The face of postural tachycardia syndrome - insights from a large cross-sectional online community-based survey.

BACKGROUND: Patients with postural tachycardia syndrome (POTS) experience chronic symptoms of orthostatic intolerance. There are minimal data detailing the demographics, clinical features and clinical course of this condition. This online, community-based survey highlights patients' experience with POTS. It consists of the largest sample of POTS patients reported to date. OBJECTIVES: To describe the demographics, past medical history, medications, treatments and diagnostic journey for patients living with POTS. METHODS: Postural tachycardia syndrome patients completed an online, community-based, cross-sectional survey. Participants were excluded if they had not received a diagnosis of POTS from a physician. The questions focused on the patient experience and journey, rather than physiological responses. RESULTS: The final analysis included 4835 participants. POTS predominantly affects white (93%) females (94%) of childbearing age, with approximately half developing symptoms in adolescence (mode 14 years). POTS is a chronic multisystem disorder involving a broad array of symptoms, with many patients diagnosed with comorbidities in addition to POTS. POTS patients often experience lengthy delays [median (interquartile range) 24 (6-72) months] and misdiagnosis, but the diagnostic delay is improving. POTS patients can present with a myriad of symptoms most commonly including lightheadedness (99%), tachycardia (97%), presyncope (94%), headache (94%) and difficulty concentrating (94%). CONCLUSIONS: These data provide important insights into the background, clinical features and diagnostic journey of patients suffering from POTS. These data should serve as an essential step for moving forward with future studies aimed at early and accurate diagnoses of these patients leading to appropriate treatments for their symptoms.

Multistage coupling of independent laser-plasma accelerators.

Laser-plasma accelerators (LPAs) are capable of accelerating charged particles to very high energies in very compact structures. In theory, therefore, they offer advantages over conventional, large-scale particle accelerators. However, the energy gain in a single-stage LPA can be limited by laser diffraction, dephasing, electron-beam loading and laser-energy depletion. The problem of laser diffraction can be addressed by using laser-pulse guiding and preformed plasma waveguides to maintain the required laser intensity over distances of many Rayleigh lengths; dephasing can be mitigated by longitudinal tailoring of the plasma density; and beam loading can be controlled by proper shaping of the electron beam. To increase the beam energy further, it is necessary to tackle the problem of the depletion of laser energy, by sequencing the accelerator into stages, each powered by a separate laser pulse. Here, we present results from an experiment that demonstrates such staging. Two LPA stages were coupled over a short distance (as is needed to preserve the average acceleration gradient) by a plasma mirror. Stable electron beams from a first LPA were focused to a twenty-micrometre radius--by a discharge capillary-based active plasma lens--into a second LPA, such that the beams interacted with the wakefield excited by a separate laser. Staged acceleration by the wakefield of the second stage is detected via an energy gain of 100 megaelectronvolts for a subset of the electron beam. Changing the arrival time of the electron beam with respect to the second-stage laser pulse allowed us to reconstruct the temporal wakefield structure and to determine the plasma density. Our results indicate that the fundamental limitation to energy gain presented by laser depletion can be overcome by using staged acceleration, suggesting a way of reaching the electron energies required for collider applications.

Active Plasma Lensing for Relativistic Laser-Plasma-Accelerated Electron Beams.

Compact, tunable, radially symmetric focusing of electrons is critical to laser-plasma accelerator (LPA) applications. Experiments are presented demonstrating the use of a discharge-capillary active plasma lens to focus 100-MeV-level LPA beams. The lens can provide tunable field gradients in excess of 3000 T/m, enabling cm-scale focal lengths for GeV-level beam energies and allowing LPA-based electron beams and light sources to maintain their compact footprint. For a range of lens strengths, excellent agreement with simulation was obtained.

Measured bremsstrahlung photonuclear production of 99Mo ((99m)Tc) with 34 MeV to 1.7 GeV electrons.

(99)Mo photonuclear yield was measured using high-energy electrons from Laser Plasma Accelerators and natural molybdenum. Spectroscopically resolved electron beams allow comparisons to Monte Carlo calculations using known (100)Mo(γ,n)(99)Mo cross sections. Yields are consistent with published low-energy data, and higher energy data are well predicted from the calculations. The measured yield is (15±2)×10(-5) atoms/electron (0.92±0.11 GBq/µA) for 25 mm targets at 33.7 MeV, rising to (1391±20)×10(-5) atoms/electron (87±2 GBq/µA) for 54 mm/ 1.7 GeV, with peak power-normalized yield at 150 MeV.

Spectral characterization of laser-driven solid-based high harmonics in the coherent wake emission regime.

Laser-produced surface high-harmonic generation is an attractive source of extreme ultraviolet radiation due to its coherent properties and high peak power. By operating at subrelativistic laser intensities in the coherent wake emission regime, the harmonic spectrum was experimentally studied versus laser properties. At higher laser intensities (>10(17) W/cm(2)) a higher spectral cutoff was observed, with accompanying blueshifting and spectral broadening of the individual orders. A model based on an expanding critical surface provides qualitative agreement with the observations.

An evaluation of a partial-walled laminar-flow operating room.

This paper contains an assessment of the physical performance of a permanently installed down-flow laminar-flow operating room at the London Hospital. This system employs partial walls extending 0.76 m (2.5 ft.) from the ceiling, from which the air is allowed to issue freely downwards at an initial velocity of about 0.4 m./sec. (80 ft./min.).The usefulness of the partial wall, as compared with a free issuing system, was demonstrated and a comparison made with a fully walled system. It was shown that a fully walled system would be more efficient than a partial-walled system as there was a loss in air velocity of about 20-25% with the partial wall due to the nonconstrained flow of air. This loss would be reflected in an increase in airborne bacterial count and would mean that an increase of 20-25% in the air volume would be required to obtain the same conditions as with the full-walled system. Entrainment of contaminated air was demonstrated but it was concluded that this would be of little consequence in the centre of the clean area, i.e. at the wound site. Sterile instruments, etc., however, on the outside of the clean area, would be more liable to airborne contamination.Bacterial and dust airborne counts taken during total hip operations gave a very low average figure (0.3 bacteria/ft.(3) or 10.5/m.(3)) from which we conclude that the system was about 30 times cleaner in terms of airborne bacteria than a well ventilated conventional operating-room. We concluded that although the partial-walled system was slightly less efficacious than a normal full-walled system, the freedom of movement and of communication for the operating team could in some circumstances outweigh this disadvantage.Sound levels were such that normal conversation was possible with little or no awareness of background noise.

The effect of obstructions and thermals in laminar-flow systems.

The influence of obstructions and thermals on the air flow in unidirectional or laminar flow systems was studied with special reference to operating rooms. It was shown that thermals induced in the operating rooms would have little influence in the normal laminar-flow system. The importance however of obstructions such as operating lamps and personnel was shown.

A bacteriological evaluation of laminar-flow systems for orthopaedic surgery.

An evaluation has been undertaken of the efficiency of laminar-flow ventilation in operating-rooms in which conventional operating-room clothing was used. It has been demonstrated that velocities in the region of 0.3-0.4 m./sec. will give maximum returns for effort in both down-flow and cross-flow systems. At this velocity the laminar-flow system, in terms of airborne bacteria measured at the wound site, was about 11 times more efficient using horizontal air-flow and 35-90 times more efficient using vertical air-flow than a plenum-ventilated operating-room.