On-Surface Stepwise Double Dehydrogenation for the Formation of a para-Quinodimethane-Containing Undecacene Isomer.

The on-surface synthesis of an isomer of undecacene, bearing two four-membered rings and two para-quinodimethane moieties, starting from a tetramethyl-substituted diepoxy precursor, is presented. The transformation implies a thermal double deoxygenation followed by a stepwise double dehydrogenation reaction on the Au(111) surface, locally induced by inelastic tunneling electrons. This results in the transformation of para-dimethylbenzene moieties into non-aromatic para-quinodimethanes. The structures and electronic properties of the intermediate and final products are investigated at the single molecule level with high spatial resolution, using both scanning tunneling microscopy/spectroscopy and non-contact atomic force microscopy. The experimental results are supported by density functional theory calculations.

Diagnostic Accuracy of the Abbott BinaxNOW COVID-19 Antigen Card Test, Puerto Rico.

BACKGROUND: The COVID-19 pandemic underscored the need for rapid and accurate diagnostic tools. In August 2020, the Abbott BinaxNOW COVID-19 Antigen Card test became available as a timely and affordable alternative for SARS-CoV-2 molecular testing, but its performance may vary due to factors including timing and symptomatology. This study evaluates BinaxNOW diagnostic performance in diverse epidemiological contexts. METHODS: Using RT-PCR as reference, we assessed performance of the BinaxNOW COVID-19 test for SARS-CoV-2 detection in anterior nasal swabs from participants of two studies in Puerto Rico from December 2020 to May 2023. Test performance was assessed by days post symptom onset, collection strategy, vaccination status, symptomatology, repeated testing, and RT-PCR cycle threshold (Ct) values. RESULTS: BinaxNOW demonstrated an overall sensitivity of 84.1% and specificity of 98.8%. Sensitivity peaked within 1-6 days after symptom onset (93.2%) and was higher for symptomatic (86.3%) than asymptomatic (67.3%) participants. Sensitivity declined over the course of infection, dropping from 96.3% in the initial test to 48.4% in testing performed 7-14 days later. BinaxNOW showed 99.5% sensitivity in participants with low Ct values (≤ 25) but lower sensitivity (18.2%) for participants with higher Cts (36-40). CONCLUSIONS: BinaxNOW demonstrated high sensitivity and specificity, particularly in early-stage infections and symptomatic participants. In situations where test sensitivity is crucial for clinical decision-making, nucleic acid amplification tests are preferred. These findings highlight the importance of considering clinical and epidemiological context when interpreting test results and emphasize the need for ongoing research to adapt testing strategies to emerging SARS-CoV-2 variants.

Current indications and surgical strategies for myocardial revascularization in patients with left ventricular dysfunction: a scoping review.

BACKGROUND: Ischemic cardiomyopathy (ICM) accounts for more than 60% of congestive heart failure cases and is associated with high morbidity and mortality rates. Myocardial revascularization in patients with left ventricular dysfunction (LVD) and a left ventricular ejection fraction (LVEF) ≤35% aims to improve survival and quality of life and reduce complications associated with heart failure and coronary artery disease. The majority of randomized clinical trials have consistently excluded those patients, resulting in evidence primarily derived from observational studies. MAIN BODY: We performed a scoping review using the Arksey and O'Malley methodology in five stages: 1) formulating the research question; 2) locating relevant studies; 3) choosing studies; 4) organizing and extracting data; and 5) compiling, summarizing, and presenting the findings. This literature review covers primary studies and systematic reviews focusing on surgical revascularization strategies in adult patients with ischemic left ventricular dysfunction (LVD) and a left ventricular ejection fraction (LVEF) of 35% or lower. Through an extensive search of Medline and the Cochrane Library, a systematic review was conducted to address three questions regarding myocardial revascularization in these patients. These questions outline the current knowledge on this topic, current surgical strategies (off-pump vs. on-pump), and graft options (including hybrid techniques) utilized for revascularization. Three independent reviewers (MAE, DP, and AM) applied the inclusion criteria to all the included studies, obtaining the full texts of the most relevant studies. The reviewers subsequently assessed these articles to make the final decision on their inclusion in the review. Out of the initial 385 references, 156 were chosen for a detailed review. After examining the full articles were examined, 134 were found suitable for scoping review. CONCLUSION: The literature notes the scarcity of surgical revascularization in LVD patients in randomized studies, with observational data supporting coronary revascularization's benefits. ONCABG is recommended for multivessel disease in LVD with LVEF < 35%, while OPCAB is proposed for older, high-risk patients. Strategies like internal thoracic artery skeletonization harvesting and postoperative glycemic control mitigate risks with BITA in uncontrolled diabetes. Total arterial revascularization maximizes long-term survival, and hybrid revascularization offers advantages like shorter hospital stays and reduced costs for significant LAD lesions.

Observation of SOMO-HOMO Inversion in a Neutral Polycyclic Conjugated Hydrocarbon.

We report the generation of a nonbenzenoid polycyclic conjugated hydrocarbon, which consists of a biphenyl moiety substituted by indenyl units at the 4,4' positions, on ultrathin sodium chloride films by tip-induced chemistry. Single-molecule characterization by scanning tunneling and atomic force microscopy reveals an open-shell biradical ground state with a peculiar electronic configuration wherein the singly occupied molecular orbitals (SOMOs) are lower in energy than the highest occupied molecular orbital (HOMO).

Tuneable Current Rectification Through a Designer Graphene Nanoribbon.

Unimolecular current rectifiers are fundamental building blocks in organic electronics. Rectifying behavior has been identified in numerous organic systems due to electron-hole asymmetries of orbital levels interfaced by a metal electrode. As a consequence, the rectifying ratio (RR) determining the diode efficiency remains fixed for a chosen molecule-metal interface. Here, a mechanically tunable molecular diode exhibiting an exceptionally large rectification ratio (>105) and reversible direction is presented. The molecular system comprises a seven-armchair graphene nanoribbon (GNR) doped with a single unit of substitutional diboron within its structure, synthesized with atomic precision on a gold substrate by on-surface synthesis. The diboron unit creates half-populated in-gap bound states and splits the GNR frontier bands into two segments, localizing the bound state in a double barrier configuration. By suspending these GNRs freely between the tip of a low-temperature scanning tunneling microscope and the substrate, unipolar hole transport is demonstrated through the boron in-gap state's resonance. Strong current rectification is observed, associated with the varying widths of the two barriers, which can be tuned by altering the distance between tip and substrate. This study introduces an innovative approach for the precise manipulation of molecular electronic functionalities, opening new avenues for advanced applications in organic electronics.

Bistability between π-diradical open-shell and closed-shell states in indeno[1,2-a]fluorene.

Indenofluorenes are non-benzenoid conjugated hydrocarbons that have received great interest owing to their unusual electronic structure and potential applications in nonlinear optics and photovoltaics. Here we report the generation of unsubstituted indeno[1,2-a]fluorene on various surfaces by the cleavage of two C-H bonds in 7,12-dihydroindeno[1,2-a]fluorene through voltage pulses applied by the tip of a combined scanning tunnelling microscope and atomic force microscope. On bilayer NaCl on Au(111), indeno[1,2-a]fluorene is in the neutral charge state, but it exhibits charge bistability between neutral and anionic states on the lower-workfunction surfaces of bilayer NaCl on Ag(111) and Cu(111). In the neutral state, indeno[1,2-a]fluorene exhibits one of two ground states: an open-shell π-diradical state, predicted to be a triplet by density functional and multireference many-body perturbation theory calculations, or a closed-shell state with a para-quinodimethane moiety in the as-indacene core. We observe switching between open- and closed-shell states of a single molecule by changing its adsorption site on NaCl.

The effect of water on gold supported chiral graphene nanoribbons: rupture of conjugation by an alternating hydrogenation pattern.

In the last few years we have observed a breakpoint in the development of graphene-derived technologies, such as liquid phase filtering and their application to electronics. In most of these cases, they imply exposure of the material to solvents and ambient moisture, either in the fabrication of the material or the final device. The present study demonstrates the sensitivity of graphene nanoribbon (GNR) zigzag edges to water, even in extremely low concentrations. We have addressed the unique reactivity of (3,1)-chiral GNR with moisture on Au(111). Water shows a reductive behaviour, hydrogenating the central carbon of the zigzag segments. By combining scanning tunnelling microscopy (STM) with simulations, we demonstrate how their reactivity reaches a thermodynamic limit when half of the unit cells are reduced, resulting in an alternating pattern of hydrogenated and pristine unit cells starting from the terminal segments. Once a quasi-perfect alternation is reached, the reaction stops regardless of the water concentration. The hydrogenated segments limit the electronic conjugation of the GNR, but the reduction can be reversed both by tip manipulation and annealing. Selective tip-induced dehydrogenation allowed the stabilization of radical states at the edges of the ribbons, while the annealing of the sample completely recovered the original, pristine GNR.

Introducing Design Strategies to Preserve N-Heterocycles Throughout the On-Surface Synthesis of Graphene Nanostructures.

Despite the impressive advances in the synthesis of atomically precise graphene nanostructures witnessed during the last decade, advancing in compositional complexity faces major challenges. The concept of introducing the desired functional groups or dopants in the molecular precursor often fails due to their lack of stability during the reaction path. Here, a study on the stability of different pyridine and pyrimidine moieties during the on-surface synthesis of graphene nanoribbons on Au(111) is presented. Combining bond-resolved scanning tunneling microscopy with X-ray photoelectron spectroscopy, the thermal evolution of the nitrogen dopants throughout the whole reaction sequence is tracked. A comparative experimental and ab initio electronic characterization confirms the presence of dopants in the final structures, revealing also that the pyridinic nitrogen leads to a significant band downshift. The results demonstrate that, by using synthetic strategies to lower the reaction temperatures, one can preserve specific N-heterocycles throughout all the reaction steps of the synthesis of graphene nanoribbons and beyond the interibbon coupling reaction that leads to nanoporous graphene.

Sequential On-Surface Cyclodehydrogenation in a Nonplanar Nanographene.

On-surface synthesis has emerged as an attractive method for the atomically precise synthesis of new molecular nanostructures, being complementary to the widespread approach based on solution chemistry. It has been particularly successful in the synthesis of graphene nanoribbons and nanographenes. In both cases, the target compound is often generated through cyclodehydrogenation reactions, leading to planarization and the formation of hexagonal rings. To improve the flexibility and tunability of molecular units, however, the incorporation of other, nonbenzenoid, subunits is highly desirable. In this letter, we thoroughly analyze sequential cyclodehydrogenation reactions with a custom-designed molecular precursor. We demonstrate the step-by-step formation of hexagonal and pentagonal rings from the nonplanar precursor within fjord and cove regions, respectively. Computer models comprehensively support the experimental observations, revealing that both reactions imply an initial hydrogen abstraction and a final [1,2] hydrogen shift, but the formation of a pentagonal ring proceeds through a radical mechanism.

Emergence of π-Magnetism in Fused Aza-Triangulenes: Symmetry and Charge Transfer Effects.

On-surface synthesis has paved the way toward the fabrication and characterization of conjugated carbon-based molecular materials that exhibit π-magnetism such as triangulenes. Aza-triangulene, a nitrogen-substituted derivative, was recently shown to display rich on-surface chemistry, offering an ideal platform to investigate structure-property relations regarding spin-selective charge transfer and magnetic fingerprints. Herein, we study electronic changes upon fusion of single molecules into larger dimeric derivatives. We show that the closed-shell structure of aza-triangulene on Ag(111) leads to closed-shell dimers covalently coupled through sterically accessible carbon atoms. Meanwhile, its open-shell structure on Au(111) leads to coupling via atoms displaying a high spin density, resulting in symmetric or asymmetric products. Interestingly, whereas all dimers on Au(111) exhibit similar charge transfer properties, only asymmetric ones show magnetic fingerprints due to spin-selective charge transfer. These results expose clear relationships among molecular symmetry, charge transfer, and spin states of π-conjugated carbon-based nanostructures.

Detecting the spin-polarization of edge states in graphene nanoribbons.

Low dimensional carbon-based materials can show intrinsic magnetism associated to p-electrons in open-shell π-conjugated systems. Chemical design provides atomically precise control of the π-electron cloud, which makes them promising for nanoscale magnetic devices. However, direct verification of their spatially resolved spin-moment remains elusive. Here, we report the spin-polarization of chiral graphene nanoribbons (one-dimensional strips of graphene with alternating zig-zag and arm-chair boundaries), obtained by means of spin-polarized scanning tunnelling microscopy. We extract the energy-dependent spin-moment distribution of spatially extended edge states with π-orbital character, thus beyond localized magnetic moments at radical or defective carbon sites. Guided by mean-field Hubbard calculations, we demonstrate that electron correlations are responsible for the spin-splitting of the electronic structure. Our versatile platform utilizes a ferromagnetic substrate that stabilizes the organic magnetic moments against thermal and quantum fluctuations, while being fully compatible with on-surface synthesis of the rapidly growing class of nanographenes.

On-Surface Synthesis and Characterization of a High-Spin Aza-[5]-Triangulene.

Triangulenes are a class of open-shell triangular graphene flakes with total spin increasing with their size. In the last years, on-surface-synthesis strategies have permitted fabricating and engineering triangulenes of various sizes and structures with atomic precision. However, direct proof of the increasing total spin with their size remains elusive. In this work, we report the combined in-solution and on-surface synthesis of a large nitrogen-doped triangulene (aza-[5]-triangulene) on a Au(111) surface, and the detection of its high-spin ground state. Bond-resolved scanning tunneling microscopy images uncovered radical states distributed along the zigzag edges, which were detected as weak zero-bias resonances in scanning tunneling spectra. These spectral features reveal the partial Kondo screening of a high-spin state. Through a combination of several simulation tools, we find that the observed distribution of radical states is explained by a quintet ground state (S=2), instead of the quartet state (S=3/2) expected for the neutral species. This confirms that electron transfer to the metal substrate raises the spin of the ground state. We further provide a qualitative description of the change of (anti)aromaticity introduced by N-substitution, and its role in the charge stabilization on a surface, resulting in an S=2 aza-triangulene on Au(111).

Pediatría: un enfoque integral desde sus orígenes hasta la actualidad / Pediatrics: A Comprehensive Approach From its Origins to Present Day / Pediatria: uma abordagem integral desde suas origens até o presente

El término pediatría surge del griego paidos (niño) e iatrea (curación). Inicialmente, la pediatría fue descrita como una de las ramas independientes de la medicina en Europa Central durante la segunda mitad del siglo XIX; se independizó de áreas como la obstetricia y la medicina interna de forma progresiva. Fue descrita por primera vez en 1722 en el tratado Paedojatreja práctica por el profesor de anatomía y teoría médica Theodor Zwinger de la Universidad de Basileam. Los escritos más antiguos de los que se tiene conocimiento de enfermedades en población pediátrica datan de 2100 a. de C., en donde primaba el componente mágico-religioso (1). En Colombia, sus primeros reportes inician en 1868 con el inicio de la época denominada «Segunda etapa de la medicina colombiana¼, tras la fundación de la Universidad de los Estados Unidos de Colombia en Bogotá, en donde se implementa la cátedra de obstetricia y patología especial de las mujeres y niños, por el médico y presidente Santos Acosta. Posteriormente, se separan las asignaturas de obstetricia y patología especial de las mujeres, originándose la cátedra opcional de patología e higiene de la infancia. En 1891, José Ignacio Barberi, bogotano graduado de la Universidad Nacional de Colombia en el año 1881, se convierte en el primer especialista en dictar la asignatura Clínica infantil. En 1911, con la cátedra de pediatría en la Universidad de Antioquia, nace la especialidad en ese departamento, y el 27 de julio de 1917 se funda la Sociedad Colombiana de Pediatría, la cual propende por el bienestar de los niños y adolescentes, su familia y la sociedad, para el desarrollo de la pediatría como disciplina del hombre (2,3).

The term pediatrics comes from the Greek paidos (child) and iatrike (medicine). Initially, pediatrics was described as one of the independent branches of medicine in Central Europe during the second half of the 19th century. It progressively became independent from areas such as obstetrics and internal medicine. It was first described in 1722 in the treatise Paedojatreja práctica by the professor of anatomy and medical theory Theodor Zwinger of the University of Basel. The oldest known works on diseases in the pediatric population date back to 2100 B.C., in which the magical-religious component was predominant (1). In Colombia, its first reports begin in 1868 with the start of the period called the "Second stage of Colombian medicine". After the foundation of the Universidad de los Estados Unidos de Colombia in Bogotá. The subject of obstetrics and special pathology of women and children was implemented by physician and President Santos Acosta. Subsequently, the subjects of obstetrics and special pathology of women were separated, creating the optional subject of childhood pathology and hygiene. In 1891, José Ignacio Barberi, a Bogotá native graduated from the Universidad Nacional de Colombia in 1881, became the first specialist to teach the subject Children's medicine. In 1911, the specialization was born in the department of Antioquia with the subject of pediatrics at University of Antioquia. The Colombian Society of Pediatrics was founded on July 27, 1917, which advocates for the well-being of children and adolescents, their families and society, to develop pediatrics as a human discipline (2,3).

O termo pediatria vem do grego paidos (criança) e iatrea (cura). Inicialmente, a pediatria foi descrita como um dos ramos independentes da medicina na Europa Central durante a segunda metade do século XIX; tornou-se progressivamente independente de áreas como obstetrícia e medicina interna. Foi descrita pela primeira vez em 1722 no tratado Paedojatreja prática de Theodor Zwinger, professor de anatomia e teoria médica na Universidade de Basileam. Os escritos mais antigos de que se tem conhecimento sobre doenças na população pediátrica datam de 2100 a.C., o componente mágico-religioso era predominante (1). Na Colômbia, seus primeiros relatos começam em 1868 com o início da era denominada «Segunda etapa da medicina colombiana¼, após a fundação da Universidade dos Estados Unidos da Colômbia em Bogotá, onde foi implantada a cátedra de obstetrícia e patologia especial de mulheres e crianças, pelo médico e presidente Santos Acosta. Posteriormente, separam-se as disciplinas de obstetrícia e patologia especial de mulheres, dando origem à cadeira facultativa de patologia e higiene infantil. Em 1891, José Ignacio Barberi, natural de Bogotá, formado pela Universidade Nacional da Colômbia em 1881, tornou-se o primeiro especialista a lecionar a disciplina de Clínica Infantil. Em 1911, com a cátedra de pediatria da Universidade de Antioquia, nasceu a especialidade nesse departamento e, em 27 de julho de 1917, foi fundada a Sociedade Colombiana de Pediatria, que visa o bem-estar de crianças e adolescentes, suas famílias e a sociedade, para o desenvolvimento da pediatria como disciplina humana (2,3).

Molecular Bridge Engineering for Tuning Quantum Electronic Transport and Anisotropy in Nanoporous Graphene.

Recent advances on surface-assisted synthesis have demonstrated that arrays of nanometer wide graphene nanoribbons can be laterally coupled with atomic precision to give rise to a highly anisotropic nanoporous graphene structure. Electronically, this graphene nanoarchitecture can be conceived as a set of weakly coupled semiconducting 1D nanochannels with electron propagation characterized by substantial interchannel quantum interferences. Here, we report the synthesis of a new nanoporous graphene structure where the interribbon electronic coupling can be controlled by the different degrees of freedom provided by phenylene bridges that couple the conducting channels. This versatility arises from the multiplicity of phenylene cross-coupling configurations, which provides a robust chemical knob, and from the interphenyl twist angle that acts as a fine-tunable knob. The twist angle is significantly altered by the interaction with the substrate, as confirmed by a combined bond-resolved scanning tunneling microscopy (STM) and ab initio analysis, and should accordingly be addressable by other external stimuli. Electron propagation simulations demonstrate the capability of either switching on/off or modulating the interribbon coupling by the corresponding use of the chemical or the conformational knob. Molecular bridges therefore emerge as efficient tools to engineer quantum transport and anisotropy in carbon-based 2D nanoarchitectures.

On-Surface Synthesis of Nanographenes and Graphene Nanoribbons on Titanium Dioxide.

The formation of two types of nanographenes from custom designed and synthesized molecular precursors has been achieved through thermally induced intramolecular cyclodehydrogenation reactions on the semiconducting TiO2(110)-(1×1) surface, confirmed by the combination of high-resolution scanning tunneling microscopy (STM) and spectroscopy (STS) measurements, and corroborated by theoretical modeling. The application of this protocol on differently shaped molecular precursors demonstrates the ability to induce a highly efficient planarization reaction both within strained pentahelicenes as well as between vicinal phenyl rings. Additionally, by the combination of successive Ullmann-type polymerization and cyclodehydrogenation reactions, the archetypic 7-armchair graphene nanoribbons (7-AGNRs) have also been fabricated on the titanium dioxide surface from the standard 10,10'-dibromo-9,9'-bianthryl (DBBA) molecular precursors. These examples of the effective cyclodehydrogenative planarization processes provide perspectives for the rational design and synthesis of molecular nanostructures on semiconductors.

Room-Temperature C-C σ-Bond Activation of Biphenylene Derivatives on Cu(111).

Activating the strong C-C σ-bond is a central problem in organic synthesis. Directly generating activated C centers by metalation of structures containing strained four-membered rings is one maneuver often employed in multistep syntheses. This usually requires high temperatures and/or precious transition metals. In this paper, we report an unprecedented C-C σ-bond activation at room temperature on Cu(111). By using bond-resolving scanning probe microscopy, we show the breaking of one of the C-C σ-bonds of a biphenylene derivative, followed by insertion of Cu from the substrate. Chemical characterization of the generated species was complemented by X-ray photoemission spectroscopy, and their reactivity was explained by density functional theory calculations. To gain further insight into this unique reactivity on other coinage metals, the reaction pathway on Ag(111) was also investigated and the results were compared with those on Cu(111). This study offers new synthetic routes that may be employed in the in situ generation of activated species for the on-surface synthesis of novel C-based nanostructures.

Clinical Features of COVID-19, Dengue, and Influenza among Adults Presenting to Emergency Departments and Urgent Care Clinics-Puerto Rico, 2012-2021.

Dengue and influenza are pathogens of global concern and cause febrile illness similar to COVID-19. We analyzed data from an enhanced surveillance system operating from three emergency departments and an urgent care clinic in Puerto Rico to identify clinical features predictive of influenza or dengue compared with COVID-19. Participants with fever or respiratory symptoms and aged ≥18 years enrolled May 2012-January 2021 with dengue, influenza, or SARS-CoV-2 confirmed by reverse transcriptase polymerase chain reaction were included. We calculated adjusted odds ratios (aORs) and 95% CIs using logistic regression to assess clinical characteristics of participants with COVID-19 compared to those with dengue or influenza, adjusting for age, subregion, and days from illness onset to presentation for clinical care. Among 13,431 participants, we identified 2,643 with dengue (N = 303), influenza (N = 2,064), or COVID-19 (N = 276). We found differences in days from onset to presentation among influenza (2 days [interquartile range: 1-3]), dengue (3 days [2-4]), and COVID-19 cases (4 days [2-7]; P < 0.001). Cough (aOR: 0.12 [95% CI: 0.07-0.19]) and shortness of breath (0.18 [0.08-0.44]) were less common in dengue compared with COVID-19. Facial flushing (20.6 [9.8-43.5]) and thrombocytopenia (24.4 [13.3-45.0]) were more common in dengue. Runny nose was more common in influenza compared with COVID-19 (8.3 [5.8-12.1]). In summary, cough, shortness of breath, facial flushing, and thrombocytopenia helped distinguish between dengue and COVID-19. Although few features distinguished influenza from COVID-19, presentation > 4 days after symptom onset suggests COVID-19. These findings may assist clinicians making time-sensitive decisions regarding triage, isolation, and management while awaiting pathogen-specific testing.

Magnetic Fingerprints in an All-Organic Radical Molecular Break Junction.

Polycyclic aromatic hydrocarbons radicals are organic molecules with a nonzero total magnetic moment. Here, we report on charge-transport experiments with bianthracene-based radicals using a mechanically controlled break junction technique at low temperatures (6 K). The conductance spectra demonstrate that the magnetism of the diradical is preserved in solid-state devices and that it manifests itself either in the form of a Kondo resonance or inelastic electron tunneling spectroscopy signature caused by spin-flip processes. The magnetic fingerprints depend on the exact configuration of the molecule in the junction; this picture is supported by reference measurements on a radical molecule with the same backbone but with one free spin, in which only Kondo anomalies are observed. The results show that the open-shell structures based on the bianthracene core are interesting systems to study spin-spin interactions in solid-state devices, and this may open the way to control them either electrically or by mechanical strain.