38 research outputs found
Follow-up between 6 and 24 months after discharge from treatment for severe acute malnutrition in children aged 6-59 months: A systematic review.
BACKGROUND: Severe acute malnutrition (SAM) is a major global health problem affecting some 16.9 million children under five. Little is known about what happens to children 6-24 months post-discharge as this window often falls through the gap between studies on SFPs and those focusing on longer-term effects. METHODS: A protocol was registered on PROSPERO (PROSPERO 2017:CRD42017065650). Embase, Global Health and MEDLINE In-Process and Non-Indexed Citations were systematically searched with terms related to SAM, nutritional intervention and follow-up between June and August 2017. Studies were selected if they included children who experienced an episode of SAM, received a therapeutic feeding intervention, were discharged as cured and presented any outcome from follow-up between 6-24 months later. RESULTS: 3,691 articles were retrieved from the search, 55 full-texts were screened and seven met the inclusion criteria. Loss-to-follow-up, mortality, relapse, morbidity and anthropometry were outcomes reported. Between 0.0% and 45.1% of cohorts were lost-to-follow-up. Of those discharged as nutritionally cured, mortality ranged from 0.06% to 10.4% at an average of 12 months post-discharge. Relapse was inconsistently defined, measured, and reported, ranging from 0% to 6.3%. Two studies reported improved weight-for-height z-scores, whilst three studies that reported height-for-age z-scores found either limited or no improvement. CONCLUSIONS: Overall, there is a scarcity of studies that follow-up children 6-24 months post-discharge from SAM treatment. Limited data that exists suggest that children may exhibit sustained vulnerability even after achieving nutritional cure, including heightened mortality and morbidity risk and persistent stunting. Prospective cohort studies assessing a wider range of outcomes in children post-SAM treatment are a priority, as are intervention studies exploring how to improve post-SAM outcomes and identify high-risk children
Response and Survival Estimates of Patients With Plasma Cell Myeloma in a Resource-Constrained Setting Using Protocols From High-Income Countries:A Single-Center Experience From Sri Lanka
There is a significant disparity in global cancer care and outcome between countries. Progress in the treatment of symptomatic plasma cell myeloma (PCM) in high-income countries is not seen in low- and middle-income countries. MATERIALS AND METHODS: This is was a retrospective cohort study of all patients diagnosed with PCM between May 1, 2013, and September 30, 2021, at the first hemato-oncology center in Sri Lanka. We aimed to provide data on clinicopathologic characteristics, response, and survival estimates. RESULTS: A total of 79 patients with PCM received first-line therapy during the study period. The median age was 64 years, and approximately one third (33%) of patients were older than 70 years. There were 42 (53%) males and 37 females. Hypercalcemia, renal impairment, anemia, and bone disease were detected in 36.7%, 38%, 72.1%, and 81%, respectively. Thirty-nine, 34, and six patients received a combination of cyclophosphamide, thalidomide, and dexamethasone; bortezomib, thalidomide, and dexamethasone; and other treatments, respectively. The overall response rate (≥ partial response) was approximately 97% for both cyclophosphamide, thalidomide, and dexamethasone and bortezomib, thalidomide, and dexamethasone. Twenty-three (29%) of these patients died during the study period, but only 14 (18%) died due to PCM or associated sepsis. After a median follow-up of 40.6 months (range, 35.2-59.07 months), the median overall survival was 84.2 months (95% CI, 60.87 to not available). The 5-year estimated overall survival was 65%. CONCLUSION: To our knowledge, this is the only well-characterized study on long-term survival of patients with PCM in Sri Lanka. We have shown that it is possible to successfully apply Western treatment and supportive care protocols to the local population. These published data will help to benchmark and improve the treatment and develop blood cancer care in the local setting
A Low-Diversity Microbiota Inhabits Extreme Terrestrial Basaltic Terrains and Their Fumaroles : Implications for the Exploration of Mars
A major objective in the exploration of Mars is to test the hypothesis that the planet hosted life. Even in the absence of life, the mapping of habitable and uninhabitable environments is an essential task in developing a complete understanding of the geological and aqueous history of Mars and, as a consequence, understanding what factors caused Earth to take a different trajectory of biological potential. We carried out the aseptic collection of samples and comparison of the bacterial and archaeal communities associated with basaltic fumaroles and rocks of varying weathering states in Hawai'i to test four hypotheses concerning the diversity of life in these environments. Using high-throughput sequencing, we found that all these materials are inhabited by a low-diversity biota. Multivariate analyses of bacterial community data showed a clear separation between sites that have active fumaroles and other sites that comprised relict fumaroles, unaltered, and syn-emplacement basalts. Contrary to our hypothesis that high water flow environments, such as fumaroles with active mineral leaching, would be sites of high biological diversity, alpha diversity was lower in active fumaroles compared to relict or nonfumarolic sites, potentially due to high-temperature constraints on microbial diversity in fumarolic sites. A comparison of these data with communities inhabiting unaltered and weathered basaltic rocks in Idaho suggests that bacterial taxon composition of basaltic materials varies between sites, although the archaeal communities were similar in Hawai'i and Idaho. The taxa present in both sites suggest that most of them obtain organic carbon compounds from the atmosphere and from phototrophs and that some of them, including archaeal taxa, cycle fixed nitrogen. The low diversity shows that, on Earth, extreme basaltic terrains are environments on the edge of sustaining life with implications for the biological potential of similar environments on Mars and their exploration by robots and humans.Peer reviewe
TREM-1 activation is a potential key regulator in driving severe pathogenesis of enterovirus A71 infection
The NANOGrav 15-Year Data Set: Detector Characterization and Noise Budget
Pulsar timing arrays (PTAs) are galactic-scale gravitational wave detectors.
Each individual arm, composed of a millisecond pulsar, a radio telescope, and a
kiloparsecs-long path, differs in its properties but, in aggregate, can be used
to extract low-frequency gravitational wave (GW) signals. We present a noise
and sensitivity analysis to accompany the NANOGrav 15-year data release and
associated papers, along with an in-depth introduction to PTA noise models. As
a first step in our analysis, we characterize each individual pulsar data set
with three types of white noise parameters and two red noise parameters. These
parameters, along with the timing model and, particularly, a piecewise-constant
model for the time-variable dispersion measure, determine the sensitivity curve
over the low-frequency GW band we are searching. We tabulate information for
all of the pulsars in this data release and present some representative
sensitivity curves. We then combine the individual pulsar sensitivities using a
signal-to-noise-ratio statistic to calculate the global sensitivity of the PTA
to a stochastic background of GWs, obtaining a minimum noise characteristic
strain of at 5 nHz. A power law-integrated analysis shows
rough agreement with the amplitudes recovered in NANOGrav's 15-year GW
background analysis. While our phenomenological noise model does not model all
known physical effects explicitly, it provides an accurate characterization of
the noise in the data while preserving sensitivity to multiple classes of GW
signals.Comment: 67 pages, 73 figures, 3 tables; published in Astrophysical Journal
Letters as part of Focus on NANOGrav's 15-year Data Set and the Gravitational
Wave Background. For questions or comments, please email
[email protected]
The NANOGrav 15-year Data Set: Search for Anisotropy in the Gravitational-Wave Background
The North American Nanohertz Observatory for Gravitational Waves (NANOGrav)
has reported evidence for the presence of an isotropic nanohertz gravitational
wave background (GWB) in its 15 yr dataset. However, if the GWB is produced by
a population of inspiraling supermassive black hole binary (SMBHB) systems,
then the background is predicted to be anisotropic, depending on the
distribution of these systems in the local Universe and the statistical
properties of the SMBHB population. In this work, we search for anisotropy in
the GWB using multiple methods and bases to describe the distribution of the
GWB power on the sky. We do not find significant evidence of anisotropy, and
place a Bayesian upper limit on the level of broadband anisotropy such
that . We also derive conservative estimates on the
anisotropy expected from a random distribution of SMBHB systems using
astrophysical simulations conditioned on the isotropic GWB inferred in the
15-yr dataset, and show that this dataset has sufficient sensitivity to probe a
large fraction of the predicted level of anisotropy. We end by highlighting the
opportunities and challenges in searching for anisotropy in pulsar timing array
data.Comment: 19 pages, 11 figures; submitted to Astrophysical Journal Letters as
part of Focus on NANOGrav's 15-year Data Set and the Gravitational Wave
Background. For questions or comments, please email [email protected]
The NANOGrav 15-year Data Set: Bayesian Limits on Gravitational Waves from Individual Supermassive Black Hole Binaries
Evidence for a low-frequency stochastic gravitational wave background has
recently been reported based on analyses of pulsar timing array data. The most
likely source of such a background is a population of supermassive black hole
binaries, the loudest of which may be individually detected in these datasets.
Here we present the search for individual supermassive black hole binaries in
the NANOGrav 15-year dataset. We introduce several new techniques, which
enhance the efficiency and modeling accuracy of the analysis. The search
uncovered weak evidence for two candidate signals, one with a
gravitational-wave frequency of 4 nHz, and another at 170 nHz. The
significance of the low-frequency candidate was greatly diminished when
Hellings-Downs correlations were included in the background model. The
high-frequency candidate was discounted due to the lack of a plausible host
galaxy, the unlikely astrophysical prior odds of finding such a source, and
since most of its support comes from a single pulsar with a commensurate binary
period. Finding no compelling evidence for signals from individual binary
systems, we place upper limits on the strain amplitude of gravitational waves
emitted by such systems.Comment: 23 pages, 13 figures, 2 tables. Accepted for publication in
Astrophysical Journal Letters as part of Focus on NANOGrav's 15-year Data Set
and the Gravitational Wave Background. For questions or comments, please
email [email protected]
The NANOGrav 15 yr Data Set: Search for Transverse Polarization Modes in the Gravitational-wave Background
Recently we found compelling evidence for a gravitational-wave background with Hellings and Downs (HD) correlations in our 15 yr data set. These correlations describe gravitational waves as predicted by general relativity, which has two transverse polarization modes. However, more general metric theories of gravity can have additional polarization modes, which produce different interpulsar correlations. In this work, we search the NANOGrav 15 yr data set for evidence of a gravitational-wave background with quadrupolar HD and scalar-transverse (ST) correlations. We find that HD correlations are the best fit to the data and no significant evidence in favor of ST correlations. While Bayes factors show strong evidence for a correlated signal, the data does not strongly prefer either correlation signature, with Bayes factors ∼2 when comparing HD to ST correlations, and ∼1 for HD plus ST correlations to HD correlations alone. However, when modeled alongside HD correlations, the amplitude and spectral index posteriors for ST correlations are uninformative, with the HD process accounting for the vast majority of the total signal. Using the optimal statistic, a frequentist technique that focuses on the pulsar-pair cross-correlations, we find median signal-to-noise ratios of 5.0 for HD and 4.6 for ST correlations when fit for separately, and median signal-to-noise ratios of 3.5 for HD and 3.0 for ST correlations when fit for simultaneously. While the signal-to-noise ratios for each of the correlations are comparable, the estimated amplitude and spectral index for HD are a significantly better fit to the total signal, in agreement with our Bayesian analysis
The NANOGrav 15-year data set: Search for Transverse Polarization Modes in the Gravitational-Wave Background
Recently we found compelling evidence for a gravitational wave background
with Hellings and Downs (HD) correlations in our 15-year data set. These
correlations describe gravitational waves as predicted by general relativity,
which has two transverse polarization modes. However, more general metric
theories of gravity can have additional polarization modes which produce
different interpulsar correlations. In this work we search the NANOGrav 15-year
data set for evidence of a gravitational wave background with quadrupolar
Hellings and Downs (HD) and Scalar Transverse (ST) correlations. We find that
HD correlations are the best fit to the data, and no significant evidence in
favor of ST correlations. While Bayes factors show strong evidence for a
correlated signal, the data does not strongly prefer either correlation
signature, with Bayes factors when comparing HD to ST correlations,
and for HD plus ST correlations to HD correlations alone. However,
when modeled alongside HD correlations, the amplitude and spectral index
posteriors for ST correlations are uninformative, with the HD process
accounting for the vast majority of the total signal. Using the optimal
statistic, a frequentist technique that focuses on the pulsar-pair
cross-correlations, we find median signal-to-noise-ratios of 5.0 for HD and 4.6
for ST correlations when fit for separately, and median signal-to-noise-ratios
of 3.5 for HD and 3.0 for ST correlations when fit for simultaneously. While
the signal-to-noise-ratios for each of the correlations are comparable, the
estimated amplitude and spectral index for HD are a significantly better fit to
the total signal, in agreement with our Bayesian analysis.Comment: 11 pages, 5 figure
How to Detect an Astrophysical Nanohertz Gravitational-Wave Background
Analysis of pulsar timing data have provided evidence for a stochastic
gravitational wave background in the nHz frequency band. The most plausible
source of such a background is the superposition of signals from millions of
supermassive black hole binaries. The standard statistical techniques used to
search for such a background and assess its significance make several
simplifying assumptions, namely: i) Gaussianity; ii) isotropy; and most often
iii) a power-law spectrum. However, a stochastic background from a finite
collection of binaries does not exactly satisfy any of these assumptions. To
understand the effect of these assumptions, we test standard analysis
techniques on a large collection of realistic simulated datasets. The dataset
length, observing schedule, and noise levels were chosen to emulate the
NANOGrav 15-year dataset. Simulated signals from millions of binaries drawn
from models based on the Illustris cosmological hydrodynamical simulation were
added to the data. We find that the standard statistical methods perform
remarkably well on these simulated datasets, despite their fundamental
assumptions not being strictly met. They are able to achieve a confident
detection of the background. However, even for a fixed set of astrophysical
parameters, different realizations of the universe result in a large variance
in the significance and recovered parameters of the background. We also find
that the presence of loud individual binaries can bias the spectral recovery of
the background if we do not account for them.Comment: 14 pages, 8 figure