Management of chest pain in the French emergency healthcare system: the prospective observational EPIDOULTHO study.

The aim of this paper was to describe the epidemiology, and diagnostic and therapeutic strategies that emergency physicians use to manage patients presenting with chest pain at all three levels of the French emergency medical system - that is, dispatch centres (SAMUs: the medical emergency system), which operate the mobile intensive care units (MICUs), and hospitals' emergency departments (EDs), with a focus on acute coronary syndrome (ACS). All patients with chest pain who contacted a SAMU and/or were managed by a MICU and/or were admitted into an ED were included in a 1-day multicentre prospective study carried out in January 2013. Data on diagnostic and therapeutic management and disposition were collected. An in-hospital follow-up was performed. In total, 1339 patients were included: 537 from SAMU, 187 attended by a MICU and 615 in EDs. Diagnosing ACS was the main diagnostic strategy of the French emergency care system, diagnosed in 16% of SAMU patients, 25% of MICU patients and 10% of ED patients. Among patients calling the SAMU, 76 (14%) received only medical advice, 15 (8%) patients remained at home after being seen by a MICU and 454 (74%) were discharged from an ED. Management of chest pain at the three levels of the French medical emergency system is mainly oriented towards ruling out ACS. The strategy of diagnostic management is based on minimizing missed diagnoses of ACS

Contribution of Tore Supra in preparation of ITER

Tore Supra routinely addresses the physics and technology of very long-duration plasma discharges, thus bringing precious information on critical issues of long pulse operation of ITER. A new ITER relevant lower hybrid current drive (LHCD) launcher has allowed coupling to the plasma a power level of 2.7 MW for 78 s, corresponding to a power density close to the design value foreseen for an ITER LHCD system. In accordance with the expectations, long distance (10 cm) power coupling has been obtained. Successive stationary states of the plasma current profile have been controlled in real-time featuring (i) control of sawteeth with varying plasma parameters, (ii) obtaining and sustaining a 'hot core' plasma regime, (iii) recovery from a voluntarily triggered deleterious magnetohydrodynamic regime. The scrape-off layer (SOL) parameters and power deposition have been documented during L-mode ramp-up phase, a crucial point for ITER before the X-point formation. Disruption mitigation studies have been conducted with massive gas injection, evidencing the difference between He and Ar and the possible role of the q = 2 surface in limiting the gas penetration. ICRF assisted wall conditioning in the presence of magnetic field has been investigated, culminating in the demonstration that this conditioning scheme allows one to recover normal operation after disruptions. The effect of the magnetic field ripple on the intrinsic plasma rotation has been studied, showing the competition between turbulent transport processes and ripple toroidal friction. During dedicated dimensionless experiments, the effect of varying the collisionality on turbulence wavenumber spectra has been documented, giving new insight into the turbulence mechanism. Turbulence measurements have also allowed quantitatively comparing experimental results with predictions by 5D gyrokinetic codes: numerical results simultaneously match the magnitude of effective heat diffusivity, rms values of density fluctuations and wavenumber spectra. A clear correlation between electron temperature gradient and impurity transport in the very core of the plasma has been observed, strongly suggesting the existence of a threshold above which transport is dominated by turbulent electron modes. Dynamics of edge turbulent fluctuations has been studied by correlating data from fast imaging cameras and Langmuir probes, yielding a coherent picture of transport processes involved in the SOL. Corrections were made to this article on 6 January 2012. Some of the letters in the text were missing