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The Spherical Tokamak for Energy Production (STEP) programme aims to deliver a first-of-a-kind fusion prototype powerplant (SPP). The SPP plasma places extreme heat, particle and structural loads onto the plasma-facing components (PFCs) of the divertor, limiters and inboard and outboard sections of the first wall. The PFCs must manage the heat and particle loads and wider powerplant requirements relating to safety, net power generation, tritium breeding and plant availability. To enable STEP PFC concepts to be identified that satisfy these wide-ranging requirements, an iterative design ('Decide & Iterate') methodology has been used to synchronize a prioritized set of decisions, within the fast-paced, iterative, whole plant concept design schedule. This paper details the 'Decide and Iterate' methodology and explains how it has enabled the identification of the SPP PFC concepts. These include innovative PFC solutions such as a helium-cooled discrete and panel limiter design to increase tritium breeding while providing sufficient coverage and enabling individual limiter replacement; the integration of the outboard first wall with the breeding zone to enhance fuel self-sufficiency and power generation; and the use of heavy water (D2O) within the inboard first wall and divertor PFCs to increase tritium breeding within the outboard breeding zone. This article is part of the theme issue 'Delivering Fusion Energy - The Spherical Tokamak for Energy Production (STEP)'.
RESUMEN
INTRODUCTION: The Salford Lung Studies (SLS) were real-world randomised controlled trials set within UK primary care that assessed the effectiveness and safety of initiating once-daily fluticasone furoate/vilanterol versus continuing usual care in patients with chronic obstructive pulmonary disease or asthma. Data were collected for a relatively short period, limiting the study of long-term outcomes. To broaden the capture of SLS patients' data, we undertook the Extended SLS (Ext-SLS), aiming to better understand the patient disease journey and the effects of treatment in a real-world setting, through collection of patient-level data. Here, we present study design information and the challenges and learnings gathered in creating the Ext-SLS. METHODS: The Ext-SLS was intended to augment the SLS by collecting retrospective and prospective (up to 10 years from consent) primary and secondary care electronic health record (EHR) data and patient questionnaires. After ethics approval, general practitioners (GPs) obtained consent from SLS patients remotely (mean 3.2 years post-SLS completion). To facilitate GPs identifying eligible patients, a novel EHR-based approach flagged SLS patients who were alive and registered with their original GP. An automated system sent consent forms/questionnaires to patients. Medical data were collected via EHRs; primary care data were extracted from GPs' systems whilst secondary care data were sourced from the UK NHS. RESULTS: Of the 75 GP sites from the SLS, 35 (47%) declined Ext-SLS participation leaving 4158 potentially eligible patients; 1169 (28%) patients were excluded as GPs could not confirm them as SLS participants or due to incapacity. Of 2989 patients invited, 1189 (40%) consented. CONCLUSIONS: Developing an EHR-based trial extension was achieved, with reasonable consent rates amongst invited patients. The resulting Ext-SLS is a unique and valuable research resource. Leveraging EHRs and technology reduced GP burden, facilitating participation. Initiation of extension studies prior to study close-out may help increase GP and patient participation.