High-dose, short-course therapy with levofloxacin in subjects with AP is at least as effective as standard 10-day therapy with ciprofloxacin.

PHIO catheter placement is significantly faster than PIV and CVC placement with increased minor complication profile and perceived pain. PHIO venous access is absolutely life saving when PIV or CVC placement is difficult or impossible.

Introduction:The blackout in North America of August 2003 was one of the worst on record. It affected eight United States states and parts of Canada for >24 hours. Additionally, two large United States cities, Detroit, Michigan and Cleveland, Ohio, suffered from a loss of water pressure and a subsequent ban on the use of public supplies of potable water that lasted four days. A literature review revealed a paucity of literature that describes blackouts and how they may affect the medical community.Methods:This paper includes a review of after-action reports from four inner-city, urban hospitals supplemented accounts from the authors' hospital's emergency operations center (emergency operations center).Results:Some of the problems encountered, included: (1)lighting; (2) elevator operations; (3) supplies of water; (4) communication operations; (5) computer failure; (6) lack of adequate supplies of food; (7) mobility to obtain Xray studies; (8) heating, air condition, and ventilation; (9) staffing; (10) pharmacy; (11) registration of patients; (12) hospital emergency operations center; (13) loss of isolation facilities; (14) inadequate supplies of paper; (15) impaired ability to provide care for non-emergency patients; (16) sanitation; and (17) inadequate emergency power.Discussion:The blackout of 2003 uncovered problems within the United States hospital system, ranging from staffing to generator coverage. This report is a review of the effects that the blackout and water ban of 2003 had on hospitals in a large inner-city area. Also discussed are solutions utilized at the time and recommendations for the future.Conclusion:The blackout of 2003 was an excellent test of disaster/emergency planning, and produced many valuable lessons to be used in future events.

Improving time to diagnosis and intervention has positively impacted outcomes in acute myocardial infarction, stroke, and trauma through elucidating the early pathogenesis of those diseases. This insight may partly explain the futility of time-insensitive immunotherapy trials for severe sepsis and septic shock. The aim of this study was to examine the early natural history of circulatory biomarker activity in sepsis, relative to previous animal and human outcome trials. We conducted a literature search using PubMed, MEDLINE, and Google Scholar to identify outcome trials targeting biomarkers with emphasis on the timing of therapy. These findings were compared with the biomarker activity observed over the first 72 h of hospital presentation in a cohort of severe sepsis and septic shock patients. Biomarker levels in animal and human research models are elevated within 30 min after exposure to an inflammatory septic stimulus. Consistent with these findings, the biomarker cascade is activated at the most proximal point of hospital presentation in our patient cohort. These circulatory biomarkers overlap; some have bimodal patterns and generally peak between 3 and 36 h while diminishing over the subsequent 72 h of observation. When this is taken into account, prior outcome immunotherapy trials have generally enrolled patients after peak circulatory biomarker concentrations. In previous immunotherapy sepsis trials, intervention was delayed after the optimal window of peak biomarker activity. As a result, future studies need to recalibrate the timing of enrollment and administration of immunotherapy agents that still may hold great promise for this deadly disease.

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The uptake of triglycerides by the isolated perfused rat liver from synthetic neutral fat emulsions or from washed rat chylomicrons was investigated. It was observed that the uptake of triglycerides was more rapid in livers from starved rats than from normal fed animals. In the absence of added lipid to the perfusate, there was release of triglyceride from livers of fed animals, whereas there was a net uptake of endogenous perfusate triglyceride by livers from fasting rats. The data suggest that both uptake and release of triglyceride by liver occur simultaneously. In livers from fasted animals uptake may be the more rapid process, whereas in livers from fed rats both uptake and release may occur at more equal rates. In contrast to the triglycerides, no difference in rate of uptake of endogenous serum nonesterified fatty acid or of added fatty acid-albumin complex was observed with livers from either fed or fasting animals.