Purpose
Treatment failures following vancomycin therapy in patients with methicillin-resistant
Staphylococcus aureus
infections have led to the utilization of higher doses of this antibiotic to ...achieve the trough concentrations of 10–20 μg/mL recommended by the Infectious Diseases Society of America clinical practice guideline. However, many questions remain on the safety of such high doses of vancomycin, specifically their nephrotoxic effects. In this review, we have collected available evidence on the nephrotoxicity of vancomycin, particularly in terms of its mechanism, incidence, predisposing factors and special target populations.
Method
The data were collected by searching Scopus, PubMed, Medline, and Cochrane database systematic reviews. The key words used as search terms were “vancomycin”, “nephrotoxicity”, “renal failure”, “renal damage”, “risk factors”, “infants”, “children”, “adult”, “elderly” and “pregnancy”. We have included all relevant animal and human studies up to the date of publication.
Results and conclusion
Vancomycin-induced renal toxicity was reported in 10–20 % and 30–40 % of patients following conventional and high doses of vancomycin therapy, respectively .The most probable mechanism for its nephrotoxicity can be at least partially attributable to an increased production of reactive oxygen species and oxidative stress. There are a number of different risk factors which could accelerate or potentiate the occurrence of vancomycin-induced nephrotoxicity, with the most documented risk factors being high trough vancomycin level (especially >20 mg/L) or doses (>4 g/day), concomitant treatment with nephrotoxic agents, prolonged therapy (even more than 7 days), and admittance to an intensive care unit (especially prolonged stay). It is necessary to carry out more studies, especially those focused on the association between nephrotoxicity and high trough levels of vancomycin.
This paper aims to introduce a framework to measure the sustainable performance of the supply chain (SC) during the COVID-19 pandemic. The SC stakeholders in this investigation are Suppliers, ...Production / Remanufacturing / Refurbishing Centers (Factories), Collection / Distribution Centers, Recycling / Landfill Centers, and Customers. The suggested sustainable supply chain (SSC) performance measurement included three pillars with 23 indicators. To evaluate the overall sustainability of the SC understudy, a composite index has been developed that combines all the indicators to reflect the sustainability performance of the SC. Four steps are involved in creating a composite index:1) measuring the value of indicators, 2) weighing indicators, 3) Using the normalization technique, and 4) Evaluating the overall SSC indicator. The real case in Iran is selected as an illustrative case. Our research contributions are: We suggested a novelty indicator of SSC to better show the economic, environmental, and social tradeoffs during the COVID-19 pandemic and lockdowns. We have found and measured the negative and positive impacts of COVID-19 on aspects of sustainability in SC. Based on the achieved data of the real case study, a numerical example is represented to explain how to calculate the composite index. The main contribution of this paper is the development of SSC indicators during the COVID-19 epidemic.
Purpose
There are limited data regarding the safety of direct oral anticoagulants (DOACs) during breastfeeding. The aim of the present study is to investigate the extent of excretion of DOACs into ...human milk according to the available clinical and experimental studies.
Methods
On 16th January 2021, we systematically searched PubMed, Scopus, Embase, and Web of Science for all studies which investigated DOACs in breastfeeding without any time frame and language limitation. Search keywords were breastfeeding, breast feeding, breastfed, lactation, milk secretion OR milk AND apixaban OR Eliquist OR rivaroxaban OR Xarelto OR edoxaban OR Savaysa OR dabigatran OR Pradaxa OR dabigatran etexilate OR dabigatran etexilate mesylate OR direct oral anticoagulant OR DOAC OR new oral anticoagulant OR NOAC. Finally, we identified six articles which reported DOAC use during breastfeeding or lactation.
Results and conclusion
According to the available limited data, dabigatran has the least excretion in human breast milk. Rivaroxaban and dabigatran both have acceptable milk excretion cutoffs, whereas apixaban milk excretion is greater than the maximum allowed range. Further well-designed studies with larger sample sizes are required to generate consistent comparable data and clarify benefits and risks of each DOAC during breastfeeding.
For many years, cellular manufacturing has been implemented by owners of manufacturing units. Furthermore, the increasing importance of sustainable development has led manufacturers and managers to ...consider the concepts of sustainable manufacturing. Sustainable manufacturing includes three components: economic, environmental, and social responsibility. Many research and studies have been conducted in the field of cellular manufacturing, and also in most studies, only the economic component or at most two components of sustainable manufacturing have been taken into account. With increasing concerns about global warming, environmental issues have become particularly important in the production of products and goods. On the other hand, customer satisfaction as one of the aspects of social responsibility is of significant importance. In this research, we put the sustainable manufacturing system in the dynamic cellular manufacturing system under uncertainty (fuzzy parameters). A multiobjective sustainable mathematical model with objective functions of minimizing costs minimizing CO2 emissions and minimizing product shortages (customer satisfaction) was proposed. In order to confirm the validity and accuracy of the proposed model, a small example was solved in GAMS software with CPLEX solver and epsilon constraint method, and its basic variables were investigated. Then, due to the high complexity of the proposed cellular manufacturing model, two meta-heuristic algorithms NSGA-II and MOGWO were used to solve larger problems in MATLAB software. To compare the performance of the two proposed algorithms, ten problems with different dimensions were designed and then the two algorithms were compared with each other based on several performance evaluation indicators. Also, in order to investigate the significance of the difference between the two algorithms based on each index, a statistical analysis was carried out by Minitab software. Taguchi method was also used to adjust the parameters of both algorithms. Based on the analytic results and statistical analysis, the MOGWO algorithm performed better than NSGA-II algorithm and the exact solution method, GAMS software.
In this study, using system dynamics approaches and multi-criteria decision-making, the investment analysis in the privatization of the National Iranian Drilling Company is investigated. For this ...purpose, key variables and factors influencing identification privatization and causal relationships between these variables are plotted in two causal loop diagram, stock and flow diagram in systems dynamics approach. Then the results are simulated in Vensim software from 2018 to 2025 and various investment scenarios for privatization are investigated. Also, using multi-criteria decision-making approach based on BWM technique, investment priorities were identified in each dimension of EFQM empowerment. The results of the system dynamics approach show that all aspects of privatization don't have the same impact on firm performance. The results of the present study will also contribute to the development of research literature in the field of privatization, and the proposed approach of the article can be used as a tool in the hands of managers and government officials to show them where and on what basis they should start privatization.
•A new integrated approach is proposed to analyze privatization in drilling industry.•The approach is based on systems dynamic and multi criteria decision making method.•The systems dynamic method is used to present a casual model of EFQM component.•The Best Worst Method is used to prioritize the investment in EFQM component.•Some strategies are proposed to manage privatization in Iranian drilling industry.
The full impact of the COVID-19 pandemic on higher education and interprofessional education programs in particular is yet to be determined, however, it is clear that this pandemic is changing the ...way we live, learn, and work. Online education is becoming the new normal in academia, but it is a development that may be posing a conundrum to some. Teachers of interprofessional education are expected to employ online education, but some may lack the knowledge and expertise to create and facilitate an engaging, positive, and supportive online environment for their students. This report discusses the application of Meaningful Discourse and the Community of Inquiry principles on developing online learning communities in interprofessional education.
Objectives
In this study, changes in lactate clearance following magnesium supplementation were evaluated in critically ill patients with severe sepsis.
Methods
Fifty-eight patients with severe ...sepsis were randomly assigned to receive either magnesium (
n
= 30) or placebo (
n
= 28). Patients in the magnesium group received intravenous magnesium sulfate to maintain serum magnesium level around 3 mg/dL for 3 days. The placebo group received the same volume of normal saline. Change in lactate clearance was considered primary outcome of the study.
Results
Mean increase in the lactate clearance in the magnesium group was significantly higher than the placebo group on day 2 (27.53% vs. 23.79% respectively,
p
< 0.001) and day 3 (49.83% vs. 37.02% respectively,
p
< 0.001). Time to lactate clearance was also significantly shorter in the magnesium group than the placebo group (47.28 ± 20.59 vs. 61.20 ± 24.31 h respectively,
p
= 0.03). Sepsis-related mortality was not significantly different but median length of ICU stay was significantly shorter in the magnesium group than the placebo group (8 vs. 15 days respectively,
p
< 0.01).
Conclusions
Magnesium supplementation increased lactate clearance in critically ill patients with severe sepsis. Optimizing serum magnesium level near the upper limit of the normal range may improve severe sepsis outcomes.
Abstract
The desulphurization of hydrocarbon fuels with high sulphur content and a wide variety of sulphur‐containing compounds brings significant challenges. In the present work, the non‐catalytic ...desulphurization of vacuum gas oil (VGO) and natural gas condensate mixed fuel has been investigated. In this regard, ozone was employed as the oxidant in a bubble column gas–liquid contactor, and an extraction step was further incorporated. The effects of the oxidation reactor scheme, ozonation time, and extraction with different solvents, applying pre‐ and post‐extraction strategies (i.e., ozonation/extraction/extraction and extraction/ozonation/extraction), have been studied. It was found that pre‐extraction of mixed fuel increases the oxidative desulphurization (ODS) efficiency due to the removal of light sulphur‐containing compounds (SCCs). N‐methyl‐2‐pyrrolidone (NMP) has been found to be the most effective extraction agent, removing 44% of sulphur by pure extraction and 77.4% by ozonation + extraction. However, in terms of fuel loss, dimethylformamide (DMF) performs better than NMP, and it has been shown to be the most appropriate solvent for achieving a 90% desulphurization ratio. Finally, it was found that the applied procedure could effectively remove the wide range of SCCs, especially refractive components such as benzothiophene (BT) and dibenzothiophene (DBT).
This study presents the design, fabrication, and measurement of a compact microstrip monopulse antenna array for surveillance applications. The design process and limitations of the planar antenna ...structure are discussed, including the stacking of two radiating elements as a parasitic loaded patch antenna to increase bandwidth and suppress mutual coupling. A distributed feeding network for Formula Omitted elements with an integrated monopulse comparator, was designed and optimized, with the comparator placed in a separate layer to prevent spurious radiation. The operating frequency is 15.5-18 GHz, and the antenna exhibited a bandwidth of approximately 15%. The measurement results for the fabricated antenna array align with the simulations and design goals, with sidelobe levels of the beam better than 17 dB in both the E- and H-plane, and a null depth in the Delta pattern of less than −30 dB. The peak gain at the operating frequency is 22.3 dB and the total efficiency of the antenna array is approximately 55%.
PDF
