Consistent Reduction Research Articles

1150: OPTIMAL DOSE OF RAPID RESPONSE TEAM ENCOUNTERS FOR CLINICAL EFFECTIVENESS AND PROGRAM EFFICIENCY

Introduction: Although rapid response systems (RRS) are ubiquitous, a consistent reduction in hospital mortality has remained elusive. A minimum threshold for RRS encounters has been observed before arrest reduction can be expected. It is unclear whether this same threshold is associated with a reduction in mortality. In addition, an optimal rate of RRS encounters beyond which additional benefit is minimal has not been identified. Here we explore the relationship between RRS encounters and hospital mortality, hypothesizing that an optimal RRS encounter rate could be identified to ensure both program effectiveness and efficiency. Methods: This was a prospective, observational study performed in a 500-bed urban hospital. A standard RRS existed for several years prior to the intervention, which included transition to a mobile/proactive team and implementation of a novel educational curriculum based on principles of cognitive psychology. The main objective for this analysis was to explore the relationship between RRS patient encounter volume and Risk-Adjusted Mortality Index (RAMI). Data were collected on a quarterly basis over a 4-year period that spanned the intervention. Polynomial regression was used to model the number of RRS encounters as a predictor of RAMI, with r-squared used to quantify the strength of association and statistical significance assumed for p< 0.05 Results: An 80% reduction in non-ICU arrests, a 20% reduction in ICU arrests, and a reduction in hospital mortality were observed following the intervention. A strong nonlinear association was observed between RRS encounter volume and RAMI (r-squared=0.73, p< 0.0001). An initial reduction in RAMI with increasing RRS volume reached a horizontal asymptote at approximately 150 encounters/1000 discharges. Conclusions: We observed a substantial reduction in hospital mortality following transition to a mobile, proactive RRS trained using a novel curriculum. A steep decrease in RAMI with increasing RRS volume was observed up to approximately 150 encounters/1000 discharges, beyond which no additional improvement in RAMI was observed. These data support an “optimal dose” of RRS encounters, potentially representing a target RRS volume for hospitals for both clinical effectiveness and program efficiency.

328 IMPACT OF INTEGRATED CARE WITH ABC PATHWAY IN PATIENTS WITH ATRIAL FIBRILLATION AND HEART FAILURE: DATA FROM MORE THAN 11000 PATIENTS ENROLLED IN A EUROPEAN REGISTRY

Abstract Background and aim Heart failure (HF) is closely associated with atrial fibrillation (AF). The Atrial fibrillation Better Care (ABC) pathway is recommended in guidelines as a holistic or integrated care approach to AF management. However, few data are specifically available on ABC pathway adherence in AF patients with HF, especially according to HF phenotypes. Therefore, we aimed to retrospectively investigate the effect of ABC management in a large contemporary cohort of AF patients with HF and the impact on the clinical outcomes. Methods We analyzed patients enrolled in the ESC-EHRA EORP-AF General Long-Term Registry. According to the availability of HF status and ejection fraction (EF) values, patients were categorized as follows: i) non-HF; ii) HF EF&amp;gt;40% iii) HF EF≤40%. The primary outcome was a composite outcome of all-cause death and major adverse cardiac events. Results Among the original 11 096 AF patients enrolled, 9175 (82.7%) were included in this analysis (median age 71 years, interquartile range [IQR 63-77], 40.1% were female, with median EF 55% [IQR 45-61%] and median CHA2DS2-VASc 3 [2-4]). In this cohort, 5935 (64.7%) were non-HF patients, and 3240 (35.3%) had HF patients. According to the EF values, 2005 (65%) were categorized as HF EF&amp;gt;40%, and 1235 (35%) were HF EF≤40%. Overall, ABC pathway adherence in HF patients was 23.3% [95% CI: 21.6-25.2], being higher in HF EF≤40% patients (28.0%) and lower in HF EF&amp;gt;40% ones (21.9%). After a median follow-up of 731[IQR 690-748] days, ABC adherence was associated with a lower risk for the composite outcome compared to non-ABC adherent patients in each HF group (HF EF&amp;gt;40%: ABC 15.4% vs no ABC 20.9%; HF EF≤40%: ABC 20.3% vs no ABC 33.9%; both p&amp;lt;0.001). Cox regression analysis showed that ABC adherence was associated with a lower risk of composite outcome in each HF category (HF EF&amp;gt;40%: HR 0.66 [95% CI: 0.46-0.96], p=0.030; HF EF≤40%: HR 0.60 [95% CI: 0.40-0.90], p=0.013). ABC adherence was associated with a consistent risk reduction for the composite outcome across the entire EF spectrum [Figure]. Conclusions In this large contemporary cohort of AF-HF patients, adherence to the ABC pathway was associated with a lower occurrence of the primary outcome, irrespective of baseline EF. ABC pathway is consistently associated with a lower risk for adverse outcomes across the entire spectrum of EF.

Effect of natural and forced charge air humidity on the performance and emissions of a compression-ignition engine operating at high warm altitude

The effect of ambient humidity on the performance and pollutant emissions of internal combustion engines is not considered in the literature despite type-approval criteria are moving closer to real driving conditions. This work analyses experimentally the effects of charge air humidity at high warm altitudes, where the use of exhaust gas recirculation (EGR) is typically lowered and even avoided to recover engine performance at the expense of NOx emissions increase, on the response of a compression-ignition engine under a wide range of steady-state conditions in terms of engine-out emissions and specific fuel consumption. The impact of specific humidity variations within the atmospheric range was analysed by coupling the engine to an altitude simulator with pressure, temperature, and humidity control capabilities. High altitudes and warm & high ambient temperatures were explored (2000 m at 30 °C and 2500 m at 45 °C) to cover ambient specific humidity up to 30 gwater/kgdry_air. In addition, the effects of increasing the specific humidity above the atmospheric levels were considered at 2500 m and 45 °C to emulate forced injection of water in the engine intake line corresponding to 60 gwater/kgdry_air. With this approach, understanding of the role of humidity is provided to highlight its importance as additional ambient property in emission control. In parallel, the assessment of the forced water content increase to control NOx emissions when EGR must be lowered was performed due to the altitude impact on the engine performance and turbocharger limits. The results showed a consistent and significant reduction in engine-out NOx emissions as the ambient humidity increased, reaching up to 300% with respect to the dry case, caused by the decrease in O2 availability due to the water content increase. The benefits of high humidity in NOx emission control at high altitudes when EGR is not feasible were complemented by an improved trade-off with particulate matter emission compared to the standard from EGR use. The results evidenced a reduction in opacity close to 250% for a given engine-out NOx emission when EGR was replaced by water content. By contrast, the slowdown of the combustion process as the fresh air humidity increased deteriorated the specific fuel consumption significantly as the engine load and speed increased. Nevertheless, these penalties ranged from 2 to 2.7% in the worst conditions and showed the same sensitivity for EGR and humidity increases.

Reducing Seed Shattering in Weedy Rice by Editing SH4 and qSH1 Genes: Implications in Environmental Biosafety and Weed Control through Transgene Mitigation.

Mitigating the function of acquired transgenes in crop wild/weedy relatives can provide an ideal strategy to reduce the possible undesired environmental impacts of pollen-mediated transgene flow from genetically engineered (GE) crops. To explore a transgene mitigation system in rice, we edited the seed-shattering genes, SH4 and qSH1, using a weedy rice line ("C9") that originally had strong seed shattering. We also analyzed seed size-related traits, the total genomic transcriptomic data, and RT-qPCR expression of the SH4 or qSH1 gene-edited and SH4/qSH1 gene-edited weedy rice lines. Substantially reduced seed shattering was observed in all gene-edited weedy rice lines. The single gene-edited weedy rice lines, either the SH4 or qSH1 gene, did not show a consistent reduction in their seed size-related traits. In addition, reduced seed shattering was closely linked with the weakness and absence of abscission layers and reduced abscisic acid (ABA). Additionally, the genes closely associated with ABA biosynthesis and signaling transduction, as well as cell-wall hydrolysis, were downregulated in all gene-edited weedy rice lines. These findings facilitate our deep insights into the underlying mechanisms of reduced seed shattering in plants in the rice genus Oryza. In addition, such a mitigating technology also has practical applications for reducing the potential adverse environmental impacts caused by transgene flow and for managing the infestation of weedy rice by acquiring the mitigator from GE rice cultivars through natural gene flow.

GLP-1 Receptor Agonists for the Reduction of Atherosclerotic Cardiovascular Risk in Patients With Type 2 Diabetes

Patients with type 2 diabetes are at high risk for development of cardiovascular disease, including myocardial infarction, stroke, heart failure, and cardiovascular death. Multiple large cardiovascular outcome trials with novel glucose-lowering agents, namely SGLT2i (SGLT2 inhibitors) and GLP-1 RA (GLP-1 receptor agonists), have demonstrated robust and significant reductions of major adverse cardiovascular events and additional cardiovascular outcomes, such as hospitalizations for heart failure. This evidence has changed the landscape for treatment of patients with type 2 diabetes. Both diabetes and cardiology guidelines and professional societies have responded to this paradigm shift by including strong recommendations to use SGLT2i and/or GLP-1 RA, with evidence-based benefits to reduce cardiovascular risk in high-risk individuals with type 2 diabetes, independent of the need for additional glucose control. GLP-1 RA were initially developed as glucose-lowering drugs because activation of the GLP-1 receptor by these agents leads to a reduction in blood glucose and an improvement in postprandial glucose metabolism. By stimulating GLP-1R in hypothalamic neurons, GLP-1 RA additionally induce satiety and lead to weight loss. Data from cardiovascular outcome trials demonstrated a robust and consistent reduction in atherothrombotic events, particularly in patients with established atherosclerotic cardiovascular disease. Despite the consistent evidence of atherosclerotic cardiovascular disease benefit from these trials, the number of patients receiving these drugs remains low. This overview summarizes the experimental and clinical evidence of cardiovascular risk reduction offered by GLP-1 RA, and provides practical information on how these drugs should be implemented in the treatment of type 2 diabetes in the cardiology community.

Energetically consistent model reduction for metriplectic systems

The metriplectic formalism is useful for describing complete dynamical systems which conserve energy and produce entropy. This creates challenges for model reduction, as the elimination of high-frequency information will generally not preserve the metriplectic structure which governs long-term stability of the system. Based on proper orthogonal decomposition, a provably convergent metriplectic reduced-order model is formulated which is guaranteed to maintain the algebraic structure necessary for energy conservation and entropy formation. Numerical results on benchmark problems show that the proposed method is remarkably stable, leading to improved accuracy over long time scales at a moderate increase in cost over naive methods.

Potential of the mirid bug Engytatus nicotianae, and the parasitic wasp Tamarixia triozae for the biological control of the tomato-potato psyllid; a cage greenhouse assay

ABSTRACT The tomato-potato psyllid (TPP) Bactericera cockerelli is an important pest of several solanaceous crops. The current pest management strategy based on synthetic insecticides is being challenged through the development of pesticide resistance and environmental concerns. This contribution investigates the biological control potential of the mirid bug Engytatus nicotianae, either alone, or in combination with the parasitic wasp T. triozae, for combating the TPP on infested greenhouse tomato plants. In doing so we measured (a) the efficacy of E. nicotianae in reducing TPP numbers on lightly infested plants and (b) the potential for E. nicotianae and T. triozae in combination for effective biological control. In the E. nicotianae only treatment, the predator reduced the number of TPP-infested leaves, but the TPP population reduction was not significant. Conversely, the combined E. nicotianae + T. triozae treatment did show a consistent and significant reduction of TPP-infested leaves as well as TPP populations. These findings suggest that using a combination of the two species might deliver a biological control of TPP under glasshouse conditions. Further research is needed to determine the optimum ratio of E. nicotianae and T. triozae release-densities under different levels of TPP infestation and how this may translate from caged conditions to greenhouse performance. HIGHLIGHTS Engytatus nicotianae alone was not enough for the control of an established TPP population on tomatoes Combined releases of E. nicotianae and Tamarixia triozae markedly reduced the TPP population on caged tomatoes The study's outcome can address some gaps in the biological control of TPP on greenhouse tomatoes.

Ketogenic diet as a glycine lowering therapy in nonketotic hyperglycinemia and impact on brain glycine levels

BackgroundNonketotic hyperglycinemia (NKH) is a severe neurometabolic disorder characterized by increased glycine levels. Current glycine reduction therapy uses high doses of sodium benzoate. The ketogenic diet (KD) may represent an alternative method of glycine reduction.AimWe aimed to assess clinical and biochemical effects of two glycine reduction strategies: high dose benzoate versus KD with low dose benzoate.MethodsSix infants with NKH were first treated with high dose benzoate therapy to achieve target plasma glycine levels, and then switched to KD with low dose benzoate. They were evaluated as clinically indicated by physical examination, electroencephalogram, plasma and cerebral spinal fluid amino acid levels. Brain glycine levels were monitored by magnetic resonance spectroscopy (MRS).ResultsAverage plasma glycine levels were significantly lower with KD compared to benzoate monotherapy by on average 28%. Two infants underwent comparative assessments of brain glycine levels via serial MRS. A 30% reduction of brain glycine levels was observed in the basal ganglia and a 50% reduction in the white matter, which remained elevated above normal, and was equivalent between the KD and high dose benzoate therapies. CSF analysis obtained while participants remained on the KD showed a decrease in glycine, serine and threonine levels, reflecting their gluconeogenetic usage. Clinically, half the patients had seizure reduction on KD, otherwise the clinical impact was variable.ConclusionKD is an effective glycine reduction method in NKH, and may provide a more consistent reduction in plasma glycine levels than high-dose benzoate therapy. Both high-dose benzoate therapy and KD equally reduced but did not normalize brain glycine levels even in the setting of low-normal plasma glycine.

К вопросу о состоянии энергосбережения и повышении энергоэффективности: зарубежный и российский опыт

Elaboration of measures and patterns to increase energy efficiency appears as one of the priority objectives of the world economy and is aimed at solving environmental problems associated with energy consumption and climate changes. The paper deals with the issue of the impact of economic growth and structural changes on the energy intensity of territories. Empirical studies highlight a significant influence of macroeconomic, demographic and political factors on changes in the energy intensity of economies. Russia has significant capacity for improving energy efficiency, primarily in the electricity and housing sectors. The released fossil fuels can be exported, reduce emissions into the atmosphere, and, as a result, improve life quality. A consistent reduction in the consumption of fuel and energy resources due to the transition to a new technological order is demonstrated by electric power industry, manufacturing industry and transport sector. It is noted that for Russia the transition from raw-material economic model to innovative one is a priority for sustainable development. To overcome the causes of low energy efficiency and realize the existing potential, it is necessary to intensify the state policy both at the regional and federal levels. At the same time, saving energy and increasing energy efficiency cannot reduce energy intensity of GDP/GRP without high economic rates. The paper analyses the influence of the gross regional product structure on energy consumption in the Rostov region as well as the characteristics of the economic structure and electricity consumption of the region. It is noted that service sector and high-tech industries development, investment in environmental technologies will allow the Rostov region to move to an energy-efficient model of economic growth.

Holding Companies and Debt Financing: A Comparative Analysis Using Option-Adjusted Spreads

This work investigates and compares the total risk attributable to holding and operating companies, using data from the United States. By proxying overall risk by the option-adjusted spread on corporate bonds, we hypothesize that operating companies face a higher risk. Our data were obtained from Bloomberg and comprise 17,800 corporate bonds. Our methodology entails stratified univariate comparisons of the means of the option-adjusted spreads of sub-samples of operating companies versus holding companies. The principal bases of stratification are issue size, bond maturity, and creditworthiness proxied by the Standard and Poor ratings. With very few exceptions, our results report insignificant t-statistics, thus making us unable to reject the null hypothesis that the operating companies have the same business risk as holding companies. When bond rating, maturity, and size are controlled, there is no consistent cost reduction attributable to holding companies, and contrary to common belief, this is more visible for smaller firms. Our work suggests that there is no evidence consistently favoring holding-company financing compared to operating ones.

Janus and Hades in M-theory

Multi-parametric and analytic families of four-dimensional AdS3 × ℝ (Janus) and AdS3 × ℝ+ (Hades) solutions are constructed in the SO(8) gauged supergravity that arises from the consistent reduction of eleven-dimensional supergravity on S7 . The solutions are generically non-supersymmetric, involve non-trivial running scalars and preserve a U(1)4 symmetry. Different patterns of (super) symmetry enhancement occur upon suitable adjustment of the free parameters which further control the boundary conditions of the running scalars. We concentrate on the non-supersymmetric Janus and Hades solutions with SU(3) × U(1)2 symmetry and provide their higher-dimensional description in terms of M-theory fluxes and membranes. Special attention is paid to a class of such Hades solutions dubbed “ridge flows” which resemble dielectric rotations of Coulomb branch flows previously investigated in the literature.

Characterization of Wild Turmeric and Holy Basil Combination Herbal Extracts and Their Synergistic Effect on the Antibacterial Properties of Knitted Fabrics

ABSTRACT In this work, the characterization of combination herbal extracts of wild turmeric (WT) and holy basil (HB) and their synergistic effect on the antibacterial properties of finished single jersey knitted fabrics of cotton, lyocell and micro-denier polyester were analyzed. The main objective of this work is to find out the influence of combination herbal extract proportion, type of material and their interactive effect on the antibacterial properties. The quantitative antibacterial test (AATCC 100) results of the combination herbal extracts-treated single jersey knitted fabrics show that the 50%WT: 50%HB proportion showed consistent bacterial reduction performance against both Staphylococcus aureus and Escherichia coli bacterial strains in all the materials as supported from the test results of phytochemical screening, Minimum Inhibitory Concentration, Fractional Inhibitory Concentration index for synergy, Antioxidant, Cytotoxicity and GC-MS analysis. In terms of material, lyocell and micro-denier polyester fabrics showed good results in 12 hr and 24 hr contact time against S. aureus. Against E. coli, cotton and micro-denier polyester showed good results in 12 hr and 24 hr contact time, respectively.

Immunomodulators in Mechanically Ventilated Patients With COVID-19: Lessons Learned From Underpowered Trials.

Immunomodulators in Mechanically Ventilated Patients With COVID-19: Lessons Learned From Underpowered Trials.

Promotion of diet-induced obesity and metabolic syndromes by BID is associated with gut microbiota.

A growing body of evidence has indicated an expanding functional network of B-cell lymphoma 2 (BCL-2) family proteins beyond regulation of cell death and survival. Here, we examined the role and mechanisms of BH3 interacting-domain death agonist (BID), a pro-death BCL-2 family member, in the development of diet-induced metabolic dysfunction. Mice deficient in bid (bid-/- ) were resistant to high-fat diet (HFD)-induced obesity, hepatic steatosis, and dyslipidemia with an increased insulin sensitivity. Indirect calorimetry analysis indicated that bid deficiency increased metabolic rate and decreased respiratory exchange ratio, suggesting a larger contribution of lipids to overall energy expenditure. While expression of several genes related to lipid accumulation was only increased in wild-type livers, metabolomics analysis revealed a consistent reduction in fatty acids but an increase in certain sugars and Krebs cycle intermediates in bid-/- livers. Gut microbiota (GM) analysis indicated that HFD induced gut dysbiosis with differential patterns in wild-type and in bid-/- mice. Notably, abrogation of GM by antibiotics during HFD feeding eliminated the beneficial effects against obesity and hepatic steatosis conferred by the bid deficiency. Conclusion: These results indicate that the protective role of bid-deficiency against diet-induced metabolic dysfunction interacts with the function of GM.

The Impact of the Danish National Smoking Ban From 2007 on the Incidence of Eight Smoking-related Diseases: A Nationwide Register-based Interrupted Time Series Analysis.

Previous research has documented the effect of comprehensive smoking bans on preventing various adverse health outcomes in the years post-ban. In 2007, Denmark implemented a national smoking ban that prohibited indoor smoking in workplaces and public settings, although only partial restrictions applied in specific premises such as small bars, one-person offices, and in psychiatric units. We tested the hypothesis that the implementation of the national smoking ban was associated with a decrease in incidence of smoking-related morbidity in the Danish population compared to the pre-ban period. Interrupted time series analyses including the entire Danish population (≥30 years) was conducted. Information of hospitalizations and cause-specific mortality due to acute myocardial infarction, heart failure, hemorrhagic stroke, ischemic stroke, chronic obstructive pulmonary disease, cancer in bronchus and lung, cancer in lip, mouth, oral cavity, and pharynx, and bladder cancer were obtained from population-based registers. Poisson regression models accounting for seasonal variations and secular trends quantified immediate changes in incidence rates occurring at the time of the smoking ban as well as changes in the post-ban trend compared to pre-ban levels. Overall, we observed no consistent declines in incidence of cardiovascular diseases, chronic obstructive pulmonary disease, or the specific types of cancer in the post-ban period compared with the pre-ban period. No consistent reduction in incidence of smoking-related diseases was observed after the smoking ban was introduced in Denmark. This probably reflects that the Danish smoking ban included several exemptions, resulting in a less comprehensive ban compared to those introduced in other countries. In this study, we found that the Danish national smoking ban from 2007 did not consistently reduced the incidence of eight smoking-related outcomes in the post-ban period compared to pre-ban levels. We argue that due to the exemptions in the smoking ban, which for example allowed smoking in specific premises of the care and nursing sector, in one-person offices, and small bars, the ban was not sufficiently comprehensive to influence smoking behavior and thereof the incidence of smoking-related morbidity. Our findings highlight the importance of introducing comprehensive legislative measures to yield largest health benefits at a population level.

Immunological and virological features of combined secondary diseases in patients with HIV-based immunodeficiency

Introduction. The HIV epidemic situation in the Russian Federation remains tense. Low coverage of antiretroviral therapy (ART) contributes to the disease progression in some PLHIV. Many authors point to a high prevalence of different secondary disease combinations.Objective. Studying the structure of secondary disease combinations in inpatients and identifying features of immunological and virological indicators.Materials and methods. There was retrospective analysis of 1440 cases of HIV-infected admission in ICU SBHI «ICH № 2» DZM in 2018–2020. The number of CD4+ cells were estimated in 1185 patients, viral load (VL) is defined in 1173 patients.Statistical analysis is held, using program StatTech v. 2.6.2 (developer — LLC «Statech», Russia).Results. 18,5% of patients had 1 secondary disease, 75,9% were diagnosed a combination of 2 and more various lesions. 275 different combinations of secondary diseases are recorded: from 50 combinations of 2 secondary lesions to 4 combinations of 7 nosological units. Ме VL in patients with no secondary diseases — 13 303 copies/ml, with 1 secondary disease it increased 3,2 times (42 926) (p&lt;0,001). Similar changes are detected with 3, 5 and 6 diseases. Ме number of CD4+ lymphosytes in the absence of a secondary pathology — 223 cells/mcl. As the number of secondary diseases increases from 1 to 4, we observe consistent reduction in the number of CD4+ lymphosytes; in a combined secondary pathology Ме CD4+ cells did not exceed 100 cells; with 4 and more secondary diseases this figure did not exceed 20 cells in mcl. Correlation analysis of CD4+ cells and the number of combined secondary diseases revealed the presence of moderate connection tightness on the Chaddock scale (rxy=0,356, p&lt;0,001). The depth of immunodeficiency also affects the outcome of the disease: (M±SD) CD4+ cells in the group of the dead were 101±153 (95% DI: 91–112), in the group of survivors — 198±226 (95% DI:172–224; p&lt;0,001).Conclusion. Combined secondary disease among patients of ICU infectious hospital were diagnosed in 75.9% patients. There were differences by VL level which increased with the growth of combined lesion number; more significant correlation was found between the amount of CD4+ cells and the number of secondary diseases. The obtained results are confirmed by reduced likelihood of a favorable outcome of the disease with increasing number of combined secondary diseases.

Abstract 12361: Efficacy and Safety of NOACs vs. Warfarin Across the Continuous Range of Body Mass Index and Body Weight: Insights From COMBINE-AF

Introduction: The efficacy and safety of non-vitamin K oral anticoagulants (NOACs) in patients with atrial fibrillation (AF) at the extremes of body mass index (BMI) and body weight (BW) remains uncertain, leading to concerns regarding use in these populations across clinical practice guidelines. Methods: This analysis of the COMBINE-AF database pools individual patient-level data from the 4 pivotal RCTs of NOAC vs. warfarin in AF: RE-LY, ROCKET-AF, ARISTOTLE, and ENGAGE AF-TIMI 48. Pts randomized to low-dose NOACs not globally approved for clinical use were excluded. The primary efficacy and safety outcome was stroke/systemic embolic event (S/SEE) and major bleeding, respectively, with intracranial hemorrhage (ICH) being a secondary outcome. Outcomes were assessed across BMI and BW using a Cox model stratified by trial, with interaction testing for NOAC vs. warfarin. Restricted cubic splines were used to display the hazard ratio of NOAC vs. warfarin for each outcome across BMI. Results: For 58,464 pts, the median BMI was 28 (25 th -75 th %ile: 25-32) kg/m 2 , with the top 5% (n=2,924) having a BMI ≥ 40 kg/m 2 . For patients randomized to warfarin, the risk of each outcome was lower with increasing BMI (HR per 5 kg/m 2 increase: S/SEE 0.79 [95% CI 0.75-0.84]; major bleeding 0.91 [95% CI 0.87-0.95]; ICH 0.72 [95% CI 0.66-0.80]; p&lt;0.01 for each). There was no significant treatment interaction for NOAC vs. warfarin by BMI for S/SEE (p-interaction = 0.71; Fig 1A ), major bleeding (p-interaction = 0.15; Fig 1B ), or ICH (p-interaction = 0.84; Fig 1C ), such that there was consistent reduction in S/SEE and ICH ( Fig 1A and 1C, respectively ) across the range of BMI with NOAC vs. warfarin. Similar results were seen for each outcome when assessed by BW (median [25 th -75 th %ile]: 81 [70-94] kg; 5 th -95 th %ile: 55-119 kg). Conclusions: In this pooled analysis of the pivotal AF trials, use of NOAC was associated with a consistent reduction in S/SEE and ICH compared with warfarin across the range of BMI and BW.

Pharmacist Involvement in Sepsis Response and Time to Antibiotics: A Systematic Review.

Sepsis is a life-threatening medical emergency and a leading cause of morbidity and mortality worldwide. Reductions in time to antibiotics in patients presenting with sepsis or septic shock are associated with reduced mortality, and Surviving Sepsis Campaign guidelines recommend antibiotics within one hour of recognition. Pharmacists are well-equipped to help navigate the therapeutic and operational challenges associated with achieving this goal. To assess the association of pharmacist involvement in sepsis response with time to antibiotics in hospitalized patients with sepsis and septic shock. A systematic review of the following databases was conducted: PubMed/MEDLINE, Embase, Cumulative Index to Nursing and Allied Health Literature (CINAHL), and Web of Science. Studies must have included a designated role of an individual pharmacist in the management of sepsis or septic shock and not be considered an operational change. The primary outcome of interest was time to antibiotic administration, with secondary outcomes including intensive care unit (ICU) and hospital length of stay as well as in-hospital mortality. We identified 10 studies including 1772 patients with sepsis or septic shock that evaluated a sepsis response in which a pharmacist was included. Studies included patients in the ICU, emergency department, and hospital ward setting. Seven studies demonstrated a significant reduction in time to antibiotics, with two other studies supporting this conclusion in extrapolation or sensitivity analysis. There was not a consistent reduction in ICU or hospital length of stay nor in-hospital mortality between those interventions involving a pharmacist compared with their defined control groups. Pharmacist involvement in sepsis response, often as part of a multi-professional team-based approach to sepsis care, is associated with a reduced time to antibiotic administration for hospitalized patients with sepsis or septic shock.

Procedure for selecting a rational technological mode for the processing of cast iron melt on the basis of graph-analytical processing of the data of serial smeltings

The object of research: cast iron grade DSTU EN 1561 (EN-GJL-200), used for the manufacture of body parts for mechanical engineering.&#x0D; Investigated problem: the choice of the technological mode of the process of producing cast iron under conditions of multifactorial influence on the formation of its microstructure.&#x0D; The main scientific results: A procedure for truncation of the influencing factors on the formation of the microstructure is proposed, which is a consistent reduction of data from serial smeltings to uniform conditions allowed by the actual data set. Common conditions mean the closeness of the chemical composition of the melt, which makes it possible to compare the effectiveness of the applied modifiers in combination with microalloying in terms of cast iron microstructure indicators. The proposed data truncation procedure made it possible, by creating conditions for comparing the efficiency of FeSi75 and FeSi65CaBaSr2 modifiers, to develop a rational technological regime for melt processing.&#x0D; It has been established that the compared modifiers have the same effect on the size of graphite – its content is (50–51) μm, however, the use of FeSi65CaBaSr2 in combination with an alloying complex (0.27 %Cr+0.083 %Ni+0.048 %Ti+0.155 %Cu+0.018 %V ) makes it possible to obtain an average amount of pearlite of 96 % in the microstructure.&#x0D; The area of practical use of the results of the study: the results obtained can be used in foundries or metallurgical shops of industrial enterprises as part of a general technology for producing cast iron of various grades, developed for cases of incomplete control of the quality of charge materials. Such a situation occurs, for example, when the charge is formed from dismantled armored vehicles that cannot be restored due to destruction on the battlefield.&#x0D; Innovative technological product: iron smelting technology that allows the possibility of minimizing the cost of smelting in terms of the use of modifiers and alloying ferroalloys&#x0D; The scope of the technological innovative product: technological regimes for the production of cast iron.

Simulating Aerosol Lifecycle Impacts on the Subtropical Stratocumulus‐to‐Cumulus Transition Using Large‐Eddy Simulations

AbstractObserved stratocumulus to cumulus transitions (SCTs) and their sensitivity to aerosols are studied using a large‐eddy simulation (LES) model that simulates the aerosol lifecycle, including aerosol sources and sinks. To initialize, force, and evaluate the LES, we used a combination of reanalysis, satellite, and aircraft data from the 2015 Cloud System Evolution in the Trades field campaign over the Northeast Pacific. The simulations follow two Lagrangian trajectories from initially overcast stratocumulus (Sc) to the tropical shallow cumulus region near Hawaii. The first trajectory is characterized by an initially clean, well‐mixed Sc‐topped marine boundary layer (MBL), then continuous MBL deepening and precipitation onset followed by a clear SCT and a consistent reduction of aerosols that ultimately leads to an ultra‐clean layer in the upper MBL. The second trajectory is characterized by an initially polluted and decoupled MBL, weak precipitation, and a late SCT. Overall, the LES simulates the observed general MBL features. Sensitivity studies with different aerosol initial and boundary conditions reveal aerosol‐induced changes in the transition, and albedo changes are decomposed into the Twomey effect and adjustments of cloud liquid water path and cloud fraction. Impacts on precipitation play a key role in the sensitivity to aerosols: for the first case, runs with enhanced aerosols exhibit distinct changes in microphysics and macrophysics such as enhanced cloud droplet number concentration, reduced precipitation, and delayed SCT. Cloud adjustments are dominant in this case. For the second case, enhancing aerosols does not affect cloud macrophysical properties significantly, and the Twomey effect dominates.