A Comparison of Rectal Diazepam Gel and Placebo for Acute Repetitive Seizures

ABSTRACT Background Acute repetitive seizures are readily recognizable episodes involving increased seizure frequency. Urgent treatment is often required. Rectal diazepam gel is a promising therapy. Methods We conducted a randomized, doubleblind, parallel-group, placebo-controlled study of home-based treatment for acute repetitive seizures. Patients were randomly assigned to receive either rectal diazepam gel, at doses ranging from 0.2 to 0.5 mg per kilogram of body weight on the basis of age, or placebo. Children received one dose at the onset of acute repetitive seizures and a second dose four hours later. Adults received three doses — one dose at onset, and two more doses 4 and 12 hours after onset. Treatment was administered by a care giver, such as a parent, who had received special training. The number of seizures after the first dose was counted for 12 hours in children and for 24 hours in adults. Results Of 125 study patients (64 assigned to diazepam and 61 to placebo) with a history of acute repetitive seizures, 91 (47 children and 44 adults) were treated for an exacerbation of seizures during the study period. Diazepam treatment was superior to placebo with regard to the outcome variables related to efficacy: reduced seizure frequency (P\u3c0.001) and improved global assessment of treatment outcome by the care giver (frequency and severity of seizures and drug toxicity) (P\u3c0.001). Post hoc analysis showed diazepam to be superior to placebo in reducing seizure frequency in both children (P\u3c0.001) and adults (P=0.02), but only in children was it superior with regard to improvement in global outcome (P\u3c0.001). The time to the first recurrence of seizures after initial treatment was longer for the patients receiving diazepam (P\u3c0.001). Thirty-five patients reported at least one adverse effect of treatment; somnolence was the most frequent. Respiratory depression was not reported. Conclusions Rectal diazepam gel, administered at home by trained care givers, is an effective and welltolerated treatment for acute repetitive seizures. (N Engl J Med 1998;338:1869-75.

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)

The Cholecystectomy As A Day Case (CAAD) Score: A Validated Score of Preoperative Predictors of Successful Day-Case Cholecystectomy Using the CholeS Data Set

Background Day-case surgery is associated with significant patient and cost benefits. However, only 43% of cholecystectomy patients are discharged home the same day. One hypothesis is day-case cholecystectomy rates, defined as patients discharged the same day as their operation, may be improved by better assessment of patients using standard preoperative variables. Methods Data were extracted from a prospectively collected data set of cholecystectomy patients from 166 UK and Irish hospitals (CholeS). Cholecystectomies performed as elective procedures were divided into main (75%) and validation (25%) data sets. Preoperative predictors were identified, and a risk score of failed day case was devised using multivariate logistic regression. Receiver operating curve analysis was used to validate the score in the validation data set. Results Of the 7426 elective cholecystectomies performed, 49% of these were discharged home the same day. Same-day discharge following cholecystectomy was less likely with older patients (OR 0.18, 95% CI 0.15–0.23), higher ASA scores (OR 0.19, 95% CI 0.15–0.23), complicated cholelithiasis (OR 0.38, 95% CI 0.31 to 0.48), male gender (OR 0.66, 95% CI 0.58–0.74), previous acute gallstone-related admissions (OR 0.54, 95% CI 0.48–0.60) and preoperative endoscopic intervention (OR 0.40, 95% CI 0.34–0.47). The CAAD score was developed using these variables. When applied to the validation subgroup, a CAAD score of ≤5 was associated with 80.8% successful day-case cholecystectomy compared with 19.2% associated with a CAAD score >5 (p < 0.001). Conclusions The CAAD score which utilises data readily available from clinic letters and electronic sources can predict same-day discharges following cholecystectomy

Sawtooth pacing with on-axis ICRH modulation in JET-ILW

A novel technique for sawteeth control in tokamak plasmas using ion-cyclotron resonance heating (ICRH) has been developed in the JET-ILW tokamak. Unlike previous ICRH methods, that explored the destabilization of the internal kink mode when the radio-frequency (RF) wave absorption was placed near the q = 1 surface, the technique presented here consists of stabilizing the sawteeth as fast as possible by applying the ICRH power centrally and subsequently induce a sawtooth crash by switching it off at the appropriate instant. The validation of this method in JET-ILW L-mode discharges, including preliminary tests in H-mode plasmas, is presented

Effect of PFC Recycling Conditions on JET Pedestal Density

There is experimental evidence that the pedestal dynamics in type-I ELMy H-mode discharges is significantly affected by a change in the recycling conditions at the tungsten plasma-facing components (W-PFCs) after an ELM event. The integrated code JINTRAC has been employed to assess the impact of recycling conditions during type-I ELMs in JET ITER-like wall H-mode discharges. By employing a heuristic approach, a model to mimic the physical processes leading to formation and release (i.e. outgassing) of finite near-surface fuel reservoirs in W-PFCs has been implemented into the EDGE2D-EIRENE plasma-wall interaction code being part of JINTRAC. As main result it is shown, that a delay in the density pedestal build-up after an ELM event can be provoked by reduced recycling induced by depleted W-PFC particle near-surface reservoirs. However the pedestal temperature evolution is barely affected by the change in recycling parameters suggesting that the presented model is incomplete

The emissivity of W coatings deposited on carbon materials for fusion applications

Tungsten coatings deposited on carbon materials such as carbon fiber composite (CFC) or fine grain graphite are currently used in fusion devices as amour for plasma facing components (PFC). More than 4000 carbon tiles were W-coated by Combined Magnetron Sputtering and Ion Implantation technology for the ITER-like Wall at JET, ASDEX Upgrade and WEST tokamaks. The emissivity of W coatings is a key parameter required by protection systems of the W-coated PFC and also by the diagnostic tools in order to get correct values of temperature and heat loading. The emissivity of tungsten is rather well known, but the literature data refer to bulk tungsten or tungsten foils and not to coatings deposited on carbon materials. The emissivity was measured at the wavelengths of 1.064 μm, 1.75 μm, 3.75 μm and 4.0 μm. It was found that the structure of the substrate has a significant influence on the emissivity values. The temperature dependence of the emissivity in the range of 400 °C–1200 °C and the influence of the viewing angle were investigated as well. The results are given in a table for W coatings and for other materials of interest for fusion such as bulk W and bulk Be

Sparse representation of signals: From astrophysics to real-time data analysis for fusion plasmas and system optimization analysis for ITER and TCV

Efficient, real-time and automated data analysis is one of the key elements for achieving scientific success in complex engineering and physical systems, two examples of which include the JET and ITER tokamaks. One problem which is common to these fields is the determination of the pulsation modes from an irregularly sampled time series. To this end, there are a wealth of signal processing techniques that are being applied to post-pulse and real-time data analysis in such complex systems. Here, we wish to present a review of the applications of a method based on the sparse representation of signals, using examples of the synergies that can be exploited when combining ideas and methods from very different fields, such as astronomy, astrophysics and thermonuclear fusion plasmas. Examples of this work in astronomy and astrophysics are the analysis of pulsation modes in various classes of stars and the orbit determination software of the Pioneer spacecraft. Two examples of this work in thermonuclear fusion plasmas include the detection of magneto-hydrodynamic instabilities, which is now performed routinely in JET in real-time on a sub-millisecond time scale, and the studies leading to the optimization of the magnetic diagnostic system in ITER and TCV. These questions have been solved by formulating them as inverse problems, despite the fact that these applicative frameworks are extremely different from the classical use of sparse representations, from both the theoretical and computational point of view. The requirements, prospects and ideas for the signal processing and real-time data analysis applications of this method to the routine operation of ITER will also be discussed. Finally, a very recent development has been the attempt to apply this method to the deconvolution of the measurement of electric potential performed during a ground-based survey of a proto-Villanovian necropolis in central Italy