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Development of utility generic functional requirements for electronic work packages and computer-based procedures - 273

The Nuclear Electronic Work Packages - Enterprise Requirements (NEWPER) initiative is a step toward a vision of implementing an eWP framework that includes many types of eWPs. This will enable immediate paper-related cost savings in work management and provide a path to future labor efficiency gains through enhanced integration and process improvement in support of the Nuclear Promise (Nuclear Energy Institute 2016). The NEWPER initiative was organized by the Nuclear Information Technology Strategic Leadership (NITSL) group, which is an organization that brings together leaders from the nuclear utility industry and regulatory agencies to address issues involved with information technology used in nuclear-power utilities. NITSL strives to maintain awareness of industry information technology-related initiatives and events and communicates those events to its membership. NITSL and Light Water Reactor Sustainability Program researchers have been coordinating activities, including joint organization of NEWPER-related meetings and report development. The main goal of the NEWPER initiative was to develop a set of utility generic functional requirements for eWP systems. This set of requirements will support each utility in their process of identifying plant-specific functional and non-functional requirements. The NEWPER initiative has 140 members where the largest group of members consists of 19 commercial U.S. nuclear utilities and eleven of the most prominent vendors of eWP solutions. Through the NEWPER initiative two sets of functional requirements were developed; functional requirements for electronic work packages and functional requirements for computer-based procedures. This paper will describe the development process as well as a summary of the requirements. (authors)

22 GENERAL STUDIES OF NUCLEAR REACTORS↗

Development of a Multiphase Adjoint Capability in OpenFOAM

Thermal hydraulic predictions of flow regimes within nuclear reactor cores require significant computational resources and accuracy to ensure that the core design does not violate the thermal limits of materials. Multiphase computational fluid dynamics (CFD) has become a valuable computational capability for predicting flow characteristics as they relate to applications such as nuclear reactor safety and mixing phenomena around spacer grids within fuel assemblies. Multiphase CFD requires closure relationships for both the effects of turbulence as well as the transfer of mass, momentum, and energy between phases. Understanding the sensitivity of the parameters used in closure relationships is important for improving accuracy, but performing rigorous sensitivity analysis is computationally expensive. Adjoint mathematics have been utilized for reactor physics and fluid dynamics applications with respect to verification, sensitivity analysis, adaptive mesh refinement, and optimization. The usage of adjoint methods to predict the sensitivities of a variety of closure relationship parameters within a given problem has been shown to return sensitivity responses with significantly fewer computations than normal 'large-scale' methods. As the complexity of multiphase CFD methods increases, the demand for accurate verification tools and improvements in computational efficiency also increases, making the development of adjoint capabilities an attractive option. Closure relationships that describe interphase momentum physics in multiphase CFD modelling rely heavily on prescribed constants determined from experimental data. Due to the computational efficiency of an adjoint approach, the time to derive these closure relationships could be dramatically reduced, and data assimilation techniques could be used to return probability density functions of closure models derived using experimental data. This work develops a multiphase adjoint capability for the Eulerian-Eulerian two field, two phase equations. Specifically, the adjoint capability has been developed for the sub-cooled nucleate boiling solver boilEulerFoam developed by Dr. Nam Dinh of NC State University within the open-source CFD library OpenFOAM.

22 GENERAL STUDIES OF NUCLEAR REACTORS↗

Development of Human Factors Awareness for Criticality Safety Specialists at Westinghouse Nuclear Fuels - 14223

Although human factors assessment typically involves specialist expertise, it is considered that enhanced local knowledge of this area for criticality safety specialists supports the incorporation of human factors consideration into tasks such as safety assessment, design and hazard reviews, development of operational and engineered criticality controls, training, incident investigation and emergency response. At the Westinghouse Springfields Fuel Manufacturing Site in the United Kingdom, specialist human factor support has been engaged to identify key competencies and training plans for criticality safety specialists. In addition, discussions have been held with the UK's Office for Nuclear Regulation (ONR) to outline the proposal and to discuss the approach. Following completion of an internationally recognised human factors training course the learning is now being applied by criticality safety specialists. Recent examples of learning applied include: 1) Review of past events and incidents to support the consideration of operator/equipment interfaces, leading to improved designs and processes. 2) Identification of critical tasks and the level of human factor assessment that is likely to be required. To support this, guidance has been produced by the criticality section for staff and contractors performing criticality safety assessments. 3) Assessment of the 'aims and operability' of engineered and procedural controls derived as part of the criticality safety assessment process. This involves participation of plant management and operators. 4) Consideration of human factors in emergency response activities such as infrequent tasks and tasks being undertaken under time pressures etc. This has been examined in recent emergency exercises and in the development of a recent criticality exercise scenario. 5) Criticality training has been reviewed with Plant Management, focussing on the methods utilised to deliver training (e.g. classroom based, computer training, on plant walk-downs); the aims and scope of training and how understanding is validated. 6) The link between criticality safety assessment and how the operations are / will be conducted has been reviewed as part of formal and informal criticality meetings and inspections. A key aspect of this is the criticality specialist's interaction with both plant management and operational staff. The development of human factors awareness into the criticality safety specialist's competency framework continues to be developed at Westinghouse but real benefits to criticality safety are already being demonstrated by this approach. (author)

11 NUCLEAR FUEL CYCLE AND FUEL MATERIALS↗

Development of criticality risk evaluation method for fuel debris in Fukushima Dai-ichi NPS - 14373

After the accident of Fukushima Dai-ichi Nuclear Power Station, there has been still damaged nuclear fuel in the reactor buildings, which is called 'fuel debris' and contains an amount of fissile materials show that it is currently subcritical, which must be kept until finishing retrieval work. In the latest plan, retrieving fuel debris is to start in 2025. The International Research Institute for Nuclear Decommissioning, IRID, has been developing the technology for decontamination in reactor building. A developed method will be reviewed and granted by the Nuclear Regulatory Authority in Japan, NRA, before the start of the retrieving. Criticality risk information will be needed for decision making on following two subcriticality issues, -Criticality control of fuel debris to keep is subcritical until the end of retrieval work. -Safe operation for retrieving fuel debris to keep it subcritical. Because fuel debris has been out of criticality control and the key condition for its current subcriticality is unknown, it is important to obtain criticality risk information as soon as possible. Applying conventional Probabilistic Safety Assessment, PSA, to fuel debris is difficult, because it is based on the probability of becoming out of criticality control due to troubles such as equipment failure, operation mistake and so on. A new method, which has been developed by Japan Atomic Energy Agency to technically support the NRA, is designed to estimate criticality risk based on a probability distribution of k{sub eff} due to uncertainty of composition and geometry of fuel debris, which method will provide risk information for the two subcriticality issues as well as for the tolerance level of criticality risk if it is unavoidable. Developed method contains four steps: two steps of analysis of criticality risk and two steps of quantification of the risk. A procedure of risk quantification has been defined, in which systematic analysis of criticality risk can be done by making 'status matrix'. A trial analysis by using the procedure shows that some events which can initiate criticality are able to be supposed to happen during maintenance period until the beginning of retrieving fuel debris, and that analysis also indicates countermeasures should be considered as soon as possible in order to reduce criticality risk for public and workers. (authors)

21 SPECIFIC NUCLEAR REACTORS AND ASSOCIATED PLANTS↗

Development of a process for remediation of enriched uranium coolant tanks at AWE Aldermaston - 14520

Machining processes involving Enriched Uranium (EU) at the UK Atomic Weapons Establishment have historically required the use of a liquid coolant to ensure product quality and to provide protection against hazards associated with ignition of the EU swarf in the non-inert gloved air box atmosphere. This coolant is typically provided by closed circuit re-circulating systems utilising large volume tanks to contain the bulk coolant. Small losses of EU to the coolant tank are experienced during the machining process leading to accumulation over time. This is expected and appropriate measures are put in place to control such accumulations to ensure criticality safety during the operational phase. The original design intent made no specific provision for recovery of the EU as it was not expected to be required based on the anticipated losses and design lifetime of the tanks. However, in support of ongoing operations it has become necessary to develop a process to remediate out of service coolant tanks to recover the EU and to replace the coolant and some of the end-of-life tank components. Detailed optioneering has been undertaken to develop a process that addresses all the relevant hazards, including nuclear criticality safety. Non-destructive assay techniques have been developed to help determine the inventory of EU present and consequently the level of control required during the remediation process. This has led to the selection of favourable geometry collection vessels that not only afford significant defence-in-depth against criticality hazards during the remediation work but also satisfy interim storage requirements. These vessels may also be of interest to other operators. This paper presents an overview of the history of operation of the coolant tanks and proposed remediation process and provides an overview of the criticality safety case that has been developed to support it. It is anticipated that the remediation work will be undertaken before 2019 allowing the findings and lessons learnt (including validation of non-destructive assay results on expected hold up) to be reported at the next ICNC. (authors)

11 NUCLEAR FUEL CYCLE AND FUEL MATERIALS↗

Development of Shielding Benchmarks Using the Godiva IV Assembly

The Nuclear Criticality Safety Program (NCSP) is developing a shielding benchmark using the Godiva IV assembly as a source. Its present status is reviewed herein. Even eight decades into the nuclear era, substantial work remains to develop a database of shielding benchmarks to support future nuclear development. A nuclear simulation is only as good as its supporting data, inputs, and validation basis. Uncertainty in these areas is addressed using conservatism, which adds margin and, occasionally, cost. In many shielding situations, high accuracy is not necessary because additional material is not particularly expensive. After all, 1–2 cm of lead often reduces the gamma ray dose substantially. However, in certain areas, conservatism can add unnecessary cost. These areas include mobile shielding applications such as casks, ships, microreactors, and spacecraft, where weight and, thus, margin is expensive. Although these characteristics are side benefits for NCSP shielding benchmark development, the main driver is enabling more reliable placement of criticality accident alarm systems (CAASs) in nuclear material facilities, such as those dedicated to the production of advanced reactor fuels. CAAS placement relies on more than accurate data and code validation. It also relies on sufficiently accurate materials specifications, geometry specifications, and a well-defined, alarm-producing baseline accident. All these things require tacit knowledge and understanding of the problem being evaluated. Benchmarks can help ensure this understanding.

21 SPECIFIC NUCLEAR REACTORS AND ASSOCIATED PLANTS↗

Incorporating A Risk-Informed, Performance-Based Concept into Nuclear Fuel and Materials Development for Advanced Reactors

The NRC’s regulatory concept for advanced reactors under 10 CFR Part 53 promotes the use of an RIPB concept. RIPB is usually referenced as a general, overarching concept. This paper is focused on how to, and if it would be worthy to, incorporate an RIPB concept into nuclear fuel and materials development for advanced reactors. This paper proposes three potential RIPB applications for nuclear fuel and materials development, including RIPB test matrix development, RIPB test matrix reduction, and RIPB design optimization. This paper discusses the projected benefits from incorporating RIPB in reducing development timeline, cost, and regulatory risk.

99 GENERAL AND MISCELLANEOUS↗

AFC Metallic Fuel Research and Development 5-Year Plan

The mission of the U.S. Department of Energy (DOE) Advanced Fuel Campaign (AFC) program is conducting R&D on nuclear fuel technology that enables near- and long-term implementation of the reactor systems necessary to meet national nuclear energy objectives. Its primary goals align with goals of the DOE Office of Nuclear Energy in sustaining the current LWR fleet through Accident Tolerant Fuels program and Enabling Advanced Reactors. The latter goal is to be achieved through the following subgoals in order of logistical priority: • Establish the qualification basis for reference metallic fuel designs for sodium-cooled fast reactors. • Develop next generation metallic fuel fabrication and design for improved fissile utilization and management. • Develop accelerated fuel development and qualification methodologies. • Identify next generation fuel technologies. The purpose of this document is to serve as a five-year research and development (R&D) plan to achieve the goals identified to support enabling advanced reactor deployment related to metallic fuels starting in 2025. The specific objectives of this document are to: • align program R&D work across technical areas, national laboratories, and with stakeholder interests, and • aid yearly and outyear scope and budgetary planning activities. This plan lays the foundation of databases, capabilities, expertise, and research-commercial-regulatory integration for launching next-generation initiatives in advanced fuel technologies (fuel and cladding) and improved methodologies for achieving accelerated qualification of next generation fuel technologies.

11 NUCLEAR FUEL CYCLE AND FUEL MATERIALS↗

APPLICATION OF OBJECTIVES-DRIVEN ASSURANCE CASES TO SYSTEM DEVELOPMENT IN AN EVOLVING ACQUISITION MODEL

System properties such as “safety” and “dependability” cannot, in practice, be proven, and must be argued in an “assurance case” aimed at supporting risk-acceptance decisions that have to be made by system acquirers and/or regulatory authorities. The paper is concerned with applications of the “assurance case” idea early in design and development of new systems, when (apart from dedicated testing) the only available operating experience information derives from previous (non-identical) systems. Much of the discussion is based on an evolving acquisition model at the US National Aeronautics and Space Administration; previously, most major systems were developed in-house, but some major systems will now be developed by and acquired from commercial providers. Key points discussed include the following. (1) By promoting a particular kind of focused discussion between acquirers and providers, the use of assurance cases should be particularly valuable under the new acquisition model. (2) In principle, objectives-driven (sometimes called “performance-based”) approaches to assurance of performance have significant advantages in cases where they are applicable. (3) For truly novel systems, completeness of the safety analysis is a significant issue; it is important for the assurance case to include a commitment by the provider (or applicant) to seriously pursue analysis of operating experience, so that previously unrecognized hazards can be identified and addressed. (4) Inquiries into major accidents often point to deficiencies in management oversight in all parts of the life cycle; management processes need to be addressed in the formulation and the implementation of an assurance case. Under the new acquisition model, these considerations imply a serious reconsideration of the way in which the development process is managed by both providers and acquirers.

99 GENERAL AND MISCELLANEOUS↗

The Impact of the Halden Reactor Project on the Development of the Bison Fuel Performance Code

The Bison fuel performance code has been under development at Idaho National Laboratory by various programs within the U.S. Department of Energy since 2009. As part of any fuel performance code development, validation is necessary. To this end, several Halden experiments have been used. Early on, the focus was on validating the thermal mechanical behaviour, including pellet cladding mechanical interaction and fission gas release models implemented in Bison. Support for design-basis accident capabilities began in approximately 2014. Also in 2014, the development of models for accident tolerant fuel (ATF) concepts also began. This includes dopedUO2 fuel for which Halden has some experiments with temperature and fission gas release measurements. The Bison team has been fortunate to have two senior developers be secondees to Halden for a year: the late Dr. Giovanni Pastore from May 2015 to April 2016 and the now retired Dr. Richard Williamson in 2018. The paper will provide examples of Bison validation using Halden data for standard UO2 fuel under normal operation and loss-of-coolant accident condition, and ATF concepts. A tribute to the legacy that both the late Giovanni and retired Richard left on the Bison code is provided.

11 NUCLEAR FUEL CYCLE AND FUEL MATERIALS↗

Application of Objectives-Driven Assurance Cases to System Development in an Evolving Acquisition Model

System properties such as “safety” and “dependability” cannot, in practice, be proven, and must be argued in an “assurance case” aimed at supporting risk-acceptance decisions that have to be made by system acquirers and/or regulatory authorities. The paper is concerned with applications of the “assurance case” idea early in design and development of new systems, when (apart from dedicated testing) the only available operating experience information derives from previous (non-identical) systems. Much of the discussion is based on an evolving acquisition model at the US National Aeronautics and Space Administration; previously, most major systems were developed in-house, but some major systems will now be developed by and acquired from commercial providers. Key points discussed include the following. (1) By promoting a particular kind of focused discussion between acquirers and providers, the use of assurance cases should be particularly valuable under the new acquisition model. (2) In principle, objectives-driven (sometimes called “performance-based”) approaches to assurance of performance have significant advantages in cases where they are applicable. (3) For truly novel systems, completeness of the safety analysis is a significant issue; it is important for the assurance case to include a commitment by the provider (or applicant) to seriously pursue analysis of operating experience, so that previously unrecognized hazards can be identified and addressed. (4) Inquiries into major accidents often point to deficiencies in management oversight in all parts of the life cycle; management processes need to be addressed in the formulation and the implementation of an assurance case. Under the new acquisition model, these considerations imply a serious reconsideration of the way in which the development process is managed by both providers and acquirers.

99 GENERAL AND MISCELLANEOUS↗

Hydrogen Leak Modeling for Development of Smart Distributed Monitoring Under Unintended Releases

Hydrogen is a versatile and clean energy carrier that can be produced from various renewable sources such as wind, solar, and hydropower. Hydrogen has the potential to play a crucial role in decarbonizing industrial processes that are currently reliant on fossil fuels and provide long-duration and/or seasonal energy storage to enable electricity decarbonization. Hydrogen can also be used as a fuel for fuel cell vehicles, providing a zero-emission alternative to traditional internal combustion engines. DOE launched the Hydrogen Energy Earthshot (Hydrogen Shot) in June 2021 to reduce the cost of clean hydrogen by 80% to $1 per 1 kilogram in 1 decade ("1 1 1"). While promising, Hydrogen is highly-flammable, and in the presence of oxygen, it can form explosive mixtures. . Therefore, understanding leak scenarios is essential to evaluate and mitigate the safety risks associated with potential hydrogen leaks. An increased understanding of leak behavior, and having tools to model leaks, can help assess how hydrogen would disperse in different environments, influencing emergency response plans and safety measures, and identify potential issues with materials and design systems that can withstand the challenges posed by hydrogen. Recently, researchers have attempted to study hydrogen leaks for development of risk management strategies. However, the focus has been on closed or semi-closed spaces like storage rooms, vehicles, garages, and fueling stations - all promising locations for future hydrogen infrastructure. In this presentation, the modeling environment extends the span of research further by modeling hydrogen leak in an outdoor, open space. We will present the key challenges with modeling hydrogen leaks in an uncontrollable environment, how they were handled, and how modeling results informed sensor selection and placement. A Hydrogen research facility at the National Renewable Energy Laboratory (NREL) was used as a case study to model hydrogen leaks. In the future, Hydrogen wide area detection methodologies will be developed and tested at this site to monitor for unintended and operational hydrogen releases. The data generated from modeling will be used to develop a predictive model to detect hydrogen leak location based on concentration measured by sensors in this open space. Furthermore, the facility was also chosen because controlled hydrogen releases can be performed. A computational fluid dynamics (CFD) based modeling approach was taken to model hydrogen leak. The full-scale hydrogen facility was modeled with a large ambient domain. The electrolyzer at the facility can produce a controlled release rate of 27 kg-H2/hr. Site-specific atmospheric and weather condition data such as wind direction, wind speed at various altitudes, and temperature were used as inputs to the model. To capture the variability of weather conditions, a subset of the weather conditions experienced during daytime hours without precipitation over the course of three months was generated; using established data clustering techniques, a total of 100 condition sets were chosen. The results show statistical distributions and ranges of hydrogen concentrations at locations throughout the domain. These distributions are compared to experimental data from a constant mass flow, controlled hydrogen release at the facility. The stochastic wind conditions of the release make direct validation difficult, therefore, statistical comparison approaches were used. Wind conditions are found to significantly impact the release behavior, including direction and concentration. Sensor selection and placement is proposed for the facility and is now based on release behavior predicted for the facility given its weather patterns; this is much more informed than without the modeling results. The methodology and analysis procedure can be translated to other facilities using modified geometries and site-specific weather conditions. Hydrogen holds great promise as a renewable energy fuel, but ensuring safety in its production, storage, and use is paramount. Studying potential leak scenarios in an open space will help develop sensors to detect hydrogen on a large spectrum of concentration and eventually build a smart distributed monitoring system.

CFD↗

Environmental Durability Assessment and Development of Subcomponent Test Methods for Advanced Materials in Marine Energy Applications: Preprint

Marine energy developers are beginning to rely more heavily on advanced composite materials for their load bearing structures. Understanding how these materials respond and degrade in harsh marine environments is a complex problem. Much research has been performed at smaller laboratory scales to understand the fundamental physical and chemical degradation mechanisms, but little structural testing research has been performed at larger scales to understand how these physical and chemical interactions scale and how they should be accounted for in the design process. The Advanced Materials project is a multilaboratory research collaboration that has been addressing these issues with the intention of reducing risks and barriers to marine energy developers wanting to adopt advanced composite materials. The National Laboratory of the Rockies has been playing a leading role in developing larger scale testing infrastructure and test methods to validate complex numerical degradation models and standardize testing procedures to do so. This paper provides a review of past structural testing activities and how they have grown into current research activities and will continue to evolve into the future to directly address industry needs. This paper covers key research areas large-scale water absorption and subsequent structural validation testing, qualification of bolted and adhesive connections, and conducting combined submerged fatigue testing at increasing scales. This paper provides insights into the complex requirements for testing infrastructure and test method development to effectively qualify materials and certify marine energy structures for harsh marine environments. This research program paves the way for better guidance and standardization within the industry when adopting advanced composite materials.

16 TIDAL AND WAVE POWER↗

MODEL DEVELOPMENT AND VERIFICATION OF A 1,350°C AIR RECEIVER TEST SYSTEM

Open-loop volumetric receivers work with air at atmospheric pressure and are suitable for single-cycle or multicycle power plants. A novel additively manufactured (AM) silicon carbide (SiC), ceramic matrix composite (CMC) volumetric receiver was developed that consisted of a lattice structure, which absorbs solar radiation and converts it into heat energy. Heat energy from the porous receiver was transferred to heated ambient air. The receiver acted as a convective heat exchanger, transferring heat to the fluid through convection. Engineering was facilitated to develop a high-temperature air receiver test bed at Sandia national Laboratories (SNL) capable of demonstrating a 50kWth open-loop volumetric SiC air receiver module developed by General Electric Aerospace Research (GE Aerospace). This paper presents the development of the high temperature AM SiC-CMC air receiver, the test bed, and the first testing operations of this device, which was experimentally demonstrated to achieve 1,350°C for over 3.5 hours of operation, based on input flux levels of 67–91 W/cm2 0.5-2.5 kg/s flow rates. From the test campaign results, based on the measured convective heat transfer to the airflow and bounded radiative-loss assumptions, the solar-thermal efficiency of HOTSSTAR test module was estimated to be approximately as high as 74% for representative test conditions.

14 SOLAR ENERGY↗

Safety Assurance of Software and Machine Learning Development for Nuclear Instrumentation and Controls

Digital instrumentation and control (DI&C) systems monitor and control parameters in nuclear power plants. Ensuring their safety is a critical part of ensuring overall plant safety. Nuclear power plant licensing generates thousands of safety documents that could be organized more effectively using a safety assurance case (SAC). We conducted a literature survey of SACs and created a SAC framework for DI&C software using Goal Structuring Notation (GSN). This framework focuses on four software development processes: management & assurance, pre-developed software (PDS) qualification, the Software Development Life Cycle (SDLC), and the Machine Learning Development Life Cycle (MLDLC). We organized our framework using a novel level structure that can be applied to other SACs to improve their clarity. Finally, we demonstrate how our framework can be incorporated as part of a SAC for a larger reactor system.

46 - INSTRUMENTATION RELATED TO NUCLEAR SCIENCE AN↗

Lessons learned from the development and implementation of a workforce training curriculum for advanced controls for high performance HVAC systems

Over the past decade, academic research on advanced controls has slowly transitioned into new software platforms, giving rise to various companies developing and deploying these innovative products, including solutions for light commercial HVAC systems. However, the current workforce remains widely unprepared to install, maintain and operate these systems, particularly complex software-based control platforms, as most workforce training programs still focus on traditional building automation for large commercial buildings. This paper presents the development and piloting of curriculum for three key types of professionals: ● Technicians (trade-level): installing and maintaining modern high-performance HVAC systems and controls ● Programmers (undergrad-level): developing and implementing advanced controls ● Engineers and energy professionals (undergrad/grad-level): managing and evaluating system performance We share details of the material developed including training videos, open-source software, instruction manuals. We also present the results of a pilot implementation of the training materials with real students.

Casillas, Armando↗

Pre-hypertrophic chondrogenic enhancer landscape of limb and axial skeleton development

Chondrocyte differentiation controls skeleton development and stature. Here we provide a comprehensive map of chondrocyte-specific enhancers and show that they provide a mechanistic framework through which non-coding genetic variants can influence skeletal development and human stature. Working with fetal chondrocytes isolated from mice bearing a Col2a1 fluorescent regulatory sensor, we identify 780 genes and 2'704 putative enhancers specifically active in chondrocytes using a combination of RNA-seq, ATAC-seq and H3K27ac ChIP-seq. Most of these enhancers (74%) show pan-chondrogenic activity, with smaller populations being restricted to limb (18%) or trunk (8%) chondrocytes only. Notably, genetic variations overlapping these enhancers better explain height differences than those overlapping non-chondrogenic enhancers. Finally, targeted deletions of identified enhancers at the Fgfr3, Col2a1, Hhip and, Nkx3-2 loci confirm their role in regulating cognate genes. This enhancer map provides a framework for understanding how genes and non-coding variations influence bone development and diseases.

59 BASIC BIOLOGICAL SCIENCES↗

A need to reduce premature CV mortality in the developing world: How could appropriate use of non-invasive imaging help?

We discuss premature deaths due to coronary heart disease (CHD) in developing countries and the importance of a comprehensive approach, involving clinical judgement, prevention, appropriate use of technology to diagnose and guide CHD treatment. Healthcare policies and levels of knowledge vary tremendously resulting heterogeneous utilization of diagnostic strategies and treatments worldwide. Many countries with high mortality have low utilization of non-invasive cardiac imaging. Appropriate use coupled with guideline-based management could help to improve care in the developing world and potentially result in better life expectancy already experienced by most high-income countries. In a scenario of increasing costs, a rational utilization of resources is imperative for all nations. A stepwise approach to suspected CHD is necessary, starting from good judgement, adding tests only as needed, preferably filtering patients who might benefit from advanced imaging. In stable patients, non-invasive tests should be used as filters to invasive procedure, preventing stable patients from undergoing revascularizations of questionable benefit. In this article, we review the relative role of exercise testing, myocardial perfusion imaging, and coronary computed tomography angiography to evaluate CHD and how these can be utilized as ways to help guide management that could impact premature mortality in developing nations.

62 RADIOLOGY AND NUCLEAR MEDICINE↗