Adequacy of care during interfacility transfer in Taiwan: A pilot study.

BACKGROUND/PURPOSE: Interfacility transfer (IFT) in Asian communities is seldom discussed. We aimed to describe the characteristics of IFT in Taiwan and to explore the adequacy of care during transfer. METHODS: A retrospective, cross-sectional, descriptive study was conducted using standardized, paper-based interfacility ambulance transfer records between 1 January 2018 and 31 January 2018 from Tainan City, Taiwan. The mode of patient care needed was classified as advanced life support (ALS) or basic life support (BLS) cares based on clinical conditions. ALS providers were defined as physicians and EMT-Paramedics, while BLS providers were defined as nurse practitioners, nurses, EMT-1s and EMT-2s. RESULTS: Of the 377 (227 [60.2%] were >65 years old; 219 [58.1%] were male) IFTs enrolled in the final analysis, 210 (55.7%) patients met the ALS transfer criteria, with poor consciousness (n = 158), tachypnea (n = 17), tachycardia (n = 5), bradycardia (n = 7), hypertension (n = 12), hypotension (n = 13), hypoxia (n = 4), endotracheal intubation (n = 18), a tracheostomy (n = 25), a precipitous labor (n = 1), and after resuscitation for out-of-hospital cardiac arrest (n = 10) or in-hospital cardiac arrest (n = 3). None of the patients who required ALS care had adequate ambulance staffing. Of the 167 BLS IFTs, 9 (5.4%) patients deteriorated and required ALS care during transportation, which included worsened consciousness (n = 2), tachycardia (n = 1), hypertension (n = 2), hypotension (n = 1), and hypoxia (n = 3). The rates of deterioration during BLS-transferals from the emergency departments, general wards, nursing facilities, and unknown areas were 4.8%, 4.7%, 7.7%, and 7.1%, respectively (p = 0.93). CONCLUSION: The patient care during IFT in Taiwan is inadequate currently and should warrant attention.

Anomalous Hall effect in Weyl semimetal half-Heusler compounds RPtBi (R = Gd and Nd).

Topological materials ranging from topological insulators to Weyl and Dirac semimetals form one of the most exciting current fields in condensed-matter research. Many half-Heusler compounds, RPtBi (R = rare earth), have been theoretically predicted to be topological semimetals. Among various topological attributes envisaged in RPtBi, topological surface states, chiral anomaly, and planar Hall effect have been observed experimentally. Here, we report an unusual intrinsic anomalous Hall effect (AHE) in the antiferromagnetic Heusler Weyl semimetal compounds GdPtBi and NdPtBi that is observed over a wide temperature range. In particular, GdPtBi exhibits an anomalous Hall conductivity of up to 60 Ω-1⋅cm-1 and an anomalous Hall angle as large as 23%. Muon spin-resonance (µSR) studies of GdPtBi indicate a sharp antiferromagnetic transition (TN) at 9 K without any noticeable magnetic correlations above TN Our studies indicate that Weyl points in these half-Heuslers are induced by a magnetic field via exchange splitting of the electronic bands at or near the Fermi energy, which is the source of the chiral anomaly and the AHE.

Bursting at the seams: Rippled monolayer bismuth on NbSe2.

Bismuth, one of the heaviest semimetals in nature, ignited the interest of the materials physics community for its potential impact on topological quantum material systems that use its strong spin-orbit coupling and unique orbital hybridization. In particular, recent theoretical predictions of unique topological and superconducting properties of thin bismuth films and interfaces prompted intense research on the growth of submonolayers to a few monolayers of bismuth on different substrates. Similar to bulk rhombohedral bismuth, the initial growth of bismuth films on most substrates results in buckled bilayers that grow in either the (111) or (110) directions, with a lattice constant close to that of bulk Bi. By contrast, we show a new growth pattern for bismuth monolayers on NbSe2. We find that the initial growth of Bi can form a strongly bonded commensurate layer, resulting in a compressively strained two-dimensional (2D) triangular lattice. We also observed unique pattern of 1D ripples and domain walls is observed. The single layer of bismuth also introduces strong marks on the electronic properties at the surface.

Electronic properties of topological insulator candidate CaAgAs.

The topological phases of matter provide the opportunity to observe many exotic properties, such as the existence of 2D topological surface states in the form of Dirac cones in topological insulators and chiral transport through the open Fermi arc in Weyl semimetals. However, these properties affect the transport characteristics and, therefore, may be useful for applications only if the topological phenomena occur near the Fermi level. CaAgAs is a promising candidate for which the ab initio calculations predict line-nodes at the Fermi energy. However, the compound transforms into a topological insulator on considering spin-orbit interaction. In this study, we investigated the electronic structure of CaAgAs with angle-resolved photoemission spectroscopy (ARPES), ab initio calculations, and transport measurements. The results from ARPES show that the bulk valence band crosses the Fermi energy at the Γ-point. The measured band dispersion matches the ab initio calculations closely when shifting the Fermi energy in the calculations by -0.5 eV. The ARPES results are in good agreement with transport measurements, which show abundant p-type carriers.

Chiral magnetoresistance in the Weyl semimetal NbP.

NbP is a recently realized Weyl semimetal (WSM), hosting Weyl points through which conduction and valence bands cross linearly in the bulk and exotic Fermi arcs appear. The most intriguing transport phenomenon of a WSM is the chiral anomaly-induced negative magnetoresistance (NMR) in parallel electric and magnetic fields. In intrinsic NbP the Weyl points lie far from the Fermi energy, making chiral magneto-transport elusive. Here, we use Ga-doping to relocate the Fermi energy in NbP sufficiently close to the W2 Weyl points, for which the different Fermi surfaces are verified by resultant quantum oscillations. Consequently, we observe a NMR for parallel electric and magnetic fields, which is considered as a signature of the chiral anomaly in condensed-matter physics. The NMR survives up to room temperature, making NbP a versatile material platform for the development of Weyltronic applications.

Multiple Dirac cones at the surface of the topological metal LaBi.

The rare-earth monopnictide LaBi exhibits exotic magneto-transport properties, including an extremely large and anisotropic magnetoresistance. Experimental evidence for topological surface states is still missing although band inversions have been postulated to induce a topological phase in LaBi. In this work, we have revealed the existence of surface states of LaBi through the observation of three Dirac cones: two coexist at the corners and one appears at the centre of the Brillouin zone, by employing angle-resolved photoemission spectroscopy in conjunction with ab initio calculations. The odd number of surface Dirac cones is a direct consequence of the odd number of band inversions in the bulk band structure, thereby proving that LaBi is a topological, compensated semimetal, which is equivalent to a time-reversal invariant topological insulator. Our findings provide insight into the topological surface states of LaBi's semi-metallicity and related magneto-transport properties.

Negative magnetoresistance without well-defined chirality in the Weyl semimetal TaP.

Weyl semimetals (WSMs) are topological quantum states wherein the electronic bands disperse linearly around pairs of nodes with fixed chirality, the Weyl points. In WSMs, nonorthogonal electric and magnetic fields induce an exotic phenomenon known as the chiral anomaly, resulting in an unconventional negative longitudinal magnetoresistance, the chiral-magnetic effect. However, it remains an open question to which extent this effect survives when chirality is not well-defined. Here, we establish the detailed Fermi-surface topology of the recently identified WSM TaP via combined angle-resolved quantum-oscillation spectra and band-structure calculations. The Fermi surface forms banana-shaped electron and hole pockets surrounding pairs of Weyl points. Although this means that chirality is ill-defined in TaP, we observe a large negative longitudinal magnetoresistance. We show that the magnetoresistance can be affected by a magnetic field-induced inhomogeneous current distribution inside the sample.

Superconductivity in Weyl semimetal candidate MoTe2.

Transition metal dichalcogenides have attracted research interest over the last few decades due to their interesting structural chemistry, unusual electronic properties, rich intercalation chemistry and wide spectrum of potential applications. Despite the fact that the majority of related research focuses on semiconducting transition-metal dichalcogenides (for example, MoS2), recently discovered unexpected properties of WTe2 are provoking strong interest in semimetallic transition metal dichalcogenides featuring large magnetoresistance, pressure-driven superconductivity and Weyl semimetal states. We investigate the sister compound of WTe2, MoTe2, predicted to be a Weyl semimetal and a quantum spin Hall insulator in bulk and monolayer form, respectively. We find that bulk MoTe2 exhibits superconductivity with a transition temperature of 0.10 K. Application of external pressure dramatically enhances the transition temperature up to maximum value of 8.2 K at 11.7 GPa. The observed dome-shaped superconductivity phase diagram provides insights into the interplay between superconductivity and topological physics.

Robust 2D topological insulators in van der Waals heterostructures.

We predict a family of robust two-dimensional (2D) topological insulators in van der Waals heterostructures comprising graphene and chalcogenides BiTeX (X = Cl, Br, and I). The layered structures of both constituent materials produce a naturally smooth interface that is conducive to proximity-induced topological states. First-principles calculations reveal intrinsic topologically nontrivial bulk energy gaps as large as 70-80 meV, which can be further enhanced up to 120 meV by compression. The strong spin-orbit coupling in BiTeX has a significant influence on the graphene Dirac states, resulting in the topologically nontrivial band structure, which is confirmed by calculated nontrivial Z2 index and an explicit demonstration of metallic edge states. Such heterostructures offer a unique Dirac transport system that combines the 2D Dirac states from graphene and 1D Dirac edge states from the topological insulator, and it offers ideas for innovative device designs.

Prediction of near-room-temperature quantum anomalous Hall effect on honeycomb materials.

Recently, the long-sough quantum anomalous Hall effect was realized in a magnetic topological insulator. However, the requirement of an extremely low temperature (approximately 30 mK) hinders realistic applications. Based on ab initio band structure calculations, we propose a quantum anomalous Hall platform with a large energy gap of 0.34 and 0.06 eV on honeycomb lattices comprised of Sn and Ge, respectively. The ferromagnetic (FM) order forms in one sublattice of the honeycomb structure by controlling the surface functionalization rather than dilute magnetic doping, which is expected to be visualized by spin polarized STM in experiment. Strong coupling between the inherent quantum spin Hall state and ferromagnetism results in considerable exchange splitting and, consequently, an FM insulator with a large energy gap. The estimated mean-field Curie temperature is 243 and 509 K for Sn and Ge lattices, respectively. The large energy gap and high Curie temperature indicate the feasibility of the quantum anomalous Hall effect in the near-room-temperature and even room-temperature regions.

Graphene-based topological insulator with an intrinsic bulk band gap above room temperature.

Topological insulators (TIs) represent a new quantum state of matter characterized by robust gapless states inside the insulating bulk gap. The metallic edge states of a two-dimensional (2D) TI, known as the quantum spin Hall (QSH) effect, are immune to backscattering and carry fully spin-polarized dissipationless currents. However, existing 2D TIs realized in HgTe and InAs/GaSb suffer from small bulk gaps (<10 meV) well below room temperature, thus limiting their application in electronic and spintronic devices. Here, we report a new 2D TI comprising a graphene layer sandwiched between two Bi2Se3 slabs that exhibits a large intrinsic bulk band gap of 30-50 meV, making it viable for room-temperature applications. Distinct from previous strategies for enhancing the intrinsic spin-orbit coupling effect of the graphene lattice, the present graphene-based TI operates on a new mechanism of strong inversion between graphene Dirac bands and Bi2Se3 conduction bands. Strain engineering leads to effective control and substantial enhancement of the bulk gap. Recently reported synthesis of smooth graphene/Bi2Se3 interfaces demonstrates the feasibility of experimental realization of this new 2D TI structure, which holds great promise for nanoscale device applications.

First-principles study of the structural stability of cubic, tetragonal and hexagonal phases in Mn3Z (Z=Ga, Sn and Ge) Heusler compounds.

We investigate the structural stability and magnetic properties of the cubic, tetragonal and hexagonal phases of Mn3Z (Z=Ga, Sn and Ge) Heusler compounds using first-principles density-functional theory. We propose that the cubic phase plays an important role as an intermediate state in the phase transition from the hexagonal to the tetragonal phases. Consequently, Mn3Ga and Mn3Ge behave differently from Mn3Sn, because the relative energies of the cubic and hexagonal phases are different. This result agrees with experimental observations for these three compounds. The weak ferromagnetism of the hexagonal phase and the perpendicular magnetocrystalline anisotropy of the tetragonal phase obtained in our calculations are also consistent with experiment.

C. elegans EIF-3.K promotes programmed cell death through CED-3 caspase.

Programmed cell death (apoptosis) is essential for the development and homeostasis of metazoans. The central step in the execution of programmed cell death is the activation of caspases. In C. elegans, the core cell death regulators EGL-1(a BH3 domain-containing protein), CED-9 (Bcl-2), and CED-4 (Apaf-1) act in an inhibitory cascade to activate the CED-3 caspase. Here we have identified an additional component eif-3.K (eukaryotic translation initiation factor 3 subunit k) that acts upstream of ced-3 to promote programmed cell death. The loss of eif-3.K reduced cell deaths in both somatic and germ cells, whereas the overexpression of eif-3.K resulted in a slight but significant increase in cell death. Using a cell-specific promoter, we show that eif-3.K promotes cell death in a cell-autonomous manner. In addition, the loss of eif-3.K significantly suppressed cell death-induced through the overexpression of ced-4, but not ced-3, indicating a distinct requirement for eif-3.K in apoptosis. Reciprocally, a loss of ced-3 suppressed cell death induced by the overexpression of eif-3.K. These results indicate that eif-3.K requires ced-3 to promote programmed cell death and that eif-3.K acts upstream of ced-3 to promote this process. The EIF-3.K protein is ubiquitously expressed in embryos and larvae and localizes to the cytoplasm. A structure-function analysis revealed that the 61 amino acid long WH domain of EIF-3.K, potentially involved in protein-DNA/RNA interactions, is both necessary and sufficient for the cell death-promoting activity of EIF-3.K. Because human eIF3k was able to partially substitute for C. elegans eif-3.K in the promotion of cell death, this WH domain-dependent EIF-3.K-mediated cell death process has potentially been conserved throughout evolution.

The subjective sleep quality and heart rate variability in hemodialysis patients.

INTRODUCTION: Sleep disturbances and cardiovascular autonomic dysfunction are major complications of hemodialysis (HD). The goal of this study is to identify clinical, heart rate variability (HRV) or laboratory parameters that are independently associated with subjective sleep quality. PATIENT AND METHODS: Forty-six stable HD patients filled out sleep questionnaires - Pittsburgh sleep quality index (PSQI), Athens insomnia scale (AIS), and Epworth sleepiness scale (ESS). In addition, they received analyses of 5-minute HRV twice, in lying posture before and after HD. We also recruited 50 healthy subjects who received 5-min HRV. RESULTS: The patients with end-stage renal disease have a high rate of poor sleep quality according to PSQI, AIS, and ESS. The activities of total power (0-0.5 Hz), high-frequency power (HF, 0.15-0.40 Hz), low-frequency power (0.04-0.15 Hz), and very-low-frequency power (0.003-0.04 Hz) in HD patients are obviously lower than that in the healthy people. The poor sleepers (PSQI > 5) show lower heart rate, higher HF and variance before HD, but did not show a significant difference after HD. There is no significant difference between HRV and global score of AIS, but the insomnia group (AIS > 5) has higher BMI. These patients with sleepiness (ESS > 9) only reveal lower hemoglobin, although the global score of ESS reveals no significant relationship with HRV. CONCLUSION: HD patients have a high rate of poor sleep quality and autonomic dysfunction. Greater attention for the evaluation of sleep quality is needed for the better care of HD patients.