The present study aimed to determine the 6-month incidence of relapse and associated factors among children who recovered from acute malnutrition (AM) following mid-upper arm circumference ...(MUAC)-based simplified combined treatment using the ComPAS protocol. A prospective cohort of 420 children who had reached a MUAC ≥ 125 mm for two consecutive measures was monitored between December 2020 and October 2021. Children were seen at home fortnightly for 6 months. The overall 6-month cumulative incidence of relapse 95%CI into MUAC < 125 mm and/or edema was 26.1% 21.7; 30.8 and 1.7% 0.6; 3.6 to MUAC < 115 mm and/or edema. Relapse was similar among children initially admitted to treatment with a MUAC < 115 mm and/or oedema and among those with a MUAC ≥ 115 mm but <125 mm. Relapse was predicted by lower anthropometry both at admission to and discharge from treatment, and a higher number of illness episodes per month of follow-up. Having a vaccination card, using an improved water source, having agriculture as the main source of income, and increases in caregiver workload during follow-up all protected from relapse. Children discharged as recovered from AM remain at risk of relapsing into AM. To achieve reduction in relapse, recovery criteria may need to be revised and post-discharge strategies tested.
Severe acute malnutrition (SAM) is treated with ready-to-use therapeutic foods (RUTF) containing a vitamin–mineral premix. Yet little is known about micronutrient status in children with SAM before ...and after treatment. We aimed to investigate vitamin B12 status in children with uncomplicated SAM, aged 6–59 months in Burkina Faso, before and after treatment with a standard or a reduced dose of RUTF. Blood samples were collected at admission and discharge. Serum B12 was determined with microbiological assay and serum methylmalonic acid (MMA) and total homocysteine (tHcy) were analyzed with gas chromatography-tandem mass spectrometry. B12 status was classified using the combined indicator (3cB12). Among 374 children, the median interquartile range age was 11.0 7.7–16.9 months, and 85.8% were breastfed. Marked or severe B12 deficiency, as judged by 3cB12, decreased from 32% to 9% between admission and discharge (p < 0.05). No differences in B12 status following treatment with either standard (n = 194) or reduced (n = 180) doses of RUTF were observed. Breastfed children showed a lower B12 status (3cB12) than non-breastfed ones (−1.10 vs −0.18, p < 0.001 at admission; −0.44 vs 0.19; p < 0.001 at discharge). In conclusion, treatment of SAM with RUTF improved children’s B12 status but did not fully correct B12 deficiency.
A simplified, combined protocol was created that admits children with a mid-upper-arm circumference (MUAC) of <125 mm or edema to malnutrition treatment with ready-to-use therapeutic food (RUTF) that ...involves prescribing two daily RUTF sachets to children with MUAC < 115 mm or edema and one daily sachet to those with 115 mm ≤ MUAC < 125 mm. This treatment was previously shown to result in non-inferior programmatic outcomes compared with standard treatment. We aimed at observing its effectiveness in a routine setting at scale, including via delivery by community health workers (CHWs). A total of 27,800 children were admitted to the simplified, combined treatment. Treatment resulted in a 92% overall recovery, with a mean length of stay of 40 days and a mean RUTF consumption of 62 sachets per child treated. Among children admitted with MUAC < 115 mm or edema, 87% recovered with a mean length of stay of 55 days and consuming an average of 96 RUTF sachets. The recovery in all sub-groups studied exceeded 85%. Treatment by CHWs resulted in a similar (94%) recovery to treatment by formal healthcare workers (92%). The simplified, combined protocol resulted in high recovery and low RUTF consumption per child treated and can safely be adopted by CHWs to provide treatment at the community level.
We studied the spatial correlations between the Hα emission and different types of massive stars in two local galaxies, the Large Magellanic Cloud (LMC) and Messier 33. We compared these to ...correlations derived for core-collapse supernovae (CCSNe) in the literature to connect CCSNe of different types with the initial masses of their progenitors and to test the validity of progenitor mass estimates which use the pixel statistics method. We obtained samples of evolved massive stars in both galaxies from catalogues with good spatial coverage and/or completeness, and combined them with coordinates of main-sequence stars in the LMC from the SIMBAD database. We calculated the spatial correlation of stars of different classes and spectral types with Hα emission. We also investigated the effects of distance, noise and positional errors on the pixel statistics method. A higher correlation with Hα emission is found to correspond to a shorter stellar lifespan, and we conclude that the method can be used as an indicator of the ages, and therefore initial masses, of SN progenitors. We find that the spatial distributions of type II-P SNe and red supergiants of appropriate initial mass (≳9 M⊙) are consistent with each other. We also find the distributions of type Ic SNe and WN stars with initial masses ≳20 M⊙ consistent, while supergiants with initial masses around 15 M⊙ are a better match for type IIb and II-L SNe. The type Ib distribution corresponds to the same stellar types as type II-P, which suggests an origin in interacting binaries. On the other hand, we find that luminous blue variable stars show a much stronger correlation with Hα emission than do type IIn SNe.
We report photometric and spectroscopic observations of the optical transient LSQ13zm. Historical data reveal the presence of an eruptive episode (that we label as ‘2013a’) followed by a much ...brighter outburst (‘2013b’) three weeks later, that we argue to be the genuine supernova explosion. This sequence of events closely resemble those observed for SN 2010mc and (in 2012) SN 2009ip. The absolute magnitude reached by LSQ13zm during 2013a (MR
= −14.87 ± 0.25 mag) is comparable with those of supernova impostors, while that of the 2013b event (MR
= −18.46 ± 0.21 mag) is consistent with those of interacting supernovae. Our spectra reveal the presence of a dense and structured circumstellar medium, probably produced through numerous pre-supernova mass-loss events. In addition, we find evidence for high-velocity ejecta, with a fraction of gas expelled at more than 20 000 km s−1. The spectra of LSQ13zm show remarkable similarity with those of well-studied core-collapse supernovae. From the analysis of the available photometric and spectroscopic data, we conclude that we first observed the last event of an eruptive sequence from a massive star, likely a Luminous Blue Variable, which a short time later exploded as a core-collapse supernova. The detailed analysis of archival images suggest that the host galaxy is a star-forming Blue Dwarf Compact Galaxy.
Nutritional treatment of children with uncomplicated severe acute malnutrition (SAM) is based on ready‐to‐use therapeutic foods (RUTF). With treatment provided at community level, children could have ...access to other foods, and a reduction in the dose of RUTF could further increase dietary diversity during treatment. We assessed the dietary diversity score (DDS), the minimum dietary diversity (MDD), the minimum meal frequency (MMF) and the minimum acceptable diet (MAD) of 459 infants and young children aged 6–23 months being treated for SAM with different doses of RUTF. We also investigated the factors associated with DDS. Dietary intake was estimated using a single 24‐h multipass dietary recall, 1 month after starting treatment, from December 2016 to August 2018. The DDS was calculated on the basis of eight food groups. Differences between children receiving the reduced RUTF and the standard RUTF dose and factors associated with DDS were assessed by Poisson and logistic regression models. RUTF dose was not associated with DDS (4.07 ± 1.25 for reduced RUTF and 4.01 ± 1.26 for standard RUTF; P = 0.77). Food groups most consumed by children were grains, roots or tubers (96%) and legumes and nuts (72%). Eggs consumption was low (3%). DDS was positively associated with child's age, mother's education, household wealth index, urban residence and rainy season. The present findings show that children with SAM consumed a variety of foods during treatment in addition to the RUTF ration prescribed to them. Reducing the dose of RUTF during SAM treatment did not impact DDS.
We present the complete set of ultra-violet, optical and near-infrared photometry and spectroscopy for SN 2012ca, covering the period from 6 d prior to maximum light, until 531 d after maximum. The ...spectroscopic time series for SN 2012ca is essentially unchanged over 1.5 yr, and appear to be dominated at all epochs by signatures of interaction with a dense circumstellar medium (CSM) rather than the underlying supernova (SN). SN 2012ca is a member of the set of type of the ambiguous IIn/Ia-CSM SNe, the nature of which have been debated extensively in the literature. The two leading scenarios are either a Type Ia SN exploding within a dense CSM from a non-degenerate, evolved companion, or a core-collapse SN from a massive star. While some members of the population have been unequivocally associated with Type Ia SNe, in other cases the association is less certain. While it is possible that SN 2012ca does arise from a thermonuclear SN, this would require a relatively high (between 20 and 70 per cent) efficiency in converting kinetic energy to optical luminosity, and a massive (~2.3-2.6 M...) circumstellar medium. On the basis of energetics, and the results of simple modelling, we suggest that SN 2012ca is more likely associated with a core-collapse SN. This would imply that the observed set of similar SNe to SN 2012ca is in fact originated by two populations, and while these are drawn from physically distinct channels, they can have observationally similar properties. (ProQuest: ... denotes formulae/symbols omitted.)
We have measured the correlation between the locations of core-collapse supernovae (CCSNe) and host galaxy light in the Ha line, near ultraviolet (NUV), R band and Ks band to constrain the ...progenitors of CCSNe using pixel statistics. Our sample consists of 86 CCSNe in 57 infrared (IR)-bright galaxies, of which many are starbursts and 10 are luminous infrared galaxies (LIRGs). We also analyse the radial distribution of CCSNe in these galaxies, and determine power-law and exponential fits to CCSN surface density profiles. To probe differences between the SN population of these galaxies and normal spiral galaxies, our results were compared to previous similar studies with samples dominated by normal spiral galaxies where possible. We obtained a normalized scale length of ... for the surface density of CCSNe in IR-bright galaxies; less than that derived for CCSNe in a galaxy sample dominated by normal spiral galaxies (0.29 ± 0.01). This reflects a more centrally concentrated population of massive stars in IR-bright galaxies. Furthermore, this centralization is dominated by a central excess of Type Ibc/IIb SNe. This may be due to a top-heavy initial mass function and/or an enhanced close binary fraction in regions of enhanced star formation. Type Ic SNe are most strongly correlated with Ha light and NUV-bright regions, reflecting the shortest lifetime and thus highest mass for Type Ic progenitors. Previous studies with samples dominated by normal spiral galaxies have indicated a lower Ibc-Ha correlation than our results do, which may be due to the central excess of Type Ibc/IIb SNe in our sample. The difference between Types II and Ib is insignificant, suggesting that progenitor mass is not the dominant factor in determining if a SN is of Type Ib or II. Similar differences in correlation can be seen in the Ks band (which in these galaxies is dominated by red supergiants and thus also traces recent star formation), with Type Ibc/IIb SNe tracing the Ks-band light better than Type II in our sample. (ProQuest: ... denotes formulae/symbols omitted.)
Admission criteria that treat children with low mid-upper-arm circumference (MUAC), and low weight-for-height z-score (WHZ) are not aligned with the evidence on which children are at risk of ...mortality. An analysis of community-based cohort data from Senegal found that a combination of weight-for-age (WAZ) and MUAC criteria identified all children at risk of near-term death associated with severe anthropometric deficits. This study will address whether children with WAZ <-3 but MUAC ≥125 mm benefit from therapeutic feeding with ready-to-use therapeutic foods (RUTF) and whether a simplified protocol is non-inferior to the weight-based standard protocol.
This is a prospective individually randomized controlled 3-arm trial conducted in the Nara health district in Mali. Children aged 6-59 months presenting with MUAC ≥125 mm and WAZ <-3 will be randomized to (1) control group receiving no treatment, (2) simplified treatment receiving 1 sachet of RUTF daily until WAZ ≥-3 for 2 visits, (3) standard treatment receiving RUTF according to WHZ category: (a) WHZ <-3 receive 200 kcal/kg/day until WHZ ≥-2 for 2 visits, (b) WHZ ≥-3 but <-2 receive 1 sachet daily until WHZ ≥-2 for 2 visits or (c) WHZ ≥-2 receive no treatment. All children will be followed up first fortnightly for 12 weeks and then monthly until 6 months post-enrolment. The primary endpoint will be measured at 2 months with the primary outcome being WAZ as a continuous measure. Other outcomes include other anthropometric measurements and a secondary endpoint will be observed at 6 months. A total of 1397 children will be recruited including 209 in the control and 594 in both the simplified and standard arms. The sample size should enable us to conclude on the superiority of the simplified treatment compared to no treatment and on the non-inferiority of the simplified treatment versus standard treatment with a margin of non-inferiority of 0.2 WAZ.
This trial aims to generate new evidence on the benefit of treating children with WAZ <-3 but MUAC ≥125 mm in order to guide the choice of admission criteria to malnutrition treatment and build evidence on the most efficient treatment protocol.
This trial was registered at ClinicalTrials.gov: NCT05248516 on February 21, 2022.
ABSTRACT
We present observations of the unusually luminous Type II supernova (SN) 2016gsd. With a peak absolute magnitude of V = −19.95 ± 0.08, this object is one of the brightest Type II SNe, and ...lies in the gap of magnitudes between the majority of Type II SNe and the superluminous SNe. Its light curve shows little evidence of the expected drop from the optically thick phase to the radioactively powered tail. The velocities derived from the absorption in H α are also unusually high with the blue edge tracing the fastest moving gas initially at 20 000 km s−1, and then declining approximately linearly to 15 000 km s−1 over ∼100 d. The dwarf host galaxy of the SN indicates a low-metallicity progenitor which may also contribute to the weakness of the metal lines in its spectra. We examine SN 2016gsd with reference to similarly luminous, linear Type II SNe such as SNe 1979C and 1998S, and discuss the interpretation of its observational characteristics. We compare the observations with a model produced by the jekyll code and find that a massive star with a depleted and inflated hydrogen envelope struggles to reproduce the high luminosity and extreme linearity of SN 2016gsd. Instead, we suggest that the influence of interaction between the SN ejecta and circumstellar material can explain the majority of the observed properties of the SN. The high velocities and strong H α absorption present throughout the evolution of the SN may imply a circumstellar medium configured in an asymmetric geometry.
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