The significance and limited influence of cerebrovascular reactivity on age and sex effects in task- and resting-state brain activity.

Functional MRI measures the blood-oxygen-level dependent signals, which provide an indirect measure of neural activity mediated by neurovascular responses. Cerebrovascular reactivity affects both task-induced and resting-state blood-oxygen-level dependent activity and may confound inter-individual effects, such as those related to aging and biological sex. We examined a large dataset containing breath-holding, checkerboard, and resting-state tasks. We used the breath-holding task to measure cerebrovascular reactivity, used the checkerboard task to obtain task-based activations, and quantified resting-state activity with amplitude of low-frequency fluctuations and regional homogeneity. We hypothesized that cerebrovascular reactivity would be correlated with blood-oxygen-level dependent measures and that accounting for these correlations would result in better estimates of age and sex effects. We found that cerebrovascular reactivity was correlated with checkerboard task activations in the visual cortex and with amplitude of low-frequency fluctuations and regional homogeneity in widespread fronto-parietal regions, as well as regions with large vessels. We also found significant age and sex effects in cerebrovascular reactivity, some of which overlapped with those observed in amplitude of low-frequency fluctuations and regional homogeneity. However, correcting for the effects of cerebrovascular reactivity had very limited influence on the estimates of age and sex. Our results highlight the limitations of accounting for cerebrovascular reactivity with the current breath-holding task.

Cerebrovascular reactivity increases across development in multiple networks as revealed by a breath-holding task: A longitudinal fMRI study.

Functional magnetic resonance imaging (fMRI) has been widely used to understand the neurodevelopmental changes that occur in cognition and behavior across childhood. The blood-oxygen-level-dependent (BOLD) signal obtained from fMRI is understood to be comprised of both neuronal and vascular information. However, it is unclear whether the vascular response is altered across age in studies investigating development in children. Since the breath-hold (BH) task is commonly used to understand cerebrovascular reactivity (CVR) in fMRI studies, it can be used to account for developmental differences in vascular response. This study examines how the cerebrovascular response changes over age in a longitudinal children's BH data set from the Nathan Kline Institute (NKI) Rockland Sample (aged 6-18 years old at enrollment). A general linear model approach was applied to derive CVR from BH data. To model both the longitudinal and cross-sectional effects of age on BH response, we used mixed-effects modeling with the following terms: linear, quadratic, logarithmic, and quadratic-logarithmic, to find the best-fitting model. We observed increased BH BOLD signals in multiple networks across age, in which linear and logarithmic mixed-effects models provided the best fit with the lowest Akaike information criterion scores. This shows that the cerebrovascular response increases across development in a brain network-specific manner. Therefore, fMRI studies investigating the developmental period should account for cerebrovascular changes that occur with age.

Factors that determine first intubation attempt success in high-risk neonates.

BACKGROUND: Approximately 50% of all neonatal endotracheal intubation attempts are unsuccessful and associated with airway injury and cardiorespiratory instability. The aim of this study was to describe intubation practice at a high-risk Neonatal Intensive Care Unit (NICU) and identify factors associated with successful intubation at the first attempt. METHODS: Retrospective cohort study of all infants requiring intubation within the Royal Children's Hospital NICU over three years. Data was collected from the National Emergency Airway Registry for Neonates (NEAR4NEOS). Outcomes were number of attempts, level of operator training, equipment used, difficult airway grade, and clinical factors. Univariate and multivariate analysis were performed to determine factors independently associated with first attempt success. RESULTS: Three hundred and sixty intubation courses, with 538 attempts, were identified. Two hundred and twenty-five (62.5%) were successful on first attempt, with similar rates at subsequent attempts. On multivariate analysis, increasing operator seniority increased the chance of first attempt success. Higher glottic airway grades were associated with lower chance of first attempt success, but neither a known difficult airway nor use of a stylet were associated with first attempt success. CONCLUSION: In a NICU with a high rate of difficult airways, operator experience rather than equipment was the greatest determinant of intubation success. IMPACT: Neonatal intubation is a high-risk lifesaving procedure, and this is the first report of intubation practices at a quaternary surgical NICU that provides regional referral services for complex medical and surgical admissions. Our results showed that increasing operator seniority and lower glottic airway grades were associated with increased first attempt intubation success rates, while factors such as gestational age, weight, stylet use, and known history of difficult airway were not. Operator factors rather than equipment factors were the greatest determinants of first attempt success, highlighting the importance of team selection for neonatal intubations in a high-risk cohort of infants.

Multifractal long-range dependence pattern of functional magnetic resonance imaging in the human brain at rest.

Long-range dependence is a prevalent phenomenon in various biological systems that characterizes the long-memory effect of temporal fluctuations. While recent research suggests that functional magnetic resonance imaging signal has fractal property, it remains unknown about the multifractal long-range dependence pattern of resting-state functional magnetic resonance imaging signals. The current study adopted the multifractal detrended fluctuation analysis on highly sampled resting-state functional magnetic resonance imaging scans to investigate long-range dependence profile associated with the whole-brain voxels as specific functional networks. Our findings revealed the long-range dependence's multifractal properties. Moreover, long-term persistent fluctuations are found for all stations with stronger persistency in whole-brain regions. Subsets with large fluctuations contribute more to the multifractal spectrum in the whole brain. Additionally, we found that the preprocessing with band-pass filtering provided significantly higher reliability for estimating long-range dependence. Our validation analysis confirmed that the optimal pipeline of long-range dependence analysis should include band-pass filtering and removal of daily temporal dependence. Furthermore, multifractal long-range dependence characteristics in healthy control and schizophrenia are different significantly. This work has provided an analytical pipeline for the multifractal long-range dependence in the resting-state functional magnetic resonance imaging signal. The findings suggest differential long-memory effects in the intrinsic functional networks, which may offer a neural marker finding for understanding brain function and pathology.

Embodying performance excellence in medicine: Can The Six Viewpoints help?

Performance excellence in healthcare relies on skilled situational awareness, but there is no comprehensive framework articulating what within a situation requires awareness. Envisioning medicine as a performing artform, we introduce Mary Overlie's The Six Viewpoints-a comprehensive, yet flexible, conceptual framework used in the performing arts world, for teaching, learning, and creating, for over 50 years. We imagine The Viewpoints could serve as a framework to help improve verbal and non-verbal communication and collaboration on medical teams and between providers and their patients. We call on health professions educators to experiment with The Viewpoints to determine how they could be adapted to support performance excellence in the medical arena.

Analysis and visualization methods for detecting functional activation using laser speckle contrast imaging.

BACKGROUND: Previous studies have used regional cerebral blood flow (CBF) hemodynamic response to measure brain activities. In this work, we use a laser speckle contrast imaging (LSCI) apparatus to sample the CBF activation in somatosensory cortex (S1BF) with repetitive whisker stimulation. Traditionally, the CBF activations were processed by depicting the change percentage above baseline; however, it is not clear how different methods influence the detection of activations. AIMS: Thus, in this work we investigate the influence of different methods to detect activations in LSCI. MATERIALS & METHODS: First, principal component analysis (PCA) was performed to denoise the CBF signal. As the signal of the first principal component (PC1) showed the highest correlation with the S1BF CBF response curve, PC1 was used in the subsequent analyses. Then, we used fast Fourier transform (FFT) to evaluate the frequency properties of the LSCI images and the activation map was generated based on the amplitude of the central frequency. Furthermore, Pearson's correlation coefficient (C-C) analysis and a general linear model (GLM) were performed to estimate the S1BF activation based on the time series of PC1. RESULTS: We found that GLM performed better in identifying activation than C-C. Additionally, the activation maps generated by FFT were similar to those obtained by GLM. Particularly, the superficial vein and arterial vessels separated the activation region as segmented activated areas, and the regions with unresolved vessels showed a common activation for whisker stimulation. DISCUSSION AND CONCLUSION: Our research analyzed the extent to which PCA can extract meaningful information from the signal and we compared the performance for detecting brain functional activation between different methods that rely on LSCI. This can be used as a reference for LSCI researchers on choosing the best method to estimate brain activation.

A Metal-Organic Framework (MOF)-Based Multifunctional Cargo Vehicle for Reactive-Gas Delivery and Catalysis.

The efficient delivery of reactive and toxic gaseous reagents to organic reactions was studied using metal-organic frameworks (MOFs). The simultaneous cargo vehicle and catalytic capabilities of several MOFs were probed for the first time using the examples of aromatization, aminocarbonylation, and carbonylative Suzuki-Miyaura coupling reactions. These reactions highlight that MOFs can serve a dual role as a gas cargo vehicle and a catalyst, leading to product formation with yields similar to reactions employing pure gases. Furthermore, the MOFs can be recycled without sacrificing product yield, while simultaneously maintaining crystallinity. The reported findings were supported crystallographically and spectroscopically (e.g., diffuse reflectance infrared Fourier transform spectroscopy), foreshadowing a pathway for the development of multifunctional MOF-based reagent-catalyst cargo vessels for reactive gas reagents as an attractive alternative to the use of toxic pure gases or gas generators.

Relationship Between Age and Cerebral Hemodynamic Response to Breath Holding: A Functional Near-Infrared Spectroscopy Study.

Cerebrovascular reactivity (CVR) is routinely measured as a predictor of stroke in people with a high risk of ischemic attack. Neuroimaging techniques such as emission tomography, magnetic resonance imaging, and transcranial doppler are frequently used to measure CVR even though each technique has its limitations. Functional near-infrared spectroscopy (fNIRS), also based on the principle of neurovascular coupling, is relatively inexpensive, portable, and allows for the quantification of oxy- and deoxy-hemoglobin concentration changes at a high temporal resolution. This study examines the relationship between age and CVR using fNIRS in 45 young healthy adult participants aged 18-41 years (6 females, 26.64 ± 5.49 years) performing a simple breath holding task. Eighteen of the 45 participants were scanned again after a week to evaluate the feasibility of fNIRS in reliably measuring CVR. Results indicate (a) a negative relationship between age and hemodynamic measures of breath holding task in the sensorimotor cortex of 45 individuals and (b) widespread positive coactivation within medial sensorimotor regions and between medial sensorimotor regions with supplementary motor area and prefrontal cortex during breath holding with increasing age. The intraclass correlation coefficient (ICC) indicated only a low to fair/good reliability of the breath hold hemodynamic measures from sensorimotor and prefrontal cortices. However, the average hemodynamic response to breath holding from the two sessions were found to be temporally and spatially in correspondence. Future improvements in the sensitivity and reliability of fNIRS metrics could facilitate fNIRS-based assessment of cerebrovascular function as a potential clinical tool.

Who will receive the last ventilator: why COVID-19 policies should not prioritise healthcare workers.

Policies promoted and adopted for allocating ventilators during the COVID-19 pandemic have often prioritised healthcare workers or other essential workers. While the need for such policies has so far been largely averted, renewed stress on health systems from continuing surges, as well as the experience of allocating another scarce resource-vaccination-counsel revisiting the justifications for such prioritisation. Prioritising healthcare workers may have intuitive appeal, but the ethical justifications for doing so and the potential harms that could follow require careful analysis. Ethical justifications commonly offered for healthcare worker prioritisation for ventilators rest on two social value criteria: (1) instrumental value, also known as the 'multiplier effect', which may preserve the ability of healthcare workers to help others, and (2) reciprocity, which rewards past usefulness or sacrifice. We argue that these justifications are insufficient to over-ride the common moral commitment to value each person's life equally. Institutional policies prioritising healthcare workers over other patients also violate other ethical norms of the healthcare professions, including the commitment to put patients first. Furthermore, policy decisions to prioritise healthcare workers for ventilators could engender or deepen existing distrust of the clinicians, hospitals and health systems where those policies exist, even if they are never invoked.

Growth of Crystalline Bimetallic Metal-Organic Framework Films via Transmetalation.

Crystalline films of the Cu3(BTC)2 (BTC3- = 1,3,5-benzenetricarboxylate) metal-organic framework (MOF) have been grown by dip-coating an alumina/Si(111) substrate in solutions of Cu(II) acetate and the organic linker H3BTC. Atomic force microscopy (AFM) experiments demonstrate that the substrate is completely covered by the MOF film, while grazing incidence wide-angle X-ray scattering (GIWAXS) establishes the crystallinity of the films. Forty cycles of dip-coating results in a film that is ∼70 nm thick with a root mean squared roughness of 25 nm and crystallites ranging from 50-160 nm in height. Co2+ ions were exchanged into the MOF framework by immersing the Cu3(BTC)2 films in solutions of CoCl2. By varying the temperature and exchange times, different concentrations of Co were incorporated into the films, as determined by X-ray photoelectron spectroscopy experiments. AFM studies showed that morphologies of the bimetallic films were largely unchanged after transmetalation, and GIWAXS indicated that the bimetallic films retained their crystallinity.

A Dual Threat: Redox-Activity and Electronic Structures of Well-Defined Donor-Acceptor Fulleretic Covalent-Organic Materials.

The effect of donor (D)-acceptor (A) alignment on the materials electronic structure was probed for the first time using novel purely organic porous crystalline materials with covalently bound two- and three-dimensional acceptors. The first studies towards estimation of charge transfer rates as a function of acceptor stacking are in line with the experimentally observed drastic, eight-fold conductivity enhancement. The first evaluation of redox behavior of buckyball- or tetracyanoquinodimethane-integrated crystalline was conducted. In parallel with tailoring the D-A alignment responsible for "static" changes in materials properties, an external stimulus was applied for "dynamic" control of the electronic profiles. Overall, the presented D-A strategic design, with stimuli-controlled electronic behavior, redox activity, and modularity could be used as a blueprint for the development of electroactive and conductive multidimensional and multifunctional crystalline porous materials.

Extended-Release Naltrexone to Prevent Opioid Relapse in Criminal Justice Offenders.

BACKGROUND: Extended-release naltrexone, a sustained-release monthly injectable formulation of the full mu-opioid receptor antagonist, is effective for the prevention of relapse to opioid dependence. Data supporting its effectiveness in U.S. criminal justice populations are limited. METHODS: In this five-site, open-label, randomized trial, we compared a 24-week course of extended-release naltrexone (Vivitrol) with usual treatment, consisting of brief counseling and referrals for community treatment programs, for the prevention of opioid relapse among adult criminal justice offenders (i.e., persons involved in the U.S. criminal justice system) who had a history of opioid dependence and a preference for opioid-free rather than opioid maintenance treatments and who were abstinent from opioids at the time of randomization. The primary outcome was the time to an opioid-relapse event, which was defined as 10 or more days of opioid use in a 28-day period as assessed by self-report or by testing of urine samples obtained every 2 weeks; a positive or missing sample was computed as 5 days of opioid use. Post-treatment follow-up occurred at weeks 27, 52, and 78. RESULTS: A total of 153 participants were assigned to extended-release naltrexone and 155 to usual treatment. During the 24-week treatment phase, participants assigned to extended-release naltrexone had a longer median time to relapse than did those assigned to usual treatment (10.5 vs. 5.0 weeks, P<0.001; hazard ratio, 0.49; 95% confidence interval [CI], 0.36 to 0.68), a lower rate of relapse (43% vs. 64% of participants, P<0.001; odds ratio, 0.43; 95% CI, 0.28 to 0.65), and a higher rate of opioid-negative urine samples (74% vs. 56%, P<0.001; odds ratio, 2.30; 95% CI, 1.48 to 3.54). At week 78 (approximately 1 year after the end of the treatment phase), rates of opioid-negative urine samples were equal (46% in each group, P=0.91). The rates of other prespecified secondary outcome measures--self-reported cocaine, alcohol, and intravenous drug use, unsafe sex, and reincarceration--were not significantly lower with extended-release naltrexone than with usual treatment. Over the total 78 weeks observed, there were no overdose events in the extended-release naltrexone group and seven in the usual-treatment group (P=0.02). CONCLUSIONS: In this trial involving criminal justice offenders, extended-release naltrexone was associated with a rate of opioid relapse that was lower than that with usual treatment. Opioid-use prevention effects waned after treatment discontinuation. (Funded by the National Institute on Drug Abuse; ClinicalTrials.gov number, NCT00781898.).

Water-gas shift activity on Pt-Re surfaces and the role of the support.

The activity of Pt-Re surfaces was studied for the water-gas shift (WGS) reaction in order to understand how Pt-Re interactions and cluster-support interactions influence activity. The results from these studies were also compared with previous reports of WGS activity on Pt-Re clusters grown on TiO2. Platinum on Re surfaces were prepared by annealing Re films on Pt(111) to form Pt-Re surface alloys, depositing Pt on Re/Pt(111), and depositing Pt on Re clusters supported on highly oriented pyrolytic graphite (HOPG) surfaces. In all cases, the turnover frequency (TOF) for the WGS reaction was higher for Pt with subsurface Re compared to pure Pt. Furthermore, the TOF for 2 ML Pt/TiO2 clusters was greater than that of Pt(111) and 2 ML Pt/HOPG clusters, indicating that the TiO2 support enhances activity for the WGS reaction on Pt. For Pt/TiO2 clusters, a plot of the fraction of perimeter/surface sites as a function of Pt coverage closely follows TOF vs Pt coverage, strongly suggesting that activity occurs at the Pt-TiO2 interface. Notably, the fraction of undercoordinated sites as a function of Pt coverage does not follow the same behavior as the TOFs.

A new interpretation of the √7×√7 R19.1° structure for P adsorbed on a Ni(111) surface.

We have studied P adsorption on Ni(111), a system which shows complex adsorbate structures. We determined the phase diagram of the surface P adsorbed on Ni(111). At low coverage, amorphous P was observed. At temperatures between 373 and 673 K and coverages above 0.1 monolayer, we found a 7 × 7   R 19.1 ∘ structure, but above 673 K, other complex structures were created. These structures seemed to correlate with each other and we reinterpret a 7 × 7   R 19.1 ∘ structure of P adsorbed on Ni(111) based on the similarities of these surface structures. The new rectangular structure for the 7 × 7   19.1 ∘ is discussed in relation to the Ni2P local structure.

Selective Catalytic Chemistry at Rhodium(II) Nodes in Bimetallic Metal-Organic Frameworks.

We report the first study of a gas-phase reaction catalyzed by highly dispersed sites at the metal nodes of a crystalline metal-organic framework (MOF). Specifically, CuRhBTC (BTC3- =benzenetricarboxylate) exhibited hydrogenation activity, while other isostructural monometallic and bimetallic MOFs did not. Our multi-technique characterization identifies the oxidation state of Rh in CuRhBTC as +2, which is a Rh oxidation state that has not previously been observed for crystalline MOF metal nodes. These Rh2+ sites are active for the catalytic hydrogenation of propylene to propane at room temperature, and the MOF structure stabilizes the Rh2+ oxidation state under reaction conditions. Density functional theory calculations suggest a mechanism in which hydrogen dissociation and propylene adsorption occur at the Rh2+ sites. The ability to tailor the geometry and ensemble size of the metal nodes in MOFs allows for unprecedented control of the active sites and could lead to significant advances in rational catalyst design.

Stack the Bowls: Tailoring the Electronic Structure of Corannulene-Integrated Crystalline Materials.

We report the first examples of purely organic donor-acceptor materials with integrated π-bowls (πBs) that combine not only crystallinity and high surface areas but also exhibit tunable electronic properties, resulting in a four-orders-of-magnitude conductivity enhancement in comparison with the parent framework. In addition to the first report of alkyne-azide cycloaddition utilized for corannulene immobilization in the solid state, we also probed the charge transfer rate within the Marcus theory as a function of mutual πB orientation for the first time, as well as shed light on the density of states near the Fermi edge. These studies could foreshadow new avenues for πB utilization for the development of optoelectronic devices or a route for highly efficient porous electrodes.

Electronic Properties of Bimetallic Metal-Organic Frameworks (MOFs): Tailoring the Density of Electronic States through MOF Modularity.

The development of porous well-defined hybrid materials (e.g., metal-organic frameworks or MOFs) will add a new dimension to a wide number of applications ranging from supercapacitors and electrodes to "smart" membranes and thermoelectrics. From this perspective, the understanding and tailoring of the electronic properties of MOFs are key fundamental challenges that could unlock the full potential of these materials. In this work, we focused on the fundamental insights responsible for the electronic properties of three distinct classes of bimetallic systems, Mx-yM'y-MOFs, MxM'y-MOFs, and Mx(ligand-M'y)-MOFs, in which the second metal (M') incorporation occurs through (i) metal (M) replacement in the framework nodes (type I), (ii) metal node extension (type II), and (iii) metal coordination to the organic ligand (type III), respectively. We employed microwave conductivity, X-ray photoelectron spectroscopy, diffuse reflectance spectroscopy, powder X-ray diffraction, inductively coupled plasma atomic emission spectroscopy, pressed-pellet conductivity, and theoretical modeling to shed light on the key factors responsible for the tunability of MOF electronic structures. Experimental prescreening of MOFs was performed based on changes in the density of electronic states near the Fermi edge, which was used as a starting point for further selection of suitable MOFs. As a result, we demonstrated that the tailoring of MOF electronic properties could be performed as a function of metal node engineering, framework topology, and/or the presence of unsaturated metal sites while preserving framework porosity and structural integrity. These studies unveil the possible pathways for transforming the electronic properties of MOFs from insulating to semiconducting, as well as provide a blueprint for the development of hybrid porous materials with desirable electronic structures.

Platinum-ruthenium bimetallic clusters on graphite: a comparison of vapor deposition and electroless deposition methods.

Bimetallic Pt-Ru clusters have been grown on highly ordered pyrolytic graphite (HOPG) surfaces by vapor deposition and by electroless deposition. These studies help to bridge the material gap between well-characterized vapor deposited clusters and electrolessly deposited clusters, which are better suited for industrial catalyst preparation. In the vapor deposition experiments, bimetallic clusters were formed by the sequential deposition of Pt on Ru or Ru on Pt. Seed clusters of the first metal were grown on HOPG surfaces that were sputtered with Ar(+) to introduce defects, which act as nucleation sites for Pt or Ru. On the unmodified HOPG surface, both Pt and Ru clusters preferentially nucleated at the step edges, whereas on the sputtered surface, clusters with relatively uniform sizes and spatial distributions were formed. Low energy ion scattering experiments showed that the surface compositions of the bimetallic clusters are Pt-rich, regardless of the order of deposition, indicating that the interdiffusion of metals within the clusters is facile at room temperature. Bimetallic clusters on sputtered HOPG were prepared by the electroless deposition of Pt on Ru seed clusters from a Pt(+2) solution using dimethylamine borane as the reducing agent at pH 11 and 40 °C. After exposure to the electroless deposition bath, Pt was selectively deposited on Ru, as demonstrated by the detection of Pt on the surface by XPS, and the increase in the average cluster height without an increase in the number of clusters, indicating that Pt atoms are incorporated into the Ru seed clusters. Electroless deposition of Ru on Pt seed clusters was also achieved, but it should be noted that this deposition method is extremely sensitive to the presence of other metal ions in solution that have a higher reduction potential than the metal ion targeted for deposition.

Brain activation during the N-back working memory task in individuals with spinal cord injury: a functional near-infrared spectroscopy study.

Cognitive impairments have frequently been reported in individuals with spinal cord injury (SCI) across different domains such as working memory, attention, and executive function. The mechanism of cognitive impairment after SCI is not well understood due to the heterogeneity of SCI sample populations, and may possibly be due to factors such as cardiovascular dysfunction, concomitant traumatic brain injury (TBI), hypoxia, sleep disorders, and body temperature dysregulation. In this study, we implement the Neuropsychiatric Unit Cognitive Assessment Tool (NUCOG) to assess cognitive differences between individuals with SCI and age-matched able-bodied (AB) controls. We then use an N-back working memory task and functional near-infrared spectroscopy (fNIRS) to elucidate the neurovascular correlates of cognitive function in individuals with SCI. We observed significant differences between the SCI and AB groups on measures of executive function on the NUCOG test. On the N-back task, across the three levels of difficulty: 0-back, 2-back, and 3-back, no significant differences were observed between the SCI and AB group; however, both groups performed worse as the level of difficulty increased. Although there were no significant differences in N-back performance scores between the two groups, functional brain hemodynamic activity differences were observed between the SCI and AB groups, with the SCI group exhibiting higher maximum oxygenated hemoglobin concentration in the right inferior parietal lobe. These findings support the use of fNIRS to study cognitive function in individuals with SCI and may provide a useful tool during rehabilitation to obtain quantitative functional brain activity metrics.