Intravenous fluids in hot pre-hospital environments: Thermal and physical stability of normal saline after exposure to simulated stress conditions

Background: Normal saline 0.9 % (NS) is the most widespread crystalloid used as a life-saving intravenous (IV) fluid. 1 NS contains sodium and chloride in equal concentrations and is subject to thermal stress conditions while stored and transported by clinicians in the pre-hospital environment. 2 This study aimed to investigate the effect of high-temperature exposure on NS bags used by the Hamad Medical Corporation Ambulance Service in Qatar. Methods: Five-hundred mL polyolefin NS soft bags (Qatar-Pharma, BN:1929013008) were divided into 4 groups of 24 each and stored at constant temperature (22, 50, or 70°C), or subjected to a temperature of 70°C for 8 hours followed by 22°C for 16 hours repeatedly over 28 days. Inspection and chromatographic analysis of the bags was performed at 0, 12, 24, 48, and 72 hours in the 72-hour study, and at 1, 2, 3, and 4 weeks in the 28-day study. Results: NS bags slightly bulged at 50°C and significantly bulged at 70°C or in the long experiment with temperature variation (Figure 1). During the exposure period, there was no discoloration, turbidity, or leaching of plastic components observed in the NS fluid. The pH readings were 5.59 ± 0.08 (22°C-Control sample), 5.73 ± 0.04 (50°C), 5.86 ± 0.02 (70°C), and 5.79 ± 0.03 following prolonged temperature variation. The sodium and chloride levels for the short-term study ranged from 100.2 ± 0.26% to 107.9 ± 0.75% and from 99.04 ± 0.76 to 102.11 ± 1.71%, and for the long-term study they ranged from 101.93 ± 0.90% to 111.27 ± 2.61 and from 99.05 ± 0.94% to 110.95 ± 1.63%; respectively (Figure 2) in comparison to manufacturer stated concentrations. Conclusion: There was no evidence to suggest that the NS fluid inside the PO bags is physically and chemically different when exposed up to 28 days to 50°C, 70°C, and prolonged temperature variations compared to 22°C. These simulated conditions are subject to further testing under real-life pre-hospital care emergency conditions in a hot country

A systematic review of stability of medicines used in emergency medical service settings

Background: Temperature, among several environment conditions like humidity, is known to impact medicine stability 1,2 . In emergency medical service (EMS) settings, it is often challenging to control these conditions. In the GCC region including Qatar, temperature and relative humidity values may rise over 50°C and 80%, respectively, according to climate data from the Qatar Civil Aviation Authority 3 . The aim of this systematic review is to collate and analyze data on the stability of EMS medicines exposed to temperature excursions beyond recommended limits (20-25°C with excursions up to 15-30°C) and provide evidence-based best practice recommendations on storage of medicines in EMS settings. Method: Literature on stability studies in EMS settings were obtained from PubMed, Embase, Web of Science and grey literature. Data from articles that met inclusion and exclusion criteria were collected using developed data collection forms then analyzed following PRISMA statement. The quality of articles were assessed using the Health Evidence Tool. Results: Thirteen studies were included (Table 1). Results were variable depending on the region and whether the study was done in an EMS setting or simulated in laboratory. Studies affirmed that medicines were exposed to temperatures beyond limits in EMS settings (Table 2). Medicines recommended to be refrigerated were not stable in a temperature-dependent manner. Although many medicines were stable, temperature-sensitive medicines degraded faster, while extreme cold produced various effects. No study has explored the biological effects of degradation and degradation products. Conclusion: EMS medicines are exposed to temperature extremes which may affect their stability and decrease their shelf-life. Therefore, routine stability testing during storage, replacement of exposed medicines and inclusion of temperature monitoring devices are paramount to validate the content of EMS medicines administered to end-users. We aim to collaborate with Hamad Medical Corporation Ambulance Service in Qatar to study the stability of EMS medicines in several settings including ambulances and paramedic bags of indoor and outdoor bike units.qscienc

Status of the BELLE II Pixel Detector

The Belle II experiment at the super KEK B-factory (SuperKEKB) in Tsukuba, Japan, has been collecting $e^+e^−$ collision data since March 2019. Operating at a record-breaking luminosity of up to $4.7×10^{34} cm^{−2}s^{−1}$, data corresponding to $424 fb^{−1}$ has since been recorded. The Belle II VerteX Detector (VXD) is central to the Belle II detector and its physics program and plays a crucial role in reconstructing precise primary and decay vertices. It consists of the outer 4-layer Silicon Vertex Detector (SVD) using double sided silicon strips and the inner two-layer PiXel Detector (PXD) based on the Depleted P-channel Field Effect Transistor (DePFET) technology. The PXD DePFET structure combines signal generation and amplification within pixels with a minimum pitch of $(50×55) μm^2$. A high gain and a high signal-to-noise ratio allow thinning the pixels to $75 μm$ while retaining a high pixel hit efficiency of about $99$. As a consequence, also the material budget of the full detector is kept low at $≈0.21$$\frac{X}{X_0}$ per layer in the acceptance region. This also includes contributions from the control, Analog-to-Digital Converter (ADC), and data processing Application Specific Integrated Circuits (ASICs) as well as from cooling and support structures. This article will present the experience gained from four years of operating PXD; the first full scale detector employing the DePFET technology in High Energy Physics. Overall, the PXD has met the expectations. Operating in the intense SuperKEKB environment poses many challenges that will also be discussed. The current PXD system remains incomplete with only 20 out of 40 modules having been installed. A full replacement has been constructed and is currently in its final testing stage before it will be installed into Belle II during the ongoing long shutdown that will last throughout 2023

Nombres de Carmichael réellement forts

A composite number $n$ is called a Carmichael number if $a^{n-1}\equiv 1\pmod{n}$ for any integer $a$ coprime with $n$. D. H. Lehmer considered the class of these numbers $n$ such that $a^{(n-1)/2}\equiv \left(\frac{a}{n}\right)\pmod{n}$ for any integer $a$ coprime with $n$. Here $\left(\frac{a}{n}\right)$ denotes the Jacobi symbol. It turns out and it is shown by Lehmer himself that this class is empty. Here, we replace $\equiv\left(\frac{a}{n}\right)\pmod n$ in Lehmer's congruence by $\equiv 1\pmod n$ and get a new class which is not empty

Thermal Stability of 0.9% Sodium Chloride IV Fluid exposed to Short- and Long-Term Extreme Conditions

Purpose: 0.9% sodium chloride IV fluid (normal saline) is critical in a clinical setting and may save lives. Data on thermal stability of normal saline, in out-of-hospital settings, are lacking. The purpose of this study was to evaluate the effect of temperature on normal saline stability. Method: Normal saline provided in flexible plastic containers (Qatar Pharma, BA:1929013008, n=96) were stored at constant temperature of 22, 50, or 70iC, and at cyclic temperature of 70iC for 8 hours and 22iC for 16 hours for a period up to 28 days. The containers were sampled at 0, 12, 24, 48 and 72 hours and at 1, 2, 3, and 4 weeks in the short- and long-term study, respectively. Fluid inside containers was evaluated for discoloration, turbidity, bulging, and pH. A 1 mL of normal saline was withdrawn from each container and stored at 4iC until analysis. A 20 mL was diluted in 12 mL distilled water to be injected into ion exchange chromatography instrument (Metrohm, 850 Professional IEC) for the measurement of sodium and chloride levels. Results: Discoloration or turbidity of normal saline fluid was not observed at any temperature or exposure period. The container slightly bulged at 50C and largely bulged at 70 C & cyclic. The pH was 5.59+-0.08 at 22C, 5.73+-0.04 at 50C, 5.86+-0.02 at 70C and 5.79+-0.03 at cyclic. Remaining sodium and chloride levels ranged from 100.2+-0.26% to 111.27+-4.22% and from 99.04+-0.76 to 110.95+-2.62%, respectively. Conclusion: Normal saline containers are stable up to 4 weeks under simulated constant and cyclic high temperatures. Storage in the cabinet of ambulance vehicles during hot summer season in an arid country like Qatar is to be assessed in real-life conditions

Setting up the Medposidonia Programme in the Mediterranean Region

The MedPosidonia programme, an initiative of the Regional Activity Centre for Specially Protected Areas (UNEP/MAP) supported by the Total corporate Foundation, aims at collecting information on the geographic distribution and evolution of Posidonia meadows (Posidonia oceanica) in four Mediterranean countries with a view to using these information to elaborate and/or adjust their conservation and sustainable use of biodiversity programmes. Within the framework of this programme, activities were performed at two locations in Algeria (Kouali Cove and El Kala coasts), three in Tunisia (Sidi Ali El Mekki coasts, Sousse/Monastir Bay and Kerkennah Island), two in Libya (Tripoli area and AM Al-Ghazala coasts) and two in Turkey (Gokceada Island and Mersin area). Several actions were carried out: (i) enhancement of national capacities by the means of training sessions, (ii) carrying out of general cartography works using side scan sonar (lower limit) and remote sensing, through satellite images, (upper limit) techniques, (iii) setting up of monitoring systems along the lower limit following a standardized protocol, (iv) general assessment of seagrass meadow location and vitality, and (v) assessment of the ecological status of the water body using Posidonia oceanica as a bio-indicator. All the data collected were included in a Geographic Information System that will be regularly updated