Temporal trends in respiratory pathogens following the COVID-19 pandemic and climate variables: A unicentric retrospective evaluation of 24 pathogens in a temperate subtropical region.

Temperature and humidity are studied in the context of seasonal infections in temperate and tropical zones, but the relationship between viral trends and climate variables in temperate subtropical zones remains underexplored. Our retrospective study analyzes respiratory pathogen incidence and its correlation with climate data in a subtropical zone. Retrospective observational study at Moinhos de Vento Hospital, South Brazil, aiming to assess seasonal trends in respiratory pathogens, correlating them with climate data. The study included patients of all ages from various healthcare settings, with data collected between April 2022 and July 2023. Biological samples were analyzed for 24 pathogens using polymerase chain reaction and hybridization techniques; demographic variables were also collected. The data was analyzed descriptively and graphically. Spearman tests and Poisson regression were used as correlation tests. Tests were clustered according to all pathogens, severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), influenza viruses, rhinovirus, and respiratory syncytial virus (RSV). Between April 2022 and July 2023, 3329 tests showed a 71.6% positivity rate. Rhinovirus and RSV predominated, exhibiting seasonal patterns. Temperature was inversely correlated with the viruses, notably rhinovirus, but SARS-CoV-2 was positively correlated. Air humidity was positively correlated with all pathogens, RSV, rhinovirus, and atmospheric pressure with all pathogens and rhinovirus. Our results showed statistically significant correlations, with modest effect sizes. Our study did not evaluate causation effects. Despite the correlation between climate and respiratory pathogens, our work suggests additional factors influencing transmission dynamics. Our findings underscore the complex interplay between climate and respiratory infections in subtropical climates.

Accuracy of emergency department triage using the Emergency Severity Index and independent predictors of under-triage and over-triage in Brazil: a retrospective cohort analysis.

BACKGROUND: Emergency department (ED) triage is performed to prioritize care for patients with critical and time-sensitive illness. Triage errors create opportunity for increased morbidity and mortality. Here, we sought to measure the frequency of under- and over-triage of patients by nurses using the Emergency Severity Index (ESI) in Brazil and to identify factors independently associated with each. METHODS: This was a single-center retrospective cohort study. The accuracy of initial ESI score assignment was determined by comparison with a score entered at the close of each ED encounter by treating physicians with full knowledge of actual resource utilization, disposition, and acute outcomes. Chi-square analysis was used to validate this surrogate gold standard, via comparison of associations with disposition and clinical outcomes. Independent predictors of under- and over-triage were identified by multivariate logistic regression. RESULTS: Initial ESI-determined triage score was classified as inaccurate for 16,426 of 96,071 patient encounters. Under-triage was associated with a significantly higher rate of admission and critical outcome, while over-triage was associated with a lower rate of both. A number of factors identifiable at time of presentation including advanced age, bradycardia, tachycardia, hypoxia, hyperthermia, and several specific chief complaints (i.e., neurologic complaints, chest pain, shortness of breath) were identified as independent predictors of under-triage, while other chief complaints (i.e., hypertension and allergic complaints) were independent predictors of over-triage. CONCLUSIONS: Despite rigorous and ongoing training of ESI users, a large number of patients in this cohort were under- or over-triaged. Advanced age, vital sign derangements, and specific chief complaints-all subject to limited guidance by the ESI algorithm-were particularly under-appreciated.

Accuracy and Reliability of Emergency Department Triage Using the Emergency Severity Index: An International Multicenter Assessment.

STUDY OBJECTIVE: We assess accuracy and variability of triage score assignment by emergency department (ED) nurses using the Emergency Severity Index (ESI) in 3 countries. In accordance with previous reports and clinical observation, we hypothesize low accuracy and high variability across all sites. METHODS: This cross-sectional multicenter study enrolled 87 ESI-trained nurses from EDs in Brazil, the United Arab Emirates, and the United States. Standardized triage scenarios published by the Agency for Healthcare Research and Quality (AHRQ) were used. Accuracy was defined by concordance with the AHRQ key and calculated as percentages. Accuracy comparisons were made with one-way ANOVA and paired t test. Interrater reliability was measured with Krippendorff's α. Subanalyses based on nursing experience and triage scenario type were also performed. RESULTS: Mean accuracy pooled across all sites and scenarios was 59.2% (95% confidence interval [CI] 56.4% to 62.0%) and interrater reliability was modest (α=.730; 95% CI .692 to .767). There was no difference in overall accuracy between sites or according to nurse experience. Medium-acuity scenarios were scored with greater accuracy (76.4%; 95% CI 72.6% to 80.3%) than high- or low-acuity cases (44.1%, 95% CI 39.3% to 49.0% and 54%, 95% CI 49.9% to 58.2%), and adult scenarios were scored with greater accuracy than pediatric ones (66.2%, 95% CI 62.9% to 69.7% versus 46.9%, 95% CI 43.4% to 50.3%). CONCLUSION: In this multinational study, concordance of nurse-assigned ESI score with reference standard was universally poor and variability was high. Although the ESI is the most popular ED triage tool in the United States and is increasingly used worldwide, our findings point to a need for more reliable ED triage tools.

Counterintuitive trends of the wetting behavior of ionic liquid-based electrolytes on modified lithium electrodes.

The demand for high energy densities has brought rechargeable lithium metal batteries back into the research focus. Ionic liquids (ILs) are considered as suitable electrolyte components for these systems. In this work, the wetting behavior of 1-ethyl-3-methylimidazolium bis((trifluoromethyl)sulfonyl)imide ([C2MIm]TFSI), 1-butyl-3-methylimidazolium bis-((trifluoromethyl)sulfonyl)imide ([C4MIm]TFSI), 1-hexyl-3-methylimidazolium bis((trifluoromethyl)sulfonyl)imide ([C6MIm]TFSI), and N-butyl-N-methylpyrrolidinium bis((trifluoromethyl)sulfonyl)imide (Pyr14TFSI) on mechanically modified lithium electrodes, with and without lithium bis((trifluoromethyl)sulfonyl)imide (LiTFSI) conducting salt, is investigated and is compared to an organic carbonate-based electrolyte. Three different patterns were chosen for the lithium modification, enabling a surface area increase of 12%, 20%, and 56% for the modified lithium electrodes. Especially for pure ILs, the contact angle on lithium was significantly larger with higher surface areas of the lithium electrodes. Since the addition of LiTFSI remarkably decreased the contact angles of the ILs on the modified lithium surfaces, it could be shown that the effect of LiTFSI can be attributed to a decreased surface tension. This observation could be explained by an interruption of the ordering of ionic liquid cations and anions, which is supported by Raman spectroscopy and molecular dynamics (MD) simulations.

Synthesis of High-Purity Imidazolium Tetrafluoroborates and Bis(oxalato)borates.

The synthesis and purification of imidazolium-based ionic liquids (ILs) with boron-containing anions is reported. The scope was the optimization of the meta thesis reaction and on the purification of the synthesized ILs. It was possible to reduce the reaction and purification times, to avoid the use of acetonitrile as processing solvent, and to increase the yield compared to the known procedure for [BOB]- anion-containing ILs. Furthermore, to the best of our knowledge the flashpoints of the ILs could be determined for the first time by the continuously closed-cup flashpoint (CCCFP) method.

Decomposition of Imidazolium-Based Ionic Liquids in Contact with Lithium Metal.

Ionic liquids (ILs) are considered to be suitable electrolyte components for lithium-metal batteries. Imidazolium cation based ILs were previously found to be applicable for battery systems with a lithium-metal negative electrode. However, herein it is shown that, in contrast to the well-known IL N-butyl-N-methylpyrrolidinium bis[(trifluoromethyl)sulfonyl]imide ([Pyr14 ][TFSI]), 1-ethyl-3-methylimidazolium bis[(trifluoromethyl)sulfonyl]imide ([C2MIm][TFSI]) and 1-butyl-3-methylimidazolium bis[(trifluoromethyl)sulfonyl]imide ([C4MIm][TFSI]) are chemically unstable versus metallic lithium. A lithium-metal sheet was immersed in pure imidazolium-based IL samples and aged at 60 °C for 28 days. Afterwards, the aged IL samples were investigated to deduce possible decomposition products of the imidazolium cation. The chemical instability of the ILs in contact with lithium metal and a possible decomposition starting point are shown for the first time. Furthermore, the investigated imidazolium-based ILs can be utilized for lithium-metal batteries through the addition of the solid-electrolyte interphase (SEI) film-forming additive fluoroethylene carbonate.

Experiments suggesting a role for the platelet-activating factor in hippocampal and amygdala synapses in memory in rats

Platelet-activating factor (1-O-alky1-2-acetyl-sn-glycero-3-phosphocholine, PAF) is present in brain, is released from neurons in culture and, in hippocampal slices, enhances glutamate release and long-term potentiation (LTP) through an action on membrane receptors sensitive to the antagonist, BN 52021. This led to the proposal that PAF may be a retrograde messenger in the genesis of LTP. LTP has been, in turn, proposed as a mechanism of memory. Male Wistar rats were implanted bilaterally with cannulae aimed at the amygdala and the dorsal hippocampus. After recovery from surgery, the animals were trained in step-down inhibitory avoidance using a 0.5 mA footshock, and tested for retention 24 h later. BN 52021 (0.5 mug) was amnestic when given into the hippocampus or the amygdala either before or immediately after training but not 30 min later. The findings support the idea that memory of this task depends on the generation of LTP at the time of training in hippocampus and amygdala, and further suggest that PAF is involved in the development of this LTP.

Memory of inhibitory avoidance in the rat is regulated by glutamate metabotropic receptors and by calcium/calmodulin kinase II in the hippocampus

We studied the effect on memory of the bilateral intrahippocampal posttraining infusion of the glutamate metabotropic receptor (mGLUR) agonist, 1S,2R-aminocyclopentane dicarboxylate (ACPD), of the mGLUR antagonist, [RS]-alpha-methyl-4-carboxyphenyl glycine (MCPG), and of the inhibitor of calcium/calmodulin protein kinase II (CaM II), 1-[N,O-Bis (5-isoquinolinesulfonyl)-N-methyl-L-tyrosyl]-4-phenyl piperazine (KN62). Male Wistar rats were implanted with cannulae in the CA1 region of the dorsal hippocampus. After recovery from surgery they were trained in a step-down inhibitory avoidance task and tested for retention 24 h later. Immediately or 180 min after training they received an intrahippocampal infusion of saline (0.5 mul), KN62 (100 mumoles), ACPD (20 nmoles), MCPG (13 nmoles) or of ACPD plus MCPG in 0.5 mul of saline. When given immediately after training, KN62 and MCPG were amnestic and ACPD caused memory facilitation and antagonized the effect od MCPG. When given 180 min after training, the drugs had no effect on memory. The results indicate that the early phase of memory is regulated by mGLURs in the hippocampus and requires CaM II activity. The data support the suggestion that memory involves long-term potentiation in the hippocampus.