Persil Çetinkol, Özgül (Dogus Author)In the biochemical conversion of lignocellulosic biomass to biofuels, the process of pretreatment is currently one of the most difficult and expensive operations. The use of ionic liquids (ILs) in biomass pretreatment has received considerable attention recently because of their effectiveness at decreasing biomass recalcitrance to subsequent enzymatic hydrolysis. In addition, ILs have the potential for decreasing the need for corrosive or toxic chemicals and associated waste streams that can be generated by other pretreatment methods that utilize acids and/or bases. In this article, we address two significant challenges to the realization of a practical IL pretreatment process. First, we describe a mixture containing specific proportions of a ketone and an alcohol that precipitates cellulose and lignocellulosic biomass from solutions of the IL 1-ethyl-3-methylimidazolium acetate without the formation of intermediate gel phases. Second, an IL recovery process is described that removes lignin and most residual IL solutes and that minimizes energy and solvent use. These two techniques are demonstrated by the pretreatment of 100 g of corn stover with the recovery of 89% of the initial IL and separate corn stover fractions rich in glucans, xylans, lignin, and non-polar substances. These results highlight one potential approach towards the realization of a scalable ionic liquid pretreatment process technology that enables ionic liquid recovery and reuse

OBJECTIVES:Results of pre-post intervention studies of sepsis early warning systems have been mixed, and randomized clinical trials showing efficacy in the emergency department setting are lacking. Additionally, early warning systems can be resource-intensive and may cause unintended consequences such as antibiotic or IV fluid overuse. We assessed the impact of a pharmacist and provider facing sepsis early warning systems on timeliness of antibiotic administration and sepsis-related clinical outcomes in our setting. DESIGN:A randomized, controlled quality improvement initiative. SETTING:The main emergency department of an academic, safety-net healthcare system from August to December 2019. PATIENTS:Adults presenting to the emergency department. INTERVENTION:Patients were randomized to standard sepsis care or standard care augmented by the display of a sepsis early warning system-triggered flag in the electronic health record combined with electronic health record-based emergency department pharmacist notification. MEASUREMENTS AND MAIN RESULTS:The primary process measure was time to antibiotic administration from arrival. A total of 598 patients were included in the study over a 5-month period (285 in the intervention group and 313 in the standard care group). Time to antibiotic administration from emergency department arrival was shorter in the augmented care group than that in the standard care group (median, 2.3 hr [interquartile range, 1.4-4.7 hr] vs 3.0 hr [interquartile range, 1.6-5.5 hr]; p = 0.039). The hierarchical composite clinical outcome measure of days alive and out of hospital at 28 days was greater in the augmented care group than that in the standard care group (median, 24.1 vs 22.5 d; p = 0.011). Rates of fluid resuscitation and antibiotic utilization did not differ. CONCLUSIONS:In this single-center randomized quality improvement initiative, the display of an electronic health record-based sepsis early warning systemtriggered flag combined with electronic health record-based pharmacist notification was associated with shorter time to antibiotic administration without an increase in undesirable or potentially harmful clinical interventions.

BackgroundWe designed an innovative porcine model of ischemia‐induced arrest to determine dynamic arrhythmia substrates during focal infarct, global ischemia from ventricular tachycardia or fibrillation (VT/VF) and then reperfusion to determine the effect of therapeutic hypothermia (TH) on dynamic arrhythmia substrates and resuscitation outcomes.Methods and ResultsAnesthetized adult pigs underwent thoracotomy and regional plunge electrode placement in the left ventricle. Subjects were then maintained at either control (CT; 37°C, n=9) or TH (33°C, n=8). The left anterior descending artery (LAD) was occluded and ventricular fibrillation occurred spontaneously or was induced after 30 minutes. Advanced cardiac life support was started after 8 minutes, and LAD reperfusion occurred 60 minutes after occlusion. Incidences of VF/VT and survival were compared with ventricular ectopy, cardiac alternans, global dispersion of repolarization during LAD occlusion, and LAD reperfusion. There was no difference in incidence of VT/VF between groups during LAD occlusion (44% in CT versus 50% in TH; P=1s). During LAD occlusion, ectopy was increased in CT and suppressed in TH (33±11 ventricular ectopic beats/min versus 4±6 ventricular ectopic beats/min; P=0.009). Global dispersion of repolarization and cardiac alternans were similar between groups. During LAD reperfusion, TH doubled the incidence of cardiac alternans compared with CT, with a marked increase in VF/VT (100% in TH versus 17% in CT; P=0.004). Ectopy and global dispersion of repolarization were similar between groups during LAD reperfusion.Conclusions TH alters arrhythmia substrates in a porcine translational model of resuscitation from ischemic cardiac arrest during the complex phases of resuscitation. TH worsens cardiac alternans, which was associated with an increase in spontaneous VT/VF during reperfusion.