Time to clinical stability in patients hospitalized with community-acquired pneumonia: implications for practice guidelines

CONTEXT: Many groups have developed guidelines to shorten hospital length of stay in pneumonia in order to decrease costs, but the length of time until a patient hospitalized with pneumonia becomes clinically stable has not been established. OBJECTIVE: To describe the time to resolution of abnormalities in vital signs, ability to eat, and mental status in patients with community-acquired pneumonia and assess clinical outcomes after achieving stability. DESIGN: Prospective, multicenter, observational cohort study. SETTING: Three university and 1 community teaching hospital in Boston, Mass, Pittsburgh, Pa, and Halifax, Nova Scotia. PATIENTS: Six hundred eighty-six adults hospitalized with community-acquired pneumonia. MAIN OUTCOME MEASURES: Time to resolution of vital signs, ability to eat, mental status, hospital length of stay, and admission to an intensive care, coronary care, or telemetry unit. RESULTS: The median time to stability was 2 days for heart rate (< or =100 beats/min) and systolic blood pressure (> or =90 mm Hg), and 3 days for respiratory rate (< or =24 breaths/min), oxygen saturation (> or =90%), and temperature (< or =37.2 degrees C [99 degrees F]). The median time to overall clinical stability was 3 days for the most lenient definition of stability and 7 days for the most conservative definition. Patients with more severe cases of pneumonia at presentation took longer to reach stability. Once stability was achieved, clinical deterioration requiring intensive care, coronary care, or telemetry monitoring occurred in 1% of cases or fewer. Between 65% to 86% of patients stayed in the hospital more than 1 day after reaching stability, and fewer than 29% to 46% were converted to oral antibiotics within 1 day of stability, depending on the definition of stability. CONCLUSIONS: Our estimates of time to stability in pneumonia and explicit criteria for defining stability can provide an evidence-based estimate of optimal length of stay, and outline a clinically sensible approach to improving the efficiency of inpatient management.     

NO/cGMP pathway is involved in exocrine secretion from rat pancreatic acinar cells

OBJECTIVE: To identify factors associated with the initiation of breast-feeding in a predominantly Puerto Rican population living in inner-city Hartford, Conn. DESIGN: Retrospective study of 144 Latino women (mean +/- standard deviation age = 26.3 +/- 5.7 years) with children at least 1 year old but younger than 6 years old (mean +/- standard deviation age = 3.0 +/- 1.2 years) at the time of the survey. Women were recruited from agencies sponsoring health programs for mothers and children. They were interviewed in their homes (69%) or at the Hispanic Health Council, Hartford, Conn (31%). SUBJECTS/SETTING: Low-income Latino women who had at least 1 preschooler at the time of the interview. The women lived in inner-city Hartford, and the overwhelming majority were Puerto Rican and received welfare assistance and food stamps. Seventy-eight percent of the women chose to be interviewed in Spanish; the other 22% were interviewed in English. STATISTICAL ANALYSES: Explanatory variables that related to breast-feeding initiation (P < or = .2) in bivariate chi 2 analyses were entered into a multivariate logistic regression model that was reduced using backward stepwise elimination procedures. RESULTS: Multivariate analyses indicated that breast-feeding the previous child, shorter length of maternal residence in the United States, not receiving prenatal bottle-feeding advice, more recent birth, and higher birth weight were positively associated with breast-feeding initiation. A major reason for choosing not to breast-feed was that women felt socially uncomfortable doing it. APPLICATIONS: Breast-feeding initiation was more likely in Latino women who received prenatal breast-feeding counselling and postpartum support. Mothers of low-birth-weight infants and women breast-feeding for the first time may need additional help. These findings can be used by programs like the Special Supplemental Nutrition Program for Women, Infants, and Children to increase breast-feeding initiation.     

Children's use of looking behavior as a cue to detect another's goal

Three studies examined children's understanding of the role that looking behavior plays in revealing another's desired goal. In each study, participants were asked which of 2 objects a protagonist wanted to obtain. Four-year-olds did not infer that an object examined via prolonged looking was more likely to be the protagonist's goal than an object that was either glanced at or inadvertently touched. Instead, they were accurate only when the protagonist looked at one of two potential goals. In contrast, the majority of 6-year-olds (and adults in Experiment 1) consistently regarded prolonged looking as the more important cue of the protagonist's goal. These age differences suggest that development is characterized by an increasing appreciation that goal is revealed by comparative differences in the quality of perceptual connectedness to objects in the world. One explanation for these age differences is that preschoolers are limited in their understanding of the difference between perceiving with full attention and without it.     

Homeless youth and their exposure to and involvement in violence while living on the streets

Sick building syndrome is the term given to a heterogeneous constellation of symptoms that affects workers in modern mechanically ventilated office buildings. Although the cause is unknown, there is evidence that the local environment of the work station is an important determinant of symptoms. In this study, investigators examined the effect of a new, individually controlled ventilation system on workers' symptoms. Investigators studied two groups of workers in one mechanically ventilated office building: (1) a control group at whose worksite no intervention was made and (2) an intervention group. The intervention consisted of installation of a device that allowed each worker control over the ventilation supplied to his or her worksite. Just before, and 4 and 16 mo after installation of this device, workers completed self-administered questionnaires regarding occurrence of symptoms. The new ventilation system resulted in higher air velocities, more variable temperatures, and higher concentrations of airborne dust and fungal spores. Four months after installation, workers with the new ventilation system reported fewer symptoms that were (a) work-related (p < .05) and that were work-related and frequent (p < .05); in addition, they reported fewer symptoms that reduced their capacity to work (p < .01). Sixteen months after installation, workers with the new device reported fewer symptoms than at baseline (although not as significantly), and they indicated that the indoor air quality improved their productivity by 11%, compared with a 4% reduction of productivity among the control group of workers (p < .001). Investigators concluded that the new ventilation system, which provided the workers with individual control over ventilation, was associated with important and sustained reduction in symptoms.     

Impact of Relative Humidity on HVAC Filters Loaded with Hygroscopic and Non-Hygroscopic Particles

The key characteristics of an air filter—flow resistance and filtration efficiency—are strongly affected by captured particles. The impact of exposing loaded heating, ventilating, and air conditioning air filters to a relative humidity (RH) other than that experienced during loading is investigated to develop an understanding of the role of RH throughout filter operation. Flat sheets of commercial filter media were loaded with hygroscopic, non-hygroscopic, or a mixture of particles in a laboratory apparatus. When filters loaded with hygroscopic particles in dry air were exposed to an elevated RH of 40%, the flow resistance reduced by up to 47%, depending on the filter being tested. Investigation of filter efficiency before and after changes in RH in the same samples shows reductions of up to 11 percentage points in the 130-nm size range. Further increasing RH causes additional drops in flow resistance and efficiency whereas reverting back to a lower humidity does not change the filter characteristics. The irreversibility of the particle-loaded filter characteristics implies that the RH increases are associated with an irreversible change in the particle structure. The response to humidity was reduced if an aerosol mixture of hygroscopic and non-hygroscopic particles is used. Exposure of filters loaded with only non-hygroscopic particles does not show the same dependence on RH. Small increases in growth factor for RH changes below deliquescence, causing morphological changes in captured particle aggregates, is a potential explanation for the changes observed.

Copyright 2015 American Association for Aerosol Research     

Sulfonated poly(ether ketone ketone) ionomers as proton exchange membranes

Sulfonated poly(ether ketone ketone) ionomers (SPEKK) with ion‐exchange capacities (IEC) between 0.2 and 3.4 meq/g were prepared by sulfonating PEKK with a mixture of concentrated and fuming sulfuric acids. Sulfonation occurs only on the phenyl rings attached to ether and ketone groups. The glass transition temperature of the dry SPEKK ionomers increased linearly with increasing IEC, and the ionomers were thermally stable to ～250°C, above which desulfonation occurred. Water‐swollen ionomers exhibited microphase separated morphologies, and the average correlation length determined by small angle X‐ray scattering increased with increasing IEC. The proton conductivity of hydrated SPEKK membranes measured by impedance spectroscopy ranged from ～10^–3 to 10^–1 S/cm as the IEC increased from ～1.0 to 2.4 meq/g. Single cell performance curves on membrane‐electrode assemblies (MEA) indicated that the SPEKK membranes approached the performance of Nafion? for an IEC of 2 meq/g. POLYM. ENG. SCI., 45:1081–1091, 2005. © 2005 Society of Plastics Engineers     

Thermoreversible Gelcasting: A Novel Ceramic Processing Technique

A new ceramic processing method, thermoreversible gelcasting (TRG), has been developed. The method uses a gelation process that can be reversed multiple times. Two Al₂O₃ systems have been explored with the use of a specific triblock copolymer to form a binding gel network. The mixture becomes a free-flowing liquid on heating above 60°C. However, on cooling below 60°C, the slurry instantaneously transforms to a physical gel. This process can be reversed easily (essentially with an infinite processing time window) while the solvent is present in the system, which is advantageous when trying to produce high-quality dense pieces if initial casting irregularities occur. Near-theoretically dense specimens have been produced with properties consistent with reported values of high-density Al₂O₃.     

Steam oxidation of X20CrMoV121: Comparison of laboratory exposures and in situ exposure in power plants

X20CrMoV121 is a 12% Cr martensitic steel which has been used in power plants in Europe for many decades. Specimens have been removed from superheater tubes to investigate long‐term exposure with respect to steam oxidation. These tubes have been exposed for various durations up to 135 000 h in power plants in Denmark at steam temperatures varying from 450–565 °C. This paper collates the data, compares oxide morphologies and assesses to what extent parabolic kinetics can be used to describe the oxidation rate. The steam oxidation behaviour has been investigated in the laboratory in an Ar‐46%H₂O mixture at 500, 600 and 700 °C for 336 h. It was observed that the morphology of the oxide layers was strongly influenced by temperature, and some of the same morphologies are also observed for power plant specimens. However, the temperatures at which they occur were different for plant and laboratory specimens, e.g. the presence of Cr rich bands within the oxide occurred at a lower temperature in the plant than in the laboratory. In addition there is a greater variety of oxide morphologies for long‐term plant specimens compared to laboratory specimens.