Impact of previous gestational diabetes management on perinatal outcomes in subsequent pregnancies affected by gestational diabetes mellitus.

OBJECTIVE: To determine the impact of prior gestational diabetes mellitus (GDM) on perinatal outcomes in a subsequent GDM pregnancy. METHODS: This retrospective cohort study included 544 multiparous patients with two consecutive pregnancies between 2012-2019, where the second (index) pregnancy was affected by GDM. The primary exposure was prior GDM diagnosis, categorized into medical and dietary management. The primary outcome was a composite including need for pharmacotherapy, large-for-gestational age, or neonatal hypoglycemia. Adjusted odds ratios (aOR) were calculated using multivariable logistic regression controlling for maternal age, pre-pregnancy body mass index, and gestational age at GDM diagnosis in the index pregnancy. RESULTS: Of the 544 patients, 164 (30.1%) had prior GDM. Prior GDM significantly increased the likelihood of composite outcome compared to no prior GDM (74.4% vs. 57.4%; P < 0.001). After adjusting for confounders, prior GDM remained significantly associated with the composite outcome (aOR 2.03, 95% confidence interval [CI] 1.31-3.15). Stratifying by prior GDM treatment modality, a significant association was found for prior pharmacotherapy-controlled GDM (aOR 3.29, 95% CI 1.64-6.59), but not for prior diet-controlled GDM (aOR = 1.54, 95% CI 0.92-2.60). CONCLUSION: A history of pharmacotherapy-controlled GDM in a previous pregnancy increases odds of adverse perinatal outcomes in a subsequent GDM pregnancy.

Electrical switching of a bistable moiré superconductor.

Electrical control of superconductivity is critical for nanoscale superconducting circuits including cryogenic memory elements1-4, superconducting field-effect transistors (FETs)5-7 and gate-tunable qubits8-10. Superconducting FETs operate through continuous tuning of carrier density, but no bistable superconducting FET, which could serve as a new type of cryogenic memory element, has been reported. Recently, gate hysteresis and resultant bistability in Bernal-stacked bilayer graphene aligned to its insulating hexagonal boron nitride gate dielectrics were discovered11,12. Here we report the observation of this same hysteresis in magic-angle twisted bilayer graphene (MATBG) with aligned boron nitride layers. This bistable behaviour coexists alongside the strongly correlated electron system of MATBG without disrupting its correlated insulator or superconducting states. This all-van der Waals platform enables configurable switching between different electronic states of this rich system. To illustrate this new approach, we demonstrate reproducible bistable switching between the superconducting, metallic and correlated insulator states of MATBG using gate voltage or electric displacement field. These experiments unlock the potential to broadly incorporate this new switchable moiré superconductor into highly tunable superconducting electronics.

Deep-Learning-Enabled Fast Optical Identification and Characterization of 2D Materials.

Advanced microscopy and/or spectroscopy tools play indispensable roles in nanoscience and nanotechnology research, as they provide rich information about material processes and properties. However, the interpretation of imaging data heavily relies on the "intuition" of experienced researchers. As a result, many of the deep graphical features obtained through these tools are often unused because of difficulties in processing the data and finding the correlations. Such challenges can be well addressed by deep learning. In this work, the optical characterization of 2D materials is used as a case study, and a neural-network-based algorithm is demonstrated for the material and thickness identification of 2D materials with high prediction accuracy and real-time processing capability. Further analysis shows that the trained network can extract deep graphical features such as contrast, color, edges, shapes, flake sizes, and their distributions, based on which an ensemble approach is developed to predict the most relevant physical properties of 2D materials. Finally, a transfer learning technique is applied to adapt the pretrained network to other optical identification applications. This artificial-intelligence-based material characterization approach is a powerful tool that would speed up the preparation, initial characterization of 2D materials and other nanomaterials, and potentially accelerate new material discoveries.

Gigahertz Frequency Antiferromagnetic Resonance and Strong Magnon-Magnon Coupling in the Layered Crystal CrCl_{3}.

We report broadband microwave absorption spectroscopy of the layered antiferromagnet CrCl_{3}. We observe a rich structure of resonances arising from quasi-two-dimensional antiferromagnetic dynamics. Because of the weak interlayer magnetic coupling in this material, we are able to observe both optical and acoustic branches of antiferromagnetic resonance in the GHz frequency range and a symmetry-protected crossing between them. By breaking rotational symmetry, we further show that strong magnon-magnon coupling with large tunable gaps can be induced between the two resonant modes.

Electrical control of 2D magnetism in bilayer CrI3.

Controlling magnetism via electric fields addresses fundamental questions of magnetic phenomena and phase transitions1-3, and enables the development of electrically coupled spintronic devices, such as voltage-controlled magnetic memories with low operation energy4-6. Previous studies on dilute magnetic semiconductors such as (Ga,Mn)As and (In,Mn)Sb have demonstrated large modulations of the Curie temperatures and coercive fields by altering the magnetic anisotropy and exchange interaction2,4,7-9. Owing to their unique magnetic properties10-14, the recently reported two-dimensional magnets provide a new system for studying these features15-19. For instance, a bilayer of chromium triiodide (CrI3) behaves as a layered antiferromagnet with a magnetic field-driven metamagnetic transition15,16. Here, we demonstrate electrostatic gate control of magnetism in CrI3 bilayers, probed by magneto-optical Kerr effect (MOKE) microscopy. At fixed magnetic fields near the metamagnetic transition, we realize voltage-controlled switching between antiferromagnetic and ferromagnetic states. At zero magnetic field, we demonstrate a time-reversal pair of layered antiferromagnetic states that exhibit spin-layer locking, leading to a linear dependence of their MOKE signals on gate voltage with opposite slopes. Our results allow for the exploration of new magnetoelectric phenomena and van der Waals spintronics based on 2D materials.

Layer-dependent ferromagnetism in a van der Waals crystal down to the monolayer limit.

Since the discovery of graphene, the family of two-dimensional materials has grown, displaying a broad range of electronic properties. Recent additions include semiconductors with spin-valley coupling, Ising superconductors that can be tuned into a quantum metal, possible Mott insulators with tunable charge-density waves, and topological semimetals with edge transport. However, no two-dimensional crystal with intrinsic magnetism has yet been discovered; such a crystal would be useful in many technologies from sensing to data storage. Theoretically, magnetic order is prohibited in the two-dimensional isotropic Heisenberg model at finite temperatures by the Mermin-Wagner theorem. Magnetic anisotropy removes this restriction, however, and enables, for instance, the occurrence of two-dimensional Ising ferromagnetism. Here we use magneto-optical Kerr effect microscopy to demonstrate that monolayer chromium triiodide (CrI3) is an Ising ferromagnet with out-of-plane spin orientation. Its Curie temperature of 45 kelvin is only slightly lower than that of the bulk crystal, 61 kelvin, which is consistent with a weak interlayer coupling. Moreover, our studies suggest a layer-dependent magnetic phase, highlighting thickness-dependent physical properties typical of van der Waals crystals. Remarkably, bilayer CrI3 displays suppressed magnetization with a metamagnetic effect, whereas in trilayer CrI3 the interlayer ferromagnetism observed in the bulk crystal is restored. This work creates opportunities for studying magnetism by harnessing the unusual features of atomically thin materials, such as electrical control for realizing magnetoelectronics, and van der Waals engineering to produce interface phenomena.

Dendron-Mediated Engineering of Interparticle Separation and Self-Assembly in Dendronized Gold Nanoparticles Superlattices.

Self-assembly of nanoparticles into designed structures with controlled interparticle separations is of crucial importance for the engineering of new materials with tunable functions and for the subsequent bottom-up fabrication of functional devices. In this study, a series of lipophilic, highly flexible, disulfide dendritic wedges (generations 0-4), based on 2,2-bis(hydroxymethyl)propionic acid, was designed to bind Au nanoparticles with a thiolate bond. By controlling the solvent evaporation rate, the corresponding dendron-capped Au hybrids were found to self-organize into hexagonal close-packed (hcp) superlattices. The interparticular spacing was progressively varied from 2.2 to 6.3 nm with increasing dendritic generation, covering a range that is intermediate between commercial ligands and DNA-based ligand shells. Dual mixtures made from some of these dendronized hybrids (i.e., same inner core size but different dendritic covering) yielded binary superlattice structures of unprecedented single inorganic components, which are isostructural with NaZn13 and CaCu5 crystals.

Optimal isolation and xeno-free culture conditions for limbal stem cell function.

PURPOSE: To preserve limbal stem cell (LSC) function in vitro with xenobiotic-free culture conditions. METHODS: Limbal epithelial cells were isolated from 139 donors using 15 variations of three dissociation solutions. All culture conditions were compared to the baseline condition of murine 3T3-J3 feeders with xenobiotic (Xeno) keratinocyte growth medium at 20% O2. Five Xeno and Xeno-free media with increasing concentrations of calcium and epidermal growth factor (EGF) were evaluated at 5%, 14%, and 20% O2. Human MRC-5, dermal (fetal, neonatal, or adult), and limbal stromal fibroblasts were compared. Statistical analysis was performed on the number of maximum serial weekly passages, percentage of aborted colonies, colony-forming efficiency (CFE), p63α(bright) cells, and RT-PCR ratio of p63α/K12. Immunocytochemistry and RT-PCR for p63α, ABCG2, Bmi1, C/EBPδ , K12, and MUC1 were performed to evaluate phenotype. RESULTS: Dispase/TrypLE was the isolation method that consistently showed the best yield, viability, and CFE. On 3T3-J2 feeders, Xeno-free medium with calcium 0.1 mM and EGF 10 ng/mL at 20% O2 supported more passages with equivalent percentage of aborted colonies, p63α(bright) cells, and p63α/K12 RT-PCR ratio compared to baseline Xeno-media. With this Xeno-free medium, MRC-5 feeders showed the best performance, followed by fetal, neonatal, adult HDF, and limbal fibroblasts. MRC-5 feeders supported serial passages with sustained high expression of progenitor cell markers at levels as robust as the baseline condition without significant difference between 20% and 5% O2. CONCLUSIONS: The LSC function can be maintained in vitro under appropriate Xeno-free conditions.

Shape-dependent plasmonic response and directed self-assembly in a new semiconductor building block, indium-doped cadmium oxide (ICO).

The influence of particle shape on plasmonic response and local electric field strength is well-documented in metallic nanoparticles. Morphologies such as rods, plates, and octahedra are readily synthesized and exhibit drastically different extinction spectra than spherical particles. Despite this fact, the influence of composition and shape on the optical properties of plasmonic semiconductor nanocrystals, in which free electrons result from heavy doping, has not been well-studied. Here, we report the first observation of plasmonic resonance in indium-doped cadmium oxide (ICO) nanocrystals, which exhibit the highest quality factors reported for semiconductor nanocrystals. Furthermore, we are able to independently control the shape and free electron concentration in ICO nanocrystals, allowing for the influence of shape on the optical response of a plasmonic semiconductor to be conclusively demonstrated. The highly uniform particles may be self-assembled into ordered single component and binary nanocrystal superlattices, and in thin films, exhibit negative permittivity in the near infrared (NIR) region, validating their use as a new class of tunable low-loss plasmonic building blocks for 3-D optical metamaterials.

Heart failure disease management: impact on hospital care, length of stay, and reimbursement.

Congestive heart failure (CHF) is a major medical problem with significant hospital costs. The authors developed an inpatient disease management program for CHF in a community hospital setting to determine if it is possible to: 1) increase implementation of Agency for Health Care Policy and Research criteria for CHF; 2) improve the quality of patient care, while lowering length of stay and treatment cost for CHF; and 3) maintain nursing staff satisfaction. The program encompassed a clinical pathway incorporating Agency for Health Care Policy and Research criteria for CHF, CHF education, and patient educational materials. When compared to "unmanaged" patients (n=197) not participating in the algorithm due to physician choice, "managed" patients (n=396) had significantly increased documentation of left ventricular dysfunction and of angiotensin-converting enzyme inhibitor use. In contrast to unmanaged patients, managed patients had a significantly lower length of stay (3.9+/-2.2 vs. 6.1+/-2.8 days; p<0.0001) with a significant reduction in cost per patient ($4404+/-$1989 vs. $6828+/-$3347; p<0.0001). These changes were sustained in follow-up over 1 year and were associated with an improvement in nursing staff education and nursing care. Thus, a disease management program for CHF can be successfully implemented in a general community hospital setting, achieving improved compliance with Agency for Health Care Policy and Research treatment criteria and enhancing patient care, while reducing length of stay and cost.