Prediction of Opioid-Induced Respiratory Depression on Inpatient Wards Using Continuous Capnography and Oximetry: An International Prospective, Observational Trial.

BACKGROUND: Opioid-related adverse events are a serious problem in hospitalized patients. Little is known about patients who are likely to experience opioid-induced respiratory depression events on the general care floor and may benefit from improved monitoring and early intervention. The trial objective was to derive and validate a risk prediction tool for respiratory depression in patients receiving opioids, as detected by continuous pulse oximetry and capnography monitoring. METHODS: PRediction of Opioid-induced respiratory Depression In patients monitored by capnoGraphY (PRODIGY) was a prospective, observational trial of blinded continuous capnography and oximetry conducted at 16 sites in the United States, Europe, and Asia. Vital signs were intermittently monitored per standard of care. A total of 1335 patients receiving parenteral opioids and continuously monitored on the general care floor were included in the analysis. A respiratory depression episode was defined as respiratory rate ≤5 breaths/min (bpm), oxygen saturation ≤85%, or end-tidal carbon dioxide ≤15 or ≥60 mm Hg for ≥3 minutes; apnea episode lasting >30 seconds; or any respiratory opioid-related adverse event. A risk prediction tool was derived using a multivariable logistic regression model of 46 a priori defined risk factors with stepwise selection and was internally validated by bootstrapping. RESULTS: One or more respiratory depression episodes were detected in 614 (46%) of 1335 general care floor patients (43% male; mean age, 58 ± 14 years) continuously monitored for a median of 24 hours (interquartile range [IQR], 17-26). A multivariable respiratory depression prediction model with area under the curve of 0.740 was developed using 5 independent variables: age ≥60 (in decades), sex, opioid naivety, sleep disorders, and chronic heart failure. The PRODIGY risk prediction tool showed significant separation between patients with and without respiratory depression (P < .001) and an odds ratio of 6.07 (95% confidence interval [CI], 4.44-8.30; P < .001) between the high- and low-risk groups. Compared to patients without respiratory depression episodes, mean hospital length of stay was 3 days longer in patients with ≥1 respiratory depression episode (10.5 ± 10.8 vs 7.7 ± 7.8 days; P < .0001) identified using continuous oximetry and capnography monitoring. CONCLUSIONS: A PRODIGY risk prediction model, derived from continuous oximetry and capnography, accurately predicts respiratory depression episodes in patients receiving opioids on the general care floor. Implementation of the PRODIGY score to determine the need for continuous monitoring may be a first step to reduce the incidence and consequences of respiratory compromise in patients receiving opioids on the general care floor.

Single-molecule magnet behavior in 2,2'-bipyrimidine-bridged dilanthanide complexes.

A series of 2,2'-bipyrimidine-bridged dinuclear lanthanide complexes with the general formula [Ln(tmhd)3]2bpm (tmhd = 2,2,6,6-tetramethyl-3,5-heptanedionate, bpm = 2,2'-bipyrimidine, Ln = Gd(III), 1; Tb(III), 2; Dy(III), 3; Ho(III), 4 and Er(III), 5) has been synthesized and characterized. Sublimation of [Tb(tmhd)3]2bpm onto a Au(111) surface leads to the formation of a homogeneous film with hexagonal pattern, which was studied by scanning tunneling microscopy (STM). The bulk magnetic properties of all complexes have been studied comprehensively. The dynamic magnetic behavior of the Dy(III) and Er(III) compounds clearly exhibits single molecule magnet (SMM) characteristics with an energy barrier of 97 and 25 K, respectively. Moreover, micro-SQUID measurements on single crystals confirm their SMM behavior with the presence of hysteresis loops.

Dynamic control of plasmon generation by an individual quantum system.

Controlling light on the nanoscale in a similar way as electric currents has the potential to revolutionize the exchange and processing of information. Although light can be guided on this scale by coupling it to plasmons, that is, collective electron oscillations in metals, their local electronic control remains a challenge. Here, we demonstrate that an individual quantum system is able to dynamically gate the electrical plasmon generation. Using a single molecule in a double tunnel barrier between two electrodes we show that this gating can be exploited to monitor fast changes of the quantum system itself and to realize a single-molecule plasmon-generating field-effect transistor operable in the gigahertz range. This opens new avenues toward atomic scale quantum interfaces bridging nanoelectronics and nanophotonics.

Convergent and divergent two-dimensional coordination networks formed through substrate-activated or quenched alkynyl ligation.

Metal coordination assemblies of the symmetric bi-functional 4,4'-di-(1,4-buta-1,3-diynyl)-benzoic acid are investigated by scanning tunnelling microscopy on metal surfaces. The formation of long-range ordered, short-range disordered and random phases depends on the competition between the convergent and divergent coordination motifs of the individual functional groups and is crucially influenced by the substrate.

Switching of a coupled spin pair in a single-molecule junction.

Single-molecule spintronics investigates electron transport through magnetic molecules that have an internal spin degree of freedom. To understand and control these individual molecules it is important to read their spin state. For unpaired spins, the Kondo effect has been observed as a low-temperature anomaly at small voltages. Here, we show that a coupled spin pair in a single magnetic molecule can be detected and that a bias voltage can be used to switch between two states of the molecule. In particular, we use the mechanically controlled break-junction technique to measure electronic transport through a single-molecule junction containing two coupled spin centres that are confined on two Co(2+) ions. Spin-orbit configuration interaction methods are used to calculate the combined spin system, where the ground state is found to be a pseudo-singlet and the first excitations behave as a pseudo-triplet. Experimentally, these states can be assigned to the absence and occurrence of a Kondo-like zero-bias anomaly in the low-temperature conductance data, respectively. By applying finite bias, we can repeatedly switch between the pseudo-singlet state and the pseudo-triplet state.

Molecular orbital gates for plasmon excitation.

Future combinations of plasmonics with nanometer-sized electronic circuits require strategies to control the electrical excitation of plasmons at the length scale of individual molecules. A unique tool to study the electrical plasmon excitation with ultimate resolution is scanning tunneling microscopy (STM). Inelastic tunnel processes generate plasmons in the tunnel gap that partially radiate into the far field where they are detectable as photons. Here we employ STM to study individual tris-(phenylpyridine)-iridium complexes on a C60 monolayer, and investigate the influence of their electronic structure on the plasmon excitation between the Ag(111) substrate and an Ag-covered Au tip. We demonstrate that the highest occupied molecular orbital serves as a spatially and energetically confined nanogate for plasmon excitation. This opens the way for using molecular tunnel junctions as electrically controlled plasmon sources.

Highly adaptable two-dimensional metal-organic coordination networks on metal surfaces.

The formation of extended two-dimensional metal-organic coordination networks (2D-MOCNs) showing high adaptability to surface step edges and structural defects is revealed by scanning tunneling microscopy. Rod-like 4,4'-di-(1,4-buta-1,3-diynyl)-benzoic acid (BDBA) and iron atoms assemble into extended 2D-MOCNs on Au(111) and Ag(100) surfaces. Independent from the chosen substrate and its surface symmetry the MOCN grows continuously over multiple surface terraces through mutual in-phase structure adaptation of network domains at step edges as well as on terraces. The adaptability of the MOCNs is mainly ascribed to the high degree of conformational flexibility of the butadiynyl functionality of the ligand. Despite their flexibility, the MOCNs exhibit considerable robustness against annealing at high temperatures. The findings show that mesoscale self-assembled functional architectures with a high degree of substrate error tolerance can be realized with metal coordination networks.

Tuning the spin-transition properties of pyrene-decorated 2,6-bispyrazolylpyridine based Fe(II) complexes.

Two 2,6-bispyrazolylpyridine ligands (bpp) were functionalized with pyrene moieties through linkers of different lengths. In the ligand 2,6-di(1H-pyrazol-1-yl)-4-(pyren-1-yl)pyridine (L1) the pyrene group is directly connected to the bpp moiety via a C-C single bond, while in the ligand 4-(2,6-di(1H-pyrazol-1-yl)pyridin-4-yl)benzyl-4-(pyren-1-yl)butanoate (L2) it is separated by a benzyl ester group involving a flexible butanoic chain. Subsequent complexation of Fe(II) salts revealed dramatic the influence of the nature of the pyrene substitution on the spin-transition behaviour of the resulting complexes. Thus, compound [Fe(L1)(2)](ClO(4))(2) (1) is blocked in its high spin state due to constraints caused by a strong intermolecular π-π stacking in its structure. On the other hand, the flexible chain of ligand L2 in compounds [Fe(L2)(2)](ClO(4))(2) (2) and [Fe(L2)(2)](BF(4))(2)·CH(3)CN·H(2)O (3) prevents structural constraints allowing for reversible spin transitions. Temperature-dependent studies of the photophysical properties of compound 3 do not reveal any obvious correlation between the fluorescence of the pyrene group and the spin state of the spin transition core.

Expanding the coordination cage: a ruthenium(II)-polypyridine complex exhibiting high quantum yields under ambient conditions.

A mononuclear ruthenium(II) polypyridyl complex with an enlarged terpyridyl coordination cage was synthesized by the formal introduction of a carbon bridge between the coordinating pyridine rings. Structurally, the ruthenium(II) complex shows an almost perfect octahedral N6 coordination around the central Ru(II) metal ion. The investigation of the photophysical properties reveals a triplet metal-to-ligand charge transfer emission with an unprecedented quantum yield of 13% and a lifetime of 1.36 mus at room temperature and in the presence of air oxygen. An exceptional small energy gap between light absorption and light emission, or Stokes shift, was detected. Additionally, time-dependent density functional theory calculations were carried out in order to characterize the ground state and both the singlet and triplet excited states. The exceptional properties of the new compound open the perspective of exploiting terpyridyl-like ruthenium complexes in photochemical devices under ambient conditions.

Silver nanowires growth via branch fragmentation of electrochemically grown silver dendrites.

We have demonstrated a new protocol of synthesizing Ag nanowires via an electrochemical Ostwald ripening (OR) driven branch fragmentation mechanism; the branching rate of the Ag nanowires is significantly decreased by means of an electrodeposition under a strong applied-potential, following a relaxation process.

Spin transition in a chainlike supramolecular iron(II) complex.

A one-dimensional supramolecular head-to-tail N+ -H...N-type hydrogen-bonded chain of the complex [FeII(L)2H](ClO4)3.MeOH [L = 4'-(4'''-pyridyl)-1,2':6'1''-bis(pyrazolyl)pyridine] exhibits a reversible, thermally driven spin transition at 286 K with a hysteresis loop of ca. 2 K.