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International audience; In a power plant scale fusion reactor, a huge amount of thermal power produced by the fusion reaction and external heating must be exhausted through the narrow area of the divertor targets. The targets must withstand the intense bombardment of the diverted particles where high heat fluxes are generated and erosion takes place on the surface. A considerable amount of volumetric nuclear heating power must also be exhausted. To cope with such an unprecedented power exhaust challenge, a highly efficient cooling capacity is required. Furthermore, the divertor must fulfill other critical functions such as nuclear shielding and channeling (and compression) of exhaust gas for pumping. Assuring the structural integrity of the neutron-irradiated (thus embrittled) components is a crucial prerequisite for a reliable operation over the lifetime. Safety, maintainability, availability, waste and costs are another points of consideration.In late 2020, the Pre-Conceptual Design activities to develop the divertor of the European demonstration fusion reactor were officially concluded. On this occasion, the baseline design and the key technology options were identified and verified by the project team (EUROfusion Work Package Divertor) based on seven years of R&D efforts and endorsed by Gate Review Panel.In this paper, an overview of the load specifications, brief descriptions of the design and the highlights of the technology R&D work are presented together with the further work still needed.

Objective: The objective of this study was to evaluate the Perceived Stress Scale, Insomnia Severity Index, and Impact of Events Scale-Revised scores of patients at a fertility clinic in Manhattan during the coronavirus disease 2019 (COVID-19) pandemic Design: Surveys were administered to 220 patients at a fertility clinic in Manhattan during the COVID-19 pandemic The surveys included a 7-item questionnaire on patient demographics, the Perceived Stress Scale (10-item questionnaire), the Insomnia Severity Index (7-item questionnaire), and the Impact of Events Scale-Revised (IES-R, 21-item questionnaire) Materials and Methods: Online surveys were administered to 220 patients at Generation Next Fertility (GNF), located in Manhattan Percentages of patients who met different thresholds along the Perceived Stress Scale, Insomnia Severity Index, and the IES-R questionnaires were calculated We excluded one question from the standard 22-item IES-R questionnaire: “During the past seven days with respect to (insert event) have you felt yourself acting or feeling like you were back at that time?” All patients who did not respond to the Perceived Stress Scale, Insomnia Severity Index, and/or IES-R questionnaires were excluded from the respective analyses Multiple linear regression was run to determine if surpassing a high school education and being unemployed were correlated with higher Perceived Stress Scale scores A p-value of less than 0 05 was considered as statistically significant Results: According to the results of the Perceived Stress Scale, 66 9% of patients at the Manhattan-based fertility clinic self-reported experiencing moderate stress during the COVID-19 pandemic 21 9% and 11 2% of patients perceived low and high stress, respectively There was no statistically significant relationship between the demographic variables of not surpassing a high school education and being unemployed and the perceived stress levels of IVF patients during the COVID-19 pandemic Additionally, the results of the Insomnia Severity Index survey demonstrated that 43 7% of patients self-reported no clinically significant insomnia, 39 5% self-reported subthreshold insomnia, 15 6% self-reported clinical insomnia of moderate severity, and 1 2% self-reported severe clinical insomnia Furthermore, the results of the IES-R survey showed that 52 1% of patients self-reported scores high enough to indicate that post-traumatic stress disorder (PSTD) is of clinical concern, 27 1% of patients self-reported scores at the cut-off level or higher for a probable diagnosis of PTSD, and 18 8% of patients self-reported scores that are high enough to suppress immune system functioning (for even 10 years after the COVID-19 pandemic) Conclusions: According to surveys administered at an IVF clinic in Manhattan, the majority of the patients self-reported moderate stress, no clinically significant levels of insomnia, and PTSD levels of clinical concern during the COVID-19 pandemic Not surpassing a high school education and being unemployed did not influence patients’ perceived stress levels during the COVID-19 pandemic References: Christianson, Steven, and Joan Marren "The impact of event scale-revised (IES-R) " Medsurg Nurs 21 5 (2012): 321-322 Cohen, Sheldon, T Kamarck, and R Mermelstein "Perceived stress scale " Measuring stress: A guide for health and social scientists 10 (1994) Morin, Charles M , et al "The Insomnia Severity Index: psychometric indicators to detect insomnia cases and evaluate treatment response " Sleep 34 5 (2011): 601-608

Objective: The objective of this study was to determine if different infertility diagnoses impacted patients’ scores on the FertiQol questionnaire, Insomnia Severity Index (ISI), and Perceived Stress Scale (PSS) during the COVID-19 pandemic The study also investigated if patients who were forced to discontinue their fertility treatment during the COVID-19 pandemic had different FertiQol scores than patients who were able to continue Design: Surveys were administered to 220 patients at a fertility clinic in Manhattan during the COVID-19 pandemic The surveys included a 36-item FertiQol questionnaire assessing Fertility Quality of Life in men and women experiencing fertility problems The surveys also asked patients to specify their infertility diagnoses (polycystic ovary syndrome, diminished ovarian reserve, uterine factor, endometriosis, or male infertility) Patients were further given a 7-item ISI questionnaire and a 10-item PSS questionnaire Finally, the surveys asked whether patients were forced to disrupt their fertility treatment plans due to the COVID-19 pandemic Materials and Methods: Using multiple linear regression, we looked for statistically significant relationships between different infertility diagnoses and FertiQol scores For this regression, we excluded all individuals who did not know their infertility diagnosis, had unexplained infertility issues, answered that they were fertile, or did not answer the FertiQol questionnaire We also used multiple linear regression to look for statistically significant relationships between different infertility diagnoses and levels of insomnia and between different infertility diagnoses and perceived stress Next, using Welch’s t-test, we investigated if patients who discontinued their fertility treatments during the COVID-19 pandemic had a different mean FertiQol score from patients who continued treatment We excluded all individuals who were not currently undergoing treatment and who did not answer the FertiQol questionnaire A p-value less than 0 05 was considered statistically significant Results: The majority of the IVF patients sampled self-reported moderate stress (66 9%) There was no statistically significant relationship between the exact etiology of an IVF patient’s infertility diagnosis and the patient’s FertiQol score There was also no statistically significant relationship between the exact etiology of an IVF patient’s infertility diagnosis and the patient’s ISI nor PSS scores Patients who discontinued their fertility treatments during COVID-19 did not have different FertiQol scores from patients who were able to continue Conclusions: The majority of the IVF patients sampled self-reported moderate stress during the COVID-19 pandemic Interestingly, the exact etiology of an IVF patient’s infertility diagnosis did not have a statistically significant impact upon his or her Fertility Quality of Life, ISI, and PSS scores during this time period Patients who were forced to discontinue their fertility treatments due to COVID-19 did not have different FertiQol scores from patients who were able to continue

Purpose The enactment of the Patient Protection and Affordable Care Act in 2010 placed an emphasis on measuring the quality of care. However, the issue of how best to measure quality remains in question. Although some surgical specialties frequently rely on quality measures such as the mortality rate, measuring quality in hand surgery necessitates the use of metrics beyond this traditional scope. A review was performed of the potential quality metrics used in the hand surgery literature published after the Affordable Care Act was enacted, to identify current trends in quality measurement and guide efforts to improve the quality of care in hand surgery. Methods We searched the PubMed and EMBASE databases to identify original research articles within hand surgery to assess how care is being measured. Data extracted from the articles included study characteristics, quality metrics, and the domain(s) of quality. Results A total of 7,308 articles were identified, and 63 prospective and retrospective articles were included in the analysis. The most common quality measure reported in the hand surgery literature was an outcome measure (100%) and the least common was a structure measure (30.2%). The most common metrics were pain (44.4%) and patient-reported measures (41.3%). Effectiveness (42.9%) was the most frequently assessed domain of quality, whereas efficiency (3.2%) was the least studied. Conclusions We identified quality measures used in contemporary hand surgery literature and found a substantial variation in the representation of quality metrics. Structure and process measures can be leveraged to provide a more holistic assessment of the quality of care in hand surgery. Clinical relevance Although outcome measurements are critical to understanding effectiveness, structure and process measures should be considered and reported as necessary, because these metrics may influence treatment outcomes and the development of quality measures.

Objective: The objective of this study was to determine the impact of coronavirus disease 2019 (COVID-19) on in vitro fertilization (IVF) patients’ stress levels, insomnia, and risk of post-traumatic stress disorder (PSTD) relative to the amount of time each patient spent trying to get pregnant Design: Surveys were administered to 220 patients at a fertility clinic in Manhattan during the COVID-19 pandemic The surveys included a 13-item questionnaire regarding fertility plans in relation to the COVID-19 pandemic, a 10-item Perceived Stress Scale questionnaire, a 7-item Insomnia Severity Index questionnaire, and a 21-item Impact of Events Scale-Revised (IES-R) questionnaire Materials and Methods: Surveys were administered online to 220 patients at Generation Next Fertility in Manhattan IVF patients were categorized according to the amount of time they spent trying to get pregnant (less than 6 months, between 6 months-1 year, between 1-2 years, between 2-3 years, between 3-4 years, and greater than 4 years) Multiple linear regression was run to determine if the amount of time patients spent trying to get pregnant was related to their Perceived Stress Scale scores, Insomnia Severity Index scores, and IES-R total scores We excluded individuals who did not answer the Perceived Stress Scale, Insomnia Severity Index, and IES-R questionnaires A p-value of less than 0 05 was considered as statistically significant Results: There was a statistically significant relationship between Perceived Stress Scale scores during the COVID-19 pandemic and attempting to get pregnant for less than 6 months (p=0 00837), between 1 year and 2 years (p=1 96e-08), between 2 and 3 years (p=7 93e-07), between 3 and 4 years (p=1 24e-06), and greater than 4 years (p=1 93e-05) The relationships between Insomnia Severity Index scores during the COVID-19 pandemic and attempting to get pregnant for between 6 months and 1 year (p=0 0462), between 1 year and 2 years (p=1 26e-05), between 2 and 3 years (p=0 00465), between 3 and 4 years (p=0 000685), and greater than 4 years (p=0 0114) were statistically significant There was a statistically significant relationship between IES-R scores during the COVID-19 pandemic and attempting to get pregnant for less than 6 months (p=0 003322), between 1 year and 2 years (p=9 22e-06), between 2 and 3 years (p=0 000671), between 3 and 4 years (p=0 000175), and greater than 4 years (p=0 008695 ) Spending between 3 and 4 years trying to get pregnant had the largest impact on the Perceived Stress Scale, Insomnia Severity Index, and IES-R scores Conclusions: Spending between 3 and 4 years attempting to get pregnant had the largest impact upon IVF patients’ perceived stress, insomnia severity, and risk of PTSD during the COVID-19 pandemic References: Christianson, Steven, and Joan Marren "The impact of event scale-revised (IES-R) " Medsurg Nurs 21 5 (2012): 321-322 Cohen, Sheldon, T Kamarck, and R Mermelstein "Perceived stress scale " Measuring stress: A guide for health and social scientists 10 (1994) Morin, Charles M , et al "The Insomnia Severity Index: psychometric indicators to detect insomnia cases and evaluate treatment response " Sleep 34 5 (2011): 601-608

Although the round goby ( Neogobius melanostomus ) has become established throughout the Laurentian Great Lakes, information is scarce on spatial variation in round goby growth between and within lakes. Based on a sample of 754 specimens captured in 2014, age, growth, and mortality of round gobies at four locations in Lake Huron were assessed via otolith analysis. Total length ( TL ) of round gobies ranged from 44 to 111 mm for Saginaw Bay, from 45 to 115 mm for Rockport, from 50 to 123 mm for Hammond Bay, and from 51 to118 mm for Thunder Bay. Estimated ages of round gobies ranged from 2 to 5 years for Saginaw Bay, from 2 to 6 years for Rockport, and from 2 to 7 years for Hammond Bay and Thunder Bay. Sex-specific, body–otolith relationships were used to back-calculate total lengths at age, which were then fitted to von Bertalanffy growth models. For each sex, round goby growth showed significant spatial variation among the four locations within Lake Huron. At all four locations in Lake Huron, males grew significantly faster than females and attained a larger asymptotic length than females. Annual mortality rate estimates were high (62 to 85%), based on catch-curve analysis, suggesting that round gobies may be under predatory control in Lake Huron.