Randomized double-blind placebo-controlled trial of 40 mg/day of atorvastatin in reducing the severity of sepsis in ward patients (ASEPSIS Trial)

Introduction: Several observational studies suggest that statins modulate the pathophysiology of sepsis and may prevent its progression. The aim of this study was to determine if the acute administration of atorvastatin reduces sepsis progression in statin naïve patients hospitalized with sepsis. Methods: A single centre phase II randomized double-blind placebo-controlled trial. Patients with sepsis were randomized to atorvastatin 40 mg daily or placebo for the duration of their hospital stay up to a maximum of 28-days. The primary end-point was the rate of sepsis progressing to severe sepsis during hospitalization. Results: 100 patients were randomized, 49 to the treatment with atorvastatin and 51 to placebo. Patients in the atorvastatin group had a significantly lower conversion rate to severe sepsis compared to placebo (4% vs. 24% p = 0.007.), with a number needed to treat of 5. No significant difference in length of hospital stay, critical care unit admissions, 28-day and 12-month readmissions or mortality was observed. Plasma cholesterol and albumin creatinine ratios were significantly lower at day 4 in the atorvastatin group (p < 0.0001 and p = 0.049 respectively). No difference in adverse events between the two groups was observed (p = 0.238). Conclusions: Acute administration of atorvastatin in patients with sepsis may prevent sepsis progression. Further multi-centre trials are required to verify these findings. Trial Registration: International Standard Randomized Control Trial Registry ISRCTN64637517

The c(4×4)–a(1×3) surface reconstruction transition on InSb(001) : static versus dynamic conditions

The transition between the a(1 × 3) and c(4 × 4) surface reconstructions of InSb(0 0 1) has been carefully monitored by reflection high energy electron diffraction as a function of temperature and Sb2 flux, without incident In flux. Arrhenius-like behaviour is observed across the whole range of Sb2 fluxes and temperatures, allowing accurate internal calibration of substrate temperature. This behaviour is in contrast to aggregated data obtained under dynamic molecular beam epitaxy conditions, which show two regimes rather than a single Arrhenius-like phase boundary. The results are explained qualitatively by the atomistic kinetics in static versus dynamic conditions

Factors influencing treatment selection and thirty-day mortality following chemotherapy for people with small cell lung cancer: an analysis of national audit data

Background Thirty-day mortality after treatment for lung cancer is a measure of unsuccessful outcome and where treatment should have been avoided. Guidelines recommend offering chemotherapy to individuals with small cell lung cancer (SCLC) who have poorer performance status (PS) because of its high initial response rate. However, this comes with an increased risk of toxicity and early death. We quantified real-world 30-day mortality in SCLC following chemotherapy, established the factors associated with this and compared these to the factors that influence receipt of chemotherapy. Methods We used linked national English datasets to define the factors associated with both receiving chemotherapy and 30-day mortality following chemotherapy. Results We identified 3,715 people diagnosed with SCLC, of which 2,235 (60.2%) received chemotherapy. There were 174 (7.8%) deaths within 30 days of chemotherapy. The adjusted odds of receiving chemotherapy decreased with older age, worsening PS and increasing comorbidities. Thirty-day mortality was independently associated with poor PS (PS 2 vs PS 0 adjusted OR 3.75 95% CI 1.71-8.25) and stage (extensive vs limited adjusted OR 1.68 95% CI 1.03-2.74) but in contrast was not associated with increasing age. Both chemotherapy administration and 30-day mortality varied by hospital network.Conclusions To reduce variation in chemotherapy administration predictors of 30-day mortality could be used as an adjunct to improve sub-optimal patient selection. We have quantified 30-day mortality risk by the two independently associated factors, PS and stage, so that patients and clinicians can make better informed decisions about the potential risk of early death following chemotherapy

A system design for distributed energy generation in low temperature district heating (LTDH) networks

Project SCENIC (Smart Controlled Energy Networks Integrated in Communities) involves connecting properties at the University of Nottingham’s Creative Energy Homes test site in a community scale, integrated heat and power network. Controls will be developed to allow for the most effective heat load allocation and power distribution scenarios. Furthermore, the system will develop the prosumer concept, where consumers are both buyers and sellers of energy in both heat and power systems. This paper describes the initial phase of project SCENIC, achieving truly distributed generation within a heat network. The first of its kind, the system has a four pipe network configuration, consisting of a network flow loop to supply heat to homes, and a generation loop to collect energy from residential heating systems and supply it to a centralised thermal store. To achieve the design, IES-VE steady state heat load and dynamic building modelling have been used. A pre-insulated Rehau Rauthermex piping diameter was sized using flow rate calculations. Pipe diameter is reduced in line with distance from the central pump and associated pressure losses. The diameter ranges from 40 to 25mm, with a heat loss as low as 7.0 W/m. In addition, flow rates will fluctuate below a maximum of 1.99 l/s. Danfoss – 7 Series BS flatstations have been selected as the network-building heat interface units (HIU), to satisfy a calculated peak design heating loads of between 36.74 and 44.06 kW. Furthermore, to enable the prosumer concept and associated business models an adapted Danfoss Flatstations – 3 Series BS was selected to interface the distributed heat sources with the network. This paper gives details of the novel system configuration and concept, energy flows, as well as calculation and modelling results for the heat network. A premise is given to maintaining low temperatures in the network to ensure system efficiency in line with the latest research thinking

Impact of Scottish vocational qualifications on residential child care : have they fulfilled the promise?

This article will present findings from a doctoral study exploring the impact of 'SVQ Care: Promoting Independence (level III)' within children's homes. The study focuses on the extent to which SVQs enhance practice and their function within a 'learning society'. A total of 30 staff were selected from seven children's homes in two different local authority social work departments in Scotland. Each member of staff was interviewed on four separate occasions over a period of 9 months. Interviews were structured using a combination of repertory grids and questions. Particular focus was given to the assessment process, the extent to which SVQs enhance practice and the learning experiences of staff. The findings suggest that there are considerable deficiencies both in terms of the SVQ format and the way in which children's homes are structured for the assessment of competence. Rather than address the history of failure within residential care, it appears that SVQs have enabled the status quo to be maintained whilst creating an 'illusion' of change within a learning society

Quantum chemistry simulation of ground- and excited-state properties of the sulfonium cation on a superconducting quantum processor

The computational description of correlated electronic structure, and particularly of excited states of many-electron systems, is an anticipated application for quantum devices. An important ramification is to determine the dominant molecular fragmentation pathways in photo-dissociation experiments of light-sensitive compounds, like sulfonium-based photo-acid generators used in photolithography. Here we simulate the static and dynamical electronic structure of the H$_3$S$^+$ molecule, taken as a minimal model of a triply-bonded sulfur cation, on a superconducting quantum processor of the IBM Falcon architecture. To this end, we combine a qubit reduction technique with variational and diagonalization quantum algorithms, and use a sequence of error-mitigation techniques. We compute dipole structure factors and partial atomic charges along ground- and excited-state potential energy curves, revealing the occurrence of homo- and heterolytic fragmentation. To the best of our knowledge, this is the first simulation of a photo-dissociation reaction on a superconducting quantum device, and an important step towards the computational description of photo-dissociation by quantum computing algorithms.Comment: 12 pages, 7 figure

Factors influencing treatment selection and thirty-day mortality following chemotherapy for people with small cell lung cancer: an analysis of national audit data

Background Thirty-day mortality after treatment for lung cancer is a measure of unsuccessful outcome and where treatment should have been avoided. Guidelines recommend offering chemotherapy to individuals with small cell lung cancer (SCLC) who have poorer performance status (PS) because of its high initial response rate. However, this comes with an increased risk of toxicity and early death. We quantified real-world 30-day mortality in SCLC following chemotherapy, established the factors associated with this and compared these to the factors that influence receipt of chemotherapy. Methods We used linked national English datasets to define the factors associated with both receiving chemotherapy and 30-day mortality following chemotherapy. Results We identified 3,715 people diagnosed with SCLC, of which 2,235 (60.2%) received chemotherapy. There were 174 (7.8%) deaths within 30 days of chemotherapy. The adjusted odds of receiving chemotherapy decreased with older age, worsening PS and increasing comorbidities. Thirty-day mortality was independently associated with poor PS (PS 2 vs PS 0 adjusted OR 3.75 95% CI 1.71-8.25) and stage (extensive vs limited adjusted OR 1.68 95% CI 1.03-2.74) but in contrast was not associated with increasing age. Both chemotherapy administration and 30-day mortality varied by hospital network. Conclusions To reduce variation in chemotherapy administration predictors of 30-day mortality could be used as an adjunct to improve sub-optimal patient selection. We have quantified 30-day mortality risk by the two independently associated factors, PS and stage, so that patients and clinicians can make better informed decisions about the potential risk of early death following chemotherapy

Ion-Pairing Limits Crystal Growth in Metal-Oxygen Batteries

Aprotic alkali metal-oxygen batteries are widely considered to be promising high specific energy alternatives to Li-ion batteries. The growth and dissolution of alkali metal oxides such as Li2O2 in Li-O2 batteries and NaO2 and KO2 in Na- and K-O2 batteries, respectively, is central to the discharge and charge processes in these batteries. However, crystal growth and dissolution of the discharge products, especially in aprotic electrolytes, is poorly understood. In this work, we chose the growth of NaO2 in Na-O2 batteries as a model system and show that there is a strong correlation between the electrolyte salt concentration and the NaO2 crystal size. With a combination of experiments and theory, we argue that the correlation is a direct manifestation of the strong cation-anion interactions leading to decreased crystal growth rate at high salt concentrations. Further, we propose and experimentally demonstrate that cation-coordinating crown molecules are suitable electrochemically stable electrolyte additives that weaken ion-pairing and enhance discharge capacities in metal-oxygen batteries while not negatively affecting their rechargeability.Comment: 13 Pages, 4 Figures, 14 pages of Supplementary Informatio

NLL+NNLO predictions for jet-veto efficiencies in Higgs-boson and Drell-Yan production

Using the technology of the CAESAR approach to resummation, we examine the jet-veto efficiency in Higgs-boson and Drell-Yan production at hadron colliders and show that at next-to-leading logarithmic (NLL) accuracy the resummation reduces to just a Sudakov form factor. Matching with NNLO calculations results in stable predictions for the case of Drell-Yan production, but reveals substantial uncertainties in gluon-fusion Higgs production, connected in part with the poor behaviour of the perturbative series for the total cross section. We compare our results to those from POWHEG with and without reweighting by HqT, as used experimentally, and observe acceptable agreement. In an appendix we derive the part of the NNLL resummation corrections associated with the radius dependence of the jet algorithm.Comment: 30 pages, 8 figures; v2 as published in JHE