Postmortem Testing Research Articles

Irish dairy farmers' engagement with animal health surveillance services: Factors influencing sample submission

A high-quality animal health surveillance service is required to inform policy and decision-making in food-animal disease control, to substantiate claims regarding national animal health status and for the early detection of exotic or emerging diseases. In Ireland, the Department of Agriculture, Food and the Marine provides partially subsidized testing of farm animal samples and postmortem examinations to the Irish agriculture sector (farmers) at 6 regional veterinary laboratories (RVL) throughout the country. Diagnoses and data from these submissions are recorded and reported monthly and annually to enable animal health monitoring and disease surveillance. In a passive surveillance model, both the veterinary practitioner and the farmer play a vital role in sample submission by determining which cases are sent to the laboratory for postmortem or diagnostic testing. This paper identified factors influencing Irish dairy farmers' decisions to submit carcasses to RVL. Behavioral determinants of the submission of samples where veterinary professionals are concerned has been studied previously; however, limited work has studied determinants among farmers. This study conducted qualitative analyses of decisions of Irish dairy farmers relevant to diagnostic sample submission to an RVL and to examine the herd-level characteristics of farmers that submitted cases to an RVL. The biographical narrative interpretive method was used to interview 5 case-study farmers who were classified nonsubmitters, medium, or high submitters to the postmortem service based on the proportion of on-farm mortalities submitted to the laboratory service in 2016. The data obtained from these interviews were supplemented and triangulated through dairy farmer focus groups. The data were thematically analyzed and described qualitatively. In addition, quantitative analysis was undertaken. Data for herds within the catchment area of a central RVL were extracted, and a multivariable logistic regression model was constructed to examine the relationship between herds from which carcasses were submitted to the laboratory and those from which none were submitted. Results from the analysis show that the farmer's veterinary practitioner was the primary influence on submission of carcasses to the laboratory. Similarly, the type of incident, logistical issues with transporting carcasses to the laboratory, influence of peers, presence of alternative private laboratories, and a fear of government involvement were key factors emerging from the case-study interview and focus group data. Herd size was identified in both the qualitative and quantitative analysis as a factor determining submission. In the logistic regression model, herd size and increased levels of expansion were positively correlated with the odds of submission, whereas distance from the laboratory was negatively associated with odds of submission. These results identify the main factors influencing the use of diagnostic services for surveillance of animal health, signaling how services may be made more attractive by policy makers to a potentially wider cohort of users.

The Effect of Emotional Centered Group Art Therapy on the Job Stress of the Correctional Public Officials

본 연구는 정서중심 집단미술치료 프로그램이 교정공무원의 직무스트레스에 미치는지 영향을 알아보는데 그 목적이 있다. 본 연구대상은 서울 소재 교정공무원으로 직무스트레스의 원인은 직무수행 시폐쇄적 환경과 역할갈등과 정체성 혼란, 정서적 결핍 소통과 상호작용의 어려움이 있는 보완과 소속교정공무원으로 단일집단을 선정하였다. 정서중심 미술치료 프로그램은 한 회기당 90분씩 주 1회 10회기를 실시하였다. 본 연구의 자료 분석은 직무스트레스의 하위영역인 직무 욕구·직무소진·대처방식·조직몰입에 대해 실시한 사전과 사후검사를 SPSS 12.0으로 분석하였다. 투사검사는 실버 DAS(Draw-A-Story), 정서내용 척도, 자아상 척도를 사전·사후로 실시하였고, 질적 자료 내러티브 4단계로 탐구하여 상호 보완적인 분석방식으로 통합방법 설계(parallel/ simultaneous mixed method designs)를 하였다. 본 연구 결과는 첫째, 직무스트레스 하위 영역인 직무 욕구·직무소진·대처방식·조직몰입은 모두 긍정적인 효과가 있었다. 둘째, 내면의 안정을 확립하고 직무스트레스도 감소하였고, 긍정적 자아상의 변화로 직무 만족도가 높아졌다. 셋째, 동질집단의 지지와 공감대 형성은 정서적인 안정과 긍정적인 관점의 변화가 있음을 보여주었다. 연구결과를 볼 때, 정서중심 집단미술치료 프로그램이 교정공무원의 직무스트레스 감소에 활용될 수 있는 프로그램이라 할 수 있다.The purpose of this study is to find out whether the emotional centered group art therapy program affects the job stress of correctional officials. This research selected a sample group from the security department, whose job stress is caused by the experience of role-playing conflict and identity confusion while performing their duties. The emotional centered group art therapy program was conducted once a week for 90 minutes per session and a total of 12 sessions. The collected data were analyzed by quantitative and qualitative studies, and parallel simultaneous mixed method designs were performed for a complementary analysis. Quantitative research was divided into sub-area of job stress, such as job desire, job exhaustion, treatment, and organizational commitment, and the pre and post-mortem tests were analyzed by SPS 12.0. The projection test Silver DAS (Draw-A-Story) was divided into emotion and self-model and proceeded preand post-analysis. Qualitative studies were analyzed by exploration in four stages of narratives. The results of the study are as follows: First, all job stress sub-area, job desire, job exhaustion, treatment, and organizational commitment, had positive effects. Second, job satisfaction increased by the inner stability and positive change to the officials’ self-images. Third, the support of homogeneous groups and the formation of consensus show that there was a change in emotional stability and positive views. In summary, this study s emotional oriented collective art therapy program affects the reduction of job stress of correctional officials.

Field Postmortem Rabies Rapid Immunochromatographic Diagnostic Test for Resource-Limited Settings with Further Molecular Applications.

Functional rabies surveillance systems are crucial to provide reliable data and increase the political commitment necessary for disease control. To date, animals suspected as rabies-positive must be submitted to a postmortem confirmation using classical or molecular laboratory methods. However, most endemic areas are in low- and middle-income countries where animal rabies diagnosis is restricted to central veterinary laboratories. Poor availability of surveillance infrastructure leads to serious disease underreporting from remote areas. Several diagnostic protocols requiring low technical expertise have been recently developed, providing opportunity to establish rabies diagnosis in decentralized laboratories. We present here a complete protocol for field postmortem diagnosis of animal rabies using a rapid immunochromatographic diagnostic test (RIDT), from brain biopsy sampling to the final interpretation. We complete the protocol by describing a further use of the device for molecular analysis and viral genotyping. RIDT easily detects rabies virus and other lyssaviruses in brain samples. The principle of such tests is simple: brain material is applied on a test strip where gold conjugated antibodies bind specifically to rabies antigens. The antigen-antibody complexes bind further to fixed antibodies on the test line, resulting in a clearly visible purple line. The virus is inactivated in the test strip, but viral RNA can be subsequently extracted. This allows the test strip, rather than the infectious brain sample, to be safely and easily sent to an equipped laboratory for confirmation and molecular typing. Based on a modification of the manufacturer's protocol, we found increased test sensitivity, reaching 98% compared to the gold standard reference method, the direct immunofluorescence antibody test. The advantages of the test are numerous: rapid, easy-to-use, low cost and no requirement for laboratory infrastructure, such as microscopy or cold-chain compliance. RIDTs represent a useful alternative for areas where reference diagnostic methods are not available.

Field Postmortem Rabies Rapid Immunochromatographic Diagnostic Test for Resource-Limited Settings with Further Molecular Applications

Field Postmortem Rabies Rapid Immunochromatographic Diagnostic Test for Resource-Limited Settings with Further Molecular Applications

Validation of OraQuick HCV Rapid Antibody Test in Postmortem Specimens.

The objective of this study is to evaluate the performance of OraQuick HCV Rapid Antibody Test against a "gold-standard", FDA-approved, laboratory-based serum immunoassay (SI) in postmortem blood. To date, OraQuick HCV Rapid Antibody Test has not been evaluated for use in postmortem testing. This OraQuick test is a manually performed, visually interpreted, single use immunoassay for the qualitative detection of antibodies to the hepatitis C virus (HCV). Blood was collected from 51 decedents whose deaths were investigated in the jurisdiction of the Knox and Anderson County Medical Examiner's Office (MEO) January 2017 through April 2017. For each consented case, blood was tested using both the OraQuick HCV Rapid Antibody Test and a laboratory-based hepatitis C serum immunoassay ("gold standard" reference assay). Results from the OraQuick HCV Rapid Antibody Test were compared against a laboratory-based hepatitis C serum immunoassay. Using the laboratory-based serum immunoassay (SI) as the "gold standard" for assessing true HCV antibody positivity, and comparing SI against OraQuick rapid test, sensitivity for the OraQuick rapid test was 95.65% and specificity was 96.15% in postmortem blood. Our results demonstrate that OraQuick HCV rapid antibody test is reliable for diagnosis of hepatitis C infection in postmortem blood with a relatively short (less than approximately 21.5 hours) postmortem sample acquisition time. The OraQuick in some cases may be superior to traditional, laboratory-based HCV SI due to potential increased viscosity of postmortem blood.

Nontraumatic Multiple-Organ Fat Embolism

The patient was an 88-year-old woman with a 10-year history of hypertension. She was suspected to have been hit by a car. At the time of the event, she was conscious and able to stand on her own and had no obvious injuries. She was sent home, but she lapsed into unconsciousness and was nonresponsive after 2 hours. She was sent to the hospital, and her heartbeat and breathing stopped. After half an hour of rescue attempts, her heartbeat did not recover, and she was declared dead. During the autopsy, a small subcutaneous hemorrhage was observed below the right knee joint. No obvious internal organ injuries or bone fractures were observed. The deceased also had mild atherosclerosis in the coronary arteries and an old cerebral infarction in the right cerebellum. The tissue histopathological tests showed distinct fat embolism in multiple organs, including the brain, lungs, kidneys, liver, and pancreas. A postmortem blood biochemistry test of the heart blood showed that the levels of low-density lipoprotein, cholesterol, triglycerides, and free fatty acids in the blood were increased, and the level of C-reactive protein was elevated. According to the autopsy results, the direct cause of death was multiorgan fat embolism. This case suggests that aging, hypertension, and hyperlipidemia may be risk factors for nontraumatic fat embolism under stressful conditions.

Clinical impact of post-mortem genetic testing in cardiac death and cardiomyopathy.

Post-mortem genetic analyses may help to elucidate the cause of cardiac death. The added value is however unclear when a cardiac disease is already suspected or affirmed. Our aim was to study the feasibility and medical impact of post-mortem genetic analyses in suspected cardiomyopathy. We studied 35 patients with cardiac death and suspected cardiomyopathy based on autopsy or clinical data. After targeted sequencing, we identified 15 causal variants in 15 patients (yield 43%) in sarcomeric (n = 8), desmosomal (n = 3), lamin A/C (n = 3) and transthyretin (n = 1) genes. The results had various impacts on families, i.e. allowed predictive genetic testing in relatives (15 families), planned early therapeutics based on the specific underlying gene (5 families), rectified the suspected cardiomyopathy subtype (2 families), assessed the genetic origin of cardiomyopathy that usually has an acquired cause (1 family), assessed the diagnosis in a patient with uncertain borderline cardiomyopathy (1 family), reassured the siblings because of a de novo mutation (2 families) and allowed prenatal testing (1 family). Our findings suggest that post-mortem molecular testing should be included in the strategy of family care after cardiac death and suspected cardiomyopathy, since genetic findings provide additional information useful for relatives, which are beyond conventional autopsy.

Utility of Postmortem Vitreous Beta-Hydroxybutyrate Testing for Distinguishing Sudden from Prolonged Deaths and for Diagnosing Ketoacidosis.

A retrospective, cross-sectional analysis of vitreous beta-hydroxybutyrate (BHB) on 967 forensic cases over a two-year period was conducted. Cases were sorted into six categories of death: (i) sudden traumatic/non-natural (ST), (ii) sudden natural (SN), (iii) prolonged traumatic/non-natural (PT), (iv) prolonged natural (PN), (v) diabetic ketoacidosis (DKA), and (vi) alcoholic ketoacidosis (AKA). The mean BHB for all cases was 1.67 mmol/L (17.4 mg/dL; range: 0.11-18.02 mmol/L). The numbers of DKA, AKA, PN, PT, SN, and ST deaths were 21, 5, 155, 258, 275, and 253, respectively. Their mean vitreous BHBs were as follows: 11.04 mmol/L (DKA), 8.88 mmol/L (AKA), 1.56 mmol/L (PN), 1.55 mmol/L (PT), 1.26 mmol/L (SN), and 1.38 mmol/L (ST). There was a statistically significant difference between the mean BHBs of the PN and SN death groups (p < 0.001), as well as between those of the PT and ST death groups (p = 0.004). Given the overlapping ranges seen between the prolonged and sudden death groups, the identified differences did not hold clinical significance. In addition, we sought to determine a threshold value for vitreous BHB to definitely diagnose cases of ketoacidosis. BHB threshold concentrations between 2.5 and 5 mmol/L produced sensitivities >92% and specificities >96%. A receiver operator characteristic curve found 3.43 mmol/L to be the optimal cutoff value, demonstrating a specificity of 98.3% and a sensitivity of 96.2%.

Oxycodone, Hydromorphone, and the Risk of Suicide: A Retrospective Population-Based Case-Control Study.

Opioids have been increasingly associated with suicide, but whether they are independent contributors is unclear. Oxycodone and hydromorphone are commonly prescribed high-potency opioids that can differentially affect mood. The objective of this study was to explore whether oxycodone and hydromorphone are differentially associated with suicide. We conducted a retrospective population-based case-control study in Ontario, Canada, from 1992 to 2014. Using coronial data, we defined case subjects as individuals who died by suicide involving an opioid overdose. Each of these was matched with up to four controls who died of accidental opioid overdose. We ascertained exposure to oxycodone, hydromorphone, and other opioids from postmortem toxicology testing. We used odds ratios and 95% confidence intervals to examine whether opioid-related suicide was disproportionately associated with oxycodone relative to hydromorphone. We identified 438 suicides and 1212 accidental deaths, each of which involved either oxycodone or hydromorphone but not both. The median age at death was 49years and 51% were men. After adjusting for a history of self-harm, psychiatric illness, and exposure to other opioids, we found that oxycodone was more strongly associated with suicide than hydromorphone (adjusted odds ratio 1.59; 95% confidence interval 1.20-2.11). In a secondary analysis, we observed a trend of similar magnitude in which combined exposure to oxycodone and hydromorphone was more strongly associated with suicide than hydromorphone alone (adjusted odds ratio 1.68; 95% confidence interval 0.92-3.09). While preliminary, these findings support the possibility that some high-potency opioids might independently influence the risk of suicide in susceptible individuals.

Implications for forensic death investigations from first Swiss post-mortem CT in a case of non-hospital treatment with COVID-19

• 3D Visualisation of lung pathology allows to better estimate the distribution of aerated, poorly aerated and non-aerated lung regions • Forensic COVID-19 autopsy apparently showing a different (higher) degree of pathology than hospital autopsy reports compared to SARS-COV-2, but on par with SARS. Case details: A case of a 50-year old HIV-positive man is presented, with focus on visualization of post-mortem computed tomography (PMCT) of the lungs, in comparison to a forensic control case. He had been found dead at home, a day after his nasopharyngeal swab had returned positive for SARS-COV-2, three days after the sample had been taken as an outpatient, over five weeks after first exhibiting possible symptoms. 3D-visualization was performed by visually discriminating correlates for aerated, poorly aerated and non-aerated lung regions. The visual side-by-side comparison with a control case shows the deterioration beyond any ”normal” post-mortem finding, however. The PMCT findings in the lungs resemble those of patients with acute respiratory distress syndrome (ARDS), while histologically identified inflammation also shows, in part binuclear, lymphocytes. In addition, acute liver dystrophy and acute tubular necrosis in the kidneys were found. Except coronary artery atherosclerosis, there appeared to be no remarkable pathology of the heart. Comment: With the pandemic impact of SARS-COV-2, a range of issues unfolds, also for medicolegal investigations into deaths, as we report the first Swiss case with post-mortem CT where death had occurred due to a SARS-COV-2 infection, with features of a severe acute respiratory distress syndrome, as an outpatient. As this pandemic from the view of risk assessment does constitute a black swan, underestimated fat tails as technical reason should be addressed by also analyzing apparent extreme single observations. This case of an outpatient (without hospital or intensive-care treatment) shows a pulmonary progression beyond the typical findings of COVID-19, to a non-specific picture of ARDS, where histologically, in part binuclear lymphocytes were remarked. What appeared to be an initially slow progression with final rapid escalation raises the question whether nasopharyngeal swabs alone or added pulmonary CT might be better for screening high-risk patients. The reported symptoms and relatively late medical consultation in this case appeared to contrast with the extensive pathology, raising the question whether any search for super-spreaders should not just focus on asymptomatic but under-reported symptomatic patients, and whether their prolonged circulation in everyday life would justify measures such as for example more extensive face mask policies. As post-mortem testing for SARS-COV-2 may not be available for every case, PMCT may provide sensitive testing for lung changes related to COVID-19. In order to allow for more precise medicolegal investigations in the context of COVID-19, however, any more specific extra tests may have to be financed by stakeholders in epidemiology, infectious disease or policy.

Hydrogenation-induced lattice expansion and its effects on hydrogen diffusion and damage in Ti–6Al–4V

Hydrogen uptake in titanium alloys leads to the formation of hydride phases, which in-turn cause severe embrittlement upon further deformation. The embrittlement micro-mechanisms are complicated by the distinct hydrogen diffusion and solution characteristics of the α and β phases, which arise from their different crystal structures. To improve the fundamental understanding of the room temperature interplay among hydrogen, the present phases and the hydride that is formed at their interface, we investigated the hydride formation process in Ti–6Al–4V alloy by in situ scanning electron microscopy and electron backscatter diffraction analyses during hydrogen charging, and post-mortem synchrotron diffraction tests. These investigations reveal that the lattice expansion of the hydrogenated β phase introduces a localized stress field near the phase boundary, which, in turn, induces hydrogen confinement therein, eventually facilitating the hydride growth along the boundary. The volumetric expansion of the α-to-hydride transformation extends the local stress field, influencing the work-hardening and damage evolution in the alloy. We discuss these findings and the overall damage initiation and propagation taking place in the hydrogenated alloy, based on the interplay among the present phases and hydrogen.

Using postmortem formalin fixed paraffin-embedded tissues for molecular testing of sudden cardiac death: A cautionary tale of utility and limitations

For archived cases of previously young healthy individuals where cause of sudden death remains undetermined, formalin fixed paraffin-embedded tissues (FFPE) samples are often the only biological resource available for molecular testing. We aim to ascertain the validity of postmortem molecular analysis of 95 cardiac genes using the FFPE samples routinely processed in the offices of medical examiners - typical fixation time in formalin ranges from days to months. The study was conducted in the College of American Pathologists accredited Molecular Genetics Laboratory within the City of New York Office of Chief Medical Examiner. Twelve cases, with FFPE samples and corresponding non-formalin fixed samples (RNAlater-preserved tissues or bloodstain card), were chosen for testing results comparison. The methods of extracting DNA from FFPE samples using Covaris, Qiagen, and Promega products showed comparable results. The quality of the extracted DNA, the target-enriched DNA libraries of 95 cardiac genes using HaloPlex Target Enrichment system by Agilent Technologies, and sequencing results using Illumina Miseq instrument were evaluated. Compared to the sequencing results of the nonfixed samples, the FFPE samples were categorized into three groups: 1) Group 1 samples fixed in formalin 2–6 days, had greater than 55 % sequencing regions ≥30x and 94%–100% variant concordance. 2) Group 2 samples fixed in formalin for 8 days, showed intra-sample sequencing variations: the surface tissues showed 25%–27% extra variants (false positive) and 8.1%–9.7% missing variants (false negative), whereas the repeated core tissues showed reduced extra variants to 1.6 % and the false negative error was unchanged. 3) Group 3 samples fixed in formalin 29–136 days, had 2–55 % sequencing regions ≥30x, up to 52.2 % missed variants and up to 6.3 % extra variants. All reportable variants (pathogenic, likely pathogenic or variant of uncertain significance) identified in the nonfixed samples were also identified in FFPE, albeit three variants had low confidence variant calling. In summary, our study showed that postmortem molecular diagnostic testing using FFPE samples routinely processed by the medical examiners should be cautioned, as they are replete with false positive and negative results, particularly when sample fixation time is longer than 8 days. Saving non-formalin fixed samples for high fidelity molecular analysis is strongly encouraged.

Этиологическая и патоморфологическая характеристика врожденной пневмонии

In order to study the etiological factors and pathomorphological changes in lungs in congenital pneumonia, 80 case histories and autopsy records of deceased children who were admitted to the pathological departments of multidisciplinary children’s hospitals in Novosibirsk in 2018–2019 were analyzed. Such parameters as gender, age, maturity, data from intravital and postmortem bacteriological tests, as well as the results of histological examination of internal organs and, taking into account the continuity of the mother — placenta — fetus system and the role of the liver as a barrier organ in perinatal infections, placenta and liver, were assessed. It was found that fatal outcomes due to congenital pneumonia are more often observed in boys, and mainly in premature newborn infants. Congenital pneumonia in most cases was part of a generalized infectious process (neonatal sepsis, intrauterine infection) (up to 85%), with frequent damage to the intestine (enterocolitis), liver (fetal hepatitis). The main etiological factors of congenital pneumonia are Klebsiella pneumoniae, Pseudomonas aeruginosa, Escherichia coli or bacterial-bacterial associations of the above pathogens. The morphological picture of the lungs was dominated by desquamative interstitial pneumonia.

Cross-validation of the RT-QuIC assay for the antemortem detection of chronic wasting disease in elk

ABSTRACT Chronic wasting disease is a progressively fatal, horizontally transmissible prion disease affecting several members of the cervid species. Conventional diagnosis relies on ELISA or IHC evaluation using tissues collected post-mortem; however, recent research has focused on newly developed amplification techniques using samples collected antemortem. The present study sought to cross-validate the real-time quaking-induced conversion assay (RT-QuIC) evaluation of rectal biopsies collected from an elk herd with endemic CWD, assessing both binary positive/negative test results as well as relative rates of amplification between laboratories. We found that results were correlative in both categories across all laboratories performing RT-QuIC, as well as to conventional IHC performed at a national reference laboratory. A significantly higher number of positive samples were identified using RT-QuIC, with results seemingly unhindered by low follicle counts. These findings support the continued development and implementation of amplification assays in the diagnosis of prion diseases of veterinary importance, targeting not just antemortem sampling strategies, but post-mortem testing approaches as well.

Verification of Two Rapid Post-mortem Tests for the Monitoring of Chronic Wasting Disease (CWD) Using Brain, Lymph Node and Tonsil Samples of Red Deer (Cervus elaphus) Negative for CWD in Histopathology

Verification of Two Rapid Post-mortem Tests for the Monitoring of Chronic Wasting Disease (CWD) Using Brain, Lymph Node and Tonsil Samples of Red Deer (Cervus elaphus) Negative for CWD in Histopathology

A Dilute and Shoot LC-MS/MS Method for Antipsychotics in Urine.

Adherence to prescribed antipsychotics is an ongoing problem. Traditionally, estimates of adherence have been made from patient interviews, pill counting and blood testing. A number of methods for the analysis of antipsychotics in blood have been reported for both therapeutic drug monitoring and postmortem testing for toxicity. This report details a dilute and shoot method for the analysis of 19 different antipsychotics and metabolites. The method takes advantage of earlier reports demonstrating unique, prevalent urine metabolites for aripiprazole, brexpiprazole, haloperidol and lurasidone to enhance sensitivity for these analytes. With a fast analysis time and minimal sample preparation, this method can be used for quantitation of antipsychotics in urine. Finally, this method has been used to test samples for over a year with the results summarized in this report. While further improvements are certainly possible, this method is selective and sensitive for this group of important compounds.

Examining opioid-involved overdose mortality trends prior to fentanyl: New York City, 2000–2015

BackgroundRates of overdose death in New York City (NYC) increased 26% from 2000 to 2015, with a notable decrease in rate from 2006 to 2010. Beginning in 2016, the synthetic opioid fentanyl entered the NYC illicit drug market and has been associated with large increases in overdose death. This study assessed NYC trends in opioid-involved overdose death prior to fentanyl to understand the contribution of specific opioids and inform overdose prevention strategies. MethodsData were derived from death certificates linked to postmortem toxicology testing. We stratified cases into three mutually exclusive groups: (1) heroin without opioid analgesics (OAs); (2) OAs without heroin; and (3) the combination of heroin and OAs. We calculated mortality rates by year, and compared rates by the demographic characteristics age, sex, and race/ethnicity. Joinpoint regression identified junctures in trends between 2000 and 2015. ResultsRates of overdose death involving heroin without OAs decreased from 2006 to 2010, then increased from 2010 to 2015 among males, persons age 15 to 54, and Blacks and Whites. Rates of overdose death involving OAs with and without heroin increased from 2000 to 2015 across all demographic subgroups. ConclusionsThe identified trends in overdose death are suggestive of demographic shifts in drug use. In particular, the tamper-resistant reformulation of oxycodone 80 mg may have increased the use of heroin among primary OA users. Notably, older adults may have had established heroin use practices prior to the proliferation of OAs and thus may have been less likely to modify drug use practices.

TES-PS10 postmortem tests: Carbon steel corrosion performance exposed to molten salts under relevant operation conditions and lessons learnt for commercial scale-up

Abstract Postmortem tests were performed over components removed from the TES-PS10 pilot plant after almost four years of continuous operation being exposed to solar salts under representative commercial operation conditions. Accordingly, corrosion performance of plates sections extracted from both storage tanks and samples cut from the hot molten salts pump were evaluated. Corrosion damage extension, oxides layers morphology, and corrosion products chemistry were analyzed by X-ray diffraction, energy dispersive X-ray spectrometry, optical microscopy, and SEM. In addition to materials compatibility with molten salts, mechanical tests were carried out over the storage tanks plates sections. Although the corrosion damage extension over the plates extracted from storage tanks was low and the mechanical properties were according to the standard, some interesting observations were seen. For example, a sample extracted from the hot storage tank and exposed to intermittent contact with molten salts showed some areas characterized by the growth of a non-protective oxide scale. Moreover, localized corrosion with slight penetration through the base material was identified for all storage plates samples under evaluation. On the other hand, the molten salt pump parts under study showed adherent and uniform oxides layers without detecting corrosion–erosion phenomena. Some cavities were found in the discharge elbow, and these imperfections were associated to a bad metallurgical quality during casting. Summarizing, corrosion phenomena suffered by the components under evaluation could be corrected in future plants by applying the lessons learned discussed in this study. As conclusion, materials selection analyzed within this postmortem evaluation is valid from the corrosion point of view to be used in the design of commercial TES systems in PTC plants.

Mothers with long QT syndrome are at increased risk for fetal death: findings from a multicenter international study

Most fetal deaths are unexplained. Long QT syndrome is a genetic disorder of cardiac ion channels. Affected individuals, including fetuses, are predisposed to sudden death. We sought to determine the risk of fetal death in familial long QT syndrome, in which the mother or father carries the long QT syndrome genotype. In addition, we assessed whether risk differed if the long QT syndrome genotype was inherited from the mother or father. This was a retrospective review of pregnancies in families with the 3 most common heterozygous pathogenic long QT syndrome genotypes in KCNQ1 (LQT1), KCNH2 (LQT2), or SCN5A (LQT3), which occur in approximately 1 in 2000 individuals. The purpose of our study was to compare pregnancy and birth outcomes in familial long QT syndrome with the normal population and between maternal and paternal carriers of the long QT syndrome genotype. We hypothesized that fetal death before (miscarriage) and after (stillbirths) 20 weeks gestation would be increased in familial long QT syndrome compared with the normal population and that the parent of origin would not affect birth outcomes. Our study was a multicenter observational case series of 148 pregnancies from 103 families (80 mothers, 23 fathers) with familial long QT syndrome (60 with LQT1, 29 with LQT2, 14 with LQT3) who were recruited from 11 international centers with expertise in hereditary heart rhythm diseases, pediatric and/or adult electrophysiology, and high-risk pregnancies. Clinical databases from these sites were reviewed for long QT syndrome that occurred in men or women of childbearing age (18-40 years). Pregnancy outcomes (livebirth, stillbirth, and miscarriage), birthweights, and gestational age at delivery were compared among long QT syndrome genotypes and between maternal vs paternal long QT syndrome-affected status with the use of logistic regression analysis. Most offspring (80%; 118/148) were liveborn at term; 66% of offspring (73/110) had long QT syndrome. Newborn infants of mothers with long QT syndrome were delivered earlier and, when the data were controlled for gestational age, weighed less than newborn infants of long QT syndrome fathers. Fetal arrhythmias were observed rarely, but stillbirths (fetal death at >20 weeks gestation) were 8 times more frequent in long QT syndrome (4% vs approximately 0.5%); miscarriages (fetal death at ≤20 weeks gestation) were 2 times that of the general population (16% vs 8%). The likelihood of fetal death was significantly greater with maternal vs paternal long QT syndrome (24.4% vs 3.4%; P=.036). Only 10% of all fetal deaths underwent postmortem long QT syndrome testing; 2 of 3 cases were positive for the family long QT syndrome genotype. This is the first report to demonstrate that mothers with long QT syndrome are at increased risk of fetal death and to uncover a previously unreported cause of stillbirth. Our results suggest that maternal effects of long QT syndrome channelopathy may cause placental or myometrial dysfunction that confers increased susceptibility to fetal death and growth restriction in newborn survivors, regardless of long QT syndrome status.

Combining Cyclic Square Wave Voltammetry Experiment and Modeling to Quantify Unknown Electron Transfer Mechanisms for Applications in Relevant Electrochemical Systems

Understanding and controlling electron transfer process(es) is of significant importance to electrochemical systems that employ Faradaic reactions, as knowledge of reaction mechanisms enables improvements on the device level (e.g., reducing the kinetic overpotential, minimizing undesirable homogeneous reactions). Therefore, developing robust and inexpensive techniques capable of diagnosing electron transfer mechanisms is highly desirable. Currently, many methods are able to quantify specific electron transfer mechanisms. For example, the Nicholson Method can determine the heterogeneous rate constant of a quasi-reversible one-electron transfer; further, voltammetric simulations can capture the behavior of more complex electron transfer phenomena.1,2 However, while these previous studies have successfully combined modeling and experiment to quantify various electrode mechanisms, such approaches require a priori knowledge of the electron transfer pathway to extract meaningful information. If a system has multiple possible electron transfer pathways, the approach used in these previous studies provides inadequate information regarding which pathway is the correct one, limiting its utility in novel or poorly understood systems. Thus, this protocol would be even more powerful if it could both determine relevant parameters for an appropriate electron transfer pathway and correctly select unknown electron transfer pathways. We successfully address this shortcoming using a robust and accessible protocol that determines electron transfer mechanisms of different redox couples by combining voltammetry, modeling, and statistical analysis. Specifically, we couple cyclic square wave voltammetry, due to its increased sensitivity to Faradaic processes as compared to conventional voltammetry,3 with model selection criteria based on statistical inference (e.g., Akaike Information Criterion, Bayesian Information Criterion), to determine the most appropriate electron transfer model. Our protocol requires only experimental data and essential inputs (e.g., simulated points per second, number of initial guesses tested) and uses an extensive library of electron transfer models derived using an approach similar to that of previous researchers.3,4 As the field becomes cognizant of the utility model selection criteria offer, researchers are starting to use them to differentiate between electron transfer mechanisms. However, the work done thus far has only been validated for moderately simple electron transfer mechanisms (at most, four reactions in series) and is ultimately targeted towards the specific application of analyzing porous electrode behavior in batteries and fuel cells.5 This protocol can be applied to an even wider variety of applications (e.g., post-mortem testing, deeper mechanistic understanding of complex electrode processes), but to do so, it must be shown to be successful for more complicated electron transfer pathways present in these applications. We pursue this goal and demonstrate its viability by extending our protocol to consider these complicated pathways. In this presentation, we first demonstrate the successful validation of our extensive model library using well-known model redox couples studied on a planar surface. We then illustrate the predictive capability of our protocol using relevant redox flow battery couples, demonstrating strong agreement with literature values. We finally discuss future work, including the addition of appropriate electron transfer models to enable this protocol’s implementation in specific, targeted applications.