Detected changes in precipitation extremes at their native scales derived from in situ measurements

The gridding of daily accumulated precipitation -- especially extremes -- from ground-based station observations is problematic due to the fractal nature of precipitation, and therefore estimates of long period return values and their changes based on such gridded daily data sets are generally underestimated. In this paper, we characterize high-resolution changes in observed extreme precipitation from 1950 to 2017 for the contiguous United States (CONUS) based on in situ measurements only. Our analysis utilizes spatial statistical methods that allow us to derive gridded estimates that do not smooth extreme daily measurements and are consistent with statistics from the original station data while increasing the resulting signal to noise ratio. Furthermore, we use a robust statistical technique to identify significant pointwise changes in the climatology of extreme precipitation while carefully controlling the rate of false positives. We present and discuss seasonal changes in the statistics of extreme precipitation: the largest and most spatially-coherent pointwise changes are in fall (SON), with approximately 33% of CONUS exhibiting significant changes (in an absolute sense). Other seasons display very few meaningful pointwise changes (in either a relative or absolute sense), illustrating the difficulty in detecting pointwise changes in extreme precipitation based on in situ measurements. While our main result involves seasonal changes, we also present and discuss annual changes in the statistics of extreme precipitation. In this paper we only seek to detect changes over time and leave attribution of the underlying causes of these changes for future work

A probabilistic gridded product for daily precipitation extremes over the United States

Gridded data products, for example interpolated daily measurements of precipitation from weather stations, are commonly used as a convenient substitute for direct observations because these products provide a spatially and temporally continuous and complete source of data. However, when the goal is to characterize climatological features of extreme precipitation over a spatial domain (e.g., a map of return values) at the native spatial scales of these phenomena, then gridded products may lead to incorrect conclusions because daily precipitation is a fractal field and hence any smoothing technique will dampen local extremes. To address this issue, we create a new "probabilistic" gridded product specifically designed to characterize the climatological properties of extreme precipitation by applying spatial statistical analyses to daily measurements of precipitation from the GHCN over CONUS. The essence of our method is to first estimate the climatology of extreme precipitation based on station data and then use a data-driven statistical approach to interpolate these estimates to a fine grid. We argue that our method yields an improved characterization of the climatology within a grid cell because the probabilistic behavior of extreme precipitation is much better behaved (i.e., smoother) than daily weather. Furthermore, the spatial smoothing innate to our approach significantly increases the signal-to-noise ratio in the estimated extreme statistics relative to an analysis without smoothing. Finally, by deriving a data-driven approach for translating extreme statistics to a spatially complete grid, the methodology outlined in this paper resolves the issue of how to properly compare station data with output from earth system models. We conclude the paper by comparing our probabilistic gridded product with a standard extreme value analysis of the Livneh gridded daily precipitation product

Mass Azithromycin and Malaria Parasitemia in Niger: Results from a Community-Randomized Trial.

Studies designed to determine the effects of mass administration of azithromycin on trachoma have suggested that mass azithromycin distributions may also reduce the prevalence of malaria. These studies have typically examined the impact of a small number of treatments over short durations. In this prespecified substudy of a cluster-randomized trial for trachoma, we compared malaria parasitemia prevalence in 24 communities in Niger randomized to receive either annual or biannual mass azithromycin distributions over 3 years. The 12 communities randomized to annual azithromycin received three treatments during the high-transmission season, and the 12 communities randomized to biannual azithromycin received a total of six treatments: three during the high-transmission season and three during the low-transmission season. Blood samples were taken to assess malariometric indices among children in all study communities at a single time point during the high-transmission season after 3 years of the intervention. No significant differences were identified in malaria parasitemia, parasite density, or hemoglobin concentration between the annual and biannual treatment arms. When compared with annual mass azithromycin alone, additional mass azithromycin distributions given during the low-transmission season did not significantly reduce the subsequent prevalence of malaria parasitemia or parasite density after 3 years, as measured during the high-transmission season

Biannual versus annual mass azithromycin distribution and malaria seroepidemiology among preschool children in Niger: a sub-study of a cluster randomized trial.

BACKGROUND: Biannual mass azithromycin administration to preschool children reduces all-cause mortality, but the mechanism for the effect is not understood. Azithromycin has activity against malaria parasites, and malaria is a leading cause of child mortality in the Sahel. The effect of biannual versus annual azithromycin distribution for trachoma control on serological response to merozoite surface protein 1 (MSP-119), a surrogate for malaria incidence, was evaluated among children in Niger. METHODS: Markers of malaria exposure were measured in two arms of a factorial randomized controlled trial designed to evaluate targeted biannual azithromycin distribution to children under 12 years of age compared to annual azithromycin to the entire community for trachoma control (N = 12 communities per arm). Communities were treated for 36 months (6 versus 3 distributions). Dried blood spots were collected at 36 months among children ages 1-5 years, and MSP-119 antibody levels were assessed using a bead-based multiplex assay to measure malaria seroprevalence. RESULTS: Antibody results were available for 991 children. MSP-119 seropositivity was 62.7% in the biannual distribution arm compared to 68.7% in the annual arm (prevalence ratio 0.91, 95% CI 0.83 to 1.00). Mean semi-quantitative antibody levels were lower in the biannual distribution arm compared to the annual arm (mean difference - 0.39, 95% CI - 0.05 to - 0.72). CONCLUSIONS: Targeted biannual azithromycin distribution was associated with lower malaria seroprevalence compared to that in a population that received annual distribution. Trial Registration Clinicaltrials.gov NCT00792922

Effect of digital psychoeducation and peer support on the mental health of family carers supporting individuals with psychosis in England (COPe-support): a randomised clinical trial

Background Psychoeducation delivered face-to-face is effective in alleviating mental health morbidities in family carers of individuals with psychosis. However, research in such interventions delivered online is scarce. We evaluated the effectiveness of a digital multicomponent intervention—COPe-support—in improving carers' mental wellbeing and caregiving-related outcomes. Methods In this two-arm, individually randomised, superiority trial, people aged 18 years or older who provided at least weekly support in any format for a relative or close friend affected by psychosis across England were randomly assigned (1:1) to either COPe-support or a passive online information resource using an independent online system. Participants were recruited through 30 mental health UK National Health Service trusts. The study team were masked to allocation and assessment of outcomes as all data collection took place online. Participants had access to either condition for 40 weeks and were advised to spend at least half an hour per week over the initial 20 weeks to go through materials at their own pace and to allow time to integrate knowledge and skills learned into practice. It was not feasible to mask participants or the online facilitator to intervention allocation. COPe-support provided psychoeducation on psychosis-related caregiving strategies and forums with professionals and other carers, and the control intervention comprised a passive online information resource. The primary outcome at 20 weeks was mental wellbeing measured by the Warwick-Edinburgh Mental Wellbeing Scale (WEMWBS; minimally clinically important difference [MCID] 3). This trial is registered with ISRCTN, 89563420. Findings Between March 1, 2018, and Feb 14, 2020, 407 participants were randomly assigned, with 204 allocated to COPe-support and 203 allocated to control. The participants (mean age 53·1 years, SD 13·2) were mostly female (330 [81%] of 407 participants) and White (359 [88%] of 407 participants). 346 (85%) of 407 participants provided primary endpoint data, 174 (85%) of 204 participants in the COPe-support group and 172 (85%) of 203 participants in the control group. The mean WEMWBS score at 20 weeks was 44·5 (SD 8·31) for the COPe-support group and 43·3 (9·19) for the control group. We found no evidence of a difference in wellbeing between the two groups (adjusted mean difference 0·37, 95% CI –1·14 to 1·88; p=0·63). In the COPe-support group, 106 (52%) of 204 participants met the complier definition of a minimum of two logins in separate weeks. The complier average causal effect analysis increased the difference in WEMWBS scores (adjusted difference 0·83, 95% CI –1·45 to 3·11; p=0·47), but this was lower than the MCID. There were no adverse events. Interpretation Our findings did not support the use of COPe-support over a passive online information resource. However, further research to optimise digital interventions adjunctive to face-to-face support for carers remains important

Azithromycin to Reduce Childhood Mortality in Sub-Saharan Africa.

BACKGROUND: We hypothesized that mass distribution of a broad-spectrum antibiotic agent to preschool children would reduce mortality in areas of sub-Saharan Africa that are currently far from meeting the Sustainable Development Goals of the United Nations. METHODS: In this cluster-randomized trial, we assigned communities in Malawi, Niger, and Tanzania to four twice-yearly mass distributions of either oral azithromycin (approximately 20 mg per kilogram of body weight) or placebo. Children 1 to 59 months of age were identified in twice-yearly censuses and were offered participation in the trial. Vital status was determined at subsequent censuses. The primary outcome was aggregate all-cause mortality; country-specific rates were assessed in prespecified subgroup analyses. RESULTS: A total of 1533 communities underwent randomization, 190,238 children were identified in the census at baseline, and 323,302 person-years were monitored. The mean (±SD) azithromycin and placebo coverage over the four twice-yearly distributions was 90.4±10.4%. The overall annual mortality rate was 14.6 deaths per 1000 person-years in communities that received azithromycin (9.1 in Malawi, 22.5 in Niger, and 5.4 in Tanzania) and 16.5 deaths per 1000 person-years in communities that received placebo (9.6 in Malawi, 27.5 in Niger, and 5.5 in Tanzania). Mortality was 13.5% lower overall (95% confidence interval [CI], 6.7 to 19.8) in communities that received azithromycin than in communities that received placebo (P<0.001); the rate was 5.7% lower in Malawi (95% CI, -9.7 to 18.9), 18.1% lower in Niger (95% CI, 10.0 to 25.5), and 3.4% lower in Tanzania (95% CI, -21.2 to 23.0). Children in the age group of 1 to 5 months had the greatest effect from azithromycin (24.9% lower mortality than that with placebo; 95% CI, 10.6 to 37.0). Serious adverse events occurring within a week after administration of the trial drug or placebo were uncommon, and the rate did not differ significantly between the groups. Evaluation of selection for antibiotic resistance is ongoing. CONCLUSIONS: Among postneonatal, preschool children in sub-Saharan Africa, childhood mortality was lower in communities randomly assigned to mass distribution of azithromycin than in those assigned to placebo, with the largest effect seen in Niger. Any implementation of a policy of mass distribution would need to strongly consider the potential effect of such a strategy on antibiotic resistance. (Funded by the Bill and Melinda Gates Foundation; MORDOR ClinicalTrials.gov number, NCT02047981 .)

Constraining the Evolution of Zz Ceti

We report our analysis of the stability of pulsation periods in the DAV star (pulsating hydrogen atmosphere white dwarf) ZZ Ceti, also called R548. On the basis of observations that span 31 years, we conclude that the period 213.13 s observed in ZZ Ceti drifts at a rate dP/dt ≤ (5:5 ± 1:9) x 10-15 s s-1, after correcting for proper motion. Our results are consistent with previous Ṗ values for this mode and an improvement over them because of the larger time base. The characteristic stability timescale implied for the pulsation period is ⎸P / Ṗ ⎸=⎹≥ 1:2 Gyr, comparable to the theoretical cooling timescale for the star. Our current stability limit for the period 213.13 s is only slightly less than the present measurement for another DAV, G117-B15A, for the period 215.2 s, establishing this mode in ZZ Ceti as the second most stable optical clock known, comparable to atomic clocks and more stable than most pulsars. Constraining the cooling rate of ZZ Ceti aids theoretical evolutionary models and white dwarf cosmochronology. The drift rate of this clock is small enough that we can set interesting limits on reflex motion due to planetary companions