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Background: Studies examining the association between asthma and hospitalization among children and youth with coronavirus disease 2019 (COVID-19) have yielded mixed results. Both asthma and COVID-19 hospitalization are characterized by racial, ethnic and socioeconomic disparities which also pattern geographically, yet no studies to date have adjusted for neighborhood context in the assessment of this association., Methods: Mixed effects logistic regression was used to estimate the association between asthma and hospitalization due to COVID-19 in a sample of 28,997 children and youth diagnosed with COVID-19 in Milwaukee County, Wisconsin, from March 1, 2020, to May 31, 2022. Models adjusted for individual-level sociodemographic factors (age, gender, race, ethnicity and city/suburb residence) and season of diagnosis were examined as moderators. Random intercepts by census tract accounted for geographic variation in neighborhood factors and census tract-level measures of education, health and environment, and social and economic factors were assessed via childhood opportunity indices., Results: Asthma history was statistically significantly associated with hospitalization due to COVID-19 among children and youth. Hospitalization rates varied statistically significantly by census tract, and results were unchanged after accounting for childhood opportunity indices and census tract. Season of diagnosis was not found to moderate the effect of asthma history on COVID-19 hospitalization., Conclusion: Our study suggests that asthma history is a risk factor for hospitalization in the context of COVID-19 infection among children and youth, warranting observation and follow-up of children with asthma as well as continued measures to prevent COVID-19 in this population., Competing Interests: The authors have no conflicts of interest to disclose., (Copyright © 2024 Wolters Kluwer Health, Inc. All rights reserved.)

Introduction: The coronavirus pandemic has placed enormous stresses on health care systems across the United States and internationally. Predictive modeling has been an important tool for projecting utilization rates and surge planning. As the initial outbreak begins to slow, questions are being raised regarding long-term coronavirus mitigation plans. This paper examines the current status of the coronavirus outbreak in Milwaukee County, Wisconsin, and simulates several scenarios where physical distancing measures are removed., Methods: The outbreak's doubling time, reproductive numbers at several points, and incidence curve were calculated to assess outbreak progression. Compartmental models were used to estimate the number of hospitalizations and critically ill patients in Milwaukee County if distancing policies were removed., Results: The compartmental models predict a substantial spike in cases and overwhelming medical resource utilization with an abrupt end to social distancing. Partial reduction in social distancing policies would likely result in a smaller spike, with less severe strain on available medical resources., Conclusions: Milwaukee County remains very susceptible to a resurgence of COVID-19 cases. Removing physical distancing policies poses significant risks with regard to resource management., (Copyright© Board of Regents of the University of Wisconsin System and The Medical College of Wisconsin, Inc.)

Background The value of patient-reported outcomes (PRO) is increasingly recognized in patient-centered care. Longitudinal data collection may be challenging and cost prohibitive. Automation of PRO collection may complement routine clinical follow-up, especially for procedures aiming to improve quality of life, such as atrial fibrillation (AF) ablation. Methods We aimed to develop a fully automated platform to collect PRO and evaluate its first clinical application in a prospective cohort of AF ablation. The duration of follow-up and data availability were assessed with automated PRO and routine follow-up versus routine follow-up alone (primary outcome). Quality of life and healthcare utilization (secondary outcomes) by PRO were assessed. Results Between 2013 and 2016, 2175 patients were eligible to receive 10 903 PRO assessment invitations, and the automated platform sent all invitations as programmed. More follow-up assessments were obtained with automated PRO and routine follow-up compared with routine follow-up alone (12 859 versus 10 248; P<0.0001) which allowed longer duration of follow-up (378 versus 217 days, 74% increase; P<0.0001). By automated PRO, a large number of disease-specific variables were collected and showed improvement in quality of life (baseline median AF symptom severity score AFSSS of 12 [6-18] and ranged between 2 and 3 on subsequent assessments; P<0.0001). This improvement was also true for each of the AFSSS individual components ( P<0.0001). In PRO, there was a significant reduction in AF burden (such as frequency and duration of episodes; P<0.0001) and associated healthcare utilization (including emergency visits and hospitalizations; P<0.0001) after the ablation procedures. Conclusions A fully automated system for PRO collection enhanced clinical follow-up and allowed collection of disease-specific data when applied in a prospective cohort of AF ablation.

Purpose: Characteristics of the amiodarone-warfarin interaction during long-term follow-up were studied., Methods: Medical records from patients seen in the anticoagulation clinic at the Hennepin County Medical Center between April 1998 and March 2003 were retrospectively reviewed. Patients were included if they were older than 18 years, used the anticoagulation clinic as their primary clinic for anticoagulation therapy, and were receiving combined amiodarone and warfarin therapy for at least one month. The primary study endpoint was the occurrence of International Normalized Ratios (INRs) of >5 at any time during combined warfarin-amiodarone therapy. The secondary endpoint was the frequency of warfarin dosage changes., Results: A total of 70 patients met study inclusion criteria. Of these 70, 7 had amiodarone started before warfarin initiation. Of the 2434 INR values analyzed, 43% (n = 1043) were in the target therapeutic range, 34% (n = 820) were below target range, and 23% (n = 571) were above target range. A total of 102 INR values (4%) were above 5. The relative risk of having an INR of >5 for patients on concurrent warfarin and amiodarone versus those on warfarin alone was 1.366 (p = 0.005). INRs of >5 were most common during the first 12 weeks of combined therapy, with no subsequent large peaks evident., Conclusion: Among patients treated in an anticoagulation clinic, INR values of >5 were most common during the first 12 weeks of combined therapy with amiodarone and warfarin and necessitated reduction in warfarin dosage. No other notable changes in INR or amiodarone or warfarin dosage occurred throughout the remainder of the 80-week study period.

Significant solubilization of ostensibly water-immiscible ionic liquids (ILs) in acidic aqueous phases is induced by the presence of any of a variety of neutral extractants, the apparent result of the formation of the protonated form of the extractant and its subsequent exchange for the cationic component of the IL. The extent of this solubilization is shown to diminish with increasing hydrophobicity of the IL cation and decreasing extractant basicity. These observations raise concerns as to the viability of ILs as "drop in replacements" for traditional organic solvents in the solvent extraction of metal ions.

The predominant mode of strontium ion transfer from aqueous nitrate media into a series of 1-fluoroalkyl-3-methylimidazolium bis[(trifluoromethylsulfonyl)]imides containing dicyclohexano-18-crown-6 (DCH18C6) is shown to shift from cation exchange to strontium nitrato-crown ether complex partitioning as the length of the fluoroalkyl substituent is increased. Fluoroalkyl substituents are shown to be only slightly more effective than their non-fluorous analogs at inducing this shift. At the same time, the fluorinated ionic liquids (ILs) yield strontium distribution ratios as much as an order of magnitude lower than the corresponding 1-alkyl-3-methylimidazolium (C(n)mim(+)) salts. Fluorous ILs thus appear to offer no compelling advantages over C(n)mim(+) ionic liquids as extraction solvents.

Blood microparticles (MPs) in sickle cell disease (SCD) are reportedly derived only from erythrocytes and platelets. Yet in SCD, endothelial cells and monocytes are activated and abnormally express tissue factor (TF). Thus, sickle blood might contain TF-positive MPs derived from these cells. With the use of flow cytometry to enumerate and characterize MPs, we found total MPs to be elevated in crisis (P =.0001) and steady state (P =.02) in subjects with sickle cell disease versus control subjects. These MPs were derived from erythrocytes, platelets, monocytes, and endothelial cells. Erythrocyte-derived MPs were elevated in sickle crisis (P =.0001) and steady state (P =.02) versus control subjects, as were monocyte-derived MPs (P =.0004 and P =.009, respectively). Endothelial and platelet-derived MPs were elevated in sickle crisis versus control subjects. Total TF-positive MPs were elevated in sickle crisis versus steady state (P =.004) and control subjects (P <.0001) and were derived from both monocytes and endothelial cells. Sickle MPs shortened plasma-clotting time compared with control MPs, and a TF antibody partially inhibited this procoagulant activity. Markers of coagulation were elevated in patients with sickle cell disease versus control subjects and correlated with total MPs and TF-positive MPs (P <.01 for both). These data support the concept that SCD is an inflammatory state with monocyte and endothelial activation and abnormal TF activity.

Chiral stationary phases (CSPs) for liquid chromatography derived from N-(acyl)proline-3,5-dimethylanilides separate the enantiomers of N-(3,5-dinitrobenzoyl)-alpha-amino esters and amides with high levels of selectivity. These CSPs have been used to assemble a large body of chromatographic data which indirectly supports the validity of the mechanistic rationale originally used in the design of these CSPs. We herein report (1)H and (13)C chemical shift data obtained when the (S)-enantiomer of chiral solvating agent (CSA) 3, a soluble analogue of the selector used in CSP (S)-1, acts on each of the enantiomers of the dimethylamide of N-(3,5-dinitrobenzoyl)leucine, 2. The changes in chemical shift in the mixture of (S)-2 and (S)-3 support the existence of those interactions thought to be essential to chiral recognition in this system. In addition, significant intermolecular NOESY enhancements are observed in this mixture. These NOE data are consistent with the structure expected for the more stable diastereomeric adsorbate formed between (S)-2 and the (S)-proline-derived CSP 1. No intermolecular NOEs are observed for corresponding mixtures of the chiral solvating agent (S)-3 and (R)-2, the enantiomer least retained on (S)-CSP 1.

We reported previously that an antitryptic glycoprotein, EDC1 (Mr 27,500), which is immunologically related to the normal serum proteinase inhibitor, inter-alpha-trypsin inhibitor (IATI), is excreted in large quantities in the urine of metastatic cancer patients. We have now measured immunoreactive titers of urinary EDC1 and five serum proteinase inhibitors (including IATI) in 16 patients with hematological cancers, 9 patients with various solid tumors, and 32 healthy subjects. The mean urinary EDC1 levels were 22-fold greater in all cancer patients as compared to normals [187.0 +/- 136.6 (S.D.) versus 8.4 +/- 8.2 mg/g creatinine; p less than 0.001]. In the cancer group, serum levels of immunoreactive alpha 1-proteinase inhibitor (also called alpha 1-antitrypsin), alpha 1-antichymotrypsin, and C1 inactivator averaged 152, 237, and 165% of the normal values, respectively (p less than 0.01). Immunoreactive alpha 2-macroglobulin levels were unchanged, and immunoreactive IATI levels were depressed (75% of the normals; p less than 0.01). The lower levels of IATI and elevated levels of EDC1 are consistent with the latter being derived from the former. In spite of the increased immunoreactive alpha 1-proteinase inhibitor level, the serum antitryptic capacity of the cancer group averaged only 50% of the normal group (p less than 0.01; range, 5 to 110% of normal average). This suggests that about 70% of the serum alpha 1-proteinase inhibitor in the cancer group is functionally inert.