Cardiovascular Risk Factors and Disparities in Management of Embolic Stroke: A Western Sydney Perspective.

BACKGROUND: Ischaemic stroke remains one of the leading causes of death and disability worldwide. The population of Western Sydney has a unique demographic with lower socioeconomic status and a culturally and linguistically diverse population. This study aims to investigate the demographics and cardiovascular risk factors of patients in Western Sydney, focusing on the prevalence and profile of cardioembolic (CE) strokes and embolic strokes of undetermined source (ESUS). METHOD: Prospective data were collected in 463 patients with ischaemic stroke presenting to a tertiary centre in Western Sydney, who underwent predischarge transthoracic echocardiography. Patients with haemorrhagic strokes or unclear stroke diagnosis were excluded. Analysis of stroke subtype (CE, ESUS, or non-embolic) and clinical characteristics was performed based on age, gender, and prior atrial fibrillation (AF) prevalence. RESULTS: Of the 463 patients, 147 (32%) had CE strokes, and 147 (32%) had ESUS. Cardioembolic (CE) strokes were associated with older age (≥65 years) and a history of congestive cardiac failure. Older patients had higher rates of hypertension, ischaemic heart disease, AF, and congestive heart failure. History of AF was present in 67 patients (14.5%); however, only 51% received anticoagulation before admission despite a low bleeding risk. The transthoracic echocardiography characteristics of ESUS/non-embolic strokes differed from those of CE strokes; 20% of patients with ESUS had an enlarged left atrium, suggesting a subset of patients with ESUS with a left atrial myopathy. CONCLUSIONS: Patients with ischaemic stroke in Western Sydney have a high prevalence of cardiovascular risk factors which were often undertreated. Half of the patients with prior AF did not receive anticoagulation despite low bleeding risk, indicating a gap in optimal stroke prevention. There were distinct echocardiographic characteristics among stroke subtypes. Further analysis of left atrium parameters may provide greater insights into the pathogenesis and prevention of embolic strokes.

Local spatiotemporal dynamics of particulate matter and oak pollen measured by machine learning aided optical particle counters.

Conventional techniques for monitoring pollen currently have significant limitations in terms of labour, cost and the spatiotemporal resolution that can be achieved. Pollen monitoring networks across the world are generally sparse and are not able to fully represent the detailed characteristics of airborne pollen. There are few studies that observe concentrations on a local scale, and even fewer that do so in ecologically rich rural areas and close to emitting sources. Better understanding of these would be relevant to occupational risk assessments for public health, as well as ecology, biodiversity, and climate. We present a study using low-cost optical particle counters (OPCs) and the application of machine learning models to monitor particulate matter and pollen within a mature oak forest in the UK. We characterise the observed oak pollen concentrations, first during an OPC colocation period (6 days) for calibration purposes, then for a period (36 days) when the OPCs were distributed on an observational tower at different heights through the canopy. We assess the efficacy and usefulness of this method and discuss directions for future development, including the requirements for training data. The results show promise, with the derived pollen concentrations following the expected diurnal trends and interactions with meteorological variables. Quercus pollen concentrations appeared greatest when measured at the canopy height of the forest (20-30 m). Quercus pollen concentrations were lowest at the greatest measurement height that is above the canopy (40 m), which is congruent with previous studies of background pollen in urban environments. The attenuation of pollen concentrations as sources are depleted is also observed across the season and at different heights, with some evidence that the pollen concentrations persist later at the lowest level beneath the canopy (10 m) where catkins mature latest in the season compared to higher catkins.

Rapid preparation of binary mixtures of sodium carboxylates as anodes in sodium-ion batteries.

Sodium-ion batteries are emerging as a sustainable solution to tackle the growing global energy demands. In this context, organic electrode materials complement such technologies as they are composed of earth-abundant elements. As organic anodes, sodium carboxylates exhibit promising applicability in a wide range of molecules. To harness the advantages of individual systems and to minimise their limitations, in this work, an approach to form binary mixtures of sodium carboxylates using one-pot, microwave-assisted synthesis is presented. The target mixtures were synthesised in 30 min with disodium naphthalene-2,6-dicarboxylate (Na-NDC) as a common constituent in all. Both components in all mixtures were shown to participate in the charge storage and had a considerable effect on the performance characteristics, such as specific capacity and working voltage, in half and full cell formats. This approach opens a new avenue for enabling organic materials to be considered as more competitive candidates in sodium-ion batteries and promote their use in other material classes to overcome their limitations.

Nine years of imported malaria in a teaching hospital in Belgium: Demographics, clinical characteristics, and outcomes.

BACKGROUND: Imported malaria is often misdiagnosed due to the aspecific symptoms and lack of familiarity among clinicians. This study aims to evaluate a decade-long trend of imported malaria cases in a Belgian teaching hospital by analyzing demographics, clinical characteristics, and outcomes. METHODS: Medical records of 223 patients with confirmed malaria diagnoses between 2010 and 2019 were analyzed. RESULTS: Most patients were male (63.2%), aged 18-65 years (77.1%), and visiting friends or relatives (40.8%). Central Africa was the most common travel destination (54.3%), and 63.7% did not take prophylaxis. Symptoms were flu-like, with fever (91.9%) being most prevalent. P. falciparum was identified in 88.3% of cases. A high proportion of severe cases (41.7%) and a low mortality rate (0.9%) were recorded. A severe form of the disease is associated with a more extended hospital stay than uncomplicated form (median of 5 vs. 4 days, p < 0.001). Thirty-five-point five percent [33/93] of patients with severe malaria have had a previous malaria infection compared to 50.8% [66/130] of uncomplicated patients (p= 0.013) wich was statistically significant. CONCLUSION: Malaria disproportionately affects VFRs traveling to Central Africa, and flu-like symptoms should raise suspicion. Prophylaxis is essential to prevent the disease, and early diagnosis is critical for effective management. A severe form of the disease is associated with a more extended hospital stay than uncomplicated form and people with a previous history of malaria have a less severe disease.

Comparative Study of Guanidine-, Acetamidine- and Urea-Based Chloroaluminate Electrolytes for an Aluminum Battery.

Aluminum-based batteries are a promising alternative to lithium-ion as they are considered to be low-cost and more friendly to the environment. In addition, aluminum is abundant and evenly distributed across the globe. Many studies and Al battery prototypes use imidazolium chloroaluminate electrolytes because of their good rheological and electrochemical performance. However, these electrolytes are very expensive, and so cost is a barrier to industrial scale-up. A urea-based electrolyte, AlCl3:Urea, has been proposed as an alternative, but its performance is relatively poor because of its high viscosity and low conductivity. This type of electrolyte has become known as an ionic liquid analogue (ILA). In this contribution, we proposed two Lewis base salt precursors, namely, guanidine hydrochloride and acetamidine hydrochloride, as alternatives to the urea-based ILA. We present the study of three ILAs, AlCl3:Guanidine, AlCl3:Acetamidine, and AlCl3:Urea, examining their rheology, electrochemistry, NMR spectra, and coin-cell performance. The room temperature viscosities of both AlCl3:Guanidine (52.9 cP) and AlCl3:Acetamidine (76.0 cP) were significantly lower than those of the urea-based liquid (240.9 cP), and their conductivities were correspondingly higher. Cyclic voltammetry (CV) and linear sweep voltammetry (LSV) showed that all three electrolytes exhibit reversible deposition/dissolution of Al, but LSV indicated that AlCl3:Guanidine and AlCl3:Acetamidine ILAs have superior anodic stability compared to the AlCl3:Urea electrolyte, as evidenced by anodic potential limits of +2.23 V for both AlCl3:Guanidine and AlCl3:Acetamidine and +2.12 V for AlCl3:Urea. Coin-cell tests showed that both AlCl3:Guanidine and AlCl3:Acetamidine ILA exhibit a higher Coulombic efficiency (98 and 97%, respectively) than the AlCl3:Urea electrolyte system, which has an efficiency of 88% after 100 cycles at 60 mA g-1. Overall, we show that AlCl3:Guanidine and AlCl3:Acetamidine have superior performance when compared to AlCl3:Urea, while maintaining low economic cost. We consider these to be valuable alternative materials for Al-based battery systems, especially for commercial production.

Measuring and Enhancing the Ionic Conductivity of Chloroaluminate Electrolytes for Al-Ion Batteries.

At the core of the aluminum (Al) ion battery is the liquid electrolyte, which governs the underlying chemistry. Optimizing the rheological properties of the electrolyte is critical to advance the state of the art. In the present work, the chloroaluminate electrolyte is made by reacting AlCl3 with a recently reported acetamidinium chloride (Acet-Cl) salt in an effort to make a more performant liquid electrolyte. Using AlCl3:Acet-Cl as a model electrolyte, we build on our previous work, which established a new method for extracting the ionic conductivity from fitting voltammetric data, and in this contribution, we validate the method across a range of measurement parameters in addition to highlighting the model electrolytes' conductivity relative to current chloroaluminate liquids. Specifically, our method allows the extraction of both the ionic conductivity and voltammetric data from a single, simple, and routine measurement. To bring these results in the context of current methods, we compare our results to two independent standard conductivity measurement techniques. Several different measurement parameters (potential scan rate, potential excursion, temperature, and composition) are examined. We find that our novel method can resolve similar trends in conductivity to conventional methods, but typically, the values are a factor of two higher. The values from our method, on the other hand, agree closely with literature values reported elsewhere. Importantly, having now established the approach for our new method, we discuss the conductivity of AlCl3:Acet-Cl-based formulations. These electrolytes provide a significant improvement (5-10× higher) over electrolytes made from similar Lewis base salts (e.g., urea or acetamide). The Lewis base salt precursors have a low economic cost compared to state-of-the-art imidazolium-based salts and are non-toxic, which is advantageous for scale-up. Overall, this is a noteworthy step at designing cost-effective and performant liquid electrolytes for Al-ion battery applications.

K2Fe(C2O4)2: An Oxalate Cathode for Li/Na-Ion Batteries Exhibiting a Combination of Multielectron Cation and Anion Redox.

The development of multielectron redox-active cathode materials is a top priority for achieving high energy density with long cycle life in the next-generation secondary battery applications. Triggering anion redox activity is regarded as a promising strategy to enhance the energy density of polyanionic cathodes for Li/Na-ion batteries. Herein, K2Fe(C2O4)2 is shown to be a promising new cathode material that combines metal redox activity with oxalate anion (C2O4 2-) redox. This compound reveals specific discharge capacities of 116 and 60 mAh g-1 for sodium-ion batterie (NIB) and lithium-ion batterie (LIB) cathode applications, respectively, at a rate of 10 mA g-1, with excellent cycling stability. The experimental results are complemented by density functional theory (DFT) calculations of the average atomic charges.

Surface-Functionalized Metal-Organic Frameworks for Binding Coronavirus Proteins.

Since the outbreak of SARS-CoV-2, a multitude of strategies have been explored for the means of protection and shielding against virus particles: filtration equipment (PPE) has been widely used in daily life. In this work, we explore another approach in the form of deactivating coronavirus particles through selective binding onto the surface of metal-organic frameworks (MOFs) to further the fight against the transmission of respiratory viruses. MOFs are attractive materials in this regard, as their rich pore and surface chemistry can easily be modified on demand. The surfaces of three MOFs, UiO-66(Zr), UiO-66-NH2(Zr), and UiO-66-NO2(Zr), have been functionalized with repurposed antiviral agents, namely, folic acid, nystatin, and tenofovir, to enable specific interactions with the external spike protein of the SARS virus. Protein binding studies revealed that this surface modification significantly improved the binding affinity toward glycosylated and non-glycosylated proteins for all three MOFs. Additionally, the pores for the surface-functionalized MOFs can adsorb water, making them suitable for locally dehydrating microbial aerosols. Our findings highlight the immense potential of MOFs in deactivating respiratory coronaviruses to be better equipped to fight future pandemics.

Nailed Through Superior Sagittal Sinus: A Case Report and Surgical Considerations.

BACKGROUND AND IMPORTANCE: We report a case of nail gun-related penetrating brain injury, puncturing through the anterior third of superior sagittal sinus, which remained patent and was associated with an arteriovenous (AV) shunt revealed on catheter angiogram. CLINICAL PRESENTATION: A previously well 35-year-old male patient presented with a self-inflicted pneumatic nail gun injury. Neurological examination was unremarkable. Computed tomography (CT) of the brain demonstrated the nail had penetrated through the skull, traversed the anterior third of the superior sagittal sinus (SSS), right frontal lobe parenchyma, frontal horn of right lateral ventricle, caudate, and right cerebral peduncle. CT angiogram showed no associated vascular injury, with CT venogram showing a short segment of filling defect within SSS adjacent to nail penetration. However, digital subtraction angiography revealed an associated arteriovenous shunt 8 mm anterior to the dural penetration site, which filled the SSS in arterial phase. Removal of the nail was performed using a double concentric craniotomy around the nail entry site. Before removal of the nail, the SSS anterior to the nail penetration site was tied off and divided along with coagulation and division of the falx, while the SSS posterior to the nail penetration site was also tied off to isolate the penetrated SSS segment. The patient recovered well with repeat digital subtraction angiography demonstrating no residual AV shunting. CONCLUSION: This case report aims to highlight the importance of performing a catheter angiogram and describe our stepwise considerations and approach in treating a penetrating injury involving the superior sagittal sinus with concurrent AV fistula.

Azo-functionalised metal-organic framework for charge storage in sodium-ion batteries.

Sodium-ion batteries (NIBs) are emerging as promising devices for energy storage applications. Porous solids, such as metal-organic frameworks (MOFs), are well suited as electrode materials for technologies involving bulkier charge carriers. However, only limited progress has been made using pristine MOFs, primarily due to lack of redox-active organic groups in the materials. In this work a azo-functional MOF, namely UiO-abdc, is presented as an electrode compound for sodium-ion insertion. The MOF delivers a stable capacity (∼100 mA h g-1) over 150 cycles, and post-cycling characterisation validates the stability of the MOF and participation of the azo-group in charge storage. This study can accelerate the realisation of pristine solids, such as MOFs and other porous organic compounds, as battery materials.

Barriers to Guideline-Directed Anticoagulation in Patients With Atrial Fibrillation: New Approaches to an Old Problem.

Optimising guideline-directed anticoagulation in atrial fibrillation remains a perennial problem despite strong evidence for improved health outcomes with guideline-directed use of anticoagulation. Efforts to improve uptake have been hampered by barriers found at the level of the physician, patient, disease, and choice of therapy. Clinician judgement is often clouded by factors such as therapeutic inertia, aversion to bleeding risk, and implicit bias. For patients, negative preconceptions of therapy, impact of therapy on day-to-day life, and the nocebo effect pose significant barriers. Both groups are affected by poor education. Utility of a single-pronged approach directed toward clinicians or patients have demonstrated variable success, with the highest impact appreciated in studies using shared-decision models. Further, there is emerging evidence for use of integrated models of care, which have shown efficacy in improving patient outcomes, as well as use of digital platforms such as mobile app-based interventions, which can be of aid to the clinician in improving patient adherence to anticoagulation, with translated improved outcomes in clinical trials. This narrative review aims to investigate the physician and health system, patient, and drug therapy and disease barriers to uptake of guideline-directed anticoagulation in the treatment of nonvalvular atrial fibrillation.

Optimal stomatal theory predicts CO2 responses of stomatal conductance in both gymnosperm and angiosperm trees.

Optimal stomatal theory predicts that stomata operate to maximise photosynthesis (Anet ) and minimise transpirational water loss to achieve optimal intrinsic water-use efficiency (iWUE). We tested whether this theory can predict stomatal responses to elevated atmospheric CO2 (eCO2 ), and whether it can capture differences in responsiveness among woody plant functional types (PFTs). We conducted a meta-analysis of tree studies of the effect of eCO2 on iWUE and its components Anet and stomatal conductance (gs ). We compared three PFTs, using the unified stomatal optimisation (USO) model to account for confounding effects of leaf-air vapour pressure difference (D). We expected smaller gs , but greater Anet , responses to eCO2 in gymnosperms compared with angiosperm PFTs. We found that iWUE increased in proportion to increasing eCO2 in all PFTs, and that increases in Anet had stronger effects than reductions in gs . The USO model correctly captured stomatal behaviour with eCO2 across most datasets. The chief difference among PFTs was a lower stomatal slope parameter (g1 ) for the gymnosperm, compared with angiosperm, species. Land surface models can use the USO model to describe stomatal behaviour under changing atmospheric CO2 conditions.

Epizootic Yersinia enterocolitica in captive African green monkeys (Chlorocebus aethiops sabaeus).

Yersinia enterocolitica is a Gram-negative bacterium that typical results in enterocolitis in humans and poses significant worldwide risks to public health. An outbreak of yersiniosis in the Vervet/African green monkey colony at the WFSM during the winter of 2015-2016 accounted for widespread systemic infection with high morbidity and mortality. Most of the cases had extensive necrosis with suppuration and large colonies of bacilli in the large bowel and associated lymph nodes; however, the small intestine, stomach, and other organs were also regularly affected. Positive cultures of Yersinia enterocolitica were recovered from affected tissues in 20 of the 23 cases. Carrier animals in the colony were suspected as the source of the infection because many clinically normal animals were culture-positive during and after the outbreak. In this study, we describe the gross and histology findings and immune cell profiles in different organs of affected animals. We found increased numbers of myeloid-derived phagocytes and CD11C-positive antigen-presenting cells and fewer adaptive T and B lymphocytes, suggesting an immunocompromised state in these animals. The pathogen-mediated microenvironment may have contributed to the immunosuppression and rapid spread of the infection in the vervets. Further studies in vervets could provide a better understanding of Yersinia-mediated pathogenesis and immunosuppression, which could be fundamental to understanding chronic and systemic inflammatory diseases in humans.

Early Catheter Ablation Versus Initial Medical Therapy for Ventricular Tachycardia Storm.

BACKGROUND: Ventricular tachycardia (VT) storm is associated with significantly increased morbidity, mortality, and exponential healthcare utilization. Although catheter ablation (CA) may be curative, there are limited data directly comparing outcomes of early CA with initial medical therapy. METHODS: We compared outcomes of patients presenting with VT storm treated with initial CA versus those treated with initial medical therapy during their first storm presentation in an observational study. Retrospective data from the host institution from January 2014 to April 2020 of 129 patients with their first VT storm presentation were analyzed (58 underwent initial CA, 71 underwent treatment with initial medical therapy). Outcomes were compared in follow-up. RESULTS: Median time to initial CA was 6 days. Over a median follow-up of 702 days, patients who underwent initial CA compared with those treated with initial medical therapy had significantly less: (i) VA recurrence (43% versus 92%; P=0.002); (ii) VT storm recurrence (28% versus 73%; P<0.001); (iii) composite end point of death, heart transplant, VT storm recurrence, and VT-related hospitalization (47% versus 89%; P=0.002); (iv) iatrogenic complications (at 12 months: 17% versus 45%; P<0.001); (v) cardiovascular-related hospitalizations (50% versus 89%; P=0.01); (vi) total number of hospitalizations (median 1 versus 4; P<0.001); and (vi) cumulative days in hospital (median 0.5 versus 18; P<0.001). There were no intraprocedural deaths in patients treated with early CA. CONCLUSION: In an observational setting in which patients presenting with storm, early CA appears superior to initial medical therapy in terms of VT recurrence, storm recurrence, iatrogenic complications, cardiovascular hospitalizations, and cumulative days in hospital in follow-up.

Exploiting anion and cation redox chemistry in lithium-rich perovskite oxalate: a novel next-generation Li/Na-ion battery electrode.

The fundamental understanding of electrochemical reaction kinetics for lithium/sodium-ion batteries (LIBs & NIBs) is a significant criterion for advancing new-generation electrode materials. Herein, we demonstrate a novel lithium-rich perovskite oxalate KLi3Fe(C2O4)3 (KLFC) cathode with the combination of cation and anion redox delivering discharge capacities of 86 and 99 mA h g-1 after 100 cycles for a LIB and NIB, respectively, with good cyclability. Experimental Raman spectroscopy analysis combined with DFT calculations of charged/discharged samples illustrate the oxalate anion redox activity. Further, first-principles calculations of the partial density of states and Bader charges analysis have also characterised the redox behaviour and charge transfer during the potassium extraction processes.