Steroid Therapy for Bacterial Meningitis

Routine dexamethasone therapy for bacterial meningitis in pediatric patients is controversial. Two experts debated this topic at the 1993 meeting of the Infectious Diseases Society of America. Both experts agreed that for management of Haemophilus influenzae meningitis, dexamethasone significantly reduced sensorineural hearing loss and probably reduced other long-term sequelae. Because relatively few patients with pneumococcal and meningococcal meningitis have been studied, no conclusions could be reached regarding the effectiveness of dexamethasone. Dr. Urs Schaad emphasized the impressive anti-inflammatory effects of dexamethasone in experimental pneumococcal meningitis and the lack of any adverse events when given to children for 2 or 4 days. He recommended routine use of dexamethasone in treating pediatric patients with bacterial meningitis. Dr. Sheldon Kaplan expressed concern regarding the effectiveness of steroids in treating pneumococcal meningitis, especially when penicillin-resistant and cephalosporin-resistant isolates are present, and he addressed the question of the long-term effects of administration of dexamethasone in children with viral meningitis. He advised against the routine use of dexamethasone for non-H. influenzae meningiti

Cefazolin inoculum effect and methicillin-susceptible Staphylococcus aureus osteoarticular infections in children

Select methicillin-susceptibl

Invasive community-onset gram-positive infections from July 2018 through December 2022 at 2 children\u27s hospitals

BACKGROUND: Invasive infections caused by METHODS: Cases of iGAS, IPD, and I-CO-SA infections were identified prospectively and retrospectively at 2 large US children\u27s hospitals by positive cultures from July 2018 through December 2022. Admission data were used to estimate frequency. For comparison, rates of respiratory syncytial virus (RSV), influenza, and SARS-CoV-2 were estimated by the number of positive viral test results at each institution. RESULTS: I-CO-SA infections showed little variation in the study period. Rates of iGAS infection and IPD decreased by 46% and 44%, respectively, from 2019 to 2020, coinciding with a substantial decrease in RSV and influenza. In 2022, RSV and influenza infection rates increased to prepandemic winter season rates, coinciding with a return to prepandemic rates of IPD (225% increase from 2021 to 2022) and a surge above prepandemic rates of iGAS infections (543% increase from 2021 to 2022). CONCLUSIONS: The COVID-19 pandemic had an unexpected influence on IPD and iGAS infections that was temporally related to changes in rates of viral infections

(Re)imagining the ‘backstreet’:Anti-abortion campaigning against decriminalisation in the UK

The risk of death or serious injury from ‘backstreet abortions’ was an important narrative in the 20th century campaign to liberalise abortion in the UK. Since then, clinical developments have reduced the overall health risks of abortion, and international health organisations have been set up to provide cross-border, medically safe abortions to places where it is unlawful, offering advice and, where possible, supplying abortion pills. These changes mean that pro-choice campaigns in Europe have often moved away from the risks of ‘backstreet abortions’ as a central narrative when campaigning for abortion liberalisation. In contrast, in the UK, anti-abortion activists are increasingly using ideas about ‘backstreet abortions’ to resist further liberalisation. These claims can be seen to fit within a broader shift from morals to risk within moral regulation campaigns and build on anti-abortion messages framed as being ‘pro-women’, with anti-abortion activists claiming to be the ‘savers’ of women. Using a parliamentary debate as a case study, this article will illustrate these trends and show how the ‘backstreet’ metaphor within anti-abortion campaigns builds on three interconnected themes of ‘abortion-as-harmful’, ‘abortion industry’, and ‘abortion culture’. This article will argue that the anti-abortion movement’s adoption of risk-based narratives contains unresolved contradictions due to the underlying moral basis of their position. These are exacerbated by the need, in this case, to defend legislation that they fundamentally disagree with. Moreover, their attempts to construct identifiable ‘harms’ and vulnerable ‘victims’, which are components of moral regulation campaigns, are unlikely to be convincing in the context of widespread public support for abortion

Composite model with neutrino large mixing

We suggest a simple composite model that induces the large flavor mixing of neutrino in the supersymmetric theory. This model has only one hyper-color in addition to the standard gauge group, which makes composite states of preons. In this model, {\bf 10} and {\bf 1} representations in SU(5) grand unified theory are composite states and produce the mass hierarchy. This explains why the large mixing is realized in the lepton sector, while the small mixing is realized in the quark sector. This model can naturally solve the atmospheric neutrino problem. We can also solve the solar neutrino problem by improving the model.Comment: 20 pages, Latex, no figure

A Rapid Host-protein Test for Differentiating Bacterial From Viral Infection: Apollo Diagnostic Accuracy Study

OBJECTIVES: To determine the diagnostic accuracy of a rapid host-protein test for differentiating bacterial from viral infections in patients who presented to the emergency department (ED) or urgent care center (UCC). METHODS: This was a prospective multicenter, blinded study. MeMed BV (MMBV), a test based on tumor necrosis factor-related apoptosis-inducing ligand (TRAIL), interferon gamma-inducible protein-10 (IP-10), and C-reactive protein (CRP), was measured using a rapid measurement platform. Patients were enrolled from 9 EDs and 3 UCCs in the United States and Israel. Patients \u3e3 months of age presenting with fever and clinical suspicion of acute infection were considered eligible. MMBV results were not provided to the treating clinician. MMBV results (bacterial/viral/equivocal) were compared against a reference standard method for classification of infection etiology determined by expert panel adjudication. Experts were blinded to MMBV results. They were provided with comprehensive patient data, including laboratory, microbiological, radiological and follow-up. RESULTS: Of 563 adults and children enrolled, 476 comprised the study population (314 adults, 162 children). The predominant clinical syndrome was respiratory tract infection (60.5% upper, 11.3% lower). MMBV demonstrated sensitivity of 90.0% (95% confidence interval [CI]: 80.3-99.7), specificity of 92.8% (90.0%-95.5%), and negative predictive value of 98.8% (96.8%-99.6%) for bacterial infections. Only 7.2% of cases yielded equivocal MMBV scores. Area under the curve for MMBV was 0.95 (0.90-0.99). CONCLUSIONS: MMBV had a high sensitivity and specificity relative to reference standard for differentiating bacterial from viral infections. Future implementation of MMBV for patients with suspected acute infections could potentially aid with appropriate antibiotic decision-making

Search for anomalous t t-bar production in the highly-boosted all-hadronic final state

A search is presented for a massive particle, generically referred to as a Z', decaying into a t t-bar pair. The search focuses on Z' resonances that are sufficiently massive to produce highly Lorentz-boosted top quarks, which yield collimated decay products that are partially or fully merged into single jets. The analysis uses new methods to analyze jet substructure, providing suppression of the non-top multijet backgrounds. The analysis is based on a data sample of proton-proton collisions at a center-of-mass energy of 7 TeV, corresponding to an integrated luminosity of 5 inverse femtobarns. Upper limits in the range of 1 pb are set on the product of the production cross section and branching fraction for a topcolor Z' modeled for several widths, as well as for a Randall--Sundrum Kaluza--Klein gluon. In addition, the results constrain any enhancement in t t-bar production beyond expectations of the standard model for t t-bar invariant masses larger than 1 TeV.Comment: Submitted to the Journal of High Energy Physics; this version includes a minor typo correction that will be submitted as an erratu

Constraints on the χ_(c1) versus χ_(c2) polarizations in proton-proton collisions at √s = 8 TeV

The polarizations of promptly produced χ_(c1) and χ_(c2) mesons are studied using data collected by the CMS experiment at the LHC, in proton-proton collisions at √s=8  TeV. The χ_c states are reconstructed via their radiative decays χ_c → J/ψγ, with the photons being measured through conversions to e⁺e⁻, which allows the two states to be well resolved. The polarizations are measured in the helicity frame, through the analysis of the χ_(c2) to χ_(c1) yield ratio as a function of the polar or azimuthal angle of the positive muon emitted in the J/ψ → μ⁺μ⁻ decay, in three bins of J/ψ transverse momentum. While no differences are seen between the two states in terms of azimuthal decay angle distributions, they are observed to have significantly different polar anisotropies. The measurement favors a scenario where at least one of the two states is strongly polarized along the helicity quantization axis, in agreement with nonrelativistic quantum chromodynamics predictions. This is the first measurement of significantly polarized quarkonia produced at high transverse momentum