Sunglass tint does not impact the indoor catching performance of cricket fielders

Introduction

Sunglasses are worn by outdoor athletes such as cricketers for many reasons, including comfort and glare reduction, which may help to improve vision. Anecdotally they are purported to have performance-enhancing benefits, but there is a lack of evidence for this. Further, it appears that fielders are the only position in cricket who wear sunglasses. Therefore, this study aimed to compare the catching performance of fielders when wearing three different colour sunglasses tints during an indoor, laboratory-based experiment.

Methods

Twenty-one male cricketers currently playing for a university or amateur provincial teams in Makhanda, South Africa, who were non-habitual sunglass wearers, were recruited for this study. An optometrist administered pre-screening tests. Players had four testing sessions during which they wore a different colour tint at each session indoors (clear, blue, G30 (rose), and red). Players were required to catch 18 balls projected from a bowling machine. The number of balls caught, as well as the quality of the catch, was recorded. At the final session, they were asked which tint they thought was best.

Results

Pre-screening tests showed that the red lens was best for contrast sensitivity and stereopsis. During data collection, sunglass tint did not affect catching performance. The players perceived the red lens as the worst and the G30 as the best.

Discussion

It can be concluded that catching performance indoors is not affected by tint colour.

120. Safety, Reactogenicity, and Immunogenicity of Three Different Doses of VAC52416 (ExPEC10V) in Adults Aged 60–85 Years in a Randomized, Multicenter, Interventional, First-In-Human, Phase 1/2a Study

Background

This Phase 1/2a study (NCT03819049) assessed the safety, reactogenicity, and immunogenicity of 3 doses of VAC52416 (ExPEC10V), a vaccine candidate to prevent invasive extraintestinal pathogenic Escherichia coli (ExPEC) disease.

Methods

Data from Cohort 1 are described. The observer-blind, active-controlled design included a 28-day screening, vaccination (Day 1), and 181-day follow-up. Participants (60–85 y) were randomized to a single dose of 1 of 5 vaccines (0.5 mL, intramuscular): ExPEC10V-high (n=104), -medium (n=102), or -low (n=104) dose; ExPEC4V (n=52); or pneumococcal 13-valent (PCV13; n=54) (Table 1). Solicited local and systemic adverse events (AEs) until Day 15, unsolicited AEs until Day 30, and serious AEs (SAEs) until Day 181 were assessed. Immunogenicity via electrochemiluminescent (ECL)-based immunoassay and multiplex opsonophagocytic assay (MOPA) was assessed on Day 15. Safety and immunogenicity outcomes were used to select the optimal ExPEC10V dose to be studied in Cohort 2. Table 1.Study Vaccination Dose

EPA, a genetically detoxified form of exotoxin A derived from Pseudomonas aeruginosa; PS, polysaccharide.

ExPEC4V consisted of the O-antigen PSs of the ExPEC serotypes O1A, O2, O6A, and O25B separately bioconjugated to the EPA carrier protein.

ExPEC10V consisted of the O-antigen PSs of the ExPEC serotypes O1A, O2, O4, O6A, O8, O15, O16, O18A, O25B, and O75 separately bioconjugated to the EPA carrier protein.

The EPA (µg) was calculated using a ratio of 0.276 for PS/EPA. However, the final EPA dose was confirmed at the release.

Results

416 participants were included (median age, 64.0 years; 54.8% female). Incidence of solicited AEs was higher in the pooled ExPEC10V groups (local, 160 [51.6%]; systemic, 135 [43.5%]) than with ExPEC4V (local, 15 [28.8%]; systemic, 17 [32.7%]) (Table 2). The high-dose ExPEC10V group experienced a lower or similar incidence of most solicited AEs relative to the PCV13 group (local, 40 [74.1%]; systemic, 26 [48.1%]). A slightly higher incidence of solicited local AEs was reported with the high ExPEC10V dose, relative to low or medium. Five SAEs, not vaccine-related, were reported. An ECL-based immunoassay revealed a robust total IgG antibody response to ExPEC10V against all vaccine serotypes (geometric mean fold increase: low, 2.33–9.54; medium, 2.38–10.05; high, 3.06–12.31). Opsonophagocytic killing activity was demonstrated against all but one serotype (O8). Table 2.Summary of Solicited Adverse Events*Among randomized patients with a vaccine administration documented from the vaccination until Day 15. AE, adverse event.Data are n (%). Participants are counted only once for any given event, regardless of the number of times they actually experienced the event. No Grade 4 solicited AEs were reported.

Conclusion

ExPEC10V is highly immunogenic and well tolerated; no safety issues were identified. High dose ExPEC10V was selected as optimal and will be further characterized in Cohort 2 and long-term follow-up. Because the MOPA lacked sensitivity to detect responses to the O8 serotype, it will be removed from vaccine formulation; ExPEC9V will proceed with clinical development.

Disclosures

Joachim Doua, MD, MPH, Janssen: Employee|Janssen: Stocks/Bonds Michal Sarnecki, MD, Janssen: Employee|Janssen: Stocks/Bonds Bart Spiessens, PhD, Janssen: Employee Oscar Go, PhD, Janssen: Employee of Janssen Research & Development LLC. Todd Davies, PhD, Janssen: Employee of Janssen Research & Development Germie van den Dobbelsteen, PhD, Janssen: Employee of Janssen Vaccines & Prevention B.V.|Janssen: Stocks/Bonds Jan Poolman, PhD, Janssen: Janssen Vaccines & Prevention B.V.|Janssen: Stocks/Bonds Wouter Haazen, MD, MSc, Janssen: Employee of Janssen Research & Development.

Global Distribution of O Serotypes and Antibiotic Resistance in Extraintestinal Pathogenic Escherichia coli Collected From the Blood of Patients With Bacteremia Across Multiple Surveillance Studies

BACKGROUND

Extraintestinal pathogenic Escherichia coli (ExPEC) is the leading cause of bacteremia worldwide, with older populations having increased risk of invasive bacterial disease. Increasing resistance to first-line antibiotics and emergence of multidrug-resistant (MDR) strains represent major treatment challenges. ExPEC O serotypes are key targets for potential multivalent conjugate vaccine development. Therefore, we evaluated the O serotype distribution and antibiotic resistance profiles of ExPEC strains causing bloodstream infections across 4 regions.

METHODS

Blood culture isolates from patients aged ≥60 years collected during 5 retrospective E. coli surveillance studies in Europe, North America, Asia-Pacific, and South America (2011-2017) were analyzed. Isolates were O serotyped by agglutination; O genotyping was performed for nontypeable isolates. Antimicrobial susceptibility testing was also conducted.

RESULTS

Among 3217 ExPEC blood culture isolates, the most ubiquitous O serotype was O25 (n = 737 [22.9%]), followed by O2, O6, O1, O75, O15, O8, O16, O4, O18, O77 group, O153, O9, O101/O162, O86, and O13 (prevalence of ≥1%). The prevalence of these O serotypes was generally consistent across regions, apart from South America; together, these 16 O serotypes represented 77.6% of all ExPEC bacteremia isolates analyzed. The overall MDR frequency was 10.7%, with limited variation between regions. Within the MDR subset (n = 345), O25 showed a dominant prevalence of 63.2% (n = 218).

CONCLUSIONS

Predominant O serotypes among ExPEC bacteremia isolates are widespread across different regions. O25 was the most prevalent O serotype overall and particularly dominant among MDR isolates. These findings may inform the design of multivalent conjugate vaccines that can target the predominant O serotypes associated with invasive ExPEC disease in older adults.

Evaluation of an Advocacy Programme for Mental Health Care Users in South Africa: A Mixed Methods Study

This study evaluates the implementation of a national advocacy programme for mental health care users, conducted by the South African National Department of Health and the South African Federation for Mental Health. Semi-structured interviews were conducted with care users (n = 18), service providers (n = 9), support persons (n = 6), NGO directors (n = 4), and programme managers in the DoH (n = 4). Although informational benefits were highlighted from programme empowerment sessions, very few advocacy groups were subsequently established. Barriers to establishing and conducting advocacy groups included a lack of follow-up support, pervasive stigma from communities and health care workers, low self-confidence, and a lack of financial resources. Facilitators for establishment of groups included conducting empowerment sessions and identifying 'mental health champions' at clinics, improving mental health training for health workers, dispensing psychiatric medication to patients on the same day, providing funding for non-governmental organisations, conducting national awareness campaigns, and establishing holistic rehabilitation centres for care users.

Post-Partum Spontaneous Coronary Artery Dissection with Occluded Left Anterior Descending Artery

Presentation We present a case of spontaneous coronary artery dissection (SCAD) in a 35-year-old lady who was 4 months post-partum. Despite a lack of typical risk factors, initial presentation and investigations were strongly suggestive of ACS. Diagnosis Coronary angiography revealed an occluded proximal left anterior descending (LAD) artery with TIMI 0 flow. Angiographic appearances and intravascular ultrasound (IVUS) were consistent with SCAD. Treatment A single drug-eluting stent was deployed, successfully restoring good flow, without extending the dissection flap. Discussion SCAD should be considered as an important and underdiagnosed cause of ACS, predominantly in young women without other apparent risk factors.

Urine Concentration Does Not Affect Biochemical Testing for Non-adherence

Hypertension is one of the most important modifiable risk factor causing cardiovascular disease. Unfortunately, non-adherence to antihypertensive medications is frequently observed in hypertensive patients and can lead to an increase in morbidity and mortality. Until recently, there was no robust clinical method to objectively diagnose non-adherence. Recently, the detection of medications in urine or blood by mass spectrometry techniques such as liquid chromatography-tandem mass spectrometry (LC–MS-MS) has been accepted as the diagnostic method of choice for the detection of non-adherence. Despite this, it is unclear whether the concentration of urine can affect the detection of medications in urine. Therefore, this study aimed to assess the effect of urine concentration on detection of antihypertensive medications by LC–MS-MS in which urine creatinine is used as an independent marker of urine concentration. Biochemical adherence results for 22 different medications (1,709 prescriptions) in 463 different subjects were converted to an adherence score. The adherence score was defined as the ratio of the total number of subjects in which the drug was detected to the total number of subjects to whom the drug was prescribed. The adherence scores for each medication were correlated with urine creatinine concentration for each medication. Non-adherence was observed in 47.1% of samples with a mean urine creatinine concentration of these samples of 9.4 ± 7.1 mmol/L. There was no significant difference between the urine creatinine concentrations in the detected vs non-detected groups for each of the 22 medications. Furthermore, there are no differences in adherence scores across the urine creatinine concentration. This is the first study to demonstrate that urine creatinine concentration does not affect the results of the adherence screening by LC–MS-MS.

Epidemiology of paediatric gastrointestinal colonisation by extended spectrum cephalosporin-resistant Escherichia coli and Klebsiella pneumoniae isolates in north-west Cambodia

Background

Extended-spectrum cephalosporin resistance (ESC-R) in Escherichia coli and Klebsiella pneumoniae is a healthcare threat; high gastrointestinal carriage rates are reported from South-east Asia. Colonisation prevalence data in Cambodia are lacking. The aim of this study was to determine gastrointestinal colonisation prevalence of ESC-resistant E. coli (ESC-R-EC) and K. pneumoniae (ESC-R-KP) in Cambodian children/adolescents and associated socio-demographic risk factors; and to characterise relevant resistance genes, their genetic contexts, and the genetic relatedness of ESC-R strains using whole genome sequencing (WGS).

Results

Faeces and questionnaire data were obtained from individuals < 16 years in north-western Cambodia, 2012. WGS of cultured ESC-R-EC/KP was performed (Illumina). Maximum likelihood phylogenies were used to characterise relatedness of isolates; ESC-R-associated resistance genes and their genetic contexts were identified from de novo assemblies using BLASTn and automated/manual annotation. 82/148 (55%) of children/adolescents were ESC-R-EC/KP colonised; 12/148 (8%) were co-colonised with both species. Independent risk factors for colonisation were hospitalisation (OR: 3.12, 95% CI [1.52–6.38]) and intestinal parasites (OR: 3.11 [1.29–7.51]); school attendance conferred decreased risk (OR: 0.44 [0.21–0.92]. ESC-R strains were diverse; the commonest ESC-R mechanisms were bla_CTX-M 1 and 9 sub-family variants. Structures flanking these genes were highly variable, and for bla_{CTX-M-15, − 55 and − 27} frequently involved IS26. Chromosomal bla_CTX-M integration was common in E. coli.

Conclusions

Gastrointestinal ESC-R-EC/KP colonisation is widespread in Cambodian children/adolescents; hospital admission and intestinal parasites are independent risk factors. The genetic contexts of bla_CTX-M are highly mosaic, consistent with rapid horizontal exchange. Chromosomal integration of bla_CTX-M may result in stable propagation in these community-associated pathogens.

Electronic supplementary material

The online version of this article (10.1186/s12866-019-1431-9) contains supplementary material, which is available to authorized users.

Can mental health treatments help prevent or reduce intimate partner violence in low- and middle-income countries? A systematic review

Background

Epidemiological research suggests an interrelationship between mental health problems and the (re)occurrence of intimate partner violence (IPV). However, little is known about the impact of mental health treatments on IPV victimization or perpetration, especially in low- and middle-income countries (LMIC).

Methods

We conducted a systematic review to identify prospective, controlled studies of mental health treatments in LMIC. We defined ‘mental health treatment’ as an intervention for individuals experiencing mental ill health (including substance misuse) including a substantial psychosocial or pharmacological component. Studies had to measure a mental health and IPV outcome. We searched across multi-disciplinary databases using a structured search strategy. Screening of title/abstracts and full-text eligibility assessments were conducted by two researchers independently, data were extracted using a piloted spreadsheet, and a narrative synthesis was generated.

Results

We identified seven studies reported in 11 papers conducted in five middle-income countries. With the exception of blinding, studies overall showed acceptable levels of risk of bias. Four of the seven studies focused on dedicated mental health treatments in various populations, including: common mental disorders in earthquake survivors; depression in primary care; alcohol misuse in men; and alcohol misuse in female adult sex workers. The dedicated mental health treatments targeting depression or alcohol misuse consistently reduced levels of these outcomes. The two studies targeting depression also reduced short-term IPV, but no IPV benefits were identified in the two alcohol-focused studies. The other three studies evaluated integrated interventions, in which a focus on substance misuse was part of efforts to reduce HIV/AIDS and violence against particularly vulnerable women. In contrast to the dedicated mental health interventions, the integrated interventions did not consistently reduce mental ill health or alcohol misuse compared to control conditions.

Conclusions

Too few studies have been conducted to judge whether mental health treatments may provide a beneficial strategy to prevent or reduce IPV in LMIC. Key future research questions include: whether promising initial evidence on the effects of depression interventions on reducing IPV hold more broadly, the required intensity of mental health components in integrated interventions, and the identification of mechanisms of IPV that are amenable to mental health intervention.

Electronic supplementary material

The online version of this article (10.1186/s12905-019-0728-z) contains supplementary material, which is available to authorized users.

Patterns of intimate partner violence among perinatal women with depression symptoms in Khayelitsha, South Africa: a longitudinal analysis

BACKGROUND

A combination of intimate partner violence (IPV) and depression is a common feature of the perinatal period globally. Understanding this association can provide indications of how IPV can be addressed or prevented during pregnancy. This paper aims to determine the prevalence and correlates of IPV among pregnant low-income women with depressive symptoms in Khayelitsha, South Africa, and changes in IPV reports during the course of the perinatal period.

METHODS

This study is a secondary analysis of data collected as part of a randomised controlled trial testing a psychosocial intervention for antenatal depression. IPV, socio-demographic measures, depression and other mental health measures were collected at recruitment (first antenatal visit), 8 months gestation, and 3 and 12 months postpartum. IPV was defined as a sexual or physical violence perpetrated by the participant's partner in the past 3 months. Descriptive statistics are reported.

RESULTS

Of 425 recruited depressed participants, 59 (13.9%) reported IPV at baseline, with physical IPV being the most frequently reported (69.5%). Reported IPV was associated with greater emotional distress, potentially higher food insecurity and higher rates of alcohol abuse. There were clear longitudinal trends in reported IPV with the majority of women no longer reporting IPV postpartum. However, some women reported IPV at later assessment points after not reporting IPV at baseline.

CONCLUSIONS

There is a strong association between IPV and depression in pregnancy. IPV reports remit over time for the women in this study, although the reason for this reduction is not clear and requires further investigation.

The Last Laugh - Reversible myeloneuropathy induced by chronic nitrous oxide use

A previously fit and well 19 year old male presents with a progressive ataxic - sensory neuropathy worsening over 2 - 3 weeks. History and investigations revealed extensive recreational use of nitrous oxide resulting in functional B12 deficiency and consequent subacute combined degeneration of the cord. Abstinence and B12 supplementation resulted in a rapid and full neurological recovery. This case report highlights the importance of considering nitrous oxide abuse in the differential diagnosis of atypical neurological symptoms and signs, and emphasizes the possibility of good clinical outcomes with treatment.

Review article: the role of the microcirculation in liver cirrhosis

BACKGROUND

Intrahepatic microvascular derangements and microcirculatory dysfunction are key in the development of liver cirrhosis and its associated complications. While much has been documented relating to cirrhosis and the dysfunction of the microcirculation in the liver parenchyma, far less is known about the state of the extrahepatic microcirculation and the role this may have in the pathogenesis of multiple organ failure in end stage liver cirrhosis.

AIM

To provide an update on the role of the microcirculation in the pathophysiology of cirrhosis and its associated complications and briefly discuss some of the imaging techniques which may be used to directly investigate the microcirculation.

METHODS

A Medline literature search was conducted using the following search terms: 'cirrhosis', 'microcirculation', 'circulation', 'systemic', 'inflammation', 'peripheral', 'hepatorenal' and 'hepatopulmonary'.

RESULTS

Significant heterogeneous microvascular alterations exist in patients with cirrhosis. Data suggest that the systemic inflammation, associated with advanced cirrhosis, induces microcirculatory dysregulation and contributes to haemodynamic derangement. The resultant vasoconstriction and hypoperfusion in the systemic extrahepatic microvasculature, is likely to be instrumental in the pathophysiology of organ failure in decompensated cirrhosis, however the mechanistic action of vasoactive agents used to correct the circulatory disturbance of advanced cirrhosis is poorly understood.

CONCLUSIONS

Further research into the role of the microcirculation in patients with liver cirrhosis, will improve physicians understanding of the pathophysiology of cirrhosis, and may provide a platform for real time evaluation of an individual's microcirculatory response to vasoactive mediators, thus guiding their therapy.

Safety, immunogenicity, and preliminary clinical efficacy of a vaccine against extraintestinal pathogenic Escherichia coli in women with a history of recurrent urinary tract infection: a randomised, single-blind, placebo-controlled phase 1b trial

BACKGROUND

Escherichia coli infections are increasing worldwide in community and hospital settings. The E coli O-antigen is a promising vaccine target. We aimed to assess the safety and immunogenicity of a bioconjugate vaccine containing the O-antigens of four E coli serotypes (ExPEC4V).

METHODS

In this multicentre phase 1b, first-in-human, single-blind, placebo-controlled trial, we randomly assigned (1:1) healthy adult women with a history of recurrent urinary tract infection (UTI) to receive a single injection of either intramuscular ExPEC4V or placebo. The primary outcome was the incidence of adverse events among vaccine and placebo recipients throughout the study. Secondary outcomes included immunogenicity and antibody functionality, and the incidence of UTIs caused by E coli vaccine serotypes in each group. This study is registered with ClinicalTrials.gov, number NCT02289794.

FINDINGS

Between Jan 20, 2014, and Aug 27, 2014, 93 women received target-dose ExPEC4V and 95 received placebo. The vaccine was well tolerated: no vaccine-related serious adverse events occurred. Overall, 56 (60%) target-dose vaccines and 47 (49%) placebo recipients experienced at least one adverse event that was possibly, probably, or certainly related to injection. Vaccination induced significant IgG responses for all serotypes: at day 30 compared with baseline, O1A titres were 4·6 times higher, O2 titres were 9·4 times higher, O6A titres were 4·9 times higher, and O25B titres were 5·9 times higher (overall p<0·0001). Immune responses persisted at 270 days but were lower than those at 30 days. Opsonophagocytic killing activity showed antibody functionality. No reduction in the incidence of UTIs with 10³ or more colony-forming units per mL of vaccine-serotype E coli was noted in the vaccine compared with the placebo group (0·149 mean episodes vs 0·146 mean episodes; p=0·522). In post-hoc exploratory analyses of UTIs with higher bacterial counts (≥10⁵ colony-forming units per mL), the number of vaccine serotype UTIs did not differ significantly between groups (0·046 mean episodes in the vaccine group vs 0·110 mean episodes in the placebo group; p=0·074). However, significantly fewer UTIs caused by E coli of any serotype were noted in the vaccine group compared with the placebo group (0·207 mean episodes vs 0·463 mean episodes; p=0·002).

INTERPRETATION

This tetravalent E coli bioconjugate vaccine candidate was well tolerated and elicited functional antibody responses against all vaccine serotypes. Phase 2 studies have been initiated to confirm these findings.

FUNDING

GlycoVaxyn, Janssen Vaccines.

An Atypical Withdrawal Syndrome in Neonates Prenatally Exposed to Gabapentin and Opioids

We report a retrospective case series of 19 infants exposed to both opioids and gabapentin prenatally. We describe a unique behavioral phenotype in 15 of these infants and report a treatment strategy.

Evaluating the effectiveness of a home-based exercise programme delivered through a tablet computer for preventing falls in older community-dwelling people over 2 years: study protocol for the Standing Tall randomised controlled trial

INTRODUCTION

In order to prevent falls, older people should exercise for at least 2 h per week for 6 months, with a strong focus on balance exercises. This article describes the design of a randomised controlled trial to evaluate the effectiveness of a home-based exercise programme delivered through a tablet computer to prevent falls in older people.

METHODS AND ANALYSIS

Participants aged 70 years or older, living in the community in Sydney will be recruited and randomly allocated to an intervention or control group. The intervention consists of a tailored, home-based balance training delivered through a tablet computer. Intervention participants will be asked to complete 2 h of exercises per week for 2 years. Both groups will receive an education programme focused on health-related information relevant to older adults, delivered through the tablet computer via weekly fact sheets. Primary outcome measures include number of fallers and falls rate recorded in weekly fall diaries at 12 months. A sample size of 500 will be necessary to see an effect on falls rate. Secondary outcome measures include concern about falling, depressive symptoms, health-related quality of life and physical activity levels (in all 500 participants); and physiological fall risk, balance, functional mobility, gait, stepping and cognitive performance (in a subsample of 200 participants). Adherence, acceptability, usability and enjoyment will be recorded in intervention group participants over 2 years. Data will be analysed using the intention-to-treat principle. Secondary analyses are planned in people with greater adherence. Economic analyses will be assessed from a health and community care provider perspective.

ETHICS AND DISSEMINATION

Ethical approval was obtained from UNSW Ethics Committee in December 2014 (ref number HC#14/266). Outcomes will be disseminated through publication in peer-reviewed journals and presentations at international conferences.

TRIAL REGISTRATION NUMBER

Australian New Zealand Clinical Trials Registry (ACTRN)12615000138583.

Effectiveness of public deliberation methods for gathering input on issues in healthcare: Results from a randomized trial

Public deliberation elicits informed perspectives on complex issues that are values-laden and lack technical solutions. This Deliberative Methods Demonstration examined the effectiveness of public deliberation for obtaining informed public input regarding the role of medical evidence in U.S. healthcare. We conducted a 5-arm randomized controlled trial, assigning participants to one of four deliberative methods or to a reading materials only (RMO) control group. The four deliberative methods reflected important differences in implementation, including length of the deliberative process and mode of interaction. The project convened 76 groups between August and November 2012 in four U.S.

LOCATIONS

Chicago, IL; Sacramento, CA; Silver Spring, MD; and Durham, NC, capturing a sociodemographically diverse sample with specific attention to ensuring inclusion of Hispanic, African-American, and elderly participants. Of 1774 people recruited, 75% participated: 961 took part in a deliberative method and 377 participants comprised the RMO control group. To assess effectiveness of the deliberative methods overall and of individual methods, we evaluated whether mean pre-post changes on a knowledge and attitude survey were statistically different from the RMO control using ANCOVA. In addition, we calculated mean scores capturing participant views of the impact and value of deliberation. Participating in deliberation increased participants' knowledge of evidence and comparative effectiveness research and shifted participants' attitudes regarding the role of evidence in decision-making. When comparing each deliberative method to the RMO control group, all four deliberative methods resulted in statistically significant change on at least one knowledge or attitude measure. These findings were underscored by self-reports that the experience affected participants' opinions. Public deliberation offers unique potential for those seeking informed input on complex, values-laden topics affecting broad public constituencies.

Essential regional nerve blocks for the dermatologist: Part 2

Following on from Part 1 of the series (regional nerve blocks for the face and scalp), we guide the clinician through the anatomy and cutaneous innervation of the digits, wrist and ankle, providing a practical step-by-step guide to regional nerve blockade of these areas.

An innovative repair for a re-recurrence of an incarcerated inguinal hernia

A patient presented with a recurrent incarcerated inguinoscrotal hernia requiring urgent surgery. The defect was through the gap in the mesh left originally for the cord structures. As a result, a modified funnel repair was performed. An innovative approach was adopted that was best suited to tackling and reducing the risk of recurrence.

Essential regional nerve blocks for the dermatologist: part 1

The aim of this two-part series is to provide an up-to-date review of essential regional nerve blocks for dermatological practice. In Part 1, we give a concise overview of local anaesthetics and their potential complications, as well as the relevant anatomy and cutaneous innervation of the face and scalp. This culminates in a step-by-step practical guide to performing each nerve block.

Reconfigurable mosaic annular arrays

Mosaic annular arrays (MAA) based on reconfigurable array (RA) transducer electronics assemblies are presented as a potential solution for future highly integrated ultrasonic transducer subsystems. Advantages of MAAs include excellent beam quality and depth of field resulting from superior elevational focus compared with 1-D electronically scanned arrays, as well as potentially reduced cost, size, and power consumption resulting from the use of a limited number of beamforming channels for processing a large number of subelements. Specific design tradeoffs for these highly integrated arrays are discussed in terms of array specifications for center frequency, element pitch, and electronic switch-on resistance. Large-area RAs essentially function as RC delay lines. Efficient architectures which take into account RC delay effects are presented. Architectures for integration of the transducer and electronics layers of large-area array implementations are reviewed.

Packaging and modular assembly of large-area and fine-pitch 2-D ultrasonic transducer arrays

A promising transducer architecture for largearea arrays employs 2-D capacitive micromachined ultrasound transducer (CMUT) devices with backside trench-frame pillar interconnects. Reconfigurable array (RA) application-specified integrated circuits (ASICs) can provide efficient interfacing between these high-element-count transducer arrays and standard ultrasound systems. Standard electronic assembly techniques such as flip-chip and ball grid array (BGA) attachment, along with organic laminate substrate carriers, can be leveraged to create large-area arrays composed of tiled modules of CMUT chips and interface ASICs. A large-scale, fully populated and integrated 2-D CMUT array with 32 by 192 elements was developed and demonstrates the feasibility of these techniques to yield future large-area arrays. This study demonstrates a flexible and reliable integration approach by successfully combining a simple under-bump metallization (UBM) process and a stacked CMUT/interposer/ASIC module architecture. The results show high shear strength of the UBM (26.5 g for 70-μm balls), high interconnect yield, and excellent CMUT resonance uniformity (s = 0.02 MHz). A multi-row linear array was constructed using the new CMUT/interposer/ASIC process using acoustically active trench-frame CMUT devices and mechanical/ nonfunctional Si backside ASICs. Imaging results with the completed probe assembly demonstrate a functioning device based on the modular assembly architecture.

Errors in anti-D immunoglobulin administration: retrospective analysis of 15 years of reports to the UK confidential haemovigilance scheme

OBJECTIVE

To highlight the errors associated with the use of anti-D immunoglobulin in RhD antigen-negative women, and their resultant clinical impact during and after pregnancy, and to suggest strategies to reduce these errors.

DESIGN

Retrospective review of cumulative reporting to the UK confidential haemovigilance scheme, Serious Hazards of Transfusion (SHOT), between 1996 and 2011.

SETTING

Obstetric departments in the UK.

POPULATION

Mothers who require anti-D immunoglobulin to prevent RhD sensitisation during pregnancy or after birth.

METHODS

Hospital transfusion teams reported adverse events to the SHOT database.

MAIN OUTCOME MEASURES

Reported number of events and their causes, and morbidity and mortality associated with errors.

RESULTS

In 15 years of reporting, SHOT haemovigilance has shown a total of 1211 errors related to the administration of anti-D immunoglobulin, particularly regarding omission or late administration (157/249 or 63% reported in 2011). Anti-D immunoglobulin errors comprised 13.7% (249/1815) of all SHOT reports in 2011. Failure to recognise women who already have RhD sensitisation occurred in 19 cases, and was followed by suboptimal monitoring of the pregnancy. Nine of the infants suffered haemolytic disease of the fetus and newborn (HDFN): one resulted in neonatal death and three required red cell transfusion.

CONCLUSIONS

Babies as well as their mothers remain at risk from avoidable errors. More active attention at national and local levels to further education and training, particularly for midwives, is an absolute necessity. We recommend the use of a SHOT-devised anti-D administration flowchart, adapted locally into a checklist, to help reduce errors.

Search for R-parity violating decays of sneutrinos to eμ, μτ, and eτ pairs in pp collisions at square root s = 1.96 TeV

We present a search for supersymmetric neutrino ν production using the Tevatron pp collision data collected with the CDF II detector and corresponding to an integrated luminosity of 1 fb-1. We focus on the scenarios predicted by the R-parity violating (RPV) supersymmetric models in which sneutrinos decay to two charged leptons of different flavor. With the data consistent with the standard model expectations, we set upper limits on σ(pp→ν)×BR(ν→eμ,μτ,eτ) and use these results to constrain the RPV couplings as a function of the sneutrino mass.

Search for new physics with a dijet plus missing E(T) signature in pp collisions at √s=1.96 TeV

We present results of a signature-based search for new physics using a dijet plus missing transverse energy (E(T)) data sample collected in 2  fb⁻¹ of pp collisions at √s=1.96  TeV with the CDF II detector at the Fermilab Tevatron. We observe no significant event excess with respect to the standard model prediction and extract a 95% C.L. upper limit on the cross section times acceptance for a potential contribution from a nonstandard model process. The search is made by using novel, data-driven techniques for estimating backgrounds that are applicable to first searches at the LHC.

Exclusion of an exotic top quark with -4/3 electric charge using soft lepton tagging

We present a measurement of the electric charge of the top quark using pp collisions corresponding to an integrated luminosity of 2.7 fb(-1) at the CDF II detector. We reconstruct tt events in the lepton + jets final state. We use soft lepton taggers to determine the flavor of the b jets, which we use to reconstruct the top quark's electric charge and exclude an exotic top quark with -4/3 charge at 95% confidence level. This is the strongest exclusion of the exotic charge scenario and the first to use soft leptons for this purpose.

Search for the production of scalar bottom quarks in pp collisions at square root(s) = 1.96 TeV

We report on a search for direct scalar bottom quark (sbottom) pair production in pp collisions at square root(s) = 1.96 TeV, in events with large missing transverse energy and two jets of hadrons in the final state, where at least one of the jets is required to be identified as originating from a b quark. The study uses a collider detector at Fermilab Run II data sample corresponding to 2.65 fb(-1) of integrated luminosity. The data are in agreement with the standard model. In an R-parity conserving minimal supersymmetric scenario, and assuming that the sbottom decays exclusively into a bottom quark and a neutralino, 95% confidence-level upper limits on the sbottom pair production cross section of 0.1 pb are obtained. For neutralino masses below 70 GeV/c2, sbottom masses up to 230 GeV/c2 are excluded at 95% confidence level.

When and why is blood crossmatched? A prospective survey of transfusion laboratory practice in two regions in the north of England

BACKGROUND AND OBJECTIVES

This study was undertaken to provide data relating to the timing of laboratory crossmatch procedures, and the source of requests for out of hours crossmatch, to support interpretation of error reports originating in the transfusion laboratory, received by the Serious Hazards of Transfusion haemovigilance scheme.

MATERIALS AND METHODS

Data on the timing, origin and urgency of all crossmatch requests were collected in 34 hospitals in northern England over a 7-day period in 2008. Additional data on clinical urgency were collected on crossmatches that were performed out of hours.

RESULTS

Data were obtained on 2423 crossmatches, including 610 (25.2%) performed outside core hours. 30.3% of out of hours crossmatch requests were for transfusions that were set up outside 4 h of completion of the crossmatch.

CONCLUSION

2008 Serious Hazards of Transfusion data showed that 29/39 (74%) of laboratory errors resulting in 'wrong blood' occurred out of hours whilst our audit shows that only 25% of crossmatch requests are made in that time period, suggesting that crossmatching performed outside core hours carries increased risks. The reason for increased risk of error needs further research, but 25 laboratories had only one member of staff working out of hours, often combining blood transfusion, haematology and coagulation work. A total of 25% of out of hours requests were not clinically urgent. Hospitals should develop policies to define indications for out of hours transfusion testing, empower laboratory staff to challenge inappropriate requests and ensure that staffing and expertise is appropriate for the workload at all times.

Measurement of W-boson polarization in Top-Quark Decay in pp collisions at sqrt[s]=1.96 TeV

We report measurements of the polarization of W bosons from top-quark decays using 2.7 fb{-1} of pp collisions collected by the CDF II detector. Assuming a top-quark mass of 175  GeV/c{2}, three measurements are performed. A simultaneous measurement of the fraction of longitudinal (f{0}) and right-handed (f{+}) W bosons yields the model-independent results f{0}=0.88±0.11(stat)±0.06(syst) and f{+}=-0.15±0.07(stat)±0.06(syst) with a correlation coefficient of -0.59. A measurement of f{0} [f{+}] constraining f{+} [f{0}] to its standard model value of 0.0 [0.7] yields f{0}=0.70±0.07(stat)±0.04(syst) [f{+}=-0.01±0.02(stat)±0.05(syst)]. All these results are consistent with standard model expectations. We achieve the single most precise measurements of f{0} for both the model-independent and model-dependent determinations.

Measurement of the ratio σ{tt}/σ{Z/γ{*}→ll} and precise extraction of the tt cross section

We report a measurement of the ratio of the tt to Z/γ{*} production cross sections in sqrt[s]=1.96  TeV pp collisions using data corresponding to an integrated luminosity of up to 4.6  fb{-1}, collected by the CDF II detector. The tt cross section ratio is measured using two complementary methods, a b-jet tagging measurement and a topological approach. By multiplying the ratios by the well-known theoretical Z/γ{*}→ll cross section predicted by the standard model, the extracted tt cross sections are effectively insensitive to the uncertainty on luminosity. A best linear unbiased estimate is used to combine both measurements with the result σ{tt}=7.70±0.52  pb, for a top-quark mass of 172.5  GeV/c{2}.

Search for pair production of supersymmetric top quarks in dilepton events from pp collisions at sqrt[s]=1.96 TeV

We present the results of a search for pair production of the supersymmetric partner of the top quark (the top squark t{1}) decaying to a b quark and a chargino χ{1}{±} with a subsequent χ{1}{±} decay into a neutralino χ{1}{0}, lepton ℓ, and neutrino ν. Using a data sample corresponding to 2.7  fb{-1} of integrated luminosity of pp collisions at sqrt[s]=1.96  TeV collected by the CDF II detector, we reconstruct the mass of top squark candidate events and fit the observed mass spectrum to a combination of standard model processes and t{1}t{1} signal. We find no evidence for t{1}t{1} production and set 95% C.L. limits on the masses of the top squark and the neutralino for several values of the chargino mass and the branching ratio B(χ{1}{±}→χ{1}{0}ℓ{±}ν).

Search for WW and WZ resonances decaying to electron, missing E(T), and two jets in pp collisions at square root(s) = 1.96 TeV

Using data from 2.9  fb(-1) of integrated luminosity collected with the CDF II detector at the Tevatron, we search for resonances decaying into a pair of on-shell gauge bosons, WW or WZ, where one W decays into an electron and a neutrino, and the other boson decays into two jets. We observed no statistically significant excess above the expected standard model background, and we set cross section limits at 95% confidence level on G* (Randall-Sundrum graviton), Z', and W' bosons. By comparing these limits to theoretical cross sections, mass exclusion regions for the three particles are derived. The mass exclusion regions for Z' and W' are further evaluated as a function of their gauge coupling strength.

Measurement of the W+ W- production cross section and search for anomalous WWγ and WWZ couplings in pp collisions at square root(s)=1.96 TeV

This Letter describes the current most precise measurement of the W boson pair production cross section and most sensitive test of anomalous WWγ and WWZ couplings in pp collisions at a center-of-mass energy of 1.96 TeV. The WW candidates are reconstructed from decays containing two charged leptons and two neutrinos. Using data collected by the CDF II detector from 3.6  fb(-1) of integrated luminosity, a total of 654 candidate events are observed with an expected background of 320±47 events. The measured cross section is σ(pp→W+ W- +X)=12.1±0.9(stat)-1.4+1.6(syst)  pb, which is in good agreement with the standard model prediction. The same data sample is used to place constraints on anomalous WWγ and WWZ couplings.