An Evaluation of Provider Adherence to Acute Bronchitis Quality Measures in Adults

Background: Acute bronchitis management continues to be mistreated. Evidence based practice guidelines do not support antibiotic therapy for the treatment of acute bronchitis. Providers are encouraged to prescribe antitussives, suppressants and inhaler medications for the treatment of acute bronchitis symptoms, including cough. Objective: The overall objective of this project is to evaluate the management of adults diagnosed with acute bronchitis in a limited services clinic. Methods: A retrospective chart review was conducted on patients in a limited services clinic. The chart review assessed patients aged 18-64 with a diagnosis of acute bronchitis from July 1, 2016- June 30, 2017. Results: Of adult patients with acute bronchitis, 31% of adults aged 18-64 were not prescribed an antibiotic (N=10/32) and 68% were prescribed at least one antibiotic. Various medication classes were prescribed to patients with acute bronchitis, including analgesics, bronchodilators, antihistamines, antibiotics, corticosteroids, cough/cold/allergy medications, nasal agents and mouth/throat agents. Conclusions: Antibiotic therapy was highly prescribed for patients with the diagnosis of acute bronchitis. However, 34% of adults with a diagnosis of acute bronchitis had at least one comorbid condition, such as chronic smoker, asthma or COPD. Among those with a comorbid condition, 82% (N=11; 9/11) were prescribed an antibiotic

Carbonate Free Electrolyte for Lithium Ion Batteries Containing γ-Butyrolactone and Methyl Butyrate

A novel carbonate free electrolyte, 1 M lithium difluoro(oxalato) borate (LiDFOB) in 1:1 gamma-butyrolactone (GBL)/methyl butyrate (MB), has been compared to a standard electrolyte, 1 M LiPF6 in 1:1:1 EC/DMC/DEC, and a 1 M LiDFOB in 1:1:1 EC/DMC/DEC electrolyte. The conductivity of 1 M LiDFOB in GBL/MB is higher at low temperature, but slightly lower at higher temperature compared to the standard electrolyte. The 1 M LiDFOB in GBL/MB electrolyte has comparable cycling performance to the standard electrolyte, and better cycling performance than the 1 M LiDFOB in EC/DMC/DEC electrolyte. The reversible cycling performance suggests that the LiDFOB in GBL/MB electrolyte forms a stable anode solid electrolyte interface (SEI) in the presence of GBL. Ex-situ surface analysis of the extracted electrodes has been conducted via a combination of XPS, FTIR-ATR and SEM which suggests that the stable anode SEI results is primarily composed of reduction products of LiDFOB. The widespread implementation of electric vehicles (EVs) requires further improvements in lithium ion batteries.1–3 Some of the biggest challenges for lithium ion batteries in EVs are cost, low temperature performance and battery lifetime.2,3 Improvements in the electrolyte can assist in the resolution of each of these problems.1,4,5 Most commercial electrolytes are composed of LiPF6 in a mixture of carbonate solvents.5 However, the high cost and poor thermal and hydrolytic stability of LiPF6 is problematic for the electrolyte.6–8 In addition, ethylene carbonate (EC) is typically a required component of the electrolyte due to the role of EC in the formation of the solid electrolyte interphase (SEI) on the anode.5,9–14 Since EC is a solid at room temperature, electrolytes containing EC frequently have poor performance at low temperature.15 Despite the shortcomings of LiPF6 / EC based electrolytes, these formulations have proven very difficult to replace. While there have been significant efforts to develop novel electrolytes with superior performance to LiPF6 in carbonates, there has been limited success. The development of novel solvent systems has been more limited and frequently targeted toward specific problems such as high voltage cathodes, salt solubility, or reactivity issues.16–21 The development of novel salts has encountered problems related to salt solubility and corrosion of the aluminum current collector on the cathode.21,22 One of the more interesting and promising alternative salts is lithium difluoro(oxalato) borate (LiDFOB).1,4,23,24 LiDFOB is promising due to good solubility, thermal stability, passivation of the aluminum current collector, stable SEI formation, and potentially lower cost. While there have been a limited number of investigations of LiDFOB as the conducting salt in the electrolyte,4,16,25 there have been several reports of the use of LiDFOB and the related salts lithium bis(oxalato) borate (LiBOB) and lithium tetrafluoro(oxalato) phosphate (LiTFOP) as additives to LiPF6 based electrolytes to form a more stable SEI.1,14,23,26–30 There have also been reports of the use of oxalate salts enabling the cycling of PC based electrolytes due to better SEI formation.30 The presence of the oxalate group in the anode thus may enable the use of EC free electrolytes and electrolytes with non-carbonate solvents. The investigation of LiDFOB has been expanded to include carbonate free electrolyte formulations. Esters and lactones are an interesting alternative to carbonate solvents. Linear esters have been studied as co-solvents due to the high dielectric constants and low freezing points which have been reported to improve the low temperature performance of lithium ion batteries,15 while lactones such as γ-butyrolactone (GBL) have high dielectric constants5 and a very wide liquid temperature range (−43.5 to 204°C). However, the use of GBL as a primary solvent in lithium ion battery electrolytes has been plagued by problems with the stability of the anode SEI.5 Despite the issues with GBL as a solvent in carbonate based electrolytes, GBL has been studied with LiBOB based electrolytes due to the limited solubility of LiBOB in carbonates.18,31 In order to investigate the use of novel electrolyte formulations for lithium ion batteries, a comparative study of three electrolytes has been conducted; a standard LiPF6 electrolyte in 1:1:1 EC/ dimethyl carbonate (DMC)/ diethyl carbonate (DEC) was tested against 1 M LiDFOB in 1:1:1 EC/DMC/DEC and 1 M LiDFOB in 1:1 GBL/MB (MB is methyl butyrate)

Matrix modification for enhancing the transport properties of the human cartilage endplate to improve disc nutrition.

Poor solute transport through the cartilage endplate (CEP) impairs disc nutrition and could be a key factor that limits the success of intradiscal biologic therapies. Here we demonstrate that treating the CEP with matrix metalloproteinase-8 (MMP-8) reduces the matrix constituents that impede solute uptake and thereby improves nutrient diffusion. Human CEP tissues harvested from four fresh cadaveric lumbar spines (age range: 38-66 years old) were treated with MMP-8. Treatment caused a dose-dependent reduction in sGAG, localized reductions to the amount of collagen, and alterations to collagen structure. These matrix modifications corresponded with 16-24% increases in the uptake of a small solute (376 Da). Interestingly, the effects of MMP-8 treatment depended on the extent of non-enzymatic glycation: treated CEPs with high concentrations of advanced glycation end products (AGEs) exhibited the lowest uptake compared to treated CEPs with low concentrations of AGEs. Moreover, AGE concentrations were donor-specific, and the donor tissues with the highest AGE concentrations appeared to have lower uptake than would be expected based on the initial amounts of collagen and sGAG. Finally, increasing solute uptake in the CEP improved cell viability inside diffusion chambers, which supports the nutritional relevance of enhancing the transport properties of the CEP. Taken together, our results provide new insights and in vitro proof-of-concept for a treatment approach that could improve disc nutrition for biologic therapy: specifically, matrix reduction by MMP-8 can enhance solute uptake and nutrient diffusion through the CEP, and AGE concentration appears to be an important, patient-specific factor that influences the efficacy of this approach