Predictors and Outcomes for COVID-19 Re-Admissions in the Anticipate Cohort.

Aims To describe readmissions of hospitalised patients with COVID-19, define predictors of readmission and explore the long term outcomes using the SF-12 score compared to patients who were not readmitted and those not hospitalised. Methods A single centre retrospective in North Inner-City Dublin. Recruitment was done through a COVID follow up clinic. Predictors of readmission and SF-12 scores at two timepoints post follow up at median 3 months and 12 months. Results Seventy (45%) participants were admitted, with a median age of 49.5 years (IQR 41.3-56.9), 36(51%) of whom were female. Unscheduled readmissions at ≤30 days in COVID-19 patients were 9(12.9%) and length of stay was four days (IQR 2-5). Readmissions were due to ongoing symptoms(n=9(64.3%)) or new complications(n=5(35.7%)). Mechanical ventilation and having symptoms of nausea and vomiting on index admission were predictive of readmission. (p=0.002). SF-12 scores at one year of readmitted patients were not different to patients who were never admitted at median one year follow up, p=.089. Conclusions Most readmissions were of short duration. Early follow up of patients post MV or who had nausea and vomiting on index admission should be prioritised. Wellbeing of readmitted patients was not different to those never hospitalised, at one year.

Angle-dependent strong-field ionization of halomethanes.

We study, experimentally and theoretically, the ionization probability of singly halogenated methane molecules, CH3Cl and CH3Br, in intense linearly polarized 800 nm laser pulses as a function of the angle between the molecular axis and the laser polarization. Experimentally, the molecules are exposed to two laser pulses with a relative time delay. The first, weaker pulse induces a nuclear rotational wave packet within the molecules, which are then ionized by the second, stronger pulse. The angle-dependent ionization yields are extracted from fits of the measured delay-dependent ionization signal to a superposition of moments of the rotational wave packet's angular distribution. Angle-dependent strong-field ionization (SFI) yields are also calculated using time-dependent density functional theory. Good agreement between measurements and theory is obtained. Interestingly, we find a marked difference between the angle-dependence of the ionization yields for these two halomethane species despite the similar structure of their highest occupied molecular orbitals. Calculations reveal that these differences are a result of multichannel (CH3Cl) vs single-channel (CH3Br) ionization and of increased hole localization on Br vs Cl. By adding calculations for CH3F, we can discern clear trends in the ionization dynamics with increasing halogen mass. These results are illustrative, as chemical functionalization and molecular alignment are likely to be important parameters for initiating and controlling charge migration dynamics via SFI.

Probing the interplay between geometric and electronic-structure features via high-harmonic spectroscopy.

We present molecular-frame measurements of the recombination dipole matrix element (RDME) in CO2, N2O, and carbonyl sulfide (OCS) molecules using high-harmonic spectroscopy. Both the amplitudes and phases of the RDMEs exhibit clear imprints of a two-center interference minimum, which moves in energy with the molecular alignment angle relative to the laser polarization. We find that whereas the angle dependence of this minimum is consistent with the molecular geometry in CO2 and N2O, it behaves very differently in OCS; in particular, the phase shift which accompanies the two-center minimum changes sign for different alignment angles. Our results suggest that two interfering structural features contribute to the OCS RDME, namely, (i) the geometrical two-center minimum and (ii) a Cooper-like, electronic-structure minimum associated with the sulfur end of the molecule. We compare our results to ab initio calculations using time-dependent density functional theory and present an empirical model that captures both the two-center and the Cooper-like interferences. We also show that the yield from unaligned samples of two-center molecules is, in general, reduced at high photon energies compared to aligned samples, due to the destructive interference between molecules with different alignments.

Electron and Ion Heating Characteristics during Magnetic Reconnection in the MAST Spherical Tokamak.

Electron and ion heating characteristics during merging reconnection start-up on the MAST spherical tokamak have been revealed in detail using a 130 channel yttrium aluminum garnet (YAG) and a 300 channel Ruby-Thomson scattering system and a new 32 chord ion Doppler tomography diagnostic. Detailed 2D profile measurements of electron and ion temperature together with electron density have been achieved for the first time and it is found that electron temperature forms a highly localized hot spot at the X point and ion temperature globally increases downstream. For the push merging experiment when the guide field is more than 3 times the reconnecting field, a thick layer of a closed flux surface form by the reconnected field sustains the temperature profile for longer than the electron and ion energy relaxation time ~4-10 ms, both characteristic profiles finally forming a triple peak structure at the X point and downstream. An increase in the toroidal guide field results in a more peaked electron temperature profile at the X point, and also produces higher ion temperatures at this point, but the ion temperature profile in the downstream region is unaffected.

Implementation of safe sleep practices in the neonatal intensive care unit.

OBJECTIVE: To increase the percentage of eligible infants engaging in safe sleep practices (SSP) in two level III neonatal intensive care units (NICUs) in the Boston, Massachusetts area. STUDY DESIGN: On the basis of eligibility criteria (⩾34 weeks or ⩾1800 g without acute medical conditions), all infants were eligible for two sleep practices: SSP or NICU therapeutic positioning (NTP) depending on their gestational age, weight, clinical illness and need for therapeutic interventions. Compliance with SSP was defined as: (1) supine positioning, (2) in a flat crib with no incline, (3) without positioning devices and (4) without toys, comforters or fluffy blankets. NTP comprised usual NICU care. Nursing education was comprised of a web-based learning module and in-person teaching sessions with a study team member. Double-sided crib cards (SSP one side and NTP on the other) were attached to the bedside of every infant. Pre- and postintervention audits of all infants were carried out at both study sites. We compared compliance across all time points using generalized estimating equations to account for correlated data (SAS v9.3, Cary, NC, USA). RESULT: Of 755 cases, 395 (52.3%) were assessed to be eligible for SSP. From the pre- to post-intervention period, there was a significant improvement in overall compliance with SSP (25.9 to 79.7%; P-value<0.001). Adherence to each component of SSP also improved significantly following the intervention. CONCLUSION: Safe infant sleep practices can be integrated into the routine care of preterm infants in the NICU. Modeling SSP to families far in advance of hospital discharge may improve adherence to SSP at home and reduce the risk of sleep-related morbidity and mortality in this vulnerable population of infants.

Mature cystic teratoma of both the fallopian tube and contralateral ovary: a case report.

UNLABELLED: Intratubal teratoma is a very rare condition. The authors believe to present the first case of a completely intratubal mature cystic teratoma with a contralateral intraovarian teratoma. Preoperative ultrasound examination allowed the intraoperative diagnosis of this rare condition, hence allowing appropriate surgical management. MATERIALS AND METHODS: A 19-year-old woman presented with a history of pelvic pain and severe dysmenorrhea. Ultrasound examination initially suggested bilateral ovarian dermoids. Upon laparoscopy, the distal left fallopian tube was obstructed and contained an inflammatory mass adhered to the rectosigmoid. The left ovary was entirely normal. A contralateral intraovarian dermoid was also identified. CONCLUSION: Although rare, when an intratubal mass is identified, consideration of intratubal dermoid should be given. Preoperative ultrasound can be of critical importance to the intraoperative diagnosis.

Design of a real-time two-color interferometer for MAST Upgrade.

A single chord two-color CO2/HeNe (10.6/0.633 µm) heterodyne laser interferometer has been designed to measure the line integral electron density along the mid-plane of the MAST Upgrade tokamak, with a typical error of 1 × 10(18) m(-3) (∼2° phase error) at 4 MHz temporal resolution. To ensure this diagnostic system can be restored from any failures without stopping MAST Upgrade operations, it has been located outside of the machine area. The final design and initial testing of this system, including details of the optics, vibration isolation, and a novel phase detection scheme are discussed in this paper.

ER stress in rodent islets of Langerhans is concomitant with obesity and ß-cell compensation but not with ß-cell dysfunction and diabetes.

OBJECTIVE: The objective of this study was to determine whether ER stress correlates with ß-cell dysfunction in obesity-associated diabetes. METHODS: Quantitative RT-PCR and western blot analysis were used to investigate changes in the expression of markers of ER stress, the unfolded protein response (UPR) and ß-cell function in islets isolated from (1) non-diabetic Zucker obese (ZO) and obese female Zucker diabetic fatty (fZDF) rats compared with their lean littermates and from (2) high-fat-diet-fed fZDF rats (HF-fZDF), to induce diabetes, compared with age-matched non-diabetic obese fZDF rats. RESULTS: Markers of an adaptive ER stress/UPR and ß-cell function are elevated in islets isolated from ZO and fZDF rats compared with their lean littermates. In islets isolated from HF-fZDF rats, there was no significant change in the expression of markers of ER stress compared with age matched, obese, non-diabetic fZDF rats. CONCLUSIONS: These results provide evidence that obesity-induced activation of the UPR is an adaptive response for increasing the ER folding capacity to meet the increased demand for insulin. As ER stress is not exacerbated in high-fat-diet-induced diabetes, we suggest that failure of the islet to mount an effective adaptive UPR in response to an additional increase in insulin demand, rather than chronic ER stress, may ultimately lead to ß-cell failure and hence diabetes.

A field programmable gate array unit for the diagnosis and control of neoclassical tearing modes on MAST.

A real-time system has been developed to trigger both the MAST Thomson scattering (TS) system and the plasma control system on the phase and amplitude of neoclassical tearing modes (NTMs), extending the capabilities of the original system. This triggering system determines the phase and amplitude of a given NTM using magnetic coils at different toroidal locations. Real-time processing of the raw magnetic data occurs on a low cost field programmable gate array (FPGA) based unit which permits triggering of the TS lasers on specific amplitudes and phases of NTM evolution. The MAST plasma control system can receive a separate trigger from the FPGA unit that initiates a vertical shift of the MAST magnetic axis. Such shifts have fully removed m∕n = 2∕1 NTMs instabilities on a number of MAST discharges.

Deconvolution of Thomson scattering temperature profiles.

Deconvolution of Thomson scattering (TS) profiles is required when the gradient length of the electron temperature (T(e)) or density (n(e)) are comparable to the instrument function length (Δ(R)). The most correct method for deconvolution to obtain underlying T(e) and n(e) profiles is by consideration of scattered signals. However, deconvolution at the scattered signal level is complex since it requires knowledge of all spectral and absolute calibration data. In this paper a simple technique is presented where only knowledge of the instrument function I(r) and the measured profiles, T(e, observed)(r) and n(e, observed)(r), are required to obtain underlying T(e)(r) and n(e)(r). This method is appropriate for most TS systems and is particularly important where high spatial sampling is obtained relative to Δ(R).

Dual channel planar waveguide surface plasmon resonance biosensor for an aqueous environment.

A theoretical study on a dual channel planar waveguide surface plasmon biosensor is presented in this paper. The proposed device consists of a planar waveguide with two active regions. It has been demonstrated that the proposed waveguide sensor can be configured to operate in either multi analyte or self referencing mode. The channel discriminative property of the device is investigated using an eigenmode solver with perfectly matched layers (PML).

A 130 point Nd:YAG Thomson scattering diagnostic on MAST.

A Thomson scattering diagnostic designed to measure both edge and core physics has been implemented on MAST. The system uses eight Nd:YAG lasers, each with a repetition rate of 30 Hz. The relative and absolute timing of the lasers may be set arbitrarily to produce fast bursts of measurements to suit the time evolution of the physics being studied. The scattered light is collected at F/6 by a 100 kg six element lens system with an aperture stop of 290 mm. The collected light is then transferred to 130 polychromators by 130 independent fiber bundles. The data acquisition and processing are based on a distributed computer system of dual core processors embedded in 26 chassis. Each chassis is standalone and performs data acquisition and processing for five polychromators. This system allows data to be available quickly after the MAST shot and has potential for real-time operations.

Absolute calibration of LIDAR Thomson scattering systems by rotational Raman scattering.

Absolute calibration of LIDAR Thomson scattering systems on large fusion devices may be achieved using rotational Raman scattering. The choice of calibrating gas molecule presents different options and design trade-offs and is likely to be strongly dependent on the laser wavelength selected. Raman scattering of hydrogenic molecules produces a very broad spectrum, however, with far fewer scattered photons than scattering from nitrogen or oxygen at the same gas pressure. Lower laser wavelengths have the advantage that the Raman cross section increases, sigma(Raman) proportional to 1/lambda(0)(4), but the disadvantage that the spectral width of the scattered spectrum decreases, Deltalambda(Raman) proportional to lambda(0)(2). This narrower spectrum makes measurement closer to the laser wavelength necessary. The design of the calibration technique presents a number of challenges. Some of these challenges are generic to all Thomson scattering systems. These include detecting a sufficient number of photoelectrons and designing filters that measure close to the laser wavelength while simultaneously achieving adequate blocking of the laser wavelength. An issue specific to LIDAR systems arises since the collection optics operates over a wide range of depth of field. This wide depth of field has the effect of changing the angle of light incident on the optical interference filter with plasma major radius. The angular distribution then determines the effective spectral transmission function of the interference filter and hence impacts on the accuracy of the absolute calibration. One method that can be used to increase absolute calibration accuracy is collecting both Stokes and anti-Stokes lines with optical filter transmission bands specifically designed to reduce systematic uncertainty.

Ablation of AMP-activated protein kinase alpha1 and alpha2 from mouse pancreatic beta cells and RIP2.Cre neurons suppresses insulin release in vivo.

AIMS/HYPOTHESIS: AMP-activated protein kinase (AMPK) is an evolutionarily conserved enzyme and a target of glucose-lowering agents, including metformin. However, the precise role or roles of the enzyme in controlling insulin secretion remain uncertain. METHODS: The catalytic alpha1 and alpha2 subunits of AMPK were ablated selectively in mouse pancreatic beta cells and hypothalamic neurons by breeding Ampkalpha1 [also known as Prkaa1]-knockout mice, bearing floxed Ampkalpha2 [also known as Prkaa2] alleles (Ampkalpha1 ( -/- ),alpha2( fl/fl ),), with mice expressing Cre recombinase under the rat insulin promoter (RIP2). RIP2 was used to express constitutively activated AMPK selectively in beta cells in transgenic mice. Food intake, body weight and urinary catecholamines were measured using metabolic cages. Glucose and insulin tolerance were determined after intraperitoneal injection. Beta cell mass and morphology were analysed by optical projection tomography and confocal immunofluorescence microscopy, respectively. Granule docking, insulin secretion, membrane potential and intracellular free Ca(2+) were measured with standard techniques. RESULTS: Trigenic Ampkalpha1 ( -/- ),alpha2( fl/fl ) expressing Cre recombinase and lacking both AMPKalpha subunits in the beta cell, displayed normal body weight and increased insulin sensitivity, but were profoundly insulin-deficient. Secreted catecholamine levels were unchanged. Total beta cell mass was unaltered, while mean islet and beta cell volume were reduced. AMPK-deficient beta cells displayed normal glucose-induced changes in membrane potential and intracellular free Ca(2+), while granule docking and insulin secretion were enhanced. Conversely, betaAMPK transgenic mice were glucose-intolerant and displayed defective insulin secretion. CONCLUSIONS/INTERPRETATION: Inhibition of AMPK activity within the beta cell is necessary, but not sufficient for stimulation of insulin secretion by glucose to occur. AMPK activation in extrapancreatic RIP2.Cre-expressing cells might also influence insulin secretion in vivo.

Design and implementation of a full profile sub-cm ruby laser based Thomson scattering system for MAST.

A major upgrade to the ruby Thomson scattering (TS) system has been designed and implemented on the Mega-ampere spherical tokamak (MAST). MAST is equipped with two TS systems, a Nd:YAG laser system and a ruby laser system. Apart from common collection optics each system provides independent measurements of the electron temperature and density profile. This paper focuses on the recent upgrades to the ruby TS system. The upgraded ruby TS system measures 512 points across the major radius of the MAST vessel. The ruby laser can deliver one 10 J 40 ns pulse at 1 Hz or two 5 J pulses separated by 100-800 µs. The Thomson scattered light is collected at F/15 over 1.4 m. This system can resolve small (7 mm) structures at 200 points in both the electron temperature and density channels at high optical contrast; ∼50% modulated transfer function. The system is fully automated for each MAST discharge and requires little adjustment. The estimated measurement error for a 7 mm radial point is <4% of T(e) and <3% of n(e) in the range of 40 eV to 2 keV, for a density of n(e)=2×10(19) m(-3). The photon statistics at lower density can be increased by binning in the radial direction as desired. A new intensified CCD camera design allows the ruby TS system to take two snapshots separated with a minimum time of 230 µs. This is exploited to measure two density and temperature profiles or to measure the plasma background light.

Patient compliance with colposcopy information leaflets.

OBJECTIVE: To investigate patient satisfaction and compliance with recommendations in information leaflets sent to women prior to colposcopy clinic attendance and to establish whether alteration to the leaflet improved compliance. STUDY DESIGN: Data was collected prospectively and analysed retrospectively on the first 50 women attending for colposcopy before and after alterations to the information leaflet. RESULTS: All the patients received our patient leaflet and over 90% in each group felt that the information was understandable, clear and adequate. This is in complete contrast to overall compliance of less than 40% in both groups of the women. The first language of the patients did not make any major impact on compliance. CONCLUSION: Patients understanding of the information provided in the leaflets was not reflected in compliance. Compliance was no better in repeat attendees. The compliance with the information provided was not affected by the womens first language. Alterations in the leaflet did not improve compliance. Other methods of information provision should be looked at to try to improve compliance.

Total laparoscopic hysterectomy in morbidly obese women with endometrial cancer anaesthetic and surgical complications.

OBJECTIVE: To assess the feasibility, associated anaesthetic and surgical morbidity in all morbidly obese women with endometrial cancer treated with total laparoscopic hysterectomy bilateral salpingo-oophorectomy (TLHBSO). STUDY DESIGN: Data was collected prospectively and analysed retrospectively on all morbidly obese women who had TLHBSO between February 2003 and January 2007. RESULTS: One case was converted to laparotomy. The mean postoperative stay was 4.04 (3-7) days. The only postoperative surgical complication was an incisional port site hernia. Comorbidities were present in 76% (26/34) of women, 29% (10/34) had a single comorbid condition, and 26% (9/34) had two. A further 21% (7/34) had more than two. There were no major anaesthetic complications. Patients with a BMI > 50 required ventilation with high airway pressure despite using ventilatory strategies to keep them to a minimum. CONCLUSION: TLHBSO in the obese population is safe in the hands of experienced surgeons and anaesthetists. The safety of a total laparoscopic approach in the surgical management of uterine cancer remains to be demonstrated in prospective randomised trials.

Primary malignant melanoma arising in an ovarian cystic teratoma.

Cystic ovarian teratomas are common tumours. Malignant melanoma developing in a teratoma, however, is an extremely rare diagnosis. A 49-year-old woman with a history of weight loss and abdominal distension was referred to UCLH. She underwent laparotomy and bilateral salpingo-oophorectomy for a large right ovarian tumour. Histopathology revealed a malignant melanoma and carcinoid tumour in the right ovarian teratoma and an endometrioid adenocarcinoma in the left ovary. Subsequent vaginal hysterectomy revealed complex atypical hyperplasia in the endometrium. An extraovarian primary maelanoma could not be found. At this time the patient remains alive and well with no indication of recurrence.

Design and optimization of a novel surface plasmon resonance biosensor based on Otto configuration.

A theoretical study on a novel planar waveguide surface Plasmon Biosensor is presented in this paper. The proposed biosensor has a configuration similar to the Otto excitation mechanism for surface Plasmon polaritons. The performance of the device with respect to key system parameters such as gap-width and device length is investigated using an eigenmode solver with perfectly matched layers (PML). Device resolution of 2.3 x 10(-6) RIU has been demonstrated for an aqueous analyte.

Design of a new Nd:YAG Thomson scattering system for MAST.

A new infrared Thomson scattering system has been designed for the MAST tokamak. The system will measure at 120 spatial points with approximately 10 mm resolution across the plasma. Eight 30 Hz 1.6 J Nd:YAG lasers will be combined to produce a sampling rate of 240 Hz. The lasers will follow separate parallel beam paths to the MAST vessel. Scattered light will be collected at approximately f/6 over scattering angles ranging from 80 degrees to 120 degrees. The laser energy and lens size, relative to an existing 1.2 J f/12 system, greatly increases the number of scattered photons collected per unit length of laser beam. This is the third generation of this polychromator to be built and a number of modifications have been made to facilitate mass production and to improve performance. Detected scattered signals will be digitized at a rate of 1 GS/s by 8 bit analog to digital converters (ADCs.) Data may be read out from the ADCs between laser pulses to allow for real-time analysis.