In 2021 JET exploited its unique capabilities to operate with T and D-T fuel with an ITER-like Be/W wall (JET-ILW). This second major JET D-T campaign (DTE2), after DTE1 in 1997, represented the culmination of a series of JET enhancements-new fusion diagnostics, new T injection capabilities, refurbishment of the T plant, increased auxiliary heating, in-vessel calibration of 14 MeV neutron yield monitors-as well as significant advances in plasma theory and modelling in the fusion community. DTE2 was complemented by a sequence of isotope physics campaigns encompassing operation in pure tritium at high T-NBI power. Carefully conducted for safe operation with tritium, the new T and D-T experiments used 1 kg of T (vs 100 g in DTE1), yielding the most fusion reactor relevant D-T plasmas to date and expanding our understanding of isotopes and D-T mixture physics. Furthermore, since the JET T and DTE2 campaigns occurred almost 25 years after the last major D-T tokamak experiment, it was also a strategic goal of the European fusion programme to refresh operational experience of a nuclear tokamak to prepare staff for ITER operation. The key physics results of the JET T and DTE2 experiments, carried out within the EUROfusion JET1 work package, are reported in this paper. Progress in the technological exploitation of JET D-T operations, development and validation of nuclear codes, neutronic tools and techniques for ITER operations carried out by EUROfusion (started within the Horizon 2020 Framework Programme and continuing under the Horizon Europe FP) are reported in (Litaudon et al Nucl. Fusion accepted), while JET experience on T and D-T operations is presented in (King et al Nucl. Fusion submitted).

JET, the world’s largest operating tokamak with unique Be/W wall and tritium handling capability, completed a Deuterium-Tritium (D-T) campaign in 2021 (Maggi et al 29th Fusion Energy Conf. ) following a decade of preparatory experiments, dedicated enhancements, technical rehearsals and training (Horton et al 2016 Fusion Eng. Des. 109–111 925). Operation with tritium raises significant technical, safety and scientific challenges not encountered in standard protium or deuterium operation. This contribution describes the tritium operational requirements, pulses and technical preparations, new operating procedures, lessons learned and details on the achieved operational availability and performance. The preparation and execution of the recent JET tritium experiments benefitted from the previous experience in 1991 (Preliminary Tritium Experiment), 1997 (DTE1 campaign) and 2003 (Trace Tritium Campaigns) and consisted of the following five phases: technical rehearsals and scenario preparation, tritium commissioning, 100% tritium campaign, D-T campaign (DTE2), tritium clean-up. Following the clean-up JET resumed normal operation and is currently undertaking a further D-T campaign (DTE3).

When completed, the DARHT-II accelerator will produce a 2-kA, 17-MeV beam in a 1600-ns pulse. After exiting the accelerator, the long pulse will be sliced into four short pulses by a kicker and quadrupole septum and then transported for several meters to a tantalum target for conversion to bremsstrahlung for radiography. In order to provide early tests of the kicker, septum, transport, and multi-pulse converter target we assembled a short accelerator from the first available refurbished cells, which are now capable of operating of operating at over 200 kV. This scaled accelerator was operated at ~8 MeV and ~1 kA, which provides a beam with approximately the same beam dynamics in the downstream transport as the final 17-MeV, 2-kA beam.

Obesity may have an adverse effect on the outcome of IVF/intracytoplasmic sperm injection (ICSI) treatment. In this study, the effects of increased body mass index (BMI) on oocyte and embryo quality during IVF cycles were studied. A retrospective analysis of 426 IVF/ICSI cycles was performed. Cycles were classified according to the BMI: normal BMI (19-24.9 kg/m(2)), overweight (25-29.9 kg/m(2)) and obese (> or = 30 kg/m(2)). Cycles were further stratified based on age (group 1, < 35 years; group 2, > or = 35 years). Markers of oocyte quality (number of oocytes inseminated and fertilization rate) and embryo quality (utilization rate, number of embryos discarded and cryopreserved, and mean embryo grade) were examined. In group 1, obesity had a significant adverse effect on the mean embryo grade (P = 0.02), the embryo utilization rate (P = 0.01), number of embryos discarded (P = 0.007) and cryopreserved (P < 0.05). In group 2, there was no difference in markers of embryo quality between the three BMI ranks. Obesity did not have any significant effect on markers of oocyte quality or clinical pregnancy rates. In conclusion, obesity may adversely affect embryo quality in young women (<35 years) undergoing IVF/ICSI, while the oocyte quality is not affected.

When completed, the DARHT-II linear induction accelerator (LIA) will produce a 2 kA, 18 MeV electron beam with more than 1500 ns current/energy “flat-top.” In initial tests DARHT-II has already accelerated beams with current pulse lengths from 500 ns to 1200 ns full-width at half maximum (FWHM) with more than 1.2 kA peak current and 12.5 MeV peak energy. Experiments will soon begin with a ∼ 1600 ns flat-top pulse, but with reduced current and energy. These pulse lengths are all significantly longer than any other multi-MeV LIA, and they define a novel regime for high-current beam dynamics, especially with regard to beam stability. Although the initial tests demonstrated the robustness of the DARHT-II LIA to BBU, the < 1200 ns FWHM pulse lengths were too short to test the predicted protection against ion-hose instability. The present experiments are designed to resolve these and other beam-dynamics issues with a ∼ 1600 ns pulse length beam.

Despite recommendations for annual screening of Chlamydia trachomatis (CT), the most commonly reported STI among adolescents, health care providers are falling short of meeting this goal. Since nearly 2/3 of teens who make contact with the health care system do so with an urgent care visit, the purpose of this study was to survey providers regarding their perceived barriers to screening adolescents for Chlamydia during urgent care visits. As part of a larger randomized control study to increase CT screening in 14-18 year olds, pediatric providers at 5 intervention clinics were given an anonymous survey to assess barriers to screening adolescents. Surveys were hand delivered to providers with a self-addressed envelope. Providers were asked to rate the frequency of 7 common barriers using a 4 point Likert scale where 1= very rarely to 4= very frequently. 82 pediatric providers from 5 clinics completed the self-report questionnaire (95% response rate). The top 4 barriers included: urine specimens not already obtained and in the room (mean 2.0), difficulty asking parents to leave the room (2.0), teen not able to urinate (1.9) and physician visit time constraints (1.7). Barriers to screening need to be identified and addressed at both the provider and the health care system levels before universal CT screening can be accomplished. Although some of the barriers may be difficult to overcome, there was no barrier that was ranked more than 2 on a scale of 1-4. Furthermore, there is a common misconception that lack of time is the most significant barrier to screening in urgent care. This study, shows that providers ranked several other barriers higher than time. Interventions need to address provider and system level barriers in order to achieve universal CT screening which includes the urgent care setting.

Purpose Despite recommendations for annual screening of Chlamydia trachomatis (CT), the most commonly reported STI among adolescents, health care providers are falling short of meeting this goal. Since nearly two-thirds of teens who make contact with the health care system do so with an urgent care visit, the purpose of this study was to survey providers regarding their perceived barriers to screening adolescents for Chlamydia during urgent care visits. Methods As part of a larger randomized control study to increase CT screening in 14-18 year olds, pediatric providers at 5 intervention clinics were given an anonymous survey to assess barriers to screening adolescents. Surveys were hand delivered to providers with a self-addressed envelope. Providers were asked to rate the frequency of 7 common barriers using a 4-point Likert scale where 1 = very rarely to 4 = very frequently. Results 82 pediatric providers from 5 clinics completed the self-report questionnaire (95% response rate). The top 4 barriers included urine specimens not already obtained and in the room (mean 2.0), difficulty asking parents to leave the room (2.0), teen not able to urinate (1.9), and physician visit time constraints (1.7). Conclusions Barriers to screening need to be identified and addressed at both the provider and the health care system levels before universal CT screening can be accomplished. Although some of the barriers may be difficult to overcome, there was no barrier that was ranked more than 2 on a scale of 1-4. Furthermore, there is a common misconception that lack of time is the most significant barrier to screening in urgent care. This study shows that providers ranked several other barriers higher than time. Interventions need to address provider and system-level barriers in order to achieve universal CT screening which includes the urgent care setting.

The beam breakup instability has long been a problem for linear induction accelerators (LIAs). Although it is predicted to saturate in the strong focus regime relevant to LIAs most, if not all, LIAs have had pulse-widths too short to observe this effect. We recently completed BBU experiments on a 1.2 kA, 6.7-MeV configuration of the DARHT-II LIA having a 1600-ns pulse length, which is much longer than the saturation time. When we reduced the magnetic guide-field strength to observe BBU, the saturated growth was in agreement with theory. We used these results to deduce that BBU growth will be insignificant in the final 2-kA, 17-MeV DARHT-II configuration with the tunes that will be used. Another problematic instability for long-pulse LIAs such as DARHT-II is the ion-hose. We also performed experiments with the 6.7-MeV long-pulse configuration of DARHT-II in which we deliberately induced ion-hose by raising the background pressure far above its normal value. The results of these experiments were used to show that ion-hose will not be a problem for to the final DARHT-II configuration.

Chlamydia trachomatis (CT) screening of sexually active girls (15–25) is a performance standard in the Health Plan Employer Data Information Set (HEDIS) as part of the National Committee for Quality Assurance (NCQA) to monitor the quality of care in managed care organizations. There has only been one published study to date examining the validity of the HEDIS measure to identify sexually active females. However, this study did not specifically report on the teen data. Because of the lack of data and concern about the HEDIS measure for teens (e.g., oral contraceptive prescription use for acne & reproductive counseling as a preventive service), we compared two different methods for calculating CT Screening rates among sexually active adolescent females: HEDIS specifications vs. teens’ self-report survey data.

Purpose Chlamydia trachomatis (CT) screening of sexually active girls is a performance standard in the Health Plan Employer Data Information Set (HEDIS) to monitor the quality of care in managed care organizations. There has only been one study examining the validity of the HEDIS measure to identify sexually active females and this study did not specifically report on teen data. Because of the lack of data and concern about the HEDIS measure for teens (e.g., oral contraceptive prescription use for acne & reproductive counseling as a preventive service), we compared two different methods for calculating CT screening rates among sexually active adolescent females: HEDIS vs. teens9 self-report survey data. Methods This study was implemented in 10 ambulatory pediatric departments of a large California HMO as part of a larger randomized control trial designed to increase CT screening rates among sexually active 14-18 yo adolescent females (Shafer et al. 2002) during regularly scheduled health maintenance visits (HMVs). CT screening rates are the number of CT tests done in the past 12 months for a given teen divided by the estimated number of sexually active teens. Laboratory (CT tests) and HMVs data was compiled for three years (2001-2003). Two different methods were used to estimate the number of sexually active teens. First, HEDIS administrative data was used (as specified with ICD-9 and CPT-4 codes). Second, anonymous surveys at each of the pediatric clinics were administered to calculate sexual activity rates. Results Significantly more teens were estimated to be sexually active using the HEDIS specifications compared to self-reported survey data. The mean number of teens identified as sexually active via HEDIS across the 3 years was 337 compared to 140 using the self-reported survey data, p=0.008. Improvements in CT screening rates in intervention clinics compared to controls were detected in both methodologies; however, the difference was not as robust with the HEDIS measure. Conclusions There are many advantages for using administrative data to estimate sexual activity used to calculate CT screening rates; however, more research is needed to examine its validity especially for the young adolescent population. This issue is extremely important, as clinicians monitor the effectiveness of their interventions to progress towards the goal of universal CT screening of sexually active females.

Mast cells participate in normal and pathogenic inflammatory processes, including innate host defense, allergy, and asthma. Stimulation of the mast cell high-affinity IgE receptor (FcεR) by receptor cross-linking activates multiple downstream signaling pathways resulting in degranulation and de novo synthesis of multiple cytokines. However, the molecular mechanisms underlying these processes are incompletely defined. It is known that Rac2 deficient murine bone marrow derived mast cells (BMMCs) have impaired degranulation, but the downstream effectors that modulate this function are unknown. We hypothesized that p-21 activated kinase 1 (Pak1), a downstream effector of Rac proteins, is important in degranulation and de novo cytokine synthesis. Mature BMMCs from wild-type (WT) and Pak1 KO mice were sensitized with anti-DNP IgE then stimulated with DNP-HSA to stimulate FcεR. Interestingly, Pak1 KO BMMCs showed significant impairment in degranulation, as demonstrated by a 3-fold reduction in the percent of B-hexosaminidase released upon IgE stimulation. IgE stimulation of mast cell results not only in degranulation, but also in the production of TNFα, which is critical in the early recruitment of neutrophils to sites of acute inflammation. TNFαsynthesis is influenced by a number of transcription factors, many which are regulated by Erk. Since Pak1 has been shown, in overexpression systems, to phosphorylate Raf and Mek to activate Erk, we examined Erk activation in WT and Pak1 KO BMMCs in response to IgE stimulation. Pak1 KO BMMCs have a 50% reduction in phospho-Erk as compared to controls. We then tested another MAPK member important in mast cell cytokine synthesis, p38, and found phospho-p38 to be decreased in Pak1 KO BMMCs as well. Further, IgE-stimulated Pak1 KO BMMCs produce only 20–30% as much TNFαas controls. To define the role of Pak1 in cytokine production as specific for TNFαversus a more global defect, we also studied IL-6 synthesis and are able to report a 50% reduction in IL-6 production by Pak1 KO BMMCs. Our results indicate that Pak1 is important in BMMC degranulation, cytokine production, and MAPK activation in response to FcεR stimulation. These studies identify Pak1 as a potential therapeutic target in pathologic inflammation. Mechanisms by which Pak1 may be influencing mast cell degranulation as well as further study of transcription factors important in mast cell cytokine production are under current investigation.