A methylation clock model of mild SARS-CoV-2 infection provides insight into immune dysregulation.

DNA methylation comprises a cumulative record of lifetime exposures superimposed on genetically determined markers. Little is known about methylation dynamics in humans following an acute perturbation, such as infection. We characterized the temporal trajectory of blood epigenetic remodeling in 133 participants in a prospective study of young adults before, during, and after asymptomatic and mildly symptomatic SARS-CoV-2 infection. The differential methylation caused by asymptomatic or mildly symptomatic infections was indistinguishable. While differential gene expression largely returned to baseline levels after the virus became undetectable, some differentially methylated sites persisted for months of follow-up, with a pattern resembling autoimmune or inflammatory disease. We leveraged these responses to construct methylation-based machine learning models that distinguished samples from pre-, during-, and postinfection time periods, and quantitatively predicted the time since infection. The clinical trajectory in the young adults and in a diverse cohort with more severe outcomes was predicted by the similarity of methylation before or early after SARS-CoV-2 infection to the model-defined postinfection state. Unlike the phenomenon of trained immunity, the postacute SARS-CoV-2 epigenetic landscape we identify is antiprotective.

Priorities for HIV and chronic pain research: results from a survey of individuals with lived experience.

The Global Task Force on Chronic Pain in HIV published seven research priorities in the field of HIV-associated chronic pain in 2019: (1) causes; (2) management; (3) treatment individualization and integration with addiction treatment; (4) mental and social health factors; (5) prevalence; (6) treatment cost effectiveness; and (7) prevention. The current study used a web-based survey to determine whether the research topics were aligned with the priorities of adults with lived experiences of HIV and chronic pain. We also collected information about respondents' own pain and treatment experiences. We received 311 survey responses from mostly US-based respondents. Most respondents reported longstanding, moderate to severe, multisite pain, commonly accompanied by symptoms of anxiety and/or depression. The median number of pain treatments tried was 10 (IQR = 8, 13), with medications and exercise being the most common modalities, and opioids being viewed as the most helpful. Over 80% of respondents considered all research topics either "extremely important" or "very important". Research topic #2, which focused on optimizing management of pain in people with HIV, was accorded the greatest importance by respondents. These findings suggest good alignment between the priorities of researchers and US-based people with lived experience of HIV-associated chronic pain.

Two-Dimensional CuMn-Layered Double Hydroxides: A Study of Interlayer Anion Variants on the Electrochemical Sensing of Trichlorophenol.

Despite their diverse application profile, aromatic organochlorides such as 2,4,6-trichlorophenol (TP) are widely renowned for creating a negative toll on the balance of the ecosystem. Strict regulatory regimes are required to limit exposure to such organic pollutants. By deployment of a straightforward detection scheme, electrochemical sensing technology offers a competitive edge over the other techniques and practices available for pollutant monitoring. Here, we present a streamlined hydrothermal approach for synthesizing copper-manganese layered double hydroxide (CuMn-LDH) rods to be employed as electrocatalysts for detecting TP in various media. With a focused intention to leverage the full potential of the prepared CuMn-LDHs, the interlamellar region is configured using a series of intercalants. Further, a thorough comparative analysis of their structures, morphologies, and electrochemical performance is accomplished using various analytical techniques. The electrocatalytic oxidation ability of the CuMn-LDH toward TP molecules is markedly altered by incorporating various anions into the gallery region. The dynamic attributes of the developed sensor, such as a wide linear response (0.02-289.2 µM), a low detection limit (0.0026 µM), and good anti-interfering ability, acclaim its superior viability for real-time detection of TP with exceptional tolerance to the presence of foreign moieties. Hence, this work manifests that the nature of intercalants is a vital aspect to consider while designing LDH-based electrochemical probes to detect priority pollutants.

Sex-specific racial and ethnic variations in short-term outcomes among patients with first or recurrent ischemic stroke: Paul Coverdell National Acute Stroke Program, 2016-2020.

BACKGROUND AND PURPOSE: To understand the association of sex-specific race and ethnicity on the short-term outcomes of initial and recurrent ischemic stroke events. METHODS: Using the Paul Coverdell National Acute Stroke Program from 2016-2020, we examined 426,062 ischemic stroke admissions from 629 hospitals limited to non-Hispanic White (NHW), non-Hispanic Black (NHB), and Hispanic patients. We performed multivariate logistic regression analyses to assess the combined effects of sex-specific race and ethnicity on short-term outcomes for acute ischemic stroke patients presenting with initial or recurrent stroke events. Outcomes assessed include rates of in-hospital death, discharge to home, and symptomatic intracranial hemorrhage (sICH) after reperfusion treatment. RESULTS: Among studied patients, the likelihood of developing sICH after reperfusion treatment for initial ischemic stroke was not significantly different. The likelihood of experiencing in-hospital death among patients presenting with initial stroke was notably higher among NHW males (AOR 1.59 [95 % CI 1.46, 1.73]), NHW females (AOR 1.34 [95 % CI 1.23, 1.45]), and Hispanic males (AOR 1.57 [95 % CI 1.36, 1.81]) when compared to NHB females. Hispanic females were more likely to be discharged home when compared to NHB females after initial stroke event (AOR 1.32 [95 % CI 1.23, 1.41]). NHB males (AOR 0.90 [95 % CI 0.87, 0.94]) and NHW females (AOR 0.89 [95 % CI 0.86, 0.92]) were less likely to be discharged to home. All groups with recurrent ischemic strokes experienced higher likelihood of in-hospital death when compared to NHB females with the highest likelihood among NHW males (AOR 2.13 [95 % CI 1.87, 2.43]). Hispanic females had a higher likelihood of discharging home when compared to NHB females hospitalized for recurrent ischemic stroke, while NHB males and NHW females with recurrent ischemic stroke hospitalizations were less likely to discharge home. CONCLUSIONS: Sex-specific race and ethnic disparities remain for short-term outcomes in both initial and recurrent ischemic stroke hospitalizations. Further studies are needed to address disparities among recurrent ischemic stroke hospitalizations.

Unlocking Catalytic Potential: Exploring the Impact of Thermal Treatment on Enhanced Electrocatalysis of Nanomaterials.

In the evolving field of electrocatalysis, thermal treatment of nano-electrocatalysts has become an essential strategy for performance enhancement. This review systematically investigates the impact of various thermal treatments on the catalytic potential of nano-electrocatalysts. The focus encompasses an in-depth analysis of the changes induced in structural, morphological, and compositional properties, as well as alterations in electro-active surface area, surface chemistry, and crystal defects. By providing a comprehensive comparison of commonly used thermal techniques, such as annealing, calcination, sintering, pyrolysis, hydrothermal, and solvothermal methods, this review serves as a scientific guide for selecting the right thermal technique and favorable temperature to tailor the nano-electrocatalysts for optimal electrocatalysis. The resultant modifications in catalytic activity are explored across key electrochemical reactions such as electrochemical (bio)sensing, catalytic degradation, oxygen reduction reaction, hydrogen evolution reaction, overall water splitting, fuel cells, and carbon dioxide reduction reaction. Through a detailed examination of the underlying mechanisms and synergistic effects, this review contributes to a fundamental understanding of the role of thermal treatments in enhancing electrocatalytic properties. The insights provided offer a roadmap for future research aimed at optimizing the electrocatalytic performance of nanomaterials, fostering the development of next-generation sensors and energy conversion technologies.

SARS-CoV-2 Transmission among Marine Recruits during Quarantine.

BACKGROUND: The efficacy of public health measures to control the transmission of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has not been well studied in young adults. METHODS: We investigated SARS-CoV-2 infections among U.S. Marine Corps recruits who underwent a 2-week quarantine at home followed by a second supervised 2-week quarantine at a closed college campus that involved mask wearing, social distancing, and daily temperature and symptom monitoring. Study volunteers were tested for SARS-CoV-2 by means of quantitative polymerase-chain-reaction (qPCR) assay of nares swab specimens obtained between the time of arrival and the second day of supervised quarantine and on days 7 and 14. Recruits who did not volunteer for the study underwent qPCR testing only on day 14, at the end of the quarantine period. We performed phylogenetic analysis of viral genomes obtained from infected study volunteers to identify clusters and to assess the epidemiologic features of infections. RESULTS: A total of 1848 recruits volunteered to participate in the study; within 2 days after arrival on campus, 16 (0.9%) tested positive for SARS-CoV-2, 15 of whom were asymptomatic. An additional 35 participants (1.9%) tested positive on day 7 or on day 14. Five of the 51 participants (9.8%) who tested positive at any time had symptoms in the week before a positive qPCR test. Of the recruits who declined to participate in the study, 26 (1.7%) of the 1554 recruits with available qPCR results tested positive on day 14. No SARS-CoV-2 infections were identified through clinical qPCR testing performed as a result of daily symptom monitoring. Analysis of 36 SARS-CoV-2 genomes obtained from 32 participants revealed six transmission clusters among 18 participants. Epidemiologic analysis supported multiple local transmission events, including transmission between roommates and among recruits within the same platoon. CONCLUSIONS: Among Marine Corps recruits, approximately 2% who had previously had negative results for SARS-CoV-2 at the beginning of supervised quarantine, and less than 2% of recruits with unknown previous status, tested positive by day 14. Most recruits who tested positive were asymptomatic, and no infections were detected through daily symptom monitoring. Transmission clusters occurred within platoons. (Funded by the Defense Health Agency and others.).

Deep Eutectic Solvent-Assisted Synthesis of a Strontium Tungstate Bifunctional Catalyst: Investigation on the Electrocatalytic Determination and Photocatalytic Degradation of Acetaminophen and Metformin Drugs.

In this work, we propose a modified solid-state approach for the sustainable preparation of a SrWO4 bifunctional catalyst using thymol-menthol-based natural deep eutectic green solvents (NADESs). Various spectroscopic and morphological techniques analyzed the as-synthesized SrWO4 particles. Acetaminophen (ATP) and metformin (MTF) were selected as the model drug compounds. The electrochemical detection and photocatalytic degradation of ATP and MTF upon ultraviolet-visible (UV-vis) light irradiation in the presence of as-prepared SrWO4 particles as an active catalyst are examined. The present study displayed that the proposed catalyst SrWO4 has enhanced catalytic activity in achieving the optimum experimental conditions, and linear ranges of ATP = 0.01-25.90 µM and MTF = 0.01-25.90 µM, a lower limit of detection (LOD) value (ATP = 0.0031 µM and MTF = 0.008 µM), and higher sensitivity toward ATP and MTF determination were obtained. Similarly, the rate constant was found to be k = ATP = 0.0082 min-1 and MTF = 0.0296 min-1 according to the Langmuir-Hinshelwood model, benefitting from the excellent synergistic impact of the SrWO4 catalyst toward the photocatalytic degradation of the drug molecule. Hence, this work offers innovative insights into the applicability of the as-prepared SrWO4 bifunctional catalyst as an excellent functional material for the remediation of emerging pollutants in water bodies with a recovery range of 98.2-99.75%.

Acute Abdominal Pain in Adults: Evaluation and Diagnosis.

Acute abdominal pain, defined as nontraumatic abdominal pain lasting fewer than seven days, is a common presenting concern with a broad differential diagnosis. The most common causes are gastroenteritis and nonspecific abdominal pain, followed by cholelithiasis, urolithiasis, diverticulitis, and appendicitis. Extra-abdominal causes such as respiratory infections and abdominal wall pain should be considered. Pain location, history, and examination findings help guide the workup after ensuring hemodynamic stability. Recommended tests may include a complete blood count, C-reactive protein, hepatobiliary markers, electrolytes, creatinine, glucose, urinalysis, lipase, and pregnancy testing. Several diagnoses, such as cholecystitis, appendicitis, and mesenteric ischemia, cannot be confirmed clinically and typically require imaging. Conditions such as urolithiasis and diverticulitis may be diagnosed clinically in certain cases. Imaging studies are chosen based on the location of pain and index of suspicion for specific etiologies. Computed tomography with intravenous contrast media is often chosen for generalized abdominal pain, left upper quadrant pain, and lower abdominal pain. Ultrasonography is the study of choice for right upper quadrant pain. Point-of-care ultrasonography can aid in the prompt diagnosis of several etiologies of acute abdominal pain, including cholelithiasis, urolithiasis, and appendicitis. In patients who have female reproductive organs, diagnoses such as ectopic pregnancy, pelvic inflammatory disease, and adnexal torsion should be considered. If ultrasonography results are inconclusive in pregnant patients, magnetic resonance imaging is preferred over computed tomography when available.

SARS-CoV-2 Outbreak Dynamics in an Isolated US Military Recruit Training Center With Rigorous Prevention Measures.

BACKGROUND: Marine recruits training at Parris Island experienced an unexpectedly high rate of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection, despite preventive measures including a supervised, 2-week, pre-entry quarantine. We characterize SARS-CoV-2 transmission in this cohort. METHODS: Between May and November 2020, we monitored 2,469 unvaccinated, mostly male, Marine recruits prospectively during basic training. If participants tested negative for SARS-CoV-2 by quantitative polymerase chain reaction (qPCR) at the end of quarantine, they were transferred to the training site in segregated companies and underwent biweekly testing for 6 weeks. We assessed the effects of coronavirus disease 2019 (COVID-19) prevention measures on other respiratory infections with passive surveillance data, performed phylogenetic analysis, and modeled transmission dynamics and testing regimens. RESULTS: Preventive measures were associated with drastically lower rates of other respiratory illnesses. However, among the trainees, 1,107 (44.8%) tested SARS-CoV-2-positive, with either mild or no symptoms. Phylogenetic analysis of viral genomes from 580 participants revealed that all cases but one were linked to five independent introductions, each characterized by accumulation of mutations across and within companies, and similar viral isolates in individuals from the same company. Variation in company transmission rates (mean reproduction number R 0 ; 5.5 [95% confidence interval [CI], 5.0, 6.1]) could be accounted for by multiple initial cases within a company and superspreader events. Simulations indicate that frequent rapid-report testing with case isolation may minimize outbreaks. CONCLUSIONS: Transmission of wild-type SARS-CoV-2 among Marine recruits was approximately twice that seen in the community. Insights from SARS-CoV-2 outbreak dynamics and mutations spread in a remote, congregate setting may inform effective mitigation strategies.

Contemporary Trends in the Treatment of Mild Ischemic Stroke with Intravenous Thrombolysis: Paul Coverdell National Acute Stroke Program.

BACKGROUND: Presentation with mild symptoms is a common reason for intravenous thrombolysis (IVT) nonuse among acute ischemic stroke (AIS) patients. We examined the impact of IVT on the outcomes of mild AIS over time. METHODS: Using the Paul Coverdell National Stroke Program data, we examined trends in IVT utilization from 2010 to 2019 among AIS patients presenting with National Institutes of Health Stroke Scale (NIHSS) scores ≤5. Outcomes adjudicated included rates of discharge to home and ability to ambulate independently at discharge. We used generalized estimating equation models to examine the effect of IVT on outcomes of AIS patients presenting with mild symptoms and calculated adjusted odds ratio (AOR) with 95% confidence intervals (CI). RESULTS: During the study period, 346,762 patients presented with mild AIS symptoms. Approximately 6.2% were treated with IVT. IVT utilization trends increased from 3.7% in 2010 to 7.7% in 2019 (p < 0.001). Patients treated with IVT had higher median NIHSS scores upon presentation (IVT 3 [2, 4] vs. no IVT 2 [0, 3]). Rates of discharge to home (AOR 2.06, 95% CI: 1.99-2.13) and ability to ambulate at time of discharge (AOR 1.82, 95% CI: 1.76-1.89) were higher among those treated with IVT. CONCLUSION: There was an increased trend in IVT utilization among AIS patients presenting with mild symptoms. Utilization of IVT increased the odds of being discharged to home and the ability to ambulate at discharge independently in patients with mild stroke.

Toward safer opioid prescribing: effects of the TOWER intervention on HIV care providers.

ABSTRACTRates of opioid use disorder and associated deaths remain alarmingly high. Measures to address the epidemic have included reductions in opioid prescribing, in part guided by the Centers for Disease Control Opioid Prescribing Guideline (CDCG). While reductions in over-prescribing have occurred, these measures have also resulted in decreased access and adverse outcomes for some stable opioid-treated chronic pain patients. The TOWard SafER Opioid Prescribing (TOWER) intervention was designed to support HIV primary care providers in use of the CDCG and in decision-making and patient-provider communication regarding safe opioid prescribing. Eleven HIV primary care providers and 40 of their patients were randomized into intervention and control groups. Transcripts from 21 patient visits were analyzed, focusing on opioid and pain-related communications. Findings from this research indicate greater alignment with the CDCG among visits carried out with providers in the TOWER intervention group. However, control group visits were notably consistent with guideline recommendations in several key areas. Differences observed between the intervention and control group visits demonstrate intervention strengths, as well as areas where additional work needs to be done to ensure prescribing and communication consistent with the CDCG.

Surfactant-Assisted Synthesis of Praseodymium Orthovanadate Nanofiber-Supported NiFe-Layered Double Hydroxide Bifunctional Catalyst: The Electrochemical Detection and Degradation of Diphenylamine.

Physiological storage disorders are caused by ineffective post-harvest handling of horticultural crops, particularly fruits. To address these post-harvest concerns, diphenylamine (DPAH•+) is widely used as a preservative to prevent fruit degradation and surface scald during storage around the world. Humans are negatively affected by the use of high concentrations of DPAH•+ because of the various health complications related to its exposure. As a result, accurate detection and quantification of DPAH•+ residues in treated fruits are critical. Rare earth metal orthovanadates, which have excellent physical and chemical properties, are potential materials for electrochemical sensors in this area. Herein, we present a simple and direct ultrasonication technique for the surfactant-assisted synthesis of praseodymium orthovanadate (PrVO4 or PrV) loaded on nickel iron layered double hydroxide (NiFe-LDH) synthesized with deep eutectic solvent assistance, as well as its application as an effective catalyst in the detection and degradation of DPAH•+ in fruits and water samples. The current work presents supreme electrochemical features of a PrV@NiFe-LDH-modified screen-printed carbon electrode (SPCE) where cetyltrimethylammonium bromide (CTAB) surfactant-driven fabrication of PrV directs the formation of highly qualified engineered structures and the deep eutectic solvent based green synthesis of NiFe-LDH creates hierarchical lamellar structures following the principles of green chemistry. PrV and NiFe-LDH combine to produce a synergistic effect that improves the number of active sites, charge transfer kinetics, and electronic conductivity. Differential pulse voltammetry analysis of PrV@NiFe-LDH/SPCE reveals a dynamic working range (0.005-226.26 µM), increased sensitivity (133.13 µA µM-1 cm-2), enhanced photocatalytic activity, and low detection limit (0.001 µM), which are considered significant when compared with the former reported electrodes in the literature for the determination of DPAH+ for its real-time applications.

In Situ Synthesis of a Bismuth Vanadate/Molybdenum Disulfide Composite: An Electrochemical Tool for 3-Nitro-l-Tyrosine Analysis.

The quantification of 3-nitro-l-tyrosine (NO2-Tyr), an in vivo biomarker of nitrosative stress, is indispensable for the clinical intervention of various inflammatory disorders caused by nitrosative stress. By integrating the unique features of BiVO4 and MoS2 with matching bandgap energies, electrode materials with amplified response signals can be developed. In this regard, we introduce a hydrothermally synthesized bismuth vanadate sheathed molybdenum disulfide (MoS2@BiVO4) heterojunction as a highly sensitive electrode material for the determination of NO2-Tyr. Excellent electrochemical behavior perceived for the MoS2@BiVO4 augments the performance of the sensor and allows the measurement of NO2-Tyr in biological media without any time-consuming pretreatments. The synergistic interactions between BiVO4 and MoS2 heterojunctions contribute to low resistance charge transfer (Rct = 159.13 Ω·cm2), a reduction potential Epc = -0.58 V (vs Ag/AgCl), and a good response range (0.001-526.3 µM) with a lower limit of detection (0.94 nM) toward the detection of NO2-Tyr. An improved active surface area, reduced charge recombination, and high analyte adsorption contribute to the high loading of the biomarker for improved selectivity (in the presence of 10 interfering compounds), operational stability (1000 s), and reproducibility (six various modified electrodes). The proposed sensor was successfully utilized for the real-time determination of NO2-Tyr in water, urine, and saliva samples with good recovery values (±98.94-99.98%), ascertaining the reliability of the method. It is noteworthy that the electrochemical activity remains unaffected by other redox interferons, thus leading to targeted sensing applications.

Integration of iron-manganese layered double hydroxide/tungsten carbide composite: An electrochemical tool for diphenylamine H•+ analysis in environmental samples.

Incompetent governance of post-harvest horticultural crops especially apples and pears lead to numerous physiological storage disorders. In order to manage this issue, diphenylamine (DPA) is widely used as an antioxidant and anti-scald agent to preserve fruits from superficial scalds and degradation during storage. As a result, this research focuses on utilizing disposable electrodes constructed with sphere-shaped iron-manganese layered double hydroxide (FeMn-LDH) entrapped tungsten carbide (WC) nanocomposite on its electrochemical performances towards emergent food contaminant, DPA. The importance of the current work is the selection and design of hierarchically structured functional materials especially layered double hydroxides, in virtue of their outstanding properties. These multi-dimensional structures when introduced to form a composite with the highly beneficial tungsten carbide offer excellent characteristics such as exceptional accessibility to active sites, enhanced surface area, and high mass transport and diffusion which serves as advantageous for the electrochemical quantification of DPA. Furthermore, the synergy between FeMn-LDH and WC nanomaterials contributes to the higher active surface area, increased electrical conductivity, fast electron transportation, and ion diffusion, resulting in static properties including a wide linear range (0.01-183.34 µM), low detection limit (1.1 nM), greater sensitivity, selectivity, and reproducibility thus confirming the potential capability of the WC@FeMn-LDH sensor towards the interference-free determination of DPA which validates its practicality and feasibility in real-time. Hence, this work aims to stimulate the fabrication of various advanced hierarchical structures by a simple hydrothermal approach that can have veracity of potential applications.

Construction of ANbO3 (A= Na, K)/f-carbon nanofiber composite: Rapid and real-time electrochemical detection of hydroxychloroquine in environmental samples.

Hydroxychloroquine (HCQ) is a significant viral resistant drug widely acknowledged for its immunomodulatory and anti-inflammatory activities. To minimize the impact of HCQ residues on environmental pathways, exploring control measures is vital. In this regard, electrochemical sensing of HCQ using well-structured functional materials is advantageous. This work aims to provide an economical and sustainable route for the synthesis of ANbO3 (A = Na,K) perovskites via a thymol-menthol-based natural deep eutectic solvent. The as-synthesized NaNbO3 and KNbO3 are pinned to functionalized carbon nanofibers (f-CNF) via an ultrasonication approach. Benefitting from the synergistic effect of rapid electron transfer and improved surface area, enhanced electrochemical activity for NaNbO3@f-CNF/GCE is achieved. The fabricated NaNbO3@f-CNF displays a LOD (DPV = 0.01 µM, i-t = 0.007 µM), wide dynamic range (DPV = 0.09-22.5 µM, i-t = 0.006-35 µM), outstanding selectivity, and reproducibility, proving feasible in real-time analysis with good recovery rates (±97.67-99.81%). The NADES-mediated preparation of perovskites evades the incorporation of traditional toxic solvents and yields atom-efficient ANbO3 (A = Na,K) associated with green solvent templates. This validates the sustainable fabrication of electrode materials with reduced energy stipulations for detecting hazardous drug pollutants in the ecosystem.

Emergency Medical Services Utilization for Acute Stroke Care: Analysis of the Paul Coverdell National Acute Stroke Program, 2014-2019.

Objective: Emergency medical service (EMS) transportation after acute stroke is associated with shorter symptom-to-arrival times and more rapid medical attention when compared to patient transportation by private vehicle. Methods: We analyzed data from the Paul Coverdell National Acute Stroke Program from 2014 to 2019 among stroke (ischemic and hemorrhagic) and transient ischemic attack (TIA) patients to examine patterns in EMS utilization. Results: Of 500,829 stroke and TIA patients (mean age 70.9 years, 51.3% women) from 682 participating hospitals during the study period, 60% arrived by EMS. Patients aged 18-64 years vs. ≥65 years (AOR 0.67) were less likely to utilize EMS. Severe stroke patients (AOR 2.29, 95%CI, 2.15-2.44) and hemorrhagic stroke patients vs. ischemic stroke patients (AOR 1.47, 95% CI, 1.43-1.51) were more likely to utilize EMS. Medicare (AOR 1.35, 95% CI, 1.32-1.38) and Medicaid (AOR 1.41, 95% CI, 1.37-1.45) beneficiaries were more likely than privately insured patients to utilize EMS, but no difference was found between no insurance/self-pay patients and privately insured patients on EMS utilization. Overall, there was a decreasing trend in the utilization of EMS (59.6% to 59.3%, p = 0.037). The decreasing trend was identified among ischemic stroke (p < 0.0001) patients but not among TIA (p = 0.89) or hemorrhagic stroke (p = 0.44) patients. There was no observed trend in pre-notification among stroke patients' arrival by EMS across the study period (56.9% to 56.5%, p = 0.99). Conclusions: Strategies to help increase stroke awareness and utilization of EMS among those with symptoms of stroke should be considered in order to help improve stroke outcomes.

Polymicrobial anaerobic sepsis due to Bacteroides fragilis, Eggerthella lenta, Ruminoccocus gnavus, and Bilophila wadsworthia in a patient with myeloproliferative neoplasm.

We report a rare case of polymicrobial anaerobic bacteremia caused by four different gut anaerobes: Bacteroides fragilis, Eggerthella lenta, Bilophila wadsworthia, and Ruminococcus gnavus. Early initiation of appropriate therapy and species identification with matrix assisted laser desorption time-of-flight mass spectrometry (MALDI-TOF MS) resulted in full recovery from the infection. Our case highlights the clinical significance of polymicrobial cultures and the importance of performing anaerobic cultures for blood specimens to ensure proper identification and treatment.

Antibacterial, Antioxidant, Larvicidal and Anticancer Activities of Silver Nanoparticles Synthesized Using Extracts from Fruits of Lagerstroemia speciose and Flowers of Couroupita guianensis.

The present study aimed to analyze the in vitro antibacterial, antioxidant, larvicidal and cytotoxicity properties of green synthesized silver nanoparticles (Ag NPs) using aqueous extracts from fruits of Lagerstroemia speciosa and flowers of Couropita guinensis. Synthesized Ag NPs were characterized using UV-DRS, FTIR, XRD, DLS, and High-Resolution SEM and TEM analyses. Absorption wavelength was observed at 386 nm by UV-DRS analysis and energy band gap was calculated as 3.24 eV. FTIR analysis showed the existence of various functional groups in the aqueous extract and in the NPs. DLS analysis showed the stability and particle size of the synthesized Ag NPs. SEM analysis revealed that Ag NPs are in a face centered cubic symmetry and spherical shape with a size of 23.9 nm. TEM analysis showed particle size as 29.90 nm. Ag NPs showed antibacterial activity against both Gram-positive and Gram-negative bacteria. DPPH scavenging trait of Ag NPs was ranging from 20.0 ± 0.2% to 62.4 ± 0.3% and observed significant larvicidal activity (LC50 at 0.742 ppm and LC90 at 6.061 ppm) against Culex quinquefasciatus. In vitro cytotoxicity activity of Ag NPs was also tested against human breast cancer (MCF-7) and fibroblast cells (L-929) and found that cells viabilities are ranging (500 to 25 µg/mL) from 52.5 ± 0.4 to 94.0 ± 0.7% and 53.6 ± 0.5 to 90.1 ± 0.8%, respectively. The synthesized Ag NPs have the potential to be used in the various biomedical applications.

Impact of Accelerate Pheno and BacT/Alert Virtuo on Clinical Processes and Outcomes in Patients with Sepsis and Concurrent Gram-Negative Bacteremia.

The Accelerate Pheno and BacT/Alert Virtuo systems may improve bacteremia management. Here, we evaluated the impact of both devices on outcomes in patients with sepsis and concurrent Gram-negative bacteremia. This quasiexperimental study included a retrospective preimplementation and a prospective postimplementation group. Patients ≥18 years old with Gram-negative bacteremia were included. Patients with neutropenia, pregnant patients, those who were transferred from an outside hospital with active bloodstream infections, and those with polymicrobial bacteremia were excluded. Blood culture incubation in the BacT/Alert 3D device and microdilution antimicrobial susceptibility testing from culture plate growth were used prior to implementation of the BacT/Alert Virtuo and Accelerate Pheno systems. Matrix-assisted laser desorption ionization-time of flight (MALDI-TOF) identification directly from blood culture was used pre- and postimplementation. Time to Gram stain results, identification, susceptibility reporting, initiation of narrow-spectrum Gram-negative therapy at 72 h, 30-day inpatient mortality, sepsis resolution, and length of hospital stay were evaluated. A total of 116 patients were included (63 preimplementation, 53 postimplementation). Median times to Gram stain and susceptibility results were significantly shorter postimplementation (P < 0.001). The postimplementation group had an improved hazard ratio for narrow-spectrum Gram-negative therapy at 72 h (hazard ratio [HR], 2.685 [95% confidence interval {CI}, 1.348 to 5.349]), a reduced hazard ratio for 30-day inpatient mortality (adjusted HR [aHR], 0.150 [95% CI, 0.026 to 0.846]), and improved sepsis resolution (92.5% versus 77.8% [P = 0.030]). The length of hospital stay was unchanged after implementation. We conclude that implementation of the BacT/Alert Virtuo and Accelerate Pheno systems improved microbiology laboratory processes, antibiotic utilization processes, and clinical outcomes. These data support the use of rapid diagnostics in sepsis with concurrent Gram-negative bacteremia.

Toward the Development of Disposable Electrodes Based on Holmium Orthovanadate/f-Boron Nitride: Impacts and Electrochemical Performances of Emerging Inorganic Contaminants.

Rare-earth metal orthovanadates have great technological relevance in the family of rare-earth compounds owing to their excellent physical and chemical properties. A significant number of studies have been carried out on this class of compounds to exploit their electrochemical properties in virtue of variable oxidation states. But holmium vanadate (HoV) and its morphology selective synthesis have not been considered, which can have potential applications similar to the rest of the family. In this work, we propose the synthesis of superior architectures of HoV with a functionalized boron nitride (f-BN) nanocomposite. The synergistic effect between HoV and f-BN can have a positive effect on the physical characteristics of the nanocomposite, which can be explored for its electrochemical capacity. Here, HoV incorporated with f-BN is explored for the electrochemical detection of Hg2+ ions, which is known for its toxicity-induced environmental health hazards. The structural and compositional revelation reveals higher conductivity and faster electron transfer in the composite, which facilitates a wide working range (0.02-53.8 and 64.73-295.4 µM), low limit of detection (5 nM), higher sensitivity (66.6 µA µM-1 cm-2), good selectivity over 10-fold higher concentration of other interfering compounds compared to Hg2+ ion concentration, and good cycles stability (30 segments) toward Hg2+ ion detection. This also envisages the morphology selective synthesis and utilization of other rare-earth metals, whose electrochemical capacities are unexplored.