The Performance Evaluation of Meso-Tetraphenyl Porphyrin and Azo Dyes as Photosensitizers in Dye-sensitized Solar Cells.

The photovoltaic properties of five different mono-azo function and meso-tetraphenyl porphyrin dyes have been investigated by computational DFT/TDDFT calculations and measurement of the J-V properties of their cells. The photovoltaic efficiency of the cells based on these dyes were determined by both experimental and theoretical methods. The efficiency-to-cost ratios of the azo-dye cells showed that they could be cheaper substitutes to porphyrin-based cells. Eriochrome blue black (EBB) and eriochrome black T (EBT) cells were shown to possess the best photovoltaic properties by the two methods employed (theory and experiment). The presence of two naphthol moieties at both ends of their -N = N- group has been adduced as possible reason for their relatively outstanding performance. The extremely low efficiency-to-cost ratio obtained for cell-POR suggests that the use of porphyrin as sensitizer may not be as economically viable as some azo dyes. MTO, EBB and EBT were found to be the most cost-effective among the investigated dyes. The porphyrin's low performance may have been amplified by the absence of an effective anchor group in its molecular structure.

Advances in the management of radioactive wastes and radionuclide contamination in environmental compartments: a review.

Several anthropogenic activities produce radioactive materials into the environment. According to reports, exposure to high concentrations of radioactive elements such as potassium (40K), uranium (238U and 235U), and thorium (232Th) poses serious health concerns. The scarcity of reviews addressing the occurrence/sources, distribution, and remedial solutions of radioactive contamination in the ecosystems has fueled data collection for this bibliometric survey. In rivers and potable water, reports show that several parts of Europe and Asia have recorded radionuclide concentrations much higher than the permissible level of 1 Bq/L. According to various investigations, activity concentrations of gamma-emitting radioactive elements discovered in soils are higher than the global average crustal values, especially around mining activities. Adsorption technique is the most prevalent remedial method for decontaminating radiochemically polluted sites. However, there is a need to investigate integrated approaches/combination techniques. Although complete radionuclide decontamination utilizing the various technologies is feasible, future research should focus on cost-effectiveness, waste minimization, sustainability, and rapid radionuclide decontamination. Radioactive materials can be harnessed as fuel for nuclear power generation to meet worldwide energy demand. However, proper infrastructure must be put in place to prevent catastrophic disasters.

Evaluating the Clinical Impact of a Novel Pediatric Emergency Medicine Curriculum on Asthma Outcomes in Belize.

BACKGROUND: Respiratory-related complaints prompt most pediatric visits to Karl Heusner Memorial Hospital Authority's (KHMHA) Emergency Department (ED) in Belize. We developed and taught a novel pediatric respiratory emergencies module for generalist practitioners there. We assessed the curriculum's clinical impact on pediatric asthma emergency management. OBJECTIVE: This study assesses the clinical impact of a pediatric emergency medicine curriculum on management of pediatric asthma emergencies at KHMHA in Belize City, Belize. METHODS: We conducted a randomized chart review of pediatric (aged 2-16 y) visits for asthma-related diagnosis at the KHMHA ED between 2015 and 2018 to assess the training module's clinical impact. Primary outcomes included time to albuterol and steroids. Secondary outcomes included clinical scoring tool (Pediatric Respiratory Assessment Measure [PRAM]) usage, ED length of stay, usage of chest radiography, return visit within 7 days, and hospital admission rates. Kaplan-Meier survival analysis and Cox proportional hazard regression were used. RESULTS: Two hundred eighty-three pediatric asthma-related diagnoses met our inclusion criteria. The patients treated by trained and untrained physician groups were demographically and clinically similar. The time to albuterol was significantly faster in the trained (intervention) group compared with the untrained (control) physician group when evaluating baseline of the group posttraining (P < 0.05). However, the time to steroids did not reach statistical significance posttraining (P = 0.93). The PRAM score utilization significantly increased among both control group and intervention group. The untrained physician group was more likely to use chest radiography or admit patients. The trained physician group had higher return visit rates within 7 days and shorter ED length of stay, but this did not reach statistical significance. CONCLUSIONS: The curriculum positively impacted clinical outcomes leading to earlier albuterol administration, increased PRAM score use, obtaining less chest radiographs, and decreased admission rates. The timeliness of systemic steroid administration was unaffected.

Analysis of gaseous polycyclic aromatic hydrocarbon emissions from cooking devices in selected rural and urban kitchens in Bomet and Narok counties of Kenya.

Traditional combustion devices and fuels such as charcoal, wood and biomass, are widely utilised in rural and urban households in Africa. Incomplete combustion can generate air pollutants which are of human toxicological importance, including polycyclic aromatic hydrocarbons (PAHs). In this study, portable multi-channel polydimethylsiloxane rubber traps were used to sample gas phase emissions from cooking devices used in urban and rural households in Bomet and Narok counties of Kenya. A wide range of total PAH concentrations was found in samples collected (0.82 - 173.69 µg/m3), which could be attributed to the differences in fuel type, combustion device, climate, and nature of households. Wood combustion using the 3-stone device had the highest average total PAH concentration of ~71 µg/m3. Narok had higher indoor total gas phase PAH concentrations averaging 35.88 µg/m3 in urban and 70.84 µg/m3 in rural households, compared to Bomet county (2.91 µg/m3 in urban and 9.09 µg/m3 in rural households). Ambient total gas phase PAH concentrations were more similar (Narok: 1.26 - 6.28 µg/m3 and Bomet: 2.44 - 6.30 µg/m3). Although the 3-stone device and burning of wood accounted for higher PAH emissions, the charcoal burning jiko stove produced the highest toxic equivalence quotient. Monitoring of PAHs emitted by these cooking devices and fuels is critical to public health and sustainable pollution mitigation.

Adsorption Studies of Volatile Organic Compound (Naphthalene) from Aqueous Effluents: Chemical Activation Process Using Weak Lewis Acid, Equilibrium Kinetics and Isotherm Modelling.

This study deals with the preparation of activated carbon (CDSP) from date seed powder (DSP) by chemical activation to eliminate polyaromatic hydrocarbon-PAHs (naphthalene-C10H8) from synthetic wastewater. The chemical activation process was carried out using a weak Lewis acid of zinc acetate dihydrate salt (Zn(CH3CO2)2·2H2O). The equilibrium isotherm and kinetics analysis was carried out using DSP and CDSP samples, and their performances were compared for the removal of a volatile organic compound-naphthalene (C10H8)-from synthetic aqueous effluents or wastewater. The equilibrium isotherm data was analyzed using the linear regression model of the Langmuir, Freundlich and Temkin equations. The R2 values for the Langmuir isotherm were 0.93 and 0.99 for naphthalene (C10H8) adsorption using DSP and CDSP, respectively. CDSP showed a higher equilibrium sorption capacity (qe) of 379.64 µg/g. DSP had an equilibrium sorption capacity of 369.06 µg/g for C10H8. The rate of reaction was estimated for C10H8 adsorption using a pseudo-first order, pseudo-second order and Elovich kinetic equation. The reaction mechanism for both the sorbents (CDSP and DSP) was studied using the intraparticle diffusion model. The equilibrium data was well-fitted with the pseudo-second order kinetics model showing the chemisorption nature of the equilibrium system. CDSP showed a higher sorption performance than DSP due to its higher BET surface area and carbon content. Physiochemical characterizations of the DSP and CDSP samples were carried out using the BET surface area analysis, Fourier-scanning microscopic analysis (FSEM), energy-dispersive X-ray (EDX) analysis and Fourier-transform spectroscopic analysis (FTIR). A thermogravimetric and ultimate analysis was also carried out to determine the carbon content in both the sorbents (DSP and CDSP) here. This study confirms the potential of DSP and CDSP to remove C10H8 from lab-scale synthetic wastewater.

IFN-λ4 Attenuates Antiviral Responses by Enhancing Negative Regulation of IFN Signaling.

Type III IFNs are important mediators of antiviral immunity. IFN-λ4 is a unique type III IFN because it is produced only in individuals who carry a dG allele of a genetic variant rs368234815-dG/TT. Counterintuitively, those individuals who can produce IFN-λ4, an antiviral cytokine, are also less likely to clear hepatitis C virus infection. In this study, we searched for unique functional properties of IFN-λ4 that might explain its negative effect on hepatitis C virus clearance. We used fresh primary human hepatocytes (PHHs) treated with recombinant type III IFNs or infected with Sendai virus to model acute viral infection and subsequently validated our findings in HepG2 cell line models. Endogenous IFN-λ4 protein was detectable only in Sendai virus-infected PHHs from individuals with the dG allele, where it was poorly secreted but highly functional, even at concentrations < 50 pg/ml. IFN-λ4 acted faster than other type III IFNs in inducing antiviral genes, as well as negative regulators of the IFN response, such as USP18 and SOCS1 Transient treatment of PHHs with IFN-λ4, but not IFN-λ3, caused a strong and sustained induction of SOCS1 and refractoriness to further stimulation with IFN-λ3. Our results suggest unique functional properties of IFN-λ4 that can be important in viral clearance and other clinical conditions.

Syngnathia.

Syngnathia is a congenital fusion of the upper and lower jaws. Its occurrence poses a significant challenge to feeding and its management is challenging to both the surgeon and the anaesthetist. Reports in the literature are mainly clinical reports or case series. To the knowledge of the authors and from the available literature, this is only the fourth report from Nigeria. The presentation and successful management of a Nigerian female neonate with congenital syngnathia is described and reviewed with literature.

Adaptable skull stand: An indigenous innovation.

The aim of this report is to describe the structure and advantages of an innovative and indigenous device, the adaptable skull stand, which serves the purpose of holding a skull model steady in a variety of positions without the need for an assistant.

Environmental factors and population at risk of malaria in Nkomazi municipality, South Africa.

OBJECTIVE: Nkomazi local municipality of South Africa is a high-risk malaria region with an incidence rate of about 500 cases per 100 000. We examined the influence of environmental factors on population (age group) at risk of malaria. METHODS: r software was used to statistically analyse data. Using remote sensing technology, a Landsat 8 image of 4th October 2015 was classified using object-based classification and a 5-m resolution. Spot height data were used to generate a digital elevation model of the area. RESULTS: A total of 60 718 malaria cases were notified across 48 health facilities in Nkomazi municipality between January 1997 and August 2015. Malaria incidence was highly associated with irrigated land (P = 0.001), water body (P = 0.011) and altitude ≤400 m (P = 0.001). The multivariate model showed that with 10% increase in the extent of irrigated areas, malaria risk increased by almost 39% in the entire study area and by almost 44% in the 2-km buffer zone of selected villages. Malaria incidence is more pronounced in the economically active population aged 15-64 and in males. Both incidence and case fatality rate drastically declined over the study period. CONCLUSION: A predictive model based on environmental factors would be useful in the effort towards malaria elimination by fostering appropriate targeting of control measures and allocating of resources.

Single-Stage Surgical Reconstruction of Posttraumatic Compound Complex Fronto-Basal Cranial Vault Fracture in a Resource-Limited Practice.

BACKGROUND: The extant literature on the surgical treatment of posttraumatic compound, complex frontal basal calvarial skull fracture suggests that this be a staged procedure. There are many socioeconomic constraints in low-resource regions of the world to the feasibility of this standard practice. METHODS: A single-stage operative procedure for the surgical treatment of these fractures in a neurosurgery practice in Nigeria is here annotated. In addition, an observational outcome analysis of this surgical technique in a prospective consecutive cohort of patients over a 6-year period is presented. RESULTS: Fourteen patients, all males, mean age 33.9 years (SD, 6.6) underwent this surgical procedure. Majority were late neurosurgical referrals, hence median time to surgery was 96 hours (range, 48-2160). Twelve patients (85.7%) had history of loss of consciousness, median duration of 34 hours; 7 (50%) had associated brain contusions; 6 (43%) significant pneumocephalus; and acute extradural and subdural haematoma in 4 and 2 patients respectively. The surgery was successful in all; 13 (93%) had normal outcome on the Glasgow outcome scale at hospital discharge; 12 have been followed up for 1 to 72 months, median 33. Seven of these were for 30 months or more. There was no patient of surgical site infection in the perioperative or the follow-up period to date. The aesthetic outcome was also acceptable. CONCLUSION: The pragmatic surgical technique herein annotated appears clinically and aesthetically effectual in the operative treatment of compound, complex frontal basal cranial vault fracture.

Histopathological alterations, biochemical responses and acetylcholinesterase levels in Clarias gariepinus as biomarkers of exposure to organophosphates pesticides.

Organophosphate pesticides, commonly used in large scale farming, have been found to be major contaminants in aquatic environment. Clarias gariepinus was exposed to acute and sublethal concentrations of phostoxin and DD Force to evaluate single and joint action toxicity of the organophosphates. Effects of phostoxin and DD force on antioxidant enzymes, fish organs and acetylcholinesterase levels in fingerlings and juveniles of C. gariepinus were also investigated. The lethal concentrations (96 h LC50) for phostoxin and DD Force were 0.631 and 1.759 mg/l, respectively. The results obtained from the bioassay showed that phostoxin was 2.8× more toxic than DD Force after exposure of C. gariepinus. Joint action toxicity evaluations of phostoxin and DD Force showed that the interaction between the chemicals was synergistic (RTU >1). The biochemical responses in the exposed fish differed significantly (P < 0.05) from the control fish. The result of acetylcholinesterase study revealed significant difference between acetylcholinesterase levels in the exposed fish and control, with reduction in the acetylcholineterase level in fish exposed to sublethal concentrations of phostoxin and DD Force. Haematological studies revealed an increase in WBC, RBC, PCV and platelets in the exposed fish. Histopathology of the gills showed shortened primary lamellae, loss of secondary lamellae and loss of ceratobrachial bones. In the acute toxicity studies, respiratory stress, erratic swimming and instant death of fish were observed in the exposed fish. This study reveals that changes in histopathology and acetylcholinesterase level are good biomarkers and can be successfully used to detect exposure to organophosphates pesticides in fish.

Multicenter Pattern of Cleft Surgeries and Factors Associated with Late Primary Cleft Surgery in Nigeria.

Background: This study aimed to analyze multicenter patterns in cleft deformity surgeries and identify factors associated with the timing of primary cleft repair in Nigeria. Methods: A cross-sectional study of children managed for clefts from January 2009 to December 2020 at three Smile Train partner tertiary institutions situated in the east (Enugu), west (Ibadan), and northern (Jos) parts of the country using a prospectively collected database. Outcomes were the types of surgery performed, yearly volume of surgeries, methods of repair, and time of surgery (early versus late). Results: Of 1043 cleft surgeries, nearly half (45.7%) involved infants (<12 months). Primary repairs of the lip or palate were performed in 83.4% of cases, with 58.4% for lip repairs and 25.1% for palate repairs. The most common cleft lip repair method was a variant of Millard rotation advancement flap. Over the study years, there was a shift from von Langenbeck palatoplasty to methods such as Bardach's palatoplasty and intravelar veloplasty. Patients with bilateral cleft lip defects were significantly more likely (P < 0.001) to undergo early repairs compared with those with unilateral defects. Late primary cleft lip repairs were significantly (P < 0.001) more common in Enugu. Conclusions: This study highlights the variability in cleft surgery patterns in Nigeria. Late primary cleft surgeries were associated with less severe cleft lip or cleft palate and were more prevalent in Enugu, Southeastern Nigeria. The findings contribute valuable insights for optimizing surgical approaches and resource allocation in the management of cleft deformities in the region.

A novel nor-megastigmane from the leaves of Rhaphiostylis beninensis.

A novel nor-megastigmane, normegastigmane-5α,9-epoxy-3ß,8-diol (1), together with 10 known compounds of diverse classes including megastigmanes, sesquiterpenoids, and triterpenoids were isolated from the leaves of Rhaphiostylis beninensis. The structure of 1 was established by 1D and 2D NMR and HRESIMS data analysis. The known compounds were identified as 5,11-epoxy-3,9-megastigmanediol (2), 7-megastigmene-3,6,9-triol (3), 1,3-dihydroxypropan-2-yl stearate (4), (1E,5E)-1,5-dimethyl-8-(propan-2-ylidene)cyclodeca-1,5-diene germacrene (5) 3,5-dihyroxy-6,7-megastigmadien-9-one (6), squalene (7), ß-amyrin (8), ß-amyrone (9), ß-amyrin eicosanoate (10), and ß-sitosterol (11). Compounds 2, 3, and 6 displayed inhibitory effects on acetylcholinesterase enzyme. This is the first report of these compounds from the plant and their anticholinesterase activity.

Emergency Department Virtual Happy Hour: A Novel Approach to Peer Group Support During a Pandemic.

Introduction Communities responded to the coronavirus disease 2019 (COVID-19) pandemic with mandatory social-distancing regulations. Pandemic and disaster research shows that social isolation can often cause negative emotions and medical provider burnout. The primary objective of this study was to create and evaluate a novel wellness program, the Happy Hour Wellness Initiative (HHWI), based on peer support group concepts to foster resilience for emergency healthcare providers in response to a novel disaster. Methods The study was performed at a large emergency department with physicians, advanced practice providers, and staff invited to attend weekly "virtual happy hour" sessions. Participants individually opted into each of the six weekly sessions, with no obligation to attend. The program was designed based on the tenets of a peer support group and implemented by video conferencing. Participants completed a demographic questionnaire and answered open-ended questions after the six-session HHWI ended. Results Of the 40 survey respondents, 30% reported feeling stressed and 40% felt isolated at the early declaration of the pandemic. Regarding the HHWI, 90% of participants had no expectations from the HHWI, but 90% reported that their favorite part of the initiative was the feeling of togetherness. Most participants (95%) requested a continuation of the HHWI, even if not by a video-conferencing platform, and 90% reported feeling sad after the HHWI ended. Conclusion The emergency department HHWI was a welcome opportunity for employees to combat stress and anxiety brought on by the COVID-19 pandemic and social distancing. The initiative fostered team building, comradery, group advocacy, stress relief, and cheerfulness. The initiative was so greatly welcomed as a tool for wellness that almost all participants recommended that the HHWI should be available, not just in times of hardship, but year-round. The HHWI has provided a new approach to promote wellness in emergency care providers using a peer support group.

Advances on microfluidic paper-based electroanalytical devices.

Since the inception of the first electrochemical devices on paper substrates, many different reports of microfluidic paper-based electroanalytical devices (µPEDs), innovative hydrophobic barriers and electrode fabrication processes have allowed the incorporation of diverse materials, resulting in different applications and a boost in performance. These advancements have led to the creation of paper-based devices with comparable performance to many standard conventional devices, with the added benefits of pumpless fluidic transport, component separation and reagent storage that can be exploited to automate and handle sample preprocessing. Herein, we review µPEDs, summarize the characteristics and functionalities of µPEDs, such as separation, fluid flow control and storage, and outline the conventional and emerging fabrication and modification approaches for µPEDs. We also examine the recent application of µPEDs in biomedicine, the environment, and food and water safety, as well as some limitations and challenges that must be addressed.

Not Just a Pain: A Medical Simulation Case About Biased Communication and Osteomyelitis in Pediatric Sickle Cell Anemia.

Introduction: Biases in communication can be harmful to patient perceptions of care and the medical team's decision-making. Optimal communication must be taught and practiced similarly to the optimal management of the complex medical conditions associated with sickle cell disease (SCD). This simulation is designed to teach about biases, optimizing communication to and about a patient with SCD, and appropriately diagnosing and managing pediatric osteomyelitis as a complication of SCD. Methods: We designed and implemented a simulation case targeting emergency medicine residents and fellows to raise awareness about biases associated with SCD care and the complication of osteomyelitis in children with SCD. The case was delivered as a scheduled educational activity. Guided debriefing about optimizing care and communication for this patient population followed the simulation. We measured outcomes based on facilitator field notes and participant evaluations (Likert-scale and open-response questions). Results: Forty learners of varying medical practice proficiencies, societal experiences, and demographics participated, with 30 completing the postsimulation feedback survey. A majority (97%) of participants indicated that the experience was useful and would improve their clinical performance. Participants learned from each other's language and communication styles and reflected on their own communication. Discussion: Overall, participants found the simulation very useful as a review of the medical diagnosis and management of osteomyelitis in pediatric SCD. Moreover, they were very engaged and interested in the opportunity to learn about communication biases, particularly as these relate to SCD, to optimize their patient care.

Sustaining Area Agency on Aging Services During a Pandemic: Innovation Through Community-Based Partnerships.

BACKGROUND AND OBJECTIVES: Area Agencies on Aging (AAAs) have funded, coordinated, and provided services since the 1960s, evolving in response to changes in policy, funding, and the political arena. Many of their usual service delivery programs and processes were severely disrupted with the onset of the coronavirus disease 2019 pandemic. Increasing evidence suggests the importance of partnerships in AAA's capacity to adapt services; however, specific examples of adaptations have been limited. We sought to understand how partnerships may have supported adaptation during the pandemic, from the perspectives of both AAAs and their partners. RESEARCH DESIGN AND METHODS: We conducted a secondary analysis of qualitative data from an explanatory sequential mixed-methods parent study. Data were collected from 12 AAAs diverse in terms of geographic region, governance structure and size, as well as a range of partner organizations. We completed 105 in-depth interviews from July 2020 to April 2021. A 5-member multidisciplinary team coded the data using a constant comparative method of analysis, supported by ATLAS.ti Scientific Software. RESULTS: AAAs and their partners described strategies and provided examples of ways to rapidly transform service delivery including reducing isolation, alleviating food insecurity, adapting program design and delivery, and leveraging partnerships and repurposing resources. DISCUSSION AND IMPLICATIONS: AAAs and partner organizations are uniquely positioned to innovate during times of disruption. Findings may enhance AAA and partner portfolios of evidence-based and evidence-supported programs.

Peripartum Cardiomyopathy.

Audience: This simulation is appropriate for emergency medicine (EM) residents of all levels. Introduction: Peripartum cardiomyopathy (PPCM) is a rare, idiopathic condition that occurs in the mother around the time of childbirth. Heart failure with reduced ejection fraction and/or reduced systolic function diagnosed in patients during the last month of pregnancy or up to five months following delivery defines PCCM.1 Another broader definition from the European Society of Cardiology defines PPCM as heart failure that occurs "towards the end of pregnancy or in the months following delivery, where no other cause of heart failure is found."2 Though PPCM occurs worldwide, most data is extracted from the United States (incidence 1:900 to 1:4000 live births), Nigeria, Haiti, and South Africa.3,4Risk factors for PPCM include pre-eclampsia, multiparity, and advanced maternal age. Unfortunately, the complete pathophysiology of PPCM remains unclear. However, it is important for emergency physicians to be aware of this rare diagnosis because though 50-80% of women with PPCM may eventually recover normal left ventricle systolic function,5 positive outcomes depend on timely recognition of PPCM as a disease and the appropriate management of heart failure. Symptomatic PPCM is an emergent condition that requires an attentive and knowledgeable emergency medicine physician for rapid recognition and treatment. A simulation of this rare condition can give residents the experience of identifying and managing this disease that they might not otherwise see personally during their training. Educational Objectives: By the end of this simulation session, learners will be able to: 1) initiate a workup of a pregnant patient who presents with syncope, 2) accurately diagnose peripartum cardiomyopathy, 3) demonstrate care of a gravid patient in respiratory distress due to peripartum cardiomyopathy, 4) appropriately manage cardiogenic shock due to peripartum cardiomyopathy. Educational Methods: This simulation was conducted as a high-fidelity medical simulation case followed by a debriefing. It could potentially be adapted for use as a low-fidelity case or an oral boards exam case. Research Methods: The educational content and clinical applicability of this simulation was evaluated by oral and written feedback from participant groups at a large three-year emergency medicine residency training program. Each participant completed the case and the facilitated debriefing afterwards. Case facilitators also provided their personal observations on the implementation of the simulation. Results: The participants gave the simulation positive feedback (n=18). Seventeen EM residents and one pediatric emergency medicine (PEM) fellow participated in the feedback survey. Learners overall agreed (18.75%) or strongly agreed (81.25%) that participating in this simulation would improve their performance in a live clinical setting. Discussion: Peripartum cardiomyopathy is a low frequency, high acuity illness that requires a synthesis of the learner's knowledge of complex physiology, navigation of logistical and systems-based challenges, and advanced communication and leadership skills to ensure the best possible patient outcome. All EM physicians will be expected to expertly manage this illness after completion of an EM training program, yet not every EM resident will encounter this type of patient during training. Supplementing the EM resident's standard training with this simulation experience provides a psychologically and educationally safe space to learn and possibly make mistakes without causing patient harm. Practically all residents were able to correctly diagnose the patient with a cardiomyopathy even if they were not familiar with the diagnosis of "peripartum cardiomyopathy." The residents particularly enjoyed the case to explore concepts of benefits and risks of medical therapeutics (ie, positive pressure ventilation, vasopressors/inotropes) and safe practice for the gravid patient. This case and the associated high yield debriefing session were effective teaching tools for emergency medicine residents about PPCM. Topics: Medical simulation, peripartum cardiomyopathy, pregnancy, respiratory failure, cardiogenic shock, emergent cesarian section.

Environmental contamination of ready meals by polychlorinated biphenyls (PCBs).

The level of polychlorinated biphenyls (PCBs) contamination in ready meals was investigated to determine exposure compared to other foodstuffs. Chilled ready meals from nine categories (ambient, Chinese, Indian, Traditional UK, Italian, American Tex-Mex, Vegetarian and Organic), and three samples within each category were Soxhlet extracted in triplicate with hexane for 24 h, followed by a clean-up on deactivated silica gel. The cleaned extracts were concentrated to 1 ml under N(2) gas and analyzed on gas chromatography mass spectrometry (GC-MS) for 7 target PCBs (congeners 28, 52, 101, 118, 153, 138, and 180). Individual congener concentrations ranged from non-detectable to 0.40 ng g(-1) (wet weight). The cumulative concentration of all congeners (ΣPCBs) ranged between 0.20 and 1.00 ng g(-1) (wet weight). These values translate into exposure levels of less than 1 µg kg(-1)day(-1) for reference men and women of 70 and 57 kg, respectively. This preliminary study demonstrates that ready meals, like many other foods, are contaminated by PCBs and may represent an important route of human exposure given contemporary changes in consumer food choice. Even though low levels of contamination were observed, long-term exposure for population groups consuming a high volume of ready meals may have cause for concern regarding chronic health risks.

Recurrent Infantile Hypertrophic Pyloric Stenosis in the Emergency Department: A Case Report.

INTRODUCTION: Infantile hypertrophic pyloric stenosis (IHPS) is a common cause of infant vomiting. Emergency department (ED) diagnosis is usually made by pyloric ultrasound and treated by pyloromyotomy. CASE REPORT: An eight-week-old boy with a history of IHPS about six weeks status post pyloromyotomy presented to the ED with vomiting and failure to thrive, and a critically narrowed pylorus was identified by ultrasound. An upper gastrointestinal series confirmed recurrent pyloric stenosis, necessitating another pyloromyotomy. CONCLUSION: Prolonged vomiting after pyloromyotomy should be concerning for recurrent IHPS. Upper gastrointestinal series should augment ultrasound to diagnose recurrent IHPS and determine whether a second pyloromyotomy is warranted.