A smartwatch-based CPR feedback device improves chest compression quality among health care professionals and lay rescuers.

Background: Cardiopulmonary resuscitation (CPR) quality significantly impacts patient outcomes during cardiac arrests. With advancements in health care technology, smartwatch-based CPR feedback devices have emerged as potential tools to enhance CPR delivery. Objective: This study evaluated a novel smartwatch-based CPR feedback device in enhancing chest compression quality among health care professionals and lay rescuers. Methods: A single-center, open-label, randomized crossover study was conducted with 30 subjects categorized into 3 groups based on rescuer category. The Relay Response BLS smartwatch application was compared to a defibrillator-based feedback device (Zoll OneStep CPR Pads). Following an introduction to the technology, subjects performed chest compressions in 3 modules: baseline unaided, aided by the smartwatch-based feedback device, and aided by the defibrillator-based feedback device. Outcome measures included effectiveness, learnability, and usability. Results: Across all groups, the smartwatch-based device significantly improved mean compression depth effectiveness (68.4% vs 29.7%; P < .05) and mean rate effectiveness (87.5% vs 30.1%; P < .05), compared to unaided compressions. Compression variability was significantly reduced with the smartwatch-based device (coefficient of variation: 14.9% vs 26.6%), indicating more consistent performance. Fifteen of 20 professional rescuers reached effective compressions using the smartwatch-based device in an average 2.6 seconds. A usability questionnaire revealed strong preference for the smartwatch-based device over the defibrillator-based device. Conclusion: The smartwatch-based device enhances the quality of CPR delivery by keeping compressions within recommended ranges and reducing performance variability. Its user-friendliness and rapid learnability suggest potential for widespread adoption in both professional and lay rescuer scenarios, contributing positively to CPR training and real-life emergency responses.

Advances in heavy alkaline earth chemistry provide insight into complexation of weakly polarizing Ra2+, Ba2+, and Sr2+ cations.

Numerous technologies-with catalytic, therapeutic, and diagnostic applications-would benefit from improved chelation strategies for heavy alkaline earth elements: Ra2+, Ba2+, and Sr2+. Unfortunately, chelating these metals is challenging because of their large size and weak polarizing power. We found 18-crown-6-tetracarboxylic acid (H4COCO) bound Ra2+, Ba2+, and Sr2+ to form M(HxCOCO)x-2. Upon isolating radioactive 223Ra from its parent radionuclides (227Ac and 227Th), 223Ra2+ reacted with the fully deprotonated COCO4- chelator to generate Ra(COCO)2-(aq) (log KRa(COCO)2- = 5.97 ± 0.01), a rare example of a molecular radium complex. Comparative analyses with Sr2+ and Ba2+ congeners informed on what attributes engendered success in heavy alkaline earth complexation. Chelators with high negative charge [-4 for Ra(COCO)2-(aq)] and many donor atoms [≥11 in Ra(COCO)2-(aq)] provided a framework for stable complex formation. These conditions achieved steric saturation and overcame the weak polarization powers associated with these large dicationic metals.

Exploring structural effects in a new class of NRF2 inhibitors.

NRF2 is a transcription factor that controls the cellular response to various stressors, such as reactive oxygen and nitrogen species. As such, it plays a key role in the suppression of carcinogenesis, but constitutive NRF2 expression in cancer cells leads to resistance to chemotherapeutics and promotes metastasis. As a result, inhibition of the NRF2 pathway is a target for new drugs, especially for use in conjunction with established chemotherapeutic agents like carboplatin and 5-fluorouracil. A new class of NRF2 inhibitors has been discovered with substituted nicotinonitriles, such as MSU38225. In this work, the effects on NRF2 inhibition with structural changes were explored. Through these studies, we identified a few compounds with as good or better activity than the initial hit but with greatly improved solubility. The syntheses involved a variety of metal-catalyzed reactions, including titanium multicomponent coupling reactions and various Pd and Cu coupling reactions. In addition to inhibiting NRF2 activity, these new compounds inhibited the proliferation and migration of lung cancer cells in which the NRF2 pathway is constitutively activated.

Synthesis, solid-state, solution, and theoretical characterization of an "in-cage" scandium-NOTA complex.

Developing chelators that strongly and selectively bind rare-earth elements (Sc, Y, La, and lanthanides) represents a longstanding fundamental challenge in inorganic chemistry. Solving these challenges is becoming more important because of increasing use of rare-earth elements in numerous technologies, ranging from paramagnets to luminescent materials. Within this context, we interrogated the complexation chemistry of the scandium(III) (Sc3+) trication with the hexadentate 1,4,7-triazacyclononane-1,4,7-triacetic acid (H3NOTA) chelator. This H3NOTA chelator is often regarded as an underperformer for complexing Sc3+. A common assumption is that metalation does not fully encapsulate Sc3+ within the NOTA3- macrocycle, leaving Sc3+ on the periphery of the chelate and susceptible to demetalation. Herein, we developed a synthetic approach that contradicted those assumptions. We confirmed that our procedure forced Sc3+ into the NOTA3- binding pocket by using single crystal X-ray diffraction to determine the Na[Sc(NOTA)(OOCCH3)] structure. Density functional theory (DFT) and 45Sc nuclear magnetic resonance (NMR) spectroscopy showed Sc3+ encapsulation was retained when the crystals were dissolved. Solution-phase and DFT studies revealed that [Sc(NOTA)(OOCCH3)]1- could accommodate an additional H2O capping ligand. Thermodynamic properties associated with the Sc-OOCCH3 and Sc-H2O capping ligand interactions demonstrated that these capping ligands occupied critical roles in stabilizing the [Sc(NOTA)] chelation complex.

Lessons Learned from the Development and Demonstration of a PPE Inventory Monitoring System for US Hospitals.

An international system should be established to support personal protective equipment (PPE) inventory monitoring, particularly within the healthcare industry. In this article, the authors discuss the development and 15-week deployment of a proof-of-concept prototype that included the use of a Healthcare Trust Data Platform to secure and transmit PPE-related data. Seventy-eight hospitals participated, including 66 large hospital systems, 11 medium-sized hospital systems, and a single hospital. Hospitals reported near-daily inventory information for N95 respirators, surgical masks, and face shields, ultimately providing 159 different PPE model numbers. Researchers cross-checked the data to ensure the PPE could be accurately identified. In cases where the model number was inaccurately reported, researchers corrected the numbers whenever possible. Of the PPE model numbers reported, 74.2% were verified-60.5% of N95 respirators, 40.0% of face shields, and 84.0% of surgical masks. The authors discuss the need to standardize how PPE is reported, possible aspects of a PPE data standard, and standards groups who may assist with this effort. Having such PPE data standards would enable better communication across hospital systems and assist in emergency preparedness efforts during pandemics or natural disasters.

ThIV-Desferrioxamine: characterization of a fluorescent bacterial probe.

Diversifying our ability to guard against emerging pathogenic threats is essential for keeping pace with global health challenges, including those presented by drug-resistant bacteria. Some modern diagnostic and therapeutic innovations to address this challenge focus on targeting methods that exploit bacterial nutrient sequestration pathways, such as the desferrioxamine (DFO) siderophore used by Staphylococcus aureus (S. aureus) to sequester FeIII. Building on recent studies that have shown DFO to be a versatile vehicle for chemical delivery, we show proof-of-principle that the FeIII sequestration pathway can be used to deliver a potential radiotherapeutic. Our approach replaces the FeIII nutrient sequestered by H4DFO+ with ThIV and made use of a common fluorophore, FITC, which we covalently bonded to DFO to provide a combinatorial probe for simultaneous chelation paired with imaging and spectroscopy, H3DFO_FITC. Combining insight provided from FITC-based imaging with characterization by NMR spectroscopy, we demonstrated that the fluorescent DFO_FITC conjugate retained the ThIV chelation properties of native H4DFO+. Fluorescence microscopy with both [Th(DFO_FITC)] and [Fe(DFO_FITC)] complexes showed similar uptake by S. aureus and increased intercellular accumulation as compared to the FITC and unchelated H3DFO_FITC controls. Collectively, these results demonstrate the potential for the newly developed H3DFO_FITC conjugate to be used as a targeting vector and bacterial imaging probe for S. aureus. The results presented within provide a framework to expand H4DFO+ and H3DFO_FITC to relevant radiotherapeutics (like 227Th).

A Novel Nrf2 Pathway Inhibitor Sensitizes Keap1-Mutant Lung Cancer Cells to Chemotherapy.

The nuclear factor erythroid-2-related factor 2 (Nrf2)-Keap1-ARE pathway, a master regulator of oxidative stress, has emerged as a promising target for cancer therapy. Mutations in NFE2L2, KEAP1, and related genes have been found in many human cancers, especially lung cancer. These mutations lead to constitutive activation of the Nrf2 pathway, which promotes proliferation of cancer cells and their resistance to chemotherapies. Small molecules that inhibit the Nrf2 pathway are needed to arrest tumor growth and overcome chemoresistance in Nrf2-addicted cancers. Here, we identified a novel small molecule, MSU38225, which can suppress Nrf2 pathway activity. MSU38225 downregulates Nrf2 transcriptional activity and decreases the expression of Nrf2 downstream targets, including NQO1, GCLC, GCLM, AKR1C2, and UGT1A6. MSU38225 strikingly decreases the protein level of Nrf2, which can be blocked by the proteasome inhibitor MG132. Ubiquitination of Nrf2 is enhanced following treatment with MSU38225. By inhibiting production of antioxidants, MSU38225 increases the level of reactive oxygen species (ROS) when cells are stimulated with tert-butyl hydroperoxide (tBHP). MSU38225 also inhibits the growth of human lung cancer cells in both two-dimensional cell culture and soft agar. Cancer cells addicted to Nrf2 are more susceptible to MSU38225 for suppression of cell proliferation. MSU38225 also sensitizes human lung cancer cells to chemotherapies both in vitro and in vivo Our results suggest that MSU38225 is a novel Nrf2 pathway inhibitor that could potentially serve as an adjuvant therapy to enhance the response to chemotherapies in patients with lung cancer.

Preparation of an Actinium-228 Generator.

Advances in targeted α-therapies have increased the interest in actinium (Ac), whose chemistry is poorly defined due to scarcity and radiological hazards. Challenges associated with characterizing Ac3+ chemistry are magnified by its 5f06d0 electronic configuration, which precludes the use of many spectroscopic methods amenable to small amounts of material and low concentrations (like EPR, UV-vis, fluorescence). In terms of nuclear spectroscopy, many actinium isotopes (225Ac and 227Ac) are equally "unfriendly" because the actinium α-, ß-, and γ-emissions are difficult to resolve from the actinium daughters. To address these issues, we developed a method for isolating an actinium isotope (228Ac) whose nuclear properties are well-suited for γ-spectroscopy. This four-step procedure isolates 228Ra from naturally occurring 232Th. The relatively long-lived 228Ra (t1/2 = 5.75(3) years) radioisotope subsequently decays to 228Ac. Because the 228Ac decay rate [t1/2 = 6.15(2) h] is fast, 228Ac rapidly regenerates after being harvested from the 228Ra parent. The resulting 228Ac generator provides frequent and long-term access (of many years) to the spectroscopically "friendly" 228Ac radionuclide. We have demonstrated that the 228Ac product can be routinely "milked" from this generator on a daily basis, in chemically pure form, with high specific activity and in excellent yield (∼95%). Hence, in the same way that developing synthesis routes to new starting materials has advanced coordination chemistry for many metals by broadening access, this 228Ac generator has the potential to broaden actinium access for the inorganic community, facilitating the characterization of actinium chemical behavior.

Catalyst design insights from modelling a titanium-catalyzed multicomponent reaction.

High oxidation state transition metal catalysis touches our daily lives through bulk chemical production, e.g. olefin polymerization, and through specialty chemical reactions common in organic synthesis, e.g. the Sharpless asymmetric epoxidation and olefin dihydroxylation. Our group has been expanding the reaction chemistry of titanium(iv) to produce a host of nitrogen-based heterocycles via multicomponent coupling reactions. One such multicomponent coupling reaction discovered in our laboratory is iminoamination, involving an amine, an alkyne, and an isonitrile. However, the experimental modeling of high oxidation state reactions lags far behind that of low oxidation state systems, where a great deal is known about ligands, their donor properties and how their structures affect catalysis. As a result, we have developed an experimental method for determining the donor abilities of anionic ligands on high oxidation state systems, which is based on the chromium(vi) nitride system NCr(NiPr2)2X, where X = the ligand being interrogated. The parameters obtained are simply called ligand donor parameters (LDP). In this contribution, a detailed optimization of the Ti(NMe2)2(dpm)-catalyzed iminoamination reaction was carried out, where dpm = 5,5-dimethyldipyrrolylmethane. During the course of these studies, dimeric {Ti(µ-N-tolyl)(dpm)}2 was isolated, which is proposed as the resting state of the catalyst. To destabilize this resting state, a more electron-rich bis(aryloxide) catalyst system was investigated. The more electron-rich system is somewhat more active for iminoamination under some conditions; however, the catalyst is prone to disproportionation. A study of heteroleptic titanium complexes revealed that the disproportionation equilibrium constant can be effectively modeled as a function of the square of the difference in LDP between the ligands, (ΔLDP)2. Using this methodology, one can estimate the stability of titanium complexes toward disproportionation.

Electronic and Structural Comparisons between Iron(II/III) and Ruthenium(II/III) Imide Analogs.

To examine structural and electronic differences between iron and ruthenium imido complexes, a series of compounds was prepared with different phosphine basal sets. The starting material for the ruthenium complexes was Ru(NAr/Ar*)(PMe3)3 (Ru1/Ru1*), where Ar = 2,6-(iPr)2C6H3 and Ar* = 2,4,6-(iPr)3C6H2, which were prepared from cis-RuCl2(PMe3)4 and 2 equiv of LiNHAr/Ar*. The starting materials for the iron complexes were the analogous Fe(NAr/Ar*)(PMe3)3 species (Fe1/Fe1*), which were not isolated but could be generated in situ from FeCl2, PMe3, and LiNHAr/Ar*. With both iron and ruthenium, the PMe3 starting materials underwent phosphine replacement with chelating ligands to give new group 8 imido complexes in the +2 oxidation state. Addition of 1,2-bis(diphenylphosphino)ethane (dppe) to M1/M1* gave Ru(NAr/Ar*)(PMe3)(dppe) and Fe(NAr/Ar*)(PMe3)(dppe). Addition of 1,2-bis(dimethylphosphino)ethane (dmpe) provided Ru(NAr/Ar*)(dmpe)2. A triphos ligand, {P(Me)2CH2}3SitBu (tP3), was also examined. Addition of tP3 to Fe1 provided Fe(NAr)(tP3) (Fe4), but a similar reaction with Ru1 only gave intractable materials. Oxidation of Fe4 with AgSbF6 gave {Fe(NAr)(tP3)}+SbF6- (Fe4a). Oxidation of Ru2 with AgSbF6 gave the unstable cation {Ru(NAr)(PMe3)(dppe)}+, which dimerized in the presence of acetonitrile via C-C bond formation at the aryl group C4 positions, affording {Ru(NAr)(PMe3)(NCMe)(dppe)}2+. This suggested that there was substantial radical character in the imide π system on oxidation and that an aromatic group substituted at the 4-position might provide greater stability. The cations {Fe(NAr*)(PMe3)(dppe)}+ (Fe2a*), {Ru(NAr*)(PMe3)(dppe)}+ (Ru2a*), and Fe4a were examined by EPR spectroscopy, which suggested differences in electronic structure depending on the metal and ligand set. CASPT2 calculations on model systems for Ru2a* and Fe2a* suggested that the large differences in electronic structure are related to the energy gap between the π-antibonding HOMO and the π-bonding HOMO-1. Both the geometry of the phosphines, which is slightly different between the iron and ruthenium analogs, and the metal center seem to contribute to this energetic difference.

A silica-supported titanium catalyst for heterogeneous hydroamination and multicomponent coupling reactions.

Highly dehydrated silica gel, SiO2700, gave a material with a total surface hydroxyl density of 0.31 ± 0.05 mmol g-1, 0.9 ± 0.1 Si-OH sites per nm2. Treatment of this material with Ti(NMe2)4 gave Ti(NMe2)3/SiO2700, which is 1.50% ± 0.07 Ti, where the titanium is bound to the surface, on average, through a single O-Si-Ti linkage. This material was tested for its properties as a catalyst for C-N bond forming reactions and was found to be a competent alkyne hydroamination and iminoamination catalyst. For iminoamination, which is the 3-component coupling of an alkyne, primary amine, and isonitrile, this heterogeneous catalyst was able to carry out some catalyses faster than previously reported homogeneous catalysts with lower catalyst loadings. The material is also a catalyst for the addition of aniline to dicyclohexylcarbodiimide to form a substituted guanidine. In addition, a known quinoline with biological activity was prepared using the heterogeneous catalyst in a one-pot procedure using half the catalyst loading of the previously reported synthesis.

A photochemical route to a square planar, ruthenium(iv)-bis(imide).

The square planar, ruthenium(iv) bis(imide) trans-Ru(NAr)2(PMe3)2 can be prepared photochemically from a Ru(ii) tetrazene. Additionally, we report reactivity of the Ru(iv) bis(imide) species, similar to that of the osmium derivative. Attempts to change both imide group and phosphine substituents are presented, which led to alternative reactivity.

Meeting The Future of Nursing Report Recommendations: A Successful Practice-Academic Partnership.

In collaboration with the University of Texas at El Paso, nurse leadership at Del Sol Medical Center implemented an internship program for nursing students in the final semester of a bachelor of science in nursing (BSN) program. The medical center experienced an increase in the proportion of BSN-prepared nurses, decreased orientation full-time equivalents (FTE), and lowered operating costs. The university experienced highly satisfied and competent new graduate nurses. The nurse interns averaged a 91.9% in-hospital registered nurse (RN) competency completion rate during the internship. All interns accepted a RN position at the medical center. Total savings for salaries, benefits, and recruitment fees at the medical center were $599,040 with a total FTE savings of 23.4 FTEs per week, over 10 weeks.

Defining and incorporating basic nursing care actions into the electronic health record.

PURPOSE: To develop a definition of basic nursing care for the hospitalized adult patient and drive uptake of that definition through the implementation of an electronic health record. DESIGN AND METHODS: A team of direct care nurses, assisted by subject matter experts, analyzed nursing theory and regulatory requirements related to basic nursing care. The resulting list of activities was coded using the Clinical Care Classification (CCC) system and incorporated into the electronic health record system of a 170-bed community hospital. RESULTS: Nine basic nursing care activities were identified as a result of analyzing nursing theory and regulatory requirements in the framework of a hypothetical "well" patient. One additional basic nursing care activity was identified following the pilot implementation in the electronic health record. The pilot hospital has successfully passed a post-implementation regulatory review with no recommendations related to the documentation of basic patient care. CONCLUSIONS: This project demonstrated that it is possible to define the concept of basic nursing care and to distinguish it from the interdisciplinary, problem-focused plan of care. The use of the electronic health record can help clarify, document, and communicate basic care elements and improve uptake among nurses. CLINICAL RELEVANCE: This project to define basic nursing care activities and incorporate into the electronic health record represents a first step in capturing meaningful data elements. When fully implemented, these data could be translated into knowledge for improving care outcomes and collaborative processes.