Variation in Current Management of Term and Late-Preterm Neonates at Risk for Early-Onset Sepsis "An International Survey and Review of Guidelines"

BACKGROUND Uncertainty about the presence of infection results in unnecessary and prolonged empiric antibiotic treatment of newborns at risk for early-onset sepsis (EOS). This study evaluates the impact of this uncertainty on the diversity in management. METHODS A web-based survey with questions addressing management of infection risk-adjusted scenarios was performed in Europe, North America, and Australia. Published national guidelines (n=5) were reviewed and compared to the results of the survey. RESULTS 439 Clinicians (68% were neonatologists) from 16 countries completed the survey. In the low-risk scenario, 29% would start antibiotic therapy and 26% would not, both groups without laboratory investigations; 45% would start if laboratory markers were abnormal. In the high-risk scenario, 99% would start antibiotic therapy. In the low-risk scenario, 89% would discontinue antibiotic therapy before 72 hours. In the high-risk scenario, 35% would discontinue therapy before 72 hours, 56% would continue therapy for five to seven days, and 9% for more than 7 days. Laboratory investigations were used in 31% of scenarios for the decision to start, and in 72% for the decision to discontinue antibiotic treatment. National guidelines differ considerably regarding the decision to start in low-risk and regarding the decision to continue therapy in higher risk situations. CONCLUSIONS There is a broad diversity of clinical practice in management of EOS and a lack of agreement between current guidelines. The results of the survey reflect the diversity of national guidelines. Prospective studies regarding management of neonates at risk of EOS with safety endpoints are needed.

Effects of early and late lesion of orbital frontal cortex on visual processing of faces in rhesus macaques (Macaca mulatta)

Many mental disorders disrupt social skills, yet few studies have examined how the brain processes social information. Functional neuroimaging, neuroconnectivity and electrophysiological studies suggest that orbital frontal cortex plays important roles in social cognition, including the analysis of information from faces, which are important cues in social interactions. Studies in humans and non-human primates show that damage to orbital frontal cortex produces social behavior impairments, including abnormal aggression, but these studies have failed to determine whether damage to this area impairs face processing. In addition, it is not known whether damage early in life is more detrimental than damage in adulthood. This study examined whether orbital frontal cortex is necessary for the discrimination of face identity and facial expressions, and for appropriate behavioral responses to aggressive (threatening) facial expressions. Rhesus monkeys (Macaca mulatta) received selective lesions of orbital frontal cortex as newborns or adults. As adults, these animals were compared with sham-operated controls on their ability to discriminate between faces of individual monkeys and between different facial expressions of emotion. A passive visual paired-comparison task with standardized rhesus monkey face stimuli was designed and used to assess discrimination. In addition, looking behavior toward aggressive expressions was assessed and compared with that of normal control animals. The results showed that lesion of orbital frontal cortex (1) may impair discrimination between faces of individual monkeys, (2) does not impair facial expression discrimination, and (3) changes the amount of time spent looking at aggressive (threatening) facial expressions depending on the context. The effects of early and late lesions did not differ. Thus, orbital frontal cortex appears to be part of the neural circuitry for recognizing individuals and for modulating the response to aggression in faces, and the plasticity of the immature brain does not allow for recovery of these functions when the damage occurs early in life. This study opens new avenues for the assessment of rhesus monkey face processing and the neural basis of social cognition, and allows a better understanding of the nature of the neuropathology in patients with mental disorders that disrupt social behavior, such as autism. ^

Factors governing late-recurrence of disease in a cohort of early-stage breast cancer survivors

Purpose. To determine the risk of late breast cancer recurrence (5 years after treatment) in a population of women diagnosed with early-stage breast cancer at The University of Texas M.D. Anderson Cancer Center (MDACC) between 1985-2000 and to examine the effect of this population’s BMI, smoking history, reproductive history, hormone use, and alcohol intake at the time of diagnosis on risk of late recurrence.^ Methods. Patients included 1,913 members of the Early Stage Breast Cancer Repository recruited at MDACC who had survived without a recurrence for at least five years after their initial diagnosis of early stage breast cancer. Clinical and epidemiological information was ascertained twice on participants during the study—first by medical record abstraction then by patient interview at least five years after receipt of adjuvant treatment. A total of 223 late breast cancer recurrences were captured, with an average follow-up of 10.6 years. Cox proportional hazards models were used to calculate hazard ratios (HR) and 95% confidence intervals (CI). ^

Late Pliocene and Early Pleistocene dinoflagellate cysts and sea surface temperture reconstruction for several IODP and DSDP sites in the North Atlantic

In an attempt to document the palaeoecological affinities of individual extant and extinct dinoflagellate cysts, Late Pliocene and Early Pleistocene dinoflagellate cyst assemblages have been compared with geochemical data from the same samples. Mg/Ca ratios of Globigerina bulloides were measured to estimate the spring-summer sea-surface temperatures from four North Atlantic IODP/DSDP sites. Currently, our Pliocene-Pleistocene database contains 204 dinoflagellate cyst samples calibrated to geochemical data. This palaeo-database is compared with modern North Atlantic and global datasets. The focus lies in the quantitative relationship between Mg/Ca-based (i.e. spring-summer) sea-surface temperature (SSTMg/Ca) and dinoflagellate cyst distributions. In general, extant species are shown to have comparable spring-summer SST ranges in the past and today, demonstrating that our new approach is valid for inferring spring-summer SST ranges for extinct species. For example, Habibacysta tectata represents SSTMg/Ca values between 10° and 15°C when it exceeds 30% of the assemblage, and Invertocysta lacrymosa exceeds 15% when SSTMg/Ca values are between 18.6° and 23.5°C. However, comparing Pliocene and Pleistocene SSTMg/Ca values with present day summer values for the extant Impagidinium pallidum suggests a greater tolerance of higher temperatures in the past. This species occupies more than 5% of the assemblage at SSTMg/Ca values of 11.6-17.9°C in the Pliocene and Pleistocene, whereas present day summer SSTs are around -1.7 to 6.9°C. This observation questions the value of Impagidinium pallidum as reliable indicator of cold waters in older deposits, and may explain its bipolar distribution.

Isotope measurements from late Paleocene - early Eocene of 5 cores from Atlantic and Pacific Ocean

High-resolution stable carbon isotope records for upper Paleocene - lower Eocene sections at Ocean Drilling Program Sites 1051 and 690 and Deep Sea Drilling Project Sites 550 and 577 show numerous rapid (40 - 60 kyr duration) negative excursions of up to 1 per mill. We demonstrate that these transient decreases are the expected result of nonlinear insolation forcing of the carbon cycle in the context of a long carbon residence time. The transients occur at maxima in Earth's orbital eccentricity, which result in high-amplitude variations in insolation due to forcing by climatic precession. The construction of accurate orbital chronologies for geologic sections older than ~ 35 Ma relies on identifying a high-fidelity recorder of variations in Earth's orbital eccentricity. We use the carbon isotope records as such a recorder, establishing a robust orbitally tuned chronology for latest Paleocene-earliest Eocene events. Moreover, the transient decreases provide a means of precise correlation among the four sites that is independent of magnetostratigraphic and biostratigraphic data at the <10^5-year scale. While the eccentricity-controlled transient decreases bear some resemblance to the much larger-amplitude carbon isotope excursion (CIE) that marks the Paleocene/Eocene boundary, the latter event is found to occur near a minimum in the ~400-kyr eccentricity cycle. Thus the CIE occurred during a time of minimal variability in insolation, the dominant mechanism for forcing climate change on 104-year scales. We argue that this is inconsistent with mechanisms that rely on a threshold climate event to trigger the Paleocene/Eocene thermal maximum since any threshold would more likely be crossed during a period of high-amplitude climate variations.

Late Miocene-early Pliocene stable isotope record of benthic foraminifera from ODP Site 177-1088 in the sub-Antarctic South Atlantic

Benthic foraminiferal stable isotope records for the past 11 Myr from a recently drilled site in the sub-Antarctic South Atlantic (Site 1088, Ocean Drilling Program Leg 177, 41°S, 15°E, 2082 m water depth) provide, for the first time, a continuous long-term perspective on deep water distribution patterns and Southern Ocean climate change from the late Miocene through the early Pliocene. I have compiled published late Miocene through Pliocene stable isotope records to place the new South Atlantic record in a global framework. Carbon isotope gradients between the North Atlantic, South Atlantic, and Pacific indicate that a nutrient-depleted watermass, probably of North Atlantic origin, reached the sub-Antarctic South Atlantic after 6.6 Ma. By 6.0 Ma the relative proportion of the northern-provenance watermass was similar to today and by the early Pliocene it had increased to greater than the modern proportion suggesting that thermohaline overturn in the Atlantic was relatively strong prior to the early Pliocene interval of inferred climatic warmth. Site 1088 oxygen isotope values display a two-step increase between ~7.4 Ma and 6.9 Ma, a trend that parallels a published delta18O record of a site on the Atlantic coast of Morocco. This is perhaps best explained by a gradual cooling of watermasses that were sinking in the Southern Ocean. I speculate that relatively strong thermohaline overturn at rates comparable to the present day interglacial interval during the latest Miocene may have provided the initial conditions for early Pliocene climatic warmth. The impact of an emerging Central American Seaway on Atlantic-Pacific Ocean upper water exchange may have been felt in the North Atlantic beginning in the latest Miocene between 6.6 and 6.0 Ma, which would be ~1.5 Myr earlier than previously thought.

Planktonic foraminifera of Oligocene sediments from DSDP Hole 77-538A in the Gulf of Mexico

A relatively extended Oligocene pelagic sequence with good to medium recovery, drilled during DSDP Leg 77 in the Gulf of Mexico, yielded rich and well diversified planktonic foraminiferal faunas. Planktonic foraminifera recorded in Hole 538A span the interval from Zone P19 through P22. Evolutionary lineages were observed among the globoquadrinids, the globigerinitids, and the "Globigerina" ciperoensis and Globigerinoides primordius groups. Quantitative analysis of planktonic foraminiferal assemblages shows that faunas fluctuate in abundance and species diversity throughout the sequence. A few of these fluctuations that could be related to selective dissolution are mainly confined to the early-mid Oligocene. A climatic curve was constructed using as warmer indicators, Turborotalia pseudoampliapertura, Globoquadrina tripartita, Dentoglobigerina globularis, Dentoglobigerina baroemoenensis,. "Globigerina" ciperoensis and Globigerinoides groups, and Cassigerinella chipolensis; and as coller indicators, Catapsydrax spp., Globorotaloides spp., Subbotina angiporoides group, Globigerina s. str., and the tenuitellides. Three major intervals are identifiable in the climatic curve: Interval 1 (lower) up to Zone P20 predominantly cooler: Interval 2 (intermediate) up to the upper part of Zone P21a with warm and cool fluctuations: and lnterval 3 (upper), warmer, with a large positive peak, due to abundant "G." angulisuturalis, at the beginning of Zone P21b with recooling midway in Zone P22. In Intervals 1 and 2 planktonic foraminiferal faunas are dominated by temperate forms. Interpretation of planktonic foraminiferal data suggests that cooler water conditions characterize the early-mid Oligocene: during the mid Oligocene (most of Zone P21a) water masses exhibit peculiar characteristics transitional to the warmer waters prevailing during the late Oligocene. Warmer conditions were not definitely settled in Zone P22, however, as indicated by the cooler episode following the warmest peak. These climatic trends are inconsistent with those inferred from oxygen isotopes except at small scale. In fact, oxygen isotope values for Oligocene Atlantic Ocean are too heavy (thus too cool) in comparison with the high abundance and diversity of warm taxa, expecially in Zone P22. When values are lighter (warmer), as in Zone P19 abundance and diversity of warm indices are too low. To explain such a cool isotope values in presence of highly diversified and abundant warm planktonic foraminifera, we suggest (1) that the oxygen isotope ratio used for estimating Oligocene paleotemperatures might be 1? heavier than Eocene values and further increased for the late Oligocene. This hypothesis implies the presence of a relatively extended ice cap in Antarctica in the early and mid Oligocene, and probably an increase in ice volume during the late Oligocenc: (2) heavier isotope values might be related to an increase in salinity, or (3) by a combination of both ice cap and increase in salinity.

Radiolarian faunal turnover across the Oligocene/Miocene boundary in the equatorial Pacific Ocean

The global warming trend of the latest Oligocene was interrupted by several cooling events associated with Antarctic glaciations. These cooling events affected surface water productivity and plankton assemblages. Well-preserved radiolarians were obtained from upper Oligocene to lower Miocene sediments at Ocean Drilling Program (ODP) Leg 199 Sites 1218 and 1219 in the equatorial Pacific, and 110 radiolarian species were identified. Four episodes of significant radiolarian faunal changes were identified: middle late Oligocene (27.5 to 27.3 Ma), latest Oligocene (24.4 Ma), earliest Miocene (23.3 Ma), and middle early Miocene (21.6 Ma). These four episodes approximately coincide with increases and decreases of biogenic silica accumulation rates and increases in delta18O values coded as "Oi" and "Mi" events. These data indicate that Antarctic glaciations were associated with change of siliceous sedimentation patterns and faunal changes in the equatorial Pacific. Radiolarian fauna was divided into three assemblages based on variations in radiolarian productivity, species richness and the composition of dominant species: a late Oligocene assemblage (27.6 to 24.4 Ma), a transitional assemblage (24.4 to 23.3 Ma) and an early Miocene assemblage (23.3 to 21.2 Ma). The late Oligocene assemblage is characterized by relatively high productivity, low species richness and four dominant species of Tholospyris anthophora, Stichocorys subligata, Lophocyrtis nomas and Lithelius spp. The transitional assemblage represents relatively low values of productivity and species richness, and consists of three dominant species of T. anthophora, S. subligata and L. nomas. The characteristics of the early Miocene assemblage are relatively low productivity, but high species richness. The two dominant species present in this assemblage are T. anthophora and Cyrtocapsella tetrapera. The most significant faunal turnover of radiolarians is marked at the boundary between the transitional/early Miocene assemblages.

Oligocene-Miocene strontium isotopes of ODP Hole 120-747A

This study tests and improves on previously published early and middle Miocene 87Sr/86Sr marine correlations, presents Sr isotopic age correlations for this interval using the new timescale of Cande and Kent [1992 doi:10.1029/92JB01202], and evaluates Sr isotopic changes against an inferred glacioeustatic proxy. We generated a latest Oligocene to early late Miocene 87Sr/86Sr isotope record from Ocean Drilling Program (ODP) Hole 747A; this site provides an excellent magnetostratigraphic record during most of this interval for independent age estimates, very good foraminiferal preservation, and excellent core recovery. Comparisons of new 87Sr/86Sr data from Hole 747A with previously published data from Deep Sea Drilling Project (DSDP) Sites 608 [Miller et al., 1991 doi:10.1029/90PA01941] and 588 [Hodell et al., 1991 doi:10.1130/0091-7613(1991)019<0024:VITSIC>2.3.CO;2] yield the following results: (1) confirmation and refinement of the early Miocene Sr isotope changes, (2) improved definition of the timing of the changes in slope of 87Sr/86Sr near 15.4 Ma and 22.8 Ma, (3) improved Sr isotopic age resolution for the middle Miocene with resolution as good as +/- 0.7 m.y., and (4) identification of an inflection in the Sr isotope record at 28.0 Ma based on the combined records from DSDP Site 522 [Miller et al., 1988 doi:10.1029/PA003i002p00223] and ODP Hole 747A. We have been unable to determine the cause of middle Miocene offset between Site 588 and Hole 747A data, although we believe it may be attributed to problems in the age assignments for Hole 588A for the interval ~14-11 Ma and Site 747 for the interval 11-8 Ma. Because Hole 747A results provide a better chronology than Site 588 for most of the Miocene and a better middle Miocene Sr isotope record than Site 608, we propose that Hole 747A serves as the best reference section for Miocene 87Sr/86Sr variations from ca. 23 to 11 Ma. Using 87Sr/86Sr data from Sites 522, 608, and 747A, we relate late Eocene to early Miocene inflections in the 87Sr/86Sr isotope record to oxygen isotope increases and decreases inferred to represent glacioeustatic events. The decreases (deglaciations) observed in the ?18O record apparently lead the 87Sr/86Sr inflections by 1 to 1.5 m.y.

Early - Late Miocene palaeoclimate data and palaefloras of 48 samples from Southern China

Southern China, especially Yunnan, has undergone high tectonic activity caused by the uplift of Himalayan Mountains during the Neogene, which led to a fast changing palaeogeography. Previous study shows that Southern China has been influenced by the Asian Monsoon since at least the Early Miocene. However, it is yet not well understood how intense the Miocene monsoon system was. In the present study, 63 fossil floras of 16 localities from Southern China are compiled and evaluated for obtaining available information concerning floristic composition, stratigraphic age, sedimentology, etc. Based on such reliable information, selected mega- and micro-floras have been analysed with the coexistence approach to obtain quantitative palaeoclimate data. Visualization of climate results in maps shows a distinct spatial differentiation in Southern China during the Miocene. Higher seasonalities of temperature and precipitation occur in the north and south parts of Southern China, respectively. During the Miocene, most regions of Southern China and Europe were both warm and humid. Central Eurasia was likely to be an arid center, which gradually spread westward and eastward. Our data provide information about Miocene climate patterns in Southern China and about the evolution of these patterns throughout the Miocene, and is also crucial to unravel and understand the climatic signals of global cooling and tectonic uplift.