A Machine Learning Model for Predicting Mortality within 90 Days of Dialysis Initiation.

Background: The first 90 days after dialysis initiation are associated with high morbidity and mortality in end-stage kidney disease (ESKD) patients. A machine learning-based tool for predicting mortality could inform patient-clinician shared decision making on whether to initiate dialysis or pursue medical management. We used the eXtreme Gradient Boosting (XGBoost) algorithm to predict mortality in the first 90 days after dialysis initiation in a nationally representative population from the United States Renal Data System. Methods: A cohort of adults initiating dialysis between 2008-2017 were studied for outcome of death within 90 days of dialysis initiation. The study dataset included 188 candidate predictors prognostic of early mortality that were known on or before the first day of dialysis and was partitioned into training (70%) and testing (30%) subsets. XGBoost modeling used a complete-case set and a dataset obtained from multiple imputation. Model performance was evaluated by c-statistics overall and stratified by subgroups of age, sex, race, and dialysis modality. Results: The analysis included 1,150,195 patients with ESKD, of whom 86,083 (8%) died in the first 90 days after dialysis initiation. The XGBoost models discriminated mortality risk in the nonimputed (c=0.826, 95% CI, 0.823 to 0.828) and imputed (c=0.827, 95% CI, 0.823 to 0.827) models and performed well across nearly every subgroup (race, age, sex, and dialysis modality) evaluated (c>0.75). Across predicted risk thresholds of 10%-50%, higher risk thresholds showed declining sensitivity (0.69-0.04) with improving specificity (0.79-0.99); similarly, positive likelihood ratio was highest at the 40% threshold, whereas the negative likelihood ratio was lowest at the 10% threshold. After calibration using isotonic regression, the model accurately estimated the probability of mortality across all ranges of predicted risk. Conclusions: The XGBoost-based model developed in this study discriminated risk of early mortality after dialysis initiation with excellent calibration and performed well across key subgroups.

Probing borophene oxidation at the atomic scale.

Two-dimensional boron (i.e. borophene) holds promise for a variety of emerging nanoelectronic and quantum technologies. Since borophene is synthesized under ultrahigh vacuum (UHV) conditions, it is critical that the chemical stability and structural integrity of borophene in oxidizing environments are understood for practical borophene-based applications. In this work, we assess the mechanism of borophene oxidation upon controlled exposure to air and molecular oxygen in UHV via scanning tunneling microscopy andspectroscopy, x-ray photoelectron spectroscopy, and density functional theory calculations. While borophene catastrophically degrades almost instantaneously upon exposure to air, borophene undergoes considerably more controlled oxidation when exposed to molecular oxygen in UHV. In particular, UHV molecular oxygen dosing results in single-atom covalent modification of the borophene basal plane in addition to disordered borophene edge oxidation that shows altered electronic characteristics. By comparing these experimental observations with density functional theory calculations, further atomistic insight is gained including pathways for molecular oxygen dissociation, surface diffusion, and chemisorption to borophene. Overall, this study provides an atomic-scale perspective of borophene oxidation that will inform ongoing efforts to passivate and utilize borophene in ambient conditions.

Borophene synthesis beyond the single-atomic-layer limit.

Synthetic two-dimensional (2D) materials have no bulk counterparts and typically exist as single atomic layers due to substrate-stabilized growth. Multilayer formation, although broadly sought for structure and property tuning, has not yet been achieved in the case of synthetic 2D boron: that is, borophene1,2. Here, we experimentally demonstrate the synthesis of an atomically well-defined borophene polymorph beyond the single-atomic-layer (SL) limit. The structure of this bilayer (BL) borophene is consistent with two covalently bonded α-phase layers (termed BL-α borophene) as evidenced from bond-resolved scanning tunnelling microscopy, non-contact atomic force microscopy and density functional theory calculations. While the electronic density of states near the Fermi level of BL-α borophene is similar to SL borophene polymorphs, field-emission resonance spectroscopy reveals distinct interfacial charge transfer doping and a heightened local work function exceeding 5 eV. The extension of borophene polymorphs beyond the SL limit significantly expands the phase space for boron-based nanomaterials.

Thermally conductive ultra-low-k dielectric layers based on two-dimensional covalent organic frameworks.

As the features of microprocessors are miniaturized, low-dielectric-constant (low-k) materials are necessary to limit electronic crosstalk, charge build-up, and signal propagation delay. However, all known low-k dielectrics exhibit low thermal conductivities, which complicate heat dissipation in high-power-density chips. Two-dimensional (2D) covalent organic frameworks (COFs) combine immense permanent porosities, which lead to low dielectric permittivities, and periodic layered structures, which grant relatively high thermal conductivities. However, conventional synthetic routes produce 2D COFs that are unsuitable for the evaluation of these properties and integration into devices. Here, we report the fabrication of high-quality COF thin films, which enable thermoreflectance and impedance spectroscopy measurements. These measurements reveal that 2D COFs have high thermal conductivities (1 W m-1 K-1) with ultra-low dielectric permittivities (k = 1.6). These results show that oriented, layered 2D polymers are promising next-generation dielectric layers and that these molecularly precise materials offer tunable combinations of useful properties.

Synthesis of borophane polymorphs through hydrogenation of borophene.

Synthetic two-dimensional polymorphs of boron, or borophene, have attracted attention because of their anisotropic metallicity, correlated-electron phenomena, and diverse superlattice structures. Although borophene heterostructures have been realized, ordered chemical modification of borophene has not yet been reported. Here, we synthesize "borophane" polymorphs by hydrogenating borophene with atomic hydrogen in ultrahigh vacuum. Through atomic-scale imaging, spectroscopy, and first-principles calculations, the most prevalent borophane polymorph is shown to possess a combination of two-center-two-electron boron-hydrogen and three-center-two-electron boron-hydrogen-boron bonds. Borophane polymorphs are metallic with modified local work functions and can be reversibly returned to pristine borophene through thermal desorption of hydrogen. Hydrogenation also provides chemical passivation because borophane reduces oxidation rates by more than two orders of magnitude after ambient exposure.

Molecular-Scale Characterization of Photoinduced Charge Separation in Mixed-Dimensional InSe-Organic van der Waals Heterostructures.

Layered indium selenide (InSe) is an emerging two-dimensional semiconductor that has shown significant promise for high-performance transistors and photodetectors. The range of optoelectronic applications for InSe can potentially be broadened by forming mixed-dimensional van der Waals heterostructures with zero-dimensional molecular systems that are widely employed in organic electronics and photovoltaics. Here, we report the spatially resolved investigation of photoinduced charge separation between InSe and two molecules (C70 and C8-BTBT) using scanning tunneling microscopy combined with laser illumination. We experimentally and computationally show that InSe forms type-II and type-I heterojunctions with C70 and C8-BTBT, respectively, due to an interplay of charge transfer and dielectric screening at the interface. Laser-excited scanning tunneling spectroscopy reveals a ∼0.25 eV decrease in the energy of the lowest unoccupied molecular orbital of C70 with optical illumination. Furthermore, photoluminescence spectroscopy and Kelvin probe force microscopy indicate that electron transfer from InSe to C70 in the type-II heterojunction induces a photovoltage that quantitatively matches the observed downshift in the tunneling spectra. In contrast, no significant changes are observed upon optical illumination in the type-I heterojunction formed between InSe and C8-BTBT. Density functional theory calculations further show that, despite the weak coupling between the molecular species and InSe, the band alignment of these mixed-dimensional heterostructures strongly differs from the one suggested by the ionization potential and electronic affinities of the isolated components. Self-energy-corrected density functional theory indicates that these effects are the result of the combination of charge redistribution at the interface and heterogeneous dielectric screening of the electron-electron interactions in the heterostructure. In addition to providing specific insight for mixed-dimensional InSe-organic van der Waals heterostructures, this work establishes a general experimental methodology for studying localized charge transfer at the molecular scale that is applicable to other photoactive nanoscale systems.

Geometric imaging of borophene polymorphs with functionalized probes.

A common characteristic of borophene polymorphs is the presence of hollow hexagons (HHs) in an otherwise triangular lattice. The vast number of possible HH arrangements underlies the polymorphic nature of borophene, and necessitates direct HH imaging to definitively identify its atomic structure. While borophene has been imaged with scanning tunneling microscopy using conventional metal probes, the convolution of topographic and electronic features hinders unambiguous identification of the atomic lattice. Here, we overcome these limitations by employing CO-functionalized atomic force microscopy to visualize structures corresponding to boron-boron covalent bonds. Additionally, we show that CO-functionalized scanning tunneling microscopy is an equivalent and more accessible technique for HH imaging, confirming the v1/5 and v1/6 borophene models as unifying structures for all observed phases. Using this methodology, a borophene phase diagram is assembled, including a transition from rotationally commensurate to incommensurate phases at high growth temperatures, thus corroborating the chemically discrete nature of borophene.

Interoperability Progress and Remaining Data Quality Barriers of Certified Health Information Technologies.

The Consolidated Clinical Document Architecture (C-CDA) is the primary standard for clinical document exchange in the United States. While document exchange is prevalent today, prior research has documented challenges to high quality, effective interoperability using this standard. Many electronic health records (EHRs) have recently been certified to a new version of the C-CDA standard as part of federal programs for EHR adoption. This renewed certification generated example documents from 52 health information technologies that have been made publicly available. This research applies automated tooling and manual inspection to evaluate conformance and data quality of these testing artifacts. It catalogs interoperability progress as well as remaining barriers to effective data exchange. Its findings underscore the importance of programs that evaluate data quality beyond schematron conformance to enable the high quality and safe exchange of clinical data.

In situ and ex situ functionalization of nanostructured gallium oxy-hydroxide with a porphyrin dye.

The surface attachment of a porphyrin dye to nanocrystalline GaOOH was performed using two routes of solution-based functionalization. The first method of functionalization utilized an in situ incorporation of dissolved porphyrin salt in solution during the microwave synthesis step. Additionally, synthesized GaOOH nanorods were mixed in porphyrin solution after the microwave process to make an ex situ GaOOH/TTP-PO-3 . X-ray photoelectron spectroscopy confirmed the presence of expected surface species and provided evidence of increased surface coverage of TTP-PO3 on GaOOH in the ex situ- GaOOH/TTP-PO3 as compared to the in situ one. Size and morphology changes were investigated using SEM and, along with analysis of XRD, the in situ samples showed larger crystallite sizes. This was confirmed with PL due to the higher bandgap energy evident in the ex situ GaOOH/TTP-PO3 compared to the in situ sample. A stability study was performed using fluorescence spectroscopy which indicated no leaching of porphyrin from the in situ GaOOH/TTP-PO3 . However, porphyrin leaching was evident from the ex situ GaOOH/TTP-PO3 sample. The stability of the in situ GaOOH/TTP-PO3 makes it attractive for a number of interfacial applications. SCANNING 38:671-683, 2016. © 2016 Wiley Periodicals, Inc.

Enzymes produced by autoactivation of blood factor XII in buffer: A contribution from the Hematology at Biomaterial Interfaces Research Group.

High-resolution electrophoresis of FXII-derived proteins produced by contact activation of FXII in buffer solutions (i.e. in absence of plasma proteins) with hydrophilic and silanized-glass activators spanning the observable range of water wettability (hydrophilic to hydrophobic), shows no evidence of proteolytic cleavage of FXII into αFXIIa or ßFXIIa. The autoactivation mixture contains only a single-chain protein with a molecular weight of ∼80 kDa, confirming Oscar Ratnoff's previous finding of a single-chain activated form of FXII that he called 'HFea'. Functional assays have shown that these autoactivation products exhibit procoagulant potential (protease activity inducing clotting of blood) or amidolytic potential (cleaves amino bonds in s-2302 chromogen but do not cause coagulation of plasma) or both amidolytic potential and procoagulant potential. Some of these proteins also have the remarkable potential to 'suppress autoactivation' (i.e. suppress creation of enzymes with procoagulant potential). It is thus hypothesized that autoactivation of FXII in the absence of plasma proteins generates not just a single type of activated conformer, as suggested by previous researchers, but rather an ensemble of conformer products with collective activity that varies with activator surface energy used in contact activation of FXII. Furthermore, reaction of αFXIIa with FXII in buffer solution does not produce additional αFXIIa by the putative autoamplification reaction FXIIa + FXII â†’ 2FXIIa as has been proposed in past literature to account for the discrepancy between chromogenic and plasma-coagulation assays for αFXIIa in buffer solution. Instead, net procoagulant activity measured directly by plasma-coagulation assays, decreases systematically with increasing FXII solution concentration. Under the same reaction conditions, chromogenic assay reveals that net amidolytic activity increases with increasing FXII solution concentration. Thus, although autoamplification does not occur it appears that there is some form of "FXII self reaction" that influences products of αFXIIa reaction with FXII. Electrophoretic measurements indicate that no proteolytic cleavage takes in this reaction leading us to conclude that change in activity is most likely due to change(s) in FXII conformation (with related change in enzyme activity).