Search

Objective: To review the new indication of cyclin-dependent kinase (CDK4/6) inhibitor abemaciclib for the adjuvant treatment of hormone receptor positive (HR+), human epidermal growth factor receptor 2 negative (HER2−), axillary lymph node (LN) positive early breast cancer (EBC) at high risk of recurrence and a Ki-67 ≥20%. Data Sources: A literature search was performed through PubMed, ClinicalTrials.gov, and Food and Drug Administration (FDA) website (February 1, 2018, to December 23, 2021) to identify relevant information. Study Selection and Data Extraction: Human and animal studies related to pharmacology, pharmacokinetics, efficacy, and safety of abemaciclib were identified. Data Synthesis: Addition of abemaciclib to standard of care endocrine therapy (ET) for patients with high-risk clinicopathologic features and Ki-67 ≥20% demonstrated 30% reduction in the risk of developing invasive disease and distant recurrence. At 15.5 months, abemaciclib + ET demonstrated a significant improvement in invasive disease-free survival (IDFS) vs ET alone (hazard ratio [HR], 0.75; 95% confidence interval [CI], 0.60-0.93, P = 0.01). At 27 months, IDFS benefit was maintained (HR, 0.70; 95% CI, 0.59-0.82, P < 0.0001). Diarrhea occurred in more than 80% of patients in the abemaciclib arm. Relevance to Patient Care and Clinical Practice: This review describes the clinical applicability of adjuvant abemaciclib for patients with HR+, HER2− EBC at high risk for recurrence. Conclusion: Adjuvant abemaciclib significantly reduces the risk for early development of invasive disease and distant recurrence in patients with HR+, HER2− node positive EBC. Longer follow-up is needed to determine the impact of adjuvant abemaciclib on late disease recurrence and survival outcomes.

Antibody drug conjugates (ADCs) continue to change the treatment paradigm of breast cancer and recent regulatory approvals of next generation ADCs are shifting how breast cancer is classified and treated. ADCs combine precision targeting with traditional cytotoxic treatment allowing for the delivery of highly potent chemotherapeutic agents to malignant cells. This chapter will cover ADCs used for the treatment of breast cancer including pharmacology, novel mechanism of action, pharmacokinetic and pharmacodynamic properties, clinical outcomes and role in breast cancer therapy, key toxicities and monitoring.

Purpose To decrease drug waste and cost by implementing automated chemotherapy dose rounding rules in the electronic health record (EHR). Dose rounding of chemotherapy is a recognized method for reducing drug waste, and professional organizations have published guidelines recommending dose rounding when possible. Summary On the basis of current literature and guideline recommendations, Mayo Clinic developed system-wide consensus to allow dose rounding for biologic and chemotherapy agents to the nearest vial size if rounding resulted in the dose being within 10% of the originally calculated dose or to a convenient measurable volume, based on concentration of the drug, if rounding to the nearest vial size resulted in the dose being outside the 10% range. Oncology pharmacists reviewed and analyzed all drugs listed in the EHR used in injectable form for the treatment of cancer and developed dose rounding rules. The rules were implemented and applied at the dose calculation stage before provider signature. From January to June 2019, approximately 40,000 cancer treatment doses were administered. The rounding rules saved a total of 9,814 vials of drug, of which 5,329 were for biologic agents and 4,485 were for oncolytic drugs. This resulted in a total 6-month cost savings of $7,284,796 (in 2019 dollars; biologics, $5,727,402; oncolytics, $1,557,394). Conclusion Systematic implementation of dose rounding rules utilizing the EHR can result in significant reduction of drug waste and realization of savings.

Objectives. To evaluate the comparative effectiveness and harms of partial breast irradiation (PBI) compared with whole breast irradiation (WBI) for early-stage breast cancer, and how differences in effectiveness and harms may be influenced by patient, tumor, and treatment factors, including treatment modality, target volume, dose, and fractionation. We also evaluated the relative financial toxicity of PBI versus WBI. Data sources. MEDLINE®, Embase®, Cochrane Central Registrar of Controlled Trials, Cochrane Database of Systematic Reviews, Scopus, and various grey literature sources from database inception to June 30, 2022. Review methods. We included randomized clinical trials (RCTs) and observational studies that enrolled adult women with early-stage breast cancer who received one of six PBI modalities: multi-catheter interstitial brachytherapy, single-entry catheter brachytherapy (also known as intracavitary brachytherapy), 3-dimensional conformal external beam radiation therapy (3DCRT), intensity-modulated radiation therapy (IMRT), proton radiation therapy, intraoperative radiotherapy (IORT). Pairs of independent reviewers screened and appraised studies. Results. Twenty-three original studies with 17,510 patients evaluated the comparative effectiveness of PBI, including 14 RCTs, 6 comparative observational studies, and 3 single-arm observational studies. PBI was not significantly different from WBI in terms of ipsilateral breast recurrence (IBR), overall survival, or cancer-free survival at 5 and 10 years (high strength of evidence [SOE]). Evidence for cosmetic outcomes was insufficient. Results were generally consistent when PBI modalities were compared with WBI, whether compared individually or combined. These PBI approaches included 3DCRT, IMRT, and multi-catheter interstitial brachytherapy. Compared with WBI, 3DCRT showed no difference in IBR, overall survival, or cancer-free survival at 5 and 10 years (moderate to high SOE); IMRT showed no difference in IBR or overall survival at 5 and 10 years (low SOE); multi-catheter interstitial brachytherapy showed no difference in IBR, overall survival, or cancer-free survival at 5 years (low SOE). Compared with WBI, IORT was associated with a higher IBR rate at 5, 10, and over 10 years (high SOE), with no difference in overall survival, cancer-free survival, or mastectomy-free survival (low to high SOE). There were significantly fewer acute adverse events (AEs) with PBI compared with WBI, with no apparent difference in late AEs (moderate SOE). Data about quality of life were limited. Head-to-head comparisons between the different PBI modalities showed insufficient evidence to estimate an effect on main outcomes. There were no significant differences in IBR or other outcomes according to patient, tumor, and treatment characteristics; however, data for subgroups were insufficient to draw conclusions. Eight studies addressed concepts closely related to financial toxicity. Compared with conventionally fractionated WBI, accelerated PBI was associated with lower transportation costs and days away from work. PBI was also associated with less subjective financial difficulty at various time points after radiotherapy. Conclusions. Clinical trials that compared PBI with WBI demonstrate no significant difference in the risk of IBR. PBI is associated with fewer acute AEs and may be associated with less financial toxicity. The current evidence supports the use of PBI in appropriately selected patients with early-stage breast cancer. Further investigation is needed to evaluate the outcomes of PBI in patients with various clinical and tumor characteristics, and to define optimal radiation treatment dose and technique for PBI.

Magnetoencephalography with optically pumped magnetometers (OPM-MEG) offers a new way to record electrophysiological brain function, with significant advantages over conventional MEG including adaptability to head shape/size, free movement during scanning, better spatial resolution, increased signal, and no reliance on cryogenics. However, OPM-MEG remains in its infancy, with significant questions to be answered regarding optimal system design and robustness. Here, we present an open-source dataset acquired using a newly constructed OPM-MEG system with a triaxial sensor design averaging 168 channels. Using OPM-optimised magnetic shielding and active background-field control, we measure the test-retest reliability of the human connectome. We employ amplitude envelope correlation to measure whole-brain functional connectivity in 10 individuals whilst they watch a 600 s move clip. Our results show high repeatability between experimental runs at the group level, with a correlation coefficient of 0.81 in the theta, 0.93 in alpha and 0.94 in beta frequency ranges. At the individual subject level, we found marked differences between individuals, but high within-subject robustness (correlations of 0.56 ± 0.25, 0.72 ± 0.15 and 0.78 ± 0.13 in theta, alpha and beta respectively). These results compare well to previously reported findings using conventional MEG; they show that OPM-MEG is a viable way to characterise whole brain connectivity and add significant weight to a growing argument that OPMs can overtake cryogenic sensors as the fundamental building block of MEG systems.

Oil & Gas industries are continuously striving to increase production capacities, achieving cost efficiencies, and venturing in technically challenging areas to maintain their respective market shares. Efficiency in Upstream operations with reduction in production costs, with high focus on safety and asset integrity remains a challenge. Similarly stretching the margin of refined barrel of oil, expanding petrochemical production, developing new high value products to meet growing demand and increasing refining capacity drives operation excellence in downstream operations. Operations of aged faculties in harsh environmental conditions creates challenging operating conditions for any Oil & Gas operator. In the Oil and Gas industry, both onshore and offshore, there are large amounts of hazardous chemicals on drilling or production sites and major incidents resulting in loss of primary containments (LoPC) in Oil & Gas industries from both Upstream & Downstream segments has enhanced focus on asset integrity, process safety and operational excellence. Several types of processes, in the oil and gas industry, have the potential for chemical releases and associated fire, safety, and health hazards due to the nature of these releases. These losses may result in asset damage, occupational injuries, environmental impact, and loss of production and or company reputation. Process safety is a combination of engineering and management controls aimed to prevent catastrophic incidents and near misses, such as structural collapse/damage, fire & explosions, releases of energy or hazardous substances such as chemicals and petroleum products. All such failures were subjected to incident investigation process, aimed to identify root causes of the event and recommending corrective actions to prevent recurrence of such events in future. A critical review of over Fifty (50) process safety events (PSE), both in Upstream and Downstream segments, was undertaken and findings & causes of these events were mapped with Center for Chemical Process Safety (CCPS) Process Safety Elements & Pillars to assess the strength of process safety barriers. Data indicates that Inadequate Identification of Worksite/Job Hazards (under category of Management Supervision/ Employee Leadership) was the topmost root cause of process safety incidents representing 26% of all root causes. It represented inadequacies in task risk assessment where a particular risk was not identified or identified risk was not effectively controlled. Approximately half (55%) of incident causes were under themes of Hazard Identification & Risk Analysis, Auditing, Asset Integrity and Reliability. This novel approach to prevent process safety incidents by integrating & strengthening process safety & operation excellence frameworks in Upstream & Downstream segments of Oil & Gas operations will be assist in preventing incidents and is adaptable by other operators and companies.

Magnetoencephalography (MEG) measures the small magnetic fields generated by current flow in neural networks, providing a noninvasive metric of brain function. MEG is well established as a powerful neuroscientific and clinical tool. However, current instrumentation is hampered by cumbersome cryogenic field-sensing technologies. In contrast, MEG using optically pumped magnetometers (OPM-MEG) employs small, lightweight, noncryogenic sensors that provide data with higher sensitivity and spatial resolution, a natural scanning environment (including participant movement), and adaptability to any age. However, OPM-MEG is new and the optimum way to design a system is unknown. Here, we construct a novel, 90-channel triaxial OPM-MEG system and use it to map motor function during a naturalistic handwriting task. Results show that high-precision magnetic field control reduced background fields to ∼200 pT, enabling free participant movement. Our triaxial array offered twice the total measured signal and better interference rejection compared to a conventional (single-axis) design. We mapped neural oscillatory activity to the sensorimotor network, demonstrating significant differences in motor network activity and connectivity for left-handed versus right-handed handwriting. Repeatability across scans showed that we can map electrophysiological activity with an accuracy ∼4 mm. Overall, our study introduces a novel triaxial OPM-MEG design and confirms its potential for high-performance functional neuroimaging.

Methylmercury (MeHg) is a highly toxic form of mercury that can bioaccumulate in fish tissue. Methylmercury is produced by anaerobic bacteria, many of which are also capable of MeHg degradation. In addition, demethylation in surface waters can occur via abiotic sunlight-mediated processes. The goal of the present study was to understand the relative importance of microbial Hg methylation/demethylation and abiotic photodemethylation that govern the mass of MeHg within an aquatic system. The study location was the Hells Canyon complex of 3 reservoirs on the Idaho–Oregon border, USA, that has fish consumption advisories as a result of elevated MeHg concentrations. Our study utilized stable isotope addition experiments to trace MeHg formation and degradation within the water column of the reservoirs to understand the relative importance of these processes on the mass of MeHg using the Water Quality Analysis Simulation Program. The results showed that rates of MeHg production and degradation within the water column were relatively low (0.5 m below the surface. These results can be used to identify the relative importance of MeHg processes that can help guide reservoir management decisions.

This article proposes a compact trench-assisted space-modulated junction termination extension (TSM-JTE) design for high-voltage 4H-silicon carbide (SiC) devices. In this design, trench structures are introduced into the JTE region to effectively split the termination region into three functional zones. The proposed termination structure is cost effective in terms of the chip area it occupies; for devices rated at 10 kV, the termination structure extends the edge of the device by only $250~\mu \text{m}$ . Requiring only one implant, it is relatively cheap to fabricate, while a wide implantation dose window endures that is relatively insensitive to variations in dose that may occur during processing. The same advantages occur at 20 kV, the TSM-JTE proving to have the best tradeoff between maximum breakdown voltage and implantation window, compared with other single implant termination designs, achieving this in $500~\mu \text{m}$ of termination length. At 3.3 kV, a 110- $\mu \text{m}$ TSM-JTE retains its advantages over the other JTE designs, but floating field rings are expected to consume less area, though this is not the case at the higher voltages.

Metal and metal oxide nanoparticles (NPs) have been increasingly utilized in many industries to harness their documented antibacterial properties. However, the mechanism(s) of action is still debated in the literature. The aim of this study is to understand how changes in outer membrane charge of a test bacteria Haemophilus influenzae alter the antibacterial activity of ZnO NPs of average sizes of 20 nM and 60 nM. H. influenzae outer membrane charge was altered through use of the wild strain (Rd) and mutant lines H543 and H446. Results indicate that antibacterial effects are both concentration and size dependent, with smaller NPs causing increased antibacterial response. Most critically, antibacterial assays and collected TEM images demonstrate that increasing negative charge on the outer membrane of bacteria decreased the antibacterial activity of the ZnO NPs. Finally, this work demonstrates the possibility of using ZnO NPs to treat H. influenzae infection in clinical settings.

In recent years’ machine learning is playing a vital role in our everyday lifelike, it can help us to route somewhere, find something for what we aren’t aware of, or can schedule appointments in seconds. Looking at the other side of the coin besides machine learning Mobile phones are equivocating and competing in the same field. If we take an optimistic view, by applying machine learning in our mobile devices, we can make our lives better and even move society forward. Image Classification is the most common and trending topic of machine learning. Among several different types of models in deep learning, Convolutional Neural Networks (CNN’s) have intimated high performance on image classification which are made out of various handling layers to gain proficiency with the portrayals of information with numerous unique levels, are the best AI models as of late. Here, we have trained a simple CNN and completed the experiments on the dataset called Fashion Mnist and Flower Recognition, and also analyzed the techniques of integrating the trained model in the Android platform.

Analyzing data gathered around COVID-19 can increase our understanding of its spread and the social and economic impacts. Data visualizations can help various stakeholders understand the outbreak. To this end, this article seeks to understand how COVID-19 data dashboards utilized actionable metrics to inform various stakeholders. Used in lean methodology, actionable metrics specifically tie data visualization to actions to improve a specific situation. The authors discuss how actionable metrics were used in COVID-19 data dashboards to inspire actions of various stakeholders by modeling different outcomes through future projections. In turn, the authors explore how actionable metrics in data dashboards can inform new business and technical communication practices for data visualization.

Internet is a source of huge amount of information generated from blog, social websites, and forums and so on by user. In today’s world information available on the internet plays an important role in human’s life. To analyze a huge amount of information it’s require an automated method to classify this type of information. High usage of web and mobile technologies, user generated content in Guajarati is increasing on the web is motivation behind sentiment analysis. Emotion analysis is the process of identifying user’s opinion in section of text. This opinion helps to carry out decisions. Now a day’s a new source of opinion for users are web documents. Sentiment analysis is natural language processing task that extract information from various sources such as news, social networking site, blog, forums and classify them into positive, negative or neutral on the basis of their polarity. Lots of research is done in English language but it’s also important to perform sentiment analysis in Gujarati language as it is 6th official language in India. This paper gives an overview how sentiment analysis can be performed in Gujarati Language.

Planar Schottky contact and various trench Schottky contacts have been integrated into the edge termination region of a 4H-SiC trench metal-oxide-semiconductor field-effect-transistor (MOSFET). The forward and reverse characteristics of various design splits have been benchmarked to determine the optimum method of the Schottky contact integration. As a result, the trench Schottky diode with Schottky metal contact in both the planar surface and the trench sidewall surface has been able to offer the best performance.

A systematic post-deposition annealing study on Silicon Carbide (SiC) metal-oxide-semiconductor capacitors (MOSCAPs) using atomic layer deposition (ALD)-deposited silicon dioxide (SiO2) layers was carried out. Anneals were done in oxidising (N2O), inert (Ar) and reducing (H2:N2) ambients at elevated temperatures from 900°C to 1300°C for 1 hour. Electrical characterisation results show that the forming gas treatment at 1100°C reduces the flatband voltage to 0.23 V from 10 V for as-deposited SiO2 layers. The density of interface traps (DIT) was also reduced by one order of magnitude to 2×1011 cm-2 eV-1 at EC-ET = 0.2 eV. As an indicator of the improvement, characterisation by x-ray photoelectron spectroscopy (XPS) showed that silicon enrichment present in as-deposited layers was largely reduced by the forming gas anneal, improving the stoichiometry. Time-dependent dielectric breakdown (TDDB) results showed that the majority of forming gas annealed samples broke down at breakdown fields of 12.5 MV × cm-1, which is about 2.5 MV × cm-1 higher than for thermally oxidised samples.

We demonstrate that stimulated microwave optical sideband generation using parametric frequency conversion can be utilized as a powerful technique for coherent state detection in atomic physics experiments. The technique has advantages over traditional absorption or polarization rotation-based measurements and enables the isolation of signal photons from probe photons. We outline a theoretical framework that accurately models sideband generation using a density matrix formalism. Using this technique, we demonstrate a novel intrinsic magnetic gradiometer that detects magnetic gradient fields between two spatially separated vapor cells by measuring the frequency of the beat note between sidebands generated within each cell. The sidebands are produced with high efficiency using parametric frequency conversion of a probe beam interacting with ^{87}Rb atoms in a coherent superposition of magnetically sensitive hyperfine ground states. Interference between the sidebands generates a low-frequency beat note whose frequency is determined by the magnetic field gradient between the two vapor cells. In contrast to traditional gradiometers the intermediate step of measuring the magnetic field experienced by the two vapor cells is unnecessary. We show that this technique can be readily implemented in a practical device by demonstrating a compact magnetic gradiometer sensor head with a sensitivity of 25 fT/cm/sqrt[Hz] with a 4.4 cm baseline, while operating in a noisy laboratory environment unshielded from Earth's field.

ObjectivesTo compare the impact of occupational exposures to SARS-CoV-2 positive patients and SARS-CoV-2 positive coworkers, by comparing the frequency of occupational exposure incidents and the rate of healthcare personnel (HCP) who developed a positive PCR test for SARS-COV-2 after occupational exposure to the two different types of infectious individuals.MethodsA retrospective analysis of all confirmed higher risk occupational exposure incidents that occurred in HCP from 20 March 2020 to 31 December 2020 at a large multisite US academic medical centre. Comparisons between groups for source type were performed using unpaired Student’s t-test for continuous variables and the χ2test for categorical variables, regression analysis was conducted to assess the associations between source type and risk of positive COVID-19 test after occupational exposure.ResultsIn total, 2253 confirmed medium or high-risk occupational exposures occurred during the study period. 57% were exposures from coworker sources. Each source individual exposed a mean of 2.6 (95% CI 2.3 to 2.9) HCP; during postexposure surveillance, 4.5% of exposed HCP tested positive within 14 days. A coworker source on average exposed 2.2 (95% CI 2.01 to 2.4) other HCP and infected 0.14 (95% CI 0.1 to 0.17) HCP, while patient sources exposed a mean of 3.4 (95% CI 2.6 to 4.2) HCP but only infected 0.07 (95% CI 0.04 to 0.11) HCP. The multivariate analysis demonstrated that exposure to a coworker source carried a higher risk of testing positive compared with exposure to a patient source (OR 3.22; 95% CI 1.72 to 6.04).ConclusionOccupational exposures to coworker sources were not only more frequent but also associated with triple the risk of developing COVID-19 infection, compared with exposures to patient sources.

Background: Coronary microvascular dysfunction results in angina and adverse outcomes in patients with evidence of ischemia and nonobstructive coronary artery disease; however, no specific therapy exists. CD34+ cell therapy increases microvasculature in preclinical models and improves symptoms, exercise tolerance, and mortality in refractory angina patients with obstructive coronary artery disease. The objective of this research was to evaluate the safety, tolerability, and efficacy of intracoronary CD34+ cell therapy in patients with coronary microvascular dysfunction. Methods: We conducted a 2-center, 20-participant trial of autologous CD34+ cell therapy (protocol CLBS16-P01; NCT03508609) in patients with ischemia and nonobstructive coronary artery disease with persistent angina and coronary flow reserve ≤2.5. Efficacy measures included coronary flow reserve, angina frequency, Canadian Cardiovascular Society angina class, Seattle Angina Questionnaire, SF-36, and modified Bruce exercise treadmill test obtained at baseline and 6 months after treatment. Autologous CD34+ cells (CLBS16) were mobilized by administration of granulocyte-colony stimulating factor 5µg/kg/day for 5 days and collected by leukapheresis. Participants received a single intracoronary left anterior descending infusion of isolated CD34+ cells in medium that enhances cell function. Results: Coronary flow reserve improved from 2.08±0.32 at baseline to 2.68±0.79 at 6 months after treatment ( P P P P ≤0.03, all scales) and SF-36 ( P ≤0.04, all scales). There were no cell-related serious adverse events. Conclusions: In this pilot clinical trial of microvascular angina, patients with ischemia and nonobstructive coronary artery disease receiving intracoronary infusion of CD34+ cell therapy had higher coronary flow reserve, less severe angina, and better quality of life at 6 months. The current study supports a potential therapeutic role for CD34+ cells in patients with microvascular angina. Registration: URL: https://www.clinicaltrials.gov ; Unique identifier: NCT03508609.

As the world grapples with the ever-worsening specter of climate change, it becomes important for various nations/governments to develop mitigating measures. One of the ways to ebb the march of climate decline is to educate the population in respective countries about sustainable consumption that reduces carbon emissions. While prior research has explored the key factors of sustainable consumption in several industries, such as consumer knowledge and personal norm, it has played relatively little attention to them macro-level variables such as level of post-materialism and innovation. To this end, we study the interplay between individual-level factors and national-level variables using a hierarchical linear model on consumers’ perceived value for sustainable products and subsequent sustainable behavior. We used a dataset from the World Value Survey, which includes over 34 thousand respondents covering 40 different nations. The finding suggests that differences in individual-level sustainable consumption are explained by national-level factors. Post-materialist societies were willing to make financial sacrifices for sustainable consumption. Our findings also emphasize that the national-level factor Green Innovation modifies the relationship between Preserved Value and Sustainable Consumption at the individual-level. The findings not only sharpen our sustainability knowledge from a hierarchical view, but also provide useful guidelines for policymakers to promote sustainable consumption. Our study emphasizes that sustainable behavior is the consequence of the interplay between multilevel factors.

Magnetoencephalography (MEG) has been revolutionised by optically pumped magnetometers (OPMs). “OPM-MEG” offers higher sensitivity, better spatial resolution, and lower cost than conventional instrumentation based on superconducting quantum interference devices (SQUIDs). Moreover, because OPMs are small, lightweight, and portable they offer the possibility of lifespan compliance and (with control of background field) motion robustness, dramatically expanding the range of MEG applications. However, OPM-MEG remains nascent technology; it places stringent requirements on magnetic shielding, and whilst a number of viable systems exist, most are custom made and there have been no cross-site investigations showing the reliability of data. In this paper, we undertake the first cross-site OPM-MEG comparison, using near identical commercial systems scanning the same participant. The two sites are deliberately contrasting, with different magnetic environments: a “green field” campus university site with an OPM-optimised shielded room (low interference) and a city centre hospital site with a “standard” (non-optimised) MSR (higher interference). We show that despite a 20-fold difference in background field, and a 30-fold difference in low frequency interference, using dynamic field control and software-based suppression of interference we can generate comparable noise floors at both sites. In human data recorded during a visuo-motor task and a face processing paradigm, we were able to generate similar data, with source localisation showing that brain regions could be pinpointed with just ∼10 mm spatial discrepancy and temporal correlations of > 80%. Overall, our study demonstrates that, with appropriate field control, OPM-MEG systems can be sited even in city centre hospital locations. The methods presented pave the way for wider deployment of OPM-MEG.

The pain experience is a complex process that involves the activation of multiple neuronal signaling pathways that originate in the peripheral nervous system and are transmitted to the central nervous system. In the peripheral nervous system, specialized peripheral nociceptor (unmyelinated C fibers and lightly myelinated Aδ fibers) depolarization results in afferent transmission of noxious signals. Small Fiber Neuropathy (SFN) can result in chronic neuropathic pain with significant lifetime morbidity if not promptly treated. Current technological and operator limitations may delay SFN diagnosis and prolong appropriate treatment. Therefore, there is an unmet need for robust and non-invasive ways to accurately measure small fiber function. It is well known that the propagation of action potentials along a nerve is the result of ionic current flow which, according to Ampere’s Law, generates a small magnetic field that is detectable by magnetometers such as superconducting quantum interference device (SQUID) Magnetoencephalography (MEG) systems. Optically pumped magnetometers (OPM) are an emerging class of quantum magnetic sensors with a demonstrated sensitivity of 1 fT/√Hz level, capable of cortical action potential detection. However, they have not as of yet been implemented for peripheral nerve action potential detection. We demonstrate for the first time, compelling evidence that OPMs can detect the magnetic signature of travelling peripheral nerve action potentials that indicate OPM’s use as a potential technique for SFN diagnosis.

D-dimer testing rules out deep vein thrombosis (DVT) and pulmonary embolism (PE) in low-risk emergency department (ED) patients. Most research has measured fibrin-equivalent units (FEUs), however, many laboratories measure D-dimer units (DDUs).Our aim was to determine whether either DDU measurements or FEU measurements can rule out DVT/PE using traditional or age-related cutoff values.We performed a de-identified multicenter retrospective evaluation of D-dimer in nonpregnant adult ED patients to evaluate for DVT/PE. DDUs were multiplied by 2 to determine equivalent FEUs prior to analysis. Sensitivity measurements for D-dimer were calculated for FEUs, DDUs, combined FEU/DDUs, and multiple age-adjusted values.We identified 47,088 ED patients with a D-dimer laboratory value (27,307 FEUs/19,781 DDUs) and 1623 DVT/PEs. The median combined FEU/DDU D-dimer was 400 ng/mL FEUs (interquartile range [IQR] 300-900 ng/mL FEUs) for patients without a DVT/PE vs 2530 ng/mL FEU (IQR 1094-6000 ng/mL FEUs) with a DVT/PE (p 0.001), overall sensitivity of 87.3% (95% confidence interval [CI] 87.0-87.6%) and negative predictive value of 99.3% (95% CI 99.2-99.4%). Individually, FEUs performed better than DDUs, with sensitivities of 88.0% (95% CI 85.8-89.9%) and 86.1% (95% CI 83.1-88.7%), respectively; however, this difference was not statistically significant. Combined age-adjusted performance had a sensitivity of 90.3% (95% CI 88.3-92.0%); however, a new DDU-only age-adjusted criteria had the highest sensitivity of 91.1% (95% CI 87.9-93.6%).Our undifferentiated D-dimer measurements had a slightly lower sensitivity to rule out DVT/PE than reported previously. Our data support using either DDU or FEU measurements for all ages or when using various age-adjusted criteria to rule out DVT/PE.