The impact of a school-based water supply and treatment, hygiene, and sanitation programme on pupil diarrhoea: a cluster-randomized trial.

The impact of improved water, sanitation, and hygiene (WASH) access on mitigating illness is well documented, although impact of school-based WASH on school-aged children has not been rigorously explored. We conducted a cluster-randomized trial in Nyanza Province, Kenya to assess the impact of a school-based WASH intervention on diarrhoeal disease in primary-school pupils. Two study populations were used: schools with a nearby dry season water source and those without. Pupils attending 'water-available' schools that received hygiene promotion and water treatment (HP&WT) and sanitation improvements showed no difference in period prevalence or duration of illness compared to pupils attending control schools. Those pupils in schools that received only the HP&WT showed similar results. Pupils in 'water-scarce' schools that received a water-supply improvement, HP&WT and sanitation showed a reduction in diarrhoea incidence and days of illness. Our study revealed mixed results on the impact of improvements to school WASH improvements on pupil diarrhoea

Impact of fibre and red/processed meat intake on treatment outcomes among patients with chronic inflammatory diseases initiating biological therapy:A prospective cohort study

Background: Biologic disease-modifying drugs have revolutionised the treatment of a number of chronic inflammatory diseases (CID). However, up to 60% of the patients do not have a sufficient response to treatment and there is a need for optimization of treatment strategies.Objective: To investigate if the treatment outcome of biological therapy is associated with the habitual dietary intake of fibre and red/processed meat in patients with a CID.Methods: In this multicentre prospective cohort study, we consecutively enrolled 233 adult patients with a diagnosis of Crohn's Disease, Ulcerative Colitis, Rheumatoid Arthritis (RA), Axial Spondyloarthritis, Psoriatic Arthritis and Psoriasis, for whom biologic therapy was planned, over a 3 year period. Patients with completed baseline food frequency questionnaires were stratified into a high fibre/low red and processed meat exposed group (HFLM) and an unexposed group (low fibre/high red and processed meat intake = LFHM). The primary outcome was the proportion of patients with a clinical response to biologic therapy after 14-16 weeks of treatment.Results: Of the 193 patients included in our primary analysis, 114 (59%) had a clinical response to biologic therapy. In the HFLM group ( N = 64), 41 (64%) patients responded to treatment compared to 73 (56%) in the LFHM group ( N = 129), but the difference was not statistically significant (OR: 1.48, 0.72-3.05). For RA patients however, HFLM diet was associated with a more likely clinical response (82% vs. 35%; OR: 9.84, 1.35-71.56). Conclusion: Habitual HFLM intake did not affect the clinical response to biological treatment across CIDs. HFLM diet in RA patients might be associated with better odds for responding to biological treatment, but this would need confirmation in a randomised trial.Trial registration: (clinicaltrials.gov), identifier [NCT03173144].</p

Opacity Issues in Games with Imperfect Information

We study in depth the class of games with opacity condition, which are two-player games with imperfect information in which one of the players only has imperfect information, and where the winning condition relies on the information he has along the play. Those games are relevant for security aspects of computing systems: a play is opaque whenever the player who has imperfect information never "knows" for sure that the current position is one of the distinguished "secret" positions. We study the problems of deciding the existence of a winning strategy for each player, and we call them the opacity-violate problem and the opacity-guarantee problem. Focusing on the player with perfect information is new in the field of games with imperfect-information because when considering classical winning conditions it amounts to solving the underlying perfect-information game. We establish the EXPTIME-completeness of both above-mentioned problems, showing that our winning condition brings a gap of complexity for the player with perfect information, and we exhibit the relevant opacity-verify problem, which noticeably generalizes approaches considered in the literature for opacity analysis in discrete-event systems. In the case of blindfold games, this problem relates to the two initial ones, yielding the determinacy of blindfold games with opacity condition and the PSPACE-completeness of the three problems.Comment: In Proceedings GandALF 2011, arXiv:1106.081

Fault-tolerant Cooperative Tasking for Multi-agent Systems

A natural way for cooperative tasking in multi-agent systems is through a top-down design by decomposing a global task into sub-tasks for each individual agent such that the accomplishments of these sub-tasks will guarantee the achievement of the global task. In our previous works [1], [2] we presented necessary and sufficient conditions on the decomposability of a global task automaton between cooperative agents. As a follow-up work, this paper deals with the robustness issues of the proposed top-down design approach with respect to event failures in the multi-agent systems. The main concern under event failure is whether a previously decomposable task can still be achieved collectively by the agents, and if not, we would like to investigate that under what conditions the global task could be robustly accomplished. This is actually the fault-tolerance issue of the top-down design, and the results provide designers with hints on which events are fragile with respect to failures, and whether redundancies are needed. The main objective of this paper is to identify necessary and sufficient conditions on failed events under which a decomposable global task can still be achieved successfully. For such a purpose, a notion called passivity is introduced to characterize the type of event failures. The passivity is found to reflect the redundancy of communication links over shared events, based on which necessary and sufficient conditions for the reliability of cooperative tasking under event failures are derived, followed by illustrative examples and remarks for the derived conditions.Comment: Preprint, Submitted for publicatio

Aquaporins: relevance to cerebrospinal fluid physiology and therapeutic potential in hydrocephalus

The discovery of a family of membrane water channel proteins called aquaporins, and the finding that aquaporin 1 was located in the choroid plexus, has prompted interest in the role of aquaporins in cerebrospinal fluid (CSF) production and consequently hydrocephalus. While the role of aquaporin 1 in choroidal CSF production has been demonstrated, the relevance of aquaporin 1 to the pathophysiology of hydrocephalus remains debated. This has been further hampered by the lack of a non-toxic specific pharmacological blocking agent for aquaporin 1. In recent times aquaporin 4, the most abundant aquaporin within the brain itself, which has also been shown to have a role in brain water physiology and relevance to brain oedema in trauma and tumours, has become an alternative focus of attention for hydrocephalus research. This review summarises current knowledge and concepts in relation to aquaporins, specifically aquaporin 1 and 4, and hydrocephalus. It also examines the relevance of aquaporins as potential therapeutic targets in hydrocephalus and other CSF circulation disorders

Survey of CT radiation doses and iodinated contrast medium administration: an international multicentric study

ObjectiveTo assess the relationship between intravenous iodinated contrast media (ICM) administration usage and radiation doses for contrast-enhanced (CE) CT of head, chest, and abdomen-pelvis (AP) in international, multicenter settings. MethodsOur international (n = 16 countries), multicenter (n = 43 sites), and cross-sectional (ConRad) study had two parts. Part 1: Redcap survey with questions on information related to CT and ICM manufacturer/brand and respective protocols. Part 2: Information on 3,258 patients (18-96 years; M:F 1654:1604) who underwent CECT for a routine head (n = 456), chest (n = 528), AP (n = 599), head CT angiography (n = 539), pulmonary embolism (n = 599), and liver CT examinations (n = 537) at 43 sites across five continents. The following information was recorded: hospital name, patient age, gender, body mass index [BMI], clinical indications, scan parameters (number of scan phases, kV), IV-contrast information (concentration, volume, flow rate, and delay), and dose indices (CTDIvol and DLP). ResultsMost routine chest (58.4%) and AP (68.7%) CECT exams were performed with 2-4 scan phases with fixed scan delay (chest 71.4%; AP 79.8%, liver CECT 50.7%) following ICM administration. Most sites did not change kV across different patients and scan phases; most CECT protocols were performed at 120-140 kV (83%, 1979/2685). There were no significant differences between radiation doses for non-contrast (CTDIvol 24 [16-30] mGy; DLP 633 [414-702] mGycm) and post-contrast phases (22 [19-27] mGy; 648 [392-694] mGycm) (p = 0.142). Sites that used bolus tracking for chest and AP CECT had lower CTDIvol than sites with fixed scan delays (p &lt; 0.001). There was no correlation between BMI and CTDIvol (r2 &lt;= - 0.1 to 0.1, p = 0.931). ConclusionOur study demonstrates up to ten-fold variability in ICM injection protocols and radiation doses across different CT protocols. The study emphasizes the need for optimizing CT scanning and contrast protocols to reduce unnecessary contrast and radiation exposure to patients. Clinical relevance statementThe wide variability and lack of standardization of ICM media and radiation doses in CT protocols suggest the need for education and optimization of contrast usage and scan factors for optimizing image quality in CECT