A latent trait approach to measuring HIV/AIDS related stigma in healthcare professionals: application of mokken scaling technique

The attitudes of healthcare professionals towards HIV positive patients and high risk groups are central to the quality of care and therefore to the management of HIV/AIDS related stigma in health settings. Extant HIV/AIDS stigma scales that measure stigmatising attitudes towards people living with HIV/AIDS have been developed using scaling techniques such as principal component analysis. This approach has resulted in instruments that are often long. Mokken scale analysis is a nonparametric hierarchical scaling technique that can be used to develop unidimensional cumulative scales. This technique is advantageous over the other approaches; as the scales are usually shorter, while retaining acceptable psychometric properties. Moreover, Mokken scales also make no distributional assumptions about the underlying data, other than that the data are capable of being ordered by item and by person. In this study we aimed at developing a precise and concise measure of HIV/AIDS related stigma among health care professionals, using Mokken scale analysis

Chromatic periodic activity down to 120 MHz in a Fast Radio Burst

Fast radio bursts (FRBs) are extragalactic astrophysical transients whose brightness requires emitters that are highly energetic, yet compact enough to produce the short, millisecond-duration bursts. FRBs have thus far been detected between 300 MHz and 8 GHz, but lower-frequency emission has remained elusive. A subset of FRBs is known to repeat, and one of those sources, FRB 20180916B, does so with a 16.3 day activity period. Using simultaneous Apertif and LOFAR data, we show that FRB 20180916B emits down to 120 MHz, and that its activity window is both narrower and earlier at higher frequencies. Binary wind interaction models predict a narrower periodic activity window at lower frequencies, which is the opposite of our observations. Our detections establish that low-frequency FRB emission can escape the local medium. For bursts of the same fluence, FRB 20180916B is more active below 200 MHz than at 1.4 GHz. Combining our results with previous upper-limits on the all-sky FRB rate at 150 MHz, we find that there are 3-450 FRBs/sky/day above 50 Jy ms at 90% confidence. We are able to rule out the scenario in which companion winds cause FRB periodicity. We also demonstrate that some FRBs live in clean environments that do not absorb or scatter low-frequency radiation.Comment: 50 pages, 14 figures, 3 tables, submitte

A novel nonparametric item response theory approach to measuring socioeconomic position: a comparison using household expenditure data from a Vietnam health survey, 2003

BACKGROUND: Measures of household socio-economic position (SEP) are widely used in health research. There exist a number of approaches to their measurement, with Principal Components Analysis (PCA) applied to a basket of household assets being one of the most common. PCA, however, carries a number of assumptions about the distribution of the data which may be untenable, and alternative, non-parametric, approaches may be preferred. Mokken scale analysis is a non-parametric, item response theory approach to scale development which appears never to have been applied to household asset data. A Mokken scale can be used to rank order items (measures of wealth) as well as households. Using data on household asset ownership from a national sample of 4,154 consenting households in the World Health Survey from Vietnam, 2003, we construct two measures of household SEP. Seventeen items asking about assets, and utility and infrastructure use were used. Mokken Scaling and PCA were applied to the data. A single item measure of total household expenditure is used as a point of contrast. RESULTS: An 11 item scale, out of the 17 items, was identified that conformed to the assumptions of a Mokken Scale. All the items in the scale were identified as strong items (Hi > .5). Two PCA measures of SEP were developed as a point of contrast. One PCA measure was developed using all 17 available asset items, the other used the reduced set of 11 items identified in the Mokken scale analaysis. The Mokken Scale measure of SEP and the 17 item PCA measure had a very high correlation (r = .98), and they both correlated moderately with total household expenditure: r = .59 and r = .57 respectively. In contrast the 11 item PCA measure correlated moderately with the Mokken scale (r = .68), and weakly with the total household expenditure (r = .18). CONCLUSION: The Mokken scale measure of household SEP performed at least as well as PCA, and outperformed the PCA measure developed with the 11 items used in the Mokken scale. Unlike PCA, Mokken scaling carries no assumptions about the underlying shape of the distribution of the data, and can be used simultaneous to order household SEP and items. The approach, however, has not been tested with data from other countries and remains an interesting, but under researched approach

The Rotterdam Study: 2012 objectives and design update

The Rotterdam Study is a prospective cohort study ongoing since 1990 in the city of Rotterdam in The Netherlands. The study targets cardiovascular, endocrine, hepatic, neurological, ophthalmic, psychiatric, dermatological, oncological, and respiratory diseases. As of 2008, 14,926 subjects aged 45 years or over comprise the Rotterdam Study cohort. The findings of the Rotterdam Study have been presented in over a 1,000 research articles and reports (see www.erasmus-epidemiology.nl/rotterdamstudy). This article gives the rationale of the study and its design. It also presents a summary of the major findings and an update of the objectives and methods

A fast radio burst with submillisecond quasi-periodic structure

Fast radio bursts (FRBs) are extragalactic radio transients of extraordinary luminosity. Studying the diverse temporal and spectral behaviour recently observed in a number of FRBs may help to determine the nature of the entire class. For example, a fast spinning or highly magnetised neutron star (NS) might generate the rotation-powered acceleration required to explain the bright emission. Periodic, subsecond components suggesting such rotation were recently reported in one FRB, and may also exist in two more. Here we report the discovery of FRB 20201020A with Apertif, an FRB that shows five components regularly spaced by 0.411 ms. This submillisecond structure in FRB 20201020A carries important clues about the progenitor of this FRB specifically, and potentially about the progenitors of FRBs in general. We therefore contrast its features to what is seen in other FRBs and pulsars, and to the predictions of some FRB models. We present a timing analysis of the FRB 20201020A components carried out in order to determine the significance of the periodicity. We compare these against the timing properties of the previously reported CHIME FRBs with subsecond quasi-periodic components, and against two Apertif bursts from repeating FRB 20180916B, which show complex time-frequency structure. We find the periodicity of FRB 20201020A to be marginally significant at 2.4σ. Its repeating subcomponents cannot be explained as pulsar rotation because the required spin rate of over 2 kHz exceeds the limits set by typical NS equations of state and observations. The fast periodicity is also in conflict with a compact object merger scenario. However, these quasi-periodic components could be caused by equidistant emitting regions in the magnetosphere of a magnetar. The submillisecond spacing of the components in FRB 20201020A, the smallest observed so far in a one-off FRB, may rule out both a NS spin period and binary mergers as the direct source of quasi-periodic FRB structure

The Apertif Radio Transient System (ARTS): Design, commissioning, data release, and detection of the first five fast radio bursts

Fast radio bursts (FRBs) must be powered by uniquely energetic emission mechanisms. This requirement has eliminated a number of possible source types, but several remain. Identifying the physical nature of FRB emitters arguably requires good localisation of more detections, as well as broad-band studies enabled by real-time alerting. In this paper, we present the Apertif Radio Transient System (ARTS), a supercomputing radio-telescope instrument that performs real-time FRB detection and localisation on the Westerbork Synthesis Radio Telescope (WSRT) interferometer. It reaches coherent-addition sensitivity over the entire field of the view of the primary-dish beam. After commissioning results verified that the system performed as planned, we initiated the Apertif FRB survey (ALERT). Over the first 5 weeks we observed at design sensitivity in 2019, we detected five new FRBs, and interferometrically localised each of them to 0.4–10 sq. arcmin. All detections are broad band, very narrow, of the order of 1 ms in duration, and unscattered. Dispersion measures are generally high. Only through the very high time and frequency resolution of ARTS are these hard-to-find FRBs detected, producing an unbiased view of the intrinsic population properties. Most localisation regions are small enough to rule out the presence of associated persistent radio sources. Three FRBs cut through the halos of M31 and M33. We demonstrate that Apertif can localise one-off FRBs with an accuracy that maps magneto-ionic material along well-defined lines of sight. The rate of one every ~7 days ensures a considerable number of new sources are detected for such a study. The combination of the detection rate and localisation accuracy exemplified by the first five ARTS FRBs thus marks a new phase in which a growing number of bursts can be used to probe our Universe

Early Management of Patients With Acute Heart Failure: State of the Art and Future Directions. A Consensus Document From the Society for Academic Emergency Medicine/Heart Failure Society of America Acute Heart Failure Working Group

Heart failure (HF) afflicts nearly 6 million Americans, resulting in one million emergency department (ED) visits and over one million annual hospital discharges. An aging population and improved survival from cardiovascular diseases is expected to further increase HF prevalence. Emergency providers play a significant role in the management of patients with acute heart failure (AHF). It is crucial that emergency physicians and other providers involved in early management understand the latest developments in diagnostic testing, therapeutics and alternatives to hospitalization. Further, clinical trials must be conducted in the ED in order to improve the evidence base and drive optimal initial therapy for AHF. Should ongoing and future studies suggest early phenotype-driven therapy improves in-hospital and post-discharge outcomes, ED treatment decisions will need to evolve accordingly. The potential impact of future studies which incorporate risk-stratification into ED disposition decisions cannot be underestimated. Predictive instruments that identify a cohort of patients safe for ED discharge, while simultaneously addressing barriers to successful outpatient management, have the potential to significantly impact quality of life and resource expenditures