Practical Approaches to Treating Patients with Bipolar Disorder

Many patients present to a primary care setting with symptoms of a mood disorder. These symptoms may be indicative of an anxiety disorder or a depressive disorder, but they may also represent bipolar disorder, which is more common than many practitioners think. Correctly diagnosing bipolar disorder can be complex, because patients tend to seek treatment when they are experiencing the symptoms of depression or anxiety rather than mania or hypomania. Comorbid disorders such as substance abuse and anxiety disorders may complicate the clinical presentation. Failing to correctly diagnose bipolar disorder can have serious consequences in terms of patients\u27 morbidity and mortality, quality of life, and financial costs

Tropospheric Ozone Assessment Report: Tropospheric ozone from 1877 to 2016, observed levels, trends and uncertainties

From the earliest observations of ozone in the lower atmosphere in the 19th century, both measurement methods and the portion of the globe observed have evolved and changed. These methods have different uncertainties and biases, and the data records differ with respect to coverage (space and time), information content, and representativeness. In this study, various ozone measurement methods and ozone datasets are reviewed and selected for inclusion in the historical record of background ozone levels, based on relationship of the measurement technique to the modern UV absorption standard, absence of interfering pollutants, representativeness of the well-mixed boundary layer and expert judgement of their credibility. There are significant uncertainties with the 19th and early 20th-century measurements related to interference of other gases. Spectroscopic methods applied before 1960 have likely underestimated ozone by as much as 11% at the surface and by about 24% in the free troposphere, due to the use of differing ozone absorption coefficients. There is no unambiguous evidence in the measurement record back to 1896 that typical mid-latitude background surface ozone values were below about 20 nmol mol–1, but there is robust evidence for increases in the temperate and polar regions of the northern hemisphere of 30–70%, with large uncertainty, between the period of historic observations, 1896–1975, and the modern period (1990–2014). Independent historical observations from balloons and aircraft indicate similar changes in the free troposphere. Changes in the southern hemisphere are much less. Regional representativeness of the available observations remains a potential source of large errors, which are difficult to quantify

The speed of increasing milk feeds: a randomised controlled trial

BACKGROUND In the UK, 1-2% of infants are born very preterm (<32 weeks of gestation) or have very low birth weight (<1500 g). Very preterm infants are initially unable to be fed nutritional volumes of milk and therefore require intravenous nutrition. Milk feeding strategies influence several long and short term health outcomes including growth, survival, infection (associated with intravenous nutrition) and necrotising enterocolitis (NEC); with both infection and NEC being key predictive factors of long term disability. Currently there is no consistent strategy for feeding preterm infants across the UK. The SIFT trial will test two speeds of increasing milk feeds with the primary aim of determining effects on survival without moderate or severe neurodevelopmental disability at 24 months of age, corrected for prematurity. The trial will also examine many secondary outcomes including infection, NEC, time taken to reach full feeds and growth. METHODS/DESIGN Two thousand eight hundred very preterm or very low birth weight infants will be recruited from approximately 30 hospitals across the UK to a randomised controlled trial. Infants with severe congenital anomaly or no realistic chance of survival will be excluded. Infants will be randomly allocated to either a faster (30 ml/kg/day) or slower (18 ml/kg/day) rate of increase in milk feeds. Data will be collected during the neonatal hospital stay on weight, infection rates, episodes of NEC, length of stay and time to reach full milk feeds. Long term health outcomes comprising vision, hearing, motor and cognitive impairment will be assessed at 24 months of age (corrected for prematurity) using a parent report questionnaire. DISCUSSION Extensive searches have found no active or proposed studies investigating the rate of increasing milk feeds. The results of this trial will have importance for optimising incremental milk feeding for very preterm and/or very low birth weight infants. No additional resources will be required to implement an optimal feeding strategy, and therefore if successful, the trial results could rapidly be adopted across the NHS at low cost. TRIAL REGISTRATION ISRCTN Registry; ISRCTN76463425 on 5 March, 2013

Modelling of the effect of ELMs on fuel retention at the bulk W divertor of JET

Effect of ELMs on fuel retention at the bulk W target of JET ITER-Like Wall was studied with multi-scale calculations. Plasma input parameters were taken from ELMy H-mode plasma experiment. The energetic intra-ELM fuel particles get implanted and create near-surface defects up to depths of few tens of nm, which act as the main fuel trapping sites during ELMs. Clustering of implantation-induced vacancies were found to take place. The incoming flux of inter-ELM plasma particles increases the different filling levels of trapped fuel in defects. The temperature increase of the W target during the pulse increases the fuel detrapping rate. The inter-ELM fuel particle flux refills the partially emptied trapping sites and fills new sites. This leads to a competing effect on the retention and release rates of the implanted particles. At high temperatures the main retention appeared in larger vacancy clusters due to increased clustering rate

Impact of ICRF on the scrape-off layer and on plasma wall interactions: From present experiments to fusion reactor

Recent achievements in studies of the effects of ICRF (Ion Cyclotron Range of Frequencies) power on the SOL (Scrape-Off Layer) and PWI (Plasma Wall Interactions) in ASDEX Upgrade (AUG), Alcator C-Mod, and JET-ILW are reviewed. Capabilities to diagnose and model the effect of DC biasing and associated impurity production at active antennas and on magnetic field connections to antennas are described. The experiments show that ICRF near-fields can lead not only to E×B convection, but also to modifications of the SOL density, which for Alcator C-Mod are limited to a narrow region near antenna. On the other hand, the SOL density distribution along with impurity sources can be tailored using local gas injection in AUG and JET-ILW with a positive effect on reduction of impurity sources. The technique of RF image current cancellation at antenna limiters was successfully applied in AUG using the 3-strap AUG antenna and extended to the 4-strap Alcator C-Mod field-aligned antenna. Multiple observations confirmed the reduction of the impact of ICRF on the SOL and on total impurity production when the ratio of the power of the central straps to the total antenna power is in the range 0.6<P$_{cen}$/P$_{total}$<0.8. Near-field calculations indicate that this fairly robust technique can be applied to the ITER ICRF antenna, enabling the mode of operation with reduced PWI. On the contrary, for the A2 antenna in JET-ILW the technique is hindered by RF sheaths excited at the antenna septum. Thus, in order to reduce the effect of ICRF power on PWI in a future fusion reactor, the antenna design has to be optimized along with design of plasmafacing components

First mirror test in JET for ITER: Complete overview after three ILW campaigns

The First Mirror Test for ITER has been carried out in JET with mirrors exposed during: (i) the third ILW campaign (ILW-3, 2015–2016, 23.33 h plasma) and (ii) all three campaigns, i.e. ILW-1 to ILW-3: 2011–2016, 63,52 h in total. All mirrors from main chamber wall show no significant changes of the total reflectivity from the initial value and the diffuse reflectivity does not exceed 3% in the spectral range above 500 nm. The modified layer on surface has very small amount of impurities such as D, Be, C, N, O and Ni. All mirrors from the divertor (inner, outer, base under the bulk W tile) lost reflectivity by 20–80% due to the beryllium-rich deposition also containing D, C, N, O, Ni and W. In the inner divertor N reaches 5×10$^{17}$ cm$^{-2}$, W is up to 4.3×10$^{17}$ cm$^{-2}$, while the content of Ni is the greatest in the outer divertor: 3.8×10$^{17}$ cm$^{-2}$. Oxygen-18 used as the tracer in experiments at the end of ILW-3 has been detected at the level of 1.1×10$^{16}$ cm$^{-2}$. The thickness of deposited layer is in the range of 90 nm to 900 nm. The layer growth rate in the base (2.7 pm s$^{-1}$) and inner divertor is proportional to the exposure time when a single campaign and all three are compared. In a few cases, on mirrors located at the cassette mouth, flaking of deposits and erosion occurred

First mirror test in JET for ITER : complete overview after three ILW campaigns

The First Mirror Test for ITER has been carried out in JET with mirrors exposed during: (i) the third ILW campaign (ILW-3, 2015-2016, 23.33 h plasma) and (ii) all three campaigns, i.e. ILW-1 to ILW-3: 2011-2016, 63,52 h in total. All mirrors from main chamber wall show no significant changes of the total reflectivity from the initial value and the diffuse reflectivity does not exceed 3% in the spectral range above 500 nm. The modified layer on surface has very small amount of impurities such as D, Be, C, N, O and Ni. All mirrors from the divertor (inner, outer, base under the bulk W tile) lost reflectivity by 20-80% due to the beryllium-rich deposition also containing D, C, N, O, Ni and W. In the inner divertor N reaches 5 x 10(17) cm(-2), W is up to 4.3 x 10(17) cm(-2), while the content of Ni is the greatest in the outer divertor: 3.8 x 10(17) cm(-2). Oxygen-18 used as the tracer in experiments at the end of ILW-3 has been detected at the level of 1.1 x 10(16) cm(-2). The thickness of deposited layer is in the range of 90 nm to 900 nm. The layer growth rate in the base (2.7 pm s(-1)) and inner divertor is proportional to the exposure time when a single campaign and all three are compared. In a few cases, on mirrors located at the cassette mouth, flaking of deposits and erosion occurred

The effect of beryllium oxide on retention in JET ITER-like wall tiles

Preliminary results investigating the microstructure, bonding and effect of beryllium oxide formation on retention in the JET ITER-like wall beryllium tiles, are presented. The tiles have been investigated by several techniques: Scanning Electron Microscopy (SEM) equipped with Energy Dispersive X-ray (EDX), Transmission Electron microscopy (TEM) equipped with EDX and Electron Energy Loss Spectroscopy (EELS), Raman Spectroscopy and Thermal Desorption Spectroscopy (TDS). This paper focuses on results from melted materials of the dump plate tiles in JET. From our results and the literature, it is concluded, beryllium can form micron deep oxide islands contrary to the nanometric oxides predicted under vacuum conditions. The deepest oxides analyzed were up to 2-micron thicknesses. The beryllium Deuteroxide (BeOxDy) bond was found with Raman Spectroscopy. Application of EELS confirmed the oxide presence and stoichiometry. Literature suggests these oxides form at temperatures greater than 700 °C where self-diffusion of beryllium ions through the surface oxide layer can occur. Further oxidation is made possible between oxygen plasma impurities and the beryllium ions now present at the wall surface. Under Ultra High Vacuum (UHV) nanometric Beryllium oxide layers are formed and passivate at room temperature. After continual cyclic heating (to the point of melt formation) in the presence of oxygen impurities from the plasma, oxide growth to the levels seen experimentally (approximately two microns) is proposed. This retention mechanism is not considered to contribute dramatically to overall retention in JET, due to low levels of melt formation. However, this mechanism, thought the result of operation environment and melt formation, could be of wider concern to ITER, dependent on wall temperatures

Modelling of tungsten erosion and deposition in the divertor of JET-ILW in comparison to experimental findings

The erosion, transport and deposition of tungsten in the outer divertor of JET-ILW has been studied for an HMode discharge with low frequency ELMs. For this specific case with an inter-ELM electron temperature at the strike point of about 20 eV, tungsten sputtering between ELMs is almost exclusively due to beryllium impurity and self-sputtering. However, during ELMs tungsten sputtering due to deuterium becomes important and even dominates. The amount of simulated local deposition of tungsten relative to the amount of sputtered tungsten in between ELMs is very high and reaches values of 99% for an electron density of 5E13 cm$^{-3}$ at the strike point and electron temperatures between 10 and 30 eV. Smaller deposition values are simulated with reduced electron density. The direction of the B-field significantly influences the local deposition and leads to a reduction if the E×B drift directs towards the scrape-off-layer. Also, the thermal force can reduce the tungsten deposition, however, an ion temperature gradient of about 0.1 eV/mm or larger is needed for a significant effect. The tungsten deposition simulated during ELMs reaches values of about 98% assuming ELM parameters according to free-streaming model. The measured WI emission profiles in between and within ELMs have been reproduced by the simulation. The contribution to the overall net tungsten erosion during ELMs is about 5 times larger than the one in between ELMs for the studied case. However, this is due to the rather low electron temperature in between ELMs, which leads to deuterium impact energies below the sputtering threshold for tungsten

Impact of fast ions on density peaking in JET : fluid and gyrokinetic modeling

The effect of fast ions on turbulent particle transport, driven by ion temperature gradient (ITG)/trapped electron mode turbulence, is studied. Two neutral beam injection (NBI) heated JET discharges in different regimes are analyzed at the radial position rho(t) = 0.6, one of them an L-mode and the other one an H-mode discharge. Results obtained from the computationally efficient fluid model EDWM and the gyro-fluid model TGLF are compared to linear and nonlinear gyrokinetic GENE simulations as well as the experimentally obtained density peaking. In these models, the fast ions are treated as a dynamic species with a Maxwellian background distribution. The dependence of the zero particle flux density gradient (peaking factor) on fast ion density, temperature and corresponding gradients, is investigated. The simulations show that the inclusion of a fast ion species has a stabilizing influence on the ITG mode and reduces the peaking of the main ion and electron density profiles in the absence of sources. The models mostly reproduce the experimentally obtained density peaking for the L-mode discharge whereas the H-mode density peaking is significantly underpredicted, indicating the importance of the NBI particle source for the H-mode density profile