Serious Games as a Therapeutic Tool in Pediatric Urology: A Review of Current Applications and Future Directions.

This paper examines the use of serious games that integrate engaging gameplay with educational and therapeutic benefits with a particular focus on their application in urology. The study reviews both domestic and international cases to evaluate the current practices and implications of these digital therapies. While serious games have been widely utilized in the treatment of pediatric cancer and psychiatric disorders-areas that require long-term care and management-their application in urology, in particular pediatric urology, has been limited. Although digital therapies like serious games are still emerging in the field of urology, they hold promise as effective supplements to traditional treatments while offering new options for managing a range of urological conditions. Pediatric conditions such as bedwetting, urinary incontinence, and dysuria, which often benefit from long-term training and habit formation, are particularly well-suited to this approach. By helping pediatric patients better understand and manage their symptoms, serious games can play a supportive role in the treatment process and have shown positive medical outcomes. This paper reviews the definitions and therapeutic effects of serious games, analyzes their current use in the medical field, and argues for their increased application in treating pediatric urinary conditions.

Public Perceptions of Enuresis: Insights From Online Communities in South Korea and the United States.

PURPOSE: To establish a foundation for raising awareness and disseminating accurate information about enuresis-one of the most challenging conditions to discuss openly-this paper examines public perceptions of enuresis. METHODS: This paper collected title and text data from posts related to enuresis on the top popular online platforms such Naver Cafe in South Korea and Reddit in the United States (US). The data along with the thematic subcommunities where the posts were uploaded, was analyzed and visualized using word cloud, Latent Dirichlet Allocation (LDA) topic modeling, and pyLDAvis. RESULTS: The findings reveal both similarities and differences in how the patients from the 2 countries addressed enuresis online. In both countries, enuresis symptoms were a daily concern, and individuals used online platforms as a space to talk about their experiences. However, South Koreans were more inclined to describe symptoms within region-based communities or mothers' forums, where they exchanged information and shared experiences before consulting a doctor. In contrast, US patients with medical experience or knowledge frequently discussed treatment processes, lifestyle adjustments, and medication options. CONCLUSION: South Koreans tend to be cautious when selecting and visiting hospitals, often relying on others for advice and preparation before seeking medical attention. Compared to online communities in the US, Korean users are more likely to seek preliminary diagnoses based on nonprofessional opinions. Consequently, it is important to lower the barriers for patients to access professional medical advice to mitigate the potential harm of relying on nonprofessional opinions. Additionally, there is a need to raise awareness so that adults can recognize and address their symptoms in a timely manner.

The Metaverse for Healthcare: Trends, Applications, and Future Directions of Digital Therapeutics for Urology.

In recent years, the emergence of digital therapeutics as a novel approach to managing conditions has garnered significant attention. This approach involves using evidence-based therapeutic interventions that are facilitated by high-quality software programs to treat, manage, or prevent medical conditions. The incorporation of digital therapeutics into the Metaverse has increased the feasibility of their implementation and application in all areas of medical services. In urology, substantial digital therapeutics are being produced and researched, including mobile apps, bladder devices, pelvic floor muscle trainers, smart toilet systems, mixed reality-guided training and surgery, and training and telemedicine for urological consultations. The purpose of this review article is to provide a comprehensive overview of the current impact of the Metaverse on the field of digital therapeutics and identify its current trends, applications, and future perspectives in the field of urology.

Continuous carbon capture in an electrochemical solid-electrolyte reactor.

Electrochemical carbon-capture technologies, with renewable electricity as the energy input, are promising for carbon management but still suffer from low capture rates, oxygen sensitivity or system complexity1-6. Here we demonstrate a continuous electrochemical carbon-capture design by coupling oxygen/water (O2/H2O) redox couple with a modular solid-electrolyte reactor7. By performing oxygen reduction reaction (ORR) and oxygen evolution reaction (OER) redox electrolysis, our device can efficiently absorb dilute carbon dioxide (CO2) molecules at the high-alkaline cathode-membrane interface to form carbonate ions, followed by a neutralization process through the proton flux from the anode to continuously output a high-purity (>99%) CO2 stream from the middle solid-electrolyte layer. No chemical inputs were needed nor side products generated during the whole carbon absorption/release process. High carbon-capture rates (440 mA cm-2, 0.137 mmolCO2 min-1 cm-2 or 86.7 kgCO2 day-1 m-2), high Faradaic efficiencies (>90% based on carbonate), high carbon-removal efficiency (>98%) in simulated flue gas and low energy consumption (starting from about 150 kJ per molCO2) were demonstrated in our carbon-capture solid-electrolyte reactor, suggesting promising practical applications.

Psychometric validation of the Korean Pressure Ulcer Knowledge Assessment Tool.

OBJECTIVE: The purpose of this study was to evaluate the psychometric properties, including content validity, validity of multiple choice items, and the reliability of the Korean version of the Pressure Ulcer Knowledge Assessment Tool (K-PUKAT 2.0), using classical test theory (CTT) and item response theory (IRT). METHOD: Linguistic validation process and factor analysis were conducted among wound care nurses, staff nurses and nursing students. Items were analysed according to the CTT and IRT using a two-parameter logistic model. Intraclass correlation coefficients were used to examine reliability. RESULTS: A total of 378 wound care nurses, staff nurses and nursing students participated in this study. While most items showed moderate difficulty based on the CTT, difficulty index values based on the IRT were more broadly distributed (low: 5 items; moderate: 9 items; high: 1 item). The intraclass correlation coefficient for K-PUKAT 2.0 was 0.72. CONCLUSION: The K-PUKAT 2.0 demonstrated concise and good psychometric properties. Based on the results of this study, repetitive use of K-PUKAT 2.0 will not only help in distinguishing whether an individual has sufficient clinical knowledge, but will also play a key role in supporting learning.

Risk Factors Associated With Pressure Injuries in Surgical Patients: A Retrospective Case-Control Study.

PURPOSE: This study aimed to identify predictive risk factors for pressure injury (PI) occurring during surgery. DESIGN: Retrospective case-control study. SUBJECTS AND SETTING: Data on records of 6070 patients hospitalized for surgery at Seoul National University Bundang Hospital located in Seoul Korea. Data were collected between May 2013 and December 2014. METHODS: Anonymized data from patients were accessed via electronic health records, nursing records, direct patient assessment, surgical, clinical laboratory, and anesthesia records, preanesthesia status evaluations, and PI incident reports, and transfusion and extracorporeal circulation reports. Descriptive and logistic regression analyses were conducted. RESULTS: Three hundred eighty-one of the 6070 patients (6.3%) developed within 24 hours a PI that was associated with surgery. The most common locations for the PIs were the coccyx (15.1%; n = 75) and trunk (chest or abdomen; 15.1%; n = 75). All PIs were classified as stage 1 (66.6%; n = 331) or 2 (33.4%; n = 166). Based on logistic regression results, we found that the risk factors that were independently predictive of surgery-related PIs were patient position during surgery, admission to an intensive care unit after surgery, required blood transfusion during surgery, and duration of surgery. CONCLUSIONS: This retrospective study identified several risk factors associated with a higher incidence of perioperative PIs in surgical patients. A PI prevention program accounting for these factors could potentially help prevent PIs and their costly complications.

Efficient and optimized communication in biomedical sensor networks based on bioinspired particle swarm optimization for medical applications.

Healthcare, sports, the military, location monitoring and wireless body networks are emerging as technology of major relevance. As a result of the widespread usage of biomedical sensor networks in medical applications, it is essential that data packets containing vital signs be reliably and effectively supplied to the medical center. Because of its mobility, real-time monitoring, cheap cost, and real-time feedback, it may be used in a broad variety of applications. Effective data transport and a limited energy supply are the main challenges in WBAN. Uses genetic heuristics to enhance routing algorithm efficiency. Low-energy adaptive clustering hierarchy (LEACH) and distributed energy efficiency clustering (DEC) are two kinds of clustering algorithms (DEEC). A clustering-based routing protocol may be optimized using this study's optimization approach so that the network's lifetime can be extended.. The cluster heads (CHs) in sensor nodes are picked with the least amount of overhead grading possible. The cluster is being balanced. Passive clustering based on Bioinspired Particle Swarm Optimization (BPSO) should be used for clustering purposes. Routing messages efficiently means sending them quickly and efficiently without using a lot of bandwidth. Using constraints such as distance and residual power, the optimal path for the cluster may be determined with the help of iterative and heuristic chicken swarm optimization (IHCSO) for short. An evaluation of the packet distribution allocation, capacity, and average end-to-end latency illustrates the practicability of the proposed system in research concerning its efficiency. According to the findings of the research, following the technique that was proposed leads to much better outcomes.

Development and Evaluation of an Artificial Intelligence-Based Cognitive Exercise Game: A Pilot Study.

Recently, cognitive serious games have successfully been employed to train cognitive abilities in elderly people with mild cognitive impairment, Alzheimer's disease, and related disorders. However, despite the continuous rehabilitation game design and its applications, the existing cognitive exercise games fall short of user interaction and personalized elements with regard to difficult levels, which leads to users leaving early and losing interests during the gameplay. In this regard, the purpose of the study was to design and develop the serious game inclusive of playful elements for user motivation, the web-based mobile application system for easy accessibility, and Artificial Intelligence- (AI-) based difficulty level adjustment system for prevention from earlier leaving out in the middle of the play so that the elderly users can feel entertaining and immersed into the cognitive game voluntarily. This study was designed as an eight-week pilot experiment with thirty-seven participants in their 60s to 80s for the game's usability assessment purpose. Results of the study showed that the AI-based cognitive exercise game was acceptable, interesting, and motivating for the elderly people and the test results before and after the eight-week training suggest a relationship between longer the training on the game and lower cognitive assessment scores including geriatric quality of life scale, geriatric depression scale, and Korean version of mini-mental state examination (MMSE). These correlations demonstrate the potential value of serious games in clinical assessment of cognitive status for the elderly users with varying cognitive ability. Based on these results, the elderly-centered serious game with playful element can be potentially used in clinical settings, allowing the cognitive training to be more enjoyable and more medically effective. Given these promising results, a more focused study can extend to the game system or additional game tools or features to be explored that solely target the elderly by applying AI and advanced visualization devices.

Efficient conversion of low-concentration nitrate sources into ammonia on a Ru-dispersed Cu nanowire electrocatalyst.

Electrochemically converting nitrate ions, a widely distributed nitrogen source in industrial wastewater and polluted groundwater, into ammonia represents a sustainable route for both wastewater treatment and ammonia generation. However, it is currently hindered by low catalytic activities, especially under low nitrate concentrations. Here we report a high-performance Ru-dispersed Cu nanowire catalyst that delivers an industrial-relevant nitrate reduction current of 1 A cm-2 while maintaining a high NH3 Faradaic efficiency of 93%. More importantly, this high nitrate-reduction catalytic activity enables over a 99% nitrate conversion into ammonia, from an industrial wastewater level of 2,000 ppm to a drinkable water level <50 ppm, while still maintaining an over 90% Faradaic efficiency. Coupling the nitrate reduction effluent stream with an air stripping process, we successfully obtained high purity solid NH4Cl and liquid NH3 solution products, which suggests a practical approach to convert wastewater nitrate into valuable ammonia products. Density functional theory calculations reveal that the highly dispersed Ru atoms provide active nitrate reduction sites and the surrounding Cu sites can suppress the main side reaction, the hydrogen evolution reaction.

Highly active and selective oxygen reduction to H2O2 on boron-doped carbon for high production rates.

Oxygen reduction reaction towards hydrogen peroxide (H2O2) provides a green alternative route for H2O2 production, but it lacks efficient catalysts to achieve high selectivity and activity simultaneously under industrial-relevant production rates. Here we report a boron-doped carbon (B-C) catalyst which can overcome this activity-selectivity dilemma. Compared to the state-of-the-art oxidized carbon catalyst, B-C catalyst presents enhanced activity (saving more than 210 mV overpotential) under industrial-relevant currents (up to 300 mA cm-2) while maintaining high H2O2 selectivity (85-90%). Density-functional theory calculations reveal that the boron dopant site is responsible for high H2O2 activity and selectivity due to low thermodynamic and kinetic barriers. Employed in our porous solid electrolyte reactor, the B-C catalyst demonstrates a direct and continuous generation of pure H2O2 solutions with high selectivity (up to 95%) and high H2O2 partial currents (up to ~400 mA cm-2), illustrating the catalyst's great potential for practical applications in the future.

Bilateral branch pulmonary artery Pulsta valve implantation for treatment of large right ventricular outflow tract in a high-risk patient.

Percutaneous pulmonary valve implantation (PPVI) has been implemented as a novel alternative strategy to surgical pulmonary valve replacement. However, PPVI has an inevitable limitation: the large right ventricular outflow tract (RVOT) lesions exhibit variable geometry and significant pulmonary regurgitation (PR). To overcome this limitation, bilateral branch pulmonary artery (PA) valve implantations using Melody or Sapien valves have been attempted and have shown a reduction in right ventricular volume with clinical benefits in the intermediate term. Nevertheless, these trials also have constraints of large branch PA size. Recently, a feasibility study using the Pulsta valve (Tae Woong Medical Co, Gyeonggi-do, South Korea) for native RVOTs was reported; the diameter of the Pulsta valve ranges from 18 to 32 mm. Herein, we present a successful percutaneous bilateral branch PA valve implantation using two 32 mm Pulsta valves in a 59-year-old man who showed right heart failure with severe pulmonary regurgitation despite several open heart surgeries for tetralogy of Fallot. The main PA was measured to be 49 mm, and both the right and left PAs were measured to be 30 mm.

General synthesis of single-atom catalysts with high metal loading using graphene quantum dots.

Transition-metal single-atom catalysts present extraordinary activity per metal atomic site, but suffer from low metal-atom densities (typically less than 5 wt% or 1 at.%), which limits their overall catalytic performance. Here we report a general method for the synthesis of single-atom catalysts with high transition-metal-atom loadings of up to 40 wt% or 3.8 at.%, representing several-fold improvements compared to benchmarks in the literature. Graphene quantum dots, later interweaved into a carbon matrix, were used as a support, providing numerous anchoring sites and thus facilitating the generation of high densities of transition-metal atoms with sufficient spacing between the metal atoms to avoid aggregation. A significant increase in activity in electrochemical CO2 reduction (used as a representative reaction) was demonstrated on a Ni single-atom catalyst with increased Ni loading.

Electrochemical ammonia synthesis via nitrate reduction on Fe single atom catalyst.

Electrochemically converting nitrate, a widespread water pollutant, back to valuable ammonia is a green and delocalized route for ammonia synthesis, and can be an appealing and supplementary alternative to the Haber-Bosch process. However, as there are other nitrate reduction pathways present, selectively guiding the reaction pathway towards ammonia is currently challenged by the lack of efficient catalysts. Here we report a selective and active nitrate reduction to ammonia on Fe single atom catalyst, with a maximal ammonia Faradaic efficiency of ~ 75% and a yield rate of up to ~ 20,000 µg h-1 mgcat.-1 (0.46 mmol h-1 cm-2). Our Fe single atom catalyst can effectively prevent the N-N coupling step required for N2 due to the lack of neighboring metal sites, promoting ammonia product selectivity. Density functional theory calculations reveal the reaction mechanisms and the potential limiting steps for nitrate reduction on atomically dispersed Fe sites.

Pregnancy outcomes in patients with structural heart disease: a single center experience.

BACKGROUND: In women, pregnancy is a period of relatively drastic hemodynamic change in a short period of time. Most pregnant women adapt well to these gradual hemodynamic changes. However, in women with congenital heart disease or other structural heart disease, adaptation to theses sudden hemodynamic changes is difficult, and heart failure or arrhythmia can get aggravated. This study shares our experiences on the outcomes of pregnancy in patients with structural heart disease. METHODS: From January 2007 to December 2016, we reviewed the medical records of all pregnant women with structural heart disease who received obstetric care at the Sejong General Hospital. RESULTS: During the study period, 103 pregnancies were observed in 79 women with structural heart disease. Of the 103 pregnancies, 55 were primiparous and 48 were multiparous. Echocardiography performed before pregnancy revealed that 52 patients had moderate to severe valvular regurgitation and 38 patients had moderate to severe valvular stenosis; 22 patients had mechanical valves and 5 patients had pulmonary hypertension. Overall, there were 9 maternal cardiac events, 7 obstetric events and 19 neonatal events. Pulmonary embolic events occurred only in 1 case; 77 deliveries were made, and 26 pregnancies did not last. Among 77 deliveries, 55 patients delivered by cesarean section (C/S) (71.43%). C/S in 16 of 55 patients was performed due to the maternal hemodynamic risk. CONCLUSIONS: Overall complications associated with pregnancy in women with structural heart disease were very high at 28.16%. However, it is hoped that maternal and neonatal outcomes will be improved through careful observation and preparedness for anticipated complications.

Low Prefrontal GABA Levels Are Associated With Poor Cognitive Functions in Professional Boxers.

Cognitive dysfunction has long been recognized as a frequently observed symptom in individuals with repetitive mild traumatic brain injury (rmTBI) such as professional boxers. The exact neurobiological mechanisms underlying this cognitive deficit have not yet been identified, but it is agreed upon that the prefrontal cortex (PFC) is one of the most commonly affected brain regions in professional boxers. Noting the pivotal role of the two major brain metabolites in human cognitive functions, γ-aminobutyric acid (GABA) and glutamate/glutamine (Glx), we hypothesized that alterations in levels of GABA and Glx in the PFC would be prominent and may correlate with cognitive deficits in professional boxers. Twenty male professional boxers (Boxers) and 14 age-matched healthy males who had never experienced any TBI (CON) were recruited. Using a 3T magnetic resonance imaging (MRI) scanner, single-voxel proton magnetic resonance spectroscopy with Mescher-Garwood point-resolved spectroscopy (MEGA-PRESS) sequence was performed to evaluate the levels of GABA and Glx in the PFC. Cognitive function was assessed using the memory and attention domains from the Cambridge Neuropsychological Test Automated Battery. The Boxers showed lower GABA level in the PFC compared to the CON, while also showing lower performance in the attention and memory domains. There were no significant between-group differences in Glx levels. Furthermore, the GABA level correlated with memory performance in the Boxers, but not in attention performance. The current findings may suggest that alterations in GABA levels in the PFC may be a potential neurochemical correlate underlying memory dysfunction related to rmTBI.

Medical device-related pressure ulcer (MDRPU) in acute care hospitals and its perceived importance and prevention performance by clinical nurses.

The incidence rate of patients developing pressure ulcers associated with medical device use is underreported in Korea. This study aims to determine clinical nurses' perceived importance and performance towards medical device-related pressure injury prevention. A total of 620 nurses from seven hospitals attending continuing education programmes in Korea responded to self-administered questionnaires. Data were collected from March to December 2017 on a 4-point-Likert scale on nurses' perceived importance and performance for prevention of medical device-related pressure ulcer (MDRPU). Secondary data analysis was performed through reported pressure injury incidence, and questionnaire data were analysed using descriptive statistics, t-test, and anova. The overall rates of hospital-acquired pressure ulcers and MDRPU were 16.9% and 0.8%, respectively. The proportion of MDRPU was 5.02%. Its perceived importance (3.56 ± 0.48) was also higher than prevention performance (3.13 ± 0.90) among nurses. Education level and participation in pressure injury management training was found to enhance prevention performance by nurses. Therefore, informational and educational programmes based on clinical practice are necessary for clinical nurses to focus on perceived importance and performance towards prevention of medical device-related pressure injury and pressure ulcer care.

Alterations in structural rich-club connectivity of the precuneus are associated with depressive symptoms among individuals with subjective memory complaints.

The association between subjective memory complaints (SMCs) and depressive symptoms has been widely reported and both have been regarded as risk factors for dementia, such as Alzheimer's disease (AD). Although SMCs arise as early as in middle age, the exact neural correlates of comorbid depressive symptoms among individuals who are middle-aged and with SMCs have not yet been well investigated. Because rich-club organization of the brain plays a key role in the pathophysiology of various neuropsychiatric disorders, the investigation of rich club organization may provide insight regarding the neurobiological mechanisms of depressive symptoms in SMCs. In the current study, we compared the rich-club organization in the structural brain connectivity between individuals who have SMCs along with depressive symptoms (SMCD) and individuals with SMCs but without depressive symptoms (SMCO). A total of 53 individuals with SMCD and 91 individuals with SMCO participated in the study. For all participants, high-resolution, T1-weighted images and diffusion tensor images were obtained, and the network analysis was performed. Individuals with SMCD had lower connectivity strength between the precuneus and other rich-club nodes than those with SMCO, which was significant after adjusting for potential confounders. Our findings suggest that disruptions of rich-club connectivity strength of the precuenus are associated with depressive symptoms in middle-aged individuals with SMCs. Given that the precuneus is one of the commonly affected regions in the early stages of AD, our findings may imply that the concomitant depressive symptoms in middle-aged individuals with SMCs could reflect structural alterations related to AD.

Risk of Metachronous Advanced Neoplasia in Patients With Multiple Diminutive Adenomas.

OBJECTIVES: Individuals with advanced adenomas or three or more adenomas have a higher risk of metachronous advanced neoplasia (AN) and are recommended to undergo surveillance colonoscopy at shorter intervals. However, it is questionable whether patients with multiple (three or more) non-advanced diminutive adenomas should be considered as high-risk. METHODS: We analyzed 5482 patients diagnosed with one or more adenomas during their first colonoscopy screening and who underwent a follow-up colonoscopy. Patients were categorized into four groups based on adenoma characteristics at baseline: Group 1, 1-2 non-advanced adenomas; Group 2, ≥3 non-advanced, diminutive (1 to 5 mm) adenomas; Group 3, ≥3 non-advanced, small (6-9 mm) adenomas; and Group 4, advanced adenomas. RESULTS: During a median follow-up of 38 months, the incidence of metachronous AN at surveillance colonoscopy was 5.6%. The incidence of AN was 3.9% in group 1, 5.9% in group 2, 10.6% in group 3, and 22.1% in group 4. The adjusted hazard ratios (HRs) [95% confidence intervals (CIs)] for metachronous AN between group 2, group 3, and group 4, and low risk group 1 were 1.71 (0.99-2.94), 2.76 (1.72-4.44), and 5.23 (3.57-7.68), respectively. Compared with group 4, the adjusted HRs (95% CIs) for group 1, group 2, and group 3 were 0.19 (0.13-0.28), 0.32 (0.18-0.59), and 0.52 (0.31-0.89), respectively. CONCLUSIONS: We found that patients with three or more non-advanced diminutive adenomas had a borderline increased risk of metachronous AN compared with patients with low risk adenomas.

Metabolic alterations in the anterior cingulate cortex and related cognitive deficits in late adolescent methamphetamine users.

The adolescent brain, with ongoing prefrontal maturation, may be more vulnerable to drug use-related neurotoxic changes as compared to the adult brain. We investigated whether the use of methamphetamine (MA), a highly addictive psychostimulant, during adolescence affect metabolic and cognitive functions of the anterior cingulate cortex (ACC). In adolescent MA users (n = 44) and healthy adolescents (n = 53), the levels of N-acetyl aspartate (NAA), a neuronal marker, were examined in the ACC using proton magnetic resonance spectroscopy. The Stroop color-word task was used to assess Stroop interference, which may reflect cognitive functions of behavior monitoring and response selection that are mediated by the ACC. Adolescent MA users had lower NAA levels in the ACC (t = -2.88, P = 0.005) and relatively higher interference scores (t = 2.03, P = 0.045) than healthy adolescents. Moreover, there were significant relationships between lower NAA levels in the ACC and worse interference scores in adolescent MA users (r = -0.61, P < 0.001). Interestingly, early onset of MA use, as compared to late onset, was related to both lower NAA levels in the ACC (t = -2.24, P = 0.03) as well as lower performance on interference measure of the Stroop color-word task (t = 2.25, P = 0.03). The current findings suggest that metabolic dysfunction in the ACC and its related cognitive impairment may play an important role in adolescent-onset addiction, particularly during early adolescence.

Network attributes underlying intellectual giftedness in the developing brain.

Brain network is organized to maximize the efficiency of both segregated and integrated information processing that may be related to human intelligence. However, there have been surprisingly few studies that focus on the topological characteristics of brain network underlying extremely high intelligence that is intellectual giftedness, particularly in adolescents. Here, we examined the network topology in 25 adolescents with superior intelligence (SI-Adol), 25 adolescents with average intelligence (AI-Adol), and 27 young adults with AI (AI-Adult). We found that SI-Adol had network topological properties of high global efficiency as well as high clustering with a low wiring cost, relative to AI-Adol. However, contrary to the suggested role that brain hub regions play in general intelligence, the network efficiency of rich club connection matrix, which represents connections among brain hubs, was low in SI-Adol in comparison to AI-Adol. Rather, a higher level of local connection density was observed in SI-Adol than in AI-Adol. The highly intelligent brain may not follow this efficient yet somewhat stereotypical process of information integration entirely. Taken together, our results suggest that a highly intelligent brain may communicate more extensively, while being less dependent on rich club communications during adolescence.