Ciprofloxacin during upper respiratory tract infections to reduce Pseudomonas aeruginosa infection in paediatric cystic fibrosis: a pilot study.

OBJECTIVES: Acute viral respiratory illnesses are associated with acquisition of Pseudomonas aeruginosa infection in cystic fibrosis (CF) patients. This study aimed to pilot a protocol for a randomized controlled trial to determine whether oral antipseudomonal antibiotics used at the onset of such episodes might delay onset of infection with this organism. METHODS: A total of 41 children with CF aged 2-14 years, without chronic Pseudomonas infection, were randomized to receive ciprofloxacin (n = 28) or placebo (n = 13) at the onset of acute viral respiratory infections on an intention to treat basis, during a study period of up to 32 months. RESULTS: There were no unexpected adverse events believed related to the use of the study medication. The rate of withdrawal from the study was low (approximately 7%) and did not differ between groups. Randomization was effective and acceptable to participants. Primary and secondary outcome measures all favoured active treatment, but there were no significant between group differences. The median rate of Pseudomonas isolates was 0/patient/year (interquartile range 0-0.38) in both the active and placebo groups. Kaplan-Meier survival curves showed no significant difference in time to first Pseudomonas isolate between groups. CONCLUSIONS: This study demonstrated the clinical feasibility of using oral ciprofloxacin in CF patients at times of viral infection. Within this sample size, no significant association was found between active treatment and decreased growth of Pseudomonas in follow-up microbiological samples. A definitive study would require at least 320 children to demonstrate significant differences in the rate of pseudomonal isolates

The Drosophila melanogaster Apaf-1 homologue ARK is required for most, but not all, programmed cell death

The Apaf-1 protein is essential for cytochrome c–mediated caspase-9 activation in the intrinsic mammalian pathway of apoptosis. Although Apaf-1 is the only known mammalian homologue of the Caenorhabditis elegans CED-4 protein, the deficiency of apaf-1 in cells or in mice results in a limited cell survival phenotype, suggesting that alternative mechanisms of caspase activation and apoptosis exist in mammals. In Drosophila melanogaster, the only Apaf-1/CED-4 homologue, ARK, is required for the activation of the caspase-9/CED-3–like caspase DRONC. Using specific mutants that are deficient for ark function, we demonstrate that ARK is essential for most programmed cell death (PCD) during D. melanogaster development, as well as for radiation-induced apoptosis. ark mutant embryos have extra cells, and tissues such as brain lobes and wing discs are enlarged. These tissues from ark mutant larvae lack detectable PCD. During metamorphosis, larval salivary gland removal was severely delayed in ark mutants. However, PCD occurred normally in the larval midgut, suggesting that ARK-independent cell death pathways also exist in D. melanogaster

The role of airspeed variability in fixed-time, fuel-optimal aircraft trajectory planning

With the advent of improved aircraft situational awareness and the need for airlines to reduce their fuel consumption and environmental impact whilst adhering to strict timetables, fixed-time, fuel-optimal routing is vital. Here, the aircraft trajectory planning problem is addressed using optimal control theory. Two variants of a finite horizon optimal control formulation for fuel burn minimization are developed, subject to arrival constraints, an aerodynamic fuel-burn model, and a data-driven wind field. In the first variant, the control variable is expressed as a set of position-dependent aircraft headings, with the optimal control problem solved through a reduced gradient approach at a range of fixed airspeeds. The fuel optimal result is taken as the lowest fuel use recorded. In the second variant, both heading angle and airspeed are controlled. Results from three months of simulated flight routes between London and New York show that permitting optimised en-route airspeed variations leads to fuel savings of 0.5% on an average day (and up to 4% on certain days), compared with fixed airspeed flights. We conclude that significant fuel savings are possible if airspeeds are allowed to vary en route to take optimal advantage of the wind field

Genome-Wide Meta-analysis identifies three novel loci associated with stroke

We conducted a European‐only and transancestral genome‐wide association meta‐analysis in 72,147 stroke patients and 823,869 controls using data from UK Biobank (UKB) and the MEGASTROKE consortium. We identified an exonic polymorphism in NOS3 (rs1799983, p.Glu298Asp; p = 2.2E‐8, odds ratio [OR] = 1.05, 95% confidence interval [CI] = 1.04–1.07) and variants in an intron of COL4A1 (rs9521634; p = 3.8E‐8, OR = 1.04, 95% CI = 1.03–1.06) and near DYRK1A (rs720470; p = 6.1E‐9, OR = 1.05, 95% CI = 1.03–1.07) at genome‐wide significance for stroke. Effect sizes of known stroke loci were highly correlated between UKB and MEGASTROKE. Using Mendelian randomization, we further show that genetic variation in the nitric oxide synthase–nitric oxide pathway in part affects stroke risk via variation in blood pressure

The Formation of Brown Dwarfs as Ejected Stellar Embryos

We conjecture that brown dwarfs are substellar objects because they have been ejected from small newborn multiple systems which have decayed in dynamical interactions. In this view, brown dwarfs are stellar embryos for which the star formation process was aborted before the hydrostatic cores could build up enough mass to eventually start hydrogen burning. The disintegration of a small multiple system is a stochastic process, which can be described only in terms of the half-life of the decay. A stellar embryo competes with its siblings in order to accrete infalling matter, and the one that grows slowest is most likely to be ejected. With better luck, a brown dwarf would therefore have become a normal star. This interpretation of brown dwarfs readily explains the rarity of brown dwarfs as companions to normal stars (aka the ``brown dwarf desert''), the absence of wide brown dwarf binaries, and the flattening of the low mass end of the initial mass function. Possible observational tests of this scenario include statistics of brown dwarfs near Class 0 sources, and the kinematics of brown dwarfs in star forming regions while they still retain a kinematic signature of their expulsion. Because the ejection process limits the amount of gas brought along in a disk, it is predicted that substellar equivalents to the classical T Tauri stars should be very rare.Comment: 8 pages, 1 figure, Accepted by the Astronomical Journa

Growth anomalies on the coral genera Acropora and Porites are strongly associated with host density and human population size across the Indo-Pacific

Growth anomalies (GAs) are common, tumor-like diseases that can cause significant morbidity and decreased fecundity in the major Indo-Pacific reef-building coral genera, Acropora and Porites. GAs are unusually tractable for testing hypotheses about drivers of coral disease because of their pan-Pacific distributions, relatively high occurrence, and unambiguous ease of identification. We modeled multiple disease-environment associations that may underlie the prevalence of Acropora growth anomalies (AGA) (n = 304 surveys) and Porites growth anomalies (PGA) (n = 602 surveys) from across the Indo-Pacific. Nine predictor variables were modeled, including coral host abundance, human population size, and sea surface temperature and ultra-violet radiation anomalies. Prevalence of both AGAs and PGAs were strongly host density-dependent. PGAs additionally showed strong positive associations with human population size. Although this association has been widely posited, this is one of the first broad-scale studies unambiguously linking a coral disease with human population size. These results emphasize that individual coral diseases can show relatively distinct patterns of association with environmental predictors, even in similar diseases (growth anomalies) found on different host genera (Acropora vs. Porites). As human densities and environmental degradation increase globally, the prevalence of coral diseases like PGAs could increase accordingly, halted only perhaps by declines in host density below thresholds required for disease establishment

Nirsevimab for Prevention of Hospitalizations Due to RSV in Infants

Copyright \ua9 2023 Massachusetts Medical Society.BACKGROUND: The safety of the monoclonal antibody nirsevimab and the effect of nirsevimab on hospitalizations for respiratory syncytial virus (RSV)-associated lower respiratory tract infection when administered in healthy infants are unclear. METHODS: In a pragmatic trial, we randomly assigned, in a 1:1 ratio, infants who were 12 months of age or younger, had been born at a gestational age of at least 29 weeks, and were entering their first RSV season in France, Germany, or the United Kingdom to receive either a single intramuscular injection of nirsevimab or standard care (no intervention) before or during the RSV season. The primary end point was hospitalization for RSV-associated lower respiratory tract infection, defined as hospital admission and an RSV-positive test result. A key secondary end point was very severe RSV-associated lower respiratory tract infection, defined as hospitalization for RSV-associated lower respiratory tract infection with an oxygen saturation of less than 90% and the need for supplemental oxygen. RESULTS: A total of 8058 infants were randomly assigned to receive nirsevimab (4037 infants) or standard care (4021 infants). Eleven infants (0.3%) in the nirsevimab group and 60 (1.5%) in the standard-care group were hospitalized for RSV-associated lower respiratory tract infection, which corresponded to a nirsevimab efficacy of 83.2% (95% confidence interval [CI], 67.8 to 92.0; P<0.001). Very severe RSV-associated lower respiratory tract infection occurred in 5 infants (0.1%) in the nirsevimab group and in 19 (0.5%) in the standard-care group, which represented a nirsevimab efficacy of 75.7% (95% CI, 32.8 to 92.9; P = 0.004). The efficacy of nirsevimab against hospitalization for RSV-associated lower respiratory tract infection was 89.6% (adjusted 95% CI, 58.8 to 98.7; multiplicity-adjusted P<0.001) in France, 74.2% (adjusted 95% CI, 27.9 to 92.5; multiplicity-adjusted P = 0.006) in Germany, and 83.4% (adjusted 95% CI, 34.3 to 97.6; multiplicity-adjusted P = 0.003) in the United Kingdom. Treatment-related adverse events occurred in 86 infants (2.1%) in the nirsevimab group. CONCLUSIONS: Nirsevimab protected infants against hospitalization for RSV-associated lower respiratory tract infection and against very severe RSV-associated lower respiratory tract infection in conditions that approximated real-world settings. (Funded by Sanofi and AstraZeneca; HARMONIE ClinicalTrials.gov number, NCT05437510)

Assessment of time effects on capacities of large-scale piles driven in dense sands

This paper considers the axial resistances of open-ended, highly instrumented, 763 mm diameter steel pipe piles driven in sands for the EURIPIDES (EURopean Initiative on PIles in DEnse Sands) project at a well characterised research site at Eemshaven, in the northern Netherlands. It offers new analyses of previously unreported dynamic tests and considers their relationship to four heavily instrumented static compression tests. Rigorous signal matching employing two distinct pile-soil interaction models is reported, supported by careful sensitivity analyses, to interpret the recorded driving signals. The back-calculated shaft resistance profiles show good agreement between the models as well as calculations performed with a global wave equation analysis approach. The study highlights the need to account for the internal soil column resistance. The combined interpretation of the dynamic and static test data indicates a 50% gain in shaft resistance over the ten days after driving and threefold shaft capacity growth over a total period of 533 days after driving. The outcomes have important implications for driven pile design and field quality monitoring; the case history contributes an important benchmark in the study of long-term set-up trends