Colonoscopy skills improvement training improves patient comfort during colonoscopy.

INTRODUCTION: We aimed to assess the effect of Colonoscopy Skills Improvement (CSI) training on patient comfort and sedation-related complications during colonoscopy. METHODS: This retrospective cohort study was performed on 19 endoscopists practicing in a Canadian tertiary care center who completed CSI training between October 2014 and May 2016. Data from 50 procedures immediately prior to, immediately after, and eight months following CSI training were included for each endoscopist. The primary outcome variable was intraprocedural comfort, and secondary outcomes included intraprocedural hypotension and hypoxia. Data were extracted from an electronic medical record and analyzed using SPSS version 20.0. Univariate analysis and stepwise multivariable logistic regression were performed to determine if there was an association between patient comfort and CSI training. Predictors of these outcomes including patient age, gender, sedation use and dosing, procedure completion, quality of bowel preparation, endoscopist experience, and specialty were included in the analysis. RESULTS: 2533 colonoscopies were included in the study. The mean dose of sedatives was reduced immediately following CSI training and at 8 months for both Fentanyl (75.4 mcg v. 67.8 mcg v. 65.9 mcg, p < 0.001) and Midazolam (2.57 mg v. 2.27 mg v. 2.19 mg, p < 0.001). The percentage of patients deemed to have a comfortable exam improved following endoscopist participation in CSI training and remained improved at 8 months (55.1% v. 70.2% v. 69.8%, p < 0.001). No significant change in rates of intraprocedural hypoxia or hypotension were noted following CSI training. CONCLUSION: CSI training is associated with improved patient comfort and reduced sedation requirements during colonoscopy.

Trumpet sounds emitted by male sperm whales in the Mediterranean Sea.

Sperm whale trumpets are sounds only occasionally documented, with a well recognisable and stereotyped acoustic arrangement. This study investigated the acoustic features of the trumpets and the context in which these sounds were recorded, using acoustic data collected over 22 years, in the Pelagos Sanctuary area (North-Western Mediterranean Sea). Analysed trumpets (n = 230), recorded at the beginning of a dive after the whale fluke-up, comprised a series of acoustic units organized in short sequences. Acoustic parameters were derived for the entire trumpet and for each distinguishable unit in a trumpet. Overall, trumpet durations and their initial frequencies were higher in recordings collected when multiple whales were visually or acoustically detected in the observation area. The identity of 68 whales was assessed through photo-identification, with 29 individuals producing trumpets within and between years. The variability of the acoustic parameters appeared to be higher within the same individuals rather than between different individuals, suggesting an individual plasticity in composing and arranging units in a trumpet. Different click patterns were observed before and after the trumpets, with more complex sequences when (1) other whales were visually/acoustically detected, and (2) individuals were in suitable foraging sites (i.e., canyon areas). Trumpets were commonly followed or preceded by click patterns suited for communication, such as codas and/or slow clicks. Significant relations between the trumpet emission and the male-only long-range communication click pattern (i.e. slow clicks) emerged, supporting the hypothesis that a trumpet is a sound emitted by maturing/mature males in feeding grounds. This study provides the first evidence that trumpets were conserved in the sperm whale acoustic repertoire at the decadal timescale, persisting across years and individuals in the same area. This persistence may be functionally specific to foraging activities performed by males in a well-established feeding area.

Reteporella spp. success in the re-colonization of bare coralligenous reefs impacted by Costa Concordia shipwreck: The pioneer species you did not expect.

We report here for the first time the effectiveness of Reteporella bryozoan genus in the early stage of coralligenous reefs recolonization through the analysis of the settlement and the population size structure over a two-years period at two impacted and two control sites. Results highlighted how Reteporella spp. colonies strongly recolonized, from 2017 to 2019, the bare coralligenous reefs subjected to the Costa Concordia shipwreck and its related anthropogenic disturbances, notably increasing both their density and percentage coverage. We recorded differences in colony size among impacted and control sites. Overall, large-sized colonies were reported at impacted sites exclusively, where Reteporella settlement and growth patterns differed if compared to control areas. This study highlights implications for the maintenance of the ecological functions, for the recovery processes, and for the future ecological shifts affecting one of the most important Mediterranean coastal ecosystems, the coralligenous reefs.

Radio frequency measurements of energetic-particle-driven emission using the ion cyclotron emission diagnostic on the DIII-D tokamak.

The Ion Cyclotron Emission (ICE) diagnostic on the DIII-D tokamak consists of two outboard midplane systems. In the first system, straps of an ion cyclotron range of frequencies antenna are configured as receiving antennas. For the second system, dedicated magnetic probes incorporated into the outer wall of carbon tiles have recently been restored. These systems collected a large set of radio frequency measurements in the 2015-2018 experimental campaigns by digitizing signals at 200 MSamples/s for ∼5 s per discharge. Each shot typically yields 32 GB of data; techniques for successful handling and analysis of this challengingly large dataset are discussed. The raw voltage fluctuations (<0.2 V and <1 mW) are analyzed in frequency space via fast Fourier transforms. Signals can be analyzed between 1 and 200 MHz with appropriate filtering and aliasing; this frequency range is limited by DC breaks used to provide 5 kV DC isolation. These high-frequency signals are driven by energetic ions and electrons. In particular, energetic-ion-driven ICE occurs at harmonics of the ion cyclotron frequency, enabling the frequency to be mapped to lab space via equilibrium reconstruction. In many DIII-D plasmas, ICE is emitted from the radial center of the plasma.

Spatiotemporal Evolution of Runaway Electron Momentum Distributions in Tokamaks.

Novel spatial, temporal, and energetically resolved measurements of bremsstrahlung hard-x-ray (HXR) emission from runaway electron (RE) populations in tokamaks reveal nonmonotonic RE distribution functions whose properties depend on the interplay of electric field acceleration with collisional and synchrotron damping. Measurements are consistent with theoretical predictions of momentum-space attractors that accumulate runaway electrons. RE distribution functions are measured to shift to a higher energy when the synchrotron force is reduced by decreasing the toroidal magnetic field strength. Increasing the collisional damping by increasing the electron density (at a fixed magnetic and electric field) reduces the energy of the nonmonotonic feature and reduces the HXR growth rate at all energies. Higher-energy HXR growth rates extrapolate to zero at the expected threshold electric field for RE sustainment, while low-energy REs are anomalously lost. The compilation of HXR emission from different sight lines into the plasma yields energy and pitch-angle-resolved RE distributions and demonstrates increasing pitch-angle and radial gradients with energy.

Italy introduces pre and post operation monitoring phases for offshore seismic exploration activities.

Concern is growing that marine fauna can be affected by noise such as naval sonar, pile driving or geophysical surveys, among others. Literature reports a variety of animal reactions to human noise (from apparently null or negligible to strong). However, conclusive results on its effects on marine mammals at individual and population level are still lacking. In 2015, the Italian Environmental Impact Assessment Commission mandated seismic operators apply a standard scientific protocol comparing marine mammal presence before, during, and after offshore seismic survey. For 60days before and after the survey, marine mammals are monitored using visual and acoustic methods. One or more acoustic autonomous recorders, depending on area size, must also be deployed throughout the three phases for continuous monitoring. Consistent data gathered from many surveys will enable robust statistical analysis of results. Diffusion of this monitoring method internationally would improve the study of far-reaching, intense, low frequency noise.

Applying the new gamma ray imager diagnostic to measurements of runaway electron Bremsstrahlung radiation in the DIII-D Tokamak (invited).

A new gamma ray imager (GRI) is developed to probe the electron distribution function with 2D spatial resolution during runaway electron (RE) experiments at the DIII-D tokamak. The diagnostic is sensitive to 0.5-100 MeV gamma rays, allowing characterization of the RE distribution function evolution during RE growth and dissipation. The GRI consists of a lead "pinhole camera" mounted on the DIII-D midplane with 123 honeycombed tangential chords 20 cm wide that span the vessel interior. Up to 30 bismuth germanate (BGO) scintillation detectors capture RE bremsstrahlung radiation for Pulse Height Analysis (PHA) capable of discriminating up to 20 000 pulses per second. Digital signal processing routines combining shaping filters are performed during PHA to reject noise and record gamma ray energy. The GRI setup and PHA algorithms will be described and initial data from experiments will be presented. A synthetic diagnostic is developed to generate the gamma ray spectrum of a GRI channel given the plasma information and a prescribed distribution function. Magnetic reconstructions of the plasma are used to calculate the angle between every GRI sightline and orient and discriminate gamma rays emitted by a field-aligned RE distribution function.

Gamma ray imager on the DIII-D tokamak.

A gamma ray camera is built for the DIII-D tokamak [J. Luxon, Nucl. Fusion 42, 614 (2002)] that provides spatial localization and energy resolution of gamma flux by combining a lead pinhole camera with custom-built detectors and optimized viewing geometry. This diagnostic system is installed on the outer midplane of the tokamak such that its 123 collimated sightlines extend across the tokamak radius while also covering most of the vertical extent of the plasma volume. A set of 30 bismuth germanate detectors can be secured in any of the available sightlines, allowing for customizable coverage in experiments with runaway electrons in the energy range of 1-60 MeV. Commissioning of the gamma ray imager includes the quantification of electromagnetic noise sources in the tokamak machine hall and a measurement of the energy spectrum of background gamma radiation. First measurements of gamma rays coming from the plasma provide a suitable testbed for implementing pulse height analysis that provides the energy of detected gamma photons.

Observation of Critical-Gradient Behavior in Alfvén-Eigenmode-Induced Fast-Ion Transport.

Experiments in the DIII-D tokamak show that fast-ion transport suddenly becomes stiff above a critical threshold in the presence of many overlapping small-amplitude Alfvén eigenmodes (AEs). The threshold is phase-space dependent and occurs when particle orbits become stochastic due to resonances with AEs. Above threshold, equilibrium fast-ion density profiles are unchanged despite increased drive, and intermittent fast-ion losses are observed. Fast-ion Dα spectroscopy indicates radially localized transport of the copassing population at radii that correspond to the location of midcore AEs. The observation of stiff fast-ion transport suggests that reduced models can be used to effectively predict alpha profiles, beam ion profiles, and losses to aid in the design of optimized scenarios for future burning plasma devices.

Environmental factors in the development of autism spectrum disorders.

Autism spectrum disorders (ASD) are highly heterogeneous developmental conditions characterized by deficits in social interaction, verbal and nonverbal communication, and obsessive/stereotyped patterns of behavior and repetitive movements. Social interaction impairments are the most characteristic deficits in ASD. There is also evidence of impoverished language and empathy, a profound inability to use standard nonverbal behaviors (eye contact, affective expression) to regulate social interactions with others, difficulties in showing empathy, failure to share enjoyment, interests and achievements with others, and a lack of social and emotional reciprocity. In developed countries, it is now reported that 1%-1.5% of children have ASD, and in the US 2015 CDC reports that approximately one in 45 children suffer from ASD. Despite the intense research focus on ASD in the last decade, the underlying etiology remains unknown. Genetic research involving twins and family studies strongly supports a significant contribution of environmental factors in addition to genetic factors in ASD etiology. A comprehensive literature search has implicated several environmental factors associated with the development of ASD. These include pesticides, phthalates, polychlorinated biphenyls, solvents, air pollutants, fragrances, glyphosate and heavy metals, especially aluminum used in vaccines as adjuvant. Importantly, the majority of these toxicants are some of the most common ingredients in cosmetics and herbicides to which almost all of us are regularly exposed to in the form of fragrances, face makeup, cologne, air fresheners, food flavors, detergents, insecticides and herbicides. In this review we describe various scientific data to show the role of environmental factors in ASD.

Spatial calibration of a tokamak neutral beam diagnostic using in situ neutral beam emission.

Neutral beam injection is used in tokamaks to heat, apply torque, drive non-inductive current, and diagnose plasmas. Neutral beam diagnostics need accurate spatial calibrations to benefit from the measurement localization provided by the neutral beam. A new technique has been developed that uses in situ measurements of neutral beam emission to determine the spatial location of the beam and the associated diagnostic views. This technique was developed to improve the charge exchange recombination (CER) diagnostic at the DIII-D tokamak and uses measurements of the Doppler shift and Stark splitting of neutral beam emission made by that diagnostic. These measurements contain information about the geometric relation between the diagnostic views and the neutral beams when they are injecting power. This information is combined with standard spatial calibration measurements to create an integrated spatial calibration that provides a more complete description of the neutral beam-CER system. The integrated spatial calibration results are very similar to the standard calibration results and derived quantities from CER measurements are unchanged within their measurement errors. The methods developed to perform the integrated spatial calibration could be useful for tokamaks with limited physical access.

Instrument for precision long-term ß-decay rate measurements.

We describe an experimental setup for making precision measurements of relative ß-decay rates of (22)Na, (36)Cl, (54)Mn, (60)Co, (90)Sr, (133)Ba, (137)Cs, (152)Eu, and (154)Eu. The radioactive samples are mounted in two automated sample changers that sequentially position the samples with high spatial precision in front of sets of detectors. The set of detectors for one sample changer consists of four Geiger-Müller (GM) tubes and the other set of detectors consists of two NaI scintillators. The statistical uncertainty in the count rate is few times 0.01% per day for the GM detectors and about 0.01% per hour on the NaI detectors. The sample changers, detectors, and associated electronics are housed in a sealed chamber held at constant absolute pressure, humidity, and temperature to isolate the experiment from environmental variations. The apparatus is designed to accumulate statistics over many years in a regulated environment to test recent claims of small annual variations in the decay rates. We demonstrate that absent this environmental regulation, uncontrolled natural atmospheric pressure variations at our location would imprint an annual signal of 0.1% on the Geiger-Müller count rate. However, neither natural pressure variations nor plausible indoor room temperature variations cause a discernible influence on our NaI scintillator detector count rate.

Mapping and uncertainty analysis of energy and pitch angle phase space in the DIII-D fast ion loss detector.

New phase space mapping and uncertainty analysis of energetic ion loss data in the DIII-D tokamak provides experimental results that serve as valuable constraints in first-principles simulations of energetic ion transport. Beam ion losses are measured by the fast ion loss detector (FILD) diagnostic system consisting of two magnetic spectrometers placed independently along the outer wall. Monte Carlo simulations of mono-energetic and single-pitch ions reaching the FILDs are used to determine the expected uncertainty in the measurements. Modeling shows that the variation in gyrophase of 80 keV beam ions at the FILD aperture can produce an apparent measured energy signature spanning across 50-140 keV. These calculations compare favorably with experiments in which neutral beam prompt loss provides a well known energy and pitch distribution.

A method for determining poloidal rotation from poloidal asymmetry in toroidal rotation (invited).

A new diagnostic has been developed on DIII-D that determines the impurity poloidal rotation from the poloidal asymmetry in the toroidal angular rotation velocity. This asymmetry is measured with recently added tangential charge exchange viewchords on the high-field side of the tokamak midplane. Measurements are made on co- and counter-current neutral beams, allowing the charge exchange cross section effect to be measured and eliminating the need for atomic physics calculations. The diagnostic implementation on DIII-D restricts the measurement range to the core (r/a < 0.6) where, relative to measurements made with the vertical charge exchange system, the spatial resolution is improved. Significant physics results have been obtained with this new diagnostic; for example, poloidal rotation measurements that significantly exceed neoclassical predictions.

Using neutral beams as a light ion beam probe (invited).

By arranging the particle first banana orbits to pass near a distant detector, the light ion beam probe (LIBP) utilizes orbital deflection to probe internal fields and field fluctuations. The LIBP technique takes advantage of (1) the in situ, known source of fast ions created by beam-injected neutral particles that naturally ionize near the plasma edge and (2) various commonly available diagnostics as its detector. These born trapped particles can traverse the plasma core on their inner banana leg before returning to the plasma edge. Orbital displacements (the forces on fast ions) caused by internal instabilities or edge perturbing fields appear as modulated signal at an edge detector. Adjustments in the q-profile and plasma shape that determine the first orbit, as well as the relative position of the source and detector, enable studies under a wide variety of plasma conditions. This diagnostic technique can be used to probe the impact on fast ions of various instabilities, e.g., Alfvén eigenmodes (AEs) and neoclassical tearing modes, and of externally imposed 3D fields, e.g., magnetic perturbations. To date, displacements by AEs and by externally applied resonant magnetic perturbation fields have been measured using a fast ion loss detector. Comparisons with simulations are shown. In addition, nonlinear interactions between fast ions and independent AE waves are revealed by this technique.

An upgrade of the magnetic diagnostic system of the DIII-D tokamak for non-axisymmetric measurements.

The DIII-D tokamak magnetic diagnostic system [E. J. Strait, Rev. Sci. Instrum. 77, 023502 (2006)] has been upgraded to significantly expand the measurement of the plasma response to intrinsic and applied non-axisymmetric "3D" fields. The placement and design of 101 additional sensors allow resolution of toroidal mode numbers 1 ≤ n ≤ 3, and poloidal wavelengths smaller than MARS-F, IPEC, and VMEC magnetohydrodynamic model predictions. Small 3D perturbations, relative to the equilibrium field (10(-5) < δB/B0 < 10(-4)), require sub-millimeter fabrication and installation tolerances. This high precision is achieved using electrical discharge machined components, and alignment techniques employing rotary laser levels and a coordinate measurement machine. A 16-bit data acquisition system is used in conjunction with analog signal-processing to recover non-axisymmetric perturbations. Co-located radial and poloidal field measurements allow up to 14.2 cm spatial resolution of poloidal structures (plasma poloidal circumference is ~500 cm). The function of the new system is verified by comparing the rotating tearing mode structure, measured by 14 BP fluctuation sensors, with that measured by the upgraded B(R) saddle loop sensors after the mode locks to the vessel wall. The result is a nearly identical 2/1 helical eigenstructure in both cases.

Enhanced localized energetic-ion losses resulting from single-pass interactions with Alfvén eigenmodes.

We report the first observation of prompt neutral beam-ion losses due to nonresonant scattering induced by toroidal and reversed shear Alfvén eigenmodes in the DIII-D tokamak. The coherent losses are of full energy beam ions expelled from the plasma on their first poloidal orbit. The first-orbit loss mechanism causes enhanced, concentrated losses on the first wall exceeding nominal levels of prompt losses. The loss amplitude scales linearly with the mode amplitude. The data provide a novel and direct measure of the radial excursion or scatter of particles induced by individual modes and may shed light on the mechanism for the scattering of energetic particles in interstellar medium.

Multi-technique study of a ceramic archaeological artifact and its content.

In this paper we report the results of a study performed with different physical and chemical methods on a ceramic vase originally attributed to the I century CE. The joint use of infrared spectroscopic analysis and laser techniques, as well as pyrolysis-gas chromatography coupled with mass spectrometry and thermoluminescence, allowed us to characterize the vase material and its content. The chemical data were combined with morphological and stylistic examinations of the object and helped in defining its actual geographical and chronological pertinence.

Near midplane scintillator-based fast ion loss detector on DIII-D.

A new scintillator-based fast-ion loss detector (FILD) installed near the outer midplane of the plasma has been commissioned on DIII-D. This detector successfully measures coherent fast ion losses produced by fast-ion driven instabilities (≤500 kHz). Combined with the first FILD at ∼45° below the outer midplane [R. K. Fisher, et al., Rev. Sci. Instrum. 81, 10D307 (2010)], the two-detector system measures poloidal variation of losses. The phase space sensitivity of the new detector (gyroradius r(L) ∼ [1.5-8] cm and pitch angle α ∼ [35°-85°]) is calibrated using neutral beam first orbit loss measurements. Since fast ion losses are localized poloidally, having two FILDs at different poloidal locations allows for the study of losses over a wider range of plasma shapes and types of loss orbits.