Spatio-temporal focal spot characterization and modeling of the NIF ARC kilojoule picosecond laser

The advanced radiographic capability (ARC) laser system, part of the National Ignition Facility (NIF) at Lawrence Livermore National Laboratory, is a short-pulse laser capability integrated into the NIF. The ARC is designed to provide adjustable pulse lengths of ∼1-38ps in four independent beamlets, each with energies up to 1 kJ (depending on pulse duration). A detailed model of the ARC lasers has been developed that predicts the time- and space-resolved focal spots on target for each shot. Measurements made to characterize static and dynamic wavefront characteristics of the ARC are important inputs to the code. Modeling has been validated with measurements of the time-integrated focal spot at the target chamber center (TCC) at low power, and the space-integrated pulse duration at high power, using currently available diagnostics. These simulations indicate that each of the four ARC beamlets achieves a peak intensity on target of up to a few 10¹⁸W/cm².

Diabetes Insipidus: Pathogenesis, Diagnosis, and Clinical Management

Diabetes insipidus (DI) is an endocrine condition involving the posterior pituitary peptide hormone, antidiuretic hormone (ADH). ADH exerts its effects on the distal convoluted tubule and collecting duct of the nephron by upregulating aquaporin-2 channels (AQP2) on the cellular apical membrane surface. DI is marked by expelling excessive quantities of highly dilute urine, extreme thirst, and craving for cold water. The two main classifications of DI are central diabetes insipidus (CDI), characterized by a deficiency of the posterior pituitary gland to release ADH, and nephrogenic diabetes insipidus (NDI), characterized by the terminal distal convoluted tubule and collecting duct resistance to ADH. The two less common classifications include dipsogenic DI, characterized by excessive thirst due to a low osmotic threshold, and gestational DI, characterized by increased concentration of placental vasopressinase during pregnancy. Treatment of DI is dependent on the disease classification, but severe complications may arise if not tended to appropriately. The most important step in symptom management is maintaining fluid intake ahead of fluid loss with emphasis placed on preserving the quality of life. The most common treatment of CDI and gestational DI is the administration of synthetic ADH, desmopressin (DDAVP). Nephrogenic treatment, although more challenging, requires discontinuation of medications as well as maintaining a renal-friendly diet to prevent hypernatremia. Treatment of dipsogenic DI is mainly focused on behavioral therapy aimed at regulating water intake and/or administration of antipsychotic pharmaceutical therapy. Central and nephrogenic subtypes of DI share a paradoxical treatment in thiazide diuretics.

Experiences of Renal Stone Fragmentation with the Use of the Ultrasound-guided Mini-percutaneous Nephrolithotipsy in 650 Patients

AIM: This study assesses the results of treatment using the mini-percutaneous nephrolithotipsy (PCNL) procedure on renal stone patients in a lateral position under ultrasound guidance, performed at the Ha Noi Hospital of Post and Telecommunications. METHODS: The study was conducted with 650 kidney stone patients who were treated using the ultrasound-guided mini-PCNL procedure in a lateral position, at the Ha Noi Hospital of Post and Telecommunications, over the period from June 2018 to June 2019. RESULTS: For the 650 patients, the mean age was 47.3 ± 7.6 (from 21 to 91 years old); the mean size of stones: 19.4 ± 1.2 mm (from 12 mm to 60 mm); the mean operative time: 49.3 minutes (from 37 to 90 min); the mean period of hospitalization: 3.9 days (from 3 to 12 days); the mean stone-free rate (SFR): 90.6%; the rate of second surgery: 1.07%; hemorrhage complication: 0.8%; urinary tract infections: 7.7%; septicemia: 0.6%; administered open surgery: 0.46%; and administered other methods: 0.76%. CONCLUSION: Renal stone fragmentation using the mini-PCNL procedure, performed on patients placed in lateral position under ultrasound guidance, is a method that is effective, beneficial, and safe for patients with renal stones and upper ureteral stones.

Using longitudinally sampled viral nucleotide sequences to characterize the drivers of HIV-1 transmission

OBJECTIVES

Understanding the drivers of HIV-1 transmission is of importance for curbing the ongoing epidemic. Phylogenetic methods based on single viral sequences allow us to assess whether two individuals are part of the same viral outbreak, but cannot on their own assess who potentially transmitted the virus. We developed and assessed a molecular epidemiology method with the main aim to screen cohort studies for and to characterize individuals who are 'potential HIV-1 transmitters', in order to understand the drivers of HIV-1 transmission.

METHODS

We developed and validated a molecular epidemiology approach using longitudinally sampled viral Sanger sequences to characterize potential HIV-1 transmitters in the Swiss HIV Cohort Study.

RESULTS

Our method was able to identify 279 potential HIV-1 transmitters and allowed us to determine the main epidemiological and virological drivers of transmission. We found that the directionality of transmission was consistent with infection times for 72.9% of 85 potential HIV-1 transmissions with accurate infection date estimates. Being a potential HIV-1 transmitter was associated with risk factors including viral load [adjusted odds ratio_{multivariable} (95% confidence interval): 1.86 (1.49-2.32)], syphilis coinfection [1.52 (1.06-2.19)], and recreational drug use [1.45 (1.06-1.98)]. By contrast for the potential HIV-1 recipients, this association was weaker or even absent [1.18 (0.82-1.72), 0.89 (0.52-1.55) and 1.53 (0.98-2.39), respectively], indicating that inferred directionality of transmission is useful at the population level.

CONCLUSIONS

Our results indicate that longitudinally sampled Sanger sequences do not provide sufficient information to identify transmitters with high certainty at the individual level, but that they allow the drivers of transmission at the population level to be characterized.

Measuring consumer access, appraisal and application of services and information for dementia (CAAASI-Dem): a key component of dementia literacy

BACKGROUND

The ability to locate, navigate and use dementia services and information, either for oneself or in providing care for others, is an essential component of dementia literacy. Despite dementia literacy being understood to be inadequate in many settings, no validated instrument exists to measure these elements. Here we describe the development and preliminary validation of the Consumer Access, Appraisal and Application of Services and Information for Dementia (CAAASI-Dem) tool.

METHODS

Items were adapted from existing health literacy tools and guided by discussion posts in the Understanding Dementia Massive Open Online Course (UDMOOC). Following expert review and respondent debriefing, a modified CAAASI-Dem was administered to UDMOOC participants online. On the basis of descriptive statistics, inter-item and item total correlations and qualitative feedback, this was further refined and administered online to a second cohort of UDMOOC participants. Exploratory factor analysis identified underlying factor structure. Items were retained if they had significant factor loadings on one factor only. Each factor required at least three items with significant factor loadings. Internal consistency of factors in the final model was evaluated using Cronbach's alpha coefficients.

RESULTS

From a pool of 70 initial items with either a 5-point Likert scale (Not at all confident - Extremely confident; or Strongly agree - Strongly disagree) or a binary scale (Yes - No), 65 items were retained in CAAASI-Dem-V1. Statistical and qualitative analysis of 1412 responses led to a further 34 items being removed and 11 revised to improve clarity. The 31 item CAAASI-Dem-V2 tool was subsequently administered to 3146 participants, one item was removed due to redundancy and EFA resulted in the removal of an additional 4 items and determination of a five factor structure: Evaluation and engagement; Readiness; Social supports; Specific dementia services; and Practical aspects.

CONCLUSIONS

The five factors and 26 constituent items in CAAASI-Dem align with functional, critical, and communicative aspects of dementia health literacy from the perspective of the carer. As a screening tool for people living with dementia and their carers, CAAASI-Dem potentially provides a means to determine support needs and may be a key component of the dementia literacy assessment toolbox.

Validation of a fuel particle dissolution model with samples from the Red Forest within the Chernobyl exclusion zone

The contamination in the near exclusion zone of the Chernobyl nuclear power plant (ChNPP) with ⁹⁰Sr, ^238-240Pu and ²⁴¹Am is associated with irradiated nuclear fuel particles. Fit for purpose models enabling long term prediction of mobility and bioavailability of particle-associated radionuclides are crucial for radiation protection of humans and the environment, as well as for planning of remediation measures and future land use. In the present work, a dynamic fuel particle dissolution model developed in 1999-2002 is described and validated using data based on sampling in 2015. The model is based on the characterization of the radionuclide source term of the waste in a shallow sub-surface radioactive waste storage, trench #22, in the Chernobyl Pilot Site (CPS) located in the Red Forest, 2.5 km west of the ChNPP, as well as the description of physical and chemical properties of the fuel particles and subsequent radionuclide leaching into the soil solution. Transformation rate constants of the fuel particle dissolution model related to topsoil, radioactive waste trench and submerged materials, and drained cooling pond sediments, should largely control the mobility and bioavailability of radionuclides (e.g., solubility in the soil, migration to groundwater and transfer to plants). The predicting power of the Chernobyl fuel particle dissolution model with respect to radionuclide leaching dynamics was validated using samples from the same experimental site, showing that predicted particle leaching and subsequent mobility and bioavailability were within 46 ± 3% of the observed data. Therefore, linking source- and release-scenario dependent characteristics of radioactive particles to their potential weathering can provide information that can be implemented in impact assessments models for existing contaminated areas as well as for future events.

Quality Improvement Project Demonstrate that Prolonged Pre-Analytical Time Does Not Lead to False Negative Blood Cultures

Introduction/Objective

Bacterial infection is a significant cause of morbidity and mortality. Prompt identification of microorganisms and their susceptibilities to antimicrobial therapies is critical in the management of patients with bloodstream infections. Blood cultures are collected in paired aerobic and anaerobic bottles. However, transport delays might allow some organisms to grow extensively prior to incubation in the blood culture instruments, leading to false-negative culture results. The Detroit Medical Center utilizes the BD Bactec™ instruments for blood culture incubation and the Verigene DNA-based molecular assay for the identification of bacteria and major resistance genes. It has a core microbiology lab that serves 6 hospitals, however, 2 of the hospitals are remotely located.

The aim of this project was to determine if transportation delays led to significant false-negative culture results. If significant false negativity occurred, additional Bactec™ instruments would need to be purchased.

Methods

For one month, we tracked the collection of blood cultures to incubation time at one of the remote hospitals. All blood cultures that remain negative after 164 hours of incubation are routinely discarded. However, in this case, they were subcultured to a Petri plate containing chocolate agar for 30 days. Any organisms that grew were identified by standard lab techniques.

Results

Of the 547 negative culture bottles that were subcultured for possible false-negative results, only 3 (0.5%) bottles grew bacteria. All three were isolated from different patients. The mean time from blood collection to incubation in the instrument was 4-8 hours. The isolates either met criteria for contaminated cultures, or they grew the same pathogen that had previously been identified in the paired bottle from the same culture. The organisms isolated include coagulase negative Staphylococcus species, Staphylococcus pettenkoferi, and Pseudomonas aeruginosa. No unexpected pathogenic organisms were detected.

Conclusion

Our results demonstrate that prolonged pre-analytical time does not lead to false-negative blood culture results. The patients’ diagnoses were not changed, therefore, the purchase of additional blood culture instruments was not necessary. However, transportation time from the patient floors to the main microbiology lab needs to be improved to meet the recommended 2 hours pre-analytical time.

Skin-Related complications of Klippel-Trenaunay Syndrome: a retrospective review of 410 patients

BACKGROUND

Little is known about skin-related complications in Klippel-Trenaunay syndrome (KTS), a complex vascular anomaly defined by capillary malformation (CM), venous malformation (VM) ± lymphatic malformation (LM) and limb overgrowth. Reported skin-related complications of KTS include ulceration, vascular ectasias (blebs), bleeding and infection.

OBJECTIVE

To determine the spectrum, prevalence and predictors of skin-related complications in KTS.

METHODS

A retrospective review of 410 patients fulfilling KTS criteria was performed to assess for the presence of skin-related complications.

RESULTS

Skin-related complications were present in 45% of patients. Most prevalent were CM-related complications including blebs, bleeding, thickening (25%), cellulitis (22%) and ulceration (21%). Features positively associated with skin-related complications were presence of LM (OR 17.17; P < 0.001), VM on the buttocks/perineum/genitalia (OR 1.92; P = 0.009), CM on the feet (OR 1.77; P = 0.039) and male sex (OR 1.63; P = 0.034). Features negatively associated with skin-related complications were CM on the trunk (OR 0.59; P = 0.029) and tissue hypertrophy of the hands (OR 0.27; P = 0.025).

CONCLUSION

Skin-related complications affect nearly half of patients with KTS. Those with lymphatic involvement or malformation presence in the undergarment area or feet are most at risk.

Phase Matching in Lower Dimensions

Phase matching refers to a process in which atom-field interactions lead to the creation of an output field that propagates coherently through the interaction volume. By studying light scattering from arrays of cold atoms, we show that conditions for phase matching change as the dimensionality of the system decreases. In particular, for a single atomic chain, there is phase-matched reflective scattering in a cone about the symmetry axis of the array that scales as the square of the number of atoms in the chain. For two chains of atoms, the phase-matched reflective scattering can be enhanced or diminished as a result of Bragg scattering. Such scattering can be used for mapping collective states within an array of neutral atoms onto propagating light fields and for establishing quantum links between separated arrays.

Inherited Interstitial Deletion of 3p22.3—p23 Involving GPD1L Gene

We report the first case of a 294 kb loss, notable for including the entirety of GPD1L, on chromosome 3p22.3—p24 in a 3-year-old girl with multiple congenital anomalies including absent left foot, single umbilical artery, bilateral vesico-ureteral reflux, rectovaginal fistula, and imperforate anus. Although GPD1L mutations have been associated with cardiac arrhythmias, including Brugada syndrome and sudden unexpected infant death syndrome, full deletions in the GPD1L gene have not been reported neither the patient nor her mother, who was later identified to carry the variant, have any signs or symptoms of Brugada syndrome. This may indicate these individuals have findings that have not yet been identified, full gene deletions of GDP1L are not necessarily disease causing, or there is incomplete penetrance of this gene or cardiac manifestations can occur at a later age.

Intrahepatic lymphatic channel sclerotic embolization for treatment of postoperative lymphatic ascites: a report of 3 cases

Postoperative hepatic lymphorrhea is extremely rare and there is no standard treatment for this condition. We report the cases of 3 men, 32-, 56-, and 37-year-old, with postoperative hepatic lymphorrhea, which was refractory to conservative treatment. Transhepatic lymphangiography allowed locating the lymphatic leak and treating it with hepatic lymphatic vessels injection of foam sclerotic agent. This technique seems efficient and safe.

Landslide Susceptibility Mapping Using Machine Learning Algorithms and Remote Sensing Data in a Tropical Environment

We used AdaBoost (AB), alternating decision tree (ADTree), and their combination as an ensemble model (AB-ADTree) to spatially predict landslides in the Cameron Highlands, Malaysia. The models were trained with a database of 152 landslides compiled using Synthetic Aperture Radar Interferometry, Google Earth images, and field surveys, and 17 conditioning factors (slope, aspect, elevation, distance to road, distance to river, proximity to fault, road density, river density, normalized difference vegetation index, rainfall, land cover, lithology, soil types, curvature, profile curvature, stream power index, and topographic wetness index). We carried out the validation process using the area under the receiver operating characteristic curve (AUC) and several parametric and non-parametric performance metrics, including positive predictive value, negative predictive value, sensitivity, specificity, accuracy, root mean square error, and the Friedman and Wilcoxon sign rank tests. The AB model (AUC = 0.96) performed better than the ensemble AB-ADTree model (AUC = 0.94) and successfully outperformed the ADTree model (AUC = 0.59) in predicting landslide susceptibility. Our findings provide insights into the development of more efficient and accurate landslide predictive models that can be used by decision makers and land-use managers to mitigate landslide hazards.

Prediction of slope failure in open-pit mines using a novel hybrid artificial intelligence model based on decision tree and evolution algorithm

In this study, the objective was to develop a new and highly-accurate artificial intelligence model for slope failure prediction in open-pit mines. For this purpose, the M5Rules algorithm was combined with a genetic algorithm (GA) in a novel hybrid technique, named M5Rules–GA model, for slope stability estimation and analysis and 450-slope observations in an open-pit mine in Vietnam were modeled using the Geo-Studio software based on essential parameters. The factor of safety was used as the model outcome. Artificial neural networks (ANN), support vector regression (SVR), and previously introduced models (such as FFA-SVR, ANN-PSO, ANN-ICA, ANN-GA, and ANN-ABC) were also developed for evaluating the proposed M5Rules–GA model. The evaluation of the model performance involved applying and computing the determination coefficient, variance account for, and root mean square error, as well as a general ranking and color scale. The results confirmed that the proposed M5Rules–GA model is a robust tool for analyzing slope stability. The other investigated models yielded less robust performance under the evaluation metrics.

Improving prediction of water quality indices using novel hybrid machine-learning algorithms

River water quality assessment is one of the most important tasks to enhance water resources management plans. A water quality index (WQI) considers several water quality variables simultaneously. Traditionally WQI calculations consume time and are often fraught with errors during derivations of sub-indices. In this study, 4 standalone (random forest (RF), M5P, random tree (RT), and reduced error pruning tree (REPT)) and 12 hybrid data-mining algorithms (combinations of standalones with bagging (BA), CV parameter selection (CVPS) and randomizable filtered classification (RFC)) were used to create Iran WQI (IRWQI_sc) predictions. Six years (2012 to 2018) of monthly data from two water quality monitoring stations within the Talar catchment were compiled. Using Pearson correlation coefficients, 10 different input combinations were constructed. The data were divided into two groups (ratio 70:30) for model building (training dataset) and model validation (testing dataset) using a 10-fold cross-validation technique. The models were evaluated using several statistical and visual evaluation metrics. Result show that fecal coliform (FC) and total solids (TS) had the greatest and least effect on the prediction of IRWQI_sc. The best input combinations varied among the algorithms; generally variables with very low correlations displayed weaker performance. Hybrid algorithms improved the prediction power of several of the standalone models, but not all. Hybrid BA-RT outperformed the other models (R² = 0.941, RMSE = 2.71, MAE = 1.87, NSE = 0.941, PBIAS = 0.500). PBIAS indicated that all algorithms, with the exceptions of RT, BA-RT and CVPS-REPT, overestimated WQI values.

Monitoring and Assessment of Water Level Fluctuations of the Lake Urmia and Its Environmental Consequences Using Multitemporal Landsat 7 ETM+ Images

The declining water level in Lake Urmia has become a significant issue for Iranian policy and decision makers. This lake has been experiencing an abrupt decrease in water level and is at real risk of becoming a complete saline land. Because of its position, assessment of changes in the Lake Urmia is essential. This study aims to evaluate changes in the water level of Lake Urmia using the space-borne remote sensing and GIS techniques. Therefore, multispectral Landsat 7 ETM⁺ images for the years 2000, 2010, and 2017 were acquired. In addition, precipitation and temperature data for 31 years between 1986 and 2017 were collected for further analysis. Results indicate that the increased temperature (by 19%), decreased rainfall of about 62%, and excessive damming in the Urmia Basin along with mismanagement of water resources are the key factors in the declining water level of Lake Urmia. Furthermore, the current research predicts the potential environmental crisis as the result of the lake shrinking and suggests a few possible alternatives. The insights provided by this study can be beneficial for environmentalists and related organizations working on this and similar topics.