Benchmarking a Center of Excellence in Vascular Surgery: Using Acute Physiology and Chronic Health Evaluation II to Validate Outcomes in a Tertiary Care Institute.

OBJECTIVE: The Society of Vascular Surgery (SVS) has made it a top priority to implement verification of vascular "centers of excellence". Our institutional aortic network was established in 2008 in order to standardize care of patients with suspected acute aortic pathology. The implementation and success of this program has been previously reported. We sought to use our experience as a benchmark for which to develop prognostic modeling to quantify clinical status upon admission and help predict outcomes. Our objective was to validate the Acute Physiology and Chronic Health Evaluation (APACHE) II scoring system using a cohort of aortic emergencies transferred by an organized transfer network. METHOD: This was a retrospective, single institution review of patients transferred through an institutional aortic network for acute aortic pathology from 2017-2018. Demographics, comorbidities, aortic diagnosis, APACHE II score, as well as 30-day mortality were recorded. Associations with 30-day mortality were evaluated using two-sample t-tests, ANOVA models, Pearson chi-square tests and Fisher exact tests. Receiver operating characteristic (ROC) curves were fit overall and by pathology to predict 30-day mortality by Apache II total score. RESULTS: There were 395 consecutive transfers were identified. The mean age was 64.7 years. Diagnoses included Type A Dissection (n = 134), Type B (n = 81), Aortic Aneurysm (n = 122), and PAU/IMH (n = 27). Mean APACHE II score on arrival was 12. Overall there were 53 deaths (13.4%) in the cohort. Patients that died had significantly higher Apache II total scores (11.3 vs 16.5, P < .001). The area under the receiver operator characteristic (ROC) curve (AUC) was .66 for the full cohort, indicating a poor clinical prediction test. CONCLUSION: APACHE II score is a poor predictor of 30-day mortality in a large transfer network accepting all aortic emergencies. The authors believe further refining a prognostic model for diverse population will not only help in predicting outcomes but to objectively quantify illness severity in order to have a basis for comparison among institutions and verification of "centers of excellence".

Filopodia and their links with membrane traffic and cell adhesion.

Filopodia are dynamic, narrow, plasma membrane protrusions filled with bundled actin filaments. Fresh actin monomers are incorporated at the tips furthest away from the cell body, where barbed end polymerases such as formins and Ena/VASP proteins are present in a complex with other regulatory proteins, including Myosin-X. The tightly packed, parallel alignment of actin filaments in the shaft is mediated by bundling, notably by fascin but also fimbrin and some formins. Filopodia often, but need not necessarily, emerge from areas of Arp2/3 complex nucleated F-actin. The membrane surrounding filopodia is tightly curved, where inverse-Bin-Amphiphysin-Rvs proteins deform the membrane, together with Ezrin-Radixin-Moesin proteins. Recent studies have revealed that phosphoinositide lipid metabolism and endophilin-dependent endocytosis are associated with filopodia and that filopodia are a site for virus and exosome internalization. The composition of filopodia can share similarity with the integrin adhesome, and adhesion plays mechanical and tissue matching roles in filopodia function. This review considers how filopodia form and discusses putative mechanistic integration between filopodia, endocytosis and adhesion.

Graphene gas sensing using a non-contact microwave method.

We report a non-contact CVD graphene gas sensing method that utilises a high Q microwave dielectric resonator perturbation technique. A graphene sample is coupled to the evanescent field of a dielectric resonator whereupon nitrogen dioxide (NO2), a p-doping gas, is detected by monitoring the change in the linewidth and frequency of the resonant mode. The resonant peak shape is dependent on the number of carriers in the graphene sheet. Therefore, the linewidth perturbation can be converted to a measurement of the graphene sheet resistance. To demonstrate the strength of this technique, sensor response curves for NO2 at different concentrations and temperatures are measured showing sub ppm sensitivity. This technique eliminates interactions between the trace gas and metal contacts that otherwise effect the sensor response of the graphene device.

Microwave surface impedance measurements on reduced graphene oxide.

Here we report a non-contact method for microwave surface impedance measurements of reduced graphene oxide samples using a high Q dielectric resonator perturbation technique, with the aim of studying the water content of graphene oxide flakes. Measurements are made before, during and after heating and cooling cycles. We have modelled plane wave propagation of microwaves perpendicular to the surface of graphene on quartz substrates, capacitively coupled to a dielectric resonator. Analytical solutions are derived for both changes in resonant frequency and microwave loss for a range of water layer thicknesses. In this way we have measured the presence of adsorbed water layers in reduced graphene oxide films. The water can be removed by low temperature annealing on both single and multilayer samples. The results indicate that water is intercalated between the layers in a multilayer sample, rather than only being adsorbed on the outer surfaces, and it can be released by applying a mild heating.

Design concept for a novel SQUID-based microdosemeter.

The interest in proton and ion-beam therapy has increased substantially in recent years, leading the Bureau International des Poids et Mesures to recommend that a new quantity be defined to account for the biological effect of treatment modalities used in the radiotherapy. In response, we have begun work on the design of a new microbolometer based on the inductive superconducting transition-edge detector (ISTED) designed at the National Physical Laboratory. Our work aims to expand the use of the ISTED from its current use as an infra-red detector to the measurement of energy deposition of photons, hadrons and ions by incorporating a tissue-equivalent absorber. We present here the work carried out till date, including the detection of single visible photons, with an energy resolution of 0.2 eV and a time response of a few microseconds, using a 15-µm Superconducting QUantum Interference Device operating at 9 K. We also describe thermal computational modelling carried out for a simple ISTED absorber. Finally, we discuss the work currently in progress and that to be carried out before the detector is realised.

Towards a metrological determination of the performance of SERS media.

Enhancement factors under SERS conditions are characterised for two SERS active substrates with different geometries using a combination of optical pumping and photobleaching. A rigorous mathematical method of the photobleaching dynamics under SERS conditions is developed to allow the average enhancement factor to be investigated whilst maximal enhancement factors are studied using optical pumping. We show that both average and maximal enhancements are correlated for the surfaces with average enhancements of approximately 10(8).

Temperature-dependent anti-stokes/stokes ratios under surface-enhanced Raman scattering conditions.

We make systematic measurements of Raman anti-Stokes/Stokes (aS/S) ratios using two different laser excitations (514 and 633 nm) of rhodamine 6G (RH6G) on dried Ag colloids over a wide range of temperatures (100 to 350 K). We show that a temperature scan allows the separation of the contributions to the aS/S ratios from resonance effects and heating/pumping, thus decoupling the two main aspects of the problem. The temperature rise is found to be larger when employing the 633 nm laser. In addition, we find evidence for mode specific vibrational pumping at higher laser power densities. We analyze our results in the framework of ongoing discussion on laser heating/pumping under surface-enhanced Raman scattering (SERS) conditions.

An integrated system to remote monitor and control anaerobic wastewater treatment plants through the internet.

The TELEMAC project brings new methodologies from the Information and Science Technologies field to the world of water treatment. TELEMAC offers an advanced remote management system which adapts to most of the anaerobic wastewater treatment plants that do not benefit from a local expert in wastewater treatment. The TELEMAC system takes advantage of new sensors to better monitor the process dynamics and to run automatic controllers that stabilise the treatment plant, meet the depollution requirements and provide a biogas quality suitable for cogeneration. If the automatic system detects a failure which cannot be solved automatically or locally by a technician, then an expert from the TELEMAC Control Centre is contacted via the internet and manages the problem.

Real-time scanning tunnelling microscopy imaging of protein motion at electrode surfaces.

A mutant (K27C) of the blue copper protein azurin [Eur. J. Biochem. 194 (1990) 109; J. Mol. Biol. 221 (1991) 765] for orientated immobilisation on gold surfaces was analysed by scanning tunnelling microscopy (STM) both in a resting state and following the application of a short potential pulse between the tip and sample.

Distribution of integrins alpha v beta 5, alpha v beta 3 and alpha v in normal human cornea: possible implications in clinical and therapeutic adenoviral infection.

PURPOSE: Integrins are heterodimeric cell surface molecules involved in cell-cell and cell-matrix interactions. Adenoviral entry into human cells has been shown to be dependent on integrins alpha v beta 5 and alpha v beta 3 that promote viral internalisation. We studied the distribution of integrins alpha v beta 5, alpha v beta 3 and the alpha v chain in normal human cornea to investigate possible mechanisms of adenoviral entry to specific corneal cell types. METHODS: We used immunohistochemistry with monoclonal antibodies to study the distribution of alpha v beta 5, alpha v beta 3 and alpha v in normal human corneas maintained for up to 4 days in corneal storage medium (Optisol) at 4 degrees C (n = 9). RESULTS: Both alpha v beta 5 and alpha v were present to a variable extent on the corneal epithelium and corneal endothelium of most specimens. In some specimens staining of both alpha v beta 5 and alpha v in the epithelium was graded, with more basal than superficial staining, alpha v beta 3 was not detectable in either the corneal epithelium or the corneal endothelium in those specimens tested. CONCLUSIONS: The integrin alpha v beta 5 is present on both epithelium and endothelium in the normal human cornea. The role of alpha v integrins in clinical infection and in adenoviral entry for gene transfer is discussed.

Identification of factors associated with the diagnosis of delirium in elderly hospitalized patients.

We analyzed factors associated with the discharge diagnosis of delirium among 1,285 patients admitted to a major teaching hospital during a 2-year period, developed a model to classify the risk of developing delirium on the basis of clinical and diagnostic data, and tested the model on 471 patients admitted during the subsequent year. Using the multivariate technique of recursive partitioning, we identified four factors that distinguished 80% of all cases of delirium: 1) a urinary tract infection at any time during the hospital stay (odds ratio = 3.1; 95% confidence interval = 2.02-4.58); 2) no urinary tract infection, but low serum albumin on admission (odds ratio = 2.4; 95% confidence interval = 1.43-3.99); 3) neither urinary tract infection nor low serum albumin, but elevated white blood cell count on admission (odds ratio = 1.99; 95% confidence interval = 1.18-3.37); 4) none of these risk factors, but proteinuria on admission (odds ratio = 1.82; 95% confidence interval = 1.25-2.66). Patients without any of these four risk factors had the lowest probability of developing delirium during their hospital stay. Among individuals with delirium, in-hospital mortality and hospital charges were higher. The model developed accurately characterized the risk of delirium when it was tested on patients admitted to the same hospital during the subsequent year.

The disabled living centre: what does it do?

Seventy five consecutive users of the Leeds disabled living foundation were surveyed. Two thirds of these users were at least moderately severely disabled. Forty eight of the 65 people (74%) who completed the questionnaire were recommended aids, and 33 had received some at the end of the survey. Only 10 of 28 people had received recommended adaptations. Few referrals were made to the centre by doctors. It is important that they tell their patients of this useful service.