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Le score de fragilité HFRS (« Hospital Frailty Risk Score ») peut être appliqué aux données médico-administratives pour déterminer les risques de mortalité à 30 jours et de séjours prolongés chez les patients âgés hospitalisés en urgence. L'objectif de cette étude était d’évaluer les gains en capacité discriminatoire à associer le score HFRS aux indices de comorbidités de Charlson et d'Elixhauser.

AbstractThe European Union Integrated Tokamak Modelling Task Force (ITM-TF) has developed a standardized platform and an integrated modeling suite of codes for the simulation and prediction of a complete plasma discharge in any tokamak. The framework developed by ITM-TF allows for the development of sophisticated integrated simulations (workflows) for physics application, e.g., free-boundary equilibrium with feedback control, magnetohydrodynamic stability analysis, core/edge plasma transport, and heating and current drive. A significant effort is also under way to integrate synthetic diagnostic modules in the ITM-TF environment, namely, focusing on three-dimensional reflectometry, motional Stark effect, and neutron and neutral particle analyzer diagnostics. This paper gives an overview of the conceptual design of ITM-TF and preliminary results of the aforementioned synthetic diagnostic modules.

OBJECTIVES: To identify characteristics of general practices associated with emergency hospital admission rates, and determine whether levels of performance and patient reports of access are associated with admission rates. DESIGN: A cross-sectional study. SETTING: Two primary care trusts (Leicester City and Leicestershire County and Rutland) in the East Midlands of England. PARTICIPANTS: 145 general practices. METHODS: Hospital admission data were used to calculate the rate of emergency admissions from 145 practices, for two consecutive years (2006/7 and 2007/8). Practice characteristics (size, distance from principal hospital, quality and outcomes framework performance data, patient reports of access to their practices) and patient characteristics (deprivation, ethnicity, gender and age), were used as predictors in a two-level hierarchical model, developed with data for 2007/8, and evaluated against data for 2006/7. RESULTS: Practice characteristics (shorter distance from hospital, smaller list size) and patient characteristics (higher proportion of older people, white ethnicity, increasing deprivation, female gender) were associated with higher admission rates. There was no association with quality and outcomes framework domains (clinical or organisation), but there was an association between patients reporting being able to see a particular general practitioner (GP) and admission rates. As the proportion of patients able to consult a particular GP increased, emergency admission rates declined. CONCLUSIONS: The patient characteristics of deprivation, age, ethnicity and gender are important predictors of admission rates. Larger practices and greater distance from a hospital have lower admission rates. Being able to consult a particular GP, an aspect of continuity, is associated with lower emergency admission rates.

AbstractFusion power production is the ultimate goal of fusion research, and its determination is crucial in any fusion energy application. In this paper the principles of collimated neutron flux measurements for fusion plasma power determination are described. In this method, a high-resolution neutron spectrometer provides an absolutely calibrated neutron flux, and a neutron profile monitor (“camera”) gives information on the neutron emission profile of the plasma. The total neutron flux seen by the spectrometer is discussed in terms of direct and scattered flux, and a model is set up to evaluate the magnitude of these different components. Particular care is taken to estimate the uncertainties involved, both in the model and the measurements. The method is put to practical use at JET, where a magnetic proton recoil spectrometer and a neutron profile monitor are available. Results from JET’s trace tritium experimental campaign in 2003 are presented and show that the systematic uncertainties in fusion power measurements are reduced in comparison to what has been presented for foil activation systems. A systematic error of 6% is reported here. For ITER these results imply that the fusion power can be redundantly measured and with better accuracies than for traditional methods.

Fast protons can react with tritons in an endothermic nuclear reaction which can act as a source of neutrons in magnetically confined fusion plasmas. We have performed an experiment to systematically study this reaction in low tritium concentration (?1%) plasmas in the Joint European Torus. A linear dependence is found between excess neutron rate and tritium concentration when the DT fusion rate is low. We discuss the properties of the neutron emission, including anisotropy, from the proton-triton reaction in a fusion reactor environment and derive simple models for the calculation of the neutron yield from this reaction in terms of tritium density, fast ion temperature and fast ion energy content.

Two-dimensional (2D) spatial profile and the temporal evolution of the 14 and 2.5?MeV neutron emissivities from D-D and D-T fusion reactions were studied using the measurements of the upgraded neutron profile monitor during the last trace tritium experiments in JET. The JET neutron profile monitor provides unique capability for 2.5 and 14?MeV neutrons line-integrated measurements simultaneously. A systematic comparison of D-D and D-T neutron emissivity was performed. The tritium concentration or fuel ratio (nT/nD) was analysed for a set of 34 ELMy-H mode discharges with tritium puff. Tritium concentration is deduced with a method based on the ratio of D-T 14?MeV and D-D 2.5?MeV neutron emissivities in order to exploit the maximum information available from neutron data. With the help of a tomography algorithm recently developed at JET, 2D spatial profiles of the tritium concentration in the plasma were obtained. These profiles can be used to perform transport studies. Tritium core confinement is clearly seen to increase with plasma density for the set of discharges studied. Differences in the shape of these profiles are also found between low and high density plasmas. Shortly after tritium puffing, 2D spatial profiles of the tritium concentration exhibit typical hollow profiles and in some cases transient poloidal asymmetric features have been observed in 2D images.

Mesenchymal stem cells (MSCs) have been proposed for use in combinatorial gene and cell therapy protocols for the treatment of disease and promotion of repair. The efficacy of such a therapeutic approach depends on determination of which vectors give maximal transgene expression with minimal cell death. The study was carried out on bone-marrow derived rat MSCs, and a range of vectors was tested on the same stem cell preparation. Adenovirus, adeno-associated virus (AAV; serotypes 1, 2, 4, 5, and 6), lentivirus, and nonviral vectors were compared. Lentivirus proved to be most effective with transduction efficiencies of up to 95%, concurrent with low levels of cell toxicity. Adenovirus also proved effective, but a significant increase in cell death was seen with increasing viral titer. Rat MSCs remained refractory to transduction by all AAV serotypes, in contrast to rabbit MSCs tested at the same time. Lipofection of plasmid DNA gave moderate transfection levels but was also accompanied by cell death. Electroporative gene transfer proved ineffective at the parameters tested and resulted in high cell death. High and moderate levels of cell transduction using lentivirus vectors did not affect the ability of the cells to differentiate down the adipogenic pathway.

This paper reports on ITER-relevant ion cyclotron resonance frequency (ICRF) physics investigated on JET in 2003 and early 2004. Minority heating of helium three in hydrogen plasmas-(3He)H-was systematically explored by varying the 3He concentration and the toroidal phasing of the antenna arrays. The best heating performance (a maximum electron temperature of 6.2?keV with 5?MW of ICRF power) was obtained with a preferential wave launch in the direction of the plasma current. A clear experimental demonstration was made of the sharp and reproducible transition to the mode conversion heating regime when the 3He concentration increased above ~2%. In the latter regime the best heating performance (a maximum electron temperature of 8?keV with 5?MW of ICRF power) was achieved with dipole array phasing, i.e. a symmetric antenna power spectrum. Minority heating of deuterium in hydrogen plasmas-(D)H-was also investigated but was found inaccessible because this scenario is too sensitive to impurity ions with Z/A= 1/2 such as C6+, small amounts of which directly lead into the mode conversion regime. Minority heating of up to 3% of tritium in deuterium plasmas was systematically investigated during the JET trace tritium experimental campaign (TTE). This required operating JET at its highest possible magnetic field (3.9 to 4?T) and the ICRF system at its lowest frequency (23?MHz). The interest of this scenario for ICRF heating at these low concentrations and its efficiency at boosting the suprathermal neutron yield were confirmed, and the measured neutron and gammay ray spectra permit interesting comparisons with advanced ICRF code simulations. Investigations of finite Larmor radius effects on the RF-induced high-energy tails during second harmonic (? = 2?c) heating of a hydrogen minority in D plasmas clearly demonstrated a strong decrease in the RF diffusion coefficient at proton energies ~ 1?MeV, in agreement with theoretical expectations. Fast wave heating and current drive experiments in deuterium plasmas showed effective direct electron heating with dipole phasing of the antennas, but only small changes of the central plasma current density were observed with the directive phasings, in particular at low single pass damping. New investigations of the heating efficiency of ICRF antennas confirmed its strong dependence on the parallel wavenumber spectrum. Advances in topics of a more technological nature are also summarized: ELM studies using fast RF measurements, the successful experimental demonstration of a new ELM-tolerant antenna matching scheme and technical enhancements planned on the JET ICRF system for 2006, they being equally strongly driven by the preparation for ITER.

Neutron emission spectroscopy diagnostic has been used to study plasmas produced at JET during the main deuterium-tritium experimental campaign (DTE1). The plasmas were subjected to radio frequency (RF) and neutral beam (NB) heating in different combinations during periods of individual discharges. Similar discharges with different heating combinations were also compared. This paper deals with the possibility of observing direct evidence of synergetic coupling of the ion cyclotron resonance frequency of the RF power to the fast ions from the NB injection. The key signature of such an effect is the high-energy tail in the spectrum of the neutron emission from plasmas subjected to either NB or RF or both simultaneously. Four discharges of the DTE1 campaign were identified as most suitable to search for the synergetic effects including NB(d) and NB(t) heated discharges with RF coupled to the second harmonic resonance of d and t ions. The measured spectra were analysed with up to four components and interpreted in terms of underlying velocity components of the ions responsible for the neutron emission. The results of the analysis are presented and studied from the aspect of finding effects of the application of NB and RF power injection, which go beyond being merely superpositional. Enhanced effects of simultaneous injection are found which are ascribed as synergetic. The strength of the synergetic effect is found to vary depending on the plasma parameters at hand, but this needs further studies to shed light on the underlying physics of the synergetic NB + RF heating effects on the plasma.

JET's recent experimental programme proved that ‘burning plasma diagnostics’, i.e. neutron, alpha particle, He ash, and fuel mixture measurements, can provide very useful information about crucial physical aspects of great reactor relevance. First of all, several of these diagnostics can improve the diagnostic capability of the ion fluid significantly. During TTE spatially resolved neutron measurements at JET were essential in obtaining the isotopic composition and the transport of the hydrogen isotopes, allowing a direct comparison between the measured transport coefficients and the neoclassical theory. The neutron emission profiles can also give crucial indications for assessing the merits of various heating schemes and their current drive capability. Neutron spectroscopy in its turn provides a clear and direct measurement of the temperature and the velocity distribution of the fuel ions. For example, the dependence of the toroidal velocity from the ion cyclotron radiofrequency heating phasing was clearly seen during TTE. The requirements of accurate neutron measurements are also promoting considerable research in detector technology, in particular in the fields of compact spectrometers and solid state detectors. ‘Burning plasma’ diagnostics can also strongly contribute to the physics of energetic particles and their interaction with the main plasma. γ-Ray spectroscopy is now an established method to determine the spatial localization, to visualize the trajectories of the alpha particles and the fast deuterons and to obtain estimates of their slowing down. A completely new method to detect the energetic particles, exploiting the line intensity ratio of extreme ultraviolet radiation emitted by suitable extrinsic impurities, is also being pursued. This technique allows investigating the energy range below 600 keV, extremely interesting for the study of wave–particle interactions.

Results are presented from the JET Trace Tritium Experimental (TTE) campaign using minority tritium (T) plasmas (nT/nD < 3%). Thermal tritium particle transport coefficients (DT, vT) are found to exceed neo-classical values in all regimes, except in ELMy H-modes at high densities and in the region of internal transport barriers (ITBs) in reversed shear plasmas. In ELMy H-mode dimensionless parameter scans, at q95 ∼ 2.8 and triangularity δ = 0.2, the T particle transport scales in a gyro-Bohm manner in the inner plasma (r/a < 0.4), whilst the outer plasma particle transport scaling is more Bohm-like. Dimensionless parameter scans show contrasting behaviour for the trace particle confinement (increases with collisionality, ν* and β) and bulk energy confinement (decreases with ν* and is independent of β). In an extended ELMy H-mode data set, with ρ*, ν*, β and q varied but with neo-classical tearing modes (NTMs) either absent or limited to weak, benign core modes (4/3 or above), the multiparameter fit to the normalized diffusion coefficient in the outer plasma (0.65 < r/a < 0.8) gives DT/Bφ ∼ ρ*2.46ν*−0.23β−1.01q2.03. In hybrid scenarios (qmin ∼ 1, low positive shear, no sawteeth), the T particle confinement is found to scale with increasing triangularity and plasma current. Comparing regimes (ELMy H-mode, ITB plasma and hybrid scenarios) in the outer plasma region, a correlation of high values of DT with high values of vT is seen. The normalized diffusion coefficients for the hybrid and ITB scenarios do not fit the scaling derived for ELMy H-modes. The normalized tritium diffusion scales with normalized poloidal Larmor radius in a manner close to gyro-Bohm , with an added inverse β dependence. The effects of ELMs, sawteeth and NTMs on the T particle transport are described. Fast-ion confinement in current-hole (CH) plasmas was tested in TTE by tritium neutral beam injection into JET CH plasmas. γ-rays from the reactions of fusion alpha and beryllium impurities (9Be(α, nγ)12C) characterized the fast fusion-alpha population evolution. The γ-decay times are consistent with classical alpha plus parent fast triton slowing down times (τTs + ταs) for high plasma currents (Ip > 2 MA) and monotonic q-profiles. In CH discharges the γ-ray emission decay times are much lower than classical (τTs+ταs), indicating alpha confinement degradation, due to the orbit losses and particle orbit drift predicted by a 3-D Fokker–Planck numerical code and modelled using TRANSP.

Some recent JET campaigns, with the introduction of a trace amount (nT/nD < 5%) of tritium into D plasmas and third harmonic ICRH acceleration of 4He, provided unique opportunities to test ‘burning plasma’ diagnostics. In particular, new approaches and techniques were investigated for the detection of neutrons, α particles and the fuel mixture. With regard to neutron detection, the recent activity covered aspects such as calibration and cross validation of the diagnostics, measurement of the spatial distribution of the neutrons, particle transport and neutron spectrometry. The first tests of some new neutron detection technologies were also undertaken during the Trace Tritium Experiment campaign. To improve JET's diagnostic capability in the field of α particles, a significant development programme was devoted to the measurement of their confinement and imaging with γ-ray spectroscopy. A new approach for the fusion community to measuring the fast ion losses, based on the activation technique, was also attempted for the first time on JET. An assessment of the neutral particle analyser's potential to determine the fuel mixture and the particle transport coefficients is under way.

Neutron emission spectroscopy (NES) has been used at JET to study deuterium-tritium discharges heated with neutral beam (NB) injection of tritium and deuterium at energies of 150?keV and 75?keV, respectively. The measurements were performed using the magnetic proton recoil neutron spectrometer and the data analysed with several contributing spectral components. The analysis model considers neutrons from reactions involving high-energy NB ions in (co and counter) passing and trapped orbits and NB ions slowed down to epithermal energies besides ion reactions within the thermal bulk. This study was undertaken to explore the level of fuel ion kinetic information that can be obtained for different NB heating scenarios. Time dependent information was extracted to study how the plasma response to NB injection is manifested in the neutron emission for apparent quiescent periods, during spontaneous plasma instabilities (such as sawteeth) and as a result of intentional changes of the plasma conditions such as the NB injection. The discharges for this study were selected to explore the systematic features that neutron emission spectra display for NB heated discharges and the possibility to interpret them in terms of the underlying kinetic state of the fuel ions. The results obtained on the ion temperature, the toroidal rotation and the supra-thermal fraction of the total neutron yield are compared with those of charge exchange recombination spectroscopy and, in some cases, with plasma equilibrium model calculations. A phenomenological analysis of the results is performed from studies of systematics with the object of exploring the uses of the NES diagnostic and their dependence on data quality.