Inactivation of HCoV-NL63 and SARS-CoV-2 in aqueous solution by 254 nm UV-C.

Ultraviolet germicidal irradiation (UVGI) is a highly effective means of inactivating many bacteria, viruses, and fungi. UVGI is an attractive viral mitigation strategy against coronaviruses, including the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), the cause of the coronavirus disease-2019 (COVID-19) pandemic. This investigation measures the susceptibility of two human coronaviruses to inactivation by 254 nm UV-C radiation. Human coronavirus NL63 and SARS-CoV-2 were irradiated in a collimated, dual-beam, aqueous UV reactor. By measuring fluence and integrating it in real-time, this reactor accounts for the lamp output transients during UVGI exposures. The inactivation rate constants of a one-stage exponential decay model were determined to be 2.050 cm2/mJ and 2.098 cm2/mJ for the NL63 and SARS-CoV-2 viruses, respectively. The inactivation rate constant for SARS-CoV-2 is within 2% of that of NL63, indicating that in identical inactivation environments, very similar UV 254 nm deactivation susceptibilities for these two coronaviruses would be achieved. Given the inactivation rate constant obtained in this study, doses of 1.1 mJ/cm2, 2.2 mJ/cm2, and 3.3 mJ/cm2 would result in a 90%, 99%, and 99.9% inactivation of the SARS-CoV-2 virus, respectively. The inactivation rate constant obtained in this study is significantly higher than values reported from many 254 nm studies, which suggests greater UV susceptibility to the UV-C than what was believed. Overall, results from this study indicate that 254 nm UV-C is effective for inactivation of human coronaviruses, including SARS-CoV-2.

Looking the Part: Stereotypicality in Appearance Among White Professionals Predicts Leadership Attainment and Perceived Leadership Suitability.

This project explores the effects of racial phenotypic stereotypicality, or the degree to which a person's appearance is perceived as typical of their racial group, on leadership outcomes. Building on research showing that people hold an image of the ideal leader as a White person, we propose that looking more typically White may facilitate leadership attainment. In Study 1, which used a sample of American college football coaches (N = 1,106), White (vs. Black) coaches were more likely to occupy leadership roles. Furthermore, within race, stereotypicality positively predicted occupying a leadership or head-coach role among White professionals (and negatively predicted occupying a head-coach role among Black professionals). Study 2 elucidated a possible mechanism by showing a causal effect of stereotypicality on perceived suitability for leadership among Whites. These findings advance theorizing on the White-leader link and have implications for the ability of people of color to access lucrative professional roles.

Utilization of Prophylactic Antibiotics After Nasal Packing for Epistaxis.

BACKGROUND: There have been few investigations examining the benefits, consequences, and patterns of use for prophylactic antibiotics for nasal packing in the emergency department setting. Given the frequency of epistaxis in the emergency department, it is an ideal setting to study the efficacy and utilization patterns of prophylactic antibiotics in nasal packing. OBJECTIVE: Our aim was to assess both rates of utilization and evidence of benefit for prophylactic antibiotics in patients with nasal packing for epistaxis. METHODS: A single-institution retrospective review of 275 cases of anterior nasal packing in an urban emergency department between September 2013 and April 2017 was performed. Chi-square statistical analysis was used to evaluate results. RESULTS: Among 275 cases studied, there were no instances of toxic shock syndrome. Roughly 73% of patients with nonabsorbable packing received prophylactic antibiotics. Only one (1.1%) case of sinusitis was noted among the nonabsorbable packing with prophylaxis group, with no such complication in the nonprophylaxis group. In contrast, 95% of patients with absorbable nasal packing were not given prophylactic antibiotics. Analysis of all cases given prophylactic antibiotics vs. no prophylaxis, regardless of packing type, revealed no statistically significant difference in the development of acute sinusitis (1% vs. 0.56%; p = 0.6793). CONCLUSIONS: There was no observed advantage or disadvantage to using prophylactic antibiotics in anterior nasal packing in the emergency department, regardless of whether patients received absorbable or nonabsorbable packing. However, patients who receive nonabsorbable nasal packing were more likely to receive antibiotic prophylaxis.

Massive Gastrointestinal Hemorrhage.

Massive gastrointestinal hemorrhage is a life-threatening condition that can result from numerous causes and requires skilled resuscitation to decrease patient morbidity and mortality. Successful resuscitation begins with placement of large-bore intravenous or intraosseous access; early blood product administration; and early consultation with a gastroenterologist, interventional radiologist, and/or surgeon. Activate a massive transfusion protocol when initial red blood cell transfusion does not restore effective perfusion or the patient's shock index is greater than 1.0. Promptly reverse coagulopathies secondary to oral anticoagulant or antiplatelet use. Use thromboelastography or rotational thromboelastometry to guide further transfusions. Secure a definitive airway and minimize aspiration.

FOAM Impact: The Influence of Open-access Medical Education on Practice Uptake.

OBJECTIVES: The FOAM Impact study sought to examine baseline rates of intravenous (IV) lidocaine usage for the treatment of renal colic and to compare rates of use between FOAM utilizers and nonutilizers. We sought to measure the effect of FOAM resources on clinical practice by timing the release of FOAM content with publication of the LIDOKET trial. METHODS: A cross-sectional before-and-after survey was conducted and disseminated on two social media platforms. The 13-question, anonymous survey was posted for 1 week prior following the release of the LIDOKET study. Descriptive statistics, Mann-Whitney t-test, and chi-square test statistics were used to describe survey respondent characteristics and Likert responses. RESULTS: There were a total of 472 survey respondents. A total of 321 physicians (75.7% of total respondents) provided pre- and postpublication survey answers. There was no significant change in the use of analgesics before and after publication of LIDOKET and concurrent REBEL EM blog post. A total of 197 (42%) survey respondents reported using lidocaine for renal colic, of which 60 respondents (13%) reported frequent or occasional use. The mean difference in perceived efficacy of lidocaine before and after publication was -0.30 (95% confidence interval [CI] = -0.80 to 0.19, p = 0.15). Being a FOAM user was not associated with changes in mean difference in perception of lidocaine efficacy (F = 0.127, p = 0.72); however, there was a significant difference in perception of lidocaine's efficacy following LIDOKET and REBEL EM publication (F = 4.718, p = 0.03). CONCLUSIONS: Using an online survey-based technique, no appreciable impact of FOAM resources was immediately apparent; however, engagement with FOAM was associated with a change in perception of IV lidocaine's efficacy. To our knowledge, this is the first study of its kind to evaluate the impact of FOAM on clinical practice. The unique method of coordinating FOAM distribution with traditional medical publication may provide future opportunities for measuring the impact of asynchronous medical education resources on medical practice.

Suction Assisted Laryngoscopy and Airway Decontamination (SALAD): A technique for improved emergency airway management.

Emergency airway management is often complicated by the presence of blood, emesis or other contaminants in the airway. Traditional airway management education has lacked task-specific training focused on mitigating massive airway contamination. The Suction Assisted Laryngoscopy and Airway Decontamination (SALAD) technique was developed in order to address the problem of massive airway contamination both in simulation training and in vivo. We review the evidence describing the dangers associated with airway contamination, and describe the SALAD technique in detail.

Evidence-Informed Practice: Diagnostic Questions in Urinary Tract Infections in the Elderly.

INTRODUCTION: Routine interventions in the practice of medicine often lack definitive evidence or are based on evidence that is either not high quality or of only modest-to-marginal effect sizes. An abnormal urinalysis in an elderly patient presenting to the emergency department (ED) with non-specific symptoms represents one condition that requires an evidence-informed approach to diagnosis and management of either asymptomatic bacteriuria or urinary tract infection (UTI). The emergency provider often will not have access to urine cultures, and the risks associated with antibiotic use in the elderly are not without potentially significant side effects. METHODS: We performed a historical and clinical review of the growing body of literature suggesting measurable differences in the systemic immune response manifest among patients with asymptomatic pyuria and UTI, including increases in the pro-inflammatory cytokine interleukin-6 and the acute phase reactant procalcitonin. RESULTS: Serum procalcitonin, a peptide that undergoes proteolysis into calcitonin, has been demonstrated to quickly and reliably rise in patients with severe bacterial infections, and may serve as a potentially sensitive and specific marker for identification of bacterial illness. CONCLUSION: In the absence of validated risk scores for diagnosing UTI in elderly patients presenting to the ED, there may be a role for the use of procalcitonin in this patient population.

A New Paradigm Shift in Acute Ischemic Stroke, Large Vessel Occlusions, and Endovascular Therapy.

BACKGROUND: In the past three years, there have been several major studies published on the use of endovascular therapy (EVT) in large vessel occlusion (LVO) acute ischemic stroke. With multiple publications in such a short amount of time, it is difficult to keep up with the evolving landscape of ischemic stroke therapy. OBJECTIVE: This narrative review discusses recent randomized controlled trials evaluating EVT and its effects on acute ischemic stroke management. DISCUSSION: Ischemic stroke is the most common type of stroke overall, and recanalization is the predominant focus in stroke therapy to improve outcomes. Treatment first focused on systemic thrombolysis for ischemic stroke, followed by studies evaluating the use of thrombolysis with EVT. Early research did not find a benefit to EVT; however, recent studies using current devices and with narrow selection criteria demonstrate significant benefit to EVT in LVOs. In patients with LVOs and perfusion mismatches, reperfusion rates are higher with EVT compared with systemic thrombolysis alone. Recognition of patients with small infarct cores and large areas of ischemic but salvageable brain tissue up to 24 h after symptom onset stresses the need for advanced imaging to recognize the target group. CONCLUSIONS: EVT technology for acute ischemic stroke has now become more efficient, minimizing complications and improving the efficacy of EVT. Several viable interventions for a small subgroup of patients with ischemic stroke up to 24 h after symptoms onset can significantly improve patient outcomes.

Dynamic stabilization of the Rayleigh-Bénard instability by acceleration modulation.

This paper presents the results of an experimental investigation of the parametric stabilization of Rayleigh-Bénard convection through the imposition of sinusoidal vibration. The ability to dynamically stabilize Rayleigh-Bénard convection using acceleration modulation is of interest to groups who design and study thermoacoustic machines as the introduction of parasitic convection can have deleterious effects on the desired operation and thermodynamic efficiency of the device. These performance issues caused by suspected convective instability have been seen both in traveling wave thermoacoustic refrigerators and cryogenic pulse tube chillers. This paper reports the results of an experiment intended to determine the vibratory, fluidic, and geometric conditions under which a small, rectangular container of statically unstable fluid may be stabilized by vertical vibration with comparison to the computational methods of R. M. Carbo [J. Acoust. Soc. Am. 135, 654-668 (2014)]. Measurements are obtained using a large-displacement kinematic shaker of an original design with the convecting gas characterized using both thermal transport measurements and flow visualization employing tracer particles illuminated by a diode laser light sheet phase-locked to the shaker. These experiments are believed to be the first demonstrating the suppression of convection through vibration in rectangular containers.