The electronic structure of the aqueous permanganate ion: aqueous-phase energetics and molecular bonding studied using liquid jet photoelectron spectroscopy

Permanganate aqueous solutions, MnO4-(aq.), were studied using liquid-micro-jet-based soft X-ray non-resonant and resonant photoelectron spectroscopy to determine valence and core-level binding energies. To identify possible differences in the energetics between the aqueous bulk and the solution-gas interface, non-resonant spectra were recorded at two different probing depths. Similar experiments were performed with different counter ions, Na+ and K+, with the two solutions yielding indistinguishable anion electron binding energies. Our resonant photoelectron spectroscopy measurements, performed near the Mn LII,III- and O K-edges, selectively probed valence charge distributions between the Mn metal center, O ligands, and first solvation shell in the aqueous bulk. Associated resonantly-enhanced solute ionisation signals revealed hybridisation of the solute constituents' atomic orbitals, including the inner valence Mn 3p and O 2s. We identified intermolecular coulombic decay relaxation processes following resonant X-ray excitation of the solute that highlight valence MnO4-(aq.)-H2O(l) electronic couplings. Furthermore, our results allowed us to infer oxidative reorganisation energies of MnO4˙(aq.) and adiabatic valence ionisation energies of MnO4-(aq.), revealing the Gibbs free energy of oxidation and permitting estimation of the vertical electron affinity of MnO4˙(aq.). Finally, the Gibbs free energy of hydration of isolated MnO4- was determined. Our results and analysis allowed a near-complete binding-energy-scaled MnO4-(aq.) molecular orbital and a valence energy level diagram to be produced for the MnO4-(aq.)/MnO4˙(aq.) system. Cumulatively, our mapping of the aqueous-phase electronic structure of MnO4- is expected to contribute to a deeper understanding of the exceptional redox properties of this widely applied aqueous transition-metal complex ion.

Threshold concepts: A portal into new ways of thinking and practising in psychiatry

Introduction: The theory of threshold concepts conjectures that there are areas in every educational curriculum that are challenging; however, mastering these areas transform the learner's view of the subject. In psychiatry, research into threshold concepts can inform educators so that they can better support students with mastering these challenging areas.Purpose: To identify threshold concepts, we conducted semi-structured interviews with six psychiatry educators and free-text surveys with medical students. To identify avenues for improving the curriculum, we discussed with educators, ways of improving understanding and looked at different approaches to learning.Materials and methods: From our analysis of all responses, we derived three threshold concepts: Therapeutic Risk-Taking, the Biopsychosocial Model, and the Concept of Diagnosis in psychiatry. The majority of students experienced difficulties grasping these concepts and applying them in their patient interactions.Results and conclusions: Hence, we propose focused teaching activities that can help students cross these thresholds: student Balint groups exploring therapeutic risk, student Balint groups exploring the role of a psychiatrist, exposure to psychological therapies/psychotherapy skills and explicit diagnostic reasoning. These activities can be integrated into the undergraduate curriculum to help medical students develop a better understanding and appreciation of psychiatry.

P373 Left atrial mechanics and aortic stiffness following high intensity interval training: a randomised controlled study

Background

Physical inactivity is associated with an increased risk of cardiovascular disease. High intensity interval training (HIIT) has been shown to improve important health parameters, including aerobic capacity, arterial blood pressure, cardiac autonomic modulation and left ventricular mechanics. However, adaptations in left atrial (LA) mechanics and aortic stiffness remain unclear. Therefore, the aim of the present study was to assess any left atrial and aortic adaptations to HIIT.

Methods

Forty-one physically inactive males and females (aged 23 ± 2.7 years) volunteered for the study. Participants were randomised to either a 4-week HIIT intervention (n = 21) or 4-week control period (n = 20). The HIIT protocol consisted of 3 x 30-second maximal cycle ergometer sprints with a resistance of 7.5% body weight, interspersed with 2-minutes of active unloaded recovery. Speckle tracking imaging of the left atrium and M-Mode tracing of the aorta was performed pre and post HIIT and control period using commercially available software (EchoPac; GE Medical Systems). Analysis of covariance, with baseline measures as the covariate, was used to explore any differences in left atrial mechanics and aortic stiffness between the intervention and control groups. Stepwise linear regression analysis using LA stiffness as the dependent variable was conducted.

Results

Following 4-weeks of HIIT, there was significant improvement in LA mechanics, including LA reservoir (13.9 ± 13.4%, p = 0.033) and LA stiffness (-0.05 ± 0.04%-1, p = 0.032) compared to the control condition. In addition, improvements were observed in aortic distensibility (2.1 ± 2.7 cm2 × dyn×-1 × 103, p = 0.031) and aortic stiffness index (-2.6 ± 4.6, p = 0.041) compared to the control condition. In stepwise linear regression analysis, aortic distensibility change was significantly associated with LA stiffness change (p = 0.002), with an R2 of 0.613.

Conclusion

A short-term programme of HIIT was associated with a significant improvement in LA mechanics and aortic stiffness. These adaptations may have important health implications and contribute to the improved left ventricular diastolic and systolic mechanics, aerobic capacity and reduced arterial blood pressure previously documented following HIIT.

Methods and considerations concerning cardiac output measurement in pregnant women: recommendations of the International Working Group on Maternal Hemodynamics

Cardiac output (CO), along with blood pressure and vascular resistance, is one of the most important parameters of maternal hemodynamic function. Substantial changes in CO occur in normal pregnancy and in most obstetric complications. With the development of several non-invasive techniques for the measurement of CO, there is a growing interest in the determination of this parameter in pregnancy. These techniques were initially developed for use in critical-care settings and were subsequently adopted in obstetrics, often without appropriate validation for use in pregnancy. In this article, methods and devices for the measurement of CO are described and compared, and recommendations are formulated for their use in pregnancy, with the aim of standardizing the assessment of CO and peripheral vascular resistance in clinical practice and research studies on maternal hemodynamics. Copyright © 2019 ISUOG. Published by John Wiley & Sons Ltd.

Do water's electrons care about electrolytes?

Ions have a profound effect on the geometrical structure of liquid water and an aqueous environment is known to change the electronic structure of ions. Here we combine photoelectron spectroscopy measurements from liquid microjets with molecular dynamical and quantum chemical calculations to address the reverse question, to what extent do ions affect the electronic structure of liquid water? We study aqueous solutions of sodium iodide (NaI) over a wide concentration range, from nearly pure water to 8 M solutions, recording spectra in the 5 to 60 eV binding energy range to include all water valence and the solute Na+ 2p, I- 4d, and I- 5p orbital ionization peaks. We observe that the electron binding energies of the solute ions change only slightly as a function of electrolyte concentration, less than 150 ± 60 meV over an ∼8 M range. Furthermore, the photoelectron spectrum of liquid water is surprisingly mildly affected as we transform the sample from a dilute aqueous salt solution to a viscous, crystalline-like phase. The most noticeable spectral changes are a negative binding energy shift of the water 1b2 ionizing transition (up to -370 ± 60 meV) and a narrowing of the flat-top shape water 3a1 ionization feature (up to 450 ± 90 meV). A novel computationally efficient technique is introduced to calculate liquid-state photoemission spectra using small clusters from molecular dynamics (MD) simulations embedded in dielectric continuum. This theoretical treatment captured the characteristic positions and structures of the aqueous photoemission peaks, reproducing the experimentally observed narrowing of the water 3a1 feature and weak sensitivity of the water binding energies to electrolyte concentration. The calculations allowed us to attribute the small binding energy shifts to ion-induced disruptions of intermolecular electronic interactions. Furthermore, they demonstrate the importance of considering concentration-dependent screening lengths for a correct description of the electronic structure of solvated systems. Accounting for electronic screening, the calculations highlight the minimal effect of electrolyte concentration on the 1b1 binding energy reference, in accord with the experiments. This leads us to a key finding that the isolated, lowest-binding-energy, 1b1, photoemission feature of liquid water is a robust energetic reference for aqueous liquid microjet photoemission studies.

Excited state wavepacket dynamics in NO2 probed by strong-field ionization

We present an experimental femtosecond time-resolved study of the 399 nm excited state dynamics of nitrogen dioxide using channel-resolved above threshold ionization (CRATI) as the probe process. This method relies on photoelectron-photoion coincidence and covariance to correlate the strong-field photoelectron spectrum with ionic fragments, which label the channel. In all ionization channels observed, we report apparent oscillations in the ion and photoelectron yields as a function of pump-probe delay. Further, we observe the presence of a persistent, time-invariant above threshold ionization comb in the photoelectron spectra associated with most ionization channels at long time delays. These observations are interpreted in terms of single-pump-photon excitation to the first excited electronic X̃ ²A₁ state and multi-pump-photon excitations to higher-lying states. The short time delay (<100 fs) dynamics in the fragment channels show multi-photon pump signatures of higher-lying neutral state dynamics, in data sets recorded with higher pump intensities. As expected for pumping NO₂ at 399 nm, non-adiabatic coupling was seen to rapidly re-populate the ground state following excitation to the first excited electronic state, within 200 fs. Subsequent intramolecular vibrational energy redistribution results in the spreading of the ground state vibrational wavepacket into the asymmetric stretch coordinate, allowing the wavepacket to explore nuclear geometries in the asymptotic region of the ground state potential energy surface. Signatures of the vibrationally "hot" ground state wavepacket were observed in the CRATI spectra at longer time delays. This study highlights the complex and sometimes competing phenomena that can arise in strong-field ionization probing of excited state molecular dynamics.

Effect of admission fascia iliaca compartment blocks on post-operative abbreviated mental test scores in elderly fractured neck of femur patients: a retrospective cohort study

Background

Post-operative cognitive impairment is common in elderly patients following surgery for hip fracture, with undertreated pain being an important etiological factor. Non-opioid based analgesic techniques, such as nerve blocks, may help reduce the risk of cognitive complications. The aim of this study was to investigate whether receiving a fascia iliaca compartment block (FICB) as part of a pre-operative analgesic regime increased the odds of high post-operative abbreviated mental test scores (AMTS) when compared with conventional analgesia without a nerve block.

Methods

A retrospective data analysis of a cohort of 959 patients, aged ≥ 65 years with a diagnosis of hip fracture and admitted to a single hospital over a two-year period was performed. A standardized analgesic regime was used on all patients, and 541/959 (56.4%) of included patients received a FICB. Provision of the FICB was primarily determined by availability of an anesthetist, rather than by patient status and condition. Post-operative cognitive ordinal outcomes were defined by AMTS severity as high (score of ≥9/10), moderate, (score of 7–8) and low (score of ≤6). A multivariable ordinal logistic regression analysis was performed on patient status and clinical care factors, including admission AMTS, age, gender, source of admission, time to surgery, type of anesthesia and ASA score.

Results

Admission FICB was associated with higher adjusted odds for a high AMTS (score of ≥9) relative to lower AMTS (score of ≤8) than conventional analgesia only (OR = 1.80, 95% CI 1.27–2.54; p = 0.001). Increasing age, lower AMTS on admission to hospital, and being admitted from a residential or nursing home were associated with worse cognitive outcomes. Mode of anesthesia or surgery did not significantly influence post-operative AMTS.

Conclusion

Post-operative AMTS is influenced by pre-operative analgesic regimes in elderly patients with hip fracture. Provision of a FICB to patients on arrival to hospital may improve early post-operative cognitive performance in this population.