Multimodal assessment of mitochondrial function in Parkinson's disease

The heterogenous aetiology of Parkinson's disease is increasingly recognized; both mitochondrial and lysosomal dysfunction have been implicated. Powerful, clinically applicable tools are required to enable mechanistic stratification for future precision medicine approaches. The aim of this study was to characterize bioenergetic dysfunction in Parkinson's disease by applying a multimodal approach, combining standardized clinical assessment with midbrain and putaminal 31-phosphorus magnetic resonance spectroscopy (31P-MRS) and deep phenotyping of mitochondrial and lysosomal function in peripheral tissue in patients with recent-onset Parkinson's disease and control subjects. Sixty participants (35 patients with Parkinson's disease and 25 healthy controls) underwent 31P-MRS for quantification of energy-rich metabolites [ATP, inorganic phosphate (Pi) and phosphocreatine] in putamen and midbrain. In parallel, skin biopsies were obtained from all research participants to establish fibroblast cell lines for subsequent quantification of total intracellular ATP and mitochondrial membrane potential (MMP) as well as mitochondrial and lysosomal morphology, using high content live cell imaging. Lower MMP correlated with higher intracellular ATP (r = -0.55, P = 0.0016), higher mitochondrial counts (r = -0.72, P < 0.0001) and higher lysosomal counts (r = -0.62, P = 0.0002) in Parkinson's disease patient-derived fibroblasts only, consistent with impaired mitophagy and mitochondrial uncoupling. 31P-MRS-derived posterior putaminal Pi/ATP ratio variance was considerably greater in Parkinson's disease than in healthy controls (F-tests, P = 0.0036). Furthermore, elevated 31P-MRS-derived putaminal, but not midbrain Pi/ATP ratios (indicative of impaired oxidative phosphorylation) correlated with both greater mitochondrial (r = 0.37, P = 0.0319) and lysosomal counts (r = 0.48, P = 0.0044) as well as lower MMP in both short (r = -0.52, P = 0.0016) and long (r = -0.47, P = 0.0052) mitochondria in Parkinson's disease. Higher 31P-MRS midbrain phosphocreatine correlated with greater risk of rapid disease progression (r = 0.47, P = 0.0384). Our data suggest that impaired oxidative phosphorylation in the striatal dopaminergic nerve terminals exceeds mitochondrial dysfunction in the midbrain of patients with early Parkinson's disease. Our data further support the hypothesis of a prominent link between impaired mitophagy and impaired striatal energy homeostasis as a key event in early Parkinson's disease.

Ultrafast Molecular Frame Quantum Tomography

We develop and experimentally demonstrate a methodology for a full molecular frame quantum tomography (MFQT) of dynamical polyatomic systems. We exemplify this approach through the complete characterization of an electronically nonadiabatic wave packet in ammonia (NH_{3}). The method exploits both energy and time-domain spectroscopic data, and yields the lab frame density matrix (LFDM) for the system, the elements of which are populations and coherences. The LFDM fully characterizes electronic and nuclear dynamics in the molecular frame, yielding the time- and orientation-angle dependent expectation values of any relevant operator. For example, the time-dependent molecular frame electronic probability density may be constructed, yielding information on electronic dynamics in the molecular frame. In NH_{3}, we observe that electronic coherences are induced by nuclear dynamics which nonadiabatically drive electronic motions (charge migration) in the molecular frame. Here, the nuclear dynamics are rotational and it is nonadiabatic Coriolis coupling which drives the coherences. Interestingly, the nuclear-driven electronic coherence is preserved over longer timescales. In general, MFQT can help quantify entanglement between electronic and nuclear degrees of freedom, and provide new routes to the study of ultrafast molecular dynamics, charge migration, quantum information processing, and optimal control schemes.

Ultrafast dynamics in polymeric carbon nitride thin films probed by time-resolved EUV photoemission and UV-Vis transient absorption spectroscopy

The ground- and excited-state electronic structures of four polymeric carbon nitride (PCN) materials have been investigated using a combination of photoemission and optical absorption spectroscopy. To establish the driving forces for photocatalytic water-splitting reactions, the ground-state data was used to produce a band diagram of the PCN materials and the triethanolamine electron scavenger, commonly implemented in water-splitting devices. The ultrafast charge-carrier dynamics of the same PCN materials were also investigated using two femtosecond-time-resolved pump-probe techniques: extreme-ultraviolet (EUV) photoemission and ultraviolet-visible (UV-Vis) transient absorption spectroscopy. The complementary combination of these surface- and bulk-sensitive methods facilitated photoinduced kinetic measurements spanning the sub-picosecond to few nanosecond time range. The results show that 400 nm (3.1 eV) excitation sequentially populates a pair of short-lived transient species, which subsequently produce two different long-lived excited states on a sub-picosecond time scale. Based on the spectro-temporal characteristics of the long-lived signals, they are assigned to singlet-exciton and charge-transfer states. The associated charge-separation efficiency was inferred to be between 65% and 78% for the different studied materials. A comparison of results from differently synthesized PCNs revealed that the early-time processes do not differ qualitatively between sample batches, but that materials of more voluminous character tend to have higher charge separation efficiencies, compared to exfoliated colloidal materials. This finding was corroborated via a series of experiments that revealed an absence of any pump-fluence dependence of the initial excited-state decay kinetics and characteristic carrier-concentration effects that emerge beyond few-picosecond timescales. The initial dynamics of the photoinduced charge carriers in the PCNs are correspondingly determined to be spatially localised in the immediate vicinity of the lattice-constituting motif, while the long-time behaviour is dominated by charge-transport and recombination processes. Suppressing the latter by confining excited species within nanoscale volumes should therefore affect the usability of PCN materials in photocatalytic devices.

Radiation damage by extensive local water ionization from two-step electron-transfer-mediated decay of solvated ions

Biomolecular radiation damage is largely mediated by radicals and low-energy electrons formed by water ionization rather than by direct ionization of biomolecules. It was speculated that such an extensive, localized water ionization can be caused by ultrafast processes following excitation by core-level ionization of hydrated metal ions. In this model, ions relax via a cascade of local Auger-Meitner and, importantly, non-local charge- and energy-transfer processes involving the water environment. Here, we experimentally and theoretically show that, for solvated paradigmatic intermediate-mass Al3+ ions, electronic relaxation involves two sequential solute-solvent electron transfer-mediated decay processes. The electron transfer-mediated decay steps correspond to sequential relaxation from Al5+ to Al3+ accompanied by formation of four ionized water molecules and two low-energy electrons. Such charge multiplication and the generated highly reactive species are expected to initiate cascades of radical reactions.

How to measure work functions from aqueous solutions

The recent application of concepts from condensed-matter physics to photoelectron spectroscopy (PES) of volatile, liquid-phase systems has enabled the measurement of electronic energetics of liquids on an absolute scale. Particularly, vertical ionization energies, VIEs, of liquid water and aqueous solutions, both in the bulk and at associated interfaces, can now be accurately, precisely, and routinely determined. These IEs are referenced to the local vacuum level, which is the appropriate quantity for condensed matter with associated surfaces, including liquids. In this work, we connect this newly accessible energy level to another important surface property, namely, the solution work function, eΦliq. We lay out the prerequisites for and unique challenges of determining eΦ of aqueous solutions and liquids in general. We demonstrate - for a model aqueous solution with a tetra-n-butylammonium iodide (TBAI) surfactant solute - that concentration-dependent work functions, associated with the surface dipoles generated by the segregated interfacial layer of TBA+ and I- ions, can be accurately measured under controlled conditions. We detail the nature of surface potentials, uniquely tied to the nature of the flowing-liquid sample, which must be eliminated or quantified to enable such measurements. This allows us to refer aqueous-phase spectra to the Fermi level and to quantitatively assign surfactant-concentration-dependent spectral shifts to competing work function and electronic-structure effects, where the latter are typically associated with solute-solvent interactions in the bulk of the solution which determine, e.g., chemical reactivity. The present work describes the extension of liquid-jet PES to quantitatively access concentration-dependent surface descriptors that have so far been restricted to solid-phase measurements. Correspondingly, these studies mark the beginning of a new era in the characterization of the interfacial electronic structure of aqueous solutions and liquids more generally.

Valence and Core Photoelectron Spectra of Aqueous I3- from Multi-Reference Quantum Chemistry

The I3- molecule is known to undergo substantial structural reorganization upon solvation by a protic solvent, e.g., water. However, the details of this process are still controversially discussed in the literature. In the present study, we combined experimental and theoretical efforts to disentangle this controversy. The valence (5p), N4,5 (4d), and M4,5 (3d) edge photoelectron spectra were measured in an aqueous solution and computed using high-level multi-reference methods. Our previous publication mainly focused on obtaining reliable experimental evidence, whereas in the present article, we focused primarily on theoretical aspects. The complex electronic structure of I3- requires the inclusion of both static and dynamic correlation, e.g., via the multi-configurational perturbation theory treatment. However, the resulting photoelectron spectra appear to be very sensitive to problems with variational stability and intruder states. We attempted to obtain artifact-free spectra, allowing for a more reliable interpretation of experiments. Finally, we concluded that the 3d Photoelectron Spectrum (PES) is particularly informative, evidencing an almost linear structure with a smaller degree of bond asymmetry than previously reported.

Time-stretched multi-hit 3D velocity map imaging of photoelectrons

The 2D photoelectron velocity map imaging (VMI) technique is commonly employed in gas-phase molecular spectroscopy and dynamics investigations due to its ability to efficiently extract photoelectron spectra and angular distributions in a single experiment. However, the standard technique is limited to specific light-source polarization geometries. This has led to significant interest in the development of 3D VMI techniques, which are capable of measuring individual electron positions and arrival times, obtaining the full 3D distribution without the need for inversion, forward-convolution, or tomographic reconstruction approaches. Here, we present and demonstrate a novel time-stretched, 13-lens 3D VMI photoelectron spectrometer, which has sub-camera-pixel spatial resolution and 210 ps (σ) time-of-flight (TOF) resolution (currently limited by trigger jitter). We employ a kHz CMOS camera to image a standard 40 mm diameter microchannel plate (MCP)/phosphor anode detector (providing x and y positions), combined with a digitizer pick-off from the MCP anode to obtain the electron TOF. We present a detailed analysis of time-space correlation under data acquisition conditions which generate multiple electrons per laser shot, and demonstrate a major advantage of this time-stretched 3D VMI approach: that the greater spread in electron TOFs permits for an accurate time- and position-stamping of up to six electrons per laser shot at a 1 kHz repetition rate.

Higher sensory cortical energy metabolism in Painful-Diabetic Neuropathy: evidence from a cerebral Magnetic Resonance Spectroscopy study

Alterations in the resting state functional connectivity and hyperperfusion of pain processing areas of the brain have been demonstrated in painful-Diabetic Peripheral Neuropathy (DPN). However, the mechanisms underlying these abnormalities are poorly understood. There is thus a good rationale to explore if there is higher energy consumption in the pain processing areas of the brain. We performed a 31Phosphorus Magnetic Resonance Spectroscopy (31P-MRS) study to explore cellular energy usage (bioenergetics) in the primary somatosensory (S1) cortex in a wellcharacterised cohort of participants with painful- and painless-DPN. S1 PCr:ATP, a measure of energy consumption, was significantly reduced in painfulcompared with painless-DPN. This is indicative of greater S1 cortical energy consumption in painful-DPN. Furthermore, S1 PCr:ATP correlated with pain intensity during the MRI. S1 PCr:ATP was also significantly lower in painful-DPN individuals with moderate/severe pain compared to those with low pain. This is the first study to demonstrate higher S1 cortical energy metabolism in painfulcompared with painless-DPN. Moreover, the relationship between PCr:ATP and neuropathic pain measures shows that S1 bioenergetics is related to the severity of neuropathic pain. S1 cortical energetics may represent a biomarker of painful-DPN and could have the potential to serve as a target for therapeutic interventions.

Updating the British Geriatrics Society recommended undergraduate curriculum in geriatric medicine: a curriculum mapping and nominal group technique study

BACKGROUND

medical education must adapt to meet the challenges and demands of an ageing population, ensuring that graduates are equipped to look after older patients with complex health and social care needs. Recommended curricula in geriatric medicine in the United Kingdom and Europe offer guidance for optimal undergraduate education in ageing. The UK version, written by the British Geriatrics Society (BGS), requires updating to take account of innovations in the specialty, changing guidance from the General Medical Council (GMC), and the need to support medical schools preparing for the introduction of the national Medical Licensing Assessment (MLA).

METHODS

the BGS recommended curriculum was mapped to the most recent European curriculum (2014) and the MLA content map, to compare and contrast between current recommendations and nationally mandated guidance. These maps were used to guide discussion through a virtual Nominal Group Technique (NGT), including 21 expert stakeholders, to agree consensus on the updated BGS curriculum.

RESULTS

the curriculum has been re-structured into seven sections, each with 1-2 overarching learning outcomes (LOs) that are expanded in multiple sub-LOs. Crucially, the curriculum now reflects the updated GMC/MLA requirements, having incorporated items flagged as missing in the mapping stages.

CONCLUSION

the combined mapping exercise and NGT have enabled appropriate alignment and benchmarking of the UK national curriculum. These recommendations will help to standardise and enhance teaching and learning around the care of older persons with complexity.

1290 CAN P1NP LEVELS INFLUENCE MANAGEMENT PLANNING FOR PATIENTS WITH A FRAGILITY HIP FRACTURE RECEIVING ANTI-RESORPTIVE MEDICATIONS?

Introduction

Procollagen-N-terminal-peptide (P1NP) is a bone formation marker. Bisphosphonates lead to a reduction in P1NP levels and levels are significantly elevated shortly after fracture. In older patients taking bisphosphonates who have had a further osteoporotic fracture there is a lack of evidence to guide ongoing osteoporotic management.

Objectives

To assess if measuring P1NP in patients receiving Bisphosphonates treatment who develop neck of femur fractures helps guide further management in regards to long term bone protection treatment.

Method

Retrospective descriptive cohort study of P1NP levels for the patients who presented with NOF# (&gt;60yrs) and who were taking anti-resorptive medications. Cases were discussed in our complex bone health MDM and patient specific plans made accordingly.

Results

60 patients were identified between March 2017 and Sept 2021 had P1NP tested (2.6 % of the 2,303 total fractures in this time). Mean age 83 years (F:M – 54:6 / # type - IC:EC – 34:26). Overall: 17 (28%) patients had significantly elevated PINP with identifiable reasons. 39 (65%) patients had supressed P1NP levels (&lt; 35mcg/L) and 5(7 %) between 36-39 mcg/L. Of those with supressed P1NP: Patients taking treatment &gt;5 years (n=9) – Treatment stopped for 6 patients, 2 changed treatment following DXA and 1 continued. On treatment 3-5 years (n=8) – 5 continued with treatment, 1 had further ix and 2 treatments changed On treatment 1-3 years (n=17) – 14 continued treatment, 2 treatments stopped, 1 treatment changed On treatment &lt;1 year (n=16) – all continued the same treatment

Conclusion

The measurement of P1NP has been helpful in making patient centred decisions in this cohort. It has added to the detailed discussions in the hip fracture bone health MDM and for 23% of patients with supressed bone turnover contributed to a change in management. Most changes occurred in those patients taking treatment for more than 5 years where the evidence of bone turnover suppression gives confidence to stop or change treatment.

Absolute Electronic Energetics and Quantitative Work Functions of Liquids from Photoelectron Spectroscopy

Liquid-jet photoelectron spectroscopy (LJ-PES) enabled a breakthrough in the experimental study of the electronic structure of liquid water, aqueous solutions, and volatile liquids more generally. The novelty of this technique, dating back over 25 years, lies in stabilizing a continuous, micron-diameter LJ in a vacuum environment to enable PES studies. A key quantity in PES is the most probable energy associated with vertical promotion of an electron into vacuum: the vertical ionization energy, VIE, for neutrals and cations, or vertical detachment energy, VDE, for anions. These quantities can be used to identify species, their chemical states and bonding environments, and their structural properties in solution. The ability to accurately measure VIEs and VDEs is correspondingly crucial. An associated principal challenge is the determination of these quantities with respect to well-defined energy references. Only with recently developed methods are such measurements routinely and generally viable for liquids. Practically, these methods involve the application of condensed-matter concepts to the acquisition of photoelectron (PE) spectra from liquid samples, rather than solely relying on molecular-physics treatments that have been commonly implemented since the first LJ-PES experiments. This includes explicit consideration of the traversal of electrons to and through the liquid's surface, prior to free-electron detection. Our approach to measuring VIEs and VDEs with respect to the liquid vacuum level specifically involves detecting the lowest-energy electrons emitted from the sample, which have barely enough energy to surmount the surface potential and accumulate in the low-energy tail of the liquid-phase spectrum. By applying a sufficient bias potential to the liquid sample, this low-energy spectral tail can generally be exposed, with its sharp, low-energy cutoff revealing the genuine kinetic-energy-zero in a measured spectrum, independent of any perturbing intrinsic or extrinsic potentials in the experiment. Together with a precisely known ionizing photon energy, this feature enables the straightforward determination of VIEs or VDEs, with respect to the liquid-phase vacuum level, from any PE feature of interest. Furthermore, by additionally determining solution-phase VIEs and VDEs with respect to the common equilibrated energy level in condensed matter, the Fermi level─the generally implemented reference energy in solid-state PES─solution work functions, eΦ, and liquid-vacuum surface dipole effects can be quantified. With LJs, the Fermi level can only be properly accessed by controlling unwanted surface charging and all other extrinsic potentials, which lead to energy shifts of all PE features and preclude access to accurate electronic energetics. More specifically, conditions must be engineered to minimize all undesirable potentials, while maintaining the equilibrated, intrinsic (contact) potential difference between the sample and apparatus. The establishment of these liquid-phase, accurate energy-referencing protocols importantly enables VIE and VDE determinations from near-arbitrary solutions and the quantitative distinction between bulk electronic structure and interfacial effects. We will review and exemplify these protocols for liquid water and several exemplary aqueous solutions here, with a focus on the lowest-ionization- or lowest-detachment-energy PE peaks, which importantly relate to the oxidative stabilities of aqueous-phase species.

Loneliness and Depression among Community Older Adults during the COVID-19 Pandemic: A cross-sectional study

BACKGROUND

Social isolation has been recommended for reducing older adults' mortality and severe cases of COVID illness. That has resulted in unavoidable consequences of mental ill-health. This study aimed to examine the impact of the COVID-19 lockdown on the development of loneliness and depression and to analyse the factors associated with these conditions among community-dwelling older adults in Jordan.

METHODS

A cross-sectional survey was conducted with a random sample of 456 community older adults contacted by telephone three weeks after the first pandemic lockdown in April 2020. The study instrument included the screening three-item UCLA Loneliness Scale, the Geriatric Depression Scale, and relevant medical and functional history.

RESULTS

The mean age was 72.48 ± 6.84 years, and 50.2% were women. 41.4% were lonely, and of those 62% had a positive screen for depression. The mean UCLA score was significantly higher during the lockdown than before. Loneliness was significantly associated with being unmarried, having never worked previously, and being functionally dependent. Lonely participants were 1.65 times more likely to have depression. Likewise, a previous history of depression and cognitive impairment, multimorbidity, poor self-perceived health, and concern about contracting COVID infection were significant predictors of depression.

CONCLUSION

The COVID-19 pandemic has had a heavy toll on older adults' mental health, particularly those with multimorbidity, baseline functional dependence, and those with a previous history of depression and cognitive impairment. Targeting these high-risk groups is important in order to minimize loneliness, depression, and subsequent increased morbidity. Using all-inclusive language might minimize ageism and the fear of catching an infection.

Probing the molecular structure of aqueous triiodide via X-ray photoelectron spectroscopy and correlated electron phenomena

Liquid-microjet-based X-ray photoelectron spectroscopy was applied to aqueous triiodide solutions, I₃^-_(aq.), to investigate the anion's valence- and core-level electronic structure, ionization dynamics, associated electron-correlation effects, and nuclear geometric structure. The roles of multi-active-electron (shake-up) ionization processes - with noted sensitivity to the solute geometric structure - were investigated through I₃^-_(aq.) solution valence, I 4d, and I 3d core-level measurements. The experimental spectra were interpreted with the aid of simulated photoelectron spectra, built upon multi-reference ab initio electronic structure calculations associated with different I₃^-_(aq.) molecular geometries. A comparison of the single-to-multi-active-electron ionization signal ratios extracted from the experimental and theoretical core-level photoemission spectra suggests that the ground state of the solute adopts a near-linear average geometry in aqueous solutions. This contrasts with the interpretation of time-resolved X-ray solution scattering studies, but is found to be fully consistent with the rest of the solution-phase I₃^-_(aq.) literature. Comparing the results of low- and high-photon-energy photoemission measurements, we further suggest that the aqueous anion adopts a more asymmetric geometry at the aqueous-solution-gas interface than in the aqueous bulk.

Probing aqueous ions with non-local Auger relaxation

Non-local analogues of Auger decay are increasingly recognized as important relaxation processes in the condensed phase. Here, we explore non-local autoionization, specifically Intermolecular Coulombic Decay (ICD), of a series of aqueous-phase isoelectronic cations following 1s core-level ionization. In particular, we focus on Na+, Mg2+, and Al3+ ions. We unambiguously identify the ICD contribution to the K-edge Auger spectrum. The different strength of the ion-water interactions is manifested by varying intensities of the respective signals: the ICD signal intensity is greatest for the Al3+ case, weaker for Mg2+, and absent for weakly-solvent-bound Na+. With the assistance of ab initio calculations and molecular dynamics simulations, we provide a microscopic understanding of the non-local decay processes. We assign the ICD signals to decay processes ending in two-hole states, delocalized between the central ion and neighbouring water. Importantly, these processes are shown to be highly selective with respect to the promoted water solvent ionization channels. Furthermore, using a core-hole-clock analysis, the associated ICD timescales are estimated to be around 76 fs for Mg2+ and 34 fs for Al3+. Building on these results, we argue that Auger and ICD spectroscopy represents a unique tool for the exploration of intra- and inter-molecular structure in the liquid phase, simultaneously providing both structural and electronic information.

Photoelectron circular dichroism in angle-resolved photoemission from liquid fenchone

We present an experimental X-ray photoelectron circular dichroism (PECD) study of liquid fenchone at the C 1s edge. A novel setup to enable PECD measurements on a liquid microjet [Malerz et al., Rev. Sci. Instrum., 2022, 93, 015101] was used. For the C 1s line assigned to fenchone's carbonyl carbon, a non-vanishing asymmetry is found in the intensity of photoelectron spectra acquired under a fixed angle in the backward-scattering plane. This experiment paves the way towards an innovative probe of the chirality of organic/biological molecules in aqueous solution.

We present the first X-ray photoelectron circular dichroism (PECD) study from a liquid phase sample, exemplified for liquid fenchone at the C 1s edge.

The informalization of doctor-patient relations in a Finnish setting: New social figurations and emergent possibilities

This article features data drawn from interviews with doctors working in the Finnish occupational health-care system. These are used to explore the value of an Eliasian approach towards interpreting and assessing the moral meanings and social dynamics of relationships between health practitioners and their patients. We attend to spiralling 'formalizing' and 'informalizing' processes and how these are operating to reconfigure doctor-patient relationships. We document some of the ways in which Finnish doctors are adapting to these processes. While data drawn from a British context suggest both doctor and patients are inclined to adopt positions of mutual distrust and hostility, by contrast we note that in this Finnish setting more concerted attempts are being made to renegotiate social roles, cultural meanings and individual responsibilities. We propose that this can be taken as an instance where informalization is accompanied by revitalized currents of formalization and new syntheses of moral codes and conduct.

The association between central ambulatory blood pressure and end-organ damage

Background/Introduction

Central blood pressure (BP) measured in the clinic relates more strongly to end-organ damage and may be superior to brachial BP in predicting cardiovascular events. Measurement of central ambulatory BP (ABP) is now possible and emerging data suggest that central ABP is better correlated with left ventricular mass index (LVMI) than brachial ABP.1,2 However, the association between central ABP and other measures of end-organ damage remains unclear.

Purpose

We investigated the association between brachial or central ABP and end-organ damage, in a large community-based population of untreated individuals.

Method

1091 participants (mean age 45±18 years; 589 females) had simultaneous measurements of brachial and central ABP over 24 hours, using the Mobil-O-Graph device. Central ABP was derived using two waveform calibration methods (1: mean/diastolic BP; 2: systolic/diastolic BP). Participants also underwent measurement of aortic pulse wave velocity (aPWV; SphygmoCor device) in the clinic. In a subset of 675 individuals, LVMI was assessed by echocardiography and in 610 individuals, carotid intima-media thickness (CIMT) was measured, using ultrasound. 24-hour and daytime brachial and central ambulatory systolic BP (ASBP) and pulse pressure (APP) were considered.

Results

The Pearson's coefficient for each correlation is listed in Table 1. LVMI was most strongly correlated with 24-hour central ASBP, using calibration method 1 (MAP/DBP; r=0.403, P&lt;0.001). CIMT was most strongly correlated with daytime central ASBP, again derived from calibration method 1 (r=0.341, p&lt;0.001), whereas aPWV measured in the clinic, was most strongly correlated with 24-hour central ASBP, derived from calibration method 2 (SBP/DBP; r=0.441, P&lt;0.001). Based on z statistics, all correlations reported above were significantly stronger than equivalent correlations using brachial ASBP (P&lt;0.001 for all three comparisons of correlation coefficients).

Conclusion

Measurement of central ABP relates more closely to end-organ damage than equivalent measures based on brachial ABP. Central ABP may provide valuable additional information concerning cardiovascular risk above and beyond brachial ABP.

Funding Acknowledgement

Type of funding sources: Public Institution(s). Main funding source(s): British Heart Foundation

Quantitative electronic structure and work-function changes of liquid water induced by solute

Recent advancement in quantitative liquid-jet photoelectron spectroscopy enables the accurate determination of the absolute-scale electronic energetics of liquids and species in solution. The major objective of the present work is the determination of the absolute lowest-ionization energy of liquid water, corresponding to the 1b₁ orbital electron liberation, which is found to vary upon solute addition, and depends on the solute concentration. We discuss two prototypical aqueous salt solutions, NaI_(aq) and tetrabutylammonium iodide, TBAI_(aq), with the latter being a strong surfactant. Our results reveal considerably different behavior of the liquid water 1b₁ binding energy in each case. In the NaI_(aq) solutions, the 1b₁ energy increases by about 0.3 eV upon increasing the salt concentration from very dilute to near-saturation concentrations, whereas for TBAI the energy decreases by about 0.7 eV upon formation of a TBAI surface layer. The photoelectron spectra also allow us to quantify the solute-induced effects on the solute binding energies, as inferred from concentration-dependent energy shifts of the I⁻ 5p binding energy. For NaI_(aq), an almost identical I⁻ 5p shift is found as for the water 1b₁ binding energy, with a larger shift occurring in the opposite direction for the TBAI_(aq) solution. We show that the evolution of the water 1b₁ energy in the NaI_(aq) solutions can be primarily assigned to a change of water's electronic structure in the solution bulk. In contrast, apparent changes of the 1b₁ energy for TBAI_(aq) solutions can be related to changes of the solution work function which could arise from surface molecular dipoles. Furthermore, for both of the solutions studied here, the measured water 1b₁ binding energies can be correlated with the extensive solution molecular structure changes occurring at high salt concentrations, where in the case of NaI_(aq), too few water molecules exist to hydrate individual ions and the solution adopts a crystalline-like phase. We also comment on the concentration-dependent shape of the second, 3a₁ orbital liquid water ionization feature which is a sensitive signature of water–water hydrogen bond interactions.

Significant differences are observed in liquid-water's lowest electron binding energy with increasing solute concentration in archetypal aqueous solutions. For NaI_(aq) and TBAI_(aq), the energy changes extend to +0.3 eV and −0.7 eV, respectively.

Following in Emil Fischer's Footsteps: A Site-Selective Probe of Glucose Acid-Base Chemistry

Liquid-jet photoelectron spectroscopy was applied to determine the first acid dissociation constant (pKa) of aqueous-phase glucose while simultaneously identifying the spectroscopic signature of the respective deprotonation site. Valence spectra from solutions at pH values below and above the first pKa reveal a change in glucose's lowest ionization energy upon the deprotonation of neutral glucose and the subsequent emergence of its anionic counterpart. Site-specific insights into the solution-pH-dependent molecular structure changes are also shown to be accessible via C 1s photoelectron spectroscopy. The spectra reveal a considerably lower C 1s binding energy of the carbon site associated with the deprotonated hydroxyl group. The occurrence of photoelectron spectral fingerprints of cyclic and linear glucose prior to and upon deprotonation are also discussed. The experimental data are interpreted with the aid of electronic structure calculations. Our findings highlight the potential of liquid-jet photoelectron spectroscopy to act as a site-selective probe of the molecular structures that underpin the acid-base chemistry of polyprotic systems with relevance to environmental chemistry and biochemistry.

Accurate vertical ionization energy and work function determinations of liquid water and aqueous solutions

The absolute-scale electronic energetics of liquid water and aqueous solutions, both in the bulk and at associated interfaces, are the central determiners of water-based chemistry. However, such information is generally experimentally inaccessible. Here we demonstrate that a refined implementation of the liquid microjet photoelectron spectroscopy (PES) technique can be adopted to address this. Implementing concepts from condensed matter physics, we establish novel all-liquid-phase vacuum and equilibrated solution–metal-electrode Fermi level referencing procedures. This enables the precise and accurate determination of previously elusive water solvent and solute vertical ionization energies, VIEs. Notably, this includes quantification of solute-induced perturbations of water's electronic energetics and VIE definition on an absolute and universal chemical potential scale. Defining and applying these procedures over a broad range of ionization energies, we accurately and respectively determine the VIE and oxidative stability of liquid water as 11.33 ± 0.03 eV and 6.60 ± 0.08 eV with respect to its liquid-vacuum-interface potential and Fermi level. Combining our referencing schemes, we accurately determine the work function of liquid water as 4.73 ± 0.09 eV. Further, applying our novel approach to a pair of exemplary aqueous solutions, we extract absolute VIEs of aqueous iodide anions, reaffirm the robustness of liquid water's electronic structure to high bulk salt concentrations (2 M sodium iodide), and quantify reference-level dependent reductions of water's VIE and a 0.48 ± 0.13 eV contraction of the solution's work function upon partial hydration of a known surfactant (25 mM tetrabutylammonium iodide). Our combined experimental accomplishments mark a major advance in our ability to quantify electronic–structure interactions and chemical reactivity in liquid water, which now explicitly extends to the measurement of absolute-scale bulk and interfacial solution energetics, including those of relevance to aqueous electrochemical processes.

A generalised liquid-phase photoelectron spectroscopy approach is reported, allowing accurate, absolute energy scale ionisation energies of liquid water and aqueous solutions, as well as liquid water's work function to be reported.

475 DEVELOPING A VIRTUAL CARE HOME SUPPORT FORUM DURING THE COVID-19 PANDEMIC

Introduction

COVID-19 has had a devastating effect on care homes, increasing both morbidity and mortality of residents and staff. Between 2 March and 12 June 2020, COVID-19 was the main cause of death in male care home residents (33.5%) and second for female (26.6%).1 By 1 May 2020, the death rate from all causes in care homes exceeded that in hospital (6,409 versus 6,397).2 Thus, care homes had to rapidly adapt to facilitate safe care of patients and staff.

Method

An expert outreach team visited a number of care homes in Surrey and Sussex to explore COVID-19 issues in care homes. Key themes were identified that informed topics for the Virtual Care Home Forum, where a series of virtual teaching, training and peer support sessions were hosted either live or on-demand, accessible for all care home staff.

Results

12 sessions were held with an average attendance of 25 people, predominantly care home managers and community healthcare professionals. Real time qualitative feedback was collected and an electronic survey was completed at the end of the series which showed 100% felt the sessions had improved their understanding of the topic, 100% felt the knowledge and skills obtained from the sessions would be useful in their job, 87.5% agreed the sessions would impact or change their practise and 100% felt more supported during the pandemic.

Conclusion

It has been an unprecedented year for the NHS, and the care home sector has suffered significantly. In order to provide the best level of care for patients and support for our community colleagues, we must work collaboratively, including provision of education and training. To ensure equal access for all, maintaining user-safety and compliance with government legislation, virtual webinars proved to be an excellent modality. We plan to continue providing training, teaching and support through this means in the future.

A quantum molecular movie: polyad predissociation dynamics in the VUV excited 3pσ2Σu state of NO2

The optical formation of coherent superposition states, a wavepacket, can allow the study of zeroth-order states, the evolution of which exhibit structural and electronic changes as a function of time: this leads to the notion of a molecular movie. Intramolecular vibrational energy redistribution, due to anharmonic coupling between modes, is the molecular movie considered here. There is no guarantee, however, that the formed superposition will behave semi-classically (e.g. Gaussian wavepacket dynamics) or even as an intuitively useful zeroth-order state. Here we present time-resolved photoelectron spectroscopy (TRPES) studies of an electronically excited triatomic molecule wherein the vibrational dynamics must be treated quantum mechanically and the simple picture of population flow between coupled normal modes fails. Specifically, we report on vibronic wavepacket dynamics in the zeroth-order 3pσ2Σu Rydberg state of NO2. This wavepacket exemplifies two general features of excited state dynamics in polyatomic molecules: anharmonic multimodal vibrational coupling (forming polyads); nonadiabatic coupling between nuclear and electronic coordinates, leading to predissociation. The latter suggests that the polyad vibrational states in the zeroth-order 3p Rydberg manifold are quasi-bound and best understood to be scattering resonances. We observed a rapid dephasing of an initially prepared 'bright' valence state into the relatively long-lived 3p Rydberg state whose multimodal vibrational dynamics and decay we monitor as a function of time. Our quantum simulations, based on an effective spectroscopic Hamiltonian, describe the essential features of the multimodal Fermi resonance-driven vibrational dynamics in the 3p state. We also present evidence of polyad-specificity in the state-dependent predissociation rates, leading to free atomic and molecular fragments. We emphasize that a quantum molecular movie is required to visualize wavepacket dynamics in the 3pσ2Σu Rydberg state of NO2.

'This Adds Another Perspective': Qualitative Descriptive Study Evaluating Simulation-Based Training for Health Care Assistants, to Enhance the Quality of Care in Nursing Homes

Much of the UK's ageing population lives in care homes, often with complex care needs including dementia. Optimal care requires strong clinical leadership, but opportunities for staff development in these settings are limited. Training using simulation can enable experiential learning in situ. In two nursing homes, Health Care Assistants (HCAs) received training in clinical communication skills (Situation-Background-Assessment-Recommendation Education through Technology and Simulation, SETS: group training with an actor simulating scenarios); and dementia (A Walk Through Dementia, AWTD: digital simulation, delivered one-to-one). In this qualitative descriptive study, we evaluated the potential of this training to enhance HCAs' clinical leadership skills, through thematic analysis of 24 semi-structured interviews with HCAs (before/after training) and their managers and mentors. Themes were checked by both interviewers. HCAs benefitted from watching colleagues respond to SETS scenarios and reported greater confidence in communicating with registered healthcare professionals. Some found role-play participation challenging. AWTD sensitised HCAs to the experiences of residents with dementia, and those with limited dementia experience gained a fuller understanding of the disease's effects. Staffing constraints affected participation in group training. Training using simulation is valuable in this setting, particularly when delivered flexibly. Further work is needed to explore its potential on a larger scale.

Low-energy constraints on photoelectron spectra measured from liquid water and aqueous solutions

We report on the effects of electron collision and indirect ionization processes, occurring at photoexcitation and electron kinetic energies well below 30 eV, on the photoemission spectra of liquid water. We show that the nascent photoelectron spectrum and, hence, the inferred electron binding energy can only be accurately determined if electron energies are large enough that cross sections for quasi-elastic scattering processes, such as vibrational excitation, are negligible. Otherwise, quasi-elastic scattering leads to strong, down-to-few-meV kinetic energy scattering losses from the direct photoelectron features, which manifest in severely distorted intrinsic photoelectron peak shapes. The associated cross-over point from predominant (known) electronically inelastic to quasi-elastic scattering seems to arise at surprisingly large electron kinetic energies, of approximately 10-14 eV. Concomitantly, we present evidence for the onset of indirect, autoionization phenomena (occurring via superexcited states) within a few eV of the primary and secondary ionization thresholds. These processes are inferred to compete with the direct ionization channels and primarily produce low-energy photoelectrons at photon and electron impact excitation energies below ∼15 eV. Our results highlight that vibrational inelastic electron scattering processes and neutral photoexcitation and autoionization channels become increasingly important when photon and electron kinetic energies are decreased towards the ionization threshold. Correspondingly, we show that for neat water and aqueous solutions, great care must be taken when quantitatively analyzing photoelectron spectra measured too close to the ionization threshold. Such care is essential for the accurate determination of solvent and solute ionization energies as well as photoelectron branching ratios and peak magnitudes.

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.