Win conditions are: >Like the RecompileGame page >RT this tweet > answer the following question. Even the inhabitants themselves can be tampered with, their programming changed to follow the player’s commands. Win 5 steam keys of Recompile and access the mainframe. Logic gates can be freely inverted (and reverted), allowing puzzles or other threatening obstacles to be peacefully and safely bypassed. Nothing is hardcoded, everything is systemic, and all fully exploitable. But what many people hate is downloading so many parts and trying to install them on their own. Many environmental features, such locked doors, forcefields, elevators and even enemy spawning systems are all powered by intricate, interconnected logic gate circuitry. Win 5 steam keys of Recompile and access the mainframe. Discover the many secrets beneath the ancient digital landscape, and prepare for system-wide. Combining traditional Metroidvania mechanics with a dynamic branching narrative system, Recompile challenges players to explore, fight, hack and survive. Win 5 steam keys of Recompile and access the mainframe. A full complement of powerful weapons and abilities are available to help you survive, defend and destroy. Witness the birth of sapient AI in this sprawling atmospheric hacking adventure. The inhabitants of the Mainframe are strange and diverse, and many are found to be inherently hostile. The game has multiple endings based on the players actions you can repair systems, restore lost data, hack or destroy enemies, all whilst uncovering the truth about the Hypervisor and the original purpose of the Mainframe. Delve into the ancient, sprawling ruins of the Mainframe and discover a range of traversal abilities to help you on your journey towards attaining true sapience. Discover the many secrets beneath the ancient digital landscape, and prepare for system-wide reconfiguration. Recompile challenges players to explore, fight, hack and survive. Buy easy with quick delivery & 24/7 support at the best price on GAMIVO. The game’s entire narrative takes place within 1 second of real time. Video games and gift cards for PC, PSN, XBOX, Nintendo, Steam, Origin & more. Discover the many secrets beneath ancient digital landscape and prepare for system-wide reconfiguration. Recompile challenges players to explore, fight, hack, and survive. Combining Metroidvania progression with non-linear exploration and gameplay. Witness the birth of sapient AI in this sprawling atmospheric hacking adventure. Recompile Free Download PC Game in a pre-Installed Direct Link With Latest Updates and Multiplayer. It doesn’t have to tell you anything because it makes you feel this post-apocalypse by its storytelling method, gameplay, world design, and even within its intradiegetic options menu.About Game Recompile Free Download (v1.02) The game doesn’t hold your hand, it drops you in the world and bare minimum instructions, giving you space to explore things on your own. This creates a story full of intrigue and wonder as it leaves you to piece together everything.Įverything about Recompile rings in this sparseness. Something’s happening out there and it’s bad, but of course, you don’t get to see any of it. In Recompile delve into the ancient, sprawling ruins of the Mainframe and discover a range of traversal abilities to help you on your journey towards. Bit by bit, you discover things not only about the HPRVSR, but the world outside of the computer. What you will find are logs made by the users of the HPRVSR, this artificial intelligent supercomputer that you are in. This atmospheric, Metroidvania hacking adventure lets you take control of a semi-sapient program struggling against deletion. There are coloured areas (like the one in a screenshot below) with a button to press. Just fastscroll through the credits and proceed to another choice. Presented to you in glitched-out code, it really feels like you are recovering parts of destroyed data. Compare prices in Canada and buy Recompile PS5 key cheap After purchase, the PS5 digital download code allows you to download, install and play Recompile. The good thing - you do NOT need to restart the game after each ending. The information provided to you is sparse and oftentimes missing parts from the many system failures. I was most struck by the use of this unique environment in its storytelling.
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This software is not needed if the Xerox can send out communication over the internet back to Xerox servers. This software checks in with the Xerox device and sends meter reads back to us so we can charge based upon consumption. **Some plans require a small piece of software to be installed on a Windows PC/Server that is on the same network as the copier/printer. If you are looking for a Xerox Maintenance Plan for one of the above devices – please email us at for more information. You can do this by emailing with your application numbers if you have them.We provide service for Xerox devices and can provide maintenance plans for Xerox devices that you did not lease/purchase from. You’ll need to contact our team to let them know which of these applications you wish to continue and which should be withdrawn. If your document doesn’t upload correctly or displays in a different section, this may signify that you’ve already submitted an application for registration using a paper form. We accept certification from services such as the Post Office. If you are unsure whether we will accept your certification, please contact us.Īs long as they meet all of the other requirements for someone certifying documents, the person certifying your documents may be your employer. Find the best Copy Centers near you on Yelp - see all Copy Centers open now.Explore other popular Professional Services near you from over 7 million businesses with over 142 million reviews and opinions from Yelpers. Religious officials such as ministers of the Church of England, rabbis, imams and others Find the best Copy Centers near you on Yelp - see all Copy Centers open now.Justices of the Peace, consular officers or other judicial officials.Bank managers, investment managers, stockbrokers.Professionals such as lawyers, solicitors, accountants and notaries.Registered health and care professionals.Most individuals who hold positions of professional responsibility are considered a person of standing. The person certifying your documents must be a person of standing in the community with an appropriate relationship to you. To do this, we ask that the certifier views the original document, and then confirms that the photocopy or scan is a true copy of it. This is because we need to be sure that the copy we see is genuine. The certification must not be written on a separate piece of paper and scanned alongside the original document. The certification must be hand-written on the photocopy or printed copy of the original document. Scan the certified copy, so that you have a digital file (PDF, JPG or PNG).Their name, professional title and contact details The statement "I certify that this is a true copy of the original document seen by me" Ask the person certifying the document to write on the copy with the following:.Show the original document to the person who is certifying it. Take a photocopy of your original document, or scan and print it (this is to preserve and protect the original).This will extend the processing time of your application. If your uploaded documents aren’t certified, we’ll contact you to request replacements. All signatures must be dated within the last six months. This means they are photocopies or scans of the originals, which are signed by someone who can verify this (see below). How to certify your documentsĪll uploads to the online form must be certified copies of the original documents. These must be certified copies of the original documents. You'll be asked to upload a number of documents during your application. There have been other options but they involve either Flash or Silverlight and most people want something that works with html5 video. The answer seems to have been that it wasn't clear that Pantos streaming was the best option and something else would come about eventually that would be more flexible. Segmenting WebM Video and the MediaSource APIįor a while now I've seen people ask when support for Apple's Pantos HTTP live streaming would make it past Safari and iOS. This entry was posted in utilities and tagged azure, docker on Januby carson. You can verify that the update has fixed the issue by running the helper by hand again: The two binaries will need to be extracted from that file and put in the /usr/local/bin/ directory. The artifacts/ file is the one with the new macOS binaries. This script will build the helper for multiple platforms and put the results in the artifacts directory. RUN apk update & apk add make bash zipĪfter modifying the Dockerfile you can build the binary by running the build.sh script. Then you will need to edit the Dockerfile so that the Golang version used is a supported version on macOS 12, I found that version 1.15 worked and the helper still compiled: To recompile using a newer version you will first need to clone the helper github repo: The fix for the error is to recompile the ACR Docker Credential Helper using a newer version of Golang. If you use the instructions provided by Microsoft to install the ACR Docker Credential Helper binary then you have installed a binary that is compiled with a fairly old version of Golang. You can run the command helper by hand to verify that it is generating the error: This error is caused when using a Golang binary that has been compiled with an older version of the Golang compiler, you can find out more in the MacOS12BSDThreadRegisterIssue Golang wiki. After upgrading to macOS 12 Monterey I started getting the following error when using docker with the ACR Docker Credential Helper:įatal error: runtime: bsdthread_register error The only difference between the sets is the size of each block and the height of the stack. There are 54 blocks in a standard Jenga set and 54 in the Big Jenga set. If you use a bigger piece (60mm) then you will have 2 pieces of every board size, totaling 284. If you use a bigger piece (36mm) then you will have 3 pieces of each board size, totaling 172. If you make your giant 2×4 the same size as a piece on the left (18mm) then you will have 2 pieces of each board size, totaling 94. There are 54 blocks in the standard Jenga and 60 blocks in the big Jenga set. This continues until either the player removes the last block and causes the tower to fall, or they can put the last block back on top of the tower without causing it to fall.Ī post shared by JENGA How Many 2×4 Do I Need to Make a Giant Jenga? Then, they must remove another block and place it on top of the first block. The player begins by removing one block from the tower and placing it on top. The game is typically played with 54 wooden blocks. The goal is to be the last player to successfully remove and place blocks without causing the tower to fall. It makes it fun to play and being an eco-friendly option makes it an awesome toy. Jenga is a popular game that involves stacking wooden blocks in a tower, and then taking turns removing blocks one at a time and balancing on the top until the tower collapses. Difference Between Giant Jenga and Regular Jenga? How Many 2×4 Do I Need to Make a Giant Jenga? You cannot remove the wooden blocks from the top two tiers of the tumble tower.Make sure you use only one hand while withdrawing the wooden blocks from the tumble tower and stacking them on top of the giant Jenga.Aren’t you excited to find out if you can build the tallest Jenga tower? Whoever is responsible for making the tower crumble will be termed the loser. The game continues until this tower falls. This multiplayer group game requires each player to push out one wooden block when their turn arrives and then placing that removed block on the top of the growing tumble tower.Start building your tumble tower by placing three blocks as the foundation and then stack it up in pairs of three till you have all 54 blocks creating a giant wooden tumbling tower in front of you.Open the bag to take out the 54 hardwood blocks that will be the building planks in the stacking tower game you are about to play.Note - these wooden jenga blocks are hand-made hence you may observe slight un-evenness on the surface of the wooden blocks.Related Category: Board Games, Card Games, Party Games for Grown Ups.Wooden Jenga Block Dimension: 14 cm (length) x 4.5 cm (width) x 2.4 cm (height).Contents: 1 Giant Jenga set with 54 wooden blocks, 1 Complimentary Bag for storage of the blocks.of players: Can be played individually as well as in groups Although make sure kids are under parental supervision while playing with this giant Jenga set as the wooden blocks can be heavy.ĭid we tell you it comes with a complimentary bag, so there’s an advantage for you to carry it to your friend’s house with absolute ease? Check out the other Jenga building blocks game from our collection if you need variations in sizes! The gaps in between the blocks help take out the pieces without upsetting the tumble tower in this balancing block game. Jenga wooden blocks vary in size, and this giant tumbling tower game has unique wooden blocks, which make this a very challenging and interesting game to play. And do we even have to say that it is fun? We kid you not it has innumerable benefits! From building hand eye coordination to helping in polishing cognitive development, it is one of the best fine motor skill games that also improves problem solving skills. If you are wondering about ways on how to increase critical thinking, then you should buy this wooden tumbling tower game. This giant Jenga set includes 54 hardwood blocks of great quality and smooth surface to ensure that you can create the biggest tower in this stacking tower game. Yes, it is one of the best team building games for the office and can double up as a fun family game. Grab a bag of this life size Jenga, and get down to compete with your family, friends, or colleagues. You know what time is it? It is Jumbo Jenga time! Who doesn’t love a good tumble tower game, and this Giant Jenga is here to chase away your boring midday blues. She has since written for publications like InStyle, PopSugar, Well+Good, Forbes, and many more. Before freelancing, she was on staff at Real Simple and Health magazines. Add some gold touches like hoop earrings and a bold lip.”įor more casual looks, Jagaric says that, at the end of the day, you can live in leggings and wear them with just about anything.Īnneke Knot is a freelance writer and content creator specializing in beauty and fashion. “A faux bomber jacket looks great paired with deep-hued leggings and instantly elevates your day look. If you’re looking for a glam option, Valponi says to not be afraid to play with colors and textures. "For an easy look, pair your favorite leggings with a perfectly fit cropped white tee for daytime, and throw on an oversized blazer.” “My favorite looks to style are daytime to nighttime athleisure looks,” says Caccamo. Valponi says that you can check the length of your favorite denim jeans and use that as a starting point for how long you want your leggings to be. If you love the fit and fabric of a certain legging, but they're too long, we recommend taking it to your local tailor for a simple alteration. “You never want them to hit your ankle too long, or fall at an awkward length mid-calf, depending on your height,” says Caccamo. Our experts say that, overall, finding leggings that hit at just the right length is important but can be difficult. “Attention to detail is crucial-even down to the type of thread and stitch each garment is sewn with.” You want the leggings to stay up and not gape or sag, but not be so tight and compressive that you are uncomfortable. “We make sure that our leggings feel even-nothing too tight or too loose-and that they stay in place while moving around,” says Jagaric. The weight of the fabric and whether you are wearing them indoors or outdoors and in hot or cold climates will guide your selection. We always recommend choosing an option with wicking, or other technical properties, for life’s sweatiest moments, and saving those comfy cotton styles for coffee runs.”Ĭonsidering climate to determine fabric thickness for warmth or moisture is also important, says Valponi. “This allows our customers to experience different options and choose their favorite. Jagaric also says that they offer different ranges of support levels of fabric, from software to slicker, and lighter to heavier. “For each fabric, we seek out the perfect stretch, softness, opacity, and technical properties, like wicking, based on our vision for the style.” “The core of a great pair of leggings is the fabric,” says Jagaric. “This can make or break a pair of leggings,” she says. Wardrobe Stylist Jasmine Caccamo also says the waistband is the first thing she looks for when shopping for leggings. Be sure to bend and twist as a test to make sure you are getting that support without prohibiting movement.” “Choosing your preference is key, but be sure the waist lays smoothly. “Check for the right fit at the waist,” says Valponi. What to Look For in Leggings Brands Waistband She previously was the sales manager of the women's ready-to-wear division at Macy's. Stephanie Valponi is a stylist and the California Styling Team Lead at Stitch Fix.She graduated from FIT with a degree in fashion design. She has also designed for Abercrombie & Fitch and Victoria's Secret. Andrea Jagaric is the Chief Design Officer at Aerie, OFFL/NE by Aerie, and Unsubscribed.She has worked with Alex Morgan, Taylor Swift, Kelly O'Hara, Camila Cabello, Katie Ledecky, and more. Jasmine Caccamo is a celebrity and athlete fashion and wardrobe stylist based out of New York and Los Angeles. If you find a flight you want to take, you can book it easily within the app. If you don’t book in 20 days, your deposit will be forfeited. Your deposit will go toward the flight and if the price drops in the 20 days, you’ll pay the lower price. You do have the option to pay a deposit for a “price freeze.” The rate that is currently displayed will then be available to book for the next 20 days, even if the fares of the flight go up during that time.If you’re notified of a rate that appeals to you, you can book the flight in the app. In that case, you’ll receive a notification each time the fare drops below the displayed price. If the app says the price will drop in the future, you can hold off and “watch” the flight. If the price is going to rise, you’ll be told that the displayed price is likely the lowest you’ll get and you can book. The app will let you know if it thinks the price will drop or rise in the future. The current lowest price for the flight will be displayed.Choose your departure date and return date, if applicable.If you don’t have set travel dates, this feature can help show you when the cheapest times to fly will be. Each date will be color-coded in the following way: A calendar showing the year ahead will be shown.Input the following flight information:.Open the app and log in if you have an account.The following steps outline how to find cheap flights, hotels, and car rentals thanks to Hopper. When using the app for this Hopper review, we discovered that using Hopper is very easy. This tip is optional, so be sure to opt-out of the tip before booking your flight or hotel if you don’t wish to add it. However, a $5 tip is automatically added to any booking. You simply pay the quoted flight or hotel rate if you wish to book. Does Hopper Have Hidden Fees?Īfter looking into the terms and conditions for this Hopper app review, we found that Hopper has no hidden fees. When you book a flight or hotel through the app, the airline or hotel gives Hopper a small percentage of the sale. Hopper makes money via a commission model. If the app sounds appealing, you may be wondering: “Does Hopper charge a fee?” The answer is no, the app is 100% free to use. Flight deals are exclusive to the app and can’t be searched in-browser. When researching for this Hopper review, we found that there is an app for both iOS and Android. Looking to save up to 40% on flights and hotels? Then you’ll definitely want to keep reading this Hopper travel app review! Our goal is to make travel easy for everyone, so we’re always keen to try other apps that promise the same. The team at Wanderlog is always eager to try out the best travel applications, so we were excited to download Hopper and give it a go! Wanderlog helps users organize their bookings and reservations and plan detailed travel itineraries. To help you decide if the app is right for you, we created this in-depth Hopper review. Many of these deals save users up to 40% on travel costs. Hopper notifies users of super-low rates on hotels, flights, and car rentals. Hopper is one of these travel deals apps. Luckily, there are many apps on the market that help make finding amazing deals easy. When planning a trip, exorbitant prices for hotels, flights, and other transportation modes can put travelers off. Alice Sewell Follow Hopper Review: Can This Travel App Really Save You Money on Hotels, Flight, and Car Rentals? Check out our Pocket Guide to Landscape Lighting for information and techniques to get more out of your landscape lights. We have low prices every day on quality lighting along with landscape light installation kits, transformers, posts, rock guards and other parts you'll need. We still carry plenty of line voltage lights for commercial and public spaces along with CFL, halogen, HPS and incandescent bulbs if that's what your project demands.Ĭount on more than 100 years of lighting industry experience by shopping with the Destination Lighting family. 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HBS also has an internal recognition program called Whale Done that gives accolades and positive reinforcement when employees go above and beyond. Our mission statement reflects our commitment to clients and to our employees whom we equip to thrive in a “personally satisfying firm environment.” As such, the firm strongly believes in the concept of furthering each person’s professional development through the creation and sponsorship of internal development programs such as our Women’s Forum, the HBS Mentoring Program, the Associate Committee and frequent education sessions that provide continuing legal education (CLE) credits. Experienced team members are assigned to work with the new employee to train the basic duties of the various roles.Īt HBS, our philosophy is simple: “It’s about we, not about me.” We attribute our growth to the hard work and allegiance of our attorneys and employees and recognize that each one is a valued part of our team and necessary for our collective success. Our Legal Secretary and Paralegal training program offers the opportunity for those new to or transitioning into a legal services environment for on the job training. We also have an Associate Committee that encourages attorneys to learn from each other, build stronger relationships and share ideas and strategies among peers. Our Mentoring Program helps those associates who are at the dawn of their careers establish and cultivate strong relationships within the firm in order to facilitate the professional, business, and personal development of all participating HBS attorneys. HBS maintains an active Women’s Forum, which conducts seminars and events throughout the year designed to provide team-building, networking, and professional growth opportunities for our female attorneys and clients. From senior partners to managers to the newest staff member or associate who just joined the firm, HBS continuously seeks opportunities for professional and personal growth for all of our employees. We strive to achieve our vision through teamwork, a comprehensive mentoring program and a commitment to ensuring a culture of diversity and inclusion. The second screen allows you to remap the Chat Volume dial and Mode button. This screen shows your game volume level at the top (non-adjustable in the app), allows you to toggle and set Superhuman Hearing strength, change your Game Preset, toggle and adjust your Mic Monitor levels, and toggle Chat Boost. After you install it, turn the Stealth 700 Gen 2 on, wait for it to pair with your device, and you should see the main screen. The Turtle Beach Audio Hub for Android or iOS lets you adjust more of the headset settings, including remapping the mode button and chat volume wheel. That’s all there is to it, and that’s all the Windows app does. The app will detect it, scan for a firmware update, and apply it if there is one. Once installed, launch the app and connect your headset to your computer. Fixes headset to console range and connectivity bug.In the case of this one, it will apply the following fixes: You will also want to do so before using the headset. To update the Turtle Beach Stealth 700 Gen 2 for Xbox, you’ll need to download the Turtle Beach Audio Hub for Windows or Mac. While you can use the Stealth 700 Gen 2 out of the box, there are two apps that you’ll definitely want to install. Overall, the headset is pretty straightforward and easy to use once you figure out where the buttons are and the Bluetooth button’s features. Press and hold: reject incoming call or activate voice recognition if available.Press three times quickly and hold: rewind.Press three times quickly: skip to the previous track.Press twice quickly and hold: fast forward.Press twice quickly: skip to the next song.Press once: play/pause or answer/end a call.The Bluetooth button also acts as a multi-function control with the following functions: Locate the Stealth 700 in the Bluetooth settings on your phone and select it. To pair with your smartphone or another Bluetooth device, hold down the Bluetooth button, and you will hear a “Bluetooth Pairing” voice prompt. If you haven’t paired it after two minutes, pairing mode will stop. Once powered on, it will automatically enter pairing mode. Finally, the top dial allows you to adjust your game volume. Both the Mode button and Chat volume wheel can be remapped in the mobile app. The first dial is to control your chat volume. Once connected, pressing the Mode button will toggle Superhuman Hearing. Charge it up, power it on, press and hold the Xbox Connect button on the headset, press and hold the Xbox Connect button on your Xbox One or Xbox Series X|S, and the headset will pair. Like most Xbox Wireless headsets, the Turtle Beach Stealth 700 Gen 2 for Xbox is super simple to use. The headset is also comfortable while wearing glasses due to the small ProSpecs Glasses Relief System channel located in the ear cushions. It is super comfortable with the various tilt adjustments on the earcups allowing for a perfect angle to suit your head. The headset does feel a bit heavier, but the weight isn’t overbearing. The controls on the left earcup on the Turtle Beach Stealth 700 Gen 2 for Xbox. From front to back, these are the USB Type-C charging port, Xbox Wireless button, Bluetooth button, power button, a remappable mode button, remappable chat volume wheel, and a game volume dial. On the bottom and moving around to the back of the earcup’s outer edge are your ports and controls. When folded up, it’s not noticeable at a glance and actually looks like a button. The microphone slides down from the front of the earcup. The right earcup is devoid of any other features, while the left earcup is packed with them. The center of the ear cushions are see-through, allowing you to get a glimpse of the 50mm drivers inside. The ear cushions are nice and plush memory foam with a layer of that cooling gel, helping keep your ears a tad cooler while playing. Covered around the outer edge with a faux leather finish, the area that goes around your ears is a nice soft cloth. The ear cushions themselves are crafted from Turtle Beach’s exclusive Aerofit cooling gel-infused ear cushions. On the inside of the earcup is a silver accent stripe to which the ear cushions are attached. The outer shell is split diagonally across the middle, allowing the earcup to angle in and out. The outer earcup shell is also plastic, with the Turtle Beach logo angled in the center. The earcups are a roundish square in design, and it looks quite slick. The headband on the Turtle Beach Stealth 700 Gen 2 for Xbox. Multivariable regression analyses were then performed to examine the independent association between loading dose and composite failure as well as loading dose and nephrotoxicity. Categorical variables were compared using the χ 2 or Fisher’s exact test while continuous variables were compared using the Student’s t test or Mann–Whitney U test. In the primary analysis, a series of bivariate analyses were performed to compare outcomes between exposure groups, determine factors associated with the primary outcome of composite failure, and determine factors associated with nephrotoxicity. All statistical analyses were performed using SPSS v.24.0 (Armonk, NY, USA). For all analyses, a P value ≤ 0.05 was considered statistically significant. Concomitant nephrotoxins assessed included aminoglycosides, colistin, acyclovir, intravenous (IV) contrast dye, amphotericin, tacrolimus, loop diuretics, non-steroidal anti-inflammatory drugs, angiotensin-converting enzyme inhibitors and angiotensin II receptor blockers.Ī sample size of 272 patients, 136 matched pairs, was required to detect a 15% difference in the primary endpoint using an alpha of 0.05 and power of 80%. Vancomycin trough concentration assessment included only initial trough concentrations drawn at steady-state of the maintenance regimen (prior to the 4th or 5th dose). Baseline SCr was the creatinine value immediately preceding the first dose of vancomycin. Nephrotoxicity was defined as an increase in serum creatinine (SCr) of greater than 0.5 mg/dL or at least a 50% increase from baseline on two consecutive measurements as per the vancomycin dosing and monitoring guidelines, and was assessed starting from the first dose of vancomycin to 72 h after the final dose. Secondary outcomes included duration of bacteremia, length of stay post-bacteremia onset, and nephrotoxicity. Patients not meeting criteria for composite failure were considered to be a treatment success. The primary outcome of this study was composite treatment failure defined as the presence of at least one of the following: 30-day mortality (from index culture), bacteremia duration ≥ 7 days after vancomycin initiation, persistent signs and symptoms of infection ≥ 7 days after vancomycin initiation, or switch to an alternative anti-MRSA antimicrobial agent due to treatment failure as determined by treating physician documentation. The primary objective of this study was to evaluate the effect of administering a one-time, weight-based vancomycin loading dose on clinical outcomes in patients with MRSA bacteremia. ĭue to the relative paucity of evidence demonstrating advantages to vancomycin loading doses, combined with the concern for increasing the risk for toxic events, continued evaluation of this practice is necessary. However, this is likely due to resultant supratherapeutic vancomycin exposures in these patients, and there are currently few data to demonstrate an association between vancomycin loading doses and nephrotoxicity. Conversely, given previous findings of higher total daily doses being correlated with higher incidence of nephrotoxicity, hypothetical concerns of increased vancomycin-associated nephrotoxicity persist with the weight-based loading dose approach, especially in obese patients. Although published data demonstrate that achievement of PD targets during the first 48 h of infection improves outcomes, clinical data showing a direct benefit of vancomycin loading doses are lacking. By increasing the likelihood of pharmacokinetic/pharmacodynamic (PK/PD) target attainment early in therapy, this would theoretically improve outcomes in those patients at highest risk of mortality. To facilitate rapid attainment of goal concentrations, the guidelines recommend a one-time loading dose of 25–30 mg/kg based off total body weight (TBW) for seriously ill patients. The vancomycin guidelines recommend targeting trough concentrations of 15–20 mg/L for patients with Staphylococcus aureus bacteremia, endocarditis, osteomyelitis, meningitis, or hospital-acquired pneumonia and dosing regimens are designed to achieve these target serum exposures at steady-state.ĭepending on a patient’s renal function, it may take anywhere from 24 to 72 h, or longer, to reach steady-state. Various guidelines have suggested different vancomycin dosing and monitoring strategies and it was not until 2009 that the first consensus guideline for the therapeutic monitoring of vancomycin was published. |
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