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Calcium channel blockers (CCBs) have seen an increase in rate of non-therapeutic exposure that is both accidental and intentional in nature. Patients experiencing the toxic effects of a CCB overdose are resource intensive and can quickly outstrip the capabilities of local health systems, necessitating transfer to larger tertiary or quaternary care centers. We present a case of intentional non-dihydropyridine CCB overdose and toxicity in a 20-year-old patient requiring initial stabilization at a referring critical access emergency department with continuation of treatment and support during a 60-minute rotor wing transport from the referring hospital to an academic quaternary care center. Emphasis is placed on the unique challenges in resuscitation and ongoing critical care administration during the transport phase of care. Proper stabilization of patients, planning, and consideration of potential problems associated with transport can help minimize stresses and risk of the transport, improving the outcome of extremely ill patients even under challenging circumstances.

Background/aim Invasive bladder cancer mortality remains high despite progresses made in early diagnosis and surgical procedures. Thus, there is a need to define new markers for bladder cancer. CLIC1 has not been previously studied in bladder cancer and thus, we aimed to assess its immunohistochemical expression in relation to different stages of bladder cancer development. Materials and methods Immunohistochemistry for CLIC1 was applied in 50 cases of muscle invasive bladder cancer. Results CLIC1 was not expressed in the normal urothelium, but a strong reaction was observed in dysplastic urothelium, carcinoma in situ and in 94% of the cases with invasive urothelial carcinoma; however, it was not expressed in squamous cell carcinoma cases. No correlation was found between the immunohistochemical expression of CLIC1 and the stage and grade of the tumour. Conclusion CLIC1 was overexpressed in urinary bladder dysplastic epithelium, carcinoma in situ and invasive carcinoma. CLIC1 constitutes a new potential marker of invasive bladder cancer.

Magnons, the quanta of spin waves, could be used to encode information in beyond-Moore computing applications, and magnonic device components, including logic gates, transistors, and units for non-Boolean computing, have already been developed. Magnonic directional couplers, which can function as circuit building blocks, have also been explored, but have been impractical because of their millimetre dimensions and multi-mode spectra. Here, we report a magnonic directional coupler based on yttrium iron garnet single-mode waveguides of 350 nm width. We use the amplitude of a spin-wave to encode information and to guide it to one of the two outputs of the coupler depending on the signal magnitude, frequency, and the applied magnetic field. Using micromagnetic simulations, we also propose an integrated magnonic half-adder that consists of two directional couplers and processes all information within the magnon domain with aJ energy consumption., 26 pages, 10 figures. arXiv admin note: text overlap with arXiv:1902.02855

BACKGROUND Acute kidney injury (AKI) after liver transplantation is associated with increased morbidity and mortality. It remains controversial whether the choice of vena cava reconstruction technique impacts AKI. METHODS This is a single-center retrospective cohort of 897 liver transplants performed between June 2009 and September 2018 using either the vena cava preserving piggyback technique or caval replacement technique without veno-venous bypass or shunts. The association between vena cava reconstruction technique and stage of postoperative AKI was assessed using multivariable ordinal logistic regression. Causal mediation analysis was used to evaluate warm ischemia time as a potential mediator of this association. RESULTS The incidence of AKI (AKI stage ≥2) within 48 h after transplant was lower in the piggyback group (40.3%) compared to the caval replacement group (51.8%, P < 0.001). Piggyback technique was associated with a reduced risk of developing a higher stage of postoperative AKI (odds ratio, 0.49; 95% confidence interval, 0.37-0.65, P < 0.001). Warm ischemia time was shorter in the piggyback group and identified as potential mediator of this effect. There was no difference in renal function (estimated glomerular filtration rate and the number of patients alive without dialysis) 1 y after transplant. CONCLUSIONS Piggyback technique, compared with caval replacement, was associated with a reduced incidence of AKI after liver transplantation. There was no difference in long-term renal outcomes between the 2 groups.

BACKGROUND Most patients are listed for liver transplant (LT) following extensive workup as outpatients ("conventional evaluation"). Some patients undergo urgent evaluation as inpatients after being transferred to a transplant center ("expedited evaluation"). We hypothesized that expedited patients would have inferior survival due to disease severity at the time of transplant and shorter workup time. METHODS Patients who underwent evaluation for LT at our institution between 2012-2016 were retrospectively reviewed. The expedited and conventional cohorts were defined as above. Living donor LT recipients, combined liver-kidney recipients, acute liver failure patients, and re-transplant patients were excluded. We compared patient characteristics and overall survival between patients who received a transplant following expedited evaluation and those who did not, and between LT recipients based on expedited or conventional evaluation. RESULTS 509 patients were included (110 expedited, 399 conventional). There was no difference in graft or patient survival at one year for expedited versus conventional LT recipients. In multivariable analysis of overall survival, only Donor Risk Index (HR 1.97, CI 1.04-3.73, p = 0.037, per unit increase) was associated with increased risk of death. CONCLUSIONS Patients who underwent expedited evaluation for LT had significant demographic and clinical differences from patients who underwent conventional evaluation, but comparable post-transplant survival. This article is protected by copyright. All rights reserved.

BACKGROUND Delayed graft function (DGF) after kidney transplantation is a common occurrence and correlates with poor graft and patient outcomes. Donor characteristics and care are known to impact DGF. We attempted to show the relationship between achievement of specific donor management goals (DMG) and DGF. METHODS This is a retrospective case-control study using data from 14 046 adult kidney donations after brain death from hospitals in 18 organ procurement organizations (OPOs) which were transplanted to adult recipients between 2012 and 2018. Data on DMG compliance and donor, recipient, and ischemia-related factors were used to create multivariable logistic regression models. RESULTS The overall rate of DGF was 29.4%. Meeting DMGs for urine output and vasopressor use were associated with decreased risk of DGF. Sensitivity analyses performed with different imputation methods, omitting recipient factors, and analyzing multiple time points yielded largely consistent results. CONCLUSIONS The development of DMGs continues to show promise in improving outcomes in the kidney transplant recipient population. Studies have already shown increased kidney utilization in smaller cohorts, as well as other organs, and shown decreased rates of DGF. Additional research and analysis are required to assess interactions between meeting DMGs and correlation versus causality in DMGs and DGF.

Supplemental Digital Content is available in the text., Background. Early prediction of whether a liver allograft will be utilized for transplantation may allow better resource deployment during donor management and improve organ allocation. The national donor management goals (DMG) registry contains critical care data collected during donor management. We developed a machine learning model to predict transplantation of a liver graft based on data from the DMG registry. Methods. Several machine learning classifiers were trained to predict transplantation of a liver graft. We utilized 127 variables available in the DMG dataset. We included data from potential deceased organ donors between April 2012 and January 2019. The outcome was defined as liver recovery for transplantation in the operating room. The prediction was made based on data available 12–18 h after the time of authorization for transplantation. The data were randomly separated into training (60%), validation (20%), and test sets (20%). We compared the performance of our models to the Liver Discard Risk Index. Results. Of 13 629 donors in the dataset, 9255 (68%) livers were recovered and transplanted, 1519 recovered but used for research or discarded, 2855 were not recovered. The optimized gradient boosting machine classifier achieved an area under the curve of the receiver operator characteristic of 0.84 on the test set, outperforming all other classifiers. Conclusions. This model predicts successful liver recovery for transplantation in the operating room, using data available early during donor management. It performs favorably when compared to existing models. It may provide real-time decision support during organ donor management and transplant logistics.

Background: Current guidelines recommend the monitoring of anti-factor Xa (anti-Xa) levels to avoid an accumulation of low-molecular-weight heparins in patients with acute kidney injury, but there is no evidence on how to proceed with such monitoring during continuous renal replacement therapy. Against this background, we investigated the potential accumulation of enoxaparin administered subcutaneously for venous thromboembolism prophylaxis in critically ill patients during continuous renal replacement therapy covered by regional citrate anticoagulation. Methods: Anti-Xa levels were measured at baseline (≤12 h before renal replacement therapy) and on three consecutive days (A to C) when enoxaparin had reached trough levels. Supplementary testing included modified assays of rotational thromboelastometry known to be highly sensitive for low-molecular-weight heparins. Results: The 16 men and 13 women included were adults comparable in age, body mass index, thromboembolism risk assessment, and clinical severity of the disease. Throughout the four examinations, the median trough levels of anti-Xa remained below the detection limit of the test (&lt, 0.1 IU mL−1), with interquartile ranges of &lt, 0.1 to 0.14 IU mL−1 at baseline and &lt, 0.1 to 0.16 IU mL−1 on days A/B/C. All rotational thromboelastometry parameters of clot initiation and clot formation dynamics did not significantly change from baseline to day C. Conclusions: Neither anti-Xa levels nor modified assays of rotational thromboelastometry revealed any accumulation of enoxaparin administered for thromboprophylaxis during continuous renal replacement therapy covered by regional citrate anticoagulation. Although generally recommended in patients with acute kidney injury, monitoring of anti-Xa levels should be questioned in this defined setting.

By their very nature, Spin Waves (SWs) consume ultra-low amounts of energy, which makes them suitable for ultra-low energy consumption applications. In addition, a compressor can be utilized to further reduce the energy consumption and enhance the speed of a multiplier. Therefore, we propose a novel energy efficient SW based 4-2 compressor consisting of 4 XOR gates and 2 Majority gates. The proposed compressor is validated by means of micromagnetic simulations and compared with the state-of-the-art SW, 22nm CMOS, Magnetic Tunnel Junction (MTJ), Domain Wall Motion (DWM), and Spin-CMOS technologies. The performance evaluation shows that the proposed compressor consumes 2.5x less and 1.25x less energy than the 22nm CMOS and the conventional SW compressor, respectively, whereas it consumes at least 3 orders of magnitude less energy than the MTJ, DWM, and Spin-CMOS designs. Furthermore, the compressor achieves the smallest chip real-estate. In summary, the performance evaluation of our proposed compressor shows that the SW technology has the potential to progress the state-of-the-art circuit design in terms of energy consumption and scalability., This work has received funding from the European Union's Horizon 2020 research and innovation program within the FET-OPEN project CHIRON under grant agreement No. 801055

This paper provides a tutorial overview over recent vigorous efforts to develop computing systems based on spin waves instead of charges and voltages. Spin-wave computing can be considered as a subfield of spintronics, which uses magnetic excitations for computation and memory applications. The tutorial combines backgrounds in spin-wave and device physics as well as circuit engineering to create synergies between the physics and electrical engineering communities to advance the field towards practical spin-wave circuits. After an introduction to magnetic interactions and spin-wave physics, all relevant basic aspects of spin-wave computing and individual spin-wave devices are reviewed. The focus is on spin-wave majority gates as they are the most prominently pursued device concept. Subsequently, we discuss the current status and the challenges to combine spin-wave gates and obtain circuits and ultimately computing systems, considering essential aspects such as gate interconnection, logic level restoration, input-output consistency, and fan-out achievement. We argue that spin-wave circuits need to be embedded in conventional CMOS circuits to obtain complete functional hybrid computing systems. The state of the art of benchmarking such hybrid spin-wave--CMOS systems is reviewed and the current challenges to realize such systems are discussed. The benchmark indicates that hybrid spin-wave--CMOS systems promise ultralow-power operation and may ultimately outperform conventional CMOS circuits in terms of the power-delay-area product. Current challenges to achieve this goal include low-power signal restoration in spin-wave circuits as well as efficient spin-wave transducers., This project has received funding from the European Union's Horizon 2020 research and innovation program under grant agreement No. 801055 "Spin Wave Computing for Ultimately-Scaled Hybrid Low-Power Electronics" - CHIRON

Electrical four-terminal sensing at (sub-)micrometer scales enables the characterization of key electromagnetic properties within the semiconductor industry, including materials’ resistivity, Hall mobility/carrier density, and magnetoresistance. However, as devices’ critical dimensions continue to shrink, significant over/underestimation of properties due to a by-product Joule heating of the probed volume becomes increasingly common. Here, we demonstrate how self-heating effects can be quantified and compensated for via 3ω signals to yield zero-current transfer resistance. Under further assumptions, these signals can be used to characterize selected thermal properties of the probed volume, such as the temperature coefficient of resistance and/or the Seebeck coefficient.

This retrospective observational case series conducted at 2 large academic centers over a 4-year period consists of 15 cases of profound hypotension in surgical patients immediately after initiation of the Belmont Fluid Management System for rapid transfusion of blood products. Halting the infusion and administering vasoactive agents led to resolution of hypotension. Repeat transfusion with the Belmont system resulted in repeat hypotension unless counteracted with vasopressors. No etiology was elucidated. This represents the largest documented association of acute hypotensive transfusion reaction with any rapid infusion system in surgical patients.

Risk factors for early bleeding complications after lung transplantation are not well described. Our aim was to evaluate coagulation test results and the use of extracorporeal membrane oxygenation as risk factors for bleeding after lung transplantation. We analyzed a single-center cohort of bilateral lung transplants between January 2009 and August 2015. Predictors of severe postoperative bleeding (bleeding requiring reoperation within 48 h of transplantation) were assessed using multivariable logistic regression. The effect of bleeding on survival was assessed using a Cox proportional-hazards model. Twenty-nine (4.5%) of 641 patients experienced severe postoperative bleeding. Postoperative fibrinogen levels (OR = 0.99, 95% CI 0.98-0.995, P = 0.001; per mg/dl increase) and pre- and postoperative use of extracorporeal membrane oxygenation (OR = 14.41% 95% CI 5.4-40.19, P < 0.001 and OR = 4.25, 95% CI 1.0-11.09, P = 0.002, respectively) were associated with an increased risk of severe postoperative bleeding. Severe postoperative bleeding was associated with decreased survival within 60 days after transplantation (adjusted HR = 5.73, 95% CI 2.52-13.02, P < 0.001). Low postoperative fibrinogen levels, and pre- and postoperative use of extracorporeal membrane oxygenation were risk factors for bleeding after lung transplantation.

In this contribution, we compare basic neural networks with convolutional neural networks for cut failure classification during fiber laser cutting. The experiments are performed by cutting thin electrical sheets with a 500 W single-mode fiber laser while taking coaxial camera images for the classification. The quality is grouped in the categories good cut, cuts with burr formation and cut interruptions. Indeed, our results reveal that both cut failures can be detected with one system. Independent of the neural network design and size, a minimum classification accuracy of 92.8% is achieved, which could be increased with more complex networks to 95.8%. Thus, convolutional neural networks reveal a slight performance advantage over basic neural networks, which yet is accompanied by a higher calculation time, which nevertheless is still below 2 ms. In a separated examination, cut interruptions can be detected with much higher accuracy as compared to burr formation. Overall, the results reveal the possibility to detect burr formations and cut interruptions during laser cutting simultaneously with high accuracy, as being desirable for industrial applications.

Background Postoperative pain after living donor hepatectomy is significant. Postoperative coagulopathy may limit the use of epidural analgesia, the gold standard for pain control in abdominal surgery. The erector spinae plane block (ESPB) is a novel regional anesthesia technique that has been shown to provide effective analgesia in abdominal surgery. In this study, we examined the effect of continuous ESPB, administered via catheters, on perioperative opioid requirements after right living donor hepatectomies for liver transplantation. Methods We performed a retrospective cohort study in patients undergoing right living donor hepatectomy. Twenty-four patients who received preoperative ESPB were compared to 51 historical controls who did not receive regional anesthesia. The primary endpoint was the total amount of oral morphine equivalents (OMEs) required on the day of surgery and postoperative day (POD) 1. Results Patients in the ESPB group required a lower total amount of OMEs on the day of surgery and POD 1 [141 (107 - 188) mg] compared the control group [293 (220 - 380) mg; P Conclusions The use of continuous ESPB significantly reduced opioid consumption following right living donor hepatectomy. This article is protected by copyright. All rights reserved.

Cancer is a multifactorial disease with increasing incidence. There are more than 100 different cancer types, defined by location, cell of origin, and genomic alterations that influence oncogenesis and therapeutic response. This heterogeneity between tumors of different patients and also the heterogeneity within the same patient’s tumor pose an enormous challenge to cancer treatment. In this review, we explore tumor heterogeneity on the longitudinal and the latitudinal axis, reviewing current and future approaches to study this heterogeneity and their potential to support oncologists in tailoring a patient’s treatment regimen. We highlight how the ideal of precision oncology is reaching far beyond the knowledge of genetic variants to inform clinical practice and discuss the technologies and strategies already available to improve our understanding and management of heterogeneity in cancer treatment. We will focus on integrating multi-omics technologies with suitable in vitro models and their proficiency in mimicking endogenous tumor heterogeneity.

et al., Spintronic devices exploit the spin, as well as the charge, of electrons and could bring new capabilities to the microelectronics industry. However, in order for spintronic devices to meet the ever-increasing demands of the industry, innovation in terms of materials, processes and circuits are required. Here, we review recent developments in spintronics that could soon have an impact on the microelectronics and information technology industry. We highlight and explore four key areas: magnetic memories, magnetic sensors, radio-frequency and microwave devices, and logic and non-Boolean devices. We also discuss the challenges—at both the device and the system level—that need be addressed in order to integrate spintronic materials and functionalities into mainstream microelectronic platforms.

We describe an extension of the micromagnetic finite difference simulation software MuMax3 to solve elasto-magneto-dynamical problems. The new module allows for numerical simulations of magnetization and displacement dynamics in magnetostrictive materials and structures, including both direct and inverse magnetostriction. The theoretical background is introduced, and the implementation of the extension is discussed. The magnetoelastic extension of MuMax3 is freely available under the GNU General Public License v3.

We report on the design, fabrication, and characterization of compact tunable yttrium iron garnet (YIG) based RF resonators based on $\mu$m-sized spin-wave cavities. Inductive antennas with both ladder and meander configurations were used as transducers between spin waves and RF signals. The excitation of ferromagnetic resonance and standing spin waves in the YIG cavities led to sharp resonances with quality factors up to 350. The observed spectra were in excellent agreement with a model based on the spin-wave dispersion relations in YIG, showing a high magnetic field tunability of about 29 MHz/mT., Comment: 13 pages, 5 figures. This project has received funding from the European Union's Horizon 2020 research and innovation program under grant agreement No. 801055 "Spin Wave Computing for Ultimately-Scaled Hybrid Low-Power Electronics" - CHIRON

The potential of a wide range of layered ternary carbide and nitride MAX phases as conductors in interconnect metal lines in advanced CMOS technology nodes has been evaluated using automated first principles simulations based on density functional theory. The resistivity scaling potential of these compounds, i.e. the sensitivity of their resistivity to reduced line dimensions, has been benchmarked against Cu and Ru by evaluating their transport properties within a semiclassical transport formalism. In addition, their cohesive energy has been assessed as a proxy for the resistance against electromigration and the need for diffusion barriers. The results indicate that numerous MAX phases show promise as conductors in interconnects of advanced CMOS technology nodes., Comment: 26 pages, 4 figures, 4 tables

Spin waves are excitations in ferromagnetic media that have been proposed as information carriers in hybrid spintronic devices with much lower operation power than conventional charge-based electronics. Their wave nature can be exploited in majority gates by using interference for computation. However, a scalable spin-wave majority gate that can be co-integrated alongside conventional electronics is still lacking. Here, we demonstrate a sub-micron inline spin-wave majority gate with fan-out. Time-resolved imaging of the magnetization dynamics by scanning transmission x-ray microscopy illustrates the device operation. All-electrical spin-wave spectroscopy further demonstrates majority gates with sub-micron dimensions, reconfigurable input and output ports, and frequency-division multiplexing. Challenges for hybrid spintronic computing systems based on spin-wave majority gates are discussed., This project has received funding from the European Union's Horizon 2020 research and innovation program under grant agreement No. 801055 "Spin Wave Computing for Ultimately-Scaled Hybrid Low-Power Electronics" - CHIRON

In this publication, we use a small convolutional neural network to detect cut interruptions during laser cutting from single images of a high-speed camera. A camera takes images without additional illumination at a resolution of 32 × 64 pixels from cutting steel sheets of varying thicknesses with different laser parameter combinations and classifies them into cuts and cut interruptions. After a short learning period of five epochs on a certain sheet thickness, the images are classified with a low error rate of 0.05%. The use of color images reveals slight advantages with lower error rates over greyscale images, since, during cut interruptions, the image color changes towards blue. A training set on all sheet thicknesses in one network results in tests error rates below 0.1%. This low error rate and the short calculation time of 120 µs on a standard CPU makes the system industrially applicable.

Author(s): Whelan, Adrian M; Johansen, Kirsten L; McCulloch, Charles E; Adelmann, Dieter; Niemann, Claus U; Roll, Garrett R; Siyahian, Salpi; Grimes, Barbara; Ku, Elaine | Abstract: Rates of kidney transplantation vary substantially across dialysis facilities in the United States. Whether distance between the dialysis facility and transplant center associates with variations in transplantation rates has not been examined.MethodsWe performed a retrospective study of adults treated with dialysis between 2005 and 2015, according to the US Renal Data System. We examined the association between distance from dialysis facility to transplant center and time to kidney transplantation (primary outcome) and waitlist registration (secondary outcome) using Fine-Gray models. We also performed sensitivity analyses using the distance from each patient's dialysis facility to the nearest transplant center as the predictor so that patients who were never registered on the waitlist (and therefore would not have a transplant center) could be included.ResultsIn total, 178 885 waitlisted patients were included for our primary analysis. As distance between dialysis facility and transplant center increased, lower hazard of transplantation (subhazard ratio [HR], 0.92; 95% confidence interval [CI], 0.91-0.94, if distance was 10 to l50 miles; sub-HR, 0.90; 95% CI, 0.88-0.92, if distance ≥50 miles compared with l10 miles) was noted. We also found a weak association between longer distance and hazard of waitlist registration (sub-HR, 0.96; 95% CI, 0.94-0.97, if distance was ≥50 miles versus l10 miles). Findings were similar in sensitivity analyses using distance between dialysis facility and the nearest transplant center (N = 1 149 721).ConclusionsPatients receiving dialysis in facilities located further away from transplant centers have lower hazard of kidney transplantation. Developing strategies to address barriers to transplantation in patients receiving dialysis at facilities located far away from a transplant center may help improve disparities in transplantation rates.

We present the recently started effort and progress towards the development of a software for start-to-end simulation of accelerator facilities employing undulator radiation. The core of this effort aims at the combination of two numerical solvers, the Object Oriented Parallel Accelerator Library (OPAL), a parallel open source tool for charged-particle optics in linear accelerators and rings, including 3D space charge, and the full-wave simulation tool for free electron lasers MITHRA, which solves the electromagnetic potential equations in free-space for radiating particles propagating along an undulator using an FDTD/PIC scheme. As an example, we present the application of the OPAL-MITHRA platform for the simulation of an experiment that will take place at the Argonne Wakefield Accelerator, in which the capability of a magnetic wiggler to induce energy modulation starting from a micro-bunched electron beam will be investigated.

We demonstrate a novel concept of integrating $110-\mu \mathrm{m}$ . thick low-resistance high-Q magnetic core inductors in fan-out wafer level packaging (FOWLP). Unlike thin-film magnetic core inductors [1], this solution offers the possibility to embed thick cores to meet power density requirements, allowing for 89% efficiency at 1.2 W /mm2 power density for 2: 1 power conversion with a backside power delivery network (BSPDN) using circular-shaped magnetic inductors.

Acute kidney injury (AKI), or worsening kidney function, is a common complication after liver transplantation (20-90% in published studies). Patients who experience AKI after liver transplantation have higher mortality, increased graft loss, longer hospital and intensive care unit stays, and more progression to chronic kidney disease compared with those who do not. In this study, half of the participants will have their body temperature cooled to slightly lower than normal (mild hypothermia) for a portion of the liver transplant operation, while the other half will have their body temperature maintained at normal. The study will evaluate if mild hypothermia protects from AKI during liver transplantation. This study is a single-blinded, randomized controlled trial of mild hypothermia during liver transplantation to provide protection from AKI. Participants will be randomized to normothermia (36.5-37.5 °C) versus mild hypothermia (34-35 °C) during a portion of the liver transplant operation. The protocol is based on preliminary data from rodent models showing that hypothermia protects the kidneys from ischemia-reperfusion injury, as well as studies in deceased organ donors showing that cooling improves post-transplant organ function. Temperature will be maintained with standard techniques plus a minimally-invasive esophageal cooling device that is approved by the U.S. Food and Drug Administration. The investigators hypothesize that mild hypothermia will reduce the incidence and severity of AKI after LTx. Standard surrogates (e.g., change in serum creatinine, need for initiation of dialysis) and biomarkers will be used to assess the severity of kidney injury.

In liver transplantation, both cold and warm ischemia times are known to impact early graft function. The extraction time is a period during the initial phase of organ cooling which occurs during deceased donor procurement. During this time, the organ is at risk of suboptimal cooling. Whether donor extraction time, the time from donor aortic cross-clamp to removal of the donor organ from the body cavity has an effect on early graft function is not known.We investigated the effect of donor extraction time on early graft function in 292 recipients of liver grafts procured locally and transplanted at our center between June 2012 and December 2016. Early graft function was assessed using the model of early allograft function score in a multivariable regression model including donor extraction time, cold ischemia time, warm ischemia time, donor risk index, and terminal donor sodium.Donor extraction time had an independent effect on early graft function measured by the model of early allograft function score (coefficient, 0.021; 95% confidence interval, 0.007-0.035; P0.01; for each minute increase of donor extraction time). Besides donor extraction time, cold ischemia time, warm ischemia time, and donor risk index had a significant effect on early graft function.We demonstrate an independent effect of donor extraction time on graft function after liver transplantation. Efforts to minimize donor extraction time could improve early graft function in liver transplantation.

Co has elicited a strong interest to replace Cu for future interconnect applications in microelectronic circuits due to its potentially lower resistivity and better reliability at scaled dimensions. Here, we demonstrate Co wires with electrical cross-sectional areas as small as 34 nm2 using a simple subtractive patterning technique. Semiclassical resistivity modeling of the wire resistivity indicates that grain boundary scattering is the dominant contribution for cross-sectional areas of the order of 100 nm2, while the contribution of surface scattering increases drastically below 50 nm2. Furthermore, wafer-level reliability tests of the Co wires show the high fusing current densities and a strong resistance to thermoelectric stress demonstrating the potential for robust reliability. The resistivity and the reliability of the Co wires are comparable with those of Ru wires.

Background Renal failure is common among patients undergoing liver transplantation. Liver allocation based on the model for end-stage liver disease score has increased the number of recipients who require perioperative renal replacement therapy (RRT). Although RRT can be continued intraoperatively, the risks and benefits of intraoperative RRT are not well defined. The aim of this study is to report the intraoperative management of patients with pretransplant renal failure at a transplant center with extremely infrequent utilization of intraoperative RRT. Materials and methods We performed a retrospective analysis of all adult patients undergoing orthotopic liver or simultaneous liver-kidney (SLK) transplantation between June 2009 and December 2015. Patients were divided into 2 groups based on their need for pretransplant RRT. Results A total of 785 patients underwent liver or SLK transplant during the study period. One hundred and seventy-four patients (22.2%) required preoperative dialysis. Only 2 patients required intraoperative RRT. There was no difference in the incidence of acidosis or hyperkalemia between patients who required preoperative dialysis and those who did not. Conclusions We describe the successful management of patients undergoing liver or SLK transplantation almost entirely without the need for intraoperative RRT.

Background and ObjectivesTo determine the real-world use of rituximab in autoimmune encephalitis (AE) and to correlate rituximab treatment with the long-term outcome.MethodsPatients with NMDA receptor (NMDAR)-AE, leucine-rich glioma-inactivated-1 (LGI1)- AE, contactin-associated protein-like-2 (CASPR2)-AE, or glutamic acid decarboxylase 65 (GAD65) disease from the GErman Network for Research on AuToimmune Encephalitis who had received at least 1 rituximab dose and a control cohort of non–rituximab-treated patients were analyzed retrospectively.ResultsOf the 358 patients, 163 (46%) received rituximab (NMDAR-AE: 57%, CASPR2-AE: 44%, LGI1-AE: 43%, and GAD65 disease: 37%). Rituximab treatment was initiated significantly earlier in NMDAR- and LGI1-AE (median: 54 and 155 days from disease onset) compared with CASPR2-AE or GAD65 disease (median: 632 and 1,209 days). Modified Rankin Scale (mRS) scores improved significantly in patients with NMDAR-AE, both with and without rituximab treatment. Although being more severely affected at baseline, rituximab-treated patients with NMDAR-AE more frequently reached independent living (mRS score ≤2) (94% vs 88%). In LGI1-AE, rituximab-treated and nontreated patients improved, whereas in CASPR2-AE, only rituximab-treated patients improved significantly. No improvement was observed in patients with GAD65 disease. A significant reduction of the relapse rate was observed in rituximab-treated patients (5% vs 13%). Detection of NMDAR antibodies was significantly associated with mRS score improvement. A favorable outcome was also observed with early treatment initiation.DiscussionWe provide real-world data on immunosuppressive treatments with a focus on rituximab treatment for patients with AE in Germany. We suggest that early and short-term rituximab therapy might be an effective and safe treatment option in most patients with NMDAR-, LGI1-, and CASPR2-AE.Class of EvidenceThis study provides Class IV evidence that rituximab is an effective treatment for some types of AE.

We report a unique sensor system based on a InGaAs photodiode to detect the formation of burr during near infrared fiber laser cutting. The sensor approach encompasses the measurement of the thermal radiation form the process zone, optical filtering, digitalized sampling at 20 kHz, digital filtering using an elliptical band-pass filter 12th order and calculation of the standard deviation. We find a linear correlation between the deduced sensor signal and the generated burr height with this functionality being experimentally confirmed for laser cutting of mild and stainless steel of different thicknesses. The underlying mechanism of this transducer concept is attributed to the melt flow dynamics inside the cut kerf.

The anesthesia community has openly debated if the care of transplant patients was generalist or specialist care ever since the publication of an opinion paper in 1999 recommended subspecialty training in the field of liver transplantation anesthesia. In the past decade, liver transplant anesthesia has become more complex with a sicker patient population and evolving evidence-based practices. Transplant training is currently not required for accreditation or certification in anesthesiology, and not all anesthesia residency programs are associated with transplant centers. Yet there is evidence that patient outcome is affected by the experience of the anesthesiologist with liver transplants as part of a multidisciplinary care team. Requests for a formal review of the inequities in training opportunities and requirements led the Society for the Advancement for Transplant Anesthesia (SATA) to begin the task of developing post-graduate fellowship training recommendations. In this article, members of the SATA Working Group on Transplant Anesthesia Education present their reasoning for specialized education and conclusions about which pathways can better prepare trainees to care for complex transplant patients.

This study reports on the low interface trap density obtained from MOS capacitors and transistors with 2.5nm EOT using MoS2 flakes in back-gated configuration. Design ideology to measure thin flake structures is explained. CV measurements on MOSCAPs show Si-high-k like behavior with a midgap Dit of 2e12cm2eV1. By using CV measurements, the thickness of the MoS2 layer was also extracted. Display Omitted CV measurements and Dit extraction reported for the first time on sub-12nm thick MoS2 flakes.Two different MOS capacitor structures were studied.From the first one, we report an interface trap density of 2e12cm2eV1.The second one provided the thickness of MoS2 films.From FET measurements, we extract Dit of 6e12cm2eV1 from subthreshold slope.

We demonstrate a novel temperature referenced polymer Bragg grating (BG) sensor structure in planar cyclo-olefin copolymer (COC) substrate for tensile and compressive strain sensing. The sensor is based on two serial BGs UV-written into a specially designed planar COC substrate using a 248-nm-KrF laser. Successively, the temperature sensitivity and the behavior toward the tensile and compressive strain of both BGs are evaluated. Furthermore, we calculate the strain distribution in the COC specimen using a numerical simulation and discuss it with regard to the experimental results.

The measurement of UV-induced DNA damage as a dosimeter of exposure and predictor of skin cancer risk has been proposed by multiple groups. Although UV-induced mutations and adducts are present in normal-appearing UV-exposed epidermis, sampling normal nonlesional skin requires noninvasive methods to extract epidermal DNA for analysis. Here, we demonstrate the feasibility of such an approach, termed surfactant-based tissue acquisition for molecular profiling. Sampling in patients was performed using a felt-tip pen soaked in a mixture of surfactants (Brij-30/N-decyl-N,N-dimethyl-3-ammonio-1-propanesulfonate). In mice, we show that the epidermis can be selectively removed without scarring, with complete healing within 2 weeks. We exposed hairless mice to low-dose UV radiation over a period of 3 months and serially sampled them through up to 2 months following the cessation of UV exposure, observing a progressive increase in a UV signature mutational burden. To test whether surfactant-based tissue acquisition for molecular profiling could be applied to human patients, samples were collected from sun-exposed and sun-protected areas, which were then subjected to high-depth targeted exome sequencing. Extensive UV-driven mosaicism and substantially increased mutational loads in sun-exposed versus sun-protected areas were observed, suggesting that genomic measures, as an integrated readout of DNA damage, repair, and clonal expansion, may be informative markers of UV exposure.

The usage of numerical models to study the evolution of particle beams is an essential step in the design process of particle accelerators. However, uncertainties of input quantities such as the beam energy and magnetic field lead to simulation results that do not fully agree with measurements; hence, the final machine will behave slightly differently than the simulations. In the case of cyclotrons, such discrepancies affect the overall turn pattern or may even alter the number of turns in the machine. Inaccuracies at the PSI Ring cyclotron facility that may harm the isochronism are compensated by additional magnetic fields provided by 18 trim coils. These are often absent from simulations or their implementation is very simplistic. In this paper, a newly developed realistic trim coil model within the particle accelerator framework OPAL is presented that was used to match the turn pattern of the PSI Ring cyclotron. Because of the high-dimensional search space consisting of 48 design variables (simulation input parameters) and 182 objectives (i.e., turns), the simulation and measurement cannot be matched in a straightforward manner. Instead, an evolutionary multiobjective optimization with a population size of more than 8000 individuals per generation together with a local search approach were applied that reduced the maximum absolute error to 4.5 mm over all 182 turns.

Atomic layer deposition of ruthenium is studied as a barrierless metallization solution for future sub-10 nm interconnect technology nodes. We demonstrate the void-free filling in sub-10 nm wide single damascene lines using an ALD process in combination with 2.5 Å of ALD TiN interface and postdeposition annealing. At such small dimensions, the ruthenium effective resistance depends less on the scaling than that of Cu/barrier systems. Ruthenium effective resistance potentially crosses the Cu curve at 14 and 10 nm according to the semiempirical interconnect resistance model for advanced technology nodes. These extremely scaled ruthenium lines show excellent electromigration behavior. Time-dependent dielectric breakdown measurements reveal negligible ruthenium ion drift into low-κ dielectrics up to 200 °C, demonstrating that ruthenium can be used as a barrierless metallization in interconnects. These results indicate that ruthenium is highly promising as a replacement to Cu as the metallization solution for future technology nodes.

The Flat Top Cavity, located in the PSI HIPA Ring Cyclotron leaks RF power of several kilo Watts into the cyclotrons vacuum space causing several complications. A detailed electromagnetic model was created and simulations performed to analyze the mechanisms by which power is leaking out of the Flat Top Cavity. The tolerances needed to limit the leaked power in future iterations of the Flat Top cavity are reported. Comparison of the model to measurements are described as well as two potential methods to limit power leakage. These studies will have direct impact on future RF cavity designs for cyclotrons as power levels increase and higher RF fields are required., 24 pages 12 figures

This work analyzes resonance frequency shift vs. the applied magnetic field strength for GHz operating GaN/Si SAW single resonators. Magnetostrictive elements (Ni and CoFeB) were deposited in the proximity of the interdigitated transducers (IDTs) of the resonators (A-type structures) and also over the IDTs, after covering them with a BCB layer to avoid short circuits with IDTs metal (B-type structures). This work targets emerging applications of SAW resonators in driving spin wave pumping and in coupling of surface acoustic waves (SAW) with superconducting Q-bits. Magnetic sensitivity of the SAWs was analyzed at room temperature (RT) and at cryogenic temperatures, obtaining high magnetic sensitivities at 16 K. According to our knowledge, GaN based SAWs are first time used in magnetic applications; also, cryogenic behavior of magnetic SAW sensors is first time analyzed., This project has received funding from the European Union's Horizon 2020 research and innovation program under grant agreement No. 801055 "Spin Wave Computing for Ultimately-Scaled Hybrid Low-Power Electronics" - CHIRON

High-fidelity physics simulations are powerful tools in the design and optimization of charged particle accelerators. However, the computational burden of these simulations often limits their use in practice for design optimization and experiment planning. It also precludes their use as online models tied directly to accelerator operation. We introduce an approach based on machine learning to create nonlinear, fast-executing surrogate models that are informed by a sparse sampling of the physics simulation. The models are 10^6 to 10^7 times more efficient to execute.We also demonstrate that these models can be reliably used with multi-objective optimization to obtain orders-of-magnitude speedup in initial design studies and experiment planning. For example, we required 132 times fewer simulation evaluations to obtain an equivalent solution for our main test case, and initial studies suggest that between 330 to 550 times fewer simulation evaluations are needed when using an iterative retraining process. Our approach enables new ways for high-fidelity particle accelerator simulations to be used, at comparatively little computational cost., Comment: under review for publication

High-aspect-ratio (HAR) Ru power rails, buried in front-end-of-line (FEOL) oxide, can potentially replace conventional middle-end-of-line (MOL) Cu power rails. The HAR feature can boost performance by reducing resistance and voltage drop along the power line. The buried nature, helps to minimize standard cell height by freeing up routing resources at MOL, enabling overall area scaling. This paper demonstrates, Ru lines of aspect ratio up to 7, at a CD of 18 nm. Line resistance at these dimensions, measures at 60 Ω/µm, with the minimum electrical resistivity of 8.8 µΩcm, as extracted from the temperature-controlled-resistance (TCR) measurements. HAR Ru lines are also found to withstand very high FEOL thermal budgets, such as 1000 °C activation anneal for 1.5 s. The combination of all these factors, make HAR Ru buried power rail, a promising scaling booster for next generation technology nodes.

Ruthenium has been recently considered as a promising candidate to replace copper as the BEOL interconnect material for sub-5nm technology nodes. In this work, single level Ru interconnects were fabricated in imec's 300-mm pilot line using EUV lithography and the subtractive etch of Ru films. Lines with critical dimension smaller than 10.5 nm were formed and electrically tested to assess the line resistance of patterned Ru. Using the TCR method, structures with resistivity of 15 μΩ.cm and cross-sectional area of 200 nm2 were obtained and benchmarked against analogous Ru and Cu damascene processes. Ru lines with aspect ratio up to 3.8 were fabricated and measured having line resistance below 500 Ω/μ $m$ at 12 nm CD. Ru is expected to outperform damascene Cu at this scale, supporting the potential insertion of Ru metal patterning for advanced technology nodes.

Background Severe burns can induce a hypercoagulable state which is not depicted in conventional coagulation assays. The thrombin generation assay allows global assessment of coagulation and can identify hypercoagulability. We report changes in thrombin generation in patients after severe burn injury. Methods We measured TGA, rotational thrombelastometry and conventional assays in 20 consecutive patients with a total body surface area burned of >20% over a 2-week period: the day after burn trauma (A), the morning after surgical excision of burn wounds (B) and on post-admission days 7 (C) and 14 (D). Results Thrombin generation assay showed a procoagulatory state: there was an increase in the velocity of thrombin generation (increase in time to peak of +13%, increase in velocity index of +22%), and peak amount of thrombin (+25%) between days A and B. All parameters reached their highest levels on day C and returned towards normal on day D. Rotational thrombelastometry showed a hypercoagulable state with an increase in clot firmness and alpha angle. Conventional coagulation tests remained within reference values. Conclusions In the first two weeks following burn, both the thrombin generation assay and rotational thrombelastometry show a hypercoagulable state, while conventional coagulation tests remain normal.

A tomographic gas-density diagnostic using a Single-Beam Wollaston Interferometer able to characterize non-symmetric density distributions in gas jets is presented. A real-time tomographic algorithm is able to reconstruct three-dimensional density distributions. A Maximum Likelihood-Expectation Maximization algorithm, an iterative method with good convergence properties compared to simple back projection, is used. With the use of graphical processing units, real-time computation and high resolution are achieved. Two different gas jets are characterized: a kHz, piezo-driven jet for lower densities and a solenoid valve-based jet producing higher densities. While the first jet is used for free electron laser photon beam characterization, the second jet is used in laser wake field acceleration experiments. In this latter application, well-tailored and non-symmetric density distributions produced by a supersonic shock front generated by a razor blade inserted laterally to the gas flow, which breaks cylindrical symmetry, need to be characterized.

We present an experimental study on fiber laser micromachining of 4H-SiC semiconductor. In particular, we optimize the process time for percussion drilling of 440 µm and 330 µm thick wafers with a minimum drilling time of, eg, 7.5 ms being achieved for 330 µm thick wafers. The drilled holes are characterized by a low taper, a high circularity and entry diameters of about 60 µm. For laser cutting, effective cutting speeds of 2 mm/s and 0.63 mm/s are obtained for 330 µm and 440 µm wafer thickness, respectively, with the cut kerf width being 65 µm. Both processes are associated with a good quality that is characterized by no chipping and cracks. The capability of the fiber laser based micromachining process is highlighted by cutting complex micrometer scale inner and outer contours into partially metallized SiC wafers with high quality.

We report on an optical sensor system attached to a 4 kW fiber laser cutting machine to detect cutting interruptions. The sensor records the thermal radiation from the process zone with a modified ring mirror and optical filter arrangement, which is placed between the cutting head and the collimator. The process radiation is sensed by a Si and InGaAs diode combination with the detected signals being digitalized with 20 kHz. To demonstrate the function of the sensor, signals arising during fusion cutting of 1 mm stainless steel and mild steel with and without cutting interruptions are evaluated and typical signatures derived. In the recorded signals the piercing process, the laser switch on and switch off point and waiting period are clearly resolved. To identify the cutting interruption, the signals of both Si and InGaAs diodes are high pass filtered and the signal fluctuation ranges being subsequently calculated. Introducing a correction factor, we identify that only in case of a cutting interruption the fluctuation range of the Si diode exceeds the InGaAs diode. This characteristic signature was successfully used to detect 80 cutting interruptions of 83 incomplete cuts (alpha error 3.6%) and system recorded no cutting interruption from 110 faultless cuts (beta error of 0). This particularly high detection rate in combination with the easy integration of the sensor, highlight its potential for cutting interruption detection in industrial applications.

We report on high aspect ratio cutting of aluminum, titanium, and steel using a water jet guided laser system equipped with a frequency doubled Nd:YAG laser. The influence of the laser power, pulse repetition rate, and number of passes on the cutting depth is investigated. High cutting depth can be achieved with high laser powers, low pulse repetition rates, and a high number of passes. The maximum cutting depth is determined to 8 mm in aluminum, 4.7 mm in titanium, and 1.5 mm in steel, respectively. The effective cutting velocity of 8 mm aluminum with 40 W laser power, in a multi pass process is determined to 0.1 mm/s. The kerf width is independent of both the chosen process parameters and the cutting depth, being in the range between 100 and 120 μm. This results in high aspect ratios of up to 12.5 in steel, 39.2 in titanium, and 66.7 in aluminum.

We report here on the simulation of temperature and stress evolution of 4H-SiC during laser-induced silicidation to locally generate ohmic contacts between the semiconductor and nickel metallization. The simulation is based on optical free carrier absorption, thermal conduction, and thermal radiation. Our results show that, during laser irradiation, similar temperatures and correspondingly similar contact resistances, as compared to conventional oven-driven annealing processes, are achievable, yet with the advantageous potential to limit the temperature treatment spatially to the desired regions for electrical contacts and without the necessity of heating complete wafers. However, due to temperature gradients during local laser silicidation, thermal induced stress appears, which may damage the SiC wafer. Based on the simulated results for temperature and stress increase, we identify an optimized regime for laser-induced local silicidation and compare it to experimental data and observations.