High resolution front-side visualization of charge stored in EEPROM with scanning nonlinear dielectric microscopy (SNDM)

By exposing floating gates of EEPROM memory cells with frontside sample preparation, scanning nonlinear dielectric microscopy (SNDM) succeeded in reading back the data stored in the memory cells with a 250 nm node size. At an optimized voltage bias of AC = 3 V and DC = 1 V, a clear signal contrast between programmed and erased cells is obtained. The high resolution SNDM signal reveals the details of bowling-pin shape structure of memory cells, providing high confidence in data assignment during forensic applications. Such high resolution also makes SNDM a promising technique for newer generation devices with smaller node size.

COVID-19 End-of-life Care: Symptoms and Supportive Therapy Use in an Australian Hospital

Background

Descriptions of symptoms and medication use at end of life in COVID‐19 are limited to small cross‐sectional studies, with no Australian longitudinal data.

Aims

To describe end‐of‐life symptoms and care needs of people dying of COVID‐19.

Methods

This retrospective cohort study included consecutive admitted patients who died at a Victorian tertiary referral hospital from 1 January to 30 September directly due to COVID‐19. Clinical characteristics, symptoms and use of supportive therapies, including medications and non‐pharmacological interventions in the last 3 days of life were extracted.

Results

The cohort comprised 58 patients (median age 87 years, interquartile range (IQR) 81–90) predominantly admitted from home (n = 30), who died after a median of 11 days (IQR 6–28) in the acute medical (n = 31) or aged care (n = 27) wards of the hospital. The median Charlson Comorbidity Score was 7 (IQR 5–8). Breathlessness (n = 42), agitation (n = 36) and pain (n = 33) were the most frequent clinician‐reported symptoms in the final 3 days of life, with most requiring opioids (n = 52), midazolam (n = 40), with dose escalation commonly being required. While oxygen therapy was commonly used (n = 47), few (n = 13) required an anti‐secretory agent.

Conclusions

This study presents one of the first and largest Australian report of the end of life and symptom experience of people dying of COVID‐19. This information should help clinicians to anticipate palliative care needs of these patients, for example, recognising that higher starting doses of opioids and sedatives may help reduce prevalence and severity of breathlessness and agitation near death.

Infective endocarditis and infected aneurysm of splenic artery post colonoscopy

Colonoscopy, a relatively non-invasive procedure, has been associated with several complications including perforation, hemorrhage and abdominal pain. Post-colonoscopy bacteremia can occur up to 4.4% of the time but is almost always transient without significant clinical sequelae. Post-colonoscopy infective endocarditis, on the other hand, is a rare occurrence associated with high rates of mortality and morbidity, and may be further complicated by aneurysm of splenic artery. Current definitive treatment of infected aneurysm is surgical ligation and excision with or without vascular anastomosis. If surgery is contraindicated, endovascular graft and transcatheter embolization may be the preferred treatment options. This is a case report of infective endocarditis and infected aneurysm of splenic artery presenting two weeks after elective colonoscopy.

Intramural hematoma of the esophagus mimicking hemorrhaging esophageal cancer

Intramural hematoma of the esophagus (IHE) is an uncommon esophageal injury. Diagnosis requires high index of suspicion as it can mimic various other cardiovascular, pulmonary, mediastinal or esophageal diseases. Although multiple imaging modalities have been reported to be useful, CT with intravenous contrast should be the imaging modality of choice if not contraindicated. Treatment of IHE is mainly supportive; complete resolution in several weeks is the expected outcome. It is crucial that this condition is recognized and considered in the differential diagnosis of any patients who present with chest pain or dysphagia.