Pneumococcal and herpes zoster – shingles – vaccination prevent a great deal of morbidity, particularly in elderly and immunocompromised hosts. Vaccination of children with conjugate pneumococcal vaccine in recent years has greatly reduced illness in older individuals as well. This article will review the historical and current recommendations for pneumococcal and herpes zoster vaccination and the rationale for changes at the level of the CDC’s Advisory Committee on Immunization Practices.Influenza is a significant cause of hospitalization and death in late fall and early spring, especially in our most vulnerable populations. Despite high mortality and morbidity of influenza infection, patients are still hesitant about getting the flu vaccine each year. This article offers advice on educating our patients to address misconceptions and help them embrace this important seasonal vaccination.A previously healthy 25-year-old Asian male was admitted with acute respiratory failure due to COVID-19 pneumonia to our intensive care unit. He received empiric therapy and higher level of respiratory support via a high flow nasal cannula. Notably, human metapneumovirus was detected from the nasopharyngeal swab by RT-PCR. Six days post-ICU admission, sinusitis was clinically and sonographically detected. SARS-CoV-2 was detected in the fluid aspirated from the antrum. The patient has made an uneventful recovery. Further studies are required to investigate co-infections with SARS-CoV-2 and other viruses.The Fourth Circuit Court of Appeals’ March 13, 2020 decision in Williams v. Dimension Health Corporation reintroduced scrutiny on the lesser-known mandate of The Emergency Medical Treatment and Active Labor Act (EMTALA) concerning good faith admission to the hospital. EMTALA was enacted by Congress in 1986 to prevent patient dumping by prohibiting hospitals with emergency departments from refusing to provide emergency medical treatment to patients unable to pay for treatment, and prohibiting the transfer of those patients before their emergency medical conditions are stabilized. Enitociclib concentration The reach of EMTALA ends when a patient is admitted and consequently becomes an inpatient, because then the hospital believes the patient would benefit from admission, and discharge and transfer would not occur as outlined in EMTALA. This paper examines the analysis of this mandate in Williams v. Dimension Health Corporation, and closely investigates one particular aspect of it that admission must be made in good faith; otherwise, application of EMTALA’s screening and stabilization requirements has not yet terminated, and hospitals can still be found culpable.The recent changes to expand the permissible scope of medical student documentation draw ample parallels to historical efforts to increase the clinical role of medical learners. While the expanded role of medical student documentation holds the potential for increased community preceptorship and enhanced medical student participation in patient care, it also comes with possible consequences for preceptors, students, and patients. The authors posit that while the rule changes represent important steps forward, further guidance around how these rules are to be implemented will be necessary before the healthcare system can reap their full benefit.Field hospitals have long been used to extend health care capabilities in times of crisis. In response to the pandemic and an anticipated surge in patients, Rhode Island Gov. Gina Raimondo announced a plan to create three field hospitals, or “alternate hospital sites” (AHS), totaling 1,000 beds, in order to expand the state’s hospital capacity. Following China’s Fangcang shelter hospital model, the Lifespan AHS (LAHS) planning group attempted to identify existing public venues that could support rapid conversion to a site for large numbers of patients at a reasonable cost. After discussions with many stakeholders – pharmacy, laboratory, healthcare providers, security, emergency medical services, and infection control – design and equipment recommendations were given to the architects during daily teleconferencing and site visits. Specific patient criteria for the LAHS were established, staffing was prioritized, and clinical protocols were designed to facilitate care. Simulations using 4 different scenarios were practiced in order to assure proper patient care and flow, pharmacy utilization, and staffing.We demonstrate and optimize a tri-layer vertical coupler for a silicon nitride (Si3N4) multilayer platform operating at a 2 µm band. The large spacing between the topmost and bottommost layers of a gradient structure enables ultra-low crossing loss and interlayer crosstalk without affecting the efficiency interlayer transition. We achieve a 0.31 dB transition loss, ultra-low multi-layer crosstalk of -59.3 dB at a crossing angle of 90° with an interlayer gap of 2300 nm at 1950nm. With width optimization of this structure, the fabrication tolerances toward lateral misalignment of two stages in this coupler have increased 61% and 56%, respectively. We also propose a vertical coupler, based on this design, with mode selectivity and achieve an extinction ratio of less then 15 dB for wavelengths in the 1910-1990 range. Meanwhile, a multi-layer interlaced AWGs centered at 1950nm and based on vertical coupler has been demonstrated. The proposed vertical couplers exhibit potential for application in large-scale photonic-integrated circuits and broadly in photonic devices.Nutrient profile determination for plant materials is an important task to determine the quality and safety of the human diet. Laser-induced breakdown spectroscopy (LIBS) is an atomic emission spectrometry of the material component analytical technique. However, quantitative analysis of plant materials using LIBS usually suffers from matrix effects and nonlinear self-absorption. To overcome this problem, a hybrid quantitative analysis model of the partial least squares-artificial neural network (PLS-ANN) was used to detect the compositions of plant materials in the air. Specifically, fifty-eight plant materials were prepared to split into calibration, validation and prediction sets. Nine nutrient composition profiles of Mg, Fe, N, Al, B, Ca, K, Mn, and P were employed as the target elements for quantitative analysis. It demonstrated that the prediction ability can be significantly improved by the use of the PLS-ANN hybrid model compared to the method of standard calibration. Take Mg and K as examples, the root-mean-square errors of calibration (RMSEC) of Mg and K were decreased from 0.