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We study linear convective instability in a mushy layer formed by solidification of a binary alloy, cooled by either an isothermal perfectly conducting boundary or an imperfectly conducting boundary where the surface temperature depends linearly on the surface heat flux. A companion paper (Hitchen & Wells, J. Fluid Mech., 2025, in press) showed how thermal and salinity conditions impact mush structure. We here quantify the impact on convective instability, described by a Rayleigh number characterising the ratio of buoyancy to dissipative mechanisms. Two limits emerge for a perfectly conducting boundary. When the salinity-dependent freezing-point depression is large versus the temperature difference across the mush, convection penetrates throughout the depth of a high-porosity mush. The other limit, which we will call the Stefan limit, has small freezing-point depression and inhibits convection, which localises at onset to a high-porosity boundary layer near the mush–liquid interface. Scaling arguments characterise variation of the critical Rayleigh number and wavenumber based on the potential energy contained in order-one aspect ratio convective cells over the high-porosity regions. The Stefan number characterises the ratio of latent and sensible heats, and has moderate impact on stability via modification of the background temperature and porosity. For imperfectly conducting boundaries, the changing surface temperature causes stability to decrease over time in the limit of large freezing-point depression, but in the Stefan limit combines with the decreasing porosity to yield non-monotonic variation of the critical Rayleigh number. We discuss the implications for convection in growing sea ice.
We model transient mushy-layer growth for a binary alloy solidifying from a cooled boundary, characterising the impact of liquid composition and thermal growth conditions on the mush porosity and growth rate. We consider cooling from a perfectly conducting isothermal boundary, and from an imperfectly conducting boundary governed by a linearised thermal boundary condition. For an isothermal boundary we characterise different growth regimes depending on a concentration ratio, which can also be viewed as characterising the ratio of composition-dependent freezing point depression versus the temperature difference across the mushy layer. Large concentration ratio leads to high porosity throughout the mushy layer and an asymptotically simplified model for growth with an effective thermal diffusivity accounting for latent heat release from internal solidification. Low concentration ratio leads to low porosity throughout most of the mushy layer, except for a high-porosity boundary layer localised near the mush–liquid interface. We identify scalings for the boundary-layer thickness and mush growth rate. An imperfectly conducting boundary leads to an initial lag in the onset of solidification, followed by an adjustment period, before asymptoting to the perfectly conducting state at large time. We develop asymptotic solutions for large concentration ratio and large effective heat capacity, and characterise the mush structure, growth rate and transition times between the regimes. For low concentration ratio the high porosity zone spans the full mush depth at early times, before localising near the mush–liquid interface at later times. Such variation of porosity has important implications for the properties and biological habitability of mushy sea ice.
The population of adults with single-ventricle congenital heart disease (CHD) is growing. This study explores their lived experiences through an adult developmental psychology framework.
Methods:
Individuals aged 18 and older with single-ventricle CHD participated in Experience Group sessions and 1:1 interviews. Sessions were transcribed and analysed thematically. Themes were categorized by developmental domains and age group.
Results:
Of the 29 participants, 18 (62%) were female, 10 (35%) were emerging (18–29 years), 13 (45%) were established (30–45 years), and 6 (21%) were midlife adults (46–60 years). Emerging adults expressed reluctance to initiate romantic relationships and fear of burdening partners, while established adults reported strong relationships with partners deeply involved in caregiving. Emerging adults struggled with finding fulfilling work that meets their health needs, whereas established and midlife adults faced unemployment or early retirement due to health limits. Family dynamics shifted, with established and midlife adults educating their children to become caregivers. Physical limitations and low self-rated health were consistent across life stages, and midlife adults did not worry about traditional chronic conditions. Mental health concerns, including anxiety and depression, persisted across all life stages, but resiliency and positive affect were also evident.
Conclusion:
Adults with single-ventricle CHD experience developmental milestones differently, indicating the need for early anticipatory guidance in these domains to achieve optimal outcomes in adulthood.
Paediatric cardiac electrophysiologists are essential in CHD inpatient care, but their involvement is typically limited to consultation with individual patients. In our integrated heart centre, an electrophysiologist reviews all cardiac inpatient telemetry over the preceding 24 hours and participates in daily multidisciplinary morning report. This study investigates the impact of the strategy of consistent, formalised electrophysiologist presence at multidisciplinary morning report.
Methods:
This is a single-centre, prospective, observational study of electrophysiologist participation in patient encounters during heart centre multidisciplinary morning report from 10/20/2021 to 10/31/2022. Multidisciplinary morning report includes discussion of all intensive care and non-intensive care cardiac patients. An encounter was defined as reporting on one patient for one day. Electrophysiologists were initially blinded to observations.
Results:
Two electrophysiologists were observed over 215 days encompassing 6413 patient encounters. Electrophysiologists made comments on 581(9.1%) encounters in 234 unique patients with diverse diagnoses, equating to a median of 3[interquartile range:1–4] encounters per day. These included identifications of arrhythmias and describing electrocardiographic findings. Recommendation to change management occurred in 282(48.5%) encounters, most commonly regarding medications (n = 142, 24.4%) or pacemaker management (n = 48, 8.3%). Of the 581 encounters, there were 61(10.5%) in which they corrected another physician’s interpretation of rhythm or electrocardiogram.
Conclusion:
Routine electrophysiologist involvement in multidisciplinary morning report provides significant, frequent, and timely input in patient management by identifying precise rhythm-related diagnoses and allowing nuanced, patient-specific medication and pacemaker management of all cardiac patients, not just those consulted. Electrophysiologist presence at multidisciplinary morning report is a vital resource and this practice should be considered at integrated paediatric cardiac centres.
Synthetic auxin herbicides were developed and commercialized 60 yr before their mode of action was definitively elucidated. Although evolution of resistance to auxinic herbicides proceeded more slowly than for some other herbicide chemistries, it has become a major problem in the dicotyledonous weeds of many cropping areas of the world. With the molecular characterization of the auxin perception and signaling pathway in the mid-2000s came a greater understanding of how auxinic herbicides work, and how resistance may develop in weeds subjected to repeated selection with these herbicides. In wild radish (Raphanus raphanistrum L.) populations in southern Australia, resistance to multiple herbicides, including synthetic auxins such as 2,4-D, has reduced the number of chemical control options available. The aim of this study was to determine whether compounds involved in auxin biosynthesis, transport, and signaling are able to synergize with 2,4-D and increase its ability to control 2,4-D–resistant R. raphanistrum populations. Although some mild synergism was observed with a few compounds (abscisic acid, cyclanilide, tryptamine), the response was not large or consistent enough to warrant further study. Similarly, alternative auxinic herbicides applied pre- or postemergence were no more effective than 2,4-D. Therefore, while use of auxinic herbicides continues to increase due to the adoption of transgenic resistant crops, nonchemical control techniques will become more important, and chemical control of 2,4-D–resistant R. raphanistrum should be undertaken with alternative modes of action, using mixtures and good stewardship to delay the development of resistance for as long as possible.
Convection from a buoyancy source distributed over a vertical wall has diverse applications, from the natural ventilation of buildings to the melting of marine-terminating glaciers which impacts on future sea level. A key challenge involves determining how the rate and mechanisms of turbulent heat transfer should be extrapolated across a range of scales. Ke et al. (J. Fluid Mech., vol. 964, 2023, A24) explore transitions in the turbulent flow dynamics using direct numerical simulation of a convective boundary layer at a heated vertical wall. A classical regime of heat transfer, consistent with previous laboratory experiments, gives way with increasing accumulation of buoyancy to an ultimate regime with enhanced heat transfer. The key to this transition lies in a near-wall sublayer, with a switch from laminar buoyancy-driven dynamics to a sublayer dominated by turbulence and shear instability from the mean flow.
CHD care is resource-intensive. Unwarranted variation in care may increase cost and result in poorer health outcomes. We hypothesise that process variation exists within the pre-operative evaluation and planning process for children undergoing repair of atrial septal defect or ventricular septal defect and that substantial variation occurs in a small number of care points.
Methods:
From interviews with staff of an integrated congenital heart centre, an initial process map was constructed. A retrospective chart review of patients with isolated surgical atrial septal defect and ventricular septal defect repair from 7/1/2018 through 11/1/2020 informed revisions of the process map. The map was assessed for points of consistency and variability.
Results:
Thirty-two surgical atrial septal defect/ventricular septal defect repair patients were identified. Ten (31%) were reviewed by interventional cardiology before surgical review. Of these, 6(60%) had a failed catheter-based closure and 4 (40%) were deemed inappropriate for catheter-based closure. Thirty (94%) were reviewed in case conference, all attended surgical clinic, and none were admitted prior to surgery. The process map from interviews alone identified surgery rescheduling as a point of major variability; however, chart review revealed this was not as prominent a source of variability as pre-operative interventional cardiology review.
Conclusions:
Significant variation in the pre-operative evaluation and planning process for surgical atrial septal defect/ventricular septal defect patients was identified. If such process variation is widespread through CHD care, it may contribute to variations in outcome and cost previously documented within CHD surgery. Future research will focus on determining whether the variation is warranted or unwarranted, associated health outcomes and cost variation attributed to these variations in care processes.
To perform a statewide characteristics and outcomes analysis of the Trisomy 18 (T18) population and explore the potential impact of associated congenital heart disease (CHD) and congenital heart surgery.
Study Design:
Retrospective review of the Texas Hospital Inpatient Discharge Public Use Data File between 2009 and 2019, analysing discharges of patients with T18 identified using ICD-9/10 codes. Discharges were linked to analyse patients. Demographic characteristics and available outcomes were evaluated. The population was divided into groups for comparison: patients with no documentation of CHD (T18NoCHD), patients with CHD without congenital heart surgery (T18CHD), and patients who underwent congenital heart surgery (T18CHS).
Results:
One thousand one hundred fifty-six eligible patients were identified: 443 (38%) T18NoCHD, 669 (58%) T18CHD, and 44 (4%) T18CHS. T18CHS had a lower proportion of Hispanic patients (n = 9 (20.45%)) compared to T18CHD (n = 315 (47.09%)), and T18NoCHD (n = 219 (49.44%)) (p < 0.001 for both). Patients with Medicare/Medicaid insurance had a 0.42 odds ratio (95%CI: 0.20–0.86, p = 0.020) of undergoing congenital heart surgery compared to private insurance. T18CHS had a higher median total days in-hospital (47.5 [IQR: 12.25–113.25] vs. 9 [IQR: 3–24] and 2 [IQR: 1–5], p < 0.001); and a higher median number of admissions (n = 2 [IQR: 1–4]) vs. 1 [IQR: 1–2] and 1 [IQR: 1–1], (p < 0.001 for both). However, the post-operative median number of admissions for T18CHS was 0 [IQR: 0–2]. After the first month of life, T18CHS had freedom from in-hospital mortality similar to T18NoCHD and superior to T18CHD.
Conclusions:
Short-term outcomes for T18CHS patients are encouraging, suggesting a freedom from in-hospital mortality that resembles the T18NoCHD. The highlighted socio-economic differences between the groups warrant further investigation. Development of a prospective registry for T18 patients should be a priority for better understanding of longer-term outcomes.
HIV and severe wasting are associated with post-discharge mortality and hospital readmission among children with complicated severe acute malnutrition (SAM); however, the reasons remain unclear. We assessed body composition at hospital discharge, stratified by HIV and oedema status, in a cohort of children with complicated SAM in three hospitals in Zambia and Zimbabwe. We measured skinfold thicknesses and bioelectrical impedance analysis (BIA) to investigate whether fat and lean mass were independent predictors of time to death or readmission. Cox proportional hazards models were used to estimate the association between death/readmission and discharge body composition. Mixed effects models were fitted to compare longitudinal changes in body composition over 1 year. At discharge, 284 and 546 children had complete BIA and skinfold measurements, respectively. Low discharge lean and peripheral fat mass were independently associated with death/hospital readmission. Each unit Z-score increase in impedance index and triceps skinfolds was associated with 48 % (adjusted hazard ratio 0·52, 95 % CI (0·30, 0·90)) and 17 % (adjusted hazard ratio 0·83, 95 % CI (0·71, 0·96)) lower hazard of death/readmission, respectively. HIV-positive v. HIV-negative children had lower gains in sum of skinfolds (mean difference −1·49, 95 % CI (−2·01, −0·97)) and impedance index Z-scores (–0·13, 95 % CI (−0·24, −0·01)) over 52 weeks. Children with non-oedematous v. oedematous SAM had lower mean changes in the sum of skinfolds (–1·47, 95 % CI (−1·97, −0·97)) and impedance index Z-scores (–0·23, 95 % CI (−0·36, −0·09)). Risk stratification to identify children at risk for mortality or readmission, and interventions to increase lean and peripheral fat mass, should be considered in the post-discharge care of these children.
With advances in care, an increasing number of individuals with single-ventricle CHD are surviving into adulthood. Partners of individuals with chronic illness have unique experiences and challenges. The goal of this pilot qualitative research study was to explore the lived experiences of partners of individuals with single-ventricle CHD.
Methods:
Partners of patients ≥18 years with single-ventricle CHD were recruited and participated in Experience Group sessions and 1:1 interviews. Experience Group sessions are lightly moderated groups that bring together individuals with similar circumstances to discuss their lived experiences, centreing them as the experts. Formal inductive qualitative coding was performed to identify salient themes.
Results:
Six partners of patients participated. Of these, four were males and four were married; all were partners of someone of the opposite sex. Themes identified included uncertainty about their partners’ future health and mortality, becoming a lay CHD specialist, balancing multiple roles, and providing positivity and optimism. Over time, they took on a role as advocates for their partners and as repositories of medical history to help navigate the health system. Despite the uncertainties, participants described championing positivity and optimism for the future.
Conclusions:
In this first-of-its-kind pilot study, partners of individuals with single-ventricle CHD expressed unique challenges and experiences in their lives. There is a tacit need to design strategies to help partners cope with those challenges. Further larger-scale research is required to better understand the experiences of this unique population.
Hypoplastic Left Heart Syndrome accounts for a significant proportion of CHD morbidity and mortality, despite improvements in care and improved survival. This study evaluates number of, reasons for, and trends in discharges of patients with hypoplastic left heart syndrome over 11 years in Texas.
Methods:
The Texas Inpatient Discharge Dataset Public Use File captures almost all discharges in Texas and was reviewed from 2009 to 2019. Discharges of patients ≥5 years of age and diagnosis codes for Hypoplastic Left Heart Syndrome were included. The admitting and principle diagnoses were categorised and all discharges were evaluated for procedures performed. Descriptive and univariate statistical analyses were performed.
Results:
A total of 1024 discharges were identified with a 16.9% annual increase over the study period. Median length of stay was 4 [IQR: 2–8] and there were 17 (1.7%) in-hospital mortalities with no differences across age groups. Seven (17.1%) discharges of patients 25+ years were uninsured, higher than other age groups (p < 0.001). The most common admitting diagnosis was CHD and 224 (21.9%) of discharges included a procedure, including 23 heart transplants. Discharges occurred from 67 different hospitals with 4 (6.0%) representing 71.4% of all discharges.
Conclusions:
Discharges of Hypoplastic Left Heart Syndrome have increased rapidly, particularly in the older age groups and were spread over a large number of hospitals. Further work is needed to understand the interplay between Hypoplastic Left Heart Syndrome and other conditions and care experiences that occur within the general population, which will become more common as this population ages and grows.
The study investigates sex differences in the prevalence of undernutrition in sub-Saharan Africa. Undernutrition was defined by Z-scores using the CDC-2000 growth charts. Some 128 Demographic and Health Surveys (DHS) were analysed, totalling 700,114 children under-five. The results revealed a higher susceptibility of boys to undernutrition. Male-to-female ratios of prevalence averaged 1.18 for stunting (height-for-age Z-score <−2.0); 1.01 for wasting (weight-for-height Z-score <−2.0); 1.05 for underweight (weight-for-age Z-score <−2.0); and 1.29 for concurrent wasting and stunting (weight-for-height and height-for-age Z-scores <−2.0). Sex ratios of prevalence varied with age for stunting and concurrent wasting and stunting, with higher values for children age 0–23 months and lower values for children age 24–59 months. Sex ratios of prevalence tended to increase with declining level of mortality for stunting, underweight and concurrent wasting and stunting, but remained stable for wasting. Comparisons were made with other anthropometric reference sets (NCHS-1977 and WHO-2006), and the results were found to differ somewhat from those obtained with CDC-2000. Possible rationales for these patterns are discussed.
The number of people over the age of 65 attending Emergency Departments (ED) in the United Kingdom (UK) is increasing. Those who attend with a mental health related problem may be referred to liaison psychiatry for assessment. Improving responsiveness and integration of liaison psychiatry in general hospital settings is a national priority. To do this psychiatry teams must be adequately resourced and organised. However, it is unknown how trends in the number of referrals of older people to liaison psychiatry teams by EDs are changing, making this difficult.
Method
We performed a national multi-centre retrospective service evaluation, analysing existing psychiatry referral data from EDs of people over 65. Sites were selected from a convenience sample of older peoples liaison psychiatry departments. Departments from all regions of the UK were invited to participate via the RCPsych liaison and older peoples faculty email distribution lists. From departments who returned data, we combined the date and described trends in the number and rate of referrals over a 7 year period.
Result
Referral data from up to 28 EDs across England and Scotland over a 7 year period were analysed (n = 18828 referrals). There is a general trend towards increasing numbers of older people referred to liaison psychiatry year on year. Rates rose year on year from 1.4 referrals per 1000 ED attenders (>65 years) in 2011 to 4.5 in 2019 . There is inter and intra site variability in referral numbers per 1000 ED attendances between different departments, ranging from 0.1 - 24.3.
Conclusion
To plan an effective healthcare system we need to understand the population it serves, and have appropriate structures and processes within it. The overarching message of this study is clear; older peoples mental health emergencies presenting in ED are common and appear to be increasingly so. Without appropriate investment either in EDs or community mental health services, this is unlikely to improve.
The data also suggest very variable inter-departmental referral rates. It is not possible to establish why rates from one department to another are so different, or whether outcomes for the population they serve are better or worse. The data does however highlight the importance of asking further questions about why the departments are different, and what impact that has on the patients they serve.
We use well resolved numerical simulations with the lattice Boltzmann method to study Rayleigh–Bénard convection in cells with a fractal boundary in two dimensions for $Pr = 1$ and $Ra \in \left [10^7, 10^{10}\right ]$, where Pr and Ra are the Prandtl and Rayleigh numbers. The fractal boundaries are functions characterized by power spectral densities $S(k)$ that decay with wavenumber, $k$, as $S(k) \sim k^{p}$ ($p < 0$). The degree of roughness is quantified by the exponent $p$ with $p < -3$ for smooth (differentiable) surfaces and $-3 \le p < -1$ for rough surfaces with Hausdorff dimension $D_f=\frac {1}{2}(p+5)$. By computing the exponent $\beta$ using power law fits of $Nu \sim Ra^{\beta }$, where $Nu$ is the Nusselt number, we find that the heat transport scaling increases with roughness through the top two decades of $Ra \in \left [10^8, 10^{10}\right ]$. For $p$$= -3.0$, $-2.0$ and $-1.5$ we find $\beta = 0.288 \pm 0.005, 0.329 \pm 0.006$ and $0.352 \pm 0.011$, respectively. We also find that the Reynolds number, $Re$, scales as $Re \sim Ra^{\xi }$, where $\xi \approx 0.57$ over $Ra \in \left [10^7, 10^{10}\right ]$, for all $p$ used in the study. For a given value of $p$, the averaged $Nu$ and $Re$ are insensitive to the specific realization of the roughness.
This article has two principal aims. The first is to assess the usefulness of ‘glocalization’ as a concept in the study of early modern global cities, using human–animal interactions as a test case. The second is to explore the reciprocal influence that human–animal interactions and the development of global cities had on each other. Exploration of these two issues interrogates the frequently contradictory, often ambiguous and always contested nature of the early modern global city itself.
Marine-terminating glaciers, such as those along the coastline of Greenland, often release meltwater into the ocean in the form of subglacial discharge plumes. Though these plumes can dramatically alter the mass loss along the front of a glacier, the conditions surrounding their genesis remain poorly constrained. In particular, little is known about the geometry of subglacial outlets and the extent to which seawater may intrude into them. Here, the latter is addressed by exploring the dynamics of an arrested salt wedge – a steady-state, two-layer flow system where salty water partially intrudes a channel carrying fresh water. Building on existing theory, we formulate a model that predicts the length of a non-entraining salt wedge as a function of the Froude number, the slope of the channel and coefficients for interfacial and wall drag. In conjunction, a series of laboratory experiments were conducted to observe a salt wedge within a rectangular channel. For experiments conducted with laminar flow (Reynolds number $Re<800$), good agreement with theoretical predictions are obtained when the drag coefficients are modelled as being inversely proportional to $Re$. However, for fully turbulent flows on geophysical scales, these drag coefficients are expected to asymptote toward finite values. Adopting reasonable drag coefficient estimates for this flow regime, our theoretical model suggests that typical subglacial channels may permit seawater intrusions of the order of several kilometres. While crude, these results indicate that the ocean has a strong tendency to penetrate subglacial channels and potentially undercut the face of marine-terminating glaciers.
We present studies of the solidification of binary aqueous solutions that undergo time-periodic cooling from below. We develop an experiment for solidification of aqueous $\text{NH}_{4}\text{Cl}$ solutions, where the temperature of the cooling boundary is modulated as a simple periodic function of time with independent variations of the modulation amplitude and frequency. The thickness of the mushy layer exhibits oscillations about the background growth obtained for constant cooling. We consider the deviation given by the difference between states with modulated and fixed cooling, which increases when the modulation amplitude increases but decreases with increasing modulation frequency. At early times, the deviation amplitude is consistent with a scaling argument for growth with quasi-steady modulation. In situ measurements of the mush temperature reveal thermal waves propagating through the mushy layer, with amplitude decaying with height within the mushy layer, whilst the phase lag behind the cooling boundary increases with height. This also leads to phase lags in the variation of the mushy-layer thickness compared to the boundary cooling. There is an asymmetry of the deviation of mushy-layer thickness: during a positive modulation (where the boundary temperature increases at the start of a cycle) the peak thickness deviation has a greater magnitude than the troughs in a negative modulation mode (where the boundary temperature decreases at the start of the cycle). A numerical model is formulated to describe mushy-layer growth with constant bulk concentration and turbulent heat transport at the mush–liquid interface driven by compositional convection associated with a finite interfacial solid fraction. The model recovers key features of the experimental results at early times, including the propagation of thermal waves and oscillations in mushy-layer thickness, although tends to overpredict the mean thickness.
We report an experimental study of the distributions of temperature and solid fraction of growing $\text{NH}_{4}\text{Cl}$–$\text{H}_{2}\text{O}$ mushy layers that are subjected to periodical cooling from below, focusing on late-time dynamics where the mushy layer oscillates about an approximate steady state. Temporal evolution of the local temperature $T(z,t)$ at various heights in the mush demonstrates that the temperature oscillations of the bottom cooling boundary propagate through the mushy layer with phase delays and substantial decay in the amplitude. As the initial concentration $C_{0}$ increases, we show that the decay rate of the thermal oscillation with height also decreases, and the propagation speed of the oscillation phase increases. We interpret this as a result of the solid fraction increasing with $C_{0}$, which enhances the thermal conductivity but reduces the specific heat of the mushy layer. We present a new methodology to determine the distribution of solid fraction $\unicode[STIX]{x1D719}(z)$ in mushy layers for various $C_{0}$, using only measurements of the temperature $T(z,t)$. The method is based on the phase behaviour during thermal modulation, and opens up a new approach for inferring mushy-layer properties in geophysical and engineering settings, where direct measurements are challenging. In our experiments, profiles of the solid fraction $\unicode[STIX]{x1D719}(z)$ exhibit a cliff–ramp–cliff structure with large vertical gradients of $\unicode[STIX]{x1D719}$ near the mush–liquid interface and also near the bottom boundary, but much more gradual variation in the interior of the mushy layer. Such a profile structure is more pronounced for higher initial concentration $C_{0}$. For very low concentration, the solid fraction appears to be linearly dependent on the height within the mush. The volume-average of the solid fraction, and the local fluctuations in $\unicode[STIX]{x1D719}(z)$ both increase as $C_{0}$ increases. We suggest that the fast increase of $\unicode[STIX]{x1D719}(z)$ near the bottom boundary is possibly due to diffusive transport of solute away from the bottom boundary and the depletion of solute content near the basal region.
To assess differences in cognition functions and gross brain structure in children seven years after an episode of severe acute malnutrition (SAM), compared with other Malawian children.
Design
Prospective longitudinal cohort assessing school grade achieved and results of five computer-based (CANTAB) tests, covering three cognitive domains. A subset underwent brain MRI scans which were reviewed using a standardized checklist of gross abnormalities and compared with a reference population of Malawian children.
Setting
Blantyre, Malawi.
Participants
Children discharged from SAM treatment in 2006 and 2007 (n 320; median age 9·3 years) were compared with controls: siblings closest in age to the SAM survivors and age/sex-matched community children.
Results
SAM survivors were significantly more likely to be in a lower grade at school than controls (adjusted OR = 0·4; 95 % CI 0·3, 0·6; P < 0·0001) and had consistently poorer scores in all CANTAB cognitive tests. Adjusting for HIV and socio-economic status diminished statistically significant differences. There were no significant differences in odds of brain abnormalities and sinusitis between SAM survivors (n 49) and reference children (OR = 1·11; 95 % CI 0·61, 2·03; P = 0·73).
Conclusions
Despite apparent preservation in gross brain structure, persistent impaired school achievement is likely to be detrimental to individual attainment and economic well-being. Understanding the multifactorial causes of lower school achievement is therefore needed to design interventions for SAM survivors to thrive in adulthood. The cognitive and potential economic implications of SAM need further emphasis to better advocate for SAM prevention and early treatment.