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Introduction We evaluated the impact of teleneurologists on the time to initiating acute stroke care versus traditional bedside neurologists at an advanced stroke center. Methods This observational study evaluated time to treatment for acute stroke patients at a single hospital, certified as an advanced primary stroke centre, with thrombectomy capabilities. Consecutive stroke alert patients between 1 March, 2016 and 31 March, 2018 were divided into two groups based on their neurology consultation service (bedside neurology: 1 March, 2016–28 February, 2017; teleneurology: 1 April, 2017–31 March, 2018). Door-to-tPA time and door-to-IR time for mechanical thrombectomy were compared between the two groups. Results Nine hundred and fifty-nine stroke patients met the inclusion criteria (436 bedside neurology, 523 teleneurology patients). There were no significant differences in sex, age, or stroke final diagnosis between groups ( p > 0.05). 85 bedside neurology patients received tPA and 35 had mechanical thrombectomy, 84 and 44 for the teleneurology group respectively. Door-to-tPA time (median (IQR)) was significantly higher among teleneurology (64 min (51.5–83.5)) than bedside neurology patients (45 min (34–69); p Discussion At this facility, our teleneurology services vendor was associated with a statistically significant delay in tPA administration compared with bedside neurologists. There was no difference in door-to-IR times. Delays in tPA administration make it harder to meet acute stroke care guidelines and could worsen patient outcomes.

Background Previous studies show that myocardial infarctions (MIs) occur most frequently in the morning. Objectives We hypothesized that there no longer is a morning predominance of MI, and that the timing of ST-elevation myocardial infarction (STEMI) vs. non-ST-elevation myocardial infarction (NSTEMI) presentation differs. Methods We reviewed MI, STEMI, and NSTEMI patients (2013–2017) from a multiple-hospital system, identified by diagnostic codes. Daily emergency department arrival times were categorized into variable time intervals for count and proportional analysis, then examined for differences. Results There were 18,663 MI patients from 12 hospitals included in the analysis. Most MIs occurred between 12:00 pm and 5:59 pm (35.7%), and least between 12:00 am –5:59 am (16.3%). After subdividing all MIs into STEMIs and NSTEMIs, both groups continued to have the greatest presentation between 12:00 pm and 5:59 pm (33.1% and 36.0%, respectively). STEMIs (17.2%) and NSTEMIs (16.2%) were least frequent between 12:00 am and 5:59 am . We found the second most common presentation time for MIs was in the 6 pm –11:59 pm time period, which held true for both subtypes (MI 26.7%, STEMI 26.4%, NSTEMI 26.7%). Conclusions These data suggest a potential shift in the circadian pattern of MI, revealing an afternoon predominance for both STEMI and NSTEMI subtypes.

D-dimer testing rules out deep vein thrombosis (DVT) and pulmonary embolism (PE) in low-risk emergency department (ED) patients. Most research has measured fibrin-equivalent units (FEUs), however, many laboratories measure D-dimer units (DDUs).Our aim was to determine whether either DDU measurements or FEU measurements can rule out DVT/PE using traditional or age-related cutoff values.We performed a de-identified multicenter retrospective evaluation of D-dimer in nonpregnant adult ED patients to evaluate for DVT/PE. DDUs were multiplied by 2 to determine equivalent FEUs prior to analysis. Sensitivity measurements for D-dimer were calculated for FEUs, DDUs, combined FEU/DDUs, and multiple age-adjusted values.We identified 47,088 ED patients with a D-dimer laboratory value (27,307 FEUs/19,781 DDUs) and 1623 DVT/PEs. The median combined FEU/DDU D-dimer was 400 ng/mL FEUs (interquartile range [IQR] 300-900 ng/mL FEUs) for patients without a DVT/PE vs 2530 ng/mL FEU (IQR 1094-6000 ng/mL FEUs) with a DVT/PE (p 0.001), overall sensitivity of 87.3% (95% confidence interval [CI] 87.0-87.6%) and negative predictive value of 99.3% (95% CI 99.2-99.4%). Individually, FEUs performed better than DDUs, with sensitivities of 88.0% (95% CI 85.8-89.9%) and 86.1% (95% CI 83.1-88.7%), respectively; however, this difference was not statistically significant. Combined age-adjusted performance had a sensitivity of 90.3% (95% CI 88.3-92.0%); however, a new DDU-only age-adjusted criteria had the highest sensitivity of 91.1% (95% CI 87.9-93.6%).Our undifferentiated D-dimer measurements had a slightly lower sensitivity to rule out DVT/PE than reported previously. Our data support using either DDU or FEU measurements for all ages or when using various age-adjusted criteria to rule out DVT/PE.

Background Methicillin-resistant Staphylococcus aureus (MRSA) can colonize up to 14.5% of healthcare workers (HCWs). The colonization rate of HCWs or the hospital setting that contributes most to MRSA colonization is less clear. In this study, we studied new resident physicians (PGY-1), as a model for HCWs, to measure their colonization rate and hypothesized that the incidence of colonization would increase during their first year. Methodology We prospectively enrolled PGY-1 residents of multiple specialties at three academic medical centers. After obtaining informed consent, PGY-1 residents were tested for MRSA in June 2019 before starting any clinical rotations and then retested every three to four months thereafter. The coronavirus disease 2019 pandemic forced us to end the study early. If MRSA-positive, residents were treated with 2% mupirocin and retested for a cure. For comparison, upper-level residents (PGY-2-5) were also enrolled to obtain a baseline prevalence of colonization. Results We enrolled 80 PGY-1 and 81 PGY-2-5 residents in the study. The baseline prevalence of MRSA colonization was 4.94% (4/81) in PGY-2-5 residents and 2.50% (2/80) for new PGY-1 residents; however, this was not statistically significant (p = 0.68). The cumulative yearly incidence of developing MRSA colonization in PGY-1 residents was 4.51%. MRSA colonization was successfully treated in 75% of cases. Conclusions PGY-1 residents had a lower MRSA colonization rate compared to PGY-2-5 residents, although this was not statistically significant. PGY-1 residents had a small incidence of developing MRSA colonization while working in the hospital. Further research is needed to determine if this is clinically relevant to HCWs or their patients.

Common bottlenose dolphins (Tursiops truncatus) have previously demonstrated exposure to phthalate esters. Phthalates and phthalate esters are commonly added to consumer goods to enhance desirable properties. As the amount of plastic marine debris increases, these chemicals can easily leach from these products into the surrounding environment. To evaluate demographic variability in exposure, eight phthalate metabolites were quantified in urine samples collected from free‐ranging bottlenose dolphins sampled in Sarasota Bay, FL, USA (2010–2019; n = 51). Approximately 75% of individual dolphins had detectable concentrations of at least one phthalate metabolite. The most frequently detected metabolites were mono(2‐ethylhexyl) phthalate (MEHP; n = 28; GM = 4.57 ng/mL; 95% CI = 2.37–8.80; KM mean = 7.95; s.d. = 15.88) and monoethyl phthalate (MEP; GM = 4.51 ng/mL; 95% CI = 2.77–7.34; ROS mean = 2.24; s.d. = 5.58). Urinary concentrations of MEHP and MEP were not significantly different between sex (MEHP p = 0.09; MEP p = 0.22) or age class (i.e., calf/juvenile vs. adult; MEHP p = 0.67; MEP p = 0.13). Additionally, there were no significant group differences in the likelihood of MEHP or MEP detection for any demographic as determined by a Peto‐Peto test. Frequency of detection was similar for both metabolites between males and females (MEHP p = 0.10; MEP p = 0.40) as well as between juveniles and adults (MEHP p = 0.50; MEP: p = 0.60). These findings suggest ubiquitous exposure risk for both sexes and age classes, warranting further investigation into potential sources and health implications., Key Points Detectable phthalate metabolites found in 75% of bottlenose dolphin urine samplesNo differences in magnitude or frequency of detectable mono(2‐ethylhexyl) phthalate/monoethyl phthalate concentrations among demographicsPotential hazard of phthalate exposure is not specific to any sex or age class

Some chemicals used in personal care products (PCPs) are associated with endocrine disruption, developmental abnormalities, and reproductive impairment. Previous studies have evaluated product use among various populations; however, information on college women, a population with a unique lifestyle, is scarce. The proportion and frequency of product use were measured using a self-administered survey among 138 female undergraduates. Respondents were predominately Caucasian (80.4%, reflecting the college’s student body), and represented all years of study (freshman: 24.6%; sophomore: 30.4%; junior: 18.8%; senior: 26.1%). All respondents reported use of at least two PCPs within 24 h prior to sampling (maximum = 17; median = 8; IQR = 6–11). Compared with studies of pregnant and postpartum women, adult men, and Latina adolescents, college women surveyed reported significantly higher use of deodorant, conditioner, perfume, liquid soap, hand/body lotion, sunscreen, nail polish, eyeshadow, and lip balm (Chi Square, p

Objectives The purpose of this study is to determine the sensitivity and specificity of novice emergency physician‐performed point‐of‐care ultrasound diagnosis of papilledema using optic nerve sheath diameter (ONSD) against ophthalmologist‐performed dilated fundoscopy. This observational study retrospectively analyzed results of ultrasound‐measured ONSD of emergency department (ED) patients with suspected intracranial hypertension from a period spanning June 2014 to October 2017. Methods This study concerns a population of ED patients at a large, tertiary‐care urban academic medical center from June 2014 to October 2017 over the age of 18 years with primary vision complaints evaluated for papilledema both by an emergency physician‐performed ultrasound and an ophthalmologist‐performed fundoscopic examination during their ED stay. Sensitivity and specificity of emergency physician‐performed ultrasound measurement of optic nerve sheath diameter in the diagnosis of papilledema were primary outcomes for this study. Results A total of 206 individual patients (male 49%, female 51%; median age 45 years) were included in the study with a total of 212 patient encounters. Calculated sensitivity for the ocular ultrasound examination performed by emergency physicians to diagnose papilledema was 46.9% (95% confidence interval [CI], 32.5% to 61.7%), and specificity was 87.0% (95% CI, 82.8% to 90.5%). Positive predictive value and negative predictive value were calculated to be 35.4% (95% CI, 23.9% to 48.2%) and 91.5% (95% CI, 87.8% to 94.4%), respectively. Conclusions Sonographic measurement of ONSD by emergency physicians has low sensitivity but high specificity for detection of papilledema compared to ophthalmologist‐conducted fundoscopy.

Phthalates are chemical esters used as additives in common consumer goods, such as plastics, household cleaners, and personal care products. Phthalates are not chemically bound to the items to which they are added and can easily leach into the surrounding environment. Anthropogenic drivers, such as coastal plastic pollution and wastewater runoff, increase the exposure potential for coastal marine fauna. Phthalate exposure in free-ranging bottlenose dolphins has been the focus of recent study, with indications of heightened exposure to certain phthalate compounds. The objective of this study was to compare urinary phthalate metabolite concentrations among bottlenose dolphins (Tursiops truncatus) sampled in Sarasota Bay, FL, to levels reported in human samples collected as part of the Centers for Disease Control and Prevention's (CDC) National Health and Nutrition Examination Survey (NHANES). Monoethyl phthalate (MEP) and mono-(2-ethylhexyl) phthalate (MEHP) were the most prevalent metabolites detected in dolphin urine (n = 51; MEP = 29.41%; MEHP = 54.90%). The geometric mean (GM) concentration of MEP was significantly lower for dolphins (GM = 4.51 ng/mL; 95% CI: 2.77-7.34 ng/mL) compared to humans (p

Phthalates are chemical additives to common consumer goods including cleaning products, cosmetics, personal care products, and plastic. Because they are not chemically bound to these products and are widely used, the potential for environmental contamination is significant. Phthalates and their metabolites have been associated with endocrine disruption and reproductive impairment, among other adverse health effects, in laboratory animals and human epidemiologic studies. Common bottlenose dolphins (Tursiops truncatus) are vulnerable to environmental pollutants due to their apex position in the food chain, long life spans, and habitat overlap with developed coastal areas. The objective of this study was to quantify phthalate metabolite concentrations in urine collected from bottlenose dolphins in Sarasota Bay, Florida, during May 2016 (n = 7) and May 2017 (n = 10). Screening of nine phthalate monoester metabolites in bottlenose dolphin urine was performed by liquid chromatography tandem mass spectrometry using methods adapted from those used for analyzing human samples. At least one phthalate metabolite was detected in 71% of the dolphins sampled across both years, with the highest concentrations detected for monoethyl phthalate (MEP; GM = 5.4 ng/ml; 95%CI: 1.3–22.0 ng/ml) and mono‐(2‐ethylhexyl) phthalate (MEHP; GM = 1.9 ng/ml; 95%CI: 1.1–3.2 ng/ml). These data demonstrate exposure to two of the most commonly used phthalates in commercial manufacturing, diethyl phthalate (DEP) and di‐2‐ethylhexyl phthalate (DEHP). This study establishes methods for urinary detection of phthalate metabolites in marine mammals and provides baseline data to address a significant and growing, yet poorly understood, health threat to marine wildlife., Key Points Phthalate metabolites were found in 71% of bottlenose dolphins sampled in Sarasota Bay, FLMonoethyl phthalate (MEP) and mono‐(2‐ethylhexyl) phthalate (MEHP) were the most common metabolites detected in bottlenose dolphin urineBottlenose dolphins in Sarasota Bay, FL, are susceptible to phthalate exposure

The potential role of morbillivirus was evaluated in the deaths of >1100 bottlenose dolphins Tursiops truncatus and other small cetaceans that stranded from February 2010 through July 2014, during the northern Gulf of Mexico (GoM) unusual mortality event (UME). Morbillivirus analysis was carried out on 142 live or freshly dead cetaceans and results were combined with samples from 102 live, free-ranging bottlenose dolphins sampled during capture-release health assessments conducted from 2011 to 2014. Polymerase chain reaction (PCR) testing for morbillivirus showed that 9.9% (14/142) of the stranded cetaceans and 1% (1/83) of the free-ranging live dolphins were positive for dolphin morbilliviral (DMV) RNA. In contrast, previous DMV dolphin die-offs had DMV detectable by PCR in 61 to 97% of animals tested. Histologic findings consistent with morbillivirus infection, including lymphoid depletion, bronchointerstitial pneumonia, syncytial cell formation, or meningoencephalitis, were found in 6.6% (9/136) of the cetaceans that underwent histologic examinations. Serological analysis using a virus neutralization assay found that 29% (5/17) of live stranded and 23% (23/102) of live free-ranging bottlenose dolphins had titers of 64 or greater for cetacean morbillivirus, indicating prior but not necessarily recent exposure to morbillivirus. Current findings suggest that DMV infection, although present in the northern GoM, was sporadic and occurred at low levels and therefore was not the primary cause of the northern GoM UME. Confirmation of DMV infections and existing DMV titers demonstrate continued exposure to morbillivirus among northern GoM cetaceans since the first detection of this virus in the early 1990s.

The 2010 Deepwater Horizon (DWH) disaster resulted in large-scale oil contamination of the northern Gulf of Mexico. As part of the Natural Resource Damage Assessment designed to investigate the potential impacts of the DWH oil spill, comprehensive health assessments were conducted on bottlenose dolphins Tursiops truncatus living in oiled bays (Barataria Bay [BB], Louisiana, and Mississippi Sound [MS], Mississippi/Alabama) and a reference bay with no evidence of DWH oil contamination (Sarasota Bay [SB], Florida). As previously reported, multiple health issues were detected in BB dolphins during 2011. In the present study, follow-on capture-release health assessments of BB dolphins were performed (2013, 2014) and indicated an overall improvement in population health, but demonstrated that pulmonary abnormalities and impaired stress response persisted for at least 4 yr after the DWH disaster. Specifically, moderate to severe lung disease remained elevated, and BB dolphins continued to release low levels of cortisol in the face of capture stress. The proportion of guarded or worse prognoses in BB improved over time, but 4 yr post-spill, they were still above the proportion seen in SB. Health assessments performed in MS in 2013 showed similar findings to BB, characterized by an elevated prevalence of low serum cortisol and moderate to severe lung disease. Prognosis scores for dolphins examined in MS in 2013 were similar to BB in 2013. Data from these follow-on studies confirmed that dolphins living in areas affected by the DWH spill were more likely to be ill; however, some improvement in population health has occurred over time.

This study describes the effect of introducing a cardiac sonographer led follow up clinic for patients with stable heart valve disease. The 2 years before and after the instigation of the valve clinic were audited.The clinic was conducted in a single centre and undertaken in the cardiology department of a district general hospital. 382 patients, with 397 clinically significant valve lesions, but for whom surgery was not yet indicated but follow up required, were seen in a cardiac sonographer run clinics. These patients no longer attended a medical follow up clinic unless there was clinical or echocardiographic deterioration. Effectiveness was judged by the percentage treated according to current best practice guidelines, the number of echocardiograms performed and the number of hospital out patient visits attended. In addition mortality data for the subjects in the clinic was collected.The proportion followed up according to best practice guidelines rose from 157 (41%) to 354 (92%) (p0.01). The total number of echocardiograms performed fell from 807 to 550. Total number of out patient visits fell from 998 to 31. 11 patients died in the two year study period, none from progressive valve disease.This study demonstrates that a protocol driven sonographer led heart valve disease follow up clinic, significantly improved the quality of follow up while bringing about a major reduction in out patients visits, without compromising patient safety.

Summary Littorinid parasperm develop from a distinctive lineage of germ cells which exhibit a process of nuclear destruction that has apototic characteristics. Fragments of DNA and other nuclear breakdown products are incorporated into secretion granules in parasperm that ultimately find their way to the female bursa copulatrix. Spermatozeugmata are stored in the seminal vesicles and, if unused during the breeding season, they are recycled by phagocytosis. Attachment between eusperm and parasperm is facilitated by an electrostatic interaction of proteins. Detachment, caused by alkaline prostate fluid, occurs by the time the ejaculate reaches the tip of the penis. Thus transport of eusperm by parasperm to the female is unlikely. parasperm are sterile cells that may function in defense against rival eusperm as suggested by the presence of lysosomes, or they may act as nuptial gifts as they are packed with glycoprotein nutrients. Differences in the reactivity of different parasperm to specific lectins may en...

PaveSim, a dynamic simulation environment, has been created to help develop performance-based operations policy. Integrated into PaveSim is another simulation program called TruckSim, which was developed at the University of Michigan to model heavy vehicles. Using the dynamic wheel loads from TruckSim, PaveSim simulates the performance of jointed concrete pavements. RigidPav, a finite element program, performs the detailed calculation of deflections and stresses in the pavement. Within the PaveSim environment it is possible to quickly vary vehicle parameters such as number of axles and axle spacing, suspension type and characteristics, and payload and distribution. We can also estimate the effects on pavement life of pavement characteristics such as thickness, subgrade support, and joint types. This report presents an overview of the PaveSim environment and its user interface. Most of the report is written as a PaveSim tutorial to be used by pavement designers and policymakers in state and federal departments of transportation.

The “Jargon Journal”—an effective, alternative method of communication for students with learning and emotional problems and its beneficial side effects

Today, flavor is attracting more attention from food chemists than ever before. The growth in popularity of ready-to-eat or convenience foods has accelerated this trend, and it has been further enhanced by greatly improved analytical techniques that have enabled chemists not only to isolate predominant flavor constituents, but to reconstitute a flavor profile that simulates to a remarkable degree the natural product.

The compounds known as carbohydrates acquired that name at a time when the known members of the group had the empirical formula Cx(H2O)y and were considered to be hydrates of carbon. By the time the structures of these compounds had been elucidated and it was discovered that the simple two-to-one hydrogen-oxygen relationship did not always hold, the name had become so well established that it was retained.

Strictly speaking, there is no such thing as a non-instrumental method, since even ordinary volumetric analysis depends ultimately on use of an analytical balance for standardization. This chapter will be restricted to explanations of the functions in analytical chemistry of several instruments that are “special” in that they are not a part of the common equipment of analytical laboratories. These instruments differ in relative availability in rough proportion to their cost. For instance, flame photometers, Polarimeters and less expensive types of fluorometers are found in quite a few food laboratories, while mass spectrometers and nuclear magnetic resonance devices are uncommon.

Proximate analysis is defined by H. Bennett in the Concise Chemical and Technical Dictionary as the “determination of a group of closely related components together, e. g. total protein, fat.” It conventionally includes determinations of the amount of water, protein, fat (ether extract), ash and fiber, with nitrogen-free extract (sometimes termed Nifext) being estimated by subtracting the sum of these five percentages from 100. In order to emphasize the group nature of the percentage of protein, fat and fiber, many chemists use the word “crude” before these three terms.

Standards and specifications are not new, but as old as commerce itself. As trade grew beyond the barter stage, the need for a common trade language and definition of terms increased. Guilds and trade associations were formed to serve this purpose. Many of our present day standards are nothing more than codified trade practices.

Traffic in spices existed very early in the history of commerce. In some countries spices were even used as a medium of exchange. These spices were gathered from wild plants, air dried, and shipped throughout the then known world. Some spices lent themselves to cultivation and, slowly at first, to genetic improvement in species and varieties.

(Tables 23–1 and 23–7 are from the Pharmacopeia of the United States of America, 17th Revision (1965); all others are from Official Methods of Analysis of the Association of Official Agricultural Chemists, 10th Ed. (1965). Reproduced by courtesy of the U.S. Pharmacopeial Convention and the Association of Official Analytical Chemists respectively.)

Foods processed in the United States and Canada must, by law, declare the names of any chemical preservatives used. Some preservatives are considered “food additives” under the U.S. Food, Drug and Cosmetic Act. Food additive regulations promulgated under this act may set certain limits, either as to the amount of permitted preservative, or the foods in which it may be used. Antioxidants are considered preservatives under these regulations.

The distinction between “fruit” and “vegetable” is completely arbitrary. Botanically, a fruit is that portion of a seed plant containing the reproductive bodies (seeds) together with any adhering or supporting structures. In other words, it is the ripened ovary of the plant. Popularly, a fruit is the edible, more or less sweet, pulpy portion of a plant, and the term is so used in this text. Under this definition, rhubarb (the petiole or leaf stem) is considered a fruit, while squash and tomato, technically fruits, are considered vegetables.