Utilization Rate Research Articles

Patterns of Acute Ischemic Stroke Treatment from 2010 to 2020: An Evolving Landscape in Stroke Management Following Thrombectomy Trials.

Population-based studies on stroke can help guide the care of patients with acute ischemic stroke (AIS) by providing health care communities with information regarding the current usage of stroke treatments. It remains unclear how rapidly new techniques, particularly endovascular stroke treatment (EST), are being adopted and whether there is any disparity in their availability. Although studies using the National Inpatient Sample (NIS) have been conducted, updated studies over a longer period may provide further insights. This study aimed to understand patterns of AIS treatment, discharge disposition, in-hospital mortality, and mean length of stay (LOS) for each modality from 2010 to 2020 using the NIS database. This retrospective longitudinal study was conducted using NIS data from 2010 to 2020. Patients were categorized into groups based on whether they received intravenous recombinant tissue plasminogen activator (rt-PA), EST, both rt-PA and EST (combined therapy), or supportive care alone. Demographic, socioeconomic, regional, insurance, and hospital data were also obtained. The primary outcome was the proportion of patients receiving each modality, whereas the secondary outcomes were in-hospital mortality, mean LOS, and discharge disposition. The usage rates increased (p < 0.001) in all groups between 2010 and 2020 (rt-PA: 5.09% to 8.39%, EST: 0.31% to 4.40%, and rt-PA+EST: 0.46% to 1.09%). The highest increase in usage was observed for EST, with a thirteen-fold increase. Mortality decreased from 2010 to 2020 in all groups (rt-PA: 8.45% to 3.54%, EST: 25.22% to 12.50%, and rt-PA+EST: 21.12% in 2010 to 9.30%) (p < 0.001). Combination therapy demonstrated the greatest improvement, with an 11.2% reduction in absolute mortality. Mean LOS was reduced for patients who received rt-PA (6.8 to 4.8 days), EST (9.3 to 8.9 days), and combined therapy (10.0 to 8.3 days) (p < 0.001) over the study period. The proportion of patients discharged to home increased for rt-PA (29.01% to 41.85%), EST (14.13% to 17.70%), and combined therapy (12.89% to 24.29%) (p < 0.001). Overall, stroke treatment usage was higher among the higher income groups, regardless of race. Higher usage was also observed for Whites in the West and Hispanic ethnicities in the South and West. Regardless of income or treatment method, utilization rates were lower for Black patients. Utilization rates were lower for Black patients with Medicare, Medicaid, or self-pay than for White patients. Our study demonstrated that endovascular stroke treatment continues to expand, leading to better outcomes for mortality, LOS, and home discharge. Despite these positive patterns, there are visible inequities across regions, income status, and races.

Quantitative study on fatigue characteristics of warm mix recycled asphalt

The warm mix recycling technology of asphalt pavement can improve the utilization rate of solid waste in highway construction industry on a large scale, and reduce the emission of harmful gases ( NOX, CO2, benzopyrene, etc.) in the process of road construction. It is one of the effective ways to realize carbon neutrality in highway construction industry. The main purpose of this study is to systematically analyze the fatigue characteristics of warm mix recycled asphalt (WMRA) from the perspective of quantitative research, and to provide scientific basis for the popularization and application of this technology. Therefore, this study mainly evaluated the anti-fatigue characteristics of WMRA under different conditions based on the linear amplitude sweeping test ( LAS test). Based on the calculation and analysis of the commonly used fatigue judgment indexes ( stress-strain curve, phase angle-strain curve, S×N curve ( S is the ratio of the instantaneous modulus to the initial modulus of the material, which is often replaced by the virtual modulus in the LAS test, and N is the number of cyclic loadings.), virtual strain storage energy-strain curve), the peak strain of virtual strain storage energy is recommended as the fatigue judgment standard from the perspective of reliability and accuracy, and the peak strain of damage factor is proposed as one of the new fatigue judgment standards. In this paper, the nucleation of microcracks and the coalescence of microcracks are distinguished in the process of fatigue damage evolution, and the peak strain of virtual strain energy storage and the peak strain of damage factor are used as the judging indexes respectively. Finally, based on the theory of continuum damage mechanics, the loss modulus of WMRA is selected as the representative value of material properties to calculate the virtual modulus and damage factor, and the fatigue damage evolution model of WMRA based on the viscoelastic continuum damage model ( VECD model) was constructed. Based on this model, the anti-fatigue characteristics of WMRA with the reclaimed asphalt pavement ( RAP) content were analyzed.

Trends and outcomes in the surgical management of young adults with knee osteoarthritis using high tibial osteotomy and unicompartmental knee arthroplasty.

A significant portion of knee osteoarthritis is diagnosed in patients under the age of 55, where greater activity demands make total knee arthroplasty less desirable. High tibial osteotomy (HTO) and unicompartmental knee arthroplasty (UKA) are useful alternatives, but there is little understanding of which procedure is advantageous. Hence, this study examines the utilization, complication, and reoperation rates among the HTO vs. UKA in young patients with primary osteoarthritis. A retrospective review of the National Surgical Quality Improvement Program was performed to identify 2318 patients < 55years of age who received either a HTO or UKA for primary osteoarthritis between 2011 and 2021. Bivariate analyses compared preoperative and intraoperative characteristics among each procedure. Then, multivariate analyses examined if either procedure was associated with worse 30-day postoperative complications or need for reoperation, independent of the statistically significant pre- and intraoperative disparities. UKAs were performed 14.2 times more commonly than HTOs, and the patients selected for HTO were more likely to be younger, have a lower BMI, have the healthiest ASA Class score, and less likely to have hypertension requiring medication (p < 0.001). HTOs took 17.5% longer to perform and had a longer average length of stay (p < 0.001), while UKAs were more likely to be performed out-patient (p < 0.001). HTOs also had higher rates of serious complications (p = 0.02), overall complications (p = 0.004), and need for reoperation (p = 0.004). Multivariate modelling demonstrated that procedure type was not a predictor of serious complications, but the use of HTO was significantly associated with any complications (odds ratio = 3.63, p = 0.001) and need for reoperation (3.21, p = 0.029). Although healthier patients were selected for HTOs, UKAs were found to have a lower risk of complications and immediate reoperation. Additionally, UKAs had the advantage of lower operative burden, shorter length of stay, and a higher efficacy in outpatient settings.

Early Diagnosis and Treatment of COPD and Asthma - A Randomized, Controlled Trial.

Many persons with chronic obstructive pulmonary disease (COPD) or asthma have not received a diagnosis, so their respiratory symptoms remain largely untreated. We used a case-finding method to identify adults in the community with respiratory symptoms without diagnosed lung disease. Participants who were found to have undiagnosed COPD or asthma on spirometry were enrolled in a multicenter, randomized, controlled trial to determine whether early diagnosis and treatment reduces health care utilization for respiratory illness and improves health outcomes. Participants were assigned to receive the intervention (evaluation by a pulmonologist and an asthma-COPD educator who were instructed to initiate guideline-based care) or usual care by their primary care practitioner. The primary outcome was the annualized rate of participant-initiated health care utilization for respiratory illness. Secondary outcomes included changes from baseline to 1 year in disease-specific quality of life, as assessed with the St. George Respiratory Questionnaire (SGRQ; scores range from 0 to 100, with lower scores indicating better health status); symptom burden, as assessed with the COPD Assessment Test (CAT; scores range from 0 to 40, with lower scores indicating better health status); and forced expiratory volume in 1 second (FEV1). Of 38,353 persons interviewed, 595 were found to have undiagnosed COPD or asthma and 508 underwent randomization: 253 were assigned to the intervention group and 255 to the usual-care group. The annualized rate of a primary-outcome event was lower in the intervention group than in the usual-care group (0.53 vs. 1.12 events per person-year; incidence rate ratio, 0.48; 95% confidence interval [CI], 0.36 to 0.63; P<0.001). At 12 months, the SGRQ score was lower than the baseline score by 10.2 points in the intervention group and by 6.8 points in the usual-care group (difference, -3.5 points; 95% CI, -6.0 to -0.9), and the CAT score was lower than the baseline score by 3.8 points and 2.6 points, respectively (difference, -1.3 points; 95% CI, -2.4 to -0.1). The FEV1 increased by 119 ml in the intervention group and by 22 ml in the usual-care group (difference, 94 ml; 95% CI, 50 to 138). The incidence of adverse events was similar in the trial groups. In this trial in which a strategy was used to identify adults in the community with undiagnosed asthma or COPD, those who received pulmonologist-directed treatment had less subsequent health care utilization for respiratory illness than those who received usual care. (Funded by Canadian Institutes of Health Research; UCAP ClinicalTrials.gov number, NCT03148210.).

Immediate and delayed placement of the intrauterine device after abortion: a systematic review and meta-analysis.

This article aims to report the comprehensive and up-to-date analysis and evidence of the insertion rate, expulsion rate, removal rate, and utilization rate of immediate placement of intrauterine devices (IUDs) versus delayed placement after artificial abortion. PubMed, Embase, Cochrane, Web of Science, CNKI, and Wanfang databases were comprehensively searched up to January 12, 2024 for studies that compared immediate versus delayed insertion of IUDs after abortion. The evaluation metrics included the number of IUD insertion after surgical or medical abortions, the frequency of expulsion and removal at 6 months or 1 year, the number of continued usage, pain intensity scores, the number of infections, the duration of bleeding, and instances of uterine perforation during or after IUD insertion. Ten randomized controlled articles were eligible, comprising 11 research projects, of which 3 projects involved the placement of an IUD after surgical abortion, and 8 projects involved the placement of an IUD after medical abortion. This included 2025 patients (977 in the immediate insertion group and 1,048 in the delayed insertion group). We summarized all the extracted evidence. The meta-analysis results indicated that for post-surgical abortions, the immediate insertion group exhibited a higher IUD placement rate than the delayed insertion group. After medical abortions, the immediate insertion group showed higher rates of IUD placement, utilization, and expulsion at 6 months or 1 year. The two groups showed no statistically significant differences in the removal rate, post-insertion infection rate, pain scores during insertion, and days of bleeding during the follow-up period. Compared to delayed placement, immediate insertion of IUDs can not only increase the usage rate at 6 months or 1 year but also enhance the placement rate.

Biological treatment options for severe asthma in Poland

Intruduction and purpose: Patients with severe asthma account for approximately 3% to 10% of all asthma patients. They have higher hospital utilization rates and treatment costs than patients with non-severe asthma. Previously, treatment options for these patients were limited due to unacceptable side effects. However, the advent of biologic therapies has provided promising targeted therapy for these patients. State of knowledge: Biologic therapies target inflammatory modulators that play a key role in the pathogenesis of asthma, particularly in patients with high T2 cells. These therapies have shown promising results in reducing asthma symptoms, improving lung function, decreasing the use of oral corticosteroids, and enhancing patients' quality of life. Conclusions: This article reviews the mechanism of action, efficacy, and indications of currently approved biologic drugs available in Poland, as well as potential therapeutic targets for the future.

Hydrothermal synthesis of high crystallinity ZSM-5 zeolite from coal gasification coarse slag and mother liquor circulation for efficient coal chemical wastewater purification.

A hydrothermal synthesis method was developed to produce high crystallinity ZSM-5 zeolite using coal gasification coarse slag (CGCS) as the raw material. Instead of the expensive NaOH(s.), Na2SiO3(s.) was utilized to activate, depolymerize, and recombine Si and Al elements in the CGCS. The mother liquor circulation technology was employed to recover and reuse raw materials and residual reagents (Na2SiO3(aq.) and TPABr), reducing waste emissions and enhancing resource utilization efficiency. The synthesized ZSM-5 had a specific surface area of 455.675 m2g-1, pore volume of 0.284 cm3g-1, and pore diameter of 2.496nm. The influence of various factors on the morphology and crystallinity of ZSM-5 was investigated, resulting in the production of ZSM-5 with higher specific surface area and pore volume. Adsorption experiments showed that WU-ZSM-5 exhibited a removal efficiency of 85% for ammonia nitrogen (NH4+-N(aq.)), validating its effectiveness in coal chemical wastewater purification. The mother liquor recycling technology enabled zero-emission utilization of solid waste resources and improved the utilization rate of alkali and template to 90%. These results demonstrate the potential application of the developed method in the efficient treatment of coal chemical wastewater.

Damage prediction and improvement method based on cutting mode of circular empty hole

Based on the theory of empty hole effect of cutting blasting, the Hopkinson effect and Saint–Venant principle are integrated to establish a two-dimensional calculation model of dynamic stress evolution of the holes wall, and then the dynamic fracture mechanism and damage distribution mode of the rock mass in the cutting area under the action of longitudinal waves are predicted. The results of the calculation and numerical simulation are verified by experiments, and the results show that: The time-varying stress function of the circular cavity wall conforms to the periodic dynamic evolution of the trigonometric function, and the theoretical calculation is consistent with the simulation results. Through the calculation of the round holes cut model and the square empty hole cut model, the change of the shape of the holes in the cut area changes the failure form of the surrounding rock mass. The circular empty hole wall is affected by the stress wave to produce "interval ring" destruction, and the effect of the reflected stretch wave is inhibited. The large range of rock mass in the square empty hole wall produces tensile and shear failure, and the rock mass collapses inward under the influence of the second stage stress. Among them, the empty space utilization rate of the square empty hole model is about 8.5 times that of the circular holes model. Vibration monitoring in the center of the cutting area shows that the vibration effect of the circular empty hole is larger than that of the square empty hole, and the proportion of rock breaking energy is lower.

Assessing the factors that influence the utilization and delivery of rehabilitation services among persons with Parkinson's disease: A scoping review.

Rehabilitation has the potential to significantly improve the lives of people and, most importantly, for persons with Parkinson's disease (PD). Although numerous studies have reported the benefits of rehabilitation for persons with PD (PwPD), these services are still limited and underutilized even when patients exhibit problems that require rehabilitation. This review aims to describe the (a) indication for referral for rehabilitation services, (b) patterns of referral for rehabilitation and (c) factors that facilitate or hinder the utilization and delivery of rehabilitation services among PwPD. A comprehensive literature search was conducted across selected databases, African Journals Online, EBSCOhost (CINAHL, Africa-wide), PubMed, SCOPUS and Web of Science. Studies published in English from January 2002 until December 2022 were applied as limiters. Reference and grey data sources tracking were also conducted. Two reviewers conducted the study selection, screening of titles, abstracts and full text and data charting. A descriptive analysis was performed. Findings were narratively presented and illustrated with tables, diagrams and descriptive formats as appropriate. Twelve studies were included in the review; however, none were from Africa. Impairments and activity limitations were the key functioning problems indicated for rehabilitation. Age, gender, income, race, disease stage, specific functioning problems, quality of life and care by a neurologist were the main predictors for referral to rehabilitation. Physiotherapy, occupational therapy and speech and language therapy were the most utilized rehabilitation services and were sometimes utilized together. The rate of rehabilitation service utilization among PwPD ranged from 0.9% to 62.5%. Lack of referrals and limited rehabilitation units/professionals were the common barriers to rehabilitation service utilization. Per the studies reviewed, utilization of rehabilitation services is generally low among PwPD. Lack of referral and nonavailability of professionals are cited as barriers to access. Adequate measures are needed to improve rehabilitation services for all PwPD.

Health reforms, facility-based delivery, and newborn's health: evidence from Rwanda

Abstract Since 2006, Rwanda has experienced a substantial rise in the facility-based delivery (FBD) rate, attributed to various health initiatives. This paper investigates the impact of multiple health reforms on maternal service utilization and neonatal mortality rates. Employing a difference-in-differences framework utilizing geographical variation in the baseline FBD rate, our estimates indicate a 10–17 percentage point increase in FBD and a 0.15–0.18 times increase in the number of antenatal care visits. While our analysis indicates some evidence of a reduction in neonatal mortality rates, the findings are inconclusive. Nevertheless, our results suggest that the effect of the reforms on neonatal mortality rates was weakly intensified for those residing near district hospitals providing care for complicated pregnancies.

Wagner diagram for modeling O2pathway - calculation and graphical display by the Helsinki O2pathway tool.

Maximal O2uptake (V̇O2max) reflects the individual's maximal rate of O2transport and utilization through the integrated whole-body pathway composed of the lungs, heart, blood, circulation, and metabolically active tissues. As such, V̇O2maxis strongly associated with physical capacity as well as overall health and thus acts as one predictor of physical performance and as a vital sign in determination of status and progress of numerous clinical conditions. Quantifying the contribution of single parts of the multistep O2pathway to V̇O2maxprovides mechanistic insights into exercise (in)tolerance and into therapy-, training-, or disuse-induced adaptations at individual or group levels. We developed a desktop application (Helsinki O2Pathway Tool - HO2PT) to model numerical and graphical display of the O2pathway based on the "Wagner diagram" originally formulated by Peter D. Wagner and his colleagues.&#xD;Approach: The HO2PT was developed and programmed in Python to integrate the Fick principle and Fick's law of diffusion into a computational system to import, calculate, graphically display, and export variables of the Wagner diagram.&#xD;Main results: The HO2PT models O2pathway both numerically and graphically according to the Wagner diagram and pertains to conditions under which the mitochondrial oxidative capacity of metabolically active tissues exceeds the capacity of the O2transport system to deliver O2to the mitochondria. The tool is based on the Python open source code and libraries and freely and publicly available online for Windows, macOS, and Linux operating systems.&#xD;Significance: The HO2PT offers a novel functional and demonstrative platform for those interested in examining V̇O2maxand its determinants by using the Wagner diagram. It will improve access to and usability of Wagner's and his colleagues' integrated physiological model and thereby benefit users across the wide spectrum of contexts such as scientific research, education, exercise testing, sports coaching, and clinical medicine.&#xD.

Forecasting of blast furnace gas utilisation rate via convolutional autoencoders and K-nearest neighbour methods

Gas utilisation rate (GUR) is an essential parameter to characterise the level of energy utilisation efficiency and operation status of blast furnaces (BFs). In the present study, data collected from a BF plant with vanadium–titanium magnetite were subjected to correlation and distribution analyses. Based on the operation cycle of the BF, production parameters from the preceding eight consecutive hours were selected as input parameters for the model. Convolutional autoencoders (CAEs) were employed to extract coded features from the selected data, serving as indirect inputs to the prediction model. Subsequently, K-nearest neighbour (KNN) was utilised to establish a mapping relationship between the coded features and GUR, facilitating forecasting for the subsequent 3 hours. Additionally, a hybrid approach incorporating both supervised and unsupervised training methods was utilised to facilitate GUR prediction, and the performance of the CAE–KNN model was re-validated using data from the remaining sections of the plant. The hit rate of predictions is no less than 96% as the permissible error was within 1.5%.

As1411-modified liposomes to enhance drug utilization and augment the anti-tumor efficacy

BackgroundThe utilization of liposomes in drug delivery has garnered significant attention due to their efficient drug loading capacity and excellent biocompatibility, rendering them a promising platform for tumor therapy. However, the average size of liposomes ~ 100 nm leads to liposomes being susceptible to hepatic and renal metabolism to excretion outside the body leading to poor drug delivery efficiency with a total utilization rate of less than 0.7%, resulting in unfavorable treatment outcomes.ResultsWe have developed a novel liposome platform equipped with tumor surface nucleolin-targeting capacity to enhance drug accumulation at the tumor in vivo. The encapsulation of doxorubicin through thin film hydration has resulted in the formation of D@L-AS1411. Through in vivo experiments, we have demonstrated the effective accumulation of D@L-AS1411 at the tumor site and its ability to improve doxorubicin utilization rates by 40%. Additionally, D@L-AS1411 induces immunogenic death of tumor cells, release of tumor-associated antigens, upregulation of calreticulin expression, and recruitment of active T cell infiltration, and ultimately improves the therapeutic efficacy against tumors (70%).ConclusionsBased on the nucleic acid aptamer AS1411, D@L-1411 is developed to specifically enhance the accumulation of Dox at tumor sites, thereby inhibiting and enhancing the anti-tumor effect. In summary, this study not only provides an efficient tumor-targeting delivery platform but also contributes to the improvement of chemotherapy–immunotherapy combination for tumor treatment strategy in the clinic.

Prioritization of emergency assembly points in a campus using grey p-median linear programming model

PurposeThe purpose of this paper is to propose a scenario-based grey methodology using clustering and optimizing with imprecise and uncertain body size data in an emergency assembly point area to assign the people on a campus to reach the emergency assembly points under uncertain disaster times.Design/methodology/approachGrey clustering and a new grey p-median linear programming model are developed to determine which units to assign to the pre-determined assembly points for a main campus in case of a disaster. The models have two scenarios: 70 and 100% occurrence capacities of administrative and academic personnel and students.FindingsIn this study, the academic and administrative units have been assigned to determine five different emergency assembly points on the main campus by using the numbers of the academic and administrative personnel and student and distances of the units to the assembly point areas of each other. The alternative solutions are obtained effectively by evaluating capacity utilization rates in the scenarios.Practical implicationsIt is often unclear when disasters can occur and therefore, a preliminary preparation time must be required to minimize the risk. In the case of natural, man-made (unnatural) or technological disasters, the people are required to defend themselves and move away from the disaster area as soon as possible in a proper direction. The proposed assignment model yields a final solution that effectively eliminates uncertainty regarding the selection of emergency assembly points for administrative and academic staff as well as students, in the event of disasters.Originality/valueGrey clustering suggests an assignment plan and concurrently, an investigation is underway utilizing the grey p-median linear programming model. This investigation aims to optimize various scenarios and body sizes concerning emergency assembly areas. All campus users who are present at the disaster in units of the campus are getting uncertainty about which emergency assembly point to use, and with this study, the vital risks aim to be ultimately reduced with reasonable plans.

Association between social capital and utilization of essential public health services among elderly migrants: a multilevel logistic study based on the 2017 China migrant dynamic survey (CMDS)

BackgroundAs the number of elderly migrants in China continues to grow, it is necessary to pay closer attention to their health and health services. Some studies have confirmed that social capital plays a significant role in the utilization of health services. Therefore, an in-depth exploration of the relationship between social capital and the utilization of essential public health services (EPHS) by elderly migrants will not only contribute to improving their overall health but also facilitate a more balanced development of public health service system in China.MethodsBased on the cross-sectional data from the 2017 China Migrants Dynamic Survey (CMDS), this study examined the impact of social capital on the utilization of EPHS among elderly migrants. We evaluated social capital at two distinct levels: the individual and the community, and considered two dimensions of social capital: structural social capital (SSC) and cognitive social capital (CSC). The study aimed to delve into the impact of these forms of social capital on the utilization of EPHS among elderly migrants, and whether the migration range moderates this impact by multilevel logistic regression analysis.ResultsA total of 5,728 migrant elderly individuals were selected. The health records establishment rate and health education acceptance rate were approximately 33.0% and 58.6%, respectively. Social capital influenceed the utilization of EPHS among elderly migrants. Specifically, individual-level SSC and CSC have impacts on both the establishment of health records (OR = 1.598, 95%CI 1.366–1.869; OR = 1.705, 95%CI 1.433–2.028) and the acceptance of health education (OR = 1.345, 95%CI 1.154–1.567; OR = 2.297, 95%CI 1.906–2.768) among elderly migrants, while community-level SSC only affected the acceptance of health education (OR = 3.838, 95%CI 1.328–11.097). There were significant differences in individual-level SSC, health records, and health education among different migration range subgroups among elderly migrants. Migration range moderated the effect of social capital on the utilization of EPHS, crossing provinces could weaken the relationship between SSC and health education.ConclusionsSocial capital is associated with a higher utilization rate of EPHS among elderly migrants. It is necessary to encourage them to actively participate in social activities, strengthen public services and infrastructure construction in the area, and improve their sense of belonging and identity.

Prescribing patterns in patients with obsessive-compulsive disorder: Retrospective, single-center study.

Obsessive-compulsive disorder (OCD) is marked by a high rate of treatment resistance. Patients are often left trialing medications within multiple drug classes with little response, causing heterogeneity to emerge in prescribing patterns. This analysis seeks to investigate the selection and dosing of the pharmacotherapy utilized, to portray an overview of prescribing trends in the United States. This retrospective, single center, review of electronic medical records investigated the pharmacotherapy utilization of patients with a primary diagnosis of OCD. Two hundred and ninety-five patients who received OCD treatment at an urban, academic medical center were included in the study. Patients were included in the review if they were at least eighteen years of age and were assigned a diagnosis of OCD according to DSM-5 criteria. Psychotropic pharmacotherapy was integrated into the care of 93% of patients. Selective serotonin reuptake inhibitors were the most utilized medication class at 85% followed by benzodiazepines (47%) and second-generation antipsychotics (37%). Tricyclic antidepressants and first-generation antipsychotics were the two medication classes utilized the least at 13% and 2% respectively. Additionally, mood stabilizers and serotonin-norepinephrine reuptake inhibitors were utilized at rates of 8% and 16%, respectively. Evidence-based treatment guidelines are being followed with varying augmentation strategies widely prevalent, thus displaying the heterogeneity in treating OCD. A high rate of benzodiazepine utilization highlights a practice trend with potential ties to clinical factors, such as the latency to treatment effect of other first-line pharmacotherapies. Future prospective studies are required to determine the cultural, pharmacoeconomic and pharmacogenomic factors that contribute to the variation in prescribing practices and whether these variations influence treatment outcomes.

Textile Flexible Job-Shop Scheduling Based on a Modified Ant Colony Optimization Algorithm

Textile Flexible Job-Shop Scheduling Based on a Modified Ant Colony Optimization Algorithm

Multi-objective green vehicle scheduling problem considering time window and emission factors in ship block transportation

Logistics distribution is one of the main sources of carbon dioxide emissions at present, and there are also such distribution problems in the shipbuilding process. With the increasing attention paid to environmental problems, how to effectively reduce the energy consumption of block transportation and improve the utilization rate of resources in the factory is the key problem that China’s shipbuilding industry needs to solve at present. This article considers the time windows for block transportation tasks, as well as the self-loading constraints of different types of flat cars, and establishes an optimization model that minimizes the empty transport time and energy consumption of the flat cars as the optimization objective. Then, an Improved Genetic Whale Optimization Algorithm is designed, which combines the cross and mutation ideas of genetic algorithms and proposes a whale individual position updating mechanism under a mixed strategy. Furthermore, the performance and computational efficiency of the algorithm are verified through comparative analysis with other classical optimization algorithms on standard test examples. Finally, the shipyard’s block transportation example proves that the energy-saving ship block transportation scheduling method can effectively improve the efficiency of shipbuilding enterprise’s block transportation and reduce the energy consumption in the block transportation process. It proves the engineering practicality of the green dispatching method proposed in this paper, which can further provide a decision-making method for shipyard managers.

Antioxidant Interfaces Enabled by Self‐Deoxidizing and Self‐Dehydrogenating Redox Couple for Reversible Zinc Metal Batteries

AbstractParasitic electrolyte reactions and dendrite growth make Zn metal anodes with high Zn utilization rates (ZURs) more inaccessible, holding back the advance of aqueous zinc metal batteries (AZMBs). Here, sodium isoascorbate (SIA) is introduced to aqueous electrolytes as a self‐deoxidizing and self‐dehydrogenating additive. Coexisting C6H7O6−/C6H5O6− couple spontaneously captures dissolved oxygen and eliminates generated hydrogen by acting as a redox buffer, which leads to the creation of antioxidant Interfaces due to an in situ formed ZnCO3‐dominated solid electrolyte interphase (SEI). This SEI enables the (100) faceted electrode with dendrite‐free and non‐corrosive Zn plating/stripping, thus yielding a Coulombic efficiency of 99.7% up to 1100 h at 5 mAh cm−2, as well as a stable cycle sustaining for over 335 h under a high ZUR of 85.5%. Full‐cell properties are demonstrated by matching a poly(3,4‐ethylenedioxythiophene) intercalated vanadium oxide (PEDOT‐V2O5) cathode, which harvests a high capacity of 302 mAh g−1 (at 0.01 A g−1) and holds 94.2% capacity retention over 600 cycles (at 1 A g−1) under practical conditions (N/P = 4.2 and E/C = 7.6 µL mg−1). These findings provide a new solution for electrolyte design for industrializing AZMBs.

Antibiotic regimens tailored by clinical pharmacist supported by intensivist enhance rational use of antibiotics

ABSTRACT Background High antibiotics utility rates have been observed in surgical intensive care units (SICU). The present study was performed to evaluate the effect of engaging a clinical pharmacist in SICU on rational use of antibiotic treatment. Methods This retrospective quasi-experimental experiment involved 505 patients, over a period of one year, admitted to emergency department surgical/trauma ICU of a large tertiary care hospital. Before and during pharmacist participation periods of six months, 226 and 153 patients, respectively, are compared. Results Antibiotics consumption pattern changed with a decrease in total antibiotic consumption from 101.42 to 94.1 Defined Daily Dose/100 patients’ days after the clinical pharmacist participation, in addition to, a statistically significant rise (p = 0.001) in percentage of appropriateness of the prescribed antibiotic therapy from 72.1% to 86.3%. Time to control infection (days) was not statistically different (p = 0.825) in both periods. The average ICU days of stay was statistically significant longer (p = 0.046) during pharmacist attendance (4.42 ± 5.61) in comparison with period without pharmacist attendance (3.31 ± 3.66). The difference in ICU mortality rate was not statistically significance (p = 0.217). Cost per stay increased by 65% during pharmacist intervention period. Conclusions Antibiotic management with pharmacist participation as a part of multidisciplinary team with intensivist can promote rate of the appropriateness of the prescribed antibiotic therapy, lower utility of antibiotic consumption, but with a longer ICU stay, no mortality reduction, and higher expenses per stay. Trial Registry ClinicalTrials.gov: NCT04931914.