Pharmacist-led urine culture follow-ups in a rural emergency department.

BACKGROUND: Urinary tract infections (UTIs) are a common indication for antibiotic prescriptions in the outpatient setting. With rising antimicrobial resistance, eliminating unnecessary antibiotics is critical. Previous research has shown that pharmacist-led antimicrobial stewardship in the emergency department (ED) setting can reduce the number of unnecessary antibiotics and increase appropriate antibiotic prescribing. By expanding the scope of ED pharmacists to include antimicrobial stewardship initiatives, rural EDs can better justify pharmacy involvement in the ED. OBJECTIVE: To determine whether pharmacist review of urine cultures in a rural ED leads to an improvement in antimicrobial stewardship outcomes. METHODS: This was a hybrid, quality improvement study conducted in a 12-bed, rural hospital ED. Data were collected from October 15, 2021, through April 15, 2022, 3 months before (preintervention) and after (postintervention) pharmacists assumed the responsibility for reviewing ED urine cultures from the nursing staff. For each urine culture, a pharmacist conducted a patient chart review and determined whether an intervention was required. If action was required, the pharmacist provided a recommendation to an ED provider and subsequently implemented the agreed on action. Primary study outcomes included (1) the number of discontinued antibiotics when there was no bacterial infection cultured and (2) when changing antibiotics on the basis of culture results, whether the antibiotic chosen matched current guidelines. Primary postintervention outcomes were compared with preintervention ones using the Fisher exact tests. RESULTS: Pharmacist review in the postintervention period led to a statistically significant higher number of discontinued antibiotics than in the preintervention period (20/65 vs. 0/71, P < 0.001). The antibiotics chosen when altering therapy on the basis of culture results did not differ statistically significant between the pre- and postintervention periods (P > 0.999). CONCLUSION: Pharmacist review of urine cultures in a rural ED can improve antimicrobial stewardship outcomes by decreasing unnecessary antibiotic use for the treatment of UTIs.

Delineation of somatosensory finger areas using vibrotactile stimulation, an ECoG study.

BACKGROUND: In surgical planning for epileptic focus resection, functional mapping of eloquent cortex is attained through direct electrical stimulation of the brain. This procedure is uncomfortable, can trigger seizures or nausea, and relies on subjective evaluation. We hypothesize that a method combining vibrotactile stimulation and statistical clustering may provide improved somatosensory mapping. METHODS: Seven pediatric candidates for surgical resection underwent a task in which their fingers were independently stimulated using a custom designed finger pad, during electrocorticographic monitoring. A cluster-based statistical analysis was then performed to localize the elicited activity on the recording grids. RESULTS: Mid-Gamma clusters (65-115 Hz) arose in areas consistent with anatomical predictions as well as clinical findings, with five subjects presenting a somatotopic organization of the fingers. This process allowed us to delineate finger representation even in patients who were sleeping, with strong interictal activity, or when electrical stimulation did not successfully locate eloquent areas. CONCLUSIONS: We suggest that this scheme, relying on the endogenous neural response rather than exogenous electrical activation, could eventually be extended to map other sensory areas and provide a faster and more objective map to better anticipate outcomes of surgical resection.

Chemically directed assembly of photoactive metal oxide nanoparticle heterojunctions via the copper-catalyzed azide-alkyne cycloaddition "click" reaction.

Metal oxides play a key role in many emerging applications in renewable energy, such as dye-sensitized solar cells and photocatalysts. Because the separation of charge can often be facilitated at junctions between different materials, there is great interest in the formation of heterojunctions between metal oxides. Here, we demonstrate use of the copper-catalyzed azide-alkyne cycloaddition reaction, widely referred to as "click" chemistry, to chemically assemble photoactive heterojunctions between metal oxide nanoparticles, using WO(3) and TiO(2) as a model system. X-ray photoelectron spectroscopy and Fourier-transform infrared spectroscopy verify the nature and selectivity of the chemical linkages, while scanning electron microscopy reveals that the TiO(2) nanoparticles form a high-density, conformal coating on the larger WO(3) nanoparticles. Time-resolved surface photoresponse measurements show that the resulting dyadic structures support photoactivated charge transfer, while measurements of the photocatalytic degradation of methylene blue show that chemical grafting of TiO(2) nanoparticles to WO(3) increases the photocatalytic activity compared with the bare WO(3) film.

A citric acid-derived ligand for modular functionalization of metal oxide surfaces via "click" chemistry.

Citric acid is a widely used surface-modifying ligand for growth and processing of a variety of nanoparticles; however, the inability to easily prepare derivatives of this molecule has restricted the development of versatile chemistries for nanoparticle surface functionalization. Here, we report the design and synthesis of a citric acid derivative bearing an alkyne group and demonstrate that this molecule provides the ability to achieve stable, multidentate carboxylate binding to metal oxide nanoparticles, while also enabling subsequent multistep chemistry via the Cu(I)-catalyzed azide-alkyne cycloaddition (CuAAC) reaction. The broad utility of this strategy for the modular functionalization of metal oxide surfaces was demonstrated by its application in the CuAAC modification of ZnO, Fe(2)O(3), TiO(2), and WO(3) nanoparticles.

Modular "click" chemistry for electrochemically and photoelectrochemically active molecular interfaces to tin oxide surfaces.

We demonstrate the use of "click" chemistry to form electrochemically and photoelectrochemically active molecular interfaces to SnO(2) nanoparticle thin films. By using photochemical grafting to link a short-chain alcohol to the surface followed by conversion to a surface azide group, we enable use of the Cu(I)-catalyzed azide-alkyne [3 + 2] cycloaddition (CuAAC) reaction, a form of "click" chemistry, on metal oxide surfaces. Results are shown with three model compounds to test the surface chemistry and subsequent ability to achieve electrochemical and photoelectrochemical charge transfer. Surface-tethered ferrocene groups exhibit good electron-transfer characteristics with thermal rates estimated at >1000 s(-1). Time-resolved surface photovoltage measurements using a ruthenium terpyridyl coordination compound demonstrate photoelectron charge transfer on time scales of nanoseconds or less, limited by the laser pulse width. The results demonstrate that the CuAAC "click" reaction can be used to form electrochemically and photoelectrochemically active molecular interfaces to SnO(2) and other metal oxide semiconductors.