Effectiveness and safety of serial endoscopic ultrasound–guided celiac plexus block for chronic pancreatitis

Background and study aims: Endoscopic ultrasound – guided celiac plexus block (EUS-CPB) is an established treatment for pain in patients with chronic pancreatitis (CP), but the effectiveness and safety of repeated procedures are unknown. Our objective is to report our experience of repeated EUS-CPB procedures within a single patient. , Patients and methods: A prospectively maintained EUS database was retrospectively analyzed to identify patients who had undergone more than one EUS-CPB procedure over a 17-year period. The main outcome measures included number of EUS-CPB procedures for each patient, self-reported pain relief, duration of pain relief, and procedure-related adverse events. , Results: A total of 248 patients underwent more than one EUS-CPB procedure and were included in our study. Patients with known or suspected CP (N = 248) underwent a mean (SD) of 3.1 (1.6) EUS-CPB procedures. In 76 % of the patients with CP, the median (range) duration of the response to the first EUS-CPB procedure was 10 (1 – 54) weeks. Lack of pain relief after the initial EUS-CPB was associated with failure of the next EUS-CPB (OR 0.17, 95 %CI 0.06 – 0.54). Older age at first EUS-CPB and pain relief after the first EUS-CPB were significantly associated with pain relief after subsequent blocks (P = 0.026 and P = 0.002, respectively). Adverse events included peri-procedural hypoxia (n = 2) and hypotension (n = 1) and post-procedural orthostasis (n = 2) and diarrhea (n = 4). No major adverse events occurred., Conclusions: Repeated EUS-CPB procedures in a single patient appear to be safe. Response to the first EUS-CPB is associated with response to subsequent blocks

Systems analysis programs for Hands-on integrated reliability evaluations (SAPHIRE) Version 5.0: Verification and validation (V&V) manual. Volume 9

A verification and validation (V&V) process has been performed for the System Analysis Programs for Hands-on Integrated Reliability Evaluation (SAPHIRE) Version 5.0. SAPHIRE is a set of four computer programs that NRC developed for performing probabilistic risk assessments. They allow an analyst to perform many of the functions necessary to create, quantify, and evaluate the risk associated with a facility or process being analyzed. The programs are Integrated Reliability and Risk Analysis System (IRRAS) System Analysis and Risk Assessment (SARA), Models And Results Database (MAR-D), and Fault tree, Event tree, and Piping and instrumentation diagram (FEP) graphical editor. Intent of this program is to perform a V&V of successive versions of SAPHIRE. Previous efforts have been the V&V of SAPHIRE Version 4.0. The SAPHIRE 5.0 V&V plan is based on the SAPHIRE 4.0 V&V plan with revisions to incorporate lessons learned from the previous effort. Also, the SAPHIRE 5.0 vital and nonvital test procedures are based on the test procedures from SAPHIRE 4.0 with revisions to include the new SAPHIRE 5.0 features as well as to incorporate lessons learned from the previous effort. Most results from the testing were acceptable; however, some discrepancies between expected code operation and actual code operation were identified. Modifications made to SAPHIRE are identified

Achievement of the Planetary Defense Investigations of the Double Asteroid Redirection Test (DART) Mission

NASA's Double Asteroid Redirection Test (DART) mission was the first to demonstrate asteroid deflection, and the mission's Level 1 requirements guided its planetary defense investigations. Here, we summarize DART's achievement of those requirements. On 2022 September 26, the DART spacecraft impacted Dimorphos, the secondary member of the Didymos near-Earth asteroid binary system, demonstrating an autonomously navigated kinetic impact into an asteroid with limited prior knowledge for planetary defense. Months of subsequent Earth-based observations showed that the binary orbital period was changed by –33.24 minutes, with two independent analysis methods each reporting a 1σ uncertainty of 1.4 s. Dynamical models determined that the momentum enhancement factor, β, resulting from DART's kinetic impact test is between 2.4 and 4.9, depending on the mass of Dimorphos, which remains the largest source of uncertainty. Over five dozen telescopes across the globe and in space, along with the Light Italian CubeSat for Imaging of Asteroids, have contributed to DART's investigations. These combined investigations have addressed topics related to the ejecta, dynamics, impact event, and properties of both asteroids in the binary system. A year following DART's successful impact into Dimorphos, the mission has achieved its planetary defense requirements, although work to further understand DART's kinetic impact test and the Didymos system will continue. In particular, ESA's Hera mission is planned to perform extensive measurements in 2027 during its rendezvous with the Didymos–Dimorphos system, building on DART to advance our knowledge and continue the ongoing international collaboration for planetary defense

The Van-Guard (poem)

A poem "written at the front in memory of comrades fallen in action while fighting with the First Battalion of the 5th Field Artillery". The final verse of the poem reads, "But the van-guard on before you, who you follow as is meet, They're the lads you left behind you With the poppies and the wheat!

Reproductive biology of Ravenala madagascariensis Gmel. as an alien species

The exotic arborescent monocot species from Madagascar, Ravenala madagascariensis, was studied in suburban gardens in Darwin, Australia. Inflorescences are long-lived branched spikes produced at right angles to a spectacular fan-like array of foliage. They are composed of a variable number of green boat-like bracts which contain a dilute liquid. Each bract subtends a series of individual, stiff, upright, large flowers which appear every 2.3 days, the total number of flowers being variable (up to 29). The slightly musty sweet smelling, creamy white hermaphrodite flowers, sometimes protogynous, opened at night (82.6% of flowers observed). Anthesis lasted, on average, 1.3 days and stigmas were receptive within the 24 hours of flower opening. Initially, nectar production was copious (1400 μl 12 hr-1) and concentration moderate (14.5% sucrose equivalents), but maximum production (1600 μl 12 hr-1) with slightly reduced concentration (12.5% sucrose) occurred at 2400 hr. Seed set occurs in Darwin plants, with the brown seed enveloped in a bright blue aril and displayed very obviously in the dehisced capsule. While autogamy treatments revealed that Ravenala is at least a facultative selfer, in Darwin the flowers were most frequently visited by the megachiropteran bat, Pteropus alecto gouldii, and only occasionally by the smaller bat, Macroglossus lagochilus, and honeyeater birds (Meliphagidae). Apart from reproducing vegetatively, the ability of Ravenala to set seed when grown outside its normal range in the absence of its co-evolved pollinator(s), either by selfing or by using a suitable indigenous pollinator, could allow the species to assume pest status in parts of the tropics where it is planted as an ornamental

Hazards assessment for the Hazardous Waste Storage Facility

This report documents the hazards assessment for the Hazardous Waste Storage Facility (HWSF) located at the Idaho National Engineering Laboratory. The hazards assessment was performed to ensure that this facility complies with DOE and company requirements pertaining to emergency planning and preparedness for operational emergencies. The hazards assessment identifies and analyzes hazards that are significant enough to warrant consideration in a facility`s operational emergency management program. The area surrounding HWSF, the buildings and structures at HWSF, and the processes used at HWSF are described in this report. All nonradiological hazardous materials at the HWSF were identified (radiological hazardous materials are not stored at HWSF) and screened against threshold quantities according to DOE Order 5500.3A guidance. Two of the identified hazardous materials exceeded their specified threshold quantity. This report discusses the potential release scenarios and consequences associated with an accidental release for each of the two identified hazardous materials, lead and mercury. Emergency considerations, such as emergency planning zones, emergency classes, protective actions, and emergency action levels, are also discussed based on the analysis of potential consequences. Evaluation of the potential consequences indicated that the highest emergency class for operational emergencies at the HWSF would be a Site Area Emergency

Generic component failure data base

This report discusses comprehensive component generic failure data base which has been developed for light water reactor probabilistic risk assessments. The Nuclear Computerized Library for Assessing Reactor Reliability (NUCLARR) was used to generate component failure rates. Using this approach, most of the failure rates are based on actual plant data rather then existing estimates