Effective Communication About Pregnancy, Birth, Lactation, Breastfeeding and Newborn Care:The Importance of Sexed Language

On 24 September 2021, The Lancet medical journal highlighted an article on its cover with a single sentence in large text; “Historically, the anatomy and physiology of bodies with vaginas have been neglected.” This statement, in which the word “women” was replaced with the phrase “bodies with vaginas,” is part of a trend to remove sexed terms such as “women” and “mothers” from discussions of female reproduction. The good and important intention behind these changes is sensitivity to, and acknowledgment of, the needs of people who are biologically female and yet do not consider themselves to be women because of their gender identity (1). However, these changes are often not deliberated regarding their impact on accuracy or potential for other unintended consequences. In this paper we present some background to this issue, describe various observed impacts, consider a number of potentially deleterious consequences, and suggest a way forward

Impaired Fasting Glucose Is Associated With Renal Hyperfiltration in the General Population

Increased glomerular filtration rate (GFR), also called hyperfiltration, is a proposed mechanism for renal injury in diabetes. The causes of hyperfiltration in individuals without diabetes are largely unknown, including the possible role of borderline hyperglycemia. We assessed whether impaired fasting glucose (IFG; 5.6–6.9 mmol/L), elevated HbA1c, or hyperinsulinemia are associated with hyperfiltration in the general middle-aged population. A total of 1,560 individuals, aged 50–62 years without diabetes, were included in the Renal Iohexol Clearance Survey in Tromsø 6 (RENIS-T6). GFR was measured as single-sample plasma iohexol clearance. Hyperfiltration was defined as GFR >90th percentile, adjusted for sex, age, weight, height, and use of renin-angiotensin system inhibitors. Participants with IFG had a multivariable-adjusted odds ratio of 1.56 (95% CI 1.07–2.25) for hyperfiltration compared with individuals with normal fasting glucose. Odds ratios (95% CI) of hyperfiltration calculated for a 1-unit increase in fasting plasma glucose (FPG) and HbA1c, after multivariable-adjustment, were 1.97 (1.36–2.85) and 2.23 (1.30–3.86). There was no association between fasting insulin levels and hyperfiltration. A nonlinear association between FPG and GFR was observed (df = 3, P < 0.0001). GFR increased with higher glucose levels, with a steeper slope beginning at FPG ≥5.4 mmol/L. Borderline hyperglycemia was associated with hyperfiltration, whereas hyperinsulinemia was not. Longitudinal studies are needed to investigate whether the hyperfiltration associated with IFG is a risk factor for renal injury in the general population

Dynamical models for sand ripples beneath surface waves

We introduce order parameter models for describing the dynamics of sand ripple patterns under oscillatory flow. A crucial ingredient of these models is the mass transport between adjacent ripples, which we obtain from detailed numerical simulations for a range of ripple sizes. Using this mass transport function, our models predict the existence of a stable band of wavenumbers limited by secondary instabilities. Small ripples coarsen in our models and this process leads to a sharply selected final wavenumber, in agreement with experimental observations.Comment: 9 pages. Shortened version of previous submissio

CORBA-Based Distributed Software Framework for the NIF Integrated Computer Control System

The National Ignition Facility (NIF), currently under construction at the Lawrence Livermore National Laboratory, is a stadium-sized facility containing a 192-beam, 1.8 Megajoule, 500-Terawatt, ultra-violet laser system together with a 10-meter diameter target chamber with room for nearly 100 experimental diagnostics. The NIF is operated by the Integrated Computer Control System (ICCS) which is a scalable, framework-based control system distributed over 800 computers throughout the NIF. The framework provides templates and services at multiple levels of abstraction for the construction of software applications that communicate via CORBA (Common Object Request Broker Architecture). Object-oriented software design patterns are implemented as templates and extended by application software. Developers extend the framework base classes to model the numerous physical control points and implement specializations of common application behaviors. An estimated 140 thousand software objects, each individually addressable through CORBA, will be active at full scale. Many of these objects have persistent configuration information stored in a database. The configuration data is used to initialize the objects at system start-up. Centralized server programs that implement events, alerts, reservations, data archival, name service, data access, and process management provide common system wide services. At the highest level, a model-driven, distributed shot automation system provides a flexible and scalable framework for automatic sequencing of work-flow for control and monitoring of NIF shots. The shot model, in conjunction with data defining the parameters and goals of an experiment, describes the steps to be performed by each subsystem in order to prepare for and fire a NIF shot. Status and usage of this distributed framework are described

Orchestrating Shots for the National Ignition Facililty (NIF)

The National Ignition Facility (NIF), currently under construction at the Lawrence Livermore National Laboratory, is a stadium-sized facility containing a 192-beam, 1.8 Megajoule, 500-Terawatt, ultra-violet laser system together with a 10-meter diameter target chamber with room for nearly 100 experimental diagnostics. When completed, NIF will be the world's largest and most energetic laser experimental system, providing an international center to study inertial confinement fusion and physics of matter at extreme densities and pressures. The NIF is operated by the Integrated Computer Control System (ICCS), which is a layered architecture of over 700 lower-level front-end processors attached to nearly 60,000 control points and coordinated by higher-level supervisory subsystems in the main control room. A shot automation framework has been developed and deployed during the past year to orchestrate and automate shots performed at the NIF using the ICCS. The Shot Automation framework is designed to automate 4-8 hour shot sequences, that includes deriving shot goals from an experiment definition, set up of the laser and diagnostics, automatic alignment of laser beams, and a countdown to charge and fire the lasers. These sequences consist of set of preparatory verification shots, leading to amplified system shots followed by post-shot analysis and archiving. The framework provides for a flexible, model-based work-flow execution, driven by scripted automation called macro steps. The shot director software is the orchestrating component of a very flexible automation layer which allows us to define, coordinate and reuse simpler automation sequences. This software provides a restricted set of shot life cycle state transitions to 26 collaboration supervisors that automate 8-laser beams (bundle) and a common set of shared resources. Each collaboration supervisor commands approximately 10 subsystem shot supervisors that perform automated control and status verification. Collaboration supervisors translate shot life cycle state commands from shot director into sequences of ''macro steps'' to be distributed to each of its shot supervisors, maintains order of macro steps for each subsystem, and supports collaboration between macro steps. They also manage failure, restarts, and rejoining into the shot cycle (if necessary) and manage auto/manual macro step execution and collaborations between other collaboration supervisors. Each macro step has database-driven verification phases and a scripted perform phase. This provides for a highly flexible framework for performing a variety of NIF shot types. Database tables define the order of work and dependencies (workflow) of macro steps to be performed for a shot. A graphical model editor facilitates the definition and viewing of an execution model. A change manager tool enables ''de-participation'' of individual devices, of entire laser segments (beams, quads, or bundles of beams) or individual diagnostics. This software has been deployed to the NIF facility and is currently being used to support NIF main laser commissioning shots and build-out of the NIF laser. This will be used to automate future target and experimental shot campaigns

Left main bronchus resection and reconstruction. A single institution experience

<p>Abstract</p> <p>Background</p> <p>Left main bronchus resection and reconstruction (LMBRR) is a complex surgical procedure indicated for management of inflammatory, benign and low grade malignant lesions. Its application provides maximal parenchymal sparing.</p> <p>Methods</p> <p>Out of 98 bronchoplastic procedures performed at the Authors' Institution in the 1995-2011 period, 4 were LMBRR. Indications were bronchial carcinoid in 2 cases, inflammatory pseudotumor in 1 case, TBC stricture in 1 case. All patients underwent preoperatively a rigid bronchoscopy to restore the airway lumen patency. At surgery a negative resection margin was confirmed by frozen section in the neoplastic patients. In all patients an end-to-end bronchial anastomosis was constructed according to Grillo.</p> <p>Results</p> <p>There were neither mortality nor major complications. Airway lumen was optimal in 3 patients, good in 1.</p> <p>Conclusion</p> <p>LMBRR is a valuable option for the thoracic surgeon. It maximizes the parenchyma-sparing philosophy, broadening the spectrum of potential candidates for cure. It remains a technically demanding procedure, to be carried out by an experienced surgical team. Correct surgical planning affords excellent results, both in the short and long term.</p

The function of fear in institutional maintenance: Feeling frightened as an essential ingredient in haute cuisine

Fear is a common and powerful emotion that can regulate behaviour. Yet institutional scholars have paid limited attention to the function of fear in processes of institutional reproduction and stability. Drawing on an empirical study of elite chefs within the institution of haute cuisine, this article finds that the multifaceted emotion of fear characterised their experiences and served to sustain their institution. Chefs’ individual feelings of fear prompted conformity and a cognitive constriction, which narrowed their focus on to the precise reproduction of traditional practices whilst also limiting challenges to the norms underpinning the institution. Through fear work, chefs used threats and violence to connect individual experiences of fear to the violation of institutionalized rules, sustaining the conditions in which fear-driven maintenance work thrived. The study also suggests that fear is a normative element of haute cuisine in its own right, where the very experience and eliciting of fear preserved an essential institutional ingredient. In this way, emotions such as fear do not just accompany processes of institutionalization but can be intimately involved in the maintenance of institutions

Shot Automation for the National Ignition Facility

A shot automation framework has been developed and deployed during the past year to automate shots performed on the National Ignition Facility (NIF) using the Integrated Computer Control System This framework automates a 4-8 hour shot sequence, that includes inputting shot goals from a physics model, set up of the laser and diagnostics, automatic alignment of laser beams and verification of status. This sequence consists of set of preparatory verification shots, leading to amplified system shots using a 4-minute countdown, triggering during the last 2 seconds using a high-precision timing system, followed by post-shot analysis and archiving. The framework provides for a flexible, model-based execution driven of scriptable automation called macro steps. The framework is driven by high-level shot director software that provides a restricted set of shot life cycle state transitions to 25 collaboration supervisors that automate 8-laser beams (bundles) and a common set of shared resources. Each collaboration supervisor commands approximately 10 subsystem shot supervisors that perform automated control and status verification. Collaboration supervisors translate shot life cycle state commands from the shot director into sequences of ''macro steps'' to be distributed to each of its shot supervisors. Each Shot supervisor maintains order of macro steps for each subsystem and supports collaboration between macro steps. They also manage failure, restarts and rejoining into the shot cycle (if necessary) and manage auto/manual macro step execution and collaborations between other collaboration supervisors. Shot supervisors execute macro step shot functions commanded by collaboration supervisors. Each macro step has database-driven verification phases and a scripted perform phase. This provides for a highly flexible methodology for performing a variety of NIF shot types. Database tables define the order of work and dependencies (workflow) of macro steps to be performed for a shot. A graphical model editor facilitates the definition and viewing of an execution model. A change manager tool enables ''de-participation'' of individual devices, of entire laser segments (beams, quads, or bundles of beams) or individual diagnostics. This software has been deployed to the NIF facility and is currently being used to support NIF main laser commissioning shots and build-out of the NIF laser. This will be used to automate future target and experimental shot campaigns