A Quality Improvement Initiative to Minimize Unnecessary Chest X-Ray Utilization in Pediatric Asthma Exacerbations

Background

Current national guidelines recommend against chest X-rays (CXRs) for patients with acute asthma exacerbation (AAE). The overuse of CXRs in AAE has become a concern, prompting the need for a quality improvement (QI) project to decrease CXR usage through guideline-based interventions. We aimed to reduce the percentage of CXRs not adhering to national guidelines obtained for pediatric patients presenting to the Emergency Department (ED) with AAE by 50% within 12 months of project initiation.

Methods

We conducted this study at a New York City urban level-2 trauma center. The team was composed of members from the ED and pediatric departments. Electronic medical records of children aged 2 to 18 years presenting with AAE were evaluated. Monthly data on CXR utilization encompassing instances where the ordered CXR did not adhere to guidelines was collected before and after implementing interventions. The interventions included provider education, visual reminders, printed cards, grand-round presentations, and electronic medical records modifications.

Results

The study encompassed 887 eligible patients with isolated AAE. Baseline data revealed a mean preintervention CXR noncompliance rate of 37.5% among children presenting to the ED with AAE. The interventions resulted in a notable decrease in unnecessary CXR utilization, reaching 16.7%, a reduction sustained throughout subsequent months.

Conclusions

This QI project successfully reduced unnecessary CXR utilization in pediatric AAE. A multi-faceted approach involving education, visual aids, and electronic reminders aligned clinical practice with evidence-based guidelines. This QI initiative is a potential template for other healthcare institutions seeking to curtail unnecessary CXR usage in pediatric AAE.

In-situ biofabrication of bacterial nanocellulose (BNC)/graphene oxide (GO) nano-biocomposite and study of its cationic dyes adsorption properties

In the present study, bacterial nanocellulose/graphene oxide nano-biocomposites (BNC-GO-NBCs) were fabricated by Komagataeibacter saccharivorans NUWB1 using an in-situ method involving three time-dependent approaches. Physicochemical studies showed that the chosen dried BNC-GO-NBC possessed a three-dimensional interconnected porous structure of BNC with GO layers embedded within the BNC fibrils. BNC-GO-NBC had a crystallinity index of 74.21 %, higher thermostability up to 380 °C and could withstand a tensile load of 84.72 MPa. N2 adsorption-desorption isotherm of the BNC-GO-NBC was found to be of type IV, suggesting a mesoporous type structure with a total pore volume and surface area of 6.232e-04 cc g-1 and 10.498 m2. BNC-GO-NBC exhibited remarkable adsorption capacity for two cationic dyes, Rhodamine B (RhB) and Acridine Orange (AO), and the adsorption data conformed well to the Langmuir isotherm (R2 = 0.99) and pseudo-second-order model. Thermodynamic studies indicated that the adsorption process was spontaneous and endothermic. Additionally, the BNC-GO-NBC displayed the potential for regeneration, with the ability to be recycled up to five times. Further, the antibacterial activity, cell cytotoxicity and oxidative stress assays of the BNC-GO-NBC revealed its non-cytotoxic nature. The findings of the present investigation evidently suggest the potentiality of BNC-GO-NBC in the application of dye adsorption and other environmental applications.

Platelet parameters as biomarker for bronchopulmonary dysplasia in very low birth weight neonates in the first two weeks of life

BACKGROUND

The pathogenesis of bronchopulmonary dysplasia (BPD) is attributed to the arrested lung development in premature infants. Studies showed the negative impact of inflammatory markers on the developing lung with higher levels of IL1, 6 and 8. Platelets contribute to the acute phase response of inflammation and are a direct source of IL-1β.

METHODS

We conducted a retrospective data review of all preterm babies with gestational age (GA) <32 weeks admitted to NICU to assess the relationship between platelet parameters in the first 2 weeks of life with the incidence and severity of BPD in very low birth weight (VLBW) neonates.

RESULTS

Of 114 screened newborns, 92 were included after exclusion criteria. Of these, 62 (67.3%) developed BPD. Mean platelet count (PC) (P=0.008) and mean platelet mass index (PMI) (P=0.027) were significantly lower and mean platelet volume (MPV) (P=0.016) was significantly higher in the BPD group. The highest difference between groups was observed at 2^nd week of life for PC and PMI and at 1^st week for MPV. Using multivariate logistic analysis, only PC (P=0.017) showed statistical significance. MPV and PMI showed a positive interaction but did not achieve significance (P=0.066 for both).

CONCLUSIONS

We concluded that platelet parameters in the first 2 weeks of life were associated with the incidence of BPD in VLBW neonates. PC may also predict the severity of BPD in these infants.

Complementary and alternative medicine for children with sickle cell disease: A systematic review

BACKGROUND

Complementary and alternative medicine (CAM) is a popular alternative to opioid and other analgesics in sickle cell disease (SCD). We review the effectiveness, prevalence, and factors associated with CAM use in the pediatric SCD population.

METHODS

The review protocol was created based on Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. A literature search was conducted in MEDLINE, Embase, Cochrane Library, PubMed, and Web of Science.

RESULTS

Twenty-four studies were examined. The prevalence of CAM use in pediatric patients with SCD ranged from 36 to 84.5%. Common inpatient CAM interventions were yoga, virtual reality, and acupuncture, which decreased pain scale scores. Outpatient CAMs were consisted of cognitive behavioral therapy, massage therapy, and guided-imagery, which increased pain tolerability and decreased pain scale scores.

CONCLUSIONS

CAM modalities can decrease pain scale scores. However, the impact of specific CAM modalities on emergency department visits, hospitalizations, and school absences were inconclusive.

Role of Steroids in Sickle Cell Patients With Acute Chest Syndrome

Background

The role of corticosteroids to treat acute chest syndrome (ACS) in patients with sickle cell disease (SCD) has always been a matter of debate. In clinical practice, systemic steroids were given for ACS with more severe disease. With the lack of standard treatment guidelines, their use to treat ACS is highly physician-dependent and varies widely across different hospitals. The utility of corticosteroids in ACS remains unclear. The objective of our study was to describe the differences between SCD patients treated with corticosteroids for ACS and those who were not and to evaluate the association between corticosteroid use, length of stay, and readmission rates.

Methodology

We performed a retrospective chart review of patients with SCD ≤18 years of age hospitalized for ACS at Brookdale University Hospital Medical Center between January 2016 and May 2021.

Results

We identified 43 patients with 60 episodes of ACS (median age was 11 years and 55% were males). In total, 32 such episodes were treated with corticosteroids. The use of bronchodilators (p = 0.23), hydroxyurea (p = 0.13), and the presence of fever (p = 0.86) showed no significant difference between the two groups. The need for blood transfusions (p = 0.005), intensive care unit admission (p = 0.031), respiratory support (p = 0.011), and chest X-ray finding with more than one lobe involvement (p = 0.003) all point to moderate or severe ACS, which has been linked to steroid use. The length of hospital stay (p = 0.07) and the readmission rate (p = 0.31) were not statistically significant between the groups. Even in the subgroup with asthma, the length of stay was not different between the groups (p = 0.44).

Conclusions

Our results show that treatment with systemic steroids for ACS is associated with more severe disease. The length of hospital stay was not different between the steroid-treated and untreated groups. Corticosteroids were not associated with a higher readmission rate in our study population, even in ACS patients with comorbid asthma. Further adequately powered prospective trials are needed to investigate the efficacy of corticosteroids in ACS.

Asthma Outcome Measures Before and After the COVID-19 Outbreak Among the Pediatric Population in a Community Hospital

Background

The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic is a global health threat that has affected patient care enormously. Moderate to severe asthma was listed as a risk factor for severe SARS-CoV-2 disease by the Centers for Disease Control. Little is known about the impact of the pandemic on asthma control in children, particularly African American children.

Objective

The present study sought to determine how changes during the coronavirus disease 2019 (COVID-19) pandemic affected asthma metrics in a majority African American pediatric population at a pediatric pulmonology clinic in a community hospital in New York.

Methods

This is a retrospective, pre-post, comparative cross-sectional study that included children three to 18 years of age with a known diagnosis of asthma followed in a pulmonary clinic. Data were gathered from electronic medical records. Subjects were selected if they presented to a pulmonology clinic within a certain time window both before and after the outbreak of the COVID-19 pandemic. Outcome variables included asthma medication statistics and healthcare utilization statistics.

Results

Inclusion criteria were met by 104 pediatric patients. The majority were African American. Emergency department visits, primary physician visits, and hospitalizations significantly decreased in the post-COVID study group compared to the pre-COVID control group.

Conclusion

Among a majority African American pediatric population, there were significant improvements in asthma outcomes after COVID-19 societal changes when compared to before COVID-19 based on outcome variables.

Investigation on Carbon Nanotube Metal Zinc Oxide Nanoparticle material synthesis and its applications

Background:

Carbon nanotubes (CNT) synthesized by CVD method at 950 ℃. CNT and metal ZnO nanocomposites material synthesized by ball mill procedure have been examined. Stability of nanocomposite material has been attained by cationic ion liquid (IL), 1-tetradecyl-3 methylimidazolium chloride, structural morphology material characterized by Fourier transform infrared (FTIR) spectroscopy, Field emission scanning electron microscopy (FESEM), Ultraviolet visible (UV-Vis) spectroscopy. Furthermore, these materials were analyzed by Energy dispersive X-ray spectroscopy (EDX) to study for the percentage of elemental compositions. Current-Voltage (I-V) characterized by electrical properties are showing highly responsive of resistance variation and easy recoverable high sensitivity was the main feature of the CO2 gas sensing properties.

Objective:

Carbon nanotube and zinc oxide nanoparticle combined with different ratio and optimization of coating methods using for sensor applications.

Methods:

It is synthesized with chemical vapour deposition method and zinc nanoparticle developed by ball mill method. We have optimized spin coating and dip coating method on glass surface.

Results:

FTIR spectrum results are recommended that the existing hydroxyl group and C group CNT-ZnO nanoparticle covered by the surface active site of ZnO. The size and composition of the CNT-ZnO were confirmed by FESEM EDAX studies. The absorption and transmittance wavelength of CNT-ZnO nanoparticle were recorded by UV-Visible spectroscopy. The I-V property shows that the drain current and voltages are varied by gas implying the materials suitable for applications.

Conclusion:

This module can be used to monitor CO¬2 gas application instruments with help of software. In future, this module and techniques can be used to study stress sensor and piezoelectric applications

Reversal of Opioid Intoxication in an Infant With Intrauterine Growth Restriction With a Single Dose of Naloxone

Perinatal exposure to opioids might result in opioid intoxication in a newborn infant. The routine use of naloxone in an opioid-exposed newborn infant is discouraged due to the risks of precipitating withdrawal and long-term developmental problems associated with naloxone. We describe a case of respiratory and neurological depression in an infant with intrauterine growth restriction (IUGR) following in utero exposure to an opioid two hours before delivery. The infant was apneic with a poor tone immediately after birth. With positive pressure ventilation, the tone and respiratory effort improved, and the baby was admitted to the neonatal intensive care unit (NICU) on oxygen support via nasal cannula. The baby started having bradypnea with shallow breathing and oxygen desaturation at eight hours of life, most likely secondary to intrauterine exposure to hydromorphone which was successfully reversed with a single dose of intravenous naloxone. The infant was discharged on day of life seven with no further symptoms. Naloxone administration might be considered in an IUGR infant with persistent cardiorespiratory and neurological depression who has a history of intrauterine opioid exposure within four hours before delivery provided the mother is not narcotic dependent.

Impact of the introduction of an integrated multi-professional pathway for atrial fibrillation on long-term outcomes

Background

An integrated structured approach to atrial fibrillation (AF) management is recommended by ESC.1 However, limited data is available on its “real-world” impact on anticoagulation uptake and subsequent AF-related hospitalisation and stroke rates.

Purpose

To evaluate the long-term impact of the introduction of a community-wide integrated AF service based in a secondary care hospital.

Methods

In September 2017 we implemented a new integrated pathway for patients with newly diagnosed “symptomatic” atrial arrhythmias across two regions (population 450,000) in England in collaboration with primary care. All patients were seen in a one-stop multi-professional clinic (Arrhythmia nurse and Electrophysiologist with ECG and echocardiogram) within 2 weeks. They underwent standardised screening for modifiable risk factors, counselling regarding diagnosis/ anticoagulation and received an individualised AF management plan as well as access to a nurse-led telephone helpline. We followed up the first 126 consecutive patients for a period of 12 months.

Results

Baseline characteristics are shown in Table 1, showing a high incidence of modifiable risk factors (previously un-identified in the majority). After review in clinic, 30-day AF-related readmission rates to hospital were low (1.6%, n=2) as compared to historical local data (5.8%). This was sustained at 3 months (4.7%, n=6) and at 12 months (7.9%, n=10). 99% of 83 of eligible patients (CHA2DS2-VASc score of &gt;2 with no major contra-indications) received oral anticoagulation. Over 12 months follow-up, rates of TIA/stroke was low (n=3, 2.4%). All-cause mortality was also low (n=1, 0.8%). NHS England region-wide data showed a marked reduction in percentage of total stroke admissions with history of AF not taking anticoagulation at stroke presentation in 2018/19 as compared to 2017/18 across our two regions; this was lower than the national average and the lowest within West Yorkshire (Figure 1).

Conclusions

An integrated service for AF management implemented community-wide was associated with high uptake of oral anticoagulation among eligible patients and low rates of AF-related hospitalisations and all-cause mortality. Across the community, among stroke admissions with AF at presentation, a lower percentage of patients without anticoagulation was observed in comparison with previous years and neighbouring regions.

Funding Acknowledgement

Type of funding sources: None.

Congenital Methemoglobinemia and Unstable Hemoglobin Variant in a Child With Cyanosis

Methemoglobinemia (Meth) is a rare hemoglobin (Hb) disorder with distinguished clinical features and complex pathophysiology. We present a three-year-old female who was diagnosed with congenital methemoglobinemia when she presented with peri-oral cyanosis and profound oxygen desaturation in the 20-30% range. This patient also had elevated deoxyhemoglobin (HHb) not explained by methemoglobinemia alone; the low pulse oximetry (SpO₂) reading suggested a rightward-shift oxyhemoglobin (O₂Hb) dissociation curve, which is the opposite of that expected in methemoglobinemia. This, along with evidence of hemolysis, raised the possibility of a concomitant low-oxygen affinity hemoglobinopathy, which could explain elevated HHb. Hemoglobin electrophoresis identified an abnormal hemoglobin variant which was categorized as heterozygous for unstable beta globin variant. The patient responded well to one dose of methylene blue, vitamin C, supportive oxygen (O₂) therapy, and IV hydration and was discharged with a baseline of 50-60% SpO₂ on room air. We are reporting this case along with a brief review of the medical literature.

Facilitators and Barriers to Access to Pediatric Medical Services in a Community Hospital

Background: Missed medical appointments decrease continuity of medical care, waste resources, and may affect health outcomes. We examined the factors associated with missed children's supervision visits in Eastern Brooklyn, NY, USA. Methods: We surveyed guardians whose children received routine medical care at four pediatric clinics. Participants filled out a questionnaire that queried: demographics, food security, recent relocation, parental support of healthy behaviors, and length of knowing provider. Preexisting disease(s) and missed visits were retrieved from medical records. Regression analyses were used to determine factors that were associated with missing medical appointments. Results: Among 213 families, 33% faced food insecurity and 16.4% reported moving within the past 12 months. Forty percent of children missed at least 1 visit. Food insecurity (adjusted odds ratio [aOR] 2.3, 95% confidence interval [CI 1.0% to 5.2%) and recent relocation (aOR 1.8, 95% CI 1.1-3.4 were associated with missed health supervision visits, whereas greater parental healthy behaviors (aOR 0.5, 95% CI 0.3-0.9) and longer length of knowing provider (aOR 0.8, 95% CI 0.7-1.0) were associated with fewer missed appointments. Conclusion: This study indicates that social inequity may contribute to poor adherence to medical appointments through multiple mechanisms, including food insecurity, lack of social stability, and parental health behaviors. Multidimensional proactive prevention, and reactive tolerance should be considered as opportunities to mitigate the impact of social inequity on health outcomes.

Investigations on the Structural, Optical and Dielectric Properties of Ball-Milled ZnO–Fe2O3 Nanocomposites

In this study, ZnO–Fe2O3 nanocomposites were prepared by high-energy ball milling technique and characterized through X-ray diffraction (XRD), field-emission scanning electron microscopy (FESEM), UV–visible spectroscopy and dielectric spectroscopy. The amount of Fe2O3 in the ZnO–Fe2O3 nanocomposites was varied at the rates of 1[Formula: see text]wt.%, 3[Formula: see text]wt.% and 5[Formula: see text]wt.% in order to investigate its influence on the structural, optical and dielectric properties of the nanocomposites. XRD patterns of nanocomposites revealed no shift in peak positions and hence confirmed the formation of composites after ball milling. Further, it was observed from FESEM analysis that Fe2O3 particles were distributed randomly on the ZnO matrix of the nanocomposites. ZnO–Fe2O3 nanocomposites reveal extended optical absorption in the range of 400–600[Formula: see text]nm from UV studies. The dielectric constant and loss of the nanocomposites decrease exponentially with increase in frequency. The composition and frequency dependences of the dielectric constant, dielectric loss and AC conductivity are explained based on the Maxwell–Wagner effect and Koop’s theory.

Low Income and Nonadherence to Health Supervision Visits Predispose Children to More Emergency Room Utilization

Social inequity can have broad health impacts. The purpose of this study was to examine the effects of low income and nonadherence to health supervision visits on emergency room (ER) utilization in Eastern Brooklyn, New York. This study surveyed parents/guardians of children who received routine medical care at Brookdale ambulatory clinics from June 2017 to February 2018. Participants were asked to fill out a questionnaire on social demographics, food insecurity, and relocation. Electronic medical records (EMRs) were reviewed to retrieve numbers of missing health supervision and ER visit in past 12 months. Comorbidity was identified through EMR by International Classification of Diseases. Logistic regression analyses were used to examine the effects of nonadherence to health supervision visits on ER utilization when controlling for demographics, food insecurity, recent moving, and comorbidity. Among 268 participants, 56.0% reported their household income was less than $20,000 annually, 39.6% missed at least 1 health supervision visit, and 31.7% had at least 1 ER visit within the past 12 months. Younger age (adjusted odds ratio [aOR] = 0.92, 95% confidence interval [CI] = 0.86-0.97, P < .01), household income less than $20,000 (aOR = 1.86, 95% CI = 1.02-3.39), preexisting comorbidity (aOR = 2.36, 95% CI = 1.26-4.42), and nonadherence to health supervision visits (aOR = 5.83, 95% CI = 3.21-10.56) were associated with increased ER utilization. Nonadherence to health supervision visits is an independent risk factor and potentially modifiable. Evaluation and remediation should be pursued as a means of improving health outcomes of children in vulnerable circumstances.

A Phase 3 Trial of l-Glutamine in Sickle Cell Disease

BACKGROUND

Oxidative stress contributes to the complex pathophysiology of sickle cell disease. Oral therapy with pharmaceutical-grade l-glutamine (USAN, glutamine) has been shown to increase the proportion of the reduced form of nicotinamide adenine dinucleotides in sickle cell erythrocytes, which probably reduces oxidative stress and could result in fewer episodes of sickle cell-related pain.

METHODS

In a multicenter, randomized, placebo-controlled, double-blind, phase 3 trial, we tested the efficacy of pharmaceutical-grade l-glutamine (0.3 g per kilogram of body weight per dose) administered twice daily by mouth, as compared with placebo, in reducing the incidence of pain crises among patients with sickle cell anemia or sickle β⁰-thalassemia and a history of two or more pain crises during the previous year. Patients who were receiving hydroxyurea at a dose that had been stable for at least 3 months before screening continued that therapy through the 48-week treatment period.

RESULTS

A total of 230 patients (age range, 5 to 58 years; 53.9% female) were randomly assigned, in a 2:1 ratio, to receive l-glutamine (152 patients) or placebo (78 patients). The patients in the l-glutamine group had significantly fewer pain crises than those in the placebo group (P=0.005), with a median of 3.0 in the l-glutamine group and 4.0 in the placebo group. Fewer hospitalizations occurred in the l-glutamine group than in the placebo group (P=0.005), with a median of 2.0 in the l-glutamine group and 3.0 in the placebo group. Two thirds of the patients in both trial groups received concomitant hydroxyurea. Low-grade nausea, noncardiac chest pain, fatigue, and musculoskeletal pain occurred more frequently in the l-glutamine group than in the placebo group.

CONCLUSIONS

Among children and adults with sickle cell anemia, the median number of pain crises over 48 weeks was lower among those who received oral therapy with l-glutamine, administered alone or with hydroxyurea, than among those who received placebo, with or without hydroxyurea. (Funded by Emmaus Medical; ClinicalTrials.gov number, NCT01179217 .).

Effects of manufactured nano-copper on copper uptake, bioaccumulation and enzyme activities in cowpea grown on soil substrate

Increased use of nanoparticles-based products in agriculture portends important implications for agriculture. Therefore, the impact of nano-copper particles (<25 nm and 60-80 nm) on Cu uptake, bioaccumulation (roots, leaves and seeds), activity of ascorbate peroxidase (APX), catalase (CAT), superoxide dismutase (SOD), glutathione reductase (GR), and lipid peroxidation in leaves and roots of Vigna unguiculata (cowpea) was studied. Plants were exposed to four levels (0, 125, 500 and 1000 mg/kg) of 25 nm or 60-80 nm nano-Cu for 65 days. Results indicated significant (P<.05) uptake of Cu at all nano-Cu levels compared to control, and bioaccumulation increased in seeds by at least 250%. Response of antioxidant enzymes to both nano-Cu types was concentration-dependent. Activity of APX and GR was enhanced in leaves and roots in response to both nano-Cu treatments in similar patterns compared to control. Both nano-Cu increased CAT activity in roots while SOD activity reduced in both leaves and roots. This shows that response of antioxidant enzymes to nano-Cu toxicity was organ-specific in cowpea. Malondialdehyde, a measure of lipid peroxidation, increased at 500 -1000 mg/kg of 25 nm nano-Cu in leaves by average of 8.4%, and 60-80 nm nano-Cu in root by 52.8%, showing particle-size and organ-dependent toxicity of nano-Cu. In conclusion, exposure of cowpea to nano-Cu treatments increased both the uptake and bioaccumulation of Cu, and also promoted the activity of APX and GR in root and leaf tissues of cowpea. Therefore, APX- and GR-activity level could be a useful predictive biomarker of nano-Cu toxicity in cowpea.

Caregiver's Health Locus of Control and Medication Adherence in Sickle Cell Disease

ACKNOWLEDGEMENTS

The authors would like to thank Dr. Morisky for giving us permission to use the Morisky Medication Adherence Scale

PURPOSE

To explore caregivers' Health Locus of Control's relationship to self-reported adherence to penicillin prophylaxis or hydroxyurea in children with sickle cell disease (SCD).

PROCEDURE

A questionnaire-based study was conducted of caregivers of children with SCD who visited a comprehensive sickle cell center in an inner city hospital, who were either on penicillin prophylaxis or hydroxyurea or both. Multidimensional Health Locus of Control Scale (MHLC) and the Morisky Medication Adherence Scale (MMAS-8) questionnaires were used for the study.

RESULTS

Caregivers of 43 children (27 on penicillin prophylaxis, 13 on hydroxyurea, and 3 on both) completed the MHLC and the MMAS-8. There was no significant difference in adherence between the penicillin and the hydroxyurea groups. The mean Powerful Others score of caregivers of the hydroxyurea only group (25.5+5.6) was higher than that of the penicillin only group (21.2+6.1, p=0.043). Regression analysis revealed an inverse relationship of Chance Locus of Control to adherence in the entire group (Beta = -0.306, R2=0.093, F[1,40]=4.12, p=0.049).

CONCLUSION

Chance Locus of control may identify caregivers of children with SCD at risk for non-adherence to treatment.

Spectroscopic (FT-IR, FT-Raman), first order hyperpolarizability, NBO analysis, HOMO and LUMO analysis of 2,4-bis(2-methoxyphenyl)-1-phenylanthracene-9,10-dione by ab initio HF and density functional methods

Anthraquinone derivatives are most important class of a system that absorb in the visible region. In this work, the vibrational spectral analysis was carried out using FT-IR and FT-Raman spectroscopy for 2,4-bis(2-methoxyphenyl)-1-phenylanthracene-9,10-dione. Theoretical calculations were performed by ab initio HF and DFT methods using 6-31G(*) basis set. The complete vibrational assignments of wavenumbers were made on the basis of potential energy distribution. The HOMO and LUMO analysis is used to determine the charge transfer within the molecule. The stability of the molecule arising from hyper-conjugative interaction and charge delocalization has been analyzed using NBO analysis. The calculated geometrical parameters (DFT) are in agreement with that of similar derivatives. The calculated first hyperpolarizability of the title compound is 4.69×10(-30) esu, which is 36.08 times that of urea and the title compound and the series of compounds it represents are attractive candidates for further studies in non linear optical applications.

Spectroscopic investigation of 4-nitro-3-(trifluoromethyl)aniline, NBO analysis with 4-nitro-3-(trichloromethyl)aniline and 4-nitro-3-(tribromomethyl)aniline

The Fourier transform infrared (FT-IR) and FT-Raman spectra of 4-nitro-3-(trifluoromethyl)aniline (NTFA) were recorded in the regions 4000-400 cm(-1) and 3500-100 cm(-1), respectively. Utilizing the observed FT-IR and FT-Raman data, a complete vibrational assignment and analysis of the fundamental modes of the compounds was carried out. Extensive studies on the vibrational, structural, thermodynamic characteristics as well as the electronic properties of NTFA were carried out using ab initio and DFT methods. In this kind of systems, the position of the substituent group in the benzene ring as well as its electron donor-acceptor capabilities play a very important role on the molecular and electronic properties. The values of the total dipole moment (μ) and the first order hyperpolarizability (β) were computed using B3LYP/6-311++G(d,p) and B3LYP/6-311G(d) calculations. The Mulliken's charges, the natural bonding orbital (NBO) analysis on 4-nitro-3-(trifluoromethyl)aniline, 4-nitro-3-(trichloromethyl)aniline and 4-nitro-3-tribromomethyl)aniline were carried out for various intramolecular interactions that are responsible for the stabilization of the molecule. Thermodynamic functions of the investigated molecule were also computed. The calculated HOMO-LUMO energies show that charge transfer occurs in the molecule. The influence of fluorine, amino and nitro group on the geometry of benzene and its normal modes of vibrations has also been discussed.

Vibrational spectroscopic investigations and computational study of 5-tert-butyl-N-(4-trifluoromethylphenyl)pyrazine-2-carboxamide

Pyrazine and its derivatives form an important class of compounds present in several natural flavors and complex organic molecules. Quantum chemical calculations of the equilibrium geometry, harmonic vibrational frequencies, infrared intensities and Raman activities of 5-tert-Butyl-N-(4-trifluoromethylphenyl)pyrazine-2-carboxamide in the ground state were carried out by using density functional methods. Potential energy distribution of normal modes of vibrations was done using GAR2PED program. Nonlinear optical behavior of the examined molecule was investigated by the determination of first hyperpolarizability. The calculated HOMO and LUMO energies show the chemical activity of the molecule. The stability of the molecule arising from hyper-conjugative interaction and charge delocalization has been analyzed using NBO analysis. The calculated geometrical parameters are in agreement with that of similar derivatives. The stability of the molecule arising from hyper-conjugative interaction and charge delocalization has been analyzed using NBO analysis.

Serum 99th centile values for two heart-type fatty acid binding protein assays

Background

We have previously demonstrated that heart-type fatty acid binding protein (H-FABP) is an independent prognostic marker for survival after acute coronary syndrome (ACS). This study aimed to define the 99th centile values for H-FABP as determined with two different assays, and to study the relationship with age, gender and renal function.

Methods

H-FABP was measured on redundant routine outpatient samples using the MARKIT-M (Dainippon) and the Evidence Investigator (Randox) assays.

Results

Two hundred and forty-two subjects with Siemens Ultra-TnI value <0.045 μg/L (99th centile) were studied. In all, 174 subjects had estimated glomerular filtration rate (eGFR) >60 mL/min. The 99th centile values for subjects with eGFR >60 mL/min for the Evidence Investigator H-FABP were 5.3 and 5.8 μg/L and for the MARKIT-M H-FABP were 8.3 and 9.1 μg/L in female and male subjects, respectively. There is an increase in H-FABP with age in subjects with normal renal function for both assays. Gender comparison showed no significant difference for either assay. Comparison of samples showed that subjects with eGFR <60 mL/min showed a median increase of 0.71 μg/L with Evidence Investigator assay and 1.09 μg/L with MARKIT-M assay compared with subjects with eGFR >60 mL/min. Calibration differences were confirmed by cross measurement of calibrators and recombinant H-FABP.

Conclusions

We have defined the 99th centile values for H-FABP in a population of primary and secondary care outpatients that can be used to risk stratify patients with ACS. We have confirmed that H-FABP increases with renal dysfunction and age, but have not confirmed the gender difference previously reported.

Seasonal variations in composting process of dead poultry birds

Composting of dead birds with caged layer manure (CLM) and farm yard manure (FYM) was carried out to study the feasibility of composting as an alternative for disposal in Tamil Nadu State, India. The dead birds were sequentially layered with manure substrate and carbon source as per recipes formulated in mini-compost bins (4 x 4 x 4 feet). The temperature profile of both CLM and FYM group reached the peak by second week of composting and started declining steadily. The temperature profile was better during summer and monsoon and bins were able to maintain temperature above 60 degrees C (thermophilic) for 3-4 weeks. Season had no influence on attainment of peak temperature and it ranged between 51.8 and 70.4 degrees C. The persistency of thermophilic temperature (above 55 degrees C) was prolonged during summer (17.5-65 days) followed by monsoon (24-39 days) and winter (15.5-21.5 days). No putrefied or obnoxious odour or fly menace was observed during all the seasons of composting. The composting process took 107-127.5 days to finish during summer, 84.5-91 days in monsoon and 61.5-73.5 days in winter. The FYM was able to retain moisture higher (41-54% at the end of primary stage and 27.5-48.2% at the end of secondary stage) than CLM group (17.5-39.3% at primary stage and 20.4-33.5% in secondary stage). Weight reduction was more in FYM group (31.8-58.7%) than CLM group (19.3-48.6%). The volume reduction was uniform in all the seasons, it ranged between 39% and 59.3%.

Using the biological taxonomy to access biological literature with PathBinderH

PathBinderH allows users to make queries that retrieve sentences and the abstracts containing them from PubMed. Another aspect of PathBinderH is that users can specify biological taxa in order to limit searches by mentioning either the specified taxa, or their subordinate taxa, in the biological taxonomy. Although the current project requires this function only for plant taxa, the principle is extensible to the entire taxonomy.

AVAILABILITY

www.plantgenomics.iastate.edu/PathBinderH. Source code and databases on request.

Photoperiod affects the expression of sex and species differences in leukocyte number and leukocyte trafficking in congeneric hamsters

Sex differences in immune function are well documented. These sex differences may be modulated by social and environmental factors. Individuals of polygynous species generally exhibit more pronounced sex differences in immune parameters than individuals of monogamous species, often displaying an energetic trade-off between enhanced immunity and high mating success. During winter, animals contend with environmental conditions (e.g. low temperatures and decreased food availability) that evoke energetic-stress responses; many mammals restrict reproduction in response to photoperiod as part of an annual winter coping strategy. To test the hypothesis that extant sex and species differences in immune surveillance may be modulated by photoperiod, we examined leukocyte numbers in males and females of two closely related hamster species (Phodopus). As predicted, uniparental P. sungorus exhibited a robust sex difference, with total white blood cells, total lymphocytes, T cells, and B cells higher in females than males, during long days when reproduction occurs, but not during short days when reproduction usually stops. In contrast, biparental male and female P. campbelli exhibited comparable leukocyte numbers during both long and short days. To study sex differences in stress responses, we also examined immune cell trafficking in response to an acute (2 h) restraint stressor. During stressful challenges, it appears beneficial for immune cells to exit the blood and move to primary immune defense areas such as the skin, in preparation for potential injury or infection. Acute stress moved lymphocytes and monocytes out of the blood in all animals. Blood cortisol concentrations were increased in P. sungorus females compared to males at baseline (52%) and in response to restraint stress (38%), but only in long days. P. campbelli males and females exhibited comparable blood cortisol and stress responses during both long and short days. Our results suggest that interactions among social factors and the environment play a significant role in modulating sex and seasonal alterations in leukocyte numbers and stress responses.

Laser flash photolysis of bismaleimidesThis paper is dedicated to Professor Fred Lewis on the event of his 60th birthday

Bismaleimides containing between 2 and 12 methylene spacer units have been synthesized and characterized using laser flash photolysis spectroscopy. In the case of the monofunctional N-methylmaleimide, the 1,4-biradical was observed only at maleimide concentrations high enough to effectively quench the triplet state, indicating that the 1,4-biradical is Formed from self-quenching of the triplet excited state. The transient spectral features and the transient lifetimes of bismaleimides containing 2 and 9 methylene spacer units closely resemble those of N-methylmaleimide and are attributed to triplet-state transients. N,N'-Alkylenebismaleimides with 3 and 6 methylene spacer groups exhibit a transient with a very short lifetime attributed to a singlet 1,4-biradical species formed from intramolecular interaction. The absence of triplet spectra in these latter bismaleimides indicate that the 1,4-biradical is formed directly from the excited singlet state. The large difference in the lifetime of the 1,4-biradical formed in monofunctional maleimide solutions and bismaleimide solutions is reflective of differences in the biradical spin-state multiplicity. The bismaleimide with a 12 methylene spacer group exhibits transient spectra corresponding to both a triplet state of the maleimide and a 1,4-biradical formed by exo interaction of two maleimide groups. As a demonstration of the ability of acrylate monomers to react with the short-lived singlet biradicals, it is shown that the photopolymerization of a multifunctional acrylate monomer is readily initiated by the 1,4-biradical formed from the bismaleimides with 3 and 6 methylene spacer groups, presumably by direct reaction of the biradical with the acrylate.

The stability of remifentanil hydrochloride and propofol mixtures in polypropylene syringes and polyvinylchloride bags at 22 degrees-24 degrees C

IMPLICATIONS

Remifentanil and propofol mixtures may be prepared extemporaneously. This study demonstrated that such mixtures are stable for 0 to 36 h, depending on relative concentrations of the drugs and the storage container used. The most stable mixtures were stored in syringes and used large concentrations of the two drugs.