Nevin Manimala

Am J Emerg Med. 2023 Mar 29;69:5-10. doi: 10.1016/j.ajem.2023.03.048. Online ahead of print.

ABSTRACT

INTRODUCTION: Prior data have suggested that suboptimal antibiotic prescribing in the emergency department (ED) is common for uncomplicated lower respiratory tract infections (LRTI), urinary tract infections (UTI), and acute bacterial skin and skin structure infections (ABSSSI). The objective of this study was to measure the effect of indication-based antibiotic order sentences (AOS) on optimal antibiotic prescribing in the ED.

METHODS: This was an IRB-approved quasi-experiment of adults prescribed antibiotics in EDs for uncomplicated LRTI, UTI, or ABSSSI from January to June 2019 (pre-implementation) and September to December 2021 (post-implementation). AOS implementation occurred in July 2021. AOS are lean process, electronic discharge prescriptions retrievable by name or indication within the discharge order field. The primary outcome was optimal prescribing, defined as correct antibiotic selection, dose, and duration per local and national guidelines. Descriptive and bivariate statistics were performed; multivariable logistic regression was used to determine variables associated with optimal prescribing.

RESULTS: A total of 294 patients were included: 147 pre-group and 147 post-group. Overall optimal prescribing improved from 12 (8%) to 34 (23%) (P < 0.001). Individual components of optimal prescribing were optimal selection at 90 (61%) vs 117 (80%) (P < 0.001), optimal dose at 99 (67%) vs 115 (78%) (P = 0.036), and optimal duration at 38 (26%) vs 50 (34%) (P = 0.13) for pre- and post-group, respectively. AOS was independently associated with optimal prescribing after multivariable logistic regression analysis (adjOR, 3.6; 95%CI,1.7-7.2). A post-hoc analysis showed low uptake of AOS by ED prescribers.

CONCLUSIONS: AOS are an efficient and promising strategy to enhance antimicrobial stewardship in the ED.

PMID:37027958 | DOI:10.1016/j.ajem.2023.03.048

J Environ Manage. 2023 Apr 5;338:117740. doi: 10.1016/j.jenvman.2023.117740. Online ahead of print.

ABSTRACT

The soil carbon (C) dynamics is strongly influenced by climate and land-use patterns in the Himalayas. Therefore, soils under five prominent land use [e.g., maize (Zea mays), horticulture, natural forest, grassland, and wasteland] were sampled down up to 30 cm depth under two climatic conditions viz., temperate and subtropical to assess the impacts of climate and landuse on soil C dynamics. Results demonstrated that irrespective of land use, temperate soil contains 30.66% higher C than subtropical soils. Temperate soils under natural forests had the higher total organic carbon (TOC, 21.90 g kg^-1), Walkley-Black carbon (WBC, 16.42 g kg^-1), contents, and stocks (TOC, 66.92 Mg ha^-1 and WBC, 50.24 Mg ha^-1), and total soil organic matter (TSOM, 3.78%) concentration as compared to other land uses like maize, horticulture, grassland, and wasteland. Under both climatic conditions, maize land use had the lowest TOC 9.63, 6.55 g kg^-1 and WBC 7.22, 4.91 g kg^-1 at 0-15 and 15-30 cm soil depth, respectively. Horticulture land use had 62.58 and 62.61% higher TOC and WBC over maize-based land use under subtropical and temperate climatic conditions at 0-30 cm soil depth, respectively. However, soils of maize land use under temperate conditions had ∼2 times more TOC than in subtropical conditions. The study inferred that the C-losses is more in the subtropical soil than in temperate soils. Hence, the subtropical region needs more rigorous adoption of C conservation farming practices than the temperate climatic setting. Although, the adoption of C storing and conserving practices is crucial under both climatic settings to arrest land degradation. Horticultural land uses along with conservation effective soil management practices may be encouraged to restore more soil C and to improve the livelihood security of the hill populace in the North Western Himalayas.

PMID:37027954 | DOI:10.1016/j.jenvman.2023.117740

Am J Emerg Med. 2023 Mar 31;68:155-160. doi: 10.1016/j.ajem.2023.03.055. Online ahead of print.

ABSTRACT

INTRODUCTION: Children under the age of 5 years suffer from the highest rates of fall-related injuries. Caretakers often leave young children on sofas and beds, however, falling and rolling off these fixtures can lead to serious injury. We investigated the epidemiologic characteristics and trends of bed and sofa-related injuries among children aged <5 years treated in US emergency departments (EDs).

METHODS: We conducted a retrospective analysis of data from the National Electronic Injury Surveillance System from 2007 through 2021 using sample weights to estimate national numbers and rates of bed and sofa-related injuries. Descriptive statistics and regression analyses were employed.

RESULTS: An estimated 3,414,007 children aged <5 years were treated for bed and sofa-related injuries in emergency departments (EDs) in the United States from 2007 through 2021, averaging 115.2 injuries per 10,000 persons annually. Closed head injuries (30%) and lacerations (24%) comprised the majority of injuries. The primary location of injury was the head (71%) and upper extremity (17%). Children <1 year of age accounted for most injuries, with a 67% increase in incidence within the age group between 2007 and 2021 (p < 0.001). Falling, jumping, and rolling off beds and sofas were the primary mechanisms of injury. The proportion of jumping injuries increased with age. Approximately 4% of all injuries required hospitalization. Children <1 year of age were 1.58 times more likely to be hospitalized after injury than all other age groups (p < 0.001).

CONCLUSION: Beds and sofas can be associated with injury among young children, especially infants. The annual rate of bed and sofa-related injuries among infants <1 year old is increasing, which underscores the need for increased prevention efforts, including parental education and improved safety design, to decrease these injuries.

PMID:37027936 | DOI:10.1016/j.ajem.2023.03.055

Cancer Epidemiol. 2023 Apr 5;84:102362. doi: 10.1016/j.canep.2023.102362. Online ahead of print.

ABSTRACT

BACKGROUND: The risk of hepatocellular carcinoma (HCC) is associated with a variety of factors. However, the possible association between the abnormal metabolism of fasting plasma glucose (FPG) and alanine aminotransferase (ALT) and the risk of HCC has not been widely studied. We examined this relationship based on a prospective cohort study.

METHODS: 162 first-attack HCC cases during three follow-up periods (2014-2020) were selected as the case group. A control group of 648 participants was obtained by 1:4 matching of age (± 2 years) and sex with noncancer participants in the same period. Conditional logistic regression models, restricted cubic spline models, additive interaction models, and generalized additive models were used to explore the effects of FPG and ALT on the risk of HCC.

RESULTS: After correction for confounding factors, we found that abnormal FPG and elevated ALT increased the risk of HCC, respectively. Compared with the normal FPG group, the risk of HCC was significantly increased in the impaired fasting glucose (IFG) (OR = 1.91, 95 %CI: 1.04, 3.50) and diabetes groups (OR = 2.12, 95 %CI: 1.24, 3.63). Compared with the lowest quartile of ALT, subjects in the fourth quartile had an 84 % increased risk of HCC (OR = 1.84, 95 %CI: 1.05-3.21). Moreover, there was an interaction between FPG and ALT on the risk of HCC, and 74 % of the HCC risk could be attributed to their synergistic effect (AP = 0.74, 95 %CI: 0.56-0.92).

CONCLUSION: Abnormal FPG and elevated ALT are independent risk factors for HCC, and they have a synergistic effect on the risk of HCC. Therefore, serum FPG and ALT levels should be monitored to prevent the development of HCC.

PMID:37027905 | DOI:10.1016/j.canep.2023.102362

Phys Rev Lett. 2023 Mar 24;130(12):120801. doi: 10.1103/PhysRevLett.130.120801.

ABSTRACT

We consider general prepare-and-measure scenarios in which Alice can transmit qubit states to Bob, who can perform general measurements in the form of positive operator-valued measures (POVMs). We show that the statistics obtained in any such quantum protocol can be simulated by the purely classical means of shared randomness and two bits of communication. Furthermore, we prove that two bits of communication is the minimal cost of a perfect classical simulation. In addition, we apply our methods to Bell scenarios, which extends the well-known Toner and Bacon protocol. In particular, two bits of communication are enough to simulate all quantum correlations associated to arbitrary local POVMs applied to any entangled two-qubit state.

PMID:37027876 | DOI:10.1103/PhysRevLett.130.120801

Phys Rev Lett. 2023 Mar 24;130(12):127201. doi: 10.1103/PhysRevLett.130.127201.

ABSTRACT

We first consider a deterministic gas of N solitons for the focusing nonlinear Schrödinger (FNLS) equation in the limit N→∞ with a point spectrum chosen to interpolate a given spectral soliton density over a bounded domain of the complex spectral plane. We show that when the domain is a disk and the soliton density is an analytic function, then the corresponding deterministic soliton gas surprisingly yields the one-soliton solution with the point spectrum the center of the disk. We call this effect soliton shielding. We show that this behavior is robust and survives also for a stochastic soliton gas: indeed, when the N-soliton spectrum is chosen as random variables either uniformly distributed on the circle, or chosen according to the statistics of the eigenvalues of the Ginibre random matrix the phenomenon of soliton shielding persists in the limit N→∞. When the domain is an ellipse, the soliton shielding reduces the spectral data to the soliton density concentrating between the foci of the ellipse. The physical solution is asymptotically steplike oscillatory, namely, the initial profile is a periodic elliptic function in the negative x direction while it vanishes exponentially fast in the opposite direction.

PMID:37027854 | DOI:10.1103/PhysRevLett.130.127201

Phys Rev Lett. 2023 Mar 24;130(12):121901. doi: 10.1103/PhysRevLett.130.121901.

ABSTRACT

The Born cross sections of the process e^{+}e^{-}→D^{*0}D^{*-}π^{+} at center-of-mass energies from 4.189 to 4.951 GeV are measured for the first time. The data samples used correspond to an integrated luminosity of 17.9 fb^{-1} and were collected by the BESIII detector operating at the BEPCII storage ring. Three enhancements around 4.20, 4.47, and 4.67 GeV are visible. The resonances have masses of 4209.6±4.7±5.9 MeV/c^{2}, 4469.1±26.2±3.6 MeV/c^{2}, and 4675.3±29.5±3.5 MeV/c^{2} and widths of 81.6±17.8±9.0 MeV, 246.3±36.7±9.4 MeV, and 218.3±72.9±9.3 MeV, respectively, where the first uncertainties are statistical and the second systematic. The first and third resonances are consistent with the ψ(4230) and ψ(4660) states, respectively, while the second one is compatible with the ψ(4500) observed in the e^{+}e^{-}→K^{+}K^{-}J/ψ process. These three charmoniumlike ψ states are observed in the e^{+}e^{-}→D^{*0}D^{*-}π^{+} process for the first time.

PMID:37027853 | DOI:10.1103/PhysRevLett.130.121901

Retina. 2023 Apr 6. doi: 10.1097/IAE.0000000000003804. Online ahead of print.

NO ABSTRACT

PMID:37027826 | DOI:10.1097/IAE.0000000000003804

Anesthesiology. 2023 Apr 7. doi: 10.1097/ALN.0000000000004578. Online ahead of print.

ABSTRACT

BACKGROUND: The dose of sugammadex recommended by the manufacturer for reversal of rocuronium is 2 mg/kg when the train-of-four count is 2 or more and 4 mg/kg when it is less than 2 but there is a post-tetanic count of at least 1. The purpose of this dose-finding study was to titrate sugammadex to produce a train-of-four ratio ≥0.9 at the conclusion of cardiac surgery, and to continue monitoring neuromuscular blockade in the ICU to identify recurrent paralysis. The hypothesis was that many patients would require less than the recommended dose of sugammadex, but that some would require more, and that recurrent paralysis would not occur.

METHODS: Neuromuscular blockade was monitored using electromyography during cardiac surgery. Administration of rocuronium was at the discretion of the anesthesia care team. During sternal closure, sugammadex was titrated in 50 mg increments every 5 minutes until a train-of-four ratio ≥0.9 was obtained. Neuromuscular blockade was monitored with electromyography in the ICU until sedation was discontinued prior to extubation or for a maximum of 7 hours.

RESULTS: Ninety-seven patients were evaluated. The dose of sugammadex required to achieve a train-of-four ratio of ≥0.9 varied from 0.43 to 5.6 mg/kg. There was a statistically significant relationship between the depth of neuromuscular blockade and the sugammadex dose required for reversal, but there was a large variation in dose required at any depth of neuromuscular blockade. Eighty-four of 97 patients (87%) required less than the recommended dose, and 13 (13%) required more. Two patients required additional sugammadex administration for recurrent paralysis.

CONCLUSIONS: When sugammadex was titrated to effect, the dose was usually less than the recommended dose, but it was more in some patients. Therefore, quantitative twitch monitoring is essential for ascertaining that adequate reversal has taken place following sugammadex administration. Recurrent paralysis was observed in 2 patients.

PMID:37027807 | DOI:10.1097/ALN.0000000000004578

Biomacromolecules. 2023 Apr 7. doi: 10.1021/acs.biomac.2c01420. Online ahead of print.

ABSTRACT

Hemoglobin-based oxygen carriers (HBOCs) are being developed to overcome limitations associated with transfusion of donated red blood cells (RBCs) such as potential transmission of blood-borne pathogens and limited ex vivo storage shelf-life. Annelid erythrocruorin (Ec) derived from the worm Lumbricus terrestris (Lt) is an acellular mega-hemoglobin that has shown promise as a potential HBOC due to the large size of its oligomeric structure, thus overcoming limitations of unmodified circulating cell-free hemoglobin (Hb). With a large molecular weight of 3.6 MDa compared to 64.5 kDa for human Hb (hHb) and 144 oxygen-binding globin subunits compared to the 4 globin subunits of hHb, LtEc does not extravasate from the circulation to the same extent as hHb. LtEc is stable in the circulation without RBC membrane encapsulation and has a lower rate of auto-oxidation compared to acellular hHb, which allows the protein to remain functional for longer periods of time in the circulation compared to HBOCs derived from mammalian Hbs. Surface coatings, such as poly(ethylene glycol) (PEG) and oxidized dextran (Odex), have been investigated to potentially reduce the immune response and improve the circulation time of LtEc in vivo. Polydopamine (PDA) is a hydrophilic, biocompatible, bioinspired polymer coating used for biomedical nanoparticle assemblies and coatings and has previously been investigated for the surface coating of hHb. PDA is typically synthesized via the self-polymerization of dopamine (DA) under alkaline (pH > 8.0) conditions. However, at pH > 8.0, the oligomeric structure of LtEc begins to dissociate. Therefore, in this study, we investigated a photocatalytic method of PDA polymerization on the surface of LtEc using 9-mesityl-10-methylacridinium tetrafluoroborate (Acr-Mes) to drive PDA polymerization under physiological conditions (pH 7.4, 25 °C) over 2, 5, and 16 h in order to preserve the size and structure of LtEc. The resulting structural, biophysical, and antioxidant properties of PDA surface-coated LtEc (PDA-LtEc) was characterized using various techniques. PDA-LtEc showed an increase in measured particle size, molecular weight, and surface ζ-potential with increasing reaction time from t = 2 to 16 h compared to unmodified LtEc. PDA-LtEc reacted for 16 h was found to have reduced oxygen-binding cooperativity and slower deoxygenation kinetics compared to PDA-LtEc with lower levels of polymerization (t = 2 h), but there was no statistically significant difference in oxygen affinity. The thickness of the PDA coating can be controlled and in turn the biophysical properties can be tuned by changing various reaction conditions. PDA-LtEc was shown to demonstrate an increased level of antioxidant capacity (ferric iron reduction and free-radical scavenging) when synthesized at a reaction time of t = 16 h compared to LtEc. These antioxidant properties may prove beneficial for oxidative protection of PDA-LtEc during its time in the circulation. Hence, we believe that PDA-LtEc is a promising oxygen therapeutic for potential use in transfusion medicine applications.

PMID:37027799 | DOI:10.1021/acs.biomac.2c01420