Caring for transgender populations: A primer for the dermatopathologist.

With increasing access to electronic health records, patients may encounter dermatopathology reports more readily. Dermatopathologists should consider their impact and interactions with transgender patients, who may face specific health and healthcare inequities. Rendering accurate diagnosis for skin diseases requires accurate information about patient's sex assigned at birth and gender identity. Understanding how sex and gender identity data flow between electronic health records, laboratory information systems, insurance billing systems, and patients will be important to avoid patient misgendering, to render accurate diagnoses, to maintain consistency in dermatopathology reports, and to avoid insurance billing denials. Dermatopathologists have important roles to build patient trust in the healthcare system and to help dermatologists diagnose, treat, and characterize skin diseases in transgender populations.

Light-Driven Ultrafast Polarization Manipulation in a Relaxor Ferroelectric.

Relaxor ferroelectrics have been intensely studied for decades based on their unique electromechanical responses which arise from local structural heterogeneity involving polar nanoregions or domains. Here, we report first studies of the ultrafast dynamics and reconfigurability of the polarization in freestanding films of the prototypical relaxor 0.68PbMg1/3Nb2/3O3-0.32PbTiO3 (PMN-0.32PT) by probing its atomic-scale response via femtosecond-resolution, electron-scattering approaches. By combining these structural measurements with dynamic phase-field simulations, we show that femtosecond light pulses drive a change in both the magnitude and direction of the polarization vector within polar nanodomains on few-picosecond time scales. This study defines new opportunities for dynamic reconfigurable control of the polarization in nanoscale relaxor ferroelectrics.

A Spatiotemporal and Multisensory Approach to Designing Wearable Clinical ICU Alarms.

In health care, auditory alarms are an important aspect of an informatics system that monitors patients and alerts clinicians attending to multiple concurrent tasks. However, the volume, design, and pervasiveness of existing Intensive Care Unit (ICU) alarms can make it difficult to quickly distinguish their meaning and importance. In this study, we evaluated the effectiveness of two design approaches not yet explored in a smartwatch-based alarm system designed for ICU use: (1) using audiovisual spatial colocalization and (2) adding haptic (i.e., touch) information. We compared the performance of 30 study participants using ICU smartwatch alarms containing auditory icons in two implementations of the audio modality: colocalized with the visual cue on the smartwatch's low-quality speaker versus delivered from a higher quality speaker located two feet away from participants (like a stationary alarm bay situated near patients in the ICU). Additionally, we compared participant performance using alarms with two sensory modalities (visual and audio) against alarms with three sensory modalities (adding haptic cues). Participants were 10.1% (0.24s) faster at responding to alarms when auditory information was delivered from the smartwatch instead of the higher quality external speaker. Meanwhile, adding haptic information to alarms improved response times to alarms by 12.2% (0.23s) and response times on their primary task by 10.3% (0.08s). Participants rated learnability and ease of use higher for alarms with haptic information. These small but statistically significant improvements demonstrate that audiovisual colocalization and multisensory alarm design can improve user response times.

Nanoscale Disorder Generates Subdiffusive Heat Transport in Self-Assembled Nanocrystal Films.

Investigating the impact of nanoscale heterogeneity on heat transport requires a spatiotemporal probe of temperature on the length and time scales intrinsic to heat navigating nanoscale defects. Here, we use stroboscopic optical scattering microscopy to visualize nanoscale heat transport in disordered films of gold nanocrystals. We find that heat transport appears subdiffusive at the nanoscale. Finite element simulations show that tortuosity of the heat flow underlies the subdiffusive transport, owing to a distribution of nonconductive voids. Thus, while heat travels diffusively through contiguous regions of the film, the tortuosity causes heat to navigate circuitous pathways that make the observed mean-squared expansion of an initially localized temperature distribution appear subdiffusive on length scales comparable to the voids. Our approach should be broadly applicable to uncover the impact of both designed and unintended heterogeneities in a wide range of materials and devices that can affect more commonly used spatially averaged thermal transport measurements.

Anomalous thermopower oscillations in graphene-nanowire vertical heterostructures.

Thermoelectric measurements have the potential to uncover the density of states (DOSs) of low-dimensional materials. Here, we present the anomalous thermoelectric behavior of monolayer graphene-nanowire (NW) heterostructures, showing large oscillations as a function of the doping concentration. Our devices consist of InAs NW and graphene vertical heterostructures, which are electrically isolated by thin (∼10 nm) hexagonal boron nitride (hBN) layers. In contrast to conventional thermoelectric measurements, where a heater is placed on one side of a sample, we use the InAs NW (diameter ∼50 nm) as a local heater placed in the middle of the graphene channel. We measure the thermoelectric voltage induced in graphene due to Joule heating in the NW as a function of temperature (1.5-50 K) and carrier concentration. The thermoelectric voltage in bilayer graphene (BLG)-NW heterostructures shows sign change around the Dirac point, as predicted by Mott's formula. In contrast, the thermoelectric voltage measured across monolayer graphene (MLG)-NW heterostructures shows anomalous large-amplitude oscillations around the Dirac point, not seen in the Mott response derived from the electrical conductivity measured on the same device. The anomalous oscillations are a signature of the modified DOSs in MLG by the electrostatic potential of the NW, which is much weaker in the NW-BLG devices. Thermal calculations of the heterostructure stack show that the temperature gradient is dominant in the graphene region underneath the NW, and thus sensitive to the modified DOSs resulting in anomalous oscillations in the thermoelectric voltage. Furthermore, with the application of a magnetic field, we detect modifications in the DOSs due to the formation of Landau levels in both MLG and BLG.

Tuning electrical and interfacial thermal properties of bilayer MoS2via electrochemical intercalation.

Layered two-dimensional (2D) materials such as MoS2have attracted much attention for nano- and opto-electronics. Recently, intercalation (e.g. of ions, atoms, or molecules) has emerged as an effective technique to modulate material properties of such layered 2D films reversibly. We probe both the electrical and thermal properties of Li-intercalated bilayer MoS2nanosheets by combining electrical measurements and Raman spectroscopy. We demonstrate reversible modulation of carrier density over more than two orders of magnitude (from 0.8 × 1012to 1.5 × 1014cm-2), and we simultaneously obtain the thermal boundary conductance between the bilayer and its supporting SiO2substrate for an intercalated system for the first time. This thermal coupling can be reversibly modulated by nearly a factor of eight, from 14 ± 4.0 MW m-2K-1before intercalation to 1.8 ± 0.9 MW m-2K-1when the MoS2is fully lithiated. These results reveal electrochemical intercalation as a reversible tool to modulate and control both electrical and thermal properties of 2D layers.

Quasi-Ballistic Thermal Transport Across MoS2 Thin Films.

Layered two-dimensional (2D) materials have highly anisotropic thermal properties between the in-plane and cross-plane directions. Conventionally, it is thought that cross-plane thermal conductivities (κ z) are low, and therefore c-axis phonon mean free paths (MFPs) are small. Here, we measure κ z across MoS2 films of varying thickness (20-240 nm) and uncover evidence of very long c-axis phonon MFPs at room temperature in these layered semiconductors. Experimental data obtained using time-domain thermoreflectance (TDTR) are in good agreement with first-principles density functional theory (DFT). These calculations suggest that ∼50% of the heat is carried by phonons with MFP > 200 nm, exceeding kinetic theory estimates by nearly 2 orders of magnitude. Because of quasi-ballistic effects, the κ z of nanometer-thin films of MoS2 scales with their thickness and the volumetric thermal resistance asymptotes to a nonzero value, ∼10 m2 K GW-1. This contributes as much as 30% to the total thermal resistance of a 20 nm thick film, the rest being limited by thermal interface resistance with the SiO2 substrate and top-side aluminum transducer. These findings are essential for understanding heat flow across nanometer-thin films of MoS2 for optoelectronic and thermoelectric applications.

Direct Visualization of Thermal Conductivity Suppression Due to Enhanced Phonon Scattering Near Individual Grain Boundaries.

Understanding the impact of lattice imperfections on nanoscale thermal transport is crucial for diverse applications ranging from thermal management to energy conversion. Grain boundaries (GBs) are ubiquitous defects in polycrystalline materials, which scatter phonons and reduce thermal conductivity (κ). Historically, their impact on heat conduction has been studied indirectly through spatially averaged measurements, that provide little information about phonon transport near a single GB. Here, using spatially resolved time-domain thermoreflectance (TDTR) measurements in combination with electron backscatter diffraction (EBSD), we make localized measurements of κ within few µm of individual GBs in boron-doped polycrystalline diamond. We observe strongly suppressed thermal transport near GBs, a reduction in κ from ∼1000 W m-1 K-1 at the center of large grains to ∼400 W m-1 K-1 in the immediate vicinity of GBs. Furthermore, we show that this reduction in κ is measured up to ∼10 µm away from a GB. A theoretical model is proposed that captures the local reduction in phonon mean-free-paths due to strongly diffuse phonon scattering at the disordered grain boundaries. Our results provide a new framework for understanding phonon-defect interactions in nanomaterials, with implications for the use of high-κ polycrystalline materials as heat sinks in electronics thermal management.

New Developments in Hypertensive Encephalopathy.

PURPOSE OF REVIEW: This review summarizes the latest science on hypertensive encephalopathy and posterior reversible encephalopathy syndrome (PRES). We review the epidemiology and pathophysiology of these overlapping syndromes and discuss best practices for diagnosis and management. RECENT FINDINGS: Diagnosis of hypertensive encephalopathy largely relies on exclusion of other neurological emergencies. We review the extensive causes of PRES and its imaging characteristics. Management strategies have not changed substantially in the past decade, though newer calcium channel blockers simplify the approach to blood pressure reduction. While this alone may be sufficient for treatment of hypertensive encephalopathy in most cases, management of PRES also depends on modification of other precipitating factors. Hypertensive encephalopathy and PRES are overlapping disorders for which intensive blood pressure lowering is critical. Further research is indicated to both in diagnosis and additional management strategies for these critical conditions.

Right-sided endocarditis: eustachian valve and coronary sinus involvement.

Infective endocarditis in patients with intravenous drug use commonly involves right-sided heart valves. Eustachian valve (EV) endocarditis is not commonly seen given the valve's infrequent presence. Involvement of the coronary sinus (CS) with endocarditis is also an unusual finding. We present a case with echocardiographic findings consistent with EV endocarditis along with CS involvement, which appropriately responded to antibiotics.

Elevated Hemi-diaphragms as a Cause of ST-segment Elevation: A case report and review of literature.

While ST-segment elevation (STE) on ECG is widely recognized as representing myocardial infarction or injury such as coronary occlusion or pericarditis, STE may occasionally ensue from non-cardiac etiologies. Indeed, gastrointestinal disorders causing STE are not well documented in the literature. We present a case wherein extreme abdominal distension and hemi-diaphragm elevation resulted in extrinsic cardiac and epicardial coronary compression manifesting as STE. Subsequent relief of the abdominal distension resulted in resolution of STE representing a noncoronary cause of STE. A brief literature review, illustrating the importance of considering abdominal etiologies as a cause of STE is provided.