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Peptic ulcer recurrent bleeding occurs in 20% to 30% of patients after standard endoscopic hemostasis, particularly within 4 days after the procedure. The application of additional tranexamic acid (TXA) to the ulcer may enhance hemostasis. This study investigated the effectiveness of TXA powder application on bleeding ulcers during endoscopic hemostasis. This study enrolled patients who had peptic ulcer bleeding between March 2022 and February 2023. After undergoing standard endoscopic therapy, the patients were randomly assigned to either the TXA group or the standard group. In the TXA group, an additional 1.25 g of TXA powder was sprayed endoscopically on the ulcer. Both groups then received 3 days of high-dose (8 mg/h) continuous infusion proton pump inhibitor therapy. Second-look endoscopy was conducted on days 3 to 4. The primary end point of early treatment failure was defined as ulcer recurrent bleeding within 4 days or major stigmata of recent hemorrhage on the second-look endoscopy. Sixty patients (30 in each group) with peptic ulcer bleeding and balanced baseline characteristics were randomly assigned to a treatment group. The early treatment failure rate was lower in the TXA group (6.7%) than in the standard group (30%) (P =.042). The freedom from treatment failure periods for 4 and 28 days was significantly longer in the TXA group than in the standard group (P =.023). No adverse events from TXA were recorded. The precise delivery of topical TXA alongside standard endoscopic hemostasis reduced the early treatment failure rate in patients with bleeding peptic ulcers. (Clinical trial registration number: NCT05248321.) [Display omitted] [ABSTRACT FROM AUTHOR]

Although a prolonged heart rate-corrected QT interval (QTcI) is associated with an increased risk of mortality in the general population, its prognostic value in surgical patients remains unclear. We aimed to examine whether preoperative QTcI prolongation predicts short-term postoperative outcomes in elderly patients undergoing noncardiac surgery. The study was a retrospective analysis using the TriNetX network database. Operating room. Assessment and categorization of preoperative QTcI. Data of patients aged ≥65 years who underwent non-cardiac surgery between 2010 and 2023 were analyzed. Patients were categorized into four groups based on preoperative QTcI: long (500-600 ms), borderline (460-500 ms), high-normal (420-460 ms) and control (370-420 ms) groups. The groups were compared using a propensity score-matched analysis. The primary outcome was the all-cause 90-day mortality risk. The secondary outcomes included 90-day risks of postoperative new-onset atrial fibrillation (Af), ventricular arrhythmias (VAs), emergency visits, hospital readmissions, and pneumonia. In total, data on 519,929 patients were collected in this study. Pairwise comparisons showed that all QTcI prolongation groups demonstrated a heightened incidence of postoperative mortality, arrhythmias, and other complications compared to the control group. Patients with a long QTcI had a 3-fold higher risk of mortality (hazard ratio [HR] = 3.124, p < 0.001), Af (HR = 3.059, p < 0.001), and VAs (HR = 3.617, p < 0.001) than controls. The risks of emergency visits (HR = 1.287, p < 0.001), hospital readmissions (HR = 1.591, p < 0.001), and pneumonia (HR = 1.672, p < 0.001) were also higher in the long QTcI group than in the control group. A dose-dependent response was evident between QTcI and mortality as well as arrhythmia risk. Preoperative QTcI screening effectively risk-stratifies elderly surgical patients, with a QTcI≥500 ms being strongly predictive of short-term postoperative mortality and other complications. Incorporating QTcI assessment into the preoperative evaluation may guide perioperative monitoring and management. • QTcI prolongation is linked to increased 3-month mortality and complications. • Preoperative longer QTcI tripled the 90-day mortality risk after surgery. • The risks increased with QTcI, showing a dose-dependent effect. • Even "high-normal" QTcI slightly increased the risks of post-operative complications. • QTcI was an independent risk indicator. [ABSTRACT FROM AUTHOR]

Paclitaxel-coated balloons are used to reduce neointimal hyperplasia in native arteriovenous (AV) fistulas. However, no study specifically evaluated their effect on venous anastomotic stenosis of dialysis grafts. We aimed to compare the efficacy of angioplasty with drug-coated balloons (DCBs) and angioplasty with conventional balloons (CBs) for venous anastomotic stenosis in dysfunctional AV grafts. In this investigator-initiated, single-center, single-blinded, prospective randomized controlled trial, we randomly assigned 44 patients who had venous anastomotic stenosis to undergo angioplasty with DCBs (n = 22) or CBs (n = 22) from July 2015 to August 2018. Access function was observed per the hemodialysis center's protocols; ancillary angiographic follow-up was performed every 2 months for 1 year after the interventions. The primary end point was target lesion primary patency at 6 months. Secondary outcomes included anatomic and clinical success after angioplasty, circuit primary patency at 6 months and 1 year, and target lesion primary patency at 1 year. At 6 months, target lesion primary patency in the DCB group was significantly greater than that in the CB group (41% vs 9%; hazard ratio [HR], 0.393; 95% confidence interval [CI], 0.194-0.795; P =.006), as was the primary patency of the entire access circuit (36% vs 9%; HR, 0.436; 95% CI, 0.218-0.870; P =.013). At 1 year, the target lesion primary patency in the DCB group remained greater than that in the CB group (23% vs 9%; HR, 0.477; 95% CI, 0.243-0.933; P =.019) but not the primary patency of the access circuit (14% vs 9%; HR, 0.552; 95% CI, 0.288-1.059; P =.056). No difference in anatomic or clinical success was observed; no major complications were noted. Angioplasty with DCBs showed a modest improvement in primary patency of venous anastomotic stenosis and all dialysis AV grafts at 6 months. The short-term benefit was not durable to 1 year, and reinterventions were eventually needed. [ABSTRACT FROM AUTHOR]

The impact of changing emission inventory scenarios is assessed based on combinations of point, mobile, area-road and biogenic sources, on the tropospheric ozone concentration in two southeast Texas urban areas, during the rapid ozone formation event (ROFE) on August 25, 2000. The results revealed that removing Texas point source volatile organic compounds (VOC) emission gives the greatest reduction in Peak O3 concentration (128 ppbv) in the Houston area.

The spatial and diurnal emission characteristics of the gridded emission inventories are assessed and compared with those of the National Emission Trend 1996 (NET96). It was found that National Emission Inventory 1999 (NEI99) data exhibit greater emissions with respect to point and mobile sources but smaller emissions with respect to area sources when compared to the corresponding gridded NET96 data in the same study domain.

• Antimicrobial resistance (AMR) has become a global crisis of growing proportions. • DNA polymerase IIIC (pol IIIC) is an unexploited target for low G + C Gram+ bacteria. • ACX-362E is the first pol IIIC inhibitor antimicrobial agent advanced to the clinic. • Pol IIIC inhibitors should not share cross-resistance with existing antibacterials. Despite the growing global crisis caused by antimicrobial drug resistance among pathogenic bacteria, the number of new antibiotics, especially new chemical class of antibiotics under development is insufficient to tackle the problem. Our review focuses on an emerging class of antibacterial therapeutic agents that holds a completely novel mechanism of action, namely, inhibition of bacterial DNA polymerase IIIC. The recent entry of this new class into human trials may herald the introduction of novel drugs whose novel molecular target precludes cross-resistance with existing antibiotic classes. This review therefore examines the evolution of DNA pol IIIC inhibitors from the discovery of 6-(p -hydroxyphenylazo)uracil (HPUra) in the 1960s to the development of current first-in-class N 7-substituted guanine drug candidate ACX-362E, now under clinical development for the treatment of Clostridioides difficile infection. [ABSTRACT FROM AUTHOR]

The ever-growing interest in performance-based wind engineering has created a need for assessment frameworks that can efficiently deal with inelasticity. The computationally efficient strain-driven dynamic shakedown approach has provided a solution that is not only capable of identifying failure mechanisms that are potentially critical during extreme winds, e.g., low cycle fatigue and ratcheting, but also allows direct estimation of inelastic deformations. This approach, however, can only solve problems at dynamic shakedown, i.e., with limited nonlinearity, and is not capable of providing response time histories. To address these limitations, this paper presents an efficient framework for reliability assessment of inelastic structures at dynamic shakedown and beyond. To this end, a novel step-by-step integration algorithm is developed for rapid response time history analysis within the setting of dynamic shakedown. The method is based on advancing fast nonlinear analysis through introducing schemes for enabling at each time step the adaptive selection of the step size, number of modes to be included, and number of potentially nonlinear elements. Inelasticity is modeled as distributed at the level of the stress resultants through a return mapping scheme based on the Haar–Kàrmàn principle, therefore enabling the integrated estimation of the state of dynamic shakedown. The scheme is seen to preserve the efficiency of recently developed strain-driven dynamic shakedown algorithms while providing a full range of response time histories at and beyond the state of dynamic shakedown. To enable reliability analysis, the scheme is embedded in a general uncertainty propagation framework. • A reliability assessment framework for inelastic wind-excited structures is presented. • A dynamic integration scheme is proposed for shakedown and time history analysis. • Uncertainty propagation is enabled through advanced stochastic simulation. • A full-scale archetype is used to illustrate the practicality of the framework. • The potential of the framework for performance-based wind design is shown. [ABSTRACT FROM AUTHOR]

Highlights • An efficient model for the inelastic analysis of wind-excited systems is presented. • The framework is based on a fully stochastic description of the wind loads. • The approach is centered on probabilistic dynamic shakedown theory. • Inelastic collapse probability is integrated with modern performance-based design. • A case study is presented demonstrating the potential of the proposed framework. Abstract The modeling and estimation of the inelastic response of wind excited structures is attracting growing interest with the introduction of performance-based wind engineering. While frameworks based on direct integration have been widely adopted in earthquake engineering for estimating inelastic responses, the significantly longer duration of typical windstorms, as compared to seismic events, makes this approach extremely computationally challenging in the case of wind excited systems. This is especially true in the case of modern performance-based wind engineering frameworks, which are based on probabilistic metrics estimated through simulation and therefore repeated evaluation of the system. This paper addresses this challenge through the development of a simulation framework based on dynamic shakedown theory. In particular, an efficient path-following algorithm is proposed for estimating not only the shakedown multipliers, but also the plastic strains and deformations associated with occurrence of the state of shakedown. The efficiency with which this information can be estimated for any given wind load time history enables the development of a simulation-based framework, driven by general stochastic wind load models, for the estimation of the system-level inelastic performance of the structure. The validity and practicality of the proposed framework is illustrated on a large-scale case study. [ABSTRACT FROM AUTHOR]

We investigated 401 geriatric patients and 453 middle-aged patients with health care–associated bloodstream infection (HABSI) at a medical center during January-December 2014. Compared with middle-aged patients, the geriatric group had higher 30-day mortality (31.2% vs 23.4%, P  = .01). Body mass index, serum albumin concentration, Charlson comorbidity index score, vancomycin-resistant Enterococcus bacteremia, and high C-reactive protein levels predict poor outcomes for HABSI among adult patients. [ABSTRACT FROM AUTHOR]

Current prescriptive design provisions are moving towards performance-based design approaches in which system-level probabilistic measures are used to explicitly describe performance. While earthquake engineering has embraced these changes over the last few decades, the same cannot be said for wind engineering where design provisions have remained predominantly prescriptive. The significant wind related economic losses incurred each year around the world has spurred strong interest in developing general performance-based wind engineering frameworks. To this end, this paper presents a simulation-based framework for multistory wind excited buildings that rigorously integrates system-level estimates of both collapse and non-collapse losses. In particular, it is proposed to use the theory of dynamic shakedown as an efficient means for describing the collapse probability of the main wind force resisting system. The practicality and potential of the proposed framework is illustrated on a full scale case study. [ABSTRACT FROM AUTHOR]

As an effective and in situ purification strategy, adsorption technology has drawn much attention and recently the utilization of biomass substrate has been regarded as a promising way to enhance the adsorption performance and reduce cost. In this study, chitosan was applied as matrix and the magnetic Fe-crosslinked chitosan (CS-Fe@Fe3O4) composite was obtained through a chelation procedure with cheap and environmentally friendly chitosan and iron salts. Then, the resultant CS-Fe@Fe3O4 composites were characterized by scanning electron microscopy, transmission electron microscopy, Fourier-transform infrared spectroscopy, X-ray photoelectron spectroscopy, X-ray diffraction, and thermogravimetric analysis. The sorption and desorption of methyl orange (MO), a common type of azo dye, on CS-Fe@Fe3O4 composite was systematically studied to understand its availability for dyeing wastewater. The results revealed that CS-Fe@Fe3O4 composites could efficiently remove MO in a wide pH range. The mixed Fe3O4 particles were physically mixed andalmost had no negative effect on its adsorption. Moreover, the dye adsorption process was found to be controlled by the pseudo-second-order rate model and the adsorption isotherm behavior could be described by the Langmuir model. The repeatability test showed that the CS-Fe@Fe3O4 composites could retain its high efficiency after desorption and regeneration. In summary, the results presented herein indicated that the resultant CS-Fe@Fe3O4 nanocomposite with high adsorption efficiency and strong magnetic property could serve as a potential adsorbent for remediating industrial dyeing wastewater. [ABSTRACT FROM AUTHOR]

Heterogeneous catalysts overcome the drawbacks of the homogeneous Fenton process, and have attracted considerable attention for degradation of organic pollutants in wastewater. In this study, a heterogeneous Fenton catalyst system was developed for the degradation of cationic dye by incorporating ferric oxide nanoparticles into modified diatomite composite. The catalyst was synthesized through two simple steps: firstly, the raw diatomite was modified by soaking into nitric acid; then, through forced hydrolysis strategy, the ferric oxide nanoparticles were incorporated into the pre-treated diatomite. The resultant catalyst were characterized by X-ray diffraction, scanning electron microscopy, and energy dispersive X-ray spectroscopy. This novel diatomite Fe2 O3 catalyst demonstrated distinct catalytic activity and desirable efficiency for degradation of organic dye. Methylene Blue (MB) was completely decomposed within 20 min, and the decomposition efficiency was remained higher than 90% after 5 cycles of catalyst regeneration. The simplicity and low cost of the demonstrated catalytic material is promising for the efficient degradation of organic pollutants. [ABSTRACT FROM AUTHOR]

Despite the important policy and welfare implications of China's energy issues, to date there has been little investigation from a micro-level perspective of the misallocation of resources in manufacturing enterprises. To fill this gap, this paper deals with resource misallocations in China with special reference to energy and labor inputs. Using a large, novel dataset of manufacturing enterprises from Zhejiang province, we employ a simultaneous system of equations for (gross) industrial output value, wage bill, energy expenditure and carbon emissions. The explanatory variables include labor, educational attainment of employees, capital value, materials, and a list of energy-related variables. Our results show that, for the same energy content, non-coal energy inputs are more productive than coal and coal-related fuels. Non-coal energy is more environmentally friendly but more expensive than coal-related fuels. Using the model estimates, we conduct Wald tests on whether the marginal productivity of labor and energy significantly differ from their respective factor costs. The main findings are that there is substantial resource misallocation in manufacturing enterprises, with labor being underpaid and energy overpaid, on average, in comparison to their marginal productivity. For energy misallocation, however, the pattern varies considerably among the various subsectors. Specifically, energy is over-used in sectors such as Textile , Paper , Chemical , Plastics , Non-metallic , Ferrous metals and Non-ferrous metal . By contrast, energy is under-used in sectors such as Beverages , Textile-wearing apparel , Leather , Metal , Transport equipment , Electrical machinery and Communication equipment . These findings can assist decision-makers in targeting the sectors where there is the most misallocation, identifying which input factors are inappropriately used, improving economic efficiency and lowering overall production costs by reducing allocative inefficiency. [ABSTRACT FROM AUTHOR]

Objectives Methicillin-resistant Staphylococcus aureus (MRSA) isolates with an elevated vancomycin MIC ≥2 mg/L have been increasingly identified in many countries. We aimed to develop a clinical score to predict vancomycin MIC ≥2 mg/L in patients with community-onset MRSA bacteraemia. Methods This retrospective cohort study enrolled 394 patients with MRSA bacteraemia. Vancomycin MICs of all MRSA isolates were determined by agar dilution method. Clinical characteristics between patients with high (≥2 mg/L) and low (≤1 mg/L) vancomycin MIC MRSA bacteraemia were compared. Independent predictors of high vancomycin MIC isolate infection were identified and used to create a score-based predictive model. Results Among the 394 study patients, 56 (14.2%) had MRSA isolates with a vancomycin MIC ≥2 mg/L. The final regression model included 6 independent predictors: chronic liver disease (adjusted odds ratio [aOR], 2.99; 95% confidence interval [CI], 1.39-6.42), prior recovery of MRSA from respiratory tract specimen (aOR, 2.54; 95% CI, 1.15-5.61), end-stage renal disease (aOR, 2.53; 95% CI, 1.33-4.78), severe sepsis or septic shock on presentation (aOR, 2.39; 95% CI, 1.28-4.44), prior vancomycin exposure (aOR, 2.21; 95% CI, 1.13-4.30), and recent hospitalization within 3 months (aOR, 2.11; 95% CI; 1.01-4.40). All independent predictors had a value of one point. Youden's index statistics indicated a score of ≥3 as best cutoff value that had a sensitivity of 69.6% and specificity of 78.4%. Conclusions Simple decision rule helps clinicians stratify the risk of high vancomycin MIC MRSA infection when deciding empirical therapy for patients with community-onset infections. [ABSTRACT FROM AUTHOR]

Background: Medical students served as covert observers of hand hygiene (HH) compliance by health care workers (HCWs) during a recent 1-year study at a teaching hospital in Taiwan. This report describes the students' experience and their views of the major factors that led to good or poor compliance. Methods: Nine upper class medical students received a basic course in HH and attended a workshop using World Health Organization standard training materials. A standardized observation tool was used to collect data on HH performance by the HCWs. On completion of the study, structured face-to-face interviews were conducted to assess the students' experiences. Results: The medical students observed a total of 17,742 HH opportunities during the study period. Eight of the 9 students participated in the poststudy interviews. Overall, the students believed that they had gained considerable knowledge of the attitudes regarding HH compliance by nurses, physicians, and surgeons according to each of the 5 HH indications. Based on their experience, they recommended that compliance could be improved by ensuring an adequate supply of HH products and by promoting role modeling in the ward, reminding, education in small groups, and objective structured clinical examinations. Conclusions: The opportunity for medical students to serve as covert observers broadened their knowledge of how infections are transmitted in hospitals and of the barriers that must be overcome to improve HCWs' HH compliance. [Copyright &y& Elsevier]