The association between preoperative length of hospital stay and deep sternal wound infection: A scoping review.

BACKGROUND: Deep sternal wound infection (DSWI) is a serious complication of cardiac surgery, associated with a significantly longer hospital stay, an increased mortality, and an almost doubling of treatment costs. The preoperative length of hospital stay has been suggested in a small number of studies as a modifiable risk factor yet is not included in surgical site infection prevention guidelines. The aim of this scoping review was to review the existing evidence on the association between preoperative length of hospital stay and DSWI, and to identify established risk factors for DSWI. METHODS: A literature search of six electronic databases yielded 2297 results. Titles concerning risk factors for DSWI, sternal or surgical wound infection, or poststernotomy complications were included. Abstracts relating to preoperative length of stay as a risk factor for DSWI proceeded to full article review. Articles regarding paediatric surgery, DSWI management or unavailable in English were excluded. RESULTS: The review identified 11 observational cohort studies. DSWI prevalence was between 0.9% and 6.8%. Preoperative length of stay ranged from 0-15.5 days and was found to be associated with DSWI in all studies. Preoperative length of stay and DSWI were inconsistently defined. Other risk factors for DSWI included diabetes, obesity, respiratory disease, heart failure, renal impairment, complex surgery, and reoperation (p < 0.05). CONCLUSION: In this scoping review, an association between preoperative length of stay and the development of DSWI following cardiac surgery was identified. Thus, preoperative length of stay as a modifiable risk factor for DSWI should be considered for inclusion in cardiothoracic surgical infection prevention guidelines.

Counting-based microfluidic paper-based devices capable of analyzing submicroliter sample volumes.

In this paper, we report the development of semiquantitative counting-based lateral flow assay (LFA)-type microfluidic paper-based analytical devices ( µ PADs) to analyze samples at submicroliter volumes. The ability to use submicroliter sample volumes is a significant advantage for µ PADs since it enables enhanced multiplexing, reduces cost, and increases user-friendliness since small sample volumes can be collected using methods that do not require trained personnel, such as finger pricking and microneedles. The challenge of accomplishing a semiquantitative test readout using submicroliter sample volumes was overcome with a counting-based approach. In order to use submicroliter sample volumes, we developed a flow strategy with a running liquid to facilitate flow through the assay. The efficacy of the devices was confirmed with glucose and total human immunoglobulin E (IgE) tests using 0.5 µ l and 1 µ l of sample solutions, respectively. Semiquantitative results were generated to predict glucose concentrations in the range of 0-12 mmol/l and IgE concentrations in the range of 0-400 ng/ml. The counting-based approach correlates the number of dots that exhibited a color change to the concentration of the analyte, which provides a more user-friendly method as compared with interpreting the intensity of a color change. The devices reported herein are the first counting-based LFA-type µ PADs capable of semiquantitative testing using submicroliter sample volumes.

Effects of Light Spectrum on Luminance Measurements in Underground Coal Mines.

Lighting regulations for luminance in U. S. coal mines are verified in the field by using a luminance photometer calibrated to the Standard Illuminant A light source. Significant measurement errors can exist when measuring light sources that are dissimilar to light sources used to calibrate the photometer. This paper quantifies the measurement errors when measuring these dissimilar light sources commonly used in U.S. underground coal mines-an LED, a CFL with a clear cover, a CFL with an amber cover, and a tungsten halogen. The impact of photometer quality was also evaluated. Three different luminance measuring instruments of high, medium, and low quality were compared-a PR-650, LS-100, and PMEX, respectively. The PMEX was under evaluation for measuring luminance compliance in U.S. underground coal mines. The PR-650 was used as the referent to which the other photometers were compared. The PMEX error ranged from -17.0% to -26.5% with the highest error for the amber CFL. The LS-100 closely matched the luminance measurement for the LED and halogen; however, it had a percent error of -10.4% for the amber CFL. After the initial experiment, MSHA made improvements to the PMEX resulting in the PMEX-MSHA. The experiment was replicated using the new photometer and the newer PR-670. After repeating the experiment, the measurement errors ranged from -16% to -19% for the PMEX-MSHA, thus indicating an improvement over the PMEX. These results show that the spectral content of a light source and the photometer quality can greatly impact the accuracy of luminance measurement.

Developing a Virtual Reality Environment for Mining Research.

Recent advances in computing, rendering, and display technologies have generated increased accessibility for virtual reality (VR). VR allows the creation of dynamic, high-fidelity environments to simulate dangerous situations, test conditions, and visualize concepts. Consequently, numerous products have been developed, but many of these are limited in scope. Therefore, the National Institute for Occupational Safety and Health researchers developed a VR framework, called VR Mine, to rapidly create an underground mine for human data collection, simulation, visualization, and training. This paper describes the features of VR Mine using self-escape and proximity detection as case studies. Features include mine generation, simulated networks, proximity detection systems, and the integration and visualization of real-time ventilation models.

Features in Microfluidic Paper-Based Devices Made by Laser Cutting: How Small Can They Be?

In this paper, we determine the smallest feature size that enables fluid flow in microfluidic paper-based analytical devices (µPADs) fabricated by laser cutting. The smallest feature sizes fabricated from five commercially available paper types: Whatman filter paper grade 50 (FP-50), Whatman 3MM Chr chromatography paper (3MM Chr), Whatman 1 Chr chromatography paper (1 Chr), Whatman regenerated cellulose membrane 55 (RC-55) and Amershan Protran 0.45 nitrocellulose membrane (NC), were 139 ± 8 µm, 130 ± 11 µm, 103 ± 12 µm, 45 ± 6 µm, and 24 ± 3 µm, respectively, as determined experimentally by successful fluid flow. We found that the fiber width of the paper correlates with the smallest feature size that has the capacity for fluid flow. We also investigated the flow speed of Allura red dye solution through small-scale channels fabricated from different paper types. We found that the flow speed is significantly slower through microscale features and confirmed the similar trends that were reported previously for millimeter-scale channels, namely that wider channels enable quicker flow speed.

Ectopic orbital meningioma: Fact or fiction?

Primary intraorbital ectopic meningiomas are rare and their existence remains controversial. We present a 30-year-old female with painless, non-axial proptosis and a palpable superomedial mass. The MRI demonstrated that the mass had no optic nerve sheath or sphenoid wing involvement and was initially reported to have no intracranial extension. The patient was initially thought to have an ectopic orbital meningioma. Subsequent multidisciplinary team (MDT) consultation and further specialist review of the MRI revealed a subtle dural tail connecting to an enhancing mass in the olfactory groove. Biopsy revealed a WHO Grade 1 transitional meningioma with an infiltrative pattern. We argue that some previously reported cases of ectopic meningioma may lack the requisite imaging to discover the primary disease. Our report highlights the importance of MRI in this group of patients and the role of a skull-base MDT with specialist neuroradiology input to determine the true origin and extent of these extradural orbital meningiomas.

Experimental investigation of interfacial energy transport in an evaporating sessile droplet for evaporative cooling applications.

In this paper we experimentally examine evaporation flux distributions and modes of interfacial energy transport for continuously fed evaporating spherical sessile water droplets in a regime that is relevant for applications, particularly for evaporative cooling systems. The contribution of the thermal conduction through the vapor phase was found to be insignificant compared to the thermal conduction through the liquid phase for the conditions we investigated. The local evaporation flux distributions associated with thermal conduction were found to vary along the surface of the droplet. Thermal conduction provided a majority of the energy required for evaporation but did not account for all of the energy transport, contributing 64±3%, 77±3%, and 77±4% of the energy required for the three cases we examined. Based on the temperature profiles measured along the interface we found that thermocapillary flow was predicted to occur in our experiments, and two convection cells were consistent with the temperature distributions for higher substrate temperatures while a single convection cell was consistent with the temperature distributions for a lower substrate temperature.

Creating compact and microscale features in paper-based devices by laser cutting.

In this work we describe a fabrication method to create compact and microscale features in paper-based microfluidic devices using a CO2 laser cutting/engraving machine. Using this method we are able to produce the smallest features with the narrowest barriers yet reported for paper-based microfluidic devices. The method uses foil backed paper as the base material and yields inexpensive paper-based devices capable of using small fluid sample volumes and thus small reagent volumes, which is also suitable for mass production. The laser parameters (power and laser head speed) were adjusted to minimize the width of hydrophobic barriers and we were able to create barriers with a width of 39 ± 15 µm that were capable of preventing cross-barrier bleeding. We generated channels with a width of 128 ± 30 µm, which we found to be the physical limit for small features in the chromatography paper we used. We demonstrate how miniaturizing of paper-based microfluidic devices enables eight tests on a single bioassay device using only 2 µL of sample fluid volume.

Influence of Geometry and Surrounding Conditions on Fluid Flow in Paper-Based Devices.

Fluid flow behaviour in paper is of increasing interest due to the advantages and expanding use of microfluidic paper-based analytical devices (known as µPADs). Applications are expanding from those which often have low sample fluid volumes, such as diagnostic testing, to those with an abundance of sample fluid, such as water quality testing. The rapid development of enhanced features in µPADs, along with a need for increased sensitivity and specificity in the embedded chemistry requires understanding the passively-driven fluid motion in paper to enable precise control and consistency of the devices. It is particularly important to understand the influence of parameters associated with larger fluid volumes and to quantify their impact. Here, we experimentally investigate the impacts of several properties during imbibition in paper, including geometry (larger width and length) and the surrounding conditions (humidity and temperature) using abundant fluid reservoirs. Fluid flow velocity in paper was found to vary with temperature and width, but not with length of the paper strip and humidity for the conditions we tested. We observed substantial post-wetting flow for paper strips in contact with a large fluid reservoir.

Nanoporous membranes enable concentration and transport in fully wet paper-based assays.

Low-cost paper-based assays are emerging as the platform for diagnostics worldwide. Paper does not, however, readily enable advanced functionality required for complex diagnostics, such as analyte concentration and controlled analyte transport. That is, after the initial wetting, no further analyte manipulation is possible. Here, we demonstrate active concentration and transport of analytes in fully wet paper-based assays by leveraging nanoporous material (mean pore diameter ≈ 4 nm) and ion concentration polarization. Two classes of devices are developed, an external stamp-like device with the nanoporous material separate from the paper-based assay, and an in-paper device patterned with the nanoporous material. Experimental results demonstrate up to 40-fold concentration of a fluorescent tracer in fully wet paper, and directional transport of the tracer over centimeters with efficiencies up to 96%. In-paper devices are applied to concentrate protein and colored dye, extending their limits of detection from ∼10 to ∼2 pmol/mL and from ∼40 to ∼10 µM, respectively. This approach is demonstrated in nitrocellulose membrane as well as paper, and the added cost of the nanoporous material is very low at ∼0.015 USD per device. The result is a major advance in analyte concentration and manipulation for the growing field of low-cost paper-based assays.

Lab-in-a-pen: a diagnostics format familiar to patients for low-resource settings.

We present a low cost, simple and integrated device for medical diagnostics in low-resource settings called the lab-in-a-pen. Finger pricking, and sample collection and processing, are integrated with commercially available paper-based assays in a pen format. This approach ensures safety (i.e. biological sample and sharps containment) and can be used by untrained end users across multiple settings. The pen format also leverages existing low cost, high volume manufacturing and assembly methods. We characterize sample wicking in the lab-in-a-pen using porcine whole blood. The clinical diagnostic utility and usability of the lab-in-a-pen is established by testing of patients for Hepatitis B surface antigen (HBsAg) and Hepatitis B 'e' antigen (HBeAg) by medical staff at the National Hospital for Tropical Diseases in Hanoi, Vietnam.

Out-of-plane ion concentration polarization for scalable water desalination.

We present a scalable, out-of-plane desalination approach using ion concentration polarization. A depletion boundary separates salt ions and purified water into distinct vertical layers. The out-of-plane design enables multiplexing in three dimensions, providing the functional density required for practical application. For membrane widths of 125-200 µm, and applied voltage of 5 V, the energy requirement is 4.6 Wh L(-1) for 20 mM solution, and 13.8 Wh L(-1) for 200 mM. Energy efficiency is found to be insensitive to flow rate as the depletion boundary adjusts to yield a commensurate volume of purified water. Scaled-up devices are presented, which have a 3-fold improvement in functional density over planar systems.

Field tested milliliter-scale blood filtration device for point-of-care applications.

In this paper, we present a low cost and equipment-free blood filtration device capable of producing plasma from blood samples with mL-scale capacity and demonstrate its clinical application for hepatitis B diagnosis. We report the results of in-field testing of the device with 0.8-1 ml of undiluted, anticoagulated human whole blood samples from patients at the National Hospital for Tropical Diseases in Hanoi, Vietnam. Blood cell counts demonstrate that the device is capable of filtering out 99.9% of red and 96.9% of white blood cells, and the plasma collected from the device contains lower red blood cell counts than plasma obtained from a centrifuge. Biochemistry and immunology testing establish the suitability of the device as a sample preparation unit for testing alanine transaminase (ALT), aspartate transaminase (AST), urea, hepatitis B "e" antigen (HBeAg), hepatitis B "e" antibody (HBe Ab), and hepatitis B surface antibody (HBs Ab). The device provides a simple and practical front-end sample processing method for point-of-care microfluidic diagnostics, enabling sufficient volumes for multiplexed downstream tests.

Onset of Marangoni convection for evaporating sessile droplets.

We have generated stability parameters using a linear stability analysis to predict the onset criteria for Marangoni convection in evaporating sessile droplets for two types of substrates, insulating and conducting. The stability problem was formulated with boundary conditions that allow for a temperature discontinuity at the liquid-vapour interface and the inclusion of an expression for the evaporation flux that considers this temperature discontinuity. We introduce no fitting coefficients; therefore, the stability parameters we generate contain only physical variables. The results indicate that spherical sessile droplets evaporating on insulating substrates are predicted to have a similar onset criteria with sessile droplets evaporating on conducting substrates. The onset prediction for sessile droplets evaporating on insulating substrates is found to be considerably different than the case of liquids evaporating from conical funnels constructed of insulating materials owing to the modification of the boundary condition from the geometrical shift and the corresponding retention of modes in the solution. A parametric analysis demonstrates how the input variables impact the stability of evaporating sessile droplets.

Hand-powered microfluidics: A membrane pump with a patient-to-chip syringe interface.

In this paper, we present an on-chip hand-powered membrane pump using a robust patient-to-chip syringe interface. This approach enables safe sample collection, sample containment, integrated sharps disposal, high sample volume capacity, and controlled downstream flow with no electrical power requirements. Sample is manually injected into the device via a syringe and needle. The membrane pump inflates upon injection and subsequently deflates, delivering fluid to downstream components in a controlled manner. The device is fabricated from poly(methyl methacrylate) (PMMA) and silicone, using CO2 laser micromachining, with a total material cost of ∼0.20 USD/device. We experimentally demonstrate pump performance for both deionized (DI) water and undiluted, anticoagulated mouse whole blood, and characterize the behavior with reference to a resistor-capacitor electrical circuit analogy. Downstream output of the membrane pump is regulated, and scaled, by connecting multiple pumps in parallel. In contrast to existing on-chip pumping mechanisms that typically have low volume capacity (∼5 µL) and sample volume throughput (∼1-10 µl/min), the membrane pump offers high volume capacity (up to 240 µl) and sample volume throughput (up to 125 µl/min).

Onset of Marangoni convection for evaporating liquids with spherical interfaces and finite boundaries.

We examine the stability of liquids with spherical interfaces evaporating from funnels constructed of different materials. A linear stability analysis predicts stable evaporation for funnels constructed of insulating materials and introduces a stability parameter for funnels constructed of conducting materials. The stability parameter is free of fitting variables since we use the statistical rate theory expression for the evaporation flux. The theoretical predictions are found to be consistent with experimental observations for H(2)O evaporating from a funnel constructed of poly(methyl methacrylate) and for H(2)O and D(2)O evaporating from a funnel constructed of stainless steel.

Stability of evaporating water when heated through the vapor and the liquid phases.

The stability of a water layer of uniform thickness held in a two-dimensional container of finite or semi-infinite extent is examined using linear stability theory. The liquid-vapor interface can be heated both through the liquid and through the vapor, as previously experimentally reported. The need to introduce a heat transfer coefficient is eliminated by introducing statistical rate theory (SRT) to predict the evaporation flux. There are no fitting or undefined parameters in the expression for the evaporation flux. The energy transport is parametrized in terms of the evaporation number, Eev, that for a given experimental circumstance can be predicted. The critical Marangoni number for the finite, Macf, and for the semi-infinite system, Mac(infinity), can be quantitatively predicted. Experiments in which water evaporated from a stainless-steel funnel and from a polymethyl methacrylate (PMMA) funnel into its vapor have been previously reported. Marangoni convection was observed in the experiments that used the stainless-steel funnel but not with the PMMA funnel even though the Marangoni number for the PMMA funnel was more than 27,000. The SRT-based stability theory indicates that the critical value of the Marangoni number for the experiments with the PMMA funnel was greater than the experimental value of the Marangoni number in each case; thus, no Marangoni convection was predicted to result from an instability. The observed convection with the stainless-steel funnel resulted from a temperature gradient imposed along the interface.

Multi-step microfluidic polymerization reactions conducted in droplets: the internal trigger approach.

We report the application of the "internal trigger" approach to multistep microfluidic polymerization reactions conducted in droplets, namely, polyaddition and polycondensation. We hypothesized and experimentally established that heat generated in an exothermic free radical polymerization of an acrylate monomer (Reaction 1) triggers the polycondensation of the urethane oligomer (Reaction 2). Completion of two microfluidic polymerization reactions led to the continuous synthesis of polymer particles with an interpenetrating polymer network (IPN) structure. Use of this microfluidic synthesis allowed us (i) to conduct efficient screening of the compositions of the monomer mixtures; (ii) to achieve control of the stoichiometric ratios of reactants in Reaction 2 by varying the flow rates of liquids; (iii) to reach control over the morphology of the resulting particles; and (iv) to produce polymer particles with a narrow size distribution and a predetermined size.