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Two methods were developed to estimate updated mean seismic hazard for existing probabilistic seismic hazard analyses (PSHAs) due to a change in the ground motion model (GMM). Both methods were used to estimate updated hazard at nuclear power plant (NPP) sites in the Central and Eastern United States (CEUS) for a change from the Electric Power Research Institute (EPRI) 2013 GMM to the Next Generation Attenuation (NGA)-East GMM. These methods present efficient tools to inform decisions on whether to perform a full PSHA revision or other detailed evaluations, especially when a large number of sites must be analyzed. A Simplified Hazard (SiHaz) method was developed to estimate mean hazard explicitly using a reduced PSHA logic tree that incorporates the updated GMM and potential changes in the site response model. An alternative scaling method was independently developed to be applied directly to current CEUS NPP hazard. Both methods were validated using updated PSHA results at several sites. Estimates at 46 NPP sites using both methods showed good agreement for mean annual frequencies of exceedance between 1E-4 and 1E-5/yr.

One of the most important environmental cues for living organisms is gravity and many developmental processes depend on it. However, when it comes to light microscopy, a majority of studies on these processes work with their objects of interest placed perpendicular to their natural orientation. One reason for that is probably that light microscopes with the required horizontal beampath are either costly or require advanced technical skills. To circumvent these obstacles and make imaging of gravity-dependent processes with a horizontal beampath possible for any lab we developed GraviKit. It converts a standard inverted research microscope into an imaging device with a horizontal beampath with a stage that rotates the sample around the optical axis. Like this, the direction of gravity can be freely chosen during an imaging experiment. The system is easy to implement and suitable for multi-user environments.

The role of tissue specific metabolism of endogenous glucocorticoids (GCs) in the pathogenesis of human disease has been a field of intense interest over the last 20 years, fuelling clinical trials of metabolism inhibitors in the treatment of an array of metabolic diseases. Localised pre-receptor metabolism of endogenous and therapeutic GCs by the 11β-hydroxysteroid dehydrogenase (11β-HSD) enzymes (which interconvert endogenous GCs between their inactive and active forms) are increasingly recognised as being critical in mediating both their positive and negative actions on bone homeostasis. In this review we explore the roles of endogenous and therapeutic GC metabolism by the 11β-HSD enzymes in the context of bone metabolism and bone cell function, and consider future strategies aimed at modulating this system in order to manage and treat various bone diseases.

Introduction Subglottic stenosis (SGS) is the commonest manifestation of tracheobronchial disease in granulomatosis with polyangiitis (GPA) and carries a high degree of morbidity. Management of SGS-GPA is a double-edged sword. Delayed treatment may cause respiratory compromise and infectious complications. However, aggressive surgical management may initiate a systemic inflammatory response, reactivating the vasculitic cascade and potentially lead to long-term complications including renal vasculitis and consequential end-stage renal failure. There is currently no internationally agreed management strategy for this disease. Method This retrospective review was undertaken to analyse our unique combination of surgical dilatations and immunosuppressive-focused adjuvant management strategy between years 2011-2020. Results Sixteen of our one hundred and nine GPA patients (14.7%) had SGS and were included in our analysis. Whilst three patients (18.8%) improved solely on medical treatment, thirteen (81.3%) required combined surgery and immunosuppression (consisting of cyclophosphamide or Rituximab regimens). Thirty-nine surgical dilatations and two tracheostomies were performed over a mean 53-month follow-up period, with a calculated mean procedure rate of one every 24.8 months (2.7 - 89 months). Conclusions Our current management strategy affords a lower procedure rate at every 24.8 months compared to other published studies with combined procedure rate at every 14.9 months.

Cachexia is the involuntary loss of muscle and adipose tissue that strongly affects mortality and treatment efficacy in patients with cancer or chronic inflammatory disease. Currently, no specific treatments or interventions are available for patients developing this disorder. Given the well-documented involvement of pro-inflammatory cytokines in muscle and fat metabolism in physiological responses and in the pathophysiology of chronic inflammatory disease and cancer, considerable interest has revolved around their role in mediating cachexia. This has been supported by association studies that report increased levels of pro-inflammatory cytokines such as tumor necrosis factor-alpha (TNF-alpha) and interleukin-6 (IL-6) in some, but not all, cancers and in chronic inflammatory diseases such as chronic obstructive pulmonary disease (COPD) and rheumatoid arthritis (RA). In addition, preclinical studies including animal disease models have provided a substantial body of evidence implicating a causal contribution of systemic inflammation to cachexia. The presence of inflammatory cytokines can affect skeletal muscle through several direct mechanisms, relying on activation of the corresponding receptor expressed by muscle, and resulting in inhibition of muscle protein synthesis (MPS), elevation of catabolic activity through the ubiquitin-proteasomal system (UPS) and autophagy, and impairment of myogenesis. Additionally, systemic inflammatory mediators indirectly contribute to muscle wasting through dysregulation of tissue and organ systems, including GCs via the hypothalamus-pituitary-adrenal (HPA) axis, the digestive system leading to anorexia-cachexia, and alterations in liver and adipocyte behavior, which subsequently impact on muscle. Finally, myokines secreted by skeletal muscle itself in response to inflammation have been implicated as autocrine and endocrine mediators of cachexia, as well as potential modulators of this debilitating condition. While inflammation has been shown to play a pivotal role in cachexia development, further understanding how these cytokines contribute to disease progression is required to reveal biomarkers or diagnostic tools to help identify at risk patients, or enable the design of targeted therapies to prevent or delay the progression of cachexia.

Pseudomonas aeruginosa is an opportunistic pathogen that causes pneumonia in immunocompromised and intensive care unit (ICU) patients. During host infection, P. aeruginosa upregulates the type III secretion system (T3SS), which is used to intoxicate host cells with exoenzyme (Exo) virulence factors. Of the four known Exo virulence factors (U, S, T and Y), ExoU has been shown in prior studies to associate with high mortality rates. Preclinical studies have shown that ExoY is an important edema factor in lung infection caused by P. aeruginosa, although its importance in clinical isolates of P. aeruginosa is unknown. We hypothesized that expression of ExoY would be highly prevalent in clinical isolates and would significantly contribute to patient morbidity secondary to P. aeruginosa pneumonia. A single-center, prospective observational study was conducted at the University of Alabama at Birmingham Hospital. Mechanically ventilated ICU patients with a bronchoalveolar lavage fluid culture positive for P. aeruginosa were included. Enrolled patients were followed from ICU admission to discharge and clinical P. aeruginosa isolates were genotyped for the presence of exoenzyme genes. Ninety-nine patients were enrolled in the study. ExoY was present in 93% of P. aeruginosa clinical isolates. Moreover, ExoY alone (ExoY+/ExoU&minus, ) was present in 75% of P. aeruginosa isolates, compared to 2% ExoU alone (ExoY&minus, /ExoU+). We found that bacteria isolated from human samples expressed active ExoY and ExoU, and the presence of ExoY in clinical isolates was associated with end-organ dysfunction. This is the first study we are aware of that demonstrates that ExoY is important in clinical outcomes secondary to nosocomial pneumonia.

Objectives Bruxism is a commonly reported oral parafunctional activity characterised by excessive tooth grinding or clenching outside normal functional activity. The present systematic review aims to examine the available literature to determine the effectiveness of occlusal splints in the treatment of bruxism compared to no treatment and alternative treatment modalities. Data Data extraction was undertaken in conjunction with quality of evidence assessment. Sources A literature search of the following databases was undertaken: MEDLINE via OVID, Pubmed (Medline), Cochrane Oral Health Group’s Trials, The Cochrane Central Register of Controlled Trials and EMBASE. Study selection Randomised Controlled Trials (RCT) and quasi-RCTs which met the inclusion criteria were selected for analysis. These included studies comparing occlusal splints to no treatment or other interventions. Results Twenty-two studies were identified for review with fourteen meeting the inclusion criteria. Only a small number of studies were available in each comparison (one or two for some) all of which had a medium to high risk of bias. Conclusions There is insufficient evidence to determine whether occlusal splint therapy for the treatment of bruxism provides a benefit over no treatment, other oral appliances, TENS, behavioural or pharmacological therapy. Furthermore, there is a lack of studies in each comparison with many suffering from a high risk of bias. There is a need for further research in this area and improvement in trial quality. Clinical significance statement This systematic review aimed to determine the effectiveness of occlusal splints in the treatment of bruxism. It found there was insufficient evidence to recommend occlusal splint therapy over no treatment or other treatment modalities. This is relevant to dental clinicians who may provide such appliances and cautions them in treatment provision.

Background: The opioid epidemic has spurred investigations for nonopioid options, yet limited research persists on medical marijuana's (MMJ) efficacy in managing cancer-related symptoms. Objective:...

A reliable and consistently reproducible technique to fabricate 222Rn-loaded radioactive sources ( ∼ 0.5–1 kBq just after fabrication) based on liquid scintillator (LS), with negligible amounts of LS quencher contaminants, was implemented. This work demonstrates the process that will be used during the Borexino detectors upcoming calibration campaign, where one or several ∼ 100 Bq such sources will be deployed at different positions in its fiducial volume, currently showing unprecedented levels of radiopurity. These sources need to fulfill stringent requirements of 222Rn activity, transparency to the radiations of interest and complete removability from the detector to ensure their impact on Borexino’s radiopurity is negligible. Moreover, the need for a clean, undistorted spectral signal for the calibrations imposes a tight requirement to minimize scintillator quenching agents (”quenchers”) to null or extremely low levels.

Burbot Lota lota in the lower Kootenai River, Idaho, have been the focus of extensive conservation efforts, particularly conservation aquaculture. One of the primary management strategies has been the release of Burbot into small tributaries in the Kootenai River basin, such as Deep Creek. Since 2012, approximately 12,000 juvenile Burbot have been stocked into Deep Creek; however, little is known about the habitat use of stocked Burbot. The objective of this study was to evaluate habitat associations of juvenile Burbot in Deep Creek. Fish and habitat were sampled from 58 reaches of the creek. Regression models suggested that Burbot moved little after stocking and were associated with areas of high mean depth and coarse substrate. This study provides additional knowledge on habitat associations of juvenile Burbot and suggests that managers should consider selecting deep habitats with coarse substrate for stocking locations.Received December 15, 2016; accepted May 22, 2017

A rational and quantitative shutdown criterion is required for a nuclear power plant in response to seismic shaking to determine whether the plant must be shut down for inspection. The shutdown criterion is generally defined in terms of seismic damage indicating parameters. This paper presents seismic damage indicating parameters of the recorded free-field and in-structure motions at the Onagawa, Fukushima Daiichi, Fukushima Daini, and Tokai Daini nuclear power plants during the 2011 Tohoku-oki earthquake. The observed seismic damage indicating parameters largely exceed the current U.S. and Japan shutdown thresholds for nuclear power plants, while minimal damage due to ground shaking was observed at the four Japanese plants. These observations indicate a potential for raising the current threshold without introducing any significant additional seismic risk to nuclear power plants. The insights presented in this paper can be used to guide regulation and industry methods for quickly evaluating the damage potential of future earthquakes that affect nuclear power plants. With some adjustment, a similar methodology and criterion could be applied to conventional structures and lifeline infrastructure.

Background Rheumatoid arthritis is a chronic and common inflammatory autoimmune disease. This primarily involves the synovia of the joints, but can cause many extra-articular manifestations as well, including peripheral ulcerative keratitis (PUK) and necrotising scleritis. These are often a threat to vision; they significantly compromise not only the eyeʼs structural integrity but are also important for prognosis and need urgent management. History and signs Three cases of peripheral ulcerative keratitis associated with rheumatoid arthritis were recorded in the electronic databank of the Jules Gonin Uveitis Clinic, two with necrotising scleritis and peripheral ulcerative keratitis and one with only peripheral ulcerative keratitis. They were all followed at Jules Gonin Eye Hospital (Lausanne, Switzerland), conjointly with the Department of Rheumatology at the Centre Hospitalier Universitaire Vaudois (Lausanne, Switzerland). Therapy and Outcome Good initial therapeutic response was observed in the two patients who received rituximab therapy. The patient who received only high dose corticosteroid developed massive colon perforation as well as acute renal insufficiency a few days after her ocular event. Conclusion From our limited number of patients, we found that the two patients who received the induction therapy with rituximab were stabilised from an ocular standpoint; however, rituximab had to be switched to other molecules, either due to other systemic symptoms from the disease itself or due to adverse effect of this treatment. This contributes to the increasing number of reports that rituximab can be an effective treatment for refractory ocular complications of rheumatoid arthritis (RA), at least as an induction therapy.

Introduction Cardiac fibrosis is a severe consequence of cardiovascular disease and aging, in which we currently have no effective treatments. The mechanisms underpinning the development of cardiac fibrosis remains poorly understood. Our preliminary data suggested extracellular matrix protein 1 (ECM1) is involved in cardiac fibrosis. We therefore aimed to investigate the role of ECM1 in several fibrotic cardiac diseases. Methods Young and ageing (3m/18m) male C57BL/6 mice, and primary mouse cardiac fibroblast (cFB) cultures, commercial human cardiac fibroblasts (Hu-cFB), human coronary artery endothelial cell (HCAEC)/smooth muscle cell (HCASMC), and human cardiac myocyte (HCM) cell lines were used. Young mice were subject to myocardial infarction (MI, 3-day/28-day, n=6/6), or pressure overload (TAC, 3-day/13-week, n=4/4). Left ventricle (LV) was collected at all time-points, and at 18m (ageing; n=3). Spleen and bone marrow was extracted from young control mice. Hu-cFB cells were treated with recombinant ECM1 (20ng/ml) for either 10, 30 or 50 min, or 48h. Immunoblotting was conducted on all samples, qPCR on LV tissue only, density gradient centrifugation and multicolour flow cytometry coupled with fluorescent ECM1 mRNA in-situ hybridisation (FISH-Flow) on bone marrow cells. Results ECM1 expression was upregulated in ageing LV (mRNA 2.2±0.1-fold, p=0.0002; protein 2.0-fold, p=0.0006), day-3 post-MI (mRNA, 4.9±2.0-fold, p=0.004; protein, 3.0-fold, p=0.004), a trend of ECM1 upregulation was observed at day-28 post-MI (mRNA, 13.2±12.0-fold, p=0.003; protein, 1.8-fold, p=0.2), but no change post-TAC. Both ERK1/2 and AKT phosphorylation was upregulated 10 min post-ECM1 treatment of Hu-cFBs (ERK1/2, 2.0-fold, p Conclusions These data demonstrate that ECM1 plays a role in ageing and post-MI fibrosis. Although ECM1 was not produced by resident cardiac cells, it was highly expressed in spleen and bone marrow; specifically, large, granular bone marrow cell sub-types such as granulocytes and/or macrophages. Our data suggest ECM1 is expressed by cardiac infiltrating leukocytes to provoke fibroblast collagen expression in a disease specific manner; potentially via the ERK1/2 and/or AKT pathway activation. Therefore, ECM1 warrants further investigation, and may be a promising target for the treatment of fibrotic cardiac diseases. Acknowledgement/Funding John hunter hospital charitable trust, Hunter medical research institute (HMRI) grants

We determined whether longitudinal changes in MetS were influenced by interaction between a genetic risk score (GRS) and habitual dietary patterns among whites and African Americans. We used the Atherosclerosis Risk in Communities study data from 4-visits (1987-1998) for 9,778 whites and 2,922 African Americans aged 45-65y at baseline. MetS was defined according to the NCEP, Adult Treatment Panel III criteria. Dietary variables were obtained from the Atherosclerosis Risk in Communities study food frequency questionnaire. Generalized linear models using risk ratios (RR) and 95% confidence intervals (CI) with p < 0.05 were used to judge model statistical significance. For every 5-allele increase, the GRS was associated with increased risk for MetS in whites (RR=1.12;95% CI=1.11-1.13) and African Americans (RR=1.16;1.14-1.19), respectively. Those in the upper half of the GRS had 1.20-fold (RR=1.20;1.18-1.23) and 1.25-fold (RR=1.25;1.20-1.29) increased risk for MetS among whites and African Americans, respectively. For every 5-unit increase in factor scores for dietary patterns: Red/processed meat (RR= 1.13;1.09-1.18), skim milk/lowfat dairy (RR=1.11;1.06-1.17), high-fat dairy/butter (RR=0.95;0.90-100), and high carbohydrate foods (RR=1.20;1.14-1.27) were associated with longitudinal changes in MetS among whites. Dietary pattern with whole milk/high fat dairy was protective in MetS among African Americans (RR=0.81;0.72-0.90) but the dietary pattern characterized by red processed meat was harmful (RR=1.16;1.08-1.25). In interaction models, among whites, a protective risk remained for high-fat dairy dietary pattern after interaction with the risk-causing GRS (RR=0.85;0.75-0.96). Certain dietary patterns may be associated with MetS. However, the effect of a higher fat intake dietary pattern may be protective of MetS among whites and African Americans even with a high burden of risk-causing alleles among whites. Disclosure D.S. Hardy: None. Funding National Heart, Lung, and Blood Institute (K01HL127278)

Pacific Northwest National Laboratory (PNNL), in collaboration with government agencies and industries, is actively engaged in the development, testing, and characterization of high efficiency, low cost modular solid oxide fuel cell power generation systems for stationary, automotive and military applications. Advanced SOFC systems are being developed which will offer ease of operation on a variety of gaseous liquid hydrocarbon and coal-derived fuels as well as "zero emissions" capability. SOFC R&D activities at PNNL continue in the areas of cell component materials, electrochemistry, cell design and modeling, high temperature corrosion, and fuel processing. Specific activities include development of optimized materials and cost effective fabrication techniques for high power density anode-supported cells operating at temperatures below 800 degrees C, characterization of processes responsible for high electrical performance and long term performance degradation, optimization and cell and stack designs using computational engineering models, and hydrocarbon fuel processing using micro technology.

Ferritic stainless steels are preferred to interconnect materials for intermediate temperature SOFCs because of their resistance to oxidation, high formability, and low cost. However, their protective oxide layer produces Cr-containing volatile species at SOFC operating temperatures and conditions, which can cause cathode poisoning. Electrically conducting spinel coatings have been developed to prevent cathode poisoning and to maintain an electrically conductive pathway through SOFC stacks. PNNL demonstrated the Mn-Co-O type of spinel coating on the interconnect part and delivered a great result. However, the industrial partners need the cost down of these coating materials. Hence, PNNL starts investigating next-generation coating materials. This paper will focus on the electrically conductive coating process.

Burbot Lota lota maculosa numbers in Kootenay Lake and Kootenai River of British Columbia, Idaho, and Montana have diminished due to habitat changes from the construction of Libby Dam. Recent implementation of a conservation strategy included aquaculture to supplement the population using a donor stock from a self-sustaining lake population within the watershed. Evaluation of release strategies using telemetry and mark recapture through hoop netting suggests lake-origin Burbot have adapted to the Kootenai system and selected riverine over lacustrine habitat. Previous telemetry work identified good survival and dispersal of released Burbot, and vast dispersal distance and lacustrine use. However, our analysis of a broader telemetry dataset indicated that only 24% of age 1–4 Burbot were detected in the lake. Recapture hoop net data indicated that Burbot residing in the river have growth and survival rates comparable to the historical population. Spawning of hatchery origin fish was detected at historical riverine spawning locations. Other than later spawn timing, our evaluations suggest lake-origin fish are mimicking movement and habitat use of the historical riverine population. This study, in combination with others, provides evidence that Burbot progeny from lacustrine brood stock can successfully survive, grow, disperse, and spawn in a riverine environment.

Recent research has shown that there are multiple motives for participation in high-risk sport; however these results have come from studies that consider a number of different sports. Therefore, the aim of the present study was to better understand the motives and risk-related aspects of freeriding, using a qualitative approach. Semi-structured interviews were conducted with 40 professional and semi-professional freeride skiers and snowboarders. All freeriders were highly experienced, of different age (19-44 years; 27.5 ± 4.5 years), gender (female = 13), and profession (professional athletes = 11). Analyses were done using MAXQDA software following a code theme approach. Mixed methods analyses using χ2-tests were computed for age (

Cancer pain syndromes in the urogenital region may be related to diagnostic procedures, antineoplastic treatments, or tumors themselves. Evaluation of cancer pain, in general, is multidimensional, involving subjective and objective data, as well as giving attention to psychosocial and spiritual factors. Management of cancer pain requires a multimodal, multidisciplinary approach. Medications are the mainstay of cancer pain treatment, with nerve blocks and radiation being important considerations in a comprehensive pain plan.

Objective Traumatic brain injury (TBI) survivors often exhibit problems with executive function (EF). Language use can also impact EF test performances. We examined the effects of TBI and bilingualism/monolingualism on several EF tests. Method The sample (N = 94) consisted of 37 healthy controls (19 bilingual; 18 monolingual), 30 acute TBI participants (10 bilingual; 20 monolingual), and 27 chronic TBI participants (16 bilingual; 11 monolingual). Acute TBI participants were tested 6 months post-injury and chronic TBI participants were tested 12 months or more post-injury. Stroop Color-Word (SCW), Delis-Kaplan Executive Function System Letter Fluency (DKEFS-LF), Trail Making Test part B (TMT-B) and a EF global composite (EF-GC) were used to assess EF. All participants passed performance validity testing. 3X2 ANOVAs were conducted to determine the effect of TBI and bilingualism/monolingualism on EF performances. Results Main effects were found between groups (control and TBI groups) on SCW, p = .046, ηp² = .07, TMT-B, p = .042, ηp² = .07, and EF-GC, p = .005, ηp² = .13; the 6-month TBI group performed worse than controls on TMT-B and EF-GC. Main effects were found for bilingualism/ monolingualism on SCW, p = .012, ηp² = .07, and TMT-B, p = .034, ηp² = .05; monolingual participants performed better than bilingual participants. No significant interactions between TBI and language were found. Conclusion The TBI group underperformed on SCW, TMT-B, and EF-GC compared to controls; relative to monolinguals, bilinguals underperformed on the SCW and TMT-B only. In conclusion, our findings seem to suggest that monolinguals have better cognitive flexibility compared to bilinguals that result in better EF performances.

As part of recovery efforts for the Kootenay population of Burbot Lota lota, we monitored 109 sonic-tagged, hatchery-reared Burbot released at 1–3 years of age throughout Kootenay Lake and the Kootenay River over a 3-year period. Our objectives were to evaluate broodstock choice, assess differences in survival and dispersal by release site and age, and evaluate spawning movements. Overall, release survival was high (66%) and there was dispersal throughout the system (up to 235 km), involving both lacustrine and riverine habitat. Spawning movements were extensive (up to 59 km/d upstream) and suggest the use of known spawning locations. However, most age-1 releases had lower survival and remained in the release tributaries for 1 year postrelease, which was longer than expected and which warrants further investigation. Overall, this telemetry study provides a positive outlook on the current aquaculture rehabilitation efforts for Kootenay Burbot and provides direction for further work. Received Septe...

Anaphylaxis has been defined as a 'severe, life-threatening generalized or systemic hypersensitivity reaction'. However, data indicate that the vast majority of food-triggered anaphylactic reactions are not life-threatening. Nonetheless, severe life-threatening reactions do occur and are unpredictable. We discuss the concepts surrounding perceptions of severe, life-threatening allergic reactions to food by different stakeholders, with particular reference to the inclusion of clinical severity as a factor in allergy and allergen risk management. We review the evidence regarding factors that might be used to identify those at most risk of severe allergic reactions to food, and the consequences of misinformation in this regard. For example, a significant proportion of food-allergic children also have asthma, yet almost none will experience a fatal food-allergic reaction; asthma is not, in itself, a strong predictor for fatal anaphylaxis. The relationship between dose of allergen exposure and symptom severity is unclear. While dose appears to be a risk factor in at least a subgroup of patients, studies report that individuals with prior anaphylaxis do not have a lower eliciting dose than those reporting previous mild reactions. It is therefore important to consider severity and sensitivity as separate factors, as a highly sensitive individual will not necessarily experience severe symptoms during an allergic reaction. We identify the knowledge gaps that need to be addressed to improve our ability to better identify those most at risk of severe food-induced allergic reactions.

Background Antipsychotics are perceived to be over-used in the management of behavioural problems in people with an intellectual disability (ID). Published guidelines have set good practice standards for the use of these drugs for behavioural indications. We sought to identify the range of indications for which antipsychotic drugs are prescribed in people with ID and to audit clinical practice against the standards. Method Data were collected from the clinical records of individuals with ID who were under the care of mental health services in the UK, and prescribed an antipsychotic drug. Results The sample comprised 2319 patients from 39 clinical services. Twenty-seven per cent of the patients had a diagnosis of a psychotic illness (ICD-10 F20–29) and 27% an affective illness (ICD-10 F30–39). The proportion who did not have a psychiatric diagnosis ranged from 6% of those with borderline/mild ID to 21% of those with severe/profound ID. Overall, the most common indications for prescribing an antipsychotic drug were comorbid psychotic illness, anxiety and agitation, and a range of behavioural disturbances. The prevalence of use of antipsychotic drugs to manage challenging behaviour in the absence of concomitant mental illness increased with the severity of ID and accounted for almost half of prescriptions in those with severe/profound ID. Adherence to the audit standards related to documentation of clinical indications and review of efficacy was high. Side effect monitoring was less assiduous. Conclusions In clinical practice, most prescriptions for antipsychotic drugs in people with ID are consistent with the evidence base and the overall quality of prescribing practice, as measured against recognised standards, is good, although in some patients potentially remedial side effects may not be detected and treated.

Introduction. Parenteral iron formulations are frequently used to correct iron deficiency anemia (IDA) and iron deficiency (ID). Intravenous formulation efficacy on ferritin and hemoglobin level improvement is greater than that of oral formulations while they are associated with lower gastrointestinal side effects. Ferric carboxymaltose- (FCM-) related hypophosphatemia is frequent and appears without clinical significance. The aim of this study was to assess the prevalence, duration, and potential consequences of hypophosphatemia after iron injection.Patients and Methods. The medical records of all patients who underwent parenteral iron injection between 2012 and 2014 were retrospectively reviewed. Pre- and postinjection hemoglobin, ferritin, plasma phosphate, creatinine, and vitamin D levels were assessed. Patients who developed moderate (range: 0.32–0.80 mmol/L) or severe (Results. During the study period, 234 patients received iron preparations but 104 were excluded because of missing data. Among the 130 patients included, 52 received iron sucrose (FS) and 78 FCM formulations. Among FS-treated patients, 22% developed hypophosphatemia versus 51% of FCM-treated patients, including 13% who developed profound hypophosphatemia. Hypophosphatemia severity correlated with the dose of FCM (p=0.04) but not with the initial ferritin, hemoglobin, or vitamin D level. Mean hypophosphatemia duration was 6 months. No immediate clinical consequence was found except for persistent fatigue despite anemia correction in some patients.Conclusions. Hypophosphatemia is frequent after parenteral FCM injection and may have clinical consequences, including persistent fatigue. Further studies of chronic hypophosphatemia long-term consequences, especially bone assessments, are needed.

Firearms are the source of a significant number of preventable injuries and deaths to children. The risk of homicide, suicide, and unintentional deaths and injuries is greater when a firearm is present, particularly when the firearm is stored unsafely. Up to 40% of children have access to firearms in their homes, and adolescents have greater access across a wider domain of areas. Children's (especially boys') fascination with guns has been well-documented and appears resistant to intervention. Young children lack the cognitive maturity to generalize lessons learned in the classroom to the real world of their homes and play areas. Older children and adolescents believe themselves to be invulnerable to injury and are easily persuaded by their peers to act in defiant and reckless ways. The interventions themselves are rarely based on sound behavioral principles, lack adequate evaluation criteria, and may promote a gun-carrying norm. Community-based education, media campaigns, access prevention laws, and physician-based counseling also appear to have little significant impact on gun ownership and safe storage practices of parents. Prevention of firearm injuries and deaths among children and adolescents needs to be depoliticized and reframed as a public health issue.

Coal is potentially a very inexpensive source of clean hydrogen fuel for use in fuel cells, turbines, and various process applications. To realize its potential however, efficient low-cost gas separation systems are needed to provide high purity oxygen that will enhance the coal gasification reaction and to extract hydrogen from the resulting gas product stream. Several types of inorganic membranes are being developed for hydrogen or oxygen separation, including porous alumina, transition metal oxide perovskites, and zirconia. Because they form the heart of the working device, numerous advances have been made in the fabrication and performance of these membrane materials. However, less emphasis has been placed on the materials that will be used in the balance of the device; in particular, the seals that bond the functional ceramic to the metallic structural component. In an effort to begin addressing this issue, we have examined ceramic-to-metal brazing as a method of sealing a model set of gas separation component materials: yttria-stabilized zirconia and stainless steel. In comparative high-temperature exposure testing of joints prepared using commercial brazes and a newly conceived braze alloy, the commercial material proved to be unsuitable due to excessive oxidation. On the other hand, the new material not only displayed superior oxidation resistance, but also excellent hermeticity in prototypic membrane testing.

Objectives . To explore what it is like to be a pregnant smoker in Sunderland and to inform the development of a Smoking Cessation Programme; to use qualitative techniques to develop a cessation programme tailored to pregnant smokers. Study design . The intervention follows years of social marketing research and development in Sunderland, Wearside, UK. Methods . Information derived from nine focus groups (mainly with women from deprived areas, social class C2D and E) provided insights into the issues facing smoking pregnant women. This information was then used to overcome barriers to smoking cessation using the principles of social marketing. The number of women recruited into a specially designed smoking cessation support initiative was compared with women recruited into comparable groups in the North East. Results . Recruitment of pregnant (and non-pregnant) smokers to the new NHS smoking cessation programme in Sunderland has increased during the intervention phase compared with neighbouring Primary Care Trust areas (in which different smoking cessation interventions targeted at pregnant women were being undertaken). Conclusions . This innovative intervention has been successful in generating ideas, guiding development of a customer-friendly service and encouraging women to come forward for smoking cessation support during their pregnancy. The target population have welcomed the approach, and health professionals have enjoyed and benefited from the role play with professional actors.

One of the challenges in manufacturing planar solid oxide fuel cells (pSOFCs) is in hermetically sealing the ceramic and metallic components such that the resulting joint remains rugged and stable over the lifetime of the stack. Traditionally, glass joining or compressive sealing has been used. While short-term success has been achieved with these techniques, it is apparent that to meet the long-term operational needs of stack designers, alternative sealing concepts will need to be conceived. At Pacific Northwest National Laboratory we have been developing two such alternatives, air brazing and bonded compliant sealing, the details of which are outlined here.

The present study investigated the effectiveness of a skills-based firearm safety program on reducing children's play with firearms. In a randomized control study, 34 children aged 4 to 7 years participated in a week-long firearm safety program; the Control Group was composed of 36 children. After the program, pairs of children were observed playing in a structured setting in which they had access to a semiautomatic pistol. A total of 53% of the pairs played with the gun, and there was no difference in gun-play behavior between those children who did and did not receive the intervention. Interview data revealed significant discrepancies in parent and child reports of parental gun ownership and inaccurate parental predictions of their children's interest in guns. The results of the current study cast doubt on the potential effectiveness of skills-based gun safety programs for children.

A test fixture and methodology was developed for testing anode-supported SOFC button cells downstream from a chromia pellet placed in the cathode air stream at a prescribed temperature to control volatilization of Cr vapor species. A porous alumina foam coated with a Cr gettering material is then placed downstream from the cell to capture Cr from the cathode air stream. The Cr gettering coating is composed of Na2CO3, which reacts with Cr vapor species to form Na2CrO4. The coating and its reaction product are both water soluble which facilitates dissolving them from the porous substrate for subsequent ICP analysis to determine the concentration of the resulting aqueous solution. The mass of collected Cr can then be calculated and used to determine the average concentration in the known volume of air that flowed past the cathode over the duration of the test. Electrochemical tests of cells with LSM/YSZ cathodes were performed with the chromia pellet at varying conditions of temperature and humidity to elicit various levels of Cr volatility. Multiple cells were tested at each condition for 600 to 1000 hours. Molar concentrations of Cr in the cathode air as small as 4×10-11 were found to cause ~4%/kh degradation in performance.

The Fuel Cycle Research and Development (FCRD) program of the Office of Nuclear Energy (NE) has implemented a program to develop a Uranium-Molybdenum (U-Mo) metal fuel for Light Water Reactors (LWR)s. Uranium-Molybdenum fuel has the potential to provide superior performance based on its thermo-physical properties, which includes high thermal conductivity for less stored heat energy. With sufficient development, it may be able to provide the Light Water industry with a melt-resistant accident tolerant fuel with improved safety response. However, the corrosion of this fuel in reactor water environments needs to be further explored and optimized by additional alloying. The Pacific Northwest National Laboratory has been tasked with performing ex-reactor corrosion testing to characterize the performance of U-Mo fuel. This report documents the results of the effort to characterize and develop the U-Mo metal fuel concept for LWRs with regard to corrosion testing. The results of a simple screening test in buffered water at 30°C using surface alloyed U-10Mo is documented and discussed. The screening test was used to guide the selection of several potential alloy improvements that were found and are recommended for further testing in autoclaves to simulate PWR water conditions more closely.

The purpose of this study was to investigate the effects of dominant leg, lower leg casting on energy cost during independent ambulation. The Physiological Cost Index, predicted VO 2max , and gait speed values of a Quarter-Mile Walk Test, with and without lower leg casting, were utilized to determine energy cost. Methods: Thirty-five subjects who were 23 to 32 years old (mean age 25.37 ± 2.02) performed the Quarter-Mile Walk Test at their comfortable walking speed on two occasions, one with and one without lower leg casting. Resting heart rate, walking heart rate, and time to complete the test were recorded. Physiological Cost Index, predicted VO 2max , and gait speed formulas were used to calculate results. Results: Physiological Cost Index increased when walking with the lower leg cast, but was not statistically significant (p=.3939). A statistically significant decrease was seen with predicted VO 2max (p

The United States Nuclear Regulatory Commission initiated a formal review of the seismic margin of all operating nuclear power plants in the US with the issuance in 1991 of Generic Letter 88-20, Supplement 4 (‘Individual Plant Examination of External Events (IPEEE) for Severe Accident Vulnerabilities’). Virtually all of the US nuclear utilities have submitted their responses for seismic IPEEE and these submittals are in the process of being reviewed by the NRC. The objective of this paper is to provide an industry perspective on the results and the insights obtained from the utility seismic IPEEE submittals.

Several seismic licensing and safety issues have emerged over the past fifteen years for commercial US Nuclear Power Plants and US Government research reactors, production reactors and process facilities. The methodologies for the resolution of these issues have been developed in numerous government and utility sponsored research programs. The resolution criteria have included conservative deterministic design criteria, deterministic seismic margins assessments criteria (SMA) and seismic probabilistic risk assessment criteria (SPRA). The criteria for SMAs and SPRAs have been based realistically on considering the inelastic energy absorption capability of ductile structures, equipment and piping and have incorporated the use of earthquake and testing experience to evaluate the operability of complex mechanical and electrical equipment. Most of the applications to date have been confined to the US, however there have been several applications to Asian, Western and Eastern Europe reactors. This paper summarizes the major issues addressed, the development of reevaluation criteria and selected applications to non US reactors including VVER reactors of Soviet origin.

Existing nuclear facilities throughout the world are being subjected to severe scrutiny of their safety in the event of an earthquake. In the United States, there have been several licensing and safety review issues for which industry and regulatory agencies have cooperated to develop rational and economically feasible criteria for resolving the issues. Currently, all operating nuclear power plants in the United States are conducting an Individual Plant Examination of External Events, including earthquakes beyond the design basis. About two-thirds of the operating plants are conducting parallel programs for verifying the seismic adequacy of equipment for the design basis earthquake. The U.S. Department of Energy is also beginning to perform detailed evaluations of their facilities, many of which had little or no seismic design. Western European countries also have been re-evaluating their older nuclear power plants for seismic events often adapting the criteria developed in the United States. With the change in the political systems in Eastern Europe, there is a strong emphasis from their Western European neighbors to evaluate and upgrade the safety of their operating nuclear power plants. Finally, nuclear facilities in Asia are also being evaluated for seismic vulnerabilities. This paper focuses on the methodologies that have been developed for re-evaluation of existing nuclear power plants and presents examples of the application of these methodologies to nuclear facilities worldwide.

This case report highlights an unusually prolonged, asymptomatic, disease-free interval in an aged male Labrador retriever that underwent partial pancreatectomy for a functionally active pancreatic insulinoma with histologically confirmed hepatic metastasis. The patient developed pancreatitis and nonseptic suppurative peritonitis 24 hr after surgical resection of the insulinoma and was managed medically until discharge. Three mo after surgery, the dog was diagnosed with exocrine pancreatic insufficiency (EPI) that was effectively managed with parenteral pancreatic enzymes. Due to normal glucose levels 3 mo postsurgically, liver samples from the initial surgery were resubmitted for immunohistochemistry. Results confirmed insulinoma metastasis with insulin expression. Ten mo postsurgically, the blood glucose was normal and serum insulin levels were slightly above the upper reference limit. The first hypoglycemic episode was documented 23 mo postoperatively, which was effectively managed with prednisone. The cause for the prolonged disease remission and survival was unknown, but was possibly a result of pancreatitis and peritonitis, partial spontaneous regression of metastatic lesions, or idiopathic. Despite life-threatening postoperativecomplications, thispatientenjoyedaprofoundly longerthanexpectedsurvival. Thiscasehighlightstheimportanceof removing the primary tumor (insulinoma) despite the presence of metastatic disease. (J Am Anim Hosp Assoc 2013; 49:224–229. DOI 10.5326/JAAHA-MS-5860)

In this paper, we propose trap-assisted tunneling (TAT) to account for the discrepancy between theoretical predictions and measured valley currents (also called excess currents) in double barrier resonant tunneling diodes (DB RTDs) with observed generation–recombination noise spectra. This proposed mechanism in DB RTDs is required, since predictions of excess currents from the models involving no gap states, such as quantum coherent tunneling, are too low. The model is also supported by the observed strong correlation between excess current and low frequency noise spectra. The trap states are assumed to be at or near the interface between the emitter and the first barrier in DB structures. The electrons trapped in the trap states emit out to tunnel through the double barriers. The empty trap states are then refilled by the electrons from the conduction band of the emitter. The conservation of the energy and momentum are incorporated through the emission–absorption of phonons. Based on these mechanisms, we propose a semiempirical formula for calculating valley current with three parameters, which are related to some physical parameters. A simple semiphysical model is set up to justify the three parameters and the detailed derivation is given. This two-step TAT currents are calculated for our examples of AlAs–GaAs–AlAs DB RTDs and are found to be in agreement with the measured excess currents. The variation of excess currents with temperature is also discussed. Improvement of the peak-to-valley current ratio, among other device design and fabrication considerations, depends on the reduction of these trap states.

Community fieldwork enhances learning by allowing students to integrate course material with actual issues in a community setting. This study investigated student and community satisfaction with programs designed and implemented by students for several pediatric populations. Both students and the community groups expressed high levels of satisfaction, and community confidence in the students' abilities rose over the course of the semester.

The paradigm of a traditional wired network protocol stack is a hierarchy of services provided by each individual layer, but the ability of such paradigm to handle an error-prone physical medium is severely compromised in wireless networks. Several approaches, including cross-layer techniques, have been developed to address this problem. While much cross-layer research endeavour focused on interactions of the lower layers, in this paper, we present a cross-layer technique that involves the transport and MAC layers. In particular, our approach allows the MAC layer of a WiMAX network to be made aware of the network congestion condition perceived by TCP at the transport layer. This cross-layer technique allows the scarce radio resource to be distributed in a more intelligent fashion among the stations in the network. More specifically, our resource allocation scheme at the MAC layer adapts to the congestion window sizes passed down from TCP. We have developed analytical and simulation models to understand the dynamics of the proposed technique and quantify the resulting performance gains. Our results show that our proposed algorithm delivers a better performance in average end-to-end delay, file download time, and throughput when the traffic intensity of the network is moderate to high.

Poly(dimethylsiloxane) (PDMS) microchannels are commonly used microfluidic structures that have a wide variety of biological testing applications, including the simulation of blood vessels to study the mechanics of vascular disease. In these studies in particular, the deformation of the channel due to the pressure inside is a critical parameter. We describe a method for using fluorescence microscopy to quantify the deformation of such channels under pressure driven flow. Additionally, the relationship between wall thickness and channel deformation is investigated. PDMS microchannels of varying top wall thickness were created using a soft lithography process. A solution of fluorescent dye is pumped through the channels at constant volume flow rates and illuminated. Pressure and fluorescence intensity are measured at five positions along the length of the channel. Fluorescence measurements are then used to determine deformation, using the linear relationship of dye layer thickness and intensity. A linear relationship between pressure and microchannel deformation is measured. Pressure drops and deformations closely correspond to values predicted by the model in most cases. Additionally, measured pressure drops are found to be up to 35% less than the pressure drop in a rigid-walled channel, and channel wall thickness is found to have an increasing effect as the channel wall thickness decreases.

Pulse shape discrimination (PSD) is one of the most distinctive features of liquid scintillators. Since the introduction of the scintillation techniques in the field of particle detection, many studies have been carried out to characterize intrinsic properties of the most common liquid scintillator mixtures in this respect. Several application methods and algorithms able to achieve optimum discrimination performances have been developed. However, the vast majority of these studies have been performed on samples of small dimensions. The Counting Test Facility, prototype of the solar neutrino experiment Borexino, as a 4 ton spherical scintillation detector immersed in 1000 tons of shielding water, represents a unique opportunity to extend the small-sample PSD studies to a large-volume setup. Specifically, in this work we consider two different liquid scintillation mixtures employed in CTF, illustrating for both the PSD characterization results obtained either with the processing of the scintillation waveform through the optimum Gatti's method, or via a more conventional approach based on the charge content of the scintillation tail. The outcomes of this study, while interesting per se, are also of paramount importance in view of the expected Borexino detector performances, where PSD will be an essential tool in the framework of the background rejection strategy needed to achieve the required sensitivity to the solar neutrino signals., 39 pages, 17 figures, submitted to Nucl. Instr. Meth. A

Over the past seven years the use of seismic experience data to address seismic concerns has received a great deal of attention, particularly regarding the Nuclear Regulatory Commission Unresolved Safety Issue (USI) A-46. The Seismic Qualification Utility Group (SQUG) was formed in January 1982 to develop a practical alternative to the rigorous seismic qualification of equipment for resolution of USI A-46. The alternative method chosen is seismic experience technology. The purpose of this paper is to explore two additional potential applications of seismic experience technology: • bb Replacement parts and • bb New equipment/design change process. The need for, and benefits of, these applications will be summarized. The available technology and the methodologies proposed will be described. The methodology descriptions include a summary of the requirements for the seismic evaluations, an outline of the method, and the documentation requirements.

The aquatic surface microlayer (SMIC), ∼50 μm thick, serves as a concentration point for metal and organic contaminants that have low water solubility or are associated with floatable particles. Also, the eggs and larvae of many fish and shellfish species float on, or come in contact with, the water surface throughout their early development. The objectives of this study were (1) to determine the present degree of aquatic surface microlayer pollution at selected sites in Chesapeake Bay, and (2) to provide a preliminary evaluation of sources contributing to any observed contamination. Twelve stations located in urban bays, major rivers, and the north central bay were sampled three times, each at ∼5-day intervals during May 1986. Samples of 1.4–4.1 each were collected from the upper 30–60-μm water surface (surface microlayer, SMIC) using a Teflon-coated rotating drum microlayer sampler. One sample of subsurface water was collected in the central bay. At all stations, concentrations of metals, alkanes, and aromatic hydrocarbons in the SMIC were high compared with one bulk-water sample and with typical concentrations in water of Chesapeake Bay and elsewhere. SMIC contamination varied greatly among the three sampling times, but high mean contaminant levels (total polycyclic aromatic hydrocarbons, 1.9–6.2 μg 1 −1 ; Pb, 4.9–24 μg 1 −1 ; Cu, 4–16 μg 1 −1 ; and Zn, 34–59 μg 1 −1 ) were found at the upper Potomac and northern bay sites. Three separate areas were identified on the basis of relative concentrations of different aromatic hydrocarbons in SMIC samples - the northern bay, the Potomac River, and the cleaner southern and eastern portions of the sampling area. Suspected sources of surface contamination include gasoline and diesel fuel combustion, coal combustion, and petroleum product releases. Concentrations of metals and hydrocarbons, at approximately half the stations sampled, are sufficient to pose a threat to the reproductive stages of some fish and shellfish. Sampling and analysis of the surface microlayer provides a sensitive tool for source identification and monitoring of potentially harmful aquatic pollution.