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Although timely administration of antibiotics has an established benefit in serious bacterial infection, the majority of studies evaluating antibiotic delay focus only on the first dose. Recent evidence suggests that delays in redosing may also be associated with worse clinical outcome. In light of the increasing burden of boarding in Emergency Departments (ED) and subsequent need to redose antibiotic in the ED, we examined the association between delayed second antibiotic dose administration and mortality among patients admitted from the ED with a broad array of infections and characterized risk factors associated with delayed second dose administration. We performed a retrospective cohort study of patients admitted through five EDs in a single healthcare system from 1/2018 through 12/2018. Our study included all patients, aged 18 years or older, who received two intravenous antibiotic doses within a 30-h period, with the first dose administered in the ED. Patients with end stage renal disease, cirrhosis and extremes of weight were excluded due to a lack of consensus on antibiotic dosing intervals for these populations. Delay was defined as administration of the second dose at a time-point greater than 125% of the recommended interval. The primary outcome was in-hospital mortality. A total of 5605 second antibiotic doses, occurring during 4904 visits, met study criteria. Delayed administration of the second dose occurred during 21.1% of visits. After adjustment for patient characteristics, delayed second dose administration was associated with increased odds of in-hospital mortality (OR 1.50, 95%CI 1.05–2.13). Regarding risk factors for delay, every one-hour increase in allowable compliance time was associated with a 18% decrease in odds of delay (OR 0.82 95%CI 0.75–0.88). Other risk factors for delay included ED boarding more than 4 h (OR 1.47, 95%CI 1.27–1.71) or a high acuity presentation as defined by emergency severity index (ESI) (OR 1.54, 95%CI 1.30–1.81 for ESI 1–2 versus 3–5). Delays in second antibiotic dose administration were frequent in the ED and early hospital course, and were associated with increased odds of in-hospital mortality. Several risk factors associated with delays in second dose administration, including ED boarding, were identified. [ABSTRACT FROM AUTHOR]

Background: The treatment for patients with acute myocardial infarction (AMI) was transformed by the introduction of intensive care units (ICUs), yet we know little about how contemporary hospitals use this resource-intensive setting and whether higher use is associated with better outcomes.Methods: We identified 114,136 adult hospitalizations for AMI from 307 hospitals in the 2009 to 2010 Premier database using codes from the International Classification of Diseases, Ninth Revision, Clinical Modification. Hospitals were stratified into quartiles by rates of ICU admission for AMI patients. Across quartiles, we examined in-hospital risk-standardized mortality rates and usage rates of critical care therapies for these patients.Results: Rates of ICU admission for AMI patients varied markedly among hospitals (median 48%, Q1-Q4 20%-71%, range 0%-98%), and there was no association with in-hospital risk-standardized mortality rates (6% all quartiles, P = .7). However, hospitals admitting more AMI patients to the ICU were more likely to use critical care therapies overall (mechanical ventilation [from Q1 with lowest rate of ICU use to Q4 with highest rate 13%-16%], vasopressors/inotropes [17%-21%], intra-aortic balloon pumps [4%-7%], and pulmonary artery catheters [4%-5%]; P for trend < .05 in all comparisons).Conclusions: Rates of ICU admission for patients with AMI vary substantially across hospitals and were not associated with differences in mortality, but were associated with greater use of critical care therapies. These findings suggest uncertainty about the appropriate use of this resource-intensive setting and a need to optimize ICU triage for patients who will truly benefit. [ABSTRACT FROM AUTHOR]

Abstract: Based on former research on the turbidity current, and learning lessons from the study on turbidity current,11 flume experiments has been operated with combined factors on different sediment concentration and different width. From the surveyed data turbidity current head going through the changing width section have been analyzed. Taken use of mathematical statistics method, local resistance coefficient of turbidity current head has been acquired on the changing width section. [Copyright &y& Elsevier]

Abstract: Research on chemical industry supply chain transportation risk assessment has very important significance not only for secure operation of chemical supply chain but also for protection of energy and resource, improvement of social environment. This paper reviews literatures of transportation risk assessment. On this basis, transportation assessment dual model of chemical industry supply chain is presented considering the transportation risk impaction on both inner and external chemical industry supply chain. Then corresponding transportation assessment process of chemical industry is given. [Copyright &y& Elsevier]

Objectives: This study sought to determine hospital variation in the use of positive inotropic agents in patients with heart failure. Background: Clinical guidelines recommend targeted use of positive inotropic agents in highly selected patients, but data are limited and the recommendations are not specific. Methods: We analyzed data from 376 hospitals including 189,948 hospitalizations for heart failure from 2009 through 2010. We used hierarchical logistic regression models to estimate hospital-level risk-standardized rates of inotrope use and risk-standardized in-hospital mortality rates. Results: The risk-standardized rates of inotrope use ranged across hospitals from 0.9% to 44.6% (median: 6.3%, interquartile range: 4.3% to 9.2%). We identified various hospital patterns based on the type of agents: dobutamine-predominant (29% of hospitals), dopamine-predominant (25%), milrinone-predominant (1%), mixed dobutamine and dopamine pattern (32%), and mixed pattern including all 3 agents (13%). When studying the factors associated with interhospital variation, the best model performance was with the hierarchical generalized linear models that adjusted for patient case mix and an individual hospital effect (receiver operating characteristic curves from 0.77 to 0.88). The intraclass correlation coefficients of the hierarchical generalized linear models (0.113 for any inotrope) indicated that a noteworthy proportion of the observed variation was related to an individual institutional effect. Hospital rates or patterns of use were not associated with differences in length of stay or risk-standardized mortality rates. Conclusions: We found marked differences in the use of inotropic agents for heart failure patients among a diverse group of hospitals. This variability, occurring in the context of little clinical evidence, indicates an urgent need to define the appropriate use of these medications. [Copyright &y& Elsevier]

Abstract: The dynamic mechanical properties of Fe–30Mn–3Si–4Al TWIP steel were studied using a split-Hopkinson pressure bar at room temperature with strain rates between 700 and 5000s−1. It was found that the effect of heat treatments on the dynamic mechanical properties is limited. With increasing the strain rate from 700 to 2500s−1, the strain hardening dominates the process. When the strain rate is further increased to 5000s−1, the effect of strain softening is active. The density of deformation twins increases with the strain rate, and then decreases a little with further increasing the strain rate. The deformation behavior is attributed to the opposite effects of pulse duration and impact pressure. [Copyright &y& Elsevier]

Abstract: An important biologically-relevant property of fullerenol is its ability to quench free radicals. Carbon tetrachloride (CCl4)-induced hepatotoxicity and nephrotoxicity model was used to investigate the possible mechanisms of fullerenol protection in Sprague–Dawley rats in this study. Rats were administrated with fullerenol (0, 1, 1.5 and 5mg/kgd) by intravenous or intraperitoneal injection for 3days before CCl4 challenge, 24h following the CCl4 challenge, all the rats were assessed using serum and tissue homogenates biomarkers as well as the pathological evaluation. All results showed that CCl4 caused significant increasing serum activity of alanine aminotransferase and aspartate aminotransferase, as well as the concentration of blood urea nitrogen and creatinine. Malondialdehyde level was also increased significantly, whereas the ratio of reduced glutathione to oxidized glutathione was decreased in tissue homogenates. The pathological evaluation indicated the liver and kidney were damaged by CCl4. Fullerenol-pretreatment alleviated biomarker changes as well as histological changes significantly, and fullerenol-pretreatment alone can increase the ratio of reduced glutathione to oxidized glutathione, which indicated fullerenol could protect tissues against CCl4-induced oxidative stress by improving the antioxidant ability. [Copyright &y& Elsevier]

Abstract: Mycobacterium bovis causes tuberculosis in cattle. Because current therapies inadequately prevent disease spread, new therapies for M. bovis infections are urgently needed. We treated M. bovis-infected cattle with combinations of DNA vaccines, resulting in significantly reduced pulmonary bacterial loads compared with the untreated group. Further, the pathological changes of lungs were also slight and the lesions were limited in animals treated with the combined DNA vaccines, whereas untreated animals had extensive lung fibrosis and consolidated lesions. This is the first report of DNA vaccine used to treat M. bovis. Thus, combined DNA vaccines may provide enhanced immunotherapeutic efficacy for treatment of bovine tuberculosis. [Copyright &y& Elsevier]