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Realization of tunable materials that are multifunctional and maintain high performance in dynamically changing environments is a fundamental goal of science and engineering. Tunable dielectrics form the basis of a wide variety of communication and sensing devices and require breakthrough performance improvement to enable next-generation technologies. Using phenomenological modeling, film growth, and characterization, we show that devices consisting of domain-wall-rich Ba 0.8 Sr 0.2 TiO 3 films close to a polar-domain-variant phase boundary exhibit colossal dielectric tunability of 100:1 (99%) at a voltage (electric field) of ~15 V (750 kV/cm), resulting in a tunability-quality factor product figure of merit that rises to nearly 10 5 , two orders of magnitude higher than the best previous reported values. Remarkably, varying the amplitude of alternating-current bias enables modulation of this tunability by 50%, owing to domain-wall motion. These results suggest that domain engineering is a powerful approach for achieving excellent modulation of functional properties in ferroelectric films. In advancing the design of electronic devices, the dielectric tunability of barium strontium titanate is enhanced by an order of magnitude relative to the previously reported values through the manipulation of polar domain characteristics.

A thin film dielectric composite has been produced consisting of lead-free barium titanate nanoparticles bound by the conformal atomic layer deposition of hafnia. The materials were examined crystallographically, topologically, and structurally using a variety of techniques including scanning electron microscopy and high-resolution transmission electron microscopy. Electrical measurements of capacitors using the composite material revealed dielectric constant variations of 200–1200 depending on the bias direction, corresponding to asymmetric leakage mechanisms and contributions from interface defects. Piezoresponse force microscopy indicated accessible polarization within the nanoparticles. This work illustrates an approach for conformally depositing a dielectrically tunable composite thin film with novel electrical properties.

The Lupus Foundation of America (LFA) convened an international working group to obtain a consensus definition of disease flare in lupus. With help from the Paediatric Rheumatology International Trials Organization (PRINTO), two web-based Delphi surveys of physicians were conducted. Subsequently, the LFA held a second consensus conference followed by a third Delphi survey to reach a community-wide agreement for flare definition. Sixty-nine of the 120 (57.5%) polled physicians responded to the first survey. Fifty-nine of the responses were available to draft 12 preliminary statements, which were circulated in the second survey. Eighty-seven of 118 (74%) physicians completed the second survey, with an agreement of 70% for 9/12 (75%) statements. During the second conference, three alternative flare definitions were consolidated and sent back to the international community. One hundred and sixteen of 146 (79.5%) responded, with agreement by 71/116 (61%) for the following definition: “A flare is a measurable increase in disease activity in one or more organ systems involving new or worse clinical signs and symptoms and/or laboratory measurements. It must be considered clinically significant by the assessor and usually there would be at least consideration of a change or an increase in treatment.” The LFA proposes this definition for lupus flare on the basis of its high face validity.

Background/purpose The LFA REAL™ is a measurement system for evaluating lupus disease activity from both clinician and patient perspectives. Patients’ viewpoints are captured using a patient-reported outcome (PRO) questionnaire. A series of visual analog scales are designed to rate disease severity and progress over the past 4 weeks. Brief instructions guide the patient to distinguish between active, potentially reversible symptoms and chronic pain or discomfort that are more likely due to damage. Beyond its simplicity and efficiency, the PRO can provide versatile assessments from a global, organ-based, and symptom-specific level. This paper describes the patient-centered approach used to evaluate the content validity of the LFA-REAL PRO. Methods The PRO was developed in accordance with FDA guidance. A two-phase qualitative study was performed with 25 lupus patients, 10 who participated in concept elicitation (Phase 1) and 15 in cognitive debriefing interviews (Phase 2). Qualitative data were analyzed using ATLAS.ti software v7.5. Upon completion of the interviews, participants completed the draft PRO and additional measures to characterize the sample. Results The mean age of participants was 45.6 and 88% were female, as expected in a lupus population. The mean SF-36 physical component score was 29.8 and the mean mental component score was 46.4. Phase 1 elicited symptom saturation and mapping of the draft PRO. Fatigue was reported by 100% of patients, highlighting its importance as a measurable domain. Additionally, 100% of patients spontaneously mentioned arthritis, which may be more important to this group than previously estimated, substantiating the approach of this PRO to break down components of arthritis into joint pain, stiffness, and swelling. Shortness of breath and fever were reported more frequently than expected. Phase 2 data demonstrated that participants found the instrument easy to use and offered recommendations to improve clarity, leading to adjustments in wording and formatting. Conclusions Results suggest that the LFA-REAL PRO has content validity and, with some modifications suggested by participants, is ready for quantitative validation, including tests of reliability, validity, responsiveness to change, and performance relative to other PROs used in lupus trials. After validation, the LFA-REAL system is intended for use in clinical practice and research.

Background In May 2021, the B.1.617 variant of SARS-CoV-2 emerged in Ireland, and both Delta and Kappa sub-lineages were initially deemed variants of concern (VOCs) on a precautionary basis. We describe a large outbreak of SARS-CoV-2 B.1.617.1 (Kappa mutation) linked to a private gathering among third level students in Cork, Ireland. Methods Surveillance data were available from the Health Service Executive COVID Care Tracker. The epidemiological sequence of infection for each new case in this outbreak was tracked and whole genome sequencing was requested on all linked cases. Enhanced public health control measures were implemented by the Department of Public Health HSE-South to contain onward spread of VOCs, including retrospective contact tracing, lengthy isolation and quarantine periods for cases and close contacts. Extensive surveillance efforts were used to describe and control onward transmission. Results There were 146 confirmed SARS-CoV-2 cases linked to the outbreak. All sequenced cases (53/146; 36%) confirmed Kappa mutation. The median age was 21 years (range 17–65). The majority (88%) had symptoms of SARS-CoV-2 infection. There were 407 close contacts; the median was 3 per case (range 0–14). There were no known hospitalisations, ICU admissions or deaths. Vaccination data was unavailable, but the outbreak pre-dated routine availability of COVID-19 vaccines among younger adults in Ireland. Conclusion Enhanced public health control measures for new and emerging variants of SARS-CoV-2 may be burdensome for cases and close contacts. The overall public health benefit of enhanced controls may only become apparent when evidence on disease transmissibility and severity becomes more complete.

The Addressing Lupus Pillars for Health Advancement (ALPHA) Project is a global consensus effort to identify, prioritise and address top barriers in lupus impacting diagnosis, care, treatment and research. To conduct this process, the ALPHA Project convened a multistakeholder Global Advisory Committee (GAC) of lupus experts and collected input from global audiences, including patients. In phase I, the ALPHA Project used expert interviews and a global survey of lupus experts to identify and categorise barriers into three overarching pillars: drug development, clinical care and access to care. In phase II, reported here, the GAC developed recommended actionable solutions to address these previously identified barriers through an in-person stakeholder meeting, followed by a two-round scoring process. Recommendations were assessed for feasibility, impact and timeline for implementation (FIT), where potential FIT component values were between 1 and 3 and total scores were between 3 and 9. Higher scores represented higher achievability based on the composite of the three criteria. Simplifying and standardising outcomes measures, including steroid sparing as an outcome (drug development) and defining the lupus spectrum (clinical care) ranked as the highest two priority solutions during the GAC meeting and received high FIT scores (7.67 and 7.44, respectively). Leveraging social media (access to care) received the highest FIT score across all pillars (7.86). Cross-cutting themes of many solutions include leveraging digital technology and applying specific considerations for special populations, including paediatrics. Implementing the recommendations to address key barriers to drug development, clinical care and access to care is essential to improving the quality of life of adults and children with lupus. Multistakeholder collaboration and guidance across existing efforts globally is warranted.

We demonstrate that micro-scale rolling bearings exhibit friction and wear properties markedly different from their macro-scale counterparts. A microfabricated testing platform uses variable rolling element diameters or vapor-phase lubricated interfaces to independently test friction force with varying contact area and surface energy. A linear, consistent, relationship between friction force and contact area is observed among different rolling element diameters. When surface free energy is altered through the introduction of vapor-phase lubrication, an 83 % decrease in friction is observed. When coupled with observed ball material adhered to the raceway, there is strong evidence for adhesion-dominated rolling friction regime at the micro-scale.

Years before she met Mann, Winnemucca was writing and speaking to advance her people's cause. [...]the United States government's \"Peace Policy,\" formally begun in the Grant Administration, provided an opening, albeit problematic, for her voice. Winnemucca changed the way Mann thought, and we can hear Winnemucca's voice in Juanita. [...]the collaboration between these two extraordinary women leads to a call for a new kind of female reformer, one who will work alongside Native women in the interest of justice.

While learning communities (LCs) are in theory fully inclusive interdisciplinary communities, when theory meets practice they reveal a challenge common to many attempts to create such large communities: drawing faculty from smaller communities (departments/disciplines) with different practices and values, they can subtly and perhaps unintentionally push to erase difference, placing instructors, especially untenured faculty, in tense and uncomfortable positions. Such tensions illustrate, therefore, the need for fewer top-down LC initiatives and more radical transformations of these programs that value polyphony over consensus and that embrace a multiplicity of communities within the larger community. A review of the scholarship on learning communities shows both their potential and the concerns that have crept into critical conversations. Teaching in LCs reveals the pressures faced by faculty (especially new faculty), pressures rooted in the competing values of their many academic communities. Such pressures are exacerbated in teaching FYC. Ultimately, any learning community venture will remain problematic for teachers unless they can somehow balance the demands of these communities, something that cannot happen without an acknowledgment of these tensions in LCs and a redefinition of what it means to be a member of the larger university community.