Paediatric acute care cardiology collaborative data registry validation.

BACKGROUND: The Pediatric Acute Care Cardiology Collaborative (PAC3) was established to improve acute care cardiology outcomes through the development of an accurate and well-validated clinical registry. We report the validation results of the initial PAC3 registry audits and describe a novel regional audit format developed to accommodate a rapidly expanding membership facilitate collaborative learning and allow for necessary modification due to the COVID-19 pandemic. MATERIALS AND METHODS: Six hospitals were audited using a regional audit format and three hospitals were subsequently audited virtually. Critical and challenging-to-collect data elements were audited among at least 40 randomly selected cases. Discrepancies were categorised as either major or minor depending on their relative importance to patient outcomes and clinical care. Results were tabulated and reported. RESULTS: We audited 386 encounters and 27,086 individual data fields across 9 hospitals. The aggregate overall accuracy rate was 99.27% and the aggregate major discrepancy rate was 0.51%. The overall accuracy rate ranged from 98.77% to 99.59%, and the major discrepancy rate ranged from 0.26% to 0.88% across the cohort. No appreciable difference was seen between audit formats. Both the regional and virtual audit methods were viewed favourably by participants. CONCLUSIONS: A low data discrepancy rate was found demonstrating that the PAC3 registry is a highly accurate data source for use in quality improvement, benchmarking, and research. Regional audits and virtual audits were both successfully implemented.

Vancomycin-Resistant Enterococci in Patients Attending for Colonoscopy: An Estimate of Community Prevalence.

Aims Ireland has the highest vancomycin-resistant Enterococcus faecium (VRE) bloodstream infection prevalence in Europe. Two patterns of VRE carriage are recognised. European, with widespread community prevalence and North American, where carriage is predominantly nosocomial. It is unclear which pattern is dominant in Ireland. This uncertainty limits infection control measures. This study sought to explore this issue via a cross sectional point prevalence study. Methods Asymptomatic community volunteers, represented by patients undergoing elective outpatient colonoscopy testing, were opportunistically screened for VRE. Demographic and risk factor data were collected via a patient survey. Rectal swabs were collected before colonoscopy and VRE was identified using the VITEK MS system. Results 102 patients were cultured. A single patient tested positive, representing a prevalence rate of 0.98% (95% CI <0.01-5.8%). This patient demonstrated traditional risk factors, suggesting nosocomial rather than community acquisition. 94% (N=94) of patients had no knowledge of VRE, while 83% (N=83) had low levels of concern regarding hospital acquired infections. Conclusion There is a low incidence of VRE in the Irish community setting, in contrast to other European Countries, suggesting asymptomatic community colonization is not responsible for the high rates of VRE seen in Ireland. Wider screening or atypical infection control measures would not be supported by this data.

Global Capnography Project (GCAP): implementation of capnography in Malawi - an international anaesthesia quality improvement project.

The Lancet Commission on Global Surgery emphasised the importance of access to safe anaesthesia care. Capnography is an essential monitor for safe anaesthesia, but is rarely available in low-income countries. The aim of this study was twofold: to measure the prevalence of capnography in the operating theatres and in intensive care units; and to determine whether its introduction was feasible and could improve the early recognition of critical airway incidents in a low-income country. This is the first project to do this. Forty capnographs were donated to eight hospitals in Malawi. Thirty-two anaesthesia providers received a 1-day capnography training course with pre- and post-course knowledge testing. Providers kept logbooks of capnography use and recorded their responses to abnormal readings. On follow-up at 6 months, providers completed questionnaires on any significant patient safety incidents identified using capnography. In January 2017, at the commencement of the project, only one operating theatre had a capnograph. Overall, 97% and 100% 'capnography gaps' were identified in the theatres and intensive care units, respectively. The mean (SD) scores of our capnography multiple choice questionnaires improved after training from 15.00 (3.16) to 18.70 (0.99), p = < 0.001. The capnography equipment was appropriately robust and performed well. Six months following implementation, 24 (77%) anaesthesia providers reported recognising 44 oesophageal intubations and 28 (90%) believed that capnography had saved lives. This study has shown it is feasible to introduce capnography in a low-income country, resulting in early recognition of critical airway incidents and ultimately helping to save lives. Building on the experience of the first trial of pulse oximetry implementation in low-income countries in 2007, we believe this is one of the most important projects in anaesthesia safety in the last decade.

High selectivity for ethylene from carbon dioxide reduction over copper nanocube electrocatalysts.

Nanostructured surfaces have been shown to greatly enhance the activity and selectivity of many different catalysts. Here we report a nanostructured copper surface that gives high selectivity for ethylene formation from electrocatalytic CO2 reduction. The nanostructured copper is easily formed in situ during the CO2 reduction reaction, and scanning electron microscopy (SEM) shows the surface to be dominated by cubic structures. Using online electrochemical mass spectrometry (OLEMS), the onset potentials and relative selectivity toward the volatile products (ethylene and methane) were measured for several different copper surfaces and single crystals, relating the cubic shape of the copper surface to the greatly enhanced ethylene selectivity. The ability of the cubic nanostructure to so strongly favor multicarbon product formation from CO2 reduction, and in particular ethylene over methane, is unique to this surface and is an important step toward developing a catalyst that has exclusive selectivity for multicarbon products.

Oxygen activation and CO oxidation over size-selected Pt(n)/alumina/Re(0001) model catalysts: correlations with valence electronic structure, physical structure, and binding sites.

Oxidation of CO over size-selected Ptn clusters (n = 1, 2, 4, 7, 10, 14, 18) supported on alumina thin films grown on Re(0001) was studied using temperature-programmed reaction/desorption (TPR/TPD), X-ray and ultraviolet photoelectron spectroscopy (XPS/UPS), and low energy ion scattering spectroscopy (ISS). The activity of the model catalysts was found to vary by a factor of five with deposited Ptn size during the first reaction cycle (TPR) and by a factor of two during subsequent cycles, with Pt2 being the least active and Pt14 the most active. The limiting step in the reaction appears to be the binding of oxygen; however, this does not appear to be an activated process as reaction is equally efficient for 300 K and 180 K oxidation temperatures. Size-dependent shifts in the valence band onset energy correlate strongly with CO oxidation activity, and there is also an apparent correlation with the availability of a particular binding site, as probed by CO TPD. The morphology of the clusters also becomes more three dimensional over the same size range, but with a distinctly different size-dependence. The results suggest that both electronic structure and the availability of particular binding sites control activity.

Protease inhibitor levels in periodontal health and disease.

BACKGROUND AND OBJECTIVE: Our previous study showed that protease inhibitors were attenuated by the periodontal pathogen Porphyromonas gingivalis in cultured gingival epithelial cells. We hypothesize that fewer protease inhibitors would be present in more advanced periodontal disease sites, where the level of P. gingivalis may be high. The goal of this study was to investigate the relationship between the protease inhibitor [secretory leukocyte protease inhibitor (SLPI), elastase-specific inhibitor (ELAFIN) and squamous cell carcinoma antigen (SCCA)] levels in gingival crevicular fluid and the number of P. gingivalis micro-organisms in subgingival plaque. MATERIAL AND METHODS: Plaque samples from subjects without (n = 18) and with moderate to advanced periodontitis (n = 41) were used to quantify P. gingivalis using real-time PCR. Protease inhibitor levels in the gingival crevicular fluid of all the subjects were determined by ELISA. RESULTS: P. gingivalis was detected in 68.3% of patients with periodontitis, while 16.7% of subjects without periodontitis had a detectable level of P. gingivalis. Patients with periodontitis and P. gingivalis in their plaque exhibited lower SLPI and ELAFIN levels (p < 0.001) compared with control subjects without periodontitis. Secretory leukocyte protease inhibitor was also reduced (p < 0.05) in gingival crevicular fluid of periodontitis patients without a detectable level of P. gingivalis. Periodontitis patients with high vs. low levels of P. gingivalis exhibited reciprocal mean levels of SLPI and ELAFIN concentrations. CONCLUSION: The reduced concentrations of SLPI and ELAFIN may contribute to the loss of host protective capacity and increase susceptibility to breakdown from chronic infection. The work of this investigation may aid in finding diagnostic and prognostic markers in periodontal health and disease and may also help in finding pharmacological targets directed against periodontal inflammation.

CO adsorption and desorption on size-selected Pd(n)/TiO2(110) model catalysts: size dependence of binding sites and energies, and support-mediated adsorption.

The nature of CO adsorption on Pd(n)/TiO(2)(110) (n = 1, 2, 7, 20) has been examined using temperature-programmed desorption (TPD), temperature-dependent helium ion scattering (TD-ISS), and X-ray photoelectron spectroscopy (XPS). All samples contain the same number of Pd atoms (0.10 ML-equivalent) deposited as different size clusters. The TPD and TD-ISS show that CO binds in two types of sites associated with the Pd clusters. The most stable sites are on top of the Pd clusters ("on-top" sites), however, there are also less stable sites, in which CO is bound in association with, but not on top of the Pd ("peripheral" sites). For saturation CO coverage over a fixed atomic concentration of Pd (present in the form of Pd(n) clusters of varying size), the population of CO in peripheral sites decreases with increasing cluster size, while the on-top site population is size-independent. This is consistent with what geometric considerations would predict for the density of the two types of sites, provided the clusters adsorb predominantly as 2D islands, which ISS results suggest to be the case. The XPS analysis indicates that CO-Pd binding is dominated by π-backbonding to the Pd(n) clusters. The results also show evidence for efficient support-mediated adsorption (reverse-spillover) of CO initially impinging on TiO(2) to binding sites associated with the Pd clusters.

Bonding in women with postnatal anaemia: a pilot case control study looking at postnatal bonding in women who have been diagnosed with anaemia at a University Hospital in the East of England.

PURPOSE: Anaemia is common postpartum; however, the effect of anaemia on mother-infant bonding is presently unknown. This case controlled study was designed to evaluate the effects of anaemia on mother and baby bonding in the first month following delivery. METHODS: 945 consecutive postpartum women who gave birth at home or in the obstetric unit at a university hospital in the East of England were identified from the hospital computer records. Blood counts had been performed on 279 of these women within 48 h of delivery, entirely at the discretion of the clinical team. The women with available blood count data were sent a self-reporting questionnaire which included a validated postpartum bonding questionnaire (PBQ). Data were collected from the 115 (41%) responses and analysed for the evidence of an effect of anaemia on bonding. RESULTS: 57 (50%) of women responding to the questionnaire were anaemic (haemoglobin < 10 g/dL). There was no evidence of a difference between maternal, age, parity, mode of delivery, gestational age, baby weight or baby age at the time of completing questionnaire between the anaemic and non-anaemic groups. Moreover, there was no evidence of a difference in maternal perception of mother-infant bonding between the anaemic and non-anaemic groups. CONCLUSION: Our study suggested no evidence of an association between postnatal anaemia and the mother's ability to bond with the baby; however a small but significant effect may still exist which we were not able to detect due to a possible lack of power, hence we suggest, further larger studies to be conducted.

Managing massive bone loss after infected total knee arthroplasty with a custom-made spacer.

Periprosthetic infection is an increasingly prevalent and challenging problem in joint reconstruction. We present a technical report of a custom spacer for management of an infected total knee arthroplasty (TKA) and concomitant severe bone loss. The spacer was designed to provide sufficient leg length, soft tissue tension, and limb stability in preparation for ultimate limb reconstruction. This technique and custom spacer serve as an alternative for managing significant bone loss in infected knee arthroplasty.

Evaluation of a new low-cost particle sensor as an internet-of-things device for outdoor air quality monitoring.

Many low-cost particle sensors are available for routine air quality monitoring of PM2.5, but there are concerns about the accuracy and precision of the reported data, particularly in humid conditions. The objectives of this study are to evaluate the Sensirion SPS30 particulate matter (PM) sensor against regulatory methods for measurement of real-time particulate matter concentrations and to evaluate the effectiveness of the Intelligent AirTM sensor pack for remote deployment and monitoring. To achieve this, we co-located the Intelligent AirTM sensor pack, developed at Clemson University and built around the Sensirion SPS30, to collect data from July 29, 2019, to December 12, 2019, at a regulatory site in Columbia, South Carolina. When compared to the Federal Equivalent Methods, the SPS30 showed an average bias adjusted R2 = 0.75, mean bias error of -1.59, and a root mean square error of 2.10 for 24-hour average trimmed measurements over 93 days, and R2 = 0.57, mean bias error of -1.61, and a root mean square error of 3.029, for 1-hr average trimmed measurements over 2300 hours when the central 99% of data was retained with a data completeness of 75% or greater. The Intelligent AirTM sensor pack is designed to promote long-term deployment and includes a solar panel and battery backup, protection from the elements, and the ability to upload data via a cellular network. Overall, we conclude that the SPS30 PM sensor and the Intelligent AirTM sensor pack have the potential for greatly increasing the spatial density of particulate matter measurements, but more work is needed to understand and calibrate sensor measurements.Implications: This work adds to the growing body of research that indicates that low-cost sensors of particulate matter (PM) for air quality monitoring has a promising future, and yet much work is left to be done. This work shows that the level of data processing and filtering effects how the low-cost sensors compare to existing federal reference and equivalence methods: more data filtering at low PM levels worsens the data comparison, while longer time averaging improves the measurement comparisons. Improvements must be made to how we handle, calibrate, and correct PM data from low-cost sensors before the data can be reliably used for air quality monitoring and attainment.

Size-dependent oxygen activation efficiency over Pd(n)/TiO2(110) for the CO oxidation reaction.

The dissociative binding efficiency of oxygen over Pd(n)/TiO(2)(110) (n = 4, 7, 10, 20) has been measured using temperature programmed reaction (TPR) mass spectrometry and X-ray photoemission spectroscopy (XPS) following exposure to O(2) with varying doses and dose temperatures. Experiments were carried out following two different O(2) exposures at 400 K (10 L and 50 L) and for 10 L of O(2) exposure at varying temperatures (T(surf) = 200, 300, and 400 K). During TPR taken after sequential O(2) and CO (5 L at 180 K) exposures, unreacted CO is found to desorb in three features at T(desorb) ≈ 150, 200, and 430 K, while CO(2) is observed to desorb between 170 and 450 K. We show that Pd(20) has exceptionally high efficiency for oxygen activation, compared to other cluster sizes. As a consequence, its activity becomes limited by competitive CO binding at low O(2) exposures, while other Pd(n) sizes are still limited by inefficient O(2) activation. This difference in mechanism can ultimately be related back to differences in electronic properties, thus making this question one that is interesting from the theoretical perspective. We also demonstrate a correlation between one of the two CO binding sites and CO(2) production, suggesting that only CO in that site is reactive.

The T1799A point mutation is present in posterior uveal melanoma.

An activating mutation in exon 15 of the BRAF gene is present in a high proportion of cutaneous pigmented lesions. Until recently this mutation had however only been identified in one case of posterior uveal melanoma. Despite this apparent lack of the BRAF mutation, inappropriate downstream activation of the Ras/Raf/MAPK pathway has been described in posterior uveal melanoma. Based on the already recognised morphological and cytogenetic heterogeneity in uveal melanoma, we hypothesised that the BRAF mutation may be present in uveal melanoma but only in some of the tumour cells. In this study, we analysed 20 ciliary body and 30 choroidal melanomas using a nested PCR-based technique resulting in the amplification of a nested product only if the mutation was present. This sensitive technique can identify mutated DNA in the presence of wild-type DNA. The mutation was identified in 4 of 20 (20%) ciliary body and 11 of 30 (40%) choroidal melanomas. Further analysis of separate areas within the same choroidal melanoma demonstrated that the mutation was not present in the entire tumour. In conclusion, the T1799A BRAF mutation is present in a proportion of posterior uveal melanomas but within these tumours the distribution of the mutation is heterogeneous.

An update on mesenchymal tumours of the orbit with an emphasis on the value of molecular/cytogenetic testing.

Mesenchymal tumours of the orbit are uncommon. Beyond childhood primary sarcomas are extremely rare and the literature is limited to case reports and short case series. However there is a diverse assortment of benign and malignant soft tissue tumours that may involve the orbit. Techniques to identify tumour specific cytogenetic or molecular genetic abnormalities often resulting in over- expressed proteins are becoming an increasingly important ancillary technique for these tumours. This review focuses on 3 specific areas: 1. Orbital mesenchymal tumours where cytogenetics are important to reach the correct diagnosis. The majority of these are chromosomal translocations that often result in a fusion gene and protein product; 2. Orbital mesenchymal tumours where cytogenetics are important to identify patients who will do well versus those with a poorer prognosis. This is turn helps with therapeutic options. In some tumours e.g. synovial sarcoma the chromosomal translocations can occur with 2 different regions resulting in different fusion products that carry a different prognosis. Alternatively whilst the majority of alveolar rhadomyosarcomas are fusion positive a minority are fusion negative with a better prognosis; 3. Orbital mesenchymal tumours where the identification of specific cytogenetic abnormalities has resulted in overexpression of specfic proteins which are diagnostically useful biomarkers for immunohistochemistry.

Subsurface Oxygen in Oxide-Derived Copper Electrocatalysts for Carbon Dioxide Reduction.

Copper electrocatalysts derived from an oxide have shown extraordinary electrochemical properties for the carbon dioxide reduction reaction (CO2RR). Using in situ ambient pressure X-ray photoelectron spectroscopy and quasi in situ electron energy-loss spectroscopy in a transmission electron microscope, we show that there is a substantial amount of residual oxygen in nanostructured, oxide-derived copper electrocatalysts but no residual copper oxide. On the basis of these findings in combination with density functional theory simulations, we propose that residual subsurface oxygen changes the electronic structure of the catalyst and creates sites with higher carbon monoxide binding energy. If such sites are stable under the strongly reducing conditions found in CO2RR, these findings would explain the high efficiencies of oxide-derived copper in reducing carbon dioxide to multicarbon compounds such as ethylene.

Immunohistochemical staining for adipophilin, perilipin and TIP47.

BACKGROUND: The presence of lipid in the cell cytoplasm is useful for supporting the diagnosis of sebaceous gland carcinoma (SGC). Currently this requires histochemical stains that are carried out on frozen sections of unprocessed tissue. Recently, several anti-adipocytic antibodies that recognise proteins associated with lipid vesicles have been described. These antibodies can be applied to paraffin-wax sections. AIM: To assess the ability of anti-adipocytic antibodies to identify intracytoplasmic lipid in SGC. METHODS: Immunohistochemistry with a monoclonal antibody to adipophilin and polyclonal antibodies to perilipin and TIP47/PP17 was carried out on archival, formalin-fixed, paraffin-wax-embedded sections of 26 samples of SGC. The immunostaining was compared with 22 other eyelid tumours (11 basal cell carcinomas (BCC), 10 squamous cell carcinomas (SCC) and 1 Merkel cell tumour). RESULTS: Immunohistochemical staining was positive in 23, 10 and 2 cases of 26 SGC with adipophilin, perilipin and TIP47, respectively. The positive staining identified cytoplasmic lipid vesicles. Anti-adipophilin was positive in five other eyelid tumours (4 BCC and 1 SCC) staining small cytoplasmic granules that can be easily distinguished from the staining in SGC. CONCLUSIONS: Immunohistochemical staining for adipophilin and perilipin is a useful ancillary technique for the demonstration of lipid in SGC that may be applied to paraffin-wax sections.

Positive immunostaining for thyroid transcription factor-1 in primary and metastatic colonic adenocarcinoma: a note of caution.

Immunohistochemistry for thyroid transcription factor-1 (TTF-1) is considered an important ancillary technique for distinguishing primary pulmonary adenocarcinomas from metastases. A case of metastatic colonic adenocarcinoma in a bronchial biopsy specimen that showed focal positive nuclear staining for TTF-1 is reported here. The primary colonic adenocarcinoma was retrieved from the file and immunostaining also showed focal nuclear positivity for TTF-1. This confirmed the morphological and clinical impression of colonic metastases in the bronchial biopsy specimen. To investigate this apparent aberrant TTF-1 expression, further sections from primary colonic adenocarcinoma were immunostained for TTF-1 using the SPT24 antibody clone. Three of the six cases studied showed focal nuclear positivity with the SPT24 clone. All six cases were subsequently shown to be negative with the 8G7G1 clone. It is concluded that the SPT24 antibody to TTF-1 may show focal nuclear positivity in adenocarcinomas of colorectal origin such that focal staining in small biopsy specimens should be interpreted with caution.

Formation of Copper Catalysts for CO2 Reduction with High Ethylene/Methane Product Ratio Investigated with In Situ X-ray Absorption Spectroscopy.

Nanostructured copper cathodes are among the most efficient and selective catalysts to date for making multicarbon products from the electrochemical carbon dioxide reduction reaction (CO2RR). We report an in situ X-ray absorption spectroscopy investigation of the formation of a copper nanocube CO2RR catalyst with high activity that highly favors ethylene over methane production. The results show that the precursor for the copper nanocube formation is copper(I)-oxide, not copper(I)-chloride as previously assumed. A second route to an electrochemically similar material via a copper(II)-carbonate/hydroxide is also reported. This study highlights the importance of using oxidized copper precursors for constructing selective CO2 reduction catalysts and shows the precursor oxidation state does not affect the electrocatalyst selectivity toward ethylene formation.

Occupational outcome after temporal lobectomy for refractory epilepsy.

We evaluated employment after temporal lobectomy for refractory epilepsy in 86 patients (3.5 to 8 years of follow-up). Seventy-three patients qualified for the work force before and after surgery. Unemployment rates declined after surgery (18 patients [25%] unemployed before surgery, eight patients [11%] unemployed after surgery), and underemployment also tended to diminish. Improvement in occupational status related strongly to the degree of postoperative seizure relief. Seizure-free patients fared better (no unemployment, little underemployment) than patients with some seizure-free years and some years with seizures after surgery, whose high underemployment level persisted. Patients with seizures in each year after surgery fared worst (despite reduced seizure frequency), with increased unemployment after surgery. Age at surgery also influenced vocational outcome in patients who were unemployed before surgery. Historical, educational, cognitive, and behavioral measures did not correlate with vocational outcome. Employment gains came slowly; unemployed patients took up to 6 years to obtain work after surgery. Of 13 students at the time of surgery, 11 have graduated and nine are now employed. We conclude that seizures play a large role in limiting employment, and that by alleviating seizures, temporal lobectomy improves employability in people with refractory epilepsy. Surgery thereby provides benefit to individuals with epilepsy by increasing financial independence and to society by reducing unemployment.