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The 2014-2016 JET results are reviewed in the light of their significance for optimising the ITER research plan for the active and non-active operation. More than 60 h of plasma operation with ITER first wall materials successfully took place since its installation in 2011. New multi-machine scaling of the type I-ELM divertor energy flux density to ITER is supported by first principle modelling. ITER relevant disruption experiments and first principle modelling are reported with a set of three disruption mitigation valves mimicking the ITER setup. Insights of the L-H power threshold in Deuterium and Hydrogen are given, stressing the importance of the magnetic configurations and the recent measurements of fine-scale structures in the edge radial electric. Dimensionless scans of the core and pedestal confinement provide new information to elucidate the importance of the first wall material on the fusion performance. H-mode plasmas at ITER triangularity (H = 1 at β N ∼ 1.8 and n/n GW ∼ 0.6) have been sustained at 2 MA during 5 s. The ITER neutronics codes have been validated on high performance experiments. Prospects for the coming D-T campaign and 14 MeV neutron calibration strategy are reviewed.

Access to maternity care is a public health concern in many rural areas. Sharing care among physicians and other health care providers is one solution. [ABSTRACT FROM AUTHOR]

The present work considers systems whose dynamics are governed by the nonlinear interactions among groups of 6 nonlinear waves, such as those described by the unforced quintic nonlinear Schrödinger equation. Specific parameter regimes in which ensemble-averaged dynamics of such systems with finite size are accurately described by a wave kinetic equation, as used in wave turbulence theory, are theoretically predicted. In addition, the underlying reasons that the wave kinetic equation may be a poor predictor of wave dynamics outside these regimes are also discussed. These theoretical predictions are directly verified by comparing ensemble averages of solutions to the dynamical equation with corresponding solutions of the wave kinetic equation.

For waves described by the focusing nonlinear Schrödinger equation (FNLS), we present an effective dispersion relation (EDR) that arises dynamically from the interplay between the linear dispersion and the nonlinearity. The form of this EDR is parabolic for a robust family of "generic" FNLS waves and equals the linear dispersion relation less twice the total wave action of the wave in question multiplied by the square of the nonlinearity parameter. We derive an approximate form of this EDR explicitly in the limit of small nonlinearity and confirm it using the wave-number-frequency spectral (WFS) analysis, a Fourier-transform based method used for determining dispersion relations of observed waves. We also show that it extends to the FNLS the universal EDR formula for the defocusing Majda-McLaughlin-Tabak (MMT) model of weak turbulence. In addition, unexpectedly, even for some spatially periodic versions of multisolitonlike waves, the EDR is still a downward shifted linear-dispersion parabola, but the shift does not have a clear relation to the total wave action. Using WFS analysis and heuristic derivations, we present examples of parabolic and nonparabolic EDRs for FNLS waves and also waves for which no EDR exists.

Collisional damping of electron plasma waves, the primary damping for high phase velocity waves, is proportional to the electron-ion collision rate, ν_{ei,th}. Here, it is shown that the damping rate normalized to ν_{ei,th} depends on the charge state, Z, on the magnitude of ν_{ei,th} and the wave number k in contrast with the commonly used damping rate in plasma wave research. Only for weak collision rates in low-Z plasmas for which the electron self-collision rate is comparable to the electron-ion collision rate is the damping rate given by the commonly accepted value. The result presented here corrects the result presented in textbooks at least as early as 1973. The complete linear theory requires the inclusion of both electron-ion pitch-angle and electron-electron scattering, which itself contains contributions to both pitch-angle scattering and thermalization.

Ion acoustic waves are found to be susceptible to at least two distinct decay processes. Which process dominates depends on the parameters. In the cases examined, the decay channel where daughter modes propagate parallel to the mother mode is found to dominate at larger amplitudes, while the decay channel where the daughter modes propagate at angles to the mother mode dominates at smaller amplitudes. Both decay processes may occur simultaneously and with onset thresholds below those suggested by fluid theory, resulting in the eventual multidimensional collapse of the mother mode to a turbulent state.

The concentration of ions, or osmolarity, in the tear film is a key variable in understanding dry eye symptoms and disease. In this manuscript, we derive a mathematical model that couples osmolarity (treated as a single solute) and fluid dynamics within the tear film on a 2D eye-shaped domain. The model includes the physical effects of evaporation, surface tension, viscosity, ocular surface wettability, osmolarity, osmosis and tear fluid supply and drainage. The governing system of coupled non-linear partial differential equations is solved using the Overture computational framework, together with a hybrid time-stepping scheme, using a variable step backward differentiation formula and a Runge-Kutta-Chebyshev method that were added to the framework. The results of our numerical simulations provide new insight into the osmolarity distribution over the ocular surface during the interblink., (© The Authors 2015. Published by Oxford University Press on behalf of the Institute of Mathematics and its Applications. All rights reserved.)

Two-dimensional simulations, both Vlasov and particle-in-cell, are presented that show the evolution of the field and electron distribution of finite-width, nonlinear electron plasma waves. The intrinsically intertwined effects of self-focusing and dissipation of field energy caused by electron trapping are studied in simulated systems that are hundreds of wavelengths long in the transverse direction but only one wavelength long and periodic in the propagation direction. From various initial wave states, both the width at focus Δm relative to the initial width Δ0 and the maximum field amplitude at focus are shown to be a function of the growth rate of the transverse modulational instability γTPMI divided by the loss rate of field energy νE to electrons escaping the trapping region. With dissipation included, an amplitude threshold for self-focusing γTPMI/νE∼1 is found that supports the analysis of Rose [Phys. Plasmas 12, 012318 (2005)].

Objective: The objective of this study was to evaluate the effectiveness of the Mercy Migraine Management Program (MMMP), an educational program for physicians and patients. The primary outcome was change in headache days from baseline at 3, 6, and 12 months. Secondary outcomes were changes in migraine-related disability and quality of life, worry about headaches, self-efficacy for managing migraines, emergency room (ER) visits for headache, and satisfaction with headache care., Background: Despite progress in the understanding of the pathophysiology of migraine and development of effective therapeutic agents, many practitioners and patients continue to lack the knowledge and skills to effectively manage migraine. Educational efforts have been helpful in improving the quality of care and quality of life for migraine sufferers. However, little work has been performed to evaluate these changes over a longer period of time. Also, there is a paucity of published research evaluating the influence of education about migraine management on cognitive and emotional factors (for example, self-efficacy for managing headaches, worry about headaches)., Methods: In this open-label, prospective study, 284 individuals with migraine (92% female, mean age = 41.6) participated in the MMMP, an educational and skills-based program. Of the 284 who participated in the program, 228 (80%) provided data about their headache frequency, headache-related disability (as measured by the Headache Impact Test-6 (HIT-6), migraine-specific quality of life (MSQ), worry about headaches, self-efficacy for managing headaches, ER visits for headaches, and satisfaction with care at 4 time points over 12 months (baseline, 3 months, 6 months, 12 months)., Results: Overall, 46% (106) of subjects reported a 50% or greater reduction in headache frequency. Over 12 months, patients reported fewer headaches and improvement on the HIT-6 and MSQ (all P < .001). The improvement in headache impact and quality of life was greater among those who had more worry about their headaches at baseline. There were also significant improvements in "worry about headaches,""self-efficacy for managing headaches," and "satisfaction with headache care.", Conclusion: The findings demonstrate that patients participating in the MMMP reported improvements in their headache frequency as well as the cognitive and emotional aspects of headache management. This program was especially helpful among those with high amounts of worry about their headaches at the beginning of the program. The findings from this study are impetus for further research that will more clearly evaluate the effects of education and skill development on headache characteristics and the emotional and cognitive factors that influence headache.

Patients with chronic daily headache are difficult and often frustrating to treat. They are in many ways similar to chronic pain patients and patients with other chronic serious illnesses that have come to alter many aspects of their life, affecting their physical and emotional well-being, their ability to work, and their family and social relationships. The best treatment strategies for patients with chronic disease combine pharmacologic and behavioral strategies with the behavioral strategies incorporating body, mind, spirit, and social interactions. Numerous studies have demonstrated a positive association between being religious or spiritual and improved health, both in response to acute events and in chronic disease. Because religion is so positively associated with improved outcomes, it is important for physicians to recognize this aspect of a patient's life and try to encourage positive use of the patient's belief system as an adjunct in treatment.

The American Medical Association (AMA) has recently published guidelines for the receipt of gifts from industry representatives. To examine faculty members' attitudes toward that AMA policy as it pertains to gifts from the pharmaceutical industry, the authors surveyed the faculty of the University of Kentucky College of Medicine in 1991. Of 462 faculty members, 248 (54%) completed the questionnaires. The faculty generally agreed with the AMA guidelines. A majority of the faculty believed that personal relationships had the potential to influence prescribing patterns but that gifts, in general, did not greatly influence prescribing behaviors. Compared with the 169 M.D. faculty, the 69 Ph.D. faculty significantly favored more restrictive policies (p less than .001). The authors discuss both the ethical considerations and the utility of guidelines for physician-industry interactions.

Policies for maternity and parenting leave in physician training programs are often lacking or inadequate. A structured elective in mother-child development has been developed by the University of Kentucky Department of Family Practice Residency Program in an attempt to provide a practical alternative for the resident-in-training who is a new parent. The course provides for the integration of personal and professional activities into an educationally beneficial experience. The new course meets the requirements of both the American Board of Family Practice and the Residency Review Committee. The first participants in the elective course have been extremely positive about its merit.