Introducing ECMO/ECLS in sub-Saharan Africa – prospects and perspectives

Background: The introduction of modern medical technologies reduced mortality in adults and increased survival in infants less than five years old. Cardiac and respiratory failure can be managed through mechanical circulatory support devices such as ECMO/ECLS (Extracorporeal Membrane Oxygenation/ Extracorporeal Life Support).Main Findings: We evaluate the importance and potential impact of using ECMO/ECLS in improving health care in sub-Saharan Africa. The intention of this recommendation is to introduce this concept as a feasible rescue method for clinicians in the region. The potential use of ECMO/ECLS will be discussed with focus on infrastructure for the retrieval services from the referring hospitals to designated ECMO centres.Conclusion: ECLS resources and time that should be committed to training of staff and on-going education should not be underestimated. ECLS should only be commenced, maintained and weaned in the hands of trained, experienced and knowledgeable medical personnel cognisant that the results will be benchmarked by ELSO (Extracorporeal Life Support Organization) and available for consumption in the public domain. Partnership models are key to the ECLS success with well-defined roles and responsibilities for each party. The possible way for ECMO/ECLS in Africa should be combining with a two-pronged education programme: Improving critical care services in themselves, and once they get to an acceptable level in this department then is to manage ECLS patients for a few hours. To upgrade critical care services, this is vital for Africa, and only then to introduce ECMO/ECLS

The European Federation of Organisations for Medical Physics Policy Statement No. 10.1: Recommended Guidelines on National Schemes for Continuing Professional Development of Medical Physicists

Continuing Professional Development (CPD) is vital to the medical physics profession if it is to embrace the pace of change occurring in medical practice. As CPD is the planned acquisition of knowledge, experience and skills required for professional practice throughout one's working life it promotes excellence and protects the profession and public against incompetence. Furthermore, CPD is a recommended prerequisite of registration schemes (Caruana et al. 2014 [1]; [2]) and is implied in the Council Directive 2013/59/EURATOM (EU BSS) [3] and the International Basic Safety Standards (BSS) [4]. It is to be noted that currently not all national registration schemes require CPD to maintain the registration status necessary to practise medical physics. Such schemes should consider adopting CPD as a prerequisite for renewing registration after a set period of time. This EFOMP Policy Statement, which is an amalgamation and an update of the EFOMP Policy Statements No. 8 and No. 10, presents guidelines for the establishment of national schemes for CPD and activities that should be considered for CPD

LDRD final report on adaptive-responsive nanostructures for sensing applications.

Functional organic nanostructures such as well-formed tubes or fibers that can easily be fabricated into electronic and photonic devices are needed in many applications. Especially desirable from a national security standpoint are nanostructures that have enhanced sensitivity for the detection of chemicals and biological (CB) agents and other environmental stimuli. We recently discovered the first class of highly responsive and adaptive porphyrin-based nanostructures that may satisfy these requirements. These novel porphyrin nanostructures, which are formed by ionic self-assembly of two oppositely charged porphyrins, may function as conductors, semiconductors, or photoconductors, and they have additional properties that make them suitable for device fabrication (e.g., as ultrasensitive colorimetric CB microsensors). Preliminary studies with porphyrin nanotubes have shown that these nanostructures have novel optical and electronic properties, including strong resonant light scattering, quenched fluorescence, and electrical conductivity. In addition, they are photochemically active and capable of light-harvesting and photosynthesis; they may also have nonlinear optical properties. Remarkably, the nanotubes and potentially other porphyrin nanostructure are mechanically responsive and adaptive (e.g., the rigidity of the micrometers-long nanotubes is altered by light, ultrasound, or chemicals) and they self-heal upon removal the environmental stimulus. Given the tremendous degree of structural variation possible in the porphyrin subunits, additional types of nanostructures and greater control over their morphology can be anticipated. Molecular modification also provides a means of controlling their electronic, photonic, and other functional properties. In this work, we have greatly broadened the range of ionic porphyrin nanostructures that can be made, and determined the optical and responsivity properties of the nanotubes and other porphyrin nanostructures. We have also explored means for controlling their morphology, size, and placement on surfaces. The research proposed will lay the groundwork for the use of these remarkable porphyrin nanostructures in micro- and nanoscale devices, by providing a more detailed understanding of their molecular structure and the factors that control their structural, photophysical, and chemical properties

Integral equations for simple fluids in a general reference functional approach

The integral equations for the correlation functions of an inhomogeneous fluid mixture are derived using a functional Taylor expansion of the free energy around an inhomogeneous equilibrium distribution. The system of equations is closed by the introduction of a reference functional for the correlations beyond second order in the density difference from the equilibrium distribution. Explicit expressions are obtained for energies required to insert particles of the fluid mixture into the inhomogeneous system. The approach is illustrated by the determination of the equation of state of a simple, truncated Lennard--Jones fluid and the analysis of the behavior of this fluid near a hard wall. The wall--fluid integral equation exhibits complete drying and the corresponding coexisting densities are in good agreement with those obtained from the standard (Maxwell) construction applied to the bulk fluid. Self--consistency of the approach is examined by analyzing the virial/compressibility routes to the equation of state and the Gibbs--Duhem relation for the bulk fluid, and the contact density sum rule and the Gibbs adsorption equation for the hard wall problem. For the bulk fluid, we find good self--consistency for stable states outside the critical region. For the hard wall problem, the Gibbs adsorption equation is fulfilled very well near phase coexistence where the adsorption is large.For the contact density sum rule, we find some deviationsnear coexistence due to a slight disagreement between the coexisting density for the gas phase obtained from the Maxwell construction and from complete drying at the hard wall.Comment: 29 page

Preparation of microporous films with sub nanometer pores and their characterization using stress and FTIR measurements

The authors have used a novel technique, measurement of stress isotherms in microporous thin films, as a means of characterizing porosity. The stress measurement was carried out by applying sol-gel thin films on a thin silicon substrate and monitoring the curvature of the substrate under a controlled atmosphere of various vapors. The magnitude of macroscopic bending stress developed in microporous films depends on the relative pressure and molar volume of the adsorbate and reaches a value of 180 MPa for a relative vapor pressure, P/Po = 0.001, of methanol. By using a series of molecules, and observing both the magnitude and the kinetics of stress development while changing the relative pressure, they have determined the pore size of microporous thin films. FTIR measurements were used to acquire adsorption isotherms and to compare pore emptying to stress development, about 80% of the change in stress takes place with no measurable change in the amount adsorbed. The authors show that for sol-gel films, pore diameters can be controlled in the range of 5--8 {angstrom} by ``solvent templating``

Capillary stress in microporous thin films

Development of capillary stress in porous xerogels, although ubiquitous, has not been systematically studied. The authors have used the beam bending technique to measure stress isotherms of microporous thin films prepared by a sol-gel route. The thin films were prepared on deformable silicon substrates which were then placed in a vacuum system. The automated measurement was carried out by monitoring the deflection of a laser reflected off the substrate while changing the overlying relative pressure of various solvents. The magnitude of the macroscopic bending stress was found to reach a value of 180 MPa at a relative pressure of methanol, P/Po = 0.001. The observed stress is determined by the pore size distribution and is an order of magnitude smaller in mesoporous thin films. Density Functional Theory (DFT) indicates that for the microporous materials, the stress at saturation is compressive and drops as the relative pressure is reduced

Generalized Interpolation Material Point Approach to High Melting Explosive with Cavities Under Shock

Criterion for contacting is critically important for the Generalized Interpolation Material Point(GIMP) method. We present an improved criterion by adding a switching function. With the method dynamical response of high melting explosive(HMX) with cavities under shock is investigated. The physical model used in the present work is an elastic-to-plastic and thermal-dynamical model with Mie-Gr\"uneissen equation of state. We mainly concern the influence of various parameters, including the impacting velocity $v$, cavity size $R$, etc, to the dynamical and thermodynamical behaviors of the material. For the colliding of two bodies with a cavity in each, a secondary impacting is observed. Correspondingly, the separation distance $D$ of the two bodies has a maximum value $D_{\max}$ in between the initial and second impacts. When the initial impacting velocity $v$ is not large enough, the cavity collapses in a nearly symmetric fashion, the maximum separation distance $D_{\max}$ increases with $v$. When the initial shock wave is strong enough to collapse the cavity asymmetrically along the shock direction, the variation of $D_{\max}$ with $v$ does not show monotonic behavior. Our numerical results show clear indication that the existence of cavities in explosive helps the creation of ``hot spots''.Comment: Figs.2,4,7,11 in JPG format; Accepted for publication in J. Phys. D: Applied Physic

LDRD final report on nanovehicle light-driven propulsion.

Having demonstrated the possibility of constructing nanoscale metallic vehicular bodies as described in last year's proposal, our goals have been to make uniform preparations of the metallized lipid assemblies and to determine the feasibility of powering these nanostructures with biological motors that are activated and driven by visible light. We desired that the propulsion system be constructed entirely by self-assembly and powered by a photocatalytic process partially already built into the nanovehicle. The nanovehicle we desire to build is composed of both natural biological components (ATPase, kinesin-microtubules) and biomimetic components (platinized liposomes, photosynthetic membrane) as functional units. The vehicle's body was originally envisioned to be composed of a surfactant liposomal bilayer coated with platinum nanoparticles, but instead of the expected nanoparticles we were able to grow dendritic 2-nm thick platinum sheets on the liposomes. Now, we have shown that it is possible to completely enclose the liposomes with sheeting to form porous platinum spheres, which show good structural stability as evidenced by their ability to survive the stresses of electron-microscopy sample preparation. Our goals were to control the synthesis of the platinized liposomes well enough to make uniform preparations of the coated individual liposomes and to develop the propulsion system for these nanovehicles a hydrogen-evolving artificial photosynthetic system in the liposomal bilayer that generates the pH gradient across the membrane that is necessary to drive the synthesis of ATP by ATP-synthase incorporated in the membrane. ATP produced would fuel the molecular motor (kinesin) attached to the vehicle, needing only light, storable ADP, phosphate, and an electron donor to be produced by ATP-synthase in the membrane. These research goals appear to be attainable, but growing the uniform preparations of the liposomes coated with dendritic platinum sheeting, a necessary accomplishment that would simplify the task of incorporating and verifying the photosynthetic function of the nanovehicle membrane, has proved to be difficult. The detailed understanding of the relative locations of surfactant and Pt in the liposomal bodies has also forced a change in the nanovehicle design strategies. Nevertheless, we have found no insurmountable obstacles to making these nanovehicles given a larger and longer term research effort. These nanovehicles could potentially respond to chemical gradients, light intensity, and field gradients, in the same manner that magnetic bacteria navigate. The cargo might include decision-making and guidance components, drugs and other biological and chemical agents, explosives, catalytic reactors, and structural materials