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PURPOSE: To develop a clinical practice guideline for systemic antifungal prophylaxis in pediatric patients with cancer and hematopoietic stem-cell transplantation (HSCT) recipients. METHODS: Recommendations were developed by an international multidisciplinary panel that included a patient advocate. We conducted a systematic review of systemic antifungal prophylaxis in children and adults with cancer and HSCT recipients. The Grading of Recommendations Assessment, Development, and Evaluation approach was used to make strong or weak recommendations and to classify level of evidence as high, moderate, low, or very low. The panel considered directness of the data to pediatric patients. RESULTS: There were 68 randomized trials included in the systematic review, of which 6 (9%) were conducted in a solely pediatric population. Strong recommendations were made to administer systemic antifungal prophylaxis to children and adolescents receiving treatment of acute myeloid leukemia, to those undergoing allogeneic HSCT pre-engraftment, and to those receiving systemic immunosuppression for graft-versus-host disease treatment. A strong recommendation was made to administer a mold-active agent with an echinocandin or a mold-active azole when systemic antifungal prophylaxis is warranted. For children younger than 13 years of age, an echinocandin, voriconazole, or itraconazole is suggested. Posaconazole may also be used in those age 13 years or older. A strong recommendation against routine administration of amphotericin as systemic antifungal prophylaxis was made. CONCLUSION: We developed a clinical practice guideline for systemic antifungal prophylaxis administration in pediatric patients with cancer and HSCT recipients. Implementation and assessment of guideline-concordant rates and impacts are important future steps.

BACKGROUND: Bacteremia and other invasive bacterial infections are common among children with cancer receiving intensive chemotherapy and in pediatric recipients of hematopoietic stem cell transplantation (HSCT). Systemic antibacterial prophylaxis is one approach that can be used to reduce the risk of these infections. Our purpose was to develop a clinical practice guideline (CPG) for systemic antibacterial prophylaxis administration in pediatric patients with cancer and those undergoing HSCT. METHODS: An international and multidisciplinary panel was convened with representation from pediatric hematology/oncology and HSCT, pediatric infectious diseases (including antibiotic stewardship), nursing, pharmacy, a patient advocate, and a CPG methodologist. The panel used the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) approach to generate recommendations based on the results of a systematic review of the literature. RESULTS: The systematic review identified 114 eligible randomized trials of antibiotic prophylaxis. The panel made a weak recommendation for systemic antibacterial prophylaxis for children receiving intensive chemotherapy for acute myeloid leukemia and relapsed acute lymphoblastic leukemia (ALL). Weak recommendations against the routine use of systemic antibacterial prophylaxis were made for children undergoing induction chemotherapy for ALL, autologous HSCT and allogeneic HSCT. A strong recommendation against its routine use was made for children whose therapy is not expected to result in prolonged severe neutropenia. If used, prophylaxis with levofloxacin was recommended during severe neutropenia. CONCLUSIONS: We present a CPG for systemic antibacterial prophylaxis administration in pediatric cancer and HSCT patients. Future research should evaluate the long-term effectiveness and adverse effects of prophylaxis.

Purpose: To update a clinical practice guideline (CPG) for the empirical management of fever and neutropenia (FN) in children with cancer and hematopoietic stem-cell transplantation recipients. Method(s): The International Pediatric Fever and Neutropenia Guideline Panel is a multidisciplinary and multinational group of experts in pediatric oncology and infectious diseases that includes a patient advocate. For questions of risk stratification and evaluation, we updated systematic reviews of observational studies. For questions of therapy, we conducted a systematic review of randomized trials of any intervention applied for the empirical management of pediatric FN. The Grading of Recommendation Assessment, Development and Evaluation approach was used to make strong or weak recommendations and to classify levels of evidence as high, moderate, low, or very low. Result(s): Recommendations related to initial presentation, ongoing management, and empirical antifungal therapy of pediatric FN were reviewed; the most substantial changes were related to empirical antifungal therapy. Key differences from our 2012 FN CPG included the listing of a fourth-generation cephalosporin for empirical therapy in high-risk FN, refinement of risk stratification to define patients with high-risk invasive fungal disease (IFD), changes in recommended biomarkers and radiologic investigations for the evaluation of IFD in prolonged FN, and a weak recommendation to withhold empirical antifungal therapy in IFD low-risk patients with prolonged FN. Conclusion(s): Changes to the updated FN CPG recommendations will likely influence the care of pediatric patients with cancer and those undergoing hematopoietic stem-cell transplantation. Future work should focus on closing research gaps and on identifying ways to facilitate implementation and adaptation.Copyright © 2017 by American Society of Clinical Oncology.

Purpose: To update a clinical practice guideline (CPG) for the empirical management of fever and neutropenia (FN) in children with cancer and hematopoietic stem-cell transplantation recipients. Method(s): The International Pediatric Fever and Neutropenia Guideline Panel is a multidisciplinary and multinational group of experts in pediatric oncology and infectious diseases that includes a patient advocate. For questions of risk stratification and evaluation, we updated systematic reviews of observational studies. For questions of therapy, we conducted a systematic review of randomized trials of any intervention applied for the empirical management of pediatric FN. The Grading of Recommendation Assessment, Development and Evaluation approach was used to make strong or weak recommendations and to classify levels of evidence as high, moderate, low, or very low. Result(s): Recommendations related to initial presentation, ongoing management, and empirical antifungal therapy of pediatric FN were reviewed; the most substantial changes were related to empirical antifungal therapy. Key differences from our 2012 FN CPG included the listing of a fourth-generation cephalosporin for empirical therapy in high-risk FN, refinement of risk stratification to define patients with high-risk invasive fungal disease (IFD), changes in recommended biomarkers and radiologic investigations for the evaluation of IFD in prolonged FN, and a weak recommendation to withhold empirical antifungal therapy in IFD low-risk patients with prolonged FN. Conclusion(s): Changes to the updated FN CPG recommendations will likely influence the care of pediatric patients with cancer and those undergoing hematopoietic stem-cell transplantation. Future work should focus on closing research gaps and on identifying ways to facilitate implementation and adaptation.Copyright © 2017 by American Society of Clinical Oncology.

The NASA Orbital Debris Observatory (NODO) astronomical survey uses a transit 3-m liquid mirror telescope to observe a strip of sky in 20 narrow-band filters. In this article, we analyze a subset of data from the 1996 observing season. The catalog consists of 18,000 objects with 10

The NASA Orbital Debris Observatory (NODO) astronomical survey uses a transit 3-m liquid mirror telescope to observe a strip of sky in 20 narrow-band filters. In this article, we analyze a subset of data from the 1996 observing season. The catalog consists of 18,000 objects with 10

We have conducted a galaxy survey based on low-resolution slitless spectra taken from the automated CFHT-Laval survey. We present redshift distributions for 522 galaxies distributed in 4 distinct regions of the sky. Redshifts are determined from the shifted positions of the 4000 A. stellar break using an automated break-finding algorithm. The redshifts so obtained have a precision of < 3000 km s-1, good enough to trace the large-scale distribution of galaxies. The most striking feature of the survey is an apparent excess of galaxies at z ~ 0.1 in 8 of the 10 fields probed. Although the statistical significance of the peaks appears marginal (~ 2.5s per field) after taken in account the small-scale galaxy clustering, the peaks may nevertheless reveal the existence of large-scale structures at z ~ 0.1, indicating that the known large structures in the local universe are not unusual., Comment: 28 pages + 4 figures, uuencoded-compressed-Postscript, EFB08294

We have conducted a galaxy survey based on low-resolution slitless spectra taken from the automated CFHT-Laval survey. We present redshift distributions for 522 galaxies distributed in 4 distinct regions of the sky. Redshifts are determined from the shifted positions of the 4000 A. stellar break using an automated break-finding algorithm. The redshifts so obtained have a precision of < 3000 km s-1, good enough to trace the large-scale distribution of galaxies. The most striking feature of the survey is an apparent excess of galaxies at z ~ 0.1 in 8 of the 10 fields probed. Although the statistical significance of the peaks appears marginal (~ 2.5s per field) after taken in account the small-scale galaxy clustering, the peaks may nevertheless reveal the existence of large-scale structures at z ~ 0.1, indicating that the known large structures in the local universe are not unusual., Comment: 28 pages + 4 figures, uuencoded-compressed-Postscript, EFB08294

The Federal Aviation Administration (FAA) Integrated Terminal Weather System (ITWS) is supporting the development of products aimed at providing automated guidance to the air traffic managers for the anticipation of changes in ceiling and visibility (C&V) conditions and wake vortex behavior in the terminal area. Fine resolution, one-dimensional (column) numerical models are being considered to provide information on the evaluation of the local fine-scale structure of the lower atmosphere over the terminal area. The Code Brouillard Eau Liquide (COBEL) column model is being investigated for potential use within the ITWS. This one-dm=imensional numerical model has been developed for the short-term prediction of fog events in the north of France.