The impact of compliance with Italian guidelines on the outcome of hospitalised community-acquired pneumonia (CAP) in internal medicine departments was evaluated. All Fine class IV or V CAP patients ...were included in this multicentre, interventional, before-and-after study, composed of three phases: 1) a retrospective phase (RP; 1,443 patients); 2) a guideline implementation phase; and 3) a prospective phase (PP; 1,404 patients). Antibiotic prescription according to the guidelines increased significantly in the PP. The risk of failure at the end of the firstline therapy was significantly lower in the PP versus the RP (odds ratio (OR) 0.83, 95% confidence interval (CI) 0.69-1.00), particularly in Fine class V patients (OR 0.71, 95% CI 0.51-0.98). Analysis of outcome in the overall population (2,847 patients) showed a statistically significant advantage for compliant versus noncompliant therapies in terms of failure rate (OR 0.74, 95% CI 0.60-0.90) and an advantage in terms of mortality (OR 0.77, 95% CI 0.58-1.04). Antipneumococcal cephalosporin monotherapy was associated with a low success rate (68.6%) and the highest mortality (16.2%); levofloxacin alone and the combination of cephalosporin and macrolide resulted in higher success rates (79.1 and 76.7%, respectively) and significantly lower mortalities (9.1 and 5.7%, respectively). Overall, a low compliance with guidelines in the prospective phase (44%) was obtained, indicating the need for future more aggressive and proactive approaches.
Abstract Background Heart failure (HF) is a major health and social problem. Internal Medicine (IM) wards admit a high proportion of patients with HF, frequently with advanced age and comorbidities. ...Few recent data are available in this setting, especially on predictors of in-hospital outcome. Methods In this observational study, we recruited patients admitted with diagnosis of HF and present in five index days, in 91 units of IM in Italy. Characteristics and management of HF, comorbidities, functional and cognitive status, and quality of life, were analyzed. Results We observed 1411 patients, with a mean age of 78.7 ± 9.6 years. At admission, 81.7% of the patients were in NYHA classes III–IV. Ninety percent of the patients had at least one comorbidity. Dementia or severely impaired functional status were registered in 21.5% and 22.8% of the patients. In 89 patients (6,3%) a negative outcome (death or clinical worsening) occurred during hospitalization. A number of variables were significantly related to negative outcome by means of univariate analysis (systolic blood pressure < 100 mmHg, pulse pressure ≥ 55 mmHg, anaemia, brain deficit, permanent bed rest, Barthel Index ≤ 30). At multivariable analysis, significant correlation was retained by anaemia and Barthel Index ≤ 30, the latter being the strongest predictor. Conclusions Real-world patients with HF and hospitalized in IM are frequently very old, frail and with multiple comorbidities. Functional and cognitive status significantly influence patients' outcome, and this could lead to a rethinking of the overall (in-hospital but also home-based) management of HF.
A macro-scale approach to R/C modeling is proposed in this paper by formulating a comprehensive model, that describes R/C behavior in the uncracked stage (solid concrete) and in the cracked stage, ...the latter with either unidirectional cracking (primary cracks) or with bidirectional cracking (primary and secondary cracks) or even multi-directional cracking. The secant stiffness matrix is formulated by means of a direct procedure, based on the assumption that the solid concrete and the reinforcement work in parallel, while the solid concrete between the cracks and the cracks themselves work in series. The resistant mechanisms active at the crack interface are introduced by means of their highly nonlinear laws, that are taken from the literature and are based on well-documented tests. The reliability and accuracy of the proposed model are checked against a few well-documented tests on 2D R/C members failing past the formation of secondary cracks.
An experimental indication of negative heat capacity in excited nuclear systems is inferred from the event by event study of energy fluctuations in Au quasi-projectile sources formed in Au+Au ...collisions at 35 A.MeV. Equilibrated events are selected and the excited source configuration is reconstructed through a calorimetric analysis of its de-excitation products. Fragment partitions show signs of a critical behavior at about 4.5 A.MeV excitation energy. Around this value the heat capacity shows a negative branch providing a direct evidence of a first order liquid gas phase transition.
A method is proposed for the analysis of the nonlinear behavior up to failure of reinforced-concrete membrane elements. The approach considers a linear elastic behavior for concrete before cracking; ...after cracking, the cracks are assumed as having a fixed direction and uniform spacing and cracked reinforced concrete is modeled as an orthotropic material. The basic element of cracked reinforced-concrete membrane is defined and the related stiffness matrix is proposed. The quantities that govern the problem are the opening and the sliding of the crack lips, as well as the strain of the concrete struts that are located between cracks. Applied to a local analysis of cracked reinforced concrete, the above variables allow for the effective modeling of compatibility and equilibrium conditions and take into account phenomena such as aggregate interlock, tension stiffening, and dowel action. To verify the reliability and capability of the proposed method, some comparisons with experimental observations of relevant tests are made.
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