Exploration of the equilibrium operating space for NSTX-Upgrade

This paper explores a range of high-performance equilibrium scenarios available in the NSTX-Upgrade device [J.E. Menard, submitted for publication to Nuclear Fusion]. NSTX-Upgrade is a substantial upgrade to the existing NSTX device [M. Ono, et al., Nuclear Fusion 40, 557 (2000)], with significantly higher toroidal field and solenoid capabilities, and three additional neutral beam sources with significantly larger current drive efficiency. Equilibria are computed with freeboundary TRANSP, allowing a self consistent calculation of the non-inductive current drive sources, the plasma equilibrium, and poloidal field coil current, using the realistic device geometry. The thermal profiles are taken from a variety of existing NSTX discharges, and different assumptions for the thermal confinement scalings are utilized. The no-wall and idealwall n=1 stability limits are computed with the DCON code. The central and minimum safety factors are quite sensitive to many parameters: they generally increases with large outer plasmawall gaps and higher density, but can have either trend with the confinement enhancement factor. In scenarios with strong central beam current drive, the inclusion of non-classical fast ion diffusion raises qmin, decreases the pressure peaking, and generally improves the global stability, at the expense of a reduction in the non-inductive current drive fraction; cases with less beam current drive are largely insensitive to additional fast ion diffusion. The non-inductive current level is quite sensitive to the underlying confinement and profile assumptions. For instance, for BT=1.0 T and Pinj=12.6 MW, the non-inductive current level varies from 875 kA with ITER-98y,2 thermal confinement scaling and narrow thermal profiles to 1325 kA for an ST specific scaling expression and broad profiles. This sensitivity should facilitate the determination of the correct scaling of transport with current and field to use for future fully non-inductive ST devices. Scenarios are presented which can be sustained for 8-10 seconds, or (20-30)τCR, at βN=3.8-4.5, facilitating, for instance, the study of disruption avoidance for very long pulse. Scenarios have been documented which can operate with βT~25% and equilibrated qmin>1. The value of qmin can be controlled at either fixed non-inductive fraction of 100% or fixed plasma current, by varying which beam sources are used, opening the possibility for feedback qmin control. In terms of quantities like collisionality, neutron emission, non-inductive fraction, or stored energy, these scenarios represent a significant performance extension compared to NSTX and other present spherical torii

The evolving SARS-CoV-2 epidemic in Africa: Insights from rapidly expanding genomic surveillance

INTRODUCTION Investment in Africa over the past year with regard to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) sequencing has led to a massive increase in the number of sequences, which, to date, exceeds 100,000 sequences generated to track the pandemic on the continent. These sequences have profoundly affected how public health officials in Africa have navigated the COVID-19 pandemic. RATIONALE We demonstrate how the first 100,000 SARS-CoV-2 sequences from Africa have helped monitor the epidemic on the continent, how genomic surveillance expanded over the course of the pandemic, and how we adapted our sequencing methods to deal with an evolving virus. Finally, we also examine how viral lineages have spread across the continent in a phylogeographic framework to gain insights into the underlying temporal and spatial transmission dynamics for several variants of concern (VOCs). RESULTS Our results indicate that the number of countries in Africa that can sequence the virus within their own borders is growing and that this is coupled with a shorter turnaround time from the time of sampling to sequence submission. Ongoing evolution necessitated the continual updating of primer sets, and, as a result, eight primer sets were designed in tandem with viral evolution and used to ensure effective sequencing of the virus. The pandemic unfolded through multiple waves of infection that were each driven by distinct genetic lineages, with B.1-like ancestral strains associated with the first pandemic wave of infections in 2020. Successive waves on the continent were fueled by different VOCs, with Alpha and Beta cocirculating in distinct spatial patterns during the second wave and Delta and Omicron affecting the whole continent during the third and fourth waves, respectively. Phylogeographic reconstruction points toward distinct differences in viral importation and exportation patterns associated with the Alpha, Beta, Delta, and Omicron variants and subvariants, when considering both Africa versus the rest of the world and viral dissemination within the continent. Our epidemiological and phylogenetic inferences therefore underscore the heterogeneous nature of the pandemic on the continent and highlight key insights and challenges, for instance, recognizing the limitations of low testing proportions. We also highlight the early warning capacity that genomic surveillance in Africa has had for the rest of the world with the detection of new lineages and variants, the most recent being the characterization of various Omicron subvariants. CONCLUSION Sustained investment for diagnostics and genomic surveillance in Africa is needed as the virus continues to evolve. This is important not only to help combat SARS-CoV-2 on the continent but also because it can be used as a platform to help address the many emerging and reemerging infectious disease threats in Africa. In particular, capacity building for local sequencing within countries or within the continent should be prioritized because this is generally associated with shorter turnaround times, providing the most benefit to local public health authorities tasked with pandemic response and mitigation and allowing for the fastest reaction to localized outbreaks. These investments are crucial for pandemic preparedness and response and will serve the health of the continent well into the 21st century

Reducing the environmental impact of surgery on a global scale: systematic review and co-prioritization with healthcare workers in 132 countries

Background Healthcare cannot achieve net-zero carbon without addressing operating theatres. The aim of this study was to prioritize feasible interventions to reduce the environmental impact of operating theatres. Methods This study adopted a four-phase Delphi consensus co-prioritization methodology. In phase 1, a systematic review of published interventions and global consultation of perioperative healthcare professionals were used to longlist interventions. In phase 2, iterative thematic analysis consolidated comparable interventions into a shortlist. In phase 3, the shortlist was co-prioritized based on patient and clinician views on acceptability, feasibility, and safety. In phase 4, ranked lists of interventions were presented by their relevance to high-income countries and low–middle-income countries. Results In phase 1, 43 interventions were identified, which had low uptake in practice according to 3042 professionals globally. In phase 2, a shortlist of 15 intervention domains was generated. In phase 3, interventions were deemed acceptable for more than 90 per cent of patients except for reducing general anaesthesia (84 per cent) and re-sterilization of ‘single-use’ consumables (86 per cent). In phase 4, the top three shortlisted interventions for high-income countries were: introducing recycling; reducing use of anaesthetic gases; and appropriate clinical waste processing. In phase 4, the top three shortlisted interventions for low–middle-income countries were: introducing reusable surgical devices; reducing use of consumables; and reducing the use of general anaesthesia. Conclusion This is a step toward environmentally sustainable operating environments with actionable interventions applicable to both high– and low–middle–income countries