Effectiveness of screened ceilings over the current best practice in reducing malaria prevalence in western Kenya: a cluster randomised controlled trial

Increases in bed net coverage and antimalarial treatment have reduced the risk of malaria in sub-Saharan Africa. However, the pace of reduction has slowed, and new tools are needed to reverse this trend. We evaluated houses screened with insecticide-treated ceiling nets using a cluster randomized-controlled trial in western Kenya. The primary endpoints were Plasmodium falciparum PCR-positive prevalence (PCRPf PR) of children from 7 months to 10 years old and anopheline density. Ceiling nets and bed nets were provided to 1073 houses, and 1162 houses were provided with bed nets only. The treatment and control arms each had four clusters. We conducted three epidemiological and entomological post-intervention surveys over the course of a year and a half. Each epidemiological survey targeted 150 children per cluster, and entomological surveys targeted 25 houses. When the three surveys were combined, the median PCRPf PRs were 23% (IQR 8%) in the intervention arm and 42% (IQR 12%) in the control arm. The adjusted risk ratio (RR) was 0.53 [95% confidence interval (CI) 0.41–0.71; P = 0.029]. The median anopheline densities were 0.4 (IQR 0.4) and 2.0 (IQR 1.4), respectively. The adjusted RR was 0.41 (95% CI 0.29–0.90; P = 0.029). The present study indicates additional protection from insecticide-screened ceilings over the current best practice.

Study of Relationships between Ceiling Smoke Leakage Rate and Evacuation Time in the Ward

With reference to the requirements of CNS 15038 and testing principles, this study proposes a set of equipment for measuring the leakage volume of ceilings and provides detailed assembly specifications for future users. In this study, a total of 405 tests were conducted as part of a set of experiments for measuring the leakage volume of ceilings, using various ceiling materials, ceiling sizes, and construction methods, in conjunction with the principles of fluid mechanics, to propose a method for evaluating the leakage volume of ceilings of various sizes and materials. Two cases-bottom-up airflow and top-down airflow-were considered. According to our research findings, in the case of bottom-up airflow, the pressure difference, panel weight, and panel size were correlated with the leakage volume; the more significant the pressure difference, the larger the leakage volume; the heavier the panel weight, the more minor the leakage volume; and the larger the panel size, the more significant the leakage volume. On the other hand, in the case of top-down airflow, different leakage volumes were observed for different ceiling materials, even if the ceiling size was identical. On the other hand, when the ceiling material was the same, and the ceiling size was different, there was not a positive relationship between the leakage volume and a larger panel size; instead, the leakage volume observed for the largest panel was the smallest. Finally, in this study we propose a volumetric leakage assessment table for assessing a ceiling as a whole, which can be utilized by engineers in the future to calculate the smoke leakage value and to estimate the smoke fall time for ward escape designs.

Sequences of cognitive decline in typical Alzheimer's disease and posterior cortical atrophy estimated using a novel event-based model of disease progression

Introduction

This work aims to characterize the sequence in which cognitive deficits appear in two dementia syndromes.

Methods

Event‐based modeling estimated fine‐grained sequences of cognitive decline in clinically‐diagnosed posterior cortical atrophy (PCA) (n=94) and typical Alzheimer's disease (tAD) (n=61) at the UCL Dementia Research Centre. Our neuropsychological battery assessed memory, vision, arithmetic, and general cognition. We adapted the event‐based model to handle highly non‐Gaussian data such as cognitive test scores where ceiling/floor effects are common.

Results

Experiments revealed differences and similarities in the fine‐grained ordering of cognitive decline in PCA (vision first) and tAD (memory first). Simulation experiments reveal that our new model equals or exceeds performance of the classic event‐based model, especially for highly non‐Gaussian data.

Discussion

Our model recovered realistic, phenotypical progression signatures that may be applied in dementia clinical trials for enrichment, and as a data‐driven composite cognitive end‐point.

Performance of Patient-Reported Outcomes Measurement Information System (PROMIS) Upper Extremity (UE) Versus Physical Function (PF) Computer Adaptive Tests (CATs) in Upper Extremity Clinics

PURPOSE

To examine the performance of the Patient-Reported Outcomes Measurement Information System (PROMIS) Upper Extremity (UE) Function Computer Adaptive Test (CAT) relative to the PROMIS Physical Function (PF) CAT in patients seeking specialty care for upper extremity conditions.

METHODS

This observational trial analyzed prospectively collected PROMIS UE and PF CAT scores from 5,202 adult patients with 10,344 outpatient clinic visits presenting to a tertiary orthopedic clinic. Pearson correlation coefficient was utilized to evaluate the association between initial PF and UE scores as well as the association between changes in PF and UE scores between visits. Differences in scores between populations presenting with hand conditions versus shoulder and elbow conditions were evaluated via Student t test, as were differences in scores between new and return patient visits.

RESULTS

The PROMIS UE CAT scores were strongly correlated with PROMIS PF CAT scores. However, patients averaged 8 points lower scoring on UE CAT testing than on PF CAT scores. The UE CAT demonstrated a ceiling effect at a score of 56 that affected 7% of patients with a secondary ceiling at 50. Changes in PF and UE scores between visits were moderately correlated with a mean difference of less than 1 point. Patients presenting for hand conditions achieved better PF and UE scores than patients presenting for shoulder and elbow conditions.

CONCLUSIONS

The PROMIS UE module appears responsive to changes over time. However, the current UE CAT has a ceiling score of 56, which does not allow for improvement of scores 0.6 SD higher than the presumptive normative population mean of 50. Although a specific assessment of upper extremity function is desirable, continued refinement of the PROMIS UE CAT is required to better assess patients with higher levels of function.

TYPE OF STUDY/LEVEL OF EVIDENCE

Diagnostic II.