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The present study was designed to extend research on supplementing social skills training (SST) with a Tootling intervention to enhance student performance of social skills in authentic social contexts. The Tootling intervention included an interdependent group contingency with randomly selected criteria, which involved the after-school class receiving rewards contingent upon students reporting classmates' performance of prosocial behaviors as they participated in a typical school activity. First, reinforcement was delivered contingent upon peer reports of classmates' giving compliments. In subsequent phases, peer reports of classmates providing encouragement and saying thank you were added to the contingency, but each day students did not know which of these behaviors was selected as the criterion for reinforcement. Results from our multiple baseline across behaviors design provided three demonstrations of a treatment effect. When peer reports of each social skill were added to the contingency, the targeted social behavior increased. Discussion focuses on supplementing SST with Tootling interventions to enhance student performance of prosocial behaviors outside the SST context. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

BackgroundVaccine-induced thrombosis and thrombocytopenia (VITT) is a rare complication following ChAdOx1 nCoV-19 vaccination. Cerebral venous sinus thrombosis (CVST) is overrepresented in VITT and is often associated with multifocal venous thromboses, concomitant hemorrhage and poor outcomes. Hitherto, endovascular treatments have not been reviewed in VITT-related CVST.MethodsPatient records from a tertiary neurosciences center were reviewed to identify patients who had endovascular treatment for CVST in VITT.ResultsPatient records from 1 January 2021 to 20 July 2021 identified three patients who underwent endovascular treatment for CVST in the context of VITT. All were female and the median age was 52 years. The location of the CVST was highly variable. Two-thirds of the patients had multifocal dural sinus thromboses (sigmoid, transverse, straight and superior sagittal) as well as internal jugular vein thromboses. Intracerebral hemorrhage occurred in all patients; subarachnoid blood was noted in two of them, and intraparenchymal hemorrhage occurred in all. There was one periprocedural parenchymal extravasation which abated on temporary cessation of anticoagulation. Outcome data revealed a 90-day modified Rankin Scale (mRS) score of 2 in all cases.ConclusionsWe demonstrate that endovascular treatment for VITT-associated CVST is feasible and can be safe in cases that deteriorate despite medical therapy. Extensive clot burden, concomitant hemorrhage, rapid clinical progression and persistent rises in intracranial pressure should initiate multidisciplinary team discussion for endovascular treatment in appropriate cases.

A withdrawal design was used to evaluate the effects of a tootling intervention targeting a specific, recently trained social skill, providing compliments, displayed by first-grade students while they engaged in a regularly scheduled, small-group math activity. The tootling intervention, called the Catching Compliments Game, included publicly posted feedback and an interdependent group-oriented contingency, which involved the entire class earning rewards for reporting their observations of classmates providing compliments. Visual analysis of a repeated-measures graph suggested that the intervention caused immediate increases in students’ complimenting peers while engaged in a small-group math activity. These results extend research on tootling interventions by providing evidence that they can cause increases in the behaviors that students are reporting, in this case, students complimenting peers. Discussion focuses on study limitations, future research, and the applied implications associated with supplementing social skills training with tootling.

Class-wide academic performance can be increased by overlaying existing instructional and classroom management procedures with supplemental interdependent group-oriented bonus rewards. The bonus reward strategies may be particularly effective for under-motivated, low-performing students. When applying supplemental interdependent group-oriented bonus rewards, rewards are delivered to all members of a class for meeting a group-oriented performance criterion. A description of supplemental interdependent group-oriented bonus rewards is provided, followed by reasons for using unknown, randomly-selected rewards and criteria for earning rewards. Guidelines for establishing a pool of possible rewards and criteria are provided that are designed to allow teachers to develop their own supplemental interdependent group-oriented bonus rewards.

Shigellosis, traditionally a foodborne and waterborne infection, causes substantial morbidity globally. It is now a leading cause of sexually transmitted gastroenteritis among gay, bisexual, and other men who have sex with men (MSM). We describe an ongoing outbreak of extensively drug-resistant (XDR) Shigella sonnei in the UK.Routine laboratory surveillance (Second Generation Surveillance System, Gastrointestinal Data Warehouse) identified an exceedance of S sonnei clade 5 in England, first detected in September, 2021. Cases within this clade were subsequently reported from Scotland, Wales, and Northern Ireland. Confirmed cases in this outbreak were defined as individuals diagnosed with S sonnei clade 5 in the UK, with a specimen date between Sept 1, 2021, and Feb 9, 2022, who were genomically confirmed as part of a ten-single nucleotide polymorphism (SNP) linkage cluster. We used whole-genome sequencing with SNP typing to identify genomic clusters and antimicrobial-resistance determinants, analysing cases across the UK. We collected demographic, epidemiological, and clinical data from people infected with S sonnei clade 5 in England using questionnaires (standard and bespoke outbreak questionnaires). We used descriptive summary statistics to characterise cases.72 cases (70 [97%] male, median age 34 years [IQR 27-39]) belonging to the ten-SNP single linkage cluster of S sonnei clade 5 were identified between Sept 4, 2021, and Feb 9, 2022. Isolates were predominantly XDR, with 66 (92%) of 72 harbouring blasubCTX-M-27/sub, a plasmid-mediated gene for production of extended-spectrum β-lactamases (ESBLs). Of 33 cases with clinical data, 19 (58%) received antibiotics and eight (24%) were hospitalised. 21 (78%) of 27 cases with completed bespoke outbreak questionnaires were HIV-negative MSM taking HIV pre-exposure prophylaxis (PrEP) who reported sexual contacts in the UK and Europe within the incubation period.We highlight the rapid dissemination of XDR ESBL-producing S sonnei in sexual networks of MSM. We recommend strengthening shigella testing where clinically indicated, antimicrobial-resistance surveillance, and integrated health promotion messaging among all MSM, including PrEP users, to reduce the burden of shigellosis.National Institute for Health Research Health Protection Research Unit in Gastrointestinal Infections at the University of Liverpool in partnership with the UK Health Security Agency.

The purpose of this study was to explore whether or not English learners (ELs) have the same annual rates of reading progress as non-EL counterparts in Grades 1 through 3 when accounting for beginn...

Sympathetic nervous system activation after aneurysmal subarachnoid hemorrhage (aSAH) is associated with complications and poor outcome. In this systematic review and meta-analysis, we investigate the effect of beta-blockers on outcome after aSAH. The review was prospectively registered with PROSPERO (CRD42019111784). We performed a systematic literature search of MEDLINE, EMBASE, the Cochrane Library, published conference proceedings, and abstracts. Eligible studies included both randomized controlled trials and observational studies up to October 2018, reporting the effect of beta-blocker therapy on the following outcomes in aSAH: mortality, vasospasm, delayed cerebral ischemia, infarction or stroke, cardiac dysfunction, and functional outcomes. Studies involving traumatic SAH were excluded. Citations were reviewed, and data extracted independently by two investigators using a standardized proforma. We identified 819 records with 16 studies (four were randomized controlled trials) including 6702 patients selected for analysis. Exposure to beta-blockade either before or after aSAH was associated with a significant reduction in unadjusted mortality (RR 0.63, 95% CI 0.42–0.93, p = 0.02). A significant reduction in unadjusted mortality was also seen in prospective trials of post-event beta-blockade (RR 0.51, 95% CI 0.28–0.93, p = 0.03). Statistically significant differences were not seen for other outcomes investigated. In adult patients with aSAH, beta-blocker therapy is associated with a mortality benefit. Studies are generally of a low quality with considerable clinical heterogeneity. Prospective large interventional trials with patient centered outcomes are required to validate this finding.

As a follow-up to earlier work [Crewdson and Lappa, “Spatial and temporal evolution of three-dimensional thermovibrational convection in a cubic cavity with various thermal boundary conditions,” Phys. Fluids 34, 014108 (2022)], where the main focus was on the modes of convection in a three-dimensional cubic enclosure filled with a Pr = 7 liquid undergoing vibrations in a direction “parallel” to the imposed temperature gradient, the present study considers the modes of particle clustering, which occur when solid spheres, with density ratio ξ = 1.85 or 0.3 and Stokes number ( St) between 0.5 and 3.5 × 10−5, are added to the fluid. Starting from a uniform distribution of solid particles and fluid in quiescent conditions, the governing equations for the involved phases are numerically solved in their complete, time-dependent, and non-linear form for a representative vibrational Rayleigh number (8.34 × 104), angular frequency Ω = 50, and non-dimensional acceleration amplitude ( γ) spanning the interval 0.4 × 107 ≤ γ ≤ 3.4 × 107. It is shown that, while for relatively high values of St and/or γ, only degenerate states are obtained, where all particles collapse on planar structures, for intermediate values of such parameters, interesting (heretofore unseen) patterns are enabled. The hallmark of these phenomena is an endless squeezing and expansion of the particle formations along the direction of the temperature gradient. As confirmed by the numerical simulations, the underlying formation mechanisms rely on the combined action of the body force acting on particles due to their different densities with respect to the host fluid and the additional drag that is produced when the carrier thermovibrational flow enters a specific stage, known as “convective burst,” where the magnitude of the fluid velocity increases dramatically.

Advanced airway management is a treatment priority in trauma care. It is likely that a proportion of patients who receive urgent airway management on arrival in the emergency department represent an unmet demand for airway intervention in the pre-hospital phase. This study aimed to investigate emergency airway practice in major trauma patients and establish any unmet demand in this patient group. A retrospective review of the Trauma Audit and Research Network database was performed to identify airway intervention(s) performed for patients admitted to major trauma centres in England from 01 April 2012 to 27 June 2016. In total, 11,010 patients had airway interventions: 4375 patients (43%) had their tracheas intubated in the pre-hospital setting compared with 5889 patients (57%) in the emergency department. Of the patients whose tracheas were intubated in the emergency department, this was done within 30 min of hospital arrival in 3264 patients (75%). Excluding tracheal intubation, 1593 patients had a pre-hospital airway intervention of which 881 (55%) subsequently had their trachea intubated in the emergency department; tracheal intubation was done within 30 min of arrival in the majority of these cases (805 patients (91%)). Over 70% of emergency department tracheal intubations in patients with traumatic injuries were performed within 30 min of hospital arrival; this suggests there may be an unmet demand in pre-hospital advanced airway management for trauma patients in England.

Patient selection for critical care admission must balance patient safety with optimal resource allocation. This study aimed to determine the relationship between critical care admission, and postoperative mortality after abdominal surgery.This prespecified secondary analysis of a multicentre, prospective, observational study included consecutive patients enrolled in the DISCOVER study from UK and Republic of Ireland undergoing major gastrointestinal and liver surgery between October and December 2014. The primary outcome was 30-day mortality. Multivariate logistic regression was used to explore associations between critical care admission (planned and unplanned) and mortality, and inter-centre variation in critical care admission after emergency laparotomy.Of 4529 patients included, 37.8% (n=1713) underwent planned critical care admissions from theatre. Some 3.1% (n=86/2816) admitted to ward-level care subsequently underwent unplanned critical care admission. Overall 30-day mortality was 2.9% (n=133/4519), and the risk-adjusted association between 30-day mortality and critical care admission was higher in unplanned [odds ratio (OR): 8.65, 95% confidence interval (CI): 3.51-19.97) than planned admissions (OR: 2.32, 95% CI: 1.43-3.85). Some 26.7% of patients (n=1210/4529) underwent emergency laparotomies. After adjustment, 49.3% (95% CI: 46.8-51.9%, P0.001) were predicted to have planned critical care admissions, with 7% (n=10/145) of centres outside the 95% CI.After risk adjustment, no 30-day survival benefit was identified for either planned or unplanned postoperative admissions to critical care within this cohort. This likely represents appropriate admission of the highest-risk patients. Planned admissions in selected, intermediate-risk patients may present a strategy to mitigate the risk of unplanned admission. Substantial inter-centre variation exists in planned critical care admissions after emergency laparotomies.

Sympathetic nervous system activation after aneurysmal subarachnoid hemorrhage (aSAH) is associated with complications and poor outcome. In this systematic review and meta-analysis, we investigate the effect of beta-blockers on outcome after aSAH.The review was prospectively registered with PROSPERO (CRD42019111784). We performed a systematic literature search of MEDLINE, EMBASE, the Cochrane Library, published conference proceedings, and abstracts. Eligible studies included both randomized controlled trials and observational studies up to October 2018, reporting the effect of beta-blocker therapy on the following outcomes in aSAH: mortality, vasospasm, delayed cerebral ischemia, infarction or stroke, cardiac dysfunction, and functional outcomes. Studies involving traumatic SAH were excluded. Citations were reviewed, and data extracted independently by two investigators using a standardized proforma.We identified 819 records with 16 studies (four were randomized controlled trials) including 6702 patients selected for analysis. Exposure to beta-blockade either before or after aSAH was associated with a significant reduction in unadjusted mortality (RR 0.63, 95% CI 0.42-0.93, p = 0.02). A significant reduction in unadjusted mortality was also seen in prospective trials of post-event beta-blockade (RR 0.51, 95% CI 0.28-0.93, p = 0.03). Statistically significant differences were not seen for other outcomes investigated.In adult patients with aSAH, beta-blocker therapy is associated with a mortality benefit. Studies are generally of a low quality with considerable clinical heterogeneity. Prospective large interventional trials with patient centered outcomes are required to validate this finding.

Thermovibrational flow in a differentially heated cubic cavity with vibrations applied in a direction parallel to the imposed temperature gradient is investigated by solving numerically the governing equations for mass, momentum, and energy in their original nonlinear form. A parametric analysis is conducted through the stepwise examination of the following degrees of freedom: magnitude of the Rayleigh number and the thermal behavior of the sidewalls. A complete characterization of the emerging time-varying convective structures is attempted in terms of spatial symmetries broken or retained, related temporal evolution, and global parameters, such as the Nusselt number. It is shown that the intrinsically three-dimensional nature of the problem and its sensitivity to the thermal boundary conditions can have a remarkable influence on the multiplicity of emerging solutions and the system temporal response.

BACKGROUND The benefits of pre-hospital emergency anaesthesia (PHEA) are controversial. Patients who are hypovolaemic prior to induction of anaesthesia are at risk of severe cardiovascular instability post-induction. This study compared mortality for hypovolaemic trauma patients (without major neurological injury) undergoing PHEA with a patient cohort with similar physiology transported to hospital without PHEA. METHODS A retrospective database review was performed to identify patients who were hypotensive on scene [systolic blood pressure (SBP) < 90 mmHg], and GCS 13-15. Patient records were reviewed independently by two pre-hospital clinicians to identify the likelihood of hypovolaemia. Primary outcome measure was mortality defined as death before hospital discharge. RESULTS Two hundred and thirty-six patients were included; 101 patients underwent PHEA. Fifteen PHEA patients died (14.9%) compared with six non-PHEA patients (4.4%), P = 0.01; unadjusted OR for death was 3.73 (1.30-12.21; P = 0.01). This association remained after adjustment for age, injury mechanism, heart rate and hypovolaemia (adjusted odds ratio 3.07 (1.03-9.14) P = 0.04). Fifty-eight PHEA patients (57.4%) were hypovolaemic prior to induction of anaesthesia, 14 died (24%). Of 43 PHEA patients (42.6%) not meeting hypovolaemia criteria, one died (2%); unadjusted OR for mortality was 13.12 (1.84-578.21). After adjustment for age, injury mechanism and initial heart rate, the odds ratio for mortality remained significant at 9.99 (1.69-58.98); P = 0.01. CONCLUSION Our results suggest an association between PHEA and in-hospital mortality in awake hypotensive trauma patients, which is strengthened when hypotension is due to hypovolaemia. If patients are hypovolaemic and awake on scene it might, where possible, be appropriate to delay induction of anaesthesia until hospital arrival.

Summary Pre-hospital emergency anaesthesia with oral tracheal intubation is the technique of choice for trauma patients who cannot maintain their airway or achieve adequate ventilation. It should be carried out as soon as safely possible, and performed to the same standards as in-hospital emergency anaesthesia. It should only be conducted within organisations with comprehensive clinical governance arrangements. Techniques should be straightforward, reproducible, as simple as possible and supported by the use of checklists. Monitoring and equipment should meet in-hospital anaesthesia standards. Practitioners need to be competent in the provision of in-hospital emergency anaesthesia and have supervised pre-hospital experience before carrying out pre-hospital emergency anaesthesia. Training programmes allowing the safe delivery of pre-hospital emergency anaesthesia by non-physicians do not currently exist in the UK. Where pre-hospital emergency anaesthesia skills are not available, oxygenation and ventilation should be maintained with the use of second-generation supraglottic airways in patients without airway reflexes, or basic airway manoeuvres and basic airway adjuncts in patients with intact airway reflexes.

Background Elevated levels of cardiac troponin T are associated with poor outcome in critically ill patients and have been proposed as a prognostic marker in major trauma. This study investigated the relationship between cardiac troponin T levels on admission to intensive care unit (ICU) and all-cause mortality in major trauma patients. Methods A retrospective database analysis of cardiac troponin T levels on admission to the ICU in major trauma patients between 1 August 2015 and 31 December 2016 at a UK Major Trauma Centre was performed. Results Of the 243 patients, 69 (28.4%) died. Cardiac troponin T levels were significantly higher in patients who died compared to survivors: 42 vs. 13 ng/L, respectively ( p Discussion This confirms cardiac troponin T at ICU admission as a marker of mortality in major trauma. Elevated cardiac troponin T may be seen in patients without evidence of direct cardiac trauma.

Loneliness is a significant but neglected circumstance in which many individuals, particularly the elderly, find themselves. This review aims to discuss the various effects that loneliness has on mental and physical health and the potential interventions that may alleviate this problem. This review used the PubMed, ScienceDirect, and WHO IRIS databases to search for relevant studies on the topic, mainly focusing on longitudinal studies due to the difficulty in distinguishing the causality between loneliness and its associated factors. In collating these studies, loneliness can be shown to be a significant independent risk factor for a number of conditions such as poor health behaviors (eg, smoking and alcohol consumption), physical health problems (eg, hypertension and motor decline), and psychiatric conditions (eg, depression and cognitive impairment). The interventions discussed, both low tech and high tech, have the potential to benefit patients at both an individual level and a population-wide level.

The need for timely and appropriate airway management for trauma patients is widely recognised. There are a small number of severely injured patients who cannot be adequately supported with basic airway manoeuvres, and require early advanced airway management. The way in which this care is provided remains highly controversial. Whilst it is clear that effective airway management remains a priority for all patients and poorly performed pre-hospital anaesthesia may be detrimental to patient outcome, debate remains over exactly which patients will benefit from early advanced airway interventions, and how it should be provided. The evidence base is small and inconsistent, with significant heterogeneity in the reported data, making it impossible to draw meaningful conclusions. Current practice is not standardised, and care is delivered by providers of different abilities using a range of equipment and techniques. Standards of care provided during in-hospital practice relating to these issues of provider competence, equipment, and monitoring should be directly translated into delivery of care outside the hospital, but this is not always the case. The aim of this review is to evaluate the current evidence surrounding pre-hospital advanced airway management.

The conduct and benefit of pre-hospital advanced airway management and pre-hospital emergency anaesthesia have been widely debated for many years. In 2011, prehospital advanced airway management was identified as a ‘top five’ in physician-provided pre-hospital critical care. This article summarises the evidence for and against this intervention since 2011 and attempts to address some of the more controversial areas of this topic.

Background Effective and timely airway management is a priority for sick and injured patients. The benefit and conduct of pre-hospital emergency anaesthesia (PHEA) and advanced airway management remains controversial but there are a proportion of critically ill and injured patients who require urgent advanced airway management prior to hospital arrival. This document provides current best practice advice for the provision of PHEA and advanced airway management. Method This best practice advice was developed from EHAC Medical Working Group enforced by pre-hospital critical care experts. The group used a nominal group technique to establish the current best practice for the provision of PHEA and advanced airway management. The group met on three separate occasions to discuss and develop the guideline. All members of the working party were able to access and edit the guideline online. Results This EHAC best practice advice covers all areas of PHEA and advanced airway management and provides up to date evidence of current best practice. Conclusion PHEA and advanced airway management are complex interventions that should be delivered by appropriately trained personnel using a well-rehearsed approach and standardised equipment. Where advanced airway interventions cannot be delivered, careful attention should be given to applying basic airway interventions and ensuring their effectiveness at all times.

Background Treatment of airway compromise in trauma patients is a priority. Basic airway management is provided by all emergency personnel, but the requirement for on-scene advanced airway management is controversial. We attempted to establish the demand for on-scene advanced airway interventions. Trauma patients managed with standard UK paramedic airway interventions were assessed to determine whether airway compromise had been effectively treated or whether more advanced airway management was required. Methods A prospective observational study was conducted to identify trauma patients requiring prehospital advanced airway management attended by a doctor–paramedic team. The team assessed and documented airway compromise on arrival, interventions performed before and after their arrival, and their impact on airway compromise. Results Four hundred and seventy-two patients required advanced airway intervention and received 925 airway interventions by ground-based paramedics. Two hundred and sixty-nine patients (57%) still had airway compromise on arrival of the enhanced care team; no oxygen had been administered to 52 patients (11%). There were 45 attempted intubations by ground paramedics with a 64% success rate and 11% unrecognized oesophageal intubation rate. Doctor–paramedic teams delivering prehospital anaesthesia achieved definitive airway management for all patients. Conclusions A significant proportion of severely injured trauma patients required advanced airway interventions to effectively treat airway compromise. Standard ambulance service interventions were only effective for a proportion of patients, but might not have always been applied appropriately. Complications of advanced airway management occurred in both provider groups, but failed intubation and unrecognized oesophageal intubation were a particular problem in the paramedic intubation group.

Introduction Prehospital emergency anaesthesia (PHEA or ‘prehospital rapid sequence intubation’) is a high-risk procedure. Standard operating procedures (SOPs) and checklists within healthcare systems have been demonstrated to reduce human error and improve patient safety. We aimed to describe the current practice of PHEA in the UK, determine the use of checklists for PHEA and describe the content, format and layout of any such checklists currently used in the UK. Method A survey of UK prehospital teams was conducted to establish the incidence and conduct of PHEA practice. Results were grouped into systems delivering a high volume of PHEA per year (>50 PHEAs) and low volume (≤50 PHEAs per annum). Standard and ‘crash’ (immediate) induction checklists were reviewed for length, content and layout. Results 59 UK physician-led prehospital services were identified of which 43 (74%) participated. Thirty services (70%) provide PHEA and perform approximately 1629 PHEAs annually. Ten ‘high volume’ services deliver 84% of PHEAs per year with PHEA being performed on a median of 11% of active missions. The most common indication for PHEA was trauma. 25 of the 30 services (83%) used a PHEA checklist prior to induction of anaesthesia and 24 (80%) had an SOP for the procedure. 19 (76%) of the ‘standard’ checklists and 5 (50%) of the ‘crash’ induction checklists used were analysed. On average, standard checklists contained 169 (range: 52–286) words and 41 (range: 28–70) individual checks. The style and language complexity varied significantly between different checklists. Conclusion PHEA is now performed commonly in the UK. The use of checklists for PHEA is relatively common among prehospital systems delivering this intervention. Care must be taken to limit checklist length and to use simple, unambiguous language in order to maximise the safety of this high-risk intervention.

Polymer architecture can have a significant effect on the properties and potential applications of materials. In this study, arborescent polyisobutylene (PIB)-poly(ethylene oxide) (PEO) graft copolymers with varying PEO content were synthesized from arborescent PIB-co-polyisoprene and compared with linear PIB-PEO graft copolymers. By AFM imaging, phase separation was detected in a 48 wt% PEO arborescent copolymer. Tensile testing revealed that, in general, increasing PEO content led to increased tensile strength and Young's modulus but decreased elongation at break. Arborescent analogues exhibited lower elongation at break and lower strength compared with linear analogues but also less plastic deformation and yielding behaviour. Like linear analogues of comparable PEO content, films of the arborescent graft copolymers resisted the adsorption of rhodamine-labelled fibrinogen, suggesting that they may also exhibit non-fouling properties. Finally, the assembly of these amphiphilic copolymers in aqueous solution was investigated. Unlike the linear analogues, the sizes of the assemblies were not greatly affected by their method of preparation. This work demonstrates that it is possible to prepare PIB-based materials with a wide range of interesting properties by tuning not only the content of PEO but also the architectures of the macromolecules. © 2014 Society of Chemical Industry

The use of a hyperthermal hydrogen induced cross-linking process to prepare laminates comprising polypropylene, poly(isobutylene-co-isoprene), and poly(vinyl acetate) is described. In this new, milder alternative to conventional plasma techniques, neutral molecular hydrogen projectiles were used to create carbon radicals on impacted surfaces by collision-induced dissociation of C-H bonds, and this process was used to cross-link polymers on a polypropylene surface. It was demonstrated that multiple layers of cross-linked materials could be added, creating polymer laminates with each layer introducing new functionalities and properties. In particular, the present work shows that the process is largely nondestructive toward ester functionalities. First, the esters were grafted to become nonleachable. Then, the esters were subsequently hydrolyzed to convert the surface from hydrophobic to hydrophilic. Afterward, the esters could be recovered by simple esterification demonstrating that further chemical transformations were possible.

Bulk platinum-rich glasses exhibiting high bulk moduli and Poisson ratios are introduced. A bulk modulus of 217 GPa and a Poisson’s ratio of 0.43 are measured, the highest values reported to date for a metallic glass. The present glasses demonstrate an unusual capacity for “liquid-like” deformation characterized by low resistance to shear flow and high resistance to cavitation, enabling extensive bending ductility in the absence of fracture. An indirect estimate of the fracture toughness yields a value of ∼125 MPa m^(1/2).

We compared the Ambu aScope ™ with a conventional fibrescope in two simulated settings. First, 22 volunteers performed paired oral and nasal fibreoptic intubations in three different manikins: the Laerdal Airway Trainer, Bill 1 and the Airsim (a total of 264 intubations). Second, 21 volunteers intubated the Airway Trainer manikin via three supraglottic airways: classic and intubating laryngeal mask airways and i-gel (a total of 66 intubations). Performance of the aScope was good with few failures and infrequent problems. In the first study, choice of fibrescope had an impact on the number of user-reported problems (p = 0.004), and user-assessed ratings of ease of endoscopy (p < 0.001) and overall usefulness (p < 0.001), but not on time to intubate (p = 0.19), or ease of railroading (p = 0.72). The manikin chosen and route of endoscopy had more consistent effects on performance: best performance was via the nasal route in the Airway Trainer manikin. In the second study, the choice of fibrescope did not significantly affect any performance outcome (p = 0.3), but there was a significant difference in the speed of intubation between the devices (p = 0.02) with the i-gel the fastest intubation conduit (mean (SD) intubation time i-gel 18.5 (6.8) s, intubating laryngeal mask airway = 24.1 (11.2) s, classic laryngeal mask airway = 31.4 (32.5) s, p = 0.02). We conclude that the aScope performs well in simulated fibreoptic intubation and (if adapted for untimed use) would be a useful training tool for both simulated fibreoptic intubation and conduit-assisted intubation. The choice of manikin and conduit are also important in the success of such training. This manikin study does not predict performance in humans and a clinical study is required.

Reaction of the dimeric allyl-nickel(II) chloro complex [Ni(η3-C3H5)(μ-Cl)]2 (5) with sulfur donor ligands (L = L10–L13) in the presence of NaBAr 4 F ( Ar 4 F = 3,5-(CF3)2C6H3) gives the corresponding cationic mononuclear complexes of the type [Ni(η3-C3H5)(L)2]+ (1–4) [L = L10 = diphenyl sulfide (1); L = L11 = 4,4′-thiodiphenol (2); L = L12 = 4,4′-thio-bis(6-tert-butyl-o-cresol) (3); L = L13 = 4,4′-thio-bis (6-tert-butyl-m-cresol) (4)]. All of these complexes were characterized by elemental analysis and NMR spectroscopy, as well as the representative complex 3 additionally by single-crystal X-ray analysis. In comparison to the known complex [Ni(η3-C3H5)(η6-BHT)][B Ar 4 F ] (BHT = 3,5-di-tert-butyl-4-hydroxytoluene), the herein described cationic complexes show an increased stability towards water. The activity of the complexes for butadiene polymerization in aqueous emulsions was studied.

Background Recent media interest in stabbings and shootings has lead to the general assumption that injury and death secondary to deliberate penetrating trauma are rising. The aim of this study was to establish the prevalence of deliberate penetrating trauma within a London-based physician-led pre-hospital trauma service, and evaluate whether the perceived increase reported by the media translates into a real increase in penetrating trauma caseload. Method A retrospective review of a physician-led pre-hospital care trauma database was conducted to identify all patients who sustained stabbing or shooting injuries over a 16-year period. Patients who died in the pre-hospital phase and paediatric patients were included. Other local and national datasets were examined to determine whether similar trends were observed. Results 1564 penetrating trauma victims were identified, including 92 children. 1358 patients (86.8%) sustained stab wounds; 206 patients were shot (13.2%). Penetrating injury accounted for 9.9% of the overall trauma caseload during the study period. The annual increase in patients sustaining stabbing injuries was 23.2%. Gun shot wounds increased by 11.0% per year. Conclusion The study demonstrates a significant annual rise in the number of cases of deliberate penetrating trauma managed by a UK physician-led pre-hospital trauma service.

A novel 6-hydroxy chromone-3-carbaldehyde benzoyl hydrazone ligand ( L ) and its Ln(III) complexes, [Ln = La( 1 ) and Sm( 2 )], have been prepared and characterized. The crystal and molecular structures of complexes 1 and 2 were determined by single-crystal X-ray diffraction. Antioxidative activity tests in vitro showed that L and its complexes have significant antioxidative activity against hydroxyl free radicals from the Fenton reaction and also oxygen free radicals, and that the effect of the La(III) complex 1 is stronger than that of mannitol and the other compounds. The compounds were tested against tumor cell lines including HL-60 and A-549. The data shows that the suppression rate of complexes 1 and 2 against the tested tumor cells are superior to the free ligand ( L ). The interactions of complexes 1 and 2 , and L , with calf thymus DNA were investigated by UV–visible (UV–vis), fluorescence, denaturation experiments and viscosity measurements. Experimental results indicated that complexes 1 and 2 , and L can bind to DNA via the intercalation mode, and that the binding affinity of complex 1 is higher than that of complex 2 and of free ligand ( L ). The intrinsic binding constants of complexes 1 and 2 , and L were (7.62 ± 0.56) × 10 6 , (3.70 ± 0.47) × 10 6 and (2.41 ± 0.46) × 10 6 M −1 , respectively.

The deprotonation of the tripyrrole MeTPH(2) [MeTPH(2) = 2,5-[(2-pyrrolyl)(C(6)H(5))2C](2)(MeNC(4)H(2))], containing one N-methylated pyrrolyl ring, was carried out with 2 equiv of KH. The corresponding dipotassium salt reacted with VCl(3)(THF)(3) to afford the complex [(MeTP)VCl(THF)].THF (1). While the two lateral pyrrolide rings are sigma-bonded, the central one is perpendicularly oriented in a sort of pi-fashion. However, the bond distances clearly indicated that only the quaternized N atom is forming a bonding contact. Subsequent reduction of 1 with Na yielded the corresponding divalent complex [(MeTP)V(THF)].(C(7)H(8))(0.5) (2) where the central N-methylated ring adopted a more regular pi-orientation. When treated with a strong Lewis acid (AlMe(3)), THF was extracted from the vanadium coordination sphere, forming the dinuclear dinitrogen complex [(MeTP)V(mu-N(2))](2).(C(7)H(8))(2.9) (3). Reduction of 3 with potassium graphite gave cleavage of dinitrogen, affording the mixed-valent nitride-bridged complex [(MeTP)V(mu-N)](2).(THF) (4).

There is good evidence that all invasively ventilated patients should undergo lung-protective ventilation (LPV) [1, 2]. As well as LPV, there is a strong evidence base for other routine interventions in the care of ventilated patients. We performed a one day snapshot audit and survey of attitudes towards invasive ventilation practice in intensive care units across the Severn (Bristol,UK) region.

Reduction of the tetravalent complex [{2,5-[(C4H3N)CPh2]2[C4H2N(Me)]}ThCl2 (THF)]-THF (2) of the tripyrrolide dianion 2,5-[(C4H3N)CPh 2 ] 2 C 4 H 2 N(Me) afforded different products depending on the reaction conditions. In every case, the reaction proceeded via the initial formation of a reduced species, as indicated by the very rapid formation of a dark red color followed by slow and complete discoloration. In the case of the reduction in toluene, the complexes ({2,5-[(C4H3N)CPh 2 ] 2 [C 4 H 2 N]} 2 Th[K(toluene)]2)· 1.5(toluene) (3a) and {2,5-[(C4H3N)CPh2]2[C4H2N]} 2 Th[K(DME)] 2 (3b) were obtained, depending on the crystallization solvent (toluene versus DME). In both cases, the products arose from a loss of the methyl group attached to the central pyrrole ring N atom. When the reduction was carried out in DME as a solvent, the complex {[{2,5-[(C4H3N)CPh2]2[C4H2N(Me)]}Th(OMe)]2(m-OC 2 H 4 OMe) 2 }· 0.75(hexane) (5) was isolated. This species is derived from two different pathways of C-O cleavage of the DME solvent. Reduction of {2,5-[(C4H3N)CPh2]2[C4H2N(Me)]}ThCl{(C4H3N)CPh2[C4H3N(Me)]} (6), containing both the monoalkylated tripyrrolide and dipyrrolide ligands, afforded instead pyrrolide ring opening and formation of [({2,5-[(C4H3N)CPh2]2[C4H2N(Me)]}Th[(C4H3N)CPh2(C=CHCH=CHNMe)])2(m-K)]-[K(DME) 4 ]·2(hexane) (7).

Treatment of the ethylene tetramerization catalyst precursor [PNP]CrCl3 with Me3Al afforded the new divalent catalyst precursor {[PNP]Cr(m-CI)AlMe3} [ClAlMe3](0.34) [Me4Al](0.66)(.)0.125(hexane)(.)0.25 (toluene) (1). The formation of 1 implies reduction to the divalent state, cationization, and ligand scrambling. The fact that this species displays, upon activation with MAO, a catalytic activity similar to that of the trivalent precursor indicates that reduction of the metal to the divalent state is a step toward the formation of the actual catalytically active species. The failure of CrCl2(THF)(2) to react with [PNP] indicates that cationization and acquisition of the second ligand and of a bridging ClAlMe3 residue are central to the stabilization of this new divalent catalyst precursor.

Artículo escrito por muchos autores, sólo se referencian el primero, los autores que firman como Universidad Autónoma de Madrid y el grupo de colaboración en el caso de que aparezca en el artículo, While the standard model of particle physics does not include free particles with fractional charge, experimental searches have not ruled out their existence. We report results from the Cryogenic Dark Matter Search (CDMS II) experiment that give the first direct-detection limits for cosmogenically produced relativistic particles with electric charge lower than e/6. A search for tracks in the six stacked detectors of each of two of the CDMS II towers finds no candidates, thereby excluding new parameter space for particles with electric charges between e/6 and e/200, This work is supported in part by the National Science Foundation, by the U.S. Department of Energy, by NSERC Canada, and by MultiDark (Spanish MINECO). Fermilab is operated by the Fermi Research Alliance, LLC under Contract No. De-AC02-07CH11359. SLAC is operated under Contract No. DE-AC02-76SF00515 with the U.S. Department of Energy

Advanced airway management is one of the most controversial areas of pre-hospital trauma care and is carried out by different providers using different techniques in different Emergency Medical Services systems. Pre-hospital anaesthesia is the standard of care for trauma patients arriving in the emergency department with airway compromise. A small proportion of severely injured patients who cannot be managed with basic airway management require pre-hospital anaesthesia to avoid death or hypoxic brain injury. The evidence base for advanced airway management is inconsistent, contradictory and rarely reports all key data. There is evidence that poorly performed advanced airway management is harmful and that less-experienced providers have higher intubation failure rates and complication rates. International guidelines carry many common messages about the system requirements for the practice of advanced airway management. Pre-hospital rapid sequence induction (RSI) should be practiced to the same standard as emergency department RSI. Many in-hospital standards such as monitoring, equipment, and provider competence can be achieved. Pre-hospital and emergency in-hospital RSI has been modified from standard RSI techniques to improve patient safety, physiological disturbance, and practicality. Examples include the use of opioids and long-acting neuromuscular blocking agents, ventilation before intubation, and the early release of cricoid pressure to improve laryngoscopic view. Pre-hospital RSI is indicated in a small proportion of trauma patients. Where pre-hospital anaesthesia cannot be carried out to a high standard by competent providers, excellent quality basic airway management should be the mainstay of management.

We report a first search for weakly interacting massive particles (WIMPs) using the background rejection capabilities of SuperCDMS. An exposure of 577 kg days was analyzed for WIMPs with mass

A facile method for cross-linking organic molecules has been developed by computational modeling, instrumentation design, and experimental research. Briefly, organic molecules are hit by H2 with controllable kinetic energy in our novel apparatus where a high flux of hyperthermal H2 is generated. When a C-H bond of the organic molecule is hit by H2 at about 20 eV, efficient kinematic energy-transfer in the H2→H collision facilitates the C-H dissociation with nearly 100% reaction probability. When H2 hits other atoms which are by nature much heavier than H2, mass disparity bars effective energy transfer and this both blocks undesirable bond dissociation and reduces unnecessary energy wastage. The recombination of the carbon radicals generated by the C-H cleavage efficiently completes the production of C-C cross-links at room temperature with no additional energy/chemicals requirements. In addition to these green chemistry merits, this new method is better than other cross-linking techniques which rely on prerequisite reactions to add cross-linkers to the organic molecules or additional reactants and additives. These promising features are validated by several cross-linking trials which demonstrate desirable mechanical, electrical, chemical, and biochemical changes while inducing no undesirable damage of chemical functionalities in the original molecules. © 2014 The Royal Society of Chemistry.

We report a first search for weakly interacting massive particles (WIMPs) using the background rejection capabilities of SuperCDMS. An exposure of 577 kg-days was analyzed for WIMPs with mass < 30 GeV/c2, with the signal region blinded. Eleven events were observed after unblinding. We set an upper limit on the spin-independent WIMP-nucleon cross section of 1.2e-42 cm2 at 8 GeV/c2. This result is in tension with WIMP interpretations of recent experiments and probes new parameter space for WIMP-nucleon scattering for WIMP masses < 6 GeV/c2., 6 pages, 4 figures; figure 1 updated, submitted to Phys. Rev. Lett