Bistable switching typically arises from ferroic orders, such as ferroelectricity and ferromagnetism, in which the bistable states are encoded in charge or spin degrees offreedom1,2. Here we report the observation of bistable superlattice switching in monolayer TaIrTe4, a dual quantum spin Hall insulator3-5. Switching occurs between two lattice configurations with sharply contrasting periodicities. In particular, in a pristine monolayer, we observe the spontaneous emergence of a long-period superlattice that can be programmed on and off in a non-volatile manner by electrostatic tuning of low-energy electronic states. This switching toggles the system between two structural configurations with unit cell areas differing by two orders of magnitude. Mechanistically, our results reveal two independent and distinct instabilities, one in the lattice and the other in the quantum spin Hall electrons. These instabilities are coupled, leading to electrostatic control of lattice configurations with non-volatile memory. This finding is enabled by combining linear and nonlinear transport measurements6-13, Raman spectroscopy and scanning tunnelling microscopy, which probe complementary aspects of the underlying orders. Notably, this non-volatile memory stabilizes a spontaneous superlattice with a periodicity on the few-nanometre scale that remains robust across a wide doping range, persists over days and survives above 70 K. Our preliminary data also show the emergence of new insulating states at fractional superlattice fillings, which can be switched on and off together with the superlattice.

Post-stroke dysphagia (PSD) is a common complication following acute ischemic stroke (AIS). Predicting the recovery of swallow function remains challenging. The Predictive Swallow Score (PRESS) model, derived and validated in a Swiss cohort, sought to predict the recovery of PSD after AIS. We aimed to validate the PRESS model in a US-cohort, conducting a two-center retrospective review of 149 patients with AIS and functional oral intake scale (FOIS) ≤ 4. We collected the predictors of recovery of PSD according to PRESS (age, NIH Stroke Scale (NIHSS), any2 score, stroke location, FOIS score), with a primary outcome of impaired swallow at day 7 (FOIS ≤ 4). Model validation was completed using the Hosmer-Lemeshow (HL) test, calibration plots, and AUC analysis. Median (IQR) age was 74 (61-86); 53% were female. Median (Q1-Q3) NIHSS at presentation was 14 (7-20). HL test demonstrated that the PRESS model did not fit the validation data (p < 0.00001, x2=48.343, df=5), and the calibration curve analysis (intercept = -0.80 (95% CI: -1.21 to -0.38), slope = 0.60 (95% CI: 0.37 to 0.82)) also demonstrated a poor calibration of the model. Area under the curve analyses demonstrated a C statistic of 0.75 (95% CI 0.67-0.82), indicating suboptimal model discrimination in predicting the recovery of swallow 7 days following AIS. In particular, the model overpredicted dysphagia severity at day-7 in patients with higher PRESS scores and more severe strokes. Further validation of the PRESS score in prospective cohorts is warranted. The suboptimal model performance could be attributed to temporal advances in stroke care, as the original PRESS cohort was derived between 2011 and 2014. Geographic variability in acute stroke care practice could also be a factor, as the PRESS score was derived solely from a European cohort. This study, however, is limited by its retrospective design and a lack of generalizability.

Many immigrants coming to the United States (US) are screened for sexually transmitted infections (STIs) according to national professional agency guidelines. Some curable infections such as gonorrhea and syphilis can preclude entry to the US, whereas testing for other infections, such as chlamydia, is not required for immigration screening. We critically review the rationale for and the practice of immigration STI screening at a time when common STIs are both readily treatable and already widespread in the US and when many individuals resettling in the US migrate through irregular pathways. In addition, we provide suggestions to improve current practices for immigrants, with a focus on distress migration, which may be associated with hazards leading to sexual violence and stigmatization. Recent actions by the federal government have also compounded structural stigma regarding immigration and health care and could negatively impact broader public health goals.

The mechanisms of luminal narrowing after percutaneous coronary intervention (PCI) with directional coronary atherectomy (DCA) and drug-coated balloon (DCB) remains unclear. This study aimed to investigate the pattern and mechanisms of luminal narrowing after DCA/DCB using optical coherence tomography (OCT). Patients who underwent DCA/DCB for de novo lesions and serial OCT imaging at 3, 6, and 18 months were evaluated to determine the pattern of luminal narrowing. Among 40 patients who had follow-up (F/U) OCT at 3 months post-PCI, 33 and 23 patients had F/U at 6 and 18 months, respectively. Thirty-six of the 40 (90.0%) cases exhibited a layered pattern at the 3-month F/U, 31 of 33 (93.9%) at the 6-month F/U, and 22 of 23 (95.7%) at the 18-month F/U. Layer progression was identified in 21 of 33 (63.6%) and 4 of 23 (17.4%) at the 6- and 18-month F/Us, respectively. The patients with layer progression tended to have a higher prevalence of diabetes (16.7% vs 52.4%, p = 0.067), a lower rate of dual-antithrombotic therapy (DATT) use (58.3% vs 19.0%, p = 0.052) between the 3- and 6-month F/Us, and a significantly higher rate of no or low-intensity statin use (0.0% vs 41.7%, p = 0.037) between the 6- and 18-month F/Us. In Conclusion, layer progression and luminal narrowing occurred mainly during the first 6 months after DCA/DCB. Patients with luminal narrowing tended to have a higher prevalence of diabetes, standard DATT duration, and no or low-intensity statin use.