bluuebunny/crossref_metadata_2025 huggingface dataset:
The foreground transfer function for H i intensity mapping signal reconstruction: MeerKLASS and precision cosmology applications
Authors: Cunnington Steven , Wolz Laura , Bull Philip , Carucci Isabella P , Grainge Keith , Irfan Melis O , Li Yichao , Pourtsidou Alkistis , Santos Mario G , Spinelli Marta , Wang Jingying
Published: May 2023

Blind cleaning methods are currently the preferred strategy for handling foreground contamination in single-dish H i intensity mapping surveys. Despite the increasing sophistication of blind techniques, some signal loss will be inevitable across all scales. Constructing a corrective transfer function using mock signal injection into the contaminated data has been a practice relied on for H i intensity mapping experiments. However, assessing whether this approach is viable for future intensity mapping surveys, where precision cosmology is the aim, remains unexplored. In this work, using simulations, we validate for the first time the use of a foreground transfer function to reconstruct power spectra of foreground-cleaned low-redshift intensity maps and look to expose any limitations. We reveal that even when aggressive foreground cleaning is required, which causes ${\gt }\, 50~{{\ \rm per\ cent}}$ negative bias on the largest scales, the power spectrum can be reconstructed using a transfer function to within sub-per cent accuracy. We specifically outline the recipe for constructing an unbiased transfer function, highlighting the pitfalls if one deviates from this recipe, and also correctly identify how a transfer function should be applied in an autocorrelation power spectrum. We validate a method that utilizes the transfer function variance for error estimation in foreground-cleaned power spectra. Finally, we demonstrate how incorrect fiducial parameter assumptions (up to ${\pm }100~{{\ \rm per\ cent}}$ bias) in the generation of mocks, used in the construction of the transfer function, do not significantly bias signal reconstruction or parameter inference (inducing ${\lt }\, 5~{{\ \rm per\ cent}}$ bias in recovered values).
3D stellar evolution: hydrodynamic simulations of a complete burning phase in a massive star
Authors: Rizzuti F , Hirschi R , Arnett W D , Georgy C , Meakin C , Murphy A StJ , Rauscher T , Varma V
Published: May 2023

Our knowledge of stellar evolution is driven by one-dimensional (1D) simulations. 1D models, however, are severely limited by uncertainties on the exact behaviour of many multidimensional phenomena occurring inside stars, affecting their structure and evolution. Recent advances in computing resources have allowed small sections of a star to be reproduced with multi-D hydrodynamic models, with an unprecedented degree of detail and realism. In this work, we present a set of 3D simulations of a convective neon-burning shell in a 20 M⊙ star run for the first time continuously from its early development through to complete fuel exhaustion, using unaltered input conditions from a 321D-guided 1D stellar model. These simulations help answer some open questions in stellar physics. In particular, they show that convective regions do not grow indefinitely due to entrainment of fresh material, but fuel consumption prevails over entrainment, so when fuel is exhausted convection also starts decaying. Our results show convergence between the multi-D simulations and the new 321D-guided 1D model, concerning the amount of convective boundary mixing to include in stellar models. The size of the convective zones in a star strongly affects its structure and evolution; thus, revising their modelling in 1D will have important implications for the life and fate of stars. This will thus affect theoretical predictions related to nucleosynthesis, supernova explosions, and compact remnants.
Successful treatment of PR3-ANCA-positive interstitial pneumonia with a moderate dose of glucocorticoid and rituximab
Authors: Higashida-Konishi Misako , Akiyama Mitsuhiro , Hama Satoshi , Oshige Tatsuhiro , Izumi Keisuke , Oshima Hisaji , Okano Yutaka
Published: May 2023

Antineutrophil cytoplasmic antibody (ANCA)–positive interstitial pneumonia (IP) is reported as IP that is ANCA-positive and does not involve organ damage associated with vasculitis other than the lungs. While the combination of glucocorticoid and rituximab is effective in ANCA-associated vasculitis, the treatment strategy for ANCA-positive IP has not been established. Here, we report the first case of successful treatment of proteinase 3 (PR3)-ANCA-positive IP with a moderate dose of glucocorticoid and rituximab. The patient was an 80-year-old male who presented with subacute dry cough and dyspnoea. Blood tests revealed elevated levels of C-reactive protein, Krebs von den Lungen 6 (KL-6), and PR3-ANCA. Chest computed tomography (CT) showed interstitial shadows and infiltrates around honeycomb cysts. 18F-fluorodeoxyglucose (FDG) positron emission tomography CT revealed an uptake of FDG in the IP area. After starting treatment with a moderate dose of prednisolone and rituximab, the patient’s clinical symptoms disappeared, C-reactive protein and KL-6 turned to be normal, and infiltrates around the cysts of honeycomb lungs disappeared. Prednisolone was gradually decreased to 2 mg, and no relapse or adverse events were observed during the course of treatment. Our case suggests that early treatment with a moderate dose of glucocorticoid and rituximab is effective for PR3-ANCA-positive IP.
Leitmotivic Strategies in Nobuo Uematsu’sFinal FantasySoundtracks
Authors: Anatone Richard
Published: May 2023

This article discusses Nobuo Uematsu’s leitmotivic soundtracks to the 16-bit Final Fantasy role-playing games. I identify five distinct techniques within these soundtracks whereby a game’s main theme is musically connected to a single character theme: eponymous omission, motivic networking, thematic hybridization, associative troping, and the double main theme. I argue that these different techniques demonstrate how a character’s individual journey reflects the story’s underlying literary theme, which is itself represented by the musical main theme. I conduct topical, motivic, formal, and semiotic analyses of the soundtracks to FFIV–VI and discuss how their character themes, though mostly non-transformative, engage in a larger leitmotivic network of inter-related thematic families that interact with their main themes in dramatically meaningful ways. This analysis demonstrates subtle ways in which leitmotivic scoring can heighten one’s narratological understanding of a story, and may be useful for those seeking to arrange video game soundtracks into programmatic music that tells or retells a game’s story.
Inter-laboratory variation in measurement of DNA damage by the alkaline comet assay in the hCOMET ring trial
Authors: Møller Peter , Azqueta Amaya , Collia Miguel , Bakuradze Tamara , Richling Elke , Bankoglu Ezgi Eyluel , Stopper Helga , Bastos Victoria Claudino , Langie Sabine A S , Jensen Annie , Ristori Sara , Scavone Francesca , Giovannelli Lisa , Wojewódzka Maria , Kruszewski Marcin , Valdiglesias Vanessa , Laffon Blanca , Costa Carla , Costa Solange , Teixeira João Paulo , Marino Mirko , Del Bo Cristian , Riso Patrizia , Zheng Congying , Shaposhnikov Sergey , Collins Andrew
Published: May 2023

The comet assay is a simple and versatile method for measurement of DNA damage in eukaryotic cells. More specifically, the assay detects DNA migration from agarose gel-embedded nucleoids, which depends on assay conditions and the level of DNA damage. Certain steps in the comet assay procedure have substantial impact on the magnitude of DNA migration (e.g. electric potential and time of electrophoresis). Inter-laboratory variation in DNA migration levels occurs because there is no agreement on optimal assay conditions or suitable assay controls. The purpose of the hCOMET ring trial was to test potassium bromate (KBrO3) as a positive control for the formamidopyrimidine DNA glycosylase (Fpg)-modified comet assay. To this end, participating laboratories used semi-standardized protocols for cell culture (i.e. cell culture, KBrO3 exposure, and cryopreservation of cells) and comet assay procedures, whereas the data acquisition was not standardized (i.e. staining of comets and image analysis). Segregation of the total variation into partial standard deviation (SD) in % Tail DNA units indicates the importance of cell culture procedures (SD = 10.9), comet assay procedures (SD = 12.3), staining (SD = 7.9) and image analysis (SD = 0.5) on the overall inter-laboratory variation of DNA migration (SD = 18.2). Future studies should assess sources of variation in each of these steps. On the positive side, the hCOMET ring trial demonstrates that KBrO3 is a robust positive control for the Fpg-modified comet assay. In conclusion, the hCOMET ring trial has demonstrated a high reproducibility of detecting genotoxic effects by the comet assay, but inter-laboratory variation of DNA migration levels is a concern.
Urinary albumin excretion and cancer risk: the PREVEND cohort study
Authors: Luo Li , Kieneker Lyanne M , van der Vegt Bert , Bakker Stephan J L , Gruppen Eke G , Casteleijn Niek F , de Boer Rudolf A , Suthahar Navin , de Bock Geertruida H , Aboumsallem Joseph Pierre , Vart Priya , Gansevoort Ron T
Published: May 2023

Background

Chronic kidney disease (CKD) is believed to be associated with an increased risk for cancer, especially urinary tract cancer. However, previous studies predominantly focused on the association of decreased estimated glomerular filtration rate (eGFR) with cancer. In this study, we investigated the association of albuminuria with cancer incidence, adjusted for eGFR.

Methods

We included 8490 subjects in the Prevention of Renal and Vascular End-stage Disease (PREVEND) observational study. Urinary albumin excretion (UAE) was measured in two 24-hour urine specimens at baseline. Primary outcomes were the incidence of overall and urinary tract cancer. Secondary outcomes were the incidence of other site-specific cancers, and mortality due to overall, urinary tract, and other site-specific cancers.

Results

Median baseline UAE was 9.4 (IQR, 6.3–17.8) mg/24 h. During a median follow-up of 17.7 years, 1341 subjects developed cancer (of which 177 were urinary tract cancers). After multivariable adjustment including eGFR, every doubling of UAE was associated with a 6% (hazard ratios (HR), 1.06, 95% confidence intervals (CI), 1.02–1.10), and 14% (HR, 1.14, 95% CI, 1.04–1.24) higher risk of overall and urinary tract cancer incidence, respectively. Except for lung and hematological cancer, no associations were found between UAE and the incidence of other site-specific cancer. Doubling of UAE was also associated with a higher risk of mortality due to overall and lung cancer.

Conclusions

Higher albuminuria is associated with a higher incidence of overall, urinary tract, lung, and hematological cancer, and with a higher risk of mortality due to overall and lung cancers, independent of baseline eGFR.
A single administration of FGF2 after renal ischemia–reperfusion injury alleviates post-injury interstitial fibrosis
Authors: Tan Xiaohua , Tao Qianyu , Yin Shulan , Fu Guangming , Wang Chengqin , Xiang Fenggang , Hu Haiqi , Zhang Sudan , Wang Zheng , Li Dequan
Published: May 2023

Background

Despite lack of clinical therapy in acute kidney injury (AKI) or its progression to chronic kidney disease (CKD), administration of growth factors shows great potential in the treatment of renal repair and further fibrosis. At an early phase of AKI, administration of exogenous fibroblast growth factor 2 (FGF2) protects against renal injury by inhibition of mitochondrial damage and inflammatory response. Here, we investigated whether this treatment attenuates the long-term renal interstitial fibrosis induced by ischemia–reperfusion (I/R) injury.

Methods

Unilateral renal I/R with contralateral nephrectomy was utilized as an in vivo model for AKI and subsequent CKD. Rats were randomly divided into four groups: Sham-operation group, I/R group, I/R-FGF2 group and FGF2-3D group. These groups were monitored for up to 2 months. Serum creatinine, inflammatory response and renal histopathology changes were detected to evaluate the role of FGF2 in AKI and followed renal interstitial fibrosis. Moreover, the expression of vimentin, α-SMA, CD31 and CD34 were examined.

Results

Two months after I/R injury, the severity of renal interstitial fibrosis was significantly attenuated in both of I/R-FGF2 group and FGF2-3D group, compared with the I/R group. The protective effects of FGF2 administration were associated with the reduction of high-mobility group box 1 (HMGB1)-mediated inflammatory response, the inhibition of transforming growth factor beta (TGF-β1)/Smads signaling–induced epithelial–mesenchymal transition and the maintenance of peritubular capillary structure.

Conclusions

A single dose of exogenous FGF2 administration 1 h or 3 days after reperfusion inhibited renal fibrogenesis and thus blocked the transition of AKI to CKD. Our findings provided novel insight into the role of FGF signaling in AKI-to-CKD progression and underscored the potential of FGF-based therapy for this devastating disease.
How has Expenditure on Nicotine Products Changed in a Fast-Evolving Marketplace? A Representative Population Survey in England, 2018–2022
Authors: Jackson Sarah E , Tattan-Birch Harry , Shahab Lion , Brown Jamie
Published: May 2023

Introduction

In the last 5 years, there has been a dramatic shift in the types of nicotine products being purchased. This study aimed to estimate how much users spend on types of cigarettes and alternative nicotine products (e-cigarettes, nicotine replacement therapy (NRT), heated tobacco, and nicotine pouches) and describe changes between 2018 and 2022.

Aims and Methods

Monthly representative cross-sectional survey in England. 10 323 adults who smoked cigarettes or used alternative nicotine reported their average weekly expenditure on these products, adjusted for inflation.

Results

Smokers spent £20.49 [95% CI = 20.09–20.91] on cigarettes each week (£27.66 [26.84–28.50] and £15.96 [15.49–16.28] among those who mainly smoked manufactured and hand-rolled cigarettes, respectively), e-cigarette users spent £6.30 [5.99–6.55] (£8.41 [7.17–9.78], £6.42 [5.58–7.39], and £5.93 [5.64–6.30] among those who mainly used disposable, pod, and refillable devices, respectively), NRT users £6.11 [5.53–6.69], and heated tobacco users £13.87 [9.58–20.09]. Expenditure on cigarettes grew by 10% from September 2018 to July 2020, then fell by 10% from July 2020 to June 2022. These changes coincided with a 13% reduction in cigarette consumption and a 14% increase in the proportion mainly smoking hand-rolled cigarettes. Expenditure on e-cigarettes was stable between 2018 and late 2020, then rose by 31% up to mid-2022. Expenditure on NRT increased slowly in 2018–2020 (+4%) and more quickly thereafter (+20%).

Conclusions

Inflation-adjusted expenditure on cigarettes has fallen since 2020, such that the average smoker in England currently spends the same on cigarettes each week as in 2018. This has been achieved by smoking fewer cigarettes and switching to cheaper hand-rolled cigarettes. Expenditure on alternative nicotine has increased above inflation; users spent around a third more on these products in 2022 than between 2018–2020.

Implications

People in England continue to spend substantially more on smoking cigarettes than using alternative nicotine products. The average smoker in England spends around £13 a week (~£670 a year) more than people using only e-cigarettes or NRT. The average expenditure on manufactured cigarettes is double that of hand-rolled cigarettes.
Cost-of-living crisis impacts the nursing and midwifery professions
Authors: McGloin Sarah
Published: May 2023

The cost-of-living crisis is having a profound effect on many nurses, midwives and healthcare support workers across the UK. This piece explores how in-work poverty is affecting their capacity to provide care for others. It considers the impact on the workforce’s mental health and well-being and practical issues including access to digital technologies. It highlights the need for a nationally co-ordinated approach to providing sustained support to staff and patients during this time.
The Impact of Opioid Use Disorder on Families and Children
Authors: Winstanley Erin L. , Newhouse Amanda , Law Kari-Beth
Published: May 2023

The consequences of an opioid use disorder (OUD) and the overdose epidemic span beyond the individual suffering with the disease, as the effects of addiction ripple across the social context in which they live. Individuals with OUD have parents, siblings, children, and extended family members. This chapter summarizes existing research on how OUD and the overdose epidemic has impacted those families’ members and children, in terms of short- and long-term sequelae. There is specific focus on parent/caregiver use of opioids and its impact on children under 18 years old including medical, psychosocial, and behavioral consequences. The chapter will begin by reviewing the incidence of OUD in parents and focus broadly on how OUD impacts parenting style, parent–child bonding, child maltreatment, trauma, family dissolution and removal of children from the home. The next section will discuss prevention and treatment services for families, the added burden of stigma experienced by parents with OUD and how policies are desperately needed to encourage cross-system collaboration. The chapter will conclude with a case report that illustrates much of the content covered in this chapter and a summary of evidence-based clinical recommendations.
Transcriptomic Interpretation on Explainable AI-Guided Intuition Uncovers Premonitory Reactions of Disordering Fate in Persimmon Fruit
Authors: Masuda Kanae , Kuwada Eriko , Suzuki Maria , Suzuki Tetsuya , Niikawa Takeshi , Uchida Seiichi , Akagi Takashi
Published: May 2023

Deep neural network (DNN) techniques, as an advanced machine learning framework, have allowed various image diagnoses in plants, which often achieve better prediction performance than human experts in each specific field. Notwithstanding, in plant biology, the application of DNNs is still mostly limited to rapid and effective phenotyping. The recent development of explainable CNN frameworks has allowed visualization of the features in the prediction by a convolutional neural network (CNN), which potentially contributes to the understanding of physiological mechanisms in objective phenotypes. In this study, we propose an integration of explainable CNN and transcriptomic approach to make a physiological interpretation of a fruit internal disorder in persimmon, rapid over-softening. We constructed CNN models to accurately predict the fate to be rapid softening in persimmon cv. Soshu, only with photo images. The explainable CNNs, such as Gradient-weighted Class Activation Mapping (Grad-Class Activation Mapping (CAM)) and guided Grad-CAM, visualized specific featured regions relevant to the prediction of rapid softening, which would correspond to the premonitory symptoms in a fruit. Transcriptomic analyses to compare the featured regions of the predicted rapid-softening and control fruits suggested that rapid softening is triggered by precocious ethylene signal–dependent cell wall modification, despite exhibiting no direct phenotypic changes. Further transcriptomic comparison between the featured and non-featured regions in the predicted rapid-softening fruit suggested that premonitory symptoms reflected hypoxia and the related stress signals finally to induce ethylene signals. These results would provide a good example for the collaboration of image analysis and omics approaches in plant physiology, which uncovered a novel aspect of fruit premonitory reactions in the rapid-softening fate.
Anomalous widespread arid events in Asia over the past 550,000 years
Authors: Carrasqueira Igor Gustavo da Fonseca , Jovane Luigi , Droxler André W , Alvarez Zarikian Carlos A , Lanci Luca , Alonso-Garcia Montserrat , Laya Juan Carlos , Kroon Dick
Published: May 2023

Records of element ratios obtained from the Maldives Inner Sea sediments provide a detailed view on how the Indian Monsoon System has varied at high-resolution time scales. Here, we present records from International Ocean Discovery Program (IODP) Site U1471 based on a refined chronology through the past 550,000 years. The record's high resolution and a proper approach to set the chronology allowed us to reconstruct changes in the Indian Monsoon System on a scale of anomalies and to verify their relationships with established records from the East Asian Monsoon System. On the basis of Fe/sum and Fe/Si records, it can be demonstrated that the Asia continental aridity tracks sea-level changes, while the intensity of winter monsoon winds responds to changes in Northern Hemisphere summer insolation. Furthermore, the anomalies of continental aridity and intensity of winter monsoon winds at millennial-scale events exhibit power in the precession band, nearly in antiphase with Northern Hemisphere summer insolation. These observations indicate that the insolation drove the anomalies in the Indian Summer Monsoon. The good correspondence between our record and the East Asian monsoon anomaly records suggests the occurrence of anomalous widespread arid events in Asia.
A score for predicting colchicine resistance at the time of diagnosis in familial Mediterranean fever: data from the TURPAID registry
Authors: Batu Ezgi Deniz , Şener Seher , Arslanoglu Aydin Elif , Aliyev Emil , Bagrul İlknur , Türkmen Şeyma , Akgün Özlem , Balık Zeynep , Tanatar Ayşe , Bayındır Yağmur , Kızıldağ Zehra , Torun Rüya , Günalp Aybüke , Coşkuner Taner , İşgüder Rana , Aydın Tuncay , Haşlak Fatih , Kasap Cüceoğlu Müşerref , Esen Esra , Akçay Ulaş , Başaran Özge , Pac Kısaarslan Aysenur , Akal Fuat , Yüce Deniz , Özdel Semanur , Bülbül Mehmet , Bilginer Yelda , Aktay Ayaz Nuray , Sözeri Betül , Kasapçopur Özgür , Ünsal Erbil , Özen Seza
Published: May 2023

Objectives

Colchicine forms the mainstay of treatment in FMF. Approximately 5–10% of FMF patients are colchicine resistant and require anti-IL-1 drugs. We aimed to compare the characteristics of colchicine-resistant and colchicine-responsive patients and to develop a score for predicting colchicine resistance at the time of FMF diagnosis.

Methods

FMF patients (0–18 years) enrolled in the Turkish Paediatric Autoinflammatory Diseases (TURPAID) registry were included. The predictive score for colchicine resistance was developed by using univariate/multivariate regression and receiver operating characteristics analyses.

Results

A total of 3445 FMF patients [256 (7.4%) colchicine-resistant and 3189 colchicine-responsive) were included (female:male ratio 1.02; median age at diagnosis 67.4 months). Colchicine-resistant patients had longer, more frequent attacks and were younger at symptom onset and diagnosis (P < 0.05). Fever, erysipelas-like erythema, arthralgia, arthritis, myalgia, abdominal pain, diarrhoea, chest pain, comorbidities, parental consanguinity and homozygosity/compound heterozygosity for exon 10 MEFV mutations were significantly more prevalent among colchicine-resistant than colchicine-responsive patients (P < 0.05). Multivariate logistic regression analysis in the training cohort (n = 2684) showed that age at symptom onset, attack frequency, arthritis, chest pain and having two exon 10 mutations were the strongest predictors of colchicine resistance. The score including these items had a sensitivity of 81.3% and a specificity of 49.1%. In the validation cohort (n = 671), its sensitivity was 93.5% and specificity was 53.8%.

Conclusion

We developed a clinician-friendly and practical predictive score that could help us identify FMF patients with a greater risk of colchicine resistance and tailor disease management individually at the time of diagnosis.
Determinants of neuropsychiatric flares in patients with systemic lupus erythematosus: results from five phase III trials of belimumab
Authors: Palazzo Leonardo , Lindblom Julius , Cetrez Nursen , Ala Henri , Parodis Ioannis
Published: May 2023

Objective

To identify determinants of neuropsychiatric (NP) flares in patients with SLE treated for active SLE yet no ongoing severe NPSLE with non-biologic standard therapy plus belimumab or placebo.

Methods

We analysed data from five phase III trials (BLISS-52, BLISS-76, BLISS-NEA, BLISS-SC, EMBRACE; n = 3638) after exclusion of patients with baseline NP BILAG A. Factors associated with NPSLE flare, defined as a new NP BILAG A or B, were investigated using Cox regression. In a subgroup analysis, we studied patients with baseline NP BILAG E for determinants of de novo NPSLE flare. Organ damage was assessed using the SLICC/ACR Damage Index (SDI).

Results

We documented 105 (2.9%) NPSLE flares. In multivariable analysis, male sex (HR = 2.37; 95% CI: 1.31, 4.28; P = 0.004), baseline NP BILAG B–D (HR = 5.91; 95% CI: 3.86, 9.06; P < 0.001), and increasing SDI scores (HR = 1.35; 95% CI: 1.21, 1.50; P < 0.001) were strongly associated with NPSLE flare. Belimumab use yielded no association at any dose or administration form. In analysis of SDI domains, NP damage was the strongest determinant of NPSLE flare (HR = 3.25; 95% CI: 2.72, 3.88; P < 0.001), holding true for cognitive impairment (HR = 14.29; 95% CI: 9.22, 22.14; P < 0.001), transverse myelitis (HR = 21.89; 95% CI: 5.40, 88.72; P < 0.001), and neuropathy (HR = 8.87; 95% CI: 5.59, 14.09; P < 0.001). Male sex was the strongest determinant of de novo NPSLE flare (HR = 3.26; 95% CI: 1.51, 7.04; P = 0.003).

Conclusion

Male sex, NPSLE history, and NP damage were strong determinants of impending NPSLE flare. No clear protection or predisposition was conferred from add-on belimumab.
Conservatism versus sustainability: recognising the interconnectivity of ALARA and sustainability
Authors: Ambrose Kathryn
Published: May 2023

Sustainability in its widest definition covers societal, economic and environmental factors and requires striking a balance between the needs of current and future generations. It is not always recognised that there is a link between sustainability and the work of radiological protection professionals. However, in managing safety and the environment, sustainability is an integral part of the radiological protection professionals’ role. Improvements to sustainability performance can also improve safety and environmental performance, i.e. introducing energy-efficient lighting has environmental and economic benefits but often improves visibility, highlighting safety hazards. Yet, decisions around safety and the environment can be unsustainable. ALARA (as low as reasonably achievable) captures the concept of sustainability as it requires the balance of safety with societal and economic impacts. However, by explicitly referencing the environment, and therefore sustainability, within the ALARA approach, alongside societal and economic impacts, the radiological protection profession can further worldwide sustainability goals.
Monitoring system of the fuel-Casette-free STATE of the control rod sleeves on the PAKS NPP
Authors: Solymosi Máté , Bujtás Tibor , Csurgai József , Marusa Andor , Nagy Gábor , Solymosi József , Zsille Ottó
Published: May 2023

Lifting the control rod sleeves (CRS) is one of the initial steps of the refuelling of the VVER-400-213 type reactor, which are operating at Paks NPP. If any fuel-cassette adheres to the CRS during its lift, it can result in unplanned exposure of the workers. The monitoring system has been recalibrated, because the first calibration of the monitoring system had been implemented 20 years ago, and Paks NPP had changed the fuel cycle from 12 months to 15 months. The task was performed under the refuelling outage of unit 1 in 2018. During preparatory works performed for refuelling of the same unit, at 6th May 2021 the monitoring system indicated the adhesion of the one of the fuel cassettes to the CRS. This work provides an overview about the operation of the system, about completed tasks relating to recalibration of the measuring system and about the adhesion event on the unit 1.
Methodology to compare alternative design options for radioactive waste disposal facilities under the principle of ALARA based on probabilistic approach with Bayesian inference
Authors: Sugiyama Daisuke
Published: May 2023

In the process of optimisation of radiological protection in long-term radioactive waste management, design options for disposal facilities are assessed from the viewpoint of practical reduction in radiation dose to as low as reasonably achievable (ALARA). In this paper, a probabilistic approach is introduced to evaluate differences in dose distributions between alternative facility designs using the Bayesian inference technique. It is demonstrated by a series of parametric calculations for hypothetic disposal system designs that an additional dose from an disposal facility could be sufficiently reduced from the viewpoint of dose reduction under the ALARA principle if the design option for a disposal facility whose 95th percentile of dose distribution is lower than the target dose of 0.1 mSv/y is provided. Reducing uncertainties of the distribution of dose from disposal options is also an important aspect for the practical reduction in radiation dose to which members of the public are exposed.
A Cautionary Note on “A Cautionary Note on the Use of Ornstein Uhlenbeck Models in Macroevolutionary Studies”
Authors: Grabowski Mark , Pienaar Jason , Voje Kjetil L , Andersson Staffan , Fuentes-González Jesualdo , Kopperud Bjørn T , Moen Daniel S , Tsuboi Masahito , Uyeda Josef , Hansen Thomas F
Published: May 2023

Models based on the Ornstein–Uhlenbeck process have become standard for the comparative study of adaptation. Cooper et al. (2016) have cast doubt on this practice by claiming statistical problems with fitting Ornstein–Uhlenbeck models to comparative data. Specifically, they claim that statistical tests of Brownian motion may have too high Type I error rates and that such error rates are exacerbated by measurement error. In this note, we argue that these results have little relevance to the estimation of adaptation with Ornstein–Uhlenbeck models for three reasons. First, we point out that Cooper et al. (2016) did not consider the detection of distinct optima (e.g. for different environments), and therefore did not evaluate the standard test for adaptation. Second, we show that consideration of parameter estimates, and not just statistical significance, will usually lead to correct inferences about evolutionary dynamics. Third, we show that bias due to measurement error can be corrected for by standard methods. We conclude that Cooper et al. (2016) have not identified any statistical problems specific to Ornstein–Uhlenbeck models, and that their cautions against their use in comparative analyses are unfounded and misleading. [adaptation, Ornstein–Uhlenbeck model, phylogenetic comparative method.]
Public health evaluation of PFAS exposures and breastfeeding: a systematic literature review
Authors: Hoadley Lydia , Watters Michelle , Rogers Rachel , Siegmann Werner Lora , Markiewicz Karl V , Forrester Tina , McLanahan Eva D
Published: May 2023

Per- and polyfluoroalkyl substances (PFAS) are a class of man-made chemicals that are persistent in the environment. They can be transferred across the placenta to fetuses and through human milk to infants. The American Academy of Pediatrics advises that the benefits of breastfeeding infants almost always outweigh the potential risks of harm from environmental chemicals. However, there are few chemical-specific summaries of the potential harms of exposure to PFAS during the neonatal period through breastfeeding. This systematic review explores whether exposure to PFAS through breastfeeding is associated with adverse health outcomes among infants and children using evidence from human and animal studies. Systematic searches identified 4297 unique records from 7 databases. The review included 37 total articles, including 9 animal studies and 1 human study measuring the direct contribution of exposure of the infant or pup through milk for any health outcome. Animal studies provided evidence of associations between exposure to PFOA through breastfeeding and reduced early life body weight gain, mammary gland development, and thyroid hormone levels. They also provided limited evidence of associations between PFOS exposure through breastfeeding with reduced early life body weight gain and cellular changes in the hippocampus. The direct relevance of any of these outcomes to human health is uncertain, and it is possible that many adverse health effects of exposure through breastfeeding have not yet been studied. This review documents the current state of science and highlights the need for future research to guide clinicians making recommendations on infant feeding.
L’octroi de la force exécutoire aux sentences arbitrales rendues sous l’égide de la CCJA
Authors: Franck Bationo Didier
Published: May 2023

En arbitrage CCJA, l’octroi de la force exécutoire aux sentences arbitrales est subordonné à l’obtention d’une ordonnance d’exequatur du président de la CCJA. Cependant, à y voir de près, un octroi de plano serait davantage le bienvenu. Considérés en soi, les enjeux liés à l’octroi dans l’espace OHADA de la force exécutoire aux sentences arbitrales CCJA n’imposent pas en effet l’exigence d’un exequatur préalable. Toutefois, la possibilité d’un contrôle devrait demeurer disponible. Ainsi, un recours en opposition à l’exécution au profit de la partie condamnée pourrait être consacré à cet effet.
L’ouverture du droit d’agir au système des règlements alternatifs des différends en droit OHADA et Camerounais : un procédé séduisant mais d’une efficacité incertaine
Authors: Njock Luc Kevin Leny
Published: May 2023

The processes by which a model of social regulation channels its way of resolving conflicts make the strength of its conflict resolution system. Court justice has lost its exemplary function. The crisis of effectiveness and the crisis of legitimacy that the processual mode of dispute resolution is undergoing in our States, make it a justice system that is considered to have broken down. The need for justice thus directly raises the question of social regulation, the relevant model of social regulation. The call for a ‘right to sue’ open to the system of alternative dispute resolution rather than restrictively to the judiciary to resolve disagreements is the spearhead of the combinatorial approach to the administration of conflicts, the ferment of a plural approach to access to justice. Has Cameroonian law begun to renew its vision of the right to take legal action? Does it renew the dominant classical approach to the system of social regulation? The study notes the global and integral recognition of the alternative dispute resolution system, another, less contentious, way of dealing with disputes, the emergence within the traditional dispute resolution system of a right to amicable dispute resolution, but in an embryonic state. It then poses, in a prospective approach, the need for a unitary and global approach to private justice as challenges to be met to ensure the quality of this form of justice.
Mutual information networks reveal evolutionary relationships within the influenza A virus polymerase
Authors: Arcos Sarah , Han Alvin X , te Velthuis Aartjan J W , Russell Colin A , Lauring Adam S
Published: May 2023

The influenza A virus (IAV) RNA polymerase is an essential driver of IAV evolution. Mutations that the polymerase introduces into viral genome segments during replication are the ultimate source of genetic variation, including within the three subunits of the IAV polymerase (polymerase basic protein 2, polymerase basic protein 1, and polymerase acidic protein). Evolutionary analysis of the IAV polymerase is complicated, because changes in mutation rate, replication speed, and drug resistance involve epistatic interactions among its subunits. In order to study the evolution of the human seasonal H3N2 polymerase since the 1968 pandemic, we identified pairwise evolutionary relationships among ∼7000 H3N2 polymerase sequences using mutual information (MI), which measures the information gained about the identity of one residue when a second residue is known. To account for uneven sampling of viral sequences over time, we developed a weighted MI (wMI) metric and demonstrate that wMI outperforms raw MI through simulations using a well-sampled severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) dataset. We then constructed wMI networks of the H3N2 polymerase to extend the inherently pairwise wMI statistic to encompass relationships among larger groups of residues. We included hemagglutinin (HA) in the wMI network to distinguish between functional wMI relationships within the polymerase and those potentially due to hitch-hiking on antigenic changes in HA. The wMI networks reveal coevolutionary relationships among residues with roles in replication and encapsidation. Inclusion of HA highlighted polymerase-only subgraphs containing residues with roles in the enzymatic functions of the polymerase and host adaptability. This work provides insight into the factors that drive and constrain the rapid evolution of influenza viruses.
Reducing Complications in Pilon Fracture Surgery: Surgical Time Matters
Authors: Shafiq Babar , Zhang Bo , Zhu Diana , Gupta Deven K. , Cubberly Mark , Stepanyan Hayk , Rezzadeh Kevin , Lim Philip K. , Hacquebord Jacques , Gupta Ranjan
Published: May 2023

Objective:

To correlate patient-specific and surgeon-specific factors with outcomes after operative management of distal intra-articular tibia fractures.

Design:

Retrospective cohort study.

Setting:

3 Level 1 tertiary academic trauma centers.

Patients/Participants:

The study included a consecutive series of 175 patients with OTA/AO 43-C pilon fractures.

Main Outcome Measurements:

Primary outcomes included superficial and deep infection. Secondary outcomes included nonunion, loss of articular reduction, and implant removal.

Results:

The following patient-specific factors correlated with poor surgical outcomes: increased age with superficial infection rate (P < 0.05), smoking with rate of nonunion (P < 0.05), and Charlson Comorbidity Index with loss of articular reduction (P < 0.05). Each additional 10 minutes of operative time over 120 minutes was associated with increased odds of requiring I&D and any treatment for infection. The same linear effect was seen with the addition of each fibular plate. The number of approaches, type of approach, use of bone graft, and staging were not associated with infection outcomes. Each additional 10 minutes of operative time over 120 minutes was associated with an increased rate of implant removal, as did fibular plating.

Conclusions:

While many of the patient-specific factors that negatively affect surgical outcomes for pilon fractures may not be modifiable, surgeon-specific factors need to be carefully examined because these may be addressed. Pilon fracture fixation has evolved to increasingly use fragment-specific approaches applied with a staged approach. Although the number and type of approaches did not affect outcomes, longer operative time was associated with increased odds of infection, while additional fibular plate fixation was associated with higher odds of both infection and implant removal. Potential benefits of additional fixation should be weighed against operative time and associated risk of complications.

Level of Evidence:

Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.
Standardized Models for Identification and Intervention for Emergency Department Patients at Risk for Alcohol Use Disorder
Authors: Gutierrez Felipe
Published: May 2023

Alcohol use disorder (AUD) is chronic, lasting a person's lifetime. An increase in driving under the influence of alcohol, as well as emergency department (ED) visits, has been reported. The Alcohol Use Disorder Identification Test Consumption (AUDIT-C) is utilized to assess hazardous drinking. The Screening, Brief Intervention, Referral to Treatment (SBIRT) model assists in early intervention and referral for treatment. The Transtheoretical Model standardized instrument assesses individual readiness to change. These tools may be used by nurses and nonphysicians in the ED to help reduce alcohol use and the consequences of its use.
Factors Associated With Function-Focused Care Among Hospitalized Older Adults Living With Dementia
Authors: Resnick Barbara , Boltz Marie , Galik Elizabeth , Kuzmik Ashley , Drazich Brittany F. , McPherson Rachel , Wells Chris L. , Renn Cindy , Dorsey Susan G. , Ellis Jeanette
Published: May 2023

This article reports a study that was designed to describe the incidence of pain among older hospitalized patients with dementia and to evaluate the factors that influence pain among these individuals. It was hypothesized that function, behavioral and psychological symptoms of dementia, delirium, pain treatment, and patient exposure to care interventions would be associated with pain. Patients who performed more functional activities had less delirium. They also experienced higher quality-of-care interactions and were less likely to have pain. The findings from this study support the relationship between function, delirium, and quality-of-care interactions and pain. It suggests that it may be useful to encourage patients with dementia to engage in functional and physical activity to prevent or manage pain. This study serves as a reminder to avoid neutral or negative care interactions among patients with dementia as a strategy to mediate delirium and pain.
Refining the retinal phenotype of patients with suspected pentosan polysulfate sodium retinopathy
Authors: Kalaw Fritz Gerald P. , Arias Juan D. , Walker Evan , Baxter Sally L. , Freeman William R. , Borooah Shyamanga
Published: May 2023

Purpose:

To refine the retinal phenotypes of suspected pentosan polysulfate sodium toxicity using ultra-widefield imaging.

Methods:

Patients with complete dosing profiles who visited the ophthalmology department and with ultra-widefield and optical coherence tomography imaging records were identified using electronic health records at a large academic center. Retinal toxicity was initially identified using previously published imaging criteria, while grading was categorized using both previously reported and new classification systems.

Results:

One hundred and four patients were included in the study. Twenty-six (25%) were identified as having toxicity from PPS. The mean duration of exposure and cumulative dose between the retinopathy group (162.7 months, 1803.2 grams) were longer and higher compared to the non-retinopathy group (69.7 months, 972.6 grams) (both p<0.001). There was variability of extra-macular phenotype in the retinopathy group, with four eyes having only peripapillary involvement and six eyes having far peripheral extension.

Conclusion:

Retinal toxicity in the setting of prolonged exposure and increased cumulative dosing from PPS therapy produces phenotypic variability. Providers should be aware of the extramacular component of toxicity when screening patients. Understanding the different retinal phenotypes may prevent continued exposure and reduce the risk of vision-threatening foveal involving disease.
RECURRENT ANTERIOR UVEITIS ASSOCIATED WITH MAJOR FLUCTUATIONS IN CHOROIDAL THICKNESS IN A PATIENT WITH PACHYCHOROID DISORDER
Authors: Santina Ahmad , Bousquet Elodie , Somisetty Swathi , Fogel-Levin Miri , Tsui Edmund , Freund K. Bailey , Sarraf David
Published: May 2023

Purpose:

To describe remarkable choroidal thickness fluctuations corresponding to episodes of recurrent anterior uveitis with subretinal fluid development when exceeding a choroidal thickness threshold.

Methods:

A patient with pachychoroid pigment epitheliopathy and unilateral acute anterior uveitis of the left eye was evaluated over a period of 3 years with multimodal retinal imaging including optical coherence tomography. Longitudinal changes in subfoveal choroidal thickness (CT) were measured and correlated with episodes of recurrent inflammation.

Results:

Over the course of five recurrent episodes of inflammation in the left eye treated with oral antiviral and topical steroid therapy, subfoveal CT increased as much as 200 μm or more. By contrast, subfoveal CT in the fellow quiescent right eye was within normal limits and minimally changed throughout the follow-up. Increased CT occurred with each episode of anterior uveitis and decreased by 200 µm or more during periods of quiescence in the affected left eye. Subretinal fluid and macular edema developed with a maximum CT of 486 μm and spontaneously resolved when CT decreased after treatment.

Conclusion:

In eyes with pachychoroid disease, anterior segment inflammation may lead to marked increases in subfoveal CT and the development of subretinal fluid at a threshold thickness value.
Patient safety in emergency departments: a problem for health care systems? An international survey
Authors: Petrino Roberta , Tuunainen Eeva , Bruzzone Giulia , Garcia-Castrillo Luis
Published: May 2023

Background and importance

Patient safety in healthcare is one of the cornerstones of quality of care. The emergency department (ED) is by its very nature a place where errors and safety issues are liable to occur.

Objective

The aim of the study was to assess health professionals’ perception of the level of safety in EDs and to identify in which work domains safety appears most at risk.

Design and participants

Between 30 January and 27 February 2023, a survey addressing the main domains of safety was distributed to ED health care professionals through the European Society of Emergency Medicine contact network. It addressed five main domains: teamwork, safety leadership, physical environment and equipment, staff/external teams, and organisational factors and informatics, with a number of items for each domain. Further questions about infection control and team morale were added. The Cronbach’s alpha measure was calculated to assure internal consistency.

Measures and analysis

A score was developed for each domain by adding the question’s value using the following ranking: never (1), rarely (2), sometimes (3), usually (4), and always (5) and was aggregated in three categories. The calculated sample size needed was 1000 respondents. The Wald method was used for analysis of the questions’ consistency and X
2 for the inferential analysis.

Main results

The survey included 1256 responses from 101 different countries; 70% of respondents were from Europe. The survey was completed by 1045 (84%) doctors and 199 (16%) nurses. It was noted that 568 professionals (45.2%) had less than 10 years’ experience. Among respondents, 80.61% [95% confidence interval (CI) 78.42–82.8] reported that monitoring devices were available, and 74.7% (95% CI 72.28–77.11) reported that protocols for high-risk medication and for triage (66.19%) were available in their ED. The area of greatest concern was the disproportionate imbalance between needs and the availability of staff at times of greatest flow, considered sufficient by only 22.4% (95% CI 20.07–24.69) of doctors and 20.7% (95% CI 18.41–22.9) of nurses. Other critical issues were overcrowding due to boarding and a perceived lack of support from hospital management. Despite these difficult working conditions, 83% of the professionals said they were proud to work in the ED (95% CI 81.81–85.89).

Conclusion

This survey highlighted that most health professionals identify the ED as an environment with specific safety issues. The main factors appeared to be a shortage of personnel during busy periods, overcrowding due to boarding, and a perceived lack of support from hospital management.