The spectrum of paediatric cardiac disease presenting to an outpatient clinic in Malawi

BACKGROUND: As progress is made towards attaining Millennium Development Goal 4, further reductions in paediatric mortality will only be achieved by concentrating on the burden of non-communicable or neglected diseases. The literature relating to paediatric cardiac disease in sub-Saharan Africa is sparse. There are no published descriptions of paediatric cardiac disease from Malawi, making it impossible to estimate the contribution it makes to childhood morbidity and mortality.

FINDINGS: In 2008, a paediatric cardiac clinic with echocardiogram scanning was established in Blantyre, southern Malawi. Between January 2009 and February 2011, the age and cardiac diagnosis of every child with an abnormal echocardiogram was recorded in a database. Of 250 children, 139 (55.6%) had congenital heart disease, and 111 (44.4%) acquired heart disease. Ventricular septal defect (VSD) (24%), Tetralogy of Fallot (10%) and patent ductus arteriousus (7.2%) were the commonest forms of congenital heart disease. Rheumatic heart disease (RHD) (22.4%) and dilated cardiomyopathy (13.6%) were the commonest acquired diseases. The mean age of presentation was 3 years 2 months for VSD and 11 years 6 months for RHD.

CONCLUSIONS: In this cohort of children from one centre in Malawi, acquired heart disease - in particular rheumatic heart disease was almost as common as congenital heart disease. Most presented late. It is likely that untreated cardiac disease causes a large number of childhood deaths in Malawi. In addition to renewing secondary preventative efforts against rheumatic heart disease, adequate and accessible cardiothoracic surgical services should be established at a regional level.

The Rossiter-McLaughlin effect reloaded: Probing the 3D spin-orbit geometry, differential stellar rotation, and the spatially-resolved stellar spectrum of star-planet systems

When a planet transits its host star, it blocks regions of the stellar surface from view; this causes a distortion of the spectral lines and a change in the line-of-sight (LOS) velocities, known as the Rossiter-McLaughlin (RM) effect. Since the LOS velocities depend, in part, on the stellar rotation, the RM waveform is sensitive to the star-planet alignment (which provides information on the system’s dynamical history). We present a new RM modelling technique that directly measures the spatially-resolved stellar spectrum behind the planet. This is done by scaling the continuum flux of the (HARPS) spectra by the transit light curve, and then subtracting the infrom the out-of-transit spectra to isolate the starlight behind the planet. This technique does not assume any shape for the intrinsic local profiles. In it, we also allow for differential stellar rotation and centre-to-limb variations in the convective blueshift. We apply this technique to HD 189733 and compare to 3D magnetohydrodynamic (MHD) simulations. We reject rigid body rotation with high confidence (>99% probability), which allows us to determine the occulted stellar latitudes and measure the stellar inclination. In turn, we determine both the sky-projected (λ ≈ −0.4 ± 0.2◦) and true 3D obliquity (ψ ≈ 7+12 −4 ◦ ). We also find good agreement with the MHD simulations, with no significant centre-to-limb variations detectable in the local profiles. Hence, this technique provides a new powerful tool that can probe stellar photospheres, differential rotation, determine 3D obliquities, and remove sky-projection biases in planet migration theories. This technique can be implemented with existing instrumentation, but will become even more powerful with the next generation of high-precision radial velocity spectrographs.

Investigating the Implications of a Variable RBE on Proton Dose Fractionation Across a Clinical Pencil Beam Scanned Spread-Out Bragg Peak

Purpose: To investigate the clinical implications of a variable relative biological effectiveness (RBE) on proton dose fractionation. Using acute exposures, the current clinical adoption of a generic, constant cell killing RBE has been shown to underestimate the effect of the sharp increase in linear energy transfer (LET) in the distal regions of the spread-out Bragg peak (SOBP). However, experimental data for the impact of dose fractionation in such scenarios are still limited.

Methods and Materials: Human fibroblasts (AG01522) at 4 key depth positions on a clinical SOBP of maximum energy 219.65 MeV were subjected to various fractionation regimens with an interfraction period of 24 hours at Proton Therapy Center in Prague, Czech Republic. Cell killing RBE variations were measured using standard clonogenic assays and were further validated using Monte Carlo simulations and parameterized using a linear quadratic formalism.

Results: Significant variations in the cell killing RBE for fractionated exposures along the proton dose profile were observed. RBE increased sharply toward the distal position, corresponding to a reduction in cell sparing effectiveness of fractionated proton exposures at higher LET. The effect was more pronounced at smaller doses per fraction. Experimental survival fractions were adequately predicted using a linear quadratic formalism assuming full repair between fractions. Data were also used to validate a parameterized variable RBE model based on linear α parameter response with LET that showed considerable deviations from clinically predicted isoeffective fractionation regimens.

Conclusions: The RBE-weighted absorbed dose calculated using the clinically adopted generic RBE of 1.1 significantly underestimates the biological effective dose from variable RBE, particularly in fractionation regimens with low doses per fraction. Coupled with an increase in effective range in fractionated exposures, our study provides an RBE dataset that can be used by the modeling community for the optimization of fractionated proton therapy.

Threshold Optimization for Energy Detection-Based Spectrum Sensing Over Hyper-Rayleigh Fading Channels

Spectrum sensing is a key function of cognitive radio systems. Sensing performance is determined by three main factors including the wireless channel between the primary system and the cognitive radio nodes, the detection threshold, and the sensing time. In this letter a closed-form expression for the average probability of detection for energy detection based spectrum sensing over two-wave with diffuse power fading channels is derived. This expression is then used to optimize the detection threshold for cognitive radio nodes, which operate in confined structures that exhibit worse than Rayleigh fading conditions. Such fading conditions can represent a behavioral model of cognitive machine-to-machine systems deployed in enclosed structures such as in-vehicular environments.

Energy Detection based Spectrum Sensing over Two-wave with Diffuse Power Fading Channels

One of the most important factors that affects the performance of energy detection (ED) is the fading channel between the wireless nodes. This article investigates the performance of ED-based spectrum sensing, for cognitive radio (CR), over two-wave with diffuse power (TWDP) fading channels. The TWDP fading model characterizes a variety of fading channels, including well-known canonical fading distributions, such as Rayleigh and Rician, as well as worse than Rayleigh fading conditions modeled by the two-ray fading model. Novel analytic expressions for the average probability of detection over TWDP fading that account for single-user and cooperative spectrum sensing as well as square law selection diversity reception are derived. These expressions are used to analyze the behavior of ED-based spectrum sensing over moderate, severe and extreme fading conditions, and to investigate the use of cooperation and diversity as a means of mitigating the fading effects. Our results indicate that TWDP fading conditions can significantly degrade the sensing performance; however, it is shown that detection performance can be improved when cooperation and diversity are employed. The presented outcomes enable us to identify the limits of ED-based spectrum sensing and quantify the trade-offs between detection performance and energy efficiency for cognitive radio systems deployed within confined environments such as in-vehicular wireless networks.

An HMM-based spectrum occupancy predictor for energy efficient cognitive radio

Spectrum sensing is the cornerstone of cognitive radio technology and refers to the process of obtaining awareness of the radio spectrum usage in order to detect the presence of other users. Spectrum sensing algorithms consume considerable energy and time. Prediction methods for inferring the channel occupancy of future time instants have been proposed as a means of improving performance in terms of energy and time consumption. This paper studies the performance of a hidden Markov model (HMM) spectrum occupancy predictor as well as the improvement in sensing energy and time consumption based on real occupancy data obtained in the 2.4GHz ISM band. Experimental results show that the HMM-based occupancy predictor outperforms a kth order Markov and a 1-nearest neighbour (1NN) predictor. Our study also suggests that by employing such a predictive scheme in spectrum sensing, an improvement of up to 66% can be achieved in the required sensing energy and time.

Applied behaviour analysis: What do teachers of students with autism spectrum disorder know

With rising numbers of school-aged children with autism educated in mainstream classrooms and applied behaviour analysis (ABA) considered the basis of best practice, teachers’ knowledge in this field has become a key concern for inclusion. Self-reported knowledge of ABA of special needs teachers (n=165) was measured and compared to their actual knowledge of ABA demonstrated in accurate responses to a multiple-choice test. Findings reported here show that teachers’ self-perceived knowledge exceeded actual knowledge and that actual knowledge of ABA was not related to training received by government agency. Implications for teacher training are discussed.

Systematic review of tools to measure outcomes for young children with autism spectrum disorder

BACKGROUND: The needs of children with autism spectrum disorder (ASD) are complex and this is reflected in the number and diversity of outcomes assessed and measurement tools used to collect evidence about children's progress. Relevant outcomes include improvement in core ASD impairments, such as communication, social awareness, sensory sensitivities and repetitiveness; skills such as social functioning and play; participation outcomes such as social inclusion; and parent and family impact.

OBJECTIVES: To examine the measurement properties of tools used to measure progress and outcomes in children with ASD up to the age of 6 years. To identify outcome areas regarded as important by people with ASD and parents.

METHODS: The MeASURe (Measurement in Autism Spectrum disorder Under Review) research collaboration included ASD experts and review methodologists. We undertook systematic review of tools used in ASD early intervention and observational studies from 1992 to 2013; systematic review, using the COSMIN checklist (Consensus-based Standards for the selection of health Measurement Instruments) of papers addressing the measurement properties of identified tools in children with ASD; and synthesis of evidence and gaps. The review design and process was informed throughout by consultation with stakeholders including parents, young people with ASD, clinicians and researchers.

RESULTS: The conceptual framework developed for the review was drawn from the International Classification of Functioning, Disability and Health, including the domains 'Impairments', 'Activity Level Indicators', 'Participation', and 'Family Measures'. In review 1, 10,154 papers were sifted - 3091 by full text - and data extracted from 184; in total, 131 tools were identified, excluding observational coding, study-specific measures and those not in English. In review 2, 2665 papers were sifted and data concerning measurement properties of 57 (43%) tools were extracted from 128 papers. Evidence for the measurement properties of the reviewed tools was combined with information about their accessibility and presentation. Twelve tools were identified as having the strongest supporting evidence, the majority measuring autism characteristics and problem behaviour. The patchy evidence and limited scope of outcomes measured mean these tools do not constitute a 'recommended battery' for use. In particular, there is little evidence that the identified tools would be good at detecting change in intervention studies. The obvious gaps in available outcome measurement include well-being and participation outcomes for children, and family quality-of-life outcomes, domains particularly valued by our informants (young people with ASD and parents).

CONCLUSIONS: This is the first systematic review of the quality and appropriateness of tools designed to monitor progress and outcomes of young children with ASD. Although it was not possible to recommend fully robust tools at this stage, the review consolidates what is known about the field and will act as a benchmark for future developments. With input from parents and other stakeholders, recommendations are made about priority targets for research.

FUTURE WORK: Priorities include development of a tool to measure child quality of life in ASD, and validation of a potential primary outcome tool for trials of early social communication intervention.

STUDY REGISTRATION: This study is registered as PROSPERO CRD42012002223.

FUNDING: The National Institute for Health Research Health Technology Assessment programme.

Occurrence of the pinewood nematode, Bursaphelenchus xylophilus in Portugal and perspectives of the disease spread in Europe.

In 1999, the pinewood nematode (PWN) , Bursaphelenchus xylophilus was found and identified for the first time in Portugal and in Europe. Following detection, Portuguese authorities initiated the implementation of eradication measures during 1999 and 2000, following an alert provided to European Community officials; as a result, the nematode was confirmed to be confined in the Setúbal region, near Lisbon. A task force from the follow-up group (GANP) created by the Secretary of State for the Rural Development established a national eradication programme (PROLUNP) to (1) Contain PWN within the initial geographic limits; (2) Implement eradication measures; and (3) Monitor PWN at a national level. Research is presently being conducted both at universities as well as research institutes, focusing on the characterization ofBursaphelenchus species associated with maritime pine, as well as on the insect vector, Monochamus galloprovincialis. Recent reports indicate that the nematode may be present in Siberia (Russia), which would present a threat to Eastern European forestry. Efforts are presently being developed by several European countries to establish a research consortium to detect and study the possible presence of PWN, for a new PRAs. A recent workshop held in Portugal, in 2001, has been an oportunity for sharing experiences and techniques on detection and control. There is clearly a greater awareness of this issue in Europe.

Clinopyroxene based glasses and glass-ceramics for functional applications

As piroxenas são um vasto grupo de silicatos minerais encontrados em muitas rochas ígneas e metamórficas. Na sua forma mais simples, estes silicatos são constituídas por cadeias de SiO3 ligando grupos tetrahédricos de SiO4. A fórmula química geral das piroxenas é M2M1T2O6, onde M2 se refere a catiões geralmente em uma coordenação octaédrica distorcida (Mg2+, Fe2+, Mn2+, Li+, Ca2+, Na+), M1 refere-se a catiões numa coordenação octaédrica regular (Al3+, Fe3+, Ti4+, Cr3+, V3+, Ti3+, Zr4+, Sc3+, Zn2+, Mg2+, Fe2+, Mn2+), e T a catiões em coordenação tetrahédrica (Si4+, Al3+, Fe3+). As piroxenas com estrutura monoclínica são designadas de clinopiroxenes. A estabilidade das clinopyroxenes num espectro de composições químicas amplo, em conjugação com a possibilidade de ajustar as suas propriedades físicas e químicas e a durabilidade química, têm gerado um interesse mundial devido a suas aplicações em ciência e tecnologia de materiais. Este trabalho trata do desenvolvimento de vidros e de vitro-cerâmicos baseadas de clinopiroxenas para aplicações funcionais. O estudo teve objectivos científicos e tecnológicos; nomeadamente, adquirir conhecimentos fundamentais sobre a formação de fases cristalinas e soluções sólidas em determinados sistemas vitro-cerâmicos, e avaliar a viabilidade de aplicação dos novos materiais em diferentes áreas tecnológicas, com especial ênfase sobre a selagem em células de combustível de óxido sólido (SOFC). Com este intuito, prepararam-se vários vidros e materiais vitro-cerâmicos ao longo das juntas Enstatite (MgSiO3) - diopsídio (CaMgSi2O6) e diopsídio (CaMgSi2O6) - Ca - Tschermak (CaAlSi2O6), os quais foram caracterizados através de um vasto leque de técnicas. Todos os vidros foram preparados por fusão-arrefecimento enquanto os vitro-cerâmicos foram obtidos quer por sinterização e cristalização de fritas, quer por nucleação e cristalização de vidros monolíticos. Estudaram-se ainda os efeitos de várias substituições iónicas em composições de diopsídio contendo Al na estrutura, sinterização e no comportamento durante a cristalização de vidros e nas propriedades dos materiais vitro-cerâmicos, com relevância para a sua aplicação como selantes em SOFC. Verificou-se que Foi observado que os vidros/vitro-cerâmicos à base de enstatite não apresentavam as características necessárias para serem usados como materiais selantes em SOFC, enquanto as melhores propriedades apresentadas pelos vitro-cerâmicos à base de diopsídio qualificaram-nos para futuros estudos neste tipo de aplicações. Para além de investigar a adequação dos vitro-cerâmicos à base de clinopyroxene como selantes, esta tese tem também como objetivo estudar a influência dos agentes de nucleação na nucleação em volume dos vitro-cerâmicos resultantes á base de diopsídio, de modo a qualificá-los como potenciais materiais hopedeiros de resíduos nucleares radioactivos.

An extensible complex fast Fourier transform processor chip for real-time spectrum analysis and measurement

This paper describes in detail the design of a CMOS custom fast Fourier transform (FFT) processor for computing a 256-point complex FFT. The FFT is well-suited for real-time spectrum analysis in instrumentation and measurement applications. The FFT butterfly processor reported here consists of one parallel-parallel multiplier and two adders. It is capable of computing one butterfly computation every 100 ns thus it can compute a 256-point complex FFT in 102.4 μs excluding data input and output processes.

An integrated 256-point complex FFT processor for real-time spectrum analysis and measurement

This paper describes in detail the design of a custom CMOS Fast Fourier Transform (FFT) processor for computing 256-point complex FFT. The FFT is well suited for real-time spectrum analysis in instrumentation and measurement applications. The FFT butterfly processor consists of one parallel-parallel multiplier and two adders. It is capable of computing one butterfly computation every 100 ns thus it can compute 256-complex point FFT in 25.6 μs excluding data input and output processes.

Spectrum of Somatic Hypermutations and Implication on Antibody Function: Case of the anti HIV-1 antibody, b12

Thesis (Ph.D.)--University of Washington, 2015