A randomised controlled trial of high vs low volume initiation and rapid vs slow advancement of milk feeds in infants with birthweights 1000 g in a resource-limited setting

Background: Optimal feeding regimens for infants ≤ 1000 g have not been established and are a global healthcare concern. Aims and objectives: A controlled trial to establish the safety and efficacy of high vs low volume initiation and rapid vs slow advancement of milk feeds in a resource-limited setting was undertaken. Methods: Infants ≤ 1000 g birthweight were randomised to one of four arms, either low (4 ml/kg/day) or high (24 ml/kg/day) initiation and either slow (24 ml/kg/day) or rapid (36 ml/kg/day) advancement of exclusive feeds of human milk (mother’s or donor) until a weight of 1200 g was reached. After this point, formula was used to supplement insufficient mother’s milk. The primary outcome was time to reach 1500 g. Results: infants were recruited (51: low/slow; 47: low/rapid; 52: high/slow; 50: high/rapid). Infants on rapid advancement regimens reached 1500 g most rapidly (hazard ratio 1.48, 95% CI 1.05–2.09, P=0.03). The rapid advancement groups also regained birthweight more rapidly (hazard ratio 1.77, 95% CI 1.26–2.50, P=0.001). There was no apparent effect of high vs low initiation volumes but there was some evidence of interaction between interventions. There were no significant differences in other secondary outcomes, including necrotising enterocolitis, feed intolerance and late-onset sepsis. Conclusions: In this small pilot study, higher initiation feed volumes and larger daily increments appeared to be well tolerated and resulted in more rapid early weight gain. These data provide justification for a larger study in resource-limited settings to address mortality, necrotising enterocolitis and other important outcomes

Resource implications of adopting a restrictive neonatal blood transfusion policy

Background. Blood transfusions (BTFs) are not without risk and pose a significant financial burden on resource-limited services. In line with current international evidence, the nursery at Groote Schuur Hospital (GSH), Cape Town, South Africa, introduced a restrictive BTF protocol to minimise transfusions and manage costs.Objective. To determine whether adopting a restrictive BTF policy results in fewer transfusions. Methods. Data were retrospectively collected on all infants who received BTFs in the GSH nursery over a 6-month period following adoption of a restrictive BTF policy in 2010. BTF figures for a similar time period before the restrictive policy, during 2008, were obtained for comparison.Results. After introduction of the restrictive BTF policy, 42 of 1 097 infants admitted (3.8%) received a total of 64 BTFs. In comparison, 102 of a total of 940 infants (10.9%) admitted during a period of the same length before introduction of the restrictive BTF policy received a total of 121 transfusions. Comparison between the number of BTFs administered before and after the restrictive policy showed a highly statistically significant difference (p<0.001). The total cost of the blood products used in the two 6-month periods was R91 870 v. R48 640, based on current prices. Conclusions. By adopting a restrictive policy, we were able to halve the number of BTFs, reduce risks associated with transfusions, and achieve significant cost benefits. Following evidence-based guidelines results in high standards of care, while also making the most effective use of resources.

Sub-millimeter to centimeter excess emission from the Magellanic Clouds. I. Global spectral energy distribution

In order to reconstruct the global SEDs of the Magellanic Clouds over eight decades in spectral range, we combined literature flux densities representing the entire LMC and SMC respectively, and complemented these with maps extracted from the WMAP and COBE databases covering the missing the 23--90 GHz (13--3.2 mm) and the poorly sampled 1.25--250 THz (240--1.25 micron). We have discovered a pronounced excess of emission from both Magellanic Clouds, but especially the SMC, at millimeter and sub-millimeter wavelengths. We also determined accurate thermal radio fluxes and very low global extinctions for both LMC and SMC. Possible explanations are briefly considered but as long as the nature of the excess emission is unknown, the total dust masses and gas-to-dust ratios of the Magellanic Clouds cannot reliably be determined.Comment: Accepted for publication by A&

The spectral energy distribution of the central parsecs of the nearest AGN

Spectral energy distributions (SEDs) of the central few tens of parsec region of some of the nearest, most well studied, active galactic nuclei (AGN) are presented. These genuine AGN-core SEDs, mostly from Seyfert galaxies, are characterised by two main features: an IR bump with the maximum in the 2-10 micron range, and an increasing X-ray spectrum in the 1 to ~200 keV region. These dominant features are common to Seyfert type 1 and 2 objects alike. Type 2 AGN exhibit a sharp drop shortward of 2 micron, with the optical to UV region being fully absorbed, while type 1s show instead a gentle 2 micron drop ensued by a secondary, partially-absorbed optical to UV emission bump. Assuming the bulk of optical to UV photons generated in these AGN are reprocessed by dust and re-emitted in the IR in an isotropic manner, the IR bump luminosity represents >70% of the total energy output in these objects while the high energies above 20 keV are the second energetically important contribution. Galaxies selected by their warm IR colours, i.e. presenting a relatively-flat flux distribution in the 12 to 60 micron range have often being classified as AGN. The results from these high spatial resolution SEDs question this criterion as a general rule. It is found that the intrinsic shape of the IR SED of an AGN and inferred bolometric luminosity largely depart from those derived from large aperture data. AGN luminosities can be overestimated by up to two orders of magnitude if relying on IR satellite data. We find these differences to be critical for AGN luminosities below or about 10^{44} erg/s. Above this limit, AGNs tend to dominate the light of their host galaxy regardless of the aperture size used. We tentatively mark this luminosity as a threshold to identify galaxy-light- vs AGN- dominated objects.Comment: 50 pages, 14 figures. Accepted for publication in MNRA

Urban interventionism as a challenge to aesthetic order::Towards an aesthetic criminology

This article is concerned with ideas of urban order and considers the scope for playing with people’s expectations of order. In particular, drawing on criminological, philosophical and urban studies literatures, the article explores the notion of aesthetic order. The power to dictate aesthetic order is highlighted. The example of urban interventionism is used to consider those that challenge an approved aesthetic order. Here the article draws on cultural criminology and visual criminology, with illustrations coming from research in Toronto, Canada. Influenced by Alison Young’s (2014a) conceptualisation of ‘cities within the city’, the article considers how different people using the same space have different or overlapping ways of understanding aesthetic order. Of relevance to criminology, it is contended that people or things that contravene an approved aesthetic order may face banishment and criminalisation. It is concluded that respect for such difference is required. An aesthetic criminology is suggested