The African Hospitalist Fellowship

The African Paediatric Fellowship Programme is rolling out a training course for newly qualified paediatricians to equip them with the leadership skills to function in complex general paediatric settings. The care of children in Africa carries its own unique demands, from the layering effects of multiple conditions through to establishing and sustaining services under severe resource constraints. This novel training concept aims to strengthen confidence and knowledge in areas that are not priorities during standard general paediatric training. The skills gained are considered of great relevance in assisting general paediatricians to achieve their full potential in their careers

Assumptions of the primordial spectrum and cosmological parameter estimation

The observables of the perturbed universe, CMB anisotropy and large structures, depend on a set of cosmological parameters, as well as, the assumed nature of primordial perturbations. In particular, the shape of the primordial power spectrum (PPS) is, at best, a well motivated assumption. It is known that the assumed functional form of the PPS in cosmological parameter estimation can affect the best fit parameters and their relative confidence limits. In this paper, we demonstrate that a specific assumed form actually drives the best fit parameters into distinct basins of likelihood in the space of cosmological parameters where the likelihood resists improvement via modifications to the PPS. The regions where considerably better likelihoods are obtained allowing free form PPS lie outside these basins. In the absence of a preferred model of inflation, this raises a concern that current cosmological parameters estimates are strongly prejudiced by the assumed form of PPS. Our results strongly motivate approaches toward simultaneous estimation of the cosmological parameters and the shape of the primordial spectrum from upcoming cosmological data. It is equally important for theorists to keep an open mind towards early universe scenarios that produce features in the PPS.Comment: 11 pages, 2 figures, discussions extended, main results unchanged, matches published versio

Integrated care for childhood epilepsy: ongoing challenges and lessons for other long-term conditions

Epilepsy care has been identified as a major global issue – and there are many recognised concerns in the UK for children and young people with the condition. A proposed new model could help to increase multi-sector integration, facilitate better outcomes, and offer lessons for improving care of other long-term conditions

Five-Year Wilkinson Microwave Anisotropy Probe (WMAP) Observations: Angular Power Spectra

We present the temperature and polarization angular power spectra of the cosmic microwave background (CMB) derived from the first 5 years of WMAP data. The 5-year temperature (TT) spectrum is cosmic variance limited up to multipole l=530, and individual l-modes have S/N>1 for l<920. The best fitting six-parameter LambdaCDM model has a reduced chi^2 for l=33-1000 of chi^2/nu=1.06, with a probability to exceed of 9.3%. There is now significantly improved data near the third peak which leads to improved cosmological constraints. The temperature-polarization correlation (TE) is seen with high significance. After accounting for foreground emission, the low-l reionization feature in the EE power spectrum is preferred by \Delta\chi^2=19.6 for optical depth tau=0.089 by the EE data alone, and is now largely cosmic variance limited for l=2-6. There is no evidence for cosmic signal in the BB, TB, or EB spectra after accounting for foreground emission. We find that, when averaged over l=2-6, l(l+1)C^{BB}_l/2\pi < 0.15 uK^2 (95% CL).Comment: 29 pages, 13 figures, accepted by ApJ

Nine-Year Wilkinson Microwave Anisotropy Probe (WMAP) Observations: Cosmological Parameter Results

We present cosmological parameter constraints based on the final nine-year WMAP data, in conjunction with additional cosmological data sets. The WMAP data alone, and in combination, continue to be remarkably well fit by a six-parameter LCDM model. When WMAP data are combined with measurements of the high-l CMB anisotropy, the BAO scale, and the Hubble constant, the densities, Omegabh2, Omegach2, and Omega_L, are each determined to a precision of ~1.5%. The amplitude of the primordial spectrum is measured to within 3%, and there is now evidence for a tilt in the primordial spectrum at the 5sigma level, confirming the first detection of tilt based on the five-year WMAP data. At the end of the WMAP mission, the nine-year data decrease the allowable volume of the six-dimensional LCDM parameter space by a factor of 68,000 relative to pre-WMAP measurements. We investigate a number of data combinations and show that their LCDM parameter fits are consistent. New limits on deviations from the six-parameter model are presented, for example: the fractional contribution of tensor modes is limited to r<0.13 (95% CL); the spatial curvature parameter is limited to -0.0027 (+0.0039/-0.0038); the summed mass of neutrinos is <0.44 eV (95% CL); and the number of relativistic species is found to be 3.84+/-0.40 when the full data are analyzed. The joint constraint on Neff and the primordial helium abundance agrees with the prediction of standard Big Bang nucleosynthesis. We compare recent PLANCK measurements of the Sunyaev-Zel'dovich effect with our seven-year measurements, and show their mutual agreement. Our analysis of the polarization pattern around temperature extrema is updated. This confirms a fundamental prediction of the standard cosmological model and provides a striking illustration of acoustic oscillations and adiabatic initial conditions in the early universe.Comment: 32 pages, 12 figures, v3: Version accepted to Astrophysical Journal Supplement Series. Includes improvements in response to referee and community; corrected 3 entries in Table 10, (w0 & wa model). See the Legacy Archive for Microwave Background Data Analysis (LAMBDA): http://lambda.gsfc.nasa.gov/product/map/current/ for further detai

The Wilkinson Microwave Anisotropy Probe (WMAP) Source Catalog

We present the list of point sources found in the WMAP 5-year maps. The technique used in the first-year and three-year analysis now finds 390 point sources, and the five-year source catalog is complete for regions of the sky away from the galactic plane to a 2 Jy limit, with SNR > 4.7 in all bands in the least covered parts of the sky. The noise at high frequencies is still mainly radiometer noise, but at low frequencies the CMB anisotropy is the largest uncertainty. A separate search of CMB-free V-W maps finds 99 sources of which all but one can be identified with known radio sources. The sources seen by WMAP are not strongly polarized. Many of the WMAP sources show significant variability from year to year, with more than a 2:1 range between the minimum and maximum fluxes.Comment: 31 pages Latex with 4 embedded figures. Version accepted by the ApJ Supplement

Primary membranous glomerulonephritis with negative serum PLA2R in haemophilia : a successfully managed with rituximab : case report and review of the literature

Background: Hepatitis C virus (HCV) and human immunodeficiency virus (HIV) cause a wide range of glomerular pathologies. In people with haemophilia, transfusion-associated infections with these viruses are common and definitive pathological diagnosis in this population is complicated by the difficulty of safely obtaining a renal biopsy. Membranous nephropathy (MN) is a common cause of adult onset nephrotic syndrome occurring in both primary and secondary forms. Primary MN is associated with podocyte autoantibodies, predominantly against phospholipase A2 receptor (PLA2R). Secondary disease is often associated with viral infection; however, infrequently with HIV or HCV. Distinguishing these entities from each other and other viral glomerular disease is vital as treatment strategies are disparate. Case presentation: We present the case of a 48-year-old man with moderate haemophilia A and well-controlled transfusion-associated HCV and HIV coinfection who presented with sudden onset nephrotic range proteinuria. Renal biopsy demonstrated grade two membranous nephropathy with associated negative serum PLA2R testing. Light and electron microscopic appearances were indeterminant of a primary or secondary cause. Given his extremely stable co-morbidities, treatment with rituximab and subsequent angiotensin receptor blockade was initiated for suspected primary MN and the patient had sustained resolution in proteinuria over the following 18 months. Subsequent testing demonstrated PLA2R positive glomerular immunohistochemistry despite multiple negative serum results. Conclusions: Pursuing histological diagnosis is important in complex cases of MN as the treatment strategies between primary and secondary vary significantly. Serum PLA2R testing alone may be insufficient in the presence of multiple potential causes of secondary MN

Seven-year Wilkinson Microwave Anisotropy Probe (WMAP) Observations: Galactic Foreground Emission

We present updated estimates of Galactic foreground emission using seven years of WMAP data. Using the power spectrum of differences between multi-frequency template-cleaned maps, we find no evidence for foreground contamination outside of the updated (KQ85y7) foreground mask.We place a 15μK upper bound on rms foreground contamination in the cleaned maps used for cosmological analysis. Further, the cleaning process requires only three power-law foregrounds outside of the mask. We find no evidence for polarized foregrounds beyond those from soft (steep-spectrum) synchrotron and thermal dust emission; in particular we find no indication in the polarization data of an extra “haze” of hard synchrotron emission from energetic electrons near the Galactic center. We provide an updated map of the cosmic microwave background (CMB) using the internal linear combination method, updated foreground masks, and updates to point source catalogs using two different techniques. With additional years of data, we now detect 471 point sources using a five-band technique and 417 sources using a three-band CMB-free technique. In total there are 62 newly detected point sources, a 12% increase over the five-year release. Also new are tests of theMarkov chain Monte Carlo foreground fitting procedure against systematics in the time-stream data, and tests against the observed beam asymmetry. Within a few degrees of the Galactic plane, the behavior in total intensity of low-frequency foregrounds is complicated and not completely understood. WMAP data show a rapidly steepening spectrum from 20 to 40 GHz, which may be due to emission from spinning dust grains, steepening synchrotron, or other effects. Comparisons are made to a 1 deg 408 MHz map (Haslam et al.) and the 11 deg ARCADE 2 data (Singal et al.).We find that spinning dust or steepening synchrotron models fit the combination of WMAP and 408 MHz data equally well. ARCADE data appear inconsistent with the steepening synchrotron model and consistent with the spinning dust model, though some discrepancies remain regarding the relative strength of spinning dust emission. More high-resolution data in the 10–40 GHz range would shed much light on these issues

Five-Year Wilkinson Microwave Anisotropy Probe (WMAP) Observations: Data Processing, Sky Maps, and Basic Results

We present new full-sky temperature and polarization maps in five frequency bands from 23 to 94 GHz, based on data from the first five years of the WMAP sky survey. The five-year maps incorporate several improvements in data processing made possible by the additional years of data and by a more complete analysis of the instrument calibration and in-flight beam response. We present several new tests for systematic errors in the polarization data and conclude that Ka band data (33 GHz) is suitable for use in cosmological analysis, after foreground cleaning. This significantly reduces the overall polarization uncertainty. With the 5 year WMAP data, we detect no convincing deviations from the minimal 6-parameter LCDM model: a flat universe dominated by a cosmological constant, with adiabatic and nearly scale-invariant Gaussian fluctuations. Using WMAP data combined with measurements of Type Ia supernovae and Baryon Acoustic Oscillations, we find (68% CL uncertainties): Omega_bh^2 = 0.02267 \pm 0.00059, Omega_ch^2 = 0.1131 \pm 0.0034, Omega_Lambda = 0.726 \pm 0.015, n_s = 0.960 \pm 0.013, tau = 0.084 \pm 0.016, and Delta_R^2 = (2.445 \pm 0.096) x 10^-9. From these we derive: sigma_8 = 0.812 \pm 0.026, H_0 = 70.5 \pm 1.3 km/s/Mpc, z_{reion} = 10.9 \pm 1.4, and t_0 = 13.72 \pm 0.12 Gyr. The new limit on the tensor-to-scalar ratio is r < 0.22 (95% CL). We obtain tight, simultaneous limits on the (constant) dark energy equation of state and spatial curvature: -0.14 < 1+w < 0.12 and -0.0179 < Omega_k < 0.0081 (both 95% CL). The number of relativistic degrees of freedom (e.g. neutrinos) is found to be N_{eff} = 4.4 \pm 1.5, consistent with the standard value of 3.04. Models with N_{eff} = 0 are disfavored at >99.5% confidence.Comment: 46 pages, 13 figures, and 7 tables. Version accepted for publication, ApJS, Feb-2009. Includes 5-year dipole results and additional references. Also available at http://lambda.gsfc.nasa.gov/product/map/dr3/map_bibliography.cf

CMBPol Mission Concept Study: Prospects for polarized foreground removal

In this report we discuss the impact of polarized foregrounds on a future CMBPol satellite mission. We review our current knowledge of Galactic polarized emission at microwave frequencies, including synchrotron and thermal dust emission. We use existing data and our understanding of the physical behavior of the sources of foreground emission to generate sky templates, and start to assess how well primordial gravitational wave signals can be separated from foreground contaminants for a CMBPol mission. At the estimated foreground minimum of ~100 GHz, the polarized foregrounds are expected to be lower than a primordial polarization signal with tensor-to-scalar ratio r=0.01, in a small patch (~1%) of the sky known to have low Galactic emission. Over 75% of the sky we expect the foreground amplitude to exceed the primordial signal by about a factor of eight at the foreground minimum and on scales of two degrees. Only on the largest scales does the polarized foreground amplitude exceed the primordial signal by a larger factor of about 20. The prospects for detecting an r=0.01 signal including degree-scale measurements appear promising, with 5 sigma_r ~0.003 forecast from multiple methods. A mission that observes a range of scales offers better prospects from the foregrounds perspective than one targeting only the lowest few multipoles. We begin to explore how optimizing the composition of frequency channels in the focal plane can maximize our ability to perform component separation, with a range of typically 40 < nu < 300 GHz preferred for ten channels. Foreground cleaning methods are already in place to tackle a CMBPol mission data set, and further investigation of the optimization and detectability of the primordial signal will be useful for mission design.Comment: 42 pages, 14 figures, Foreground Removal Working Group contribution to the CMBPol Mission Concept Study, v2, matches AIP versio