Delirium in the Neonate.

Delirium is likely present in the neonatal intensive care unit and has been largely unrecognized. There are several risk factors for delirium including illness severity, neurosedative exposure, and environmental disruptions that put infants at risk for delirium. Regular use of scoring systems should be considered to improve delirium detection. When identified, initial steps in management should include resolving underlying causes and implementation of standard nonpharmacologic measures. Mounting pediatric evidence suggests that the atypical antipsychotics, as well as the α-2 agonists, may be additionally beneficial in treating delirium as well as improving the ability to wean off other neurosedative medications.

Bis-cyclometalated iridium(iii) complexes with terpyridine analogues: syntheses, structures, spectroscopy and computational studies.

Two ligands based upon a 2,6-disubstituted pyridine bridge introduce bis-quinoxalinyl units in a fashion that yields analogues to the archetypal terdentate ligand, 2,2':6',2''-terpyridine. The ligands were synthesised from the key intermediate 2,6-bis(bromoacetyl)pyridine: a new, high-yielding route is described for this reagent. Two ligand variants (differentiated by H/Me substituents on the quinoxaline ring) were explored as coordinating moieties for iridium(iii) in the development of luminescent complexes. Computational studies (DFT approaches employing B3LYP, B3LYP/LANL2DZ, and M062X/LANL2DZ levels) were used to investigate the geometric and coordination mode preferences of the new ligands and two possibilities arose from theoretical investigations: [Ir(N^N^N)2]3+ and [Ir(N^N^C)2]+, with the former predicted to be more energetically favourable. Upon synthesis and isolation of the Ir(iii) complexes, X-ray crystallographic studies revealed coordination spheres that were cyclometalated, the structures both showing a [Ir(N^N^C)2]PF6 arrangement. Further spectroscopic characterization via NMR confirmed the ligand arrangements in the complexes, and photophysical studies, supported by DFT, showed that a mixture of metal-to-ligand charge transfer (MLCT) and intra-ligand charge transfer (ILCT) character is likely to contribute to the emission features of the complexes, which phosphoresce orange-red (λ em = 580-618 nm). The emission wavelength was influenced by the substituents on the quinoxaline ring (H vs. Me), thereby implying further tuneability is possible with future ligand iterations.

Quality improvement for reducing utilization drift in hypoxic-ischemic encephalopathy management.

OBJECTIVES: Therapeutic hypothermia is an effective neuroprotective intervention for infants with moderate or severe hypoxic-ischemic encephalopathy (HIE). With the introduction of new medical therapy comes a learning curve with regards to its proper implementation and understanding of eligibility guidelines. We hypothesized that variation in patient selection and lack of adherence to established protocols contributed to the utilization drift away from the original eligibility guidelines. METHODS: A retrospective cohort study was conducted including infants who received therapeutic hypothermia in the neonatal intensive care unit (NICU) for HIE to determine utilization drift. We then used QI methodology to address gaps in medical documentation that may lead to the conclusion that therapeutic hypothermia was inappropriately applied. RESULTS: We identified 54% of infants who received therapeutic hypothermia who did not meet the clinical, physiologic, and neurologic examination criteria for this intervention based on provider admission and discharge documentation within the electronic medical record (EMR). Review of the charts identified incomplete documentation in 71% of cases and led to the following interventions: 1) implementation of EMR smartphrases; 2) engagement of key stakeholders and education of faculty, residents, and neonatal nurse practitioners; and 3) performance measurement and sharing of data. We were able to improve both adherence to the therapeutic hypothermia guidelines and achieve 100% documentation of the modified Sarnat score. CONCLUSIONS: Incomplete documentation can lead to the assumption that therapeutic hypothermia was inappropriately applied when reviewing a patient's EMR. However, in actual clinical practice physicians follow the clinical guidelines but are not documenting their medical decision making completely. QI methodology addresses this gap in documentation, which will help determine the true utilization drift of therapeutic hypothermia in future studies.

Synthesis and photophysical properties of imine borane adducts towards vapochromic materials.

A series of alkynyl aryl conjugated aldehydes and imines were prepared and their adducts with various Lewis acidic boranes have been studied via NMR, absorption, and luminescence spectroscopies in solution. The imine-B(C6F5)3 adduct showed remarkable solution stability, and was then trialled in vapochromism experiments using simple impregnated paper strips to examine the fluorescence responses.

pH dependent binding in de novo hetero bimetallic coiled coils.

Herein the first example of a bimetallic coiled coil featuring a lanthanide binding site is reported, opening opportunities to exploit the attractive NMR and photophysical properties of the lanthanides in multi metallo protein design. In our efforts to fully characterise the system we identified for the first time that lanthanide binding to such sites is pH dependent, with optimal binding at neutral pH, and that the double AsnAsp site is more versatile in this regard than the single Asp site. Our second site featured the structural HgCys3 site, the chemistry of which was essentially unaltered by the presence of the lanthanide site. In fact, both metal binding sites within the hetero bimetallic coiled coil displayed the same properties as their mononuclear single binding site controls, and operated independently of each other. Finally, pH can be used as an external trigger to control the binding of Hg(ii) and Tb(iii) to the two distinct sites within this coiled coil, and offers the opportunity to "activate" metal binding sites within complex multi metallo and multi-functional designs.

Luminescent gold surfaces for sensing and imaging: patterning of transition metal probes.

Luminescent transition metal complexes are introduced for the microcontact printing of optoelectronic devices. Novel ruthenium(II), RubpySS, osmium(II), OsbpySS, and cyclometalated iridium(III), IrbpySS, bipyridyl complexes with long spacers between the surface-active groups and the metal were developed to reduce the distance-dependent, nonradiative quenching pathways by the gold surface. Indeed, surface-immobilized RubpySS and IrbpySS display strong red and green luminescence, respectively, on planar gold surfaces with luminescence lifetimes of 210 ns (RubpySS·Au) and 130 and 12 ns (83%, 17%) (IrbpySS·Au). The modified surfaces show enhancement of their luminescence lifetime in comparison with solutions of the respective metal complexes, supporting the strong luminescence signal observed and introducing them as ideal inorganic probes for imaging applications. Through the technique of microcontact printing, complexes were assembled in patterns defined by the stamp. Images of the red and green patterns rendered by the RubpySS·Au and IrbpySS·Au monolayers were revealed by luminescence microscopy studies. The potential of the luminescent surfaces to respond to biomolecular recognition events is demonstrated by addition of the dominant blood-pool protein, bovine serum albumin (BSA). Upon treatment of the surface with a BSA solution, the RubpySS·Au and IrbpySS·Au monolayers display a large luminescence signal increase, which can be quantified by time-resolved measurements. The interaction of BSA was also demonstrated by surface plasmon resonance (SPR) studies of the surfaces and in solution by circular dichroism spectroscopy (CD). Overall, the assembly of arrays of designed coordination complexes using a simple and direct µ-contact printing method is demonstrated in this study and represents a general route toward the manufacture of micropatterned optoelectronic devices designed for sensing applications.