Under pressure: pulmonary hypertension associated with left heart disease.

© ERS 2015.Pulmonary hypertension (PH) associated with left heart disease (PH-LHD) is the most common type of PH, but its natural history is not well understood. PH-LHD is diagnosed by right heart catheterisation with a mean pulmonary arterial pressure ⩾25 mmHg and a pulmonary capillary wedge pressure >15 mmHg. The primary causes of PH-LHD are left ventricular dysfunction of systolic and diastolic origin, and valvular disease. Prognosis is poor and survival rates are low. Limited progress has been made towards specific therapies for PH-LHD, and management focuses on addressing the underlying cause of the disease with supportive therapies, surgery and pharmacological treatments. Clinical trials of therapies for pulmonary arterial hypertension in patients with PH-LHD have thus far been limited and have provided disappointing or conflicting results. Robust, long-term clinical studies in appropriate target populations have the potential to improve the outlook for patients with PH-LHD. Herein, we discuss the knowledge gaps in our understanding of PH-LHD, and describe the current unmet needs and challenges that are faced by clinicians when identifying and managing patients with this disease

Extension and its characteristics of ECRH plasma in the LHD

One of the main objectives of the LHD is to extend the plasma confinement database for helical systems and to demonstrate such extended plasma confinement properties to be sustained in steady state. Among the various plasma parameter regimes, the study of confinement properties in the collisionless regime is of particular importance. Electron cyclotron resonance heating (ECRH) has been extensively used for these confinement studies of the LHD plasma from the initial operation. The system optimizations including the modification of the transmission and antenna system are performed with the special emphasis on the local heating properties. As the result, central electron temperature of more than 10 keV with the electron density of 0.6 x 10$^{19}$ m$^{-3}$ is achieved near the magnetic axis. The electron temperature profile is characterized by a steep gradient similar to those of an internal transport barrier observed in tokamaks and stellarators. 168 GHz ECRH system demonstrated efficient heating at over the density more than 1.0 x 10$^{20}$ m$^{-3}$. CW ECRH system is successfully operated to sustain 756 s discharge.Comment: 12th International Congress on Plasma Physics, 25-29 October 2004, Nice (France

Optimization of flux-surface density variation in stellarator plasmas with respect to the transport of collisional impurities

Avoiding impurity accumulation is a requirement for steady-state stellarator operation. The accumulation of impurities can be heavily affected by variations in their density on the flux-surface. Using recently derived semi-analytic expressions for the transport of a collisional impurity species with high-$Z$ and flux-surface density-variation in the presence of a low-collisionality bulk ion species, we numerically optimize the impurity density-variation on the flux-surface to minimize the radial peaking factor of the impurities. These optimized density-variations can reduce the core impurity density by $0.75^Z$ (with $Z$ the impurity charge number) in the Large Helical Device case considered here, and by $0.89^Z$ in a Wendelstein 7-X standard configuration case. On the other hand, when the same procedure is used to find density-variations that maximize the peaking factor, it is notably increased compared to the case with no density-variation. This highlights the potential importance of measuring and controlling these variations in experiments.Comment: 19 figures, 17 pages. Accepted into Nuclear Fusio

Left ventricular heart failure and pulmonary hypertension

In patients with left ventricular heart failure (HF), the development of pulmonary hypertension (PH) and right ventricular (RV) dysfunction are frequent and have important impact on disease progression, morbidity, and mortality, and therefore warrant clinical attention. Pulmonary hypertension related to left heart disease (LHD) by far represents the most common form of PH, accounting for 65–80% of cases. The proper distinction between pulmonary arterial hypertension and PH-LHD may be challenging, yet it has direct therapeutic consequences. Despite recent advances in the pathophysiological understanding and clinical assessment, and adjustments in the haemodynamic definitions and classification of PH-LHD, the haemodynamic interrelations in combined post- and pre-capillary PH are complex, definitions and prognostic significance of haemodynamic variables characterizing the degree of pre-capillary PH in LHD remain suboptimal, and there are currently no evidence-based recommendations for the management of PH-LHD. Here, we highlight the prevalence and significance of PH and RV dysfunction in patients with both HF with reduced ejection fraction (HFrEF) and HF with preserved ejection fraction (HFpEF), and provide insights into the complex pathophysiology of cardiopulmonary interaction in LHD, which may lead to the evolution from a ‘left ventricular phenotype’ to a ‘right ventricular phenotype’ across the natural history of HF. Furthermore, we propose to better define the individual phenotype of PH by integrating the clinical context, non-invasive assessment, and invasive haemodynamic variables in a structured diagnostic work-up. Finally, we challenge current definitions and diagnostic short falls, and discuss gaps in evidence, therapeutic options and the necessity for future developments in this context

Analisis Karakteristik Geologi Bawah Permukaan Berdasarkan Composite Log serta Data Tekanan dan Suhu untuk Penentuan Perlakuan Sumur LHD-24, Lapangan Panasbumi Lahendong, Sulawesi Utara

Lapangan panasbumi Lahendong merupakan lapangan panasbumi di Indonesia dengan kapasitas produksi listrik mencapai 80 MW. Potensi lapangan panasbumi Lahendong hingga saat ini masih dieksplorasi lebih lanjut dengan tujuan peningkatan kapasitas produksi sehingga dapat memenuhi kebutuhan listrik Provinsi Sulawesi Utara yang semakin meningkat. Penelitian dilakukan dengan analisis composite log, data tekanan dan suhu sumur LHD-24 yang dikompilasikan dengan data sumur LHD-23, data penyelidikan Magnetotellurik (MT) dan analisis geokimia air manifestasi panasbumi Lahendong dari penelitian terdahulu. Analisis composite log dilakukan untuk mengetahui karakteristik geologi bawah permukaan meliputi litologi, tipe alterasi dan zona permeabel sumur LHD-24 yang digambarkan dalam model dua dimensi sistem panasbumi. Analisis data tekanan dan suhu dilakukan untuk mengetahui potensi reservoir sumur LHD-24 sehingga dapat diperkirakan perlakuan reservoir yang tepat untuk peningkatan kapasitas produksi sumur LHD-24. Sumur LHD-24 memiliki variasi litologi berupa breksi andesit, breksi andesit terubah, breksi tuff terubah, andesit basaltik terubah dan andesit terubah. Tipe alterasi yang dijumpai pada batuan di sumur LHD-24 adalah alterasi tipe argilik dan tipe propilitik. Kedalaman sumur LHD-24 yang memiliki permeabilitas masa kini berada pada kedalaman 1620-2043 meter, hal ini diindikasikan dengan terjadinya partial loss circulation. Hasil pengukuran suhu reservoir LHD-24 menunjukkan suhu reservoir LHD-24 mencapai 258.94 ˚C, dengan demikian berdasarkan suhu reservoirnya sumur LHD-24 memiliki potensi untuk dikembangkan karena tergolong dalam sistem panasbumi temperatur tinggi dengan suhu >225˚C (Hochstein, 1990). Berdasarkan perhitungan waktu pencapaian suhu ideal produksi yang ditunjukkan oleh nilai suhu Boiling Point with Depth (BPD), waktu yang dibutuhkan reservoir sumur LHD-24 mencapai suhu BPD adalah lima tahun. Sedangkan untuk mempercepat pencapaian suhu BPD tersebut, dapat dilakukan rekayasa dengan injeksi Nitrogen ke sumur LHD-24 sehingga titik didih fluida reservoir menurun. Kata kunci: Kapasitas reservoir, composite log, suhu dan tekanan, karakteristik geologi, perlakuan reservoir

Adaptive numerical designs for the calibration of computer codes

Making good predictions of a physical system using a computer code requires the inputs to be carefully specified. Some of these inputs called control variables have to reproduce physical conditions whereas other inputs, called parameters, are specific to the computer code and most often uncertain. The goal of statistical calibration consists in estimating these parameters with the help of a statistical model which links the code outputs with the field measurements. In a Bayesian setting, the posterior distribution of these parameters is normally sampled using MCMC methods. However, they are impractical when the code runs are high time-consuming. A way to circumvent this issue consists of replacing the computer code with a Gaussian process emulator, then sampling a cheap-to-evaluate posterior distribution based on it. Doing so, calibration is subject to an error which strongly depends on the numerical design of experiments used to fit the emulator. We aim at reducing this error by building a proper sequential design by means of the Expected Improvement criterion. Numerical illustrations in several dimensions assess the efficiency of such sequential strategies

An in-depth spectroscopic examination of molecular bands from 3D hydrodynamical model atmospheres I. Formation of the G-band in metal-poor dwarf stars

Recent developments in the three-dimensional (3D) spectral synthesis code Linfor3D have meant that, for the first time, large spectral wavelength regions, such as molecular bands, can be synthesised with it in a short amount of time. A detailed spectral analysis of the synthetic G-band for several dwarf turn-off-type 3D atmospheres (5850 <= T_eff [K] <= 6550, 4.0 <= log g <= 4.5, -3.0 <= [Fe/H] <= -1.0) was conducted, under the assumption of local thermodynamic equilibrium. We also examine carbon and oxygen molecule formation at various metallicity regimes and discuss the impact it has on the G-band. Using a qualitative approach, we describe the different behaviours between the 3D atmospheres and the traditional one-dimensional (1D) atmospheres and how the different physics involved inevitably leads to abundance corrections, which differ over varying metallicities. Spectra computed in 1D were fit to every 3D spectrum to determine the 3D abundance correction. Early analysis revealed that the CH molecules that make up the G-band exhibited an oxygen abundance dependency; a higher oxygen abundance leads to weaker CH features. Nitrogen abundances showed zero impact to CH formation. The 3D corrections are also stronger at lower metallicity. Analysis of the 3D corrections to the G-band allows us to assign estimations of the 3D abundance correction to most dwarf stars presented in the literature. The 3D corrections suggest that A(C) in CEMP stars with high A(C) would remain unchanged, but would decrease in CEMP stars with lower A(C). It was found that the C/O ratio is an important parameter to the G-band in 3D. Additional testing confirmed that the C/O ratio is an equally important parameter for OH transitions under 3D. This presents a clear interrelation between the carbon and oxygen abundances in 3D atmospheres through their molecular species, which is not seen in 1D.Comment: 19 pages, 13 figures, 4 tables. Accepted for publication in A&