A large outbreak of the Kappa mutation of COVID-19 in Cork, Ireland, April-May 2021.

BACKGROUND: In May 2021, the B.1.617 variant of SARS-CoV-2 emerged in Ireland, and both Delta and Kappa sub-lineages were initially deemed variants of concern (VOCs) on a precautionary basis. We describe a large outbreak of SARS-CoV-2 B.1.617.1 (Kappa mutation) linked to a private gathering among third level students in Cork, Ireland. METHODS: Surveillance data were available from the Health Service Executive COVID Care Tracker. The epidemiological sequence of infection for each new case in this outbreak was tracked and whole genome sequencing was requested on all linked cases. Enhanced public health control measures were implemented by the Department of Public Health HSE-South to contain onward spread of VOCs, including retrospective contact tracing, lengthy isolation and quarantine periods for cases and close contacts. Extensive surveillance efforts were used to describe and control onward transmission. RESULTS: There were 146 confirmed SARS-CoV-2 cases linked to the outbreak. All sequenced cases (53/146; 36%) confirmed Kappa mutation. The median age was 21 years (range 17-65). The majority (88%) had symptoms of SARS-CoV-2 infection. There were 407 close contacts; the median was 3 per case (range 0-14). There were no known hospitalisations, ICU admissions or deaths. Vaccination data was unavailable, but the outbreak pre-dated routine availability of COVID-19 vaccines among younger adults in Ireland. CONCLUSION: Enhanced public health control measures for new and emerging variants of SARS-CoV-2 may be burdensome for cases and close contacts. The overall public health benefit of enhanced controls may only become apparent when evidence on disease transmissibility and severity becomes more complete.

Low mortality risk but high loss to follow-up among patients in the Tanzanian national HIV care and treatment programme.

UNLABELLED: OBJECTIVE To analyse survival and retention rates of the Tanzanian care and treatment programme. METHODS: Routine patient-level data were available from 101 of 909 clinics. Kaplan-Meier probabilities of mortality and attrition after ART initiation were calculated. Mortality risks were corrected for biases from loss to follow-up using Egger's nomogram. Smoothed hazard rates showed mortality and attrition peaks. Cox regression identified factors associated with death and attrition. Median CD4 counts were calculated at 6 month intervals. RESULTS: In 88,875 adults, 18% were lost to follow up 12 months after treatment initiation, and 36% after 36 months. Cumulative mortality reached 10% by 12 months (15% after correcting for loss to follow-up) and 14% by 36 months. Mortality and attrition rates both peaked within the first six months, and were higher among males, those under 45 kg and those with CD4 counts below 50 cells/µl at ART initiation. In the first year on ART, median CD4 count increased by 126 cells/µl, with similar changes in both sexes. CONCLUSION: Earlier diagnoses through expanded HIV testing may reduce high mortality and attrition rates if combined with better patient tracing systems. Further research is needed to explore reasons for attrition.

Modelling the biological half-life and seasonality of ¹4C in Fucus vesiculosus from the east coast of Ireland: implications for the estimation of future trends.

Radiocarbon levels were recorded in Fucus vesiculosus samples collected on a monthly basis over a three-year period at a site on the east coast of Ireland. The resulting data was analysed using a numerical model which estimates the transit times from the Sellafield plant to the sampling location, and the mean availability time of ¹4C in seaweed. With the inclusion of a model parameter allowing for seasonal variability in uptake by the Fucus, good correlation was observed between the predicted and measured concentrations. Future temporal trends of ¹4C Fucus concentrations along the eastern Irish coastline were modelled with the application of three possible prospective discharge scenarios, predicting ¹4C Fucus concentrations to reduce to ambient background levels within 2.5-years of discharges being set to zero. Such projections may prove helpful in assessing the consequences of discharge management and policy making in the context of the OSPAR convention.

Making choices: why parents present to the emergency department for non-urgent care.

OBJECTIVES: This study aims to provide a better understanding of the motivations and actions of parents of children with non-urgent injury or illness who attend the emergency department at a tertiary paediatric hospital seeking care. DESIGN: A prospective questionnaire-based survey of 355 parents aimed to ascertain information about parent care-giving and care-seeking behaviours prior to presentation at the emergency department with their child. RESULTS: A total of 355 parents were surveyed, representing 8% of the parents/carers presenting to the emergency department in a 3-month period for non-urgent (Australasian Triage System 4 and 5) care of their child. The factors identified were: parents rated their child's condition as moderate to very serious (242 (68%)); two-thirds of parents (234 (66%)) had sought advice prior to attending the emergency department; 54% (77) of the 137 children who attended with an injury presented promptly to emergency (ie, within 4 h of injury) whereas of the 216 presenting with an illness, 41% (88) presented within 2-7 days of the onset of the illness. CONCLUSIONS: This study displayed the accuracy of "parental triage," that is, parents assess their child's health and generally engage in appropriate care-giving and care-seeking behaviours before presenting to a paediatric emergency department. Highlighted are the deficiencies in current primary care services available to families and the perception that not all cases deemed as non-urgent by the emergency department are able to be dealt with in a primary care setting.

Analysis of functional results and quality of life following free jejunal flaps for reconstruction after upper aerodigestive neoplastic resection: the St James's experience.

Surgical treatment of hypopharyngeal cancers with extension to the postcricoid region generally requires a circumferential pharyngolaryngoesphagectomy followed by reconstruction of the upper aerodigestive tract. Many techniques have been described in order to achieve a safe and functional reconstruction. Interposition of the jejunal free flap (JFF) is a well-established technique and is the flap of choice in our unit. This is a retrospective review of all patients who required a JFF following pharyngolaryngoesphagectomy over an 9-year period. We studied medical charts, histological reports, and speech and language therapy assessments. Eight of the nine surviving patients completed a quality of life questionnaire. Analysis was carried out on patient demographics, flap survival, patient survival and quality of life including swallow function and speech restoration. A total of 23 patients had 24 jejunal free flaps. There were four perioperative deaths. Two flaps failed, and were salvaged with a second JFF in one case and a gastric pull-up in the second. Functioning swallow was established in 74% of patients with four patients complaining of dysphagia. Speech was restored using an electrolarynx or Blom Singer valve in 70% of patients. Most patients required radiotherapy as part of their adjuvant treatment. In our hands the JFF for reconstruction following pharyngolaryngoesophageal resection allows restoration of function following major ablative surgery.

Trends in the spatial and temporal distribution of 129I and 99Tc in coastal waters surrounding Ireland using Fucus vesiculosus as a bio-indicator.

Spatial and temporal trends in (129)I and (99)Tc concentrations around the Irish coastline have been evaluated using Fucus vesiculosus as a bio-indicator. (129)I concentrations in a recent set of seawater samples have also been recorded and reveal an identical spatial pattern. Concentrations of (129)I in Fucus from the northeast coast of Ireland proved to be at least two orders of magnitude higher than concentrations in Fucus from the west coast. The (129)I content of Fucus increased significantly between 1985 and 2003, in line with increases in discharges of (129)I from the Sellafield nuclear reprocessing plant. Similar trends were observed in the case of (99)Tc. (129)I/(99)Tc ratios in Irish seawater were deduced from the Fucus data, and compared to ratios in discharges from Sellafield and from the French reprocessing plant at Cap de la Hague. Levels of (129)I and (99)Tc in Fucus from the west coast were found to be enhanced with respect to levels in seaweeds from other regions in the Northern Hemisphere unaffected by discharges from nuclear installations such as those referred to.

Bundling and diameter selectivity in HiPco SWNTs poly(p-phenylene vinylene-co-2,5-dioctyloxy-m-phenylene vinylene) composites.

Temperature-dependent (TD) Raman measurements at laser excitation 514.5 nm were performed at different concentrations. The spectral profile of the radial breathing modes were investigated up to a polymer concentration of 1 g/L and were found to be dominated by approximately 1.2-1.4 nm diameter tubes at room temperature. Upon heating above the glass transition of the polymer (60 degrees C) the smaller tubes around approximately 0.9 nm increased significantly in relative intensity. This suggests that below the glass transition of the polymer (60 degrees C) RBMs within the composite are damped and spectral changes cannot be interpreted as diameter selective solubilization. The observed RBM damping at room temperature only occurred up to a concentration of approximately 1.2 x 10(-4) g/L and below this no damping was observed. Photoluminescence intensity (PL) measurements were taken for a range of PmPV concentrations, in which HiPco single walled carbon nanotubes (SWNTs) at 100%, 10%, 1%, 0.1%, 0.01%, and 0% mass fractions were added. Fitting of the concentration dependence to a dynamic absorption/desorption model indicates that the polymer interacts with nanotube bundles until a critical concentration of approximately 1.2 x 10(-4) g/L is reached, below which the nanotubes are isolated. The polymer and or solvent has a significant effect on the debundling and aggregation within these systems. Aggregation and/or interaction with the polymer at higher concentrations can effect the RBM profile in the composite at ambient temperatures, providing an incomplete representation of the selection of diameters present within composites at a particular wavelength.

Temperature-induced nucleation of poly(p-phenylene vinylene-co-2,5-dioctyloxy-m-phenylene vinylene) crystallization by HiPco single-walled carbon nanotubes.

Hybrid systems of the conjugated organic polymer poly(p-phenylene vinylene-co-2,5-dioctyloxy-m-phenylene vinylene)(PmPV) and HiPco single-walled carbon nanotubes (SWNTs) are explored using spectroscopic and thermal techniques to determine specific interactions. Vibrational spectroscopy indicates a weak interaction, and this is further elucidated using differential scanning calorimetry (DSC), confocal laser scanning microscopy, temperature-dependent Raman spectroscopy, and temperature-dependent infrared spectroscopy of the raw materials and the composite. An endothermic transition is observed in the DSC of both the polymer and the 0.1% HiPco composite in the region of 50 degrees C. Also observed in the DSC of the composite is a double-peaked endotherm at -39 and -49 degrees C, which does not appear in the polymer. The Raman spectroscopy of the polymer upon increasing the temperature to 60 degrees C shows a diminished cis-vinylene mode at 1575 cm(-1), with an increase in relative intensity of the trans-vinylene mode at 1630 cm(-1). Partially irreversible change in isomerization suggests increased order in the polymer. This change in the polymer is also manifest in the Raman composite spectrum upon increase of the temperature to 60 degrees C, where the spectrum becomes abruptly dominated by nanotubes. Raman spectroscopy of the composite shows no change at -35 degrees C; however, infrared absorption measurements suggest that the transition at -35 degrees C derives from the polymer side chains. Here the composite at -35 degrees C shows a change in the absorbance of the polymer side chain aryl-oxide linkage at 1250 cm(-1) and alkyl-oxide stretch at 1050 cm(-1). Infrared spectra thus suggest that the transitions in the lower temperature region around -35 degrees C are side chain-induced, while Raman spectra suggest that the transition at 60 degrees C is backbone-induced. Furthermore, temperature cycling induces an irreversible decrease in the mean fluorescence intensity of the polymer, coupled with a further reduction in the mean fluorescence intensity of the composite. This suggests that an increase in crystallization of the composite is supported and enhanced by an increase in ordering of the polymer. Implications are discussed.

Spectroscopic analysis of single-walled carbon nanotubes and semiconjugated polymer composites.

Interactions between arc discharge single-walled carbon nanotubes within polymer composites have been well documented. Here hybrid systems of the conjugated organic polymer poly(p-phenylene vinylene-co-2,5-dioctyloxy-m-phenylene vinylene) (PmPV) and HiPco SWNTs are explored using UV/vis/NIR and Raman spectroscopy at 514.5 and 632.8 nm to determine specific interactions. An examination of the radial breathing modes at 514.5 nm shows similar tube diameters of 1.28 and 1.35 nm selected for both the arc discharge and HiPco composites. The corresponding G lines of both composites show no specific type of tubes being selected. At 514.5 nm, the G line of the HiPco composite (1% mass fraction) shows contributions from semiconducing and metallic tubes, and the arc discharge composite (1% mass fraction) is dominated by semiconducting nanotubes. At 632.8 nm, the G line of the HiPco composite (1% mass fraction) is dominated by semiconducting tubes, and the arc discharge composite (1% mass fraction) shows strong contributions from metallic tubes. This finding is a strong indication that the selection process is dependent on tube diameter rather than backbone structure. The solubility limits of both composites are determined by investigating the G lines of both composites and have been found to be greater than 1% mass fraction by weight for the arc discharge composite and greater than 0.1% mass fraction by weight for the HiPco composite.

Prehospital resuscitative thoracotomy for cardiac arrest after penetrating trauma: rationale and case series.

OBJECTIVE: The purpose of this study is to present the rationale for an algorithm that describes the place of resuscitative thoracotomy in the prehospital management of a patient with penetrating chest injury, and to review a 6-year experience using this algorithm. METHODS: This study was a retrospective review of all cases where a prehospital thoracotomy was performed by the medical teams of the London Helicopter Emergency Medical Service. RESULTS: Thirty-nine prehospital thoracotomies were performed. Four (10%) patients survived, one with long-term disability. Factors associated with survival were stab wound, single cardiac wound, cardiac tamponade, and loss of pulse in the presence of an experienced prehospital doctor. CONCLUSION: Current evidence suggests that patients who suffer a cardiac arrest more than 10 minutes away from emergency room thoracotomy are very unlikely to survive. Prehospital thoracotomy is associated with a small number of survivors. This intervention should be considered if there is an appropriately experienced, trained, and equipped doctor present, who is acting within a trauma system with ongoing training and quality assurance.

Developing and implementing clinical practice tools: the legal and ethical implications.

The complexity of health care is ever increasing, as is the volume of research and literature available. In response there has been a corresponding emphasis on basing clinical decisions on the best available research evidence. The development and implementation of clinical practice tools is cited as a means of ensuring research utilisation as well as moderating variations in clinical practice. It is important that nurses contribute to the development of these clinical tools in order to actively shape their own practice. Nurses therefore need to have an understanding of the terminology and processes involved, and the implications for practice. This paper outlines definitions of the various clinical tools, the development process, and the legal and ethical implications of clinical practice tools.

Cleavage of BID during cytotoxic drug and UV radiation-induced apoptosis occurs downstream of the point of Bcl-2 action and is catalysed by caspase-3: a potential feedback loop for amplification of apoptosis-associated mitochondrial cytochrome c release.

BID, a pro-apoptotic Bcl-2 family member, promotes cytochrome c release during apoptosis initiated by CD95L or TNF. Activation of caspase-8 in the latter pathways results in cleavage of BID, translocation of activated BID to mitochondria, followed by redistribution of cytochrome c to the cytosol. However, it is unclear whether BID participates in cytochrome c release in other (non-death receptor) cell death pathways. Here, we show that BID is cleaved in response to multiple death-inducing stimuli (staurosporine, UV radiation, cycloheximide, etoposide). However BID cleavage in these contexts was blocked by Bcl-2, suggesting that proteolysis of BID occurred distal to cytochrome c release. Furthermore, addition of cytochrome c to Jurkat post-nuclear extracts triggered breakdown of BID at Asp-59 which was catalysed by caspase-3 rather than caspase-8. We provide evidence that caspase-3 catalysed cleavage of BID represents a feedback loop for the amplification of mitochondrial cytochrome c release during cytotoxic drug and UV radiation-induced apoptosis.

Failure of Bcl-2 to block cytochrome c redistribution during TRAIL-induced apoptosis.

Tumour necrosis factor (TNF)-related apoptosis-inducing ligand (TRAIL) is a member of the TNF family of cytokines that promotes apoptosis and NF-kappaB activation. Here we show that recombinant hu-TRAIL initiates the activation of multiple caspases, the loss of mitochondrial transmembrane potential, the cleavage of BID and the redistribution of mitochondrial cytochrome c. However, whereas Bcl-2 efficiently blocked UV radiation-induced cytochrome c release and consequent apoptosis of CEM cells, it failed to do either in the context of TRAIL treatment. Thus, TRAIL engages a death pathway that is at least partially routed via the mitochondria, but in contrast with other stimuli that engage this pathway, TRAIL-induced cytochrome c release is not regulated by Bcl-2.

Comparison of Ottawa ankle rules and current local guidelines for use of radiography in acute ankle injuries.

A prospective consecutive study of 252 adult patients presenting to Accident and Emergency (A&E) departments was performed to assess any advantage of the Ottawa vs. local guidelines for radiography of the acutely injured ankle or midfoot. All patients taking part in the study underwent an ankle or midfoot radiograph. A comparison was made to determine whether a safe reduction in radiography could be produced by following the Ottawa criteria. Simultaneously, the accuracy of both guidelines were assessed. Twenty-two fractures were diagnosed radiologically. Both guidelines had a sensitivity of 1.0 in detecting fractures and a negative predictive value of 1.0. Ottawa guidelines produced a specificity of 0.48 and a positive predictive value of 0.15. Local guidelines produced a specificity of 0.19 and a positive predictive value of 0.1. Following Ottawa guidelines produced a highly significant reduction (X = 74.0 P < 0.001) in radiography of 37%, and no fractures were missed. This could potentially save the department approximately 7500 Pounds per annum.

Suicide in the Northwest Territories: A descriptive review.

The incidence of suicide among the populations of the Northwest Territories (NWT) is notably higher than in the rest of Canada. A comparison of three five-year time periods between 1982 and 1996 reveals an increasing incidence rate, particularly for Nunavat, the eastern half of the NWT, occupied primarily by Inuit people. This is largely attributable to a rising use of hanging as opposed to other methods of suicide. A coroner's record review of suicides occurring between 1994 and 1996 demonstrates the preponderance of young males and of Inuit among those who committed suicide, the majority of whom committed suicide in familiar settings, usually their own homes, and often while others were on the premises. Thirty-six percent of those who committed suicide had experienced a recent family or relationship breakup, and twenty-one percent were facing criminal proceedings. Understanding the impact of these and other reported circumstances on the imminent risk of suicide requires further investigation.

Survival following pre-hospital arrest with on-scene thoracotomy for a stabbed heart.

A 34-year-old man was stabbed in the heart with the loss of all signs of life at the site of the incident. A resuscitative thoracotomy was performed at the roadside rather than transport a lifeless patient to hospital. Thoracotomy revealed asystole, pericardial tamponade and a right ventricular stab wound. Following further roadside resuscitation and subsequent air transport, and 30 min after loss of signs of life the patient was defibrillated in hospital and regained sinus rhythm. He recovered and was discharged at 25 days with normal neurology and mentation. Pre-hospital thoracotomy on a patient who had lost signs of life following a penetrating chest wound is an alternative to a "scoop and run' policy.

Children falling from a height in London.

OBJECTIVES: To determine the frequency and geographical distribution of children falling from a height in London and to suggest possible causes and preventative measures. METHODS: All relevant cases attended by the Helicopter Emergency Medical Service (HEMS) in a three and a half year period were reviewed and the locations related to the boroughs. The rates, per 1,000 resident children, were compared with socioeconomic indices for the boroughs concerned. In addition, a survey was undertaken of window fittings and maintenance in high rise flats close to one particular incident. RESULTS: A total of 90 incidents were attended involving 91 patients (64 male, 27 female) of whom five died. HEMS attends approximately one third of incidents involving serious trauma. In the study period the maximum frequency was 0.2 fallers per 1,000 resident children, occurring in three boroughs. In three boroughs there were no fallers. There was no overlap in socioeconomic indices between the five boroughs with the highest fall rates and the five with the lowest. The building survey found a high incidence of faulty window catches, a slow response rate for repair, and a lack of safety advice for residents. CONCLUSIONS: The frequency of falling is related to urban deprivation, poor maintenance, and lack of safety information. A combination of regulation and targeted education could substantially decrease deaths and injuries in children from this cause.