1
|
Hutchings HA, Rahman M, Carter K, Islam S, O'Neill C, Roberts S, John A, Fegan G, Dave U, Hawkes N, Ahmed F, Hasan M, Azad AK, Rahman MM, Kibria MG, Rahman MM, Mia T, Akhter M, Williams JG. Did the COVID-19 pandemic affect levels of burnout, anxiety and depression among doctors and nurses in Bangladesh? A cross-sectional survey study. BMJ Open 2024; 14:e079350. [PMID: 38453200 PMCID: PMC10921535 DOI: 10.1136/bmjopen-2023-079350] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/04/2023] [Accepted: 02/14/2024] [Indexed: 03/09/2024] Open
Abstract
INTRODUCTION COVID-19 has caused severe disruption to clinical services in Bangladesh but the extent of this, and the impact on healthcare professionals is unclear. We aimed to assess the perceived levels of anxiety, depression and burnout among doctors and nurses during COVID-19 pandemic. METHODS We undertook an online survey using RedCap, directed at doctors and nurses across four institutions in Bangladesh (The Sheikh Russel Gastro Liver Institute & Hospital (SRNGIH), Dhaka Medical College Hospital (DMCH), Mugda Medical College Hospital (MMCH) and M Abdur Rahim Medical College (MARMC) Hospital). We collected information on demographics, awareness of well-being services, COVID-19-related workload, as well as anxiety, depression and burnout using two validated questionnaires: the Hospital Anxiety and Depression Scale (HADS) and the Maslach Burnout Inventory (MBI). RESULTS Of the 3000 participants approached, we received responses from 2705 (90.2%). There was a statistically significant difference in anxiety, depression and burnout scores across institutions (p<0.01). Anxiety, depression and burnout scores were statistically worse in COVID-19 active staff compared with those not working on COVID-19 activities (p<0.01 for HADS anxiety and depression and MBI emotional exhaustion (EE), depersonalisation (DP) and personal accomplishment (PA)). Over half of the participants exhibited some level of anxiety (SRNGIH: 52.2%; DMCH: 53.9%; MMCH: 61.3%; MARMC: 68%) with a high proportion experiencing depression (SRNGIH: 39.5%; DMCH: 38.7%; MMCH: 53.7%; MARMC: 41.1%). Although mean burnout scores were within the normal range for each institution, a high proportion of staff (almost 20% in some instances) were shown to be classified as experiencing burnout by their EE, DP and PA scores. CONCLUSION We identified a high prevalence of perceived anxiety, depression and burnout among doctors and nurses during the COVID-19 pandemic. This was worse in staff engaged in COVID-19-related activities. These findings could help healthcare organisations to plan for future similar events.
Collapse
Affiliation(s)
| | - Mesbah Rahman
- Swansea Bay University Health Board, Port Talbot, UK
| | | | | | | | | | | | | | - Umakant Dave
- Swansea Bay University Health Board, Port Talbot, UK
| | - Neil Hawkes
- Cwm Taf Morgannwg University Health Board, Abercynon, UK
| | - Faruque Ahmed
- Department of Gastroenterology, Sheikh Russel National Gastroliver Institute and Hospital, Dhaka, Bangladesh
| | | | | | | | - Md Golam Kibria
- Sheikh Russel National Gastroliver Institute, Dhaka, Bangladesh
| | | | - Titu Mia
- Mugda Medical College and Hospital, Dhaka, Bangladesh
| | | | - John G Williams
- Faculty of Medicine, Health and Life Science, Swansea University, Swansea, UK
| |
Collapse
|
2
|
Siau K, Pelitari S, Green S, McKaig B, Rajendran A, Feeney M, Thoufeeq M, Anderson J, Ravindran V, Hagan P, Cripps N, Beales ILP, Church K, Church NI, Ratcliffe E, Din S, Pullan RD, Powell S, Regan C, Ngu WS, Wood E, Mills S, Hawkes N, Dunckley P, Iacucci M, Thomas-Gibson S, Wells C, Murugananthan A. JAG consensus statements for training and certification in flexible sigmoidoscopy. Frontline Gastroenterol 2023; 14:181-200. [PMID: 37056324 PMCID: PMC10086722 DOI: 10.1136/flgastro-2022-102259] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/02/2022] [Accepted: 10/04/2022] [Indexed: 01/28/2023] Open
Abstract
IntroductionJoint Advisory Group (JAG) certification in endoscopy is awarded when trainees attain minimum competency standards for independent practice. A national evidence-based review was undertaken to update standards for training and certification in flexible sigmoidoscopy (FS).MethodsA modified Delphi process was conducted between 2019 and 2020 with multisociety representation from experts and trainees. Following literature review and Grading of Recommendations, Assessment, Development and Evaluations appraisal, recommendation statements on FS training and certification were formulated and subjected to anonymous voting to obtain consensus. Accepted statements were peer-reviewed by national stakeholders for incorporation into the JAG FS certification pathway.ResultsIn total, 41 recommendation statements were generated under the domains of: definition of competence (13), acquisition of competence (17), assessment of competence (7) and postcertification support (4). The consensus process led to revised criteria for colonoscopy certification, comprising: (A) achieving key performance indicators defined within British Society of Gastroenterology standards (ie, rectal retroversion >90%, polyp retrieval rate >90%, patient comfort <10% with moderate-severe discomfort); (B) minimum procedure count ≥175; (C) performing 15+ procedures over the preceding 3 months; (D) attendance of the JAG Basic Skills in Lower gastrointestinal Endoscopy course; (E) satisfying requirements for formative direct observation of procedural skill (DOPS) and direct observation of polypectomy skill (SMSA level 1); (F) evidence of reflective practice as documented on the JAG Endoscopy Training System reflection tool and (G) successful performance in summative DOPS.ConclusionThe UK standards for training and certification in FS have been updated to support training, uphold standards in FS and polypectomy, and provide support to the newly independent practitioner.
Collapse
Affiliation(s)
- Keith Siau
- Department of Gastroenterology, Royal Cornwall Hospital, Truro, UK
- University of Birmingham College of Medical and Dental Sciences, Birmingham, UK
| | - Stavroula Pelitari
- Department of Gastroenterology, Royal Free London NHS Foundation Trust, London, UK
| | - Susi Green
- Department of Gastroenterology, University Hospitals Sussex NHS Foundation Trust, Worthing, UK
| | - Brian McKaig
- Department of Gastroenterology, Royal Wolverhampton Hospitals NHS Trust, Wolverhampton, UK
| | - Arun Rajendran
- Department of Gastroenterology, Hillingdon Hospitals NHS Foundation Trust, Uxbridge, UK
| | - Mark Feeney
- Department of Gastroenterology, Torbay and South Devon NHS Foundation Trust, Torquay, UK
| | - Mo Thoufeeq
- Department of Gastroenterology, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
| | - John Anderson
- Department of Gastroenterology, Gloucestershire Hospitals NHS Foundation Trust, Cheltenham, UK
| | - Vathsan Ravindran
- Department of Gastroenterology, St Mark's Hospital and Academic Institute Wolfson Unit for Endoscopy, Harrow, UK
| | - Paul Hagan
- Endoscopy, Royal Derby Hospital, Derby, UK
| | - Neil Cripps
- Colorectal Surgery, University Hospitals Sussex NHS Foundation Trust, Worthing, UK
| | - Ian L P Beales
- University of East Anglia, Norwich, UK
- Department of Gastroenterology, Norfolk and Norwich University Hospitals NHS Foundation Trust, Norwich, UK
| | | | | | - Elizabeth Ratcliffe
- Department of Gastroenterology, Wrightington Wigan and Leigh NHS Foundation Trust, Wigan, UK
- Division of Diabetes, Endocrinology and Gastroenterology Faculty of Biology, Medicine and Health School of Medical Sciences, The University of Manchester, Manchester, UK
| | - Said Din
- Department of Gastroenterology, University Hospitals of Derby and Burton NHS Foundation Trust, Derby, UK
| | - Rupert D Pullan
- Colorectal Surgery, Torbay and South Devon NHS Foundation Trust, Torquay, UK
| | - Sharon Powell
- Endoscopy, Royal Wolverhampton Hospitals NHS Trust, Wolverhampton, UK
| | - Catherine Regan
- Department of Gastroenterology, Royal Wolverhampton Hospitals NHS Trust, Wolverhampton, UK
| | - Wee Sing Ngu
- Colorectal Surgery, City Hospitals Sunderland NHS Foundation Trust, South Shields, UK
| | - Eleanor Wood
- Gastroenterology, Homerton University Hospital NHS Foundation Trust, London, UK
| | - Sarah Mills
- Colorectal Surgery, Chelsea and Westminster Hospital, London, UK
- Imperial College London, London, UK
| | - Neil Hawkes
- Department of Gastroenterology, Royal Glamorgan Hospital, Llantrisant, UK
| | - Paul Dunckley
- Department of Gastroenterology, Gloucestershire Hospitals NHS Foundation Trust, Gloucester, UK
| | - Marietta Iacucci
- University of Birmingham College of Medical and Dental Sciences, Birmingham, UK
- Department of Gastroenterology, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Siwan Thomas-Gibson
- Imperial College London, London, UK
- St Mark's Hospital and Academic Institute Wolfson Unit for Endoscopy, Harrow, UK
| | - Christopher Wells
- Department of Gastroenterology, North Tees and Hartlepool NHS Foundation Trust, Hartlepool, UK
| | - Aravinth Murugananthan
- Department of Gastroenterology, Royal Wolverhampton Hospitals NHS Trust, Wolverhampton, UK
- Faculty of Health, Education and Life Sciences, Birmingham City University, Birmingham, UK
| |
Collapse
|
3
|
Siau K, Pelitari S, Green S, McKaig B, Rajendran A, Feeney M, Thoufeeq M, Anderson J, Ravindran V, Hagan P, Cripps N, Beales ILP, Church K, Church NI, Ratcliffe E, Din S, Pullan RD, Powell S, Regan C, Ngu WS, Wood E, Mills S, Hawkes N, Dunckley P, Iacucci M, Thomas-Gibson S, Wells C, Murugananthan A. JAG consensus statements for training and certification in colonoscopy. Frontline Gastroenterol 2023; 14:201-221. [PMID: 37056319 PMCID: PMC10086724 DOI: 10.1136/flgastro-2022-102260] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/02/2022] [Accepted: 10/04/2022] [Indexed: 01/28/2023] Open
Abstract
IntroductionIn the UK, endoscopy certification is awarded when trainees attain minimum competency standards for independent practice. A national evidence-based review was undertaken to update and develop standards and recommendations for colonoscopy training and certification.MethodsUnder the oversight of the Joint Advisory Group (JAG), a modified Delphi process was conducted between 2019 and 2020 with multisociety expert representation. Following literature review and Grading of Recommendations, Assessment, Development and Evaluations appraisal, recommendation statements on colonoscopy training and certification were formulated and subjected to anonymous voting to obtain consensus. Accepted statements were peer reviewed by JAG and relevant stakeholders for incorporation into the updated colonoscopy certification pathway.ResultsIn total, 45 recommendation statements were generated under the domains of: definition of competence (13), acquisition of competence (20), assessment of competence (8) and postcertification support (4). The consensus process led to revised criteria for colonoscopy certification, comprising: (1) achieving key performance indicators defined within British Society of Gastroenterology standards (ie, unassisted caecal intubation rate >90%, rectal retroversion >90%, polyp detection rate >15%+, polyp retrieval rate >90%, patient comfort <10% with moderate–severe discomfort); (2) minimum procedure count 280+; (3) performing 15+ procedures over the preceding 3 months; (4) attendance of the JAG Basic Skills in Colonoscopy course; (5) terminal ileal intubation rates of 60%+ in inflammatory bowel disease; (6) satisfying requirements for formative direct observation of procedure skills (DOPS) and direct observation of polypectomy skills (Size, Morphology, Site, Access (SMSA) level 2); (7) evidence of reflective practice as documented on the JAG Endoscopy Training System reflection tool; (8) successful performance in summative DOPS.ConclusionThe UK standards for training and certification in colonoscopy have been updated, culminating in a single-stage certification process with emphasis on polypectomy competency (SMSA Level 2+). These standards are intended to support training, improve standards of colonoscopy and polypectomy, and provide support to the newly independent practitioner.
Collapse
Affiliation(s)
- Keith Siau
- Department of Gastroenterology, Royal Cornwall Hospitals NHS Trust, Truro, Cornwall, UK
- University of Birmingham College of Medical and Dental Sciences, Birmingham, Birmingham, UK
| | - Stavroula Pelitari
- Department of Gastroenterology, Royal Free London NHS Foundation Trust, London, London, UK
| | - Susi Green
- Department of Gastroenterology, University Hospitals Sussex NHS Foundation Trust, Worthing, West Sussex, UK
| | - Brian McKaig
- Department of Gastroenterology, Royal Wolverhampton Hospitals NHS Trust, Wolverhampton, Wolverhampton, UK
| | - Arun Rajendran
- Department of Gastroenterology, Hillingdon Hospitals NHS Foundation Trust, Uxbridge, Greater London, UK
| | - Mark Feeney
- Department of Gastroenterology, Torbay and South Devon NHS Foundation Trust, Torquay, Torbay, UK
| | - Mo Thoufeeq
- Department of Gastroenterology, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, Sheffield, UK
| | - John Anderson
- Gastroenterology, Gloucestershire Hospitals NHS Foundation Trust, Cheltenham, Gloucestershire, UK
| | - Vathsan Ravindran
- Gastroenterology, St Mark's Hospital and Academic Institute Wolfson Unit for Endoscopy, Harrow, London, UK
| | - Paul Hagan
- Endoscopy, Royal Derby Hospital, Derby, UK
| | - Neil Cripps
- Colorectal Surgery, University Hospitals Sussex NHS Foundation Trust, Worthing, West Sussex, UK
| | - Ian L P Beales
- Department of Gastroenterology, Norfolk and Norwich University Hospitals NHS Foundation Trust, Norwich, Norfolk, UK
- University of East Anglia, Norwich, Norfolk, UK
| | | | - Nicholas I Church
- Department of Gastroenterology, NHS Lothian, Edinburgh, Edinburgh, UK
| | - Elizabeth Ratcliffe
- Faculty of Medical and Human Sciences, The University of Manchester, Manchester, Manchester, UK
- Wrightington Wigan and Leigh NHS Foundation Trust, Wigan, Wigan, UK
| | - Said Din
- Department of Gastroenterology, University Hospitals of Derby and Burton NHS Foundation Trust, Derby, UK
| | - Rupert D Pullan
- Colorectal Surgery, Torbay and South Devon NHS Foundation Trust, Torquay, Torbay, UK
| | - Sharon Powell
- Endoscopy, Royal Wolverhampton Hospitals NHS Trust, Wolverhampton, Wolverhampton, UK
| | - Catherine Regan
- Endoscopy, Royal Wolverhampton Hospitals NHS Trust, Wolverhampton, Wolverhampton, UK
| | - Wee Sing Ngu
- Colorectal Surgery, City Hospitals Sunderland NHS Foundation Trust, South Shields, Tyne and Wear, UK
| | - Eleanor Wood
- Department of Gastroenterology, Homerton University Hospital NHS Foundation Trust, London, London, UK
| | - Sarah Mills
- Colorectal Surgery, Chelsea and Westminster Hospital, London, UK
- Imperial College London, London, UK
| | - Neil Hawkes
- Department of Gastroenterology, Royal Glamorgan Hospital, Llantrisant, UK
| | - Paul Dunckley
- Department of Gastroenterology, Gloucestershire Hospitals NHS Foundation Trust, Gloucester, Gloucestershire, UK
| | - Marietta Iacucci
- University of Birmingham College of Medical and Dental Sciences, Birmingham, Birmingham, UK
- Department of Gastroenterology, University Hospitals Birmingham NHS Foundation Trust, Birmingham, Birmingham, UK
| | - Siwan Thomas-Gibson
- Imperial College London, London, UK
- St Mark's Hospital and Academic Institute Wolfson Unit for Endoscopy, Harrow, London, UK
| | - Christopher Wells
- Department of Gastroenterology, North Tees and Hartlepool NHS Foundation Trust, Hartlepool, Hartlepool, UK
| | - Aravinth Murugananthan
- Department of Gastroenterology, Royal Wolverhampton Hospitals NHS Trust, Wolverhampton, Wolverhampton, UK
- Faculty of Health, Education and Life Sciences, Birmingham City University, Birmingham, UK
| |
Collapse
|
4
|
Eley C, Hawkes N, Lewis W. EP.TU.657Scoping the role and content of a simulator-based endosim curriculum. Br J Surg 2021. [DOI: 10.1093/bjs/znab311.089] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Abstract
Background
Endoscopy training requires simultaneous acquisition of practical skill and knowledge. Virtual reality Simulators, such as EndoSim (SurgicalScience), offer the opportunity to deconstruct a skill into fundamental components (1), to allow repetitive practice, and achievement of task-specific objectives. Trainees with the least endoscopy experience benefit most from early simulated training (2,3), supporting the introduction of a simulation curriculum into SPRINT: Structured PRogramme for INduction and Training, an existing initiative to improve endoscopy training delivery in Wales. (4) The aim of this study was to design a pilot simulator curriculum for the EndoSim (Surgical Science, Gothemberg) simulator.
Methods
A focus group completed all EndoSim modules. Each EndoSim exercise was cross-examined against the relevant DOPS tool “Direct Observation of Procedural Skill” used by the Joint Advisory Group for Endoscopy Training and Certification. Exercises were chosen that represented each DOPS domain to teach basic skills in endoscopy scope handling.
Results
12 exercises were chosen. These exercises addressed the insertion and withdrawal, and visualisation components of the JAG DOPS tool. Pre-procedural skills, management of findings, post-procedural skills and endoscopic non-technical Skills (ENTS) are beyond the scope of this simulator and require additional taught sessions to provide the context for current simulation training.
Discussion
This is the first step in developing and refining appropriate exercises to inform the proposed curriculum. The next step will be validating the chosen exercises against expert benchmark performance.
Collapse
Affiliation(s)
| | - Neil Hawkes
- Royal Glamorgan Hospital, Department of Gastroenterology
| | - Wyn Lewis
- Health Education and Improvement Wales
- University Hospital of Wales, Department of Surgery
| |
Collapse
|
5
|
Eley C, Brown C, Hawkes N, Egan R, Lewis W. SP2.2.16Hospital compound level endoscopy training quality performance: scoping the spectrum. Br J Surg 2021. [DOI: 10.1093/bjs/znab361.051] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Abstract
Aims
This study aimed to assess the quality of endoscopy training in a single UK Statutory Educational Body (SEB), related to individual hospitals,compared with the Joint Advisory Group on Gastrointestinal Endoscopy Training (JETS) certification standards.
Methods
Training procedures numbering 28,928 recorded by 211 consecutive cross-specialty trainee endoscopists registered with JETS in18 hospitals during 2019were analysed. Data included trainer and trainee numbers, training list frequency, procedures, Direct Observation of Procedural Skills (DOPS) completion and Key Performance Indicators (KPI).
Results
Annual median training procedures per hospital were 1395 (interquartile range (IQR) 465-2365). Median (IQR) trainers and trainees per unit were 11 (6-18) and 12 (7-16) respectively (ratio 0.8 (0.7-1.3)). Annual training list frequency per trainee was 13 (10-17), 35.0% short of JAG standard (n = 20, p = 0.001, effect size -0.56), and median points per adjusted training list were 11 (5-18). Median DOPS completion per trainee and trainer were 3 (1-6) and 4 (1-7) respectively; completing 0.2 DOPS (0.1-0.4) per list and amounting to 6 (2-12) per 200 procedures: less than half of the JAG standard (p < 0.001, -0.61). Median KPI for OGD: J Manoeuvre 94% (90-96), D2 intubation was 93% (91-96); and for Colonoscopy: Caecal intubation 82% (72-90), and Polyp Detection Rate 25% (18-34). Compound hospital training quality score varied 3-fold, the highest performing hospital scoring 26; compared to the poorest performing scoring 9: median 17 (14-20).
Conclusion
Important variation in endoscopy unit performance were apparent with compound hospital training quality varying almost 3-fold. Trainees, Training Programme Directors alike, should be aware of such data when planning educational programmes to focus, optimise the quality of endoscopic training.
Collapse
Affiliation(s)
| | | | - Neil Hawkes
- Royal Glamorgan Hospital, Department of Gastroenterology
| | - Richard Egan
- Morriston Hospital, Department of Surgery
- Swansea University
| | - Wyn Lewis
- Health Education and Improvement Wales
| |
Collapse
|
6
|
Hawkes N, Dave U, Rahman M, Richards D, Hasan M, Rowshon AHM, Ahmed F, Rahman MM, Kibria MG, Dodds P, Hawkes B, Goddard S, Rahman I, Neville P, Feeney M, Jenkins G, Lloyd K, Ragunath K, Edwards C, Taylor-Robinson SD. The Role of National Specialist Societies in Influencing Transformational Change in Low-Middle Income Countries - Reflections on the Model of Implementation for a National Endoscopy Training Programme in Bangladesh. Clin Exp Gastroenterol 2021; 14:103-111. [PMID: 33790613 PMCID: PMC7997947 DOI: 10.2147/ceg.s297667] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/17/2020] [Accepted: 03/02/2021] [Indexed: 12/03/2022] Open
Abstract
The British Society of Gastroenterology (BSG) and the Bangladesh Gastroenterology Society (BGS) have collaborated on an endoscopy training programme, which has grown up over the past decade from a small scheme borne out of the ideas of consultant gastroenterologists in Swansea, South Wales (United Kingdom) to improve gastroenterology services in Bangladesh to become a formalised training programme with broad reach. In this article, we document the socioeconomic and historical problems that beset Bangladesh, the current training needs of doctors and how the BSG-BGS collaboration has made inroads into changing outcomes both for gastroenterologists in Bangladesh, but also for the populations they serve.
Collapse
Affiliation(s)
- Neil Hawkes
- Department of Gastroenterology, Cwm Taf Morgannwg University Health Board, Llantrisant, South Wales, UK
- British Society of Gastroenterology Central Office, London, UK
| | - Umakant Dave
- Department of Gastroenterology, Swansea Bay University Health Board, Swansea, UK
| | - Mesbah Rahman
- British Society of Gastroenterology Central Office, London, UK
- Department of Gastroenterology, Swansea Bay University Health Board, Swansea, UK
| | - Dafydd Richards
- Department of Gastroenterology, Swansea Bay University Health Board, Swansea, UK
| | - Mahmud Hasan
- Office of the Central Secretariat, Bangladesh Gastroenterology Society, Dhaka, Bangladesh
- Office of Central Secretariat, Gastroliver Foundation, Dhaka, Bangladesh
| | - A H M Rowshon
- Office of the Central Secretariat, Bangladesh Gastroenterology Society, Dhaka, Bangladesh
| | - Faruque Ahmed
- Office of the Central Secretariat, Bangladesh Gastroenterology Society, Dhaka, Bangladesh
- Department of Gastroenterology, Sheikh Russel National Gastroliver Institute and Hospital, Dhaka, Bangladesh
| | - M Masudur Rahman
- Department of Gastroenterology, Sheikh Russel National Gastroliver Institute and Hospital, Dhaka, Bangladesh
| | - M G Kibria
- Department of Gastroenterology, Sheikh Russel National Gastroliver Institute and Hospital, Dhaka, Bangladesh
| | - Phedra Dodds
- Department of Endoscopy Nursing, Office of the JAG GRS Team, Powys Health Board, Brecon, UK
| | - Bethan Hawkes
- Office of the Wales Cancer Network Pathway, Welsh Cancer Network, Cardiff, UK
| | - Stuart Goddard
- Welsh Institute of Minimal Access Therapy, Cardiff MediCentre, Welsh Institute for Minimal Access Therapy, Cardiff University, Cardiff, UK
| | - Imdadur Rahman
- Department of Gastroenterology, Southampton NHS Trust, Southampton, UK
| | - Peter Neville
- Department of Gastroenterology, Cwm Taf Morgannwg University Health Board, Llantrisant, South Wales, UK
| | - Mark Feeney
- Department of Gastroenterology and Liver Medicine, Torbay and South Devon NHS Foundation Trust, Devon, UK
| | - Gareth Jenkins
- Faculty of Health and Life Sciences, Medicine, Swansea University, Swansea, UK
| | - Keith Lloyd
- Faculty of Health and Life Sciences, Medicine, Swansea University, Swansea, UK
| | - Krish Ragunath
- Office of the Provost, Faculty of Health Sciences, Bentley Campus, Curtin Medical School, Curtin University, Perth, Western Australia, Australia
| | - Cathryn Edwards
- British Society of Gastroenterology Central Office, London, UK
- Department of Gastroenterology and Liver Medicine, Torbay and South Devon NHS Foundation Trust, Devon, UK
| | | |
Collapse
|
7
|
Siau K, Green J, Hawkes N, Broughton R, Feeney M, Dunckley P, Barton J, Stebbing J, Thomas-Gibson S. Review of the impact of the Joint Advisory Group on gastrointestinal endoscopy (JAG) on accreditation services and training. Clin Med (Lond) 2019. [DOI: 10.7861/clinmedicine.19-2-s80] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
|
8
|
Figueiredo J, Murari A, Perez Von Thun C, Marocco D, Tardocchi M, Belli F, García Muñoz M, Silva A, Craciunescu T, Blanchard P, Balboa I, Hawkes N, Carvalho IS, Tal B, Bernardo J, Zychor I. JET diagnostic enhancements testing and commissioning in preparation for DT scientific campaigns. Rev Sci Instrum 2018; 89:10K119. [PMID: 30399696 DOI: 10.1063/1.5038548] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/03/2018] [Accepted: 06/29/2018] [Indexed: 06/08/2023]
Abstract
In order to optimize the scientific exploitation of JET (Joint European Torus) during the upcoming deuterium-tritium experiments, a set of diagnostic systems is being enhanced. These upgrades focus mainly on the experimental and operational conditions expected during tritium campaigns. It should be stressed that measurements relevant for burning plasmas are specifically targeted. Previously non-available capabilities, such as a current measurement system fully covering all poloidal field circuits, are described in detail. Instrument descriptions, performance prediction, testing, and initial commissioning results of these systems are presented.
Collapse
Affiliation(s)
- J Figueiredo
- EUROfusion Programme Management Unit, Culham Science Centre, Abingdon, United Kingdom
| | - A Murari
- EUROfusion Programme Management Unit, Culham Science Centre, Abingdon, United Kingdom
| | - C Perez Von Thun
- EUROfusion Programme Management Unit, Culham Science Centre, Abingdon, United Kingdom
| | - D Marocco
- Unità Tecnica Fusione, ENEA C. R. Frascati, Via E. Fermi 45, 00044 Frascati, Roma, Italy
| | - M Tardocchi
- IFP-CNR, Via R. Cozzi 53, 20125 Milano, Italy
| | - F Belli
- Unità Tecnica Fusione, ENEA C. R. Frascati, Via E. Fermi 45, 00044 Frascati, Roma, Italy
| | | | - A Silva
- Instituto de Plasmas e Fusão Nuclear, Instituto Superior Técnico, Universidade de Lisboa, Lisboa, Portugal
| | - T Craciunescu
- The National Institute for Laser, Plasma and Radiation Physics, Magurele, Bucharest, Romania
| | - P Blanchard
- Ecole Polytechnique Fédérale de Lausanne (EPFL), CRPP, CH-1015 Lausanne, Switzerland
| | - I Balboa
- CCFE, Culham Science Centre, Abingdon, Oxon OX14 3DB, United Kingdom
| | - N Hawkes
- CCFE, Culham Science Centre, Abingdon, Oxon OX14 3DB, United Kingdom
| | - I S Carvalho
- Instituto de Plasmas e Fusão Nuclear, Instituto Superior Técnico, Universidade de Lisboa, Lisboa, Portugal
| | - B Tal
- Wigner Research Centre for Physics, P.O. Box 49, H-1525 Budapest, Hungary
| | - J Bernardo
- Instituto de Plasmas e Fusão Nuclear, Instituto Superior Técnico, Universidade de Lisboa, Lisboa, Portugal
| | - I Zychor
- Narodowe Centrum Badań Jądrowych (NCBJ), 05-400 Otwock-Swierk, Poland
| |
Collapse
|
9
|
Biswas S, Alrubaiy L, China L, Lockett M, Ellis A, Hawkes N. Trends in UK endoscopy training in the BSG trainees' national survey and strategic planning for the future. Frontline Gastroenterol 2018; 9:200-207. [PMID: 30046424 PMCID: PMC6056087 DOI: 10.1136/flgastro-2017-100848] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2017] [Revised: 07/26/2017] [Accepted: 08/19/2017] [Indexed: 02/04/2023] Open
Abstract
BACKGROUND Improvements in the structure of endoscopy training programmes resulting in certification from the Joint Advisory Group in Gastrointestinal Endoscopy have been acknowledged to improve training experience and contribute to enhanced colonoscopy performance. OBJECTIVES The 2016 British Society of Gastroenterology trainees' survey of endoscopy training explored the delivery of endoscopy training - access to lists; level of supervision and trainee's progression through diagnostic, core therapy and subspecialty training. In addition, the barriers to endoscopy training progress and utility of training tools were examined. METHODS A web-based survey (Survey Monkey) was sent to all higher specialty gastroenterology trainees. RESULTS There were some improvements in relation to earlier surveys; 85% of trainees were satisfied with the level of supervision of their training. But there were ongoing problems; 12.5% of trainees had no access to a regular training list, and 53% of final year trainees had yet to achieve full certification in colonoscopy. 9% of final year trainees did not feel confident in endoscopic management of upper GI bleeds. CONCLUSIONS The survey findings provide a challenge to those agencies tasked with supporting endoscopy training in the UK. Acknowledging the findings of the survey, the paper provides a strategic response with reference to increased service pressures, reduced overall training time in specialty training programmes and the requirement to support general medical and surgical on-call commitments. It describes the steps required to improve training on the ground: delivering additional training tools and learning resources, and introducing certification standards for therapeutic modalities in parallel with goals for improving the quality of endoscopy in the UK.
Collapse
Affiliation(s)
- Sujata Biswas
- Translational Gastroenterology Unit, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Laith Alrubaiy
- Department of Gastroenterology, Swansea University Medical School, Swansea, UK
| | - Louise China
- Division of Medicine, University College London, London, UK
| | | | - Melanie Lockett
- Department of Gastroenterology, North Bristol NHS Trust, Bristol, UK
| | - Antony Ellis
- Translational Gastroenterology Unit, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Neil Hawkes
- Department of Gastroenterology, Royal Glamorgan Hospital, Llantrisant, UK
| |
Collapse
|
10
|
Figueiredo J, Murari A, Perez Von Thun C, Marocco D, Tardocchi M, Belli F, García Muñoz M, Silva A, Soare S, Craciunescu T, Santala M, Blanchard P, Balboa I, Hawkes N. JET diagnostic enhancements in preparation for DT operations. Rev Sci Instrum 2016; 87:11D443. [PMID: 27910612 DOI: 10.1063/1.4962247] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
In order to complete the exploitation of the JET ITER-like Wall and to take full benefit from deuterium-tritium experiments on JET, a set of diagnostic system refurbishments or upgrades is in progress. These diagnostic enhancements focus mainly on neutron, gamma, fast ions, instabilities, and operations support. These efforts intend to provide better spatial, temporal, and energy resolution while increasing measurement coverage. Also previously non-existing capabilities, such as Doppler reflectometry is now available for scientific exploitation. Guaranteeing diagnostic reliability and consistency during the expected DT conditions is also a critical objective of the work and systems being implemented. An overview of status and scope of the ongoing projects is presented.
Collapse
Affiliation(s)
- J Figueiredo
- EUROfusion Programme Management Unit, Culham Science Centre, Abingdon, United Kingdom
| | - A Murari
- EUROfusion Programme Management Unit, Culham Science Centre, Abingdon, United Kingdom
| | - C Perez Von Thun
- EUROfusion Programme Management Unit, Culham Science Centre, Abingdon, United Kingdom
| | - D Marocco
- Unità Tecnica Fusione-ENEA C. R. Frascati, Via E. Fermi 45, Frascati, 00044 Roma, Italy
| | - M Tardocchi
- IFP-CNR, Via R. Cozzi 53, 20125 Milano, Italy
| | - F Belli
- Unità Tecnica Fusione-ENEA C. R. Frascati, Via E. Fermi 45, Frascati, 00044 Roma, Italy
| | | | - A Silva
- Instituto de Plasmas e Fusão Nuclear, Instituto Superior Técnico, Universidade de Lisboa, Lisboa, Portugal
| | - S Soare
- The National Institute for Cryogenics and Isotopic Technology, Ramnicu Valcea, Romania
| | - T Craciunescu
- The National Institute for Laser, Plasma and Radiation Physics, Magurele, Bucharest, Romania
| | - M Santala
- Aalto University, P.O. Box 14100, FIN-00076 Aalto, Finland
| | - P Blanchard
- Ecole Polytechnique Fédérale de Lausanne (EPFL), CRPP, CH-1015 Lausanne, Switzerland
| | - I Balboa
- CCFE, Culham Science Centre, Abingdon, Oxon OX14 3DB, United Kingdom
| | - N Hawkes
- CCFE, Culham Science Centre, Abingdon, Oxon OX14 3DB, United Kingdom
| |
Collapse
|
11
|
Delabie E, Hawkes N, Biewer TM, O'Mullane MG. In situ wavelength calibration of the edge CXS spectrometers on JET. Rev Sci Instrum 2016; 87:11E525. [PMID: 27910676 DOI: 10.1063/1.4960306] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
A method for obtaining an accurate wavelength calibration over the entire focal plane of the JET edge CXS spectrometers is presented that uses a combination of the fringe pattern created with a Fabry-Pérot etalon and a neon lamp for cross calibration. The accuracy achieved is 0.03 Å, which is the same range of uncertainty as when neglecting population effects on the rest wavelength of the CX line. For the edge CXS diagnostic, this corresponds to a flow velocity of 4.5 km/s in the toroidal direction or 1.9 km/s in the poloidal direction.
Collapse
Affiliation(s)
- E Delabie
- Oak Ridge National Laboratory, Oak Ridge, Tennessee 37831-6169, USA
| | - N Hawkes
- CCFE, Culham Science Centre, Abingdon, Oxon OX14 3DB, United Kingdom
| | - T M Biewer
- Oak Ridge National Laboratory, Oak Ridge, Tennessee 37831-6169, USA
| | - M G O'Mullane
- Department of Physics, University of Strathclyde, Glasgow G4 0NG, United Kingdom
| |
Collapse
|
12
|
Reyes Cortes S, Alper B, Alves D, Baruzzo M, Bernardo J, Buratti P, Coelho R, Challis C, Chapman I, Hawkes N, Hender TC, Hobirk J, Joffrin E. MHD marking using the MSE polarimeter optics in ILW JET plasmas. Rev Sci Instrum 2016; 87:11E556. [PMID: 27910694 DOI: 10.1063/1.4962244] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
In this communication we propose a novel diagnostic technique, which uses the collection optics of the JET Motional Stark Effect (MSE) diagnostic, to perform polarimetry marking of observed MHD in high temperature plasma regimes. To introduce the technique, first we will present measurements of the coherence between MSE polarimeter, electron cyclotron emission, and Mirnov coil signals aiming to show the feasibility of the method. The next step consists of measuring the amplitude fluctuation of the raw MSE polarimeter signals, for each MSE channel, following carefully the MHD frequency on Mirnov coil data spectrograms. A variety of experimental examples in JET ITER-Like Wall (ILW) plasmas are presented, providing an adequate picture and interpretation for the MSE optics polarimeter technique.
Collapse
Affiliation(s)
- S Reyes Cortes
- IPFN, Instituto Superior Técnico, Universidade de Lisboa, 1049-001 Lisboa, Portugal
| | - B Alper
- CCFE, Culham Science Centre, Abingdon OX14 3DB, United Kingdom
| | - D Alves
- European Organization for Nuclear Research, CERN, F-01631CERN Cedex, France
| | - M Baruzzo
- Conzorsio RFX, Corso Stati Uniti 4, 35127 Padova, Italy
| | - J Bernardo
- IPFN, Instituto Superior Técnico, Universidade de Lisboa, 1049-001 Lisboa, Portugal
| | - P Buratti
- ENEA C. R. Frascati, Via E. Fermi 45, Frascati, Italy
| | - R Coelho
- IPFN, Instituto Superior Técnico, Universidade de Lisboa, 1049-001 Lisboa, Portugal
| | - C Challis
- CCFE, Culham Science Centre, Abingdon OX14 3DB, United Kingdom
| | - I Chapman
- CCFE, Culham Science Centre, Abingdon OX14 3DB, United Kingdom
| | - N Hawkes
- CCFE, Culham Science Centre, Abingdon OX14 3DB, United Kingdom
| | - T C Hender
- CCFE, Culham Science Centre, Abingdon OX14 3DB, United Kingdom
| | - J Hobirk
- Max-Planck-Institute fur Plasmaphysik, Euratom Association, 85748 Garching bei Munchen, Germany
| | - E Joffrin
- IRFM-CEA, Centre de Cadarache, 13108 Saint-Paul-lez-Durance, France
| |
Collapse
|
13
|
Tanabe H, Yamada T, Watanabe T, Gi K, Kadowaki K, Inomoto M, Imazawa R, Gryaznevich M, Michael C, Crowley B, Conway NJ, Scannell R, Harrison J, Fitzgerald I, Meakins A, Hawkes N, McClements KG, O'Gorman T, Cheng CZ, Ono Y. Electron and Ion Heating Characteristics during Magnetic Reconnection in the MAST Spherical Tokamak. Phys Rev Lett 2015; 115:215004. [PMID: 26636857 DOI: 10.1103/physrevlett.115.215004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/05/2015] [Indexed: 06/05/2023]
Abstract
Electron and ion heating characteristics during merging reconnection start-up on the MAST spherical tokamak have been revealed in detail using a 130 channel yttrium aluminum garnet (YAG) and a 300 channel Ruby-Thomson scattering system and a new 32 chord ion Doppler tomography diagnostic. Detailed 2D profile measurements of electron and ion temperature together with electron density have been achieved for the first time and it is found that electron temperature forms a highly localized hot spot at the X point and ion temperature globally increases downstream. For the push merging experiment when the guide field is more than 3 times the reconnecting field, a thick layer of a closed flux surface form by the reconnected field sustains the temperature profile for longer than the electron and ion energy relaxation time ~4-10 ms, both characteristic profiles finally forming a triple peak structure at the X point and downstream. An increase in the toroidal guide field results in a more peaked electron temperature profile at the X point, and also produces higher ion temperatures at this point, but the ion temperature profile in the downstream region is unaffected.
Collapse
Affiliation(s)
- H Tanabe
- Graduate School of Frontier Sciences, University of Tokyo, Tokyo 113-0032, Japan
| | - T Yamada
- Faculty of Arts and Science, Kyusyu University, Fukuoka 819-0395, Japan
| | - T Watanabe
- Graduate School of Frontier Sciences, University of Tokyo, Tokyo 113-0032, Japan
| | - K Gi
- Graduate School of Frontier Sciences, University of Tokyo, Tokyo 113-0032, Japan
| | - K Kadowaki
- Graduate School of Frontier Sciences, University of Tokyo, Tokyo 113-0032, Japan
| | - M Inomoto
- Graduate School of Frontier Sciences, University of Tokyo, Tokyo 113-0032, Japan
| | - R Imazawa
- Japan Atomic Energy Agency, Ibaraki 311-0193, Japan
| | - M Gryaznevich
- CCFE, Culham Science Centre, Abingdon, Oxfordshire OX14 3DB, United Kingdom
| | - C Michael
- CCFE, Culham Science Centre, Abingdon, Oxfordshire OX14 3DB, United Kingdom
| | - B Crowley
- CCFE, Culham Science Centre, Abingdon, Oxfordshire OX14 3DB, United Kingdom
| | - N J Conway
- CCFE, Culham Science Centre, Abingdon, Oxfordshire OX14 3DB, United Kingdom
| | - R Scannell
- CCFE, Culham Science Centre, Abingdon, Oxfordshire OX14 3DB, United Kingdom
| | - J Harrison
- CCFE, Culham Science Centre, Abingdon, Oxfordshire OX14 3DB, United Kingdom
| | - I Fitzgerald
- CCFE, Culham Science Centre, Abingdon, Oxfordshire OX14 3DB, United Kingdom
| | - A Meakins
- CCFE, Culham Science Centre, Abingdon, Oxfordshire OX14 3DB, United Kingdom
| | - N Hawkes
- CCFE, Culham Science Centre, Abingdon, Oxfordshire OX14 3DB, United Kingdom
| | - K G McClements
- CCFE, Culham Science Centre, Abingdon, Oxfordshire OX14 3DB, United Kingdom
| | - T O'Gorman
- CCFE, Culham Science Centre, Abingdon, Oxfordshire OX14 3DB, United Kingdom
| | - C Z Cheng
- Graduate School of Frontier Sciences, University of Tokyo, Tokyo 113-0032, Japan
- Institute of Space and Plasma Sciences, National Cheng Kung University, Tainan 70101, Taiwan
| | - Y Ono
- Graduate School of Frontier Sciences, University of Tokyo, Tokyo 113-0032, Japan
| |
Collapse
|
14
|
Murari A, Gelfusa M, Peluso E, Gaudio P, Mazon D, Hawkes N, Point G, Alper B, Eich T. Improved equilibrium reconstructions by advanced statistical weighting of the internal magnetic measurements. Rev Sci Instrum 2014; 85:123507. [PMID: 25554293 DOI: 10.1063/1.4904450] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
In a Tokamak the configuration of the magnetic fields remains the key element to improve performance and to maximise the scientific exploitation of the device. On the other hand, the quality of the reconstructed fields depends crucially on the measurements available. Traditionally in the least square minimisation phase of the algorithms, used to obtain the magnetic field topology, all the diagnostics are given the same weights, a part from a corrective factor taking into account the error bars. This assumption unduly penalises complex diagnostics, such as polarimetry, which have a limited number of highly significant measurements. A completely new method to choose the weights, to be given to the internal measurements of the magnetic fields for improved equilibrium reconstructions, is presented in this paper. The approach is based on various statistical indicators applied to the residuals, the difference between the actual measurements and their estimates from the reconstructed equilibrium. The potential of the method is exemplified using the measurements of the Faraday rotation derived from JET polarimeter. The results indicate quite clearly that the weights have to be determined carefully, since the inappropriate choice can have significant repercussions on the quality of the magnetic reconstruction both in the edge and in the core. These results confirm the limitations of the assumption that all the diagnostics have to be given the same weight, irrespective of the number of measurements they provide and the region of the plasma they probe.
Collapse
Affiliation(s)
- A Murari
- Consorzio RFX-Associazione EURATOM ENEA per la Fusione, I-35127 Padova, Italy
| | - M Gelfusa
- Associazione EURATOM-ENEA - University of Rome "Tor Vergata," Roma, Italy
| | - E Peluso
- Associazione EURATOM-ENEA - University of Rome "Tor Vergata," Roma, Italy
| | - P Gaudio
- Associazione EURATOM-ENEA - University of Rome "Tor Vergata," Roma, Italy
| | - D Mazon
- Association EURATOM-CEA, CEA Cadarache, 13108 Saint-Paul-lez-Durance, France
| | - N Hawkes
- EURATOM/CCFE Fusion Association, Culham Science Centre, Abingdon, Oxon OX14 3DB, United Kingdom
| | - G Point
- Ecole Normale Supérieure de Cacahn- 61 Avenue du Président Wilson, 94230 Cachan, France
| | - B Alper
- EURATOM/CCFE Fusion Association, Culham Science Centre, Abingdon, Oxon OX14 3DB, United Kingdom
| | - T Eich
- Max-Planck-Institut für Plasmaphysik, Teilinstitut Greifswald, EURATOM Association, Wendelsteinstr.1, 17491 Greifswald, Germany
| |
Collapse
|
15
|
Hawkes N. Initiative aims to make London Europe's commercial centre for life sciences. Assoc Med J 2014. [DOI: 10.1136/bmj.g2687] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
|
16
|
|
17
|
Gelfusa M, Murari A, Lupelli I, Hawkes N, Gaudio P, Baruzzo M, Brix M, Craciunescu T, Drozdov V, Meigs A, Peluso E, Romanelli M, Schmuck S, Sieglin B. Influence of plasma diagnostics and constraints on the quality of equilibrium reconstructions on Joint European Torus. Rev Sci Instrum 2013; 84:103508. [PMID: 24188275 DOI: 10.1063/1.4824200] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
One of the main approaches to thermonuclear fusion relies on confining high temperature plasmas with properly shaped magnetic fields. The determination of the magnetic topology is, therefore, essential for controlling the experiments and for achieving the required performance. In Tokamaks, the reconstruction of the fields is typically formulated as a free boundary equilibrium problem, described by the Grad-Shafranov equation in toroidal geometry and axisymmetric configurations. Unfortunately, this results in mathematically very ill posed problems and, therefore, the quality of the equilibrium reconstructions depends sensitively on the measurements used as inputs and on the imposed constraints. In this paper, it is shown how the different diagnostics (Magnetics Measurements, Polarimetry and Motional Stark Effect), together with the edge current density and plasma pressure constraints, can have a significant impact on the quality of the equilibrium on JET. Results show that both the Polarimetry and Motional Stark Effect internal diagnostics are crucial in order to obtain reasonable safety factor profiles. The impact of the edge current density constraint is significant when the plasma is in the H-mode of confinement. In this plasma scenario the strike point positions and the plasma last closed flux surface can change even by centimetres, depending on the edge constraints, with a significant impact on the remapping of the equilibrium-dependent diagnostics and of pedestal physics studies. On the other hand and quite counter intuitively, the pressure constraint can severely affect the quality of the magnetic reconstructions in the core. These trends have been verified with several JET discharges and consistent results have been found. An interpretation of these results, as interplay between degrees of freedom and available measurements, is provided. The systematic analysis described in the paper emphasizes the importance of having sufficient diagnostic inputs and of properly validating the results of the codes with independent measurements.
Collapse
Affiliation(s)
- M Gelfusa
- Associazione EURATOM-ENEA, University of Rome "Tor Vergata", Roma, Italy
| | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
18
|
Hawkes N. Flu vaccine associated with reduced risk of acute myocardial infarction. Assoc Med J 2013. [DOI: 10.1136/bmj.f5226] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
|
19
|
Ansell J, Arnaoutakis K, Goddard S, Hawkes N, Leicester R, Dolwani S, Torkington J, Warren N. The WIMAT colonoscopy suitcase model: a novel porcine polypectomy trainer. Colorectal Dis 2013; 15:217-23; discussion 223. [PMID: 22672629 DOI: 10.1111/j.1463-1318.2012.03122.x] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
AIM Simulation allows the acquisition of complex skills within a safe environment. Endoscopic polypectomy has a long learning curve. Our novel polypectomy simulator may be a useful adjunct for training. The aim of this study was to assess its content validity. METHOD The Welsh Institute for Minimal Access Therapy (WIMAT) endoscopy suitcase was designed to simulate colonic polypectomy. Participants from regional and national courses were recruited into the study. Each undertook a standardized simulated polypectomy and completed a seven-point Likert scale questionnaire examining its realism. RESULTS In all, 17 participants completed the questionnaire: 15 (88.2%) gastroenterologists, one (5.9%) colorectal surgeon and one (5.9%) experienced endoscopic nurse specialist. Of the gastroenterologists, seven (46.7%) were consultants and eight (53.3%) were senior trainees or Post CCT (Certificate of Completion of Training) fellows. The mean number of real-life polypectomies performed by the cohort was 156 (95% CI 35-355). The highest scores were for 'mucosal realism' (median score 6.0, P=0.001), 'endoscopic snare control' (median score 6.0, P=0.001), 'handling the polyp' (median score 6.0, P=0.001) and 'raising mucosa' (median score 6.0, P<0.001). Of the 15 parameters examined only three were not statistically significant in favour of the simulator. These were 'anatomical realism of sessile polyps', 'resistance of scope movement' and 'paradoxical motion'. The overall score for the simulation was 6.0 (P < 0.001). There was no significant difference between the level of difficulty of the simulator compared with real life (median score 4.0, P = 0.559). CONCLUSION The WIMAT colonoscopy suitcase model has excellent content validity for several parameters. This may have potential applications in medical training and assessment.
Collapse
Affiliation(s)
- J Ansell
- Welsh Institute for Minimal Access Therapy (WIMAT), Heath Park, Cardiff CF14 4UJ, UK.
| | | | | | | | | | | | | | | |
Collapse
|
20
|
Hawkes N. Abstracts often do not accurately reflect trial results, study shows. Assoc Med J 2013. [DOI: 10.1136/bmj.f179] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
|
21
|
|
22
|
Hawkes N. Volunteers will help diagnose dementia earlier and support patients in the community. Assoc Med J 2012. [DOI: 10.1136/bmj.e7601] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
|
23
|
Klinkhamer F, Krimmer A, Biel W, Hawkes N, Kiss G, Koning J, Krasikov Y, Neubauer O, Snijders B. Optimization of the availability of the core CXRS diagnostics for ITER. Fusion Engineering and Design 2011. [DOI: 10.1016/j.fusengdes.2011.01.064] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
|
24
|
Lee BL, Turner J, Hurley J, Green J, Hawkes N, Alcolado R. Two for the price of one: a dual treatment benefit of long-acting octreotide in occult bleeding and diuretic intractable ascites. Frontline Gastroenterol 2011; 2:226-229. [PMID: 28839614 PMCID: PMC5517236 DOI: 10.1136/fg.2010.003459] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/22/2011] [Indexed: 02/04/2023] Open
Abstract
Transfusion-dependent anaemia and portal hypertension are recognised complications of hereditary haemorrhagic telangiectasia (HHT). The anaemia is a result of chronic bleeding from gastrointestinal telangiectasias, which are usually multiple and located throughout the gastrointestinal tract. As a result, treatment with argon plasma coagulation via gastroscopy and or colonoscopy is often insufficient to prevent ongoing blood loss. Portal hypertension in HHT occurs as a result of blood shunting between the hepatic artery and the portal vein within the liver. The somatostatin analogue octreotide has been used as a treatment for bleeding angiodysplasia; however, its possible role as a treatment for diuretic intractable ascites secondary to portal hypertension has not been previously established. The authors report a case that apparently illustrates a dual benefit of long-acting octreotide in the management of both occult bleeding and refractory ascites in a patient with HHT.
Collapse
Affiliation(s)
- Bee Leng Lee
- Department of Gastroenterology, Llandough Hospital, UK,Department of Gastroenterology, Royal Glamorgan Hospital, UK
| | - Jeff Turner
- Department of Gastroenterology, Llandough Hospital, UK
| | - Joanna Hurley
- Department of Gastroenterology, Llandough Hospital, UK
| | - John Green
- Department of Gastroenterology, Llandough Hospital, UK
| | - Neil Hawkes
- Department of Gastroenterology, Royal Glamorgan Hospital, UK
| | - Ruth Alcolado
- Department of Gastroenterology, Royal Glamorgan Hospital, UK
| |
Collapse
|
25
|
Krasikov Y, Baross T, Biel W, Litnovsky A, Hawkes N, Kiss G, Klinkhamer J, Koning J, Krimmer A, Neubauer O, Panin A. Development of design options for the port plug components of the ITER core CXRS diagnostic. Fusion Engineering and Design 2011. [DOI: 10.1016/j.fusengdes.2011.01.086] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
|
26
|
Krimmer A, Klinkhamer F, Biel W, Hawkes N, Kiss G, Koning J, Krasikov Y, Neubauer O. Alternative system design concepts for the ITER core CXRS upper port plug front end. Fusion Engineering and Design 2011. [DOI: 10.1016/j.fusengdes.2011.04.049] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
|
27
|
Mantica P, Angioni C, Challis C, Colyer G, Frassinetti L, Hawkes N, Johnson T, Tsalas M, deVries PC, Weiland J, Baiocchi B, Beurskens MNA, Figueiredo ACA, Giroud C, Hobirk J, Joffrin E, Lerche E, Naulin V, Peeters AG, Salmi A, Sozzi C, Strintzi D, Staebler G, Tala T, Van Eester D, Versloot T. A key to improved ion core confinement in the JET tokamak: ion stiffness mitigation due to combined plasma rotation and low magnetic shear. Phys Rev Lett 2011; 107:135004. [PMID: 22026864 DOI: 10.1103/physrevlett.107.135004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/13/2011] [Indexed: 05/31/2023]
Abstract
New transport experiments on JET indicate that ion stiffness mitigation in the core of a rotating plasma, as described by Mantica et al. [Phys. Rev. Lett. 102, 175002 (2009)] results from the combined effect of high rotational shear and low magnetic shear. The observations have important implications for the understanding of improved ion core confinement in advanced tokamak scenarios. Simulations using quasilinear fluid and gyrofluid models show features of stiffness mitigation, while nonlinear gyrokinetic simulations do not. The JET experiments indicate that advanced tokamak scenarios in future devices will require sufficient rotational shear and the capability of q profile manipulation.
Collapse
Affiliation(s)
- P Mantica
- Istituto di Fisica del Plasma "P. Caldirola," Associazione Euratom-ENEA-CNR, Milano, Italy
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
28
|
Hawkes N. Overseas companies could run NHS hospitals, emails reveal. West J Med 2011. [DOI: 10.1136/bmj.d5666] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
|
29
|
Hawkes N. Reforms of incapacity benefit are seen as attack on the disabled, report says. West J Med 2011. [DOI: 10.1136/bmj.d4786] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
|
30
|
Hawkes N. UK government pushes ahead with value based pricing of drugs. West J Med 2011. [DOI: 10.1136/bmj.d4632] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
|
31
|
Hawkes N. Future Forum is to examine integrated care and other issues in its next phase of work. West J Med 2011. [DOI: 10.1136/bmj.d4475] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
|
32
|
|
33
|
|
34
|
Hawkes N. Too much information. West J Med 2011. [DOI: 10.1136/bmj.d4341] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
|
35
|
Hawkes N. A winning night. Assoc Med J 2011. [DOI: 10.1136/bmj.d3183] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
|
36
|
Hawkes N. Criticisms of health reform are "noticeably misinformed," say supporters. West J Med 2011. [DOI: 10.1136/bmj.d3012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
|
37
|
Hawkes N. England's health secretary faces increasing isolation. West J Med 2011. [DOI: 10.1136/bmj.d2947] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
|
38
|
Hawkes N. Competition can bring benefits for the NHS--provided it's the right kind, meeting hears. West J Med 2011. [DOI: 10.1136/bmj.d2857] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
|
39
|
|
40
|
Hawkes N. The stakes for Andrew Lansley could not be higher. West J Med 2011. [DOI: 10.1136/bmj.d2427] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
|
41
|
Hawkes N. Death rate after bowel cancer surgery is higher than previously thought. West J Med 2011. [DOI: 10.1136/bmj.d2379] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
|
42
|
Hawkes N. Even Stephen: is it Dorrell to the rescue? West J Med 2011. [DOI: 10.1136/bmj.d2221] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
|
43
|
|
44
|
|
45
|
Hawkes N. NHS reforms will distract GPs from the work that "really matters". West J Med 2011. [DOI: 10.1136/bmj.d1974] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
|
46
|
Hawkes N. Chancellor sets out plans to speed up approval for clinical trials. West J Med 2011. [DOI: 10.1136/bmj.d1931] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
|
47
|
|
48
|
Hawkes N. Lansley promises to review health bill after Liberal Democrats oppose reforms. West J Med 2011. [DOI: 10.1136/bmj.d1646] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
|
49
|
Hawkes N. GPs could share profits from savings made through consortiums. West J Med 2011. [DOI: 10.1136/bmj.d1439] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
|
50
|
Hawkes N. GPs are accused of using profits from commissioning to meet practice expenses. West J Med 2011. [DOI: 10.1136/bmj.d1471] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
|