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Penicillin allergies are reported in 10–15% of the US population, but the actual rate is less than 1%. Inappropriate penicillin allergies are associated with adverse patient outcomes, poor antimicrobial stewardship, and increased healthcare costs. Direct oral provocation testing (DOPT) is a safe and cost-effective way to remove false penicillin allergy labels (PAL). However, widespread implementation is currently limited due to inadequate safety data and protocol variations. This systematic review evaluates the safety of single-dose, nongraded DOPT by the nonallergist.
Design:
Systematic review. MEDLINE, Embase, Web of Science, and the Cochrane Central Register of Controlled Trials were searched from inception to May 2025.
Setting:
Inpatient (Intensive care unit (ICU) and general medical ward) and outpatient
Participants:
Adults with self-reported penicillin allergies deemed low risk by a validated scoring system.
Interventions:
DOPT by nonallergists with single-dose oral amoxicillin 250 mg with a 60-minute observation period.
Results:
3 352 studies were identified, 15 were included in the analysis. Of the 1786 patients who completed DOPT, 66 (3.7%) experienced any reaction: 27 (1.5%) immediate rashes, 24 (1.3%) delayed rashes, and 15 (.8%) other reactions. No cases of anaphylaxis, angioedema, or epinephrine use were reported.
Conclusion:
The use of single-dose DOPT in patients deemed low risk, using a validated risk scoring tool, is safe, with low rates of mild reactions and no serious adverse events. A nonallergist can significantly improve penicillin delabeling rates and patient outcomes using this approach.
Diet in the first years of life is a key determinant of lifelong disease risk and is highly affected by socioeconomic status (SES). However, the specific relation between SES and food consumption in toddlers and preschoolers is poorly understood. This study assesses SES-related differences in food consumption in 1–5-year-olds in Germany using weighed food records (3+1 days) of a subsample of 887 children from the cross-sectional Children’s Nutrition Survey to Record Food Consumption (KiESEL) undertaken 2014–2017. Children were categorized as having a low, medium, or high SES depending on parental income, education, and occupation. A two-step generalized linear model corrected for age and sex was applied to assess differences in food consumption, using bootstrapping to address unequal group sizes. Differences between SES groups were found for unfavourable foods (and the subgroups sugar-sweetened beverages and confectionary/desserts), fruit, bread/cereals, and fats/oils (pBoot < 0.05). Mean daily consumption in the low SES-group as compared to the high-SES group was 84 g lower for total fruit, 22 g lower for bread/cereals, and 3 g lower for fats/oils, while being 123 g higher for sugar-sweetened beverages and 158 g higher for unfavourable foods in total (based on bootstrap 95 % confidence intervals). In conclusion, this study suggests a social gradient in the diet of German toddlers and preschoolers, with lower SES linked to lower diet quality. To prevent adverse health trajectories, public health measures to improve early life nutrition should address all children, prioritizing those of lower SES.
LONDON – “Economic reform” has been the banner slogan of Japanese governments for the last 10 years, and the new government promises more of it.
For Prime Minister Abe Shinzo, it is not quite the strident claim to fearless determination that it was for his predecessor, but there is no doubt about the general direction of economic institutional change. Abe's chief Cabinet secretary is a dedicated neoliberal, and the appointment of renowned market fundamentalists as academic members of his Economic Council is a clear sign of which way some of the long-standing controversial issues are likely to be resolved. Expect tax reforms to make it easier for foreign firms to take over Japanese firms, for instance.
Koizumi Junichiro, Japan's prime minister, has lost the vote on his grand scheme to privatise the country's post office with its vast savings pool and will go to the polls. For now, the village-pump communitarian face of Japanese conservatism has won out over anti-bureaucratic, privatising radicalism. The global finance industry will have to wait a little longer to get its hands on that Dollars 3,000 billion of Japanese savings.
The objective of the trial was to evaluate the effects of arginine supplementation in the feed of gestating sows on the variability of piglet birth weight. The weight of the piglets was evaluated using descriptive analysis, correlation analysis and analysis of variance with a 2 × 3 factorial arrangement. This arrangement included no supplementation or supplementation with 1.0 % L-arginine, combined in three periods. Period 1: from days 25 to 53 of gestation, providing 23 g/day from days 25 to 28 and 18 g/day from days 29 to 53 of gestation; period 2: from days 30 to 60 of gestation and from day 80 of gestation to farrowing, providing 18 g/day in the first period and 45 g/day in the second period and period 3: from day 85 of gestation to delivery, with 24 g/day was provided from day 85 until farrowing and 28 g/day from days 85 to 107, increasing to 56 g/day from day 108 until farrowing. Supplementation with 1.0 % of L-arginine reduced the percentage of total piglets born and piglets born alive with less than 800 g by 2.26 and 2.05 percentage points, respectively; and increased the percentage of total piglets born and piglets born alive between 1601 and 1800g by 5.89 and 6.08 percentage points, respectively. Supplementing with 1.0 % of L-arginine improves litter uniformity, with an average reduction of 4.06 percentage points in the piglet population of less than 1180 g and an increase in the piglet population of 1180 to 1890 g by 4.70 percentage points.
Many of the world's continents are bounded or traversed by vast fault networks that move laterally, like the well-known San Andreas Fault. As well as being major tectonic features of the Earth's surface, these strike-slip regimes are vitally important to the world's natural resources – petroleum, water, and geothermal energy. This book covers all aspects of these regimes; how they initiate; how they develop; and the natural resources associated with them. Numerous global case studies illustrate structural development, thermal and fluid flow implications, and commercial applicability. No other book provides such a comprehensive overview of these settings, and this volume will stand as a critical reference of the state of knowledge of strike-slip terrains and transform margins. It will be invaluable for a broad range of readers, from advanced students of geology and researchers specializing in strike-slip regimes to geoscientists and managers involved in natural resources and energy solutions.
This chapter starts with a review of the knowledge about petroleum generation, and its controlling mechanisms and factors. Then it follows with expulsion and its controlling mechanisms and factors. Subsequent discussion focuses on source rock richness and maturity characterization. The main portion of the chapter deals with source rocks in strike-slip terrains and transform margin settings, providing a number of worldwide examples.
This chapter starts with the introduction of heat conduction and its controlling parameters. It then describes the control of thermal regimes of transform margins and strike-slip terrains by a number of material parameters such as specific heat capacity, thermal conductivity, thermal diffusivity, and radioactive heat production rate, which, together with their controlling factors, are described individually.
This chapter goes through a list of potential thermal regimes occurring prior to the development of the strike-slip setting or transform margin. These have a strong impact on the thermal regime among all controlling factors. This is due to the fact that the thermal regime affects the host continental lithosphere in many different aspects, such as its thickness, metamorphic reactions, melt formation, rheological zonation, and mechanical behavior. Following a brief summary of basic concepts of heat transport and generation, and heat flow presently observed at the Earth’s surface, the chapter discusses thermal regimes and temperature distribution with depth that can exist in continental lithosphere affected by transform margin formation. It sets the stage for the subsequent evolution, which is strongly dependent on the initial subsurface temperature field. Although this influence progressively diminishes as the transform margin evolves, the knowledge of pre-existing thermal regimes may also help to understand spatial variations along a specific transform margin segment and present-day differences between transform margins.
This chapter describes the effect of erosion and deposition on the thermal regimes of strike-slip and pull-apart terrains, and transform margins. It defines the significant deposition rate, which is faster than 0.1 mmyr–1, as exerting a noticeable cooling effect on the surface heat flow while a significant erosional rate has the opposite effect, resulting in advection of hotter material toward the surface. It support this discussion with examples from the East Slovakian and Vienna pull-apart basins in the Western Carpathians, Wasatch normal fault example from Utah, and offshore North Gabon and East Indian examples.
The chapter defines the top seal as a transient feature on the geological timescale. It divides seals into lithological and fault seals. The chapter goes through the physical apparatus controlling the behavior of various types of seals, all the main mechanisms involved together with their controlling factors, and finishes with an attempt to use case strike-slip and transform regions for describing the seals of these settings in a systematic way, trying to tie their variability to variations in the structural architecture of their respective settings.
This chapter discusses fluid flow mechanisms at strike-slip fault-related and transform margin-related settings. It focuses on the identification of specific fluid flow systems, and, subsequently, the determination of their role in the local fluid regime, as well as their migration pathways, time span of their activity, fluid sources, and their controlling factors. The discussion draws from the current literature on case studies, as well as numerical and analog models.
Many of the world’s continents are bounded, or traversed, by vast fault networks that move laterally, like the well-known San Andreas Fault. These strike-slip regimes are vitally important to the world’s natural resources – petroleum, water, and geothermal energy. This book covers all aspects of transform and strike-slip regimes: how they initiate, how they develop, and the natural resources associated with them. Numerous global case studies are utilized to illustrate structural development, thermal and fluid flow implications, and commercial applicability. The work aims to be useful to a broad range of readers, from students of geology and researchers specializing in strike-slip regimes to geoscientists and managers involved in the business of natural resources and energy solutions.
This chapter focuses on how the thermal evolution of transform margins is controlled by deformation related to ridge migration parallel to the margin, creating pronounced thermal perturbation. It draws from insights provided from the three-dimensional thermal finite element models using a kinematic boundary condition to account for sea-floor spreading center migration. The models are used to quantitatively investigate the complex spatial patterns and temporal changes in the thermal regime of the ocean–continent transform development stage and subsequent transform margin. The models demonstrate the consequences for the uplift history, structural style and crustal structure of a transform margin as lithospheric strength is strongly temperature dependent.
The chapter describes the development history and controlling dynamics of strike-slip faulting in various geologic settings, and its transition to continental breakup and the early drifting stage.