Endothermic Charge Separation Occurs Spontaneously in Non-Fullerene Acceptor/Polymer Bulk Heterojunction

Organic photovoltaics (OPVs) based on non-fullerene acceptors (NFAs) have achieved a power conversion efficiency close to 20%. These NFA OPVs can generate free carriers efficiently despite a very small energy level offset at the donor/acceptor (D/A) interface. Why these NFAs can enable efficient charge separation (CS) with low energy losses remains an open question. Here, the CS process in the PM6:Y6 bulk heterojunction (BHJ) is probed by time-resolved two-photon photoemission (TR-TPPE) spectroscopy. We found that the CS, the conversion from bound charge transfer (CT) excitons to free carriers, is an endothermic process with an enthalpy barrier of 0.15 eV. The CS can occur spontaneously despite being an endothermic process, which implies that it is driven by entropy. We further argue that the morphology of the PM6:Y6 film and the anisotropic electron delocalization restrict the electron and hole wavefunctions within the CT exciton such that they can primarily contact each other through point-like junctions. This configuration can maximize the entropic driving force. This article is protected by copyright. All rights reserved.

Enthalpy-uphill exciton dissociation in organic/2D heterostructures promotes free carrier generation

Despite the large binding energy of charge transfer (CT) excitons in type-II organic/2D heterostructures, it has been demonstrated that free carriers can be generated from CT excitons with a long lifetime. Using a model fluorinated zine phthalocyanine (F8ZnPc)/monolayer-WS2 interface, we find that CT excitons can dissociate spontaneously into free carriers despite it being an enthalpy-uphill process. Specifically, it is observed that CT excitons can gain an energy of 250 meV in 50 ps and dissociate into free carriers without any applied electric field. This observation is surprising because excited electrons typically lose energy to the environment and relax to lower energy states. We hypothesize that this abnormal enthalpy-uphill CT exciton dissociation process is driven by entropy gain. Kinetically, the entropic driving force can also reduce the rate for the reverse process - the conversion of free electron-hole pairs back to CT excitons. Hence, this mechanism can potentially explain the very long carrier lifetime observed in organic/2D heterostructures.

Efficacy and safety of innate and adaptive immunotherapy combined with standard of care in high-grade gliomas: a systematic review and meta-analysis

Background

Malignant glioma is the most common intracranial malignant tumor with the highest mortality. In the era of immunotherapy, it is important to determine what type of immunotherapy provides the best chance of survival.

Method

Here, the efficacy and safety of immunotherapy in high-grade glioma (HGG) were evaluated by systematic review and meta-analysis. The differences between various types of immunotherapy were explored. Retrieved hits were screened for inclusion in 2,317 articles. We extracted the overall survival (OS) and progression-free survival (PFS) hazard ratios (HRs) as two key outcomes for examining the efficacy of immunotherapy. We also analyzed data on the reported corresponding adverse events to assess the safety of immunotherapy. This study was registered with PROSPERO (CRD42019112356).

Results

We included a total of 1,271 patients, of which 524 received a combination of immunotherapy and standard of care (SOC), while 747 received SOC alone. We found that immunotherapy extended the OS (HR = 0.74; 95% confidence interval [CI], 0.56-0.99; Z = -2.00, P = 0.0458 < 0.05) and PFS (HR = 0.67; 95% CI, 0.45-0.99; Z = -1.99, P = 0.0466 < 0.05), although certain adverse events occurred (proportion = 0.0773, 95% CI, 0.0589-0.1014). Our data have demonstrated the efficacy of the dendritic cell (DC) vaccine in prolonging the OS (HR = 0.38; 95% CI, 0.21-0.68; Z = -3.23; P = 0.0012 < 0.05) of glioma patients. Oncolytic viral therapy (VT) only extended patient survival in a subgroup analysis (HR = 0.60; 95% CI, 0.45-0.80; Z = -3.53; P = 0.0004 < 0.05). By contrast, immunopotentiation (IP) did not prolong OS (HR = 0.69; 95% CI, 0.50-0.96; Z = -2.23; P = 0.0256).

Conclusion

Thus, DC vaccination significantly prolonged the OS of HGG patients, however, the efficacy of VT and IP should be explored in further studies. All the therapeutic schemes evaluated were associated with certain side effects.

Systematic review registration

https://www.crd.york.ac.uk/PROSPERO/display_record.php?RecordID=112356.

Nanoscale Periodic Trapping Sites for Interlayer Excitons Built by Deformable Molecular Crystal on 2D Crystal

The nanoscale moiré pattern formed at 2D transition-metal dichalcogenide crystal (TMDC) heterostructures provides periodic trapping sites for excitons, which is essential for realizing various exotic phases such as artificial exciton lattices, Bose-Einstein condensates, and exciton insulators. At organic molecule/TMDC heterostructures, similar periodic potentials can be formed via other degrees of freedom. Here, we utilize the structure deformability of a 2D molecular crystal as a degree of freedom to create a periodic nanoscale potential that can trap interlayer excitons (IXs). Specifically, two semiconducting molecules, PTCDI and PTCDA, which possess similar band gaps and ionization potentials but form different lattice structures on MoS₂, are investigated. The PTCDI lattice on MoS₂ is distorted geometrically, which lifts the degeneracy of the two molecules within the crystal's unit cell. The degeneracy lifting results in a spatial variation of the molecular orbital energy, with an amplitude and periodicity of ∼0.2 eV and ∼2 nm, respectively. On the other hand, no such energy variation is observed in PTCDA/MoS₂, where the PTCDA lattice is much less distorted. The periodic variation in molecular orbital energies provides effective trapping sites for IXs. For IXs formed at PTCDI/MoS₂, rapid spatial localization of the electron in the organic layer toward the interface is observed, which demonstrates the effectiveness of these interfacial IX traps.

Hybrid Heterostructures to Generate Long-Lived and Mobile Photocarriers in Graphene

We report the generation of long-lived and highly mobile photocarriers in hybrid van der Waals heterostructures that are formed by monolayer graphene, few-layer transition metal dichalcogenides, and the organic semiconductor F₈ZnPc. Samples are fabricated by dry transfer of mechanically exfoliated MoS₂ or WS₂ few-layer flakes on a graphene film, followed by deposition of F₈ZnPc. Transient absorption microscopy measurements are performed to study the photocarrier dynamics. In heterostructures of F₈ZnPc/few-layer-MoS₂/graphene, electrons excited in F₈ZnPc can transfer to graphene and thus be separated from the holes that reside in F₈ZnPc. By increasing the thickness of MoS₂, these electrons acquire long recombination lifetimes of over 100 ps and a high mobility of 2800 cm² V^-1 s^-1. Graphene doping with mobile holes is also demonstrated with WS₂ as the middle layers. These artificial heterostructures can improve the performance of graphene-based optoelectronic devices.

Defect-Polaron and Enormous Light-Induced Fermi-Level Shift at Halide Perovskite Surface

Halide perovskites intrinsically contain a large amount of point defects. The interaction of these defects with photocarriers, photons, and lattice distortion remains a complex and unresolved issue. We found that for halide perovskite films with excess halide vacancies, the Fermi level can be shifted by as much as 0.7 eV upon light illumination. These defects can trap photocarriers for hours after the light illumination is turned off. The enormous light-induced Fermi level shift and the prolonged electron trapping are explained by the capturing of photocarriers by halide vacancies at the surface of the perovskite film. The formation of this defect-photocarrier complex can result in lattice deformation and an energy shift in the defect state. The whole process is akin to polaron formation at a defect site. Our data also suggest that these trapped carriers increase the electrical polarizability of the lattice, presumably by enhancing the defect migration rate.

Phosphine-Catalyzed Enantioselective (3+2) Annulation of Vinylcyclopropanes with Imines for the Synthesis of Chiral Pyrrolidines

A phosphine-catalyzed highly enantioselective and diastereoselective (up to 98 % ee and >20 : 1 dr) (3+2) annulation between vinylcyclopropanes and N-tosylaldimines has been developed, which allows facile access to a range of highly functionalized chiral pyrrolidines. Notably, this method makes use of vinylcyclopropanes as a synthon for phosphine-mediated asymmetric annulation reaction, which will offer new opportunities for potential applications of cyclopropanes substrates in phosphine-catalyzed organic transformations.

Lanthanide-tetrapyrrole complexes: synthesis, redox chemistry, photophysical properties, and photonic applications

Tetrapyrrole derivatives such as porphyrins, phthalocyanines, naphthalocyanines, and porpholactones, are highly stable macrocyclic compounds that play important roles in many phenomena linked to the development of life. Their complexes with lanthanides are known for more than 60 years and present breath-taking properties such as a range of easily accessible redox states leading to photo- and electro-chromism, paramagnetism, large non-linear optical parameters, and remarkable light emission in the visible and near-infrared (NIR) ranges. They are at the centre of many applications with an increasing focus on their ability to generate singlet oxygen for photodynamic therapy coupled with bioimaging and biosensing properties. This review first describes the synthetic paths leading to lanthanide-tetrapyrrole complexes together with their structures. The initial synthetic protocols were plagued by low yields and long reaction times; they have now been replaced with much more efficient and faster routes, thanks to the stunning advances in synthetic organic chemistry, so that quite complex multinuclear edifices are presently routinely obtained. Aspects such as redox properties, sensitization of NIR-emitting lanthanide ions, and non-linear optical properties are then presented. The spectacular improvements in the quantum yield and brightness of Yb^III-containing tetrapyrrole complexes achieved in the past five years are representative of the vitality of the field and open welcome opportunities for the bio-applications described in the last section. Perspectives for the field are vast and exciting as new derivatizations of the macrocycles may lead to sensitization of other Ln^III NIR-emitting ions with luminescence in the NIR-II and NIR-III biological windows, while conjugation with peptides and aptamers opens the way for lanthanide-tetrapyrrole theranostics.

Extracting Electrons from Delocalized Excitons by Flattening the Energetic Pathway for Charge Separation

At organic donor-acceptor (D-A) interfaces, electron and hole are bound together to form charge transfer (CT) excitons. The electron and hole wave functions in these CT excitons can spatially delocalize. The electron delocalization opens up possibilities of extracting free charges from bound excitons by manipulating the potential energy landscape on the nanoscale. Using a prototype trilayer structure that has a cascade band structure, we show that the yield of charge separation can be doubled as compared to the bilayer counterpart when the thickness of the intermediate layer is around 3 nm. This thickness coincides with the electron delocalization size of CT excitons typically found in these organic films. Tight-binding calculation for the CT states in the trilayer structure further demonstrates that electron delocalization, together with the energy level cascade, can effectively flatten the energetic pathway for charge separation. Hence, it is possible to add nanometer-thick layers between the donor and the acceptor to significantly enhance the charge separation yield.

Probing the Origin of Light-Enhanced Ion Diffusion in Halide Perovskites

Organic-inorganic hybrid halide perovskites have emerged recently as highly promising materials for optoelectronics such as photovoltaics and photodetectors. A unique feature of these materials is ion diffusion that directly impacts the optoelectronic process by affecting the charge transport and trapping. In order to shed light on the ionic diffusion behavior, the hybrid perovskites MAPbI₃ and MAPbI₃ with minor doping of phenyl-C61-butyric acid methyl-ester (MAPbI₃-PCBM) thin-film capacitors were investigated in the presence of steady and dynamic visible illumination of different intensities. Light-induced capacitance, which increases monotonically with the increase of light intensity, was observed in the low-frequency range below 300 kHz of the electric field on both while differing quantitatively. Specifically, the large light-induced capacitance in the MAPbI₃ capacitors can be obtained in the MAPbI₃-PCBM ones in the dark. In addition, the increase of capacitance with light intensity is much less in the latter with electron trapping induced by PCBM. This result has revealed that the light-induced capacitance in MAPbI₃ capacitors can be ascribed to the contribution of the additional charges across the capacitors associated with ionic diffusion activated by the illumination and that the effects on the capacitance will remain after the illumination is turned off due to residual photoexcited electrons trapped in the MAPbI₃-PCBM sample.

Solid-phase fluorescent BODIPY-peptide synthesis via in situ dipyrrin construction

Traditional fluorescent peptide chemical syntheses hinge on the use of limited fluorescent/dye-taggable unnatural amino acids and entail multiple costly purifications. Here we describe a facile and efficient protocol for in situ construction of dipyrrins on the N-terminus with 20 natural and five unnatural amino acids and the lysine's side chain of selected peptides/peptide drugs through Fmoc-based solid-phase peptide synthesis. The new strategy enables the direct formation of boron-dipyrromethene (BODIPY)-peptide conjugates from simple aldehyde and pyrrole derivatives without pre-functionalization, and only requires a single-time chromatographic purification at the final stage. As a model study, synthesized EBNA1-targeting BODIPY1-Pep4 demonstrates intact selectivity in vitro, responsive fluorescence enhancement, and higher light cytotoxicity due to the photo-generation of cytotoxic singlet oxygen. This work offers a novel practical synthetic platform for fluorescent peptides for multifaceted biomedical applications.

Collective Effects of Band Offset and Wave Function Dimensionality on Impeding Electron Transfer from 2D to Organic Crystals

Excited-state electron transfer (ET) across molecules/transition metal dichalcogenide crystal (TMDC) interfaces is a critical process for the functioning of various organic/TMDC hybrid optoelectronic devices. Therefore, it is important to understand the fundamental factors that can facilitate or limit the ET rate. Here it is found that an undesirable combination of the interfacial band offset and the spatial dimensionality of the delocalized electron wave function can significantly slow down the ET process. Specifically, it is found that whereas the ET rate from TMDCs (MoS₂ and WSe₂) to fullerenes is relative insensitive to the band offset, the ET rate from TMDCs to perylene molecules can be reduced by an order of magnitude when the band offset is large. For the perylene crystal, the sensitivity of the ET rate on the band offset is explained by the 1D nature of the electronic wave function, which limits the availability of states with the appropriate energy to accept the electron.

Chinese version of the Rotator Cuff Quality of Life questionnaire: Cross-cultural adaptation and validation in rotator cuff-impaired patients in Hong Kong

Purpose:

To adapt the Rotator Cuff Quality of Life (RC-QOL) questionnaire into traditional Chinese (Chi-RC-QOL) and to evaluate the validity and reliability in patients suffering from rotator cuff pathologies in Hong Kong.

Methods:

The Chi-RC-QOL will be constructed using the forward-translation followed by the backward-translation method. Thirty consecutive patients with clinically and radiologically confirmed rotator cuff pathology were recruited. Descriptive statistics will be followed by validity assessment using comparison with the Constant Shoulder (CS) score, University of California Los Angeles (UCLA) Shoulder Rating Scale, and Western Ontario Rotator Cuff (WORC) score. Parametric data will be tested using Pearson’s correlation coefficient for the total scores. Reliability was assessed using a test–retest interval of 30 min. The Cronbach’s α and intraclass correlation coefficient were calculated.

Results:

Cronbach’s α and internal consistency scores were high for all parts of the Chi-RC-QOL, with Cronbach’s α ranging between 0.89 and 0.98. Internal consistency scores range from 0.82 to 0.92, which can be regarded as an excellent correlation. Test–retest reliability was excellent for all parts of the Chi-RC-QOL with good absolute reliability. Chi-RC-QOL correlates well with the CS score, UCLA Shoulder Rating Scale, and the WORC score, with all being statistically significant.

Conclusions:

The current study adapted the RC-QOL to traditional Chinese version. The analysis confirmed the validity and reliability of the Chi-RC-QOL questionnaire.

Level of Evidence:

III.

Using Silver Nanoparticles-Embedded Silica Metafilms as Substrates to Enhance the Performance of Perovskite Photodetectors

Plasmonic metal nanostructures provide a promising strategy for light trapping and therefore can dramatically enhance photocurrent in optoelectronics only if the trapped light can be coupled effectively from plasmons to excitons, whereas the reverse transfer of energy, charge, and heat from excitons to plasmons can be suppressed. Motivated by this, this work develops a scheme to implement a metafilm with Ag nanoparticles (NPs) embedded in 10 nm thick silica (Ag NPs-silica metafilm) to the active device channel of a hybrid perovskite film/graphene photodetector. Remarkably, an enhancement factor of 7.45 in photoresponsivity, the highest so far among all the reports adopting plasmonic metal NPs in perovskite photodetectors, has been achieved on the photodetectors with the Ag NPs-silica metafilms. Considering that the synthesis of the Ag NPs-silica metafilms can be readily scaled up to coat both rigid and flexible substrates, this result provides a low-cost metaplatform for a variety of high-performance optoelectronic device applications.

Effect of the Interfacial Energy Landscape on Photoinduced Charge Generation at the ZnPc/MoS2 Interface

Monolayer transition-metal dichalcogenide crystals (TMDC) can be combined with other functional materials, such as organic molecules, to form a wide range of heterostructures with tailorable properties. Although a number of works have shown that ultrafast charge transfer (CT) can occur at organic/TMDC interfaces, conditions that would facilitate the separation of interfacial CT excitons into free carriers remain unclear. Here, time-resolved and steady-state photoemission spectroscopy are used to study the potential energy landscape, charge transfer, and exciton dynamics at the zinc phthalocyanine (ZnPc)/monolayer (ML) MoS₂ and ZnPc/bulk MoS₂ interfaces. Surprisingly, although both interfaces have a type-II band alignment and exhibit sub-100 fs CT, the CT excitons formed at the two interfaces show drastically different evolution dynamics. The ZnPc/ML-MoS₂ behaves like typical donor-acceptor interfaces in which CT excitons dissociate into electron-hole pairs. On the contrary, back electron transfer occur at ZnPc/bulk-MoS₂, which results in the formation of triplet excitons in ZnPc. The difference can be explained by the different amount of band bending found in the ZnPc film deposited on ML-MoS₂ and bulk-MoS₂. Our work illustrates that the potential energy landscape near the interface plays an important role in the charge separation behavior. Therefore, considering the energy level alignment at the interface alone is not enough for predicting whether free charges can be generated effectively from an interface.

Impressive near-infrared brightness and singlet oxygen generation from strategic lanthanide-porphyrin double-decker complexes in aqueous solution

Although lanthanide double-decker complexes with hetero-macrocyclic ligands as functional luminescent and magnetic materials have promising properties, their inferior water solubility has negated their biomedical applications. Herein, four water-soluble homoleptic lanthanide (Ln = Gd, Er, Yb and La) sandwiches with diethylene-glycol-disubstituted porphyrins (DD) are reported, with their structures proven by both quantum chemical calculations and scanning tunneling microscopy. Our findings demonstrate that the near-infrared emission intensity and singlet oxygen (¹O₂) quantum yields of YbDD and GdDD in aqueous media are higher than those of the reported capped lanthanide monoporphyrinato analogues, YbN and GdN; the brightness and luminescence lifetime in water of YbDD are greater than those of YbN. This work provides a new dimension for the future design and development of molecular theranostics-based water-soluble double-decker lanthanide bisporphyrinates.

Creation of bispiro[pyrazolone-3,3′-oxindoles] via a phosphine-catalyzed enantioselective [3 + 2] annulation of the Morita–Baylis–Hillman carbonates with pyrazoloneyldiene oxindoles

A [3 + 2] annulation between the Morita–Baylis–Hillman (MBH) carbonates and pyrazoloneyldiene oxindoles catalyzed by (S)-SITCP has been developed.

The relationship between the coherent size, binding energy and dissociation dynamics of charge transfer excitons at organic interfaces

At organic semiconductor interfaces, an electron and a hole can be bound Coulombically to form an interfacial charge transfer (CT) exciton. It is still under debate how a CT exciton can overcome its strong binding and dissociate into free carriers. Experimentally, capturing the evolution of the CT exciton on time (fs-ps) and length scales (nm) in which the dissociation process occurs is challenging. To overcome this challenge, time-resolved two photon photoemission spectroscopy is used to measure the binding energies and electronic coherent sizes of a series of CT states at organic interfaces, and capture the temporal dynamics of these CT excitons after their excitation. Using zinc phthalocyanine (ZnPc)/fullerene (C₆₀) interface as a model system, it is shown that the interfacial CT process first populates a hot CT state with a coherent size of ~4 nm. Hot and delocalized CT excitons subsequently relax into CT excitons with lower energies and smaller coherent sizes. To correlate the CT exciton properties with the dissociation efficiency, we develop a method that exploits graphene field effect transistors to probe the rate and yield of free carrier generation at the interface. Our results show that exciton dissociation can be more efficient if one can extract electrons from the hot and delocalized CT state. We propose a cascade structure that would serve this purpose.

High-Sensitivity Light Detection via Gate Tuning of Organometallic Perovskite/PCBM Bulk Heterojunctions on Ferroelectric Pb0.92La0.08Zr0.52Ti0.48O3 Gated Graphene Field Effect Transistors

Organometallic perovskite (OMP) CH₃NH₃PbI₃ doped with [6,6]-phenyl-C₆₁-butyric acid methyl ester (PCBM) has been shown to form bulk heterojunction (OMP-PCBM BHJ) for improved charge separation. In this work, the OMP-PCBM BHJ photosensitizer is combined with graphene field effect transistors (GFETs) with a ferroelectric Pb_0.92La_0.08Zr_0.52Ti_0.48O₃ gate of high gating efficiency. A remarkable gate tunability via shifting the Fermi energy of graphene with respect to the valence band maximum and conduction band minimum of the OMP was observed, which is critical for facilitating efficient charge transfer across the OMP-PCBM BHJ/GFET interface. The combination of the high-efficiency charge separation by BHJ and charge transfer by high gate tunability leads to achievement of high photoresponsivity up to 7 × 10⁶ A/W and detectivity exceeding 7 × 10¹² Jones at 550 nm at a small gate voltage of 1.0 V. These results represent almost 2 orders of magnitude improvement over that without a gate tuning under the similar experimental condition, illustrating the importance of the interface electronic structure in optimizing the optoelectronic performance of the OMP-PCBM BHJ/GFET devices.

A Case of Acute Calcific Tendinitis of the Hand: An Uncommon Condition that is Easily Overlooked and Misdiagnosed

Acute calcific tendinitis of the hand is uncommon, yet it has a high rate of misdiagnosis as it resembles other conditions such as fractures, inflammatory and infectious causes that give rise to pain and swelling in the hand. We present a case of acute calcific tendinitis in a middle age woman affecting the extensor pollicis longus to raise awareness of this uncommon, but easily treatable cause of pain and swelling. This case was first diagnosed as septic arthritis of the interphalangeal joint of the thumb. Correct diagnosis was made after careful review of history, physical examination findings, laboratory results and radiographs. (Hong Kong j. emerg.med. 2015;22:316-319)

Can Emergency Medicine Ward Shorten Hospital Length of Stay in Patients with Nasogastric Tube Related Coffee Ground Aspirate?

Introduction

The aim of this study was to determine whether elderly patients on nasogastric (NG) tube feeding who presented with coffee ground aspirate could be effectively and safely managed in a local setting of Emergency Medicine Ward (EMW).

Method

A retrospective study with data retrieved from all the cases admitted with a diagnosis of coffee ground aspirate or vomiting who were on NG tube feeding during three years before and after EMW was launched. Data including patient demographics, length of stay (LOS), types of pharmaceutical treatment received, need of upper endoscopy, in-hospital death and readmission rate within fourteen days were studied. Patients who were haemodynamically unstable, having melaena on per rectal examination, on warfarin or with underlying gastrointestinal malignancy were excluded.

Results

A total of 223 patients matching the studied criteria were included in the study, with 103 of them being admitted before the opening of EMW. For the 120 cases admitted after EMW was launched, 70 cases were admitted to EMW and 50 admitted to Medical Ward. The LOS for elderly patients on NG tube feeding presented with coffee ground aspirate was significantly shortened after EMW was launched (5.2 days vs. 4.2 days, p=0.046). In-hospital mortality and 14-day readmission rate were similar in the two studied period. Patients admitted to EMW and Medical Ward in the second study period were also analysed. Those admitted to EMW had a shorter LOS than those admitted to Medical ward during the same period (3.4 days vs. 5.3 days, p=0.001).

Conclusion

The establishment of EMW in local setting can achieve a significant reduction in hospital LOS without jeopardizing patient outcome for elderly patients who are on NG tube feeding presenting with coffee ground aspirate.

A Retrospective Study of Geriatric Patients Presenting with Fever to an Accident and Emergency Department in Hong Kong

Objectives

To study the characteristics and outcome of geriatric patients presenting with fever to an emergency department in Hong Kong and to analyse the factors affecting their length of stay.

Methods

Retrospective study. Patients aged ≥65 who complained of fever, or with temperature ≥37.5°C (aural) presenting to the Accident and Emergency Department (AED) of Caritas Medical Centre in Hong Kong from 14 November 2006 to 13 December 2006 were enrolled. The demographic data, clinical information and outcomes were studied. The characteristics of short stay and long stay patients were compared.

Results

There were 370 patients in the study. Their median age was 80. Of these patients, 64.9% were category 3 or above, i.e. urgent, emergent or critical. The most common chief complaints were fever, shortness of breath, dizziness and cough. The admission rate was 81.9%. The median length of stay in hospital was 4.3 days. The most common hospital discharge diagnoses were chest infection, urinary tract infection, and fever with unknown cause. The discharge rate within 48 hours was 24.6%. With further analysis, temperature, walking ability, triage category and neutrophil count were significantly different between short stay (≤48 h) and long stay (>48 h) patients. For those discharged alive either from the AED or ward, 20.1% re-attended the AED within 14 days of discharge, and 17.5% of those previously discharged were admitted again for fever or other problems.

Conclusion

Elders with fever are a major challenge to the AED and health care facilities. The admission rate for this group of patients is usually high. Elders with poor walking ability, high triage category, high temperature and neutrophil count were prone to have longer stay.

Charge Transfer Exciton and Spin Flipping at Organic-Transition-Metal Dichalcogenide Interfaces

Two-dimensional transition-metal dichalcogenides (TMD) can be combined with other materials such as organic small molecules to form hybrid van der Waals heterostructures. Because of different properties possessed by these two materials, the hybrid interface can exhibit properties that cannot be found in either of the materials. In this work, the zinc phthalocyanine (ZnPc)-molybdenum disulfide (MoS₂) interface is used as a model system to study the charge transfer at these interfaces. It is found that the optically excited singlet exciton in ZnPc transfers its electron to MoS₂ in 80 fs after photoexcitation to form a charge transfer exciton. However, back electron transfer occurs on the time scale of ∼1-100 ps, which results in the formation of a triplet exciton in the ZnPc layer. This relatively fast singlet-triplet transition is feasible because of the large singlet-triplet splitting in organic materials and the strong spin-orbit coupling in TMD crystals. The back electron transfer would reduce the yield of free carrier generation at the heterojunction if it is not avoided. On the other hand, the spin-selective back electron transfer could be used to manipulate electron spin in hybrid electronic devices.

All-Printable ZnO Quantum Dots/Graphene van der Waals Heterostructures for Ultrasensitive Detection of Ultraviolet Light

In ZnO quantum dot/graphene heterojunction photodetectors, fabricated by printing quantum dots (QDs) directly on the graphene field-effect transistor (GFET) channel, the combination of the strong quantum confinement in ZnO QDs and the high charge mobility in graphene allows extraordinary quantum efficiency (or photoconductive gain) in visible-blind ultraviolet (UV) detection. Key to the high performance is a clean van der Waals interface to facilitate an efficient charge transfer from ZnO QDs to graphene upon UV illumination. Here, we report a robust ZnO QD surface activation process and demonstrate that a transition from zero to extraordinarily high photoresponsivity of 9.9 × 10⁸ A/W and a photoconductive gain of 3.6 × 10⁹ can be obtained in ZnO QDs/GFET heterojunction photodetectors, as the ZnO QDs surface is systematically engineered using this process. The high figure-of-merit UV detectivity D* in exceeding 1 × 10¹⁴ Jones represents more than 1 order of magnitude improvement over the best reported previously on ZnO nanostructure-based UV detectors. This result not only sheds light on the critical role of the van der Waals interface in affecting the optoelectronic process in ZnO QDs/GFET heterojunction photodetectors but also demonstrates the viability of printing quantum devices of high performance and low cost.

How the Number of Layers and Relative Position Modulate the Interlayer Electron Transfer in π-Stacked 2D Materials

Understanding the interfacial electron transfer (IET) between 2D layers is central to technological applications. We present a first-principles study of the IET between a zinc phthalocyanine film and few-layer graphene by using our recent method for the calculation of electronic coupling in periodic systems. The ultimate goal is the development of a predictive in silico approach for designing new 2D materials. We find IET to be critically dependent on the number of layers and their stacking orientation. In agreement with experiment, IET to single-layer graphene is shown to be faster than that to double-layer graphene due to interference effects between layers. We predict that additional graphene layers increase the number of IET pathways, eventually leading to a faster rate. These results shed new light on the subtle interplay between structure and IET, which may lead to more effective "bottom up" design strategies for these materials.

Designing the Interface of Carbon Nanotube/Biomaterials for High-Performance Ultra-Broadband Photodetection

Inorganic/biomolecule nanohybrids can combine superior electronic and optical properties of inorganic nanostructures and biomolecules for optoelectronics with performance far surpassing that achievable in conventional materials. The key toward a high-performance inorganic/biomolecule nanohybrid is to design their interface based on the electronic structures of the constituents. A major challenge is the lack of knowledge of most biomolecules due to their complex structures and composition. Here, we first calculated the electronic structure and optical properties of one of the cytochrome c (Cyt c) macromolecules (PDB ID: 1HRC ) using ab initio OLCAO method, which was followed by experimental confirmation using ultraviolet photoemission spectroscopy. For the first time, the highest occupied molecular orbital and lowest unoccupied molecular orbital energy levels of Cyt c, a well-known electron transport chain in biological systems, were obtained. On the basis of the result, pairing the Cyt c with semiconductor single-wall carbon nanotubes (s-SWCNT) was predicted to have a favorable band alignment and built-in electrical field for exciton dissociation and charge transfer across the s-SWCNT/Cyt c heterojunction interface. Excitingly, photodetectors based on the s-SWCNT/Cyt c heterojunction nanohybrids demonstrated extraordinary ultra-broadband (visible light to infrared) responsivity (46-188 A W^-1) and figure-of-merit detectivity D* (1-6 × 10¹⁰ cm Hz^1/2 W^-1). Moreover, these devices can be fabricated on transparent flexible substrates by a low-lost nonvacuum method and are stable in air. These results suggest that the s-SWCNT/biomolecule nanohybrids may be promising for the development of CNT-based ultra-broadband photodetectors.

Atypical periprosthetic femoral fracture: a case report

We report an 82-year-old woman who underwent fixation with a long-spanning cable-plate for a bisphosphonate-induced Vancouver B1 periprosthetic femoral fracture. Non-union and breakage of the plate occurred at 16 months and necessitated revision surgery using a long-stem femoral prosthesis augmented with a cable-plate construct. Bone union was achieved eventually after 10 months.

Highly enantioselective synthesis of dihydrocoumarin-fused dihydropyrans via the phosphine-catalyzed [4 + 2] annulation of allenones with 3-aroylcoumarins

Phosphine-catalyzed [4 + 2] annulation between 3-aroylcoumarins and allenones has been developed. In the presence of a dipeptide phosphine catalyst 7, dihydrocoumarin-fused dihydropyrans were prepared in high yields and with excellent enantioselectivities.

Efficacy and safety of hylan G-F 20 injection in treatment of knee osteoarthritis in Chinese patients: results of a prospective, multicentre, longitudinal study

OBJECTIVE

To study the efficacy and safety of single intra-articular injection of 6-mL hylan G-F 20 in Chinese patients with symptomatic knee osteoarthritis.

DESIGN

Prospective case series.

SETTING

Six government hospitals in Hong Kong.

PATIENTS

Patients with primary knee osteoarthritis were recruited from six government hospitals from 1 October 2010 to 31 May 2012. All patients received 6-mL intra-articular injection of hylan G-F 20.

MAIN OUTCOME MEASURES

Pain visual analogue scale, functional visual analogue scale, and 5-point Likert scale on change of pain and function were assessed. Adverse events were checked. Radiographs were taken pre-injection and at 3 months and 1 year.

RESULTS

A total of 110 knees of 95 patients with primary knee osteoarthritis were treated. The mean age of the patients was 62 (standard deviation, 9.8) years. All patients completed 1 year of follow-up. The mean pain visual analogue scale, functional visual analogue scale, and Likert value for pain and function showed statistically significant improvements at 6 weeks, 3 months, 6 months, and 1 year compared with the pre-injection values. No significant correlations were found between changes in visual analogue scale and age, body mass index, pre-injection radiological osteoarthritis severity, serum erythrocyte sedimentation rate, or C-reactive protein. Serial radiographs did not show any changes in the radiological severity of knee osteoarthritis. Overall, 16.4% of the patients experienced mild and self-limiting adverse events.

CONCLUSION

Hylan G-F 20 is a safe and effective therapy to relieve pain and improve function for up to 1 year in Chinese patients with knee osteoarthritis.

Directional Plk1 inhibition-driven cell cycle interruption using amphiphilic thin-coated peptide-lanthanide upconversion nanomaterials as in vivo tumor suppressors

Polo-like kinase 1 (Plk1) is a major serine/threonine protein kinase which regulates key mitotic events.

Monitoring and inhibition of Plk1: amphiphilic porphyrin conjugated Plk1 specific peptides for its imaging and anti-tumor function

Polo-like kinase 1 (Plk1) is well-known for taking part in cell cycle progression and regulation. Using small molecules for Plk inhibition has been well documented in the literature. However, there are several intrinsic and intractable problems associated with this approach. For example monitoring small molecule Plk inhibitors as anti-tumor agents in vitro/in vivo is often ineffective, they can have poor cell internalization and be susceptible to enzymatic degradation. Herein, we report the synthesis of cell-permeable, water-soluble amphiphilic porphyrin – Plk1 specific peptide bioconjugates, Por-P1 and Por-P2. In addition to resolving the aforementioned problems of the small molecule inhibitors Por-P2 manifests responsive emission enhancement upon binding with Plk1 in aqueous medium and in vitro, while potently triggering G2-M phase arrest and then apoptosis selectively in the cancer cells tested. In combination our findings make Por-P2 a promising candidate for the preparation of a new generation of smart chemotherapeutic targeting agents (imaging and inhibition) for Plk1 in particular cancer cell lines.

Dynamical Localization Limiting the Coherent Transport Range of Excitons in Organic Crystals

Exciton or energy transport in organic crystals is commonly described by a series of incoherent hoppings. This picture is no longer valid if the transport range is on the order of the exciton coherent (or delocalization) size. However, coherent effects are often neglected because the exciton wave function generally localizes to a few molecules within an ultrafast time scale (<1 ps) after photoexcitation. Here, by using time-resolved photoemission spectroscopy and nanometer-thick zinc phthalocyanine crystals, we are able to observe a transition from the coherent to incoherent transport regime while the exciton coherent size is decreasing as a function of time. During the transition, a distinct phonon mode is excited, which suggests that the electron-vibrational interaction localizes the exciton and reduces its coherent size. It is anticipated that the coherent transport range can be increased by controlling the electron-vibrational coupling. An enhanced coherent transport range can be advantageous in applications such as organic photovoltaics.

EBNA1-specific luminescent small molecules for the imaging and inhibition of latent EBV-infected tumor cells

An EBNA1-specific small molecule (JLP2) has been synthesised. As a strong binder and dimerization inhibitor of EBNA1 in vitro, JLP2 may be used as a selective luminescent agent for the imaging and inhibition of latent EBV-infected cancer cells.

A combined method to estimate parameters of the thalamocortical model from a heavily noise-corrupted time series of action potential

A combined method composing of the unscented Kalman filter (UKF) and the synchronization-based method is proposed for estimating electrophysiological variables and parameters of a thalamocortical (TC) neuron model, which is commonly used for studying Parkinson's disease for its relay role of connecting the basal ganglia and the cortex. In this work, we take into account the condition when only the time series of action potential with heavy noise are available. Numerical results demonstrate that not only this method can estimate model parameters from the extracted time series of action potential successfully but also the effect of its estimation is much better than the only use of the UKF or synchronization-based method, with a higher accuracy and a better robustness against noise, especially under the severe noise conditions. Considering the rather important role of TC neuron in the normal and pathological brain functions, the exploration of the method to estimate the critical parameters could have important implications for the study of its nonlinear dynamics and further treatment of Parkinson's disease.

The quantum coherent mechanism for singlet fission: experiment and theory

The absorption of one photon by a semiconductor material usually creates one electron-hole pair. However, this general rule breaks down in a few organic semiconductors, such as pentacene and tetracene, where one photon absorption may result in two electron-hole pairs. This process, where a singlet exciton transforms to two triplet excitons, can have quantum yields as high as 200%. Singlet fission may be useful to solar cell technologies to increase the power conversion efficiency beyond the so-called Shockley-Queisser limit. Through time-resolved two-photon photoemission (TR-2PPE) spectroscopy in crystalline pentacene and tetracene, our lab has recently provided the first spectroscopic signatures in singlet fission of a critical intermediate known as the multiexciton state (also called a correlated triplet pair). More importantly, we found that population of the multiexciton state rises at the same time as the singlet state on the ultrafast time scale upon photoexcitation. This observation does not fit with the traditional view of singlet fission involving the incoherent conversion of a singlet to a triplet pair. However, it provides an experimental foundation for a quantum coherent mechanism in which the electronic coupling creates a quantum superposition of the singlet and the multiexciton state immediately after optical excitation. In this Account, we review key experimental findings from TR-2PPE experiments and present a theoretical analysis of the quantum coherent mechanism based on electronic structural and density matrix calculations for crystalline tetracene lattices. Using multistate density functional theory, we find that the direct electronic coupling between singlet and multiexciton states is too weak to explain the experimental observation. Instead, indirect coupling via charge transfer intermediate states is two orders of magnitude stronger, and dominates the dynamics for ultrafast multiexciton formation. Density matrix calculation for the crystalline tetracene lattice satisfactorily accounts for the experimental observations. It also reveals the critical roles of the charge transfer states and the high dephasing rates in ensuring the ultrafast formation of multiexciton states. In addition, we address the origins of microscopic relaxation and dephasing rates, and adopt these rates in a quantum master equation description. We show the need to take the theoretical effort one step further in the near future by combining high-level electronic structure calculations with accurate quantum relaxation dynamics for large systems.

Hot charge-transfer excitons set the time limit for charge separation at donor/acceptor interfaces in organic photovoltaics

Photocurrent generation in organic photovoltaics (OPVs) relies on the dissociation of excitons into free electrons and holes at donor/acceptor heterointerfaces. The low dielectric constant of organic semiconductors leads to strong Coulomb interactions between electron-hole pairs that should in principle oppose the generation of free charges. The exact mechanism by which electrons and holes overcome this Coulomb trapping is still unsolved, but increasing evidence points to the critical role of hot charge-transfer (CT) excitons in assisting this process. Here we provide a real-time view of hot CT exciton formation and relaxation using femtosecond nonlinear optical spectroscopies and non-adiabatic mixed quantum mechanics/molecular mechanics simulations in the phthalocyanine-fullerene model OPV system. For initial excitation on phthalocyanine, hot CT excitons are formed in 10(-13) s, followed by relaxation to lower energies and shorter electron-hole distances on a 10(-12) s timescale. This hot CT exciton cooling process and collapse of charge separation sets the fundamental time limit for competitive charge separation channels that lead to efficient photocurrent generation.