxial superconducting layers on semiconductors. However, a significant challenge arises when these films return to room temperature, as they tend to undergo dewetting. This issue can be mitigated by capping the films with an amorphous layer. In this study, we investigate the influence of different in situ fabricated caps on the structural characteristics of Sn thin films deposited at 80 K on InSb substrates. Regardless of the type of capping, we consistently observe that the films remain smooth upon returning to room temperature and exhibit epitaxy on InSb in the cubic Sn ( α -Sn) phase. Notably, we identify a correlation between alumina capping using an electron beam evaporator and an increased presence of tetragonal Sn ( β -Sn) grains. This suggests that heating from the alumina source may induce a partial phase transition in the Sn layer. The existence of the β -Sn phase induces superconducting behavior of the films by percolation effect. This study highlights the potential for tailoring the structural properties of cryogenic Sn thin films through in situ capping. This development opens avenues for precise control in the production of superconducting Sn films, facilitating their integration into quantum computing platforms., (© 2023 IOP Publishing Ltd.)

Abstract: The purpose of this report was to estimate the additional annual cost to the U.S. healthcare system attributable to preventable medication errors (MEs) in the operating room. The ME types were iteratively grouped by their associated harm (or potential harm) into 13 categories, and we determined the incidence of operations involving each ME category (number of operations involving each category/total number of operations): (1) delayed or missed required perioperative antibiotic (1.4% of operations); (2) prolonged hemodynamic swings (7.6% of operations); (3) untreated postoperative pain >4/10 (18.9% of operations); (4) residual neuromuscular blockade (2.9% of operations); (5) oxygen saturation <90% due to ME (1.8% of operations); (6) delayed emergence (1.1% of operations); (7) untreated new onset intraoperative cardiac arrhythmia (0.72% of operations); (8) medication documentation errors (7.6% of operations); (9) syringe swaps (5.8% of operations); (10) presumed hypotension with inability to obtain a blood pressure reading (2.2% of operations); (11) potential for bacterial contamination due to expired medication syringes (8.3% of operations); (12) untreated bradycardia <40 beats/min (1.1% of operations); and (13) other (13.0% of operations). Through a PubMed search, we determined the likelihood that the ME category would result in downstream patient harm such as surgical site infection or acute kidney injury, and the additional fully allocated cost of care (in 2021 U.S. dollars) for each potential downstream patient harm event. We then estimated the cost of the MEs across the U.S. healthcare system by scaling the number of MEs to the total number of annual operations in the United States (N = 19,800,000). The total estimated additional fully allocated annual cost of care due to perioperative MEs was $5.33 billion U.S. dollars., Competing Interests: M.E.L. reports stock options from Guided Clinical Solutions (Boston, Massachusetts). K.C.N. reports author royalties from UpToDate, Inc (Waltham, Massachusetts), equity from Guided Clinical Solutions (Boston, Massachusetts), and consulting fees from NORC at the University of Chicago. The remaining authors disclose no conflict of interest., (Copyright © 2023 Wolters Kluwer Health, Inc. All rights reserved.)

Majorana zero modes, with prospective applications in topological quantum computing, are expected to arise in superconductor/semiconductor interfaces, such as β-Sn and InSb. However, proximity to the superconductor may also adversely affect the semiconductor's local properties. A tunnel barrier inserted at the interface could resolve this issue. We assess the wide band gap semiconductor, CdTe, as a candidate material to mediate the coupling at the lattice-matched interface between α-Sn and InSb. To this end, we use density functional theory (DFT) with Hubbard U corrections, whose values are machine-learned via Bayesian optimization (BO) [ npj Computational Materials 2020, 6, 180]. The results of DFT+U(BO) are validated against angle resolved photoemission spectroscopy (ARPES) experiments for α-Sn and CdTe. For CdTe, the z -unfolding method [ Advanced Quantum Technologies 2022, 5, 2100033] is used to resolve the contributions of different k z values to the ARPES. We then study the band offsets and the penetration depth of metal-induced gap states (MIGS) in bilayer interfaces of InSb/α-Sn, InSb/CdTe, and CdTe/α-Sn, as well as in trilayer interfaces of InSb/CdTe/α-Sn with increasing thickness of CdTe. We find that 16 atomic layers (3.5 nm) of CdTe can serve as a tunnel barrier, effectively shielding the InSb from MIGS from the α-Sn. This may guide the choice of dimensions of the CdTe barrier to mediate the coupling in semiconductor-superconductor devices in future Majorana zero modes experiments.

Background: In the setting of primary hyperparathyroidism (PHPT), [ 18 F]fluorocholine PET/CT (FCH-PET) has excellent diagnostic performance, with experienced practitioners achieving 97.7% accuracy in localising hyperfunctioning parathyroid tissue (HPTT). Due to the relative triviality of the task for human readers, we explored the performance of deep learning (DL) methods for HPTT detection and localisation on FCH-PET images in the setting of PHPT., Patients and Methods: We used a dataset of 93 subjects with PHPT imaged using FCH-PET, of which 74 subjects had visible HPTT while 19 controls had no visible HPTT on FCH-PET. A conventional Resnet10 as well as a novel mPETResnet10 DL model were trained and tested to detect (present, not present) and localise (upper left, lower left, upper right or lower right) HPTT. Our mPETResnet10 architecture also contained a region-of-interest masking algorithm that we evaluated qualitatively in order to try to explain the model's decision process., Results: The models detected the presence of HPTT with an accuracy of 83% and determined the quadrant of HPTT with an accuracy of 74%. The DL methods performed statistically worse (p < 0.001) in both tasks compared to human readers, who localise HPTT with the accuracy of 97.7%. The produced region-of-interest mask, while not showing a consistent added value in the qualitative evaluation of model's decision process, had correctly identified the foreground PET signal., Conclusions: Our experiment is the first reported use of DL analysis of FCH-PET in PHPT. We have shown that it is possible to utilize DL methods with FCH-PET to detect and localize HPTT. Given our small dataset of 93 subjects, results are nevertheless promising for further research., (© 2022 Leon Jarabek, Jan Jamsek, Anka Cuderman, Sebastijan Rep, Marko Hocevar, Tomaz Kocjan, Mojca Jensterle, Ziga Spiclin, Ziga Macek Lezaic, Filip Cvetko, Luka Lezaic, published by Sciendo.)