Optimal duration of antibiotic treatment for community-acquired pneumonia in adults: a systematic review and duration-effect meta-analysis

ABSTRACTImportanceCommunity-acquired pneumonia (CAP) is a leading cause of morbidity and mortality globally. The optimal duration of antimicrobial therapy remains unclear and controversial.ObjectiveTo find the optimal treatment duration with antibiotics for CAP in adults.Data SourcesMEDLINE, Embase and CENTRAL from inception to present (25 August, 2021).Study SelectionAll randomized controlled trials comparing the same antibiotics used at the same daily dosage but for different durations for CAP in adults. We included any antibiotics, administered orally or intravenously. We included both outpatients and inpatients but not those admitted to intensive care unit.Data Extraction and SynthesisTwo review authors independently screened and extracted data. We conducted random-effects, one-stage duration-effect meta-analysis with restricted cubic splines. We tested the non-inferiority with the pre-specified non-inferiority margin of 10% examined against 10 days using intention-to-treat dataset.Main Outcomes and MeasuresThe primary outcome was clinical improvement at day 15 (range 7-45 days). Secondary outcomes were all-cause mortality, serious adverse events, and clinical improvement at day 30 (15-60 days). We calculated odds ratios.ResultsWe included 9 trials (2399 patients with a mean [SD] age of 61.2 [22.1]; 39% women). The duration-effect curve was monotonic with longer duration leading to lower probability of improvement, and the lower 95%CI curve was constantly above the prespecified non-inferiority margin throughout the examined duration. Harmful outcome curves indicated no association. The average percentage of clinical improvement rate at day 15 in the 10-day treatment arms was 68%. Using that average, we computed the absolute clinical improvement rates at the following durations: a 3-day treatment 75% (95%CI: 68 to 81%), 5-day treatment 72% (66 to 78%), and 7-day treatment 69% (61 to 76%).Conclusions and RelevanceShorter treatment duration probably achieves the optimal balance between efficacy and treatment burden for treating CAP in adults. However, the small number of included studies and the overall moderate to high risk of bias may compromise the certainty of the results. Further research focusing on the shorter duration range is required.RegistrationPROSPERO (CRD 42021273357).KEY POINTSQuestionWhat is the optimal treatment duration of antibiotics for community-acquired pneumonia (CAP) in adults.?FindingsThis systematic review and duration-effect meta-analysis of 9 trials with 2399 patients found that the shorter treatment duration (3-9 days) was likely to be non-inferior to the standard treatment duration (10 days) for CAP in adults if they achieved clinical stability.MeaningShorter antibiotic treatment duration probably achieves the optimal balance between efficacy and treatment burden for CAP in adults.

Determination of the charge and discharge modes duration effect on the LiFePO4 cells resource in the electric power source

The paper is devoted to the determination of the resource of LiFePO4 battery cells when they are used as a primary source of energy in an electric vehicle. The analysis of the WLTC driving cycle from the point of view of the currents arising in the battery of an electric vehicle was carried out, its main parameters were revealed, such as: the duration and magnitude of the charge and discharge currents and the duration of the pause. The results of experiments on determining the resource of an 18650 cell at various load cycles are presented. It was found that cells loaded with a low current with a high switching frequency of the operating mode are subject to the greatest degradation. The lowest degradation rate was observed in cells loaded with low current with short-term charging modes. The result obtained will make it possible to more accurately determine the remaining life of the battery cells. Also, the data can be used to improve the algorithms of the BMS in order to extend the battery life.

COMMUNIST CAROTIC ARTERY CLOSURE DURATION EFFECT ON WISTAR WHITE RATS MOTORIC

The carotid artery consists of two carotid arteries, namely the dextra communist artery and the sinistra, the main blood vessels in the neck that supply blood to the brain, the basal ganglia, which have the function of regulating the motor functions of the body. The communal carotid arteries blocked flow can cause brain ischemia. It is due to hypoxia due to a lack of oxygen supply carried by the brain, resulting in motor body function disorders, incredible blockages in the carotid arteries that supply blood to the brain, and neurons as regulators of motor functions. The research is a literature study that has relevance to the formulation of the problem meets the criteria and research objectives to determine the effect of the length of the blockage of the arteries of the carotid artery of the communist to the motor function of the Wistar strain rats. The results of a literature review or literature studies in some previous scientific research journals indicate if the blockage of the arteries of the communal carotid arteries affects the disruption of motor function caused by hypoxia and damage to neurons and brain tissue in motor neurons. The conclusion is that the blockage and the duration of blockage of the communal carotid arteries affect motor function.

Duración del desempleo y la migración en México ante la crisis financiera

This article examines structural breaks in the effect of the unemployment duration for the population of Mexico on the probability of migrating, both internal and internationally. Data from the National Survey of Occupation and Employment for 2007, 2008, and 2010 is used, and estimations are made from both binary and multinomial response models. Furthermore, a Chowtype test is used to estimate structural breaks in the unemployment duration effect after the financial crisis, and sensitivity tests are carried out using different specifications of the migration and unemployment duration variables. The results show that after the crisis the unemployment duration effects on the probability of migrating have been reduced, leading to restrictions on the free mobility of the labor factor

Japanese orthographic complexity and speech duration in a reading task

The number of letters in a word’s orthographic form can affect speech duration (Brewer, Jordan B. 2008. Phonetic reflexes of orthographic characteristics in lexical representation. University of Arizona Doctoral Dissertation; Warner, Natasha, Allard Jongman, Joan Sereno & Rachèl Kemps. 2004. Incomplete neutralization and other sub-phonemic durational differences in production and perception: Evidence from Dutch. Journal of Phonetics 32(2). 251–276. Previous research in this area has been limited to studies of languages with alphabets. The current study expands upon this previous research by investigating effects on speech duration from units of orthographic complexity potentially analogous to letter length in Japanese, a language with a logography. In a modified version of Brewer, Jordan B. 2008. Phonetic reflexes of orthographic characteristics in lexical representation. University of Arizona Doctoral Dissertation, reading task, native Japanese-speaking participants were audio-recorded reading pairs of homophonous words that varied by: 1) number of pen strokes in a single character; or 2) number of whole characters in their orthographic forms. Two-character words were produced significantly longer than one-character words. No significant effect was found from pen strokes on speech duration. These results are presented as evidence that the orthographic duration effect observed in previous studies is not limited to languages with alphabetic writing systems.

The impact of COVID-19 pandemic shock on major Asian stock markets: evidence of decoupling effects

Introduction. Despite the start of the outbreak of the virus (COVID-19) was in December 2019, stock markets did not respond immediately as there was little information about the expected duration of the crisis and whether China would be able to contain it within a short period of time, and the risks entailing to the global economy due to the virus spread becoming pandemic that endanger the global health situation. As a result of the great uncertainty that prevailed among investors in the third week of February, stock markets around the world incurred trillions of US dollars in losses in a single week (ending February) seen as the worst week for financial markets since the 2008 global financial crisis. The initial purpose of this paper is to assess the reaction of major Asian stock markets to the early outbreak of COVID-19 pandemic and its spillover effects among these markets. Material and methods. To capture switching behavior of major Asian stock markets due to the early outbreak of COVID-19, the paper uses daily price indexes of Shanghai composite, Hong Kong, Nikkei 225, and Korea stock market, during the period from December 2, 2019 to March, 13,2020. Markov switching dynamic regression (MSDR) employed to assess the behavior of each market to the response of the other markets’ behavior. Results. Our finding indicate evidence of two states that distinguish the behavior of the stock markets during the early outbreak of the pandemic. In state 1, when the significance of the pandemic was not fully realized there was a strong link and influence between these markets, but in state 2, when the scale and size of the pandemic realized these markets displayed decoupling behavior. Results also indicate, Hong Kong and Nikkie stock markets were the epicenter in both states. The impact of the pandemic news on the behavior of these markets as indicated by the transition probabilities of state 2, varied from 3 days duration effect (Hong Kong) to 3month duration effect (Nikkei 225). Discussion and conclusions. The interactive association between these stock markets is important for investors as well as for policy-makers. Increasing departure of stock prices from their fundamental driver, that is the common economic bonds linking these markets, implies increasing risk for investors in these stock markets. The duration of the shock as indicated by the transition probabilities show that Hong Kong stock exchange was the most resilient in the group, while Nikkei was the most reactive to the pandemic shock.

The Effect of Heating Duration on the Quantitative Estimation of Defect Depth Using Sonic Infrared Imaging

Sonic infrared (SIR) imaging is an original hybrid nondestructive evaluation (NDE) technique that has seen rapid acceptance in the industry. A single-tone ultrasonic wave in the 15–40 kHz range is induced to the specimen under inspection through a high-power ultrasonic plastic welder. Heating duration is equal to the ultrasonic excitation duration. In a previous article, an analytical model for depth profiling using SIR NDE was presented. According to the proposed model, material thermal properties, defect size and ultrasonic excitation duration influence defect characterization and contribute to the total temperature-time curves. In this paper, heating duration effect on the quantitative estimation of flaws using sonic infrared nondestructive evaluation was investigated.

Duration of Adjuvant Doublet Chemotherapy (3 or 6 months) in Patients With High-Risk Stage II Colorectal Cancer

PURPOSE: As oxaliplatin results in cumulative neurotoxicity, reducing treatment duration without loss of efficacy would benefit patients and healthcare providers. PATIENTS AND METHODS: Four of the six studies in the International Duration of Adjuvant Chemotherapy (IDEA) collaboration included patients with high-risk stage II colon and rectal cancers. Patients were treated (clinician and/or patient choice) with either fluorouracil, leucovorin, and oxaliplatin (FOLFOX) or capecitabine and oxaliplatin (CAPOX) and randomly assigned to receive 3- or 6-month treatment. The primary end point is disease-free survival (DFS), and noninferiority of 3-month treatment was defined as a hazard ratio (HR) of < 1.2- v 6-month arm. To detect this with 80% power at a one-sided type one error rate of 0.10, a total of 542 DFS events were required. RESULTS: 3,273 eligible patients were randomly assigned to either 3- or 6-month treatment with 62% receiving CAPOX and 38% FOLFOX. There were 553 DFS events. Five-year DFS was 80.7% and 83.9% for 3-month and 6-month treatment, respectively (HR, 1.17; 80% CI, 1.05 to 1.31; P [for noninferiority] .39). This crossed the noninferiority limit of 1.2. As in the IDEA stage III analysis, the duration effect appeared dependent on the chemotherapy regimen although a test of interaction was negative. HR for CAPOX was 1.02 (80% CI, 0.88 to 1.17), and HR for FOLFOX was 1.41 (80% CI, 1.18 to 1.68). CONCLUSION: Although noninferiority has not been demonstrated in the overall population, the convenience, reduced toxicity, and cost of 3-month adjuvant CAPOX suggest it as a potential option for high-risk stage II colon cancer if oxaliplatin-based chemotherapy is suitable. The relative contribution of the factors used to define high-risk stage II disease needs better understanding.