IBRD Operational Decision Framework

The IBRD Operational Decision Framework in this document is an expansion of an emerging general risk management framework under development by an interagency working group. It provides the level of detail necessary to develop a general Consequence Management Guidance Document for biological contamination remediation and restoration. It is the intent of this document to support both wide area and individual site remediation and restoration activities. This product was initiated as a portion of the IBRD Task 1 Systems Analysis to aid in identification of wide area remediation and restoration shortcomings and gaps. The draft interagency general risk management framework was used as the basis for the analysis. The initial Task 1 analysis document expanded the draft interagency framework to a higher level of resolution, building on both the logic structure and the accompanying text explanations. It was then employed in a qualitative manner to identify responsible agencies, data requirements, tool requirements, and current capabilities for each decision and task. This resulted in identifying shortcomings and gaps needing resolution. Several meetings of a joint LLNL/SNL working group reviewed and approved the initial content of this analysis. At the conclusion of Task 1, work continued on the expanded framework to generate this Operational Decision Framework which is consistent with the existing interagency general risk management framework. A large LLNL task group met repeatedly over a three-month period to develop the expanded framework, coordinate the framework with the biological remediation checklist, and synchronize the logic with the Consequence Management Plan table of contents. The expanded framework was briefed at a large table top exercise reviewing the interagency risk management framework. This exercise had representation from major US metropolitan areas as well as national agencies. This product received positive comments from the participants. Upon completion of the Operational Decision Framework, another joint LLNL/SNL working group conducted a day-long review. Identified modifications were made to the document, resulting in the included product

The rise and fall of aspirin in the primary prevention of cardiovascular disease

Aspirin is one of the most frequently used drugs worldwide and is generally considered effective for the secondary prevention of cardiovascular disease. By contrast, the role of aspirin in primary prevention of cardiovascular disease is controversial. Early trials evaluating aspirin for primary prevention, done before the turn of the millennium, suggested reductions in myocardial infarction and stroke (although not mortality), and an increased risk of bleeding. In an effort to balance the risks and benefits of aspirin, international guidelines on primary prevention of cardiovascular disease have typically recommended aspirin only when a substantial 10-year risk of cardiovascular events exists. However, in 2018, three large randomised clinical trials of aspirin for the primary prevention of cardiovascular disease showed little or no benefit and have even suggested net harm. In this narrative Review, we reappraise the role of aspirin in primary prevention of cardiovascular disease, contextualising data from historical and contemporary trials

Selective APRIL Blockade Delays Systemic Lupus Erythematosus in Mouse

SLE pathogenesis is complex, but it is now widely accepted that autoantibodies play a key role in the process by forming excessive immune complexes; their deposits within tissues leading to inflammation and functional damages. A proliferation inducing ligand (APRIL) is a member of the tumor necrosis factor (TNF) superfamily mediating antibody-producing plasma cell (PC)-survival that may be involved in the duration of pathogenic autoantibodies in lupus. We found significant increases of APRIL at the mRNA and protein levels in bone marrow but not spleen cells from NZB/W lupus mice, as compared to control mice. Selective antibody-mediated APRIL blockade delays disease development in this model by preventing proteinuria, kidney lesions, and mortality. Notably, this was achieved by decreasing anti-DNA and anti-chromatin autoantibody levels, without any perturbation of B- and T- cell homeostasis. Thus, anti-APRIL treatment may constitute an alternative therapy in SLE highly specific to PCs compared to other B-cell targeting therapies tested in this disease, and likely to be associated with less adverse effects than any anti-inflammatory and immunosuppressant agents previously used

Formaldehyde, glyoxal, and methylglyoxal in air and cloudwater at a rural mountain site in central Virginia

As part of the Shenandoah Cloud and Photochemistry Experiment (SCAPE), we measured formaldehyde (HCHO), glyoxal (CHOCHO), and methylglyoxal (CH3C(O)CHO) concentrations in air and cloudwater at Pinnacles (elevation 1037 m) in Shenandoah National Park during September 1990. Mean gas‐phase concentrations of HCHO and CHOCHO were 980 and 44 pptv, respectively. The concentration of CH3C(O)CHO rarely exceeded the detection limit of 50 pptv. Mean cloudwater concentrations of HCHO and CHOCHO were 9 and 2 μM, respectively; the mean CH3C(O)CHO concentration was below its detection limit of 0.3 μM. The maximum carbonyl concentrations were observed during stagnation events with high O3, peroxides, and CO. Outside of these events the carbonyls did not correlate significantly with O3, CO, or NOy. Carbonyl concentrations and concentration ratios were consistent with a major source for the carbonyls from isoprene oxidation. Oxidation of CH4 supplies a significant background of HCHO. The carbonyl concentrations were indistinguishable in two size fractions of cloudwater having a cut at d=18 μm. Gas‐ and aqueous‐phase concentrations of HCHO from samples collected during a nighttime cloud event agree with thermodynamic equilibria within a factor of 2. Samples collected during a daytime cloud event show HCHO supersaturation by up to a factor of 4. Positive artifacts in the cloudwater samples due to hydrolysis of hydroxymethylhydroperoxide (HOCH2OOH) could perhaps account for this discrepancy

Measurement of fractionated plasma metanephrines for exclusion of pheochromocytoma: Can specificity be improved by adjustment for age?

BACKGROUND: Biochemical testing for pheochromocytoma by measurement of fractionated plasma metanephrines is limited by false positive rates of up to 18% in people without known genetic predisposition to the disease. The plasma normetanephrine fraction is responsible for most false positives and plasma normetanephrine increases with age. The objective of this study was to determine if we could improve the specificity of fractionated plasma measurements, by statistically adjusting for age. METHODS: An age-adjusted metanephrine score was derived using logistic regression from 343 subjects (including 33 people with pheochromocytoma) who underwent fractionated plasma metanephrine measurements as part of investigations for suspected pheochromocytoma at Mayo Clinic Rochester (derivation set). The performance of the age-adjusted score was validated in a dataset of 158 subjects (including patients 23 with pheochromocytoma) that underwent measurements of fractionated plasma metanephrines at Mayo Clinic the following year (validation dataset). None of the participants in the validation dataset had known genetic predisposition to pheochromocytoma. RESULTS: The sensitivity of the age-adjusted metanephrine score was the same as that of traditional interpretation of fractionated plasma metanephrine measurements, yielding a sensitivity of 100% (23/23, 95% confidence interval [CI] 85.7%, 100%). However, the false positive rate with traditional interpretation of fractionated plasma metanephrine measurements was 16.3% (22/135, 95% CI, 11.0%, 23.4%) and that of the age-adjusted score was significantly lower at 3.0% (4/135, 95% CI, 1.2%, 7.4%) (p < 0.001 using McNemar's test). CONCLUSION: An adjustment for age in the interpretation of results of fractionated plasma metanephrines may significantly decrease false positives when using this test to exclude sporadic pheochromocytoma. Such improvements in false positive rate may result in savings of expenditures related to confirmatory imaging

Critical Perspective: Named Reactions Discovered and Developed by Women

Named organic reactions. As chemists, we’re all familiar with them: who can forget the Diels−Alder reaction? But how much do we know about the people behind the names? For example, can you identify a reaction named for a woman? How about a reaction discovered or developed by a woman but named for her male adviser? Our attempts to answer these simple questions started us on the journey that led to this Account. We introduce you to four reactions named for women and nine reactions discovered or developed by women. Using information obtained from the literature and, whenever possible, through interviews with the chemists themselves, their associates, and their advisers, we paint a more detailed picture of these remarkable women and their outstanding accomplishments. Some of the women you meet in this Account include Irma Goldberg, the only woman unambiguously recognized with her own named reaction. Gertrude Maud Robinson, the wife of Robert Robinson, who collaborated with him on several projects including the Piloty−Robinson pyrrole synthesis. Elizabeth Hardy, the Bryn Mawr graduate student who discovered the Cope rearrangement. Dorothee Felix, a critical member of Albert Eschenmoser’s research lab for over forty years who helped develop both the Eschenmoser−Claisen rearrangement and the Eschenmoser−Tanabe fragmentation. Jennifer Loebach, the University of Illinois undergraduate who was part of the team in Eric Jacobsen’s lab that discovered the Jacobsen−Katsuki epoxidation. Keiko Noda, a graduate student in Tsutomu Katsuki’s lab who also played a key role in the development of the Jacobsen−Katsuki epoxidation. Lydia McKinstry, a postdoc in Andrew Myers’s lab who helped develop the Myers asymmetric alkylation. Rosa Lockwood, a graduate student at Boston College whose sole publication is the discovery of the Nicholas reaction. Kaori Ando, a successful professor in Japan who helped develop the Roush asymmetric alkylation as a postdoc at MIT. Bianka Tchoubar, a critically important member of the organic chemistry community in France who developed the Tiffeneau−Demjanov rearrangement. The accomplishments of the women in this Account illustrate the key roles women have played in the discovery and development of reactions used daily by organic chemists around the world. These pioneering chemists represent the vanguard of women in the field, and we are confident that many more of the growing number of current and future female organic chemists will be recognized with their own named reactions