Development of a workflow for the detection of vancomycin-resistant Enterococcus faecium and Enterococcus faecalis from rectal swabs using the spectra VRE medium.

BACKGROUND: Spectra™ VRE agar (Remel, Lenexa, KS) is a chromogenic agar that is FDA approved for screening patients for VRE colonization. The package insert recommends confirming isolates with identification and susceptibility testing, but confirming every culture delays time to result. Given the agar's historic high specificity for E. faecium isolates, we theorized the agar could be utilized as a stand-alone screening to minimize reagents and time. AIM: Our laboratory sought to develop a workflow to optimize the use of the medium. METHODS: We plated 3,815 rectal swabs to the Spectra VRE agar and compared results to traditional identification and susceptibility testing. RESULTS: Dark blue or purple colonies on the agar demonstrated a sensitivity of 98% and specificity of 85% for detection of VRE faecium, but light blue colonies were significantly less specific for E. faecalis. CONCLUSIONS: We streamlined our workflow to accept dark blue or purple colonies as VRE faecium and plan to perform additional testing only on light blue colonies. Interestingly, higher quantity of growth increased the accuracy of the agar. In the future, growth quantity may be used to further streamline the workflow once more data is obtained.

Enabling In Vivo Optical Imaging of an Osmium Photosensitizer by Micellar Formulation.

Osmium (Os)-based photosensitizers (PSs) exhibit unique broad, red-shifted absorption, favoring PDT activity at greater tissue depths. We recently reported on a potent Os(II) PS, rac-[Os(phen)2(IP-4T)](Cl)2 (ML18J03) with submicromolar hypoxia activity. ML18J03 exhibits a low luminescence quantum yield of 9.8 × 10-5 in PBS, which limits its capacity for in vivo luminescence imaging. We recently showed that formulating ML18J03 into 10.2 nm DSPE-mPEG2000 micelles (Mic-ML18J03) increases its luminescence quantum yield by two orders of magnitude. Here, we demonstrate that Mic-ML18J03 exhibits 47-fold improved accumulative luminescence signals in orthotopic AT-84 head and neck tumors. We show, for the first time, that micellar formulation provides up to 11.7-fold tumor selectivity for ML18J03. Furthermore, Mic-ML18J03 does not experience the concentration-dependent quenching observed with unformulated ML18J03 in PBS, and formulation reduces spectral shifting of the emission maxima during PDT (variance = 6.5 and 27.3, respectively). The Mic-ML18J03 formulation also increases the production of reactive molecular species 2-3-fold. These findings demonstrate that micellar formulation is a versatile and effective approach to enable in vivo luminescence imaging options for an otherwise quenched, yet promising, PS.

In Situ Nanoscale Dynamics Imaging in a Proton-Conducting Solid Oxide for Protonic Ceramic Fuel Cells.

Hydrogen fuel cells and electrolyzers operating below 600 °C, ideally below 400 °C, are essential components in the clean energy transition. Yttrium-doped barium zirconate BaZr0.8 Y0.2 O3-d (BZY) has attracted a lot of attention as a proton-conducting solid oxide for electrochemical devices due to its high chemical stability and proton conductivity in the desired temperature range. Grain interfaces and topological defects modulate bulk proton conductivity and hydration, especially at low temperatures. Therefore, understanding the nanoscale crystal structure dynamics in situ is crucial to achieving high proton transport, material stability, and extending the operating range of proton-conducting solid oxides. Here, Bragg coherent X-ray diffractive imaging is applied to investigate in situ and in 3D nanoscale dynamics in BZY during hydration over 40 h at 200 °C, in the low-temperature range. An unexpected activity of topological defects and subsequent cracking is found on a nanoscale covered by the macroscale stability. The rearrangements in structure correlate with emergent regions of different lattice constants, suggesting heterogeneous hydration. The results highlight the extent and impact of nanoscale processes in proton-conducting solid oxides, informing future development of low-temperature protonic ceramic electrochemical cells.

A Series of Papaya-Associated Salmonella Illness Outbreak Investigations in 2017 and 2019: A Focus on Traceback, Laboratory, and Collaborative Efforts.

ABSTRACT: In 2017 and 2019, five outbreaks of infections from multiple strains of Salmonella linked to the consumption of whole, fresh Maradol papayas were reported in the United States, resulting in 325 ill persons. Traceback, laboratory, and epidemiologic evidence indicated papayas as the likely vehicle for each of these outbreaks and identified the source of papayas. State and U.S. Food and Drug Administration (FDA) laboratories recovered Salmonella from papaya samples from various points of distribution, including at import entry, and conducted serotyping, pulsed-field gel electrophoresis, and phylogenetic analyses of whole genome sequencing data. Federal and state partners led traceback investigations to determine the source of papayas. Four different suppliers of papayas were linked by traceback and laboratory results to five separate outbreaks of Salmonella infections associated with papayas. In 2017, multiple states tested papaya samples collected at retail, and Maryland and Virginia investigators recovered strains of Salmonella associated with one outbreak. FDA collected 183 papaya samples in 2017, and 11 samples yielded 62 isolates of Salmonella. Eleven serotypes of Salmonella were recovered from FDA papaya samples, and nine serotypes were closely related genetically by pulsed-field gel electrophoresis and whole genome sequencing to clinical isolates of four outbreaks, including the outbreak associated with positive state sample results. Four farms in Mexico were identified, and their names were released to the general public, retailers, and foreign authorities. In 2019, FDA collected 119 papaya samples, three of which yielded Salmonella; none yielded the 2019 outbreak strain. Investigators determined that papayas of interest had been sourced from a single farm in Campeche, Mexico, through traceback. This information was used to protect public health through public guidance, recalls, and import alerts and helped FDA collaborate with Mexican regulatory partners to enhance the food safety requirements for papayas imported from Mexico.

Cu(I) Reducibility Controls Ethylene vs Ethanol Selectivity on (100)-Textured Copper during Pulsed CO2 Reduction.

The electrochemical CO2 reduction reaction (CO2RR) can convert widely available CO2 into value-added C2 products, such as ethylene and ethanol. However, low selectivity toward either compound limits the effectiveness of current CO2RR electrocatalysts. Here, we report the use of pulsed overpotentials to improve the ethylene selectivity to 67% with >75% overall C2 selectivity on (100)-textured polycrystalline Cu foil. The pulsed CO2RR can be made selective to either ethylene or ethanol by controlling the reaction temperature. We attribute the enhanced C2 selectivity to the improved CO dimerization kinetics on the active Cu surface on predominately (100)-textured Cu grains with the reduced hydrogen adsorption coverage during the pulsed CO2RR. The ethylene vs ethanol selectivity can be explained by the reducibility of the Cu(I) species during the cathodic potential cycle. Our work demonstrates a simple route to improve the ethylene vs ethanol selectivity and identifies Cu(I) as the species responsible for ethanol production.

Materials Combining Asymmetric Pore Structures with Well-Defined Mesoporosity for Energy Storage and Conversion.

Porous materials design often faces a trade-off between the requirements of high internal surface area and high reagent flux. Inorganic materials with asymmetric/hierarchical pore structures or well-defined mesopores have been tested to overcome this trade-off, but success has remained limited when the strategies are employed individually. Here, the attributes of both strategies are combined and a scalable path to porous titanium nitride (TiN) and carbon membranes that are conducting (TiN, carbon) or superconducting (TiN) is demonstrated. These materials exhibit a combination of asymmetric, hierarchical pore structures and well-defined mesoporosity throughout the material. Fast transport through such TiN materials as an electrochemical double-layer capacitor provides a substantial improvement in capacity retention at high scan rates, resulting in state-of-the-art power density (28.2 kW kg-1) at competitive energy density (7.3 W-h kg-1). In the case of carbon membranes, a record-setting power density (287.9 kW kg-1) at 14.5 W-h kg-1 is reported. Results suggest distinct advantages of such pore architectures for energy storage and conversion applications and provide an advanced avenue for addressing the trade-off between high-surface-area and high-flux requirements.

Sr3CrN3: A New Electride with a Partially Filled d-Shell Transition Metal.

Electrides are ionic crystals in which the electrons prefer to occupy free space, serving as anions. Because the electrons prefer to be in the pockets, channels, or layers to the atomic orbitals around the nuclei, it has been challenging to find electrides with partially filled d-shell transition metals, since an unoccupied d-shell provides an energetically favorable location for the electrons to occupy. We recently predicted the existence of electrides with partially filled d-shells using high-throughput computational screening. Here, we provide experimental support using X-ray absorption spectroscopy and X-ray and neutron diffraction to show that Sr3CrN3 is indeed an electride despite its partial d-shell configuration. Our findings indicate that Sr3CrN3 is the first known electride with a partially filled d-shell transition metal, in agreement with theory, which significantly broadens the criteria for the search for new electride materials.

Controlled Selectivity of CO2 Reduction on Copper by Pulsing the Electrochemical Potential.

We demonstrate a simple strategy to enhance the CO2 reduction reaction (CO2 RR) selectivity by applying a pulsed electrochemical potential to a polycrystalline copper electrode. By controlling the pulse duration, we show that the hydrogen evolution reaction (HER) is highly suppressed to a fraction of the original value (<5 % faradaic efficiency) and selectivity for the CO2 RR dramatically improves (>75 % CH4 and >50 % CO faradaic efficiency). We attribute the improved CO2 RR selectivity to a dynamically rearranging surface coverage of hydrogen and intermediate species during the pulsing. Our finding provides new insights into the interplay of transport and reaction processes as well as timescales of competing pathways to enable new opportunities to tune CO2 RR selectivity by adjusting the pulse profile. Additionally, the pulsed potential method we describe can be easily applied to other catalysts materials to improve their CO2 RR selectivity.

Mesoporous titanium and niobium nitrides as conductive and stable electrocatalyst supports in acid environments.

The stability of carbon-based catalyst supports represents one of the biggest challenges for the commercialisation of proton-exchange membrane fuel cells (PEMFCs). Metal nitrides are an attractive alternative to carbon-based supports, owing to their high bulk conductivity and acid stability. We report the electrochemical stability evaluation of high-surface-area metal nitrides in acidic electrolytes. Three-dimensional mesoporous titanium (TiN) and niobium nitride (NbN) thin films were prepared using block copolymer self-assembly and were evaluated without using any conductive carbon additives or a carbon-based substrate. Both TiN and NbN are stable and maintain conductivity in acidic electrolytes up to at least 0.85 V (NbN) and 1.4 V (TiN) vs. reversible hydrogen electrode (RHE) after 2000 cycles. We also deposited platinum on the TiN films and demonstrate the expected cyclic voltammogram features, indicating the nitride's utility as a catalyst support.

Effect of bandage contact lens wear and postoperative medical therapies on corneal healing rate after diamond burr debridement in dogs.

PURPOSE: To determine the effect of bandage contact lens wear and type of post-operative medical treatment on corneal healing rates in dogs after diamond burr debridement. ANIMALS STUDIED: 237 client-owned dogs. PROCEDURES: Canine patients having undergone diamond burr debridement (DBD) for treatment of spontaneous chronic corneal epithelial defects (SCCEDs) were included. Patients were put into 1 of 12 different groups based on type of postoperative medical regimen and whether a bandage contact lens (BCL) was utilized. Each dog was examined on a routine basis until the cornea was fluorescein negative. Data points collected included age, sex, breed, diabetic status, eye affected, Schirmer tear test 1, rebound tonometry, type and frequency of topical antibiotic, use of topical sodium chloride, use and retention of BCL, and days until healed. RESULTS: A total of 237 dogs, each contributing one eye to the study, underwent DBD for SCCEDs. All eyes treated had estimated median ± standard error (SE) days to heal of 9.37 ± 0.42 days. When sodium chloride and BCL were utilized, ofloxacin had a significantly shorter median healing time when compared to oxytetracycline (adjusted P = 0.0158) and tobramycin (adjusted P = 0.0261). BCL use significantly improved healing times (P = 0.0002). Overall BCL retention rate was 62.02% (80 of 129). PureVision lenses were retained more often compared to Acrivet lenses (P < 0.0001). Overall, BCL retention significantly improved healing rates (P = <0.0001). CONCLUSIONS: Postdebridement antibiotic type or use of sodium chloride ointment had minor effects on healing rates. Bandage contact lens use and retention significantly improves healing times.

A General Method for High-Performance Li-Ion Battery Electrodes from Colloidal Nanoparticles without the Introduction of Binders or Conductive-Carbon Additives: The Cases of MnS, Cu(2-x)S, and Ge.

In this work, we demonstrate a general lithium-ion battery electrode fabrication method for colloidal nanoparticles (NPs) using electrophoretic deposition (EPD). Our process is capable of forming robust electrodes from copper sulfide, manganese sulfide, and germanium NPs without the use of additives such as polymeric binders and conductive agents. After EPD, we show two postprocessing treatments ((NH4)2S and inert atmosphere heating) to effectively remove surfactant ligands and create a linked network of particles. The NP films fabricated by this simple process exhibit excellent electrochemical performance as lithium-ion battery electrodes. Additive-free Cu(2-x)S and MnS NP films show well-defined plateaus at ∼1.7 V, demonstrating potential for use as cathode electrodes. Because of the absence of additives in the NP film, this additive-free NP film is an ideal template for ex situ analyses of the particles to track particle morphology changes and deterioration as a result of Li ion cycling. To this end, we perform a size-dependent investigation of Cu(2-x)S NPs and demonstrate that there is no significant relationship between size and capacity when comparing small (3.8 nm), medium (22 nm), and large (75 nm) diameter Cu(2-x)S NPs up to 50 cycles; however, the 75 nm NPs show higher Coulombic efficiency. Ex situ TEM analysis suggests that Cu(2-x)S NPs eventually break into smaller particles (<10 nm), explaining a weak correlation between size and performance. We also report for the first time on additive-free Ge NP films, which show stable capacities for up to 50 cycles at 750 mAh/g.

APHAKIC PHACOEMULSIFICATION AND AUTOMATED ANTERIOR VITRECTOMY, AND POSTRETURN MONITORING OF A REHABILITATED HARBOR SEAL (PHOCA VITULINA RICHARDSI) PUP.

A female harbor seal pup rescued along the coast of San Diego on 13 June 2012 was diagnosed with bilateral mature cataracts, apparently congenital, in association with vitreal herniation in the anterior chamber of each eye. The cataracts were surgically removed on 1 August 2012 with single-port aphakic phacoemulsification and automated anterior vitrectomy. Postoperative monitoring during the next several weeks indicated that vision had been functionally repaired and that she could visually orient to and capture live fish in three different environments and in the presence of other animals. Consequently, we equipped the seal with a satellite-linked radio transmitter and returned her to the Pacific Ocean on 21 November 2012, and then monitored her movements until radio contact ended on 2 March 2013. She remained along the San Diego coast from 21 November until 5 December 2012 when she relocated to the Coronado Islands and remained there until 26 December. She then traveled directly to San Clemente Island and remained foraging in the near-shore kelp beds there through 2 March 2013, when radio contact ended. To our knowledge, this is the first published report of cataract treatment in a marine mammal using high-frequency ultrasound to emulsify the lenses followed by suction removal of the emulsified microfragments (i.e., phacoemulsification). Moreover, the rapid postoperative recovery of the seal and its quick acclimation, orientation, navigation, and foraging in marine habitats after return to the Pacific Ocean indicates that these surgical procedures can be safe and effective treatments for cataracts in seals, with substantially reduced postsurgical complications relative to other types of lens fragmentation and removal procedures.

Efficacy of prophylactic antiglaucoma and anti-inflammatory medications in canine primary angle-closure glaucoma: a multicenter retrospective study (2004-2012).

PURPOSE: To evaluate long-term efficacy of antiglaucoma medications with or without combined topical anti-inflammatory treatment in preventing increased intraocular pressure and clinical signs of glaucoma in eyes considered at risk of the development of the disease. METHODS: Retrospective analysis identified 88 canine patients presenting with unilateral acute congestive primary angle-closure glaucoma (IOP > 25 mm Hg) and gonioscopic findings of pectinate ligament dysplasia and/or narrow or closed iridocorneal angle in the contralateral nonglaucomatous eye. Patients with histopathologic confirmation of pectinate ligament dysplasia or angle closure in the initial glaucomatous eye receiving prophylactic medical therapy in the contralateral eye were included. Time to medical failure for each antiglaucoma medication and efficacy of the combination therapy were evaluated. RESULTS: The most commonly affected pure-breds were the American Cocker Spaniel (20.4%) and Basset Hound (11.36%). The patients receiving demecarium bromide 0.125% had the longest estimated median time to medical failure at 330.0 days, followed by latanoprost 0.005%, dorzolamide hydrochloride 2.0%, and demecarium bromide 0.25% at 284.0 days, 272.5 days, and 143.0 days, respectively. The estimated median time to medical failure for patients receiving topical antiglaucoma and anti-inflammatory medication was 324.0 days versus 195.0 days in patients receiving antiglaucoma medication alone. Survival analysis showed no statistical significance. CONCLUSIONS: None of the four antiglaucoma medications evaluated statistically delayed medical failure when compared to each other. Although significance was not achieved, our data suggest that adjunctive use of topical anti-inflammatory medications may be beneficial in these cases.

Evaluation of intraorbital prosthetic pigmentation using 0.3 and 1.5 Tesla magnetic resonance imaging and computed tomography.

PURPOSE: To investigate the magnetic susceptibility artifact associated with pigmented intraorbital prosthetics when performing magnetic resonance imaging (MRI) and computed tomography (CT). Potential artifact reduction techniques were also investigated. STUDY DESIGN: Prospective study. METHODS: Five different-colored 20-millimeter small animal silicone intraorbital prosthetics and two equine prosthetics were evaluated using 0.3 and 1.5 Tesla (T) MRI and CT. MRI sequences included T1- (T1WI) and T2-weighted spin echo (T2WI), T2 gradient echo (T2*), short tau inversion recovery (STIR), and fluid-attenuated inversion recovery (FLAIR). When present, artifact size was measured using computerized software by three separate observers. Artifact reduction techniques included alterations in receiver bandwidth, field of view, slice thickness, and matrix size. RESULTS: The ferrous brown-pigmented prosthetic resulted in a magnetic susceptibility artifact with MRI. No artifact was observed on CT images. Interobserver variability was not statistically significant. For both the 0.3T and 1.5T MRI, the T2* sequence exhibited the largest artifact surface area followed by T2WI, T1WI, STIR, and FLAIR. Decreasing slice thickness showed a decrease in artifact size; however, this difference was not statistically significant. CONCLUSIONS: The ferrous substances in the brown intraorbital prosthetic resulted in a significant magnetic susceptibility artifact when performing MRI. Artifact reduction techniques did not significantly decrease artifact surface area. The use of ferrous brown-pigmented prosthetics and their potential to affect future MR imaging studies should be adequately discussed with pet owners.

Major breed distribution of canine patients enucleated or eviscerated due to glaucoma following routine cataract surgery as well as common histopathologic findings within enucleated globes.

PURPOSE: To identify the most significantly represented breeds that were enucleated or eviscerated due to intractable glaucoma following elective cataract surgery and to describe the major histopathologic features of enucleated globes. METHODS: A retrospective review of the Comparative Ocular Pathology Laboratory of Wisconsin database revealed 153 canine evisceration or enucleation submissions that met inclusion criteria. The most commonly represented breeds were identified, and enucleated globes of these breeds were further evaluated histologically (n = 69). Following standard hematoxylin & eosin staining, globes were evaluated for the presence of; corneal pathology, goniodysgenesis, pigment dispersion, pre-iridal fibrovascular membranes (PIFVMs), peripheral anterior, and/or posterior synechiation, inflammatory infiltrates, lens pathology, retinal pathology, and/or endophthalmitis. RESULTS: The most significantly represented breeds were the Cocker Spaniel (11.7%), Boston Terrier (10.5%), Labrador Retriever (6.5%), Bichon Frise (6.5%), Shih Tzu (5.8%), and Jack Russell Terrier (5.8%). Common histopathologic findings included inflammatory keratitis, the presence of PIFVMs, and lymphoplasmacytic uveal infiltrates. CONCLUSIONS: The Cocker Spaniel, Boston Terrier, Labrador Retriever, Bichon Frise, Shih Tzu, and Jack Russell Terrier may be at increased risk of the development of glaucoma following elective cataract surgery. These findings have potential clinical implications.

"Broken heart syndrome" after separation (from OxyContin).

We describe a 61-year-old woman with "broken heart syndrome" (Takotsubo-like cardiomyopathy) after abrupt postsurgical withdrawal of OxyContin. Her medical history was remarkable for long-term opiold dependence associated with the treatment of multi-Joint degenerative osteoarthritis. The patient presented to the emergency department 1 day after discharge from the hospital following total knee arthroplasty revision with acute-onset dyspnea and mild chest pain. She had precordial ST-segment elevation characteristic of acute myocardial infarction and elevated cardiac biomarkers. Emergency coronary angiography revealed no major coronary atherosclerosis. However, the left ventricular ejection fraction was severely decreased (26%), and new regional wall motion abnormalities typical of broken heart syndrome were noted. In addition to resuming her opioid therapy, she was treated supportively with bilevel positive airway pressure, diuretic therapy, morphine, aspirin, metoprolol, enalaprilat, intravenous heparin, nitroglycerin infusion, and dopamine infusion. Ventricular systolic function recovered completely by the fourth hospital day. To our knowledge, broken heart syndrome after opioid withdrawal has not been reported previously in an adult. Our case illustrates the importance of continuing adequate opiate therapy perioperatively in the increasing number of opioid-dependent patients to prevent potentially life-threatening complications such as broken heart syndrome.

Planning and implementing image delivery to outpatient specialty clinical practices in a large medical center.

Softcopy image viewing using web-based technologies has been deployed to 3 specialty outpatient practices - Lung Center, Neurosurgery, Orthopedic Surgery - where films remain available. Physicians and staff use Philips Easyweb (a web-based image browser) and BJC HealthCare ClinDesk (a Java-based electronic patient record) clients in patient examination rooms and physician workrooms to retrieve images from a Mitra image server. Practice-specific planning and training preceded deployment; on-site training and support came with deployment; on-site and telephone support are available as needed. Softcopy viewing generally is accepted although a few physicians continue to use films. The unavailability of studies performed before the introduction of the image server remains an issue until the server builds a suitable archive. Softcopy-based clinical-image viewing can be supported with web-based technologies, but effective practice-specific planning, training, and technical support are crucial to successful deployment to those accepting softcopy image viewing.

Enhanced interfaces for web-based enterprise-wide image distribution.

Modern Web browsers support image distribution with two shortcomings: (1) image grayscale presentation at client workstations is often sub-optimal and generally inconsistent with the presentation state on diagnostic workstations and (2) an Electronic Patient Record (EPR) application usually cannot directly access images with an integrated viewer. We have modified our EPR and our Web-based image-distribution system to allow access to images from within the EPR. In addition, at the client workstation, a grayscale transformation is performed that consists of two components: a client-display-specific component based on the characteristic display function of the class of display system, and a modality-specific transformation that is downloaded with every image. The described techniques have been implemented in our institution and currently support enterprise-wide clinical image distribution. The effectiveness of the techniques is reviewed.