Control System Implementation and Follow-up within the Cooling and Ventilation Contracts for the LHC

The control system implementation for the cooling and ventilation facilities connected to the LHC Project relies on the technical and human resources that are organised within large-size industrial contracts. Beside the technical aspects, the follow-up of the implementation activities in the framework of such contracts also involves a managerial effort in order to achieve a flexible and coherent control system. The purpose is to assure precise and reliable regulation together with accurate local and remote supervision in conformity with the operational requirements. These objectives can only be reached by a systematic approach that keeps the co-ordination between the in-house and external cross-disciplinary teams as well as the fulfilment of the validation procedures and the contractual formalities. The case that here illustrates this approach is the control system implementation for the heating, ventilation and air conditioning of the LHC surface buildings, which shall extend up to 2004

Validation of SOLPS-ITER Simulations against the TCV-X21 Reference Case

This paper presents a quantitative validation of SOLPS-ITER simulations against the TCV-X21 reference case and provides insights into the neutral dynamics and ionization source distribution in this scenario. TCV-X21 is a well-diagnosed diverted L-mode sheath-limited plasma scenario in both toroidal field directions, designed specifically for the validation of turbulence codes [D.S. Oliveira, T. Body, et al 2022 Nucl. Fusion 62 096001]. Despite the optimization to reduce the impact of the neutral dynamics, the absence of neutrals in previous turbulence simulations of TCV-X21 was identified as a possible explanation for the disagreements with the experimental data in the divertor region. This motivates the present study with SOLPS-ITER that includes kinetic neutral dynamics via EIRENE. Five new observables are added to the extensive, publicly available TCV-X21 dataset. These are three deuterium Balmer lines in the divertor and neutral pressure in the common and private flux regions. The quantitative agreement metric is combined with the conjugate gradient method to approach the SOLPS-ITER input parameters that return the best overall agreement with the experiment. A proof-of-principle of this method results in a modest improvement in the level-of-agreement; shortcomings of the method and how to improve it are discussed. Alternatively, a scan of the particle and heat diffusion coefficients shows an improvement of 10.4% beyond the agreement level achieved by the gradient method. The result is found for an increased transport coefficient compared to what is usually used for TCV L-mode plasmas, suggesting the need for accurate self-consistent turbulence models for predictive boundary simulations. The simulations indicate that ~65% of the total ionization occurs in the SOL, motivating the inclusion of neutrals in future turbulence simulations towards improved agreement with the experiment

Enhanced triage for patients with suspected cardiac chest pain: the History and Electrocardiogram-only Manchester Acute Coronary Syndromes decision aid.

OBJECTIVES: Several decision aids can 'rule in' and 'rule out' acute coronary syndromes (ACS) in the Emergency Department (ED) but all require measurement of blood biomarkers. A decision aid that does not require biomarker measurement could enhance risk stratification at triage and could be used in the prehospital environment. We aimed to derive and validate the History and ECG-only Manchester ACS (HE-MACS) decision aid using only the history, physical examination and ECG. METHODS: We undertook secondary analyses in three prospective diagnostic accuracy studies that included patients presenting to the ED with suspected cardiac chest pain. Clinicians recorded clinical features at the time of arrival using a bespoke form. Patients underwent serial troponin sampling and 30-day follow-up for the primary outcome of ACS. The model was derived by logistic regression in one cohort and validated in two similar prospective studies. RESULTS: The HE-MACS model was derived in 796 patients and validated in cohorts of 474 and 659 patients. HE-MACS incorporated age, sex, systolic blood pressure plus five historical variables to stratify patients into four risk groups. On validation, 5.5 and 12.1% (pooled total 9.4%) patients were identified as 'very low risk' (potential immediate rule out) with a pooled sensitivity of 99.5% (95% confidence interval: 97.1-100.0%). CONCLUSION: Using only the patient's history and ECG, HE-MACS could 'rule out' ACS in 9.4% of patients while effectively risk stratifying remaining patients. This is a very promising tool for triage in both the prehospital environment and ED. Its impact should be prospectively evaluated in those settings

How events in emergency medicine impact doctors' psychological well-being

© Author(s) (or their employer(s)) 2018. No commercial re-use. See rights and permissions. Published by BMJ. Background: Emergency medicine is a high-pressured specialty with exposure to disturbing events and risk. We conducted a qualitative study to identify which clinical events resulted in emotional disruption and the impact of these events on the well-being of physicians working in an ED. Methods: We used the principles of naturalistic inquiry to conduct narrative interviews with physicians working in the ED at Central Manchester University Hospitals NHS Foundation Trust, between September and October 2016. Participants were asked, Could you tell me about a time when an event at work has continued to play on your mind after the shift in which it occurred was over?' Data were analysed using framework analysis. The study had three a priori themes reported here. Other emergent themes were analysed separately. Results: We interviewed 17 participants. Within the first a priori theme (clinical events') factors associated with emotional disruption included young or traumatic deaths, patients or situations that physicians could relate to, witnessing the impact of death on relatives, the burden of responsibility (including medical error) and conflict in the workplace. Under theme 2 (psychological and physical effects), participants reported substantial upset leading to substance misuse, sleep disruption and neglecting their own physical needs through preoccupation with caring. Within theme 3 (impact on relationships), many interviewees described becoming withdrawn from personal relationships following clinical events, while others described feeling isolated because friends and family were non-medical. Conclusions: Clinical events encountered in the ED can affect a physician's psychological and physical well-being. For many participants these effects were negative and long lasting

Application des recommandations dans la prise en charge du cancer de l’endomètre en pratique clinique. Étude rétrospective bretonne

National audienceObjective - To assess the use of French Cancer Institute recommendations for the diagnosis and treatment of endometrial cancer. Methods - Retrospective observational study involving 137 patients with endometrial cancer between 2011 and 2013. Results - Both MRI and pathological assessment with correct report as recommended were used for 66.4% of patients with endometrial cancer. For patients with correct preoperative assessment, 44.9% of patients were uncorrectly classified and upgraded on final pathological analysis of hysterectomy concerning lymph node involvement risk. These patients did not have confident surgical assessment, according this risk. Conclusion - To improve relevance of preoperative assessment in endometrial cancer, radiological and pathological expertise is required. However, even performed optimally, preoperative assessment does not allow correct risk stratification of lymph node involvement in endometrial cancer. This ineffective stratification leads to propose sentinel lymph node biopsy with hysterectomy in case of preoperative low risk endometrial cancer assessment

Pain outcomes in patients with bone metastases from advanced cancer: assessment and management with bone-targeting agents

Bone metastases in advanced cancer frequently cause painful complications that impair patient physical activity and negatively affect quality of life. Pain is often underreported and poorly managed in these patients. The most commonly used pain assessment instruments are visual analogue scales, a single-item measure, and the Brief Pain Inventory Questionnaire-Short Form. The World Health Organization analgesic ladder and the Analgesic Quantification Algorithm are used to evaluate analgesic use. Bone-targeting agents, such as denosumab or bisphosphonates, prevent skeletal complications (i.e., radiation to bone, pathologic fractures, surgery to bone, and spinal cord compression) and can also improve pain outcomes in patients with metastatic bone disease. We have reviewed pain outcomes and analgesic use and reported pain data from an integrated analysis of randomized controlled studies of denosumab versus the bisphosphonate zoledronic acid (ZA) in patients with bone metastases from advanced solid tumors. Intravenous bisphosphonates improved pain outcomes in patients with bone metastases from solid tumors. Compared with ZA, denosumab further prevented pain worsening and delayed the need for treatment with strong opioids. In patients with no or mild pain at baseline, denosumab reduced the risk of increasing pain severity and delayed pain worsening along with the time to increased pain interference compared with ZA, suggesting that use of denosumab (with appropriate calcium and vitamin D supplementation) before patients develop bone pain may improve outcomes. These data also support the use of validated pain assessments to optimize treatment and reduce the burden of pain associated with metastatic bone disease

Profilin-1 Is Expressed in Human Atherosclerotic Plaques and Induces Atherogenic Effects on Vascular Smooth Muscle Cells

.Here we monitored profilin-1 expression in human atherosclerotic plaques by immunofluorescent staining. The effects of recombinant profilin-1 on atherogenic signaling pathways and cellular responses such as DNA synthesis (BrdU-incorporation) and chemotaxis (modified Boyden-chamber) were evaluated in cultured rat aortic and human coronary vascular smooth muscle cells (VSMCs). Furthermore, the correlation between profilin-1 serum levels and the degree of atherosclerosis was assessed in humans.<0.001 vs. no atherosclerosis or control group).Profilin-1 expression is significantly enhanced in human atherosclerotic plaques compared to the normal vessel wall, and the serum levels of profilin-1 correlate with the degree of atherosclerosis in humans. The atherogenic effects exerted by profilin-1 on VSMCs suggest an auto-/paracrine role within the plaque. These data indicate that profilin-1 might critically contribute to atherogenesis and may represent a novel therapeutic target

Ranging patterns and site fidelity of Snubfin Dolphins in Yawuru Nagulagun/Roebuck Bay, Western Australia

For long-lived species such as marine mammals, having sufficient data on ranging patterns and space use in a timescale suitable for population management and conservation can be difficult. Yawuru Nagulagun/Roebuck Bay in the northwest of Western Australia supports one of the largest known populations of Australian snubfin dolphins (Orcaella heinsohni)—a species with a limited distribution, vulnerable conservation status, and high cultural value. Understanding the species’ use of this area will inform management for the long-term conservation of this species. We combined 11 years of data collected from a variety of sources between 2007 and 2020 to assess the ranging patterns and site fidelity of this population. Ranging patterns were estimated using minimum convex polygons (MCPs) and fixed kernel densities (weighted to account for survey effort) to estimate core and representative areas of use for both the population and for individuals. We estimated the population to range over a small area within the bay (103.05 km2). The Mean individual representative area of use (95% Kernel density contour) was estimated as 39.88 km2 (± 32.65 SD) and the Mean individual core area of use (50% Kernel density contour) was estimated as 21.66 km2 (±18.85 SD) with the majority of sightings located in the northern part of the bay less than 10 km from the coastline. Most individuals (56%) showed moderate to high levels of site fidelity (i.e., part-time or long-term residency) when individual re-sight rates were classified using agglomerative hierarchical clustering (AHC). These results emphasize the importance of the area to this vulnerable species, particularly the area within the Port of Broome that has been identified within the population’s core range. The pressures associated with coastal development and exposure to vessel traffic, noise, and humans will need to be considered in ongoing management efforts. Analyzing datasets from multiple studies and across time could be beneficial for threatened species where little is known on their ranging patterns and site fidelity. Combined datasets can provide larger sample sizes over an extended period of time, fill knowledge gaps, highlight data limitations, and identify future research needs to be considered with dedicated studies