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The formation of the Earth remains an epoch with mysterious puzzles extending to our still incomplete understanding of the planet's potential origin and bulk composition. Direct confirmation of the Earth's internal heat engine was accomplished by the successful observation of geoneutrinos originating from uranium (U) and thorium (Th) progenies, manifestations of the planet's natural radioactivity dominated by potassium (40K) and the decay chains of uranium (238U) and thorium (232Th). This radiogenic energy output is critical to planetary dynamics and must be accurately measured for a complete understanding of the overall heat budget and thermal history of the Earth. Detecting geoneutrinos remains the only direct probe to do so and constitutes a challenging objective in modern neutrino physics. In particular, the intriguing potassium geoneutrinos have never been observed and thus far have been considered impractical to measure. We propose here a novel approach for potassium geoneutrino detection using the unique antimatter signature of antineutrinos to reduce the otherwise overwhelming backgrounds to observing this rarest signal. The proposed detection framework relies on the innovative LiquidO detection technique to enable positron (e+) identification and antineutrino interactions with ideal isotope targets identified here for the first time. We also provide the complete experimental methodology to yield the first potassium geoneutrino discovery.

Background The introduction of Emergency Medicine in Rwanda in 2015 has been associated with a mortality reduction in patients presenting to Kigali University Teaching Hospital (KUTH). In the context of increasing numbers of critically ill patients presenting to Emergency Departments (ED) globally, the aim of this study was to describe the characteristics of critically ill patients, the critical care interventions performed, and the outcomes of critically ill patients presenting to the KUTH ED with the goal of informing future research into the root causes of mortality of critically ill ED patients and of identifying high yield topics for didactic and procedural training. Methods A descriptive observational prospective cohort pilot study analyzed all patients ≥15 years who presented to KUTH between April and June 2022 with modified South African Triage Scores of Red with alarm, Red without alarm, and Orange. Results Of 320 patients, 66.9% were male and median age was 40 years. Patients were triaged as Orange (65.3%), Red without alarm (22.8%), and Red with alarm (11.9%). Presentations were categorized as: medical emergencies (48.0%), traumatic injury (44.5%), and surgical emergencies (7.6%). Median length of stay was 31 h (IQR 28, 56) and boarding was 23 h (IQR 8, 48). Overall mortality was 12.2% and highest among medical emergencies (16.5%, p  = 0.048) and increased significantly with triage color: Red with alarm (47.4%), Red without alarm (16.4%), and Orange (4.3%, p  < 0.0001). Cardiopulmonary resuscitation (CPR) (10.3%), endotracheal intubation (8.8%), and vasopressor administration (3.1%) were the most frequent critical interventions performed. Survival after cardiac arrest was 9.1% and 32.1% after intubation. Mortality was associated with the following interventions: CPR, intubation, and use of vasopressors ( p  < 0.05). Conclusions This pilot study identified the most common critical care interventions performed and a high mortality among patients who required these interventions in the ED of a tertiary teaching hospital in Rwanda. These findings will inform didactics and procedural training for emergency care providers. Future research should focus on the root causes of mortality in these specific patient populations and identify areas of system strengthening to reduce mortality.

IntroductionPseudomonas aeruginosa (PA) is a significant respiratory pathogen but is not well described in patients requiring long term ventilation (LTV). Whilst national guidance exists for the management of PA in the bronchiectasis population, standards for sputum surveillance and the use of nebulised antibiotics (NA) or long term macrolides (LTM) in the LTV population have not been established.Our aim was to record the rate of PA and describe its treatment, in a large cohort of LTV patients.MethodsRetrospective cohort study using the regional LTV service database to identify patients. Electronic patient records were analysed for LTV indication and treatment with NA and LTM, and cross-referenced with regional microbiology datasets: specifically, positive results for Pseudomonas, Serratia, Proteus and/or Burkholderia spp.ResultsWe identified 837 patients under the regional LTV service. 52/837 (6.2%) were ventilated via tracheostomy. 57/837 (6.8%) used a cough assist device alone and the remainder used non-invasive ventilation.Figure 1 shows prevalence of PA by diagnostic subgroup; the burden of PA in bronchiectasis and CF was high as expected, however there was also a high burden of disease in patients with spinal cord injuries and primary muscle disorders, such as Duchenne Muscular Dystrophy.Abstract P41 Figure 1Prevalence of pseudomonas aeruginosa by diagnostic subgroupOf the PA positive cohort, 45/146 (30.8%) were treated with NA: colistin (64.4%), an alternative NA (11.1%) or a combination (24.4%). 49.2% were taking long term macrolides: alone (56.2%) or combined with NA (43.7%).Commencement of NA was poorly documented, hindering assessment of PA suppression or effects on emerging pathogens. Proteus/Serratia/Burkholderia spp. were isolated in 5.1% of the LTV cohort, of which 38% were co-colonising patients with PA.ConclusionsPA is common and seen across a diverse number of LTV indications, including neuromuscular conditions not traditionally associated with high bacterial load. PA prevalence was higher in tracheostomy patients. Many patients are treated with NA but the recording of eradication rates and sputum surveillance is low. The rate of 3 sentinel emergent pathogens was low but this may reflect the low rate of sputum surveillance. This study highlights a need for further studies and development of guidance on pseudomonas in patients on LTV.

BackgroundTranscutaneous CO2(TCCO2) measurement is widely used in the diagnosis and monitoring of ventilatory failure. Robust data on the success rates in measurement is scant. TCCO2 measurement requires a multimodal setup. We aimed to discern the factors affecting success rate of TCCO2 measurement in patients either referred or already under the care of a regional LTV service. We also aimed to determine if successful recordings influence management.MethodsAll patients undergoing TCCO2 measurement between October 2019 and January 2022 were identified retrospectively. Notes were analysed for basic demographics, indications for TCCO2 measurement, measurement and device used (Radiometer TCM5 or Sentec), setup (ie.self, clinician or carer), inpatient or outpatient study, and how many attempts of TCCO2 measurement had occurred. Successful measurement was defined as adequate dataset for the clinical question not requiring repeat investigation. Statistical comparisons were made by Fisher’s exact test.ResultsWe identified 435 recording events on 288 patients, mean age of 53, and 56% were males. 189(65.6%) had a neuromuscular disorder (NMD). The commonest indications for TCCO2 measurement were in those naïve to ventilation; ‘assessment of diaphragmatic weakness or hypoventilation’ (43.2%) and a second group established on treatment ‘assessing adequacy of home ventilation therapy due to persistent symptoms’ (27.2%).Overall TCM5 devices had statistically higher successful recording rates (197/268,73.5%) than Sentec (100/165,60.6%)[p=0.0056]. Similarly in outpatient studies, TCM5’s success rate 187/253(73.9%) vs. Sentec’s 94/154(61.0%) was significant [p=0.0079]. Inpatient studies trended correspondingly but failed to reach significance likely due to sample size. When comparing setup the same pattern was seen (Non-clinician setup: TCM 171/218(78.1%), Sentec 80/139(57.6%)[p<0.001] but note clinician setup was not significant (sample size, n=25).Upon successful TCCO2 measurement, 110/297(37%) progressed to new ventilation setup or a change in ventilator settings; notably in patients with diagnosis of NMDs [p=0.0001]. 9/44 of the recording events with successful measurement that were done routinely to monitor those already on ventilation resulted in ventilator settings change.Abstract P124 Table 1Rate of successful TCCO2 measurement - Radiometer TCM5 versus Sentec (Overall, Inpatient vs Outpatient, Non-clinician setup vs Clinician setup) Overall, N=433 Successful measurement, N (%) Failed measurement, N (%) p = 0.0056 TCM5 197 (73.5%) 71 (26.5%) Sentec 100 (60.6%) 65 (39.4%) Inpatient Study, N=26 Successful measurement, N (%) Failed measurement, N (%) p = 0.6922 TCM5 9 (64.3%) 5 (35.7%) Sentec 6 (50%) 6 (50%) Outpatient Study, N=407 Successful measurement, N (%) Failed measurement, N (%) p = 0.0079 TCM5 187 (73.9%) 66 (26.1%) Sentec 94 (61.0%) 60 (39.0%) Non-clinician setup (self/carer setup), N=358 Successful measurement, N (%) Failed measurement, N (%) p < 0.0001 TCM5 171 (78.1%) 48 (21.9%) Sentec 80 (57.6%) 59 (42.4%) Clinician setup, N=25 Successful measurement, N (%) Failed measurement, N (%) p = 0.6729 TCM5 12 (75.0%) 4 (25.0%) Sentec 6 (66.7%) 3 (33.3%) ConclusionRadiometer TCM5 had statistically significant higher success rates in our TCCO2 recordings. The reasons for this are unclear. Successful measurement can be helpful in decision making and there is a high success rate of domiciliary recordings.

A method is defined for identifying late T and Y dwarfs in WISE down to low values of signal-to-noise. This requires a WISE detection only in the W2-band and uses the statistical properties of the WISE multi-frame measurements and profile fit photometry to reject contamination resulting from non-point-like objects, variables and moving sources. To trace our desired parameter space we use a control sample of isolated non-moving non-variable point sources from the SDSS, and identify a sample of 158 WISE W2-only candidates down to a signal-to-noise limit of 8. For signal-to-noise ranges >10 and 8-10 respectively, ~45% and ~90% of our sample fall outside the selection criteria published by the WISE team (Kirkpatrick et al. 2012), due mainly to the type of constraints placed on the number of individual W2 detections. We present follow-up of eight candidates and identify WISE 0013+0634 and WISE 0833+0052, T8 and T9 dwarfs with high proper motion (~1.3 and ~1.8 arcsec/yr). Both objects show a mid-infrared/near-infrared excess of ~1-1.5 magnitudes, and are K-band suppressed. Distance estimates lead to space motion constraints that suggest halo (or at least thick disk) kinematics. We then assess the reduced proper motion diagram of WISE ultracool dwarfs, which suggests that late T and Y dwarfs may have a higher thick-disk/halo population fraction than earlier objects.

Jul 1, 1997 Editor-As methicillin resistant Staphylococcus aureus (MRSA) seems to be no more virulent than methicillin sensitive S aureus (MSSA) E L Teare and S P Barrett suggest that these organisms should not be treated differently. 1 However, this raises the question of the role of screening for MSSA as well as MRSA, rather than supporting a policy of not screening for either. Since the 1950s the asymptomatic nasal carriage of S aureus has been known to lead to an increased incidence of wound infection with S aureus postoperatively. 2 This has recently been highlighted in a study of patients undergoing cardiothoracic surgery 3 ; other studies in patients undergoing dialysis and in those who are HIV positive have shown a clear link between colonisation with S aureus and bacteraemia. 4 In addition, several of these studies also show a significant reduction in the incidence of wound infection and bacteraemia after the eradication of nasal S aureus with mupirocin ointment. Unfortunately, mass screening often diverts the attention of infection control staff away from these fundamental aspects of infection control. Since current policies and guidelines are clearly failing to control MRSA, it is time to reassess the way in which the limited resources for infection control are used.