Implications of Measles Inclusion by Commercial Syndromic Polymerase Chain Reaction Panels - United States, May 2022-April 2023.

Syndromic polymerase chain reaction (PCR) panels are used to test for pathogens that can cause rash illnesses, including measles. Rash illnesses have infectious and noninfectious causes, and approximately 5% of persons experience a rash 7-10 days after receipt of a measles, mumps, and rubella (MMR) vaccine. MMR vaccine includes live attenuated measles virus, which is detectable by PCR tests. No evidence exists of person-to-person transmission of measles vaccine virus, and illness does not typically result among immunocompetent persons. During September 2022-January 2023, the Tennessee Department of Health received two reports of measles detected by syndromic PCR panels. Both reports involved children (aged 1 and 6 years) without known risk factors for measles, who were evaluated for rash that occurred 11-13 days after routine MMR vaccination. After public health responses in Tennessee determined that both PCR panels had detected measles vaccine virus, six state health departments collaborated to assess the frequency and characteristics of persons receiving a positive measles PCR panel test result in the United States. Information was retrospectively collected from a commercial laboratory testing for measles in syndromic multiplex PCR panels. During May 2022-April 2023, among 1,548 syndromic PCR panels, 17 (1.1%) returned positive test results for measles virus. Among 14 persons who received a positive test result and for whom vaccination and case investigation information were available, all had received MMR vaccine a median of 12 days before specimen collection, and none had known risk factors for acquiring measles. All positive PCR results were attributed to detection of measles vaccine virus. Increased awareness among health care providers about potential measles detection by PCR after vaccination is needed. Any detection of measles virus by syndromic PCR testing should be immediately reported to public health agencies, which can use measles vaccination history and assessment of risk factors to determine the appropriate public health response. If a person recently received MMR vaccine and has no risk factors for acquiring measles, additional public health response is likely unnecessary.

Food and Drug Administration Approval of Artesunate for Severe Malaria: Enough to Achieve Best Practice?

Intravenous artesunate has been the global standard of care for severe malaria for over 2 decades. Yet, until recently, artesunate has only been available to patients through an expanded-access protocol from the Centers for Disease Control and Prevention. In May 2020, the Food and Drug Administration approved artesunate, allowing US hospitals to stock the drug and ensuring prompt treatment for this life-threatening infection. However, because of artesunate's high cost and the infrequency of severe malaria in the United States, hospitals may be reluctant to stock the drug. As US health systems weigh the decision to stock artesunate, we propose a hospital tier framework to inform this decision and support clinicians caring for patients who present with severe malaria.

Si-H Bond Activation and Dehydrogenative Coupling of Silanes across the Iron-Amide Bond of a Bis(amido)bis(phosphine) Iron(II) Complex.

Despite the utility of Si-Si bonds, there are relatively few examples of Si-Si bond formation by base metals. In this work, a four-coordinate iron complex, (PNNP)FeII, is shown to strongly activate the Si-H bonds in primary silanes across the Fe-amide bonds in a metal-ligand cooperative fashion. Upon treatment with excess silane, Si-Si dehydrogenative homocoupling is shown to occur across the Fe-Namide bond without concomitant oxidation and spin state changes at the Fe center.

Early and Increased Influenza Activity Among Children - Tennessee, 2022-23 Influenza Season.

Influenza seasons typically begin in October and peak between December and February (1); however, the 2022-23 influenza season in Tennessee began in late September and was characterized by high pediatric hospitalization rates during November. This report describes a field investigation conducted in Tennessee during November 2022, following reports of increasing influenza hospitalizations. Data from surveillance networks, patient surveys, and whole genome sequencing of influenza virus specimens were analyzed to assess influenza activity and secondary illness risk. Influenza activity increased earlier than usual among all age groups, and rates of influenza-associated hospitalization among children were high in November, reaching 12.6 per 100,000 in children aged <5 years, comparable to peak levels typically seen in high-severity seasons. Circulating influenza viruses were genetically similar to vaccine components. Among persons who received testing for influenza at outpatient clinics, children were twice as likely to receive a positive influenza test result as were adults. Among household contacts exposed to someone with influenza, children were more than twice as likely to become ill compared with adults. As the influenza season continues, it is important for all persons, especially those at higher risk for severe disease, to protect themselves from influenza. To prevent influenza and severe influenza complications, all persons aged ≥6 months should get vaccinated, avoid contact with ill persons, and take influenza antivirals if recommended and prescribed.

One Bridge, Three Bonds: A Frontier in Multiple Bonding in Heterobimetallic Complexes.

A single bridging phosphinoamide ligand was shown to support a metal-metal triple bond in a Zr/Co heterobimetallic complex. The similarity of the bonding in this compound to previously synthesized Zr/Co species, and therefore the assignment of the Zr/Co triple bond, is supported by the structural parameters of the complex, the electronic structure predicted by density functional theory, and complete-active-space self-consistent-field (CASSCF) calculations. This demonstrates that metal-metal multiple bonds can be realized in heterobimetallic complexes without multiple bridging ligands to enforce the proximity of the two metals.

Synthesis, Characterization, and Reactivity of a (PPP) Pincer-Ligated Manganese Carbonyl Complex: Polarity Reversal Imparted by the Electrophilic Nature of a Planar Mn-P(NR2)2 Fragment.

The bonding interactions of a synthesized pincer-ligated manganese dicarbonyl complex featuring an N-heterocyclic phosphenium (NHP+) central moiety are explored. The pincer ligand [PPP]Cl was coordinated to a manganese center using Mn(CO)5Br and 254 nm light to afford the chlorophosphine complex (PPClP)Mn(CO)2Br (2) as a mixture of halide exchange products and stereoisomers. The target dicarbonyl species (PPP)Mn(CO)2 (3) was prepared by treatment of 2 with 2 equiv of the reductant KC8. Computational investigations and analysis of structural parameters were used to elucidate multiple bonding interactions between the Mn center and the PNHP atom in 3. The generation of a product of formal H2 addition, (PPHP)Mn(CO)2H (4), was achieved through the dehydrogenation of NH3BH3, affording a 2:1 mixture of 4syn:4anti stereoisomers. The nucleophilic nature of the Mn center and the electrophilic nature of the PNHP moiety were demonstrated through hydride addition and protonation of 3 to produce K(THF)2[(PPHP)Mn(CO)2] (6) and (PPClP)Mn(CO)2H (5), respectively. The observed reactivity suggests that 3 is best described as a Mn-I/NHP+ complex, in contrast to pincer-ligated dicarbonyl manganese analogues typically assigned as MnI species.

Electronic and Structural Variations of a Nickel(0) N-Heterocyclic Phosphenium Complex in Comparison to Group 10 Analogues.

The bonding interactions and electronic structure of a diphosphine pincer ligand featuring an N-heterocyclic phosphenium/phosphido (NHP±) central moiety with nickel are explored. Treating Ni(COD)2 with the pincer ligand [PPP]Cl in the presence of a two-electron phosphine donor ligand PMe3 generates chlorophosphine complex (PPClP)Ni(PMe3) (2a). The cationic Ni complex [(PPP)Ni(PMe3)][BPh4] (3a) can be prepared by subsequent halide abstraction from 2a with NaBPh4. The assignment of 3a as a Ni0/NHP+ complex, based on analysis of structural parameters and computational investigations, lies in contrast to its previously reported group 10 MII/NHP- (M = Pd, Pt) analogues. The activation of O-H bonds across the Ni-PNHP bond is demonstrated by the addition of isopropanol to afford the metal hydride species [(PPOiPrP)Ni(PMe3)(H)][BPh4] (4). Notably, the installation of a P-H bond in the NHP unit by treatment of 2a with LiAlH4 yields (PPHP)Ni(PMe3) (6). The ambiphilic nature of the P-H bond was demonstrated through reactivity studies of P-H bond cleavage in comparison to a Pd analogue (PPHP)Pd(PPh3) (8).

Antifungal drug price increases in the United States, 2000-2019.

BACKGROUND: Antifungal drugs treat a variety of conditions, ranging from localised dermatologic disease to life-threatening systemic infections. Some common antifungal drugs experienced large price increases in recent years, however, factors contributing to these price increases are poorly understood. We sought to examine trends in antifungal drug prices and determine underlying drivers of price changes. METHODS: Antifungal drug products in the United States were identified using the Food and Drug Administration (FDA) Label database. For each product, we determined the wholesale acquisition cost per unit over time between 2000 and 2019, adjusting for inflation, and examined variables that could impact price: route of administration, number of FDA indications, the quantity of professional guideline recommendations, use for prophylaxis, number of FDA-approved manufacturers, and whether it was compounded. Price trajectories were clustered into four groups: (1) stable, 2) moderate, (3) high, and (4) extreme price increases. RESULTS: Of 139 identified drug products, one outlier was removed due to exorbitant price increases. Cluster 1 (n = 31) demonstrated the most stable prices with a 25% mean price increase. Clusters 2 (n = 97), 3 (n = 7), and 4 (n = 3) demonstrated moderate, high, and extreme price increases with 52%, 318%, and 900% mean price increases, respectively. Atypical routes of administration and compounding were over-represented in clusters 3 and 4. There was no correlation between the number of manufacturers and price changes. CONCLUSIONS: Antifungal drugs exhibited large, inflation-adjusted price increases. Atypical routes of administration and compounding were over-represented within clusters exhibiting extraordinary price increases. Our data support policies aiming to curb large price increases for medically important drugs.

Hospital pharmacy acquisition of nonstocked antimicrobials-current processes and areas for improvement.

BACKGROUND: The delivery of prompt and appropriate antimicrobial therapy for life-threatening infections is an important antimicrobial stewardship measure and a priority for hospitals. OBJECTIVES: To better understand U.S. hospital pharmacy stocking processes and acquisition of nonstocked antimicrobials and to identify strategies for improving this process. METHODS: This mixed-methods study recruited infectious diseases and antimicrobial stewardship pharmacists. Semistructured interviews with pharmacists in Minnesota were conducted via video conferencing software from January 21, 2021, to March 17, 2021. Audio recordings of the interviews guided survey development and were also transcribed, coded, and qualitatively analyzed. Surveys were distributed throughout the United States via an e-mail listserv, and responses were collected between August 5, 2021, and September 15, 2021. RESULTS: Ten interviews and 78 surveys were included in the analysis. Formulary and stocking practices varied based on institution. Stocking decisions were most frequently based on the frequency of use, clinical utility, and cost of antimicrobials. Nonstocked antimicrobials were often ordered from the wholesale distributor but, if needed urgently, acquired from another local institution. Antibacterial agents were the most frequently needed nonstocked antimicrobials, especially those targeting multidrug-resistant gram-negative bacteria. When acquiring nonstocked antimicrobials, barriers include process inefficiencies, cost, availability, and safety concerns. Improved information sharing between local institutions may help improve this process. CONCLUSION: In this exploratory study, antimicrobial stocking practices varied within U.S. hospitals. Acquisition of nonstocked, urgently needed antimicrobials from neighboring hospitals may be common; however, this process lacks guidance and is often inefficient. Establishing better mechanisms for information sharing may improve this process and should be explored.

Nickel-Templated Replacement of Phosphine Substituents in a Tetradentate Bis(amido)bis(phosphine) Ligand.

The replacement of phosphine substituents in nickel-bound PNNP ligands is reported as an alternative method for preparing multidentate phosphine ligands with alkyl substituents. Treatment of the previously reported bis(phosphide) complex {K(THF)x}22Ph[PNNP]Ni (2) with 2 equiv of MeI, iPrI, and 1,3-dibromoethane formed alkyl-substituted complexes 2Ph,2Me[PNNP]Ni (3), 2Ph,2iPr[PNNP]Ni (4), and 2Ph,propylene[PNNP]Ni (5), respectively. The stereoselectivity (racemic vs meso) of these reactions can be controlled by varying the reaction temperature. The racemic mixtures of products with the new alkyl substituents in an anti configuration were favored at lower temperatures, whereas a larger proportion of meso compounds was acquired at higher temperatures. Further treatment of 3 with KH resulted in selective elimination of the remaining phenyl groups rather than the methyl substituents, affording bis(methylphosphide) complex {K(THF)x}22Me[PNNP]Ni (6). Subsequent treatment of 6 with additional MeI formed 4Me[PNNP]Ni (7), in which all four phenyl groups were replaced with methyl substituents. As a proof of concept, demetalation of the ligand from 7 was achieved using aqueous KCN to form a free dimethylphosphine-substituted ligand H24Me[PNNP] (8), and 8 was subsequently coordinated to a different metal, using PdCl2 to form 4Me[PNNP]Pd (9). Unlike the clean elimination of phenyl substituents from 3, the reactions of KH with 4 and 5 exhibited competitive elimination of both alkyl and phenyl substituents and/or attenuated reactivity.

A Nickel-Doped Dehydrobenzoannulene-Based Two-Dimensional Covalent Organic Framework for the Reductive Cleavage of Inert Aryl C-S Bonds.

The development of metalated covalent organic frameworks (COFs) is useful for generating recyclable catalytic systems for practical applications. Herein, we report the synthesis, characterization, and catalytic properties of an azine-linked two-dimensional (2D) COF containing nickel-doped dehydrobenzoannulene (DBA) units. We demonstrate that Ni-DBA-2D-COF can be used to reductively cleave the aryl C-S bonds of several organosulfur compounds utilizing dimethylethylsilane as the reducing agent. The Ni-DBA-2D-COF catalytic system displays excellent recyclability and good yields. This work highlights a rare example of utilizing metalated DBA complexes to perform catalytic transformations.

Insights into Molecular Magnetism in Metal-Metal Bonded Systems as Revealed by a Spectroscopic and Computational Analysis of Diiron Complexes.

A pair of bimetallic compounds featuring Fe-Fe bonds, [Fe(iPrNPPh2)3FeR] (R = PMe3, ≡NtBu), have been investigated using High-Frequency Electron Paramagnetic Resonance (HFEPR) as well as field- and temperature-dependent 57Fe nuclear γ resonance (Mössbauer) spectroscopy. To gain insight into the local site electronic structure, we have concurrently studied a compound containing a single Fe(II) in a geometry analogous to that of one of the dimer sites. Our spectroscopic studies have allowed for the assessment of the electronic structure via the determination of the zero-field splitting and 57Fe hyperfine parameters for the entire series. We also report on our efforts to correlate structure with physical properties in metal-metal bonded systems using ligand field theory guided by quantum chemical calculations. Through the insight gained in this study, we discuss strategies for the design of single-molecule magnets based on polymetallic compounds linked via direct metal-metal bonds.

A Series of Dimeric Cobalt Complexes Bridged by N-Heterocyclic Phosphido Ligands.

A tridentate [PPP] ligand has been used to construct a series of dimeric cobalt complexes and explore cooperative multielectron redox processes that are both metal- and ligand-centered. Reduction of (PPClP)CoCl2 (1) with excess magnesium affords the CoICoI N-heterocyclic phosphido (NHP-)-bridged symmetric dimer [(µ-PPP)Co]2 (2). Two-electron oxidation of 2 with FcPF6 generates an asymmetrically bridged dication [(µ-PPP)Co]2[PF6]2 (3) in which the oxidation has occurred in a delocalized fashion throughout the Co2P2 core. In contrast, [(µ-PPP)Co]2+ (5), which can be generated either by one-electron oxidation of 2 with FcPF6 or comportionation of 2 and 3, features an asymmetric geometry and localized mixed valence. Treatment of 1 with the milder reductants CoCp2 and KBEt3H does not lead to formation of 2, 3, or 5 but instead generates dimeric species [(PPP)CoCl]2 (6) and [(PPP)CoH]2 (7). Unlike 2-5, where the phosphine side arms of the tridentate [PPP] ligand span the two Co centers, complex 6 and 7 are connected solely by NHP- ligands that bridge the two (PPP)Co fragments.

O2 Activation by a Heterobimetallic Zr/Co Complex.

Oxygen reduction is a critical half reaction in renewable fuel cell development and a key step in the development of aerobic oxidation reactions. Herein, we report rapid two-electron O2 reduction by a d0 ZrIV center with an appended redox-active Co-I site serving as an electron reservoir. The early/late heterobimetallic Zr/Co complex (THF)Zr(MesNP iPr2)3CoCN tBu (1) reacts readily with O2 and O atom transfer reagents to generate reactive oxygenated species including terminal peroxo and oxo complexes, (O2)Zr(MesNP iPr2)3CoCN tBu (2) and O≡Zr(MesNP iPr2)3CoCN tBu (3). The bimetallic Zr/Co complex provides a new cooperative synthetic pathway to promote multielectron redox processes such as oxygen reduction, with each metal playing a distinct role as a substrate binding site or redox mediator.

Assessing the Metal-Metal Interactions in a Series of Heterobimetallic Nb/M Complexes (M = Fe, Co, Ni, Cu) and Their Effect on Multielectron Redox Properties.

A one-pot synthetic procedure for a series of bimetallic Nb/M complexes, Cl-Nb( iPrNPPh2)3M-X (M = Fe (2), Ni (4), Cu (5)), is described. A similar procedure aimed at synthesizing a Nb/Co analogue instead affords iPrN═Nb( iPrNPPh2)2(µ-PPh2)Co-I (3) through cleavage of one phosphinoamide P-N bond under reducing conditions. Complexes 4 and 5 are found to have short Nb-M distances, corresponding to unusual metal-metal bonds between Nb and these first row transition metals. For comparison, a series of heterobimetallic O≡Nb( iPrNPPh2)3M-X complexes (M = Fe (7), Co (8), Ni (9), Cu (10)) was synthesized. In these complexes, the NbV center is engaged in sufficient π-bonding to the terminal oxo ligand to remove the driving force for direct metal-metal interactions. A comparison of the cyclic voltammograms of 2 and 4-10 reveals that the presence of a second metal shifts the redox potentials of both Nb and the late metal center anodically, even when direct metal-metal interactions are not present.

Probing Fe-V Bonding in a C3-Symmetric Heterobimetallic Complex.

Direct metal-metal bonding of two distinct first-row transition metals remains relatively unexplored compared to their second- and third-row heterobimetallic counterparts. Herein, a recently reported Fe-V triply bonded species, [V( iPrNPPh2)3FeI] (1; Kuppuswamy, S.; Powers, T. M.; Krogman, J. P.; Bezpalko, M. W.; Foxman, B. M.; Thomas, C. M. Vanadium-iron complexes featuring metal-metal multiple bonds. Chem. Sci. 2013, 4, 3557-3565), is investigated using high-frequency electron paramagnetic resonance, field- and temperature-dependent 57Fe nuclear gamma resonance (Mössbauer) spectroscopy, and high-field electron-electron double resonance detected nuclear magnetic resonance. From the use of this suite of physical methods, we have assessed the electronic structure of 1. These studies allow us to establish the effective g̃ tensors as well as the Fe/V electro-nuclear hyperfine interaction tensors of the spin S = 1/2 ground state. We have rationalized these tensors in the context of ligand field theory supported by quantum chemical calculations. This theoretical analysis suggests that the S = 1/2 ground state originates from a single unpaired electron predominately localized on the Fe site.

Addition of H2 Across a Cobalt-Phosphorus Bond.

Addition of H2 across the cobalt-phosphorus bond of (PPP)CoPMe3 (3) is demonstrated, where PPP is a monoanionic diphosphine pincer ligand with a central N-heterocyclic phosphido (NHP- ) donor. The chlorophosphine CoII complex (PPCl P)CoCl2 (2) can be generated through coordination of the chlorophosphine ligand (PPCl P, 1) to CoCl2 . Subsequent reduction of 2 with KC8 in the presence of PMe3 generates (PPP)CoPMe3 (3), in which both the phosphorus and cobalt centers have been reduced. The addition of 1 atm of H2 to complex 3 cleanly affords (PPH P)Co(H)PMe3 (4), in which H2 has ultimately been added across the metal-phosphorus bond. Complex 4 was characterized spectroscopically and using computational methods to predict its geometry.

Heterobimetallic Complexes Comprised of Nb and Fe: Isolation of a Coordinatively Unsaturated NbIII/Fe0 Bimetallic Complex Featuring a Nb≡Fe Triple Bond.

Heterometallic multiple bonds between niobium and other transition metals have not been reported to date, likely owing to the highly reactive nature of low-valent niobium centers. Herein, a C3-symmetric tris(phosphinoamide) ligand framework is used to construct a Nb/Fe heterobimetallic complex Cl-Nb(iPrNPPh2)3Fe-Br (2), which features a Fe→Nb dative bond with a metal-metal distance of 2.4269(4) Å. Reduction of 2 in the presence of PMe3 affords Nb(iPrNPPh2)3Fe-PMe3 (6), a compound with an unusual trigonal pyramidal geometry at a NbIII center, a Nb≡Fe triple bond, and the shortest bond distance (2.1446(8) Å) ever reported between Nb and any other transition metal. Complex 6 is thermally unstable and degrades via P-N bond cleavage to form a NbV═NR imide complex, iPrN═Nb(iPrNPPh2)3Fe-PMe3 (9). The heterobimetallic complexes iPrN═Nb(iPrNPPh2)3Fe-Br (8) and 9 are independently synthesized, revealing that the strongly π-bonding imido functionality prevents significant metal-metal interactions. The 57Fe Mössbauer spectra of 2, 6, 8, and 9 show a clear trend in isomer shift (δ), with a decrease in δ as metal-metal interactions become stronger and the Fe center is reduced. The electronic structure and metal-metal bonding of 2, 6, 8, and 9 are explored through computational studies, and cyclic voltammetry is used to better understand the effect of metal-metal interaction in early/late heterobimetallic complexes on the redox properties of the two metals involved.

Cobalt N-Heterocyclic Phosphenium Complexes Stabilized by a Chelating Framework: Synthesis and Redox Properties.

Two cobalt complexes containing coordinated N-heterocyclic phosphenium (NHP+) ligands are synthesized using a bidentate NHP+/phosphine chelating ligand, [PP]+. Treatment of Na[Co(CO)4] with the chlorophosphine precursor [PP]Cl (1) affords [PP]Co(CO)2 (2), which features a planar geometry at the NHP+ phosphorus center and a short Co-P distance [1.9922(4) Å] indicative of a Co═P double bond. The more electron-rich complex [PP]Co(PMe3)2 (3), which is synthesized in a one-pot reduction procedure with 1, CoCl2, PMe3, and KC8, has an even shorter Co-P bond [1.9455(6) Å] owing to stronger metal-to-phosphorus back-donation. The redox properties of 2 and 3 were explored using cyclic voltammetry, and oxidation of 3 was achieved to afford [[PP]Co(PMe3)2]+ (4). The electron paramagnetic resonance spectrum of complex 4 features hyperfine coupling to both 59Co and 31P, suggesting strong delocalization of the unpaired electron density in this complex. Density functional theory calculations are used to further explore the bonding and redox behavior of complexes 2-4, shedding light on the potential for redox noninnocent behavior of NHP+ ligands.