Neighborhood Racial Characteristics, Credit History, and Bankcard Credit in Indian Country

We examine whether concerns about lenders’ discrimination based on community racial characteristics can be empirically substantiated in the context of neighborhoods on and near American Indian reservations. Drawing on a large-scale dataset consisting of individual-level credit bureau records, we find that residing in a predominantly American Indian neighborhood is ceteris paribus associated with worse bankcard credit outcomes than residing in a neighborhood where the share of American Indian residents is low. While these results are consistent with the possibility of lenders’ discrimination based on community racial characteristics, we explain why our findings should not be readily interpreted as conclusive evidence thereof. We further find that consumer’s credit history is a robust and quantitatively more important predictor of bankcard credit outcomes than racial composition of the consumer’s neighborhood, and that the consumer’s location vis-à-vis a reservation exhibits no effect on bankcard credit outcomes

Preoperative Endovascular Embolization Planning for Cerebral Arteriovenous Malformations: Patient-Specific Compartmentalisation Identification

Cerebral arteriovenous malformations (cAVMs) are complex vascular anomalies in the brain that pose significant risks of haemorrhage and neurological dysfunction. In young adults (under 40 years), cAVMs are the most common cause of brain haemorrhage in absence of head trauma. Endovascular embolization treatments aim to occlude the cAVM vasculature with an embolic agent injected via a catheter. To avoid incomplete embolization or recanalization, it is essential to gain insight into the patient-specific cAVM compartmentalisation, determining which feeding/draining vessel corresponds to what part of the cAVM. Although previous studies demonstrated that compartmentalisation may be based on either anatomical [1] or hemodynamic features [2], no optimized and validated compartmentalisation methods are available. Therefore, this feasibility study proposes an anatomically inspired three-dimensional cAVM compartmentalization model. Building upon our previous work (kidney perfusion zones [3]), the patient-specific 3D model starts from segmentations in Mimics (Materialise, Belgium) after which centrelines were calculated using VMTK (vmtk.org) to label arterial feeders and draining veins. Seed points were placed at the final artery/vein centerline point before entering/leaving the cAVM, respectively. The seeds initiated a Python-based region-growing algorithm, executed in a voxelised bounding box surrounding the cAVM and its feeding/draining vessels, resulting in cAVM-specific feeding and/or draining compartments. The anatomically-based compartmentalisation model resulted in the amount of feeding compartments equalling the number of feeding arteries. The algorithm detected compartments of varying volumes, each with its own drainers when seeded from the arterial side. Additionally, it identified a fistula (i.e. high-flow and wide artery-vein passageway), which is important to account for regarding intervention safety. Future development will focus on integration of hemodynamic features including but not limited to information derived from intensity analysis of digital subtraction angiography images. [1] Pertuiset et al., Neurol Res., 1982. [2] ApSimon et al., Acta Radiol, 1986 [3] De Backer, Vermijs et al., European Urology, 2023

Robot-assisted partial nephrectomy using intra-arterial renal hypothermia for highly complex endophytic or hilar tumors : case series and description of surgical technique

Background: In partial nephrectomy for highly complex tumors with expected long ischemia time, renal hypothermia can be used to minimize ischemic parenchymal damage.Objective: To describe our case series, surgical technique, and early outcomes for robot-assisted partial nephrectomy (RAPN) using intra-arterial cold perfusion through arteriotomy.Design, setting, and participants: A retrospective analysis was conducted of ten patients with renal tumors (PADUA score 9-13) undergoing RAPN between March 2020 and March 2023 with intra-arterial cooling because of expected arterial clamping times longer than 25 min.Surgical procedure: Multiport transperitoneal RAPN with full renal mobilization and arterial, venous, and ureteral clamping was performed. After arteriotomy and venotomy, 4 degrees C heparinized saline is administered intravascular through a Fogarty catheter to maintain renal hypothermia while performing RAPN.Measurements: Demographic data, renal function, console and ischemia times, surgical margin status, hospital stay, estimated blood loss, and complications were analyzed.Results and limitations: The median warm and cold ischemia times were 4 min (interquartile range [IQR] 3-7 min) and 60 min (IQR 33-75 min), respectively. The median rewarming ischemia time was 10.5 min (IQR 6.5-23.75 min). The median pre-and postoperative estimated glomerular filtration rate values at least 1 mo after surgery were 90 ml/min (IQR 78.35-90 ml/min) and 86.9 ml/min (IQR 62.08-90 ml/min), respectively. Limitations include small cohort size and short median follow-up (13 [IQR 9.1-32.4] mo).Conclusions: We demonstrate the feasibility and first case series for RAPN using intra-arterial renal hypothermia through arteriotomy. This approach broadens the scope for minimal invasive nephron-sparing surgery in highly complex renal masses.Patient summary: We demonstrate a minimally invasive surgical technique that reduces kidney infarction during complex kidney tumor removal where surround-ing healthy kidney tissue is spared. The technique entails arterial cold fluid irriga-tion, which temporarily decreases renal metabolism and allows more kidneys to be salvaged.(c) 2023 The Authors. Published by Elsevier B.V. on behalf of European Association of Urology. This is an open access article under the CC BY-NC-ND license (http://creative-commons.org/licenses/by-nc-nd/4.0/)

How to accelerate the heat transition: a guide for local government and actors: Module 4- Technology choices, data, and mapping for sustainable heating

This document is one of a four-part guide on how to accelerate the heattransition in cities. In this module the technical and physical aspects of the transition from fossil to renewable heating are emphasised. In the first section the reader is informed about the reasons why we need to transition our heating systems in the built environment to renewable sources. The second section provides the reader with an overview of technology choices and strategies, and is aimed at helping you make technical decisions.Organisation & GovernanceClimate Design and Sustainabilit

Step-by-step: Intra-arterial renal hypothermia during robot-assisted partial nephrectomy

Objective: Renal hypothermia, which can be achieved through several techniques, might allow for longer clamping times in complex robot-assisted partial nephrectomy (RAPN). Intra-arterial cooling (IAC) through arteriotomy was previously found safe and feasible. It may offer several advantages such as prolonged clamping times and working in a bloodless field, allowing for more nephron-sparing surgery in challenging lesions. We provide a step-by-step video elaborating on the surgical technique of RAPN with IAC and present the long-term results of our case series. Patients and surgical procedure: Ten patients with complex renal masses (deep endophytic, hilar, multiple ipsilateral and very large lesions), where clamping times over 25 min were expected, were treated with RAPN using IAC between March 2020 and March 2023 in 3 referral centers by 2 surgeons. All surgeries were performed using the Da Vinci Xi robot. Three-dimensional (3D) models were created for pre-operative planning and peri‑operative guidance. Results: Median warm, cold and rewarming ischemia times were 4 (IQR 3-7) min, 60 (IQR 33-75) min and 11 (IQR 7-24) min respectively. One case was converted to radical nephrectomy and one case required postoperative coiling due to pseudo-aneurysm formation (Clavien-Dindo 3b). No other intraoperative or postoperative complications occurred. Median pre- and postoperative (3 month and 6 month) GFR values were 90 (IQR 78-90) ml/min, 87 (IQR 71-90) ml/min and 90 (IQR 67-90) ml/min. At a median follow-up of 24 (IQR 13-44) months, the median GFR was stable at 90 (IQR 82-90) ml/min. Conclusions: We present a step-by-step video description of RAPN using IAC. This technique allows for safe prolonged clamping times in complex renal masses, with maintained kidney function and no long-term complications at a median follow-up of 2 years. This technique could be considered by expert robotic surgeons, expanding indications for robotic nephron-sparing surgery

Technical note: correcting for shear strain in an oscillatory squeeze flow rheometer

Currently, rheologists working in the field of oscillatory squeeze flow use extensional strain to characterize the deformations. Due to the shear-dominated flow observed in low Trouton ratio fluids undergoing squeeze flow, it is proposed that an alternate geometry-dependent definition for shear strain in squeeze flow be used instead. Through the use of finite element modelling, it has been shown that this geometry-dependent strain definition allows for better comparison of measurements between both squeeze flow rheometers of different geometric configurations and rotational rheometers. This idea was then explored through laboratory experiments, further supporting this hypothesis. While this definition of strain will only hold true within the bounds of a material’s linear viscoelastic regime, it will help to determine where this boundary is, and thus allow for more accurate material characterization. This type of relationship will become increasingly important with the growing use of squeeze flow rheometers for large-amplitude oscillatory squeezing trials