Nitrogen-doped pyrolytic carbon films as highly electrochemically active electrodes.

Nitrogen-doped Pyrolytic Carbon (N-PyC) films were employed as an electrode material in electrochemical applications. PyC was grown by via non-catalysed chemical vapour deposition and subsequently functionalised via exposure to ammonia-hydrogen plasma. The electrochemical properties of the N-PyC films were investigated using the ferri/ferro-cyanide and hexaamine ruthenium(III) chloride redox probes. Exceptional electron transfer properties were observed and quantified for the N-PyC compared to the as-grown films. X-ray photoelectron spectroscopy confirmed the presence of nitrogen in edge plane graphitic configurations and the surface of the N-PyC was investigated using scanning electron microscopy and atomic force microscopy. The excellent electrochemical performance of the N-PyC, in addition to its ease of preparation, renders this material ideal for applications in electrochemical sensing.

A systematic review of studies reporting the development of core outcome sets for use in routine care.

OBJECTIVES: Core outcome sets (COS) represent the minimum health outcomes to be measured for a given health condition. Interest is growing in using COS within routine care to support delivery of patient-focused care. This review aims to systematically map COS developed for routine care to understand their scope, stakeholder involvement, and development methods. METHODS: Medline (Ovid), Scopus, and Web of Science Core collection were searched for studies reporting development of COS for routine care. Data on scope, methods, and stakeholder groups were analyzed in subgroups defined by setting. RESULTS: Screening 25,301 records identified 262 COS: 164 for routine care only and 98 for routine care and research. Nearly half of the COS (112/254, 44%) were developed with patients, alongside input from experts in registries, insurance, legal, outcomes measurement, and performance management. Research publications were often searched to generate an initial list of outcomes (115/198, 58%) with few searching routine health records (47/198, 24%). CONCLUSION: An increasing number of COS is being developed for routine care. Although involvement of patient stakeholders has increased in recent years, further improvements are needed. Methodology and scope are broadly similar to COS for research but implementation of the final set is a greater consideration during development.

Management of antenatally detected fetal airway obstruction.

Five cases of antenatally diagnosed fetal airway obstruction have been cared for at the John Hunter Children's Hospital, Newcastle, Australia. A multidisciplinary team manages them during the perinatal period. We present our technique at the time of delivery, which aims to afford us the greatest flexibility in managing both the mother, her child's airway, and the underlying lesion. We begin with an ex utero intrapartum technique (EXIT) and favor routine rigid bronchoscopy to secure the neonate's airway without preliminary attempts at endotracheal intubation.

Foregut duplication cyst arising in the floor of mouth.

Enteric duplications are uncommon. A rare foregut duplication cyst arising in the floor of mouth is reported. Diagnosis of cystic lesion within the oral cavity was made in utero. Enteric duplications have not yet been attributed to a single embryogenesis but are likely to represent an error in migration of normal cells that rest in an abnormal position. Immediately following delivery of the neonate via an ex-utero intrapartum treatment (EXIT) procedure, the cyst was marsupialised but required definitive surgical excision at 5 weeks of age.

A collaborative partnership between patient and caregiver.

Lynn Young highlights not just the financial benefits of self-care, but touches on the important elements that make self-management strategies a success (reflections July 18).

Prenatal diagnosis of congenital disorder of glycosylation type Ia (CDG-Ia) by cordocentesis and transferrin isoelectric focussing of serum of a 27-week fetus with non-immune hydrops.

Blood was obtained by cordocentesis from a fetus with non-immune hydrops demonstrated by ultrasound scanning at 27 weeks' gestation. Abnormalities of serum transferrin isoelectric focussing (IEF) were identified, characteristic of a congenital disorder of glycosylation type I (CDG-Ia). A diagnosis of CDG-Ia was confirmed by enzyme analysis of cultured amniocytes. This is the first report of CDG-Ia diagnosed by serum analysis in a fetus. Previous reports have warned that diagnostic abnormalities do not appear in serum until several weeks after birth. The sensitivity of cordocentesis transferrin IEF is unknown but is less than 100% effective because cases have been diagnosed postnatally after normal prenatal or neonatal studies. Enzyme analysis or mutation analysis is required for diagnosis of congenital disorder of glycosylation (CDGs) regardless of whether a diagnostic transferrin pattern is identified prenatally. The analysis of a small sample of serum, from cordocentesis, performed to check for fetal anemia, simplified the investigation, diagnosis, and genetic counselling of a case of non-immune hydrops detected at 27 weeks' gestation. This might be a useful test for other cases in these circumstances, as fetal blood is usually collected to check for anemia.

The Doppler assessment in multiple pregnancy randomised controlled trial of ultrasound biometry versus umbilical artery Doppler ultrasound and biometry in twin pregnancy.

OBJECTIVE: To assess the addition value of umbilical artery Doppler ultrasound added to standard ultrasound biometry measurements in the management of twin pregnancies. DESIGN: A prospective randomised controlled multicentre trial of women with twin pregnancies. SETTING: Tertiary level referral hospitals in Australia, New Zealand and Southeast Asia. POPULATION: Pregnant women with twin pregnancies. METHODS: Women were randomised at 25 weeks of gestation to receive either standard ultrasound biometric assessment or standard assessment plus Doppler ultrasound umbilical artery flow velocity waveform analysis. The studies were repeated at 30 and 35 weeks unless otherwise indicated. Physicians were advised to institute close fetal surveillance in the presence of an abnormal umbilical artery Doppler study or with biometry indicators of fetal compromise. MAIN OUTCOME MEASURES: Standard obstetric (mode of delivery, perinatal mortality, hypertension, antenatal admissions and gestation at delivery) and neonatal (5 minute Apgar scores <5, admissions to neonatal nursery and requirements for ventilation) outcomes and statistical analysis was on intention-to-treat. There were no significant differences between the two groups with respect to demography, antenatal, peripartum and neonatal outcomes. There was no difference in the perinatal mortality rate in the no Doppler group (n = 264), which was 11/1000 live births, and the Doppler group (n = 262), which was 9/1000 live births. There were three unexplained intrauterine deaths in the no Doppler group and none in the Doppler group (OR 0.14, 95% CI 0.01-1.31). Two intrauterine deaths in the Doppler group were due to cord prolapse in labour and a fetomaternal haemorrhage, both very unlikely to be influenced by Doppler surveillance. CONCLUSIONS: In this study, close surveillance in twin pregnancy resulted in a lower than expected fetal mortality from 25 weeks of gestation in both the no Doppler and Doppler groups. The lower rate of unexplained fetal death in the no Doppler group was not significantly different from the Doppler group.

Endothelial cell function enhancement in a late normal human pregnancy.

OBJECTIVE: To assess endothelial cell function throughout normal human pregnancy. DESIGN: Longitudinal observational study. POPULATION: Pregnant women attending antenatal clinics and female nursing staff. METHODS: Flow mediated dilatation (FMD) was measured by high resolution ultrasound and used as a surrogate measure for endothelial cell function and measured in pregnant women and in non-pregnant female controls. Measurements were performed throughout normal pregnancies in each trimester. RESULTS: Mean FMD was increased by 80% and 64% in the third trimester compared to the first and second trimesters, respectively, and by 92% compared to the mean FMD of the non-pregnant controls. The increased FMD in the third trimester was demonstrated to be statistically significant in comparison with all the above groups by two-sample t-tests (P < 0.01 for all comparisons). CONCLUSION: Endothelial cell function, measured by ultrasound assessment of FMD, is enhanced in late normal human pregnancy.