Assessing the effects of transient weather conditions on airborne transmission risk in naturally ventilated hospitals

BACKGROUND

Many UK hospitals rely heavily on natural ventilation as their main source of airflow in patient wards. This method of ventilation can have cost and energy benefits, but it may lead to unpredictable flow patterns between indoor spaces, potentially leading to the unexpected transport of infectious material to other connecting zones. However, the effects of weather conditions on airborne transmission are often overlooked.

METHODS

A multi-zone CONTAM model of a naturally ventilated hospital respiratory ward, incorporating time-varying weather, was proposed. Coupling this with an airborne infection model, this study assessed the variable risk in interconnected spaces, focusing particularly on occupancy, disease and ventilation scenarios based on a UK respiratory ward.

RESULTS

The results suggest that natural ventilation with varying weather conditions can cause irregularities in the ventilation rates and interzonal flow rates of connected zones, leading to infrequent but high peaks in the concentration of airborne pathogens in particular rooms. This transient behaviour increases the risk of airborne infection, particularly through movement of pathogens between rooms, and highlights that large outbreaks may be more likely under certain conditions. This study demonstrated how ventilation rates achieved by natural ventilation are likely to fall below the recommended guidance, and that the implementation of supplemental mechanical ventilation can increase ventilation rates and reduce the variability in infection risks.

CONCLUSION

This model emphasises the need for consideration of transient external conditions when assessing the risk of transmission of airborne infection in indoor environments.

Stabilisation of the [SiH6]2- Anion within a Supramolecular Assembly

The hypercoordinate [SiH6]2- anion is not stable in solution. Here, we report the room temperature, solution stable molecular [SiH6]2- complex, [{KCa(NON)(OEt2)}2][SiH6] (NON=4,5-bis(2,6-diisopropylanilido)-2,7-di-tert-butyl-9,9-dimethyl-xanthene)), where the [SiH6]2- anion is stabilised within a supramolecular assembly that mimics the solid-state environment of the anion in the lattice of K2SiH6. Solution-state reactivity of the complex towards carbon monoxide, benzaldehyde, azobenzene and acetonitrile is reported, yielding a range of reduction and C-C coupled products.

The Ambiguous Origin of Thermochromism in Molecular Crystals of Dichalcogenides: Chalcogen Bonds versus Dynamic Se-Se/Te-Te Bonds

We report thermochromism in crystals of diphenyl diselenide (dpdSe) and diphenyl ditelluride (dpdTe), which is at variance with the commonly known mechanisms of thermochromism in molecular crystals. Variable temperature neutron diffraction studies indicated no conformational change, tautomerization or phase transition between 100 K and 295 K. High-pressure crystallography studies indicated no associated piezochromism in dpdSe and dpdTe crystals. The evolution of the crystal structures and their electronic band structure with pressure and temperature reveal the contributions of intramolecular and intermolecular factors towards the origin of thermochromism-especially the intermolecular Se⋅⋅⋅Se and Te⋅⋅⋅Te chalcogen bonds and torsional modes of vibrations around the dynamic Se-Se and Te-Te bonds. Further, a co-crystal of dpdSe with iodine (dpdSe-I2 ) and an alloy crystal of dpdSe and dpdTe implied a predominantly intramolecular origin of the observed thermochromism associated with vibronic coupling.

Magnesium(I) Reduction of Aluminum(III) Hydride Complexes: Generation of Mixed Valence Aluminum (AlI/Al0) Hydride Cluster Compounds, [Al6H8(NR3)2{Mg(β-diketiminate)}4]

Reduction of a range of amido- and aryloxy-aluminum dihydride complexes, e.g. [AlH2(NR3){N(SiMe3)2}] (NR3 = NMe3 or N-methylpiperidine (NMP)), with β-diketiminato dimagnesium(I) reagents, [{(ArNacnac)Mg}2] (ArNacnac = [HC(MeCNAr)2]-, Ar = mesityl (Mes) or 2,6-xylyl (Xyl)), have afforded deep red mixed valence aluminum hydride cluster compounds, [Al6H8(NR3)2{Mg(ArNacnac)}4], which have an average Al oxidation state of +0.66, the lowest for any well-defined aluminum hydride compound. In the solid-state, the clusters are shown to have distorted octahedral Al6 cores, having zero-valent Al axial sites and mono-valent AlH2- equatorial units. Several novel by-products were isolated from the reactions that gave the clusters, including the Mg-Al bonded magnesio-aluminate complexes, [(ArNacnac)(Me3N)Mg-Al(μ-H)3[{Mg(ArNacnac)}2(μ-H)]]. Computational analyses of one aluminum hydride cluster revealed its Al6 core to be electronically delocalized, and to possess one unoccupied, and six occupied, skeletal molecular orbitals.

Diagnostic accuracy of a decision-support software for the detection of intracranial large-vessel occlusion in CT angiography

AIM

To investigate the real-world clinical performance of the decision-support software "e-CTA" (e-Stroke Suite, Brainomix Limited, Oxford UK) for the detection of acute intracranial large-vessel occlusion (LVO) on computed tomography (CT) angiography at a UK district general hospital.

MATERIALS AND METHODS

The retrospective study included 300 consecutive CT angiograms of the head and neck performed between 8 March 2021 and 20 May 2021. e-CTA findings were recorded and compared with the radiologist report. Cases in which there was disagreement between e-CTA and the radiologist were reviewed by a sub-specialist vascular radiologist as the reference standard.

RESULTS

The incidence of intracranial LVO was 7%. e-CTA correctly identified 18 of 21 intracranial proximal LVOs (86%). There were 34 false positives. The sensitivity was 0.86 (95% confidence interval [CI], 0.64-0.97), with specificity of 0.88 (95% CI, 0.83-0.91). The positive predictive value was 0.35 (95% CI, 0.27-0.43). The negative predictive value was 0.99 (95% CI, 0.96-1.00).

CONCLUSION

Sensitivity, specificity, and negative predictive values were similar to those reported in the literature (Seker et al., Int J Stroke. 2021; 17:77-82); however, the positive predictive value for e-CTA was significantly lower. In practice, this meant that over half of all reported occlusions by the software were false positives. Radiologists should be aware of these metrics in order to assign appropriate weight to software findings when formulating a report. Differences in population demographics, scanners, CT protocols, and incidence are all factors potentially influencing software accuracy. Local validation testing may help provide accuracy metrics more relevant to individual institutions.

Anionic Magnesium and Calcium Hydrides: Transforming CO into Unsaturated Disilyl Ethers

The synthesis, characterisation and reactivity of two isostructural anionic magnesium and calcium complexes is reported. By X-ray and neutron diffraction techniques, the anionic hydrides are shown to exist as dimers, held together by a range of interactions between the two anions and two bridging potassium cations. Unlike the vast proportion of previously reported dimeric group 2 hydrides, which have hydrides that bridge two group 2 centres, here the hydrides are shown to be "terminal", but stabilised by interactions with the potassium cations. Both anionic hydrides were found to insert and couple CO under mild reaction conditions to give the corresponding group 2 cis-ethenediolate complexes. These cis-ethenediolate complexes were found to undergo salt elimination reactions with silyl chlorides, allowing access to small unsaturated disilyl ethers with a high percentage of their mass originating from the C1 source CO.

The Continuum Between Hexagonal Planar and Trigonal Planar Geometries

New heterometallic hydride complexes that involve the addition of {Mg-H} and {Zn-H} bonds to group 10 transition metals (Pd, Pt) are reported. The side-on coordination of a single {Mg-H} to Pd forms a well-defined σ-complex. In contrast, addition of three {Mg-H} or {Zn-H} bonds to Pd or Pt results in the formation of planar complexes with subtly different geometries. We compare their structures through experiment (X-ray diffraction, neutron diffraction, multinuclear NMR), computational methods (DFT, QTAIM, NCIPlot), and theoretical analysis (MO diagram, Walsh diagram). These species can be described as snapshots along a continuum of bonding between ideal trigonal planar and hexagonal planar geometries.

Nickel and Palladium Complexes of a PP(O)P Pincer Ligand Based upon a peri-Substituted Acenaphthyl Scaffold and a Secondary Phosphine Oxide

A PP(O)P pincer ligand based upon a peri-substituted acenaphthyl (Ace) scaffold and a secondary phosphine oxide, (5-Ph₂P-Ace-6-)₂P(O)H, was prepared and fully characterized including a neutron diffraction study. The reaction with [Ni(H₂O)₆]Cl₂ and PdCl₂ produced ionic metal(II) complexes [κ³-P,P',P''((5-Ph₂P-Ace-6-)₂P(OH))MCl]Cl, which upon addition of Et₃N gave rise to zwitterionic metal(II) complexes κ³-P,P',P''((5-Ph₂P-Ace-6-)₂P(O))MCl (M = Ni, Pd). The reaction with Ni(COD)₂ (COD = cyclooctadiene) provided the η³-cyclooctenyl Ni(II) complex κ³-P,P',P''((5-Ph₂P-Ace-6-)₂P(O))Ni(η³-C₈H₁₃). A detailed complementary bonding analysis of the P-H, P-O, and P-M interactions was carried out (M = Ni, Pd).

N-Heterocyclic carbene, carbodiphosphorane and diphosphine adducts of beryllium dihalides: synthesis, characterisation and reduction studies

Reaction of several N-heterocyclic carbenes, a carbodiphosphorane, and bis(diphenylphosphino)ethane (DPPE) with [BeX2(OEt2)2] (X = Br or I) have yielded a variety of beryllium dihalide adduct complexes, all of which were crystallographically characterised. Attempts to reduce the compounds to low oxidation state beryllium complexes using a variety of reducing agents have been carried out, but were of limited success. However, reaction of [(IPr)BeBr2] (IPr = :C{(DipNCH)2}; Dip = 2,6-diisopropylphenyl) with the aluminium(i) heterocycle, [:Al(DipNacnac)] (DipNacnac = [HC(MeCNDip)2]-) afforded the adduct complex, [{(IPr)(Br)Be(μ-H)}2], while reduction of [(IPr)BeBr2] with potassium naphthalenide gave the beryllium naphthalenediyl complex, [(IPr)Be(C10H8)]. Furthermore, reaction of [{(DPPE)BeI2}∞], with [:Al(DipNacnac)] led to insertion of the Al centre of the heterocycle into a Be-I bond, and formation of a rare example of an Al-Be bonded complex, [(DPPE)(i)Be-Al(i)(DipNacnac)].

C-H and C-F coordination of arenes in neutral alkaline earth metal complexes

A series of neutral magnesium and calcium complexes bearing an extremely bulky diamido ligand have been synthesised and crystallographically characterised. A number of these complexes feature rare group 2 metalaromatic interactions, such as the η6-coordination of benzene and 'agostic-like' C-H coordination, the latter previously unseen in neutral Mg and Ca complexes.

'Big Data' informed drug development: a case for acceptability

Data, which help inform various stages of drug product development, are increasingly being collected using newer, more novel platforms, such as mobile applications, and analysed computationally as much larger 'Big Data' data sets, revealing patterns relating to human behaviour and interactions. Medicine acceptability gauges the ability and willingness of patients to take their dosage forms. It has become a crucial human component of drug product design. Vouching for the age appropriateness of medicinal products, acceptability related data are now expected by regulatory bodies. Shifting from traditional paper-based to electronic data-gathering platforms will allow the pharmaceutical industry to collect real-world, real-time, clinically relevant data, capable of informing current and future drug product development, reducing time and cost, and setting foundations for patient-centric drug product design.

Identification of stable genes in the corpus luteum of lactating Holstein cows in pregnancy and luteolysis: Implications for selection of reverse-transcription quantitative PCR reference genes

In lactating dairy cattle, the corpus luteum (CL) is a dynamic endocrine tissue vital for pregnancy maintenance, fertility, and cyclicity. Understanding processes underlying luteal physiology is therefore necessary to increase reproductive efficiency in cattle. A common technique for investigating luteal physiology is reverse-transcription quantitative PCR (RT-qPCR), a valuable tool for quantifying gene expression. However, reference-gene-based RT-qPCR quantification methods require utilization of stably expressed genes to accurately assess mRNA expression. Historically, selection of reference genes in cattle has relied on subjective selection of a small pool of reference genes, many of which may have significant expression variation among different tissues or physiologic states. This is particularly concerning in dynamic tissues such as the CL, with its capacity for rapid physiologic changes during luteolysis, and likely in the less characterized period of CL maintenance during pregnancy. Thus, there is a clear need to identify reference genes well suited for the bovine CL over a wide range of physiological states. Whole-transcriptome RNA sequencing stands as an effective method to identify new reference genes by enabling the assessment of the expression profile of the entire pool of mRNA transcripts. We report the identification of 13 novel putative reference genes using RNA sequencing in the bovine CL throughout early pregnancy and luteolysis: RPL4, UQCRFS1, COX4I1, RPS4X, SSR3, CST3, ZNF266, CDC42, CD63, HIF1A, YWHAE, EIF3E, and PPIB. Independent RT-qPCR analyses were conducted confirming expression stability in another set of CL tissues from pregnancy and regression, with analyses performed for 3 groups of samples: (1) all samples, (2) samples from pregnancy alone, and (3) samples throughout the process of CL regression. Seven genes were found to be more stable in all states than 2 traditional reference genes (ACTB and GAPDH): RPS4X, COX4I1, PPIB, SSR3, RPL4, YWHAE, and CDC42. When CL tissues from pregnant animals alone were analyzed, CST3, HIF1A, and CD63 were also identified as more stable than ACTB and GAPDH. Identification of these new reference genes will aid in accurate normalization of RT-qPCR results, contributing to proper interpretation of gene expression relevant to luteal physiology. Furthermore, our analysis sheds light on the effects of luteolysis and pregnancy on the stability of gene expression in the bovine CL.

Hydrogen atoms in bridging positions from quantum crystallographic refinements: influence of hydrogen atom displacement parameters on geometry and electron density

Hydrogen atom positions can be obtained accurately from X-ray diffraction data of hydrogen maleate salts via Hirshfeld atom refinement.

Proximity Enforced Agostic Interactions Involving Closed-Shell Coinage Metal Ions

A proximity enforcing diarylsilane ligand is reported, which gives rise to unusual Si-H···M interactions with the d¹⁰ metal ions Cu⁺ and Ag⁺ upon complexation. These interactions are studied in detail both experimentally and computationally and can be classified to be weakly agostic in nature for the Si-H···Cu interaction. The Si-H···Ag interaction has more signatures of an electrostatic contact.

Experimental Insights into the Electronic Nature, Spectral Features, and Role of Entropy in Short CH3···CH3 Hydrophobic Interactions

Hydrophobic interactions are often explored in solution-state aggregation of molecules. However, an experimental electron density description about these interactions is still lacking. Here, we report a systematic study on the electronic nature of methyl···methyl hydrophobic interactions in a series of multicomponent crystals of biologically active molecules. Charge density models based on high-resolution X-ray diffraction allow the visualization of subtle details of electron density features in the interaction region. Our study classifies these interactions as atypical group···group interactions in contrast to σ-hole interactions, which are stabilized by the minimized electrostatic repulsion and maximized dispersion forces. For the first time, we quantified the solid-state entropic contribution from the torsional mode of the methyl groups in stabilizing these interactions by thermal motion analysis based on neutron diffraction as well as variable-temperature crystallography. The carbon atoms in methyl···methyl interactions show a unique upfield chemical shift in the ¹³C solid-state NMR signal.

Fast and Accurate Quantum Crystallography: From Small to Large, from Light to Heavy

The coupling of the crystallographic refinement technique Hirshfeld atom refinement (HAR) with the recently constructed libraries of extremely localized molecular orbitals (ELMOs) gives rise to the new quantum-crystallographic method HAR-ELMO. This method is significantly faster than HAR but as accurate and precise, especially concerning the free refinement of hydrogen atoms from X-ray diffraction data, so that the first fully quantum-crystallographic refinement of a protein is presented here. However, the promise of HAR-ELMO exceeds large molecules and protein crystallography. In fact, it also renders possible electron-density investigations of heavy elements in small molecules and facilitates the detection and isolation of systematic errors from physical effects.

The partial dehydrogenation of aluminium dihydrides

The reactions of a series of β-diketiminate stabilised aluminium dihydrides with ruthenium bis(phosphine), palladium bis(phosphine) and palladium cyclopentadienyl complexes is reported. In the case of ruthenium, alane coordination occurs with no evidence for hydrogen loss resulting in the formation of ruthenium complexes with a pseudo-octahedral geometry and cis-relation of phosphine ligands. These new ruthenium complexes have been characterised by multinuclear and variable temperature NMR spectroscopy, IR spectroscopy and single crystal X-ray diffraction. In the case of palladium, a series of structural snapshots of alane dehydrogenation have been isolated and crystallographically characterised. Variation of the palladium precursor and ligand on aluminium allows kinetic control over reactivity and isolation of intermetallic complexes that contain new Pd-Al and Pd-Pd interactions. These complexes differ by the ratio of H : Al (2 : 1, 1.5 : 1 and 1 : 1) with lower hydride content species forming with dihydrogen loss. A combination of X-ray and neutron diffraction studies have been used to interrogate the structures and provide confidence in the assignment of the number and position of hydride ligands. 27Al MAS NMR spectroscopy and calculations (DFT, QTAIM) have been used to gain an understanding of the dehydrogenation processes. The latter provide evidence for dehydrogenation being accompanied by metal-metal bond formation and an increased negative charge on Al due to the covalency of the new metal-metal bonds. To the best of our knowledge, we present the first structural information for intermediate species in alane dehydrogenation including a rare neutron diffraction study of a palladium-aluminium hydride complex. Furthermore, as part of these studies we have obtained the first SS 27Al NMR data on an aluminium(i) complex. Our findings are relevant to hydrogen storage, materials chemistry and catalysis.

Investigation of an Unusual Crystal Habit of Hydrochlorothiazide Reveals Large Polar Enantiopure Domains and a Possible Crystal Nucleation Mechanism

The observation of an unusual crystal habit in the common diuretic drug hydrochlorothiazide (HCT), and identification of its subtle conformational chirality, has stimulated a detailed investigation of its crystalline forms. Enantiomeric conformers of HCT resolve into an unusual structure of conjoined enantiomorphic twin crystals comprising enantiopure domains of opposite chirality. The purity of the domains and the chiral molecular conformation are confirmed by spatially revolved synchrotron micro-XRD experiments and neutron diffraction, respectively. Macroscopic inversion twin symmetry observed between the crystal wings suggests a pseudoracemic structure that is not a solid solution or a layered crystal structure, but an unusual structural variant of conglomerates and racemic twins. Computed interaction energies for molecular pairs in the racemic and enantiopure polymorphs of HCT, and the observation of large opposing unit-cell dipole moments for the enantiopure domains in these twin crystals, suggest a plausible crystal nucleation mechanism for this unusual crystal habit.

Long-term impacts of rising sea temperature and sea level on shallow water coral communities over a ~40 year period

Effects of combined rising sea temperature and increasing sea level on coral reefs, both factors associated with global warming, have rarely been addressed. In this ~40 y study of shallow reefs in the eastern Indian Ocean, we show that a rising relative sea level, currently estimated at ~11 mm y⁻¹, has not only promoted coral cover but also has potential to limit damaging effects of thermally-induced bleaching. In 2010 the region experienced the most severe bleaching on record with corals subject to sea temperatures of >31 °C for 7 weeks. While the reef flats studied have a common aspect and are dominated by a similar suite of coral species, there was considerable spatial variation in their bleaching response which corresponded with reef-flat depth. Greatest loss of coral cover and community structure disruption occurred on the shallowest reef flats. Damage was less severe on the deepest reef flat where corals were subject to less aerial exposure, rapid flushing and longer submergence in turbid waters. Recovery of the most damaged sites took only ~8 y. While future trajectories of these resilient reefs will depend on sea-level anomalies, and frequency of extreme bleaching the positive role of rising sea level should not be under-estimated.