Measurement of the Gamma-Ray-to-Neutron Branching Ratio for the Deuterium-Tritium Reaction in Magnetic Confinement Fusion Plasmas.

At present, magnetic confinement fusion devices rely solely on absolute neutron counting as a direct way of measuring fusion power. Absolute counting of deuterium-tritium gamma rays could provide the secondary neutron-independent technique required for the validation of scientific results and as a licensing tool for future power plants. However, this approach necessitates an accurate determination of the gamma-ray-to-neutron branching ratio. The gamma-ray-to-neutron branching ratio for the deuterium-tritium reaction ^{3}H(^{2}H,γ)^{5}He/^{3}H(^{2}H,n)^{4}He was determined in magnetic confinement fusion plasmas at the Joint European Torus in predominantly deuterium beam heated plasmas. The branching ratio was found to be equal to (2.4±0.5)×10^{-5} over the deuterium energy range of (80±20) keV. This accurate determination of the deuterium-tritium branching ratio paves the way for a direct and neutron-independent measurement of fusion power in magnetic confinement fusion reactors, based on the absolute counting of deuterium-tritium gamma rays.

Readiness for practice in undergraduate nursing students during the COVID-19 pandemic: a cross-sectional study.

Background: The Coronavirus disease 2019 (COVID-19) pandemic negatively impacted nursing students' opportunity to gain experience through clinical placement, potentially threatening their readiness for practice and their clinical competence. The aim of this study was to explore whether and to what extent the third-year undergraduate nursing students perceived that their readiness for practice was impacted by changes to clinical placement and classroom learning implemented in response to the COVID-19 pandemic. Study design: Cross-sectional study. Methods: The study was conducted in a university of North-western Italy that provides nursing education across five sites. All sites stopped in-person classroom learning at the beginning of March 2020, but each site was free to decide whether to continue in-person clinical placement based on the local epidemiological situation. All 228 third-year nursing students who completed their degree by June 2020 were invited to participate. Data were collected via online questionnaire, which included the question "What impact do you think that COVID-19 safety measures employed by your nursing programme had on your readiness for practice?" Answers were given on a 5-point Likert scale (none, minimal, moderate, major, and severe). Explanatory variables were collected at the individual, nursing programme, and university site levels. Results: A total of 126 (response rate 55.3%) nursing students completed the questionnaire. Overall, 84 (66.7%) perceived that COVID-19 safety measures had a moderate to severe impact on their readiness for practice. These students often had lower grade point averages (p=0.037) and received no clinical placement during the pandemic (72.6% vs 90.5% of students who reported no or minimal impact, p=0.022). Average duration of third-year clinical placement was also lower among these students, though it was not statistically significant. No differences emerged at the university site level. Conclusions: Despite important advances in technology-based educational activities, clinical placement remains the best educational strategy to allow nursing students to feel prepared to work effectively during a pandemic.

Knowledge and attitude of pain management among Italian nurses in intensive care unit: a multicentric descriptive study.

Aim: The main objective of the study was to document the current knowledge and attitudes towards pain management among Italian nurses working in intensive care unit (ICU). Methods: A multicenter cross-sectional study design was carried out. In order to assess the knowledge and attitudes of pain management, the KASRP questionnaire was used. The questionnaire was submitted online through Google Forms platform. Results: A total of 864 nurses completed and returned the study questionnaire (58% were males). The mean of the total correct answers was 31.21 (SD 2.92) out of 40 (total score if all items answered correctly) with range of 22-38. No significant differences were observed with regard to gender (t = 1.875, P = .061). Spearman's correlation test showed a positive significant relationship between knowledge and attitude of pain management and years of ICU experience (r = -.424, P <.001) and between knowledge and attitude of pain management and the attendance of a pain update course in the last 3 years (r= -0.83, P =.014). We haven't found any correlation neither between age and knowledge nor between age and attitude score (r = -0.32, P = .351). Conclusions: This study has shown that Italian ICU nurses have good level of pain management knowledge and attitudes of pain medication. It is recommended to consider pain management in the context of continuing professional development.

Social media and nurse education: an integrative review of the literature.

INTRODUCTION: The exponential advance of social media has touched all areas of society, no exception for the professional and personal lives of healthcare people. The issue to be considered is not whether or not social media are being used, but how they are used. The line between proper and improper use, and even abuse, of social media is a subtle one. Thus, the key issue is to be aware of the tool that is being used and this should be supported with suitable training for healthcare professionals and, at an even earlier stage, for students at healthcare training institutions during their studies. OBJECTIVE: To describe, through an integrative review of the literature, the use of social media by teachers and students during teaching activity and practical training courses. MATERIALS AND METHODS: An integrative review of the literature was conducted in October 2014. The literature search was performed by consulting the main biomedical databases: PubMed, CINAHL and Embase. RESULTS: The literature search brought up a total of 854 citations. 804 abstracts were excluded as they were not relevant. Of the remaining 50, 31 were excluded for not meeting the general criteria and, hence, only 19 articles were included. Two aspects emerged from the works selected: the use and potential of social media in nursing education and the ethical and professional implications of their use. CONCLUSIONS: The analysis of the literature reveals two areas for further investigation: evaluating the level of moral awareness in nursing education with regards to the use of Web 2.0 communication tools and implementing teaching methods to promote the construction and development of moral reasoning in professionals.

Nursing research priorities in internal medicine nursing practice: an Italian Delphi study.

INTRODUCTION: In order to develop an effective and accountable nursing practice is necessary to launch research projects through coordinated studies and one of the main strategies to achieve this goal is to define research priorities. METHODS: he aim of this study is define the nursing priority research in Internal Medicine and explore the possibility to define the nursing priority research in Internal Medicine. This is an observational study using a three-round Delphi method. RESULTS: Fifty-five nurses (77%) completed all three rounds. Two hundred eighty-four research priorities were recorded, organized in eighty areas. The technical - care and organized - management are the areas in which were identify more priorities. CONCLUSIONS: The top five priorities, identify as the most important, suggest the attention of Italian nurses in care of patients, management and in safe-care.

COSMONAUT: A COmpact spectrometer for measurements of neutrons at the ASDEX upgrade tokamak.

A COmpact Spectrometer for Measurements Of Neutrons at the ASDEX Upgrade Tokamak (COSMONAUT) has been developed for spectroscopy measurements of the 2.45 MeV neutron emission from deuterium plasmas at the ASDEX Upgrade. The instrument is based on a CLYC-7 inorganic scintillator, whereby the detection of fusion neutrons occurs via their interaction with 35Cl nuclei in the detector crystal, leading to a peak in the detector response function and providing excellent neutron/gamma-ray discrimination capabilities. The diagnostics is installed along a radial line of sight and makes use of a digital system to record time resolved data for the whole duration of the discharge. Measurements in ASDEX Upgrade plasmas with neutral beam injection have been carried out and are successfully interpreted using state-of-the-art modeling codes. Next step applications of the diagnostics are in experiments aimed at generating energetic particles by ion cyclotron resonance heating schemes. In these scenarios, COSMONAUT will provide unique information on the acceleration of deuterons beyond the beam injection energy and on their confinement, for comparison with modeling.

Design solutions for the hodoscope of the magnetic proton recoil neutron spectrometer of the SPARC tokamak.

A new 14 MeV neutron spectrometer utilizing the magnetic proton recoil (MPR) technique is under development for the SPARC tokamak. This instrument measures neutrons by converting them into protons, whose momenta are subsequently analyzed using a series of magnets before detection by an array of scintillators known as the hodoscope. In this work, we explore various solutions for the hodoscope detectors through laboratory tests with radioactive sources and simulations. We present findings on light collection and pulse shape discrimination based on detector types, as well as optimal solutions for photo-detectors studying the differences between SiPM and PMT. Our results also led to the determination of a better optimized design for the hodoscope detectors, consisting of a 0.7 cm width and a 13 cm length EJ276D scintillation rod.

Development of fast 2.5 MeV neutron detectors for high-intensity stray magnetic field environments.

Several small to medium-scale magnetic confinement fusion devices operate using deuterium as fuel. These low neutron rate (108-1010 n/s) devices rely on 2.45 MeV neutron measurements to validate physical models and to assess their performance. Given the modest rate, neutron monitors have to be placed as close as possible to the machine to maximize data gathering. In these regions, intense stray magnetic fields could affect the detector's performance. In this work, the development of a neutron detector based on an EJ-276D scintillator crystal coupled with a SiPM and a custom-made readout system is presented. The detector has particle discrimination capability and is insensitive to magnetic fields.

Development of a measuring technique based on JET second D-T campaign (DTE2) experience for assessing fusion power at ITER during D-T operation using the radial gamma-ray spectrometer.

The ITER Radial Gamma-Ray Spectrometer (RGRS) consists of three gamma-ray detectors observing the plasma through three collimated, coplanar, radial lines of sight (LoS). The system was initially designed to monitor the runaway electron emission and the alpha-particle density profile [Nocente et al., Nucl. Fusion 57, 076016 (2017)]. This work presents a novel technique for measuring the fusion power during D-T operation using the RGRS. This method is based on the absolute measurement of the 17 MeV fusion gamma-rays and a semi-analytical computation of their transport from the plasma source to the detectors. This approach was initially developed and tested at JET during the second D-T campaign (DTE2) on a single LoS diagnostic [Dal Molin et al., Phys. Rev. Lett. (submitted) (2024); Rebai et al., Phys. Rev. C (submitted) (2024); and Marcer et al., Nucl. Fusion (unpublished) (2024)]. This work exploits the multiple LoS of the RGRS to create a combined virtual diagnostic whose detected fraction of the total plasma emission is less affected by variations in the plasma emission profile, reducing systematic uncertainties on the estimated total emission, compared to the individual detectors.

Learning from each other: Cross-cutting diagnostic development activities between magnetic and inertial confinement fusion (invited).

Inertial Confinement Fusion and Magnetic Confinement Fusion (ICF and MCF) follow different paths toward goals that are largely common. In this paper, the claim is made that progress can be accelerated by learning from each other across the two fields. Examples of successful cross-community knowledge transfer are presented that highlight the gains from working together, specifically in the areas of high-resolution x-ray imaging spectroscopy and neutron spectrometry. Opportunities for near- and mid-term collaboration are identified, including in chemical vapor deposition diamond detector technology, using gamma rays to monitor fusion gain, handling neutron-induced backgrounds, developing radiation hard technology, and collecting fundamental supporting data needed for diagnostic analysis. Fusion research is rapidly moving into the igniting and burning regimes, posing new opportunities and challenges for ICF and MCF diagnostics. This includes new physics to probe, such as alpha heating; increasingly harsher environmental conditions; and (in the slightly longer term) the need for new plant monitoring diagnostics. Substantial overlap is expected in all of these emerging areas, where joint development across the two subfields as well as between public and private researchers can be expected to speed up advancement for all.

Validity and reliability of the Italian Constipation Assessment Scale.

Constipation is a common problem among oncology patients and requires careful assessment. Use of validated instruments is important to improving its management. The aim of this study was to validate the Italian translation of the Constipation Assessment Scale (CAS). To test construct validity, patients and apparently healthy adults were asked to complete the CAS. The results indicated that there was a significant difference between the median CAS of the patient group and that of the apparently healthy group. Test-retest reliability was very high (r=0.96; P=0.0001), and the internal consistency as assessed by Cronbach's alpha was 0.768. These findings suggest that the Italian CAS can be used in clinical practice to document the presence and severity of constipation in cancer patients. However, further studies should be conducted in a larger sample of patients to confirm the results.

Upgrades to the gamma ray imager on DIII-D enabling access to high flux hard x-ray measurements during the runaway electron plateau phase (invited).

The Gamma Ray Imager (GRI) is a pinhole camera providing 2D imaging of MeV hard x-ray (HXR) bremsstrahlung emission from runaway electrons (REs) over the poloidal cross section of the DIII-D tokamak. We report a series of upgrades to the GRI expanding the access to RE scenarios from the diagnosis of a trace amount of REs to high flux HXR measurements during the RE plateau phase. We present the implementation of novel gamma ray detectors based on LYSO and YAP crystals coupled to multi-pixel photon counters, enabling a count rate in excess of 1 MHz. Finally, we highlight new insights into the RE physics discovered during the current quench and RE plateau phase experiments as the result of these upgrades.

Vitamin D and calcium intakes in general pediatric populations: A French expert consensus paper.

OBJECTIVES: Nutritional vitamin D supplements are often used in general pediatrics. Here, the aim is to address vitamin D supplementation and calcium nutritional intakes in newborns, infants, children, and adolescents to prevent vitamin D deficiency and rickets in general populations. STUDY DESIGN: We formulated clinical questions relating to the following categories: the Patient (or Population) to whom the recommendation will apply; the Intervention being considered; the Comparison (which may be "no action," placebo, or an alternative intervention); and the Outcomes affected by the intervention (PICO). These PICO elements were arranged into the questions to be addressed in the literature searches. Each PICO question then formed the basis for a statement. The population covered consisted of children aged between 0 and 18 years and premature babies hospitalized in neonatology. Two groups were assembled: a core working group and a voting panel from different scientific pediatric committees from the French Society of Pediatrics and national scientific societies. RESULTS: We present here 35 clinical practice points (CPPs) for the use of native vitamin D therapy (ergocalciferol, vitamin D2 and cholecalciferol, vitamin D3) and calcium nutritional intakes in general pediatric populations. CONCLUSION: This consensus document was developed to provide guidance to health care professionals on the use of nutritional vitamin D and dietary modalities to achieve the recommended calcium intakes in general pediatric populations. These CPPs will be revised periodically. Research recommendations to study key vitamin D outcome measures in children are also suggested.

Role of neutron attenuators for gamma-ray measurements in deuterium-tritium magnetic confinement plasmas.

The Joint European Torus (JET) is the only tokamak in the world able to operate in Deuterium-Tritium (DT) plasmas. A successful DT experimental campaign, the DTE2, has recently been carried out, providing unique opportunities for studying both physics and technological aspects. In particular, it allowed us to investigate and benchmark the solutions adopted to attenuate the significant 14 MeV neutron flux, needed to enable high-resolution gamma-ray spectroscopy measurements on a tokamak. While in inertial confinement experiments, gamma-rays and neutrons are discriminated through time-of-flight techniques; in magnetic confinement experiments, the neutron attenuators are a key element to allow gamma-ray measurements in order to reestablish the 1 × 105 to 1 background to signal ratio. In this paper, the role of the reference neutron attenuators at JET, based on LiH, has been analyzed and described.

A new dedicated signal processing system for gamma-ray spectrometers in high power deuterium-tritium plasma scenarios in tokamaks.

The most performant deuterium-tritium (DT) plasma discharges realized by the Joint European Torus (JET) tokamak in the recent DT campaign have produced neutron yields on the order of 1018 n/s. At such high neutron yields, gamma-ray spectroscopy measurements with scintillators are challenging as events from the neutron-induced background often dominate over the signal, leading to a significant fraction of pileup events and instability of the photodetector gain along with the consequent degradation of the reconstructed spectrum. Here, we describe the solutions adopted for the tangential lanthanum bromide spectrometer installed at JET. A data acquisition system with free streaming mode digitization capabilities for the entire duration of the discharge has been used to solve dead-time related issues and a data reconstruction code with pileup recovery and photodetector gain drift restoration has been implemented for off-line analysis of the data. This work focuses on the acquired data storage and parsing, with a detailed explanation of the pileup recovery and gain drift restoration algorithms.

Fusion product measurements by nuclear diagnostics in the Joint European Torus deuterium-tritium 2 campaign (invited).

A new deuterium-tritium experimental, DTE2, campaign has been conducted at the Joint European Torus (JET) between August 2021 and late December 2021. Motivated by significant enhancements in the past decade at JET, such as the ITER-like wall and enhanced auxiliary heating power, the campaign achieved a new fusion energy world record and performed a broad range of fundamental experiments to inform ITER physics scenarios and operations. New capabilities in the area of fusion product measurements by nuclear diagnostics were available as a result of a decade long enhancement program. These have been tested for the first time in DTE2 and a concise overview is provided here. Confined alpha particle measurements by gamma-ray spectroscopy were successfully demonstrated, albeit with limitations at neutron rates higher than some 1017 n/s. High resolution neutron spectroscopy measurements with the magnetic proton recoil instrument were complemented by novel data from a set of synthetic diamond detectors, which enabled studies of the supra-thermal contributions to the neutron emission. In the area of escaping fast ion diagnostics, a lost fast ion detector and a set of Faraday cups made it possible to determine information on the velocity space and poloidal distribution of the lost alpha particles for the first time. This extensive set of data provides unique information for fundamental physics studies and validation of the numerical models, which are key to inform the physics and scenarios of ITER.

A high-resolution neutron spectroscopic camera for the SPARC tokamak based on the Jet European Torus deuterium-tritium experience.

Dedicated nuclear diagnostics have been designed, developed, and built within EUROFUSION enhancement programs in the last ten years for installation at the Joint European Torus and capable of operation in high power Deuterium-Tritium (DT) plasmas. The recent DT Experiment campaign, called DTE2, has been successfully carried out in the second half of 2021 and provides a unique opportunity to evaluate the performance of the new nuclear diagnostics and for an understanding of their behavior in the record high 14 MeV neutron yields (up to 4.7 × 1018 n/s) and total number of neutrons (up to 2 × 1019 n) achieved on a tokamak. In this work, we will focus on the 14 MeV high resolution neutron spectrometers based on artificial diamonds which, for the first time, have extensively been used to measure 14 MeV DT neutron spectra with unprecedented energy resolution (Full Width at Half Maximum of ≈1% at 14 MeV). The work will describe their long-term stability and operation over the DTE2 campaign as well as their performance as neutron spectrometers in terms of achieved energy resolution and high rate capability. This important experience will be used to outline the concept of a spectroscopic neutron camera for the SPARC tokamak. The proposed neutron camera will be the first one to feature the dual capability to measure (i) the 2.5 and 14 MeV neutron emissivity profile via the conventional neutron detectors based on liquid or plastics scintillators and (ii) the 14 MeV neutron spectral emission via the use of high-resolution diamond-based spectrometers. The new opportunities opened by the spectroscopic neutron camera to measure plasma parameters will be discussed.

Providing a nurse-led complex nursing INtervention FOcused on quality of life assessment on advanced cancer patients: The INFO-QoL pilot trial.

PURPOSE: Unmet needs for advanced-disease cancer patients are fatigue, pain, and emotional support. Little information is available about the feasibility of interventions focused on patient-reported outcome measurement developed according to the Medical Research Council (MRC) Framework in advanced-disease cancer patients. We aimed to pilot a nurse-led complex intervention focused on QoL assessment in advanced-disease cancer patients. METHODS: The INFO-QoL study was based on an exploratory, nonequivalent comparison group, pre-test-post-test design. Study sites received either the INFO-QoL intervention or usual care. Adult advanced-disease cancer patients admitted to hospice inpatient units that gave their informed consent were included in the study. Subjects were 187 patients and their families and 19 healthcare professionals. We evaluated feasibility, acceptability, and patients' outcomes using the Integrated Palliative Care Outcome Scale. RESULTS: Nineteen healthcare professionals were included. The mean competence score increased significantly over time (p < 0.001) and the mean usefulness score was high 8.63 (±1.36). In the post-test phase, 54 patients were allocated to the experimental unit and 36 in the comparison unit. Compared to the comparison unit, in the experimental unit anxiety (R2 = 0.07; 95% CI = -0.06; 0.19), family anxiety (R2 = 0.22; 95% CI = -0.03; 0.41), depression (R2 = 0.31; 95% CI = -0.05; 0.56) and sharing feelings (R2 = 0.09; 95% CI = -0.05; 0.23), were improved between pre-test and post-test phase. CONCLUSIONS: The INFO-QoL was feasible and potentially improved psychological outcomes. Despite the high attrition rate, the INFO-QoL improved the quality and safety culture for patients in palliative care settings.

Novel compact hard x-ray spectrometer with MCps counting rate capabilities for runaway electron measurements on DIII-D.

A novel compact spectrometer optimized for the measurement of hard x rays generated by runaway electrons is presented. The detector is designed to be installed in the fan-shaped collimator of the gamma-ray imager diagnostic at the DIII-D tokamak. The spectrometer is based on a 1 × 1 cm2 cerium doped yttrium aluminum perovskite scintillator crystal coupled with a silicon photomultiplier. The detector dynamic energy range is in excess of 10 MeV, with an energy resolution of ∼10% at 661.7 keV. The fast detector signal (≈70 ns full width at half maximum) allows for operation at counting rates in excess of 1 MCps. The gain stability of the system can be monitored in real time using a light-emitting diode embedded in the instrument. The detector is expected to be deployed in the forthcoming DIII-D runaway electron experimental campaign.

A new tangential gamma-ray spectrometer for fast ion measurements in deuterium and deuterium-tritium plasmas of the Joint European Torus.

A new tangential gamma-ray spectrometer has been developed for fast ion measurements in deuterium and deuterium-tritium plasmas of the Joint European Torus (JET). The instrument is based on a LaBr3 crystal with a photo-multiplier tube and replaces a pre-existing bismuth germanate detector, providing enhanced energy resolution and a counting rate capability in the MHz range. The line of sight is equipped with a LiH attenuator, which reduces the background due to 14 MeV neutron interactions with the crystal by more than two orders of magnitude and enables the observation of gamma-ray emission from confined α particles in JET deuterium-tritium plasmas. Thanks to its tangential line of sight, the detector can distinguish co- and counter-passing ions. The performance of the instrument is demonstrated through the results of recent JET fast ion experiments in deuterium plasmas.