Disordered enthalpy-entropy descriptor for high-entropy ceramics discovery.

The need for improved functionalities in extreme environments is fuelling interest in high-entropy ceramics1-3. Except for the computational discovery of high-entropy carbides, performed with the entropy-forming-ability descriptor4, most innovation has been slowly driven by experimental means1-3. Hence, advancement in the field needs more theoretical contributions. Here we introduce disordered enthalpy-entropy descriptor (DEED), a descriptor that captures the balance between entropy gains and enthalpy costs, allowing the correct classification of functional synthesizability of multicomponent ceramics, regardless of chemistry and structure. To make our calculations possible, we have developed a convolutional algorithm that drastically reduces computational resources. Moreover, DEED guides the experimental discovery of new single-phase high-entropy carbonitrides and borides. This work, integrated into the AFLOW computational ecosystem, provides an array of potential new candidates, ripe for experimental discoveries.

Ultrascaled Contacts to Monolayer MoS2 Field Effect Transistors.

Two-dimensional (2D) semiconductors possess promise for the development of field-effect transistors (FETs) at the ultimate scaling limit due to their strong gate electrostatics. However, proper FET scaling requires reduction of both channel length (LCH) and contact length (LC), the latter of which has remained a challenge due to increased current crowding at the nanoscale. Here, we investigate Au contacts to monolayer MoS2 FETs with LCH down to 100 nm and LC down to 20 nm to evaluate the impact of contact scaling on FET performance. Au contacts are found to display a ∼2.5× reduction in the ON-current, from 519 to 206 µA/µm, when LC is scaled from 300 to 20 nm. It is our belief that this study is warranted to ensure an accurate representation of contact effects at and beyond the technology nodes currently occupied by silicon.

Active pixel sensor matrix based on monolayer MoS2 phototransistor array.

In-sensor processing, which can reduce the energy and hardware burden for many machine vision applications, is currently lacking in state-of-the-art active pixel sensor (APS) technology. Photosensitive and semiconducting two-dimensional (2D) materials can bridge this technology gap by integrating image capture (sense) and image processing (compute) capabilities in a single device. Here, we introduce a 2D APS technology based on a monolayer MoS2 phototransistor array, where each pixel uses a single programmable phototransistor, leading to a substantial reduction in footprint (900 pixels in ∼0.09 cm2) and energy consumption (100s of fJ per pixel). By exploiting gate-tunable persistent photoconductivity, we achieve a responsivity of ∼3.6 × 107 A W-1, specific detectivity of ∼5.6 × 1013 Jones, spectral uniformity, a high dynamic range of ∼80 dB and in-sensor de-noising capabilities. Further, we demonstrate near-ideal yield and uniformity in photoresponse across the 2D APS array.

AI-based classification of three common malignant tumors in neuro-oncology: A multi-institutional comparison of machine learning and deep learning methods.

PURPOSE: To determine if machine learning (ML) or deep learning (DL) pipelines perform better in AI-based three-class classification of glioblastoma (GBM), intracranial metastatic disease (IMD) and primary CNS lymphoma (PCNSL). METHODOLOGY: Retrospective analysis included 502 cases for training (208 GBM, 67 PCNSL and 227 IMD), with external validation on 86 cases (27:27:32). Multiparametric MRI images (T1W, T2W, FLAIR, DWI and T1-CE) were co-registered, resampled, denoised and intensity normalized, followed by semiautomatic 3D segmentation of the enhancing tumor (ET) and peritumoral region (PTR). Model performance was assessed using several ML pipelines and 3D-convolutional neural networks (3D-CNN) using sequence specific masks, as well as combination of masks. All pipelines were trained and evaluated with 5-fold nested cross-validation on internal data followed by external validation using multi-class AUC. RESULTS: Two ML models achieved similar performance on test set, one using T2-ET and T2-PTR masks (AUC: 0.885, 95% CI: [0.816, 0.935] and another using T1-CE-ET and FLAIR-PTR mask (AUC: 0.878, CI: [0.804, 0.930]). The best performing DL models achieved an AUC of 0.854, (CI [0.774, 0.914]) on external data using T1-CE-ET and T2-PTR masks, followed by model derived from T1-CE-ET, ADC-ET and FLAIR-PTR masks (AUC: 0.851, CI [0.772, 0.909]). CONCLUSION: Both ML and DL derived pipelines achieved similar performance. T1-CE mask was used in three of the top four overall models. Additionally, all four models had some mask derived from PTR, either T2WI or FLAIR.

Vertebral pneumaticity of the North American therizinosaur Nothronychus.

Nothronychus was a large, derived therizinosaur from the Upper Cretaceous of Utah and New Mexico. The genus is known from elements that have been referred to single individuals. Therizinosaurs were unusual maniraptoran theropods close to the origin of birds. The axial skeleton is extensively pneumatized, but CT scans reveal an apneumatic synsacrum. Inferred air sacs invade the basicranium, the presacral vertebrae, and the proximal caudal vertebrae, but bypassed the sacrum resulting in a caudosacral hiatus similar to some sauropods and reflecting the development of multiple diverticula from the abdominal air sac. The vertebral pneumatic chambers are described here and compared with those observed in the theropod Allosaurus and the recent avian Dinornis. The vertebrae of Nothronychus are intermediate between those two theropods. It is inferred to have possessed avian-like abdominal air sacs. This theropod would have had unidirectional lungs, as in birds, but this character cannot be related to endothermy.

Transient synaptic potentiation in nucleus accumbens shell during refraining from cocaine seeking.

Repeated exposure to drug-associated cues without reward (extinction) leads to refraining from drug seeking in rodents. We determined if refraining is associated with transient synaptic plasticity (t-SP) in nucleus accumbens shell (NAshell), akin to the t-SP measured in the NAcore during cue-induced reinstatement of drug seeking. Using whole cell patch electrophysiology, we found that medium spiny neurons (MSNs) in NAshell expressed increased ratio of AMPA to NMDA glutamate receptor currents during refraining, which normalized to baseline levels by the end of the 2-hour extinction session. Unlike t-SP observed in NAcore during reinstated drug seeking, neither dendrite spine head enlargement nor activation of matrix metalloproteases (MMP2/9) accompanied the increased AMPA:NMDA in NAshell during refraining. Refraining was also not associated with changes in paired pulse ratio, NMDA receptor current decay time, or AMPA receptor rectification index in NAshell MSNs. Our preliminary data in transgenic mice suggest that t-SP may increase D2-MSN inputs relative to D1-MSN inputs.

Drug Refraining and Seeking Potentiate Synapses on Distinct Populations of Accumbens Medium Spiny Neurons.

Cocaine-associated cues and contexts can precipitate drug seeking in humans and in experimental animals. Glutamatergic synapses in the core subcompartment of the nucleus accumbens (NAcore) undergo transient potentiation in response to presenting drug-associated cues. The NAcore contains two populations of medium spiny neurons (MSNs) that differentially express D1 or D2 dopamine receptors. By recording the ratio of AMPA and NMDA glutamate receptor currents (AMPA/NMDA ratio) from MSNs in NAcore tissue slices, we endeavored to understand which subpopulation of MSNs was undergoing transient potentiation. Transgenic female and male mice differentially expressing fluorescent reporters in D1 or D2 MSNs were withdrawn for 2-3 weeks after being trained to self-administer cocaine. In some mice, discrete cocaine-conditioned cues were isolated from the drug-associated context via extinction training, which causes rodents to refrain from drug seeking in the extinguished context. By measuring AMPA/NMDA ratios in the drug context with or without contextual or discrete cues, and with or without extinction training, we made the following three discoveries: (1) mice refraining from cocaine seeking in the extinguished context showed selective elevation in AMPA/NMDA ratios in D2 MSNs; (2) without extinction training, the drug-associated context selectively increased AMPA/NMDA ratios in D1 MSNs; (3) mice undergoing cue-induced cocaine seeking after extinction training in the drug-associated context showed AMPA/NMDA ratio increases in both D1 and D2 MSNs. These findings reveal that the NAcore codes drug seeking through transient potentiation of D1 MSNs, and that refraining from cocaine seeking in an extinguished context is coded through transient potentiation of D2 MSNs.SIGNIFICANCE STATEMENT Relapse is a primary symptom of addiction that can involve competition between the desire to use drugs and the desire to refrain from using drugs. Drug-associated cues induce relapse, which is correlated with transiently potentiated glutamatergic synapses in the nucleus accumbens core. We determined which of two cell populations in the accumbens core, D1-expressing or D2-expressing neurons, undergo transient synaptic potentiation. After being trained to self-administer cocaine, mice underwent withdrawal, some with and others without extinguishing responding in the drug-associated context. Extinguished mice showed transient potentiation in D2-expressing neurons in the extinguished environment, and all mice engaged in context-induced or cue-induced drug seeking showed transient potentiation of D1-expressing neurons. A simple binary engram in accumbens for seeking drugs and refraining from drugs offers opportunities for cell-specific therapies.

Bayesian nonparametric models for ranked set sampling.

Ranked set sampling (RSS) is a data collection technique that combines measurement with judgment ranking for statistical inference. This paper lays out a formal and natural Bayesian framework for RSS that is analogous to its frequentist justification, and that does not require the assumption of perfect ranking or use of any imperfect ranking models. Prior beliefs about the judgment order statistic distributions and their interdependence are embodied by a nonparametric prior distribution. Posterior inference is carried out by means of Markov chain Monte Carlo techniques, and yields estimators of the judgment order statistic distributions (and of functionals of those distributions).

Genetic variants and effect modifiers of QT interval prolongation in patients with sickle cell disease.

BACKGROUND: Sickle cell disease (SCD) is a common inherited blood disorder among African Americans (AA), with premature mortality which has been associated with prolongation of the heart rate-corrected QT interval (QTc), a known risk factor for sudden cardiac death. Although numerous genetic variants have been identified as contributors to QT interval prolongation in the general population, their impact on SCD patients remains unclear. This study used an unweighted polygenic risk score (PRS) to validate the previously identified associations between SNPs and QTc interval in SCD patients, and to explore possible interactions with other factors that prolong QTc interval in AA individuals with SCD. METHODS: In SCD patients, candidate genetic variants associated with the QTc interval were genotyped. To identify any risk SNPs that may be correlated with QTc interval prolongation, linear regression was employed, and an unweighted PRS was subsequently constructed. The effect of PRS on the QTc interval was evaluated using linear regression, while stratification analysis was used to assess the influence of serum alanine transaminase (ALT), a biomarker for liver disease, on the PRS effect. We also evaluated the PRS with the two subcomponents of QTc, the QRS and JTc intervals. RESULTS: Out of 26 candidate SNPs, five risk SNPs were identified for QTc duration under the recessive model. For every unit increase in PRS, the QTc interval prolonged by 4.0 ms (95% CI: [2.0, 6.1]; p-value: <0.001) in the additive model and 9.4 ms in the recessive model (95% CI: [4.6, 14.1]; p-value: <0.001). Serum ALT showed a modification effect on PRS-QTc prolongation under the recessive model. In the normal ALT group, each PRS unit increased QTc interval by 11.7 ms (95% CI: [6.3, 17.1]; p-value: 2.60E-5), whereas this effect was not observed in the elevated ALT group (0.9 ms; 95% CI: [-7.0, 8.8]; p-value: 0.823). CONCLUSION: Several candidate genetic variants are associated with QTc interval prolongation in SCD patients, and serum ALT acts as a modifying factor. The association of a CPS1 gene variant in both QTc and JTc duration adds to NOS1AP as evidence of involvement of the urea cycle and nitric oxide metabolism in cardiac repolarization in SCD. Larger replication studies are needed to confirm these findings and elucidate the underlying mechanisms.

Surfactant-Dependent Bulk Scale Mechanochemical Synthesis of CsPbBr3 Nanocrystals for Plastic Scintillator-Based X-ray Imaging.

We report a facile, solvent-free surfactant-dependent mechanochemical synthesis of highly luminescent CsPbBr3 nanocrystals (NCs) and study their scintillation properties. A small amount of surfactant oleylamine (OAM) plays an important role in the two-step ball milling method to control the size and emission properties of the NCs. The solid-state synthesized perovskite NCs exhibit a high photoluminescence quantum yield (PLQY) of up to 88% with excellent stability. CsPbBr3 NCs capped with different amounts of surfactant were dispersed in toluene and mixed with polymethyl methacrylate (PMMA) polymer and cast into scintillator discs. With increasing concentration of OAM during synthesis, the PL yield of CsPbBr3/PMMA nanocomposite was increased, which is attributed to reduced NC aggregation and PL quenching. We also varied the perovskite loading concentration in the nanocomposite and studied the resulting emission properties. The most intense PL emission was observed from the 2% perovskite-loaded disc, while the 10% loaded disc exhibited the highest radioluminescence (RL) emission from 50 kV X-rays. The strong RL yield may be attributed to the deep penetration of X-rays into the composite, combined with the large interaction cross-section of the X-rays with the high-Z atoms within the NCs. The nanocomposite disc shows an intense RL emission peak centered at 536 nm and a fast RL decay time of 29.4 ns. Further, we have demonstrated the X-ray imaging performance of a 10% CsPbBr3 NC-loaded nanocomposite disc.

Radiation Resilient Two-Dimensional Electronics.

Limitations in cloud-based computing have prompted a paradigm shift toward all-in-one "edge" devices capable of independent data sensing, computing, and storage. Advanced defense and space applications stand to benefit immensely from this due to their need for continual operation in areas where maintaining remote oversight is difficult. However, the extreme environments relevant to these applications necessitate rigorous testing of technologies, with a common requirement being hardness to ionizing radiation. Two-dimensional (2D) molybdenum disulfide (MoS2) has been noted to enable the sensing, storage, and logic capabilities necessary for all-in-one edge devices. Despite this, the investigation of ionizing radiation effects in MoS2-based devices remains incomplete. In particular, studies on gamma radiation effects in MoS2 have been largely limited to standalone films, with few device investigations; to the best of our knowledge, no explorations have been made into gamma radiation effects on the sensing and memory capabilities of MoS2-based devices. In this work, we have used a statistical approach to study high-dose (1 Mrad) gamma radiation effects on photosensitive and programmable memtransistors fabricated from large-area monolayer MoS2. Memtransistors were divided into separate groups to ensure accurate extraction of device characteristics pertaining to baseline performance, sensing, and memory before and after irradiation. All-MoS2 logic gates were also assessed to determine the gamma irradiation impact on logic implementation. Our findings show that the multiple functionalities of MoS2 memtransistors are not severely impacted by gamma irradiation even without dedicated shielding/mitigation techniques. We believe that these results serve as a foundation for more application-oriented studies going forward.

Clinical and Laboratory Correlates of QTc Duration in Adult and Pediatric Sickle Cell Disease.

Background: Sickle cell disease, a common genetic disorder in African Americans, manifests an increased risk of sudden death, the basis of which is incompletely understood. Prolongation of heart rate-corrected QT (QTc) interval on the electrocardiogram, a standard clinical measure of cardiac repolarization, may contribute to sudden death by predisposing to torsades de pointes ventricular tachycardia. Methods: We established a cohort study of 293 adult and 121 pediatric sickle cell disease patients drawn from the same geographic region as the Jackson Heart Study (JHS) cohort, in which significant correlates of QT duration have been characterized and quantitatively modeled. Herein, we establish clinical and laboratory correlates of QTc duration in our cohort using stepwise multivariate linear regression analysis. We then compared our adult sickle cell disease data to effect-size predictions from the published JHS statistical model of QT interval duration. Results: In adult sickle cell disease, gender, diuretic use, QRS duration, serum ALT levels, anion gap, and diastolic blood pressure show positive correlation; hemoglobin levels show inverse correlation; in pediatric sickle cell disease, age, hemoglobin levels, and serum bicarbonate and creatinine levels show inverse correlation. The mean QTc in our adult sickle cell disease cohort is 7.8 milliseconds longer than in the JHS cohort, even though the JHS statistical model predicts that the mean QTc in our cohort should be > 11 milliseconds shorter than in the much older JHS cohort, a differential of > 18 milliseconds. Conclusion: Sickle cell disease patients have substantial QTc prolongation relative to their age, driven by factors some overlapping, in adult and pediatric sickle cell disease, and distinct from those that have been defined in the general African American community.

Extreme γ-Ray Radiation Tolerance of Spectrometer-Grade CsPbBr3 Perovskite Detectors.

The perovskite compound CsPbBr3 has recently been discovered as a promising room-temperature semiconductor radiation detector, offering an inexpensive and easy-to-manufacture alternative to the current benchmark material Cd1-x Znx Te (CZT). The performance of CsPbBr3 sensors is evaluated under harsh conditions, such as high radiation doses often found in industrial settings and extreme radiation in space. Results show minimal degradation in detector performance after exposure to 1 Mrad of Co-60 gamma radiation, with no significant change to energy resolution or hole mobility and lifetime. Additionally, many of the devices are still functional after being exposed to a 10 Mrad dose over 3 days, and those that do not survive can still be refabricated into working detectors. These results suggest that the failure mode in these devices is likely related to the interface between the electrode and material and their reaction, or the electrode itself and not the material itself. Overall, the study suggests that CsPbBr3 has high potential as a reliable and efficient radiation detector in various applications, including those involving extreme fluxes and energies of gamma-ray radiation.

Toward High-Performance p-Type Two-Dimensional Field Effect Transistors: Contact Engineering, Scaling, and Doping.

n-type field effect transistors (FETs) based on two-dimensional (2D) transition-metal dichalcogenides (TMDs) such as MoS2 and WS2 have come close to meeting the requirements set forth in the International Roadmap for Devices and Systems (IRDS). However, p-type 2D FETs are dramatically lagging behind in meeting performance standards. Here, we adopt a three-pronged approach that includes contact engineering, channel length (Lch) scaling, and monolayer doping to achieve high performance p-type FETs based on synthetic WSe2. Using electrical measurements backed by atomistic imaging and rigorous analysis, Pd was identified as the favorable contact metal for WSe2 owing to better epitaxy, larger grain size, and higher compressive strain, leading to a lower Schottky barrier height. While the ON-state performance of Pd-contacted WSe2 FETs was improved by ∼10× by aggressively scaling Lch from 1 µm down to ∼20 nm, ultrascaled FETs were found to be contact limited. To reduce the contact resistance, monolayer tungsten oxyselenide (WOxSey) obtained using self-limiting oxidation of bilayer WSe2 was used as a p-type dopant. This led to ∼5× improvement in the ON-state performance and ∼9× reduction in the contact resistance. We were able to achieve a median ON-state current as high as ∼10 µA/µm for ultrascaled and doped p-type WSe2 FETs with Pd contacts. We also show the applicability of our monolayer doping strategy to other 2D materials such as MoS2, MoTe2, and MoSe2.

Bayesian Networks in Radiology.

A Bayesian network is a graphical model that uses probability theory to represent relationships among its variables. The model is a directed acyclic graph whose nodes represent variables, such as the presence of a disease or an imaging finding. Connections between nodes express causal influences between variables as probability values. Bayesian networks can learn their structure (nodes and connections) and/or conditional probability values from data. Bayesian networks offer several advantages: (a) they can efficiently perform complex inferences, (b) reason from cause to effect or vice versa, (c) assess counterfactual data, (d) integrate observations with canonical ("textbook") knowledge, and (e) explain their reasoning. Bayesian networks have been employed in a wide variety of applications in radiology, including diagnosis and treatment planning. Unlike deep learning approaches, Bayesian networks have not been applied to computer vision. However, hybrid artificial intelligence systems have combined deep learning models with Bayesian networks, where the deep learning model identifies findings in medical images and the Bayesian network formulates and explains a diagnosis from those findings. One can apply a Bayesian network's probabilistic knowledge to integrate clinical and imaging findings to support diagnosis, treatment planning, and clinical decision-making. This article reviews the fundamental principles of Bayesian networks and summarizes their applications in radiology. Keywords: Bayesian Network, Machine Learning, Abdominal Imaging, Musculoskeletal Imaging, Breast Imaging, Neurologic Imaging, Radiology Education Supplemental material is available for this article. © RSNA, 2023.

Differentiation Between Glioblastoma and Metastatic Disease on Conventional MRI Imaging Using 3D-Convolutional Neural Networks: Model Development and Validation.

RATIONALE AND OBJECTIVES: Imaging-based differentiation between glioblastoma (GB) and brain metastases (BM) remains challenging. Our aim was to evaluate the performance of 3D-convolutional neural networks (CNN) to address this binary classification problem. MATERIALS AND METHODS: T1-CE, T2WI, and FLAIR 3D-segmented masks of 307 patients (157 GB and 150 BM) were generated post resampling, co-registration normalization and semi-automated 3D-segmentation and used for internal model development. Subsequent external validation was performed on 59 cases (27 GB and 32 BM) from another institution. Four different mask-sequence combinations were evaluated using area under the curve (AUC), precision, recall and F1-scores. Diagnostic performance of a neuroradiologist and a general radiologist, both without and with the model output available, was also assessed. RESULTS: 3D-model using the T1-CE tumor mask (TM) showed the highest performance [AUC 0.93 (95% CI 0.858-0.995)] on the external test set, followed closely by the model using T1-CE TM and FLAIR mask of peri-tumoral region (PTR) [AUC of 0.91 (95% CI 0.834-0.986)]. Models using T2WI masks showed robust performance on the internal dataset but lower performance on the external set. Both neuroradiologist and general radiologist showed improved performance with model output provided [AUC increased from 0.89 to 0.968 (p = 0.06) and from 0.78 to 0.965 (p = 0.007) respectively], the latter being statistically significant. CONCLUSION: 3D-CNNs showed robust performance for differentiating GB from BMs, with T1-CE TM, either alone or combined with FLAIR-PTR masks. Availability of model output significantly improved the accuracy of the general radiologist.

Plasmonic high-entropy carbides.

Discovering multifunctional materials with tunable plasmonic properties, capable of surviving harsh environments is critical for advanced optical and telecommunication applications. We chose high-entropy transition-metal carbides because of their exceptional thermal, chemical stability, and mechanical properties. By integrating computational thermodynamic disorder modeling and time-dependent density functional theory characterization, we discovered a crossover energy in the infrared and visible range, corresponding to a metal-to-dielectric transition, exploitable for plasmonics. It was also found that the optical response of high-entropy carbides can be largely tuned from the near-IR to visible when changing the transition metal components and their concentration. By monitoring the electronic structures, we suggest rules for optimizing optical properties and designing tailored high-entropy ceramics. Experiments performed on the archetype carbide HfTa4C5 yielded plasmonic properties from room temperature to 1500K. Here we propose plasmonic transition-metal high-entropy carbides as a class of multifunctional materials. Their combination of plasmonic activity, high-hardness, and extraordinary thermal stability will result in yet unexplored applications.

First remains of the enormous alligatoroid Deinosuchus from the Upper Cretaceous Menefee Formation, New Mexico.

The neosuchian Deinosuchus is known from numerous localities throughout the Campanian of North America, from New Jersey to Montana (USA) and as far south as Coahuila (Mexico). Here we describe six osteoderms, two vertebrae, and a partial tooth discovered in the Menefee Formation of New Mexico and assign them to Deinosuchus sp., representing one of the earliest occurrences of this genus on the Laramidian subcontinent, and among the earliest known occurrences of this large alligatoroid in all of North America. The osteoderms are morphologically distinct in their inflated construction, with deep and radially distributed pitting, which closely matches osteoderms of Deinosuchus.

A new brachylophosaurin (Dinosauria: Hadrosauridae) from the Upper Cretaceous Menefee Formation of New Mexico.

Brachylophosaurini is a clade of hadrosaurid dinosaurs from the Campanian of western North America. Although well-known from northern localities in Montana and Alberta, including abundant material of Brachylophosaurus canadensis and Maiasaura peeblesorum and the holotypes of Acristavus gagslarsoni and Probrachylophosaurus bergei, material from southern localities in Utah and Colorado is restricted to a partial skull referred to A. gagslarsoni and several indeterminate specimens. Here we describe Ornatops incantatus gen. et sp. nov., a new brachylophosaurin known from a partial skeleton from the Allison Member of the Menefee Formation in New Mexico. Ornatops is the first brachylophosaurin reported from New Mexico and the southernmost occurrence of the clade. Ornatops shares with Probrachylophosaurus and Brachylophosaurus a caudally expanded nasofrontal suture on the frontals, but also exhibits an autapomorphic nasofrontal suture morphology, with a horizontal rostral region and elevated caudal region with two prominent parasagittal bumps, which is different from other brachylophosaurin specimens, including juvenile and adult Brachylophosaurus. A phylogenetic analysis places Ornatops in a trichotomy with Probrachylophosaurus and Brachylophosaurus, with Maiasaura and Acristavus as successive outgroups.

Rapid Implementation of a Complex, Multimodal Technology Response to COVID-19 at an Integrated Community-Based Health Care System.

BACKGROUND: The rapid spread of severe acute respiratory syndrome coronavirus-2 or SARS-CoV-2 necessitated a scaled treatment response to the novel coronavirus disease 2019 (COVID-19). OBJECTIVE: This study aimed to characterize the design and rapid implementation of a complex, multimodal, technology response to COVID-19 led by the Intermountain Healthcare's (Intermountain's) Care Transformation Information Systems (CTIS) organization to build pandemic surge capacity. METHODS: Intermountain has active community-spread cases of COVID-19 that are increasing. We used the Centers for Disease Control and Prevention Pandemic Intervals Framework (the Framework) to characterize CTIS leadership's multimodal technology response to COVID-19 at Intermountain. We provide results on implementation feasibility and sustainability of health information technology (HIT) interventions as of June 30, 2020, characterize lessons learned and identify persistent barriers to sustained deployment. RESULTS: We characterize the CTIS organization's multimodal technology response to COVID-19 in five relevant areas of the Framework enabling (1) incident management, (2) surveillance, (3) laboratory testing, (4) community mitigation, and (5) medical care and countermeasures. We are seeing increased use of traditionally slow-to-adopt technologies that create additional surge capacity while sustaining patient safety and care quality. CTIS leadership recognized early that a multimodal technology intervention could enable additional surge capacity for health care delivery systems with a broad geographic and service scope. A statewide central tracking system to coordinate capacity planning and management response is needed. Order interoperability between health care systems remains a barrier to an integrated response. CONCLUSION: The rate of future pandemics is estimated to increase. The pandemic response of health care systems, like Intermountain, offers a blueprint for the leadership role that HIT organizations can play in mainstream care delivery, enabling a nimbler, virtual health care delivery system that is more responsive to current and future needs.