Focused use of drug screening in overdose patients increases impact on management.

UNLABELLED: Drug poisoning is a common cause for attendance in the emergency department. Several toxicology centres suggest performing urinary drug screens, even though they rarely influence patient management. STUDY OBJECTIVES: Measuring the impact on patient management, in a University Emergency Department with approximately 40 000 admissions annually, of a rapid urinary drug screening test using specifically focused indications. Drug screening was restricted to patients having a first psychotic episode or cases demonstrating respiratory failure, coma, seizures, a sympathomimetic toxidrome, severe opiate overdose necessitating naloxone, hypotension, ventricular arrhythmia, acquired long QT or QRS >100 ms, and high-degree heart block. METHODS: Retrospective analysis of Triage® TOX drug screen tests performed between September 2009 and November 2011, and between January 2013 and March 2014. RESULTS: A total of 262 patients were included, mean age 35 ± 14.6 (standard deviation) years, 63% men; 29% poisoning with alcohol, and 2.3% deaths. Indications for testing were as follows: 34% were first psychotic episodes; 20% had acute respiratory failure; 16% coma; 8% seizures; 8% sympathomimetic toxidromes; 7% severe opioid toxidromes; 4% hypotension; 3% ventricular arrhythmias or acquired long QT intervals on electrocardiogram. A total of 78% of the tests were positive (median two substances, maximum five). The test resulted in drug-specific therapy in 6.1%, drug specific diagnostic tests in 13.3 %, prolonged monitoring in 10.7% of methadone-positive tests, and psychiatric admission in 4.2%. Overall, 34.3% tests influenced patient management. CONCLUSIONS: In contrast to previous studies showing modest effects of toxicological testing, restricted use of rapid urinary drug testing increases the impact on management of suspected overdose patients in the ED

Admissions of patients with alcohol intoxication in the Emergency Department: a growing phenomenon.

QUESTION UNDER STUDY: To investigate the change over time in the number of ED admissions with positive blood alcohol concentration (BAC) and to evaluate predictors of BAC level. METHODS: We conducted a single site retrospective study at the ED of a tertiary referral hospital (western part of Switzerland) and obtained all the BAC performed from 2002 to 2011. We determined the proportion of ED admissions with positive BAC (number of positive BAC/number of admissions). Regression models assessed trends in the proportion of admissions with positive BAC and the predictors of BAC level among patients with positive BAC. RESULTS: A total of 319,489 admissions were recorded and 20,021 BAC tests were performed, of which 14,359 were positive, divided 34.5% female and 65.5% male. The mean (SD) age was 41.7(16.8), and the mean BAC was 2.12(1.04) permille (g of ethanol/liter of blood). An increase in the number of positive BAC was observed, from 756 in 2002 to 1,819 in 2011. The total number of admissions also increased but less: 1.2 versus 2.4 times more admissions with positive BAC. Being male was independently associated with a higher (+0.19 permille) BAC, as was each passing year (+0.03). A significant quadratic association with age indicated a maximum BAC at age 53. CONCLUSION: We observed an increase in the percentage of admissions with positive BAC that was not limited to younger individuals. Given the potential consequences of alcohol intoxication, and the large burden imposed on ED teams, communities should be encouraged to take measures aimed at reducing alcohol intoxication

Models of organometallic complexes for optoelectronic applications

Organometallic complexes have potential applications as the optically active components of organic light emitting diodes (OLEDs) and organic photovoltaics (OPV). Development of more effective complexes may be aided by understanding their excited state properties. Here we discuss two key theoretical approaches to investigate these complexes: first principles atomistic models and effective Hamiltonian models. We review applications of these methods, such as, determining the nature of the emitting state, predicting the fraction of injected charges that form triplet excitations, and explaining the sensitivity of device performance to small changes in the molecular structure of the organometallic complexes.Comment: To appear in themed issue of J. Mat. Chem. on the modelling of material

Charge-transfer excited states in phosphorescent organo-transition metal compounds: a difficult case for time dependent density functional theory?

Light emitting organo-transition metal complexes have found widespread use in the past. The computational modelling of such compounds is often based on time-dependent density functional theory (TDDFT), which enjoys popularity due to its numerical efficiency and simple black-box character. It is well known, however, that TDDFT notoriously underestimates energies of charge-transfer excited states which are prominent in phosphorescent metal–organic compounds. In this study, we investigate whether TDDFT is providing a reliable description of the electronic properties in these systems. To this end, we compute 0–0 triplet state energies for a series of 17 pseudo-square planar platinum(II) and pseudo-octahedral iridium(III) complexes that are known to feature quite different localization characteristics ranging from ligand-centered (LC) to metal-to-ligand charge transfer (MLCT) transitions. The calculations are performed with conventional semi-local and hybrid functionals as well as with optimally tuned range-separated functionals that were recently shown to overcome the charge transfer problem in TDDFT. We compare our results against low temperature experimental data and propose a criterion to classify excited states based on wave function localization. In addition, singlet absorption energies and singlet–triplet splittings are evaluated for a subset of the compounds and are also validated against experimental data. Our results indicate that for the investigated complexes charge-transfer is much less pronounced than previously believed

Synthesis and Luminescence Modulation of Pyrazine-Based Gold(III) Pincer Complexes

The first examples of pyrazine-based gold(III) pincer complexes have been synthesized; their intense photoemissions can be modified by interactions with the non-coordinating pyrazine-N atom. Luminescence modulation is possible without the need for altering the ligand framework. Emissions shift from red (77 K) to blue (298 K) due to thermally activated delayed fluorescence (TADF

Red Phosphorescence from Benzo[2,1,3]thiadiazoles at Room Temperature

We describe the red phosphorescence exhibited by a class of structurally simple benzo[2,1,3]thiadiazoles at room temperature. The photophysical properties of these molecules in deoxygenated cyclohexane, including their absorption spectra, steady-state photoluminescence and excitation spectra, and phosphorescence lifetimes, are presented. Time-dependent density functional theory calculations were carried out to better understand the electronic excited states of these benzo[2,1,3]thiadiazoles and why they are capable of phosphorescence.National Science Foundation (U.S.) (1122374)United States. Dept. of Energy. Office of Basic Energy Sciences (DE-FG02-07ER46474

TADF Material Design: Photophysical Background and Case Studies Focusing on CuI and AgI Complexes

The development of organic light emitting diodes (OLEDs) and the use of emitting molecules have strongly stimulated scientific research of emitting compounds. In particular, for OLEDs it is required to harvest all singlet and triplet excitons that are generated in the emission layer. This can be achieved using the so-called triplet harvesting mechanism. However, the materials to be applied are based on high-cost rare metals and therefore, it has been proposed already more than one decade ago by our group to use the effect of thermally activated delayed fluorescence (TADF) to harvest all generated excitons in the lowest excited singlet state S1. In this situation, the resulting emission is an S1→S0 fluorescence, though a delayed one. Hence, this mechanism represents the singlet harvesting mechanism. Using this effect, high-cost and strong SOC-carrying rare metals are not required. This mechanism can very effectively be realized by use of CuI or AgI complexes and even by purely organic molecules. In this investigation, we focus on photoluminescence properties and on crucial requirements for designing CuI and AgI materials that exhibit short TADF decay times at high emission quantum yields. The decay times should be as short as possible to minimize non-radiative quenching and, in particular, chemical reactions that frequently occur in the excited state. Thus, a short TADF decay time can strongly increase the material's long-term stability. Here, we study crucial parameters and analyze their impact on the TADF decay time. For example, the energy separation ΔE(S1–T1) between the lowest excited singlet state S1 and the triplet state T1 should be small. Accordingly, we present detailed photophysical properties of two case-study materials designed to exhibit a large ΔE(S1–T1) value of 1000 cm−1 (120 meV) and, for comparison, a small one of 370 cm−1 (46 meV). From these studies—extended by investigations of many other CuI TADF compounds—we can conclude that just small ΔE(S1–T1) is not a sufficient requirement for short TADF decay times. High allowedness of the transition from the emitting S1 state to the electronic ground state S0, expressed by the radiative rate kr(S1→S0) or the oscillator strength f(S1→S0), is also very important. However, mostly small ΔE(S1–T1) is related to small kr(S1→S0). This relation results from an experimental investigation of a large number of CuI complexes and basic quantum mechanical considerations. As a consequence, a reduction of τ(TADF) to below a few μs might be problematic. However, new materials can be designed for which this disadvantage is not prevailing. A new TADF compound, Ag(dbp)(P2-nCB) (with dbp=2,9-di-n-butyl-1,10-phenanthroline and P2-nCB=bis-(diphenylphosphine)-nido-carborane) seems to represent such an example. Accordingly, this material shows TADF record properties, such as short TADF decay time at high emission quantum yield. These properties are based (i) on geometry optimizations of the AgI complex for a fast radiative S1→S0 rate and (ii) on restricting the extent of geometry reorganizations after excitation for reducing non-radiative relaxation and emission quenching. Indeed, we could design a TADF material with breakthrough properties showing τ(TADF)=1.4 μs at 100 % emission quantum yield. © 2017 Wiley-VCH Verlag GmbH & Co. KGaA, Weinhei

State of Emergency Medicine in Switzerland: a national profile of emergency departments in 2006

BACKGROUND: Emergency departments (EDs) are an essential component of any developed health care system. There is, however, no national description of EDs in Switzerland. Our objective was to establish the number and location of EDs, patient visits and flow, medical staff and organization, and capabilities in 2006, as a benchmark before emergency medicine became a subspecialty in Switzerland. METHODS: In 2007, we started to create an inventory of all hospital-based EDs with a preliminary list from the Swiss Society of Emergency and Rescue Medicine that was improved with input from ED physicians nationwide. EDs were eligible if they offered acute care 24 h per day, 7 days per week. Our goal was to have 2006 data from at least 80% of all EDs. The survey was initiated in 2007 and the 80% threshold reached in 2012. RESULTS: In 2006, Switzerland had a total of 138 hospital-based EDs. The number of ED visits was 1.475 million visits or 20 visits per 100 inhabitants. The median number of visits was 8,806 per year; 25% of EDs admitted 5,000 patients or less, 31% 5,001-10,000 patients, 26% 10,001-20,000 patients, and 17% >20,000 patients per year. Crowding was reported by 84% of EDs with >20,000 visits/year. Residents with limited experience provided care for 77% of visits. Imaging was not immediately available for all patients: standard X-ray within 15 min (70%), non-contrast head CT scan within 15 min (38%), and focused sonography for trauma (70%); 67% of EDs had an intensive care unit within the hospital, and 87% had an operating room always available. CONCLUSIONS: Swiss EDs were significant providers of health care in 2006. Crowding, physicians with limited experience, and the heterogeneity of emergency care capabilities were likely threats to the ubiquitous and consistent delivery of quality emergency care, particularly for time-sensitive conditions. Our survey establishes a benchmark to better understand future improvements in Swiss emergency care

The Response of the Honey Bee Gut Microbiota to Nosema ceranae Is Modulated by the Probiotic Pediococcus acidilactici and the Neonicotinoid Thiamethoxam.

The honey bee Apis mellifera is exposed to a variety of biotic and abiotic stressors, such as the highly prevalent microsporidian parasite Nosema (Vairimorpha) ceranae and neonicotinoid insecticides. Both can affect honey bee physiology and microbial gut communities, eventually reducing its lifespan. They can also have a combined effect on the insect's survival. The use of bacterial probiotics has been proposed to improve honey bee health, but their beneficial effect remains an open question. In the present study, western honey bees were experimentally infected with N. ceranae spores, chronically exposed to the neonicotinoid thiamethoxam, and/or supplied daily with the homofermentative bacterium Pediococcus acidilactici MA18/5M thought to improve the honey bees' tolerance to the parasite. Deep shotgun metagenomic sequencing allowed the response of the gut microbiota to be investigated with a taxonomic resolution at the species level. All treatments induced significant changes in honey bee gut bacterial communities. Nosema ceranae infection increased the abundance of Proteus mirabilis, Frischella perrara, and Gilliamella apicola and reduced the abundance of Bifidobacterium asteroides, Fructobacillus fructosus, and Lactobacillus spp. Supplementation with P. acidilactici overturned some of these alterations, bringing back the abundance of some altered species close to the relative abundance found in the controls. Surprisingly, the exposure to thiamethoxam also restored the relative abundance of some species modulated by N. ceranae. This study shows that stressors and probiotics may have an antagonistic impact on honey bee gut bacterial communities and that P. acidilactici may have a protective effect against the dysbiosis induced by an infection with N. ceranae