CMB low multipole alignments in the Λ\mathbf{\Lambda}CDM and Dipolar models

The dipolar model \cite{Gordon:2005ai} has attracted much interest because it may phenomenologically explain the CMB hemispherical power asymmetry found in the WMAP and Planck data. Since such a model explicitly breaks isotropy at large angular scales it is natural to wonder whether it can also explain other CMB directional anomalies. Focusing on the low $\ell$ alignments and assuming $\Lambda$CDM, we confirm that the quadrupole/octupole and the dipole/quadrupole/octupole alignments are anomalous with a significance up to $99.9\%$ C.L., for both WMAP and Planck data. Moreover, we show for the first time that such features are anomalous also in the dipolar model, roughly at the same level as in $\Lambda$CDM. We conclude that the dipolar model does not provide a better fit to the data than the $\Lambda$CDM.Comment: 13 pages, 2 figures and 4 table

Proposal for a standardized design and modeling procedure of tall CLT buildings

A crucial issue in the design of a mid-rise Cross Laminated Timber (CLT) building under horizontal seismic action, is the definition of the principal elastic vibration period of an entire superstructure. Such vibration period depends on the mass distribution and on the global stiffness of the buildings. In a CLT structure the global stiffness of the buildings is highly sensitive to deformability of the connection elements. Consequently for a precise control of the vibration period of the building it is crucial to define the stiffness of each connections used to assemble a superstructure. A design procedure suitable for a reliable definition of the connection stiffness is proposed referring to code provisions and experimental tests. Discussion addresses primary issues associated with the usage of proposed procedure for numerical modeling of case study tall CLT buildings is reported

The use of automated real-time feedback devices to improve quality during CPR training and real CPR performance: a systematic review

High quality cardiopulmonary resuscitation (CPR) is imperative to improve patient outcome after a cardiac arrest. However, it has been demonstrated that CPR quality is normally of suboptimal quality in both real-life resuscitation attempts or simulated training. Automated real-time feedback (ARTF) devices have been considered a potential tool to improve the quality of CPR and maximise retention of the skills. Although previous studies have supported the usefulness of such devices during training, others have conflicting conclusions with regards to its efficacy during real-life CPR. This systematic review of the literature aims to assess the effectiveness of ARTF for improving CPR performance during simulated training and real-life resuscitation in the adult and paediatric population. Following PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines [1], articles published between January 2010 and November 2019 were searched from 7 electronic databases (SCIELO, LILACS, BVS, PubMed, Web of Science, Embase, Cochrane, Cinahl, Google Scholar) and reviewed according to the pre-defined eligibility criteria. CPR performance quality was assessed based on guideline compliance for chest compression rate, chest compression depth and complete chest recoil. 871 studies were found and 32 studies met inclusion criteria. 14 randomised controlled trials (RCTs), 08 randomised trials (RTs) and 10 randomised cross-over trials (RCOTs). Each study used ARTF devices during CPR training or real CPR to analyse the performance of healthcare professionals for paediatric or adult population. According to the studies, the use of ARTF devices enhances CPR performance in terms of achieving the recommended chest compression rate, depth and recoil. Based on the results of the studies analysed in this review, the use of ARTF can significantly help improve CPR performance during training of healthcare professionals. Further research is needed to reach the same conclusion for real-life CPR

The use of the Borg Rating of perceived exertion scale in cardiopulmonary resuscitation

Cardiorespiratory arrest is a critical event whose survival rate is related to the quality of resuscitation manoeuvres, combined with technology. It is important to understand the perception of tiredness during this procedure, aiming at the effectiveness of compressions and increasing the chances of survival. Goal Apply the Borg Scale to analyze the effort perceived by nurses during cardiopulmonary resuscitation manoeuvres with a feedback device. Method Experimental study with randomized distribution of nurses in a teaching hospital, simulating cardiac arrest, to assess perceived exertion using the Borg scale during cardiopulmonary resuscitation with/without a feedback device. A statistical significance level of 5% was adopted. Results Sixty-nine nurses working in critical and non-critical adult care units were included. Perceived exertion and heart rate were lower in the intervention group (p<0.001), influenced by the feedback device, with no significant difference regarding the actuation units. Conclusion The Borg scale proved to be adequate for the proposed objectives. The feedback device contributed to less effort and reduced heart rate during resuscitation manoeuvres. The low cost and ease of application favour its use in training and real-time consultations to assess performance during resuscitation, using a feedback device to reduce efforts and the perception of tiredness. It also allows reflection on the intervening factors and resources that can influence the quality of care and the chances of survival

What can be learned from the literature about intervals and strategies for paediatric CPR retraining of healthcare professionals? A scoping review of literature

Background: Effective training and retraining may be key to good quality paediatric cardiopulmonary resuscitation (pCPR). PCPR skills decay within months after training, making the current retraining intervals ineffective. Establishing an effective retraining strategy is fundamental to improve quality of performance and potentially enhance patient outcomes. Objective: To investigate the intervals and strategies of formal paediatric resuscitation retraining provided to healthcare professionals, and the associated outcomes including patient outcomes, quality of performance, retention of knowledge and skills and rescuer's confidence. Methods: This review was drafted and reported using the Preferred Reporting Items for Systematic Reviews and Meta-analysis extension for Scoping Reviews (PRISMA-ScR). PubMed, Medline, Cochrane, Embase, CINAHL Complete, ERIC and Web of Science were searched and studies addressing the PICOST question were selected. Results: The results indicate complex data due to significant heterogeneity among study findings in relation to study design, retraining strategies, outcome measures and length of intervention. Out of 4706 studies identified, 21 were included with most of them opting for monthly or more frequent retraining sessions. The length of intervention ranged from 2-minutes up to 3.5 hours, with most studies selecting shorter durations (<1h). All studies pointed to the importance of regular retraining sessions for acquisition and retention of pCPR skills. Conclusions: Brief and frequent pCPR retraining may result in more successful skill retention and consequent higher-quality performance. There is no strong evidence regarding the ideal retraining schedule however, with as little as two minutes of refresher training every month, there is the potential to increase pCPR performance and retain the skills for longer

Insulin-secreting pituitary GH3 cells : a potential beta-cell surrogate for diabetes cell therapy

In a companion article, we describe the engineering and characterization of pituitary GH3 cell clones stably transfected with a furin-cleavable human insulin cDNA (InsGH3 cells). This article describes the performance of InsGH3 (clones 1 and 7) cell grafts into streptozotocin (STZ)-induced diabetic nude mice. Subcutaneous implantation of 2 7 106 InsGH3 cells resulted in the progressive reversal of hyperglycemia and diabetic symptoms, even though the progressive growth of the transplanted cells (clone 7) eventually led to glycemic levels below the normal mouse range. Proinsulin transgene expression was maintained in harvested InsGH3 grafts that, conversely, lose the expression of the prolactin (PRL) gene. Elevated concentrations of circulating mature human insulin were detected in graft recipients, demonstrating that proinsulin processing by InsGH3 cells did occur in vivo. Histologic analysis showed that transplanted InsGH3 grew in forms of encapsulated tumors composed of cells with small cytoplasms weakly stained for the presence of insulin. Conversely, intense insulin immunoreactivity was detected in graft-draining venules. Compared to pancreatic \u3b2TC3 cells, InsGH3 cells showed in vitro a higher rate of replication, an elevate resistance to apoptosis induced by serum deprivation and proinflammatory cytokines and significantly higher antiapoptotic Bcl-2 protein levels. Moreover, InsGH3 cells were resistant to the streptozotocin toxicity that, in contrast, reduced \u3b2TC3 cell viability to 50-60% of controls. In conclusion, proinsulin gene expression and mature insulin secretion persisted in transplanted InsGH3 cells that reversed hyperglycemia in vivo. InsGH3 cells might represent a potential \u3b2-cell surrogate because they are more resistant than pancreatic \u3b2 cells to different apoptotic insults and might therefore be particularly suitable for encapsulation

Proinflammatory Cytokines Activate the Intrinsic Apoptotic Pathway in β-Cells

OBJECTIVE:Proinflammatory cytokines are cytotoxic to beta-cells and have been implicated in the pathogenesis of type 1 diabetes and islet graft failure. The importance of the intrinsic mitochondrial apoptotic pathway in cytokine-induced beta-cell death is unclear. Here, cytokine activation of the intrinsic apoptotic pathway and the role of the two proapoptotic Bcl-2 proteins, Bad and Bax, were examined in beta-cells.RESEARCH DESIGN AND METHODS:Human and rat islets and INS-1 cells were exposed to a combination of proinflammatory cytokines (interleukin-1beta, interferon-gamma, and/or tumor necrosis factor-alpha). Activation of Bad was determined by Ser136 dephosphorylation, mitochondrial stress by changes in mitochondrial metabolic activity and cytochrome c release, downstream apoptotic signaling by activation of caspase-9 and -3, and DNA fragmentation. The inhibitors FK506 and V5 were used to investigate the role of Bad and Bax activation, respectively. [...

Stage 4 neuroblastoma: sequential hemi-body irradiation or high-dose chemotherapy plus autologous haemopoietic stem cell transplantation to consolidate primary treatment

The aim of the present study was to evaluate the effectiveness of two consecutive nonrandomised treatment programs applied between 1989 and 1999 at the Istituto Nazionale Tumori of Milan in an unselected cohort of 59 children over the age of one with stage 4 neuroblastoma. Both treatment programs consisted of two phases, the induction of the remission phase and the consolidation phase. The induction of the remission phase consisted of intensive chemotherapy, and remained the same throughout the study period. The consolidation phase consisted of sequential hemi-body irradiation (HBI) (10 Gy per session, 6 weeks apart) in the first period (1988–June 1994) and sequential high-dose cyclophosphamide, etoposide, mitoxantrone+L-PAM and autologous haemopoietic stem cell transplantation in the second (July 1994–1999). Intention-to-treat analysis revealed a significantly better outcome for patients treated with the second program, the 5-year event-free survival probability being 0.12 for program 1 and 0.31 for program 2 (P=0.03). This finding led us to conclude that sequential HBI is useless as consolidation treatment. The high-dose chemotherapy adopted in the second program enabled a proportion of patients to obtain long-term survival but, since the clinical results remain unsatisfactory, new treatment strategies are warranted

Planck intermediate results. XLVI. Reduction of large-scale systematic effects in HFI polarization maps and estimation of the reionization optical depth

This paper describes the identification, modelling, and removal of previously unexplained systematic effects in the polarization data of the Planck High Frequency Instrument (HFI) on large angular scales, including new mapmaking and calibration procedures, new and more complete end-to-end simulations, and a set of robust internal consistency checks on the resulting maps. These maps, at 100, 143, 217, and 353 GHz, are early versions of those that will be released in final form later in 2016. The improvements allow us to determine the cosmic reionization optical depth τ using, for the first time, the low-multipole EE data from HFI, reducing significantly the central value and uncertainty, and hence the upper limit. Two different likelihood procedures are used to constrain τ from two estimators of the CMB E- and B-mode angular power spectra at 100 and 143 GHz, after debiasing the spectra from a small remaining systematic contamination. These all give fully consistent results. A further consistency test is performed using cross-correlations derived from the Low Frequency Instrument maps of the Planck 2015 data release and the new HFI data. For this purpose, end-to-end analyses of systematic effects from the two instruments are used to demonstrate the near independence of their dominant systematic error residuals. The tightest result comes from the HFI-based τ posterior distribution using the maximum likelihood power spectrum estimator from EE data only, giving a value 0.055 ± 0.009. In a companion paper these results are discussed in the context of the best-fit PlanckΛCDM cosmological model and recent models of reionization

Planck intermediate results. XLIX. Parity-violation constraints from polarization data

Parity-violating extensions of the standard electromagnetic theory cause in vacuo rotation of the plane of polarization of propagating photons. This effect, also known as cosmic birefringence, has an impact on the cosmic microwave background (CMB) anisotropy angular power spectra, producing non-vanishing T–B and E–B correlations that are otherwise null when parity is a symmetry. Here we present new constraints on an isotropic rotation, parametrized by the angle α, derived from Planck 2015 CMB polarization data. To increase the robustness of our analyses, we employ two complementary approaches, in harmonic space and in map space, the latter based on a peak stacking technique. The two approaches provide estimates for α that are in agreement within statistical uncertainties and are very stable against several consistency tests.Considering the T–B and E–B information jointly, we find from the harmonic analysis and from the stacking approach. These constraints are compatible with no parity violation and are dominated by the systematic uncertainty in the orientation of Planck’s polarization-sensitive bolometers