Emergency uncross-matched blood transfusions in a tertiary neonatal unit.

AIM: To determine the neonatal incidence, indications and outcomes following transfusions with emergency uncross-matched O-negative blood. METHODS: A five-year retrospective review in a single tertiary neonatal unit was conducted. The blood transfusion laboratory's database was analysed for all infants who had received an emergency released blood transfusion (ERBT) between January 2010 and December 2014. RESULTS: We calculated a total ERBT rate of 0.91 per 1000 live births (39/42 657) and a rate of 0.43 per 1000 in infants >34 weeks' gestation (18/41 637). A rate of 0.14 per 1000 births (6/42 657) received an ERBT as part of newborn stabilisation despite almost half of our infant cohort having intrapartum haemorrhages (n = 18, 46%). One-third (13/39) of all infants who were transfused died. Outcome varied depending on underlying aetiology, gestation and birthweight. The highest mortality was in preterm infants weighing <1000 g, of whom 70% died. CONCLUSION: This study establishes an ERBT rate of <1 per 1000 births, and 0.14 per 1000 infants received an ERBT as part of newborn delivery room stabilisation. ERBTs are associated with a high mortality rate. This study highlights the need for further research and guidelines that clarify the role of ERBTs in newborn stabilisations.

En-bloc femoral cement removal after failure of cemented total hip replacement in two dogs.

In two dogs with periprosthetic infection after total hip replacement, the femoral cement mantle was retrieved by proximal extraction without an invasive osteotomy or cortical fenestration. En-bloc femoral cement removal was performed by injection of polymethylmethacrylate cement into the central mantle void left after stem removal, and by threading a positive profile pin into the newly injected cement. Once the PMMA had polymerized, the pin was withdrawn with the entire mantle attached. This technique should be considered in patients with circumferential deterioration of the femoral bone-cement interface in which the diameter of the femoral isthmus would not obstruct withdrawal of the cement mantle.

Engineering and public health at CDC.

Engineering is the application of scientific and technical knowledge to solve human problems. Using imagination, judgment, and reasoning to apply science, technology, mathematics, and practical experience, engineers develop the design, production, and operation of useful objects or processes. During the 1940s, engineers dominated the ranks of CDC scientists. In fact, the first CDC director, Assistant Surgeon General Mark Hollis, was an engineer. CDC engineers were involved in malaria control through the elimination of standing water. Eventually the CDC mission expanded to include prevention and control of dengue, typhus, and other communicable diseases. The development of chlorination, water filtration, and sewage treatment were crucial to preventing waterborne illness. Beginning in the 1950s, CDC engineers began their work to improve public health while developing the fields of environmental health, industrial hygiene, and control of air pollution. Engineering disciplines represented at CDC today include biomedical, civil, chemical, electrical, industrial, mechanical, mining, and safety engineering. Most CDC engineers are located in the National Institute for Occupational Safety and Health (NIOSH) and the Agency for Toxic Substances and Disease Registry (ATSDR). Engineering research at CDC has a broad stakeholder base. With the cooperation of industry, labor, trade associations, and other stakeholders and partners, current work includes studies of air contaminants, mining, safety, physical agents, ergonomics, and environmental hazards. Engineering solutions remain a cornerstone of the traditional "hierarchy of controls" approach to reducing public health hazards.

Atomic spectral methods for molecular electronic structure calculations.

Theoretical methods are reported for ab initio calculations of the adiabatic (Born-Oppenheimer) electronic wave functions and potential energy surfaces of molecules and other atomic aggregates. An outer product of complete sets of atomic eigenstates familiar from perturbation-theoretical treatments of long-range interactions is employed as a representational basis without prior enforcement of aggregate wave function antisymmetry. The nature and attributes of this atomic spectral-product basis are indicated, completeness proofs for representation of antisymmetric states provided, convergence of Schrodinger eigenstates in the basis established, and strategies for computational implemention of the theory described. A diabaticlike Hamiltonian matrix representative is obtained, which is additive in atomic-energy and pairwise-atomic interaction-energy matrices, providing a basis for molecular calculations in terms of the (Coulombic) interactions of the atomic constituents. The spectral-product basis is shown to contain the totally antisymmetric irreducible representation of the symmetric group of aggregate electron coordinate permutations once and only once, but to also span other (non-Pauli) symmetric group representations known to contain unphysical discrete states and associated continua in which the physically significant Schrodinger eigenstates are generally embedded. These unphysical representations are avoided by isolating the physical block of the Hamiltonian matrix with a unitary transformation obtained from the metric matrix of the explicitly antisymmetrized spectral-product basis. A formal proof of convergence is given in the limit of spectral closure to wave functions and energy surfaces obtained employing conventional prior antisymmetrization, but determined without repeated calculations of Hamiltonian matrix elements as integrals over explicitly antisymmetric aggregate basis states. Computational implementations of the theory employ efficient recursive methods which avoid explicit construction the metric matrix and do not require storage of the full Hamiltonian matrix to isolate the antisymmetric subspace of the spectral-product representation. Calculations of the lowest-lying singlet and triplet electronic states of the covalent electron pair bond (H(2)) illustrate the various theorems devised and demonstrate the degree of convergence achieved to values obtained employing conventional prior antisymmetrization. Concluding remarks place the atomic spectral-product development in the context of currently employed approaches for ab initio construction of adiabatic electronic eigenfunctions and potential energy surfaces, provide comparisons with earlier related approaches, and indicate prospects for more general applications of the method.

Occupational silica exposure and risk of various diseases: an analysis using death certificates from 27 states of the United States.

BACKGROUND: Although crystalline silica exposure is associated with silicosis, lung cancer, pulmonary tuberculosis, and chronic obstructive pulmonary disease (COPD), there is less support for an association with autoimmune disease, and renal disease. METHODS: Using data from the US National Occupational Mortality Surveillance (NOMS) system, a matched case-control design was employed to examine each of several diseases (including silicosis, lung cancer, stomach cancer, oesophageal cancer, COPD, pulmonary tuberculosis, sarcoidosis, systemic lupus erythematosus, systemic sclerosis, rheumatoid arthritis, and various types of renal disease). Cases were subjects whose death certificate mentioned the disease of interest. A separate control group for each of the diseases of interest was selected from among subjects whose death certificate did not mention the disease of interest or any of several diseases reported to be associated with crystalline silica exposure. Subjects were assigned into a qualitative crystalline silica exposure category based on the industry/occupation pairing found on their death certificate. We also investigated whether silicotics had a higher risk of disease compared to those without silicosis. RESULTS: Those postulated to have had detectable crystalline silica exposure had a significantly increased risk for silicosis, COPD, pulmonary tuberculosis, and rheumatoid arthritis. In addition, a significant trend of increasing risk with increasing silica exposure was observed for these same conditions and for lung cancer. Those postulated to have had the greatest crystalline silica exposure had a significantly increased risk for silicosis, lung cancer, COPD, and pulmonary tuberculosis only. Finally, those with silicosis had a significantly increased risk for COPD, pulmonary tuberculosis, and rheumatoid arthritis. CONCLUSIONS: This study corroborates the association between crystalline silica exposure and silicosis, lung cancer, COPD, and pulmonary tuberculosis. In addition, support is provided for an association between crystalline silica exposure and rheumatoid arthritis.

Evaluation of opioid receptors in synovial membranes of horses.

OBJECTIVE: To evaluate mu-opioid receptors in synovial membranes of horses and determine whether these receptors are up-regulated in nerve endings during inflammation. SAMPLE POPULATION: Synovial tissue obtained from 39 client-owned horses during arthroscopy and 14 research horses during necropsy; brain and synovial tissues were obtained during necropsy from 1 horse, and control tissues were obtained from a mouse. PROCEDURE: Horses were classified into 7 groups on the basis of histologically determined degree of inflammation. Binding of primary rabbit antibody developed against mu-opioid receptors in equine synovial tissue was studied, using western blot analysis. Synovial membranes were tested for mu-opioid receptors by immunohistochemical staining, using a diaminobenzidine-cobalt chloride chromogen. Homogenates of synovial membranes were evaluated by use of radioligand binding. RESULTS: Examination of western blots of equine thalamus revealed that rabbit antibody developed against mu-opioid receptors yielded a band (molecular weight, 55 kd) that corresponded with that of other opioid receptors. Use of immunohistochemical staining of synovial tissue revealed considerable staining in the proliferative lining layer and in regions surrounding vascular structures. Specific radioligand binding of tissue homogenates was found in all groups. We did not detect significant differences in binding between horses with inflammation and horses without inflammation. CONCLUSIONS AND CLINICAL RELEVANCE: Results of immunohistochemical analysis and radioligand binding of tissue homogenates suggest that there are opioid receptors in synovial membranes of horses. Our results support the practice of intra-articular administration of opioids to relieve pain after arthroscopic surgery in horses.

Synthesis and characterization of the first examples of perfluoroalkyl-substituted trialkyloxonium salts, [(CH3)2OCF3]+[Sb2F11]- and [(CH3)2OCF(CF3)2]+[Sb2F11]-.

In the superacidic HF/SbF(5) system, methyl trifluoromethyl ether forms at -78 degrees C the new tertiary oxonium salt [(CH(3))(2)OCF(3)](+)[Sb(2)F(11)](-), which was characterized by Raman and multinuclear NMR spectroscopy and its crystal structure. The same oxonium salt was also obtained by methylation of CH(3)OCF(3) with CH(3)F and SbF(5) in HF solution at -30 to -10 degrees C. Replacement of one methyl group in the trimethyloxonium cation by the bulkier and more electronegative trifluoromethyl group increases the remaining O-CH(3) bond lengths by 0.037(1) A and the sum of the C-O-C bond angles by about 4.5 degrees. Methylation of CH(3)OCF(CF(3))(2) with CH(3)F in HF/SbF(5) solution at -30 degrees C produces [(CH(3))(2)OCF(CF(3))(2)](+)[Sb(2)F(11)](-). The observed structure and vibrational and NMR spectra were confirmed by theoretical studies at the B3LYP/6-311++G(2d,2p) and the MP2/6-311++G(2d,p) levels.

Polynitrogen chemistry. Synthesis, characterization, and crystal structure of surprisingly stable fluoroantimonate salts of N5+.

The new N5+ salt, N5+ SbF(6)(-), was prepared from N(2)F(+)SbF(6)(-) and HN(3) in anhydrous HF solution. The white solid is surprisingly stable, decomposing only at 70 degrees C, and is relatively insensitive to impact. Its vibrational spectrum exhibits all nine fundamentals with frequencies that are in excellent agreement with the theoretical calculations for a five-atomic V-shaped ion of C(2)(v)symmetry. The N5+ Sb(2)F(11)(-) salt was also prepared, and its crystal structure was determined. The geometry previously predicted for free gaseous N5+ from theoretical calculations was confirmed within experimental error. The Sb(2)F(11)(-) anions exhibit an unusual geometry with eclipsed SbF(4) groups due to interionic bridging with the N5+ cations. The N5+ cation is a powerful one-electron oxidizer. It readily oxidizes NO, NO(2), and Br(2) but fails to oxidize Cl(2), Xe, or O(2).

Crystal structure of ClF(4)(+)SbF(6)(-), normal coordinate analyses of ClF(4)(+), BrF(4)(+), IF(4)(+), SF(4), SeF(4), and TeF(4), and simple method for calculating the effects of fluorine bridging on the structure and vibrational spectra of ions in a strongly interacting ionic solid.

The crystal structure of the 1:1 adduct ClF(5).SbF(5) was determined and contains discrete ClF(4)(+) and SbF(6)(-) ions. The ClF(4)(+) cation has a pseudotrigonal bipyramidal structure with two longer and more ionic axial bonds and two shorter and more covalent equatorial bonds. The third equatorial position is occupied by a sterically active free valence electron pair of chlorine. The coordination about the chlorine atom is completed by two longer fluorine contacts in the equatorial plane, resulting in the formation of infinite zigzag chains of alternating ClF(4)(+) and cis-fluorine bridged SbF(6)(-) ions. Electronic structure calculations were carried out for the isoelectronic series ClF(4)(+), BrF(4)(+), IF(4)(+) and SF(4), SeF(4), TeF(4) at the B3LYP, MP2, and CCSD(T) levels of theory and used to revise the previous vibrational assignments and force fields. The discrepancies between the vibrational spectra observed for ClF(4)(+) in ClF(4)(+)SbF(6)(-) and those calculated for free ClF(4)(+) are largely due to the fluorine bridging that compresses the equatorial F-Cl-F bond angle and increases the barrier toward equatorial-axial fluorine exchange by the Berry mechanism. A computationally simple model, involving ClF(4)(+) and two fluorine-bridged HF molecules at a fixed distance as additional equatorial ligands, was used to simulate the bridging in the infinite chain structure and greatly improved the fit between observed and calculated spectra.

Large nondipole effects in the angular distributions of K-shell photoelectrons from molecular nitrogen.

Measurements of angular distributions of K-shell electrons photoejected from molecular nitrogen are reported which reveal large deviations at relatively low photon energies (Planck's omega < or = 500 eV) from emission patterns anticipated from the dipole approximation to interactions between radiation and matter. A concomitant theoretical analysis incorporating the effects of electromagnetic retardation attributes the observed large nondipole behaviors in N2 to bond-length-dependent terms in the E1 [multiply sign in circle] (E2,M1) photoelectron emission amplitudes which are indicative of a potentially universal nondipole behavior in molecular photoionization.

Multichannel auditory brainstem implantation: the Australian experience.

The multichannel auditory brainstem implant (ABI) provides the potential for hearing restoration in patients with neurofibromatosis type 2 (NF2). Programmes for auditory brainstem implantation have been established in two Australian centres. Eight patients have been implanted under the protocol of an international multi-centre clinical trial. Three patients had ABI insertion at the time of first side tumour removal, four at second side tumour removal and one after previous bilateral surgery where there was some residual tumour. The translabyrinthine approach was used in all cases. Successful positioning of the electrode array was achieved in seven of eight patients, all of whom achieved auditory perception with electrical stimulation. Intra-operative electrically evoked auditory brainstem response testing was successful in four patients and was useful in confirming correct electrode position. In six cases post-operative psychophysical and auditory perception testing demonstrated that useful auditory sensations were achieved. Five of these patients regularly used the implant. In one patient electrode placement was unsuccessful and only non-auditory sensations occurred on stimulation. In the remaining patients non-auditory sensations were minimal and avoidable by selective electrode programming. Auditory brainstem implantation should be considered in patients with NF2. The greatest benefit is seen in patients without debilitating disease who have non-aidable hearing in the contralateral ear.

Malignant transformation of craniopharyngioma.

Craniopharyngioma is a well recognised intracranial tumour; malignant transformation has been rarely described. In that case, malignant change occurred following irradiation for local recurrence and information is not provided on the biological behaviour of the tumour or the response to management. We report a further case of malignant transformation in recurrent craniopharyngioma following radiotherapy. The biological behaviour of malignant change in craniopharyngioma is uncertain so the treatment modalities require consideration of toxicity and other adverse sequelae balanced against anticipated outcome and comorbidities from previous treatments. The pathophysiology and therapeutic strategies are discussed. We review the possible pathogenic link between radiation therapy and malignant transformation.

The cerebellopontine angle: does the translabyrinthine approach give adequate access?

A long-standing but unfounded criticism of the translabyrinthine approach is the misperception that this approach does not give adequate access to the cerebellopontine angle. Because of what is perceived as limited visualization and operating space within the cerebellopontine angle, some surgeons still believe that the translabyrinthine approach is inappropriate for large acoustic tumors. In this study, the surgical access to the cerebellopontine angle by virtue of the translabyrinthine approach is measured and analyzed. The parameters are compared with those measured for the retrosigmoid approach. This series objectively confirms that the translabyrinthine approach offers the neurotologic surgeon a shorter operative depth to the tumor, via a similar-sized craniotomy. This permits superior visualization by virtue of a wider angle of surgical access. Such access is achieved with the merit of minimal cerebellar retraction.

Intraoperative wound infiltration with bupivacaine in patients undergoing lumbar spine surgery.

We conducted a randomized double-blind trial to evaluate the effect of intraoperative wound infiltration with bupivacaine 0.25% (1 ml/kg) compared to placebo (NaCl 0.9% 1 ml/kg) in patients undergoing lumbar spine surgery. Fifty-two patients were entered in the trial and 50 completed it. Two methods of wound infiltration were assessed: (a) infiltration after partial wound closure and (b) infiltration prior to wound closure. Postoperatively patients received morphine sulfate on demand. Visual analog pain scores were recorded every 2 h for 12 h after the operation. Analgesia requirements were recorded over the duration of the study for each patient. The patients who received bupivacaine infiltration prior to wound closure had significantly reduced pain scores in the recovery room and used significantly less morphine in the first 2 h following the procedure. They also had reduced pain scores and reduced morphine demand in the first 10 h but this did not reach statistical significance. No difference was noted between the placebo group and those receiving infiltration after partial wound closure. It is concluded that infiltration of bupivacaine is a simple and safe aid in obtaining analgesia in patients undergoing lumbar spine surgery provided that it is infiltrated prior to wound closure.

Petrous apex meningiomas: an alternative surgical approach.

The literature describes a variety of surgical approaches to deal with meningiomas that involve the apex of the petrous bone and lie predominantly in the posterior fossa, e.g. the transpetrosal (translabyrinthine and transcochlear), the combined supra- and infratentorial, the subtemporal with or without pyramid resection, the suboccipital and the orbitozygomatic approaches. This study presents an alternative surgical approach, namely a modification of the occipital craniotomy with or without tentorial division. This approach was used for the removal of three petrous bone apex meningiomas which were medium to large in size and located predominantly in the posterior fossa with extension into the middle fossa. Complete tumour excision was achieved with no morbidity and no mortality.

Encouraging small businesses to adopt effective technologies to prevent exposure to health hazards.

Small businesses are heterogeneous and the prospects are low for direct OSHA inspection and enforcement. Opportunities are explored to encourage voluntary adoption of new technology to reduce workplace exposures. The case of radiator repair shops is used in this paper to illustrate an approach to the dissemination of control technology to small businesses that will encourage these companies to adopt controls. Several behavioral theories are applied to the case.