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".

Sustainable production of highly conductive multilayer graphene ink for wireless connectivity and IoT applications

Printed electronics offer a breakthrough in the penetration of information technology into everyday life. The possibility of printing electronic circuits will further promote the spread of the Internet of Things applications. Inks based on graphene have a chance to dominate this technology, as they potentially can be low cost and applied directly on materials like textile and paper. Here we report the environmentally sustainable route of production of graphene ink suitable for screen-printing technology. The use of non-toxic solvent Dihydrolevoglucosenone (Cyrene) significantly speeds up and reduces the cost of the liquid phase exfoliation of graphite. Printing with our ink results in very high conductivity (7.13 × 10⁴ S m⁻¹) devices, which allows us to produce wireless connectivity antenna operational from MHz to tens of GHz, which can be used for wireless data communication and energy harvesting, which brings us very close to the ubiquitous use of printed graphene technology for such applications.

Printed conductive inks show promise for future electronic device applications. Here, the authors report synthesis of graphene inks with conductivity of 7.13 × 10^4 S/m by Cyrene assisted liquid phase exfoliation, and their applications in data communication and RF energy harvesting.

Electrical Homogeneity Mapping of Epitaxial Graphene on Silicon Carbide

Epitaxial graphene is a promising route to wafer-scale production of electronic graphene devices. Chemical vapor deposition of graphene on silicon carbide offers epitaxial growth with layer control but is subject to significant spatial and wafer-to-wafer variability. We use terahertz time-domain spectroscopy and micro four-point probes to analyze the spatial variations of quasi-freestanding bilayer graphene grown on 4 in. silicon carbide (SiC) wafers and find significant variations in electrical properties across large regions, which are even reproduced across graphene on different SiC wafers cut from the same ingot. The dc sheet conductivity of epitaxial graphene was found to vary more than 1 order of magnitude across a 4 in. SiC wafer. To determine the origin of the variations, we compare different optical and scanning probe microscopies with the electrical measurements from nano- to millimeter scale and identify three distinct qualities of graphene, which can be attributed to the microstructure of the SiC surface.

Transparent Conducting Graphene Hybrid Films To Improve Electromagnetic Interference (EMI) Shielding Performance of Graphene

Conducting graphene-based hybrids have attracted considerable attention in recent years for their scientific and technological significance in many applications. In this work, conductive graphene hybrid films, consisting of a metallic network fully encapsulated between monolayer graphene and quartz-glass substrate, were fabricated and characterized for their electromagnetic interference shielding capabilities. Experimental results show that by integration with a metallic network the sheet resistance of graphene was significantly suppressed from 813.27 to 5.53 Ω/sq with an optical transmittance at 91%. Consequently, the microwave shielding effectiveness (SE) exceeded 23.60 dB at the K_u-band and 13.48 dB at the K_a-band. The maximum SE value was 28.91 dB at 12 GHz. Compared with the SE of pristine monolayer graphene (3.46 dB), the SE of graphene hybrid film was enhanced by 25.45 dB (99.7% energy attenuation). At 94% optical transmittance, the sheet resistance was 20.67 Ω/sq and the maximum SE value was 20.86 dB at 12 GHz. Our results show that hybrid graphene films incorporate both high conductivity and superior electromagnetic shielding comparable to existing ITO shielding modalities. The combination of high conductivity and shielding along with the materials' earth-abundant nature, and facile large-scale fabrication, make these graphene hybrid films highly attractive for transparent EMI shielding.

Nanoscale Superconducting Quantum Interference Devices Add Another Dimension

Over the past decade, nanoscale superconducting quantum interference devices (nanoSQUIDs) have rapidly risen from nowhere to forge a new sphere of applications of these macroscopic quantum devices. New fabrication techniques have enabled these advances. In this Perspective, we highlight another recent major development in this area-the demonstration of a three-axis nanoSQUID magnetometer, which enables the vector magnetization of a nanoscale magnetic particle to be measured in the presence of an applied magnetic field. We illustrate the technological demands and developments that have driven the development of nanoSQUIDs and make suggestions for future directions for applications.

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.

The quantum electrical triangle

The past 35 years have seen the development of an unexpected plethora of quantum electrical standards based on just two fundamental constants, e and h. First came a voltage standard based on the Josephson a.c. effect, in terms of which most maintained primary standards of voltage are defined. This was followed a decade later by the quantized Hall effect, based on the von Klitzing constant which allows the ohm to be maintained very precisely. It became clear 20 years ago that there is also a possible quantum current standard. This third standard has yet to play a full part in practical electrical metrology. However, recent developments suggest that there are many different possible manifestations in which such a current standard might be realized. The three quantum standards, taken together, define the quantum electrical triangle of standards which would allow the units to be realized in terms of different combinations of e and h. We summarize the very different physics behind the three standards, reviewing the present state of development in all three. Implications for the future are also considered, especially relating to ultra-low temperature, nanoscale and truly quantum mechanical versions of the standards.

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.

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.

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.