An exceptional trait of the quantum Hall effect is quantum adiabatic transport, dissipationless quantized edge transport that is robust to bias voltages multiple orders of magnitude larger than any known relevant energy scale. This enables stable and highly sensitive measurements in quantum metrology at temperatures above 1 K. In contrast, prior experiments have shown that an electrical bias of the same order applied to the quantum anomalous Hall edge modes in magnetic topological insulators causes a breakdown of quantization, resulting from material limitations (electric field activates bulk transport). In this paper, to mitigate the effects of this electric field and study edge transport at a large electrical bias, we utilize electrochemical potential balancing. We find that electrical transport along the edge of a quantum anomalous Hall insulator is ubiquitously of dissipationless quantum adiabatic nature. In fact, we can verify that the adiabaticity holds at least up to an applied bias voltage of some 600 mV at 4.2 K, multiple orders of magnitude larger than any known energy scale associated with the quantum anomalous Hall state. This is a level of robustness on par with the conventional quantum Hall modes used in mainstream metrology.
2D van der Waals (vdW) magnets provide new opportunities for spin-orbit torque magnetoresistive random-access memory (SOT-MRAM) due to their unique properties. Electrically manipulating the magnetization of vdW magnets is key to realizing 2D SOT-MRAM, whereas conventional spin Hall materials such as heavy metals and topological insulators suffer from limitations in torque efficiency and energy consumption. Although recent studies show that the orbital Hall conductivity in light metals greatly exceeds the spin Hall conductivity, direct experimental demonstrations that the orbital Hall effect (OHE) can induce more energy-efficient SOT switching than the spin Hall effect in vdW magnets remain scarce. Here, we utilize Cr as the orbital current source to efficiently manipulate the magnetization of the vdW ferromagnet Fe3GaTe2 at room temperature. In the Fe3GaTe2/Pt (1.5 nm)/Cr (4.5 nm) trilayer structure, the orbital current originating from Cr is converted into the spin current via Pt, which then exerts a torque on Fe3GaTe2. Compared with control samples using 6 nm Pt as the spin current source, the switching current density in OHE-based devices is reduced by ∼3.9 times, resulting in a ∼52% reduction in power consumption. This work presents the promising potential of harnessing orbital currents to realize energy-efficient 2D SOT-MRAM.
Spontaneous isospin ordering fundamentally reshapes quantum nonlinear transport, yet the nature of nonlinear responses in strongly correlated and symmetry-broken quantum states remain largely unexplored. In this work, we investigate a regime where symmetry breaking is not static but emerges dynamically as a tunable property of the electronic system, driven by strong correlations. Using high-quality, dual-gated Bernal bilayer graphene, we observe a giant nonlinear Hall conductivity (9.1 µm S V⁻¹) that manifests strongly in a field-driven isospin-polarized phase. In this correlated regime, the nonlinear conductivity scales exponentially with the linear conductivity, in stark contrast to the quadratic scaling expected in conventional nonlinear systems. Combined with quantum oscillation measurements and self-consistent theoretical modelling, our results indicate that this giant response is closely linked to an interaction-driven valley-polarized state. Our findings establish spontaneous isospin symmetry breaking as an effective route to giant nonlinear quantum transport, where interaction-enhanced skew scattering emerges as the dominant transport mechanism.
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Non-contact flexible sensors, capable of perceiving spatial physical fields without direct contact, overcome the inherent limitations of conventional contact-based counterparts such as mechanical wear, poor stability, and discomfort. This review systematically presents the research progress of non-contact flexible sensors. It elaborates diverse working principles including capacitive coupling, Hall effect, magnetoresistance, thermoelectric effect, infrared radiation, ultrasound, and photoelectric sensing, followed by a comparative analysis of their sensitivity, response speed, and applicable scenarios. Effective strategies for enhancing sensing performance are summarized from materials and structural perspectives, including high-sensitivity functional materials, bioinspired microstructures, and three-dimensional integration. Typical applications in medical health monitoring, bioinspired electronic skin, robotic perception, and human-machine interaction are highlighted. Finally, major challenges and future trends are discussed. Non-contact flexible sensors signify a paradigm shift from surface-based to spatial sensing, laying a foundation for smarter, more natural, and sustainable sensing systems.
In austere environments, surgeons commonly use a manual brace instead of a power drill to insert external fixation pins. Yet the biomechanical performance of manually inserted pins is uncertain. This study aimed to compare the pull-out strength of external fixator pins inserted with a manual brace with that of pins inserted with a power drill. We hypothesized that manual insertion would result in reduced pull-out strength compared to powered methods. Self-drilling, self-tapping external fixator pins were inserted into 90 porcine femoral shaft segments using 3 techniques: hand drilled, power drilled, and pre-drilled/power-inserted. Each of the 3 techniques was performed by 3 surgeons, with a total of 30 specimens per technique and equal distribution between diaphyseal and metaphyseal bone. Pull-out strength to failure was measured using a materials testing machine. A generalized linear mixed effects model (GLMM) (least squares means [LMS] ± standard error) and post hoc pairwise comparisons were utilized for statistical analysis. A GLMM identified drilling technique (P = .02) and diaphyseal pin location (P = .03) as significant predictors of pin pull-out strength, while the performing surgeon had no significant effect. Contrary to the hypothesis, post hoc pairwise analysis demonstrated hand drilled pins (LMS: 1,542.6 N ± 74.7) had significantly greater pull-out strength compared to both power drilled (LMS: 1,344.2 N ± 74.1) and pre-drilled/power-inserted pins (LMS: 1,248.5 N ± 89.8) (P = .05 and .006, respectively). No significant difference was observed between the power drilled and pre-drilled power-inserted techniques. The pull-out strength of pins inserted with a hand brace was superior to that of pins inserted with power tools. This finding challenges common assumptions about the mechanical inferiority of manual drilling. These findings support the continued use and funding of hand drilled external fixator training programs within military and humanitarian aid settings. Finally, pre-drilling does not appear to confer any mechanical advantage over direct, powered pin insertion.
As a prototypical topological insulator, the bismuth-antimony (Bi1-xSbx) alloy offers both a large spin Hall angle and high carrier mobility. However, preserving their surface-dominated transport properties in the quasi-two-dimensional (quasi-2D) limit remains challenging due to carrier scattering induced by surface roughness. Here, we report a laminated growth strategy followed by a self-diffusion process that enables the fabrication of high-quality quasi-2D Bi1-xSbx films with precisely controlled compositions, smooth surfaces, and the preferred (00l) orientation. The effective mass of Bi1-xSbx can be effectively manipulated by controlling the Sb content. Notably, the surface roughness of the Bi0.5Sb0.5 film (∼0.2 nm) is substantially lower than that of pure Bi (∼7.6 nm) and pure Sb (∼6.3 nm), indicating effective suppression of surface scattering. As a result, the 2D Bi0.5Sb0.5 films exhibit a high room-temperature electron mobility of up to 1500 cm2 V-1 s-1. The optimized surface quality also yields a 20-fold enhancement in mobility relative to previous BiSb films of similar thicknesses. Furthermore, Ti/Bi0.5Sb0.5/Pt Schottky diodes fabricated from these films demonstrate a cut-off frequency of 48 GHz, underscoring their potential for high-frequency rectification and advanced 6G communication applications.
The Lancet Oncology Commission on Global Cancer Surgery recommended that access to and the quality of surgical care be improved. This study aimed to understand differences in surgical quality between emergency and elective resection among patients with potentially curative colorectal cancer. This preplanned secondary analysis included patients undergoing only curative-intent surgery for colorectal cancer from three contemporary global prospective cohort studies (GlobalSurg-3, 5506 patients; CovidSurg-Cancer, 6719 patients; APOLLO, 876 patients) registered from 2018 to 2023. Hierarchical multilevel logistic regression models quantified associations between the urgency of surgery (elective versus emergency) and surgical quality, measured by margin-positive resection, adjusting for patient, disease, and health system factors. Bootstrap multivariable simulations evaluated effect modification by country income level, cancer stage, and location. Of the 45 699 patients registered, 13 101 across 95 countries were included in this analysis. Overall, 678 patients (5.4%) had margin-positive resections, with higher rates in the emergency than elective surgery group (13.7 versus 4.5%; P < 0.0001). In adjusted multilevel models, emergency surgery was associated with increased odds of margin-positive resections (adjusted odds ratio 2.45, 95% confidence interval (c.i.) 1.86 to 3.22), consistent across all country income groups and robust to alternative health system indicators. Bootstrap-derived absolute risk differences revealed the greatest disparities in patients with stage III-IV rectal cancers, with absolute differences of 12.6% (95% c.i. 10.2 to 15.7) in high-income countries, 19.0% (95% c.i. 13.6 to 23.9) in upper middle-income countries, and 14.1% (95% c.i. 10.9 to 16.5) in lower middle- and low-income countries. Variance decomposition demonstrated that hospital- and country-level factors accounted for 76% of the explained variation in surgical quality. Emergency surgery was associated with a two- to threefold increase in the risk of margin-positive resections globally, independent of resource availability, highlighting a neglected area of global surgical practice. These findings challenge the assumption that poorer outcomes after emergency surgery are due to advanced disease stage. For patients presenting as an emergency with potentially curative resection, enhanced decision-making around resectability, ensuring specialist surgeon availability, and developing bridge-to-surgery pathways represent immediate, low-cost strategies to improve global cancer outcomes.
Workflow Management Systems (WMSs) make it easier to run bioinformatics analyses by combining tools into reusable workflows. However, selecting the right WMS can be challenging, particularly for users from noncomputational backgrounds. Many reviews of WMSs focus on technical details or only consider usability from the perspective of developers. The first objective of this scoping review was to identify the characteristics of bioinformatics WMSs that are most relevant for life scientists. The second objective was to explore how these characteristics have previously been evaluated. The review included 21 papers published since 2018 that evaluated bioinformatics WMSs based on criteria relating to the user experience. Published papers and websites describing 55 currently available WMSs were also included to identify characteristics highlighted by their developers. Twelve themes emerged from these evaluation criteria and WMS characteristics: Basic Computing, Functions, Security, Scalability, Cost/Efficiency, Sustainability, Usability, Learnability, Reproducibility, FAIRness (Findability, Accessibility, Interoperability, Reusability), Flexibility, and Support. Evaluations focusing on the needs of noncomputational users preferred Graphical User Interfaces and platforms that provided plenty of guidance for users. Papers prioritizing the needs of developers instead favoured text-based interfaces and flexible platforms that gave users greater control. In addition to these contrasting views on what was considered a positive characteristic, differences in how criteria were defined and scored meant that evaluations could not be compared between papers and would be impossible for users to repeat on new or updated WMSs. Users do not currently have a clear approach to follow when selecting a WMS.
Black women are under-represented in clinical research, contributing to persistent health inequities and undermining the validity and generalisability of research findings. Understanding facilitators and barriers to their research engagement is essential to addressing these challenges. This study aimed to identify and synthesise evidence on barriers and facilitators which influence Black women's participation in healthcare research, to inform inclusive recruitment strategies and equitable research designs. This systematic review was conducted in accordance with PRISMA guidelines and registered with PROSPERO (CRD42024587308). Findings were narratively synthesised using thematic analysis and discussed iteratively through Patient and Public Involvement. Five databases were searched (CINAHL, PsycInfo, Embase, MIDIRS, MEDLINE) for studies published since 2010. Papers in any language were screened for inclusion. Patient and Public Involvement members informed review objectives and data interpretation. Primary research studies reporting on Black women's experiences, attitudes, and facilitators/barriers to participating in any type of healthcare research. Studies were included if ≥ 50% (to ensure primary representation) of the sample recruited were Black women. Seventy-two studies were included. Most were from America and spanned research areas relating to oncology, Human Immunodeficiency Virus (HIV), dementia, maternity, and general health. Five overarching themes identified how Black women's participation in healthcare research is shaped by a complexity of factors. These were mistrust, interpersonal experiences, altruism, self-interest, and low health/research literacy and awareness. Patient and Public Involvement consultations concurred that the findings aligned with a "bridge and barriers" analogy, illustrating how various factors can facilitate or prevent Black women from engaging with research opportunities. This provided a clear framework to guide culturally sensitive implementation for researchers, healthcare professionals, and policymakers. Inclusive strategies for recruiting Black women into research must focus on co-constructing a bridge between communities and research systems. This requires structural and systemic change in research delivery environments and ongoing collaborations with all stakeholders including Black women, healthcare system providers, and research teams. PROSPERO (CRD42024587308).
Scaling up opioid stewardship interventions without compromising their effectiveness is complex and requires careful consideration. Furthermore, scaling up within resource-constrained rural and remote hospitals is even more complex given the additional challenges of geographical isolation, transient workforce, and population-specific needs. This multi-method study assessed the potential scalability of the Opioid Stewardship Framework across Queensland, Australia, addressing risks associated with hospital-initiated opioid use and post-discharge harms. The Intervention Scalability Assessment Tool (ISAT) was used to guide the scalability assessment. A variety of approaches was used, including a document review, an online survey, qualitative interviews, and a focus group. The assessment process sought to identify factors influencing the likelihood of successful scale-up. Ten participants from six hospitals across urban, regional, remote, and rural localities took part. This included pharmacists, medical staff, and people in clinical and senior management roles. The participants rated the importance of the problem and the effectiveness of the Framework highly, while infrastructure and cost considerations received lower ratings. The lower ratings in some domains reflected concerns that dedicated support was essential for successful implementation, particularly in rural/remote settings. The Framework shows promise for scale-up in remote and rural settings, as it aligns with the broader strategic and political context of opioid safety. However, the moderate to low scores across several implementation and resource-related domains highlight a range of potential issues that would need to be addressed prior to scale-up, including specific allocation for dedicated implementation support. http://links.lww.com/IJEBH/A660.
Transition-metal-based kagome compounds have recently attracted considerable attention due to their rich correlated electronic states and unconventional quantum transport phenomena, as well as their potential for anisotropic magnetotransport functionalities. Here, we report magnetic field-induced rotational symmetry distortion of the in-plane anisotropic magnetoresistance (AMR) in kagome semimetal Ni3In2Se2 nanoflakes synthesized via an iterative chemical vapor transport approach. High-quality Ni3In2Se2 nanoflakes possess a canted ferromagnetic order, along with a large magnetoresistance of 590%, an out-of-plane AMR of 200%, and a carrier mobility up to 8761 cm2 V-1 s-1. Furthermore, a large in-plane AMR of 41% and the planar Hall effect (PHE) are detected in Ni3In2Se2, with PHE stemming from the complex interaction of field-induced ferromagnetism and orbital magnetoresistance. Notably, the in-plane AMR exhibits a field-induced rotational symmetry distortion, characterized by the coexistence of the two-, four-, and six-fold AMR components. Band structure calculations suggest that the low-temperature distortions in the AMR of Ni3In2Se2 may arise from field-induced orbital polarization and field-enhanced Fermi surface anisotropy. Our findings contribute to understanding exotic transport behaviors in kagome semimetals and advancing low-power electronic devices and future spintronic applications.
Achieving fully electrically controlled magnetization switching of magnetically compensated synthetic antiferromagnets grown on flexible substrates would significantly advance high-density wearable memory and neuromorphic spintronic applications. Here, we illustrate the field-free spin-orbit-torque (SOT)-driven perpendicular magnetization switching in high-quality Pt/CoPt/Ru/CoTb synthetic antiferromagnets grown on polyimide substrates, which exhibit room-temperature compensated magnetization and enhanced anomalous Hall resistance at remanence. A 3% tensile strain induces a 390 Oe shift in the interlayer exchange coupling field and reduces the field-free SOT switching ratio to ∼28%. Crucially, the near-linear nonvolatile synaptic plasticity and neuronal nonlinearity of this field-free SOT switching are preserved under bending, stretching, and tensile fatigue. Leveraging these experimentally measured synaptic and neuronal characteristics, we computationally implemented a fully connected neural network, achieving simulated recognition accuracies exceeding 95.8% for handwritten digits and 86.2% for fashion products. These results offer an effective method for developing flexible spintronic devices.
Drug-induced liver injury affects some people living with HIV (PWH) during antiretroviral therapy (ART). We examined associations of polygenic risk scores (PRS) with liver injury during ART. We derived PRS using summary statistics from the Veterans Affairs Million Veteran Program (MVP) and the Penn Medicine BioBank (PMBB). We constructed PRS for individuals of African (AFR) and European (EUR) ancestry in 3,619 treatment-naïve participants from ART-naive studies of the Advancing Clinical Therapeutics Globally (ACTG) network. Liver injury was defined as incident grade 3 or greater alanine aminotransferase (ALT) within 48 weeks. Associations were evaluated by multivariable regression models. Clinical variables associated with higher baseline ALT values included hepatitis B or C virus infection, increasing BMI and age, and male sex. In analyses of liver injury among 1,897 EUR participants (28 cases, 1869 controls) and 1722 AFR participants (21 cases, 1701 controls), HBV was associated with liver injury in both EUR and AFR participants, and HCV in EUR participants (p < 0.001 for each). PRSALT was not independently associated with incident liver injury in either EUR or AFR participants. No association was observed between baseline PRSALT and subsequent liver injury following initiation of ART. Some people living with HIV (PWH) experience liver injury after starting antiretroviral therapy (ART). Liver injury causes liver enzymes in the blood to increase. Differences in liver enzyme levels between people may be inherited. We hypothesized that an individual’s genetic underpinnings may identify who is at most risk for liver injury after starting ART. We tested whether a polygenic risk score, for alanine aminotransferase (ALT) and metabolic dysfunction-associated steatotic liver disease (MASLD), which is a way to classify each person’s cumulative genetic risk for a condition, identified who is more likely to have liver injury after starting ART. We generated polygenic scores for ALT from the Penn Medicine BioBank and MASLD from the VA Million Veteran Program, and then tested these on past participants from large, randomized ART clinical trials. We found that polygenic scores of ALT and MASLD did not help to identify who was more likely to develop liver injury.
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Vaginal reconstruction is limited by the lack of biomaterials that replicate the structure, biomechanics, and biochemistry of the native tissues. Synthetic meshes, xenografts, and autologous skin or bowel grafts are hindered by their immunogenicity, poor integration, and non-physiological properties. We report a scalable platform for the fabrication of patient-specific living vaginal grafts from autologous fibroblasts.Using scaffold-free micromolding and automated assembly, fibroblasts from small full-thickness vaginal biopsies self-assembled into a collagen-rich, highly aligned extracellular matrix that mimicked the native architecture. The twisted subunit assemblies displayed highly aligned collagen, dense cellularity, and a predominantly quiescent fibroblast phenotype with minimal myofibroblast activation. This autologous tissue-specific construct addresses the shortcomings of current materials and offers a customizable and biocompatible solution for regenerative gynecology. By combining tissue specificity, immunologic safety, and modular scalability, this approach has the potential to transform surgical options for congenital anomalies, sex-affirming surgeries, post-oncologic reconstruction, fistula repair, and pelvic organ prolapse.
Military-connected children with medical complexity (CMC) have multifaceted healthcare needs. This study describes the share of ambulatory care delivered to young military-connected CMC within civilian and military health facilities, identifies the predominant clinician providing care, and identifies factors associated with having a predominant clinician at a civilian health facility. This retrospective cohort study analyzed United States military Birth and Infant Health Research program data, 2009-2020. The Complex Chronic Condition and Pediatric Medical Complexity algorithms were used to identify CMC <5 years. The clinician and care setting for each ambulatory care visit were determined, and the clinician providing the plurality of care each year from birth through five years was identified. Generalized estimating equations were used to identify factors associated with having a predominant clinician at a civilian health facility. Among 66,920 CMC, 68.7% (n=46,001) received care at both military and civilian health facilities. The proportion with a predominant clinician at a civilian facility ranged from 45.5% (n=17,953) during infancy to 54.5% (n=28,568) by five years. Child-level factors associated with having a civilian predominant clinician included preterm delivery, older age at diagnosis, multisystem disease, and technology dependence. Two-thirds of military-connected young CMC received ambulatory care across both military and civilian facilities, with increasing reliance on clinicians at civilian facilities beyond infancy and as complexity increased. These findings highlight the importance of coordinated care across healthcare sectors to address the unique needs of military-connected CMC and their families.
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