Background: Vancomycin and piperacillin-tazobactam (VPT) is a common antibiotic combination used in hospitals, and there has been increasing data indicating that the combination is associated with increased rates of acute kidney injury (AKI). It is unclear if the dosing method of vancomycin would mitigate the risk of AKI seen with VPT. Objective: To observe and compare incidence of AKI in patients on VPT when using the trough-based dosing method versus the area-under-the-curve (AUC)-based dosing method. Methods: This was a multi-center, retrospective, observational study at 3 community hospitals. Adults receiving at least 48 hours of VPT were included. Patients with severe renal dysfunction, pregnant patients, prisoners, and patients with central nervous system infections, or malignancy were excluded. The primary outcome was incidence of AKI as defined by the Infectious Disease Society of America (IDSA) criteria. Results: A total of 300 patients were included in the study; 150 patients in both the trough and AUC groups. A total of 23 patients (15%) in the trough group and 17 patients (11%) in the AUC group met the primary outcome (odds ratio [OR]: 0.7058, 95% confidence interval [CI]: [0.3603, 1.3826], P = .3098). Conclusion and Relevance: The incidence of AKI was lower in the AUC group compared with the trough group; however, this was not significant. The results of our study suggest that there is no difference between incidence of AKI when using trough- or AUC-based dosing in those receiving VPT. Because of the small sample size and retrospective nature of the study, more data are needed.
Unmanned aerial vehicles (UAVs) and smart munitions require low-cost IR sensors that fit within very small volumes, yet offer acceptable performance and landing/launch survivability. The LWIR band provides unique contrast for specific applications in both UAVs and smart munitions, with smart munitions presenting an additional challenge of high g-loads during launch. These high g-loads are not typically a design target of low-cost, un-cooled commercial off the shelf (COTS) LWIR sensors. This work addresses the challenges of adapting a COTS un-cooled LWIR imager for launch survivability. The sensor was modeled for mechanical stability and weaknesses identified. Modifications were made to improve launch survivability and multiple units were tested. Data is presented on the optical performance as measured through the modulation transfer function (MTF) both before and after launches for multiple locations across the lens.
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