The motional Stark effect diagnostic for ITER.

An overview of the plans for the motional Stark effect (MSE) diagnostic installation on the International Thermonuclear Experimental Reactor (ITER) is presented. The MSE diagnostic uniquely provides spatially localized magnetic field measurements inside the plasma. These are used to constrain equilibrium reconstructions to determine q(r), the safety factor as a function of minor radius. Meeting the system requirements to deliver q-profiles and related quantities with the specified radial resolution of 20 points over the minor radius, 10 ms time resolution, and better than 10% accuracy is challenging. MSE systems observe the D/H-α emission near 656.3 nm from neutral beams. As the beam atoms traverse the magnetic field, B⃗, at high velocity, v⃗, they experience a Lorentz electric field, v⃗×B⃗, which causes the spectral emission to be split and polarized due to the Stark effect. Traditional MSE-LP (line polarization) measurements determine the direction of the magnetic field in the observation volume using polarimetric analysis of the detected light. The harsh conditions of ITER are expected to deposit thin films of contaminants on the first mirror, which would alter the polarization state of reflected light significantly. On ITER, the combination of high magnetic field strength and high energy beams makes the Stark spectrum resolution suitable for the determination of the magnetic field magnitude from the line shift, so this approach has been selected. Every aspect of the measurement system must be planned for the burning plasma environment and carefully analyzed ahead of time. Current status and plans for the system are presented.

Designing ITER motional Stark effect line shift (MSE-LS) spectrometers.

As a part of ITER beam aided diagnostics, the design of Motional Stark Effect (MSE) diagnostic observing the emission from the Balmer-α line is underway. The physics of Stark splitting shows that the Stark manifold is polarization dependent, and the energy splitting results in a line shift proportional to the electric field. Due to the challenges of maintaining the calibration of the plasma facing mirrors in ITER, the conventional MSE polarimetry measurement technique is replaced with a spectral approach that is deemed more favorable in the ITER environment. The MSE line shift (LS) diagnostic is designed to quantify the Lorentz electric field magnitude by measuring the Stark manifold using visible spectroscopy. In the presence of large magnetic fields and high energy heating beams of 1 MeV, the expected Stark splitting is much larger than in typical devices. The MSE-LS design has unique challenges requiring careful consideration and modeling of its viewing geometry and photon budget. The MSE-LS approach on ITER is promising but has stringent demands on the allowable errors for the statistical and systematic fitting uncertainties. In this study, a full system model and numerical simulations of data for each sightline are completed. For a range of optical transmission fractions, photon noise analysis is conducted to determine the statistical uncertainties. This provides guidance on the spectrometer throughput, dispersion at the detector, optics, and other design choices. A conceptual design of a high throughput spectrometer with a volume phase transmission grating is presented.

Sacral plexus catheter analgesia in a patient with traumatic sacral fractures and Tarlov cysts.

We report the use of a sacral plexus catheter for continuous local anaesthetic infusion in a patient with a unilateral sacral ala fracture following a fall from a horse. Although sacral plexus blockade has been well described for lower limb surgery, an ultrasound-guided continuous catheter technique for conservatively managed fractures has not been described. Despite appropriate oral analgesia, the patient reported severe pain, particularly in the right gluteal region, which meant she was unable to sit upright or take deep breaths. A sacral plexus catheter was inserted with ultrasound guidance and an initial bolus of 30 ml levobupivicaine 0.25% was delivered followed by infusion of 8 ml.h-1 levobupivicaine 0.125%. Daily follow-up and assessment were provided by the acute pain team. We judged the procedure to be a success as measured by an improvement in mobilisation, deep breathing, cough and patient satisfaction.

Psychological wellness and health-related stigma: a pilot study of an acceptance-focused cognitive behavioural intervention for people with lung cancer.

People with lung cancer experience health-related stigma that is related to poorer psychosocial and quality of life outcomes. The present Phase 1 study applied mixed methods to test the acceptability of an acceptance-focused cognitive behavioural intervention targeting stigma for this patient group. Fourteen lung cancer patients completed a 6-week Psychological Wellness intervention with pre- and post-test outcome measures of psychological and cancer-specific distress, depression, health-related stigma and quality of life. In-depth interviews applying interpretative phenomenological analysis assessed participants' experiences of the intervention. Moderate to large improvements were observed in psychological (ηp (2) = 0.182) and cancer-specific distress (ηp (2) = 0.056); depression (ηp (2) = 0.621); health-related stigma (ηp (2) = 0.139). In contrast, quality of life declined (ηp (2) = 0.023). The therapeutic relationship; self-management of distress; and relationship support were highly valued aspects of the intervention. Barriers to intervention included avoidance and practical issues. The lung cancer patients who completed the Psychological Wellness intervention reported improvements in psychological outcomes and decreases in stigma in the face of declining quality of life with patients reporting personal benefit from their own perspectives. A randomised controlled trial is warranted to establish the effectiveness of this approach.

Summary and highlights of the scientific tracks at the STI & AIDS World Congress 2013, Vienna.

The joint meeting of International Society for Sexually Transmitted Diseases Research (ISSTDR) and International Union against Sexually Transmitted Infections (IUSTI) was held in July 2013 in Vienna, Austria. The conference had attracted over 1300 submissions and was divided into six tracks. The track chairs reviewed all presentations and identified key themes and data that delegates should be aware of. In a conference summary session, each track chair presented these highlights. This conference report details and expands on this summary.

Increasing screening frequency in men who have sex with men: impact of guidance on risk profiling on workload and earlier diagnosis of sexually transmitted infection and HIV.

Increasing screening frequency in men who have sex with men (MSM) engaging in high-risk behaviours can reduce prevalence of sexually transmitted infections (STIs). This evaluation investigated the impact of applying stricter screening guidelines for MSM on service workload and earlier STI diagnoses. A validated risk assessment tool (RAT) was distributed to MSM attending a level 3 sexual health service over three months. Australian screening guidelines were applied to the data to identify MSM requiring more frequent screening and data projected to the larger MSM population. The RAT identified a 2-5-fold increase in the number of STI and HIV screenings required based on six- and three-monthly screening intervals, respectively, in the MSM cohort. When screening intervals are reduced from three-monthly to six-monthly there is a potential loss of 66.7% of earlier HIV diagnoses. The use of RATs will increase workload in sexual health services, but potentially diagnose a large proportion of disease earlier.

Measurements with magnetic field in the National Spherical Torus Experiment using the motional Stark effect with laser induced fluorescence diagnostic.

The motional Stark effect with laser-induced fluorescence diagnostic (MSE-LIF) has been installed and tested on the National Spherical Torus Experiment (NSTX) at the Princeton Plasma Physics Lab. The MSE-LIF diagnostic will be capable of measuring radially resolved profiles of magnetic field magnitude or pitch angle in NSTX plasmas. The system includes a diagnostic neutral hydrogen beam and a laser which excites the n = 2 to n = 3 transition. A viewing system has been implemented which will support up to 38 channels from the plasma edge to past the magnetic axis. First measurements of MSE-LIF signals in the presence of small applied magnetic fields in neutral gas are reported.

"Extreme" or tariff sports: their injuries and their prevention (with particular reference to diving, cheerleading, gymnastics, and figure skating).

The interface between sports medicine and performing arts medicine is closest for "tariff" sports, where the sportsperson can select their own programme of varying difficulty with the more complex skills carrying potential for higher marks. Inevitably, some performers over-reach themselves. Examples of injuries and prevention strategies to avoid such injuries are discussed in a preliminary analysis of four sports: diving, cheerleading, gymnastics, and figure skating.

Hypermobility in dance: asset, not liability.

Opinions vary on whether joint hypermobility is an asset or liability in dance. This paper argues that it is an asset, the arguments for its being a liability often confounded by inadequate scoring systems inappropriately applied. The ambiguity and distress this presents to dancers, the several different causes of joint hypermobility and the separate needs of the many different diverse styles of dance are all discussed. A strategy for the future care and training of hypermobile dancers is proposed.

Access to genitourinary medicine clinics: how long does it take to book an appointment by telephone?

A unique feature of genitourinary (GU) medicine clinics is that patients can book appointments themselves. The aim of this study was to assess how long it takes and the barriers that exist when making an appointment in a UK GU medicine clinic. Male and female researchers recorded the number of attempts needed to make a successful contact, how the call was dealt with, and the time taken for the call to be initially answered and then completed; 72% (479/666) of the telephone contacts were answered on the first attempt (range: 1-17). The median length of the total call was one minute 51 seconds (range: 15 seconds to eight minutes, six seconds) but male callers took a mean of 40 seconds longer to complete a call (P < 0.001), reflecting additional and often intrusive questions they were asked compared with female researchers. Care should be taken to ensure that the first point of contact with a clinic is favourable as it reflects on how an entire service may be perceived.

Patient views on examinations as part of asymptomatic screening in sexual health clinics.

Examinations of asymptomatic patients (AP) do not always take place in sexual health clinics, partly due to the evidence that clinically significant findings (not identified by urine and blood tests) are rarely found on examination of these patients. However, it is unclear from the literature as to whether patients, given the option, would choose to be examined when fully aware of what may be identified on examination as well as the frequency of positive findings. A total of 110 men attending a sexual health clinic who self-identified as asymptomatic were given a patient information sheet (PIS) describing the place and value (if any) of examinations in AP and were asked if they would like an examination. Of the 83 truly asymptomatic men with low sexual risk involved, 86% expressed the intention of having an examination having read the PIS.

Observation of multiple vibrational modes in ultrahigh vacuum tip-enhanced Raman spectroscopy combined with molecular-resolution scanning tunneling microscopy.

Multiple vibrational modes have been observed for copper phthalocyanine (CuPc) adlayers on Ag(111) using ultrahigh vacuum (UHV) tip-enhanced Raman spectroscopy (TERS). Several important new experimental features are introduced in this work that significantly advance the state-of-the-art in UHV-TERS. These include (1) concurrent sub-nm molecular resolution STM imaging using Ag tips with laser illumination of the tip-sample junction, (2) laser focusing and Raman collection optics that are external to the UHV-STM that has two cryoshrouds for future low temperature experiments, and (3) all sample preparation steps are carried out in UHV to minimize contamination and maximize spatial resolution. Using this apparatus we have been able to demonstrate a TERS enhancement factor of 7.1 × 10(5). Further, density-functional theory calculations have been carried out that allow quantitative identification of eight different vibrational modes in the TER spectra. The combination of molecular-resolution UHV-STM imaging with the detailed chemical information content of UHV-TERS allows the interactions between large polyatomic molecular adsorbates and specific binding sites on solid surfaces to be probed with unprecedented spatial and spectroscopic resolution.

European guideline for the management of genital herpes, 2010.

This is the guideline for genital herpes simplex virus (HSV) management for the IUSTI/WHO Europe, 2010. They describe the epidemiology, diagnosis, clinical features, treatment and prevention of genital HSV infection. They include details on the management of HSV in pregnancy, those who are immunocompromised and the clinical investigation and management of suspected HSV-resistant disease.

Preoperative chemoradiation for rectal cancer using capecitabine and celecoxib correlated with posttreatment assessment of thymidylate synthase and thymidine phosphorylase expression.

PURPOSE: Thymidylate synthase (TS) and thymidine phosphorylase (TP) expression have been shown to be predictors of response to therapy. The toxicity, efficacy, surgical morbidity, and immunohistochemical TS and TP expression were assessed in surgical resection specimens after preoperative chemoradiation. METHODS AND MATERIALS: Twenty patients with clinical stage I to III rectal adenocarcinoma received preoperative chemoradiation and underwent surgical resection 6 weeks later. RESULTS: Posttreatment tumor stages were T1 to T2 and N0 in 30% of patients; T3 to T4 and N0 in 30% of patients; and T1 to T3 and N1 to N2 in 15% of patients. Pathologic complete response (pCR) was evident in 25% and tumor regression occurred in a total of 80% of patients. Anal sphincter-sparing surgery was performed in 80% of cases. Acute and perioperative complications were minimal, with no grade 3/4 toxicity or treatment breaks. Pelvic control was obtained in 90% of patients. With a median follow-up of 65.5 months (range, 8-80 months), the 6-year actuarial survival rate was 75%. Local failure was significantly associated with nonresponse to therapy and with high TS and low TP expression (p = 0.008 and p = 0.04, respectively). CONCLUSIONS: The combination of capecitabine, celecoxib, and x-radiation therapy yields excellent response: a 25% pathologic pCR, no acute grade 3/4 toxicity, and minimal surgical morbidity. Nonresponders expressed significantly increased TS levels and decreased TP levels in posttreatment resection specimens compared to responders.

Do 'do not attends' at a genitourinary medicine service matter?

Patients who do not attend (DNA) clinic appointments are wasteful of resources and may also pose a potential public health risk through the onward transmission of untreated sexually transmitted infections (STIs). This service evaluation was performed to assess the demographics of DNAs, patient reasons for non-attendance and follows up data to determine the health outcomes of non-attendance. The genitourinary (GU) medicine clinic DNA rate between October 2008 and March 2009 was 6% (383/6961). Of the 383 patients who DNA'd their appointment successful telephone contact was made in 182 (48%) of them. Of these 40% of patients reported that they had forgotten they held an appointment; no patients reported that clinic opening hours prevented their attendance. Telephone contact increased GU medicine clinic attendance by 9% (35/383), but led to a greater number of subsequent DNAs; 43/75 (63%) of patients who accepted a further appointment DNA'd that appointment. Sending a SMS text message to patients who DNA notifying them of the time of walk-in services might be the most effective way of recapturing these patients without compromising future clinic appointment slots.

Sex dimorphic actions of rosiglitazone in generalised peroxisome proliferator-activated receptor-gamma (PPAR-gamma)-deficient mice.

AIMS/HYPOTHESIS: The aim of this study was to determine the dependency on peroxisome proliferator-activated receptor-gamma (PPAR-gamma) of insulin sensitisation and glucose homeostasis by thiazolidinediones using a global Ppar-gamma (also known as Pparg)-knockout mouse model. METHODS: Global Mox2-Cre-Ppar-gamma-knockout (MORE-PGKO) mice were treated with rosiglitazone and analysed for insulin sensitivity and glucose metabolism. Metabolic and hormonal variables were determined. Adipose and other tissues were measured and analysed for gene expression. RESULTS: Rosiglitazone induced regrowth of fat in female but not male MORE-PGKO mice, and only in specific depots. Insulin sensitivity increased but, surprisingly, was not associated with the typical changes in adipokines, plasma NEFA or tissue triacylglycerol. However, increases in alternatively activated macrophage markers, which have been previously associated with metabolic improvement, were observed in the regrown fat. Rosiglitazone improved glucose homeostasis but not insulin sensitivity in male MORE-PGKO mice, with further increase of insulin associated with an apparent expansion of pancreatic islets. CONCLUSIONS/INTERPRETATION: Stimulating fat growth by rosiglitazone is sufficient to improve insulin sensitivity in female mice with 95% PPAR-gamma deficiency. This increase in insulin sensitivity is not likely to be due to changes typically seen in adipokines or lipids but may involve changes in macrophage polarisation that occur independent of PPAR-gamma. In contrast, rosiglitazone improves glucose homeostasis in male mice with similar PPAR-gamma deficiency by increasing insulin production independent of changes in adiposity. Further, the insulin-sensitising effect of rosiglitazone is dependent on PPAR-gamma in this male lipodystrophic model.

Transient isolated lingual nerve neuropraxia associated with general anaesthesia and laryngeal mask use: two case reports and a review of the literature.

BACKGROUND: Transient, isolated lingual nerve neuropraxia is a rare complication following general anaesthesia. Reports implicate airway manipulation and we describe two new cases associated with laryngeal mask airway (LMA) and review the related English language literature. RESULTS: Unilateral numbness and loss of taste on the anterior tongue were the characteristic symptoms. Collation of literature data (median and range) with that from the new cases showed: patient age was 38 (20-61) years and female to male ratio was 1.2:1. Surgery time was 62.5 (20-150) min and symptom duration was 28 (7-120) days. CONCLUSION: Lingual neuropraxias reported have been transient and patients can be advised, despite disturbing symptoms, that recovery is anticipated in about 1 month. Lingual neuropraxia reports are becoming more frequent, perhaps associated with increasing LMA use. Research is recommended as modification to LMA cuff volume, pressure and/or position within the oral cavity might ameliorate the entity.

Contraceptive use among women attending an open access genitourinary medicine department.

Termination of pregnancy rates among young women are rising in the UK and are associated with poor use of reliable contraceptive methods. Many women attending the genitourinary (GU) department for sexually transmitted infection screening do so because of poor or no condom use and are at ongoing risk of unwanted pregnancy. Few of these women attend a contraception clinic, where a full range of contraceptive methods, including long-acting reversible contraception, are available. In this study of 152 women of reproductive age, half stated that they needed further contraceptive advice. In total four-fifths of the women without a reliable method of contraception wanted contraceptive advice and/or future contraceptive provision in the GU medicine clinic.

The motional Stark effect diagnostic for ITER using a line-shift approach.

The United States has been tasked with the development and implementation of a motional Stark effect (MSE) system on ITER. In the harsh ITER environment, MSE is particularly susceptible to degradation, as it depends on polarimetry, and the polarization reflection properties of surfaces are highly sensitive to thin film effects due to plasma deposition and erosion of a first mirror. Here we present the results of a comprehensive study considering a new MSE-based approach to internal plasma magnetic field measurements for ITER. The proposed method uses the line shifts in the MSE spectrum (MSE-LS) to provide a radial profile of the magnetic field magnitude. To determine the utility of MSE-LS for equilibrium reconstruction, studies were performed using the ESC-ERV code system. A near-term opportunity to test the use of MSE-LS for equilibrium reconstruction is being pursued in the implementation of MSE with laser-induced fluorescence on NSTX. Though the field values and beam energies are very different from ITER, the use of a laser allows precision spectroscopy with a similar ratio of linewidth to line spacing on NSTX as would be achievable with a passive system on ITER. Simulation results for ITER and NSTX are presented, and the relative merits of the traditional line polarization approach and the new line-shift approach are discussed.

Should men with asymptomatic non-specific urethritis be identified and treated?

There is currently a debate as to whether microscopy is necessary in asymptomatic men presenting for a sexual health screen. Arguments favouring microscopy include finding chlamydia in a significant proportion of sexual partners of men with non-specific urethritis (NSU) in studies that included symptomatic men. We aimed to investigate the proportion of partners of men with asymptomatic NSU who were diagnosed with a sexually transmitted infection. A retrospective case-note review was carried out for all men diagnosed with asymptomatic pathogen-negative NSU, and their traced sexual contacts, during a nine-month period. As a result of contact-tracing, we identified 42 partners who attended the clinic. Only one partner (2.4%) tested positive for chlamydia. A further two partners were diagnosed with a viral sexually transmitted infection (STI). The low level of chlamydia and other STIs in partners of asymptomatic men with pathogen-negative NSU does not support the routine use of microscopy to identify these patients.