Search

In this paper we provide an overview of the anomalous and enhanced nonlinear effects available when optical nonlinear materials are combined inside plasmonic waveguide structures. Broad, bistable and all-optical switching responses are exhibited at the cut-off frequency of these waveguides, characterized by reduced Q-factor resonances. These phenomena are due to the large field enhancement obtained inside specific plasmonic gratings, which ensures a significant boosting of the nonlinear operation. Several exciting applications are proposed, which may potentially lead to new optical components and add to the optical nanocircuit paradigm.

This work presents a thorough hazards identification methodology for liquid hydrocarbon fuel storage tanks, by applying a checklist technique on the accident causes and the relevant protection measures, in the framework of implementing the SEVESO Directive series. A forum discussion with Greek industrial safety experts has also been organized by the authors in order to improve and correct any lack of the method. Results are presented and discussed, and it is concluded that the present hazard assessment method helps to identify the major contributors to risk, to improve safety measures and to assist the analysis in these aspects.

Panels of informative biallelic single nucleotide polymorphisms (SNPs) have been proposed to be an economical method to fast-track the population genetic analysis of Plasmodium falciparum in malaria-endemic areas. Whilst used successfully in low-transmission areas where infections are monoclonal and highly related, we present the first study to evaluate the performance of these 24- and 96-SNP molecular barcodes in African countries, characterised by moderate-to-high transmission, where multiclonal infections are prevalent. For SNP barcodes it is generally recommended that the SNPs chosen i) are biallelic, ii) have a minor allele frequency greater than 0.10, and iii) are independently segregating, to minimise bias in the analysis of genetic diversity and population structure. Further, to be standardised and used in many population genetic studies, these barcodes should maintain characteristics i) to iii) across various iv) geographies and v) time points. Using haplotypes generated from the MalariaGEN P. falciparum Community Project version six database, we investigated the ability of these two barcodes to fulfil these criteria in moderate-to-high transmission African populations in 25 sites across 10 countries. Predominantly clinical infections were analysed, with 52.3% found to be multiclonal, generating high proportions of mixed-allele calls (MACs) per isolate thereby impeding haplotype construction. Of the 24- and 96-SNPs, loci were removed if they were not biallelic and had low minor allele frequencies in all study populations, resulting in 20- and 75-SNP barcodes respectively for downstream population genetics analysis. Both SNP barcodes had low expected heterozygosity estimates in these African settings and consequently biased analyses of similarity. Both minor and major allele frequencies were temporally unstable. These SNP barcodes were also shown to identify weak genetic differentiation across large geographic distances based on Mantel Test and DAPC. These results demonstrate that these SNP barcodes are vulnerable to ascertainment bias and as such cannot be used as a standardised approach for malaria surveillance in moderate-to-high transmission areas in Africa, where the greatest genomic diversity of P. falciparum exists at local, regional and country levels.

We investigate the design and performance of a new multilayer graphene metasurface for achieving ultrabroadband coherent perfect absorption (CPA) in the THz regime. The proposed structure comprises three graphene patterned metasurfaces separated by thin dielectric spacer layers. The top and bottom metasurfaces have crossed shape unit cells of varying sizes, while the middle graphene metasurface is square-shaped. This distinctive geometrical asymmetry and the presence of multiple layers within the structure facilitate the achievement of wideband asymmetric reflection under incoherent illumination. This interesting property serves as a crucial step towards achieving near-total absorption under coherent illumination across a broad frequency range. Numerical simulations demonstrate that the absorption efficiency surpasses 90% across an ultrabroadband frequency range from 2.8 to 5.7 THz, i.e., a bandwidth of 2.9 THz. The CPA effect can be selectively tuned by manipulating the phase difference between the two incident coherent beams. Moreover, the absorption response can be dynamically adjusted by altering the Fermi level of graphene. The study also examines the influence of geometric parameters on the absorption characteristics. The results of this research work offer valuable insights into the design of broadband graphene metasurfaces for coherent absorption applications, and they contribute to the advancement of sophisticated optical devices operating in the THz frequency range.

Rationale & Objective: Reasons for transfer from peritoneal dialysis (PD) to hemodialysis (HD) remain incompletely understood. Among incident and prevalent patients receiving PD, we evaluated the association of clinical factors, including prior treatment with HD, with PD technique survival., Study Design: Retrospective cohort study., Setting & Participants: Adults who initiated PD at a Dialysis Clinic, Inc (DCI) outpatient facility between January 1, 2010, and September 30, 2019., Exposure: The primary exposure of interest was timing of PD start, categorized as PD-first, PD-early, or PD-late. Other covariates included demographics, clinical characteristics, and routine laboratory results., Outcome: Modality switch from PD to HD sustained for more than 90 days., Analytical Approach: Multivariable Fine-Gray models with competing risks and time-varying covariates, stratified at 9 months to account for lack of proportionality., Results: Among 5,224 patients who initiated PD at a DCI facility, 3,174 initiated dialysis with PD ("PD-first"), 942 transitioned from HD to PD within 90 days ("PD-early"), and 1,108 transitioned beyond 90 days ("PD-late"); 1,472 (28%) subsequently transferred from PD to HD. The PD-early and PD-late patients had a higher risk of transfer to HD as compared with PD-first patients (in the first 9 months: adjusted hazard ratio [AHR], 1.51 [95% CI, 1.17-1.96] and 2.41 [95% CI, 1.94-3.00], respectively; and after 9 months: AHR, 1.16 [95% CI, 0.99-1.35] and AHR, 1.43 [95% CI, 1.24-1.65], respectively). More peritonitis episodes, fewer home visits, lower serum albumin levels, lower residual kidney function, and lower peritoneal clearance calculated with weekly Kt/V were additional risk factors for PD-to-HD transfer., Limitations: Missing data on dialysis adequacy and residual kidney function, confounded by short PD technique survival., Conclusions: Initiating dialysis with PD is associated with greater PD technique survival, though many of those who initiate PD-late in their dialysis course still experience substantial time on PD. Peritonitis, lower serum albumin, and lower Kt/V are risk factors for PD-to-HD transfer that may be amenable to intervention., Plain-Language Summary: Peritoneal dialysis (PD) is an important kidney replacement modality with several potential advantages compared with in-center hemodialysis (HD). However, a substantial number of patients transfer to in-center HD early on, without having experienced the quality-of-life and other benefits that come with sustained maintenance of PD. Using retrospective data from a midsize national dialysis provider, we found that initiating dialysis with PD is associated with longer maintenance of PD, compared with initiating dialysis with HD and a later switch to PD. However, many of those who initiate PD-late in their dialysis course still experience substantial time on PD. Peritonitis, lower serum albumin, and lower small protein removal are other risk factors for PD-to-HD transfer that may be amenable to intervention., (Copyright © 2024 National Kidney Foundation, Inc. Published by Elsevier Inc. All rights reserved.)

Chirality is omnipresent in the living world. As biomimetic nanotechnology and self-assembly advance, they too need chirality. Accordingly, there is a pressing need to develop general methods to characterize chiral building blocks at the nanoscale in liquids such as water─the medium of life. Here, we demonstrate the chiroptical second-harmonic Tyndall scattering effect. The effect was observed in Si nanohelices, an example of a high-refractive-index dielectric nanomaterial. For three wavelengths of illumination, we observe a clear difference in the second-harmonic scattered light that depends on the chirality of the nanohelices and the handedness of circularly polarized light. Importantly, we provide a theoretical analysis that explains the origin of the effect and its direction dependence, resulting from different specific contributions of "electric dipole-magnetic dipole" and "electric dipole-electric quadrupole" coupling tensors. Using numerical simulations, we narrow down the number of such terms to 8 in forward scattering and to a single one in right-angled scattering. For chiral scatterers such as high-refractive-index dielectric nanoparticles, our findings expand the Tyndall scattering regime to nonlinear optics. Moreover, our theory can be broadened and adapted to further classes where such scattering has already been observed or is yet to be observed.

The inherently weak chiroptical responses of natural materials limit their usage for controlling and enhancing chiral light-matter interactions. Recently, several nanostructures with subwavelength scale dimensions were demonstrated, mainly due to the advent of nanofabrication technologies, as a potential alternative to efficiently enhance chirality. However, the intrinsic lossy nature of metals and the inherent narrowband response of dielectric planar thin films or metasurface structures pose severe limitations toward the practical realization of broadband and tailorable chiral systems. Here, we tackle these problems by designing all-dielectric silicon-based L-shaped optical metamaterials based on tilted nanopillars that exhibit broadband and enhanced chiroptical response in transmission operation. We use an emerging bottom-up fabrication approach, named glancing angle deposition, to assemble these dielectric metamaterials on a wafer scale. The reported strong chirality and optical anisotropic properties are controllable in terms of both amplitude and operating frequency by simply varying the shape and dimensions of the nanopillars. The presented nanostructures can be used in a plethora of emerging nanophotonic applications, such as chiral sensors, polarization filters, and spin-locked nanowaveguides., (© 2024. The Author(s).)

Diabetes mellitus (DM) and chronic kidney disease (CKD) are common in middle aged and older adult individuals. DM may accelerate the aging process, and the age-related declines in the estimated glomerular filtration rate (eGFR) can pose a challenge to diagnosing diabetic kidney disease (DKD) using standard diagnostic criteria especially with the absence of severe albuminuria among older adults. In the presence of CKD and DM, older adult patients may need multidisciplinary care due to susceptibility to various health issues, e.g., cognitive decline, auditory or visual impairment, various comorbidities, complex medical regimens, and increased sensitivity to medication adverse effects. As a result, it can be challenging to apply recent therapeutic advancements for the general population to older adults. We review the evidence that the benefits from these newer therapies apply equally to older and younger patients with CKD and diabetes type 2 and propose a comprehensive management. This framework will address nonpharmacological measures and pharmacological management with renin angiotensin system inhibitors (RASi), sodium glucose co-transporter 2 inhibitors (SGLT2i), non-steroidal mineralocorticoids receptor antagonists (MRAs), and glucagon like peptide 1 receptor agonists (GLP1-RAs).

Purpose: The major aims were to quantify patient weight loss using various approaches adminstered by a primary care provider for at least 6 months and to unveil relevant contextual factors that could improve patient weight loss on a long-term basis., Methods: A systematic review and meta-analysis was conducted using Cochrane Central Register of Controlled Trials, MEDLINE, EMBASE, Scopus, and Web of Science from inception to December 5, 2022. COVIDENCE systematic review software was used to identify and abstract data, as well as assess data quality and risk of bias., Results: Seven studies included 2,187 people with obesity testing (1) anti-obesity medication (AOM), (2) AOM, intensive lifestyle counseling + meal replacements, and (3) physician training to better counsel patients on intensive lifestyle modification. Substantial heterogeneity in the outcomes was observed, as well as bias toward lack of published studies showing no effect. The random effect model estimated a treatment effect for the aggregate efficacy of primary care interventions -3.54 kg (95% CI: -5.61 kg to -1.47 kg). Interventions that included a medication component (alone or as part of a multipronged intervention) achieved a greater weight reduction by -2.94 kg ( p  < 0.0001). In all interventions, efficacy declined with time (reduction in weight loss by 0.53 kg per 6 months, 95% CI: 0.04-1.0 kg)., Conclusion: Weight loss interventions administered by a primary care provider can lead to modest weight loss. Weight loss is approximately doubled if anti-obesity medication is part of the treatment. Nevertheless, attenuated weight loss over time underscores the need for long-term treatment., Systematic Review Registration: [https://www.crd.york.ac.uk/prospero/ CRD4202121242344], identifier (CRD42021242344)., Competing Interests: LP has received personal fees for speaking and/or consulting from Novo Nordisk, Sanofi, Boehringer Ingelheim, Elli Lilly, Bayer, Neurobo, Medscape, WebMD and UpToDate. The remaining authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2023 Perreault, Kramer, Smith, Schmidt and Argyropoulos.)

Rationale & Objective: Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infections are likely underdiagnosed, but the degree of underdiagnosis among patients receiving maintenance dialysis is unknown. The durability of the immune response after the third vaccine dose in this population also remains uncertain. This descriptive study tracked antibody levels to (1) assess the rate of undiagnosed infections and (2) characterize seroresponse durability after the third dose., Study Design: Retrospective observational study., Setting & Participants: SARS-CoV-2-vaccinated patients receiving maintenance dialysis through a national dialysis provider. Immunoglobulin G spike antibodies [anti-spike immunoglobulin (Ig) G] titers were assessed monthly after vaccination., Exposures: Two and 3 doses of SARS-CoV-2 vaccine., Outcomes: Undiagnosed and diagnosed SARS-CoV-2 infections; anti-spike IgG titers over time., Analytical Approach: Undiagnosed SARS-CoV-2 infections were identified as an increase in anti-spike IgG titer of ≥100 BAU/mL, not associated with receipt of vaccine or diagnosed SARS-CoV-2 infection (by polymerase chain reaction test or antigen test). In descriptive analyses, anti-spike IgG titers were followed over time., Results: Among 2,703 patients without previous coronavirus disease 2019 (COVID-19) who received an initial 2-dose vaccine series, 271 had diagnosed SARS-CoV-2 infections (3.4 per 10,000 patient-days) and 129 had undiagnosed SARS-CoV-2 infections (1.6 per 10,000 patient-days). Among 1,894 patients without previous COVID-19 who received a third vaccine dose, 316 had diagnosed SARS-CoV-2 infections (7.0 per 10,000 patient-days) and 173 had undiagnosed SARS-CoV-2 infections (3.8 per 10,000 patient-days). In both cohorts, anti-spike IgG levels declined over time. Of the initial 2-dose cohort, 66% had a titer of ≥500 BAU/mL in the first month, with 24% maintaining a titer of ≥500 BAU/mL at 6 months. Of the third dose cohort, 95% had a titer of ≥500 BAU/mL in the first month after the third dose, with 77% maintaining a titer of ≥500 BAU/mL at 6 months., Limitations: The assays used had upper limits., Conclusions: Among patients receiving maintenance dialysis, about 1 in every 3 SARS-CoV-2 infections was undiagnosed. Given this population's vulnerability to COVID-19, ongoing infection control measures are needed. A 3-dose primary mRNA vaccine series optimizes seroresponse rate and durability., Plain-Language Summary: Patients receiving maintenance dialysis have been particularly vulnerable to COVID-19. Using serially measured antibodies, we found that a substantial proportion (about one-third) of SARS-CoV-2 infections among this population had been missed, both among those who had completed a 2-dose vaccine series and among those who had received a third vaccine dose. Such missed infections likely had only mild or minimal symptoms, but this failure to recognize all infections is concerning. Furthermore, vaccines have been effective among patients receiving dialysis, but our study additionally shows that the immune response wanes over time, even after a third dose. There is therefore a role for ongoing vigilance against this highly transmissible infection., (© 2023 The Authors.)

There has been significant progress made in the field of nanopore biosensor development and sequencing applications, which address previous limitations that restricted widespread nanopore use. These innovations, paired with the large-scale commercialization of biological nanopore sequencing by Oxford Nanopore Technologies, are making the platforms a mainstay in contemporary research laboratories. Equipped with the ability to provide long- and short read sequencing information, with quick turn-around times and simple sample preparation, nanopore sequencers are rapidly improving our understanding of unsolved genetic, transcriptomic, and epigenetic problems. However, there remain some key obstacles that have yet to be improved. In this review, we provide a general introduction to nanopore sequencing principles, discussing biological and solid-state nanopore developments, obstacles to single-base detection, and library preparation considerations. We present examples of important clinical applications to give perspective on the potential future of nanopore sequencing in the field of molecular diagnostics.

Controlling the spectral and angular response of infrared (IR) radiation is a challenging task of paramount importance to various emerging photonic applications. Here, we overcome these problems by proposing and analyzing a new design of a tunable narrowband directional optical transmission filter. The presented thermally controlled multilayer filter leverages the temperature dependent phase change properties of vanadium dioxide (VO 2 ) to enable efficient and reversible fast optical switching by using a pump-probe laser excitation setup. More specifically, transmission is blocked for high intensity probe lasers due to the VO 2 metallic properties induced at elevated temperatures while at low probe laser intensities high transmission through the filter occurs only for a narrowband IR range confined to near normal incident angles. The proposed multilayer composite dielectric filter is expected to have applications in optical communications, where it can act as dual functional infrared filter and optical switch.

This work compares four different image processing algorithms for the analysis of image data obtained during the Multiscale Boiling Experiment of ESA, executed on-board the International Space Station. Two separate experimental campaigns have been performed in 2019 and 2020, aiming to investigate boiling phenomena in microgravity, with and without the presence of shear flow and electric field. A heated substrate, at the bottom of the test cell, creates a temperature profile across the liquid bulk above it. A laser beam hits a designated microcavity at the middle of the substrate, to initiate nucleation of a single, isolated bubble. In the presence of shear flow or electric field forces, the bubble slides or detaches respectively, leaving the cavity free for the nucleation and growth of a new bubble. The growth of such a bubble within the prescribed temperature profile is studied for varying experimental conditions (i.e. pressure, heat flux, subcooling temperature) by capturing high speed, black and white video images. The presence of light reflections at random locations around the bubble contour vary with bubble size and population. This, combined with the refraction induced optical distortion of vertical image dimension close to the heater, make the accurate detection of bubbles contour a real challenge. Four research teams, namely the University of Pisa (UNIPI), the Institute of Fluid Mechanics of Toulouse (IMFT), the joint group of Aix Marseille University (AMU) and Kutateladze Institute of Thermophysics (IT), and the joined group of Aristotle University of Thessaloniki (AUTH), Technical University of Darmstadt (TUD) and Foundation of Research and Technology in Crete (FORTH), developed separate specialized algorithms to: a) detect bubble edges and b) use these edges to calculate basic bubble geometrical features, such as contact line diameter, bubble diameter and contact angles. These four different approaches diverge in complexity and concept. In the absence of reference measurements at microgravity conditions, measurements efficiency is evaluated based on the comparison of the estimated bubble geometrical features along with pertinent physical arguments. Results show that the efficiency of each approach varies with the nature of measurement. The studied benchmark dataset is published allowing other research groups to test further their own image processing algorithms., Competing Interests: Declaration of Competing Interest The authors declare the following financial interests/personal relationships which may be considered as potential competing interests., (Copyright © 2022. Published by Elsevier B.V.)

Enhanced electromagnetic fields within plasmonic nanocavity mode volumes enable multiple significant effects that lead to applications in both the linear and nonlinear optical regimes. In this work, we demonstrate enhanced second harmonic generation from individual plasmonic nanopatch antennas which are formed by separating silver nanocubes from a smooth gold film using a sub-10 nm zinc oxide spacer layer. When the nanopatch antennas are excited at their fundamental plasmon frequency, a 10 4 -fold increase in the intensity of the second harmonic generation wave is observed. Moreover, by integrating quantum emitters that have an absorption energy at the fundamental frequency, a second order nonlinear exciton - polariton strong coupling response is observed with a Rabi splitting energy of 19 meV. The nonlinear frequency conversion using nanopatch antennas thus provides an excellent platform for nonlinear control of the light-matter interactions in both weak and strong coupling regimes which will have a great potential for applications in optical engineering and information processing., Competing Interests: Conflict of Interests The authors declare no conflict of interest.

Diabetic kidney disease is the most frequent cause of kidney failure, accounting for half of all cases worldwide. Moreover, deaths from diabetic kidney disease increased 106% between 1990 and 2013, with most attributed to cardiovascular disease. Recommended screening and monitoring for diabetic kidney disease are conducted in less than half of patients with diabetes. Standard-of-care treatment with an angiotensin-converting enzyme inhibitor or an angiotensin receptor blocker is correspondingly low. Sodium-glucose cotransporter 2 inhibitors, glucagon-like peptide 1 receptor agonists, and a nonsteroidal mineralocorticoid antagonist are highly effective therapies to reduce kidney and cardiovascular risks in diabetic kidney disease. However, <20% of eligible patients are receiving these agents. Critical barriers are high out-of-pocket drug costs and low reimbursement rates. Data demonstrating clinical and cost-effectiveness of diabetic kidney disease care are needed to garner payer and health care system support. The pharmaceutical industry should collaborate on value-based care by increasing access through affordable drug prices. Additionally, multidisciplinary models and communication technologies tailored to individual health care systems are needed to support optimal diabetic kidney disease care. Community outreach efforts are also central to make care accessible and equitable. Finally, it is imperative that patient preferences and priorities shape implementation strategies. Access to care and implementation of breakthrough therapies for diabetic kidney disease can save millions of lives by preventing kidney failure, cardiovascular events, and premature death. Coalitions composed of patients, families, community groups, health care professionals, health care systems, federal agencies, and payers are essential to develop collaborative models that successfully address this major public health challenge., (Copyright © 2022 by the American Society of Nephrology.)

Kidney transplant (KT) recipients face post-transplant health issues. Immunosuppressive agents can cause hyperlipidemia, hypertension, post-transplant diabetes, and glomerulopathy. Post-transplant weight gain and decreased activity are associated with poor quality of life, sleep, and cardiometabolic outcomes. This study will test the feasibility and acceptability of a culturally tailored diet and exercise intervention for KT patients delivered immediately post-transplant using novel technology. A registered dietitian nutritionist (RDN) and physical rehabilitation therapist will examine participants' cultural background, preferences, and health-related obstacles (with consultation from the transplant team) to create an individualized exercise and meal plan. The RDN will provide medical nutrition therapy via the nutrition care process throughout the course of the intervention. The Twistle Patient Engagement Platform will be used to deliver and collect survey data, communicate with participants, and promote retention. Outcomes to be assessed include intervention feasibility and acceptability and intervention efficacy on patients' adherence, medical, quality of life, and occupational outcomes., (Copyright © 2022 National Kidney Foundation, Inc. Published by Elsevier Inc. All rights reserved.)

Localized plasmons formed in ultrathin metallic nanogaps can lead to robust absorption of incident light. Plasmonic metasurfaces based on this effect can efficiently generate energetic charge carriers, also known as hot electrons, owing to their ability to squeeze and enhance electromagnetic fields in confined subwavelength spaces. However, it is very challenging to accurately identify and quantify the dynamics of hot carriers, mainly due to their ultrafast time decay. Their nonequilibrium temperature response is one of the key factors missing to understand the short time decay and overall transient tunable absorption performance of gap-plasmon metasurfaces. Here, we systematically study the temperature dynamics of hot electrons and their transition into thermal carriers at various timescales from femto to nanoseconds by using the two-temperature model. Additionally, the hot electron temperature and generation rate threshold values are investigated by using a hydrodynamic nonlocal model approach that is more accurate when ultrathin gaps are considered. The derived temperature dependent material properties are used to study the ultrafast transient nonlinear modification in the absorption spectrum before plasmon-induced lattice heating is established leading to efficient tunable nanophotonic absorber designs. We also examine the damage threshold of these plasmonic absorbers under various pulsed laser illuminations, an important quantity to derive the ultimate input intensity limits that can be used in various emerging nonlinear optics and other tunable nanophotonic applications. The presented results elucidate the role of hot electrons in the response of gap-plasmon metasurface absorbers which can be used to design more efficient photocatalysis, photovoltaics, and photodetection devices., (© 2022 Larousse Khosravi Khorashad and Christos Argyropoulos, published by De Gruyter, Berlin/Boston.)

Introduction: Older patients with advanced chronic kidney disease (CKD) often are inadequately prepared to make informed decisions about treatments including dialysis and cardiopulmonary resuscitation. Further, evidence shows that patients with advanced CKD do not commonly engage in advance care planning (ACP), may suffer from poor quality of life, and may be exposed to end-of-life care that is not concordant with their goals. We aim to study the effectiveness of a video intervention on ACP, treatment preferences and other patient-reported outcomes., Methods and Analysis: The Video Images about Decisions for Ethical Outcomes in Kidney Disease trial is a multi-centre randomised controlled trial that will test the effectiveness of an intervention that includes a CKD-related video decision aid followed by recording personal video declarations about goals of care and treatment preferences in older adults with advancing CKD. We aim to enrol 600 patients over 5 years at 10 sites., Ethics and Dissemination: Regulatory and ethical aspects of this trial include a single Institutional Review Board mechanism for approval, data use agreements among sites, and a Data Safety and Monitoring Board. We intend to disseminate findings at national meetings and publish our results., Trial Registration Number: NCT04347629., Competing Interests: Competing interests: NE is a scientific advisor for Somatus and Davita. MKT has received honoraria from the American Federation of Aging Research and serves as Associate Editor at CJASN. Views expressed are those of the authors and not necessarily those of the Department of Veterans Affairs. AV has a financial interest in ACP decisions, a non-profit organisation developing advance care planning video decision support tools. AV’s interests were reviewed and are managed by MGH and Mass General Brigham in accordance with their conflict-of-interest policies. No other disclosures to report., (© Author(s) (or their employer(s)) 2022. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

Raman sensing is a powerful technique for detecting chemical signatures, especially when combined with optical enhancement techniques such as using substrates containing plasmonic nanostructures. In this work, we successfully demonstrated surface-enhanced Raman spectroscopy (SERS) of two analytes adsorbed onto gold nanosphere metasurfaces with tunable subnanometer gap widths. These metasurfaces, which push the bounds of previously studied SERS nanostructure feature sizes, were fabricated with precise control of the intersphere gap width to within 1 nm for gaps close to and below 1 nm. Analyte Raman spectra were measured for samples for a range of gap widths, and the surface-affected signal enhancement was found to increase with decreasing gap width, as expected and corroborated via electromagnetic field modeling. Interestingly, an enhancement quenching effect was observed below gaps of around 1 nm. We believe this to be one of the few studies of gap-width-dependent SERS for the subnanometer range, and the results suggest the potential of such methods as a probe of subnanometer scale effects at the interface between plasmonic nanostructures. With further study, we believe that tunable sub-nanometer gap metasurfaces could be a useful tool for the study of nonlocal and quantum enhancement-quenching effects. This could aid the development of optimized Raman-based sensors for a variety of applications.

In October 2020, KDIGO (Kidney Disease: Improving Global Outcomes) published its first clinical practice guideline directed specifically to the care of patients with diabetes and chronic kidney disease (CKD). This commentary presents the views of the KDOQI (Kidney Disease Outcomes Quality Initiative) work group for diabetes in CKD, convened by the National Kidney Foundation to provide an independent expert perspective on the new guideline. The KDOQI work group believes that the KDIGO guideline takes a major step forward in clarifying glycemic targets and use of specific antihyperglycemic agents in diabetes and CKD. The purpose of this commentary is to carry forward the conversation regarding optimization of care for patients with diabetes and CKD. Recent developments for prevention of CKD progression and cardiovascular events in people with diabetes and CKD, particularly related to sodium/glucose cotransporter 2 (SGLT2) inhibitors, have filled a longstanding gap in nephrology's approach to the care of persons with diabetes and CKD. The multifaceted benefits of SGLT2 inhibitors have facilitated interactions between nephrology, cardiology, endocrinology, and primary care, underscoring the need for innovative approaches to multidisciplinary care in these patients. We now have more interventions to slow kidney disease progression and prevent or delay kidney failure in patients with diabetes and kidney disease, but methods to streamline their implementation and overcome barriers in access to care, particularly cost, are essential to ensuring all patients may benefit., (Copyright © 2021 National Kidney Foundation, Inc. Published by Elsevier Inc. All rights reserved.)

Background and Objectives: Although most patients receiving maintenance dialysis exhibit initial seroresponse to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) vaccination, concerns exist regarding the durability of this antibody response. This study evaluated seroresponse over time., Design, Setting, Participants, & Measurements: This retrospective cohort study included patients on maintenance dialysis, from a midsize national dialysis provider, who received a complete SARS-CoV-2 vaccine series and had at least one antibody titer checked after full vaccination. IgG spike antibodies (anti-spike IgG) titers were assessed monthly with routine laboratory tests after vaccination; the semiquantitative assay reported a range between zero and ≥20 Index. Descriptive analyses compared trends over time by history of coronavirus disease 2019 (COVID-19) and vaccine type. Time-to-event analyses examined the outcome of loss of seroresponse (anti-spike IgG <1 Index or development of COVID-19). Cox regression adjusted for additional clinical characteristics., Results: Among 1870 patients receiving maintenance dialysis, 1569 had no prior COVID-19. Patients without prior COVID-19 had declining titers over time. Among 443 recipients of BNT162b2 (Pfizer), median (interquartile range) anti-spike IgG titer declined from ≥20 (5.89 to ≥20) in month 1 after full vaccination to 1.96 (0.60-5.88) by month 6. Among 778 recipients of mRNA-1273 (Moderna), anti-spike IgG titer declined from ≥20 (interquartile range, ≥20 to ≥20) in month 1 to 7.99 (2.61 to ≥20) by month 6. The 348 recipients of Ad26.COV2.S (Janssen) had a lower titer response than recipients of an mRNA vaccine over all time periods. In time-to-event analyses, recipients of Ad26.COV2.S and mRNA-1273 had the shortest and longest time to loss of seroresponse, respectively. The maximum titer reached in the first 2 months after full vaccination was associated with durability of the anti-spike IgG seroresponse; patients with anti-spike IgG titer 1-19.99 had a shorter time to loss of seroresponse compared with patients with anti-spike IgG titer ≥20 (hazard ratio, 15.5; 95% confidence interval, 11.7 to 20.7)., Conclusions: Among patients receiving maintenance dialysis, vaccine-induced seroresponse wanes over time across vaccine types. Early titers after full vaccination are associated with the durability of seroresponse., (Copyright © 2022 by the American Society of Nephrology.)

Spontaneous parametric down-conversion (SPDC) is one of the most versatile nonlinear optical techniques for the generation of entangled and correlated single-photon pairs. However, it suffers from very poor efficiency leading to extremely weak photon generation rates. Here we propose a plasmonic metasurface design based on silver nanostripes combined with a bulk lithium niobate (LiNbO 3 ) crystal to realize a new scalable, ultrathin, and efficient SPDC source. By coinciding fundamental and higher order resonances of the metasurface with the generated signal and idler frequencies, respectively, the electric field in the nonlinear media is significantly boosted. This leads to a substantial enhancement in the SPDC process which, subsequently, by using the quantum-classical correspondence principle, translates to very high photon-pair generation rates. The emitted radiation is highly directional and perpendicular to the metasurface in contrast to relevant dielectric structures. The incorporation of circular polarized excitation further increases the photon-pair generation efficiency. The presented work will lead to the design of new efficient ultrathin SPDC single-photon nanophotonic sources working at room temperature that are expected to be critical components in free-space quantum optical communications. In a more general context, our findings can have various applications in the emerging field of quantum plasmonics.

The effects of the coronavirus disease-2019 (COVID-19) pandemic, particularly among those with chronic kidney disease (CKD), who commonly have defects in humoral and cellular immunity, and the efficacy of vaccinations against severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) are uncertain. To inform public health and clinical practice, we synthesized published studies and preprints evaluating surrogate measures of immunity after SARS-CoV-2 vaccination in patients with CKD, including those receiving dialysis or with a kidney transplant. We found 35 studies (28 published, 7 preprints), with sample sizes ranging from 23 to 1140 participants and follow-up ranging from 1 week to 1 month after vaccination. Seventeen of these studies enrolled a control group. In the 22 studies of patients receiving dialysis, the development of antibodies was observed in 18% to 53% after 1 dose and in 70% to 96% after 2 doses of mRNA vaccine. In the 14 studies of transplant recipients, 3% to 59% mounted detectable humoral or cellular responses after 2 doses of mRNA vaccine. After vaccination, there were a few reported cases of relapse or de novo glomerulonephritis, and acute transplant rejection, suggesting a need for ongoing surveillance. Studies are needed to better evaluate the effectiveness of SARS-CoV-2 vaccination in these populations. Rigorous surveillance is necessary for detection of long-term adverse effects in patients with autoimmune disease and transplant recipients. For transplant recipients and those with suboptimal immune responses, alternate vaccination platforms and strategies should be considered. As additional data arise, the NephJC COVID-19 page will continue to be updated (http://www.nephjc.com/news/covid-vaccine)., (© 2021 International Society of Nephrology. Published by Elsevier Inc.)

Donor race should not be used in models to predict allograft and patient survival.Removing donor race from the Kidney Donor Risk Index may reduce kidney discard by reclassifying approximately 50% of high kidney donor profile index kidneys.Future prediction models should focus on using relevant biologic factors rather than social constructs when trying to predict outcomes., Competing Interests: C. Argyropoulos reports having consultancy agreements with Alkahest and Momenta Pharma; reports receiving research funding from Dialysis Clinic Inc. and the University of Pennsylvania; reports being a scientific advisor or member of Baxter Healthcare, Bayer, and Health Services Advisory Group; and reports other interests/relationships with AbbVie as Sub-I in a phase 3 study of an experimental agent in diabetic nephropathy, Akebia principal investigator in two phase 3 trials of an investigational product for the correction and maintenance of anemia in patients with nondialysis-dependent CKD and one phase 3 study of the same agent in dialysis, Dialysis Clinic Inc. as Medical Director of the Outpatient Dialysis Unit in Cuba, New Mexico, and the Dialysis Outcomes and Practice Patterns Program, principal investigator for CKD-DOPP. Y. Zhu reports receiving research funding from Dialysis Clinic Inc., Patient-Centered Outcomes Research Institute, the National Institutes of Health, and US Department of State. All remaining authors have nothing to disclose., (Copyright © 2021 by the American Society of Nephrology.)

Background: Converting electronic health record (EHR) entries to useful clinical inferences requires one to address the poor scalability of existing implementations of Generalized Linear Mixed Models (GLMM) for repeated measures. The major computational bottleneck concerns the numerical evaluation of multivariable integrals, which even for the simplest EHR analyses may involve millions of dimensions (one for each patient). The hierarchical likelihood (h-lik) approach to GLMMs is a methodologically rigorous framework for the estimation of GLMMs that is based on the Laplace Approximation (LA), which replaces integration with numerical optimization, and thus scales very well with dimensionality., Methods: We present a high-performance, direct implementation of the h-lik for GLMMs in the R package TMB. Using this approach, we examined the relation of repeated serum potassium measurements and survival in the Cerner Real World Data (CRWD) EHR database. Analyzing this data requires the evaluation of an integral in over 3 million dimensions, putting this problem beyond the reach of conventional approaches. We also assessed the scalability and accuracy of LA in smaller samples of 1 and 10% size of the full dataset that were analyzed via the a) original, interconnected Generalized Linear Models (iGLM), approach to h-lik, b) Adaptive Gaussian Hermite (AGH) and c) the gold standard for multivariate integration Markov Chain Monte Carlo (MCMC)., Results: Random effects estimates generated by the LA were within 10% of the values obtained by the iGLMs, AGH and MCMC techniques. The H-lik approach was 4-30 times faster than AGH and nearly 800 times faster than MCMC. The major clinical inferences in this problem are the establishment of the non-linear relationship between the potassium level and the risk of mortality, as well as estimates of the individual and health care facility sources of variations for mortality risk in CRWD., Conclusions: We found that the direct implementation of the h-lik offers a computationally efficient, numerically accurate approach for the analysis of extremely large, real world repeated measures data via the h-lik approach to GLMMs. The clinical inference from our analysis may guide choices of treatment thresholds for treating potassium disorders in the clinic., (© 2021. The Author(s).)

Background: Recently, there has been an abundance of encouraging data regarding the creation of percutaneous arteriovenous fistulas. Despite promising data regarding their clinical maturation, a paucity of data exists which provides direct comparison between percutaneously created AVFs (pAVF) and open surgically created AVFs (sAVF). This study has 2 primary objectives: First, to compare clinical outcomes of pAVFs to sAVFs, with emphasis on clinical maturation and frequency of postoperative interventions to facilitate maturation. Second, to contribute toward the evidence-based incorporation of the pAVF procedure into the hemodialysis access algorithm., Methods: A single-center retrospective review was performed on all consecutive patients undergoing surgically created brachiocephalic arteriovenous fistula (BC-AVF, sAVF group) from January 1, 2018 to December 31, 2018 and Ellipsys-created percutaneous arteriovenous fistula (pAVF group) from January 1, 2019 to December 31, 2019. Comparative analysis between groups was performed., Results: A total of 24 patients underwent Ellipsys-created pAVF with mean age of 56.7 ± 22.6 years (12 males [50%], 12 females [50%]) and 62 patients underwent surgically created BC-AVF with mean age of 62.5 ± 13.2 years (32 males [52%], 30 females [48%]). Both the pAVF and sAVF groups had comparable mean operating times (60 ± 40 vs. 56 ± 25 min, P = 0.67) and frequency of procedural technical success (23 [96%] vs. 62 [100%], P = 0.28), respectively. The pAVF group had a lower clinical maturation rate (12 [52%] vs. 54 [87%], P = 0.003) and a higher primary failure rate (9 [39%] vs. 6 [10%], P = 0.003) when compared to the sAVF group. The pAVF group had an increased overall rate of undergoing a postoperative intervention (18 [78%] vs. 13 [21%], P< 0.001), as well as an increased number of total postoperative interventions (1.1 ± 0.9 vs. 0.3 ± 0.6 interventions, P< 0.001) compared to the sAVF group. Percutaneous transluminal angioplasty of the juxta anastomotic segment was the most prevalent postoperative intervention performed in the pAVF group and occurred at a significantly increased frequency when compared to the sAVF group rate (13 [57%] vs. 5 [8%], P< 0.001)., Conclusions: In our single-center retrospective review, patients undergoing Ellipsys-created pAVF in the first year following introduction of percutaneous endovascular had inferior rates of clinical maturation and underwent more postoperative interventions when compared to historical patients undergoing surgically created BC-AVF. Outcome discrepancies compared to previously reported Ellipsys data demonstrate a need for further studies examining the practical translatability of the pAVF., (Copyright © 2021 Elsevier Inc. All rights reserved.)

Background: Percutaneous arteriovenous fistulas have recently proven successful alternatives to surgical arteriovenous fistulas with encouraging initial results. The Ellipsys Endovascular Arteriovenous Fistula System utilizing ultrasound and thermal energy has recently received approval for use in the United States. At the University of New Mexico, we developed an integrated service between Vascular Surgery, Interventional Radiology, and Interventional Nephrology for percutaneous arteriovenous fistulas utilizing Ellipsys ., Methods: We performed a retrospective chart review of the initial 6 months (January 1 st 2019 to July 1 st 2019) of 18 percutaneous arteriovenous fistula placements to evaluate our initial technical success rate, the number of arteriovenous fistulas meeting maturation characteristics or use in dialysis, and to identify areas for quality improvement., Results: Initial technical success was achieved in 17 out of 18 arteriovenous fistulas (94.4%). Three patients did not report for any follow-up at the end of the initial 6 months. Of the remaining patients, 7 out of 15 were using their arteriovenous fistulas or meeting maturation characteristics at the end of the study (46.7%). Patient loss to follow-up/no-show (16.7%), patient not yet requiring hemodialysis (27.8%), and poor post-surgical maturation and/or need for additional maturation procedures (55.6%) were the predominate reasons for non-use. We identified improved coordination of care, early intervention, and outpatient dialysis center education as the primary areas of focus for quality improvement., Conclusion: Initial technical success rate of percutaneous arteriovenous fistulas placement was comparable to published studies. Early and aggressive secondary angiographic interventions of arteriovenous fistulas failing to meet cannulation requirements, improved coordination of post-operative care, and outpatient dialysis center education appear to be the primary targets for quality improvement.