Controlling magnetic order on ultrafast timescales, driven by spintronic and recording applications, is one of the main directions of current research in magnetism. Despite major advances in understanding the temporal evolution of magnetic order upon its emergence or quenching, experimental demonstration of the local link between microstructure and dynamic nucleation is missing. Here, taking advantage of the high structural and magnetic resolution of in situ transmission electron microscopy, we observe that cumulative laser irradiation significantly alters the nucleation pathway of the first-order antiferromagnetic to ferromagnetic phase transition of FeRh thin films, causing the transition to switch from homogeneous to heterogeneous nucleation. This leads to a decrease of 20 K in transition temperature and the emergence of submicron magnetic vortices as preferential nucleation motifs. These vortices are pinned in the film by underlying dislocation networks. We observe that the dislocation networks are formed and rearranged upon repeated crossing of the phase transition using both femtosecond and picosecond laser pulses. Our results establish a direct link between defect formation and the microscopic morphology of the nucleated ferromagnetic phase, with broad implications for ultrafast stroboscopic experiments and defect-mediated phase transitions in functional materials.
Introduction Hereditary angioedema (HAE) is a rare disorder characterized by unpredictable swelling attacks. Social determinants of health may impact patient care. Methods US patients from Inovalon’s closed claims database with ≥2 medical claims (D84.1 complement system or T783XXX angioedema) and ≥1 prescription for HAE medication between 1/1/2017–9/30/2021 were screened (first claim defined as index date). Patients with evidence of ACE inhibitor use after HAE diagnosis were excluded. Eligible patients had 12 months continuous enrollment in a health-plan pre- and 24 months post-index. Race/ethnicity, income, and rurality were analyzed to understand differences in healthcare resource utilization across the population. Results In multivariable models, Black and Hispanic/Latino patients had a greater risk of ≥1 emergency department (ED) visit than White patients (risk ratio [RR; 95% CI]: 1.29 [1.19–1.40] and 1.22 [1.10–1.36], respectively). Black patients also had a greater risk of hospitalization than White patients (RR [95% CI]: 1.69 [1.28–2.24]). Low-income (<$50K) patients had a higher risk of having ≥1 ED visit or hospitalization than patients with higher incomes (≥$50K; RR [95% CI]: 1.31 [1.21–1.41] and 1.31 [1.03–1.67], respectively). However, rural patients had a lower risk of hospitalization than urban/suburban patients (RR [95% CI]: 0.63 [0.40–0.99]) with a higher mean number of prophylaxis medication fills than urban/suburban patients (RR [95% CI]: 2.0 [1.10–3.66]; no differences by race/ethnicity or income). Conclusion Differences in healthcare resource utilization occur among patients with HAE associated with race/ethnicity, income, and rurality. Strategies to improve equity in care are needed.
Introduction Cyanoacrylates are known contact allergens, particularly octyl cyanoacrylate (OCA), a topical surgical adhesive. Butyl cyanoacrylate (BCA) is an emerging contact allergen used to treat varicose veins. We present a case series of patients with positive patch testing to BCA, but negative to OCA as-is and ethyl cyanoacrylate (ECA) at 10% in petrolatum. Case Description This case series includes two women with reactions after their BCA procedure. The first, a 47-year-old female, developed localized redness and swelling a few days post-procedure that spread to her trunk and legs. She improved with oral corticosteroids, although the rash persisted for three months. The second patient, a 72-year-old female, developed localized severe itching ten days after her procedure, which resolved with prednisone, but later recurred along the treated vein. Our third patient, a 50-year-old female with allergic contact dermatitis (not known allergic to acrylates), underwent patch testing prior to her procedure out of concern for risk of reaction. All patients tested positive to BCA but negative to other cyanoacrylates. BCA applied as-is was non-irritating on one patient. Discussion BCA is a cyanoacrylate injected intravenously to treat varicose veins. Dermatitis may occur along the vein closure site or diffusely. None of our patients required surgical excision and reactions resolved with systemic corticosteroids. Our cohort demonstrates that patch testing to ECA and OCA may be negative in a patient with allergy to BCA. Testing with BCA is therefore an important part of the work up in patients with a hypersensitivity reaction after this vascular procedure.
Introduction Hereditary angioedema (HAE) is a rare genetic disorder characterized by recurrent swelling that impacts quality of life (QoL). This retrospective study evaluated QoL among pediatric patients receiving lanadelumab and their caregivers. Methods Patients with HAE aged 2 to <18 years at lanadelumab initiation, and their caregivers, were identified through the TRIO Health Consortium of Independent Immunology Clinics (CIIC) PIONEER HAE registry. Caregivers completed a cross-sectional survey including validated measures: Pediatric QoL Inventory (PedsQL) and PedsQL-Family Impact Module (FIM); scores 0-100, higher scores indicate better QoL. Data were collected for the 12 months before lanadelumab initiation (pre-lanadelumab) and the last 3 months of lanadelumab treatment (current). Data are mean±SD unless stated. Results Eleven caregivers (age 42.3±5.6 years; 64% female;) reported for 13 pediatric patients (age 12.2±3.6 years; 62% male;) who received lanadelumab for 3.7±1.7 years and were aged 8.9±3.3 years at initiation. Caregiver-perceived QoL (1=poor; 5=excellent) improved from 1.9±1.0 pre-lanadelumab to 4.5±0.7 in the current period, and caregiver-perceived patient QoL improved from 2.2±1.1 to 4.7±0.6. Most caregivers (69%) reported no work or daily activity impact during the current period versus 23% and 8%, respectively, pre-lanadelumab. In the current period, PedsQL total scores were high across age groups (5-7 years, 68.5±15.4; 8-12 years, 91±8; 13-18 years, 84±20), and PedsQL-FIM scores were high across domains (family functioning, 92±13; daily activities, 90±20). Conclusion Caregivers of pediatric patients with HAE receiving lanadelumab prophylaxis reported improved QoL (PedsQL and PedsQL-FIM) and reduced caregiving burden versus pre-lanadelumab, indicating a low impact of HAE on patient and family QoL during treatment.
