What Local Climate Change Plans Can Teach Us About City Power

Discussions of city power have long focused on cities’ power relative to higher levels of government and to each other. The diffuse causes of climate change offer an opportunity to revisit the question of city power by focusing more closely on the intended object of influence. Although these two perspectives on power will at times overlap, they are not identical. If we consider greenhouse gas emissions as the target, cities can employ their relatively minor powers to substantial effect and many of them appear to be trying to do so. But consideration of cities’ climate change policies alters the usual analysis of city power further. While local government theorists have generally evaluated cities’ autonomy in terms of residents’ ability to shape their local community or their metropolitan region, municipal climate change policies aim to meaningfully contribute to resolution of a global problem. Although some elements of climate change plans may provide fiscal or other benefits that may make cities better providers of services to “consumer-voters” on a public choice model, many other elements cannot be explained other than recognizing these as efforts to engage their residents in a community building effort that encompasses the entire world. Perhaps Frug’s future vision for cities is already taking shape in the realm of local climate change policies, but on a grander vision of geographic interconnection than even he envisioned

Hall Thruster Direct-Drive Assessment and Demonstration

This thesis involves the theoretical and experimental study of the Hall thruster Direct Drive configuration: a innovative way to deliver power to the electric thrusters and candidate for future propulsion system of spacecraft. The direct connection between the solar array and the thruster anode, made possible by the current development of technology, allows a drastic simplification of the power processing unit of the propulsion system. This has an immediate impact on the propulsion system and its thermal control system which can be consequently lightened. Then, additional mass benefits can be exploited in other parts of the spacecraft such as the electric power system. The work is mainly divided in two parts. The first one assesses in terms of mass reduction the impact that the Direct Drive configuration entails in the spacecraft systems. Different kind of space missions with different level of Hall thruster power are considered. The second part of thesis concerns an experimental demonstration of a Direct Drive system supplying the HT-100, the low power electric thruster developed at Alta. The test required the procurement of the solar panel and the design of an electrical filter. By means of simulations with Pspice, a LC filter was developed and then arranged between the solar modules and thruster in order to dampen the current oscillations. This test successfully proved the correct ignition and operations of the thruster, representing in this way the first attempt in Europe of a Direct Drive demonstration

Predictive Value of Endobronchial Ultrasound Strain Elastography in Mediastinal Lymph Node Staging: The E-Predict Multicenter Study Results

Background: Systematic assessment of lymph node status by endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) is indicated in (suspected) lung cancer. Sampling is herein guided by nodal size and FDG-PET characteristics. Ultrasound strain elastography (SE) might further improve risk stratification. By imaging tissue deformation over time, SE computes relative tissue strain. In several tissues, a lower strain (deformation) has been associated with a higher likelihood of malignancy. Objectives: To assess if EBUS-SE can independently help predict malignancy, and when combined with size and FDG uptake information. Methods: This multicenter (n = 5 centers) prospective trial included patients with suspected or proven lung cancer using a standardized measurement protocol. Cytopathology combined with surgery or follow-up imaging (>6 months) were used as reference standard. Results: Between June 2016 and July 2018, 327 patients and 525 lymph nodes were included (mean size 12.3 mm, malignancy prevalence 0.48). EBUS-SE had an overall AUC of 0.77. A mean strain <115 (range 0-255) showed 90% sensitivity, 43% specificity, 60% positive predictive value, and 82% negative predictive value. Combining EBUS-SE (<115) with size (<8 mm) and FDG-PET information into a risk stratification algorithm increased the accuracy. Combining size and SE showed that the 48% a priori chance of malignancy changed to 11 and 70% in double negative or positive nodes, respectively. In the subset where FDG-PET was available (n = 370), triple negative and positive nodes went from a 42% a priori chance of malignancy to 9 and 73%, respectively. Conclusions: EBUS-SE can help predict lymph node malignancy and may be useful for risk stratification when combined with size and PET information. (c) 2020 The Author(s) Published by S. Karger AG, Base

Endobronchial ultrasound in diagnosing and staging of lung cancer by Acquire 22G TBNB versus regular 22G TBNA needles: A randomized clinical trial

Objectives: Endobronchial ultrasound guided transbronchial needle aspiration (EBUS-TBNA) has an important role in the diagnosis and staging of lung cancer. Evaluation of programmed death ligand 1 (PD-L1) expression and molecular profiling has become standard of care but cytological samples frequently contain insufficient tumor cells. The 22G Acquire needle with Franseen needle tip was developed to perform transbronchial needle biopsy (TBNB) with improved tissue specimens. This study evaluated if the 22G Acquire TBNB needle results in enhanced PD-L1 suitability rate compared to the regular Expect 22G TBNA needle.Methods: in this multi-center randomized clinical trial (Netherlands Trial Register NL7701), patients with sus-pected (N)SCLC and an indication for mediastinal/hilar staging or lung tumor diagnosis were recruited in five university and general hospitals in the Netherlands, Poland, Italy and Czech Republic. Patients were randomized (1:1) between the two needles. Two blinded reference pathologists evaluated the samples. The primary outcome was PD-L1 suitability rate in patients with a final diagnosis of lung cancer. In case no malignancy was diagnosed, the reference standard was surgical verification or 6 month follow-up.Results: 154 patients were randomized (n = 76 Acquire TBNB; n = 78 Expect TBNA) of which 92.9% (n = 143) had a final malignant diagnosis. Suitability for PD-L1 analysis was 80.0% (n = 56/70; 95 %CI 0.68-0.94) with the Acquire needle and 76.7% (n = 56/73; 95 %CI 0.65-0.85) with the Expect needle (p = 0.633). Acquire TBNB needle specimens provided more frequent superior quality (65.3% (95 %CI 0.57-0.73) vs 49.4% (95 %CI 0.41-0.57, p = 0.005) and contained more tissue cores (72.0% (95 %CI 0.60-0.81) vs 41.0% (95 %CI 0.31-0.54, p < 0.01). There were no statistically significant differences in tissue adequacy, suitability for molecular analysis and sensitivity for malignancy and N2/N3 disease.Conclusion: The 22G Acquire TBNB needle procured improved quality tissue specimens compared to the Expect TBNA needle but this did not result in an improved the suitability rate for PD-L1 analysis

Targeted molecular characterization of adult midline and circumscribed gliomas for the identification of new potential targets for personalized therapy

Diffuse midline gliomas (MLG) are primary brain tumours arising from thalamus, hypothalamus, brainstem, cerebellum or spinal cord, mainly occurring in children. In adults, less than 10% of diffuse gliomas arises in midline structures and recent works suggested that this subset of tumours may present with phenotypic and molecular characteristics differing from both pediatric MLG and adult supratentorial gliomas. Circumscribed gliomas (CG) are low-grade tumours but may progress to anaplasia. They have lower genetic complexity than diffuse gliomas and could be better candidate for targeted therapies, when complete surgical resection is not feasible. Unravelling the genomic landscape of MLG and CG will better define the prognostic value of molecular biomarkers and identify new therapeutic strategies that could improve patient care. Adult patients with diagnosis of MLG and CG were retrospectively identified from \uabMaggiore della Carit\ue0\ubb Hospital and GH Piti\ue9-Salp\ueatri\ue8re (Paris). Mutation analysis was performed by Sanger sequencing of the major hot-spots: IDH1, IDH2, H3F3A, HIST1H3B, FGFR1, TERT promoter. FISH analyses of NTRK1-2-3 rearrangements were performed by break-apart probes on tissue microarray of MLG cases. We identified 116 (French) and 47 (Italian) patients. The two cohorts showed a lower percentage of H3F3A mutations (20% vs 33%), the mutation was not associated to a worse prognosis. FGFR1 mutations were identified in 18% of cases and are restricted to MLG. NTRKs analysis in the Italian cohort showed NTRK1 translocations in 15% of cases. We reported a high rate of FGFR1 mutations in optic nerve pilocytic astrocitomas and the presence of alternative BRAF activating mutations (Thr599_Val600insThr and Val600_Lys601>Glu). Our finding of frequent and potentially targetable FGFR1 and BRAF mutations and NTRK1 translocations have important therapeutical implications in the current context of clinical trials, and further reinforces the need for molecular analyses

Holistic Climate Change Governance: Towards Mitigation and Adaptation Synthesis

Climate change already has begun destabilizing natural systems, prompting unprecedented heat waves, droughts, floods, and severe storms. While scientists admonish us that greenhouse gases must be cut deeply and quickly to avoid the worst impacts, past emissions have committed the planet to some further warming. Resulting physical changes will require a legal system that functions amidst extreme weather, rising seas, and scientific uncertainty about the stability of natural systems upon which we relied in designing institutions and infrastructure. An effective response requires both substantial reductions in greenhouse gas emissions to limit the harm ( mitigation\u27) and significant adaptation. Scholars and policymakers have largely treated mitigation and adaptation as distinct strategies, overlooking critical interactions between the two issues. This Article addresses the resulting gap in scholarship. Adequate preparation for climate change requires fundamentally rethinking systems and infrastructure designed for more stable conditions. Part of this rethinking process includes evaluating whether legal measures designed to red greenhouse gas emissions will ultimately aid or hinder adaptation. Using a case study of one proposed mitigation measure-expanded reliance on nuclear power-this Article illustrates how disconnected approaches to adaptation and mitigation can undermine both efforts. The Article then offers a preliminary framework for holistic climate change governance that directs mitigation investment toward adaptive and adaptable infrastructure that reduces human risks, decreases reliance on complex networks, and moderates the extent of scientific uncertainty that legislators and administrative agencies will face in an unpredictable future environment

Waste Not, Want Not: Landfill Gas to Energy Projects, Climate Change, and the Clean Air Act

This Article aims to address this gap, proposing how the Rule could be amended to reduce methane generally and enhance LGTE specifically. The sections discuss legal mechanisms to reduce landfill methane emissions and promote LGTE where appropriate, focusing on the federal Clean Air Act’s potential role in regulating landfill gas emissions. Section II explains the adverse effects of methane emissions generally and the potential benefits of reducing landfill emissions specifically. Section III describes federal emissions standards under the Clean Air Act and incentive programs for expanded use of LGTE. The discussion highlights potential conflicts between divergent means of regulating landfill gas and discusses criticisms of LGTE incentives. Section IV proposes amendments to Landfill Gas Rule that would more effectively control landfill methane emissions and improve the benefits of LGTE projects by reducing their risks. Section V briefly concludes

The Medicare Physician Group Practice Demonstration: Lessons Learned on Improving Quality and Efficiency in Health Care

Discusses the experiences of ten large practices earning performance payments for improving the quality and cost-efficiency of health care delivered to Medicare fee-for-service beneficiaries

Propagation and reconstruction of re-entry uncertainties using continuity equation and simplicial interpolation

This work proposes a continuum-based approach for the propagation of uncertainties in the initial conditions and parameters for the analysis and prediction of spacecraft re-entries. Using the continuity equation together with the re-entry dynamics, the joint probability distribution of the uncertainties is propagated in time for specific sampled points. At each time instant, the joint probability distribution function is then reconstructed from the scattered data using a gradient-enhanced linear interpolation based on a simplicial representation of the state space. Uncertainties in the initial conditions at re-entry and in the ballistic coefficient for three representative test cases are considered: a three-state and a six-state steep Earth re-entry and a six-state unguided lifting entry at Mars. The paper shows the comparison of the proposed method with Monte Carlo based techniques in terms of quality of the obtained marginal distributions and runtime as a function of the number of samples used

The “Polonium In Vivo” Study: Polonium-210 in Bronchial Lavages of Patients with Suspected Lung Cancer

Few studies have reported on polonium-210, a decay breakdown product of radon-222 and lead-210, in human lungs and there has been no study in patients with suspected lung cancer. The main aim of this "Polonium in vivo" study was to evaluate polonium-210 radioactivity in bronchopulmonary systems of smoker, ex-smoker and never smoker patients with suspected lung cancer. Alpha-spectrometric analyses were performed on bronchial lavage (BL) fluids from two Italian hospitals in 2013-2016. Socio-demographic, smoking, occupational and spirometric characteristics, lung cancer confirmation and histologic type and radon-222 concentration in patients' homes were collected. Seventy BL samples from never (n = 13), former (n = 35) and current smokers (n = 22) were analyzed; polonium-210 was detected in all samples from current and former smokers and in 54% of samples from never smokers (p < 0.001; median values: 1.20, 1.43 and 0.40 mBq, respectively). Polonium-210 levels were significantly higher in COPD versus no COPD patients (median value: 3.60 vs. 0.97 mBq; p = 0.007); former and current smokers, without and with COPD, had significantly increased polonium-210 levels (p = 0.012); 96% of confirmed versus 69% of non-confirmed lung cancer patients recorded detectable polonium-210 levels (p = 0.018). A polonium-210 detectable activity was measured in BL samples from all current and former smokers. Polonium-210 in the lungs could be the result of lead-210 entrapment, which, with its half-life of 22 years, could provide a continuous emission of alpha radioactivity, even many years after quitting, thus proposing a possible explanation for the onset of lung cancer, particularly in former smokers