Skin-reducing mastectomy and one-stage implant reconstruction with a myodermal flap: A safe and effective technique in risk-reducing and therapeutic mastectomy

Introduction: Immediate reconstruction following mastectomy for breast cancer has been shown to be oncologically safe and associated with improved psychosocial outcomes for patients. Bostwick described a technique for one-stage implant based reconstruction, combining skin-sparing mastectomy with concurrent reduction of the skin envelope. This report reviews the experience of a single centre using skin-reducing mastectomy and one-stage implant reconstruction in both early stage breast cancer and risk-reducing mastectomy, with specific reference to frequency of complications, implant loss and oncological outcomes.

Methods and results: A retrospective review was undertaken to identify women who had undergone skin-reducing mastectomy and one-stage implant reconstruction using a de-epithelialised dermal flap, between October 2008 and October 2012. One hundred and four consecutive mastectomies, with reconstruction, were performed by two surgeons on 64 patients. No complications were seen in 43.8% of patients. At three months, four implants were lost (3.8% of breast reconstructions, 6.3% of patients), due to either peri-implant infection or mastectomy skin flap necrosis. One patient required unplanned return to theatre for evacuation of a haematoma. Minor mastectomy skin flap necrosis was seen in 10 breasts (9.6% of reconstructed breasts) and superficial wound infection in 8 breasts (7.7% of reconstructed breasts). All of these complications were managed conservatively and none required operative intervention. At a median follow up of 35 months (4-53 months) there had been one episode of ipsilateral axillary nodal recurrence.

Conclusion: One-stage implant reconstruction using a myo-dermal flap technique following skin-reducing mastectomy is safe and should be considered in selected patients. Most complications are minor and will resolve with conservative management. Major complications such as implant failure or immediate reoperation, were relatively uncommon (6.3% patients, 3.8% of reconstructed breasts). Early follow-up suggests that oncological outcomes are satisfactory, but longer follow-up is required to substantiate this. (C) 2013 British Association of Plastic, Reconstructive and Aesthetic Surgeons. Published by Elsevier Ltd. All rights reserved.

Efficient, Scalable, and Solvent-free Mechanochemical Synthesis of the OLED Material Alq(3) (q=8-Hydroxyquinolinate)

The aluminum complex Alq(3) (q = 8-hydroxyquinolinate), which has important applications in organic light-emitting diode materials, is shown to be readily synthesized as a pure phase under solvent-free mechanochemical conditions from Al(OAc)(2)OH and 8-hydroxyquinoline by ball milling. The initial product of the mechanochemical synthesis is a novel acetic acid solvate of Alq(3), and the alpha polymorph of Alq(3) is obtained on subsequent heating/desolvation of this phase. The structure of the mechanochemically prepared acetic acid solvate of Alq(3) has been determined directly from powder X-ray diffraction data and is shown to be a different polymorph from the corresponding acetic acid solvate prepared by solution-state crystallization of Alq(3) from acetic acid. Significantly, the mechanochemical synthesis of Alq(3) is shown to be fully scalable across two orders of magnitude from 0.5 to 50 g scale. The Alq(3) sample obtained from the solvent-free mechanochemical synthesis is analytically pure and exhibits identical photoluminescence behavior to that of a sample prepared by the conventional synthetic route.

I/Q imbalance in two-way AF relaying

We analyze the performance of dual-hop two-way amplify-and-forward relaying in the presence of in-phase and quadrature-phase imbalance (IQI) at the relay node. In particular, two power allocation schemes, namely, fixed power allocation and instantaneous power allocation, are proposed to improve the system reliability and robustness against IQI under a total transmit power constraint. For each proposed scheme, the outage probability is investigated over independent, non-identically distributed Nakagami- m fading channels, and exact closed-form expressions and bounds are derived. Our theoretical analysis indicates that, without IQI compensation, IQI can create fundamental performance limits on two-way relaying. However, these limits can be avoided by performing IQI compensation at source nodes. Compared with the equal power allocation scheme, our numerical results show that the two proposed power allocation schemes can significantly improve the outage performance, thus reducing the IQI effects, particularly when the total power budget is large.

Safe moving and handling of patients: an inter-professional approach

A gap in the medical undergraduate curriculum on safe moving and handling of patients was identified, and a project to enhance moving and handling education for undergraduates in various healthcare disciplines was undertaken. A team of nurses, doctors, physiotherapists and e-learning professionals developed a cross-discipline e-learning resource, piloted with medical and nursing students at Queen’s University Belfast. One outcome of the project was the development of a deeper recognition of the common curriculum across healthcare disciplines.

The struggle for safe staffing levels in the USA: A political economy of evidence-based practice

This paper examines the debate over nursing staff to patient ratios through the lens of Marxist political economy, arguing that the owners and controllers of healthcare in the USA have a vested interest in opposing mandated minimum ratios, while those involved in carrying out nursing care have a vested interest in their implementation, which coincides with the interests of patients. We examine how evidence-based practice articulates with social power, and proceed to interrogate the research methods used to generate evidence for practice, noting that randomised controlled trials are not suitable for evaluating nurse/patient ratios, which means that observational studies are the primary source of evidence. Representatives of nursing managers have used the fact that observational studies, while demonstrating an association between high ratios and poor outcomes, have not established a causal relationship, to support their argument that there is not sufficient evidence for the imposition of mandatory ratios. We argue that the precautionary principle provides firm justification for mandatory ratios, unless and until a causal relationship has been disproved. We conclude that those involved in the generation of evidence have to choose between technical arguments about the inferiority of observational studies, or emphasising their sufficiency in triggering the precautionary principle.

Can Safe Clinical Thinking be Taught?

OBJECTIVES: To determine if: (a) safe clinical decision making can be taught to undergraduate final year medical students and (b) if such students can be taught to specifically recognise illness severity from nominal clinical data. 
METHODS: 115 final year undergraduate medical students completed a 3 hour interactive Safe Thinking Workshop which focussed entirely on nontechnical skills such as potential perceptive pitfalls, attention to detail, teamwork and safe clinical decision making. The study involved students inspecting and interpreting a set of arterial blood gas results relating to a patient with acute respiratory distress, then answering a short questionnaire addressing biochemical diagnosis, clinical diagnosis and effective management. A separate question was embedded in the questionnaire to determine if astute students could determine the severity of the illness from the CO2 value provided. The study group (n = 58) completed the questionnaire immediately after the Safe Thinking Workshop, whilst the control group (n = 57) completed the questionnaire prior to the Workshop.
RESULTS: The mean total score for study students was 80.51%, with a mean total score of 63.86% for the control group (Student’s t-test; p<0.05). Correct classification of illness severity was observed in 10.35% of study students, compared with 3.51% of control students (p<0.05). 
CONCLUSION: These results suggest that safe clinical decision making and recognition of illness severity can be fostered by specific teaching in the nontechnical skill areas described above.

STARTEC: Novel processing technologies in the development of a decision support tool to ensure safe and nutritious Ready-To-Eat foods

Ready-to-eat (RTE) foods can be readily consumed with minimum or without any further preparation; their processing is complex—involving thorough decontamination processes— due to their composition of mixed ingredients. Compared with conventional preservation technologies, novel processing technologies can enhance the safety and quality of these complex products by reducing the risk of pathogens and/ or by preserving related health-promoting compounds. These novel technologies can be divided into two categories: thermal and non-thermal. As a non-thermal treatment, High Pressure Processing is a very promising novel methodology that can be used even in the already packaged RTE foods. A new “volumetric” microwave heating technology is an interesting cooking and decontamination method directly applied to foods. Cold Plasma technology is a potential substitute of chlorine washing in fresh vegetable decontamination. Ohmic heating is a heating method applicable to viscous products but also to meat products. Producers of RTE foods have to deal with challenging decisions starting from the ingredients suppliers to the distribution chain. They have to take into account not only the cost factor but also the benefits and food products’ safety and quality. Novel processing technologies can be a valuable yet large investment for several SME food manufacturers, but they need support data to be able to make adequate decisions. Within the FP7 Cooperation funded by the European Commission, the STARTEC project aims to develop an IT decision supporting tool to help food business operators in their risk assessment and future decision making when producing RTE foods with or without novel preservation technologies.

3-Methylpiperidinium ionic liquids

A wide range of room temperature ionic liquids based on the 3-methylpiperdinium cation core were produced from 3-methylpiperidine, which is a derivative of DYTEK® A amine. First, reaction with 1-bromoalkanes or 1-bromoalkoxyalkanes generated the corresponding tertiary amines (Rmβpip, R = alkyl or alkoxyalkyl); further quaternisation reactions with the appropriate methylating agents yielded the quaternary [Rmmβpip]X salts (X(-) = I(-), [CF3CO2](-) or [OTf](-); Tf = -SO2CF3), and [Rmmβpip][NTf2] were prepared by anion metathesis from the corresponding iodides. All [NTf2](-) salts are liquids at room temperature. [Rmmβpip]X (X(-) = I(-), [CF3CO2](-) or [OTf](-)) are low-melting solids when R = alkyl, but room temperature liquids upon introduction of ether functionalities on R. Neither of the 3-methylpiperdinium ionic liquids showed any signs of crystallisation, even well below 0 °C. Some related non-C-substituted piperidinium and pyrrolidinium analogues were prepared and studied for comparison. Crystal structures of 1-hexyl-1,3-dimethylpiperidinium tetraphenylborate, 1-butyl-3-methylpiperidinium bromide, 1-(2-methoxyethyl)-1-methylpiperidinium chloride and 1-(2-methoxyethyl)-1-methylpyrrolidinium bromide are reported. Extensive structural and physical data are collected and compared to literature data, with special emphasis on the systematic study of the cation ring size and/or asymmetry effects on density, viscosity and ionic conductivity, allowing general trends to be outlined. Cyclic voltammetry shows that 3-methylpiperidinium ionic liquids, similarly to azepanium, piperidinium or pyrrolidinium counterparts, are extremely electrochemically stable; the portfolio of useful alternatives for safe and high-performing electrolytes is thus greatly extended.

Phytoremediation assessment of Gomphrena globosa and Zinnia elegans grown in arsenic-contaminated hydroponic conditions as a safe and feasible alternative to be applied in arsenic-contaminated soils of the Bengal Delta

Several agricultural fields show high contents of arsenic because of irrigation with arsenic- contaminated groundwater. Vegetables accumulate arse- nic in their edible parts when grown in contaminated soils. Polluted vegetables are one of the main sources of arsenic in the food chain, especially for people living in rural arsenic endemic villages of India and Bangladesh. The aim of this study was to assess the feasibility of floriculture in the crop rotation system of arsenic en- demic areas of the Bengal Delta. The effects of different arsenic concentrations (0, 0.5, 1.0, and 2.0 mg As L−1) and types of flowering plant (Gomphrena globosa and Zinnia elegans) on plant growth and arsenic accumula- tion were studied under hydroponic conditions. Total arsenic was quantified using atomic absorption spec- trometer with hydride generation (HG-AAS). Arsenic was mainly accumulated in the roots (72 %), followed by leaves (12 %), stems (10 %), and flowers (<1 %). The flowering plants studied did not show as high phytoremediation capacities as other wild species, suchas ferns. However, they behaved as arsenic tolerant plants and grew and bloomed well, without showing any phytotoxic signs. This study proves that floriculture could be included within the crop rotation system in arsenic-contaminated agricultural soils, in order to im- prove food safety and also food security by increasing farmer’s revenue.

I/Q imbalance in AF dual-hop relaying: Performance analysis in Nakagami-m fading

We analyze the performance of amplify-and-forward dual-hop relaying systems in the presence of in-phase and quadrature-phase imbalance (IQI) at the relay node. In particular, an exact analytical expression for and tight lower bounds on the outage probability are derived over independent, non-identically distributed Nakagami-m fading channels. Moreover, tractable upper and lower bounds on the ergodic capacity are presented at arbitrary signal-to-noise ratios (SNRs). Some special cases of practical interest (e.g., Rayleigh and Nakagami-0.5 fading) are also studied. An asymptotic analysis is performed in the high SNR regime, where we observe that IQI results in a ceiling effect on the signal-to-interference-plus-noise ratio (SINR), which depends only on the level of I/Q impairments, i.e., the joint image rejection ratio. Finally, the optimal I/Q amplitude and phase mismatch parameters are provided for maximizing the SINR ceiling, thus improving the system performance. An interesting observation is that, under a fixed total phase mismatch constraint, it is optimal to have the same level of transmitter (TX) and receiver (RX) phase mismatch at the relay node, while the optimal values for the TX and RX amplitude mismatch should be inversely proportional to each other.

Visual outcomes of cataract surgery performed by supervised novice surgeons during training in rural China

To assess the outcomes of cataract surgery performed by novice surgeons during training in a rural programme. Design: Retrospective study. Participants: Three hundred thirty-four patients operated by two trainees under supervision at rural Chinese county hospitals. Methods: Two trainees performed surgeries under supervision. Visual acuity, refraction and examinations were carried out 3 months postoperatively. Main Outcome Measures: Postoperative uncorrected visual acuity, pinhole visual acuity, causes of visual impairment (postoperative uncorrected visual acuity<6/18) Results: Among 518 operated patients, 426 (82.2%) could be contacted and 334 (64.4% of operated patients) completed the examinations. The mean age was 74.1±8.8 years and 62.9% were women. Postoperative uncorrected visual acuity was available in 372 eyes. Among them, uncorrected visual acuity was ≥6/18 in 278 eyes (74.7%) and <6/60 in 60 eyes (16.1%), and 323 eyes (86.8%) had pinhole visual acuity≥6/18 and 38 eyes (10.2%) had pinhole visual acuity<6/60. Main causes of visual impairment were uncorrected refractive error (63.9%) and comorbid eye disease (24.5%). Comorbid eye diseases associated with pinhole visual acuity<6/60 (n=23, 6.2%) included glaucoma, other optic nerve atrophy, vitreous haemorrhage and retinal detachment. Conclusions: The findings suggest that hands-on training remains safe and effective even when not implemented in centralized training centres. Further refinement of the training protocol, providing postoperative refractive services and more accurate preoperative intraocular lens calculations, can help optimize outcomes. © 2012 The Authors Clinical and Experimental Ophthalmology © 2012 Royal Australian and New Zealand College of Ophthalmologists.