Following approval of the ICD‐11 by the World Health Assembly in May 2019, World Health Organization (WHO) member states will transition from the ICD‐10 to the ICD‐11, with reporting of health ...statistics based on the new system to begin on January 1, 2022. The WHO Department of Mental Health and Substance Abuse will publish Clinical Descriptions and Diagnostic Guidelines (CDDG) for ICD‐11 Mental, Behavioural and Neurodevelopmental Disorders following ICD‐11’s approval. The development of the ICD‐11 CDDG over the past decade, based on the principles of clinical utility and global applicability, has been the most broadly international, multilingual, multidisciplinary and participative revision process ever implemented for a classification of mental disorders. Innovations in the ICD‐11 include the provision of consistent and systematically characterized information, the adoption of a lifespan approach, and culture‐related guidance for each disorder. Dimensional approaches have been incorporated into the classification, particularly for personality disorders and primary psychotic disorders, in ways that are consistent with current evidence, are more compatible with recovery‐based approaches, eliminate artificial comorbidity, and more effectively capture changes over time. Here we describe major changes to the structure of the ICD‐11 classification of mental disorders as compared to the ICD‐10, and the development of two new ICD‐11 chapters relevant to mental health practice. We illustrate a set of new categories that have been added to the ICD‐11 and present the rationale for their inclusion. Finally, we provide a description of the important changes that have been made in each ICD‐11 disorder grouping. This information is intended to be useful for both clinicians and researchers in orienting themselves to the ICD‐11 and in preparing for implementation in their own professional contexts.
The ExxonMobil Corp. oil refinery in Torrance, California, experienced an explosion on 18 February 2015, causing ground shaking equivalent to a magnitude 2.0 earthquake. The impulse response for the ...source was computed from Southern California Seismic Network data for a single force system with a value of 2 × 105 kN vertically downward. The refinery explosion produced an air pressure wave that was recorded 22.8 km away in a 52-story high-rise building in downtown Los Angeles by a dense accelerometer array that is a component of the Community Seismic Network. The array recorded anomalous waveforms on each floor displaying coherent arrivals that are consistent with the building's elastic response to a pressure wave caused by the refinery explosion. Using a finite-element model of the building, the force on the building on a floor-by-floor scale was found to range up to 1.42 kN, corresponding to a pressure perturbation of 7.7 Pa.
This review updates and extends earlier Consensus Reports related to current basic and escalating immunomodulatory treatments in multiple sclerosis (MS). The recent literature has been extracted for ...new evidence from randomized controlled trials, open treatment studies and reported expert opinion, both in original articles and reviews, and evaluates indications and safety issues based on published data. After data extraction from published full length publications and critically weighing the evidence and potential impact of the data, the review has been drafted and circulated within the National MS Societies and the European MS Platform to reach consensus within a very large group of European experts, combining evidence-based criteria and expert opinion where evidence is still incomplete. The review also outlines a few areas of controversy and delineates the need for future research.
Mass development of macrophytes in freshwater ecosystems is today considered a worldwide problem and substantial resources are spent on macrophyte removal each year. By removing the dominant primary ...producer, however, this management practice radically changes the ecosystem overnight. Here, we studied short-term effects of the removal of a mass development of free-floating (Pontederia crassipes), submerged (Elodea nuttallii) and emergent (mix of Ludwigia grandiflora and L. peploides) macrophytes on fluxes of CH4 and CO2 in three lakes. In our field experiment, we assigned an impact site where macrophytes were removed, and a control site where vegetation remained. Before and after removal, diffusive fluxes of CO2 and CH4 were determined in lakes dominated by P. crassipes and E. nuttallii, whereas total emission of CH4 was determined in all three case study lakes. Additionally, plant biomass, and physical and chemical parameters were measured before and after removal. While removal of emergent Ludwigia spp. showed no clear effect on total CH4 emission, removal of submerged E. nuttallii reduced both CO2 fixation and total CH4 emission. Removal of free-floating P. crassipes, on the other hand, increased CH4 fluxes and stimulated phytoplankton blooms. The lack of a universal response across our case study lakes suggests that both macrophyte life forms and environmental parameters can be important factors determining effects of removal. Additionally, indirect effects of macrophyte removal on temperature and dissolved oxygen can help to explain carbon emissions. Long-term effects should be studied to allow development of sustainable management practices.
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A new Reference Material (RM) for radionuclides in mussel (
Mytilus
galloprovincialis
) from the Mediterranean Sea (IAEA-437) is described and the results of the certification process are presented. ...Four radionuclides (
40
K,
234
U,
238
U, and
239+240
Pu) have been certified, and information values on massic activities with 95% confidence intervals are given for nine radionuclides (
137
Cs,
210
Pb(
210
Po),
226
Ra,
228
Ra,
228
Th,
230
Th,
232
Th,
235
U, and
241
Am). Results for less frequently reported radionuclides (
90
Sr,
129
I,
238
Pu,
239
Pu, and
240
Pu) are also reported. The RM can be used for quality assurance/quality control of the analysis of radionuclides in mussel samples, for the development and validation of analytical methods and for training purposes. The material is available in 200 g units.
CGILS—the CFMIP‐GASS Intercomparison of Large Eddy Models (LESs) and single column models (SCMs)—investigates the mechanisms of cloud feedback in SCMs and LESs under idealized climate change ...perturbation. This paper describes the CGILS results from 15 SCMs and 8 LES models. Three cloud regimes over the subtropical oceans are studied: shallow cumulus, cumulus under stratocumulus, and well‐mixed coastal stratus/stratocumulus. In the stratocumulus and coastal stratus regimes, SCMs without activated shallow convection generally simulated negative cloud feedbacks, while models with active shallow convection generally simulated positive cloud feedbacks. In the shallow cumulus alone regime, this relationship is less clear, likely due to the changes in cloud depth, lateral mixing, and precipitation or a combination of them. The majority of LES models simulated negative cloud feedback in the well‐mixed coastal stratus/stratocumulus regime, and positive feedback in the shallow cumulus and stratocumulus regime. A general framework is provided to interpret SCM results: in a warmer climate, the moistening rate of the cloudy layer associated with the surface‐based turbulence parameterization is enhanced; together with weaker large‐scale subsidence, it causes negative cloud feedback. In contrast, in the warmer climate, the drying rate associated with the shallow convection scheme is enhanced. This causes positive cloud feedback. These mechanisms are summarized as the “NESTS” negative cloud feedback and the “SCOPE” positive cloud feedback (Negative feedback from Surface Turbulence under weaker Subsidence—Shallow Convection PositivE feedback) with the net cloud feedback depending on how the two opposing effects counteract each other. The LES results are consistent with these interpretations.
Key Points
Reasons of negative and positive cloud feedbacks in SCMs are explained
A framework is provided to interpret cloud feedbacks in models
SCM results are compared with LES simulations
Abstract
Glycans play a pivotal role in biology. However, because of the low-affinity of glycan-protein interactions, many interaction pairs remain unknown. Two important glycoproteins involved in ...B-cell biology are the B-cell receptor and its secreted counterpart, antibodies. It has been indicated that glycans expressed by these B-cell-specific molecules can modulate immune activation via glycan-binding proteins. In several autoimmune diseases, an increased prevalence of variable domain glycosylation of IgG autoantibodies has been observed. Especially, the hallmarking autoantibodies in rheumatoid arthritis, anti-citrullinated protein antibodies, carry a substantial amount of variable domain glycans. The variable domain glycans expressed by these autoantibodies are N-linked, complex-type, and α2–6 sialylated, and B-cell receptors carrying variable domain glycans have been hypothesized to promote selection of autoreactive B cells via interactions with glycan-binding proteins. Here, we use the anti-citrullinated protein antibody response as a prototype to study potential in solution and in situ B-cell receptor–variable domain glycan interactors. We employed SiaDAz, a UV-activatable sialic acid analog carrying a diazirine moiety that can form covalent bonds with proximal glycan-binding proteins. We show, using oligosaccharide engineering, that SiaDAz can be readily incorporated into variable domain glycans of both antibodies and B-cell receptors. Our data show that antibody variable domain glycans are able to interact with inhibitory receptor, CD22. Interestingly, although we did not detect this interaction on the cell surface, we captured CD79 β glycan–B-cell receptor interactions. These results show the utility of combining photoaffinity labeling and oligosaccharide engineering for identifying antibody and B-cell receptor interactions and indicate that variable domain glycans appear not to be lectin cis ligands in our tested conditions.
It is generally assumed that hemodialysis adequacy is only minimally affected by increasing the dialysate flow rate (Qd). Recent in vitro studies showed that dialyzer urea clearance (Kd
urea ) may ...increase substantially more than expected in response to an increase in Qd. Because these studies implied that dialysis efficacy may benefit from greater Qds, we studied in vivo the effects of various Qds on the delivered dose of dialysis in 23 maintenance hemodialysis (MHD) patients. Hemodialysis was performed at Qds of 300, 500, and 800 mL/min for at least 3 weeks each, whereas specific dialysis prescriptions (treatment time, blood flow rate Qb, ultrafiltration volume, and type and size of dialyzer) were kept constant. Delivered dose of dialysis, assessed by single-pool Kt/V (Kt/V
sp ) and double-pool Kt/V (Kt/ V
dp ), was measured at least three times for each Qd (218 measurements). Mean ± SEM Kt/V
sp was 1.19 ± 0.03 at Qd of 300 mL/min, 1.32 ± 0.04 at 500 mL/min, and 1.45 ± 0.04 at 800 mL/min. The relative gains in Kt/V
sp for increasing Qd from 300 to 500 mL/min and 500 to 800 mL/min were 11.7% ± 8.7% and 9.9% ± 5.1%, respectively. Kt/V
dp increased at a similar percentage (11.2% ± 8.9% and 10.3% ± 5.1%, respectively). The observed gain in urea clearance by increasing Qd from 500 to 800 mL/min was significantly greater than the increase in Kd
urea predicted from mathematical modeling (5.7% ± 0.4%;
P = 0.0008). Removal ratios for creatinine and the high-molecular-weight marker, β
2 -microglobulin, were not affected by increasing Qd from 500 to 800 mL/min. The proportion of patients not achieving adequacy (Kt/V
sp ≥ 1.2) was reduced from 56% at Qd of 300 mL/min to 30% at 500 mL/min and further to 13% at 800 mL/min. It is concluded that increasing Qd from 500 to 800 mL/min is associated with a significant increase in Kt/V. Hemodialysis with Qd of 800 mL/min should be considered in selected patients not achieving adequacy despite extended treatment times and optimized Qbs.
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