Emergency and postoperative access to critical and enhanced care: a multicentre prospective observational study.

Introduction: The ability to admit patients to enhanced or critical care may be limited by bed availability. In a network with low provision of critical and enhanced care beds, we aimed to assess the proportion of patients having surgery with moderate (1%-< 5%) or high (≥ 5%) predicted risk of 30-day postoperative mortality and their postoperative care location. We also aimed to study referral and admission outcomes to critical care.

Electronic interactions in Dirac fluids visualized by nano-terahertz spacetime interference of electron-photon quasiparticles.

Ultraclean graphene at charge neutrality hosts a quantum critical Dirac fluid of interacting electrons and holes. Interactions profoundly affect the charge dynamics of graphene, which is encoded in the properties of its electron-photon collective modes: surface plasmon polaritons (SPPs). Here, we show that polaritonic interference patterns are particularly well suited to unveil the interactions in Dirac fluids by tracking polaritonic interference in time at temporal scales commensurate with the electronic scattering.

Employing a switching valve to automate external standard calibration in inductively coupled plasma optical emission spectrometry.

The traditional external standard calibration method (EC) is automated and simplified using a four-port switching valve (SV4) and a multi-signal approach that enables the generation of several calibration points from a single calibration solution. The SV4-EC method is applied to inductively coupled plasma optical emission spectrometry (ICP-OES) and is based on gradient dilution taking place within the instrument's sample introduction tubing. Both the calibration solution and the samples are diluted by a blank solution containing an internal standard species.

Commercially available mouthguards: Unearthing trace elements for the first time.

The use of mouthguards is advocated by the American Dental Association for orofacial injury prevention and teeth protection. However, the chemical environment in the mouth may cause harmful substances within the mouthguard's polymer material to leach out and be absorbed by the user. Considering this, the present study for the first time analyzed commercially available mouthguards and disclosed the presence of trace elements.

Tissue discrimination in head and neck cancer using image fusion of IR and optical microscopy.

A regression-based fusion algorithm has been used to merge hyperspectral Fourier transform infrared (FTIR) data with an H&E image of oral squamous cell carcinoma metastases in cervical lymphoid nodal tissue. This provides insight into the success of the ratio of FTIR absorbances at 1252 cm and 1285 cm in discriminating between these tissue types. The success is due to absorbances at these two wavenumbers being dominated by contributions from DNA and collagen, respectively.

Metric-based analysis of FTIR data to discriminate tissue types in oral cancer.

A machine learning algorithm (MLA) has predicted the prognosis of oral potentially malignant lesions and discriminated between lymph node tissue and metastatic oral squamous cell carcinoma (OSCC). The MLA analyses metrics, which are ratios of Fourier transform infrared absorbances, and identifies key wavenumbers that can be associated with molecular biomarkers. The wider efficacy of the MLA is now shown in the more complex primary OSCC tumour setting, where it is able to identify seven types of tissue.

Chiral excitonic order from twofold van Hove singularities in kagome metals.

Recent experiments on kagome metals AVSb (A=K,Rb,Cs) identify twofold van Hove singularities (TvHS) with opposite concavity near the Fermi energy, generating two approximately hexagonal Fermi surfaces - one electron-like and the other hole-like. Here we propose that a TvHS generates a novel time-reversal symmetry breaking excitonic order - arising due to bound pairs of electrons and holes located at opposite concavity van Hove singularities. We introduce a minimal model for the TvHS and investigate interaction induced many-body instabilities via the perturbative renormalisation group technique and a free energy analysis.

Prediction of malignant transformation in oral epithelial dysplasia using machine learning.

A machine learning algorithm (MLA) has been applied to a Fourier transform infrared spectroscopy (FTIR) dataset previously analysed with a principal component analysis (PCA) linear discriminant analysis (LDA) model. This comparison has confirmed the robustness of FTIR as a prognostic tool for oral epithelial dysplasia (OED). The MLA is able to predict malignancy with a sensitivity of 84 ± 3% and a specificity of 79 ± 3%.

A basement membrane discovery pipeline uncovers network complexity, regulators, and human disease associations.

Basement membranes (BMs) are ubiquitous extracellular matrices whose composition remains elusive, limiting our understanding of BM regulation and function. By developing a bioinformatic and in vivo discovery pipeline, we define a network of 222 human proteins and their animal orthologs localized to BMs. Network analysis and screening in and zebrafish uncovered BM regulators, including ADAMTS, ROBO, and TGFβ.

Soil survey laboratory grain count data to substantiate the rarity of mineral grains in forensic soil reports of examination.

The Natural Resources Conservation Service-Kellogg Soil Survey Laboratory has a large publicly available database of laboratory analyses of soil horizons collected from soil profiles largely from the United States. Among these soil properties are mineral grain counts from selected sand and silt fractions of soil horizons, performed by polarized light microscopy (PLM). These grain counts of over 20,000 fractions from 7534 sites provide a substantial reference that a forensic soil examiner could use to substantiate the rarity or commonness of a mineral species.

Genetic Disorders of the Glomerular Filtration Barrier.

The glomerular filtration barrier is a highly specialized capillary wall comprising fenestrated endothelial cells, podocytes, and an intervening basement membrane. In glomerular disease, this barrier loses functional integrity, allowing the passage of macromolecules and cells, and there are associated changes in both cell morphology and the extracellular matrix. Over the past 3 decades, there has been a transformation in our understanding about glomerular disease, fueled by genetic discovery, and this is leading to exciting advances in our knowledge about glomerular biology and pathophysiology.

Revitalising audit and feedback to improve patient care.

Audit and feedback are widely used in quality improvement. argue that their full potential to improve patient care could be realised through a more evidence based and imaginative approach

Seismic retrofitting of Māori wharenui in Aotearoa New Zealand.

The design of Māori wharenui (meeting houses), refined over the last 180 years, has given rise to a distinctive typology that demonstrates an understanding of tectonic-narrative expression. It is a visual codex designed to be read. Set within the context of pre-disaster readiness, this current study investigated the resilience of Māori buildings and communities through a dual interpretation of seismic, regulatory and historical frameworks.

The ophthalmic blade perfectly made to create an oral antral communication blockade; a technical note.

Oral antral fistulas are commonly referred to the Oral and Maxillofacial department for surgical management. Though conventional methods of repair are well established, we present a technical note highlighting the novel use of an ophthalmic blade in raising palatal mucoperiosteal flaps. We have experienced much success with this instrument and believe it represents a very useful and complimentary addition to the oral and maxillofacial surgeon's kit.

Health-services utilisation amongst older persons during the last year of life: a population-based study.

Background: Accurate population-based data regarding hospital-based care utilisation by older persons during their last year of life are important in health services planning. We investigated patterns of acute hospital-based service use at the end of life, amongst older decedents in New South Wales (NSW), Australia.

Methods: Data from all persons aged ≥70 years who died in the state of NSW Australia in 2007 were included.

Respiratory Failure, Noninvasive Ventilation, and Symptom Burden: An Observational Study.

Background: Noninvasive ventilation (NIV) is commonly used to manage acute respiratory failure due to decompensated cardiorespiratory disease. We describe symptom burden in this population.

Measures: Fifty consecutive, consenting, English-speaking, cognitively intact patients, admitted to wards other than the intensive care unit in a tertiary teaching hospital and treated with NIV for hypercapnic respiratory failure, were recruited.

Onabotulinum toxin A in children with refractory idiopathic overactive bladder: medium-term outcomes.

Introduction: Botulinum toxin-A (BtA) has been used for refractory idiopathic overactive bladder (IOAB) in children. Data on the optimum dose success rates, duration of effect, complications and medium-term outcomes are limited. This study aims to analyse the authors' experience to provide medium-term results of BtA in symptomatic refractory patients.

Review of outcomes of 500 consecutive cases of non-melanoma skin cancer of the head and neck managed in an oral and maxillofacial surgical unit in a District General Hospital.

We provide a non-melanoma skin cancer (NMSC) service for skin cancers of the head and neck in the south-west of England. We hypothesised that certain anatomical sites such as the nose and eyelid would have a higher incidence of close or involved margins than others, and that the choice of repair might influence the excised margins. We therefore retrospectively analysed the data of 500 consecutive NMSC that were operated on in the oral and maxillofacial surgery unit of Taunton and Somerset NHS Trust.

Application of a quantum cascade laser aperture scanning near-field optical microscope to the study of a cancer cell.

This work reports the first images obtained by combining an infrared aperture scanning near-field optical microscope (SNOM) with a quantum cascade laser (QCL). The future potential of this set-up is demonstrated by a preliminary study on an OE33 human oesophageal adenocarcinoma cell in which the cell is imaged at 1751 cm-1, 1651 cm-1, 1539 cm-1 and 1242 cm-1. In addition to the 1651 cm-1 image, three other images were acquired within the Amide I band (1689 cm-1, 1675 cm-1 and 1626 cm-1) chosen to correspond to secondary structures of proteins.