The Prevalence of Aspiration Pneumonia in Rest Home Residents with Reduced Cough Reflex Sensitivity

The aim of this study was to determine whether there was an association between a failed test of cough reflex sensitivity and history of chest infection in a general population of rest home residents. One hundred rest home residents from four different levels of care (rest home, hospital, dementia and psycho-geriatric) were recruited and their cough reflex assessed using a solution of 0.6 Mol/L citric acid nebulised and presented via a facemask.Participant’s records were then checked to see if there were any documented episodes of chest infection in the 6 month period prior to cough reflex testing.The results showed that out of 100 participants, 4 failed the cough reflex test. Of the 4 that failed the test, 3 had no documented episodes of chest infections recorded in the 6 month period prior to cough reflex testing. Data was not available for one participant who was deceased by the time of collection of the second data set. As such, there was no direct association demonstrated between a failed cough reflex test and development of chest infection or aspiration pneumonia. The results of the study are unexpected in two ways. Firstly, the relatively low number of participants who failed the cough reflex test is surprising as 72% of the participants for whom a full data set was obtained had neurological conditions that are known predisposing factors for reduced cough reflex sensitivity. Secondly, the finding of no association between a failed cough reflex test and history of recorded chest infection is not consistent with other studies. There is however an established body of research that indicates the causes of aspiration pneumonia are multifactorial and not solely dependent upon aspiration. The characteristics of participants and the implications of the findings are described. The potential use of cough reflex testing as a tool to screen against the risks of silent aspiration in relation to assessment of oro-pharyngeal dysphagia in this frail, elderly population is discussed

Évaluation de la formation portant sur l'approche centrée sur la personne dans le cadre du projet d'amélioration de la santé des mères et des enfants

La deuxième phase du programme d’amélioration de la santé des mères et des enfants au Burkina Faso a développé et implanté une formation portant sur l’approche centrée sur la personne dans les soins maternels pour les professionnels de la santé afin d’améliorer la qualité des soins. Il a aussi prévu d’évaluer cette formation qui fait l’objet de ce travail. L’objectif est : 1) d’évaluer la fidélité de l’implantation de la formation ACP, 2) d’évaluer les déterminants contextuels (les facteurs ayant influencés l’implantation et le résultat du projet) et 3) d’évaluer les effets immédiats. Elle a été réalisée à l’aide de trois modèles : le « Conceptual Framework for Implementation Fidelity », « The presage, process and product (3P) model of learning and teaching » et le modèle intégré. Cette évaluation a été conduite dans une perspective d’évaluation participative afin de renforcer l’utilisation des résultats de l’évaluation et de permettre le renforcement des capacités des acteurs. Il s’agit d’une recherche évaluative qui a combiné des méthodes qualitatives et quantitatives. La composante qualitative est basée sur une analyse documentaire et des entrevues auprès de sept (7) acteurs impliqués dans le projet. La composante quantitative a été faite à l’aide des questionnaires : 1) de satisfaction, 2) d’apprentissage et 3) le DPC-Réaction. Les résultats de la composante qualitative ont montré que l’approche participative utilisée a permis des ajustements dans l’implantation de la formation. Les résultats de la composante quantitative ont aussi montré une satisfaction élevée des participants à la formation ACP, une augmentation des connaissances acquises après la formation ACP et une intention élevée de changement de comportement des professionnels de la santé. Ces résultats présentent aussi les recommandations des participants afin d’améliorer la formation.The second phase of the Maternal and Child Health Improvement Program in Burkina Faso has developed and implemented training on the person-centred approach (PCA) in maternal care for health professionals to improve quality care. It also planned to evaluate this training, which is the subject of this work. The objective is: 1) to evaluate the implementation fidelity of the PCA training, 2) to evaluate the contextual determinants (the factors that influenced the implementation and the outcome of the project) and 3) to evaluate the immediate effects. It was carried out using three models: the Conceptual Framework for Implementation Fidelity, the presage, process and product (3P) model of learning and teaching and the integrated model. This evaluation was conducted in a participatory evaluation perspective in order to strengthen the use of the evaluation results and to enable the capacity building of the actors. It is an evaluative research that has combined qualitative and quantitative methods. The qualitative component is based on a documentary analysis and interviews with 7 actors involved in the project. The quantitative component was done using questionnaires: 1) satisfaction, 2) learning and 3) CPD-Reaction. The results of the qualitative component showed that the participatory approach used allowed adjustments in the implementation of the training. The results of the quantitative component also showed a high satisfaction of PCA training participants, an increase in knowledge gained after PCA training and a high intention of behavioural change among health professionals. These results also present participants

Les Organisations de la Société Civile et la Lutte Contre la Pauvreté en Afrique Subsaharienne

The paper presents the role played by civil society organisations to bring down the poverty

Primary and secondary eclipse spectroscopy with JWST: exploring the exoplanet parameter space

Eclipse exoplanet spectroscopy has yielded detection of H_2O, CH_4, CO_2 and CO in the atmosphere of hot jupiters and neptunes. About 40 large terrestrial planets are announced or confirmed, two of which are transiting, and another deemed habitable. Hence the potential for eclipse spectroscopy of terrestrial planets with James Webb Space Telescope (JWST) has become an active field of study. We explore the parameter space (type of stars, planet orbital periods and types, and instruments/wavelengths) in terms of the signal-to-noise ratio (S/N) achievable on the detection of spectroscopic features. We use analytic formula and model data for both the astrophysical scene and the instrument, to plot S/N contour maps, while indicating how the S/N scales with the fixed parameters. We systematically compare stellar photon noise-only figures with ones including detailed instrumental and zodiacal noises. Likelihood of occurring targets is based both on model and catalog star population of the solar neighborhood. The 9.6 micron ozone band is detectable (S/N = 3) with JWST, for a warm super-earth 6.7 pc away, using ~2% of the 5-year nominal mission time (summing observations, M4V and lighter host star for primary eclipses, M5V for secondary). If every star up to this mass limit and distance were to host a habitable planet, there should be statistically ~1 eclipsing case. Investigation of systematic noises in the co-addition of 5 years worth-, tens of days separated-, hours-long observations is critical, complemented by dedicated characterisation of the instruments, currently in integration phase. The census of nearby transiting habitable planets must be complete before the beginning of science operations.Comment: Accepted for publication in A&A, 16 pages, 19 figure

Synthesis and optimization of low-pressure chemical vapor deposition-silicon nitride coatings deposited from SiHCl3 and NH3

Stoichiometric silicon nitride films were deposited by low-pressure chemical vapor deposition from the SiHCl3-NH3-H2-Ar system in a hot wall reactor at pressures ranging from 0.3 to 2 kPa. The films are amorphous for deposition temperatures up to 1000 °C and crystalline, in the α-form, at 1200 °C and above. A method for evaluating the internal stresses based on the curvature of the silicon substrate wafer and the resulting silicon Raman peak shift was developed. Some amorphous films exhibit high internal tensile stresses that can lead to cracking during deposition depending on the mechanism and effective precursors involved. Residual stresses can thus be reduced and cracking avoided by, in descending order of importance, reducing the concentration of reactive gases through dilution, increasing the deposition temperature and decreasing the total pressure. The effects of these parameters on the intrinsic stresses were related to the amount of residual hydrogen successively incorporated and thermally released during the growth of the coating according to the Noskov's model

JWST/MIRI coronagraphic performances as measured on-sky

Characterization of directly imaged exoplanets is one of the most eagerly anticipated science functions of the James Webb Space Telescope. MIRI, the mid-IR instrument has the capability to provide unique spatially resolved photometric data points in a spectral range never achieved so far for such objects. We aim to present the very first on-sky contrast measurements of the MIRI's coronagraphs. In addition to a classical Lyot coronagraph at the longest wavelength, this observing mode implements the concept of the four quadrant phase mask for the very first time in a space telescope. We observed single stars together with a series of reference stars to measure raw contrasts as they are delivered on the detector, as well as reference subtracted contrasts. MIRI's coronagraphs achieve raw contrasts greater than $10^3$ at the smallest angular separations (within $1''$) and about $10^5$ further out (beyond $5\sim6''$). Subtracting the residual diffracted light left unattenuated by the coronagraph has the potential to bring the final contrast down to the background and detector limited noise floor at most angular separations (a few times $10^4$ at less than $1''$). MIRI coronagraphs behave as expected from simulations. In particular the raw contrasts for all four coronagraphs are fully consistent with the diffractive model. Contrasts obtained with subtracting reference stars also meet expectations and are fully demonstrated for two four quadrant phase masks (F1065C and F1140C). The worst contrast, measured at F1550C, is very likely due to a variation of the phase aberrations at the primary mirror during the observations, and not an issue of the coronagraph itself. We did not perform reference star subtraction with the Lyot mask at F2300C, but we anticipate that it would bring the contrast down to the noise floor.Comment: submitted to A&

Planet Populations as a Function of Stellar Properties

Exoplanets around different types of stars provide a window into the diverse environments in which planets form. This chapter describes the observed relations between exoplanet populations and stellar properties and how they connect to planet formation in protoplanetary disks. Giant planets occur more frequently around more metal-rich and more massive stars. These findings support the core accretion theory of planet formation, in which the cores of giant planets form more rapidly in more metal-rich and more massive protoplanetary disks. Smaller planets, those with sizes roughly between Earth and Neptune, exhibit different scaling relations with stellar properties. These planets are found around stars with a wide range of metallicities and occur more frequently around lower mass stars. This indicates that planet formation takes place in a wide range of environments, yet it is not clear why planets form more efficiently around low mass stars. Going forward, exoplanet surveys targeting M dwarfs will characterize the exoplanet population around the lowest mass stars. In combination with ongoing stellar characterization, this will help us understand the formation of planets in a large range of environments.Comment: Accepted for Publication in the Handbook of Exoplanet

On the formation of planetary systems via oligarchic growth in thermally evolving viscous discs

GALC acknowledges the support of an STFC PhD studentship. The simulations presented in this paper were performed on the QMUL HPC facility purchased under the SRIF initiatives

A seven-planet resonant chain in TRAPPIST-1

The TRAPPIST-1 system is the first transiting planet system found orbiting an ultra-cool dwarf star1. At least seven planets similar to Earth in radius were previously found to transit this host star2. Subsequently, TRAPPIST-1 was observed as part of the K2 mission and, with these new data, we report the measurement of an 18.77 d orbital period for the outermost transiting planet, TRAPPIST-1h, which was unconstrained until now. This value matches our theoretical expectations based on Laplace relations3 and places TRAPPIST-1h as the seventh member of a complex chain, with three-body resonances linking every member. We find that TRAPPIST-1h has a radius of 0.727 R⊕ and an equilibrium temperature of 169 K. We have also measured the rotational period of the star at 3.3 d and detected a number of flares consistent with a low-activity, middle-aged, late M dwarf