Air Activation Following an Atmospheric Explosion

In addition to thermal radiation and fission products, nuclear explosions result in a very high flux of unfissioned neutrons. Within an atmospheric nuclear explosion, these neutrons can activate the various elemental components of natural air, potentially adding to the radioactive signature of the event as a whole. The goal of this work is to make an order-of-magnitude estimate of the total amount of air activation products that can result from an atmospheric nuclear explosion

Representative Atmospheric Plume Development for Elevated Releases

An atmospheric explosion of a low-yield nuclear device will produce a large number of radioactive isotopes, some of which can be measured with airborne detection systems. However, properly equipped aircraft may not arrive in the region where an explosion occurred for a number of hours after the event. Atmospheric conditions will have caused the radioactive plume to move and diffuse before the aircraft arrives. The science behind predicting atmospheric plume movement has advanced enough that the location of the maximum concentrations in the plume can be determined reasonably accurately in real time, or near real time. Given the assumption that an aircraft can follow a plume, this study addresses the amount of atmospheric dilution expected to occur in a representative plume as a function of time past the release event. The approach models atmospheric transport of hypothetical releases from a single location for every day in a year using the publically available HYSPLIT code. The effective dilution factors for the point of maximum concentration in an elevated plume based on a release of a non-decaying, non-depositing tracer can vary by orders of magnitude depending on the day of the release, even for the same number of hours after the release event. However, the median of the dilution factors based on releases for 365 consecutive days at one site follows a power law relationship in time, as shown in Figure S-1. The relationship is good enough to provide a general rule of thumb for estimating typical future dilution factors in a plume starting at the same point. However, the coefficients of the power law function may vary for different release point locations. Radioactive decay causes the effective dilution factors to decrease more quickly with the time past the release event than the dilution factors based on a non-decaying tracer. An analytical expression for the dilution factors of isotopes with different half-lives can be developed given the power law expression for the non-decaying tracer. If the power-law equation for the median dilution factor, Df, based on a non-decaying tracer has the general form Df=a〖×t〗^(-b) for time t after the release event, then the equation has the form Df=e^(-λt)×a×t^(-b) for a radioactive isotope, where λ is the decay constant for the isotope

Effect of angiotensin-converting enzyme inhibitor and angiotensin receptor blocker initiation on organ support-free days in patients hospitalized with COVID-19

IMPORTANCE Overactivation of the renin-angiotensin system (RAS) may contribute to poor clinical outcomes in patients with COVID-19. Objective To determine whether angiotensin-converting enzyme (ACE) inhibitor or angiotensin receptor blocker (ARB) initiation improves outcomes in patients hospitalized for COVID-19. DESIGN, SETTING, AND PARTICIPANTS In an ongoing, adaptive platform randomized clinical trial, 721 critically ill and 58 non–critically ill hospitalized adults were randomized to receive an RAS inhibitor or control between March 16, 2021, and February 25, 2022, at 69 sites in 7 countries (final follow-up on June 1, 2022). INTERVENTIONS Patients were randomized to receive open-label initiation of an ACE inhibitor (n = 257), ARB (n = 248), ARB in combination with DMX-200 (a chemokine receptor-2 inhibitor; n = 10), or no RAS inhibitor (control; n = 264) for up to 10 days. MAIN OUTCOMES AND MEASURES The primary outcome was organ support–free days, a composite of hospital survival and days alive without cardiovascular or respiratory organ support through 21 days. The primary analysis was a bayesian cumulative logistic model. Odds ratios (ORs) greater than 1 represent improved outcomes. RESULTS On February 25, 2022, enrollment was discontinued due to safety concerns. Among 679 critically ill patients with available primary outcome data, the median age was 56 years and 239 participants (35.2%) were women. Median (IQR) organ support–free days among critically ill patients was 10 (–1 to 16) in the ACE inhibitor group (n = 231), 8 (–1 to 17) in the ARB group (n = 217), and 12 (0 to 17) in the control group (n = 231) (median adjusted odds ratios of 0.77 [95% bayesian credible interval, 0.58-1.06] for improvement for ACE inhibitor and 0.76 [95% credible interval, 0.56-1.05] for ARB compared with control). The posterior probabilities that ACE inhibitors and ARBs worsened organ support–free days compared with control were 94.9% and 95.4%, respectively. Hospital survival occurred in 166 of 231 critically ill participants (71.9%) in the ACE inhibitor group, 152 of 217 (70.0%) in the ARB group, and 182 of 231 (78.8%) in the control group (posterior probabilities that ACE inhibitor and ARB worsened hospital survival compared with control were 95.3% and 98.1%, respectively). CONCLUSIONS AND RELEVANCE In this trial, among critically ill adults with COVID-19, initiation of an ACE inhibitor or ARB did not improve, and likely worsened, clinical outcomes. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT0273570