"Always Events® " just another quality improvement tool or is it?

INTRODUCTION: Always Events® are defined as "those aspects of the care experience that should always occur when patients, their family members or other care partners, and service users interact with health care professionals and the health care system". It is a quality improvement methodology that starts by asking our patients the simple question "what matters to you?" and then through coproduction, works out a way to achieve this. METHODS AND RESULTS: This article tells our story and highlights the value of undertaking an Always Event® within the Radiology department at Warrington and Halton Hospitals. It will demonstrate how this approach combines research, an evaluation of findings and implementation of those findings within a very short timeframe. Embedded within the article are comments from our staff, volunteers and patients which reflect upon their experiences, our limitations, the outcomes we achieved and the impact it has had upon our patients and staff. CONCLUSION AND IMPLICATIONS FOR PRACTICE: It was important to our patients that they would be informed of how long they would wait for their examination once they booked in at x-ray reception. By undertaking an Always Event® this process is now embedded in our departments everyday activities with over 90% of our patients now being informed of their waiting time. This continued collaboration has really emphasised the value of listening to our patients, and the benefits this can lead to. It has also encouraged a positive research culture within our department (optimisation studies, working with industry, quality projects), helping to progress our profession and resulting in a quality service for our patients.

Magnetospherically driven optical and radio aurorae at the end of the stellar main sequence.

Aurorae are detected from all the magnetized planets in our Solar System, including Earth. They are powered by magnetospheric current systems that lead to the precipitation of energetic electrons into the high-latitude regions of the upper atmosphere. In the case of the gas-giant planets, these aurorae include highly polarized radio emission at kilohertz and megahertz frequencies produced by the precipitating electrons, as well as continuum and line emission in the infrared, optical, ultraviolet and X-ray parts of the spectrum, associated with the collisional excitation and heating of the hydrogen-dominated atmosphere. Here we report simultaneous radio and optical spectroscopic observations of an object at the end of the stellar main sequence, located right at the boundary between stars and brown dwarfs, from which we have detected radio and optical auroral emissions both powered by magnetospheric currents. Whereas the magnetic activity of stars like our Sun is powered by processes that occur in their lower atmospheres, these aurorae are powered by processes originating much further out in the magnetosphere of the dwarf star that couple energy into the lower atmosphere. The dissipated power is at least four orders of magnitude larger than what is produced in the Jovian magnetosphere, revealing aurorae to be a potentially ubiquitous signature of large-scale magnetospheres that can scale to luminosities far greater than those observed in our Solar System. These magnetospheric current systems may also play a part in powering some of the weather phenomena reported on brown dwarfs.

Shock tube explorations of roaming radical mechanisms: the decompositions of isobutane and neopentane.

The thermal decompositions of isobutane and neopentane have been studied using both shock tube experiments and ab initio transition state theory based master equation calculations. Dissociation rate constants for these molecules have been measured at high temperatures (1260-1566 K) behind reflected shock waves using high-sensitivity H-ARAS detection. The two major dissociation channels at high temperature are iso-C(4)H(10) → CH(3) + i-C(3)H(7) (1a) and neo-C(5)H(12) → CH(3) + t-C(4)H(9) (2a). Ultrahigh-sensitivity ARAS detection of H-atoms produced from the rapid decomposition of the product radicals, i-C(3)H(7) in (1a) and t-C(4)H(9) in (2a), through i-C(3)H(7) + M → H + C(3)H(6) + M (3a) and t-C(4)H(9) + M → H + i-C(4)H(8) + M (4a) allowed measurements of both the total decomposition rate constants, k(total), and the branching to radical products, which were observed to be equivalent in both systems, k(1a)/k(total) and k(2a)/k(total) = 0.79 ± 0.05. Theoretical analyses indicate that in isobutane, the non-H-atom fraction has two contributions, the dominant fraction being due to the roaming radical mechanism leading to molecular products through iso-C(4)H(10) → CH(4) + C(3)H(6) (1b) with k(1b)/k(total) = 0.16, and a minor fraction that involves the isomerization of i-C(3)H(7) to n-C(3)H(7) that then subsequently forms methyl radicals, i-C(3)H(7) + M → n-C(3)H(7) + M → CH(3) + C(2)H(4) + M (3b). In contrast to isobutane, in neopentane, the contribution to the non-H-atom fraction is exclusively through the roaming radical mechanism that leads to neo-C(5)H(12) → CH(4) + i-C(4)H(8) (2b) with k(2b)/k(total) = 0.21. These quantitative measurements of larger contributions from the roaming mechanism for larger molecules are in agreement with the qualitative theoretical arguments that suggest long-range dispersion interactions (which become increasingly important for larger molecules) may enhance roaming.

Shock tube and theoretical studies on the thermal decomposition of propane: evidence for a roaming radical channel.

The thermal decomposition of propane has been studied using both shock tube experiments and ab initio transition state theory-based master equation calculations. Dissociation rate constants for propane have been measured at high temperatures behind reflected shock waves using high-sensitivity H-ARAS detection and CH(3) optical absorption. The two major dissociation channels at high temperature are C(3)H(8) → CH(3) + C(2)H(5) (eq 1a) and C(3)H(8) → CH(4) + C(2)H(4) (eq 1b). Ultra high-sensitivity ARAS detection of H-atoms produced from the decomposition of the product, C(2)H(5), in (1a), allowed measurements of both the total decomposition rate constants, k(total), and the branching to radical products, k(1a)/k(total). Theoretical analyses indicate that the molecular products are formed exclusively through the roaming radical mechanism and that radical products are formed exclusively through channel 1a. The experiments were performed over the temperature range 1417-1819 K and gave a minor contribution of (10 ± 8%) due to roaming. A multipass CH(3) absorption diagnostic using a Zn resonance lamp was also developed and characterized in this work using the thermal decomposition of CH(3)I as a reference reaction. The measured rate constants for CH(3)I decomposition agreed with earlier determinations from this laboratory that were based on I-atom ARAS measurements. This CH(3) diagnostic was then used to detect radicals from channel 1a allowing lower temperature (1202-1543 K) measurements of k(1a) to be determined. Variable reaction coordinate-transition state theory was used to predict the high pressure limits for channel (1a) and other bond fission reactions in C(3)H(8). Conventional transition state theory calculations were also used to estimate rate constants for other tight transition state processes. These calculations predict a negligible contribution (<1%) from all other bond fission and tight transition state processes, indicating that the bond fission channel (1a) and the roaming channel (1b) are indeed the only active channels at the temperature and pressure ranges of the present experiments. The predicted reaction exo- and endothermicities are in excellent agreement with the current version of the Active Thermochemical Tables. Master equation calculations incorporating these transition state theory results yield predictions for the temperature and pressure dependence of the dissociation rate constants for channel 1a. The final theoretical results reliably reproduce the measured dissociation rate constants that are reported here and in the literature. The experimental data are well reproduced over the 500-2500 K and 1 × 10(-4) to 100 bar range (errors of ∼15% or less) by the following Troe parameters for Ar as the bath gas: k(∞) = 1.55 × 10(24)T(-2.034) exp(-45 490/T) s(-1), k(0) = 7.92 × 10(53)T(-16.67) exp(-50 380/T) cm(3) s(-1), and F(c) = 0.190 exp(-T/3091) + 0.810 exp(-T/128) + exp(-8829/T).

Rate constants for the thermal decomposition of ethanol and its bimolecular reactions with OH and D: reflected shock tube and theoretical studies.

The thermal decomposition of ethanol and its reactions with OH and D have been studied with both shock tube experiments and ab initio transition state theory-based master equation calculations. Dissociation rate constants for ethanol have been measured at high T in reflected shock waves using OH optical absorption and high-sensitivity H-atom ARAS detection. The three dissociation processes that are dominant at high T are C2H5OH--> C2H4+H2O (A) -->CH3+CH2OH (B) -->C2H5+OH (C).The rate coefficient for reaction C was measured directly with high sensitivity at 308 nm using a multipass optical White cell. Meanwhile, H-atom ARAS measurements yield the overall rate coefficient and that for the sum of reactions B and C , since H-atoms are instantaneously formed from the decompositions of CH(2)OH and C(2)H(5) into CH(2)O + H and C(2)H(4) + H, respectively. By difference, rate constants for reaction 1 could be obtained. One potential complication is the scavenging of OH by unreacted ethanol in the OH experiments, and therefore, rate constants for OH+C2H5OH-->products (D)were measured using tert-butyl hydroperoxide (tBH) as the thermal source for OH. The present experiments can be represented by the Arrhenius expression k=(2.5+/-0.43) x 10(-11) exp(-911+/-191 K/T) cm3 molecule(-1) s(-1) over the T range 857-1297 K. For completeness, we have also measured the rate coefficient for the reaction of D atoms with ethanol D+C2H5OH-->products (E) whose H analogue is another key reaction in the combustion of ethanol. Over the T range 1054-1359 K, the rate constants from the present experiments can be represented by the Arrhenius expression, k=(3.98+/-0.76) x10(-10) exp(-4494+/-235 K/T) cm3 molecule(-1) s(-1). The high-pressure rate coefficients for reactions B and C were studied with variable reaction coordinate transition state theory employing directly determined CASPT2/cc-pvdz interaction energies. Reactions A , D , and E were studied with conventional transition state theory employing QCISD(T)/CBS energies. For the saddle point in reaction A , additional high-level corrections are evaluated. The predicted reaction exo- and endothermicities are in good agreement with the current Active Thermochemical Tables values. The transition state theory predictions for the microcanonical rate coefficients in ethanol decomposition are incorporated in master equation calculations to yield predictions for the temperature and pressure dependences of reactions A - C . With modest adjustments (<1 kcal/mol) to a few key barrier heights, the present experimental and adjusted theoretical results yield a consistent description of both the decomposition (1-3) and abstraction kinetics (4 and 5). The present results are compared with earlier experimental and theoretical work.

Shock tube and theory investigation of cyclohexane and 1-hexene decomposition.

The decomposition of cyclohexane (c-C(6)H(12)) was studied in a shock tube using the laser-schlieren technique over the temperature range 1300-2000 K and for 25-200 Torr in mixtures of 2%, 4%, 10%, and 20% cyclohexane in Kr. Vibrational relaxation of the cyclohexane was also examined in 10 experiments covering 1100-1600 K for pressures below 20 Torr, and relaxation was found to be too fast to allow resolution of incubation times. The dissociation of 1-hexene (1- C(6)H(12)), apparently the sole initial product of cyclohexane decomposition, was also studied over 1220-1700 K for 50 and 200 Torr using 2% and 3% 1-hexene in Kr. On heating, cyclohexane simply isomerizes to 1-hexene, and this then dissociates almost entirely by a more rapid C-C scission to allyl and n-propyl radicals. This two-step reaction results in an initial small density gradient from the slight endothermicity of the isomerization. The gradient then rises strongly as the product 1-hexene dissociates. For the lower temperatures, this behavior is fully resolved here. For the higher pressures, 1-hexene decomposition generates negative gradients (exothermic reaction) as the radicals formed begin to recombine. Cyclohexane also generates such gradients, but these are now much smaller because the radical pool is depleted by abstraction from the reactant. A complete mechanism for the 1-hexene decomposition and for that of cyclohexane involving 79 reactions and 30 species is used in the final modeling of the gradients. Rate constants and RRKM fit parameters for the initial reactions are provided for the entire range of conditions. The possibility of direct reaction to allyl and n-propyl radicals, without stabilization of the intermediate 1-hexene, is examined down to pressures as low as 25 Torr, without a clear resolution of the issue. High-pressure limit rate constants from RRKM extrapolation are k(infinity)(c-C(6)H(12) --> 1-C(6)H(12)) = (8.76 x 10(17)) exp((-91.94 kcal/mol)/RT) s(-1) (T = 1300-2000 K) and k(infinity)(1-C(6)H(12) --> (*)C(3)H(7) + (*)C(3)H(5)) = (1.46 x 10(16)) exp((-69.12 kcal/mol)/RT) s(-1) (T = 1200-1700 K). This high-pressure rate for cyclohexane is entirely consistent with the notion that the isomerization involves initial C-C fission to a diradical. These extrapolated high-pressure rates are in good agreement with much of the literature.

Thermal decomposition of NH2OH and subsequent reactions: ab initio transition state theory and reflected shock tube experiments.

Primary and secondary reactions involved in the thermal decomposition of NH2OH are studied with a combination of shock tube experiments and transition state theory based theoretical kinetics. This coupled theory and experiment study demonstrates the utility of NH2OH as a high temperature source of OH radicals. The reflected shock technique is employed in the determination of OH radical time profiles via multipass electronic absorption spectrometry. O-atoms are searched for with atomic resonance absorption spectrometry. The experiments provide a direct measurement of the rate coefficient, k1, for the thermal decomposition of NH2OH. Secondary rate measurements are obtained for the NH2 + OH (5a) and NH2OH + OH (6a) abstraction reactions. The experimental data are obtained for temperatures in the range from 1355 to 1889 K and are well represented by the respective rate expressions: log[k/(cm3 molecule(-1) s(-1))] = (-10.12 +/- 0.20) + (-6793 +/- 317 K/T) (k1); log[k/(cm3 molecule(-1) s(-1))] = (-10.00 +/- 0.06) + (-879 +/- 101 K/T) (k5a); log[k/(cm3 molecule(-1) s(-1))] = (-9.75 +/- 0.08) + (-1248 +/- 123 K/T) (k6a). Theoretical predictions are made for these rate coefficients as well for the reactions of NH2OH + NH2, NH2OH + NH, NH + OH, NH2 + NH2, NH2 + NH, and NH + NH, each of which could be of secondary importance in NH2OH thermal decomposition. The theoretical analyses employ a combination of ab initio transition state theory and master equation simulations. Comparisons between theory and experiment are made where possible. Modest adjustments of predicted barrier heights (i.e., by 2 kcal/mol or less) generally yield good agreement between theory and experiment. The rate coefficients obtained here should be of utility in modeling NOx in various combustion environments.

Kinetics and product branching ratios of the reaction of (1)CH2 with H2 and D2.

The reactions of singlet methylene (a(1)A1 (1)CH2) with hydrogen and deuterium have been studied by experimental and theoretical techniques. The rate coefficients for the removal of singlet methylene with H2 (k1) and D2 (k2) have been measured from 195 to 798 K and are essentially temperature-independent with values of k1 = (10.48 +/- 0.32) x 10(-11) cm(3) molecule(-1) s(-1) and k2 = (5.98 +/- 0.34) x 10(-11) cm(3) molecule(-1) s(-1), where the errors represent 2sigma, giving a ratio of k1/k2 = 1.75 +/- 0.11. In the reaction with H2, singlet methylene can be removed by reaction giving CH3 + H or deactivated to ground-state triplet methylene. Direct measurement of the H atom product showed that the fraction of relaxation decreased from 0.3 at 195 K to essentially zero at 398 K. For the reaction with deuterium, either H or D may be eliminated. Experimentally, the H:D ratio was determined to be 1.8 +/- 0.5 over the range 195-398 K. Theoretically, the reaction kinetics has been predicted with variable reaction coordinate transition state theory and with rigid-body trajectory simulations employing various high-level, ab initio-determined potential energy surfaces. The magnitudes of the calculated rate coefficients are in agreement with experiment, but the calculations show a significant negative temperature dependence that is not observed in the experimental results. The calculated and experimental H to D ratios from the reaction of singlet methylene with D2 are in good agreement, suggesting that the reaction proceeds entirely through the formation of a long-lived methane intermediate with a statistical distribution of energy.

Measurement of the internal dose to families of outpatients treated with 131I for hyperthyroidism.

OBJECTIVE: The aim of this study was to measure the internal dose received by family members from ingestion of radioactive contamination after outpatient therapy. MATERIALS AND METHODS: Advice was given to minimise transfer of radioiodine. Home visits were made approximately 2, 7 and 21 days after treatment to measure radioactivity in the thyroids of family members. A decay correction was applied to radioactivity detected assuming ingestion had occurred at the earlier contact time, either the day of treatment or the previous home visit. An effective half-life of 6 or 7 days was used depending on age. Thyroid activity was summed if activity was found at more than one visit in excess of the amount attributable to radioactive decay. Effective dose (ED) was calculated using ICRP72. RESULTS AND DISCUSSION: Fifty-three adults and 92 children, median age 12 (range 4-17) years participated. Median administered activity was 576 (range 329-690) MBq (131)I. Thyroid activity ranged from 0 to 5.4 kBq in the adults with activity detected in 17. Maximum adult ED was 0.4 mSv. Thyroid activity ranged from 0 to 11.8 kBq in the children with activity detected in 26. The two highest values of 5.0 and 11.8 kBq occurred in children aged 5 and 14 years from different families. Eighty-five children had no activity or <1 kBq detected. ED was <0.2 mSv in 86 out of 92 children (93%). Previous published data showed 93% of children received an ED

The development of microthermal analysis and photothermal microspectroscopy as novel approaches to drug-excipient compatibility studies.

The use of microthermal analysis as a novel means of assessing chemical incompatibility between drugs and excipients is assessed using magnesium stearate and acetylsalicylic acid as a model system. Localised thermomechanical analysis (L-TMA), localised differential thermal analysis (L-DTA), nanosampling, thermally assisted particle manipulation (TAPM) and photothermal microspectrometry (PTMS) are developed as a means of allowing extremely small quantities of drug and excipient to be heated in close proximity to each other. Differential scanning calorimetry (DSC), hot stage microscopy (HSM) and temperature controlled attenuated total internal reflection (ATR) FTIR were used as supportive techniques. L-TMA and macroscopic TMA of magnesium stearate indicated that the endothermic DSC peak normally associated with melting does not correspond to significant liquefaction. An optimised method for detecting the interaction at a particulate level of scrutiny was developed whereby the drug is placed on the excipient surface via TAPM and the construct heated, allowing the interaction to be detected in both the L-TMA and L-DTA signal. PTMS allowed spectra to be obtained on nanogram-sized samples and also allowed the interaction to be detected. The study has therefore demonstrated the potential for using TAPM with PTMS for studying interactions at an individual particle level.

Thermal decomposition of CF3 and the reaction of CF2 + OH --> CF2O + H.

The reflected shock tube technique with multipass absorption spectrometric detection (at a total path length of approximately 1.75 m) of OH-radicals at 308 nm has been used to study the dissociation of CF3-radicals [CF3 + Kr --> CF2 + F + Kr (a)] between 1,803 and 2,204 K at three pressures between approximately 230 and 680 Torr. The OH-radical concentration buildup resulted from the fast reaction F + H2O --> OH + HF (b). Hence, OH is a marker for F-atoms. To extract rate constants for reaction (a), the [OH] profiles were modeled with a chemical mechanism. The initial rise in [OH] was mostly sensitive to reactions (a) and (b), but the long time values were additionally affected by CF2 + OH --> CF2O + H (c). Over the experimental temperature range, rate constants for (a) and (c) were determined from the mechanistic fits to be kCF3+Kr = 4.61 x 10-9 exp(-30,020 K/T) and kCF2+OH = (1.6 +/- 0.6) x 10-10, both in units of cm3 molecule-1 s-1. Reaction (a), its reverse recombination reaction reaction (-a), and reaction (c) are also studied theoretically. Reactions (c) and (-a) are studied with direct CASPT2 variable reaction coordinate transition state theory. A master equation analysis for reaction (a) incorporating the ab initio determined reactive flux for reaction (-a) suggests that this reaction is close to but not quite in the low-pressure limit for the pressures studied experimentally. In contrast, reaction (c) is predicted to be in the high-pressure limit due to the high exothermicity of the products. A comparison with past and present experimental results demonstrates good agreement between the theoretical predictions and the present data for both (a) and (c).

Reflected shock tube and theoretical studies of high-temperature rate constants for OH+CF3H<-->CF3+H2O and CF3+OH-->products.

The reflected shock tube technique with multipass absorption spectrometric detection of OH radicals at 308 nm, using either 36 or 60 optical passes corresponding to total path lengths of 3.25 or 5.25 m, respectively, has been used to study the bimolecular reactions, OH+CF3H-->CF3+H2O (1) and CF3+H2O-->OH+CF3H (-1), between 995 and 1663 K. During the course of the study, estimates of rate constants for CF3+OH-->products (2) could also be determined. Experiments on reaction -1 were transformed through equilibrium constants to k1, giving the Arrhenius expression k1=(9.7+/-2.1)x10(-12) exp(-4398+/-275K/T) cm3 molecule(-1) s(-1). Over the temperature range, 1318-1663 K, the results for reaction 2 were constant at k2=(1.5+/-0.4)x10(-11) cm3 molecule(-1) s(-1). Reactions 1 and -1 were also studied with variational transition state theory (VTST) employing QCISD(T) properties for the transition state. These a priori VTST predictions were in good agreement with the present experimental results but were too low at the lower temperatures of earlier experiments, suggesting that either the barrier height was overestimated by about 1.3 kcal/mol or that the effect of tunneling was greatly underestimated. The present experimental results have been combined with the most accurate earlier studies to derive an evaluation over the extended temperature range of 252-1663 K. The three parameter expression k1=2.08x10(-17) T1.5513 exp(-1848 K/T) cm3 molecule(-1) s(-1) describes the rate behavior over this temperature range. Alternatively, the expression k1,th=1.78x10(-23) T3.406 exp(-837 K/T) cm3 molecule(-1) s(-1) obtained from empirically adjusted VTST calculations over the 250-2250 K range agrees with the experimental evaluation to within a factor of 1.6. Reaction 2 was also studied with direct CASPT2 variable reaction coordinate transition state theory. The resulting predictions for the capture rate are found to be in good agreement with the mean of the experimental results and can be represented by the expression k2,th=2.42x10(-11) T-0.0650 exp(134 K/T) cm3 molecule(-1) s(-1) over the 200-2500 K temperature range. The products of this reaction are predicted to be CF2O+HF.

Prophylactic vs postoperative antibiotic use in complex septorhinoplasty surgery: a prospective, randomized, single-blind trial comparing efficacy.

OBJECTIVE: To compare the efficacy of prophylactic vs postoperative antibiotic use in complex septorhinoplasty and strengthen the evidence base for antibiotic use in nasal surgery. DESIGN: A randomized, prospective, single-blinded trial. One hundred sixty-four patients requiring complex septorhinoplasty surgery were recruited sequentially from the waiting lists of the 2 senior authors. Power was calculated at 80% at the 5% significance level. Patients randomized to the prophylactic arm of the study received three 1200-mg intravenous doses of amoxicillin-clavulanate, given at induction of anesthesia and at 6 and 12 hours postoperatively. Patients in the postoperative antibiotic arm received a 7-day course of 375 mg of amoxicillin-clavulanate 3 times a day. Patients allergic to penicillin were given erythromycin. Clinical and microbiological evidence of infection on the 10th postoperative day was categorized as either minor (vestibulitis) or major (nasal or septal cellulitis, septal abscess, secondary hemorrhage, or donor-site infection) infections. RESULTS: At follow-up, 6 (7%) of 82 patients in the prophylactic arm and 9 (11%) of 82 of patients in the postoperative arm showed evidence of infection. Most (80%) of infections were minor. There was no significant difference in infection rates between the prophylactic and postoperative arms on chi2 analysis (P = .42). All 164 patients completed the study on an intention-to-treat basis. CONCLUSION: We recommend the use of prophylactic antibiotics rather than empirical postoperative antibiotics for patients undergoing complex septorhinoplasty.

Measurement of exogenous carbohydrate oxidation: a comparison of [U-14C]glucose and [U-13C]glucose tracers.

The purpose of this study was to assess the level of agreement between two techniques commonly used to measure exogenous carbohydrate oxidation (CHO(EXO)). To accomplish this, seven healthy male subjects (24 +/- 3 yr, 74.8 +/- 2.1 kg, V(O2(max)) 62 +/- 4 ml x kg(-1) x min(-1)) exercised at 50% of their peak power for 120 min on two occasions. During these exercise bouts, subjects ingested a solution containing either 144 g glucose (8.7% wt/vol glucose) or water. The glucose solution contained trace amounts of both [U-13C]glucose and [U-14C]glucose to allow CHO(EXO) to be quantified simultaneously. The water trial was used to correct for background 13C enrichment. 13C appearance in the expired air was measured using isotope ratio mass spectrometry, whereas 14C appearance was quantified by trapping expired CO(2) in solution (using hyamine hydroxide) and adding a scintillator before counting radioactivity. CHO(EXO) measured with [13C]glucose ([13C]CHO(EXO)) was significantly greater than CHO(EXO) measured with [14C]glucose ([14C]CHO(EXO)) from 30 to 120 min. There was a 15 +/- 4% difference between [13C]CHO(EXO) and [14C]CHO(EXO) such that the absolute difference increased with the magnitude of CHO(EXO). Further investigations suggest that the difference is not because of losses of CO2 from the trapping solution before counting or an underestimation of the "strength" of the trapping solution. Previous research suggests that the degree of isotopic fractionation is small (S. C. Kalhan, S. M. Savin, and P. A. Adam. J Lab Clin Med89: 285-294, 1977). Therefore, the explanation for the discrepancy in calculated CHO(EXO) remains to be fully understood.

The roaming atom: straying from the reaction path in formaldehyde decomposition.

We present a combined experimental and theoretical investigation of formaldehyde (H2CO) dissociation to H2 and CO at energies just above the threshold for competing H elimination. High-resolution state-resolved imaging measurements of the CO velocity distributions reveal two dissociation pathways. The first proceeds through a well-established transition state to produce rotationally excited CO and vibrationally cold H2. The second dissociation pathway yields rotationally cold CO in conjunction with highly vibrationally excited H2. Quasi-classical trajectory calculations performed on a global potential energy surface for H2CO suggest that this second channel represents an intramolecular hydrogen abstraction mechanism: One hydrogen atom explores large regions of the potential energy surface before bonding with the second H atom, bypassing the saddle point entirely.

The Cardiff paediatric laryngoscope blade: a comparison with the Miller size 1 and Macintosh size 2 laryngoscope blades.

The Cardiff paediatric laryngoscope blade is a single blade that has been designed for use in children from birth to adolescence. This open, randomised, crossover study compared the Cardiff blade with the straight, size 1, Miller laryngoscope blade in 39 infants under 1 years of age and the curved, size 2, Macintosh blade in 39 children aged 1-16 years. The same laryngoscopic view was obtained with the Cardiff and Miller blades in 26 patients; the view was better with the Cardiff blade in seven patients and better with the Miller blade in six (median (IQR [range]) grade of laryngoscopy 1 (1-2 [1-3]) vs. 1 (1-2 [1-3]), respectively; p = 0.405). The Cardiff blade was faster at gaining a view than the Miller blade (mean (SD) time 8.5 (2.9) s vs. 10.2 (3.5) s, respectively; 95% CI for difference -2.8 to -0.4; p = 0.009). The Cardiff and Macintosh blades produced the same view in 32 patients; the view was better with the Cardiff blade in seven patients (median (IQR [range]) grade of laryngoscopy 1 (1-1 [1-3]) vs. 1 (1-2 [1-3]), respectively; p = 0.008). There was no difference in time to gain these views: mean (SD) 8.7 (3.0) s vs. 9.3 (2.7) s, respectively (95% CI for difference -1.58 to 0.40; p = 0.237). The Cardiff paediatric laryngoscope blade compares favourably with these two established laryngoscope blades in children.