Uncovering the spin ordering in magic-angle graphene via edge state equilibration.

The flat bands in magic-angle twisted bilayer graphene (MATBG) provide an especially rich arena to investigate interaction-driven ground states. While progress has been made in identifying the correlated insulators and their excitations at commensurate moiré filling factors, the spin-valley polarizations of the topological states that emerge at high magnetic field remain unknown. Here we introduce a technique based on twist-decoupled van der Waals layers that enables measurement of their electronic band structure and-by studying the backscattering between counter-propagating edge states-the determination of the relative spin polarization of their edge modes. We find that the symmetry-broken quantum Hall states that extend from the charge neutrality point in MATBG are spin unpolarized at even integer filling factors. The measurements also indicate that the correlated Chern insulator emerging from half filling of the flat valence band is spin unpolarized and suggest that its conduction band counterpart may be spin polarized.

Manipulation of the seagrass-associated microbiome reduces disease severity.

Host-associated microbes influence host health and function and can be a first line of defence against infections. While research increasingly shows that terrestrial plant microbiomes contribute to bacterial, fungal, and oomycete disease resistance, no comparable experimental work has investigated marine plant microbiomes or more diverse disease agents. We test the hypothesis that the eelgrass (Zostera marina) leaf microbiome increases resistance to seagrass wasting disease. From field eelgrass with paired diseased and asymptomatic tissue, 16S rRNA gene amplicon sequencing revealed that bacterial composition and richness varied markedly between diseased and asymptomatic tissue in one of the two years. This suggests that the influence of disease on eelgrass microbial communities may vary with environmental conditions. We next experimentally reduced the eelgrass microbiome with antibiotics and bleach, then inoculated plants with Labyrinthula zosterae, the causative agent of wasting disease. We detected significantly higher disease severity in eelgrass with a native microbiome than an experimentally reduced microbiome. Our results over multiple experiments do not support a protective role of the eelgrass microbiome against L. zosterae. Further studies of these marine host-microbe-pathogen relationships may continue to show new relationships between plant microbiomes and diseases.

Higher rank chirality and non-Hermitian skin effect in a topolectrical circuit.

While chirality imbalances are forbidden in conventional lattice systems, non-Hermiticity can effectively avoid the chiral-doubling theorem to facilitate 1D chiral dynamics. Indeed, such systems support unbalanced unidirectional flows that can lead to the localization of an extensive number of states at the boundary, known as the non-Hermitian skin effect (NHSE). Recently, a generalized (rank-2) chirality describing a 2D robust gapless mode with dispersion ω = kxky has been introduced in crystalline systems. Here we demonstrate that rank-2 chirality imbalances can be established in a non-Hermitian (NH) lattice system leading to momentum-resolved chiral dynamics, and a rank-2 NHSE where there are both edge- and corner-localized skin modes. We then experimentally test this phenomenology in a 2-dimensional topolectric circuit that implements a NH Hamiltonian with a long-lived rank-2 chiral mode. Using impedance measurements, we confirm the rank-2 NHSE in this system, and its manifestation in the predicted skin modes and a highly unusual momentum-position locking response. Our investigation demonstrates a circuit-based path to exploring higher-rank chiral physics, with potential applications in systems where momentum resolution is necessary, e.g., in beamformers and non-reciprocal devices.

Single-port hidden incision endoscopic (HIdES) pediatric nephrectomy via pfannenstiel incision.

Laparoendoscopic single-site surgery (LESS) and hidden incision endoscopic surgery techniques are increasingly used in pediatric urology. For pediatric nephrectomy, access through a single Pfannenstiel incision is novel and may offer cosmetic benefit. In this retrospective study, we describe this approach and assess operative outcomes associated with this technique. Patients who underwent LESS nephrectomy through a single Pfannenstiel incision had minimal blood loss, short length of stay, low risk of surgical complications, and satisfactory wound healing. The Pfannenstiel approach to LESS nephrectomy is feasible, versatile, and achieves excellent operative and cosmetic outcomes, although direct comparison to other approaches is warranted.

Spin-selective tunneling from nanowires of the candidate topological Kondo insulator SmB6.

Incorporating relativistic physics into quantum tunneling can lead to exotic behavior such as perfect transmission through Klein tunneling. Here, we probed the tunneling properties of spin-momentum-locked relativistic fermions by designing and implementing a tunneling geometry that uses nanowires of the topological Kondo insulator candidate samarium hexaboride. The nanowires are attached to the end of scanning tunneling microscope tips and used to image the bicollinear stripe spin order in the antiferromagnet Fe1.03Te with a Neel temperature of about 50 kelvin. The antiferromagnetic stripes become invisible above 10 kelvin concomitant with the suppression of the topological surface states in the tip. We further demonstrate that the direction of spin polarization is tied to the tunneling direction. Our technique establishes samarium hexaboride nanowires as ideal conduits for spin-polarized currents.

Health Disparities in the Treatment of Supraventricular Tachycardia in Pediatric Patients.

Supraventricular tachycardia (SVT) is a common pediatric arrhythmia. The objective of this investigation was to investigate the existence and degree of the health disparities in the treatment of pediatric patients with supraventricular tachycardia based on sociodemographic factors. This was retrospective cohort study at a large academic medical center including children ages 5-18 years old diagnosed with SVT. Patients with congenital heart disease and myocarditis were excluded. Initial treatment and ultimate treatment with either medical management or ablation were determined. The odds of having an ablation procedure were determined based on patient age, sex, race, ethnicity, and insurance status. There was a larger portion of non-White patients (p = 0.033) within the cohort that did not receive an ablation during the study period. Patients that were younger, female, American Indian/Alaskan Native, unknown race, and had missing insurance information were less likely to receive ablation therapy during the study period. In this single center, regional evaluation, we demonstrated that disparities in the treatment of pediatric SVT are present based on multiple patient sociodemographic factors. This study adds evidence to the presence of inequities in health care delivery across pediatric populations.

Bound states at partial dislocation defects in multipole higher-order topological insulators.

The bulk-boundary correspondence, which links a bulk topological property of a material to the existence of robust boundary states, is a hallmark of topological insulators. However, in crystalline topological materials the presence of boundary states in the insulating gap is not always necessary since they can be hidden in the bulk energy bands, obscured by boundary artifacts of non-topological origin, or, in the case of higher-order topology, they can be gapped altogether. Recently, exotic defects of translation symmetry called partial dislocations have been proposed to trap gapless topological modes in some materials. Here we present experimental observations of partial-dislocation-induced topological modes in 2D and 3D insulators. We particularly focus on multipole higher-order topological insulators built from circuit-based resonator arrays, since crucially they are not sensitive to full dislocation defects, and they have a sublattice structure allowing for stacking faults and partial dislocations.

Predicting postoperative complications in pediatric surgery: A novel pediatric comorbidity index.

INTRODUCTION/BACKGROUND: Comorbidity-driven surgical risk assessment is essential for informed patient counseling, risk-stratification, and outcomes-based health-services research. Existing mortality-focused comorbidity indices have had mixed success at risk-adjustment in children. OBJECTIVE: To develop a new comorbidity-driven multispecialty surgical risk index predicting 30-day postoperative complications in children. STUDY DESIGN: This retrospective cohort study investigated children undergoing surgical procedures across seven specialties in 2014-2015 using the MarketScan® Research databases. The risk index was derived separately for ambulatory and inpatient surgery patients using logistic regression with backward selection. The performance of the novel index in discriminating postoperative complications vis-à-vis three existing comorbidity indices was compared using bootstrapping and area under the receiver operating characteristics curves (AUC). RESULTS: We identified 190,629 ambulatory and 22,633 inpatient patients. The novel index had the best performance for discriminating postoperative complications for inpatients (AUC 0.76, 95% confidence interval [CI] 0.75-0.77) relative to the Charlson Comorbidity Index (CCI, 0.56, 95% CI 0.56-0.57), Van Walraven Index (VWI, 0.60, 95% CI 0.60-0.61), and Rhee Score (RS, 0.69, 95% CI 0.68-0.70). In the ambulatory cohort, the novel index outperformed all three existing indices, though none demonstrated excellent discriminatory ability for complications (novel score 0.68, 95% CI 0.67-0.68; CCI 0.53, 95% CI 0.52-0.53; VWI 0.53, 95% CI 0.52-0.53; RS 0.50, 95% CI 0.49-0.50). DISCUSSION: In both inpatient and ambulatory pediatric settings, our novel comorbidity index demonstrated better performance at predicting postoperative complications than three widely used alternatives. This index will be useful for research and may be adaptable to clinical settings to identify high-risk patients and facilitate perioperative planning. CONCLUSION: We developed a novel pediatric comorbidity index with better performance at predicting postoperative complications than three widely used alternatives.

Topological spintronics and magnetoelectronics.

Topological electronic materials, such as topological insulators, are distinct from trivial materials in the topology of their electronic band structures that lead to robust, unconventional topological states, which could bring revolutionary developments in electronics. This Perspective summarizes developments of topological insulators in various electronic applications including spintronics and magnetoelectronics. We group and analyse several important phenomena in spintronics using topological insulators, including spin-orbit torque, the magnetic proximity effect, interplay between antiferromagnetism and topology, and the formation of topological spin textures. We also outline recent developments in magnetoelectronics such as the axion insulator and the topological magnetoelectric effect observed using different topological insulators.

Geometric Response and Disclination-Induced Skin Effects in Non-Hermitian Systems.

We study the geometric response of three-dimensional non-Hermitian crystalline systems with nontrivial point-gap topology. For systems with fourfold rotation symmetry, we show that in the presence of disclination lines with a total Frank angle, which is an integer multiple of 2π, there can be nontrivial one-dimensional point-gap topology along the direction of the disclination lines. This results in disclination-induced non-Hermitian skin effects. By doubling a non-Hermitian Hamiltonian to a Hermitian three-dimensional chiral topological insulator, we show that the disclination-induced skin modes are zero modes of the effective surface Dirac fermion(s) in the presence of a pseudomagnetic flux induced by disclinations. Furthermore, we find that our results have a field theoretic description, and the corresponding geometric response actions (e.g., the Euclidean Wen-Zee action) enrich the topological field theory of non-Hermitian systems.

Evidence for one-dimensional chiral edge states in a magnetic Weyl semimetal Co3Sn2S2.

The physical realization of Chern insulators is of fundamental and practical interest, as they are predicted to host the quantum anomalous Hall (QAH) effect and topologically protected chiral edge states which can carry dissipationless current. Current realizations of the QAH state often require complex heterostructures and sub-Kelvin temperatures, making the discovery of intrinsic, high temperature QAH systems of significant interest. In this work we show that time-reversal symmetry breaking Weyl semimetals, being essentially stacks of Chern insulators with inter-layer coupling, may provide a new platform for the higher temperature realization of robust chiral edge states. We present combined scanning tunneling spectroscopy and theoretical investigations of the magnetic Weyl semimetal, Co3Sn2S2. Using modeling and numerical simulations we find that depending on the strength of the interlayer coupling, chiral edge states can be localized on partially exposed kagome planes on the surfaces of a Weyl semimetal. Correspondingly, our dI/dV maps on the kagome Co3Sn terraces show topological states confined to the edges which display linear dispersion. This work provides a new paradigm for realizing chiral edge modes and provides a pathway for the realization of higher temperature QAH effect in magnetic Weyl systems in the two-dimensional limit.

Evidence for higher order topology in Bi and Bi0.92Sb0.08.

Higher order topological insulators (HOTIs) are a new class of topological materials which host protected states at the corners or hinges of a crystal. HOTIs provide an intriguing alternative platform for helical and chiral edge states and Majorana modes, but there are very few known materials in this class. Recent studies have proposed Bi as a potential HOTI, however, its topological classification is not yet well accepted. In this work, we show that the (110) facets of Bi and BiSb alloys can be used to unequivocally establish the topology of these systems. Bi and Bi0.92Sb0.08 (110) films were grown on silicon substrates using molecular beam epitaxy and studied by scanning tunneling spectroscopy. The surfaces manifest rectangular islands which show localized hinge states on three out of the four edges, consistent with the theory for the HOTI phase. This establishes Bi and Bi0.92Sb0.08 as HOTIs, and raises questions about the topological classification of the full family of BixSb1-x alloys.

Sexual Function and Dysfunction in Individuals with Spina Bifida: A Systematic Review.

OBJECTIVE: To conduct a systematic review of self-reported experiences of sexual function and dysfunction in individuals with spina bifida (SB). MATERIALS AND METHODS: Medline, Embase, and Web of Science were systematically searched. Studies included contained self-reported data from SB patients on one or more of the following sexual function domains: Genital sensitivity, orgasm, erectile function, ejaculation, lubrication, and/or dyspareunia. Two authors independently assessed eligibility, extracted data, and cross-checked results, with disagreements resolved by consensus. Studies included contained self-reported data from SB patients on one or more of the following sexual function domains: Genital sensitivity, orgasm, erectile function, ejaculation, lubrication, and/or dyspareunia. RESULTS: Systematic search yielded 23 studies representing 1441 patients (816 males, 625 females). Eight utilized questionnaires validated in non-SB adults; the remainder used semi-structured interviews and non-validated instruments. Eleven assessed dysfunctions in both sexes, 10 in males, and 2 in females. Erectile function and orgasm were the most commonly assessed outcomes in males and females respectively. 12%-88% of males experienced erectile dysfunction; a majority (51%-90%) reported normal ejaculatory function. Many females were unable to experience orgasm (28%-63%). CONCLUSION: Males with SB report significant erectile and ejaculatory dysfunction. Both sexes report impaired orgasms and genital sensitivity. SB-specific instruments assessing sexual dysfunction are needed in order to improve multidisciplinary care for this population.

Trapped fractional charges at bulk defects in topological insulators.

Topological crystalline insulators (TCIs) can exhibit unusual, quantized electric phenomena such as fractional electric polarization and boundary-localized fractional charge1-6. This quantized fractional charge is the generic observable for identification of TCIs that lack clear spectral features5-7, including ones with higher-order topology8-11. It has been predicted that fractional charges can also manifest where crystallographic defects disrupt the lattice structure of TCIs, potentially providing a bulk probe of crystalline topology10,12-14. However, this capability has not yet been confirmed in experiments, given that measurements of charge distributions in TCIs have not been accessible until recently11. Here we experimentally demonstrate that disclination defects can robustly trap fractional charges in TCI metamaterials, and show that this trapped charge can indicate non-trivial, higher-order crystalline topology even in the absence of any spectral signatures. Furthermore, we uncover a connection between the trapped charge and the existence of topological bound states localized at these defects. We test the robustness of these topological features when the protective crystalline symmetry is broken, and find that a single robust bound state can be localized at each disclination alongside the fractional charge. Our results conclusively show that disclination defects in TCIs can strongly trap fractional charges as well as topological bound states, and demonstrate the primacy of fractional charge as a probe of crystalline topology.

Vortex and Surface Phase Transitions in Superconducting Higher-order Topological Insulators.

Topological insulators, having intrinsic or proximity-coupled s-wave superconductivity, host Majorana zero modes (MZMs) at the ends of vortex lines. The MZMs survive up to a critical doping of the TI at which there is a vortex phase transition that eliminates the MZMs. In this work, we show that the phenomenology in higher-order topological insulators (HOTIs) can be qualitatively distinct. In particular, we find two distinct features. (i) We find that vortices placed on the gapped (side) surfaces of the HOTI, exhibit a pair of phase transitions as a function of doping. The first transition is a surface phase transition after which MZMs appear. The second transition is the well-known vortex phase transition. We find that the surface transition appears because of the competition between the superconducting gap and the local T-breaking gap on the surface. (ii) We present numerical evidence that shows strong variation of the critical doping for the vortex phase transition as the center of the vortex is moved toward or away from the hinges of the sample. We believe our work provides new phenomenology that can help identify HOTIs, as well as illustrating a promising platform for the realization of MZMs.

A fractional corner anomaly reveals higher-order topology.

Spectral measurements of boundary-localized topological modes are commonly used to identify topological insulators. For high-order insulators, these modes appear at boundaries of higher codimension, such as the corners of a two-dimensional material. Unfortunately, this spectroscopic approach is only viable if the energies of the topological modes lie within the bulk bandgap, which is not required for many topological crystalline insulators. The key topological feature in these insulators is instead fractional charge density arising from filled bulk bands, but measurements of such charge distributions have not been accessible to date. We experimentally measure boundary-localized fractional charge density in rotationally symmetric two-dimensional metamaterials and find one-fourth and one-third fractionalization. We then introduce a topological indicator that allows for the unambiguous identification of higher-order topology, even without in-gap states, and we demonstrate the associated higher-order bulk-boundary correspondence.

Robust temporal pumping in a magneto-mechanical topological insulator.

The transport of energy through 1-dimensional (1D) waveguiding channels can be affected by sub-wavelength disorder, resulting in undesirable localization and backscattering phenomena. However, quantized disorder-resilient transport is observable in the edge currents of 2-dimensional (2D) topological band insulators with broken time-reversal symmetry. Topological pumps are able to reduce this higher-dimensional topological insulator phenomena to lower dimensionality by utilizing a pumping parameter (either space or time) as an artificial dimension. Here we demonstrate a temporal topological pump that produces on-demand, robust transport of mechanical energy using a 1D magneto-mechanical metamaterial. We experimentally demonstrate that the system is uniquely resilient to defects occurring in both space and time. Our findings open a path towards exploration of higher-dimensional topological physics with time as a synthetic dimension.

Evidence for dispersing 1D Majorana channels in an iron-based superconductor.

The possible realization of Majorana fermions as quasiparticle excitations in condensed-matter physics has created much excitement. Most studies have focused on Majorana bound states; however, propagating Majorana states with linear dispersion have also been predicted. Here, we report scanning tunneling spectroscopic measurements of crystalline domain walls (DWs) in FeSe0.45Te0.55 We located DWs across which the lattice structure shifts by half a unit cell. These DWs have a finite, flat density of states inside the superconducting gap, which is a hallmark of linearly dispersing modes in one dimension. This signature is absent in DWs in the related superconductor, FeSe, which is not in the topological phase. Our combined data are consistent with the observation of dispersing Majorana states at a π-phase shift DW in a proximitized topological material.

Higher-Order Weyl Semimetals.

We investigate higher-order Weyl semimetals (HOWSMs) having bulk Weyl nodes attached to both surface and hinge Fermi arcs. We identify a new type of Weyl node, which we dub a 2nd-order Weyl node, that can be identified as a transition in momentum space in which both the Chern number and a higher order topological invariant change. As a proof of concept we use a model of stacked higher order quadrupole insulators (QI) to identify three types of WSM phases: 1st order, 2nd order, and hybrid order. The model can also realize type-II and hybrid-tilt WSMs with various surface and hinge arcs. After a comprehensive analysis of the topological properties of various HOWSMs, we turn to their physical implications that show the very distinct behavior of 2nd-order Weyl nodes when they are gapped out. We obtain three remarkable results: (i) the coupling of a 2nd-order Weyl phase with a conventional 1st-order one can lead to a hybrid-order topological insulator having coexisting surface cones and flat hinge arcs that are independent and not attached to each other. (ii) A nested 2nd-order inversion-symmetric WSM by a charge-density wave (CDW) order generates an insulating phase having coexisting flatband surface and hinge states all over the Brillouin zone. (iii) A CDW order in a time-reversal symmetric higher-order WSM gaps out a 2nd-order node with a 1st-order node and generates an insulating phase having coexisting surface Dirac cone and hinge arcs. Moreover, we show that a measurement of charge density in the presence of magnetic flux can help to identify some classes of 2nd-order WSMs. Finally, we show that periodic driving can be utilized as a way for generating HOWSMs. Our results are relevant to metamaterials as well as various phases of Cd_{3}As_{2}, KMgBi, and rutile-structure PtO_{2} that have been predicted to realize higher order Dirac semimetals.