| 1. |
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Overview of the JET results
- 2015
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Ingår i: Nuclear Fusion. - : IOP Publishing. - 0029-5515 .- 1741-4326. ; 55:10
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Tidskriftsartikel (refereegranskat)
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| 2. |
- Abel, I, et al.
(författare)
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Overview of the JET results with the ITER-like wall
- 2013
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Ingår i: Nuclear Fusion. - : IOP Publishing. - 1741-4326 .- 0029-5515. ; 53:10, s. 104002-
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Tidskriftsartikel (refereegranskat)abstract
- Following the completion in May 2011 of the shutdown for the installation of the beryllium wall and the tungsten divertor, the first set of JET campaigns have addressed the investigation of the retention properties and the development of operational scenarios with the new plasma-facing materials. The large reduction in the carbon content (more than a factor ten) led to a much lower Z(eff) (1.2-1.4) during L- and H-mode plasmas, and radiation during the burn-through phase of the plasma initiation with the consequence that breakdown failures are almost absent. Gas balance experiments have shown that the fuel retention rate with the new wall is substantially reduced with respect to the C wall. The re-establishment of the baseline H-mode and hybrid scenarios compatible with the new wall has required an optimization of the control of metallic impurity sources and heat loads. Stable type-I ELMy H-mode regimes with H-98,H-y2 close to 1 and beta(N) similar to 1.6 have been achieved using gas injection. ELM frequency is a key factor for the control of the metallic impurity accumulation. Pedestal temperatures tend to be lower with the new wall, leading to reduced confinement, but nitrogen seeding restores high pedestal temperatures and confinement. Compared with the carbon wall, major disruptions with the new wall show a lower radiated power and a slower current quench. The higher heat loads on Be wall plasma-facing components due to lower radiation made the routine use of massive gas injection for disruption mitigation essential.
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| 3. |
- Romanelli, F, et al.
(författare)
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Overview of the JET results
- 2011
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Ingår i: Nuclear Fusion. - : IOP Publishing. - 1741-4326 .- 0029-5515. ; 51:9
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Tidskriftsartikel (refereegranskat)abstract
- Since the last IAEA Conference JET has been in operation for one year with a programmatic focus on the qualification of ITER operating scenarios, the consolidation of ITER design choices and preparation for plasma operation with the ITER-like wall presently being installed in JET. Good progress has been achieved, including stationary ELMy H-mode operation at 4.5 MA. The high confinement hybrid scenario has been extended to high triangularity, lower ρ*and to pulse lengths comparable to the resistive time. The steady-state scenario has also been extended to lower ρ*and ν*and optimized to simultaneously achieve, under stationary conditions, ITER-like values of all other relevant normalized parameters. A dedicated helium campaign has allowed key aspects of plasma control and H-mode operation for the ITER non-activated phase to be evaluated. Effective sawtooth control by fast ions has been demonstrated with3He minority ICRH, a scenario with negligible minority current drive. Edge localized mode (ELM) control studies using external n = 1 and n = 2 perturbation fields have found a resonance effect in ELM frequency for specific q95values. Complete ELM suppression has, however, not been observed, even with an edge Chirikov parameter larger than 1. Pellet ELM pacing has been demonstrated and the minimum pellet size needed to trigger an ELM has been estimated. For both natural and mitigated ELMs a broadening of the divertor ELM-wetted area with increasing ELM size has been found. In disruption studies with massive gas injection up to 50% of the thermal energy could be radiated before, and 20% during, the thermal quench. Halo currents could be reduced by 60% and, using argon/deuterium and neon/deuterium gas mixtures, runaway electron generation could be avoided. Most objectives of the ITER-like ICRH antenna have been demonstrated; matching with closely packed straps, ELM resilience, scattering matrix arc detection and operation at high power density (6.2 MW m-2) and antenna strap voltages (42 kV). Coupling measurements are in very good agreement with TOPICA modelling. © 2011 IAEA, Vienna.
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| 4. |
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| 5. |
- Gurung, SC, et al.
(författare)
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The role of active case finding in reducing patient incurred catastrophic costs for tuberculosis in Nepal
- 2019
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Ingår i: Infectious diseases of poverty. - : Springer Science and Business Media LLC. - 2049-9957. ; 8:1, s. 99-
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Tidskriftsartikel (refereegranskat)abstract
- BackgroundThe World Health Organization (WHO) End TB Strategy has established a milestone to reduce the number of tuberculosis (TB)- affected households facing catastrophic costs to zero by 2020. The role of active case finding (ACF) in reducing patient costs has not been determined globally. This study therefore aimed to compare costs incurred by TB patients diagnosed through ACF and passive case finding (PCF), and to determine the prevalence and intensity of patient-incurred catastrophic costs in Nepal.MethodsThe study was conducted in two districts of Nepal: Bardiya and Pyuthan (Province No. 5) between June and August 2018. One hundred patients were included in this study in a 1:1 ratio (PCF: ACF, 25 consecutive ACF and 25 consecutive PCF patients in each district). The WHO TB patient costing tool was applied to collect information from patients or a member of their family regarding indirect and direct medical and non-medical costs. Catastrophic costs were calculated based on the proportion of patients with total costs exceeding 20% of their annual household income.The intensity of catastrophic costs was calculated using the positive overshoot method. The chi-square and Wilcoxon-Mann-Whitney tests were used to compare proportions and costs. Meanwhile, the Mantel Haenszel test was performed to assess the association between catastrophic costs and type of diagnosis.ResultsNinety-nine patients were interviewed (50 ACF and 49 PCF). Patients diagnosed through ACF incurred lower costs during the pre-treatment period (direct medical: USD 14 vs USD 32,P = 0.001; direct non-medical: USD 3 vs USD 10,P = 0.004; indirect, time loss: USD 4 vs USD 13,P < 0.001). The cost of the pre-treatment and intensive phases combined was also lower for direct medical (USD 15 vs USD 34,P = 0.002) and non-medical (USD 30 vs USD 54,P = 0.022) costs among ACF patients. The prevalence of catastrophic direct costs was lower for ACF patients for all thresholds. A lower intensity of catastrophic costs was also documented for ACF patients, although the difference was not statistically significant.ConclusionsACF can reduce patient-incurred costs substantially, contributing to the End TB Strategy target. Other synergistic policies, such as social protection, will also need to be implemented to reduce catastrophic costs to zero among TB-affected households.
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| 6. |
- Dixit, K, et al.
(författare)
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Barriers and facilitators to accessing tuberculosis care in Nepal: a qualitative study to inform the design of a socioeconomic support intervention
- 2021
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Ingår i: BMJ open. - : BMJ. - 2044-6055. ; 11:10, s. e049900-
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Tidskriftsartikel (refereegranskat)abstract
- Psychosocial and economic (socioeconomic) barriers, including poverty, stigma and catastrophic costs, impede access to tuberculosis (TB) services in low-income countries. We aimed to characterise the socioeconomic barriers and facilitators of accessing TB services in Nepal to inform the design of a locally appropriate socioeconomic support intervention for TB-affected households.DesignFrom August 2018 to July 2019, we conducted an exploratory qualitative study consisting of semistructured focus group discussions (FGDs) with purposively selected multisectoral stakeholders. The data were managed in NVivo V.12, coded by consensus and analysed thematically.SettingThe study was conducted in four districts, Makwanpur, Chitwan, Dhanusha and Mahottari, which have a high prevalence of poverty and TB.ParticipantsSeven FGDs were conducted with 54 in-country stakeholders, grouped by stakeholders, including people with TB (n=21), community stakeholders (n=13) and multidisciplinary TB healthcare professionals (n=20) from the National TB Programme.ResultsThe perceived socioeconomic barriers to accessing TB services were: inadequate TB knowledge and advocacy; high food and transportation costs; income loss and stigma. The perceived facilitators to accessing TB care and services were: enhanced championing and awareness-raising about TB and TB services; social protection including health insurance; cash, vouchers and/or nutritional allowance to cover food and travel costs; and psychosocial support and counselling integrated with existing adherence counselling from the National TB Programme.ConclusionThese results suggest that support interventions that integrate TB education, psychosocial counselling and expand on existing cash transfer schemes would be locally appropriate and could address the socioeconomic barriers to accessing and engaging with TB services faced by TB-affected households in Nepal. The findings have been used to inform the design of a socioeconomic support intervention for TB-affected households. The acceptability, feasibility and impact of this intervention on TB-related costs, stigma and TB treatment outcomes, is now being evaluated in a pilot implementation study in Nepal.
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| 7. |
- Dixit, K, et al.
(författare)
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Research protocol for a mixed-methods study to characterise and address the socioeconomic impact of accessing TB diagnosis and care in Nepal
- 2020
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Ingår i: Wellcome open research. - : F1000 Research Ltd. - 2398-502X. ; 5, s. 19-
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Tidskriftsartikel (refereegranskat)abstract
- Background: WHO’s 2015 End TB Strategy advocates social and economic (socioeconomic) support for TB-affected households to improve TB control. However, evidence concerning socioeconomic support for TB-affected households remains limited, especially in low-income countries. Protocol: This mixed-methods study in Nepal will: evaluate the socioeconomic impact of accessing TB diagnosis and care (Project 1); and create a shortlist of feasible, locally-appropriate interventions to mitigate this impact (Project 2). The study will be conducted in the Chitwan, Mahottari, Makawanpur, and Dhanusha districts of Nepal, which have frequent TB and poverty. The study population will include: approximately 200 people with TB (Cases) starting TB treatment with Nepal’s National TB Program and 100 randomly-selected people without TB (Controls) in the same sites (Project 1); and approximately 40 key in-country stakeholders from Nepal including people with TB, community leaders, and TB healthcare professionals (Project 2). During Project 1, visits will be made to people with TB’s households during months 3 and 6 of TB treatment, and a single visit made to Control households. During visits, participants will be asked about: TB-related costs (if receiving treatment), food insecurity, stigma; TB-related knowledge; household poverty level; social capital; and quality of life. During Project 2, stakeholders will be invited to participate in: a survey and focus group discussion (FGD) to characterise socioeconomic impact, barriers and facilitators to accessing and engaging with TB care in Nepal; and a one-day workshop to review FGD findings and suggest interventions to mitigate the barriers identified. Ethics and dissemination: The study has received ethical approval. Results will be disseminated through scientific meetings, open access publications, and a national workshop in Nepal. Conclusions: This research will strengthen understanding of the socioeconomic impact of TB in Nepal and generate a shortlist of feasible and locally-appropriate socioeconomic interventions for TB-affected households for trial evaluation.
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| 8. |
- Getahun, H, et al.
(författare)
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Management of latent Mycobacterium tuberculosis infection: WHO guidelines for low tuberculosis burden countries
- 2015
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Ingår i: The European respiratory journal. - : European Respiratory Society (ERS). - 1399-3003 .- 0903-1936. ; 46:6, s. 1563-1576
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Tidskriftsartikel (refereegranskat)abstract
- Latent tuberculosis infection (LTBI) is characterised by the presence of immune responses to previously acquired Mycobacterium tuberculosis infection without clinical evidence of active tuberculosis (TB). Here we report evidence-based guidelines from the World Health Organization for a public health approach to the management of LTBI in high risk individuals in countries with high or middle upper income and TB incidence of <100 per 100 000 per year. The guidelines strongly recommend systematic testing and treatment of LTBI in people living with HIV, adult and child contacts of pulmonary TB cases, patients initiating anti-tumour necrosis factor treatment, patients receiving dialysis, patients preparing for organ or haematological transplantation, and patients with silicosis. In prisoners, healthcare workers, immigrants from high TB burden countries, homeless persons and illicit drug users, systematic testing and treatment of LTBI is conditionally recommended, according to TB epidemiology and resource availability. Either commercial interferon-gamma release assays or Mantoux tuberculin skin testing could be used to test for LTBI. Chest radiography should be performed before LTBI treatment to rule out active TB disease. Recommended treatment regimens for LTBI include: 6 or 9 month isoniazid; 12 week rifapentine plus isoniazid; 3–4 month isoniazid plus rifampicin; or 3–4 month rifampicin alone.
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| 9. |
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| 10. |
- Herzan, A., et al.
(författare)
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Detailed spectroscopy of Bi-195
- 2017
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Ingår i: Physical Review C. - : American Physical Society. - 2469-9985 .- 2469-9993. ; 96:1
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Tidskriftsartikel (refereegranskat)abstract
- An experiment focused on the study of shape coexistence and new high-spin structures in Bi-195 has been performed. The nucleus is in a transitional region of the bismuth isotope chain. A large number of new states have been found, resulting in a significant extension of the previously known level scheme. Several new collective structures have been identified. A strongly coupled rotational band built upon the 13/2(+) isomeric state was extended up to I-pi = (49/2(+)) and an energy of 5706 keV. The I-pi = 31/2(+) member of the pi i(13/2) band was also found to feed a new long-lived isomeric state with an excitation energy of 2616 keV and a spin and parity of I-pi = 29/2(+). The half-life of the 29/2+ isomeric state was determined to be 1.49(1) mu s. It decays via the emission of 457-keV E2 and 236-keV E1 transitions, respectively. A low-energy 46-keV E2 transition has been identified to depopulate the (29/(2-)) isomeric state, with a measured half-life of T-1/2 = 614(5) ns. This transition allows the excitation energy of the isomeric state to be determined as 2381 keV. The feeding patterns of both 29/2(+) and (29/2(-)) isomeric states have also been described. This is the first time collective structures have also been observed up to high spins and excitation energies in the neutron-deficient Bi-195 nucleus. Evidence for the manifestation of shape coexistence in Bi-195 is also discussed.
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| 11. |
- Lonnroth, K, et al.
(författare)
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Towards tuberculosis elimination: an action framework for low-incidence countries
- 2015
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Ingår i: The European respiratory journal. - : European Respiratory Society (ERS). - 1399-3003 .- 0903-1936. ; 45:4, s. 928-952
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Tidskriftsartikel (refereegranskat)abstract
- This paper describes an action framework for countries with low tuberculosis (TB) incidence (<100 TB cases per million population) that are striving for TB elimination. The framework sets out priority interventions required for these countries to progress first towards “pre-elimination” (<10 cases per million) and eventually the elimination of TB as a public health problem (less than one case per million). TB epidemiology in most low-incidence countries is characterised by a low rate of transmission in the general population, occasional outbreaks, a majority of TB cases generated from progression of latent TB infection (LTBI) rather than local transmission, concentration to certain vulnerable and hard-to-reach risk groups, and challenges posed by cross-border migration. Common health system challenges are that political commitment, funding, clinical expertise and general awareness of TB diminishes as TB incidence falls. The framework presents a tailored response to these challenges, grouped into eight priority action areas: 1) ensure political commitment, funding and stewardship for planning and essential services; 2) address the most vulnerable and hard-to-reach groups; 3) address special needs of migrants and cross-border issues; 4) undertake screening for active TB and LTBI in TB contacts and selected high-risk groups, and provide appropriate treatment; 5) optimise the prevention and care of drug-resistant TB; 6) ensure continued surveillance, programme monitoring and evaluation and case-based data management; 7) invest in research and new tools; and 8) support global TB prevention, care and control. The overall approach needs to be multisectorial, focusing on equitable access to high-quality diagnosis and care, and on addressing the social determinants of TB. Because of increasing globalisation and population mobility, the response needs to have both national and global dimensions.
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| 12. |
- Nieminen, P., et al.
(författare)
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gamma-ray spectroscopy of Bi-191,Bi-193
- 2004
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Ingår i: Physical Review C. Nuclear Physics. - 0556-2813 .- 1089-490X. ; 69:6, s. 064326-
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Tidskriftsartikel (refereegranskat)abstract
- Prompt and delayed gamma rays from Bi-191,Bi-193 have been identified using the recoil-decay tagging, isomer tagging, and recoil gating techniques, resulting in extensive level schemes for both nuclei. Excitation energies of the isomeric 13/2(+) states have been established and oblate strongly coupled bands built on them have been observed. The nearly spherical 9/2(-) ground-state bands appear to be crossed by more oblate-deformed low-lying structures. The properties of the bands feeding the 1/2(+) intruder states indicate some structural change between Bi-193 and Bi-191. The deformation associated with each of these states has been extracted from total Routhian surface calculations which also reveal the development of prolate minima with decreasing neutron number. B(M1)/B(E2) ratios have been measured for the observed strongly coupled bands in order to resolve the intrinsic excitations. The observed quasiparticle structures in Bi-193 and high-spin isomers both in Bi-193 and Bi-191 are interpreted based on the coupling of the odd proton to the even-even Pb core.
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| 13. |
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| 14. |
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| 15. |
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| 16. |
- Alene, KA, et al.
(författare)
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Sequelae of multidrug-resistant tuberculosis: protocol for a systematic review and meta-analysis
- 2018
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Ingår i: BMJ open. - : BMJ. - 2044-6055. ; 8:2, s. e019593-
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Tidskriftsartikel (refereegranskat)abstract
- The sequelae of multidrug-resistant tuberculosis (MDR-TB) are poorly understood and inconsistently reported. We will aim to assess the existing evidence for the clinical, psychological, social and economic sequelae of MDR-TB and to assess the health-related quality of life in patients with MDR-TB.Methods and analysisWe will perform a systematic review and meta-analysis of published studies reporting sequelae of MDR-TB. We will search PubMed, SCOPUS, ProQuest, Web of Science and PsychINFO databases up to 5 September 2017. MDR-TB sequelae will include any clinical, psychological, social and economic effects as well as health-related quality of life that occur after MDR-TB treatment or illness. Two researchers will screen the titles and abstracts of all citations identified in our search, extract data, and assess the scientific quality using standardised formats. Providing there is appropriate comparability in the studies, we will use a random-effects meta-analysis model to produce pooled estimates of MDR-TB sequelae from the included studies. We will stratify the analyses based on treatment regimen, comorbidities (such as HIV status and diabetes mellitus), previous TB treatment history and study setting.Ethics and disseminationAs this study will be based on published data, ethical approval is not required. The final report will be disseminated through publication in a peer-reviewed scientific journal and will also be presented at relevant conferences.PROSPERO registration numberCRD42017073182.
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| 17. |
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| 18. |
- Biermann, O, et al.
(författare)
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Factors influencing active tuberculosis case-finding policy development and implementation: a scoping review
- 2019
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Ingår i: BMJ open. - : BMJ. - 2044-6055. ; 9:12, s. e031284-
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Tidskriftsartikel (refereegranskat)abstract
- To explore antecedents, components and influencing factors on active case-finding (ACF) policy development and implementation.DesignScoping review, searching MEDLINE, Web of Science, the Cochrane Database of Systematic Reviews and the World Health Organization (WHO) Library from January 1968 to January 2018. We excluded studies focusing on latent tuberculosis (TB) infection, passive case-finding, childhood TB and studies about effectiveness, yield, accuracy and impact without descriptions of how this evidence has/could influence ACF policy or implementation. We included any type of study written in English, and conducted frequency and thematic analyses.ResultsSeventy-three articles fulfilled our eligibility criteria. Most (67%) were published after 2010. The studies were conducted in all WHO regions, but primarily in Africa (22%), Europe (23%) and the Western-Pacific region (12%). Forty-one percent of the studies were classified as quantitative, followed by reviews (22%) and qualitative studies (12%). Most articles focused on ACF for tuberculosis contacts (25%) or migrants (32%). Fourteen percent of the articles described community-based screening of high-risk populations. Fifty-nine percent of studies reported influencing factors for ACF implementation; mostly linked to the health system (eg, resources) and the community/individual (eg, social determinants of health). Only two articles highlighted factors influencing ACF policy development (eg, politics). Six articles described WHO’s ACF-related recommendations as important antecedent for ACF. Key components of successful ACF implementation include health system capacity, mechanisms for integration, education and collaboration for ACF.ConclusionWe identified some main themes regarding the antecedents, components and influencing factors for ACF policy development and implementation. While we know much about facilitators and barriers for ACF policy implementation, we know less abouthowto strengthen those facilitators andhowto overcome those barriers. A major knowledge gap remains when it comes to understanding which contextual factors influence ACF policy development. Research is required to understand, inform and improve ACF policy development and implementation.
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| 19. |
- Biermann, O, et al.
(författare)
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'Power plays plus push': experts' insights into the development and implementation of active tuberculosis case-finding policies globally, a qualitative study
- 2020
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Ingår i: BMJ open. - : BMJ. - 2044-6055. ; 10:6, s. e036285-
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Tidskriftsartikel (refereegranskat)abstract
- To explore experts’ views on factors influencing national and global active case-finding (ACF) policy development and implementation, and the use of evidence in these processes.DesignThis is an exploratory study based on semistructured expert interviews. Framework analysis was applied.ParticipantsThe study involved a purposive sample of 39 experts from international, non-governmental and non-profit organisations, funders, government institutions, international societies, think tanks, universities and research institutions worldwide.ResultsThis study highlighted the perceived need among experts for different types of evidence for ACF policy development and implementation, and for stakeholder engagement including researchers and policymakers to foster evidence use. Interviewees stressed the influence of government, donor and non-governmental stakeholders in ACF policy development. Such key stakeholders also influence ACF policy implementation, in addition to available systems and processes in a given health system, and implementers’ motivation and incentives. According to the interviewees, the World Health Organization (WHO) guidelines for systematic screening face the innate challenge of providing guidance to countries across the broad area of ACF in terms of target groups, settings and screening algorithms. The guidelines could be improved by focusing on what should be done rather than what can be done in ACF, and by providing howto examples. Leadership, integration into health systems and long-term financing are key for ACF to be sustainable.ConclusionsWe provide new insights into ACF policy processes globally, particularly regarding facilitators for and barriers to ACF policy development, evidence need and use, and donor organisations’ influence. According to expert participants, national and global ACF policy development and implementation can be improved by broadening stakeholder engagement. Meanwhile, using diverse evidence to inform ACF policy development and implementation could mitigate the ‘power plays plus push’ that might otherwise disrupt and mislead these policy processes.
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| 20. |
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| 21. |
- Codlin, AJ, et al.
(författare)
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Independent evaluation of 12 artificial intelligence solutions for the detection of tuberculosis
- 2021
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Ingår i: Scientific reports. - : Springer Science and Business Media LLC. - 2045-2322. ; 11:1, s. 23895-
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Tidskriftsartikel (refereegranskat)abstract
- There have been few independent evaluations of computer-aided detection (CAD) software for tuberculosis (TB) screening, despite the rapidly expanding array of available CAD solutions. We developed a test library of chest X-ray (CXR) images which was blindly re-read by two TB clinicians with different levels of experience and then processed by 12 CAD software solutions. Using Xpert MTB/RIF results as the reference standard, we compared the performance characteristics of each CAD software against both an Expert and Intermediate Reader, using cut-off thresholds which were selected to match the sensitivity of each human reader. Six CAD systems performed on par with the Expert Reader (Qure.ai, DeepTek, Delft Imaging, JF Healthcare, OXIPIT, and Lunit) and one additional software (Infervision) performed on par with the Intermediate Reader only. Qure.ai, Delft Imaging and Lunit were the only software to perform significantly better than the Intermediate Reader. The majority of these CAD software showed significantly lower performance among participants with a past history of TB. The radiography equipment used to capture the CXR image was also shown to affect performance for some CAD software. TB program implementers now have a wide selection of quality CAD software solutions to utilize in their CXR screening initiatives.
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| 22. |
- de Vries, P. C., et al.
(författare)
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Effect of toroidal field ripple on plasma rotation in JET
- 2008
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Ingår i: Nuclear Fusion. - : IOP Publishing. - 0029-5515 .- 1741-4326. ; 48:3
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Tidskriftsartikel (refereegranskat)abstract
- Dedicated experiments on TF ripple effects on the performance of tokamak plasmas have been carried out at JET. The TF ripple was found to have a profound effect on the plasma rotation. The central Mach number, M, defined as the ratio of the rotation velocity and the thermal velocity, was found to drop as a function of TF ripple amplitude (3) from an average value of M = 0.40-0.55 for operations at the standard JET ripple of 6 = 0.08% to M = 0.25-0.40 for 6 = 0.5% and M = 0.1-0.3 for delta = 1%. TF ripple effects should be considered when estimating the plasma rotation in ITER. With standard co-current injection of neutral beam injection (NBI), plasmas were found to rotate in the co-current direction. However, for higher TF ripple amplitudes (delta similar to 1%) an area of counter rotation developed at the edge of the plasma, while the core kept its co-rotation. The edge counter rotation was found to depend, besides on the TF ripple amplitude, on the edge temperature. The observed reduction of toroidal plasma rotation with increasing TF ripple could partly be explained by TF ripple induced losses of energetic ions, injected by NBI. However, the calculated torque due to these losses was insufficient to explain the observed counter rotation and its scaling with edge parameters. It is suggested that additional TF ripple induced losses of thermal ions contribute to this effect.
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| 23. |
- de Vries, P. C., et al.
(författare)
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Effect of toroidal field ripple on the formation of internal transport barriers
- 2008
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Ingår i: Plasma Physics and Controlled Fusion. - : IOP Publishing. - 0741-3335 .- 1361-6587. ; 50:6
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Tidskriftsartikel (refereegranskat)abstract
- The effect of a toroidal field (TF) ripple on the formation and performance of internal transport barriers (ITBs) has been studied in JET. It was found that the TF ripple had a profound effect on the toroidal plasma rotation. An increased TF ripple up to delta = 1% led to a lower rotation and reduced the rotational shear in the region where the ITBs were formed. ITB triggering events were observed in all cases and it is thought that the rotational shear may be less important for this process than, for example, the q-profile. However, the increase in the pressure gradient following the ITB trigger was reduced in discharges with a larger TF ripple and consequently a lower rotational shear. This suggests that toroidal rotation and its shear play a role in the growth of the ITB once it has been triggered.
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| 24. |
- Gurung, SC, et al.
(författare)
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Comparative Yield of Tuberculosis during Active Case Finding Using GeneXpert or Smear Microscopy for Diagnostic Testing in Nepal: A Cross-Sectional Study
- 2021
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Ingår i: Tropical medicine and infectious disease. - : MDPI AG. - 2414-6366. ; 6:2
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Tidskriftsartikel (refereegranskat)abstract
- This study compared the yield of tuberculosis (TB) active case finding (ACF) interventions applied under TB REACH funding. Between June 2017 to November 2018, Birat Nepal Medical Trust identified presumptive cases using simple verbal screening from three interventions: door-to-door screening of social contacts of known index cases, TB camps in remote areas, and screening for hospital out-patient department (OPD) attendees. Symptomatic individuals were then tested using smear microscopy or GeneXpert MTB/RIF as first diagnostic test. Yield rates were compared for each intervention and diagnostic method. We evaluated additional cases notified from ACF interventions by comparing case notifications of the intervention and control districts using standard TB REACH methodology. The project identified 1092 TB cases. The highest yield was obtained from OPD screening at hospitals (n = 566/1092; 52%). The proportion of positive tests using GeneXpert (5.5%, n = 859/15,637) was significantly higher than from microscopy testing 2% (n = 120/6309). (OR = 1.4; 95%CI = 1.12–1.72; p = 0.0026). The project achieved 29% additionality in case notifications in the intervention districts demonstrating that GeneXpert achieved substantially higher case-finding yields. Therefore, to increase national case notification for TB, Nepal should integrate OPD screening using GeneXpert testing in every district hospital and scale up of community-based ACF of TB patient contacts nationally.
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| 25. |
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| 26. |
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| 27. |
- Herzmann, C, et al.
(författare)
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Radiological screening of refugees in Germany
- 2017
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Ingår i: The European respiratory journal. - : European Respiratory Society (ERS). - 1399-3003 .- 0903-1936. ; 49:5
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Tidskriftsartikel (övrigt vetenskapligt/konstnärligt)
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| 28. |
- Kranzer, K, et al.
(författare)
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Tuberculosis control
- 2016
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Ingår i: Lancet (London, England). - 1474-547X. ; 387:10024, s. 1159-1160
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Tidskriftsartikel (övrigt vetenskapligt/konstnärligt)
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| 29. |
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| 30. |
- Lonnroth, J. S., et al.
(författare)
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Effects of ripple-induced ion thermal transport on H-mode plasma performance
- 2007
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Ingår i: Plasma Physics and Controlled Fusion. - : IOP Publishing. - 0741-3335 .- 1361-6587. ; 49:3, s. 273-295
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Tidskriftsartikel (refereegranskat)abstract
- A recent series of dimensionless pedestal identity experiments at JET and JT-60U failed to produce a match in the dimensional pedestal parameters and edge-localized mode (ELM) frequency despite a good match in the main dimensionless plasma parameters. This paper describes the progress made in understanding these experimental results. First, it is investigated whether differences in the magnetohydrodynamic stability of the pedestal, including those potentially arising from the 10% difference in the aspect ratio between the two tokamaks, can explain the results. The potential effects of differences in plasma rotation between the two machines are also examined. Given the result that these mechanisms fail to explain the experimental observations and the fact that JT-60U features considerably stronger toroidal magnetic field ripple than JET, the bulk of the paper, however, discusses the effects of ripple losses. The analysis shows that ripple losses of thermal ions can affect H-mode plasma performance very sensitively. Orbit-following simulations indicate that losses due to diffusive transport give rise to a wide radial distribution of enhanced ion thermal transport, whereas non-diffusive losses have a very edge-localized distribution. In predictive transport simulations with an energy sink term in the continuity equation for the ion pressure representing non-diffusive losses, reduced performance as well as an increase in the ELM
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| 33. |
- Markenroth, Karin, 1973, et al.
(författare)
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Crossing the dripline to N-11 using elastic resonance scattering
- 2000
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Ingår i: Physical Review C - Nuclear Physics. - 2469-9985 .- 2469-9993. ; 6203:3
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Tidskriftsartikel (refereegranskat)abstract
- The level structure of the unbound nucleus N-11 has been studied by C-10+p elastic resonance scattering in inverse geometry with the LISE3 spectrometer at GANIL, using a C-10 beam with an energy of 9.0 MeV/ nucleon. An additional measurement was done at the A1200 spectrometer at MSU. The excitation function above the C-10+p threshold has been determined up to 5 MeV. A potential-model analysis revealed three resonance states at energies 1.27(-0.05)(+0.18) MeV (Gamma = 1.44 +/- 0.2 MeV), 2.01(-0.05)(+0.15) MeV (Gamma = 0.84 +/- 0.2 MeV), and 3.75 +/- 0.05 MeV (Gamma = 0.60 +/- 0.05 MeV) with the spin-parity assignments I-pi=1/2+,1/2,-,5/2+, respectively. Hence, N-11 is shown to have a ground state parity inversion completely analogous to its mirror partner Be-11. A narrow resonance in the excitation function at 4.33 +/- 0.05 MeV was also observed and assigned spin parity 3/2-.
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| 34. |
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| 35. |
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| 36. |
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| 37. |
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| 38. |
- Rai, B, et al.
(författare)
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Developing Feasible, Locally Appropriate Socioeconomic Support for TB-Affected Households in Nepal
- 2020
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Ingår i: Tropical medicine and infectious disease. - : MDPI AG. - 2414-6366. ; 5:2
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Tidskriftsartikel (övrigt vetenskapligt/konstnärligt)abstract
- Tuberculosis (TB), the leading single infectious diseases killer globally, is driven by poverty. Conversely, having TB worsens impoverishment. During TB illness, lost income and out-of-pocket costs can become “catastrophic”, leading patients to abandon treatment, develop drug-resistance, and die. WHO’s 2015 End TB Strategy recommends eliminating catastrophic costs and providing socioeconomic support for TB-affected people. However, there is negligible evidence to guide the design and implementation of such socioeconomic support, especially in low-income, TB-endemic countries. A national, multi-sectoral workshop was held in Kathmandu, Nepal, on the 11th and 12th September 2019, to develop a shortlist of feasible, locally appropriate socioeconomic support interventions for TB-affected households in Nepal, a low-income country with significant TB burden. The workshop brought together key stakeholders in Nepal including from the Ministry of Health and Population, Department of Health Services, Provincial Health Directorate, Health Offices, National TB Program (NTP); and TB/Leprosy Officers, healthcare workers, community health volunteers, TB-affected people, and external development partners (EDP). During the workshop, participants reviewed current Nepal NTP data and strategy, discussed the preliminary results of a mixed-methods study of the socioeconomic determinants and consequences of TB in Nepal, described existing and potential socioeconomic interventions for TB-affected households in Nepal, and selected the most promising interventions for future randomized controlled trial evaluations in Nepal. This report describes the activities, outcomes, and recommendations from the workshop.
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| 39. |
- Rai, B, et al.
(författare)
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Protocol for the Addressing the Social Determinants and Consequences of Tuberculosis in Nepal (ASCOT) pilot trial
- 2022
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Ingår i: Wellcome open research. - : F1000 Research Ltd. - 2398-502X. ; 7, s. 141-
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: The World Health Organization’s End TB (tuberculosis) Strategy advocates social and economic support for TB-affected households but evidence from low-income settings is scarce. We will evaluate the feasibility and acceptability of a locally-appropriate socioeconomic support intervention for TB-affected households in Nepal. METHODS: We will conduct a pilot randomised-controlled trial with mixed-methods process evaluation in four TB-endemic, impoverished districts of Nepal: Pyuthan, Chitwan, Mahottari, and Morang. We will recruit 128 people with TB notified to the Nepal National TB Program (NTP) and 40 multisectoral stakeholders including NTP staff, civil-society members, policy-makers, and ASCOT (Addressing the Social Determinants and Consequences of Tuberculosis) team members. People with TB will be randomised 1:1:1:1 to four study arms (n=32 each): control; social support; economic support; and combined social and economic (socioeconomic) support. Social support will be TB education and peer-led mutual-support TB Clubs providing TB education and stigma-reduction counselling. Economic support will be monthly unconditional cash transfers during TB treatment with expectations (not conditions) of meeting NTP goals. At 0, 2, and 6 months following TB treatment initiation, participants will be asked to complete a survey detailing the social determinants and consequences of TB and their feedback on ASCOT. Complementary process evaluation will use focus group discussions (FGD), key informant interviews (KII), and a workshop with multi-sectoral stakeholders to consider the challenges to ASCOT’s implementation and scale-up. A sample of ~100 people with TB is recommended to estimate TB-related costs. Information power is estimated to be reached with approximately 25 FGD and 15 KII participants. CONCLUSIONS: The ASCOT pilot trial will both generate robust evidence on a locally-appropriate, socioeconomic support intervention for TB-affected households in Nepal and inform a large-scale future ASCOT trial, which will evaluate the intervention’s impact on catastrophic costs mitigation and TB outcomes. The trial is registered with the ISRCTN (ISRCTN17025974).
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| 40. |
- Shuaib, YA, et al.
(författare)
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Smear Microscopy for Diagnosis of Pulmonary Tuberculosis in Eastern Sudan
- 2018
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Ingår i: Tuberculosis research and treatment. - : Hindawi Limited. - 2090-150X .- 2090-1518. ; 2018, s. 8038137-
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Tidskriftsartikel (refereegranskat)abstract
- Background. In Sudan, tuberculosis diagnosis largely relies on clinical symptoms and smear microscopy as in many other low- and middle-income countries. The aim of this study was to investigate the positive predictive value of a positive sputum smear in patients investigated for pulmonary tuberculosis in Eastern Sudan. Methods. Two sputum samples from patients presenting with symptoms suggestive of tuberculosis were investigated using direct Ziehl-Neelsen (ZN) staining and light microscopy between June to October 2014 and January to July 2016. If one of the samples was smear positive, both samples were pooled, stored at −20°C, and sent to the National Reference Laboratory (NRL), Germany. Following decontamination, samples underwent repeat microscopy and culture. Culture negative/contaminated samples were investigated using polymerase chain reaction (PCR). Results. A total of 383 samples were investigated. Repeat microscopy categorized 123 (32.1%) as negative, among which 31 were culture positive. This increased to 80 when PCR and culture results were considered together. A total of 196 samples were culture positive, of which 171 (87.3%), 14 (7.1%), and 11 (5.6%) were M. tuberculosis, M. intracellulare, and mixed species. Overall, 15.6% (57/365) of the samples had no evidence of M. tuberculosis, resulting in a positive predictive value of 84.4%. Conclusions. There was a discordance between the results of smear microscopy performed at local laboratories in the Sudan and at the NRL, Germany; besides, a considerable number of samples had no evidence of M. tuberculosis. Improved quality control for smear microscopy and more specific diagnostics are crucial to avoid possible overtreatment.
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| 41. |
- Tomeny, EM, et al.
(författare)
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TB morbidity estimates overlook the contribution of post-TB disability: evidence from urban Malawi
- 2022
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Ingår i: BMJ global health. - : BMJ. - 2059-7908. ; 7:5
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Tidskriftsartikel (refereegranskat)abstract
- Despite growing evidence of the long-term impact of tuberculosis (TB) on quality of life, Global Burden of Disease (GBD) estimates of TB-related disability-adjusted life years (DALYs) do not include post-TB morbidity, and evaluations of TB interventions typically assume treated patients return to pre-TB health. Using primary data, we estimate years of life lost due to disability (YLDs), years of life lost due to premature mortality (YLL) and DALYs associated with post-TB cardiorespiratory morbidity in a low-income country.MethodsAdults aged ≥15 years who had successfully completed treatment for drug-sensitive pulmonary TB in Blantyre, Malawi (February 2016–April 2017) were followed-up for 3 years with 6-monthly and 12-monthly study visits. In this secondary analysis, St George’s Respiratory Questionnaire data were used to match patients to GBD cardiorespiratory health states and corresponding disability weights (DWs) at each visit. YLDs were calculated for the study period and estimated for remaining lifespan using Malawian life table life expectancies. YLL were estimated using study mortality data and aspirational life expectancies, and post-TB DALYs derived. Data were disaggregated by HIV status and gender.ResultsAt treatment completion, 222/403 (55.1%) participants met criteria for a cardiorespiratory DW, decreasing to 15.6% after 3 years, at which point two-thirds of the disability burden was experienced by women. Over 90% of projected lifetime-YLD were concentrated within the most severely affected 20% of survivors. Mean DWs in the 3 years post-treatment were 0.041 (HIV-) and 0.025 (HIV+), and beyond 3 years estimated as 0.025 (HIV-) and 0.010 (HIV+), compared with GBD DWs of 0.408 (HIV+) and 0.333 (HIV-) during active disease. Our results imply that the majority of TB-related morbidity occurs post-treatment.ConclusionTB-related DALYs are greatly underestimated by overlooking post-TB disability. The total disability burden of TB is likely undervalued by both GBD estimates and economic evaluations of interventions, particularly those aimed at early diagnosis and prevention.
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| 42. |
- Viney, K, et al.
(författare)
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The Financial Burden of Tuberculosis for Patients in the Western-Pacific Region
- 2019
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Ingår i: Tropical medicine and infectious disease. - : MDPI AG. - 2414-6366. ; 4:2
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Tidskriftsartikel (refereegranskat)abstract
- The End Tuberculosis (TB) Strategy has the ambitious goal of ending the global TB epidemic by the year 2030, which is aligned to the Sustainable Development Goals. One of three high level indicators of the Strategy is the “catastrophic costs” indicator, which aims to determine the proportion of TB-affected households that incur TB-care related costs equivalent to 20% or more of their annual household income. The target is that zero percentage of TB-affected households will incur catastrophic costs related to TB care by the year 2020. In the Western Pacific Region of the World Health Organization, it is a priority to determine the financial burden of TB and then act to mitigate it. To date, eight countries in the Region have conducted nationally representative TB patient cost surveys to determine the costs of TB care. The results from four countries that have completed these surveys (i.e., Fiji, Mongolia, the Philippines, and Vietnam) indicate that between 35% and 70% of TB patients face catastrophic costs related to their TB care. With these results in mind, significant additional efforts are needed to ensure financial risk protection for TB patients, expand Universal Health Coverage, and improve access to social protection interventions. A multi-sectoral approach is necessary to achieve this ambitious goal by the year 2020.
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| 43. |
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| 44. |
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| 45. |
- Beurskens, M. N. A., et al.
(författare)
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Pedestal width and ELM size identity studies in JET and DIII-D; implications for ITER
- 2009
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Ingår i: Plasma Physics and Controlled Fusion. - : IOP Publishing. - 0741-3335 .- 1361-6587. ; 51:12, s. 124051-
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Tidskriftsartikel (refereegranskat)abstract
- The dependence of the H-mode edge transport barrier width on normalized ion gyroradius (rho* = rho/a) in discharges with type I ELMs was examined in experiments combining data for the JET and DIII-D tokamaks. The plasma configuration as well as the local normalized pressure (beta), collisionality (nu*), Mach number and the ratio of ion and electron temperature at the pedestal top were kept constant, while rho* was varied by a factor of four. The width of the steep gradient region of the electron temperature (T-e) and density (n(e)) pedestals normalized to machine size showed no or only a weak trend with rho*. A rho(1/2) or rho(1) dependence of the pedestal width, given by some theoretical predictions, is not supported by the current experiments. This is encouraging for the pedestal scaling towards ITER as it operates at lower rho* than existing devices. Some differences in pedestal structure and ELM behaviour were, however, found between the devices; in the DIII-D discharges, the n(e) and T-e pedestal were aligned at high rho* but the ne pedestal shifted outwards in radius relative to T-e as rho* decreases, while on JET the profiles remained aligned while rho* was scanned by a factor of two. The energy loss at an ELM normalized to the pedestal energy increased from 10% to 40% as rho* increased by a factor of two in the DIII-D discharges but no such variation was observed in the case of JET. The measured pedestal pressures and widths were found to be consistent with the predictions from modelling based on peeling-ballooning stability theory, and are used to make projections towards ITER
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| 46. |
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| 47. |
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| 48. |
- Collin, SM, et al.
(författare)
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Effectiveness of interventions for reducing TB incidence in countries with low TB incidence: a systematic review of reviews
- 2019
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Ingår i: European respiratory review : an official journal of the European Respiratory Society. - : European Respiratory Society (ERS). - 1600-0617. ; 28:152
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Tidskriftsartikel (refereegranskat)abstract
- What is the evidence base for the effectiveness of interventions to reduce tuberculosis (TB) incidence in countries which have low TB incidence?MethodsWe conducted a systematic review of interventions for TB control and prevention relevant to low TB incidence settings (<10 cases per 100 000 population). Our analysis was stratified according to “direct” or “indirect” effects on TB incidence. Review quality was assessed using AMSTAR2 criteria. We summarised the strength of review level evidence for interventions as “sufficient”, “tentative”, “insufficient” or “no” using a framework based on the consistency of evidence within and between reviews.ResultsWe found sufficient review level evidence for direct effects on TB incidence/case prevention of vaccination and treatment of latent TB infection. We also found sufficient evidence of beneficial indirect effects attributable to drug susceptibility testing and adverse indirect effects (measured as sub-optimal treatment outcomes) in relation to use of standardised first-line drug regimens for isoniazid-resistant TB and intermittent dosing regimens. We found insufficient review level evidence for direct or indirect effects of interventions in other areas, including screening, adherence, multidrug-resistant TB, and healthcare-associated infection.DiscussionOur review has shown a need for stronger evidence to support expert opinion and country experience when formulating TB control policy.
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| 49. |
- Collin, SM, et al.
(författare)
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Tuberculosis in the European Union and European Economic Area: a survey of national tuberculosis programmes
- 2018
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Ingår i: The European respiratory journal. - : European Respiratory Society (ERS). - 1399-3003 .- 0903-1936. ; 52:6
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Tidskriftsartikel (refereegranskat)abstract
- How many European Union (EU) and European Economic Area (EEA) countries have national tuberculosis (TB) control plans/strategies, and what are the priority actions/populations and barriers to implementation?In order to answer this question, a survey of EU/EEA national TB programme leads was undertaken.The response rate was 100% (31 countries). 55% of countries reported having a national TB strategy, all of which were in implementation; five countries were preparing a strategy. 74% had a defined organisational TB control structure with central coordination and 19% had a costed programme budget; few organisational structures included patient/civil society representation. The most frequently mentioned priority TB control actions were: reaching vulnerable population groups (80%), screening for active TB in high-risk groups (63%), implementing electronic registries (60%), contact tracing and outbreak investigation (60%), and tackling multidrug-resistant TB (60%). Undocumented migrants were the most commonly (46%) identified priority population. Perceived obstacles to implementation included barriers related to care recipients (lack of TB knowledge, treatment seeking/adherence), care providers (including need for specialist training of nurses and doctors) and health system constraints (funding, communication between healthcare and social care systems).This survey has provided an insight into TB control programmes across the EU/EEA that will inform the development of a TB strategy toolkit for member states.
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| 50. |
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