Oral versus Intravenous Antibiotics for Bone and Joint Infection

BACKGROUND

The management of complex orthopedic infections usually includes a prolonged course of intravenous antibiotic agents. We investigated whether oral antibiotic therapy is noninferior to intravenous antibiotic therapy for this indication.

METHODS

We enrolled adults who were being treated for bone or joint infection at 26 U.K. centers. Within 7 days after surgery (or, if the infection was being managed without surgery, within 7 days after the start of antibiotic treatment), participants were randomly assigned to receive either intravenous or oral antibiotics to complete the first 6 weeks of therapy. Follow-on oral antibiotics were permitted in both groups. The primary end point was definitive treatment failure within 1 year after randomization. In the analysis of the risk of the primary end point, the noninferiority margin was 7.5 percentage points.

RESULTS

Among the 1054 participants (527 in each group), end-point data were available for 1015 (96.3%). Treatment failure occurred in 74 of 506 participants (14.6%) in the intravenous group and 67 of 509 participants (13.2%) in the oral group. Missing end-point data (39 participants, 3.7%) were imputed. The intention-to-treat analysis showed a difference in the risk of definitive treatment failure (oral group vs. intravenous group) of -1.4 percentage points (90% confidence interval [CI], -4.9 to 2.2; 95% CI, -5.6 to 2.9), indicating noninferiority. Complete-case, per-protocol, and sensitivity analyses supported this result. The between-group difference in the incidence of serious adverse events was not significant (146 of 527 participants [27.7%] in the intravenous group and 138 of 527 [26.2%] in the oral group; P=0.58). Catheter complications, analyzed as a secondary end point, were more common in the intravenous group (9.4% vs. 1.0%).

CONCLUSIONS

Oral antibiotic therapy was noninferior to intravenous antibiotic therapy when used during the first 6 weeks for complex orthopedic infection, as assessed by treatment failure at 1 year. (Funded by the National Institute for Health Research; OVIVA Current Controlled Trials number, ISRCTN91566927 .).

Photonic ring resonator filters for astronomical OH suppression

Ring resonators provide a means of filtering specific wavelengths from a waveguide, and optionally dropping the filtered wavelengths into a second waveguide. Both of these features are potentially useful for astronomical instruments. In this paper we focus on their use as notch filters to remove the signal from atmospheric OH emission lines from astronomical spectra. We derive the design requirements for ring resonators for OH suppression from theory and finite difference time domain simulations. We find that rings with small radii (< 10 μm) are required to provide an adequate free spectral range, leading to high index contrast materials such as Si and Si₃N₄. Critically coupled rings with high self-coupling coefficients should provide the necessary Q factors, suppression depth, and throughput for efficient OH suppression, but will require post-inscription tuning of the coupling and the resonant wavelengths. The overall prospects for the use of ring resonators in astronomical instruments is promising, provided efficient fibre-chip coupling can be achieved.

Writing Bragg Gratings in Multicore Fibers

Fiber Bragg gratings in multicore fibers can be used as compact and robust filters in astronomical and other research and commercial applications. Strong suppression at a single wavelength requires that all cores have matching transmission profiles. These gratings cannot be inscribed using the same method as for single-core fibers because the curved surface of the cladding acts as a lens, focusing the incoming UV laser beam and causing variations in exposure between cores. Therefore we use an additional optical element to ensure that the beam shape does not change while passing through the cross-section of the multicore fiber. This consists of a glass capillary tube which has been polished flat on one side, which is then placed over the section of the fiber to be inscribed. The laser beam enters the fiber through the flat surface of the capillary tube and hence maintains its original dimensions. This paper demonstrates the improvements in core-to-core uniformity for a 7-core fiber using this method. The technique can be generalized to larger multicore fibers.

Characterization and on-sky demonstration of an integrated photonic spectrograph for astronomy

We present results from the first on-sky demonstration of a prototype astronomical integrated photonic spectrograph (IPS) using the Anglo-Australian Telescope near-infrared imaging spectrometer (IRIS2) at Siding Spring Observatory to observe atmospheric molecular OH emission lines. We have succeeded in detecting upwards of 27 lines, and demonstrated the practicality of the IPS device for astronomy. Furthermore, we present a laboratory characterization of the device, which is a modified version of a commercial arrayed-waveguide grating multiplexer. We measure the spectral resolution full-width-half-maximum to be 0.75 +/- 0.05 nm (giving R = lambda/deltalambda = 2100 +/- 150 at 1500 nm). We find the free spectral range to be 57.4 +/- 0.6 nm and the peak total efficiency to be approximately 65%. Finally, we briefly discuss the future steps required to realize an astronomical instrument based on this technology concept.

Chemical Changes During Growth and Storage of the Avocado Fruit

Changes in the petrol-soluble, 80 per cent. ethanol-soluble, and insoluble fractions of the mesocarp of the avocado fruit were followed during 6 months development on the tree and during storage at 20�C of the fully grown fruit. Changes in triglyceride fatty acids, lipid phosphorus, insoluble phosphorus, sugars, protein, and soluble nitrogen were also studied.