External validation of the RISC, RISC-Malawi, and PERCH clinical prediction rules to identify risk of death in children hospitalized with pneumonia

BACKGROUND: Existing scores to identify children at risk of hospitalized pneumonia-related mortality lack broad external validation. Our objective was to externally validate three such risk scores. METHODS: We applied the Respiratory Index of Severity in Children (RISC) for HIV-negative children, the RISC-Malawi, and the Pneumonia Etiology Research for Child Health (PERCH) scores to hospitalized children in the Pneumonia REsearch Partnerships to Assess WHO REcommendations (PREPARE) data set. The PREPARE data set includes pooled data from 41 studies on pediatric pneumonia from across the world. We calculated test characteristics and the area under the curve (AUC) for each of these clinical prediction rules. RESULTS: The RISC score for HIV-negative children was applied to 3574 children 0-24 months and demonstrated poor discriminatory ability (AUC = 0.66, 95% confidence interval (CI) = 0.58-0.73) in the identification of children at risk of hospitalized pneumonia-related mortality. The RISC-Malawi score had fair discriminatory value (AUC = 0.75, 95% CI = 0.74-0.77) among 17 864 children 2-59 months. The PERCH score was applied to 732 children 1-59 months and also demonstrated poor discriminatory value (AUC = 0.55, 95% CI = 0.37-0.73). CONCLUSIONS: In a large external application of the RISC, RISC-Malawi, and PERCH scores, a substantial number of children were misclassified for their risk of hospitalized pneumonia-related mortality. Although pneumonia risk scores have performed well among the cohorts in which they were derived, their performance diminished when externally applied. A generalizable risk assessment tool with higher sensitivity and specificity to identify children at risk of hospitalized pneumonia-related mortality may be needed. Such a generalizable risk assessment tool would need context-specific validation prior to implementation in that setting

A Search for Photons with Energies Above 2 × 1017^{17} eV Using Hybrid Data from the Low-Energy Extensions of the Pierre Auger Observatory

Ultra-high-energy photons with energies exceeding 10$^{17}$ eV offer a wealth of connections to different aspects of cosmic-ray astrophysics as well as to gamma-ray and neutrino astronomy. The recent observations of photons with energies in the 10$^{15}$ eV range further motivate searches for even higher-energy photons. In this paper, we present a search for photons with energies exceeding 2 × 10$^{17}$ eV using about 5.5 yr of hybrid data from the low-energy extensions of the Pierre Auger Observatory. The upper limits on the integral photon flux derived here are the most stringent ones to date in the energy region between 10$^{17}$ and 10$^{18}$ eV

A Search for Photons with Energies above 2 × 1017eV Using Hybrid Data from the Low-Energy Extensions of the Pierre Auger Observatory

Ultra-high-energy photons with energies exceeding 1017 eV offer a wealth of connections to different aspects of cosmic-ray astrophysics as well as to gamma-ray and neutrino astronomy. The recent observations of photons with energies in the 1015 eV range further motivate searches for even higher-energy photons. In this paper, we present a search for photons with energies exceeding 2 × 1017 eV using about 5.5 yr of hybrid data from the low-energy extensions of the Pierre Auger Observatory. The upper limits on the integral photon flux derived here are the most stringent ones to date in the energy region between 1017 and 1018 eV

Cosmological implications of photon-flux upper limits at ultra-high energies in scenarios of Planckian-interacting massive particles for dark matter

We present a thorough search for signatures that would be suggestive of super-heavy $X$ particles decaying in the Galactic halo, in the data of the Pierre Auger Observatory. From the lack of signal, we derive upper limits for different energy thresholds above ${\gtrsim}10^8$\,GeV on the expected secondary by-product fluxes from $X$-particle decay. Assuming that the energy density of these super-heavy particles matches that of dark matter observed today, we translate the upper bounds on the particle fluxes into tight constraints on the couplings governing the decay process as a function of the particle mass. We show that instanton-induced decay processes allow us to derive a bound on the reduced coupling constant of gauge interactions in the dark sector: \alpha_X \alt 0.09, for 10^{9} \alt M_X/\text{GeV} < 10^{19}. This upper limit on $\alpha_X$ is complementary to the non-observation of tensor modes in the cosmic microwave background in the context of Planckian-interacting massive particles for dark matter produced during the reheating epoch. Viable regions for this scenario to explain dark matter are delineated in several planes of the multidimensional parameter space that involves, in addition to $M_X$ and $\alpha_X$, the Hubble rate at the end of inflation, the reheating efficiency, and the non-minimal coupling of the Higgs with curvature.Comment: 15 pages, 8 figures, Accompanying paper of arXiv:2203.0885

Searches for Ultra-High-Energy Photons at the Pierre Auger Observatory

The Pierre Auger Observatory, being the largest air-shower experiment in the world, offers an unprecedented exposure to neutral particles at the highest energies. Since the start of data taking more than 18 years ago, various searches for ultra-high-energy (UHE, $E\gtrsim10^{17}\,\text{eV}$) photons have been performed: either for a diffuse flux of UHE photons, for point sources of UHE photons or for UHE photons associated with transient events like gravitational wave events. In the present paper, we summarize these searches and review the current results obtained using the wealth of data collected by the Pierre Auger Observatory.Comment: Review article accepted for publication in Universe (special issue on ultra-high energy photons

Arrival Directions of Cosmic Rays above 32 EeV from Phase One of the Pierre Auger Observatory

A promising energy range to look for angular correlations between cosmic rays of extragalactic origin and their sources is at the highest energies, above a few tens of EeV (1 EeV ≡ 10¹⁸ eV). Despite the flux of these particles being extremely low, the area of ∼3000 km² covered at the Pierre Auger Observatory, and the 17 yr data-taking period of the Phase 1 of its operations, have enabled us to measure the arrival directions of more than 2600 ultra-high-energy cosmic rays above 32 EeV. We publish this data set, the largest available at such energies from an integrated exposure of 122,000 km² sr yr, and search it for anisotropies over the 3.4π steradians covered with the Observatory. Evidence for a deviation in excess of isotropy at intermediate angular scales, with ∼15° Gaussian spread or ∼25° top-hat radius, is obtained at the 4σ significance level for cosmic-ray energies above ∼40 EeV

A Catalog of the Highest-energy Cosmic Rays Recorded during Phase I of Operation of the Pierre Auger Observatory

A catalog containing details of the highest-energy cosmic rays recorded through the detection of extensive air-showers at the Pierre Auger Observatory is presented with the aim of opening the data to detailed examination. Descriptions of the 100 showers created by the highest-energy particles recorded between 1 January 2004 and 31 December 2020 are given for cosmic rays that have energies in the range 78 EeV to 166 EeV. Details are also given of a further nine very-energetic events that have been used in the calibration procedure adopted to determine the energy of each primary. A sky plot of the arrival directions of the most energetic particles is shown. No interpretations of the data are offered

A Search for Photons with Energies Above 2X10(17) eV Using Hybrid Data from the Low-Energy Extensions of the Pierre Auger Observatory

Ultra-high-energy photons with energies exceeding 10(17) eV offer a wealth of connections to different aspects of cosmic-ray astrophysics as well as to gamma-ray and neutrino astronomy. The recent observations of photons with energies in the 10(15) eV range further motivate searches for even higher-energy photons. In this paper, we present a search for photons with energies exceeding 2 x 10(17) eV using about 5.5 yr of hybrid data from the low-energy extensions of the Pierre Auger Observatory. The upper limits on the integral photon flux derived here are the most stringent ones to date in the energy region between 10(17) and 10(18) eV