The United Kingdom National Audit Projects: a narrative review

The Royal College of Anaesthetists’ National Audit Project (NAP) programme has been running in its current form since 2006. Since NAP3 was commissioned the NAPs have examined rare but important complications of anaesthesia and related subspecialties. The topics covered include major complications of central neuraxial block (NAP3), major complications of airway management in hospitals (NAP4) and accidental awareness during general anaesthesia (NAP5). NAP6 is currently studying severe perioperative anaphylaxis. The NAPs have shed new light on the major complications of anaesthesia, providing both quantitative (frequencies, prevalence, incidence, risk factors) and qualitative (themes, patient stories, human factors) knowledge that has led to new learning, recommendations and changes in practice. This article describes the background, nature and processes of the NAPs.Keywords: Audit, Anaesthesia, Central neuraxial blockade, Airway, Awareness, Complication

Recognition of specific sialoglycan structures by oral streptococci impacts the severity of endocardial infection.

Streptococcus gordonii and Streptococcus sanguinis are primary colonizers of the tooth surface. Although generally non-pathogenic in the oral environment, they are a frequent cause of infective endocarditis. Both streptococcal species express a serine-rich repeat surface adhesin that mediates attachment to sialylated glycans on mucin-like glycoproteins, but the specific sialoglycan structures recognized can vary from strain to strain. Previous studies have shown that sialoglycan binding is clearly important for aortic valve infections caused by some S. gordonii, but this process did not contribute to the virulence of a strain of S. sanguinis. However, these streptococci can bind to different subsets of sialoglycan structures. Here we generated isogenic strains of S. gordonii that differ only in the type and range of sialoglycan structures to which they adhere and examined whether this rendered them more or less virulent in a rat model of endocarditis. The findings indicate that the recognition of specific sialoglycans can either enhance or diminish pathogenicity. Binding to sialyllactosamine reduces the initial colonization of mechanically-damaged aortic valves, whereas binding to the closely-related trisaccharide sialyl T-antigen promotes higher bacterial densities in valve tissue 72 hours later. A surprising finding was that the initial attachment of streptococci to aortic valves was inversely proportional to the affinity of each strain for platelets, suggesting that binding to platelets circulating in the blood may divert bacteria away from the endocardial surface. Importantly, we found that human and rat platelet GPIbα (the major receptor for S. gordonii and S. sanguinis on platelets) display similar O-glycan structures, comprised mainly of a di-sialylated core 2 hexasaccharide, although the rat GPIbα has a more heterogenous composition of modified sialic acids. The combined results suggest that streptococcal interaction with a minor O-glycan on GPIbα may be more important than the over-all affinity for GPIbα for pathogenic effects

Droplet dynamics on a wettability patterned surface during spray impact

Wettability patterning of a surface is a passive method to manipulate the flow and heat transport mechanism in many physical processes and industrial applications. This paper proposes a rational wettability pattern comprised of multiple superhydrophilic wedges on a superhydrophobic background, which can continuously remove the impacted spray droplets from the horizontal surface. We observed that the spray droplets falling on the superhydrophilic wedge region spread and form a thin liquid film, which is passively transported away from the surface. However, most of the droplets falling on the superhydrophobic region move towards the wedge without any flooding. The physics of the passive transport of the liquid film on a wedge is also delved into using numerical modelling. In particular, we elucidate the different modes of droplet transport in the superhydrophobic region and the interaction of multiple droplets. The observed droplet dynamics could have profound implications in spray cooling systems and passive removal of liquid from a horizontal surface. This study’s findings will be beneficial for the optimization of efficient wettability patterned surfaces for spray cooling application

A frotarsius chatrathi, first tarsiiform primate (? Tarsiidae) from Africa

Tarsiiform primates have long been regarded as a Laurasian group, with an extensive fossil record in the Eocene of North America and EuropeI and two important but less well-known records from Asia

Validation of a LiDAR-based player tracking system during football-specific tasks

Tracking players’ movements in sports is important to monitor and optimise exercise volume, avoid injuries, and enhance game performance. A new LiDAR-based system (Sportlight®) purports to provide accurate velocity and acceleration metrics derived from player movements. This study examined the validity of the LiDAR-based system against a 3D motion analysis system. Two competitive football players (age: 18 years, height: 1.74 ± 0.01 m, mass: 66.5 ± 7.8 kg; playing experience at this level: 3 years) completed nine trials each of six sport-specific movements, consisting of straight-line sprints, cuts, and curved runs. Trials were recorded concurrently by a four-unit LiDAR system and a 64-camera 3D motion analysis system. Instantaneous velocity and acceleration, and time spent within key performance indicator bands (defined by velocity and acceleration thresholds) were compared between systems. Agreement between the systems was evaluated by root mean square error. Differences in time spent within each key performance indicator band between systems were assessed with t tests and standardised effect sizes. Velocity root mean square error values ranged from 0.04 to 0.14 m·s−1 across all movements and acceleration root mean square error values ranged from 0.16 to 0.7 m·s−2. Differences between systems for time spent within each key performance indicator band were mostly trivial. These results show that the LiDAR-based system can provide valid measures of velocity and acceleration in football-specific tasks, thus providing accurate tracking of players and calculation of relevant key performance indicators