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Introduction Borderline personality disorder (BPD) is a real source of suffering for people affected and for those around them. Objectives The aim of this study was to describe the socio-demographic and clinical characteristics of out patients with BPD consulting the psychiatry department of Hedi Chaker hospital in sfax tunisia during the period between January 2022 and October 2022. Methods It was a descriptive study. The population study consisted of patients diagnosed with BPD (DSM 5) consulting the psychiatry department of the hospital Hédi Chaker of Sfax tunisia during the period from January 2022 to October 2022. Sociodemographic and clinical data were collected using a predefined form. All statistical analyses were performed using the SPSS software package v 18. Results Among 700 adult patients referred to the psychiatric unit of hedi chaker hospital in sfax from january 2022 to october 2022, 35 patients (5%) were identified as meeting the criteria for BPD. The average age was about 35 years, 54.3% of the patients were men. They were married in 40% of cases.Only 31.4% of the patients had a regular job. The presence of a family psychiatric illness was noted in 48.5% of cases and 20% had a childhood psychiatric follow-up . The rates of sexual abuse, physical abuse, psychological abuse and neglect were 17.1%, 65.7% and 68.6% respectively. In our sample,48.6% of the patients had attempted suicide and 60% of them had committed self-harm. The most common means of attempted suicide was phlebotomy.No prior thoughts of suicide were mentioned, all suicide attempts were impulsive. Negative feelings and family conflicts motivated the suicide attempt (37.5% ,56.25%). Comorbid psychiatric disorder was mentioned in 54.3% and The most frequent comorbid psychiatric disorders was depression (20%). Pharmacotherapie was used in 88.6% of cases. Conclusions The results emphasize on the comorbidities with mainly depressive episodes and a high proportion of suicide attempts and self-harm. Moreover, this study confirms the impact of family conflicts and abuse in the development of this disorder Disclosure of Interest None Declared

Introduction Patients with Borderline Personality Disorder (BPD) require a significant amount of time and effort on the part of general practitioners and psychiatrists, resulting in longer visits and complex medical records, with a poor resolution of both physical and mental symptoms. These patients are likely to express feelings of anger and violence, compared to other patients which makes it difficult to deal with them. Objectives To determine attitudes toward patients with BPD among psychiatry and family medicine residents in Tunisia. To understand in addition the challenges that these professionals encounter in their everyday practice Methods An online anonymous questionnaires was distributed through social networks to psychiatry residents and family medicine resident. The attitudes of health professionals towards people with BPD was used to assess clinicians’ attitudes towards people with BPD. Results Thirty three clinicians were in the study. A high proportion of respondents (81.8%) were females .The age of the participants ranged from 25 to 34 years, with an average age of 28 years and 3 months (SD = 2.23).In our study 34% reported that they often see patients with borderline personality .The half of the participants (51.5%) reported a feeling being on guard when meeting borderlines while 36.4% were empathetic and neutral. The feeling of anger and frustration was reported with 12.1 % of the participants. The most frequent cause of these feelings was the difficulty of taking care of patients with BPD. The majority of the participants (51.5%) reported avoiding working with them. However, only 39.4% reported asking a colleague to replace them in their follow-up. The results of Attitudes of health professionals towards people with BPD Scale indicate that clinicians generally present a positive attitude towards patient BPD with a mean score 94.94(SD=18.60) Conclusions Working with patients with BPD can be challenging. Professionals’ attitude can create obstacles to effective communication and successful treatment. Therefore, all clinicians should receive more specific training to be able to deal with this condition. Disclosure of Interest None Declared

Introduction Functional impairment is a major target in the treatment of bipolar disorder (BD), but the magnitude and type of functional difficulties differ across patients. Objectives The aim of this study was to assess functioning and identify factors associated with global functioning in euthymic patients. Methods It was a descriptive cross-sectional study. The population study consisted of patients diagnosed with BD (DSM 5), who were euthymic and followed up at the psychiatry department of CHU Hedi Chaker. The Hamilton Depression Scale (HAM-D), the Young Mania Rating Scale (YMRS) and the Functioning Assessment Short Test (FAST) were used to assess depressive, manic symptoms and the functional impairment in bipolar patients respectively. All statistical analyses were performed using the SPSS software package v 18. Results We collected 40 patients. They had an average age of 36 years and the sex ratio (M/F) was 1. They had an educational level not exceeding primary studies in 46% of cases. The average scores of HAM-D and YMRS were 4.57±4.58 and 3.43±2.89 respectively. The average total functioning score of our patients was 19.13±16.5. Functional impairment was noted in 60% of them. The domains most affected were: occupational activity (62%), cognitive functioning (63%) and autonomy (50%). Fonctional impairement was associated with residual depressive and manic symptoms (p=0.013) and manic/hypomanic or depressive episodes with mixed features (p=0,005). Conclusions Greater efforts should be directed toward targeting functioning in patient care, as it constitutes the most meaningful endpoint of response to treatment, especially with occupational and cognitive rehabilitation, thus allowing patients to overcome the course of illness and carry fulfilling lives. Disclosure of Interest None Declared

Introduction Clinical evidence supports the interaction between genetic predisposition and environmental stressors on the emergence of positive psychotic symptoms. Childhood trauma might be a modifiable risk factor among adults with serious mental illness. Objectives The aim of our study was to investigate associations between childhood trauma (physical abuse, sexual abuse, emotional abuse, emotional neglect, and physical neglect) and symptoms of schizophrenia. Methods We included in our study 33 stabilized inpatients with schizophrenia at the Psychiatry C department at University Hospital in Sfax-Tunisia. Data on Sociodemographic and clinical variables were collected from medical records. Psychotic symptoms were evaluated using the Positive and Negative Syndrome Scale (PANSS). We used the Childhood Trauma Questionnaire-Short Form (CTQ-SF) to evaluate childhood trauma experiences. Results Our sample was exclusively composed of men with an average age of 35 years and 4 months. The majority of patients were unemployed (75.8%). Only 6.1% of them were married. Among the patients included in the study, 15.2% of our patients were illiterate. The majority of subjects were treated after a period of untreated psychosis (65.5%). The analysis revealed that 42.4% of our patients experienced childhood adversities with mean CTQ-SF total score 35.48 (SD=9.44) We found that positive and general psychopathology schizophrenia symptomatology were correlated to Childhood abuse (0.03; 0.004), emotional abuse (0.009; 0.004), physical neglect (0.02; 0.01), and emotional neglect (0.01). In addition, our analysis showed that only emotional abuse lead to more negative schizophrenia symptomatology (p=0.009).* Conclusions Several studies have shown an association between childhood trauma and specific symptoms of psychosis. Therefore, Childhood trauma should be considered and inquired about in the course of clinical care of schizophrenia patients. Disclosure of Interest None Declared

Introduction Schizophrenia is a neurodevelopmental process affecting approximately 1% of the population. Multiple studies have found that Childhood trauma is an important risk factor in the emergence and clinical course of schizophrenia. Objectives The purpose of this study was to assess the characteristics of schizophrenic inpatients with childhood trauma among a tunisian sample. Methods Stabilized inpatients with schizophrenia at the Psychiatry C department at University Hospital in Sfax were involved in our study. Sociodemographic and clinical data of patients were collected from medical records. We used Childhood Trauma Questionnaire-Short Form (CTQ-SF) to evaluate the occurrence of childhood maltreatment. Results We recruited 33 patients, all men with a mean age of 35 years and 4 months (SD=9.44 years). They were married in 6.1% and 24.2% of patients had regular work. The mean age of onset of the disorder was 24.42(3.25).The level of poor psychotropic medication adherence was 72.7%. According to CTQ-SF, 78.8% of patients had experienced child trauma with a mean score of 35.67 (SD =8.61). A rate of 39.4% reported having experienced one child trauma, while 60.6% reported having experienced more than one. We found high rates of emotional neglect (87.8%) while emotional and physical abuse during childhood were experienced by 39.4%, and 6% respectively and physical neglect were found in 30.3% of cases. Patients with more than one childhood trauma were found to have an earlier onset of psychosis (p=0.004) The occurrence of childhood trauma was not associated with the socio-demographic characteristics of the respondents or the clinical features of the disease. Conclusions The results point toward childhood emotional neglect being of specific importance to schizophrenia, which may be an area for future prevention and clinical attention. Disclosure of Interest None Declared

To support future ITER operation, experimental campaigns at the Joint European Torus (JET) with an ITER-like wall (tungsten divertor and beryllium main chamber) in pure deuterium (D), tritium (T) and Deuterium-Tritium (D-T) were performed. One of the most important challenges in recent years was the development of two main scenarios that investigated different approaches to achieve the high fusion power as well as good plasma confinement (Garzotti et al., 2023). The first one, so-called baseline scenario is relying on high plasma current (Ip≈3.5 MA), normalized beta βN 2 and safety factor q95 ≈ 4.8 (Hobirk et al., 2023).In this paper we focus on the impurity behaviour analysis for the baseline discharges at Ip = 3.5 MA and BT = 3.3 T with D, T and DT plasmas, in which the gas and power waveform were optimized to achieve the best possible performance. In particular, we study the impact of total heating power (Ptot + Palpha), flat-top gas flow and ELM (edge localized modes) frequency on mid-Z (Nickel (Ni), Copper (Cu)) and high-Z (Tungsten (W)) impurities. In addition, we compared the two best performing pulses of the baseline scenario (Ip = 3.5MA, BT = 3.3 T and Pin ≈ 35 MW) in D and DT in order to identify the causes responsible for the increase in radiation during the DT pulse, which led to an early plasma termination. All presented results rely on the data collected by the VUV as well as the bolometry system. Detailed analysis indicates that in the baseline scenario, higher radiation, which is most likely due to the tungsten (W), is observed for T and DT plasmas in comparison to D. Moreover, for the two best performing baseline pulses, tomographic reconstructions show that the radiated power density is mainly emitted from the low field side (LFS) of the plasma and W does not accumulate in the plasma center (Telesca et al., 2024).

The pre-fusion power operation (PFPO) phase of ITER, as described in the ITER research plan with Staged Approach,22 ITER Organization, “ITER Research Plan within the Staged Approach,” ITR-18–003, Aug. 2018. includes both hydrogen (H) and helium (He) plasma operations. In preparation for PFPO, both WEST and JET ran He plasma campaigns to study plasma-wall interactions in a tungsten environment. The campaigns included a back-and-forth transition between H or deuterium (D) and He plasma operation allowing the assessment of the achievable plasma content as well as the accessible wall reservoirs for respective species. The WEST changeovers included tokamak pulses with a fixed divertor configuration. The JET changeovers applied ion cyclotron wall conditioning (ICWC) and tokamak pulses including limiter phases and four different divertor configurations. Glow discharge conditioning (GDC) was applied to complete the changeovers. The results are characterized by subdivertor optical and mass spectrometric gas analyzers and spatially resolved optical emission spectroscopy. A He content of 96–97 % after H operations is achieved by tens of ICWC pulses (JET) and several dedicated diverted plasmas (WEST and JET), while a fivefold is estimated to be required for the back transition. Effective pumping of the wall released species is a key parameter for a fast changeover. Upon applying higher heating power, the relative content of the fueled plasma species decreases. The JET gas balance analysis indicates that He operation may increase H retention. WEST divertor spectroscopy indicates a larger He inventory near the inner divertor strike line. He GDC has a clear effect on the He recycling light at the WEST divertor while D GDC did not reduce the long lasting He content observed in D pulses after the JET He campaign.

The two best performing pulses of the so called ITER-Baseline scenario ( I _p = 3.5 MA and P _in ≈ 35 MW) of JET-ITER like wall, one in deuterium (D) the other in deuterium–tritium (D–T) plasma are examined and compared in this study. Generally, the D–T Baseline pulses exhibit an electron density level higher than the D pulses and the plasma energy is higher than in the comparable D pulses by up to 20%, reaching about 12 MJ in the pulse studied here. In contrast with the D pulses, the D–T pulses are often characterised by the increase in time of the radiated power in the mantle region (0.70 < ρ < 0.95), which may lead to the loss of the edge localised mode activity when the threshold H–L transition power is approached and to the subsequent plasma disruption due to excessive radiation. In this study we try to identify the physical mechanisms responsible for this behaviour using the available experimental data (principally the total radiated power from the bolometry) and the results of the fluid COREDIV model (1D in the core, 2D in the scrape-off-layer (SOL)), self-consistent with respect to core-SOL and also to main plasma-impurities. In fact, the loss of power caused by impurity radiation affects the temperature profile and finally the power to the divertor plate. The electron density and temperature profiles are numerically reconstructed as well as the radiated power density profiles, indicating no major difference in impurity transport in D and D–T. Indeed, the impurity transport coefficients used in COREDIV to match the experimental radiated power profiles are similar in the two pulses. The computed tungsten sources and densities are lower in the D–T pulse and the divertor impurity retention capability is a little better in the D–T pulse, indicatinga stronger collisional drag force in the SOL. The higher electron density and the broadening of its profile are the main cause of the observed increase of the radiated power in the D–T pulse.

ITER is of key importance in the European fusion roadmap as it aims to prove the scientific and technological feasibility of fusion as a future energy source. The EUROfusion consortium of labs within Europe is contributing to the preparation of ITER scientific exploitation and operation and aspires to exploit ITER outcomes in view of DEMO. The paper provides an overview of the major progress obtained recently, carried out in the frame of the new (initiated in 2021) EUROfusion work-package called ‘ Pr eparation of I TER O peration’ (PrIO). The overview paper is directly supported by the eleven EUROfusion PrIO contributions given at the 29th Fusion Energy Conference (16–21 October 2023) London, UK [ https://www.iaea.org/events/fec2023 ]. The paper covers the following topics: (i) development and validation of tools in support to ITER operation (plasma breakdown/burn-through with evolving plasma volume, new infra-red synthetic diagnostic for off-line analysis and wall monitoring using Artificial Intelligence techniques, synthetic diagnostics development, development and exploitation of multi-machine databases); (ii) R&D for the radio-frequency ITER neutral beam sources leading to long duration of negative deuterium/hydrogen ions current extraction at ELISE and participation in the neutral beam test facility with progress on the ITER source SPIDER, and, the commissioning of the 1 MV high voltage accelerator (MITICA) with lessons learned for ITER; (iii) validation of neutronic tools for ITER nuclear operation following the second JET deuterium–tritium experimental campaigns carried out in 2021 and in 2023 (neutron streaming and shutdown dose rate calculation, water activation and activated corrosion products with advanced fluid dynamic simulation; irradiation of several materials under 14.1 MeV neutron flux etc).

The JET-ILW pure tritium and deuterium–tritium (DTE2) experimental campaigns took place in 2021–2022. Tritium (T) and deuterium–tritium (D–T) operations present challenges not encountered in present day tokamaks (Horton et al 2016 Fusion Eng. Des. 109–111 925–36). This contribution focuses on ion cyclotron resonance heating (ICRH) operations in tritium and deuterium–tritium plasmas, starting with a summary of the program of improvements to the ICRH system which spanned a few years prior to these experiments. Procedures were implemented to address specific constraints from tritium and deuterium–tritium operations (tritium safety and reduced access to the RF generator area) and increase the system reliability and power availability during plasma pulses. Operation of the upgraded real time RF power control system that maximises the launched power while taking into account limitations from the system or antenna coupling is described. We also report on the result from dedicated pulses performed to assess the potential harmful impact of the 2nd harmonic tritium resonance in the plasma, close to the inner wall, when using the standard central hydrogen minority ICRH scheme. During DTE2, the ITER-like antenna was not used because water leaked from an in-vessel capacitor into the vessel on day-2 of the experimental campaign. The lessons learnt from this incident are highlighted. Finally, the ICRH plant adjustments required to safely perform ion cyclotron wall cleaning discharges are described.

A baseline scenario of deuterium–tritium (D–T) plasma with peripheral high-field-side fuelling pellets has been produced in JET in order to mimic the situation in ITER. The isotope mix ratio is controlled in order to target the value of 50%–50% by a combination of tritium gas puffing and deuterium pellet injection. Multiple factors controlling the fuelling efficiency of individual pellets are analysed, with the following findings: (1) prompt particle losses due to pellet-triggered edge-localised modes (ELMs) are detected, (2) the plasmoid drift velocity might be smaller than that predicted by simulation, (3) post-pellet particle loss is controlled by transient phases with ELMs.The overall pellet particle flux normalised to the heat flux is similar to that in previous pellet fuelling experiments in AUG and JET.

The fusion reaction between deuterium and tritium, D ( T,n ) ^4 He is the main source of energy in future thermonuclear reactors. Alpha-particles ( ^4 He -ions) born with an average energy of 3.5 MeV transferring energy to the thermal plasma during their slowing down, should provide the self-sustained D–T plasma burn. The adequate confinement of α -particles is essential to provide efficient heating of the bulk plasma and steady burning of a reactor plasma. That is why the fusion-born α -particle studies have been a priority task in the second D–T experiments (DTE2) on the Joint European Torus (JET) to understand the main mechanisms of their slowing down, redistribution and losses and to develop optimal plasma scenarios. JET with Be -wall and W -divertor, enhanced auxiliary heating systems and improved energetic-particle diagnostic capabilities, producing significant population of α -particles, provided the possibility for comprehensive studying of the α -particle behaviour. Selected results of the confined and lost α -particle measurements, evidence of α -particle self-heating and assessments of the fusion performance are presented in this paper giving an opportunity for further modelling and extrapolation to the International Thermonuclear Experimental Reactor and burning plasma reactors.

The JET Deuterium-Tritium-Experiment Campaign 2 (DTE2) has demonstrated the highest-ever fusion energy production. To forecast the transport dynamics within these discharges, the TGLF and NEO models within the TGYRO transport code were employed. A critical development in this study is the new quasilinear transport model, TGLF-SAT2, specifically designed to resolve discrepancies identified in JET deuterium discharges. This model accurately describes the saturated three-dimensional (3D) fluctuation spectrum, aligning closely with a database of nonlinear CGYRO turbulence simulations, thereby enhancing the predictive accuracy of TGYRO simulations. In validating against the JET DTE2 discharges across two primary operating scenarios, TGYRO effectively predicted the temperature profiles within a broad radial window ( ρ ∼ 0.2–0.85), though with minor ion temperature discrepancies near the core. However, a consistent underprediction of electron density profiles by 20% across the simulation domain was noted, indicating areas for future refinement. To achieve a self-consistent steady-state solution based on the JET DTE2 discharges, an integrated modeling workflow TGYRO-STEP within the OMFIT framework was introduced. This workflow iterates among the core transport, the pedestal pressure and the MHD equilibrium, ultimately yielding a converged solution that significantly reduces dependence on experimental boundary conditions for temperature and density profiles. The integrated simulation results show negligible differences in electron density and temperature profiles compared to standalone TGYRO modeling, while the ion temperature profile is lower due to the updated boundary condition in TGYRO-STEP. The application of the TGYRO-STEP workflow to JET DTE2 discharges serves as a crucial test to validate its robustness and highlights its limitations, providing valuable insights for its potential future application in ITER and Fusion Power Plant deuterium and tritium prediction modeling.

A new H-mode regime at low density and low edge safety factor ( q _95 = 3.2, with $I_\mathrm{p}$ = 3 MA) that combines high energy confinement, stationary conditions for density and radiation and small Edge Localized Modes (ELMs) have been found in JET with Be/W wall. Such a regime is achieved by operating without external gas puffing, leading to a decrease in the edge density and a substantial increase in rotation and ion temperature in both the pedestal and the core region. Transport modelling shows a reduction of the turbulence, which starts in the pedestal region and extends into the plasma core, and outward impurity convection, consistent with the improved energy confinement and the lack of W accumulation observed in those conditions. In addition, large type I ELMs, typically found in gas-fuelled plasmas, are replaced by smaller and more frequent ELMs, whose appearance is correlated with a substantial reduction of the pedestal density and its gradient. Pedestals in this operating regime are stable to peeling–ballooning modes, consistent with the lack of large ELMs. This is in contrast to results in unfuelled JET-C plasmas that typically operated at higher pedestal densities and developed low frequency, large type I ELMs, thus pointing to the low density as one of the critical parameters for accessing this small ELMs regime in JET. This small ELMs regime exhibits the same low pedestal collisionality ( $\nu_{\mathrm{e},\mathrm{ped}}^*\sim0.1$ ) expected in ITER and operates at low q _95 , thus making it different from other small ELMs regimes that are typically obtained at higher q _95 and higher pedestal collisionality. These features make this newly developed H-mode regime in JET with Be/W wall a valuable tool for exploring the underlying transport, the different mechanisms of turbulence stabilization, as well as the physics associated with the appearance of small ELMs in high-temperature plasmas at ITER relevant pedestal collisionality.

JET, the world’s largest operating tokamak with unique Be/W wall and tritium handling capability, completed a Deuterium-Tritium (D-T) campaign in 2021 (Maggi et al 29th Fusion Energy Conf. ) following a decade of preparatory experiments, dedicated enhancements, technical rehearsals and training (Horton et al 2016 Fusion Eng. Des. 109–111 925). Operation with tritium raises significant technical, safety and scientific challenges not encountered in standard protium or deuterium operation. This contribution describes the tritium operational requirements, pulses and technical preparations, new operating procedures, lessons learned and details on the achieved operational availability and performance. The preparation and execution of the recent JET tritium experiments benefitted from the previous experience in 1991 (Preliminary Tritium Experiment), 1997 (DTE1 campaign) and 2003 (Trace Tritium Campaigns) and consisted of the following five phases: technical rehearsals and scenario preparation, tritium commissioning, 100% tritium campaign, D-T campaign (DTE2), tritium clean-up. Following the clean-up JET resumed normal operation and is currently undertaking a further D-T campaign (DTE3).

This paper reports the first experiment carried out in deuterium–tritium addressing the integration of a radiative divertor for heat-load control with good confinement. Neon seeding was carried out for the first time in a D–T plasma as part of the second D–T campaign of JET with its Be/W wall environment. The technical difficulties linked to the re-ionisation heat load are reported in T and D–T. This paper compares the impact of neon seeding on D–T plasmas and their D counterpart on the divertor detachment, localisation of the radiation, scrape-off profiles, pedestal structure, edge localised modes and global confinement.

The JET hybrid scenario has been developed from low plasma current carbon wall discharges to the record-breaking Deuterium-Tritium plasmas obtained in 2021 with the ITER-like Be/W wall. The development started in pure Deuterium with refinement of the plasma current, and toroidal magnetic field choices and succeeded in solving the heat load challenges arising from 37 MW of injected power in the ITER like wall environment, keeping the radiation in the edge and core controlled, avoiding MHD instabilities and reaching high neutron rates. The Deuterium hybrid plasmas have been re-run in Tritium and methods have been found to keep the radiation controlled but not at high fusion performance probably due to time constraints. For the first time this scenario has been run in Deuterium-Tritium (50:50). These plasmas were re-optimised to have a radiation-stable H-mode entry phase, good impurity control through edge T _i gradient screening and optimised performance with fusion power exceeding 10 MW for longer than three alpha particle slow down times, 8.3 MW averaged over 5 s and fusion energy of 45.8 MJ.

We present the JETTO-QuaLiKiz-SANCO fully predictive modelling of two JET-ILW high-performance baseline plasmas, a Ne seeded shot and an equivalent unseeded one. The motivation of the work lies in the experimental observation of a slightly higher confinement and performance of the Ne seeded shot with respect to the unseeded one, despite sharing the same main plasma parameters and heating powers. Moreover, the neon seeded shot shows a lower pedestal electron density and a higher core ion temperature with respect to the unseeded one. Integrated modelling is performed in order to understand if the cause of the improved confinement has to be ascribed to the improved pedestal parameters with neon seeding or if an impurity-induced turbulence stabilization is at play. The QuaLiKiz transport model is used for predicting the electron density, electron and ion temperatures and rotation in the core up to the pedestal top, while the pedestal is empirically modelled to reproduce the experimental kinetic profiles. The thermal diffusivities of the two shots, computed by QuaLiKiz, are compared, as well as the turbulence spectra, suggesting that the reduced transport found in the neon seeded shot is due in part to the stabilization of ion temperature gradient and electron temperature gradient modes. Further modelling is performed in order to disentangle the neon seeding effects, which are a direct effect on the turbulence stabilization and an indirect effect on the pedestal parameters. The results suggest that the improved performance with neon is due to a combination of turbulence stabilization and improved pedestal parameters.

In JET deuterium-tritium (D-T) plasmas, the fusion power is produced through thermonuclear reactions and reactions between thermal ions and fast particles generated by neutral beam injection (NBI) heating or accelerated by electromagnetic wave heating in the ion cyclotron range of frequencies (ICRFs). To complement the experiments with 50/50 D/T mixtures maximizing thermonuclear reactivity, a scenario with dominant non-thermal reactivity has been developed and successfully demonstrated during the second JET deuterium-tritium campaign DTE2, as it was predicted to generate the highest fusion power in JET with a Be/W wall. It was performed in a 15/85 D/T mixture with pure D-NBI heating combined with ICRF heating at the fundamental deuterium resonance. In steady plasma conditions, a record 59 MJ of fusion energy has been achieved in a single pulse, of which 50.5 MJ were produced in a 5 s time window ( P _fus = 10.1 MW) with average Q = 0.33, confirming predictive modelling in preparation of the experiment. The highest fusion power in these experiments, P _fus = 12.5 MW with average Q = 0.38, was achieved over a shorter 2 s time window, with the period of sustainment limited by high-Z impurity accumulation. This scenario provides unique data for the validation of physics-based models used to predict D-T fusion power.

The reference ion cyclotron resonance frequency (ICRF) heating schemes for ITER deuterium–tritium (D-T) plasmas at the full magnetic field of 5.3 T are second harmonic heating of T and ^3 He minority heating. The wave-particle resonance location for these schemes coincide and are central at a wave frequency of 53 MHz at 5.3 T. Experiments have been carried out in the second major D-T campaign (DTE2) at JET, and in its prior D campaigns, to integrate these ICRF scenarios in JET high-performance plasmas and to compare their performance with the commonly used hydrogen (H) minority heating. In 50:50 D:T plasmas, up to 35% and 5% larger fusion power and diamagnetic energy content, respectively, were obtained with second harmonic heating of T as compared to H minority heating at comparable total input powers and gas injection rates. The core ion temperature was up to 30% and 20% higher with second harmonic T and ^3 He minority heating, respectively, with respect to H minority heating. These are favourable results for the use of these scenarios in ITER and future fusion reactors. According to modelling, adding ICRF heating to neutral beam injection using D and T beams resulted in a 10%–20% increase of on-axis bulk ion heating in the D-T plasmas due to its localisation in the plasma core. Central power deposition was confirmed with the break-in-slope and fast Fourier transform analysis of ion and electron temperature in response to ICRF modulation. The tail temperature of fast ICRF-accelerated tritons, their enhancement of the fusion yield and time behaviour as measured by an upgraded magnetic proton recoil spectrometer and neutral particle analyser were found in agreement with theoretical predictions. No losses of ICRF-accelerated ions were observed by fast ion detectors, which was as expected given the high plasma density of n _e ≈ 7–8 × 10 ^19 m ^−3 in the main heating phase that limited the formation of ICRF-accelerated fast ion tails. ^3 He was introduced in the machine by ^3 He gas injection, and the ^3 He concentration was measured by a high-resolution optical penning gauge in the sub-divertor region. The DTE2 experiments with ^3 He minority heating were carried with a low ^3 He concentration in the range of 2%–4% given the fact that the highest neutron rates with ^3 He minority heating in D plasmas were obtained at low ^3 He concentrations of ∼2%, which also coincided with the highest plasma diamagnetic energy content. In addition to ^3 He introduced by ^3 He gas injection, an intrinsic concentration of ^3 He of the order of 0.2%–0.4% was measured in D-T plasmas before ^3 He was introduced in the device, which is attributed to the radioactive decay of tritium to ^3 He. According to modelling, even such low intrinsic concentrations of ^3 He lead to significant changes in ICRF power partitioning during second harmonic heating of T due to absorption of up to 30% of the wave power by ^3 He.

The need for a model able to provide the dynamic evolution of the intrinsic magnetic error fields amplitude in tokamaks is of a significant importance in order to develop strategies to correct its destabilizing effect. The present paper specifically aims to deliver this kind of model and adjacent code. A previously built direct perturbations interpretative model (Miron (JET Contributors) 2021 Nucl. Fusion 61 106016) is used to calculate the plasma instabilities amplitude and frequency aiming to match the same quantities provided by the device diagnostics data analysis specific code for various discharges at JET. The mentioned good match ensures our model validity against the experimental results. Based on its proven structural validity, our model considering the error field quantities is inverted. This time the initial direct model output results, namely the plasma perturbations amplitude and frequency, become input data for our inverse model aiming to solve the corresponding error field modes system of equations searched as unknowns. The error fields basically satisfy the same outer plasma perturbed equations as the plasma perturbations do (vacuum/wall/plasma column external structures). Obviously they do not satisfy the perturbed plasma equations. A clear and explicit dynamic error field solution is finally provided. It has been demonstrated that whenever the error fields are responsible for the mode locking effect and plasma rotation damping, the calculated error fields shows its expected disruptive resonant behavior during various discharges at JET.

After the second Deuterium–Tritium Campaign (DTE2) in the JET tokamak with the ITER-Like Wall (ILW) and full tritium campaigns that preceded and followed after the DTE2, a sequence of fuel recovery methods was applied to promote tritium removal from wall components. The sequence started with several days of baking of the main chamber walls at 240 °C and at 320 °C. Subsequently, baking was superimposed with Ion-Cyclotron Wall Conditioning (ICWC) and Glow Discharge Conditioning (GDC) cleaning cycles in deuterium. Diverted plasma operation in deuterium with different strike point configurations, including a Raised Inner Strike Point (RISP) configuration, and with different plasma heating—Ion Cyclotron Resonance Frequency (ICRF) and Neutral Beam Injection (NBI)—concluded the cleaning sequence. Tritium content in plasma and in the pumped gas was monitored throughout the experiment. The applied fuel recovery methods allowed reducing the residual tritium content in deuterium NBI-heated plasmas to about 0.1% as deduced from neutron rate measurements. This value is well below the requirement of 1% set by the maximum 14 MeV fusion neutron budget allocated in the ensuing deuterium plasma campaign. The quantified tritium removal over the course of the experiment was $\left( {13.4 \pm 0.7} \right) \times {10^{22}}$ atoms or $\left( {0.67 \pm 0.03} \right)$ g with ∼58% attributed to baking, ∼12.5% to ICWC, ∼26% to GDC, and ∼3.5% to first low power RISP plasmas. The experimentally estimated amount of removed tritium is in good agreement with long-term tritium accounting by the JET tritium reprocessing plant, in which the unaccounted amount was reduced by $0.71$ g after the cleaning experiment.

The midplane electron separatrix density, n _e,sep , in JET-ILW L-mode and H-mode low triangularity deuterium fuelled plasmas exhibits a strong explicit dependence on the averaged outer divertor target electron temperature, n _e,sep ∼ T _e,ot ^−1/2 . This dependence is reproduced by analytic reversed two point model (rev-2PM), and arises from parallel pressure balance, as well as the ratio of the power and momentum volumetric loss factors, (1 − f _cooling )/(1 − f _mom-loss ). Quantifying the influence of the (1 − f _cooling ) and (1 − f _mom-loss ) loss factors on n _e,sep has been enabled by measurement estimates of these quantities from L-mode density (fueling) ramps in the outer horizontal, VH(C), and vertical target, VV, divertor configurations. Rev-2PM n _e,sep estimates from the extended H-mode and more limited L-mode datasets are recovered to within ±25% of the measurements, with a scaling factor applied to account for use of $\left\langle {{T_{{\text{e,ot}}}}} \right\rangle $ , an averaged quantity, rather than flux tube resolved target values. Both the (1 − f _cooling ) and (1 − f _mom-loss ) trends and recovery of n _e,sep using the rev-2PM formatting are reproduced in EDGE2D-EIRENE L-mode-like and H-mode-like density scan simulations. The general lack of a divertor configuration effect in the JET-ILW n _e,sep trends can be attributed to a significant influence of main chamber recycling, which has been shown in the EDGE2D-EIRENE results to moderate n _e,sep with respect to changes in divertor neutral leakage imposed by changes in the divertor configuration. The unified n _e,sep vs $\left\langle {{T_{{\text{e,ot}}}}} \right\rangle $ trends can, however, be broken if large modifications to the divertor geometry (e.g. complete removal of the outer divertor baffle structure) are introduced in the model. The more pronounced high-field side high density region formation in the VH(C) configuration with reduced clearance to the separatrix does not appear to have a significant influence on the outer midplane separatrix and pedestal parameters when mapped to $\left\langle {{T_{{\text{e,ot}}}}} \right\rangle $ , although conditions at the inner midplane could not be assessed.

Competing Interests: Conflict of InterestFaye Rim, MD, Mary Kelly, FNP-BC, ONC, RN-C, Jefrey Meletio, LCSW, and Spencer Liu, MD, declare that they have no conflicts of interest.

Opioid-tolerant individuals have greater risk of perioperative complications and worse clinical outcomes. A preoperative screening process and structured approach to opioid-tolerant patients was developed to identify and optimize these patients before elective surgery.

Results from epidemiological studies suggest that there is an association between periodontitis and prediabetes, however, causality is not known. The results from our previous studies suggest that induction of periodontitis leads to hyperinsulinemia glucose intolerance and insulin resistance, all hallmarks of prediabetes. However, global effects of periodontitis on critical organs in terms of metabolic alterations are unknown. We determined the metabolic effects of periodontitis on brain, liver, heart and plasma resulting from Porphyromonas gingivalis induced periodontitis in mice. Periodontitis was induced by oral application of the periodontal pathogen, Porphyromonas gingivalis for 22 weeks. Global untargeted biochemical profiles in samples from these organs/plasma were determined by liquid and gas chromatography/mass spectrometry and compared between controls and animals with periodontitis. Oral application of Porphyromonas gingivalis induced chronic periodontitis and hallmarks of prediabetes. The results of sample analyses indicated a number of changes in metabolic readouts, including changes in metabolites related to glucose and arginine metabolism, inflammation and redox homeostasis. Changes in biochemicals suggested subtle systemic effects related to periodontal disease, with increases in markers of inflammation and oxidative stress most prominent in the liver. Signs of changes in redox homeostasis were also seen in the brain and heart. Elevated bile acids in liver were suggestive of increased biosynthesis, which may reflect changes in liver function. Interestingly, signs of decreasing glucose availability were seen in the brain. In all three organs and plasma, there was a significant increase in the microbiome-derived bioactive metabolite 4-ethylphenylsulfate sulfate in animals with periodontitis. The results of metabolic profiling suggest that periodontitis/bacterial products alter metabolomic signatures of brain, heart, liver, and plasma in the prediabetic state. These data provide scientific community valuable metabolic signatures that become the basis for understanding the impact of periodontitis on a systemic disease and potentially targets for therapeutic intervention.

Objectives: Opioid medications are frequently used in pain and palliative care patients with malignancy to manage symptoms such as pain and dyspnea. However, opiates are associated with various side effects. Constipation is a particularly problematic and common side effect of opioid pharmacology. Opioid antagonists have been studied in the management of opioid-induced constipation. Methylnaltrexone (MNTX) is a peripheral opioid antagonist currently under clinical investigation. It offers the potential to reverse undesirable side effects without reversing analgesia., Methods: This article attempts to review existing clinical data, focusing on antagonism of opioid-induced adverse effects on the gastrointestinal system., Results: MNTX seems to be well tolerated with limited or transient side effects. MNTX has been shown to improve oral-cecal transit times in opioid treated patients, induce laxation in chronic opioid users, and neither reverses the analgesic effects of morphine nor cause withdrawal symptoms., Significance of Results: Larger clinical trials of MNTX are still necessary to support its use as a standard for treatment of opioid-induced constipation.