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.
Although systematic screening for child abuse of children presenting at emergency departments might increase the detection rate, studies to support this are scarce. This study investigates whether ...introducing screening, and training of emergency department nurses, increases the detection rate of child abuse.
In an intervention cohort study, children aged 0 to 18 years visiting the emergency departments of 7 hospitals between February 2008 and December 2009 were enrolled. We developed a screening checklist for child abuse (the "Escape Form") and training sessions for nurses; these were implemented by using an interrupted time-series design. Cases of suspected child abuse were determined by an expert panel using predefined criteria. The effect of the interventions on the screening rate for child abuse was calculated by interrupted time-series analyses and by the odds ratios for detection of child abuse in screened children.
A total of 104028 children aged 18 years or younger were included. The screening rate increased from 20% in February 2008 to 67% in December 2009. Significant trend changes were observed after training the nurses and after the legal requirement of screening by the Dutch Health Care Inspectorate in 2009. The detection rate in children screened for child abuse was 5 times higher than that in children not screened (0.5% vs 0.1%, P < .001).
These results indicate that systematic screening for child abuse in emergency departments is effective in increasing the detection of suspected child abuse. Both a legal requirement and staff training are recommended to significantly increase the extent of screening.
This paper presents a 6th-order switched capacitor lowpass filter implemented in 0.35 /spl mu/m CMOS for baseband channel selection in direct conversion Universal Mobile Telecommunications System ...(UMTS) receiver. The filter selects a 2 MHz channel and attenuates by at least 51 dB from 2.9 MHz to 10 MHz. It presents a passband ripple less than 0.35 dB.
This paper presents a 6/sup th/-order switched capacitor lowpass filter implemented in 0.35 /spl mu/m CMOS for baseband channel selection in direct conversion Universal Mobile Telecommunications ...System (UMTS) receiver. The filter selects a 2 MHz channel and attenuates by at least 51 dB from 2.9 MHz to 10 MHz. It presents a passband ripple less than 0.35 dB.
This paper presents a PWM controlled buck DC-DC converter. Switching frequency is up to 10 MHz and optimized output voltages are 0.65 V, 0.9 V and 1.2 V. At maximum switching frequency the DC-DC ...converter presents an efficiency of 73% with a current load of 300 mA and 0.9 V as output and 78% for the same load current and 1.2 V as output voltage both from 3.6 V input voltage. Average ripple is lower than 18 mV for both outputs.
•The main sterols found were β Sitosterol, Δ5-avenasterol and campesterol.•Two triterpenic dialcohols were detected (Erythrodiol and Uvaol).•The highest sterol content was found in ZI1 oil and the ...lowest in H3 oil.•Virgin olive oil sterolic composition strongly depends on olive variety.
The aim of the present investigation is to discriminate seven selected wild olive trees by studying their sterol and triterpenic dialcohol compositions with those of VOOs obtained from Chemlali and Chetoui olive cultivars, all growing in the in the same pedoclimatic conditions. The main sterol found in all the samples is β Sitosterol, followed by Δ5-avenasterol These two major sterols are strongly and negatively correlated, and there is a clear differentiation between cultivars. Thus, MAT22 oleaster shows the highest value for β-sitosterol (87.18%), whereas SB12 oleaster is characterised by the lowest percentage of β-sitosterol (71%) and the highest one of Δ5-avenasterol (21.73%). For the remaining varieties, the levels of b-sitosterol and Δ-5-avenasterol are within the range of 74–86% and 4–17%, respectively.
Two triterpenic dialcohols (erythrodiol and uvaol), were also detected besides the sterolic components. Sterol content of oils was below the upper legal limit of 4% in all nalysed samples, with a range from 1.05% to 3.40%. The statistical analyses (PCA and HCA) can explain the variability of the oil composition according to the cultivar. We note a good discrimination between varieties according to sterol and triterpenic dialcohol data. These components seem to be an effective tool to discriminate between the oleasters.
