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A man in his 70s with a complex medical history, including cadaveric renal transplant, presented with recurrent urinary tract infections. Investigation revealed recurrent urinary pathogens, includingEnterobacter cloacaeand persistent BK viruria. Cystoscopy revealed a pedunculated mass in the right posterior–lateral wall, inferior to the transplant urethral orifice, and biopsy of this mass showed invasive small cell carcinoma with a prominent adenocarcinoma component. The tumour was treated with complete transurethral resection followed by carboplatin, etoposide and radiation. Laboratory analysis of biopsied samples showed immunostaining and molecular evidence of BK virus DNA in the cancer cells. Follow-up cystoscopies have shown no recurrence of the cancer.

Despite the country’s extensive environmental jurisprudence and many historic rulings in which the courts have rescued worsening environmental situations, river (Ganga and Yamuna) water does not match the mandated minimum “bathing quality.” Rivers like the Ganga and Yamuna, which flow through numerous states and towns, would be in a different situation. Without strict monitoring and enforcement of the measures, no action plan can work. Punishment of defaulters can serve as deterrence while also instilling fear in other non-compliant enterprises. In comparison to environmental legislation, the NGT Act allows for substantially harsher fines and penalties. River rejuvenation plans must be carefully monitored to ensure that they do not suffer the same fate. Making action plans will not improve river water quality unless they are implemented with sincerity and consistency, as well as continuous monitoring and severe enforcement.

A 95 days experiment was conducted to observe the growth performance of giant fresh water prawn (Macrobrachium rosenbergii) replacing fishmeal protein by dietary soybean meal protein in ten earthen mini ponds (50 m2), at Khulna University campus . Five experimental diets containing 25% protein as Control, Diet 1, Diet 2, Diet 3 and Diet 4 were used. In Control, 36% fishmeal was used as a sole source of protein and Diet 1, 2, 3 and 4 were prepared by substituting fishmeal protein with 30, 40, 50, and 80% fishmeal protein with soybean meal protein respectively. Juvenile shrimps were collected from local vendors having 1.7 g average weight and stocked at a density of 3 m-2. Water and soil quality was monitored regularly and found within the acceptable range. The prawns were fed twice daily at satiations by serving the diets in feeding trays. The highest average weight gain was found in Diet 4 (23.89 ± 5.29 g) and the lowest in Diet 2 (17.68 ± 1.09), although no significant difference (p>0.05) was observed among the treatment and the lowest FCR (1.09) the highest SGR (2.60) and PER (3.43) was achieved in Diet 4 that showed significant difference (p

Optimal cell spreading and interplay of vascular smooth muscle cells (VSMC), inflammatory cells, and cell adhesion molecules (CAM) are critical for progressive atherosclerosis and cardiovascular complications. The role of vitronectin (VTN), a major cell attachment glycoprotein, in the pathogenesis of atherosclerosis remains elusive. In this study, we attempt to examine the pathological role of VTN in arterial plaque progression and inflammation. We found that, relative expression analysis of VTN from the liver of Apolipoprotein E (ApoE) Knockout mice revealed that atherosclerotic progression induced by feeding mice with high cholesterol diet (HCD) causes a significant downregulation of VTN mRNA as well as protein after 60 days. Promoter assay confirmed that cholesterol modulates the expression of VTN by influencing its promoter. Mimicking VTN reduction with siRNA in HCD fed ApoE Knockout mice, accelerated athero‐inflammation with an increase in NF‐kB, ICAM‐1, and VCAM‐1 at the site of the plaque along with upregulation of inflammatory proteins like MCP‐1 and IL‐1β in the plasma. Also, matrix metalloprotease (MMP)‐9 and MMP‐12 expression were increased and collagen content was decreased in the plaque, in VTN deficient condition. This might pose a challenge to plaque integrity. Human subjects with acute coronary syndrome or having risk factors of atherosclerosis have lower levels of VTN compared to healthy controls suggesting a clinical significance of plasma VTN in the pathophysiology of coronary artery disease. We establish that, VTN plays a pivotal role in cholesterol‐driven atherosclerosis and aortic inflammation and might be a useful indicator for atherosclerotic plaque burden and stability.

A green and sustainable route for selective esterification of glycerol has been developed. The high selectivity of tri-acetin (99%), recyclability of catalyst and overall green methodology were the advantageous features.

Purpose: Allergen immunotherapy (AIT) while usually safe, is not without risk. Both sublingual (SLIT) and subcutaneous immunotherapy (SCIT) have the potential for systemic reactions including anaphylaxis. Materials and Methods: A short survey was distributed to fellows of the American Academy of Otolaryngic Allergy (AAOA) (n = 553) in July of 2019 to determine current prescribing practices. Results: A total of 103/553 surveys were completed, giving a response rate of 18.6%. Prescribing patterns for SCIT showed 79.6% prescribed auto-injectable epinephrine (AIE) to all patients, 11.7% prescribed only to high risk patients, while 1.9% did not prescribe AIE at all. SLIT showed similar patterns with 71.8% prescribing AIE to all, 11.7% to high risk or letting patient choose, and 6.8% did not prescribe to anyone. Just under half of the physicians responded affirmatively to giving a written anaphylaxis plan to patients on immunotherapy. 48.5% physicians reported treating in-office anaphylaxis due to SCIT or skin testing in the past year, while 6% reported anaphylaxis due to SLIT. Conclusions: A majority of otolaryngic allergists are still prescribing AIE for both SCIT and SLIT. With the recent higher costs attributed to AIE as well as drug shortages, some physicians are risk-stratifying patients. While SCIT has a higher risk for treatment related systemic reactions, anaphylaxis does occur with SLIT, thus making it imperative to counsel patients on a clear anaphylaxis protocol in all forms of AIT.

Background: Older adults with Type 2 diabetes (T2D) are more likely to be frail, which increases the risk for disability and mortality. Objectives: To determine the feasibility of a behavioral lifestyle intervention, enhanced with mobile health technology for self-monitoring of diet and activity, to improve frailty in overweight/obese older adults (≥65 years) diagnosed with T2D. Design, Setting, and Participants: Single arm, 6-month study of a behavioral lifestyle intervention in 20 overweight/obese (BMI>25) older adults (≥ 65 years) with self-reported T2D diagnosis who owned a smartphone. A Fitbit tracker was provided to all participants for self-monitoring of diet and physical activity. Our primary outcome of feasibility was measured by session attendance, adherence to Fitbit usage to self-monitor diet and physical activity, and study retention. Secondary outcomes included the preliminary efficacy of the intervention on frailty, physical function, quality of life, and T2D-related outcomes. Results: Eighteen participants completed the study. The mean age was 71.5 (SD ± 5.3) years, 56% were female, and half were Hispanic. At baseline, 13 (72%) were pre-frail, 4 (22%) were frail, and 1 (6%) were non-frail. At follow-up, frailty scores improved significantly from 1.61 ± 1.15 to 0.94 ± 0.94 (p=0.01) and bodyweight improved from 205.66 ± 45.52 lbs. to 198.33 ± 43.6 lbs. (p=

Build Environ 219, 109187 (2022). doi:10.1016/j.buildenv.2022.109187, Published by Elsevier, New York, NY [u.a.]

Polyethylene glycol-6000 supported copper-molybdenum nanoparticles (CuO–MoO3@PEG) has been synthesized as a highly efficient, novel and recyclable heterogeneous catalyst by simple impregnation method. The catalyst was characterized by FTIR, XRD, SEM, EDX, elemental mapping, TEM, TGA, EPR, ICP-AES, UV–visible DRS and XPS analyses. The catalyst was successfully applied for the enamination of pyrimidine dione and dimedone (1,3- dicarbonyl compounds). The catalyst was found to be efficient up to five cycles with minor loss in catalytic activity. The recovered catalyst (5th run) retained its structure integrity which was confirmed by FTIR, XRD, SEM, TEM, TGA, and ICP-AES analyses. The products (β-enaminones) were obtained in excellent yield (92%) and short reaction time period (30–35 ​min).

A novel mesostructured catalyst sulphated alumina tungstic acid (SATA) has been prepared by an easy route. Various techniques such as IR, XRD, SEM, EDX, TEM, TGA and BET were used to characterize the synthesized catalyst. The catalytic activity of the meso material has been explored by synthesizing a series of new pyrazole carbonitrile derivatives from aromatic aldehydes, ethylcyanoacetate, phenylhydrazine/hydrazine hydrate in ethanol under reflux conditions. Furthermore, the "greenness" of this protocol when estimated by green metrics, displayed satisfactory results. The protocol is free from column chromatography, and toxic solvents and is more efficient as compared to reported ones.

Silica modified imidazolium [smim] based halometallic ionic liquids, [smim][MCl4] (M = Fe, Cu and Zn), were synthesized for the evaluation of acidic and catalytic properties. Among these ILs, [smim][FeCl4]− was used for the preparation of heterogeneous catalyst ([smim][FeCl4]−@Nd2O3) by simple immobilization of IL on Nd2O3 nanoparticles. The structure of [smim][FeCl4]−@Nd2O3 was established by various techniques including FTIR, Raman, UV-vis DRS, powder XRD, SEM/EDX, elemental mapping, TEM, TGA, EPR and XPS analyses. The stability of nano-catalyst, [smim][ FeCl4]−@Nd2O3, was established with the help of zeta potential analysis which showed a value of −40.32 mV lying under the stability range. Potentiometric titration with n-butyl amine was used to evaluate the acidic properties of [smim][MCl4] as well as [smim][FeCl4]−@Nd2O3. The catalytic potential of the material was probed through the one pot synthesis of N-aryl indeno pyrrole derivatives. The results showed excellent performance of the material by producing a high yield (98%) of indeno pyrrole derivatives. A recyclability experiment revealed that the catalyst was efficient in up to five cycles with insignificant loss in catalytic activity. The evaluation of green metrics indicated the sustainability of the present protocol in terms of high atom economy and low E-factor.

A highly efficient and eco-friendly route for the reduction of graphene oxide (GO) to reduced graphene oxide (rGO) was developed by using polyvinylpyrrolidone coated CeO2 NPs (PVP–CeO2) as a reducing and stabilizing agent. The resulting carbonaceous material, PVP–CeO2/rGO, was well characterized with different spectroscopic techniques such as Fourier Transform Infrared (FTIR) spectroscopy, Scanning Electron Microscopy (SEM), Energy Dispersive X-ray (EDX), elemental mapping, Transmission Electron Microscopy (TEM), Raman spectroscopy, powder X-ray diffraction (XRD), Brunauer–Emmett–Teller (BET), X-ray Photoelectron Spectroscopy (XPS), and Thermal Gravimetric (TG) analyses. The material exhibited high catalytic potential towards multicomponent reactions for the synthesis of biologically relevant benzodiazepine derivatives in aqueous media. The efficiency of the material for the desired reaction was shown in the form of an excellent product yield (96–98%) and a very short reaction time period (7–10 min). The use of water as solvent and recyclability of the catalyst made the present protocol acceptable from a green perspective.

HClO4–SiO2 catalyzed synthesis of coumarinyl chalcones (8a–j) under solvent-free conditions is reported. The catalyst is characterized by powder XRD and SEM–EDX analysis. The stability of the catalyst is evaluated by thermogravimetric (TG) and differential scanning calorimetry (DSC) techniques. The remarkable features of this green protocol are the excellent yields of the products, shorter reaction time, simple experimental procedure, easy preparation and reusability of the catalyst. Keywords: HClO4–SiO2, Coumarinyl chalcones, Heterogeneous catalyst, Thermal solvent-free conditions

Pyrazines are renowned heterocyclic compounds that have played an important role in drug design and are part of many polycyclic compounds of biological and industrial significance. In this article, a novel chitosan-immobilized ionic liquid, [DSIM][AlCl3]x–@CS, has been synthesized easily at ambient temperature and used for catalyzing the synthesis of a series of biologically relevant pyrazine derivatives. The catalyst is well characterized by various techniques such as Fourier transform infrared spectroscopy, Raman spectroscopy, solid-state 13C MAS nuclear magnetic resonance, scanning electron microscopy/energy-dispersive X-ray, elemental mapping, transmission electron microscopy, powder X-ray diffraction, and thermal gravimetric analyses. The advantageous features of the present energy-sustainable methodology include high yield of product (>99%), shorter reaction time periods, and recyclability of the catalyst.

Glycation of biological macromolecules, due to hyperglycemia, promotes the formation of advanced glycation end products (AGEs). It is accelerated in diabetic patients and is responsible for the pathophysiology and progression of diabetes. Previous reports have shown that amount of AGEs formation and glycation-induced structural damage is higher in hemoglobin (Hb) than other proteins present in blood. In our previous study, we have shown structural changes in Hb by D-ribose which may result into the generation of immunogenic neo-epitopes. Thus, we hypothesized that D-ribose induced structural perturbations in Hb, could result in the formation of neo-epitopes which may provoke an auto-immune response and may also be involved in the immuno-pathogenesis of diabetes type-2 associated complications. Therefore, in the current study, we analyzed the prevalence of autoantibodies in diabetic patient's sera against D-ribose glycated-Hb by direct binding and competitive ELISA. Direct binding ELISA confirmed that autoantibodies in diabetic patients exhibit significantly high binding with D-ribose glycated-Hb as compared to its native form. The antigen binding specificity of these antibodies was also screened by competitive inhibition ELISA. We also used D-glucose glycated-Hb as a positive control to detect the presence of auto-antibodies by direct binding and inhibiton ELISA. We found that D-glucose glycated-Hb binds with T2DM samples but the affinity to binding is lower than D-ribose glycated-Hb. The overall findings of this study suggest the prevalence of circulating autoantibodies against D-ribose glycated-Hb in diabetic patients and thus, the level of these autoantibodies may be used as biomarker for progression of diabetes.

Acute limb ischemia (ALI) is the sudden decrease in limb perfusion caused by embolism secondary to many blood stasis conditions. Treatment commences with intravenous (IV) unfractionated heparin infusion. Individuals can have an immune-mediated reaction to heparin products which results in heparin-induced thrombocytopenia (HIT). Coronavirus disease 2019 (COVID-19) has added to the difficulty of treating patients with ALI due to increasing the likelihood of HIT via the virus's ability to manipulate the coagulation parameters. We present a case of ALI complicated by HIT in a 49-year-old male with a confirmed asymptomatic COVID-19. The patient initially presented with progressive pain, coldness, and tingling in the right foot. He was treated with a tissue plasminogen activator (TPA) and a heparin drip. The occlusion persisted despite medical intervention leading to right below-knee amputation. The patient returned to the emergency department (ED) 13 days later with massive intracranial hemorrhage and subsequently expired. This case study demonstrates the significance of COVID-19 diagnostic testing due to the possibility of developing blood clots and potential complications, including HIT.

A simple method for the reduction of 4-Nitrophenol (4-NP) to 4-Aminophenol (4-AP) has been described using ionic liquid incorporated graphene nanosheets (IMD-Si/FeCl4ˉ@GNS). The material was also tested for nonenzymatic glucose sensing and found to be a promising material as glucose sensor with very high sensitivity (0.57 ​mA ​mM-1.cm-2) and low detection limit (1.2 ​μm).

Background Severe mental illness (SMI) is associated with an increased risk of cardiovascular disease and mortality. However, it is unclear whether SMI patients are just as likely to receive guideline-recommended therapy for AMI as those without mental illness. Purpose To examine national-level estimates of the prevalence, management strategies and in-hospital clinical outcomes of SMI patients presenting with AMI. Methods All AMI hospitalisations from the United States National Inpatient Sample were included, stratified by mental health status in to 5 groups: no-SMI, Schizophrenia, “Other non-organic psychoses” (ONOP), Bipolar Disorder and Major Depression. Multivariable logistic regression modelling was performed to examine the association between SMI subtypes and receipt of invasive management and subsequent in-hospital clinical outcomes, expressed as adjusted odds ratios (aOR) and 95% confidence intervals (CI). Results Out of 6,968,777 AMI hospitalisations between 2004 and 2014, a total of 439,544 (6.5%) had an SMI diagnosis. The prevalence of SMI amongst the ACS population doubled over the study period (from 4.5% in 2004 to 9.5% in 2014), primarily due to an increase in Major Depression and Bipolar Disorder diagnoses. All SMI subtypes were less likely to receive coronary angiography and PCI, with the Schizophrenia group being at least odds of either procedure (aOR 0.46 95% CI 0.45, 0.48 and aOR 0.57 95% CI 0.55, 0.59, respectively). Although patients with Schizophrenia and ONOP experienced higher crude rates of in-hospital mortality and stroke compared to those without SMI, only Schizophrenia patients were associated with increased odds of mortality (aOR 1.10 95% CI 1.04, 1.16), while ONOP were the only group at increased odds of stroke (aOR 1.53 95% CI 1.42,1.65) following multivariate adjustment. Patients with ONOP were the only group associated with increased odds of in-hospital bleeding compared to those without SMI (aOR 1.11 95% CI 1.04,1.17). Conclusion Patients with SMI are less likely to receive invasive management for AMI, with women and schizophrenia diagnosis being the strongest predictors of conservative management. Schizophrenia and “other non-organic psychoses” are the only SMI subtypes associated with adverse clinical outcomes after AMI. A multidisciplinary approach between psychiatrists and cardiologists could improve outcomes of this high-risk population. Odds of management and clinical outcomes Funding Acknowledgement Type of funding source: None

Silica modified imidazolium [smim] based halometallic ionic liquids, [smim][MCl

Bangladesh has undergone dramatic land use and land cover changes (LULCC) in recent years, but no quantitative analysis of LULCC drivers at the national scale exists so far. Here, we quantified the drivers of major LULCC in combination with biophysical and socioeconomic observations at the sub-district level. We used Landsat satellite data to interpret LULCC from 2000 to 2010 and employed a Global Surface Water Dataset to account for the influences of water seasonality. The results suggest that major LULCC in Bangladesh occur between agricultural land and waterbodies and between forest and shrubland. Exclusion of seasonal waterbodies can improve the accuracy of our LULCC results and driver analysis. Although the gross gain and loss of agricultural land are large on the local scale, the net change (gross gain minus gross loss) at a country scale is almost negligible. Climate dynamics and extreme events and changes in urban and rural households were driving the changes from forest to shrubland in the southeast region. The conversion from agricultural land to standing waterbodies in the southwest region was mainly driven by urban household dynamics, population growth, distance to cities and major roads, and precipitation dynamics. This study, which is the first effort accounting for water seasonality and quantifying biophysical and socioeconomic drivers of LULCC at the national scale, provides a perspective on overall LULCC and underlying drivers over a decadal time scale and national spatial scale and can serve as a scientific basis for developing land policies in Bangladesh.

Background Circulating tumor cells (CTCs) serve as predictive and prognostic markers for numerous cancers including non-small-cell lung cancer (NSCLC). CTCs are extremely rare in the blood with a frequency of one CTC per 106–107 leukocytes, therefore, highly sensitive methods are required to detect them. Recently, a new method using the detection of folate receptor-positive CTCs showed promising results in NSCLC patients. We conducted a meta-analysis of the diagnostic accuracy of the ligand-targeted polymerase chain reaction (LT-PCR) in the detection of folate-positive CTCs and thus, the diagnosis of NSCLC. Methods We conducted a systematic search of Medline (PubMed) and the Cochrane. Central Register of Controlled Trials for abstracts and fully published studies (from inception through May 2019). Only fully published studies and abstracts measuring the diagnostic accuracy of LT-PCR in the detection of folate-positive CTCs in patients with NSCLC were included in the meta-analysis. A total of 71,116 studies were identified. Studies which were duplicate, systematic reviews or meta-analysis, or studies based on other techniques to detect CTCs were excluded. Data were abstracted by two independent reviewers (YI, NS). Pooled sensitivities, pooled specificities and summary receiver operating curves (SROC) were obtained. Meta Disc version 1.4 software was used for statistical analyses. Results Four fully published studies and one abstract were used for the meta-analysis. Pooled sensitivity and specificity for LT-PCR to detect folate-positive CTCs were 0.77 (confidence interval: 0.75–0.79) and 0.87 (confidence interval: 0.85–0.89), respectively. Heterogeneity for both pooled sensitivity and specificity was not significant. The SROC obtained in the meta-analysis showed an area under the curve (AUC) of 0.84. Conclusion Detection of folate-positive CTCs with LT-PCR showed very high accuracy in our meta-analysis.

Determine the significance of urinary tract infection (UTI) as a cause of late onset sepsis (LOS) in very low birth weight (VLBW) infants in the Neonatal Intensive Care Unit (NICU). Analysis of blood, cerebrospinal fluid and urine culture results in VLBW infants >72-h old, admitted to the Georgetown University Hospital NICU between 2005 and 2015. Of 527 VLBW infants, 297 (56.4%) underwent 911 evaluations for LOS; only one-third included urine cultures. UTI was diagnosed in 8.5% of VLBW infants (range 2–15.9%) and in 13.8% of infants weighing

A highly efficient and recyclable catalyst, cerium-immobilized silicotungstic acid nanoparticle-impregnated zirconia (Ce@STANPs/ZrO2), has been synthesized. The catalytic activity of Ce@STANPs/ZrO2 was investigated for the first time in multicomponent synthesis of isatin-based imidazoles under microwave irradiation in water. Ce@STANPs/ZrO2 was used for C=O bond activation in overall reaction to synthesize isatin-based imidazoles. The structure of catalyst was confirmed by characterization techniques, such as Fourier transform infrared (FTIR), scanning electron microscopy (SEM)/energy dispersive X-ray, elemental mapping, transmission electron microscopy, ζ-potential and diffraction light scattering, X-ray diffraction (XRD), thermogravimetric analysis, temperature-programmed desorption-NH3, electron paramagnetic resonance (EPR), and inductively coupled plasma atomic emission spectroscopy (ICP-AES) analyses. The recovered catalyst was found to be efficient up to seventh cycle and was confirmed by FTIR, SEM, XRD, EPR, and ICP-AES analyses. The advantages of the present protocol are recyclability of catalyst, green reaction conditions, excellent yield (94%) of the products, shorter reaction time period (5–7 min), and clean reaction profile.

The novel Nd-Salen Schiff base complex Immobilized Mesoporous Silica was synthesized by adsorption of NdCl3 on mesoporous-SiO2 and characterized soundly with various spectroscopic techniques such as FT-IR, Powder XRD, BET, TGA, SEM/EDX, TEM and ICP-AES analysis. The properties of mesoporous silica surface facilitate and accelerate the synthesis of desired products in high yields. All reactions progressed with high efficacy under solvent-free conditions and gave excellent yields avoiding slow workup and further purification of products.

Glycation of biological macromolecule leads to the establishment of advanced glycation end products (AGES) having implications in metabolic disorders. D ribose appears to be the most reactive among the naturally occurring sugars and contribute significantly to the glycation reactions in vivo, however, no report have been published yet to discuss D ribose induced glycation of hemoglobin (Hb). Therefore, the present study was designed to investigate D ribose induced glycoxidative damage to Hb protein. Briefly, the commercially available Hb was glycated with D ribose for varying time intervals. The structural perturbation induced in glycated Hb (GHb) was confirmed by biophysical techniques viz., UV-visible, fluorescence spectroscopy, circular dichroism, Fourier transform infrared spectroscopy, dynamic light scattering, MALDIthermal denaturation by UV-visible spectrophotometer and DSC. Biophysical techniques confirm the secondary and tertiary structural perturbation in GHb as compared to native Hb. The values of carbonyl content, hydroxy methyl furfural, thiobarbituric acid reactive substance and nitro blue tetrazolium were found to be increased and free lysine and free arginine content were decreased in the GHb due to structural change. Thus, results of this study have established that glycation with D ribose lead to the structural changes in the native Hb which might play an important role in pathophysiology metabolic diseases. (C) 2018 Elsevier B.V. All rights reserved.

Background: Integrated palliative care (PC) is recommended for all cancer patients. It improves patient experience and communication, reduces symptom burden and futile medical interventions, and shortens length of hospital stay. Despite the mortality of 27-43% for cancer patients admitted to intensive care (ICU), early PC involvement has not been widely adopted. Previous studies have shown the potential for using specific “trigger” criteria to identify ICU patients for early PC referral. We show the benefits of using a novel trigger tool in practice at the time of admission to ICU in a specialist cancer hospital. Methods: We developed a novel electronic tool, combining criteria outlined by Hua et al. (2016) with a locally-developed triggers checklist already used in the outpatient setting. This tool was integrated into the ICU clerking proforma. Patients meeting any of the tool’s criteria were referred to the PC team who provided early advice for symptom control and advanced care planning. Quality improvement methodology was used between February 2020 and January 2021 as we embedded this tool into clinical practice. Results: In a timeline disrupted by two waves of COVID-19, there were 151 admissions of which 74 (49%) had a triggers form completed. Sixty-six cases (89%) were positive (≥1 criterion), leading to 16 (24%) referrals to palliative care. This represented 46% of all PC referrals made from ICU during this period. We show that many patients admitted to ICU have a poor functional baseline (47% had metastatic cancer progressing despite 1st line chemotherapy, 49% had an ECOG score ≥2). Many patients also had severe or uncontrolled symptoms (52%). Early palliative care provided vital input for those patients. Conclusions: Our tool proactively identifies patients for early PC referral, streamlines the referral process, and empowers staff to consider treatment goals in a timely manner for the benefit of patients. Technical, practical, and cultural barriers to implementation were identified and changes made to address these, for example, having PC present at the weekly ICU meeting. We demonstrate a model for collaborative working which can be adapted for use in other ICUs and facilitate early PC for a broader cohort of cancer patients. Legal entity responsible for the study: The authors (all staff at The Royal Marsden NHS Foundation Trust). Funding: Has not received any funding. Disclosure: All authors have declared no conflicts of interest.

Emergency physicians are responsible for admitting children with asthma who do not respond to initial therapy. We examined the hypothesis that an initial room air pulse oximetry ≤90% elevates the risk of a complicated hospital course in children who require admission with acute asthma. Methods Charts of all patients ages 2 years–17 years admitted for asthma from January 2017 to December 2017 were reviewed. An explicit chart review was performed by trained data extractors using a standardized form. Results: A total of 244 children meeting inclusion criteria were admitted for asthma from the ED during the study period. All patients had an initial room air pulse oximetry documented. Sixty-five were admitted to PICU status (27%), and 179 (73%) were admitted to floor status. The relative risk of a complicated course in those patients presenting with a saturation of ≤90% was 11.3 (95% CI 3.9–32.6). The mean initial pulse oximetry on patients with a complicated course was 85% versus 93% for those without a complicated course (p Conclusion Our data suggest that in pediatric asthmatics that require admission from the ED, those with pulse oximetry readings less than or equal to 90% on presentation are at higher risk of a complicated hospital course.

The ‘irritable hip’ continues to pose a challenge for clinicians. Even with predictive clinical algorithms, decision making can be difficult. Emergency treatment is required if septic arthritis is suspected. Other differential diagnoses such as transient synovitis, pyomyositis of the pelvic girdle muscles and osteomyelitis must be considered in order to help guide appropriate investigations and allow early treatment. We report the case of a 13-year-old boy presenting to our institution with an acutely painful left hip but still able to weight bear. Despite a fever and raised inflammatory markers, the clinical examination did not correspond to that of an infected hip joint. Urgent magnetic resonance imaging (MRI) confirmed pyomyositis of the pectineus muscle. To our knowledge, this is the first reported case in the literature. The child was treated with seven days of intravenous antibiotics. There was a good clinical response as well as normalisation of the C-reactive protein level and white cell count. The patient was discharged home with a further week of oral antibiotics. Follow-up MRI at two weeks demonstrated a dramatic reduction in the inflammation of the pectineus. At the clinic follow-up appointment, the child was asymptomatic and back to normal function. Pyomyositis is typically found in tropical areas but its rates in temperate climates have been rising. It usually affects large groups of muscles such as the quadriceps and gluteal muscles. MRI is the gold standard investigation. If diagnosed early, the condition can be treated successfully with intravenous antibiotics alone. Given the widespread availability of MRI, we recommend its increased use to distinguish between pyomyositis and other paediatric hip pathologies.

A sulfonic acid functionalized metal–organic framework (S-IRMOF-3) has been synthesized by dropwise addition of chlorosulfonic acid (0.5 mL) in IRMOF-3 (1 g) containing 20 mL of CHCl3 at 0 °C under simple stirring. The catalyst was applied in Knoevenagel condensation of various aromatic and hetero-aromatic aldehydes forming acrylonitrile derivatives. The catalyst was characterized thoroughly by using FT-IR, XRD, 13C MAS NMR, SEM, EDX, elemental mapping, TEM, BET, NH3-TPD and TGA/DTA techniques. The presence of characteristic bands at 1694 cm−1, 1254–769 cm−1 and 1033 cm−1 in the FT-IR spectrum, 2θ ≃ 6.7° and 9.8° in the XRD pattern and δ = 31.79, 39.55, 129.61, 131.46 (4C, CH), 133.54, 140.07 (2C), 167.71, 171.47 ppm (2C, 2CO) in the solid state 13C MAS NMR spectrum confirmed the successful formation of catalyst. This new eco-friendly approach resulted in a significant improvement in the synthetic efficiency (90–96% yield), high product purity, and minimizing the production of chemical wastes without using highly toxic reagents for the synthesis of acrylonitriles with selectivity for (Z)-isomer. Steric interactions seem to have an influence on the control of the Z-configurational isomers. By performing DFT calculations, it was found that the (Z)-isomer 3a is stabilized by 1.64 kcal mol−1 more than the (E)-isomer. The catalyst could be reused for five consecutive cycles without substantial loss in catalytic activity.

The novel LaCl3/nano-SiO2 catalyst was synthesized by adsorption of LaCl3 on nano-SiO2 and characterized by powder XRD, FE-SEM, TEM, EDX, FT-IR spectra, BET surface area, TPD of ammonia and ICP-AES analyses. It was found as an efficient catalyst for the one-pot synthesis of 2,3-dihydroquinazolinones. All reactions proceeded with high efficacy under solvent-free conditions and gave excellent yields avoiding tedious workup and purification of products.

A new algorithm for reducing peak-to-average power ratio (PAPR) of multicode code division multiple access (MC-CDMA) systems under binary PSK modulation is presented. The algorithm is based on Reed-Muller (RM) codes that are modified by finding a suitable binary sequence that minimises the PAPR of the MC-CDMA. Three types of RM codes are investigated: namely, zero order, first order and second order. Simulation studies conducted show that the proposed algorithm achieves transmitter power savings of up to 6 dB. Zero-order and first-order codes exhibit 0 dB PAPR, while several others maintain a constant and low PAPR as compared with the original MC-CDMA systems.

The catalytic multicomponent reaction between different aldehydes, malononitrile and sodium azide, for the synthesis of functionalised tetrazoles in pure water was performed using silica molybdic acid as an acidic catalyst under microwave irradiation at ambient temperature. The catalyst showed remarkable activity by decreasing the time period of the reaction from 24 h (without catalyst) to 15 min under microwave irradiation. The catalyst successfully tolerated different aromatic and heterocyclic aldehydes furnishing the desired products in excellent yields. The major advantages of this protocol are recyclable catalyst, water as a green solvent, excellent yields, very short reaction times, use of microwaves and high TOF of the catalyst.

A chitosan supported Dy(III) nanocatalyst was synthesised by a simple procedure. It was used as a catalyst for one pot, three component synthesis of hexahydropyrimidine derivatives. All the reactions were completed in a short time period at room temperature and the products were obtained in high to excellent yields. The catalyst was characterized by FT-IR, XRD, SEM-EDX, TEM and ICP-AES analyses. The stability of the catalyst was evaluated by TG analysis. Use of water, ambient conditions, recyclability and high TOF of the catalyst make this protocol a sustainable alternative to existing protocols.