Children with severe malnutrition: can those at highest risk of death be identified with the WHO protocol?

Background With strict adherence to international recommended treatment guidelines, the case fatality for severe malnutrition ought to be less than 5%. In African hospitals, fatality rates of 20% are common and are often attributed to poor training and faulty case management. Improving outcome will depend upon the identification of those at greatest risk and targeting limited health resources. We retrospectively examined the major risk factors associated with early (<48 h) and late in-hospital death in children with severe malnutrition with the aim of identifying admission features that could distinguish a high-risk group in relation to the World Health Organization (WHO) guidelines. Methods and Findings Of 920 children in the study, 176 (19%) died, with 59 (33%) deaths occurring within 48 h of admission. Bacteraemia complicated 27% of all deaths: 52% died before 48 h despite 85% in vitro antibiotic susceptibility of cultured organisms. The sensitivity, specificity, and likelihood ratio of the WHO-recommended “danger signs” (lethargy, hypothermia, or hypoglycaemia) to predict early mortality was 52%, 84%, and 3.4% (95% confidence interval [CI] = 2.2 to 5.1), respectively. In addition, four bedside features were associated with early case fatality: bradycardia, capillary refill time greater than 2 s, weak pulse volume, and impaired consciousness level; the presence of two or more features was associated with an odds ratio of 9.6 (95% CI = 4.8 to 19) for early fatality (p < 0.0001). Conversely, the group of children without any of these seven features, or signs of dehydration, severe acidosis, or electrolyte derangements, had a low fatality (7%). Conclusions Formal assessment of these features as emergency signs to improve triage and to rationalize manpower resources toward the high-risk groups is required. In addition, basic clinical research is necessary to identify and test appropriate supportive treatments

Surveying the solar system by measuring angles and times: from the solar density to the gravitational constant

A surprisingly large amount of information on our solar system can be gained from simple measurements of the apparent angular diameters of the sun and the moon. This information includes the average density of the sun, the distance between earth and moon, the radius of the moon, and the gravitational constant. In this note it is described how these and other quantities can be obtained by simple earthbound measurements of angles and times only, without using any explicit information on distances between celestial bodies. The pedagogical and historical aspects of these results are also discussed briefly.Comment: 12 pges, one figur

Completed cohomology of Shimura curves and a p-adic Jacquet-Langlands correspondence

We study indefinite quaternion algebras over totally real fields F, and give an example of a cohomological construction of p-adic Jacquet-Langlands functoriality using completed cohomology. We also study the (tame) levels of p-adic automorphic forms on these quaternion algebras and give an analogue of Mazur's `level lowering' principle.Comment: Updated version. Contains some minor corrections compared to the published versio

A Search for Additional Bodies in the GJ 1132 Planetary System from 21 Ground-based Transits and a 100 Hour Spitzer Campaign

We present the results of a search for additional bodies in the GJ 1132 system through two methods: photometric transits and transit timing variations of the known planet. We collected 21 transit observations of GJ 1132b with the MEarth-South array since 2015. We obtained 100 near-continuous hours of observations with the $Spitzer$ Space Telescope, including two transits of GJ 1132b and spanning 60\% of the orbital phase of the maximum period at which bodies coplanar with GJ 1132b would pass in front of the star. We exclude transits of additional Mars-sized bodies, such as a second planet or a moon, with a confidence of 99.7\%. When we combine the mass estimate of the star (obtained from its parallax and apparent $K_s$ band magnitude) with the stellar density inferred from our high-cadence $Spitzer$ light curve (assuming zero eccentricity), we measure the stellar radius of GJ 1132 to be $0.2105^{+0.0102}_{-0.0085} R_\odot$, and we refine the radius measurement of GJ 1132b to $1.130 \pm 0.056 R_\oplus$. Combined with HARPS RV measurements, we determine the density of GJ 1132b to be $6.2 \pm 2.0$\ g cm$^{-3}$, with the mass determination dominating this uncertainty. We refine the ephemeris of the system and find no evidence for transit timing variations, which would be expected if there was a second planet near an orbital resonance with GJ 1132b.Comment: 29 pages, 4 Tables, 8 Figures, Submitted to ApJ. Comments welcom

Is There a Fundamental Line for Disk Galaxies?

We show that there are strong local correlations between metallicity, surface brightness, and dynamical mass-to-light ratio within M33, analogous to the fundamental line of dwarf galaxies identified by Prada & Burkert (2002). Using near-infrared imaging from 2MASS, the published rotation curve of M33, and literature measurements of the metallicities of HII regions and supergiant stars, we demonstrate that these correlations hold for points at radial distances between 140 pc and 6.2 kpc from the center of the galaxy. At a given metallicity or surface brightness, M33 has a mass-to-light ratio approximately four times as large as the Local Group dwarf galaxies; other than this constant offset, we see broad agreement between the M33 and dwarf galaxy data. We use analytical arguments to show that at least two of the three fundamental line correlations are basic properties of disk galaxies that can be derived from very general assumptions. We investigate the effect of supernova feedback on the fundamental line with numerical models and conclude that while feedback clearly controls the scatter in the fundamental line, it is not needed to create the fundamental line itself, in agreement with our analytical calculations. We also compare the M33 data with measurements of a simulated disk galaxy, finding that the simulation reproduces the trends in the data correctly and matches the fundamental line, although the metallicity of the simulated galaxy is too high, and the surface brightness is lower than that of M33.Comment: 14 pages, 14 figures (5 in color). Accepted for publication in Ap

The potential therapeutic effects of creatine supplementation on body composition and muscle function in cancer

Low muscle mass in individuals with cancer has a profound impact on quality of life and independence and is associated with greater treatment toxicity and poorer prognosis. Exercise interventions are regularly being investigated as a means to ameliorate treatment-related adverse effects, and nutritional/supplementation strategies to augment adaptations to exercise are highly valuable. Creatine (Cr) is a naturally-occurring substance in the human body that plays a critical role in energy provision during muscle contraction. Given the beneficial effects of Cr supplementation on lean body mass, strength, and physical function in a variety of clinical populations, there is therapeutic potential in individuals with cancer at heightened risk for muscle loss. Here, we provide an overview of Cr physiology, summarize the evidence on the use of Cr supplementation in various aging/clinical populations, explore mechanisms of action, and provide perspectives on the potential therapeutic role of Cr in the exercise oncology setting

High Resolution X-Ray Imaging of the Center of IC342

We presented the result of a high resolution (FWHM~0.5'') 12 ks Chandra HRC-I observation of the starburst galaxy IC342 taken on 2 April 2006. We identified 23 X-ray sources within the central 30' x 30' region of IC342. Our HRC-I observation resolved the historical Ultraluminous X-ray sources (ULX), X3, near the nucleus into 2 sources, namely C12 and C13, for the first time. The brighter source C12, with L(0.08-10keV)=(6.66\pm0.45)\times10^{38}ergs^-1, was spatially extended (~82 pc x 127 pc). From the astrometric registration of the X-ray image, C12 was at R.A.=03h:46m:48.43s, decl.=+68d05m47.45s, and was closer to the nucleus than C13. Thus we concluded that source was not an ULX and must instead be associated with the nucleus. The fainter source C13, with L(0.08-10keV)=(5.1\pm1.4) x 10^{37}ergs^-1 was consistent with a point source and located $6.51'' at P.A. 240 degree of C12. We also analyzed astrometrically corrected optical Hubble Space Telescope and radio Very Large Array images, a comparison with the X-ray image showed similarities in their morphologies. Regions of star formation within the central region of IC342 were clearly visible in HST H alpha image and this was the region where 3 optical star clusters and correspondingly our detected X-ray source C12 were observed. We found that a predicted X-ray emission from starburst was very close to the observed X-ray luminosity of C12, suggesting that nuclear X-ray emission in IC342 was dominated by starburst. Furthermore, we discussed the possibility of AGN in the nucleus of IC342. Although our data was not enough to give a firm existence of an AGN, it could not be discarded.Comment: 29 page, 8 figures, accepted by Ap

Bar imprints on the inner gas kinematics of M33

We present measurements of the stellar and gaseous velocities in the central 5' of the Local Group spiral M33. The data were obtained with the ARC 3.5m telescope. Blue and red spectra with resolutions from 2 to 4\AA covering the principal gaseous emission and stellar absorption lines were obtained along the major and minor axes and six other position angles. The observed radial velocities of the ionized gas along the photometric major axis of M33 remain flat at ~22 km s^{-1} all the way into the center, while the stellar velocities show a gradual rise from zero to 22 km s^{-1} over that same region. The central star cluster is at or very close to the dynamical center, with a velocity that is in accordance with M33's systemic velocity to within our uncertainties. Velocities on the minor axis are non-zero out to about 1' from the center in both the stars and gas. Together with the major axis velocities, they point at significant deviations from circular rotation. The most likely explanation for the bulk of the velocity patterns are streaming motions along a weak inner bar with a PA close to that of the minor axis, as suggested by previously published IR photometric images. The presence of bar imprints in M33 implies that all major Local Group galaxies are barred. The non-circular motions over the inner 200 pc make it difficult to constrain the shape of M33's inner dark matter halo profile. If the non-circular motions we find in this nearby Sc galaxy are present in other more distant late-type galaxies, they might be difficult to recognize.Comment: 20 pages, 12 figures, ApJ in pres