Nurses' perceptions of aids and obstacles to the provision of optimal end of life care in ICU

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Real-time protection of the JET ITER-like wall based on near infrared imaging diagnostic systems

In JET with ITER-like wall (JET-ILW), the first wall was changed to metallic materials (tungsten and beryllium) [1] which require a reliable protection system to avoid damage of the plasma-facing components (PFCs) due to beryllium melting or cracking of tungsten owing to thermal fatigue. To address this issue, a protection system with real time control, based on imaging diagnostics, has been implemented on JET-ILW in 2011. This paper describes the design, implementation, and operation of the near infrared imaging diagnostic system of the JET-ILW plasma experiment and its integration into the existing JET-ILW protection architecture. The imaging system comprises eleven analogue CCD cameras which demonstrate a high robustness against changes of system parameters like the emissivity. The system covers about two thirds of the main chamber wall and almost half of the divertor. A real-time imaging processing unit is used to convert the raw data into surface temperatures taking into account the different emissivity for the various materials and correcting for artefacts resulting e.g. from neutron impact. Regions of interest (ROI) on the selected PFCs are analysed in real time and the maximum temperature measured for each ROI is sent to other real time systems to trigger an appropriate response of the plasma control system, depending on the location of a hot spot. A hot spot validation algorithm was successfully integrated into the real-time system and is now used to avoid false alarms caused by neutrons and dust. The design choices made for the video imaging system, the implications for the hardware components and the calibration procedure are discussed. It will be demonstrated that the video imaging protection system can work properly under harsh electromagnetic conditions as well as under neutron and gamma radiation. Examples will be shown of instances of hot spot detection that abort the plasma discharge. The limits of the protection system and the associated constraints on plasma operation are also presented. The real-time protection system has been operating routinely since 2011. During this period, less than 0.5% of the terminated discharges were aborted by a malfunction of the system. About 2%-3% of the discharges were terminated due to the detection of actual hot spots

Chronic coronary syndromes without standard modifiable cardiovascular risk factors and outcomes: the CLARIFY registry

Background and Aims: It has been reported that patients without standard modifiable cardiovascular (CV) risk factors (SMuRFs—diabetes, dyslipidaemia, hypertension, and smoking) presenting with first myocardial infarction (MI), especially women, have a higher in-hospital mortality than patients with risk factors, and possibly a lower long-term risk provided they survive the post-infarct period. This study aims to explore the long-term outcomes of SMuRF-less patients with stable coronary artery disease (CAD). Methods: CLARIFY is an observational cohort of 32 703 outpatients with stable CAD enrolled between 2009 and 2010 in 45 countries. The baseline characteristics and clinical outcomes of patients with and without SMuRFs were compared. The primary outcome was a composite of 5-year CV death or non-fatal MI. Secondary outcomes were 5-year all-cause mortality and major adverse cardiovascular events (MACE—CV death, non-fatal MI, or non-fatal stroke). Results: Among 22 132 patients with complete risk factor and outcome information, 977 (4.4%) were SMuRF-less. Age, sex, and time since CAD diagnosis were similar across groups. SMuRF-less patients had a lower 5-year rate of CV death or non-fatal MI (5.43% [95% CI 4.08–7.19] vs. 7.68% [95% CI 7.30–8.08], P = 0.012), all-cause mortality, and MACE. Similar results were found after adjustments. Clinical event rates increased steadily with the number of SMuRFs. The benefit of SMuRF-less status was particularly pronounced in women. Conclusions: SMuRF-less patients with stable CAD have a substantial but significantly lower 5-year rate of CV death or non-fatal MI than patients with risk factors. The risk of CV outcomes increases steadily with the number of risk factors