Rate of early hospital readmission amongst cirrhotic patients is high in Australia: experience from a single liver transplant centre.

BACKGROUND AND AIMS: The 30-day hospital readmission rate in cirrhotic patients has been demonstrated to be up to 40% in international studies, but is not well studied in Australia. The aim of the current study was to report on the rate and cause of 30-day hospital readmission from a single liver transplant referral centre, including a cost analysis of readmissions. METHODS: This was a retrospective study of consecutive cirrhotic patients admitted to a liver transplant centre in Victoria, Australia, between 1 January 2019 and 31 December 2019. Cases were identified through International Classification of Diseases, Tenth Revision, 10 coding for cirrhosis and its complications. Baseline demographic data, liver-related complications and unrelated extra-hepatic comorbidities, laboratory values and prognostic scores were collected from the electronic medical record. RESULTS: One hundred seventy-nine (63% men; median age at index admission, 59 years) patients who were admitted 427 times during the study period were included in the final analysis. The 30-day hospital readmission rate was 46%, with the majority of readmissions attributable to fluid overload (29%), miscellaneous reasons (27%) and infection (20%). One fifth of readmissions were considered preventable. History of variceal haemorrhage was found to be an independent predictor of 30-day hospital readmission. The annual cost of readmission is over AU$2.7 million and the median cost of hospital readmission was about AU$9000. CONCLUSIONS: The 30-day hospital readmission rate of 46% is higher than previously reported and almost half of cases were caused by either fluid overload or infection.

Physician attitudes regarding the Advisory Committee on Immunization Practices Adult Immunization Schedule.

The Advisory Committee on Immunization Practices (ACIP) was created out of the need to formalize vaccine recommendations for the United States. Annually, ACIP delivers recommendations to the CDC director for guidance about United States vaccine use and publishes the Adult Immunization Schedule. Updated schedules feature changes to vaccine recommendations as well as changes to the schedule's usability for physicians. The objective of this study was to determine physicians' attitudes about the Adult Immunization Schedule. Surveys were administered to a sentinel physician network from October 2019 through January 2020. Physicians that responded were comfortable using the Adult Immunization Schedule, but reported confusion about some medical condition-based indications. Physicians reported a lack engagement with mobile applications, CDC Vaccine Schedules and Shots by STFM (the Society for Teachers of Family Medicine). Future work should focus on increasing clarity regarding the recommendations with medical condition-based indications and increasing knowledge of mobile applications for physicians.

Three-Dimensional (3D) Animation and Calculation for the Assessment of Engaging Hill-Sachs Lesions With Computed Tomography 3D Reconstruction.

PURPOSE: To dynamically assess for Hill-Sachs engagement with animated 3-dimensional (3D) shoulder models. METHODS: We created 3D shoulder models from reconstructed computed tomography (CT) images from a consecutive series of patients with recurrent anterior dislocation. They were divided into 2 groups based on the perceived Hill-Sachs severity. For our cohort of 14 patients with recurrent anterior dislocation, 4 patients had undergone osteoarticular allografting of Hill-Sachs lesions and 10 control patients had undergone CT scanning to quantify bone loss but no treatment for bony pathology. A biomechanical analysis was performed to rotate each 3D model using local coordinate systems to the classical vulnerable position of the shoulder (abduction = 90°, external rotation = 0-135°) and through a functional range. A Hill-Sachs lesion was considered "dynamically" engaging if the angle between the lesion's long axis and anterior glenoid was parallel. Results: In the vulnerable position of the shoulder, none of the Hill-Sachs lesions aligned with the anterior glenoid in any of our patients. However, in our simulated physiological shoulder range, all allograft patients and 70% of controls had positions producing alignment. CONCLUSIONS: The technique offers a visual representation of an engaging Hill-Sachs using 3D-animated reconstructions with open-source software and CT images. In our series of patients, we found multiple shoulder positions that align the Hill-Sachs and glenoid axes that do not necessarily meet the traditional definition of engagement. Identifying all shoulder positions at risk of "engaging," in a broader physiological range, may have critical implications toward selecting the appropriate surgical management of bony defects. LEVEL OF EVIDENCE: level III, case-control study.

Production routes to bio-acetic acid: life cycle assessment.

BACKGROUND: Similar to biofuels, numerous chemicals produced from petroleum resources can also be made from biomass. In this research we investigate cradle to biorefinery exit gate life cycle impacts of producing acetic acid from poplar biomass using a bioconversion process. A key step in developing acetic acid for commercial markets is producing a product with 99.8% purity. This process has been shown to be potentially energy intensive and in this work two distillation and liquid-liquid extraction methods are evaluated to produce glacial bio-acetic acid. Method one uses ethyl acetate for extraction. Method two uses alamine and diisobutyl ketone. Additionally two different options for meeting energy demands at the biorefinery are modeled. Option one involves burning lignin and natural gas onsite to meet heat/steam and electricity demands. Option two uses only natural gas onsite to meet heat/steam demands, purchases electricity from the grid to meet biorefinery needs, and sells lignin from the poplar biomass as a co-product to a coal burning power plant to be co-fired with coal. System expansion is used to account for by-products and co-products for the main life cycle assessment. Allocation assessments are also performed to compare the life cycle tradeoffs of using system expansion, mass allocation, or economic allocation for bio-acetic acid production. Finally, a sensitivity analysis is conducted to determine potential effects of a decrease in the fermentation of glucose to acetic acid. RESULTS: Global warming potential (GWP) and fossil fuel use (FFU) for ethyl acetate extraction range from 1000-2500 kg CO2 eq. and 32-56 GJ per tonne of acetic acid, respectively. Alamine and diisobutyl ketone extraction method GWP and FFU ranges from -370-180 kg CO2 eq. and 15-25 GJ per tonne of acetic acid, respectively. CONCLUSIONS: Overall the alamine/diisobutyl ketone extraction method results in lower GWP and FFU values compared to the ethyl acetate extraction method. Only the alamine/diisobutyl extraction method finds GWP and FFU values lower than those of petroleum based acetic acid. For both extraction methods, exporting lignin as a co-product produced larger GWPs and FFU values compared to burning the lignin at the biorefinery.

Techno-Economic Analysis of Producing Glacial Acetic Acid from Poplar Biomass via Bioconversion.

Most of the current commercial production of glacial acetic acid (GAA) is by petrochemical routes, primarily methanol carbonylation. GAA is an intermediate in the production of plastics, textiles, dyes, and paints. GAA production from biomass might be an economically viable and sustainable alternative to petroleum-derived routes. Separation of acetic acid from water is a major expense and requires considerable energy. This study evaluates and compares the technical and economic feasibility of GAA production via bioconversion using either ethyl acetate or alamine in diisobutylkerosene (DIBK) as organic solvents for purification. Models of a GAA biorefinery with a production of 120,650 tons/year were simulated in Aspen software. This biorefinery follows the path of pretreatment, enzymatic hydrolysis, acetogen fermentation, and acid purification. Estimated capital costs for different scenarios ranged from USD 186 to 245 million. Recovery of GGA using alamine/DIBK was a more economical process and consumed 64% less energy, due to lower steam demand in the recovery distillation columns. The estimated average minimum selling prices of GGA were USD 756 and 877/ton for alamine/DIBK and ethyl acetate scenarios, respectively. This work establishes a feasible and sustainable approach to produce GGA from poplar biomass via fermentation.

Multicenter evaluation of the Alere™ i influenza A&B assay using respiratory specimens collected in viral transport media.

Rapid and accurate detection of influenza virus is critical for proper patient management. The Alere™ i Influenza A&B assay is an isothermal nucleic acid amplification test capable of detecting influenza A and B viruses directly from respiratory specimens. In this multicenter clinical trial conducted in the US, we evaluated the clinical performance of the Alere™ i Influenza A&B assay against that of the Prodesse ProFlu+ assay. A total of 1243 fresh, leftover nasal or nasopharyngeal swabs eluted in viral transport medium were tested by both assays. Sensitivity and specificity of the Alere™ i Influenza A&B assay were 97.8% (95% CI 94.6-99.2) and 96.6% (95% CI 95.2-97.5) for influenza A and 92.9% (95% CI 85.5-96.9) and 98.3% (95% CI 97.4-98.0) for influenza B. The Alere™ i Influenza A&B assay is an ideal molecular assay for influenza virus detection due to its high sensitivity and specificity with minimal hands-on and turn-around-time.

Assessment of afoxolaner efficacy against Otodectes cynotis infestations of dogs.

BACKGROUND: The efficacy of a single 2.5 mg/kg dose of afoxolaner (NexGard®, Merial) against induced Otodectes cynotis infestations was assessed in eight afoxolaner-treated dogs, compared to eight untreated dogs. METHODS: After O. cynotis infestations were established and confirmed by otoscopic assessments in 16 dogs, all of the dogs were included in the study and allocated to two separate treatment groups. The first group of eight ear mite-infested dogs remained untreated, while afoxolaner was administered orally to the second group of dogs at the minimum recommended dose once on Day 0. Otoscopic assessments performed on all dogs (Days -7, -2, 14 and 28) confirmed the presence or absence of live mites throughout the study. No serious adverse events were recorded throughout the study, and no adverse events were likely related to the administration of NexGard. RESULTS: By Day 28, seven out of eight untreated dogs were still infested with ear mites, while only two out of eight afoxolaner-treated dogs were infested, with one and four ear mites, respectively. On Day 28, the reductions of mite counts in the afoxolaner-treated group versus those of the control dogs were 98.5% based on geometric means, and 99.4% based on arithmetic means. Significantly fewer (P < 0.05) live mites were present in the afoxolaner-treated group than the untreated group on Day 28. CONCLUSION: The results of this study demonstrated that a single oral administration of afoxolaner at the minimum recommended dose is highly effective (>98%) in treating dogs with induced O. cynotis infestations.

Hydrocarbon bio-jet fuel from bioconversion of poplar biomass: life cycle assessment.

BACKGROUND: Bio-jet fuels compatible with current aviation infrastructure are needed as an alternative to petroleum-based jet fuel to lower greenhouse gas emissions and reduce dependence on fossil fuels. Cradle to grave life cycle analysis is used to investigate the global warming potential and fossil fuel use of converting poplar biomass to drop-in bio-jet fuel via a novel bioconversion platform. Unique to the biorefinery designs in this research is an acetogen fermentation step. Following dilute acid pretreatment and enzymatic hydrolysis, poplar biomass is fermented to acetic acid and then distilled, hydroprocessed, and oligomerized to jet fuel. Natural gas steam reforming and lignin gasification are proposed to meet hydrogen demands at the biorefineries. Separate well to wake simulations are performed using the hydrogen production processes to obtain life cycle data. Both biorefinery designs are assessed using natural gas and hog fuel to meet excess heat demands. RESULTS: Global warming potential of the natural gas steam reforming and lignin gasification bio-jet fuel scenarios range from CO2 equivalences of 60 to 66 and 32 to 73 g MJ(-1), respectively. Fossil fuel usage of the natural gas steam reforming and lignin gasification bio-jet fuel scenarios range from 0.78 to 0.84 and 0.71 to 1.0 MJ MJ(-1), respectively. Lower values for each impact category result from using hog fuel to meet excess heat/steam demands. Higher values result from using natural gas to meet the excess heat demands. CONCLUSION: Bio-jet fuels produced from the bioconversion of poplar biomass reduce the global warming potential and fossil fuel use compared with petroleum-based jet fuel. Production of hydrogen is identified as a major source of greenhouse gas emissions and fossil fuel use in both the natural gas steam reforming and lignin gasification bio-jet simulations. Using hog fuel instead of natural gas to meet heat demands can help lower the global warming potential and fossil fuel use at the biorefineries.

Hydrocarbon bio-jet fuel from bioconversion of poplar biomass: techno-economic assessment.

BACKGROUND: Infrastructure compatible hydrocarbon biofuel proposed to qualify as renewable transportation fuel under the U.S. Energy Independence and Security Act of 2007 and Renewable Fuel Standard (RFS2) is evaluated. The process uses a hybrid poplar feedstock, which undergoes dilute acid pretreatment and enzymatic hydrolysis. Sugars are fermented to acetic acid, which undergoes conversion to ethyl acetate, ethanol, ethylene, and finally a saturated hydrocarbon end product. An unfermentable lignin stream may be burned for steam and electricity production, or gasified to produce hydrogen. During biofuel production, hydrogen gas is required and may be obtained by various methods including lignin gasification. RESULTS: Both technical and economic aspects of the biorefinery are analyzed, with different hydrogen sources considered including steam reforming of natural gas and gasification of lignin. Cash operating costs for jet fuel production are estimated to range from 0.67 to 0.86 USD L-1 depending on facility capacity. Minimum fuel selling prices with a 15 % discount rate are estimated to range from 1.14 to 1.79 USD L-1. Capacities of 76, 190, and 380 million liters of jet fuel per year are investigated. Capital investments range from 356 to 1026 million USD. CONCLUSIONS: A unique biorefinery is explored to produce a hydrocarbon biofuel with a high yield from bone dry wood of 330 L t-1. This yield is achieved chiefly due to the use of acetogenic bacteria that do not produce carbon dioxide as a co-product during fermentation. Capital investment is significant in the biorefinery in part because hydrogen is required to produce a fully de-oxygenated fuel. Minimum selling price to achieve reasonable returns on investment is sensitive to capital financing options because of high capital costs. Various strategies, such as producing alternative, intermediate products, are investigated with the intent to reduce risk in building the proposed facility. It appears that producing and selling these intermediates may be more profitable than converting all the biomass into aviation fuel. With variability in historical petroleum prices and environmental subsidies, a high internal rate of return would be required to attract investors.

The group II metabotropic glutamate receptor agonist, LY379268, decreases methamphetamine self-administration in rats.

BACKGROUND: Given the problems associated with the escalation in methamphetamine (METH) use, the identification of more effective treatment strategies is essential. Group II metabotropic glutamate receptors (mGluRs) have been suggested to be a novel therapeutic target for psychostimulant addiction. We sought to test the ability of the selective group II mGluR agonist LY379268 to reduce METH self-administration in rats. METHODS: Rats were trained to self-administer METH on a progressive ratio (PR) schedule. Animals were then switched to fixed ratio responding and given daily extended access (6 h/day) to METH self-administration for 14 days. Rats were then re-tested on the PR schedule. The effect of LY379268 on METH-reinforced PR responding was determined before and after 14 days of extended access. To test for non-specific effects, a separate group of animals received LY379268 prior to a sucrose pellet-reinforced PR schedule. RESULTS: Animals escalated their daily intake of METH during extended access. PR responding did not change as a function of extended access. LY379268 significantly attenuated METH reinforced responding, both before and after extended access. The degree of attenuation did not change as a function of extended access. LY379268 had no effect on sucrose pellet-reinforced responding at any dose. CONCLUSIONS: LY379268 selectively reduced the motivation to self-administer METH. In contrast to data with other compounds, the sensitivity to the effects of LY379268 did not change following extended access to METH self-administration. Group II mGluR agonists, therefore, may represent a relatively new class of compounds for the development of pharmacotherapies for METH addiction.