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Background: A penicillin allergy guidance document containing an algorithm for challenging penicillin allergic patients with β-lactams was developed by the antimicrobial stewardship program (ASP). As part of this algorithm, a “graded challenge” order set was created containing antimicrobial orders and safety medications along with monitoring instructions. The process is designed to challenge patients at low risk of reaction with infusions of 1% of the target dose, then 10%, and finally the full dose, each 30 minutes apart. We evaluated outcomes from the order set. Methods: Orders of the graded challenge over 17 months (March 2018 through July 2019) were reviewed retrospectively. Data were collected on ordering and outcomes of the challenges and allergy documentation. Use was evaluated based on ASP-recommended indications: history of IgE-mediated or unknown reaction plus (1) no previous β-lactam tolerance and the reaction occurred >10 years ago, or (2) previous β-lactam tolerance, now requiring a different β-lactam for treatment. Only administered challenges were included and descriptive statistics were utilized. Results: Of 67 orders, 57 graded challenges were administered to 56 patients. The most common allergies were penicillins (87.7%) and cephalosporins (38.6%), with the most common reactions being unknown (41.7%) or hives (22%). The most common antibiotics challenged were ceftriaxone (43.9%), cefepime (21.1%), and cefazolin (5.3%). Antibiotics given prior to challenge included vancomycin (48.2%), fluoroquinolones (35.7%), carbapenems (21.4%), aztreonam (19.6%), and clindamycin (12.5%). The median duration of challenged antibiotic was 6 days. The infectious diseases service was consulted on 59.6% of challenges and 75.4% of challenges were administered in non-ICU settings. There was 1 reaction (1.8%) involving a rash with the second infusion, which was treated with oral diphenhydramine and had no lasting effects. Based on indications, 80.7% of challenges were aligned with ASP guidance criteria. The most common use outside of these criteria was in patients without IgE-mediated reactions (10.5%). Most of these had minor rashes and could have received a full dose of a cephalosporin. Allergy information was updated in the electronic health record after 91.2% of challenges. Conclusions: We demonstrated the utility of a graded challenge process at our academic medical center. It was well tolerated, ordered frequently by noninfectious diseases clinicians, administered primarily in non-ICU settings, and regularly resulted in updated allergy information in the medical record. With many patients initially receiving broad-spectrum antibiotics with high costs or increased rates of adverse effects, graded challenges can potentially prevent the use of suboptimal therapies with minimal time and resource investment.
Disclosures: Scott Bergman reports a research grant from Merck.
Recent funding from Welsh Government for mental health has helped to develop liaison psychiatry services in Wales. Systematic data collection was undertaken to map the liaison psychiatry services in Wales in collaboration with the Royal College of Psychiatrists in Wales and Public Health Wales 1000 Lives Improvement. A questionnaire was designed and circulated to all the health boards in Wales to gather information to map liaison psychiatry services in Wales. Up-to-date information was confirmed in January 2018, via email.
Over the past 2 years, liaison psychiatry services have been set up in six out of seven health boards in Wales. Staffing levels have increased and the remit of services has broadened.
Mapping has highlighted that liaison psychiatry services in Wales continue to evolve. It will be important to continue to monitor these developments and their effects. Comparison with services in England will provide a useful comparison of service provision. A particular challenge will be to establish and monitor liaison psychiatry standards in Wales.
Carbon dioxide (CO2) is arguably the most high-profile molecule of recent times. Although much of its bad press comes from environmental concerns associated with greenhouse gas emissions, there exists the possibility to harness this abundant resource for application to the synthesis and processing of useful materials. This article describes a selection of recent successes in using supercritical carbon dioxide (scCO2) as a solvent for polymerizations. Further, the uses of compressed CO2 as a processing tool in the fabrication of materials for applications such as coatings and biomaterials are discussed. Finally, the application of scCO2 to photolithography is demonstrated, with particular focus on CO2 as a processing solvent for the patterning of organic electronic devices.
The stringent weight and space requirements of advanced space and aerospace systems have lead to a need for stronger, lighter, smaller, and more flexible cable and wiring components. Syscom has fabricated a multifunctional metal/polymer hybrid fiber from a rigid-rod type of polymer, such as poly(p-phenylene benzobisoxazole) (PBO) fiber, for signal transfer and electromagnetic interference (EMI) shielding in wiring and cable applications. The test results indicated that the metal/polymer hybrid PBO fiber exhibited ∼67% the electrical conductivity, ∼73% the weight and ∼200% the tensile strength of a comparable size of beryllium-copper CS95 wire. Additional experimental results of electric current carrying capability, cable shielding performance and atomic oxygen erosion protection will also be discussed.
An endo-DNase with single strand nicking activity from
the bean pathogen, F. solani f. sp. phaseoli
has been previously reported to
induce the expression of defence genes in peas. Culture
filtrates of the potato pathogen, Colletotrichum
coccodes, also contain a single
strand nicking endo-DNase (CCN). This nuclease has a
molecular weight of ∼27 kDa, an isoelectric point of
pH 7·8, optimal
catalytic activity at pH 5–6 and is stable at temperatures
below 50°C. CCN activity increases are observed with
addition of cation cofactors, favouring
Na+>Zn2+. CCN is inhibited by
aurintricarboxylic acid, a nuclease inhibitor. The point
of CCN cleavage on the DNA molecule is between the
5′-phosphate and the 3′-hydroxyl. CCN also
possesses RNase activity.
Although the C. coccodes culture filtrate can
induce the expression of disease resistance response genes
and phytoalexin production in
pea tisue, this inductive activity does not co-purify with
the CCN DNase activity through the Sephacel G-75 purification
step, and thus CCN applied singly does not serve as a signal
for initiating the host defence reponses. Because CCN degrades
both DNA and RNA, it is more probably a nutrient scavenging enzyme.
The effect of uniaxial stress on the NL8 EPR spectrum in 450°C heattreated silicon containing thermal donors (TD's) is described. Changes in the relative amplitudes of the NL8 spectral components are interpreted as arising from electronic redistribution between the differently oriented defects. These changes are consistent in sign and magnitude with those predicted for TD+ from observed stress effects on the TD IR and DLTS spectra.
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