Programming tunable active dynamics in a self-propelled robot.

We present a scheme for producing tunable active dynamics in a self-propelled robotic device. The robot moves using the differential drive mechanism where two wheels can vary their instantaneous velocities independently. These velocities are calculated by equating robot's equations of motion in two dimensions with well-established active particle models and encoded into the robot's microcontroller. We demonstrate that the robot can depict active Brownian, run and tumble, and Brownian dynamics with a wide range of parameters. The resulting motion analyzed using particle tracking shows excellent agreement with the theoretically predicted trajectories. Later, we show that its motion can be switched between different dynamics using light intensity as an external parameter. Intriguingly, we demonstrate that the robot can efficiently navigate through many obstacles by performing stochastic reorientations driven by the gradient in light intensity towards a desired location, namely the target. This work opens an avenue for designing tunable active systems with the potential of revealing the physics of active matter and its application for bio- and nature-inspired robotics.

Emerging universality classes in thermally assisted activation of interacting diffusive systems: A perturbative hydrodynamic approach.

Thermal activation of a particle from a deep potential trap follows the Arrhenius law. Recently, this result has been generalized for interacting diffusive particles in the trap, revealing two universality classes-the Arrhenius class and the excluded volume class. The result was demonstrated with the aid of numerical analysis. Here, we present a perturbative hydrodynamic approach to analytically validate the existence and range of validity for the two universality classes.

Innate and adaptive immune responses in subjects with CPA secondary to post-pulmonary tuberculosis lung abnormalities.

BACKGROUND: Post-tuberculosis lung abnormality (PTLA) is the most common risk factor for chronic pulmonary aspergillosis (CPA), and 14%-25% of the subjects with PTLA develop CPA. The pathogenesis and the host immune response in subjects with PTLA who develop CPA need to be better understood. METHODS: We prospectively compared the innate and adaptive immune responses mounted by patients of PTLA with or without CPA (controls). We studied the neutrophil oxidative burst (by dihydrorhodamine 123 test), classic (serum C3 and C4 levels) and alternative (mannose-binding lectin [MBL] protein levels) complement pathway, serum immunoglobulins (IgG, IgM and IgA), B and T lymphocytes and their subsets in subjects with PTLA with or without CPA. RESULTS: We included 111 subjects (58 CPA and 53 controls) in the current study. The mean ± SD age of the study population was 42.6 ± 15.7 years. The cases and controls were matched for age, gender distribution and body weight. Subjects with CPA had impaired neutrophil oxidative burst, lower memory T lymphocytes and impaired Th-1 immune response (lower Th-1 lymphocytes) than controls. We found no significant difference between the two groups in the serum complement levels, MBL levels, B-cell subsets and other T lymphocyte subsets. CONCLUSION: Subjects with CPA secondary to PTLA have impaired neutrophil oxidative burst and a lower Th-1 response than controls.

Directional synchrony among self-propelled particles under spatial influence.

Synchronization is one of the emerging collective phenomena in interacting particle systems. Its ubiquitous presence in nature, science, and technology has fascinated the scientific community over the decades. Moreover, a great deal of research has been, and is still being, devoted to understand various physical aspects of the subject. In particular, the study of interacting active particles has led to exotic phase transitions in such systems which have opened up a new research front-line. Motivated by this line of work, in this paper, we study the directional synchrony among self-propelled particles. These particles move inside a bounded region, and crucially their directions are also coupled with spatial degrees of freedom. We assume that the directional coupling between two particles is influenced by the relative spatial distance which changes over time. Furthermore, the nature of the influence is considered to be both short and long-ranged. We explore the phase transition scenario in both the cases and propose an approximation technique which enables us to analytically find the critical transition point. The results are further supported with numerical simulations. Our results have potential importance in the study of active systems like bird flocks, fish schools, and swarming robots where spatial influence plays a pertinent role.

Rapid Escherichia coli Cloned DNA Detection in Serum Using an Electrical Double Layer-Gated Field-Effect Transistor-Based DNA Sensor.

In this study, a rapid diagnosis platform was developed for the detection of Escherichia coli O157:H7. An electrical double layer (EDL)-gated field-effect transistor-based biosensor (BioFET) as a point-of-care testing device is demonstrated with its high sensitivity, portability, high selectivity, quick response, and ease of use. The specially designed ssDNA probe was immobilized on the extended gate electrode to bind the target complementary DNA segment of E. coli, resulting in a sharp drain current change within minutes. The limit of detection for target DNA is validated to a concentration of 1 fM in buffer solution and serum. Meanwhile, the results of a Kelvin probe force microscope were shown to have reduced surface potential of the DNA immobilized sensors before and after the cDNA detection, which is consistent with the decreased drain current of the BioFET. A 1.2 kb E. coli duplex DNA synthesized in plasmid was sonicated and detected in serum samples with the sensor array. Gel electrophoresis was used to confirm the efficiency of sonication by elucidating the length of DNA. Those results show that the EDL-gated BioFET system is a promising platform for rapid identification of pathogens for future clinical needs.

Shape-Tunable BaTiO3 Crystals Presenting Facet-Dependent Optical and Piezoelectric Properties.

BaTiO3 octahedra, edge-, and corner-truncated cubes, and cubes with four tunable sizes from 132 to 438 nm are synthesized by a solvothermal growth approach. Acetic acid treatment can cleanly remove BaCO3 impurity. Rietveld refinement of X-ray diffraction patterns and Raman spectra help to confirm the particles have a tetragonal crystal structure. The crystals also exhibit size- and facet-dependent bandgap shifts. BaTiO3 octahedra show larger piezoelectric, ferroelectric, and pyroelectric effects than truncated cubes and cubes. The measured dielectric constant differences should be associated with their various facet-dependent behaviors. Piezoelectric nanogenerators fabricated from BaTiO3 octahedra consistently show the best performance than those containing truncated cubes and cubes. In particular, a nanogenerator with 30 wt.%-incorporated octahedra displays an open-circuit voltage of 23 V and short-circuit current of 324 nA. The device performance is also highly stable. The maximum output power reaches 3.9 µW at 60 MΩ. The fabricated nanogenerator can provide sufficient electricity to power light-emitting diodes. This work further demonstrates that various physical properties of semiconductor crystals show surface dependence.

Universal Framework for Record Ages under Restart.

We propose a universal framework to compute record age statistics of a stochastic time series that undergoes random restarts. The proposed framework makes minimal assumptions on the underlying process and is furthermore suited to treat generic restart protocols going beyond the Markovian setting. After benchmarking the framework for classical random walks on the 1D lattice, we derive a universal criterion underpinning the impact of restart on the age of the nth record for generic time series with nearest-neighbor transitions. Crucially, the criterion contains a penalty of order n that puts strong constraints on restart expediting the creation of records, as compared to the simple first-passage completion. The applicability of our approach is further demonstrated on an aggregation-shattering process where we compute the typical growth rates of aggregate sizes. This unified framework paves the way to explore record statistics of time series under restart in a wide range of complex systems.

Resetting-mediated navigation of an active Brownian searcher in a homogeneous topography.

Designing navigation strategies for search-time optimization remains of interest in various interdisciplinary branches in science. Herein, we focus on active Brownian walkers in noisy and confined environments, which are mediated by one such autonomous strategy, namely stochastic resetting. As such, resetting stops the motion and compels the walkers to restart from the initial configuration intermittently. The resetting clock is operated externally without any influence from the searchers. In particular, the resetting coordinates are either quenched (fixed) or annealed (fluctuating) over the entire topography. Although the strategy relies upon simple governing laws of motion, it shows a significant ramification for the search-time statistics, in contrast to the search process conducted by the underlying reset-free dynamics. Using extensive numerical simulations, we show that the resetting-driven protocols enhance the performance of these active searchers. This, however, depends robustly on the inherent search-time fluctuations, measured by the coefficient of variation of the underlying reset-free process. We also explore the effects of different boundaries and rotational diffusion constants on the search-time fluctuations in the presence of resetting. Notably, for the annealed condition, resetting is always found to expedite the search process. These features, as well as their applicability to more general optimization problems from queuing systems, computer science and randomized numerical algorithms, to active living systems such as enzyme turnover and backtracking recovery of RNA polymerases in gene expression, make resetting-based strategies universally promising.

Free drug provision for tuberculosis increases patient follow-ups and successful treatment outcomes in the Indian private sector: a quasi experimental study using propensity score matching.

BACKGROUND: The private sector is an important yet underregulated component of the TB treatment infrastructure in India. The Joint Effort for Elimination of Tuberculosis (Project JEET) aims to link private sector TB care with the constellation of social support mechanisms available through the Indian National TB Elimination Programme (NTEP), including the provision of free fixed-dose combination (FDCs) drugs to patients. This quasi-experimental study analysed routinely collected data to determine the impact of free drugs on patient follow-ups and treatment outcomes. METHODS: We used data for private sector patients enrolled with Project JEET who were diagnosed with pulmonary and extrapulmonary TB between 1 and 2019 and 31 March 2020, and completed treatment by 31 December 2021. Propensity score matching was used to create a dataset to compare the number of follow-ups and proportion of successful treatment outcomes for patients on free drugs to a control group who paid out-of-pocket. 11,621 matched pairs were included in the analysis. Logistic regression and ordinary least squares regression models were used to estimate the impact of free drugs on number of follow-ups and treatment success, where latter is defined as treatment completion or cure. RESULTS: After controlling for potential confounders, patients on free drugs received on average 2.522 (95% C.I.: 2.325 to 2.719) additional follow-ups compared to patients who paid out of pocket. This equates to a 25% mean and 32% median increase in follow-ups for patients availing free drugs. For treatment success, patients receiving free drugs had 45% higher odds of a successful treatment (Odds Ratio: 1.452, 95% C.I.: 1.288 to 1.637). CONCLUSIONS: Patients receiving free drugs were found to follow up with their treatment coordinator more frequently, in part likely to enable drug refilling, compared to patients who were paying out of pocket. These additional contacts would have offered opportunities to address concerns regarding side effects, provide additional treatment information, and connect with social support services, all of which subsequently contributed to patients' continual engagement with their treatment. This potentially represents the unmeasured effect of free drugs on continual social support, which translates into a higher odds of treatment success for patients.

Mpemba effect in a Langevin system: Population statistics, metastability, and other exact results.

The Mpemba effect is a fingerprint of the anomalous relaxation phenomenon wherein an initially hotter system equilibrates faster than an initially colder system when both are quenched to the same low temperature. Experiments on a single colloidal particle trapped in a carefully shaped double well potential have demonstrated this effect recently [A. Kumar and J. Bechhoefer, Nature 584, 64 (2020)]. In a similar vein, here, we consider a piece-wise linear double well potential that allows us to demonstrate the Mpemba effect using an exact analysis based on the spectral decomposition of the corresponding Fokker-Planck equation. We elucidate the role of the metastable states in the energy landscape as well as the initial population statistics of the particles in showcasing the Mpemba effect. Crucially, our findings indicate that neither the metastability nor the asymmetry in the potential is a necessary or a sufficient condition for the Mpemba effect to be observed.

Fick-Jacobs description and first passage dynamics for diffusion in a channel under stochastic resetting.

The transport of particles through channels is of paramount importance in physics, chemistry, and surface science due to its broad real world applications. Much insight can be gained by observing the transition paths of a particle through a channel and collecting statistics on the lifetimes in the channel or the escape probabilities from the channel. In this paper, we consider the diffusive transport through a narrow conical channel of a Brownian particle subject to intermittent dynamics, namely, stochastic resetting. As such, resetting brings the particle back to a desired location from where it resumes its diffusive phase. To this end, we extend the Fick-Jacobs theory of channel-facilitated diffusive transport to resetting-induced transport. Exact expressions for the conditional mean first passage times, escape probabilities, and the total average lifetime in the channel are obtained, and their behavior as a function of the resetting rate is highlighted. It is shown that resetting can expedite the transport through the channel-rigorous constraints for such conditions are then illustrated. Furthermore, we observe that a carefully chosen resetting rate can render the average lifetime of the particle inside the channel minimal. Interestingly, the optimal rate undergoes continuous and discontinuous transitions as some relevant system parameters are varied. The validity of our one-dimensional analysis and the corresponding theoretical predictions is supported by three-dimensional Brownian dynamics simulations. We thus believe that resetting can be useful to facilitate particle transport across biological membranes-a phenomenon that can spearhead further theoretical and experimental studies.

Rate enhancement of gated drift-diffusion process by optimal resetting.

"Gating" is a widely observed phenomenon in biochemistry that describes the transition between the activated (or open) and deactivated (or closed) states of an ion-channel, which makes transport through that channel highly selective. In general, gating is a mechanism that imposes an additional restriction on a transport, as the process ends only when the "gate" is open and continues otherwise. When diffusion occurs in the presence of a constant bias to a gated target, i.e., to a target that switches between an open and a closed state, the dynamics essentially slow down compared to ungated drift-diffusion, resulting in an increase in the mean completion time, ⟨TG⟩ > ⟨T⟩, where T denotes the random time of transport and G indicates gating. In this work, we utilize stochastic resetting as an external protocol to counterbalance the delay due to gating. We consider a particle in the positive semi-infinite space that undergoes drift-diffusion in the presence of a stochastically gated target at the origin and is moreover subjected to rate-limiting resetting dynamics. Calculating the minimal mean completion time ⟨Tr⋆G⟩ rendered by an optimal resetting rate r⋆ for this exactly solvable system, we construct a phase diagram that owns three distinct phases: (i) where resetting can make gated drift-diffusion faster even compared to the original ungated process, ⟨Tr⋆G⟩<⟨T⟩<⟨TG⟩, (ii) where resetting still expedites gated drift-diffusion but not beyond the original ungated process, ⟨T⟩≤⟨Tr⋆G⟩<⟨TG⟩, and (iii) where resetting fails to expedite gated drift-diffusion, ⟨T⟩<⟨TG⟩≤⟨Tr⋆G⟩. We also highlight various non-trivial behaviors of the completion time as the resetting rate, gating parameters, and geometry of the set-up are carefully ramified. Gated drift-diffusion aptly models various stochastic processes such as chemical reactions that exclusively take place in certain activated states of the reactants. Our work predicts the conditions under which stochastic resetting can act as a useful strategy to enhance the rate of such processes without compromising their selectivity.

Microscopic theory of adsorption kinetics.

Adsorption is the accumulation of a solute at an interface that is formed between a solution and an additional gas, liquid, or solid phase. The macroscopic theory of adsorption dates back more than a century and is now well-established. Yet, despite recent advancements, a detailed and self-contained theory of single-particle adsorption is still lacking. Here, we bridge this gap by developing a microscopic theory of adsorption kinetics, from which the macroscopic properties follow directly. One of our central achievements is the derivation of the microscopic version of the seminal Ward-Tordai relation, which connects the surface and subsurface adsorbate concentrations via a universal equation that holds for arbitrary adsorption dynamics. Furthermore, we present a microscopic interpretation of the Ward-Tordai relation that, in turn, allows us to generalize it to arbitrary dimension, geometry, and initial conditions. The power of our approach is showcased on a set of hitherto unsolved adsorption problems to which we present exact analytical solutions. The framework developed herein sheds fresh light on the fundamentals of adsorption kinetics, which opens new research avenues in surface science with applications to artificial and biological sensing and to the design of nano-scale devices.

Effects of metformin on clinical, hormonal and relevant gene expression parameters in patients with acne: an observational study.

BACKGROUND: Acne vulgaris is associated with insulin resistance and elevated insulin-like growth factor-1 (IGF-1). Metformin is commonly used for treatment of acne in patients with polycystic ovarian syndrome (PCOS). However, the benefits of metformin in patients with acne in general are not well established. AIM: To study the effectiveness of metformin treatment in patients with acne but who do not have PCOS and to understand the mechanisms of action of metformin in acne not related to PCOS. METHOD: In this observational study, 30 patients with clinically confirmed acne vulgaris were treated with metformin (1000 mg daily) for 3 months without any other topical or systemic active intervention for their acne. The effect of metformin at the clinical, hormonal and genetic level was assessed. RESULTS: Metformin monotherapy significantly (P < 0.001) decreased the global acne grading score for acne followed by a marginal increase in insulin; with a significant (P = 0.03) increase in insulin-like growth factor-1 (IGF-1). A significant (P < 0.001) decrease in free androgen index resulting from a significant (P < 0.001) increase in sex hormone-binding globulin (SHBG) with decrease in testosterone was observed. Homeostasis model assessment insulin resistance (HOMA-IR) was not significantly changed. Forkhead box protein O1 (FOXO1) expression was significantly (P = 0.006) downregulated with metformin treatment at the mRNA level without any significant changes at protein level. Expression of lipogenic genes, namely HMGCR, SQLE and ACSL5 (P = 0.001, P = 0.03, P = 0.03, respectively) were also downregulated. CONCLUSION: Metformin monotherapy led to significant clinical improvement in acne, possibly by reducing testosterone, inhibiting FOXO1 and reducing lipid synthesis by decreasing the expression of lipogenic genes.

The microbiome and precision oncology: an emerging paradigm in anticancer therapy.

Understanding the host-microbiome interactions has emerged as an essential factor in improving human health and disease. Recent advances in understanding the intimate relationship of microbes with the host have uncovered various previously unknown underlying causes of disease development, progression, and treatment failure. The dynamic behaviour of the microbiome confers the heterogeneity in treatment response by modulating the immune response and inflammation in various diseases, including cancer. The growing insights into the microbial modulation of cancer through immunoregulation, xenometabolism, and increase in toxicity open a new era of personalised medicine. In the current review, we discuss the essential roles played by the microbiome in modulating the efficacy and toxicity of anticancer therapies (immunotherapy, chemotherapy, and radiotherapy). We also outline the current state of personalised medicine in the context of cancer and microbiome modulation. The knowledge about the role of cancer-microbiome communication will lead to designing other precise microbial modulation strategies for cancer treatment through enhanced efficacy and decreased toxicity.

Income inequality and mobility in geometric Brownian motion with stochastic resetting: theoretical results and empirical evidence of non-ergodicity.

We explore the role of non-ergodicity in the relationship between income inequality, the extent of concentration in the income distribution, and income mobility, the feasibility of an individual to change their position in the income rankings. For this purpose, we use the properties of an established model for income growth that includes 'resetting' as a stabilizing force to ensure stationary dynamics. We find that the dynamics of inequality is regime-dependent: it may range from a strictly non-ergodic state where this phenomenon has an increasing trend, up to a stable regime where inequality is steady and the system efficiently mimics ergodicity. Mobility measures, conversely, are always stable over time, but suggest that economies become less mobile in non-ergodic regimes. By fitting the model to empirical data for the income share of the top earners in the USA, we provide evidence that the income dynamics in this country is consistently in a regime in which non-ergodicity characterizes inequality and immobility. Our results can serve as a simple rationale for the observed real-world income dynamics and as such aid in addressing non-ergodicity in various empirical settings across the globe. This article is part of the theme issue 'Kinetic exchange models of societies and economies'.

Effectiveness of topical pilocarpine in refractory oral lesions of pemphigus vulgaris: Results from an open-label, prospective, pilot study.

BACKGROUND: The literature suggests a beneficial role of cholinomimetic agents in the treatment of pemphigus. In the present open-label, prospective pilot study, we assessed the effectiveness of topical pilocarpine 2% eye-drops in the treatment of recalcitrant oral lesions of pemphigus. METHODS: Twenty patients with recalcitrant oral lesions of pemphigus were recruited and instructed to apply pilocarpine 2% eye-drops twice daily on the resistant oral lesions for 180 days. The systemic immunosuppression at the time of inclusion in the present study was continued at the same dose throughout the study duration. The photographs of the lesions were obtained at baseline and an interval of 30 days. The area representing the erosion was measured on clinical photographs using the imageJ software (National Institute of Health). Visual analogue scale and oral health impact profile-14 questionnaire were used to assess the degree of subjective improvement. Anti-desmoglein 1 and 3, and anti-acetylcholine M3 receptor antibodies were measured both in serum and saliva; at baseline and at the completion of the study. RESULTS: Twenty patients were recruited in this pilot study. Mean total duration of illness was 3.4±1.3 years. The mean area of the erosions decreased significantly from 142.01±130.05 mm2 to 44.38±67.78 mm2 at study completion at 180 days (p 0.002, paired t-test). Repeated measures ANOVA demonstrated a significant trend in the reduction of the mean area of the erosions from baseline to day 180 (p 0.002). Mean VAS decreased significantly from 7.2±1.0 at baseline to 5.1±1.9 at day 180 (paired t-test, p 0.001). Mean OHIP-14 decreased significantly from 10.1±2.7 at baseline to 8.4±2.9 at day 180. No significant difference was observed between pre- and post-treatment levels of anti-desmoglein 1, anti-desmoglein 3, and anti-acetylcholine M3 receptor antibodies, in both serum and saliva. LIMITATIONS: The depth component in the erosions could not be measured. An orabase formulation could be used in future studies to facilitate retention of the medication at the site of application. CONCLUSION: Topical pilocarpine holds potential for the treatment of recalcitrant oral lesions of pemphigus vulgaris. It probably brings about re-epithelialization without imparting any immunomodulatory activity. This article is protected by copyright. All rights reserved.

Dental pulp stem cell secretome ameliorates d-galactose induced accelerated aging in rat model.

Advancing age is associated with several diseases and disorders due to multiorgan atrophy. The increasing proportion of elderly humans demands the identification of means to counteract aging and age-associated disorders. There is an increased depletion of stem cells in the aged organs, resulting in their inability to repair the damage and hence organ degeneration. Stem cell therapy has been implicated in counteracting aging and shown promise. However, the use of stem cells encounters several side effects and complications such as handling and storage of the cells for transplantation purpose. Stem cells secretome has proven to be of significant importance in a variety of disorders. In this study, we have shown that secretome derived from dental pulp stem cells (DPSCs) can reverse the age-associated degeneration induced by chronic exposure to d-galactose in a rat model. The secretome was able to increase muscle grip strength and animal activity. Secretome also improved the kidney function and hepatic biochemistry similar to healthy controls as evaluated by renal function test and Fourier-transform infrared spectroscopy. We also showed that secretome reduced the levels of monoamine oxidase and acetylcholinesterase in the brain and liver, indicating aging reversal. Finally, proteomic profiling of DPSCs secretome revealed the presence of 13 proteins which have antiaging functions. Thus, our study provides first proof of concept that DPSCs secretome can render protection against d-galactose induced accelerated aging.

Cerebrospinal fluid and plasma procalcitonin for the diagnosis of neonatal bacterial meningitis.

AIM: There is a paucity of data on cerebrospinal fluid (CSF) procalcitonin (PCT) to diagnose neonatal meningitis. We evaluated CSF PCT to diagnose bacterial meningitis among neonates with suspected sepsis. METHODS: Neonates undergoing lumbar puncture (LP) as part of sepsis workup were included. INDEX TESTS: CSF PCT, plasma PCT, CSF:plasma PCT ratio and CSF cytochemistry. Reference Standards: 'Definite meningitis' defined by positive CSF culture and/or gram stain and/or broad-based primer 16S rDNA polymerase chain reaction. 'Definite or probable' meningitis is defined as definite meningitis or abnormal cytochemistry. RESULTS: Of 216 eligible neonates, 18 had 'definite meningitis' and 37 'definite or probable meningitis'. Median (Q1 , Q3 ) CSF PCT level was significantly higher in 'definite meningitis' compared to 'no definite meningitis' (0.429 (0.123, 1.300) vs. 0.181 (0.119, 0.286) ng/mL respectively, P = 0.028). Likewise, it was significantly higher in 'definite or probable meningitis' compared to no meningitis (0.245 (0.136, 0.675) vs. 0.170 (0.116, 0.28), P = 0.01). The area under the receiver operator characteristics curve of CSF PCT level for definite meningitis was 0.656 and for 'definite or probable meningitis' 0.635. Paired comparisons of area under the receiver operator characteristics curve of CSF PCT with the other index tests showed no significant differences. Based on a priori cut-off of 0.2 ng/mL, CSF PCT level had a sensitivity (95% confidence interval) of 67% (50, 80), specificity 58% (54, 61), LR+ 1.6 (1.1, 2.0) and LR- 0.6 (0.3, 0.9). CONCLUSIONS: Higher values of CSF PCT are associated with neonatal bacterial meningitis. However, the diagnostic performance of CSF PCT is modest and not significantly different from standard tests.

Is Lumbar Puncture Avoidable in Low-Risk Neonates with Suspected Sepsis?

OBJECTIVE: Performing lumbar punctures (LP) in all clinically suspected neonatal sepsis, as per current recommendations, results in many "negative" LPs. LPs are not without their own risks. With the intention of minimizing unnecessary LPs among neonates, we aimed to identify a subgroup at extremely low risk of developing possible meningitis so that an LP could be safely avoided in it. STUDY DESIGN: This was a prospective, observational, and cross-sectional study in a level III neonatal unit. We included 300 episodes, in which LP was performed for suspected sepsis. We recorded a comprehensive set of clinico-demographic variables, laboratory parameters, sickness score, organ dysfunction score, and organ localization and studied association of these factors with "definite (culture positive) or possible meningitis." "Possible" meningitis was defined with liberal criteria, intending not to miss any meningitis. A subgroup without a single factor associated with "definite or possible meningitis" was analyzed for incidence of meningitis. RESULTS: There were 121 episodes of "definite or possible meningitis" among 300 episodes of sepsis. On unadjusted analysis, apnea, irritability, high-pitched cry, seizures, neutrophilia, high C-reactive protein (CRP), score for acute neonatal physiology and perinatal extension II (SNAPPE-II), urine output, and leukomalacia were associated with "definite or possible" meningitis (p < 0.05). On multivariate analysis, no apneas, no neutrophilia, and normal CRP were independently associated with "no definite or possible meningitis." Nevertheless, the subgroup that had a combination of no apneas, no neutrophilia, and normal CRP (n = 118) had a 29% probability of "definite or possible meningitis." CONCLUSION: The lowest risk subgroup had a 29% chance of having "definite or possible" meningitis. There is no subgroup that we could identify among neonates with suspected sepsis, in which it is safe to avoid an LP. KEY POINTS: · LP are performed in all cases of late onset neonatal sepsis.. · Previous authors unsuccessfully tried to identify high-risk groups for performing LP.. · We were unable to identify an extremely low-risk group in which LP could be safely avoided..