Impedance of nanocapacitors from molecular simulations to understand the dynamics of confined electrolytes.

Nanoelectrochemical devices have become a promising candidate technology across various applications, including sensing and energy storage, and provide new platforms for studying fundamental properties of electrode/electrolyte interfaces. In this work, we employ constant-potential molecular dynamics simulations to investigate the impedance of gold-aqueous electrolyte nanocapacitors, exploiting a recently introduced fluctuation-dissipation relation. In particular, we relate the frequency-dependent impedance of these nanocapacitors to the complex conductivity of the bulk electrolyte in different regimes, and use this connection to design simple but accurate equivalent circuit models. We show that the electrode/electrolyte interfacial contribution is essentially capacitive and that the electrolyte response is bulk-like even when the interelectrode distance is only a few nanometers, provided that the latter is sufficiently large compared to the Debye screening length. We extensively compare our simulation results with spectroscopy experiments and predictions from analytical theories. In contrast to experiments, direct access in simulations to the ionic and solvent contributions to the polarization allows us to highlight their significant and persistent anticorrelation and to investigate the microscopic origin of the timescales observed in the impedance spectrum. This work opens avenues for the molecular interpretation of impedance measurements, and offers valuable contributions for future developments of accurate coarse-grained representations of confined electrolytes.

Remembering the Work of Phillip L. Geissler: A Coda to His Scientific Trajectory.

Phillip L. Geissler made important contributions to the statistical mechanics of biological polymers, heterogeneous materials, and chemical dynamics in aqueous environments. He devised analytical and computational methods that revealed the underlying organization of complex systems at the frontiers of biology, chemistry, and materials science. In this retrospective we celebrate his work at these frontiers.

First-in-human: Leaflet laceration with balloon mediated annihilation to prevent coronary obstruction with radiofrequency needle (LLAMACORN) for valve-in-valve transcatheter aortic valve replacement.

Coronary obstruction (CO) is a potential pitfall for transcatheter aortic valve replacement (TAVR), especially in valve in valve procedures into degenerated surgical or transcatheter prostheses. Bioprosthetic leaflet modification techniques that incorporate electrosurgery are evolving as the preferred strategy to mitigate the risk of CO in high CO risk settings. The UNICORN method is proposed as a more predictable leaflet modification strategy than the earlier described BASILICA approach, but its proponents have hitherto mandated the use of a balloon-expandable valve (BEV) prosthesis. Many patients have small prostheses and therein face a significant risk of patient prosthesis mismatch with BEV in this setting. This risk may be curtailed if a self-expanding valve (SEV) prosthesis could be used. Herein described is a modified approach to allow for the utilization of SEV systems in this setting.

The limit of macroscopic homogeneous ice nucleation at the nanoscale.

Nucleation in small volumes of water has garnered renewed interest due to the relevance of pore condensation and freezing under conditions of low partial pressures of water, such as in the upper troposphere. Molecular simulations can in principle provide insight on this process at the molecular scale that is challenging to achieve experimentally. However, there are discrepancies in the literature as to whether the rate in confined systems is enhanced or suppressed relative to bulk water at the same temperature and pressure. In this study, we investigate the extent to which the size of the critical nucleus and the rate at which it grows in thin films of water are affected by the thickness of the film. Our results suggest that nucleation remains bulk-like in films that are barely large enough accommodate a critical nucleus. This conclusion seems robust to the presence of physical confining boundaries. We also discuss the difficulties in unambiguously determining homogeneous nucleation rates in nanoscale systems, owing to the challenges in defining the volume. Our results suggest any impact on a film's thickness on the rate is largely inconsequential for present day experiments.

Crumbling crystals: on the dissolution mechanism of NaCl in water.

Dissolution of ionic salts in water is ubiquitous, particularly for NaCl. However, an atomistic scale understanding of the process remains elusive. Simulations lend themselves conveniently to studying dissolution since they provide the spatio-temporal resolution that can be difficult to obtain experimentally. Nevertheless, the complexity of various inter- and intra-molecular interactions require careful treatment and long time scale simulations, both of which are typically hindered by computational expense. Here, we use advances in machine learning potential methodology to resolve at an ab initio level of theory the dissolution mechanism of NaCl in water. The picture that emerges is that of a steady ion-wise unwrapping of the crystal preceding its rapid disintegration, reminiscent of crumbling. The onset of crumbling can be explained by a strong increase in the ratio of the surface area to volume of the crystal. Overall, dissolution comprises a series of highly dynamical microscopic sub-processes, resulting in an inherently stochastic mechanism. These atomistic level insights contribute to the general understanding of dissolution mechanisms in other crystals, and the methodology is primed for more complex systems of recent interest such as water/salt interfaces under flow and salt crystals under confinement.

A classical density functional theory for solvation across length scales.

A central aim of multiscale modeling is to use results from the Schrödinger equation to predict phenomenology on length scales that far exceed those of typical molecular correlations. In this work, we present a new approach rooted in classical density functional theory (cDFT) that allows us to accurately describe the solvation of apolar solutes across length scales. Our approach builds on the Lum-Chandler-Weeks (LCW) theory of hydrophobicity [K. Lum et al., J. Phys. Chem. B 103, 4570 (1999)] by constructing a free energy functional that uses a slowly varying component of the density field as a reference. From a practical viewpoint, the theory we present is numerically simpler and generalizes to solutes with soft-core repulsion more easily than LCW theory. Furthermore, by assessing the local compressibility and its critical scaling behavior, we demonstrate that our LCW-style cDFT approach contains the physics of critical drying, which has been emphasized as an essential aspect of hydrophobicity by recent theories. As our approach is parameterized on the two-body direct correlation function of the uniform fluid and the liquid-vapor surface tension, it straightforwardly captures the temperature dependence of solvation. Moreover, we use our theory to describe solvation at a first-principles level on length scales that vastly exceed what is accessible to molecular simulations.

Effect of low-volume combined aerobic and resistance high-intensity interval training on vascular health in people with type 2 diabetes: a randomised controlled trial.

PURPOSE: We compared the effects of low-volume combined aerobic and resistance high-intensity interval training (C-HIIT), combined moderate-intensity continuous training (C-MICT) and waitlist control (CON) on vascular health after 8-weeks of supervised training, and an additional 10-months of self-directed training, in adults with type 2 diabetes (T2D). METHODS: Sixty-nine low active adults with T2D were randomised to 8-weeks of supervised C-HIIT (3 times/week, 78-min/week), C-MICT (current exercise guidelines, 4 times/week, 210-min/week) or CON. CON underwent usual care for 8-weeks before being re-randomised to C-HIIT or C-MICT. This was followed by 10-months of self-directed training for participants in C-HIIT and C-MICT. Vascular outcomes were evaluated at baseline, 8-weeks, and 12-months. RESULTS: After 8-weeks, supervised C-HIIT significantly improved relative flow-mediated dilation (FMD) compared with CON (mean difference [MD] 0.8% [0.1, 1.4], p = 0.025). Although not significantly different from CON, the magnitude of change in relative FMD following 8-weeks of supervised C-MICT was similar (MD 0.8% [-0.1, 1.7], p = 0.080). There were no differences in haemodynamic indices, carotid-femoral pulse wave velocity (cfPWV), or aortic reservoir pressure between groups at 8-weeks. After 12-months, there was a significant reduction in haemodynamic indices (time effect, p < 0.05) for both C-HIIT and C-MICT, with no between-group difference. The reduction in cfPWV over 12-months was significantly greater in C-MICT than C-HIIT (group × time effect, p = 0.018). There was no difference in FMD over time or between groups at 12-months. CONCLUSIONS: Short-term supervised C-HIIT and C-MICT both increased brachial artery FMD compared with CON. Long-term C-HIIT and C-MICT were beneficial for improving haemodynamic indices, but not brachial artery FMD. C-MICT was superior to C-HIIT for improving cfPWV at 12-months. TRIAL REGISTRATION: Australian New Zealand Clinical Trials Registry Identifier ACTRN12615000475549.

Classical Quantum Friction at Water-Carbon Interfaces.

Friction at water-carbon interfaces remains a major puzzle with theories and simulations unable to explain experimental trends in nanoscale waterflow. A recent theoretical framework─quantum friction (QF)─proposes to resolve these experimental observations by considering nonadiabatic coupling between dielectric fluctuations in water and graphitic surfaces. Here, using a classical model that enables fine-tuning of the solid's dielectric spectrum, we provide evidence from simulations in general support of QF. In particular, as features in the solid's dielectric spectrum begin to overlap with water's librational and Debye modes, we find an increase in friction in line with that proposed by QF. At the microscopic level, we find that this contribution to friction manifests more distinctly in the dynamics of the solid's charge density than that of water. Our findings suggest that experimental signatures of QF may be more pronounced in the solid's response rather than liquid water's.

Third-Generation Transcatheter Aortic Heart Valve with Reverse Parachute Sealing Cuff in Patients with Aortic Valve Disease.

BACKGROUND: The Navitor (Abbott Inc, IL, USA) transcatheter heart valve is a novel third-generation self-expanding bioprosthesis with specific features to mitigate paravalvular regurgitation (PVR). Owing to its novelty, there is a paucity of data on its application in clinical practice. METHODS: Consecutive cohort analysis of the use of the Navitor system in an as-treated clinical setting at a quaternary heart hospital. RESULTS: Sixty consecutive non-clinical trial patients treated with Navitor were identified. All patients underwent a successful procedure. The mean age was 79.3 years (±SD 7.82), 56.67% (n=34) were female, and the mean STS score was 4.87 (±SD 5.70). At 30 days post-procedure, all patients were alive with no readmissions for heart failure. One patient had a major vascular complication (1.7%). Four patients (7.14% of patients without a pre-existing pacemaker) received a new permanent pacemaker. Two patients (3.4%) had a non-disabling stroke. PVR at 30 days was trivial or none in 75% of patients, and no patient had worse than mild PVR. CONCLUSIONS: The Navitor system in this as-treated cohort was associated with favourable clinical, haemodynamic, and safety outcomes.

Dielectric response with short-ranged electrostatics.

The dielectric nature of polar liquids underpins much of their ability to act as useful solvents, but its description is complicated by the long-ranged nature of dipolar interactions. This is particularly pronounced under the periodic boundary conditions commonly used in molecular simulations. In this article, the dielectric properties of a water model whose intermolecular electrostatic interactions are entirely short-ranged are investigated. This is done within the framework of local molecular-field theory (LMFT), which provides a well-controlled mean-field treatment of long-ranged electrostatics. This short-ranged model gives a remarkably good performance on a number of counts, and its apparent shortcomings are readily accounted for. These results not only lend support to LMFT as an approach for understanding solvation behavior, but also are relevant to those developing interaction potentials based on local descriptions of liquid structure.

30-Day Outcomes With the Portico Transcatheter Heart Valve: Insights From a Multi-Centre Australian Observational Study.

BACKGROUND: Transcatheter aortic valve implantation (TAVI) is an established therapy for the treatment of aortic valve disease in appropriately selected patients. Previous studies using the self-expanding Portico transcatheter heart valve (THV), (Abbott Structural Heart, St Paul, MN, USA) have demonstrated the technical feasibility of this system albeit in the hands of relatively inexperienced Portico users. The objective of this study was to assess the real-world safety and efficacy of the Portico THV (with and without the FlexNav delivery system, Abbott Structural Heart) at the 30-day timepoint in an Australian cohort. METHODS AND RESULTS: This study was a retrospective real-world cohort analysis of 269 consecutive patients with severe aortic valve disease who underwent TAVI at multiple centres within Australia between February 2015 and April 2021. Of the 269 patients, 51.7% were female, mean Society of Thoracic Surgeons (STS) score was 5.2 (±6.8) and 98.5% had successful implantations. Thirty (30)-day post-implantation all-cause mortality was observed in one (0.4%) patient, major vascular complications in two (0.7%) patients, more-than-mild paravalvular leak in six (2.2%) patients and requirement for new permanent pacemaker implantation in 27 (10.2%) patients. Haemodynamic parameters at 30 days included mean effective orifice area (EOA) of 2.3 (±0.9) cm2 and mean aortic valve gradient (AVG) of 9.6 (±6.2) mmHg. CONCLUSION: This analysis of the Portico THV in a real-world setting suggested that the system is associated with satisfactory safety and efficacy parameters. Previously published datasets may not have found similar findings owing to lower operator experience with the Portico THV system.

Clinical experience improves academic outcomes in dental Oral surgery education.

INTRODUCTION: This paper aimed to determine if the level of a dental student's clinical experience in oral surgery influences the student's oral surgery academic outcomes. MATERIALS AND METHODS: The oral surgery clinical activity and academic outcomes for all students who completed their dental training in 2017, 2018, 2019 and 2020 from the University of Sydney were analysed for correlation. RESULTS: The clinical activity performed by 313 students was recorded. There was a weak, but statistically significant, Pearson correlation between total dental extractions and academic outcomes (r = .243, p = <.001). The total number of dental extractions performed was the only statistically significant variable on academic outcomes with linear regression analysis (ß = .227, p = .005; model R2  = .077). The increase of a student's clinical experience from less than 45 to more than 65 dental extractions raised their oral surgery academic results by an average of 6.4%. There were no academic benefits to earlier clinical experience. CONCLUSION: An increase in experience with dental extractions resulted in an increase in oral surgery academic outcomes, plateauing at 65 dental extractions. There was no academic advantage to dental student's having earlier clinical experience.

Dental student oral surgery training-Comparing the impact of COVID-19 and cohort sizes.

INTRODUCTION: The response to the COVID-19 pandemic potentially reduced the clinical experience and academic education of dental trainees through reduced supervised clinical sessions. Graduating dental students, future employers and regulators may be concerned over the level of clinical experience of graduates trained within the COVID-19 pandemic. The purpose of this study was to try and document the evidence for, and significance of, this impact. MATERIALS AND METHODS: From dental student data in the 2017, 2018, 2019 and 2020 cohorts attending the University of Sydney, Australia, the number of dental extractions and adjunct oral surgery procedures, as well as final end-of-year examination results, was recorded. Results were compared to determine whether differences in experience and final academic achievement existed between these cohorts. RESULTS: The smallest student cohort, 2017, demonstrated greater clinical experience than the 2018, 2019 and 2020 cohorts. The 2020 COVID-19-affected cohort demonstrated no statistically significant reduction in clinical experience in all measured clinical procedures when compared to the 2018 and 2019 cohorts. The decrease in city teaching hospital clinical experience was compensated by an increase in rural placements. The 2020 cohort achieved the lowest academic results, and this was statistically significant. CONCLUSION: The oral surgery clinical experience of the 2020 dental cohort at the University of Sydney was comparable to prior cohorts. Rural clinics were able to compensate for COVID-19 interruptions to clinical training. The number of students in a cohort, if all other variables remain constant, appeared to affect clinical exposure to a greater extent than COVID-19.

A theory for the stabilization of polar crystal surfaces by a liquid environment.

Polar crystal surfaces play an important role in the functionality of many materials and have been studied extensively over many decades. In this article, a theoretical framework is presented that extends existing theories by placing the surrounding solution environment on an equal footing with the crystal itself; this is advantageous, e.g., when considering processes such as crystal growth from solution. By considering the polar crystal as a stack of parallel plate capacitors immersed in a solution environment, the equilibrium adsorbed surface charge density is derived by minimizing the free energy of the system. In analogy to the well-known diverging surface energy of a polar crystal surface at zero temperature, for a crystal in solution it is shown that the "polar catastrophe" manifests as a diverging free energy cost to perturb the system from equilibrium. Going further than existing theories, the present formulation predicts that fluctuations in the adsorbed surface charge density become increasingly suppressed with increasing crystal thickness. We also show how, in the slab geometry often employed in both theoretical and computational studies of interfaces, an electric displacement field emerges as an electrostatic boundary condition, the origins of which are rooted in the slab geometry itself, rather than the use of periodic boundary conditions. This aspect of the work provides a firmer theoretical basis for the recent observation that standard "slab corrections" fail to correctly describe, even qualitatively, polar crystal surfaces in solution.

Can molecular simulations reliably compare homogeneous and heterogeneous ice nucleation?

In principle, the answer to the posed titular question is undoubtedly "yes." But in practice, requisite reference data for homogeneous systems have been obtained with a treatment of intermolecular interactions that is different from that typically employed for heterogeneous systems. In this article, we assess the impact of the choice of truncation scheme when comparing water in homogeneous and inhomogeneous environments. Specifically, we use explicit free energy calculations and a simple mean field analysis to demonstrate that using the "cut-and-shift" version of the Lennard-Jones potential (common to most simple point charge models of water) results in a systematic increase in the melting temperature of ice Ih. In addition, by drawing an analogy between a change in cutoff and a change in pressure, we use existing literature data for homogeneous ice nucleation at negative pressures to suggest that enhancements due to heterogeneous nucleation may have been overestimated by several orders of magnitude.

Ice is born in low-mobility regions of supercooled liquid water.

When an ice crystal is born from liquid water, two key changes occur: (i) The molecules order and (ii) the mobility of the molecules drops as they adopt their lattice positions. Most research on ice nucleation (and crystallization in general) has focused on understanding the former with less attention paid to the latter. However, supercooled water exhibits fascinating and complex dynamical behavior, most notably dynamical heterogeneity (DH), a phenomenon where spatially separated domains of relatively mobile and immobile particles coexist. Strikingly, the microscopic connection between the DH of water and the nucleation of ice has yet to be unraveled directly at the molecular level. Here we tackle this issue via computer simulations which reveal that (i) ice nucleation occurs in low-mobility regions of the liquid, (ii) there is a dynamical incubation period in which the mobility of the molecules drops before any ice-like ordering, and (iii) ice-like clusters cause arrested dynamics in surrounding water molecules. With this we establish a clear connection between dynamics and nucleation. We anticipate that our findings will pave the way for the examination of the role of dynamical heterogeneities in heterogeneous and solution-based nucleation.

Reconstructing animated eye movements from electrooculography data to aid the diagnosis of vestibular disorders.

OBJECTIVE: To develop a method of visualising electrooculography data to improve the interpretability of nystagmus eye-movements captured using the Continuous Ambulatory Vestibular Assessment (CAVA®) device. DESIGN: We are currently undertaking a clinical investigation to evaluate the capabilities of the CAVA® device to detect periods of pathological nystagmus. The work presented here was undertaken using unblinded data obtained from the preliminary phase of this investigation. STUDY SAMPLE: One patient with Ménière's disease and one with Benign Paroxysmal Positional Vertigo. RESULTS: Using the electrooculography data captured by the CAVA® device, we reconstructed 2D animations of patients' eye movements during attacks of vertigo. We were able to reanimate nystagmus produced as a consequence of two conditions. Concurrent video footage showed that the animations were visually very similar to the patient's actual eye-movements, excepting torsional eye-movements. CONCLUSIONS: The reconstructed animations provide an alternative presentation modality, enabling clinicians to largely interpret electrooculography data as if they were present during a vertigo attack. We were able to recreate nystagmus from attacks experienced in the community rather than a clinical setting. This information provides an objective record of a patient's nystagmus and could be used to complement a full neurotologic history when considering diagnosis and treatment options.

Microscopic Kinetics Pathway of Salt Crystallization in Graphene Nanocapillaries.

The fundamental understanding of crystallization, in terms of microscopic kinetic and thermodynamic details, remains a key challenge in the physical sciences. Here, by using in situ graphene liquid cell transmission electron microscopy, we reveal the atomistic mechanism of NaCl crystallization from solutions confined within graphene cells. We find that rock salt NaCl forms with a peculiar hexagonal morphology. We also see the emergence of a transitory graphitelike phase, which may act as an intermediate in a two-step pathway. With the aid of density functional theory calculations, we propose that these observations result from a delicate balance between the substrate-solute interaction and thermodynamics under confinement. Our results highlight the impact of confinement on both the kinetics and thermodynamics of crystallization, offering new insights into heterogeneous crystallization theory and a potential avenue for materials design.

Plaster pipes and crystalized graphite: Open transventricular transcatheter aortic valve replacement for failed mechanical aortic valve prostheses in the porcelain aorta.

Patients with a true porcelain aorta and a failed mechanical aortic valve prosthesis have limited treatment options. Using a hybrid of an open trans-ventricular approach with peripheral cardiopulmonary bypass and integration of transcatheter techniques this challenge can be overcome. Trans-ventricular mechanical valve extraction (with transcatheter endovascular occlusion and cardioplegia) followed by direct ante-grade transcatheter heart valve implantation offers a potential solution to this conundrum. The procedure described is a novel technique that allows for the effective treatment of patients with failed mechanical surgical aortic valve prostheses in the setting of an inoperable porcelain aorta. In addition, a collaborative integrated multi-disciplinary heart team environment is required for the management of these complex patients.

Disease-Modifying Treatments for Transthyretin Amyloidosis.

ABSTRACT: The transthyretin (TTR) amyloidoses result from misfolding of the protein leading to fibril formation and aggregation as amyloid deposits in predominantly the cardiovascular and nervous systems. Cardiac involvement can manifest as heart failure, arrhythmias, and valvular disease. Neurologic involvement can cause sensorimotor polyneuropathies, mononeuropathies, and dysautonomia. Previously, treatment has focused on management of these symptoms and disease sequelae, with a high rate of mortality due to the absence of disease-modifying therapies. In this article, we review novel treatments focusing on 3 mechanistic pathways: (1) silencing of the TTR gene to suppress production, (2) stabilizing of TTR tetramers to prevent misfolding, or (3) disrupting of existing TTR amyloid fibrils to promote reabsorption.