137 research outputs found
Antibiotic treatment duration and prevention of complications in neonatal Staphylococcus aureus bacteraemia
Blood pressure intervention levels in preterm infants : pilot randomised trial
OBJECTIVE: To examine the feasibility of a trial allocating different blood pressure (BP) intervention levels for treatment in extremely preterm infants. DESIGN: Three-arm open randomised controlled trial performed between February 2013 and April 2015. SETTING: Single tertiary level neonatal intensive care unit. PATIENTS: Infants born <29 weeks' gestation were eligible to participate, if parents consented and they did not have a major congenital malformation. INTERVENTIONS: Infants were randomised to different levels of mean arterial BP at which they received cardiovascular support: active (<30 mm Hg), moderate (<gestational age mm Hg) or permissive (signs of poor perfusion or <19 mm Hg). Once this threshold was breached, all were managed using the same treatment guideline. BP profiles were downloaded continuously; cardiac output and carotid blood flow were measured at 1 day and 3 days, and amplitude integrated EEG was recorded during the first week. Cranial ultrasound scans were reviewed blind to study allocation. MAIN OUTCOME MEASURE: Inotrope usage and achieved BP. RESULTS: Of 134 cases screened, 60 were enrolled, with mean gestation 25.8 weeks (SD 1.5) and birth weight 817 g (SD 190). Invasively measured BP on the first day and inotrope usage were highest in the active and lowest in the permissive arms. There were no differences in haemodynamic or EEG variables or in clinical complications. Predefined cranial ultrasound findings did not differ significantly; no infants in the active arm had parenchymal brain lesions. CONCLUSION: The BP threshold used to trigger treatment affects the achieved BP and inotrope usage, and it was possible to explore these effects using this study design. TRIAL REGISTRATION NUMBER: ISRCTN83507686
Identification and rejection of scattered neutrons in AGATA
Gamma rays and neutrons, emitted following spontaneous fission of 252Cf, were
measured in an AGATA experiment performed at INFN Laboratori Nazionali di
Legnaro in Italy. The setup consisted of four AGATA triple cluster detectors
(12 36-fold segmented high-purity germanium crystals), placed at a distance of
50 cm from the source, and 16 HELENA BaF2 detectors. The aim of the experiment
was to study the interaction of neutrons in the segmented high-purity germanium
detectors of AGATA and to investigate the possibility to discriminate neutrons
and gamma rays with the gamma-ray tracking technique. The BaF2 detectors were
used for a time-of-flight measurement, which gave an independent discrimination
of neutrons and gamma rays and which was used to optimise the gamma-ray
tracking-based neutron rejection methods. It was found that standard gamma-ray
tracking, without any additional neutron rejection features, eliminates
effectively most of the interaction points due to recoiling Ge nuclei after
elastic scattering of neutrons. Standard tracking rejects also a significant
amount of the events due to inelastic scattering of neutrons in the germanium
crystals. Further enhancements of the neutron rejection was obtained by setting
conditions on the following quantities, which were evaluated for each event by
the tracking algorithm: energy of the first and second interaction point,
difference in the calculated incoming direction of the gamma ray,
figure-of-merit value. The experimental results of tracking with neutron
rejection agree rather well with Geant4 simulations
Octupole transitions in the 208Pb region
The 208Pb region is characterised by the existence of collective octupole states.
Here we populated such states in 208Pb + 208Pb deep-inelastic reactions. γ-ray angular
distribution measurements were used to infer the octupole character of several E3 transitions.
The octupole character of the 2318 keV 17− → 14+ in 208Pb, 2485 keV 19/2
− → 13/2
+ in
207Pb, 2419 keV 15/2
− → 9/2
+ in 209Pb and 2465 keV 17/2
+ → 11/2
− in 207Tl transitions was
demonstrated for the first time. In addition, shell model calculations were performed using two
different sets of two-body matrix elements. Their predictions were compared with emphasis on
collective octupole states.This work is supported by the Science and Technology Facilities Council
(STFC), UK, US Department of Energy, Office of Nuclear Physics, under Contract No. DEAC02-06CH11357
and DE-FG02-94ER40834, NSF grant PHY-1404442
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Comparison of clinical outcomes between active and permissive blood pressure management in extremely preterm infants.
BACKGROUND: There remains uncertainty about the definition of normal blood pressure (BP), and when to initiate treatment for hypotension for extremely preterm infants. To determine the short-term outcomes of extremely preterm infants managed by active compared with permissive BP support regimens during the first 72 hours of life. METHOD: This is a retrospective medical records review of 23 +0-28 +6 weeks' gestational age (GA) infants admitted to neonatal units (NNU) with active BP support (aimed to maintain mean arterial BP (MABP) >30 mmHg irrespective of the GA) and permissive BP support (used medication only when babies developed signs of hypotension) regimens. Babies admitted after 12 hours of age, or whose BP data were not available were excluded. RESULTS: There were 764 infants admitted to the participating hospitals; 671 (88%) were included in the analysis (263 active BP support and 408 permissive BP support). The mean gestational age, birth weight, admission temperature, clinical risk index for babies (CRIB) score and first haemoglobin of infants were comparable between the groups. Active BP support group infants had consistently higher MABP and systolic BP throughout the first 72 hours of life (pgrade 2 intra ventricular haemorrhage (IVH). Death before discharge (adjusted OR 1.38 (0.88 - 2.16)) or IVH (1.38 (0.96 - 1.98)) was similar between the two groups. Necrotising enterocolitis (NEC) ≥stage 2 was significantly higher in permissive BP support group infants (1.65 (1.07 - 2.50)). CONCLUSIONS: There was no difference in mortality or IVH between the two BP management approaches. Active BP support may reduce NEC. This should be investigated prospectively in large multicentre randomised studies
A retrospective evaluation of the impact of a dedicated obstetric and neonatal transport service on transport times within an urban setting
OBJECTIVE:To determine whether the establishment of a dedicated obstetric and neonatal flying squad resulted in improved performance within the setting of a major metropolitan area.DESIGN AND SETTING:The Cape Town metropolitan service of the Emergency Medical Services was selected for a retrospective review of the transit times for the newly implemented Flying Squad programme. Data were imported from the Computer Aided Dispatch programme. Dispatch, Response, Mean Transit and Total Pre-hospital times relating to the obstetric and neonatal incidents was analysed for 2005 and 2008. RESULTS: There was a significant improvement between 2005 and 2008 in all incidents evaluated. Flying Squad dispatch performance improved from 11.7% to 46.6% of all incidents dispatched within 4 min (p < 0.0001). Response time performance at the 15-min threshold did not demonstrate a statistically significant improvement (p = 0.4), although the improvement in the 30-min performance category was statistically significant in both maternity and neonatal incidents. Maternity incidents displayed the greatest improvement with the 30-min performance increasing from 30.3% to 72.9%. The analysis of the mean transit times demonstrated that neonatal transfers displayed the longest status time in all but one of the categories. Even so, the introduction of the Flying Squad programme resulted in a reduction in a total pre-hospital time from 177 to 128 min. CONCLUSION: The introduction of the Flying Squad programme has resulted in significant improvement in the transit times of both neonatal and obstetric patients. In spite of the severe resource constraints facing developing nations, the model employed offers significant gains
Schottky mass measurements of heavy neutron-rich nuclides in the element range 70\leZ \le79 at the ESR
Storage-ring mass spectrometry was applied to neutron-rich Au
projectile fragments. Masses of Lu, Hf, Ta,
W, and Re nuclei were measured for the first time. The
uncertainty of previously known masses of W and Os nuclei
was improved. Observed irregularities on the smooth two-neutron separation
energies for Hf and W isotopes are linked to the collectivity phenomena in the
corresponding nuclei.Comment: 10 pages, 9 figures, 2 table
ADEPT - Abnormal Doppler Enteral Prescription Trial
<p>Abstract</p> <p>Background</p> <p>Pregnancies complicated by abnormal umbilical artery Doppler blood flow patterns often result in the baby being born both preterm and growth-restricted. These babies are at high risk of milk intolerance and necrotising enterocolitis, as well as post-natal growth failure, and there is no clinical consensus about how best to feed them. Policies of both early milk feeding and late milk feeding are widely used. This randomised controlled trial aims to determine whether a policy of early initiation of milk feeds is beneficial compared with late initiation. Optimising neonatal feeding for this group of babies may have long-term health implications and if either of these policies is shown to be beneficial it can be immediately adopted into clinical practice.</p> <p>Methods and Design</p> <p>Babies with gestational age below 35 weeks, and with birth weight below 10th centile for gestational age, will be randomly allocated to an "early" or "late" enteral feeding regimen, commencing milk feeds on day 2 and day 6 after birth, respectively. Feeds will be gradually increased over 9-13 days (depending on gestational age) using a schedule derived from those used in hospitals in the Eastern and South Western Regions of England, based on surveys of feeding practice. Primary outcome measures are time to establish full enteral feeding and necrotising enterocolitis; secondary outcomes include sepsis and growth. The target sample size is 400 babies. This sample size is large enough to detect a clinically meaningful difference of 3 days in time to establish full enteral feeds between the two feeding policies, with 90% power and a 5% 2-sided significance level. Initial recruitment period was 24 months, subsequently extended to 38 months.</p> <p>Discussion</p> <p>There is limited evidence from randomised controlled trials on which to base decisions regarding feeding policy in high risk preterm infants. This multicentre trial will help to guide clinical practice and may also provide pointers for future research.</p> <p>Trial registration</p> <p>Current Controlled Trials ISRCTN: 87351483</p
Technique for Resolving Low-lying Isomers in the Experimental Storage Ring (ESR) and the Occurrence of an Isomeric State in 192Re
A recent experiment using projectile fragmentation of a 197Au beam on a 9Be target, combined with the fragment recoil separator and experimental storage ring at ring at GSI, has uncovered an isomeric state in 192Re at 267(10) keV with a half-life of ∼6
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