The impact of a school-based water supply and treatment, hygiene, and sanitation programme on pupil diarrhoea: a cluster-randomized trial.

The impact of improved water, sanitation, and hygiene (WASH) access on mitigating illness is well documented, although impact of school-based WASH on school-aged children has not been rigorously explored. We conducted a cluster-randomized trial in Nyanza Province, Kenya to assess the impact of a school-based WASH intervention on diarrhoeal disease in primary-school pupils. Two study populations were used: schools with a nearby dry season water source and those without. Pupils attending 'water-available' schools that received hygiene promotion and water treatment (HP&WT) and sanitation improvements showed no difference in period prevalence or duration of illness compared to pupils attending control schools. Those pupils in schools that received only the HP&WT showed similar results. Pupils in 'water-scarce' schools that received a water-supply improvement, HP&WT and sanitation showed a reduction in diarrhoea incidence and days of illness. Our study revealed mixed results on the impact of improvements to school WASH improvements on pupil diarrhoea

Late systolic central hypertension as a predictor of incident heart failure : the Multi-Ethnic Study of Atherosclerosis

Background: Experimental studies demonstrate that high aortic pressure in late systole relative to early systole causes greater myocardial remodeling and dysfunction, for any given absolute peak systolic pressure. Methods and Results: We tested the hypothesis that late systolic hypertension, defined as the ratio of late (last one third of systole) to early (first two thirds of systole) pressure-time integrals (PTI) of the aortic pressure waveform, independently predicts incident heart failure (HF) in the general population. Aortic pressure waveforms were derived from a generalized transfer function applied to the radial pressure waveform recorded noninvasively from 6124 adults. The late/early systolic PTI ratio (L/ESPTI) was assessed as a predictor of incident HF during median 8.5 years of follow-up. The L/ESPTI was predictive of incident HF (hazard ratio per 1% increase= 1.22; 95% CI= 1.15 to 1.29; P58.38%) was more predictive of HF than the presence of hypertension. After adjustment for each other and various predictors of HF, the HR associated with hypertension was 1.39 (95% CI= 0.86 to 2.23; P=0.18), whereas the HR associated with a high L/E was 2.31 (95% CI=1.52 to 3.49; P<0.0001). Conclusions: Independently of the absolute level of peak pressure, late systolic hypertension is strongly associated with incident HF in the general population

Cyclotron line energy in Hercules X-1: stable after the decay

We summarize the results of a dedicated effort made between 2012 and 2019 to follow the evolution of the cyclotron line in Her X-1 through repeated NuSTAR observations. The previously observed nearly 20-year-long decay of the cyclotron line energy has ended in 2012: from then on, the pulse-phase-averaged flux-corrected cyclotron line energy has remained stable and constant at an average value of E_(cyc) = (37.44 ± 0.07) keV (normalized to a flux level of 6.8 RXTE/ASM-cts s⁻¹). The flux dependence of E_(cyc) discovered in 2007 is now measured with high precision, giving a slope of (0.675 ± 0.075) keV/(ASM-cts s⁻¹), corresponding to an increase of 6.5% of E_(cyc) for an increase in flux by a factor of two. We also find that all line parameters as well as the continuum parameters show a correlation with X-ray flux. While a correlation between E_(cyc) and X-ray flux (both positive and negative) is now known for several accreting binaries with various suggestions for the underlying physics, the phenomenon of a long-term decay has so far only been seen in Her X-1 and Vela X-1, with far less convincing explanations

Assessment of Discordance Between Physicians and Family Members Regarding Prognosis in Patients With Severe Acute Brain Injury.

Shared decision-making requires key stakeholders to align in perceptions of prognosis and likely treatment outcomes. For patients with severe acute brain injury, the objective of this study was to better understand prognosis discordance between physicians and families by determining prevalence and associated factors. This mixed-methods cross-sectional study analyzed a cohort collected from January 4, 2018, to July 22, 2020. This study was conducted in the medical and cardiac intensive care units of a single neuroscience center. Participants included families, physicians, and nurses of patients admitted with severe acute brain injury. Severe acute brain injury was defined as stroke, traumatic brain injury, or hypoxic ischemic encephalopathy with a Glasgow Coma Scale score less than or equal to 12 points after hospital day 2. Prognosis discordance was defined as a 20% or greater difference between family and physician prognosis predictions; misunderstanding was defined as a 20% or greater difference between physician prediction and the family's estimate of physician prediction; and optimistic belief difference was defined as any difference (&gt;0%) between family prediction and their estimate of physician prediction. Logistic regression was used to identify associations with discordance. Optimistic belief differences were analyzed as a subgroup of prognosis discordance. Among 222 enrolled patients, prognostic predictions were available for 193 patients (mean [SD] age, 57 [19] years; 106 men [55%]). Prognosis discordance occurred for 118 patients (61%) and was significantly more common among families who identified with minoritized racial groups compared with White families (odds ratio [OR], 3.14; CI, 1.40-7.07, P = .006); among siblings (OR, 4.93; 95% CI, 1.35-17.93, P = .02) and adult children (OR, 2.43; 95% CI, 1.10-5.37; P = .03) compared with spouses; and when nurses perceived family understanding as poor compared with good (OR, 3.73; 95% CI, 1.88-7.40; P &lt; .001). Misunderstanding was present for 80 of 173 patients (46%) evaluated for this type of prognosis discordance, and optimistic belief difference was present for 94 of 173 patients (54%). In qualitative analysis, faith and uncertainty emerged as themes underlying belief differences. Nurse perception of poor family understanding was significantly associated with misunderstanding (OR, 2.06; 95% CI, 1.07-3.94; P = .03), and physician perception with optimistic belief differences (OR, 2.32; 95% CI, 1.10-4.88; P = .03). Results of this cross-sectional study suggest that for patients with severe acute brain injury, prognosis discordance between physicians and families was common. Efforts to improve communication and decision-making should aim to reduce this discordance and find ways to target both misunderstanding and optimistic belief differences

Driving Errors in Parkinson’s Disease: Moving Closer to Predicting On-Road Outcomes

Age-related medical conditions such as Parkinson’s disease (PD) compromise driver fitness. Results from studies are unclear on the specific driving errors that underlie passing or failing an on-road assessment. In this study, we determined the between-group differences and quantified the on-road driving errors that predicted pass or fail on-road outcomes in 101 drivers with PD (mean age 5 69.38 ± 7.43) and 138 healthy control (HC) drivers (mean age 5 71.76 ± 5.08). Participants with PD had minor differences in demographics and driving habits and history but made more and different driving errors than HC participants. Drivers with PD failed the on-road test to a greater extent than HC drivers (41% vs. 9%), x2(1) 5 35.54, HC N 5 138, PD N 5 99, p \u3c .001. The driving errors predicting on-road pass or fail outcomes (95% confidence interval, Nagelkerke R2 5.771) were made in visual scanning, signaling, vehicle positioning, speeding (mainly underspeeding, t (61) 5 7.004, p \u3c .001, and total errors. Although it is difficult to predict on-road outcomes, this study provides a foundation for doing so

Revealing the spectral state transition of the Clocked Burster, GS 1826-238 with NuSTAR StrayCats

We present the long term analysis of GS 1826-238, a neutron star X-ray binary known as the "Clocked Burster", using data from NuSTAR StrayCats. StrayCats, a catalogue of NuSTAR stray light data, contains data from bright, off-axis X-ray sources that have not been focused by the NuSTAR optics. We obtained stray light observations of the source from 2014-2021, reduced and analyzed the data using nustar-gen-utils Python tools, demonstrating the transition of source from the "island" atoll state to a "banana" branch. We also present the lightcurve analysis of Type I X-Ray bursts from the Clocked Burster and show that the bursts from the banana/soft state are systematically shorter in durations than those from the island/hard state and have a higher burst fluence. From our analysis, we note an increase in mass accretion rate of the source, and a decrease in burst frequency with the transition

Theoretical Properties of Projection Based Multilayer Perceptrons with Functional Inputs

Many real world data are sampled functions. As shown by Functional Data Analysis (FDA) methods, spectra, time series, images, gesture recognition data, etc. can be processed more efficiently if their functional nature is taken into account during the data analysis process. This is done by extending standard data analysis methods so that they can apply to functional inputs. A general way to achieve this goal is to compute projections of the functional data onto a finite dimensional sub-space of the functional space. The coordinates of the data on a basis of this sub-space provide standard vector representations of the functions. The obtained vectors can be processed by any standard method. In our previous work, this general approach has been used to define projection based Multilayer Perceptrons (MLPs) with functional inputs. We study in this paper important theoretical properties of the proposed model. We show in particular that MLPs with functional inputs are universal approximators: they can approximate to arbitrary accuracy any continuous mapping from a compact sub-space of a functional space to R. Moreover, we provide a consistency result that shows that any mapping from a functional space to R can be learned thanks to examples by a projection based MLP: the generalization mean square error of the MLP decreases to the smallest possible mean square error on the data when the number of examples goes to infinity

Prognostic value of NT-proBNP levels in the acute phase of sepsis on lower long-term physical function and muscle strength in sepsis survivors

Background: Sepsis survivors often develop chronic critical illness (CCI) and demonstrate the persistent inflammation, immunosuppression, and catabolism syndrome predisposing them to long-term functional limitations and higher mortality. There is a need to identify biomarkers that can predict long-term worsening of physical function to be able to act early and prevent mobility loss. N-terminal pro-brain natriuretic peptide (NT-proBNP) is a well-accepted biomarker of cardiac overload, but it has also been shown to be associated with long-term physical function decline. We explored whether NT-proBNP blood levels in the acute phase of sepsis are associated with physical function and muscle strength impairment at 6 and 12 months after sepsis onset. Methods: This is a retrospective analysis conducted in 196 sepsis patients (aged 18-86 years old) as part of the University of Florida (UF) Sepsis and Critical Illness Research Center (SCIRC) who consented to participate in the 12-month follow-up study. NT-proBNP was measured at 24 h after sepsis onset. Patients were followed to determine physical function by short physical performance battery (SPPB) test score (scale 0 to12-higher score corresponds with better physical function) and upper limb muscle strength by hand grip strength test (kilograms) at 6 and 12 months. We used a multivariate linear regression model to test an association between NT-proBNP levels, SPPB, and hand grip strength scores. Missing follow-up data or absence due to death was accounted for by using inverse probability weighting based on concurrent health performance status scores. Statistical significance was set at p ≤ 0.05. Results: After adjusting for covariates (age, gender, race, Charlson comorbidity index, APACHE II score, and presence of CCI condition), higher levels of NT-proBNP at 24 h after sepsis onset were associated with lower SPPB scores at 12 months (p &lt; 0.05) and lower hand grip strength at 6-month (p &lt; 0.001) and 12-month follow-up (p &lt; 0.05). Conclusions: NT-proBNP levels during the acute phase of sepsis may be a useful indicator of higher risk of long-term impairments in physical function and muscle strength in sepsis survivors

MAXI and NuSTAR observations of the faint X-ray transient MAXI J1848-015 in the GLIMPSE-C01 Cluster

We present the results of MAXI monitoring and two NuSTAR observations of the recently discovered faint X-ray transient MAXI J1848-015. Analysis of the MAXI light-curve shows that the source underwent a rapid flux increase beginning on 2020 December 20, followed by a rapid decrease in flux after only $\sim5$ days. NuSTAR observations reveal that the source transitioned from a bright soft state with unabsorbed, bolometric ($0.1$-$100$ keV) flux $F=6.9 \pm 0.1 \times 10^{-10}\,\mathrm{erg\,cm^{-2}\,s^{-1}}$, to a low hard state with flux $F=2.85 \pm 0.04 \times 10^{-10}\,\mathrm{erg\,cm^{-2}\,s^{-1}}$. Given a distance of $3.3$ kpc, inferred via association of the source with the GLIMPSE-C01 cluster, these fluxes correspond to an Eddington fraction of order $10^{-3}$ for an accreting neutron star of mass $M=1.4M_\odot$, or even lower for a more massive accretor. However, the source spectra exhibit strong relativistic reflection features, indicating the presence of an accretion disk which extends close to the accretor, for which we measure a high spin, $a=0.967\pm0.013$. In addition to a change in flux and spectral shape, we find evidence for other changes between the soft and hard states, including moderate disk truncation with the inner disk radius increasing from $R_\mathrm{in}\approx3\,R_\mathrm{g}$ to $R_\mathrm{in}\approx8\,R_\mathrm{g}$, narrow Fe emission whose centroid decreases from $6.8\pm0.1$ keV to $6.3 \pm 0.1$ keV, and an increase in low-frequency ($10^{-3}$-$10^{-1}$ Hz) variability. Due to the high spin we conclude that the source is likely to be a black hole rather than a neutron star, and we discuss physical interpretations of the low apparent luminosity as well as the narrow Fe emission.Comment: 19 pages, 9 figures, 3 tables. Accepted for publication in Ap

Impact Factor: outdated artefact or stepping-stone to journal certification?

A review of Garfield's journal impact factor and its specific implementation as the Thomson Reuters Impact Factor reveals several weaknesses in this commonly-used indicator of journal standing. Key limitations include the mismatch between citing and cited documents, the deceptive display of three decimals that belies the real precision, and the absence of confidence intervals. These are minor issues that are easily amended and should be corrected, but more substantive improvements are needed. There are indications that the scientific community seeks and needs better certification of journal procedures to improve the quality of published science. Comprehensive certification of editorial and review procedures could help ensure adequate procedures to detect duplicate and fraudulent submissions.Comment: 25 pages, 12 figures, 6 table