Application of Granulated Nickel-Aluminum-Zirconium Complex Hydroxide in the Flow Method for Recovery of Chromium(VI) Ions.

A colloidal silicate granulated nickel-aluminum-zirconium (CSG-NAZ) was prepared, and the chromium(VI) (Cr(VI)) ions recovery capacity was evaluated using a sodium sulfate solution in a column experiment. The amount adsorbed and breakthrough time were enhanced by decreasing the flow rate (flow rate is in the order of 3.0 > 2.0 > 0.5 mL). The breakthrough curves and model parameters were estimated using the Thomas and Yoon-Nelson models. The obtained data confirmed to fit both the Yoon-Nelson model (0.858-0.906) and the Thomas model (0.813-0.906). Additionally, Cr(VI) ions that adsorbed onto CSG-NAZ could be desorbed using a sodium sulfate solution in a column experiment. The total recovery percentage of Cr(VI) ions was 80.9% after six repetitions of adsorption/desorption. Finally, the obtained results revealed that CSG-NAZ was a candidate adsorbent for the recovery of Cr(VI) ions owing to its applicability toward a continuous system.

Estimating the euro area output gap using multivariate information and addressing the COVID-19 pandemic.

We estimate the euro area output gap by applying the Beveridge-Nelson decomposition based on a large Bayesian vector autoregression. Our approach incorporates multivariate information through the inclusion of a wide range of variables in the analysis and addresses data issues associated with the COVID-19 pandemic. The estimated output gap lines up well with the CEPR chronology of the business cycle for the euro area and we find that hours worked, more than the unemployment rate, provides the key source of information about labor utilization in the economy, especially in pinning down the depth of the output gap during the COVID-19 recession when the unemployment rate rose only moderately. Our findings confirm that labor market adjustments to the business cycle in the euro area occur more through the intensive, rather than extensive, margin.

A quantitative assay for agarase activity determination using agarose-iodine complex.

Rapid and simple spectrophotometric methods are required to detect various oligosaccharides produced by agar-hydrolysing enzymes. Herein, we present a quantitative agarose-iodine assay for agarase activity determination via the detection of the extent of agarose degradation. The agarose-iodine complex becomes reddish orange upon the addition of Lugol solution, and the enzymatic activity can be detected with ultraviolet-visible spectroscopy at 600 nm. The main advantages of this modified Lugol assay are high sensitivity, simple detection, and cost effectiveness. A novel definition of the unit to measure and compare the activities of agarases is also suggested.

Cancer Risk in Nodules Detected at Follow-Up Lung Cancer Screening CT.

BACKGROUND. Nodules may have different lung cancer risks when new on follow-up CT versus when present on previously performed CT (i.e., existing nodules). Diameter-based Lung-RADS and volume-based NELSON (Nederlands-Leuvens Longkanker Screenings ONderzoek trial) categories have shown variable performance in nodule risk assessment. OBJECTIVE. The purpose of this study was to assess Lung-RADS and NELSON classifications of nodules detected on follow-up lung cancer screening CT examinations. METHODS. This retrospective study included 185 patients (100 women and 85 men; median age, 66 years) who underwent a lung cancer screening CT examination for which a prior CT examination was available. Stratified random sampling was performed to enrich the sample with suspicious nodules, yielding 50, 45, 47, 30, and 13 nodules with Lung-RADS categories 2, 3, 4A, 4B, and 4X, respectively. Lung-RADS categories were recorded from clinical reports. The linear measurements of the nodules were extracted from clinical reports to generate Lung-RADS categories by use of strict criteria from Lung-RADS version 1.1. Two radiologists used a semiautomated tool to obtain nodule volumes, which were used to generate NELSON categories. Lung cancer risk was assessed. ROC analysis was performed. Percentages and AUCs were weighted on the basis of Lung-RADS category frequencies in the underlying screening cohort. RESULTS. Twenty-nine cancers were diagnosed. The weighted cancer risk was 5% for new nodules, 1% for stable existing nodules, and 44% for growing existing nodules. None of the clinical Lung-RADS category 2 nodules were cancer. With use of strict Lung-RADS version 1.1 criteria, 34 nodules, including seven cancers, were downgraded to category 2. The AUC for cancer was 0.96 for clinical Lung-RADS, 0.81 for strict Lung-RADS, 0.71-0.84 for the NELSON algorithm (two readers), and 0.89 for nodule diameter measurement. Clinical Lung-RADS achieved weighted sensitivity and specificity, respectively, of 100% and 85% for the entire sample, 100% and 41% for new nodules, and 100% and 94% for existing nodules. The optimal diameter threshold was 8 mm for existing nodules versus 6 mm for new nodules. CONCLUSION. Lung-RADS, as applied by radiologists in clinical practice, achieved excellent performance on follow-up screening examinations. Strict Lung-RADS resulted in the downgrading of some cancers to category 2. Volumetric assessments had weaker performance than clinical Lung-RADS. New nodules warrant smaller size thresholds than existing nodules. CLINICAL IMPACT. The findings of the present study provide insight into radiologists' management of nodules detected on follow-up screening examinations.

Complete positivity and distance-avoiding sets.

We introduce the cone of completely positive functions, a subset of the cone of positive-type functions, and use it to fully characterize maximum-density distance-avoiding sets as the optimal solutions of a convex optimization problem. As a consequence of this characterization, it is possible to reprove and improve many results concerning distance-avoiding sets on the sphere and in Euclidean space.

Needle and Syringe Programs in Prisons: Victoria's "Problematic" Policy Position.

With high rates of blood-borne virus infection in Australian prisons, a needle and syringe program (NSP) stands ready to deliver similar benefits to its community counterpart. Supplying sterile injecting equipment and safe-use guidance in prisons could improve prisoner health outcomes and the safety of the corrections system. Yet, despite the protestations of public health experts and the recommendations of State, national, and international bodies, Australian States and Territories refuse to implement prison-based NSPs, with serious consequences for prisoner health. This article focuses on the Australian State of Victoria as a case study representative of other jurisdictions. Victoria's inaction is arguably in breach of international standards and the Victorian Charter of Human Rights and Responsibilities, but less likely to constitute a breach of the common law duty of care. Undertaking a legal analysis of these areas, this article examines the potential of each area to support the case for reform of the Victorian Government's policy on a prison-based NSP. Looking ahead, this article suggests reforms to ensure the proper functioning and administration of prison NSPs.

Management of Nelson's Syndrome.

Nelson's syndrome is a potentially severe condition that may develop in patients with Cushing's disease treated with bilateral adrenalectomy. Its management can be challenging. Pituitary surgery followed or not by radiotherapy offers the most optimal tumour control, whilst pituitary irradiation alone needs to be considered in cases requiring intervention and are poor surgical candidates. Observation is an option for patients with small lesions, not causing mass effects to vital adjacent structures but close follow-up is required for a timely detection of corticotroph tumour progression and for further treatment if required. To date, no medical therapy has been consistently proven to be effective in Nelson's syndrome. Pharmacotherapy, however, should be considered when other management approaches have failed. A subset of patients with Nelson's syndrome may develop further tumour growth after primary treatment, and, in some cases, a truly aggressive tumour behaviour can be demonstrated. In the absence of evidence-based guidance, the management of these cases is individualized and tailored to previously offered treatments. Temozolomide has been used in patients with aggressive Nelson's with no consistent results. Development of tumour-targeted therapeutic agents are an unmet need for the management of aggressive cases of Nelson's syndrome.

US and EA yield curve persistence during the COVID-19 pandemic.

This paper investigates changes in persistence caused by the COVID-19 pandemic in the US and EA yield curves. We extract the long-term, short-term and medium-term factors and proxy the persistence by estimating the autoregressive coefficient of each factor. To examine the time-varying effects, we employ a local linear estimation. Our findings suggest that, during the first phases of the pandemic, the US long-term and short-term factors exhibited explosive behaviour while, at the same time, the EA factors diminished in persistence, making the EA yield curve more predictable even though the EA countries were hit by the pandemic somewhat earlier than the US.

Causal mediation of semicompeting risks.

The semi-competing risks problem arises when one is interested in the effect of an exposure or treatment on both intermediate (e.g., having cancer) and primary events (e.g., death) where the intermediate event may be censored by the primary event, but not vice versa. Here we propose a nonparametric approach casting the semi-competing risks problem in the framework of causal mediation modeling. We set up a mediation model with the intermediate and primary events, respectively as the mediator and the outcome, and define an indirect effect as the effect of the exposure on the primary event mediated by the intermediate event and a direct effect as that not mediated by the intermediate event. A nonparametric estimator with time-varying weights is proposed for direct and indirect effects where the counting process at time t of the primary event N2n1(t) and its compensator An1(t) are both defined conditional on the status of the intermediate event right before t, N1(t-)=n1 . We show that N2n1(t)-An1(t) is a zero-mean martingale. Based on this, we further establish theoretical properties for the proposed estimators. Simulation studies are presented to illustrate the finite sample performance of the proposed method. Its advantage in causal interpretation over existing methods is also demonstrated in a hepatitis study.

Issues with implementing a high-quality lung cancer screening program.

After a comprehensive review of the evidence, the United States Preventive Services Task Force recently endorsed screening with low-dose computed tomography as an early detection approach that has the potential to significantly reduce deaths due to lung cancer. Prudent implementation of lung cancer screening as a high-quality preventive health service is a complex challenge. The clinical evaluation and management of high-risk cohorts in the absence of symptoms mandates an approach that differs significantly from that of symptom-detected lung cancer. As with other cancer screenings, it is essential to provide to informed at-risk individuals a safe, high-quality, cost-effective, and accessible service. In this review, the components of a successful screening program are discussed as we begin to disseminate lung cancer screening as a national resource to improve outcomes with this lethal cancer. This information about lung cancer screening will assist clinicians with communications about the potential benefits and harms of this service for high-risk individuals considering participation in the screening process.

Prevalence of Nelson's syndrome after bilateral adrenalectomy in patients with cushing's disease: a systematic review and meta-analysis.

PURPOSE: Bilateral adrenalectomy (BA) still plays an important role in the management of Cushing's disease (CD). Nelson's syndrome (NS) is a severe complication of BA, but conflicting data on its prevalence and predicting factors have been reported. The aim of this study was to determine the prevalence of NS, and identify factors associated with its development. DATA SOURCES: Systematic literature search in four databases. STUDY SELECTION: Observational studies reporting the prevalence of NS after BA in adult patients with CD. DATA EXTRACTION: Data extraction and risk of bias assessment were performed by three independent investigators. DATA SYNTHESIS: Thirty-six studies, with a total of 1316 CD patients treated with BA, were included for the primary outcome. Pooled prevalence of NS was 26% (95% CI 22-31%), with moderate to high heterogeneity (I2 67%, P < 0.01). The time from BA to NS varied from 2 months to 39 years. The prevalence of NS in the most recently published studies, where magnet resonance imaging was used, was 38% (95% CI 27-50%). The prevalence of treatment for NS was 21% (95% CI 18-26%). Relative risk for NS was not significantly affected by prior pituitary radiotherapy [0.9 (95% CI 0.5-1.6)] or pituitary surgery [0.6 (95% CI 0.4-1.0)]. CONCLUSIONS: Every fourth patient with CD treated with BA develops NS, and every fifth patient requires pituitary-specific treatment. The risk of NS may persist for up to four decades after BA. Life-long follow-up is essential for early detection and adequate treatment of NS.

Corticotroph tumor progression during long-term therapy with osilodrostat in a patient with persistent Cushing's disease.

PURPOSE: Corticotroph tumor progression (CTP) or Nelson's syndrome (NS) can occur in patients with Cushing's disease (CD) following bilateral adrenalectomy. It has rarely been observed in patients treated with long-term medical therapy for persistent CD. Osilodrostat (LCI699) is a new steroidogenesis inhibitor of 11ß-hydroxylase (CYP11ß1) that induced remission of hypercortisolism in 86% of patients with refractory CD in the randomized placebo-controlled trial LINC-3 (NCT02180217). METHODS: A 40-year-old woman with persistent CD following transsphenoidal surgery was treated with osilodrostat in the LINC-3 trial and was followed with regular hormonal assessments and imaging of residual corticotroph tumor. RESULTS: Under oral therapy with osilodrostat 10 mg twice daily, urinary free cortisol (UFC) normalized and clinical signs of CD regressed during therapy. However after 4 years of treatment, ACTH levels increased from 73 to 500 pmol/L and corticotroph tumor size increased rapidly from 3 to 14 mm, while UFCs remained well controlled. Surgical resection of an atypical tumor with weak ACTH expression and increased proliferative index (Ki-67 ≥ 8%) resulted in current remission but will require close follow-up. CONCLUSION: This case highlights the importance of monitoring ACTH and corticotroph tumor size in patients with persistent CD, either under effective treatment with steroidogenesis inhibitors or after bilateral adrenalectomy.

Stereotactic radiosurgery before bilateral adrenalectomy is associated with lowered risk of Nelson's syndrome in refractory Cushing's disease patients.

BACKGROUND: Nelson's syndrome is a rare but challenging sequelae of Cushing's disease (CD) after bilateral adrenalectomy (BLA). We sought to determine if stereotactic radiosurgery (SRS) of residual pituitary adenoma performed before BLA can decrease the risk of Nelson's syndrome. METHODS: Consecutive patients with CD who underwent BLA after non-curative resection of ACTH secreting pituitary adenoma and had at least one follow-up visit after BLA were studied. Nelson's syndrome was diagnosed based on the combination of rising ACTH levels, increasing volume of the pituitary adenoma and/or hyperpigmentation. RESULTS: Fifty patients underwent BLA for refractory CD, and 43 patients (7 men and 36 women) had at least one follow-up visit after BAL. Median endocrine, imaging, and clinical follow-up were 66 months, 69 months, and 80 months, respectively. Nine patients (22%) were diagnosed with the Nelson's syndrome at median time after BLA at 24 months (range: 0.6-119.4 months). SRS before BLA was associated with reduced risk of the Nelson's syndrome (HR = 0.126; 95%CI [0.022-0.714], p=0.019), while elevated ACTH level within 6 months after BLA was associated with increased risk for the Nelson's syndrome (HR = 9.053; 95%CI [2.076-39.472], p=0.003). CONCLUSIONS: SRS before BLA can reduce the risk for the Nelson's syndrome in refractory CD patients requiring BLA and should be considered before proceeding to BLA. Elevated ACTH concentration within 6 months after BLA is associated with greater risk of the Nelsons' syndrome. When no prior SRS is administered, those with a high ACTH level shortly after BLA may benefit from early SRS.

Comments on "Treatment of malachite green dye containing solution using bio-degradable sodium alginate/NaOH treated activated sugarcane baggsse charcoal beads: Batch, optimization using response surface methodology and continuous fixed bed column study" and "Adsorption and oxidation of ciprofloxacin in a fixed bed column using activated sludge derived activated carbon".

This comment analyses the results of the fixed-bed column modeling from the studies published by Gupta and Garg (2019), and Das et al. (2020), which are the last two papers on this topic published in this journal.

Evaluation of Antimicrobial, Antioxidant, and Cytotoxic Activity of Phenolic Preparations of Diverse Composition, Obtained from Elaeagnus rhamnoides (L.) A. Nelson Leaf and Twig Extracts.

Although the major components of various organs of sea buckthorn have been identified (particularly phenolic compounds), biological properties of many of these phytochemicals still remain poorly characterized. In this study, we focused on the chemical composition and biological activity of preparations that were obtained from sea buckthorn twigs and leaves. The objective was to investigate cytotoxicity of these preparations against human fibroblast line HFF-1, using MTT reduction assay, their anti- or pro-oxidant activities against the effects of a biological oxidant -H2O2/Fe-on human plasma lipids and proteins in vitro (using TBARS and carbonyl groups as the markers of oxidative stress). Antimicrobial activity of the tested preparations against Gram-positive (Staphylococcus aureus, S. epidermidis, Enterococcus faecalis) and Gram-negative bacteria (Escherichia coli, Pseudomonas aeruginosa), as well as against fungi (Candida albicans, C. glabrata) by the EUCAST-approved broth microdilution method, followed by growth on solid media, were also assessed. Our analysis showed significant differences in chemical composition and biological properties of the tested preparations (A-F). All tested preparations from sea buckthorn twigs (D-F) and one preparation from sea buckthorn leaves (preparation C) may be a new source of phenolic antioxidants for pharmacological and cosmetic applications.

Dr. Richard C. Nelson: Behind the Scenes.

As the first PhD graduate of the Biomechanics Laboratory at the Pennsylvania State University under the leadership of Dr. Richard C. Nelson, I reflect on my early experience in sport biomechanics there and its influence on some of my subsequent, and typically unpublished, research challenges.

Doubly robust estimation and causal inference for recurrent event data.

Many longitudinal databases record the occurrence of recurrent events over time. In this article, we propose a new method to estimate the average causal effect of a binary treatment for recurrent event data in the presence of confounders. We propose a doubly robust semiparametric estimator based on a weighted version of the Nelson-Aalen estimator and a conditional regression estimator under an assumed semiparametric multiplicative rate model for recurrent event data. We show that the proposed doubly robust estimator is consistent and asymptotically normal. In addition, a model diagnostic plot of residuals is presented to assess the adequacy of our proposed semiparametric model. We then evaluate the finite sample behavior of the proposed estimators under a number of simulation scenarios. Finally, we illustrate the proposed methodology via a database of circus artist injuries.

ACTH increment post total bilateral adrenalectomy for Cushing's disease: a consistent biosignature for predicting Nelson's syndrome.

PURPOSE: Nelson's syndrome (NS) is regarded as an aggressive complication of total bilateral adrenalectomy (TBA) for Cushing's disease (CD). This challenge may be addressed by using clinical criteria to guide frequency of neuroimaging to enable timely management of NS and also avoid unnecessary frequent imaging. METHODS: All patients (n = 43) with CD subjected to TBA over 35 years at a tertiary care centre were included. NS was defined as a newly appearing or expanding (> 2 mm) pituitary adenoma with or without ACTH levels exceeding 500 pg/ml. Pre-and post-TBA parameters like clinical symptomatology, cortisol, ACTH and radiology were analysed for the prediction of NS. RESULTS: NS developed in 39.5% (n = 17) patients with a median follow-up of 7 years. Half of them had new appearance, while rest had an expansion of pre-existing pituitary tumour. Majority (90%) had ACTH above 500 pg/ml. On Cox proportional hazards analysis, frequent discriminatory features of protein catabolism (≥ 4) (HR 1.15, CI 0.18, 7.06), proximal myopathy (HR 8.82, CI 1.12, 69.58) and annual ACTH increment of 113 pg/ml (HR 12.56, CI 1.88, 88.76) predicted NS. First post-operative year ACTH indices predicting NS included ACTH rise of 116 pg/ml and absolute ACTH of 142 pg/ml (sensitivity, specificity exceeding 90%). Annual ACTH increment exceeding 113 pg/ml, ≥ 4 discriminatory features and uncontrolled hypertension had the best overall prediction. CONCLUSION: Patients who developed NS had higher rebound rise of ACTH following TBA and a more severe disease phenotype at baseline. Consistent ACTH increment can be used as a marker for predicting the development of NS.

Wetland water-management may influence mercury bioaccumulation in songbirds and ducks at a mercury hotspot.

Mercury is a persistent, biomagnifying contaminant that can cause negative behavioral, immunological, and reproductive effects in wildlife and human populations. We examined the role of wetland water-management on mercury bioaccumulation in songbirds and ducks at Kellys Slough National Wildlife Refuge Complex, near Grand Forks, North Dakota USA. We assessed mercury concentrations in blood of wetland-foraging songbirds (80 common yellowthroats [Geothlypis trichas] and 14 Nelson's sparrows [Ammospiza nelsoni]) and eggs of upland-nesting ducks (28 gadwall [Mareca strepera], 19 blue-winged teal [Spatula discors], and 13 northern shoveler [S. clypeta]) across four wetland water-management classifications. Nelson's sparrow blood mercury concentrations were elevated (mean: 1.00 µg/g ww; 95% CL: 0.76-1.31) and similar to those reported 6 years previously. Mercury in songbird blood and duck eggs varied among wetland water-management classifications. Songbirds and ducks had 67% and 49% lower mercury concentrations, respectively, when occupying wetlands that were drawn down with water flow compared to individuals occupying isolated-depressional wetlands with no outflow. Additionally, songbirds within impounded and partially drawn-down wetland units with water flow had mercury concentrations that were 26-28% lower, respectively, than individuals within isolated-depressional wetlands with no outflow. Our results confirm that mercury concentrations in songbirds at Kellys Slough continue to be elevated and suggest that water-management could be an important tool for wetland managers to reduce bioaccumulation of mercury in birds.

Function-based hypothesis testing in censored two-sample location-scale models.

Function-based hypothesis testing in two-sample location-scale models has been addressed for uncensored data using the empirical characteristic function. A test of adequacy in censored two-sample location-scale models is lacking, however. A plug-in empirical likelihood approach is used to introduce a test statistic, which, asymptotically, is not distribution free. Hence for practical situations bootstrap is necessary for performing the test. A multiplier bootstrap and a model appropriate resampling procedure are given to approximate critical values from the null asymptotic distribution. Although minimum distance estimators of the location and scale are deployed for the plug-in, any consistent estimators can be used. Numerical studies are carried out that validate the proposed testing method, and real example illustrations are given.