Hotter and Weaker Mediterranean Outflow as a Response to Basin-Wide Alterations

Time series collected from 2004 to 2020 at an oceanographic station located at the westernmost sill of the Strait of Gibraltar to monitor the Mediterranean outflow into the North Atlantic have been used to give some insights on changes that have been taking place in the Mediterranean basin. Velocity data indicate that the exchange through the Strait is submaximal (that is, greater values of the exchanged flows are possible) with a mean value of −0.847 ± 0.129 Sv and a slight trend to decrease in magnitude (+0.017 ± 0.003 Sv decade−1). Submaximal exchange promotes footprints in the Mediterranean outflow with little or no-time delay with regards to changes occurring in the basin. An astonishing warming trend of 0.339 ± 0.008°C decade−1 in the deepest layer of the outflow from 2013 onwards stands out among these changes, a trend that is an order of magnitude greater than any other reported so far in the water masses of the Mediterranean Sea. Biogeochemical (pH) data display a negative trend indicating a gradual acidification of the outflow in the monitoring station. Data analysis suggests that these trends are compatible with a progressively larger participation of Levantine Intermediate Water (slightly warmer and characterized by a pH lower than that of Western Mediterranean Deep Water) in the outflow. Such interpretation is supported by climatic data analysis that indicate diminished buoyancy fluxes to the atmosphere during the seven last years of the analyzed series, which in turn would have reduced the rate of formation of Western Mediterranean Deep Water. The flow through the Strait has echoed this fact in a situation of submaximal exchange and, ultimately, reflects it in the shocking temperature trend recorded at the monitoring station.Postprin

Multiple solutions to a magnetic nonlinear Choquard equation

We consider the stationary nonlinear magnetic Choquard equation [(-\mathrm{i}\nabla+A(x))^{2}u+V(x)u=(\frac{1}{|x|^{\alpha}}\ast |u|^{p}) |u|^{p-2}u,\quad x\in\mathbb{R}^{N}%] where $A\$is a real valued vector potential, $V$ is a real valued scalar potential$,$ $N\geq3$, $\alpha\in(0,N)$ and $2-(\alpha/N) <p<(2N-\alpha)/(N-2)$. \ We assume that both $A$ and $V$ are compatible with the action of some group $G$ of linear isometries of $\mathbb{R}^{N}$. We establish the existence of multiple complex valued solutions to this equation which satisfy the symmetry condition $$u(gx)=\tau(g)u(x)\text{\ \ \ for all}g\in G,\text{}x\in\mathbb{R}^{N},$$ where $\tau:G\rightarrow\mathbb{S}^{1}$ is a given group homomorphism into the unit complex numbers.Comment: To appear on ZAM

On the origin of the seasonal and interannual T–S variability of the inflow through the Strait of Gibraltar

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Non-Surgical Respiratory Management in Relation to Feeding and Growth in Patients with Robin Sequence; a Prospective Longitudinal Study

Objective: To reflect upon our non-surgical respiratory management by evaluating clinical outcomes regarding airway, feeding, and growth during the first year of life in patients with Robin Sequence. Design: Prospective study. Setting: Sophia Children's Hospital, Rotterdam, the Netherlands. Patients/ Participants: 36 patients with Robin Sequence who were treated between 2011 and 2021. Interventions: Positional therapy and respiratory support. Main Outcome Measure(s): Data on respiratory outcomes included polysomnography characteristics and capillary blood gas values. Feeding outcomes were based on the requirement of additional tube feeding. Outcomes on growth were expressed as standard-deviation-scores (SDS) for weight-for-age (WFA) and height-for-age (HFA). Results: Twenty patients were treated with positional therapy (PT), whilst the other 16 patients required respiratory support. Twenty-two patients presented with non-isolated Robin Sequence (RS). During the first year of life, obstructive apnea hypopnea index decreased, oxygen levels enhanced, and capillary blood gas values improved. Eighty-six percent (31/36) experienced feeding difficulties, which completely resolved in 71% (22/31) during their first year of life. From start treatment, to stop treatment, to the age of 1 year, the SDS WFA worsened from −0.40 to −0.33 to −1.03, respectively. Conclusions: Non-surgical respiratory treatment resulted in an improvement of respiratory outcomes to near normal during the first year of life in patients with RS. These patients often experience feeding difficulties and endure impaired weight gain up to 1 year of age, despite near normalization of breathing. The high prevalence of feeding difficulties and impaired weight for age indicate the urgency for early recognition and adequate treatment to support optimal growth.</p

An event-triggered coincidence algorithm for fast-neutron multiplicity assay corrected for cross-talk and photon breakthrough

A model quantifying detector cross-talk and the misidentification of events in fast neutron coincidence distributions is described. This is demonstrated for two experimental arrangements comprising rings of 8 and 15 organic liquid scintillation detectors. Correction terms developed as part of this model are tested with  252Cf and a relationship is developed between the  235U enrichment of U 3 O8 and the order of correlated, fast neutron multiplets induced by an americium-lithium source. The model is also supported by Geant4 simulations. The results suggest that a typical assay, for experimental arrangements that are similar to the examples investigated in this research, will exhibit cross-talk for less than 1% of all detected fast neutrons but, if not accounted for, this can bias the numerical analysis by a margin of 10% and 35% in second- and third-order coincidences (i.e. couplet and triplet counts), respectively. Further, for the case of  252Cf, it is shown that a relatively low proportion of 4% breakthrough by γ rays (that is, photons misidentified as neutrons by the pulse-shape discrimination process) can lead to an erroneous increase of 20% in total neutron counts in the assay of a mixed-field, in this case of  252Cf. These findings will help direct the developments needed to enable organic scintillation detectors with pulse shape discriminators to be applied reliably to nuclear safeguards and non-proliferation verification tasks

Cost-Effectiveness of Including a Nurse Specialist in the Treatment of Urinary Incontinence in Primary Care in the Netherlands.

#### Objective Incontinence is an important health problem. Effectively treating incontinence could lead to important health gains in patients and caregivers. Management of incontinence is currently suboptimal, especially in elderly patients. To optimise the provision of incontinence care a global optimum continence service specification (OCSS) was developed. The current study evaluates the costs and effects of implementing this OCSS for community-dwelling patients older than 65 years with four or more chronic diseases in the Netherlands. #### Method A decision analytic model was developed comparing the current care pathway for urinary incontinence in the Netherlands with the pathway as described in the OCSS. The new care strategy was operationalised as the appointment of a continence nurse specialist (NS) located with the general practitioner (GP). This was assumed to increase case detection and to include initial assessment and treatment by the NS. The analysis used a societal perspective, including medical costs, containment products (out-of-pocket and paid by insurer), home care, informal care, and implementation costs. #### Results With the new care strategy a QALY gain of 0.005 per patient is achieved while saving €402 per patient over a 3 year period from a societal perspective. In interpreting these findings it is important to realise that many patients are undetected, even in the new care situation (36%), or receive care for containment only. In both of these groups no health gains were achieved. #### Conclusion Implementing the OCSS in the Netherlands by locating a NS in the GP practice is likely to reduce incontinence, improve quality of life, and reduce costs. Furth

Integrated Bioluminescent Immunoassays for High-Throughput Sampling and Continuous Monitoring of Cytokines

Immunoassays show great potential for the detection of low levels of cytokines, due to their high sensitivity and excellent specificity. There is a particular demand for biosensors that enable both high-throughput screening and continuous monitoring of clinically relevant cytokines such as interleukin-6 (IL-6) and tumor necrosis factor-α (TNFα). To this end, we here introduce a novel bioluminescent immunoassay based on the ratiometric plug-and-play immunodiagnostics (RAPPID) platform, with an improved intrinsic signal-to-background and an &gt;80-fold increase in the luminescent signal. The new dRAPPID assay, comprising a dimeric protein G adapter connected via a semiflexible linker, was applied to detect the secretion of IL-6 by breast carcinoma cells upon TNFα stimulation and the production of low concentrations of IL-6 (∼18 pM) in an endotoxin-stimulated human 3D muscle tissue model. Moreover, we integrated the dRAPPID assay in a newly developed microfluidic device for the simultaneous and continuous monitoring of changes in IL-6 and TNFα in the low-nanomolar range. The luminescence-based read-out and the homogeneous nature of the dRAPPID platform allowed for detection with a simple measurement setup, consisting of a digital camera and a light-sealed box. This permits the usage of the continuous dRAPPID monitoring chip at the point of need, without the requirement for complex or expensive detection techniques.</p

Correlation of pulse wave velocity with left ventricular mass in patients with hypertension once blood pressure has been normalized

Vascular stiffness has been proposed as a simple method to assess arterial loading conditions of the heart which induce left ventricular hypertrophy (LVH). There is some controversy as to whether the relationship of vascular stiffness to LVH is independent of blood pressure, and which measurement of arterial stiffness, augmentation index (AI) or pulse wave velocity (PWV) is best. Carotid pulse wave contor and pulse wave velocity of patients (n=20) with hypertension whose blood pressure (BP) was under control (<140/90 mmHg) with antihypertensive drug treatment medications, and without valvular heart disease, were measured. Left ventricular mass, calculated from 2D echocardiogram, was adjusted for body size using two different methods: body surface area and height. There was a significant (P<0.05) linear correlation between LV mass index and pulse wave velocity. This was not explained by BP level or lower LV mass in women, as there was no significant difference in PWV according to gender (1140.1+67.8 vs 1110.6+57.7 cm/s). In contrast to PWV, there was no significant correlation between LV mass and AI. In summary, these data suggest that aortic vascular stiffness is an indicator of LV mass even when blood pressure is controlled to less than 140/90 mmHg in hypertensive patients. The data further suggest that PWV is a better proxy or surrogate marker for LV mass than AI and the measurement of PWV may be useful as a rapid and less expensive assessment of the presence of LVH in this patient population