Clinical features and outcomes of elderly hospitalised patients with chronic obstructive pulmonary disease, heart failure or both

Background and objective: Chronic obstructive pulmonary disease (COPD) and heart failure (HF) mutually increase the risk of being present in the same patient, especially if older. Whether or not this coexistence may be associated with a worse prognosis is debated. Therefore, employing data derived from the REPOSI register, we evaluated the clinical features and outcomes in a population of elderly patients admitted to internal medicine wards and having COPD, HF or COPD + HF. Methods: We measured socio-demographic and anthropometric characteristics, severity and prevalence of comorbidities, clinical and laboratory features during hospitalization, mood disorders, functional independence, drug prescriptions and discharge destination. The primary study outcome was the risk of death. Results: We considered 2,343 elderly hospitalized patients (median age 81 years), of whom 1,154 (49%) had COPD, 813 (35%) HF, and 376 (16%) COPD + HF. Patients with COPD + HF had different characteristics than those with COPD or HF, such as a higher prevalence of previous hospitalizations, comorbidities (especially chronic kidney disease), higher respiratory rate at admission and number of prescribed drugs. Patients with COPD + HF (hazard ratio HR 1.74, 95% confidence intervals CI 1.16-2.61) and patients with dementia (HR 1.75, 95% CI 1.06-2.90) had a higher risk of death at one year. The Kaplan-Meier curves showed a higher mortality risk in the group of patients with COPD + HF for all causes (p = 0.010), respiratory causes (p = 0.006), cardiovascular causes (p = 0.046) and respiratory plus cardiovascular causes (p = 0.009). Conclusion: In this real-life cohort of hospitalized elderly patients, the coexistence of COPD and HF significantly worsened prognosis at one year. This finding may help to better define the care needs of this population

Development and application of multiscale procedures for the thermomechanical analysis of the DEMO Water-Cooled Lithium Lead Breeding Blanket

The Breeding Blanket is an essential component of the DEMO fusion reactor and its design is one of the pivotal purposes of the DEMO project. Indeed, this component has to withstand severe operating conditions, as it is directly exposed to the plasma, making its design particularly challenging. In particular, the Water-Cooled Lithium-Lead (WCLL) BB concept is one of the candidates currently considered for the conceptual design of the European DEMO reactor. The development of a robust BB system is crucial for the design of the whole DEMO reactor and the thermo-mechanical assessment of the whole BB segments is mandatory to allow checking their structural performances in different loading scenarios. In this dissertation, a multi-scale procedure, allowing to investigate in detail the thermo-mechanical performances of an entire blanket segment, is proposed. In particular, the Central Outboard Blanket (COB) segment has been considered and the results are herewith presented. The structural performances have been investigated in view of the RCC-MRx design criteria

The DEMO Water-Cooled Lead–Lithium Breeding Blanket: Design Status at the End of the Pre-Conceptual Design Phase

The Water-Cooled Lead–Lithium Breeding Blanket (WCLL BB) is one of the two blanket concept candidates to become the driver blanket of the EU-DEMO reactor. The design was enacted with a holistic approach. The influence that neutronics, thermal-hydraulics (TH), thermo-mechanics (TM) and magneto-hydro-dynamics (MHD) may have on the design were considered at the same time. This new approach allowed for the design team to create a WCLL BB layout that is able to comply with different foreseen requirements in terms of integration, tritium self-sufficiency, and TH and TM needs. In this paper, the rationale behind the design choices and the main characteristics of the WCLL BB needed for the EU-DEMO are reported and discussed. Finally, the main achievements reached during the pre-conceptual design phase and some remaining open issues to be further investigated in the upcoming conceptual design phase are reported as well

The Design of Water Loop Facility for Supporting the WCLL Breeding Blanket Technology and Safety

The WCLL Breeding Blanket of DEMO and the Test Blanket Module (TBM) of ITER require accurate R&D activities, i.e., concept validation at a relevant scale and safety demonstrations. In view of this, the strategic objective of the Water Loop (WL) facility, belonging to the W-HYDRA experimental platform planned at C.R. Brasimone of ENEA, is twofold: to conduct R&D activities for the WCLL BB to validate design performances and to increase the technical maturity level for selection and validation phases, as well as to support the ITER WCLL Test Blanket System program. Basically, the Water Loop facility will have the capability to investigate the design features and performances of scaled-down or portions of breeding blanket components, as well as full-scale TBM mock-ups. It is a large-/medium-scale water coolant plant that will provide water coolant at high pressure and temperature. It is composed by single-phase primary (designed at 18.5 MPa and 350 °C) and secondary (designed at 2.5 MPa and 220 °C) systems thermally connected with a two-phase tertiary loop acting as an ultimate heat sink (designed at 6 bar and 80 °C). The primary loop has two main sources of power: an electrical heater up to about 1 MWe, installed in the cold side, downstream of the pump and upstream of the test section, and an electron beam gun acting as a heat flux generator. The WL has unique features and is designed as a multi-purpose facility capable of being coupled with the LIFUS5/Mod4 facility to study PbLi/water reaction at a large scale. This paper presents the status of the Water Loop facility, highlighting objectives, design features, and the analyses performed

Design and Integration of the EU-DEMO Water-Cooled Lead Lithium Breeding Blanket

The water-cooled lead lithium breeding blanket (WCLL BB) is one of two BB candidate concepts to be chosen as the driver blanket of the EU-DEMO fusion reactor. Research activities carried out in the past decade, under the umbrella of the EUROfusion consortium, have allowed a quite advanced reactor architecture to be achieved. Moreover, significant efforts have been made in order to develop the WCLL BB pre-conceptual design following a holistic approach, identifying interfaces between components and systems while respecting a system engineering approach. This paper reports a description of the current WCLL BB architecture, focusing on the latest modifications in the BB reference layout aimed at evolving the design from its pre-conceptual version into a robust conceptual layout. In particular, the main rationale behind design choices and the BB’s overall performances are highlighted. The present paper also gives an overview of the integration between the BB and the different in-vessel systems interacting with it. In particular, interfaces with the tritium extraction and removal (TER) system and the primary heat transfer system (PHTS) are described. Attention is also paid to auxiliary systems devoted to heat the plasma, such as electron cyclotron heating (ECH). Indeed, the integration of this system in the BB will strongly impact the segment design since it envisages the introduction of significant cut-outs in the BB layout. A preliminary CAD model of the central outboard blanket (COB) segment housing the ECH cut-out has been set up and is reported in this paper. The chosen modeling strategy, adopted loads and boundary conditions, as well as obtained results, are reported in the paper and critically discussed

Conceptual design of the main Ancillary Systems of the ITER Water Cooled Lithium Lead Test Blanket System

The Water Cooled Lithium Lead Test Blanket System (WCLL TBS) is one of the EU Test Blanket Systems candidate for being installed and operated in ITER. In view of its Conceptual Design Review by F4E and ITER Organization (IO), planned for mid-September 2020, several technical activities have been performed in the areas of WCLL TBS Ancillary Systems design. In this article the outcomes of the conceptual design phase of the four main Ancillary Systems of WCLL TBS, namely the Water Cooling System (WCS), the Coolant Purification System (CPS), the PbLi loop and the Tritium Extraction System (TES), are reported and critically discussed. In particular, for each Ancillary System hereafter are reported: i) a short design description, including the conceptual design of their main components together with their operative conditions under the so-called Normal Operational State (NOS), ii) the ESP-ESPN classification for their main components, and iii) their arrangement and integration in the assigned ITER areas (PC#16, Vertical Shaft, TCWS Vault, Galleries and Tritium Process Room)