Lower Initial Rate Research Articles

A Survey of the Society for Pediatric Anesthesia on the Use, Monitoring, and Antagonism of Neuromuscular Blockade.

Although the package insert clearly states that "the safety and efficacy of sugammadex in pediatric patients have not been established," we hypothesized that sugammadex is used widely in pediatric anesthetic practice supplanting neostigmine as the primary drug for antagonizing neuromuscular blockade (NMB). Additionally, we sought to identify the determinants by which pediatric anesthesiologists choose reversal agents and if and how they assess NMB in their practice. Finally, because of sugammadex's effects on hormonal contraception, we sought to determine whether pediatric anesthesiologists counseled postmenarchal patients on the need for additional or alternative forms of contraception and the risk of unintended pregnancy in the perioperative period. We e-mailed a questionnaire to all 3245 members of the Society of Pediatric Anesthesia (SPA) requesting demographic data and attitudes regarding use of NMB agents, monitoring, and antagonism practices. To address low initial response rates and quantify nonresponse bias, we sent a shortened follow-up survey to a randomly selected subsample (n = 75) of SPA members who did not initially respond. Response differences between the 2 cohorts were determined. Initial questionnaire response rate was 13% (419 of 3245). Overall, 163 respondents (38.9%; 95% confidence interval [CI], 34.2-43.8) used sugammadex as their primary reversal agent, and 106 (25.2%; 95% CI, 21.2-30.0) used it exclusively. Respondents with ≤5 years of practice used sugammadex as their primary reversal agent more often than those with ≥6 years of practice (odds ratio [OR]: 2.08; 95% CI, 1.31-3.31; P = .001). This increased utilization remained after controlling for institutional restriction and practice type (adjusted OR [aOR]: 2.20; 95% CI, 1.38-3.54; P = .001). Only 40% of practitioners always assess NMB (train-of-four), and use was inversely correlated with years of practice (Spearman ρ = -0.11, P = .04). Anesthesiologists who primarily used sugammadex assess NMB less routinely (OR: 0.56; 95% CI, 0.34-0.90; P = .01). A slim majority (52.8%) used sugammadex for pediatric postmenarchal girls; those with less experience used it more commonly (P < .001). Thirty-eight percent did not discuss its effects on hormonal contraception with the patient and/or family, independent of anesthesiologist experience (P = .33) and practice location (P = .38). No significant differences were seen in demographics or practice responses between initial and follow-up survey respondents. Sugammadex is commonly used in pediatric anesthesia, particularly among anesthesiologists with fewer years of practice. Failure to warn postmenarchal adolescents of its consequences may result in unintended pregnancies. Finally, pediatric anesthesia training programs should emphasize objective monitoring of NMB, particularly with sugammadex use.

Initial outcomes at a nascent tertiary pediatric thyroid surgical center

ObjectivesPrevious studies on pediatric thyroid surgical complications suggest that high-volume centers achieve improved outcomes. We hypothesize that initial outcomes from a nascent pediatric surgical practice may be comparable to higher volume centers. Furthermore, we determine whether a low-volume center can safely transition to an intermediate or high-volume center. MethodsA retrospective chart review was performed for all pediatric patients undergoing thyroid surgery at a single institution from 2014 to 2020. Surgeries were performed by two pediatric otolaryngologists. All patients were managed postoperatively by a multidisciplinary team of physicians that included pediatric otolaryngologists and endocrinologists. Data collection focused on patient demographics and postoperative complications, including rates of recurrent laryngeal nerve injury and permanent hypoparathyroidism. ResultsFrom 2014 to 2020, a total of 31 patients underwent thyroid surgery at our pediatric thyroid surgery center, 9 of whom underwent neck dissection. The mean age of our cohort was 14.4 ± 3.9 years (range 8 months–20 years). Postoperative pathology results revealed that 15 patients (46.9%) were diagnosed with PTC, 6 (18.8%) with follicular adenoma, and 4 (15.6%) with benign thyroid tissue. One (2.0%) patient had permanent unilateral recurrent laryngeal nerve paralysis and one patient experienced permanent hypoparathyroidism (2.7%). ConclusionsOur initial low complication rate as a nascent pediatric thyroid surgery center suggests that favorable outcomes can be achieved at lower volume surgery centers. In order to increase patient access to high-volume pediatric thyroid surgery centers, new centers must start with lower volumes before ultimately becoming high-volume centers. Our study shows that this can be safely achieved. Level of evidenceIV.

The Cost-Effectiveness of Closed Incisional Negative Pressure Wound Therapy for Infection Prevention after Revision Total Knee Arthroplasty.

Recent investigations have shown that closed incisional negative pressure wound therapy (ciNPWT) decreases the rate of postoperative wound complications following revision total knee arthroplasty (TKA). In this study, we used a break-even analysis to determine whether ciNPWT is a cost-effective measure for reducing prosthetic joint infection (PJI) after revision TKA. The cost of ciNPWT, cost of treatment for PJI, and baseline infection rates following revision TKA were collected from institutional data and the literature. The absolute risk reduction (ARR) in infection rate necessary for cost-effectiveness was calculated using break-even analysis. Using our institutional cost of ciNPWT ($600), this intervention would be cost-effective if the initial infection rate of revision TKA (9.0%) has an ARR of 0.92%. The ARR needed for cost-effectiveness remained constant across a wide range of initial infection rates and declined as treatment costs increased. The use of ciNPWT for infection prevention following revision TKA is cost-effective at both high and low initial infection rates, across a broad range of treatment costs, and at inflated product expenses.

The Effects of Coronavirus Disease 2019 on Pediatric Anesthesiologists: A Survey of the Members of the Society for Pediatric Anesthesia.

The coronavirus disease 2019 (COVID-19) pandemic has affected the personal and professional lives of all health care workers. Anesthesiologists frequently perform virus-aerosolizing procedures (eg, intubation and extubation) that place them at increased risk of infection. We sought to determine how the initial COVID-19 outbreak affected members of the Society for Pediatric Anesthesia (SPA) on both personal and professional levels. Specifically, we examined the potential effects of gender and age on personal stress, burnout, sleep deprivation, anxiety, depression, assessed job satisfaction, and explored financial impact. After receiving approval from the SPA Committees for Research and Quality and Safety and the Colorado Multiple Institutional Review Board, we e-mailed a questionnaire to all 3245 SPA members. The survey included 22 questions related to well-being and 13 questions related to effects of COVID-19 on current and future practice, finances, retirement planning, academic time and productivity, and clinical and home responsibilities. To address low initial response rates and quantify nonresponse bias, we sent a shortened follow-up survey to a randomly selected subsample (n = 100) of SPA members who did not respond to the initial survey. Response differences between the 2 cohorts were determined. A total of 561 (17%) members responded to the initial questionnaire. Because of COVID-19, 21.7% of respondents said they would change their clinical responsibilities, and 10.6% would decrease their professional working time. Women were more likely than men to anticipate a future COVID-19-related job change (odds ratio [OR] = 1.92, 95% confidence interval [CI], 1.12-2.63; P = .011), perhaps because of increased home responsibilities (OR = 2.63, 95% CI, 1.74-4.00; P < .001). Additionally, 14.2% of respondents planned to retire early, and 11.9% planned to retire later. Women and non-White respondents had higher likelihoods of burnout on univariate analysis (OR = 1.75, 95% CI, 1.06-2.94, P = .026 and OR = 1.82, 95% CI, 1.08-3.04, P = .017, respectively), and 25.1% of all respondents felt socially isolated. In addition, both changes in retirement planning and future occupational planning were strongly associated with total job satisfaction scores (both P < .001). The COVID-19 pandemic has affected the personal and professional lives of pediatric anesthesiologists, albeit not equally, as women and non-Whites have been disproportionately impacted. The pandemic has significantly affected personal finances, home responsibilities, and retirement planning; reduced clinical and academic practice time and responsibilities; and increased feelings of social isolation, stress, burnout, and depression/anxiety.

Quantitative and qualitative assessment of an all-inclusive postpartum human papillomavirus vaccination program

A postpartum human papillomavirus vaccination program was locally implemented to address low initiation rates among young adults. Within 20 months, the program achieved high vaccine initiation and series completion rates. Based on the program's success, it was expanded to all 36 counties served by a public hospital. This study aimed to conduct a quantitative and qualitative evaluation to examine the success and limitations of the program when expanded from 1 county to 36 counties, many of which are home to rural and medically underserved communities. Patient navigators reviewed the electronic medical records and immunization registry records of women aged ≤26 years, who delivered an infant at the public hospital, to determine whether they needed to initiate or complete the human papillomavirus vaccine series. Eligible women were counseled and offered the human papillomavirus vaccine during their hospital stay. Patient navigators scheduled follow-up injections in addition to the mother's postpartum or her infant's well-child visits, made reminder phone calls, and rescheduled missed appointments. Descriptive statistics, including frequencies and proportions, were used for patients approached in the initial and expansion programs. Frequencies from the initial and expansion programs were examined separately. Qualitative interviews were conducted with the clinic staff to evaluate the program. The qualitative analyses were conducted using NVivo (QSR International, Melbourne, Australia, version 10). Both initial and expanded programs achieved vaccine completion rates above 70%. Of the 2631 eligible postpartum women enrolled in the initial program, 785 (30%) had already been fully vaccinated. Of the remaining 1846 women, 1265 (69%) women received their first dose, and 196 (11%) women received their second or third dose on the postpartum unit. Of the 1461 women who received at least 1 dose through the initial program, 1124 (77%) completed all 3 doses. Of the 4330 eligible postpartum women enrolled in the expanded program, 886 (21%) had already been fully vaccinated. Of the remaining 3444 women, 2284 (66%) received their first dose, and 343 (10%) received their second or third dose on the postpartum unit. Of the 2627 women receiving at least 1 dose through the expanded program, 1932 (74%) completed all 3 doses. Clinic staff interviewed felt the program benefited the postpartum unit and clinics, because it increased patient knowledge of the vaccine, increased patient volume for vaccination, and gave healthcare providers more time to focus on other tasks. Human papillomavirus vaccination on the postpartum unit is an effective way to increase catchup rates and is well accepted by healthcare providers. High completion rates can be achieved if adequate support is provided, even among patients residing in rural or underserved areas who need extensive support to access primary healthcare services. Although this particular program may be considered costly, it is overall effective because the vaccine prevents 5 different types of cancer in women. The inclusion of human papillomavirus vaccination in routine postpartum care is a relatively easy way to reach many adults not vaccinated at a younger age and could help address low vaccination rates among young women in the United States, including hard-to-reach populations.

H2 generation kinetics/thermodynamics and hydrolysis mechanism of high-performance La-doped Mg-Ni alloys in NaCl solution—A large-scale and quick strategy to get hydrogen

In this work, La-doped Mg-Ni multiphase alloys were prepared by resistance melting furnace (RMF) and then modified by high-energy ball milling (HEBM). The hydrolysis H2 generation kinetics/thermodynamics of prepared alloys in NaCl solutions have been investigated with the help of nonlinear and linear fitting by Avrami-Erofeev and Arrhenius equations. Combining the microstructure information before and after hydrolysis and thermodynamics fitting results, the hydrolysis H2 generation mechanism based on nucleation & growth has been elaborated. The final H2 generation capacities of 0La, 5La, 10La and 15 La alloys are 677, 653, 641 and 770 mL·g − 1 H2 in 240 min at 291 K, respectively. While, the final H2 generation capacities of HEBM 0La, 5La, 10La and 15 La alloys are 632, 824, 611 and 653 mL·g − 1 H2 in 20 min at 291 K, respectively. The as-cast 15La alloy and HEMB 5La alloy present the best H2 production rates and final H2 production capacities, especially the HEBM 5La can rapidly achieve high H2 generation capacity (670 and 824 mL·g − 1 H2) at low temperature (291 K) within short time (5 and 20 min). The difference between the H2 generation capacities is mainly originated from the initial nucleation rate of Mg(OH)2 and the subsequent processes affected by the microstructures and phase compositions of the hydrolysis alloys. Relative low initial nucleation rate and fully growth of Mg(OH)2 nucleus are the premise of high H2 generation capacity due to the hydrolysis H2 generation process consisted by the nucleation, growth and contacting of Mg(OH)2 nucleus. To utilization H2 by designing solid state H2 generators using optimized Mg-based alloys is expected to be a feasible H2 generation strategy at the moment.

Electrical Characterization of a Double-Layered Conductive Pattern with Different Crack Configurations for Durable E-Textiles.

For the conductive patterns of electronic textiles (e-textiles), it is still challenging to maintain low electrical resistance, even under large or cyclic tensile deformation. This study investigated a double-layered pattern with different crack configurations as a possible solution. Patterns with single crack growth exhibit a low initial resistance and resistance change rate. In contrast, patterns with multiple crack growth maintain their conductivity under deformation, where electrical failure occurs in those with single crack growth. We considered that a double-layered structure could combine the electrical characteristics of patterns with single and multiple crack growths. In this study, each layer was theoretically designed to control the crack configuration. Then, meandering copper patterns, silver ink patterns, and their double layers were fabricated on textiles as patterns with single and multiple crack growths and double-layered patterns, respectively. Their resistance changes under the single (large) and cyclic tensile deformations were characterized. The results confirmed that the double-layered patterns maintained the lowest resistance at the high elongation rate and cycle. The resistance change rates of the meandering copper and silver ink patterns were constant, and changed monotonically against the elongation rate/cycle, respectively. In contrast, the change rate of the double-layered patterns varied considerably when electrical failure occurred in the copper layer. The change rate after the failure was much higher than that before the failure, and on the same order as that of the silver ink patterns.

A generalized model for correcting bias due to permeability using emergent fry traps in mesocosm experiments

Relative abundance, or CPUE, is a commonly used metric for fisheries conservation and management. Interpreting CPUE data requires understanding the probability that a fish will be caught (catchability) by a particular type of gear and factors that affect catchability. Escape is often not considered in catchability studies, and there is little to no mention of this phenomenon in fisheries textbooks. However, most passive sampling gear, particularly traps, is ‘permeable’, so the number of organisms actually collected will fluctuate based on probability of escapement. Because high or variable escape rates have the potential to bias measures of abundance, the use of passive traps requires recognition and assessment of permeability. To better understand these dynamics, and particularly how they apply to salmonid emergent fry traps, we conducted a series of mesocosm experiments with early-life stage lake trout (Salvelinus namaycush). We assessed entry and exit rates by fitting daily capture data to a hierarchical state-space model. We also evaluated a trap modification and the effect of thiamine deficiency on capture rates; thiamine-deficient fish can be lethargic and unlikely to enter traps, so deficiency in the wild may be underestimated. Results revealed distinct temporal trends, with low initial entry rates that rose around the third week after hatch and remained constant thereafter. Thiamine deficiency decreased entry rates but appeared to have no effect on exit rates. Conversely, a minor trap design change had an unexpectedly large effect on exit rates. We developed a generalizable model for estimating abundance using passive traps based on soak time and entry/exit rates, as well as specific rate estimates for lake trout in emergent fry traps. Such corrections should be performed whenever feasible, as abundance estimates may otherwise be biased by exit-related equilibrium.

Barriers to Human Papillomavirus Vaccine Uptake Among Racial/Ethnic Minorities: a Systematic Review.

Human papillomavirus (HPV) is associated with poor health outcomes, including cervical cancer. Racial/ethnic minority populations experience poor health outcomes associated with HPV at higher rates. A vaccine is available to protect against HPV infections and prevent HPV-related sequelae; however, vaccination rates have remained low in the United States (U.S.) population. Thus, there is an urgent need to increase the HPV vaccination rate. Moreover, little is known about barriers to HPV vaccination in racial/ethnic minority groups. This paper highlights the most recent findings on barriers experienced by these groups. The PubMed database was searched on July 30, 2020, for peer-reviewed articles and abstracts that had been published in English from July 2010 to July 2020 and covered racial/ethnic disparities in HPV vaccination. Similar findings were observed among the articles reviewed. The low HPV vaccination initiation and completion rates among racial/ethnic minority populations were found to be associated with lack of provider recommendations, inadequate knowledge and awareness of HPV and HPV vaccination, medical mistrust, and safety concerns. Provider recommendations and accurate distribution of information must be increased and targeted to racial/ethnic minority populations in order to bolster the rate of vaccine uptake. To effectively target these communities, multi-level interventions need to be established. Further, research to understand the barriers that may affect unvaccinated adults in the catch-up age range, including males, may be beneficial, as majority of the previous studies focused on either parents of adolescents or women.

Novel TrxR1 Inhibitors Show Potential for Glioma Treatment by Suppressing the Invasion and Sensitizing Glioma Cells to Chemotherapy.

Currently, available glioblastoma (GBM) treatment remains ineffective, with relapse after initial response and low survival rate of GBM patients. The reasons behind limited capacities for GBM treatment are high tumor heterogeneity, invasiveness, and occurrence of drug resistance. Therefore, developing novel therapeutic strategies is of utmost importance. Thioredoxin reductase (TrxR) is a novel, promising target due to its overexpression in many cancer types and important role in cancer progression. Previous research on Ugi-type Michael acceptors–inhibitors of TrxR showed desirable anticancer properties, with significant selectivity toward cancer cells. Herein, two TrxR inhibitors, 5 and 6, underwent in-depth study on multidrug-resistant (MDR) glioma cell lines. Besides the antioxidative effects, 5 and 6 induced cell death, decreased cell proliferation, and suppressed invasion and migration of glioma cells. Both compounds showed a synergistic effect in combination with temozolomide (TMZ), a first-line chemotherapeutic for GBM treatment. Moreover, 5 and 6 affected activity of P-glycoprotein extrusion pump that could be found in cancer cells and in the blood–brain barrier (BBB), thus showing potential for suppressing MDR phenotype in cancer cells and evading BBB. In conclusion, investigated TrxR inhibitors are effective anticancer compounds, acting through inhibition of the thioredoxin system and perturbation of antioxidative defense systems of glioma cells. They are suitable for combining with other chemotherapeutics, able to surpass the BBB and overcome MDR. Thus, our findings suggest further exploration of Ugi-type Michael acceptors–TrxR inhibitors’ potential as an adjuvant therapy for GBM treatment.

Dual mobility total hip arthroplasty for the treatment of femoral neck fracture with hemiplegia

To investigate the clinical effects of dual mobility total hip prosthesis in treating femoral neck fracture patients with hemiplegia. A retrospective analysis was performed on 18 patients with femoral neck fracture combined with hemiplegia who underwent dual mobility total hip prosthesis replacement from March 2014 to December 2016. The follow up data of these patients was complete. There were 5 males and 13 females, aged 65 to 70 years old with an average of (66.50±1.38) years. The left side was involved in 12 cases, while the right side in 6 cases. There were 4 cases with Garden Ⅲ type and 14 cases with type Ⅳ. Limb muscle strength of hemiplegia were in grade Ⅳ. The posterior-lateral approach of hip joint was used in surgery for all patients. The implant position, dislocation and loosening of the prosthesis were evaluated by X-ray examination. Harris hip score and the Merle D'aubigne score were used to assess the hip function in the follow up. The operation duration was for 70-90 (81.56±7.48) min and the blood loss during the operation was for 160-200 (170.32± 12.56) ml. No blood was transfused during the operation. Postoperative incisions were healed at the first stage. The follow-up time was for 28-60(36.0±3.5) months. Harris hip score increased from 16.94±0.73 preoperatively to 96.19±1.27 at the final follow-up(P<0.05). Merle D 'Aubigne score increased from 3.96±0.06 preoperatively to 16.81±0.63 at the final follow-up(P< 0.05). No fracture or nerve or vascular injury were found during the operation. The postoperative X-ray showed that the prosthesis was in good position. No complications such as joint dislocation, dislocation of prosthesis, loosening of prosthesis, fracture around the prosthesis, pain in the front of thethigh, fracture of the self tapping screw in the ilium, and delayed infection occurred in the patients after operation. Dual mobility total hip prosthesis has the advantages of both good initial stability and low dislocation rate of the prosthesis, and the clinical application of total hip replacement in hemiplegic femoral neck fracture is satisfactory.

Alternative stabilised rammed earth materials incorporating recycled waste and industrial by-products: Durability with and without water repellent

Rammed earth (RE) materials with low greenhouse gas emissions have been developed as replacements for conventional construction materials. In this series, we examine the strength development, durability and sustainability, via life cycle assessment, of these new materials.In this paper, we present findings for material durability with and without the addition of the water repellent admixture, Tech-Dry ‘Plasticure’. Understanding of durability properties is essential to verify the suitability of the RE materials for building. The study assessed four distinct RE materials, all based on a substrate of crushed limestone: a control mix, cement-stabilised RE (the industry standard in Western Australia) and three alternative stabilisers, i) alkali-, ii) lime-, and iii) self-activated RE. The alternative RE stabilisers incorporated industrial by-products fly ash, ground granulated blast furnace slag and silica fume, in combination with sodium hydroxide, hydrated lime or no activator (respectively, by mix). Durability was assessed using initial rate of absorption, immersion and wire brush testing. Both with and without Plasticure, all materials either passed these tests or, where pass/fail criteria were unavailable, were found to be comparable to conventional building materials. Scanning electron microscopy and energy dispersive spectroscopy showed that greater maturity in terms of reaction of raw materials was associated with lower absorption. Those materials with Plasticure had lower initial rate of absorption than those without, especially in the case of lime- and self-activated RE. Plasticure was shown to improve durability properties of all tested RE mixes.

A Case Study on the Evolutionary Development of U.S Unmanned Aerial Vehicles (UAVs)

In October 2018, the Korean Army established a Dronebot unit. The future battleground is expected to be led by drones and robots. However, in order to utilize new weapons systems such as drones and unmanned aerial vehicles (UAVs) in the Korean army, it is necessary to go through complicated and long-term defense acquisition procedures, which make it difficult to adopt and reflect the latest technologies immediately. The purpose of this study is to derive some implications for the efficient development and acquisition of UAVs in Korea through in-depth case analysis on the evolutionary development and acquisition of U.S. military UAVs. Accordingly, this study focused on the tactical/strategic U.S. fixed-wing UAVs which have been developed and mass-produced since 1990s, weighing more than 150kg. They include Shadow-200 as brigade/division-level UAV, Predator and Reaper as midium altitude UAVs, and Global Hawk as high altitude UAV. These must not only satisfy the required operational capability (ROC), but also receive strict airworthiness certification. Among them, Predator and Global Hawk were carried out as New Conceptual Technology Development Demonstration (ACTD), and prototypes under development were put into the Middle East battle. Although there were several accidents, flexible development processes such as system development or initial mass production were applied after ACTD. The initial target performance was set to be low and operability verification was prioritized, and the performance was improved through the evolutionary development of initial low rate mass production, subsequent mass production, and subsequent performance improvement. Despite the initial mass production phase, all required performance was not confirmed, and the required performance was presented in a range of flexibility. On the other hand, there have been large-scale changes such as engine replacement, aircraft change and communication systems upgrade to improve performance. Mission equipment was developed separately and applied to mass production when operability was confirmed. In the process of the development and acquisition of these UAVs, unforeseen accidents, huge losses and increased costs happened, but the U.S. government continued to pursue an evolutionary development policy for military drones. Therefore, in developing and acquiring new high-tech military unmanned aerial vehicles, it is necessary for Korea to develop and acquire them based on operability in the initial development stage, and to enhance its combat capabilities by improving its performance in the stages of initial mass production, follow-up mass production and performance improvement.

The Relationship Between Place of Birth and Early Breastfeeding Initiation in Indonesia.

In many countries, hospital-based births are associated with the early initiation of breastfeeding, within the first hour postpartum, especially where the Baby Friendly Hospital Initiative guidelines have been adopted. While Indonesia has adopted the guidelines, there is a relatively low rate of early breastfeeding initiation in the country. To determine the relationship between place of birth and early breastfeeding initiation in Indonesia. This study was a retrospective cross-sectional survey using national data from the 2017 Indonesia Demographic and Health Survey (N = 14,279). The association between place of birth and early breastfeeding initiation was examined using logistic regression models, adjusting for potential confounders. The overall prevalence of early breastfeeding initiation in Indonesia was 60.9% with a greater proportion of mothers giving birth in health facilities. In the multivariate model, there was a significant interaction between wealth index, insurance status, and place of birth on the timing of breastfeeding initiation. In the subgroup of mothers residing in middle wealth index households, women who gave birth in clinics and hospitals had lower odds of early breastfeeding initiation compared to those who gave birth at home (0.56; 0.34, 0.90; p = .018) and (0.58; 0.40, 0.85; p = .005), respectively. Place of birth was significantly associated with early breastfeeding initiation. There is a need to consider health disparities and to strengthen the implementation of the WHO guidelines, Baby Friendly Hospital Initiative, and International Code of Marketing of Breastmilk Substitutes, to increase early breastfeeding initiation in Indonesia.

Using Online Communication Skills Training to Increase Organ Donation Authorization.

Family denial of organ donation from deceased donor-eligible patients is a major contributor to the deficit of transplantable organs in the United States. Does an evidence-based communication intervention improve deceased organ donor authorization rates from family decision-makers? This implementation and dissemination study used Communicating Effectively about Donation on Organ Procurement Organization professionals responsible for discussing donation and obtaining authorization from family decision-makers. A 14-month, nationwide social marketing campaign generated a sample of 682 requesters, yielding a final analyzable sample of 253 participants. Serving as their own controls, participants spent the first 3 months in a preintervention period, completed the web-based intervention, and progressed to a 3-month postintervention period. Participants completed brief online weekly surveys to assess the intervention's impact on their communication skills. Authorization rates did not improve overall between the pre- and postintervention periods. A differential effect of the intervention on 3 distinct groups of requesters was found: one group exhibited high and stable authorization rates pre-post (78%-74%); a second group had low initial authorization rates that increased after exposure to the intervention (46%-73%); the third had low and variable rates of authorization that failed to improve after the intervention (45%-36%). This study underscores the value of evidence-based communication training. Training targeted to requesters' skill levels is needed to realize overall improvements in individual performance, the quality of donation discussions, and rates of family decision-maker authorization to solid organ donation.

Reactivity Ratios Estimation of the Free‐Radical Polymerization of Itaconic Acid and N‐Vinyl‐2‐Pyrrolidone by the Error‐in‐Variables Methodology

AbstractDesigned copolymers require an understanding of the relative reactivity ratios of the monomer pair and a proper regression technique that can extract this data from the experiments. An implementation of the error‐in‐variables method previously describes in the literature is written and made available for use, along with an high‐performance liquid chromatography (HPLC) methodology for acquiring the kinetic data for the regression analysis of the itaconic acid and N‐vinyl‐2‐pyrrolidone (IA/NVP) free‐radical copolymerization system. From the data, it is observed that higher initial mole fractions of IA in the reaction medium change the reaction kinetics, limiting the validity of the Mayo–Lewis model to a narrow range of initial mole fractions of IA. This effect is not observed at molar fractions below 10%, enabling the parameters to be estimated. The performance of the developed algorithm is satisfactory, and within less than 5% error when applied to data found in the literature. The parameters estimated by the algorithm for the IA/NVP system are r1 = 0.3046 and r2 = 0.0170, with IA as compound 1. A rather large deviation is observed for r1 and this is attributed to measurement errors associated with the low IA concentrations and high initial reaction rates.

Nucleophilic versus Electrophilic Activation of Hydrogen Peroxide over Zr-Based Metal-Organic Frameworks.

Zr-based metal-organic frameworks (Zr-MOF) UiO-66 and UiO-67 catalyze thioether oxidation in nonprotic solvents with unprecedentedly high selectivity toward corresponding sulfones (96-99% at ca. 50% sulfide conversion with only 1 equiv of H2O2). The reaction mechanism has been investigated using test substrates, kinetic, adsorption, isotopic (18O) labeling, and spectroscopic tools. The following facts point out a nucleophilic character of the peroxo species responsible for the superior formation of sulfones: (1) nucleophilic parameter XNu = 0.92 in the oxidation of thianthrene 5-oxide and its decrease upon addition of acid; (2) sulfone to sulfoxide ratio of 24 in the competitive oxidation of methyl phenyl sulfoxide and p-Br-methyl phenyl sulfide; (3) significantly lower initial rates of methyl phenyl sulfide oxidation relative to methyl phenyl sulfoxide (kS/kSO = 0.05); and (4) positive slope ρ = +0.42 of the Hammett plot for competitive oxidation of p-substituted aryl methyl sulfoxides. Nucleophilic activation of H2O2 on Zr-MOF is also manifested by their capability of catalyzing epoxidation of electron-deficient C═C bonds in α,β-unsaturated ketones accompanied by oxidation of acetonitrile solvent. Kinetic modeling on methyl phenyl sulfoxide oxidation coupled with adsorption studies supports a mechanism that involves the interaction of H2O2 with Zr sites with the formation of a nucleophilic oxidizing species and release of water followed by oxygen atom transfer from the nucleophilic oxidant to sulfoxide that competes with water for Zr sites. The nucleophilic peroxo species coexists with an electrophilic one, ZrOOH, capable of oxygen atom transfer to nucleophilic sulfides. The predominance of nucleophilic activation of H2O2 over electrophilic one is, most likely, ensured by the presence of weak basic sites in Zr-MOFs identified by FTIR spectroscopy of adsorbed CDCl3 and quantified by adsorption of isobutyric acid.

Reduced Susceptibility of Mycobacterium tuberculosis to Bedaquiline During Antituberculosis Treatment and Its Correlation With Clinical Outcomes in China.

We aimed to assess the proportion of multidrug-resistant tuberculosis (MDR-TB) cases with initial bedaquiline (BDQ) resistance, monitor the dynamics of BDQ susceptibility of Mycobacterium tuberculosis isolates during therapy, and correlate susceptibility with MDR-TB patient clinical outcomes in China. A retrospective, cohort study of MDR-TB patients was conducted, with positive cultures collected from cases at 13 sites. Patients with nontuberculous mycobacterial infection during anti-TB therapy were excluded. BDQ minimal inhibitory concentrations (MICs) were determined using a 7H9 Middlebrook broth-based microdilution method. Mutations that conferred BDQ resistance were detected via Sanger sequencing. A total of 277 patients receiving BDQ treatment were studied, with BDQ resistance noted in isolates from 2.2% (6/277) of MDR-TB cases, sputum conversion observed in 5 cases, and culture conversion observed in 138 cases within 2 weeks. Another 15 and 30 isolates were excluded from final analysis due to failures in obtaining subcultures and serial isolates, respectively. Of 94 cases that yielded serial isolates, 11 exhibited reduced BDQ susceptibility, while 3 of 5 cases with acquired resistance failed to culture-convert. Sequence analysis revealed that 6 of 11 BDQ-resistant isolates harbored Rv0678 mutations; no mutations were detected in 3 other BDQ resistance-associated genes. No significant intergroup difference in culture conversion time was observed. MDR-TB patients in China exhibited a low initial BDQ resistance rate. MDR-TB cases with acquired BDQ resistance were at greater risk of treatment failure relative to initially BDQ-resistant cases. Rv0678 mutations accounted for BDQ resistance in this cohort.

Synthesis and Characterization of Ti-Nb2O5 Catalysts for Discoloration Reaction of Bromophenol Blue and Indigo Carmine Dyes

This work investigated the photodegradation of bromophenol blue (BPB) and indigo carmine (IC) dye under UV–Visible light using pure oxides of titanium and niobium, as well as TiO2-Nb2O5 oxides containing 0.5, 2.5 and 5 wt% of TiO2, prepared by wet impregnation of Nb2O5 with Ti tert-butoxide under inert atmosphere. The results of XRD and Raman spectroscopy showed the presence of anatase TiO2 phase and T-Nb2O5 phase with orthorhombic structure in the pure TiO2 and Nb2O5 oxides, respectively. The Nb2O5 oxides doped with TiO2 presented a T-Nb2O5 phase, but there was no formation of TiNb2O7. TiO2 anatase was observed in the mixed oxide with higher Ti content (5 wt% TiO2). A zeta potential analysis showed positive surface charge values for titanium oxide and negative for niobium oxide and mixed oxides. The addition of up to 5 wt% of the TiO2 fold the activity of Nb2O5 in the discoloration of both dyes. Pure TiO2 exhibits higher initial activity, which could be related to its positive PZC and higher attraction to sulphonic groups present in the dyes. Despite of the lower initial rate, 2.5 and 5% TiNb catalysts achieved full degradation of the dyes after 4 h of reaction.

Homophobic bullying victimization trajectories: The roles of perpetration, sex assigned at birth, and sexuality.

There is a paucity of research on developmental trajectories of bias-based aggression. We examined homophobic bullying victimization trajectories among high school students (N = 3,064; M age = 13.67; Girls = 50.2%) and how these developmental pathways vary as a function of factors like homophobic bullying perpetration, sex assigned at birth, and sexuality. Using data from a 3-wave longitudinal investigation over a 2-year period, we utilized latent growth mixture modeling to explore the aforementioned trajectories. Findings suggested that there were three distinct classes characterized by high initial rates and declines over time, low initial rates, and increases over time, and low, stable, rate across time. Furthermore, results indicated that homophobic bullying perpetration, sex assigned at birth, and sexuality all predicted class membership.