Modal analysis and nonlinear characterization of an airborne power ultrasonic transducer with rectangular plate radiator

Some industrial processes like particle agglomeration or food dehydration among others can be enhanced by the use of power ultrasonic technologies. These technologies are based on an airborne power ultrasonic transducer (APUT) constituted by a pre-stressed Langevin-type transducer, a mechanical amplifier and an extensive plate radiator. In order to produce the desired effects in industrial processing, the transducer has to vibrate in an extensional mode driving an extensive radiator in the desired flexural mode with high amplitude displacements. Due to the generation of these high amplitude displacements in the radiator surfaces, non-linear effects like frequency shifts, hysteresis or modal interactions, among others, may be produced in the transducer behavior. When any nonlinear effect appears, when applying power, the stability and efficiency of this ultrasonic technology decreases, and the transducer may be damaged depending on the excitation power level and the nature of the nonlinearity. In this paper, an APUT with flat rectangular radiator is presented, as the active part of an innovative system with stepped reflectors. The nonlinear behavior of the APUT has been characterized numerically and experimentally in case of the modal analysis and experimentally in the case of dynamic analysis. According to the results obtained after the experiments, no modal interactions are expected, nor do other nonlinear effects.

Experimental determination of drift and PM10 cooling tower emissions: Influence of components and operating conditions

Cooling tower emissions have become an increasingly common hazard to the environment (air polluting, ice formation and salts deposition) and to the health (Legionella disease) in the last decades. Several environmental policies have emerged in recent years limiting cooling tower emissions but they have not prevented an increasing intensity of outbreaks. Since the level of emissions depends mainly on cooling tower component design and the operating conditions, this paper deals with an experimental investigation of the amount of emissions, drift and PM₁₀, emitted by a cooling tower with different configurations (drift eliminators and distribution systems) and working under several operating conditions. This objective is met by the measurement of cooling tower source emission parameters by means of the sensitive paper technique. Secondary objectives were to contextualize the observed emission rates according to international regulations. Our measurements showed that the drift rates included in the relevant international standards are significantly higher than the obtained results (an average of 100 times higher) and hence, the environmental problems may occur. Therefore, a revision of the standards is recommended with the aim of reducing the environmental and human health impact. By changing the operating conditions and the distribution system, emissions can be reduced by 52.03% and 82% on average. In the case of drift eliminators, the difference ranges from 18.18% to 98.43% on average. As the emissions level is clearly influenced by operating conditions and components, regulation tests should be referred to default conditions. Finally, guidelines to perform emission tests and a selection criterion of components and conditions for the tested cooling tower are proposed.

The revolving door: antibiotic allergy labelling in a tertiary care centre

BACKGROUND

Patients frequently report antibiotic allergies; however, only 10% of labelled patients have a true allergy.

AIM

We investigated the documentation of antibiotic 'allergy' labels (AAL) and the effect of labelling on clinical outcomes, in a West Australian adult tertiary hospital.

METHODS

Retrospective cross-sectional analysis of patients captured in the 2013 and 2014 National Antimicrobial Prescribing Surveys was carried out. Data were collected on documented antibiotic adverse drug reactions, antibiotic cost, prescribing appropriateness, prevalence of multi-drug resistant organisms, length of stay, intensive care admission and readmissions.

RESULTS

Of the 687 patients surveyed, 278 (40%) were aged 70 or above, 365 (53%) were male and 279 (41%) were prescribed antibiotics. AAL were recorded in 122 (18%) patients and the majority were penicillin labels (n = 87; 71%). Details of AAL were documented for 80 of 141 (57%) individual allergy labels, with 61 describing allergic symptoms. Patients with beta-lactam allergy labels received fewer penicillins (P = 0.0002) and more aminoglycosides (P = 0.043) and metronidazole (P = 0.021) than patients without beta-lactam labels. Five patients received an antibiotic that was contraindicated according to their allergy status. Patients with AAL had significantly more hospital readmissions within 4 weeks (P = 0.001) and 6 months (P = 0.025) of discharge, compared with unlabelled patients. The majority (81%) of readmitted labelled patients had major infections.

CONCLUSIONS

AAL are common, but poorly documented in hospital records. Patients with AAL are significantly more likely to require alternative antibiotics and hospital readmissions. There may be a role for antibiotic allergy delabelling to mitigate the clinical and economic burdens for patients with invalid allergy labels.

Reassessment of antibiotic therapy in hospitals

INTRODUCTION

French national guidelines state that antibiotic therapies should be reassessed between 48 and 72hours after treatment initiation and that reassessment of antibiotic therapy (RA) must be recorded in patients' files.

OBJECTIVE

To determine whether RA is performed and recorded in patients' files in hospitals in a region of France.

METHODS

Setting: hospitals participating in the National nosocomial infection point- prevalence survey (NPS) in Upper-Normandy, France. Patients included those receiving antibiotic therapy (excluding antibiotic prophylaxis) on NPS day, started in the hospital in which the survey was conducted and ongoing for more than 72hours. Data collected included characteristics of participating hospitals and, for each included patient, characteristics of ward, infection and antibiotic therapy, and mention in the patients' files of explicit or implicit RA. The rate of explicit and implicit RA was calculated and factors associated with explicit or implicit RA were evaluated using a univariate analysis.

RESULTS

Thirty-three hospitals representing 87% of hospital beds region-wide were included in the study. In addition, 933 prescriptions were assessed for 724 infections in 676 patients. The overall rate of RA was 67.6% (49.3% of explicit RA and 18.3% of implicit RA). The rate of RA differed significantly according to infection and antibiotic class but not according to hospital or ward characteristics.

CONCLUSION

Our study provides new and reassuring results regarding reassessment of antibiotic therapy.

Return to sender: the need to re-address patient antibiotic allergy labels in Australia and New Zealand

BACKGROUND/AIM

Antibiotic allergies are frequently reported and have significant impacts upon appropriate prescribing and clinical outcomes. We surveyed infectious diseases physicians, allergists, clinical immunologists and hospital pharmacists to evaluate antibiotic allergy knowledge and service delivery in Australia and New Zealand.

METHODS

An online multi-choice questionnaire was developed and endorsed by representatives of the Australasian Society of Clinical Immunology and Allergy (ASCIA) and the Australasian Society of Infectious Diseases (ASID). The 37-item survey was distributed in April 2015 to members of ASCIA, ASID, the Society of Hospital Pharmacists of Australia and the Royal Australasian College of Physicians.

RESULTS

Of 277 respondents, 94% currently use or would utilise antibiotic allergy testing (AAT) and reported seeing up to 10 patients/week labelled as antibiotic-allergic. Forty-two per cent were not aware of or did not have AAT available. Most felt that AAT would aid antibiotic selection, antibiotic appropriateness and antimicrobial stewardship (79, 69 and 61% respectively). Patients with the histories of immediate hypersensitivity were more likely to be referred than those with delayed hypersensitivities (76 vs 41%, P = 0.0001). Lack of specialist physicians (20%) and personal experience (17%) were barriers to service delivery. A multidisciplinary approach was a preferred AAT model (53%). Knowledge gaps were identified, with the majority overestimating rates of penicillin/cephalosporin (78%), penicillin/carbapenem (57%) and penicillin/monobactam (39%) cross-reactivity.

CONCLUSIONS

A high burden of antibiotic allergy labelling and demand for AAT is complicated by a relative lack availability or awareness of AAT services in Australia and New Zealand. Antibiotic allergy education and deployment of AAT, accessible to community and hospital-based clinicians, may improve clinical decisions and reduce antibiotic allergy impacts. A collaborative approach involving infectious diseases physicians, pharmacists and allergists/immunologists is required.

A multi-scale model of the interplay between cell signalling and hormone transport in specifying the root meristem of Arabidopsis thaliana

The growth of the root of Arabidopsis thaliana is sustained by the meristem, a region of cell proliferation and differentiation which is located in the root apex and generates cells which move shootwards, expanding rapidly to cause root growth. The balance between cell division and differentiation is maintained via a signalling network, primarily coordinated by the hormones auxin, cytokinin and gibberellin. Since these hormones interact at different levels of spatial organisation, we develop a multi-scale computational model which enables us to study the interplay between these signalling networks and cell-cell communication during the specification of the root meristem. We investigate the responses of our model to hormonal perturbations, validating the results of our simulations against experimental data. Our simulations suggest that one or more additional components are needed to explain the observed expression patterns of a regulator of cytokinin signalling, ARR1, in roots not producing gibberellin. By searching for novel network components, we identify two mutant lines that affect significantly both root length and meristem size, one of which also differentially expresses a central component of the interaction network (SHY2). More generally, our study demonstrates how a multi-scale investigation can provide valuable insight into the spatio-temporal dynamics of signalling networks in biological tissues.

Free kappa light chains in cerebrospinal fluid as a biomarker to assess risk conversion to multiple sclerosis

Background

Multiple sclerosis (MS) initiates with a first attack or clinically isolated syndrome (CIS). The importance of an early treatment in MS leads to the search, as soon as possible, for novel biomarkers which can predict conversion from CIS to MS.

Objective

The purpose of this study was to assess the predictive value of the kappa index (κ index), using kappa free light light chains (κFLCs) in cerebrospinal fluid (CSF), for the conversion of CIS patients to MS, and compare its accuracy with other parameters used in clinical practice.

Methods

FLC levels were analysed in CSF from 176 patients: 70 as control group, 77 CIS, and 29 relapsing–remitting MS. FLC levels were quantified by nephelometry.

Results

κ Index sensitivity and specificity (93.1%; 95.7%) was higher than those from the immunoglobulin G (IgG) index (75.9%; 94.3%), and lower than those from oligoclonal IgG bands (OCGBs) (96.5%; 98.6%). The optimal cut-off for κ index was 10.62. Most of the CIS patients with κ index >10.62 presented OCGBs, IgG index >0.56 and fulfilled magnetic resonance imaging (MRI) criteria.

Conclusion

CIS patients above κ index cut-off of 10.62 present 7.34-fold risk of conversion to MS than CIS below this value. The κ index correlated with positive OCGBs, IgG index above 0.56 and MRI criteria.

Molecular diagnosis in cerebral cavernous malformations

INTRODUCTION

Cerebral cavernous malformations (CCMs; OMIM 116860) are enlarged vascular cavities without intervening brain parenchyma whose estimated prevalence in the general population is between 0.1% and 0.5%. Familial CCM is an autosomal dominant disease with incomplete clinical and radiological penetrance. Three genes have been linked to development of the lesions: CCM1/KRIT1, CCM2/MGC4607, and CCM3/PDCD10.

DEVELOPMENT

The aetiological mutation is not detected in a large percentage of cases and new approaches are therefore needed. The aim of this review is to analyse current molecular techniques and the possible mutations or variations which can be detected in a molecular genetics or molecular biology laboratory. Likewise, we will analyse other alternatives that may help detect mutations in those patients showing negative results.

CONCLUSIONS

A molecular diagnosis of cerebral cavernous malformations should provide at least the copy number variation and sequencing of CCM genes. In addition, appropriate genetic counselling is a crucial source of information and support for patients and their relatives.

Therapeutic immunoglobulin should be dosed by clinical outcome rather than by body weight in obese patients

There are currently no data to support the suggestion that the dose of therapeutic immunoglobulin (Ig) should be capped in obese patients for pharmacokinetic (PK), safety and economic reasons. We compared IgG trough levels, increment and efficiency in matched pairs of obese and lean patients receiving either replacement or immunomodulatory immunoglobulin therapy. Thirty-one obese patients were matched with a clinically equivalent lean patient across a range of indications, including primary antibody deficiency or autoimmune peripheral neuropathy. Comprehensive matching was carried out using ongoing research databases at two centres in which the dose of Ig was based on clinical outcome, whether infection prevention or documented clinical neurological stability. The IgG trough or steady state levels, IgG increments and Ig efficiencies at times of clinical stability were compared between the obese and lean cohorts and within the matched pairs. This study shows that, at a population level, obese patients achieved a higher trough and increment (but not efficiency) for a given weight-adjusted dose compared with the lean patients. However at an individual patient level there were significant exceptions to this correlation, and upon sub-group analysis no significant difference was found between obese and lean patients receiving replacement therapy. Across all dose regimens a high body mass index (BMI) cannot be used to predict reliably the patients in whom dose restriction is clinically appropriate.