Associations of blood pressure with body composition among Afro-Caribbean children in Barbados

Despite complex presentation of adult hypertension and a concomitant obesity epidemic, little is known about overweight in relation to blood pressure among Caribbean children. We examined blood pressure in relation to body size in a cross-sectional study of 573 Barbadian children aged 9–10 years (2010-2011).The United States normative blood pressure percentiles were used to identify children with high (≥ 95th percentile) or high normal blood pressure (90th – 95th percentile). The World Health Organization body mass index cut-off points were used to assess weight status. Major findings: Thirty percent of children were overweight/obese. Percentage fat mass differed between girls (20.4%) and boys (17.72%) (p< 0.05). Mean systolic blood pressure among girls was 106.11 (95% CI 105.05, 107.17) mmHg and 105.23 (104.09, 106.38) for boys. The percentages with high or high-normal mean systolic blood pressurewere14.38% (10.47, 18.29) for girls and 8.08% (4.74, 11.41) for boys. Height and body mass index were independent correlates of systolic and diastolic blood pressure. Mean systolic blood pressure was related to lean mass but not fat mass, while diastolic blood pressure was associated with fat mass index and overweight. Principal conclusion: One third of 9-10 year old children in Barbados were overweight/obese and 12% had elevated mean systolic blood pressure. BP was related to body size. These findings signal potential adverse trends in weight gain and BP trends for children growing up in the context of a country that has recently undergone rapid economic transition

Full-Shell X-Ray Optics Development at NASA Marshall Space Flight Center

NASAs Marshall Space Flight Center (MSFC) maintains an active research program toward the development of high-resolution, lightweight, grazing-incidence x-ray optics to serve the needs of future x-ray astronomy missions such as Lynx. MSFC development efforts include both direct fabrication (diamond turning and deterministic computer-controlled polishing) of mirror shells and replication of mirror shells (from figured, polished mandrels). Both techniques produce full-circumference monolithic (primary + secondary) shells that share the advantages of inherent stability, ease of assembly, and low production cost. However, to achieve high-angular resolution, MSFC is exploring significant technology advances needed to control sources of figure error including fabrication- and coating-induced stresses and mounting-induced distortions

X-Ray Optics at NASA Marshall Space Flight Center

NASA's Marshall Space Flight Center (MSFC) engages in research, development, design, fabrication, coating, assembly, and testing of grazing-incidence optics (primarily) for x-ray telescope systems. Over the past two decades, MSFC has refined processes for electroformed-nickel replication of grazing-incidence optics, in order to produce high-strength, thin-walled, full-cylinder x-ray mirrors. In recent years, MSFC has used this technology to fabricate numerous x-ray mirror assemblies for several flight (balloon, rocket, and satellite) programs. Additionally, MSFC has demonstrated the suitability of this technology for ground-based laboratory applications-namely, x-ray microscopes and cold-neutron microscopes and concentrators. This mature technology enables the production, at moderately low cost, of reasonably lightweight x-ray telescopes with good (15-30 arcsecond) angular resolution. However, achieving arcsecond imaging for a lightweight x-ray telescope likely requires development of other technologies. Accordingly, MSFC is conducting a multi-faceted research program toward enabling cost-effective production of lightweight high-resolution x-ray mirror assemblies. Relevant research topics currently under investigation include differential deposition for post-fabrication figure correction, in-situ monitoring and control of coating stress, and direct fabrication of thin-walled full-cylinder grazing-incidence mirrors

ANCA-Associated Glomerulonephritis: Risk Factors for Renal Relapse.

Relapse in ANCA-associated vasculitis (AAV) has been studied previously, but there are few studies on renal relapse in particular. Identifying patients at high risk of renal relapse may aid in optimizing clinical management. We investigated which clinical and histological parameters are risk factors for renal relapse in ANCA-associated glomerulonephritis (AAGN). Patients (n = 174) were newly diagnosed and had mild-moderate or severe renal involvement. Data were derived from two trials of the European Vasculitis Society: MEPEX and CYCAZAREM. The Cox regression model was used to identify parameters increasing the instantaneous risk (= rate) of renal relapse (useful for instant clinical decisions). For identifying predictors of renal relapse during follow-up, we used Fine & Gray's regression model. Competing events were end-stage renal failure and death. The cumulative incidence of renal relapse at 5 years was 9.5% (95% CI: 4.8-14.3%). In the Cox model, sclerotic class AAGN increased the instantaneous risk of renal relapse. In Fine & Gray's model, the absence of interstitial infiltrates at diagnosis was predictive for renal relapse. In this study we used two different models to identify possible relationships between clinical and histopathological parameters at time of diagnosis of AAV with the risk of experiencing renal relapse. Sclerotic class AAGN increased the instantaneous risk of renal relapse. This association is most likely due to the high proportion of sclerosed glomeruli reducing the compensatory capacity. The absence of interstitial infiltrates increased the risk of renal relapse which is a warning sign that patients with a relatively benign onset of disease may also be prone to renal relapse. Renal relapses occurring in patients with sclerotic class AAGN and renal relapses occurring in patients without interstitial infiltrates were mutually exclusive, which may indicate that they are essentially different

The HEROES Balloon-Borne Hard X-Ray Telescope

No abstract availabl

SuperHERO: The Next Generation Hard X-Ray HEROES Telescope

SuperHERO is a new high-sensitivity Long Duration Balloon (LDB)-capable, hard-x-ray (20-75 keV) telescope for making novel astrophysics and heliophysics observations. The proposed SuperHERO payload will be developed jointly by the Astrophysics Office at NASA Marshall Space Flight Center, the Solar Physics Laboratory and Wallops Flight Facility at NASA Goddard Space Flight Center. SuperHERO is a follow-on payload to the High Energy Replicated Optics to Explore the Sun (HEROES) balloon-borne telescope that recently launched from Fort Sumner, NM in September of 2013. The HEROES core instrument is a hard x-ray telescope consisting of x-ray 109 optics configured into 8 modules. Each module is aligned to a matching gas-filled detector at a focal length of 6 m. SuperHERO will make significant improvements to the HEROES payload, including: new solid-state multi-pixel CdTe detectors, additional optics, the Wallops Arc-Second Pointer, alignment monitoring systems and lighter gondola

Toward Large-Area Sub-Arcsecond X-Ray Telescopes II

In order to advance significantly scientific objectives, future x-ray astronomy missions will likely call for x-ray telescopes with large aperture areas (approx. = 3 sq m) and fine angular resolution (approx. = 1"). Achieving such performance is programmatically and technologically challenging due to the mass and envelope constraints of space-borne telescopes and to the need for densely nested grazing-incidence optics. Such an x-ray telescope will require precision fabrication, alignment, mounting, and assembly of large areas (approx. = 600 sq m) of lightweight (approx. = 2 kg/sq m areal density) high-quality mirrors, at an acceptable cost (approx. = 1 M$/sq m of mirror surface area). This paper reviews relevant programmatic and technological issues, as well as possible approaches for addressing these issues-including direct fabrication of monocrystalline silicon mirrors, active (in-space adjustable) figure correction of replicated mirrors, static post-fabrication correction using ion implantation, differential erosion or deposition, and coating-stress manipulation of thin substrates

X-Ray Optics at NASA Marshall Space Flight Center

NASA's Marshall Space Flight Center (MSFC) engages in research, development, design, fabrication, coating, assembly, and testing of grazing-incidence optics (primarily) for x-ray telescope systems. Over the past two decades, MSFC has refined processes for electroformed-nickel replication of grazing-incidence optics, in order to produce high-strength, thin-walled, full-cylinder x-ray mirrors. In recent years, MSFC has used this technology to fabricate numerous x-ray mirror assemblies for several flight (balloon, rocket, and satellite) programs. Additionally, MSFC has demonstrated the suitability of this technology for ground-based laboratory applications-namely, x-ray microscopes and cold-neutron microscopes and concentrators. This mature technology enables the production, at moderately low cost, of reasonably lightweight x-ray telescopes with good (15-30 arcsecond) angular resolution. However, achieving arcsecond imaging for a lightweight x-ray telescope likely requires development of other technologies. Accordingly, MSFC is conducting a multi-faceted research program toward enabling cost-effective production of lightweight high-resolution x-ray mirror assemblies. Relevant research topics currently under investigation include differential deposition for post-fabrication figure correction, in-situ monitoring and control of coating stress, and direct fabrication of thin-walled full-cylinder grazing-incidence mirrors

Using Verbal Autopsy to Measure Causes of Death: the Comparative Performance of Existing Methods.

Monitoring progress with disease and injury reduction in many populations will require widespread use of verbal autopsy (VA). Multiple methods have been developed for assigning cause of death from a VA but their application is restricted by uncertainty about their reliability. We investigated the validity of five automated VA methods for assigning cause of death: InterVA-4, Random Forest (RF), Simplified Symptom Pattern (SSP), Tariff method (Tariff), and King-Lu (KL), in addition to physician review of VA forms (PCVA), based on 12,535 cases from diverse populations for which the true cause of death had been reliably established. For adults, children, neonates and stillbirths, performance was assessed separately for individuals using sensitivity, specificity, Kappa, and chance-corrected concordance (CCC) and for populations using cause specific mortality fraction (CSMF) accuracy, with and without additional diagnostic information from prior contact with health services. A total of 500 train-test splits were used to ensure that results are robust to variation in the underlying cause of death distribution. Three automated diagnostic methods, Tariff, SSP, and RF, but not InterVA-4, performed better than physician review in all age groups, study sites, and for the majority of causes of death studied. For adults, CSMF accuracy ranged from 0.764 to 0.770, compared with 0.680 for PCVA and 0.625 for InterVA; CCC varied from 49.2% to 54.1%, compared with 42.2% for PCVA, and 23.8% for InterVA. For children, CSMF accuracy was 0.783 for Tariff, 0.678 for PCVA, and 0.520 for InterVA; CCC was 52.5% for Tariff, 44.5% for PCVA, and 30.3% for InterVA. For neonates, CSMF accuracy was 0.817 for Tariff, 0.719 for PCVA, and 0.629 for InterVA; CCC varied from 47.3% to 50.3% for the three automated methods, 29.3% for PCVA, and 19.4% for InterVA. The method with the highest sensitivity for a specific cause varied by cause. Physician review of verbal autopsy questionnaires is less accurate than automated methods in determining both individual and population causes of death. Overall, Tariff performs as well or better than other methods and should be widely applied in routine mortality surveillance systems with poor cause of death certification practices

Medium-size-vessel vasculitis

Medium-size-artery vasculitides do occur in childhood and manifest, in the main, as polyarteritis nodosa (PAN), cutaneous PAN and Kawasaki disease. Of these, PAN is the most serious, with high morbidity and not inconsequential mortality rates. New classification criteria for PAN have been validated that will have value in epidemiological studies and clinical trials. Renal involvement is common and recent therapeutic advances may result in improved treatment options. Cutaneous PAN is a milder disease characterised by periodic exacerbations and often associated with streptococcal infection. There is controversy as to whether this is a separate entity or part of the systemic PAN spectrum. Kawasaki disease is an acute self-limiting systemic vasculitis, the second commonest vasculitis in childhood and the commonest cause of childhood-acquired heart disease. Renal manifestations occur and include tubulointerstitial nephritis and renal failure. An infectious trigger and a genetic predisposition seem likely. Intravenous immunoglobulin (IV-Ig) and aspirin are effective therapeutically, but in resistant cases, either steroid or infliximab have a role. Greater understanding of the pathogenetic mechanisms involved in these three types of vasculitis and better long-term follow-up data will lead to improved therapy and prediction of prognosis