Antimicrobial de-escalation in the critically ill patient and assessment of clinical cure: the DIANA study

Purpose: The DIANA study aimed to evaluate how often antimicrobial de-escalation (ADE) of empirical treatment is performed in the intensive care unit (ICU) and to estimate the effect of ADE on clinical cure on day 7 following treatment initiation. Methods: Adult ICU patients receiving empirical antimicrobial therapy for bacterial infection were studied in a prospective observational study from October 2016 until May 2018. ADE was defined as (1) discontinuation of an antimicrobial in case of empirical combination therapy or (2) replacement of an antimicrobial with the intention to narrow the antimicrobial spectrum, within the first 3 days of therapy. Inverse probability (IP) weighting was used to account for time-varying confounding when estimating the effect of ADE on clinical cure. Results: Overall, 1495 patients from 152 ICUs in 28 countries were studied. Combination therapy was prescribed in 50%, and carbapenems were prescribed in 26% of patients. Empirical therapy underwent ADE, no change and change other than ADE within the first 3 days in 16%, 63% and 22%, respectively. Unadjusted mortality at day 28 was 15.8% in the ADE cohort and 19.4% in patients with no change [p = 0.27; RR 0.83 (95% CI 0.60\u20131.14)]. The IP-weighted relative risk estimate for clinical cure comparing ADE with no-ADE patients (no change or change other than ADE) was 1.37 (95% CI 1.14\u20131.64). Conclusion: ADE was infrequently applied in critically ill-infected patients. The observational effect estimate on clinical cure suggested no deleterious impact of ADE compared to no-ADE. However, residual confounding is likely

Electrode modification using nanocomposites of electropolymerised cobalt phthalocyanines supported on multiwalled carbon nanotubes

A polymer of tetra(4)-(4,6-diaminopyrimidin-2-ylthio) phthalocyaninatocobalt(II) (CoPyPc) has been deposited over a multiwalled carbon nanotube (MWCNT) platform and its electrocatalytic properties investigated side by side with polymerized cobalt tetraamino phthalocyanine (CoTAPc). X-ray photoelectron spectroscopy, scanning electron microscopy and cyclic voltammetry studies were used for characterization of the prepared polymers of cobalt phthalocyanine derivatives and their nanocomposites. L-Cysteine was used as a test analyte for the electrocatalytic activity of the nanocomposites of polymerized cobalt phthalocyanines and multiwalled carbon nanotubes. The electrocatalytic activity of both polymerized cobalt phthalocyanines was found to be superior when polymerization was done on top of MWCNTs compared to bare glassy carbon electrode. A higher sensitivity for L-cysteine detection was obtained on CoTAPc compared to CoPyPc

Prediction of the main caving span in longwall mining using fuzzy MCDM technique and statistical method

Immediate roof caving in longwall mining is a complex dynamic process, and it is the core of numerous issues and challenges in this method. Hence, a reliable prediction of the strata behavior and its caving potential is imperative in the planning stage of a longwall project. The span of the main caving is the quantitative criterion that represents cavability. In this paper, two approaches are proposed in order to predict the span of the main caving in longwall projects. Cavability index (CI) is introduced based on the hybrid multi-criteria decision-making technique, combining the fuzzy analytical network processes (ANP) and the fuzzy decision-making trial and evaluation laboratory (DEAMTEL). Subsequently, the relationship between the new index and the caving span is determined. In addition, statistical relationships are developed, incorporating the multivariate regression method. The real data for nine panels is used to develop the new models. Accordingly, two models based on CI including the Gaussian and cubic models as well as the linear and non-linear regression models are proposed. The performance of the proposed models is evaluated in various actual cases. The results obtained indicate that the CI-Gaussian model possesses a higher performance in the prediction of the main caving span in actual cases when compared to the other models. These results confirm that it is not possible to consider all the effective parameters in an empirical relationship due to a higher error in the prediction

Plastic rotation capacity of high-strength concrete beams

Abstract  This work describes an experimental study on the plastic rotation capacity of high strength beams. Nine simply supported isotatic beams were tested, by applying comprising two symmetrical concentrated loads at approximately one-third and two-third's span. A method of analysis is defined that leads to the development of a parameter that characterizes the plastic rotation capacity at the failure section by means of a plastic analysis of the tested beams. The influence of concrete strength and the longitudinal tensile reinforcement ratio on the capacity for plastic rotation is examined and discussed. The results are discussed and compared with previous studies

Lithium attenuated the behavioral despair induced by acute neurogenic stress through blockade of opioid receptors in mice

Major depressive disorder is disease with high rate of morbidity and mortality. Stressful events lead to depression and they can be used as a model of depression in rodents. In this study we aimed to investigate whether lithium modifies the stressed-induced depression through blockade of opioid receptors in mice. We used foot shock stress as stressor and forced swimming test (FST), tail suspension test (TST) and open field test (OFT) to evaluation the behavioral responses in mice. We also used naltrexone hydrochloride (as opioid receptor antagonist), and morphine (as opioid receptor agonist). Our results displayed that foot-shock stress significantly increased the immobility time in TST and FST but it could not change the locomotor behavior in OFT. When we combined the low concentrations of lithium and naltrexone a significant reduction in immobility time was seen in the FST and TST in comparison with control foot-shock stressed group administered saline only. Despite the fact that our data showed low concentrations of lithium, when administered independently did not significantly affect the immobility time. Also our data indicated that concurrent administration of lithium and naltrexone had no effect on open field test. Further we demonstrated that simultaneous administration of morphine and lithium reverses the antidepressant like effect of active doses of lithium. Our data acclaimed that we lithium can augment stressed-induced depression and opioid pathways are involved in this action. © 201

Defluoridation of synthetic and natural waters by polyaluminum chloride-chitosan (PACl-Ch) composite coagulant

Removal of fluoride from drinking water by polyaluminum chloride-chitosan (PACl-Ch) composite coagulant was studied in a batch system. Two types of PACl-Ch coagulant were synthetized as PACl-Ch I and PACl-Ch II with chitosan to aluminum (Ch:Al) weight ratios of 0.5 and 1.0, respectively, and were used for defluoridation under different operating conditions. The composite coagulants were found to be more efficient than both PACl and chitosan. By an increase in the Ch:Al ratio from 0.5 to 1.0, the composite coagulant provided a little more efficiency of fluoride removal and lower residual level of Al. The optimum conditions of pH for fluoride removal by PACl-Ch I and PACl-Ch II were 8.0 and 7.5, respectively. Fluoride removal by the coagulants was not significantly affected by natural organic matter and turbidity, but was declined by high concentrations of common ions. To achieve desirable fluoride levels (lower than 1.0 mg/L) for natural water samples with fluoride levels of 2.0-2.9 mg/L, the required dosage of the composite coagulants were determined to be as low as 3-5 mgAl/L. The PACl-Ch coagulants demonstrated high efficiency for fluoride removal as well as low Al residual level (mainly lower than 0.2 mg/L) in a wide range of operating conditions