Prevalence of unrecognised myocardial infarction in a low-intermediate risk asymptomatic cohort and its relation to systemic atherosclerosis

The study was funded by the Souter Charitable Foundation and the Chest, Heart and Stroke Scotland Charity. J.R.W.M. is supported by the Wellcome Trust through the Scottish Translational Medicine and Therapeutics Initiative (grant no. WT 085664) in the form of a clinical research fellowship.Aims :  Unrecognized myocardial infarctions (UMIs) have been described in 19-30% of the general population using late gadolinium enhancement (LGE) on cardiac magnetic resonance. However, these studies have focused on an unselected cohort including those with known cardiovascular disease (CVD). The aim of the current study was to ascertain the prevalence of UMIs in a non-high-risk population using magnetic resonance imaging (MRI). Methods and Results :  A total of 5000 volunteers aged >40 years with no history of CVD and a 10-year risk of CVD of <20%, as assessed by the ATP-III risk score, were recruited to the Tayside Screening for Cardiac Events study. Those with a B-type natriuretic peptide (BNP) level greater than their gender-specific median were invited for a whole-body MR angiogram and cardiac MR including LGE assessment. LGE was classed as absent, UMI, or non-specific. A total of 1529 volunteers completed the imaging study; of these, 53 (3.6%) were excluded because of either missing data or inadequate LGE image quality. Ten of the remaining 1476 (0.67%) displayed LGE. Of these, three (0.2%) were consistent with UMI, whereas seven were non-specific occurring in the mid-myocardium (n = 4), epicardium (n = 1), or right ventricular insertion points (n = 2). Those with UMI had a significantly higher BNP [median 116 (range 31-133) vs. 22.6 (5-175) pg/mL, P = 0.015], lower ejection fraction [54.6 (36-62) vs. 68.9 (38-89)%, P = 0.007], and larger end-systolic volume [36.3 (27-61) vs. 21.7 (5-65) mL/m(2), P = 0.014]. Those with non-specific LGE had lower diastolic blood pressure [68 (54-70) vs. 72 (46-98) mmHg, P = 0.013] but no differences in their cardiac function. Conclusion :  Despite previous reports describing high prevalence of UMI in older populations, in a predominantly middle-aged cohort, those who are of intermediate or low cardiovascular risk have a very low risk of having an unrecognized myocardial infarct.Publisher PDFPeer reviewe

On the mechanisms governing gas penetration into a tokamak plasma during a massive gas injection

A new 1D radial fluid code, IMAGINE, is used to simulate the penetration of gas into a tokamak plasma during a massive gas injection (MGI). The main result is that the gas is in general strongly braked as it reaches the plasma, due to mechanisms related to charge exchange and (to a smaller extent) recombination. As a result, only a fraction of the gas penetrates into the plasma. Also, a shock wave is created in the gas which propagates away from the plasma, braking and compressing the incoming gas. Simulation results are quantitatively consistent, at least in terms of orders of magnitude, with experimental data for a D 2 MGI into a JET Ohmic plasma. Simulations of MGI into the background plasma surrounding a runaway electron beam show that if the background electron density is too high, the gas may not penetrate, suggesting a possible explanation for the recent results of Reux et al in JET (2015 Nucl. Fusion 55 093013)

Velocity-space sensitivity of the time-of-flight neutron spectrometer at JET

The velocity-space sensitivities of fast-ion diagnostics are often described by so-called weight functions. Recently, we formulated weight functions showing the velocity-space sensitivity of the often dominant beam-target part of neutron energy spectra. These weight functions for neutron emission spectrometry (NES) are independent of the particular NES diagnostic. Here we apply these NES weight functions to the time-of-flight spectrometer TOFOR at JET. By taking the instrumental response function of TOFOR into account, we calculate time-of-flight NES weight functions that enable us to directly determine the velocity-space sensitivity of a given part of a measured time-of-flight spectrum from TOFOR

An observational study of bail decision-making

Pre-trial detention of defendants has important legal, human rights and practical implications for defendants, their families, and society and therefore the area justifies research scrutiny. However, there is a dearth of empirical studies of bail decision-making and most of them have been retrospective studies. Prior studies have nevertheless identified a number of purported shortcomings in bail legislation and decision-making. The rarely used observational methodology employed in this study provided data that are not normally available from official records. The first appearances of 648 defendants were observed in the lower courts in metropolitan Perth (Western Australia) to identify factors that play a significant role in bail decision-making and to collect baseline data for a longitudinal study. Legal factors made a significant contribution to the bail decision, while extra-legal factors did not

First observations of confined fast ions in MAST Upgrade with an upgraded neutron camera

Spherical tokamaks are key to the successful design of operating scenarios of future fusion reactors in the areas of divertor physics, neutral beam current drive and fast ion physics. MAST Upgrade, which has successfully concluded its first experimental campaign, was specifically designed to address the role of the radial gradient of the fast ion distribution in driving the excitation of magneto-hydrodynamic (MHD) instabilities, such as toroidal Alfvén eigenmodes, fish-bones and long-lived mode, thanks to its two tangential neutral beam injection systems, one on the equatorial plane and one that is vertically shifted 65 cm above the equatorial plane. To study the fast ion dynamics in the presence of such instabilities, as well as of sawteeth and neo-classical tearing modes, several fast ion diagnostics were upgraded and new ones added. Among them, the MAST prototype neutron camera (NC) has been upgraded to six, equatorial sight-lines. The first observations of the confined fast ion behavior with the upgraded NC in a wide range of plasma scenarios characterized by on-axis and/or off-axis heating and different MHD instabilities are presented here. The observations presented in this study confirm previous results on MAST but with a higher level of detail and highlight new physics observations unique to the MAST Upgrade. The results presented here confirm the improved performance of the NC Upgrade, which thus becomes one of the key elements, in combination with the rich set of fast ion diagnostics available on the MAST Upgrade, for a more constrained modeling of the fast ion dynamics in fusion reactor relevant scenarios

2020 American College of Rheumatology Guideline for the Management of Gout

Peer Reviewedhttps://deepblue.lib.umich.edu/bitstream/2027.42/155484/1/art41247.pdfhttps://deepblue.lib.umich.edu/bitstream/2027.42/155484/2/art41247_am.pd

RE: pedagogy – after neutrality

Within the UK and in many parts of the world, official accounts of what it is to make sense of religion are framed within a rhetorics of neutrality in which such study is premised upon the possibility of dispassionate engagement and analysis. This paper, which is largely theoretical in scope, explores both the affordances and the costs of such an approach which has become ‘black boxed’ on account of the work that it achieves. A series of new orientations within the academy that are broadly associated with post-structuralist philosophies, feminist and post-colonial studies, together with insights from Science and Technology Studies, question the plausibility of these claims for neutrality whilst in turn raising a series of new questions and priorities. It therefore becomes necessary to re-think and re-frame what it is to make sense of religious and cultural difference after neutrality. The gathering and co-ordination of new planes of sense-making that are responsive to an emergent series of epistemological, ontological, and ethical orientations are considered. Some of the distinctive pedagogical implications of such an approach that engages material practice, difference and uncertainty are then entertained

Overview of recent physics results from MAST

New results from MAST are presented that focus on validating models in order to extrapolate to future devices. Measurements during start-up experiments have shown how the bulk ion temperature rise scales with the square of the reconnecting field. During the current ramp-up, models are not able to correctly predict the current diffusion. Experiments have been performed looking at edge and core turbulence. At the edge, detailed studies have revealed how filament characteristics are responsible for determining the near and far scrape off layer density profiles. In the core the intrinsic rotation and electron scale turbulence have been measured. The role that the fast ion gradient has on redistributing fast ions through fishbone modes has led to a redesign of the neutral beam injector on MAST Upgrade. In H-mode the turbulence at the pedestal top has been shown to be consistent with being due to electron temperature gradient modes. A reconnection process appears to occur during edge localized modes (ELMs) and the number of filaments released determines the power profile at the divertor. Resonant magnetic perturbations can mitigate ELMs provided the edge peeling response is maximised and the core kink response minimised. The mitigation of intrinsic error fields with toroidal mode number n > 1 has been shown to be important for plasma performance

Model for screening of resonant magnetic perturbations by plasma in a realistic tokamak geometry and its impact on divertor strike points

This work addresses the question of the relation between strike-point splitting and magnetic stochasticity at the edge of a poloidally diverted tokamak in the presence of externally imposed magnetic perturbations. More specifically, ad-hoc helical current sheets are introduced in order to mimic a hypothetical screening of the external resonant magnetic perturbations by the plasma. These current sheets, which suppress magnetic islands, are found to reduce the amount of splitting expected at the target, which suggests that screening effects should be observable experimentally. Multiple screening current sheets reinforce each other, i.e. less current relative to the case of only one current sheet is required to screen the perturbation.Comment: Accepted in the Proceedings of the 19th International Conference on Plasma Surface Interactions, to be published in Journal of Nuclear Materials. Version 2: minor formatting and text improvements, more results mentioned in the conclusion and abstrac

Characterization of the I-phase regime at TCV

The I-phase is an H-mode confinement regime of tokamaks characterized by limit cycle oscillations, the so-called LCOs or bursts. These bursts are the manifestation of a periodic flattening of the plasma edge pressure profile. The profile flattening is caused by increased radial transport, driven by a high-frequency plasma edge mode that periodically appears. This short-living mode is intrinsically connected to each burst. It vanishes once the profiles are fully flattened, and it reestablishes during profile recovery once critical gradients are reached and a new cycle begins. In this paper, we describe for the first time the unambiguous presence of the I-phase at the tokamak `a configuration variable (TCV). As the I-phase confinement regime is found in the parameter regime between the L-mode and the fully developed H-mode, it is often confused with dithers between H-mode and L-mode. Therefore, we are highlighting the differences between these two phenomena. Furthermore, we show the two-dimensional dynamics of the I-phase mode and bursts and the associated filamentary transport, enabled by the outstanding capabilities of the 2D TCV Gas Puff Imaging diagnostics