Diabetes mellitus with Addison's disease

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Observations on a family with chronic hyperbilirubinaemia

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Empowering citizen-led adaptation to systemic climate change risks

The increasing impacts of climate change instigate the need for adaptation. However, most adaptation initiatives focus on actions by government or businesses, despite growing calls for communities on the frontline of climate risks to be involved in planning and selecting strategies. Here, we appraise a pilot process using participatory systems mapping with citizens to identify 1) diverse threat vectors for local climate impacts and 2) context-relevant interventions to protect households and communities while 3) considering synergies and tradeoffs with other socially desirable outcomes. We tested the pilot process in communities in the lower Volta Basin in Ghana, the Assam region in India, and Southern England. From participants' perspectives, the process increased awareness of- and preparedness for climate change impacts and raised essential learning points for upscaling citizen-led adaptation approaches. These include understanding multiple outcomes of interventions, barriers, and enablers to implementation, and sensitivity of co-design to regional geography and socio-cultural context

Cohort profile: cholangiocarcinoma screening and care program (CASCAP)

Background: Cholangiocarcinoma (CCA) is an extremely aggressive cancer that is usually fatal. Although globally morbidity and mortality are increasing, knowledge of the disease remains limited. The Mekong region of Southeast Asia, and particularly the northeast of Thailand, has by far the highest incidence of CCA worldwide with 135.4 per 100,000 among males and 43.0 per 100,000 among females being reported in Khon Kaen Province. Most patients are first seen during late stage disease with 5-year survival being less than 10 %. Starting in 1984, control and prevention strategies have been focused on health education. Although early detection can substantially increase 5-year survival, there are currently no strategies to increase early diagnosis. Methods/design: The Cholangiocarcinoma Screening and Care Program (CASCAP) is a prospective cohort study comprising two cohorts- the screening and the patient cohorts. For the screening cohort, ultrasound examination will be carried out regularly at least annually to determine whether there is current bile duct and/or liver pathology so that the optimal screening program for early diagnosis can be established. This cohort is expected to include at least 150,000 individuals coming from high-risk areas for CCA. For the patient cohort, it is estimated that about 25,000 CCA patients will be included during the 5-year recruitment period. All CCA patients will be treated according to routine clinical care and followed so that effective surgical treatment can be formulated. This cohort is indeed a conventional cancer registry. Thus, CASCAP is an ongoing project in which the number of participants changes dynamically. Discussions: This is the first project on CCA that involves screening the at risk population at the community level. At the time of preparing this report, a total of 85,927 individuals have been enrolled in the screening cohort, 55.0 % of whom have already undergone ultrasound screening, and 2661 CCA cases have been enrolled in the patient cohort. Among the participants of the screening, whose mean age was 53.8 ± 9.8 years, 55.6 % were female, 77.5 % attained primary school as the highest level of education, 79.9 % were farmers, 29.9 %, reported having relatives with CCA, 89.1 % had eaten uncooked fish, and 42.2 % of those who had been tested for liver fluke were found to be infected

Current ramps in tokamaks: from present experiments to ITER scenarios

In order to prepare adequate current ramp-up and ramp-down scenarios for ITER, present experiments from various tokamaks have been analysed by means of integrated modelling in view of determining relevant heat transport models for these operation phases. A set of empirical heat transport models for L-mode (namely, the Bohm-gyroBohm model and scaling based models with a specific fixed radial shape and energy confinement time factors of H(96-L) = 0.6 or H(IPB98) = 0.4) has been validated on a multi-machine experimental dataset for predicting the l(i) dynamics within +/- 0.15 accuracy during current ramp-up and ramp-down phases. Simulations using the Coppi-Tang or GLF23 models (applied up to the LCFS) overestimate or underestimate the internal inductance beyond this accuracy (more than +/- 0.2 discrepancy in some cases). The most accurate heat transport models are then applied to projections to ITER current ramp-up, focusing on the baseline inductive scenario (main heating plateau current of I(p) = 15 MA). These projections include a sensitivity study to various assumptions of the simulation. While the heat transport model is at the heart of such simulations (because of the intrinsic dependence of the plasma resistivity on electron temperature, among other parameters), more comprehensive simulations are required to test all operational aspects of the current ramp-up and ramp-down phases of ITER scenarios. Recent examples of such simulations, involving coupled core transport codes, free-boundary equilibrium solvers and a poloidal field (PF) systems controller are also described, focusing on ITER current ramp-down.</p