Antibiotics to improve recovery following tonsillectomy: a systematic review.

OBJECTIVE: To determine if antibiotics improve recovery following tonsillectomy. STUDY DESIGN: DATA SOURCES: Electronic databases Medline, Embase, and Cochrane Controlled Trials Register were searched using relevant search terms. Additional trials, if any, were retrieved by searching the references from all identified trials, reviews, correspondences, editorials, and conference proceedings. No language restriction was applied. STUDY SELECTION: Systematic review of trials in which antibiotic was administered as a study medication intraoperatively and/or postoperatively, in children or adults undergoing tonsillectomy or adenotonsillectomy. Only randomized, placebo-controlled, double-blind trials attaining preset quality scores were included. Outcomes analyzed: 1) pain, need for analgesia, fever, halitosis, and return to normal diet and activities; 2) secondary hemorrhage using 2 parameters-significant hemorrhage (ie, warranting readmission, blood transfusion, or return to theatre for hemostasis) and total hemorrhage; and 3) adverse events. RESULTS: Five trials met the eligibility criteria. Antibiotics significantly reduced the number of subjects manifesting fever (relative risk [RR]: 0.62, 95% confidence interval [CI]: 0.45, 0.85) and duration of halitosis (-1.94 [-3.57, -0.30] days), and marginally reduced the time taken to resume normal activity (-0.63 [-1.12, -0.14] days), but had no significant effect in reducing pain scores (-0.01 [-0.60, 0.57]) or need for analgesia. Similarly, there was no significant difference in the time taken to resume normal diet or incidence of significant and total hemorrhage, although data was underpowered to detect differences for these outcomes. In the antibiotic group 4 patients developed an adverse reaction (3 cases of rash and 1 case of oropharyngeal candidiasis), while in the control group 1 patient had an adverse reaction (rash). The RR of antibiotic-related adverse events was 2.45 (0.45, 13.31). CONCLUSION: Antibiotics appear to be effective in reducing some, but not all, morbid outcomes following tonsillectomy, and may increase the risk of adverse events. Further trials are needed to better define the role of antibiotics in facilitating post-tonsillectomy recovery. EBM RATING: A-1a

Primary Klebsiella pneumoniae Osteomyelitis with Bacteremia and Sepsis in a Patient with Cirrhosis

Osteomyelitis is commonly caused by Staphylococci, Streptococci, Escherichia coli, and anaerobes. There have been cases of rare organisms like Klebsiella pneumoniae (Kp) being initially overlooked as causes of osteomyelitis. We report a case of an elderly cirrhotic adult male transferred for further management of liver failure, who was subsequently diagnosed with Kp osteomyelitis and sepsis. He had a history of blunt leg trauma, and MRI of the leg revealed osteomyelitis, with a negative workup for other sources of infection. Kp osteomyelitis is reported in less than 100 cases, mainly in pediatric and sickle-cell patients. There are no pathognomonic imaging findings. Lesions may be metastatic, with rapid widespread destruction and exuberant periosteal reaction. Kp is a rare, under recognized cause of osteomyelitis in immune-suppressed adults. Given its pathogenicity, early identification is critical

DB-PABP: a database of polyanion-binding proteins

The interactions between polyanions (PAs) and polyanion-binding proteins (PABPs) have been found to play significant roles in many essential biological processes including intracellular organization, transport and protein folding. Furthermore, many neurodegenerative disease-related proteins are PABPs. Thus, a better understanding of PA/PABP interactions may not only enhance our understandings of biological systems but also provide new clues to these deadly diseases. The literature in this field is widely scattered, suggesting the need for a comprehensive and searchable database of PABPs. The DB-PABP is a comprehensive, manually curated and searchable database of experimentally characterized PABPs. It is freely available and can be accessed online at http://pabp.bcf.ku.edu/DB_PABP/. The DB-PABP was implemented as a MySQL relational database. An interactive web interface was created using Java Server Pages (JSP). The search page of the database is organized into a main search form and a section for utilities. The main search form enables custom searches via four menus: protein names, polyanion names, the source species of the proteins and the methods used to discover the interactions. Available utilities include a commonality matrix, a function of listing PABPs by the number of interacting polyanions and a string search for author surnames. The DB-PABP is maintained at the University of Kansas. We encourage users to provide feedback and submit new data and references

Hazardous Processes and Their Risk Mitigation Techniques in Iron and Steel Industry Emission in CFB Boiler- A Review

Steel manufacturing industries are one of the major industries in the world where number of hazards are being involved in Daily work practices. While working in such steel industries safe operating/work procedures are too much significant as employees are exposed to various threats due to nature of job and work operations. For any industry labour is considered as a great asset which follows the work as trades. As per the New Occupational Safety and Health CODE – Hazardous Process is mentioned in two ways (i) consequence in toxic waste of universal atmosphere or (ii) reason material injury to health of a worker occupied [1]. The working environment in steel industry is too much noisy with excessive heat. In today’s world most of the steel industries are using new technologies where control systems are used in various steel manufacturing industries to control number of incidents and accidents and have precise control over steel composition addition which reflects the quality. As the safety is being considered paramount in today’s working environment, so regardless the hazardous process of various steel manufacturing industries achieving an accident free environment is achievable. Several Risk Assessment Techniques like Hazard Identification and Risk Assessment (HIRA) Techniques/Job Safety Analysis are used to reduce the work place injuries i.e. Frequency rate, severity rate and incident rate statistically and statistics of several years has been studied on the various mentioned process and injuries resulting in ill-health is mitigated [2]

Secure and Internet-Less Connectivity to a Blockchain Network for Limited Connectivity Bank Users

Over the past few years, we have seen the emergence of a wide range of banking architectures, technologies, and applications made possible by the significant improvements in hardware, software, and networking technologies. Nowadays, innovative solutions are being developed by banks to leverage the benefits of blockchain, to improve their business agility and performance, and to make their business operations more efficient and secure. However, there are still cases where regular access to Internet is impossible or unreliable due to saturated networks or harsh environments, hence limiting the deployment of typical blockchain based solutions. In this context, an approach using a new connectivity technology is needed in order to increase mobile Internet services for any device to reach nearly 95% of the world population, instantly, simply by drawing on existing mobile phone networks, with no additional infrastructure development. We aim to give the user full bank access from their device, even if the device is not a smart one, using ordinary mobile phone networks. However, providing efficient and secure communications over lossy and low bandwidth networks remains a challenge. The main objective of this paper will be to design an end-to-end and low overhead secure solution for the communications between mobile devices and their corresponding remote application servers that using blockchain via ordinary mobile networks

Numerical Study of N-Heptane Fuelled Hcci Under Different Air Fuel Ratio and Inlet Air Temperature

This paper examines on numerical modeling of Homogenous Charge Compression Ignition (HCCI) engine model using n-heptane as base fuel. The parameters used in this study is different air to fuel ratio (AFR) (25, 30, 35, 40, 45, 50) and different air inlet temperature (25°C, 50°C, 75°C, 100°C). Performance and emission characteristics of n-heptane were investigated at constant engine speed of 1000 rpm in a HCCI engine model. The effects of inlet air temperature were also examined. The test results showed that brake power, brake mean effective pressure and brake specific fuel consumption decreased when increased AFR and inlet air temperature. Meanwhile, brake thermal efficiency shows an increase when increase when AFR and temperature of the inlet increased. The test results also showed that NOx, CO and HC emissions decreased with the increase of inlet air temperature for all AFR value. Overall, this numerical model can be used to predict the performance and emission of the HCCI engine

Supervisory Control Theory in System Safety Analysis

Development of safety critical systems requires a risk management strategy to identify and analyse hazards, and apply necessary actions to eliminate or control them as malfunctions could be catastrophic. Fault Tree Analysis (FTA) is one of the most widely used methods for safety analysis in industrial use. However, the standard FTA is manual, informal, and limited to static analysis of systems. In this paper, we present preliminary results from a model-based approach to address these limitations using Supervisory Control Theory. Taking an example from the Fault Tree Handbook, we present a systematic approach to incrementally obtain formal models from a fault tree and verify them in the tool Supremica. We present a method to calculate minimal cut sets using our approach. These compositional techniques could potentially be very beneficial in the safety analysis of highly complex safety critical systems, where several components interact to solve different tasks

A selective metasurface absorber with an amorphous carbon interlayer for solar thermal applications

This is the author accepted manuscript. The final version is available from Elsevier via the DOI in this recordData availability: Data shown in this paper is accessible via the University of Bristol data repository: 10.5523/bris.11twobtdyxfs1ib2fxhlvn107This paper presents fabrication, measurement and modelling results for a metal-dielectric-metal metasurface absorber for solar thermal applications. The structure uses amorphous carbon as an inter-layer between thin gold films with the upper film patterned with a 2D periodic array using focused ion beam etching. The patterned has been optimised to give high absorptance from 400-1200nm and low absorptance above this wavelength range to minimise thermal radiation and hence obtain higher temperature performance. Wide angle absorptance results are shown and detailed modelling of a realistic nanostructured upper layer results in excellent agreement between measured and modelled results. The use of gold in this paper is a first step towards a high temperature metasurface where gold can be replaced by other refractory metals such as tungsten or chrome.Engineering and Physical Sciences Research Council (EPSRC

Whole genome sequence analysis of blood lipid levels in \u3e66,000 individuals

Blood lipids are heritable modifiable causal factors for coronary artery disease. Despite well-described monogenic and polygenic bases of dyslipidemia, limitations remain in discovery of lipid-associated alleles using whole genome sequencing (WGS), partly due to limited sample sizes, ancestral diversity, and interpretation of clinical significance. Among 66,329 ancestrally diverse (56% non-European) participants, we associate 428M variants from deep-coverage WGS with lipid levels; ~400M variants were not assessed in prior lipids genetic analyses. We find multiple lipid-related genes strongly associated with blood lipids through analysis of common and rare coding variants. We discover several associated rare non-coding variants, largely at Mendelian lipid genes. Notably, we observe rare LDLR intronic variants associated with markedly increased LDL-C, similar to rare LDLR exonic variants. In conclusion, we conducted a systematic whole genome scan for blood lipids expanding the alleles linked to lipids for multiple ancestries and characterize a clinically-relevant rare non-coding variant model for lipids