Health care seeking among detained undocumented migrants: a cross-sectional study

BACKGROUND: As in many European countries, access to care is decreased for undocumented migrants in the Netherlands due to legislation. Studies on the health of undocumented migrants in Europe are scarce and focus on care-seeking migrants. Not much is known on those who do not seek care. METHODS: This cross-sectional study includes both respondents who did and did not seek care, namely undocumented migrants who have been incarcerated in a detention centre while awaiting expulsion to their country of origin. A consecutive sample of all new arrivals was studied. Data were collected through structured interviews and reviews of medical records. RESULTS: Among the 224 male migrants who arrived at the detention centre between May and July 2008, 173 persons were interviewed. 122 respondents met inclusion criteria. Only half of the undocumented migrants in this study knew how to get access to medical care in the Netherlands if in need. Forty-six percent of respondents reported to have sought medical help during their stay in the Netherlands while having no health insurance (n = 57). Care was sought most frequently for injuries and dental problems. About 25% of these care seekers reported to have been denied care by a health care provider. Asian migrants were significantly less likely to seek care when compared to other ethnic groups, independent from age, chronic health problems and length of stay in the Netherlands. CONCLUSION: The study underlines the need for a better education of undocumented patients and providers concerning the opportunities for health care in the Netherlands. Moreover, there is a need to further clarify the reasons for the denial of care to undocumented patients, as well as the barriers to health care as perceived by undocumented migrants

Overview of the third JET deuterium-tritium campaign

JET returned to deuterium-tritium operations in 2023 (DTE3 campaign), approximately two years after DTE2. DTE3 was designed as an extension of JET's 2022-2023 deuterium campaigns, which focused on developing scenarios for ITER and DEMO, integrating in-depth physics understanding and control schemes. These scenarios were evaluated with mixed D-T fuel, using the only remaining tritium-capable tokamak until its closure in 2023. A core-edge-SOL integrated H-mode scenario was developed and tested in D-T, showing good confinement and partial divertor detachment with Ne-seeding. Stationary pulses with good performance, no tungsten accumulation, and even without ELMs were achieved in D-T. Plasmas with pedestals limited by peeling modes were studied with D, T-rich, and D-T fuel, revealing a positive correlation between pedestal electron pressure and pedestal electron density. The Quasi-Continuous Exhaust regime was successfully achieved with D-T fuel, with access criteria similar to those in D plasmas. A scenario with full detachment, the X-point radiator regime, was established in D-T, aided by the real-time control of the radiator's position. The crucial characterisation of tritium retention continued in DTE3, using gas balance measurements and the new LID-QMS diagnostic. Nuclear technology studies were advanced during the DTE3 campaign, addressing issues such as the activation of water in cooling loops and single event effects on electronics. Building on the previous D, T and DTE2 campaigns and the lessons learned from them, DTE3 extended our understanding of D-T plasmas, particularly in scenarios relevant to next-generation devices such as ITER and DEMO

X-point radiator control and its dynamics in ASDEX Upgrade and JET deuterium–tritium discharges

Control of heat exhaust is essential for the operation of power producing fusion reactors. Here, we present results of heat exhaust feedback control experiments in JET and AUG. In JET, we demonstrate the first X-point radiator (XPR) control in DD and DT discharges using argon seeding. In AUG, we improve the XPR control with nitrogen seeding, resulting in achieving the first detached L-H and H-L transition (in a single discharge). The controllers are designed using a model-based design procedure. The required models are obtained experimentally using perturbative (system identification) experiments. We study the dynamic response of the XPR to various seeding species and varying operating conditions. We find that the sensitivity (relative gain) of the XPR varies as function the height of the radiator inside the confined region but that the relative phase is consistent for all operating points. In AUG, the XPR is also less sensitive to impurity seeding changes for higher heating powers. In JET, we show that the XPR dynamics are the same for DD and DT plasmas. However, we observe that XPR control is only possible with argon and not with neon. The results show that a controller might well be designed in earlier stages of operation of a future device, but remains applicable and can be further tuned for full power operation

DIII-D research to provide solutions for ITER and fusion energy

The DIII-D tokamak has elucidated crucial physics and developed projectable solutions for ITER and fusion power plants in the key areas of core performance, boundary heat and particle transport, and integrated scenario operation, with closing the core-edge integration knowledge gap being the overarching mission. New experimental validation of high-fidelity, multi-channel, non-linear gyrokinetic turbulent transport models for ITER provides strong confidence it will achieve Q ⩾ 10 operation. Experiments identify options for easing H-mode access in hydrogen, and give new insight into the isotopic dependence of transport and confinement. Analysis of 2,1 islands in unoptimized low-torque IBS demonstration discharges suggests their onset time occurs randomly in the constant β phase, most often triggered by non-linear 3-wave coupling, thus identifying an NTM seeding mechanism to avoid. Pure deuterium SPI for disruption mitigation is shown to provide favorable slow cooling, but poor core assimilation, suggesting paths for improved SPI on ITER. At the boundary, measured neutral density and ionization source fluxes are strongly poloidally asymmetric, implying a 2D treatment is needed to model pedestal fuelling. Detailed measurements of pedestal and SOL quantities and impurity charge state radiation in detached divertors has validated edge fluid modelling and new self-consistent 'pedestal-to-divertor' integrated modeling that can be used to optimize reactors. New feedback adaptive ELM control minimizes confinement reduction, and RMP ELM suppression with sustained high core performance was obtained for the first time with the outer strike point in a W-coated, compact and unpumped small-angle slot divertor. Advances have been made in integrated operational scenarios for ITER and power plants. Wide pedestal intrinsically ELM-free QH-modes are produced with more reactor-relevant conditions, Low torque IBS with W-equivalent radiators can exhibit predator-prey oscillations in Te and radiation which need control. High-βP scenarios with qmin > 2, q95–7.9, βN > 4, βT–3.3% and H98y2 > 1.5 are sustained with high density (= 7E19 m−3, fG–1) for 6 τE, improving confidence in steady-state tokamak reactors. Diverted NT plasmas achieve high core performance with a non-ELMing edge, offering a possible highly attractive core-edge integration solution for reactors

A practical risk scale for predicting morbidity and mortality in the emergency general surgical setting: A prospective multicenter study

Background Low albumin is a poor prognostic factor for surgical outcomes. We aimed to examine the predicative ability of easily obtainable point of care variables in combination to low albumin level to derive a practical risk scale for predicting older adults at risk of poor outcomes on admission to the emergency general surgical setting. Methods This is an international multi-center prospective cohort study conducted as part of the Older Persons Surgical Outcomes Collaboration (www.OPSOC.eu). The effect of having hypoalbuminemia (defined as albumin ≤3.5  g/dL) on selected outcomes was examined using fully adjusted multivariable models. In a subgroup of patients with hypoalbuminemia, we observed four risk characteristics (Male, Anemia, Low albumin, Eighty-five and over [MALE]). Subsequently, the impact of incremental increase in MALE score (each characteristic scoring 1 point (maximum score 4) on measured outcomes was assessed. Results The cohort consisted of 1406 older patients with median (IQR) age of 76 (70–83) years. In fully adjusted models, hypoalbuminemia was significantly associated with undergoing emergency surgery (1.32 (95%CI 1.03–1.70); p = 0.03), 30-day mortality (4.23 (2.22–8.08); p

Fusion Burn Regulation via Deuterium Tritium Mixture Control in the Joint European Torus

The first generation of nuclear fusion reactors is expected to operate using a mixture of deuterium (D) and tritium (T) fuel. Controlling the D:T ratio is a promising option to control the fusion burn rate. The Joint European Torus (JET), as the only operational tokamak that can use tritium, is uniquely placed to test the feasibility of such control. Experiments carried out in 2023, during the third JET D-T campaign, have demonstrated effective feedback control of the D:T ratio under H-mode conditions. The D:T ratio was measured using visible spectroscopy and tritium was injected via gas valves, while deuterium was injected either via gas valves or pellets. In these experiments, the fusion power, measured via the neutron rate, responded promptly to variations in the measured D:T ratio. This demonstrates that, although the plasma is fueled mainly at the edge, rapid mixing of the isotopes occurs throughout the plasma and controlling the D:T ratio is an effective way of controlling the burn rate. To sustain a stable type-I ELMy H-mode plasma, it is desirable to maintain a given edge localised mode (ELM) frequency. However, both the total fueling rate and the D:T ratio influence this ELM frequency, with higher fueling rates and higher D:T ratios both resulting in more frequent ELMs. For this reason, the D:T ratio controller was combined with an ELM frequency controller in a multi-input multi-output controller. Successful simultaneous decoupled control of the D:T ratio and ELM frequency was demonstrated using a combination of pellet and gas fueling. This is the first and, for the time being, only demonstration of such an advanced burn control scheme in a DT plasma

Heating technology for malignant tumors: a review

The therapeutic application of heat is very effective in cancer treatment. Both hyperthermia, i.e., heating to 39-45 degrees C to induce sensitization to radiotherapy and chemotherapy, and thermal ablation, where temperatures beyond 50 degrees C destroy tumor cells directly are frequently applied in the clinic. Achievement of an effective treatment requires high quality heating equipment, precise thermal dosimetry, and adequate quality assurance. Several types of devices, antennas and heating or power delivery systems have been proposed and developed in recent decades. These vary considerably in technique, heating depth, ability to focus, and in the size of the heating focus. Clinically used heating techniques involve electromagnetic and ultrasonic heating, hyperthermic perfusion and conductive heating. Depending on clinical objectives and available technology, thermal therapies can be subdivided into three broad categories: local, locoregional, or whole body heating. Clinically used local heating techniques include interstitial hyperthermia and ablation, high intensity focused ultrasound (HIFU), scanned focused ultrasound (SFUS), electroporation, nanoparticle heating, intraluminal heating and superficial heating. Locoregional heating techniques include phased array systems, capacitive systems and isolated perfusion. Whole body techniques focus on prevention of heat loss supplemented with energy deposition in the body, e.g., by infrared radiation. This review presents an overview of clinical hyperthermia and ablation devices used for local, locoregional, and whole body therapy. Proven and experimental clinical applications of thermal ablation and hyperthermia are listed. Methods for temperature measurement and the role of treatment planning to control treatments are discussed briefly, as well as future perspectives for heating technology for the treatment of tumors

Overview of the EUROfusion Tokamak Exploitation programme in support of ITER and DEMO

Within the 9th European Framework programme, since 2021 EUROfusion is operating five tokamaks under the auspices of a single Task Force called 'Tokamak Exploitation'. The goal is to benefit from the complementary capabilities of each machine in a coordinated way and help in developing a scientific output scalable to future largre machines. The programme of this Task Force ensures that ASDEX Upgrade, MAST-U, TCV, WEST and JET (since 2022) work together to achieve the objectives of Missions 1 and 2 of the EUROfusion Roadmap: i) demonstrate plasma scenarios that increase the success margin of ITER and satisfy the requirements of DEMO and, ii) demonstrate an integrated approach that can handle the large power leaving ITER and DEMO plasmas. The Tokamak Exploitation task force has therefore organized experiments on these two missions with the goal to strengthen the physics and operational basis for the ITER baseline scenario and for exploiting the recent plasma exhaust enhancements in all four devices (PEX: Plasma EXhaust) for exploring the solution for handling heat and particle exhaust in ITER and develop the conceptual solutions for DEMO. The ITER Baseline scenario has been developed in a similar way in ASDEX Upgrade, TCV and JET. Key risks for ITER such as disruptions and run-aways have been also investigated in TCV, ASDEX Upgrade and JET. Experiments have explored successfully different divertor configurations (standard, super-X, snowflakes) in MAST-U and TCV and studied tungsten melting in WEST and ASDEX Upgrade. The input from the smaller devices to JET has also been proven successful to set-up novel control schemes on disruption avoidance and detachment

The feasibility of Pressurised Intraperitoneal Aerosolised Virotherapy (PIPAV) to administer oncolytic adenoviruses

Background: The prognosis of patients with peritoneal metastases is poor. Treatment options are limited because systemically delivered chemotherapy is not usually effective in this type of disease. Pressurised intraperitoneal aerosolised chemotherapy (PIPAC) is a recently developed alternative technology for delivering intraperitoneal chemotherapy, potentially enhancing treatment efficacy. Here, we assess the feasibility of pressurised intraperitoneal aerosolised virotherapy (PIPAV) to deliver a different class of anticancer agents, oncolytic adenoviruses, in vitro and in vivo. Methods: Adenoviral vectors expressing reporter genes green fluorescence protein (Ad5.GFP) or firefly luciferase (Ad5.Luc) were subject to pressurised aerosolisation. The ability of the virus to survive PIPAV was assessed in vitro and in vivo by monitoring reporter gene activity. Wistar rats subjected to PIPAV were assessed for any adverse procedure related events. Results: In vitro transduction assays demonstrated that Ad5 retained viability following pressurised aerosolisation and could transduce permissive cells equally effectively as non-aerosolised control vector. PIPAV was well tolerated in rats, although minimal transduction was observed following intraperitoneal administration. Conclusions: PIPAV appears viable and well tolerated, though in vivo efficacy requires further optimisation