Multifunctional tunneling devices based on graphene/h-BN/MoSe2 van der Waals heterostructures

The vertically stacked devices based on van der Waals heterostructures (vdWHs) of two-dimensional layered materials (2DLMs) have attracted considerable attention due to their superb properties. As a typical structure, graphene/hexagonal boron nitride (h-BN)/graphene vdWH has been proved possible to make tunneling devices. Compared with graphene, transition metal dichalcogenides possess intrinsic bandgap, leading to high performance of electronic devices. Here, tunneling devices based on graphene/h-BN/MoSe2 vdWHs are designed for multiple functions. On the one hand, the device shows a typical tunneling field-effect transistor behavior. A high on/off ratio of tunneling current (5 × 103) and an ultrahigh current rectification ratio (7 × 105) are achieved, which are attributed to relatively small electronic affinity of MoSe2 and optimized thickness of h-BN. On the other hand, the same structure also realizes 2D non-volatile memory with a high program/erase current ratio (>105), large memory window (∼150 V from ±90 V), and good retention characteristic. These results could enhance the fundamental understanding of tunneling behavior in vdWHs and contribute to the design of ultrathin rectifiers and memory based on 2DLMs

Increased mortality among acute respiratory distress patients from immigrant dense urban districts

Torgny Wessman,1,2 Rafid Tofik,1,2 Klas Gränsbo,2,3 Olle Melander2,3 1Department of Emergency Medicine, Skåne University Hospital, Malmö, Sweden; 2Department of Clinical Sciences, Lund University, Malmö, Sweden; 3Department of Internal Medicine, Skåne University Hospital, Malmö, Sweden Purpose: This study investigated whether living in immigrant dense urban districts (IDUDs) and low-income areas in the city of Malmö predicted 5-year mortality among patients admitted to the emergency department (ED) because of acute respiratory distress. Patients and methods: We randomly selected 184 patients with acute respiratory distress during 2007, visiting the ED at Skåne University Hospital, Malmö. In 2007, Malmö had 36% first- and second-generation immigrants. The main exposure was defined as being resident in any of the five IDUDs of Malmö compared to being resident in the five districts of Malmö with the highest proportion of Sweden-born inhabitants (SDUDs). We recorded vital parameters; medical triage priority according to Adaptive Process Triage (ADAPT), ICD-10 diagnoses, and the mean annual income for the patient’s urban district. We examined 5-year mortality risk using Cox proportional hazards model. Results: After adjustment for age and gender, patients from IDUDs (n=100, 54%) had an HR (95% CI) of 1.65 (1.087–2.494; P=0.019) regarding mortality at 5-year follow-up. Patients in the lowest vs highest income quartile had an HR of 2.00 (1.06–3.79; P=0.032) regarding mortality at 5-year follow-up. Age, male gender, presence of cardiopulmonary disease, and ADAPT priority also independently predicted the 5-year mortality. The excess risk of 5-year mortality associated with living in IDUDs remained significant after adjustment for age, gender, ADAPT priority, presence of cardiopulmonary disease, and income with an HR of 1.79 (1.15–2.78; P=0.010). Conclusion: Living in an IDUD is a strong independent risk factor for 5-year mortality in patients with acute respiratory distress. The cause is unknown. Our study suggests a need for better structured follow-up of cardiopulmonary disease in such patients. Keywords: dyspnea, emergency department, mortality, socioeconomic, income, ADAP

Endostatin predicts mortality in patients with acute dyspnea – A cohort study of patients seeking care in emergency departments

Background: Increased levels of circulating endostatin predicts cardiovascular morbidity and impaired kidney function in the general population. The utility of endostatin as a risk marker for mortality in the emergency department (ED) has not been reported. Aim: Our main aim was to study the association between plasma endostatin and 90-day mortality in an unselected cohort of patients admitted to the ED for acute dyspnea. Design Circulating endostatin was analyzed in plasma from 1710 adults and related to 90-day mortality in Cox proportional hazard models adjusted for age, sex, body mass index, oxygen saturation, respiratory rate, body temperature, C-reactive protein, lactate, creatinine and medical priority according to the Medical Emergency Triage and Treatment System–Adult score (METTS-A). The predictive value of endostatin for mortality was evaluated with receiver operating characteristic (ROC) analysis and compared with the clinical triage scoring system and age. Results: Each one standard deviation increment of endostatin was associated with a HR of 2.12 (95% CI 1.31–3.44 p < 0.01) for 90-day mortality after full adjustment. Levels of endostatin were significantly increased in the group of patients with highest METTS-A (p < 0.001). When tested for the outcome 90-day mortality, the area under the ROC curve (AUC) was 0.616 for METTS-A, 0.701 for endostatin, 0.708 for METTS -A and age and 0.738 for METTS-A, age and levels of endostatin. Conclusions: In an unselected cohort of patients admitted to the ED with acute dyspnea, endostatin had a string association to 90-day mortality and improved prediction of 90-day mortality in the ED beyond the clinical triage scoring system and age with 3%