1. |
-
Overview of the JET results
- 2015
-
Ingår i: Nuclear Fusion. - : IOP Publishing. - 0029-5515 .- 1741-4326. ; 55:10
-
Tidskriftsartikel (refereegranskat)
|
|
2. |
- Romanelli, F, et al.
(författare)
-
Overview of the JET results
- 2011
-
Ingår i: Nuclear Fusion. - : IOP Publishing. - 1741-4326 .- 0029-5515. ; 51:9
-
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.
|
|
3. |
- Abel, I, et al.
(författare)
-
Overview of the JET results with the ITER-like wall
- 2013
-
Ingår i: Nuclear Fusion. - : IOP Publishing. - 1741-4326 .- 0029-5515. ; 53:10, s. 104002-
-
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.
|
|
4. |
|
|
5. |
|
|
6. |
- Herzan, A., et al.
(författare)
-
Detailed spectroscopy of Bi-195
- 2017
-
Ingår i: Physical Review C. - : American Physical Society. - 2469-9985 .- 2469-9993. ; 96:1
-
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.
|
|
7. |
- Virtanen, KA, et al.
(författare)
-
Differential effects of rosiglitazone and metformin on adipose tissue distribution and glucose uptake in type 2 diabetic subjects
- 2003
-
Ingår i: Diabetes. - : American Diabetes Association. - 0012-1797 .- 1939-327X. ; 52:2, s. 283-290
-
Tidskriftsartikel (refereegranskat)abstract
- We evaluated the effects of rosiglitazone (4 mg b.i.d.) and metformin (1 g b.i.d.) monotherapy for 26 weeks on adipose tissue insulin-stimulated glucose uptake in patients (n = 41) with type 2 diabetes. Before and after the treatment, glucose uptake was measured using 2-[18F]fluoro-2-deoxyglucose and positron emission tomography and adipose tissue masses were quantified using magnetic resonance imaging. Rosiglitazone improved insulin-stimulated whole-body glucose uptake by 44% (P < 0.01 vs. placebo). Mean body weight was unchanged in the rosiglitazone group, while it decreased by 2.0 kg in the metformin group (P < 0.05 vs. placebo). In visceral adipose tissue, glucose uptake increased by 29% (from 17.8 ± 2.0 to 23.0 ± 2.6 μmol · kg−1 · min−1, P < 0.05 vs. placebo) in the rosiglitazone group but to a lesser extent (17%) in the metformin group (from 16.2 ± 1.5 to 18.9 ± 1.7 μmol · kg−1 · min−1, P < 0.05 vs. baseline). Because the visceral adipose tissue mass simultaneously decreased with both treatments (P < 0.05), no change was observed in total visceral glucose uptake per depot. Rosiglitazone significantly enhanced glucose uptake in the femoral subcutaneous area, either when expressed per tissue mass (from 10.8 ± 1.2 to 17.1 ± 1.7 μmol · kg−1 · min−1, P < 0.01 vs. placebo) or per whole-fat depot (P < 0.05 vs. placebo). In conclusion, metformin treatment resulted in improvement of glycemic control without enhancement of peripheral insulin sensitivity. The improved insulin sensitivity of the nonabdominal subcutaneous adipose tissue during treatment with rosiglitazone partly explains the enhanced whole-body insulin sensitivity and underlies the central role of adipose tissue for action of peroxisome proliferator-activated receptor γ agonist in vivo.
|
|
8. |
- de Vries, P. C., et al.
(författare)
-
Effect of toroidal field ripple on the formation of internal transport barriers
- 2008
-
Ingår i: Plasma Physics and Controlled Fusion. - : IOP Publishing. - 0741-3335 .- 1361-6587. ; 50:6
-
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.
|
|
9. |
- Dixit, K, et al.
(författare)
-
Research protocol for a mixed-methods study to characterise and address the socioeconomic impact of accessing TB diagnosis and care in Nepal
- 2020
-
Ingår i: Wellcome open research. - : F1000 Research Ltd. - 2398-502X. ; 5, s. 19-
-
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.
|
|
10. |
- Getahun, H, et al.
(författare)
-
Management of latent Mycobacterium tuberculosis infection: WHO guidelines for low tuberculosis burden countries
- 2015
-
Ingår i: The European respiratory journal. - : European Respiratory Society (ERS). - 1399-3003 .- 0903-1936. ; 46:6, s. 1563-1576
-
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.
|
|
11. |
- Kurki-Suonio, T., et al.
(författare)
-
ASCOT simulations of fast ion power loads to the plasma-facing components in ITER
- 2009
-
Ingår i: Nuclear Fusion. - : IOP Publishing. - 0029-5515 .- 1741-4326. ; 49:9
-
Tidskriftsartikel (refereegranskat)abstract
- The wall loads due to fusion alphas as well as neutral beam injection-and ICRF-generated fast ions were simulated for ITER reference scenario-2 and scenario-4 including the effects of ferritic inserts (FIs), test blanket modules (TBMs), and 3D wall with two limiter structures. The simulations were carried out using the Monte Carlo guiding-centre orbit-following code ASCOT. The FIs were found very effective in ameliorating the detrimental effects of the toroidal ripple: the fast ion wall loads are reduced practically to their negligible axisymmetric level. The thermonuclear alpha particles overwhelmingly dominate the wall power flux. In scenario-4 practically all the power goes to the limiters, while in scenario-2 the load is fairly evenly divided between the divertor and the limiter, with hardly any power flux to other components in the first wall. This is opposite to earlier results, where hot spots were observed with 2D wall (Tobita et al 2003 Fusion Eng. Des. 65 561-8). In contrast, uncompensated ripple leads to unacceptable peak power fluxes of 0.5 MW m(-2) in scenario-2 and 1 MW m(-2) in scenario-4, with practically all power hitting the limiters and substantial flux arriving even at the unprotected first wall components. The local TBM structures were found to perturb the magnetic field structure globally and lead to increased wall loads. However, the TBM simulation results overestimate the TBM contribution due to an over-simplification in the vacuum field. Therefore the TBM results should be considered as an upper limit.
|
|
12. |
|
|
13. |
- Lonnroth, J. S., et al.
(författare)
-
Effects of ripple-induced ion thermal transport on H-mode plasma performance
- 2007
-
Ingår i: Plasma Physics and Controlled Fusion. - : IOP Publishing. - 0741-3335 .- 1361-6587. ; 49:3, s. 273-295
-
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
|
|
14. |
- Lonnroth, K, et al.
(författare)
-
Towards tuberculosis elimination: an action framework for low-incidence countries
- 2015
-
Ingår i: The European respiratory journal. - : European Respiratory Society (ERS). - 1399-3003 .- 0903-1936. ; 45:4, s. 928-952
-
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.
|
|
15. |
|
|
16. |
- Nieminen, P., et al.
(författare)
-
gamma-ray spectroscopy of Bi-191,Bi-193
- 2004
-
Ingår i: Physical Review C. Nuclear Physics. - 0556-2813 .- 1089-490X. ; 69:6, s. 064326-
-
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.
|
|
17. |
|
|
18. |
|
|
19. |
- Beurskens, M. N. A., et al.
(författare)
-
Pedestal width and ELM size identity studies in JET and DIII-D; implications for ITER
- 2009
-
Ingår i: Plasma Physics and Controlled Fusion. - : IOP Publishing. - 0741-3335 .- 1361-6587. ; 51:12, s. 124051-
-
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
|
|
20. |
|
|
21. |
|
|
22. |
- de Vries, P. C., et al.
(författare)
-
Effect of toroidal field ripple on plasma rotation in JET
- 2008
-
Ingår i: Nuclear Fusion. - : IOP Publishing. - 0029-5515 .- 1741-4326. ; 48:3
-
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.
|
|
23. |
- Dixit, K, et al.
(författare)
-
Barriers and facilitators to accessing tuberculosis care in Nepal: a qualitative study to inform the design of a socioeconomic support intervention
- 2021
-
Ingår i: BMJ open. - : BMJ. - 2044-6055. ; 11:10, s. e049900-
-
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.
|
|
24. |
- Gurung, SC, et al.
(författare)
-
The role of active case finding in reducing patient incurred catastrophic costs for tuberculosis in Nepal
- 2019
-
Ingår i: Infectious diseases of poverty. - : Springer Science and Business Media LLC. - 2049-9957. ; 8:1, s. 99-
-
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.
|
|
25. |
- JUTTINEN, S, et al.
(författare)
-
GAMMA-RAY SPECTROSCOPY OF CD-110
- 1994
-
Ingår i: Nuclear Physics A. - 0375-9474 .- 1873-1554. ; 573:2, s. 306-332
-
Tidskriftsartikel (refereegranskat)abstract
- The nucleus Cd-110 has been studied using the C-13 and O-18 induced reactions and the NORDBALL multi-detector array. The yrast band was observed to I(pi) = 28+ and a large number of side bands were identified. The h11/2 neutrons were found to play a dominant role in the observed rotational structures. The weakly populated yrast 3187 keV 8+ state is interpreted as arising from the proton g9/2(-2) configuration. Collective bands, where the band members are connected by DELTAI = 1 transitions and where the DELTAI = 2 transitions are not observed, are also reported. These bands are interpreted to have prolate configurations involving both the h11/2 neutrons and the g9/2 protons. The experimental data are discussed in terms of the total routhian surface and cranked shell model calculations.
|
|
26. |
- Juutinen, S, et al.
(författare)
-
Band structures in Ba-132
- 1995
-
Ingår i: PHYSICAL REVIEW C-NUCLEAR PHYSICS. - : AMER INST PHYSICS. ; 52:6, s. 2946-2954
-
Tidskriftsartikel (övrigt vetenskapligt/konstnärligt)abstract
- Excited states of Ba-132 were studied in an experiment utilizing the Sn-124(C-13,5n) reaction at a beam energy of 65.5 MeV. The level scheme of Ba-132 was considerably extended from what was previously known. Evidence is presented for neutron h(11/2) alig
|
|
27. |
|
|
28. |
|
|
29. |
- Markenroth, Karin, 1973, et al.
(författare)
-
Crossing the dripline to N-11 using elastic resonance scattering
- 2000
-
Ingår i: Physical Review C - Nuclear Physics. - 2469-9985 .- 2469-9993. ; 6203:3
-
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-.
|
|
30. |
|
|
31. |
|
|
32. |
|
|
33. |
- Rai, B, et al.
(författare)
-
Developing Feasible, Locally Appropriate Socioeconomic Support for TB-Affected Households in Nepal
- 2020
-
Ingår i: Tropical medicine and infectious disease. - : MDPI AG. - 2414-6366. ; 5:2
-
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.
|
|
34. |
- Rai, B, et al.
(författare)
-
Protocol for the Addressing the Social Determinants and Consequences of Tuberculosis in Nepal (ASCOT) pilot trial
- 2022
-
Ingår i: Wellcome open research. - : F1000 Research Ltd. - 2398-502X. ; 7, s. 141-
-
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).
|
|
35. |
|
|
36. |
|
|
37. |
|
|
38. |
- Viney, K, et al.
(författare)
-
The Financial Burden of Tuberculosis for Patients in the Western-Pacific Region
- 2019
-
Ingår i: Tropical medicine and infectious disease. - : MDPI AG. - 2414-6366. ; 4:2
-
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.
|
|
39. |
|
|
40. |
|
|