Field evaluation of a point-of-care triage test for active tuberculosis (TriageTB)

BACKGROUND

To improve tuberculosis (TB) diagnosis, the World Health Organisation (WHO) has called for a non-sputum based triage test to focus TB testing on people with a high likelihood of having active pulmonary tuberculosis (TB). Various host or pathogen biomarker-based testing devices are in design stage and require validity assessment. Host biomarkers have shown promise to accurately rule out active TB, but further research is required to determine generalisability. The TriageTB diagnostic test study aims to assess the accuracy of diagnostic test candidates, as well as field-test, finalise the design and biomarker signature, and validate a point-of-care multi-biomarker test (MBT).

METHODS

This observational diagnostic study will evaluate sensitivity and specificity of biomarker-based diagnostic candidates including the MBT and Xpert® TB Fingerstick cartridge compared with a gold-standard composite TB outcome classification defined by symptoms, sputum GeneXpert® Ultra, smear and culture, radiological features, response to TB therapy and presence of an alternative diagnosis. The study will be conducted in research sites in South Africa, Uganda, The Gambia and Vietnam which all have high TB prevalence. The two-phase design allows for finalisation of the MBT in Phase 1 in which candidate host proteins will be evaluated on stored serum from Asia, South Africa and South America and on fingerstick blood from 50 newly recruited participants per site. The MBT test will then be locked down and validated in Phase 2 on 250 participants per site.

DISCUSSION

By targeting confirmatory TB testing to those with a positive triage test, 75% of negative GXPU may be avoided, thereby reducing diagnostic costs and patient losses during the care cascade. This study builds on previous biomarker research and aims to identify a point-of-care test meeting or exceeding the minimum World Health Organisation target product profile of a 90% sensitivity and 70% specificity. Streamlining TB testing by identifying individuals with a high likelihood of TB should improve TB resources use and, in so doing, improve TB care.

TRIAL REGISTRATION

NCT04232618 (clinicaltrials.gov) Date of registration: 16 January 2020.

Plotter Cut Stencil Masks for the Deposition of Organic and Inorganic Materials and a New Rapid, Cost Effective Technique for Antimicrobial Evaluations

Plotter cutters in stencil mask prototyping are underutilized but have several advantages over traditional MEMS techniques. In this paper we investigate the use of a conventional plotter cutter as a highly effective benchtop tool for the rapid prototyping of stencil masks in the sub-250 μm range and characterize patterned layers of organic/inorganic materials. Furthermore, we show a new diagnostic monitoring application for use in healthcare, and a potential replacement of the Standard Kirby-Bauer Diffusion Antibiotic Resistance tests was developed and tested on both Escherichia coli and Xanthomonas alfalfae as pathogens with Oxytetracycline, Streptomycin and Kanamycin. We show that the reduction in area required for the minimum inhibitory concentration tests; allow for three times the number of tests to be performed within the same nutrient agar Petri dish, demonstrated both theoretically and experimentally resulting in correlations of R ≈ 0.96 and 0.985, respectively for both pathogens.

Laser induced plant leaf extract mediated synthesis of CuO nanoparticles and its photocatalytic activity

Metal nanoparticles furnished by the green synthesis approach have exhibited fascinating attributes owing to their biocompatibility with biomolecules, and their rapid environmentally friendly synthesis. On copper oxide (CuO) nanoparticles, a laser induced bio reduction work has been accomplish using Centella asiatica aqueous extract at room temperature is the pioneer in the field. This synthesis technique is easy, fruitful, eco-friendly, and counterfeit for the size-tunable synthesis of diverse shapes of stable copper nanoparticles. UV-visible spectroscopy, Field Emission Scanning Electron Microscopy (FESEM), Fourier Transform Infrared Spectroscopy (FTIR), Energy - Dispersive X-ray Spectroscopy (EDX), X-ray diffraction (XRD) and photodegradation study have astounding properties of regulating the formation, crystalline nature, and morphology of an integrated specimen. Moreover, the obtained copper oxide nanoparticle has the tendency to decrease the absorbance maximum value of methylene blue because of the catalytic activity posed by these nanoparticles on the reduction of methylene blue by Centella asiatica. It has been studied and confirmed by UV-visible spectrophotometer, and it has been recognised as an electron relay effect.

3D Continuously Porous Graphene for Energy Applications

Constructing bulk graphene materials with well-reserved 2D properties is essential for device and engineering applications of atomically thick graphene. In this article, the recent progress in the fabrications and applications of sterically continuous porous graphene with designable microstructures, chemistries, and properties for energy storage and conversion are reviewed. Both template-based and template-free methods have been developed to synthesize the 3D continuously porous graphene, which typically has the microstructure reminiscent of pseudo-periodic minimal surfaces. The 3D graphene can well preserve the properties of 2D graphene of being highly conductive, surface abundant, and mechanically robust, together with unique 2D electronic behaviors. Additionally, the bicontinuous porosity and large curvature offer new functionalities, such as rapid mass transport, ample open space, mechanical flexibility, and tunable electric/thermal conductivity. Particularly, the 3D curvature provides a new degree of freedom for tailoring the catalysis and transport properties of graphene. The 3D graphene with those extraordinary properties has shown great promises for a wide range of applications, especially for energy conversion and storage. This article overviews the recent advances made in addressing the challenges of developing 3D continuously porous graphene, the benefits and opportunities of the new materials for energy-related applications, and the remaining challenges that warrant future study.

Twisting of 2D Kagomé Sheets in Layered Intermetallics

Chemical bonding in 2D layered materials and van der Waals solids is central to understanding and harnessing their unique electronic, magnetic, optical, thermal, and superconducting properties. Here, we report the discovery of spontaneous, bidirectional, bilayer twisting (twist angle ∼4.5°) in the metallic kagomé MgCo₆Ge₆ at T = 100(2) K via X-ray diffraction measurements, enabled by the preparation of single crystals by the Laser Bridgman method. Despite the appearance of static twisting on cooling from T ∼300 to 100 K, no evidence for a phase transition was found in physical property measurements. Combined with the presence of an Einstein phonon mode contribution in the specific heat, this implies that the twisting exists at all temperatures but is thermally fluctuating at room temperature. Crystal Orbital Hamilton Population analysis demonstrates that the cooperative twisting between layers stabilizes the Co-kagomé network when coupled to strongly bonded and rigid (Ge₂) dimers that connect adjacent layers. Further modeling of the displacive disorder in the crystal structure shows the presence of a second, Mg-deficient, stacking sequence. This alternative stacking sequence also exhibits interlayer twisting, but with a different pattern, consistent with the change in electron count due to the removal of Mg. Magnetization, resistivity, and low-temperature specific heat measurements are all consistent with a Pauli paramagnetic, strongly correlated metal. Our results provide crucial insight into how chemical concepts lead to interesting electronic structures and behaviors in layered materials.

Erratum: Azimuthal Anisotropy of K_{S}^{0} and Λ+Λ[over ¯] Production at Midrapidity from Au+Au Collisions at sqrt[s]_{NN}=130 GeV [Phys. Rev. Lett. 89, 132301 (2002)]

This corrects the article DOI: 10.1103/PhysRevLett.89.132301.

Polyaza functionalized graphene oxide nanomaterial based sensor for Escherichia coli detection in water matrices

Water quality is widely discussed owing to its significance in public health due to the inability to access clean water. Waterborne diseases account for the presence of pathogens like Escherichia coli (E. coli) in drinking water in the environmental community. Owing to the rapid increase of such bacterial microorganisms, a cost-effective sensor setup has been developed. Herein, we demonstrate the amine-functionalized graphene oxide (fGO) based 2D nanomaterial used to graft E. coli on its surface. The comparative analysis of the deposition of nanosheets on the glass substrate and PDMS was executed. The impedance variations of GO-based nanosensor at various concentrations of E. coli were performed and their potential difference was recorded. It was observed that the impedance changes inversely with the bacterial concentrations and was fed to the Arduino microcontroller. The experimental setup was standardized for the range of 0.01 Hz to 100 kHz. The obtained analog data was programmed with a microcontroller and the bacterial concentration in colony-forming units was displayed. The real-time analysis showsthe low-level detection of E. coli in aquatic environments. Experiments were conducted using the developed nanosensor to test the efficiency in complex water matrices and whose behavior changes with various physical, chemical, and environmental factors.

Effect of Local Atomic Structure on Sodium Ion Storage in Hard Amorphous Carbon

The fundamental understanding of sodium storage mechanisms in amorphous carbon is essential to develop high-performance anode materials for sodium-ion batteries. However, the intrinsic relation between the structure of amorphous carbon and Na⁺ storage remains to be debated due to the difficulty in controlling and characterizing the local atomic configurations of amorphous carbon. Here we report quantitative measurements of Na⁺ storage in a low-temperature dealloyed hard carbon with a tunable local structure from completely disordered micropores to gradually increased graphitic order domains. The structure-capacity-potential correlation not only verifies the disputing "adsorption-intercalation" mechanisms, i.e., Na⁺ intercalation into local graphitic domains for the low-voltage plateaus and adsorption in fully disordered carbon for the sloping voltage profiles, but also unveils a new mechanism of Na⁺ adsorption on defective sites of graphitic carbon in the medium-potential sloping region. The quantitative investigations provide essential insights into the reaction mechanisms of Na⁺ with amorphous carbon for designing advanced sodium-ion battery anodes.

Erratum: Azimuthal Anisotropy at the Relativistic Heavy Ion Collider: The First and Fourth Harmonics [Phys. Rev. Lett. 92, 062301 (2004)]

This corrects the article DOI: 10.1103/PhysRevLett.92.062301.

Graphene-coated nanoporous nickel towards a metal-catalyzed oxygen evolution reaction

Developing highly active electrocatalysts with low costs and long durability for oxygen evolution reactions (OERs) is crucial towards the practical implementations of electrocatalytic water-splitting and rechargeable metal-air batteries. Anodized nanostructured 3d transition metals and alloys with the formation of OER-active oxides/hydroxides are known to have high catalytic activity towards OERs but suffer from poor electrical conductivity and electrochemical stability in harsh oxidation environments. Here we report that high OER activity can be achieved from the metallic state of Ni which is passivated by atomically thick graphene in a three-dimensional nanoporous architecture. As a free-standing catalytic anode, the non-oxide transition metal catalyst shows a low OER overpotential, high OER current density and long cycling lifetime in alkaline solutions, benefiting from the high electrical conductivity and low impedance resistance for charge transfer and transport. This study may pave a new way to develop high efficiency transition metal OER catalysts for a wide range of applications in renewable energy.

Atomic Ni and Cu co-anchored 3D nanoporous graphene as an efficient oxygen reduction electrocatalyst for zinc-air batteries

Highly active, cost-effective and durable electrocatalysts for the oxygen reduction reaction (ORR) are critically important for renewable energy conversion and storage. Here we report a 3D bicontinuous nitrogen doped nanoporous graphene electrocatalyst co-anchoring with atomically dispersed nickel and copper atoms ((Ni,Cu)-NG) as a highly active single-atom ORR catalyst, fabricated by the combination of chemical vapor deposition and high temperature gas transportation. The resultant (Ni,Cu)-NG exhibits an exceptional ORR activity in alkaline electrolytes, comparable to the Pt-based benchmarks, from the synergistic effect of the CuNx and NiNx complexes. Endowed with high catalytic activity and outstanding durability under harsh electrochemical environments, rechargeable zinc-air batteries using (Ni,Cu)-NG as the cathodes show excellent energy efficiency (voltage gap of 0.74 V), large power density (150.6 mW cm-2 at 250 mA cm-2) and high cycling stability (>500 discharge-charge cycles at 10 mA cm-2). This study may pave an efficient avenue for designing highly durable single-atom ORR catalysts for metal-air batteries.

Racial Implicit Associations in Psychiatric Diagnosis, Treatment, and Compliance Expectations

OBJECTIVE

Racial and ethnic disparities are well documented in psychiatry, yet suboptimal understanding of underlying mechanisms of these disparities undermines diversity, inclusion, and education efforts. Prior research suggests that implicit associations can affect human behavior, which may ultimately influence healthcare disparities. This study investigated whether racial implicit associations exist among medical students and psychiatric physicians and whether race/ethnicity, training level, age, and gender predicted racial implicit associations.

METHODS

Participants completed online demographic questions and 3 race Implicit Association Tests (IATs) related to psychiatric diagnosis (psychosis vs. mood disorders), patient compliance (compliance vs. non-compliance), and psychiatric medications (antipsychotics vs. antidepressants). Linear and logistic regression models were used to identify demographic predictors of racial implicit associations.

RESULTS

The authors analyzed data from 294 medical students and psychiatric physicians. Participants were more likely to pair faces of Black individuals with words related to psychotic disorders (as opposed to mood disorders), non-compliance (as opposed to compliance), and antipsychotic medications (as opposed to antidepressant medications). Among participants, self-reported White race and higher level of training were the strongest predictors of associating faces of Black individuals with psychotic disorders, even after adjusting for participant's age.

CONCLUSIONS

Racial implicit associations were measurable among medical students and psychiatric physicians. Future research should examine (1) the relationship between implicit associations and clinician behavior and (2) the ability of interventions to reduce racial implicit associations in mental healthcare.

Dirac Fermion Kinetics in 3D Curved Graphene

3D integration of graphene has attracted attention for realizing carbon-based electronic devices. While the 3D integration can amplify various excellent properties of graphene, the influence of 3D curved surfaces on the fundamental physical properties of graphene has not been clarified. The electronic properties of 3D nanoporous graphene with a curvature radius down to 25-50 nm are systematically investigated and the ambipolar electronic states of Dirac fermions are essentially preserved in the 3D graphene nanoarchitectures, while the 3D curvature can effectively suppress the slope of the linear density of states of Dirac fermion near the Fermi level are demonstrated. Importantly, the 3D curvature can be utilized to tune the back-scattering-suppressed electrical transport of Dirac fermions and enhance both electron localization and electron-electron interaction. As a result, nanoscale curvature provides a new degree of freedom to manipulate 3D graphene electrical properties, which may pave a new way to design new 3D graphene devices with preserved 2D electronic properties and novel functionalities.

What Does Immunology Have to Do With Normal Brain Development and the Pathophysiology Underlying Tourette Syndrome and Related Neuropsychiatric Disorders?

Objective: The goal of this article is to review the past decade's literature and provide a critical commentary on the involvement of immunological mechanisms in normal brain development, as well as its role in the pathophysiology of Tourette syndrome, other Chronic tic disorders (CTD), and related neuropsychiatric disorders including Obsessive-compulsive disorder (OCD) and Attention deficit hyperactivity disorder (ADHD). Methods: We conducted a literature search using the Medline/PubMed and EMBASE electronic databases to locate relevant articles and abstracts published between 2009 and 2020, using a comprehensive list of search terms related to immune mechanisms and the diseases of interest, including both clinical and animal model studies. Results: The cellular and molecular processes that constitute our "immune system" are crucial to normal brain development and the formation and maintenance of neural circuits. It is also increasingly evident that innate and adaptive systemic immune pathways, as well as neuroinflammatory mechanisms, play an important role in the pathobiology of at least a subset of individuals with Tourette syndrome and related neuropsychiatric disorders In the conceptual framework of the holobiont theory, emerging evidence points also to the importance of the "microbiota-gut-brain axis" in the pathobiology of these neurodevelopmental disorders. Conclusions: Neural development is an enormously complex and dynamic process. Immunological pathways are implicated in several early neurodevelopmental processes including the formation and refinement of neural circuits. Hyper-reactivity of systemic immune pathways and neuroinflammation may contribute to the natural fluctuations of the core behavioral features of CTD, OCD, and ADHD. There is still limited knowledge of the efficacy of direct and indirect (i.e., through environmental modifications) immune-modulatory interventions in the treatment of these disorders. Future research also needs to focus on the key molecular pathways through which dysbiosis of different tissue microbiota influence neuroimmune interactions in these disorders, and how microbiota modification could modify their natural history. It is also possible that valid biomarkers will emerge that will guide a more personalized approach to the treatment of these disorders.

Inlaid ReS2 Quantum Dots in Monolayer MoS2

Two-dimensional (2D) transition-metal dichalcogenides (TMDs) are prospective materials for quantum devices owing to their inherent 2D confinements. They also provide a platform to realize even lower-dimensional in-plane electron confinement, for example, 0D quantum dots, for exotic physical properties. However, fabrication of such laterally confined monolayer (1L) nanostructure in 1L crystals remains challenging. Here we report the realization of 1L ReS₂ quantum dots epitaxially inlaid in 1L MoS₂ by a two-step chemical vapor deposition method combining with plasma treatment. The lateral lattice mismatch between ReS₂ and MoS₂ leads to size-dependent crystal structure evolution and in-plane straining of the 1L ReS₂ quantum dots. Optical spectroscopies reveal the abnormal charge transfer between the 1L ReS₂ quantum dots and the MoS₂ matrix, resulting from electron trapping in the 1L ReS₂ quantum dots. This study may shed light on the development of in-plane quantum-confined devices in 2D materials for potential applications in quantum information.

XRootD Third Party Copy for the WLCG and HLLHC

A Third Party Copy (TPC) mechanism has existed in the pure XRootD storage environment for many years. However, using the XRootD TPC in the WLCG environment presents additional challenges due to the diversity of the storage systems involved such as EOS, dCache, DPM and ECHO, requiring that we carefully navigate the unique constraints imposed by these storage systems and their site-specific environments through customized configuration and software development. To support multitenant setups seen at many WLCG sites, X509 based authentication and authorization in XRootD was significantly improved to meet both security and functionality requirements. This paper presents architecture of the pull based TPC with optional X509 credential delegation, and how it is implemented in native XRootD and dCache. The paper discusses technical requirements, challenges, design choices and implementation details in the WLCG storage systems, as well as in FTS/gfal2. It also outlines XRootD’s plan to support newer TPC and security models such as token based authorization.

Measuring oral health impact among care home residents in Wales

Objective

To explore inequalities in oral health impact among care home residents using OHIP-14 and ADHS criteria.

Basic research design

Cross-sectional survey with structured interview and clinical examination using 2009 ADHS criteria including OHIP-14. Comparisons were made between groups of residents and with findings from the ADHS 2009.

Participants

Care homes and residents were randomly selected. Those without capacity and non-English/Welsh speakers were excluded. 447 residents answered all OHIP-14 questions and had full oral examination.

Main Outcome Measure

OHIP-14.

Results

Reporting of OHIP problems was more common among care home residents compared with older people examined in the ADHS 2009 (50% vs 40%). There was no difference in the mean number of impacts between residents who were: dentate/edentate; denture wearing/non-denture wearing; with/without caries. Residents reporting 'problems and pain in your mouth at the moment', or 'occasional or more frequent dry mouth', more often experienced OHIP-14 impacts.

Conclusion

Compared with peers living in the community, both dentate and edentate care home residents are more likely to live with one or more impacts. Two simple questions related to 'Any problems and pain in your mouth?' and 'Do you have frequent dry mouth?' may help to target care home residents more likely to experience oral health impacts.

The challenges of implementing an integrated One Health surveillance system in Australia

As 75 per cent of emerging infectious diseases are of animal origin, a One Health approach that integrates the health of humans, animals and the environment could provide an earlier opportunity for zoonotic disease detection and prevention. In Australia, human, animal and ecological health are managed by separate sectors with limited communication. This study aims to explore how professionals in these fields perceive a One Health approach to zoonotic disease surveillance, aiming to identify the challenges to the implementation of an integrated system in Australia. Using a qualitative research method, ten semistructured interviews were conducted with academic experts to gain insight into the possibility of developing an integrated surveillance system in Australia. A thematic analysis of the data was undertaken. Findings showed the absence of a clear definition and subsequent vision for the future of One Health act as a barrier to interdisciplinary collaboration, and that siloed approaches by different sectors restrict the ability for professionals to work collaboratively across disciplines. An understanding of disease transmission was considered by participants to be a necessary requirement for a successful One Health approach. Finally, participants considered political will an essential requirement for the integration of surveillance systems. This study demonstrates that for a One Health approach to be implemented in an Australian setting, those working in the fields of human, animal and ecological health must agree on several aspects. The establishment of a formal governance body with representatives from each sector could assist in overcoming long‐standing barriers of privacy and distrust. Further, developing interdisciplinary training in One Health concepts for medical, environmental and veterinary students may encourage cross‐disciplinary collaboration. Finally, demonstrating to policymakers the economic benefit of improved and timely detection of zoonoses may help in facilitating a structured One Health approach to disease surveillance in Australia.

The Heartrate Reaction to Acute Stress in Horned Passalus Beetles (Odontotaenius disjunctus) is Negatively Affected by a Naturally-Occurring Nematode Parasite

There are many events in the lives of insects where rapid, effective stress reactions are needed, including fighting conspecifics to defend territories, evading predators, and responding to wounds. A key element of the stress reaction is elevation of heartrate (HR), for enhancing distribution of blood (hemolymph) to body compartments. We conducted two experiments designed to improve understanding of the insect stress reaction and how it is influenced by parasitism in a common beetle species (Odontotaenius disjunctus). By non-destructively observing heartbeat frequency before, during and after applying a stressor (physical restraint) for 10 min, we sought to determine: (1) the exact timing of the cardiac stress reaction; (2) the magnitude of heartrate elevation during stress; and (3) if the physiological response is affected by a naturally-occurring nematode parasite, Chondronema passali. Restraint caused a dramatic increase in heartrate, though not immediately; maximum HR was reached after approximately 8 min. Average heartrate went from 65.5 beats/min to a maximum of 81.5 (24.5% increase) in adults raised in the lab (n = 19). Using wild-caught adults (n = 77), average heartrates went from 54.9 beats/min to 74.2 (35.5% increase). When restraint was removed, HR declined after ~5 min, and reached baseline 50 min later. The nematode parasite did not affect baseline heartrates in either experiment, but in one, it retarded the heartrate elevation during stress, and in the other, it reduced the overall magnitude of the elevation. While we acknowledge that our results are based on comparisons of beetles with naturally-occurring parasite infections, these results indicate this parasite causes a modest reduction in host cardiac output during acute stress conditions.

Achievement Motivation and Indirect Testing for Manual Skills

Time estimation and need for achievement were used to predict typing skills. Unlike a previous study time estimation did not predict performance but there was a significant relationship between achievement motivation for adolescents and learning to type. Some reasons for these results were suggested.

Undergraduate students' experiences of outreach placements in dental secondary care settings

INTRODUCTION

Outreach teaching is delivered as part of the undergraduate curricula of many dental schools. Evaluations of outreach in primary care settings have found learning opportunities beyond those available in the dental school setting, but less is known about secondary care placements. The aim of this evaluation was to assess dental students' experiences of an undergraduate outreach placement in secondary care.

MATERIALS AND METHODS

Questionnaire survey based on a single cohort of final-year undergraduate dental students at Cardiff University who had completed a 1-week outreach secondment to a District General Hospital.

RESULTS

Fifty-five of the 57 eligible students completed the questionnaire. Outreach placements in secondary care were experienced to provide positive additional educational benefit and were considered to be worthwhile by many (but not all) students. Clinical opportunities and staff teaching varied by site.

DISCUSSION

In the current programme, the variability of student experience during secondments to secondary care means that some students report more benefit than others. However, even apparently negative experiences, such as cancelled operating lists, can contribute to the overall outcome in that they accurately reflect the reality of hospital practice.

CONCLUSION

Careful management of secondary care undergraduate secondments is needed to ensure worthwhile learning experiences.

Capturing dynamics with Eiger, a fast-framing X-ray detector

Eiger is the next-generation single-photon-counting pixel detector following the widely used Pilatus detector. Its smaller pixel size of 75 µm × 75 µm, higher frame rate of up to 22 kHz, and practically zero dead-time (~4 µs) between exposures will further various measurement methods at synchrotron sources. In this article Eiger's suitability for X-ray photon correlation spectroscopy (XPCS) is demonstrated. By exploiting its high frame rate, complementary small-angle X-ray scattering (SAXS) and XPCS data are collected in parallel to determine both the structure factor and collective diffusion coefficient of a nano-colloid suspension. For the first time, correlation times on the submillisecond time scale are accessible with a large-area pixel detector.

Pressure and oxygen debt on bypass - potential quality markers of perfusion?

No markers of quality of perfusion pressure and oxygen delivery during cardiopulmonary bypass (CPB), to complement rewarming rate, maximum temperature on rewarming, lowest haematocrit, and blood glucose, exist. Using the electronic acquisition of blood pressure on bypass (JOCAP system), the percentage of time perfusion pressure was below 30, 40, 50, 60 and 70 mmHg, average deviance, confidence interval, median, mode, standard deviation, variance, and average, maximum and cumulative oxygen debt were calculated. Numerous different readouts of achievement of maintenance of constant pressure on bypass and oxygen debt are now easily achievable with perfusion electronic data management systems. Mean, median, and mode offer poor discrimination of pressure control during CPB. Percentage of time perfusion pressure was below 30, 40, 50, 60 and 70 mmHg, average deviance, confidence interval, and standard deviation all have discriminatory power, but need clinical correlation for their significance. A composite score involving non-pressure readouts (e.g. oxygen delivery, arterial and venous saturations, and flow rates) may need to be integrated into any perfusion quality marker. Assessment of adequacy of constant perfusion pressure and oxygen delivery may allow the scientific evaluation of pressure and oxygen delivery on bypass for patients to be compared accurately. Currently, in studies involving CPB, blood pressure targets are stated with no quantitative assessment of adequacy of achievement of these targets. Electronic data monitoring during cardiopulmonary bypass, when correlated with clinical outcome, may help to provide a marker of quality of perfusion pressure during CPB and may, indeed, allow patient-specific perfusion pressure strategies to be developed.

Micrometre resolution of a charge integrating microstrip detector with single photon sensitivity

A synchrotron beam has been used to test the spatial resolution of a single-photon-resolving integrating readout-chip coupled to a 320 µm-thick silicon strip sensor with a dedicated readout system. Charge interpolation methods have yielded a spatial resolution of σ(x) ≃ 1.8 µm for a 20 µm-pitch strip.

A randomised controlled trial of 300 versus 225 IU recombinant FSH for ovarian stimulation in predicted normal responders by antral follicle count

OBJECTIVE

To test the hypothesis that among women predicted to have a normal ovarian response, ovarian stimulation using 300 IU follicle-stimulating hormone (FSH) results in the retrieval of more mature oocytes than 225 IU during in vitro fertilisation (IVF)/intracytoplasmic sperm injection (ICSI) treatment.

DESIGN

Prospective randomised controlled study.

SETTING

University-based assisted conception unit.

POPULATION

A cohort of 131 women predicted to have a normal ovarian response to gonadotrophin stimulation, based on antral follicle count.

METHODS

Subjects undergoing their first cycle of IVF/ICSI were randomised to receive a fixed daily dose of 300 (experimental arm) or 225 IU (control arm) of recombinant FSH (Gonal-F).

MAIN OUTCOME MEASURES

Number of mature oocytes retrieved and live birth rates.

RESULTS

The number (mean +/- standard deviation) of mature oocytes retrieved (8.2 +/- 5.0 versus 9.0 +/- 4.8, for 300 and 225 IU, respectively; P = 0.34) was similar in each group. There were no differences between the 300- and 225 IU arms in live birth rates (31 versus 41%, respectively; P = 0.25), cycle cancellations resulting from insufficient ovarian response (0 versus 6.1%, respectively; P = 0.12), and prevalence of moderate (3.1 versus 3.0, respectively; P = 1.0) and severe (0 versus 1.5%, respectively; P = 1.0) ovarian hyperstimulation syndrome.

CONCLUSIONS

The use of a higher daily dose of 300 IU of recombinant FSH for ovarian stimulation does not improve the number of mature oocytes retrieved, or live birth rates, among women with a predicted normal response during conventional IVF/ICSI.

Endometrial blood flow is impaired in women with polycystic ovarian syndrome who are clinically hyperandrogenic

OBJECTIVES

To quantify endometrial and subendometrial blood flow in Caucasian women with polycystic ovarian syndrome (PCOS) and to determine whether these values differ according to the phenotypic expression of PCOS.

METHODS

Transvaginal pelvic ultrasound was performed on the 3(rd)-5(th) day of the menstrual cycle in 36 women with PCOS and 36 controls to examine the endometrial and subendometrial vascularity. The subendometrial and endometrial blood flow indices (vascularizaton index (VI), flow index (FI) and vascularization flow index (VFI)) were measured using three-dimensional power Doppler angiography. Uterine artery blood flow was assessed through analysis of two-dimensional (2D) pulsed-wave Doppler waveforms. Analysis was performed to compare PCOS with non-PCOS women, and subgroup analysis was performed of the PCOS women categorized according to their phenotypic manifestation.

RESULTS

There were no significant differences in endometrial volume, subendometrial vascularity and uterine artery blood flow between women with PCOS and controls after controlling for body mass index (BMI). On subgroup analysis, compared with anovulatory but clinically normoandrogenic women with polycystic ovaries (PCO) and with controls, women with PCO who were both clinically hyperandrogenic and anovulatory had significantly lower endometrial (VI: 0.57% vs. 1.11% and 0.86%, respectively, both P = 0.01; VFI: 0.14 vs. 0.42 and 0.28, respectively, both P = 0.02) and subendometrial (VI: 1.59% vs. 3.17% and 2.47%, P = 0.01 and 0.02, respectively; VFI: 0.50 vs. 1.67 and 0.96, P = 0.01 and 0.02, respectively) blood flow. Moreover, clinically hyperandrogenic but ovulatory women with PCO also had significantly lower endometrial blood flow (VI: 0.52% vs. 1.11%, P = 0.04) than did anovulatory but clinically normoandrogenic women with PCO. There were no differences in any of the 2D pulsed-wave Doppler measures of blood flow between the subgroups.

CONCLUSIONS

Subendometrial and endometrial blood flow is significantly impaired in women with PCOS who have clinical signs of hyperandrogenism.

Performance of single-photon-counting PILATUS detector modules

PILATUS is a silicon hybrid pixel detector system, operating in single-photon-counting mode, that has been developed at the Paul Scherrer Institut for the needs of macromolecular crystallography at the Swiss Light Source (SLS). A calibrated PILATUS module has been characterized with monochromatic synchrotron radiation. The influence of charge sharing on the count rate and the overall energy resolution of the detector were investigated. The dead-time of the system was determined using the attenuated direct synchrotron beam. A single module detector was also tested in surface diffraction experiments at the SLS, whereby its performance regarding fluorescence suppression and saturation tolerance were evaluated, and have shown to greatly improve the sensitivity, reliability and speed of surface diffraction data acquisition.

The development of an ecological approach to manage the pollution risk from highway runoff

In the UK, the Highways Agency is responsible for operating, maintaining and improving the strategic road network in England. One focus of the Highways Agency's ongoing research into the nature and impact of highway runoff is aimed at ensuring that the Highways Agency will meet the requirements of the EU Water Framework Directive. A research programme, undertaken in partnership with the Environment Agency, is in progress to develop a better understanding of pollutants in highway runoff and their ecological impact. The paper presents the outcome of a study to: (1) monitor pollutants in highway runoff under different climate and traffic conditions; (2) develop standards to assess potential ecological risks from soluble pollutants in highway runoff; and (3) develop a model to predict pollutant concentrations in highway runoff. The model has been embedded in a design tool incorporating risk assessment procedures and receiving water standards for soluble and insoluble pollutants--the latter has been developed elsewhere in another project within the research programme. The design tool will be used to support improved guidance on where, and to what level, treatment of runoff is required for highway designers to manage the risk of ecological impact from highway runoff.

A Geiger-mode avalanche photodiode array for X-ray photon correlation spectroscopy

X-ray photon correlation spectroscopy (XPCS) provides an opportunity to study the dynamics of systems by measuring the temporal fluctuations in a far-field diffraction pattern. A two-dimensional detector system has been developed to investigate fluctuations in the frequency range of several Hz to kHz. The X-ray detector system consists of a thin 100 microm scintillation crystal coupled to a Geiger-mode avalanche photodiode array. In this article the elements of the system are detailed and the detector for XPCS measurements is demonstrated.

SonoAVC: a novel method of automatic volume calculation

OBJECTIVES

To assess the ability of the new software SonoAVC to measure follicular volume and to compare these volume calculations with those made by conventional methods.

METHODS

Three-dimensional ultrasound imaging was used to acquire volumetric data from the ovaries of 51 women undergoing controlled ovarian stimulation as part of in-vitro fertilization treatment. All assessments were performed on the day of oocyte retrieval and the true volume of each follicle was ascertained by manual measurement of the follicular aspirate. SonoAVC was used to automatically measure the volume of follicles and to provide three perpendicular diameters (xyz diameters), which were used to estimate volume using the sphere formula. The sphere formula was also used to estimate the volume from manual measurements of follicle diameter derived from conventional two-dimensional (2D) displays. Virtual Organ Computer-aided AnaLysis (VOCAL) was also used to measure volume, and the validity of each technique was compared using limits of agreement.

RESULTS

Two hundred and twenty-four follicles with a mean follicular volume of 3.7 (range, 0.4-16.2) cm(3) were studied. SonoAVC provided highly accurate automatic follicular volume measurements in all cases. Volume estimations made from the automatic maximal follicular diameter measurements (xyz diameters) were less valid. VOCAL proved highly valid but was less accurate than SonoAVC. Volumes estimated from manually derived follicular diameter measurements were the least accurate.

CONCLUSIONS

SonoAVC provides highly valid, automatic measurements of follicular volume. These measurements are more accurate than volumes estimated from 2D manual measurements, automated measurements of follicular diameter and those calculated using VOCAL.

Coherent diffractive imaging using phase front modifications

We introduce a coherent diffractive imaging technique that utilizes multiple exposures with modifications to the phase profile of the transmitted wave front to compensate for the missing phase information. This is a single spot technique sensitive to both the transmission and phase shift through the sample. Along with the details of the method, we present results from the first proof of principle experiment. The experiment was performed with 6.0 keV x rays, in which an estimated spatial resolution of 200 nm was achieved.

Continuous measurement of dissolved sulfide in sewer systems

Sulfides are particularly problematic in the sewage industry. Hydrogen sulfide causes corrosion of concrete infrastructure, is dangerous at high concentrations and is foul smelling at low concentrations. Despite the importance of sulfide monitoring there is no commercially available system to quantify sulfide in waste water. In this article we report on our use of an in situ spectrometer to quantify bisulfide in waste water and additional analysis with a pH probe to calculate total dissolved sulfide. Our results show it is possible to use existing commercially available and field proven sensors to measure sulfide to mg/l levels continuously with little operator intervention and no sample preparation.

The development of a risk-based approach to managing the ecological impact of pollutants in highway runoff

In the UK, the Highways Agency is responsible for the strategic road network. It is recognised that current design guidance to control pollutants in highway runoff is out of date. A research programme is in progress to develop a better understanding of pollutants in highway runoff and their ecological impact. The paper summarises the outcome of a study to: (1) monitor pollutants in highway runoff under different climate and traffic conditions at 24 sites; (2) develop standards to assess potential ecological risks; and (3) develop a model to predict pollutant concentrations in highway runoff. Data collection and analysis of the resulting data have identified a link between pollutant concentrations and traffic density. A number of pollutants routinely present in highway runoff have been identified as posing the greatest ecological risk. Ecologically based standards for acute impacts have been derived for the soluble form of these pollutants. These standards will be used in conjunction with the model to indicate where runoff treatment may be required to mitigate ecological risk. The model and standards will be used to develop improved design guidance to protect receiving waters from pollutants in highway runoff by identifying where runoff treatment is required, and to what degree.

Eicosapentaenoic acid (EPA, an omega-3 fatty acid from fish oils) for the treatment of cancer cachexia

BACKGROUND

Cancer cachexia is a distressing weight loss syndrome commonly seen in advanced cancer patients. It is associated with reduced quality of life and shorter survival time. Eicosapentaenoic acid (EPA) is a long chain polyunsaturated fatty acid found naturally in some fish which has been used to decrease weight loss, promote weight gain and increase survival times in patients affected with cancer cachexia.

OBJECTIVES

To evaluate the effectiveness and safety of EPA in relieving symptoms associated with the cachexia syndrome in patients with advanced cancer.

SEARCH STRATEGY

Studies were sought through an extensive search of a range of electronic databases. Hand searching was conducted on selected journals and reference lists as well as contact made with investigators, manufacturers and experts. The most recent electronic search was conducted in February 2005.

SELECTION CRITERIA

Studies were included in the review if they assessed oral EPA compared with placebo or control in randomised controlled trials of patients with advanced cancer and either a clinical diagnosis of cachexia or self-reported weight loss of 5% or more.

DATA COLLECTION AND ANALYSIS

Both methodological quality evaluation of potential trials and data extraction were conducted by two independent review authors.

MAIN RESULTS

Five trials (involving 587 patients) met the inclusion criteria. Three trials compared EPA at different doses with placebo with two outcomes, nutritional status and adverse events comparable across two of the three included trials. In addition, two trials compared different doses of EPA with an active matched control. It was possible to compare the outcomes of weight, quality of life and adverse events across these two trials. There were insufficient data to define the optimal dose of EPA.

AUTHORS' CONCLUSIONS

There were insufficient data to establish whether oral EPA was better than placebo. Comparisons of EPA combined with a protein energy supplementation versus a protein energy supplementation (without EPA) in the presence of an appetite stimulant (Megestrol Acetate) provided no evidence that EPA improves symptoms associated with the cachexia syndrome often seen in patients with advanced cancer.

Hard-x-ray lensless imaging of extended objects

We demonstrate a hard-x-ray microscope that does not use a lens and is not limited to a small field of view or an object of finite size. The method does not suffer any of the physical constraints, convergence problems, or defocus ambiguities that often arise in conventional phase-retrieval diffractive imaging techniques. Calculation times are about a thousand times shorter than in current iterative algorithms. We need no a priori knowledge about the object, which can be a transmission function with both modulus and phase components. The technique has revolutionary implications for x-ray imaging of all classes of specimen.