Improving cardiovascular magnetic resonance access in low- and middle-income countries for cardiomyopathy assessment: rapid cardiovascular magnetic resonance

AIMS: To evaluate the impact of a simplified, rapid cardiovascular magnetic resonance (CMR) protocol embedded in care and supported by a partner education programme on the management of cardiomyopathy (CMP) in low- and middle-income countries (LMICs). METHODS AND RESULTS: Rapid CMR focused particularly on CMP was implemented in 11 centres, 7 cities, 5 countries, and 3 continents linked to training courses for local professionals. Patients were followed up for 24 months to assess impact. The rate of subsequent adoption was tracked. Five CMR conferences were delivered (920 attendees-potential referrers, radiographers, reporting cardiologists, or radiologists) and five new centres starting CMR. Six hundred and one patients were scanned. Cardiovascular magnetic resonance indications were 24% non-contrast T2* scans [myocardial iron overload (MIO)] and 72% suspected/known cardiomyopathies (including ischaemic and viability). Ninety-eighty per cent of studies were of diagnostic quality. The average scan time was 22 ± 6 min (contrast) and 12 ± 4 min (non-contrast), a potential cost/throughput reduction of between 30 and 60%. Cardiovascular magnetic resonance findings impacted management in 62%, including a new diagnosis in 22% and MIO detected in 30% of non-contrast scans. Nine centres continued using rapid CMR 2 years later (typically 1-2 days per week, 30 min slots). CONCLUSIONS: Rapid CMR of diagnostic quality can be delivered using available technology in LMICs. When embedded in care and a training programme, costs are lower, care is improved, and services can be sustained over time. KEY QUESTION: KEY FINDING: TAKE-HOME MESSAGE

The activity of sodium in cryolite-aluminun melts

Activities of sodium in alumina-saturated cryolite-aluminum melts have been measured by the equilibration of a three phase system of cryolite, aluminum and lead. An approximate linear increase in the activity of sodium was noted on a log plot of activity as a function of NaF-A1F₃ weight ratios over the range pertinent to commercial reduction cell operation. Activities of sodium in cryolite-aluminum melts have been calculated by employing the equilibrium reaction between cryolite and aluminum metal and the thermodynamic data from-an analysis of the NaF-A1F₃ phase diagram. Differences between the reversible deposition potential for aluminum and sodium at one atmosphere partial pressure were calculated from the measured equilibrium sodium activities. The values obtained were of the order of .15 to .4O volts, increasing with decreasing NaF-A1F₃, ratio.Applied Science, Faculty ofMaterials Engineering, Department ofGraduat

Risk Workshop: Moorland Wildfires in the Peak District. Technical Report,

Manuscrito. -- 9 h.; papel; folio. -- Fondo Universidad de Salamanca; sección Claustros; serie Borradores de claustros. -- Buena conservación. -- Fechas: 15/01/1790 - 16/01/179