The extensive hydrocarbon-mediated fixation of hydrothermal gold in the Witwatersrand Basin, South Africa

Abstract There is a close spatial relation between high-grade gold mineralization in the Witwatersrand basin and carbonaceous nodules, veins and seams. Hydrocarbons thus may well have been essential in ore genesis. We have sampled four major gold-, uranium- and hydrocarbon-bearing ore horizons, namely the Carbon Leader, Vaal, B and Black reefs, to determine the role of hydrocarbons in the accumulation and hydrothermal fixation of gold. Our multipronged approach included high-resolution scanning and transmission electron microscopy (SEM, TEM), nanotomography with video clips, and geochemical modeling. Post-depositional hydrothermal activity at the peak of regional metamorphism produced an assemblage of quartz, phyllosilicates, brannerite, crandallite, florencite, monazite and gold in all four reefs. The gold, hydrocarbons and associated mineral assemblages are closely related on the micro to nano scale. Gold deposition occurred in interstices, as fracture fillings in detrital minerals, and on the surface of migrated solid hydrocarbon residues. The spherical to elliptical inclusions in the gold consist of an outer pyrobitumen phase and a central void space, partially associated with nanometric gold, uraninite, coffinite and silica. The hydrocarbon-bearing inclusion likely formed by the entrapment of a fossil liquid oil precursor during gold precipitation. The oil was subsequently thermally altered and converted into the final pyrobitumen and gaseous residues. Geochemical calculations to simulate the interaction of an invading hot hydrothermal fluid with the hydrocarbons in the reefs reveal that a very small amount of hydrocarbons will drastically decrease the aqueous solubility of gold and hence cause its instant precipitation. We extend our genetic model for the epigenetic formation of gold in the Witwatersrand. Regional metamorphism promoted the extensive and likely basin-wide circulation of hydrothermal fluids; these were capable of mobilizing substantial amounts of gold. The liquid, gaseous and solid hydrocarbons in the reefs acted as efficient chemical traps for the concentration of gold. Being strong chemical reductants, they caused the rapid precipitation and accumulation of gold on the surface of the fossil oil droplets and already solidified hydrocarbons. The release of the gases from accessible hydrocarbons into the sediments away from their source buffered the redox state of the hydrothermal solutions even at a considerable distance from the pyrobitumen seams and veins, likely resulting in the deposition of gold in the absence of visible hydrocarbons. Although our findings do not explain the ultimate origin and exceptional endowment of gold in the Witwatersrand, we do provide intriguing evidence for the large-scale hydrothermal mobilization, accumulation and fixation of gold mediated by hydrocarbons during post-depositional metamorphism

Merger of two dispatch centres: does it improve quality and patient safety?

Dispatch centres (DCs) are considered an essential but expensive component of many highly developed healthcare systems. The number of DCs in a country, region, or state is usually based on local history and often related to highly decentralised healthcare systems. Today, current technology (Global Positioning System or Internet access) abolishes the need for closeness between DCs and the population. Switzerland went from 22 DCs in 2006 to 17 today. This study describes from a quality and patient safety point of view the merger of two DCs. The study analysed the performance (over and under-triage) of two medical DCs for 12 months prior to merging and for 12 months again after the merger in 2015. Performance was measured comparing the priority level chosen by dispatcher and the severity of cases assessed by paramedics on site using the National Advisory Committee for Aeronautics (NACA) score. We ruled that NACA score > 3 (injuries/diseases which can possibly lead to deterioration of vital signs) to 7 (lethal injuries/diseases) should require a priority dispatch with lights and siren (L&S). While NACA score < 4 should require a priority dispatch without L&S. Over-triage was defined as the proportion of L&S dispatches with a NACA score < 4, and under-triage as the proportion of dispatches without L&S with a NACA > 3. Prior to merging, Dispatch A had a sensitivity/specificity regarding the use of lights and sirens and severity of cases of 86%/48% with over- and under-triage rates of 78% and 5%, respectively. Dispatch B had sensitivity and specificity of 92%/20% and over- and under-triage rates of 84% and 7%, respectively. After they merged, global sensitivity/specificity reached 87%/67%, and over- and under-triage rates were 71% and 3%, respectively CONCLUSIONS: A part the potential cost advantage achieved by the merger of two DCs, it can improve the quality of services to the population, reducing over- and under-triage and the use of lights and sirens and therefore, the risk of accidents. This is especially the case when a DC with poor triage performance merges with a high-performing DC

Emergency front-of-neck access in infants: A pragmatic crossover randomized control trial comparing two approaches on a simulated rabbit model.

BACKGROUND Rapid-sequence tracheotomy and scalpel-bougie tracheotomy are two published approaches for establishing emergency front-of-neck access in infants. It is unknown whether there is a difference in performance times and success rates between the two approaches. AIMS The aim of this cross-over randomized control trial study was to investigate whether the two approaches were equivalent for establishing tracheal access in rabbit cadavers. The underlying hypothesis was that the time to achieve the tracheal access is the same with both techniques. METHODS Between May and September 2022, thirty physicians (pediatric anesthesiologists and intensivists) were randomized to perform front-of-neck access using one and then the other technique: rapid-sequence tracheotomy and scalpel-bougie tracheotomy. After watching training videos, each technique was practiced four times followed by a final tracheotomy during which study measurements were obtained. Based on existing data, an equivalence margin was set at ∆ = ±10 s for the duration of the procedure. The primary outcome was defined as the duration until tracheal tube placement was achieved successfully. Secondary outcomes included success rate, structural injuries, and subjective participant self-evaluation. RESULTS The median duration of the scalpel-bougie tracheotomy was 48 s (95% CI: 37-57), while the duration of the rapid-sequence tracheotomy was 59 s (95% CI: 49-66, p = .07). The difference in the median duration between the two approaches was 11 s (95% CI: -4.9 to 29). The overall success rate was 93.3% (95% CI: 83.8%-98.2%). The scalpel-bougie tracheotomy resulted in significantly fewer damaged tracheal rings and was preferred among participants. CONCLUSIONS The scalpel-bougie tracheotomy was slightly faster than the rapid-sequence tracheotomy and favored by participants, with fewer tracheal injuries. Therefore, we propose the scalpel-bougie tracheostomy as a rescue approach favoring the similarity to the adult approach for small children. The use of a comparable equipment kit for both children and adults facilitates standardization, performance, and logistics. TRIAL REGISTRATION ClinicalTrials.gov identifier: NCT05499273

Kinematics of Metal-Poor Stars in the Galaxy. II. Proper Motions for a Large Non-Kinematically Selected Sample

We present a revised catalog of 2106 Galactic stars, selected without kinematic bias, and with available radial velocities, distance estimates, and metal abundances in the range 0.0 <= [Fe/H] <= -4.0. This update of the Beers and Sommer-Larsen (1995) catalog includes newly-derived homogeneous photometric distance estimates, revised radial velocities for a number of stars with recently obtained high-resolution spectra, and refined metallicities for stars originally identified in the HK objective-prism survey (which account for nearly half of the catalog) based on a recent re-calibration. A subset of 1258 stars in this catalog have available proper motions, based on measurements obtained with the Hipparcos astrometry satellite, or taken from the updated Astrographic Catalogue (AC 2000; second epoch positions from either the Hubble Space Telescope Guide Star Catalog or the Tycho Catalogue), the Yale/San Juan Southern Proper Motion (SPM) Catalog 2.0, and the Lick Northern Proper Motion (NPM1) Catalog. Our present catalog includes 388 RR Lyrae variables (182 of which are newly added), 38 variables of other types, and 1680 non-variables, with distances in the range 0.1 to 40 kpc.Comment: 31 pages, including 8 figures, to appear in AJ (June 2000), full paper with all figures embedded available at http://pluto.mtk.nao.ac.jp/people/chiba/preprint/halo4

Results of minimally toxic nonmyeloablative transplantation in patients with sickle cell anemia and β-thalassemia

AbstractWe describe previously transfused patients with sickle cell disease (n = 6) and thalassemia (n = 1) who received nonmyeloablative hematopoietic stem cell transplantation (HCT) to induce stable (full or partial) donor engraftment. Patients were 3 to 20 years (median, 9 years) old. All 7 received pretransplantation fludarabine and 200 cGy of total body irradiation; 2 patients also received horse antithymocyte globulin. Patients received bone marrow (n = 6) or peripheral blood stem cells (n = 1) from HLA-identical siblings, followed by a combination of mycophenolate mofetil and cyclosporine or tacrolimus for postgrafting immunosuppression. After nonmyeloablative HCT, absolute neutrophil counts were <0.5 × 109/L and <0.2 × 109/L for a median of 5 days (range, 0–13 days) and 0 days (range 0–13 days), respectively. A median of 0 (range, 0–9) platelet transfusions were administered. No grade IV nonhematologic toxicities were observed. One patient experienced grade II acute graft-versus-host disease. Two months after transplantation, 6 of 7 patients had evidence of donor chimerism (range, 25%–85%). Independent of red blood cell transfusions, these 6 patients initially had increased total hemoglobin and hemoglobin A concentrations and a reduction of reticulocytosis and transfusion requirements. There were no complications attributable to sickle cell disease during the interval of transient mixed chimerism. However, after posttransplantation immunosuppression was tapered, there was loss of the donor graft, and all patients experienced autologous hematopoietic recovery and disease recurrence. One patient did not engraft. The duration of transient mixed chimerism ranged from 97 to 441 days after transplantation in patients 4 and 6, respectively, and persisted until immunosuppressive drugs were discontinued after transplantation. In summary, the nonmyeloablative HCT regimens described here produced minimal toxicity and resulted in transient donor engraftment in 6 of 7 patients with hemoglobinopathies. Although complications from the underlying hemoglobinopathies did not occur during the period of mixed chimerism, these results suggest that stable (full or partial) donor engraftment after nonmyeloablative HCT is more difficult to achieve among immunocompetent pediatric patients with hemoglobinopathies than among adults with hematologic malignancies, perhaps in part because recipients may have been sensitized to minor histocompatibility antigens of their donor by preceding blood transfusions

Mutations in the gdpP gene are a clinically relevant mechanism for β-lactam resistance in meticillin-resistant Staphylococcus aureus lacking mec determinants

In Staphylococcus aureus, resistance to β-lactamase stable β-lactam antibiotics is mediated by the penicillinbinding protein 2a, encoded by mecA or by its homologues mecB or mecC. However, a substantial number of meticillin-resistant isolates lack known mec genes and, thus, are called meticillin resistant lacking mec (MRLM). This study aims to identify the genetic mechanisms underlying the MRLM phenotype. A total of 141 MRLM isolates and 142 meticillin-susceptible controls were included in this study. Oxacillin and cefoxitin minimum inhibitory concentrations were determined by broth microdilution and the presence of mec genes was excluded by PCR. Comparative genomics and a genome-wide association study (GWAS) approach were applied to identify genetic polymorphisms associated with the MRLM phenotype. The potential impact of such mutations on the expression of PBP4, as well as on cell morphology and biofilm formation, was investigated. GWAS revealed that mutations in gdpP were significantly associated with the MRLM phenotype. GdpP is a phosphodiesterase enzyme involved in the degradation of the second messenger cyclic-di-AMP in S. aureus. A total of 131 MRLM isolates carried truncations, insertions or deletions as well as amino acid substitutions, mainly located in the functional DHH-domain of GdpP. We experimentally verified the contribution of these gdpP mutations to the MRLM phenotype by heterologous complementation experiments. The mutations in gdpP had no effect on transcription levels of pbp4; however, cell sizes of MRLM strains were reduced. The impact on biofilm formation was highly strain dependent. We report mutations in gdpP as a clinically relevant mechanism for β-lactam resistance in MRLM isolates. This observation is of particular clinical relevance, since MRLM are easily misclassified as MSSA (meticillin-susceptible S. aureus), which may lead to unnoticed spread of β-lactam-resistant isolates and subsequent treatment failure.Peer Reviewe