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The light absorbing ability of silver atoms, and the catalytic prowess of palladium were both combined in this research to conduct a sustainable Suzuki–Miyaura cross coupling reaction. Alloy nano-particle photo-catalysts were synthesised using different ratios of AgNO 3 and PdCl 2 , while ZrO 2 was used as the catalysts support platform. The synthesised alloys nano-particles were characterised for metal content with the aid of an EDS while the surface area of the nanoparticle was estimated using the BET method. The surface area of all the synthesised nano-particle were very close to that of the ZrO 2 support platform which was reported to be 11.10 M 2 g −1 . XRD and UV–VIS spectrometry analysis were also carried out on the synthesised alloy nanoparticle photo catalysts. The six synthesised alloy nanoparticle photo-catalyst with an average diameter of less than 8 nm and an even distribution of Ag and Pd in it crystal was then used individually to carry out the cross coupling of 3 iodotoluene and phenylboronic. acid, alloy 1 which has a 1:1 mol ratio of Ag and Pd metal gave a percentage conversion of 96% which was higher than that of other Alloys. Similarly, the TON and quantum yield when alloy 1 was used was higher than other alloys. The versatility of the synthesised alloy in this research was also tested by using the alloy to carry out the cross coupling of a broad range of substrate, and the percentage conversion, TON, and quantum yield in each case was impressive. The biaryl cross coupling product generated in each reaction were also characterised.

Clinical imaging based techniques such as phase contrast MRI (PCMRI), vector flow mapping, echo particle image velocimetry (echo PIV), have been utilized in order to study ventricular flow (Dyverfeldt et al., 2006; Kheradvar et al., 2010). The authors reported that the AR jet collides with the mitral inflow vortex resulting in increased viscous energy dissipation (VED), similar to previous observations (Okafor et al., 2017; Stugaard et al., 2015). Using an advanced and more realistic left ventricle simulator – similar to the one developed by the authors of this study – is an important aspect of simulating all the cardiac mechanics that is relevant to the disease state.

Background The development of clinically applicable fluid-structure interaction (FSI) models of the left heart is inherently challenging when using in vivo  cardiovascular magnetic resonance (CMR) data for validation, due to the lack of a well-controlled system where detailed measurements of the ventricular wall motion and flow field are available a priori . The purpose of this study was to (a) develop a clinically relevant, CMR-compatible left heart physical model; and (b) compare the left ventricular (LV) volume reconstructions and hemodynamic data obtained using CMR to laboratory-based experimental modalities. Methods The LV was constructed from optically clear flexible silicone rubber. The geometry was based off a healthy patient’s LV geometry during peak systole. The LV phantom was attached to a left heart simulator consisting of an aorta, atrium, and systemic resistance and compliance elements. Experiments were conducted for heart rate of 70 bpm. Wall motion measurements were obtained using high speed stereo-photogrammetry (SP) and cine-CMR, while flow field measurements were obtained using digital particle image velocimetry (DPIV) and phase-contrast magnetic resonance (PC-CMR). Results The model reproduced physiologically accurate hemodynamics (aortic pressure = 120/80 mmHg; cardiac output = 3.5 L/min). DPIV and PC-CMR results of the center plane flow within the ventricle matched, both qualitatively and quantitatively, with flow from the atrium into the LV having a velocity of about 1.15 m/s for both modalities. The normalized LV volume through the cardiac cycle computed from CMR data matched closely to that from SP. The mean difference between CMR and SP was 5.5 ± 3.7 %. Conclusions The model presented here can thus be used for the purposes of: (a) acquiring CMR data for validation of FSI simulations, (b) determining accuracy of cine-CMR reconstruction methods, and (c) conducting investigations of the effects of altering anatomical variables on LV function under normal and disease conditions.

Correspondence to Dr Ikechukwu Okafor, Emergency Department, Temple Street Children's University Hospital, Dublin, Ireland; Ikechukwu.Okafor@cuh.ie A 73%–88% reduction in paediatric emergency department (PED) presentations has been reported during the severe acute respiratory syndrome coronavirus 2 (SARS-2-CoV-2) pandemic.1 The magnitude of this decrease suggests that a combination of biological, psychological and social factors influence the decisions of families to attend PED. Based on the Irish Children’s Triage System, the acuity of presentations has remained similar in proportion to the attendances.2 Category 1 presentations remained stable at 0.7%–0.8%, and a slight increase in category 2 presentations was seen in 2020 (20.3%) compared with 18.4% and 17.9% in 2018 and 2019.Table 1 Emergency department attendances categorised and percentage reduction in 2020 compared with preceding 2 years4 March+April 2018 March+April 2019 March+April 2020 Percentage change in 2018 and 2019 Injury and poisoning 2651 2691 1488 −43.9%; −44.7% Respiratory illnesses 1742 1742 864 −50.4%; −50.4% Digestive disorders 915 1033 449 −50.9%; 56.5% Nervous system disorders 195 187 104 −46.6%; −44.4% Mental health+safeguarding 118 113 83 −29.7%; −26.5% Surgical 222 183 133 −40%; −27.3% Emergency/life-threatening 26 23 19 −26.9%; −17.4% Total attendances 8199 9133 4434 −45.9%; −51.45% Online supplementary table available. Pandemic-related delay of life-altering presentations is a major social and political concern currently; many paediatricians worry that more deaths will be seen in children from collateral damage from the COVID-19 response than from COVID-19.1 This review has not demonstrated significant delays in the most serious presentations (leukaemia and space occupying lesions), with most of the disappearing attendances related to mild conditions due to non-specific viral triggers or stresses in normal life.

Infection is the most frequent indication for non-scheduled admission to paediatric hospitals, leading to high levels of empiric antibiotic prescribing. Antibiotic prescribing in line with local guidelines, improves patient outcomes, reduces adverse drug events and helps to reduce the emergence of antimicrobial resistance. We undertook an improvement project at Temple Street Children’s University Hospital targeting documentation of indication and compliance with empiric antibiotic prescribing guidelines among medical admissions via the emergency department (ED). Results of weekly audits of empiric antibiotic prescribing were fed back to prescribers. Front-line ownership techniques were used to empower prescribers to generate ideas for change, such as regular discussion of antibiotic prescribing issues at weekly clinical meetings, antibiotic ‘spot quiz’, updates to prescribing guidelines, improved access and promotion of a prescribing app, laminated guideline summary cards, and reminders and guideline summaries at a point of prescribing in ED. Documentation of indication and guideline compliance increased from a median of 30% in December 2014 to 100% in March 2015, and was sustained at 100% to September 2016, then 90% to December 2017. The intervention was associated with improvements in non-targeted indicators of prescribing quality, an overall reduction in antimicrobial consumption in the hospital, and a €105 000 reduction in annual antimicrobial acquisition costs. We found that a simple, paper-based, data collection system was effective, provided opportunities for a point-of-care interaction with prescribers, and facilitated weekly data feedback. We also found that using a pre-existing weekly clinical meeting to foster prescriber ownership of the data, allowing prescribers to identify possible tests of change, and exploiting the competitive nature of doctors, led to a rapid and sustained improvement in prescribing quality. Awareness of local prescribing processes and culture are essential to delivering improvements in antimicrobial stewardship.

Drilling engineers and operators are stuck with challenges associated with loss circulation of drilling fluids in wellbores during drilling operation. At such times, a clear and careful decision is required in order to minimize cost or save resources that would have been lost in the bid to remedy the situation. This then informs the need to deploy reliable tools that will inform useful decisions as drawn from a thorough risk-analysis coined from the information gathered from the formation characteristics and operating pressure. In this study, a real-time statistic based approach was adopted in carrying out risk-evaluation of loss circulation events in a wellbore. Based on the expected opportunity loss analysis, it is often non-negotiable to consider other options when the analytical solution suggests that the well should be “abandoned”. For the decision tree, at the decision node, D1, the expected loss of the seal off zone option is $161.25, the expected loss of the drill ahead option is $19.2 and the expected loss of the abandon option is $13.2. Since the expected loss of the abandon option is less than the expected value of both the seal off and the drill ahead option, it is recommended to abandon the well. Furthermore, the risk analysis proved to be a veritable tool considering the cost implications of other options; and can also serve as basis for automated decision-making.

Valve-in-valve transcatheter aortic valve replacement (VIV-TAVR) has proven to be a successful treatment for high risk patients with failing aortic surgical bioprostheses. However, thrombus formation on the leaflets of the valve has emerged as a major issue in such procedures, posing a risk of restenosis, thromboembolism, and reduced durability. In this work we attempted to understand the effect of deployment position of the transcatheter heart valve (THV) on the spatio-temporal flow field within the sinus in VIV-TAVR. Experiments were performed in an in vitro pulsatile left heart simulator using high-speed Particle Image Velocimetry (PIV) to measure the flow field in the sinus region. The time-resolved velocity data was used to understand the qualitative and quantitative flow patterns. In addition, a particle tracking technique was used to evaluate relative thrombosis risk via sinus washout. The velocity data demonstrate that implantation position directly affects sinus flow patterns, leading to increased flow stagnation with increasing deployment height. The particle tracking simulations showed that implantation position directly affected washout time, with the highest implantation resulting in the least washout. These results clearly demonstrate the flow pattern and flow stagnation in the sinus is sensitive to THV position. It is, therefore, important for the interventional cardiologist and cardiac surgeon to consider how deployment position could impact flow stagnation during VIV-TAVR.

Aims/Objectives/BackgroundVP shunts are used to drain CSF from the cranial vault because of a wide range of pathologies and, like any piece of hardware, can fail. Traditionally investigations include SSR and CT. This project examines the role of SSR in evaluating children with suspected VP shunt failure.Primary outcome: Sensitivity and specificity of SSR in children presenting to the CED with concern for shunt failure.Methods/DesignConducted in a single centre, tertiary CED of the national Irish Neurosurgical(NS) referral centre (ED attendance:>50,000 patients/year). 100 sequential SSR requested by the CED were reviewed. Clinical information was extracted from electronic requests. Shunt failure was defined by the need for NS intervention(Revision).Abstract 332 Figure 1Abstract 332 Figure 2Results/ConclusionsSensitivity and specificity is presented in figure 1 (two by two table).100 radiographs performed in 84 children.22% shunts revised (see flow diagram).7 SSR’s were abnormal.85% (n=6) shunts revised. [5 following abnormal CT].Of the normal SSR’s; 16 had abnormal CT and revised.85/100 received CT.64 of 85 CT’s (75%) were normal.□6 of the 64 had focal shunt concern. SSR’s shouldn’t be used in isolation. NPV&PPV, Sensitivity&Specificity is low.SSR’s are beneficial where there’s concern over focal shunt problems (injury/pain/swelling) or following abnormal CT.VP shunt failure is not well investigated with SSR alone.SSR’s could be omitted where there is no focal shunt concern/after normal CT (without impacting clinical outcome) reducing radiation exposure and reduce impact on CED’s.59 SSR’s could have been avoided without adverse clinical outcome.

We have developed and tested a dynamic, context-specific paediatric resuscitation course with tiered level of complexity with targeting different levels of healthcare workers in limited resource healthcare settings. The PAIRS course is now established in Dar Es Salaam, Tanzania with a plan for spread to Uganda and Nigeria in 2019.In 2012, under a joint initiative between the Paediatric Oncology Unit at Muhimbili National Hospital and the Tanzanian children’s cancer charity, Their Lives Matter (TLM), a team of Irish paediatric resuscitation specialists was invited to train the oncology staff. This early enterprise has matured into provision of an annual training programme by a dedicated paediatric faculty, with course content specifically designed for use in a limited resource setting and expanded to involve clinical staff from any specialty, with interest from all paediatric settings and from adult, maternity and neonatal specialties.Children on the paediatric oncology ward were experiencing poor clinical outcomes after common oncological emergencies and inter-current illnesses. Deterioration was sometimes slow to detect with 100% mortality rates for any child requiring CPR. Multifactorial issues were identified including:Poor team approach to resuscitationLow knowledge of basic and advanced life supportNon–availability of emergency equipmentNo access to paediatric intensive care supportAdditional hurdles related to culture, communication and infrastructureEstablished internationally recognised resuscitation courses were trialled over the years, but none was deemed appropriate for the setting.The one-day Paediatric Assessment of Illness, Recognition and Resuscitation (PAIRS) course was designed to build foundational skills and knowledge of any nurse or doctor working with children in a limited resource setting. A further one-day PAIRS + module was developed for paediatric doctors and senior nurses.The three-pronged implementation strategy consists ofa massive rollout of the course, targeting the entire paediatric community of the hospital, championed by local nursing and medical managementlocal endorsement and accreditationestablishment of local faculty and national accreditation of the course with the aim of handing over to the local faculty after 5 years of sustained annual training.A variety of engagement strategies are necessary to influence behaviour and drive change. In order to achieve active buy-in for sustainability, it is essential to engage with local stakeholders, foster cooperative relationships and adapt, adopt or generate training programmes that reflect the real-life needs of the clinical team and setting are critical success factors that influence sustainability, scale and spread.