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Purpose: Benzodiazepines are the mainstay treatment in Alcohol Withdrawal Syndrome (AWS), though they have the potential for abuse and cognitive side effects. Non-benzodiazepines are of growing interest for treatment of AWS; however, the prevalence of non-benzodiazepine use remains unknown. The purpose of this study is to evaluate the prevalence and predictors of non-benzodiazepine use for AWS in the Emergency Department (ED). Methods: A cross-sectional, retrospective study utilizing data from the National Hospital Ambulatory Medical Care Survey (NHAMCS) spanning the years 2014-2020 investigated patients presenting to the ED with AWS. The primary outcome of this study is the prevalence of patients with AWS who received non-benzodiazepine treatment during their ED visit. The secondary outcome was the identification of predictor variables for non-benzodiazepine use. A multivariate logistic regression with a backward elimination approach was employed to identify predictor variables. Results: A total of 2,300 unweighted ED visits included over the study years. When weighted, this represented over 15.2 million ED visits. Across the study period, 3.1% (95% CI, 1.6-6.1%) of patients received non-benzodiazepines. Positive predictors of non-benzodiazepine use included the year 2020 compared to 2014 (OR 6.32, 95% CI, 1.39-28.73) and comorbid depression (OR 4.13, 95% CI, 1.38-12.36). Negative predictors of non-benzodiazepine use included ages 18-40 compared to ages 41-64 (OR 0.34, 95% CI, 0.13-0.91), nursing home residence compared to private residence (OR 0.02, 95% CI, 0.001-0.80), and the South compared to the Midwest region of the United States (OR 0.19, 95% CI, 0.07- 0.51). Conclusion: This study found that non-benzodiazepine use, despite being less common, is becoming more prevalent. Further research is needed to determine the optimal dosing and duration of non-benzodiazepines for AWS. Understanding the factors influencing the prescription patterns of non-benzodiazepines can contribute to informed decision-making and improve the management of AWS.

Abstract The oxidative coupling of methane to higher hydrocarbons offers a promising autothermal approach for direct methane conversion, but its progress has been hindered by yield limitations, high temperature requirements, and performance penalties at practical methane partial pressures (~1 atm). In this study, we report a class of Li2CO3-coated mixed rare earth oxides as highly effective redox catalysts for oxidative coupling of methane under a chemical looping scheme. This catalyst achieves a single-pass C2+ yield up to 30.6%, demonstrating stable performance at 700 °C and methane partial pressures up to 1.4 atm. In-situ characterizations and quantum chemistry calculations provide insights into the distinct roles of the mixed oxide core and Li2CO3 shell, as well as the interplay between the Pr oxidation state and active peroxide formation upon Li2CO3 coating. Furthermore, we establish a generalized correlation between Pr4+ content in the mixed lanthanide oxide and hydrocarbons yield, offering a valuable optimization strategy for this class of oxidative coupling of methane redox catalysts.

Inertial measurement units (IMU) are increasingly utilized to capture biomechanical measures such as joint kinematics outside traditional biomechanics laboratories. These wearable sensors have been proven to help clinicians and engineers monitor rehabilitation progress, improve prosthesis development, and record human performance in a variety of settings. The Valor IMU aims to offer a portable motion capture alternative to provide reliable and accurate joint kinematics when compared to industry gold standard optical motion capture cameras. However, IMUs can have disturbances in their measurements caused by magnetic fields, drift, and inappropriate calibration routines. Therefore, the purpose of this investigation is to validate the joint angles captured by the Valor IMU in comparison to an optical motion capture system across a variety of movements. Our findings showed mean absolute differences between Valor IMU and Vicon motion capture across all subjects’ joint angles. The tasks ranged from 1.81 degrees to 17.46 degrees, the root mean squared errors ranged from 1.89 degrees to 16.62 degrees, and interclass correlation coefficient agreements ranged from 0.57 to 0.99. The results in the current paper further promote the usage of the IMU system outside traditional biomechanical laboratories. Future examinations of this IMU should include smaller, modular IMUs with non-slip Velcro bands and further validation regarding transverse plane joint kinematics such as joint internal/external rotations.

Chronic diabetic foot ulcers (DFUs) are a significant complication of diabetes mellitus, often leading to amputation, increased morbidity, and a substantial financial burden. Even with the advancements in the treatment of DFU, the risk of amputation still exists, and this occurs due to the presence of gangrene and osteomyelitis. Nonhealing in a chronic DFU is due to decreased angiogenesis, granulation tissue formation, and extracellular matrix remodeling in the presence of persistent inflammation. During wound healing, the proliferation and migration of fibroblasts, smooth muscle cells, and keratinocytes play a critical role in extracellular matrix (ECM) remodeling, angiogenesis, and epithelialization. The molecular factors regulating the migration, proliferation, and differentiation of these cells are scarcely discussed in the literature. The literature review identifies the key factors influencing the proliferation, migration, and differentiation of fibroblasts, keratinocytes, and vascular smooth muscle cells (VSMCs), which are critical in wound healing. This is followed by a discussion on the various novel factors regulating the migration, proliferation, and differentiation of these cells but not in the context of wound healing; however, they may play a role. Using a network analysis, we examined the interactions between various factors, and the findings suggest that the novel factors identified may play a significant role in promoting angiogenesis, granulation tissue formation, and extracellular matrix remodeling during wound healing or DFU healing. However, these interactions warrant further investigation to establish their role alone or synergistically.

Combustion of mixed materials during open air burning of refuse or structural fires in the wildland urban interface produces emissions that worsen air quality, contaminate rivers and streams, and cause poor health outcomes including developmental effects. The zebrafish, a freshwater fish, is a useful model for quickly screening the toxicological and developmental effects of agents in such species and elicits biological responses that are often analogous and predictive of responses in mammals. The purpose of this study was to compare the developmental toxicity of smoke derived from the burning of 5 different burn pit-related material types (plywood, cardboard, plastic, a mixture of the three, and the mixture plus diesel fuel as an accelerant) in zebrafish larvae. Larvae were exposed to organic extracts of increasing concentrations of each smoke 6-to-8-hr post fertilization and assessed for morphological and behavioral toxicity at 5 days post fertilization. To examine chemical and biological determinants of toxicity, responses were related to emissions concentrations of polycyclic hydrocarbons (PAH). Emissions from plastic and the mixture containing plastic caused the most pronounced developmental effects, including mortality, impaired swim bladder inflation, pericardial edema, spinal curvature, tail kinks, and/or craniofacial deformities, although all extracts caused concentration-dependent effects. Plywood, by contrast, altered locomotor responsiveness to light changes to the greatest extent. Some morphological and behavioral responses correlated strongly with smoke extract levels of PAHs including 9-fluorenone. Overall, the findings suggest that material type and emissions chemistry impact the severity of zebrafish developmental toxicity responses to burn pit-related smoke.

ObjectiveIn Malaysia, there is now a dearth of recommendations pertaining to the priority of biologic treatments for the effective management of psoriasis, given the multitude of available therapeutic alternatives. Present analysis reports results of a cost-effectiveness model that determines the most optimal arrangement of biologic treatments, with a particular focus of adding biosimilars to the existing treatment pathway for psoriasis in Malaysia.MethodsA Markov model was developed to compare the cost effectiveness of various biologic sequential treatments in a hypothetical cohort of moderate to severe psoriasis patient in Malaysia over a lifetime horizon. The model simulated the progression of patients through three lines of active biologic therapy, before transitioning to best supportive care. Costs and effects were discounted annually at a rate of 3%.ResultsFirst line secukinumab has produced lowest incremental cost effectiveness ratios (ICERs) when compared to first line systemic [ICERs value; US$152,474 (first set analysis) and US$110,572 (second set analysis)] and first line phototherapy [ICERs value; US$147,057 (first set analysis) and US$107,616 (second set analysis)]. However, these values were slightly higher than the Malaysian based threshold of three times gross domestic product per capita, US$104,337. A 40% reduction in the unit costs of reference biologics renders most of the evaluated treatment sequences cost-effective.ConclusionAdding biosimilar to the current treatment sequence could achieve cost savings ranging from 4.3% to 10.8% without significant loss of effectiveness. Given the significant impact of comorbidities and the resulting decline in quality of life among individuals with psoriasis, it may be justifiable to establish a threshold of up to US$184,000 per quality-adjusted life year (QALY) for the provision of therapies in the context of Malaysia.

SARS-CoV-2 (CoV2) infected, asymptomatic individuals are an important contributor to COVID transmission. CoV2-specific immunoglobulin (Ig)-as generated by the immune system following infection or vaccination-has helped limit CoV2 transmission from asymptomatic individuals to susceptible populations (e.g. elderly). Here, we describe the relationships between COVID incidence and CoV2 lineage, viral load, saliva Ig levels (CoV2-specific IgM, IgA and IgG), and ACE2 binding inhibition capacity in asymptomatic individuals between January 2021 and May 2022. These data were generated as part of a large university COVID monitoring program in Ohio, United States of America, and demonstrate that COVID incidence among asymptomatic individuals occurred in waves which mirrored those in surrounding regions, with saliva CoV2 viral loads becoming progressively higher in our community until vaccine mandates were established. Among the unvaccinated, infection with each CoV2 lineage (pre-Omicron) resulted in saliva Spike-specific IgM, IgA, and IgG responses, the latter increasing significantly post-infection and being more pronounced than N-specific IgG responses. Vaccination resulted in significantly higher Spike-specific IgG levels compared to unvaccinated infected individuals, and uninfected vaccinees' saliva was more capable of inhibiting Spike function. Vaccinees with breakthrough Delta infections had Spike-specific IgG levels comparable to those of uninfected vaccinees; however, their ability to inhibit Spike binding was diminished. These data are consistent with COVID vaccines having achieved hoped-for effects in our community, including the generation of mucosal antibodies that inhibit Spike and lower community viral loads, and suggest breakthrough Delta infections were not due to an absence of vaccine-elicited Ig, but instead limited Spike binding activity in the face of high community viral loads.

Background: Central-line–associated bloodstream infections (CLABSIs) are an important public health issue. Recent data from the CDC have shown an increase in healthcare-associated infections (including CLABSI) during the COVID-19 pandemic. Therefore, the main aim of this project was to analyze the epidemiology of central-line–associated bloodstream infection during different periods at the Baystate Medical Center (Springfield, MA) before, during, and after COVID-19 peaks of infection. Methods: Two specific periods were considered during the year (quarter January–March and quarter July–September) to consider potential seasonal variations, and the incidence of CLABSI during those 2 quarters was analyzed for 4 different years: 2019 (prepandemic), 2020–2021 (intrapandemic), and 2022 (postpandemic). An analysis of the microbial pathogens causing line infections was also performed to investigate differences described by other authors. Results: In total, 97 CLABSI (all from different patients) were reported into the NHSN website during the 8 periods considered. The average age of the patients was 55 years, with a male:female ratio of 57%:43%, and 14 renal patients were on dialysis. The CLABSI rates ranged from a minimum of 1.11 in Q1 of 2020 (start of COVID) to a maximum of 2 in Q3 of 2021 (SARS-CoV-2 delta variant) (Table 1). A statistical comparison of the pre–COVID-19 period with the respective quarters during the pandemic years (2020, 2021, and 2022) did not show any significant differences (Table 2). In term of microbiological data, of the 97 patients with CLABSIs, most of the patients (n = 70) had only 1 pathogen isolated, 14 patients had 2 pathogens, and 3 patients had 3 pathogens, bringing the total number of bacteria cultured to 117. Candida spp and Enterococcus spp were the most frequently isolated pathogens at 19% and 13%, respectively (Fig. 1). There was no statistically significant difference between the pre–COVID-19 and intra–COVID-19 periods for Candida spp (rate ratio, 1.391; 95% CI, 0.5477–3.533; P = .48) or Enterococcus spp (rate ratio, 2.385; 95% CI, 0.8365–6.798; P = .09). Conclusions: The COVID-19 pandemic did not seem to have an impact on the local epidemiology at Baystate Medical Center in terms of CLABSI rates or type of pathogens causing infections, but the sample size taken into consideration may not have been powerful enough to detect statistical significance.

Research indicates that excessive use of social media can be related to depression and anxiety. This study conducted a systematic review of social media and mental health, focusing on Facebook, Twitter, and Instagram. Based on inclusion criteria from the systematic review, a meta-analysis was conducted to explore and summarize studies from the empirical literature on the relationship between social media and mental health. Using PRISMA guidelines on PubMed and Google Scholar, a literature search from January 2010 to June 2020 was conducted to identify studies addressing the relationship between social media sites and mental health. Of the 39 studies identified, 20 were included in the meta-analysis. Results indicate that while social media can create a sense of community for the user, excessive and increased use of social media, particularly among those who are vulnerable, is correlated with depression and other mental health disorders.

This article examines the 1958 US trade mission to Yugoslavia through the lens of technocratic internationalism, which is—borrowing Gabrielle Hetch's definition of the term—a “less visible, but sometimes more powerful means of shaping and reshaping” international relations during the Cold War. This article examines how trade fairs, personal relationships, and international business networks functioned as sites of technocratic internationalism and considers mid-level bureaucrats from the United States and Yugoslavia who believed that expertise and technical advice in areas such as transportation, industrial management, travel, and marketing could bridge political differences between Cold War actors. The article focuses in particular on Fred Wittner, an important figure in American advertising who was part of the trade mission. Utilizing Wittner’s personal papers, housed at the Wisconsin Historical Society, this article explores how technical expertise served as a conduit through which the United States attempted to strengthen ties with Yugoslavia and reveals the political importance of personal relationships and networks, even within a framework that encouraged seemingly “apolitical” information exchange and expertise.

Summary: Background: Better understanding of the association between characteristics of patients hospitalized with coronavirus disease 2019 (COVID-19) and outcome is needed to further improve upon patient management. Methods: Immunophenotyping Assessment in a COVID-19 Cohort (IMPACC) is a prospective, observational study of 1164 patients from 20 hospitals across the United States. Disease severity was assessed using a 7-point ordinal scale based on degree of respiratory illness. Patients were prospectively surveyed for 1 year after discharge for post-acute sequalae of COVID-19 (PASC) through quarterly surveys. Demographics, comorbidities, radiographic findings, clinical laboratory values, SARS-CoV-2 PCR and serology were captured over a 28-day period. Multivariable logistic regression was performed. Findings: The median age was 59 years (interquartile range [IQR] 20); 711 (61%) were men; overall mortality was 14%, and 228 (20%) required invasive mechanical ventilation. Unsupervised clustering of ordinal score over time revealed distinct disease course trajectories. Risk factors associated with prolonged hospitalization or death by day 28 included age ≥ 65 years (odds ratio [OR], 2.01; 95% CI 1.28–3.17), Hispanic ethnicity (OR, 1.71; 95% CI 1.13–2.57), elevated baseline creatinine (OR 2.80; 95% CI 1.63– 4.80) or troponin (OR 1.89; 95% 1.03–3.47), baseline lymphopenia (OR 2.19; 95% CI 1.61–2.97), presence of infiltrate by chest imaging (OR 3.16; 95% CI 1.96–5.10), and high SARS-CoV2 viral load (OR 1.53; 95% CI 1.17–2.00). Fatal cases had the lowest ratio of SARS-CoV-2 antibody to viral load levels compared to other trajectories over time (p=0.001). 589 survivors (51%) completed at least one survey at follow-up with 305 (52%) having at least one symptom consistent with PASC, most commonly dyspnea (56% among symptomatic patients). Female sex was the only associated risk factor for PASC. Interpretation: Integration of PCR cycle threshold, and antibody values with demographics, comorbidities, and laboratory/radiographic findings identified risk factors for 28-day outcome severity, though only female sex was associated with PASC. Longitudinal clinical phenotyping offers important insights, and provides a framework for immunophenotyping for acute and long COVID-19. Funding: NIH.

Background: Recent evidence suggests that patients prefer subjective and crowd-sourced information over data-driven or quality-based outcomes when choosing a surgeon. Online physician rating and review websites continue to increase in popularity, and over half of patients use them to research physicians. Specifically, Yelp.com is the most frequently utilized online resource by patients. Data regarding the characteristics of negative reviews for spine surgeons and practices is lacking. Methods: Orthopedic Spine surgeons and practices in 8 major US metropolitan regions were surveyed for one-star reviews on Yelp.com. The factors noted in the reviews were recorded and they were classified according to their clinical or nonclinical nature. Reviews were also subclassified into nonsurgical or surgical episodes of care. Results: A total of 6,286 Yelp reviews were discovered, 671 (10.6%) of which were rated one-star. The majority of negative reviews (76.4%) were from patients who did not report surgery by the surgeon or practice. Of all comments, 491 (77.6%) related to nonclinical complaints. The most common factors noted in negative reviews were related to bedside manner, rude or unprofessional staff, and wait time. Conclusion: Choosing a surgeon is a complex process for patients. The large majority of negative reviews were related to nonclinical issues such as poor bedside manner or rude staff and most of these were written by patients that did not undergo a surgical procedure. This may explain the large discrepancy that has been observed between quality metrics and online crowd-sourced reviews. Paying attention to these nonclinical factors may represent the most feasible and valuable targets to improve a surgeon's practice and attract future patients.

Biowastes from agriculture, sewage, household wastes, and industries comprise promising resources to produce biomaterials while reducing adverse environmental effects. This study focused on utilising waste-derived materials (i.e., eggshells as a calcium source, struvite as a phosphate source, and CH3COOH as dissolution media) to produce value-added products (i.e., calcium phosphates (CaPs) derived from biomaterials) using a continuous flow hydrothermal synthesis route. The prepared materials were characterised via XRD, FEG-SEM, EDX, FTIR, and TEM analysis. Magnesium whitlockite (Mg-WH) and hydroxyapatite (HA) were produced by single-phase or biphasic CaPs by reacting struvite with either calcium nitrate tetrahydrate or an eggshell solution at 200 °C and 350 °C. Rhombohedral-shaped Mg-WH (23–720 nm) along with tube (50–290 nm diameter, 20–71 nm thickness) and/or ellipsoidal morphologies of HA (273–522 nm width) were observed at 350 °C using HNO3 or CH3COOH to prepare the eggshell and struvite solutions, and NH4OH was used as the pH buffer. The Ca/P (atomic%) ratios obtained ranged between 1.3 and 1.7, indicating the formation of Mg-WH and HA. This study showed that eggshells and struvite usage, along with CH3COOH, are promising resources as potential sustainable precursors and dissolution media, respectively, to produce CaPs with varying morphologies.

Studies were conducted in 2020 and 2021 at the Delta Research and Extension Center in Stoneville, MS, to determine the residual concentrations of chlorantraniliprole in cotton (Gossypium hirsutum, L.) leaves, as well as the concentrations in petals and anthers that developed after the time of application. Foliar applications of chlorantraniliprole were applied at four rates for leaves and two rates for petals and anthers at the second week of bloom. Additional bioassays were conducted to determine mortality of corn earworm (Helicoverpa zea, Boddie) in anthers. For the leaf study, plants were partitioned into three zones consisting of top, middle, and bottom zones. Leaf samples from each zone were analyzed for chemical concentrations at 1, 7, 14, 21, and 28 days after treatment (DAT). Residual concentrations, although variable, persisted through all sampling dates, rates, and zones tested. In this study, chlorantraniliprole remained detectable up to 28 DAT. Results from the cotton flower petal and anther studies detected concentrations of chlorantraniliprole in petals at 4, 7, 10, and 14 DAT, but no concentrations were detected in anthers. Therefore, no mortality of corn earworm was recorded in the anther bioassays. A series of diet-incorporated bioassays were conducted using concentrations previously found in the petal study to determine baseline susceptibilities of corn earworms and predicted mortality. Results from the diet-incorporated bioassays showed similar susceptibility in field and lab colony corn earworms. Concentrations of chlorantraniliprole could provide up to 64% control of corn earworm when feeding occurs on the petals.

Exposure to particulate matter (PM) air pollution increases risk of adverse human health effects. As more attention is brought to bear on the problem of PM, traditional mammalian in vivo models struggle to keep up with the risk assessment challenges posed by the countless number of unique PM samples across air sheds with limited or no toxicity information. This review examines the utility of three higher throughput, alternative, in vivo animal models in PM toxicity research: Danio rerio (zebrafish), Caenorhabditis elegans (nematode), and Drosophila melanogaster (fruit fly). These model organisms vary in basic biology, ease of handling, methods of exposure to PM, number and types of available assays, and the degree to which they mirror human biology and responsiveness, among other differences. The use of these models in PM research dates back over a decade, with assessments of the toxicity of various PM sources including traffic-related combustion emissions, wildland fire smoke, and coal fly ash. This article reviews the use of these alternative model organisms in PM toxicity studies, their biology, the various assays developed, endpoints measured, their strengths and limitations, as well as their potential role in PM toxicity assessment and mechanistic research going forward.

Progress is being made on human Lunar and Martian missions by space agencies and private organisations around the world, with the aims of establishing reliable long-duration architectures. Complementing this, research is being carried out under controlled and isolated conditions within simulated space habitats, to gain insights into the effects of such conditions on the research subjects and their impacts on crews’ wellbeing and success. This paper provides an overview of the experiments conducted during two separate 15-day missions—one Martian and one Lunar—conducted in the LunAres Research Base in Piła, Poland, in 2018. Some activities were common between the two crews; others were only carried out by one. Using the same methodology, both collected cognitive function, environmental, physiological, and inventory data, resulting in a larger dataset allowing comparisons between the two missions in terms of varying human factors. Experiments conducted by the Lunar crew included the following: effects of consuming lyophilised food on oral health and saliva production, influence of isolation on hearing capability, feelings on security in the isolated habitat, and research into earthworm growth in different soil compositions. The Mars mission analysed physical performances of the crew and compared them to performances realised during similar activities in Mars Research Desert Station missions and the impact of confinement on their efficiency performing a remote operation of a rover. For each piece of research, an overview of the background, methodology, results, and conclusions is given, referencing the resulting papers. In addition, nonresearch activities are included for completeness and context.

For many biological systems, a variety of simulation models exist. A new simulation model is rarely developed from scratch, but rather revises and extends an existing one. A key challenge, however, is to decide which model might be an appropriate starting point for a particular problem and why. To answer this question, we need to identify entities and activities that contributed to the development of a simulation model. Therefore, we exploit the provenance data model, PROV-DM, of the World Wide Web Consortium and, building on previous work, continue developing a PROV ontology for simulation studies. Based on a case study of 19 Wnt/β-catenin signaling models, we identify crucial entities and activities as well as useful metadata to both capture the provenance information from individual simulation studies and relate these forming a family of models. The approach is implemented in WebProv, a web application for inserting and querying provenance information. Our specialization of PROV-DM contains the entities Research Question, Assumption, Requirement, Qualitative Model, Simulation Model, Simulation Experiment, Simulation Data, and Wet-lab Data as well as activities referring to building, calibrating, validating, and analyzing a simulation model. We show that most Wnt simulation models are connected to other Wnt models by using (parts of) these models. However, the overlap, especially regarding the Wet-lab Data used for calibration or validation of the models is small. Making these aspects of developing a model explicit and queryable is an important step for assessing and reusing simulation models more effectively. Exposing this information helps to integrate a new simulation model within a family of existing ones and may lead to the development of more robust and valid simulation models. We hope that our approach becomes part of a standardization effort and that modelers adopt the benefits of provenance when considering or creating simulation models.

Background: We describe a mobile unit (UniMóvil) designed to improve poor healthcare access delivery to residents in two South Texas underserved Colonias. The interprofessional team measured seven clinical outcomes [obesity, diabetes, hypertension, hypertriglyceridemia, low high-density lipoprotein cholesterol (HDL-C) levels, and depression], and using the Duke Health Profile, assessed the health-related quality of life (HrQoL).Methods: The investigators used previously reported disease prevalence, an implementation model, and community needs-assessments to design an outreach healthcare delivery model. A retrospective review of the cohort provides data used to determine potential predictors of clinical variables, 11 domains of HrQOL, and inter/intra Colonia differences.Results: The average age of patients was 45 years-old and females represented 67% of the population served. Results include a high prevalence of obesity (55.5%), hypertension (39%), diabetes (32.5%), and depression (19%), gender differences, and inter-Colonia differences. A generalized linear mixed model analysis provided associations between clinical outcomes and predictors (age, sex, BMI, PHQ-9 score, HbA1c, blood pressure, serum cholesterol, low HDL, triglycerides, and HrQOL domains). The HrQol domain of low self-perceived health, relates to obesity, diabetes, low HDL, and depression. Depression predicted all 11 domains of the HrQol.Conclusion: The prevalence of diabetes, hypertension, obesity, and depression remains epidemic. Mobile clinics increase access and address highly prevalent illnesses in the Colonias. The data collected can be used to address chronic disease and quality of life, focus care, and direct research in high-need underserved areas.

Introduction: Administration of tranexamic acid (TXA) has been shown to effectively reduce all-cause mortality in trauma patients when given within three hours of injury. We found that many trauma patients in our hospital were not receiving TXA. This was due to a variety of factors, including late presentation to hospital, lack of staff awareness, short staffing, and unavailable drugs or equipment. Our aim was to develop a protocol for safe, nurse-led administration of TXA in the emergency centre in order to increase the number of eligible patients treated. Methods: We developed a protocol based on the inclusion criteria of the CRASH-2 study, opting to use physiological observations along with criteria from the South African Triage Scale to allow nursing staff to identify patients with, or at risk of, significant haemorrhage. We tailored the protocol to the equipment and training available in our poorly resourced rural healthcare setting. Results: In a two-month period, 14 patients were given TXA by nurses before the arrival of a doctor. 13/14 (92.9%) were deemed appropriate, with 1/14 (7.1%) deemed inappropriate due to the time since injury. 12/13 (92.3%) patients received the correct infusion dose, with 1/13 (7.7%) only receiving the infusion once the doctor arrived. No adverse events were reported. Conclusions: Nursing staff in resource poor rural settings can use a protocol based on the South African Triage Scale and the CRASH-2 study to safely administer TXA to trauma patients. We believe this to be the first published literature on nurse-led administration of TXA. Mortality from trauma may be reduced in rural settings by the timely administration of TXA in the prehospital and rural primary healthcare settings. Keywords: Nurse-led care in health technology, Triage, Trauma, Emergency medicine