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We perform a three-dimensional direct numerical simulation of flow over the Tacoma Narrows Bridge to understand the vertical and torsional vibrations that occurred before its collapse in 1940. Real-scale structural parameters of the bridge are used for the simulation. The Reynolds number based on the free-stream velocity and height of the deck fence is lower (
${Re}=10\ 000$) than the actual one on the day of its collapse (
${Re}=3.06 \times 10^{6}$), but the magnitude of a fluid property is modified to provide the real-scale aerodynamic force and moment on the deck. The vertical and torsional vibrations are simulated through two-way coupling of the fluid flow and structural motion. The vertical vibration occurs from the frequency lock-in with the vortex shedding, and its wavelength and frequency agree well with the recorded data in 1940. After saturation of the vertical vibration, a torsional vibration resulting from the aeroelastic fluttering grows exponentially in time, with its wavelength and frequency in excellent agreement with the recorded data of the incident. The critical flutter wind speed for the growth of torsional vibration is obtained as 
$3.56 < U_c / (f_{nat} B) \le 4$, where 
$U_{c}$ is the critical flutter wind speed, 
$f_{nat}$ is the natural frequency of the torsional vibration and 
$B$ is the deck width. Finally, apart from the actual vibration process in 1940, we perform more numerical simulations to investigate the roles of the free-stream velocity and vertical vibration in the growth of the torsional vibration.
Background: The purpose of this study was to find out the relationship between appropriateness of antibiotic prescription and clinical outcomes in patients with community-acquired acute pyelonephritis (CA-APN). Methods: A multicenter prospective cohort study was performed in 8 Korean hospitals from September 2017 to August 2018. All hospitalized patients aged ≥19 years diagnosed with CA-APN at admission were recruited. Pregnant women and patients with insufficient data were excluded. In addition, patients with prolonged hospitalization due to medical problems that were not associated with APN treatment were excluded. The appropriateness of empirical and definitive antibiotics was divided into “optimal,” “suboptimal,” and “inappropriate,” and optimal and suboptimal were regarded as appropriate antibiotic use. The standard for the classification of empirical antibiotics was defined reflecting the Korean national guideline for the antibiotic use in urinary tract infection 2018. The standards for the classification of definitive antibiotics were defined according to the result of in vitro susceptibility tests of causative organisms. Clinical outcomes including clinical failure (mortality or recurrence) rate, hospitalization days, and medical costs were compared between patients who were prescribed antibiotics appropriately and those who were prescribed them inappropriately. Results: In total, 397 and 318 patients were eligible for the analysis of the appropriateness of empirical and definitive antibiotics, respectively. Of these, 10 (2.5%) and 18 (5.7%) were inappropriately prescribed empirical and definitive antibiotics, respectively, and 28 (8.8%) were prescribed either empirical or definitive antibiotics inappropriately. Patients who were prescribed empirical antibiotics appropriately showed a lower mortality rate (0 vs 10%; P = .025), shorter hospitalization days (9 vs 12.5 days; P = .014), and lower medical costs (US$2,333 vs US$4,531; P = .007) compared to those who were prescribed empirical antibiotics “inappropriately.” In comparison, we detected no significant differences in clinical outcomes between patients who were prescribed definitive antibiotics appropriately and those who were prescribed definitive antibiotics inappropriately. Patients who were prescribed both empirical and definitive antibiotics appropriately showed a lower clinical failure rate (0.3 vs 7.1%; P = .021) and shorter hospitalization days (9 vs 10.5 days; P = .041) compared to those who were prescribed either empirical or definitive antibiotics inappropriately. Conclusions: Appropriate use of antibiotics leads patients with CA-APN to better clinical outcomes including fewer hospitalization days and lower medical costs.
Funding: No
Disclosures: None
The aim of this article is to apply a Floer theory to study symmetric periodic Reeb orbits. We define positive equivariant wrapped Floer homology using a (anti-)symplectic involution on a Liouville domain and investigate its algebraic properties. By a careful analysis of index iterations, we obtain a non-trivial lower bound on the minimal number of geometrically distinct symmetric periodic Reeb orbits on a certain class of real contact manifolds. This includes non-degenerate real dynamically convex star-shaped hypersurfaces in
${\mathbb {R}}^{2n}$
which are invariant under complex conjugation. As a result, we give a partial answer to the Seifert conjecture on brake orbits in the contact setting.
