Search

Non-steroidal anti-inflammatory drugs (NSAIDs) have been widely used to treat inflammatory pain for decades. More recently, newer NSAIDs were developed to target the inducible isoform of cyclooxygenase (COX), COX-2, with the aim of reducing gastrointestinal toxicity. While the COX-2 selective inhibitors were effective in reducing pain and gastrointestinal harm, they soon were associated with an increased risk of adverse cardiovascular events. Initially, the view emerged that selective inhibition of COX-2, and sparing of COX-1, was responsible for the increased cardiovascular harm observed. However, as more data from different human populations has become available this view has begun to be challenged. This review examines the current understanding of the role of prostaglandins and COX-1 and COX-2, particularly in platelets, the vasculature, and the kidney together with an overview of the cardiovascular and renal safety of both traditional NSAIDs and COX-2 selective inhibitors. Available data from active comparator randomized controlled trials, including the data from the PRECISION trial investigating the long term cardiovascular safety of patients exclusively with elevated baseline cardiovascular risk, are presented. The data, when considered holistically, support the idea that all NSAIDs carry some level of cardiovascular risk, be they traditional NSAIDs or COX-2 selective agents. There is also some evidence of heterogeneity of effect with NSAIDs particularly in relation to effects on blood pressure, with no clear demarcation based on the degree of COX-2 selectivity.

In most smelting operations, there is a strong incentive to improve safety, reduce downtime and extend the campaigns of furnaces and related equipment. An asset management strategy that is based on information, rather than simple throughput metrics and intuition, can be developed to improve uptime and unlock value currently unrealized at existing smelters. Advances in digital technology, including data analysis, modelling and monitoring for hot pyro-metallurgical vessels, make it possible to assess the current condition of an asset, as well as to make more informed projections about its future condition, using on-line and historical data. This would allow practices around asset management to be more proactive and less reactive, with the end-result of optimized uptime. ‘Digital Asset Management’ describes a concept in which digital technology is used to support an asset management strategy and accelerate decision-making by providing information on what, why and how an asset should be designed, operated or maintained. With the overall goals of effective resource utilization, optimized operations, capital efficiency and social acceptance, Smelter 4.0 is a program of holistic improvement and is underpinned by the effective use of data to drive decisions. This paper focuses on Asset Reliability, which is one of the improvement pillars of Smelter 4.0, and introduces a methodology that is aimed at closing the gap between recorded data and evidence-based decision-making through Digital Asset Management.

In 2014, at the request of the Brazilian government and under the sponsorship of PAHO, the Cuban government sent 11,400 doctors to work in underserved areas. This article examines the origins and development of this programme, Mais Medicos. The significance of this programme is explored, as well as what it illustrates about south-south cooperation as a whole.

Background: Chronic use of non-steroidal anti-inflammatory drugs (NSAIDs) is associated with an increased risk of gastrointestinal (GI) toxicity, including occult blood loss and the development of clinically significant anaemia. Methods: 700 primary care physicians who routinely used NSAIDs to manage their patients were questioned to probe their understanding of the potential importance of blood loss in the OA populations they commonly treated with NSAIDs in a chronic fashion. Results: Approximately 50% of doctors surveyed measured their osteoarthritis patients’ haemoglobin routinely as part of a complete blood count (CBC). The remaining cohort of physicians only considered conducting CBCs if they believed there was cause for concern, with the most common reasons cited being anaemia/blood loss (90/80% of physicians respectively) or the patient showing signs of weakness and fatigue (78% of physicians). When all doctors were queried on their understanding of normal range of haemoglobin (Hb) values, as defined by the WHO, significant variation in the absolute figures were reported with approximately 40% of physicians citing a low end range for normal that would actually place the patient below the threshold for anaemia. Conclusion: Physician practice in relation to carrying out blood tests in OA patients and their understanding of the potential significance of specific results obtained, namely haemoglobin values, varies substantially across the countries surveyed. As NSAIDs form a pivotal part in the chronic treatment of osteoarthritis and are well recognised agents that can precipitate blood loss, guidelines may be needed to advise physicians as to when monitoring a patient’s haemoglobin levels may be appropriate.

Robotics is a key transformative technology that can revolutionize seismic acquisition in both land and marine applications. We are moving forward to develop, through the SpiceRack research initiative, an integrated autonomous seafloor acquisition system incorporating robotics-based technologies. The goal of this multi-year research collaboration is to move toward nodal seafloor acquisition operations that will match towed streamer costs and turnaround time, while at the same time will retain the technical advantages of OBN systems. Furthermore, the use of automation and robotics in seafloor acquisition will accomplish high productivity by adding a substantial number of AUVs and making it possible to conduct higher resolution surveys in a cost-effective manner employing any desired acquisition design. We believe that by 2020 the geophysical industry will be mature enough to accommodate robotics-based solutions which will become the seismic seafloor acquisition technology of choice.

Introduction Celecoxib is an effective treatment for pain associated with osteoarthritis. There are differences in patient demographics among ethnic groups, with Asian populations typically smaller in body size. As a consequence, there may be a perception that celecoxib is less effective, or has poorer tolerability in Asian patients. Methods This analysis compares data from two multicenter, randomized, double-blind, placebo-controlled, active-comparator trials of celecoxib for the treatment of osteoarthritis of the knee: one study in Asian patients and the other in a mixed population comprised mostly of non-Asian patients (from which Asian patients were excluded for this analysis). Each trial was of similar design, with patients randomized 2:2:1 to 6 weeks treatment with celecoxib 200 mg once daily, active comparator (naproxen 500 mg twice daily or ibuprofen 800 mg three times daily), or placebo. The primary efficacy endpoint in each trial was the change from baseline to week 6 in the Patient’s Assessment of Arthritis Pain, as measured on a visual analog scale. Results In total, 329 patients were included in the efficacy analysis, 179 in the Asian study and 150 in the non-Asian study. The Asian population was significantly older and smaller in body size (P

Objective To compare the efficacy and tolerability of celecoxib and ibuprofen for the treatment of knee osteoarthritis symptoms. Method In this 6-week, multicentre, double-blind, non-inferiority trial, patients were randomized to 200 mg celecoxib once daily, 800 mg ibuprofen three times daily or placebo. The primary outcome was non-inferiority of celecoxib to ibuprofen in Patient’s Assessment of Arthritis Pain (scored 0–100). Secondary outcomes included the Western Ontario and McMaster Universities (WOMAC) Osteoarthritis Index, Pain Satisfaction Scale, and upper gastrointestinal tolerability. Results A total of 388 patients were treated (celecoxib n = 153; ibuprofen n = 156; placebo n = 79). Mean difference (95% confidence interval) between celecoxib and ibuprofen in the Patient’s Assessment of Arthritis Pain was 2.76 (−3.38, 8.90). As the lower bound was greater than −10, celecoxib was non-inferior to ibuprofen. The WOMAC total score was significantly improved with celecoxib and ibuprofen, versus placebo. Patients receiving celecoxib were significantly more satisfied (versus placebo) in 10 of 11 measures on the Pain Satisfaction Scale versus three measures with ibuprofen. Upper gastrointestinal events were less frequent with celecoxib (1.3%) than ibuprofen (5.1%) or placebo (2.5%). Conclusion Celecoxib was well tolerated and as effective as ibuprofen for symptoms associated with knee osteoarthritis. ClinicalTrials.gov identifier NCT00630929

This paper discusses the use of deep auto encoder networks to find a compressed representation of an image, which can be used for visual navigation. Images reconstructed from the compressed representation are tested to see if they retain enough information to be used as a visual compass (in which an image is matched with another to recall a bearing/movement direction) as this ability is at the heart of a visual route navigation algorithm. We show that both reconstructed images and compressed representations from different layers of the auto encoder can be used in this way, suggesting that a compact image code is sufficient for visual navigation and that deep networks hold promise for finding optimal visual encodings for this task.

Background To evaluate the effectiveness of quetiapine extended release once daily in bipolar depression. Methods Double-blind, placebo-controlled study in acutely depressed adults with bipolar I or II disorder, with or without rapid cycling. Patients were randomized to 8 weeks of quetiapine extended release (XR) 300 mg daily monotherapy or placebo. The primary outcome measure was changed from baseline to Week 8 in MADRS total score. Results Quetiapine XR 300 mg once daily (N=133) showed significantly greater improvement in depressive symptoms compared with placebo (N=137) from Week 1 (p Limitations Fewer patients with bipolar II disorder included, only one fixed dose tested and the lack of an active comparator. Conclusions Quetiapine XR (300 mg) once daily monotherapy was significantly more effective than placebo for treating episodes of depression in bipolar I disorder, throughout the 8-week study, with significance observed as early as Day 7. Adverse events were consistent with the known effects of quetiapine.

Jaspers’ nosology is indebted to Immanuel Kant’s theory of knowledge. He drew the distinction of form and content from the Transcendental Analytic of Kant’s Critique of Pure Reason. The distinction is universal to all knowledge, including psychopathology. Individual experience is constituted by a form or category of the Understanding to give a determinate or knowable object classified into the generic type of a real disease entity. The application of form and content is limited by the boundaries of experience. Beyond this boundary are wholes whose conception requires Ideas of reason drawn from the Transcendental Dialectic. Wholes are regulated by Ideas of reason to give an object or schema of the Idea collected into ideal types of an ideal typical disease entity. Jaspers drew ideal types from Max Weber’s social theory. He anticipated that, as knowledge advanced, ideal typical disease entities would become real disease entities. By 1920, this had been the destiny of general paralysis as knowledge of its neuropathology, serology and microbiology emerged. As he presented the final edition of General Psychopathology in 1946, Jaspers was anticipating the transition of schizophrenia from ideal typical to real disease entity. Almost 70 years later, with knowledge of its aetiology still unclear, schizophrenia remains marooned as an ideal typical disease entity – still awaiting that crucial advance!

Diagnostics play an essential role for the successful operation of the ITER tokamak. They provide the means to observe control and to measure plasma during the operation of ITER tokamak. The components of the diagnostic system in the ITER tokamak will be installed in the vacuum vessel, in the cryostat, in the upper, equatorial and divertor ports, in the divertor cassettes and racks, as well as in various buildings. Diagnostic components that are placed in a high radiation environment are expected to operate for the life of ITER. There are approx. 45 diagnostic systems located on ITER. Some diagnostics incorporate direct or independently pumped extensions to maintain their necessary vacuum conditions. They require a base pressure less than 10 −7 Pa, irrespective of plasma operation, and a leak rate of less than 10 −10 Pa m 3 s −1 . In all the cases it is essential to maintain the ITER closed fuel cycle. These directly coupled diagnostic systems are an integral part of the ITER vacuum containment and are therefore subject to the same design requirements for tritium and active gas confinement, for all normal and accidental conditions. All the diagnostics, whether or not pumped, incorporate penetration of the vacuum boundary (i.e. window assembly, vacuum feedthrough etc.) and demountable joints. Monitored guard volumes are provided for all elements of the vacuum boundary that are judged to be vulnerable by virtue of their construction, material, load specification etc. Standard arrangements are made for their construction and for the monitoring, evacuating and leak testing of these volumes. Diagnostic systems are incorporated at more than 20 ports on ITER. This paper will describe typical and particular arrangements of pumped diagnostic and monitored guard volume. The status of the diagnostic vacuum systems, which are at the start of their detailed design, will be outlined and the specific features of the vacuum systems in ports and extensions will be described.

Extensive diagnostics systems will be installed on the ITER machine to provide the measurements necessary to control, evaluate and optimize plasma performance in ITER and to further the understanding of plasma physics. These include measurements of temperature, density, impurity concentration, and particle and energy confinement times. ITER diagnostic systems extend from the center of the Tokamak to the various diagnostic areas, where they are controlled and acquired data is processed. This mainly includes the areas such as ports, port cells, gallery, diagnostics enclosures and cubicle areas. The diagnostics port plugs encloses the front end of the diagnostic systems and the diagnostics building houses the diagnostics equipment, instrumentation and control cubicles. There are several systems providing services to diagnostics. These mainly include ITER buildings, electrical power services, cooling water services, Heating Ventilation and Air Conditioning (HVAC), vacuum services, liquid and gas distribution services, cable engineering, de-tritiation systems, control cubicles, etc. Requirements of these service systems have to be defined, even though many of the diagnostics are at an early stage of development. It is a real challenge to define and to design diagnostics systems considering the constraints imposed by these service systems. This paper summarizes the provision of these services to the individual diagnostics and diagnostics areas as well as the total requirements to a significant level of definition. It demonstrates the impact of this as a design restraint and requirement on both the diagnostics and the service systems as they are further specified, designed and procured.

Most of ITER's diagnostics will be provided with viewing lines (optical, microwave, spectroscopic) for the monitoring of key characteristics of the plasma or for the achievement of physical measurements inside the vacuum vessel. For many of them the nature of the physical signal transmitted through the viewing lines requires the implementation of window assemblies incorporating either Glass/Ceramic or Beryllium window. The main requirements of the Diagnostic Window Assemblies are the transmission of the signals without attenuation or disturbances, the containment of vacuum, the confinement of in-vessel radioactive materials. Although they are generally not in direct viewing of the plasma, they are exposed to severe environmental conditions in normal and accidental conditions. The concept chosen for ITER Diagnostic Window Assemblies is based on a system of two windows with a monitored interspace, largely inspired from previous large machine solutions. Such a system is able to satisfy the transmission and vacuum requirements. Although this capability has previously proven a high reliability level, ITER conditions, which are more stringent, impose the requirement for improvement of existing designs and even the development of novel solutions, in particular to assure the radioactive material confinement function, which must be met in all circumstances including all off-normal conditions. Moreover the qualification of these concepts shall meet the nuclear safety requirements, although non metallic and beryllium components are not covered by existing codes and standards. This paper presents designs of window assemblies for different diagnostics. It gives an update of the current R&D programme implemented to solve several technical issues specific to ITER. Finally it presents the approach to the demonstration that safety requirements will be met by these components, involving the development of ITER Practice for replaceable non-metallic windows.

ITER will have a set of 45 diagnostics to ensure controlled operation. Many of them are integrated in the ITER ports. This paper addresses the integration process of the diagnostic systems and the approach taken to enable coordinated progress. An overview of the Port Integration hardware introduces the various structures needed for hosting tenant systems inside ITER diagnostics ports. The responsibilities of the different parties involved (ITER Organization and the Domestic Agencies) are outlined. The main challenges for diagnostic port integration engineering are summarized. The plan for a common approach to design and manufacture of the supporting structures, in particular the Port Plug is detailed. A coordinated design including common components and a common approach for neutronic analyses is proposed. One particular port, the equatorial port 11, is used to illustrate the approach.

Diagnostic electrical services provide the electrical infrastructure to serve diagnostic components installed on the ITER tokamak. This infrastructure is composed of cables, connectors, cable tails, looms, conduits and feedthroughs. The diagnostic services offer as well a shelter for various instrumentations – vacuum vessel (VV), blanket and divertor. The diagnostic sensors are located on the inner and outer VV wall, on blanket shield modules, divertor cassettes and in port plugs. They require electrical cabling to extract the measurement and, in some cases, to supply electrical power to the sensors. These cables run from the sensors to feedthroughs on the VV and the port interspace or cryostat. The design and integration of all components that are part of diagnostic electrical services is an important engineering activity that is being challenged by the multiple requirements and constraints which have to be satisfied while at the same time delivering the required diagnostic performance. The positioning of the components must correlate not only with their functional specifications but also with the design of the major ITER components. This is a particular challenge because not all systems have reached the same level of design maturity. This paper outlines the engineering challenges of ITER diagnostics electrical services. The environmental conditions inside the VV will have an important impact. Leading risks to these components include poor electrical contact at connectors, the effects of exposure to nuclear irradiation, such as material transmutation, heating, and generation of spurious electrical signals etc., failure due to electromagnetic forces and electrical interference due to the noisy environment. Last but not least are the challenges for confinement and vacuum requirements set up on electrical feedthroughs. It will focus as well on the design and structural assessment of all components, and their requirements. Besides the integration limitations, the loads are the main design driver.

Summary Food and non-alcoholic beverage marketing is recognized as an important factor influencing food choices related to non-communicable diseases. The monitoring of populations’ exposure to food and nonalcoholic beverage promotions, and the content of these promotions, is necessary to generate evidence to understand the extent of the problem, and to determine appropriate and effective policy responses. A review of studies measuring the nature and extent of exposure to food promotions was conducted to identify approaches to monitoring food promotions via dominant media platforms. A step-wise approach, comprising ‘minimal’, ‘expanded’ and ‘optimal’ monitoring activities, was designed. This approach can be used to assess the frequency and level of exposure of population groups (especially children) to food promotions, the persuasive power of techniques used in promotional communications (power of promotions) and the nutritional composition of promoted food products. Detailed procedures for data sampling, data collection and data analysis for a range of media types are presented, as well as quantifiable measurement indicators for assessing exposure to and power of food and non-alcoholic beverage promotions. The proposed framework supports the development of a consistent system for monitoring food and non-alcoholic beverage promotions for comparison between countries and over time.

Summary A food supply that delivers energy-dense products with high levels of salt, saturated fats and trans fats, in large portion sizes, is a major cause of non-communicable diseases (NCDs). The highly processed foods produced by large food corporations are primary drivers of increases in consumption of these adverse nutrients. The objective of this paper is to present an approach to monitoring food composition that can both document the extent of the problem and underpin novel actions to address it. The monitoring approach seeks to systematically collect information on high-level contextual factors influencing food composition and assess the energy density, salt, saturated fat, trans fats and portion sizes of highly processed foods for sale in retail outlets (with a focus on supermarkets and quick-service restaurants). Regular surveys of food composition are proposed across geographies and over time using a pragmatic, standardized methodology. Surveys have already been undertaken in several high- and middle-income countries, and the trends have been valuable in informing policy approaches. The purpose of collecting data is not to exhaustively document the composition of all foods in the food supply in each country, but rather to provide information to support governments, industry and communities to develop and enact strategies to curb food-related NCDs.

Food prices and food affordability are important determinants of food choices, obesity and non-communicable diseases. As governments around the world consider policies to promote the consumption of healthier foods, data on the relative price and affordability of foods, with a particular focus on the difference between 'less healthy' and 'healthy' foods and diets, are urgently needed. This paper briefly reviews past and current approaches to monitoring food prices, and identifies key issues affecting the development of practical tools and methods for food price data collection, analysis and reporting. A step-wise monitoring framework, including measurement indicators, is proposed. 'Minimal' data collection will assess the differential price of 'healthy' and 'less healthy' foods; 'expanded' monitoring will assess the differential price of 'healthy' and 'less healthy' diets; and the 'optimal' approach will also monitor food affordability, by taking into account household income. The monitoring of the price and affordability of 'healthy' and 'less healthy' foods and diets globally will provide robust data and benchmarks to inform economic and fiscal policy responses. Given the range of methodological, cultural and logistical challenges in this area, it is imperative that all aspects of the proposed monitoring framework are tested rigorously before implementation.

This paper outlines a step-wise framework for monitoring foods and beverages provided or sold in publicly funded institutions. The focus is on foods in schools, but the framework can also be applied to foods provided or sold in other publicly funded institutions. Data collection and evaluation within this monitoring framework will consist of two components. In component I, information on existing food or nutrition policies and/or programmes within settings would be compiled. Currently, nutrition standards and voluntary guidelines associated with such policies/programmes vary widely globally. This paper, which provides a comprehensive review of such standards and guidelines, will facilitate institutional learnings for those jurisdictions that have not yet established them or are undergoing review of existing ones. In component II, the quality of foods provided or sold in public sector settings is evaluated relative to existing national or sub-national nutrition standards or voluntary guidelines. Where there are no (or only poor) standards or guidelines available, the nutritional quality of foods can be evaluated relative to standards of a similar jurisdiction or other appropriate standards. Measurement indicators are proposed (within ‘minimal’, ‘expanded’ and ‘optimal’ approaches) that can be used to monitor progress over time in meeting policy objectives, and facilitate comparisons between countries.

20 Global Alliance for Improved Nutrition (GAIN), Geneva, Switzerland Summary Non-communicable diseases (NCDs) dominate disease burdens globally and poor nutrition increasingly contributes to this global burden. Compre- hensive monitoring of food environments, and evaluation of the impact of public and private sector policies on food environments is needed to strengthen accountability systems to reduce NCDs. The International Network for Food and Obesity/NCDs Research, Monitoring and Action Support (INFORMAS) is a global network of public-interest organizations and researchers that aims to monitor, benchmark and support public and private sector actions to create healthy food environments and reduce obesity, NCDs and their related inequalities. The INFORMAS framework includes two 'process' modules, that monitor the policies and actions of the public and private sectors, seven 'impact' modules that monitor the key characteristics of food environments and three 'outcome' modules that monitor dietary quality, risk factors and NCD morbidity and mortality. Monitoring frameworks and indicators have been developed for 10 modules to provide consistency, but allowing for stepwise approaches ('minimal', 'expanded', 'optimal') to data collection and analysis. INFORMAS data will enable benchmarking of food environments between countries, and monitoring of progress over time within countries. Through monitoring and benchmarking, INFORMAS will strengthen the account- ability systems needed to help reduce the burden of obesity, NCDs and their related inequalities.

Private-sector organizations play a critical role in shaping the food environments of individuals and populations. However, there is currently very limited independent monitoring of private-sector actions related to food environments. This paper reviews previous efforts to monitor the private sector in this area, and outlines a proposed approach to monitor private-sector policies and practices related to food environments, and their influence on obesity and non-communicable disease (NCD) prevention. A step-wise approach to data collection is recommended, in which the first (‘minimal’) step is the collation of publicly available food and nutrition-related policies of selected private-sector organizations. The second (‘expanded’) step assesses the nutritional composition of each organization's products, their promotions to children, their labelling practices, and the accessibility, availability and affordability of their products. The third (‘optimal’) step includes data on other commercial activities that may influence food environments, such as political lobbying and corporate philanthropy. The proposed approach will be further developed and piloted in countries of varying size and income levels. There is potential for this approach to enable national and international benchmarking of private-sector policies and practices, and to inform efforts to hold the private sector to account for their role in obesity and NCD prevention.

The port-based plasma diagnostic infrastructure on ITER is described, including the port plugs, the interspace support structure and port cell structure. These systems are modular in nature with st...

Background Finding work is a top priority for most people; however, this goal remains out of reach for the majority of individuals with a severe mental illness (SMI) who remain on benefits or are unemployed. Supported employment (SE) programs aimed at returning people with a severe mental illness to work are successful; however, they still leave a significant number of people with severe mental illness unemployed. Cognitive deficits are commonly found in SMI and are a powerful predictor of poor outcome. Fortunately, these deficits are amenable to treatment with cognitive remediation therapy (CRT) that significantly improves cognition in SMI. CRT combined with SE significantly increases the likelihood of individuals with severe mental illness obtaining and staying in work. However, the availability of CRT is limited in many settings. Objective The aim of this study was to examine whether Web-based CRT combined with a SE program can improve the rate return to work of people with severe mental illness. Methods A total of 86 people with severe mental illness (mean age 39.6 years; male: n=55) who were unemployed and who had joined a SE program were randomized to either a Web-based CRT program (CogRem) or an Internet-based control condition (WebInfo). Primary outcome measured was hours worked over 6 months post treatment. Results At 6 months, those participants randomized to CogRem had worked significantly more hours (P=.01) and had earned significantly more money (P=.03) than those participants randomized to the WebInfo control condition. No change was observed in cognition. Conclusions This study corroborates other work that has found a synergistic effect of combining CRT with a SE program and extends this to the use of Web-based CRT. The lack of any improvement in cognition obscures the mechanism by which an improved wage outcome for participants randomized to the active treatment was achieved. However, the study substantially lowers the barrier to the deployment of CRT with other psychosocial interventions for severe mental illness. Trial Registration Australian and New Zealand Clinical Trials Registry (ANZCTR) 12611000849998; http://www.anzctr.org.au/TrialSearch.aspx?searchTxt=12611000849998&isBasic=True (Archived by WebCite at http://www.webcitation.org/6sMKwpeos)

Background Although there have been several large reviews documenting the complications following intraoperative transesophageal echocardiography (TEE), most of these prior reports are almost 2 decades old and may not reflect current practices. The purpose of this study was to determine the incidence and types of complications following TEE in a contemporary cardiac surgical population. Methods We conducted a retrospective analysis of all cardiac surgical patients having undergone an intraoperative TEE between April 1, 2004, and April 30, 2012. Patients with TEE-related complications were identified from our institutional cardiac surgical database to have their medical records manually reviewed through International Classification of Diseases-10th Revision coding for: 1) a priori defined complications including dysphagia, vocal cord and laryngeal injury, dysphonia, accidental puncture and laceration during a procedure, and hemorrhage and hematoma complicating a procedure; 2) the requirement for an in-hospital esophageal or bronchial endoscopy procedure; or 3) the requirement for postoperative specialist consultation from gastrointestinal bleed or other surgery services. A multivariable model was then developed to identify risk factors for TEE complications. Results Of the 7,954 cardiac surgical cases performed during the study period, 1,074 had their records manually reviewed and 111 (1.4%) patients had possible complications. Multivariate analysis showed an increased risk of complications associated with age, body mass index, previous stroke, procedure other than isolated coronary artery bypass grafting, cardiopulmonary bypass time, and return to the operating room for any reason (model c-statistic = 0.81). Conclusions The overall incidence of TEE complications after cardiac surgery was 1.4%. Advanced age, low body mass index, complexity of procedure, prior stroke, prolonged bypass time, and return to the operating room appear to be significant risk factors for TEE complications.

Objective: To evaluate gastrointestinal risk profiles in patients with osteoarthritis who are currently being treated, or who are candidates for treatment, with a non-steroidal anti-inflammatory drug. Methods: Patients with osteoarthritis treated by primary care physicians or physical and rehabilitation medicine (PRM) specialists in Belgium and Luxembourg were scored for gastrointestinal risk profile, low, moderate or high, based on the presence of gastrointestinal risk factors. These included advanced age, gastrointestinal history, comorbidities, medication use, smoking, and alcohol consumption. Use of gastro-protective agents (proton pump inhibitors) was also assessed. Results: A total of 190 primary care physicians and PRM specialists provided data on 885 patients. A large majority of patients were rated high-risk gastrointestinal (77.8%), with fewer moderate (19.4%) or low (2.8%) risk. The proportion of high-risk patients treated by PRM specialists was significantly lower than that treated by primary care physicians (64.7% vs 79.9%; p

This paper discusses the implementation of insect-inspired visual navigation strategies in flying robots, in particular focusing on the impact of changing height. We start by assessing the information available at different heights for visual homing in natural environments, comparing results from an open environment against one where trees and bushes are closer to the camera. We then test a route following algorithm using a gantry robot and show that a robot would be able to successfully navigate a route at a variety of heights using images saved at a different height.

The nuclear engineering infrastructure of port-based diagnostics on ITER is presented, including the equatorial and upper port plug generic designs, the adopted modular concept, the loads and associated load response and the remote handling. A modular approach is adopted for the internal shielding modules as this helps to reduce the dominant electromagnetic loads, reduces interfaces and accelerates remote handling. Extensive use of gun-drilling is employed to produce water channels in the stainless steel plate and forgings used to construct the port plugs and modules. The French Nuclear Code RCC-MR (2007) is employed in the design and the manufacturing. An integrated remote handling scheme is described, including a description of maintenance operations in the Hot Cell Facility.

The efficacy and feasibility of using zerovalent zinc (ZVZ) to treat 1,2,3-trichloropropane (TCP)-contaminated groundwater was assessed in laboratory and field experiments. In the first portion of the study, the reactivity of commercially available granular ZVZ toward TCP was measured in bench-scale batch-reactor and column experiments. These results were used to design columns for on-site pilot-scale treatment of contaminated groundwater at a site in Southern California. Two of the ZVZ materials tested were found to produce relatively high rates of TCP degradation as well as predictable behavior when scaling from bench-scale to field testing. In addition, there was little decrease in the rates of TCP degradation over the duration of field testing. Finally, no secondary impacts to water quality were identified. The results suggest that ZVZ may be an effective and feasible material for use in engineered treatment systems, perhaps including permeable reactive barriers.

Electromagnetic analysis of the ITER generic upper port plug was carried out to estimate the most severe load to which the in-vessel components would be subjected. Static and dynamic analyses based on expected EM loads were also performed to evaluate the structural behavior of the generic upper port plug. These analyses reveal that stress and displacement of the upper port plug structure exceed design guidelines when the structure is subjected to an upward fast VDE. Stiffening the upper port plug will decrease stress and the severity of potential displacement. The design of the middle part of the generic upper port plug was considered. Static and dynamic analyses for stress and displacement of the port plug indicate that the stiffened model satisfies structural design guidelines. Further improvements have been considered to achieve sufficient design margins for the generic upper port plug for ITER. A deep slit in the diagnostic first wall and the diagnostic shield module was designed to mitigate the EM load. Additional EM analysis confirmed the applicability of these proposals. Results confirm that the generic upper port plug structure is able to withstand plasma disruptions.

ITER diagnostic components are installed within the vacuum vessel, and in vacuum vessel ports at the upper, equatorial and divertor levels. The installation and integration issues are different in each of these 4 locations. In the divertor, diagnostic components are concentrated in the cassettes which are remote handleable through divertor ports. Of the 54 divertor cassettes, 16 are dedicated to various diagnostics. These include both optical diagnostics where light is relayed through the divertor ports, and electrical sensors. Diagnostic equipment in the divertor cassette itself is integrated in a protected housing, called a “mirror box” cooled with the cooling water of the divertor cassette. In the divertor ports, diagnostic equipment is installed in a diagnostic support structure called the diagnostic rack. Permanent cabling for instrumented and diagnostic cassettes is routed along the port.

ITER Diagnostic systems extend from plasma to the various diagnostic areas where they are controlled and acquired data is processed. Diagnostic equipment is found at three levels of the Tokamak Building, within 21 port cells, the gallery and also at three levels of Diagnostic Area. Diagnostic equipment is also located in other buildings, such as the Hot Cell Facility for neutron testing and port plug receipt and preparation. This paper describes the relationship of the ITER Diagnostics with the Buildings and highlights the design requirement and solutions of satisfying this interface acceptably to diagnostic and building performance.

ITER has diagnostics with machine protection, basic and advanced control, and physics roles. Several are distributed on the inner and outer periphery of the vacuum vessel. They have reduced maintainability compared to diagnostics in ports. They also endure some of the highest nuclear and EM loads of any diagnostic for the longest time. They include

ITER requires extensive diagnostic systems in order to meet the requirements for machine operation, protection, plasma control and physics studies. The realization of these systems is a major challenge not only because of the harsh environment and the nuclear requirements but also with respect to Instrumentation and Control (I&C) of all the 59 diagnostics plants. The Plant Systems I&C are mostly “in-kind”, i.e. procured by the seven ITER Domestic Agencies (DAs), while the Central I&C Systems are “in-fund”, i.e. procured by ITER Organization (IO). Standardization of Plant Systems I&C is of primary importance and has been one of the highest priority tasks of CODAC. The standards are published in the Plant Control Design Handbook (PCDH) [1] which will be followed to ensure a homogeneous design, guarantee high availability and simplify maintenance and support future upgrades. Most important for a successful commissioning and operation of the ITER facility are the concepts of interfacing the diagnostics plant systems with CODAC and the standards for instrumentation and control which must be followed all contributing parties. In this paper, we will elaborate on the concepts of interfacing the diagnostics plant systems with CODAC and the standards that must be followed for the design.

OBJECTIVE To evaluate the effect of a culturally sensitive diabetes self-management education program that uses a low-cost, peer-educator format (Project Dulce) on glucose control and metabolic parameters in low-income Mexican Americans with type 2 diabetes. RESEARCH DESIGN AND METHODS A total of 207 Mexican-American patients recruited from federally funded community health centers in San Diego County with HbA1c >8% were randomly assigned to the Project Dulce peer intervention or continuation of standard diabetes care. The primary outcome of interest was HbA1c. RESULTS The majority of subjects were born in Mexico, were female, were middle-aged, had less than an eighth-grade education, and had high baseline HbA1c levels. Significant time-by-group interaction effects for HbA1c (P = 0.02) and diastolic blood pressure (P = 0.04) indicated that the Project Dulce group exhibited greater improvement (i.e., decreases) across time. Within-group analyses showed that the intervention group exhibited significant improvements from baseline to month 4 in absolute levels of HbA1c (−1.7%, P = 0.001) and HDL cholesterol (+1.4 mg/dL, P = 0.01) and from baseline to month 10 in absolute levels of HbA1c (−1.5%, P = 0.01), total cholesterol (−7.2 mg/dL, P = 0.04), HDL cholesterol (+1.6 mg/dL, P = 0.01), and LDL cholesterol (−8.1 mg/dL, P = 0.02). No significant changes were noted in the control group. CONCLUSIONS This randomized trial, using the Project Dulce model of culturally sensitive, peer-led education, demonstrates improvement in glucose and metabolic control and suggests that this low-cost approach to self-management education for high-risk diabetic populations is effective.