52 research outputs found
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An Update on the Status of the NIF Power Conditioning System
The National Ignition Facility (NIF) Power Conditioning System provides the pulsed excitation required to drive flashlamps in the laser's optical amplifiers. Modular in design, each of the 192 Main Energy Storage Modules (MESMs) stores up to 2.2 MJ of electrical energy in its capacitor bank before delivering the energy to 20 pairs of flashlamps in a 400 {micro}s pulse (10% power points). The peak current of each MESM discharge is 0.5 MA. Production, installation, commissioning and operation of the NIF Power Conditioning continue to progress rapidly, with the goals of completing accelerated production and commissioning by early 2008, while maintaining an aggressive operation schedule. To date, more than 97% of the required modules have been assembled, shipped and installed in the facility, representing more that 380 MJ of stored energy available for driving NIF flashlamps. The MESMs have displayed outstanding reliability during daily, multiple-shift operations
Documenting the Recovery of Vascular Services in European Centres Following the Initial COVID-19 Pandemic Peak: Results from a Multicentre Collaborative Study
Objective: To document the recovery of vascular services in Europe following the first COVID-19 pandemic peak. Methods: An online structured vascular service survey with repeated data entry between 23 March and 9 August 2020 was carried out. Unit level data were collected using repeated questionnaires addressing modifications to vascular services during the first peak (March – May 2020, “period 1”), and then again between May and June (“period 2”) and June and July 2020 (“period 3”). The duration of each period was similar. From 2 June, as reductions in cases began to be reported, centres were first asked if they were in a region still affected by rising cases, or if they had passed the peak of the first wave. These centres were asked additional questions about adaptations made to their standard pathways to permit elective surgery to resume. Results: The impact of the pandemic continued to be felt well after countries’ first peak was thought to have passed in 2020. Aneurysm screening had not returned to normal in 21.7% of centres. Carotid surgery was still offered on a case by case basis in 33.8% of centres, and only 52.9% of centres had returned to their normal aneurysm threshold for surgery. Half of centres (49.4%) believed their management of lower limb ischaemia continued to be negatively affected by the pandemic. Reduced operating theatre capacity continued in 45.5% of centres. Twenty per cent of responding centres documented a backlog of at least 20 aortic repairs. At least one negative swab and 14 days of isolation were the most common strategies used for permitting safe elective surgery to recommence. Conclusion: Centres reported a broad return of services approaching pre-pandemic “normal” by July 2020. Many introduced protocols to manage peri-operative COVID-19 risk. Backlogs in cases were reported for all major vascular surgeries
Secondary Endoleak Management Following TEVAR and EVAR.
Endovascular abdominal and thoracic aortic aneurysm repair and are widely used to treat increasingly complex aneurysms. Secondary endoleaks, defined as those detected more than 30 days after the procedure and after previous negative imaging, remain a challenge for aortic specialists, conferring a need for long-term surveillance and reintervention. Endoleaks are classified on the basis of their anatomic site and aetiology. Type 1 and type 2 endoleaks (EL1 and EL2) are the most common endoleaks necessitating intervention. The management of these requires an understanding of their mechanics, and the risk of sac enlargement and rupture due to increased sac pressure. Endovascular techniques are the main treatment approach to manage secondary endoleaks. However, surgery should be considered where endovascular treatments fail to arrest aneurysm growth. This chapter reviews the aetiology, significance, management strategy and techniques for different endoleak types
How should I treat renal artery in-stent restenosis and stent fracture after endovascular abdominal aortic aneurysm repair?
Global impact of the first coronavirus disease 2019 (COVID-19) pandemic wave on vascular services
This online structured survey has demonstrated the global impact of the COVID-19 pandemic on vascular services. The majority of centres have documented marked reductions in operating and services provided to vascular patients. In the months during recovery from the resource restrictions imposed during the pandemic peaks, there will be a significant vascular disease burden awaiting surgeons. One of the most affected specialtie
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