Impedance Study of Temperature-Stable Relaxor Dielectrics in the System of BCT-BMT Ceramics.

Preparation of a lead-free system (Ba0.8Ca0.2)TiO3-xBi(Mg0.5Ti0.5)O3 (BCT-BMT) with x = 0, 0.1, 0.2, 0.3, 0.4, and 0.5 was carried out using a solid-state reaction technique. X-ray (XRD) diffraction analysis confirmed a tetragonal structure for x = 0, which shifted to cubic (pseudocubic) at x ≥ 0.1. From Rietveld refinement, a single phase with a tetragonal symmetry model (P4mm) was observed for x = 0, and however, for sample x = 0.1 and sample x = 0.5, the data are modeled to cubic (Pm3m). Composition x = 0 showed a prominent Curie peak, typical of ordinary ferroelectrics with a Curie temperature (Tc) ∼130 °C, modified to a typical relaxor dielectric at x ≥ 0.1. However, samples at x = 0.2-0.5 displayed a single semicircle attributed to the bulk response of the material, whereas a slightly depressed second arc appeared for x = 0.5 at 600 °C, indicating a slight contribution to the electrical properties, ascribed to the grain boundary of the material. Finally, the dc resistivity increased with the increase of the BMT content and the solid solution increased the activation energy from 0.58 eV at x = 0 to 0.99 eV for x = 0.5. Adding the BMT content eliminated the ferroelectric behavior at compositions x ≥ 0.1 and led to a linear dielectric response and electrostrictive behavior with a maximum strain of 0.12% for x = 0.2.

Active learning in head and neck trauma: outcomes after an innovative educational course.

Excellence in teaching and learning is fundamental to the provision of quality training for doctors and for this a sound knowledge of the principles of adult learning theory is important. We present an educational course in head and neck trauma skills for emergency medicine (EM) registrars, using the pedagogical principle of active learning. Our aim was to provide trainees with skills in the evaluation and management of hard and soft tissue injuries to the head, neck, and mouth. Active learning has been shown to provide a superior experience in classrooms, creating a 'deep' understanding of the material. To maximise learning, we used these principles to develop small group seminars led by a diverse range of teachers that allowed trainees to acquire hands-on skills. Questionnaires that were completed before and after the course showed an appreciable educational impact. We conclude that innovative teaching methods facilitate the sharing of knowledge that will benefit patient care.

The effect of lockdown during SARS-CoV-2 pandemic on maxillofacial injuries in a level I trauma centre: a comparative study.

INTRODUCTION: The SARS-CoV-2 pandemic forced many governments to impose nation-wide lockdowns. Government legislation forced limited travel on the population with restrictions on the normal way of life to limit spread of the SARS-CoV-2 virus. The aim of this study is to explore the effects of lockdown on the presentation of maxillofacial trauma in a level I trauma centre. METHODS: Comparative analysis was carried out using prospective and retrospective review of all consecutive patients admitted with any maxillofacial fracture in the lockdown period between 15th March and 15th June 2020 with the same period in 2019 to a Regional Trauma Maxillofacial Surgery Unit. Data included basic demographics and mechanism of injury including alcohol/drug influence, polytrauma, site of injury and treatment modality including escalation of care. RESULTS: Across both periods, there were a total of one hundred and five (n = 105) recorded episodes of traumatic fractures with fifty-three (n = 53) in the pre-lockdown cohort and fifty-two (n = 52) in the lockdown. Included patients were significantly (p = 0.024) older during lockdown (mean age 41.44 years SD 20.70, range 5-96) with no differences in gender distribution between cohorts (p = 0.270). Patients in lockdown were more likely to be involved in polytrauma (p < 0.05) and have sustained their injury by cycling/running or any outdoor related activity (p = 0.013). Lockdown saw a significant reduction in alcohol and drug related violence (p < 0.05). Significantly more patients required operative management (p = 0.038). CONCLUSION: Local lockdowns form part of the governments public health strategy for managing future outbreaks of SARS-CoV-2. Our study showed no significant reduction in volume of trauma during lockdown. It is vital that hospitals maintain trauma capacity to ensure that patients are treated in a timely manner.

Trends in obstetric management of extreme preterm birth at 23 to 27 weeks' gestation in a tertiary obstetric unit: A 10-year retrospective review.

OBJECTIVE: To evaluate maternal and perinatal outcomes in deliveries from 23 + 0 to 26 + 6 weeks gestation in a tertiary hospital. STUDY DESIGN: A 10-year retrospective analysis was performed which included all women who delivered between 23 + 0 and 26 + 6 weeks gestation in a tertiary obstetric unit from 01/01/2007 to 31/12/2017 inclusive. Data were collected from electronic patient records and individual chart reviews using predetermined variables. RESULTS: 340 women and 402 infants were included. 84 % (282/340) were singleton pregnancy and 17 % (59/340) had multiple pregnancies. 36.8 % (125/340) of women were delivered by Caesarean section, 11.2 % (14/125) had a classical caesarean section. The leading indications for delivery were preterm premature ruptured membranes (PPROM) 28.2 % (96/340), 8.5 % (29/340) severe pre-eclampsia (PET) and 5.6 % (19/340) were delivered for suspected placental abruption. Of all infants (N = 402), 18.9 % (76/402) were stillborn. 300 infants were admitted to the Neonatal Intensive Care Unit (NICU). The NICU survival to discharge rate was 83.7 % (251/300). The overall perinatal mortality rate (PNMR) was 328.4/1000 and a further late neonatal mortality of 47.3/1000 births. Notably, at the 23 week gestation NNDs are the major contributor to the PNMR and at later gestations stillbirths are the largest contributor. CONCLUSION: Pregnant women delivering at extreme preterm gestations are at risk of maternal morbidity. Their infants have high rates of serious morbidity and mortality, with all survivors in this cohort affected by neonatal morbidity. Informed decision-making by providers and parents requires evidence based information on perceived outcomes, ideally individualized to the mother and pregnancy in question. Information from this retrospective cohort study can be used to counsel women and their families on potential morbidity and mortality and to manage expectations.

Establishing the Maximum Collectivity in Highly Deformed N=Z Nuclei.

The lifetimes of the first excited 2^{+} states in the N=Z nuclei ^{80}Zr, ^{78}Y, and ^{76}Sr have been measured using the γ-ray line shape method following population via nucleon-knockout reactions from intermediate-energy rare-isotope beams. The extracted reduced electromagnetic transition strengths yield new information on where the collectivity is maximized and provide evidence for a significant, and as yet unexplained, odd-odd vs even-even staggering in the observed values. The experimental results are analyzed in the context of state-of-the-art nuclear density-functional model calculations.

Adult Comorbidity Evaluation-27 as a predictor of postoperative complications, two-year mortality, duration of hospital stay, and readmission within 30 days in patients with squamous cell carcinoma of the head and neck.

The Adult Comorbidity Evaluation (ACE)-27 is a validated scoring system for comorbid conditions. We have evaluated the correlation between it and the duration of hospital stay, readmission within 30 days, complications, and two-year survival in patients having primary surgical treatment for squamous cell carcinoma (SCC) of the head and neck. We studied patients with SCC who had selective neck dissection, resection of the tumour, and reconstruction between 2007 and 2013. Patients who had palliative procedures were excluded. We studied the casenotes of 231 patients and recorded the following outcome measures: TNM staging, ACE-27 score, number of days spent in hospital, readmission within 30 days, complications, and mortality at two years.The relation between the ACE-27 score and duration of hospital stay was significant (p=0.000001). The relations between complications and ACE-27 score, and complications and tumour stage, were also significant (p<0.002, and p<0.008, respectively). Two year mortality is significantly related to stage of tumour and ACE-27 score (p=0.001 and p=0.000246 respectively). We conclude that ACE-27 is a validated, relevant, scoring system for patients being operated on for SCC of the head and neck. It is a better prognostic indicator of two-year mortality than TNM stage, and is a good reflection of complications. We therefore suggest that it is used when discussing surgical outcomes, taking consent from newly-diagnosed patients, and when calculating the costs of head and neck oncological surgery.

N-terminal or signal peptide sequence engineering prevents truncation of human monoclonal antibody light chains.

Monoclonal antibodies (mAbs) contain short N-terminal signal peptides on each individual polypeptide that comprises the mature antibody, targeting them for export from the cell in which they are produced. The signal peptide is cleaved from each heavy chain (Hc) and light chain (Lc) polypeptide after translocation to the ER and prior to secretion. This process is generally highly efficient, producing a high proportion of correctly cleaved Hc and Lc polypeptides. However, mis-cleavage of the signal peptide can occur, resulting in truncation or elongation at the N-terminus of the Hc or Lc. This is undesirable for antibody manufacturing as it can impact efficacy and can result in product heterogeneity. Here, we describe a truncated variant of the Lc that was detected during a routine developability assessment of the recombinant human IgG1 MEDI8490 in Chinese hamster ovary cells. We found that the truncation of the Lc was caused due to the use of the murine Hc signal peptide together with a lambda Lc containing an SYE amino acid motif at the N-terminus. This truncation was not caused by mis-processing of the mRNA encoding the Lc and was not dependent on expression platform (transient or stable), the scale of the fed-batch culture or clonal lineage. We further show that using alternative signal peptides or engineering the Lc SYE N-terminal motif prevented the truncation and that this strategy will improve Lc homogeneity of other SYE lambda Lc-containing mAbs. Biotechnol. Bioeng. 2017;114: 1970-1977. © 2017 Wiley Periodicals, Inc.

Isospin Symmetry at High Spin Studied via Nucleon Knockout from Isomeric States.

One-neutron knockout reactions have been performed on a beam of radioactive ^{53}Co in a high-spin isomeric state. The analysis is shown to yield a highly selective population of high-spin states in an exotic nucleus with a significant cross section, and hence represents a technique that is applicable to the planned new generation of fragmentation-based radioactive beam facilities. Additionally, the relative cross sections among the excited states can be predicted to a high level of accuracy when reliable shell-model input is available. The work has resulted in a new level scheme, up to the 11^{+} band-termination state, of the proton-rich nucleus ^{52}Co (Z=27, N=25). This has in turn enabled a study of mirror energy differences in the A=52 odd-odd mirror nuclei, interpreted in terms of isospin-nonconserving (INC) forces in nuclei. The analysis demonstrates the importance of using a full set of J-dependent INC terms to explain the experimental observations.

The Dan Young Neonatal Surgical Unit audit: an audit of admissions and mortality rates pre- and post-amalgamation.

BACKGROUND AND AIMS: (1) To record the number of Index Surgical Cases (ISCs) admitted to the Royal Hospital for Sick Children (RHSC) Yorkill in 2012-2014. (2) To investigate if the amalgamation of the neonatal intensive care unit with the Dan Young Neonatal Surgical Unit in 2008 has impacted on the number of admissions and deaths. METHOD AND RESULTS: Data were collected from the ward admission books and the BadgerNet UK database. Reason for admission and outcome was recorded. Nonsurgical cases were categorised as 'miscellaneous'.The total number of admissions per year and the number of miscellaneous cases have been increasing since the amalgamation. There were no clinically significant differences in the number of babies with each ISC. The death rate was 1.8% in 2012, 2.9% in 2013 and 2.6% 2014. CONCLUSIONS: The unit now admits more miscellaneous babies and this has caused an increase in total admissions. Although the total number of deaths has increased, the death rates as a percentage of total admissions have now plateaued after an initial rise at the time of union. There has been no significant increase in the number of ISC deaths. Thus, it appears that the amalgamation has affected survival outcomes in the short term only.

Alternate scoring of the Bayley-III improves prediction of performance on Griffiths Mental Development Scales before school entry in preschoolers with developmental concerns.

BACKGROUND: The Bayley-III is widely used as an assessment tool in young children; however, its standard composite scores appear to under-estimate delay, severe and profound delay cannot be identified, and the lack of an overall score makes it difficult to compare results with later assessments. AIMS: To explore the use of Bayley-III quotient subtest and average scores, compared with composite subtest and average scores for both clinical and research purposes, comparing their ability to predict performance on the Griffiths Mental Development Scales (Griffiths) before school entry. METHOD: One hundred preschoolers referred for a diagnosis were assessed on the Bayley-III before 3.5 years. They were reassessed before school entry on the Griffiths. Composite and quotient scores were calculated and their ability to predict outcome compared across the score range. RESULTS: Averaging the three subscale quotient scores (Bayley-AQS) gave a similar mean score for this sample (61.1, SD 16.2) as for the Griffiths general quotient (Griffiths-GQ) (61.1, SD 19.6). The average composite scores (Bayley-ACS) had a significantly higher mean (74.2, SD 12.1). Correlations between the average scores on the Bayley-III and the Griffiths-GQ (0.8) were at least as strong as any of the individual subscale scores. Kappa coefficients showed that Bayley-AQS was superior to Bayley-ACS for predicting moderate and severe delay. Average change in scores was -0.1 for Bayley-AQS, and -13.2 for Bayley-ACS. Improvement in category of delay was seen in 28% of children using Bayley-AQS, and deterioration in 22%. In contrast, 5% improvement was seen using Bayley-ACS, and 65% deterioration. CONCLUSIONS: The three directly assessed subscales of the Bayley-III can be averaged to give an overall score. Bayley-AQS are a better measure of development in young children with delay than Bayley-ACS, and most children maintain their developmental classification using this method of scoring when re-assessed before school entry.

Sperm DNA damage caused by oxidative stress: modifiable clinical, lifestyle and nutritional factors in male infertility.

DNA fragmentation is an important factor in the aetiology of male infertility. However, it is still underevaluated and its inclusion in routine semen analysis is debated. DNA fragmentation has been shown to be a robust indicator of fertility potential, more so than conventional semen parameters. Men with high DNA fragmentation levels have significantly lower odds of conceiving, naturally or through procedures such as intrauterine insemination and IVF. Couples may be counselled to proceed directly to intracytoplasmic sperm injection as it is more successful in this group, avoiding costly procedures, recurrent failures or pregnancy losses; however, this treatment is not without limitations or risks. Ideally DNA fragmentation should be minimized where possible. Oxidative stress is the major cause of DNA fragmentation in spermatozoa. Endogenous and exogenous factors that contribute to oxidative stress are discussed, and in many cases are shown to be easily modifiable. Antioxidants play a protective role, although a delicate balance of reduction and oxidation is required for essential functions, including fertilization. Reducing oxidative stress may improve a couple's chances of conception either naturally or via assisted reproduction. Sources of oxidative stress therefore should be thoroughly examined in men with high levels of DNA fragmentation and modified where possible. DNA fragmentation is an important factor in the aetiology of male infertility. However it is still underevaluated and its inclusion in routine semen analysis is still debated. DNA fragmentation has been shown to be a robust indicator of fertility potential, more so than conventional semen parameters. Men with high levels of DNA fragmentation will have significantly lower odds of conceiving naturally or through procedures such as intrauterine insemination and IVF. Intracytoplasmic sperm injection (ICSI) may be much more successful in this group, and couples may be counselled to proceed directly to ICSI, avoiding costly procedures, recurrent failures or pregnancy losses. However, ICSI is not without its limitations or risks. Ideally, DNA fragmentation should be investigated and minimized where possible in men trying to conceive naturally or through assisted reproduction technology. Oxidative stress is the major cause of DNA fragmentation in spermatozoa. Endogenous and exogenous factors that contribute to oxidative stress are discussed and in many cases are easily modifiable. Antioxidants play a protective role, although a delicate balance of reduction and oxidation is required for essential sperm function, including fertilization. Reducing oxidative stress may improve a couple's chances of conception either naturally or via assisted reproduction treatment. Sources of oxidative stress therefore should be thoroughly examined in men with high levels of DNA fragmentation and modified where possible.

The influence of different dressings on the pH of the wound environment.

OBJECTIVE: This study examines the effect of various wound dressings on the pH levels of a wound, using a simulated wound environment. METHOD: The pH levels of a 4 different wound dressings (manuka honey dressing, sodium carboxymethylcellulose hydrofiber dressing, polyhydrated ionogen-coated polymer mesh dressing, and a protease modulating collagen cellulose dressing) were tested in a simulated horse serum wound environment. The effect of local buffering was observed and pH changes in real time were measured. RESULTS: All dressings were found to have low pH (below pH 4), with the lowest being the protease modulating collage cellulose dressing, with a pH of 2.3. The dressing with the strongest acid concentration was the polyhydrated, ionogen-coated, polymer mesh dressing. CONCLUSION: The low pH and strong acidic nature of the dressing investigated indicate that they may play a role in influencing the healing process in a wound. DECLARATION OF INTEREST: The authors have no conflicts of interest to declare. This study was funded by the EPSRC.

Women's satisfaction and symptoms following NovaSure endometrial ablation: a postal questionnaire survey in Lothian, Scotland.

Impedance-controlled endometrial ablation (NovaSure) is commonly used to treat premenopausal heavy menstrual bleeding in Lothian, Scotland. Using postal questionnaires, we assessed patient satisfaction, treatment success and post-procedure symptoms in a cohort of women who had NovaSure treatment between January 2007 and May 2009. The response rate was 61.2% (115/188): 90.4% (104/115) of women were satisfied and would recommend the procedure; 36.8% (42/114) of women were amenorrhoeic at follow-up (mean = 497 days) and NovaSure significantly improved levels of both menstrual bleeding and pain (p < 0.01). Of the women, 67.0% (77/115) reported symptoms such as discomfort, vaginal discharge and bleeding/spotting within 6 weeks following NovaSure. A total of 13.9% (16/115) required further treatment following NovaSure, including hysterectomy. Patient satisfaction with NovaSure was high. Preoperative counselling needs to include information on character and duration of postoperative symptoms. Future research could compare patient satisfaction and clinical outcomes between NovaSure and the levonorgestrel-releasing intrauterine system.

A South African database of samples analysed for the presence of asbestos

Background: Asbestos mining and other activities have left a legacy of environmental contamination. Asbestos was used in a large number of manufactured products but little is documented about the nature and location of these products. Compliance with asbestos regulations depends on accurate identification of the presence of asbestos. The National Institute for Occupational Health (NIOH) has been identifying asbestos for regulatory purposes since 2003. Objective: To analyse a database of samples submitted for asbestos analysis to the NIOH. Methods: Asbestos was identified using scanning electron microscopy and energy dispersive spectroscopy. The data were analysed using STATISTICA version 11. Results: From 2003 to 2012; 1514 samples were analysed. Asbestos was identified in 59.9 of the bulk samples and crocidolite was present in 45.4 of these. Information about samples containing asbestos; including their origin and associated activities; are described. Conclusions: Although asbestos is no longer mined or used in South Africa; workers remain at risk of exposure due to asbestos-containing materials which persist in the environment. Knowledge of these materials gained from routinely collected data may assist in the safe removal of asbestos and prevent further adverse health =effects

Characterization of dentine structure in three dimensions using FIB-SEM.

All biological tissues are three dimensional and contain structures that span a range of length scales from nanometres through to hundreds of millimetres. These are not ideally suited to current three-dimensional characterization techniques such as X-ray or transmission electron tomography. Such detailed morphological analysis is critical to understanding the structural features relevant to tissue function and designing therapeutic strategies intended to address structural deficiencies encountered in pathological states. We show that use of focused ion beam milling combined with scanning electron microscopy can provide three-dimensional information at nanometre resolution from biologically relevant volumes of material, in this case dentine.

Nanoparticles for dentine tubule infiltration: an in vitro study.

Nanosized particles of hydroxyapatite were produced by a hydrothermal synthesis technique. Reaction time and starting pH were varied in order to produce a range of particle dimensions and morphologies. The particles were suspended in alcohol and used for in-vitro trials of dentinal tubule infiltration in etched sections of clinically extracted human molars. Particles were of rod-like morphology, and decreased in aspect ratio as the starting pH was raised. Particles prepared at pH 12 had a mean length of approximately 70 nm and diameter of approximately 30 nm. These showed the most promising infiltration results, with up to 90% of the tubules being fully or partially occluded. Comparisons were made with commercially-available 40 nm spherical silica particles. Information on the depth of infiltration was obtained from sections of dentine prepared using focussed ion beam milling (FIB-SEM).

Use of seclusion in an English high security hospital.

There is a paucity of information about the use of seclusion in secure settings. The aim of this paper was to establish if any significant trends could be found for its use in a high secure setting. A retrospective descriptive survey of seclusions occurring over a one-year period at Rampton Hospital was utilised. Of the 443 patients within the study sample, 131 (29.6%) were involved in episodes of seclusion. Forty-five per cent of women experienced episodes of seclusion as opposed to 27% of men (p = 0.004). Women were secluded at an average of 11.4 times, mostly following threatening behaviour, whereas males were secluded at an average of 4.3 times (p = 0.03). There were two peak times for initiation of seclusion--10.00 hrs and 17.00 hrs. The survey concluded that women were nearly twice as likely to be secluded as men and averaged three times as many episodes of seclusion. Younger patients were more likely to experience seclusion and spent longer periods of time in seclusion. No statistically significant differences were found between the use of seclusion and ethnicity. The observations related to female patients were particularly interesting and further studies on seclusion are required to inform upon strategies to minimise its use, with specific attention to female patients.