Causative agent distribution and antibiotic therapy assessment among adult patients with community acquired pneumonia in Chinese urban population

<p>Abstract</p> <p>Background</p> <p>Knowledge of predominant microbial patterns in community-acquired pneumonia (CAP) constitutes the basis for initial decisions about empirical antimicrobial treatment, so a prospective study was performed during 2003–2004 among CAP of adult Chinese urban populations.</p> <p>Methods</p> <p>Qualified patients were enrolled and screened for bacterial, atypical, and viral pathogens by sputum and/or blood culturing, and by antibody seroconversion test. Antibiotic treatment and patient outcome were also assessed.</p> <p>Results</p> <p>Non-viral pathogens were found in 324/610 (53.1%) patients among whom <it>M. pneumoniae </it>was the most prevalent (126/610, 20.7%). Atypical pathogens were identified in 62/195 (31.8%) patients carrying bacterial pathogens. Respiratory viruses were identified in 35 (19%) of 184 randomly selected patients with adenovirus being the most common (16/184, 8.7%). The nonsusceptibility of <it>S. pneumoniae </it>to penicillin and azithromycin was 22.2% (Resistance (R): 3.2%, Intermediate (I): 19.0%) and 79.4% (R: 79.4%, I: 0%), respectively. Of patients (312) from whom causative pathogens were identified and antibiotic treatments were recorded, clinical cure rate with β-lactam antibiotics alone and with combination of a β-lactam plus a macrolide or with fluoroquinolones was 63.7% (79/124) and 67%(126/188), respectively. For patients having mixed <it>M. pneumoniae </it>and/or <it>C. pneumoniae </it>infections, a better cure rate was observed with regimens that are active against atypical pathogens (e.g. a β-lactam plus a macrolide, or a fluoroquinolone) than with β-lactam alone (75.8% vs. 42.9%, <it>p </it>= 0.045).</p> <p>Conclusion</p> <p>In Chinese adult CAP patients, <it>M. pneumoniae </it>was the most prevalent with mixed infections containing atypical pathogens being frequently observed. With <it>S. pneumoniae</it>, the prevalence of macrolide resistance was high and penicillin resistance low compared with data reported in other regions.</p

Rapid Transfer Alignment of MEMS SINS Based on Adaptive Incremental Kalman Filter

In airborne MEMS SINS transfer alignment, the error of MEMS IMU is highly environment-dependent and the parameters of the system model are also uncertain, which may lead to large error and bad convergence of the Kalman filter. In order to solve this problem, an improved adaptive incremental Kalman filter (AIKF) algorithm is proposed. First, the model of SINS transfer alignment is defined based on the “Velocity and Attitude” matching method. Then the detailed algorithm progress of AIKF and its recurrence formulas are presented. The performance and calculation amount of AKF and AIKF are also compared. Finally, a simulation test is designed to verify the accuracy and the rapidity of the AIKF algorithm by comparing it with KF and AKF. The results show that the AIKF algorithm has better estimation accuracy and shorter convergence time, especially for the bias of the gyroscope and the accelerometer, which can meet the accuracy and rapidity requirement of transfer alignment

Error Prediction for SINS/GPS after GPS Outage Based on Hybrid KF-UKF

The performance of MEMS-SINS/GPS integrated system degrades evidently during GPS outage due to the poor error characteristics of low-cost IMU sensors. The normal EKF is unable to estimate SINS error accurately after GPS outage owing to the large nonlinear error caused by MEMS-IMU. Aiming to solve this problem, a hybrid KF-UKF algorithm for real-time SINS/GPS integration is presented in this paper. The linear and nonlinear SINS error models are discussed, respectively. When GPS works well, we fuse SINS and GPS with KF with linear SINS error model using normal EKF. In the case of GPS outage, we implement Unscented Transform to predict SINS error covariance with nonlinear SINS error model until GPS signal recovers. In the simulation test that we designed, an evident accuracy improvement in attitude and velocity could be noticed compared to the normal EKF method after the GPS signal recovered

Effect of porosity on thermal conductivity of quintuple element ceramic system materials

With the development of aerospace technology, protective materials for hot-end components have reached higher requirements. In this paper, a （ZrxY（1-x/4）Ta（1-x/4）Ti（1-x/4）Er（1-x/4））O（x=0.2，0.544，0.672，0.796和0.92）quintuple element ceramic system composite is studied based on the solid-phase reaction method and molecular dynamics simulation. By experimental means, ZrO2 （99.99%）, Y2O3 （99.99%）, Ta2O5 （99.99%）, Er2O3 （99.99%） and TiO2 （99%） powder was used as raw material to prepare （ZrxY（1-x/4）Ta（1-x/4）Ti（1-x/4）Er（1-x/4））O composite by the solid-phase reaction method. The thermal conductivity of （ZrxY（1-x/4）Ta（1-x/4）Ti（1-x/4）Er（1-x/4））O ceramic material was investigated computationally using the LAMMPS program. The study result shows that a consistent trend in the variation of the thermal conductivity is obtained by experiments and simulations at the interval of 200-900 °C. The thermal conductivity reaches a minimum value at x = 0.796, which proves the feasibility of molecular dynamics simulation of the thermal conductivity of multi-ceramic materials. Meanwhile, the effect of porosity on thermal conductivity was investigated, and it is found that there was a competitive relationship between the elemental ratios and the effect of porosity on thermal conductivity. When the porosity is larger than 6.67%, the effect of the porosity is the main influencing factor. when the porosity is smaller than 6.67%, the elemental ratios are the dominant factors in the thermal conductivity

Line-of-Sight Rate Estimation Based on UKF for Strapdown Seeker

Aiming at the problem that the strapdown imaging seeker cannot measure line-of-sight (LOS) rate directly, this paper presents an effective algorithm for LOS rate estimation. To address the problem, the reference frames and angles are defined. According to the relative kinematics and attitude relationship between missile and target, the nonlinear state equations and measurement equations of LOS rate are derived, and the estimation algorithm based on unscented Kalman filter (UKF) is proposed. Considering the estimation accuracy mainly depends on body LOS (BLOS) angle accuracy and gyro accuracy, the paper is unprecedented to research how these two factors impact the LOS angle and rate accuracy by simulation. Semiphysical simulation experiment verifies the correctness and accuracy of the algorithm, and the result shows that the estimation algorithm can meet the accuracy and real-time requirements of guidance system simultaneously. Thus LOS rate estimation algorithm based on UKF provides a theoretical basis for engineering applications of strapdown imaging seeker

Immune enhancement in patients with predicted severe acute necrotising pancreatitis: a multicentre double-blind randomised controlled trial

PURPOSE: Infected pancreatic necrosis (IPN) is a highly morbid complication of acute necrotising pancreatitis (ANP). Since there is evidence of early-onset immunosuppression in acute pancreatitis, immune enhancement may be a therapeutic option. This trial aimed to evaluate whether early immune-enhancing Thymosin alpha 1 (Tα1) treatment reduces the incidence of IPN in patients with predicted severe ANP. METHODS: We conducted a multicentre, double-blind, randomised, placebo-controlled trial involving ANP patients with an Acute Physiology and Chronic Health Evaluation II (APACHE II) score ≥ 8 and a computed tomography (CT) severity score ≥ 5 admitted within 7 days of the advent of symptoms. Enrolled patients were assigned to receive a subcutaneous injection of Tα1 1.6 mg every 12 h for the first 7 days and 1.6 mg once a day for the subsequent 7 days or matching placebos (normal saline). The primary outcome was the development of IPN during the index admission. RESULTS: A total of 508 patients were randomised, of whom 254 were assigned to receive Tα1 and 254 placebo. The vast majority of the participants required admission to the intensive care unit (ICU) (479/508, 94.3%). During the index admission, 40/254(15.7%) patients in the Tα1 group developed IPN compared with 46/254 patients (18.1%) in the placebo group (difference -2.4% [95% CI − 7.4 to 5.1%]; p = 0.48). The results were similar across four predefined subgroups. There was no difference in other major complications, including new-onset organ failure (10.6% vs. 15%), bleeding (6.3% vs. 3.5%), and gastrointestinal fistula (2% vs. 2.4%). CONCLUSION: The immune-enhancing Tα1 treatment of patients with predicted severe ANP did not reduce the incidence of IPN during the index admission. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1007/s00134-022-06745-7