Impact of transthoracic echocardiography at district hospital level

Background. The use of and demand for echocardiography (ECHO) has increased worldwide. In developed countries, this has nottranslated into improved access outside tertiary centres. Previous studies have favoured the appropriate use of ECHO over its clinicalimpact, limiting generalisability to resource-constrained settings.Objectives. To assess the impact of an ECHO service at district hospital level in Cape Town, South Africa.Methods. A prospective, cross-sectional study was performed. A total of 210 consecutive patients, referred to the ECHO clinic over a5-month period, were recruited. Transthoracic ECHO was evaluated in terms of its indication, new information provided, correlation withthe referring doctor’s diagnosis and subsequent management plan. Impact included the escalation and de-escalation of treatment, as wellas usefulness without a change in management.Results. The results show that 83.8% of the patients’ management was impacted on by echocardiography. Valvular lesions were themain indication. The most frequent contribution was information provided towards the diagnosis of heart failure and assessment aftermyocardial infarction. Of the echocardiograms, 56.2% confirmed the referring doctor’s diagnosis, yet were still associated with a significantimpact. The rational prescription of medication had the major impetus, followed by de-escalation of therapy and screening patients todetermine referral to a tertiary facility.Conclusion. ECHO has a positive impact on patient management outside tertiary settings, where the definition of impact appears to bedifferent. The value of a normal study, screening prior to upstream referral and usefulness irrespective of change have been established. Thisshould alert policy makers against restriction of access to ECHO and promote training of personnel in its use

Birth of a comet magnetosphere: A spring of water ions

The Rosetta mission shall accompany comet 67P/Churyumov-Gerasimenko from a heliocentric distance of >3.6 astronomical units through perihelion passage at 1.25 astronomical units, spanning low and maximum activity levels. Initially, the solar wind permeates the thin comet atmosphere formed from sublimation, until the size and plasma pressure of the ionized atmosphere define its boundaries: A magnetosphere is born. Using the Rosetta Plasma Consortium ion composition analyzer, we trace the evolution from the first detection of water ions to when the atmosphere begins repelling the solar wind (~3.3 astronomical units), and we report the spatial structure of this early interaction. The near-comet water population comprises accelerated ions (<800 electron volts), produced upstream of Rosetta, and lower energy locally produced ions; we estimate the fluxes of both ion species and energetic neutral atoms

Spatial and depth-associated distribution patterns of shallow gorgonians in the Algarve coast (Portugal, NE Atlantic)

The ecological role of gorgonians for marine rocky bottoms is worldwide recognized, but the information on the distribution patterns of NE Atlantic temperate species is insufficient, considering current global, regional and local threats. To overcome the lack of information on the spatial distribution patterns of gorgonians in south Portugal, in 2009/2010, the occurrence and abundance of gorgonian species in rocky bottoms were quantified over more than 25 km of coast (37.1N/8.6W) down to 30 m depth. Eunicella labiata, Eunicella gazella, Eunicella verrucosa and Leptogorgia sarmentosa were abundant and frequent in the studied area, while Leptogorgia lusitanica was less abundant. All species evidenced a similar depth pattern, that is abundance significantly increased with depth below 15 m. At shallower waters (up to 15 m), the distribution of gorgonians may be constrained by abiotic factors and competition with algae. Indeed, the abundance of gorgonians was negatively correlated with the percentage cover of algae along the depth gradient, but gorgonians and sponges coexist. Competition among gorgonian species also seems to be low in this area because of the similarity in the abundance pattern observed for the most abundant species and also their high association. In NE Atlantic shallow temperate rocky bottoms, the distribution of gorgonians seems to be influenced by environmental factors and biological interactions, namely competition (algae) and coexistence (sponges and other gorgonians).info:eu-repo/semantics/publishedVersio

Overview of ASDEX Upgrade results

The experimental ASDEX Upgrade results of the Divertor I phase are reviewed with emphasis on H-mode physics, power handling, plasma edge and divertor physics, operational limits (beta and density), disruption behaviour and testing of tungsten as a target plate material. All these investigations are focused on the preparation of the ITER physics database. The change to the new divertor is briefly outlined

Micro ion beam analysis for the erosion of beryllium marker tiles in a tokamak limiter

Beryllium limiter marker tiles were exposed to plasma in the Joint European Torus to diagnose the erosion of main chamber wall materials. A limiter marker tile consists of a beryllium coating layer (7-9 mu m) on the top of bulk beryllium, with a nickel interlayer (2-3 mu m) between them. The thickness variation of the beryllium coating layer, after exposure to plasma, could indicate the erosion measured by ion beam analysis with backscattering spectrometry. However, interpretations from broad beam backscattering spectra were limited by the non-uniform surface structures. Therefore, micro-ion beam analysis (mu-IBA) with 3 MeV proton beam for Elastic back scattering spectrometry (EBS) and PIXE was used to scan samples. The spot size was in the range of 3-10 mu m. Scanned areas were analysed with scanning electron microscopy (SEM) as well. Combining results from mu-IBA and SEM, we obtained local spectra from carefully chosen areas on which the surface structures were relatively uniform. Local spectra suggested that the scanned area (approximate to 600 mu m x 1200 mu m) contained regions with serious erosion with only 2-3 mu m coating beryllium left, regions with intact marker tile, and droplets with 90% beryllium. The nonuniform erosion, droplets mainly formed by beryllium, and the possible mixture of beryllium and nickel were the major reasons that confused interpretation from broad beam EBS

Overview of the JET results

Since the installation of an ITER-like wall, the JET programme has focused on the consolidation of ITER design choices and the preparation for ITER operation, with a specific emphasis given to the bulk tungsten melt experiment, which has been crucial for the final decision on the material choice for the day-one tungsten divertor in ITER. Integrated scenarios have been progressed with the re-establishment of long-pulse, high-confinement H-modes by optimizing the magnetic configuration and the use of ICRH to avoid tungsten impurity accumulation. Stationary discharges with detached divertor conditions and small edge localized modes have been demonstrated by nitrogen seeding. The differences in confinement and pedestal behaviour before and after the ITER-like wall installation have been better characterized towards the development of high fusion yield scenarios in DT. Post-mortem analyses of the plasma-facing components have confirmed the previously reported low fuel retention obtained by gas balance and shown that the pattern of deposition within the divertor has changed significantly with respect to the JET carbon wall campaigns due to the absence of thermally activated chemical erosion of beryllium in contrast to carbon. Transport to remote areas is almost absent and two orders of magnitude less material is found in the divertor