Comparison of Standard Versus Intermediate Prophylaxis Dose for Venous Thromboembolism Prophylaxis in Patients Hospitalized With COVID-19 Infection.

Background: COVID-19 infection is associated with a high risk of venous thromboembolism (VTE) events. VTE prophylaxis reduces the risk of these events. The optimal dose of VTE prophylaxis however remains uncertain. Objectives: To compare the incidence of VTE in patients treated with either standard dose VTE versus intermediate dose VTE prophylaxis. Methods: In this retrospective cohort study, we analyzed data from 1786 adult patients admitted into the hospital with polymerase chain reaction confirmed COVID-19 infection between April 2020 to September 2021. For analysis, patients were divided into 2 cohorts: either standard dose prophylaxis treatment group (patients who received either unfractionated heparin 5000units 3 times a day or enoxaparin 30-40 mg daily subcutaneously) or intermediate dose VTE prophylaxis group (patients received either unfractionated heparin 7500 units 3 times daily or enoxaparin 30-40 mg twice a day subcutaneously). The primary outcome was incidence of VTE events described as either deep vein thrombosis (DVT) or pulmonary embolism (PE). Secondary outcome was bleeding events. Results: During the study period, 398 (22%) patients were primarily treated with standard dose VTE prophylaxis, whereas 1388 (78%) patients were treated with intermediate dose VTE prophylaxis. There was a significantly higher incidence of venous thromboembolism events noted in the standard dose prophylaxis treatment group when compared with the intermediate dose prophylaxis group (25/398 (6.3%) vs 35/1388 (2.5%) P < .001, [Odds Ratio 2.6197, 95% confidence interval = 1.5482-4.4327]). Multivariable-adjusted logistic regression, adjusting for age, obesity, and smoking, with the intermediate dose prophylaxis treatment group as the referent category revealed higher odds for incident venous thromboembolism events in the standard dose prophylaxis group. There was no statistically significant difference in bleeding events between the 2 treatment groups (9 (2.3%) for standard dose prophylaxis group vs 46 (3.3%) for intermediate dose prophylaxis group P = .26). Conclusions: Among patients hospitalized with COVID-19 infection, patients receiving intermediate dose VTE prophylaxis experienced lower incident rates of venous thromboembolism events compared to those receiving standard dose VTE prophylaxis without a statistically significant increase in the risk of bleeding events.

Unexpectedly rapid aerosol formation in the Hunga Tonga plume.

The Hunga Tonga-Hunga Ha'apai (HT-HH) volcanic eruptions on January 13 and 15, 2022, produced a plume with the highest signal in stratospheric aerosol optical depth observed since the eruption of Mt. Pinatubo in 1991. Suites of balloon-borne instruments on a series of launches from Réunion Island intercepted the HT-HH plume between 7 and 10 d of the eruptions, yielding observations of the aerosol number and size distribution and sulfur dioxide (SO2) and water vapor (H2O) concentrations. The measurements reveal an unexpected abundance of large particles in the plume, constrain the total sulfur injected to approximately 0.2 Tg, provide information on the altitude of the injection, and indicate that the formation of sulfuric acid aerosol was complete within 3 wk. Large H2O enhancements contributed as much as ~30% to ambient aerosol surface area and likely accelerated SO2 oxidation and aerosol formation rates in the plume to approximately three times faster than under normal stratospheric conditions.

Rapid ozone depletion after humidification of the stratosphere by the Hunga Tonga Eruption.

The eruption of the Hunga Tonga-Hunga Ha'apai volcano on 15 January 2022 offered a good opportunity to explore the early impacts of tropical volcanic eruptions on stratospheric composition. Balloon-borne observations near Réunion Island revealed the unprecedented amount of water vapor injected by the volcano. The enhanced stratospheric humidity, radiative cooling, and expanded aerosol surface area in the volcanic plume created the ideal conditions for swift ozone depletion of 5% in the tropical stratosphere in just 1 week. The decrease in hydrogen chloride by 0.4 parts per million by volume (ppbv) and the increase in chlorine monoxide by 0.4 ppbv provided compelling evidence for chlorine activation within the volcanic plume. This study enhances our understanding of the effect of this unusual volcanic eruption on stratospheric chemistry and provides insights into possible chemistry changes that may occur in a changing climate.

Subpicosecond HI elimination in the 266 nm photodissociation of branched iodoalkanes.

The 266 nm photodissociation dynamics of 1-iodopropane and 2-iodopropane were studied using photofragment translational energy spectroscopy using vacuum ultraviolet (VUV) photoionization and electron impact ionization detection of products. The photochemistry of 1-iodopropane was found to be similar to that of iodomethane and iodoethane, with dominant production of I*(2P1/2), and no evidence (<0.21%) for HI + alkene formation. Significantly different behavior was observed for 2-iodopropane, with dominant production of ground state I(2P3/2), and a HI yield >10.5%. The anisotropy (ß) parameters for all channels approached the limiting value of 2.0, indicating that 1,2-HI elimination occurs on subpicosecond timescales, like direct C-I bond fission, following excitation to 3Q0. The HI translational energy and angular distributions were similar to those for I(2P3/2), suggesting that motion of the heavy I atom in HI is largely derived from the repulsive nature of the 1Q1 surface correlating to R + I with the light H atom picked up by ground state I late in the exit channel producing highly vibrationally excited HI.

Bivalirudin Anticoagulation Dosing Protocol for Extracorporeal Membrane Oxygenation: A Retrospective Review.

Anticoagulation with unfractionated heparin during extracorporeal membrane oxygenation (ECMO) is common, but alternative agents are being evaluated for safety and efficacy. The objective of this analysis was to assess if a comprehensive bivalirudin dosing and monitoring protocol effectively guides dose adjustments and monitoring of bivalirudin in patients during ECMO. Our analysis included 11 patients who received bivalirudin during ECMO therapy and had dosing managed using our hospital derived protocol. Patients treated over a 1-year period were included in this retrospective analysis. Clinical characteristics and changes in activated partial thromboplastin time (aPTT) were evaluated from medical records to determine the efficacy of the dosing protocol. ECMO was initiated for acute respiratory distress syndrome in eight (72.7%) patients and for cardiac arrest in three (27.3%) patients. A total of 178 protocol guided dose adjustments were made during the study. Among the dose adjustments, 56 (31.5%) attained the protocol predicted aPTT level change, 96 (53.9%) of the measured aPTT changes were less than predicted, and 26 (14.6%) of the measured aPTT changes were more than predicted. On average, patients were within their defined therapeutic aPTT target range 66.3% of the time. All patients reached their designated aPTT target range within the first 24 hours of therapy. Significant bleeding was documented in eight (72.7%) patients. No clinically evident thromboembolic events were identified in vivo while cannulated. This analysis suggests that bivalirudin can be managed using a dosing protocol to provide anticoagulation therapy to patients during ECMO and can provide foundational guidance for dose adjustment and monitoring for other institutions.

Role of Photogenerated Iodine on the Energy-Conversion Properties of MoSe2 Nanoflake Liquid Junction Photovoltaics.

Transition metal dichalcogenides (TMDs) such as MoSe2 and WSe2 are efficient materials for converting solar energy to electrical energy in photoelectrochemical photovoltaic cells. One limiting factor of these liquid junction solar cells is that photogenerated oxidation products accumulate on the electrode surface and decrease the photocurrent efficiency. However, it is unclear where the reaction products accumulate on the electrode surface and how they impact the local photoelectrochemical response. This open question is especially important for the structurally heterogeneous TMD nanoflake thin-film electrodes that are promising for large-area solar energy conversion applications. Here, we use a single-nanoflake photoelectrochemical and Raman microscopy approach to probe how the photogenerated I2/I3- products impact the photocurrent collection efficiency and the onset potential in MoSe2-nanoflake|I-/I2|Pt photoelectrochemical solar cells. We observed localized I2/I3- deposition on all types of MoSe2 nanoflake surface motifs, including basal planes, perimeter edges, and interior step edges. Illuminated nanoflake spots with the highest photocurrent collection efficiency are the first to be limited by I2/I3- formation under high-intensity illumination. Interestingly, I2/I3- formation occurs on illuminated surface spots that have the lowest photocurrent onset potential for iodide oxidation, corresponding to the highest open circuit voltage ( VOC). The VOC shifts could be attributed to variations in the surface reaction kinetics or doping density across the nanoflake. Our results highlight important limiting factors of nanoflake thin-film TMD liquid junction photovoltaics under concentrated solar illumination intensities.

High intensity vacuum ultraviolet and extreme ultraviolet production by noncollinear mixing in laser vaporized media.

A method is described for generating intense pulsed vacuum ultraviolet (VUV) and extreme ultraviolet (XUV) laser radiation by resonance enhanced four-wave mixing of commercial pulsed nanosecond lasers in laser vaporized mercury under windowless conditions. By employing noncollinear mixing of the input beams, the need of dispersive elements such as gratings for separating the VUV/XUV from the residual UV and visible beams is eliminated. A number of schemes are described, facilitating access to the 9.9-14.6 eV range. A simple and convenient scheme for generating wavelengths of 125 nm, 112 nm, and 104 nm (10 eV, 11 eV, and 12 eV) using two dye lasers without the need for dye changes is described.

Crossed molecular beams studies of phenyl radical reactions with propene and trans-2-butene.

The reactions of phenyl radicals with propene have been studied at collision energies of 84 and 108 kJ/mol using the crossed molecular beams technique. The branching ratios between methyl radical elimination forming C8H8 and H-atom elimination forming C9H10 were found to be 10 ± 1:1 at 84 kJ/mol and 3 ± 1:1 at 108 kJ/mol. By using "soft" 9.9 eV vacuum ultraviolet photoionization for product detection, we were able to observe both product channels with negligible fragmentation of C9H10 to C8H8(+). Our finding that CH3 elimination is dominant is consistent with conclusions from a recent study employing a pyrolysis molecular beam reactor using photoionization detection. However, our C8H8/C9H10 branching ratios are significantly larger than inferred from previous CMB experiments and RRKM calculations. For comparison, we have also studied the reactions of phenyl radicals with trans-2-butene at Ecoll = 97 kJ/mol. In this case, the symmetry of trans-2-butene makes both alkene addition sites chemically equivalent. The intermediate formed in the reaction with trans-2-butene is similar to the 2-carbon addition intermediate in the reaction with propene. We observed only methyl elimination in the reaction with trans-2-butene, with no evidence for H-atom elimination, consistent with conclusions that C-C bond fission is the most favorable channel in these systems. Analogies between phenyl radical reactions with propene and trans-2-butene are used to provide insight into the mechanisms in the propene reaction.