Rehabilitation of irrigation systems in Sri Lanka: A literature review

Rehabilitation / Irrigation systems / Water management / Tank irrigation / Modernization / Research / Investment / Farmer participation / Sri Lanka / Gal Oya Project / Uda Walawe

Feasibility and acceptability of a primary care liver fibrosis testing pathway centred on the diabetes annual review: PRELUDE1 prospective cohort study protocol.

INTRODUCTION: Non-alcoholic fatty liver disease is the most common chronic liver disease worldwide affecting 20%-25% in the USA and Europe with a 60%-80% lifetime prevalence for people with type 2 diabetes (T2D). Fibrosis has repeatedly been demonstrated to be the major determinant of liver disease morbidity and mortality and there is currently no routine screening for liver fibrosis in at-risk T2D population. METHODS AND ANALYSIS: This 12-month prospective cohort study of automated fibrosis testing uses the fibrosis-4 score (FIB-4) in patients with T2D linked to the investigation of hospital-based versus community-based second-tier transient elastography (TE) testing. We plan to include >5000 participants across 10 General Practitioner (GP) practices in East London and Bristol. This will determine the rate of undiagnosed significant liver fibrosis in a T2D population, the feasibility of two-tier liver fibrosis screening using FIB-4 at the diabetes annual review and subsequent TE delivered either in the community or secondary care settings. This will include an intention-to-treat analysis for all those invited to attend for diabetes annual review. A qualitative substudy regarding the acceptability of the fibrosis screening pathway will comprise semistructured interviews/focus groups with primary care staff (GPs and practice nurses), and patients taking part in the wider study. ETHICS AND DISSEMINATION: This study received a favourable opinion from the Cambridge East research ethics committee. The results of this study will be disseminated in peer-reviewed scientific journals, conference presentations and local diabetes lay panel meetings. TRIAL REGISTRATION NUMBER: ISRCTN14585543

Molybdenum targets for production of 99mTc by a medical cyclotron

Introduction Alternative methods for producing the medical imaging isotope 99mTc are actively being developed around the world in anticipation of the imminent shutdown of the National Research Universal (NRU) reactor in Chalk River, Ontario, Canada and the high flux reactor (HFR) in Petten, Holland that together currently produce up to 80 % of the world’s supply through fission. The most promising alternative methods involve accelerators that focus Bremsstrahlung radiation or protons on metallic targets comprised of 100Mo and a supporting material used to conduct heat away during irradiation. As an example, the reaction 100Mo(p,2n)99mTc provides a direct route that can be incorporated into routine production in regional nuclear medicine centers that possess medical cyclotrons for production of other isotopes, such as those used for Positron Emission Tomography (PET). The targets used to produce 99mTc are subject to a number of operational constraints. They must withstand the temperatures generated by the irradiation and be fashioned to accommodate temperature gradients from in situ cooling. The targets must be resilient, which means they cannot disintegrate during irradiation or post processing, because of the radioactive nature of the products. Yet, the targets must be easily post-processed to separate the 99mTc. In addition, the method used to manufacture the targets must not be wasteful of the 100Mo, because of its cost (~$2/mg). Any manufacturing process should be able to function remotely in a shielded space to accommodate the possibility of radioactive recycled target feedstock. There are a number of methods that have been proposed for large-scale target manufacturing including electrophoretic deposition, pressing and sinter-ing, electroplating and carburization [1]. How to develop these methods for routine production is an active business [2,3]. From the industrial perspective, plasma spraying showed promising results initially [4], but the process became very expensive requiring customized equipment in order to reduce losses because of overspray,which also required a large inventory of expen-sive feedstock. In this paper we report the ex-perimental validation of an industrial process for production of targets comprising a Mo layer and a copper support. Materials and methods Target Design Targets have been manufactured for irradiation at 15 MeV. Two targets are shown in FIG. 1: one as-manufactured and another after irradiation; no visible changes were observed following irradiation. The supporting circular copper (C101) disks have diameters of 24 mm and thickness of 1.6 mm. The molybdenum in the center of the target is fully dense with thickness 230 μm determined from SEM cross-sections.Targets have also been manufactured for irradi-ation in a general-purpose target holder designed to be attached to all makes of cyclotrons found in regional nuclear medicine centers. The elliptical targets were designed for high-volume production of 99mTc with 15 MeV protons at currents of 400 µA with 15% collimation [4]. The elliptical shape reduces the heat flux associated with high current sources. The cooling channels on the back of the target are designed to with-stand the high temperature generated during Irradiation. A thermal simulation of expected temperatures during irradiation is shown in FIG. 3. The center of the target is expected to reach 260 oC during irradiation. The elliptical targets were formed from a 27 mm C101 copper plate with width 22 mm and length 55 mm. The molybdenum in the center of the target is fully dense with thickness 60 m de-termined from SEM cross-sections. FIG. 4 shows the molybdenum deposition in the center of the target in a form of an ellipse (38×10 mm). Results and Conclusions Circular targets have been produced and suc-cessfully irradiated for up to 5 h with a proton beam with energy 15 MeV and current 50 µA. (FIG. 1). The targets were resilient. Before irradi-ation the targets were subjected to mechanical shock tests and thermal gradients with no ob-servable effect. After irradiation there was no indication of any degradation. The manufacturing process produced 20 consistently reproducible targets within an hour with a molybdenum loss of less than 2 %. After irradiation the targets were chemically processed and the products characterized by Ge-HP gamma spectrometry. Only Tc isotopes were found. No other contami-nants were identified after processing. The de-tails of the separation and purification are de-scribed elsewhere [5]. Circular targets suitable for low-volume produc-tion of 99mTc have been manufactured and test-ed. The targets have been shown to meet the required operation constraints: the targets are resilient withstanding mechanical shock and irradiation conditions; they are readily produced with minimal losses; and post-processing after irradiation for 5 h has been shown to produce 99mTc. Elliptical targets suitable for high-volume pro-duction of 99mTc with high power cyclotrons have been manufactured (FIG. 4). Like the circular targets, the elliptical targets are readily pro-duced with minimal losses and are able to with-stand mechanical shock and thermal gradients; however, they have yet to be irradiated

Regional variation in characteristics of patients with decompensated cirrhosis admitted to hospitals in the UK

[no abstract

Evaluating future risk of NAFLD in adolescents:a prediction and decision curve analysis

BACKGROUND: Non-alcoholic fatty liver disease (NAFLD) is the commonest liver condition in the western world and is directly linked to obesity and the metabolic syndrome. Elevated body mass index is regarded as a major risk factor of NAFL (steatosis) and NAFLD fibrosis. Using data from the Avon Longitudinal Study of Parents and Children (ALSPAC), we sought to investigate whether other variables from adolescence could improve prediction of future NAFL and NAFLD fibrosis risk at 24 years, above BMI and sex. METHODS: Aged 24 years, 4018 ALSPAC participants had transient elastography (TE) and controlled attenuation parameter (CAP) measurement using Echosens 502 Touch. 513 participants with harmful alcohol consumption were excluded. Logistic regression models examined which variables measured at 17 years were predictive of NAFL and NAFLD fibrosis in young adults. Predictors included sex, BMI, central adiposity, lipid profile, blood pressure, liver function tests, homeostatic model assessment for insulin resistance (HOMA-IR), and ultrasound defined NAFL at 17 years (when examining fibrosis outcomes). A model including all these variables was termed “routine clinical measures”. Models were compared using area under the receiver operator curve (AUROC) and Bayesian Information Criterion (BIC), analysis, which penalises model complexity. Models were tested in all participants and those with overweight or obese standardised BMIs (BMI SDS) centiles at the 17-year time point. A decision curve analysis (DCA) was performed to evaluate the clinical utility of models in overweight and obese adolescents predicting NAFLD fibrosis at a threshold probability of 0.1. RESULTS: The “routine clinical measures” model had the highest AUROC for predicting NAFL in all adolescent participants (AUROC 0.79 [SD 0.00]) and those with an overweight/obese BMI SDS centile (AUROC 0.77 [SD 0.01]). According to BIC analysis, insulin resistance was the best predictor of NAFL in all adolescents, whilst central adiposity was the best predictor in those with an overweight/obese BMI SDS centile. The “routine clinical measures” model also had the highest AUROC for predicting NAFLD fibrosis in all adolescent participants (AUROC 0.78 [SD 0.02]) and participants with an overweight/obese BMI SDS centile (AUROC 0.84 [SD 0.03]). However, following BIC analysis, BMI was the best predictor of NAFLD fibrosis in all adolescents including those with an overweight/obese BMI SDS centile. A decision curve analysis examining overweight/obese adolescent participants showed the model that had the greatest net benefit for increased NAFLD fibrosis detection, above a treat all overweight and obese adolescents’ assumption, was the “routine clinical measures” model. However, the net benefit was marginal (0.0054 [0.0034–0.0075]). CONCLUSION: In adolescents, routine clinical measures were not superior to central adiposity and BMI at predicting NAFL and NAFLD fibrosis respectively in young adulthood. Additional routine clinical measurements do provide incremental benefit in detecting true positive fibrosis cases, but the benefit is small. Thus, to reduce morbidity and mortality associated with NASH cirrhosis in adults, the ultimate end point of NAFLD, the focus must be on obesity management at a population level. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1186/s12876-022-02401-y

All-Metal water target with spherical window

Introduction The use of a prefabricated target window assembly greatly simplifies the window installation. The window module is sealed by metal knife-edges, thus eliminating any elestomers in the target construction. Spherical Havar window offers high strength at reduced thickness and does not require helium cooling. The target body is of platinum-plated silver. The target assembly includes an integral beam collimator and a four-sector mask