Harnessing a real-time location system for contact tracing in a busy emergency department.

BACKGROUND: With the persistent threat of emerging infectious diseases (EIDs), digital contact tracing (CT) tools can augment conventional CT for the prevention of healthcare-associated infectious disease transmission. However, their performance has yet to be evaluated comprehensively in the fast-paced emergency department (ED) setting. OBJECTIVE: This study compared the CT performance of a radiofrequency identification (RFID)-based real-time location system (RTLS) with conventional electronic medical record (EMR) review against continuous direct observation of close contacts ('gold standard') in a busy ED during the coronavirus disease 2019 pandemic period. METHODS: This cross-sectional study was conducted at the ED of a large tertiary care hospital in Singapore from December 2020 to April 2021. CT performance [sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV) and kappa] of the RTLS, EMR review and a combination of the two approaches (hybrid CT) was compared with direct observation. Finally, the mean absolute error (MAE) in the duration of each contact episode found via the RTLS and direct observation was calculated. RESULTS: In comparison with EMR review, both the RTLS and the hybrid CT approach had higher sensitivity (0.955 vs 0.455 for EMR review) and a higher NPV (0.997 vs 0.968 for EMR review). The RTLS had the highest PPV (0.777 vs 0.714 for EMR review vs 0.712 for hybrid CT). The RTLS had the strongest agreement with direct observation (kappa=0.848). The MAE between contact durations of 80 direct observations and their respective RTLS contact times was 1.81 min. CONCLUSION: The RTLS was validated to be a high-performing CT tool, with significantly higher sensitivity than conventional CT via EMR review. The RTLS can be used with confidence in time-strapped EDs for time-sensitive CT for the prevention of healthcare-associated transmission of EIDs.

Determinants of antibiotic over-prescribing for upper respiratory tract infections in an emergency department with good primary care access: a quantitative analysis.

BACKGROUND: Upper respiratory tract infections (URTI) account for the highest proportion of non-urgent visits to the emergency department (ED), resulting in unnecessary antibiotic use. AIM: This study sought to understand the determinants of antibiotic prescribing for URTI among 130 junior physicians in a busy adult ED in Singapore. METHODS: Forty-four Likert-scale statements were developed with reference to a prior qualitative study, followed by an anonymous cross-sectional survey among ED junior physicians. Data analysis was performed with factor reduction and multivariable logistic regression. FINDINGS: One-in-six (16.9%) physicians were high antibiotic prescribers (self-reported antibiotic prescribing rate of >30% of URTI patients). After adjusting for place of medical education and years of practice as a physician, perceived over-prescribing of antibiotics in the ED (adjusted odds ratio (OR) 2.37, 95% confidence interval (CI) (1.15, 4.86), P=0.019) and perceived compliance with the antibiotic prescribing practices in the ED (adjusted OR 2.10, 95% CI (1.02, 4.30), P=0.043) were positively associated with high antibiotic prescribing. In contrast, high antibiotic prescribers were 6.67 times (95% CI (1.67, 25.0), P=0.007) less likely to treat and manage patients with URTI symptomatically and 7.12 times (95% CI (1.28, 39.66), P=0.025) more likely to depend on diagnostic tests to prescribe antibiotics than the regular antibiotic prescribers. CONCLUSION: Organizational-related factors (organizational norms and culture) were strong determinants of antibiotic prescribing practices for uncomplicated URTI in the ED. Other contributing factors include diagnostic uncertainty and knowledge gaps. Role-modelling of institutional best practice norms and clinical decision support tools based on local epidemiology can optimize antibiotic prescribing in the ED.

Proliferation dynamics of acute myeloid leukaemia and haematopoietic progenitors competing for bone marrow space.

Leukaemia progressively invades bone marrow (BM), outcompeting healthy haematopoiesis by mechanisms that are not fully understood. Combining cell number measurements with a short-timescale dual pulse labelling method, we simultaneously determine the proliferation dynamics of primitive haematopoietic compartments and acute myeloid leukaemia (AML). We observe an unchanging proportion of AML cells entering S phase per hour throughout disease progression, with substantial BM egress at high levels of infiltration. For healthy haematopoiesis, we find haematopoietic stem cells (HSCs) make a significant contribution to cell production, but we phenotypically identify a quiescent subpopulation with enhanced engraftment ability. During AML progression, we observe that multipotent progenitors maintain a constant proportion entering S phase per hour, despite a dramatic decrease in the overall population size. Primitive populations are lost from BM with kinetics that are consistent with ousting irrespective of cell cycle state, with the exception of the quiescent HSC subpopulation, which is more resistant to elimination.

Integrated oxygen-doping and dye sensitization of graphitic carbon nitride for enhanced visible light photodegradation.

Graphitic carbon nitride (GCN) is a promising metal-free photocatalyst while suffering from low charge mobility induced inefficient photocatalysis. In this work, oxygen doping was employed to enhance the photodegradation of organic pollutants in water on graphitic carbon nitride (GCNO) under visible light. For further absorption extension, four organic dyes (Eosin-Y, Perylene, Nile-red and Coumarin) were adopted to dye-sensitize the GCNO photocatalyst. It was found that O-doping can promote dye sensitization, which was dependent on the type of dyes and influenced the photodegradation efficiencies of methylene blue (MB) and phenol. Nile-red sensitized GCNO presented the best activity in MB degradation under λ>480nm irradiations while Eosin-Y showed the best sensitization performance for phenol degradation under λ>420nm light source. However, dye sensitization was not effective for enhanced pollutant degradation on GCN without O-doping. UV-vis diffuse reflectance spectra (UV-vis DRS), photoluminescence (PL) spectra, and photocurrent analyses were applied to investigate the mechanism of carriers' transfer, which indicated that dye molecules could inject extra electrons into GCNO energy band and the energy dislocation could suppress electron/hole recombination, enhancing photocatalytic performances.

Metal-free melem/g-C3N4 hybrid photocatalysts for water treatment.

In this study, graphitic carbon nitride was engineered to produce metal-free melem/g-C3N4 hybrid photocatalysts through a hydrothermal technique. It was revealed that the hydrothermal treatment of g-C3N4 could produce a hybrid structure of "thorn ball" liked melem on g-C3N4 layer at a high temperature, and was able to modify the photoelectronic properties of g-C3N4. The spectroscopic measurements implied that a melem/g-C3N4 hybrid has better light absorption and lower electron/hole recombination than pristine g-C3N4. Therefore, the melem/g-C3N4 photocatalysts can decompose methylene blue solution under artificial sunlight with a higher rate and also present good stability.

Role of ferric and ferrous ions in the enhancement of the heterogeneous solar photocatalytic degradation of combined mixture of chlorophenols.

The solar photocatalytic degradation of 4-chlorophenol (4-CP) and 2,4-dichlorophenol (2,4-DCP) was investigated individually and combined in the presence of Fe2+ and Fe3+ ions. The results revealed that both Fe2+ and Fe3+ ions enhanced the heterogeneous photocatalytic degradation. Fe3+ ions rapidly converted to Fe2+ ions as soon as the irradiation started. The intermediates formed during the degradation of 4-CP/2,4-DCP were also monitored and identified. Three main intermediates were observed, hydroquinone, phenol, and 4-chlorocatechol with traces of benzoquinone. The results support a new trend of research by utilising other cheap iron ion sources in the photocatalytic degradation.

Comparison of intra-ocular pressure changes with liquid or flat applanation interfaces in a femtosecond laser platform.

Cataract surgery is the most common surgical procedure and femtosecond laser assisted cataract surgery (FLACS) has gained increased popularity. FLACS requires the application of a suction device to stabilize the laser head and focus the laser beam accurately. This may cause a significant escalation in intra-ocular pressure (IOP), which poses potential risks for patients undergoing cataract surgery. In this study we aimed to assess the effect of the Ziemer LDV Z8 femtosecond cataract machine on IOP. We demonstrated through a porcine model that IOP was significantly higher with a flat interface but could be abrogated by reducing surgical compression and vacuum. Pressure was lower with a liquid interface, and further altering angulation of the laser arm could reduce the IOP to 36 mmHg. A pilot series in patients showed comparable pressure rises with the porcine model (30 mmHg). These strategies may improve the safety profile in patients vulnerable to high pressure when employing FLACS with the Ziemer LDV Z8.

Coarctation of the aorta: nonsurgical treatment using stent implantation.

INTRODUCTION: Coarctation of the aorta (CoA) accounts for 5%-8% of all congenital heart defects. If left untreated, most patients with significant CoA will have varying degrees of morbidity (e.g. hypertension, stroke, collateral formation and ventricular hypertrophy), possibly even mortality. Traditionally, treatment for this condition is surgical. Herein, we report stenting during catheterisation as an alternative nonsurgical treatment option for patients with CoA, and present the treatment outcomes of patients who underwent this treatment option. METHODS: We retrospectively reviewed four patients (2 men and 2 women; age range 20-41 years) who underwent CoA stenting under general anaesthesia for the treatment of native CoA or restenosis of CoA at our institution. Three patients had a 40-mm Palmaz stent inserted, while one had a 39-mm Cheatham-Platinum covered stent inserted. Angiography and measurement of pressure gradients were performed before and after stent implantation to ensure good treatment outcomes. RESULTS: The patients' treatment outcomes were good, with a significant reduction in pressure gradients across the narrowed segments. Angiography showed relief of CoA. The patients were followed up for 1-3 years, during which no complications were noted. CONCLUSION: This is the first reported series in Singapore on the nonsurgical treatment of CoAs in adult patients using stents during interventional cardiac catheterisation. This less invasive procedure may lead to a new paradigm shift with regard to the treatment of CoA.

Dye and its removal from aqueous solution by adsorption: a review.

In this review article the authors presented up to-date development on the application of adsorption in the removal of dyes from aqueous solution. This review article provides extensive literature information about dyes, its classification and toxicity, various treatment methods, and dye adsorption characteristics by various adsorbents. One of the objectives of this review article is to organise the scattered available information on various aspects on a wide range of potentially effective adsorbents in the removal of dyes. Therefore, an extensive list of various adsorbents such as natural materials, waste materials from industry, agricultural by-products, and biomass based activated carbon in the removal of various dyes has been compiled here. Dye bearing waste treatment by adsorption using low cost alternative adsorbent is a demanding area as it has double benefits i.e. water treatment and waste management. Further, activated carbon from biomass has the advantage of offering an effected low cost replacement for non-renewable coal based granular activated carbon provided that they have similar or better adsorption on efficiency. The effectiveness of various adsorbents under different physico-chemical process parameters and their comparative adsorption capacity towards dye adsorption has also been presented. This review paper also includes the affective adsorption factors of dye such as solution pH, initial dye concentration, adsorbent dosage, and temperature. The applicability of various adsorption kinetic models and isotherm models for dye removal by wide range of adsorbents is also reported here. Conclusions have been drawn from the literature reviewed and few suggestions for future research are proposed.

Early MRI in term infants with perinatal hypoxic-ischaemic brain injury: interobserver agreement and MRI predictors of outcome at 2 years.

AIM: To compare diffusion-weighted imaging (DWI) and non-DWI magnetic resonance imaging (MRI), proton MR spectroscopy (1H-MRS), and clinical biomarkers for prediction of 2 year developmental outcome in term infants with perinatal hypoxic-ischaemic encephalopathy (HIE). MATERIALS AND METHODS: Nineteen infants ≥36 weeks gestation with HIE were recruited and MRI performed day 3-7 (mean = 5). MRI was scored independently by three radiologists using a standardized scoring system. Lactate-to-N-acetylaspartate ratio (Lac:NAA) in the lentiform nucleus was calculated. Developmental assessment was performed at 2 years using the Bayley Scales of Infant and Toddler Development (BSID-III). Interobserver agreement about abnormality in 10 brain regions was measured. Univariate analysis was performed to determine variables associated with adverse outcome (i.e., death or Bayley score for any domain <70). RESULTS: Good interobserver agreement (kappa = 0.61-0.69) on scores for DWI was obtained for the cortex, putamen, and brainstem, but not for any region on non-DWI. A significant association was found between outcome and Lac:NAA (p < 0.003) and DWI scores for lentiform nucleus, thalamus, cortex, posterior limb of the internal capsule (PLIC), and paracentral white matter (p = 0.001-0.013), but for non-DWI score only in the vermis or brainstem. A combination of Lac:NAA ≥0.25 or DWI/apparent diffusion coefficient (ADC) signal abnormality in the PLIC had 100% specificity and sensitivity for poor outcome. CONCLUSION: Interobserver agreement for non-DWI performed during the first week is poor. Agreement by three radiologists about the presence of abnormal signal within the PLIC on ADC/DWI images or elevation of Lac:NAA above 0.25 improved sensitivity without reducing the prognostic specificity of MRS in the 19 patients, but this requires validation in a larger group of infants with HIE who have been treated with hypothermia.

Neuroprotective effects of LBP on brain ischemic reperfusion neurodegeneration.

AIM: The present study was conducted to investigate whether LBP had a protective effect on cerebral ischemic reperfusion injury and to determine the possible mechanisms. MATERIALS AND METHODS: Male Kunming (KM) mice were used to make the model cerebral artery occlusion/reperfusion (MCAO/R). The behavioral test was used to measure neurological deficit scores for evaluation of ischemic reperfusion damage of brain. The change of electroencephalograph (EEG) was monitored by Model SMUP-E Bio-electric Signals Processing System. The infarction area of brain was assessed in brain slices with 2% solution of 2,3,5-triphenyl tetrazolium chloride (TTC). Spectrophotometric assay was used to determine the activities of superoxide dismutase (SOD), glutathione peroxidase (GSH-Px), catalase (CAT) and lactate dehydrogenase (LDH), contents of malondialdehyde (MDA) and adenosine triphosphate (ATP) of the brain. RESULTS: The results showed that LBP at doses of 20 and 40 mg/kg markedly decreased the neurological deficit scores and the infarction area in MCAO/R mice. At the same time, LBP significantly decreased MDA content, and increased SOD, GSH-Px, CAT, LDH activities in ischemic reperfusion brain. CONCLUSIONS: These suggest that LBP might act as a potential neuroprotective agent against the cerebral reperfusion-induced injury in the brain through reducing lipid peroxides, scavenging free radicals, and improving the energy metabolism.

Different crystallographic one-dimensional MnO2 nanomaterials and their superior performance in catalytic phenol degradation.

Three one-dimensional MnO2 nanoparticles with different crystallographic phases, α-, ß-, and γ-MnO2, were synthesized, characterized, and tested in heterogeneous activation of Oxone for phenol degradation in aqueous solution. The α-, ß-, and γ-MnO2 nanostructured materials presented in morphologies of nanowires, nanorods, and nanofibers, respectively. They showed varying activities in activation of Oxone to generate sulfate radicals for phenol degradation depending on surface area and crystalline structure. α-MnO2 nanowires exhibited the highest activity and could degrade phenol in 60 min at phenol concentrations ranging in 25-100 mg/L. It was found that phenol degradation on α-MnO2 followed first order kinetics with an activation energy of 21.9 kJ/mol. The operational parameters, such as MnO2 and Oxone loading, phenol concentration and temperature, were found to influence phenol degradation efficiency. It was also found that α-MnO2 exhibited high stability in recycled tests without losing activity, demonstrating itself to be a superior heterogeneous catalyst to the toxic Co3O4 and Co(2+).

Medical response to the 2009 Sumatra earthquake: health needs in the post-disaster period.

INTRODUCTION: This paper provides an overview of cases seen by the Singapore Armed Forces (SAF) medical and surgical teams in the 2009 Sumatra earthquake and discusses the role of militaries in the acute phase of a disaster. METHODS: Two SAF primary healthcare clinics prospectively collected patient medical information for comparison. Descriptive analysis of the Emergency Department (ED) and surgical case records was performed. RESULTS: 1,015 patients were seen by the two primary healthcare clinics. In both Koto Bangko and Pariaman, respiratory-related conditions were the most common diagnoses (47.2% and 30.6%, respectively), followed by musculoskeletal/joint conditions (31.6% and 20.6%, respectively). In the ED, 55% and 27% of the 113 patients had trauma-related and infective-related diagnoses, respectively. Lacerations and contusions were the most common forms of trauma. Lung infection was the most common infective diagnosis seen at the ED. The number of ED cases was high during the first week and gradually declined in the second week. 56% of the 102 surgical procedures were performed on dirty or infective wounds. Fractures requiring fixation comprised 38% of surgical procedures. CONCLUSION: Medical aid remains an important component of the overall humanitarian response. Militaries could play an important role in disaster response due to their ability to respond in a timely fashion and logistic capabilities. Pre-launch research on the affected area and knowledge on disaster-specific injury patterns would impact the expertise, equipment and supplies required. The increasing evidence base for disaster preparedness and medical response allows for better planning and reduces the impact of disasters on affected populations.

Rising from the dead!

A report of a patient with Lazarus phenomenon (the return of spontaneous circulation after cardiopulmonary resuscitation) following cardiac arrest (myocardium ischemia) is presented. A 65 year patient was found unconscious at home. He taken to the emergency department On arrival he was unconscious, his pupils fixed and dilated bilaterally. Resuscitation proceeded for 55 minutes. He was then pronounced dead. Forty minutes later spontaneous breathing was noted and his blood pressure was 110/48 and heart rate 90bpm. He survived a further 13 days in the coronary care unit. The implications for management of cardiac arrest in the emergency and medical department are discussed.

Novel applications of red mud as coagulant, adsorbent and catalyst for environmentally benign processes.

Red mud (RM) is a by-product of bauxite processing via the Bayer process. Its disposal remains an issue of great importance with significant environmental concerns. In the past decades, a lot of research has been done to utilize red mud for environmental-benign applications such as a building material additive and for metal recovery. In recent years, red mud has also been explored for gas cleaning and wastewater treatment. In this paper, we review varying novel applications of red mud as a coagulant and adsorbent for water and gas treatment as well as catalyst for some industrial processes. The environmental compatibility of red mud is discussed. Some directions of future research are also proposed. Red mud presents a promising application in water treatment for removal of toxic heavy metal and metalloid ions, inorganic anions such as nitrate, fluoride, and phosphate, as well as organics including dyes, phenolic compounds and bacteria. In addition, red mud can also be employed as catalysts for hydrogenation, hydrodechlorination and hydrocarbon oxidation. Moreover, leaching and eco-toxicological tests indicate that red mud does not present high toxicity to the environment before or after reuse.

Lead contamination in Eugenia dyeriana herbal preparations from different commercial sources in Malaysia.

The Drug Control Authority (DCA) of Malaysia implemented the phase three registration of traditional medicines on 1 January, 1992. A total of 100 products in various pharmaceutical dosage forms of a herbal preparation, containing Eugenia dyeriana, either single or combined preparations (more than one medicinal plant), were analyzed for the presence of lead contamination, using atomic absorption spectrophotometry. These samples were bought from different commercial sources in the Malaysian market, after performing a simple random sampling. Results showed that 22% of the above products failed to comply with the quality requirement for traditional medicines in Malaysia. Although this study showed that 78% of the products fully complied with the quality requirement for traditional medicines in Malaysia pertaining to lead, however, they cannot be assumed safe from lead contamination because of batch-to-batch inconsistency.

Volatile organic compounds in indoor environment and photocatalytic oxidation: state of the art.

Volatile organic compounds (VOCs) are the major pollutants in indoor air, which significantly impact indoor air quality and thus influencing human health. A long-term exposure to VOCs will be detrimental to human health causing sick building syndrome (SBS). Photocatalytic oxidation of VOCs is a cost-effective technology for VOCs removal compared with adsorption, biofiltration, or thermal catalysis. In this paper, we review the current exposure level of VOCs in various indoor environment and state of the art technology for photocatalytic oxidation of VOCs from indoor air. The concentrations and emission rates of commonly occurring VOCs in indoor air are presented. The effective catalyst systems, under UV and visible light, are discussed and the kinetics of photocatalytic oxidation is also presented.

Contamination of mercury in tongkat Ali hitam herbal preparations.

The DCA (Drug Control Authority), Malaysia has implemented the phase three registration of traditional medicines on 1 January 1992. As such, a total of 100 products in various pharmaceutical dosage forms of a herbal preparation found in Malaysia, containing tongkat Ali hitam, either single or combined preparations, were analyzed for the presence of a heavy toxic metal, mercury, using atomic absorption spectrophotometer, after performing a simple random sampling to enable each sample an equal chance of being selected in an unbiased manner. Results showed that 26% of these products possessed 0.53-2.35 ppm of mercury, and therefore, do not comply with the quality requirement for traditional medicines in Malaysia. The quality requirement for traditional medicines in Malaysia is not exceeding 0.5 ppm for mercury. Out of these 26 products, four products have already registered with the DCA, Malaysia whilst the rest, however, have not registered with the DCA, Malaysia.

Herbal use amongst multiethnic medical patients in Penang Hospital: pattern and perceptions.

A cross sectional survey on pattern and perception of herbal use among medical patients in Penang Hospital was conducted. Among 250 patients surveyed, 67.9% were using herbal medicine and conventional medicine concomitantly. A majority of the patients used herbs for health maintenance (51.3%) purpose. More than 90% of herbal users did not disclose herbal use to their physician and "Doctor never asked" was the major reason given (54.2%). The Chinese reported the highest rate of herbal use but was least likely to disclose. These findings are important for health professionals to ensure medication safety and recognise potential drug herb interaction.