Physical Causes Research Articles

Glomerular Hemodynamics During Recovery from Renal Ischemia-Reperfusion Injury Addressed with Micropuncture in Rats

Objective: To establish the physical basis for low GFR in ischemic renal injury (IR) and determine whether abnormalities in GFR determinants persist after renal recovery. Method: IR was generated in male and female Wistar Froemter rats by clamping both renal pedicles for 60 minutes. Controls had same surgery without pedicle clamp. Glomerular hemodynamics were assessed by renal micropuncture (MP) after 1 day, 1 week, or 4 weeks. Single nephron GFR (SNGFR) was paired with tubular stop-flow (PSF) and free-flow pressure (PFF) in each nephron. Afferent Starling pressure (EFPa) is PSF-PFF. Glomerular capillary pressure (PGC) was computed from PSF, PFF and plasma oncotic pressure. ANOVA factors included IR, sex, time point and date of experiment (nested). Inter-nephron heterogeneity was extracted from normalized root-square difference between each data point and the mean for that animal. (total n=349 nephrons, 47 rats). Results: [Formula: see text] Summary and conclusion: The physical cause of low GFR in IR was low EFPa, which resulted from low PGC with normal PFF in all animals except 1. The injured kidney manifest elevated inter-nephron variability for all variables. Mean values for SNGFR and intra-renal pressures returned to normal in the “recovered” kidney, but variability between nephrons did not return to normal. Female rats had lower baseline SNGFR and PGC than males but the hemodynamic patterns during IR and renal recovery were not differentiable by sex (excluding one female outlier with high PFF). Despite “normal” GFR and PGC, the “recovered” kidney is not a “normal” kidney. NIH NIDDK R01 132690. This is the full abstract presented at the American Physiology Summit 2024 meeting and is only available in HTML format. There are no additional versions or additional content available for this abstract. Physiology was not involved in the peer review process.

Study of Phase Changes in Operational Risk for Trucks

This study concerns the management of operational risk in truck transport using the reliability theory of risks. In this regard, the risk analysis of changes in the vehicle unavailability represents an important topic. In this study, the authors present their own method for analysing the phase changes in risk corresponding to successive sections (phases) of vehicle mileage. The presented risk analysis method is based on an integrated assessment of losses associated with the costs of incidental repairs and losses caused by lost income during vehicle downtime. This includes the following: assessment of differences in average risk and differences in the coefficient of variation in the time series of vehicle mileage phases, indicating the outliers and extremes of phase risk, identifying their physical causes and testing the statistical significance of phase risk differences. The proposed method is described mathematically and verified experimentally based on the operational data concerning trucks from two selected brands (20 trucks from each brand). We show that the method can be used to predict the continuity of transport services in the short term (one-year horizon). The method could also be useful to compare vehicles of different brands in the context of their sensitivity to operational risks.

Role of the Indian Ocean basin mode in driving the interdecadal variations of summer precipitation over the East Asian monsoon boundary zone

Abstract. Based on long-term observational and reanalysis datasets from 1901 through 2014, this study investigates the characteristics and physical causes of the interdecadal variations in the summer precipitation over the East Asian monsoon boundary zone (EAMBZ), which is a peculiar domain defined from the perspective of the interplay between climatic systems (i.e., mid-latitude westerly and East Asian summer monsoon). Observational evidence reveals that, similarly to previous studies, the EAMBZ precipitation featured prominent interdecadal fluctuations, e.g., with dry summers during the periods preceding 1927, 1939–1945, 1968–1982, and 1998–2010 and wet summers during the periods of 1928–1938, 1946–1967, and 2011 onwards. Further analyses identify that, amongst the major interdecadal oceanic forcings (e.g., Atlantic multidecadal oscillation and Pacific decadal oscillation), the Indian Ocean basin mode (IOBM) is a significant oceanic forcing responsible for the interdecadal variations of the EAMBZ precipitation, playing an independent and critical modulation role. When the cold phase of the IOBM occurs, an anomalous cyclonic circulation is excited around the northeast corner of the tropical Indian Ocean, which further induces a north-low–south-high meridional seesaw pattern over the Northeast China–subtropical western Pacific (SWP) sector. Such seesaw pattern is conducive to the enhanced EAMBZ precipitation by linking favorable environments for the transportation of water vapor from the SWP and the convergence over the EAMBZ at interdecadal timescales. For this reason, a physical–empirical model for the EAMBZ precipitation is developed in terms of the IOBM cooling. Despite the fact that the extreme summer EAMBZ precipitation cannot be captured by this model, it can still well capture its interdecadal fluctuations and reflect their steady relationship. The key physical pathway connecting the IOBM cooling with the interdecadal variations of the summer EAMBZ precipitation is supported by the numerical results based on the large ensemble experiment and the Indian Ocean pacemaker experiment. Our findings may provide new insights into the understanding of the causes of the interdecadal variations in the summer EAMBZ precipitation, which may favor the long-term policy decision-making for the local hydrometeorological planning.

Lessons Learned from Information Sources on Building Defect Studies

Building defects are very prevalent and contribute significantly to a building’s economic value. There are numerous information sources on building defects that have significant potential for learning more about building defects. This study aimed to identify the information sources used in previous building defect studies and to identify the motivation for carrying out such studies. To fulfil this aim, a scoping study was carried out. The information sources identified included insurance companies, private databases, questionnaire surveys, lawsuits, building surveys, client complaint forms, and maintenance reports. This study found that insurance company and client complaint forms include the largest collection of real building defect cases, but such databases may lack detailed descriptions of the causes of the defects. The main purposes of the building defects studies identified here included design challenges, identification of defects, building maintenance management, quality management, systematization in data collection, providing an overview of typical defects, and classifying defects. Identification was found to be the most common purpose, indicating that the industry wants to learn more. This study identified research gaps in the climate perspective in relation to building defects. Most of the studies focused on the economical perspective, and none focused on the carbon footprint perspective. This study provides an overview of information sources, which can motivate stakeholders to collaborate in learning about the physical causes of building defects as well as about other key aspects such as fault, finances consequences, and procedural causes.

Determinants of hospital readmissions in older people with dementia: a narrative review

IntroductionOver 50% of hospitalised older people with dementia have multimorbidity, and are at an increased risk of hospital readmissions within 30 days of their discharge. Between 20-40% of these readmissions may be preventable. Current research focuses on the physical causes of hospital readmissions. However, older people with dementia have additional psychosocial factors that are likely to increase their risk of readmissions. This narrative review aimed to identify psychosocial determinants of hospital readmissions, within the context of known physical factors.MethodsElectronic databases MEDLINE, EMBASE, CINAHL and PsychInfo were searched from inception until July 2022 and followed up in February 2024. Quantitative and qualitative studies in English including adults aged 65 years and over with dementia, their care workers and informal carers were considered if they investigated hospital readmissions. An inductive approach was adopted to map the determinants of readmissions. Identified themes were described as narrative categories.ResultsSeventeen studies including 7,194,878 participants met our inclusion criteria from a total of 6369 articles. Sixteen quantitative studies included observational cohort and randomised controlled trial designs, and one study was qualitative. Ten studies were based in the USA, and one study each from Taiwan, Australia, Canada, Sweden, Japan, Denmark, and The Netherlands. Large hospital and insurance records provided data on over 2 million patients in one American study. Physical determinants included reduced mobility and accumulation of long-term conditions. Psychosocial determinants included inadequate hospital discharge planning, limited interdisciplinary collaboration, socioeconomic inequalities among ethnic minorities, and behavioural and psychological symptoms. Other important psychosocial factors such as loneliness, poverty and mental well-being, were not included in the studies.ConclusionPoorly defined roles and responsibilities of health and social care professionals and poor communication during care transitions, increase the risk of readmission in older people with dementia. These identified psychosocial determinants are likely to significantly contribute to readmissions. However, future research should focus on the understanding of the interaction between a host of psychosocial and physical determinants, and multidisciplinary interventions across care settings to reduce hospital readmissions.

Implementation of calculations of normal sections of reinforced concrete structures in software packages

Introduction. In previous publications, the authors examined the features of calculating the strength of normal sections of reinforced concrete structures associated with the possibility of using two approaches – the nonlinear deformation model (NDM) and the method of limiting forces (MLF). Using specific examples, the results obtained with both approaches are compared. Cases of significant discrepancies in the consumption of selected reinforcement have been identified, trends have been explained, and the physical essence of the phenomenon has been analyzed. Calculations were performed according to the OM SNiP Reinforced Concrete program.
 
 Aim. To analyze the implementation of features when using various computer programs for calculations of reinforced concrete structures, identify differences in results, establish their physical cause, evaluate economic aspects and problems, and make the necessary recommendations.
 
 Materials and methods. The studies were performed for three types of structures. The first type included four sections of elements under two stress states: off-center compression (rectangular and annular) and oblique offcenter compression (rectangular and I-beam). The second type of structures included columns and pylons of a projected and constructed reinforced concrete building. The third type was an illustrative example – the T-section of the bent element at different operating moments and percentages of reinforcement. Calculations of the first type of structures were carried out by the authors by the OM SNiP Reinforced Concrete program, as well as the program developers of the Ing+, Arbat, Lira-SAPR, Lira 10, STARK ES programs. The calculation of structures of the second type was carried out by the authors by the OM SNiP Reinforced Concrete program and the designers by the Lira-SAPR 2022 program. The test example was calculated by the authors according to the OM SNiP Reinforced Concrete program.
 
 Results. When calculating according to the NDM, a significant unjustified overspending of the required reinforcement was revealed compared to the calculation according to the MLF. In an illustrative example, the overspend is 220 %.
 
 Conclusions. The general state of calculations of reinforced concrete structures should be recognized as requiring adjustments. To obtain a multibillion-dollar economic effect, it is proposed to provide in SP 63.13330.2018 two equal approaches to the calculation of normal sections of reinforced concrete structures - NDM and MLF. It is advisable to develop a document with a set of reference examples that allows you to get the same results for different programs with the same source data.

A modified atmospheric scattering model and degradation image clarification algorithm for haze environments

Addressing the limitation of existing image dehazing algorithms based on atmospheric scattering models, which often overlook the underlying physical causes of color distortion in hazy images, resulting in suboptimal algorithm robustness and image clarity when faced with varying levels of haze pollution, this study introduces a refined atmospheric scattering model. It also presents a haze image clarity algorithm based on this modified atmospheric scattering model by analyzing the fundamental factors contributing to image degradation and distortion caused by haze. Initially, the hazy image undergoes conversion to a new HSI color space. The hazy image is aligned more closely with human visual perception characteristics by implementing an adaptive saturation enhancement technique and adjusting contribution coefficients for the three RGB channels to the luminance component. Subsequently, the hazy image is partitioned into dense haze and non-dense haze regions based on haze distribution characteristics within the image. A global light intensity computation method is devised for the hazy image utilizing a quad-tree segmentation algorithm. Following this, calculations are performed to determine the atmospheric light value and transmittance for dense and non-dense haze regions separately. The global atmospheric light and transmittance values are then derived based on the probability density function of the dense haze region using Alpha Fusion. Finally, corrections are applied to the global atmospheric light values using an atmospheric light correction vector, while denoising the global transmittance is achieved through a fast non-local mean filtering algorithm. Experimental findings demonstrate that the proposed haze image clarity algorithm, grounded in the modified atmospheric scattering model, exhibits adaptability across various degrees and types of haze images. Comparative analysis against other prominent image dehazing algorithms reveals its efficacy in addressing severe color distortion in dense haze scenarios, achieving a more natural clarity effect, and showcasing superior performance across all numerical evaluation metrics.

Rožės liga ir jos užkalbėjimas Musteikoje: žvilgsnis iš etnomedicininės, mitologinės ir socialinės perspektyvos

Erysipelas, called rožė (‘rose’) in Lithuanian, is one of the very few diseases that still make patients turn to traditional charmers for help. Using narratives from the remote village of Musteika (in the Varėna district) and materials recorded elsewhere in Lithuania, the author attempts to establish the ethnomedical concept of erysipelas, and to what extent the treatment by charming can be effective. The research in Musteika allows for the conclusion that the ethnomedical etiology of erysipelas includes both physical and mental causes, and the disease might be a somatic expression of mental experiences. Traditional charming therefore serves as an effective treatment practice.

Havelock Ellis, Sexology, and Sexual Selection in Post-Darwinian Evolutionary Biology.

This study situates Henry Havelock Ellis's sexological research within the nineteenth-century evolutionary debates, especially the discussion over sexual selection's applicability to humanity. For example, Ellis's monograph on sexual behavior, Sexual Inversion (1897), treated inborn homosexuality as a natural variation of evolutionary mechanisms. This book was situated within a longer study of human sexuality in relation to evolutionary selection. His later works dealt even more directly with Charles Darwin's concept of selection, such as Sexual Selection in Man (1905). Through Sexual Selection in Man, Ellis asserted that sexual attraction stemmed from a physical cause rather than an innate aesthetic sense. I argue that Ellis's best-known historical publications, including his work on sexual inversion, were intended to intervene in the contemporary evolutionary debates. This analysis also identifies a specific point where evolutionary theory informed the foundation of sexology as a scientific discipline.

Healthcare professionals’ experiences and views of providing continence support and advice to people living at home with dementia: “That’s a carer’s job”

BackgroundPeople living with dementia at home and their family carers often feel unsupported by healthcare professionals in managing continence problems. In turn, primary and community-based healthcare professionals have reported lacking specific knowledge on dementia-continence. This study aimed to understand more about healthcare professionals’ experiences and views of supporting people living with dementia experiencing continence problems, as part of developing acceptable resources. Having a nuanced understanding of unmet need would facilitate the design of engaging resources that enable healthcare professionals to provide more effective continence support to people living with dementia at home.MethodsSemi-structured interviews were conducted with a range of healthcare professionals (n = 31) working in primary and community care in the South of England in 2023. Transcribed interviews were uploaded to NVivo 12, then analysed inductively and deductively using a thematic framework.ResultsContinence-related conversations were avoided by many healthcare professionals due to lack of dementia-continence specific knowledge. Many considered that continence problems of people living with dementia were largely outside their remit once a physical cause had been ruled out. This contributed to a lack of priority and proactivity in raising the subject of continence in their consultations. Challenges to providing support included limited consultation time and lack of access to specialist services with availability to support individuals.ConclusionThere is substantial scope to support primary and community-based healthcare professionals in their provision of continence-related support and advice to people living at home with dementia. This includes addressing knowledge deficits, enhancing confidence and instilling a sense of accomplishment.

The influence of exotic and native plants on illnesses with physical and spiritual causes in the semiarid region of Piauí, Northeast of Brazil

BackgroundLocal medical systems (LMS) include native and exotic plants used for the treatment of diseases of physical and spiritual nature. The incorporation of exotic plants into these systems has been the subject of many studies. In this context, an analysis was conducted on the influence of the origin of plants on diseases of physical and spiritual nature in order to evaluate the therapeutic versatility of native and exotic species in these therapeutic targets, to investigate whether exotic plants mainly fill gaps not met by native plants (diversification hypothesis), and identify which species are prioritized in the redundant targets in these two therapeutic groups in the rural community of Morrinhos, Monsenhor Hipólito, Piauí.MethodsData collection took place in 2 stages. First, free lists and semi-structured interviews with local residents (n = 134) were conducted to survey plants used for therapeutic purposes and the associated illnesses. Then, another phase of interviews was carried out to evaluate the prioritization between native and exotic plants in redundant therapeutic targets. To test the diversification hypothesis (DH) in each group of illnesses, data were analyzed using generalized linear models (Poisson and Binomial GLMs); versatility was measured by the number of therapeutic indications and compared between resources using the Mann–Whitney test, and prioritization in each group was verified by comparing the proportions of native and exotic plants with the χ2 test.ResultsOne hundred and thirty-two species of plants were surveyed, being 71 exotic and 61 native, with indications for physical and spiritual illnesses. The results revealed that the diversification hypothesis did not explain the inclusion of exotic plants in the local medical system to treat physical or spiritual illnesses and that the therapeutic versatility of exotic and native resources in the two groups was also similar (p > 0.05). However, exotic plants were prioritized in illnesses with physical causes and native plants in illnesses with spiritual causes.ConclusionsThe local medical system presents similar and distinct patterns in the therapeutic targets, depending on the perspective evaluated. Therefore, it is necessary to investigate the patterns of use of medicinal plants in different sociocultural contexts in order to broaden the debate about the role of plant origin in the selection of treatments for illnesses with different causes.

Vietnam Association of Gastroenterology consensus for the diagnosis and treatment of functional dyspepsia.

Functional dyspepsia (FD) is a common disorder in clinical practice. It is necessary to rule out physical causes to diagnose this condition. However, the diagnosis is challenging particularly in resource-limited areas. The aim of this consensus is to update international and regional guidelines on the management of FD. The consensus panel included 32 experts from major Vietnamese universities and institutes. This consensus study was conducted using the Delphi method. The grade of recommendation and level of evidence were assessed using the Grading of Recommendations, Assessment, Development, and Evalua-tion system. The consensus level was defined as ≥80% for agreement on the proposed statements. The expert panel approved 14 statements after two rounds of voting, which were related to two sections: (1) diagnostic tests for FD and (2) treatment of FD. This consensus is expected to help physicians in identifying and managing FD appropriately in daily clinical practice and to contribute FD data to Asian regions.

Flight of the Bumblebee: the Early Excess Flux of Type Ia Supernova 2023bee Revealed by TESS, Swift, and Young Supernova Experiment Observations

We present high-cadence ultraviolet through near-infrared observations of the Type Ia supernova (SN Ia) 2023bee at D = 32 ± 3 Mpc, finding excess flux in the first days after explosion, particularly in our 10 minutes cadence TESS light curve and Swift UV data. Compared to a few other normal SNe Ia with early excess flux, the excess flux in SN 2023bee is redder in the UV and less luminous. We present optical spectra of SN 2023bee, including two spectra during the period where the flux excess is dominant. At this time, the spectra are similar to those of other SNe Ia but with weaker Si ii, C ii, and Ca ii absorption lines, perhaps because the excess flux creates a stronger continuum. We compare the data to several theoretical models on the origin of early excess flux in SNe Ia. Interaction with either the companion star or close-in circumstellar material is expected to produce a faster evolution than observed. Radioactive material in the outer layers of the ejecta, either from double detonation explosion or from a 56Ni clump near the surface, cannot fully reproduce the evolution either, likely due to the sensitivity of early UV observable to the treatment of the outer part of ejecta in simulation. We conclude that no current model can adequately explain the full set of observations. We find that a relatively large fraction of nearby, bright SNe Ia with high-cadence observations have some amount of excess flux within a few days of explosion. Considering potential asymmetric emission, the physical cause of this excess flux may be ubiquitous in normal SNe Ia.

P693 Care needs and reasons for (not) seeking care among fatigued patients with Inflammatory Bowel Disease: A qualitative study

Abstract Background Fatigue is one of the most prevalent and burdensome symptoms experienced by patients with inflammatory bowel disease (IBD), even when the disease is in remission. Many patients report dissatisfaction towards fatigue-related care and uptake of available interventions is often low. This study aims to explore reasons why IBD patients do or do not engage in professional fatigue-related care and their needs regarding type of care and how to offer care. Methods We conducted a qualitative study, taking a phenomenological methodological approach. Sixteen adult IBD patients with disease in remission and severe fatigue (i.e., Checklist Individual Strength – subjective fatigue ≥ 35) were recruited from an academic hospital. We performed semi-structured interviews. Data were analysed using template analyses. Results We identified six themes regarding reasons why to (not) seek care for fatigue: 1) cognitions about fatigue and coping (e.g., a need to deal with fatigue alone), 2) perceptions of fatigue-related care and previous care experiences (e.g., perceiving that nothing can be done about fatigue), 3) knowledge and behaviour of the healthcare provider (e.g., fatigue complaints are not taken seriously), 4) somatic factors (e.g., physical symptoms of IBD), 5) social factors (e.g., feeling misunderstood by others) and 6) practical factors (e.g., time and money). Furthermore, we identified needs regarding how to offer care, i.e., proactive screening and active offer of care by healthcare providers, a holistic and person-centred approach and practical needs taken into account. Finally, regarding what care to offer, patients suggested a broad range of options, including information provision on fatigue management, eliminating physical causes of fatigue, discussing medication options, lifestyle support, psychological support, peer support and practical support. Conclusion IBD patients’ perceptions, coping and knowledge, as well as healthcare professionals’ behaviours play a major role in seeking fatigue-related care. Findings emphasize the importance of discussing IBD-related fatigue actively and taking a holistic and patient-centred approach to treat fatigue, targeting a broad range of physical- and psychological factors. These findings yield a better understanding of factors that hinder and facilitate care seeking in fatigued IBD patients and hereby provide ways to optimize the uptake of care.

Structured case conference for sleep disturbances in nursing home residents with cognitive impairment

Structured case conference for sleep disturbances in nursing home residents with cognitive impairment Abstract: Background: Nursing home residents living with cognitive impairment often suffer from sleep disturbances. Pharmacological interventions are not recommended to be the first-choice therapy. In general, a wide variance of non-pharmacological interventions is available, but no clearly suitable intervention can currently be specified. Aim: The case report presents the procedure of a structured analysis to support the selection of non-pharmacological interventions to promote sleep. Methods: A structured case conference was held using a developed case management template to draw up an individual intervention plan. Results: Based on the description of the situation and the determination of causes, different interventions from six main topics were planned: "offering appropriate activations during daytime", "creating bedtime routines", "checking the sleep environment", "observation of potential physical and psychological causes", "reflection on night care routines", and "use of drug therapies only in exceptional cases". Conclusions: For a successful management of sleep disturbances in nursing home residents living with cognitive impairment, it is essential that the specific sleep-related symptoms and causes are assessed systematically and interprofessionally to be able to work towards an improvement with appropriate measures. In order to obtain adequate solutions, evidence-based expertise should be taken into consideration.

Statistical Analysis of Mt. Vesuvius Earthquakes Highlights Pitfalls in Magnitude Estimation

Here, we characterize the statistical behaviour of the Mt. Vesuvius seismicity using distinct available catalogues. Our analysis confirms that for this area, the GR distribution exhibited two scaling regimes of the b-value, not commonly observed for the standard frequency-magnitude distribution of earthquakes. By assuming a physical cause, we tested four different hypotheses for the source of the break in the scaling: finite size effect, depth variations in the b-value, radial dependence in the b-value, and different b-values for swarm and non-swarm events. None of the above reasons are able to explain the observation. Thus, we investigated the possibility of some pitfalls in magnitude estimation. Based on our analysis, we suggest there is a bias in the duration magnitude the catalogues are based on. This is due to the arbitrary extrapolation to smaller magnitudes of a linear regression derived for earthquakes with m≥3.0. When a suitable correction is applied to the estimated magnitude, the GR distribution assumes the usual shape, with a b-value closer to that usually observed in volcanic areas. Finally, the analysis of the time variation of some statistical parameters reveals that the state of the volcano appears to be stationary over the entire analysed period, possibly with only a slight decrease in the b-value, indicating a small reduction in differential stress.

Gastroesophageal Reflux Disease: Pathophysiology and New Treatment Trends.

Gastroesophageal reflux disease (GERD) is caused by the reflux of gastric contents into the esophagus due to a decline in esophageal clearance and anti-reflux barrier mechanisms. Mucosal injury is caused by a combination of gastric juice directly damaging the esophageal mucosa and the immune and inflammatory mechanism in which inflammatory cytokines released from the esophageal mucosal epithelium cause neutrophil migration, triggering inflammation. Gastric secretion inhibitors are the first-line treatment for GERD, but they can be combined with prokinetic agents and Chinese herbal remedies. However, pharmacotherapy cannot improve anatomical problems or prevent physical causes of GERD, such as reflux of non-acidic contents. Therefore, surgery can be warranted, depending on the pathology. Intraluminal endoscopic therapy, which is both less invasive and more effective than surgery, was recently developed and applied in Europe and the United States. In Japan, intraluminal endoscopic therapies, such as anti-reflux mucosectomy, anti-reflux mucosal ablation, and endoscopic submucosal dissection, for GERD have been independently developed.

Laparoscopic renal denervation: A treatment option for management of refractory loin pain

Background: Intractable loin pain is a debilitating condition with a significant impact on the patient's quality of life. Loin pain haematuria syndrome (LPHS) is a disease of exclusion and can be of two subtypes, Primary or Type 2 and secondary or Type 1. The type 1 LPHS could be a result of congenital anomalies, or acquired due infections, trauma, or surgery. Management of these patients can be pharmacological, nerve blocks, renal denervation, auto-transplantation and nephrectomy. Laparoscopic renal denervation (LRDN) has emerged as a minimally invasive surgical procedure, with acceptable results. Materials and Methods: All patients who underwent laparoscopic renal denervation in our unit from 2007 to 2022 by a single surgeon were included in this study. The indications for surgical intervention were loin pain refractory to medical therapy in the absence of any physical causes of pain. All patients were assessed by a multidisciplinary team, involving a urologist, a nephrologist, a pain consultant, and a pain psychologist. Baseline and postoperative pain scores of the patients were obtained. The patients underwent splanchnic or coeliac nerve blocks under local anaesthesia and were reviewed in the outpatient clinic post-procedure. If there were an improvement in the pain control and pain scores, they were offered LRDN. During the surgery, the renal vessels and proximal ureter were stripped from the neuronal and lymphatic tissues. Results: The 20 patients included in the study underwent 23 procedures. All patients were female. The mean age was 44 years, and the median follow up was 24 months. The median operating time was 90 minutes, excluding anaesthetic time. There were no significant adverse events other than one patient needed antibiotics for chest infection. There was significant improvement of pain scores with the mean pain scores falling to 2.47 postoperatively from 8.40. Fifty percent of patients had complete resolution of pain, while 30% had significant reduction in use of pain medication. Patients with primary LPHS did not have significant improvement in their pain scores, and one of these patients required auto-transplantation of her kidney.

Comparative Analysis of the 2013 and 2022 Record-Breaking Heatwaves over the Yangtze River Basin

The Yangtze River Basin (YRB) experienced record-breaking heatwaves (HWs) during the summers of 2013 and 2022. A comparative analysis of their variations and physical causes was undertaken using ERA5 reanalysis data to determine the similarities and differences between their characteristics and mechanisms. The results show that the duration of the 2013 and 2022 HWs rank as the second and first longest, respectively, since the 1950s. Both HWs were associated with anomalous high pressure and descending motions over the middle and lower reaches of the YRB in conjunction with a westward shift of the Northwestern Pacific subtropical high in summer. These high-pressure anomalies over the YRB led to decreases in total precipitation, soil moisture, and cloud cover and increases in surface solar radiation and air temperature, favoring the 2 HWs. However, high-pressure anomalies associated with the 2013 HWs peaked in July, while those associated with the 2022 HWs peaked in August. The 2022 HWs were of longer duration and higher intensity than those in 2013, which was primarily due to the stronger anticyclonic circulation anomalies induced by more intense Rossby wave trains in the mid to high latitudes in 2022. Notably, the zonal sea surface temperature gradient in the tropical Pacific, which was larger in 2022 than in 2013, played a crucial role in triggering the high-pressure anomalies and extreme HWs over the YRB through forcing distinct patterns of northeastward propagating wave trains over East Asia in the 2 years.

Beyond Crisis and Emergency: Climate Change as a Political Epic

AbstractThe available choices of political responses to disruption in the global climatic system depend in part on how the problem is conceptualized. Researchers and policymakers often invoke a “climate crisis” or “climate emergency,” but such language fits poorly with current knowledge of the problem's physical causes and social impacts. This article argues that climate change is instead more like a political epic. It involves neither sudden onset, as in the concept of emergency, nor decisive resolution, as in the concept of crisis, but rather a protracted ordeal of (temporally) obscure origins and uncertain outcomes. This alternative ontology of climate change highlights its novel temporal properties, including unusually slow-moving or time-lagged causal dynamics, with unsettling implications for academic research on the climatic-institutional nexus. Normatively, it undermines arguments for democracies’ environmental superiority over autocracies that rely on the former's general superiority at resolving crises and responding to emergencies. At the same time, some new arguments for democratic distributions of power become possible within the epic frame. More broadly, embracing the assumption of epic climate change may redirect attention from Promethean, managerial, or technocratic solutions to questions about which values or identities deserve preservation amid presumptively interminable and imperfectly remediable sources of disorder.