Trends in New South Wales infant hospital admission rates in the first year of life: population-based study

Objective: To examine the trends in hospital admissions in the first year of life and identify whether changes in maternal and infant risk factors explain any changes Design: Population-based study using de-identified linked health data. Participants: All 788,798 liveborn infants delivered in New South Wales from 2001 to 2009 with a linked birth and hospital record. Main outcome measures: The number of infants readmitted to hospital at least once, up to one year of age, per 100 livebirths each year; changes in maternal and infant risk factors were assessed using logistic regression. Results: The number of infants admitted to hospital up to age one decreased 10.5%, from 18.4 per 100 births in 2001 to 16.5 in 2009. Fifty five per cent of this decrease could be explained by changes in factors that are associated with likelihood of hospitalisation; length of stay during the birth admission, maternal age and maternal smoking. The rate of admissions for jaundice and feeding difficulties increased significantly over the study period, while admissions for infections decreased. Conclusions: There has been a decrease in the rate of infants admitted to hospital in the first year of life, which can be partly explained by increasing maternal age, decreasing maternal smoking and a shift to shorter length of hospital stay at birth. Improved maternal and neonatal care in hospital and increased postnatal support at home may have contributed to reduced risk of readmission. The introduction of government policies may explain the rest of the decrease

Irrotational binary neutron stars in quasiequilibrium

We report on numerical results from an independent formalism to describe the quasi-equilibrium structure of nonsynchronous binary neutron stars in general relativity. This is an important independent test of controversial numerical hydrodynamic simulations which suggested that nonsynchronous neutron stars in a close binary can experience compression prior to the last stable circular orbit. We show that, for compact enough stars the interior density increases slightly as irrotational binary neutron stars approach their last orbits. The magnitude of the effect, however, is much smaller than that reported in previous hydrodynamic simulations.Comment: 4 pages, 2 figures, revtex, accepted for publication in Phys. Rev.

Relationship of food insecurity to women's dietary outcomes: a systematic review

Context: Food insecurity matters for women's nutrition and health. Objective: This review sought to comprehensively evaluate how food insecurity relates to a full range of dietary outcomes (food groups, total energy, macronutrients, micronutrients, and overall dietary quality) among adult women living in Canada and the United States. Data sources: Peer-reviewed databases (PubMed/MEDLINE, CINAHL, Scopus, Web of Science) and gray literature sources from 1995 to 2016 were searched. Data extraction: Observational studies were used to calculate a percentage difference in dietary intake for food-insecure and food-secure groups. Results: Of the 24 included studies, the majority found food-insecure women had lower food group frequencies (dairy, total fruits and vegetables, total grains, and meats/meat alternatives) and intakes of macro- and micronutrients relative to food-secure women. Methodological quality varied. Among high-quality studies, food insecurity was negatively associated with dairy, fruits and vegetables, grains, meats/meats alternatives, protein, total fat, calcium, iron, magnesium, vitamins A and C, and folate. Conclusions: Results hold practical relevance for selecting nutritional targets in programs, particularly for nutrient-rich foods with iron and folate, which are more important for women's health

Relativistic Models for Binary Neutron Stars with Arbitrary Spins

We introduce a new numerical scheme for solving the initial value problem for quasiequilibrium binary neutron stars allowing for arbitrary spins. The coupled Einstein field equations and equations of relativistic hydrodynamics are solved in the Wilson-Mathews conformal thin sandwich formalism. We construct sequences of circular-orbit binaries of varying separation, keeping the rest mass and circulation constant along each sequence. Solutions are presented for configurations obeying an n=1 polytropic equation of state and spinning parallel and antiparallel to the orbital angular momentum. We treat stars with moderate compaction ((m/R) = 0.14) and high compaction ((m/R) = 0.19). For all but the highest circulation sequences, the spins of the neutron stars increase as the binary separation decreases. Our zero-circulation cases approximate irrotational sequences, for which the spin angular frequencies of the stars increases by 13% (11%) of the orbital frequency for (m/R) = 0.14 ((m/R) = 0.19) by the time the innermost circular orbit is reached. In addition to leaving an imprint on the inspiral gravitational waveform, this spin effect is measurable in the electromagnetic signal if one of the stars is a pulsar visible from Earth.Comment: 21 pages, 14 figures. A few explanatory sentences added and some typos corrected. Accepted for publication in Phys. Rev.

The Asymptotic distribution of circles in the orbits of Kleinian groups

Let P be a locally finite circle packing in the plane invariant under a non-elementary Kleinian group Gamma and with finitely many Gamma-orbits. When Gamma is geometrically finite, we construct an explicit Borel measure on the plane which describes the asymptotic distribution of small circles in P, assuming that either the critical exponent of Gamma is strictly bigger than 1 or P does not contain an infinite bouquet of tangent circles glued at a parabolic fixed point of Gamma. Our construction also works for P invariant under a geometrically infinite group Gamma, provided Gamma admits a finite Bowen-Margulis-Sullivan measure and the Gamma-skinning size of P is finite. Some concrete circle packings to which our result applies include Apollonian circle packings, Sierpinski curves, Schottky dances, etc.Comment: 31 pages, 8 figures. Final version. To appear in Inventiones Mat

CASSETTE—clindamycin adjunctive therapy for severe Staphylococcus aureus treatment evaluation: Study protocol for a randomised controlled trial

Background Exotoxins are important virulence factors in Staphylococcus aureus. Clindamycin, a protein synthesis inhibitor antibiotic, is thought to limit exotoxin production and improve outcomes in severe S. aureus infections. However, randomised prospective data to support this are lacking. Methods An open-label, multicentre, randomised controlled trial (RCT) will compare outcome differences in severe S. aureus infection between standard treatment (flucloxacillin/cefazolin in methicillin-susceptible S. aureus; and vancomycin/daptomycin in methicillin-resistant S. aureus) and standard treatment plus an additional clindamycin given for 7 days. We will include a minimum of 60 participants (both adult and children) in the pilot study. Participants will be enrolled within 72 h of an index culture. Severe infections will include septic shock, necrotising pneumonia, or multifocal and non-contiguous skin and soft tissue/osteoarticular infections. Individuals who are immunosuppressed, moribund, with current severe diarrhoea or Clostridiodes difficile infection, pregnant, and those with anaphylaxis to β-lactams or lincosamides will be excluded. The primary outcomes measure is the number of days alive and free (1 or 0) of systemic inflammatory response syndrome (SIRS) within the first 14 days post randomisation. The secondary outcomes measure will include all-cause mortality at 14, 42, and 90 days, time to resolution of SIRS, proportion with microbiological treatment failure, and rate of change of C-reactive protein over time. Impacts of inducible clindamycin resistance, strain types, methicillin susceptibility, and presence of various exotoxins will also be analysed. Discussion This study will assess the effect of adjunctive clindamycin on patient-centred outcomes in severe, toxin-mediated S. aureus infections. The pilot study will provide feasibility for a much larger RCT. Trial registration Australian New Zealand Clinical Trials Registry, ACTRN12617001416381p. Registered on 6 October 2017