Association between antibiotic administration before discharge and emergency department length of stay for urinary tract infection: A retrospective analysis.

BACKGROUND: Patients with urinary tract infections (UTIs) may have treatment initiated in the emergency department (ED) before discharge with an antibiotic prescription. The effect of a single antibiotic dose administered before discharge on ED length of stay (LOS) is unknown. OBJECTIVES: The purpose of this study was to compare the LOS and the rate of revisits within 30 days among patients diagnosed as having UTIs other than pyelonephritis who received parenteral, oral, or no antibiotic during an ED visit. METHODS: This was a retrospective cohort study of adult patients with a diagnosis of UTI who received an antibiotic prescription at discharge from a single community ED in the United States between 2019 and 2020. Patients were excluded if they were admitted to the hospital, were diagnosed as having pyelonephritis, or had an ED visit in the previous 30 days. ED LOS was compared using 3-factor analysis of variance. ED revisits at 72 hours and 30 days were compared using the chi-square test. RESULTS: A total of 694 patients with an ED visit for UTI and an antibiotic prescription at discharge were included. The mean age of the study population was 58 years. Parenteral antibiotic administration in the ED was associated with a 60-minute increase in ED LOS compared with those who received an oral antibiotic (P < 0.001) and a 30-minute increase in ED LOS compared with no antibiotic (P < 0.001). No differences were observed in revisits to the ED at 72 hours (5%, 5%, 2%; P = 0.17) or 30 days (15%, 16%, 17%: P = 0.98) among patients who received parenteral, oral, or no antibiotic before discharge. CONCLUSIONS: A single dose of parenteral antibiotic before discharge was associated with an increased ED LOS compared with treatment with oral antibiotic or discharge without ED treatment. ED revisit rates were similar regardless of ED treatment.

[Prenatal rescue dose of betamethasone in the preterm infant with intrauterine growth restriction]. / Dosis prenatal de rescate de betametasona en el prematuro con restricción del crecimiento intrauterino.

Antenatal corticosteroids reduce mortality and respiratory distress syndrome (RDS) in preterm newborns. These benefits decrease after a week of administration, recommending a rescue therapy if there is a new threat of premature delivery. Repeated administration of antenatal corticosteroids may have deleterious effects and their benefits are controversial in intrauterine growth restriction (IUGR). OBJECTIVE: to verify the effects in the IUGR population of antenatal betamethasone rescue therapy on neonatal morbidity and mortality, RDS, and neurodevelopment at 2 years. PATIENTS AND METHOD: Retrospective study including ≤ 34 weeks and ≤ 1,500g preterm newborns divided according to antenatal betamethasone exposure: Single-cycle (2 doses) vs Rescue therapy (3 doses). Subgroups were created for those ≥ 30 weeks. Both cohorts were followed up to 24 months of corrected age. The Ages & Stages Questionnaires (ASQ)® was administered to assess neurodevelopment. RESULTS: 62 preterm infants with a diagnosis of IUGR were included. The rescue therapy group compared with the single-dose group showed no differences in morbidity and mortality and less intubation rate at birth (p = 0.02), with no differences in respiratory support at 7 days of life. Preterm newborns ≥ 30 weeks exposed to rescue therapy showed higher morbidity and mortality (p = 0.03) and bronchopulmonary dysplasia (BPD) (p = 0.02), showing no differences in RDS. The rescue therapy group showed worse mean scores on the ASQ-3 scale, with no significant differences in cerebral palsy or sensory deficits. CONCLUSIONS: Rescue therapy reduces intubation at birth but does not reduce morbidity and mortality. However, at > 30 weeks, this benefit is not observed and the IUGR population exposed to rescue therapy presented more BPD and lower scores on the ASQ-3 scale at 2 years. Future studies should be aimed at the individualization of antenatal corticosteroid therapy.

Objective Bayes model selection in probit models.

We describe a new variable selection procedure for categorical responses where the candidate models are all probit regression models. The procedure uses objective intrinsic priors for the model parameters, which do not depend on tuning parameters, and ranks the models for the different subsets of covariates according to their model posterior probabilities. When the number of covariates is moderate or large, the number of potential models can be very large, and for those cases, we derive a new stochastic search algorithm that explores the potential sets of models driven by their model posterior probabilities. The algorithm allows the user to control the dimension of the candidate models and thus can handle situations when the number of covariates exceed the number of observations. We assess, through simulations, the performance of the procedure and apply the variable selector to a gene expression data set, where the response is whether a patient exhibits pneumonia. Software needed to run the procedures is available in the R package varselectIP.

Antenatal Betamethasone Every 12 Hours in Imminent Preterm Labour.

BACKGROUND: Benefits of antenatal corticosteroids have been established for preterm infants who have received the full course. In imminent preterm labours there is no time to administer the second dose 24 h later. OBJECTIVE: To determine whether the administration of two doses of betamethasone in a 12 h interval is equivalent to the effects of a full maturation. METHODS: We performed a retrospective cohort study including preterm infants ≤34 weeks gestational age at birth and ≤1500 g, admitted to an NICU IIIC level in a tertiary hospital from 2015 to 2020. The population was divided into two cohorts: complete maturation (CM) (two doses of betamethasone 24 h apart), or advanced maturation (AM) (two doses of betamethasone 12 h apart). The primary outcomes were mortality or survival with severe morbidities. The presence of respiratory distress syndrome and other morbidities of prematurity were determined. These variables were analysed in the neonates under 28 weeks gestational age cohort. Neurodevelopment at 2 years was evaluated with the validated Ages and Stages Questionnaires®, Third Edition (ASQ®-3). Multiple regression analyses were performed and adjusted for confounding factors. RESULTS: A total of 275 preterm neonates were included. Serious outcomes did not show differences between cohorts, no increased incidence of morbidity was found in AM. A lower percentage of hypotension during the first week (p = 0.04), a tendency towards lower maximum FiO2 (p = 0.14) and to a shorter mechanical ventilation time (p = 0.14) were observed for the AM cohort. Similar results were found in the subgroup of neonates under 28 weeks gestational age. There were no differences in cerebral palsy or sensory deficits at 24 months of corrected age, although the AM cohort showed a trend towards better scores on the ASQ3 scale. CONCLUSIONS: Administration of betamethasone every 12 h showed similar results to the traditional pattern with respect to mortality and severe morbidities. No deleterious neurodevelopmental effects were found at 24 months of corrected age. Earlier administration of betamethasone at 12 h after the first dose would be an alternative in imminent preterm delivery. Further studies are needed to confirm these results.

Photocatalytic activity of bulk TiO2 anatase and rutile single crystals using infrared absorption spectroscopy.

A systematic study on the photocatalytic activity of well-defined, macroscopic bulk single-crystal TiO(2) anatase and rutile samples has been carried out, which allows us to link photoreactions at surfaces of well-defined oxide semiconductors to an important bulk property with regard to photochemistry, the life time of e-h pairs generated in the bulk of the oxides by photon absorption. The anatase (101) surface shows a substantially higher activity, by an order of magnitude, for CO photo-oxidation to CO(2) than the rutile (110) surface. This surprisingly large difference in activity tracks the bulk e-h pair lifetime difference for the two TiO(2) modifications as determined by contactless transient photoconductance measurements on the corresponding bulk materials.

Testing Hardy-Weinberg equilibrium: an objective Bayesian analysis.

We analyze the general (multiallelic) Hardy-Weinberg equilibrium problem from an objective Bayesian testing standpoint. We argue that for small or moderate sample sizes the answer is rather sensitive to the prior chosen, and this suggests to carry out a sensitivity analysis with respect to the prior. This goal is achieved through the identification of a class of priors specifically designed for this testing problem. In this paper, we consider the class of intrinsic priors under the full model, indexed by a tuning quantity, the training sample size. These priors are objective, satisfy Savage's continuity condition and have proved to behave extremely well for many statistical testing problems. We compute the posterior probability of the Hardy-Weinberg equilibrium model for the class of intrinsic priors, assess robustness over the range of plausible answers, as well as stability of the decision in favor of either hypothesis.

Bayesian meta-analysis: The role of the between-sample heterogeneity.

The random effect approach for meta-analysis was motivated by a lack of consistent assessment of homogeneity of treatment effect before pooling. The random effect model assumes that the distribution of the treatment effect is fully heterogenous across the experiments. However, other models arising by grouping some of the experiments are plausible. We illustrate on simulated binary experiments that the fully heterogenous model gives a poor meta-inference when fully heterogeneity is not the true model and that the knowledge of the true cluster model considerably improves the inference. We propose the use of a Bayesian model selection procedure for estimating the true cluster model, and Bayesian model averaging to incorporate into the meta-analysis the clustering estimation. A well-known meta-analysis for six major multicentre trials to assess the efficacy of a given dose of aspirin in post-myocardial infarction patients is reanalysed.

Electrosynthesis of Biomimetic Manganese-Calcium Oxides for Water Oxidation Catalysis--Atomic Structure and Functionality.

Water-oxidizing calcium-manganese oxides, which mimic the inorganic core of the biological catalyst, were synthesized and structurally characterized by X-ray absorption spectroscopy at the manganese and calcium K edges. The amorphous, birnesite-type oxides are obtained through a simple protocol that involves electrodeposition followed by active-site creation through annealing at moderate temperatures. Calcium ions are inessential, but tune the electrocatalytic properties. For increasing calcium/manganese molar ratios, both Tafel slopes and exchange current densities decrease gradually, resulting in optimal catalytic performance at calcium/manganese molar ratios of close to 10 %. Tracking UV/Vis absorption changes during electrochemical operation suggests that inactive oxides reach their highest, all-Mn(IV) oxidation state at comparably low electrode potentials. The ability to undergo redox transitions and the presence of a minor fraction of Mn(III) ions at catalytic potentials is identified as a prerequisite for catalytic activity.

A Bayesian sensitivity study of risk difference in the meta-analysis of binary outcomes from sparse data.

In most cases, including those of discrete random variables, statistical meta-analysis is carried out using the normal random effect model. The authors argue that normal approximation does not always properly reflect the underlying uncertainty of the original discrete data. Furthermore, in the presence of rare events the results from this approximation can be very poor. This review proposes a Bayesian meta-analysis to address binary outcomes from sparse data and also introduces a simple way to examine the sensitivity of the quantities of interest in the meta-analysis with respect to the structure dependence selected. The findings suggest that for binary outcomes data it is possible to develop a Bayesian procedure, which can be directly applied to sparse data without ad hoc corrections. By choosing a suitable class of linking distributions, the authors found that a Bayesian robustness study can be easily implemented. For illustrative purposes, an example with real data is analyzed using the proposed Bayesian meta-analysis for binomial sparse data.

Reversible amorphization and the catalytically active state of crystalline Co3O4 during oxygen evolution.

Water splitting catalysed by earth-abundant materials is pivotal for global-scale production of non-fossil fuels, yet our understanding of the active catalyst structure and reactivity is still insufficient. Here we report on the structurally reversible evolution of crystalline Co3O4 electrocatalysts during oxygen evolution reaction identified using advanced in situ X-ray techniques. At electrode potentials facilitating oxygen evolution, a sub-nanometre shell of the Co3O4 is transformed into an X-ray amorphous CoOx(OH)y which comprises di-µ-oxo-bridged Co(3+/4+) ions. Unlike irreversible amorphizations, here, the formation of the catalytically-active layer is reversed by re-crystallization upon return to non-catalytic electrode conditions. The Co3O4 material thus combines the stability advantages of a controlled, stable crystalline material with high catalytic activity, thanks to the structural flexibility of its active amorphous oxides. We propose that crystalline oxides may be tailored for generating reactive amorphous surface layers at catalytic potentials, just to return to their stable crystalline state under rest conditions.

New clinical practice guideline on enteral feeding in very low birth weight infants; first part.

INTRODUCTION: The nutrition of very low birth weight (VLBW) infants is aimed at promoting a similar growth to that occurring in the uterus. However, in practice this is difficult to achieve and extrauterine growth restriction is frequent. The current tendency is to avoid this restriction by means of early parenteral and enteral nutrition. Nonetheless, uncertainty about many of the practices related with nutrition has resulted in a great variation in the way it is undertaken. In 2009 and 2011 in our hospital there was an unexpected increase in necrotizing enterocolitis. To check to see whether our nutrition policy was involved, we undertook a systematic review and drew up clinical practice guidelines (CPG) about enteral feeding in VLBW infants. New considerations about the duration of the fortification and the use of probiotics have led to an update of these CPG. METHODS: A total of 21 clinical questions were designed dealing with the type of milk, starting age, mode of administration, rate and volume of the increments, fortification, use of probiotics and protocol. After conducting a systematic search of the available evidence, the information was contrasted and summarized in order to draw up the recommendations. The quality of the evidence and the strength of the recommendations were determined from the SIGN scale. COMMENT: These CPG aim to help physicians in their decision making. The protocolized application of well-proven measurements reduces the variation in clinical practice and improves results.

Introducción: La nutrición de recién nacidos con peso muy bajo peso al nacer (MBPN) busca fomentar un crecimiento similar al que tiene lugar en el útero. Sin embargo, en la práctica, esto resulta difícil de conseguir y es frecuente encontrar una restricción del crecimiento extrauterino. La tendencia actual es evitar esta restricción por medio de una nutrición temprana parenteral y enteral. No obstante, la falta de certeza sobre muchas de las prácticas relacionadas con la nutrición ha dado lugar a una gran variación en los métodos. En 2009 y 2011 en nuestro hospital se dio un aumento inesperado de enterocolitis necrosante. Para comprobar la posible implicación de nuestra política de nutrición, pusimos en marcha una revisión sistemática y redactamos unas directrices para la práctica clínica (DPC) sobre la alimentación enteral en recién nacidos con MBPN. Las nuevas consideraciones sobre la duración de la fortificación y el uso de probióticos han dado lugar a una actualización de estas DPC. Métodos: Se definió un total de 21 preguntas clínicas sobre el tipo de leche, edad de inicio, modo de administración, porcentaje y volumen de los incrementos, fortificación, uso de probióticos y protocolo. Tras realizar una investigación sistemática de la evidencia disponible, la información fue contrastada y resumida para redactar las recomendaciones. La calidad de la evidencia disponible y la fuerza de las recomendaciones quedaron determinadas conforme a la escala SIGN. Comentario: Estas DPC pretenden ayudar a los médicos en su toma de decisiones. La aplicación protocolizada de mediciones bien probadas reduce la variación en la práctica clínica y mejora los resultados.

New clinical practice guideline on enteral feeding in very low birth weight infants; second part.

INTRODUCTION: The nutrition of very low birth weight (VLBW) infants is aimed at promoting a similar growth to that occurring in the uterus. However, in practice this is difficult to achieve and extrauterine growth restriction is frequent. The current tendency is to avoid this restriction by means of early parenteral and enteral nutrition. Nonetheless, uncertainty about many of the practices related with nutrition has resulted in a great variation in the way it is undertaken. In 2009 and 2011 in our hospital there was an unexpected increase in necrotizing enterocolitis. To check to see wether our nutrition policy was involved, we underlook a systematic review and drewup clinical practice guidelines (CPG) about enteral feeding in VLBW infants. New considerations about the duration of the fortification and the use of probiotics have led to an update of these CPG. METHODS: A total of 21 clinical questions were designed dealing with the type of milk, starting age, mode of administration, rate and volume of the increments, fortification, use of probiotics and protocol. Afete conducting a systematic search of the available evidence, the information was contrasted and summarized in order to draw up the recommendations. The quality of the evidence and the strength of the recommendations were determined from the SIGN scale. COMMENT: These CPG aim to help physicians in their decision making. The protocolized application of well-proven measurements reduces the variation in clinical practice and improves results.

Introducción: La nutrición de recién nacidos con peso muy bajo peso al nacer (MBPN) busca fomentar un crecimiento similar al que tiene lugar en el útero. Sin embargo, en la práctica, esto resulta difícil de conseguir y es frecuente encontrar una restricción del crecimiento extrauterino. La tendencia actual es evitar esta restricción por medio de una nutrición temprana parenteral y enteral. No obstante, la falta de certeza sobre muchas de las prácticas relacionadas con la nutrición ha dado lugar a una gran variación en los métodos. En 2009 y 2011 en nuestro hospital se dio un aumento inesperado de enterocolitis necrosante. Para comprobar la posible implicación de nuestra política de nutrición, pusimos en marcha una revisión sistemática y redactamos unas directrices para la práctica clínica (DPC) sobre la alimentación enteral en recién nacidos con MBPN. Las nuevas consideraciones sobre la duración de la fortificación y el uso de probióticos han dado lugar a una actualización de estas DPC. Métodos: Se definió un total de 21 preguntas clínicas sobre el tipo de leche, edad de inicio, modo de administración, porcentaje y volumen de los incrementos, fortificación, uso de probióticos y protocolo. Tras realizar una investigación sistemática de la evidencia disponible, la información fue contrastada y resumida para redactar las recomendaciones. La calidad de la evidencia disponible y la fuerza de las recomendaciones quedaron determinadas conforme a la escala SIGN. Comentario: Estas DPC pretenden ayudar a los médicos en su toma de decisiones. La aplicación protocolizada de mediciones bien probadas reduce la variación en la práctica clínica y mejora los resultados.

Comparing meta-analyses for chronic obstructive pulmonary disease.

Evaluation of: Oppe M, Al M, Rutten-van Mölken M. Comparing methods of data synthesis. Re-estimating parameters of an existing probabilistic cost-effectiveness model. Pharmacoeconomics 29(3), 239-250 (2011). In the paper by Oppe et al., a cost-effectiveness analysis of alternative treatments for chronic obstructive pulmonary disease (COPD), based on data from four different trials, is considered. The goal is to compare the usual (frequentist and Bayesian) fixed-effects (FE) and random-effects (RE) normal model for carrying out meta-analysis. Under RE and FE models, the meta-estimation of some quantities of interest for the disease are also carried out using three out of the four trials, and afterwards data from the fourth are incorporated into the meta-estimation. From these sequential estimators, some conclusions on the FE and RE procedures are drawn. Furthermore, as far as the cost-effectiveness is concerned, the main conclusion of the paper is that the Bayesian RE procedure overrides the Bayesian FE and frequentist methods for cost-effectiveness meta-analysis.

Bayesian variable selection in cost-effectiveness analysis.

Linear regression models are often used to represent the cost and effectiveness of medical treatment. The covariates used may include sociodemographic variables, such as age, gender or race; clinical variables, such as initial health status, years of treatment or the existence of concomitant illnesses; and a binary variable indicating the treatment received. However, most studies estimate only one model, which usually includes all the covariates. This procedure ignores the question of uncertainty in model selection. In this paper, we examine four alternative Bayesian variable selection methods that have been proposed. In this analysis, we estimate the inclusion probability of each covariate in the real model conditional on the data. Variable selection can be useful for estimating incremental effectiveness and incremental cost, through Bayesian model averaging, as well as for subgroup analysis.

Intrinsic meta-analysis of contingency tables.

Meta-analysis has a natural formulation as a Bayesian hierarchical model. The main theoretical difficulty is the construction of a sensible relationship between the parameters of the individual statistical experiments and the meta-parameter. Since that prior information on such a relationship is typically not available, we argue that this relationship should be dictated by the structure of the model at hand. We then propose a novel procedure based on intrinsic priors which we fully develop for the case of meta-analysis of 2 x 2 contingency tables. Illustrations on real and artificial tables are given.