Paradigmenwechsel in der postmenopausalen Hormonersatztherapie: Untersuchung zum Einfluss unterschiedlicher Evidenzquellen

Durch systematische Literatursuche und Qualitätsbeurteilung entstand für die postmenopausale Hormonersatzbehandlung (HRT) eine zuverlässige und aktuelle (2005) Evidenzhierarchie. Konjugierte equine Östrogene und Östradiol, auch mit Medroxyprogesteronacetat, sind am besten untersucht. Es gibt keine Evidenz, dass andere Medikamente oder Dosierungen oder Applikationswege eine andere Wirkung haben. HRT erreicht keine Wirkung in der Primär- und Sekundärprävention von kardiovaskulären Erkrankungen, die klinisch relevant ist oder in Zukunft wird (Evidenzklasse I). Gegen Placebo ist eine signifikante Zunahme von Schlaganfällen belegt, auch für die Östrogenmonotherapie. HRT erhöht das Thromboserisiko und das der Re-Thrombose. HRT wirkt nicht bei etablierten Depressionen, auch nicht bei postpartalen. Die Gedächtnisleistung ist durch "Hormone" nicht positiv zu beeinflussen, für Teilaspekte der Kognition sind sie nachteilig. Östrogene oder HRT wirken nicht bei Morbus Alzheimer. Vasomotorische und urogenitale Symptome werden durch jegliche HRT erheblich gebessert (Goldstandard). HRT ist wirksam in der Primär- und Sekundärprävention von vertebralen und nicht vertebralen Frakturen. Der klinische Effekt ist begrenzt. Es ist nicht zuverlässig zu klären, ob HRT die Inzidenz des Uterus- oder Ovarialkarzinoms beeinflusst. Ein großer klinischer Effekt ist nicht gegeben. Die Risikoreduktion für ein Kolonkarzinom ist gering und für die Klinik nicht bedeutend. HRT erhöht die Häufigkeit von Brustkrebs (Evidenzklasse I). Equine Östrogene als Monotherapie erhöhen bis zu 7 Jahren das Risiko für ein Mammakarzinom nicht (Evidenzklasse I b). Wer HRT einnimmt, erhöht gegen Placebo sein Risiko für Abrasio, Wiederholungsmammografie und Gallenblasenoperation. Aber der Rückgang der Verordnungen könnte auch Gesundheitsfolgen haben, eine Beeinträchtigung der Lebensqualität durch unbehandelte Menopausensymptome oder eine Zunahme vertebraler Frakturen

A computational model for the confinement and performance of circular and d-shaped Tokamak plasmas

A combined onedimensional and twodimensional ("1$\frac{1}{2}$ d") description of toroidaland axisymmetric plasmas is presented which is based essentially on an equilibriumsolver resorting to the fast Buneman invertor ("equilibrium module") andtwo onedimensional transport codes describing the protium, deuterium, tritiurn,and plasma energy inventory ("plasma module") and accounting for three impurityspeeies ("impurity module") ; it is employed to compute the timeevolutian ofTokamak plasmas . The attempt was mute to achieve a consistent modelling of thetransport and equilibrium phenomena in a plasma which interacts with the peripheraldevices for e .g . confinement, plasma heating and limitation of theplasma aperture . The equilibrium solver is connected to a coil submodule computingthe poloidal field coil currents maintaining the designed plasma shapeapproximately . A surface current density standing for the magnetization of theiron core and the yokes is calculated by means of the module for the transformeriron . This module is linked to the equilibrium solver as well so that consistencybetween the coil currents, the plasma current distribution and themagnetization of the transformer iron is achieved.The "scrape off module" resorts to a radial model for the limiters . The modulesfor additional heating account for a full beam geometry and within asimple approach for the RF-heating . The neutral atomic and molecular hydrogenspeeies are described by a multidimensional Monte Carlo code or, alternatively,by the fast 1d-code SPUDNUT ("neutral gas module") . The SIND behaviour isestimated by evaluating the time evolution of the Mercier- and the resistiveinterchange criteria ( " stability module " ) . The calculations are based on TUTOR-,JET- and INITOR-data . Concentrating mainly on the equilibrium-, the coilandthe transformer module, it is shown that e .g . in case of .a speeific shotthe measured time evolution of the currents in the pol oidal field coils ofTUTOR can be reproduced within an accuracy of 8% . The main results concerningJET and INTOR are : The performance of the JET-plasma is strongly influenced bythe impurities essentially due to sputtering at the noncarbonized liner material(iron) . They radiate 50% of the input Power . These losses and the conductionlosses limit the maximum plasma temperature at around 10 keV

Impact of vibrationally resolved H2 on particle balance in Eirene simulations

| openaire: EC/H2020/633053/EU//EUROfusion Funding Information: The authors would like to thank Professor U. Fantz and Professor D. Reiter for valuable discussions enabling this work. This work has been carried out within the framework of the EUROfusion Consortium and has received funding from the Euratom research and training programme 2014–2018 and 2019–2020 under grant agreement number 633053. The views and opinions expressed herein do not necessarily reflect those of the European Commission. This work was supported by the Academy of Finland under grant no. 13330050. Publisher Copyright: © 2022 The Authors. Contributions to Plasma Physics published by Wiley-VCH GmbH.To evaluate the impact of transport of metastable, vibrationally excited states of the hydrogen molecule in dense and cold plasmas each vibrational state must be simulated as an individual species. Eirene neutral gas simulations of a one-dimensional flux-tube using a metastable-resolved model indicate a 30–50% decrease in the effective dissociation rate compared to simulations using a metastable-unresolved setup, which consider a single molecular species. Zero-dimensional Eirene simulations omitting transport effects predict a 25–65% decrease in the effective dissociation rate due to differences between the metastable-unresolved AMJUEL and the metastable-resolved H2VIBR rates available in Eirene. The exclusion of molecular hydrogen depletion via electronically excited states and vibrational transitions (Formula presented.) from the metastable-resolved rates reduce the effective dissociation rate. By accounting for the difference caused by the different collisional-radiative treatment of the metastable-resolved rates compared to the metastable-unresolved rates, transport effects are expected to be relevant under detached divertor conditions. It is, however, not possible to individually assess the role of the collisional-radiative processes and transport on the effective dissociation rate using the currently available atomic and molecular rates for the metastable-resolved and metastable-unresolved Eirene setups.Peer reviewe

Efficient code simulation strategies for B2-EIRENE

Plasma edge simulation codes are crucial for the interpretation of present experiments as well as for the assessment of new concepts and next generation nuclear fusion devices. These codes are most often based on a combined Finite Volume (FV) / Monte Carlo (MC) numerical approach to simulate coupled plasma and neutral particle transport. In this paper we apply recently derived error reduction analysis to assess numerical errors in a partially detached ITER case. We show that also for this strongly cou- pled FV/MC simulation case, statistical averaging over iterations provides an accurate means to achieve well reproducible and statistically accurate results. Moreover, the error reduction analysis with respect to numerical parameters provide a framework to achieve increased accuracy for a given computational cost. We also show how significant code speed-up can be achieved for a desirable accuracy compared to presently used simulation strategies.status: publishe

Solitary Waves, Periodic and Elliptic Solutions to the Benjamin, Bona and Mahony Equation Modified by Viscosity

In this paper, we use a traveling wave reduction or a so-called spatial approximation to comprehensively investigate periodic and solitary wave solutions of the modified Benjamin. Bona and Mahony equation (BBM) to include both dissipative and dispersive effects of viscous boundary layers. Under certain circumstances that depend on the traveling wave velocity, classes of periodic and solitary wave like solutions are obtained in terms of Jacobi elliptic functions. An ad-hoc theory based on the dissipative term is presented, in which we have found a set of solutions in terms of an implicit function. Using dynamical systems theory we prove that the solutions experience a transcritical bifurcation for a certain velocity of the traveling wave. Finally, we present qualitative numerical results

Accuracy and convergence of coupled finite-volume / Monte Carlo codes for plasma edge simulations

status: publishe

2D edge plasma modeling extended up to the main chamber

Far SOL plasma flow, and hence main chamber recycling and plasma surface interaction, are today still only very poorly described by current 2D fluid edge codes, such as B2, UEDGE or EDGE2D, due to a common technical limitation. We have extended the B2 plasma fluid solver in the current ITER version of B2-EIRENE (SOLPS4.3) to allow plasma solutions to be obtained up to the “real vessel wall”, at least on the basis of ad hoc far SOL transport models. We apply here the kinetic Monte Carlo Code EIRENE on such plasma solutions to study effects of this model refinement on main chamber fluxes and sputtering, for an ITER configuration. We show that main chamber sputtering may be significantly modified both due to thermalization of CX neutrals in the far SOL and poloidally highly asymmetric plasma wall contact, as compared to hitherto applied teleportation of particle fluxes across this domain.status: publishe

Error assessment and code speed-up for SOLPS-ITER

In 2016 the work on SOLPS code speed-up in terms of accuracy is finalized by its implementation in the SOLPS-ITER version. The procedure essentially consists of three subsequent steps. Every step provides an additional level of information on simulation results, its related errors and optimal use of numerical parameters. The first step is the reference user run. In this step, the averaging procedure is used to achieve simulation results with reduced statistical noise. Therefore, it is recommended to be used in all cases. In addition, variances are monitored to estimate the statistical error. It is shown in [1] that this averaging procedure introduces a small bias. In this first step, however, the value of this bias is not yet known. Nevertheless, it becomes already apparent from residual evaluation that increased accuracy is achieved. In order to achieve optimal numerical parameters given a required accuracy of simulation results for a specific case and its related grid size, the bias needs to be assessed. To this end, runs with a different number of Monte Carlo particles are needed. Based on theoretical error reduction rates [1, 2] for statistical error and bias, the optimal numerical parameters can be set to minimize CPU for a desired accuracy. The averaging procedure enables us to drastically reduce the statistical error in the solution within a reasonable computational time. As a result of this, we now can go even one step further and assess the discretization error, i.e. the error related to the finite grid size. The procedure as described in this manual is applied to a slab test case first and subsequently tested for a Deuterium only ITER F12 case, a C-MOD Deuterium only case and a C-MOD case with Deuterium and Boron. This report provides a practical user manual for the averaging procedure to be used to determine numerical parameters for code speed-up. Information on underlying theoretical and numerical studies can be found in [1–3]. [1] K. Ghoos, W. Dekeyser, G. Samaey, P. Börner, D. Reiter, and M. Baelmans, “Accuracy and convergence of coupled finite-volume / Monte-Carlo codes for plasma edge simulations of nuclear fusion reactors",” Contributions to Plasma Physics, vol. 56, no. 6-8, pp. 616–621, 2016. Plasma Edge Theory Conference, Nara, Japan. [2] K. Ghoos, W. Dekeyser, G. Samaey, and M. Baelmans, “Accuracy and convergence of coupled finite-volume / Monte-Carlo codes for plasma edge simulations of nuclear fusion reactors,” Journal of Computational Physics, vol. 322, pp. 162–182, 2016. 2nd Frontiers in Computational Physics: Energy conference, Zurich, Switzerland. [3] M. Baelmans, P. Börner, K. Ghoos, and G. Samaey, “Efficient code simulation strategies for b2- eirene,” Nuclear Materials and Energy, vol. 1-6, 2016.status: publishe

Researching with Care – Participatory Health Research with Afghan Women Refugees in Germany During the Covid-19 Pandemic: A Case with Commentaries

This article comprises a short case exemplifying ethical challenges arising for a participatory researcher working with Afghan women refugees during the Covid-19 pandemic in Germany. The researcher is an Iranian-German woman, qualified as a midwife, undertaking doctoral research on refugees’ access to reproductive health care. Disclosures about some women’s experience of domestic violence are made, which raise ethical issues for the researcher relating to personal-professional boundaries, roles and responsibilities. Two commentaries are given on this case from participatory researchers based in Germany, UK and Austria. Both commentaries highlight the relevance of the ethics of care for participatory research and for this research in particular, which entails very close relationships between the doctoral researcher and the refugee women with whom she is researching. The first commentary analyses the research process in terms of Tronto’s five phases of care, while the second illustrates the importance of caring institutions in supporting researchers working on sensitive topics

Benchmarking of B2 Code with a One-Dimensional Plasma Fluid Model Incorporating Anisotropic Ion Pressures on Simple Mirror Configurations

A plasma fluid code B2 has been benchmarked with a one-dimensional plasma fluid model incorporating the anisotropic ion pressures (AIP model) on simple mirror configurations. In a low collisionality case, profiles of plasma parameters of the B2 code deviate from those of the AIP model. The validity of the viscous-flux approximation is investigated by direct comparisons with the anisotropic part of the ion pressure indicating the invalidity of the viscous-flux approximation is considered to be responsible to deviations of profiles. In addition, supersonic plasma flows downstream from the mirror throat are observed