Utilization of thromboelastography and a low molecular weight heparin anti-Xa assay for guidance in apixaban reversal: A case report.

Reversal of oral factor Xa (FXa) inhibitors, such as apixaban, remains a controversial topic. However, the controversy goes beyond what reversal agent to utilize. Often times these patients present with an acute major bleed and are difficult to assess whether reversal is warranted or not. Furthermore, it is difficult to assess whether reversal was successful in a timely manner. A paucity of literature exists regarding the utilization of low molecular weight heparin (LMWH) anti-Xa assays and thromboelastography for identifying coagulopathies associated with oral FXa inhibitors. We report a case of apixaban induced coagulopathy utilizing thromboelastography and a LMWH anti-Xa assay as a guide for reversal.

Assessing Challenges of 2D-Molybdenum Ditelluride for Efficient Hydrogen Generation in a Full-Scale Proton Exchange Membrane (PEM) Water Electrolyzer.

Proton exchange membrane (PEM) water electrolyzers are critical enablers for sustainable green hydrogen production due to their high efficiency. However, nonplatinum catalysts are rarely evaluated under actual electrolyzer operating conditions, limiting knowledge of their feasibility for H2 production at scale. In this work, metallic 1T'-MoTe2 films were synthesized on carbon cloth supports via chemical vapor deposition and tested as cathodes in PEM electrolysis. Initial three-electrode tests revealed that at 100 mA cm-2, the overpotential of 1T'-MoTe2 approached that of leading 1T'-MoS2 systems, confirming its promise as a hydrogen evolution catalyst. However, when tested in a full-scale PEM electrolyzer, 1T'-MoTe2 delivered only 150 mA cm-2 at 2 V, far below expectations. Postelectrolysis analysis revealed an unexpected passivating tellurium layer, likely inhibiting catalytic sites. While initially promising, the unanticipated passivation caused 1T'-MoTe2 to underperform in practice. This highlights the critical need to evaluate emerging electrolyzer catalysts in PEM electrolyzers, revealing limitations of the idealized three-electrode configuration. Moving forward, validation of model systems in actual electrolyzers will be key to identifying robust nonplatinum catalysts for sustainable green hydrogen production.

Increased efficiency of direct nanoimprinting on planar and curved bulk titanium through surface modification.

In this work the direct transfer of nanopatterns into titanium is demonstrated. The nanofeatures are imprinted at room temperature using diamond stamps in a single step. We also show that the imprint properties of the titanium surface can be altered by anodisation yielding a significant reduction in the required imprint force for pattern transfer. The anodisation process is also utilised for curved titanium surfaces where a reduced imprint force is preferable to avoid sample deformation and damage. We finally demonstrate that our process can be applied directly to titanium rods.

Low-Molecular-Weight Heparin Anti-Xa Guided Reversal of Apixaban With Prothrombin Complex Concentrate in a Patient on Hemodialysis.

The growing use of oral factor Xa (FXa) inhibitors in patients with chronic kidney disease (CKD), particularly the recent increased use of apixaban in patients with end-stage renal disease (ESRD), has created a new dilemma in the already controversial topic of oral FXa inhibitor reversal. With the limited availability of anti-Xa levels specific to oral FXa inhibitors and even scarcer availability of reversal data for patients on these agents with ESRD, ensuring adequate reversal is currently often solely guided by repeat imaging and changes in clinical status. Low molecular weight heparin (LMWH) anti-Xa levels have been used as a more commonly accessible test to guide the need for and efficacy of reversal of oral FXa inhibitors in patients with normal renal function. However, evidence supporting this technique is again lacking in patients with renal dysfunction. This case report focuses on the use of LMWH anti-Xa levels to guide reversal of apixaban in a patient with ESRD on hemodialysis and correlation of those levels to the patient's clinical status.

Thermally Stable, High Performance Transfer Doping of Diamond using Transition Metal Oxides.

We report on optimisation of the environmental stability and high temperature operation of surface transfer doping in hydrogen-terminated diamond using MoO3 and V2O5 surface acceptor layers. In-situ annealing of the hydrogenated diamond surface at 400 °C was found to be crucial to enhance long-term doping stability. High temperature sheet resistance measurements up to 300 °C were performed to examine doping thermal stability. Exposure of MoO3 and V2O5 transfer-doped hydrogen-terminated diamond samples up to a temperature of 300 °C in ambient air showed significant and irreversible loss in surface conductivity. Thermal stability was found to improve dramatically however when similar thermal treatment was performed in vacuum or in ambient air when the oxide layers were encapsulated with a protective layer of hydrogen silsesquioxane (HSQ). Inspection of the films by X-ray diffraction revealed greater crystallisation of the MoO3 layers following thermal treatment in ambient air compared to the V2O5 films which appeared to remain amorphous. These results suggest that proper encapsulation and passivation of these oxide materials as surface acceptor layers on hydrogen-terminated diamond is essential to maximise their environmental and thermal stability.

Evaluation of process variations in noncompliance in the implementation of evidence-based sepsis care.

INTRODUCTION: Sepsis is recognized as an often-lethal disease. Recommended guidelines are complex and time sensitive. Response teams (RTs) have demonstrated success in implementation of quality initiatives. The purpose of this study was to evaluate variations in noncompliance with recommended sepsis guidelines overall and between a sepsis-focused RT and standard care. METHODS: This retrospective chart review categorized septic patients based on treatment by a sepsis response team (SRT) versus standard care (non-SRT). Guideline compliance was based upon the Surviving Sepsis evaluation and treatment guidelines. RESULTS: Patient records for 123 identified septic patients post first-year implementation were evaluated. Overall, compliance rates were low and there were variations in compliance between the treatment providers. The SRT was more compliant than the non-SRT. SRT noncompliance was more often due to failure to achieve therapeutic goals within the recommended time. Mortality benefit was not statistically significant between groups; however mortality was higher in the non-SRT group. CONCLUSION: Noncompliance is more complex than simple failure to initiate, especially in time-dependent therapies. The development and education of an RT demonstrates improvement in application of sepsis-focused therapies over standard care.

Screening de parametros hemostáticos en adultos y jóvenes influencia del sexo y altitud

En el laboratorio de fisiología de la Facultad de Medicina (Quito- Ecuador) se procedió a determinar los parámetros hemostáticos: tiempo de ssangría, tiempo de coagulación, tiempo de retraccción dle coïgulo: en adultos y jóvenes residnetes a 2.800mts sobre el nivel del mar (Quito) De una muestra de 203 jóvenes adultos en 104 hombres y 99 mujeres, se determinó, el tiempo de sangría (n=93) en 49 hombres y 44 mujeres: el tiempo de coagulación (n=71) en 36 hombres y 35 mujeres, el tiempo de retracción del coágulo (n=39) en 19 hombres y 20 mujeres. Se aplicaron técnicas convencionales para el timpo de sangría, punción a nivel del pulpejo de un dedo, para tiempo de coagulación y tiempo de tretracción del coágulo gota fresca en placa de vidrio. Se encontró que los valores promedios de la población total del tiempo de ssangría, tiempo de coagulación y tiempo de retracción del coagúlo fueron 3:37 más o menos1.85;8.55 más o menos2.76; 44.10 más o menos 12.31 respectivamente. Se observó que los valores de Ts y Tc fueron similares entre ambos sexos en tanto que TCR fue superior en el sexo masculino (p 0.03); sin influencia de los cambios crónicos de la altitud. Los valores de referencia local en adultos jóvenes de ambos sexos residentes a 2820 mts sobre el nivel del mar se muestran simialres con los parámetros de referencia internacional...