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Spontaneous pneumomediastinum (SPM) is defined as free air in the mediastinum thought to be due to non-traumatic rupture of marginal alveoli without evidence of underlying lung disease. Secondary causes must be excluded, including perforations of the esophagus, trachea, and bronchi, due to their propensity for unfavorable outcomes. Infectious etiologies have been documented to cause pneumomediastinum, but this is most frequently observed in the setting of mechanical and noninvasive positive-pressure ventilation (NIPPV). Here we present a case of asymptomatic spontaneous pneumomediastinum in a patient with COVID-19 in absence of mechanical ventilation.

Cryptococcal neoformans is a rare fungal pathogen that has been associated with immunocompromised individuals. Due to its rare occurrence, clinicians have a low index of suspicion for diagnosis, which can lead to increased morbidity and mortality. We present an 81-year-old fully functional woman with no known predisposing risk factors or previous immunocompromising conditions who was found to have cryptococcal meningitis on cerebrospinal fluid analysis in the setting of newly diagnosed uncontrolled type 2 diabetes and systemic lupus erythematosus (SLE).

Abstract Systemic lupus erythematosus (SLE) is a multisystem disease with a complex etiology, which manifests in a multitude of manners. We present a case of lupus nephritis in a patient who developed complications of immunosuppressive treatment with eventual resolution of her nephritis following cure of her Nocardia brain abscess.

Immunoglobulin G4-related systemic disease (IgG4-RSD) is a fibro-inflammatory immune condition characterized by IgG4 positive plasma cells, fibrosis, and frequently elevated serum IgG4 level. Akin to sarcoidosis, IgG4-RSD is a systemic disease with diverse organ manifestations linked by common histopathologic features. IgG4-RSD typically presents sub acutely without significant constitutional symptoms or fever. Hepatic Inflammatory pseudotumor (HIP) is a rare manifestation of IgG4-RSD composed of dense lymphoplasmacytic infiltrate and extensive fibrosis. We present an older Asian male who presented with acute onset of fever and weight loss found to have IgG4-RSD complicated by a HIP and concomitant MSSA abscess.

Abstract Although ICEP is an exceptionally rare disease, it is potentially overlooked and misdiagnosed. This case highlights the importance of peripheral eosinophilia in raising suspicion for ICEP. Without treatment, majority of patients fail to improve.

The mechanisms leading to wake-up and fatigue in ferroelectric hafnium zirconium oxide thin film devices with symmetric RuO2 electrodes are investigated via polarization, relative permittivity, dielectric nonlinearity, pyroelectric coefficient, and microfocus x-ray diffraction (XRD) measurements. The devices are observed to wake-up for up to 103 bipolar pulsed field cycles, after which fatigue occurs with polarization approaching zero following 108 cycles. Wake-up is accompanied by a decrease in both high-field permittivity and hysteresis loop pinching and an increase in the pyroelectric coefficient, indicating that the wake-up process involves a combination of transformations from the tetragonal to the orthorhombic phase and domain depinning from defect redistribution. Fatigue is observed to coincide with an increase in irreversible domain wall motion and a decrease in pyroelectric coefficient. Finite pyroelectric coefficients are measured on fully fatigued devices, indicating that domain pinning is a strong contributor to fatigue and that fatigued devices contain domain structures that are unable to switch under the fields applied for measurement. Microfocus XRD patterns measured on each device reveal that the phase constitution is qualitatively unaffected by field cycling and resultant polarization fatigue. These data indicate that the wake-up process has contributions from both phase transformations and domain depinning, whereas the fatigue process is driven primarily by domain pinning, and the near-zero measured switchable polarization is actually a poled device with immobile domains. These observations provide insight into the physical changes occurring during field cycling of HfO2-based ferroelectrics while examining a possible oxide electrode material for silicon CMOS device implementation. [ABSTRACT FROM AUTHOR]

INTRODUCTIONA tribal land base or homeland is the sine qua non of sovereignty. Tribal territories form the geographical limits of each tribe’s jurisdiction, support a residing population, are the basis of the tribal economy, and provide an irreplaceable forum for cultural vitality based on religious practices and cultural traditions premised on the sacredness of land. Today, fully functioning Indian nations possess four distinct yet interwoven and interdependent attributes of sovereignty: secure land base, functioning economies, self-government and cultural vitality. Some describe these attributes as geographic and political independence. In short, the tribes’ land bases are the linchpin to tribal existence and autonomy as sovereign nations. Moreover, a priority implicit in Indian land tenure is maintaining a homeland in which both present and future generations of the tribes may live and flourish, since tribal individuals and families reside on secure land bases which have supported and nourished their ancestors for thousands of years past, and continue to be the core and integral foundation of tribal existence.

The article evaluates a statewide initiative in rural emergency departments (EDs) aimed at addressing the increasing presentation of children with mental health concerns and subsequent ED boarding. The initiative involves providing youth activity kits and self-care binders to ED staff caring for children boarding with primary mental health issues, with the assessment focusing on utilization and acceptability through a survey of clinical quality leaders in participating EDs (92% response rate).

Ellipsometric spectra of polycrystalline thin film tantalum nitride (TaN) have been collected and analyzed to obtain the complex dielectric function (ɛ = ɛ1 + iɛ2) and complex refractive index (N = n + ik) spectra over the photon energy range of 0.059–8.500 eV. Complex optical properties are obtained for TaN in the as-deposited state and rapid thermal annealed at 750 °C for 30 s post deposition. A parametric expression including the contribution from intraband and interband transitions along with a structural model is used and fitted to experimental ellipsometric spectra using iterative least-square regression, which minimizes the unweighted error function or mean square error to extract complex optical properties. The parametric expression developed in this work is successful in describing and differentiating the optical response of measured as-deposited and annealed TaN films and can potentially be used to analyze the optical properties of similar TaN films regardless of their deposition techniques. [ABSTRACT FROM AUTHOR]

Contractual arrangements for joint machinery ownership between independent agribusinesses are explored. A two-farm economic simulation model of locations in Texas, Colorado, and Montana is developed to provide insight associated with sharing combines. Important variables include combine size (efficiency), yield losses resulting from untimely access to equipment, the penalty structure for untimely delivery, and cost-sharing and depreciation deductions claimed between producers. Combine sharing is risk-reducing in most cases. The gains to both parties are lowest when harvesting periods overlap. While the value of sharing is positive under many scenarios, benefits from sharing are small relative to total farm revenue.

Identifying and then optimizing initial crystallization conditions is a prerequisite for macromolecular structure determination by crystallography. Improved technologies enable data collection on crystals that are difficult if not impossible to detect using visible imaging. The application of second-order nonlinear imaging of chiral crystals and ultraviolet two-photon excited fluorescence detection is shown to be applicable in a high-throughput manner to rapidly verify the presence of nanocrystals in crystallization screening conditions. It is noted that the nanocrystals are rarely seen without also producing microcrystals from other chemical conditions. A crystal volume optimization method is described and associated with a phase diagram for crystallization.