Predicting illness progression for children with lower respiratory infections (LRTI) presenting to primary care

Background Antibiotics are commonly prescribed for children with lower respiratory tract infections (LRTIs), fuelling antibiotic resistance, and there are few prognostic tools available to inform management. Aim To externally validate an existing prognostic model (STARWAVe) to identify children at low risk of illness progression, and if model performance was limited to develop a new internally validated prognostic model. Design and setting Prospective cohort study with a nested trial in a primary care setting. Method Children aged 6 months to 12 years presenting with uncomplicated LRTI were included in the cohort. Children were randomised to receive amoxicillin 50 mg/kg per day for 7 days or placebo, or if not randomised they participated in a parallel observational study to maximise generalisability. Baseline clinical data were used to predict adverse outcome (illness progression requiring hospital assessment). Results A total of 758 children participated (n= 432 trial, n= 326 observational). For predicting illness progression the STARWAVe prognostic model had moderate performance (area under the receiver operating characteristic [AUROC] 0.66, 95% confidence interval [CI] = 0.50 to 0.77), but a new, internally validated model (seven items: baseline severity; respiratory rate; duration of prior illness; oxygen saturation; sputum or a rattly chest; passing urine less often; and diarrhoea) had good discrimination (bootstrapped AUROC 0.83, 95% CI = 0.74 to 0.92) and calibration. A three-item model (respiratory rate; oxygen saturation; and sputum or a rattly chest) also performed well (AUROC 0.81, 95% CI = 0.70 to 0.91), as did a score (ranging from 19 to 102) derived from coefficients of the model (AUROC 0.78, 95% CI = 0.67 to 0.88): a score of &lt;70 classified 89% (n= 600/674) of children having a low risk (&lt;5%) of progression of illness. Conclusion A simple three-item prognostic score could be useful as a tool to identify children with LRTI who are at low risk of an adverse outcome and to guide clinical management.</p

Non Degenerate Dual Atomic Parametric Amplifier: Entangled Atomic Fields

In this paper, we investigate the dynamics of two coupled quantum degenerate atomic fields (BEC) interacting with two classical optical fields in the nonlinear atom optics regime. Two photon interaction produces entangled atom-atom pairs which exhibit nonclassical correlations. Since the system involves the creation of two correlated atom pairs, we call it the nondegenerate dual atomic parametric amplifier.Comment: 5 figure

Impacts and effects of ocean warming on intertidal rocky habitats.

• Intertidal rocky habitats comprise over 50% of the shorelines of the world, supporting a diversity of marine life and providing extensive ecosystem services worth in the region of US$ 5-10 trillion per year. • They are valuable indicators of the impacts of climate change on the wider marine environment and ecosystems. • Changes in species distributions, abundance and phenology have already been observed around the world in response to recent rapid climate change. • Species-level responses will have considerable ramifications for the structure of communities and trophic interactions, leading to eventual changes in ecosystem functioning (e.g. less primary producing canopy-forming algae in the North-east Atlantic). • Whilst progress is made on the mitigation1 required to achieve goals of a lower-carbon world, much can be done to enhance resilience to climate change. Managing the multitude of other interactive impacts on the marine environment, over which society has greater potential control (e.g. overfishing, invasive non-native species, coastal development, and pollution), will enable adaptation1 in the short and medium term of the next 5-50 years

Wall-Crossing in Coupled 2d-4d Systems

We introduce a new wall-crossing formula which combines and generalizes the Cecotti-Vafa and Kontsevich-Soibelman formulas for supersymmetric 2d and 4d systems respectively. This 2d-4d wall-crossing formula governs the wall-crossing of BPS states in an N=2 supersymmetric 4d gauge theory coupled to a supersymmetric surface defect. When the theory and defect are compactified on a circle, we get a 3d theory with a supersymmetric line operator, corresponding to a hyperholomorphic connection on a vector bundle over a hyperkahler space. The 2d-4d wall-crossing formula can be interpreted as a smoothness condition for this hyperholomorphic connection. We explain how the 2d-4d BPS spectrum can be determined for 4d theories of class S, that is, for those theories obtained by compactifying the six-dimensional (0,2) theory with a partial topological twist on a punctured Riemann surface C. For such theories there are canonical surface defects. We illustrate with several examples in the case of A_1 theories of class S. Finally, we indicate how our results can be used to produce solutions to the A_1 Hitchin equations on the Riemann surface C.Comment: 170 pages, 45 figure

CHIMPS: the ¹³CO/C¹⁸O (<i>J</i> = 3 → 2) Heterodyne Inner Milky Way Plane Survey

We present the 13CO/C18O (J = 3 → 2) Heterodyne Inner Milky Way Plane Survey (CHIMPS) which has been carried out using the Heterodyne Array Receiver Program on the 15 m James Clerk Maxwell Telescope (JCMT) in Hawaii. The high-resolution spectral survey currently covers |b| ≤ 0.5° and 28° ≲ l ≲ 46°, with an angular resolution of 15 arcsec in 0.5 km s-1 velocity channels. The spectra have a median rms of ˜0.6 K at this resolution, and for optically thin gas at an excitation temperature of 10 K, this sensitivity corresponds to column densities of NH2 ˜ 3 × 1020 cm-2 and NH2 ˜ 4 × 1021 cm-2 for 13CO and C18O, respectively. The molecular gas that CHIMPS traces is at higher column densities and is also more optically thin than in other publicly available CO surveys due to its rarer isotopologues, and thus more representative of the three-dimensional structure of the clouds. The critical density of the J = 3 → 2 transition of CO is ≳104 cm-3 at temperatures of ≤20 K, and so the higher density gas associated with star formation is well traced. These data complement other existing Galactic plane surveys, especially the JCMT Galactic Plane Survey which has similar spatial resolution and column density sensitivity, and the Herschel infrared Galactic Plane Survey. In this paper, we discuss the observations, data reduction and characteristics of the survey, presenting integrated-emission maps for the region covered. Position-velocity diagrams allow comparison with Galactic structure models of the Milky Way, and while we find good agreement with a particular four-arm model, there are some significant deviations

A Peculiar Family of Jupiter Trojans: the Eurybates

The Eurybates family is a compact core inside the Menelaus clan, located in the L4 swarm of Jupiter Trojans. Fornasier et al. (2007) found that this family exhibits a peculiar abundance of spectrally flat objects, similar to Chiron-like Centaurs and C-type main belt asteroids. On the basis of the visible spectra available in literature, Eurybates family's members seemed to be good candidates for having on their surfaces water/water ice or aqueous altered materials. To improve our knowledge of the surface composition of this peculiar family, we carried out an observational campaign at the Telescopio Nazionale Galileo (TNG), obtaining near-infrared spectra of 7 members. Our data show a surprisingly absence of any spectral feature referable to the presence of water, ices or aqueous altered materials on the surface of the observed objects. Models of the surface composition are attempted, evidencing that amorphous carbon seems to dominate the surface composition of the observed bodies and some amount of silicates (olivine) could be present.Comment: 23 pages, 2 figures, paper accepted for publication in Icaru

Parent–Child Separation Due to Incarceration: Assessment, Diagnosis, and Treatment Considerations

Decades of research and clinical observations have demonstrated the harmful effects of parent-child separation on children's short- and long-term well-being (Society for Research in Child Development, 2018). Young children may be separated from their parents due to a variety of circumstances. This article provides recommendations for the assessment, diagnosis, and treatment of young children who experience trauma as a result of being separated from their parent due to incarceration. An example of a multidisciplinary health care clinic is highlighted to demonstrate how clinicians and community partners work together to provide evaluation and care coordination services for children in foster care

Effectiveness of seasonal influenza vaccine in preventing laboratory-confirmed influenza in primary care in the United Kingdom : 2015/16 mid-season results

In 2015/16, the influenza season in the United Kingdom was dominated by influenza A(H1N1)pdm09 circulation. Virus characterisation indicated the emergence of genetic clusters, with the majority antigenically similar to the current influenza A(H1N1)pdm09 vaccine strain. Mid-season vaccine effectiveness (VE) estimates show an adjusted VE of 41.5% (95% confidence interval (CI): 3.0–64.7) against influenza-confirmed primary care consultations and of 49.1% (95% CI: 9.3–71.5) against influenza A(H1N1)pdm09. These estimates show levels of protection similar to the 2010/11 season, when this strain was first used in the seasonal vaccine