New Tests of Magnetospheric Accretion in T Tauri Stars

We examine 3 analytic theories of magnetospheric accretion onto classical T Tauri stars under the assumption that the magnetic field strength does not vary appreciably from star to star. From these investigations we derive predicted relationships among the stellar mass, radius, rotation period, and disk accretion rate. Data from 5 studies of the accretion parameters of CTTSs are used to test the predicted correlations. We generally find that the data do not display the predicted correlations except for that predicted by the model of Shu et al. as detailed by Ostriker and Shu and extended here to include non-dipole field topologies. Their identification of the trapped flux as an important quantity in the model appears to be critical for reconciling the observed data to the theory. While the data do generally support the extended Ostriker and Shu predictions, only one of the two studies for which the requisite data exist show the highest correlation when considering all the relevant parameters. This suggests great care must be taken when trying to use existing observations to test the theory.Comment: 36 pages, including figure

Antimicrobial resistance among migrants in Europe: a systematic review and meta-analysis

BACKGROUND: Rates of antimicrobial resistance (AMR) are rising globally and there is concern that increased migration is contributing to the burden of antibiotic resistance in Europe. However, the effect of migration on the burden of AMR in Europe has not yet been comprehensively examined. Therefore, we did a systematic review and meta-analysis to identify and synthesise data for AMR carriage or infection in migrants to Europe to examine differences in patterns of AMR across migrant groups and in different settings. METHODS: For this systematic review and meta-analysis, we searched MEDLINE, Embase, PubMed, and Scopus with no language restrictions from Jan 1, 2000, to Jan 18, 2017, for primary data from observational studies reporting antibacterial resistance in common bacterial pathogens among migrants to 21 European Union-15 and European Economic Area countries. To be eligible for inclusion, studies had to report data on carriage or infection with laboratory-confirmed antibiotic-resistant organisms in migrant populations. We extracted data from eligible studies and assessed quality using piloted, standardised forms. We did not examine drug resistance in tuberculosis and excluded articles solely reporting on this parameter. We also excluded articles in which migrant status was determined by ethnicity, country of birth of participants' parents, or was not defined, and articles in which data were not disaggregated by migrant status. Outcomes were carriage of or infection with antibiotic-resistant organisms. We used random-effects models to calculate the pooled prevalence of each outcome. The study protocol is registered with PROSPERO, number CRD42016043681. FINDINGS: We identified 2274 articles, of which 23 observational studies reporting on antibiotic resistance in 2319 migrants were included. The pooled prevalence of any AMR carriage or AMR infection in migrants was 25·4% (95% CI 19·1-31·8; I2 =98%), including meticillin-resistant Staphylococcus aureus (7·8%, 4·8-10·7; I2 =92%) and antibiotic-resistant Gram-negative bacteria (27·2%, 17·6-36·8; I2 =94%). The pooled prevalence of any AMR carriage or infection was higher in refugees and asylum seekers (33·0%, 18·3-47·6; I2 =98%) than in other migrant groups (6·6%, 1·8-11·3; I2 =92%). The pooled prevalence of antibiotic-resistant organisms was slightly higher in high-migrant community settings (33·1%, 11·1-55·1; I2 =96%) than in migrants in hospitals (24·3%, 16·1-32·6; I2 =98%). We did not find evidence of high rates of transmission of AMR from migrant to host populations. INTERPRETATION: Migrants are exposed to conditions favouring the emergence of drug resistance during transit and in host countries in Europe. Increased antibiotic resistance among refugees and asylum seekers and in high-migrant community settings (such as refugee camps and detention facilities) highlights the need for improved living conditions, access to health care, and initiatives to facilitate detection of and appropriate high-quality treatment for antibiotic-resistant infections during transit and in host countries. Protocols for the prevention and control of infection and for antibiotic surveillance need to be integrated in all aspects of health care, which should be accessible for all migrant groups, and should target determinants of AMR before, during, and after migration. FUNDING: UK National Institute for Health Research Imperial Biomedical Research Centre, Imperial College Healthcare Charity, the Wellcome Trust, and UK National Institute for Health Research Health Protection Research Unit in Healthcare-associated Infections and Antimictobial Resistance at Imperial College London

Surgical site infection after gastrointestinal surgery in high-income, middle-income, and low-income countries: a prospective, international, multicentre cohort study

Background: Surgical site infection (SSI) is one of the most common infections associated with health care, but its importance as a global health priority is not fully understood. We quantified the burden of SSI after gastrointestinal surgery in countries in all parts of the world. Methods: This international, prospective, multicentre cohort study included consecutive patients undergoing elective or emergency gastrointestinal resection within 2-week time periods at any health-care facility in any country. Countries with participating centres were stratified into high-income, middle-income, and low-income groups according to the UN's Human Development Index (HDI). Data variables from the GlobalSurg 1 study and other studies that have been found to affect the likelihood of SSI were entered into risk adjustment models. The primary outcome measure was the 30-day SSI incidence (defined by US Centers for Disease Control and Prevention criteria for superficial and deep incisional SSI). Relationships with explanatory variables were examined using Bayesian multilevel logistic regression models. This trial is registered with ClinicalTrials.gov, number NCT02662231. Findings: Between Jan 4, 2016, and July 31, 2016, 13 265 records were submitted for analysis. 12 539 patients from 343 hospitals in 66 countries were included. 7339 (58·5%) patient were from high-HDI countries (193 hospitals in 30 countries), 3918 (31·2%) patients were from middle-HDI countries (82 hospitals in 18 countries), and 1282 (10·2%) patients were from low-HDI countries (68 hospitals in 18 countries). In total, 1538 (12·3%) patients had SSI within 30 days of surgery. The incidence of SSI varied between countries with high (691 [9·4%] of 7339 patients), middle (549 [14·0%] of 3918 patients), and low (298 [23·2%] of 1282) HDI (p < 0·001). The highest SSI incidence in each HDI group was after dirty surgery (102 [17·8%] of 574 patients in high-HDI countries; 74 [31·4%] of 236 patients in middle-HDI countries; 72 [39·8%] of 181 patients in low-HDI countries). Following risk factor adjustment, patients in low-HDI countries were at greatest risk of SSI (adjusted odds ratio 1·60, 95% credible interval 1·05–2·37; p=0·030). 132 (21·6%) of 610 patients with an SSI and a microbiology culture result had an infection that was resistant to the prophylactic antibiotic used. Resistant infections were detected in 49 (16·6%) of 295 patients in high-HDI countries, in 37 (19·8%) of 187 patients in middle-HDI countries, and in 46 (35·9%) of 128 patients in low-HDI countries (p < 0·001). Interpretation: Countries with a low HDI carry a disproportionately greater burden of SSI than countries with a middle or high HDI and might have higher rates of antibiotic resistance. In view of WHO recommendations on SSI prevention that highlight the absence of high-quality interventional research, urgent, pragmatic, randomised trials based in LMICs are needed to assess measures aiming to reduce this preventable complication

The National Early Warning Score and its subcomponents recorded within ±24 hours of emergency medical admission are poor predictors of hospital-acquired acute kidney injury

YesBackground: Hospital-acquired Acute Kidney Injury (H-AKI) is a common cause of avoidable morbidity and mortality. Aim: To determine if the patients’ vital signs data as defined by a National Early Warning Score (NEWS), can predict H-AKI following emergency admission to hospital. Methods: Analyses of emergency admissions to York hospital over 24-months with NEWS data. We report the area under the curve (AUC) for logistic regression models that used the index NEWS (model A0), plus age and sex (A1), plus subcomponents of NEWS (A2) and two-way interactions (A3). Likewise for maximum NEWS (models B0,B1,B2,B3). Results: 4.05% (1361/33608) of emergency admissions had H-AKI. Models using the index NEWS had the lower AUCs (0.59 to 0.68) than models using the maximum NEWS AUCs (0.75 to 0.77). The maximum NEWS model (B3) was more sensitivity than the index NEWS model (A0) (67.60% vs 19.84%) but identified twice as many cases as being at risk of H-AKI (9581 vs 4099) at a NEWS of 5. Conclusions: The index NEWS is a poor predictor of H-AKI. The maximum NEWS is a better predictor but seems unfeasible because it is only knowable in retrospect and is associated with a substantial increase in workload albeit with improved sensitivity.The Health Foundatio

Mortality from gastrointestinal congenital anomalies at 264 hospitals in 74 low-income, middle-income, and high-income countries: a multicentre, international, prospective cohort study

Summary Background Congenital anomalies are the fifth leading cause of mortality in children younger than 5 years globally. Many gastrointestinal congenital anomalies are fatal without timely access to neonatal surgical care, but few studies have been done on these conditions in low-income and middle-income countries (LMICs). We compared outcomes of the seven most common gastrointestinal congenital anomalies in low-income, middle-income, and high-income countries globally, and identified factors associated with mortality. Methods We did a multicentre, international prospective cohort study of patients younger than 16 years, presenting to hospital for the first time with oesophageal atresia, congenital diaphragmatic hernia, intestinal atresia, gastroschisis, exomphalos, anorectal malformation, and Hirschsprung’s disease. Recruitment was of consecutive patients for a minimum of 1 month between October, 2018, and April, 2019. We collected data on patient demographics, clinical status, interventions, and outcomes using the REDCap platform. Patients were followed up for 30 days after primary intervention, or 30 days after admission if they did not receive an intervention. The primary outcome was all-cause, in-hospital mortality for all conditions combined and each condition individually, stratified by country income status. We did a complete case analysis. Findings We included 3849 patients with 3975 study conditions (560 with oesophageal atresia, 448 with congenital diaphragmatic hernia, 681 with intestinal atresia, 453 with gastroschisis, 325 with exomphalos, 991 with anorectal malformation, and 517 with Hirschsprung’s disease) from 264 hospitals (89 in high-income countries, 166 in middleincome countries, and nine in low-income countries) in 74 countries. Of the 3849 patients, 2231 (58·0%) were male. Median gestational age at birth was 38 weeks (IQR 36–39) and median bodyweight at presentation was 2·8 kg (2·3–3·3). Mortality among all patients was 37 (39·8%) of 93 in low-income countries, 583 (20·4%) of 2860 in middle-income countries, and 50 (5·6%) of 896 in high-income countries (p<0·0001 between all country income groups). Gastroschisis had the greatest difference in mortality between country income strata (nine [90·0%] of ten in lowincome countries, 97 [31·9%] of 304 in middle-income countries, and two [1·4%] of 139 in high-income countries; p≤0·0001 between all country income groups). Factors significantly associated with higher mortality for all patients combined included country income status (low-income vs high-income countries, risk ratio 2·78 [95% CI 1·88–4·11], p<0·0001; middle-income vs high-income countries, 2·11 [1·59–2·79], p<0·0001), sepsis at presentation (1·20 [1·04–1·40], p=0·016), higher American Society of Anesthesiologists (ASA) score at primary intervention (ASA 4–5 vs ASA 1–2, 1·82 [1·40–2·35], p<0·0001; ASA 3 vs ASA 1–2, 1·58, [1·30–1·92], p<0·0001]), surgical safety checklist not used (1·39 [1·02–1·90], p=0·035), and ventilation or parenteral nutrition unavailable when needed (ventilation 1·96, [1·41–2·71], p=0·0001; parenteral nutrition 1·35, [1·05–1·74], p=0·018). Administration of parenteral nutrition (0·61, [0·47–0·79], p=0·0002) and use of a peripherally inserted central catheter (0·65 [0·50–0·86], p=0·0024) or percutaneous central line (0·69 [0·48–1·00], p=0·049) were associated with lower mortality. Interpretation Unacceptable differences in mortality exist for gastrointestinal congenital anomalies between lowincome, middle-income, and high-income countries. Improving access to quality neonatal surgical care in LMICs will be vital to achieve Sustainable Development Goal 3.2 of ending preventable deaths in neonates and children younger than 5 years by 2030

Convalescent plasma in patients admitted to hospital with COVID-19 (RECOVERY): a randomised controlled, open-label, platform trial

SummaryBackground Azithromycin has been proposed as a treatment for COVID-19 on the basis of its immunomodulatoryactions. We aimed to evaluate the safety and efficacy of azithromycin in patients admitted to hospital with COVID-19.Methods In this randomised, controlled, open-label, adaptive platform trial (Randomised Evaluation of COVID-19Therapy [RECOVERY]), several possible treatments were compared with usual care in patients admitted to hospitalwith COVID-19 in the UK. The trial is underway at 176 hospitals in the UK. Eligible and consenting patients wererandomly allocated to either usual standard of care alone or usual standard of care plus azithromycin 500 mg once perday by mouth or intravenously for 10 days or until discharge (or allocation to one of the other RECOVERY treatmentgroups). Patients were assigned via web-based simple (unstratified) randomisation with allocation concealment andwere twice as likely to be randomly assigned to usual care than to any of the active treatment groups. Participants andlocal study staff were not masked to the allocated treatment, but all others involved in the trial were masked to theoutcome data during the trial. The primary outcome was 28-day all-cause mortality, assessed in the intention-to-treatpopulation. The trial is registered with ISRCTN, 50189673, and ClinicalTrials.gov, NCT04381936.Findings Between April 7 and Nov 27, 2020, of 16 442 patients enrolled in the RECOVERY trial, 9433 (57%) wereeligible and 7763 were included in the assessment of azithromycin. The mean age of these study participants was65·3 years (SD 15·7) and approximately a third were women (2944 [38%] of 7763). 2582 patients were randomlyallocated to receive azithromycin and 5181 patients were randomly allocated to usual care alone. Overall,561 (22%) patients allocated to azithromycin and 1162 (22%) patients allocated to usual care died within 28 days(rate ratio 0·97, 95% CI 0·87–1·07; p=0·50). No significant difference was seen in duration of hospital stay (median10 days [IQR 5 to >28] vs 11 days [5 to >28]) or the proportion of patients discharged from hospital alive within 28 days(rate ratio 1·04, 95% CI 0·98–1·10; p=0·19). Among those not on invasive mechanical ventilation at baseline, nosignificant difference was seen in the proportion meeting the composite endpoint of invasive mechanical ventilationor death (risk ratio 0·95, 95% CI 0·87–1·03; p=0·24).Interpretation In patients admitted to hospital with COVID-19, azithromycin did not improve survival or otherprespecified clinical outcomes. Azithromycin use in patients admitted to hospital with COVID-19 should be restrictedto patients in whom there is a clear antimicrobial indication

Partially protected areas as a management tool on inshore reefs

Partially Protected Areas (PPAs) are a widely-used management tool, yet comparatively little is known about their effectiveness compared to more commonly studied No-Take Marine Reserves (NTMRs). Here, we examine the efficacy of two kinds of PPAs (with and without spearfishing) within the Great Barrier Reef Marine Park (GBRMP) that are subject to a range of fishing limitations, and assess their utility as a marine park zoning and fisheries management tool. Fish abundance, size, and habitat composition were compared inside PPAs and NTMRs on inshore reefs of the central GBR. Fish abundances were lower inside PPAs relative to adjacent NTMRs for primary fishing targets, with no detectable effects for secondary targets and non-targets, or for species richness. Fish assemblages differed amongst zones, but these variations were minor compared to regional variations in species composition. Partially Protected Areas supported 46%–69% of the relative abundance of total primary targets compared to adjacent NTMRs, with no evident increase in abundance in zones where spearfishing was prohibited. There were no reductions in the size of two key target species: coral trout (Plectropomus spp.) and stripey snapper (Lutjanus carponotatus) inside PPAs, and only stripey snapper had significant reductions in abundance inside PPAs compared to NTMRS. Habitat and biophysical characteristics (especially topographic complexity) were strong drivers of fish abundance, but the relative influence of zone was greater for target species compared to non-targets. This study provides novel data on PPAs and highlights their utility as a spatial management tool in contributing to conservation and fisheries management goals

Evaluation of mating behaviour and mating compatibility methods for the Old World screwworm fly, Chrysomya bezziana.

The effectiveness of the Sterile Insect Technique program (SIT) to eradicate pest insects relies on the success of mating competitiveness between irradiated male flies and wild type males for the wild type females. It has been successfully applied for the New World screwworm fly (NWSF), Cochliomyia hominivorax but remains unproven for the Old World screwworm fly (OWSF), Chrysomya bezziana. The aim of the study was to develop methods for investigating mating behaviour and mating compatibility of C. bezziana under laboratory conditions. Two methods were used for studying mating: individual mating (method 1) and group mating (method 2). The flies used in this study were 5-7 days old. Twenty four hours after emergence, adult flies were sexed and placed into different cages until studied. The female : male ratio in the group mating was 1 : 5 and the males were marked by painting a dot on the thorax using different oil colours. Observation of mating behaviour was investigated every 30 minutes through 10-20 replications for all methods depending on the availability of flies. Data were analysed using ANOVA and the Student’s t-test, with significance demonstrated at the 95% confidence level. The results demonstrated that the frequency of contacts between males and females at different ages was a significantly different (p 0.05) and method 2 (p > 0.05). Copulation was only initiated following longer periods of contact, mainly in the range of 270-449 seconds. The highest frequency of copulation occurred between 7-8 days, but the duration of mating was similar between 5-8 days old. The study demonstrated that the methods developed were suitable for a mating compatibility study of C. bezziana

Geographical characteristics of Chrsyomya bezziana based on external morphology study

Correct identification of Chrysomya bezziana is a fundamental step to evaluate the successfulness of the eradication program based on Sterile Insect Techinque (SIT). However, geographical variation of the fly is being controversial among scientists. The aim of the study was to investigate the effect of preservation method on visualisation of characters of external morphology and to analyse geographical variation of C. bezziana populations throughout their distribution regions. A total of 88 flies collected from 7 populations in Indonesia, 2 populations in Africa and each 1 population from Oman, India, Malaysia and Papua New Guinea (PNG) were tested in the study. All larvae were removed from natural myiasis cases. The larvae were reared at laboratory until they became adult flies. The samples were preserved into two methods, wet (80% ethanol) and dried (pin) methods. Ten external characters of head and body were observed. Data were subjected to principal components and hierarchical cluster analyses in UNISTATÒ software. The Euclid distance measure was used for the cluster analysis, and the linking method used was the unweighted pair-group method using arithmetic average (UPGMA), to compute the distance between clusters. Results indicated that dried preservation (pinned samples) provided better external character than ethanol preservation. Based on external morphology of adult stages revealed that C. bezziana occurs as two geographical races, African and Asian races. There was no geographical variation of C. bezziana throughout Indonesian archipelago, except for the population from PNG forming its own cluster

Geographical characteristics of Chrsyomya bezziana based on external morphology study

Correct identification of Chrysomya bezziana is a fundamental step to evaluate the successfulness of the eradication program based on Sterile Insect Techinque (SIT). However, geographical variation of the fly is being controversial among scientists. The aim of the study was to investigate the effect of preservation method on visualisation of characters of external morphology and to analyse geographical variation of C. bezziana populations throughout their distribution regions. A total of 88 flies collected from 7 populations in Indonesia, 2 populations in Africa and each 1 population from Oman, India, Malaysia and Papua New Guinea (PNG) were tested in the study. All larvae were removed from natural myiasis cases. The larvae were reared at laboratory until they became adult flies. The samples were preserved into two methods, wet (80% ethanol) and dried (pin) methods. Ten external characters of head and body were observed.  Data were subjected to principal components and hierarchical cluster analyses in UNISTATÒ software. The Euclid distance measure was used for the cluster analysis, and the linking method used was the unweighted pair-group method using arithmetic average (UPGMA), to compute the distance between clusters. Results indicated that dried preservation (pinned samples) provided better external character than ethanol preservation. Based on external morphology of adult stages revealed that C. bezziana occurs as two geographical races, African and Asian races. There was no geographical variation of C. bezziana throughout Indonesian archipelago, except for the population from PNG forming its own cluster. Key Words: Myiasis, Chrysomya bezziana, Morphology, Geographical Variato