Antibiotic Treatment of Suspected and Confirmed Neonatal Sepsis Within 28 Days of Birth: A Retrospective Analysis

Neonatal sepsis causes significant mortality and morbidity worldwide. Diagnosis is usually confirmed via blood culture results. Blood culture sepsis confirmation can take days and suffer from contamination and false negatives. Empiric therapy with antibiotics is common. This study aims to retrospectively describe and compare treatments of blood culture-confirmed and unconfirmed, but suspected, sepsis within the University of Utah Hospital system. Electronic health records were obtained from 1,248 neonates from January 1, 2006, to December 31, 2017. Sepsis was categorized into early-onset (≤3 days of birth, EOS) and late-onset (\u3e3 and ≤28 days of birth, LOS) and categorized as culture-confirmed sepsis if a pathogen was cultured from the blood and unconfirmed if all blood cultures were negative with no potentially contaminated blood cultures. Of 1,010 neonates in the EOS cohort, 23 (2.3%) were culture-confirmed, most with Escherichia coli (42%). Treatment for unconfirmed EOS lasted an average of 6.1 days with primarily gentamicin and ampicillin while confirmed patients were treated for an average of 12.3 days with increased administration of cefotaxime. Of 311 neonates in the LOS cohort, 62 (20%) were culture-confirmed, most culturing coagulase negative staphylococci (46%). Treatment courses for unconfirmed LOS lasted an average of 7.8 days while confirmed patients were treated for an average of 11.4 days, these patients were primarily treated with vancomycin and gentamicin. The use of cefotaxime for unconfirmed EOS and LOS increased throughout the study period. Cefotaxime administration was associated with an increase in neonatal mortality, even when potential confounding factors were added to the logistic regression model (adjusted odds ratio 2.8, 95%CI [1.21, 6.88], p = 0.02). These results may not be generalized to all hospitals and the use of cefotaxime may be a surrogate for other factors. Given the low rate of blood culture positive diagnosis and the high exposure rate of empiric antibiotics, this patient population might benefit from improved diagnostics with reevaluation of antibiotic use guideline

Extraction and Characterization of Linoleic Acid from the Leaves of the Traditional Medicinal Plant Caloncoba Echinata in Sierra Leone

Dried powdered organs of Caloncoba echinata plant were subjected to organoleptic evaluation and Fluorescence properties. The reagent which gave the most fluorescent character was used to extract a compound from the plant materials. 3.14% (2.50 g) of an oily substance was extracted from 79.62g of powdered leaves of Caloncoba echinata in 450 mL 10% of HNO3 and allowed to stand for 72 hours. The extract was filtered using a Buchner funnel attached to portable Vacuum Pump and the acidic crude extracted with petroleum ether (10 mL x 3).The crude oily compound was separated from the mixture, purified weighed and labelled as LKL01. Sample LK01 tested positive for terpenoids and unsaturation with Saponification and Iodine Values of 201.96 and 177.66 respectively indicating that the compound is very suitable soap production and cosmetic purposes. Chemical and spectroscopic analysis and from literature revealed the compound to be Linoleic acid. This is the first report of the presence of Linoleic acid in the leaves of Caloncoba echinata. Linoleic acid has been reported to be used as an emollient and thickening agent in cosmetics, antioxidant and an anti-inflammatory agent in the treatment of burns, cold sores and other minor wounds supporting the use of Caloncoba echinata plant in traditional medicine

Meson Spectroscopy in AdS/CFT with Flavour

We compute the meson spectrum of an N=2 super Yang-Mills theory with fundamental matter from its dual string theory on AdS_5 x S_5 with a D7-brane probe. For scalar and vector mesons with arbitrary R-charge the spectrum is computed in closed form by solving the equations for D7-brane fluctuations; for matter with non-zero mass m_q it is discrete, exhibits a mass gap of order m_q / sqrt(g_s N) and furnishes representations of SO(5) even though the manifest global symmetry of the theory is only SO(4). The spectrum of mesons with large spin J is obtained from semiclassical, rotating open strings attached to the D7-brane. It displays Regge-like behaviour for J << sqrt(g_s N), whereas for J >> sqrt(g_s N) it corresponds to that of two non-relativistic quarks bound by a Coulomb potential. Meson interactions, baryons and `giant gauge bosons' are briefly discussed.Comment: LaTeX, 39 pages, 4 figures, uses epsf. v2: typos corrected. references adde

Risk Categorization Using New American College of Cardiology/American Heart Association Guidelines for Cholesterol Management and Its Relation to Alirocumab Treatment Following Acute Coronary Syndromes

BACKGROUND: The 2018 US cholesterol management guidelines recommend additional lipid-lowering therapies for secondary prevention in patients with lowdensity lipoprotein cholesterol ≥70 mg/dL or non−high-density lipoprotein cholesterol ≥100 mg/dL despite maximum tolerated statin therapy. Such patients are considered at very high risk (VHR) based on a history of >1 major atherosclerotic cardiovascular disease (ASCVD) event or a single ASCVD event and multiple high-risk conditions. We investigated the association of US guideline-defined risk categories with the occurrence of ischemic events after acute coronary syndrome and reduction of those events by alirocumab, a PCSK9 (proprotein convertase subtilisin/kexin type 9) inhibitor. METHODS: In the ODYSSEY OUTCOMES trial (Evaluation of Cardiovascular Outcomes After an Acute Coronary Syndrome During Treatment With Alirocumab), patients with recent acute coronary syndrome and residual dyslipidemia despite optimal statin therapy were randomly assigned to alirocumab or placebo. The primary trial outcome (major adverse cardiovascular events, ie, coronary heart disease death, nonfatal myocardial infarction, is

SERA: Simulation Environment for Radiotherapy Applications - Users Manual Version 1CO

This document is the user manual for the Simulation Environment for Radiotherapy Applications (SERA) software program developed for boron-neutron capture therapy (BNCT) patient treatment planning by researchers at the Idaho National Engineering and Environmental Laboratory (INEEL) and students and faculty at Montana State University (MSU) Computer Science Department. This manual corresponds to the final release of the program, Version 1C0, developed to run under the RedHat Linux Operating System (version 7.2 or newer) or the Solaris™ Operating System (version 2.6 or newer). SERA is a suite of command line or interactively launched software modules, including graphical, geometric reconstruction, and execution interface modules for developing BNCT treatment plans. The program allows the user to develop geometric models of the patient as derived from Computed Tomography (CT) and Magnetic Resonance Imaging (MRI) images, perform dose computation for these geometric models, and display the computed doses on overlays of the original images as three dimensional representations. This manual provides a guide to the practical use of SERA, but is not an exhaustive treatment of each feature of the code

Seasonal size variation in the predatory cladoceran Bythotrephes cederstroemii in Lake Michigan

1.  Dry weight, body length and spine length were measured for the exotic cladoceran Bythotrephes cederstroemii collected from offshore and inshore stations in southeastern Lake Michigan. Average dry weight of each developmental stage exhibited seasonal variation by a factor of more than 5. 2.  Mean dry weight of Bythotrephes was closely correlated with water temperature. Contrary to the inverse relationship between water temperature and body size frequently observed for other invertebrates, the dry weight of Bythotrephes increased at higher ambient temperatures. 3.  No significant correlation was observed between abundances of major zooplankton taxa and the dry weight of Bythotrephes . An indirect effect of temperature on prey consumption may cause seasonal variation in dry weight of Bythotrephes in Lake Michigan. 4.  Distances between adjacent pairs of barbs, added to the caudal spine with each moult, are significantly shorter in Bythotrephes which produce resting eggs. Less material investment in the exoskeleton of sexually reproducing females was observed in favour of growth and reproduction.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/74641/1/j.1365-2427.1994.tb00842.x.pd

Unfolding of differential energy spectra in the MAGIC experiment

The paper describes the different methods, used in the MAGIC experiment, to unfold experimental energy distributions of cosmic ray particles (gamma-rays). Questions and problems related to the unfolding are discussed. Various procedures are proposed which can help to make the unfolding robust and reliable. The different methods and procedures are implemented in the MAGIC software and are used in most of the analyses.Comment: Submitted to NIM

Implementation of the Random Forest Method for the Imaging Atmospheric Cherenkov Telescope MAGIC

The paper describes an application of the tree classification method Random Forest (RF), as used in the analysis of data from the ground-based gamma telescope MAGIC. In such telescopes, cosmic gamma-rays are observed and have to be discriminated against a dominating background of hadronic cosmic-ray particles. We describe the application of RF for this gamma/hadron separation. The RF method often shows superior performance in comparison with traditional semi-empirical techniques. Critical issues of the method and its implementation are discussed. An application of the RF method for estimation of a continuous parameter from related variables, rather than discrete classes, is also discussed.Comment: 16 pages, 8 figure

Probing quantum gravity using photons from a flare of the active galactic nucleus Markarian 501 observed by the MAGIC telescope

We analyze the timing of photons observed by the MAGIC telescope during a flare of the active galactic nucleus Mkn 501 for a possible correlation with energy, as suggested by some models of quantum gravity (QG), which predict a vacuum refractive index \simeq 1 + (E/M_{QGn})^n, n = 1,2. Parametrizing the delay between gamma-rays of different energies as \Delta t =\pm\tau_l E or \Delta t =\pm\tau_q E^2, we find \tau_l=(0.030\pm0.012) s/GeV at the 2.5-sigma level, and \tau_q=(3.71\pm2.57)x10^{-6} s/GeV^2, respectively. We use these results to establish lower limits M_{QG1} > 0.21x10^{18} GeV and M_{QG2} > 0.26x10^{11} GeV at the 95% C.L. Monte Carlo studies confirm the MAGIC sensitivity to propagation effects at these levels. Thermal plasma effects in the source are negligible, but we cannot exclude the importance of some other source effect.Comment: 12 pages, 3 figures, Phys. Lett. B, reflects published versio

Holographic Hydrodynamics with a Chemical Potential

We consider five-dimensional gravity coupled to a negative cosmological constant and a single U(1) gauge field, including a general set of four-derivative interactions. In this framework, we construct charged planar AdS black hole solutions perturbatively and consider the thermal and hydrodynamic properties of the plasma in the dual CFT. In particular, we calculate the ratio of shear viscosity to entropy density and argue that the violation of the KSS bound is enhanced in the presence of a chemical potential. We also compute the electrical conductivity and comment on various conjectured bounds related to this coefficient.Comment: v2: comparison to supergravity lagrangian added, references added, typos fixe