Meropenem vs standard of care for treatment of neonatal late onset sepsis (NeoMero1): A randomised controlled trial.

BACKGROUND: The early use of broad-spectrum antibiotics remains the cornerstone for the treatment of neonatal late onset sepsis (LOS). However, which antibiotics should be used is still debatable, as relevant studies were conducted more than 20 years ago, recruited in single centres or countries, evaluated antibiotics not in clinical use anymore and had variable inclusion/exclusion criteria and outcome measures. Moreover, antibiotic-resistant bacteria have become a major problem in many countries worldwide. We hypothesized that efficacy of meropenem as a broad-spectrum antibiotic is superior to standard of care regimens (SOC) in empiric treatment of LOS and aimed to compare meropenem to SOC in infants aged 44 weeks meeting the Goldstein criteria of sepsis, were randomized in a 1:1 ratio to receive meropenem or one of the two SOC regimens (ampicillin+gentamicin or cefotaxime+gentamicin) chosen by each site prior to the start of the study for 8-14 days. The primary outcome was treatment success (survival, no modification of allocated therapy, resolution/improvement of clinical and laboratory markers, no need of additional antibiotics and presumed/confirmed eradication of pathogens) at test-of-cure visit (TOC) in full analysis set. Stool samples were tested at baseline and Day 28 for meropenem-resistant Gram-negative organisms (CRGNO). The primary analysis was performed in all randomised patients and in patients with culture confirmed LOS. Proportions of participants with successful outcome were compared by using a logistic regression model adjusted for the stratification factors. From September 3, 2012 to November 30th 2014, total of 136 patients (instead of planned 275) in each arm were randomized; 140 (52%) were culture positive. Successful outcome at TOC was achieved in 44/136 (32%) in the meropenem arm vs. 31/135 (23%) in the SOC arm (p = 0.087). The respective numbers in patients with positive cultures were 17/63 (27%) vs. 10/77 (13%) (p = 0.022). The main reason of failure was modification of allocated therapy. Treatment emergent adverse events occurred in 72% and serious adverse events in 17% of patients, the Day 28 mortality was 6%. Cumulative acquisition of CRGNO by Day 28 occurred in 4% of patients in the meropenem and 12% in the SOC arm (p = 0.052). CONCLUSIONS: Within this study population, we found no evidence that meropenem was superior to SOC in terms of success at TOC, short term hearing disturbances, safety or mortality were similar in both treatment arms but the study was underpowered to detect the planned effect. Meropenem treatment did not select for colonization with CRGNOs. We suggest that meropenem as broad-spectrum antibiotic should be reserved for neonates who are more likely to have Gram-negative LOS, especially in NICUs where microorganisms producing extended spectrum- and AmpC type beta-lactamases are circulating

The regulation of television sports broadcasting: a comparative analysis

Based on seven different sports broadcasting markets (Australia, Brazil, Italy, India, South Africa, United Kingdom and the United States), this article provides a comparative analysis of the regulation of television sports broadcasting. The article examines how contrasting perspectives on television and sport – economic and sociocultural – have been reflected in two main approaches to the regulation of sports broadcasting, namely competition law and major events legislation. The results of this analysis suggest that in many cases, the balance between commerce and culture in sports broadcasting has shifted too far in favour of the commercial interests of dominant pay-TV operators and sports organisations. Here, the case is made for the pursuit of an approach to sports broadcasting regulation that seeks to balance the commercial priorities of broadcasters and sports organisations with the wider sociocultural benefits citizens gain from freeto- air sports broadcasting

Antimicrobial consumption and resistance in adult hospital inpatients in 53 countries:results of an internet-based global point prevalence survey

Summary: Background: The Global Point Prevalence Survey (Global-PPS) established an international network of hospitals to measure antimicrobial prescribing and resistance worldwide. We aimed to assess antimicrobial prescribing and resistance in hospital inpatients. Methods: We used a standardised surveillance method to collect detailed data about antimicrobial prescribing and resistance from hospitals worldwide, which were grouped by UN region. The internet-based survey included all inpatients (adults, children, and neonates) receiving an antimicrobial who were on the ward at 0800 h on one specific day between January and September, 2015. Hospitals were classified as primary, secondary, tertiary (including infectious diseases hospitals), and paediatric hospitals. Five main ward types were defined: medical wards, surgical wards, intensive-care units, haematology oncology wards, and medical transplantation (bone marrow or solid transplants) wards. Data recorded included patient characteristics, antimicrobials received, diagnosis, therapeutic indication according to predefined lists, and markers of prescribing quality (eg, whether a stop or review date were recorded, and whether local prescribing guidelines existed and were adhered to). We report findings for adult inpatients. Findings: The Global-PPS for 2015 included adult data from 303 hospitals in 53 countries, including eight lower-middle-income and 17 upper-middle-income countries. 86 776 inpatients were admitted to 3315 adult wards, of whom 29 891 (34·4%) received at least one antimicrobial. 41 213 antimicrobial prescriptions were issued, of which 36 792 (89·3%) were antibacterial agents for systemic use. The top three antibiotics prescribed worldwide were penicillins with β-lactamase inhibitors, third-generation cephalosporins, and fluoroquinolones. Carbapenems were most frequently prescribed in Latin America and west and central Asia. Of patients who received at least one antimicrobial, 5926 (19·8%) received a targeted antibacterial treatment for systemic use, and 1769 (5·9%) received a treatment targeting at least one multidrug-resistant organism. The frequency of health-care-associated infections was highest in Latin America (1518 [11·9%]) and east and south Asia (5363 [10·1%]). Overall, the reason for treatment was recorded in 31 694 (76·9%) of antimicrobial prescriptions, and a stop or review date in 15 778 (38·3%). Local antibiotic guidelines were missing for 7050 (19·2%) of the 36 792 antibiotic prescriptions, and guideline compliance was 77·4%. Interpretation: The Global-PPS showed that worldwide surveillance can be accomplished with voluntary participation. It provided quantifiable measures to assess and compare the quantity and quality of antibiotic prescribing and resistance in hospital patients worldwide. These data will help to improve the quality of antibiotic prescribing through education and practice changes, particularly in low-income and middle-income countries that have no tools to monitor antibiotic prescribing in hospitals. Funding: bioMérieux

The novel E. coli cell division protein, YtfB, plays a role in eukaryotic cell adhesion.

Characterisation of protein function based solely on homology searches may overlook functions under specific environmental conditions, or the possibility of a protein having multiple roles. In this study we investigated the role of YtfB, a protein originally identified in a genome-wide screen to cause inhibition of cell division, and has demonstrated to localise to the Escherichia coli division site with some degree of glycan specificity. Interestingly, YtfB also shows homology to the virulence factor OapA from Haemophilus influenzae, which is important for adherence to epithelial cells, indicating the potential of additional function(s) for YtfB. Here we show that E. coli YtfB binds to N'acetylglucosamine and mannobiose glycans with high affinity. The loss of ytfB results in a reduction in the ability of the uropathogenic E. coli strain UTI89 to adhere to human kidney cells, but not to bladder cells, suggesting a specific role in the initial adherence stage of ascending urinary tract infections. Taken together, our results suggest a role for YtfB in adhesion to specific eukaryotic cells, which may be additional, or complementary, to its role in cell division. This study highlights the importance of understanding the possible multiple functions of proteins based on homology, which may be specific to different environmental conditions

Alpha-1 antitrypsin mitigates the inhibition of airway epithelial cell repair by neutrophil elastase

Copyright © 2016 by the American Thoracic Society. Neutrophil elastase (NE) activity is associated with many destructive lung diseases and is a predictor for structural lung damage in early cystic fibrosis (CF), which suggests normal maintenance of airway epitheliumis prevented byuninhibitedNE.However, limited data exist on how the NE activity in airways of very young children with CF affects function of the epithelia. The aimof this studywas to determine if NE activity could inhibit epithelial homeostasis and repair and whether any functional effect was reversible by antiprotease alpha-1 antitrypsin (a1AT) treatment. Viability, inflammation, apoptosis, and proliferation were assessed in healthy non-CF and CF pediatric primary airway epithelial cells (pAEC non-CF and pAEC CF , respectively) during exposure to physiologically relevant NE. The effect of NE activity on pAEC CF wound repair was also assessed.We report that viability after 48 hours was significantly decreased by 100 nM NE in pAEC non-CF and pAEC CF owing to rapid cellular detachment that was accompanied by inflammatory cytokine release. Furthermore, both phenotypes initiated an apoptotic response to 100 nM NE, whereas ≥50 nM NE activity significantly inhibited the proliferative capacity of cultures. Similar concentrations of NE also significantly inhibited wound repair of pAEC CF , but this effect was reversed by the addition of a1AT. Collectively, our results demonstrate free NE activity is deleterious for epithelial homeostasis and support the hypothesis that proteases inthe airway contribute directly toCF structural lung disease. Our results also highlight the need to investigate antiprotease therapies in early CF disease in more detail

The role of bacterial size, shape and surface in macrophage engulfment of uropathogenic E. coli cells.

Uropathogenic Escherichia coli (UPEC) can undergo extensive filamentation in the host during acute urinary tract infections (UTIs). It has been hypothesised that this morphological plasticity allows bacteria to avoid host immune responses such as macrophage engulfment. However, it is still unclear what properties of filaments are important in macrophage-bacteria interactions. The aim of this work was to investigate the contribution of bacterial biophysical parameters, such as cell size and shape, and physiological parameters, such as cell surface and the environment, to macrophage engulfment efficiency. Viable, reversible filaments of known lengths and volumes were produced in the UPEC strain UTI89 using a variety of methods, including exposure to cell-wall targeting antibiotics, genetic manipulation and isolation from an in vitro human bladder cell model. Quantification of the engulfment ability of macrophages using gentamicin-protection assays and fluorescence microscopy demonstrated that the ability of filaments to avoid macrophage engulfment is dependent on a combination of size (length and volume), shape, cell surface and external environmental factors. UTI89 filamentation and macrophage engulfment efficiency were also found to occur independently of the SOS-inducible filamentation genes, sulA and ymfM in both in vivo and in vitro models of infection. Compared to filaments formed via antibiotic inhibition of division, the infection-derived filaments were preferentially targeted by macrophages. With several strains of UPEC now resistant to current antibiotics, our work identifies the importance of bacterial physiological and morphological states during infection

Bias in data-driven artificial intelligence systems—An introductory survey

Artificial Intelligence (AI)-based systems are widely employed nowadays to make decisions that have far-reaching impact on individuals and society. Their decisions might affect everyone, everywhere, and anytime, entailing concerns about potential human rights issues. Therefore, it is necessary to move beyond traditional AI algorithms optimized for predictive performance and embed ethical and legal principles in their design, training, and deployment to ensure social good while still benefiting from the huge potential of the AI technology. The goal of this survey is to provide a broad multidisciplinary overview of the area of bias in AI systems, focusing on technical challenges and solutions as well as to suggest new research directions towards approaches well-grounded in a legal frame. In this survey, we focus on data-driven AI, as a large part of AI is powered nowadays by (big) data and powerful machine learning algorithms. If otherwise not specified, we use the general term bias to describe problems related to the gathering or processing of data that might result in prejudiced decisions on the bases of demographic features such as race, sex, and so forth. This article is categorized under: Commercial, Legal, and Ethical Issues > Fairness in Data Mining Commercial, Legal, and Ethical Issues > Ethical Considerations Commercial, Legal, and Ethical Issues > Legal Issues

Bias in data-driven artificial intelligence systems—An introductory survey

Artificial Intelligence (AI)-based systems are widely employed nowadays to make decisions that have far-reaching impact on individuals and society. Their decisions might affect everyone, everywhere, and anytime, entailing concerns about potential human rights issues. Therefore, it is necessary to move beyond traditional AI algorithms optimized for predictive performance and embed ethical and legal principles in their design, training, and deployment to ensure social good while still benefiting from the huge potential of the AI technology. The goal of this survey is to provide a broad multidisciplinary overview of the area of bias in AI systems, focusing on technical challenges and solutions as well as to suggest new research directions towards approaches well-grounded in a legal frame. In this survey, we focus on data-driven AI, as a large part of AI is powered nowadays by (big) data and powerful machine learning algorithms. If otherwise not specified, we use the general term bias to describe problems related to the gathering or processing of data that might result in prejudiced decisions on the bases of demographic features such as race, sex, and so forth. This article is categorized under: Commercial, Legal, and Ethical Issues > Fairness in Data Mining Commercial, Legal, and Ethical Issues > Ethical Considerations Commercial, Legal, and Ethical Issues > Legal Issues

Bias in data-driven artificial intelligence systems - An introductory survey

Artificial Intelligence (AI)-based systems are widely employed nowadays to make decisions that have far-reaching impact on individuals and society. Their decisions might affect everyone, everywhere, and anytime, entailing concerns about potential human rights issues. Therefore, it is necessary to move beyond traditional AI algorithms optimized for predictive performance and embed ethical and legal principles in their design, training, and deployment to ensure social good while still benefiting from the huge potential of the AI technology. The goal of this survey is to provide a broad multidisciplinary overview of the area of bias in AI systems, focusing on technical challenges and solutions as well as to suggest new research directions towards approaches well-grounded in a legal frame. In this survey, we focus on data-driven AI, as a large part of AI is powered nowadays by (big) data and powerful machine learning algorithms. If otherwise not specified, we use the general term bias to describe problems related to the gathering or processing of data that might result in prejudiced decisions on the bases of demographic features such as race, sex, and so forth. This article is categorized under: Commercial, Legal, and Ethical Issues > Fairness in Data Mining Commercial, Legal, and Ethical Issues > Ethical Considerations Commercial, Legal, and Ethical Issues > Legal Issues