Using low voltage ionization chamber (LVIC) in current mode for energy spectrum reconstruction: Experiments and validation

Due to the International Thermonuclear Experimental Reactor (ITER) radiative environment, in particular during high D-T power phase, classic x-ray detectors, such as semiconductor diodes, might be too fragile and are thus not viable. Instead, robust detectors, such as gas-filled detectors, are nowadays considered. The Low Voltage Ionization Chamber (LVIC) is one of the most promising candidates for x-ray measurement during the ITER nuclear phase. A complete model of the detector, recently developed at IRFM (Intitute for Research on Magnetic Fusion), now requires experimental validation. Experimental testing at the IRFM laboratory of an ITER industrial LVIC prototype and comparison with modeling are presented. In particular, an original approach to extract information on the x-ray spectrum from current-mode LVIC measurement is validated experimentally.

68 DEVELOPMENT OF AN IRISH HIP FRACTURE DATABASE FRAILTY INDEX: ASSOCIATIONS WITH LENGTH OF STAY, DELIRIUM, MORTALITY AND NURSING HOME ADMISSION

Background

In older people, hip fracture can lead to adverse outcomes. Frailty, capturing biological age and vulnerability to stressors, can indicate those at higher risk. This study aimed to derive a frailty index (FI) in the Irish Hip Fracture Database (IHFD), to explore associations with prolonged length of hospital stay (LOS ≥ 30 days), delirium, inpatient mortality and new nursing home (NH) admission and to assess whether the FI added value to those predictions above and beyond age, sex, and pre-operative American Society of Anaesthesiology (ASA) score.

Methods

A 21-item FI was constructed with 16 dichotomous comorbidities, three 4-level ordinal pre-morbid functional variables (difficulty with indoor mobility, outdoor mobility, and shopping), and nursing home provenance (yes/no). The FI was computed as the proportion of items present, and divided into tertiles (low, medium, high risk). Independent associations between FI and outcomes were explored with logistic regression, from which we extracted adjusted Odds Ratios (aOR) and areas under the curve (AUC).

Results

From 2017-2020, the IHFD included 14,615 hip fracture admissions, mean (SD) age 80.4 (8.8), 68.9% women. Complete FI data was available for 12,502 (85.5%). By FI tertile (low to high risk), prolonged LOS proportions were 5.9%, 16.1% and 23.1%; delirium 5.5%, 13.5% and 17.6%; inpatient mortality 0.6%, 3.3% and 10.1%; and new nursing home admission 2.2%, 5.9% and 11.3%. All associations were statistically significant (p<0.001) independently of age and sex. AUC analyses suggested that the FI score, added to age, sex, and ASA score, added value to the prediction of delirium and new NH admission (p<0.05), and especially to prolonged LOS and inpatient mortality (p<0.001).

Conclusion

A 21-item FI in the IHFD was a significant predictor of outcomes and added value to traditional risk markers. The utility of a routinely derived FI to more efficiently direct limited orthogeriatric resources requires further investigation.

344 LONG-TERM OUTCOMES FOR HIP FRACTURE PATIENTS WHO HAVE RECEIVED A PERIOD OF INPATIENT REHABILITATION

Background

Twenty-eight percent of the 3,666 hip fractures reported by the Irish Hip Fracture Database (IHFD) in 2020 received a period of rehabilitation in an off-site facility nationally. Longer term outcomes for hip fracture patients are not yet included in the IHFD. This study aimed to describe recovery after hip fracture in patients admitted to a single inpatient rehabilitation facility.

Methods

Patients who experienced hip fracture between January 2020 and July 2020 were followed up for one year after their fracture. Baseline data was collected in relation to age, pre-fracture residence and New Mobility Score (NMS) and clinical frailty score. Residence, NMS and quality of life (EQ-5D-5L) were collected by a clinical physiotherapist at 30 days, 120 days and 1 year after hip fracture. Data was inputted and analysed using Microsoft Excel.

Results

Of 122 hip fracture patients admitted to rehabilitation,103 were followed up. The average age of patients was 79, 66% were female. The mortality rate was 9% (n=9) at 1 year follow up. Pre-fracture, n= 98 lived at home. Of these patients, 67%, 82% and 83% had returned home by 30 days, 120 days and 1 year. Pre-fracture 53% had high mobility levels (NMS>6). Of these patient 4%, 27% and 34% had returned to this level by 30 days, 120 and 1 year. 70% of patients had a low mobility score (0-6 on NMS) and 30 % had a high mobility score (7-9) at 1 year follow-up. 56% and 4% of patients reported no pain and severe pain at 1 year post op, respectively. 45% of patients had no issues performing their usual activities and 4% had severe issues/an inability to perform their usual activities at 1 year.

Conclusion

Our results show that recovery after hip fracture is slow with many not achieving baseline mobility or return to pre-fracture function within the first year.

Evaluation of prognostic risk models for postoperative pulmonary complications in adult patients undergoing major abdominal surgery: a systematic review and international external validation cohort study

BACKGROUND

Stratifying risk of postoperative pulmonary complications after major abdominal surgery allows clinicians to modify risk through targeted interventions and enhanced monitoring. In this study, we aimed to identify and validate prognostic models against a new consensus definition of postoperative pulmonary complications.

METHODS

We did a systematic review and international external validation cohort study. The systematic review was done in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. We searched MEDLINE and Embase on March 1, 2020, for articles published in English that reported on risk prediction models for postoperative pulmonary complications following abdominal surgery. External validation of existing models was done within a prospective international cohort study of adult patients (≥18 years) undergoing major abdominal surgery. Data were collected between Jan 1, 2019, and April 30, 2019, in the UK, Ireland, and Australia. Discriminative ability and prognostic accuracy summary statistics were compared between models for the 30-day postoperative pulmonary complication rate as defined by the Standardised Endpoints in Perioperative Medicine Core Outcome Measures in Perioperative and Anaesthetic Care (StEP-COMPAC). Model performance was compared using the area under the receiver operating characteristic curve (AUROCC).

FINDINGS

In total, we identified 2903 records from our literature search; of which, 2514 (86·6%) unique records were screened, 121 (4·8%) of 2514 full texts were assessed for eligibility, and 29 unique prognostic models were identified. Nine (31·0%) of 29 models had score development reported only, 19 (65·5%) had undergone internal validation, and only four (13·8%) had been externally validated. Data to validate six eligible models were collected in the international external validation cohort study. Data from 11 591 patients were available, with an overall postoperative pulmonary complication rate of 7·8% (n=903). None of the six models showed good discrimination (defined as AUROCC ≥0·70) for identifying postoperative pulmonary complications, with the Assess Respiratory Risk in Surgical Patients in Catalonia score showing the best discrimination (AUROCC 0·700 [95% CI 0·683-0·717]).

INTERPRETATION

In the pre-COVID-19 pandemic data, variability in the risk of pulmonary complications (StEP-COMPAC definition) following major abdominal surgery was poorly described by existing prognostication tools. To improve surgical safety during the COVID-19 pandemic recovery and beyond, novel risk stratification tools are required.

FUNDING

British Journal of Surgery Society.

Improving the Quality of Paediatric ECG Interpretation

Aims Our aim was to complete an audit loop and identify whether implementing a paediatric ECG checklist improved the documentation and therefore the quality of paediatric ECG interpretation. We designed a paediatric ECG and education proforma in a Paediatric Emergency Department and incorporated it into daily practice. Methods We audited the medical records of children presenting with clinical indications for ECG. We included 40 records before and 40 records after the introduction of a paediatric ECG interpretation checklist. Results We assessed 10 items of documentation of which 8 related to the wave-form. Recording of these ranged from 0-65% before and from 95-100% after the checklist. Conclusion An intervention to introduce a paediatric ECG checklist, including education proforma, demonstrated significant improvement in the interpretation and documentation of a paediatric ECG. We recommend the use of this checklist in primary care and hospital settings.

Epistaxis in the Sars-CoV-2 Era

Introduction Epistaxis was the third most common unscheduled ENT surgical intervention in Ireland in 2019. Otorhinolaryngologists are exposed to a high viral reservoir of Sars-CoV-2, as they are dealing with pathology in the upper respiratory tract. Risk analysis is required to minimise nosocomial transmission. Methods A prospective audit of epistaxis management in the outpatients at a tertiary hospital was undertaken pre pandemic. A retrospective review of patients records during the Sars-CoV-2 pandemic. Comparative analysis was utilised to assess outcomes. Results Pre Sars-CoV-2 analysis revealed 14 patients (70%) were manged with rigid endoscopy compared to one (5%) interpandemic. Cauterization treated 20 patients (100%) pre pandemic and four patients (20%) interpandemic. Nasal packing modality differed in that 13 patients (65%) were treated with Nasopore pre pandemic and 14 (70%) with Rapid Rhino interpandemic. This exhibited a paradigm shift in that 18 (90%) patients were managed conservatively with nasal packing interpandemic. Conclusion A paradigm shift in the management of Epistaxis during the pandemic has led to treatment which is less invasive, has less morbidity for the patient, requires less hospital admissions and lessens nosocomial transmission of the Sars-CoV-2. Further study is required given the advent of vaccines and development of various strains Sars-CoV-2.

210 A SYSTEMATIC REVIEW OF LONG-TERM OUTCOME COLLECTION FOLLOWING HIP FRACTURE IN IRELAND FROM 2005 TO 2021

Background

The Irish Hip Fracture Database (IHFD) drives clinical improvements across 16 acute hospitals for over 3,500 patients annually. The IHFD aims to begin recording long-term outcomes. Past practice in Ireland could inform this activity. This review aims to identify and summarise studies that have collected long-term outcomes following hip fracture in Ireland.

Methods

A search of electronic databases (MEDLINE, Embase, Scopus, Web of Science, CINAHL) and grey literature was conducted in July 2021 for articles, abstracts, theses and reports. Search terms related to hip fracture and Ireland. Studies published from 2005–2021 were included if post-hospital discharge data were collected in the Republic of Ireland for patients with hip fracture. Study and patient characteristics, data collection methods and long-term outcomes were extracted.

Results

From all sources, 21 articles, 3 theses and 84 abstracts from 18 clinical sites were identified. Numbers of patients with hip fracture ranged from 9 to 2,483 (median 168) across publications. The most common outcome recorded was mortality (59% of publications), most frequently at 30 days and/or one year. Ascertainment methods for mortality included electronic patient records, online death notices, phone calls to family or general practitioners and the national death register. Non-mortality long-term outcomes were assessed in 64% of publications, most commonly through outpatient or virtual clinics or phone calls. They included place of residence, function, mobility and bone-health status at time-points of 30 days, 6 weeks, 3, 4, 6 or 12 months. Only 11 publications followed patients past the 1 year time-point. One third of publications did not report data collection methods.

Conclusion

Meta-analyses of results will provide estimates of mortality rates and other key hip fracture outcomes. Some long-term outcomes have been collected at most hospitals treating acute hip fracture in Ireland in the last 15 years. Qualitative research in needed to identify facilitators of follow-up to inform practice nationally.

WTO must ban harmful fisheries subsidies

[Figure: see text].

786 Retrospective analysis of paediatric ENT surgery outcomes during the COVID pandemic

Introduction

Studies show high morbidity/mortality for adults with peri-operative SARS-CoV-2 infection, leading to recommendations curtailing elective operations during the height of the pandemic. Our understanding of the risks associated with paediatric surgery is more limited, with preliminary data suggesting lower morbidity/mortality than in adults. A < 1% incidence of COVID-19 in paediatric patients undergoing preoperative universal screening is reported, and even in those testing positive, morbidity and mortality seem to be low. As waiting lists swell and the detriment associated with delaying surgery mounts, it is imperative to accurately quantify the risks of surgery in the paediatric population.

Method

Retrospective review of all paediatric ENT operations performed at the Evelina Children’s Hospital at the height of lockdown, from March to May 2020.

Results

61 procedures were performed on 56 patients. 50% had a pre-operative SARS-CoV-2 nasopharyngeal swabs. All cases involved a change in anesthetic practice; 2 cases involved a change in surgical practice. We noted 2 medical complications and 1 surgical complication. All patients are currently extant. No staff or patients subsequently developed COVID.

Conclusions

Our perioperative infection rates and mortality/morbidity figures concord with figures published elsewhere in literature. We are cautiously optimistic regarding risks associated with paediatric ENT surgery.

Silk Film Stiffness Modulates Corneal Epithelial Cell Mechanosignaling

Silk fibroin films are excellent candidate biomaterials for corneal tissue engineering due to their optical transparency, biocompatibility, and mechanical strength. Their tunable chemical and mechanical properties open the possibility of engineering cellular microenvironments that can both mimic native corneal tissue and provide stimuli to actively promote wound regeneration. While silk film mechanical properties, such as surface topography, have demonstrated the ability to control corneal epithelial cell wound regenerating behavior, few studies have explored the stiffness tunability of these films and its cellular effects. Cells are known actively sense the stiffness of their surroundings and processes such as cell adhesion, migration, proliferation, and expression of stem markers can be strongly influenced by matrix stiffness. This study develops technical solutions that allow for both the fabrication of films with stiffnesses similar to corneal tissue and also for their characterization in an aqueous, native-like environment at a scale relevant to cellular forces. Physiological evidence demonstrates that corneal epithelial cells are mechanosensitive to films of different stiffnesses and show that cell spreading, cytoskeletal tension, and molecular mechanotransducer localization are associated with film stiffness. These results indicate that silk film stiffness can be used to regulate cell behavior for the purposes of ocular surface repair.

A novel UV-fluorescence approach to assess the long wear efficacy of foundations

BACKGROUND

The long wear properties of foundations are regarded as a must-have in terms of claims. Here, we propose an instrumental approach based on UV-fluorescence imaging as an alternative to clinical grading methods.

METHODS

A method was developed, with UV-fluorescence images captured with the Visia CR as a first step, followed by images analysis using Image-Pro plus. Repeated-measures correlation was used to assess the degree of association between the UV-fluorescence method and a grading method when removing the foundation incrementally from the skin using wipes. Thresholds to ascertain whether a foundation pass or fail long-wearing using the newly developed method were established using a mixed linear model and cross-validated using two subsets of a panel of 20 women.

RESULTS

The method could measure incremental removal of foundation using wipes, in a similar fashion to a grading method, as outlined with repeated measures correlation (r = -.86). Pass/fail thresholds established with the mixed linear model were tested versus the grading method when assessing a foundation under real conditions for a duration over 24 hours, with minimal discrepancies between the two methods.

CONCLUSION

By capitalising on foundation physical/chemical properties, the proposed method allows to assess their long wear properties, irrespective of basal skin tone or foundation shade. It offers the advantage of appealing visuals for efficacy and to be less resource intensive than a clinical grading approach.

Modeling a low voltage ionization chamber based tomography system on ITER

Soft x-ray (SXR) tomography is a key diagnostic method for impurity transport study in tokamaks since it allows for local impurity density reconstruction. The International Thermonuclear Experimental Reactor (ITER) radiative environment in deuterium-deuterium and deuterium-tritium phases will limit the choices of SXR detector technologies, and gas detectors are one of the most promising solutions. In this paper, we, thus, investigate the SXR tomography possibilities on ITER using Low Voltage Ionization Chambers (LVICs). The study contains the development of a LVIC synthetic diagnostic and its application to estimate the LVIC tomographic capabilities in an ITER D-T scenario, including the influence of LVIC parameters and noise in the measurements.

Citizens' juries give verdict on whether private practice veterinarians should attend unvaccinated Hendra virus suspect horses

BACKGROUND

Hendra virus (HeV) is endemic in Australian flying foxes, posing a threat to equine and human health. Equine vaccination remains the most effective risk mitigation strategy. Many horses remain unvaccinated - even in higher-risk regions. Debate surrounding the vaccine's use is characterised by conflicting perspectives, misunderstanding and mistrust. Private veterinary practitioners are critical to early identification of public health risk through recognition, sampling and management of suspect-equine-HeV-cases. However, managing such cases can be burdensome, with some veterinarians opting not to attend unvaccinated horses or to abandon equine practice because of risk posed by HeV disease and liability.

OBJECTIVE

Ascertain the perspectives of informed citizens on what obligations (if any) private veterinarians have to attend unvaccinated horses with HeV or HeV-like disease.

METHODS

Three citizens' juries were tasked with considering approaches to managing HeV risk in Australia, including (reported here) roles and obligations of private veterinarians in responding to HeV-suspect-cases.

RESULTS

Jurors acknowledged that HeV management posed an important challenge for private veterinarians. A clear majority (27 of 31 jurors) voted that veterinarians should not be obliged to attend unvaccinated horses. All recognised that greater support for veterinarians should be a priority.

CONCLUSIONS

When informed of HeV risks and strategies for control and management, citizens appreciated the need to support veterinarians performing this critical 'One Health' role for public benefit. The current governance framework within which zoonotic disease recognition and response operates limits the contingency and scope for increasing support and efficacy of these important veterinary public health practices.

Knowledge, Attitudes and Practices of Australian Trainee Childcare Educators Regarding Their Role in the Feeding Behaviours of Young Children

Background: Early childhood (2-5 years) is acknowledged as a critical time for the establishment of healthy behaviours. The increasing number of children and amount of time spent in childcare provides strong rationale to explore the important role that childcare services and childcare educators play in influencing healthy eating behaviours of young children in their care. Methods: This study used a qualitative exploratory approach to describe the knowledge, attitudes and practices of Australian childcare trainee educators' regarding their role in the feeding of young children. Results: All participants agreed that feeding of young children was an important part of their role, but described challenges to the promotion of healthy eating and the adoption of responsive child feeding practices. These included personal beliefs and experiences with food, the bi-directional nature of child feeding, conflicting parental requests and/or unsupportive centre-based policies and procedures. Conclusion: Training about responsive child feeding practices within the childcare sector should include all childcare staff; aim to enhance relational efficacy and communication skills with parents; and empower childcare staff to lead organisational change. To support this, childcare centres need to provide coherent centre-based healthy eating policies inclusive of healthy food provision and desirable feeding practices.

Awake tracheal intubation in a suspected COVID-19 patient with critical airway obstruction

We report the airway management of a patient with suspected COVID-19 with impending airway obstruction requiring urgent surgical tracheostomy. To our knowledge, this is the first reported case of an awake tracheal intubation in a suspected COVID-19-positive patient. Various modifications were put in place during the awake tracheal intubation and surgical tracheostomy procedures to minimise aerosol generation from the patient, such as avoiding high-flow nasal oxygen, establishing conscious sedation with remifentanil before commencing airway topicalisation and avoiding transtracheal local anaesthetic infiltration. A multidisciplinary team discussion before performing the case highlighted aspects of both the airway management and the surgical procedure where particular care and modifications are required. There is a lack of national and international guidance for awake tracheal intubation and tracheostomy in COVID-19 cases. This report nevertheless addresses the key procedural modifications required.

Clinical evidences of benefits from an advanced skin care routine in comparison with a simple routine

BACKGROUND

The use of a skin care routine is commonly promoted by the cosmetic industry, yet there is a lack of clinical evidence to support this practice over the use of a single skin care product.

AIMS

In the present study, we aimed at showing the clinical benefits of using a comprehensive skin care routine vs a simple one.

METHODS

Skin micro-/macro-topographic, skin color, and superficial/deep hydration were collected at baseline and after 4 weeks of use, on forty-nine women randomly allocated to two groups. The first one followed the use of an advanced routine (AR: Cleanser/Toner/Eye cream/Serum/Day & Night cream), while the other group was instructed to use a simple routine (SR: Cleanser & Day cream).

RESULTS

Hemoglobin heterogeneity was found to be significantly reduced only in the SR group. However, the AR outperformed the SR when it comes to improving superficial hydration, deep hydration, skin roughness, mean pore area, melanin heterogeneity, and crow's feet wrinkle depth. A significant increase in skin brightness from baseline was only recorded when using the AR while both routines significantly improved the nasolabial wrinkles.

CONCLUSION

These findings advocate for using a relevant daily routine as it demonstrates the visible skin benefits over a short period, while driving the creation of habits for the prevention of aging signs.

Immunoaffinity Column Cleanup with Liquid Chromatography Using Post-Column Bromination for Determination of Aflatoxin B1 in Cattle Feed: Collaborative Study

A collaborative study was conducted to evaluate the effectiveness of an immunoaffinity column cleanup liquid chromatography (LC) method for determination of aflatoxin B1 in cattle feed at a possible future European regulatory limit (1 ng/g). The test portion was extracted with acetone–water (85 + 15), filtered, diluted with water, and applied to an immunoaffinity column. The column was washed with water to remove interfering compounds, and the purified aflatoxin B1 was eluted with methanol. Aflatoxin B1 was separated and determined by reversed-phase liquid chromatography (RP–LC) and detected by fluorescence after post column derivatization (PCD) involving bromination. PCD was achieved with either pyridinium hydrobromide perbromide (PBPB), used by 14 laboratories, or an electrochemical cell and addition of bromide to the mobile phase, used by 7 laboratories. Both derivatization techniques were not significantly different when compared by the t-test; the method was statistically evaluated for all laboratories together (bromination and PBPB). The cattle feed samples, both spiked and naturally contaminatedwithaflatoxinB1, were sent to 21 laboratories in 14 different countries (United States, Japan, and Europe). Test portions were spiked at levels of 1.2 and 3.6 ng/g for aflatoxin B1. Recoveries ranged from 74 to 157%. Based on results for spiked samples (blind pairs at 2 levels) as well as naturally con-taminated samples (blind pairs at 3 levels), the relative standard deviation for repeatability (RSDr) ranged from 5.9 to 8.7%. The relative standard deviation for reproducibility (RSDR) ranged from 17.5 to 19.6%. The method showed acceptable within-and between-laboratory precision for this matrix, as evidenced by HORRAT values, at the target levels of determination for aflatoxin B1. No major differences in RSD were observed, showing that the composition of the feeds was not a factor for the samples tested and that the method was applicable for all materials used.

DermaTOP Blue and Antera 3D as methods to assess cosmetic solutions targeting eyelid sagging

BACKGROUND

As the eye contour ages, the skin on the lid becomes lax often causing a voluminous protrusion where the superior palpebral sulcus begins to sag onto the upper eyelid. This sagging feature may present a novel anti-ageing target for cosmetic products when treating the eye area. A quantitative method to evaluate the volume of this sagging feature has not been previously established. We investigate the use of the DermaTOP fringe projector and Antera 3D Camera to this end.

METHODS

Eyelid topographic measurements were collected on 20 female volunteers aged 50-75 years with the DermaTOP and Antera 3D. The DermaTOP and Antera 3D measurements were assessed for reproducibility and product effect detection capabilities.

RESULTS

The DermaTOP and Antera 3D successfully measured sagging feature volume, demonstrated reproducibility of measurement and furthermore were suitably sensitive to allow for detection of sagging feature volume reduction after a single application of aqueous tightening serum. DermaTOP parameters were found to moderately correlated with the Antera 3D parameters.

CONCLUSION

Both the DermaTOP and Antera 3D allow for quantitative measurement of eyelid sagging feature volume and in-turn permit evaluation of anti-ageing cosmetic preparations targeting the eyelid.

B-53 Inefficient Clock-Checking is Associated with Reduced Prospective Memory Performance in Veterans with Blast-Related Mild Traumatic Brain Injury

Objective

We investigated whether clock-checking frequency during a prospective memory (PM) task differed between Veterans with reported histories of blast-related mild traumatic brain injury (mTBI) and Veteran Controls (VCs) without a history mTBI. We hypothesized that, compared to controls, the mTBI group would less frequently clock check. Additionally, we expected that reduced clock-checking would contribute to poorer time-based PM performance in the mTBI group.

Method

Twenty-seven Veterans (9 mTBI and 18 VC) with sufficient effort testing completed a structured TBI history interview, the Post-Traumatic Stress Disorder Checklist (PCL) and the Memory for Intentions Test (MIST) as a PM task. During MIST administration, examiners recorded clock-checking behavior each time a participant physically turned a digital clock to observe the current time.

Results

Compared to VCs, the mTBI group performed worse on the Time subscale of the MIST [Mean (SD) VC = 6.7 (1.1), mTBI = 5.7 (1.1), p < .05], and demonstrated significantly fewer clock-checks over the duration of the test [VC = 14.2(4.7), mTBI = 10.2 (3.4), p < .05]. Clock-checking significantly correlated with MIST Time subscale performance (r = .38, p < .05). Groups did not significantly differ in PCL scores, and PCL scores did not significantly correlate with clock-checking counts.

Conclusion

Our preliminary results are the first to show that clock-checking behavior may contribute to reduced performance on time-based PM tasks in Veterans with histories of mTBI. Specifically, our findings demonstrate that participants with mTBI employ an inefficient time monitoring strategy wherein infrequent clock checking contributes to poorer test performance. These findings suggest that strategies to improve clock checking may improve PM performance.

Design of the collection optics for the Core Plasma Thomson Scattering (CPTS) in ITER

In the ITER Core Plasma Thomson Scattering, the scattered light collection optics system is installed both inside and outside the diagnostic port under vacuum. The length of the optical path (∼6 m) and the need to shield the neutron and γ radiation increased the complexity of the system with the inclusion of multiple dog-legs, forcing the use of many elements with optical power. Multiple rounds of design have been required in order to satisfy iteratively the system requirements in terms of resolution, aberration, and shielding. The adoption of quasi-free-form reflective surfaces for several mirrors eventually allowed the correct compromise between all conflicting requirements.

Steady state magnetic sensors for ITER and beyond: Development and final design (invited)

The measurements of the magnetic field in tokamaks such as ITER and DEMO will be challenging due to the long pulse duration, high neutron flux, and elevated temperatures. The long duration of the plasma pulse makes standard techniques, such as inductive coils, prone to errors. At the same time, the hostile environment, with repairs possible only on blanket exchange, if at all, requires a robust magnetic sensor. This contribution presents the final design of novel, steady-state, magnetic sensors for ITER. A poloidal array of 60 sensors mounted on the vacuum vessel outer shell contributes to the measurement of the plasma current, plasma-wall clearance, low-frequency MHD modes and will allow for crosscheck with the outer-vessel inductive coils. Each sensor hosts a pair of bismuth Hall probes, themselves an outcome of extensive R&D, including neutron irradiations (to 10²³ n/m²), temperature cycling tests (73-473 K) and tests at high magnetic field (to 12 T). A significant effort has been devoted to optimize the sensor housing by design and prototyping. The production version features an indium-filled cell for in situ recalibration of the onboard thermocouple, vital for the interpretation of the Hall sensor measurement.

Simultaneous false aneurysm and arterio-venous fistula in the presence of a single wound

We describe a patient in whom a stab wound to the right supraclavicular fossa led to a subclavian artery false aneurysm and an arterio-venous fistula (AVF) between the right subclavian artery and the right internal jugular vein. The diagnosis was made clinically and with computerised tomographic angiography (CTA). Open vascular repair was successful. We postulate that this presentation was the result of the knife being inserted then partly withdrawn and reinserted at a different angle. This pattern of injury has been reported previously following central venous line insertion, but rarely following a stab injury.

A Descriptive Study of Antidepressant Prescribing In a Semi-Rural Practice

Aims Mental health conditions are increasingly encountered in general practice. The aim of this study was to review the antidepressant prescribing of this practice. Methods Health One analysis was used to search for patients prescribed antidepressants in the last 6 months and to generate a list of their antidepressant prescriptions over the last three years. Charts were reviewed to determine if these patients were reviewed by a GP in the last 6 months, and by psychiatry in the last year. Results Six hundred and two patients (7% of the practice adult population) were prescribed antidepressants in the last 6 months. Fifty-four percent (n=324) of patients have been on antidepressants for three years or more. Escitalopram was most frequently prescribed. 89% (n=535) were reviewed by a GP in the last 6 months, and 21% (n=127) were reviewed by psychiatry services in the last year. Discussion The majority of patients with mental health problems are being managed in primary care.