This study determined age specific, free thyroxine and thyroid stimulating hormone reference intervals for a pediatric population.
The data set was partitioned into age groups and the Tukey method ...was used to identify outliers for removal. The Harris and Boyd algorithm was used to determine if groups could be merged. Reference intervals were calculated using both non-parametric and robust methods. Boot-strapping was used to determine the 90% confidence intervals surrounding the upper and lower limits of each reference interval. These population based reference intervals were then compared to the manufactures suggested reference intervals.
This study provides non-parametric and robust reference intervals with associated 90% confidence intervals for free thyroxine and thyroid stimulating hormone as measured on the Roche Modular Analytics E 170.
The results emphasize the importance of establishing population-based reference intervals for the clinical laboratory.
Oxidative stress contributes to muscular fatigue. GSH is the major intracellular antioxidant, the biosynthesis of which is dependent on cysteine availability. We hypothesized that supplementation ...with a whey-based cysteine donor Immunocal (HMS90) designed to augment intracellular GSH would enhance performance. Twenty healthy young adults (10 men, 10 women) were studied presupplementation and 3 mo postsupplementation with either Immunocal (20 g/day) or casein placebo. Muscular performance was assessed by whole leg isokinetic cycle testing, measuring peak power and 30-s work capacity. Lymphocyte GSH was used as a marker of tissue GSH. There were no baseline differences (age, ht, wt, %ideal wt, peak power, 30-s work capacity). Follow-up data on 18 subjects (9 Immunocal, 9 placebo) were analyzed. Both peak power 13 +/- 3.5 (SE) %, P < 0.02 and 30-s work capacity (13 +/- 3.7%, P < 0.03) increased significantly in the Immunocal group, with no change (2 +/- 9.0 and 1 +/- 9.3%) in the placebo group. Lymphocyte GSH also increased significantly in the Immunocal group (35.5 +/- 11.04%, P < 0.02), with no change in the placebo group (-0.9 +/- 9.6%). This is the first study to demonstrate that prolonged supplementation with a product designed to augment antioxidant defenses resulted in improved volitional performance.
Up to 7% of term and late-preterm neonates in high-income countries receive antibiotics during the first 3 days of life because of suspected early-onset sepsis. The prevalence of culture-proven ...early-onset sepsis is 0·1% or less in high-income countries, suggesting substantial overtreatment. We assess whether procalcitonin-guided decision making for suspected early-onset sepsis can safely reduce the duration of antibiotic treatment.
We did this randomised controlled intervention trial in Dutch (n=11), Swiss (n=4), Canadian (n=2), and Czech (n=1) hospitals. Neonates of gestational age 34 weeks or older, with suspected early-onset sepsis requiring antibiotic treatment were stratified into four risk categories by their treating physicians and randomly assigned 1:1 using a computer-generated list stratified per centre to procalcitonin-guided decision making or standard care-based antibiotic treatment. Neonates who underwent surgery within the first week of life or had major congenital malformations that would have required hospital admission were excluded. Only principal investigators were masked for group assignment. Co-primary outcomes were non-inferiority for re-infection or death in the first month of life (margin 2·0%) and superiority for duration of antibiotic therapy. Intention-to-treat and per-protocol analyses were done. This trial was registered with ClinicalTrials.gov, number NCT00854932.
Between May 21, 2009, and Feb 14, 2015, we screened 2440 neonates with suspected early-onset sepsis. 622 infants were excluded due to lack of parental consent, 93 were ineligible for reasons unknown (68), congenital malformation (22), or surgery in the first week of life (3). 14 neonates were excluded as 100% data monitoring or retrieval was not feasible, and one neonate was excluded because their procalcitonin measurements could not be taken. 1710 neonates were enrolled and randomly assigned to either procalcitonin-guided therapy (n=866) or standard therapy (n=844). 1408 neonates underwent per-protocol analysis (745 in the procalcitonin group and 663 standard group). For the procalcitonin group, the duration of antibiotic therapy was reduced (intention to treat: 55·1 vs 65·0 h, p<0·0001; per protocol: 51·8 vs 64·0 h; p<0·0001). No sepsis-related deaths occurred, and 9 (<1%) of 1710 neonates had possible re-infection. The risk difference for non-inferiority was 0·1% (95% CI −4·6 to 4·8) in the intention-to-treat analysis (5 0·6% of 866 neonates in the procalcitonin group vs 4 0·5% of 844 neonates in the standard group) and 0·1% (−5·2 to 5·3) in the per-protocol analysis (5 0·7% of 745 neonates in the procalcitonin group vs 4 0·6% of 663 neonates in the standard group).
Procalcitonin-guided decision making was superior to standard care in reducing antibiotic therapy in neonates with suspected early-onset sepsis. Non-inferiority for re-infection or death could not be shown due to the low occurrence of re-infections and absence of study-related death.
The Thrasher Foundation, the NutsOhra Foundation, the Sophia Foundation for Scientific research.
This study reflects on the conceptualisation of wild animals as co-creators. Its purpose is to encourage reflection about the role of animals in wildlife tourism. Therefore, to this end - and in the ...belief that diversity and creativity are important elements in critical thinking - the study was developed by a research team with diverse professional backgrounds. It adopts a fictional methodological approach, employing a fictive dialogue between a tourist joining a swim-with-dolphins tour and a dolphin and draws upon recent scholarly contributions on animals from the perspective of various disciplines, including philosophy, biology and tourism, The study's most important contribution comes in the form of a discussion of the co-creation concept from a critical perspective, based on innovative and explicitly-described ontological, epistemological and methodological considerations.
The community of Tenganan in eastern Bali, Indonesia, has requested technical assistance from Engineers Without Borders Australia (EWB) to improve the quantity and quality of water delivered through ...their water supply system. This is a unique development project in which the Tenganan people have identified their own needs and developed their own conceptual solution to the problem. For the first time, EWB is undertaking the design phase for the water system by an off-shore design team and project assistance team (PAT) based in Australia. This allows EWB to draw on resources and experience of EWB members and their employing companies in Australia. It also enables young engineers to develop skills and experience in development work without having to leave the country. However, the innovative approach also presented significant challenges to the project members, particularly in establishing appropriate design criteria and the co-ordination of simultaneous activities across Australia. This paper describes the approach taken by EWB and makes a preliminary assessment of the benefits and limitations inherent in this approach. The overall aim of the project is to produce a successful "bottom-up" development action that will deliver a sustainable solution to the Tenganan community.
Bone markers are specific bone-derived molecules that reflect bone remodeling activity and can be classified into two categories: bone formation and bone resorption markers. Children have ...significantly elevated bone marker levels due to high skeletal growth velocity and rapid bone turnover during childhood growth. Many physiological and pathological processes may influence bone metabolism and bone marker concentrations during childhood growth. Measurements of bone markers may be useful in investigating skeletal diseases in children and monitoring the response to treatment. This review documents recent advances in analytical methods, preanalytical considerations related to each marker and particularly highlights the most valuable bone formation markers, bone alkaline phosphatase and osteocalcin, and bone resorption markers, pyridinium cross-links and cross-linked telopeptides. Age- and sex-specific pediatric reference intervals and their limitations in clinical application are also discussed.
The goal of this study was to examine the ability of the current Canadian CF center network to conduct sweat testing, with a particular focus on testing in infants less than 3 months old.
Surveys ...were sent to the 37 CF centers in Canada supported by the Canadian CF Foundation, and results were interpreted with respect to their ability to obtain adequate sweat volumes in children less than 3 months and potential factors influencing these results.
Ten centers that care for adult patients referred patients to their local pediatric CF center for sweat testing; the remaining 27 centers conducted sweat tests and 26 responded. Insufficient sweat volume results in children <3 months occurred in a median of 18.3% of tests. The corresponding proportion for the remaining population was 4.5% (
P < 0.001). 15 of 19 centers had an incidence of >5% of insufficient tests in children <3 months of age, and 9 of 19 had an incidence of <20% in this age group. Six of 19 had an incidence of >5% of insufficient sweat volumes in older children and adults.
Standardization of testing procedures is required to reduce the rates of insufficient sweat volumes in both infants less than 3 months old and children >3 months old. This will decrease the need for repeat testing and delay in diagnosis.
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