Background
A documented penicillin allergy is associated with increased morbidity including length of hospital stay and an increased incidence of resistant infections attributed to use of ...broader‐spectrum antibiotics. The aim of the systematic review was to identify whether inpatient penicillin allergy testing affected clinical outcomes during hospitalization.
Methods
We performed an electronic search of Ovid MEDLINE/PubMed, Embase, Web of Science, Scopus, and the Cochrane Library over the past 20 years. Inpatients having a documented penicillin allergy that underwent penicillin allergy testing were included.
Results
Twenty‐four studies met eligibility criteria. Study sample size was between 24 and 252 patients in exclusively inpatient cohorts. Penicillin skin testing (PST) with or without oral amoxicillin challenge was the main intervention described (18 studies). The population‐weighted mean for a negative PST was 95.1% CI 93.8‐96.1. Inpatient penicillin allergy testing led to a change in antibiotic selection that was greater in the intensive care unit (77.97% CI 72.0‐83.1 vs 54.73% CI 51.2‐58.2, P<.01). An increased prescription of penicillin (range 9.9%‐49%) and cephalosporin (range 10.7%‐48%) antibiotics was reported. Vancomycin and fluoroquinolone use was decreased. Inpatient penicillin allergy testing was associated with decreased healthcare cost in four studies.
Conclusions
Inpatient penicillin allergy testing is safe and effective in ruling out penicillin allergy. The rate of negative tests is comparable to outpatient and perioperative data. Patients with a documented penicillin allergy who require penicillin should be tested during hospitalization given its benefit for individual patient outcomes and antibiotic stewardship.
A review of the current literature on soil behavior modeling reveals the great success of constitutive models proposed within the critical state soil mechanics framework. Imam et al. (2005) proposed ...a critical state constitutive model for predicting the behavior of sand consolidated to a wide range of void ratios and pressures. The model uses capped yield surfaces and was formulated with special emphasis on its ability to simulate the behavior of loose liquefiable sand. Since sands with fines are abundant in nature, it is often necessary to modify existing models proposed for clean sand to enable them to predict the behavior of sand-fines mixtures. In recent years, the equivalent granular void ratio has been used as an alternative state variable in order to obtain a single trend of variation for some aspects of behavior of sand-fines mixtures such as the critical state condition. In this paper, application of this concept for upgrading the mentioned constitutive model in order to enable it to simulate the behavior of such mixtures is attempted. It is shown that the approach implemented in the current study successfully takes into account effects of non-plastic fines on the sand-fines mixture behavior, and that the modified model simulations are in good agreement with the observed behavior of such mixtures. Performances of two relationships proposed for the determination of the equivalent granular void ratio used in the modified model are also compared.
•The equivalent granular void ratio concept is used to upgrade the model of Imam et al. (2005) for sand-fines mixtures.•Four series of undrained monotonic triaxial tests are used for validation of the upgraded model.•The modified model simulations are in good agreement with the experimental results.•Results obtained from two equations proposed previously for the equivalent granular void ratio are also compared.
Abstract
During the rainy season, there are still puddles of water in the village due to overflowing rivers and flooding due to landslides of embankments. Therefore, it is necessary to control the ...water and handle it quickly and precisely. Emergency Weir, which is ready to be installed, can be used to overcome this problem. It is named Knock Down Weir as Emergency Weirs that are effective, efficient, practical, can be arranged vertically, horizontally, can be stored and reassembled with 4 Forms of Arrangement and proven by Stability value > 1.5 based on the test on the support of wall roughness: hard stone, gravel, sand, clay and using Matlab application analysis. The simulation uses a model arrangement, namely: 1). Model L filled with sand + water; 2). The model I filled with sand + water; 3). Model L filled with water; 4). Model L filled with water. The result based on the Matlab application is obtained that the arrangement of model no. 1 (L shape) is the most stable against hard rock, gravel, sand and clay as support.
Abstract
The speed and pressure of the water flow are determined by the height and volume of the water. The speed of the water flow in the actuator is determined by the use of this flow sensor ...system. A good tank-based water flow control model should be developed. At a certain point, the actuator stabilizes the rate of water production per minute. Therefore, it is necessary to develop an automatic and precise control technique. Many Artificial Intelligence (AI) methods are used in system optimization. Among them are Particle Swarm Optimization (PSO), Neural Network (NN), Fuzzy Inference System (FIS), and ANFIS. Adaptive Neuro Fuzzy Inference System (ANFIS) is a combination of NN and FIS. In this study, the PSO method was combined with ANFIS. This hybrid method produces better optimization compared to the previous method. The best water level control simulation results are PSO-ANFIS with an overshot of 0.572 pu, undershot of 0.563 pu, and flow output overshot of 0.008 pu, undershot of 0.009 pu.
Homeobox genes encode transcription factors that are essential for normal development and are often dysregulated in cancers. The molecular mechanisms that cause their misregulation in cancers are ...largely unknown. In this study, we investigate the mechanism by which the Six1 homeobox protein, which has a crucial role during development, is frequently deregulated in several poor outcome, aggressive, metastatic adult human cancers, including breast cancer, ovarian cancer, hepatocellular carcinoma and pediatric malignancies such as rhabdomyosarcoma and Wilms' tumor. Our results reveal that miRNA-185 translationally represses Six1 by binding to its 3'-untranslated region. Analyses of ovarian cancers, pediatric renal tumors and multiple breast cancer cell lines showed decreased miR-185 expression, paralleling an increase in Six1 levels. Further investigation revealed that miR-185 impedes anchorage-independent growth and cell migration, in addition to suppressing tumor growth in vivo, implicating it to be a potent tumor suppressor. Our results indicate that miR-185 mediates its tumor suppressor function by regulating cell-cycle proteins and Six1 transcriptional targets c-myc and cyclin A1. Furthermore, we show that miR-185 sensitizes Six1-overexpressing resistant cancer cells to apoptosis in general and tumor necrosis factor-related apoptosis-inducing ligand (TRAIL)-mediated apoptosis in particular. Together, our findings suggest that the altered expression of the novel tumor suppressor miR-185 may be one of the central events that leads to dysregulation of oncogenic protein Six1 in human cancers.
Cellulose nanowhiskers were prepared by sulfuric acid hydrolysis from coconut husk fibers which had previously been submitted to a delignification process. The effects of preparation conditions on ...the thermal and morphological behavior of the nanocrystals were investigated. Cellulose nanowhisker suspensions were characterized by Fourier transform infrared spectroscopy (FTIR), transmission electron microscopy (TEM), thermogravimetric analysis (TGA) and X-ray diffraction. Results showed that it was possible to obtain ultrathin cellulose nanowhiskers with diameters as low as 5
nm and aspect ratio of up to 60. A possible correlation between preparation conditions and particle size was not observed. Higher residual lignin content was found to increase thermal stability indicating that by controlling reaction conditions one can tailor the thermal properties of the nanowhiskers.
The aim of this study is to evaluate the anti-diabetic nephropathy effect of Caffeic acid and to prove our hypothesis for its mechanism of action that it may occur by reactivation of autophagy ...pathway via suppression of autophagy regulatory miRNAs. In vivo, high-fat diet and streptozotocin-induced (HFD-STZ) diabetic rats were treated with Caffeic acid once per day for 12 weeks before and after development of diabetic nephropathy. Blood and urine biochemical parameters, autophagy transcripts and their epigenetic regulators together with renal tissue morphology were investigated. In diabetic rats, Caffeic acid intake, caused improvement in albumin excretion,blood glucose, reduced renal mesangial matrix extension with increased vacuolation and reappearance of autophagosomes. Meanwhile, it resulted in autophagy genes up-regulation RB 1-inducible coiled coil protein (RB1CC1), Microtubule-associated proteins 1A/1B light chain 3(MAP1LC3B), Autophagy related gene (ATG-12), with simultaneous reduction in their epigenetic regulators; miRNA-133b, -342 and 30a, respectively. These above mentioned effects were more significant in the diabetic nephropathy Caffeic treated rats than in the prophylactic group. Based on our results we postulated that caffeic acid modulates autophagy pathway through inhibition of autophagy regulatory miRNAs, that could explain its curative properties against diabetic kidney disease.
The greening of analytical methods has gained interest in the quantitative analysis field to reduce environmental impact and improve safety health conditions for analysts. Nirmatrelvir plus ritonavir ...is a new FDA approved co-packaged medication developed for the treatment of COVID-19. The aim of this research was to develop green fitted HPLC method using pre experimental computational testing of different stationary phases as well as selecting mobile phase regarding to green analytical chemistry principles. Computational study was designed to test the physical interaction between nirmatrelvir and ritonavir and different columns (C8, C18, Cyano column). The study showed that the C18 column was better for simultaneous HPLC analysis of the cited drugs. Regarding to green point of view, mobile phase consisted of ethanol: water (80:20, v/v) provided an efficient chromatographic separation of nirmatrelvir and ritonavir within a short analytical run time, reasonable resolution and excellent sensitivity. Isocratic elution was performed on a selected C18 column and a green adjusted mobile phase at flow rate of 1 mL/min and UV detection at 215 nm. The chromatographic system allowed complete baseline separation with retention times of 4.9 min for nirmatrelvir and 6.8 min for ritonavir. The method succeeded to determine nirmatrelvir and ritonavir over the concentration range of 1.0-20.0 μg/mL in the pure form and in pharmaceutical dosage form. Greenness profiles of the applied HPLC method was assessed using analytical eco-scale, the green analytical procedure index and the AGREE evaluation method. The results revealed adherence of the described method to the green analytical chemistry principles. The authors hope to provide a promising challenge for achieving green goals through integrating computational tools and applying them with green assessment metrics.
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