Wrong Site Research Articles

The site of Cr+ attachment to gas-phase aniline from infrared spectroscopy.

Infrared spectroscopy of gas-phase Cr+ complexes of aniline was studied using the FELIX free electron laser interfaced to a Fourier transform ion cyclotron resonance spectrometer. For both the monomer complex Cr+(aniline) and the dimer complex Cr+(aniline)2 the spectra showed features indicating binding of the metal ion to the aromatic pi cloud, as opposed to the nitrogen atom. Agreement with DFT-calculated infrared absorption spectra for the ring-bound complexes was good using the MPW1PW91 functional, but the B3LYP functional predicted the wrong binding site. The spectroscopic results resolve the ambiguity in computational prediction of the preferred binding site and support the use of the MPW1PW91 functional for these systems.

All electron scalar relativistic calculations on adsorption of CO on Pt(1 1 1) with full-geometry optimization: a correct estimation for CO site-preference

Adsorption of CO on Pt(1 1 1) has been investigated by density functional theory (DFT) method (periodic DMol 3) with full-geometry optimization, changing calculation parameters (core treatment, functional, number of slab layer, k-points, and size of unit cell). There is a puzzling problem for the CO/Pt(1 1 1) system that DFT tends to predict the wrong adsorption site, the fcc-hollow site, whereas experimentally the atop site is preferred. The present work clearly shows that all electron scalar relativistic (AER) calculations are essential to obtain the correct site-preference, atop followed by bridge and then hollow (fcc and hcp). The AER calculations give a deeper Fermi level for a Pt surface with all the functionals, which provides the effect for decreasing the interaction of the LUMO of CO with the metal substrate. The adsorption structures agree well with those determined by LEED.

Significance of single-electron energies for the description of CO on Pt(111)

Semilocal density functionals predict that the stable adsorption site of carbon monoxide (CO) on Pt(111) is the hollow fcc site, in disagreement with experimental studies which indicate that CO adsorbs on the top site at low coverage. This site preference depends on a subtle balance between the interaction of the lowest unoccupied molecular orbital (LUMO) and highest occupied molecular orbital (HOMO) with the metal substrate. Local and semilocal functionals seem to overestimate the interaction of the LUMO with the metal substrate, in turn favoring the wrong site. It is argued that this error is related to the ``gap'' problem of present density functionals and might be cured by functionals that increase the HOMO-LUMO separation.

When scanning tunneling microscopy gets the wrong adsorption site: H on Rh(100).

At low tunneling resistance, scanning tunneling microscopy (STM) images of a Rh(100) surface with adsorbed hydrogen reproducibly show protrusions in all bridge sites of the surface, leading to a naive interpretation of all bridge sites being occupied with H atoms. Using quantitative low-energy electron diffraction and temperature programmed desorption we find a much lower H coverage, with most H atoms in fourfold hollow sites. Density functional theory calculations show that the STM result is due to the influence of the tip, attracting the mobile H atoms into bridge sites. This demonstrates that STM images of highly mobile adsorbates can be strongly misleading and underlines the importance of additional analysis techniques.

Incidence of wrong-site surgery among hand surgeons.

Until recently, wrong-site surgery had received little attention and had been considered a random, infrequent event. In 1997, the American Academy of Orthopaedic Surgeons (AAOS) Task Force on Wrong-Site Surgery was formed to determine the incidence of wrong-site surgery and to initiate the "Sign Your Site" campaign. The purpose of our study was to determine the incidence of wrong-site surgery among hand surgeons, elucidate surgeons' practice habits and measures taken to prevent its occurrence, and evaluate the effectiveness of the AAOS "Sign Your Site" campaign. One thousand, five hundred and sixty active members of the American Society for Surgery of the Hand (ASSH) were polled by mail. Each member received a confidential twenty-nine-question survey. Nonrespondents were sent a second, identical survey. One thousand and fifty (67%) of the surgeons responded. One hundred and seventy-three surgeons (16%) reported that they had prepared to operate on the wrong site but then noticed the error prior to the incision, and 217 (21%) reported performing wrong-site surgery at least once. Of an estimated 6,700,000 surgical procedures, 242 were performed at the wrong site, an incidence of one in 27,686 procedures. The three most common locations of wrong-site surgery were the fingers (153), hands (twenty), and wrists (twenty-one). Permanent disability occurred in twenty-one patients (9%). Ninety-three cases (38%) led to legal action or monetary settlement. Seventy percent of the responding orthopaedic surgeons were aware of the "Sign Your Site" campaign, and 45% had changed their practice habits as a result. Prior to the AAOS "Sign Your Site" campaign, the issue of wrong-site surgery by hand surgeons had not been addressed. Although wrong-site surgery is rare, 21% of hand surgeons reported performing it at least once during their careers. Since the institution of the "Sign Your Site" campaign, 45% of orthopaedic hand surgeons have changed their practice habits, and almost all routinely take some action to prevent wrong-site surgery.

Preoperative Safety Briefing Project

Increased media attention on surgical procedures that were performed on the wrong anatomic site or wrong patient has prompted the health care industry to identify and address human factors that lead to medical errors. To increase patient safety in the perioperative setting, our objective was to create a climate of improved communication, collaboration, team-work, and situational awareness while the surgical team reviewed pertinent information about the patient and the pending procedure. A team of doctors, nurses, and technicians used human factors principles to develop the Preoperative Safety Briefing for use by surgical teams, a briefing similar to the preflight checklist used by the airline industry. A six-month pilot of the briefing began in the Kaiser Permanente (KP) Anaheim Medical Center in February 2002. Four indicators of safety culture were used to measure success of the pilot: occurrence of wrong-site/wrong procedures, attitudinal survey data, near-miss reports, and nursing personnel turnover data. Wrong-site surgeries decreased from 3 to 0 (300%) per year; employee satisfaction increased 19%; nursing personnel turnover decreased 16%; and perception of the safety climate in the operating room improved from "good" to "outstanding." Operating suite personnel perception of teamwork quality improved substantially. Operating suite personnel perception of patient safety as a priority, of personnel communication, of their taking responsibility for patient safety, of nurse input being well received, of overall morale, and of medical errors being handled appropriately also improved substantially. Team members who work together and communicate well can quickly detect and more easily avoid errors. The Preoperative Safety Briefing is now standard in many operating suites in the KP Orange County Service Area. The concepts and design of this project are transferable, and similar projects are underway in the Departments of Radiology and of Labor and Delivery at KP Anaheim Medical Center.

Ensuring Correct Site Surgery

In 2000, a report was published that focused on the high rate of medical errors in the United States. Wrong site surgery is defined as any surgery performed on the wrong site or patient or performing the wrong procedure. Since January 1995, 197 wrong site surgeries have been reported through the Joint Commission on Accreditation of Healthcare Organizations sentinel event reporting system. Incidents of wrong site surgery should not happen. The perioperative health care team composed of nurses, physicians, anesthesia care providers, unlicensed assistive personnel, admission workers, clerks, and other ancillary staff members must make patient safety an uncompromising goal. This article describes the problem and identifies potential causes for incidences of wrong site surgery. The article also describes steps to act on AORNs patient safety initiative, which includes five suggestions for the development of any surgical site verification policy. Using these suggestions as guidelines for developing a policy and procedure will help decrease the risk of avoidable errors.

Ensuring correct site surgery

AORN is committed to promoting the identification of the correct surgical site. Using the suggested risk-prevention strategies when developing policies and procedures will reduce the risk of error. AORN's position statement on correct site surgery is available on AORN Online (i.e., http://www.aorn.org/about/positions/correct site.htm). Other resources can be found on the Patient Safety First web site (i.e., http://www.patient safetyfirst.org). As patient advocates, perioperative RNs should communicate with all members of the surgical team to verify the correct surgical site. Individual facility policy should clearly delineate the role and responsibility of the physician and other team members in marking and verifying the patient's-identity and the correct surgical site, procedure, and laterality. Perioperative nurses also should think about the last time an error or a near miss related to wrong site surgery occurred. Compare your facility's current policy and procedure to JCAHO recommendations and work within your facility to develop, implement, and monitor a collaboratively developed, multidisciplinary policy and procedure. If your facility has not addressed the issue of wrong site surgery, learn more about why this problem occurs and see what you can do to make correct site surgery an expectation--100% of the time.

Cytokines as Novel Therapeutic Agents for Neuroinflammatory Disorders: A Role for Interferon-β in the Treatment of Multiple Sclerosis

Cytokines are proteins that play an important role in the control of different diseases but, produced in excess or in the wrong site, they can cause pathological changes. The existence of the basic effector subsets of proinflammatory and anti-inflammatory cytokines is now well accepted, and is being used to plan therapeutic strategies for inflammatory and autoimmune disorders. Multiple sclerosis (MS) is a demyelinating disorder of the central nervous system (CNS). It is considered as an autoimmune disease associated with immune activity directed against CNS antigens. Immune mechanisms involving proinflammatory cytokines are believed to play an important role in the pathogenesis of MS. Thus, immunosuppression and immunomodualtion have become a focus of therapeutic strategies in MS. Recombinant interferon-beta (IFN-β) has been introduced as a drug and was considered to be the first breakthrough in the treatment of multiple sclerosis. Placebo-controlled, double-blind studies, have demonstrated the efficacy of three different forms of IFN-β administrated by either subcutaneous or intramuscular routes and at different doses in patients with active relapsing-remitting MS (RR-MS). These drugs are IFN-β-1b (Betaferon®) and IFN-β-1a (Avonex® and Rebif®). Different clinical trials demonstrated clear benefits of IFN-β for decreasing relapses and probability of sustained clinical disability progression in patients with RR-MS as assessed by brain magnetic resonance imaging (MRI). Beneficial effects in secondary progressive MS (SP-MS) was also reported. This review addresses the introduction of cytokines as novel and effective therapeutic agents as demonstrated by IFN-β in the treatment for MS. Further evaluation for combination of therapeutic immunomodulatory agents should be considered.

Low-energy dynamics of CO and NO chemisorbed on Rh(111)

The structure and the low-energy vibrational dynamics of CO and NO chemisorbed on a Rh(111) surface have been investigated by means of He-atom scattering (HAS). For a dilute phase of isolated CO molecules a characteristic frequency of ℏω=5.7 meV is observed which shifts to 5.45 meV for the (3×3)R30° phase (θ=1/3). Based on isotope exchange measurements this mode is assigned to the parallel frustrated translational mode (T-mode) of CO at on-top sites. For the (2×2)3CO saturation structure a further molecular vibrational mode with a frequency of ℏω=11.7 meV is obtained and is assigned to the T-mode of CO adsorbed at hollow sites which are predominantly populated in this phase. The He-atom diffraction patterns indicate a successive appearance of various NO superstructures upon increasing NO exposure including a low coverage c(4×2), an intermediate (3×3) and finally the (2×2)3NO saturation structure. The corresponding inelastic HAS measurements reveal again two characteristic molecular vibrational modes at 7.5 and 11.5 meV which are identified as the T-modes of NO adsorbed at on-top and hollow sites, respectively. Moreover, for the NO saturation phase two additional phonon modes appear at energies below 14 meV. Based on a lattice dynamical analysis of their dispersion curves they are identified as a back-folded Rayleigh mode and a further perpendicular polarized phonon mode caused by the reduced Brillouin zone of the NO adlayer. The different T-mode frequencies for CO or NO at on-top and hollow sites suggest that this mode is a sensitive signature of adsorption sites rather than the commonly used internal stretch mode which had led to wrong adsorption site assignments.

First-Principles Pseudo-Potential Study of the Pd(110)-c(2×2)-Ethylene Adsorption System

The interaction of molecular ethylene with the Pd(110) surface has been investigated by means of periodic first-principles density functional theory slab calculations. At 0.5 ML coverage, DFT-GGA-PW91 calculations favor the formation of a short bridge (di-σ type) adsorption mode over an atop (π-bonded) ethylene state by 196 meV. On the other hand, HREELS, NEXAFS, and STM measurements unambiguously reveal the presence of π-bonded ethylene on Pd(110). The possible causes of this wrong site preference in DFT-GGA calculations are discussed.

Deformation of Co 3AlC 0.5 and a Co 3AlC 0.5-strengthened cobalt-based alloy

Plastic deformation features of Co 3AlC 0.5 and a Co 3AlC 0.5-strengthened cobalt-based alloy were studied by means of transmission electron microscopy. It was found that <110>{111} slip system is activated and dissociation of superlattice dislocations occurs in Co 3AlC 0.5 in a manner similar to the L1 2 structure. However, in contrast to the L1 2 structure, motion of dislocations is hindered by the pre-existing thermally grown-in anti-phase boundaries formed by wrong site occupation of carbon atoms, a unique type of crystal defects in Co 3AlC 0.5. On the other hand, deformation of the α(Co) alloy containing fine Co 3AlC 0.5 precipitates is characterized by localized slip of 1/6<211> Shockley partial dislocations cutting through the fine Co 3AlC 0.5 particles, leaving behind a highly disordered band region.

Referral patterns within Scotland to specialist oncology centres for patients with testicular germ cell tumours. The Scottish Radiological Society and the Scottish Standing Committee of the Royal College of Radiologists.

Details of 1123 patients registered in Scotland between 1983 and 1990 for testicular cancer under the Scottish Cancer Registration Scheme were obtained and compared with registrations within the five Scottish oncology centres. Some registration discrepancies were identified. Twenty-eight cancer registrations (2.5%) were coded to the wrong site, 29 patients seen at oncology centres had no cancer registration and 14 cancer registrations had the wrong histology. Five hundred and twenty-seven patients with testicular non-seminomatous germ cell tumours (NSGCT) and 567 with testicular seminoma were identified. Referral rates to specialist oncology centres for testicular germ cell tumours were measured by period and health board area of residence. For the whole study period 92% of NSGCT and 93% of seminoma patients were referred to specialist centres for treatment. Referral rates for different health board areas of residence were not significantly different. This study shows that within Scotland the majority of patients with testicular NSGCT and seminoma are referred to specialist centres, and suggests referral rates of around 92% are underestimates. Access is not related to area of residence.

Wrong site for Japanese labs

Wrong site for Japanese labs

The mechanism of ATP inhibition of wild type and mutant phosphofructo-1-kinase from Escherichia coli.

Escherichia coli 6-phosphofructo-1-kinase was inhibited by high concentrations of ATP at alkaline pH. The mechanism of the inhibition was studied with two mutants generated by site-directed mutagenesis; I126A, with a Km for fructose-6-P that was more than two orders of magnitude higher than that of wild type but with minimal changes in kcat and Km for ATP, and R72H, with little change in substrate half-saturation concentrations but with a kcat that was 300-fold lower that of wild type enzyme. ATP and fructose-6-P interacted in a mutually antagonistic manner; that is ATP decreased the apparent affinity for fructose-6-P and vice versa. The half-saturation concentrations for both substrates, most strikingly fructose-6-P, increased with increasing pH while the kcat increased. Studies with I126A suggested that ATP inhibition was not dependent on a dissociable group with a pK in the alkaline range and that the inhibition was not caused by abortive binding of substrate to the wrong substrate site. Inhibition was not the result of differential affinity of ATP for the R and T states of the enzyme. The low kcat mutant, R72H, did not display ATP inhibition. These data indicate that ATP inhibition results from substrate antagonism coupled with a steady state random mechanism wherein the high rate of catalysis does not permit equilibration of substrates.

A Theoretical Study of Amorphous-Crystalline Transition in Si [111] MBE Growth

ABSTRACTThe amorphous crystalline transition temperature for Si MBE growth is higher for [111] growth than for [100] growth. The mechanism for the growth of amorphous Si in [111] growth is thought to be due to the possibility of of direct formation of stacking faults on the [111] surface. To investigate this mechanism, a kinetic model describing the amorphous-crystalline transition in low temperature Si [111] MBE growth is proposed. The model allows Si atoms to incorporate at three types of sites: A, B and C where A is the triply covalent bonded correct diamond site, B is the triply covalent bonded wrong hep site and C is the singly covalent bonded wrong site. The model allows for the migration of atoms from a wrong site to a nearest neighbor correct site through Arrhenius type rate equations. The migration from B → A is assumed 1000 times weaker than the reverse migration process. Similarly migrations from C → A are assumed 106 time stronger than the reverse migration. All possible migrations are considered with different rates. At the high temperature, the model will allow the growth of a perfect diamond cubic structure with correct ordering of layers AaBbCc etc. A stochastic model describing the above kinetic model is developed based on the master equation approach and random distribution approximation. The low temperature MBE growth of Si [111] is investigated using this model. The results of the model are compared with existing experimental work [1]. The results are in good agreement. The study shows that the kinetics of the site correcting migration process well describes the observed amorphous-crystalline transition in [111] Si MBE growth.

Acute gouty arthritis without urate crystals identified on initial examination of synovial fluid

AbstractNine patients who ultimately proved to have acute gouty arthritis did not have urate crystals demonstrable by compensated polarized light in the first joint fluid aspirated despite leukocyte counts as high as 100,000/mm3. In 6 cases crystals were found in fluid from the same joint 5 hours to 1 day later. Factors that might explain the difficulty in identifying crystals include aspiration of the wrong site because diffuse swelling obscured predominant involvement of a bursa or adjacent small joint, loculation within a joint, crystal dissolution leaving only tiny birefringent chunks, and inexpert or insufficient search. Some cases remain without any tentative explanation. The possibility of acute gouty arthritis should not be excluded if crystals are not demonstrable in the first search of joint fluid. Repeated searches for typical monosodium urate crystals may be required for diagnosis.

Les débuts difficiles de la capitale de la République Centrafricaine. Bangui de 1889 à 1893.

R. Goutalier — The Hard Beginnings of a Capital: Bangui, 1889-1893. The outstation which was to become eventually the capital of the Central African Republic was built on the wrong site, with the wrong climate and was for years a colonial hell-hole, maintained only to check Belgian competition on the other bank of the Ubangi river.