Single-crystal diamond, with its unique optical, mechanical and thermal properties, has emerged as a promising material with applications in classical and quantum optics. However, the lack of heteroepitaxial growth and scalable fabrication techniques remains the major limiting factors preventing more wide-spread development and application of diamond photonics. In this work, we overcome this difficulty by adapting angled-etching techniques, previously developed for realization of diamond nanomechanical resonators, to fabricate racetrack resonators and photonic crystal cavities in bulk single-crystal diamond. Our devices feature large optical quality factors, in excess of 10 5 , and operate over a wide wavelength range, spanning visible and telecom. These newly developed high-Q diamond optical nanocavities open the door for a wealth of applications, ranging from nonlinear optics and chemical sensing, to quantum information processing and cavity optomechanics.

With its host of outstanding material properties, single-crystal diamond is an attractive material for nanomechanical systems. Here, the mechanical resonance characteristics of freestanding, single-crystal diamond nanobeams fabricated by an angled-etching methodology are reported. Resonance frequencies displayed evidence of significant compressive stress in doubly clamped diamond nanobeams, while cantilever resonance modes followed the expected inverse-length-squared trend. Q-factors on the order of 104 were recorded in high vacuum. Results presented here represent initial groundwork for future diamond-based nanomechanical systems which may be applied in both classical and quantum applications

Scalable microfabrication technology has enabled semiconductor and microelectronics industries, among other fields. Meanwhile, rapid and sensitive bio-molecule detection is increasingly important for drug discovery and biomedical diagnostics. In this work, we designed and demonstrated that photonic crystal sensor chips have high sensitivity for protein detection and can be mass-produced with scalable deep-UV lithography. We demonstrated label-free detection of carcinoembryonic antigen from pg/mL to μg/mL, with high quality factor photonic crystal nanobeam cavities.

In this post hoc analysis of a randomized controlled trial, patients with septic shock randomized to receive thiamine had lower serum creatinine levels and a lower rate of progression to RRT than patients randomized to placebo. These findings should be considered hypothesis generating and can be used as a foundation for further, prospective investigation in this area.

Objective The Sepsis III clinical criteria for the diagnosis of sepsis rely on scores derived to predict in-hospital mortality. In this study, we introduce the novel outcome of ‘received critical care intervention (CCI)’ and investigate the related predictive performance of both the quick-Sequential Organ Failure Assessment (qSOFA) and the Systemic Inflammatory Response Syndrome (SIRS) criteria. Design This was a single center, retrospective analysis of electronic health records. Setting Tertiary care hospital in the United States. Patients Patients with suspected infection who presented to the Emergency Department (ED) and were admitted to the hospital between January 2010 and December 2014. Interventions SIRS and qSOFA scores were calculated and their relationships to the receipt of CCI and in-hospital mortality were determined. Measurement and Main Results 24,164 patients were included of whom 6,693 (27.7%) were admitted to an ICU within 48-hours. 4,453 (66.5%) patients admitted to the ICU received a CCI. Among those with qSOFA <2, 13.4% received a CCI and 3.5% died compared to 48.2% and 13.4% respectively for qSOFA ≥2. The area under the receiver operating characteristic (AUROC) was similar whether qSOFA was used to predict receipt of CCI or in-hospital mortality (0.74 [95%CI 0.73, 0.74] vs. 0.71 [0.69, 0.72]). The AUROC of SIRS for CCI (0.69) and mortality (0.66) were lower than that for qSOFA (p<0.001 for both outcomes). The sensitivity of qSOFA for predicting CCI was 38%. Conclusions ED patients with suspected infection and low qSOFA scores frequently require CCIs. The misclassification of these patients as ‘low risk,’ in combination with the low sensitivity of qSOFA ≥2, may diminish the clinical utility of the qSOFA score for patients with suspected infection in the ED.

BackgroundThe purpose of this study was to determine whether the provision of corticosteroids improves time to shock reversal and outcomes in patients with post-cardiac arrest shock.MethodsWe conducted a randomized, double-blind trial of post-cardiac arrest patients in shock, defined as vasopressor support for a minimum of 1 hour. Patients were randomized to intravenous hydrocortisone 100 mg or placebo every 8 hours for 7 days or until shock reversal. The primary endpoint was time to shock reversal.ResultsFifty patients were included with 25 in each group. There was no difference in time to shock reversal between groups (hazard ratio: 0.83 [95 % CI: 0.40–1.75], p = 0.63). We found no difference in secondary outcomes including shock reversal (52 % vs. 60 %, p = 0.57), good neurological outcome (24 % vs. 32 %, p = 0.53) or survival to discharge (28 % vs. 36 %, p = 0.54) between the hydrocortisone and placebo groups. Of the patients with a baseline cortisol < 15 ug/dL, 100 % (6/6) in the hydrocortisone group achieved shock reversal compared to 33 % (1/3) in the placebo group (p = 0.08). All patients in the placebo group died (100 %; 3/3) whereas 50 % (3/6) died in the hydrocortisone group (p = 0.43).ConclusionsIn a population of cardiac arrest patients with vasopressor-dependent shock, treatment with hydrocortisone did not improve time to shock reversal, rate of shock reversal, or clinical outcomes when compared to placebo.Clinical trial registrationClinicaltrials.gov: NCT00676585, registration date: May 9, 2008.

Purpose sepsis has broad implications for both clinical care and interventional trial design. However, reasons for death in sepsis remain poorly understood. We sought to characterize reasons for in-hospital mortality in a population of patients with sepsis or septic shock. Materials and methods We performed a retrospective review of patients admitted to the intensive care unit with sepsis or septic shock who died during their index admission. Reasons for death were classified into 6 categories determined a priori by group consensus. Interrater reliability was calculated and Fleiss κ reported. The associations between selected patient characteristics (eg, serum lactate) and reason for death were also assessed. Results One hundred fifteen patients were included. Refractory shock (40%) and comorbid withdrawal of care (44%) were the most common reasons for death. Overall interrater agreement was substantial (κ = 0.61, P < .01). Lactate was higher in patients who died because of refractory shock as compared with those who died for other reasons (4.7 vs 2.8 mmol/L, P < .01). Conclusion In this retrospective cohort, refractory shock and comorbid withdrawal of care were the most common reasons for death. Following prospective validation, the classification methodology presented here may be useful in the design/interpretation of trials in sepsis.

Summary Renal impairment is common in patients who are critically ill with coronavirus disease‐19 (COVID‐19). We examined the association between acute and chronic kidney disease with clinical outcomes in 372 patients with coronavirus disease‐19 admitted to four regional intensive care units between 10 March 2020 and 31 July 2020. A total of 216 (58%) patients presented with COVID‐19 and renal impairment. Acute kidney injury and/or chronic kidney disease was associated with greater in‐hospital mortality compared with patients with preserved renal function (107/216 patients (50%) (95%CI 44–57) vs. 32/156 (21%) (95%CI 15–28), respectively; p < 0.001, relative risk 2.4 (95%CI 1.7–3.4)). Mortality was greatest in patients with renal transplants (6/7 patients (86%) (95%CI 47–100)). Mortality rates increased in patients with worsening renal injury according to the Kidney Disease: Improving Global Outcomes classification: stage 0 mortality 33/157 patients (21%) (95%CI 15–28) vs. stages 1–3 mortality 91/186 patients (49%) (95%CI 42–56); p < 0.001, relative risk 2.3 (95%CI 1.7–3.3). Survivors were less likely to require renal replacement therapy compared with non‐survivors (57/233 patients (24%) vs. 64/139 patients (46%), respectively; p < 0.001, relative risk 1.9 (95%CI 1.4–2.5)). One‐fifth of survivors who required renal replacement therapy acutely in intensive care continued to require renal support following discharge. Our data demonstrate that renal impairment in patients admitted to intensive care with COVID‐19 is common and is associated with a high mortality and requirement for on‐going renal support after discharge from critical care. Our findings have important implications for future pandemic planning in this patient cohort.