External Sites Research Articles

Electrospun Nanofiber Supported Nano/Mesoscale Covalent Organic Frameworks Boost Iodine Sorption.

Covalent Organic Frameworks (COFs) are benchmark materials for iodine sorption, but their use has largely been confined to crystalline bulk forms. In this state, COFs face diffusion limitations leading to slow sorption kinetics. To address this, a series of [2+3] imine-linked COFs with varying particle sizes and morphologies (mesospheres, nanoflowers, and bulk) is synthesized. Reducing particle size (from 826±48 to 412±22 nm) and adding surface protrusions in COF mesospheres improved iodine adsorption capacity (7.6 to 8.5 g g⁻¹), kinetics (K80%, 0.61 to 0.76 g g⁻¹ h⁻¹), and chemisorption efficiency. Notably, solvothermally synthesized (120°C, 5 d) crystalline bulk COF with accessible porous surfaces exhibited faster kinetics (K80%, 1.13 g g⁻¹ h⁻¹) than nano/mesoCOFs.This implies nano- and mesoCOFs exhibit surface aggregation that passivates their external binding sites and hinders iodine diffusion and mass transfer.To prevent this, morphologically controlled COF particles are immobilized onto electrospun polyacrylonitrile nanofibrous membranes via in situ growth strategy, creating a hierarchical structure that improved iodine diffusion pathways. This modification increased iodine sorption kinetics by 98%-153% and strengthened the charge-transfer process compared to COF powders.

Nutation Spectroscopy of a Weakly Interacting Heterobimetallic Spin System.

The use of VIV and CuII spins to design weakly coupled and dissymmetric spin systems has been examined. Such systems were synthesized using porphyrin-based complexes, with external coordination sites allowing for the formation of dimers via a PdII linker ion. Continuous-wave (CW) Electron Paramagnetic Resonance (EPR) spectroscopy allowed the unequivocal magnetic characterization of the mononuclear precursors VO and Cu. The porphyrin dimer (VO)PdCu presented a broad and overlapped spectrum that was more pronounced than for the previously reported (VO)Pd(VO), hinting at the effect of weak interspin interactions between dissimilar spins. Pulsed EPR experiments on VO, (VO)Pd(VO) and (VO)PdCu samples diluted in a diamagnetic matrix confirmed that this complication is also present in the Field-Swept Echo-Detected (FSED) spectra of the heterometallic (VO)PdCu system. Despite the strongly overlapped field-swept spectra, spin nutation experiments revealed two distinct oscillations in the case of (VO)PdCu, which are assigned to transitions with different spin characters. Remarkably, coherence is retained above liquid nitrogen temperatures for all complexes, in particular up to 295 K for VO and (VO)Pd(VO) and 150 K for (VO)PdCu.

Developing a composite index of conservation value to determine the conservation status of protected areas: The case of the Krau Wildlife Reserve and Tasek Bera Ramsar Site, Peninsular Malaysia

In Peninsular Malaysia, the various forms and contexts of assessing the conservation status of a protected area has led to inconsistent results, causing misunderstanding and uncertainty among protected area managers. Furthermore, these assessments rely heavily on the conservation value inside the protected area, despite the fact that its value is also influenced by the external environment. In this regard, using a composite index of conservation value (CICV) provides the opportunity for a more practical assessment of conservation status. Therefore, the objective of this study was to develop a CICV to determine the conservation status of two protected areas in Peninsular Malaysia, i.e., the Krau Wildlife Reserve and Tasek Bera Ramsar Site. Land use/land cover maps inside and outside the protected areas, developed using Landsat images from 2014, were the basis for the conservation value assessment, which employed three landscape scale indicators, i.e., naturalness, fragmentation, and connectivity. Through an analytical hierarchical process, the indicators were combined to develop a CICV inside and outside each protected area. Acceptable robustness values obtained through sensitivity analysis enabled the calculation of the CICV scores. For each protected area, the internal and external sites were then merged to calculate a net CICV. The inside, outside, and net CICV scores were used to determine the area’s conservation status on a critical value scale with the markers ‘very critical’, ‘critical’, ‘moderate’, ‘good’, and ‘excellent’. Inside the Krau Wildlife Reserve, the CICV was 88.4 %, indicating an ‘excellent’ conservation status, while its outside status is ‘critical’ with a CICV of 35 %. The net CICV of this area was 64.29 %, yielding a ‘good’ net conservation status. The CICV inside and outside Tasek Bera Ramsar Site were 35 % and 21.34 % respectively, both of which represent a ‘critical’ conservation status. The net CICV was found to be 22.52 %, suggesting that the net conservation status is ‘critical’. The results show that the external landscape of protected areas is a threat that influences the areas’ net conservation status. Therefore, a comprehensive conservation status assessment requires a composite index that integrates conservation values from the outside to help protected area managers easily understand and interpret findings, and thus, effectively coordinate conservation planning.

Electrochemical Sacrificial Alchemy: Crafting Hollow Hydroxide Hierarchy for Practical Aqueous Energy Storage Solution

AbstractEffective utilization of internal active sites in high‐mass loading electrode materials is essential for advancing practical energy storage. Herein, a novel electrochemical sacrificial alchemy for the first time to directly transform the solid Co‐Ni‐Zn carbonate hydroxide (CH) into its hollow structure with a strategic hierarchical architecture is introduced. In contrast to the complex and often cumbersome procedures of traditional methods, the approach is built on the simple electrochemically induced in situ etching and remodeling process. The experimental and theoretical analyses highlight the significant role of electric field force‐induced Zn sacrificial etching and hydroxide redeposition in creating internal cavities and regenerating external active sites, leading to the final hollow hierarchical structure with primary 1D hollow nanorod arrays and secondary reconstructed 2D nanoflakes, effectively exposing abundant energy storage sites. Benefiting from the synergistic effect, the resulting Co‐Ni‐Zn CH exhibited exceptional electrochemical performance. As proof of concept, a modular pouch‐type hybrid supercapacitor (HSC) composed of Co‐Ni‐Zn CH cathode achieved an ultrahigh energy density of 46.9 Wh kg−1. This device can efficiently power consumer electronics with a faster charging speed compared to commercial shared power banks. This research unveils a facile electrochemical approach for structuring electrode materials in energy storage solutions.

Intergrowth MFI Zeolite with Inverse Al Zoning and Predominant Sinusoidal Channels for Highly Selective Production of Styrene.

ZSM-5 zeolites with accessible micropore architecture and tunable acid-base sites are important shape-selective catalysts. However, the presence of exposed straight channels and the external acid-base sites of conventional ZSM-5 has a negative impact on shape selectivity. Herein, we report on the direct synthesis of an intergrowth ZSM-5 zeolite mimicking the mortise-tenon joints. It can be revealed by various methods that the mortise-tenon ZSM-5 shows an inverse Al gradient from the surface to the core of the zeolite. More importantly, the sinusoidal channels predominantly opened to their external surfaces are constructed. The shape-selective capability of the ZSM-5 zeolite has been fully exploited due to the intrinsic inert external surface and unique sinusoidal channel features, thereby resulting in high styrene selectivity (>90%) and good catalytic stability (>100 h) in the toluene side-chain alkylation reaction. In addition, in situ DRIFTS confirms that this intergrowth ZSM-5 contributes to the formation of more active intermediates of HCOO* and H3CO*, which is another reason responsible for the superior performance.

Reactivity and stability of Ni encapsulated hierarchical HZSM-5 for lignite-to-aromatics via catalytic pyrolysis

Metal-zeolite composite catalysts, as a special type via metallic encapsulation technology, hold great promise for lignite-to-aromatics conversion due to their high activity, shape-selectivity, and stability. However, the key issues lie in the location of the efficient metal sites and the nature of coke evolved in metal-encapsulated zeolites. Herein, we reported an efficient in situ encapsulation method to confine Ni species inside hierarchical channels and on the surface of HZSM-5 (i.e., Ni-HeZ5) assisted by water-soluble carbon black as hard template. Compared to core-shell Ni-impregnated hierarchical HZSM-5 (i.e., Ni@HeZ5), Ni-HeZ5 exhibited high activity, good stability and enhanced coke resistance in lignite-to-aromatics conversion via catalytic pyrolysis under an H2 atmosphere. The selectivity for light aromatics reached 93.6% in a single-pass reaction. The Ni species on the surface and within the zeolite were evidenced to facilitate, respectively, the cracking reaction of aliphatics and light oxygenates to produce olefins, and the secondary reaction of olefines to produce aromatics. The coke deposition and its influence on deactivation of Ni-HeZ5 and Ni@HeZ5 were studies based on coke location, chemical nature and formation mechanism. The principle of coke development in lignite-to-aromatics conversion is different from that in biomass-to-aromatics conversion. The heavy aliphatic coke deposits, which undergo chain-growth, play a more significant role in catalyst deactivation than the aromatic coke species. This work provides a facile strategy for designing metal-encapsulated zeolites (i.e., balancing the internal and external metallic sites on hierarchical channels) for lignite-to-aromatics conversion.

Modified medial approach for the treatment of fractures of the lower third of the humeral shaft: An anatomical study

BackgroundThe anatomical study of the modified medial approach for addressing fractures of the distal third of the humeral shaft aimed to elucidate the benefits of this method in providing optimal exposure for surgical intervention. MethodsSixteen upper limb specimens from eight cadavers, obtained from the Anatomy Teaching Department of Fujian Medical University, were dissected. Three-dimensional anatomical structures were mapped onto a two-dimensional coordinate system. Key anatomical structures relevant to the modified medial approach, including the medial cutaneous nerve, musculocutaneous nerve, ulnar nerve, basilic vein, brachial artery, superior ulnar collateral artery, and inferior ulnar collateral artery, were documented in detail. ResultsThe average humeral shaft length measured (29.22 ± 2.78) cm, with its medial surface being flat and well-suited for plate fixation. The basilic vein, located superficially in the upper arm's first quadrant, measured (1.35 ± 0.35) cm from the most prominent point of the medial epicondyle of the humerus, with the deep fascia being penetrated at (12.41 ± 1.71) cm. The basilic vein serves as a key landmark for the modified medial approach. The nervi cutanei antebrachii medialis, running along the medial biceps humerus, closely accompanies the basilic vein, perforating the deep fascia above the medial epicondyle and extending anterior external and posterior medial branches. These branches are positioned (0.80 ± 0.17) cm and (0.45 ± 0.29) cm, respectively, from the basilic vein. Additionally, all nervi cutanei antebrachii medialis pass anteriorly to the basilic vein before continuing distally to the forearm. The ulnar nerve initially accompanies the basilic vein in the upper arm but diverges posteriorly without branching at (14.75 ± 1.74) cm, with the maximum separation from the basilic vein measuring (2.28 ± 0.59) cm. The brachial artery bifurcates into the superior and inferior ulnar collateral arteries along the humeral shaft. The superior collateral ulnar artery primarily supplies the ulnar nerve, positioned (14.14 ± 1.27) cm from the medial epicondyle, which ensures a sufficient blood supply for operative procedures. The musculocutaneous nerve and radial nerve branch are located in the lateral region of the brachial muscle, with minimal postoperative impact on muscle strength when splitting the brachial muscle by one-third. ConclusionsThe modified medial approach, as revealed by anatomical studies, focuses on the fracture site with a straight skin incision aligned between the most prominent point of the medial epicondyle and the midpoint of the axilla, positioned one transverse finger from the radial side. Using the basilic vein as a reference, major vessels and nerves remain undisturbed, ensuring a safe operative zone. This technique allows for significant exposure of both the anterior and external humeral shaft fracture site and the ulnar side butterfly fragment while minimizing tissue damage and facilitating rapid recovery. The approach offers notable clinical value due to its reduced invasiveness and accelerated postoperative rehabilitation.

Development and Multinational Validation of an Ensemble Deep Learning Algorithm for Detecting and Predicting Structural Heart Disease Using Noisy Single-lead Electrocardiograms.

AI-enhanced 12-lead ECG can detect a range of structural heart diseases (SHDs) but has a limited role in community-based screening. We developed and externally validated a noise-resilient single-lead AI-ECG algorithm that can detect SHD and predict the risk of their development using wearable/portable devices. Using 266,740 ECGs from 99,205 patients with paired echocardiographic data at Yale New Haven Hospital, we developed ADAPT-HEART, a noise-resilient, deep-learning algorithm, to detect SHD using lead I ECG. SHD was defined as a composite of LVEF<40%, moderate or severe left-sided valvular disease, and severe LVH. ADAPT-HEART was validated in four community hospitals in the US, and the population-based cohort of ELSA-Brasil. We assessed the model's performance as a predictive biomarker among those without baseline SHD across hospital-based sites and the UK Biobank. The development population had a median age of 66 [IQR, 54-77] years and included 49,947 (50.3%) women, with 18,896 (19.0%) having any SHD. ADAPT-HEART had an AUROC of 0.879 (95% CI, 0.870-0.888) with good calibration for detecting SHD in the test set, and consistent performance in hospital-based external sites (AUROC: 0.852-0.891) and ELSA-Brasil (AUROC: 0.859). Among those without baseline SHD, high vs. low ADAPT-HEART probability conferred a 2.8- to 5.7-fold increase in the risk of future SHD across data sources (all P<0.05). We propose a novel model that detects and predicts a range of SHDs from noisy single-lead ECGs obtainable on portable/wearable devices, providing a scalable strategy for community-based screening and risk stratification for SHD.

A-342 Precision Evaluation of the pH, PO2 and PCO2 tests in the i-STAT® G3+ Cartridge using the i-STAT 1 System for Venous, Arterial and Capillary Whole Blood Specimens in Clinical Settings

Abstract Background Precise and accurate measurements of blood gases are important for the diagnosis, monitoring and treatment of respiratory, metabolic, and acid-base disturbances. This study demonstrates the precision of the pH, partial pressure of oxygen (PO2), and partial pressure of carbon dioxide (PCO2) tests in the i-STAT G3+ cartridge with the i-STAT 1 System in arterial, venous, and capillary whole blood specimens in point-of-care or clinical laboratory settings. Methods The precision of the i-STAT pH, PO2, and PCO2 tests in the i-STAT G3+ cartridge was assessed at external clinical sites by end-users using whole blood specimens across the measurement range for each test: pH (6.500 - 7.800 pH units), PO2 (5 - 700 mmHg), PCO2 (5.0 - 130.0 mmHg). The study included venous whole blood samples from ∼140 adult subjects (≥ 18 years) and arterial whole blood samples from ∼140 adult subjects at 3 clinical sites. Each whole blood sample was run in duplicate on the i-STAT G3+ cartridge. In addition, ∼140 specimens were collected in capillary tubes using two fingerstick draws from adult subjects and ∼20 capillary heel-stick specimens were collected into two capillary tubes from neonate subjects (birth - 28 days) at two clinical sites. Specimens used in this study were prospectively collected venous, arterial, or capillary specimens under an Institutional Review Board approved informed consent or were de-identified leftover venous or arterial specimens. For each specimen type, duplicates from each subject were grouped into subintervals based on their mean values. The subintervals included the medical decision levels of 7.300, 7.350 and 7.450 pH units for pH, 30, 45 and 60 mmHg for PO2 and 35, 45, 50 and 70 mmHg for PCO2. The estimates of the pooled standard deviation (SD) and pooled coefficient of variation (%CV), as well as their respective 95% confidence intervals were calculated for each subinterval. Results Across all specimen types (excluding outliers), the pooled SD for pH ranged from 0.00591 - 0.01747 pH units for subintervals 6.500 - 7.300, &amp;gt;7.300 - 7.450, &amp;gt;7.450 - 7.800 pH units. For PO2, the pooled SD ranged from 0.71 - 3.76 mmHg for subintervals 10 - 40 mmHg and &amp;gt;40 - 50 mmHg and the pooled %CV ranged from 1.63 - 8.76 %CV for subintervals &amp;gt;50 - 100 mmHg, &amp;gt;100 - 250 mmHg and &amp;gt;250 - 700 mmHg. For PCO2, the pooled SD ranged from 0.000 - 1.709 mmHg for subintervals 5.0 - 35.0 mmHg, &amp;gt;35.0 - 50.0 mmHg and &amp;gt;50.0 - 62.5 mmHg and the pooled %CV ranged from 1.10 - 3.62 %CV for subinterval &amp;gt;62.5 - 130.0 mmHg. Conclusions The precision study demonstrated that the pH, PO2 and PCO2 tests in the i-STAT G3+ cartridge when tested using the i-STAT 1 System deliver precise results within ∼2 minutes for venous, arterial, and capillary whole blood patient specimens when tested by end users in a point-of-care or clinical laboratory setting. These studies were funded by Abbott Laboratories.

A-341 Precision Evaluation of the i-STAT® Glucose Test in the i-STAT G Cartridge using thei-STAT 1 System for Venous, Arterial and Capillary Whole Blood Specimens in Clinical Settings

Abstract Background Precise and accurate measurements of whole blood glucose levels are important for the diagnosis and treatment of patients suffering from diabetes and hypoglycemia. This study demonstrates the precision of the i-STAT G cartridge with the i-STAT 1 System in arterial, venous, or capillary whole blood in point of care or clinical laboratory settings. Methods The precision of the i-STAT G cartridge was assessed at external clinical sites by intended end users with whole blood specimens across the measurement range of 20 - 700 mg/dL. The study included testing venous whole blood samples from 154 adult (≥ 18 years) patients and arterial whole blood samples from 173 adult patients at three clinical sites. Each whole blood sample was run in duplicate on the i-STAT G cartridge. In addition, 139 capillary whole blood specimens from both adult subjects and neonate subjects (birth - 28 days) were collected and tested for capillary whole blood precision. Duplicate fingerstick draws were collected in capillary tubes from 119 adult subjects at two clinical sites and duplicate heel-stick specimens were collected in capillary tubes from 20 neonate subjects at two clinical sites. Specimens used in this study were prospectively collected venous, arterial, or capillary specimens under an Institutional Review Board approved informed consent or were de-identified leftover venous or arterial specimens. For each specimen type, duplicates from each subject were grouped into subintervals based on their mean values. The subintervals included the glucose medical decision levels of 45 mg/dL, 120 mg/dL and 180 mg/dL. The estimates of the pooled standard deviation (SD) and pooled coefficient of variation (%CV), as well as their respective 95% confidence intervals (CI) were calculated for each subinterval (20-90 mg/dL, &amp;gt;90-150 mg/dL, &amp;gt;150-250 mg/dL, &amp;gt;250-700 mg/dL or &amp;gt;250-400 mg/dL and &amp;gt;400-700 mg/dL, as applicable). The precision estimates for each subinterval were compared against an acceptance criteria of the greater of 3 mg/dL or 5% of the mean (mg/dL) of the subinterval. Results The whole blood precision was found to be less than or equal to 5.00 %CV for all subintervals for each specimen type. For venous specimens, the %CV ranged from 0.35% to 0.43%; for arterial specimens the %CV ranged from 0.26% to 0.46% and for capillary specimens (adult and neonate combined), the %CV ranged from 1.38% to 2.71%. Conclusions The study demonstrated that the i-STAT Glucose test in the i-STAT G cartridge when tested using the i-STAT 1 System delivers precise results within ∼2 minutes for venous, arterial, and capillary whole blood patient specimens across a glucose range of 20 - 700 mg/dL when tested by end users in a point of care or clinical laboratory setting. The studies were funded by Abbott Laboratories.

A-328 Accuracy of the Glucose Test in the i-STAT® G Cartridge Using the i-STAT 1 System for Venous, Arterial and Capillary Whole Blood Specimens in Clinical Settings

Abstract Background Precise and accurate measurements of whole blood glucose levels are important for the diagnosis, monitoring and treatment of carbohydrate metabolism disorders, such as diabetes and hypoglycemia. This study demonstrates the accuracy of the glucose test in the i-STAT G cartridge with the i-STAT 1 System in arterial, venous, and capillary whole blood specimens in point of care or clinical laboratory settings. Methods The accuracy of the glucose test in the i-STAT G cartridge was assessed at external clinical sites in a method comparison study using whole blood specimens across the measurement range of 20 - 700 mg/dL. Specimens used in this study were venous, arterial, and capillary specimens prospectively collected under Institutional Review Board-approved informed consent or were leftover de-identified venous or arterial specimens. The study included venous whole blood samples from 164 adult subjects (≥ 18 years) and arterial whole blood samples from 173 adult subjects at 3 clinical sites, and capillary whole blood samples from 211 adult subject at 3 clinicals sites and 23 neonate subjects (birth to 28 days) at 2 clinical sites. For venous and arterial whole blood, samples were collected and tested in duplicate on the i-STAT G cartridge and on the i-STAT CHEM8+ cartridge (comparator). For capillary whole blood samples, adult fingerstick samples and neonate heel-stick samples were collected in capillary tubes and tested in singlicate on the i-STAT G cartridge and in singlicate on the epoc® Blood Analysis System (comparator). Passing-Bablok linear regression was performed for venous and arterial whole blood samples using the first replicate from the i-STAT G cartridge versus the mean result of the comparator, and for capillary whole blood samples (adult and neonate combined) using the singlicate result from the i-STAT G cartridge versus the singlicate result of the comparator. Results Passing-Bablok regression of i-STAT G cartridge results versus the comparator was used to calculate slope and correlation coefficient (r). Adult venous whole blood results had slope = 1.00 and r = 1.00, and adult arterial whole blood results had slope = 1.00 and r = 1.00. Adult and neonate capillary whole blood results had slope = 1.00 and r = 1.00. Conclusions These results demonstrate that the i-STAT 1 System delivers accurate glucose test results within ∼2 minutes using the i-STAT G cartridge for venous, arterial and capillary whole blood samples for adult and neonate subjects across a glucose range of 20-700 mg/dL when tested by end-users in a point of care or clinical laboratory setting. This study was funded by Abbott Laboratories.

A-329 Accuracy of the pH, PO2, and PCO2 Tests in the i-STAT® G3+ Cartridge Using the i-STAT 1 System for Venous, Arterial and Capillary Whole Blood Specimens in Clinical Settings

Abstract Background Precise and accurate measurements of blood gases are important for the diagnosis, monitoring and treatment of respiratory, metabolic, and acid-base disturbances. This study demonstrates the accuracy of the pH, partial pressure of oxygen (PO2), and partial pressure of carbon dioxide (PCO2) tests in the i-STAT G3+ cartridge with the i-STAT 1 System in arterial, venous, and capillary whole blood specimens in point of care or clinical laboratory settings. Methods The accuracy of the PO2, and PCO2 tests in the i-STAT G3+ cartridge was assessed at external clinical sites in a method comparison study using whole blood specimens across the measurement range for each test: pH 6.5-7.8, PO2 5-700 mmHg, PCO2 5.0-130.0 mmHg. Specimens used in this study were venous, arterial, and capillary specimens prospectively collected under Institutional Review Board-approved informed consent or were leftover de-identified venous or arterial specimens. The study included venous and arterial whole blood samples from ∼140 adult subjects (≥ 18 years) at 3 clinical sites, and capillary whole blood samples from ∼180 adult subject at 3 clinicals sites and ∼25 neonate subjects (birth to 28 days) at 2 clinical sites. The RapidPoint System was used as comparator. For venous and arterial whole blood, samples were collected and tested in duplicate on the i-STAT G3+ cartridge and in singlicate on the RapidPoint System. For capillary whole blood samples, adult fingerstick samples and neonate heel-stick samples were collected in capillary tubes and tested in singlicate on the i-STAT G3+ cartridge and on the RapidPoint System. Passing-Bablok regression was performed for venous and arterial whole blood samples combined, using the first replicate from the i-STAT G3+ cartridge versus the singlicate result from the comparator, and for capillary whole blood samples (adult and neonate combined) using the singlicate result from the i-STAT G3+ cartridge versus the singlicate result from the comparator. Results Passing-Bablok regression of i-STAT G3+ cartridge results versus the comparator was used to calculate slope and correlation coefficient (r). For adult venous and arterial whole blood results, pH had slope = 0.96 and r = 0.99, PO2 had slope = 1.05 and r = 1.00, and PCO2 had slope = 1.04 and r = 0.98. For adult and neonate capillary whole blood results, pH had slope = 1.02 and r = 0.98, PO2 had slope = 1.09 and r = 0.99, and PCO2 had slope = 1.07 and r = 0.96. Conclusions These results demonstrate that the i-STAT 1 System delivers accurate pH, PO2, and PCO2 test results with ∼2 minutes using the i-STAT G3+ cartridge for venous, arterial and capillary whole blood samples for adult and neonate subjects when tested by end-users in a point of care or clinical laboratory setting. This study was funded by Abbott Laboratories.

Improving external fixator pin site care through user involvement: A quality improvement project

IntroductionExternal fixation is widely used in treating complex fractures and limb reconstruction. Pin site infections remain a significant complication, impacting on patients' physical and psychosocial wellbeing. This clinical improvement project at a University Hospital in Denmark aimed to enhance pin site care by involving patients and caregivers throughout the treatment pathway. BackgroundAt our hospital, approximately 55 trauma patients are annually treated with lower limb external fixators. Pin site care is crucial for preventing serious infections/osteomyelitis and involves collaboration between hospital and municipal caregivers. Traditional pin site care in our unit was complex and time-consuming, causing patient anxiety and frequent unplanned clinic visits. MethodsInspired by the Participatory Design research methodology, a quality improvement project was conducted in three phases: (1) identifying users’ needs, (2) developing solutions collaboratively, and (3) testing/evaluating these solutions. Iterative cycles of planning, acting, observing, and reflecting were employed, facilitating mutual learning among participants. Interviews with patients, families and healthcare professionals and field observations both at the hospital and in the municipality were conducted. Inspiration was sought from international literature. ResultsPhase 1 identified the need for improved education about infection recognition, a less painful and time-consuming dressing method, and an assessment tool for pin site infection. Phase 2 involved extensive user input to develop and implement a new dressing procedure using PolyMem™ along with an assessment tool. Phase 3 evaluated the new methods, revealing reduced patient pain, fewer clinic visits, and stable infection rates as well as less time-consuming pin site care. ConclusionThe project successfully enhanced pin site care, involving users in developing a new care process, thus improving patient satisfaction and care efficiency. Implications for future practiceIncorporating patient perspectives and collaborative methods can significantly improve clinical care pathways. Future efforts should focus on further integrating patient centered and participatory approaches in healthcare improvements.

Development, External Validation, and Biomolecular Corroboration of Interoperable Models for Identifying Critically Ill Children at Risk of Neurologic Morbidity.

Declining mortality in the field of pediatric critical care medicine has shifted practicing clinicians' attention to preserving patients' neurodevelopmental potential as a main objective. Earlier identification of critically ill children at risk for incurring neurologic morbidity would facilitate heightened surveillance that could lead to timelier clinical detection, earlier interventions, and preserved neurodevelopmental trajectory. Develop machine-learning models for identifying acquired neurologic morbidity while hospitalized with critical illness and assess correlation with contemporary serum-based, brain injury-derived biomarkers. Retrospective cohort study. Two large, quaternary children's hospitals. Critical illness. The outcome was neurologic morbidity, defined according to a computable, composite definition at the development site or an order for neurocritical care consultation at the validation site. Models were developed using varying time windows for temporal feature engineering and varying censored time horizons prior to identified neurologic morbidity. Optimal models were selected based on F1 scores, cohort sizes, calibration, and data availability for eventual deployment. A generalizable created at the development site was assessed at an external validation site and optimized with spline recalibration. Correlation was assessed between development site model predictions and measurements of brain biomarkers from a convenience cohort. After exclusions there were 14,222-25,171 encounters from 2010-2022 in the development site cohorts and 6,280-6,373 from 2018-2021 in the validation site cohort. At the development site, an extreme gradient boosted model (XGBoost) with a 12-hour time horizon and 48-hour feature engineering window had an F1-score of 0.54, area under the receiver operating characteristics curve (AUROC) of 0.82, and a number needed to alert (NNA) of 2. A generalizable XGBoost model with a 24-hour time horizon and 48-hour feature engineering window demonstrated an F1-score of 0.37, AUROC of 0.81, AUPRC of 0.51, and NNA of 4 at the validation site. After recalibration at the validation site, the Brier score was 0.04. Serum levels of the brain injury biomarker glial fibrillary acidic protein measurements significantly correlated with model output (r s =0.34; P =0.007). We demonstrate a well-performing ensemble of models for predicting neurologic morbidity in children with biomolecular corroboration. Prospective assessment and refinement of biomarker-coupled risk models in pediatric critical illness is warranted. Question Can interoperable models for predicting neurological deterioration in critically ill children be developed, correlated with serum-based brain-derived biomarkers, and validated at an external site? Findings A development site model demonstrated an area under the receiver operating characteristics curve (AUROC) of 0.82 and a number needed to alert (NNA) of 2. Predictions correlated with levels of glial fibrillary acidic protein in a subset of children. A generalizable model demonstrated an AUROC of 0.81 and NNA of 4 at the validation site. Meaning Well performing prediction models coupled with brain biomarkers may help to identify critically ill children at risk for acquired neurological morbidity.

Dual carbon confining SnO2 nanocrystals as high-performance anode for sodium-ion batteries

The increasing global demand for sustainable energy sources has driven research into sodium-ion batteries (SIBs) for large-scale energy storage. However, their electrochemical performance is hindered by poor reaction kinetics and significant volume expansion in electrode materials. In this work, we developed a dual-carbon-confined SnO2 nanocrystal anode (CNTs@SnO2@NC) designed for high-performance SIBs. This innovative structure uses carbon nanotubes (CNTs) and a nitrogen-doped carbon (NC) coating to stabilize SnO2, ensuring structural integrity during charge/discharge cycles. The CNTs network in CNTs@SnO2@NC can alleviate the agglomeration of SnO2 nanocrystals to a certain extent; With its superior electronic conductivity, CNTs can enhance the anode's conductivity and function as an electronic highway; The sodiophilic properties and good electrical conductivity of CNTs enable sodium ions to migrate rapidly on the surface of the nanotubes. Moreover, numerous external defects and active sites generated by nitrogen doping enhance the sodium ion absorption capabilities; The existence of nitrogen-doped carbon coating can effectively accommodate the volume changes of SnO2 and enhance the structural stability of CNTs@SnO2@NC composites during the repeated charge and discharge cycles. As a result, the CNTs@SnO2@NC composite demonstrates excellent electrochemical performance, achieving capacity of 235 mAh g−1 at 0.1 A g−1 over 100 cycles and 102 mAh g−1 at 1.0 A g−1 over 300 cycles. In a full-cell configuration with a Na3V2(PO4)3 cathode, it delivers 38 mAh g−1 at 100th cycle at 0.1 A g−1. This study underscores the substantial improvements achieved by dual-carbon confinement for high-performance SIB anodes, offering a promising direction for future anode material design.

Negative online news articles are shared more to social media

Prior research demonstrates that news-related social media posts using negative language are re-posted more, rewarding users who produce negative content. We investigate whether negative material from external news sites is also introduced to social media through more user posts, offering comparable incentives for journalists to adopt a negative tone. Data from four US and UK news sites (95,282 articles) and two social media platforms (579,182,075 posts on Facebook and Twitter, now X) show social media users are 1.91 times more likely to share links to negative news articles. The impact of negativity varies by news site and social media platform and, for political articles, is moderated by topic focus, with users showing a greater inclination to share negative articles referring to opposing political groups. Additionally, negativity amplifies news dissemination on social media to a greater extent when accounting for the re-sharing of user posts containing article links. These findings suggest a higher prevalence of negatively toned articles on Facebook and Twitter compared to online news sites. Further, should journalists respond to the incentives created by the heightened sharing of negative articles to social media platforms, this could even increase negative news exposure for those who do not use social media.

Development and Internal-External Validation of a Post-Operative Mortality Risk Calculator for Pediatric Surgical Patients in Low- and Middle- Income Countries Using Machine Learning

BackgroundThe purpose of this study was to develop and validate a mortality risk algorithm for pediatric surgery patients treated at KidsOR sites in 14 low- and middle-income countries. MethodsA SuperLearner machine learning algorithm was trained to predict post-operative mortality by hospital discharge using the retrospectively and prospectively collected KidsOR database including patients treated at 20 KidsOR sites from June 2018 to June 2023. Algorithm performance was evaluated by internal-external cross-validated AUC and calibration. FindingsOf 23,905 eligible patients, 21,703 with discharge status recorded were included in the analysis, representing a post-operative mortality rate of 3.1% (671 mortality events). The candidate algorithm with the best cross-validated performance was an extreme gradient boosting model. The cross-validated AUC was 0.945 (95% CI 0.936 to 0.954) and cross-validated calibration slope and intercept were 1.01 (95% CI 0.96 to 1.06) and 0.05 (95% CI -0.10 to 0.21). For Super Learner models trained on all but one site and evaluated in the holdout site for sites with at least 25 mortality events, overall external validation AUC was 0.864 (95% CI 0.846 to 0.882) with calibration slope and intercept of 1.03 (95% CI 0.97 to 1.09) and 1.18 (95% CI 0.98 to 1.39). InterpretationThe KidsOR post-operative mortality risk algorithm had outstanding cross-validated discrimination and strong cross-validated calibration. Across all external validation sites, discrimination of Super Learner models trained on the remaining sites was excellent, though re-calibration may be necessary prior to use at new sites. This model has the potential to inform clinical practice and guide resource allocation at KidsOR sites world-wide. Type of Study and Level of EvidenceObservational Study, Level III.

Modification on different recycled fine aggregates by biological CaCO3: Physical properties and packing state

MICP was a modification method often used to modify recycled fine aggregates (RFAs) in recent years. The paper studied the mechanism of modifying two RFAs with different particle grading by MICP. The results showed a corresponding alteration in the proportion of internal mineralization sites and external mineralization sites within RFAs with the variation in particle size, thereby impacting the amount and proportion of internal and external CaCO3. The internal and external CaCO3 improved the properties and packing state (closer to the MAA model) of the RFAs, respectively. The use of <1.18 mm RFAs could take into account both improvement efficiency.

The Impact of Race, Ethnicity, and Sex on Fairness in Artificial Intelligence for Glaucoma Prediction Models

ObjectiveDespite advances in artificial intelligence (AI) in glaucoma prediction, most works lack multi-center focus and do not consider fairness concerning sex, race, or ethnicity. This study aims to examine the impact of these sensitive attributes on developing fair AI models that predict glaucoma progression to necessitating incisional glaucoma surgery. DesignDatabase study. Participants39,090 patients with glaucoma, as identified by International Classification of Disease codes from 7 academic eye centers participating in the Sight OUtcomes Research Collaborative (SOURCE). MethodsWe developed XGBoost models using three approaches: (1) excluding sensitive attributes as input features, (2) including them explicitly as input features, and (3) training separate models for each group. Model input features included demographic details, diagnosis codes, medications, and clinical information (intraocular pressure, visual acuity etc.), from electronic health records. The models were trained on patients from 5 sites (N=27,999) and evaluated on a held-out internal test set (N=3,499) and 2 external test sets consisting of N=1,550 and N=2,542 patients. Main Outcomes and MeasuresArea under the receiver operating characteristic curve (AUROC) and equalized odds on the test set and external sites. Results6,682 (17.1%) of 39,090 patients underwent glaucoma surgery with a mean age of 70.1 (std. 14.6) years, 54.5% female, 62.3% White, 22.1% Black and 4.7% Latinx/Hispanic. We found that not including the sensitive attributes led to better classification performance (AUROC: 0.77-0.82) but worsened fairness when evaluated on the internal test set. However, on external test sites, the opposite was true: including sensitive attributes resulted in better classification performance (AUROC: external #1 - (0.73-0.81), external #2 - (0.67-0.70)), but varying degrees of fairness for sex and race as measured by equalized odds. ConclusionsAI models predicting whether patients with glaucoma progress to surgery demonstrated bias with respect to sex, race, and ethnicity. The effect of sensitive attribute inclusion and exclusion on fairness and performance varied based on internal versus external test sets. Prior to deployment, AI models should be evaluated for fairness on the target population.

Synergistic Electrocatalyst-Cathode Architecture for Stable Long-Term Cycling Lithium-Sulfur Batteries

Lithium-sulfur (Li-S) batteries are a promising candidate for next-generation energy storage owing to the high theoretical capacity of sulfur (1,675 mAh g−1). However, the intrinsically low electrical conductivity of sulfur and complex multistep electrolyte-mediated redox reactions involving soluble lithium polysulfide intermediates engender critical challenges toward practical realization. Specifically, migration and diffusion of higher-order lithium polysulfides provokes continuous loss of active sulfur species, yielding premature capacity fade. Electrochemical kinetics also remain sluggish due to the insulating nature of sulfur cathodes, which require engineering designs to accelerate charge transfer.Rational morphological and compositional cathode tuning represents a compelling strategy for addressing fundamental Li-S limitations. Herein, we develop an extended cathode architecture composed of a porous carbon nanotube network decorated with homogenously dispersed nanocatalysts. Electron microscopy and spectroscopy analysis verify platinum group metals are well-incorporated both within internal channels and external surface sites of conductive carbon nanotubes. The composite framework affords multifaceted functionality arising from synergistic chemical and structural attributes of components. Nanocatalyst sites demonstrate a pronounced chemical affinity toward soluble polysulfide intermediates, effectively localizing them within cathode, minimizing diffusional losses toward the anode. This anchoring phenomenon is complemented by the inherent microporosity of the high-surface-area nanotube network, further obstructing polysulfide migration through a confinement effects. Concurrently, noble metal nanoparticles facilitate the redox conversion of trapped higher-order polysulfides into solid Li2S alleviating the precipitation of electrically insulating discharge products. The excellent electrical conductivity of CNTs ensures efficient charge transport to all incorporated sulfur active materials, further maximizing reversible utilization.As a result of complementary polysulfide confinement and electrocatalytic conversion functionalities, Li-S coin cells exhibit enhanced reversible capacities exceeding 900 mAh g−1 for over 500 cycles at 0.558 A g−1. Notably, over 500 cycles, minimal capacity decay of 0.018% per cycle and 92% retention of the initial capacity are obtained at moderate sulfur loadings highlighting the exceptional cycling stability enabled by engineered cathodes. Outstanding rate performance is also demonstrated with the delivery of 854 mAh g−1 capacity at a very high current density of 1.675 A g−1. Our rationally designed cathode architecture provides critical mechanistic insight toward addressing fundamental bottlenecks to progress Li-S technologies.