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Background California has experienced an increase in reported cases of disseminated gonococcal infection (DGI). Given significant morbidity associated with DGI and the ability of Neisseria gonorrhoeae to rapidly develop antibiotic resistance, characterization of these cases can inform diagnosis, management, and prevention of DGI. Methods As part of the public health response to increased reports of DGI, we used gonorrhea surveillance data reported to the California Department of Public Health to identify all DGI cases in a geographically-bound region. Standardized case report forms were used to collect epidemiologic risk factors and clinical information obtained from provider/laboratory reports, medical records, and patient interviews. Results From 1 July 2020 to 31 July 2021, we identified 149 DGI patients among 63 338 total gonorrhea infections, representing 0.24% of gonorrhea cases. Estimated incidence was 0.47 DGI cases per 100 000 person-years. Mean age of DGI patients was 40 years, and 75 (50%) were cisgender men, of whom only 13 were known to have male partners. Where reported, more than one-third (36%) used methamphetamine and nearly one-quarter (23%) experienced homelessness. Clinically, 61% lacked urogenital, pharyngeal, or rectal symptoms; 2 patients died in the hospital. Among 47 isolates from patients with antimicrobial susceptibility testing (AST) results available, all were susceptible to ceftriaxone and cefixime. Conclusions Most DGI patients lacked urogenital symptoms and were not among populations for which routine gonorrhea screening is currently recommended. Expanding gonorrhea screening might prevent DGI. Cefixime is likely the best option if transitioning from parenteral to oral therapy when AST results are unavailable.

El Estudio caracteriza y actualiza la fauna silvestre vertebrada de la Península de Cosigüina, evaluando los elementos ambientales y sociales en que esta se desarrolla, identificando en el proceso las amenazas a la biodiversidad y opciones de conservación. Analizamos los resultados faunísticos de muchas de las “Evaluación de campo” conocidas para la reserva, incluyendo datos históricos. Esta zona presenta una variedad de hábitats típicos de Pacífico nicaragüense, sobresaliendo una importante cobertura vegetal de bosque seco alrededor del volcán (con su laguna cratérica al fondo), así como una amplia zona marinocostera con pequeños parches de esteros y manglares; que en conjunto abrigan poblaciones faunísticas esenciales para el equilibrio ecológico de la zona y de las poblaciones humanas. En total se registran 305 especies de fauna silvestre vertebrada (no ictiológica), de las cuales 176 son aves, 69 son mamíferos y 60 especies herpetológicas (ocho de anfibios y 52 de reptiles). Una cuarta parte de las especies presentan mayor prioridad de conservación e investigación, debido a que se encuentran amenazadas de extinción a nivel mundial y/o nacional, de las cuales, nueve se encuentran amenazadas a nivel mundial (cinco especies herpetológicas, tres de aves y una de mamíferos). Además, se evidencia la extinción de dos especies de grandes mamíferos en la Península. Un total de 82 especies (27%) presentan una distribución restringida a la región mesoamericana, de las cuales, quince de ellas son endémicas de Centroamérica (13 especies herpetológicas y dos de aves). Muchas de estas especies son habitantes típicos del bosque seco, por lo que su distribución en el país es principalmente la bioregión del Pacífico de Nicaragua, y al menos el 16% de la riqueza faunística de la península depende de este ecosistema (48 especies). Sitios de cañadas con coberturas de bosque natural (incluyendo el bosque cratérico) son los de mayor diversidad faunística, siendo estos de gran importancia para la reproducción, refugio y disponibilidad de alimento. Para mantener la diversidad de especies en la reserva, será importante conservar la diversidad de hábitat naturales en todas sus dimensiones, incentivando la regeneración natural para aumentar la conectividad del paisaje, procurando corredores entre éstos, y así contribuir al flujo genético de la vida silvestre en la zona.

The discovery that certain long chain fatty acids potentiate glucose stimulated insulin secretion through the previously orphan receptor GPR40 sparked interest in GPR40 agonists as potential antidiabetic agents. Optimization of a series of β-substituted phenylpropanoic acids led to the identification of (S)-3-(4-((4'-(trifluoromethyl)biphenyl-3-yl)methoxy)phenyl)hex-4-ynoic acid (AMG 837) as a potent GPR40 agonist with a superior pharmacokinetic profile and robust glucose-dependent stimulation of insulin secretion in rodents.

The provision of emergency care in the United States, regionalized or not, depends on an adequate workforce. Adequate must be defined both qualitatively and quantitatively. There is currently a shortage of emergency care providers, one that will exist for the foreseeable future. This article discusses what is known about the current emergency medicine (EM) and non-EM workforce, future trends, and research opportunities.

Cu/Al2O3 catalysts with metal loading from 0.64 to 8.8 wt.% have been prepared and characterized by different techniques: N2 adsorption at −196 °C (BET surface area), ICP (Cu loading), XRD, selective copper surface oxidation with N2O (Cu dispersion), TPR-H2 (redox properties), and XPS (copper surface species). The catalytic activity for soot oxidation has been tested both in air and NOx/O2. The activity in air depends on the amount of easily-reduced Cu(II) species, which are reduced around 275 °C under TPR-H2 conditions. The amount of the most active Cu(II) species increases with the copper loading from Cu_1% to Cu_5% and remains almost constant for higher copper loading. In the presence of NOx, the first step of the mechanism is NO oxidation to NO2, and the catalytic activity for this reaction depends on the copper loading. For catalysts with copper loading between Cu_1% and Cu_5%, the catalytic activity for soot oxidation in the presence of NOx depends on NO2 formation. For catalysts with higher copper loading this trend is not followed because of the low reactivity of model soot at the temperature of maximum NO2 production. Regardless the copper loading, all the catalysts improve the selectivity towards CO2 formation as soot oxidation product both under air and NOx/O2. MEC (project CTQ2005-01358); FELS thanks University of Alicante (International Cooperation Office) his thesis grant.

A series of Pt–Sn/C catalysts used as anodes during ethanol oxidation are synthesized by a deposition process using NaBH4 as the reducing agent. The order in which the precursors are added affects the electrocatalytic activity and physical-chemical characteristics of the bimetallic catalysts, where the Pt–Sn catalyst prepared by co-precipitation of both metals functions best below a potential of 0.5 V and the catalyst prepared by sequential deposition of Sn and Pt (drying after Sn addition) is most active above a potential of 0.5 V. The electrochemical behavior of catalysts during ethanol oxidation in an acidic medium are characterized and monitored in a half-cell test at room temperature by cyclic voltammetry, chronoamperometry and anode potentiostatic polarization. Catalyst structure and chemical composition are investigated by transmission electron microscopy (TEM), X-ray powder diffraction (XRD) and X-ray photoelectron spectroscopy (XPS). This behavior presented for best Pt–Sn catalyst can be attributed to the so-called bifunctional mechanism and to the electronic interaction between Pt and Sn. The authors thank the Brazilian National Council of Technological and Scientific Development-CNPq (grants: 303630/2012-4, 402243/2012-9 and 310282/2013-6) for the scholarships and financial support for this work.

Alumina-supported manganese catalysts with cryptomelane and/or birnessite structure have been prepared using a simple method based on the thermal decomposition of potassium permanganate. The samples have been characterized by XRD, FTIR, TGA, DSC, N2 adsorption at −196 °C, SEM, H2-TPR and XPS, and their catalytic activity for soot combustion has been tested and compared to that of a reference Pt/alumina catalyst. The thermal decomposition of alumina-supported KMnO4 yields a mixture of supported birnessite and potassium manganate which is the most effective, among those prepared, to lower the soot combustion temperature. However, this material is not useful for soot combustion because the accelerating effect is not based on a catalytic process but on the oxidation of soot by potassium manganate. A suitable soot combustion catalyst is obtained after potassium manganate is removed by water washing, yielding only the birnessite phase on the γ-Al2O3 support. This birnessite phase can be transformed into cryptomelane by calcination at 600 °C. These two samples, γ-Al2O3-supported birnessite and cryptomelane are suitable catalysts for soot combustion in NOx/O2 mixtures, as their catalytic activity is based on the NO2-assited mechanism, that is, both catalysts accelerate the oxidation of NO to NO2 and NO2 promotes soot oxidation. The soot combustion temperatures obtained with these birnessite/cryptomelane alumina-supported catalysts are similar to that obtained with the reference Pt/alumina catalyst. The authors thank to Spanish government (MICINN project CTQ2009-07475), DIMA (Dirección de Investigaciones) and Laboratorio de Magnetismo y Materiales Avanzados (Universidad Nacional de Colombia, Sede Manizales) and Vicerrectoría de Investigaciones de la Universidad de Caldas for the financial support.

Objective To develop a rapid, easy and clinically relevant in vivo model to evaluate novel insulin secretagogues on human islets, we investigated the effect of insulin secretagogues on functional human islets in a humanized mouse model. Materials/Methods Human islets were transplanted under the kidney capsule of streptozotocin (STZ)-induced diabetic mice with immunodeficiency. Human islet graft function was monitored by measuring non-fasting blood glucose levels. After diabetes was reversed, human islet transplanted mice were characterized physiologically by oral glucose tolerance and pharmacologically with clinically proven insulin secretagogues, glucagon-like peptide-1 (GLP-1), exenatide, glyburide, nateglinide and sitagliptin. Additionally, G protein-coupled receptor 40 (GPR40) agonists were evaluated in this model. Results Long-term human islet graft survival could be achieved in immunodeficient mice. Oral glucose challenge in human islet transplanted mice resulted in an immediate incremental increase of plasma human C-peptide, while the plasma mouse C-peptide was undetectable. Treatments with GLP-1, exenatide, glyburide, nateglinide and sitagliptin effectively increased plasma human C-peptide levels and improved postprandial glucose concentrations. GPR40 agonists also stimulated human C-peptide secretion and significantly improved postprandial glucose in the human islet transplanted mice. Conclusions Our studies indicate that a humanized mouse model with human islet grafts could mimic the in vivo characteristics of human islets and could be a powerful tool for the evaluation of novel insulin secretagogues or other therapeutic agents that directly and/or indirectly target human β cells.

Agonists of GPR40 (FFA1) have been proposed as a means to treat type 2 diabetes. Through lead optimization of a high throughput screening hit, we have identified a novel GPR40 agonist called AMG 837. The objective of these studies was to understand the preclinical pharmacological properties of AMG 837. The activity of AMG 837 on GPR40 was characterized through GTPγS binding, inositol phosphate accumulation and Ca(2+) flux assays. Activity of AMG 837 on insulin release was assessed on isolated primary mouse islets. To determine the anti-diabetic activity of AMG 837 in vivo, we tested AMG 837 using a glucose tolerance test in normal Sprague-Dawley rats and obese Zucker fatty rats. AMG 837 was a potent partial agonist in the calcium flux assay on the GPR40 receptor and potentiated glucose stimulated insulin secretion in vitro and in vivo. Acute administration of AMG 837 lowered glucose excursions and increased glucose stimulated insulin secretion during glucose tolerance tests in both normal and Zucker fatty rats. The improvement in glucose excursions persisted following daily dosing of AMG 837 for 21-days in Zucker fatty rats. Preclinical studies demonstrated that AMG 837 was a potent GPR40 partial agonist which lowered post-prandial glucose levels. These studies support the potential utility of AMG 837 for the treatment of type 2 diabetes.

The provision of emergency care in the United States, regionalized or not, depends on an adequate workforce. Adequate must be defined both qualitatively and quantitatively. There is currently a shortage of emergency care providers, one that will exist for the foreseeable future. This article discusses what is known about the current emergency medicine (EM) and non-EM workforce, future trends, and research opportunities.

La Cira Infantas (LCI) is the oldest Colombian field in production since the beginning of the twentieth century. Hundreds of wells are scattered throughout the field which is divided in two principal areas, La Cira and Infantas. This field is crossed by faults and is characterized by depleted and shallow gas bearing formations, challenging drilling activity with both loss circulation and well control issues. Casing while drilling (CWD) has moved from being a new technology to one that is now recognized as a practical method of solving particular drilling problems, optimizing conventional drilling processes and consequently reducing drilling costs. This paper describes the process from the engineering and operational point of view of deploying CWD technology coupled with rotary steerable (RSS) and logging while drilling (LWD) tools, transmitting in real-time with electromagnetic (EM) telemetry in this mature field to improve drilling performance while taking advantage of the automated drilling rig already equipped to deal with casing and currently under contract in this field drilling wells conventionally. Five injector wells were drilled. The wells ranged in depth from 3,400 to 4,600 ft MD. The project was completed successfully with all wells reaching the geological targets, setting the production casing at the desired depths and acquiring the data required by the Reservoir Team. Lessons learned were applied from well to well which allowed the reduction of execution time from 7.06 drilling days on the first well to 3.54 drilling days on the last one, reducing the total well cost 28.1% from the first well to the last.

Quantitative analysis of free fatty acids was achieved using matrix-assisted laser desorption/ionization time-of-flight mass spectrometry (MALDI-TOF MS) with a meso-tetrakis porphyrin matrix. Cesium acetate was employed as a cationizing agent. The MALDI signal was reproducible and dominated by cesiated cesium carboxylates [RCOOCs + Cs]+. The addition of two Cs ions resulted in a mass shift of 264.8 Da for each fatty acid and greatly reduced background peaks. A linear relationship between fatty acid concentration and corresponding fatty acid to internal standard peak intensity ratio was observed for three representative fatty acids analyzed across a concentration range from 4.40 to 150 microM, with correlation coefficients between 0.986 and 0.987. The application of this method was demonstrated with the analysis of free fatty acids in nonfasted and fasted rat plasmas. A total of eight free fatty acids (14:0, 16:0, 16:1, 17:0, 18:0, 18:1, 18:2, and 20:4) were detected. The relative peak height ratios of the fatty acids to the internal standard allow quantitative measurements of the free fatty acids. It was shown that the levels of free fatty acids were higher in fasted rats than in rats in a nonfasted state. This method is simple, sensitive, and fast. Thus, it provides an appealing tool for the analysis of free fatty acids or other low-molecular weight compounds during drug discovery and/or development.

The design and application of a colorimetric titration instrument that is rugged, free from ambient light interference, and inexpensive.