Electrostatic Trapping of N_{2} Molecules in High Rydberg States.

N_{2} molecules traveling in pulsed supersonic beams have been excited from their X ^{1}Σ_{g}^{+} ground electronic state to long-lived Rydberg states with principal quantum numbers between 39 and 48 using a resonance-enhanced two-color three-photon excitation scheme. The Rydberg states populated had static electric dipole moments exceeding 5000 D which allowed deceleration of the molecules to rest in the laboratory-fixed frame of reference and three-dimensional trapping using inhomogeneous electric fields. The trapped molecules were confined for up to 10 ms, with effective trap decay time constants increasing with principal quantum number, and ranging from 450 to 700 µs. These observations, and comparison with the results of similar measurements with He atoms, indicate that the decay dynamics of the trapped Rydberg N_{2} molecules are dominated by spontaneous emission and do not exhibit significant contributions from effects of intramolecular interactions that lead to non-radiative decay.

Effects of rotational excitation on decay rates of long-lived Rydberg states in NO.

Nitric oxide (NO) molecules in pulsed supersonic beams have been excited to long-lived Rydberg-Stark states in series converging to the lowest vibrational level in the ground electronic state of NO+ with rotational quantum numbers N+ = 2, 4, and 6. The molecules in these excited states were then guided, or decelerated and trapped in a chip-based Rydberg-Stark decelerator, and detected in situ by pulsed electric field ionization. Time constants, reflecting the decay of molecules in N+ = 2 Rydberg-Stark states, with principal quantum numbers n between 38 and 44, from the electrostatic traps were measured to be ∼300µs. Molecules in Rydberg-Stark states with N+ = 4 and 6, and the same range of values of n were too short-lived to be trapped, but their decay time constants could be determined from complementary sets of delayed pulsed electric field ionization measurements to be ∼100 and ∼25 µs, respectively.

Evaluating the performance characteristics of five lateral flow assays for the detection of the SARS-CoV-2 nucleocapsid antigen.

In response to the COVID-19 pandemic, lateral flow assays (LFAs) for the detection of SARS-CoV-2 antigen have been proposed as a complementary option to the more costly and time consuming reverse-transcriptase polymerase chain reaction (RT-PCR). We assessed five commercially available SARS-CoV-2 antigen detecting LFAs (ASSUT EUROPE (Rome, Italy), Besthree (Taizhou, China), Encode (Zhuhai, China), Fortress (Antrim UK), and Hughes Medical (Buckinghamshire, UK), using samples collected from hospitalised individuals with COVID-19 and compared these results against established RT-PCR assays with the aim of estimating test performance characteristics. We performed a diagnostic accuracy study of the five LFAs on 110 inpatients with confirmed COVID-19 and 75 COVID-19 negative control participants. Assay evaluation was performed using a modified version of each manufacturer's protocol allowing for parallel testing of a single sample on multiple assays. Additional variables were studied including infection acquisition, oxygenation requirements at time of swabbing, and patient outcomes. The 110 patients were 48% (53) female, with mean age 67 years (range 26-100 years), and 77% (85) cases were community onset SARS-CoV-2. Across the five assays, sensitivity ranged from 64 (95% CI 53-73) to 76% (95% CI 65-85); Fortress performed best with sensitivity of 76% (95% CI 65-85). Specificity was high across all assays with 4/5 LFAs achieving 100%. LFA sensitivity was not dependant on RT-PCR cycle thresholds. SARS-CoV-2 antigen detecting LFAs may complement RT-PCR testing to facilitate early diagnosis and provide community testing strategies for identification of patients with COVID-19, however we find suboptimal test performance characteristics across a range of commercially available manufacturers, below WHO and MHRA pre-set sensitivity performance thresholds. With such variation in sensitivity between LFAs and PCR testing and between assay brands, we advise caution in the deployment of LFAs outside of environments with clinical oversight.

Quantum-state-dependent decay rates of electrostatically trapped Rydberg NO molecules.

Nitric oxide (NO) molecules travelling in pulsed supersonic beams have been prepared in long-lived Rydberg-Stark states by resonance-enhanced two-colour two-photon excitation from the X 2Π1/2 (v'' = 0, J'' = 3/2) ground state, through the A 2Σ+ (v' = 0, N' = 0, J' = 1/2) intermediate state. These excited molecules were decelerated from 795 ms-1 to rest in the laboratory-fixed frame of reference, in the travelling electric traps of a transmission-line Rydberg-Stark decelerator. The decelerator was operated at 30 K to minimise effects of blackbody radiation on the molecules during deceleration and trapping. The molecules were electrostatically trapped for times of up to 1 ms, and detected in situ by pulsed electric field ionisation. Measurements of the rate of decay from the trap were performed for states with principal quantum numbers between n = 32 and 50, in Rydberg series converging to the N+= 0, 1, and 2 rotational states of NO+. For the range of Rydberg states studied, the measured decay times of between 200 µs and 400 µs were generally observed to reduce as the value of n was increased. For some particular values of n deviations from this trend were seen. These observations are interpreted, with the aid of numerical calculations, to arise as a result of contributions to the decay rates, on the order of 1 kHz, from rotational and vibrational channel interactions. These results shed new light on the role of weak intramolecular interactions on the slow decay of long-lived Rydberg states in NO.

Overriding water table control on managed peatland greenhouse gas emissions.

Global peatlands store more carbon than is naturally present in the atmosphere1,2. However, many peatlands are under pressure from drainage-based agriculture, plantation development and fire, with the equivalent of around 3 per cent of all anthropogenic greenhouse gases emitted from drained peatland3-5. Efforts to curb such emissions are intensifying through the conservation of undrained peatlands and re-wetting of drained systems6. Here we report eddy covariance data for carbon dioxide from 16 locations and static chamber measurements for methane from 41 locations in the UK and Ireland. We combine these with published data from sites across all major peatland biomes. We find that the mean annual effective water table depth (WTDe; that is, the average depth of the aerated peat layer) overrides all other ecosystem- and management-related controls on greenhouse gas fluxes. We estimate that every 10 centimetres of reduction in WTDe could reduce the net warming impact of CO2 and CH4 emissions (100-year global warming potentials) by the equivalent of at least 3 tonnes of CO2 per hectare per year, until WTDe is less than 30 centimetres. Raising water levels further would continue to have a net cooling effect until WTDe is within 10 centimetres of the surface. Our results suggest that greenhouse gas emissions from peatlands drained for agriculture could be greatly reduced without necessarily halting their productive use. Halving WTDe in all drained agricultural peatlands, for example, could reduce emissions by the equivalent of over 1 per cent of global anthropogenic emissions.

Slow Decay Processes of Electrostatically Trapped Rydberg NO Molecules.

Nitric oxide (NO) molecules initially traveling at 795 m/s in pulsed supersonic beams have been photoexcited to long-lived hydrogenic Rydberg-Stark states, decelerated and electrostatically trapped in a cryogenically cooled, chip-based transmission-line Rydberg-Stark decelerator. The decelerated and trapped molecules were detected in situ by pulsed electric field ionization. The operation of the decelerator was validated by comparison of the experimental data with the results of numerical calculations of particle trajectories. Studies of the decay of the trapped molecules on timescales up to 1 ms provide new insights into the lifetimes of, and effects of blackbody radiation on, Rydberg states of NO.

HIV/HCV/HBV testing in the emergency department: a feasibility and seroprevalence study.

OBJECTIVES: The aims of this study were to to assess the feasibility of simultaneous testing for the blood-borne viruses (BBV), HIV, hepatitis C (HCV) and hepatitis B (HBV), in the Emergency Department (ED) and ascertain the seroprevalence for these three viruses in this setting. METHODS: A pilot BBV testing program was undertaken as part of routine clinical care in the ED. All ED attendees aged between 16 and 65 years old who were able to consent were tested over a 55 week period on an opt out basis. Patients with positive test results were linked to clinical services. Interventions aimed at improving testing rates were implemented and evaluated by quality improvement (QI) methodology. RESULTS: Of 25,520 age-eligible ED attendees, 6108 (24%) underwent BBV testing; an additional 1160 (4.5%) underwent a standalone HIV test (total of 7268 (28%) individuals).There were 83/7268 (1.1%) non-negative (ie reactive or equivocal) results for HIV and 103/6108 (1.7%) and 32/6108 (0.52%) for anti-HCV IgG and HBsAg, respectively. Of these, 12 (0.17%), 16 (0.26%) and 8 (0.13%) were new reactive tests for HIV, HCV and HBV, respectively, which were able to be confirmed on a second test. Specific QI interventions led to temporary increases in testing rates. CONCLUSIONS: An opt out BBV testing program in the ED is feasible and effective at finding new cases. However, the testing rate was low at 24%. Although QI interventions led to some improvement in testing rates, further studies are required to identify ways to achieve sustained increases in testing in this setting.

Treatment-limiting renal tubulopathy in patients treated with tenofovir disoproxil fumarate.

OBJECTIVES: Tenofovir disoproxil fumarate (TDF) is widely used in the treatment or prevention of HIV and hepatitis B infection. TDF may cause renal tubulopathy in a small proportion of recipients. We aimed to study the risk factors for developing severe renal tubulopathy. METHODS: We conducted an observational cohort study with retrospective identification of cases of treatment-limiting tubulopathy during TDF exposure. We used multivariate Poisson regression analysis to identify risk factors for tubulopathy, and mixed effects models to analyse adjusted estimated glomerular filtration rate (eGFR) slopes. RESULTS: Between October 2002 and June 2013, 60 (0.4%) of 15,983 patients who had received TDF developed tubulopathy after a median exposure of 44.1 (IQR 20.4, 64.4) months. Tubulopathy cases were predominantly male (92%), of white ethnicity (93%), and exposed to antiretroviral regimens that contained boosted protease inhibitors (PI, 90%). In multivariate analysis, age, ethnicity, CD4 cell count and use of didanosine or PI were significantly associated with tubulopathy. Tubulopathy cases experienced significantly greater eGFR decline while receiving TDF than the comparator group (-6.60 [-7.70, -5.50] vs. -0.34 [-0.43, -0.26] mL/min/1.73 m2/year, p < 0.0001). CONCLUSIONS: Older age, white ethnicity, immunodeficiency and co-administration of ddI and PI were risk factors for tubulopathy in patients who received TDF-containing antiretroviral therapy. The presence of rapid eGFR decline identified TDF recipients at increased risk of tubulopathy.

Auditing HIV Testing Rates across Europe: Results from the HIDES 2 Study.

European guidelines recommend the routine offer of an HIV test in patients with a number of AIDS-defining and non-AIDS conditions believed to share an association with HIV; so called indicator conditions (IC). Adherence with this guidance across Europe is not known. We audited HIV testing behaviour in patients accessing care for a number of ICs. Participating centres reviewed the case notes of either 100 patients or of all consecutive patients in one year, presenting for each of the following ICs: tuberculosis, non-Hodgkins lymphoma, anal and cervical cancer, hepatitis B and C and oesophageal candidiasis. Observed HIV-positive rates were applied by region and IC to estimate the number of HIV diagnoses potentially missed. Outcomes examined were: HIV test rate (% of total patients with IC), HIV test accepted (% of tests performed/% of tests offered) and new HIV diagnosis rate (%). There were 49 audits from 23 centres, representing 7037 patients. The median test rate across audits was 72% (IQR 32-97), lowest in Northern Europe (median 44%, IQR 22-68%) and highest in Eastern Europe (median 99%, IQR 86-100). Uptake of testing was close to 100% in all regions. The median HIV+ rate was 0.9% (IQR 0.0-4.9), with 29 audits (60.4%) having an HIV+ rate >0.1%. After adjustment, there were no differences between regions of Europe in the proportion with >0.1% testing positive (global p = 0.14). A total of 113 patients tested HIV+. Applying the observed rates of testing HIV+ within individual ICs and regions to all persons presenting with an IC suggested that 105 diagnoses were potentially missed. Testing rates in well-established HIV ICs remained low across Europe, despite high prevalence rates, reflecting missed opportunities for earlier HIV diagnosis and care. Significant numbers may have had an opportunity for HIV diagnosis if all persons included in IC audits had been tested.

Routine HIV testing in the emergency department: tough lessons in sustainability.

OBJECTIVES: Routine HIV testing in nonspecialist settings has been shown to be acceptable to patients and staff in pilot studies. The question of how to embed routine HIV testing, and make it sustainable, remains to be answered. METHODS: We established a service of routine HIV testing in an emergency department (ED) in London, delivered by ED staff as part of routine clinical care. All patients aged 16 to 65 years were offered an HIV test (latterly the upper age limit was removed). Meetings were held weekly and two outcome measures examined: test offer rate (coverage) and test uptake. Sustainability methodology (process mapping; plan-do-study-act (PDSA) cycles) was applied to maximize these outcome measures. RESULTS: Over 30 months, 44,582 eligible patients attended the ED. The mean proportion offered an HIV test was 14%, varying from 6% to 54% per month over the testing period. The mean proportion accepting a test was 63% (range 33-100%). A total of 4327 HIV tests have been performed. Thirteen patients have been diagnosed with HIV infection (0.30%). PDSA cycles having the most positive and sustained effects on the outcome measures include the expansion to offer blood-based HIV tests in addition to the original oral fluid tests, and the engagement of ED nursing staff in the programme. CONCLUSIONS: HIV testing can be delivered in the ED, but constant innovation and attention have been required to maintain it over 30 months. Patient uptake remains high, suggesting acceptability, but time will be required before true embedding in routine clinical practice is achieved.

Automatic oral fluid-based HIV testing in HIV screening programmes: automatic for the people.

OBJECTIVES: UK guidelines recommend routine HIV testing in general clinical settings when the local HIV prevalence is > 0.2%. During pilot programmes evaluating the guidelines, we used laboratory-based testing of oral fluid from patients accepting tests. Samples (n = 3721) were tested manually using the Bio-Rad Genscreen Ultra HIV Ag-Ab test (Bio-Rad Laboratories Ltd, Hemel Hempstead, UK). This was a methodologically robust method, but handling of samples was labour intensive. We performed a validation study to ascertain whether automation of oral fluid HIV testing using the fourth-generation HIV test on the Abbott Architect (Abbott Diagnostics, Maidenhead, UK) platform was possible. METHODS: Oral fluid was collected from 143 patients (56 known HIV-positive volunteers and 87 others having contemporaneous HIV serological tests) using the Oracol+ device (Malvern Medicals, Worcester, UK). Samples were tested concurrently: manually using the Genscreen Ultra test and automatically on the Abbott Architect. RESULTS: For oral fluid, the level of agreement of results between the platforms was 100%. All results agreed with HIV serology. The use of the Oracol+ device produced high-quality samples. Subsequent field use of the test has shown a specificity of 99.97% after nearly 3000 tests. CONCLUSIONS: Laboratory-based HIV testing of oral fluid requires less training of local staff, with fewer demands on clinical time and space than near-patient testing. It is acceptable to patients. The validation exercise and subsequent clinical experience support automation, with test performance preserved. Automation reduces laboratory workload and speeds up the release of results. Automated oral fluid testing is thus a viable option for large-scale HIV screening programmes.

Comparison of two cohorts of patients presenting with AIDS: patients with previously known HIV diagnoses and true late presenters.

OBJECTIVES: We aimed to identify the factors associated with developing AIDS 6 months or more after an HIV diagnosis, and to examine how post-HIV diagnosis AIDS (PHDA) patients differed from true late presenters (HIV diagnosed concurrent with the first AIDS presenting event) in their demographics and comorbidities. METHODS: A retrospective analysis was undertaken of all inpatients admitted to a large HIV unit presenting with the following AIDS-defining infections: cryptococcal meningitis, cerebral toxoplasmosis or Pneumocystis jirovecii pneumonia between 1 January 2005 and 31 December 2010. RESULTS: 114 HIV-positive patients presented with AIDS-defining infections. Compared with late presenters, PHDA patients had a larger proportion of migrants and visitors (53.7% vs. 34.0%, p=0.047), were more likely to inject drugs (9.3% vs 0.0%, p=0.032), had more previous HIV-associated diseases (57.4% vs. 12.8%, p=0.000), psychiatric comorbidities (35.2% vs. 12.8%, p=0.009), rates of alcohol abuse (24.1% vs. 4.3%, p=0.005) and reported social issues (25.9% vs. 0.00%, p=0.000). 88.9% of PHDA patients were lost to follow-up for a period of at least 4 months since diagnosis. Common reasons for clinic non-attendance included travel, social issues, transfer of care and treatment avoidance. Common reasons for antiretroviral treatment breaks included drug side effects, negative beliefs about medication, incompatible lifestyles and social issues. CONCLUSIONS: Compared with late presenters, PHDA patients demonstrate clear demographical differences including higher rates of psychiatric comorbidities, social issues, alcohol and substance abuse. Many PHDA patients default follow-up. The retention of HIV patients in care and on treatment must be addressed by clinicians to prevent avoidable morbidity.

Power Doppler 'blanching' after the application of transducer pressure.

The aim of this study was to determine if transducer pressure modifies power Doppler assessments of rheumatoid arthritis synovium at the metacarpophalangeal joints and metatarsophalangeal joints. Five rheumatoid arthritis patients of varying degrees of 'disease activity' and damage were assessed with power Doppler ultrasound scanning of the dominant hand second to fifth metacarpophalangeal joints. Two rheumatoid arthritis patients had their dominant foot first to fifth metatarsophalangeal joints assessed with power Doppler ultrasound. Ultrasonography was performed with a high frequency transducer (14 MHz) with a colour mode frequency of 10 Mhz, and a standard colour box and gain. In the joint that showed the highest power Doppler signal, an image was made. A further image was taken after transducer pressure was applied. In all patients, there was increased flow to at least one joint. After pressure was applied, power Doppler signal intensity markedly reduced in all images and in some there was no recordable power Doppler signal. Increased transducer pressure can result in a marked reduction or obliteration in power Doppler signal. This power Doppler 'blanching' shows the need for further studies to evaluate sources of error and standardization before power Doppler ultrasound becomes a routine measure of 'disease activity' in rheumatoid arthritis.

Photosynthesis and respiration of black spruce at three organizational scales: shoot, branch and canopy.

To gain insight into the function of photosynthesis and respiration as processes operating within a global ecosystem, we measured gas exchange of mature black spruce (Picea mariana (Mill.) B.S.P.) trees at three organizational scales: individual shoots, whole branches and a forest canopy. A biochemical model was fitted to these data, and physiological parameters were extracted. Pronounced seasonal variation in the estimated model parameters was found at all three organizational scales, highlighting the need to make physiological measurements throughout the year. For example, it took over 100 days for physiological activity to increase from zero during the springtime thaw to its yearly maximum. Good agreement was found between parameter values estimated for the different organizational scales, suggesting that, in the case of aerodynamically rough, largely mono-specific forest canopies, physiological parameters can be estimated from eddy covariance flux measurements. The small differences between photosynthetic parameters estimated at the different scales suggest that the overall spatial organization of photosynthetic capacity is nearly optimized for carbon uptake at each scale.

Measuring and modeling conductances of black spruce at three organizational scales: shoot, branch and canopy.

To investigate the extent to which the energy balance of a globally important ecosystem is controlled by biological and environmental processes, measurements of water vapor flux were made on individual black spruce (Picea mariana [Mill.] B.S.P.) shoots, branches, and a whole canopy at the BOREAS Southern Study Area Old Black Spruce (SSA OBS) site. These measurements were used to estimate stomatal, branch boundary layer and canopy boundary layer conductances to water vapor. On a projected needle area basis, stomatal conductances varied between 14 and 92 mmol m(-2) s(-1), and total branch conductance varied seasonally between zero and about 35 mmol m(-2) s(-1). On a ground area basis, total canopy conductance varied between 24 and 105 mmol m(-2) s(-1). Total canopy conductance was partitioned into aerodynamic and physiological components by using shoot-scale measurements scaled by leaf area index. Good agreement was found with an independent estimate of aerodynamic conductance measured when the canopy was wet. Compared with most coniferous forests, the canopy was relatively uncoupled from the atmosphere, and at the ecosystem scale, the control of water vapor flux was approximately equally divided between physiological and abiotic conductances. Two widely used steady-state models of stomatal conductance were parameterized from the shoot and branch measurements. Parameters varied considerably throughout the growing season. A time-constant term was added to these static models to construct dynamic models of stomatal conductance under naturally varying environmental conditions. The dynamic versions of the models outperformed the static versions in explaining stomatal response to rapidly changing environmental conditions. The length of the time-constant term, derived using the dynamic models, suggested that stomata were slow to respond to changing environmental conditions, and that the speed of the response was strongly temperature-dependent.

Client/Server computing: is this the future direction for the clinical laboratory?

One of the major trends in computing for the 1990s is the move towards distributed systems based on Client/Server architecture. Although a recent survey has suggested that some 41% of the major companies in the UK are either using or planning to adopt this new technology, there is little evidence at present of similar progress in the field of clinical laboratory computing. The Pathology Laboratories at St. Luke's Hospital have been developing in-house computer systems using object-oriented software tools since 1988, but these were initially based on conventional file sharing and suffered from poor performance under load. The conversion to Client/Server took place in March 1993 and the results have either met or exceeded all expectations. Our experience suggests that this approach may well be the way forward for the high performance but user-friendly laboratory systems of the future.