Quality control of B-lines analysis in stress Echo 2020

Background The effectiveness trial “Stress echo (SE) 2020” evaluates novel applications of SE in and beyond coronary artery disease. The core protocol also includes 4-site simplified scan of B-lines by lung ultrasound, useful to assess pulmonary congestion. Purpose To provide web-based upstream quality control and harmonization of B-lines reading criteria. Methods 60 readers (all previously accredited for regional wall motion, 53 B-lines naive) from 52 centers of 16 countries of SE 2020 network read a set of 20 lung ultrasound video-clips selected by the Pisa lab serving as reference standard, after taking an obligatory web-based learning 2-h module ( http://se2020.altervista.org ). Each test clip was scored for B-lines from 0 (black lung, A-lines, no B-lines) to 10 (white lung, coalescing B-lines). The diagnostic gold standard was the concordant assessment of two experienced readers of the Pisa lab. The answer of the reader was considered correct if concordant with reference standard reading ±1 (for instance, reference standard reading of 5 B-lines; correct answer 4, 5, or 6). The a priori determined pass threshold was 18/20 (≥ 90%) with R value (intra-class correlation coefficient) between reference standard and recruiting center) > 0.90. Inter-observer agreement was assessed with intra-class correlation coefficient statistics. Results All 60 readers were successfully accredited: 26 (43%) on first, 24 (40%) on second, and 10 (17%) on third attempt. The average diagnostic accuracy of the 60 accredited readers was 95%, with R value of 0.95 compared to reference standard reading. The 53 B-lines naive scored similarly to the 7 B-lines expert on first attempt (90 versus 95%, p = NS). Compared to the step-1 of quality control for regional wall motion abnormalities, the mean reading time per attempt was shorter (17 ± 3 vs 29 ± 12 min, p < .01), the first attempt success rate was higher (43 vs 28%, p < 0.01), and the drop-out of readers smaller (0 vs 28%, p < .01). Conclusions Web-based learning is highly effective for teaching and harmonizing B-lines reading. Echocardiographers without previous experience with B-lines learn quickly.info:eu-repo/semantics/publishedVersio

Multi-messenger observations of a binary neutron star merger

On 2017 August 17 a binary neutron star coalescence candidate (later designated GW170817) with merger time 12:41:04 UTC was observed through gravitational waves by the Advanced LIGO and Advanced Virgo detectors. The Fermi Gamma-ray Burst Monitor independently detected a gamma-ray burst (GRB 170817A) with a time delay of ~1.7 s with respect to the merger time. From the gravitational-wave signal, the source was initially localized to a sky region of 31 deg2 at a luminosity distance of 40+8-8 Mpc and with component masses consistent with neutron stars. The component masses were later measured to be in the range 0.86 to 2.26 Mo. An extensive observing campaign was launched across the electromagnetic spectrum leading to the discovery of a bright optical transient (SSS17a, now with the IAU identification of AT 2017gfo) in NGC 4993 (at ~40 Mpc) less than 11 hours after the merger by the One- Meter, Two Hemisphere (1M2H) team using the 1 m Swope Telescope. The optical transient was independently detected by multiple teams within an hour. Subsequent observations targeted the object and its environment. Early ultraviolet observations revealed a blue transient that faded within 48 hours. Optical and infrared observations showed a redward evolution over ~10 days. Following early non-detections, X-ray and radio emission were discovered at the transient’s position ~9 and ~16 days, respectively, after the merger. Both the X-ray and radio emission likely arise from a physical process that is distinct from the one that generates the UV/optical/near-infrared emission. No ultra-high-energy gamma-rays and no neutrino candidates consistent with the source were found in follow-up searches. These observations support the hypothesis that GW170817 was produced by the merger of two neutron stars in NGC4993 followed by a short gamma-ray burst (GRB 170817A) and a kilonova/macronova powered by the radioactive decay of r-process nuclei synthesized in the ejecta

The green economy: mythical or meaningful?

The conflicts among ecological and economic goals have been a central characteristic of environmental politics since the emergence of the modern environmental movement in the 1960s. On one side of the debate is the argument that reducing pollution and protecting ecosystems and other resources unnecessarily impairs economic expansion, competitiveness and prosperity. From this point of view, although some environmental safeguards are needed, public policy should favour growth as a general rule. On the other side is the assertion that human health and ecological limits demand a carefully managed path for growth, including little or even no growth, and a preference for ecological over economic goals when they conflict. Environmental politics has consisted of a struggle to define where the balance between these goals should be struck

Conceptual innovation in environmental policy

Concepts are thought categories through which we apprehend the world; they enable, but also constrain, reasoning and debate and serve as building blocks for more elaborate arguments. This book traces the links between conceptual innovation in the environmental sphere and the evolution of environmental policy and discourse. It offers both a broad framework for examining the emergence, evolution, and effects of policy concepts and a detailed analysis of eleven influential environmental concepts. In recent decades, conceptual evolution has been particularly notable in environmental governance, as new problems have emerged and as environmental issues have increasingly intersected with other areas. "Biodiversity," for example, was unheard of until the late 1980s; "negative carbon emissions" only came into being over the last few years. After a review of concepts and their use in environmental argument, chapters chart the trajectories of a range of environmental concepts: environment, sustainable development, biodiversity, environmental assessment, critical loads, adaptive management, green economy, environmental risk, environmental security, environmental justice, and sustainable consumption. The book provides a valuable resource for scholars and policy makers and also offers a novel introduction to the environmental policy field through the evolution of its conceptual categories

Making environmental policy

Who speaks for the trees, the water, the soil, and the air in American government today? Which agencies confront environmental problems, and how do they set priorities? How are the opposing claims of interest groups evaluated? Why do certain issues capture the public's attention?In Making Environmental Policy , Daniel Fiorino combines the hands-on experience of an insider with the analytic rigor of a scholar to provide the fullest, most readable introduction to federal environmental policymaking yet published. A committed environmental advocate, he takes readers from theory to practice, demonstrating how laws and institutions address environmental needs and balance them against other political pressures.Drawing on the academic literature and his own familiarity with current trends and controversies, Fiorino offers a lucid view of the institutional and analytic aspects of environmental policymaking. A chapter on analytic methods describes policymakers' attempts to apply objective standards to complex environmental decisions. The book also examines how the law, the courts, political tensions, and international environmental agencies have shaped environmental issues. Fiorino grounds his discussion with references to numerous specific cases, including radon, global warming, lead, and hazardous wastes. Timely and necessary, this is an invaluable handbook for students, activists, and anyone wanting to unravel contemporary American environmental politics